Identification of alcohol-related problems in older women

The stereotype of an alcohol or drug abuser rarely elicits an image of an older woman. However, if an expanded definition of alcohol abuse is considered, many older women are at risk because of normal changes in the body due to aging and the high number of prescription and over-the-counter medications they use. This article reviews current knowledge about alcohol-related problems in older women.

Are practice nurses an unexplored resource in the identification and management of alcohol misuse? Results from a study of practice nurses in England and Wales in 1995

Changes in the health promotional work undertaken in primary care, including the work needed to meet the 'Health of the Nation' alcohol targets, have led to a rapid expansion of the number of practice nurses in England and Wales. However, there has been little evaluation of this role. This study provides data, for the first time at a national level, about practice nurses' work in identifying and managing patients drinking above recommended sensible guidelines. Data were collected by postal questionnaire from all nurses in a 50% random sample of 1852 practices (drawn from a general practitioner (GP) national study, undertaken at the same time). 43% of nurses responded from 62% of the targeted practices. Respondents reported identifying a mean of 3.1 patients per month who were drinking above recommended sensible guidelines. These patients tended to be male, above 40 years of age and in contact with the nurse for the first time about this problem. Most patients were categorized as having a potential alcohol problem; few were classified as currently dependent. Very little intervention work was undertaken by nurses except for referral to the GP. If real progress is to be made in meeting the 'Health of the Nation' targets on population alcohol consumption, then primary care work in identifying alcohol misusing patients needs to be developed as a matter of urgency. The patients identified by practice nurses are those patients relevant to the 'Health of the Nation' alcohol targets. More emphasis needs to be placed on the valuable contribution practice nurses can make, particularly through the use of screening instruments and brief interventions.

Excessive drinking--brief intervention by a primary health care nurse. A randomized controlled trial

OBJECTIVE

To evaluate the effect of a nurse-conducted intervention on excessive drinkers.

DESIGN

Randomized, controlled trial.

SETTING

Vårby Health Centre, Stockholm.

INTERVENTION

The intervention group visited a nurse three times during a 12-month period. The controls met once with a general practitioner (GP).

PATIENTS

Patients were recruited at a health screening on the basis of a raised gamma-glutamyl transferase (GGT). Of 2338 subjects, aged 25-54 years, 222 had a screening GGT of > or = 0.9 mukat/l. 100 were randomized to the treatment and 122 to the control group.

MAIN OUTCOME MEASURES

GGT, self-reported alcohol consumption (g/week), sickness allowance and use of health care.

RESULTS

After 2 years a reduction of GGT from 1.52 to 1.21 mukat/l (p = 0.02) had occurred in the treatment group. The controls increased their mean level of GGT from 1.75 to 2.16 mukat/l. Mean weekly alcohol consumption in the intervention group was reduced from 337 to 228 g/week (p = 0.02). The controls did not quantify their alcohol consumption initially, but reported a reduced weekly consumption at follow-up.

CONCLUSION

The intervention had an impact on GGT and self-reported consumption. The controls also reported decreased consumption possibly because their appointment with the GP functioned as a very brief intervention.

Alcohol-related problems: a critical review of the literature and directions in nurse education

It is generally accepted the around 2-5% of the adult population show major signs of alcohol dependence, that alcohol-related harm is experienced by up to 20% of the population, and that approximately 60% drink at risk-free levels. Further prevalence studies show that there are high numbers of problem drinkers who attend general hospital services for reasons other than their alcohol consumption. Nurses are in constant contact with patients who may have an early problem with alcohol but who are admitted for other reasons, and they are in a prime position to comprehensively assess patients (including alcohol screening), develop rapport and provide 'counselling'. Also, university nursing education is propelling nurses toward adoption of independent discipline focused models of care which are increasingly becoming independent of the medical model. Recent trends in the management of problem drinkers suggest that controlled drinking approaches may well offer treatment options to nurses that the traditional abstinence approaches did not. This paper presents a brief overview of the notion of controlled drinking, then critically reviews the nursing research studies and the descriptive literature providing direction for nursing education. Some recent clinical initiatives are discussed which highlight the flaws existing in nursing education, including lack of sufficient curriculum hours and the need for better designed education models and strategies.

Recovery from alcoholism: a spiritual journey

The purpose of this study was to discover the internal aspects of change in persons who are doing well living without alcohol. The heuristic research method, a qualitative phenomenological design, was used to investigate the experience of recovery. Eight recovering alcoholics were interviewed in depth. The process of recovery reflected a mythological journey comprising a departure from the shadowland of drinking, initiation into the world of sobriety, and knowledge gained along the way. New adaptive strategies were acquired, including strengthening the will, training the mind, and exercising spiritual qualities in one's daily life. The profile of doing well in recovery also reflected self-acceptance and an ongoing search for connecting with the transpersonal realm.

Late-life drinking among women

Although alcoholism exists among older people, the number of cases is unknown, and many alcoholics, particularly women, are unidentified. Late-onset alcoholism is a risk condition for older women. Nurses are in a strategic position to recognize this underidentified condition and to assist affected women in understanding what caused them to rely on alcohol.

Self-resolution of drinking problems as a process of reinvesting in self

PROBLEM

Resolution of alcohol problems without formal treatment or participation in self-help groups.

METHODS

Qualitative study using grounded theory (N = 11).

FINDINGS

The onset of alcohol problems begins with negligible penalties. Over time, the cost-benefit ratio of drinking habits continues to rise and the risks become too great. Individuals find it necessary to change their drinking patterns by reinvesting in themselves. Assets such as the ongoing availability of information, life-management skills, and self-confidence promote the change process; cultural mores and behaviors of some healthcare providers serve as liabilities. The dividends of self-resolving alcohol problems include self-pride, mental and physical health, conscientious work performance, rewarding relationships, enhancement of creative talents, and spiritual well-being.

CONCLUSIONS

Nurses can play an important role in promoting self-resolution of alcohol problems by providing accurate information and encouraging clients to reinvest in long-standing priorities and values.

Genetics and alcoholism: implications for advanced practice psychiatric/mental health nursing

This article uses the research findings on genetics and alcoholism as a basis for nursing practice. Alcoholism is a complex genetic disorder in which multiple genes and the environment interact and contribute to the disease process. Family, twin, and adoption studies have consistently shown the genetic influence on alcoholism. Animal and human studies are identifying biological and genetic markers for alcoholism. The results of these studies should direct nurses in assessing patients at risk, educating patients about the disease and the rationale for selected treatments, referring at-risk individuals to support groups, and using supportive therapy.

Brief intervention after alcohol-related injuries

Brief intervention is a clinically-based, cost effective, time efficient intervention designed to counsel nondependent drinkers about strategies to reduce their alcohol consumption. The ultimate goal of brief intervention is to prevent future alcohol-related injury and health problems. This focused and time limited intervention is designed for use by health care providers in their ongoing daily practice. Patients who recently experienced an alcohol-related injury are particularly receptive to brief intervention.

Resolution of drinking problems without formal treatment

TOPIC

Self-resolution of alcohol abuse among individuals with mild to moderate drinking problems.

PURPOSE

To examine self-resolution of drinking problems and clinical/research implications.

SOURCE

Review of the literature.

CONCLUSION

Two pathways toward self-resolution of alcohol problems have been proposed. One appears to be relatively spontaneous, the other involves ongoing cognitive appraisals and a conscious effort to change. Nurses have the potential to play an important role in encouraging self-change by conducting screenings, implementing brief interventions, and promoting the use of self-help materials. Opportunities also exist for nurses to spearhead research efforts in this long-neglected area.

Impact of a Body-Mind Treatment Component on Alcoholic Inpatients

1. A group of alcoholic patients who were treated with a physical fitness program as an adjunct to the usual program showed significantly less craving for alcohol than members in the standard treatment group. 2. The group treated with physical fitness as well as therapy saw themselves as having more internal locus of control and being less controlled by powerful others. 3. Nurses are the hospital professionals most likely to be involved with important roles in exercise programs with alcoholic patients.

Caring for alcoholic patients with dissociative identity disorder

Nursing care of the alcoholic patient becomes multifaceted and complex with the presence of a psychiatric-mental health disorder. Although issues surrounding dual-diagnosis patients have been addressed in the literature, there is a paucity of research and theory regarding care of the patient who has both alcoholism and dissociative identity disorder. This article presents a synthesis of the nursing literature with the author's experience to elucidate factors that enhance healing. Nursing interventions that are unique and sensitive for the alcoholic patient with dissociative identity disorder are discussed.

Naltrexone: A Controversial Therapy for Alcohol Dependence

1. Naltrexone HCL (ReVia) may be an effective adjunct in the treatment of alcohol dependence in motivated individuals. 2. Naltrexone therapy is controversial because its use conflicts with the view of abstinence held by Alcoholics Anonymous and most medical treatment programs. 3. Knowledge of the controversy can help nurses advocate for their patients, and may help nurses acknowledge the need to define their care according to a nursing paradigm.