Alcoholism – a disease at which physical and mental dependence on alcohol is observed. Is followed by the increased thirst for alcohol, inability to regulate quantity drunk, tendency to hard drinkings, developing of a pronounced abstinence syndrome, decrease in control over own behavior and motivations, the progressing mental degradation and toxic damage of internals. Alcoholism – the irreversible state, the patient can stop reception of alcohol only completely. The use of the slightest doses of alcohol even after the long period of abstention causes failure and further progressing of a disease.
Alcoholism – the most widespread kind of toxicomania, the mental and physical dependence on reception of etanolsoderzhashchy drinks which is followed by the progressing degradation of the personality and characteristic damage of internals. Experts consider that prevalence of alcoholism is directly connected with increase in the standard of living of the population. In the last decades the number of patients with alcoholism grows, according to WHO data now in the world there are about 140 million alcoholics.
The disease develops gradually. The probability of developing of alcoholism depends on a set of factors, including – features of mentality, a social environment, national and family traditions, and also genetic predisposition. Children of the people having alcoholism become alcoholics more often than children of teetotal parents that can be connected with certain traits of character, is hereditary the caused features of metabolism and formation of the negative vital scenario. Teetotal children of alcoholics quite often show tendency to sozavisimy behavior and form families with patients with alcoholism. Treatment of alcoholism is performed by experts in the field of narcology.
Metabolism of ethanol and development of dependence
The main component of alcoholic beverages – ethanol. The small number of this chemical compound is a part of natural metabolic processes in a human body. Normal the content of ethanol makes no more than 0,18 per milles. Exogenous (external) ethanol is quickly soaked up in a digestive tract, comes to blood and exerts impact on nervous cages. The maximum of intoxication comes in 1,5-3 hours after reception of alcohol. At reception of too high dose of alcohol there is an emetic reflex. In process of development of alcoholism this reflex weakens.
About 90% of the accepted alcohol are oxidized in cages, is split in a liver and brought out of an organism in the form of the final products of metabolism. The remained 10% are allocated in not processed look through kidneys and lungs. Ethanol is removed from an organism approximately within a day. At chronic alcoholism intermediate products of splitting of ethanol remain in an organism and exert negative impact on activity of all bodies.
Development of mental dependence at alcoholism is caused by influence of ethanol on nervous system. After acceptance of alcohol of people feels euphoria. Uneasiness decreases, the level of self-confidence increases, it becomes easier to communicate. In fact, people try to use alcohol as simple, available, high-speed antidepressant and antistressful means. As "the single help" this way sometimes really works – the person temporarily removes stress, feels happy and weakened.
However alcohol intake is not natural and physiologic. Over time the need for alcohol increases. The person, without being an alcoholic yet, begins to take regularly alcohol, without noticing gradual changes: increases in a necessary dose, emergence of memory blackouts etc. When these changes become significant, it turns out that psychological dependence is already combined with physical and to refuse independently reception of alcohol very difficult or it is almost impossible.
Alcoholism – the disease which is closely connected with social interactions. At the initial stage people quite often take alcohol owing to family, national or corporate traditions. In the drinking environment it is more difficult for person to remain the nondrinker as the concept of "normal behavior" is displaced. At socially successful patients alcoholism can be caused by the high level of a stress at work, tradition "to wash" successful transactions etc. However regardless of the prime cause of a consequence of regular alcohol intake will be identical – there will be alcoholism with the progressing mental degradation and deterioration in the state of health.
Alcohol intake consequences
Alcohol has the oppressing effect on nervous system. In the beginning there is an euphoria which is followed by some excitement, decrease in criticism to own behavior and the taking place events and also deterioration in coordination of movements and delay of reaction. In the subsequent excitement is replaced by drowsiness. At reception of high doses of alcohol the contact with the world around is more and more lost. The progressing absent-mindedness of attention in a combination to decrease in temperature and painful sensitivity is noted.
Expressiveness of motive violations depends on intoxication degree. At heavy intoxication the rough static and dynamic ataxy is observed – the person cannot keep vertical position of a body, its movements are strongly not coordinated. Control over activity of pelvic bodies is broken. At reception of excessive doses of alcohol there can be a weakening of breath, violation of warm activity, a sopor and a coma. Death is possible.
At chronic alcoholism the typical defeats of nervous system caused by long intoxication are noted. During an exit from hard drinking can develop alcoholic deliriya (delirium tremens). Slightly more rare alcoholic encephalopathy (gallyutsinoza, crazy states), depressions and alcoholic epilepsy are diagnosed for the patients having alcoholism. Unlike alcoholic the deliriya, these states are not necessarily connected with the sharp termination of the use of alcoholic drinks. At patients with alcoholism gradual mental degradation, narrowing of a focus of interest, disorder of cognitive abilities, decrease in intelligence etc. comes to light. At late stages of alcoholism the alcoholic polyneuropathy is quite often observed.
From digestive tract carry pains in a stomach to typical violations, gastritis, erosion of a mucous membrane of a stomach, and also an atrophy of a mucous membrane of intestines. Sharp complications in the form of the bleedings caused by an ulceration of a stomach or rough vomiting with gaps mucous in transitional department between a stomach and a gullet are possible. Because of atrophic changes of a mucous membrane of intestines at patients with alcoholism absorption of vitamins and minerals worsens, the metabolism is broken, there is avitaminosis.
Cells of a liver at alcoholism are replaced with connecting fabric, cirrhosis develops. The sharp pancreatitis which arose against the background of alcohol intake is followed by the expressed endogenous intoxication, can be complicated by a sharp renal failure, hypostasis of a brain and gipovolemichesky shock. The lethality at sharp pancreatitis fluctuates from 7 to 70%. The cardiomyopathy, an alcoholic nephropathy, anemia and immune violations belong to number of characteristic violations from other bodies and systems at alcoholism. At patients with alcoholism the risk of development of subarakhnoidalny hemorrhages and some forms of cancer increases.
Symptoms and stages of alcoholism
Allocate three stages of alcoholism and prodry – a state when the patient is not an alcoholic yet, but regularly takes alcoholic drinks and treats risk group of development of this disease. At a stage of a prodrom of people willingly admits alcohol to the companies and, as a rule, seldom drinks alone. The use of alcohol happens according to circumstances (a celebration, a friendly meeting, rather significant pleasant or unpleasant event etc.). The patient can at any time cease to accept alcohol, without suffering from any unpleasant consequences. He has no desire to continue to drink after the end of an event and is easily restored to usual sober life.
The first stage of alcoholism is followed by strengthening of an inclination to alcohol. The need for alcohol intake reminds hunger or I am eager and becomes aggravated in adverse circumstances: at quarrels with relatives, problems at work, increase in the general level of a stress, fatigue etc. If the patient having alcoholism does not manage to drink, he distracts and thirst for alcohol temporarily decreases to the following adverse situation. If alcohol is available, the patient with alcoholism drinks more, than the person at a stage of a prodrom. He tries to reach a condition of the expressed intoxication, drinking in the company or accepting alcohol alone. It is more difficult for it to stop, he seeks for continuation of "holiday" and continues to drink even after the end of an event.
Characteristics of this stage of alcoholism are fading of an emetic reflex, aggression, irritability and memory blackouts. The patient accepts alcohol irregularly, the periods of absolute sobriety can alternate with isolated cases of the use of alcohol or be replaced by hard drinkings lasting several days. The criticism of own behavior is lowered even in the period of the sobriety sick with alcoholism tries to justify in every possible way the need for alcohol, finds various "worthy occasions", shifts responsibility for the alcoholism on people around etc.
The second stage of alcoholism is shown by increase in amount of the drunk alcohol. The person accepts more alcohol, than earlier, at the same time ability to control reception of etanolsoderzhashchy drinks disappears after the first dose. Against the background of sharp refusal of alcohol there is an abstinence syndrome: tachycardia, increase HELL, sleep disorders, trembling of fingers, vomiting at reception of liquid and food. Development of the delirium tremens which is followed by temperature increase, oznoba and hallucinations is possible.
The third stage of alcoholism is shown by decrease in tolerance to alcohol. For achievement of intoxication the patient having alcoholism has enough to accept absolutely small dose of alcohol (about one shot glass). At reception of the subsequent doses the condition of the patient with alcoholism practically does not change, despite increase in concentration of alcohol in blood. There is an uncontrollable thirst for alcohol. The use of alcohol becomes constant, duration of hard drinkings increases. At refusal of reception of etanolsoderzhashchy drinks often develops alcoholic deliriya. Mental degradation in combination with the expressed changes of internals is noted.
Treatment and rehabilitation at alcoholism
Actions for treatment of alcoholism can be emergency or planned, be carried out at home, is out-patient or in stationary conditions. Medicamentous therapy, psychotherapeutic methods of influence and the combined techniques is used. In hard cases after treatment of alcoholism rehabilitation in stationary conditions is required. Depending on concrete circumstances can recommend to the patient with alcoholism personal or family psychotherapy, visit of support groups etc.
The emergency actions for treatment of the patients having alcoholism include removal from hard drinking and elimination of the phenomena of an abstinence syndrome. At initial stages of alcoholism and at short hard drinkings treatment is possible at home. In other cases transportation in narcological clinic is necessary. To the patient with alcoholism pour salt solutions, enter vitamins, antioxidants, soothing and antipsychotic means, and also medicines for normalization of work of heart, a liver, a pancreas and a brain. At hard drinkings lasting 2-3 days the volume of infusional therapy makes 600-800 ml, at hard drinkings up to 7-10 days – 800-1000 ml, at hard drinkings over 10 days – 1000-1200 ml.
Planned treatment of alcoholism can be medicamentous or non-drug. When using medicamentous ways of coding from alcoholism in an organism of the patient inject the drug causing sharply expressed negative consequences at reception of alcohol. Perhaps vshivany capsules or intravenous administration of medicine (usually – a disulfirama). Non-drug treatment assumes impact on mentality of the patient for the purpose of creation of installation on refusal of the use of alcoholic drinks, awareness of gravity of consequences of alcoholism etc. Now often use combined methods of treatment – introduction of medicines in combination with gipnosugessivny psychotherapy. Perhaps both out-patient treatment, and hospitalization for performing the therapy directed to restoration of functions of various bodies.
The final stage of treatment for alcoholism is social rehabilitation. Now this direction in Russia is poorly developed, however every year there are more and more clinics, along with treatment, begin to offer rehabilitation programs. The group program "12 steps" (community of anonymous alcoholics) enjoys the increasing popularity. Within this program the people having alcoholism give each other mutual aid and support. It should be noted that participation in the AA programs without use of other ways of treatment is effective only at an initial stage of alcoholism. At 2-3 stage before the introduction it is necessary to undergo treatment at the narcologist in AA.
The forecast at alcoholism
The forecast depends on duration and intensity of alcohol intake. At the first stage of alcoholism chances of treatment are rather high, however at this stage patients often do not consider themselves alcoholics therefore do not ask for medical care. With physical dependence remission within a year is also more observed at only 50-60% of patients. Narcologists note that the probability of long remission significantly increases at active desire of the patient to refuse reception of alcohol.
Life expectancy of the patients having alcoholism is 15 years less, than on average on population. Typical chronic diseases and sharp states become the reason of a lethal outcome: alcoholic deliriya, stroke, cardiovascular insufficiency and cirrhosis. Alcoholics suffer from accidents more often and more often finish life with suicide. Among this group of the population the high level of an early exit to disability in connection with consequences of injuries, organ pathology and heavy frustration of a metabolism is noted.