Substance Related And Addictive Disorders (Alcohol Use Disorder)

Question 1

Individuals are considered to have a substance use disorder when what ?

Answer 1

When the use of the substance interferes with the ability to fulfill obligations such as work, school, or home

Question 2

What is Alcohol ?

Answer 2

A CNS depressant

Question 3

How many stages of withdrawal are there ?

Answer 3

3 stages

Question 4

What are the 3 stages of Withdrawal ?

Answer 4

Stage 1: Minor Withdrawal
Stage 2: Moderate to Severe Withdrawal
Stage 3: Most Dangerous Withdrawal: Delirium Tremens (DT’s)

Question 5

When does Stage 1 of Withdrawal occur ?

Answer 5

Within 4-12 hours of cessation of drinking

Question 6

What do the symptoms look like for a client in Stage 1 of Withdrawal ?

Answer 6

• Mild tremors
• Nervous
• Nausea
• Insomnia
• Headaches
• palpitations

Question 7

What do you want to do for a client in stage 1 of Withdrawal ?

Answer 7

Orient to time, place, and person

Question 8

What do the symptoms look like for a client in Stage 2 of Withdrawal ?

Answer 8

• Increased tremors
• Confused
• Hyperthermic
• Hyperactive
• Nightmares
• Increased BP
• Increased Respirations
• Hallucinations
• Illusions

Question 9

Why do you want to carefully assess and provide treatment during Stage I and II of Withdrawal ?

Answer 9

To prevent the client from progressing to delirium tremens

Question 10

Which stage of Withdrawal is considered a Medical Emergency ?

Answer 10

Stage III

Question 11

What are most common in Stage III of Withdrawal ?

Answer 11

Kinesthetic DT’s (Delirium Tremens)

  - Clients feel things crawling on them

Question 12

What are possible in stage III of Withdrawal ?

Answer 12

Tonic Clonic Seizures

Question 13

What are the Tx’s for Alcohol Use Disorder ?

Answer 13

• Keep the light on
• Encourage a close family or friend to stay with them
• Provide a quiet environment
• Walk and talk to them
• Orient the client frequently
• Clarify illusions
• Seizure precautions
• Anxiolytics (don’t be afraid to use them)
• Sedatives (like Benzo’s)
• Keep client well hydrated
• Prevent DT’s
• Disulfiram (Antabuse)

Question 14

Tx’s: Alcohol Use Disorder

Why do you want to keep the light on for Alcohol Use Disorder clients ?

Answer 14

b/c clients are very scared

Question 15

Tx’s: Alcohol Use Disorder

Why are Seizure Precautions implemented in client’s with Alcohol Use Disorder ?

Answer 15

Worry about Tonic-clonic seizures

Question 16

_____________ is an anxiolytic that is frequently used for outpatient detox ?

Answer 16

Chlordiazepoxide (Librium)

Question 17

Why should you not be afraid to give Alcohol Use Disorder client’s Anxiolytics ?

Answer 17

B/c the client has a cross-tolerance to other CNS depressants

Question 18

Why are sedatives like Benzodiazepines used in the Tx of Alcohol Use Disorder ?

Answer 18

because they not only sedate, but they have anti-convulsant qualities

Question 19

What is CIWA-Ar ?

Answer 19

An assessment tool that guides alcohol withdrawal medication dosing

Question 20

Based on a CIWA-Ar assessment, treatment frequently begins when ?

And when may they be transferred to the ICU ?

Answer 20

When scores reach 8 - 10

Client may be transferred to the ICU for scores > 20

Question 21

What electrolytes is an Alcoholic usually low in ? and why ?

Answer 21

Usually have low…

• Thiamine
• Magnesium
• Calcium
• Potassium
• Phosphorus

Because Alcoholics don’t eat or drink hydration fluids well

Question 22

Tx: Alcohol Use Disorder

Because Alcoholic clients typically don’t eat or drink well, what type of replacements might be required (even during detox) ?

Answer 22

• Multi-vitamins
• Electrolyte solutions
• Thiamine injections

Question 23

Thiamine is what type of vitamin ? and is needed for what ?

Answer 23

• Is a Complex vitamin

- Needed for good brain functioning

Question 24

Thiamine deficiency can lead to what 2 chronic conditions ?

Answer 24

• Wernicke’s Encephalopathy

- Korsakoff’s Psychosis

Question 25

What is Wernicke’s Encephalopathy ?

Answer 25

The most serious form of thiamine deficiency in alcoholics

Question 26

Symptoms of Wernicke’s Encephalopathy include what ?

Answer 26

• Paralysis of the ocular muscles
• Diplopia
• Ataxia
• Somnolence
• Stupor

Question 27

Alcoholic client’s with Wernicke’s Encephalopathy require what ?

What will happen without it ?

Answer 27

Require Thiamine Injections

Without, death will occur

Question 28

What is Korsakoff’s Psychosis ?

Answer 28

Syndrome of confusion and loss of recent memory

Question 29

When is Korsakoff’s Psychosis often seen ?

Answer 29

Often seen when the Alcoholic client is coming out of Wernicke’s Encephalopathy

Question 30

What is it called when Wernicke’s Encephalopathy and Korsakoff’s Psychosis occur together ?

Answer 30

The two disorders are called Wernicke-Korsakoff syndrome when they occur together

Question 31

What are the major defense mechanisms seen in Alcoholism ?

Answer 31

Denial & rationalization

Question 32

What is Disulfiram (Antabuse) ?

Answer 32

Is a deterrent to Drinking

Question 33

What must be done before Antabuse can be given ?

Answer 33

Client must sign a consent

Question 34

A client receiving Antabuse must stay away from what ?

Answer 34

Stay away from any form of Alcohol

including. ..
- cough syrup
- aftershave
- colognes
- chemicals such as varnish

Question 35

An Alcoholic client must have what once detox is over ?

Answer 35

must have Support

Question 36

________ issues emerge once the client is sober ?

Answer 36

Family issues

–> Family therapy is important for all family members

Question 37

What is effective for Alcoholics ?

Answer 37

12-step program is effective (ex: alcohol anonymous)