The use of alcohol in accompaniment with other drugs sets the tone for various challenges in society from increase in crime to high mortality rates. Wisconsin as a state suffers a high rate of alcohol consumption with the consequences associated with it use being higher than average, (University of Wisconsin, 2016). According to the World Health Organization (2011), the public health objective on alcohol is to reduce the health burden caused by harmful consumption of alcohol. Alcohol abuse is a leading contributing factor to death, injury, and mental illness. This is evident through debilitating diseases such as Korsakoff’s syndrome and alcoholism. On average, alcohol abuse results in about two million deaths each year, causing great harm to communities and societies. The prevalence of alcohol consumption varies in different parts of the world, with the burden of disease presenting various consequences for countries. This paper examines the epidemiology of alcohol abuse disorder in Outagamie and Winnebago counties in Wisconsin, where it is a pressing public health concern.
Alcohol presents devastating effects to those who abuse the substance. As outlined by the WHO (2011), it is a risk factor for disease and disability accounting for about sixty diseases and injuries. The complexity of alcohol abuse is that it presents various social and economic issues ranging from abuse, absenteeism from work, and increase in crime rate. Of concern to researchers is heavy episodic drinking that characterizes alcohol abuse. About 12 percent of drinkers engage in this kind of drinking with it being responsible for large incidents of injury. Through such statistics, it is clear to see that harmful alcohol consumption is risky, not just for the abuser but also surrounding individuals. With economic impacts involving overbearing hospital costs for family members and rehabilitation, such strains on the various systems interferes with societal growth. To this effect, the health, socioeconomic, and safety problems caused by alcohol are controllable through implementation of evidence-based policies.
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Overview of Wisconsin State
As a state, Wisconsin carries a population of over 5.5 million. In terms of geography, it covers more than 50,000 square miles and boats in having 72 counties, 407 villages, 1,255 towns, (Wisconsin Department of Health Services, 2016). In the state, alcohol consumption is high with binge drinking being popular among adults, (University of Wisconsin School of Medicine and Public Health 2012). To understand the context of the effect of alcohol consumption, it is important to study its contribution to alcohol related deaths. According to the Wisconsin Department of Health Services, motor vehicle deaths lead in causing alcohol related deaths. In 2005 alone, more than 350 people died in vehicle crashes. With cirrhosis that is one of the major diseases caused by alcohol consumption, 244 people in Wisconsin died from cirrhosis. Other health effects include heart disease, stroke, various cancers and pancreatitis.
In Outagamie County, excessive alcohol consumption contributes to various effects. One of them being 34 alcohol related deaths, 1,364 hospitalizations, and 1,980 alcohol related arrests, (Black and Paltzer, 2013). Of concern in the county is binge drinking which is responsible for 76% of the economic cost of managing the effects associated with excess alcohol consumption. Compared to other counties, Outagamie is high in binge drinking, representing 30% of binge drinking in Wisconsin, (Black and Paltzer, 2013). With alcohol consumption presenting consequences in the economic sector, Outagamie suffers from the effects. This follows excessive alcohol consumption accounting for 272.2 million dollars. Unintended costs fall onto the criminal justice system, through motor vehicle crashers and incarceration of offenders.
With Winnebago County, the statistics are higher with alcohol consumption contributing to various effects. One of them being 43 alcohol related deaths, 1,581 hospitalizations, and 3,173 alcohol related arrests, (Black and Paltzer, 2013). The county accounts for 34% of binge drinking with it sending about 215 million dollars on excessive alcohol consumptions. From an evaluation of both counties, it is clear that excessive alcohol consumption is a concern and there needs to be measures in place to manage the situation.
Screening
For classification of an individual to be having alcohol abuse disorder, there has to be dependence on alcohol, drinking above recommended levels and experiencing symptoms of dependence. According to the DSM 5, symptoms of alcohol use disorder involve craving, physical dependence, increasing tolerance for alcohol and loss of control, (American Psychiatric Association, 2013). During assessment, it is important to identify other underlying conditions that could be causing the disorder. This follows that substance abuse disorders such as alcohol abuse is co-morbid with depression, posttraumatic stress disorder, bipolar and other mental health conditions.
The use of screening tools such as, the Alcohol use disorder identification test (AUDIT) helps in the screening process. It is a tool developed by the World Health Organization to assess alcohol consumption, drinking behavior and alcohol related problems, (Drug Abuse, 2017). It consists of 10 items to which participants have to respond to. In an analysis of the scores, a score of eight or more indicates harmful alcohol use. Through the reliance of such tools, it is impossible to prepare for interventions grounded on accurate screening.
Prevention and Treatment
Concerning treatment approaches in Wisconsin, drug abuse clients benefit from publicly funded drug programs. Following the etiology surrounding understanding alcoholism and alcohol dependence, treatment involves three main modalities including the medical, psychological, and social approaches. The medical approach is the first form of treatment that takes on a detoxification method. This step is necessary to manage the withdrawal symptoms. As Martin (2008), explains, although alcohol dependence includes psychological and physiological changes, detoxification manages the physiological aspects. In managing the withdrawal symptoms associated with the process, pharmacological agents are in place. Some of the agents include benzodiazepines as the medication of choice. Precautions are in place when facilitating the treatment to discourage co-dependence. Another important aspect of treatment involves psychological interventions. The modality of treatment in this case involves various approaches. Some of them include behavioral and cognitive approaches. Behavioral involves various techniques and interventions to modify the maladaptive behavior associated to drinking. Cognitive, on another hand involves a direct focus on the idiosyncratic thoughts, feelings, and behaviors that drive individuals to drinking.
With social cultural approaches, the aim is to involve changes in the social environment that predispose individuals to drinking. A good example is participation in support group such as alcoholics anonymous that helps individuals throughout the treatment process.
Prevention of alcohol abuse disorder involves having an awareness of responsible social drinking. Both counties are attempting to provide preventive and treatment solution for members. For example in Outagamie County, there is an initiative spearheaded by the CHIP Alcohol subcommittee, to raise awareness on underage drinking. One such campaign involved public awareness to young people on the consequences of underage drinking, (Outagamie County, 2017). In Winnebago, various community initiatives and treatment groups provide support to individuals. One such example is the Winnebago County Drug and Alcohol Coalition that focus on treatment, prevention and community involvement to minimize the effects of alcohol and drug abuse, (Winnebago County Drug and Alcohol Coalition, 2017).
Role of Advanced Nursing Practice in Alcohol Abuse Disorder
When dealing with patients with a substance abuse disorder, the SBIRT approach is acceptable. It represents an advancement in nursing practice as it involves screening, brief intervention, and referral for specialized treatment. As an approach, it is comprehensive and objective in providing early intervention and treatment services for individuals with a substance abuse disorder, or those likely to get one, (Strobbe, Perhats, and Broyles, 2013). In screening, it involves the assessment of the severity of alcohol abuse to identify the suitable modes of treatment. Regarding brief intervention, it helps create awareness of the issue to inspire motivation for behavioral change. Referral to treatment involves guiding patients to receive specialty care.
As part of improving the nursing practice, nurses in all specialties should be aware of the approach. This is to handle alcohol abuse related disorders. To build onto the approach, more research should be in place to evaluate its effectiveness, (Strobbe, Perhats, and Broyles, 2013).
Legal and Ethical issues affecting Alcohol Abuse Disorder
The intersection of legal and ethical issues has the potential to affect treatment of alcohol abuse disorders. In drug cases, informed consent is a challenge following that the frequency of mandatory drug treatment referrals continues to expand. In this instance, drug treatment is under the mandate of the court. This begs the question as to whether individuals ‘choose to join the program on their own or from court’s decision. Similar to the court mandated programs are employee assistance programs that lay down continuation of employment based on successful recovery from the existing programs, (National Institute of Alcohol Abuse and Alcoholism, 2017). The law in general proposes mandates that drive individuals to seek treatment. For example, statues around ‘driving under the influence’ posit mandatory drug rehabilitation as part regaining and maintainingthe driving license. In this case, mental health professionals have a role to ensure that they obtain client’s consent before starting treatment interventions. By helping clients understand the benefits of the proposed treatment, they are more open to the treatment process and some of the risks involved.
Another ethical concern that presents challenges is confidentiality. There are states that have limitations on confidentiality. For instance, there exist mandatory reporting statutes for family violence. While this places a limitation on confidentiality, it coincides with the duty to warn. Social workers work closely with clients and identify the environments they operate in. When they identify harmful environments, they have a role in warning the clients or surrounding individuals whose lives maybe in danger. Social workers then need to be knowledgeable in identifying risk factors responsible for clients’ drug abuse while helping them throughout the process.This is part of an attempt to have the client consent to receiving treatment. According to the National Institute of Alcohol Abuse and Alcoholism (2017), maintaining confidentiality is different for children and adolescents. By law, parents and guardians have legal consent over minors, (Lambert, 2011). They require parental permission to engage in any form of treatment, although some states do allow minors to contract for alcohol and drug treatment without such permission. For social workers and mental health practitioners obtaining consent from the parents is necessary. Other circumstances revolve around times where breach of confidentiality is possible. For instance, where minors mention or display the ability to cause themselves harm or to others, there is need for the parents and guardians to know. Parents in most cases facilitatepayment for the therapeutic services offered and as interested parties, appreciate feedback concerning progress made.
T he Tarasoff v California Board of Regents ruling set the precedent on the effect of two opposing ethical dilemmas. The case references a client who admits to wishing to murder his girlfriend. The psychologist had the client detained by the campus police, who then released the client. Upon his release, the client murdered the girlfriend. This prompted the girls’ parents to sue the psychologist for not letting them know about the impending harm on their daughter. In court, the ruling advocated for the warning of parties who were in harm’s way to shield them from danger.
Concerning the legal issues, the law is intricate in drug enforcement strategies. For example with court mandated treatment programs, clients have to prove that they tend the required sessions so that they can return to normalcy. This affects the patients’ right to autonomy and privacy when seeking treatment. An interesting concern in this case equally revolves around management of patient’s records. Sometimes social workers share information and consult with each other on cases to better help clients. In such a case, it is important to have in mind the limitation of confidentiality and exercise caution when sharing medical records.
Alcohol treatment programs are unique, embedded with policies. There is need for resilience especially for patients who continue to relapse and cause harm to themselves. By working with agencies at the community level, patients draw support groups such as alcohol anonymous to support treatment options.
Role of Genetics
The influence of genetic factors on alcohol dependence as explained by Fallgater and Nieratschker (2013) is high. Some of the genes identified in affecting dependence include alcohol dehydrogenase (ADH) and aldehyde dehydrogenase. The genes participate in the enzymic degradation of alcohol, (Fallgater and Nieratschker 2013). Genes are not wholly responsible for alcohol dependence as the environment equally plays a role. Gene environment interactions influence the modification of the genes that cause dependence as alcohol consumption in itself is an environmental factor. In active drinking individuals, there are elevated levels of homocysteine levels. Genetic research capitalizes on studying the levels among non-drinkers to identify if there is a specific gene marker responsible for dependence.
Wisconsin is a state in need of interventions in alcohol abuse disorder. With consumption rapidly increasing in the various counties such as Outagamie and Winnebago, there is need for intervention. Excessive alcohol consumption is harmful as it results in various negative effects such as alcohol related deaths, here there is need to strengthen the war against substance abuse. Through integrating various treatment approaches from the medical, psychological and social, it is possible to develop sustainable treatment interventions. With legal and ethical issues posing a challenge to the work of mental health practitioners, there is need to streamline the issues. From an epidemiological perspective, it is clear that alcohol abuse is a public health concern that requires the use of available resources to manage the condition.
References
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Black, P. and Paltzer, J. (2013). The Burden of Excessive Alcohol Abuse in Wisconsin. University of Wisconsin Population Health.
Drug Abuse. (2017). Alcohol Use Disorder Identification Test (AUDIT). Web. Retrieved from https://www.drugabuse.gov/sites/default/files/files/AUDIT.pdf on 6 Oct 2017.
Lambert, S. F. (2011).Ethical and legal Issues in addictions outcome research. Counseling Outcome Research and Evaluation , 2 (1), 25-36.
Strobbe, S., Perhats, C., & Broyles, L. M. (2013). Expanded roles and responsibilities for nurses in screening, brief intervention, and referral to treatment (SBIRT) for alcohol use. Journal of addictions nursing , 24 (3), 203-204.
Nieratschker, V., Batra, A., & Fallgatter, A. J. (2013). Genetics and epigenetics of alcohol dependence. Journal of molecular psychiatry , 1 (1), 11.
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