Alcohol Dependence Notes

Setting Limits and Enforcing Them

  • Teach the codependent person to say "no."
    • Examples:
      • "I’m not going to call your boss."
      • "I’m not going to buy drugs for you."
      • "You do it yourself."
  • Enforce the limit and follow through.

Working on Self-Esteem of the Codependent

  • It's crucial to work on the self-esteem of the codependent, otherwise the intervention won't be effective.
  • The goal is to have the codependent person believe that setting a limit and saying "no" makes them a good person.
  • Abusers will attack the self-esteem of the codependent to make them cave in and comply.
  • The codependent needs to bolster their self-esteem from other sources to be less vulnerable to the abuser's attacks.
  • Without addressing self-esteem, codependency cannot be effectively treated.
  • In dependency/codependency, there are two patients: the abuser and the codependent.
    • Set limits on the abuser.
    • Work on the self-esteem of the codependent.

Manipulation

  • Definition: When the abuser gets the significant other to do things for them that are not in the best interest of the significant other.
  • The nature of the act is dangerous or harmful.
  • Dependency, codependency, and manipulation are similar because the abuser is getting the significant other to do something for them.

Telling the Difference Between Dependency and Manipulation

  • Look at the act that the abuser is asking the other person to do.
  • If the act is perfectly harmless, it's dependency.
  • If the act is harmful, it's manipulation.
Examples
  • Dependency: A 48-year-old patient with alcohol dependence disorder asks her 48-year-old partner to buy alcohol for her.
    • There is nothing inherently harmful about a 48-year-old buying alcohol.
  • Manipulation: A 48-year-old person with alcohol dependence disorder asks her 16-year-old daughter to go to the store and buy alcohol for her.
    • It is illegal and potentially harmful for a 16-year-old to buy alcohol.
    • The 48-year-old is asking the 16-year-old to do something that is not in their best interest.

Treatment of Manipulation

  • Manipulation is easier to treat because nobody likes being manipulated.
  • Set a limit, just like with dependency, but you don't have to deal with the self-esteem of the manipulated person.
  • People who are manipulated often express feelings of being stupid or foolish, which is not positive self-esteem.
  • When dealing with manipulation, there is only one patient: the abuser. Set limits on them and say no.

Psychological Problems in Abuse

  • Dependency/codependency and manipulation are the three big psychological problems in abuse.
  • The principles apply generally to all forms of abuse, not just alcohol dependence.

Wernicke-Korsakoff Syndrome

  • Occurs in alcohol dependence disorder.
  • It is a dementia caused by a deficiency in thiamine (vitamin B1).
  • It destroys the brain.

Symptoms

  • Memory loss (amnesia) is the primary symptom.
  • Confabulation: Making up stories that aren't true to fill in memory gaps.
    • Example: A patient with a 40-year history of alcoholism who didn't remember the 1980s claimed to be Ronald Reagan's national security advisor and responsible for the Berlin Wall coming down.

Characteristics

  • Preventable: Can be prevented by taking daily doses of vitamin B1, even without stopping alcohol consumption.
  • Arrestable: Can be stopped from getting worse by taking vitamin B1.
  • Irreversible: The memory loss is permanent, and lost memories will not return.
  • Goals for dementia clients should focus on maintaining the current level of function or slowing deterioration, not on improvement.

Medications for Alcohol Dependence Disorder

  • Disulfiram and naltrexone.
  • Adjuvant therapy: Used in addition to other therapies like psychotherapy and group therapy.

Onset and Duration

  • It takes two weeks for the drugs to become effective.
  • It takes two weeks for the drugs to clear from the system.

Reactions with Alcohol

  • Disulfiram and naltrexone have dangerous reactions when mixed with alcohol.
  • Teach patients to avoid all forms of alcohol to prevent physiological crises like nausea, vomiting, and death.

Things to Avoid

  • Mouthwash (unless labeled non-alcohol)
  • Aftershave
  • Perfumes
  • Elixirs (liquid medications that contain alcohol)
  • Insect repellents (e.g., OFF, Deep Woods Cutter, Skin So Soft)
  • Vanilla extract (if not cooked)
  • Vinaigrettes (salad dressings that may contain alcohol)
  • Alcohol-based hand sanitizer
  • Alcohol prep pads