Coupon Accepted Successfully!


Management of Alcohol Dependence

Cage Questionnaire – For testing alcohol dependence
The CAGE questionnaire basically consists of four questions:
  1. Have you ever had to Cut down on alcohol (amount).
  2. Have you ever been Annoyed by people’s criticism of alcoholism.
  3. Have you ever felt Guilty about drinking
  4. Have you ever needed an Eye opener drink (early morning drink)
A score of 2 or more identifies problem drinkers.

Alcohol withdrawal syndrome:
  1. Tremors (Morning shakes): within 6 hours
  2. Rum fits: cluster Seizures GTCS; within 12-36 hours
  3. Alcoholic hallucinosis: auditory hallucinations; within 12-24 hrs
  4. Delirium tremens à Called as delirium tremens because there is a Delirium + Tremors + Autonomic hyperactivity. (occur min-48-72 hrs of withdrawal)
Alcohol dependence Treatment:
  1. Detoxification is done by - Benzodiazepines esp. longer acting Benzodiazepines, like chlordiazepoxide, other Benzodiazepine like Diazepam, Lorazepam, Alprazolam can also be used.
  2. Relapse prevention
    1. Aversion treatment – Disulfiram
    2. Anti-Craving agent like – Naltrexone, Acamprosate, Fluoxetine, Topiramate & Baclofen.
Pharmacologic Actions
  1. Disulfiram
    Disulfiram is almost completely absorbed from the gastrointestinal (GI) tract after oral administration. Its half-life is estimated to be 60 to 120 hours. Therefore, 1 or 2 weeks may be needed before disulfiram is totally eliminated from the body after the last dose has been taken.
    The metabolism of ethanol proceeds through oxidation via alcohol dehydrogenase to the formation of acetaldehyde, which is further metabolized to acetyl-coenzyme A (acetyl- CoA) by aldehyde dehydrogenase. Disulfiram is a predominantly aldehyde dehydrogenase inhibitor that interferes with the metabolism of alcohol by producing a marked increase in blood acetaldehyde concentration. The accumulation of acetaldehyde (to a level up to ten times higher than occurs in the normal metabolism of alcohol) produces a wide array of unpleasant reactions, called the Disulfiram Ethanol Reaction (DER), characterized by nausea, throbbing headache, vomiting, hypertension, flushing, sweating, thirst, dyspnea, tachycardia, chest pain, vertigo, and blurred vision. The reaction occurs almost immediately after the ingestion of one alcoholic drink and can last from 30 minutes to 2 hours.
  2. Anti craving Agent1. Acamprosate 2. Topiramate 3. Naltrexone, 4.Fluoxetine, 5.  Baclofen.
    1. Acamprosate
      Acamprosate’ s mechanism of action is not fully understood, but it is thought to antagonize neuronal overactivity related to the actions of the excitatory neurotransmitter glutamate. In part, this may result from antagonism of N-methyl- D-aspartate (NMDA) receptors.
      Acamprosate is used for treating alcohol-dependent individuals seeking to continue to remain alcohol-free after they have stopped drinking. Its efficacy in promoting abstinence has not been demonstrated in persons who have not undergone detoxification and who have not achieved alcohol abstinence before beginning treatment.
    2. Baclofen
      Baclofen is used for the treatment of spastic movement, especially in instances of cord injury, spastic diplegia, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig’s Disease) and trigeminal and glossopharyngeal neuralgias.
      Baclofen has also been shown to be as effective as diazepam in uncomplicated alcohol withdrawal syndrome. It was effective in promoting alcohol abstinence in patients with severe liver cirrhosis.
      Mechanism of action
      Baclofen produces its effect via modulating the GABAB receptor, similar to the drug GHB which also has the same mechanism of action and also similar effects. However, there are some pharmacological differences in that baclofen appears to have reduced abuse and dependence potential. The modulation of the GABA receptor is what produces baclofen’s range of therapeutic properties.
    3. Topiramate
      Mechanism of action
      Electrophysiological and biochemical evidence suggests that topiramate, at pharmacologically relevant concentrations, blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABAA receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV. It is used as a Anti epileptic drug, migraine prophylaxis and anti craving drug for alcohol.
Opioid Use Disorders
  1. Smack: street form of heroin, Brown Sugar, Morphine, opioid, Doda, Afeem.
Recent use of an opioid
Clinically significant maladaptive behavioral changes eg initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment, or impaired functioning

Action of Opioid Receptors
Receptor Type   :  Actions
Mu (e.g., morphine)  :  Analgesia, reinforcement euphoria, cough and appetite suppression, decreased respiration, decreased GI motility, sedation, hormone changes, dopamine and acetylcholine release
Kappa (k)(e.g., butorphanol)  :  Decreased dysphoria, decreased GI motility, decreased, psychotic symptoms, sedation, diuresis, analgesia
Delta (e.g., etorphine)  :  Hormone changes, appetite, suppression, dopamine release

Opioid Derivatives
  1. Natural Alkaloids of Opium
    1. Morphine                              
    2. Codeine            
    3. Thebaine
    4. Noscapine              
    5. Papaverine
  2. Synthetic Compounds
    1. Heroin              
    2. Nalorphine                      
    3. Hydromorphone
    4. Methadone          
    5. Dextropropoxyphene    
    6. Meperidine (Pethidine)
    7. Cyclazocine          
    8. Levallorphan                  
    9. ​Diphenoxylate
Signs:- Pupillary constriction, drowsiness or coma , slurred speech & impairment in attention or memory.

Treatment:- Naloxone & supportive care
  1. Due to cessation of (or reduction in) opioid use or administration of an opioid antagonist after a period of opioid use
  2. Withdrawal are features: Dysphoric mood , Nausea or vomiting , Muscle aches ,
  3. Lacrimation or rhinorrhea , Pupillary dilatation,
  4. Piloerection (goose flesh “cold turkey”), or Sweating , Diarrhea , Fever,
  5. Insomnia ,Yawning.

Test Your Skills Now!
Take a Quiz now
Reviewer Name