Question 1: evidence of substance abuse disorder
According to DSM-IV TR for substance abuse and substance dependence, the patient has to show a maladaptive pattern of substance misuse which leads to clinical distress or impairment. The patient has to show recurrent use of substance which leads to his or her failure to accomplish most responsibilities at home or at work. The patient can also show recurrent use of substance even in physically hazardous circumstances. Despite having consistent interpersonal or social problems that are a result of or are exacerbated by the use of substance, the patient shows continued use of substance. From the above criteria, Steve in the case study shows evidence of substance abuse disorder. He failed to cope up with work because of the effects of alcohol. As a result he got dismissed. He sneaked alcohol into his place of work going against the rules. Steve’s wife and kids left him because the effect of alcohol abuse posed a threat to his family. Despite being left by his family, he still continued to drink. He also failed to accomplish his major responsibilities as a father, husband, and at work. Steve therefore meets the criteria for a substance abuse disorder.
Question 2: Epidemiology of alcohol use in Australia
Australians commonly consume alcohol. A 2007 survey on drug strategy indicated that 83 percent of the population aged above 14 years consumes alcohol. This implies that 9 out of every 10 Australian aged above 14 has consumed alcohol in their lifetime. OECD ranks Australia at position 14 among the developed countries for alcohol consumption per capita. Beer is the most consumed alcoholic drink among Australians despite an increase in the wine consumption rate.
The Australian Bureau of Statistics indicates that alcohol consumption in Australia is generally at a low level of immediate risk. However, this is not experienced in everyone as some people consume alcohol at high levels that would potentially cause injuries related to alcohol. People mostly engage in alcohol use due to various reasons. The most common is peer pressure, cultural norm, genetic, environmental, and coping mechanism.
Australia Bureau of Statistics also notes that excessive use of alcohol in Australia has lead to significant burden of disease. A total of 3.2 percent of injuries and burden of disease in Australia can be attributed to alcohol consumption. Admission to hospital as a result of an alcohol related injury includes: kwosikwoff syndrome, young girl rape, lover, and accidents. Alcohol use disorder is on a rise and from the 2007 survey the prevalence rate stands at 6 percent of the population. Alcohol related conditions account for 30 percent of all admissions within Australian hospitals. In 2004, there were slightly over 1000 deaths directly related to alcohol use. Approximately 1 million people were hospitalized from alcohol use and this accounted for up to 693 million dollars in hospital cost. Alcohol use has therefore brought huge financial and emotional cost to the society as families and the government struggle to handle the situation. The many accidents resulting from drunken driving has lead to the involvement of ambulance, traffic police, tow cars, and cleanup crews
Question 3: causes and psychodynamics behind the development of Steve’s disorder
Based from the case study, the cause behind Steve’s excessive use of alcohol is genetics. The father was a heavy drinker and according to Steve’s statements, he used to witness the father hit the mother after he had a couple of shots. The problem might have been caused because he saw his father drink while growing up and he must have followed suit. The risk of developing this condition must have raised in Steve based on the fact that he witnessed one his close family member depend and abuse alcohol. The condition may not entirely be inherited but the susceptibility to it may have been triggered by the fact that he witnessed his father depending on alcohol.
Additionally, Steve may have further developed the problem as a result of psychiatric conditions. It can be noted that he admitted feeling like a failure and unable to meet his roles and obligations both at work and at home. This therefore led him to further dependency on alcohol despite the fact that alcohol was the primary reason for the injuries. Anxiety, depression and social isolation are risk factors that increased his consumption after losing his job, wife, and kids. His consumption rate increased after the occurrence of these events. Steve also says that he uses alcohol to cope with stress he faced at work. This means that the disorder might have also been triggered by the fact that his body processes alcohol differently. In other words, in order to achieve an effect, Steve has to consume alcohol. As a result this has caused a major dependency because without alcohol, he cannot cope with work or achieve any effect at work. The fact that alcohol is also a social norm within the Australian society might have triggered further the dependency and use of alcohol by Steve.
Question 4: Problems and risks related to Steve’s case
Anxiety and fear: risk of perceiving death threats and threat to self concept.
Sensory Perceptual alterations: the risk of sleep deprivation and alcohol consumption sudden cessation
Question 5 and 6:
Problem/Risk1: Risk for ineffective breathing patterns. Direct effect of the toxicity of alcohol upon the respiratory center
1. Respiratory monitoring: the nurse is expected to monitor the rate of respiratory by noting the periods of apnea
2. Airway management by encouraging frequent position change, exercises, deep breathing, and coughing. The nurse can also ensure his bed head is elevated and utilize the air suction equipments.
3. Administering supplemental oxygen.
1. Rationale for the first intervention is based on the need to conduct frequent assessment as the level of toxicity can change. Due to the risk of withdrawal, Steve is likely to experience hyperventilation and Kussmaul’s respiration. In order to control alcohol withdrawal in Steve, drugs may be compounded with CNS depressants.
2. Airway management enhances lung inflation, lowers diaphragm, and decreases chances for aspiration. It also facilitates the expansion of lungs and mobilizes necessary body secretions so that there can be reduced risk of pneumonia and atelectasis.
3. The third intervention is important since the Hypoxia may occur with depression of the respiratory system or the CNS.
Problem/Risk 2: Anxiety and fear: risk of perceiving death threats and threat to self concept.
1. Identify cause of anxiety and fear while engaging Steve in the process. Explain to him that the withdrawal would increase levels of anxiety and cause him to become uneasy. The nurse also needs to conduct continuous assessment for anxiety.
2. The nurse needs to develop a relationship based on trust. There is need to make frequent, honest and non judgmental contact with Steve and to help him accept the situation.
3. Administering medication such as Benzodiazepine
1. since Steve was is in a phase of withdrawal, he may not be able to accept what is happening. Anxiety in this case is due to environmental and psychological causes.
2. This intervention is important since it help give Steve a sense of humanness. It will help him lower the levels of distrust and paranoia.
3. Benzodiazepine is anti-anxiety agent administered especially during the stage of withdrawal. They will help Steve to relax and feel like he is in control.
Problem/Risk 3: Sensory Perceptual alterations: the risk of sleep deprivation and alcohol consumption sudden cessation
1. the nurse needs to assess response to stimuli, ability to speak, and level of consciousness.
2. The nurse may be required to make observations of behavioral responses such as irritability, sleeplessness, confusion, and disorientation.
3. Allowing the patient to remain in seclusion
1. This is important because the slurred speech my reveal confusion, while response to stimuli may reveal failure to be attentive, muscle coordination deficit, and inability to make sound judgment.
2. Because of CNS disturbance, hyperactivity may increase. The sedative effect f alcohol causes insomnia or sleeplessness. Deprivation of sleep leads to the confusion and disorientation.
3. This is important since a patient with suicidal thought, confusion, and hallucination respond properly when left alone.
de Wit, M., Gennings, C., Zilberberg, M., Burnham, E. L., & Moss, M. (2008). Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients. Addisction, 1500-1508.
Hack, J. B., Hoffman, R. S., & Nelson, L. S. (2006). Resistant alcohol withdrawal: Does an unexpectedly large sedative requirement identify these patients early? Journal of Medical Toxicology, 55-60.
Lansford, C. D., Guerriero, C. H., Kocan, M. J., Turley, R., & Groves, M. W. (2008). Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal. Archives of Otolaryngology - Head & Neck Surgery, 865.
Maney, D. W., Higham-Gardill, D. A., & Mahoney, B. S. (2002). The alcohol-related psychosocial and behavioral risks of a nationally representative sample of adolescents. The journal of social health, 157-63.
Mayo-Smith, M. F., Beecher, L. H., Fischer, T. L., & Gorelick, D. A. (2004). Management of Alcohol Withdrawal Delirium: An Evidence-Based Practice Guideline. Archives of Internal Medicine, 1405-12.
Rallings, M., Martin, P., & Davey, J. (2005). A prospective study of alcohol consumption rates of first-year Australian police officers. An International Journal of Police Strategies & Management, 206 - 220.
Schofield, C. (2004). How do I care for a patient with alcohol withdrawal syndrome? Nursing, 25.
Spooner, C., Mattick, R., & Noffs, W. (2001). Outcomes of a comprehensive treatment program for adolescents with a substance disorder. Journal of substance abuse treatment, 20(3), 205-213.
Tovar, R. (2011). Diagnosis and Treatment of Alcohol Withdrawal. Journal of Clinical Outcomes Management, 361.
Trevisan, L., Boutros, N., Petrakis, I., & Krystal, J. (1998). complication of alcohol withdrawal: pathophysiological insights. Alcohol Health and Research world, 61-65.