Alcohol Use Disorder and Detox

What is the most abused drug in the world?

Alcohol

Define Binge Drinking

• Five or more drinks per occasion for men

• Four or more drinks per occasion for women

Why is alcohol one of the most dangerous drugs to be intoxicated on?

Respiratory arrest due to CNS depression

• slow, shallow breaths

Why is alcohol one of the most dangerous drugs to withdrawal from?

Causes:

• Seizures

• Critically high blood pressures leading to myocardial infarctions

What does CAGE stand for?

CAGE

• Have you ever felt the need to Cut down on drinking?

• Has anyone been Annoyed by your drinking?

• Have you ever felt Guilty about drinking?

• Have you ever needed alcohol as an Eye-opener?

What does AUDIT stand for?

Alcohol Use Disorders Identification Test

What is the timeframe of alcohol withdrawal symptoms?

• Mild withdrawal symptoms usually occurring 6 – 12 hours after last drink

• Moderate withdrawal symptoms usually 12 - 24 hours after last drink

• Peak withdrawal symptoms 24 – 48 hours after last drink

BAC

• 0.02-0.04 % slight euphoria, relaxed

• 0.05-0.07 % “buzzed”

• 0.08-0.10 % legally drunk

• 0.11-0.15 % clearly drunk

• 0.16-0.19 % very drunk

• 0.20 % disorientation & confusion

• 0.30 % stupor

• 0.35 % equivalent to general anesthesia

• 0.40+ % coma likely, possible death due to respiratory arrest

Drug Tolerance

the need for increasingly larger or more frequent doses of substance in order to obtain the desired effects originally produced by a lower dose

Alcohol Intoxication Symptoms

• Mood lability

• Aggressive impulses

• Impaired judgment

• Slurred speech

• Impaired coordination

• Unsteady gait

Things to remember when admitting an intoxicated patient:

• Communication with staff of new patient with high risk of injury

• Increased risk of falls

• Closer room to nurses station

• Check very closely for injuries

• Focused assessment

• May be uncooperative

• Decreased stimulation

Alcohol Withdrawal Syndrome

A set of signs & symptoms, including hyperactivity such as nausea, agitation, anxiety, that develop

when alcohol use is stopped after a period of heavy drinking

Levels of Alcohol Withdrawal

Mild Withdrawal

• Tremors, anxiety, headache, diaphoresis, gastrointestinal upset

• (Dim lights, decrease noise, fall prevention, monitoring emesis)

Seizures

• Single or brief flurry of seizures

• (Loose clothing such as hospital gown, seizure pads on bed)

Alcoholic hallucinosis

• Visual, auditory, or tactile hallucinations

• (Antipsychotic medications, increased monitoring)

Delirium Tremens

What is Delirium Tremens? Interventions?

Delirium Tremens (DTs) is a severe form of alcohol withdrawal.

• A state of severe confusion and visual hallucinating

• A medical emergency

• Delirium, agitation, tachycardia, HTN, fever

• Interventions: antipsychotic meds, 1:1 monitoring

Alcohol Intoxication Lab Tests

• BAC - elevated

• Liver Function Tests - tend to be elevated

• Potassium - often hypokalemia

• Magnesium - often hypomagnesia

What is Wernicke-Korsakoff syndrome?

A serious brain disorder caused by a severe deficiency of thiamine (vitamin B1).

• The condition combines two distinct stages: Wernicke’ Encephalopathy (acute) and Korsakoff Syndrome (chronic)

Wernicke’ Encephalopathy

A brain degenerative disease from thiamine deficiency.

• Alcohol tends to flush water soluble vitamins (eg, thiamine, a form of Vitamin B1) out of the body

Korsakoff Syndrome

A neuropsychiatric disorder resulting from Wernicke’s encephalopathy

• Korsasoff is a combination of:

  • Confusion

  • Memory loss

  • Confabulation (making things up because someone cannot remember)

• Patient can be treated for Wernicke-Korsakoff by giving them large doses of (Thiamine) Vitamin B1.

• Often see this vitamin replacement in treatment plans for alcohol detox.

What does CIWA stand for?

Clinical Institute Withdrawal Assessment

• Created to assess & guide the treatment of alcohol withdrawal

• Has a list of 10 signs and symptoms

• Well documented reliability and validity and free to use

• A cummulative score determines therapy for patient

Lorazepam

Lorazepam (Ativan) 2-4mg for CIWA score usually a 10 or higher

• Lorazepam is a CNS depressant like alcohol, therefore suppresses the nervous system and prevents over excitability that sudden alcohol cessation causes

• Given PO, IM, or IV

Haldol

An antipsychotic used for hallucinations in withdrawal

• 5mg PO, IM, or IV

Why are patients going through alcohol withdrawal prescribed extra vitamins, in particular Vitamin B?

Alcohol decreases absorption of vitamin B. It also protects liver from alcohol damage

What does AA stand for and what is the purpose of this organization?

To help individuals achieve and maintain sobriety from alcohol use disorder through mutual peer support and shared experience.

Common Symptoms of Intoxication: Marijuana/Cannabis

• Euphoria,

• increased hunger,

• spatial perception & time distortion,

• decreased awareness of environmental cues

Common Symptoms of Intoxication: Cocaine/Methamphetamine (Strong CNS stimulants)

Euphoric rush followed by a mental crash, decreased appetite, dilated pupils (mydriasis) 

Common Symptoms of Intoxication: Opioid/Opiates (Strong CNS depressants) 

• Strong sedation,

• decreased respirations,

• impaired CNS coordination,

• pinpoint pupils (miosis) 

Common Symptoms of Withdrawal

• Fever 

• Tremors 

• Increased blood pressure 

• Agitation 

• Decreased concentration. 

• Fatigue & body aches 

• Nausea/Vomiting