ALCOHOLISM ALCOHOL WITHDRAWAL

Alcohol decreases lifespan by 12-15 years unless

treatment is received Begins: 48-72 H after the last drink
 Tolerance – less effect even with more drinks Disappears: 5-14 days after
 Withdrawal – occurs when one abruptly stops  Hand tremors
drinking after alcohol has become a necessity of life  Sleep disturbance (insomnia, nightmares)
to maintain functioning  Nausea and vomiting
DISORDERS  Transient hallucinations (visual, tactile, auditory)
ALCOHOL DEPENDENCE  Illusions
 Psychomotor agitation
 cluster of cognitive, behavioral, and physiologic S/S  Anxiety
 continues alcohol intake despite critical alcohol  Grand mal seizure (generalized)
related problems
 a cluster of 3 or more of the 7 symptoms in a 12- ALCOHOL WITHDRAWAL DELIRIUM
month period: (DELIRIUM TREMENS)
 Tolerance
 Withdrawal symptoms  ↑ V/S (37.8 C, >100 bpm)
 Drinks to relieve or avoid withdrawal  Restlessness
symptoms  Agitation
 Large amounts over long periods  Hyperalertness
 Awareness of compulsion to drink/craving  Noises/quick movements perceived are greatly
for alcohol exaggerated
 Persistent desire/unsuccessful efforts to cut
 Incoherent speech
down or control use of alcohol
 Hallucinations and illusions
 A significant time spent in activities to obtain
alcohol, drink alcohol or recover from its effects
ALCOHOLIC INDUCED-PERSISTING AMNESTIC
 Social, occupational, or recreational activities are
DISORDERS
given up or reduced because of drinking alcohol
 Continues to drink despite knowledge of
1. Korsakoff’s Psychosis
consequences that were cause by alcohol
-Loss of short term memory and inability to
 Narrowing of drinking repertoire (focusing on 1 type
learn new skills
of alcohol)
 disorientation
 Drink-seeking behaviors (won’t go to activities
 confabulation
without drinking; won’t hangout with people who
-deficiency of Vit. B complex (↓B1 and B12)
don’t drink)
 May be with or without physiologic dependence
2. Wernicke’s Encephalopathy
-inflammatory, hemorrhagic, degenerative
ALCOHOL ABUSE
condition of the brain caused by ↓thiamine
 Double vision
 Include tolerance, withdrawal or compulsion
 Nystagmus
 Exhibit 1 or more symptoms in a 12-month period
 Lack of muscular coordination
 Recurrent drinking (failure to fulfill roles)
 ↓ mental status
 Recurrent physical hazards with drinking
 Recurrent alcohol related legal problems
 Continued use despite recurrent social, or DETOXIFICATION
interpersonal problems Not a treatment, but a first step

What happens?
ALCOHOL INTOXICATION  Overall exam: blood work, drinking therapy, tests to
Evidenced by: check physical and mental health
 Impaired social/occupational functioning  Detox support: medications given
 Fighting o Disulfram (antabuse)
 Impaired judgment o Naltrexone
o GOAL: help to stabilize px (mental &
 Increased verbalization
physical)
 Impaired attention span
 Help get into the treatment to break addiction
 Irritability
 Mood changes
Choosing a program consider the ff:
 Slurred speech  Insurance, Staff, Ttt plan, Counseling, Medical
 Lack of coordination services, Relapse prevention, Aftercare
 Unsteady gait
 Impaired memory Follow-up: after 1 year
 Stupor
 Coma
MEDICATIONS:

1. disulfram (Antabuse)
-for chronic alcoholism
-alcohol aversive / alcohol sensitizing agent
-unpleasant effects:
 flushing
 headache
 nausea and vomiting
 chest pain
 weakness
*never give when px is still intoxicated
*give with consent

2. naltrexone (Revia & Vivitrol)

-manage alcohol/opiate dependency
-↓ cravings

CODEPENDENCY
 Pattern of behavior wherein 1 or both partner
lacks autonomy and depend on the other for
happiness and approval
 Base identity and self-worth on their partner
 When sense of purpose is satisfying partner’s
needs even in his/her own detriment
 The second step of enabling

ENABLING
 Common in partners of alcoholics
 Act of extending help that actually perpetuates
a problem (eg. Helping partner make an excuse
for being absent to work due to hang over)
 May not provide alcohol, but lie to keep a
partner out of trouble, help a partner not face
the reality of day-to-day life as an alcoholic

CODEPENDENTS and ADDICTS

 Attach self-worth to the partner, depend on
each other
 Enabling
 If user overcomes his/her dependence, can be
devastating for the codependent partner whose
life has been dedicated to the person’s needs
 ↑ chance that they will resent partner’s
recovery because their self-worth has been
taken away
 May be an addiction itself

Why separation is sometimes ineffective:

>She returns because he needs her
>She finds herself in another codependent relationship
>Husband will be devastated losing a caregiver or
realize she is an enabler and leave her

SIGNS OF CODEPENDENCY
 In a relationship with an addict
 Own issues are also partner’s issues
 Partner can’t manage without you
 You let your partner have their way
 You think your responsible for your partners
action
 Your partner’s mood (good or bad) changes
your day