Alcohol Use Disorder (AUD-Alcoholism)

Patient Case Study: Alcohol Use Disorder (AUD)

• Patient Profile: 38-year-old male construction worker

• History: Completed inpatient rehabilitation for severe AUD.

  • Health Issues:

    • Cirrhosis

    • Tremors

• Functional Impairment:

  • Difficulty maintaining employment, frequent absences, decreased job performance.

  • Neglect of personal hygiene and self-care needs leading to isolation and decreased social participation.

  • Issues with managing stress, aggression, and mood changes.

Anatomy of the Heart

• Chambers:

  • Two Atria (top)

  • Two Ventricles (bottom)

  • Left Ventricle: Critical due to its role in pumping oxygenated blood throughout the body.

• Alcohol-Induced Cardiomyopathy:

  • Weakened and dilated heart muscle, especially in the left ventricle, leading to ineffective pumping.

  • Increased risk of heart failure.

Pathophysiology

• Chronic Alcohol Consumption Effects:

  • Toxic effects on cardiomyocytes (heart muscle cells).

  • Consequences include:

    • Mitochondrial dysfunction

    • Oxidative stress

    • Apoptosis (cell death)

  • Impact on heart's electrical system may result in arrhythmias (e.g., atrial fibrillation), worsening heart failure symptoms (palpitations, shortness of breath).

Liver Function and Impact of Alcohol

• Liver's Role:

  • Detoxification, nutrient processing, bile production, filtering blood toxins.

• Alcohol Effects:

  • Inflammation leading to fibrosis and potential cirrhosis.

  • Breakdown products (e.g., acetaldehyde) cause liver cell injury and oxidative stress, initiating inflammatory processes and leading to worsening liver conditions.

• Cirrhosis:

  • Loss of liver function affecting overall health, causing complications (portal hypertension, fluid retention).

Diagnosis of Alcohol Use Disorder (AUD)

• Diagnostic Criteria (DSM-5): Must meet at least 2 criteria within a 12-month period:

  • Alcohol consumed in larger amounts or for longer than intended.

  • Persistent desire/control issues.

  • Significant time spent obtaining/using/recovering from alcohol.

  • Strong craving.

  • Recurrent alcohol use leading to failure in obligations.

  • Use despite social problems.

  • Giving up/reducing activities.

  • Physically hazardous use.

  • Continued use despite worsening issues.

  • Tolerance and withdrawal symptoms (e.g. tremors, anxiety).

Treatment Approaches

Medical Treatment

• Pharmacological Interventions:

  • Disulfiram: Causes adverse reactions when alcohol is consumed.

  • Naltrexone: Reduces cravings and pleasure from alcohol by blocking opioid receptors.

  • Acamprosate: Restores chemical balance to reduce cravings.

Psychological Interventions

• Cognitive Behavioral Therapy (CBT): Modify thought patterns and behaviors regarding alcohol use to improve job performance and reintegration.

• Motivational Enhancement Therapy: Enhances motivation for change through personalized feedback and goals.

Occupational Impacts of AUD

• Impacts on Work:

  • Decreased productivity (absenteeism, late arrivals).

  • Poor job performance (hangovers, intoxication at work).

• Self-Care Issues:

  • Neglect of hygiene, nutrition, sleep leading to deteriorating health.

• Cognitive Functioning:

  • Impaired decision-making, memory problems.

• Physical Limitations:

  • Tremors, coordination issues affecting daily tasks.

Progression of AUD Impairments

• Mid-Stages: Increased difficulty with personal care; reduced stamina and concentration at work; social withdrawal due to discomfort.

• Late Stages: Severe dependence on others for self-care; inability to perform job functions; minimal leisure participation; significant social isolation.

Adaptive Techniques and Interventions

Self-Care Support

• Routine Tracking:

  • Use apps (e.g., Google Calendar) to schedule hygiene tasks.

• Adaptive Tools:

  • Electric toothbrushes, shower stools, long-handled sponges for ease of hygiene.

Nutrition and Meal Preparation

• Meal Services:

  • Enrollment in services like HelloFresh for reduced meal prep effort.

• Adaptive Utensils:

  • Ergonomic utensils for easier cooking despite tremors.

Employment and Financial Management

• Job Coaching & Accommodations:

  • Connect with programs to regain confidence and skills; energy management strategies (scheduled breaks, task prioritization).

Social Engagement & Emotional Regulation

• Support Groups:

  • Encourage participation in Alcoholics Anonymous and online recovery communities for peer support.

• Mindfulness Practices:

  • Introduce stress-reduction techniques and guided breathing exercises.

Visual Aid

• Image depicting a support group sharing experiences:

  • Illustrates the sense of community and shared understanding for individuals facing similar challenges in recovery.

References

• [References Provided in Presentation]

• Thank You.