— It is customary to distinguish three stages of alcoholism. How do they differ from each other?
— The division into stages of alcoholism in domestic drug addiction has existed for almost 70 years. This is a symbol of the activity of alcohol poisoning. The first stage is the onset of the disease. It is characterized by the fact that the patient begins to drink large amounts of alcohol. Regularity appears, control of the situation gradually disappears and drinking becomes a priority, that is, a pathological attraction to alcohol appears and intensifies. At the same time, the physical and intellectual condition of a person, as a rule, does not deteriorate noticeably.
At this stage, the person can still be helped by activating all available defensive resources. However, as a rule, the patient does not want to stop drinking alcohol. In addition, often those around an alcoholic perceive his addiction as a “psychologically understandable hobby” that does not go beyond the norm. Such patients do not come to treatment of their own volition.
As a result, at the initial stage of addiction, a set of symptoms occurs, the protective gag reflex disappears, and alcoholic beverages are drunk more and more often and in large quantities. They often say about such people: “He drinks a liter of vodka and nothing happens to him.” This is the same high tolerance that almost inevitably accompanies the transition of the disease to the second stage.
— How much is a large amount of alcohol?
– A liter of vodka. If an ordinary person drinks half a liter, he will feel very sick. An alcoholic has a “trained” system capable of dealing with large amounts of “poison” to recycle alcohol and its metabolites. Sometimes it even becomes a reason for bravado and an indicator of “wonderful health resources.” However, alcohol still kills the human body and turns it into an “alcoholic robot”.
— What is the second stage of addiction characterized by?
– The emergence of excessive drinking, withdrawal syndrome, increased tolerance to what you drink. Here a person can already drink more than a liter of vodka. The patient develops physical dependence, amnesia appears and intensifies, different forms of intoxication occur when unmotivated aggression, suspicion and inadequate claims are noticed.
An important criterion is alcohol withdrawal syndrome. The next day, the patient experiences a hangover after drinking and drinks again to get back to normal. If this is not done, severe anxiety, discomfort, increased sweating, rapid heartbeat, tremors, insomnia, vomiting and extremely unpleasant sensations begin in the body.
A person’s character changes. For example, when drinking before, he experienced pleasant emotions, a feeling of joy, euphoria, and was “himself” outside of drinking alcohol. However, in the second stage of alcoholism, the person becomes irritable, constantly fluctuates in mood, and inappropriately increased emotional reactions occur both when drinking alcohol and especially when not drinking alcohol.
Criticisms of the person’s situation almost disappear here: the alcoholic does not accept his illness, he is still “fine”. If at the first stage of the disease a person can still listen to the advice of relatives and change his behavior, then at the second stage this is extremely unlikely.
— Is it possible to help a person in the last third stage?
– In the third one it is no longer possible. The body is so exhausted from alcoholism that, being in a constant state of intoxication, it “supports” itself with small fractional doses of alcohol.
— So the person starts drinking less?
– He begins to get drunk from a very small amount of alcohol, which does not create excitement, on the contrary, it is stupefying. Therefore, the alcoholic drinks very little, in fractional doses, and the basic idea is preserved: alcohol is the main value in life, despite the detriment of everything else.
But as they say, we still have to live to see the third stage: Develops after 15-20 years of active smoking. Unfortunately, it often results in premature death. There are many reasons for this: alcoholic psychoses, diseases of the cardiovascular system, liver and kidney diseases, accidents and injuries.
— Does the person’s character change at this stage?
— Yes, cynicism, aggression, cruelty, conflict, resentment and antisociality are increasing. The person becomes primitive, does not understand humor, intellectual stress causes irritation, healthy interests disappear. There is a mental decline in the patient’s personality.
— Does alcohol psychosis occur fully in the third stage?
– They occur quite often at the end of the second stage and the beginning of the third stage. Different alcohol psychoses have similar clinical presentations. This is persistent insomnia, severe fear, hallucinatory symptoms (voices and visions) of a threatening nature. Perceptual illusions are realistic, vivid and very similar to real images.
They are formed against the background of chronic intoxication, acquired inferiority of the brain, pathology of internal organs and toxic formation systems. The situation quickly worsens, drunkenness very quickly and inevitably “does its job.”
Alcoholic psychoses are accompanied by darkness and impaired consciousness. This is a particularly recognizable clinic. The most common of these is delirium tremens or delirium tremens. It occurs at the end of the distinct phase of alcohol addiction disease, or more precisely, at the end of the second phase and the beginning of the third phase of alcoholism.
– How does it show itself?
— Occurs after a sharp cessation of alcohol in an alcoholic with a long history of drinking. It develops gradually in the evening and at night. The patient experiences increasing anxiety, anxiety, fear, insomnia, and nightmares that turn into “psychotic reality.”
The person’s orientation in his own personality is preserved, but the person is oriented to place and time. He experiences visual and auditory illusions and hallucinations, usually of a threatening, frightening, frightening nature. The color scheme is usually dark green or black.
— The New Year holiday, which for some is associated with the possibility of binge drinking, is over. I have to go to work, so it’s time to stop drinking. Is delirium tremens more likely to occur during the first working days?
– Yes. This probability is high. Doctors have long been aware of periods when hospitalizations for alcoholism and alcoholic psychosis increase after long holidays and long weekends.
— What are the consequences of “Delirium tremens”?
— Delirium is generally very dangerous. This is accompanied by acute deterioration of the brain, cardiovascular, pulmonary and other body systems. The whole body suffers severely.
Korsakoff syndrome may also develop. (characterized by memory impairment. – “socialbites.ca”). Heavy and prolonged alcohol consumption leads to delirium, often with a convulsive component, after which the person may develop acute dementia. The patient is ignorant, does not understand where he is, does not remember what is happening around him, cannot find a toilet and “fulfills his needs in the most inappropriate place”.
In terms of symptoms, the clinical picture vaguely resembles prolonged delirium, but is still characterized by memory impairment and recognition impairment. Symptoms of alcoholic encephalopathy are complemented by polyneuropathy of the extremities; Paralysis and paresis with muscle atrophy and sensory disturbances may occur. The so-called “rooster” gait is characteristic when the patient lifts his leg up, throws it forward and lowers it sharply. The posture is straight, the steps are rhythmic, the arms make swinging movements.
— How does delirium differ from acute alcoholic hallucinosis?
—Acute alcoholic hallucinosis is like a “little delirium.” There is no disorientation in place and time, but there is a rather strong emotional stress, auditory hallucinations, but weaker than delirium tremens. A person often hears familiar sounds before falling asleep. The duration of psychosis may last up to 2-3 weeks.
Acute alcoholic hallucinosis rarely becomes chronic. In medical practice, hallucinosis occurs approximately in every 10 cases of delirium (those admitted to hospital). Although not every case of alcoholic psychosis is necessarily recorded in real life. Many alcohol-induced psychotic episodes have an inchoate manifestation, and such patients do not always end up in a hospital bed.
— What if this situation lasts more than a month?
— In alcoholism, there is chronic hallucinosis that can last more than six months. In some cases, these are complex comorbid cases that require qualified psychiatric diagnosis.
Hallucinations intensify and develop delusional ideas of various contents, arising against the background of pronounced anxious emotional tension and fear for one’s life. An alcoholic’s behavior becomes consistent with his experiences; It may pose a danger to the patient and his/her environment.
— Can schizophrenia also be caused by alcohol?
— Schizophrenia is considered an independent mental pathology by most clinical psychiatrists. However, it is often combined with alcoholism. Whether this type of alcoholism is a symptom of schizophrenia or a symptom of alcohol dependence is a question about the accuracy of clinical diagnosis. This is a very difficult and controversial aspect of clinical psychiatry.
— What other types of psychoses are there?
— There are alcoholic paranoids. This is nonsense with a more specific plot, consisting of everyday content usually associated with acquaintances or close people. It can be defined as delusions of persecution. The alcoholic also hears the voices and sees visual images of those who pursue him.
Delusions of alcoholic jealousy are also quite common in men. According to some data, women suffer from this pathology very rarely. I have never encountered such patients in my practice. It is generally accepted that this is due to male sexual dysfunction, although it is possible that everything is more complicated.
— What determines what type of psychosis a person suffering from alcoholism will develop?
— It all depends on the general condition of the soul and the body as a whole. The nature of alcohol addiction is important here: the stronger it is, the worse the person’s condition, the greater the likelihood of acute psychosis. History of traumatic brain injury, other psychiatric pathologies, somatic and neurological diseases – all this inevitably aggravates the patient’s condition and can “facilitate” the onset of alcoholic psychosis.
The parameters of alcohol-containing drinks also play a role. Surrogates, vodka and other “heavy” drinks quickly lead to the development of psychosis. Why did it get the name “White Tremens”? Because of the vodka. However, this does not mean that wine or beer is guaranteed not to cause such an outcome.
– At what stage can a person be treated?
– My research direction – clinical addiction science – is to develop one’s own professional vocabulary, to create one’s own clinical-pathogenetic model of pathological addiction as a psychiatric pathology. We are no longer talking about the stages of alcohol addiction, but its clinical and dynamic stages. This is the clinical emergence phase, the clinical manifestation phase, the clinical outcome phase.
It is possible and necessary to treat a person at the initial stage, when the pathology has not yet progressed. This will be difficult at the clinical manifestation stage, but at the clinical outcome stage we are most likely faced with the established disability of a “clinically advanced” patient. But this is a separate, long and professional conversation.