A. G. , a 53 year old African American male was admitted for Alcohol Dependence. His Axis I diagnosis was Alcohol Dependence and Alcohol Induced Mood Disorder with Depression. A. G. was admitted to the Mentally Ill and Chemically Addicted (MICA) Unit of Bergen Regional Medical Center on November 20. Upon admission his alcohol level was . 278. The legal level in New Jersey is . 08. ( oade. nd. edu) He stated that he was practically unconscious when he was brought to the ER. He had suicidal ideations and was consequently admitted.
Four days later the patient was calm and it was almost impossible to imagine him as the character in his story. A. G. experienced his first intoxication at the age of 14. He stated that he and his friends drank and smoked pot before attending “house parties” because it would suppress their inhibitions. Eventually he became an alcoholic and developed a high tolerance which made it easier to hide his addiction. The essential nursing role was to empathetic, provide active listening and reinforcement as needed, and assist him in recognizing his triggers so that he may recognize and avoid them.
Alcoholism is a disease that affects 10% of women and 20% of men in the United States. (www. medicinenet. com). The DSM-IV TR diagnosis of alcohol dependence is able to be given when an individual has met three or more of the seven criteria associated with the disorder. The physiological aspects of alcohol dependence are associated with a much greater potential for medical problems such as acute alcohol withdrawal. The first criteria usually associated with alcohol dependence are considered to be tolerance and alcohol withdrawal.
The other criteria usually are seen as behavioral and cognitive aspects of alcohol dependence. These may include alcohol use becomes incredibly important to the client, including spending a great deal of time drinking, recovering from its effects, or when important social and occupational activities are given up or reduced because of drinking. These are all key measures in the diagnosis of alcohol dependence. Diagnosis of alcohol dependence can be difficult as the tolerance increases.
Behavioral habits and mood changes are often the indicators of alcohol dependence. Blood alcohol level is frequently used to measure intoxication. As the level of intoxication increases, an individual will experience marked deficits in coordination, psychomotor skills, decreased attention, ataxia, impaired judgment, slurred speech and a great variability of mood. Severe alcohol intoxication includes a lack of coordination, incoherent thoughts, confusion, nausea and vomiting, which frequently is observed at blood alcohol levels between 0.
20 and 0. 30. However, some heavy drinkers are still able to perform seemingly normal at these higher blood alcohol levels due to their increased tolerance. When blood alcohol levels measures between 0. 30 and 0. 40, stupor and loss of consciousness often occur. Beyond this level, many individuals experience coma, respiratory depression and even death. Risk factors for developing a drinking problem include depression, anxiety, or another mood problem in the individual, as well as having parents with alcoholism.
Low self-esteem and feeling out of place are other risk factors for developing alcohol dependence. Both men and women are more likely to develop alcoholism if they have a childhood history of being physically or sexually abused. Children and teens who have their first drink of alcohol between 11 and 14 years old are more at risk for developing a drinking problem than those who do so when either younger or older. Alcohol-dependent patients also experience craving, defined as the conscious desire or urge to drink alcohol.
This craving has been linked to dopaminergic and serotonergic systems. Long-term use of alcohol makes it necessity to relieve chronic stress and dysphoria. Chronic excessive alcohol consumption can negatively affect virtually every organ system. Specific examples of alcohol-abuse effects on the body include poor coordination, thiamine deficiency, hypertension and irregular heartbeat, reproductive problems like impotence and irregular menses. The main complications often result in gastrointestinal problems, such as cirrhosis of the liver and pancreatitis.
Alcohol-abuse effects on the brain include, but are not limited to, strokes, confusion, and amnesia. Alcohol dependence can also bring on mood disorders accompanied by depression. Alcohol induced mood disorders are usually characterized by a depressed mood and lack of interest in normal activities, as well as the client having and extremely irritable mood. This may develop after heavy drinking and symptoms may occur during episodes of alcohol intoxication or withdrawal. Approximately 10%-15% of people with alcoholism tend to commit suicide.
The client, A. G., also has a left prosthesis below the knee which he credits to the alcoholism. When he was about 35 years of age he became so intoxicated one night that he was struck by a car. He is not even sure how the accident occurred but he ended up in a coma for two days and lost his left leg right below the knee. His Axis III diagnosis is pain above the knee. He was taken to Kessler to have his prostheses adjusted which improved the knee pain. The client stated that he then experienced a sober 7 year period. All was going well until he was faced with stressors that caused him to relapse.
His current medications include Librium 2X2mg every 6 hours, Folic Acid 1 mg daily, Thiamine HCL 100mg daily, multivitamin 1 tablet daily with food or milk, Motrin 600mg every 6 hours as needed for pain, and Aluminum and Magnesium Hydroxide as needed. The client was alert and oriented to person, place and time. He appeared in good spirits and his vital signs were within normal limits. His gait had a slight limp due to his prosthesis on the left leg. The client was able to perform independent activities of daily living.
He was active and aware of his disease and expressed the desire to get sober. In the MICA unit his treatment includes group therapy in order to promote social interaction in an alcohol/substance free environment and psychotherapy. There are currently more drugs available to treat clients with alcoholism. Some are Naltrexone (Trexan, Revia), Acamprosate (Campral), Topiramate (Topamax), and Disulfiram (Antabuse) (Varcarolis and Halter 2010). A. G. ’s drug therapy includes Librium which works by boosting the brain’s natural calming agent GABA (gamma-aminobutyric acid).
Because of this, Librium can be helpful in controlling some of the symptoms associated with withdrawal from alcohol such as shaking, agitation and delirium tremens (DTs). Besides residential therapy and drug therapy, there is also outpatient therapy, the 12 step program of Alcoholics Anonymous (AA), and alcoholism education (Varcarolis and Halter 2010). As the client prepares for his next phase he is aware that AA meetings will be crucial in his future and in maintaining sobriety when he re-enters society. A. G. hopes to be able to regain custody of one of his sons who is currently in a foster home because he recently lost his mother.
A. G. hopes to find strength to recover and end the vicious cycle of his addiction through his current and future treatments. References http://bestpractice. bmj. com/best-practice/monograph/198/basics/pathophysiology. html http://www. medicinenet. com/alcohol_abuse_and_alcoholism/article. htm http://oade. nd. edu/educate-yourself-alcohol/blood-alcohol-concentration/ http://www. rightdiagnosis. com/a/alcohol_induced_disorders/intro. htm Varcarolis, E. M. , & Jordan Halter, M. (2010). Foundations of Psychiatric Mental Health Nursing (6th ed. ). St. Louis, MO: Saunders