Alcohol addiction or alcoholism can be defined as over consumption of alcohol beverages by people worldwide. Addiction of alcohol later results in developing dependance and affects physiological and behavioural aspects of an individual. It is caused due to multiple factors such as stress, depression environmental changes and other physiological conditions.
Information to be achieved during first appointment:
It is very necessary to gather basic information about the alcohol addicted lady related to her drinking habits in order to help her get rid of alcohol intake frequently. Answers to the below given questions will help in deciding the type of treatment she needs to overcome her alcoholism.
- Is she a working lady, a house-wife or a divorcee?
- Does she live alone or she is supported by a care taker in her house?
- What was the age when she initially started taking alcohol?
- What types of alcohol beverages she consumes often? Is it beer, wine or whisky?
- How often she drinks in a day and in a week?
- What is the quantity of alcohol that lady consumes each time during drinking session?
- Has she ever tried to quit her drinking habits?
- How does her body reacts when she stops consuming alcohol for sometime?
- Has she ever been a patient of depression earlier in her life?
Factors to be considered when assessing if this lady is ready to address her alcohol use:
This alcohol addicted lady revealed the reason behind her heavy drinking tendency. It is because she lives all alone in her house as her children are grown up now and have recently moved out from her house to a new place (Brower, Aldrich and Greden, 2014). Different screening evaluations and assessments needs to be carries out in order to convince the lady to address her alcohol use.
Trauma assessments: It is essential to carry out an evaluation on different trauma levels that she is going through. It can help in determining exact reasons for her stress and depression.
Blood Alcohol Concentration Determination: Assessing alcohol level in blood is necessary so that it do not exceeds the threshold limit which can be fatal to her life.
How to decide to admit the patient for an inpatient 'detox' or outpatient 'detox'?
After studying the above case of severe alcohol addiction it would not be preferrable and beneficial to carryout outpatient detoxification treatment on her. As she lives alone in her house without any caretaker's support it will not be convenient for her to visit hospital and other addiction relief centres on a regular basis (Larimer, 2013). On other hand if she is given outpatient detox treatment she will have an easy access to alcohol beverages which can prove to be harmful and hazardous during the treatment.
Contrary to outpatient detox care inpatient detox treatment can be of several benefits to her. She will be under constant supervision of healthcare professional assigned to her. Chances of severe medical complications will be minimised because the staff will guide her for administration of different types of drugs on daily basis. The main benefit of inpatient treatment is that she will not have access to any kind of alcohol drinks in hospital where she is treated.
What is likely to have happened to her on those two occasions?
Visual and auditory hallucinations can be one of the reason which could have disturbed her sleep because it is generally experienced by people who are chronic to alcohol consumption. The other reason can be heart palpitation or irregular heart beats which is caused due to anxiety.
Mechanism for Hallucinations and Heart palpitation:
Hallucinations: The mechanism behind hallucintions is very spontaneous which can result in different type of hallucinations such as visual, auditory, tactile, gustatory and proprioceptive hallucinations (Stimmel, 2014). These hallucinations which she encountered were due to irregular fluctuating nerve and electric signals crossing through brain. She experienced it because her consumption of alcohol is in larger quantity on daily basis. The temporal and olfactory lobes of her brain gave abnormal and abrupt signals which in turn caused hallucinations to occur. Persons who are patients of stress, depression, schizophernia, cerebral palsy and epileptic disorders often suffers from various types of hallucinations.
Heart palpitations: Palpitations can be defined as the sensation of irregular and rapid heartbeats generally experienced during night time (Walker, Cousins and Haddad, 2013). The alcohol addicted lady encountered this due to abnormal conduction of electrical impulses through atries and ventricles of heart chambers. When her atries failed to pump blood normally other cells of ventricles were activated for pumping but when both atries and veins failed to pump normal amount of blood palpitations occurred. Irregular and abnomal heartbeats is generally noticed in individuals whose alcohol intake is heavy . Her Palpitations were also accompanied with night sweating and anxiety which is called as arrhythmias or heart rhythm irregularity.
How can this be prevented?
- General measures can be adopted by physicians to treat her reduce the severity of hallucinations and heart palpitations.
- Over intake of alcohol and other illicit drugs by her should be stopped in order to avoid halluciantions.
- She should be encouraged to participate in rehabilitation camps and programs for better counselling which can further aid in releiving her from alcohol depression and anxiety.
Medications to reduce alcohol consumption:
Following mentioned medications can help in preventing and reducing alcohol intake
Naltrexone (ReVia, Vivitrol): This is an anti craving drug that can be used temprorily as she has a serious problem of alcoholism.
Acamprosate (Campral): This drug will inhibit neurotransmitter GABA, in her which will further reduce craving for alcohol.
Disulfiram (Antabuse): This drug is generally regarded as adversion drug and will make her experience uncomfortable side effets while drinking.
Mechanism of action of the drugs mentioned above:
Baclofen generally known as β-(4-chlorophenyl)-γ-aminobutyric acid (β-(4-chlorophenyl)-GABA) is used to treat patients with excessive consumption of alcohol. It functions by depressing central nervous system and relaxing skeletal muscles of the body. Baclofen mechanism of actions works by blocking mono-and-polysynaptic reflexes by acting as an suppressing neurochemical agents (Maisto, Galizio and Connors, 2014). Blocking the release of stimulative transmitters is also done by Baclofen.
This drug is not suitable for her as it has many side effects like nausea, headache, irregular heartbeats, repiratory depression and anxiety which can further disturb her to a greater extent.
Mechanism of cognitive problems in someone with long term alcoholism:
The long term effects of alcohol can be beneficial and serious life threatening consequence on her. It includes various disorders and abnormalities like alcoholism, food and water deficiency disease, alcoholic liver disease and different malignant tumours in lungs and brain. Long term alcohol consumption will destabilizes mental and physical health of that lady which can increase the risk of liver damange, kidney failure and other psychotic disturbances. Se can also suffer from neuropathic disorders and sever arrhythmia and depression resulting in loss of mental growth and stability.
How can it be prevented?
- Different cognitive therapies can be adopted to treat her with this problem.
- Drugs which boost and increases the level of neurotransmitters should be prescrbed so that it reduces her craving for alcohol.
- Various therapeutic and behavioural therapies can be used to study and rtreat her behaviour changes due to alcohol consumptions.
- Awareness on side effects of alcoholism is necessary to be given to her so that she reduces her dailly intake.
Biological, psychological and social factors that are contributing to this lady’s current presentation:
- Different causes contributed in develolping present condition of this lady with heavyy drinking habit.
- Separation from her husband and children increased her lonliness which further resulted in anxiety and depression.
- Different behavioural changes also contributed in her present day condition.
- Family history of father being an alcoholic was again the major riskl factor which resulted in her alcoholism.
- Stress reduction was also of the factors which forced her to indulge in alcoholic activities.
It is concluded that various biological and psychological factors were responsible for lady's alcoholiosm in the above discussed case. Different medications and therapies have been adopted to overcome and reduce alcohol dependence in her.
- Johnson, B.A., 2014. Medication treatment of different types of alcoholism. The American journal of psychiatry.
- Patterson, T.L. and Jeste, D.V., 2014. The potential impact of the baby-boom generation on substance abuse among elderly persons. Journal on Psychiatric Services.
- Maisto, S., Galizio, M. and Connors, G., 2014. Drug use and abuse. Cengage Learning.
- Brower, K.J., Aldrich, M.S. And Greden, J.F., 2014. Insomnia, self-medication, and relapse to alcoholism. American Journal of Psychiatry.
- McBride, W.J., Rodd, Z.A. and Li, T.K., 2014. The alcohol-preferring and high-alcohol-drinking (HAD) rats–Animal models of alcoholism.