alcohol dependence

physical dependence:

“DT - level” requires:
- blood concentration of ethanol > 100mg/dl most of waking day (intake 200-350g/d) for period of 1wk, or,
- 4-7wks at levels nearer 100mg/dl;
- ie. 1-1.5 bottles spirits, 3-5 bottles wine, or 5-9 litres beer each day)

having an early morning drink or 'eye opener'
exceeding NHMRC recommendations (pdf) for low risk, sensible drinking:
- short-term:
  - men - 6 std drinks in one day, < 4 days per wk
  - women - 4 std drinks in one day, < 4 days per wk
- long term:
  - men - 4 std drinks in one day, up to 28 per wk
  - women - 2 std drinks in one day, up to 14 per wk
no alcohol free days in the week
reduced social or occupational activities as a result of time spent either obtaining alcohol or recovering from its effects

headache, vertigo, N, pallor, sweating, nystagmus, tachycardia;
responds to more ethanol → use is 1st sign of physical depend.
? due to:
- persistence of mechanisms → ac. P/D tolerance;
- dehydration & electrolyte disturbance;
- hypoglycaemia, lactic acidaemia;

in mild-mod. dependence;
onset 8-24hrs →
- nervousness, apprehension, muscle weakness
- tremor, nausea, retching, anorexia, “butterflies in stomach”.

in mod-severe dependence;
abstinence continued → develops 12-24hrs in 1st phase
marked tremor, muscle cramps, incr. body temp., sweating, diarrhoea, nausea, vomiting, tachycardia, incr. BP, incr. incr. agitation.
insomnia - only brief completely REM-sleep full of nightmares, hyperpnoea → initial metab. acidosis → resp. alkalosis

begins 2-4 days after onset abstinence with persisting phase 1&2 S/S;
verbalised delusions (muttering delirium), confusion, disorientation, marked agitation, panic reactions, paranoid reactions + auditory hallucinations
hyperacusis may precede auditory hallucinations;
tactile & visual (often terrifying) hallucinations;
tremor ++++ may be interspersed with clonic jerks → petit mal → grand mal → status;
Untreated mortality 15-50% assoc. with convulsions, hyperthermia, coma, shock;
If survives, lasts up to 3 days then deep sleep & awakes calm & lucid but full recovery with return to REM sleep in normal proportion takes about 2 weeks from onset abstinence, but delayed if nutritional/organic disorders incurred during the ethanol use;