What is the alcoholic addiction?
So has already developed historically that some diseases are surrounded by series of myths which frequently prevent to perceive to the person that to it descends and to revert behind the qualified help. Alcoholic dependence – the chronic disease educing as a result of the long use of alcohol and showing pathological appetence to the use of alcohol, psychotic episodes, various disturbances of activity of an internal and degradation of the person in final stages of disease. It is formal all chronic diseases are incurable. So it is received, can be them and there is no sense to treat, time absolutely they do not pass? For any chronic disease there are two components is a remission and an exacerbation. Remission is a state when the person feels well, it is the calm season between two exacerbations. There is essential plus, and it consists that the remission state can last during all life. And why then remission, instead of recover? That is why that if the person suffering by alcoholic dependence, even “having fastened” for some years, will iterate the alcohol use, it will quickly return besides to a state that was earlier (for example, the drinking-bout) again will begin.
The uniform cause of occurrence of an alcoholism as illnesses – is not present. An appreciable role here play biological, psychologic and social factors. The leading biological factor – genetical predisposition (heredity). Psychologic factors it is those features of the person which prevent to find comfort in the present world, harmoniously to fall into to itself and associates, to frame warm, confidential attitudes. Better to say, those features which force to search for the person harmony in a virtual reality of intoxication instead of to change something in itself, the attitude. Social factors are diverse, they include also that is imposed, in the form of ideals by TV, the press, radio; traditions and customs of monogynopaedium; the attitude to alcohol in significant bunch of contemporaries. One of the most important factors is education in parent monogynopaedium because so-called «the family scenario» there is put. For example, if to the child it is constantly declared what to drink badly, but the father after a pay and advance payment regulary leaves in a drinking-bout, and mum valorously «nurses it», it is not enough hope that already having matured, the yielded person will adequately fall into to alcohol not at declaration level, and at level of mechanisms of behaviour, the decision of intrafamily problems. Besides genetics and psychologic factors craniocerebral traumas, neuroinfections influence development and disease passing. The alcoholism is often combined with other alienations which can be its cause or a consequence. More often patients suffer depression, risk of suicide at them of 15 %. Life of patients because of series of somatic complications is truncated for 10 years in comparison with other population. The mortality is greatest from a heart failure, an idiopathic hypertensia, strokes and a cirrhosis. However, for the alcoholic of illness and early mors are routinely accepted as something not falling into to it, and an event only with other people.
Clinical exhibitings
Why for many patients alcohol becomes such serious problem?
The part of people tries to correct the state of mind (to enrich mood to reduce alarm to recover a sleep to leave from daily problems) by means of alcohol. Also the impression is made that alcohol helps, and the alcoholism problem seems illusive and concerning everybody only not itself. One of the most dangerous symptoms of dependence is the alcoholic anosognosia – the beautiful florid medical term designating clear enough phenomenon – disturbance of an adequate assessment of the state, routinely combined with disease negation. Is present at all people, suffering dependence on alcohol, but at someone it is expressed in larger, and at someone to a lesser degree.
Let’s result a household scale of expression of the yielded symptom.
Maximum. The drunk person rolls in a pool at the underground. On a question why he drinks, answers that at us the country such, the wife mean of the house has expelled, the chief from work has dismissed. That is at all round a problem, and at it all in norm.
Hardly a smaller degree of manifestation. «It at me drinking-bouts? Yes I for work go, and here at my neighbour Sashi, Vasi, Roofing felts, Peti, here at it drinking-bouts, it on a month the drunk rolls!». That is who drinks comparison of to someone more. And if there is no such person in an environment always it is possible and to think up. After all to find the one who drinks more yes it lives worse not a problem, it is cleverer to meet itself!
Or other variant of an old song about the main thing: «the Doctor, yes you did not see as drink! You to a bar approach there drunks and will see. I do not drink technical alcohol, but only noble beverages – vodka, cognac».
And last more or less soft variant. «Yes dependence most likely is not present, has simply started to afford more. So, laxity, delicacy of character» there is more.
And now yield together we will think, why the alcoholic anosognosia is such dangerous symptom? By itself the answer arises, after all if the person does not realise the problem with what then to struggle, what it can variate in the life?
If the person who never took alcohol earlier, drinks 250 grammes of vodka it is routine after that the intoxication begins: the head is ill, as a whole it is very bad. All it descends because the organism struggles with foreign material, a poison. More often after a similar venenating the person any time does not drink. But then notices that if to drink a bit less or to use less a hard liquor there are pleasant sensations, and obvious signs of a venenating are not present. The Root of all evil consists that alcohol practically yields everyone though also virtual, but subjectively pleasant sensations. At one the strain drops, the provoked person can be abirritated, selfcontained starts to communicate, constraining to get acquainted with the person of an opposite sex easier. By means of this mechanism psychologic dependence on alcohol starts to be formed. The neglect concerns precursory symptoms of formation of alcoholic dependence interests of monogynopaedium and work in favour of time carrying out in “the using” company. Occurs more causings for the alcohol use, the circle of friends which «too wish» is formed. Gradually varies not only behaviour, but also physiological reaction of an organism. At first the person notices that former doses of alcohol any more do not yield that intoxication, as earlier. On a professional slang it is called as tolerance or fastness growth. From the point of view of physiology it means that the organism starts to adapt to a poison. Vomitive jerk vanishes at the use of the big doses of alcohol. The person starts to tolerate appreciable doses of alcohol without notable consequences. In the people it sometimes ascends in a rank of merits «what strong healthy muzhik – can drink one and a half litre of vodka and though that». The healthy person cannot «drink one and a half litre of vodka and though that»! Exhibitings of growing dependence affect not only the moment of the use of alcohol, but also in those seasons while the person does not drink already sleep disturbances, weakness, slackness show. The majority of patients is not bound by the yielded changes to a previous alcoholization and accept alcohol as “medicine”. From memory separate episodes of intoxication can disappear. Gradually more and more values and significant events their realities are tolerated to the illusory world of intoxication.
If on incipient states the syndrome of a pathological appetence to alcohol fractionally joins prevails, and starts to occupy a larger specific gravity an acute alcoholic abstinent syndrome. A withdrawal (an alcoholic abstinence) – the complex of distresses affecting an internal, the excitatory system and the psychics, arising through 24 – 48 hours after the termination of reception of alcohol and lasting on the average during 5 – 7 days. The most typical signs are: a tremor of arms, weakness, a sweating, thirst, absence of appetite, alarm, mood depression, a sense of guilt, sleep distress, a pathological appetence to binge. From diseases of an internal the exacerbation accompanying or resulting abuse by alcohol of lesions of a liver, a gastritis, a pancreatitis, a cardiopathy, an idiopathic hypertensia etc. becomes perceptible. The most serious exhibiting of a withdrawal are acute alcoholic psychoses, most widespread of which tremens (delirium tremens). On depth of pathological alterations excrete deliriums light, moderately severe and serious (B.S.Frolov, 1970). A moderately severe delirium B.S.Frolov names “classical”. It is preceded by long drinking-bouts or continuous drunkenness lasting by months. Distresses of a sleep with dreadful dreamings and awakening with pavor, a sweating, increase of beats of heart are considered as harbingers. The psychosis begins with excitation, motorial and speech excitation, flows of figurative, is sensual-evident representations and memoirs. Then there are visual illusions which against a plane, for example, wall-paper on a wall, take the form of changeable fantastic landscapes, persons of the people, unusual animals. Sometimes there are visual hallucinations deprived of dimensions:« Cinema on a wall ». Further there comes a full sleeplessness and in a clinical pattern visual hallucinations, more often in the form of various hexapods and small animals start to prevail. Can occur and modes of humanoids, devils, dead persons, etc. The behaviour is characterised by fussiness, disturbing, flight, desire to hide. Speech consists of short words, phrases; patients speak not so much, how many show that see. Duration of a classical delirium from 2 till 8 days. Serious deliriums are accompanied by the expressed distresses of an internal and the excitatory system and quite often conclude a lethal outcome. Besides a tremens there are other variants of the alcoholic psychoses which description is not included now into our problems.
Formally, on new classification of illnesses , the diseased can consider only the person at whom physical dependence on alcohol was generated. The yielded position is not indisputable, after all for timely treatment revealing of earlier stages of dependence is important. The cancellation physiological state arises, when alcohol reception is stopped or decreases, to what the characteristic withdrawal or utilisation of alcohol or other material for simplification or prevention of occurrence of symptoms of cancellation at comprehension of testifies that it is effective. At a stage of physical dependence drinking-bouts last from several days about several weeks; their occurrence is is more often connected to situational factors (celebrations, salary reception, etc.). At the yielded stage of disease there is an accentuation of features of the person, sick becomes superficial in the judgements, indifferent in the decision of the important vital questions, false.
To a disease end-stage there is a depression of shipping of alcohol, for comfort achievement already smaller doses are demanded. True drinking-bouts begin with a primary pathological appetence, have strictly cyclic character, some days proceed, are accompanied by serious disturbances from outside an internal and full disability. At this stage there comes an alcoholic deterioration of the person.
Research methods
At alcoholism diagnostics in incipient states the clinical method is used. For a long time and to this day the most important still have conversation of the doctor with the patient in which course the doctor defines a disease stage, schedules stages of treatment and discusses them with the patient. At the subsequent stages when the withdrawal is clinically defined, including. Laboratory tests and tool methods. Urine analysis, definition concern them in urine of psychoactive materials, an electrocardiography, thorax roentgenography, a series of tests for functioning of a gastrointestinal tract clinical analysis of a blood with definition of the maintenance of electrolytes, calcium, magnesium, a biochemical blood analysis with definition of indexes of function of a liver. Under indications effect an electroencephalography, a computer tomography, neurolymph research.
Treatment of alcoholic dependence
At the initial stages treatment out-patient, with utilisation of the complex psychotherapeutic approach referred on revealing of the intrinsic causes of an alcoholization and on the decision of intrafamily and professional problems. Very important stage is overcoming of an alcoholic anosognosia and motivation of the patient on applying of own efforts for maintenance of a sober mode of life. Unfortunately, patients are is more often oriented on «a magic wand which for one session will blast an alcoholic majorant». At similar methods of treatment the patient does not act as the awake participant of medical process. All responsibility for the subsequent relapses is tolerated on the doctor-psychotherapist. The patient does not perceive that much depends on it and it is required not simply «not to drink year», and awakely to change itself, the stereotype of thinking, not adaptable forms of behaviour, mechanisms of the permission of intrafamily problems. Withdrawal treatment (alcoholic abstinent syndrome) is made in a stationary conditions, under the control over indexes of the vital functions and includes intravenous dropping introduction of disintoxication agents: drugs of a potassium, diuretics, cardiovascular drugs, vitamins. Medicamental treatment can be referred on depressing, senses of pleasure of alcohol received at the use. At the moment there were drugs which are introduced intramusculary and react month. Thus, the conditioned reflex starts to be blasted: the alcohol use – pleasure reception. Awake medicamental antialcoholic treatment, can be referred on development of disgust for alcoholic beverages, it includes a summer residence of drugs which in a combination to alcohol reception invoke vomiting. At the moment such drugs it is used infrequently. Sensitising therapy consists in accumulation in an organism of medicinal material which at a combination to an alcohol summer residence invokes a pulsing in temples, sense of gravity in a head, difficulty of breath. The bolstering out-patient treatment includes work with the psychotherapist or the expert in narcology having psychotherapeutic preparation. Together with the expert to move forward easier, recovering the life and to overcome catchers which with enviable insidiousness are placed by dependence. The effective bolstering factor is visitation of bunches of mutual aid which at us, unfortunately, have received less a wide circulation than abroad. The primary goal of treatment is adequate comprehension of the illness, understanding of that as it can provoke the person and long maintenance of motivation to a sober mode of life.