Substance related disorders alcoholism

SUBSTANCE RELATED DISORDERS
(ALCOHOLISM)
RICHARD OPOKU ASARE
COLLEGE OF NURSING, NTOTROSO
SAHS-UDS, TAMALE
19-Mar-16 asareor@yahoo.com 2016 1

MEANING OF TERMS
To communicate about substance-related
disorders, an understanding of terms is
necessary. I therefore urge all students to find
the meanings to the following terms and write
them in their note books:
1. Substance
2. Substance use
3. Substance Dependence: (2 types)
a. Physical/Physiological dependence
b. Psychological dependence

MEANING OF TERMS – Cont’d
4. Abuse
5. Substance Abuse
6. Abused Substances
7. Mind-Altering Drug
8. Drug
9. Drug Misuse
10. Illicit Drug
11. Deviant Drug Use

12. Psychoactive Drugs
13. Substance/Drug Abuse
14. Detoxification
15. Habituation
16. Tolerance
17. Dependency
a. Physical dependence
b. Psychological dependence

18. Addiction
19. Drug Addiction
20. Abstinence
21. Intoxication
22. Inhalant Intoxication
23. withdrawal
24. Substance Withdrawal

25. Narcotics/Opiates
26. Sedatives
27. Stimulants
28. Hallucinogens
29. Cannabis
30. Alcohol
31. Alcoholism
32. Substance Induced Disorder

WHY PEOPLE USE DRUGS
• To change their mood
• To alter their perception of self and the world
around them
• To produce novel sensations and experiences
• To enhance their ability to function in
unfamiliar or anxiety-producing situations

CLASSES OF PSYCHOACTIVE
SUBSTANCES
The following eleven (11) classes of
psychoactive substances are associated with
substance-use and substance-induced
disorders. They include:
1. Alcohol, e.g., spirits, beers, wines, etc.
2. Amphetamines and related stimulants,
e.g., benzedrine, dextroamphetamine, etc.
3. Caffeine, e.g., coffee, tea.

SUBSTANCES – Cont’d
4. Cannabis, e.g., marijuana, hashish oil, etc.
5. Cocaine and related narcotics
6. Hallucinogens, e.g., LSD, mescaline,
psilocybin, etc.
7. Inhalants, e.g., gasoline, toluene vapors
(correction fluid, glue, marking pens), etc.
8. Nicotine, e.g., tobacco, cigarette smoking,
etc.

SUBSTANCES – Cont’d
9. Opioids, e.g., opium, morphine,
codeine, heroin, hydromorphone,
meperidine, etc.
10. Phencyclidine (PCP) and related
substances, e.g., tic tac, love boat, angel
dust, etc.
11. Sedatives, hypnotics, or anxiolytics,
e.g., barbiturates, tranquilizers, etc.

These psychoactive drugs can also be categorized as
follows:
CLASS DRUGS GENERAL MEDICAL
USES
Hallucinogens Phencyclidine, LSD,
Amphetamine,
Psilocybin, Mescaline
Phencyclidine is
used as veterinary
anaesthetic
Stimulants Cocaine,
Amphetamines,
Caffeine, Nicotine,
Methylphenidate,
Phenmetrazine
Local anaesthetic,
Weight control,
Hyperactivity,
Narcolepsy

These psychoactive drugs can also be categorized as follows – Cont’d
USES
Opiates/Narcotics Heroin, Morphine,
Meperidine, Codeine,
Opium, Methadone
Antitussive,
Antidiarrhoea,
Addictive
maintenance,
Analgesic
Depressants Alcohol, Barbiturates,
Benzodiazepines or
hypnotics, Choral
hydrate, Dalmane,
Methaqualone
Hypnotic,
Anaesthestic,
Anticonvulsant,
Sedative

USES
Cannabis Marijuana,
Tetrahydrocannabinol,
Hashish oil
Nausea
Opiates Heroin, Morphine,
Meperidine, Codeine,
Opium, Methadone
Antitussive,
Antidiarrhoea,
Addictive
maintenance,
Analgesic

USES
Inhalants Gasoline, Cleaning fluids,
Toluene acetone, Amyl
nitrate, Airplane cement,
nitrous oxide
Dental anaesthetic
ASSIGNMENT
Please prepare notes on the 7 Classes of Drugs of Abuse under the following headings:
i. Possible Effects
ii. Effects of overdose
iii. Withdrawal syndrome
Source of Reference:
Oakley Ray & Charles Ksir: Drugs, Society, and Human Behavior. Copyright © 2004 by
McGraw-Hill

CAUSES OF SUBSTANCE DISORDERS
1. Biological/Organic Factors
• Genetics
a) children of alcoholics are 4 times more likely
than other children to become alcoholics.
b) identical (monozygotic) twins have twice the
rate for concordance of alcoholism compared
with fraternal (dizygotic) twins.

CAUSES OF SUBSTANCE DISORDERS
• Genetics – cont’d
c) male biological offspring of alcoholic fathers
have 4–5 times greater incidence of alcoholism
than offspring of non-alcoholic fathers.
• Biochemical abnormalities
e.g., alcohol produce morphine-like substances in
the brain that are responsible for alcohol addiction,
e.g., tetrahydropapaveroline, salsolinol.

2. Psychological/Emotional Factors
• Developmental deficiencies, e.g.,
a) fixation at the oral stage of psychosexual
development.
b) inability to defer/delay gratification.
• Personality type, e.g., shy, passive, schizoid
• Low self-esteem
• Frequent depression
• Inability to relax

2. Psychological/Emotional Factors – Cont’d
• Inability to communicate effectively
• Feelings of dependency
• Low tolerance for frustration
• Stresses in life, e.g., suffering from
trauma (i.e., posttraumatic stress
disorder)
• Anxiety
• Fear

2. Psychological/Emotional Factors – Cont’d
• Antisocial behaviour
• Divorce
• Rejection
• Loss of prestige
• Loss of job
• Loss of property
• Loss of relative
• Chronic physical illness

3. Sociocultural/Environmental/Physical
Factors
• Drug-oriented culture, i.e., the use of prescribed
drugs for relief of tension and pain
• Availability of drugs in the system
• Easy accessibility of drug without restrictions
• Cheap cost of drugs
• Cultural approval of intake of substances, e.g.,
alcohol
• Pleasurable environment increases substance use

Factors – Cont’d
• Peer/Group influence
• Family influence
• Modeling
• Imitation
• Age, i.e., societal approval that one is of age to
take substances, such as alcohol
• Sex, i.e., societal approval of men taking
substances

Factors – Cont’d
• Curiosity and experimentation with the chemical
• Poverty
• Poor management and administration of
narcotics and other drugs in the society
• Break down of cultural values
• Advertisement of alcohol beverages and other
drugs in the media
• * The list is inexhaustible; add the rest.

COMMON SIGNS OF DRUG ADDICTION
1. Constantly thinking about the drug
2. Drowsiness
3. Frequently Argumentative
4. Hallucinations
5. Irritability
6. Memory loss

COMMON SIGNS OF DRUG ADDICTION
– Cont’d
7. Nausea
8. Poor coordination
9. Rapid or slurred speech
10. Red eyes
11. Smelling of the substance
12. Unable to quit using drugs on his/her
own

KEY NURSING INTERVENTIONS FOR
SUBSTANCE ABUSE
• Detoxify client with medications prescribed
and as ordered.
• Meet physical needs during detoxification.
• Address the physiological problems resulting
from substance dependence in the same
manner as these needs would be met in any
person.
• Monitor the effects of the therapies that may
be prescribed to control the substance use.
• Teach client about the disease and its
progression.

KEY NURSING INTERVENTIONS FOR SUBSTANCE ABUSE – Cont’d
• Focus on client’s strengths, and help client build
on them.
• Help client solve his problem and the dilemmas
he fears.
• Encourage client to focus on the present and the
future, not on the past.
• Behave toward client in a consistent manner,
confronting him in a non-judgemental, non-
punitive manner, if he breaks the rules of the
treatment setting.
• Assist client’s family by encouraging them to
become involve in group counselling.

ALCOHOLISM
Alcoholism is the popular term for two disorders,
alcohol abuse and alcohol dependence. The
hallmarks of both these disorders involve repeated
life problems that can be directly attributed to the
use of alcohol. Both these disorders can have
serious consequences, affecting an individual's
health and personal life, as well as having an impact
on society at large. Alcoholism is a chronic
disorder.

DEFINITIONS OF ALCOHOLISM
1. Alcoholism refers to any condition that results in
the continued consumption of alcoholic
beverages despite the health problems and
negative social consequences it causes.
2. Alcoholism is described as uncontrolled intake of
alcoholic beverages that interferes with physical
and mental health, social and familial
relationships, and occupational responsibilities.
3. Medical definitions describe alcoholism as a
disease which results in a persistent use of
alcohol despite negative consequences.

DEFINITIONS OF ALCOHOLISM – Cont’d
4. Alcoholism is also defined as having four major symptoms:
a) Craving: A strong need or urge to drink alcohol;
b) Impaired (loss of) control: The inability to limit the
amount one drinks on any given occasion, or inability to
stop drinking once drinking has begun;
c) Physical dependence: Appearance of withdrawal signs
and symptoms after stopping drinking, i.e., having
withdrawal symptoms (e.g., nausea, sweating, shakiness)
when alcohol use is stopped after a period of heavy
drinking; and
d) Tolerance: The need for increasing amounts of alcohol to
feel its effects, i.e., the need to drink greater amounts of
alcohol to get “high.”

DEFINITIONS OF ALCOHOLISM – Cont’d
Alcohol abuse requires that one of the following
four criteria is met. Because of drinking, a
person repeatedly:
1. Fails to live up to his/her most important
responsibilities.
2. Physically endangers himself/herself or
others (for example, by drinking when
driving).
3. Gets into trouble with the law.
4. Experiences difficulties in relationships or
jobs.

INCIDENCE
• Alcoholism cuts across all social and economic
groups.
• It involves both sexes.
• Alcohol intake starts as early as the elementary
school age.
• The average age of first use of alcohol is 12.5
years.
• Alcohol is the number one substance abuse
problems for adolescents.
• About 13–15% of all adults over age 18 have
suffered from alcohol abuse.
• The prevalence of drinking is highest between the
ages of 21 and 34. These are problem drinkers.

INCIDENCE – Cont’d
• The heaviest drinkers, however, are 35 to 49
years old.
• Males are 2–5 times more likely to abuse alcohol
than females.
• Women take twice as long to metabolize the
same amount of alcohol as men.
• Alcohol abuse is a factor in about 55–60% of all
lorry accidents.
• It takes one hour for each drink to be
metabolized.
• About 25% of all hospital admissions are alcohol
related.
• Different tolerance for each individual.

CAUSES
• Advertisements of alcoholic beverages in the
media
• Allergic responses
• Availability of alcoholic beverages
• Biochemical abnormalities
• Easy affordability of alcoholic beverages, i.e.,
cheap cost
• Endocrine imbalances
• Excessively stressful lifestyle
• Group/peer pressure

CAUSES – Cont’d
• Hereditary/Genetics
• Nutritional deficiencies
• Rape and sexual abuse
• Social attitudes that approve of frequent
drinking
• Symptoms of mental illness
• The desire to avoid responsibility in familial,
social and work relationships
• The need to bolster self-esteem
• The urge to drink to reduce anxiety

DIAGNOSIS OF ALCOHOLISM USING
THE CAGE QUESTIONNAIRE
One very simple tool for beginning
the diagnosis of alcoholism is
called the CAGE questionnaire.
It consists of four questions, with
the first letters of each key word
spelling out the word CAGE:

DIAGNOSIS OF ALCOHOLISM USING
THE CAGE QUESTIONNAIRE
• Have you ever tried to Cut down on your drinking?
• Have you ever been Annoyed by anyone’s comments
about your drinking?
• Have you ever felt Guilty or bad about your drinking?
• Do you ever need an Eye-opener (a morning drink of
alcohol) to start the day or get rid of a hangover?
If the client answers yes to two of the above questions,
he or she is likely into alcoholism.

MEDICAL CONDITIONS RELATED TO
ALCOHOL ABUSE
Cardiovascular
• alcoholic cardiomyopathy
• increased systolic and pulse pressure
• tissue damage, weakened heart muscle, and
heart failure
Metabolic
• hypoglycemia, hyperlipidemia, hyperuricemia
• ketoacidosis
• osteoporosis

ALCOHOL ABUSE – Cont’d
Gastrointestinal
• abdominal distention, pain, belching, and hematemesis
• acute and chronic pancreatitis
• alcoholic hepatitis leading to cirrhosis
• cancer of the esophagus, liver, or pancreas
• esophageal varicies, hemorrhoids, and ascites
• gastritis, colitis, and enteritis
• gastric or duodenal ulcers
• gastrointestinal malabsorption
• hepatorenal syndrome
• swollen, enlarged fatty liver

Genitourinary
• hypogonadism, hypoandrogenization,
hyperestrogenization in men
• increased urinary excretion of potassium and
magnesium (results in hypomagnesemia, hypokalemia)
• infertility, decreased menstruation
• prostate gland enlargement, leading to prostatitis and
interference with urination
• prostate cancer
• sexual dysfunction: decreased libido, sexual
performance decreased,
• impotency

Hematologic
• abnormal red blood cells, white blood cells,
and platelets
• anemia and increased risk of infection
• bleeding tendencies, increased bruising, and
decreased clotting time
• mineral and vitamin deficiencies (folate, iron,
phosphate, thiamine)

Neurologic
• Wernicke-Korsakoff syndrome, Marchiafava-
Bignami disease, cerebellar degeneration
• peripheral neuropathy, polyneuropathy
• seizures
• sleep disturbances
• stroke (increased risk of hemorrhagic stroke)

Respiratory
• cancer of the oropharynx
• impaired diffusion, chronic obstructive
pulmonary disease, infection, and tuberculosis
• respiratory depression causing decreased
respiratory rate and cough reflex and
increased susceptibility to infection and
trauma

Trauma related
• burns, smoke inhalation injuries
• injuries from motor vehicle crashes and falls
Source:
ISPN Position Paper, October 2000: AWS in the Acute Care Setting, p. 8
www.ispn-psych .org

ALCOHOL & REPRODUCTIVE SYSTEM
• Heavy drinking has a negative effect on
fertility in both men and women, by
decreasing testicle and ovary size, and
interfering with both sperm and egg
production.
• When pregnancy is achieved in an alcoholic
woman, the baby has a great risk of being
born with fetal alcohol syndrome, which
causes distinctive facial defects, lowered IQ,
and behavioral problems.

ALCOHOL & REPRODUCTIVE SYSTEM – Cont’d
Other female complications include:
• Changes in menstrual cycles
• Amenorrhoea
• Decreased or loss of ability to become
pregnant
In males, complications include:
• Diminished libido (low sexual energy)
• Decreased sexual performance
• Impotency

Explanation to Alcohol and Sexual Dysfunction
From Virginia Alcohol Safety Action
Program ([VASAP], 2002), alcohol interferes
with the normal production and
maintenance of female and male
hormones.
For women, this can mean changes in the
menstrual cycles and a decreased or loss of
ability to be become pregnant.

Explanation to Alcohol and Sexual Dysfunction
For men, the decreased hormone levels
result in a diminished libido, decreased
sexual performance, and the development
of reactive or absolute impotence over
time.

Social complications of alcoholism
include:
• Crime
• Prostitution
• Rape
• Murder
• Family negligence
• Unemployment
• Indebtedness
• Malnutrition
• Delinquency
• Road traffic accidents (RTAs), etc

ALCOHOLIC INTOXICATION
• Intoxication occurs after drinking
excessive amounts of alcohol and
is evidenced in maladaptive
behaviour such as fighting,
impaired judgement, or
interference with social or
occupational functioning.

ALCOHOLIC INTOXICATION – Cont’d
• Physiologic signs, such as slurred
speech, incoordination, unsteady
gait, nystagmus, and flushed face,
may accompany intoxication.
• Psychological signs also may be
observed, such as mood changes,
irritability, talkativeness, or impaired
attention.

The following are the six stages of
alcohol intoxication:
1) Euphoria
2) Excitement
3) Confusion
4) Stupor
5) Coma
6) Death

GENERAL SIGNS OF ALCOHOL ABUSE
• Odour on the breath, intoxication (obviously
drunk)
• Difficulty focusing, glazed appearance of the eyes
• Unusually passive or aggressive behavior or
irritability
• Gradual (or sudden in adolescents) lack of
concern for personal appearance or hygiene
• Worsening job performance or school work
• Missing work or school (especially on Monday)

GENERAL SIGNS OF ALCOHOL ABUSE – Cont’d
• Unexplained bruises and accidents
• Flushed skin
• Loss of memory (blackouts)
• Getting and drinking alcohol becomes the
focus of social or professional activities
• Damage to relationships with friends and
close family (e.g., not being as responsible
with household chores or driving, breaking
dates in order to drink, not being able to have
normal discussions when drunk.)

ALCOHOL WITHDRAWAL SYNDROME
This is also referred to as Abstinence Syndrome. It
occurs 24–48 hours after a reduction in or cessation
of prolonged heavy drinking, commonly lasting 1–3
days.
Symptoms include:
• tremors of the hand, tongue and eye eyelids;
• nausea and vomiting;
• general body weakness or malaise;
• autonomic nervous system hyperactivity (e.g.,
increased blood pressure and pulse) or
tachycardia, or increased vital signs;

ALCOHOL WITHDRAWAL SYNDROME – Cont’d
• anxiety;
• depressed mood;
• irritability; and
• orthostatic hypotension.
• Sleep disturbances, insomnia, and nightmares
may occur during withdrawal.
Other symptoms are:

ALCOHOL WITHDRAWAL SYNDROME – Cont’d
• fever and
• diaphoresis (sweating),
• restlessness,
• disorientation,
• visual illusions, and
• hallucinations.
A complicated or serious form of this disorder is
Alcohol Withdrawal Delirium, also known as
Delirium Tremens (DTs). Symptoms include
those described above.

COMMON DIFFERENCES BETWEEN POST-ICTAL ALCOHOL
WITHDRAWAL SEIZURES AND EPILEPTIC SEIZURES
FEATURE ALCOHOL WITHDRAWAL SEIZURES EPILEPSY
Consciousness level Sleeplessness Post-ictal sleep/drowsy
Mood Anxiety, agitated Calm
Tremor Yes No
Sweating Yes No
Blood Pressure,
Pulse Rate
Elevated Normal
Temperature Fever (lower than 38.5⁰C);
presence of fever
Normal/slight fever;
absence of fever
Arterial bloods Respiratory alkalosis Normal
EEG Normal, low-amplitude Pathology

MEDICAL TREATMENT OF ALCOHOL WITHDRAWAL DELIRIUM
• Give IV glucose to maintain
hydration, as ordered.
• Give Vitamin B12 supplement, as
prescribed.
• Sedate client with Librium, Valium, or
Thorazine/Largactil
(Chlorpromazine), as ordered.

NURSING INTERVENTION
• Reassure client, and family.
• Be calm towards him/her.
• Frequently orient client in all spheres, if
disoriented.
• Maintain safety of client always.
• Serve prescribed drugs, as ordered.
• Cautiously administer maintenance doses of
alcohol to prevent addiction.
• Supervise client constantly to prevent impulsive
behaviour and self injury.
• Restraint, if necessary.

NURSING INTERVENTION – Cont’d
• Ensure adequate lighting in the environment to
reduce visual distortion.
• Decrease noise and other activities to enhance
relaxation.
• Monitor vital signs every 2–4 hours.
• Promote intake of high caloric vitamin feeds.
• Assist client in feeding, as needed.
• Assist client in other activities of daily living, e.g.,
grooming, etc.
• Monitor intake and output of fluids.
• Document all procedures.
* Other nursing cares are symptomatic.

Cocaine
• Place the patient in a quiet room
• If cocaine was ingested, induce vomiting or perform
gastric lavage. Follow with activated charcoal and a
saline cathartic.
• If cocaine was sniffed, remove residual drug from
mucous membranes.
• Monitor vital signs.
• Give propranolol for tachycardia.
• Perform cardiopulmonary resuscitation for ventricular
fibrillation and cardiac arrest as indicated.
• Give a tepid sponge bath for fever.
• Administer an anticonvulsant.

Opiates
• If the drug was ingested, induce vomiting or
perform gastric lavage.
• Give naloxone until CNS effects are reversed.
• Give I.V. fluids to increase circulatory volume.
• Use extra blankets for hypothermia; if ineffective,
use a hyperthermia blanket.
• Reorient the patient to time, place, and person.
• Assess breath sounds to monitor for pulmonary
oedema.
• Monitor for signs and symptoms of withdrawal.

FETAL ALCOHOL SYNDROME
(FAS)
Some pregnant women take drugs, smoke
tobacco, and drink alcohol without thinking
about the possible effects on the foetus.
Pregnant women who consume approximately 18
drinks per day have a 30-33% chance of having a
baby with fetal alcohol syndrome (FAS). The
problems caused by fetal alcohol syndrome may
vary from child to child; however, the defects
caused by fetal alcohol syndrome are
irreversible.

FETAL ALCOHOL SYNDROME
(FAS) – Cont’d
Heavy drinking by pregnant women, therefore,
has a devastating effect on the offspring. Caution
is hereby giving that there is no amount of
alcohol that is known to be safe to consume
during pregnancy. If a woman drinks during
pregnancy, she places her baby at risk of fetal
alcohol syndrome. FAS is a cluster of
abnormalities that appears in the offspring of
mothers who drink alcohol heavily during
pregnancy (Santrock, 1998).

DEFINITION(S) - FAS
1. Fetal alcohol syndrome (FAS) is a condition that
results from alcohol exposure during pregnancy.
Problems that may be caused by fetal alcohol
syndrome include physical deformities, mental
retardation, learning disorders, vision difficulties and
behavioral problems.
2. Fetal alcohol syndrome refers to growth, mental,
and physical problems that may occur in a baby
when a mother drinks alcohol during pregnancy.
3. Fetal alcohol syndrome (FAS) is a pattern of mental
and physical defects that can develop in a foetus in
association with high levels of alcohol consumption
during pregnancy.19-Mar-16 asareor@yahoo.com 2016 65

Incidence
• More than 20% of children have been exposed to high
levels of alcohol in utero.
Causes
• Prenatal alcohol exposure is the cause of fetal
alcohol syndrome. When a pregnant woman
drinks alcohol, it easily passes across the placenta
to the foetus. Because a foetus metabolizes
alcohol more slowly than an adult does, the
developing baby’s blood alcohol concentrations
are higher than those in an adult’s body.

Causes
• Alcohol also interferes with the delivery
of oxygen and optimal nutrition to the
baby’s developing tissues and organs,
including the brain which can result in
psychological or behavioral problems,
and cause other physical damage.

Symptoms
A baby with fetal alcohol syndrome may have the following
symptoms:
• Poor growth while the baby is in the womb and after
birth
• Decreased muscle tone and poor coordination
• Delayed development and significant functional
problems in three or more major areas:
 Thinking,
 Speech,
 Movement, or
 Social skills (as expected for the baby’s age)
• Heart defects such as ventricular septal defect (VSD) or
atrial septal defect (ASD)

Symptoms – cont’d
• Structural problems with the face, including:
Narrow, small eyes with large epicanthal folds
Small head
Small upper jaw
Smooth groove in upper lip
Smooth and thin upper lip

Complications
Drinking alcohol during pregnancy may result in:
• Miscarriage
• Stillbirth
• Premature delivery
Complications seen in the infant may include:
• Abnormal heart structure
• Behavior problems
• Infant death
• Mental retardation
• Problems in the structure of the head, eyes, nose, or mouth
• Poor growth before birth
• Slow growth after birth
• Poor coordination after birth

Prevention of FAS
These guidelines can help prevent fetal alcohol syndrome:
• Do not drink alcohol if you are trying to get pregnant.
• Continue to avoid alcohol throughout your pregnancy.
• Consider giving up alcohol during your childbearing years if you
are sexually active and you are having unprotected sex.
• If you have an alcohol problem, get help before you get
pregnant.
• Counselling can help prevent recurrence in women who have
already had a child with fetal alcohol syndrome.
• Sexually active women who drink heavily should use birth
control.
• Sexually active women should control their drinking behaviors,
or stop using alcohol before trying to conceive.
• Screening and other diagnostic tests should be conducted
during pregnancy.

Treatment
• There is no cure or specific treatment for
fetal alcohol syndrome, because the CNS
damage creates a permanent disability.
The physical defects and mental
deficiencies typically persist for a
lifetime.
• Heart abnormalities may require surgery.
• Learning problems may be helped by
special services in school.

Treatment
• Parents often benefit from counseling to
help the family with a child's behavioral
problems.
• Pregnant women with alcoholism should
join an alcohol abuse rehabilitation
program and be checked closely by a
health care provider throughout
pregnancy.

Treatment
Other treatment plan for children living with FAS include the
following:
• Music,
• playing instruments,
• composing,
• singing,
• art,
• spelling,
• reading,
• computers,
• mechanics,
• woodworking,
• skilled vocations (welding, electrician, etc.),
• writing,
• poetry. (Malbin, 2002)

Coping and support
The psychological and emotional
problems associated with fetal alcohol
syndrome can be difficult to manage.
Health professionals and parents with
children living with FAS may find the
following suggestions helpful in
dealing with behavioral problems
associated with the syndrome:

Coping and support – cont’d
• Implement daily routines to which the child
can become accustomed.
• Create and enforce simple rules and limits.
• Point out and use rewards to reinforce
acceptable behavior.
• Because many children with fetal alcohol
syndrome are vulnerable, guard against their
being taken advantage of by others.

Coping and support – cont’d
• Teach the child skills for daily living.
• Carefully chose who you ask to care for the
child when you cannot be there, because
some behaviors may be difficult to manage.
WELCOME TO THE END OF PRESENTATION
THANK YOU

Substance related disorders alcoholism

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