Shafa

OUR DOCTOR SPEAKS

Dr. B. S. Arora (Neuro Psychiatrist) at Shafa shared his view on Alcoholism............................as he sees it

Alcohol-Related Disorders

Alcohol use disorders are common, lethal conditions that often masquerade as other psychiatric syndromes. The average alcohol-dependent person decreases his or her life span by 10 to 15 years, and alcohol contributes to 22,000 deaths and two million nonfatal injuries each year.

At least 20 percent of the patients in mental health settings have alcohol abuse or dependence, including individuals from all socioeconomic strata and both genders.

Prevalence of Drinking

At some time during life, 90 percent of the population in the United States drinks, with most people beginning their alcohol intake in the early to middle teens . By the end of high school, 80 percent of students have consumed alcohol, and more than 60 percent have been intoxicated.

Alcohol Abuse or Dependence

The lifetime risk for alcohol dependence is approximately 10 to 15 percent for men and 3 to 5 percent for women. The rate of alcohol abuse and dependence combined may be as high as 20 percent for men and more than 10 percent for women, and the 1-year prevalence of abuse and dependence that are clinically significant is estimated at 6 percent or more.

Alcohol Intoxication—

A. Recent ingestion of alcohol.

B. Clinically significant maladaptive behavior or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion.

C. One (or more) of the following signs, developing during, or shortly after, alcohol use:

(1) Slurred speech

(2) Incoordination

(3) Unsteady gait

(4) Nystagmus

(5) Impairment in attention or memory

(6) Stupor or coma

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Alcohol Withdrawal-

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

B. Two (or more) of the following, developing within several hours to a few days after Criterion A:

(1) Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)

(2) Increased hand tremor

(3) Insomnia

(4) Nausea or vomiting

(5) Transient visual, tactile, or auditory hallucinations or illusions

(6) Psychomotor agitation

(7) Anxiety

(8) Grand mal seizures

C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

TREATMENT

The elements of treatment appropriate for patients with severe alcohol problems are fairly straightforward. The core of these efforts involves steps to maximize motivation for abstinence, helping alcoholics to restructure their lives without alcohol, and taking steps to minimize a return, or relapse, to substance-using behaviors.

Three general steps are involved in treating the alcoholic person once the disorder has been diagnosed: a)intervention,

b)detoxification,

c) rehabilitation.

Intervention

The goal in this step is to break through feelings of denial and to help the patient recognize the adverse consequences likely to occur if the disorder is not treated. Intervention is a process aimed at increasing to as high a level as possible the levels of motivation for treatment and for continued abstinence.

Reaching out to the Family

The family can be of great help in the intervention. Members must learn not to protect the patient from the problems caused by alcohol, or else the patient may not be able to generate the energy and the motivation necessary to stop drinking

Detoxification

Most people with alcohol dependence have relatively mild symptoms when they stop drinking.

Mild or Moderate Withdrawal

Withdrawal develops because the brain has physically adapted to the presence of a brain depressant and cannot function adequately in the absence of the drug. Giving enough of a brain depressant on the first day to diminish symptoms and then weaning the patient off the drug over the next 5 days offers most patients optimal relief and minimizes the possibility that a severe withdrawal will develop.

Severe Withdrawal

For less than 1 percent of alcoholic patients with extreme autonomic dysfunction, agitation, and confusion—that is, those with alcoholic withdrawal delirium, also called delirium tremens—no perfect treatment has been found.

Rehabilitation

For most patients, rehabilitation includes three major components:

(1) continued efforts to increase and maintain high levels of motivation for abstinence,

(2) work to help the patient readjust to a lifestyle free of alcohol,

(3) relapse prevention.

The treatment process in either setting involves intervention, optimizing physical and psychological functioning, enhancing motivation, reaching out to family, and using the first 2 to 4 weeks of care as an intensive period of help. Those efforts must be followed by at least 3 to 6 months of less frequent outpatient care.

Counseling

Counseling efforts in the first several weeks to months should focus on day-to-day life issues to help patients maintain a high level of motivation for abstinence and to enhance their levels of functioning. Psychotherapy techniques that provoke anxiety or that require deep insights have not been shown to be of benefit during the early phases of recovery and, at least theoretically, may impair efforts at maintaining abstinence.

Relapse Prevention

The third major component of rehabilitation efforts, relapse prevention, begins with identifying situations in which the risk for relapse is high.

Importance of the Family

Most treatment efforts recognize the effects that alcoholism has on the significant people in the patient's life, and an important aspect of recovery involves helping   family members and close friends to understand alcoholism and how rehabilitation is an ongoing process that lasts for 6 to 12 months or more.

Medications

If detoxification has been completed, and the patient is not one of the 10 to 15 percent of alcoholic people who have an independent mood disorder, schizophrenia, or anxiety disorder, there is little evidence in favor of prescribing psychotropic medications for the treatment of alcoholism

Self-Help Groups

Clinicians must recognize the potential importance of self-help groups such as AA. Members of AA have help available 24 hours a day, associate with a sober peer group, learn that it is possible to participate in social functions without drinking, and are given a model of recovery by observing the accomplishments of sober members of the group.

Learning about AA usually begins during inpatient or outpatient rehabilitation. The clinician can play a major role in helping patients understand the differences between specific groups. Some are comprised only of men or women, and others are mixed; some meetings are comprised mostly of blue collar men and women, whereas others are mostly for professionals; some groups place great emphasis on religion, and others are eclectic. Patients with coexisting psychiatric disorders may need some additional education about AA.

        !!!! Watch out for the next date.....   

  Dr. Arora will be available for video conferencing to address all your problems !!!!