ALCOHOL ABUSE ALCOHOL ABUSE AND AND ASSOCIATED DISORDERSASSOCIATED DISORDERS

KARTHIKEYAPRASATHDEPARTMENT OF PSYCHIATRY

IntroductionIntroductionThe term First used by Magnus Huss, a

Swedish Public Health Authority, in 1849, the word Alcoholism was quickly adopted by many other languages, with only minor variation.

Alcohol is a natural substance formed by the reaction of fermenting sugar with yeast spores. Alcohol is classified as a food because it contains calories; however, it has no nutritional value

Beers contain - 3 to 6% alcoholWines average - 10 to 20%Distilled beverages - 40 to 50%

“There are five “species” of alcohol dependence –

on the basis of patterns of uses”- Jellinek,

 

Patterns Characteristics

A. Alpha () Alcoholism Drinking to relieve physical /

emotional pain.

No loss of control

B. Beta () Alcoholism Physical complications due to

cultural drinking patterns

No dependence

C. Gamma () Alcoholism Malignant alcoholism

Physical dependence

Inability to control drinking

D. Delta () Alcoholism Inability to abstain and Tolerance

Withdrawal symptoms

Social disruption

E. Epsilon () Alcoholism Dipsomania

Spree – drinking

Phases of AlcoholismPhases of Alcoholism::

Phase I: The pre-alcoholic phasePhase II: Early Alcoholic phasePhase III: True Alcoholics (Crucial Phase)Phase IV: Chronic (Chronic Alcoholic)

Phase I: The prealcoholic phase:This phase is characterized by the

use of alcohol to relieve the everyday stress of tensions of life. One individual drinks because of social motivations, and finds that alcohol relieves stress. Overtime, needs to increase the amount of alcohol needed for relief.

Phase II: Early Alcoholic phaseThis phase begins the black

outs – brief periods of amnesia that occur during or immediately following a period of drinking. In this phase, person begins to drink alone and becomes preoccupation with the supply of drinks. Person wakes up in the morning and needs a drink to control tremors

Phase III: True Alcoholics (Crucial Phase)In this phase the individual has lost control and physiological dependence is clearly evident. In which, completely loses control over ability to choose whether or not to drink.The person experiences the following:

isolation from other’s aggression, loss of interest in any activity that once brought pleasure,

impotence, nutritional impairment.

Phase IV: Chronic (Chronic Alcoholic)This phase is characterized by

emotional and physical disintegration. Emotional disintegration is evidenced by profound helplessness and self pity.

Hallucinations, Tremors and convulsions, severe agitation and panic are

symptoms of alcoholism. Depression and ideas of suicide are

common.

Etiological Factors:Etiological Factors:I. Biological factors:

Genetic vulnerability – family history of substance with disorder.

Personality disorder Reinforcing effects of drugs Craving and withdrawal effects Biochemical factors

Etiological Factors:Etiological Factors:

II. Psychological factors:◦Curiosity◦Early initiation of alcohol and

tobacco◦Poor impulse control◦Low self-esteem◦Poor stress management skills◦Childhood trauma / loss◦Psychological distress

Etiological Factors:Etiological Factors:

III. Social factors:◦Peer pressure◦Modeling◦Ease of availability of alcohol / drugs◦Religious reasons◦Poor social / familial support◦Rapid urbanization

Complications of alcohol Complications of alcohol dependence:dependence:I. Medical complications:

A. Gastro – Intestinal system: Fatty liver, cirrhosis of liver, hepatitis,

liver cell carcinoma, liver failure. Gastritis, reflux esophasitis, peptic

ulcer, carcinoma stomach and esophagus.

Malabsorption syndrome Pancreatitis, acute, chronic & relapsing

Complications of alcohol Complications of alcohol dependence:dependence:

I. Medical complications:B. Central Nervous System: Delirium tremens Rumfits Alcoholic hallucinosis Alcoholic dementia Sexual dysfunction Head injury & fractures

Complications of alcohol Complications of alcohol dependence:dependence:

II. Social Complications: Accidents Marital disharmony Divorce Occupational problems Criminality Financial difficulties

Complications by Complications by phasesphases

A. Acute Intoxication:Symptoms of alcohol intoxication

includes disinhibition of sexual or aggressive impulses, mood lability, impairment judgement, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus & flushed face. Intoxications usually occurs at blood alcohol levels between 100 and 200 mg/dl.

Complications by phasesComplications by phasesB. Alcohol withdrawal syndrome:

1. Delirium Tremens:1. Delirium Tremens:It is the most severe alcohol withdrawal

syndrome. It occurs usually within 2 – 4 days of complete or significant abstinence from heavy alcohol drinking in 5% of patients. This is with the characteristic of clouding of consciousness, disorientation, poor attention span and distractibility, visual hallucinations & illusions, tachycardia, hypertension, fever, sweating, insomnia, dehydration and electrolyte imbalance.

2. Alcoholic Seizures (“rum fits”): Generalized tonic clonic seizures occur in

about 10% of alcohol dependence patients. Usually 12 – 48 hours after a heavy bout of

drinking. Multiple seizures 2 – 6 at one time, are more common

3. Alcoholic hallucinosis: This is characterized by the presence of

hallucinations during abstinence, following regular alcohol intake.

These hallucinations persist after the withdrawal syndrome is over, and classically occur in clear consciousness.

Treatment:Treatment:1. Detoxification:

This is the treatment of alcohol withdrawal symptoms i.e., symptoms produced by the removal of the “toxin” (alcohol). The usual duration.

The drugs of choice are benzodiazepines.

These drugs dosage steadily decreasing every day before being stopped, usually on the tenth day.

Treatment:Treatment:Treatment of alcohol dependence:

Behaviour therapy (The most commonly used behaviour therapy is aversion therapy)

PsychotherapyGroup therapyDeterrent agents (like disulfiram, citrated calcium carbamide, animal charcoal , etc)

Anti-craving agents: Ex: Acamprosate, Naltrexone, Fluoxetine etc.

Psychosocial rehabilitation

Nursing diagnosisNursing diagnosisAlteration in mood and

perception due to drug abuse Alteration in thought process and

familial interactionAlteration in nutritional statusAltered social relationship and

behaviour pattern Potential complication for liver

cirrhosis, and stroke

SUMMARYSUMMARY

Here with we have seen about the alcohol abuse and associated disorders and its types , phases , etiology, complications, and treatment methods and nursing diagnosis.

Thank you Thank you