Psychiatry For Physicians-Substance Use Disorder-Alcohol
When a person abuses alcohol with no desire to lessen the amount of consumption, rather feels irritated to those that suggest such, and never feel bad for the abuse and often has hangover effect - can be designated fully as an alcohol dependent person. Alcohol withdrawal is characterized by:
1. Autonomic hyperactivity
2. Increased hand tremor
3. Insomnia
4. Nausea
5. Vomiting
6. Hallucinations
7. Illusions
8. Psychomotor agitation
9. Anxiety
10. Grand mal seizure
Alcoholism is related with the disorders of brain, digestive tract, heart, muscles, blood, hormones and pregnancy. All the frightening diseases of all the above tracts and parts of the body have their link to alcoholism. Depression, anxiety, personality disorders, and drug abuse are the most common morbidities present along with alcohol abuse. Maternal alcohol abuse can lead to fetal alcohol syndrome that presents with growth retardation, abnormal face and head, and CNS abnormality. Alcohol changes the rate and quality of metabolism of many drugs including anticoagulants, tranquilizers etc.
When a patient of alcohol abuse is screened with laboratory tests the following findings are typical
1. Blood alcohol level
2. Positive breathalyzer
3. Elevated MCV
4. Elevated AST and ALT
5. Elevated SGGT
6. Decreased albumin, B12, folic acid
7. Uric acid and amylase increases with bone suppression
Alcoholism is a result of the complex interaction of biological and environmental factors. The following information are important in relation to the pathophysiology of alcoholism –
1. Reduced serotonergic function
2. Depressed endogenous opiates
3. Increase relaxation
4. One with alcoholic parent shows high tolerance initially
Alcoholism can induce the following mental disorders
1. Alcohol intoxication
2. Substance induced amnestic disorder
3. Alcohol withdrawal
4. Alcohol withdrawal seizure
5. Delirium tremens
6. Alcohol induced psychotic disorders
A comprehensive model of management in case of alcoholism can be as follows
1. Diagnostic evaluation
2. Drug free periods
3. Medication trials (disulfiram, naltrexone)
4. Team approach
5. Group therapy
6. Psychoeducation
7. Family evaluation and treatment
8. 12 step programs (Alcoholic anonymous)
9. Individual counseling
10. Activity therapy
11. Urine testing
12. Discharge planning
13. Follow-up
Treatment outcome varies in relation to the different patient factors and also planning of the treatment.
About the Author:
Dr. Mohammad Samir Hossain PhD is a researcher teacher of Psychiatry and a Psychotherapist in Bangladesh. He is renouned for his educational and research activity in mental health sector nationally and internationally. The Dictionary of International Biography cites his brief biography starting from its 33rd edition. One of the best educational institutions involved with his educational activity is the Harvard Medical School of USA. Visit his personal page at http://www.samirhossain.org
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