ADDICTION CYCLE IN ALCOHOL USE DISORDER
The negative affect/Withdrawal stage occurs when an individual stops drinking, and withdrawal symptoms occur. These symptoms can be physical (sleep disturbances, pain, and ill feelings) or emotional (dysphoria, irritability, anxiety, and emotional pain)—negative feelings associated with alcohol withdrawal come from two sources. Diminished activation in the reward system makes it difficult to experience the euphoria associated with everyday living. Increased activation of brain stress contributes to anxiety, irritability, and unease (NIAAA, 2021). The individual consumes alcohol to escape the lows of chronic alcohol use. The preoccupation/Anticipation stage occurs when an individual seeks alcohol after abstinence. This stage can be triggered by various factors such as stress, social situations, or environmental associated with previous substance use. These triggers can create a psychological and physiological response in the brain, leading to a strong urge to use alcohol. The prefrontal cortex, responsible for executive function, is compromised in alcohol use disorder (NIAAA, 2021). Blood Alcohol Concentrations (BAC) with Impairment 20-30 mg/dL Slowed motor impairment with decreased thinking ability 30-80 mg/dL Increased motor and cognitive problems 80-200 mg/dL Incoordination and judgment errors with deterioration in cognition 200-300 mg/dL Nystagmus, slurred speech, and blackouts >300 mg/dL Impaired vital signs and possible death Pharmacodynamic tolerance may be present if an individual lacks significant impairment at 150 mg/dL (Boland & Verduin, 2022). In addition, repeated alcohol intoxication can predispose individuals to depressed immune function leading to repeated infections and some cancers (APA, 2013). are affected. However, intellectual faculties remain intact, and the individual can perform complicated tasks. It is important to note that blackouts are not the same as passing out, which occurs when a person loses consciousness due to alcohol intoxication.
Alcohol consumption is linked to health and social consequences interfering with personal relationships, heart, and liver disease, cancer, motor vehicle collisions, and violence (NIAAA, 2021). In addition, the consequential effects on the brain account for euphoria and pleasurable feelings, increasing the motivation to use substances despite the risk of harm (HHS, 2016). The addiction cycle is based on three concepts: (1) binge/intoxication, (2) withdrawal/negative effects, and (3) preoccupation/anticipation (NIAAA, 2021). Individuals may experience all stages in a day or over weeks or months. In the binge/intoxication stage, an individual experiences rewarding experiences, including euphoria, anxiety reduction, and easing social interactions. Repeat activation of the basal ganglia reinforces the likelihood of repeated consumption through motivation and routine behaviors. In addition, the repeated activation of the basal ganglia changes how an individual responds to stimuli, which triggers powerful urges to consume the substance over time (NIAAA, 2021). Alcohol intoxication Alcohol intoxication usually develops over minutes to hours and lasts about several hours (APA, 2013). The first episode of alcohol intoxication likely occurs in the mid-teens, but alcohol use disorder is not identified in the late teens or early 20s. The essential feature of alcohol intoxication is the presence of behavioral or psychological changes, including inappropriate sexual or aggressive behavior, mood lability, impaired judgment, and levels of incoordination that may interfere with the performance of usual activities (APA, 2013). In addition, the degree of intoxication increases with the blood alcohol concentration, especially when combined with other sedation- producing substances (APA, 2013).
Blackouts Blackouts are identified as anterograde amnesia (the inability to form new memories while under the influence of alcohol) occurring with alcohol intoxication. During blackouts, individuals’ remote memory remains intact, but short-term memory is deficient. Likely, the hippocampus and temporal lobe structures
ALCOHOL WITHDRAWAL
The decision to stop drinking is usually in response to a crisis followed by weeks of abstinence and then controlled nonproblematic drinking (APA, 2013). However, consumption escalates rapidly, and severe problems likely occur (APA, 2013). In addition, individuals will often continue consumption to decrease the unpleasant side effects of withdrawal. As a result, repetitive and intense use develops, and individuals spend a lot of time consuming alcohol (APA, 2013). Alcohol withdrawal can be severe, including seizures and autonomic hyperactivity (diaphoresis, tachycardia). The classic sign of alcohol withdrawal is tremulousness (Boland & Verduin, 2022). Other withdrawal symptoms include nausea, vomiting, insomnia, transient visual, tactile, and auditory hallucination or illusions, psychomotor agitation, anxiety, and seizure (APA, Withdrawal seizures Alcohol withdrawal produces generalized tonic-clonic seizures, but status epilepticus is rare (Boland & Verduin, 2022). However, long-term alcohol use can produce hypoglycemia, hyponatremia,
2013). The estimated progression of alcohol withdrawal symptoms is presented here. Progression Symptoms Time to Presentation Mild Tremulousness 6-8 hours Moderate Perceptual disturbances 8-12 hours Severe Seizures 12-24 hours Life Threatening Delirium tremens Within 72 hours (Boland & Verduin, 2022)
and hypomagnesemia, producing seizures (Boland & Verduin, 2022).
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