ALCOHOL-RELATED

DISORDERS

MEDRIANO, ROXANNE
BARCENA, LOWREY GAIL
JUNIOR INTERNS
GROUP 3
BATCH 2015
EPIDEMIOLOGY
 COMORBIDITY

• other substance-related disorders

• antisocial personality disorder
• mood disorders
• anxiety disorders
 ANTISOCIAL PERSONALITY DISORDER

• common in men with an alcohol-related disorder

• can precede the development of the alcohol-related
disorder
 ALCOHOL

STIMULANT OR DEPRESSANT?
By depressing inhibitor centers in the
brain , it allows the individual
unhampered expression of
underlying drives, released in what
appears to be a state of stimulation
 COMORBIDITY

• other substance-related disorders

• antisocial personality disorder
• mood disorders
• anxiety disorders
 ANTISOCIAL PERSONALITY DISORDER

• common in men with an alcohol-related disorder

• can precede the development of the alcohol-related
disorder
 MOOD DISORDERS

• 30 to 40 % of persons with an alcohol-related disorder  major depressive disorder

• Depression: women>men with these disorders.
• alcohol-related disorders who have a high daily consumption of alcohol and a family history of alcohol
abuse

• alcohol-related disorders and major depressive disorder: great risk for attempting suicide
andother substance-related disorder diagnoses.
• antidepressant drug therapy for depressive symptoms that remain after 2 to 3 weeks of
sobriety.
• bipolar I disorder: at risk for developing an alcohol-related disorder
• both alcohol-related disorder and depressive disorder diagnoses have concentrations of
dopamine metabolites (homovanillic acid) and γ-aminobutyric acid (GABA) in their cerebrospinal
fluid (CSF).
 ANXIETY DISORDERS

• 25 to 50%: anxiety disorder

• Phobias and panic disorder: frequent comorbid diagnoses
• attempt to self-medicate symptoms of agoraphobia or social
phobia
• precede the development of panic disorder or generalized
anxiety disorder.
 SUICIDE

• 10 to 15 %
• Factors that have been associated:
• presence of a major depressive episode
• weak psychosocial support systems
• serious coexisting medical condition
• Unemployment
• living alone
ALCOHOL RELATED
DISORDERS
OUTLINE:

A.Objectives
B. Etiology
• Psychological theories
• Psychodynamic theories
• Behavioral theories
• Sociocultural theories
• Childhood history
• Genetic theories
OUTLINE:

C. Alcohol related disorders

• Alcohol dependence
• Alcohol abuse
• Alcohol intoxication
• Alcohol withdrawal
• Alcohol withdrawal delirium
• Alcohol induced psychotic disorder, with
delusions
OBJECTIVES

1. To be able to know the different etiologies

or theories regarding alcohol related
disorders
2. To be able to identify and differentiate the
different alcohol related disorders
 Psychological Theories

• to reduce TENSION
• increase feelings of POWER
• decrease the effects of psychological PAIN
• decreases feelings of NERVOUSNESS
• Coping up with the day-to-day STRESSES OF
LIFE
 Psychological Theories

• Nonalcoholic, low doses

• enhanced feeling of well-being
• improved ease of interactions
• In high doses
• muscle tension
• psychological feelings of nervousness
and tension are increased
 Psychodynamic Theories

disinhibiting or anxiety-lowering effects of

lower doses of alcohol
self-punitive harsh superegos
decrease unconscious stress levels
classic psychoanalytical theory
alcoholic people: FIXATED AT THE ORAL STAGE
of development
Behavioral Theories

• Factors contributing to the decision to drink again

after the first experience with alcohol and to
continue to imbibe despite problems
a. Expectations about the rewarding effects of
drinking
b. cognitive attitudes toward responsibility for
one's behavior
c. subsequent reinforcement after alcohol intake
Sociocultural Theories

• based on extrapolations from social groups that

have high and low rates of alcoholism
• ethnic groups, such as Jews, who introduce children
to modest levels of drinking in a family atmosphere
and eschew drunkenness have low rates of
alcoholism
Sociocultural Theories

• Irish men or some American Indian tribes with high

rates of abstention but a tradition of drinking to the
point of drunkenness among drinkers, are believed
to have high rates of alcoholism
• These theories, however, often depend on
stereotypes that tend to be erroneous, and
prominent exceptions to these rules exist
Sociocultural Theories

• cultural factors, account for as much as 40 percent

of the alcoholism risk
• important contributors to the rates of alcohol-
related problems in a society
1. cultural attitudes toward drinking
2. drunkenness
3. personal responsibility for consequences
Sociocultural Theories

• In the final analysis, social and psychological

theories are probably highly relevant, because they
outline factors that contribute to the onset of
drinking, the development of temporary alcohol-
related life difficulties, and even alcoholism
Childhood History

• A childhood history of attention-

deficit/hyperactivity disorder, conduct disorder, or
both, increases a child's risk for an alcohol-related
disorder as an adult
• Personality disorders, especially antisocial
personality disorder, also predispose a person to
an alcohol-related disorder
Genetic theories

• Four lines of evidence support the conclusion that

alcoholism is genetically influenced
1. a three- to fourfold increased risk for severe
alcohol problems is seen in close relatives of
alcoholic people
->The rate of alcohol problems increases with the
number of alcoholic relatives, the severity of their
illness, and the closeness of their genetic relationship
to the person under study
Genetic theories

2. The rate of similarity, or concordance, for severe

alcohol-related problems is significantly higher in
identical twins of alcoholic individuals than in
fraternal twins
3. There significantly enhanced risk for alcoholism in
the offspring of alcoholic parents
Alcohol dependence and abuse

• Clinical features
1. A need for daily use of large amounts of alcohol
for adequate functioning
2. regular pattern of heavy drinking limited to
weekends
3. long periods of sobriety interspersed with binges
of heavy alcohol intake lasting for weeks or months
Alcohol dependence and abuse

• The drinking patterns are often associated with

certain behaviors
1. the inability to cut down or stop drinking
2. repeated efforts to control or reduce excessive
drinking by “going on the wagon”(periods of
temporary abstinence) or by restricting drinking to
certain times of the day
3. binges (remaining intoxicated throughout the day
for at least 2 days)
Alcohol dependence and abuse

4. occasional consumption of a fifth of spirits (or its

equivalent in wine or beer)
5. amnestic periods for events occurring while
intoxicated (blackouts)
6. the continuation of drinking despite a serious
physical disorder that the person knows is
exacerbated by alcohol use
7. and drinking nonbeverage alcohol, such as fuel and
commercial products containing alcohol
Alcohol dependence and abuse

• In addition, persons with alcohol dependence and

alcohol abuse show”
1. impaired social or occupational functioning because
of alcohol use
2. legal difficulties
3. arguments or difficulties with family members or
friends about excessive alcohol consumption
According to DSM-IV-TR, the current rate of alcohol
dependence is 5 percent
DSM-IV-TR Diagnostic Criteria for Substance Dependence
A maladaptive pattern of substance use, leading to clinically significant
impairment or distress, as manifested by three (or more) of the following,
occurring at any time in the same 12-month period:
A. Tolerance, as defined by either of the following:
1. a need for markedly increased amounts of the substance to
achieve intoxication or desired effect
2. markedly diminished effect with continued use of the same
amount of the substance
B. Withdrawal, as manifested by either of the following:
1. the characteristic withdrawal syndrome for the substance
(refer to Criteria A and B of the criteria sets for Withdrawal
from the specific substances)
2. the same (or a closely related) substance is taken to relieve
or avoid withdrawal symptoms
C. The substance is often taken in larger amounts or over a longer
period than was intended
D. There is a persistent desire or unsuccessful efforts to cut down or
control substance use
E. A great deal of time is spent in activities necessary to obtain the
substance (e.g., visiting multiple doctors or driving long distances),
use the substance (e.g., chain-smoking), or recover from its effects
F. Important social, occupational, or recreational activities are given
up or reduced because of substance use
G. The substance use is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by the substance (e.g.,
current cocaine use despite recognition of cocaine-induced
depression, or continued drinking despite recognition that an
ulcer was made worse by alcohol consumption)
DSM-IV-TR Criteria for Substance Abuse
A. A maladaptive pattern of substance use leading to clinically
significant impairment or distress, as manifested by one (or more)
of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill
major role obligations at work, school, or home (e.g.,
repeated absences or poor work performance related to
substance use; substance-related absences, suspensions, or
expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is
physically hazardous (e.g., driving an automobile or
operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests
for substance-related disorderly conduct)
4. Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance (e.g., arguments
with spouse about consequences of intoxication, physical
fights)
B. The symptoms have never met the criteria for Substance
Dependence for this class of substance
Alcohol intoxication

• The DSM-IV-TR diagnostic criteria for alcohol

intoxication are based on evidence of recent
ingestion of ethanol, maladaptive behavior, and at
least one of six possible physiological correlates of
intoxication
• the legal definition of intoxication in most states in
the United States requires a blood concentration of
80 or 100 mg ethanol per deciliter of blood
(mg/dL)
Impairment likely to be seen at different blood alcohol concentrations
Level (mg/dL) Likely impairment
20-30 Slowed motor performance and decreased thinking
ability
30-80 Increases in motor and cognitive problems
80-200 Increases in coordination and judgment errors
Mood lability
Deterioration in cognition
200-300 Nystagmus, marked slurring of speech, and alcoholic
blackouts
>300 Impaired vital signs and possible death
DSM-IV-TR Diagnostic Criteria for Alcohol Intoxication
A. Recent ingestion of alcohol
B. Clinically significant maladaptive behavioral or psychological changes
(e.g. inappropriate sexual or aggressive behavior, mood lability, impaired
judgement, impaired social or occupational functioning) that developed
during, or shortly after, alcohol ingestion.
C. One (or more) of the following signs, developing during, or shortly after,
alcohol use:
1. Slurred speech
2. Incoordination
3. Unsteady gait
4. Nystagmus
5. Impairment in attention or memory
6. Stupor or coma
D. The symptoms are not due to a general medical condition and are not
better accounted for by another mental disorder
Alcohol withdrawal

• Alcohol withdrawal, even without delirium, can be

serious; it can include seizures and autonomic
hyperactivity
• Conditions that may predispose to, or aggravate,
withdrawal symptoms include
1. fatigue
2. Malnutrition
3. physical illness
4. depression
Alcohol withdrawal

• The DSM-IV-TR criteria for alcohol withdrawal

require
1. cessation or reduction of alcohol use that was
heavy and prolonged
2. presence of specific physical or neuropsychiatric
symptoms
Alcohol withdrawal

• One recent positron emission tomographic (PET)

study of blood flow during alcohol withdrawal in
otherwise healthy persons with alcohol dependence
reported a globally low rate of metabolic activity,
although, with further inspection of the data, the
authors concluded that activity was especially low in
the left parietal and right frontal areas.
Alcohol withdrawal

• The classic sign of alcohol withdrawal:

1. tremulousness
2. psychotic and perceptual symptoms (e.g., delusions
and hallucinations)
3. seizures
4. symptoms of delirium tremens (DTs), called alcohol
withdrawal delirium in DSM-IV-TR
Tremulousness 6 to 8 hours
psychotic and perceptual 8 to 12 hours
symptoms

seizures 12 to 24 hours
DT (delirium tremen) for the first week of
withdrawal
The syndrome of withdrawal sometimes
skips the usual progression and, for
example, goes directly to DTs
Alcohol withdrawal

• Other signs and symptoms

• general irritability
• gastrointestinal symptoms (e.g., nausea and
vomiting)
• sympathetic autonomic hyperactivity
• anxiety, arousal, sweating, facial flushing,
mydriasis, tachycardia, and mild hypertension
DSM-IV-TR Diagnostic Criteria for Alcohol Withdrawal
A. Cessation of (or reduction in) alcohol use that has been heavy and
prolonged.
B. Two (or more) of the following, developing within several hours to a few
days after Criterion A:
1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than
100)
2. Increased hand tremor
3. Insomnia
4. Nausea and vomiting
5. Transient visual, tactile, or auditory hallucinations or illusions
6. Psychomotor agitation
7. Anxiety
8. Grand mal seizures
C. The symptoms in Criterion B cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
D. The symptoms are not due to a general medical condition and are not
better accounted for by another mental disorder
Specify if:
With perceptual disturbances
Alcohol withdrawal delirium

• alcohol withdrawal delirium is the most severe form

of the withdrawal syndrome, also known as DTs
(delirium tremens)
• a medical emergency that can result in significant
morbidity and mortality
• Patients with delirium are a danger to themselves
and to others
Alcohol withdrawal delirium

• Clinical features:
1. delirium occurring within 1 week after a person
stops drinking or reduces the intake of alcohol
2. autonomic hyperactivity such as tachycardia,
diaphoresis, fever, anxiety, insomnia, and
hypertension
3. perceptual distortions(visual or tactile
hallucinations)
4. fluctuating levels of psychomotor activity
Alcohol withdrawal delirium

• About 5 percent-alcohol-related disorders who are

hospitalized have DTs.
• Because the syndrome usually develops on the third
hospital day, a patient admitted for an unrelated
condition may unexpectedly have an episode of
delirium, the first sign of a previously undiagnosed
alcohol-related disorder
Alcohol withdrawal delirium

• Episodes of DTs usually begin in a patient's 30s or

40s after 5 to 15 years of heavy drinking, typically
of the binge type. Physical illness (e.g., hepatitis or
pancreatitis) predisposes to the syndrome; a person
in good physical health rarely has DTs during
alcohol withdrawal
 Alcohol induced psychotic
disorder, with delusion

• Secondary and substance-induced delusions are

usually present in a state of full wakefulness.
• Patients experience no change in the level of
consciousness, although mild cognitive impairment may
be observed.
• Patients may appear confused, disheveled, or
eccentric, with tangential or even incoherent speech..
 Alcohol induced psychotic
disorder, with delusion

• Hyperactivity and apathy may be present, and an

associated dysphoric mood is thought to be common
• The delusions can be systematized or fragmentary, with
varying content, but persecutory delusions are the most
common
DSM-IV-TR Diagnostic Criteria for Substance-Induced Psychotic Disorder
A. Prominent hallucinations or delusions. Note: Do not include
hallucinations if the person has insight that they are substance induced
B. There is evidence from the history, physical examination, or laboratory
findings of either (1) or (2):
1. The symptoms in Criterion A developed during, or within a month
of, substance intoxication or withdrawal
2. Medication use is etiologically related to the disturbance
C. The disturbance is not better accounted for by a psychotic disorder that is
not substance induced. Evidence that the symptoms are better accounted
for by a psychotic disorder that is not substance induced might include
the following: the symptoms precede the onset of the substance use (or
medication use); the symptoms persist for a substantial period of time
(e.g., about a month) after the cessation of acute withdrawal or severe
intoxication, or are substantially in excess of what would be expected
given the type or amount of the substance used or the duration of use; or
there is other evidence that suggests the existence of an independent non-
substance-induced psychotic disorder (e.g., a history of recurrent non-
substance-related episodes)
D. The disturbance does not occur exclusively during the course of a
delirium. Note: This diagnosis should be made instead of a diagnosis of
substance intoxication or substance withdrawal only when the symptoms
are in excess of those usually associated with the intoxication or
withdrawal syndrome and when the symptoms are sufficiently severe to
warrant independent clinical attention.
My great, great granddaddy
always told me, "When you're
holding a
conversation, be sure to let go of
it once in awhile." I'm letting go of
ours
right now. Are there any
questions?