True: The gastrointestinal effects of heavy alcohol consumption include gastritis, vomiting, Mallory–Weiss tear, stomach and duodenal ulcers, cirrhosis of the liver, pancreatitis and an increased risk of cancer of the mouth, pharynx, oesophagus, stomach and liver. Garro and Lieber concluded that excess drinking increases the risk of cancer of the oropharynx by threefold, cancer of the oesophagus by twofold and cancer of the larynx by fourfold. Those who smoke or abuse other drugs are at even higher risk (DSM-IV 1994, p. 200; Chick & Cantwell 1994, p. 81; Johnstone et al 2004, p. 370).

True: The majority of people charged by the police with drunkenness offences are alcohol dependent. Drink-driving offences are common among dependent drinkers. Though one instance of high alcohol concentration does not differentiate between an isolated episode of heavy drinking and chronic misuse, if the person has high blood levels and is not intoxicated, it would suggest tolerance and, hence, habitual heavy drinking.

Offenders with exceptionally high blood levels of alcohol, i.e. over 150 mg/L, or who have previous drink-driving convictions are particularly likely to be alcohol dependent. Drink-driving offences are also common in patients with other alcohol-related problems. This question is about convictions being strongly suggestive, not about one single conviction being diagnostic (Ghodse 2002, p. 159; Johnstone et al 2004, p. 372).

True: Binge drinking is defined as consumption of at least half of the recommended weekly limits per occasion, i.e. ≥10 units/occasion for men and ≥7 units/occasion for women.

Binge drinkers can be identified by dividing number of units of alcohol consumed in the last week by usual drinking frequency. Binge drinking, and particularly frequent binge drinking, is more likely than regular moderate drinking to be associated with alcohol-related problems. Many of the binge drinkers have low average consumption. This has resulted in the ‘second order prevention paradox’.

True: Bus conductors and bus drivers’ mates have a higher risk than the general population of developing alcoholic liver disease. Bus drivers are not considered a high-risk group (Chick & Cantwell 1994, p. 115).

False: The indirect effect of alcohol on the GABA-_A receptor is responsible for sedating, sleep-inducing, anticonvulsant and muscle-relaxant effects of alcohol. Chronic alcohol intake decreases GABA-benzodiazepine receptor function. This may be causally related to dependence (King 2004, p. 494; Sadock & Sadock 2005, p. 1171).

True: The microsomal ethanol oxidizing system (MEOS) metabolizes 5–10% of the alcohol consumed. Its activity increases with tolerance (Ghodse 2002, p. 149; King 2004, p. 492; Sadock & Sadock 2005, p. 1171).

False: Type 1 is environmentally caused, milieu limited, affects both men and women, starts after age 20 years, the severity is mild and there is minimal criminality.

Type 2 is genetically determined, starts before age 20, affects mostly males and is associated with severe alcoholism, criminality and other substance misuse (Gelder et al 2006, p. 441).

False: Acute alcohol intoxication does not raise GGT levels. Regular moderate drinking in the preceding weeks raises the levels slightly. The heavier the drinking, the higher the levels (Ghodse 2002, p. 149).

False: There is no particular pattern associated with alcohol use. There is increased fast activity, decreased alpha activity and decreased EEG coherence in alcoholics and even their alcohol-naïve offspring. This may reflect higher arousal levels and may be a possible marker of susceptibility to alcoholism. Acute ingestion of alcohol increases alpha activity and slows alpha frequency. Higher blood levels increase theta activity. Chronic alcohol use may be associated with a lower voltage and slightly faster resting EEG. Withdrawal is associated with increased higher frequency beta activity. Delirium tremens is associated with dominant fast activity. A state of subacute encephalopathy with seizures has been described in chronic alcohol users who are not withdrawing, associated with prominent slowing and periodic lateralized paroxysmal discharges (Chick & Cantwell 1994, p. 97; Sadock & Sadock 2005, p. 185).

False: Withdrawal delirium is not a criterion for ICD-10 diagnosis of dependence syndrome, although withdrawal symptoms are (ICD-10 1992, p. 79).

True: Transient visual, tactile or auditory hallucinations or illusions occur in alcohol withdrawal (DSM-IV, p. 198; Gelder et al 2000, p. 489).

True: Nicotinic acid deficiency can manifest in 3 ways:

True: Approximately 10% of hospitalized alcoholics develop seizures – ‘rum fits’. Causes include direct toxic effect of alcohol, alcohol withdrawal, hypoglycaemia and head injury. An epileptic fit for the first time in an adult should alert to the possibility of alcohol dependence. Withdrawal fits can occur without other gross features (Ghodse 2002, p. 153; Johnstone et al 2004, p. 373).

False: Alcoholic hallucinosis is a rare condition. In people who have been drinking heavily for many years, auditory hallucinations are present in clear consciousness and without autonomic overactivity. The hallucinations are fragmentary to start with, but soon become second or third person auditory hallucinations. It is classified as a substance-induced psychotic disorder in both ICD-10 1992 and DSM-IV 1994.

In contrast, in alcohol withdrawal and delirium tremens the hallucinations are transient and disorganized. They are mainly visual, but also auditory and tactile. Delirium tremens is also associated with altered consciousness (Gelder et al 2000, p. 490; Johnstone et al 2004, p. 368).

True: Confabulation is the unconscious filling of gaps in memory by imagined or untrue but often plausible experiences, occurring in clear sensorium. It is associated with organic pathology, e.g. neurodegenerative conditions, dementias, amnesic disorders and psychotic disorders. It is not synonymous with lying or factitious disorders where symptoms are deliberately distorted or feigned. It is more common in damage to diencephalic structures than in bilateral hippocampal damage. In Korsakoff’s syndrome it is most often seen in the acute stages but is not universal. The provoked or momentary type is more common and usually has reference to the recent past, sometimes a memory that is displaced. The spontaneous or fantastic type does not have a stimulus and has been linked to frontal lobe damage. Suggestibility may facilitate confabulation (Lishman 1997, p. 30).

False: Semantic memory deals with organized knowledge about the world, i.e. knowledge of objects, labels, vocabulary, principles and concepts.

Korsakoff’s syndrome is characterized by severe impairment of episodic memory. Other deficits, although they may exist, are comparatively modest (Hodges 1994, pp. 5, 19; Lishman 1997, p. 30).

False: The EEG is useful in the diagnosis, prognosis and monitoring of severity of hepatic encephalopathy. EEG changes appear even before psychological abnormalities. First there is alpha slowing and appearance of 5–7-Hz theta waves, most prominently in the frontal and temporal regions. As consciousness deteriorates, alpha waves are increasingly replaced by theta. Then the characteristic triphasic waves appear. This is followed by a decrease in amplitude, blunting of triphasic waves and periods of flattening. Similar changes occur also in uraemia, hypokalaemia, anoxia, vitamin B12 deficiency and raised intracranial pressure (Lishman 1997, p. 564).

True: In Victor et al’s (1971) series of 245 patients 84% developed a typical amnesic syndrome (Gelder et al 2000, p. 491; Gelder et al 2006, p. 328).

False: The risk of suicide in alcoholism is 15%. Alcoholics form 15–25% of all completed suicides. Their risk is 6–20%, i.e. 100 times that of the general population.

False: The Minnesota model, 28-day programme or 12-step programme is a refined and expanded version of the 12-step principles of Alchoholics Anonymous. It is usually used in private residential treatment programmes. Like the AA, the focus is on abstinence (Gelder et al 2000, p. 507; Sadock & Sadock 2005, p. 1151).

True: Acamprosate antagonizes the excitatory neurotransmitter glutamate by antagonizing NMDA receptors.

Acamprosate is an analogue of taurine and structurally resembles GABA. Some believe that acamprosate stimulates GABAergic inhibitory neuro-transmission (Gelder et al 2006, p. 448; Johnstone et al 2004, p. 375; King 2004, p. 495; Sadock & Sadock 2005, p. 1187).

False: Indications for inpatient detoxification include severe symptoms, medical/psychiatric complications, a history of withdrawal seizures or DT, comorbid severe mental illness, frail and elderly patients, intercurrent acute physical illness, failure of previous outpatient detoxification and lack of social support (Chick & Cantwell 1994, p. 132; Wright et al 2005, p. 431).

True: (See ABPI 2005, p. 125).

False: There is no evidence that the results of group psychotherapy differ in general from those of individual therapy of similar form and duration and used for the same problem. Moreover, different styles of group therapy produce almost similar results (Gelder et al 2006, p. 449; Johnstone et al 2004, p. 377).

True: Marchiafava–Bignami syndrome involves extensive demyelination of the corpus callosum and adjacent subcortical white matter, optic tracts and cerebellar peduncles. The clinical features include dysarthria, ataxia, epilepsy and impaired consciousness. Dementia and limb paralysis are seen in the more slowly progressive forms. Mortality is high and recovery is rare. The cause may be nutritional and/or alcohol-related (Gelder et al 2006, p. 437; Lishman 1997, p. 586).