ALCOHOL ABUSE AND WITHDRAWAL SYNDROME IN THE ELDERLY. Colin Muscat Family Medicine

Size: px
Start display at page:

Download "ALCOHOL ABUSE AND WITHDRAWAL SYNDROME IN THE ELDERLY. Colin Muscat Family Medicine"

Transcription

1 ALCOHOL ABUSE AND WITHDRAWAL SYNDROME IN THE ELDERLY Colin Muscat Family Medicine

2 Case 90 year old Female Lives with son on vacation Admitted for FTT Consult -? GARP Develops increasing confusion during hospital stay Tremulous, tachycardic, anxious

3 Case Collateral Hx from daughter reveals at least 2 known drinks daily Closet Alcoholic years of drinking behind closed doors, with bottles hidden around the house Takes Xanax TID (and PRN...) since 1980 s

4 Questions How does alcohol abuse affect the Elderly? How is alcohol withdrawal syndrome different in the Elderly? How is alcohol withdrawal treated in the Elderly? Special considerations?

5 Patterns of Alcohol Consumption in the Elderly Early onset lifelong pattern of drinking and are now elderly 2/3 of elderly alcoholics More likely to have chronic health problems due to alcohol liver disease, organic brain syndrome, comorbid psychiatric disorders

6 Patterns of Alcohol Consumption in the Elderly Late Onset Became alcoholic in their drinking pattern for first time later in life 1/3 of elderly drinkers Often triggered by stressful life event Generally milder cases of alcoholism Fewer accompanying medical problems

7 Special Considerations in the Elderly Decreased body water reach higher blood alcohol concentration quicker, with lower doses Slower metabolism of ETOH in gut and liver Polypharmacy and drug interactions More prone to alcoholic gastritis Increased risk of delirium, falls Self medication

8 Acute ETOH Intoxication Inhibits neuro-excitatory NMDA receptors and reduces release of their NT Glutamate Activates neuro-inhibitory GABA receptors Leads to anxiolysis, sedation, motor incoordination

9 Chronic ETOH use Down-regulates GABA receptors Up-regulates NMDA receptors Leads to phenomenon of tolerance

10 ETOH Withdrawal NMDA function increases GABA function decreases Increased excitation and decreased inhibition Leads to psychomotor agitation and autonomic excitability *Worse in patients with chronic ETOH neural changes

11 Diagnosis of ETOH Withdrawal

12 Diagnosis

13 Clinical Manifestations The 4 clinical states of ETOH withdrawal

14 Autonomic Hyperactivity Sx typically develop between 6-24 hrs after the last drink Due to increased levels of circulating catecholamines HTN, tachycardia, palpitations, diaphoresis, GI tract upset, tremors, hyper-reflexia, irritability, agitation, anxiety Clear sensorium

15 Alcoholic Hallucinosis 30% Develops within hrs of abstinence Resolve within hrs Usually visual and tactile (formication) Auditory uncommon Clear sensorium

16 Withdrawal Seizures 10% hrs after last drink Generalized tonic-clonic convulsions Usually in patients with long history of alcoholism Usually singular episode or a brief flurry over a short period Prolonged/recurrent/status epilepticus should prompt investigation into other etiology

17 Delerium Tremens 5% hrs after last drink Lasts 1-5 days Delerium combined with autonomic hyperactivity and alcoholic hallucinosis Clouded sensorium, hallucinations, disorientation, tachycardia, HTN, fever, diaphoresis, agitation Metabolic and electrolyte disturbances due to hypermetabolic state Mortality rate of around 5% when treated

18 Management of ETOH withdrawal

19 Goals of Management 1) Prevent Seizures and DT 2) Decrease severity of withdrawal sx 3) Prevention of concurrent complications 4) Facilitate entry into a treatment program

20 Supportive Therapy Fluids Correction of electrolyte and metabolic disturbances Prevention of Wernicke s Encephalopathy with thiamine Correction of nutritional deficiencies

21 Benzodiazepines Cornerstone of therapy for Alcohol Withdrawal Counter neurologic hyperexcitation by stimulating inhibitory GABA receptors Treat psychomotor agitation and progression to seizures and delirium No one benzodiazepine has been proven superior for the treatment of ETOH withdrawal 2010 Cochrane review: benzodiazepines are effective against alcohol withdrawal seizures, when compared to placebo Not studied well against other agents

22 Lorazepam vs Diazepam Diazepam - longer acting (T 1/2: h) with active metabolites. Theoretically smoother course with less chance of recurrent withdrawal or seizures Lorazepam shorter half life (T 1/2: 12.9 h). Prevents prolonged effects if over-sedation occurs. Better for patients with cirrhosis Moldonado et al - no evidence of clinical advantage for choosing benzodiazepines based on their half lives

23 CIWA-Ar Protocol Clinical institute withdrawal assessment for alcohol Gold standard observer rated measure of withdrawal severity Provides a guide for Symptom Triggered Therapy Symptom Triggered Therapy vs. Scheduled Dosing regimens - less time to symptom control and less medication used

24 Beta Blockers and A2 Agonists Shown to be effective for symptomatic treatment through reductions in autonomic hyperactivity Helpful in reducing hemodynamic stresses in patients with underlying cardiac disease Do not prevent seizures or delirium May mask the severity of the withdrawal syndrome and subsequently lead to under-medicating with benzodiazepines Do not use as monotherapy

25 Neuroleptics Halperidol has been shown to be useful as an adjunctive therapy Reduces agitation and hallucinations Decreases seizure threshold, hypotension, QT prolongation Must be used sparingly and with caution

26 Alcohol Withdrawal in the Elderly Data is lacking about the optimal management of alcohol withdrawal in the elderly Confusion may be the predominant sign Benzodiazpines are still the mainstay of treatment

27 Alcohol Withdrawal in the Elderly Short acting (lorazepam, oxazepam) are preferred as long acting benzodiazepines will have an increased risk of excess sedation Particular attention to titrating benzodiazepine dose to relieve withdrawal symptoms while causing the smallest amount of sedation May still use antipsychotic medications judiciously for hallucinations

28 References 1) Substance abuse and withdrawal in the critical care setting. Tetrault JM. O'Connor PG. Critical Care Clinics. 24(4):767-88, viii, 2008 Oct. 2) Alcohol withdrawal syndromes in the intensive care unit. Sarff M, Gold JA. Crit Care Med Sep;38(9 Suppl):S ) Anticonvulsants for alcohol withdrawal. Minozzi, Silvia; Amato, Laura; Vecchi, Simona; Davoli, Marina. The Cochrane Database of Systematic Reviews. Issue: Volume (3), ) Benzodiazepines for alcohol withdrawal. Amato, Laura; Minozzi, Silvia; Vecchi, Simona; Davoli, Marina. The Cochrane Database of Systematic Reviews. Issue: Volume (3), ) Management of moderate and severe alcohol withdrawal syndromes. Hoffman R, Weinhouse G. Uptodate.com May ) Assessment and treatment of alcoholism and substance-related disorders in the elderly. Menninger J. Bulletin of the Menninger Clinic. 66(2):166-83, ) Rigler, S K K. "Alcoholism in the elderly." American family physician 61.6 (2000):

Case. History of psoriatic arthritis, htn, essential tremor Meds: propranolol, etodolac, etanercept No history of prior psychiatric disease.

Case. History of psoriatic arthritis, htn, essential tremor Meds: propranolol, etodolac, etanercept No history of prior psychiatric disease. Case 48 year old man admitted complaining of hallucinations. Mild hallucinations for a year. Worsened tremor for 3 weeks and then markedly worse hallucinations last 2 days History of psoriatic arthritis,

More information

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission

More information

Alcohol withdrawal syndromes in the intensive care unit

Alcohol withdrawal syndromes in the intensive care unit 本 檔 僅 供 內 部 教 學 使 用 檔 案 內 所 使 用 之 照 片 之 版 權 仍 屬 於 原 期 刊 公 開 使 用 時, 須 獲 得 原 期 刊 之 同 意 授 權 Alcohol withdrawal syndromes in the intensive care unit MaryClare Sarff, MD; Jeffrey A. Gold, MD Crit Care Med 2010

More information

Alcohol Withdrawal Syndrome & CIWA Assessment

Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome is a set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use. Prolonged

More information

Alcohol Withdrawal Syndromes

Alcohol Withdrawal Syndromes Alcohol Withdrawal Syndromes Should You Treat This Patient s Alcohol Withdrawal With Benzodiazepines?! Meta-analysis of RCTs of benzodiazepines for the treatment of alcohol withdrawal! 11 RCTs identified,

More information

Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth

Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth I. II. Background A. AWS can occur in anyone who consumes alcohol B. Risk correlates

More information

5/6/2016. Alcohol Withdrawal. How long has it been around? Some Strategies in Diagnosis and Treatment

5/6/2016. Alcohol Withdrawal. How long has it been around? Some Strategies in Diagnosis and Treatment Alcohol Withdrawal Some Strategies in Diagnosis and Treatment Historical and cultural aspects of man's relationship with addictive drugs With the colonial era, industrial revolution, and international

More information

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA Outpatient Treatment of Alcohol Withdrawal Daniel Duhigg, DO, MBA DSM V criteria for Alcohol Withdrawal A. Cessation or reduction of heavy/prolonged alcohol use B. 2 or more of the following in hours to

More information

Alcohol Withdrawal Syndrome. Jeffrey P Schaefer MSc MD FRCPC GI Emergencies Update October 14, 2007 http:dr.schaeferville.com

Alcohol Withdrawal Syndrome. Jeffrey P Schaefer MSc MD FRCPC GI Emergencies Update October 14, 2007 http:dr.schaeferville.com Alcohol Withdrawal Syndrome Jeffrey P Schaefer MSc MD FRCPC GI Emergencies Update October 14, 2007 http:dr.schaeferville.com Objectives Alcohol Intoxication Take-Aways diagnosis avoid mis-diagnosis management

More information

Alcohol Withdrawal. Medical Director, New York City Poison Center. Sorrento, Italy (September 19, 2007)

Alcohol Withdrawal. Medical Director, New York City Poison Center. Sorrento, Italy (September 19, 2007) Alcohol Withdrawal Sorrento, Italy (September 19, 2007) Lewis R. Goldfrank, MD Professor and Chairman, Emergency Medicine New York University School of Medicine Director, Emergency Medicine Bellevue Hospital/NYU

More information

Alcohol Withdrawal Recognition and Treatment

Alcohol Withdrawal Recognition and Treatment Alcohol Withdrawal Recognition and Treatment Thomas Meyer BS EMS, MICP SREMSC Page 1 Purpose As EMTs a mantle of responsibility is placed upon you to ensure the safety and well-being of those in your charge

More information

Symptom Based Alcohol Withdrawal Treatment

Symptom Based Alcohol Withdrawal Treatment Symptom Based Alcohol Withdrawal Treatment -Small Rural Hospital- Presenter CDR Dwight Humpherys, DO dwight.humpherys@ihs.gov Idaho State University Baccalaureate Nursing Program Lake Erie College of Osteopathic

More information

GP Drug & Alcohol Supplement No.7 May 1997

GP Drug & Alcohol Supplement No.7 May 1997 GP Drug & Alcohol Supplement No.7 May 1997 This is the seventh of the monthly Drug and Alcohol Supplements prepared for Central Coast GPs. Detoxification from Alcohol Dr Tony Gill Introduction The management

More information

Care of the Patient Undergoing Alcohol Withdrawal. Meggen Platzar RN, BSN, CMSRN Jennifer Wilhelm RN, BSN, CMSRN

Care of the Patient Undergoing Alcohol Withdrawal. Meggen Platzar RN, BSN, CMSRN Jennifer Wilhelm RN, BSN, CMSRN Care of the Patient Undergoing Alcohol Withdrawal Meggen Platzar RN, BSN, CMSRN Jennifer Wilhelm RN, BSN, CMSRN If you know someone who tries to drown their sorrows, you might tell them sorrows know how

More information

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE Authors Sponsor Responsible committee Ratified by Consultant Psychiatrist; Pharmacist Team Manager Medical Director Medicines Management Group

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

Glasgow Assessment and Management of Alcohol

Glasgow Assessment and Management of Alcohol Glasgow Assessment and Management of Alcohol If you would like further information or advice on the alcohol screening and withdrawal management guideline(gmaws) please contact your local acute addiction

More information

Alcohol Withdrawal in the AMU. Dr Ewan Forrest Glasgow Royal Infirmary

Alcohol Withdrawal in the AMU. Dr Ewan Forrest Glasgow Royal Infirmary Alcohol Withdrawal in the AMU Dr Ewan Forrest Glasgow Royal Infirmary The Society for Acute Medicine, 7 th International Conference, 3-4 October 2013 AWS: The Scale of the Problem Hospital Admissions (England):

More information

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern

More information

ALCOHOL WITHDRAWAL. Ravi Dhanisetty 11/30/2007

ALCOHOL WITHDRAWAL. Ravi Dhanisetty 11/30/2007 ALCOHOL WITHDRAWAL SYNDROME Ravi Dhanisetty 11/30/2007 Veterans Affairs Hospital ACGME CORE COMPETENCIES Medical Knowledge Patient Care Interpersonal Skills Practice Based Learning Systems Based Learning

More information

Quality and Patient Safety Division

Quality and Patient Safety Division Commonwealth of Massachusetts Board of Registration in Medicine Quality and Patient Safety Division Advisory Alcohol Screening and Management Protocols July 2013 Background The Quality and Patient Safety

More information

INTOXICATED PATIENTS AND DETOXIFICATION

INTOXICATED PATIENTS AND DETOXIFICATION VAMC Detoxification Decision Tree Updated May 2006 INTOXICATED PATIENTS AND DETOXIFICATION Patients often present for evaluation of substance use and possible detoxification. There are certain decisions

More information

2.6.4 Medication for withdrawal syndrome

2.6.4 Medication for withdrawal syndrome .6.3 Self-medication Self-medication presents a risk during alcohol withdrawal, particularly when there is minimal supervision (low level and medium level 1 settings). Inform patients of the risk of selfmedication

More information

Alcohol withdrawal A challenge in caring for patients after heart surgery

Alcohol withdrawal A challenge in caring for patients after heart surgery Abteilung Praxisentwicklung Pflege Alcohol withdrawal A challenge in caring for patients after heart surgery Wolfgang Hasemann, RN, PhD Deborah Leuenberger, MScN.cand. June 2015 Content Alcohol consumption

More information

Running head: BEST TREATMENT FOR ALCOHOL WITHDRAWAL SYNDROME 1

Running head: BEST TREATMENT FOR ALCOHOL WITHDRAWAL SYNDROME 1 1 Best Treatment for Alcohol Withdrawal Syndrome Kathryn Obert Auburn University School of Nursing 2 Abstract Alcoholism is defined as a pattern of uncontrolled drinking leading to medical, legal, and

More information

SUBSTANCE ABUSE SCREENING

SUBSTANCE ABUSE SCREENING OVERVIEW Substance abuse in the elderly is a common problem that is frequently under- diagnosed by primary care doctors and families. Alcohol abuse is present in 10% to 15% of elderly individuals who seek

More information

ALCOHOL WITHDRAWAL SYNDROME

ALCOHOL WITHDRAWAL SYNDROME ALCOHOL WITHDRAWAL SYNDROME INTRODUCTION Alcohol is the most commonly abused drug in the United States and when someone who chronically abuses alcohol does not drink, that person is at risk for developing

More information

Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal

Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal Roger Cicala, M. D. Assistant Medical Director Tennessee Physician s Wellness Program Step 1 Don t 1 It is legal in

More information

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Phenobarbital in Severe Alcohol Withdrawal Syndrome Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Disclosure: No relevant financial relationship exists. Objectives 1. Describe the pathophysiology

More information

Supported Alcohol Withdrawal Treatment Information

Supported Alcohol Withdrawal Treatment Information Supported Alcohol Withdrawal Treatment Information Alcohol Liaison Service What is Alcohol Withdrawal Syndrome? If you are dependent on alcohol and suddenly stop drinking or you are admitted to hospital

More information

Background. Population/Intervention(s)/Comparison/Outcome(s) (PICO) List of the systematic reviews identified by the search process

Background. Population/Intervention(s)/Comparison/Outcome(s) (PICO) List of the systematic reviews identified by the search process updated 2012 Treatment of alcohol withdrawal delirium Q3: In the treatment of alcohol withdrawal delirium, are benzodiazepines or antipsychotics safe and effective when compared to a placebo/appropriate

More information

Alcohol Withdrawal. Julie Teater, MD. Associate Professor - Clinical Department of Psychiatry The Ohio State University Wexner Medical Center

Alcohol Withdrawal. Julie Teater, MD. Associate Professor - Clinical Department of Psychiatry The Ohio State University Wexner Medical Center Alcohol Withdrawal Julie Teater, MD Associate Professor - Clinical Department of Psychiatry The Ohio State University Wexner Medical Center Learning Goals/Objectives Discuss the diagnosis of and screening

More information

Alcohol Withdrawal. Julie Teater, MD Associate Professor - Clinical Department of Psychiatry The Ohio State University Wexner Medical Center

Alcohol Withdrawal. Julie Teater, MD Associate Professor - Clinical Department of Psychiatry The Ohio State University Wexner Medical Center Julie Teater, MD Associate Professor - Clinical Department of Psychiatry The Ohio State University Wexner Medical Center Learning Goals/Objectives Discuss the diagnosis of and screening for alcohol use

More information

Emergencies Related to ETHANOL (ETOH) Alcohol

Emergencies Related to ETHANOL (ETOH) Alcohol University of Wisconsin Hospital and Clinics Emergency Education Center Emergencies Related to ETHANOL (ETOH) Alcohol Alcoholics are in all socio-economical levels of society ~ETOH is one of the most commonly

More information

Hair of the Dog. www.wellcon.net. Reference Information. Scope of the Problem. How To Avoid Being Bitten By Withdrawal Syndromes

Hair of the Dog. www.wellcon.net. Reference Information. Scope of the Problem. How To Avoid Being Bitten By Withdrawal Syndromes Hair of the Dog How To Avoid Being Bitten By Withdrawal Syndromes Reference Information Copies of slides and modified CIWA (Clinical Institute Withdrawal Assessment) scale available at: www.wellcon.net

More information

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Medical assessment of patient with Alcohol Use Disorder Identification patients suitable for home detox Process for referral to inpatient

More information

Alcohol Liaison Service. Alcohol Withdrawal. Information

Alcohol Liaison Service. Alcohol Withdrawal. Information Alcohol Liaison Service Alcohol Withdrawal Information Alcohol withdrawal If you are dependent on alcohol and suddenly stop drinking, there are a series of symptoms that you may experience. These include:

More information

Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set. Kathleen Lenaghan MSN, RN-BC

Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set. Kathleen Lenaghan MSN, RN-BC Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set Kathleen Lenaghan MSN, RN-BC 1 2 Genesis Medical Center Davenport, Iowa Objectives Identify the process of developing and

More information

Alcohol Dependence and Motivational Interviewing

Alcohol Dependence and Motivational Interviewing Alcohol Dependence and Motivational Interviewing Assessment of Alcohol Misuse Checklist Establish rapport patients are often resistant Longitudinal history of alcohol use Assess additional drug use Establish

More information

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011 RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for

More information

Internal Medicine Residency Noon Lecture October 30, 2007

Internal Medicine Residency Noon Lecture October 30, 2007 Internal Medicine Residency Noon Lecture October 30, 2007 Rebecca J. Beyth, MD, MSc Associate Professor GRECC, NF/SGVHS UF COM, Dept of Aging & Geriatrics Case 82 year old man with history of DJD, and

More information

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE Dr Millicent Chikoore MBBS MRCPsych Dr O Lagundoye MBBS MRCPsych Community based alcohol detoxification is a safe and effective option for

More information

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines MOH CLINICL PRCTICE GUIELINES 2/2008 Prescribing of Benzodiazepines College of Family Physicians, Singapore cademy of Medicine, Singapore Executive summary of recommendations etails of recommendations

More information

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult Comprehensive ehavioral Care, Inc. delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors

More information

A COMPARATIVE STUDY OF EFFICACY & TOLERABILITY OF LORAZEPAM AND GABAPENTIN IN THE TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME

A COMPARATIVE STUDY OF EFFICACY & TOLERABILITY OF LORAZEPAM AND GABAPENTIN IN THE TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME A COMPARATIVE STUDY OF EFFICACY & TOLERABILITY OF LORAZEPAM AND GABAPENTIN IN THE TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME Dr. Ashutosh Chourishi,* Dr. O.P. Raichandani**, Dr. Sunita Chandraker***, Dr.

More information

Alcohol Withdrawal and Delirium 11-4-03

Alcohol Withdrawal and Delirium 11-4-03 Alcoholism Lecture Alcohol Withdrawal and Delirium Jeff Thiele MD 11-4-03 Alcohol intoxication occurs at blood levels of.050 to.080 depending on your criteria. In MO the legal definition is now a BAL of.80

More information

Introduction to Alcohol Withdrawal. Richard Saitz, M.D., M.P.H.

Introduction to Alcohol Withdrawal. Richard Saitz, M.D., M.P.H. Introduction to Alcohol Withdrawal Richard Saitz, M.D., M.P.H. Heavy drinkers who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal (AW). Signs and symptoms

More information

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety Alcohol Withdrawal Recognition and Assessment Alcohol withdrawal may be a presenting feature or occur as an unexplained development in a patient who has been admitted for other reasons and deprived of

More information

1. According to recent US national estimates, which of the following substances is associated

1. According to recent US national estimates, which of the following substances is associated 1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates

More information

Pharmacological Management of Alcohol Dependence Syndrome

Pharmacological Management of Alcohol Dependence Syndrome Pharmacological Management of Alcohol Dependence Syndrome Cite as : Doyle, L. Keogh, B. & Lynch, A., Pharmacological Management of Alcohol Dependence Syndrome, Mental Health Practice, 14, (1), 2010, p14-19

More information

Assessment and management of alcohol dependence and withdrawal in the acute hospital

Assessment and management of alcohol dependence and withdrawal in the acute hospital Assessment and management of alcohol dependence and withdrawal in the acute hospital Concise guidance to good practice series June 01 CONCISE GUIDANCE Clinical Medicine 01, Vol 1, No : 71 Assessment Main

More information

Addiction Medicine 2013

Addiction Medicine 2013 Addiction Medicine 2013 Pharmacotherapy for alcohol dependence Part I: alcohol withdrawal Roy M Stein, MD Durham Veterans Affairs Medical Center Duke University School of Medicine Objectives Identify goals

More information

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Disclaimer: This speaker has no financial disclaimers to report.

More information

Section Editor Stephen J Traub, MD

Section Editor Stephen J Traub, MD Official reprint from UpToDate www.uptodate.com 2015 UpToDate Management of moderate and severe alcohol withdrawal syndromes Authors Robert S Hoffman, MD Gerald L Weinhouse, MD Section Editor Stephen J

More information

Audit of Alcohol Detoxification Prescribing Observatory for Mental Health (POMH-UK) Regional Event

Audit of Alcohol Detoxification Prescribing Observatory for Mental Health (POMH-UK) Regional Event Audit of Alcohol Detoxification Prescribing Observatory for Mental Health (POMH-UK) Regional Event Wakefield 4th December 2013 definition and guidance Duncan Raistrick Leeds Addiction Unit Detoxification

More information

Withdrawal syndromes

Withdrawal syndromes Withdrawal syndromes P Hantson Louvain Centre for Toxicology and Applied Pharmacology Department of Intensive Care Louvain Centre for Toxicology and Applied Pharmacology Université catholique de Louvain,

More information

The CCB Science 2 Service Distance Learning Program

The CCB Science 2 Service Distance Learning Program S2S 2055 DETOXIFICATION Module 1 Post-Test 1. A common use of a biochemical marker is. a. to support or refute other information that leads to proper diagnosis b. for forensic purposes c. in detecting

More information

Lorraine Wilson, 74 years of age, is admitted. Alcohol Withdrawal. During Hospitalization. Early recognition and consistent intervention are critical.

Lorraine Wilson, 74 years of age, is admitted. Alcohol Withdrawal. During Hospitalization. Early recognition and consistent intervention are critical. 1.9 h o u r s Continuing Education Withdrawal During Hospitalization Early recognition and consistent intervention are critical. Overview: For a chronic drinker, sudden alcohol withdrawal because of an

More information

Alcohol and Mental Health in Acute Medical Care. Dr Chris Daly Consultant Addiction Psychiatrist

Alcohol and Mental Health in Acute Medical Care. Dr Chris Daly Consultant Addiction Psychiatrist Alcohol and Mental Health in Acute Medical Care Dr Chris Daly Consultant Addiction Psychiatrist Contents 1 Delirium Tremens 2 Wernicke- Korsakoffs syndrome 3 Mental Health Problems relating to alcohol

More information

MEDICATION ABUSE IN OLDER ADULTS

MEDICATION ABUSE IN OLDER ADULTS MEDICATION ABUSE IN OLDER ADULTS Clifford Milo Singer, MD Adjunct Professor, University of Maine, Orono ME Chief, Division of Geriatric Mental Health and Neuropsychiatry The Acadia Hospital and Eastern

More information

Alcohol. Problems with drinking alcohol

Alcohol. Problems with drinking alcohol Alcohol Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol. If you are alcohol- dependent then

More information

Alcohol: Acute problems and withdrawal syndrome

Alcohol: Acute problems and withdrawal syndrome Alcohol: Acute problems and withdrawal syndrome Author: Dr Moira Sim Topic Reviewers: Dr Peter Tait; Dr Steven Skov; Dr Dan Ewald; Vivien (RAN, Amata Clinic); Kaz Knudsen (RAN, WA); Dave Corstorpan (RAN,

More information

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative.

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative. Title: Staff Guidelines For The Management Of Alcohol Withdrawal In NHS Grampian Adult ( Age 18) Inpatients Unique Identifier: Replaces: (provided by the NHS Grampian Review Group for Clinical Process

More information

Martin Jackson. August 2011

Martin Jackson. August 2011 Martin Jackson August 2011 Substance Related Brain Injury: Basic Research Findings All neurotoxic substances have an acute intoxicating effect (and withdrawal effect) that produces changes in cognition,

More information

Title Alcohol Withdrawal Management Guidelines

Title Alcohol Withdrawal Management Guidelines Document Control Title Alcohol Withdrawal Management Guidelines Author Consultant Physicians, Core Medical Trainee and Glossop Ward Manager Directorate Version Date Issued Status 0.1 Dec Draft Initial

More information

Alcohol withdrawal syndromes ADDICTION, ALCOHOL ABUSE AND DEPENDENCY

Alcohol withdrawal syndromes ADDICTION, ALCOHOL ABUSE AND DEPENDENCY DDICTION, LCOHOL BUSE ND DEPENDENCY DEPT.OF PSYCH. UNIV.OF PÉCS HTTP://PSYCHITRY.POTE.HU the clinical importance of alcohol-related disorders is essential for the practice of psychiatry. lcohol intoxication

More information

In the United States, alcohol is the most commonly abused. Alcohol Withdrawal. Review Article

In the United States, alcohol is the most commonly abused. Alcohol Withdrawal. Review Article Review Article Alcohol Withdrawal Anton Manasco, BS, Shannon Chang, MD, Joseph Larriviere, MD, L. Lee Hamm, MD, and Marcia Glass, MD Abstract: Alcohol withdrawal is a common clinical condition that has

More information

. DELIRIUM TREMENS. Alcohol and Narcotic Withdrawals

. DELIRIUM TREMENS. Alcohol and Narcotic Withdrawals . DELIRIUM TREMENS Alcohol and Narcotic Withdrawals Delirium Tremens (commonly referred to as "The Horrors", "Jazz Hands", or "The Shakes") is a psychological and physiological reaction to the sudden disruption

More information

CORRECTIONAL HEALTHCARE WEBINAR

CORRECTIONAL HEALTHCARE WEBINAR 1 CORRECTIONAL HEALTHCARE WEBINAR 2 Managing Alcohol Withdrawal in the Correctional Setting February 29, 2012 3 Michelle Foster Earle President OMNISURE CONSULTING GROUP, LLC 401 Congress Ave., Suite 1540

More information

Managing Patients with Alcohol Withdrawal

Managing Patients with Alcohol Withdrawal Managing Patients with Alcohol Withdrawal Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar) Department of Medicine Regulated Health Professionals Developed by: Tammy Datars/Crystal

More information

Teen Misuse and Abuse of Alcohol and Prescription Drugs. Information for Parents

Teen Misuse and Abuse of Alcohol and Prescription Drugs. Information for Parents Teen Misuse and Abuse of Alcohol and Prescription Drugs Information for Parents Terminology Misuse: Using a drug in a way in which it was not intended Example: Using a higher dose of medication than was

More information

Alcohol Overuse and Abuse

Alcohol Overuse and Abuse Alcohol Overuse and Abuse ACLI Medical Section CME Meeting February 23, 2015 Daniel Z. Lieberman, MD Professor and Vice Chair Department of Psychiatry George Washington University Alcohol OVERVIEW Definitions

More information

Benzodiazepines: A Model for Central Nervous System (CNS) Depressants

Benzodiazepines: A Model for Central Nervous System (CNS) Depressants Benzodiazepines: A Model for Central Nervous System (CNS) Depressants Objectives Summarize the basic mechanism by which benzodiazepines work in the brain. Describe two strategies for reducing and/or eliminating

More information

Hugh Myrick, M.D., and Raymond F. Anton, M.D.

Hugh Myrick, M.D., and Raymond F. Anton, M.D. Treatment of Alcohol Withdrawal Hugh Myrick, M.D., and Raymond F. Anton, M.D. Appropriate treatment of alcohol withdrawal (AW) can relieve the patient s discomfort, prevent the development of more serious

More information

In 1992, approximately 13.8 million

In 1992, approximately 13.8 million Alcohol Withdrawal Syndrome MAX BAYARD, M.D., JONAH MCINTYRE, M.D., KEITH R. HILL, M.D., and JACK WOODSIDE, JR., M.D. East Tennessee State University James H. Quillen College of Medicine, Johnson City,

More information

Treatments for Major Depression. Drug Treatments The two (2) classes of drugs that are typical antidepressants are:

Treatments for Major Depression. Drug Treatments The two (2) classes of drugs that are typical antidepressants are: Treatments for Major Depression Drug Treatments The two (2) classes of drugs that are typical antidepressants are: 1. 2. These 2 classes of drugs increase the amount of monoamine neurotransmitters through

More information

Emergency Room Treatment of Psychosis

Emergency Room Treatment of Psychosis OVERVIEW The term Lewy body dementias (LBD) represents two clinical entities dementia with Lewy bodies (DLB) and Parkinson s disease dementia (PDD). While the temporal sequence of symptoms is different

More information

University of Michigan Alcohol Withdrawal Guidelines Overview

University of Michigan Alcohol Withdrawal Guidelines Overview University of Michigan Alcohol Withdrawal Guidelines Overview The following document contains the University of Michigan Alcohol Withdrawal Guidelines. These guidelines were developed through an intensive

More information

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers SUPPLEMENT 1: (Supplementary Material for online publication) Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers About this

More information

Pain Medication Taper Regimen Time frame to taper off 30-60 days

Pain Medication Taper Regimen Time frame to taper off 30-60 days Pain Medication Taper Regimen Time frame to taper off 30-60 days Medication to taper Taper Regimen Comments Methadone Taper by no more than 25% Morphine Taper by no more than 25% Tramadol Taper by no more

More information

Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice

Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological

More information

Alcohol Use Disorders Information for Patients and Carers

Alcohol Use Disorders Information for Patients and Carers Alcohol Liaison Service Alcohol Use Disorders Information for Patients and Carers Information Drinking too much alcohol greatly increases your risk of serious health problems. Many different health problems

More information

Alcohol intervention programs in other countries

Alcohol intervention programs in other countries Alcohol intervention programs in other countries Assist. Prof. Dr. Suttiporn Janenawasin Siriraj Hosp. Mahidol Univ. A Major Task for Drug Treatment is Changing Brains Back! The Most Effective Treatment

More information

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body.

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body. Alcohol information Facts about alcohol use Alcohol (grog) is the most widely used recreational drug in Australia NT drinks 70% more and WA 25% more than the rest of Australia Alcohol related deaths for

More information

Background. Population/Intervention(s)/Comparison/Outcome(s) (PICO) Management of alcohol withdrawal

Background. Population/Intervention(s)/Comparison/Outcome(s) (PICO) Management of alcohol withdrawal updated 2012 Management of alcohol withdrawal Q2: What interventions are safe and effective for the management of alcohol withdrawal, including treatment for alcohol withdrawal seizures and prevention

More information

Phenobarbital Use as Adjunct to Benzodiazepines in the Treatment of Severe Alcohol Withdrawal Syndrome

Phenobarbital Use as Adjunct to Benzodiazepines in the Treatment of Severe Alcohol Withdrawal Syndrome Journal of Pharmacy and Pharmacology (014) 1-7 D DAVID PUBLISHING Phenobarbital Use as Adjunct to Benzodiazepines in the Treatment of Severe Alcohol Withdrawal Cristina Roman, Sibusisiwe Gumbo and Kevin

More information

Chapter 5 Alcohol withdrawal management

Chapter 5 Alcohol withdrawal management Chapter 5 Alcohol withdrawal management Alcohol Withdrawal Syndrome: Clinical Presentation This section discusses the clinical signs and symptoms, onset and duration, and common complications of alcohol

More information

Prescribing for substance misuse: Alcohol detoxification

Prescribing for substance misuse: Alcohol detoxification Prescribing for substance misuse: Alcohol detoxification Dr Julia Sinclair Senior Lecturer in Psychiatry University of Southampton Previously: Sensible Hazardous Harmful Dependence Current: Lower Risk

More information

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Issued: February 2011 guidance.nice.org.uk/cg115 NICE has accredited the process used by the Centre

More information

Case conference November 13, 2015

Case conference November 13, 2015 Case conference November 13, 2015 52-year-old Man CC: Fatigue and vomiting PMHx: Afib CAD s/p CABG HTN Hyperlipidemia GERD PUD Cirrhosis Pancreatitis DM II Low back pain OSA- does not use CPAP FHx: Mother:

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean 'alcohol dependence' (alcohol addiction). Some people are 'problem drinkers' without being dependent on alcohol.

More information

Alcohol: The good, the bad and

Alcohol: The good, the bad and Alcohol: The good, the bad and the Clare Wilhelm, Ph.D. Portland VA Medical Center Oregon Health & Science University Supported by VA Career Development Grant (BX001294) Overview Alcohol statistics the

More information

INTRODUCTION OBJECTIVES. When the learner has finished this module, she/she will be able to:

INTRODUCTION OBJECTIVES. When the learner has finished this module, she/she will be able to: Chronic Alcohol Abuse and Long Term Complications WWW.RN.ORG Reviewed September, 2015, Expires September, 2017 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited

More information

75-09.1-08-02. Program criteria. A social detoxi cation program must provide:

75-09.1-08-02. Program criteria. A social detoxi cation program must provide: CHAPTER 75-09.1-08 SOCIAL DETOXIFICATION ASAM LEVEL III.2-D Section 75-09.1-08-01 De nitions 75-09.1-08-02 Program Criteria 75-09.1-08-03 Provider Criteria 75-09.1-08-04 Admission and Continued Stay Criteria

More information

Update and Review of Medication Assisted Treatments

Update and Review of Medication Assisted Treatments Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment

More information

Alcohol Use Dates Back 7,000 to 10,000 Years. Though Scientists Still Debate the Mechanisms of Hangovers. Proposed Causes of Hangovers

Alcohol Use Dates Back 7,000 to 10,000 Years. Though Scientists Still Debate the Mechanisms of Hangovers. Proposed Causes of Hangovers Alcohol Use Dates Back 7,000 to 10,000 Years Though Scientists Still Debate the Mechanisms of Hangovers Proposed Causes of Hangovers Acute ethanol withdrawal Ethanol can alleviate symptoms Acetaldehyde

More information

Drug and Alcohol Assessment

Drug and Alcohol Assessment Drug and Alcohol Assessment Engagement the first step What is engagement? building a working relationship Showing that you care (do you?) Working towards mutually acceptable goals building rapport building

More information