ALCOHOLISM

SATINDER PAUL KAUR LECTURER PSYCHIATRIC NURSING

DEFINITIONS
DRUG USE:
ANY TAKING OF DRUG.

DRUG ABUSE:

PERSISTENT OR SPORADIC DRUG USE INCONSISTENT WITH OR UNRELATED TO ACCEPTABLE MEDICAL PRACTICE.

ALCOHOLISM
A CHRONIC DISEASE MANIFESTED BY REPEATED DRINKING THAT PRODUCES INJURY TO THE DRINKERS HEALTH OR HIS SOCIAL OR ECONOMIC FUNCTIONING.

DEPENDENCE
CONDITION OCCURING WHEN INDIVIDUALS EXHIBIT A SET OF BEHAVIOURS ASSOCIATED WITH INABILITY TO CONTROL USE OF A DRUG OR ALCOHOL.

CRAVING
STRONG, OVERPOWERING URGE FOR DRUGS/ ALCOHOL FELT BY AN INDIVIDUAL WHO ABUSES IT.

TOLERANCE
AQUIRED RESISTENCE TO THE EFFECTS OF THE DRUGS.

WITHDRAWAL
CONDITION OCCURING WHEN
CESSATION OF DRUG USE RESULTS IN A DRUG-SPECIFIC SET OF SYMPTOMS THAT WOULD BE RELIEVED BY ADDITIONAL DOSES OF THE DRUG/ALCOHOL.

A STATE, PSYCHIC & USUALLY ALSO PHYSICAL, RESULTING FROM TAKING ALCOHOL,CHARACTERISED BY BEHAVIOURAL & OTHER RESPONSES THAT ALWAYS INCLUDE A COMPULSION TO TAKE ALCOHOL ON A CONTINUOUS OR PERIODIC BASIS IN ORDER TO EXPERIENCE ITS PSYCHIC EFFECTS & SOMETIMES TO AVOID DISCOMFORT OF ITS ABSENCE, TOLERENCE MAY OR MAY NOT BE PRESENT.

ALCOHOL DEPENDENCE SYNDROME

EPIDEMIOLOGY
MOST COMMON PSYCHIATRIC
DISORDER 20-40% PEOPLE ABOVE 15YEARS ARE ALCOHOLICS 15-30% ADMITTED IN PSYCHIATRIC EMERGENCY MORE IN MALES MORE IN LOW SOCIOECONOMIC STATUS

COMORBIDITY
ANTISOCIAL PERSONALITY
DISORDER MOOD DISORDERS ANXIETY DISORDERS SUICIDE

CAUSES
BIOLOGICAL

PSYCHOLOGICAL

FACTORS: PSYCHODYNAMIC THEORIES PSYCHIATRIC DISORDERS PERSONALITY FACTORS POOR COPING

FACTORS: GENETIC FACTORS BIOCHEMICAL FACTORS PHYSICAL DEFICIETS FATIGUE

CAUSES
SOCIOCULTURAL FACTORS PEER PRESSURE STATUS SYMBOL SOCIAL
GATHERINGS AVAILABILITY UNEMPLOYMENT INJUSTICE

BEHAVIORAL & LEARNING FACTORS:

ROLE MODELLING

PROCESS OF DEVELOPMENT
EXPERIMENTAL RECREATIONAL RELAXATIONAL COMPULSIVE

STAGES OF ALCOHOLISM
EARLY STAGE
-INCREASED TOLERANCE -BLACKOUTS -PREOCCUPATION

MIDDLE STAGE
-PERIODS OF ABSTINENCE FOLLOWED BY OBSESSIVE DRINKING CHRONIC STAGE -GETTING DRUNK EVEN ON SMALL AMOUNTS -LIES,BEGS,BORROWS OR STEALS TO GET ALCOHOL -ALCOHOL TAKES PRIORITY OVER FAMILY OR JOB

METABOLISM
ALCOHOL
ALCOHOL DEHYDROGENASE

ACETALDEHYDE
ALDEHYDE DEHYDROGENASE

ACETIC ACID

G-I EFFECTS DYSPEPSIA VOMITING GASTRITIS PEPTIC ULCER CANCER PANCREATITIS MALABSORPTION

PHYSICAL EFFECTS

LIVER FATTY DEGENERATION ALCOHOLIC HEPATITIS HEPATIC CIRRHOSIS

CARDIOVASCULAR MUSCLES -MUSCLE -HIGH BP

-CARDIOMYOPATHY -HIGH RISK FOR MI -FOLIC ACID DEFICIENCY ANAEMIA -LESS WBC PRODUCTION

WEAKNESS -MUSCLE WASTING

REPRODUCTIVE SYSTEM
-SEXUAL DYSFUNCTION -FAILURE OF OVULATION

NERVOUS SYSTEM
ALCOHOLIC PERIPHERAL
NEUROPATHY WERNICKES-KORSAKOFF SYNDROME RUM FITS DURING WITHDRAWAL

OTHER EFFECTS
LOOSENED THOUGHT &
JUDGEMENT RESPIRATORY DEPRESSION DECREASE IN REM SLEEP SLEEP FRAGMENTATION

HYPOGLYCEMEA

PSYCHIATRIC EFFECTS
ALCOHOL INDUCED DELIRIUM ALCOHOL INDUCED DEMENTIA AMNESTIC DISORDER PSYCHOTIC DISORDER MOOD DISORDER ANXIETY DISORDER SEXUAL DYSFUNCTION SLEEP DISORDER DELIRIUM TREMENS OTHELLO SYNDROME

SOCIAL EFFECTS

WORK PROBLEMS FAMILY PROBLEMS ACCIDENTS DELINQUENCY IN OFFSPRINGS

 RECENT INGESTION OF ALCOHOL MALADAPTIVE BEHAVIOUR OR

PSYCHOLOGICAL CHANGES ONE OR MORE OUT OF THESE: -SLURRED SPEECH -INCOORDINATION -UNSTEADY GAIT -NYSTAGMUS

SIGNS OF INTOXICATION

-IMPAIRMENT IN ATTENTION OR
MEMORY -STUPOR OR COMA SYMPTOMS ARE NOT DUE TO ANY MENTAL OR PHYSICAL DISORDER

SIGNS OF WITHDRAWAL
CESSATION OF PROLONGED
ALCOHOL USE 2 OR MORE OF THESE: -AUTONOMIC HYPERACTIVITY -INCREASED HAND TREMOR -INSOMNIA -NAUSEA OR VOMITING -HALLUCINATIONS OR ILLUSIONS -PSYCHOMOTOR AGITATION

-ANXIETY -SEIZURES SYMPTOMS INTERFERE SIGNIFICANTLY WITH SOCIAL, OCCUPATIONAL OR OTHER AREAS SYMPTOMS ARE NOT DUE TO ANY MENTAL OR PHYSICAL DISORDER

 PSYCHOLOGICAL METHODS:
-COUNSELLING -INDIVIDUAL & GROUP PSYCHOTHERAPY -FAMILY/ MARITAL PSYCHOTHERAPY PHYSICAL METHODS: -DETOXIFICATION -AVERSION THERAPY -MEDICATION THERAPY

TREATMENT

REHABILITATION
SELF HELP GROUPS
-ALCOHOL ANONYMOUS -AL ANON COMMUNITY INVOLVEMENT

NURSING MANAGEMENT