ETOH Abuse

TazziRN, RN · Mar 17, 2008

There is always hope, but his way isn't working. If he will let you, call the local AA chapter and ask for someone in AA to visit him. Without AA he will most certainly relapse again.

Bugaloo · Mar 17, 2008

Lifelong ETOH patients have a very difficult time changing their behavior. Some of them don't want to change, but some do. The problem is if they try to do it alone, they usually fail because they do not have the tools needed to fight their addiction.

Depression and anxiety play a huge part of any type of addiction. These people know that they have hurt loved ones, and that is an added pressure. Self-loathing is also common. This has been their way of life for so long that it petrifies them to think of going without that crutch. Rehab is usually the only way to go.

I did not go into nursing to do psych/substance abuse either, but I am a Med-Surg nurse and it comes with the territory. I do not have to agree with their way of life in order to provide nursing care. Although I find their situations very sad, I realize that being non-judgemental is the best way to deal with them. I listen when they want to talk, offer resource info if they ask, and provide the best nursing care that I can, just like the rest of my patients. I do not preach at them or get them to change their behavior. Trust me..they know why they are in the shape they are in. These patients sometimes can be manipulative, or abusive with staff. If that type of behavior presents itself, I let them know that it is unacceptable.

MikeyJ, RN · Mar 17, 2008

I am suprised that he has made it into his 50's!

My aunt died a few years ago from liver cirrhosis at the young age of 41. She had been an alcoholic since her teenage years as well.

I agree with the others -- he will most definitely relapse if he doesn't have the support and tools to become sober. After being an alcoholic for nearly 40 years, he is going to have to fight more than the dependency alcohol has on his body. He is going to have to leave behind the life he has known for nearly the entirety of his existence.

elkpark · Mar 17, 2008

I just wanted to share with you my experience with a patient I had the last two days I have worked, and get a little insight from all you nurses out there. First of all, I did not chose to specialize in drug and alcohol abuse as a feild because I do not like to care for individuals that suffer with drug and etoh addictions. I also do not feel I have the level of sympathy for these patients that I should. We have a handful of chronic abusers that come in, dry out, swear to change, and three months later they are back again. They mix rehab in here and there. I am pestimest usually when they tell me they are "never gonna touch it again"...I don't say so to the patient, and I try to be encouraging, but I "know" in the back of my mind I will see them again. I've also experience this with a few family members, and know the effects it has on the family first hand, which might cause some of my disdain for caring for people who abuse drugs/acohol.

I'm glad that you've had an experience that is starting to improve your attitude toward these clients, but I'm wondering -- do you have the same negative attitude toward the clients you encounter with DM, COPD, emphysema, CAD, etc.? Addiction is a chronic disease, and lots of people struggle with it despite their best efforts, just as lots of people do with other kinds of chronic disease ...

jessiern, BSN, RN · Mar 17, 2008

do you have the same negative attitude toward the clients you encounter with DM, COPD, emphysema, CAD, etc.? Addiction is a chronic disease, and lots of people struggle with it despite their best efforts, just as lots of people do with other kinds of chronic disease ...

I never said my views and attitude was right. But it comes from a background of a 12 year old girl without a father becuase he is too busy at the bar drinking to be worried with me. And years of broken promises. I know first hand what the family is going through, and chronic disease or not, it is heartbreaking. I can pray about my attitude, and hope the Lord will help me with it, but some things are hard to change.

And just like I provide quality care and education for a patient with CAD, COPD, DM, I do my absolute best to provide the same for patients with these disorders. But, I can't help the fact that I had rather not deal with it.

And yes, I agree it is a disease. But choices are involved too. My biological dad knew the first time he picked up a beer that many of his relative are alcoholic--and he still choose to take that risk. He also choose to never try and get help.

:twocents:

Medic2RN, BSN, RN, EMT-P · Mar 17, 2008

I've also experience this with a few family members, and know the effects it has on the family first hand, which might cause some of my disdain for caring for people who abuse drugs/acohol.

She's already stated why she feels this way about addiction patients. Identification of the "why" is half the battle, working on changing that thought behavior is the second.

I would assume she already is aware that addiction is a chronic disease. Anyone who says that ALL healthcare workers have no pre judgement about ANY type of patient ALL of the time is probably not telling the truth. As long as the patient is treated in the same manner as any other patient, then no harm is done. The individual will have to work on changing his/her beliefs on their own.

UM Review RN, ASN, RN · Mar 17, 2008

I'm glad that you've had an experience that is starting to improve your attitude toward these clients, but I'm wondering -- do you have the same negative attitude toward the clients you encounter with DM, COPD, emphysema, CAD, etc.? Addiction is a chronic disease, and lots of people struggle with it despite their best efforts, just as lots of people do with other kinds of chronic disease ...

Really, isn't that comparing apples and oranges?

Alcoholism and other addictions are simply not like other disease processes because addicts manipulate the family dynamic in entirely unhealthy ways.

Yes, they're sick, no two ways about it. But I've never known a diabetic, even a noncompliant one, to abuse a wife or child and then claim that he didn't know what he was doing because he was ketoacidotic.

Would the diabetic choose to be diabetic? Would the Alzheimer's patient choose to be confused? They're certainly not addicted to their disease. But the addict is.

It's easier for me to deal with the addict with a healthy amount of skepticism. So I get an ETOH'er, I treat them so they don't go into withdrawal, I figure they'll be noncompliant with their treatment plan but I give it to them anyway, and then they leave the hospital.

Lots of people leave the hospital and are noncompliant after promising to take their Coumadin or whatever, so why should one more noncompliant patient bug me?

Tweety, BSN, RN · Mar 17, 2008

There's no such thing as a hopeless alcoholic. But you have to let him go knowing his chances for relapse remain high. People do recover, there's nothing wrong with hoping and praying that he's had his last drink.

Kudos to you for seeing the human being and his suffering.

Tweety, BSN, RN · Mar 17, 2008

I'm glad that you've had an experience that is starting to improve your attitude toward these clients, but I'm wondering -- do you have the same negative attitude toward the clients you encounter with DM, COPD, emphysema, CAD, etc.? Addiction is a chronic disease, and lots of people struggle with it despite their best efforts, just as lots of people do with other kinds of chronic disease ...

Nurses are human beings. We get a COPD smoker well to watch them go out to smoke. We get a diabetic patient well only to watch them return to poor habits, come back and have their foot chopped off, return to bad habits, come back with a stump infection and have a BKA. We release a CAD patient after an angioplasty and see them return 20 pounds heavier having a CABG. We see an abused wive continually goes back to her husband.......on and on and on. We see an alcholic with end-stage liver disease, massive ascites, drink again and return to the hospital.

To judge ourselves and our fellow nurses for being human and harboring negative feelings doesn't seem fair.

I think as long as it doesn't affect our patient care, and or our hope in them that eventually find peace and wellness, we should feel free to say we don't like taking care of those patients and to express some negativity, which isn't the same as passing judgement.

dekatn · Mar 17, 2008

I have my moments with the etoh abusers. We have a few, the same ones, every month. They spend every penny of their disability check for etoh,regular as clockwork, the second week of every month, they all end up on our floor. We have the protocol memorized, can do it with our eyes closed!!!! They come in and spend a night or sometimes two, then out they go just to start the cycle over again for the next month. I don't know what they do with the other three weeks of the month, probably best I don't know. Sometimes ignorance really is bliss!!! It gets really frustrating at times, especially during the flu and pnuemonia season when you have pt. out the wazoo to take care of, because as one of the other posters stated, sometimes they can get really demanding and ugly to staff. It goes w/o saying that these people aren't going to change, they don't want to, this is a way of life with them and we accept this. Some of them are vets, some of them grew up this way, to them this is "normal". My dad was an alcholic, but for the life of me, I can't ever remember him going to the hospital to sleep off one of his binges!!! The powers that be have made it too easy for these people to come in and abuse the system the same way they abuse alcohol. One of my favorite sayings is, "It is what it is".

oramar · Mar 17, 2008

I just wanted to share with you my experience with a patient I had the last two days I have worked, and get a little insight from all you nurses out there. First of all, I did not chose to specialize in drug and alcohol abuse as a feild because I do not like to care for individuals that suffer with drug and etoh addictions. I also do not feel I have the level of sympathy for these patients that I should. We have a handful of chronic abusers that come in, dry out, swear to change, and three months later they are back again. They mix rehab in here and there. I am pestimest usually when they tell me they are "never gonna touch it again"...I don't say so to the patient, and I try to be encouraging, but I "know" in the back of my mind I will see them again. I've also experience this with a few family members, and know the effects it has on the family first hand, which might cause some of my disdain for caring for people who abuse drugs/acohol.
But, I have had a patient over the last couple of days that makes me wonder. He has abused alcohol since he was a teenager, and he is in his fifty's (although, as goes it with their lifestyle, he's appearance and health makes him appear to be 70 at least). He has been with us for about 2 weeks now, being monitoring/treated because of a very poor cardiac status. I was bathing him the first day, and noted he had large bruised to his back, and lower abd. I asked him about the bruises, and he told me they occured when he was "drunk". This lead to a conversation about the abuse, and he admitted his had a great desire to quit. We talked about it a great deal. Yesterday, we cont talking about for about an hour, and we prayed together about it. He says he knows it will be hard, but he is determined to stop because he doesn't want to die and cont to hurt his family. He truely does seem desperate to give it up. Even says he wished he could remain hospitalized "till he dies" so he won't be tempted. He has even told his friends that he drinks with not to visit him now, or when he goes home. This patient, as far as I know, has never told another nurse he plans to quit (I have asked other nurses), and on some visits he has called a taxi at discharge to take him to the liquor store.
After all the years of abuse, and the state of his health being so poor, should I have realistic hope that he can quit? I have never personally seen anyone be able to do it, but I would really love for this man to be able to do so.

Seems to me you have done all you can possibly do as a nurse for this person. From now on it is up to him to get behind the wheel and drive the bus.