Alcoholism
Substance Dependance
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 

(1) tolerance, as defined by either of the following: 
 (a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect 
 (b) markedly diminished effect with continued use of the same amount of the substance 

(2) Withdrawal, as manifested by either of the following: 
 (a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances) 
 (b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended 

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use 

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects 

(6) important social, occupational, or recreational activities are given up or reduced because of substance use 

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption) 

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Alcohol Intoxication
A. Recent ingestion of alcohol. 

B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion. 

C. One (or more) of the following signs, developing during, or shortly after, alcohol use: 
(1) slurred speech 
(2) incoordination 
(3) unsteady gait 
(4) nystagmus 
(5) impairment in attention or memory 
(6) stupor or coma 

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

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Alcohol Withdrawal Symptoms 1.General withdrawal symptoms (6-12 hours post-alcohol)
��Anxiety or Panic Attacks
��Paresthesias, Shakes or Jitters
��Chills, Sweats, or Fevers
��Chest Pain or Palpitations
��Insomnia
��Headache
��Nausea or Vomiting
��Abdominal pain

2.Hallucinations (12-24 hours post-alcohol)
��Paranoid delusions or illusions
��Auditory, visual, and tactile hallucinations

3.Withdrawal Seizures (24-48 hours post-alcohol)
��Generalized tonic-clonic Seizures

4.Delirium tremens (48-72 hours post-alcohol)
��Visual hallucinations
��Disorientation
��Tachycardia and Hypertension
��Agitation
��Low grade fever

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Delirium Tremens ��caused by the direct effect that ethanol has on the benzodiazepine-GABAa-chloride receptor complex.
��When ethanol is withdrawn, a functional decrease in the inhibitory neurotransmitter GABA is seen. This results in an unopposed increase in sympathetic activity with a resultant increase in plasma and urinary catecholamines.
��Ethanol also acts as an N-methyl D-aspartate receptor antagonist. Withdrawal of ethanol leads to increased activity of these excitatory neural receptors.
��Ethanol withdrawal seizures typically occur 6-48 hours after the last drink.
��DT usually begins 24-72 hours after cessation or reduction of ethanol use.
��altered mental status (eg, confusion, hallucinations, severe agitation) or generalized seizures.

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