Alcohol Withdrawal Adds Challenges to Caring for Critically Ill Patients

Article in Critical Care Nurse provides guidance on identifying, managing and assessing critically ill patients experiencing alcohol withdrawal

Newswise, February 1, 2016 — Alcohol withdrawal adds challenges to caring for critically ill patients, and nurses must be diligent at each stage of care to minimize complications, according to an article in the February issue of Critical Care Nurse (CCN).

The article, “Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management,” provides much-needed guidance to critical care nurses and other clinicians whose patients may have alcohol use disorder (AUD), including abuse and dependency conditions of varying severity.

Lead author Lynsey Sutton, RN, MNclin, is associate charge nurse manager of a level 3 intensive care unit, Capital and Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand. She is a guest teaching assistant in the postgraduate nursing program at Victoria University of Wellington, Wellington, New Zealand.

“The abrupt cessation of alcohol places patients with an AUD at risk for additional complications, and nurses are perfectly placed at the bedside to obtain histories of alcohol consumption from patients or the patients’ families. This may help identify those at risk for withdrawal early,” she said.

For the study, the researchers reviewed more than 100 articles related to alcohol use and critically ill patients that had been published in peer-reviewed journals.

Their work can help frontline nurses who are caring for critically ill patients at risk for alcohol withdrawal syndrome (AWS).

Managing alcohol withdrawal effectively begins with the identification of patients with an AUD as indicated by the patients’ medical histories. 

Unfortunately, a patient’s history of alcohol consumption is often poorly obtained, not detailed enough or not obtained at all.

The researchers recommend that a validated tool be developed to enable nurses to obtain a more comprehensive history of alcohol use, including past withdrawal or detoxification episodes.

If patients at risk are identified at the time of admission, nurses will be better able to detect signs and symptoms of alcohol withdrawal and initiate treatment early. This practice might halt the progression from mild to severe withdrawal and prevent delirium tremens.

The researchers also suggest development of a laboratory test or biomarker to highlight chronic alcohol use, especially when an alcohol history is unobtainable. Current blood tests focus on recent alcohol consumption, which may not help identify those at risk for withdrawal.

“The clinical manifestations of critical illness and alcohol withdrawal are often similar, and a worsening clinical condition in a patient with AWS should not always be assumed to be withdrawal related,” Sutton said.

The article also discusses various therapies, tools and assessment scales nurses can use to evaluate and monitor response to treatment.

The researchers call for further studies related to nearly every aspect of alcohol withdrawal in critically ill patients to help validate tools and develop evidence-based practice guidelines.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org/.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 106,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than 500,000 acute and critical care nurses and includes more than 225 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. www.aacn.org; www.facebook.com/aacnface; www.twitter.com/aacnme

Kicking an Addiction? Replace It with Joy, UCLA Expert Advises in New Book

Bringing pleasure into recovery is the key to turning over a new leaf

Newswise, November 16, 2015 — People in the midst of alcohol or drug addiction tend to imagine life without those substances as one of deprivation, which can make kicking the habit seem like a joyless and dreary prospect.

But recovery from addiction has at least as much to do with rewarding oneself as it does with depriving oneself, according to a new book by a UCLA expert in addiction treatment.

“People with the most success in staying sober tend to get involved in a range of pleasurable activities and do them frequently,” said Suzette Glasner-Edwards, author of “The Addiction Recovery Skills Workbook,” which is to be published Dec. 1 by New Harbinger Publications.

“These activities can replace the time and energy that they had been spending on addictive behaviors, enabling them to experience pleasure without the devastating consequences of alcohol or drug use.”

Glasner-Edwards is an adjunct associate professor at UCLA’s Semel Institute for Neuroscience and Human Behavior and a licensed clinical psychologist. Her research focuses on advancing treatments for addictions and mental health problems at the UCLA Integrated Substance Abuse Programs.

Subtitled “Changing Addictive Behaviors using CBT, Mindfulness and Motivational Interviewing Techniques,” the workbook details the science of a wide range of treatment options for addicts and their loved ones, and it is filled with worksheets, lists and questionnaires that allow readers to try them out.

Among the newest approaches it describes is behavioral activation therapy, which advocates rediscovering life’s healthy rewards. Glasner-Edwards said the strategy is effective because it combats the allure of drugs and alcohol at their source.

Both drugs and alcohol release dopamine, a chemical that the brain associates with the pleasure of receiving rewards, but both cause the brain to release dopamine at a far greater rate than life’s normal pleasures. As a result, the book explains, activities that once brought pleasure pale by comparison.

“While the feeling of disappointment at routine pleasure does get better over time, it is one of the things that prevents people from really getting a head start in recovery,” Glasner-Edwards writes.

“They keep relapsing in that early phase when nothing feels enjoyable. Their brain is still really healing from all that depletion and depression that the depletion can lead to.”

To combat these disappointments and blues, Glasner-Edwards encourages people in sobriety to resume activities that they once enjoyed or discover new ones: Cook something new. Plan a party. Exercise. Go to a museum. Take up a sport. And, to increase the likelihood that readers will carry out the activities, the book advocates scheduling them for specific times.

“Ideally you should have one pleasant activity worked into each day,” Glasner-Edwards writes. What if embarking on the activity feels more like a chore than a diversion?

“The workbook urges readers to rate how good — or miserable — they expect the experience will be on a 10-point scale, and then, after the activity, to rate how fun (or not) it actually proved to be.

“More often than not, an activity is more fun than you thought it was going to be,” she said, adding that seeing the pattern play out repeatedly can break down people’s resistance to enjoying future fun pursuits.

Readers are also urged to reward themselves again after the activity: Get a massage or eat a piece of chocolate cake, for example. The intent is to make them more inclined to pursue the activity again.

“Just like the rewarding feelings that follow the use of drugs or alcohol in the early stages lead to forming a damaging habit, rewarding healthy behaviors can establish positive habits,” Glasner-Edwards said.

In choosing which activities to pursue, the book notes, one important consideration is whether the activity is likely to trigger a relapse. Glasner-Edwards counsels against activities that a recovering addict would associate with their substance abuse.

Someone trying to stop using marijuana, for instance, might avoid attending concerts by musicians they used to listen to while high.

Another consideration is people the recovering addict spends time with during their new activities. One person who Glasner-Edwards treated for alcoholism began grilling dinners for his friends.

Although he relished his guests’ compliments about his cooking, there was one problem: They often arrived with bottles of wine or six-packs of beer.

“I finally had to say, ‘OK, you have this love of grilling, but you have to be careful who you grill with,’” she said. “Because if they bring booze, all of a sudden you’re feeling like, ‘Why not just one?’”

Although behavioral activation therapy has not yet been extensively studied as a treatment for substance abuse, the new approach builds on some of the oldest and most often validated findings in addiction therapy, Glasner Edwards said.

Since the 1970s, repeated studies have shown that individuals with all kinds of addictions are more likely to stay sober if researchers routinely test them for substance abuse and then reward clean results, especially when the value of the rewards climb with each negative test.

“It could even be a gift card — a whole range of prizes will do,” Glasner-Edwards said. “It doesn’t even matter what the income level of the addict is, so long as the value of the rewards escalates with consecutive good outcomes. There’s something about the process of being rewarded that’s very motivating.”