Alcohol abuse and addiction is drug addiction. Because of the acceptance of ‘social drinking’ in society, individuals often feel that it is an acceptable drug. When alcohol ingestion becomes uncontrolled, a preoccupation or compulsive alcohol consumption becomes an issue. Alcohol use disorder is diagnosed. Alcoholism is classically defined as greater than three drinks a day or seven per week for women. For men, it is four or more drinks a day or 14 per week. Although today, alcoholism is often viewed as drinking that is recognized as out of control. Individuals that use hard liquor, wine, or beer can become an alcoholic.
Some individuals are considered alcoholics even though they drink much less than the defined amounts. Some drink only on weekends, typically classified as binge drinking; However, there is still the preoccupation with anticipation of the weekend or an uncontrolled ability to stop once started. Others are high functioning in that they maintain a job and lifestyle that does not equate with the stereotypical alcoholic as in being unable to deal with day-to-day living needs. Still, they are anticipating alcohol or overindulge when presented with alcohol. Sometimes this can be referred to as functional alcoholism or ‘dry drunk’ in that the amount of alcohol consumed on off-hours stays in the body until drinking can resume. Others keep alcohol hidden at work or home only to imagine they are drinking less than they actually are.
Intoxication often plays a role in brain injury or spinal cord injury from trauma or disease. Intoxication occurs in 50% of those at the time of traumatic brain injury. Alcohol is a risk factor for hemorrhagic stroke. If you have already had an ischemic (blood clot) or hemorrhagic (bleeding in the brain) stroke, you are at significant risk for a second stroke with alcohol use. It is estimated that one-third of individuals who sustain a spinal cord injury are intoxicated at the time of trauma. This can be from chronic alcohol abuse or a one-time binge at the wrong time.
One of the key issues in all addictions, especially alcoholism, is a lack of insight into the situation. A person may justify alcohol use based on the way it makes them feel. They may experience some euphoria at first, easing of problems, relaxation, and disregard for worries and concerns. Even though the individual has knowledge of what they are doing is extreme, the desire to escape from the reality of life may be overpowering. They may not be able to resolve their desire for alcohol with its effects on their body and their life.
Recognizing alcoholism in an individual’s life is challenging. Human bodies react differently as they metabolize alcohol. Some individuals are less able to metabolize alcohol than others. Some do not care for the taste or effects of alcohol and reject drinking it. Others crave the taste and effects. Individuals with alcoholism have difficulty controlling their drinking. It may be a consuming desire or compulsion to have another drink. They may not recognize concerns about their own behavior or how their drinking is affecting those around them.
Symptoms of alcohol abuse include mental status changes, blackouts, shakiness, sweating, aggression, agitation, poor judgment, self-abusive or self-destructive behavior, bodily or emotional harm to others, compulsiveness, guilt, loneliness, isolation, nausea and vomiting, Delirium incoordination, slurred speech, or tremor. You may have all, some, or just a few symptoms with varying degrees of intensity.
For individuals with central nervous system (CNS) injuries such as brain injury, stroke, or spinal cord injury from trauma or disease, the symptoms of alcoholism can magnify existing issues. Mental acuity can be dulled. The inability to sweat can lead to body temperature overheating. If the judgment is a concern, poor judgment is further enhanced. Seizure threshold is lowered. Movement is less controlled. Falling is increased. Tone (spasms) may or may not decrease initially but then greatly increase. Alcohol reduces your desire to care for yourself. The high sugar content in alcohol increases your risk of diabetes as well as urinary incontinence, which increases pressure injury and infection. Bowel control lessens, leading to incontinence. High calories in alcohol lead to weight gain, which makes transfers less independent. Alcohol can lead to brain injury or further injury to your brain and central nervous system.
After a brain injury or spinal cord injury, your body is more sensitive to alcohol. As with any drug use, rehabilitation progress is slower and poorer outcomes for individuals abusing alcohol. It is recommended that alcohol consumption be stopped after a trauma to the central nervous system as it increases risks of bodily harm from falls, poor judgment, depression, and delays or can even stop nervous system recovery.
Alcohol can interfere with medications required after central nervous system injury. As alcohol and many medications are metabolized in the liver, the competition for alcohol and medication to be metabolized is confounded. These medications include antibiotics, antidepressants, antihistamines, muscle relaxants, nonnarcotic and some narcotic pain medications, anti-inflammatories, opioids, and the blood thinner, warfarin, among many others.
It is very difficult to recognize alcoholism in yourself especially if you have been abusing it for some time. Typically, individuals rationalize their drinking as it progresses. Some individuals rationalize that if they only drink on weekends, in social situations, or limit themselves to wine or beer, they are not alcoholic. You will need to pay attention to the people who love and care for you as well as your healthcare professionals if they express concern about your alcohol consumption.
If you think you may have an issue with alcohol, if it is suggested to you, or if you want to verify that you do not have an issue, check with your healthcare provider. You can also take an inventory of your drinking by honestly answering the questions here. The Substance Abuse and Mental Health Services Administration, through the US Department of Health and Human Services, has an abundance of information on a variety of subjects about alcohol and drug abuse.
Self-medicating with alcohol does not treat underlying issues such as central nervous system injury or depression. In fact, it makes both issues worse. If you are having mental health struggles, seek help from your medical professional. Mental health issues are imbalances in the brain. They can be helped. Alcohol is not a treatment and can further poorly affect your mental health.
There are prescribed medications that can be used to help you resist drinking. These include naltrexone (blocks brain receptors), acamprosate (prevents negative feelings that encourage individuals to drink), and disulfiram (causes nausea and vomiting in response to alcohol consumption).
Treatment programs include Alcoholics Anonymous, Moderation Management, and Smart Recovery. Each of these programs works differently, so see which program might work best for you.
Remove yourself from the people who enable your drinking. This can be difficult if you have caregivers or rely on family for support. Some individuals bully their caregivers and families into supplying them with alcohol and drugs that they can no longer get for themselves. This harassment by the individual is usually given into by the enablers as the belligerence is so intolerable or they are addicted as well. Family members give up as they feel sorry for the individual. Your central nervous system injury is not the end of life. You can be successful without the detriment of alcohol or other drugs. Utilize counseling to help both you and any enablers seek opportunities to change strategies. Alcoholism is a family issue, even if only one person is drinking.
Never drink and drive or ride with someone who has been drinking.
Remember stopping an addiction is a process. It takes dedication and determination. If you have a slip, recognize that fact, and correct it right away. You can be successful. Nurse Linda
Underage drinking is a concern. It can be a challenge for parents to keep on top of children and teens, especially when with their peers. Most children do not consume alcohol, but there is the temptation of peer pressure or the thought that it will ease their situation. The brain is still developing until about age 25 years. Drinking can affect that development. It can make learning more difficult.
Talking about alcohol and drug use in the home is effective against abuse. Teaching children about the effects of alcohol and drugs as well as demonstrating behavior is a good lesson for everyone. Nurse Linda
Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.
In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the “how-to” on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.
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