Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Alcohol
149
4. Psychotherapy and support groups
The final form of aftercare is made up of regular visits to counsellors and use of
support groups. This type of care is usually detailed in a treatment plan and is part
of a weekly treatment regime. This type of aftercare is good for people who are
ready to manage most of their recovery but still need some help and guidance on
a regular basis.
Aftercare For Drug Addiction Treatment
The point of any type of aftercare is to help people gradually ease back into their
everyday lives without feeling out of control or falling back into destructive habits.
It also gives people a chance to do any extra work on themselves or their recovery
that was left unfinished by primary treatment.
Anyone looking at aftercare should make sure they know which type of care they
need and what they want to get out of this. Often times these decisions can be made
with the help of a primary care facility and a doctor. By choosing the appropriate
treatment path, drug addicts can start their recovery from a point of strength and
avoid the fear and doubt that may lead to backsliding or relapse.
Self-help Resources
Self-help resources can be useful tools to assist patients to reduce or cease use of
alcohol. These resources work best when used in conjunction with a health check-up.
Self Help For Substance Misuse
“Substances” includes any substance that an individual wants to reduce to stop
using, so this may include nicotine, or caffeine, for instance, in addition to alcohol
or drugs. Misusing substances, perhaps alcohol or drugs, often starts as a way of
coping with difficult situations or feelings, and finding that the substance helps you
feel better, more relaxed. Every time a similar situation comes up, you know it
helps, so you get into the habit.
Citation: https://www.getselfhelp.co.uk//picts/substance1.gif
150
After a while though, as you start to rely more and more on alcohol or drugs to help
you feel better, other problems seem to emerge as a result. Things like problems
in your relationships. not being able to keep up with work or study, getting into
trouble with the police, getting into real financial problems.
You might start to feel more depressed, anxious or angry and frustrated. All these
things get worse as you continue to drink or use drugs, and so you drink and use
more drugs in order to help you feel better, which results in making the problems
worse.
A real vicious cycle:
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: https://www.getselfhelp.co.uk//picts/substance2.gif
Important - Beware!
You must seek help before stopping or cutting down suddenly on drinking or using
drugs - you must obtain the advice of an appropriate professional. This might be your
GP in the first instance. It is potentially dangerous, even life-threatening, and can
be a very unpleasant and distressing experience to suddenly stop taking something
your body has become accustomed to having. You may require a prescribed detox
(whether in hospital or at home), or to reduce your drinking or drug use gradually.
The self help information on this page can then help you overcome your cravings.
Identify your triggers
What or when are the times when you are more likely to drink or use? If you can
see the patterns, then maybe you can do something about those situations, and do
something different.
■ Certain places?
■ Certain people?
■ Anytime, anyplace?
Alcohol
■ See certain things?
■ Hear certain things?
■ Think ahead to certain situation?
■ Feeling stressed, anxious, angry, sad....?
■ Think self-critical thoughts?
Understanding the problem is perhaps the easiest part. The most important part of
resolving the problem, is being motivated enough to change. Having motivation
to not only stop the drinking or drug taking, but making changes that will affect
whole lifestyles and friendships.
151
Identify the factors that help keep the problem going
Use the cogs diagram (PDF) to help you identify what keeps you drinking/taking
drugs. Put the name of the problem in the middle big cog, then write in other
factors, such as: isolation, life stress, low mood, habit, low self esteem, want to be
like my friends, physical addition etc.
Then you can look at each factor and try to make changes in each. You may
need help for some of them - so look for the best and most appropriate person or
organisation to get that help from. Example cogs:
Citation: https://www.getselfhelp.co.uk//picts/substancecogs.JPG
Self-help Groups
Alcoholics Anonymous, or AA, is a worldwide mutual help organisation with over 2
152
million members. It accepts no outside contributions and is run by and for ‘recovering
alcoholics’. The recovery program is based on universal spiritual principles. AA is
a fellowship of support that encourages altruistic behaviour but makes no demands
of its members apart from a desire to remain sober. The longevity of sobriety and
positive attitude of many members can be exemplars for many patients. AA meets
in most towns in Australia, many of which also offer support groups for partners
(Al-Anon) and children (Al-Ateen) of drinkers. Locate your local AA program in the
telephone directory or the regional service via the Internet.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Pharmacotherapies to Reduce Relapse/Promote Abstinence
Controlled trials have shown that some medications effectively reduce relapse amongst
dependent drinkers. These medications are best used as part of a comprehensive
psychosocial treatment plan, such as counselling, motivational interviewing, relapse
prevention, goal setting, risk and cue identification.
Table 6: Diazepam regime for home/outpatient withdrawal
Alcohol-Related Brain Injury (ARBI)
Alcohol-Related Brain Injury (ARBI) is a term used to describe the damage caused
to the brain as a result of excessive alcohol use. Alcohol can harm almost all
organs of the body such as your liver and heart. The brain is a very delicate organ
and is very vulnerable to the effects of alcohol. People who have been drinking
very large amounts of alcohol for long periods of time run the risk of developing
serious changes to their brain.
These changes are:
■ Structural – involves changes to the anatomy (or building blocks) of the
brain.
■ Functionall – involves changes in the way the brain works.
Alcohol
These changes can impact on a person’s ability to perform normal activities on a
day-to-day basis.
Alcohol-related brain injury (ARBI) can not only occur from extremely high levels
of alcohol due to binge drinking, but also from more moderate alcohol intake
but over a long period of time. Alcohol has a toxic effect on the central nervous
system, disrupts the intake vitamin B1, and also causes dehydration which can
affect brain cells.
Prolonged high risk use of alcohol may result in specific psychological and biochemical
changes that may be described as alcohol-related brain injury (ARBI). This condition
is often confused with dementia, or pre-morbid deficits associated with learning
disorders, and manifests in various ways, including:
■ Disturbance in executive functions
o poor attention, planning, organising, problem solving abilities, have dif-
ficulty in new environments or with new routines
o ‘concrete’ thinking, difficulties with self-awareness and insight, appear
poorly motivated
o rigid repetitive behaviour patterns and inability to recognise consequences
of behaviour
153
o problems responding to changes in routine
■ Memory disturbances
o poor short-term memory, may confuse dates/events
o problems learning new information
■ Non-verbal disturbance
o problems with hand-eye coordination and perception related tasks
With abstinence, proper nutrition, and psychological intervention, significant
improvement is possible. Physical examination, CT scan, and blood tests (LFT,
MCV etc.) will assist diagnosis.
There is no doubting the impact that an Alcohol-Related Brain Injury (ARBI) can
have on the family. The trauma experienced by family members while coping
with the person’s alcoholdependence may have been significant and presented
enormous challenges over many years. This burden is felt all the more heavily
with the development of a complex brain injury. Most often, those caring for
people with ARBI will have no special expertise in working with issues related to
this condition. This guide has been developed to help fill this gap, by serving as
a resource to families and carers. We have tried to structure the guide so that you
can easily access the information most relevant to you. We want to assist families
to feel more comfortable and confident in their interactions with those who have
developed this type of brain injury. Ultimately, the aim of this guide is to alleviate
154
some of the difficulties felt by families who have received little or no support in
the past. While not a definitive guide, we hope that you find this resource useful
in your continued efforts to support your loved one.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Effects of alcohol-related brain injury
Similar to other types of brain injury, ARBI can result in:
■ impaired judgment and self-awareness
■ social isolation
■ depression and mood disorders
■ lack of motivation
■ distractibility and concentration issues
■ impulsivity and reckless behaviour.
Types of alcohol-related brain injury
Like other types of brain injury, it varies from mild to severe in its effects and
various types of ARBI result from where the brain injury occurs:
■ Cerebellar atrophy causes balance and coordination issues
■ Peripheral neuropathy - sensory issues with the hands, feet and legs
■ Hepatic encephalopathy as an outcome of liver disease
■ Frontal lobe dysfunction affecting cognition, behaviour and personality
■ Wernicke›s encephalopathy caused by extreme thiamine deficiency
■ Korsakoff›s amnesic syndrome with severe short-term memory deficits.
Is recovery from ARBI possible?
Effects vary from person to person, as does the potential for recovery. Some
improvement may result when a person stops using alcohol and maintains a healthy
diet. The brain has only a limited ability to heal itself so improvements may actually
be due to effective rehabilitation as the person learns to compensate for lost skills
and abilities.
Alcohol-related Brain Damage
Alcohol-related brain damage is the damage that occurs to brain structures or
function of the Central Nervous System as a result of the direct neurotoxic effects
of alcohol intoxication or acute withdrawal. The frontal lobes are the most damaged
region of the brains of alcohol abusers but other regions of the brain are also
affected. The damage that occurs from heavy drinking/high blood alcohol levels
causes impairments in judgement and decision making and social skills. These
brain changes are linked to poor behavioural control and impulsivity, which tend
Alcohol
to worsen the existing addiction problem. The problems of alcoholism are well
known, such as memory disorders, liver disease, high blood pressure, muscle
weakness, heart problems, anaemia, low immune function, disorders of the digestive
system and pancreatic problems as well as depression, unemployment and family
problems including child abuse. Recently attention has been increasingly focused
on binge drinking by adolescents and young adults due to neurochemical changes
and brain damage which unlike with alcoholism can occur after a relatively short
period of time; the damage is particularly evident in the corticolimbic region. This
brain damage increases the risk of abnormalities in mood and cognitive abilities,
increases the risk of dementia and additionally binge drinkers have an increased
risk of developing chronic alcoholism.
Individuals who are impulsive are at high risk of addiction due to impaired behavioural
control and increased sensation seeking behaviour. Alcohol abuse especially during
adolescence causes or worsens deterioration of executive functions in the frontal
lobe. This brain damage from alcohol actually increases impulsivity and therefore
worsens the addictive disorder. With prolonged abstinence neurogenesis occurs
which can potentially reverse the damage from alcohol abuse.
155
How does alcohol damage the brain?
Dehydration
People who drink too much alcohol can become very dehydrated. Long-standing
dehydration can cause cells in the brain to waste away.
Toxic Effects Of Alcohol
Alcohol (or ethanol) is a toxic substance. This can have a negative effect on all
organs of the body, including the brain.
Malnutrition
People who misuse alcohol may choose to drink alcohol instead of eating a healthy
diet. Over time, this deprives the brain of essential energy. This can cause damage
to the brain.
Vomiting
Vomiting and diarrhea are often linked with excessive alcohol misuse. These reduce
the amount of vitamins and minerals being kept in the body and this can disrupt
how the brain works.
156
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Damage To Stomach And Intestines
Alcohol can damage the linings of our stomach and intestines. This means nutrients
from our food are not absorbed properly. Over time, this can damage the brain.
Liver Damage
Alcohol can damage the liver, which breaks down toxins in our body. If the liver
is not working properly, toxins stay in the body for longer and this can damage
the brain.
Depletion of Vitamin B1 (Thiamine)
A combination of alcohol, poor diet and poor absorption of nutrients can lead to
a deficiency in Vitamin B1 (also called Thiamine).
Vitamin B1 is important because it helps convert food into energy for the brain.
When levels of Vitamin B1 are too low, brain cells do not get enough energy to
work properly.
Withdrawal
In order for the body and brain to withdraw from alcohol in a safe way, it needs
plenty of Vitamin B1 to support this process. People who drink in a harmful way
may have very low levels of Vitamin B1 in their bodies and brain because of the
factors previously described. Repeated withdrawals or detoxes from alcohol without
enough Vitamin B1 can cause serious damage to the brain.
Wernicke–Korsakoff’s Syndrome
This ‘syndrome’ is the result of thiamine deficiency, essential for effective CNS
function.
The acute phase, Wernicke’s encephalopathy, is a life-threatening condition,
manifesting in:
■ global confusional state
■ ocular disturbances: horizontal nystagmus, ophthalmoplegia or 6th nerve
palsy, resulting in diplopia
■ ataxia: wide-based and reeling steps, although may be obscured by
polyneuropathies
One symptom is required for a diagnosis. When severe, main features include
difficulty walking unaided, disinterest and lassitude. Following administration of
parenteral thiamine, rapid recovery is possible.
Korsakoff’s psychosis (the chronic form of the syndrome) manifests in short-term
memory loss, confusion, confabulation, and Wernicke’s-type symptoms.
Alcohol
Alcohol-related brain damage (ARBD) is a brain disorder caused by regularly
drinking too much alcohol over several years. The term ARBD covers several different
conditions including Wernicke-Korsakoff syndrome and alcoholic dementia. None
of these is actually a dementia, but they may share similar symptoms. However, in
contrast to common causes of dementia such as Alzheimer’s disease, most people
with ARBD who receive good support and remain alcohol-free make a full or partial
recovery. In addition, there is a good possibility that their condition will not worsen.
Patterns of drinking in Great Britain have changed over the past 10 years. Middleaged people are now the age group which consumes the most alcohol and they
are drinking more than in the past, especially middle-aged women. In contrast,
younger people (aged 16-24) are now drinking less, particularly when it comes to
binge drinking.
157
Cognitive Impairment
Cognitive abilities are our brain-based skills that we need to carry out any task from
the simplest to the most difficult. For instance, getting the bus involves: planning
(what time, what route), decision making, motor skill (walking to the bus stop),
attention (noticing the bus is arriving), and social skills (asking for a ticket and
respecting other people on the bus).
Cognitive impairment is when a person has trouble with one or more aspects of
their cognitive abilities. This could include remembering, learning new things or
making decisions. Cognitive impairment can range from mild to severe. With mild
impairment, people may notice minor changes in their memory but still be able to
do everyday activities. Severe levels of impairment can lead to the person needing
a great deal of support to cope with day-to-day life.
REFERENCES
1. http://www.drugfreeworld.org/drugfacts/alcohol.html
2. http://www.wisegeek.com/what-is-pharmacology.htm
3. https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Whatcounts-as-a-drink/Whats-A-Standard-Drink.aspx
4. http://www.alcohol.org.nz/help-advice/standard-drinks/whats-a-standarddrink
5. http://www.ehow.com/facts_6144931_drug-alcohol-treatment-assessments.
html
6. http://www.ehow.com/about_5162286_alcohol-evaluation.html
7. https://pubs.niaaa.nih.gov/publications/aa65/aa65.htm
8. https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mentalhealth/alcohol-dependence/
158
9. http://www.beatalcohol.com.au/WhatisAlcoholDependence.html
10. http://www.wisegeek.com/what-is-diazepam.htm
11. http://www.wisegeek.com/what-is-diazepam-withdrawal.htm
12. http://www.wisegeek.com/what-are-the-side-effects-of-diazepam.htm
13. http://alcohol.addictionblog.org/what-is-aftercare-for-drug-addictiontreatment/
14. https://www.promises.com/articles/aftercare/
15. http://www.drugs.ie/resourcesfiles/guides/ARBIFamilyGuide2.pdf
Illustrated Handbook of Drugs & Alcohol Related Health Issues