ALCOHOLISM

Substance abuse disorders (SUDs) pose significant challenges to individuals, families,

and communities worldwide. SUDs encompass a range of conditions characterized by the
excessive and harmful use of psychoactive substances, including drugs and alcohol.

Alcoholism often referred to today as Alcohol Use Disorder (AUD), is more than just
occasional social drinking. It's a complex, chronic medical condition characterized by an
impaired ability to control alcohol consumption despite negative consequences in various
areas of life. Whether it's physical health problems, strained relationships, or job loss, AUD
weaves its influence throughout, creating a cycle of dependence and harm.

Nursing Management

Nursing care of a client with substance abuse disorder includes the following:

Nursing Assessment

Assessment of a client with substance abuse disorder includes:

 History. Clients with a parent or other family members with substance abuse
problems may report a chaotic family life, although this is not always the case.
 Thought process and content. During the assessment of thought process and
content, clients are likely to minimize their substance abuse, blame others for their
problems, and rationalize their behavior.
 Sensorium and intellectual process. Clients generally are oriented and alert unless
they are experiencing lingering effects of withdrawal.
 General appearance and motor behavior. Assessment of general appearance and
behavior usually reveals appearance and speech to be normal.
 Self-concept. Clients generally have low self-esteem, which they may express
directly or cover with grandiose behavior.

Nursing Interventions

Nursing interventions for a client with substance abuse include:

 Providing health teaching for client and family. Clients and family members need
facts about the substance, its effects, and recovery.
 Addressing family issues. Without support and help to understand and cope, many
family members may develop substance abuse problems of their own, thus
perpetuating the dysfunctional circle; treatment and support groups are available to
address issues of family members.
  Promoting coping skills. Nurses can encourage clients to identify problem areas in
their lives and to explore the ways that substance use may have intensified those
problems.

Medications

Pharmacologic treatment in substance abuse has two main purposes: to permit safe
withdrawal from alcohol, sedative-hypnotics, and benzodiazepines and to prevent relapse.

 Benzodiazepines. Alcohol withdrawal is usually managed with a benzodiazepine-

anxiolytic agent, which is used to suppress the symptoms of abstinence.
 Disulfiram. Disulfiram (Antabuse) may be prescribed to help deter clients from
drinking.
 Acamprosate. Acamprosate (Campral), may be prescribed for clients recovering
from alcohol abuse or dependence to help reduce cravings for alcohol and decrease
the physical and emotional discomfort that occurs especially in the first few months
of recovery.
 Methadone. Methadone, a potent synthetic opiate, is used as a substitute for heroin
in some maintenance programs.
 Levomethadyl. Levomethadyl is a narcotic analgesic whose only purpose is the
treatment of opiate dependence.
 Naltrexone. Naltrexone (ReVia) is an opioid antagonist often used to treat an
overdose. It can also be used to treat alcohol abuse.

Therapies: Various therapies can be beneficial for AUD treatment, including:

Talk Therapy

Psychotherapy is the classic approach of having a conversation. During

psychotherapy, a patient talks to a trained psychologist about their problems and
experiences. A talk therapy session could take place in a one-to-one, group, or family
setting. A patient and their psychologist might discuss daily challenges, long-standing issues,
and past traumas. Psychotherapy allows a psychologist to formulate a mental health
diagnosis on the basis of psychoanalysis. A psychiatrist who conducts psychotherapy can
prescribe patients medication.

In cases of psychotherapy for alcoholism, a psychologist might help a patient better

understand and manage their cravings and stay motivated to achieve their sobriety goals.
Psychotherapy sessions can last for severals weeks or span many months. During
psychotherapy, the psychologist and patient develop a relationship on the basis of trust,
openness, and confidentiality.
 Psychotherapy acts as a roadmap for clinicians. It guides them though the process of
understanding their clients and developing solutions. There are multiple approaches to
psychotherapy, such as psychoanalysis, behavioral therapy, cognitive therapy, and
integrative or holistic therapy.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a proven method for alleviating the burdens of
alcoholism. The basic premise of CBT is the importance of identifying negative thoughts and
behaviors and replacing them with positive thoughts and behaviors. A CBT session will be a
conversation between a patient and a psychologist. CBT is a solutions-oriented approach to
treatment which focuses less on diagnosis and more on constructive action, such as
challenging harmful beliefs, confronting fears, role playing to improve social interactions,
and crafting strategies to stop drinking alcohol or using drugs. CBT is often effective with as
few as five sessions.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavioral Therapy (DBT) is another type of evidence-based talk therapy. The
DBT method operates from the assumptions that everything is connected, the world
constantly changes, and opposite elements (thesis and antithesis) may synthesize into a
better element or a greater truth. These assumptions comprise the basis of the
philosophical system of dialectics. In practice, an individual or group DBT session will involve
learning to live in the present instead of dwelling on the past, managing emotions and
distress, and practicing honest communication. Ultimately, DBT is designed to help patients
find emotional balance and embrace positive change. The method is dialectical because the
practitioner who developed it wanted patients to be able to synthesize change and
acceptance of the past to create a better life. Research has shown that DBT is effective for
people who struggle with alcoholism and other substance abuse disorders.

Motivational Interviewing

In counseling, motivational interviewing (MI) is a method for encouraging a patient

to overcome ambivalence, set direct goals for self-improvement, and stay motivated to
realize them. MI is a popular technique for treating substance abuse disorders because
many people feel powerless against addiction and benefit from an infusion of willpower to
decide to take action against it. In a motivational interview, a therapist will encourage a
patient to commit to change, such as quitting alcohol.

Motivational interviewing is a brief, client-centered, semi-directive psychological

treatment approach that concentrates on improving and strengthening a client’s
motivations for change. MI aims to increase a client’s perspective on the importance of
change. MI is useful for clients who are less motivated or ready for change. The practice
involves a form of supportive and empathetic counseling style that rolls with resistance. MI
is a brief intervention, where the counselor and client will meet for an average of 1 to 4
sessions. MI incorporates four basic principles in therapy:
  Expressing empathy
 Rolling with resistance
 Developing self-efficacy
 Developing discrepancy

Yoga And Meditation

Yoga and meditation can be beneficial techniques for managing cravings and staying
focused during recovery. Some rehab centers even offer their own yoga and meditation
courses. Broadly speaking, yoga is a collection of physical and mental exercises. A yoga
practice does not necessarily have to involve a spiritual or religious dimension. Meditation is
any method of relaxation which helps a person maintain calm, emotional peace, and clarity.
Studies have indicated that yoga and meditation can function as therapy for people with
substance use disorders, especially if the sessions are led by a mental health professional
and supplement other treatment.

Art And Music Therapy

Art and music are mediums of creative expression which can enhance the recovery
process. As such, rehab centers sometimes offer art and music therapy to their patients. In
the rehab setting, art and music therapy is more than just painting a picture or playing a
song. Art and music therapy sessions are taught by therapists specifically to help people
with alcoholism. The purpose of art and music therapy is to help people relax, express how
they feel, and stay occupied with a positive activity. Art and music also help alleviate
symptoms of depression and anxiety, two common mental health condition which afflict
people struggling with alcoholism.

Art and music therapy are thought to help patients tap into emotions and needs that
may be difficult to express through more traditional forms of communication. Music therapy
also provides clients with increased motivation for treatment. Physically, artistic expression
connects us to our emotions. It is a tangible way to reconcile emotional conflicts. This
connection can help fill the void that drugs and alcohol leave in a substance abuser. It also
helps build new insights.

Online Therapy

Online therapy has grown tremendously in popularity since the COVID-19 pandemic,
and is now considered to be an effective way to treat a host of conditions, including
alcoholism. Alcoholism has many physical, emotional, and social impacts on a person’s life,
and online therapy can be a great way to work through the underlying causes of alcohol
abuse without significantly disrupting their life.

Online therapy for alcoholism can involve several techniques and approaches, which
some people may find adapt better to a virtual format. Things like cognitive behavioral
therapy (CBT), motivational interviewing, and even eye movement desensitization and
reprocessing (EMDR) therapy can all be adjusted to work via the phone, computer, or web-
based platforms.

 Cognitive-behavioral therapy (CBT): Helps identify and change unhealthy thinking

patterns and behaviors related to alcohol use.
 Motivational enhancement therapy (MET): Helps individuals explore their reasons for
wanting to change and develop motivation for recovery.
 Family therapy: Helps families understand AUD and develop supportive strategies for
recovery.