The Alcoholic Progression PowerPoint Presentation

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Medical Aspects of Chemical Dependency Hal Vorse, M.D.

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Chemical Dependency: A Disease To be a disease, a condition must qualify 4 ways: A specific cause A specific group of signs and symptoms A predictable clinical course A predictable outcome Characteristics of Chemical Dependency Primary Progressive Chronic Fatal

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Clay Tablet

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Dr. Benjamin Rush1746-1813 1St to define alcoholism 1786- alcoholism as a disease Surgeon General of the Continental Army Member of Continental Congress Signed the Declaration of Independence

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AN INQUIRY INTO THE EFFECTS OF ARDENT SPIRITS UPON THE HUMAN BODY AND MIND WITH AN Account of the Means of Preventing AND OF THE REMEDIES FOR CURING THEM. BY BENJAMIN RUSH, M.D. Professor of Medicine in the University of Pennsylvania. THE EIGHTH EDITION, WITH ADDITIONS. BROOKFIELD: PRINTED BY E. MERRIAM & CO. 1814

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1874 CartoonWoman’s Christian Temperance Union volunteers picketing a saloon full of drunks

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Federal Agent destroying a barrel of beer during prohibition

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Repeal the 18th Amendment

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Dr. Jellinek

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The Alcoholic Progression

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High Risk Drinking Men: More than 2 drinks per day or Five or more drinks on one occasion each month Women: More than one drink per day or More than 4 drinks on one occasion each month A drink is: 12 ounces of beer 5 ounces of wine 11/2 ounces of liquor

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The Alcoholic Progression Occasional Relief drinking Constant relief drinking starts

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The Alcoholic Progression Occasional Relief drinking Constant relief drinking starts Increase in alcohol tolerance

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking (drunk)

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts)

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal)

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal) Urgency of the first drink

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal) Urgency of the first drink Feelings of guilt Unable to discuss problem (DENIAL) Problem?........ What problem?

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking JOB STRESS FAMILY $$$ FEELINGS Celebrations

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests GOLF

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The Alcoholic Progression Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Work problems Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made Avoiding family and friends The Alcoholic Progression

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Financial difficulty

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The Alcoholic Progression Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made Neglect of food

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Early morning drinks

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Drinks with “inferiors” Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Moral deterioration Breaking the Law Sneeking Around Telling Lies Covering Up Busted

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Moral deterioration Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Loss of alcoholic tolerance Physical Complications

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Medical Complications of Alcoholism Gastrointestinal Tract Acute gastritis Malabsorption Diarrhea Liver Alcoholic hepatitis Acute fatty liver Cirrhosis Pancreas Acute pancreatitis Pancreatic pseudocyst Diabetes Gastrointestinal Tract Acute gastritis Malabsorption Diarrhea Heart Cardiomyopathy Arrhythmias Fetal Alcohol Syndrome Nervous System Peripheral Neuropathy Optic Neuritis Wernicke Encephalopathy Musculoskeletal System Acute Proximal Myopathy Osteonecrosis of the Hip Trauma Blood Anemia White Cell Dysfunction Decreased Platelet Function Infectious Disease Tuberculosis Decreased response to bacterial infection Cancer Larynx Esophagus Liver

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Moral deterioration Loss of alcoholic tolerance Physical Complications Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression Brain Damage

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Normal

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Increase in alcohol dependence Urgency of the first drink Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Avoiding family and friends Work problems Financial difficulty Neglect of food Early morning drinks Drinks with “inferiors” Moral deterioration Loss of alcoholic tolerance Physical Complications Brain Damage Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made The Alcoholic Progression DEATH

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Drugs of Addiction The Depressants (“Downers”) Alcohol Opiates (Narcotics) Heroin (smack, “H”, horse) Morphine Codeine Oxycodone (Oxycontin, Percocet, Tylox) Hydrocodone (Lortab, Vicodin) Demerol (Meperidine) Dilaudid (Hydromorphone) Tawin (Pentazocine) Darvocet (Proxyphene) Ultacet, Ultram (tramodol) * Fentanyl

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Drugs of Addiction The Depressants (“Downers”) Sedatives/Hypnotics/Tranquilizers Barbituates (Seconal, Nembutal) Memprobamate (Miltown, Equanil, Soma,carisoprodol*) Benzodiazapines (Xanax, Valium, Klonopin, Ativan, Librium, many others) Methaqualone (Quaalude, ‘ludes) Nitrous oxide Chloral hydrate * These drugs are addictive but not controlled by the DEA

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Depressants Drug effects: Neurological depression Symptoms of intoxication: Loss of inhibitions Decreased fine motor and gross motor coordination Stupor Loss of consciousness (coma) Respiratory depression and death

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Depressants Symptoms of withdrawal: Tremors (shaking) Loss of appetite Insomnia, sleep disturbances Hypersensitive to stimuli Gastrointestinal upset Hallucinations Seizures (convulsions) Death Withdrawal from these drugs is a serious medical condition which requires supervision of a physician to be done safely Overdoses and death commonly occur when two or more of these drugs are used in combination Brain damage is twice as sever when depressants are use with stimulants, i.e. alcohol and methamphetamine.