Thinking about Drinking

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Thinking about Drinking GP management of
alcohol dependence

• RACGP Victoria FacultyDrug Alcohol committee

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Thinking about Drinking

• Facilitated by
• Dr Paul Grinzi FRACGP, MMed, MBBS, BMedSci
  (Hons), DipDerm
• Panel  
• Dr Christine Longman FRACGP, MMed, MBBS, DipObs
• Dr Michael Aufgang MBBS, DipRACOG, FRACGP
• Dr Cameron Loy FRACGP, MBBS BmedSci (Hons), DCH,
  DRANZCOG, GDRGP, FARGP
• Dr Rob Weiss MBBS

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Helping patients who are drinking at risky levels
webinar via Australian Drug Foundation

• Click to view - Australian Drug Foundation Webinar

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Case - Amanda

• Download case from
• www.racgp.org.au/facultyeventlinks/alcohol.pdf

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Assessment

• What would you consider should be considered in
  the clinical assessment of Amanda?

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Assessment
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Alcohol use disorder (DSM V)

1. taken in larger amounts or over a longer period
   than was intended
2. There is a persistent desire or unsuccessful
   efforts to cut down or control alcohol use
3. A great deal of time is spent in activities
   necessary to obtain alcohol, use alcohol, or
   recover from its effects
4. Craving, or a strong desire or urge to use
   alcohol
5. Continued alcohol use despite having persistent
   or recurrent social or interpersonal problems
   caused or exacerbated by the effects of alcohol
6. Important social, occupational, or recreational
   activities are given up or reduced

• 7. Recurrent use in situations in which it is
  physically hazardous
• 8. Use is continued despite knowledge of having a
  persistent or recurrent alcohol-related physical
  or psychological problem
• 9.Tolerance a) increased amounts to achieve
  intoxication or desired effect b) diminished
  effect with continued use of the same amount
• 10. Withdrawal, as manifested by either of the
  following a) characteristic withdrawal
  syndrome b) Alcohol (or a closely related
  substance, such as a benzodiazepine) is taken to
  relieve or avoid withdrawal symptoms

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Alcohol use disorder

• The severity of the AUD is defined as
• Mild The presence of 2 to 3 symptoms
• Moderate The presence of 4 to 5 symptoms
• Severe The presence of 6 or more symptoms
• Moderate/severe similar to DSM IV/IDC-10
  dependence

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Alcohol use disorder

1. taken in larger amounts or over a longer period
   than was intended
2. There is a persistent desire or unsuccessful
   efforts to cut down or control alcohol use
3. A great deal of time is spent in activities
   necessary to obtain alcohol, use alcohol, or
   recover from its effects
4. Craving, or a strong desire or urge to use
   alcohol
5. Continued alcohol use despite having persistent
   or recurrent social or interpersonal problems
   caused or exacerbated by the effects of alcohol

• Important social, occupational, or recreational
  activities are given up or reduced
• Recurrent use in situations in which it is
  physically hazardous
• Use is continued despite knowledge of having a
  persistent or recurrent alcohol-related physical
  or psychological problem
• Tolerancea) increased amounts to achieve
  intoxication or desired effectb) diminished
  effect with continued use of the same amount
• Withdrawal, as manifested by either of the
  followinga) characteristic withdrawal
  syndromeb) Alcohol (or a closely related
  substance, such as a benzodiazepine) is taken to
  relieve or avoid withdrawal symptoms

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QA

• From the chatroom.

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Objectives of withdrawal (detox) program/regime

• Interrupt pattern of drinking
• Alleviate withdrawal symptoms
• Prevent severe withdrawal complications
• Facilitate links to ongoing alcohol dependence
  treatment
• Facilitate links to other treatment/services

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Outpatient/inpatient
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Referrals pathways in Victoria
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Outpatient detox considerations

• No medical contra-indications a history of
  severe withdrawal complications (seizures,
  delirium, hallucinations) or significant medical
  or psychiatric comorbidity
• A safe, alcohol-free environment
• Reliable support lay people that can regularly
  monitor (at least daily during the first 3 or 4
  days) and support the patient
• Regular monitoring by a suitably skilled health
  professional (such as alcohol and drug worker,
  nursing or medical professional).
• Daily review (face-to-face, telephone) for first
  3 or 4 days
• Medication should be closely supervised (for
  example, daily supplies). Benzodiazepines to be
  withheld if the patient resumes alcohol use
• Access to 24-hour telephone crisis support.

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QA

• From the chatroom.

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Detox clinical aspects

• Monitoring
• Medications
• Complications
• Support
• Follow up.

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Post-detoxification

• Goals abstinence or moderation?
• Medications naltrexone, acamprosate,
  (disulfiram, baclofen)
• Counselling relapse prevention
• Rehabilitation programs
• Self-help programs

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Aftercare

• Chronic relapsing remitting condition long term
  involvement
• GP Management plan /- mental health plans
• Referrals through team-care arrangement
• Persisting problem drinker

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Specific populations

• Dual diagnosis mental health, plus drug
  alcohol
• Polydrug use
• Adolescents
• Pregnant/breastfeeding
• Indigenous Australians
• Older people
• Cognitive impairment
• Australian Treatment Guidelines /- get help

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Resources

• Clinical www.DACAS.org.au / 1800 812 804
• Alcohol Treatment Guidelines bit.ly/1Glxqfc
• Patient info www.druginfo.adf.org.au
• RACGP Vic DA committee - vic.faculty_at_racgp.org.au
  
• RACGP NFSI Addiction network nfsi_at_racgp.org.au
  

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Thank you

• This webinar is accredited for 3 Category 2 RACGP
  QICPD points
• A survey will be sent to all attendees in the
  next hour, please provide
• your feedback on this session.
• If you would like to join the RACGP Victoria
  Faculty Drug and Alcohol
• Committee, email vic.faculty_at_racgp.org.au
• For all other enquiries, please contact
  vic.events_at_racgp.org.au or
• 03 8699 0488.