Objectives: Alcohol Abuse or Alcohol Dependence, Anticoagulant therapyThe Twelve Step Program of Alcoholics Anonymous (AA)School of Health ProfessionsDepartment of Physical TherapyCase Management IIObjectives: Alcohol Abuse or Alcohol Dependence, Anticoagulant therapyStudents will be able to: 1. Describe the immediate physical effects of ethanol, and the blood concentrations in mg/dL associated with increasingly marked effects, including death. Differentiate “blackout” and “passing out”.A blackout is an episodic memory loss, while passing out is going unconscious.0.05 (50 mg/dL*) Social high; tranquillity0.08 (80 mg/dL) Reduced coordination (reduced mental and physical abilities) Slowed reflexes (Both impair safe driving). This is Missouri’s blood alcohol limit.0.10 (100 mg/dL) Noticeably impaired coordination0.20 (200 mg/dL) ConfusionReduced memorySevere impairment (unable to stand)0.30 (300 mg/dL) Loss of consciousness0.40 (400 mg/dL and higher) Coma, death2. Recognize the legal limits for blood alcohol in Missouri, and why they were changed in 2001.Lowered from 0.10 to 0.08 Federal highway funds in 2000/2001 were linked to this legislation3. Briefly describe the alcohol detoxification process. Alcoholics who develop withdrawal symptoms generally treat themselves by drinking. Some people seek medical attention either because they don't want to continue drinking or because withdrawal symptoms are too severe. In either case, a doctor first checks for the possibility of an illness or head injury that could complicate the situation. The doctor then tries to characterize the type of withdrawal symptoms, determine how much the person usually drinks, and find out when the drinking ended.Because vitamin deficiency causes potentially life-threatening withdrawal symptoms, doctors in emergency departments generally give large intravenous doses of vitamin C and B complex vitamins, especially thiamine, B1. Intravenous fluids, magnesium, and glucose are often given to prevent some of the symptoms of alcohol withdrawal and to avoid dehydration.Often, doctors prescribe a benzodiazepine drug for a few days to calm agitation and help prevent withdrawal symptoms. Antipsychotic drugs are generally given to small numbers of people with alcoholic hallucinosis. Delirium tremens can be life threatening and is treated more aggressively to control the high fever and severe agitation. Usually intravenous fluids, drugs that lower fever (such as acetaminophen), sedatives, and close supervision are needed. With such treatment, delirium tremens generally begins to clear within 12 to 24 hours following onset.After the urgent medical problems are resolved, a detoxification and rehabilitation program should be started. In the first phase of treatment, alcohol is completely withdrawn. Then an alcoholic has to modify his behavior. Staying sober is difficult. Without help, most people relapse within a few days or weeks. Group treatment is generally believed to be superior to one-on-one counseling; however, the treatment should be tailored to the individual. Enlisting the support of family members may be important as well.Sometimes an alcoholic can benefit from the use of a drug to avoid drinking alcohol. A drug called disulfiram (Antabuse) may be prescribed. This drug interferes with alcohol metabolism, causing acetaldehyde, a Page 1 of 5metabolite of alcohol, to build up in the bloodstream. Acetaldehyde is toxic and produces facial flushing, throbbing headache, rapid heart rate, rapid breathing, and sweating within 5 to 15 minutes after the person drinks alcohol. Nausea and vomiting may follow 30 to 60 minutes later. These uncomfortable and potentially dangerous reactions last 1 to 3 hours. The discomfort from drinking alcohol after taking disulfiram is so intense that few people risk taking alcohol--even the small amount in some over-the-counter cough and cold preparations or some foods.A recovering alcoholic can't take disulfiram right after stopping drinking; the drug can be taken only after a few days of abstinence. Disulfiram can affect alcohol metabolism 3 to 7 days after the last dose of the drug. Because of the severe reaction to alcohol associated with the treatment, disulfiram should be given only to recovering alcoholics who really want help and are willing to cooperate with a doctor and treatment counselors. Pregnant women or people who have a serious illness shouldn't use disulfiram.Naltrexone another pharmacy option: reduces the desire for alcohol after drinking has stopped.4. List and describe the long-term physical changes that frequently develop with chronic alcohol use, focusing particularly on those with implications for physical therapy.Peripheral neuropathy and CNS damage: resulting from alcohol and from thiamine (B-1) deficiency (bal)Cerebellar ataxia (bal)Hepatotoxicity resulting in hypoglycemia, risk of ketoacidosis (aerobic)Cardiomyopathy: dysrhythmias, CHF (aerobic)5. Describe permanent mental changes that may occur with ETOH abuse.Korsakoff’s Syndrome: disturbed recent memory, with confabulation. Affect is comfortable and cheerful, though non comprehendingWernicke’s Encephalopathy: (more advanced) ocular palsy, impaired mentation, ataxia, polyneuropathy6. Demonstrate familiarity with AA, Al-Anon, AlaTeen.- AA: Fellowship of alcoholics: practice the Twelve Step program as well as using other core literature.http://www.aa.org/?Media=PlayFlash - Al-Anon/Alateen: Fellowship of relatives and friends of alcoholics http://www.al-anon.org/english.htmlFor both organizations: meetings are open to anyone; non-professional peer support is offered; anonymity is maintained outside of the meeting; a peer may serve as supportive sponsor for an individual.The Twelve Step Program of Alcoholics Anonymous (AA)1. We admitted we were powerless over alcohol—that our lives had become unmanageable.2. Came to believe that a Power greater than ourselves could restore us to sanity.3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves.5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.6. Were entirely ready to have God remove all these defects of character.7. Humbly asked Him to remove our shortcomings.8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made a direct amends to such people wherever