ALCOHOL USE DISORDER
Alcohol addiction is a chronic relapsing disorder associated with compulsive drinking (NIAAA, 2021). Alcohol use is a common dis- order defined by a cluster of behavioral and physical symptoms and can include withdrawal, tolerance, and craving (APA, 2013). Approximately 69.5% of ages 18 and older reported drinking al- cohol in the past year, with 59.4% in the last month (NIAAA, 2022). Alcohol is a potent drug that causes physiological changes in al- most every body system. The severity of the disorder is based on the number of diagnostic criteria in a given individual, along with changes in the severity of alcohol use across time, reflected by re - ductions in the frequency of alcohol consumed (APA, 2013). Alco- hol use disorder has a variable course characterized by remissions and relapses (APA, 2013). Alcohol use disorder is associated with increased risks of accidents, violence, and suicide (APA, 2013). Severe alcohol use is associated with comorbid conditions such as depression or other disinhibitions of feelings which contributes to suicide attempts as well as completed suicides (APA, 2013). Other disorders associated with alcohol use disorders include psychosis, bipolar disorders, anxiety disorders, sleep disorders, and neuro- Alcohol consumption is linked to health and social consequenc- es interfering in personal relationships, heart and liver disease, cancer, motor vehicle collisions, and violence (NIAAA, 2021). The powerful effects on the brain account for euphoria and pleasur- able 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 during the day, over weeks or months: ● Binge/intoxication stage is when an individual experiences a rewarding experience, including euphoria, anxiety reduc- tion, and easing of social interactions. Repeat activation of the basal ganglia reinforces the likelihood of repeated consump- tion through motivation and routine behaviors. The repeated activation of the basal ganglia changes the way an individual responds to stimuli, which triggers powerful urges to consume the substance over time (NIAAA, 2021). ● Negative affect/withdrawal stage occurs when an individual stops drinking and withdrawal symptoms occur. These symp- toms can be physical (sleep disturbances, pain, and ill feel- ings) or emotional (dysphoria, irritability, anxiety, and emotion- al pain). Negative feelings associated with alcohol withdrawal come from two sources. Diminished activation in the reward system makes it difficult to experience the euphoria associ - ated 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. cognitive disorders (Levin et al., 2013). Addiction cycle in alcohol use disorder ● Pre-occupation/anticipation stage occurs when an individual seeks alcohol after abstinence. This stage can be triggered by various factors such as stress, social situations, or environ- mental 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). 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 disor- der 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 aggres- sive behavior, mood lability, impaired judgment, and levels of incoordination that may interfere with the performance of usual activities (APA, 2013). The degree of intoxication increases with the blood alcohol concentration, especially when combined with other sedation producing substances (APA, 2013).
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. If an individual lacks significant impairment at 150 mg/dL pharma - codynamic tolerance may be present (Boland & Verduin, 2022). Repeated alcohol intoxication can predispose individuals to de- pressed immune function leading to repeated infections and some cancers (APA, 2013). Blackouts Blackouts are identified as anterograde amnesia (the inability to form new memories while under the influence of alcohol) occur - ring with alcohol intoxication. During blackouts, individuals’ re- mote memory remains intact but short-term memory is deficient. Likely, the hippocampus and temporal lobe structures are affect- ed. Intellectual faculties remain intact, and the individual can per- form complicated tasks. It's important to note that blackouts are not the same as passing out, which occurs when a person loses consciousness due to alcohol intoxication. Alcohol withdrawal The decision to stop drinking is usually in response to a crisis fol- lowed by weeks of abstinence and then controlled nonproblemat- ic drinking (APA, 2013). However, consumption escalates rapidly, and severe problems likely occur (APA, 2013). Individuals will of- ten continue consumption to decrease the unpleasant side effects of withdrawal. A repetitive and intense use pattern develops, and individuals spend time consuming alcohol (APA, 2013). Alcohol withdrawal can be severe, including seizures and auto- nomic 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; psy- chomotor agitation; anxiety; and seizure (APA, 2013). The esti- mated progression of alcohol withdrawal symptoms is presented here:
Time to Presentation
Progression
Symptoms
Mild
Tremulousness.
6-8 hours.
Moderate
Perceptual disturbances. 8-12 hours.
Severe
Seizures.
12-24 hours.
Life Threatening Delirium tremens.
Within 72 hours.
Note . Boland & Verduin, 2022. Withdrawal seizures
Alcohol withdrawal produces generalized tonic-clonic seizures, but status epilepticus is rare (Boland & Verduin, 2022). Long-term alcohol use can produce hypoglycemia, hyponatremia, and hy- pomagnesemia, which also produces seizures (Boland & Verduin, 2022). Delirium Although confusion and changes in the level of consciousness are not criteria for alcohol withdrawal, delirium may occur. Individuals with delirium are dangerous to themselves and others (Boland & Verduin, 2022). Delirium tremens occurs on the third day after reduction or cessation of alcohol and has a mortality of 20% if left untreated. Individuals demonstrate confusion, disorientation, hallucinations, delusions along with autonomic
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