Alcohol-Related Disorders / Self Review & Study

Alcohol:

• brain depressant
• a cause of considerable morbidity and mortality

Dopamine is one of the primary neurotransmitters within the CNS and is known to be involved in the integration of environmental stimuli with physiologic responses. Cannabis, cocaine, and alcohol increase the dopamine level, thereby producing a strong association between physiologic effects and behavior.

Diagnostic Evaluation ( measurement tools for alcohol abuse or dependence ):

• CAGE
• Michigan Alcohol Screening Test (MAST)
• The Alcohol Use Disorders Identification Test (AUDIT)

 

Alcohol-related disorders:

• alcohol dependence
  • physiological dependence:
    • evidence of tolerance
    • symptoms of withdrawal (sleep problems, depression, blackouts, delirium, grand mal seizures, etc.)
  • alcohol withdrawal is characterized by withdrawal symptoms that develop 4-12 hours or so after the reduction of intake following prolonged, heavy, alcohol ingestion.
  • because withdrawal from alcohol can be unpleasant and intense, individuals with alcohol dependence may continue to consume alcohol, despite adverse consequences, often to avoid or to relieve the symptoms of withdrawal.
• alcohol abuse
  • differ than dependence
  • alcohol abuse vs. alcohol dependence
    • school and job performance may suffer either from the aftereffects of drinking or from actual intoxication on the job or at school
    • child care or household responsibilities may be neglected
    • alcohol-related absences may occur from school or job
    • may use alcohol in physically hazardous circumstance: driving an automobile or operating machinery while intoxicated
    • legal difficulties may arise because of alcohol use: arrests for intoxicated behavior or for driving under the influence
    • individuals with alcohol abuse may continue to consume alcohol despite the knowledge that continued consumption poses significant social or interpersonal problems for them (such as violent arguments with spouse while intoxicated, child abuse)
    • while all these problems above are accompanied by evidence of tolerance, withdrawal, or compulsive behavior related to alcohol use, a diagnosis of alcohol dependence should be considered.
  • Drugs may used in the treatment of alcohol abuse:
    • Aversion Therapy: Disufiram (Antabuse)
      • It leads to accumulation of acetaldehyde in the blood system, causing flushing, tachycardia, vomiting, nausea, and chest pain, if alcohol is consumed.
    • Nonaversion therapy: Acamprosate sodium (Campral)
      • to ensure abstinence from alcohol.
      • interacts with GABA neurotransmitter system to restore balance between neuronal excitation and inhibition
    • Topiramate (Topamax)
      • an anticonvulsant
      • reduce craving for alcohol
    • Ondansetron (Zofran)
      • clinical trials have demonstrated that it may aid in reducing drinking

Complications: 

• psychological complications: increased potential for risk taking and suicidal behavior.
  • suicide rates increase in the presence of substance use and abuse, including accidental overdose related to the substances
• individuals under the influence of alcohol are more likely to experience automobile or other accidents

 

Nursing Assessment: 

• assess physiologic stability
  • elevated / decreased BP
  • cardiac abnormalities
  • confusion, memory deficits, ataxia, nystagmus (Wernicke’s encephalopathy, a thiamine deficiency)
  • lasting memory deficits (Korsakoff’s amnesic disorder)
  • lung congestion or diminished breath sounds
  • fever
  • mood lability

 

• assess for evidence of medical complication
  • hepatic disease
  • renal disease
  • anemia
  • sexually transmitted disease
  • COPD
  • anxiety
  • depression

 

• identify risk-taking behaviors
  • participation in criminal activities
  • sexual activity and behaviors, including use of protective device
  • motor vehicle violations
  • participation in hazardous sports or activities

 

• gather information regarding substance use
  • amounts
  • previous attempts to reduce or stop use
  • prior history of withdrawal symptoms
  • longest previous period of sobriety
  • prior treatment programs attended
  • familial history of substance use
  • precipitating events to substance use

 

• examine coping mechanisms and behaviors
  • denial?
  • does not recognize the presence of physical or emotional health problems
  • blames others for the presence of problems
  • uses substance in stress-provoking situations
  • justifies use of the substance
  • prior psychiatric history

 

• monitor for withdrawal symptoms
  • agitation, mood lability
  • dehydration, nutritional deficiencies, hallucinations, seizures, GI disturbances

Nursing Diagnoses:

• ineffective denial r/t substance use
• compromised family coping r/t roles and relationships
• Risk for injury r/t effects of the substance
• ineffective coping r/t life stressors
• Risk for self-directed or other-directed violence
• self-care deficit
• imbalanced nutrition: less than body requirements

Nursing Interventions: 

• facilitate recognition of substance-related disorder
  • approach pt in a direct, nonjudgemental manner
  • assess patient’s level of knowledge about substance (alcohol)
  • have patient identify situations preceding substance (alcohol) use
  • discuss consequences of substance (alcohol) use
  • reinforce desire for change

 

• encourage participation of significant others
  • family support
  • attend supportive and educational group meetings

 

• ensuring safety
  • monitor symptoms of withdrawal
  • provide prescribed medication as indicated for the treatment of withdrawal symptomatology
  • monitor hydration and nutritional status

 

• enhancing coping strategies
  • aid in identifying triggers to use
  • have patient develop a list of personal strengths
  • help patient develop an understanding of dependence as an illness
  • assist patient in developing alternative coping strategies through participation in role-play activities and groups
  • identify alternative methods of participating in social situations without resorting to use of substance
  • reinforce need for ongoing attendance of support group meetings

 

• Community and home care considerations
  • assist in resource finding
  • assist in educating and encouraging adherence to drug therapy regimen

 

• family education and health maintenance
  • educate about adverse physiologic and psychological effects
  • discuss  health maintenance: vitamin use, proper diet
  • explain the potential for injury from risk-taking behaviors
  • reinforce the need for aftercare groups and activities
    • National Institutes on Alcohol Abuse and Alcoholism
    • Alcoholics Anonymous