INDEX
CONTENT
S.N PAGE
O NO.
1. INTRODUCTION
2. DEFINITION
3. PROPERTIES OF ALCOHAL
4. STRUCTURE OF PERSONALITY
5. AIM
6. GOAL
7. INDICATION
8. CONTRAINDICATION
9. LIMITATION
10. TECHNIQUE
11. PROCESS
12. BENEFITS
13. SUMMARY
14. CONCLUSION
15. BIBLIOGRAPHY
INTRODUCTION :-
Alcohol use disorder (which includes a level that's sometimes called
alcoholism) is a pattern of alcohol use that involves problems controlling
your drinking, being preoccupied with alcohol, continuing to use alcohol
even when it causes problems, having to drink more to get the same
effect, or having withdrawal symptoms when you rapidly decrease or
stop drinking.
Unhealthy alcohol use includes any alcohol use that puts your health or
safety at risk or causes other alcohol-related problems. It also includes
binge drinking — a pattern of drinking where a male consumes five or
more drinks within two hours or a female downs at least four drinks
within two hours. Binge drinking causes significant health and safety
risks.
If your pattern of drinking results in repeated significant distress and
problems functioning in your daily life, you likely have alcohol use
disorder. It can range from mild to severe. However, even a mild
disorder can escalate and lead to serious problems, so early treatment is
important Alcohol abuse encompasses a spectrum of
unhealthy alcohol drinking behaviors, ranging from binge
drinking to alcohol dependence, in extreme cases resulting in health
problems for individuals and large scale social problems such
as alcohol-related crimes.
Alcohol abuse was a psychiatric diagnosis in the DSM-IV, and has been
merged with alcohol dependence into alcohol use disorder in the DSM-
5.
Globally, excessive alcohol consumption is the seventh leading risk
factor for both death and the burden of disease and injury. In short,
except for tobacco, alcohol accounts for a higher burden of disease than
any other drug. Alcohol use is a major cause of preventable liver
disease worldwide, and alcoholic liver disease is the main alcohol-
related chronic medical illness. Millions of men and women of all ages,
from adolescents to the elderly, engage in unhealthy drinking in
the United States. Alcohol use disorder can affect people from all walks
of life. There are many factors that play a role in causing someone to
obtain an Alcohol use disorder (AUD), genetics, psychiatric conditions,
trauma, environments, even parental drinking habits.
PROPERTIES OF ALCOHAL:-
Alcohol is a clear color liquid with a strong burning test. The rate of
absorption of alcohol into the bloodstream is more rapid than its
elimination. Absorption of alcohol into the blood stream is slower when
food is present in the stomach. A small amount is excreted through urine
and a small amount is exhaled.
CONCENTRATION OF ALCOHAL IN BLOOD:-
BLOOD ALCOHAL
CONTENT
LIFE THREATNING
Loss of consciousness
Significant risk of death
Danger of life 0.31-0.45%
SEVERE IMPAIRMENT
Speech,memory,driving,
coordination, judgment.
Blackouts
Loss of counsiousness
0.16-0.30%
INCREASED IMPAREMENT
Perceived beneficial effects of
alcohal, such as relaxation, give
way to increasing intoxication.
Increase risk of aggression in
some people.
0.06-0.15%
Attention impairement
EPIDEMIOLOGY:-
Incidence of alcohol dependence is 2% in india. 20-3-% of subject aged
above 15 years are current users of alcohol,nearly 10% of them are
regular or excessive users.
15-30% of patient are developing alcohol related problems and seeking
admission in psychiatric hospitals.
TYPES OF DRINKERS:-
Moderate drinkers:-
Is does not cause much problems physically and mentally
Problem drinkers:-
It cause impaired healthy,family and society.
CASUAL\NON-PROBLEMATIC CHRONIC DEPENDENCE:-
USE:-
Recreational,casual,or other use Use that has become habitual and
that has negligible health or social compulsive despite negative
effects. health social effect.
Beneficial use Problematic use:-
Use that has positive health, Use that begins to have negative
spiritual, or social impact. consequences for individual,
friends or society.
SPECTRUM OF PSYCHOACTIVE SUBSTANCE USE:-
CAUSES OF ALCOHALISM:-
PROCESS OF ALCOHOLISM:-
Experimental phase
Crucial phase
Chronic phase
Rehabilitative phase
Road for recovery
PHASE OF ALCOHALISM:-
1. PHASE I:-
Abusive drinking enlargement of allostasis kinding.
2. PHASE II
Dependence.
1) PHASE III
a) PHASE IIIa
Repeated withdrawal sesnsitization of negative symptoms
Craving during withdrawal.
b) PHASE III B
Repeted stress sensitization of negative symptoms during sobriety
Craving during sobriety
HOW ALCOHAL ATTACK BRAIN:-
PSYCHOPATHOLOGY:
First alcohol affect the forebrain and assaults motor coordination and
decision making
Then alcohol knocks out the midbrain
Finally alcohol betters the brainstem as is affects heart rate, body
temperature, appetite and consciousness
CLINICAL FEATURES OF ALCOHAL DEPENDENCE:-
c) Minor complaints:- malaise, dyspepsia, mood swing or
depression, increased incidence of infection.
d) Poor personal hygiene
e) Untreated injuries (cigarette burns, fractures, bruises that cannot be
fully explained)
f) Secretive behavior ( may attemps to hide disorder or alcohol
supply)
g) Consumption of alcohol containing product (mouthwash, after
shave lotion, hair spray, lighter fluid, body spray,shampoo)
h) Denial of problems
i) Tendency to blame others and rationalize problems.
ICD 10 CRITERIA FOR ALCOHAL DEPENDENCE:-
1) A strong desire to take the substance.
2) Difficulty in controlling substance taking behavior.
3) A physiological withdrawal state.
4) Progressive neglect of alternative pleasure or interest.
PSYCHIATRIC DISORDER DUE ALCOHAL DEPENDENCE:-
1. ACUTE INTOXICATION
2. WITHDRAWAL SYNDROME
3. ALCOHAL INDUCED AMNESTIC DISORDER
4. ALCOHAL INDUCED PSYCHIATRIC DISORDER
1) ACUTE INTOXICATION:- acute intoxication developes during
or shortly after alcohol ingestion.
Chatecterized by,
i. Clinical significant maladaptive behavior or psychosocial changes
ex; inappropriate sexual or aggressive behavior.
ii. Mood liability
iii. Impaired judgment
iv. Slurred speech
v. Unstable gait
vi. Impaired attention
2) WITHDRAWAL SYNDROME:- person who have been drinking
heavily over a prolonged period of time, any rapid decrease in the
amount of alcohol in the body is likely to produce withdrwal
symptoms.
These are:
i. delirium tremens- it occur usually within 2-4 days of complete or
significant abstinence from heavy drinking.
ii. Mild treamors
iii. Nausea
iv. Vomiting
v. Weakness
vi. Irritability
3) ALCOHAL INDUCED AMNESTIC DISORDER:- chronic
alcohol abuse associated with thiamine deficiency (vitamin b) is
the most frequent cause of amnestic disorders.
This condition is divided into,
WERNICKE’S SYNDROME- characterized by
Prominent cerebellar ataxia
Palsy of 6th cranial nerve
Peripheral neuropathy
Mental confusion
KORSAKOFF’S SYNDROME- characterized by
Gross memory disturbance
Disorientation
Confusion
Confabulation
Impared attention
4) ALCOHAL INDUCED PSYCHIATRIC DISORDER:-
Alcohal It is long term complication of alcohal abuse,
induced characterized by global decrease in cognitive
dementia functioning and memory. This disorder tends to
improve with abstinence, but the most of the patient
have permanent disability.
Mood disorder Persistence depression and anxiety
Anxiety Alcoholic report panic attacks during acute
disorder withdrawal
Suicidal Suicidal rates are higher in alcoholic when compared
behaviour to non alcoholics of the same age. The risk factor for
suicidal beaviour are continued drinking, comorbid
majaor depression, serious medical illness,
unemployment and poor social support.
Impaired Erectile dysfunction, delayed ejaculation
psychosexual
function
Pathological Excessive drinkers may develop an overvalues idea
jealousy or delusion that the partner is being unfaithful
Alcoholic Tonic clonic seizure
seizure
Alcoholic Auditory hallucination,
hallucination
COMPLICATION:-
CARDIOPULMONARY COMPLICATION-
Arrythmias
Cardiomyopathy
Essential hypertension
COPD
Pneumonia
GI COMPLICATION-
Chronic diarrhea
Esophagitis
Esophageal cancer
Esophageal varices
Gastritis
Gi bleeding
Malabsorption
Pancreatitis
HEPATIC COMPLICATION-
Alcoholic hepatitis
Cirrhosis
Fatty liver
NEUROLOGICAL COMPLICATION-
Dementia
Delirium
Hallucination
Peripheral neuropathy
Seizure
PSYCHIATRIC COMPLICATION-
Depression
Anxiety
Suicidal tendency
Multiple substance abuse
Impaired social functioning
COMPLICATION FROM ALCOHAL DEPENDENCE:-
Insomnia
dementia
sucide
DIAGNOSTIC EVALUATION:-
History collection
Mental status examination
Physical examination
Neurological examination
CAGE questionnaires
Michigan alcohal screening test
Alcohal use disorder identification tests
Serum electrolyte
LFT
MANAGEMENT :-
1) MEDICAL MANAGEMENT-
Symptomatic treatment
Fluid replacement therapy
Iv glucose to prevent hypoglycemia
Correction of hyponatremia
2) PHARMACOLOGICAL MANAGEMENT-
Drug choice are benzodiazepines
Vitamin b
Anticonvulsant
3) ALCOHAL DETERENT THERAPY:-
Deterents agents are given to desensitize the individual to the
effects of alcohal and abstinence. The most common drugs is
disulfiram used for alcohal dependence syndrome.
4) PSYCHOLOGICAL MANAGEMENT:-
Motivational interview
Group therapy
Aversive conditioning
Cognitive therapy
Relapse prevention technique- this technique helps the pt. to
identify high risk relapse factor and develop strategies to deal with
them
Cue exposure technique
Assertive traning
5) NURSING MANAGEMENT:-
RECOGINIZATION OF ALCOHAL ABUSE USING CAGE
C- have you ever felt you cought by criticizing your drinking?
A – have people annoyed you by criticizing your drinking?
G – have you ever felt guilty about your drinking?
E – have you ever had drinks dirst thing in the morning to steady your
nerves or get rid of hangover?
Be suspicious about risk factor like
marriage,
Family work
Finances
If at risk factor raise suspicion, the next step is to ask tactful but
persistent question to confirm diagnosis.
Certain clinical signs lead to the suspicion that drugs are being
injected: needle tract thrombosed veins, wearing garments with
long sleeves.
At risk occupation.
Withdrwal symptoms after admission
Alcohal related physical disorder.
Repeted accident.
Deliberate self harm.
Identify type of substance the person using.
Note of any suicidal ideation or intent, with drained symptoms.
Assess for level of motivation for treatment.
Identify reason for admission.
Laboratory test
SUMMARY-:
So now I am summarize my topic alcohal abuse, introduction,
definition,topography of mind, structure of
personality,aims,goals,indication,contraindication,limitation,risk,
preparation,techniques,duration,process,benefits,effectiveness,role of
nurse in psychoanalytic therapy.
BIBLIOGRAPHY-:
“Kp neeraja” a text book of mental health nursing “published by
jaypee”
“Sreevani R” a text book of mental health nursing “published by
jaypee”
“G konnur” a textbook of psychiatric nursing “published by japee
brother”
Blass, R. B. "On Ethical Issues at the Foundation of the Debate Ov
er the Goals of Psychoanalysis “international journal of alcohal
abuse”
Lombardi, R. "Mental Models and Language Registers in the Psyc
hoanalysis of Psychosis: An Overview of a Thirteen Year
Analysis.
“international journal of alcohal abuse”
www.webmd .alcohal abuse.com.
www.healthline .com.
www.myoclinic .com.
Https:\\psychocentral.com.
https:\\ alcohal abusecounseling resources.com
https:\\alcohal abuse alternative therapy.com
