Alcoholism

Alcoholism (chronic alcoholism). Disease with a progressive (progressive) course, which is based on a passion for ethyl alcohol. In social terms, alcoholism means alcohol abuse (drunkenness), leading to a violation of moral and social norms of behavior, damage to their own health, material and moral condition of the family, as well as affecting the health and welfare of society as a whole. Alcohol abuse, according to WHO, is the third after cardiovascular disease and cancer cause of death.

First, a severe form of intoxication (alcohol poisoning) - are often the cause of death at a young age.

Secondly, the abuse of alcohol may occur sudden "cardiac" death due to primary cardiac arrest or cardiac arrhythmia (eg atrial fibrillation).

Third, abuse alcohol are more prone to injury - domestic, industrial, and transportation. And suffer not only themselves, but also may contribute to injury by others.

In addition, the risk of suicide among patients with alcoholism increased tenfold compared to the population. About half the murders committed as a state of intoxication.

For the early stages of alcoholism are more common diseases such as peptic ulcer disease, trauma, cardiovascular disorders, for later - cirrhosis, polyneuritis, brain disorders. High mortality rates among men is associated mainly with an increase in alcoholism. 60-70% of men who abuse alcohol and die before the age of 50 years. Reasons for alcohol use are different. One of them is the psychoactive effects of ethanol: eyforiziruyuschee (improves mood), relaxing (stress relieving, relaxing) and sedative (calming, sometimes causing drowsiness). The need to achieve such an effect exists in many categories of people: those with a pathological nature, suffering from neuroses, poorly adapted to the society, as well as in dealing with emotional and physical overload. In the formation of addiction to alcohol play an important role social environment, climate in the family, education, tradition, the presence of stressful situations, stress and ability to adapt. Undoubtedly the influence of genetic factors that determine how personality traits and predisposition to metabolic disorders.

Drunkenness. The degree of severity of intoxication depends on the quality and quantity of alcoholic beverages drunk, individual sensitivity to alcohol and psycho-physical condition of man. There are 3 degrees of drunkenness: mild, moderate and severe.

Easy stepen.V typically at the beginning of intoxication increases mood, facilitated communication. The man pleased with himself and others, become more confident and talkative. A feeling of muscular relaxation and physical comfort. Mimicry becomes more expressive, less precise movements.

Average stepen.Pri transition to moderate intoxication, instead of the good mood may be irritability, resentment, sometimes vicious and aggressive. The criticism to themselves and others down. Disturbed coordination of movements and gait. A person may commit impulsive acts unmotivated. It becomes slurred. Reduced pain and temperature sensitivity. After intoxication are usually marked symptoms of intoxication: heaviness in the head, and headache, thirst, weakness, fatigue, decreased mood with apathy or irritability. Memory for the period of intoxication is usually not disturbed. There are also atypical forms of intoxication, euphoria, when, instead of from the beginning of intoxication appears depressed mood, irritability to anger, frustration, which turns into aggression towards others. In some cases, it heightened the mood of motor excitation, silliness or caricature sharpening of character traits. Atypical forms of intoxication are usually observed in patients who had undergone in the past, traumatic brain injury who suffer from mental retardation, psychopaths.

Severe intoxication symptoms observed shutdown of consciousness - from stun to coma. Sometimes there are seizures. There may be involuntary urination and defecation. Such a state, as a rule, completely falls out of human memory.

Diagnosis of alcohol is carried out on the basis of clinical data, and special tests. Clinical criteria of intoxication are: bad breath, especially motor skills and speech, vegetative-vascular symptoms. Because the fact of alcohol is often hidden in order to avoid undesirable consequences, experts have to examine the content of alcohol in the blood, urine, using various rapid methods. They are also used display tubes moss-Shinkarenko to detect alcohol vapors in exhaled air.

Treatment. With an average degree of intoxication should wash out the stomach with a weak solution of potassium permanganate (1.5-2 l) and induce vomiting.

In severe intoxication assistance is provided in a hospital. Vomiting should not be called as can be aspirated (inhaled into the lungs) of vomit.

Pathological intoxication - acute mental disorder associated with alcohol. Usually develops in the streets with defective nervous system - epileptic encephalopathy, psychopathy, etc. Sometimes pathological intoxication can occur in those who showed no signs of intolerance to alcohol. In these cases, is of great importance prior to the influence of adverse factors (stress, enforced sleeplessness, fasting, excessive heat) that weaken the body's adaptive capabilities.

Symptoms and flow. Pathological intoxication may occur after ingestion of even small doses of alcohol (50-100 g) and manifested a kind of stupefaction. The behavior of the patient is not associated with the real situation and is fully determined by plot delusional experiences. Attention is drawn to the expressed emotion of fear, anger or rage. The patient is excited, it is either defensive, making a violent destructive acts, or attempts to flee to avoid the impending danger. The patient might attempt to commit suicide, having appeared in "hopeless" situation. The duration of the pathological intoxication - from several minutes to several hours. Typically, the excitation moves to the overall weakness, and deep sleep. The memory of what happened is completely absent. Persons who have committed the offense in a state of pathological intoxication, forensic psychiatric examination recognized as insane, so recognition of this form of psychosis is of great importance.

Alcoholism. The systematic use of alcohol can lead to disease with particular mental and somatic symptoms.

In the first stage of alcoholism, there is an irresistible craving for alcohol with the loss of quantitative control ("the loss of a sense of proportion"). Alcohol is also a manifestation of altered reactivity to alcohol in the form of increasing tolerance (tolerance) to alcohol and the transition to a systematic drunkenness. In case of overdose of alcohol starts to fall out of memory-related events over time with intoxication.

In the second stage of tolerance to alcohol reaches its maximum value (up to 1-2 liters of vodka a day). Formed hangover (withdrawal) syndrome, which occurs only after the first heavy alcoholic excesses, or after several days of hard drinking. Its essence lies in the fact that the day after "binge" drinking takes a small amount of bad feeling and relieves. In healthy people, the day after intoxication are symptoms of intoxication (see above), which may be aggravated by alcohol intake, which causes an aversion to alcohol.

Hangover manifests itself in the form of symptoms such as flushing of the face, redness of the sclera, palpitations, high blood pressure, sweating, pain in the heart, trembling in the body and limb tremors, weakness, fatigue. A number of patients having dyspepsia: abdominal pain, loss of appetite, nausea, vomiting, and diarrhea. Initially, patients in relation to the ethical and social circumstances may refrain from sober in the morning. However, this process can take place, and after work in the afternoon. Sometime during the day, the patient does not work, but dreams of a time when he could finally get drunk. With the passage of time to physical manifestations of mental hangover join. In the state of a hangover mood changes with the prevalence of depression, anxiety, fear. Have thoughts of his own guilt, the universal condemnation. Sleep becomes a surface with nightmares and frequent waking. Early appearance in a state of hangover of mental disorders, as well as their dominance over the somatic suggests the possibility of further development of psychosis. The maximum intensity of the phenomenon Abstinent reach for the third day of abstinence from alcohol. In the second stage of alcoholism patients drink a day for many years. Breaks in the drinking is usually determined by external circumstances: the lack of money, service complications, and family conflict. The attraction also to alcohol and physical abilities to continue drinking reserved.

The third stage of alcoholism. Reduced tolerance to alcohol. Intoxication comes from smaller than before, doses of alcohol. Many patients begin to use vodka instead of fortified wines. In these cases, the patient is constantly in a state of intoxication, though shallow. Along with the quantitative and situational control is lost. Alcohol is produced by any means, without the ethical and social norms of behavior. A number of patients abuse alcohol acquires the character of true drinking bouts that occur spontaneously in the irresistible attraction to alcohol. The first two days at the fractional consumption of alcoholic beverages is taken the maximum dose of alcohol. In the days that intoxication comes from smaller and smaller doses of alcohol in connection with violation of the exchange of ethyl alcohol in the body. Deteriorating physical and mental condition. There is loss of appetite, weight loss, drop in blood pressure, shortness of breath, speech, gait, seizures, limb, seizures. The deterioration of the physical condition makes it impossible to continue the bout. Therefore, over time binges are becoming shorter (2-3 days), and the intervals between them longer. Personality changes in alcoholism appear in the second stage and reach the level of alcohol in the third stage of degradation. A so-called alcoholic nature. On the one hand, it would be sharpened all the emotional reaction (grief, joy, resentment, admiration, etc.) by increasing the overall excitability. Then there slabodushie, tearfulness, especially in a state of intoxication. The patient cries of joy and grief. On the other hand, there is an emotional brutalization. The patient becomes selfish, indifferent to his wife and children. Disappearing sense of duty, responsibility, lost value of ethical conduct. All the patient's attention is focused on just one - how to get alcohol. Drunkenness is always underestimated, and embellished their personal qualities. The patient usually does not consider himself an alcoholic (or do not admit it to others), arguing that "everyone drinks" and it "all." At first, find excuses, excuses, trying to find excuses for drinking bouts. In this exhibit resourcefulness, lying in the arguments of their actions. In the future, the alcoholic no longer hide his desire to drink, drink to anyone, even not very suitable for this situation, ie lost situational control. To purchase alcoholic beverages used by any means. The patient begins to take things out of the house, sell them for nothing, steal, beg. Alcohol humor inherent in such patients, it is becoming more flat, primitive, cynically, as well as behavior in general. There are brutal (superfluous, antisocial) forms of response, such as aggression, anger, violence, frank cynicism. Increasingly, patients are resorting to the use of surrogates (denatured alcohol, cologne, medicinal tinctures, etc.).

Accompanies the progression of alcoholism and social decline. The patient loses skills, descends the ladder to the transition to low-skilled work, odd jobs and finally, a parasitic way of life. Family relationships are breaking down until the divorce, children usually do not want to talk with their fathers alcoholics. The family retained only in those cases where there is hope for a cure, change a life, or when both parents abuse alcohol (and sometimes attracted to it, and children from an early age). These changes usually occur after a person 40 years of seniority in alcohol for more than 20 years.

Alcoholism in teenagers. Quite frequently occurring phenomenon, particularly in those families where the weak control over the behavior of adolescents, as well as in families of alcoholics. Of no small importance that they have the spare cash that they have the opportunity to earn. It should be noted that alcoholism usually begins to develop in 13-15 years, at least - at an earlier age (children's alcoholism). Teenagers drink alcohol in the company of their peers, at least - adults (eg, at work, with parents). From the beginning, used large doses of alcohol, without self-control, to severe intoxication. Rapidly growing tolerance (tolerance), especially in a systematic, sometimes daily, taking alcohol. Pretty quickly formed a hangover, whose structure is dominated by mental disorders. The character is also changing rapidly, acquiring psychopathic traits. It is expressed either in increased excitability, explosiveness with aggressive manifestations, or in reducing the activity, initiative, and intellectual capabilities, apathy. In this age of frequent combination of alcohol with drugs. There are scenes of drug use ("on trial", "for fun").

Alcoholism in women. Distributed to a lesser extent than men, due to the historical society intolerant of women's drinking. In addition, women are to some extent conceal their alcohol problems, using alcohol alone or in a circle of close friends. Most suffer from alcoholism, middle-aged women (35 to 50 years), and, at first drink has the character of either episodic (situational), or cyclic, where women drink alcohol as a drug to enhance the mood, as a sedative to relieve tension, anxiety, , irritability, tearfulness, sleep disorders, which often occur before menstruation (premenstrual syndrome - see below). In the future, and in either case, acceptance of alcohol has become systematic (sometimes daily) or develop true binges. When a woman begins to appear in a state of intoxication (or hangover) at work or freshen the nip in the same circle of drunks in the early morning shopping at the "points", it shows nothing of the far come alcoholism and degradation of the individual. In these cases, usually strongly expressed moral degradation of women, reducing social interests with a concentration of only the production and reception of alcohol, emotional deepening of the loss of love for children and taking care of his own family, sexual disinhibition with random connections without regard to consequences.

If men are more likely to alcoholism associated cardiovascular disorders, in women - diseases of the gastrointestinal tract (pancreatitis, hepatitis, cholecystitis, gastritis).

The treatment of alcoholism. Successful treatment of alcoholism is only possible if the patient so desires. Given the fact that alcoholics, in most cases do not consider themselves as such, you must first spend with advocacy. If it can not be done in the family, you can use the services of doctors, drug treatment specialists, psychologists, psychiatrists. Treatment can be conducted on an outpatient basis or in hospital. The choice of treatment conditions on the one hand, is determined by the patient's desire, on the other hand, depends on his mental and physical condition. In cases of severe alcohol withdrawal syndrome, with marked physical and mental health problems, in the presence of psychotic episodes in the past, inpatient treatment is shown.

METHODS OF TREATMENT OF ALCOHOLISM.

At one stage, detoxification therapy, usually in cases where admission to the hospital pronounced hangover, or to stop binge. For detoxification using various means, primarily using the parenteral route of administration (intravenous or intramuscular). Use unitiol, magnesium sulfate, vitamins B1, B6, C, nootropics (nootropil, piracetam, pirroksan). When expressed mental disorders and prescribe tranquilizers (Seduxenum, relanium, phenazepam, tazepam). Sleep disorders radedorm used, and in cases of insomnia with nightmares, fear, anxiety - barbiturates (Barbamyl, Luminal). The patient was recommended to drink plenty of liquids (mineral water, juices, fruit drinks) with a simultaneous appointment of diuretics. In severe somatic disorders (diseases of internal organs), and the patient consults a physician appointed by the additional treatment aimed at the elimination of certain disorders. Should be nutritious, vitamin-rich food. When a patient is prescribed a strong depletion of small (4-6 IU) dose of insulin to increase appetite.

Upon reaching the good state of mental and physical, conduct anti-alcohol treatment. His choice made, together with the patient and his relatives, due to the nature and implications of the proposed techniques. Throughout the treatment process should be applied psychotherapy, promoting, making installation a patient for treatment and sober lifestyle. The treatment will be effective only when the patient believed the doctor when the necessary contacts, mutual understanding and trust.

One method of treatment is a conditioned reflex therapy. The method consists in the elaboration of conditioned reflex reactions such as vomiting, taste or smell of alcohol. This is achieved by the combined use of emetic drugs (broth Barantsev, apomorphine injection) and small amounts of alcohol. Treatment is carried out every day or two. In the course of treatment - 20-25 sessions. The most effective conditioned reflex therapy in patients with a stage, and especially women, are usually poorly tolerate vomiting, and reacting with disgust at the very medical procedure.

The method of sensitizing therapy. Its purpose is to suppress craving for alcohol and creating conditions for the forced abstinence from alcohol. The patient was given daily drug Antabuse (teturam), which in itself is harmless. However, when ingested alcohol (even small amounts of beer, wine), there is a reaction of the consequences of which can be very severe and unpredictable. One option for this type of therapy is to create a depot of drug in the body, which is implanted subcutaneously or intramuscularly (usually in the gluteal region) esperal drug. Esperal is 10 tablets, coated with a special envelope, sealed in a sterile bottle. The reaction to the drug in the body occurs only in the case of alcohol. There are deaths. Possible consequences of violations of sobriety the patient is warned of what he gives a receipt, which, in turn, the doctor is a legal document justifying his actions.

Psychotherapy is applied to the first visit to the doctor and the patient is accompanied by the whole process of treatment. Advocacy psychotherapy aimed at explaining the nature of the disease, its damage and adverse effects, development of installation of treatment and long-term sobriety. The patient should understand that drinking "all" he was not able to, and that without the help of a doctor it is not enough. In addition to psychotherapy, advocacy, and other techniques are used.

Hypnotherapy (hypnosis) - suggestion in a state of hypnotic sleep. It is shown that patients can easily suggestible, and believing in the efficacy of this method. It is used either individually or in specially selected groups (group hypnosis).

Particular form of psychotherapy is to encode. Methods of copyrights, which has exclusive rights to the doctors.

Group rational psychotherapy. For this type of treatment selected a small group of patients (about 10 people.), United by common psychological and social problems that contribute to the establishment of emotional bonds between them, a sense of mutual trust, membership of a particular group. Patients with a doctor and discuss among themselves a variety of life issues, primarily related to alcoholism. Joint discussion of various issues allows patients to take another look at ourselves, evaluate their behavior. The special atmosphere of mutual respect and trust can develop a certain style of life, with others (temperance), attitudes and aspirations, to believe in themselves and their capabilities.

Remission and relapse. After being discharged from the hospital the most difficult for the patient are the first 1-2 months, when it comes to adapting to the new role of teetotaler. During this period it is necessary to rehabilitate at work, build relationships within the family, compose a "legend" for his companions to justify a sober lifestyle. Moral support in the family, from friends, employees - a necessary condition for the formation of high-quality remission.Craving for alcohol may persist for quite some time, depending on the severity of the disease. It is usually accompanied by the same autonomic and mental disorders that have been observed in a state of hangover. Therefore, this condition occurs on a background of absolute sobriety is psevdoabstinentnym syndrome. The patient becomes irritable, flutter "breaks" at his wife and children, could find no rest. The doctor usually makes recommendations on discharge, what to do in such cases that there was no "failure" - a return to drinking. If the recommendations were not, should seek medical attention and may undergo prophylactic treatment. The easiest way to prevent alcohol abuse, if there was a desire "to drink", you must close and delicious food and famous play in the stomach, as is known, is the desire disappears. In addition, you need to take, a sedative, (Seduxenum, phenazepam, sonapaks - table 1-2.), And take them on a regular basis to improve the condition and the disappearance of craving for alcohol. Psychotropic medications and their doses should be agreed with the doctor.