Alcohol dependence : Need large amount. In ability to cut down. Amnestic periods. With serious physical illness. Social & occupational functioning.
DSM-VI criteria for Alcohol Dependence * maladaptive pattern of substance use, by 3 or more of the following in the same 12 months period : **-Tolerance, either marked increase in amount for the desired effect or reduce effect with same amount used. **- Withdrawal **- Taken in larger amounts and in longer periods than intended. **- Unsuccessful efforts to cut down or control the use. **- A great deal of time is spent in obtaining, using or recovering from the substance. **- Important life activities are given up because of the substance use. **- Use is continued despite knowledge of having a problem.
Subtypes of dependence : Type A & B. Others :-early stage problem -affiliative drinkers. -schizoid isolated drinkers. Type 1 & 2 male limited drinkers (psychological > physical )
Alcohol intoxication: Its not a trivial problem! Legal intoxication = 0,1%_0,15% At 0,20% == motor area in brain dep. At 0,3% == confusion At 0,4_0,5 == coma & death.
DSM-VI criteria for Alcohol Intoxication : A)- Recent ingestion of alcohol. B) - Significant maladaptive behavioral or psychological changes. C)- One or more of the following : - slurred speech - in coordination - unsteady gait - nystagmus - impaired attention - stupor or coma. D)- Are not due to a general medical condition or other mental disorder.
Alcohol withdrawal : A) - Cessation or reduction in heavy alcohol use. B)-two or more of the following( several hours – few days ): - autonomic hyperactivity - increased hand tremor - insomnia - nausea or vomiting - transient hallucinations or illusions - psychomotor agitation - anxiety - grand mal seizures C) - Impairment in function. D)- Not due to a general medical condition or mental disorder.
Jitters = = = in 6-8 hrs. Perceptual ===in 8-12 hrs Seizures === in 12- 24 hrs D.T= == in 72 hrs up to 1 week !
Delirium tremens ( DT’s): Medical emergency Mortality 20% Can appear up to 1 st week & can start from 3d day. Autonomic hyperactivity.
The best Treatment for DT’s is prevention. Benzodiazepine Systemic stabilization
Effects of alcohol : Physiological : liver, esophgitis, varices,alcoholic hepatitis. Sleep : ease of falling sleep. Other body system : M.I, HTN, cancer