SHANKARACHARYA SWAMI

SWAROOPANAD
COLLEGE OF NURSING,
JUNWANI, BHIALI
SUBJECT:- MENTAL HEALTH NURSING
SEMINAR ON :- “ALCOHOLISM”

SUBMITTED TO :- SUBMITTED BY :-

PROF. MRS. VINEETA SATYA KUMAR MISS STRELLA WILLSON

SHANKARACHARYA SWAMI SHANKARACHARYA SWAMI
SWAROOPANAD COLLEGE OF NURSING, SWAROOPANAD COLLEGE OF NURSING,
JUNWANI, BHIALI JUNWANI, BHIALI

MSC NURSING 1ST YEAR

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-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.

DEFINITION:

ACCORDING TO AMERICAN PSYCHIATRIC ASSOCIATION

Alcohol abuse, or alcohol use disorder (AUD,) is a medical condition in which a person

continues to consume alcohol despite the adverse consequences.

ACCORDING TO KP NEERAJA

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.

ACCORDING TO R.SREEVANI

A chronic disease in which a person craves drinks that contain alcohol and is unable to control

his or her drinking. A person with this disease also needs to drink greater amounts to get the

same effect and has withdrawal symptoms after stopping alcohol use.

.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.

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 USE:- CHRONIC DEPENDENCE:-

Alcohol Use that has become habitual and compulsive

despite negative health social effect.

Beneficial use

Use that has positive health, spiritual, or Problematic use:-

social impact. Use that begins to have negative

consequences for individual, friends or

society.

CAUSES OF ALCOHALISM:-

 Genetic

 Psychological

 Social
  environmental factors

Over time, drinking too much alcohol may change the normal function of the areas of your

brain associated with the experience of pleasure, judgment and the ability to exercise control

over your behavior. This may result in craving alcohol to try to restore good feelings or

reduce negative ones.

RISK FACTORS:-

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s

and 30s, though it can start at any age.

 Steady drinking over time. Drinking too much on a regular basis for an extended period or

binge drinking on a regular basis can lead to alcohol-related problems or alcohol use

disorder.

 Starting at an early age. People who begin drinking — especially binge drinking — at an

early age are at a higher risk of alcohol use disorder.

 Family history. The risk of alcohol use disorder is higher for people who have a parent or

other close relative who has problems with alcohol. This may be influenced by genetic

factors.

 Depression and other mental health problems. It's common for people with a mental

health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have

problems with alcohol or other substances.

 History of trauma. People with a history of emotional or other trauma are at increased risk

of alcohol use disorder.

 Having bariatric surgery. Some research studies indicate that having bariatric surgery may

increase the risk of developing alcohol use disorder or of relapsing after recovering from

alcohol use disorder.

 Social and cultural factors. Having friends or a close partner who drinks regularly could

increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes

portrayed in the media also may send the message that it's OK to drink too much. For young

people, the influence of parents, peers and other role models can impact risk.

 Are a young adult experiencing peer pressure

 Have low self-esteem

 Experience a high level of stress

 Live in a family or culture where alcohol use is common and accepted

 Have a close relative with alcohol use disorder

PROCESS OF ALCOHOLISM:-

1. Experimental phase

2. Crucial phase

3. Chronic phase

4. Rehabilitative phase

5. Road for recovery

PHASE OF ALCOHALISM:-

1. PHASE I:-

Abusive drinking enlargement of all stasis kindling.

2. PHASE II

Dependence. .

1) PHASE III

a) PHASE Imia

Repeated withdrawal sensitization of negative symptoms

Craving during withdrawal.

b) PHASE III B

Reputed stress sensitization of negative symptoms during sobriety

Craving during sobriety

STAGES OF ALCOHOLIAM

Alcohol use that turns into a use disorder develops in stages.

 At-risk stage: This is when you drink socially or drink to relieve stress or to feel better.

You may start to develop a tolerance for alcohol.

 Early alcohol use disorder: In this stage, you have progressed to blackouts, drinking

alone or in secret, and thinking about alcohol a lot.

  Mid-stage alcohol use disorder: Your alcohol use is now out of control and causes

problems with daily life (work, family, financial, physical and mental health). Organ

damage can be seen on lab tests and scans.

 End-stage alcohol use disorder: Drinking is now the main focus of your life, to the

exclusion of food, intimacy, health and happiness. Despair, complications of organ

damage and death are now close.

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:-

 Blacking out or not remembering things that happened.

 Continuing to drink even if it causes distress or harm to you or others.

 Drinking more or longer than you planned.

 Feeling irritable or cranky when you’re not drinking.

 Frequent hangover
  Getting into dangerous situations when you’re drinking (for example, driving, having

unsafe sex or falling).

 Giving up activities so you can drink.

 Having cravings for alcohol.

 Having repeated problems with work, school, relationships or the law because of

drinking.

 Needing to drink more and more to get the same effect.

 Not being able to stop drinking once you’ve started.

 Spending a lot of time drinking or recovering from drinking.

 Wanting to cut back but not being able to.

 Obsessing over alcohol.

A person with alcohol use disorder also might experience symptoms of withdrawal when

they cut back or stop drinking, such as:

 Anxiety

 Depression.

 Irritability.

 Nausea, dry heaves.

 Racing heart.

 Restlessness.

 Shakiness.

 Sweating

 Trouble sleeping
  Seizures.

 Seeing things that aren’t there (hallucinations).

 Delirium tremens

 Coma and death.

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 develops during or shortly after alcohol

ingestion.

Characterized 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

vi. gait

vii. 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 withdrawal symptoms.

These are:

i. delirium tremens- it occur usually within 2-4 days of complete or significant

abstinence from heavy drinking.

ii. Mild tremors

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 amnesic disorders.

This condition is divided into,

WERNICKE’S SYNDROME- characterized by

 Prominent cerebella ataxia

 Palsy of 6th cranial nerve

 Peripheral neuropathy

 Mental confusion
 KORSAKOFF’S SYNDROME- characterized by

 Gross memory disturbance

 Disorientation

 Confusion

 Confabulation

 Impaired attention

4) ALCOHAL INDUCED PSYCHIATRIC DISORDER:-

Alcohol induced It is long term complication of alcohol abuse, characterized by global

dementia decrease in cognitive 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 disorder Alcoholic report panic attacks during acute withdrawal

Suicidal behavior Suicidal rates are higher in alcoholic when compared to non alcoholics

of the same age. The risk factor for suicidal behavior are continued

drinking, co morbid major depression, serious medical illness,

unemployment and poor social support.

Impaired Erectile dysfunction, delayed ejaculation

psychosexual

function

Pathological Excessive drinkers may develop an overvalues idea or delusion that

jealousy the partner is being unfaithful

Alcoholic seizure Tonic clonic seizure

 Alcoholic Auditory hallucination,

hallucination

COMPLICATION:-

CARDIOPULMONARY COMPLICATION-

 Arrhythmias

 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 ALCOHOL DEPENDENCE:-

 Insomnia

 dementia

 suicide

DIAGNOSTIC EVALUATION:-
  History collection

 Mental status examination

 Physical examination

 Neurological examination

 CAGE questionnaires

 Michigan alcohol screening test

 Alcohol 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) ANTABUSE THERAPY:-
  Deterrents agents are given to desensitize the individual to the effects of alcohol and

abstinence. The most common drugs is disulfiram used for alcohol 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 training

5) NURSING MANAGEMENT:-

RECOGINIZATION OF ALCOHAL ABUSE USING CAGE

C- have you ever felt you caught 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 direst 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.

 Withdrawal symptoms after admission

 Alcohol related physical disorder.

 Repeated 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 alcohol dependence syndrome,

introduction,definition,properties,concentration,epidemiology,types,spectrum,causes, risk factor,

process,phases,psychopathology,clinical feature, ICD10criteria for alcohol dependence,

psychiatric disorder due to alcohol dependence, complication, diagnostic evaluation,

management.

CONCLUSION-:

Alcohol is not an ordinary commodity. While it carries connotations of pleasure and sociability

in the minds of many, harmful consequences of its use are diverse and widespread

From a global perspective, in order to reduce the harm caused by alcohol, policies need to take

into account specific situations in different societies. Average volumes consumed and patterns of

drinking are two dimensions of alcohol consumption that need to be considered in efforts to

reduce the burden of alcohol-related problems. Avoiding the combination of drinking and

driving is an example of measures that can reduce the health burden of alcohol.

Worldwide, alcohol takes an enormous toll on lives and communities, especially in developing

countries and its contribution to the overall burden of disease is expected to increase in the

future. Particularly worrying trends are the increases in the average amount of alcohol consumed

per person in countries such as China and India and the more harmful and risky drinking patterns

among young people.

National monitoring systems need to be developed to keep track of alcohol consumption and its

consequences, and to raise awareness amongst the public and policy-makers. It is up to both

governments and concerned citizens to encourage debate and formulate effective public health

policies that minimize the harm caused by alcohol.

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the Goals of Psychoanalysis “international journal of alcohal abuse”

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s: An Overview of a Thirteen Year Analysis.

 “international journal of alcohal abuse”

 www.webmd .alcohol abuse.com.

 www.healthline .com.

 www.myoclinic .com.

 Https:\\psychocentral.com.

 https:\\ alcohol abuse counseling resources.com

 https:\\alcohal abuse alternative therapy.com