Week 10 Discussion: Diagnostics and Treatment for Alcohol Abuse

Diagnostics and Treatment for Alcohol Abuse

Introduction

Alcohol abuse constitutes a common public health concern in many societies across the globe. Excessive drinking of alcohol is associated with adverse health conditions, emotional deprivation, and addiction. Since alcohol affects the brain’s communication pathways, it is observed to disrupt a person’s behaviour and mood changes, which makes it hard to think clearly and make informed decisions. Prolonged alcohol abuse may result in life-threatening conditions such as high blood pressure, alcoholic hepatitis, and fibrosis. Alcohol abuse is also associated with certain cancers, such as oesophagal, liver, and colorectal cancer (LoConte et al., 2018, p. 83). People who abuse alcohol also experience an elevated risk of addiction, resulting in an impaired ability to stop or control alcohol use despite adverse social, occupational, and health consequences. Such individuals find it hard to associate with other people due to the emotional implications of addiction, which may result in adverse psychological health effects. Caregivers, therefore, utilize diverse diagnostic and treatment strategies to help people overcome alcohol addiction and avoid its potential health implications. This study investigates the bio-psychosocial aspects of alcohol abuse and diagnoses that nurses may use to conduct detoxification and restore health among people with alcohol addiction. Various diagnostic tools are used to assess biological aspects of alcohol abuse drugs to inform therapeutic interventions and detoxification management strategies.

Assessment and Screening Tools Used to Determine Alcohol Abuse

Some screening tools used to assess alcohol abuse among individuals in the care setting include the Alcohol Use Disorder Identification Test (AUDIT) and the severity of alcohol dependence questionnaire. The Alcohol Use Disorder Identification Test involves a questionnaire that requires individuals to submit information concerning alcohol use and its potential health implications. AUDIT focuses on identifying the preliminary symptoms of unhealthy drinking and dependence (Gowin et al., 2017, p. 1094). Patients fill out the questionnaire and submit it for assessment by a therapist who establishes their dependence on alcohol and the risk of hazardous drinking based on the patient’s score. AUDIT is praised as an effective screening tool for alcohol use disorder as it describes both the behavioural and cognitive symptoms of toxication to inform therapeutic interventions. Similar to AUDIT, the severity of the alcohol dependence questionnaire helps to detect behavioural and cognitive signs of alcohol use disorder. However, the severity of alcohol dependence questionnaire is used when a patient has reported symptoms of alcohol dependence and is used to establish its seriousness to help therapists identify the most effective interventions. The severity of alcohol use disorder is determined by the number of symptoms presented whereby two or three symptoms indicate mild, 4 and 5 symptoms insinuate a moderate condition, while more than five symptoms indicate a severe case (Higgins-Biddle & Babor, 2018, p. 578). The tool, therefore, helps caregivers develop interventional strategies that concur with the severity of the condition.

Some clinical assessment tests for alcohol use disorder include ethyl glucuronide (EtG) and carbohydrate-deficient transferrin (CDT) tests. The ethyl glucuronide test is used to detect the presence of ethyl glucuronide in a patient’s urine to establish the concentration of breakdown products of alcohol in the blood. Ethyl glucuronide is the intoxicating agent of alcohol that causes addiction and interferes with the normal functioning of neurotransmitters (Reisfield et al., 2020, p. 1102). Since the test indicates the concentration of toxic substances in the patient’s blood, it is often used to establish an appropriate detoxication strategy for each patient. The carbohydrate-deficient transferrin is used in healthcare to determine whether a person is a binge drinker or a daily heavy drinker. A CDT concentration between 60 mg/litre and 100 mg/litre indicates a chance that a patient could be alcoholic, while a result that exceeds 100 mg/litre indicates the highest likelihood that the person has an alcohol use disorder (Suzuki et al., 2021). After conducting assessment tests for alcohol use disorder in a patient, therapists must comply with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) when providing care to the patients. According to the regulations, clinical intervention may only be applied if the patient submits consent regarding their persistent desire or unsuccessful efforts to cut down or control alcohol use (Saunders et al., 2018, p. 257). Interventions could also be administered to patients who engage in recurrent alcohol use in situations that could be physically hazardous. Such patients may be diagnosed with alcohol use disorder and provided with appropriate treatments.

Bio Psychosocial Aspects of Alcohol Abuse

Alcohol abuse causes profound implications on the neuro system and affects an individual’s cognitive function. Alcohol blocks the transmission of chemical signals in the brain cells to cause immediate symptoms of intoxication, such as behavioural abnormalities, memory interruptions, and blurred speech. Prolonged alcohol abuse permanently affects the neuro system as the brain adapts to the blocked signals and eliminates certain neurotransmission processes (Obad et al., 2018, p. 81). The brain tissues may also develop complications due to excessive drinking, resulting in a reduced volume of grey and white matter in the brain over time. During withdrawal from alcohol, people report more adverse symptoms, and the brain fails to re-establish formerly eliminated or disrupted processes. The brain may also over-activate the neurotransmitter, which can eventually cause neurons to burn out and adversely affect an individual’s cognitive function. In such a situation, an individual may experience severe withdrawal symptoms such as loss of memory, restlessness, and anxiety. In severe cases, such individuals may report a loss of body coordination, slower reflexes, and impulsive behaviour that may progress to complete cognitive or physical incapacitation. Therefore, prolonged alcohol consumption may cause serious implications in the brain, increasing a person’s vulnerability to mental health disorders and causing loss of physical coordination of the body.

A person’s genetic makeup influences their predisposition to alcohol addiction and alcohol use disorders. Due to the association between alcoholism and genetics, alcohol use disorders have been observed to run in certain families. A study conducted by Deak et al. (2019) revealed that genetic makeup is responsible for about half of the risk for alcohol use disorder. The study, therefore, asserts that an individual may inherit an inclination to engage in alcoholism from their parents, which results in health-related implications. Although a genetic predisposition exists to alcoholism and its associated health implications, tolerance to alcohol addiction is not inherited. Conversely, alcohol intolerance may be inherited, whereby individuals develop an adverse reaction to the presence of alcohol despite being born by parents who have long histories of alcohol abuse with no serious health implications. While people can have genes that predispose them to develop an alcohol use disorder and other health effects of alcoholism, factors other than genetics are responsible for such risks. They include social and environmental factors that individuals encounter throughout their childhood and life that affect their later health. Therefore, predisposition to alcohol abuse disorders is observed to be determined by both genetic and personal health factors.

Detoxification management is for alcohol abuse.

Medical detoxication for alcohol abuse involves clearing the body of alcohol that an individual has consumed to alleviate symptoms of alcohol use disorder. It may involve the administration of substances that react with and neutralize toxic compounds formed in the body due to alcohol abuse. Opioid receptor agonists, such as Methadone and Buprenorphine, are administered to lower the effects of withdrawal symptoms and cravings to use alcohol during detoxification (Law et al., 2017, p. 1046). The physiological and psychological processes involved in detoxification necessitate nursing care to keep patients safe from the adverse implications of withdrawal symptoms. During withdrawal, the brain is forced to reactivate neurotransmitters that the toxic effect of alcohol abuse had formerly blocked. Due to irregularities in the production of hormones and other substances responsible for adequate reactivation of neurotransmitters, patients often experience severe withdrawal symptoms. After refraining from alcohol abuse, patients may experience headaches, anxiety, restlessness, and nausea within 24 hours (Holt & Tetrault, 2020). As the detoxification process progresses, patients may also experience confusion, seizures, elevated heart rate, and blood pressure that causes severe headaches. Healthcare organizations, therefore, provide resources to reduce the risk of dehydration, electrolyte and nutritional imbalance among patients, and the possibility of physical injury due to altered mental state.

Nurses also play a critical role in providing care services to alleviate severe withdrawal symptoms among patients. They administer painkillers and offer treatment for concurrent medical conditions that may mask, mimic, or complicate the withdrawal process. The short-term treatment plan for detoxification focuses on helping patients cope with withdrawal symptoms and cravings for alcohol. It involves pharmacological treatments such as administering Methadone and Buprenorphine to reduce the severity of withdrawal symptoms and protect the patient’s mental health. A long-term detoxification treatment plan focuses on helping the patients cope with persistent withdrawal symptoms and embracing lifestyle changes that reduce their inclination to engage in alcohol abuse. Such strategies include drinking fluids that contain electrolytes to address dehydration and nausea. According to Stotts & Peterson (2021), many individuals with alcohol use disorder experience severe dehydration and nausea during withdrawal, which necessitates the intake of drinks rich in calcium, potassium, and magnesium electrolytes. Such individuals are also encouraged to eat healthy fruits and vegetables to generate enough sugar to reduce their craving for alcohol (Stotts & Peterson, 2021, p. 49). Behavioural changes may include avoiding friends and relatives who drink, using intentional breathing techniques, and practising regular exercise and meditation. Individuals who adopt such strategies achieve a speedy withdrawal process with less severe symptoms.

Potential Nursing Diagnoses for Alcohol Abuse

Some potential diagnoses for people with alcohol abuse disorder include anxiety, amnesia, and hypertension. Individuals with alcohol abuse disorder often experience a decline in the capacity to respond to stress, which results in anxiety positively. Long-term and heavy drinkers may also be predisposed to developing an anxiety disorder, necessitating clinical diagnosis for anxiety (Du Preez et al., 2017, p. 530). The available treatments for anxiety among individuals with alcohol abuse disorder include the administration of selective Serotonin Reuptake Inhibitors, serotonin–Norepinephrine Reuptake Inhibitors, and tranquillizers. Such individuals may also receive non-pharmacologic treatments such as cognitive-behavioural therapy and relaxation training. Individuals with alcohol abuse disorder may also experience amnesia due to lapses in memory caused by the toxic effect of alcohol in the neuro system. Available treatments include administering cholesterol-lowering drugs, antiseizure medications, and acetylcholinesterase inhibitors. Non-pharmacologic interventions may include occupational therapy, Memory training, and the administration of external memory aids. Alcohol abuse also affects the cardiovascular system and causes a temporary increase in heart rate and blood pressure (Day & Rudd, 2019, p. 1670). Prolonged alcohol abuse may cause serious cardiovascular diseases such as arrhythmia and heart failure. The available interventions for hypertension include the administration of antihypertensives, beta-blockers, and angiotensin ii receptor blockers. Non-pharmacologic care interventions may include cognitive behavioural therapy and dietary modification.

Conclusion

Different assessment and screening tools are used to determine the severity of alcohol abuse among patients to help therapists identify effective detoxification treatments and management strategies. Some screening tools used to assess alcohol abuse among individuals in the care setting include the Alcohol Use Disorder Identification Test (AUDIT) and the severity of alcohol dependence questionnaire (SADQ). Assessment tests conducted to confirm the presence of alcohol use disorder include ethyl glucuronide (EtG) and carbohydrate-deficient transferrin (CDT) tests. The ethyl glucuronide test is used to detect the presence of ethyl glucuronide in a patient’s urine to establish the concentration of breakdown products of alcohol in the blood, while the carbohydrate-deficient transferrin helps to determine whether a person is a binge drinker or a daily heavy drinker. Alcohol abuse affects the neuro system and interferes with an individual’s cognitive function. A person’s genetic makeup influences their vulnerability to alcohol use disorders. Medical detoxication for alcohol abuse involves clearing the body of alcohol that an individual has consumed to alleviate symptoms of alcohol use disorder. Nurses are critical in providing care services to individuals with alcohol abuse disorder and alleviating severe withdrawal symptoms among patients. They may diagnose such individuals with alcohol abuse disorders, including anxiety, amnesia, and hypertension.

References

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Reisfield, G. M., Teitelbaum, S. A., Opie, S. O., Jones, J., Morrison, D. G., & Lewis, B. (2020). The roles of phosphatidylethanol, ethyl glucuronide, and ethyl sulfate in identifying alcohol consumption among participants in professional health programs. Drug testing and analysis, 12(8), 1102-1108. https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/abs/10.1002/dta.2809

Suzuki, T., Eguchi, A., Shigefuku, R., Nagao, S., Morikawa, M., Sugimoto, K., Iwasa, M., & Takei, Y. (2021). Accuracy of carbohydrate‐deficient transferrin as a biomarker of chronic alcohol abuse during alcoholism treatment. Hepatology Research. https://onlinelibrary.wiley.com/doi/full/10.1111/hepr.13642

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Law, F. D., Diaper, A. M., Melichar, J. K., Coulton, S., Nutt, D. J., & Myles, J. S. (2017). Buprenorphine/naloxone versus methadone and lofexidine in community stabilisation and detoxification: A randomised controlled trial of low dose short-term opiate-dependent individuals. Journal of Psychopharmacology, 31(8), 1046-1055. https://journals.sagepub.com/doi/abs/10.1177/0269881117711710

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Stotts, M. J., & Peterson, B. D. (2021). Beyond the Banana Bag: Treating Nutritional Deficiencies of Alcohol Withdrawal Syndrome. Practical Gastroenterology, 49. https://practicalgastro.com/wp-content/uploads/2021/08/Parrish-June-2021.pdf

Du Preez, E. J., Graham, K. S., Gan, T. Y., Moses, B., Ball, C., & Kuah, D. E. (2017). Depression, anxiety, and alcohol use in elite rugby league players over a competitive season. Clinical Journal of Sports Medicine, 27(6), 530-535. https://journals.lww.com/cjsportsmed/Fulltext/2017/11000/Depression,_Anxiety,_and_Alcohol_Use_in_Elite.3.aspx

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