Mark Klimek Lectures- Alcoholism
Alcoholism- #1 problem is Denial (also same problem with any other addiction)
❖ Denial- in addiction/abuse*
➢ Refusal to accept the reality of a problem
❖ How to treat denial
➢ Confront it- point out difference between what they say and what they do
■ Ex. alcoholism- “you say you’re not an alcoholic, but its 10am and you
already drank a 6-pack
■ Child abuse- “you say you’re not a child abuser, but child services took
your children”
➢ Don’t confuse confrontation with aggression
■ Confrontation attacks the problem
■ Aggression attacks the person
❖ Denial- in stages of grief*
➢ Normal and healthy response in grief process
■ Support it
● Ex. somebody gets hand amputated and next day says to you “i
cant wait to go home and play piano”
● You say “oh whats your favorite song to play”, “how long have you
been playing”,
❖ Dependence- Codependency- #2 problem in abuse
➢ Dependence
■ Abuser relies on somebody else to perform things for them
● Ex. abuser needs spouse to call boss because he cannot go to
work bc he is drunk
➢ Co-dependence
■ Spouse gets self-esteem boost from performing hings for abuser
● Ex. Spouse calls abuser’s boss to call out of work and thinks to
self “aren’t i the best. Who else would do that for this jerk?”
■ How to treat codependency
● Set limits and enforce them
● Teach significant other to say “no”
● Work on self-esteem of codependent spouse
, ❖ Manipulation
➢ Abuser gets s/o to do things for him/her not in the best interest of the s/o. The act
is dangerous or harmful
■ Codependence- alcoholic man asks 35yr old wife to go to the liquor store
for him
■ Manipulation- mother asks 17yr old daughter to go to the liquor store for
her. (illegal and dangerous for daughter)
❖ Wernicke’s Encephalopathy/Korsakoff's psychosis
➢ Wernikes = encephalopathy
■ Confusion
■ Inability to coordinate voluntary movements
■ Eye abnormalities
➢ Korsakoff
■ Loss of touch with reality = psychosis
■ Due to deficient vitamin B1
■ Amnesia with confalbulation (memory loss, making up stories because
they forgot)
■ The lie is just as real as reality
■ Will lose entire decades of memory
➢ Psychosis induced by vitamin B1 or psychosis deficiency
➢ Primary symptom
■ Amnesia with confabulation- they believe the confabulations
➢ Treatment
■ Redirect- rechannel their confabulation to something more plausible
● Ex. somebody thinks they’re the VP of the country and have a
meeting this morning and need to leave. You can tell them let’s
watch CNN and we can see whats going on in the country
➢ Preventable
■ Vitamin B1 & thiamine supplements
➢ Arrestable- (stop it from getting worse)
■ Take B1
➢ Irreversible
■ Can stop the progress with B1, but brain damage cannot be undone
Drugs for Alcoholism
❖ Antabuse orethia (disulfiram)
, ➢ Aversion therapy (aversion means hatred)
■ Tries to get alcoholics to get a gut hatred for alcohol
➢ 2 week onset and 2 week duration- cannot come into contact with alcohol for 2
weeks after it is discontinued
➢ Teach patients to avoid all forms of alcohol
■ Mouthwash
■ Aftershave
■ Any OTC that ends in Elixir
■ Cologne
■ Insect repellent
■ Alcohol based hand sanitizer
■ Uncooked icings (have vanilla extract, contains alcohol)
■ DO NOT pick red wine vinaigrette
Drug Overdoses and Withdrawals
❖ Ask yourself 2 questions to get these answers right
❖ 1. Is it an upper or downer?
❖ 2. Are they asking about overdose or withdrawal?
❖ Every abused is either an upper or downer
❖ Uppers- adderall, caffeine, LSD/PCP, Methamphetamines, Cocaine,
➢ All the signs go up- HR, BP, Euphoria, tachypnea, restlessness, irritability,
diarrhea, hyperactive reflexes (+3, +4), seizure risk (have suction ready)
❖ The rest are downers- there’s a lot
➢ Signs go down- HR,BP,RR, drowsiness, lethargy, respiratory depression (risk for
arrest), hypoactive reflexes
❖ Withdrawal affect-
➢ Withdrawal from an upper will have the same symptoms as intoxication of a
downer and withdrawal of a downer will have same symptoms as intoxication of
an upper
➢ RR depression= overdose of downer, upper withdrawal
➢ Seizure= overdose of upper, downer withdrawal
➢ Always assume intoxication, not withdrawal at birth
■ After 24 hrs. birth, you can assume withdrawal
, ■Ex. You’re caring for an infant born to a downer addicted mom. 24 hrs.
after birth, SATA.
● Seizure risk, high pitched cry, restlessness/difficult to console,
exaggerated startle
Alcohol Withdrawal (AWS) vs. Delirium Tremens (DT)
❖ Every alcohol goes to alcohol withdrawal 24 hours after stopping drinking alcohol
❖ Not all alcoholics go through DT- DT 48-72 hour onset
AWS
❖ AWS not threat to self or others
❖ Regular diet
❖ Semi-private room, anywhere on unit
❖ Can go anywhere on the unit they want
❖ No restraints
❖ Antihypertensive
❖ Tranquilisers
❖ Multivitamin containing B1- prevent Wernicke’s & Korsakoff’s
DT (fatal, dangerous to self or others)
❖ NPO- clear liquids (seizure precautions)
❖ Private room, near nurse’s station
❖ Restricted bedrest- no bathroom privileges (bedpans & urinals)
❖ Restraints- threat to self and others
➢ Vest or 2-point locked leather restraints (2-point= 1 arm and the leg diagonal-
switch sides every 2 hours
❖ Antihypertensive
❖ tranquilizer
❖ Multivitamin containing B1- prevent Wernicke’s & Korsakoff’s
Drugs
❖ Aminoglycosides
➢ The “big guns” of antibiotics
➢ “A mean old micin”
➢ Antibiotics to treat resistant, life threatening gram-negative infections
➢ All aminoglycosides end in “micin” but 3 “micins” are not aminoglycosides
Alcoholism- #1 problem is Denial (also same problem with any other addiction)
❖ Denial- in addiction/abuse*
➢ Refusal to accept the reality of a problem
❖ How to treat denial
➢ Confront it- point out difference between what they say and what they do
■ Ex. alcoholism- “you say you’re not an alcoholic, but its 10am and you
already drank a 6-pack
■ Child abuse- “you say you’re not a child abuser, but child services took
your children”
➢ Don’t confuse confrontation with aggression
■ Confrontation attacks the problem
■ Aggression attacks the person
❖ Denial- in stages of grief*
➢ Normal and healthy response in grief process
■ Support it
● Ex. somebody gets hand amputated and next day says to you “i
cant wait to go home and play piano”
● You say “oh whats your favorite song to play”, “how long have you
been playing”,
❖ Dependence- Codependency- #2 problem in abuse
➢ Dependence
■ Abuser relies on somebody else to perform things for them
● Ex. abuser needs spouse to call boss because he cannot go to
work bc he is drunk
➢ Co-dependence
■ Spouse gets self-esteem boost from performing hings for abuser
● Ex. Spouse calls abuser’s boss to call out of work and thinks to
self “aren’t i the best. Who else would do that for this jerk?”
■ How to treat codependency
● Set limits and enforce them
● Teach significant other to say “no”
● Work on self-esteem of codependent spouse
, ❖ Manipulation
➢ Abuser gets s/o to do things for him/her not in the best interest of the s/o. The act
is dangerous or harmful
■ Codependence- alcoholic man asks 35yr old wife to go to the liquor store
for him
■ Manipulation- mother asks 17yr old daughter to go to the liquor store for
her. (illegal and dangerous for daughter)
❖ Wernicke’s Encephalopathy/Korsakoff's psychosis
➢ Wernikes = encephalopathy
■ Confusion
■ Inability to coordinate voluntary movements
■ Eye abnormalities
➢ Korsakoff
■ Loss of touch with reality = psychosis
■ Due to deficient vitamin B1
■ Amnesia with confalbulation (memory loss, making up stories because
they forgot)
■ The lie is just as real as reality
■ Will lose entire decades of memory
➢ Psychosis induced by vitamin B1 or psychosis deficiency
➢ Primary symptom
■ Amnesia with confabulation- they believe the confabulations
➢ Treatment
■ Redirect- rechannel their confabulation to something more plausible
● Ex. somebody thinks they’re the VP of the country and have a
meeting this morning and need to leave. You can tell them let’s
watch CNN and we can see whats going on in the country
➢ Preventable
■ Vitamin B1 & thiamine supplements
➢ Arrestable- (stop it from getting worse)
■ Take B1
➢ Irreversible
■ Can stop the progress with B1, but brain damage cannot be undone
Drugs for Alcoholism
❖ Antabuse orethia (disulfiram)
, ➢ Aversion therapy (aversion means hatred)
■ Tries to get alcoholics to get a gut hatred for alcohol
➢ 2 week onset and 2 week duration- cannot come into contact with alcohol for 2
weeks after it is discontinued
➢ Teach patients to avoid all forms of alcohol
■ Mouthwash
■ Aftershave
■ Any OTC that ends in Elixir
■ Cologne
■ Insect repellent
■ Alcohol based hand sanitizer
■ Uncooked icings (have vanilla extract, contains alcohol)
■ DO NOT pick red wine vinaigrette
Drug Overdoses and Withdrawals
❖ Ask yourself 2 questions to get these answers right
❖ 1. Is it an upper or downer?
❖ 2. Are they asking about overdose or withdrawal?
❖ Every abused is either an upper or downer
❖ Uppers- adderall, caffeine, LSD/PCP, Methamphetamines, Cocaine,
➢ All the signs go up- HR, BP, Euphoria, tachypnea, restlessness, irritability,
diarrhea, hyperactive reflexes (+3, +4), seizure risk (have suction ready)
❖ The rest are downers- there’s a lot
➢ Signs go down- HR,BP,RR, drowsiness, lethargy, respiratory depression (risk for
arrest), hypoactive reflexes
❖ Withdrawal affect-
➢ Withdrawal from an upper will have the same symptoms as intoxication of a
downer and withdrawal of a downer will have same symptoms as intoxication of
an upper
➢ RR depression= overdose of downer, upper withdrawal
➢ Seizure= overdose of upper, downer withdrawal
➢ Always assume intoxication, not withdrawal at birth
■ After 24 hrs. birth, you can assume withdrawal
, ■Ex. You’re caring for an infant born to a downer addicted mom. 24 hrs.
after birth, SATA.
● Seizure risk, high pitched cry, restlessness/difficult to console,
exaggerated startle
Alcohol Withdrawal (AWS) vs. Delirium Tremens (DT)
❖ Every alcohol goes to alcohol withdrawal 24 hours after stopping drinking alcohol
❖ Not all alcoholics go through DT- DT 48-72 hour onset
AWS
❖ AWS not threat to self or others
❖ Regular diet
❖ Semi-private room, anywhere on unit
❖ Can go anywhere on the unit they want
❖ No restraints
❖ Antihypertensive
❖ Tranquilisers
❖ Multivitamin containing B1- prevent Wernicke’s & Korsakoff’s
DT (fatal, dangerous to self or others)
❖ NPO- clear liquids (seizure precautions)
❖ Private room, near nurse’s station
❖ Restricted bedrest- no bathroom privileges (bedpans & urinals)
❖ Restraints- threat to self and others
➢ Vest or 2-point locked leather restraints (2-point= 1 arm and the leg diagonal-
switch sides every 2 hours
❖ Antihypertensive
❖ tranquilizer
❖ Multivitamin containing B1- prevent Wernicke’s & Korsakoff’s
Drugs
❖ Aminoglycosides
➢ The “big guns” of antibiotics
➢ “A mean old micin”
➢ Antibiotics to treat resistant, life threatening gram-negative infections
➢ All aminoglycosides end in “micin” but 3 “micins” are not aminoglycosides
