- Has anyone told you that you drink too much alcohol?
- Did you not do something because of drinking alcohol?
- Do you experience changes in your sleep or mood after drinking alcohol?
- Alcohol consumption is widespread in today’s world. But at what point does use become a problem, an addiction?
When should you really worry?
The following statements will help you understand whether you have a problem with alcohol.
- You need to consume alcoholic beverages in excessive amounts from the site to achieve intoxication.
- You have tremors, headache, muscle pain a few hours after the last dose of alcohol.
- You drink secretly or lie about the actual amount you drink.
- For you, every day starts with drinking or tinkering.
- You drink alcohol early in the morning, every day.
- You look for any excuse to use alcohol.
- Alcohol is consumed so much that the events during consumption are partially or completely forgotten after consumption.
From the information provided by the World Health Organization, it is known that almost 75 million people suffer from alcohol addiction in the world. Almost 2 million people die from alcohol consumption and its consequences.
Addiction is a primary, chronic and progressive disease that increases the risk of mortality. It is an incurable but certainly treatable disease that affects the patient’s physical, mental and social health, as well as the personality in general.
Alcohol not only affects our physical condition, but also our emotional one. After drinking alcohol, sleep disturbances are often observed, which improve when the use is stopped. Alcohol changes the natural phases of sleep. Mood disorders appear, more often depressive mood, depression, annoyance, gloomy outlook on life. Emotional disturbances can last up to several weeks. It affects both daily activity and work ability.
With long-term use of alcohol, both emotional disorders and sleep and physical disorders pass into a chronic phase, which is more difficult to treat. In some cases, the disorder becomes irreversible. Sensory disorders are most common in the hands and feet, polyneuropathy develops – the gait becomes unstable, which is due to the fact that the feet remain numb, it becomes more and more difficult to walk and maintain balance. Superficial sensation (tactile sensation) in the hands deteriorates.
How to recognize and understand if you have problems?
The simplest way is to fill out the AUDIT (Alcohol Use Disorders Identification Test) scale, in which the answers to the questions show the real situation in your life, even if you think there are no problems. The maximum number of points is 40.
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Results:
- Up to 15 points – risky alcohol use, you need advice from a doctor to reduce it.
- 16 – 19 points – it is necessary to seek help from a doctor, to be observed in the long term.
- 20 or more points – clearly indicates addiction, treatment by a specialist is required for diagnosis.
Where is the line between alcohol addiction and harmful overuse?
In the case of alcohol addiction, there is a loss of control over the amount drunk, a pronounced desire, a changed reaction, an abstinence syndrome that appears up to 48 hours after drinking alcohol.
An altered response should be explained in more detail. If in a normal situation, alcohol acts as a depressant, it means that when using it, a person relaxes, calms down, then with a changed reaction, aggressiveness, agitation, conflicts often arise. Withdrawal occurs after stopping alcohol consumption. It is often interpreted as a hangover condition. But abstinence is more complicated and serious. Clinically, it is understood as a complex of vegetative, somatic, neurological, psychiatric disorders that occur in alcohol addicts after stopping alcohol consumption or drastically reducing the amount of alcohol. Withdrawal syndrome develops 6-48 hours after stopping alcohol consumption, lasts from 2-3 days to 2-3 weeks. Abstinences are distinguished by several degrees of severity: from mild to severe (usually 3 or 4 degrees). The CIWA-Ar scale (Clinical Institute Withdrawal Assessment of Alcohol Scale) is used to assess the severity of withdrawal.
Why does addiction develop?
The development of the disease of alcohol dependence is characterized by a desire to control the use (craving), which in the further development of the disease turns into continuous thoughts about use (obsession) and the inability to resist (compulsive use). Compulsive action is distinguished from impulsive action by a clear awareness of consequences that comes from previous experience. Ultimately, a person comes to the conclusion that he cannot stop drinking alcohol, resisting intrusive thoughts about alcohol, admitting his weakness in front of alcohol.
Of course, it cannot be ruled out that the basis of alcohol consumption could also be some mental disorders such as anxiety, depression or some other disorders in which alcohol consumption is a form of self-medication.
Addiction Panacea!
Alcohol addiction goes hand in hand with alcohol-induced changes in the body, sometimes also personality changes, which are permanent. The treatment should be combined, but to start it requires the patient’s own consent and active participation. This means, ideally, medication and psychotherapy. In addition, you should pay attention to a healthy way of life, which includes both healthy nutrition and physical activities. Both the way of life and the way of thinking must be changed. Addicted patients are often unable to make a rational decision regarding treatment, impulsively choosing the path of least resistance, which reduces obsessive tendencies and compulsive actions, just as quickly expecting a result and an effect that, of course, does not occur.
The modern offer of drugs for the treatment of alcohol addiction is very wide. How to understand where to start? First and foremost, drug treatment must be supervised by a professional. Medications can be prescribed and applied in each individual situation only by a doctor, because a person’s needs, severity of illness, previous experience, goals and motivation must be understood. Medications vary in effects, uses, and side effects Certain medications, such as Naltrexone, an opioid antagonist that reduces cravings and is recommended by various guidelines as first-line therapy, but cannot be combined with opioid pain therapy. Next is Disulfiram, which discourages alcohol consumption, according to the principle of the whip and the carrot – while using the drug, it is forbidden to drink alcohol, otherwise, as a result of the interaction of the two, an extremely unpleasant physiological reaction will occur. Disulfiram is also available in depot forms recommended for comorbid patients. However, it also has a number of contraindications – liver disease, heart disease, psychosis during life. If alcohol consumption is rare, but with a loss of control, or if the patient does not have the motivation to take medication in the long term, then Nalmefen is recommended, which is also an opioid antagonist and reduces alcohol consumption because it suppresses the pleasure caused by alcohol. An important place in the treatment is not only the treatment of the addiction itself, but the treatment of the changes in the body caused by it. It is very important to improve sleep, to ensure that it is full-fledged both in terms of time and quality. For alcohol addiction patients, as a sleep aid, medications are recommended that have a relatively lower risk of addiction or none at all. This means that all classical sleep aids, which ended with the ending -pāms, can only be used in severe cases and in the form of short-term courses. Nebenzodiazepines and sedative antipsychotics in low doses are recommended. Both antidepressants and mood stabilizers are used to balance and improve mood. Each case is very individual, so professional help is needed.
The next, no less important, stage is psychotherapy, which is long-term and its results are expected only after a longer period. This explains why people with addiction choose this type of treatment less often. Loss of impulse control appears not only in situations where alcohol is required, but also in other areas of life. Several types of psychotherapy are used to treat alcohol addiction, such as client-centered psychotherapy (process-oriented psychotherapy that does not have specific goals, but works with “dangerous situations” in the client’s life), gestalt therapy (the goal is to develop comprehensive awareness, creative adaptability), psychodrama (the ability and opportunity to act out any important role or event in life), behavioral therapy (its goal is to change daily behavior patterns). There is no one method that will help everyone, but you should definitely try to find yours and never give up.
Author : psychiatrist and resident in narcology Yulija Rudenko.
Useful link: http://www.atbildigi.lv/lv/lasamviela/alkohola-vienibas/alkohola-vienibas-jeb-devas/
Reference list:
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- “Counseling and psychotherapy. Theory and practice”, a collective of authors led by Dr.psych.Kristīnes Martinsones, 2016, pp. 196-216, pp. 245-261, pp. 295-318, pp. 323-341.
- “Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Applications” Stephen M. Stahl, 2013, 4th ed., pp. 537-575.
- World Health Organization (WHO). WHO global status report on alcohol 2004. Geneva: WHO; 2004
- “Pharmacotherapy for alcohol use disorder”, Bankole A Johnson, DSc, MD, MBChB, MPhil, FRCPsych, DFAPA , 2018.07. ( https://www.uptodate.com/contents/pharmacotherapy-for-alcohol-use-disorder?search=alcohol%20abuse%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 )
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- “Overview of the chronic neurological complications of alcohol” Michael E Charness, MD , 2012.05. ( https://www.uptodate.com/contents/overview-of-the-chronic-neurologic-complications-of-alcohol?search=alcohol%20abuse%20treatment&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4 )
- http://www.drugs.ie/NDRICdocs/protocol1/templates/AUDIT.pdf
- https://thecanyonmalibu.com/alcoholism/