And whether you know...
June 4, 2011
Alcoholism – the disease arising at a systematic alcohol abuse is characterized by mental dependence in intoxication, somatic and neurologic disturbances, degradation of the personality. The disease can progress also at abstention from alcohol.
In the CIS 14% of adult population abuse alcohol and another 80% are moderated take alcoholic drinks that is caused by the certain drinkable traditions created in society.
Often lead such factors as the conflicts with the family, an unsatisfactory standard of living, inability to implement themselves in life to abuse. At young age alcohol is used as a way to feel internal comfort, courage, to overcome shyness. It is in the middle age used as a way to take off fatigue, a stress, to leave from social problems.
The constant appeal to this way of relaxation results in resistant dependence and inability to feel internal comfort without alcoholic intoxication. On degree of dependence and symptoms distinguish several stages of alcoholism.
First stage of alcoholism. Increase of doses and frequency of alcohol intake is characteristic of the first stage of a disease. There is a syndrome of the changed reactivity at which portability of alcohol changes. Defense reactions of an organism from overdose disappear, in particular there is no vomiting at the use of high doses of alcohol. At strong intoxication palimpsests – memory blackouts are observed. Psychological dependence is shown by feeling of dissatisfaction in a sober state, constant thoughts of alcohol, a mood raising before alcohol intake. The first stage lasts from 1 year to 5 flyings, at the same time the inclination gives in to control as there is no syndrome of physical dependence. The person does not degrade and does not lose ability to work.
Complications at alcoholism of the first stage first of all are shown from a liver, there is alcoholic fatty dystrophy. Clinically it is almost not shown, in certain cases there can be a feeling of overflow of a stomach, a meteorism, diarrhea. It is possible to diagnose complication on increase and a plotnovaty consistence of a liver. At a palpation the liver edge is rounded, it is a little sensitive. At abstention these signs disappear.
Complications from a pancreas is acute and chronic pancreatitis. At the same time abdominal pains which are localized at the left are noted and irradirut in a back, and also loss of appetite, nausea, a meteorism, an unstable chair. Often the alcohol abuse carries out to alcoholic gastritis at which there is also no appetite and there are nausea, painful feelings in epigastric area.
Second stage. Alcoholism of the second stage has the period of progressing from 5 to 15 years and is characterized by strengthening of a syndrome of the changed reactivity. Portability of alcohol reaches a maximum, there are so-called pseudo-hard drinkings, their frequency is connected not with attempts of the patient to get rid of addiction to alcohol, and with external circumstances, for example, lack of money and impossibility to get alcohol.
Succeeds sedation of alcohol activating, memory blackouts at the use of a large amount of alcohol are replaced by full amnesia of the end of intoxication. At the same time daily alcoholism is explained by existence of a syndrome of mental dependence, in a sober condition of the patient loses ability to mental work, there is a disorganization of mental activity. There is a syndrome of physical alcohol addiction which quashes all feelings except an inclination to alcohol which becomes uncontrollable. The patient is suppressed, irritable, disabled, after reception of alcohol these functions become into place, but control over amount of alcohol is lost that results in excessive intoxication.
Treatment of alcoholism at the second stage has to be carried out in a specialized hospital, the narcologist or the psychiatrist. Sharp refusal of alcohol causes such somatoneurologic symptoms of alcoholism as an exophthalmos, a mydriasis, a hyperemia of upper part of a trunk, a tremor of fingers, nausea, vomiting, eases of intestines, pain in heart, a liver, headaches. There are mental symptoms degradation of the personality, weakening of intelligence, crazy ideas. Often there are an alarm, night concern, convulsive attacks which are harbingers of acute psychosis – the tremens, in the people called "delirium tremens".
Complications at alcoholism of the second degree from a liver are provided by alcoholic hepatitis, often a chronic form. The disease meets in a persistent form more often, than progressing. As well as complications at the first degree, hepatitis is a little shown by clinical symptoms. It is possible to diagnose complication on gastrointestinal pathology, there is a weight in epigastric area of a stomach, the right hypochondrium, slight nausea, a meteorism is observed. At a palpation the liver condensed, increased and a little painful.
Alcoholic gastritis at the second stage of alcoholism can have the symptoms masking under displays of an abstinence syndrome, difference is painful numerous vomiting in the mornings, is frequent with blood impurity. At a palpation morbidity in epigastric area is observed.
After long hard drinkings the acute alcoholic myopathy develops, weakness, hypostases in muscles of hips and shoulders appear. Alcoholism most often becomes the reason of heart diseases not of ischemic character.
Third stage. Alcoholism of the third stage considerably differs from two previous, duration of this stage of 5-10 years. It is a final stage of a disease and as practice shows, most often it comes to an end letalno. Portability of alcohol decreases, intoxication comes after small doses of alcohol. Hard drinkings come to an end with physical and psychological exhaustion.
Multi-day alcoholism can be replaced by long abstentions or systematic daily alcoholism remains. There is no activating effect of alcohol, intoxications come to an end with amnesia. Mental dependence has no the expressed symptomatology as at the third stage of alcoholism there are profound mental changes. Physical dependence is in return shown quite strongly, defining way of life. The person becomes rough, selfish.
In an ebrietas emotional instability which represents alcoholism symptoms, gaiety, irritability, rage is shown it is unpredictable replace each other.
Degradation of the personality, decrease in mental abilities, not working capacity, lead to the fact that the alcoholic, without having funds for alcoholic drinks, uses substitutes, sells things, steals. As denatured alcohol, cologne, polish, etc. lead the use of such substitutes to heavy complications.
Complications at alcoholism of the third stage are most often provided by alcoholic cirrhosis. Two forms of alcoholic cirrhosis – the compensated and dekompensirovanny form are observed. The first form of a disease is characterized by persistent nervous anorexia, a meteorism, fatigue, is lowered - apathetic mood. There is a thinning of integuments, on them white spots and vascular asterisks appear. The liver is increased, dense, has a keen edge.
Appearance of the patient strongly changes, there is a sharp weight loss, a hair loss.
The Dekompensirovanny form of cirrhosis differs by three types of clinical symptoms. Treat them a portal hypertension which brings to hemorrhoidal and ezofagalny bleeding, ascites – accumulation of liquid in an abdominal cavity. Jaundice at which the liver is considerably increased is often observed, in hard cases there is a liver failure, to development of a coma. The increased content of melanin is found in the patient that gives to skin an icteric or earthy shade.
Diagnosis of alcoholism
The diagnosis alcoholism can be suspected on appearance and behavior of the person. Patients look is more senior than the years, over the years the person becomes hyperemic, turgor of skin is lost. The person takes a special form of strong-willed dissoluteness, because of slackness of a circular muscle of a mouth. In many cases untidiness, negligence in clothes is observed.
Diagnosis of alcoholism in most cases is quite exact, even in the analysis not of the most sick, but its environment. At members of the family of the alcoholic a number of psychosomatic frustration, neurotization or a psikhotization of the teetotal spouse, pathology at children is observed. The most frequent pathology at children whose parents abuse alcohol systematically is inborn small brain insufficiency. Often such children have excess mobility, they are not concentrated, have thirst for destructions and an agressive behavior. Except inborn pathology development of the child is influenced also by the psychoinjuring situation in a family. The logoneurosis, enuresis, nightmares, frustration of behavior is found in children. Children are depressive, are inclined to attempts of a suicide, they have often difficulties with training and communication with peers.
In many cases at the pregnant women abusing alcohol the birth of an alcoholic fruit is observed. The alcoholic syndrome of a fruit is characterized by gross morphological violations. Most often pathology of a fruit consists in irregular shape of the head, proportions of a body, the spherical deeply put eyes, an underdevelopment of jawbones, shortening of tubular bones.
Treatment of alcoholism
We already in brief described treatment of alcoholism depending on its stages. In most cases after treatment there can be a recurrence. It is connected with the fact that treatment is often directed only to elimination of the most acute displays of alcoholism. Without correctly carried out psychotherapy, lack of support from close people, alcoholism recurs. But as practice shows, the psychotherapy is an important component of treatment.
The first stage of treatment of alcoholism consists in elimination of the acute and subacute states caused by organism intoxication. First of all interruption of hard drinking and elimination of abstinent frustration is carried out. At late stages therapy is carried out only under supervision of medical personnel as the delirichesky syndrome arising at hard drinking interruption demands psychotherapy and a number of sedative drugs. Stopping of acute alcoholic psychosis consists in fast immersion of the patient in a dream with dehydration and support of cardiovascular system. In cases of a heavy drunkenness treatment of alcoholism is carried out only in specialized hospitals or in psychiatric departments. At early stages antialcoholic treatment can be enough, but more often at refusal of alcohol there is a deficit of neuroendocrinal regulation, the disease progresses and leads to complications and organ pathology.
The second stage of treatment is directed to remission establishment. Full diagnosis of the patient and therapy of mental and somatic disturbances is carried out. Therapy at the second stage of treatment can be rather peculiar, its main task to eliminate somatic disturbances which are key in formation of pathological thirst for alcohol.
Carry Rozhnov's technique which consists in emotional and stressful therapy to not sample methods of therapy. The good forecast in treatment gives hypnotic influence and psychotherapeutic conversations preceding it. During hypnosis to the patient disgust for alcohol, toshnotno-emetic reaction to taste and a smell of alcohol takes root. The method of verbal aversivny therapy is quite often used. It consists in setup of mentality by method of verbal suggestion, to answer with emetic reaction to alcohol intake, even in the imagined situation.
The third stage of treatment means extension of remission and return of normal way of life. This stage can be considered as the most important in successful treatment of alcoholism. After two previous stages, people returns to former society, to the problems, friends who in most cases also alkogolno dependent, to the family conflicts. It more influences a palindromia. In order that the person could remove independently the causes and external symptoms of alcoholism the long psychotherapy is required. Autogenic trainings give a positive effect, they are widely used for group therapies. Training consists in normalization of vegetative disturbances and removal of an emotional pressure after treatment.
Behavioural therapy, so-called correction of way of life is applied. The person learns to live in a sober state, to solve the problems, gaining skill of self-checking. Very important stage in recovery of normal life activity is achievement of mutual understanding in a family and understanding of the problem.
For successful treatment it is important to achieve from sick desire will get rid of alcohol addiction. Compulsory treatment does not yield such results as voluntary. But nevertheless refusal of treatment demands from the local narcologist of the forced direction of the patient on treatment in LTP. Therapy in an all-medical network does not yield positive takes as the patient has open access to alcohol, he is visited by drunk friends, etc.
In a case when the alcohol abuse began at mature age, the individual approach in the therapy choice is required. It is connected with the fact that somatoneurologic symptoms of alcoholism appear emergence of dependence and mental disorders much earlier.
Mortality at alcoholism is most often connected with complications. There is a decompensation of vitals caused by long hard drinking, abstinent states, intercurrent diseases. 20% of elderly alcoholics have symptoms of epilepsy, the acute syndrome of Gayet-Vernique meets a little less often. Attacks of both diseases at alcoholic intoxication can be deadly. Existence of an alcoholic cardiomyopathy considerably worsens the forecast. Continuation of systematic alcohol intake brings into mortality.
Less than 25% of the patients having this complication live longer than three years after statement of the diagnosis.
The high mortality percentage in alcoholic intoxication occupies death as a result of a suicide. It is promoted by development of a chronic gallyuzinoz, alcoholic paraphrenia, nonsense of jealousy. The patient is not capable to control crazy thoughts and makes acts unusual in a sober state.