ALCOHOL
DEPENDENCE
SYNDROME
ALCOHOL DEPENDENCE(ALCOHOLISM)
• It refers to frequent consumption of large amounts of alcohol with
greater than or equal to 3 of the following
• Tolerance to the effects of alcohol
• Withdrawal symptoms
• Drinking larger amounts or over a long period than intended
• Persistent desire or unsuccessful efforts to reduce use without
success
• Spending significant time obtaining, using or recovering from
alcohol
• Important social ,occupational or recreational activities are
given up or reduced because of drinking
• Continued use despite physical or psychologic problems
CLASSIFICATION
• Alpha alcoholism; no psychological or physical dependence
• Beta alcoholism: no psychological or physical dependence but
cirrhosis develops
• Gama alcoholism: physical and behavioral complications
• Delta alcoholism: strong psychological or physical dependence
due to long continued use
• Epsilon alcholism: dipsomania develops and drinks to death
ETIOLOGY OF ALCOHOL DEPENDENCE
• Availability of alcohol and social patterns of use
• Genetic factors
• As a measure to relieve anxiety or depression
• Certain personality traits like feeling of isolation, loneliness,
shyness ,depression, dependency, sexual immaturity
• Social problems like broken home, disturbed relationship with
their family
CLINICAL FEATURES
• Social problems : absenteeism from work, unemployment,
marital tensions ,child abuse ,financial difficulties and problems
with the law such as violence and traffic offences
• Low mood: no mood is common since alcohol has a direct
depressant effect and and heavy drinking creates numerous
social problems. Attempted and completed suicide are
associated with alcohol misuse.
• Anxiety: people who are anxious may use alcohol as a means
of relieving anxiety in the short term and this can develop into
dependence .Conversely alcohol withdrawal increases anxiety
• Alcohol withdrawal syndrome : the symptoms usually
become maximal about 2 to 3 days after the last drink and can
include seizures. Symptoms include
• Psychological symptoms like restlessness ,anxiety, panic attacks
• Autonomic symptoms include tachycardia, sweating, pupil
dilatation, nausea and vomiting
• Delirium and seizures
• Hallucinations : hallucinations are common in delirium
tremens. Less common is the phenomenon called alcoholic
hallucinosis where a patient with the alcohol dependence
experience auditory hallucinations in clear consciousness at a
time when they are not withdrawing from alcohol
• Wernicke- korsakoff syndrome : it is an organic brain disorder
resulting from damage to the mamillary bodies ,dorsomedial nuclei
of thalamus and adjacent areas of peri ventricular grey matter
caused by a deficiency of Thiamine
• It results from long standing heavy drinking and an inadequate diet
but can also arise from Malabsorption or even protracted vomiting.
• Alcohol related brain damage: it is a term used as a collective description of
many brain pathologies associated with alcohol excess which often coexist in
the same patient
• Acute alcohol intoxication causes ataxia, slurred speech emotional incontinence
and aggression
• Very heavy drinkers may experience periods of Amnesia for events that
occurred during bouts of intoxication, it is termed as alcoholic blackouts
• Established alcohol dependence may lead to alcohol dementia
• Effect on other organs:
• Neurological: peripheral neuropathy ,cerebellar degeneration ,cerebral hemorrhage
dementia
• Hepatic: fatty change and cirrhosis ,liver cancer
• Gastro intestinal: oesophagitis ,gastritis,pancreatitis ,oesophageal cancer Malabsorption
• Respiratory: pulmonary tuberculosis, pneumonia
• Cardiac: cardiomyopathy, hypertension
• Musculoskeletal: myopathy, fractures
• Reproductive: infertility ,fetal alcohol syndrome
• Endocrine and metabolic: hypoglycemia ,gout
MANAGEMENT
• Advise about the harmful effects of alcohol and safe levels of consumption
• Supportive psychotherapy
• Pharmacotherapy includes naltrexone, disulfiram and acamprosate are helpful to treat alcohol
dependence
• Naltrexone is an opiate antagonist. It can be started while the patient is still drinking. It lessens
the pleasurable effects of alcohol and it also reduces craving for alcohol
• Disulfiram should be used by abstinent patients to maintain abstinence
• Acamprosate should be used once abstinence is achieved it reduces craving and helps
maintenance of abstinence
THANKYOU
