Treatment of alcoholism
Treatment of alcoholism Alcoholism can be divided into acute alcoholism (all kinds of drunkenness) and chronic alcoholism (alcohol dependence, delirium tremens, alcohol hallucinations, alcohol delusions, Kosakov psychosis, alcohol dementia, Wernicke encephalopathy, etc. ). Acute alcoholism is mainly treated by internal medicine, and chronic alcoholism must be treated with alcohol withdrawal at the same time.
1. Treatment of withdrawal symptoms. Patients with chronic alcoholism will inevitably have withdrawal symptoms when they quit drinking. I usually give up drinking for 3 days and disappear naturally after 5-7 days. If it lasts for more than 7 days, alcohol hallucinations often occur. Most withdrawal symptoms are mild, so you can pay attention to observation and take diazepam. However, there are also quite serious cases, even convulsions or tremulous delirium, which must be dealt with in time. Pay attention to the balance of water and electrolyte, supplement vitamins, strengthen nutrition and give drugs to promote brain metabolism. For those who have insomnia, nervousness and anxiety, vomiting or convulsions, benzodiazepines such as diazepam can be injected orally or intramuscularly. People with delusions and hallucinations can take antipsychotic drugs. Pay attention to the heart condition of patients with delirium tremens and prevent heart failure. Giving insulin hypoglycemia treatment every day (30-40 times as a course of treatment) is beneficial to improve nutrition and relieve withdrawal symptoms. A large amount of vitamin B 1B 12 can also be used in combination with adrenocortical hormones in patients with Wernicke encephalopathy. When liver injury and nicotinic acid deficiency occur, corresponding treatment measures should be taken.
2. Drug treatment. Antialcoholism drugs are mainly used for patients with chronic poisoning: (1) Disulfuron (Antabuse). The medicine is used to stop compulsive drinking, thus blocking the process of alcohol oxidation and making acetaldehyde accumulate in the blood. If you continue to drink alcohol after taking the medicine, you will have nausea, vomiting, vasodilation, rapid pulse, blushing, sweating, strong throbbing sensation in your head, neck and heart, and discomfort such as dyspnea, suffocation, dizziness, blurred vision, weakness and anxiety. In this way, patients are afraid of alcohol and never dare to drink it again. Sulfur abstinence must be taken 24 hours after the last drinking, and patients should be informed of the danger of drinking when taking this medicine the day before treatment. Contraindications of this product are coronary heart disease, cardiomyopathy, severe pulmonary liver disease, acute poisoning and acute psychosis. The initial dose of this medicine is 250 mg once a day, then 500 mg once a day for 7 days, and then gradually decrease, and continue to take it for 2-3 weeks. Don't drink alcohol while taking the medicine. After the seventh day of medication, mixing 50- 100 ml of alcohol with 150-200 ml of water and giving it to patients for trial will produce the above-mentioned pharmacological reaction, so that patients can experience that drinking is no longer a pleasure, thus strengthening their determination to give up drinking. (2) Carbonyl calcium citrate. As a mild substitute for alcohol-abstinence sulfur, the drug is mild in nature, does not produce any toxic reactions and side effects, and can produce sensitive reactions to alcohol within a few hours. (3) Furazolidone. This medicine can also cause an aversion to alcohol. The course of treatment is 7- 10 days, and the rest 10 days continue a course of treatment. At this time, symptoms such as dizziness, palpitation, blushing, suspense, dry mouth, nausea, pulse, chest pain, vomiting, limb weakness, and even sudden vomiting may appear after drinking, and the symptoms will be relieved after about one hour and disappear after two hours. According to domestic reports, the success rate of abstinence after one-year follow-up is 87.5%.
3. Behavioral therapy. During the period of 1942, Voegtlin reported that apomorphine and emetic emetic can achieve curative effect in the chemotherapy of aversion to conditioned conditions, and the success rate is over 2/3. The specific method is to inject apomorphine subcutaneously immediately after drinking alcohol, or after injecting apomorphine, patients will smell alcohol. When the patient feels sick, he will immediately give the patient a drink, once a day or once every other day, for 10-30 times in a row, and then he will form a vomiting reflex to the wine, thus becoming disgusted with the wine and then giving up drinking. You can also watch scary videos, movies and TV while drinking, and inject apomorphine at the same time, which can improve the curative effect. Generally speaking, the curative effect of abstinence from sulfur is better than aversion therapy, but because abstinence from sulfur will produce a series of pharmacological reactions, aversion therapy is more acceptable to alcoholics.
In 1970, Lowe Bonde and Kadi reported the success of eliminating alcohol addiction by electric shock stimulation. The specific practice of this therapy is: let patients drink a small amount of alcohol when socializing. If the alcohol content in the blood exceeds 60 mg/100 ml, patients will receive painful electric shocks, and many patients will not become chronic alcoholics. This is considered as a new achievement of behavioral therapy.
4. Psychotherapy. The formation of alcohol addiction has social factors as well as individual factors, such as drinking environment, individual personality defects, or psychological and social factors causing anxiety. For alcoholics who simply give up drinking with drugs, they will return to society and live their previous lives after giving up drinking. After long-term observation, the recurrence rate is extremely high, less than 20% can be cured, and it often recurs quickly. Therefore, at the same time of detoxification, psychological treatment should be carried out. In psychotherapy, we should pay attention to the following basic principles: (1) Inspire alcoholics to recover their self-knowledge, admit that they are alcoholics, and agree to give up drinking for life. (2) The patient must be honest with the doctor. If it recurs, contact your doctor as soon as possible. (3) Doctors and patients' relatives must treat patients as adults, make their own decisions and be responsible for their actions. (4) Don't threaten the patient with the description that the body will collapse, the spirit will collapse, and the society will be under siege, because this will not only be useless, but also make the patient have an attitude of "I don't care about life or death" and have a rebellious attitude towards the therapist. (5) One of the keys to successful treatment is to help patients find a kind of fun to fill the gap in life. Foreign Alcoholics Abstinence Association is a group of former alcoholics, which aims to help other alcoholics. They help other alcoholics quit drinking through religious vows, persuasion and some psychotherapy, and the effect is quite good.
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