ITS FOR THE NURSING STUDENTS

1. ALCOHOLISM
Unit-ix

2. INTRODUCTION
ALCOHOL:
The word alcohol is derived from the Arabic word “Alkuhl”
meaning “essence’. Alcohol is the number one problem in most
countries of world, including India. The use of alcoholic
beverages to the point of causing damage to the individual,
society or both.
Alcohol is part of our society. People use it to celebrate,
socialize, relax, and enhance the enjoyment of meals. In de-
addiction centers, almost 95% of these people are brought by
family members. Nearly 88 percent of people in India report that
they drank alcohol at some point in their lifetime.
Alcohol Abuse:
It means having unhealthy or dangerous drinking habits
such as drinking every day or drinking too much at a time.
Alcohol abuse can harm relationships, cause to miss work and
can lead to legal problem such as driving while drunk.

3. DEFINITION
Alcoholism is defined as chronic dependence characterized by
compulsive drinking of alcohol to such degree that it produces
mental disturbance interferes with social economics functioning.
Major signs of the addiction are increasing consumption
,Sneaking and gulping drinks , morning drinking ,excessive
drinking when alone , Confusion and tremors, uninhibited
behavior and severe withdraw symptoms.
- Bimala kap
Alcoholism is defined as chronic disease manifested by
repeating drinking that produced injury to the drinkers health or
to his social , economic functioning.
-S. Nambi

4. FIGURE:SHOW THE ENJOYMENT OF ALCOHOLISM
Causes of Alcoholism
1. Biological Factors
Genetic Vulnerability: Family history of alcohol use
disorder.
Co- morbid psychiatric disorder or personality disorder.
Co –morbid medical disorders.
Personality factors: Alcoholism is more common in anxiety
and antisocial personalities.
Withdrawal effect and craving.

5. Biochemical factors: A genetically determined deficiency
of brain neurotransmitters (endorphins) predisposes as
individual to alcoholism.
2. Psychological Factors
Curiosity
Early initiation of alcohol
Poor impulse control
Low- self esteem
Concerns regarding personal autonomy
Poor stress management skills
Childhood trauma or loss.
Lack of interest in conventional goals.
Psychological distress
Poor coping strategies: The person unable to face stress
often resort to alcoholism.
Psychiatric disorders: Some patients with depressive
disorders take alcohol in the mistaken hope that it will
alleviate low mood.
3. Social Factors
Peer pressure
Modeling : imitating behavior of important others

6. Easily availability of alcohol
Intrafamilial conflicts
Religious region
Poor family /social support
Availability: Alcohol is easily available and drinking is
accepted as a norm in functions and social gathering.
Isolation , Unemployment, loss, injustice.
High risk groups: Person suffering from chronic physical
illness, business executives, travelling salesperson,
industrial workers, military personal, commercial travelers.
Broken or disturb family member.
ClinicalFeatures
1. Physical problems:
 Bloodshot eyes
 Thin hair
 Jaundice
 Anaemia
 Liver damage
 Abdominal pain and bleeding
 Cirrhosis of liver
 Sexual dysfunction

7.  Accidents or injuries due to alcohol use.
 Edema of foot
 Acute and chronic gastritis
 wasting of muscles due to poor nutrition and by absorption.
 Failure of ovulation in female.
2. Psychiatric symptoms / Mental Problems
 Personality and image changes
 Irritability
 Loss of concentration
 Depression
 Loss of memory
 Fits ,irresponsible
 Alcoholic psychosis- if drinking for a long time in large
quantities.
3. Social Problems
 Fight, quarrel and trouble with other.
 Loss of work
 Money spent on alcohol
 Breakdown of family relationship
 Violent towards children and family
 Divorce

8.  Suicide
 Financial problem
 Criminality occasionally
Diagnosis of Alcoholism
I. History taking about the genetic influence, other stressful
situation and predisposing factors along with features.
II. Physical examination from head to toe to find out the
physical problems
III. Blood test for HB%,TC, DC , RBC, WBC, liver function
test ,Thyroid function test , Serum magnesium test, Urine
microscopic examination, and other related test.
I. Asking CAGE questionnaire to screen alcohol dependence.
C- Have you ever had to cut down on alcohol
(amount?)
A- Have you ever been annoyed by people’s criticism
of alcoholism.
G- Have you ever feel Guilty about drinking.
E- Have you ever needed an Eye opener drink (early
morning drinking)?
A score of 2 or more identifies problem drinkers.

9. Treatment
Treatment can be divided into two categories:
1. Detoxification
Detoxification or detoxication is the physiological or
medicinal removal of toxic substances from a living
organism, including the human body, which is mainly
carried out by the liver. Additionally, it can refer to the
period of withdrawal during which an organism returns to
homeostasis after long-term use of an addictive substance.
 The aim of detoxification is the symptomatic management
of the emergent withdrawal symptoms.
 The drugs of choice for detoxification are usually
benzodiazepines e.g. Chlordiazepoxide (80 to 2oomg/day
in divided doses) are the most frequently used.
 In addition, Vitamins should also be administered e.g.
Vitamin B6, B1, etc.
 The Care of hydration is another important step.
2. Treatment of alcohol depending
 Behavior therapy such as aversion therapy or covert
sensitization.

10.  Psychotherapy such as individual psychotherapy.
 Group therapy such as Alcohol Anonymous.
 Anti craving agent such as flouxetine, naltrexone.
 Other medicines
 If depression present –anti depressant drugs can be given.
 Psychosocial rehabilitation should be done after the
treatment is over.
Nursing care of Clients with Alcohol Dependence
Assessment
 Sleeplessness ,restlessness
 Fluid and electrolyte imbalance
 Confusion , disorientation
 Suicidal behavior
 Delirium tremens
 Additional physical health problems such as liver failure
,GI bleeding , etc
Nursing Diagnosis
 Impaired verbal communication related to mental
confusion.
 Ineffective health maintenance related to lack of self care.

11.  Anxiety related to feeling of inadequacy /inability to deal
with responsibility.
 Risk for violence: Self directed or other directed related to
intake of mind altering substance.
 Potential for injury to self and other related to aggressive
behavior.
 Altered nutritional state related poor eating patterns
/chronic alcohol intake.
 Disturbance in balance of rest, sleep and activity related to
alcohol withdrawal.
Planning/Implementation
 Supervise and prevent injury; institute seizure precaution
during withdrawal.
 Monitor for CNS and respiratory depression if intoxicated.
 Provide support without criticism or judgment.
 Administer prescribed medicines that support nutritional
status and limits signs and symptoms of withdrawal.
 Provide support during alcohol withdrawal delirium.
 Provide support during hallucination and illusion occur;
stay with client ; point out reality.

12.  Monitor visitors because they may supply the client with
alcohol.
 Provide a well –controlled, alcohol free environment;
explain unit routines.
 Plan a full program of activities but provide for adequate
rest: environment should be well lit and quiet.
 Avoid attempting to talk client out of the problem or
making client feel guilty.
 Accept hostility and acting out behaviours without criticism
or relation; set appropriate limits if hostility is physical or
escalates.
 Recognize ambivalence and limit the need for decision
making.
 Maintain the client’s interest in a therapy program.
 Provide education on alcohol as a disease with negative
effects on physical and mental health.
 Provide family counseling and refer to self– help groups to
address effects of drinking and sobriety on family.
 Maintain appropriate hydration and nutrition.
 Teach the anxiety relieving methods; involve the patient in
relaxation therapy.

13.  Involve the patient in group interaction.
Evaluation
 Decreased risk for violence and self injury.
 Homeostasis is maintained.
 Involves in interaction with group members and society.
Complication
a. Physical complications of alcoholism
 Gastro- intestinal system
High concentration of alcohol causes
↓
Increased secretion of gastric juices leads to inflammation
of mucosa (gastritis)
↓
It produces direct erosion of the stomach mucosa which
results malabsorption syndrome as vitamin deficiency of A,
D, K and thiamine.
↓
Symptoms occur as heartburn, reflux oesophagitis, diarrhea,
decrease absorption, etc.
 On liver
Excessive drinking affect liver .

14. ↓
Liver changes alcohol into highly toxic compound i.e.
acetaldehyde.
↓
Which damage the liver in a toxic form.
↓
Causes liver disease such as alcoholic hepatitis, alcoholic
cirrhosis .
 On Pancreas :
Heavy drinking of alcohol damage pancreas which produces the
hormones that regulate metabolism and enzymes that help digest
fats, proteins and carbohydrates
 On heart :
Effect of alcohol on the heart.
↓
Accumulation of lipids in the myocardial cells.
↓
Resulting in enlargement and weakened condition.
↓

15. Effect of toxic on heart muscle cells, weak to pump
efficiently.
↓
Symptoms of alcoholic cardiomyopathy, result of heart
failure
 Alcohol and diabetes :
Alcohol contributes to calories and upset the
dietary regulation. It blocks the production of glucose by the
liver, which can cause symptoms of low blood sugar, or
hypoglycemia.
 Alcohol and HIV Infection:
It leads to unproductive sex and high risk of unhealthy
behavior. E.g. not using condom , sex with multiple partners,
unwanted pregnancy , etc.
 Alcohol induced fractures :
Excessive alcohol intake increases the risk of fractures due to
fall , lead to increased skeletal fragility and increase the risk
of fractures.
 Sexual dysfunction :

16. It interferes with the normal production and maintenance of
male and female hormones .In female, changes in
menstrual cycles and a decreased hormones levels result in
decreased sexual performance and diminished libido
(sexual desire or drive). In male, erectile dysfunction
 Alcohol and pregnancy :
It is directly toxic to the fetus and causes birth
defects as microcephaly, limp and heart defects and mental
retardation. In the last stage of pregnancy, lessen in the amount
of oxygen delivered to the child lead to fetal death and still birth.
 On Nervous system :
Alcohol causes anesthetic (loss of sensation) effect :
- Alcoholic peripheral neuropathy
- Delirium tremens
- Rum fits
- Alcoholic peripheral dementia
- Cerebella degeneration
- Head injury
- Fractures
- Wernicke korsakoff syndrome: A brain disorder involving
loss of specific brain functions due to thiamine deficiency.

17. - Wernicke’s encephalopathy involves damage to multiple
nerves in both the central nervous system and the
peripheral nervous system.
 Nutrition :
- Alcohol irritates the gut wall, leading to inflammation and
ulceration. This can result to poor absorption of nutrients
and poor digestion as Protein malnutrition, vitamin
deficiency disorder like beriberi.
 Anemia :
- It can result from decreased intake of iron, Vitamin B12
and folic acid.
 Leucopenia :
- Production, function and movement of the white blood
cells are impaired in chronic alcoholics.
 Thrombocytopenia:
- Platelet production and survival is impaired as a result
of the toxic effects of alcohol.
b. Psychiatric Complication of Alcohol Abuse
 Pathological Intoxication :
Maladaptive behavioral effects such as fighting
impaired judgment .Physiological signs such as slurred

18. speech, in coordination unsteady gait .Psychological
changes such as mood changes, irritability and impaired
attention.
 Withdrawal Phenomenon:
Withdrawal symptoms are tremor, nausea and
vomiting, malaise, tachycardia, elevated BP, irritability,
anorexia, insomnia, fits.
 Delirium tremens (DT):
Acute confusional state and occurs withdrawal
symptoms 2-4 days. Physical effects may include shaking,
shivering, irregular heart rate, and sweating.
 Alcoholic hallucination :
Vivid hallucinations developing shortly after cessation or
reduction of alcohol . The syndrome consists of persistent
hallucinations which develop within 48 hours of stopping
or decreasing alcohol intake. It may even start while the
patient is continuing to drink. Auditory hallucinations
predominate usually consisting of voice reproachful

19. (scold), threatening and unstructured hallucination continue
sound like that a bee buzz( confused low sound as of
people talking).
 Alcoholic Psychosis :
Person drinking alcohol for a long time and in large
quantities is prone to develop a psychotic disorder which
resembles a paranoid schizophrenia with clinical features
like behavioral problem, thought disturbance, delusions,
hallucination and impairment of primary mental function.
 Morbid Jealousy:
A paranoid disorder with predominal
delusion of infidelity of spouse (suspecting wife’s
character).
 Alcoholism and criminality:
It reduces inhibition and increases hostile behavior hence,
more prone to violence and antisocial behavior.
 Alcoholism and Sex:
It increases the sexual desire but takes away
the performance .Alcoholic males suffer from sexual
dysfunction.

20.  Alcohol amnesic disorder:
Impairment in short and long –term
memory with disorientation and confusion.
 Alcohol dementia :
A chronic organic mental disorder due to
long term alcohol drinking . Irreversible impairment in
memory, orientation , impulse control, ability to solve the
problems, etc.
 Alcohol and Specific Psychiatric illness:
Patients with depression, anxiety and
psychological disorder tend to use alcohol for relief of
mood, anxiety or fear. It actually depressant of the CNS
and more prone to develop depression, attempted suicide,
etc.
c. Social Complicationof alcoholism:
 Work problems:
Decreased work performance, hence
decreased productivity due to chronic absence.
 Family Problems :
It affect whole family; loss of job, loss of
income will make the family condition miserable and

21. caused financial difficulties, conflict divorce, contributing
to domestic violence, damage the emotional development
of the alcohols children, etc
 Legal problem: (criminality)
Increased frequency of accidents (RTA)