Alcohol Use Disorder: Medications and Treatment (Nursing)

00:01 So, there are a number of different ways that we can treat alcohol use disorder and we want to make sure that as we're looking at these treatments, these are not treatments for somebody who is going through withdrawal.

00:15 These are people who are coming in and saying, "I recognize the fact that alcohol is now interfering in every aspect of my life." I have quite a number of people who come to me.

00:29 Usually, it's their family members who come to me first to say, "My mom, my dad, my child, my sister is going into trouble and I don't know how to help them." And I cannot treat somebody who is not coming to me themselves.

00:46 If the person themself has not recognized that this disorder is now impacting their lives, we're not going to go ahead and start asking them to do things because they won't.

01:00 But when that person comes in, when that person says, "I need some help." What we have found is that there are a number of medications that help in this person recovering from alcohol use disorder.

01:16 And recovery is possible. It's possible with medications.

01:20 It is possible without medications.

01:23 So, first, let's think about the psychosocial treatment.

01:27 You need to have their family on board.

01:29 You need to have a supportive community for a person who has alcohol use disorder who is living in an area where everyone is getting drunk every single day, it is going to be very, very hard for them. Because that is their norm.

01:45 That is their community and when they separate and decide not to drink, their community is going to revolt against them.

01:54 They're going to lose their community.

01:56 I know that may sound really strange but one person in a community of persons with alcohol use disorder who starts to recover actually represents to the rest that with a little hard work, they can also recover.

02:14 And so, either they want to recover or they don't and if they don't, they want to reject the person who is actually recovering.

02:23 So, we have to make sure that that person has a social support system around them to help them move forward.

02:31 One other thing that I have found quite frequently is that family members who have lived with a person with alcohol use disorder, overtime, they become the caretaker.

02:42 Their role in their entire life is to make sure mom or dad or sister or brother is able to get up and get to work.

02:52 Their role is to go to the bar at night and pick-up that person and bring them home and sit with them to make sure that they don't die in the night from vomiting and aspirating.

03:03 So, when we're thinking about this, we have to understand that we are altering the roles in an entire family.

03:11 And oftentimes, I will sit down with the family, with the person who wants to recover from alcohol use disorder and I will ask them, in your family, what is your role.

03:22 And, you know, more than often than not, you're going to have the mother who says, "Oh, my role is to wait up until 1:00 in the morning and worry about her." And you say, "Well, what new role would you like to have?" Help the family move into the new role.

03:38 Because this person needs a family who's not going to be dragging them back to remember the days you used to get drunk.

03:46 It's also really important that they are in therapy.

03:52 Now, that therapy doesn't have to be one therapist or one-on-one.

03:57 It can be. It doesn't have to be.

04:00 There's alcoholics anonymous that provides therapy and it's peer to peer therapy.

04:06 So, there's no nurse practitioner or psychologist in that group.

04:12 These are all people who have done the struggle, worked through the struggle, understand the struggle and provide support to each other.

04:22 It's hard to do it without medication.

04:25 So, the first medication I'm going to introduce to you is Naltrexone.

04:31 Naltrexone is a medication that can be taken either by mouth or by syringe.

04:40 They can have an IM injection of it and that's called Vivitrol.

04:44 Naltrexone as a pill, normally, they will take 50 milligrams a day.

04:50 I usually tell people to take it in the afternoon.

04:53 Because the craving usually occurs in the evening.

04:57 So, they take, if they have chronic alcohol use disorder and they've been drinking a lot, I usually have them take 50 in the morning and then 50 in the evening.

05:09 But for the most part for most of the clients I've worked with, 50 in the afternoon has been sufficient.

05:15 Naltrexone just takes away that craving.

05:19 And so, they have to have alternative things to do.

05:23 They have to figure out how to get home from work without passing by a bar or passing by the place that they normally buy their vodka or their gin.

05:33 Acamprosate is another medication that people take.

05:39 Again, it is used to reduce your desire to drink and it's a little bit more expensive than Naltrexone, so, I usually stay with Naltrexone.

05:55 And then, you have Disulfram. A Disulfram is really an anti-drinking drug.

06:04 It will make the person extremely ill if they drink anything at all.

06:13 So, that means any alcohol whatsoever will make them sick and if you're not thinking about it and you use mouthwash, mouthwash has - many mouthwashes have alcohol in it.

06:30 The person will start gagging and vomiting, any alcohol at all.

06:35 I had a patient who had her hair dyed.

06:39 She hadn't had a drink in four years and she started having cravings.

06:46 And she always carried Disulfram with her just to remind herself not to drink and she called me.

06:56 She called me from the beauty parlor to tell me she had such terrible cravings that she knew that she was going to go out and get alcohol and she didn't know why and should she take her Disulfram? And I said, "Absolutely not." It turns out that the dye that was used in her hair had alcohol in it and when it was on her scalp, it went through and actually affected her.

07:20 When do people use this? When a person finds that reducing the cravings is not enough.

07:25 That even without the cravings, they still want to go back.

07:30 Their physiological being wants to go back.

07:34 Their intellectual being does not and they say, "I need just something extra.

07:41 Something to keep me.

07:43 Something that I know is going to have an immediate and terrible, terrible consequence." And that is when they will take that.

07:54 It's so important to let the patient know that if they are taking that, they are going to be very, very, very sick.

08:03 I had another client who prior to coming to me, had gone to her general practitioner and had said, "I don't ever want to drink again.

08:13 I need something that's going to stop me." And he said, "This pill will stop you." And he put her on that.

08:21 And about eight hours later as she started to feel withdrawal, she found where she had hidden her little bottle of vodka and just took a couple of sips to help herself out a little bit and almost ended up in the emergency room because nobody knew what was going on and why she became so violently ill.

08:43 So, as practitioners, as nurses, if you know that your patients are going to be going on any of these medications, make sure that you know what they do and you are able to help that patient.

08:56 So, what other therapies are available? Well, I did mention alcoholics anonymous.

09:03 What is alcoholics anonymous? It is self-help, peer-led and it's a 12-step program.

09:12 Then, there is the medication assisted treatment, MAT, and that is the use of Disulfiram also known as Antabuse and the other medications, Naltrexone and Acamprosate.

09:29 There's also as I mentioned earlier, in-patient detox and there's also out-patient detox.

09:39 What I really want you to walk away from this with is alcohol use disorder is a brain-based disorder and it needs to have medical attention because as it becomes worse and more chronic, it is very hard to help those organs that have been physiologically altered due to this poison that has constantly been introduced into the body.

10:08 And so, these people are struggling and they really need our help and they need our help without us having any kind of judgment on them for their disorder.