Tips on management of alcoholism

alcoholism
Alcoholism is common, serious, and expensive. Physicians encounter alcohol-related cirrhosis, cardiomyopathy, pancreatitis, and gastrointestinal bleeding, as well as intoxication and alcohol addiction, on a daily basis.

Alcoholism is also associated with many cancers.Wernicke encephalopathy and Korsakoff psychosis are also important causes of chronic disability as well as dementia. Fetal alcohol syndrome is a leading cause of mental retardation. In addition, accidents (especially automobile), depression, dementia, suicide, and homicide are important consequences of alcoholism.

The following are signs and symptoms of alcohol withdrawal:

1. Nausea and vomiting
2. Diaphoresis
3. Agitation and anxiety
4. Headache
5. Tremor
6. Seizures
Visual and auditory hallucinations: Many patients who are not disoriented—and who therefore do not have delirium tremens—have hallucinations
The following are signs of delirium tremens
( alcohol withdrawal delirium):
1. Tachycardia and hypertension
2. Temperature elevation
3. Delirium
The following are signs of chronic alcoholism:
1. Gynecomastia
2. Spider angiomata
3. Dupuytren contractures
4. Testicular atrophy
5. Enlarged or shrunken liver
6. Enlarged spleen

COMPLICATIONS OF ALCOHOLISM

1. Wernicke encephalopathy: Ataxia, ophthalmoplegia , and confusion.
2. Korsakoff syndrome: Anterograde and retrograde amnesia, often with confabulation and preceded by Wernicke encephalopathy
3. Hepatic encephalopathy: Asterixis and confusion.

MANAGEMENT OF ALCOHOLISM

1. Complete abstinence is the only treatment for alcohol dependence.
2. Emphasize that the most common error is underestimating the amount of help needed to stop drinking.
3. Hospitalize patients if they have a history of delirium tremens or if they have significant comorbidity.
4. Consider inpatient treatment if the patient has poor social support, significant psychiatric problems, or a history of relapse after treatment.
5. Strongly recommend Alcoholics Anonymous (AA)
6. Encourage hospitalized patients to call AA from the hospital; AA will send someone to talk to them if the patient makes the contact
7. Patients need to attend AA meetings regularly (daily at first) and for a sufficient length of time (usually 2 years or more) because recovery is a difficult and lengthy process.
8. In the beginning of treatment, and perhaps ongoing, patients should remove alcohol from their homes and avoid bars and other establishments where strong pressures to drink may hinder abstinence.
9. If the patient has an antisocial personality ( severe problems with family, peers, school, and police before age 15 years and before the onset of alcohol problems), recovery is less likely.
10. If the patient has primary depression, anxiety disorder, or another potentially contributory disorder (the other disorder must antedate the problems with alcohol or it must be a significant problem during long periods of sobriety), treat this primary problem aggressively.
The prognosis for alcoholism should not be considered hopeless. As many as 30% of persons with alcoholism stop drinking. Even a patient with cirrhosis might have a favorable prognosis if alcohol cessation is achieved.



Rehab 4 Alcoholism offers a free helpline and intervention service for people suffering from alcoholism and mental health problems. Website: http://www.rehab4alcoholism.com/
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