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.

[aeauooo]

"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."

You didn't offend me, we'll just have to agree to disagree.

I'm not trying to make the case that you are judgmental in your care of substance abusers, but I see it all the time in my colleagues - and I'm not talking about what we say to each other out of the earshot of our patients. I know a nurse for whom I sincerely believe there is a special place in Hell reserved because of the way she treats patients with substance abuse problems - ugly! It's out there - even among nurses with whom I work, whom I like, and for whom I have a great deal of respect.

It's at those times when I believe my alcoholism and my recovery make me a better nurse, because I can show compassion and empathy, I can reach that patient on a level that nurses who've never had a substance abuse problem can't; "I've been there" goes a long way towards gaining that person's trust - especially in an environment where she/he may be feeling judged.

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.

The alcoholic has to be allowed to heal.

Shame is not a motivator to stay clean/sober. Shame is the best reason I can think of to drink. Just as I know I will stop feeling hungry if I eat, I know I will stop feeling shame if I drink.

There is one thing alone that allows me to be sober: love. Christ's love for me that when I felt worthless He valued me, and God's love revealed through the people who forgave me and loved me.

I also had to forgive myself, even if other people weren't willing to do so.

Love is the only thing that stands between me and the bottle.

[TazziRN, RN]

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.

Ah, but this just shows the lack of understanding of the disease. All people who drink do so by choice, but the alcoholic/addict can't stop. It's not a matter of responsibility, except in picking up that first drink or using that drug for the first time, or taking the extra Vicodin. Even people with dependency in their family history think that "I can control it, I won't turn into Grandpa/Aunt Lois/Cousin George." Many don't know that dependency is in their family until it happens to them and someone says "Grandpa Jim used to get drunk all the time." People with heriditary dependency who know the dangers and never drink or use still have the disease, but it's dormant until the chemical hits the system.

[suanna]

I worked in ETOH/drug tx. for a few years. Gave it up when they stopped being sick people seeking help to just another da** drunk abusing the system. I do remember enough to say your patient dosn't have a snowballs chance of staying off the booze unless he is willing to commit to a program to keep him sober- AA is the most used. An alcoholic wanting to stay sober is like a diabetic wanting to have normal glucose levels- wanting it and being committed to a treatment program to make it happen are two different things.

[tirednursedude]

Yes exactly.We have the same losers come to ER with syncope,alcohol is .45. HELLO!!! Passing out is part of being drunk.We had one the other night,came in on the damn squad with vomiting,.29.These people are a waste of time and money,they are self pay,they use the squad like a taxi cab,they come in wanting every bit of food we have in the hospital,they want to go outside to smoke,they disturb the other patients (semiprivate rooms). The police will find someone staggering on the street,where theytake them,to ER!! They have been doing this for years obviously,let them stagger home.

If someone wants to stop drinking,they will check themselves into a detox center.A medsurg floor is not a detox unit and it is actually illegal for med surg units where i live anyway to treat etoh'ers with ativan and heroin users with methadone since we arent certified detox centers.

[UM Review RN, ASN, RN]

If someone wants to stop drinking,they will check themselves into a detox center.A medsurg floor is not a detox unit and it is actually illegal for med surg units where i live anyway to treat etoh'ers with ativan and heroin users with methadone since we arent certified detox centers.

OK, first of all -- detox centers. It's more than a matter of wanting to get help. Help is not as readily available or as affordable as you make it sound.

Second, no, a med-surg floor is not a detox unit, but keeping an ETOHer safe from DTs (which can kill them) while they're being treated on a med-surg (or tele) unit is NOT illegal, it is part of a medical dx and certainly is part of the patient's standard of care.

Third, I don't know where you live, but in my world, alcoholism is a tragedy that destroys people and families. While I'm not fond of seeing the awful fruits of this disease, somewhere underneath it all is a person. Not a loser. A person who desperately needs help. And maybe just a touch of compassion. How much does it cost you to give that, compared to how much alcoholism has cost them?

It's one of my least favorite diseases to deal with, yes. Detoxing ETOHers can be frighteningly violent if they're not treated with ativan or librium, so I'd have to wonder what your part of the world would do with the ETOHer who comes in with chest pain and an emergent MI who's been trying to kick the habit on his own and hasn't had a drink for the past week.

[bagladyrn, RN]

Ah, but this just shows the lack of understanding of the disease. All people who drink do so by choice, but the alcoholic/addict can't stop. It's not a matter of responsibility, except in picking up that first drink or using that drug for the first time, or taking the extra Vicodin. Even people with dependency in their family history think that "I can control it, I won't turn into Grandpa/Aunt Lois/Cousin George." Many don't know that dependency is in their family until it happens to them and someone says "Grandpa Jim used to get drunk all the time." People with heriditary dependency who know the dangers and never drink or use still have the disease, but it's dormant until the chemical hits the system.

This is why I think it is so important to educate our kids in an open honest way about the risks. Alcoholism runs very strongly on one side of my family (many close family members) so my son was educated from childhood on the probable genetic link and the possibility of him having inherited it. I shared with him research that showed that the younger one starts drinking, the more likely dependence is, and asked that he wait until he was mature physically before trying alcohol. (No use trying to address psychological maturity with a teenager). He did so (small town, would have heard) and told me the first time he tried drinking. Seems to have worked - he's adult now without any dependency issues. Lucky me - I got the diabetic gene instead of the alcoholic gene my brother inherited.

I think the OP is to be commended for recognizing their issues with alcoholics and working to not let this affect the care given, even going beyond basic physical needs to help this patient. It takes a lot of compassion to go the extra step for those we might find personally less sympathetic individuals.

[banditrn]

This is why I think it is so important to educate our kids in an open honest way about the risks. Alcoholism runs very strongly on one side of my family (many close family members) so my son was educated from childhood on the probable genetic link and the possibility of him having inherited it. I shared with him research that showed that the younger one starts drinking, the more likely dependence is, and asked that he wait until he was mature physically before trying alcohol. (No use trying to address psychological maturity with a teenager). He did so (small town, would have heard) and told me the first time he tried drinking. Seems to have worked - he's adult now without any dependency issues. Lucky me - I got the diabetic gene instead of the alcoholic gene my brother inherited.

I think the OP is to be commended for recognizing their issues with alcoholics and working to not let this affect the care given, even going beyond basic physical needs to help this patient. It takes a lot of compassion to go the extra step for those we might find personally less sympathetic individuals.

baglady - I educated ALL my children about their risk of developing an addiction from the time they could walk almost. I did not keep alcohol in my house or drink, yet we still ended up with an alcoholic child who didn't believe anything that I said about it at the time, because he didn't WANT to hear it.

It was only after he was going thru withdrawal that it actually occured to him that I wasn't making it all up.

[TazziRN, RN]

baglady - I educated ALL my children about their risk of developing an addiction from the time they could walk almost. I did not keep alcohol in my house or drink, yet we still ended up with an alcoholic child who didn't believe anything that I said about it at the time, because he didn't WANT to hear it.

It was only after he was going thru withdrawal that it actually occured to him that I wasn't making it all up.

Same in our family. My kids used to go to meetings with me. What they heard in the meetings sank into one kid's brain but not the other. My daughter just finished a stint in a treatment center. She seems to have "gotten it", I can only pray that she continues to "get it".

[bagladyrn, RN]

baglady - I educated ALL my children about their risk of developing an addiction from the time they could walk almost. I did not keep alcohol in my house or drink, yet we still ended up with an alcoholic child who didn't believe anything that I said about it at the time, because he didn't WANT to hear it.

It was only after he was going thru withdrawal that it actually occured to him that I wasn't making it all up.

I completely understand - as I said some of us get the gene, some don't. My brother and I - raised in the same family under the same house rules, one is an alcoholic, the other not. All we can do as parents is what you have done and I have done - educate, try to lower the risk. Ultimately our children are going to make their own choices and roll those dice.

[banditrn]

Same in our family. My kids used to go to meetings with me. What they heard in the meetings sank into one kid's brain but not the other. My daughter just finished a stint in a treatment center. She seems to have "gotten it", I can only pray that she continues to "get it".

Oh, Tazzi, I know how awful you must have felt - I blamed myself - I felt like I wasn't finding the right words to explain it to him. After growing up as I did, then watching this son, I felt like the worst kind of failure.

I will pray that your chick does get it now.