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The Alcoholic Progression

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Slide 1 - Medical Aspects of Chemical Dependency Hal Vorse, M.D.
Slide 2 - Chemical Dependency: A Disease To be a disease, a condition must qualify 4 ways: A specific cause A specific group of signs and symptoms A predictable clinical course A predictable outcome Characteristics of Chemical Dependency Primary Progressive Chronic Fatal
Slide 3 - Clay Tablet
Slide 4 - Dr. Benjamin Rush1746-1813 1St to define alcoholism 1786- alcoholism as a disease Surgeon General of the Continental Army Member of Continental Congress Signed the Declaration of Independence
Slide 5 - AN INQUIRY INTO THE EFFECTS OF ARDENT SPIRITS UPON THE HUMAN BODY AND MIND WITH AN Account of the Means of Preventing AND OF THE REMEDIES FOR CURING THEM. BY BENJAMIN RUSH, M.D. Professor of Medicine in the University of Pennsylvania. THE EIGHTH EDITION, WITH ADDITIONS. BROOKFIELD: PRINTED BY E. MERRIAM & CO. 1814
Slide 6 - 1874 CartoonWoman’s Christian Temperance Union volunteers picketing a saloon full of drunks
Slide 7 - Federal Agent destroying a barrel of beer during prohibition
Slide 8 - Repeal the 18th Amendment
Slide 9 - Dr. Jellinek
Slide 10 - The Alcoholic Progression
Slide 11 - High Risk Drinking Men: More than 2 drinks per day or Five or more drinks on one occasion each month Women: More than one drink per day or More than 4 drinks on one occasion each month A drink is: 12 ounces of beer 5 ounces of wine 11/2 ounces of liquor
Slide 12 - The Alcoholic Progression Occasional Relief drinking Constant relief drinking starts
Slide 13 - The Alcoholic Progression Occasional Relief drinking Constant relief drinking starts Increase in alcohol tolerance
Slide 14 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking (drunk)
Slide 15 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts)
Slide 16 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal)
Slide 17 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal) Urgency of the first drink
Slide 18 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal) Urgency of the first drink Feelings of guilt Unable to discuss problem (DENIAL) Problem?........ What problem?
Slide 19 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase
Slide 20 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do
Slide 21 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking JOB STRESS FAMILY $$$ FEELINGS Celebrations
Slide 22 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior
Slide 23 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail
Slide 24 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests GOLF
Slide 25 - The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made
Slide 26 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression
Slide 27 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Work problems Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made Avoiding family and friends The Alcoholic Progression
Slide 28 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Financial difficulty
Slide 29 - The Alcoholic Progression Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made Neglect of food
Slide 30 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Early morning drinks
Slide 31 - Drinks with “inferiors” Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression
Slide 32 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Moral deterioration Breaking the Law Sneeking Around Telling Lies Covering Up Busted
Slide 33 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Moral deterioration Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Loss of alcoholic tolerance Physical Complications
Slide 34 - Medical Complications of Alcoholism Gastrointestinal Tract Acute gastritis Malabsorption Diarrhea Liver Alcoholic hepatitis Acute fatty liver Cirrhosis Pancreas Acute pancreatitis Pancreatic pseudocyst Diabetes Gastrointestinal Tract Acute gastritis Malabsorption Diarrhea Heart Cardiomyopathy Arrhythmias Fetal Alcohol Syndrome Nervous System Peripheral Neuropathy Optic Neuritis Wernicke Encephalopathy Musculoskeletal System Acute Proximal Myopathy Osteonecrosis of the Hip Trauma Blood Anemia White Cell Dysfunction Decreased Platelet Function Infectious Disease Tuberculosis Decreased response to bacterial infection Cancer Larynx Esophagus Liver
Slide 35 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Moral deterioration Loss of alcoholic tolerance Physical Complications Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Brain Damage
Slide 36 - Normal
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Slide 38 - Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Moral deterioration Loss of alcoholic tolerance Physical Complications Brain Damage Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression DEATH
Slide 39 - Drugs of Addiction The Depressants (“Downers”) Alcohol Opiates (Narcotics) Heroin (smack, “H”, horse) Morphine Codeine Oxycodone (Oxycontin, Percocet, Tylox) Hydrocodone (Lortab, Vicodin) Demerol (Meperidine) Dilaudid (Hydromorphone) Tawin (Pentazocine) Darvocet (Proxyphene) Ultacet, Ultram (tramodol) * Fentanyl
Slide 40 - Drugs of Addiction The Depressants (“Downers”) Sedatives/Hypnotics/Tranquilizers Barbituates (Seconal, Nembutal) Memprobamate (Miltown, Equanil, Soma,carisoprodol*) Benzodiazapines (Xanax, Valium, Klonopin, Ativan, Librium, many others) Methaqualone (Quaalude, ‘ludes) Nitrous oxide Chloral hydrate * These drugs are addictive but not controlled by the DEA
Slide 41 - Depressants Drug effects: Neurological depression Symptoms of intoxication: Loss of inhibitions Decreased fine motor and gross motor coordination Stupor Loss of consciousness (coma) Respiratory depression and death
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Slide 43 - Depressants Symptoms of withdrawal: Tremors (shaking) Loss of appetite Insomnia, sleep disturbances Hypersensitive to stimuli Gastrointestinal upset Hallucinations Seizures (convulsions) Death Withdrawal from these drugs is a serious medical condition which requires supervision of a physician to be done safely Overdoses and death commonly occur when two or more of these drugs are used in combination Brain damage is twice as sever when depressants are use with stimulants, i.e. alcohol and methamphetamine.