ALCOHOLISM Caring for the Vulnerable NUR 485 Concordia University Jennifer Schiermeyer

ALCOHOLISM: A chronic disease that gets worse as time goes on, and includes problems with controlling how much alcohol is consumed, having a preoccupation with alcohol, the drinking causing problems but continuing to drink, having to drink an increased amount due to tolerance also known as physical dependence, or even having withdrawal symptoms if rapidly decreasing the amount of alcohol consumed (Mayo Clinic, 2014).

STATISTICS ON ALCOHOL IN NEBRASKA  DWI arrests in 2013 – 2,324 (NOHS).  Alcohol related crashes in 2013 – 1,709 (NOHS).  Alcohol related injury with crash in 2013 – 764 (NOHS).  Alcohol related fatal crashes in 2013 – 65 (NOHS).  Alcohol related deaths in 2013 – 70 (NOHS).  8.9 Million Americans live with severe alcohol disorders (NCADD).

Predominate Health Concerns  Dementia, stroke and neuropathy  Cardiovascular problems - myocardial infarction, cardiomyopathy, atrial fibrillation and hypertension  Psychiatric problems - depression, anxiety, and suicide  Social problems - unemployment, lost productivity, family problems, violence including child abuse, fights and homicide  Unintentional injuries - motor-vehicle traffic crashes, falls, drowning, burns and firearm injuries.  Increased risk for cancer - liver, mouth, throat, and esophagus  Liver diseases -fatty liver, alcoholic hepatitis, cirrhosis  Gastrointestinal problems –pancreatitis, gastritis, esophageal varices (NCADD)

Strengths and Resiliencies The strengths and resiliencies are found in the families of an alcoholic, not the alcoholic themselves. Often times part of their resilience is in being able to put up a front for the parent that is using, by saying things like “Mom is in bed because she has a headache” or “Dad is drinking more than usual tonight because he had a rough day at work.” The kids and the significant other get really good at being resilient and strong despite what is going on around them. The resilience found in the alcoholic would be that they are able to hide the addiction well, from family, medical professionals, and friends.

Relevant Cultural Factors and Alcoholism o Overall there is not difference in alcoholic prevalence among African-Americans, Caucasians, and Hispanic – Americans (New York Times, 2013). o The groups that have an increased incidence of alcoholism is Native Americans, and Jewish and Asian Americans have a low risk of alcoholism (NYT, 2013). o Depression is the most common psych problem in people with alcoholism (NYT, 2013). o Alcoholism is common among those with bipolar disorder and schizophrenia (NYT, 2013). o Those with panic disorders and anxiety are at more risk to use alcohol (NYT, 2013).

BARRIERS THAT EXIST FOR ALCOHOLICS  Believing that one can quite drinking at any time.  The stigma of being called an alcoholic or addict.  Social stereotypes can also create barriers.  Denial, not actually believing that they are alcoholic.  Not having access to a treatment program.

SERVICES AND RESOURCES  Alcoholics Anonymous  Al-Anon  Alateen  Family Counseling  Church Pastors, Ministers, or Priests  Doctors for prescription medications to help with drinking  Rehab centers for addiction

NURSING IMPLICATIONS  Do a full assessment paying close attention to the digestive system.  Make sure and look at labs, thiamine will be decreased in advanced alcohol dependence.  Elevated liver enzymes and history of pancreatitis can indicate alcohol abuse also.  Use the CAGE Tool on each patient. (Nursing Link, 2015)

The CAGE Questionnaire: More than 2 positive responses to the questions suggest alcohol dependence. A score of 1 and at least one positive lab result should also suggest alcohol dependence. 1)Have you ever thought you ought to cut down on drinking? 2) Have people annoyed you by criticizing your drinking? 3) Have you ever felt guilty about your drinking? 4) Have you ever had a drink first thing in the morning (eye opener) to steady your nerves, or to get rid of a hangover? (Nursing Link, 2015)

NURSING THEORY The Two Steps Back Framework applies to alcoholics well. In treating alcoholics we need to know what has led them to alcohol so that we can help fix the root of the problem. We need to know what is triggering the drinking and try to get the patient to the help that they need so that they can stop dinking. We also need to make sure that we are caring for the families that are involved also. We need to make sure that they know that alcoholism is genetic so that they can find a better way to deal with problems, instead of turning to alcohol or other drugs.

REFERENCES Mayo Clinic (2014). Alcoholism. Retrieved on March 2015 from National Council on Alcoholism and Drug Dependence. Understanding Alcohol and Alcoholism. Retrieved on March 2015 from Nebraska Office of Highway Safety (2012). Alcohol – Related Information. Retrieved on March 2015 from 1 enf.htmlhttp:// 1 enf.html New York Times (2013). Alcohol Use Disorder. Retrieved on March 2015 from Nursing Link Where Nurses Call the Shots (2015). How to care for patients who abuse alcohol. Retrieved on March 2015 from patients-who-abuse-alcohol?page=2 Prevention Institute (2009). Reducing Inequities in Health through Prevention. Retrieved on April 2015 from