Alcohol Treatment and Rehabilitation

Introduction

In its 2010 report, the World Health Organization has identified harmless use of alcohol as an important factor that adversely affects health and has established a global strategy. In this report, the World Health Organization stresses that the use of harmful alcohol is “third of the risk factors leading to premature death and disability of all humanity,” and the first problem in underdeveloped countries. This is larger than the number of deaths caused by smoking, and 2.7% of deaths and disabilities worldwide are caused by smoking while 3.5% are reportedly caused by drinking. Reflecting this trend, alcohol consumption in OECD countries has been on a downward trend in recent years.

Causes

It is not yet clear what causes alcoholism. Animal testing suggests that drinking alcohol in rats or monkeys may be accompanied by changes in the brain, with symptoms similar to alcohol dependence, suggesting that the disease is accompanied by changes in the brain. However, in describing human behavior, various analyzes will also be needed to determine in what circumstances the child grew up, what psychological conditions influenced the development of alcoholism, and what social circumstances produced alcoholism.

1. Genetic Causes

Investigating the households of alcoholics shows that adults and siblings who have had alcohol problems are toxic. So many researchers think that genetic factors play a role in the development of alcoholism.

Studies in twins also show that if a parent is an alcoholic, she is more likely to get alcoholic even if she is adopted by a healthy family. And if one of the identical twins is addicted to alcohol, the other sibling is more likely to become alcoholic than the fraternal twins.

2. Biological Causes

In our brain, there is a part called the compensation circuit. The reward circuit is the part that controls the motivations that people need to live. All living things must meet the basic needs of living and preserving the race, such as eating food and contact between the opposite sex. The reward circuits make you feel like a pleasure when the conditions are met, leading you to repeat the action in the future.

The frontal lobe also plays a role in regulating pleasure.

Addictive substances, such as alcohol, tobacco, and drugs, affect this compensatory circuit and frontal lobe, causing abnormal pleasure, craving to continue drinking, and losing the control to stop drinking.

3. Psychological Causes

Alcoholics tend to have depression, inferiority, anxiety and hypersensitivity compared to the general population.

Psychoanalytically, alcoholism has been linked to an oral miracle of overcoming something by eating when you feel anxious. There is also a theory that, in childhood, when parents’ lack of affection or lack of sufficient satisfaction, hostility toward parents causes self-destructive desires and develops into alcoholism. As such, conflicts and deficiencies in the individual’s mental aspects are thought to be less likely to be involved in the formation of alcoholism, and this aspect of treatment is also necessary.

4. Sociocultural Factors

It is also a persuasive theory that the person who has experience in relieving anxiety, stress, and tension by drinking alcohol will find alcohol easily when there is a similar conflict.

Symptoms

When alcoholics reach a state of intoxication, the following symptoms are common:

1. Immunity

Tolerance, along with withdrawal, is one of two symptoms that represent physical dependence of an addictive disease. It is often said that if you drink alcohol often, you drink. Tolerance can be understood as a result of the body’s adaptation to a substance, such as an increase in the amount of alcohol to be drunk through repeated drinking, or when the same dose of alcohol is no longer taken.

2. Withdrawal

Withdrawal is a term used to describe a complex and diverse group of symptoms that occur when a person stops using the substance and stops suddenly. You can see people who suddenly quit smoking become sensitive and sharp, very anxious, increase their craving for cigarettes, and eventually scour the trash to save cigarette butts burned by others. The same is true for alcohol, and similar symptoms are observed in behavioral addictions such as the Internet. Alcohol withdrawal is the case when alcohol withdrawal symptoms characteristic of alcohol appear or alcohol is used to alleviate or avoid withdrawal symptoms. Withdrawal syndrome develops within 5-10 hours after you stop or reduce your alcohol intake. It is most acute on days 3-5 and improves on days 5-7, but sometimes lasts more than a month. 2-5% suffered from convulsions and treacherous delirium (delivers with tremor, severe nervousness, hyperactivity of the autonomic nervous system (increased pulse, blood pressure, respiration) within 48 hours after abstinence) and, in severe cases, death from respiratory palsy. You can also reach

3. Obsession

Talk about the state of losing important social and professional skills to continue drinking, giving up hobbies, spending a lot of time looking for alcohol, putting off what you have to do to drink, and not being responsible It is.

4. Compulsion

Although alcoholics have problems and aftereffects caused by habitual behavior, they will not stop drinking and will continue to use substances or repeat behaviors. It means that you are still drunk, even if you are still drunk, unable to go to work, or because family drinking causes worsening family discord.

Complications

1. A common mental illness in alcoholics

1) Alcoholics don’t sleep well.

Many alcoholics are sleepy. Because you do not sleep well, it is common to drink to sleep. However, it is clear that the problem of not being able to sleep is caused by alcohol. Alcohol makes you fall asleep, but usually wakes you up at the same time you wake up.

Drinking can help you fall asleep once, but deep sleep will interfere.

Most importantly, if you continue to drink alcohol for the purpose of going to sleep, you will fall into a situation where you will not fall asleep afterwards.

2) Many alcoholics have depression or anxiety disorders.

Some patients get drunk because of depression or anxiety, and alcoholism. Some people have depression or anxiety disorder because of alcoholism.

While alcohol can make you feel like you’re improving your depression or anxiety in a short time, these symptoms get worse with alcohol.

Alcoholism makes your life devastated. It causes general problems with family relationships and social activities at work, which can reach patients as seriously as they can’t overcome, causing serious depression or anxiety.

Alcoholic people do not have enough control over their emotional state and become impulsive. You may be aggressive to people around you, and sometimes you will be violent. Suicide rates in alcoholics are more than double that of the general population.

3) Alcoholic dementia is not just another person’s problem.

More than half of the drinkers have experienced a phenomenon called ‘film breaks’ after heavy drinking.

This phenomenon, called black-out, is known as an early symptom of alcoholic dementia. Too much alcohol itself has a toxic effect on the nerve cells, the more this toxic effect, the nerve cells are damaged, blackouts appear, and repeated prolonged alcoholic dementia. Alcoholics often don’t eat snacks or foods other than alcohol. Alcohol also interferes with the absorption of vitamins from the stomach. This is why malnutrition is common in alcoholic patients. Malnutrition, such as vitamin deficiency, adversely affects the development of alcoholic dementia.

2. Physical illness common in alcoholics

There are no organs that are not affected by the absorption of alcohol into our bodies. Among them, the liver, cardiovascular system, pancreas and stomach are particularly vulnerable.

1) Alcohol and Liver Disease

Alcoholic hepatitis: When fatty liver gets worse, it progresses to alcoholic hepatitis. This can lead to nausea, loss of appetite, vomiting, jaundice or fever. Alcoholic hepatitis also recovers naturally if you quit drinking and live a healthy life.

Alcoholic cirrhosis: Cirrhosis, commonly known as cirrhosis, is caused by prolonged inflammation of the alcohol. Cirrhosis is a condition in which the liver tissue has already lost its role and cannot return to normal liver. It is also common to develop ascites, peritonitis, hepatic encephalopathy, varicose veins, and cancer.

2) Alcohol and Cardiovascular Disease

Scholars claim that moderate amounts of drinking have a positive effect on the cardiovascular system. However, moderate drinking at this time means alcohol of about 1 standard drink per day. Any more alcohol will never help your cardiovascular system.

Alcohol causes illness in the heart muscle itself. This can lead to an emergency heart disease caused by poorly beating the heart.

In alcohol dependent people, arteriosclerosis of blood vessels is often severe, and diseases such as high blood pressure are more common than general people.

3) Alcohol and Pancreatic Diseases

The pancreas is where you produce the enzymes needed to digest food. The enzymes produced by the pancreas break down all the foods we eat to make them absorbable.

Repeated excessive drinking destroys pancreatic cells and causes inflammation around the pancreas. In alcohol dependence, pancreatitis occurs infrequently, in which case a severe abdominal pain causes a visit to the emergency room. Repeated damage to the pancreas can lead to chronic pancreatitis, which can only worsen pancreatic inflammation with a slight stress or overeating.

If pancreatic cells are directly damaged by alcohol, they can be affected by insulin production, resulting in diabetes.

4) Alcohol and Gastrointestinal Diseases

Alcohol causes inflammation in the oral cavity and esophagus mucosa after ingestion. This increases the risk of future cancer.

Excessive drinking can cause esophagitis, and can also cause acid reflux. Alcohol also destroys the gastric mucosa, causing gastric ulcers and gastritis. Alcohol not only damages the mucous membranes, but also interferes with the smooth movement of the stomach and intestines, which can lead to poor digestion and problems with nutrient intake.

3. Drinking in pregnant women

1) Fetal Alcohol Syndrome

If a pregnant woman consumes alcohol during pregnancy, the alcohol is passed through the umbilical cord to the child in the belly. Even small amounts of alcohol, if delivered to the child through the umbilical cord, can have a devastating effect on the child’s development. This is called fetal alcohol syndrome. Consistent drinking from pregnant women can lead to cerebellum, low intelligence, abnormal limbs and heart, and facial discomfort in the fetus.

Diagnoses

1. Meaning of standard drink

1) What is standard drink?

A standard drink is an alcohol consumption measure that represents a virtual drink containing a fixed amount of pure alcohol. The standard drink varies in volume depending on the alcohol concentration of the drink, but always contains the same amount of alcohol, causing the same level of drunkenness.

2) Amount of alcohol equivalent to 1 standard drink

Standard drink is the amount of alcohol defined in each country to standardize drinking level measurement and provide public health information. In addition to choosing a different amount for a standard drink, some are defined based on the mass (g) of alcohol, while others are based on volume (mL).¹

2. Limiting the amount of alcohol to reduce the harm caused by alcohol

1) Criteria for heavy drinking

In general, drinking up to 2 standard drinks for men, 1 standard drink for men (14 standard drink for men per week, and 7 standard drinks for women per day) with moderate risk of drinking harm is moderate. This is defined as drinking alcohol, and when it exceeds this level, it is considered dangerous drinking.

3. Criteria for Diagnosing Alcohol Use Disorder

This excessive drinking can lead to a variety of physical illnesses that lead to alcohol abuse, which can eventually lead to alcohol abuse or alcohol dependence (addiction).

Alcohol use disorders are largely divided into alcohol abuse and alcohol dependence. In short, alcohol abuse means repeating drinking behavior despite the personal or social harm caused by drinking alcohol, and it is used to describe a situation in which a pathological obsession with alcohol persists in the presence of withdrawal and resistance to alcohol. It’s called dependence.

Treatments

Treatment for alcoholics has not yet been perfect in one way, whether it is counseling or medication. Some alcohol addicts are eventually helped and recovered through any treatment, while others are recurring and worsening.

Therefore, most clinical sites try to mobilize all of the treatment methods that can be mobilized at each site among the various treatment methods.

1. Psychological treatment for alcoholics (counseling)

1) Motivational Therapy

The first difficulty encountered in the treatment of alcoholics is the patient’s lack of awareness of the disease. Most patients deny that they are alcoholics, and claim that they have the ability to drink and drink.

However, alcoholics, in fact, are somewhat aware of their problems and have the idea of ​​solving them. In other words, they deny their problems on the outside, but there is a hidden will of change inside, and it is motivated therapy to bring out this will of voluntary change and change their lives.

An essential part of explaining motivational therapy is Prochaska’s change stage model. According to this model, the process by which a person modifies and changes his or her behavior is in a series of stages, which develop into a more continuous state.

2) Cognitive Behavioral Therapy

The basic background of cognitive behavioral therapy for alcoholics is that human behavior is learned and new learning is needed to change the learned behavior.

When you are lonely, you will want to drink whenever you are lonely, and when you are sad, you will want to drink whenever you feel sad, and when you are happy, you also want to drink. Will drink.

In other words, the goal and treatment of cognitive behavioral therapy is to return these behaviors that have been learned to addiction to the patient to their pre-learning situation.

3) 12-step treatment

In mentioning 12-step treatment, you cannot miss the Alcoholic Anonymous (AA) group.² The anonymous alcoholics group succeeded in abstinence in 1935 after the alcoholic addict named Bill had a special experience and realized the principles of treatment, and he taught many other addicts the principles that he realized. It started with what led to it. Since then, Bill has joined forces with the abstinence successors to form a group, which is AA. The system of their abstinence success is made into a single book called ‘Anonymous Alcoholic’ and the core of this book is ’12 -step ‘.

The key to 12-step treatment is that the process of getting out of alcohol addiction is not perfect at any moment, but it is a complete recovery that needs to be done step by step.

12-step treatment is considered a meaningful treatment for many therapists because it raises more fundamental questions about not only excessive consumption of alcohol but also attitudes toward life and how to live. Recently, some or all of the 12-step programs have been used not only at AA gatherings, but also at various alcohol hospitals and alcohol counseling programs.

4) Personal Counseling Therapy

Depending on the nature of the alcoholic, personal psychotherapy (personal counseling) may also be given priority.

In personal psychotherapy, alcoholism is the result of psychological changes in the growing environment, together with the temperament that a person has had since birth, which in turn led to the phenomenon of constant drinking. In other words, each psychological vulnerability that leads to alcoholism exists in patients and can be freed from alcoholism by realizing these psychological weaknesses and leading them to change.

5) Family Counseling Therapy

As much as alcoholics, counseling about alcoholics’ families is very important. Most families with alcoholics have problems with marital conflict, domestic violence, and child conflict. The wives of alcoholics, in particular, are in a “co-dependency” state of anxiety, social isolation, guilt, self-pity, and depression associated with their husband’s drinking.

The various counseling courses that lead to recovery for alcoholics may also require a variety of interventions for families of alcoholics.

2. Drug Treatment for Alcoholics

1) Treatment of acute withdrawal symptoms

The most pronounced process of abnormal adaptation to excessive alcohol is withdrawal symptoms for alcohol. Alcohol basically acts to reduce the activity of our nervous system. The alcoholic’s brain is balancing the activity of the brain abnormally by counteracting the effects of alcohol.

Sudden discontinuation of alcohol in this abnormally balanced state results in an imbalance caused by excessively activated nervous system reactions, which causes alcohol dependents to withdraw their pulses, increase anxiety, experience hallucinations, and withdrawal symptoms that may be violent. Occurs. At this time, you should visit the hospital because medications that replace alcohol, which is to rebalance the brain activity and to gradually return to normal brain activity.

2) Treatment of malnutrition

Many alcoholics do not eat on a balanced diet, and because ethanol itself inhibits the absorption of vitamin B1, many alcoholics suffer from vitamin B1 deficiency. Vitamin B1 deficiency can cause memory loss, abnormal gait, and brain damage, so vitamin B1 supplementation is essential for chronic alcoholic dependents.

In some cases, dementia-like cognitive deterioration and brain complications can occur, which can lead to medication.

3) Administration of anti-craving drugs

Naltrexone and acamprosate are the two drugs that have been developed as a result of the study of alcohol-dependent patients’ drug obsession. Both drugs are known to reduce the cravings for alcohol by acting directly on nerve areas that act to compulsively drink alcohol in the brain.

Naltrexone and acamprosate have been shown to be effective in reducing alcohol consumption and in alcohol dependence by reducing alcohol consumption. It is also said to help repair brain nerve cells damaged by alcohol. And naltrexone and acamprosate have been known to reduce the likelihood of relapse and reduce the duration of relapse.

However, it is known that the effects are increased when the psychotherapy of alcohol dependence is accompanied by the drug treatment rather than the treatment alone.

Both naltrexone and acamprosate have been shown to have few side effects on the body.

Frequently Asked Questions

1. Is it good to sweat in the sauna after drinking alcohol?

Do not sweat a lot in the sauna after heavy drinking. In situations where alcohol acts to release moisture to the body, which can lead to a lack of water in the body, sudden sweating in the sauna can lead to excessive water loss and can be dangerous. Taking a shower in warm water and keeping your body well hydrated will help with your hangover.

2. Can vomiting help sober up?

If you have drank a lot of alcohol, there are people who want to vomit too much to drain the alcohol. However, during vomiting, stomach acid can be refluxed, cause inflammation of the esophagus, rupture of the esophagus, and sometimes lead to aspiration pneumonia.

3. Is someone who drinks a lot of alcohol addicts?

It is true that drinking alcohol often can be more dangerous and increase the risk of developing alcoholism, but the diagnosis of alcoholism is not based on the amount of alcohol and the frequency of drinking. People who drink a lot of alcohol are not necessarily alcoholics, and drinking less alcohol does not mean that they are not alcoholics. In diagnosing alcoholism, the criteria are obsessive obsession with alcohol, causing and causing social problems and withdrawal symptoms. Even if you drink less alcohol, you will be diagnosed with alcoholism if you have accompanying problems.