Self-instructional module on Alcohol dependence syndrome

Prepared By:
Ms. Shama Sharma
M.Sc. II Year
Aurovindo College of Nursing
Aurobindo College of Nursing, Bhopal (M.P.)

Prepared By:
Ms. Shama Sharma
M.Sc. II Year
Aurobindo College of Nursing

Guided by:
Mr. Shihabudeen M H
Associate Professor & HOD of Mental Health Nursing
Aurovindo College of Nursing
 INDEX

S. No. CONTENT

1. Objectives

2. Guidelines for the use of SIM

3. ALCOHOL DEPENDENCE SYNDROME:

 Introduction
 Definition
 Incidence
 Properties of Alcohol
 Classification of Alcohol Drinkers
 Causes
 Signs and Symptoms
 Treatment
 Prevention
General objective:

The learners will acquire adequate knowledge about the Alcohol Dependence
Syndrome, especially regarding causes, symptoms, treatment and prevention of
Alcohol Dependence Syndrome.

Specific objective:

After reading this self-instructional module peoples will learn: -

 Definition of Alcohol Dependence Syndrome

 Incidence of Alcohol Dependence Syndrome

 Properties of alcohol and classification of Alcohol Drinkers

 Causes of Alcohol Dependence Syndrome

 Signs and symptoms of Alcohol Dependence Syndrome

 Treatment and prevention of Alcohol Dependence Syndrome

How to use this self-instructional module?

 Self-Instructional Module (SIM) is one of the educational materials that helps

in self-learning.

 It is important to go through the content of this module in systematic way from

the beginning till the end.

 Take your own time to read, understand and learn carefully.

 ALCOHOL DEPENDENCE SYNDROME

Introduction:

Young adults have a higher prevalence of alcohol consumption and binge

drinking than any other age group. They also drink more heavily and experience more
negative consequences of drinking. Rates of alcohol abuse and dependence are
disproportionately higher among those between the ages of 18 and 29 compared with
other age groups. Young adults are also overrepresented among alcohol-related traffic
fatalities. Over time, distinct patterns of change in frequent binge drinking occur, and
most heavy-drinking young adults appear to “mature out” of abusive drinking patterns
as the responsibilities of later adulthood supervene. Drinking patterns are affected by
demographic, psychological, behavioral, and social factors as well as minimum
drinking age legislation and the cost of alcohol. Motivational programs designed to
reduce risks and consequences associated with young-adult drinking may help in
reducing alcohol consumption and its consequences.

Definition:

Alcohol- Alcohol constitute of ethanol, an intoxicating agent present in

fermented and distilled liquor.

Dependence- The state of being psychologically or

physiologically dependent on a drug after a prolonged period of use.

Syndrome- A syndrome is a set of medical signs and symptoms which are

correlated with each other and often associated with a particular disease or disorder.
 Alcoholism- Alcoholism can be defined as a chronic disease, characterized by
repeated drinking that produces injuring to the drinker’s health or to his social or
economic functioning.

Alcoholism is use of alcoholic beverages to the point of causing damage to the

individual society or both.

Alcohol dependence syndrome- 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. Alcohol dependence affects physical
and mental health, and can cause problems with family, friends, and work.

Withdrawal symptoms- Abnormal physical or psychological features that

follow the abrupt discontinuation of a drug that has the capability of producing physical
dependence.

Incidence-

1. Worldwide, 3 million deaths every year result from harmful use of alcohol, this
represents 5.3% of all deaths.

2. Alcohol use is quite common in India both in rural and urban areas with
prevalence rates varying from 23% to 74% in males in general and although it’s
not that common in females but it has been found to be prevalent at the rate 24%
to 48 % in females in certain sections and communities.

3. Alcoholism reduces a person's life expectancy by approximately ten years

Properties of alcohol
  Alcohol is available in the form of popular drinks as beer, wine, rum, liquor
etc.

 The chemical name of alcohol is ethyl alcohol or ethanol.

 It is a clear and colorless, volatile & inflammable liquid.

 It has a strong burning taste.

 It is a CNS depressant.

 It is absorbed rapidly into the blood stream, but slowly on full stomach.

 It is eliminated slowly, through urine and exhalation.

 The blood alcohol level brings many changes.

 If, the alcohol concentration is 80-100 mg/100 ml of blood, the person loses
his self-control. 200-250 mg blood alcohol level causes coma and 500 mg
ultimately result into death.

Classification of alcohol drinkers-

The alcoholic drinkers are classified into many types. They are

1. Rare users: Drink once or twice a year

2. Infrequent users: drink once or twice in 2-3 months

3. Light drinkers: drink once or twice a month

4. Moderate drinkers: drink three or four times a month

5. Heavy drinkers: drink every day or several times within a day

6. Problem drinkers: drinkers get physical, psychological, emotional and social

problems

Thus, when a person reaches to stage of problem drinkers, the condition is

known as alcohol dependence syndrome.
Causes-

Alcohol Dependence Syndrome can arise from different factors. After a long
period of drinking, your brain back relies on alcohol to generate certain chemicals. This
is something which makes stimulating for heavy drinkers to stop. Following are the
causes .

1. Biological factors

Research has revealed a link between alcoholism and biological factors especially
genetics and physiology. There is a special chemical in the brain that can make you
more susceptible to alcohol abuse. For instance, a specialist has indicated that alcohol
dependence may be associated with up to 51 genes in different chromosome regions. If
these genes are carried down through generations, a family member is much likely to
developing drinking problems.

2. Social factors

 Social factors can add to a person’s view of drinking. Your culture, religion,
family, and work impact many of your behaviors that include drinking alcohol.

 Family plays a most important role in a person’s likelihood of developing

alcoholism.
 Children who are exposed to alcohol abuse from an advanced age are likewise
at risk of falling into a dangerous drinking pattern.

 The beginning of college also makes you more sensitive to alcoholism. During
these times, you are looking to make new friends and improve relations with
others who want to fit in and be well-liked may cause you to participate in
actions that you wouldn’t normally take part in.

3. Psychological factors

 The different psychological factors may raise the possibility of heavy drinking.

 Every person handles the situations in their individual way. However, how you
cope with these emotions can impact certain behavioral traits.

 As an example, people with high stress, anxiety depression, and other mental

 health ailments are more vulnerable to developing alcoholism.

  Over time drinking can become accustomed and leads to ADS. The more you
turn to alcohol to relieve the feeling of pain and sorrow, the more you become
tolerant to the drug and rely on its effects.

Signs and symptoms

1. Minor symptoms –

 Malaise
 Dyspepsia

 Mood swings or depression

 Increased incidence of infection

2. Poor personal hygiene

3. Untreated Injuries (Cigarette Burns, Fractures, Bruises that cannot be fully

Explained)
 4. Unusually High tolerance for Sedatives & Opioids

5. Nutritional Deficiency (Vitamins & minerals)

6. Secretive Behavior (may Attempt to Hide disorder or Alcohol supply)

7. Consumption Of Alcohol- Containing products (Mouthwash, After-Shave

lotion, Hair Spray, Lighter Fluid, Body Spray, Shampoos)

8. Denial of Problem

9. Tendency to Blame others & Rationalize Problems (Problems Displacing

Anger, Guilt)

ICD-10 criteria for alcohol 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 pleasures or Interests

5. Persisting with Substance Use Despite Clear Evidence of Harmful

Consequences
Psychiatric disorders due to alcohol dependence

 Acute Intoxication

 Withdrawal Syndrome

 Alcohol-Induced Amnestic Disorders

 Alcohol-Induced psychiatric Disorders

Acute intoxication-

 It Develops During or Shortly After Alcohol Ingestion.

 It is Characterized by,

 Clinically Significant Maladaptive Behavior or Psychological Changes

(E.g., Inappropriate Sexual or Aggressive Behavior)

 Mood Lability
 Impaired Judgment

 Slurred Speech

 Inco-ordination

 Unsteady gait

 Nystagmus

 Impaired Attention & Memory

 Finally Resulting in Stupor or Coma

Withdrawal syndrome-

 Person Who Has 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:

 Simple Withdrawal Symptoms

 Delirium Tremens

Simple withdrawal syndrome-

 It is Characterized by

 Mild tremors

 Nausea

 Vomiting

 Weakness

 Irritability

 Insomnia

 Anxiety

Delirium tremens-

 It Occurs usually within 2- 4 days of Complete or Significant Abstinence from

Heavy drinking

 The course is Very Short, with Recovery Occurring within 3-7days

 Treatment

Alcoholism is a treatable and preventable disease. The treatment of alcohol is aimed at

promoting health status, maintaining good family relationships, improving education
performance, increasing social adjustment, Changing the factors that cause excessive
drinking.

The treatment includes both medical and psychological managements. Before starting
any treatment, it is very important to see the complete history of drinking pattern, family
pattern, environmental conditions, history of any medical or psychological disease, any
motivation for treatment.

Both the medical and psychological managements will be given in 3 phases.

A. First phase – withdrawal phase

The best way to stop alcohol is to stop it suddenly, unless the risks of discontinuation
are felt to be very high by the treating team. It will be given in first 7 - 14 days. It
involves much medical management to control the symptoms that are developed by
withdrawing the alcohol. It includes checking the temperature, pulse, respiration, blood
pressure, level of consciousness, small doses of sedatives, vitamin - B.

These can be given at outpatient level. If the alcoholic withdrawal problems are severe
and are associated with any other physical and psychological illness, suicidal ideas or
attempts and unable to stop alcohol in the home setting, the treatment involves
hospitalization, close observation, large dose of sedatives, 50 ml of 50% glucose, if
blood glucose level is less, if necessary, treatment for fits, connecting saline bottles to
maintain fluid & electrolyte balance, calm, quiet, safe and protective environment.
B. Second phase – active treatment phase

This phase will be continued up to 3 -12 months. This phase includes-

1. Treatment of any associated medical or psychiatric conditions like

anxiety, depression. Maintaining them stopping from alcohol drinking
by giving the tablet Disulfiram and Naltrexone which completely
reduces the desire to drink alcohol. This medicine will give good results,
if the patient is free from other medical problem of lungs, heart, kidneys,
liver, fits, brain, thyroid gland, diabetes, pregnancy and other
psychological problems like anxiety, depression.

2. The person when on this medicine should completely avoid alcohol

containing preparations like cough syrups, drops, inhalation of after
shaving lotions, paints, varnishes, sauces etc., and any other alcoholic
drinks.

3. When a patient consumes alcohol along with this medicine it gives

adverse effects.

Psychological management: It includes, Counseling by explaining all the pleasurable

& evil effects, behavior modification by giving gifts, rewards, suggesting alternative
coping methods, relaxation techniques, meetings conducted by ex-alcoholics, involving
family members, religious people.

C. Third phase – post treatment phase:

It usually continues from 3 – 5 years or even longer. It includes relapse prevention.

Even after the treatment, there are possibilities of relapse of alcohol consumption. This
is due to some personal and environmental factors like excessive and continuous desire
to drink alcohol, stress, boredom, anxiety, depression, positive feelings of success,
celebrations, pressure by friends, irregular follow-up check-ups, nearby bars.

Relapse will be prevented by improving the qualities of life and adequate social support
like breaking relations with other drinkers, encouraging non-drinker friends,
developing new interests and habits, new ways of celebrating some positive feelings,
choosing alternative methods to avoid stress, yoga, meditation, other relaxation
techniques under supervision, regular follow-up to heath care centers.
 PREVENTION

“Prevention is better than cure”

It is the responsibility of the student, family, society and government responsibility to

make this life healthy, smooth, colorful and successful, by preventing alcoholism. The
prevention includes:

 Primary level

 Secondary level

 Tertiary level

1. Primary prevention: This level of prevention includes:

a) Identification of person who are at risk for drinking like children of

single parent, from broken homes, death of a parent, any family history
of alcoholism.

b) Introducing some alcohol awareness programmes which involve giving

education about the adverse effects of alcohol, removing the negative
opinions such as alcohol removes fatigue, it has a medicinal value giving
strength, directing good role models, ban on advertisements, clarifying
the advertisements, cultivating good hobbies, recreation by playing a
sport etc., helping is choosing alternative coping mechanisms like yoga,
family togetherness etc.
2. Secondary prevention:

It includes early detection and counseling. Peoples should be provided feedback on the
personal risks of alcohol use and other options to change. Alcoholics will be detected
for any medical and psychological problems and other effects of alcoholism. Proper
medical and psychological treatments will be given.

3. Tertiary prevention:

It includes alcohol relapse prevention by behavior counseling, teaching coping skills,

improving qualities of life, adequate social support etc.