From Clinicaltools.com

Pharmacology of Alcohol and Neurobiology of Alcohol Addiction

Description

(Steve draft) Since the physician is able to prescribe medications, are there any pharmacological interventions they can administer to their patient to help them halt their negative alcohol use which effects their health?

Research on the neurological and pharmacological effects of alcohol intake provides compelling scientific evidence that alcohol addiction is a medical disease, with progressive symptoms that often manifest with repeated alcohol use. This course provides an overview of the biological, neurological, and clinical alterations that occur as a result of excessive alcohol use.

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Need

Before a physician can properly treat patients who abuse or are dependent on alcohol, the physician must be able to explain the pharmacology and neurobiological alterations that are caused by alcohol.

Needs Analysis

In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The results are summarized below:

Brief Summary: The focus group shaped our module outline and content. With a rating scale of 1-5, the importance of Pharmacology as a course was rated 4.38. The belief that the average medical student would benefit from additional instruction in this topic was rated 4.42, a rating of 4.33 was deemed for encouragement of students to learn more about the topic, and the belief that the topic aligned with recommended physician competencies in the area of substance abuse was rated 4.40. Faculty thought that the module would fit easily into their institution's curriculum, with a rating of 4.17, and that they would include this module in their current teachings, with a rating of 4.25. The most respondents (8) thought the topic area should have 1 hours of lecture time devoted to it. Also, multiple areas of concentration were suggested in the topic area and these were taken into consideration when constructing the course.

Mission

To educate physicians-in-training with the biological basis of alcohol addiction that will empower them to make informed treatment choices for their patients.

Goal

After taking this course, medical students will be able to discuss the biological, neurobiological, and clinical alterations that result from alcohol abuse or dependence.

Learning Objectives

Correlate the neurobiology and neurochemistry of alcohol addiction to neuroclinical manifestations.
Describe how alcohol affects neurotransmitters and the reward mechanism
Counsel patients about potential genetic risk factors for alcohol abuse or dependence.

Case Study 1: Jeannette

Case Focus: Jeannette is presented in 1 page. Her case is set within the section on genetic studies dealing with alcohol outcomes.

Case Goal: Physicians-in-training should be able to identify genetic contributory factors that will affect the outcomes of alcohol use.

Course Objectives Met: 2

Patient: Jeannette - 31YOAF

Chief Complaint: Worried about her genetic pre-dispositions, particularly alleles
Narrative: Jeannette is 31 years old and concerned about her genetic pre-dispositions, particularly alleles
Alcohol Use: Unknown
AUD Diagnosis: 50% of Asians have ALDH2*2 allele causing decreased elimination of acetaldehyde and alcohol.
Relevant Past Medical, Psychosocial, Family History: Asian family background, which causes genetic pre-disposition
Take Home Message: 50% of Asians have ALDH2*2 allele causing decreased elimination of acetaldehyde and alcohol.
Practice Tip: Patients may be pre-disposed to some genetic problems
URL's: Meet Jeannette

Case Study 2: George

Case Focus: George is presented in 1 pages, immediately following a discussion on Pharmacotherapies.

Case Goal: Physicians-in-training should be able to identify medications currently available to treat alcohol dependence and choose the best prescription for the patient.

Course Objectives Met: 3, 4

Patient: George - 23YOWM

Chief Complaint: He is seeking pharmacological treatment for his alcohol addiction
Narrative: George is 23 years old and has been in treatment previously.
Alcohol Use: Known alcohol addiction
AUD Diagnosis: George is in need of pharmacological treatment for his alcohol addiction and the best choice for him would be injectable Naltrexone as it has a 30 day duration and a higher treatment adherence because the patient cannot miss doses.
Relevant Past Medical, Psychosocial, Family History: Unknown
Take Home Message: Previous treatment failure leads to a need for medication that has a higher treatment adherence
Practice Tip: Injectable Naltrexone has a 30 day duration and has a higher treatment adherence because the patient cannot miss doses.
URL's: Meet George

Case Study 3: Pauline

Case Focus: Pauline is presented in 1 page, immediately following a discussion on different pharmacological treatment choices.

Case Goal: Physicians-in-training should be able to identify medications currently available to treat alcohol dependence and choose the best prescription for the patient.

Course Objectives Met: 3, 4

Patient: Pauline - 36YOHF

Chief Complaint: Pauline has come into your office seeking pharmacological treatment for her alcohol addiction.
Narrative: Pauline is a 36 year old secretary who is married with 2 children. She needs pharmacological treatment for her alcohol addiction. Complicating matters is that she has hepatic impairment, so selecting her therapy should take that into account.
Alcohol Use: Known alcohol use problems
AUD Diagnosis: Pauline is in need of pharmacological treatment for her alcohol addiction and the best choice for her would be Acamprosate as it does not have any noted contraindications for hepatic impairment.
Relevant Past Medical, Psychosocial, Family History: 2 children, husband, hepatic impairment
Take Home Message: Acamprosate is the best choice for Pauline as does not have any noted contraindications for hepatic impairment.
Practice Tip: Co-occurring physical issues must be taken into account when prescribing medication
URL's: Meet Pauline