Substance Abuse - Phases of Alcohol, Alcohol on the Body, Sedatives, Hypnotics, Anxiolytics

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Ch. 23
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Phases of Alcoholism

1. The Prealcoholic Phase

2. The Early Alcoholic Phase

3. The Crucial Phase

4. The Chronic Phase


The Prealcholic Phase - Phase 1

  • Alcohol is used as form of relaxation and release of stress
  • Children/Adolescents observe parents consuming alcohol and learns it is acceptable means of coping
  • Tolerance develops - takes longer to achieve desired effects.

The Early Phase - Phase 2

  • Blackouts and Amnesia follow consumption of alcohol.
  • Alcohol now becomes a "drug"
  • Begins to sneak drinks, Preoccupied with drinking
  • Feels an increased amount of guilt - utilizes denial and rationalization

The Crucial Phase - Phase 3

  • Lost control of behavior, Addiction is now evident
  • Binge drinking few hours to several weeks
  • Squalor, degradation, sickness, loss of consciousness - Extremely illness
  • Anger and aggression is common because drinking is the main focus.
  • Willing to risk everything - demonstrated by loss of job, marriage and family.

The Chronic Phase - Phase 4

  • Emotional and Physical disintegration
  • Almost always intoxicated

Lack of alcohol could lead to alcohol withdrawal - 4-12 hours after the cessation of alcohol: hallucinations, tremors, convulsions, severe agitation.


Alcohol's effects on the body

Peripheral Neuropathy

  • Peripheral nerve damage - leading to pain, burning, tingling or prickly sensations.
  • Due to B vitamin/Thiamine deficiencies
  • Common in chronic alcoholics. Process is reversible w/abstinence from alcohol and restoration of deficiencies. Otherwise permanent muscle wasting occurs.

Alcohol's effects on the body

Alcoholic Myopathy

  • Characterized by increased levels of phosphokinase (CPK), Lactate dehydrogenase (LDH). aldolase and aspartate aminotransferase (AST).
  • S/S: Sudden muscle pain, swelling, weakness and red tinge in urine. Progresses to muscle wasting and weakness in skeletal muscle with absence of pain and tenderness in Chronic conditions.
  • Due to B vitamin deficiency and can reversed with stopping alcohol and consumption of Vit B.

Alcohol's effects on the body

Wernicke's Encephalopathy

  • Due to thiamine deficiency in alcoholics
  • S/S: Ocular muscle paralysis, diplopia, ataxia, somnolence and stupor
  • Caution!!! If thiamine is NOT replaced DEATH may occur.

Alcohol's effects on the body

Korsakoff's Psychosis

  • Defined by confusion, loss of recent memory, and confabulation (Making up of thoughts and events)
  • Frequently encountered in Wernicke's patients - Wernicke'S-Korsakoff's Syndrome

Alcohol's effects on the body

Alcoholic Cardiomyopathy

  • Alcohol causes increased amount of lipids in myocardial cells - causing enlargement and weakening.
  • Arrhythmias and CHF present
  • S/S: decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, and cough.
  • Increased CPK, AST, LDH present.

Alcohol's effects on the body


  • Inflammation and pain of the esophagus
  • Due to toxic effects on the mucosa - and frequent vomiting w/ alcohol abuse

Alcohol's effects on the body


  • Inflammation of stomach lining due to alcohol breaking down stomach's mucosal barrier - hchloric acid to erode stomach wall - this leads to hemorrage
  • S/S: N & V, epigastric distress, distention
  • Similar adverse effect - Esophageal Varices

Alcohol's effects on the body


  • Acute or chronic - occurs 1-2 days after binge drinking of alcohol.
  • S/S: Constant severe epigastric pain, n and v, abdominal distention, steatorrhea, malnutrition, weight loss and DM.
  • Seen in chronic alcoholics i.e. phase 3

Alcohol's effects on the body

Alcoholic Hepatitis

  • Inflammation liver - long term use of heavy alcohol use.
  • S/S: Enlarged and tender liver, N and V, Lethargy, Anorexia, Increased WBC (Risk for infection???) fever, jaundice, ascites and weight loss.
  • TX: Strict abstinence from alcohol, proper nutrition, and rest
  • Severe cases may progress to hepatic encephalopathy.

Alcohol's effects on the body

Cirrhosis of Liver

  • Chronic Injury to liver/end stage of alcoholic liver disease results from chronic alcohol abuse.
  • Due to destrution of liver cells - replaced by fibrous scar tissue
  • S/S: N and V, anorexia, weight loss, abdominal pain, jaundice, anemia, blood coagulation problem.
  • TX: Abstain from alcohol, correct malnutrition and supportive care.

Alcohol's effects on the body

Portal HTN

  • Increased BP through portal circulation due to defective blood flow - fibrous tissue

Alcohol's effects on the body


  • Serous fluid accumulates in abdominal cavity due to portal HTN

Alcohol's effects on the body

Esophageal Varices

  • Distended veins due to increased pressure from defective blood flow thorough cirrhotic liver.
  • More pressure may cause varicosities to rupture leading to hemorrhage

Alcohol's effects on the body

Hepatic Encephalopathy

  • Diseased liver fails to convert ammonia to urea - as result ammonia accumulates in the blood
  • S/S: Impaired mental functioning, apathy, euphoria, depression, sleep disturbance, increasing confusion, progression to coman and death.
  • TX: Abstain from alcohol, eliminate protein from diet and reduce intestinal ammonia - neomycin/lactulose

Alcohol absorption in the body

  • When consumed, 20% of alcohol is absorbed in the stomach and directly carreid to the brain where it depresses the CNS/Brain activity.
  • 80% of alcohol is processed slower in the intestinal tract - and can be found in all tissues, organs, and secretions of the body.
  • Delayed absorption can occur when drink is sipped rather than gulped or when stomach contains food.

Alcohol's effects on the body

Leukopenia & Thrombocytopenia

  • Leukopenia - impaired WBC production and function in chronic alcoholics. Places individual at risk for developing an infection.
  • Thrombocytopenia - Impaired production of platelets due to alcohol toxic effects - puts one at risk for hemorrhage. TX: abstain from alcohol.

Alcohol's effects on the body

Sexual Dysfunction

  • Alcohol interferes w/ male and female hormones
  • Women - changes in menstrual cycle and decreased ability to fall pregnant.
  • Men - diminished libido and sexual performance, impaired fertility.

Alcohol's effects on the body

Pregnancy: FAS