Alcohol Dependence Essay Example

he returned and joined a travel agency for six months. While working as an autodriver, he got into an accident. According to the informant, his brother-in-law spotted him intoxicated on 28/10/09 with physical injuries resulting from a car accident. His last drink was at 12 pm on 28/10/2009, after which he was hospitalized for two months. He then left for Delhi for a job but started drinking again and was brought back to Mangalore.

HISTORY OF PRESENT ILLNESS: The patient's history begins around 12 years ago when he discontinued school in the 9th standard and experienced a failed love affair. He then started working in his father's hotel and began consuming alcohol while delivering tea to a nearby bar. His parents were unaware of his drinking habits for three years. At the age of 17, he began working at Vikram Travels, but would come home intoxicated with 2-3 bottles of alcohol. He did not provide financial support to his parents and would borrow money of Rs 1000-2000 from acquaintances without returning it.

The patient has been unemployed for the past 3 months, although he claims to have a job in a canteen. Additionally, he frequently engages in theft from hotels. A week ago, he left home with the intention of finding work but hasn't returned since. According to him, he completed up to grade 9 but lost interest in studying and instead joined his father's business. This decision caused his girlfriend to leave him. Consequently, he turned to alcohol as a coping mechanism and felt betrayed, which ultimately led him to leave his hometown. He subsequently worked in Mumbai for one year before

returning and joining a travel agency for six months.

Regarding previous psychiatric history, on 29/10/10 the patient was admitted due to a road traffic accident and was readmitted on 17/10/2008 for issues related to alcoholism such as increased talking, elevated self-esteem, grandiose ideas, assertive behavior, irritability, and head injuries. During this admission period, the patient received a diagnosis of BPAD (bipolar affective disorder) and alcoholic dependence syndrome. Treatment included antipsychotic medication as well as disulfiram therapy (250mg). On 25/1/2009 ,the patient experienced vomiting along with irrelevant speech auditory and visual hallucinations,and fearfulness associated with drinking.

The patient was in a car accident, hit by a bus, and did not have alcohol in his system at the time. However, he suffered an injury that caused him to lose consciousness. Sadly, one of the passengers in his car died. Since then, he has been experiencing fear and dreams related to the incident and has difficulty sleeping. He also reported hearing abusive voices from another survivor for about a year. The case is still ongoing in court.
Throughout different stages of his life (at 14 years old, 16 years old, 19 years old, 24 years old, and 25 years old), the patient has had significant experiences including love failure, work tension, car accidents, failure in 7th STD (standard), bipolar affective disorder (BPAD), work overload,
and attention deficit syndrome (ADS). In terms of past medical history,
besides alcohol dependency and tobacco chewing for the past three
years , there are no other significant medical issues known.Unfortunately,
information regarding previous treatments is unavailable.
Currently , the patient is undergoing treatment with various medications:

• Trade name: T.Valium;Generic name:Benzodiazepam;Dosage:10mg;
  Frequency:1-1-4 ;Action:Anxiolytic
• Trade name :Inj trineurosol;Generic name Thaiamin;Dosage :1cc;
  Frequency:OD(5 days);Action Thiaminesupplement
• Trade name Cap
  

benfomet;

Mr.[last name] does not provide any additional information about
the H2 receptor action in terms of his family history.Generic name: Benformet (500mg, BD) is an anti-craving medication. Its trade name is T Rantac, which contains the generic name Rantidine (150mg, OD).

Ramachandra lives with his nuclear family, which has a history of Alcohol Dependence Syndrome (ADS) and suicide. He himself is an alcoholic and tobacco chewer. The family genogram shows the personal history of Mr. Shan kappa, who was born in Mangalore through normal vaginal delivery in a government hospital. There were no reported psychiatric illnesses or complications during pregnancy, such as convulsions, cyanosis, or jaundice. No birth defects were observed either. Mr. Shan kappa is the fourth child.

Mr Shankappa was raised by his mother and breastfed for 7 months. His motor, language, and social development are not delayed, and his developmental milestones are normal for his age. In his childhood, he did not have a history of thumb sucking, nail biting, or head hanging. Regarding education, Mr Shankappa started school at the age of 5 but discontinued his studies in 9th grade due to lack of interest. In terms of play, he enjoyed spending time with his childhood friends and the children in his neighbourhood, particularly playing cricket. He maintained good relationships with his peers.

Occupational history: The patient completed his studies up to the 9th standard but lost interest and dropped out. He then joined his father's business, which caused a breakup with his girlfriend. After that, he spent a year working in Mumbai before returning and working as an autodriver at a travel agency for six months.

Marital

and sexual history: Mr. Shankappa is married but states that he has only had one instance of sexual contact, resulting in him becoming a father to a son.

Pre-morbid personality:

Interpersonal relationship:

Mr. Shankappa has a positive interpersonal relationship with his family and friends, creating and maintaining relationships, trusting others, and handling criticisms. He takes on family responsibilities and tends to be submissive. Overall, he possesses an optimistic mood and a cheerful attitude towards himself. For leisure activities, he enjoys going out with friends, having small picnics, and watching movies, especially love stories. He believes he deserves more in life and respects the values of others. In terms of work and responsibility, Mr. Shankappa's attitude is positive as he takes them seriously.

He possesses a moderate level of decision-making and responsibility-taking skills. In terms of his religious beliefs and moral attitude, he has faith in god and Lord Krishna is his favorite deity. He attends the temple every Friday. As for his fantasy life, he aspires to establish his own travel agency in the future. Regarding his habits, he has been consuming alcohol for 12 years. However, for the past year, he has been experiencing sleep disturbance due to hearing voices. During the physical examination, it was observed that he had a well-nourished appearance with an athletic body build. His overall health is good and his activity level is normal. The assessment also included evaluating his posture.

Body curves: normal, Gait: normal, Skin condition: Colour - wheatish, Texture - dry, Temperature - warm, Lesions - none, Head and face: Scalp - clean, Face - no deformities seen, Eyes - pupils equally reacting,

wears spectacles, Ear - normal and bilateral, Nose - no structural deformity, Mouth - no dentures hygiene is maintained, Neck - normal range of motion and no enlargement of lymph nodes. Chest Thorax - normal bilateral symmetrical expansion, Breath sounds - normal, no wheezing or crepitation heard. Heart - normal, no cardiac murmur. Heart rate 66 beats per second. Respiration: rate—20 per minute.

Blood pressure is 118/74mmHg. Abdomen shows normal bowel sounds, normal appetite, and normal bowel and bladder movements. Extremities have normal range of motion, adequate power and tone, and no visible scars or wounds. Genitals show no significant infections. Central Nervous System (CNS) is conscious, oriented with normal speech.

MENTAL STATUS EXAMINATION GENERAL APPEARANCE & BEHAVIOUR: Mr Ramachandra Nayak is moderately built and moderately nourished. He has bruise marks over his nose and forehead. He maintains hygienic practices and is able to perform self-care activities.

ATTITUDE TOWARDS EXAMINER:

Mr Ramachandra Nayak is somewhat cooperative and interested in conversing with me. In terms of comprehension, he understood and adequately responded to questions. As for gait and posture, he maintains a normal and upright position without any deformities during walking. His motor activity is also normal. In terms of social manners and verbal behavior, Mr Nayak exhibits appropriate manners and maintains good eye contact. Establishing rapport with him was slightly difficult. There were no instances of hallucinatory behavior.

The patient has been experiencing auditory hallucinations of women since the accident. He is capable of speaking and understanding multiple languages, such as English, Tulu, Kannada, Konkani, Tamil, Hindi, and Malayalam. His speech is spontaneous and productive with a high rate. There are no signs of poverty or

pressure in his speech. Although his volume is low, his tone remains normal. The flow and rhythm of his speech are smooth without any stuttering, stammering, circumstantialities, tangentiality, verbigeration, flight of ideas or clang associations.

When asked about his mood and affect he describes feeling good and happy which aligns with his facial expression. His thought process does not show any poverty of thought or thought blockage. The content of his thoughts mainly revolves around Bhajans and verses from the Bhagavadgeetha where he refers to every woman as mother. While he experiences grandiose ideas there are no obsessions or fear of death nor suicidal ideation present. He does not experience any illusions depersonalisation or derealisation nor somatic phenomena.However auditory hallucinations do occur for him.

In terms of cognition he accurately identifies the date as January 20th 2010 correctly locates himself at home.He also accurately identifies the person questioning him as a student studying nursing.

The patient demonstrated intact attention by successfully reciting three digits forward and backward.

Moreover, the patient demonstrated clear focus as they successfully remembered all five items when presented with multiple pictures. Nonetheless, their ability to concentrate appeared to be hindered as they were not able to consistently subtract 3 from 50 accurately. In relation to memory, the patient displayed unimpaired skills in recalling recent occurrences such as breakfast and distant memories like their schooling year. Concerning intelligence, the patient correctly identified the Chief Minister of Karnataka and the capital of Goa. They also provided a reasonably accurate estimation for the distance separating Bangalore and Mangalore. On the whole, their level of intelligence can be deemed average.

ABSTRACT THINKING: Both private travels and

KSRTC provide comfort and speed. However, KSRTC buses are considered safer for traveling while private buses are cheaper and more readily available.
PROVERB TESTING: The proverb "All that glitters is not gold" illustrates the presence of abstract thinking as it implies that someone may appear good on the outside but be bad on the inside.
INSIGHT: When asked why they were admitted, a person responded that it was because they were an alcoholic and causing problems for their family. This response indicates a Grade V level of abstract thinking.
JUDGEMENT: When questioned about what they would do during a road traffic accident, a person said they would call an ambulance using their mobile phone.

Mr Ramachandra Nayak was admitted on 28/10/09 with complaints of a road traffic accident, alcohol dependence, and decreased sleep. He displayed mild memory impairment and grandiose ideas during the mental status examination.

Alcoholism, which is excessive use of alcoholic beverages resulting in harm to the individual or society, is known as alcohol dependence syndrome.

Alcohol is a clear colored liquid with a strong burning taste.

Alcohol is absorbed into the bloodstream faster than it is eliminated. The presence of food in the stomach slows down alcohol absorption. Some alcohol is eliminated through urine and exhalation. Intoxication occurs at a blood concentration of 80 to 100 mg per 100ml. A concentration between 200 mg and 250 mg leads to toxicity, sleepiness, confusion, and altered thought processes. Loss of consciousness may occur at a concentration of 300 mg per 100 ml. Fatalities can occur with concentrations as low as 5 mg per 100 ml. Symptoms experienced vary based on tolerance levels.

The prevalence of alcohol dependence in India is

estimated to be around 2%. Among individuals aged approximately 15 years, the current usage of alcohol ranges from 20% to 40%, with about 10% being regular excessive users. Additionally, between 15% and 30% of patients seeking admission in psychiatric hospitals display alcohol-related problems.

There are various medical and social complications associated with alcohol dependence. From a medical perspective, these complications include gastrointestinal issues such as gastritis, peptic ulcer, reflux esophagitis, stomach and esophageal carcinoma, fatty liver disease, cirrhosis of the liver, hepatitis, and liver cell carcinoma. Acute and chronic pancreatitis as well as malabsorption syndrome are also potential consequences.

The cardiovascular system can also be affected by conditions like alcoholic cardiomyopathy and an increased risk for myocardial infarction. Furthermore, central nervous system complications may manifest as peripheral neuropathy, epilepsy, head injuries or cerebellar degeneration.

In addition to these health concerns, vitamin deficiency disorders may arise along with muscle weakness in peripheral areas of the body. Acne breakouts can occur alongside sexual dysfunction in males and failure of ovulation in females.

Furthermore, there are miscellaneous effects such as damage to a fetus through Fetal Alcohol Syndrome (FAS). FAS includes facial abnormalities, low birth weight, and lower intelligence levels among affected individuals. It is estimated that this condition accounts for about 3% of all cases involving mental retardation.Alcohol dependence can have various negative effects on a social level, such as causing marital disharmony, occupational problems, financial issues, criminal behavior, and accidents. It can also lead to psychiatric disorders like acute intoxication and withdrawal symptoms. Acute intoxication occurs while or shortly after consuming alcohol and is characterized by maladaptive behavior, impaired speech, coordination difficulties, an unsteady gait, involuntary eye movement (nystagmus), decreased

attention and memory. Eventually, it may progress to a state of stupor or coma. Excessive long-term alcohol consumption can also result in withdrawal symptoms when there is a sudden decrease in alcohol levels within the body.

Alcohol withdrawal syndromes come in different forms, including simple withdrawal syndrome and delirium tremens. The simple withdrawal syndrome is characterized by mild symptoms like tremors, nausea, vomiting, weakness, irritability, insomnia, and anxiety. On the other hand, delirium tremens usually occurs 2-4 days after completely or significantly stopping heavy alcohol consumption. It has a short duration with recovery taking place within 3-7 days.
Delirium tremens is marked by intense and rapidly changing disarray in mental activity along with clouded consciousness and confusion about time and location. Other signs include decreased attention span, vivid visual hallucinations (and occasionally tactile hallucinations), severe restlessness, shouting, obvious fear, visibly shaky hands that may grasp imaginary objects at times, unsteady body movements due to lack of muscle control (truncal ataxia), autonomic disturbances such as excessive sweating fever rapid heartbeat increased blood pressure dilated pupils. Additional symptoms include dehydration with electrolyte imbalances reversal of sleep-wake pattern or inability to sleep leukocytosis impaired liver function as shown through blood tests. Fatality can occur from cardiovascular collapse infection high body temperature or self-inflicted harm.

1. A complete evaluation is conducted, which includes an assessment of current medical, psychological, and social issues.
2. Goal setting is implemented to address concurrent health, marital, employment, and social challenges with short-term goals initially established. As treatment progresses, long-term goals can be structured to address factors like familial tensions that trigger or sustain excessive drinking.
3. The treatment

plan for alcohol withdrawal involves the following steps:
a. Detoxification: Alcohol withdrawal symptoms are alleviated through detoxification.

The preferred drugs for treatment are benzodiazepines such as chlordiazepoxide (80-200 mg/day) and diazepam (40-80 mg/day), which should be taken in divided doses. Other options for treatment include:

• For Vitamin B deficiency, it is advised to administer 100 mg of thiamine parenterally twice daily for 3 to 5 days, followed by oral intake of vitamin B for at least 6 months.
• If necessary, anticonvulsants can be administered.
• Maintaining fluid and electrolyte balance is essential.
• Continuous monitoring of vitals, level of consciousness, and orientation is crucial.

Close observation in the first five days is crucial. Alcohol deterrent therapy involves using agents to desensitize individuals to alcohol's effects and promote abstinence. The drug commonly used for this purpose is disulfiram (tetraethyl thiuram disulfide) or antabuse. Disulfiram ensures abstinence by causing severe and unpleasant reactions in individuals who consume any alcohol while taking it.

Disulfiram functions by blocking aldehyde dehydrogenase, which disrupts the breakdown of alcohol and leads to a significant increase in acetaldehyde levels within the blood. This accumulation initiates the Disulfiram-ethanol reaction (DER), resulting in unpleasant effects such as nausea, intense headache, vomiting, low blood pressure flushing, sweating, thirst, difficulty breathing, rapid heartbeat, chest pain, dizziness, and blurred vision. Moreover, it induces a feeling of imminent catastrophe accompanied by severe anxiety.

The effects of alcohol consumption can persist for approximately 30 minutes. Disulfiram is primarily employed as a therapy for alcohol addiction, specifically as an aversive conditioning treatment. The side effects

of Disulfiram in the absence of alcohol intake consist of fatigue, dermatitis, impotence, optic neuritis, mental changes, acute polyneuropathy and hepatic damage. The severity of the disulfiram-alcohol reactions differs among individuals.

Extreme cases of disulfiram use can result in convulsions, respiratory depression, cardiovascular collapse, myocardial infarction, and death. There are various contraindications for this drug, including pulmonary and cardiovascular disease. Disulfiram should also be used with caution in patients with nephritis, brain damage, hypothyroidism, diabetes, hepatic disease, seizures, poly-drug dependence or an abnormal electroencephalogram. Patients who are at high risk of alcohol ingestion should also exercise caution when using this medication.

Disulfiram is available as tablets in dosages of 250 mg and 500 mg. The initial dose typically consists of 500 mg/day for the first two weeks followed by a maintenance dosage of 250 mg/day. The maximum dosage should not exceed 500 mg/day.

When administering disulfiram to a patient, the nurse has several responsibilities which include obtaining informed consent before starting treatment. Additionally, the drug should not be administered until at least 12 hours have elapsed since the patient's last alcohol consumption.

The patient should be cautioned about the potential consequences of consuming even small amounts of alcohol, as it can cause a disulfiram-ethanol reaction that leads to unpleasant effects. It is crucial for them to completely avoid alcohol in any form, including alcoholic beverages, cough syrups and drops, and foods and sauces containing alcohol. Additionally, they should be warned against using aftershave lotions that contain alcohol or inhaling paints and varnishes with alcohol. They should also steer clear of topical applications containing alcohol and exercise caution when taking CNS depressants or over-the-counter

medications while undergoing disulfiram therapy. Until they fully comprehend how the medication affects them, patients should refrain from activities such as driving that require alertness. Patients need to be informed that the disulfiram-alcohol reaction may persist for 1 to 2 weeks after their last dose of disulfiram. It is recommended for patients to carry identification cards explaining this reaction along with their physician's name and contact information. Stressing the importance of attending follow-up appointments with their physician to monitor progress in long-term therapy is vital.

Psychological treatment encompasses various approaches such as motivational interviewing, group therapy, and aversive conditioning. Motivational interviewing entails giving patients feedback about the potential hazards of alcohol and presenting them with options for making changes. Group therapy assists patients in recognizing their own problems by observing them in others and acquiring more effective coping mechanisms. Aversive conditioning employs classical conditioning principles to modify self-rewarding and enjoyable behaviors that become detrimental due to external factors beyond the client's influence.

The method described involves inducing vomiting or shock in the client when they consume alcohol. Cognitive therapy is used to reduce alcohol intake by identifying and modifying negative thoughts. The cue exposure technique helps desensitize substance abusers to drugs through repeated exposure, improving their ability to abstain. Other therapies include assertiveness training, behavior counseling, supportive psychotherapy, and individual psychotherapy.
Alcoholics Anonymous (AA) was established on June 10th, 1935 by two alcoholic individuals named Dr. Bob Smith and Bill Wilson, a stockbroker. AA has expanded globally since then and views alcoholism as a progressive disease that is physical, mental, and spiritual in nature - it can be halted but not cured. Members attend

group meetings twice a week for an extended period of time. They are assigned a support person who they can turn to during moments of temptation to drink. Immediate assistance can be obtained via phone during times of crisis.

Once a person achieves sobriety, they are expected to assist others in their journey. The organization believes that complete abstinence is necessary and anyone seeking to quit drinking can join. There is no hierarchy, only a community of flawed individuals whose strength lies in their weaknesses. The primary goal of this group is to support one another in staying sober and helping others achieve sobriety.

The comparative study below provides information on the complications of alcohol dependence, both medically and socially, as well as epidemiology, course, psychiatric disorders resulting from alcohol dependence, and treatment options. Nursing diagnosis includes ineffective denial due to a weak ego and underdeveloped sense of self caused by substance abuse. It also includes ineffective coping due to insufficient coping skills and a weak ego demonstrated through using substances as a coping mechanism.

The individual is experiencing imbalanced nutrition and deficient body fluid volume because they substitute substance use for eating. This is evidenced by weight loss, pale conjunctiva and mucous membranes, poor skin turgor, electrolyte imbalance, anemia, and potential signs and symptoms of malnutrition and dehydration. and their contents are preserved.

Impaired social interactions related to egocentric & narcissistic behaviour, such as the inability to develop satisfying relationships and manipulation of others for personal desires. A nursing care plan applying Hildegard E Peplau's theory of interpersonal relationships can address these issues. Peplau emphasized the importance of prominent interpersonal relationships in solving

patient problems. According to Peplau, there are four stages in the relationship process. The first stage is the orientation phase, where the individual recognizes a need and seeks professional assistance.

The nurse assists the patient in recognizing and understanding his problem and determining his need for help. During the identification phase, the nurse empathizes with those who can provide assistance. The nurse explores the patient's emotions to help them cope with the illness and find strength in positive experiences. In the exploitation phase, the patient becomes more demanding, making numerous requests or utilizing attention-seeking methods to fulfill their individual needs. The nurse employs communication tools such as clarification, active listening, acceptance, teaching, and interpretation to offer services. The patient then takes advantage of these services based on their specific interests and needs, with the nurse guiding them in solving the problem. In the resolution phase, collaborative efforts between the patient and nurse have already addressed the patient's needs. Now, they need to end the relationship and sever their connections. The nurse plays various roles throughout this process, including that of a stranger and a resource person.

Role of a teacher C Leadership Surrogate role D Counseling role A B Energy transformation 5. Ineffective denial 6. Ineffective coping 7. Imbalanced nutrition less than body requirement / Deficient body fluid volume, 8. Impaired social interactions Identification. The nurses collect a detailed history and conduct a thorough physical and mental status examination to reveal the following problems the client faces: Frequent lying, Physical injuries, Stealing, Involvement in anti-social activities, Increased talk, High self-esteem, Grandiosal ideas Assaultive ; irritable behavior.

The client positively responded to the

treatment, nursing management, and socialization efforts. They became more involved in group activities and their communication and socializing skills have improved. Interventions were planned to help the client accept their responsibilities and develop coping patterns. Family support was requested. The resolution, exploitation, orientation, evaluation, planning, implementation, diagnosis, and assessment were all part of the process.

The client appears restless and irritable, indicating ineffective denial due to a weak ego. This is shown by statements denying substance abuse. The goal is for the client to accept responsibility for their behavior and recognize the connection between substance use and personal problems. To achieve this, it is crucial to create a comfortable environment, avoid arguing or dismissing their beliefs, refrain from laughing or physical contact, and instead discuss real events and provide hope. It is also important to watch out for signs of hallucination. Encourage the client to get enough sleep, create a safe space, suggest taking a hot bath before bed, and maybe offer hot milk as well. Additionally, preparing a clean bed and allowing the client to read or listen to music can promote restful sleep. Lastly, the client complains of general body ache, heaviness in the head, and drug cravings.

Clients are exhibiting withdrawal symptoms, due to ineffective coping skills and a weak ego leading to substance abuse as a coping mechanism. The goal is for the client to verbalize and utilize healthier coping mechanisms to manage stress. It is important to closely monitor the intensity of withdrawal symptoms, record vital signs and symptoms, provide fluids to reduce constipation and dehydration, change the client's clothes if they become stuck due to excessive respiration,

and offer comfort and support. The client should be able to verbalize these adoptive coping mechanisms. Additionally, the client complains of fatigue, decreased appetite, and appears restless. This is likely due to imbalanced nutrition and deficient body fluid volume caused by substance use instead of eating. The client should ultimately be free of signs and symptoms of malnutrition and dehydration. To achieve this, it is recommended to provide high protein, high calorie nutritious food that can be consumed on the go, offer 6-8 glasses of fluids per day, maintain an accurate record of intake and output, regularly weigh the patient, supplement the diet with vitamins and minerals, and accompany the patient during meals. Currently, there are no signs orSymptoms of malnutrition include difficulty in talking to new people. This is due to impaired social interactions related to egocentric and narcissistic behavior. The client is unable to develop satisfying relationships and manipulates others for their own desires. To improve social interaction, it is important to recognize manipulative behaviors and help reduce feelings of insecurity by increasing feelings of power and control. Setting limits on manipulative behaviors and explaining expectations and consequences can also be helpful. All staff working with the client should agree on these limitations. Ignoring attempts to argue or charm their way out of limit setting, providing positive reinforcement for non-manipulative behaviors, discussing consequences of the clien