Lesson 1Short-term physiological effects: central nervous system, motor function, sleep, and acute intoxicationCovers acute effects of alcohol on the brain, behaviour, and physiology. Examines dose-related CNS depression, motor and cognitive impairment, sleep disruption, acute intoxication syndromes, and factors that modify short-term responses relevant to local populations.
Dose-response and blood alcohol levelsCNS depression and neurochemical changesMotor incoordination and reaction timeEffects on sleep architecture and qualityClinical features of acute intoxicationRisk factors for accidents and injuriesLesson 2Long-term effects on mental health: depression, anxiety, suicidality, and interaction with psychiatric medicationsExplores how chronic alcohol use affects mental health, contributing to depression, anxiety, suicidality, and relapse. Covers bidirectional relationships, diagnostic challenges, and interactions with psychiatric medications and therapies commonly used in South Africa.
Alcohol and depressive disordersAnxiety, panic, and alcohol useSuicidal ideation and attempt riskDiagnostic overlap and masking effectsInteractions with antidepressants and mood stabilisersIntegrated treatment and relapse preventionLesson 3Long-term organ-specific effects: brain (cognitive impairment, Wernicke-Korsakoff), neuroadaptation and dependenceFocuses on chronic alcohol effects on the brain, including cognitive decline, Wernicke-Korsakoff syndrome, and structural changes. Explains neuroadaptation, tolerance, dependence, and links to clinical assessment and prevention strategies suited to diverse communities.
Cognitive impairment and dementia riskThiamine deficiency and Wernicke-KorsakoffStructural and functional brain changesMechanisms of tolerance and sensitisationNeural circuits of dependence and cravingScreening and neurocognitive assessmentLesson 4Metabolism and elimination: alcohol dehydrogenase, CYP2E1, acetaldehyde, first-pass metabolism, elimination kineticsDetails enzymatic pathways that clear ethanol, including alcohol dehydrogenase, CYP2E1, and catalase. Explains acetaldehyde toxicity, first-pass metabolism, zero-order kinetics, genetic variants, and how disease and drugs alter clearance in varied South African demographics.
Alcohol dehydrogenase pathwaysCYP2E1 induction and toxic byproductsAcetaldehyde formation and detoxificationFirst-pass metabolism and gut-liver axisZero-order kinetics and clinical implicationsGenetic polymorphisms affecting metabolismLesson 5Distribution of alcohol: blood alcohol concentration, body water, sex and age differencesExplains how ethanol distributes in body water, how blood alcohol concentration is determined, and how sex, age, body composition, and pregnancy influence levels. Introduces Widmark concepts and implications for testing and dosing in local healthcare settings.
Volume of distribution and body waterWidmark formula and BAC estimationSex differences in BAC and effectsAge-related pharmacokinetic changesImpact of obesity and body compositionPregnancy and lactation considerationsLesson 6Interactions with common comorbidities and medications (antihypertensives, diabetes medications, psychotropics)Reviews how alcohol interacts with common chronic diseases and medications, including antihypertensives, diabetes drugs, and psychotropics. Discusses pharmacokinetic and pharmacodynamic interactions and clinical management strategies prevalent in South African practice.
Effects on blood pressure and heart drugsInteractions with diabetes medicationsAlcohol and psychotropic drug synergyHepatic metabolism and drug levelsAlcohol in chronic pain and opioidsCounselling patients on safe useLesson 7Ethanol absorption: oral intake, gastric emptying, and factors affecting rateExamines how ethanol is absorbed after oral intake, including gastric and small intestinal phases. Discusses gastric emptying, food effects, beverage concentration, and other factors that modify absorption rate and peak BAC in everyday South African contexts.
Sites and mechanisms of ethanol absorptionRole of gastric emptying and motilityInfluence of food and meal compositionBeverage concentration and carbonationEffects of GI disease and surgeryPractical ways to slow absorptionLesson 8Alcohol withdrawal physiology and risk factors for severe withdrawal (delirium tremens, seizures)Describes the neurobiology of alcohol withdrawal, from mild symptoms to delirium tremens and seizures. Reviews receptor adaptations, autonomic hyperactivity, risk factors for severe withdrawal, and principles of clinical risk stratification for local patients.
Neuroadaptation of GABA and glutamateAutonomic hyperactivity mechanismsClinical spectrum of withdrawal signsPathophysiology of seizures and DTsRisk factors for complicated withdrawalAssessment tools and risk stratificationLesson 9Long-term organ-specific effects: liver (steatosis, hepatitis, cirrhosis) and pathophysiologyExplores how chronic alcohol use injures the liver, from fatty change to hepatitis and cirrhosis. Reviews cellular mechanisms, fibrosis pathways, clinical manifestations, and how dose, pattern of use, and comorbidities shape disease risk in South Africa.
Progression from steatosis to cirrhosisHepatocellular injury and oxidative stressInflammation, fibrosis, and stellate cellsClinical features and diagnostic evaluationImpact of nutrition, obesity, and viral hepatitisLesson 10Long-term organ-specific effects: cardiovascular system (hypertension, cardiomyopathy, arrhythmia)Analyses long-term cardiovascular consequences of alcohol, including hypertension, cardiomyopathy, and arrhythmias. Reviews dose-response data, mechanisms of injury, clinical presentations, and implications for risk counselling in South African healthcare.
Blood pressure changes and mechanismsAlcoholic cardiomyopathy pathophysiologyArrhythmias, including atrial fibrillationInteractions with cardiovascular drugsReversibility with abstinence or reductionRisk communication and patient advice
