This document provides information about alcoholism (also known as alcohol use disorder) including its definition, signs and symptoms, stages of progression, diagnostic criteria, management, and complications. It begins with objectives of defining alcoholism, listing its phases and effects, and outlining management approaches. Introduction defines alcoholism and notes its prevalence among certain groups. Several factors that can contribute to risk of alcoholism are described like social, environmental, biological, and psychological factors. The document then outlines clinical stages of alcoholism from earliest to most advanced, lists diagnostic criteria, and discusses management strategies like detoxification and treatment. Complications of long-term alcohol dependence are also summarized.

1. By,
Akash R. Ghorpade
M.Sc. Psychiatric Nursing Tutor

2. OBJECTIVES
General Objective: At the end of the teaching- learning activity, group will able to define alcohol syndrome, state its signs and
symptoms and management of withdrawal and rehabilitation.
Specific Objectives: At the end of teaching, group will able to;
1. Define alcoholism and its relative terminologies.
2. Determine the etiology of alcoholism.
3. Enumerate the phases of alcoholism.
4. Classify the severity of alcoholism.
5. State the significance of alcoholism dependence.
6. Enlist the effects of alcoholism.
7. List the withdrawal symptoms of alcoholism.
8. Elaborate the management for alcoholism.

3. INTRODUCTION
 Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in
mental or physical health problems.
 The disorder was previously divided into two types: alcohol abuse and alcohol dependence.
 The most common substance of abuse/dependence in patients presenting for treatment is alcohol. Alcoholism has
a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.
 Current evidence indicates that in both men and women, alcoholism is 50–60 percent genetically determined,
leaving 40–50 percent for environmental influences.
 31 percent of college students show signs of alcohol abuse, while six percent are dependent on alcohol.
 Under the DSM's new definition of alcoholics, that means about 37 percent of college students may meet the
criteria.

4. EPIDEMIOLOGY
Race: Whites and hispanics have higher chances, blacks have lower.
Gender: Males > Females
Region and urbanization: High in western countries more in large metropolitan cities (56%) than non metropolitan
(46%).
Education: Higher in college degree students than people with less than high school education.
Marital status: Unmarried persons have more incidence rate than married.
Age group: Age group of 25 to 40 have highest prevalence rate of alcoholism.
Eye openers: Earning members of the family in young.

5. STATISTICS
 In Asia, India is the highest consumer of whiskey (40%).
Kerala,
In India, the highest consumption of alcohol is done in the regions with highest literacy rate such as
West Bengal, Mumbai and Tamil Nadu.
 About 45% of alcohol origins are from India.
 Approximately, (30%) consume alcohol daily.
 4 crores (3% of total population) are alcoholics, in India.

6. DEFINITIONS
1. Alcoholism: Alcoholism is characterized by the prolonged period of frequent, heavy alcohol use. The
inability to control drinking once it has begun.
2. Abuse: Use of any drug, usually applies to drugs prescribed by the physicians that are not used properly.
3. Misuse: Similar to abuse, but usually applies to drugs prescribed by physicians that are not used
properly.
4. Dependence: Repeated use of a drug or chemical substance, with or without physical dependence
5. Tolerance: Tolerance in which, after repeated use, a drug produces a decreased effect or increasingly
larger doses are required to obtain the effect observed with the previous/ original dose.

7. 6.Withdrawal: A substance specific syndrome that occurs, after stopping or reducing the substance that has been
used regularly over the prolonged period. It is characterized by physiological signs and symptoms, in addition to
psychological changes like disturbances in thinking, feeling or behaving. Also known as abstinence or
discontinuation syndrome.
7.Co- dependence: Term used to refer to the family members affected or influenced by the behavior of substance
abuser.
8. Co- tolerance: Term refers to the ability of one drug to be substituted for another, each usually producing the
same physiological and psychological effect. Also known as cross-dependence.
9.Intoxication: A reversible syndrome caused by a specific substance, that affects one or more of the following
mental functions: memory, orientation, mood, judgement, and behavioral, social or occupational functioning.

8. 10.Enabling: The act of facilitating the abuser’s addictive behavior. Also includes the unwillingness of
a family member to accept addiction as a medical- psychiatric disorder or to deny that the person is
abuser.
11.Denial: The family member often behaves as if the substance use that is causing obvious problems,
are not really problems.
12. Neuroadaptation: Neurochemical or neurophysiological changes in the body that results from the
repeated administration of the drug.

10. 1. Social Factors:
 Social factors can contribute to a person’s views of drinking. Your culture, religion, family and work influence many of
your behaviors, including drinking. Family plays the biggest role in a person’s likelihood of developing alcoholism.
Children who are exposed to alcohol abuse from an early age are more at risk of falling into a dangerous drinking pattern.
The desire to fit in and be well-liked may cause you to participate in activities that you normally wouldn’t partake in.
Before you know it, you’re heading to every company happy hour, drinking more frequently and even craving
alcohol after a long workday – all warning signs of AUD.
2. Environmental Factors:
 In recent years, studies have explored a possible connection between your environment and risk of AUD. For example,
many researchers have examined whether or not a person’s proximity to alcohol retail stores or bars affect their chances of
alcoholism. People who live closer to alcohol establishments are said to have a more positive outlook on drinking
and are more likely to participate in the activity. Another environmental factor, income, can also play a role in the
amount of alcohol a person consumes. Contrary to popular belief, individuals who come from affluent neighborhoods
are more likely to drink than those living below poverty.

11. 3. Biological Factors:
 Research has shown a close link between alcoholism and biological factors, particularly genetics and physiology. While
some individuals can limit the amount of alcohol they consume, others feel a strong impulse to keep going. For some,
alcohol gives off feelings of pleasure, encouraging the brain to repeat the behavior. Repetitive behavior like this can
make you more vulnerable to developing alcoholism. There are also certain chemicals in the brain that can make you
more susceptible to alcohol abuse. For instance, scientists have indicated that alcohol dependence may be
associated with up to 51 genes in various chromosome regions. If these genes are passed down through
generations, family members are much more prone to developing drinking problems.
4. Psychological Factors:
 Different psychological factors may increase the chances of heavy drinking. Every person handles situations in their
own unique way. However, how you cope with these feelings can impact certain behavioral traits. For example, people
with high stress, anxiety, depression and other mental health conditions are more vulnerable to developing
alcoholism. In these types of circumstances, alcohol is often used to suppress feelings and relieve the symptoms of
psychological disorders.

13. CLINICAL STAGES OFALCOHOLISM
Alpha Earliest stage, Drinker uses to relieve pain, Can control drinking.
Beta
Heavy drinkers, drinks daily, physical symptoms can be seen, No addiction, can quit,
No withdrawal symptoms.
Gamma
Loss of control in drinking, physical dependence, can quit, withdrawal symptoms
seen.
Delta Physical dependence, withdrawal symptoms seen, can’t quit.
Epsilon
Final stage of drinking, continual and insatiable urge to drink (craving), compulsive
drinking.

15.  20-30 mg/dl: Slowed motor performance and decreased thinking ability.
 30-80 mg/dl: Increased motor and cognitive deficits.
 80-200 mg/dl: In coordination and judgement errors, mood lability.
 200-300 mg/dl: Nystagmus, slurring of speech, blackouts.
 >300 mg/dl: Impaired vital signs.
 >400 mg/dl: Respiratory failure, coma, death.

16. SIGNIFICANT AND CONFIRMATORY CLINICAL DIAGNOSIS FOR ALCOHOLISM
In past 12 months, at least 3 symptoms from:
1. Tolerance
2. Withdrawal
3. Increased used over time
4. Loss of control
5. Giving up important activities.
6. Significant time spent obtaining, imbibing, recovering.
7. Continued use in spite of perceived adverse consequences.
8. Lack of concentration and attention, forgetfulness and constant lethargic mood.

17. CAGE Questionnaire’s to know the dependency and tolerance of
Alcohol

18. EFFECTS OFALCOHOLACCORDING TO
BLOOD LEVELCONCENTRATION
It is the percentage of ethanol in the blood in units of alcohol per volume of blood or mass of alcohol
per mass of blood.
The blood alcohol legal limit in India is 0.03% alcohol in blood. Counted as (30 mg in 100 ml blood)

19. Progressive effect of alcohol
BAC (% by vol.) Behaviour Impairment
0.010– 0.029 • Average individual appears normal.
•Subtle effects that can be
detected with special tests
0.030– 0.059
INDIAN LIMIT
• Mild euphoria
• Sense of well being
• Relaxation
• Joyousness
• Talkativeness
• Decreased inhibition
• Concentration
0.06 - 0.09
• Blunted feelings
• Disinhibition
• Extroversion
• Reasoning
• Depth perception
• Peripheral vision
• Glare recover

20. 0.10 – 0.19 • Over expression
• Emotional swings
• Angriness or sadness
• Boisterousness
• Super human feeling
• Decreased libido
• Reflexes
• Reaction time
• Gross motor control
• Staggering
• Slurred speech.
0.20 – 0.29 • Stupor
• Loss of understanding
• Impaired sensations
• Severe motor impairment
• Loss of consciousness
• Memory impairment
0.30 – 0.39 • Severe CNS depression
• Unconsciousness
• Death is possible
• Bladder function
• Breathing
• Heart rate
>0.40 • General lack of behavior
• Unconsciousness
• Death
• Breathing
• Heart rate

21. ALCOHOL WITHDRAWALSYMPTOMS
Withdrawal usually begins 6 to 24 hours after the last drink. It can last for up to one week.
To be classified as alcohol withdrawal syndrome, patients must exhibit at least 2 of the following symptoms:
1. Increased hand tremor,
2. Insomnia,
3. Nausea or vomiting,
4. Transient hallucinations (auditory, visual or tactile),
5. Psychomotor agitation,
6. Anxiety,
7. Tonic–Clonic seizures,
8. Autonomic instability.

22. Classic signs of withdrawal is tremulousness
Duration from last intake Signs and symptoms
6 to 8 hours
Tremulousness, irritability, GI
symptoms, autonomic
hyperactivity
8 to 12 hours Psychotic and perceptual abnormalities
12 to 24 hours
Seizures (can occur within first 72
hours of withdrawal).
Up to 72 hours Delirium tremors

23. MANAGEMENT OF ALCOHOLDEPENDENCE SYNDROME
➢Start With Your Doctor: Alcoholism is (not a medical term) it is alcohol use disorder. In Milder
cases, people binge alcohol intake but aren’t dependent on it. Your doctor may say you have alcohol
use disorder if you:
1. Feel like you have to drink
2. Can’t control how much you drink
3. Feel bad when you can’t drink

24. ➢ Go to Detox:
For people who have severe alcohol use disorder, this is a key step. The goal is to stop drinking and give your
body time to get the alcohol out of your system. That usually takes a few days to a week. Most people go to a
hospital or treatment center because of withdrawal symptoms like:
1. Shaking (tremors)
2. Seeing or feeling things that aren’t really there (hallucinations)
3. Seizures

25. ➢ Delirium tremors:
→ Alcohol withdrawal tremors with delirium are a serious medicalemergency.
→ Essentially Delirium tremors is seen within 1 week after the abuser stops or decreases drinking doses or
frequency. Begins generally after 5-15 years of heavy drinking.
→ Best treatment is prevention.
→ BZD chlordiazepoxide (50 – 100mg every 4 hrs).
→ Lorazepam Intravenously
→ Correct the dehydration

26. Pharmacological Management
Drug Used for Symptoms like Dose
Chlordiazepoxide → Tremors and tremulousness
→ Extreme agitation
→ 25- 100 mg every 4-6 hrs.
→ O.5 mg/kg at 12.5 mg/min IV.
Diazepam → Mild to moderate agitation.
→ Withdrawal seizures
→ 5– 20 mg every 4- 6 hrs.
→ 0.15 mg/kg at 2.5 mg/min
Lorazepam → Hallucinations
→ Delirium tremors
→ 2-10 mg every 4-6 hrs.
→ 0.1 mg/kg at 2mg/min IV
.

27. COMPLICATIONS OF PROLONGED ALCOHOL DEPENDENCESYNDROME
1) Wernicke's encephalopathy:
Caused by deficiency of vitamin B1 (thiamine that helps in conduction of axon potential along the axon and synaptic
transmission).
Manifested by ataxia, opthalmoplegia, confusion.
Treatment: 100mg BD or TDS for 1-2 weeks.
2) Korsakoff’s syndrome:
Cardinal features are: irreversible damage, impaired anterograde memory with confabulations.
Treatment: thiamine 100 mg BD or TDS for 3-12 months.

28. disease of alcoholism characterized by corpus callosum
3) Marchia Fava Bignami syndrome:
 It is an progressive neurological
demyelination and necrosis.
4) Fetal Alcoholsyndrome:
Alcohol intake in women who are pregnant or lactating. Alcohol inhibits intrauterine growth and
postnatal development leading to mirocepaly, malformation of heart, limbs and lungs.

29. See a Counselor orTherapist:
With alcohol use disorder, controlling your drinking is only part of the answer. You also need to learn
new skills and strategies to use in everyday life. Psychologists, social workers, or alcohol counselors
can teach you how to:
a) Change the behaviors that make you want to drink.
b) Deal with stress and other triggers.
c) Build a strong support system.
d) Set goals and reach them.

30. Rehabilitation:
Inpatient treatment is a good choice for anyone who wants to focus completely on recovery
without the stress or distractions of work, school, or social obligations. It allows for a thorough
immersion in the recovery process and may be a good choice for people who have tried other
treatments unsuccessfully.

31. BIBLIOGRAPHY
1) “Charles G. Morris, Albert A. Maisto, Girishwar Misra”, ‘Psychology for Nurses’– ‘Pearson publication’, page no.- 76 to 81.
2) “Fernald”, ‘Munn’s Introduction to Psychology’– ‘AITBS publication, India’, ‘5th- edition’ – page no.- 244 to252.
3) “M Basavanna”, ‘Psychology for Nurses’, ‘Jaypee publication’– page no.- 18 to22.
4) “S K Mangal”, ‘Essentials of Psychology’, ‘Avichal publishing company’, page no.- 98 to 103.
5) “N.KAnand, Shikha Goel”, ‘Psychology for Nurses’, ‘AITBS publication, India’page no.- 116 to 118.
6) “R Sreevani’- Foreword- ‘K Redemma”, ‘Psychology for Nurses’, ‘3rd edition’, page no.- 48 to 54.
7) “Harish Kumar Sharma, Gulshan Mann”, ‘Psychology for Nurses’, ‘Lotus publication’, ‘5th edition’ page no.- 19 to22.
8) https://www.slideshare.net
9) https://healthline.com
10) https://drinkware.com
11) www.niaaa.nih.gov
12) www.who.int

32. THANK
YOU