In Western civilization, people have been drinking alcoholic beverages for centuries. Moderate alcohol consumption is not satisfactory. However, many people cross the border, going from moderate to risky, harmful, or addictive use. The reasons for this may be social prerequisites, as well as the fight against the pathological state of anxiety or insomnia.
WHO makes a distinction between moderate consumption (healthy men – 40 g, healthy non-pregnant women – 20 g of pure alcohol per day = one to two glasses of wine) and harmful consumption leading to physical health problems (for example, gastritis, fatty liver), mental disorders (depression in most cases is aggravated by alcohol) or social harm (divorce, loss of a driver’s license). With alcohol dependence, the following stages can manifest: loss of control, increasing the dose, decreasing the need, and completely refusing to drink.
More than 10% of the Central European population has alcohol-related problems or illnesses.
The most reliable method of therapy for people with alcohol dependence is a complete rejection of alcohol, which means: not a drop of alcohol anymore. After all, an alcoholic once is always an alcoholic.
Fewer than 10% of people with alcohol use disorders seek withdrawal symptoms. Many do not admit to themselves or others in their problems with alcohol due to the fear of lifelong abstinence from alcohol.
There are people who are unable to control themselves they must strive for abstinence. However, there are people who are unable to abstain – then they should strive for increased control (Bruegger’s model). The doctor accompanies and supports his patient throughout the entire path of treatment. At the same time, the goal is not final, it can change in the process based on the experience gained. Thus, only 20% of people who seek controlled alcohol consumption choose total abstinence, even though they initially did not want to. And some people who were aiming for complete rejection and did not achieve the goal still significantly reduce their daily intake.
Individual assistance should be offered for each person, both in the fight against alcohol consumption and in the elimination of a possible underlying medical condition (anxiety, chronic pain or sleep disturbance).
Cognitive behavioral therapy and psycho dynamic psychotherapy are useful adjuncts to treatment, especially for anxiety and depression. Relaxation and neurofeedback techniques are also applicable.
The importance of drug treatment is growing. Nalmefene is a drug that helps reduce consumption. Baclofen (in most countries still used to treat other diseases) helps to get rid of alcohol dependence, reduces the need for alcohol and relieves the stress arising from abstinence.
Inpatient treatment for alcohol dependence makes sense only for addiction syndrome and usually lasts only a few days.