Alcoholism is a substance use/abuse disorder that affects about 3 in 10 American adults (National Institute of Alcohol Abuse and Alcoholism [NIAAA],  2005). Alcohol is a central nervous system depressant that is absorbed readily into the bloodstream from the stomach (Videbeck, 2004).

Men who drink more than 4 drinks per day or 14 per week and women who drink more than 3 per day or 7 drinks per week are at risk of developing alcohol-related problems (NIAAA, 2005). Even this consumption can present problems if ingested at more than one alcoholic beverage in one hour. Alcohol abuse and alcoholism (alcohol dependence) is largely seen in adults between ages 35 to 50 years. Current trends indicate that usage is apparent in younger school-aged populations and among women (Herfindal 1996).

Drinking alcohol frequently begins during adolescence. Early indications of use/abuse are frequent episodes of drinking, inability to control the intake of alcohol, and alcoholic “blackouts”. The pattern of abuse develops with significant interference in school or work functioning and personal relationships. Alcoholism can manifest as acute alcohol intoxication with cyclic drinking or “binges” or chronic alcohol dependence with daily drinking of an increased amount. An individual can experiencing “blackouts” described as when the person continues to function but has no conscious awareness of his or her behavior at the time or any later memory of the behavior (Videbeck, 2004). As the person develops a tolerance for alcohol, he or she needs to drink more alcohol to get the same effect. Factors such as age, weight, tolerance and the use of other drugs should be considered. A “hangover” or withdrawal symptoms after heavy consumption usually begin 4 to 12 hours after stopping drinking. Following some legal, social, or interpersonal crisis a person may attempt to control consumption by having periods of abstinence or controlled drinking frequently (NIAAA, 2009; NIAAA, 2005).

As a psychoactive agent alcohol is used by some as a coping mechanism to reduce stress or tension. It is a sedative-hypnotic drug. At low dose levels it causes excitation and stimulation as it depresses the inhibition centers in the brain. At one dose level, alcohol provides relief of anxiety and sedation; yet at high dose level, it produces sleep and depression of the CNS.

Many Americans abuse more than one substance termed polydrug abuse or polysubstance abuse. This may include the use/abuse of additional addictive substances such as nicotine, pharmaceutical, cannabis and other illicit substances (Martin, 2008). Polydrug use can have dangerous consequences and is associated with overdose deaths due to combining alcohol with additional central nervous systems (CNS) depressants, benzodiazepines, oxycodone, or heroin. Persons addicted to alcohol and drugs have a rate of suicide that is 20% higher than that of the general population (Videbeck, 2004).

Alcohol has both a physical and psychologic dependency. Children of alcoholic parents are at a higher risk for developing alcoholism and drug dependence (Dick & Agrawal, 2008). Women are more sensitive to the toxic effects of alcohol. Prenatal exposure to alcohol can result in babies having fetal alcohol syndrome.

Symptoms:

Potential problems from acute alcohol intoxication are alcohol poisoning and depression of the CNS and respiratory system. With chronic intoxication liver, heart, and brain damage can occur.

Symptoms of acute alcohol intoxication include drowsiness, slurred speech, unsteady gait, tremors, impaired thinking, memory loss, and nystagmus. Excessive alcohol intake can result in vomiting, unconsciousness, and respiratory depression. This can result in aspiration or airway obstruction.

Symptoms of withdrawal may include delirium tremors (DTs), easily startled, insomnia, anxiety, sweating, anorexia, or alcoholic hallucinations. Symptoms of withdrawal for chronic alcoholism can manifest as delirium (Kay & Talsman, 2000).

The chronic use of alcohol has a 10% mortality rate and can cause CNS disorders such as alcoholic chronic brain syndrome (dementia) with fatigue, anxiety, personality changes, depression, confusion, loss of memory of recent events and can progress to a dependent bedridden state. Long term use of alcohol use can cause cardiac myopathy, Wernicke’ encephalopathy, Korsakoff’s psychosis, pancreatitis, esophagitis, hepatitis, cirrhosis, leucopenia, thrombocytopenia and ascites (Videbeck, 2004).

Self help groups are effective for the individual as well as family members. Alcoholics Anonymous (AA) provides support from peers and allows the alcoholic human contact with others coping with alcohol problems. The focus of AA is to stop drinking one day at a time – living in the present. Al-Anon is available for the spouse or significant other and Alateen groups are for children of alcoholics (Kay & Talsman, 2000).

References Adams, M. P., Josephson, D., & Holland, L. N. (2005). Pharmacology for nurses: A pathophysiologic approach. Upper Saddle River, Pearson Prentiss Hall.

Dick, D. M., & Agrawal, A., (2008). The genetics of alcohol and other drug dependence [Electronic Version]. Alcohol and Other Drugs, 31(2): 111-118.

Herfindal, E. T. G., D. R., Ed. (1996). Textbook of therapeutics: Drug and disease management. Baltimore, MD: Williams & Wilkerson.

National Institute of Alcohol Abuse and Alcoholism (2005) Helping patients who drink too much: A clinician's guide. Retrieved on May 30, 2009 from http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

National Institute of Alcohol Abuse and Alcoholism (2009). Rethinking drinking: Alcohol and your health. NIH Publication No. 09-3770.

Videbeck, S. (2004). Psychiatric mental health nursing. Philadelphia, Lippincott Williams and Wilkins.