CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Alcoholic drinks are widely consumed globally and are considered a socially acceptable aspect of various recreational and ceremonial practices. When consumed in moderate amounts, alcohol can contribute to socializing by diminishing anxiety and loosening inhibitions in social interactions.
It's worth noting that compared to other addictive substances, alcohol necessitates the consumption of larger quantities to produce physiological effects. For instance, an average alcoholic beverage contains approximately 14 grams of ethanol (Wackernah et al., 2014), while a tobacco cigarette or a tablet of oxycodone hydrochloride only contains milligram quantities of their respective active substances.
The US National Institute on Alcohol Abuse and Alcoholism provides a definition of "heavy drinking." For males, it is characterized as consuming more than four drinks per day or 14 drinks per week. For females, it is defined as consuming more than three drinks per day or seven drinks per week (Wackernah et al., 2014).
Engaging in excessive and uncontrolled alcohol consumption has been associated with various negative consequences, including increased risk for diseases, health impacts, criminal behavior, and involvement in road incidents. Additionally, some individuals may develop alcohol use disorder (AUD), a medical condition characterized by a diminished ability to cease or regulate alcohol consumption despite experiencing negative social, occupational, or health-related effects.
Alcohol use disorder (AUD) encompasses various conditions such as alcohol abuse, alcohol dependence, alcohol addiction, or colloquially known as alcoholism. It is recognized as a brain disorder and can present as mild, moderate, or severe in its manifestations (National Institute of Alcohol Abuse and Alcoholism, 2023). This highlights the complexity and severity of AUD as a pressing public health issue with far-reaching consequences worldwide.
The 2018 World Health Organization (WHO) Global Status Report on Alcohol and Health revealed that the detrimental effects of alcohol misuse led to around 3 million deaths in 2016, representing 5.3% of all fatalities worldwide. This surpassed the combined mortality caused by conditions such as hypertension and diabetes.
The report also revealed that alcohol use contributed to 5.1% of the overall burden of disease and injury globally, corresponding to 132.6 million Disability-adjusted Life Years (DALYs) (World Health Organization (WHO), 2018). Furthermore, in 2016, an estimated 2.3 billion individuals were classified as current drinkers, and 283 million individuals aged 15 and above were affected by AUD, representing 5.1% of adults.
Alcohol use imposes a significant economic burden, amounting to more than 1% of the gross national product in middle and high income countries, as estimated by Rehm et al. in 2009. In terms of global health risks, alcohol use ranked as the 7th leading cause of premature death and disability, according to the GBD 2016 Alcohol Collaborators in 2018.
Although there has been a decline in per capita alcohol consumption in certain World Health Organization (WHO) regions, it is projected that worldwide per capita alcohol consumption will increase over the next decade, potentially resulting in a greater disease burden (WHO, 2018).
When individuals diagnosed with Alcohol Use Disorder (AUD) suddenly stop or substantially decrease their alcohol consumption, they may encounter a variety of symptoms collectively referred to as Alcohol Withdrawal Syndrome (AWS). AWS is a prevalent condition observed in individuals seeking treatment for AUD.
The onset of AWS typically occurs within 4 to 6 hours after the last instance of alcohol use. Symptoms can vary in severity, ranging from mild manifestations like insomnia, tremors, and heightened autonomic activity to more severe symptoms such as seizures and delirium tremens (Chand et al., 2022).
The mild to moderate form of Alcohol Withdrawal Syndrome (AWS) is often self-managed by patients and typically resolves within 2 to 7 days after the last drink (Hall and Zador, 1997; Leggio et al., 2008). However, the more severe cases of AWS necessitate medical intervention (Saitz, 2005; Hall and Zador, 1997). Recognizing and treating AWS is crucial from a clinical standpoint since it contributes to preventable morbidity and mortality (Mokdad et al., 2005).
While the detrimental effects of chronic excessive alcohol consumption are well-known, effectively managing and treating Alcohol Use Disorder (AUD) and alcohol withdrawal syndrome remains a challenge. The diverse nature of AUD calls for a multidisciplinary treatment approach to address the various unmet medical needs of individuals with AUD.
Pharmacists, being accessible healthcare professionals with expertise in medications, hold a pivotal position in the management of Alcohol Use Disorder (AUD) and the treatment of Alcohol Withdrawal Syndrome (AWS) in various settings, including emergency departments (ED) and inpatient facilities (Antrim, 2022). Recognizing their significance, this study aims to investigate and examine the roles of pharmacists in the management of alcohol use disorder and withdrawal syndrome.
1.2 Statement of the Problem
Alcohol use disorder (AUD) and alcohol withdrawal syndrome (AWS) are critical health concerns that demand effective management and support to achieve favorable outcomes for individuals affected by these conditions. Pharmacists, possessing specialized expertise in medications, possess a distinct skill set and knowledge base that can make a significant contribution to the management of AUD and AWS.
The American Society of Health-System Pharmacists (ASHP) recognizes and highlights the valuable role of pharmacists in three key areas of AUD: prevention, education, and assistance. In terms of prevention, pharmacists can actively participate in the development of programs and policies aimed at promoting safer alcohol consumption practices (Yasin and Banoub, 2018).
In terms of education, pharmacists have the opportunity to collaborate with clinicians and support groups. They can also engage in didactic and experiential training for pharmacy trainees to educate individuals about the negative consequences of excessive alcohol consumption and appropriate treatment strategies.
Additionally, for assistance, pharmacists can play a vital role in identifying individuals with unhealthy alcohol consumption patterns, providing guidance in selecting pharmacotherapy or other treatment options, and establishing protocols to streamline the process of medication selection and access (Yasin and Banoub, 2018).
However, the roles and contributions of pharmacists in the management of AUD and withdrawal syndrome need further exploration. Understanding their involvement can inform the development of strategies to enhance the quality of care provided to individuals with AUD and withdrawal syndrome.
Therefore, this study aims to investigate and examine the roles of pharmacists in the management of alcohol use disorder and withdrawal syndrome. By exploring their responsibilities and contributions, this research seeks to enhance understanding of the pharmacist's role in the care of individuals with AUD and withdrawal syndrome.
1.3 Aim of the Study
The aim of this study is to examine the roles of pharmacists in the management of alcohol use disorder and withdrawal syndrome.
1.4 Research Objectives
The specific objectives of this study are as follows:
- To identify the roles of clinical pharmacists in the management of alcohol use disorder and withdrawal syndrome.
- To evaluate the impact of pharmacist-led interventions on patient outcomes, treatment adherence, and quality of life.
- To propose recommendations for improving the role of pharmacists in the management of alcohol use disorder and withdrawal syndrome.
1.5 Research questions
- What are the roles of clinical pharmacists in the management of alcohol use disorder and withdrawal syndrome?
- What is the impact of pharmacist-led interventions on patient outcomes, treatment adherence, and quality of life?
- What recommendations can be made to improve the role of pharmacists in the management of alcohol use disorder and withdrawal syndrome?
1.6 Research Hypothesis
H0: Pharmacists do not play significant roles in the management of alcohol use disorder and withdrawal syndrome.
Ha: Pharmacists play significant roles in the management of alcohol use disorder and withdrawal syndrome.
1.7 Justification of the Study
This study is significant for several reasons. It will contribute to the existing literature by exploring and documenting the roles of pharmacists in the management of alcohol use disorder and withdrawal syndrome. It will help raise awareness among healthcare professionals, policymakers, and the general public about the valuable contributions pharmacists can make in addressing these conditions.
The findings of this study may inform the development of interventions and strategies to enhance the involvement of pharmacists in the management of AUD and AWS, leading to improved patient outcomes. It may help identify areas where additional training and education for pharmacists are needed to enhance their competencies in managing these conditions.
1.8 Scope of the Study
This study will focus on the roles of pharmacists in the management of alcohol use disorder and withdrawal syndrome. The research will delve into the roles and impact of pharmacists within the context of alcohol use disorder and withdrawal syndrome in the Nigerian healthcare system.
