A psychoactive substance (surfactant) is understood as any substance (natural or synthetic) that, with a single dose, can change mood, physical state, self-awareness, perception of the environment, behavior, or give other psychophysical effects desirable from the consumer’s point of view, and, when taken systematically, cause mental and physical dependence.

There are three groups of psychoactive substances: alcohol, drugs and toxic substances. The latter also include drugs with a psychotropic effect (so-called psychotropic drugs), approved for medical use by the Pharmacological Committee of the Russian Federation and not included in the official “List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation.”

Alcohol – the most commonly used psychoactive substance. From the standpoint of pharmacology, toxicology and narcology, alcohol-containing drinks are a narcotic substance. But since alcohol is not included in the list of controlled substances like drugs, alcoholism is not legally considered a drug addiction. In the system of organizing drug treatment services for the population, alcoholism occupies a leading place and represents the main form of disease in this group.

Under drug means a substance that meets the following criteria:

a) has a specific effect on mental processes - stimulating, euphoric, sedative, hallucinogenic, etc. (medical criterion);

b) non-medical consumption of the substance is on a large scale, the consequences of which acquire social significance (social criterion);

c) in accordance with the procedure established by law, it is recognized as a narcotic and is included by the Ministry of Health of the Russian Federation in the list of narcotic drugs (legal criterion).

Psychoactive substances not classified as drugs are usually called toxic . They have all the psychotropic properties of drugs and have common patterns of addiction formation with drugs. Moreover, addiction to toxic substances is often more pronounced. If the Criminal Code of the Russian Federation does not provide for criminal liability for the illegal acquisition, storage, production, processing, shipment and sale of these substances, then they are not considered drugs.

Due to the fact that currently in our country there is an increase in the use and abuse of psychoactive substances, a doctor of any specialty must know the specifics of taking an anamnesis, somatic examination and the possibility of rapid diagnosis of patients with suspected substance abuse.

History taking: Usually these patients tend to deny the fact of use or downplay the dose due to fear of the consequences that may entail admitting the use of psychoactive substances. Therefore, if you suspect the use of surfactants, you must strive to obtain objective information from other sources. At the same time, the doctor must understand that the patient will try to downplay or completely deny the fact of using surfactants.

It should be borne in mind that substance abuse often coexists with mental disorders (depression, anxiety), which in itself is also the cause of their occurrence. Patients can self-medicate using both prescribed and non-prescribed medications. When assessing a patient with symptoms of depression, anxiety or psychosis, it is necessary to exclude the possibility that these disorders could be caused by the use of psychoactive substances.

During physical examination it should be determined whether the patient's physical illness is associated with the use of surfactants. Thus, if symptoms of HIV infection, abscesses, bacterial endocarditis, hepatitis, thrombophlebitis, tetanus, abscesses, scars from intravenous or subcutaneous injections are suspected or detected, it is necessary to exclude intravenous or subcutaneous administration of surfactants. Patients who inhale cocaine or heroin often experience a displaced or perforated nasal septum, nasal bleeding, and rhinitis. Patients who smoke refined cocaine, crack, marijuana, or other drugs (including inhalants) often suffer from bronchitis, asthma, and chronic respiratory diseases.

If you suspect the use of surfactants, you can with a high degree of probability use rapid tests for detecting narcotic substances in urine. Domestic tests have proven themselves to be effective, allowing one to determine with very high reliability whether a patient uses certain narcotic substances. The availability of tests to determine one or several surfactants at once opens up wide opportunities for early diagnosis. The simplicity of diagnostic testing, the ability to determine drugs of the opium group within five days, and cannabinoids within 2 weeks after the last use, makes it possible to use them in medical institutions, everyday life, educational institutions, during examinations, etc.

Medical documentation must provide a detailed description of the substance used, not the category to which it belongs. Also indicate the method, dose and frequency of administration, if rapid testing was carried out - its results. It should be borne in mind that rapid tests, as well as laboratory research methods in diagnosing addiction to psychoactive substances, have only an auxiliary value, since the very fact of detecting a surfactant in the patient’s body is not the basis for making a diagnosis. The main method in diagnosing the disease remains the clinical examination method.

Alcoholism and alcoholic (metalcoholic) psychoses

Alcoholic hallucinosis

Alcoholic hallucinosis – the second most common psychosis in patients with alcoholism. The duration of the existence of the second stage of alcoholism by the time the first hallucinosis occurs in life in 90% of cases exceeds 5 years, the age of patients ranges from 25 to 40 years. Psychosis occurs in the first days after stopping alcohol abuse. The previous binge is usually at least 3-4 days. Most patients have additional pathology: residual effects of organic brain damage, various somatic diseases.

The prodromal stage of alcoholic hallucinosis is an alcohol withdrawal syndrome that is more severe than is typical for a given patient. This is due to the fact that before the onset of the first hallucinosis in life, the duration of the binge increases or the daily dosage of alcohol increases. The severity of withdrawal syndrome is less than with the development of delirium, seizures occur very rarely

The clinical picture of psychosis is dominated by true verbal hallucinations; the patient’s consciousness is not clouded. True hallucinations usually contain unpleasant content for the patient: threats, insults, abuse. The patient is called an “alcoholic, a drunkard,” and is threatened with violence. There is no criticism of hallucinatory experiences, while the patient’s consciousness is not grossly impaired, auto- and allopsychic orientation is preserved. The behavior of patients is usually determined by the content of hallucinations. Mandatory hallucinations are especially dangerous for others and the patient himself. Unstable secondary delusions of persecution and relationships may be added. The mood background corresponds to the theme of hallucinations; often the patient is wary, anxious, and sometimes depressed.

Treatment of patients with alcoholic hallucinosis is carried out in a psychiatric hospital. The main thing in treatment is the elimination of productive psychotic symptoms. For this purpose, psychotropic drugs are prescribed: haloperidol, tizercin, etaprazine. Mandatory components of complex treatment are detoxification, vitamin therapy (especially group B), and nootropics. All patients who have suffered from alcoholic hallucinosis are prescribed anti-alcohol treatment.

Alcohol paranoia (delusions of jealousy)

Alcoholic paranoia (alcoholic delusions of jealousy, alcoholic delusions of adultery) – a chronic form of alcohol psychosis with a predominance of primary paranoid delusions occurs exclusively in men, the average age of onset of the disease is about 50 years.

Alcohol paranoia occurs predominantly in individuals with psychopathic character traits. They are characterized by such characterological properties as distrust, a tendency to regimentation, sthenicity, egocentrism, excessive demands, stagnant affects, and a tendency to form overvalued ideas. These character traits are especially noticeable during periods of alcoholic excesses.

Usually delirium is monothematic, develops gradually and unnoticeably. Initially, individual delusional statements are observed only during the period of intoxication, and after sobering up, patients refuse accusations, explaining unfounded claims by the fact that they were drunk. Then jealous fears begin to be expressed even in a state of hangover. Gradually, a persistent, systematized delusion of jealousy is formed. Patients delusionally interpret the actions of their wife or mistress, meticulously examine the body, carefully check women's underwear, trying to find confirmation of their thoughts. Delusional and affective illusions can often arise: folds on the pillow are regarded as traces of a lover’s head, stains on the floor in the bedroom are interpreted as traces of sperm. Usually at this stage of the development of delirium, a conflict arises in family relationships, which leads to a refusal of intimacy. This further strengthens the patient’s confidence in his wife’s infidelity. The content of delusional experiences, reflecting the characteristics of relationships and conflicts encountered in life, retains a certain plausibility. In this regard, those around the sick person do not consider his condition painful for a long time.

Often, to prove that they are right, patients force their wives to admit to infidelity. If a woman cannot withstand requests, threats, beatings and admits to allegedly committing infidelity, this only strengthens the patient in his rightness.

Further changes in psychosis may be associated with the appearance of retrospective delusions. The patient begins to claim that his wife is cheating on him not only now, but did it before, even in the first years of marriage, moreover, she did not give birth to children from him. To support his words, the patient cites a lot of real facts, interpreted in a delusional way. Behavior towards children becomes consistent with delusion. Sometimes the transformation of a monothematic delusional syndrome is complicated by delusional ideas of poisoning, witchcraft or damage, usually associated in a system with pre-existing delusions. Often in these cases, suppressed angry affect and continued drunkenness can result in delusional behavior with acts of cruel aggression towards wives. A fairly common form of delusional behavior in such patients is the murder of a spouse, usually committed in a state of alcoholic behavior. Aggressive behavior towards an imaginary opponent, even a personified one, is rarely observed.

Patients are usually hospitalized as involuntary hospitalization due to the danger of their behavior to others. Criticism of the ideas of jealousy usually does not appear during neuroleptic therapy, but patients stop delusionally assessing the actions of others, and behavior becomes harmless for loved ones. Discharge from the hospital is possible only if delirium is deactualized.

In remission The patient is considered to have completely abstained from drinking alcoholic beverages for at least six months with the preservation of all the disorders characteristic of alcoholism. During the period of remission, the general condition of the patient improves, all signs of alcohol intoxication disappear. However, not all symptoms of alcoholism disappear or are alleviated during remission at the same time. Very often, at the beginning of abstinence, irritability, affective mood swings, dissatisfaction with oneself are noted, an obsessive craving for alcohol periodically occurs, and phenomena of pseudo-abstinence syndrome with vegetative manifestations are noted. The most stable remission is formed only after 3-5 years of abstinence. Features of remission depend on the stage of alcoholism.

Remissions are divided into therapeutic (occurs after treatment) and spontaneous (under the influence of somatic and/or social factors).

Therapeutic remissions are determined by the quality of treatment measures, the severity of the disease and the personal characteristics of the patient. Abstinence from drinking alcohol after treatment for 6-12 months is considered therapeutic remission, for 1-5 years is regarded as good, and for more than 5 years - as a very good result. But even in these cases, any resumption of alcohol use usually leads to a loss of control and a resumption of all manifestations of alcohol dependence. This does not exclude, however, the possibility of short-term “breakdowns” occurring due to random circumstances during the period of remission, which, if immediate therapeutic measures are taken, do not lead to further alcohol abuse.

According to the literature, the frequency of spontaneous remissions ranges from 10 to 40% of cases. More often, spontaneous remissions occur with symptomatic alcoholism and are caused by the course of the underlying disease, in older people with a long duration of the disease due to decreased alcohol tolerance, severe intercurrent diseases and social reasons.

In general, remissions lasting up to a year, according to various authors, are observed in no more than 30-70% of cases, more than 1-2 years - in 7-20%, more than 5 years - in 4-5%. The highest results are achieved in cases of early initiation of treatment (in the period of pre-illness and stage 1), with the use of long-term and complex supportive treatment (psychotherapy, psychotropic and symptomatic drugs).

Relapse in alcoholism, this is the resumption of alcoholism during a period of remission with the appearance of symptoms of a secondary or primary pathological desire. They arise under the influence of both unfavorable social and everyday factors, and in connection with the ongoing pathological attraction to alcohol associated with the biological mechanisms of the disease. The first include unfavorable environmental conditions, negative influences from drinking company, conflicts at work and in the family, divorce, and loneliness. Uncontrollable (compulsive) attraction is manifested by a feeling of internal tension, anxiety, depressed mood, fussiness, as a result of which the patient’s actions are deprived of conscious control, and he, as if forgetting about his previous intentions and the promises he made, begins to act without realizing it. , obtains alcoholic drinks and brings himself to a state of severe intoxication.

Often, a relapse of alcoholism in conditions of persistent and worsening compulsive desire occurs in connection with pseudo-abstinence, when phenomena resembling withdrawal syndrome occur spontaneously and without drinking alcohol.

Alcoholism is a difficult to treat and very insidious disease. It can haunt its victim for many years, even after qualified treatment in specialized clinics. In this regard, the former alcoholic himself and the people around him need to remember that the relapse of this disease, like other chronic diseases, never occurs spontaneously, it is always due to specific reasons: unemployment or serious problems at work, conflicts in the family, as well as the exacerbation of internal psychological problems, which each of us has in abundance, but not everyone knows how to cope with them on their own.

So, the main signs indicating the possibility of a person falling into the network of alcohol addiction again come down to the following:

• an individual susceptible to this type of addiction begins to go to extremes, which is expressed either in his lack of faith in defeating the disease to the end, or, on the contrary, in excessive self-confidence in his own willpower, which will not allow him to return to his previous drunken life;
• Depressive states become more frequent and last longer;
• the person is haunted by images of the past (usually negative), and an obsessive state of anxiety does not leave him;
• bouts of sudden irritation appear again, easily turning into anger, manifested in uncontrollable and very often unfounded blaming others for their own failures;
• insomnia returns, appetite worsens, constant anxiety does not allow you to relax and fully rest
• the person again withdraws into the small world of his monotonous sad thoughts, rejects help, and does not want to communicate;
• he is haunted by thoughts of drinking;
• a person persistently assures himself that the disease has long receded and, therefore, today he can drink in moderation, like everyone else, without getting drunk to the point of unconsciousness;
• at the moment such a thought arises, he, of course, does not know that it is nothing more than a myth, and in this situation, any experiments involving strong drinks are extremely dangerous: they lead to an inevitable breakdown.

A natural question arises: what to do in such a situation? How can you help a loved one avoid being at the mercy of the green snake again? And, finally, how can and should a person help himself in this case?

The answers are simple and complex at the same time. In the current situation, relatives and friends should under no circumstances show irritation or respond to aggression with aggression. This will not lead to anything good: in the mind of a newly ill person, the spirit of contradiction will only strengthen, which will not allow him to make the right decision. The person himself, who has been subjected to the onslaught of such a negative state, characterized by the listed signs, should not isolate himself in his problem. He urgently needs to contact a qualified specialist and, without hesitation, reveal to him all the nuances of his situation. And then subsequent assistance will be effective and professional.

Types of alcoholism

Based on clinical observations, four main types of the course of alcoholism are distinguished: progressive, stationary, relapsing and regressive.

The progressive type of course is evidenced by alcohol abuse, which practically does not stop for several years. Treatment in most such cases turns out to be ineffective; the period of abstinence from drinking after treatment is no more than 6 months. Observe the progression of the main alcoholic symptoms with the transition to new stages of the pathological process.

The stationary course of alcoholism is characterized by the slow formation of stage II of the disease (10-15 years or more), while professional performance, social and family connections are preserved for a long time. Drunkenness is relatively moderate, alcoholic psychosis usually does not occur, however, remissions are also short-lived.

The relapsing course of alcoholism is accompanied by relatively long remissions (both therapeutic and spontaneous) - from 6 months. up to 1 year or more. However, there is no reverse development of alcohol symptoms. This type of course is relatively favorable, but the prognosis depends on the effectiveness and timeliness of therapeutic measures.

The regressive type of flow can be defined as favorable. It is often a consequence of effective treatment and preventive measures. Therapeutic or spontaneous remissions are long-term (at least a year) and are accompanied by a reverse development of alcohol symptoms. The occurrence of spontaneous remissions is facilitated by certain constitutional and typological personality traits, deterioration of somatic condition, and active intervention of the microsocial environment. During short-term relapses, alcohol symptoms do not reach the severity that was observed in remission. The absence of exacerbations for 3 years or more is assessed as conditional recovery, which gives grounds to consider the issue of deregistration from drug treatment. When addressing this issue, it should be remembered that, despite the restoration of social functions and the leveling of alcoholic deformations of personality and behavior, a number of pathogenetic mechanisms remain in such individuals that determine readiness for relapse in the event of alcohol consumption. Therefore, it is advisable to consider this situation as recovery, but only as long-term remission.

Remissions and relapses

During the development of alcoholic illness, more or less long-term remissions are possible: spontaneous and after treatment. Most often they are observed in the initial stages of alcoholism: in stages I and II. Conventionally, such remissions can be divided into two groups: a conscious reluctance to further alcoholism and the inability to drink alcohol due to exacerbation of somatic diseases. Remissions in alcoholism cannot be equated with recovery, because in the case of alcohol consumption, even after a long remission (10-20 years), symptoms of physical dependence quickly appear. So some scientists consider alcoholism an incurable disease.

The following types of remissions are distinguished:

2. subcompensated remission (more than one year) with affective reactions, actualization of pathological craving for alcohol, pseudo-abstinence syndrome, belonging to relapses of dangerous clinical situations.

3. Remissions (more than one year) with the absence of clinically pronounced affective reactions and actualization of pathological craving for alcohol are compensated. With such remissions, in some cases short-term (no more than 2 weeks), mildly expressed involuntary or situationally provoked mood swings are observed.

The stability of remission increases if the patient understands the value of sobriety, the impossibility of moderate consumption of alcoholic beverages and filling free time with other meaningful activities (work, hobbies, sports, etc.).

The causes of relapse of the disease can be both external and internal. The first includes the influence of the drinker’s company (sometimes taking the form of outright pressure) and constant reminders from the environment about the patient’s alcoholism (at home, at work, former friends). Internal causes include hormonal fluctuations (especially in women), affective fluctuations (in the direction of both pleasant and unpleasant sensations), states of hunger, physical and mental fatigue.

Separately, it is worth considering the spontaneous craving for alcohol and the activation of the alcoholic dynamic stereotype. Most often this occurs in the form of an “influx” of thoughts about the desire to drink (most often in the evening and at night) and dreams on an alcoholic theme. Usually these dreams are vivid and thematically related to preparation for drinking alcoholic beverages. At the initial stages of sobriety, such experiences can lead to the appearance of pseudo-withdrawal syndrome: psychopathological and somatovegetative disorders resembling this condition. Activation of the alcoholic dynamic stereotype can be caused by any memory of drinking alcohol: a similar place, situation, visit to a store, etc.

It must be borne in mind that the causes of relapse never exist separately and are not always recognized by the patient. To prevent relapses, it is recommended to carry out special psychotherapeutic treatment in the form of courses for 0.5-2 years.

The arsenal of medications aimed at relieving the pathological craving for alcoholic beverages and developing a negative reflex to alcohol is quite large and varied. A skillful combination of psychotherapy, various medications and techniques in 60-70% of cases gives a positive therapeutic effect. It must be assumed that in some cases the lack of success is due to incorrect selection of medications and insufficiently thought-out treatment tactics.
The difficulty of treating alcoholism lies in the quality of its results. Unfortunately, a number of factors make alcoholism a special disease. What are these features? The first of them. lies in the fact that most people consider alcohol consumption to be a common occurrence, without attaching much importance to the possibility of developing alcohol-related diseases. The line of reasoning usually goes like this: “I drink a little, like everyone else...”; “Millions of people drink and don’t get sick, why should it be me who gets sick... I can’t not drink all my life when many around me do it.”
The second feature of alcoholism is that the treatment provided is mainly pathogenetic, not etiological, that is, we are trying to disrupt the pathogenetic chain of development of the disease, without excluding the cause itself. In this regard, many scientists believe that a person suffering from alcoholism is not cured of it, but only enters a state of remission (improvement). This point of view is incorrect because there are many examples where timely treatment interrupts the progression of the disease and completely restores the patient’s position in society with good health. In addition, this position causes a kind of pessimism in the patient himself and his relatives, undermining faith in the success of treatment. All this has led to the fact that at the present stage of alcoholism treatment it is recognized as necessary to carry out long-term (5 years) continuous therapy, without which it is difficult to count on success.
The above-cited order “On approval of mandatory minimum courses of treatment for patients with chronic alcoholism” states: “Patients who have completed an outpatient course of active anti-alcohol therapy, discharged from drug treatment (psychiatric) hospitals and who have completed treatment in medical-labor dispensaries are subject to outpatient maintenance treatment.
Maintenance therapy is a mandatory stage of anti-alcohol treatment, ensuring the prevention of relapse of the disease.” Thus, maintenance therapy is the general line in the treatment of alcoholism.
Just as in the previous stages of treatment, psychotherapy in its various types and combinations occupies one of the main places in the structure of supportive treatment.
Periodically, depending on the general condition of the body, restorative, tonic or sedative therapy is recommended. The latter type of treatment mainly involves the use of various psychotropic drugs. To relieve neurotic, psychopathic states, it is recommended to prescribe trioxazine, elenium, etc. If necessary, reduce or suppress the growing craving for alcoholic beverages, neuleptil, carbidine, etaparazine, etc. should be prescribed.
When using psychotropic drugs, we must not forget that alcoholics and alcohol abusers tend to quickly become addicted to psychotropic and narcotic drugs, therefore, they can be prescribed only for a short time and preferably in combination with other symptomatic drugs.
For a number of patients, “chemical isolation” from alcohol is very important immediately after the active phase of treatment, after discharge from LTP. In these cases, maintenance doses of teturam 0.15-0.25 g, metronidazole 0.5-0.75 g, nicotinic acid 0.1 g per day can be prescribed. Then, in the 1st year of remission, these drugs are prescribed in systematic courses daily for 1-3 months with breaks between courses of 2 months, in the 2nd year of remission - daily for 1-2 months with breaks between courses of up to 3 months. in the 3rd year of remission - daily for 1 -1.5 months with an interval of 4-6 months, in the 4th and 5th year of remission, treatment is also carried out daily for 1 -1.5 months with intervals of 5 -6 months
Depending on the patient’s condition, the appearance of cravings for alcoholic beverages, and the attenuation of the negative reflex to alcohol, it is recommended to carry out tetramoalcohol and metronidazolealcohol provocations. Some patients should be invited simply to be present at such tests for psychotherapeutic influence.
Conditioned reflex therapy should be carried out depending on the year of observation. In the 1st year of remission, conditioned reflex therapy is prescribed three times: as a course of active anti-alcohol treatment, then after 3-6 months; in the 2nd year they are carried out 2 times; in the 3rd year - once a year; in the 4th-5th year - according to indications.
If necessary, patients can be periodically admitted to the hospital for courses of conditioned reflex therapy. If provocations are carried out on an outpatient basis, then on the day of the test the patient can be released from work. Conditioned reflex therapy with apomorphine, emetine, vomiting cocktails averages 5-7 procedures, and lamb decoction - 1-2 procedures.
Questions about the timing of therapy, combinations of various medications used in treatment must be applied strictly according to official instructions approved by the Office for the Introduction of New Medicines and Medical Equipment of the Ministry of Health.
To maintain stable remissions, it is recommended that patients refrain from visiting restaurants, cafes, and even avoid parties in the 1st and 2nd year of remission. It is useful to lead a measured lifestyle, adhere to a certain pattern of work and rest, and eat regularly. It is advisable that the food be rich in vitamins, fruits, vegetables with some limitation of meat dishes.
When conducting maintenance and relief therapy, one should carefully examine the characteristics of a person’s personality and character and use this information in therapeutic measures. For example, in patients with a predominance of excitability and psychopathic behavior, psychotropic drugs such as neuleptil 10-30 mg, melleril 25-30 mg per day are indicated when the condition worsens.
In excitable individuals with epileptoid character traits during exacerbations of conditions, etaprazCn 10-20 mg, corbidin 75-100 mg, seduxen 10-30 mg, neuleptil 10-30 mg are prescribed.
Patients with asthenic personality traits when irritability, sleep disturbances and other neurotic symptoms appear are given seduxen 10-30 mg, phenazepam 2-4 mg, teralen 10-15 mg, elenium 15-30 mg. A combination of these drugs with vitamin therapy and restorative treatment is indicated.
People with paranoid character traits (ideas of jealousy, suspicion, hypochondria) are advised to take haloperidol 1.5-3 mg, Melleril 70-100 mg. For persons with unstable behavior, it is recommended: seduxen 10-30 mg, elenium 15-30 mg, carbidine 58-75 mg, teralen 10-15 mg, melleril 10-25 mg.
Short courses, up to 2 weeks, of neuleptil (10-20 mg), carbidine (50-100 mg), etaperazine (15-25) have a positive effect in individuals with hysterical and hysterical behavior.
During periods of remission, some patients may experience breakdowns or relapses of the disease. There are many reasons contributing to these conditions, the main ones being the following.
1. “I have been cured, now I can gradually start drinking again,” “you don’t need to drink a lot, but you can try to see what the result of the treatment is,” “friends and relatives drink, they persuade me to take a sip, it’s inconvenient to refuse, especially since I received good treatment,” “The doctor said that I won’t be able to drink for two years, the deadline has passed, I can try to live like other people.” These and similar statements are called autopsychological reasons.
2. Increased emotionality, inability to restrain emotions, decreased volitional qualities of patients at the slightest adversity, traumatic situations in everyday life, at work are often reasons for disruption of remissions. These reasons are classified as emotional and situational.
3. In some patients, as a result of the fading of the negative reflex to alcohol, a growing craving for alcoholic beverages, increasing anxiety, internal discomfort, and malaise, a desire to drink may sometimes appear, which leads to a breakdown in remission. Particular concern should be caused by causeless mood disorders and cravings for alcoholic beverages that arise without prior use. Such conditions are classified as endogenous-somatic, depending on the existing addiction to alcoholic beverages.
Remission failures are possible, consisting of periodic consumption of alcoholic beverages, but not leading again to their abuse. At the same time, the pathological (mental and physical) desire to drink alcoholic beverages does not have time to develop again, although frequent breakdowns can lead to this. Relapses include those conditions in which the systematic consumption of alcoholic beverages is resumed, often in the form of binge drinking.
and all the pathology that the patient had before treatment is revealed again.
Providing for the possibility of failures of remissions or relapses of the disease, it is necessary to psychotherapeutically prepare the patient, his family, and friends for this. This must be done so that when symptoms of a possible breakdown, binge drinking, i.e., the threat of relapse appear, they immediately seek help from a narcologist, psychiatrist, or paramedic-narcologist.
Next, it is important to restore psychotherapeutic contact with the patient again, first daily, and then 2-3 times a week, conduct rational psychotherapy with him, instill in him that he needs to develop a sincere desire to stop drinking and be cured. In some cases, the patient should be warned that otherwise he will face compulsory treatment. Treatment measures for remission failures and relapses can be divided into several stages.
The first is sobering up if the patient seeks help while intoxicated or drunk. These procedures should be carried out in a medical sobering station. If possible, it is not recommended to do this in a medical institution, so that patients do not develop dependent tendencies and do not count on this type of help in medical institutions.
The second stage is stopping the craving for alcoholic beverages that has arisen. Various means are used for this. Pyrogenic medicinal substances have proven themselves well. According to some data, hyperthermia relieves binge drinking and hangovers in 96-98% of cases. Sulfazine and pyrogenal are used.
5-7 ml of 0.37% sulfazine solution is injected intramuscularly into the upper outer quadrant of the buttock. Pyrogenal is also administered intramuscularly in increasing doses - 500, 750, 1000, 1250, 15,000 minimum pyrogenic doses. Hyperthermia during treatment with sulfazine occurs after 4-6 hours, with pyrogenal - after 2-3 hours, reaches 38-39 ° C and decreases during the day. Therefore, treatment can be carried out daily or every other day, for a total of 3-5 procedures. To prevent the patient from wanting to drink alcohol before the temperature rises, it is recommended to induce vomiting by giving 0.1-0.2 g of nicotinic acid or administering 50 ml of a 1% copper sulfate solution orally. Pyrogen therapy is contraindicated during pregnancy, with cardiovascular failure, exacerbations of kidney disease, tuberculosis, and febrile conditions.
When stopping remission failures and relapses, use teturam 0.5-1 g / day, metronidazole 1.5-2 g 3 times with an interval of 1 hour. Thiol drugs (unithiol, dicaptol) cause nausea, vomiting, restore the negative reflex to alcohol , sodium thiosulfate).
To speed up the withdrawal symptoms, symptomatic treatment should be started immediately, aimed at combating asthenia, neurotic symptoms, sleep and appetite disorders. For this purpose, glucose, vitamins, oxygen injection, strychnine injections, small doses of insulin, sleeping pills, and electrosleep are prescribed.
To eliminate the symptoms of a hangover, normalize sleep, mitigate affective disorders and deceptions of perception, tranquilizers, antidepressants, and antipsychotics are used in short courses and in small doses. Prescriptions of these drugs and their combinations are recommended by the attending physician.
In case of remission failures and relapses of the disease, reflexology can be used. These can be one-time appointments or treatment courses aimed, among other things, at relieving cravings for alcohol.
In the later stages of the disease, a number of patients have intellectual-mnestic disorders, which reduce criticism of their condition and push them to repeatedly consume alcohol.
In these cases, pirocetam (nootropil) and aminalon are indicated. The courses are long - from 2-4 weeks to 2-4 months with subsequent repetitions.
At the third stage of treatment, active anti-alcohol therapy is again prescribed, combined with massive psychotherapy. It is recommended to change treatment methods: if the patient previously received conditioned reflex therapy, then it is advisable to prescribe him TAR or perform TAAR. In some cases, hospitalization is indicated (if the patient has never been treated in a hospital before, etc.). Outpatient relief of remission failures and relapses also has its advantage, since it does not separate the patient from work, family, and instills confidence in the success of treatment.
It should be remembered that successful treatment of remission failures, binges, and relapses of diseases is possible only with the complex use of psychotherapy, pyrogenic, hypnotic drugs, psychotropic drugs, and active methods of treatment.