Alcohol Use Disorder
Alcohol Use Disorder (AUD) is a medical condition characterized by a pattern of excessive drinking that interferes with a person's daily life. AUD ranges from mild to severe and can lead to a range of physical, psychological, and social problems.
see Alcohol intoxication.
Alcohol use disorders and neurosurgery
Alcohol use disorders (AUDs) and neurosurgery can intersect in several ways:
Preoperative Evaluation: Before undergoing neurosurgery, patients are typically evaluated for their overall health, including any underlying medical conditions such as alcohol use disorder. It's essential for the surgical team to be aware of a patient's AUD because it can affect anesthesia requirements, increase the risk of complications, and impact the overall success of the surgery.
Risk Assessment: Chronic alcohol use can have detrimental effects on the body, including the liver, which plays a crucial role in metabolizing drugs and anesthesia. Patients with AUD may have compromised liver function, making it important to assess the risk of anesthesia-related complications.
Withdrawal Management: Patients with AUD are at risk of alcohol withdrawal symptoms if they stop drinking abruptly. These symptoms can be severe and even life-threatening. Neurosurgical patients may require careful management of alcohol withdrawal both before and after surgery to minimize risks.
Postoperative Care: After neurosurgery, patients often require intensive care and monitoring. Alcohol use can interfere with wound healing, increase the risk of infections, and affect the patient's ability to follow postoperative instructions. Addressing AUD and providing appropriate support and treatment during the recovery process is essential.
Medication Interactions: Some medications prescribed after neurosurgery may interact with alcohol or exacerbate its effects. Healthcare providers must consider these interactions when managing pain, infection, or other postoperative issues.
Long-Term Outcomes: For patients with a history of AUD, long-term outcomes following neurosurgery may be influenced by their alcohol use. Continued alcohol abuse can hinder recovery, increase the risk of complications, and negatively impact overall health.
It's crucial for patients to be honest with their healthcare providers about their alcohol use and history when preparing for neurosurgery. This information allows the medical team to make informed decisions and provide appropriate care tailored to the individual's needs. In some cases, patients with AUD may be referred for addiction treatment or counseling before or after surgery to improve their chances of a successful outcome and overall health. Collaboration between neurosurgeons, anesthesiologists, and addiction specialists is often necessary to provide comprehensive care to individuals with both AUD and a neurosurgical condition.
In a systematic analysis, disparities in Lip, oral, and pharyngeal cancer burden existed across the Socio-demographic Index spectrum, and a considerable percentage of the burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in Lip, oral, and pharyngeal cancer burden globally and support cancer control planning efforts 1)
The acute and chronic effects of ethyl alcohol (ethanol, EtOH) abuse on the nervous system (not to mention the effects of EtOH on other organ systems)
Neuromuscular effects include:
1. acute intoxication
2. effects of chronic alcohol abuse
b) cerebellar degeneration:due to degeneration of Purkinje cells in the cerebellar cortex, predominantly in the anterior superior vermis
c) central pontine myelinolysis
d) stroke:increased risk of
● ischemic stroke
● possibly aneurysmal SAH
e) peripheral neuropathy
f) skeletal myopathy
3. effects of alcohol withdrawal: usually seen in habituated drinkers with cessation or reduction of ethanol intake
a) alcohol withdrawal syndromes
b) seizures: up to 33% of patients have generalized tonic-clonic seizure 7–30 hrs after cessation of drinking— see Alcohol withdrawal seizures
c) delirium tremens (DTs):
Increasing blood ethanol concentration (BEC) was associated with increasing odds of being in a more severe GCS group. However, because the modelled probability of significant brain injury was high in patients with high levels of BEC, a reduced level of consciousness in intoxicated patients mandates further radiological investigations 2).
Clinical features
Some common symptoms of AUD include:
Craving alcohol Inability to stop or limit drinking Withdrawal symptoms when not drinking, such as anxiety, shaking, or nausea Building up a tolerance to alcohol, so that you need more to feel the effects Drinking in hazardous situations, such as while driving or operating heavy machinery Neglecting responsibilities at work, school, or home Continuing to drink even though it is causing problems in relationships Giving up activities you once enjoyed in order to drink Drinking more than intended or for longer periods of time If you think you may have AUD, it's important to seek help from a healthcare provider or mental health professional. They can diagnose and treat the condition, and help you develop a plan for recovery. Treatment options for AUD may include behavioral therapy, medication, or a combination of both. Support from friends, family, or support groups, such as Alcoholics Anonymous, can also be helpful in recovery
Persons at risk for developing alcohol use disorder (AUD) differ in their sensitivity to acute alcohol intoxication. Alcohol effects are complex and are thought to depend on multiple mechanisms. Harmata et al. explored whether acid-sensing ion channels (ASICs) might play a role. They tested ASIC function in transfected CHO cells and amygdala principal neurons and found alcohol-potentiated currents mediated by ASIC1A homomeric channels, but not ASIC1A/2 A heteromeric channels. Supporting a role for ASIC1A in the intoxicating effects of alcohol in vivo, they observed marked alcohol-induced changes on local field potentials in the basolateral amygdala, which differed significantly in Asic1a-/- mice, particularly in the gamma, delta, and theta frequency ranges. Altered electrophysiological responses to alcohol in mice lacking ASIC1A, were accompanied by changes in multiple behavioral measures. Alcohol administration during amygdala-dependent fear conditioning dramatically diminished context and cue-evoked memory on subsequent days after the alcohol had cleared. There was significant alcohol-by-genotype interaction. Context- and cue-evoked memory were notably worse in Asic1a-/- mice. They further examined the acute stimulating and sedating effects of alcohol on locomotor activity, loss of righting reflex, and an acute intoxication severity scale. They found loss of ASIC1A increased the stimulating effects of alcohol and reduced the sedating effects compared to wild-type mice, despite similar blood alcohol levels. Together these observations suggest a novel role for ASIC1A in the acute intoxicating effects of alcohol in mice. They further suggest that ASICs might contribute to the intoxicating effects of alcohol and AUD in humans 3).
Treatment
Treatment for Alcohol Use Disorder (AUD) can be highly effective, and various approaches are available to help individuals recover from this condition. The choice of treatment depends on the severity of the disorder, individual preferences, and the recommendations of healthcare professionals. Here are some common components of AUD treatment:
Assessment and Diagnosis: The first step is to assess the extent of the individual's alcohol use and determine if they meet the criteria for AUD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A healthcare professional, such as a doctor, psychologist, or addiction specialist, can perform this evaluation.
Detoxification (Detox): For individuals with severe alcohol dependence, a medically supervised detox may be necessary to safely manage withdrawal symptoms. Detoxification can take place in an inpatient or outpatient setting and may involve medications to alleviate withdrawal symptoms.
Medications: Several medications have been approved by the FDA to assist in the treatment of AUD, including:
Acamprosate: Helps reduce cravings and maintain abstinence. Naltrexone: Blocks the euphoric effects of alcohol and can reduce cravings. Disulfiram: Creates unpleasant physical reactions (e.g., nausea, vomiting) if alcohol is consumed, acting as a deterrent. These medications are often used in combination with counseling and psychosocial interventions.
Behavioral Therapies: Various therapy approaches can be effective in treating AUD:
Cognitive-Behavioral Therapy (CBT): Focuses on identifying and changing unhealthy thought patterns and behaviors related to alcohol use. Motivational Enhancement Therapy (MET): Aims to increase motivation and commitment to change. Contingency Management (CM): Provides incentives or rewards for staying sober and adhering to treatment. 12-Step Facilitation Therapy: Utilizes the principles of Alcoholics Anonymous (AA) or similar self-help groups. Individual and Group Counseling: These forms of therapy provide a supportive environment for individuals to explore the underlying causes of their alcohol use, develop coping strategies, and build a strong support network.
Family Therapy: Involving family members in the treatment process can help address family dynamics, improve communication, and provide a supportive environment for recovery.
Rehabilitation Programs: Inpatient or outpatient rehabilitation programs offer structured environments for individuals to focus on their recovery. Inpatient programs are more intensive and are typically recommended for those with severe AUD.
Relapse Prevention: Learning strategies to prevent relapse is a crucial aspect of treatment. This may involve identifying triggers, developing coping skills, and having a plan for managing high-risk situations.
Support Groups: Participation in support groups like Alcoholics Anonymous (AA) or SMART Recovery can provide ongoing peer support and encouragement.
Lifestyle Changes: Encouraging healthy habits, such as regular exercise, a balanced diet, and stress management, can support recovery.
Continuing Care: Long-term follow-up and support are often necessary to maintain sobriety. Many individuals benefit from ongoing counseling and participation in support groups even after the initial treatment phase.
It's important to note that AUD treatment is highly individualized, and what works best for one person may not be the same for another. Effective treatment often involves a combination of the above approaches tailored to the individual's unique needs and circumstances. Seeking professional help and support is a crucial step toward recovery from Alcohol Use Disorder.