Hello, My Name Is... And I'm An Alcoholic.

Caring for patients who are withdrawing from alcohol abuse is not an "if", it's a "when". The statistics are overwhelming, and increasing in frequency with an aging population. Developing rapport and maintaining a "no judgment" zone while delivering care is critical for support and treatment.

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Hello, My Name Is... And I'm An Alcoholic.

Drug Abuse Statistics

  • Alcohol abuse, alcoholism, and alcohol use disorder (AUD) kill over 3 million people each year, accounting for up to 6% of global deaths1
  • 1-in-10 Americans over the age of 12 have an Alcohol Use Disorder1
  •  140,557 Americans die from the effects of alcohol in an average year.1

Background

The incidence and frequency of encounters with patients experiencing alcohol withdrawal symptoms on the Med/Surg floor were not surprising to me as a new nurse. My background includes growing up in a rural community that was once known to have the highest per capita consumption of alcohol in the state. Unfortunately, I have seen firsthand the effects of alcoholism within the family unit and the generations-long consequences.

As nursing students, our class was tasked with attending an AA (Alcoholics Anonymous) meeting in order to augment our studies on alcohol and drug abuse. Polysubstance abuse is more common than not in the adult population and can be hidden behind other signs & symptoms of patients brought to the Emergency Department. Withdrawal symptoms can begin as soon as 8 hours after the last drink. It's crucial to ask when that time was while receiving a handoff report if alcohol abuse is part of the patient's known or suspected history. Thorough and frequent assessments utilizing tools such as CAGE and CIWA2 are invaluable in the nurse's "best practices" orificenal. I share my observations here to hopefully offer insight into the ongoing struggle with addiction of these patients and utilize that understanding to deliver compassionate care as RNs.

Attending the Meeting

The AA Group Meeting that I attended took place from 7 pm – 8 pm at a local church. The age range of the group seemed to be from the late 40s to the late 60s; there was definitely a sense of familiarity and relationship among the participants who attended. As the speakers were sharing their stories, the mention of familiar local establishments added to the sense of fellowship.

When I walked into the group, I initially thought there might not be a lot of sharing. For some reason, I jumped to the conclusion that these looked like "seasoned" AA attendees who were probably just going through the motions of attendance.  I was immediately made to feel welcome by almost every one of the attendees. I was offered coffee, handshakes, smiles, and deliberately attentive eye contact. The active nature of my welcome gave me my first hint that I had been wrong to make assumptions.

A Common Thread

The overwhelming common thread that ran through not only the opening statements of the organization but also through the individual stories was that of humility. There was an enormous acceptance of the fact that "The person is not in charge of the drinking—the drinking is in charge of the person.” They acknowledge that they cannot recover and heal on their own; between God and their "family" in the AA meetings, they take it "One day at a time."

I was especially moved by one speaker who was 11 years sober. It wasn't what he shared but rather how little he was able to share as he was still obviously battling his demons. I truly did not realize before attending this meeting that someone would still absolutely crave alcohol after so many years of abstaining. He just kept repeating that he had today, he could not count on tomorrow, and he couldn't let himself even think about taking that first drink.

Relationships and Collateral Damage

All of the speakers who shared their stories had attended 28-day rehab programs at least twice. The realization that those programs on their own were not cure-alls led them to seek out the safe haven of AA meetings; many said they attended almost daily at some point in their lives.

Relationships seemed to be the turning point---whether attending rehab because of the insistence of a loved one or reaching a point of almost turning to violence when a loved one wouldn't give in to the demands for alcohol.

One woman shared that after completing a rehab program, she was staying at home with her mother and brother. She started battling with her mother to go to the store and get her some booze. When her mother refused, the woman lunged at her mom, ready to physically take her out because she wanted alcohol so badly. Her brother had to step in before it got really out of control; that's when the woman knew she had to get back into a structured program.

Another woman shared how she couldn't believe how hateful alcoholism was and how hateful she was when she was using. She admitted to looking her daughter in the eye and lying over and over again just to get what she wanted. She called herself despicable and manipulative. In fact, the low self-opinion was also a common theme as each person looked back and described their behaviors with family and friends.

In the end, each speaker recognized that reliance on God/higher power and their fellow program participants had carried them through to this day and that they were grateful for THIS sober day.

Acceptance

Although the leader did go around and ask certain members to share, they did so agreeably and without much hesitation. These attendees were not "going through the motions," as I had originally thought. I was struck again and again by the reliance on relationships displayed by the attendees; there was absolute authenticity as they consistently expressed their gratitude for the members of the group. I really came to learn how much of a safety net the group was for each other, not just locally but as part of the consistent structure of the AA program itself. One gentleman took me aside after and shared how he and two other men used to drive all over the state attending meetings and how they would quite often come across the same people in many different locations. It was definitely part of what kept them coming back—familiarity and acceptance. These factors are a crucial and valuable part of the recovery process.

Insights

While we had learned about the acute signs and symptoms of withdrawal, I had no idea that there was a prolonged period of time where it was almost impossible for the person to really be "present" mentally. Each speaker touched on this in their own way as they described being at the meetings but not really hearing anything; or having conversations with family members and friends but only in body, not mind.

One woman shared how it was a miracle to her when she finally retained something she'd heard at a meeting and was able to remember it the next day. Another shared how she was shocked when she woke up one morning and realized that she hadn't thought about drinking at all in the past few days. I truly had no idea that even after rehab programs and months and even years of abstinence that there would still be an all-consuming desire for alcohol. Repetition and redundancy when interacting with the patients who are actively withdrawing may seem frustrating, but it is certainly the cornerstone of accurate and effective ongoing assessments and support.

I was really struck by the woman who shared that growing up in an alcoholic family and then turning to alcohol herself left her unable to cope with life skills and social situations from a sober perspective. She had no idea how to deal with day-to-day life without the buffer of being drunk. She believed she was unemployable and unlovable. This type of psychosocial gap is an area that is crucial for the nurse to step in and provide educational and emotional support, as well as advocate for the patient with social services.

I have always seen substance abuse as a disease, and believe that it has to be treated from a physical, mental, and spiritual perspective. I was glad to have gained more knowledge of the realities and the ongoing nature of recovery.  A concept from the meeting that I already strive to incorporate is that of acknowledging God's grace in my life, which gives me a heart to serve "whosoever" He places in my path—with compassion and without judgment.

References/Resources

1 Drug Abuse Statistics: National Center for Drug Abuse Statistics

2 Caring for hospitalized patients with alcohol withdrawal syndrome: Nursing 2020 Critical Care/LWW Journals/Wolters Kluwer Health, Inc.

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Michelle D-J

About Michelle D-J, BSN, RN

Michelle has 6 years of experience as a BSN, RN staff/traveler and specializes in Med/Surg.

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Specializes in Psych (25 years), Medical (15 years).

A well-written article with a very good perspective, Michelle.

The 12-step program of AA, and other anonymous groups has the potential to be a life changer. Basically, the 12 steps are rules for living that can be called upon for every situation we experience, and they are just a good bottom-line philosophy by which to live.

The meme, "Delivering Care Without Judgement" is very fitting to the medical/psychiatric nursing field. We often believe that if we "punish" the chemical abuser, or others in need of guidance, through an aversion therapy technique, that they will see the error of their ways and right their wrongs.

As nurses, we are to provide care in accordance with the patient's symptoms, and not necessarily be a moral guide. Rendering nonjudgmental care to those who suffer as a direct result of their actions is sometimes a difficult task.

The 12-step program encourages us to "put principles before personalities" and this reminds us to act professionally and not by means of our emotions.

It is also noteworthy to stay that you allowed an unforeseen perspective with chemical abuse treatment to elevate your consciousness, Michelle.

Good for you, and thanks for sharing!

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Specializes in Med/Surg and Travel Nursing.

Thanks so much for your thoughtful response!

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Specializes in Nurse Leader specializing in Labor & Delivery.

First thing we need to do is strike "alcoholic" and "alcoholism" from our vernacular. It's outdated, stigmatizing, and not medically accepted. 
 

The next thing we need to do is strike 12-Step programs from the treatment modalities of medical professionals. They are not based in science whatsoever, and have the worst longterm effectiveness rate of pretty much all alcohol addiction treatments, and are based in shame and making people believe they are powerless (how damaging is that??). No other medical condition exists where, if the treatment doesn't work effectively, the patient is blamed.
 

Finally, we need to make sure all medical professionals are familiar with MAT, particularly Naltrexone. Targeted oral Naltrexone has about a 75% effectiveness at successfully treating and completely eliminating alcohol use disorder and alcohol addiction. 
 

Read up on The Sinclair Method. I could write a book (actually, I am).

 

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

 

 

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klone said:

[...]

... Finally, we need to make sure all medical professionals are familiar with MAT, particularly Naltrexone. ...

[...]

Forgive the ignorant PICU nurse, MAT?

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I could not agree more with @klone. I do not have alcoholism, but I cannot think of a more effective way of enabling someone to feel powerless than to make them call themselves an "alcoholic" on a daily basis. We do not live in a non-judgmental society and continually having to identify oneself as something which is such a pejorative is simply not healthy. We would not encourage a child to identify themselves as a "bed wetter" when introducing themselves..and we consciously do not encourage people to give themselves demeaning names, even in jest. Yet we encourage someone with an alcohol dependency to do so. What happened to the "person first" way of identifying an individual? We don't countenance - "He is a diabetic."  We are encouraged to say "He is a person with diabetes." People are NOT their diseases - and that includes a person with alcoholism. Ban the "I'm an alcoholic." rhetoric. It is demeaning, crippling and fundamentally inaccurate.

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Specializes in Nurse Leader specializing in Labor & Delivery.
chare said:

Forgive the ignorant PICU nurse, MAT?

Medication-assisted therapy. Generally, Naltrexone (or Nalmafene, if you're in Europe) or acamprosate.

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klone said:

Medication-assisted therapy. Generally, Naltrexone (or Nalmafene, if you're in Europe) or acamprosate.

Thank you; this is why I dislike nmemonics.  

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Good article.  I know people who credit AA with saving their lives and I have witnessed their transformation and return to health and to maintaining  satisfying family relationships and being able to be employed at the level they desire - completely turning their life around so that they are enjoying their life again in a healthy and positive way.

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chare said:

Forgive the ignorant PICU nurse, MAT?

Where I work, MAT is Medication Assisted Treatment.  Clients who are seeking help for alcohol use disorder may receive oral Naltrexone, though the vast majority choose to receive Vivitrol ( monthly injection). 

Medication is used in conjunction with required counseling ( individual counseling, group counseling, or both).  Many clients also attend AA / NA programs in the community.   

  

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