Alcoholism

CLINICAL MANIFESTATIONS Medical consequences of alcohol drinking may manifest in any organ
system of the body. Unhealthy alcohol use is often associated with psychological consequences and may
have serious impact on social well-being. Manifestations of unhealthy drinking that are seen in general
medical settings include:
Trauma or injury
Anxiety, depression, suicidality
Comorbid substance-use disorders
Hypertension
Gastrointestinal symptoms
Cardiac symptoms
Central or peripheral neurologic symptoms
Electrolyte disturbance
Sleep disturbance
Increased liver enzymes, including elevated gamma-glutamyl transpeptidase
Bone marrow suppression
Macrocytosis
Social or legal problems
Medical morbidity Alcohol can be a significant contributing factor to many medical conditions.
Comorbidities associated with unhealthy alcohol use include:
General medical conditions
Hypertension
Cardiovascular disease
Liver disease
Pancreatitis
Gastritis
Esophagitis
Bone marrow suppression
Peripheral neuropathy
Chronic infectious diseases
Pneumonia
Several malignancies, including cancers of the mouth, esophagus, throat, liver and breast.
Psychiatric disorders
Depressive disorders
Anxiety disorders
Posttraumatic stress disorder
Eating disorders
Other substance use disorders
Sleep disturbances
Treatments:
First Line;
1. Naltrexone- CI in patients who take opioids, S/E: Nausea, headache and elevated liver enzymes
2. Acamprosate- safe in liver failure, S/E: diarrhea, nervousness, fatigue
Second Line:
1. Disulfiram- Aversive agent, CI in pts/w myocardial dz, psychosis, pregnancy. S/E: hepatotoxic,
fatigue, drowsiness,
2. Topiramate- Black box
3. Gabapentin- S/E: sedation, dizziness
4. Baclofen-trials
5. Nalmefene- better than naltrexone(no dose dep. hepatotoxicity, stronger activity). S/E: nausea,
insomnia, fatigue, with cases of psychosis and dissociation
6. SSRI
7. Ondansetron- S/E: diarrhea, headache, fever, Prolong QT