journal entry psych

Type of drinkers:

Binge Drinkers

• Definition:
• Consumes large amounts of alcohol in a short period, usually on weekends or during specific periods.
• Some may binge only on weekends, while others may drink during the week and abstain on weekends.
• Psychological Aspect:
• Uses Freud’s Ego Defense Mechanisms to justify their drinking behavior.
• Rationalization: They minimize or justify their drinking (e.g., “I only drink on weekends, so it’s fine.”).

Alcohol Withdrawal:

• Onset:
• Symptoms typically begin 6 to 8 hours after the last drink.
• Peak severity occurs 24 to 72 hours after cessation but can last for days to weeks, depending on the severity.

Withdrawal Symptoms:

• Ataxia:
• Loss of coordination, clumsy movements, and difficulty walking.
• Vital Sign Fluctuations:
• Blood pressure, heart rate, and respiratory rate may fluctuate due to the body adjusting to the absence of alcohol.
• Hypertension:
• Elevated blood pressure due to increased sympathetic nervous system activity.
• Vomiting:
• Nausea and vomiting as the body attempts to rid itself of toxins.
• Headache:
• Resulting from dehydration and changes in blood flow to the brain.

More Serious Symptoms of Alcohol Withdrawal:

• Delirium Tremens (DTs):
• A severe and life-threatening form of alcohol withdrawal.
• Can cause seizures, hallucinations, confusion, heart attack, agitation
• Onset: Usually occurs 48 to 72 hours after the last drink but can take up to 2 weeks in some cases.
• Confabulation:
• Filling in gaps in memory with false information, often seen in people with chronic alcohol abuse.
• Happens due to damage in memory areas of the brain.
• Wernicke’s Encephalopathy and Korsakoff Syndrome:
• Both are conditions caused by thiamine (vitamin B1) deficiency, common in chronic alcoholics.
• Wernicke’s Encephalopathy: Acute and reversible condition causing confusion, lack of coordination, and eye movement abnormalities.
• Korsakoff Syndrome: Chronic and often irreversible condition marked by severe memory loss and confabulation.

Brain Effects:

• Disturbance of Glutamate:
• Alcohol suppresses glutamate, a neurotransmitter that stimulates brain activity.
• During withdrawal, glutamate levels spike, leading to over-excitation of the brain, which causes seizures, agitation, and hallucinations seen in DTs.

Detox protocol: Librium (benzodiazepines) – low potency longer acting because we want to avoid 1 addiction substituting another addiction, Thiamine, Folic acid, Vitamin B12, B1

Detox: 3-4 days (typical)

Day 4: Librium q 4hr, Day 3 q 3 hrs, Day 2, q 2 hours – the drug is tapered throughout the 4 day period

Slow with medication management: because pt can go into resp depression

What is their history?

Detox Protocol for Alcohol Withdrawal:

1. Medications Used:

• Librium (Chlordiazepoxide)
• Class: Benzodiazepine
• Why Librium?
• Low potency and long-acting → Preferred for alcohol withdrawal to prevent severe symptoms (seizures, DTs).
• Goal: Avoid substituting one addiction (alcohol) with another (short-acting benzodiazepines like Xanax or Ativan).
• Tapering Protocol:
• Day 1: Administered every 4 hours
• Day 2: Administered every 3 hours
• Day 3: Administered every 2 hours
• Taper Duration: Usually over 3-4 days to gradually reduce the dosage and prevent withdrawal complications.
  
  
  Antipsychotics may be given as well because the patient may be having illusions, pt must be observed

2. Essential Vitamins and Supplements:

• Thiamine (Vitamin B1):
• Prevents Wernicke’s Encephalopathy and Korsakoff Syndrome.
• Given to replace deficiencies caused by chronic alcohol use.
• Folic Acid (Folate):
• Helps with red blood cell production and prevents anemia caused by poor nutrition in alcoholics.
• Vitamin B12:
• Supports nerve function and helps prevent further neurological damage.

3. Duration of Detox:

• Typical Length:
• 3 to 4 days depending on the severity of withdrawal and patient response.

4. Tapering Librium Schedule (Example):

• Day 1: Librium every 6-8 hours 50 mg
• Day 2: Librium every 6-8 hours 25 mg
• Day 3: Librium every 6-8 hours 15 mg
• Day 4: Gradual tapering and discontinuation
  
  Librium may not be necessary if mild withdrawals or when the pt is about to be discharged
  

5. Why Slow Medication Tapering is Important:

• Risk of Respiratory Depression:
• Benzodiazepines (like Librium) depress the central nervous system.
• Rapid administration or high doses may cause respiratory depression, sedation, and coma.
• Goal: Use the minimum effective dose and taper gradually to avoid complications.
  

✅ Key Points:

• Librium is used for safe withdrawal and to prevent seizures/DTs.
• Vitamin replacement prevents long-term neurological damage.
• Slow tapering minimizes the risk of respiratory depression.
  
  Flushed red, puffy appearance, ascites (perfusion of abdomen), ulcer bleeding, Liver becomes affected.
  History of patient: what is the cause of the alcoholism? Could be genetics

As a younger child the individual may have had to take over the parent role to their younger siblings – this could effect the future and have the person result to substance abuse

Features of family members:

• Enabler: utilizing Freuds coping mechanism, justifying and rationalizing things, keeping alcohol and saving some for later but hiding the alcohol throughout the day

- Dependency: Allowing individual to stay at home and allowing them to drink

Alcoholics should stay away from other alcoholics: example gf alcoholic is very educated about alcohol but she is an alcoholic as well, she is an enabler

Treatment: Rehab 30 days, individual is 2x likely to resort back to alcohol

90 day rehab is preferred because the rehab digs into what is the route cause of the problem – “why have they suppressed repressed their problems”

Rehab is voluntary, programs are to follow once rehab is complete, after rehab is over the problem doesn’t end because its easy for the individual to go back to old ways

Alcoholics may guilt trip someone to help them get their fix – Families can be referred to support groups as well to figure out how to deal with the alcoholic

Family members would often fight about the individual as one could believe that they are doing what's best vs what the other person believe what is best

12 Steps of AA:

• Denial → Admission of Powerlessness
• “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
• Hope → Belief in a Higher Power
• “Came to believe that a Power greater than ourselves could restore us to sanity.”
• Surrender → Turning Life Over to Higher Power
• “Made a decision to turn our will and our lives over to the care of God as we understood Him.”
• Self-Reflection → Moral Inventory
• “Made a searching and fearless moral inventory of ourselves.”
• Confession → Admitting Wrongs
• “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.”
• Readiness → Prepared for Change
• “Were entirely ready to have God remove all these defects of character.”
• Humility → Asking for Help
• “Humbly asked Him to remove our shortcomings.”
• Accountability → List of Those Harmed
• “Made a list of all persons we had harmed and became willing to make amends to them all.”
• Making Amends → Taking Responsibility
• “Made direct amends to such people wherever possible, except when to do so would injure them or others.”
• Continuous Reflection → Ongoing Self-Assessment
• “Continued to take personal inventory, and when we were wrong, promptly admitted it.”
• Spiritual Growth → Prayer and Meditation
• “Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.”
• Service to Others → Spreading the Message
• “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.”

Substance abuse: relapse may happen, rehabs tell them to keep it pushing but don’t look at it like a failure

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Alcohol Dependence

Three patterns of use varies from person to person

Drinking large amounts every day

Binge drinking for weeks followed by abstinence

Binge drinking every weekend

People with ETOH dependence can drink with control and at other times, they cannot control drinking behaviour. As the course of alcoholism continues, there may be behaviours such as starting the day off with a drink, sneaking drinks through the day, gulping alcoholic drinks, shifting from one alcoholic beverage to another, and hiding bottles at work and at home.