The lecture has been given on Feb. 12th, 2011 by Dr. Mohammad Shaikhani.

1. ALCOHOL MISUSE AND DEPENDENCE Dr. Mohammad Shaikhani

3. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Mod drink NIAAA Men,≤2 drinks / day Women, ≤1 drink/day >65 ys, ≤1 drink/day Category Organization Definition

4. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire At-risk drinking NIAAA Men, >14 drinks/week or >4 drinks/ occasion Women, >7 drinks/week or >3 drinks/occasion Category Organization Definition

5. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Hazardous drinking WHO At risk for adverse consequences from alcohol Harmful drinking WHO Alcohol causing physical or psychological harm Category Organization Definition

6. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Alcohol abuse (DSM-IV) APA 1 or more of the following events in a 12-month period: • Recurrent use resulting in failure to fulfill major role obligations • Recurrent use in hazardous situations • Recurrent alcohol-related legal problems • Continued use despite social or interpersonal problems caused or exacerbated by alcohol use Category Organization Definition

7. Categories and Definitions for Patterns of Alcohol Use The CAGE Questionnaire Alcohol dependance (DSM-IV) APA 3 or more of the following events in a 12-month period: • Tolerance (increased amounts to achieve effect or diminished effect from same amount) • Withdrawal • Great deal of time spent obtaining alcohol, using it, or recovering from its effects • Important activities given up or reduced because of alcohol • Drinking more or longer than intended • Persistent desire or unsuccessful efforts to cut down or control alcohol use • Use continued despite knowledge of having a psychological problem caused or exacerbated by alcohol Category Organization Definition

22. CONSEQUENCES OF CHRONIC ALCOHOL MISUSE : The CAGE Questionnaire Acute intoxication Emotional & behavioural disturbance Medical problems: hypoglycaemia, aspiration of vomit, respiratory depression Complicating other medical problems Accidents&injuries sustained in fights Withdrawal phenomena Psychological symptoms: restlessness, anxiety, panic attacks Autonomic symptoms: tachycardia, sweating, pupil dilation, nausea, vomiting Delirium tremens: agitation, hallucinations, illusions, delusions Seizures

23. MEDICAL CONSEQUENCES : The CAGE Questionnaire Neurological Peripheral neuropathy Cerebellar degeneration Cerebral haemorrhage Dementia Hepatic Fatty change,hepatiti, & cirrhosis, Liver cancer Gastrointestinal Oesophagitis, gastritis Pancreatitis Oesophageal cancer Mallory-Weiss syndrome Malabsorption Oesophageal varices Respiratory Pulmonary TB ,Pneumonia

24. MEDICAL CONSEQUENCES : The CAGE Questionnaire Skin Spider naevi ,Palmar erythema Duypuytren's contractures ,Telangiectasiae Cardiac Cardiomyopathy Hypertension Musculoskeletal Myopathy Fractures Endocrine and metabolic Pseudo-Cushing's syndrome Hypoglycaemia ,Gout Reproductive Hypogonadism Fetal alcohol syndrome Infertility

25. PSYCHIATRIC &CEREBRAL CONSEQUENCES : The CAGE Questionnaire Depression Alcoholic hallucinosis Alcoholic 'blackouts' Wernicke's encephalopathy: nystagmus, opthalmoplegia, ataxia, confusion Korsakoff's syndrome: short-term memory deficits, confabulation

31. What Determines Alcohol Dependency? 1. Tolerance 2. Withdrawal 3. Significant time spent obtaining/using alcohol, or recovering from its effects 4. Reducing or giving up important activities because of alcohol 5. Drinking more or longer than intended 6. Persistent desire or unsuccessful efforts to cut down or control use 7. Continued use despite problems caused or exacerbated by alcohol Those with alcohol dependency suffer clinically significant impairment or distress in the presence of three or more of the following: Source: Saitz R. Unhealthy Alcohol Use. NEJM. 2005;352:596-607.

34. The AUDIT Test Includes 10 Questions with Multiple Choice Answers Scaled 0 to 4 How often do you have a drink containing alcohol? How many drinks do you have in one day? How often do you have six or more drinks? How often during the past year were you unable to stop drinking? How often during the past year have you failed to do what was normally expected from you? Has a relative, friend, doctor, or health care worker been concerned and suggested you cut down? Score of 8 or more AUDIT Unhealthy Use Sources: Saitz R. Unhealthy Alcohol Use. NEJM. 2005;352:596-607. Fiellin DA, Reid MC, O’Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med . 2000;160:1977-1989. Cited in Saitz R.