True: Alcohol and other substance use and abuse may be 2–3 times higher among homosexuals than in the general population. However, homosexuals do not have higher rates of drug or alcohol dependence (Sadock & Sadock 2005, p. 1960).

True: Heavy drinkers have more alcohol-related problems than moderate and light drinkers. However, their contribution to the total alcohol-related harm in the community is less compared to that of the far greater numbers of moderate and light drinkers. Hence, preventive measures should focus on the whole population, rather than only on the very high-risk group. This is called the ‘prevention paradox’ (Chick & Cantwell 1994, p. 85).

True: The prevalence of alcohol-related problems in a population is linked to the alcohol consumption per person in that population. There is a close correlation between cirrhosis mortality and national average consumption (Gelder et al 2006, p. 435; Johnstone et al 2004, p. 359).

False: Alcohol consumption decreases with age. This may be because of decreased tolerance and increased financial pressures in old age and the premature mortality of heavy drinkers. Alcohol abuse in the elderly is often undiagnosed. This is partly because the commonly used screening questionnaires and blood indices are less sensitive tools in the elderly. In the elderly, alcohol abuse is 3 times more common in men than in women (Gelder et al 2000, p. 1637; Johnstone et al 2004, p. 649).

False: 20–30% of male admissions and 5–10% of female admissions misuse alcohol (Gelder et al 2006, p. 434).

False: Alcohol dehydrogenase metabolizes 90–95% of the alcohol consumed in social drinkers. This is the rate-limiting enzyme (King 2004, p. 492; Sadock & Sadock 2005, p. 1171).

False: A given dose of ethanol per kg bodyweight produces a higher peak blood level in women than in men. This is because women have relatively more body fat than water and lower activity of alcohol dehydrogenase in the gastric mucosa compared to men (Johnstone et al 2004, p. 366).

False: Those with alcoholic parents and/or siblings are 3–4 times more likely to become alcoholics than those without such family history. The rate of alcohol problems increases with the number of alcoholic relatives, the severity of their problems and the closeness of their genetic relationship (Gelder et al 2000, p. 479; Sadock & Sadock 2005, p. 1174).

False: GGT may be raised even when there is no demonstrable liver damage (Gelder et al 2006, p. 445).

True: Salience of drinking was proposed as a feature of alcohol dependence by Edwards & Gross in 1976. Preoccupation with substance use as manifest by neglect of alternative pleasures or interests is an ICD-10 criterion for alcohol dependence (Gelder et al 2000, p. 483).

True: Alcohol withdrawal starts 4–12 hours after cessation of/reduction in alcohol use. This may last for up to 4–5 days (DSM-IV 1994, p. 198; Gelder et al 2000, p. 489).

True: Delirium tremens starts 48–72 hours following stopping or reducing alcohol intake. It usually lasts for 2–3 days (Chick & Cantwell 1994, p. 174).

False: Alcoholic blackouts are periods of intoxication during which the patient appeared alert and performed complex tasks, but which are followed by amnesia for this period. This can last for hours or even days. Brain damage increases the susceptibility to developing alcoholic blackouts (Gelder et al 2000, p. 489; Sadock & Sadock 2005, p. 1178).

True: The effects of maternal alcohol intake on organogenesis were first described by Lemoine and colleagues. The features of fetal alcohol syndrome include the triad of pre- and postnatal growth retardation, learning difficulties and craniofacial abnormalities. The craniofacial abnormalities include midfacial hypoplasia, microcephaly, thin upper lip, small palpebral fissure, flat maxillary area, poorly developed philtrum, etc. In addition, they have congenital dislocation of the hip and atrial septal defects, delayed language development, sleep disturbance and overactivity (Gelder et al 2006, p. 437; Ghodse 2002, p. 151; Johnstone et al 2004, p. 745).

True: The prognosis of alcoholic hallucinosis is good. It usually resolves spontaneously within days or weeks in patients who are abstinent. Cases that persist beyond 6 months have a poor prognosis (Gelder et al 2000, p. 490).

True: Implicit memory is preserved in Korsakoff’s syndrome.

Explicit or declarative memory is memory to which we have conscious access. The anatomical basis includes the limbic and temporal neocortical structures.

Implicit or procedural memory involves conditioned reflexes and motor tasks, e.g. the ability to ride a bicycle. The anatomical substrate is less clear and may involve the basal ganglia, cerebral cortex and possibly even the cerebellum.

Recall, retrieval or conscious recollection applies to explicit memory whereas recognition applies equally to both (Hodges 1994, p. 18).

True: The patient with Korsakoff’s syndrome is often highly suggestible (Lishman 1997, p. 31).

True: Methanol has relatively low toxicity. Methanol is oxidized by alcohol dehydrogenase to formaldehyde. Formaldehyde is oxidized to formic acid by formaldehyde dehydrogenase. Formic acid is converted to carbon dioxide and water by 10-formyl tetrahydrofolate synthetase.

Methanol poisoning causes nausea, vomiting, abdominal pain and CNS (central nervous system) depression. After a latent phase of 12–24 hours, metabolic acidosis develops with blurring of vision, altered visual fields and blindness. It can cause necrosis of the putamen. Mortality is 20%.

Management includes general support, correction of metabolic acidosis using sodium bicarbonate, blocking further production of formic acid using fomepizole or ethanol as antidotes, enhancing metabolism of formic acid using folinic acid and haemodialysis to eliminate methanol and formate (Barcelous et al 2002).

True: There is amnesia for the entire episode (Lishman 1997, p. 595).

True: Sixth nerve palsies and other ocular abnormalities recover with thiamine treatment. The improvement often starts within hours of starting treatment. Sometimes it takes several days or weeks to disappear completely. The only exception is horizontal nystagmus which persists in two-thirds of patients (Lishman 1997, p. 579).

False: There is no evidence to support this claim (Gelder et al 2006, p. 449; Johnstone et al 2004, p. 377).

False: The excitatory (glutamate) and inhibitory (GABA) neurotransmitters are important in alcohol dependence. Acamprosate, a GABA analogue, has an effect on both. It is a dose-dependent antagonist to NMDA receptors in the neocortex and hippocampus. Acamprosate has no effect on the metabolism of alcohol or acetaldehyde (Gelder et al 2006, p. 448; Ghodse 2002, p. 158; Johnstone et al 2004, p. 375; King 2004, p. 495; Sadock & Sadock 2005, p. 1187).

False: CBT for addictions identifies five phases:

True: Disulfiram inhibits the conversion of dopamine to noradrenaline by inhibiting dopamine-beta-hydroxylase due to depletion of its cofactor copper. The depletion of noradrenaline in the heart and blood vessels allows acetaldehyde to act directly on these tissues to cause flushing, tachycardia and hypertension (ABPI 2005, p. 125; Anderson & Reid 2002, p. 160).

True: The main predictors of suicide in the elderly include age above 75 years, male gender, physical illness (35–85%), social isolation, widowed or separated status, recent bereavement, alcohol or other substance abuse, depression (70–80%) and past history of depression. The estimates of prevalence of alcohol abuse in the elderly vary widely. The prevalence of alcohol and substance misuse and dependence in the elderly may be 1–2% in the community and 40–65% in those admitted to medical wards, those admitted with mood disorders and in suicide victims. Older people with alcohol dependence are at higher risk for suicide, possibly due to depression, social isolation and alcohol-induced impulsive behaviour (Gelder et al 2006, p. 410; Johnstone et al 2004, p. 648; Sadock & Sadock 2005, pp. 3713, 3715, 3805; Wright et al 2005, p. 488).