🍺 Lecture 2
Alcohol & Substance Abuse
Denial, dependency, Wernicke, overdose/withdrawal, delirium tremens.
Psych Concepts
⭐
#1 Psychological Problem in ANY abuse = DENIAL
Child abuse, gambling, cocaine, spousal, elder — always DENIAL
Child abuse, gambling, cocaine, spousal, elder — always DENIAL
| Situation | Nursing Action |
|---|---|
| Denial in LOSS (grief) | SUPPORT — stages: DABDA |
| Denial in ABUSE | CONFRONT — point out behavior difference |
😢 DABDA — Stages of Grief
Denial → Anger → Bargaining → Depression → Acceptance
✅
Good answer uses "I" | Bad answer uses "YOU"
| Dependency (Abuser) | Co-Dependency (Significant Other) |
|---|---|
| Gets others to do things — DENIAL → Confront | Self-esteem from helping — Teach to say NO, set limits |
🧠 Wernicke-Korsakoff
Vitamin B1 (Thiamine) deficiency
S/Sx: Amnesia + Confabulation (making up stories that feel real)
Preventable (B1) | Arrestable (B1) | 70% IRREVERSIBLE
Nursing: REDIRECT — don't argue!
Preventable (B1) | Arrestable (B1) | 70% IRREVERSIBLE
Nursing: REDIRECT — don't argue!
Overdose & Withdrawal
⭐
Step 1: Upper or Downer? Step 2: Overdose or Withdrawal? (opposite effects!)
| UPPERS (memorize 5!) | DOWNERS |
|---|---|
| Caffeine, Cocaine, PCP/LSD, Meth, Adderall | Everything else (135+ drugs) |
| OD = things go UP (seizures, tachy, hyperreflexia) | OD = things go DOWN (resp arrest!) |
| Withdrawal = too LITTLE → resp arrest risk | Withdrawal = too MUCH → seizures |
🚨
Resp arrest priority: OD on Downer | Withdrawal from Upper
🚨
Seizure risk: OD on Upper | Withdrawal from Downer
👶
Newborn: <24hrs = INTOXICATION assumed | ≥24hrs = WITHDRAWAL assumed
Alcohol Withdrawal
| AWS (24 hrs) | Delirium Tremens (72 hrs) |
|---|---|
| NOT life threatening | LIFE THREATENING |
| Regular diet, semiprivate room | NPO/clear liquids, private room near station |
| Up ad lib, no restraints | Restricted bed rest, restraints (vest/2-point) |
✅
Both get: anti-HTN + tranquilizer + multivitamin with Vit B1
💊 Antabuse (Disulfiram) Teaching
Onset AND Duration = 2 WEEKS
Avoid ALL alcohol including mouthwash, cologne, hand sanitizer, vanilla extract, OTC liquids
Red wine vinaigrette = OK | Drinking causes: N/V, even DEATH
Red wine vinaigrette = OK | Drinking causes: N/V, even DEATH
📖 Notes for Dummies
🧠 Think of it this way…
Alcohol and drug abuse on the NCLEX is about two things: (1) how to respond to the person emotionally, and (2) what happens physically when someone uses or stops using drugs.
🙈
Denial is ALWAYS #1 — no matter what the abuse. Alcoholic? Denier. Gambling addict? Denier. Drug addict? Denier.
Confront abuse. Support grief. Don't mix these up!
Confront abuse. Support grief. Don't mix these up!
⬆️⬇️
Uppers vs Downers:
UPPERS (Cocaine, Meth, PCP, Caffeine, Adderall) = everything SPEEDS UP (heart races, seizures, hyperactive)
DOWNERS (everything else) = everything SLOWS DOWN (sleepy, slow breathing, coma)
OD on a downer → breathing STOPS first! (most dangerous)
UPPERS (Cocaine, Meth, PCP, Caffeine, Adderall) = everything SPEEDS UP (heart races, seizures, hyperactive)
DOWNERS (everything else) = everything SLOWS DOWN (sleepy, slow breathing, coma)
OD on a downer → breathing STOPS first! (most dangerous)
🔄
Withdrawal = OPPOSITE of the drug:
Downer withdrawal = things speed UP (seizures, agitation)
Upper withdrawal = things slow DOWN (resp arrest risk)
Downer withdrawal = things speed UP (seizures, agitation)
Upper withdrawal = things slow DOWN (resp arrest risk)
⏰
Alcohol withdrawal timeline:
24 hours → AWS (not deadly — regular room, no restraints)
72 hours → DTs (DEADLY — private room, restraints, NPO)
24 hours → AWS (not deadly — regular room, no restraints)
72 hours → DTs (DEADLY — private room, restraints, NPO)
📝 Real-life example:
Imagine someone who drinks every day stops suddenly. After 1 day they feel shaky (AWS — manageable). By day 3 without help, they could have seizures and see things (DTs — life-threatening). That's why nurses watch so closely!
Imagine someone who drinks every day stops suddenly. After 1 day they feel shaky (AWS — manageable). By day 3 without help, they could have seizures and see things (DTs — life-threatening). That's why nurses watch so closely!