The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 15

Table 1. DSM-5 Criteria for Substance Use Disorder A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following:  Substance is often taken in larger amounts or over a longer period than was intended.  There is a persistent desire or unsuccessful efforts to cut down or control substance use.  A great deal of time is spent in activities necessary to obtain substance, use substance, or recover from its effects.  Craving, or a strong desire or urge to use substance.  Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.  Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substance.  Important social, occupational, or recreational activities are given up or reduced.  Recurrent substance use in situations in which it is physically hazardous.  Substance use is continued despite knowledge of its having caused or exacerbated persistent or recurrent physical or psychological problems.  Tolerance  Withdrawal epines and sedative hypnotics) and those who have had prior alcohol withdrawal experiences. Less than 10% of individuals in alcohol with- drawal ever demonstrate withdrawal delirium or withdrawal seizures. Moreover, confusion and changes in consciousness are not core criteria for alcohol withdrawal, though alcohol withdrawal delirium may occur. Older adults are likely more vulnerable to withdrawal delirium, which typically presents in the context of other clinically relevant medical conditions. A particular vulnerability of older adults is that unintended alcohol withdrawal in hospitalized patients for whom a diagnosis of AUD has been overlooked can add to the risks and costs of hos- pitalization. General risks of alcohol use in later life include the following: (1) increased brain susceptibility to the depressant effects of alcohol, (2) decreased rates of liver metabolism of alcohol and other sub- stances, (3) decreased percentages of body water and lean body mass, and (4) diminished aware- ness. 1 All of these factors may result in more severe intoxication and subsequent problems at lower lev- els of consumption – especially when associated with other medical complications. It should be noted that while most drinkers sometimes consume enough alcohol to feel intoxi- cated, only a minority (less than 20%) ever develop AUD. 3 Therefore, drinking, even daily, in low doses and occasional intoxication do not, by themselves, warrant a clinical diagnosis. However, it is also true that many alcohol users who do not meet diagnostic criteria for AUD unwittingly drink more than is recommended by the CDC to minimize health risks. CDC defines excessive drinking as “heavy drinking and binge drinking.” Table 2 outlines the CDC’s definitions of light, moderate, and heavy drinking, as well as what constitutes a drink. Table 2. CDC’s Definitions for Alcohol Use 4 Light Drinking For the majority of diseases linked to alcohol, the risks increase with increasing consumption – without a threshold under which there is no in- creased risk. Table 3 identifies a broad variety of health risks associated with excessive alcohol use. A variety of cancers are associated with ex- cessive alcohol use. These include: liver, mouth, throat, larynx, esophagus, breast, and colon. The risk varies by type of cancer, and the greatest risks are associated with moderate to heavy use. Some risk persists at even low levels of use. 6 Safety risks associated with excessive alco- hol use include: MVAs, falls, drowning, burns, fire- arm injuries, unsafe sex, domestic violence, homi- cide, and suicide. Additional health risks include: (1) poor nutrition and associated vitamin deficien- cies, (2) poor medication adherence resulting in difficult management of all medical conditions, and (3) diminished healthcare utilization. 3 In the recent past there has been a body of research interpreted to suggest that a number of positive health outcomes are associated with low- volume alcohol use, e.g. diminished mortality due to heart disease. However, a recent systematic > Continued on page 160. More Than Healthcare, Correct Care Solutions. WHO WE ARE CCS is a national public healthcare leader caring for underserved patients in correctional settings, psychiatric hospitals and residential treatment facilities. < 1 drink per day for women < 2 drinks per day for men Moderate Drinking: 1 drink per day for women 2 drinks per day for men Heavy Drinking: Opportunities for: Physician Locations throughout Arkansas Full-time, part-time and PRN available Comprehensive Benefits • 401K Tuition Reimbursement Competitive Compensation • So Much More... 8 or more drinks per week for women Empathy 15 or more drinks per week for men Compassion What is a Drink? 12 oz of beer 5 oz of wine 1.5 oz of 80 proof (40% alcohol) liquor CALL TODAY OR APPLY ONLINE Chris Phillips [phone] or email [email protected] ccs.careers NUMBER 7 CCS IS PROUDLY AN EQUAL OPPORTUNITY EMPLOYER JANUARY 2019 • 159