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Alcohol Abuse

Alcoholic Beverage
An alcoholic drink contains ethanol, commonly termed as alcohol. Alcohol is a psychoactive drug that is central nervous system depressant and rapidly absorbed in the bloodstream. It can be addictive and the state of alcohol addiction is known as alcoholism.

Physiologic Effects of Alcohol Use
When a person drinks alcohol, he or she may experience relaxation and loss of inhibitions initially. However, when large amount of alcohol is ingested intoxication may occur. The person who is intoxicated may experience the following manifestations.
  • Slurred speech
  • Unsteady gait
  • Lack of coordination
  • Decreased attention span
  • Reduced concentration
  • Impaired memory
  • Impaired judgment
An overdose of alcohol in a short period of time can result to the following manifestations:
  • Vomiting
  • Loss of consciousness
  • Respiratory depression
Physiologic Effects of Long-term Alcohol Use
  • Cardiac myopathy
  • Wernicke’s encepalopathy
  • Korsakoff’s psychosis
  • Pacreatitis
  • Esophagitis
  • Hepatitis
  • Cirrhosis
  • Leucopenia
  • Thrombocytopenia
  • Ascites

Treatment of Alcohol Overdose
  1. Gastric lavage or dialysis. The procedure is performed to remove the drug from the systemic circulation.
  2. Support of respiratory and cardiovascular functioning.

Alcohol Withdrawal
When an alcoholic withdraws from alcohol use, withdrawal symptoms usually starts at about 4 to 12 hours after a marked reduction or cessation of alcohol intake. The withdrawal may take 1 to 2 weeks. It can be life-threatening thus, prompt treatment and management is required or necessary.
Symptoms of alcohol withdrawal are:
  • Coarse hand tremors
  • Sweating
  • Elevated pulse
  • Increase blood pressure
  • Insomnia
  • Anxiety
  • Nausea and vomiting

Delirium Tremens (DT’s)
In cases where the withdrawal signs and symptoms are not treated or becomes severe, the condition may progress to a condition called delirium tremens. Delirium tremens is an acute episode of delirium that is mainly caused after a long period of drinking and being stop abruptly and the person experiences withdrawal. It may also be triggered by head injury, infection, or illness in people with a history of heavy use of alcohol
Signs and Symptoms of delirium tremens:
  • Transient hallucinations
  • Seizures
  • Delirium

Management for Alcohol Withdrawal
  1. Detoxification under medical supervision
  2. For mild alcohol withdrawal symptoms and the client can abstain from alcohol, home treatment is possible.
  3. For severe cases where the client cannot abstain from alcohol during detoxification, a short admission (about 3-5 days) is done.
  4. Safe withdrawal is accomplished through the administration of benzodiazepines such as Chlordiaxepoxide (Librium), Lorazepam (Ativan) or Diazepam (Valium) to suppress the withdrawal symptoms.

Alcohol DetoxificationAlcohol detoxification is the removal of alcohol from the body of an individual who is alcohol dependent or alcoholic. It is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with drugs used to prevent alcohol withdrawal. Alcohol detoxification is not possible without support from friends and family. Most of all it needs a commitment on the part of the individual who will undergo detoxification to abstain from alcohol use.
Alcohol Detoxification Process
The process of alcohol detoxification requires that alcohol be eliminated from the human body and that any withdrawal or other symptoms that are bound to occur are treated medically or psychologically or both. As mentioned earlier, the detoxification process is largely determined by the alcoholic himself. The detoxification process is determined by the person’s condition and by his approach.
In some cases, patients who undergo the alcohol detoxification process may suffer from hallucinations, delirium tremens and convulsions, which require immediate attention and treatment. To minimize these symptoms, medical drugs are given. However, the administration of these medications has to be monitored and accurately controlled. Usually such medications have are given at high dosages initially, but is gradually tampered down over a week.
Withdrawal symptoms can be quite distressing and can even become fatal if the addiction to alcohol is very severe. Safe withdrawal is accomplished with the administration of benzodiazepines to suppress the withdrawal symptoms. Drugs under this category are:
  • Chlordiaxepoxide (Librium) – is the benzodiazepine of choice in uncomplicated alcohol withdrawal due to its long half-life.
  • Diazepam (Valium) – is available as an injection for patients who cannot safely take medications by mouth.
  • Lorazepam (Ativan) – is available as an injection for patients who cannot safely take medications by mouth. This is also indicated in patients with impaired liver function because they are metabolized outside of the liver.
The most common drugs used for alcohol detoxification are benzodiazepines, with Chlordiazepoxide being the most preferred benzodiazepine used. Diazepam is also widely used, but fatal effects may occur if it is mixed with huge doses of alcohol. Hence, supervision is necessary for use of diazepam as a detoxifier.
Where is alcohol detoxification done?
In most cases, alcohol detoxification can be done at home. This is applicable when the alcohol consumption is just moderate. However, in cases where hallucinations, severe withdrawal symptoms and multi-substance misuse are noted, an inpatient detoxification is required.

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