Alcohol Dependence: Diagnosis and Treatment

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Questions and Answers

A patient with a long-standing history of alcohol dependence presents to the emergency department exhibiting disorientation, ataxia, and pronounced emotional lability. Their blood alcohol level is likely in which of the following ranges, considering the complex interplay of tolerance and individual variability?

> 0.5 percent, pointing to a state incompatible with consciousness unless extreme tolerance has developed, which would fundamentally alter physiological responses.
0.06 to 0.1 percent, suggesting a level where motor impairment is present but higher-order cognitive functions remain relatively intact.
0.02 to 0.05 percent, indicative of mild impairment possibly exacerbated by pre-existing neurological deficits.
0.2 to 0.3 percent, aligning with established clinical benchmarks for significant cognitive and motor dysfunction in chronic alcohol users. (correct)

A researcher is investigating the neurobiological mechanisms underlying alcohol-induced changes in neurotransmitter systems. Considering the intricate balance between excitatory and inhibitory neurotransmission, which of the following best describes the compensatory response observed in chronic alcohol exposure?

Progressive desensitization of both GABA and glutamate receptors, resulting in generalized reduction in neuronal activity.
Initial increase in GABA activity followed by a reactive decrease and concurrent sensitization of glutamate receptors. (correct)
Sustained potentiation of GABA receptors, alongside downregulation of glutamate receptors, leading to prolonged sedation.
Selective upregulation of GABAergic interneurons, modulating cortical excitability without affecting glutamate transmission.

In the management of acute alcohol withdrawal syndrome, an experienced clinician opts for a benzodiazepine with a longer half-life for tapering. Given the intricate pharmacokinetic and pharmacodynamic properties of these agents, what is the most critical rationale behind this therapeutic decision?

To counteract the hepatic enzyme induction caused by chronic alcohol use, optimizing benzodiazepine metabolism and therapeutic efficacy.
To leverage the decreased potential for respiratory depression associated with longer-acting agents, enhancing patient safety during withdrawal.
To exploit the cumulative sedative effects of long-acting benzodiazepines, thereby mitigating the risk of seizures during detoxification.
To minimize the risk of rebound anxiety and breakthrough withdrawal symptoms by ensuring a gradual reduction in GABAergic activity. (correct)

A patient undergoing treatment for alcohol use disorder is prescribed naltrexone. How does naltrexone, an opioid antagonist, assist in maintaining abstinence from alcohol, considering the complex interplay of reward pathways and neurochemical modulation?

By competitively binding to mu-opioid receptors, indirectly reducing alcohol-induced dopamine release and associated pleasurable effects. (B) Signup and view all the answers

A researcher is designing a study to evaluate the effectiveness of acamprosate in maintaining abstinence among individuals with alcohol dependence. Considering the neurochemical mechanisms of action of acamprosate, which of the following parameters would provide the MOST direct measure of its therapeutic efficacy?

Self-reported craving scores and frequency of drinking occasions, indicating the impact on subjective experience and behavioral patterns. (A) Signup and view all the answers

Considering the neurobiological perspective of addiction, which statement MOST accurately differentiates addiction from physical dependence?

Addiction is distinguished by compulsive drug-seeking behavior despite adverse consequences, while physical dependence is marked by physiological adaptations to chronic drug exposure, evidenced solely by withdrawal. (D) Signup and view all the answers

A researcher is investigating the prevalence of substance use disorders within different socioeconomic strata. Based on commonly observed trends, which legal psychoactive substance is MOST likely to demonstrate a disproportionately high rate of abuse among individuals from lower socioeconomic backgrounds?

Tobacco products, particularly cigarettes. (D) Signup and view all the answers

A hospital administrator aims to implement an evidence-based prevention program targeting the misuse of legal psychoactive substances. Considering public health impact, which substance should be the HIGHEST priority for this intervention?

Both B and C. (D) Signup and view all the answers

A clinical trial is designed to evaluate the efficacy of a novel therapeutic intervention targeting addiction. Which outcome measure would provide the MOST compelling evidence of the intervention's success in addressing the core pathological processes underlying addiction, rather than merely suppressing withdrawal symptoms?

Restoration of normative function within the prefrontal cortex as measured by functional neuroimaging. (B) Signup and view all the answers

In the context of addiction treatment, what is the crucial distinction between interventions that address physical dependence and those that target the addictive disorder itself?

Physical dependence interventions involve pharmacological support for detoxification, while addiction interventions incorporate psychosocial therapies to address compulsive drug-seeking behavior. (B) Signup and view all the answers

A neuroscientist is investigating the comparative effects of various psychoactive substances on synaptic plasticity within the mesolimbic dopamine system. Which of the following mechanisms would be MOST indicative of a substance's high addictive potential?

Sustained potentiation of long-term potentiation (LTP) at glutamatergic synapses onto dopamine neurons in the ventral tegmental area (VTA). (C) Signup and view all the answers

A researcher discovers a novel compound that selectively inhibits the reinforcing effects of alcohol without affecting its metabolism or subjective intoxicating effects. Which of the following mechanisms of action would be MOST consistent with this profile?

Inhibition of dopamine release in the nucleus accumbens (NAc) specifically triggered by alcohol-related cues. (A) Signup and view all the answers

An addiction specialist is evaluating the long-term outcomes of patients treated for opioid use disorder with medication-assisted treatment (MAT). Which of the following factors would be the STRONGEST predictor of sustained remission and reduced risk of relapse?

Consistent adherence to prescribed MAT regimen combined with active participation in evidence-based psychosocial therapies. (D) Signup and view all the answers

Given the neurobiological underpinnings of addiction, which statement best describes the role of dopamine in the context of substance-induced reward pathways?

Dopamine serves as the primary mediator of the brain's reward pathway, with addictive substances hijacking this system to induce supraphysiological dopamine release, reinforcing drug-seeking behavior. (D) Signup and view all the answers

Considering the interplay between genetics and environment in addiction, which of the following scenarios best illustrates the 'genetics loads the gun, environment pulls the trigger' concept?

An individual with a strong family history of alcohol use disorder remains abstinent throughout their life due to supportive social networks and access to preventative care. (C) Signup and view all the answers

In the context of dual diagnoses involving substance use disorders and mental illnesses, which of the following best describes the implications for treatment planning?

An integrated treatment approach should be implemented, addressing both the substance use disorder and the co-occurring mental illness concurrently. (C) Signup and view all the answers

How does the concept of tolerance development in addiction impact the long-term neuroadaptive changes within the brain's reward circuitry?

Tolerance involves a downregulation of dopamine receptors and reduced dopamine release, requiring higher drug doses to achieve the initial euphoric effects and contributing to compulsive drug-seeking behavior. (A) Signup and view all the answers

Considering the diagnostic criteria for substance use disorder, how does 'neglected activities' manifest differently in an adolescent compared to an adult?

Adolescents typically neglect academic pursuits and extracurricular activities, whereas adults may neglect family obligations and occupational performance. (A) Signup and view all the answers

If a patient presents with symptoms indicative of both substance abuse and a personality disorder, what therapeutic approach would be most appropriate?

Simultaneously addressing both conditions through integrated therapy, such as dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT) adapted for co-occurring disorders. (A) Signup and view all the answers

Given the neuroplastic changes associated with chronic substance use, to what extent can the brain fully recover its pre-addiction state after prolonged abstinence, and what factors influence this recovery?

The extent of recovery varies depending on factors such as the type of substance used, duration of use, individual genetics, and the presence of co-occurring mental health conditions. There are no guarantees of returning to a 'pre-addiction state'. (D) Signup and view all the answers

How do cross-addictions manifest neurobiologically, considering the shared neural pathways and neurotransmitter systems involved in different substance use disorders?

Cross-addictions occur because of shared vulnerabilities in neural pathways, where using one substance can prime the reward system, making the individual more susceptible to developing an addiction to another substance. (C) Signup and view all the answers

In the context of harm reduction strategies for substance use, how does the provision of safe injection sites or needle exchange programs align with the principles of public health ethics, considering potential moral objections?

Harm reduction strategies can be ethically justified by prioritizing the reduction of harm, prevention of disease transmission, and promotion of overall public health, even if they conflict with certain moral perspectives. (D) Signup and view all the answers

Given the progression of addiction and the concept that the brain is not 'protected' after treatment, what relapse prevention strategies demonstrate a comprehensive understanding of long-term neuroadaptive changes?

Relapse prevention requires ongoing support, cognitive restructuring to address maladaptive thought patterns, and the development of coping strategies targeting the specific triggers and vulnerabilities that can reactivate the reward system. (A) Signup and view all the answers

Given the AMA's 1956 definition of addiction as a primary, progressive, permanent, and terminal illness, which neurobiological adaptation BEST exemplifies the 'permanent' aspect from a contemporary neuroscientific perspective?

Epigenetic modifications leading to altered gene expression in reward circuitry, persisting even after prolonged abstinence. (A) Signup and view all the answers

Considering the Bio/Psycho/Social/Spiritual model of addiction vulnerability, which intervention strategy BEST addresses the 'spiritual emptiness' component, assuming a patient expresses existential angst and a lack of purpose?

Facilitating participation in mindfulness-based practices and exploring personal values to cultivate a sense of meaning and connection. (C) Signup and view all the answers

Which of the following BEST describes how an altered state of consciousness, achieved through substance use, directly reinforces continued drug-seeking behavior, taking into account the principles of operant conditioning and neuroadaptation?

The altered state serves as a positive reinforcer, directly enhancing pleasure pathways and increasing the probability of repeated substance use through dopamine release. (B) Signup and view all the answers

Given the predictable and progressive nature of addiction, according to the AMA's 1956 definition, which long-term neuroplastic change is MOST indicative of the transition from recreational drug use to compulsive drug-seeking behavior?

Potentiation of synaptic connections within the dorsal striatum, shifting control from goal-directed to habit-based behavior. (A) Signup and view all the answers

Considering both psychological liabilities and social access within the integrated Bio/Psycho/Social/Spiritual model, which scenario presents the HIGHEST risk for rapid progression to substance dependence?

An adult with a history of childhood trauma and limited social support who works in an environment where substance use is normalized and readily available. (C) Signup and view all the answers

Assuming an individual presents with constricted pupils, slurred speech, and unsteady gait, which neurotransmitter system is MOST likely being directly influenced by the ingested substance?

Endogenous opioid system, resulting in analgesia, sedation, and decreased respiratory drive. (C) Signup and view all the answers

Given an individual exhibiting both unexplained weight loss and financial problems, which substance use pattern is the MOST probable underlying cause, considering metabolic and behavioral effects of different drugs?

Stimulant dependence (e.g., methamphetamine or cocaine), causing increased metabolism and decreased appetite, alongside compulsive drug-seeking behaviors. (C) Signup and view all the answers

When assessing changes in mood or attitude as a potential sign of substance abuse, what cognitive bias is MOST critical to consider to avoid misdiagnosis, particularly in adolescent populations?

Fundamental attribution error, causing clinicians to attribute mood changes solely to dispositional factors rather than situational stressors. (D) Signup and view all the answers

Considering the long-term effects of substance abuse on executive function, which specific neurocognitive domain is MOST likely to be impaired, hindering relapse prevention efforts, and requiring targeted cognitive remediation?

Working memory, affecting the ability to hold and manipulate information, crucial for resisting cravings. (B) Signup and view all the answers

Given the heterogeneity of addiction and the interplay of genetic and environmental factors, which methodological approach provides the MOST comprehensive understanding of individual vulnerability to substance use disorders?

Longitudinal studies integrating multi-omics data (genomics, transcriptomics, proteomics, and metabolomics) with environmental exposures. (D) Signup and view all the answers

Given the historical context of psychoactive substance use, which of the following statements MOST accurately reflects the evolving motivations behind recreational drug consumption across different eras?

While initial uses often intertwined with religious or medicinal purposes, a gradual shift occurred towards leveraging psychoactive substances for pleasure-seeking and escapism, particularly amplified by cultural movements in the 20th century. (B) Signup and view all the answers

Considering the multifaceted costs associated with alcohol and drug abuse, which of the following scenarios presents the MOST comprehensive economic impact assessment, incorporating both direct and indirect financial burdens?

A holistic evaluation encompassing healthcare costs, lost productivity, increased crime rates necessitating law enforcement and judicial intervention, and the societal costs of family instability and social welfare programs. (C) Signup and view all the answers

In the context of the "Monitoring the Future Survey" data, how do the reported rates of substance use among 8th and 12th graders reflect potential age-related changes in risk perception and decision-making processes regarding drug experimentation?

While alcohol and marijuana use show marked increases between 8th and 12th grade, the rates of inhalant use decrease, potentially indicating a shift away from substances perceived as less sophisticated or more dangerous with increasing age and awareness. (A) Signup and view all the answers

Considering the historical progression of drug use in America, what critical distinction differentiates the drug epidemic of the 1800s from contemporary substance abuse crises in terms of accessibility and societal perception?

During the 1800s, access to drugs like opium and morphine was relatively unrestricted, often available through common retail outlets, while contemporary crises involve substances that are subject to stringent legal controls and require clandestine procurement. (C) Signup and view all the answers

Given the reported trends of rising teen drug abuse in North Carolina, how might public health officials strategically allocate resources to address the multifaceted drivers of this increase, considering both supply-side and demand-side interventions?

Implementing comprehensive prevention programs in schools and communities, coupled with increased access to mental health services and substance abuse treatment, to address underlying factors contributing to drug use and reduce demand. (B) Signup and view all the answers

Considering the historical use of cannabis across various cultures, evaluate the accuracy of the statement: "The application of cannabis has predominantly revolved around recreational indulgence, disregarding its potential therapeutic benefits."

The statement is inaccurate; historical evidence suggests that cannabis has been utilized for diverse purposes, including medicinal applications (e.g., treatment of gout) and ritualistic practices, thus challenging a purely recreational interpretation. (A) Signup and view all the answers

In what way did Timothy Leary's espousal of LSD in the 1960s, characterized by the "feel good forever" philosophy, MOST significantly influence societal attitudes and perceptions towards drug use, and how did this deviate from earlier approaches?

Leary's message introduced a novel emphasis on individualistic pleasure-seeking and the rejection of societal norms, shifting the focus from viewing drug use as a functional tool (e.g., pain relief) to a means of personal liberation and self-discovery. (D) Signup and view all the answers

Considering the statistic that "At least 50% of all adults arrested for major crimes test positive for drugs," which of the following interpretations BEST captures the underlying relationship between substance abuse and criminal behavior?

The statistic suggests a correlational relationship, indicating a potential interplay between substance abuse and criminal activity, but requires further investigation to determine causality and directionality. (D) Signup and view all the answers

With the rise of synthetic opioids, prescription drug abuse, and novel psychoactive substances, what implications does this have for current drug testing methodologies and their effectiveness in accurately assessing the scope and nature of substance abuse?

The emergence of novel substances necessitates the continuous development and refinement of drug testing methodologies to ensure their sensitivity and specificity in detecting a wider range of compounds, thereby addressing potential gaps in current assessment capabilities. (B) Signup and view all the answers

Analyze the ramifications of teens believing prescription drugs are easier to acquire than illegal drugs on public health initiatives and prevention strategies, particularly in light of the potential for heightened risks associated with unfamiliar pharmacological effects and unsupervised consumption.

This perception necessitates targeted education campaigns emphasizing the inherent dangers of prescription drug misuse, as well as stricter monitoring and regulation of prescription drug distribution channels to reduce accessibility and prevent diversion. (C) Signup and view all the answers

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Study Notes

Psychoactive Drugs

Psychoactive drugs affect mood, thinking, and behavior.
These are the drugs people are most likely to misuse, often leading to addiction.
Psychoactive drugs can be legal or illegal.
Alcohol and tobacco are the most commonly abused psychoactive substances and are legal.

Prevalence of Addiction

Approximately 30 million Americans grapple with addiction to psychoactive drugs.
30% of individuals attribute family troubles to drinking.
20% report problems with drug abuse.
Alcohol is the most commonly used drug among 12-17 year olds.
Alcohol-related car crashes are the number one killer of teens.
More deaths and injuries result from prescription drug misuse than from all illegal drugs combined.
Annual healthcare costs attributable to addiction exceed $124 billion.
Alcohol/drug abuse costs industry over $100 billion annually, primarily from lost productivity.
At least 50% of adults arrested for major crimes test positive for drugs.
Monitoring the Future Survey (2010 US Data) reported drug use by 8th and 12th graders.
- Alcohol use among 8th graders: 35%, and 71% for 12th graders.
- Any illicit drug use among 8th graders: 21%, and 48% for 12th graders.
- Tobacco use among 8th graders: 20%, and 42% for 12th graders.
- Marijuana use among 8th graders: 17.3%, and 43% for 12th graders.
- Inhalant use among 8th graders: 14%, and 9% for 12th graders.
- Cocaine/Hallucinogen use among 8th graders: 1-4%, and 2-8% for 12th graders.
- MDMA use among 8th graders: 3.3%, and 7.3% for 12th graders.
- Prescription drug use among 8th graders: 3%, and 5-8% for 12th graders.
March 2010 Update shows teen drug abuse in NC on the rise.
- Among teens in grades 9-12, alcohol use in the past month is near 40%.
- Past-year ecstasy use increased by 67%.
- Marijuana use increased by roughly 20%.
- Approximately 75% of teens believe their friends usually get high at parties.
- 56% of teens find prescription drugs easier to obtain than illegal drugs.

History of Substance Use

Historically, substances have been used in religious rituals
Substances have been used to alter states of consciousness
Substances have been used for recreation
Substances have been used for relief from pain or distress.
Alcohol has been used for beer/hackleberry wine, 6400 BC.
Opium was used as a "joy plant" in Asia Minor, 5000 BC.
Cannabis was used as tea to treat gout and absentmindedness in China, 2700 BC.
Cocaine was used to prepare Stone Agers for battle.
In 1492, Native Americans introduced Columbus and other explorers/settlers to psychoactive plants like tobacco and peyote.
In the 1600s, Europe introduced distilled spirits to colonies.
Beginning in the 1800s, an epidemic arose with drugs like opium, morphine (soldier's disease), marijuana, heroin, and cocaine, which were all easy to obtain.
In the early 1900s, amphetamines, inhalants, and tranquilizers were introduced to society.
In the 1960s, Timothy Leary popularized LSD, advocating the "feel good forever" answer to life's realities—"If it feels good, DO IT (Me-ism)." America had arrived with the introduction of hallucinogens.
Reasons for alcohol and drug use have remained consistent, with users seeking altered consciousness, a different perception of the world, and relief from emotional, physical, or societal discomfort.
The American Medical Association (AMA) formally recognized addiction as a disease in 1956.
- Addiction an illness that can be described, with a predictable and progressive course, that is a primary condition rather than just a symptom, and is permanent and terminal if untreated.

Risk Factors for Addiction

Biological vulnerability through genetic factors.
Psychological liability due to emotional distress.
Social access through cultural influences.
Spiritual emptiness, or lack of purpose.
Addiction manifests when a person's biological vulnerabilities, psychological liabilities, social pressures (drug availability), and individual sense of spiritual emptiness converge.

Signs of Substance Abuse

Changes in attendance at school or work.
Changes in mood and attitude.
Negative changes in appearance and personal hygiene.
Withdrawal from family and friends.
Outbreaks of temper or agitation.
Lying and stealing.
Unexplained weight loss or gain.
Financial problems.
Secretive or inconsistent behavior.
Sudden changes in energy levels, such as falling asleep in class or being unable to sit still.

Physical Signs of Substance Abuse

Bloodshot eyes associated with alcohol and marijuana use.
Watery eyes associated with heroin and opiate use.
Shakes, tremors, swaying, and staggering.
Odors of alcohol and marijuana.
Slow reactions and poor coordination (alcohol, marijuana).
Runny nose/nasal sores associated with cocaine, amphetamines, and heroin.
Unsteady gait (alcohol, narcotics, marijuana).
Slurred speech (stimulants, depressants, opiates).
Dilated pupils (stimulants)
Constricted pupils (depressants)

Defining Addiction

Difficulty controlling the amount or duration of substance use.
Continued substance despite negative consequences.

Nature of Addiction

A progressive disease.
A brain disorder.
A neurobiologic disease involving genetic, psychosocial, and environmental factors.
Diagnosis is based on criteria from the American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10).
Meeting three of the following seven criteria within a 12 month period can indicate addiction.
- Tolerance
- Withdrawal
- Difficulty controlling use
- Negative consequences
- Significant time or emotional energy spent on substance
- Neglected activities
- Desire to cut down on use

Basic Truths About Addiction

Alcohol and nicotine are drugs.
Addiction is a brain disorder.
Addiction affects all ages, races, and socioeconomic groups.
Addiction can start at any age.
Addiction can occur with legal and illicit drugs.
Addiction is not a weakness.

Dual Diagnoses

Many people with substance abuse also have a diagnosed, or undiagnosed, mental illness
Comorbid mental illnesses can include: bipolar disorder, depression, schizophrenia, ADHD, and personality disorders.
Genetics play a significant role; addiction is influenced by genes and poor coping skills.
Children of addicts are eight times more likely to develop an addiction.
Heredity and environment are contributing factors.
Genetics can load the gun, but environment pulls the trigger.
Cross addictions are common.

Addiction Myths

Addiction is NOT when you must use every day
Addiction is NOT when you must have cravings
Addiction is NOT when you must have withdrawal
Addiction is NOT when you must have hit bottom
Addiction is NOT when you must have fancy definition
Someone may have an addiction if they believe they do

Substance Abuse vs. Addiction

Not all who abuse drugs are addicted.
Use involves sporadic use without consequences.
Abuse involves experiencing consequences; frequency varies.
Examples of abuse include the binge drinker and the weekend cocaine user.
According to DSM-IV, substance abuse involves meeting one of these criteria.
- Continued use despite social or interpersonal problems.
- Repeated use resulting in failure to fulfill obligations at work, school, or home.
- Repeated use resulting in dangerous situations.
- Use resulting in legal problems.

Physical and Psychological Dependence

Physical dependence: the body adapts to a drug and experiences withdrawal upon abrupt cessation, rapid dose reduction, or administration of an antagonist.
Psychological dependence: a subjective need a specific psychoactive substance either for its positive effects or to prevent negative effects when abstinent.

The Brain and Addiction

Brain cells communicate through chemical messengers (neurotransmitters) released as a result of electrical impulses.
Chemical messengers include dopamine, serotonin, norepinephrine, epinephrine, GABA, and glutamate.
All drugs of abuse affect the limbic system in the brain (the reward pathway).
Pleasure triggers the release of the neurotransmitter dopamine.
Dopamine is the "feel good" chemical messenger.
The brain desires more dopamine.
Drugs mimic the actions of chemical messengers, but not perfectly.
Drugs replace neurotransmitters in the nerve synapse, they take up the space.
The brain stops making its own neurotransmitters because it appears there are enough.
The brain memorizes pleasurable feelings.
After continued drug use, the brain needs more drug to get the same feeling (tolerance).
The concept of "normal" changes as the brain rewires itself.
Once the brain heals when the patient is clean for some time, it is not protected against drug use and addiction.
If an individual begins using again, the brain remembers and picks up where it left off after the last use.
Addiction is a chronic disease.

Addictive Drugs

Sedative-hypnotics (alcohol, benzodiazepines, barbiturates).
Opioids (heroin, prescription pain relievers).
Stimulants (cocaine, methamphetamine, nicotine).
Other substances like marijuana, hallucinogens, psychedelics, and designer drugs.
The appeal of a drug can depend on it's pharmacokinetics (duration of the high), pharmacodynamics (quality of the high), pharmaceutics (solubility and ability to crush or cut), market availability, route of administration convenience.
Alcohol is a very common substance and two-thirds of American adults drink.
About 10% of Americans abuse alcohol.
Alcohol is the third leading preventable cause of death.
Forty percent of traffic fatalities are alcohol related.
Alcohol kills 6 1/2 times more teenagers than all other illicit drugs combined.
40% of those who started drinking before age 13 developed alcohol dependence later in life.
Teens who consume alcohol are 50 times more likely to use cocaine than those who do not.
Alcohol influence GABA and glutamate, can cause medical consequences like hypertension, liver damage, red blood cell damage and depression
Moderate drinking is no more than 3 drinks per day for men, and no more than 2 drinks per day for women and adults over 65.
Heavy drinking is more than 14 drinks per week, or 4 per occasion for men and more than 7 drinks per week, or 3 per occasion for women.
Binge drinking is more than 5 drinks in a row for men and more than 4 drinks in a row for women.
A standard drink contains 14 grams of alcohol, equal to 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of liquor.
Blood Alcohol Levels (BAC) are associated with varying effects.
- 0.02 - 0.03% may result in mild sedation and normal behavior
- 0.03 - 0.05% may result in euphoria and decreased inhibitions
- 0.06 - 0.1% may result in excitation, memory impairment, and increased reaction time
- 0.2 - 0.3% may result in disorientation, ataxia, and emotional outbursts
- 0.4 - 0.5% may result in stupor, incontinence, and inability to stand
- BAC above 0.5% typically results in death

Alcohol Withdrawal

Minor withdrawal occurs 6-36 hours after last drink. -Tremulousness, mild anxiety, headache, diaphoresis, palpitations, anorexia, GI upset -Normal mental status
Seizures start 6-48 hours after last drink. -Single or brief generalized tonic clonic seizure. -Short post-ictal period.
Alcoholic hallucinosis begins 12-48 hours after last drink. -Experiences visual, auditory, and/or tactile hallucinations with intact orientation and normal vital signs.
Delirium tremens happens 48-96 hours after the last drink. -Delirium, tachycardia, hypertension, agitation, fever, diaphoresis, psychosis.
Alcohol withdrawal is treated with benzodiazepines (lorazepam, clonazepam) to enhance GABA activity.
Encephalopathy is treated with lactulose to bind nitrogen
Psychosis is treated with an antipsychotic.

Wernicke-Korsakoff Syndrome

Wernicke's encephalopathy occurs with thiamine deficiency, which decreases glucose uptake in the brain and can result in lesions.
Korsakoff psychosis manifests as short term memory loss, psychosis, as confabulation
Korsakoff psychosis is usually permanent if not treated
Anxiety, insomnia, and autonomic dysfunction may persist for up to three months.
Alcoholism is a chronic disease; alcoholics are usually not successful as moderate drinkers.
Abstinence from alcohol can be supported by pharmacotherapy (ideally with intensive outpatient programs).
- Naltrexone is an opioid antagonist reducing the reinforcing effects of the first drink and is administered as ReVia 50 mg PO daily or Vivitrol 380 mg IM every 4 weeks.
- Naltrexone is contraindicated in opioid-dependent patients and may cause side effects like GI issues, anxiety, headache, and liver toxicity.
- Disulfiram (Antabuse) antagonizes acetaldehyde dehydrogenase, causing acetaldehyde toxicity with hypertension, nausea, vomiting, and tachycardia if the patient drinks. Disulfiram Dosage is 500mg Q Day X 2 weeks, then 250 mg Q Day and takes up to 14 days to clear.
- Acamprosate (Campral) interacts with GABA and glutamate systems, decreasing cravings and drinking occasions.
- Acamprosate Dosage is 666 mg TID and may cause diarrhea, nausea, depression, and anxiety.

Benzodiazepines and Sedatives

Includes diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonapin), and barbiturates (phenobarbital, Fioricet).
Often legitimate prescriptions used to treat anxiety, sleep, and pain disorders.
Those who abuse BZDs typically abuse other drugs and the high is not rated highly among drugs.
High potential for abuse, can only be used in the short term
Withdrawal and tolerance can occur within one month.
Can cause sedation.
Cognitive impairment.
Anterograde amnesia.
Respiratory depression
Disinhibition, especially in elderly.
BZDs bind to the BZD binding sites on GABA-a, but not the same site as GABA - GABA binding enhances the potency of BZDs.
Affects frequency of opening of Cl channels
Often used with antidepressants, must taper slowly to stop their use
BZDs with longer T 1/2 preferred in treatment
T 1/2 increases in long acting BZD with continued administration
Most commonly abused BZDs are Diazepam (Valium) and alprazolam (Xanax), these have a quicker onset of action.

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Explore alcohol dependence, blood alcohol levels, and neurobiological mechanisms. Understand compensatory responses in neurotransmitter systems due to chronic alcohol exposure. Discuss benzodiazepines for managing alcohol withdrawal and treatments for alcohol use disorder.