Alcoholism is defined as chronic dependence on alcohol characterized by compulsive drinking. Major signs include increasing consumption, sneaking drinks, morning drinking, and excessive drinking alone. Alcoholism is caused by biological, psychological, and social factors and can lead to numerous physical, psychiatric, and social complications. Physically, alcoholism can damage the liver, heart, and pancreas and increase risks of cancers and fractures. Psychiatrically, it is associated with withdrawal symptoms, alcoholic hallucinations, Korsakoff's syndrome, and increased risks of depression, suicide and violence. Socially, alcoholism often results in work and family problems, domestic violence, and legal issues like drunk driving. Treatment involves detoxification and therapies

1. ALCOHOLISM

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.

3. Definition
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.

4. Alcoholism
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 kapoor

5. Acoholism:
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

6. 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 .
 Biochemical factors: A genetically determined deficiency of brain
neurotransmitters (endorphins) predisposes as individual to alcoholism.

7. Contd….
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.

8. Contd……..
 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.

9. Contd……
3. Social Factors
 Peer pressure
 Modeling : imitating behavior of important others
 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.

10. Contd…
Clinical Features
1. Physical problems:
 Bloodshot eyes
 Thin hair
 Jaundice
 Anaemia
 Liver damage
 Abdominal pain and bleeding
 Cirrhosis of liver
 Sexual dysfunction
 Accidents or injuries due to alcohol use.
 Oedema of foot
 Acute and chronic gastritis

11. Contd…
 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

12. Contd….
 Loss of memory
 Fits ,irresponsible
 Alcoholic psychosis- if drinking for a long time in a large quantities.
3. Social Problems
 Fight
 Quarre
 Trouble with other

13. Contd…..
 Loss of work
 Money spent on alcohol
 Breakdown of family relationship
 Violent towards children and family
 Divorce
 Suicide
 Financial problem
 Criminality occasionally

14. Contd….
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

15. Contd….
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.

16. Contd…..
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.

17. Contd….
 Aim of detoxification is the symptomatic management of the emergent withdrawal
symptoms.
 The drugs of choice for detoxification are usually benzodiazepines (Antianxiety
drugs)e.g. Chlordiazepoxide (80 to 2oomg/day in divided doses) are the most
frequently used.
 Vitamins should also be administered e.g. Vitamin B6, B1, etc.
 The Care of hydration is another important step.

18. Contd…
2. Treatment of alcohol depending
 Behavior therapy such as aversion therapy or covert sensitization.
 Psychotherapy such as individual psychotherapy.
 Group therapy such as Alcohol Anonymous.
 Anti craving agent such as flouxetine ,naltrexone.
 Other medicines if necessary.
 If depression present –anti depressant drugs can be given.
 Psychosocial rehabilitation should be done after the treatment is over.

19. Contd….
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

20. Contd…..
Nursing Diagnosis
 Impaired verbal communication related to mental confusion.
 Ineffective health maintenance related to lack of self care.
 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 to poor eating patterns /chronic alcohol intake.
 Disturbance in balance of rest ,sleep and activity related to alcohol withdrawal.

21. Contd….
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.
 Monitor visitors because they may supply the client with alcohol.
 Provide a well –controlled ,alcohol free environment ;explain unit routines.

22. Contd…
 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.

23. Contd ….
 Maintain appropriate hydration and nutrition.
 Teach the anxiety relieving methods, involve the patient in relaxation therapy.
 Involve the patient in group interaction.
Evaluation
 Decreased risk for violence and self injury.
 Homeostasis (equilibrium,)is maintained.
 Involves in interaction with group members and society.

24. Contd…
Complication
a. Physical complications of alcoholism
 Gastro- intestinal system
High concentration of alcohol causes
Increased secretion of gastric juices which
leads to inflammation of mucosa (gastritis )
It produce direct erosion of the stomach
mucosa which results malabsorption
syndrome as vitamin deficiency of A,D, K
and thiamine.
Symptoms occurs as heartburn ,reflux
oesophagitis ,diarrhea ,decrease absorption
, etc.

25. Contd….
 On liver :
Excessive drinking affect liver .
↓
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.

26. Contd…..
 On Pancreas :
Heavy drinking of alcohol damage
pancreas which produces the hormones
that regulate metabolism and enzymes
that help digest fats, proteins and
carbohydrates.

27. Contd….
 On heart :
.
Effect of alcohol on the heart .
↓
Accumulation of lipids in the myocardial cells.
↓
Resulting in enlargement and weakened
condition.
↓
Effect of toxic on heart muscle cells, weak to
pump efficiently .
↓
symptoms of alcoholic cardiomyopathy ,result of
heart failure

28. Contd….
 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 lead 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
falls , lead to increased skeletal fragility and increase the risk of fractures.

29. Contd…
 Sexual dysfunction :
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 and delayed ejaculation.
 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.

30. Contd…
 On Nervous system :
Alcohol causes anesthetic( loss of sensation) effect :
- Alcoholic peripheral neuropathy
- Delirium tremens
- Rum fits
- Alcoholic peripheral dementia
- Cerebellar degeneration
- Head injury
- Wernicke korsakoff syndrome : A brain disorder involving loss of specific brain
functions due to thiamine deficiency.
- Wernicke’s encephalopathy involves damage to multiple nerves in both the
central nervous system and the peripheral nervous system.

31. Contd…..
 Nutrition :
- Alcohol irritates the gut wall, leading to inflammation and ulceration. This can
result to poor absorption of nutrients and poor digestion as Protein Energy
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.

32. Contd…..
b. Psychiatric Complication of Alcohol Abuse
 Pathological Intoxication :
Maladaptive behavioral effects such as fighting impaired judgment .Physiological
signs such as slurred 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 which occurs withdrawal symptoms 2-4 days. Physical
effects may include shaking, shivering, irregular heart rate, and sweating.

33. Contd….
 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 (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.

34. Contd…
 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.

35. contd…
Alcohol amnesic disorder:
Impairment in short and long
–term memory with disorientation
and confusion.

36. Contd…
 Alcohol dementia :
A chronic organic mental disorder due to long term alcohol
drinking. Irreversible impairment in memory , orientation , impulse control,
inability 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.

37. Contd…
c. Social Complication of 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 caused financial difficulties, conflict divorce,
contributing to domestic violence, damage the emotional development of the
children, etc
 Legal problem: (criminality)
Increased frequency of accidents (RTA).

38. Thankyou
First you take
a drink ,then
the drink
takes a drink,
and then the
drink takes
you!!..
AVOID
ALCOHOL
AND
ACCEPT THE HEALTHY
LIFE