ALCOHOLISM: ALCOHOLISM A FORM OF CHEMICAL DEPENDENCY


THIS COULD BE YOU: THIS COULD BE YOU


Different types of Chemical Use: Different types of Chemical Use 1. The Chemical upsets the person therefore they don’t use again. 2. The effects are pleasant and the chemical is used socially, but in a controlled fashion. There is Freedom of Choice. 3. Heavy use. Pre-planned and again there is Freedom of Choice. 4. Addictively. ONCE THE INITIAL DOSE HAS BEEN TAKEN THE RELIABILITY OF FREEDOM OF CHOICE IS LOST AND WITHOUT HELP RELAPSE INTO PROGRESSIVE ABUSE IN THE FULLNESS OF TIME IS PROBABLE.


What is Alcoholism?: What is Alcoholism? According to the WHO, Alcoholism is a continuing problem in any part of a person’s life, due to ethyl alcohol, ie Financial, Physical, Work, Family, Mental, Recreational, Spiritual, etc., etc., etc..


Chemical dependency includes mood altering drugs other than alcoholEG cannabis, amphetamine, benzodiazepines, codeine and other similar analgesics including dihydrocodeine, dextropropoxyphene (coproxamol), as well as heroin, cocaine, phenobarbitone, etc.: Chemical dependency includes mood altering drugs other than alcohol EG cannabis, amphetamine, benzodiazepines, codeine and other similar analgesics including dihydrocodeine, dextropropoxyphene (coproxamol), as well as heroin, cocaine, phenobarbitone, etc.


Slide7: CHEMICAL DEPENDENCY IS A “NEED”, EITHER PSYCHOLOGICAL OR PHYSICAL, FOR THE USE OF A MOOD ALTERING CHEMICAL, WITH DEVELOPMENT OF PSYCHOLOGICAL OR PHYSICAL DISTRESS WHEN THE CHEMICAL IS WITHDRAWN OR NOT AVAILABLE.


Slide8: THIS DISTRESS LEADS TO THE DEVELOPMENT OF DRUG SEEKING BEHAVIOUR, WHICH MAY RANGE FROM SHOPLIFTING AND “SCORING” THE NEXT DOSE OF HEROIN TO


Slide9: ORGANISING THE NEXT MESS PARTY, “Borrowing” medication from the ward or practice drug cupboard or anaesthetic trolley


Slide10: THIS DRUG SEEKING BEHAVIOUR IS NOT, AT LEAST INITIALLY, PERCEIVED AS ABNORMAL BY THE SUFFERER. Rationalisation and other forms of DENIAL enable the person to give themselves excellent “reasons” for their drug use and any subsequent behaviour.


Slide11: ENABLERS, SUCH AS FAMILY, COLLEAGUES, PEERS, DOCTORS, EMPLOYERS, ETC., COLLUDE - i.e. accept and agree with the excuses / rationalisations of the alcoholic / addict.


It is a deteriorating illnessin which, although the progress may vary from time to time, there is a downward trend.: It is a deteriorating illness in which, although the progress may vary from time to time, there is a downward trend.


Slide14: Social drinking. Pre-alcoholic phase Occasional relief drinking Heavy habitual social drinking Increase in alcohol tolerance Surreptitious drinking Urgency of first drinks Unable to discuss problem Constant relief drinking


Slide15: Drinking bolstered with excuses Persistent remorse Promises and resolutions fail Increasing dependence on alcohol Loss of other interests Work & money problems Neglect of food Tremors and early morning drinks


Slide16: Repeated under the influence driving Feelings of guilt about drinking Memory blackouts increase Decrease of ability to stop drinking when others do Grandiose and aggressive behaviour Efforts to control fail repeatedly Tries geographic escapes Family and friends avoided


Slide17: Unreasonable resentments Loss of ordinary willpower Decrease in alcohol tolerance Onset of lengthy intoxications Impaired thinking Physical and mental damage Moral deterioration Indefinable fears Unable to initiate action All alibis exhausted


ALCOHOL RELATED CONDITIONS: ALCOHOL RELATED CONDITIONS CNS – Amnesic episodes – “blackouts” Convulsions due to withdrawal state Delirium Tremens Wernicke’s Encephalopathy Korsakoff’s Psychosis Hallucinations Vertical nystagmus Tremor


Slide20: Tunnel vision Hyper-reflexia Peripheral neuritis Neuropathic joints Brain damage with intellectual deterioration – Mamillary bodies and general cortical with enlarged sulci and ventricles


Slide21: CVS - Myocarditis Congestive Cardiac failure Arrhythmias Tachycardia Hypertension Haemorrhoids


Slide22: Gastro-intestinal Carcinoma of tongue and upper GI Tract Hepatitis, Cirrhosis, Ascites, Liver failure Villous atrophy & Malabsorption Early morning vomiting (withdrawal) Carcinoma of Liver, Pancreas & Colon


Slide23: Oesophagitis and oesophageal varices Gastritis Duodenal Ulcer Pancreatitis Monday morning diarrhoea


Slide24: Blood Anaemia – hypochromic (MCHC 100 with no anaemia Bruising of shins Gout


Other Associated Conditions: Other Associated Conditions Muscle Wasting causing weight loss Disturbances of libido Affect disturbances Self harm (slashed wrists, etc.) Arthritis due to overuse of neuropathic joints Gynaecomastia Dupuytren’s Contracture


Slide26: Finger clubbing Liver palms Excessive palmar & general sweating in withdrawal Cushinoid state Increased frequency of trauma


Slide27: Biochemical Hypokalaemia Hypoglycaemia Raised uric acid Abnormal liver function tests (gamma glutamyl transpeptidase, Aspartate transaminase, etc.)


Slide28: Unstable anticoagulation Unstable anti-epileptic control Unstable diabetic control Need for extra sedation in anaesthesia Poor resistance to infections Premature aging


Slide29: Mood altering drugs (including alcohol) ease the pain of emotional events in the person’s life. E.G. bereavement due to loss of friends and relatives, jobs, physical health, inability to attain to the high ideals which one had hoped to maintain, etc.. With people who have a susceptibility (whether genetic or otherwise) to become chemically dependent, this causes a lack of development of emotional maturity due to avoidance of working through these problems.


Slide30: This causes a failure to mature emotionally and a feeling of being “different” from other people. The patient has become an emotional child in an adult’s body and has never learned to cope with emotional stresses in the way that “normal” people do. Learning these skills without relapse into abuse of the drug is virtually impossible without help from those who understand and can offer help because of their own experiences.


SOURCES OF HELP: SOURCES OF HELP ALCOHOLICS ANONYMOUS HAS A 24 HOUR HELP-LINE WHICH CAN BE ACCESSED BY ‘PHONING NATIONAL NUMBER 0845.7697555 AL-ANON FAMILY GROUPS & ALATEEN FOR SPOUSES AND OTHERS INVOLVED WITH THE ALCOHOLIC, INCLUDING TEENAGERS, IS AVAILABLE VIA THE AA HELP-LINE or Direct on 0207.403.0888. NARCOTICS ANONYMOUS TELEPHONE NUMBER IS 0207.730.0009 nationally. FAMILIES ANONYMOUS FOR THE FAMILIES OF ADDICTS IS CONTACTABLE ON 0207.498.4680


SOURCES OF HELP: SOURCES OF HELP SICK DOCTORS’ TRUST - FOR HELP FOR DOCTORS WITH A CHEMICAL DEPENDENCY PROBLEM. This can be accessed by a concerned colleague, spouse, patient, etc. CONFIDENTIAL HELPLINE - 0870.4445163. The call is transferred to one of a panel of responders, who understand the illness and the recovery process. If the doctor is alcoholic / addicted, help can given by an empathic approach and, in many cases, sharing of experience. Contact with the local branch of the British Doctors and Dentists Group can be facilitated and, if necessary, admission to a rehabilitation unit for Healthcare professionals can be arranged. If a partner or relative is the caller and the doctor refuses help, the SDT withdraws and it is up to the informant to take such action re the GMC, etc., as they may wish. Relatives can be referred to the local Families’ group of the BDDG. CONFIDENTIALITY IS GUARANTEED


Slide35: SICK DOCTORS TRUST WEBSITE IS


RECOVERY IS POSSIBLE: RECOVERY IS POSSIBLE