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Alcohol Abuse: Pharmacology, Effects, and Management

Explore the pharmacology of alcohol, its chronic and acute effects on the body, impact on cognitive function, and the use of drugs for alcohol use disorder management. Learn about alcohol's pharmacokinetics, drug interactions, and therapeutic uses.

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Alcohol Abuse: Pharmacology, Effects, and Management

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  1. Chapter 38 Drug Abuse II: Alcohol

  2. Alcohol • Most commonly used and abused psychoactive agent in the United States • Some therapeutic use • Primarily used for nonmedical purposes • Moderate consumption: prolongs life, reduces risk of dementia and cardiovascular disorders • Excessive consumption: diminishes quality and quantity of life

  3. Basic Pharmacology of Alcohol • Central nervous system effects • Acute effects • General depression of CNS function • Enhances GABA-mediated inhibition • Dose-dependent • Activation of the reward circuit • Binds with 5-HT3 receptors

  4. Basic Pharmacology of Alcohol • Chronic effects • Two neuropsychiatric syndromes • Wernicke’s encephalopathy • Korsakoff’s psychosis • Impact on cognitive function • Effect on sleep

  5. Basic Pharmacology of Alcohol • Other pharmacologic effects • Cardiovascular system • Respiration • Liver • Stomach • Kidney • Pancreas • Sexual function • Cancer: breast and colorectal cancer • Pregnancy and lactation • Impact on longevity

  6. Basic Pharmacology of Alcohol • Pharmacokinetics • Absorption • Distribution • Metabolism • Blood levels • Tolerance • Physical dependence

  7. Basic Pharmacology of Alcohol • Drug interactions • CNS depressants • Nonsteroidal anti-inflammatory drugs • Acetaminophen • Disulfiram • Antihypertensive drugs

  8. Basic Pharmacology of Alcohol • Acute overdose • Vomiting, coma, pronounced hypotension and respiratory depression • Therapeutic uses • Topical • Oral • Intravenous • Replacement of calories and fluid • Local injection • Nerve block

  9. Alcohol Use Disorder • 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

  10. Drugs for Alcohol Use Disorder • Drugs used to facilitate withdrawal • Drugs used to maintain abstinence • Other drugs used in the treatment of alcohol abuse

  11. Drugs Used to Facilitate Withdrawal • Benzodiazepines • Chlordiazepoxide (Librium, others) • Diazepam (Valium) • Oxazepam (Serax) • Lorazepam (Ativan) • Adjuncts to benzodiazepines • Carbamazepine (antiepileptic drug) • Clonidine (alpha-adrenergic blocker) • Atenolol and propranolol (beta-adrenergic blockers)

  12. Drugs Used to Maintain Abstinence • Disulfiram aversion therapy • 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)

  13. Fig.38–1. Ethanol metabolism and the effect of disulfiram.

  14. Drugs Used to Maintain Abstinence • Naltrexone (Revia) • Pure opioid antagonist • Decreases craving for alcohol • Blocks reinforcing effects of alcohol • Mechanism unclear • Adverse effects • Nausea • Headache

  15. Drugs Used to Maintain Abstinence • Acamprosate (Campral) • 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

  16. Drugs Used to Maintain Abstinence • Topiramate (Topamax) • Reduces craving for alcohol • Ondansetron (Zofran) • Selective 5-HT3 receptor antagonist

  17. Nutritional Support, Fluid Replacement, and Antibiotics • B vitamins • Thiamine • Folic acid • Cyanocobalamin • Vitamin supplements • Fluid replacement therapy • Antibiotics

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