Page 525 - Medicine and Surgery

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Overdose, poisoning 15

and addiction

Alcohol and drugs of abuse, 521 Overdose and poisoning, 526

Alcohol and drugs of abuse Alcohol dependence is defined as a maladaptive pat-
tern of use associated with tolerance and withdrawal
syndrome despite significant physical and psycholog-
Alcohol abuse and dependence ical problems. Patients often exhibit a stereotyped
drinking pattern with alcohol consumption taking
Definition
preference over other activities.
Regular or binge consumption of alcohol sufficient to
A history of alcohol consumption should be taken from
cause physical, neuropsychiatric or social damage.
all patients with consideration given to the aforemen-
tioned social consequences of heavy drinking. In addi-
Incidence/prevalence
tion signs of chronic liver disease and other complica-
3–4%ofthepopulationreportalcohol-relatedproblems.
tions may be evident.
Sex
Complications
2M : 1F
Medical complications include gastritis, peptic ulcer

Aetiology disease, pancreatitis, hepatitis, cirrhosis, portal hy-
Various factors have been implicated: pertensionwithoesophagealvarices,cardiomyopathy,
Genetic factors: Evidence includes variation across
hypertension.
racial groups and twin studies. Neuropsychiatric complications: Acute withdrawal
Psychiatric factors: Family history of depression, in-
(also known as delirium tremens) within 48 hours
creased risk in the presence of chronic psychiatric and may result in malaise, nausea, autonomic hyperactiv-
physical illness especially pain. ity, tremulousness, lability, insomnia, and transient
Social factors: Occupation, cultural and peer group
hallucinations,illusionsespeciallyvisual(e.g.spiders),
pressure. frequent seizures. Serious delirium tremens has a sig-
nificant mortality.
Clinical features Chronic dependence causes Wernicke–Korsakoff psy-
Alcohol abuse and alcohol dependence are classified as chosis (see page 317).
recognisable entities. Other neuropsychiatric complications include de-
Alcohol abuse is a drinking pattern associated with so-
mentia, peripheral neuropathy, cerebellar degenera-
cial compromise such as work or school absenteeism, tion, alcoholic hallucinations, symptoms of depres-
legal problems related to alcohol use, or continued al- sion and/or anxiety.
cohol use despite causing social or relationship prob- Social problems include job loss, marital difficulties,
lems. criminal activity and alcohol-related accidents.

521