Alcohol is the most widely available and culturally acceptable substance of abuse. 90% of people in most western societies consume alcohol, and alcohol problems occur in 30% of drinkers.
The definition of alcoholism refers to repeated impairments in different areas of a person’s existence, due to alcohol, despite which the person continues to consume alcoholic beverages.
Disorders associated with alcohol consumption can be classified into 3 groups:
- Disorders related to the direct effects of alcohol on the brain: intoxication, withdrawal, withdrawal delirium and alcoholic hallucinosis
- Alcohol-related behavior disorders: abuse and addiction
- Disorders with persistent effects: alcoholic dementia, Wernicke’s encephalopathy, Korsakoff’s syndrome
Epidemiology of alcohol consumption:
- Drank at least once – 90%
- Drink now – 60-70%
- Temporary problems -40%
- Abuse – men 10%, women 5%
- Addiction – men 10%, women 3-5%
- Genetic hypothesis: close relatives of alcoholics are 4 times more likely to have problems with alcohol consumption
- Psychological hypothesis: the anxiolytic, antidepressant and relaxing effect of alcohol can be an easy solution to manage stress or traumatic situations
- Behavioral hypothesis: alcoholism is a behavior learned through rewarding and strengthening started after the first contact with alcohol.
Signs and symptoms:
- Tolerance – manifested by the need to ingest larger and larger quantities to achieve the desired effect.
- Withdrawal – at the sudden cessation of consumption there are specific physical and mental signs that disappear if alcohol is consumed. Signs are: anxiety, psychomotor anxiety, sweating, tremor in the extremities, general malaise, nausea, vomiting.
- There are successive efforts to reduce or stop alcohol consumption, but which are unsuccessful.
- time and money are invested to obtain or consume alcohol, but also to recover from its effects.
- Other daily activities are gradually abandoned in favor of consumption.
- There is a clinically significant impairment of social and personal functioning.
- Alcohol use is continued despite awareness of the problem or the occurrence of physical complications.
Complications of alcohol dependence:
- Digestive: hepatic steatosis, risk of acute pancreatitis, esophagitis, gastritis, liver cirrhosis.
- Cardiovascular: hypertension, alcoholic cardiomyopathy with heart rhythm disorders that can become fatal.
- Neurological: peripheral neuropathy, hepatic encephalopathy with confusion, agitation
- Psychiatric: simple or complicated withdrawal syndrome, alcoholic dementia, alcoholic depression.
The objectives of the treatment are:
- Increasing the motivation for abstinence
- Stabilization of acute physical or psychiatric conditions
- Identifying social support resources and correcting them
- Improving professional integration
- Increasing the chances of successful treatment by maintaining adherence to post-treatment structures or self-help groups, such as Alcoholics Anonymous
- Prolonged support for restructuring an alcohol-free life and reducing the risk of relapse
Tratamentul sevrajului la alcool
Sevrajul apare la circa 12 ore de la ultima ingestie de alcool și atinge un maxim de intensitate în 48-72 de ore.Reprezintă o urgență medicală care poate genera deces în lipsa unei conduite terapeutice adecvate .
Presupune revitaminizare cu preparate care să conțină obligatoriu vitamina B1, administrare de preparate minerale cu zinc, magneziu, vitamina D, hidratare orală și/sau I.V.
Benzodiazepinele de tip diazepam sau lorazepam sunt cele mai utilizate. Dozele sunt ajustate de medicul psihiatru în funcție de severitatea simptomelor, cantitatea de alcool ingerată zilnic și perioada de consum, gradul de afectare al ficatului sau alte organe cu risc vital.
Treatment of alcohol withdrawal
Withdrawal occurs about 12 hours after the last alcohol ingestion and reaches a maximum intensity in 48-72 hours. Represents a medical emergency that can cause death in the absence of proper therapeutic conduct.
It involves revitaminization with preparations that contain vitamin B1, administration of mineral preparations with zinc, magnesium, vitamin D, oral hydration and / or I.V.
Benzodiazepines such as diazepam or lorazepam are the most commonly used. Doses are adjusted by a psychiatrist based on the severity of symptoms, the amount of alcohol ingested daily and the period of consumption, the degree of damage to the liver or other vital organs.
Maintaining total abstinence primarily involves the patient’s acceptance of the existence of a problem related to alcohol consumption.
Alcoholic anonymous group therapies and family therapy are effective.
Disulfiram – Antalcohol – is a drug that generates an extremely unpleasant reaction to ingestion of even a small amount of alcohol, with throbbing headaches, sweating, anxiety, difficulty breathing, weakness, confusion. Rarely, complications can occur that can lead to death.
Naltrexone – Revia – decreases the desire to consume alcohol, thus helping the patient to remain abstinent. It is much more effective as part of a complex intervention program to which is added psychotherapy.
Acamprosate – increases abstinence rates.
Most psychiatrists recommend that the alcohol-dependent patient stay abstinent for life and discourage attempts to drink normally.