Tuesday, May 3, 2022

Alcohol Abuse Disorder

 

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What is Alcohol Use Disorder?

 

 

Alcohol use disorder AUD can be a severe problem. It involves a pattern of drinking alcohol too much or too often. If you drink too much alcohol at one time (binge)or too often during a given week, you may be suffering from AUD. If you find yourself having trouble stopping or quitting drinking, and your relationships suffer from your drinking habits, you may be suffering from AUD. Physical dependency on alcohol or alcoholism can develop from AUD. Binge drinking can also lead to alcohol poisoning and even death. The definition of one alcoholic drink is a 5-ounce glass of wine, a 12-ounce bottle of beer, or a 1.5-ounces of whiskey, tequila, or rum.

 

How do you know you are abusing alcohol?

 

Women: you drink seven drinks per week or more than three drinks on one occasion.

Men: you drink more than 14 drinks in a week or more than four drinks on one occasion.

Forth both women and men older than 65 years old: drink seven drinks per week or more than three drinks on one occasion.

 

What are the Symptoms of alcohol disorder?

 

                You can’t stop drinking once you start.

                You recognize you need to stop or cut back but are unable to

                You have tried stopping using alcohol for a week or more but can’t make it past a few days.

                You are unable to perform at work or home when you are drinking.

                You have guilty after drinking.

                Family members and friends tell you that you have a problem.

                You feel annoyed by criticism of your drinking.

                You have a drink in the morning to get yourself going after drinking too much.

                You have physically hurt someone else or yourself after drinking too much. 

                You hide your drinking or your alcohol.

                You have blackouts and memory lapses after drinking too much.

                You feel depressed.

                You are getting traffic or driving tickets while under the influence of alcohol.

                Your drinking is interfering with your relationships.

                Your hands are shaking.

 

You may experience a few mild symptoms initially— which you might not see as trouble signs — but this can signal the start of a drinking problem. Recognizing and acting on your situation early on can help you make changes early on. You probably know or have heard that alcohol affects your physical health. Too much alcohol can cause cirrhosis of the liver, death by injuries and accidents, fetal alcohol syndrome if you drink while pregnant, bleeding ulcers, weight gain, cancer, type 2 diabetes, feelings of dizziness and sickness, bad breath, and skin breakouts, among others.

 

 

How is alcohol abuse diagnosed?

 

Generally, doctors or healthcare providers believe a person is abusing alcohol when:

                The repeated use of alcohol interferes with your work, home, or school responsibilities.

                Repeated alcohol use puts you or someone else in physical danger (driving, operating machinery, mixing alcohol and medicine, drinking alcohol while pregnant).

                Repeated alcohol use leads to legal problems and harms your relationships.

 

What is the CAGE Questionnaire?

 

The CAGE questionnaire is an international tool assessment instrument used to help indicate potential problems with alcohol use disorder. It is popular with primary caregivers. Your healthcare provider may use the CAGE questionnaire in a clinical setting using informal phrases. The CAGE questionnaire is 4 item questions with yes or no answers.

 

CAGE Questionnaire

 

                Have you ever felt you should Cut down on your drinking? 

                Have people Annoyed you by criticizing your drinking? 

                Have you ever felt bad or Guilty about your drinking? 

                Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? 

 

Scoring: Item responses on the CAGE are scored 0 or 1, with a higher score indicating alcohol problems. A total score of 2 or greater is considered clinically significant. 

 

Can alcohol abuse be prevented or avoided?

 

Having a family history of alcoholism or alcohol abuse may make you work harder to resist or limit alcohol. 

A few ways to reduce your alcohol consumption are:

 

                Limit yourself to one drink when by yourself or with friends.

                Seek treatment for underlying mental health conditions.

                Avoid spending time with others who abuse alcohol.

                Talk to your doctor or healthcare provider.

                Consider joining a support group of others facing the same challenge.

 

Excessive alcohol use is one of the most common causes of premature mortality in the United States. The U.S. Preventive Task Force (USPTF) recommends screening for alcohol abuse at 18 years or older, including pregnant women. Teens between 12 and 17 need teaching and recommendations on avoiding alcohol use. 

 

Is There a Treatment for Alcohol Use Disorder?

 

While there are treatments available for AUD, not all treatments work for every person. The first step is recognizing that you need help. The sooner you seek help, the better. Possible treatments are behavioral therapy (counseling) and medicine. 

The U.S Food and Drug Administration FDA has approved the three medicines to treat alcohol abuse disorder.

 

                acamprosate (Campral)

                disulfiram (Antabuse)

                naltrexone (Revia or Vivitrol). 

 

Both Acamprosate and naltrexone usually work the best. These medicines may help you drink less or stop drinking and not start again. Other medications may also help you consume less alcohol, such as:

                antidepressants

                antiseizure drugs, like gabapentin (brand: Neurontin) or topiramate (brand: Topamax); 

                antinausea medicine like ondansetron (brand: Zofran) 

 

Medications and counseling together work best. Take your medicine daily and regularly. Once you have found an effective treatment, it’s essential to stick to that treatment.  Avoid situations that involve much alcohol. Medications are not a cure for alcohol use disorder; you must be aware that living with alcohol abuse means recognizing the triggers that make you want to drink. You may have to stop or limit hanging out with others who drink as it may make it difficult for you not to drink.

 

What is alcohol withdrawal?

 

You are likely to experience alcohol withdrawal AWS if you consume alcohol in large quantities for a prolonged period, usually greater than two weeks and suddenly discontinue. The symptoms can begin up to six to 24 hours after the last alcohol drink. 

 

Here are some of the symptoms of AWS

                Autonomic hyperactivity (sweating, tachycardia)

                Increased hand tremor

                Insomnia

                Nausea or vomiting

                Transient visual, tactile, auditory hallucinations or illusions

                Psychomotor agitation; anxiety; or tonic-clonic seizures.

                Delirium tremens (severe; hyperthermia, diaphoresis, tachypnea, tachycardia) 

                disorientation, impaired attention and consciousness, and visual and auditory hallucinations. 

 

Where can I get more information? 

                Your doctor or healthcare provider

                Al-Anon Family Groups http://www.al-anon.alateen.org 

                Alcoholics Anonymous http://www.aa.org 

                National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/alcohol-health/overview- alcohol-consumption/alcohol-use-disorders 

                Self-Management and Recovery Training http://www.smartrecovery.org 

                Women for Sobriety http://www.womenforsobriety.org 

 

 

Resources

National Institute on Alcohol Abuse and Alcoholism: Alcohol Use Disorder

National Institutes of Health: Drinking Levels Defined

National Institutes of Health: Drinking to Excess

National Institutes of Health, MedlinePlus: Alcoholism and Alcohol Abuse

https://familydoctor.org/condition/alcohol-abuse/

Post-Traumatic Stress Disorder, PTSD

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By Rosabel Zohfeld, MSN, APRN, FNP-C

 

Post-traumatic stress disorder (PTSD) is a severe, disabling, and often chronic condition.  PTSD develops mostly following exposure to a traumatic event involving actual or threatened injury to the individual or others. While most individuals experience trauma to some degree during their lifetime, patients with Post-traumatic stress disorder have marked cognitive, affective, and behavioral responses to stimuli that lead to severe anxiety, flashback, and combative behavior. Individuals with PTSD may try coping by avoiding the triggers that may elicit their symptoms, leading to emotional numbing, detachment from others, and decreased interest in everyday life activities. According to The National Comorbidity Survey, 16% of those with PTSD have at least one coexisting psychiatric disorder. In comparison, 17% can have two psychiatric disorders, and 50% have three or more coexisting conditions such as depression, anxiety, substance abuse, and others. Alcohol and other substance abuse are more prevalent among people living with PTSD. 

PTSD increases the occurrence of borderline personality disorder (BPD) and antisocial personality disorder (APD). Individuals with two or more comorbid conditions are more likely to attempt suicide. Somatic symptoms are much more likely in patients with PTSD than in those without the disorder.

 

PTSD is associated with a range of physical health conditions, including:

 

                Bone and joint, neurologic, cardiovascular, respiratory, and metabolic disease 

                Cardiovascular and pulmonary risk factors, including obesity, dyslipidemia, tobacco use, hypertension, and type II diabetes in women.

                Angina, heart failure, asthma, bronchitis, liver disease and peripheral artery disease, myocardial infarction, autoimmune and endocrine disorders.

                Accelerated aging, traumatic brain injury (TBI), among others.

 

Individuals with one or more PTSD symptoms are more likely to experience: 

                occupational problems, 

                have lower social support

                higher rates of problems in intimate relationships, including marital difficulties, compared with people without the disorder

 

Is there any help for PTSD?

 

Psychotherapy improves the overall psychosocial functioning cognitive-behavioral therapy strategy for reducing PTSD symptom severity. Patients with possible PTSD should receive a comprehensive psychiatric assessment. A diagnosis of PTSD begins with patients six years of age and older who meet the DSM-5 criteria, which include: experiencing or witnessing a severe, traumatic event resulting in symptoms in each of four categories (intrusion, adverse alteration in mood and cognition, avoidance, and arousal); social or occupational impairment; and signs and impairment lasting at least one month after the trauma.

The therapeutic goals of pharmacologic therapy for those individuals with PTSD are to decrease intrusive thoughts and images, phobic avoidance, irritability and anger, pathological hyperarousal, hypervigilance, and depression. Drug therapies are generally more effective in reducing hyperarousal and mood (irritability, anger, depression) symptoms. They are less useful for re-experiencing, emotional numbing, and behavioral avoidance; individual responses generally outweigh treatment-specific differences. 

Some of the drug classes used in the pharmacologic treatment of PTSD may include:

                Serotonin reuptake inhibitors (SRIs): Sertraline, Paroxetine, Escitalopram

                Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine, Citalopram

                Serotonin-norepinephrine reuptake inhibitors (SNRIs): Duloxetine

                Second-generation antipsychotics (SGAs): aripiprazole, clozapine, risperidone

                Monotherapy:  quetiapine and other SGAs reduce PTSD symptoms in military and non-military patients. 

                Drug Augmentation: Use of SRIs + SSRIs

                Alpha-adrenergic receptor blockers — prazosin 

                Benzodiazepines — alprazolam, clonazepam, Diazepam

                 

Other medications may include: 

                Other antidepressants (trazodone) or atypical antidepressants ( mirtazapine) 

                Beta-adrenergic receptor blockers – such as propranolol in the early prevention or subsequent treatment of PTSD

                Mood stabilizers – Anticonvulsant medications with mood-stabilizing properties such as Tiagabine, Topiramate, Divalproex. 

                Ketamine, an N-methyl-D-aspartic acid antagonist used as an anesthetic and understudy in depression, reduced PTSD symptoms in a clinical trial 

                Cannabis  

                Nabilone: A test of the synthetic cannabinoid in patients with difficult-to-treat PTSD Duration of Treatment

Effective oral medication treatment should be continued for at least 6-12 months to prevent relapse and recurrence. 

 

When should I get help?

If you are having trouble coping because of your PTSD symptoms, you should do one or both of the following:

                Seek medical attention to start treatment with medicine

                See a therapist who is trained in CBT to start therapy

If you are thinking of hurting yourself, or if you feel that life isn't worth living, you should get help right away:

                If you see a therapist or doctor for your PTSD, call them immediately. If you do not see a therapist or health provider, call 911 or go to the emergency room.

Sources:

https://www.uptodate.com/contents/pharmacotherapy-for-posttraumatic-stress-disorder-in-adults?search=ptsd%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.uptodate.com/contents/approach-to-treating-posttraumatic-stress-disorder-in-adults?search=ptsd&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1