Nurses play a critical role in promoting compassionate care for patients and families affected by alcohol use disorder (AUD), including evidence-based medication-assisted treatment (MAT) approaches, according to a paper in the July/September Journal of Christian Nursing, official journal of the Nurses Christian Fellowship. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"Using a compassionate, informed, and understanding approach, nurses can reinforce the idea that AUD is a disease in need of treatment, and those afflicted can be led to accept help," writes CDR John C. Umhau, MD, MPH, CPE. He discusses the causes of and treatments for AUD – including the Sinclair Method, with targeted use of the opioid blocker naltrexone to reduce the desire to drink.
Nurses 'A powerful force' in helping patients with AUD
Affecting more than 10 percent of the population, AUD is the major preventable cause of death in adults under age 50. Despite the devastating effects AUD, less than 10 percent of affected patients receive medically proven treatment – especially early in the course of disease, when treatment is most effective.
Dr. Umhau writes:
Considering the remarkable gap between treatment given and the potential for medicine to help, nurses can be important advocates to reduce the scope of suffering."
Susceptibility to AUD is influenced by genetic and environmental factors. When a susceptible person is exposed to alcohol, a series of brain adaptations occur, increasing the desire for alcohol.
These adaptations involve neurochemical and neuro-inflammatory changes which are induced by the effects of alcohol consumption and which are exacerbated by an inferior diet."
Traditionally, treatment for AUD has focused on social and psychological support, emphasizing abstinence. A growing body of evidence supports the effectiveness of MAT to reduce craving and excessive consumption of alcohol, reducing harm and promoting abstinence. Available treatments include targeted use of the oral opioid blocker naltrexone, as part of an approach called the Sinclair Method.
In the Sinclair method, patients take naltrexone before drinking in order to block alcohol's reinforcing effect on the desire to drink. Over time, using naltrexone to block the euphoric effect of brain endorphin produces "pharmacologic extinction" of drinking behavior. Dr. Umhau writes, "The gradual reduction in the desire to drink induced by naltrexone makes treatment acceptable to people who would otherwise reject help because they are not ready to give up drinking completely."
Other medications, can promote abstinence, including acamprosate and disulfiram. Nutritional therapy can help to correct the malnutrition that is common in patients with AUD. Psychological interventions can be very helpful, such as the use of cognitive behavioral therapy to help patients cope with cravings and relapses. "While continuing care for AUD is associated with better outcomes, and residential rehabilitation programs lasting a month or longer have helped many people, there is little data on their effectiveness," Dr. Umhau comments.
Faith-based programs have a long played an important role in helping people with AUD. Although no longer overtly Christian, Alcoholics Anonymous still focuses on a "higher power." Dr. Umhau notes that faith-based groups "may help overcome the guilt and shame which can be severe obstacles to recovery." He adds, "The faith community has begun to recognize the important role of MAT to help prevent the devastating effect of AUD on family relationships."
"Nurses can be a powerful force in the process of recovery from AUD," Dr. Umhau concludes. "Using a compassionate, informed, and understanding approach, nurses can reinforce the idea that AUD is a disease in need of treatment, and those afflicted can be led to accept help."