A person is chemically dependent, and that is how a patient is usually called in a medical narcological environment, and should be treated for a long time and in a complex manner. Moreover, it is considered that alcoholism is a systemic disease in the social sense: if a person is surrounded by a family, then ideally all members of the family should attend special sessions, sessions with a psychologist or psychotherapist. These people are considered to be co-addicted to the disease, that is, they are also suffering, only without the participation of spirits.
Undoubtedly, the effectiveness of therapeutic actions depends on the motivation of the patient himself. However much the spouse wishes to save her husband from the addiction, until he understands the whole tragedy of the situation himself, does not want to change his life, all efforts will be reduced only in physiological remission. At the level of the psyche, the dependence will remain at the same level, therefore there are disruptions after drug treatment methods. Ideal conditions for the treatment of patients with alcoholism are specialized medical rehabilitation centers, where the patient must be at least three months, or even more.
The standard methods of treatment are the following stages:
- Neutralization of withdrawal, detoxification;
- The use of various types of coding, the choice of which depends on the patient's condition, length of use, and also on the psychotype;
- Attending psychotherapy sessions is the help of a psychologist, a psychotherapist, better if it is a combination of individual therapy and family therapy.
Treatment of acute alcohol intoxication
When people consume alcohol to the level of intoxication, the main task of treatment is to stop consuming any additional amount of alcohol, as this can lead to loss of consciousness and death. The second task is to ensure the safety of the patient and others, not allowing the patient to drive vehicles or to activities that can be dangerous due to alcohol consumption. Calm patients can become anxious and aggressive after lowering the concentration of alcohol in the blood.
Treatment of chronic alcoholism
Medical examination is primarily necessary for the diagnosis of concomitant diseases that can make the withdrawal state worse, and eliminate the CNS lesion, which can hide behind the mask of withdrawal syndrome or mimic it. Symptoms of withdrawal syndrome should be recognized and treated. It is necessary to take steps to prevent the syndrome of Wernicke-Korsakov.
Some drugs used in the state of alcohol withdrawal have similarities in pharmacological effects with alcohol. All patients with withdrawal syndrome can be shown CNS depressants, but not everyone needs it. In many patients, detoxification can be performed without medication, provided that appropriate psychological support is provided, if the environment and the contact itself are safe. On the other hand, these methods may not be available in general hospitals and emergency departments.
The basis for the treatment of alcoholism are benzodiazepines. Their dosage depends on the physical and mental state. In most situations, chlordiazepoxide is recommended in an initial dose of 50-100 mg orally; if necessary, the dose can be repeated twice after 4 hours. Alternatively, diazepam may be used at a dose of 5-10 mg intravenously or orally every hour until sedation is achieved. In comparison with short-acting benzodiazepines (lorazepam, oxazepam) long-acting benzodiazepines (eg, chlordiazepoxide, diazepam) require less frequent administration, and when the dose decreases, their concentration in the blood decreases more evenly. In severe liver diseases, short-acting benzodiazepines (lorazepam) or metabolized by glucuronidase (oxazepam) are preferred. (Note: Benzodiazepines may cause intoxication, physical dependence and withdrawal states in patients with alcoholism, so they should be discontinued after a detoxification period.) Alternatively, carbamazepine 200 mg orally may be used 4 times a day, followed by a gradual cancellation.)
Isolated convulsions do not require specific therapy; with repeated attacks, diazepam 1-3 mg is effective. The abusive use of phenytoin is unnecessary. Outpatient reception of phenytoin almost always is an unnecessary waste of time and medication, as convulsions are observed only in the state of alcohol withdrawal, and heavily drinking or undoing patients do not take anticonvulsants.
Although alcoholic delirium may begin to resolve within 24 hours, it can be lethal, and treatment must begin immediately. Patients with alcoholic delirium are extremely suggestive and respond well to beliefs.
They are usually not subject to physical restraint. The fluid balance should be maintained, it is necessary to immediately give large doses of vitamins B and C, especially thiamine. A significant increase in temperature during alcoholic delirium is a poor prognostic sign. If no improvement is observed within 24 hours, it is possible to suspect the presence of other disorders, such as subdural hematoma, liver and kidney disease or other mental disorders.
Supportive treatment of alcoholism
Maintaining a sober lifestyle is a difficult task. The patient needs to be warned that a few weeks later, when he recovers from the last binge, he may have an excuse for drinking. It is also necessary to say that the patient can try to control alcoholic beverages for several days, less often weeks, but eventually control, as a rule, is lost with time.
Often the best option is to include in the rehabilitation program. Most in-patient rehabilitation programs last 3-4 weeks and are conducted in the center, which is not allowed to leave throughout the course of treatment. Rehabilitation programs combine medical observation and psychotherapy, including individual and group therapy. Psychotherapy includes techniques that enhance motivation and educate patients to avoid the circumstances leading to binge drinking. Important social support for a sober lifestyle, including support for family and friends.
Anonymous alcoholics (AA) are the most successful approach for the treatment of alcoholism. The patient needs to find a group of anonymous alkoglyks, in which he will be comfortable. Anonymous alcoholics provide the patient with non-drinking companions who are always available, as well as the non-drinking environment in which socialization takes place. The patient also hears the confessions of other members of the group about how they explained the reasons for their drunkenness. The help that the patient gives to other alcoholics helps to raise his self-esteem and confidence, in what alcohol helped him earlier. In the United States, unlike other countries, many anonymous alcoglyk groups are included not voluntarily, but by a court decision or on probation. Many patients are reluctant to turn to anonymous alkoglyks, individual counselors or family therapy groups are more suitable for them. For those who are looking for other approaches to treatment, there are alternative organizations, such as "The Life Circle of Recovery" (self-help organizations fighting for sobriety).
Drug treatment for alcoholism
To reduce the symptoms of withdrawal, sedatives with cross-tolerance with alcohol are also introduced. Because of possible damage to the liver, short-acting benzodiazepines should be used, for example, oxazepam, which is prescribed in doses sufficient to prevent or reduce symptoms. In most alcoholics, treatment with oxazepam is advisable to start with a dose of 30-45 mg 4 times a day with an additional intake of 45 mg per night. In the subsequent dose corrected depending on the severity of the condition. The drug is gradually canceled within 5-7 days. After the examination, uncomplicated alcohol abstinence can be effectively treated in an outpatient setting. In the detection of somatic complications or anamnestic indications for epileptic seizures, hospitalization is indicated. To prevent or reverse the development of memory impairments, it is necessary to replenish the deficiency of food and vitamins, primarily thiamine.
Drug treatment for alcoholism should be used in combination with psychotherapy.
Disulfiram disrupts the metabolism of acetaldehyde (an intermediate product of alcohol oxidation), which leads to the accumulation of acetaldehyde. Drinking alcohol for 12 hours after taking disulfiram leads to reddening of the face after 5-15 minutes, then intense face and neck vasodilation, conjunctivitis hyperemia, pulsating headache, tachycardia, hyperpnoea, sweating. When using large doses of alcohol after 30-60 minutes, nausea and vomiting can occur, which can lead to hypotension, dizziness, sometimes to fainting and collapse. The reaction to alcohol can last up to 3 hours. Few patients will take alcohol against the background of disulfiram because of severe discomfort. Also, avoid drugs that contain alcohol (for example, tinctures, elixirs, some solutions for cough and cold, sold without a prescription, which can contain 40% alcohol). Disulfiram is contraindicated in pregnancy and in decompensating cardiovascular diseases. Outpatient, he can be appointed after 4-5 days of abstinence from drinking alcohol. The initial dose of 0.5 g inside 1 time per day for 1-3 weeks, then the maintenance dose is 0.25 g once a day. The effect can last from 3 to 7 days after the last reception. Periodic examinations of the doctor are necessary to support continuation of reception of disulfiram as part of the sobriety program. In general, the use of disulfiram is not established, and many patients do not follow the prescribed treatment. Compliance with such treatment usually requires adequate social support, such as monitoring the intake of the drug.
Naltrexone, an opioid antagonist, reduces the relapse rate in most patients who take it continuously. Naltrexone is taken 50 mg once a day. It is unlikely to be effective without the advice of a doctor. Acamprosate, a synthetic analogue of gamma-aminobutyric acid, is given 2 grams 1 time per day. Acamprosat reduces the level of relapse and the number of days of drinking alcohol if the patient is in a drinking bout; Like naltrexone, it is more effective if it is administered under the supervision of a physician. Nalmefene and the topiromate are currently in the process of studying their ability to reduce cravings for alcohol.
Alcohol abstinence syndrome is a potentially lethal condition. In occasion of mild manifestations of alcohol abstinence, patients usually do not consult a doctor, but in severe cases a general examination, detection and correction of water-electrolyte disorders, deficiency of vitamins, especially the administration of thiamine in a high dose (initial dose of 100 mg IM) is necessary.
Alcoholism is much easier, easier and cheaper to prevent at the earliest stages. For this, of course, we need a system strategy at the state level. But the family can do a lot in this area, it is necessary to start from early childhood - to instil the foundations of a common culture, to bring up the ability to relieve stress in healthy ways - music, sports, create a trusted family environment without distortions towards dictatorship or connivance, permissiveness. The task is difficult, but even more dramatic, and even more tragic can end the life story of a patient with alcoholism.
, , , , ,