Alcoholism is defined as harmful and uncontrollable alcohol consumption that can cause disorders like depression and anxiety. Long-term alcoholism affects the body's metabolism, organs, and nutrition levels. It has genetic and environmental causes, and is more common in males. Symptoms include intoxication, withdrawal, tolerance, and medical conditions. Treatment aims to promote abstinence through detoxification, counseling, social support, and medications like disulfiram or naltrexone.

2. Introduction
• Alcoholism is defined as alcohol seeking and
consumption behavior that is harmful.
• Long-term and uncontrollable harmful
consumption can cause alcohol-related
disorders that include: antisocial personality
disorder, mood disorders (bipolar and major
depression) and anxiety disorders.

3. Description
• The hallmarks of this disorder are addiction to alcohol,
inability to stop drinking, and repeated interpersonal,
school- or work-related problems that can be directly
attributed to the use of alcohol.
• Alcohol-related disorders can affect the person’s
metabolism, gastrointestinal tract, nervous system, bone
marrow and can cause endocrine (hormone) problems.
• Additionally, alcoholism can result in nutritional
deficiencies.
• Vitamin deficiencies, alterations in sugar and fat levels in
• blood, hepatitis, fatty liver, cirrhosis, esophagitis, gastritis,
dementia, abnormal heart rates and rhythms, lowered
platelets, leukopenia.

4. Cloninger’s Alcoholism Typology
Type I
Late onset
Rapid development of
behavioral tolerance
Mood issues: Prominent guilt
and anxiety about drinking
Personality traits:
– High reward
– dependence
– High harm avoidance
– Low novelty seeking
Type II
Early onset
Not specified
Mood issues: Absence of
guilt and anxiety about
drinking
Personality traits:
– Low reward dependence
– Low harm avoidance
– High novelty seeking

5. Causes
• Alcoholism is a complex, multifaceted disorder
• Behavioral
– Related to the internal feedback: shame or
hangover
– External feedback: reprimands, criticism, or
encouragement
• Other external factors: peer pressure, acceptance in a
peer group
• Specific moods (easygoing, relaxed, calm, sociable)
that are related to the formation of intimate
relationships.

6. • Environmental factors:
– Severe childhood trauma
– Lack of peer and family support
• Biological factors:
– Repeated use of alcohol can impair the brain levels
of a “pleasure” neurotransmitter called dopamine.
– Norepinephrine - modulate reward dependence or
the resistance to extinction of previously rewarded
behavior
– A high testosterone concentration during pregnancy
may be a risk factor for the ADS in future

7. • Genetic factors:
– Alcoholism recognized to be run in the family
– 7 fold risk of alcoholism in first-degree relatives of
alcohol-dependent individuals predominantly
among males.
– Twin studies & adoption studies- evident to the
genetic vulnerability of the alcohol dependency
– Type 2 alcoholism is more male limited type

8. Demographics
• The lifetime prevalence in the general
population for alcoholism is between 9.4% and
14.1%
• Twice more among males (11.9:1.7- In india)
• 20% among general hospital inpatients
• Can develop among any caste irrespective of
the socio-economic status
• Urban Vs Rural: 5.8 & 7.3/1000 Overall:
6.9/1000.

9. Pathophysiology
Alcohol has anesthetic & depressive property
when taken as large dosage
It causes euphoria when taken less
This is caused by activation of mesolimbic
dopaminergic circuit, particularly the ventral
tegmental area (VTA) and the nucleus accumbens
(NAc) by the alcohol.
Anxiolysis and relaxation appear to be
mediated by activation of the GABAergic
neurotransmitter system (rewarding effect)

10. Clinical features
• Alcohol dependence:
– Compulsive drinking till the level of intoxication (S.
Ethanol:50 to 150 mg/dl of blood)
– Intoxication will be euphoria at first.
– A/c intoxication- impaired thinking, in coordination,
slow or irregular eye movements, and impaired
vision.
– A level of tolerance with chronic drinks.
– Alcohol blackouts: amnesia with the presence of
consciousness

11. • Alcohol withdrawal state:
–disordered perceptions, seizures, tremor
(often accompanied by irritability, nausea,
and vomiting). Tremor of the hands called
“morning shakes,” usually occurs in the
morning due to overnight abstinence
–Delirium tremens: 15% of alcohol dependent
cases.
(agitation, disorientation, insomnia,
hallucinations, delusions, intense sweating,
fever, and increased & tachycardia)- Medical
emergency.

12. Assessment
• DSM IV/ ICD 10 diagnostic criteria
• Based on medical and (or) psychological
conditions related to the alcoholism
• Psychological diagnosis can be established using
standardized tools such as;
– CAGE questionnaire(Ewing, 1984),
– MAST (Brief: 10 items; Short: 15 items & Self-
Administered Alcohol Screening Test – SAAST: 35
items)- Selzer (1971)
– AUDIT: 10-items.
– Other psychological test for depression (BDI-II)

13. Psychiatric co-morbidity
• 36.6% of those with a lifetime alcohol use disorder
have at least one other psychiatric diagnosis (Regier et
al.,1990)
• Women diagnosed with AUD are more (72%) risk than
males (57%)
• Prevalence of illness was more with alcohol dependency
than abuse.
• The most frequent co-occurring diagnoses are for other
drug use disorders, conduct disorder, antisocial
personality disorder (more among men), anxiety
disorders and affective disorders (more among women)

14. age of onset,
severity of
alcohol
dependence and
comorbid
psychiatric
disorders
Course & natural history
heavy
drinking
during the
late
twenties
interference
with
functioning in
multiple life
areas during
their early
thirties
loss of control,
followed by an
intensification
of social and
work-related
problems, and
onset of
medical
consequences in
the mid- to late
thirties
severe
long-term
consequen
ces by the
late
thirties
and early
forties
(Schuckit et al.1993)

15. Goals of Alcoholism Treatment
1. Promote complete abstinence from alcohol.
2. Stabilize acute medical (including alcohol
withdrawal) and psychiatric conditions, as needed.
3. Increase motivation for recovery.
4. Initiate treatment for chronic medical and psychiatric
conditions, as needed.
5. Assist the patient in locating suitable housing (e.g.,
moving from a setting in which drinking is
widespread), as needed.
• Continues…

16. 6. Enlist social support for recovery (e.g., introduce
to 12-step programs and, when possible, help the
patient to repair damaged marital and other
family relationships).
7. Enhance coping and relapse prevention skills
(including social skills, identification and
avoidance of high-risk situations).
8. Improve occupational functioning.
9. Promote maintenance of recovery through
ongoing
10.participation in structured treatment or self-help
groups.

17. Identification & management of alcoholism
Initial assessment
Diagnostic
evaluation and
treatment
Intervention (AUDIT
16-40)
Brief intervention and
periodic reevaluation AUDIT
8-15)
No intervention
Needed (AUDIT <8)
Evaluate presence and
severity of physical
dependence

18. Management of alcohol withdrawal
• Through detoxification
– Objectives: 1. Relief of discomfort, 2. Prevention
or treatment of complications, & 3. Preparation
for rehabilitation.
– Careful screening for concurrent medical
problems
– Administration of thiamine (50–100 mg by
mouth or IM) and multivitamins: prophylaxis for
alcohol- related neurological disturbances.

19. • Social detoxification: Frequent reassurance,
Reality orientation, monitoring of vital signs,
personal attention & general nursing care
• The commonly used drugs for the Rx of alcohol
withdrawal are Benzodiazepines, diazepam
and chlordiazepoxide (Hepatic side effects)

20. Non pharmacological measures
• Cognitive and behavior therapies:
– Relapse prevention,
– Social skills and assertiveness training,
– Contingency management,
– Deep muscle relaxation,
– Self-control training and
– Cognitive restructuring
– MET
• Teach more adaptive coping strategies alter to the
conditions that precipitate and reinforce drinking
• Self help groups (AA)

21. Pharmacological management
• Alcohol-sensitizing Drugs:
–Disulfiram (125 to 500 mg ): disulfiram-
ethanol reaction (DER)
• Common S/e: drowsiness, lethargy and
fatigue
• Rare S/e: optic neuritis, peripheral
neuropathy and hepatotoxicity.

22. Drugs that May Directly Reduce Alcohol
Consumption
1. Opioid Antagonists
2. Serotonergic Medications
3. Acamprosate

23. Nursing care of
patient with alcohol
related disorders

24. Comparison between ICD 10 with DSM IV
ICD 10
• flushed face and conjunctival
injection for the Sx of
alcohol intoxication
• Alcohol Withdrawal require
three symptoms from a list of
10 which includes headache
DSM IV
• impairment in attention for
the Sx of alcohol intoxication