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Chapter 38
Drug Abuse II: Alcohol
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Alcohol
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Most commonly used and abused
psychoactive agent in the United States
Some therapeutic use
Primarily used for nonmedical purposes
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Moderate consumption: prolongs life, reduces risk
of dementia and cardiovascular disorders
Excessive consumption: diminishes quality and
quantity of life
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Basic Pharmacology of Alcohol
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Central nervous system effects
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Acute effects
• General depression of CNS function

Enhances GABA-mediated inhibition
Dose-dependent

Binds with 5-HT3 receptors

• Activation of the reward circuit
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Basic Pharmacology of Alcohol
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Chronic effects
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Two neuropsychiatric syndromes
• Wernicke’s encephalopathy
• Korsakoff’s psychosis
 Impact on cognitive function
 Effect on sleep
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Basic Pharmacology of Alcohol
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Other pharmacologic effects
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Cardiovascular system
Respiration
Liver
Stomach
 Kidney
 Pancreas
 Sexual function
 Cancer: breast and colorectal cancer
 Pregnancy and lactation
 Impact on longevity
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Basic Pharmacology of Alcohol
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Pharmacokinetics
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Absorption
Distribution
Metabolism
Blood levels
Tolerance
Physical dependence
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Basic Pharmacology of Alcohol
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Drug interactions
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CNS depressants
Nonsteroidal anti-inflammatory drugs
Acetaminophen
Disulfiram
Antihypertensive drugs
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Basic Pharmacology of Alcohol
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Acute overdose
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Vomiting, coma, pronounced hypotension and
respiratory depression
Therapeutic uses
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Topical
Oral
Intravenous
• Replacement of calories and fluid
Local injection
• Nerve block
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Alcohol Use Disorder
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Relapsing disorder
Impaired control over drinking
Preoccupation with alcohol consumption
Use of alcohol despite awareness of adverse
consequences
Distortions in thinking
Influenced by genetics and psychosocial and
environmental factors
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs for Alcohol Use Disorder
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Drugs used to facilitate withdrawal
Drugs used to maintain abstinence
Other drugs used in the treatment of alcohol
abuse
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs Used to Facilitate Withdrawal
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Benzodiazepines
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Chlordiazepoxide (Librium, others)
Diazepam (Valium)
Oxazepam (Serax)
Lorazepam (Ativan)
Adjuncts to benzodiazepines
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Carbamazepine (antiepileptic drug)
Clonidine (alpha-adrenergic blocker)
Atenolol and propranolol (beta-adrenergic
blockers)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs Used to Maintain Abstinence
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Disulfiram aversion therapy
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Refrain from drinking
Causes irreversible inhibition of aldehyde
dehydrogenase
Effects caused by alcohol plus disulfiram are
referred to as acetaldehyde syndrome
Patients must be carefully chosen
Patients must be thoroughly informed to avoid all
forms of alcohol
• Sauces, cough syrups
• Alcohol applied to the skin (lotions, colognes, liniments)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Fig. 38–1. Ethanol metabolism and the effect of disulfiram.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs Used to Maintain Abstinence
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Naltrexone (Revia)
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Pure opioid antagonist
Decreases craving for alcohol
Blocks reinforcing effects of alcohol
Mechanism unclear
Adverse effects
• Nausea
• Headache
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs Used to Maintain Abstinence
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Acamprosate (Campral)
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Reduces unpleasant feelings brought on by
abstinence
Devoid of direct anxiolytic, anticonvulsant, and
antidepressant activity
Does not cause alcohol aversion
Administered orally
Excreted unchanged in the urine
Adverse effects and drug interactions
• Diarrhea
• Avoid during pregnancy
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drugs Used to Maintain Abstinence
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Topiramate (Topamax)
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Reduces craving for alcohol
Ondansetron (Zofran)
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Selective 5-HT3 receptor antagonist
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Nutritional Support, Fluid
Replacement, and Antibiotics
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B vitamins
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Thiamine
Folic acid
Cyanocobalamin
Vitamin supplements
Fluid replacement therapy
Antibiotics
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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