ETOH Abuse

[jessiern]

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.

[leslie :-D]

as a nurse, i would provide him w/all the necessary referrals in hopes of being successful.

depending on how earnest he is, there's a chance he will f/u and get the help he needs.

leslie

[flightnurse2b, LPN]

there is always hope, jessie. he just really, truly has to want with every ounce of his being to change his ways. sometimes people like that do better in sober living facility for a while. instead of him coming into the hospital, maybe case mgmt can arrange for this man to go to an inpt detox center for a while.

i know it is difficult to see through the disease and addiction and see the scared human being underneath it all.

i am a recovered addict and i have also worked in an inner city ER where crack-cocaine abuse was very prevalent. it would break my heart to hear the screech of a crack baby cry while we took mom to for emergency dialysis. in the back of my mind, i wanted to just scream at her and tell her how stupid she was. in my heart, i remembered the scared little girl i was who no matter how hard i tried, couldn't stop popping pills, until i found myself almost dead and spent 6 months in treatment.

its a double edged sword with drug/etoh users, and it is sometimes such a hard thing to be empathetic towards someone that is the cause of their own suffering. but kudos to you, jessie, for not giving up on this man. all it takes is one person to believe in you, and sometimes, that's just enough.....

there is always hope.

[tirednursedude]

I have seen the same etoh'ers come and go. We have them on the vent in icu on ativan drips,2 days later they get dc'd and go right to the bar.I could care less about them,they are obnoxious,take precious pca's to sit with them while they dt and for what? Send them to a detox clinic if they want them to stop,not to the hospital ER.

[TazziRN, RN]

I have seen the same etoh'ers come and go. We have them on the vent in icu on ativan drips,2 days later they get dc'd and go right to the bar.I could care less about them,they are obnoxious,take precious pca's to sit with them while they dt and for what? Send them to a detox clinic if they want them to stop,not to the hospital ER.

And where do these people go when there is no detox clinic in the area? I really hope that while you're caring for these people your "I couldn't care less" attitude doesn't show.

[tirednursedude]

No it doesnt show while caring for them,I let them punch me,kick me,swear at me.I take it like a trooper. Im sorry,but i have no sympathy for someone who jumps off a vent and runs to the bar.The patient has to want to quit themselves,no amount of ativan or me feeling good about trying to help them is going to get them to quit.If they want to stay the course I would love to see it happen,but 99.9% of them dont want to quit. They take up valuable resources in people and time,they disturb the entire floor,they abuse the staff verbally and physically.A med surg floor is not detox. When you drink and pass out and them come to ER with syncope,get a grip,passing out is part of drinking and then these idiotic docs admit them for the syncope.When your etoh level is .35,syncope tends to happen.

I have no problem with the people that truly want help,its the drunks that the bars call ems on or the police find wandering and dump into the ER.I'm sorry,but they can wait,the patient with colon cancer or heart disease is far more important.

[pattycakeRN]

No it doesnt show while caring for them,I let them punch me,kick me,swear at me.I take it like a trooper. Im sorry,but i have no sympathy for someone who jumps off a vent and runs to the bar.The patient has to want to quit themselves,no amount of ativan or me feeling good about trying to help them is going to get them to quit.If they want to stay the course I would love to see it happen,but 99.9% of them dont want to quit. They take up valuable resources in people and time,they disturb the entire floor,they abuse the staff verbally and physically.A med surg floor is not detox. When you drink and pass out and them come to ER with syncope,get a grip,passing out is part of drinking and then these idiotic docs admit them for the syncope.When your etoh level is .35,syncope tends to happen.

I have no problem with the people that truly want help,its the drunks that the bars call ems on or the police find wandering and dump into the ER.I'm sorry,but they can wait,the patient with colon cancer or heart disease is far more important.

I could not agree with you more. I personally do not believe that drug and alcohol addiction is a disease, at least at first. Everything you put in your body, you put there by choice. It's your hand that picks up the bottle and takes a drink, your hand that picks up the crackpipe, etc.

People just have no sense of personal responsibility. It seems like they would rather blame a 'disease' for their choices.

[banditrn]

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.

It's OK, Jessie, I understand how you feel. I went thru much of the same as a kid, and grew up with a real disdain for the things people do to their families because of booze and drugs.

I was non-judgemental in my nursing care, and as long as you remain the same, no one has the right to tell you how you should feel about it. :)

[aeauooo]

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.

No one chooses to be an addict or alcoholic. Addicts are not addicted to a disease, they are addicted to very powerful substances that alter brain chemistry, and therefore behavior. Smokers are addicted to a substance that alters their behavior, causing them to continue to smoke despite the deleterious effects of smoking on their health. Use of alcohol is generally socially acceptable, but to the person with a predisposition for alcohol dependency, social use is a trap.

It's very hard to take care of someone who has "done this to himself," but it's not our place as nurses to blame the victim - and a review of the medical and nursing literature can easily demonstrate that both genetics and environment play an overwhelming part in the development of an addiction. A very good review that I recently read is found in:

Zimmermann, U. S., Blomeyer, D., Laucht, M., Mann, K. F. (2007). How genes-stress-behavior interactions can promote adolescent alcohol use: the roles of predrinking allostatic load and childhood behavior disorders. Pharmacology, Biochemistry and Behavior, 86, 246-262.

Alcoholics and other substance abusers are not weak-willed people, or people who have some moral deficit.

Do we blame the person with diabetes for his renal failure? More often than not, he could have prevented it by controlling his blood sugar. What about the person who has a stroke because she/he failed to control her/his blood pressure? Or are these people less blame-worthy for the outcome of their disease than the person with a substance abuse problem?

Those who work in addiction recovery will tell you that relapse is the rule. There are people who do recover successfully, often times despite relapse.

I've been sober for eight years. Everything I have now, most importantly, my marriage, I would not have without my sobriety. I could not have gotten sober and stayed sober without two things: God's help, and people in my life who cared - who loved me even when I was very difficult to love.

[banditrn]

Aeauooo - good for you, I'm truly happy that you're doing well.

I mentioned above that I came from an alcoholic family - and even with all my warnings and such, ended up with an alcoholic son.

I wonder if any of you ever realize what you put your families and loved ones thru - really. My son has not only cost me multiple dollars, but he has also cost me much stress and heartache - and a level of trust that I'm not sure I'll ever get back.

He has pretty much lost the trust and closeness he once had with his brothers, and I'm basically his last support. He's been dry now for 2 years, but for some reason, I can't trust him to stay that way - and I'm NOT going thru it again.

My mother's family were all drunks - my cousins and I would gather at family get-together's and comment on who was on and off the wagon "Hey, Uncle John is drinking coffee like crazy - he's on!"

I have memories of my father driving drunk and swerving all over the road. And there was a point later in my life, after I had kids, that I refused my mother access to them for awhile unless and until she cleaned up her act.

Yes, alcoholism is a disease, but it's a selfish disease, that harms not just the person, but all those around them.

[aeauooo]

I wonder if any of you ever realize what you put your families and loved ones thru - really.

Yes, we do - I do. That's one of the reasons denial is an integral component of addiction, and guilt is one of the things that make staying clean/sober very difficult.

The thought processes associated with addiction are not logical - you can't make sense of the behavior of the addict or alcoholic.

I remember in my psych rotation working with an older schizophrenic gentleman and hearing him beg his son not to abandon him - but his son had had enough and really didn't want anything to do with his father anymore.

You can argue that schizophrenia and substance abuse are different, but is the frustration and anger that family of a schizophrenic feels any different than that of the family of an alcoholic?

We have to accept responsibility for our actions, but there's a big difference between accepting responsibility for our actions and accepting blame for our disease.

John 9:1-3

I can't run away from my past, but if I want to stay sober, I can't live in it.

[UM Review RN, ASN, RN]

No one chooses to be an addict or alcoholic.

I hope I don't offend you, but I respectfully disagree. No one chooses to be an addict on a conscious level, but I believe that the addictive process begins and ends with a choice, albeit a conscious or unconsious choice.

It's very hard to take care of someone who has "done this to himself," but it's not our place as nurses to blame the victim

I certainly hope that you don't think that I can't be professional and caring about the tragedy of addiction. I am professional. I am caring enough to insist that we follow the CIWA scale and appropriate interventions so that the addict does not have to suffer.

But I have no illusions. I don't expect a hospital stay to motivate an addict to change, no matter how much I might personally like him/her and want him/her to change.

I congratulate you on your sobriety. I wish sobriety for all addicts. But in answering the OP's question, the hard truth is that I've learned not to expect compliance with addicted patients leaving the hospital and getting into a 12-step program and sticking with it.

Again, this doesn't mean that I treat them badly or that I don't treat them appropriately, it just means what I said -- a patient comes into the hospital with a BAC of over 300 and spends half his time in four-points and the other half overmedicated on Librium, and then after what must be a horrible experience for the patient, we expect the little light bulb to flash on and the patient to leave the hospital a walking miracle of instant sobriety?

I doubt it. But I give my teachings and care as though it's possible, despite what the evidence clearly tells me.

[banditrn]

Yes, we do - I do.

John 9:1-3

I can't run away from my past, but if I want to stay sober, I can't live in it.

I guess that's true. But as long as you acknowledge and understand what harm it has caused, and don't try to belittle that, then maybe ALL can heal.

Again, the best of luck to you.:)