412 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
is highest among people of Asian ancestry (National
Institute on Alcohol Abuse and Alcoholism, 2000).
Another genetic difference between ethnic groups
is found in other enzymes involved in metabolizing al-
cohol in the liver. Variations have been found in the
structure and activity levels of the enzymes among
Asians, African Americans, and whites. One enzyme
found in people of Japanese descent has been associ-
ated with faster elimination of alcohol from the body.
Other enzyme variations are being studied to deter-
mine their effects on the metabolism of alcohol among
various ethnic groups (National Institute on Alcohol
Abuse and Alcoholism, 2000).
Statistics for individual tribes vary, but alcohol
abuse overall plays a part in the five leading causes of
death for Native Americans (motor vehicle crashes,
alcoholism, cirrhosis, suicide, and homicide). Among
tribes with high rates of alcoholism, an estimated 75%
of all accidents are alcohol-related (National Institute
on Alcohol Abuse and Alcoholism, 2000).
In Japan, alcohol consumption has quadrupled
since 1960. The Japanese do not regard alcohol as a
drug, and there are no religious prohibitions against
drinking. Milne (2002) describes a traditionally in-
dulgent attitude toward those who drink too much,
stating “In a tightly knit society where concealing
emotions and frustrations is a highly developed and
necessary part of maintaining consensus, getting
drunk is a socially sanctioned safety valve” (p. 388).
Brady (2002) identifies explosive binge drinking
among some Aboriginal people that is associated
with trauma, violence, and accidents. Alcohol “poi-
soning” is identified as one major aspect of Russia’s
“dismal health situation” (Onishchenko, 2002, p. 23).
TYPES OF SUBSTANCES
AND TREATMENT
The classes of mood-altering substances have some
similarities and differences in terms of intended effect,
intoxication effects, and withdrawal symptoms. Treat-
ment approaches after detoxification, however, are
quite similar. This section presents a brief overview
of seven classes of substances and the effects of in-
toxication, overdose, withdrawal, and detoxification
and it highlights important elements the nurse to be
aware of.
Alcohol
INTOXICATION AND OVERDOSE
Alcohol is a central nervous system depressant that
is absorbed rapidly into the bloodstream. Initially the
effects are relaxation and loss of inhibitions. With
intoxication, there is slurred speech, unsteady gait,
lack of coordination, and impaired attention, concen-
tration, memory, and judgment. Some people become
aggressive or display inappropriate sexual behavior
when intoxicated. The person who is intoxicated may
experience a blackout.
An overdose, or excessive alcohol intake in a short
period, can result in vomiting, unconsciousness, and
respiratory depression. This combination can cause
aspiration pneumonia or pulmonary obstruction.
Alcohol-induced hypotension can lead to cardiovascu-
lar shock and death. Treatment of an alcohol overdose
is similar to that for any central nervous system de-
pressant: gastric lavage or dialysis to remove the drug,
and support of respiratory and cardiovascular func-
tioning in an intensive care unit. The administration
of central nervous system stimulants is contraindi-
cated (Lehne, 2001). The physiologic effects of repeated
intoxication and long-term use are listed in Box 17-1.WITHDRAWAL AND DETOXIFICATION
Symptoms of withdrawal usually begin 4 to 12 hours
after cessation or marked reduction of alcohol intake.
Symptoms include coarse hand tremors, sweating,
elevated pulse and blood pressure, insomnia, anxi-
ety, and nausea or vomiting. Severe or untreated
withdrawal may progress to transient hallucinations,
seizures, or delirium—called delirium tremens (DTs).
Alcohol withdrawal usually peaks on the second day
and is over in about 5 days (American Psychiatric As-
sociation [APA], 2000). This can vary, however, and
withdrawal may take 1 to 2 weeks.
Because alcohol withdrawal can be life threat-
ening, detoxification needs to be accomplished under
medical supervision. If the client’s withdrawal symp-
toms are mild and he or she can abstain from alcohol,
he or she can be treated safely at home. For more se-
vere withdrawal or for clients who cannot abstain
during detoxification, a short admission of 3 to 5 daysBox 17-1
➤ PHYSIOLOGICEFFECTS OF
LONG-TERMALCOHOLUSE- Cardiac myopathy
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
- Pancreatitis
- Esophagitis
- Hepatitis
- Cirrhosis
- Leukopenia
- Thrombocytopenia
- Ascites