2ข้อควรรู้สำหรับบุคคลากร LOGOข้อควรรู้สำหรับบุคคลากรปัญหาการดื่มสุรา (Alcohol Related Disorder) เกิดได้ 3 รูปแบบ คือพฤติกรรมการดื่มที่ผิดปกติ (Alcohol Use Disorder)ความผิดปกติทางพฤติกรรมและจิตใจที่เกิดจากสุรา (Alcohol Induced Disorder)โรคทางกายที่สัมพันธ์กับสุรา (Alcohol Related Physical Illness)
3หัวข้อการบรรยายวันนี้ LOGOหัวข้อการบรรยายวันนี้อยู่ในส่วน ของ โรคทางกายที่สัมพันธ์กับสุรา (Alcohol Related Physical Illness) และการดูแลภาวะถอนพิษสุราสมองและกลไกการออกฤทธิ์ของแอลกอฮอล์ภาวะแทรกซ้อนทางกายที่พบบ่อยในผู้ที่ดื่มสุราภาวะถอนพิษสุรา การวินิจฉัย การดูแลและแนวทางการรักษา (ALCOHOL WITHDRAWAL: PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT)
4สมองและกลไกการออกฤทธิ์ของแอลกอฮอล์ THE EFFECTS OF ALCOHOL ON THE BRAIN LOGOสมองและกลไกการออกฤทธิ์ของแอลกอฮอล์ THE EFFECTS OF ALCOHOL ON THE BRAINSignificant shrinking of the brain50% - 75% show cognitive impairmentEffects remain even after detoxification & abstinenceAlcohol dementia is 2nd-leading cause of adult dementia
5Alcohol and the GABA Receptor LOGOAlcohol and the GABA ReceptorWhen alcohol enters the brain, it binds to GABA receptors and amplifies the hyperpolarization effect of GABA.The neuron activity is further diminishedThis accounts for someof the sedative affectsof alcohol
6Drugs That Influence Neurotransmitters LOGODrugs That Influence NeurotransmittersChange in NeurotransmissionEffect on Neurotransmitter release or availabilityDrug that acts this wayincrease the number of impulsesincreased neurotransmitter releasenicotine, alcohol, opiatesrelease neurotransmitter from vesicles with or without impulsesincreased neurotransmitter releaseamphetaminesmethamphetaminesrelease more neurotransmitter in response to an impulsenicotineblock reuptakemore neurotransmitter present in synaptic cleftcocaineamphetamineproduce less neurotransmitterless neurotransmitter in synaptic cleftprobably does not work this wayprevent vesicles from releasing neurotransmitterless neurotransmitter releasedNo drug exampleblock receptor with another moleculeno change in the amount of neurotransmitter released, or neurotransmitter cannot bind to its receptor on postsynaptic neuronLSDcaffeine
7ภาวะแทรกซ้อนทางกายที่พบบ่อยในผู้ที่ดื่มสุรา Alcohol: Effects on the Body and Behavior
8Statistics on teen drinking Short- and long-term effects of alcohol LOGOOverview:DefinitionsStatistics on teen drinkingShort- and long-term effects ofalcoholBlood alcohol levelsIntroduction to fetal alcohol syndrome (FAS)
9Slower reaction times/reflexes Heavy sweating Blurry vision LOGOShort-term Effects(5,6)Slower reaction times/reflexesHeavy sweatingBlurry visionNausea and vomitingLowered reasoning abilityStatistics show that there is alcohol consumption among teens; therefore, they should be familiar with what alcohol can do to the body and behavior.As you move through each of these effects, take time to solicit examples from the students. An example of slower reaction time/reflexes might involve a person that has been drinking trying to catch a ball. Hand-eye coordination might not be as quick for someone who has been drinking. So someone who has been drinking might not catch the ball when it is thrown to them as easily as they would otherwise. Since alcohol irritates the lining of the stomach and intestinal lining, nausea and vomiting are common occurrences. There is a danger of choking on vomit, which could cause death by asphyxiation if the person is unconscious. Lowered reasoning ability might involve someone taking risks that they normally would not take. For example, they may leave a party with a stranger.Graphic Reference:Cool Archive-Free Clipart, Fonts, Icons [online] [cited 4 July 2005] Available online at URL:
10Short-term Effects (cont.)(5,6) LOGOShort-term Effects (cont.)(5,6)Poor motor coordinationSlower heart rate/breathing rateIncreased blood pressureAnxiety/restlessnessLower inhibitionThe characteristics of poor motor skills can be seen in a task as simple as walking. Alcohol will decrease the ability of a person to walk in a straight line and might even cause him/her to fall. Poor motor skills might also lead to driving accidents.Alcohol acts as a depressant and slows the heart rate. It also interferes with normal contraction and rhythm of the heartbeat. These effects are thought to be major reasons for sudden death among alcoholics.(6) Increased blood pressure, or hypertension, is associated with chronic drinking and usually goes away two to three weeks after drinking has stopped. Mood swings might be noticed, with anxiety and restlessness being at the top of the list.Lower inhibitions might lead a teen to do things he or she would not normally do, which could put them in a compromising or dangerous situation. Risky behavior, such as unprotected sex, might result. They might also have poor judgment.
11Short-term Effects (cont.)(5,6) LOGOShort-term Effects (cont.)(5,6)Mental confusionMemory lossComaDeath from respiratory arrestWhen alcohol is consumed at a faster rate than the liver can absorb, it moves into areas of high water content in the body, for example, the brain. It can cause mental confusion and memory loss. Drinking causes some people to “not remember” their evening. In larger doses, alcohol can affect the medulla oblongata, which is responsible for basic survival functions, such as heart rate and breathing. Respiratory arrest occurs when a person stops breathing.
12Long-term Effects(5,6) Nervous system Muscles Lungs Liver LOGO Long-term Effects(5,6)Nervous systemMusclesLungsLiverChronic use of alcohol can lead to long term effects on the body. As synapses and transmitters are affected in the nervous system, loss of sensation in hands and feet occur.The muscles of the body become weak, and lungs have a greater chance for infection as the immune system becomes less responsive.The liver receives blood directly from the intestines, which is the major site for absorption of alcohol. The liver breaks down the alcohol; however, the products that are produced during this process are toxic to the liver. This can cause liver damage in the form of inflammation or cirrhosis (scarring of the liver).(5,6)Graphic Reference:Cool Archive-Free Clipart, Fonts, Icons [online] [cited 4 July 2005] Available online at URL:
13Long-term Effects (cont.)(5,6) LOGOLong-term Effects (cont.)(5,6)Sexual organsBrainHeartEsophagus/stomachAlthough sexual desire is enhanced, impotence could be a long term result with the use of alcohol.Alcohol affects all parts of the brain and can result in brain cell damage. Loss of memory occurs with impairment of the hippocampus, which is the part of the brain responsible for storing new memories. Damage to the cerebral cortex will lead to lack of coordination while damage to the cerebellum will affect mood. Finally, damage to the brain stem may result in lack of normal body functions and regulations, such as breathing, heart rate and body temperature.Long term affects of heavy drinking may interfere with the mitochondria of the heart cells. These are the energy producing organelles and without proper energy, the heart does not function as normal. Hypertension is also a problem for the chronic drinker and could possibly lead to a stroke.The esophagus normally contracts and relaxes allowing food to move to the stomach. Alcohol inhibits this contraction which allows stomach acids to move into the esophagus causing irritation. It might also be a factor in gastritis. Scientist are currently undergoing studies to determine if alcohol or bacteria are the major cause of ulcers in alcoholics.(5,6)
14LOGOA picture is worth a thousand words. In this diagram, students can see just how much the body is affected by the use of alcohol.Graphic used with permission from:Beaware. Alcohol [online]. [Cited 20 June 2005]. Available at URL:
15Blood Alcohol Level: What’s It All About?(6) LOGOBlood Alcohol Level: What’s It All About?(6)Blood alcohol level (BAL) depends on:WeightAmount of food and water instomachCarbonated alcoholic beveragesGenderNow that we know the effects of alcohol on our brain and body, how is alcohol measured in the body?Blood alcohol level or concentration is associated with the rate at which alcohol is metabolized by the liver. The higher the alcohol level in the blood, the more intoxicated a person will be. As the liver removes the alcohol from the blood and processes it, the blood alcohol level will drop. Here are some factors that effect BAL:Weight: The larger a person, the lower the blood alcohol level will be for a given amount of alcohol consumed.Amount of food and water in the stomach: Food will slow the absorption of the alcohol into the blood stream, resulting in a lower blood alcohol level.Carbonated alcoholic beverages: Carbonation speeds up the absorption of alcohol into the blood stream.Gender: Females tend to be smaller than males and also have a higher fat concentration in body tissues. More fat means less water. Alcohol is soluble in water, so in males the alcohol is more evenly distributed throughout the body creating a lower blood alcohol level. A woman will have a higher blood alcohol level after consuming the same amount of alcohol.Graphic Reference:Cool Archive-Free Clipart, Fonts, Icons [online] [cited 4 July 2005] Available online at URL:
16Blood Alcohol Levels: So What?(8) LOGOBlood Alcohol Levels: So What?(8)BAL = 0.03 to 0.12 (Euphoria)Self-confident/daringShort attention spanPoor judgmentFine motor skills impairedAt blood alcohol levels of 0.03 to 0.12, the drinker is in a state of euphoria. This is the beginning stage where self confidence increases, and the drinker feels good about him/herself. The drinker could also exhibit a short attention span, poor judgment, and have trouble with his/her fine motor skills. (8) All of these effects were discussed in the short term effects earlier in the slide show.
17Blood Alcohol Levels(8) LOGOBlood Alcohol Levels(8)BAL = 0.09 to 0.25 (Excitement)SleepyMemory lossReaction time decreasedUncoordinated/loss of balanceBlurry vision and impaired sensesAt the upper edge of euphoria, around 0.09, the drinker heads into a stage known as excitement. The stage name does not support the characteristics since the drinker becomes sleepy and slow. Reaction time is decreased, which could make driving or operating machinery a hazard. The drinker looses coordination and may become unbalanced. He/she may also experience blurry vision and impaired senses, becoming numb around the face area.(8)
18Blood Alcohol Levels(8) LOGOBlood Alcohol Levels(8)BAL = 0.18 to 0.30 (Confusion)Confused/dizzyHighly emotionalCannot see/slurred speechUncoordinated/sleepyMay not feel pain as easilyAt the upper edge of excitement, at around 0.18, the drinker may become confused and highly emotional. Slurred speech is a common characteristic at this level. They continue to be sleepy and uncoordinated and might not feel pain as easily.
19Blood Alcohol Levels(8) LOGOBlood Alcohol Levels(8)BAL = 0.25 to 0.40 (Stupor)Can barely move at allCannot respond to stimuliCannot stand or walkVomitingLapse in and out of consciousnessMoving up the blood alcohol ladder leads to stupor. At this point, the drinker basically cannot perform normally and could become ill and even pass out.(8)
20Blood Alcohol Levels(8) LOGOBlood Alcohol Levels(8)BAL = 0.35 to 0.50 (Coma)UnconsciousReflexes depressedDecreased body temperatureDecreased breathing rateDecreased heart rateCould dieThe last level is known as alcohol poisoning and could lead to death. The alcohol affects the brain stem, as well as other basic body functions. Breathing, heart rate, and body temperature might not be regulated, which could lead to a coma.(8)
21Blood Alcohol Levels(8) LOGOBlood Alcohol Levels(8)BAL = Greater than 0.50 (Death)Breathing stopsThat says it all!At blood alcohol levels greater than 0.50, death occurs.(8)Since most students associate blood alcohol levels with drinking and driving, this is a good time to introduce some blood alcohol limits regulated by law.
22Most states set the legal level of intoxication at 0.08 to 0.10 LOGODriving Limits(6)Most states set the legal level ofintoxication at 0.08 to 0.10One area regulated by law is the blood alcohol driving limit.Currently, half of the states in the US have 0.08 BAL and the other half have 0.10 BAL. This level of intoxication relates to the blood alcohol level of the driver.(6)If the driver’s blood alcohol level tests at 0.08 in some states, then the driver is considered legally intoxicated and can be cited with a DUI (Driving Under the Influence). In other states, blood alcohol levels of 0.10 define whether the driver is legally intoxicated or not.Graphic Reference:Microsoft Office Clipart [cited 23 June, 2005].
23Drinking is a Personal Choice but Who Else is Affected? LOGODrinking is a Personal Choice but Who Else is Affected?Friends and familyStrangersUnborn babies –Fetal alcohol syndromeDrinking may be a personal choice, but it affects more than just you.For example strangers may be affected through accidents.Statistics from the US Department of Transportation include:Alcohol was involved in 39% of fatal crashes in 1997.About 3 in every 10 Americans will be involved in an alcohol-related crash in their lifetime.In 1997, the highest rates for fatal crashes while intoxicated involved persons years of age.One third of all pedestrians 16 years or older killed in traffic crashes in 1997 were intoxicated.(6)Drinking lowers inhibitions and increases risky behavior. Teens might engage in unprotected sex while under the influence, which could lead to unplanned pregnancy. If a woman drinks while pregnant, it could lead to fetal alcohol syndrome.Graphic Reference:Microsoft Office Clipart [cited 23 June, 2005].
24การป้องกันและรักษาภาวะถอนพิษสุรา Note: The lecture notes are present in this file, they may not be visible. Go to “view” and “notes pages”[Slide 1] IntroductionThis module begins by describing the process of moving an individual from assessment and diagnosis into treatment intervention. The first section discusses non-adherence and ways to enhance client adherence. Interventions are discussed as they relate to the technique of motivational interviewing. As mentioned in Module 5, the process of motivational interviewing actually begins in the Assessment and Diagnosis phase.The second section of this module addresses the empirical support for various types of alcohol treatment interventions. These include:Brief Interventions (for at-risk drinkers)Motivational Enhancement Therapy, Cognitive Behavioral TherapyRelationship Enhancement TherapyPharmacotherapy.It is important for social workers to understand the premises that underlie these interventions, and to become familiar with the empirical support for applying these approaches with different types of client populations. .
57ALCOHOL DETOXIFICATION Supplements:เป็นการให้เพื่อทดแทนสารอาหารหรือเกลือแร่ที่บกพร่องไป เช่น thiamine, magnesium, phosphate, folate, zinc, vitamins A, D, E, C และ Bพิจารณาให้ thiamine (vitamin B1) ในขนาดที่เพียงพอในการป้องกันการเกิดภาวะ Wernicke-Kosarkoff SyndromeNutrition and Hydration
58ALCOHOL DETOXIFICATION Supplements:ตัวอย่างวิธีการให้ ThiamineThiamine: B1 100mg IM daily x 3 daysB1 100 mg oral 3 times a dayRemark:ให้ thiamine ก่อนให้ dextrose หรืออาหารMTV oral 3 times a dayPotassium, Magnesium, Phosphate, Folate