Alcoholism( alcohol dependence syndrome) - Causes, symptoms and treatment. MF.
Jun 28, 2018
Alcohol is the most common psychoactive substance in the world. It is an indispensable attribute of holidays, solemn meetings, but its systematic abuse leads to the formation of alcohol dependence, which is one of the most common chronic diseases in the world and remains a global medical, economic and social problem.
According to the World Health Organization( WHO), alcohol dependence is defined as a violation in the mental and physical state, resulting from the constant or periodic use of alcohol. It manifests itself in the behavior, disability, loss of strong-willed control, forcing the patient to drink alcohol to influence the psyche or to avoid unpleasant conditions when refusing to drink alcohol.
The accepted safe standard dose of alcohol per day is 12-14 g of pure ethanol, which corresponds to 250-300 ml of beer, 100-300 ml of wine or 30 ml of vodka. When this dose is exceeded, there is an unhealthy use of alcohol, leading to the development of alcohol dependence.
Unhealthy use of alcohol:
1. Unsafe alcohol consumption. For women and people over 65: more than 7 standard doses of alcohol per week;for men under 65 years: more than 14 standard doses per week. There are no consequences and dependencies on alcohol consumption, but the risk of physical, mental and social threat increases.
2. Drinking alcohol with harmful consequences( a synonym for household drunkenness).The re-emergence during the last 12 months of such symptoms associated with alcohol use, as the inability to fulfill the social role in society, conflicts with the law, interpersonal problems. This entails only consequences for mental and physical health.
3. Alcohol dependence. Corresponds to the following criteria: compulsive( irresistible attraction, perceived as wrong) need for alcohol intake;decreased control over alcohol intake;the development of withdrawal syndrome with a decrease in the dose of alcohol or with the cessation of its intake( withdrawal syndrome);increased tolerance( to achieve euphoria, each time an increasing dose of alcohol is required).The emergence and development of somatic diseases: alcoholic liver disease with the outcome of cirrhosis, alcoholic cardiomyopathy, chronic pancreatitis, toxic encephalopathy.
Causes of alcoholism
Currently, alcohol-related disorders are considered as a result of the combined interaction of many factors.
1. Genetic predisposition. A high risk of developing the disease( 4-5 times) in children whose parents suffer from alcoholism, as well as in adopted twins, whose parents suffered from this disease. Probably - this is due to biochemical reactions( insufficient ability of the hepatic enzyme alcohol dehydrogenase to oxidize aldehydes - alcohol decay products).
2. Psychological factors. Individual predisposition to alcohol, taking alcohol to relieve inner tension, anxiety, fears, raising inner self-esteem.
3. Social factors. Traditions of alcohol abuse in the family, environment;low incomes, stressful situations, marital disharmony.
Manifestations of alcohol dependence
With the systematic abuse of alcohol over time, there is an increase in tolerance( tolerance) to alcohol, control over the amount of alcohol consumed, an increasing dose is required to achieve euphoria;the protective emetic reflex disappears and aversion to alcohol disappears.
After periods of binge drinking, alcohol withdrawal status occurs( withdrawal syndrome) - a condition caused by a sudden discontinuation of alcohol intake. It manifests a painful state of health, expressed by vegetative disorders: red face, tremor( trembling) of the hands, feet, tongue, eyelids;headache, dizziness, increased blood pressure, palpitations. Accompanied by a violation of sleep, a sense of fear. The abstinent state is stopped by taking another dose of alcohol.
In the future, the cancellation status occurs after small doses of alcohol, becomes heavier, up to the development of delirium( white fever).With the development of delirium, complete insomnia comes. Multiple visual deceptions( hallucinations) often appear in the form of animals and whole scenes in which the patient feels himself a participant. The condition is accompanied by a violation of orientation in space and time, a sharp motor excitement. Delirium lasts about 5 days, ends with sleep, in severe cases death may occur.
Epileptiform seizures may occur( alcoholic epilepsy) - short-term loss of consciousness, convulsions. The cause of their occurrence is an organic alcohol damage to the cerebral cortex.
The character of intoxication changes. At the beginning of the disease, with an average degree of intoxication, there is euphoria, speech excitement, disinhibition, with a drop in intoxication - drowsiness. With alcoholism, the emotional background of a drunk alcoholic is grumpy, malicious, prone to aggression with sudden transitions to a tearful state.
With the course of the disease there are episodes of amnesia( memory loss) that deepen and the patient can remember only a short period of time, the beginning of the binge.
The duration of the hangover state gradually increases, which leads to a constant use of alcohol, which is interrupted only by external circumstances. There are signs of alcoholic degradation of the person - deceit with a characteristic understatement of the size of drunkenness, rudeness, explosiveness of character, loss of interests to everything except alcohol. Ethical standards are reduced: they are slovenly, careless in their clothes. Human relationships lose value and meaning. Patients are deprived of a sense of responsibility for their actions. Intellectual abilities decrease.
In the alcohol dependence syndrome, all internal organs and systems suffer. Severe chronic diseases, slower the clinical effect of the prescribed treatment is achieved.
Consequences of alcoholism
The consequence of alcohol use is liver disease( alcoholic liver disease with outcome in cirrhosis), pancreatic damage( development of chronic pancreatitis, secondary diabetes, pancreatic cancer), heart damage( alcohol dilated cardiomyopathy).
As a result of liver damage, lipid( fatty) metabolism is violated, which leads to atherosclerosis, leading to the development of stroke and myocardial infarction, heart failure. In patients, hypertension is observed, with frequent crises. Developing toxic encephalopathy, leading to alcoholic dementia( dementia).There are violations in the immune system, as a result, increased respiratory diseases, frequent pneumonia. Violated sexual and reproductive function.
Diagnosis of alcoholism
The diagnosis of alcohol dependence has the right to put only a doctor - a narcologist. Diagnostic criteria, which doctors use when recognizing this disease, makes it possible to distinguish between domestic drunkenness and alcoholism.
Patient consult: neurologist, therapist, psychotherapist. When revealing the pathology of internal organs, the necessary complex of clinical and diagnostic studies is prescribed.
Treatment of alcohol dependence
The patient's motivation for a complete refusal to drink alcohol is the most important condition for the treatment of .
Basic principles of alcoholism treatment:
voluntary consent of the patient, individual approach, complex measures. Hereditary factors, family and socio-cultural traditions, type of personality, presence of concomitant pathology are taken into account.
At the beginning of treatment, detoxification therapy is carried out, aimed at eliminating the toxic effect of alcohol on the body, normalizing homeostasis( constancy of the internal environment of the body).Methods of carrying out detoxification( forced diuresis, hemosorption, plasmapheresis, gastroenterosorption, physical hyperthermia) depend on the patient's state of health. They are conducted in a specialized medical institution.
Patients with mild cancellation syndrome have the possibility of using medications at home:
Medrochanal .The contents of 2 packages( package No. 1 and No. 2) are dissolved in 1/3 cup of boiled water, taken 30 minutes before meals.
Regidron .The contents of the package are dissolved in 1 liter of warm water, taken within 24 hours.
The amount of fluid injected depends on the patient's state of health. Schemes of admission and duration of treatment are recommended by a doctor - a narcologist. These methods of treatment lead the patient out of the drinking-bout.
Also used drugs that cause discomfort( nausea, vomiting) after drinking alcohol( disulfiram), reducing the manifestations of craving for alcohol( naltrexone), they are also prescribed only by a specialist - a narcologist.
Treatment of alcohol dependence by folk remedies
Use decoctions of herbs that cause aversion to alcohol( centaury, wormwood, lavender root, herb thyme).
Formation of the motivation for refusal of alcohol
The reception of only medical preparations and phytotherapy medicines for the treatment of dependence without motivation does not give a positive result.
Currently, the best effect is provided by the use of combination therapy - medical drugs prescribed under the supervision of an expert in narcology and psychological methods conducted by psychotherapists. It is often necessary to change the behavior and relationships between all close people of the dependent patient.
The most commonly used and most effective methods are: cognitive-behavioral therapy( CBT), anonymous alcoholics group( 12 step program).
Psychotherapists working with the CBT method, the main cause of dependence consider the person to have negative attitudes towards himself, to his future, to the world around him, the transformation of these beliefs, increasing his own self-esteem, voluntary refusal of alcohol is the main task of the therapist. Work with patients is carried out both individually and in groups. Apply homework to fix positive changes.
The most widely used method in the world are groups of anonymous alcoholics. They take place in the form of meetings, where everyone can tell about their problem and share their experience of sobriety. Most patients deny themselves a harmful addiction to alcohol and do not seek help. The main goal of such groups is the recognition of participants of their dependence and the change in dependent thinking.12 step-by-step program is designed so that people with long experience of using it train new members of the group.
Often, so-called "conspiracies" have a good psychological effect, but only when a person wants to part with alcohol dependence.
Method for coding alcoholics
The methodology of emotional stress therapy( coding) is widespread in the territory of Russia and Ukraine. Its essence lies in inducing the patient rigid settings - a sense of fear of death or fear of getting a serious illness if he does not stop drinking alcohol. There are different types of coding:
1. Programming by the method of AG Dovzhenko. The patient under hypnosis is inspired by aversion to alcohol and a ban on its use. This method is not recognized by many narcologists, since it is not effective.
2. Implantation( implantation) of drugs that cause unpleasant sensations( nausea, vomiting, abdominal pain, headache) with the use of even a small dose of alcoholic beverages.
3. The Torpedo method. The basis of this method is the receipt in the body of the patient, for a long time, drugs that cause aversion to alcohol.
There are also negative sides to coding. The drugs used in coding are toxic and have many contraindications for use. The patient receives a strict ban on alcohol consumption, but the problems that led to dependence have remained. As a result, he gets additional stress, depressive moods increase( despair, despair), which makes the period of abstinence from alcohol( remission) extremely painful. And the effectiveness of this method is extremely low, about 85% of patients within a year again begin to abuse alcohol. Therefore, coding is used only at the initial stage, under the control of an expert in narcology, in a certain group of patients, and then psychological methods are used.
Treatment of alcohol dependence is prohibited only, there must be changes in the patient's consciousness, there is a responsibility for their life, feel for themselves new opportunities that realize it as a person. To do this, apply psychological methods. Modern methods of treatment of alcohol dependence require the use of a wide variety of methods and means of treatment and this, as a rule, is a long process.
Complications of alcohol dependence:
1. Mental disorders: acute - alcohol delirium( white fever);chronic - epileptiform seizures( alcoholic epilepsy), dementia( dementia), Korsakov's psychosis( gross memory disorders for current events, impossibility of memorization).
2. Somatic( internal organ damage) disorders: alcoholic liver cirrhosis, chronic pancreatitis, alcoholic cardiomyopathy.
Alcohol consumption is closely related to rituals and customs. The centuries-old traditions can not be suppressed by prohibition or replaced by something else. Only with an increase in the level of internal culture, consciousness, an increase in intellectual values will lead to a rejection of the abuse of alcoholic beverages. Of course, national programs for advertising healthy lifestyles are very important. Formation of attitudes about the fact that drinking alcohol is harmful and not prestigious.
Consultation of a doctor
Question: Is it possible to consume alcohol in moderation to prevent heart disease?
Answer: The results of recent studies say that the use of even small doses of alcohol in elderly patients and those suffering from cardiovascular pathology significantly increases the risk of developing ischemic stroke. Therefore, such patients should completely stop taking alcohol.
Question: Is it possible to cure a patient with alcoholism without his knowledge?
Answer: No, it's not possible. This disease is not only the body, but also the soul, which can only be helped by taking into account the individual characteristics of the person. Treatment will be effective only if the patient has fully realized his condition and is determined to part with this problem.
Doctor therapist Vostrykova I.N.