1. Alcoholism Etiology
- Genetic predisposition
o Children of alcoholics 4x risk of developing alcohol dependence
- Refers to all types of harmful drinking - Males
o Alcohol dependence - Occupation
o Alcohol related complications o Sailors, bartenders, military
- Ethnic – Chinese have protective aldehyde dehydrogenase deficiciency
- Suspect if >14 units/wk males, >7 units/wk females - Personality
o 1 unit = 9g alcohol = 1 shot , 1 glass of wine, ½ pint of beer - Mental Illness
DSM-IV Criteria
- A destructive pattern of alcohol use, leading to significant social, occupational, Complications
or medical impairment. - Liver
o Fatty liver
Must have three (or more) of the following, occurring when the alcohol use was at o CLD
its worst: o HCC
1. Alcohol tolerance: Either need for markedly increased amounts of alcohol to
achieve intoxication, or markedly diminished effect with continued use of the - Neurological
same amount of alcohol. o Memory lapses, amnesia
2. Alcohol withdrawal symptoms: Either (a) or (b). o Dementia
(a) Two (or more) of the following, developing within several hours to a o Peripheral Neuropathy
few days of reduction in heavy or prolonged alcohol use: o Wernicke’s encephalopathy (NOA)
- sweating or rapid pulse Nystagmus
- increased hand tremor Ophthalmoplegia
- insomnia Ataxia
- nausea or vomiting +/- confusion
- physical agitation mx: oral/IM thiamine
- anxiety o Korsakoff’s psychosis (irreversible)
- transient visual, tactile, or auditory hallucinations or illusions Progression from Wernicke’s
- grand mal seizures Confubalutions
(b) Alcohol is taken to relieve or avoid withdrawal symptoms. o Marchiafava-Bignami
3. Alcohol was often taken in larger amounts than was intended Degeneration of corpus callosum
4. Persistent desire to cut down alcohol use Unilateral dysgraphia/arthria
5. Great deal of time spent in using alcohol, or recovering from hangovers Dementia/ mutism
6. Important social, occupational, or recreational dysfunction
7. Alcohol use is continued despite knowledge of it causing harm - Cardiovascular
o Cardiomyopathy
CAGE screening (2 out of 4) o Arrythmia
- Cut down
- Annoyed at others’ comments - GIT
- Guilty o Peptic ulcers, erosions
- Eye-Opener o Pancreatitis

2. - Blood - Primary Rehab
o Anemia o Group support
Either macrocytic secondary to folate deficiency o Counseling
Or microcytic secondary to GI bleed o Continuing care e.g 12-step Alcoholics Anonymous
- Medication (if indicated, can reduce relapse rates)
- Teratogenic o Disulfiram
o Fetal Alcohol Syndrome Alcohol-flushing: flushing, tachycardia, tachypnea
Low IQ Severe SE: stroke, malignant HTN, death
Absent philtrum o Naltrexone
Short palpebral fissure Hepatitis
Small eyes N+V+D
dizziness
- Psychiatric/ Social o Acamprosate
o Delirium Tremens NVD
3 days after alcohol stoppage C/I: pregnancy
Tachycardia
Sweating Organisations
Anxiety - Alcohol Clinics: IMH, NUH
Visual/ Tactile hallucinations - Alcoholics Anonymous
o Depression - Halfway Houses
o Anxiety o Christian Outreach Center
o Family neglect/ Abuse o Teen Challenge
o Work performance decline
o Accidents
Investigations
- LFT – gamma GT esp
- FBC – anemia, plt dysfunction
- Other investigations as indicated to look for complications
Management
- Outpatient
- Inpatient if
o Severe med/psy cx
o Elderly
Digitally signed by DR WANA HLA SHWE
o Poor support DN: cn=DR WANA HLA SHWE, c=MY,
o Failed inpatient tx o=UCSI University, School of Medicine,
KT-Campus, Terengganu, ou=Internal
- After 1 year: 30% relapse into heavy drinking Medicine Group, email=wunna.
hlashwe@gmail.com
Reason: This document is for UCSI year 4
- Detox students.
Date: 2009.02.22 15:23:20 +08'00'
o Diazepam/ lorazepam tapered dose
o + Vitamin B1 supplementation