Where habit ends and disease begins
The limit is drawn not by the amount of drinking or the frequency of feasts, but by the loss of control. A person without addiction calmly refuses, stops at one portion and skips any event without internal tension. With addiction, these simple things become difficult, and the explanations become more and more convincing: “there was a reason,” “the work is stressful,” “I don’t do it every day.”
- A strong desire to drink that is difficult to ignore and returns
- Loss of control: it is impossible to stop at the planned quantity
- Increased tolerance - the previous dose does not work, more is needed
- Severe morning condition, which is relieved by a new portion of alcohol
- Use continues despite health problems, in the family and at work
- Narrowing the circle of interests: plans, communication and relaxation are built around drinking
- Loss of memory for events of the evening, drinking alone, secretiveness
There are four short questions that doctors use to quickly self-test. Have you ever tried to cut down on your use? Do others' comments on this matter irritate you? Have you ever felt guilty about drinking? Have you ever had to drink in the morning to get yourself going? Two affirmative answers are already a sufficient reason to consult a narcologist, even if outwardly life looks prosperous. These questions do not make a diagnosis, but they do a good job of separating a situation that requires attention from normal episodic use.
How addiction develops
The course of the disease is usually described in three stages. The boundaries between them are arbitrary, and no one moves from one to another in one day, but the general logic is important: the further you go, the less control remains and the more bodily consequences accumulate. It is useful to know this sequence in advance - it allows you to see the problem before others notice it.
- Начальная стадия: растёт переносимость, исчезает защитная рвота на передозировку, появляются провалы в памяти. Тяжёлого утреннего состояния с потребностью опохмелиться пока нет, и именно поэтому проблему не замечают.
- Средняя стадия: формируется абстинентный синдром — утром плохо, и это снимается алкоголем. Появляются запои, конфликты дома, прогулы, первые изменения в печени и поджелудочной, скачки давления.
- Тяжёлая стадия: переносимость падает, опьянение наступает от малых доз. Употребление становится почти непрерывным, нарастают изменения характера, поражение печени, сердца и нервной системы, возможны психозы.
The transition between stages usually takes years, but with early use, in women and people with hereditary burdens, it goes much faster. Therefore, appealing at the first stage, when “everything is not so bad yet,” gives better results and requires less effort.
What alcohol does to the body
Ethanol is toxic to all tissues without exception, and the liver takes the brunt of it because it is the one that processes it. The insidious thing is that organs are damaged silently for a long time: fatty hepatosis does not hurt, incipient pancreatitis manifests itself only as discomfort after eating, and high blood pressure is discovered by chance during a medical examination. By the time complaints arise, the changes are already significant. The other side of the same coin is encouraging: when you stop using, a lot is restored, and fatty hepatosis, for example, goes away within a few months of sobriety.
- Liver: fatty hepatosis, then alcoholic hepatitis and cirrhosis - a path that has been asymptomatic for a long time
- Pancreas: acute and chronic pancreatitis, one of the most painful scenarios
- Heart and blood vessels: persistent increase in pressure, rhythm disturbances, alcoholic cardiomyopathy
- Nervous system: polyneuropathy with burning and numbness in the feet and hands, memory and attention problems
- Digestive tract: gastritis, ulcers, bleeding from dilated veins of the esophagus with cirrhosis
- Increased risk of cancer of the oral cavity, pharynx, esophagus, liver, colon, and in women - breast
- Psyche: Alcohol relieves anxiety for a short time and then increases it, supporting depression and insomnia.
- Immunity and metabolism: wounds heal worse, infections are more severe, absorption of B vitamins is impaired
- Reproductive area: decreased testosterone levels and potency in men, cycle disorders in women
The question of a safe dose deserves a separate discussion. The usual formulation “a glass of wine a day is good for the heart” has been revised in recent years: modern data do not confirm the protective effect of alcohol on blood vessels, and there is no safe threshold for cancer risks at all. This does not mean that everyone who drinks will get sick, but it does mean that there is no reason to consider alcohol as a health remedy.
Withdrawal syndrome and delirium tremens
Withdrawal syndrome develops 6 to 24 hours after stopping or sharply reducing the dose in a person with addiction. This is not the hangover of a healthy person after a holiday: the body, accustomed to the constant presence of ethanol, enters a state of overexcitation of the nervous system. The danger is that on days 1–3 the condition may develop into a seizure or delirium delirium.
- Trembling hands and whole body, drenching sweat, rapid pulse, high blood pressure
- Severe anxiety, fear, insomnia, nightmares
- Nausea, vomiting, complete lack of appetite
- Convulsive seizure - most often in the first two days
- Confusion, disorientation in time and place, visual and auditory hallucinations, agitation
- Increase in temperature and sudden fluctuations in pressure
An important pattern: the severity of withdrawal increases from episode to episode. Each subsequent exit from the binge is tolerated worse than the previous one, and the likelihood of seizures and delirium increases. Therefore, the argument “it was possible before” does not work well as an argument in favor of coping at home alone.
How to treat and why coding is not the endgame
Addiction treatment is not one procedure, but a sequence of steps, each of which solves its own problem. Skipping any of them sharply reduces the chances: withdrawal from withdrawal without psychotherapy leaves the person alone with the previous reasons, and psychotherapy during continued use is simply not accepted. Order matters here.
- Снятие абстиненции: восстановление водно-солевого баланса, витамины группы B, средства для купирования возбуждения и профилактики судорог. Это первый шаг, а не лечение самой зависимости.
- Обследование и лечение последствий: печень, поджелудочная железа, сердце, нервная система, дефициты питания.
- Психотерапия — основная часть работы: разбор ситуаций, которые приводят к срыву, обучение отказу, восстановление отношений, лечение тревоги и депрессии, если они есть.
- Поддерживающая терапия по назначению нарколога: препараты, снижающие тягу или формирующие непереносимость алкоголя.
- Длительное сопровождение: регулярные встречи со специалистом, группы поддержки, заранее составленный план действий на случай срыва.
What is called coding combines different techniques with a common meaning: they create a barrier before the first drink. The barrier is useful, but it is limited in time and does not answer the main question - how will a person fill the vacant space: evenings, company, a familiar way to relieve stress. If this issue is not resolved, a breakdown at the end of the term is natural, and the blame for it falls on the person, although the reason is incomplete treatment. Coding makes sense as part of a plan, not as a sole measure.
What can the family do?
The family is both the main resource and one of the reasons why the disease drags on for years. Relatives usually go through the same path: first, persuasion and tears, then scandals and ultimatums, then a silent accommodation in which a protective system is built around the drinker - they call work for him, pay off debts, come up with explanations for relatives. This system is convenient for everyone, except for the result: it removes from a person the consequences of his own decisions and thereby removes the main reason to change something.
- Talk about facts and consequences, rather than making personal assessments: “you didn’t come to your daughter’s birthday party” works better than “you’re an alcoholic.”
- Stop extinguishing the consequences - making excuses to your superiors, paying off debts, cleaning up your tracks. As long as the family bears the consequences, a person has no reason to change anything
- Do not pour out alcohol and do not conduct searches: this turns the disease into a family war and does not solve anything
- Choose a sober time for conversation, a calm tone and end with a specific proposal: make an appointment with a doctor, go together
- Not trying to break a heavy multi-day binge at home on your own is a medical task
- Take care of yourself and your children: seek advice yourself, even if the addict still refuses
The conversation should be prepared in advance, and not started on emotions. The following scheme works: name two or three specific cases with dates, talk about your own feelings instead of assessments, indicate what exactly will change in the family’s behavior, and end with a ready-made proposal - a recorded consultation time. Doesn’t work: talking while intoxicated, generalizations like “you always” and “you never”, threats that you know will not be carried out. If a person refuses, the conversation was not in vain: what is heard is almost always returned later, and the decision to contact is rarely made the first time.