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👍 | Kazuhiro Kiyohara confesses the current state of drug treatment


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Kazuhiro Kiyohara confesses the current state of drug treatment

 
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More than five years have passed since he was arrested for violating the Stimulant Drug Control Law, and Mr. Kiyohara is now living his days fighting drug / alcoholism and depression.
 

[Mr. Kazuhiro Kiyohara leaked, "The coming season is very difficult ...".What kind of words did you get from your doctor?Former ... → Continue reading

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Alcoholism

Of the worldDisease burden(WHO, 2019)[1]
Rankingcause of deathDALYs (XNUMX)DALYs (%)DALYs
(Per 10 people)
1Neonatal disease20,182.18.02,618
2Ischemic heart disease18,084.77.12,346
3stroke13,942.95.51,809
4Lower respiratory tract infection10,565.24.21,371
5diarrheaSexual illness7,931.13.11,029
6Traffic accident7,911.63.11,026
7COPD7,398.12.9960
8Diabetes mellitus7,041.12.8913
9tuberculosis6,602.42.6857
10Birth defects5,179.72.0672
11Back and neck pain4,653.21.8604
12depressionSexual dysfunction4,635.91.8601
13Cirrhosis4,279.81.7555
14Trachea, bronchi, lung cancer4,137.81.6537
15Kidney disease4,057.11.6526
16HIV / AIDS4,014.71.6521
17OtherDeafness3,947.71.6512
18Death3,821.61.5496
19malaria3,339.81.3433
20Refractive error of the naked eye3,198.11.3415

Alcoholism(Alcohol damage, alcohol damage,British: Alcoholism),Alcohol use disorder(Alcohol use disorder,AUD) IsDrug addictionIt is a kind of drinking, etc.alcohol(Especiallyethanol) Ingestion (hereinafter,DrinkingBeing strongly trapped in the mental and physical pharmacological actions obtained by (S)), he cannot control his drinking behavior by his own will, and he compulsively repeats his drinking behavior.Mental disorderIs[2][3].. PreviouslyChronic alcoholism(Alcoholism),Chronic alcoholismWas sometimes called[4]..The first systematization of the effects of alcohol on the human body was in 1849, a Swedish doctor.(Swedish version.

Symptoms consist of psychological and physical dependence, and drinking alcoholControl with your own willSymptoms that can not be donePsychological dependence,Delirium tremensWithdrawal symptoms such asAlcohol withdrawal syndrome, Also called rebound)Physical dependenceSay[4].. Patients may lose their social and human credibility by causing damage to their bodies due to alcohol, annoying their families, and causing various incidents, accidents, and problems ("Alcohol abuse[3][5].

In the past, it was convinced that the reason for this situation was that the person had a weak will and lacked moral ideas and humanity, but nowadays it is a social necessity. From a medical point of view, it is considered to be a target for promoting treatment as one of the mental disorders as the coverage of medicine is further expanded.[4].

who (WHO) estimates that the untreated rate of alcohol abuse / dependence is 78.1% (2004).[6]). It can be said that it has a high morbidity rate among mental illnesses and can be affected by anyone regardless of their personality and will. The drinking population of Japan is said to be about 6,000 million, of which about 230 million are alcoholics. In addition, this number of 230 million peopleWHOIt was calculated by the calculation method of.

For treatment and support methods, see "Alcoholism # ManagementSee.

symptom

In the diagnostic criteria of ICD, craving,Self-controlloss,Withdrawal symptoms,Resistance, Drinking-centered life is mentioned[7].

Always strong against alcohol while awakeCravingOccurs.
When compulsive drinking progresses, you always want to be drunk or have alcohol in your body, and when you think that you are not feeling well, you should not drink while you are awake (during work or) "Continuous drinking attacks" often occur, in which you continue to drink, even when you are stopped by a doctor.[7].. If you cannot drink alcohol in a conspicuous place such as an office worker in the daytime, there is an example of hiding in the bathroom and drinking alcohol. As the symptoms progress further, "continuous drinking" will continue until the physical limit is reached, and when the body stops accepting alcohol, it will stop drinking for a while, and when it recovers, it will continue to drink continuously. "Mountain-shaped drinking cycle" May shift to. When the symptoms progress to this point, it is quite severe.
Drink alcohol at your own willコ ン ト ロ ー ルCan not.
"A chronic illness in which a person longs for a drink containing alcohol and cannot control his drinking"(ICD-9[8])
"Obsessive-compulsive drinking" is the following condition. Even a small amount of alcohol paralyzes the brain, and once you start drinking, it is almost impossible to control your subsequent drinking.[7].
Alcoholics are often thinking about getting the right amount of alcohol or not drinking it today. However, if you start drinking, you will choose the action of alcohol.[7].. In addition, although there are many benefits of not drinking alcohol for a long period of time, the effects of alcohol may lead to wrong thoughts and judgments, and the immediate pleasure may be selected. By repeating this process, I do not think that the situation will worsen and the symptoms will progress, so I will not find the need, I will not have a clear intention to stop drinking, and I will choose the pleasure of alcohol. And when I start drinking, I drink until I get drunk[7].
Although he causes various troubles with drinking and regrets it afterwards, he continues to drink again to forget it.
"Disorders characterized by drinking patterns that cause serious impairment of social or occupational function"(ICD-9[8])
Extremely high levels of alcohol consumption can eventually damage one's body (such as visceral disease) and cause social and economic problems.Domestic violenceIt will cause troubles with family members.Although he feels more stressed and regrets violently, he continues to drink more to relieve his mental distress.In this way, the behavior of continuing to drink alcohol despite the increasing loss for me is "punishmentCalled "resistance to".
Withdrawal symptoms(Withdrawal / withdrawal symptoms) appears.
Various symptoms occur when alcohol intake is interrupted. If it is mild, it may cause headache, insomnia, irritability, sweating, tremor of fingers and whole body (tremor), dizziness, nausea, etc., but when it becomes severe, delusions such as "someone is aiming"Delirium tremens, Convulsive seizures (alcohol-induced epilepsy), etc.[7][9].Hallucination(Hallucination / hallucination) is also a frequent symptom, and the symptom varies depending on the patient, such as seeing something like a small insect, seeing a person who should not be there, tinnitus or hearing a person's voice, but hallucinations. Many people do not experience it at all. These are painful for the patient and they will drink to escape from it.
In addition, emotional instability such as anger and depression even after the withdrawal symptoms in the acute phase have passed.Prolonged withdrawal syndromeThe condition called may last for several months.
ResistanceIncrease.
Increases the amount of alcohol consumed to feel the same drunkenness[7].. Or, the feeling of drunkenness diminishes with the same amount of drinking[7].

complications

Alcoholics are at risk of having many physical and mental illnesses. Conversely, other mental disorders have been shown to induce alcoholism.

Psychiatric disorders

depression[7]
Alcoholism can cause depression[3][5].. Conversely, depression can lead to alcoholism (wrong).Self-medication). 30-40% of people with illness meet the diagnostic criteria for depression in their lifetime[2].
Anxiety disorder[7]
panic disorder,Social anxiety disorderetc.
Bipolar affective disorder(Manic depression)
Patients with bipolar affective disorder may become alcoholic as a result of continued self-medication.
schizophrenia
Patients with schizophrenia may become alcoholic as a result of continued self-medication.
Wernicke-Korsakov Syndrome[7]
ThiaminAcute symptoms caused by a deficiency of (vitamin B1)Wernicke encephalopathy(Alcoholic encephalopathy), chronic conditionKorsakov syndromeThat is.Wernicke's encephalopathy is reversible and may resolve spontaneously within a few weeks, but if it progresses to Korsakoff syndrome, 80 percent does not recover, but it is less life-threatening.Consciousness disorder,Extraocular muscle paralysis,Memory disorder, Cerebellar ataxia,DisorientationSymptoms appear.It is known that in Korsakoff syndrome, as a result of memory impairment, confabulation attempts to supplement uncertainties in memory.Thiamine administration is effective.
Alcoholic hallucinosis
Hallucinations of damaging content (English,auditory hallucination) MainlyHallucinationHowever, it appears acutely or subacutely when drinking alcohol is stopped or heavy drinking occurs. It often disappears within a few weeks by stopping drinking. In some cases, hallucinations lead to murder.[10].
Alcoholic delusional state
Mainly jealousy delusions that can be understood and seen in alcoholism. It gradually disappears due to abstinence.
Nicotinic acid deficiency encephalopathy (Pellagra
Nicotic acid (Niacin) Is caused by deficiency.Hallucination-妄想,DeliriumSymptoms appear.
Spinocerebellar degeneration
literallycerebellumIs denatured by the influence of alcohol. Lower limbs such as gait disturbanceMalfunctionHappens.
Alcoholic dementia
Alcohol itselfdementiaAlthough it is unclear if it can cause dementia, there is certainly dementia that clinically appears to be due to alcohol intake. Imaging tests include enlargement of the ventricular systemCerebral cortexAtrophy is seen.
Alcoholic polyneuritis (peripheral neuritis)
Nutritional disorders caused by alcohol (with B vitamins)Nicotinic acidDeficiency).Symptoms such as dysesthesia and pain in the limbs, hypoesthesia and pain, weakness in the muscles of the limbs, easy falling, and difficulty running.If it is associated with Korsakoff syndrome, it is called "alcoholic polyneuritis psychosis".

Physical illness

Since physical illness is caused by alcohol, it may be recovered by quitting alcohol. However, recovery in units of several days is impossible, and in the case of months to long, recovery often takes several years. In addition, there are cases where the brain and body are irreversibly damaged and do not heal beyond a certain level.

High blood pressure[3][7]
arrhythmia[7]
Malignant tumor
Oral cancer, liver cancer, intestinal cancer, breast cancer[3]
Alcoholic liver disease
AlcoholicFatty liver[7] --Fat accumulates in the liver, and if left untreated, there is a risk of developing cirrhosis and liver cancer. There are few subjective symptoms.
Alcoholic hepatitis[7] --A disease in which the liver becomes inflamed and hepatocytes are destroyed. Symptoms such as general malaise, upper abdominal pain, jaundice, and ascites appear.
AlcoholicCirrhosis[3] --A disease in which hepatocytes are widely destroyed and cells become fibrotic. Symptoms similar to hepatitis appear. It is said that there are 4.5 patients in Japan.
Alcoholicgastritis
Inflammation of the gastric mucosa. It may become chronic and develop into gastric ulcer. Symptoms such as stomach pain, heartburn, and hematemesis.
AlcoholicPancreatitis[7]
It is said that about half of chronic pancreatitis is alcoholic due to inflammation of the pancreas. Symptoms such as abdominal and back pain and fever. acutePancreatitisAnd chronicPancreatitisAcute exacerbations of the disease can lead to death.
Esophageal varices
Appears as a secondary symptom of cirrhosis. The blood flow that should normally flow to the liver flows into the veins of the esophagus, creating a hump-like bulge. Should it rupture, massive bleeding can be fatal.
AlcoholicCardiomyopathy
Due to the influence of alcohol, the myocardium is diffusely atrophied and fibrosis progresses, the cardiac contractile force is weakened, and the function of pumping blood is reduced.
Mallory-Weiss Syndrome
Bleeding occurs due to repeated vomiting after drinking alcohol.

Alcohol withdrawal

Withdrawal from alcoholism can be as fatal as hypnotic sedatives such as barbiturates and benzodiazepines, without proper management.[11].. The main action of alcohol isGABAAReceptorIt is to increase the stimulation to the central nervous system and promote the suppression of the central nervous system. Repeated heavy consumption of alcohol reduces the sensitivity and number of this receptor. for that reasonDrug resistancePhysical dependenceOccurs. With rapid alcohol abstinence, the central nervous system loses control of synaptic firing. This leads to anxiety, fatal seizures, tremors, delirium, hallucinations, heart failure, etc.[12][13].. In other central nervous systems, mainlyDopamine,NMDA,Glutamic acidIs involved[14].

Acute withdrawal symptoms often last for 1 to 3 weeks. Non-serious symptoms (insomnia, anxiety, anhedonia)Prolonged withdrawal syndromeIt will be gradually improved by abstaining from alcohol for one year or more.[15][16][17].. Withdrawal symptoms continue until the body and central nervous system are restored to normal for alcohol tolerance and GABA function.[18][19].

Formation and features

Usually, drinking behavior is often sought from the physical and mental transformations that are mainly obtained by alcohol, but in the beginning, it is not taken every day, but it starts with occasional drinking, which is only taken occasionally on some occasion. However, for some reason, people often shift to habitual drinking, and when it comes to habitual drinking, they cannot get drunk with the same amount of alcohol, and the amount of alcohol consumed gradually increases (ResistanceFormation). In other words, becoming alcoholic is closely related to this "addictive drinking". Of course, not all people who drink habitually are alcoholics, but there is a high risk that if something happens, they will drink more and become addicted. It can be said that.

At first glance, it seems that the person himself likes to drink alcohol at his own discretion, and the patient himself likes to drink alcohol.errorIn many cases. Therefore, when telling a patient about alcoholism, he is often rejected violently, saying, "I am different."DenialIllnessIs also said[4].. However, when dependence becomes severe, withdrawal symptoms (withdrawal symptoms) occur physically and mentally due to abstinence, so drinking is repeated not for fun but for the purpose of avoiding withdrawal symptoms.[4].. If you fall into such a state, it will be extremely difficult to stop drinking by your own will (Self-controlLoss)[4].

In addition, as a means of promoting the formation of alcoholism, people who become alcoholics are provided with pocket money that can be used as alcoholic beverages, and a number of social mischief caused by excessive drinking (annoying others) To apologize on behalf of the person himself / herself, or to wipe the butt of the person who is drinking alcohol, etc.Enabler (enabler) is often present[20].. It is said that the enabler does not need to reflect on the person who is drinking, and makes it possible to drink excessively endlessly. On the contrary, when all the enablers disappear or the doctor declares death, the person himself may call it a "bottom experience" (also called a "bottom experience" or a turning point.[20].. There is a chance that you will recover from alcoholism as a result of the awareness that “it will be difficult if nothing is done”).[20](Self-controlImpossibleacceptance[4].

In addition, the spouse of an alcoholic, etc., needs to be needed by an alcoholic.Co-dependence Some people are in a state of (co-dependency)[4][20].. Therefore, there is a possibility that family members other than the alcoholic person may have a problem, and there are cases where correct counseling is required not only for the alcoholic person himself but also for his spouse.[4][20].

In addition to this, the disease has the following characteristics due to the symptoms of alcoholics and their impact on the surrounding society.

Progressive disease
If you continue to drink without noticing that you are dependent on alcohol, you will drink more and your symptoms will worsen, creating a vicious cycle.
Chronic illness
Once addicted, recovery is extremely difficult. It becomes impossible to say so-called "drinking well".
Diseases that cause personality changes[4]
That I fell into dependenceDenialAggressive, other punishment, by blaming the surroundingsSelf-centeredBecome a personality[4].. Losing interest in others and using it as a means[4].. Or, on the contrary, he becomes self-deprecating because of himself, and suffers from regret, anxiety, and loneliness. In addition, even when alcohol is not contained, it is often the case that a person is called "dry drunk" who behaves in the same way when he is drunk. As a result of these, the people around them become "unable to associate" with themselves and lose their sociality.[4].
Incurable disease
It is almost impossible for an alcoholic to return to the original opportunity drinker. Even those who have recovered physically and have been abstaining from alcohol for several years are very likely to return to their original obsessive-compulsive drinking state by drinking a sip. And because it is a progressive illness, the symptoms get worse. In other words, it is a disease that can get worse but never get better, and the important point of treatment is how to prevent recurrence, that is, re-drinking in a state of remission.
Deadly disease
Without proper treatment, it may be due to visceral disease or mental stress.suicideIn many cases, death occurs in some way, such as accidental death. The 10-year prognosis for alcoholics is very high at 30-40%, and there is no difference in mortality between patients who try to save alcohol and those who drink normally, and survive only by abstaining from alcohol. Increasing rate[21].
Dysfunctional familyFactors forming
The problematic behavior of drinking causes the family to be constantly stressed. The family has always been thinking about stopping drinking, and even the familyMental illnessThere are many cases of suffering from. It starts with a crack in the relationship of trust with the family and develops into separation or divorce, causing the family to collapse.[4].
Adult childrenAs the origin of the term (AC, Adult Children of Alcoholics, adults who grew up with alcoholic parents), the impact on families in families with alcoholics is enormous. , Especially from parents to children, such as alcohol dependenceAddictionIt is common for problems to propagate between generations. As a result, alcoholism is not just a problem for the patient, but involves the entire family, especiallyDysfunctional familyPromotes the formation of.

Gender difference

Women are generally smaller than men, have a lower water content than men, and female hormones are a factor that inhibits alcohol metabolism, so even if they consume the same amount of alcohol, they are more than men. A small amount of alcohol has an effect[22].. Alcoholics are characterized by a long history of drinking, but women are at risk of rapidly becoming alcoholic even if they have a short history of drinking and drink a relatively small amount. Amethyst is sometimes referred to as an alcoholic woman because of the Greek word "not drunk".

According to one theory, the period of progression from habitual drinking to alcoholism is about 10 years for men and about 6 years for women.[By whom?].

Diagnosis

Diagnostic scales include:[23].

For mild dependence (SADQ score 15 or less), withdrawal support is usually not required[3].. Withdrawal support is required for moderate dependence (SADQ score 15-30), but can be treated outpatiently if there are no other risks[3].. Severe dependence (SADQ score of 30 or higher) usually requires inpatient treatment.

Management

Stop drinking and your hands tremble in a short timeTremorIf this happens,Physical dependenceHas been formed, and a few days laterAlcohol withdrawal syndromeIs the maximum, at this timeDelirium tremensThere is a risk of death. In such cases, medical management of withdrawal symptoms is necessary, and alcohol outpatients will be consulted without stopping drinking.

In psychiatrySelf-help groupMany hospitals ban alcohol intake and proceed with treatment by encouraging participation in alcohol use and using anti-alcohol drugs. Of the local prefectureMental Health and Welfare CenterAnd at the nearest health center, you can get free consultation about alcoholism, and you may be referred to a specialized hospital.

UK National Institute of Medical Technology (NICE) is for mild alcohol dependencePsychotherapyI will provide a[24].. In that case,Cognitive behavioral therapyLet's have a 1-minute session once a week for 60 weeksBehavior therapyIt is said that a 1-minute session will be held once a week for 60 weeks.[24].

NICE is also available after withdrawal in the case of moderate alcohol dependence.AcamprosateOr medication is combined with individual psychotherapy (cognitive behavioral therapy, behavioral therapy, social network / environment-based therapy)[25].DisulfiramProposes as a second line of those drugs[25].

Assistance policy

Three pillars of abstinence[26]
  • Going to hospital
  • Anti-alcohol
  • Participation in self-help groups
HALT's Law (Factors that cause the desire to drink)
  • H --Hungry (hungryDon't get hungry)
  • A --Angry (angry,do not be angry)
  • L-Lonely (lonely, Don't be alone)
  • T --Tiard (tired,never tired)

The first important thing in the treatment of alcohol dependence is "recognition of the person". Patients are reluctant to admit that they are alcoholic, as in many cases they will not be able to drink if they admit that they are addicted. First and foremost, the person is aware of the disease (Insight) And willingness to treat, which is the first step towards recovery[20].

Excessive drinking of alcoholics is often attributed to weak will, low morality, or unfortunate psychological and social problems, but in reality it is not so many. Often the result of this illness. In other words, alcohol causes pathological changes in the body and mind, which leads to excessive drinking behavior. Understanding and acknowledging this by yourself and those around you is an essential first step in recovering from this illness. But helpers must not punish in the name of treatment[27].

However, once you become alcoholic, it is difficult to treat, and the only fundamental cure at the moment is to stop drinking. However, since it is difficult to solve the problem only by the will of the person, the understanding and cooperation of those around him are required. In severe cases, inpatient treatment may be required. But it will not be completely curedIncurable diseaseIt is also called, and even after years or decades of abstinence, drinking a sip of alcohol often causes it to return to its previous state sooner or later.[20].. Therefore, it takes a great deal of effort for alcoholics to continue to abstain from alcohol for the rest of their lives, even if they recover from treatment.

Acute management

Acute phaseAlcohol withdrawal syndromeTo manageBenzodiazepines(Chlordiazepoxide,Diazepam),CarbamazepineIs used[27][28][29].. NICE is also an option, but should be used with caution only in inpatients[28], It is said that it should not be prescribed outpatiently because of the risk of abuse[30].Delirium tremensTo manageLorazepamIs the first choice[28].AntipsychoticIt is,Mental illnessCan be used only during the period when symptoms appear[27].

In the case of outpatient treatmentOverdoseAnd because of the risk of diversion, patients should always be prescribed not to hold more than 2 days' worth of medication.[29].

Psychosocial care

There is currently no cure other than abstinence (regaining sociality through abstinence)[20].. However, quitting alcohol, an addictive drug, is not a trivial effort, and continuing this for a lifetime is more difficult or psychologically distressing than you might imagine. For this reason, various attempts have been made to support abstinence.

For all alcohol abusersSelf-help group(For exampleAlcoholics Anonymous,(English editionEtc.) should be provided, and their participation should be supported and encouraged.[31][27].

Alcoholics Anonymous (AA)
Of alcoholicsSelf-help group.Drinking partyIt is the prototype of. It started in the United States in the 1930s and has spread to more than 180 countries around the world. The basic text, commonly known as the Big Book, has been translated into more than 70 countries. Group work called "meetings" to recover from alcohol dependence and "12 stepsUse the recovery program. To protect privacy and to prioritize principles over individuals, we do not give our full name. Therefore, unlike the abstinence party, there is no list, no membership fee, and no organization. There are closed meetings that only alcoholics can attend and open meetings that can be attended by outsiders such as family members and medical personnel. There are also women-only meetings and youth-only meetings.
Drinking party
A self-help group created by alcoholics and their families. An organization unique to Japan that is organized with a membership fee system and has an open attitude to the outside world. We support each other to continue to abstain from alcohol, and carry out activities to widely enlighten the correct understanding and knowledge of alcohol dependence, including alcohol abuse.

In addition,stressSince drinking alcohol may be used to eliminate alcohol, stress coping methods (“”Stress management"relaxationIt is also suggested that there is a need for support and support to acquire (see also).[32].

Drug therapy

Wernicke encephalopathyFor preventionThiaminTake 100 mg daily[27].

Anti-alcohol

Acetaldehyde dehydrogenase(Acetaldehyde dehydrogenase) Is a drug that inhibits the action of, and when taken, it is in the blood when drinking alcohol.AcetaldehydeAs the concentration increases, it becomes uncomfortable and you cannot drink a lot of alcohol. In other words, it is "a drug that makes you get drunk with a small amount of alcohol" and "it is not a drug that suppresses the desire to drink itself."[20].. Because there is a risk of life-threatening if you take anti-alcohol and drink a lot.DoctorUnder the guidance of, it is essential to take the drug after giving sufficient explanation to the person and making a decision to stop drinking.[20].. It is strictly forbidden to secretly administer it so that it is not known to alcoholics.[20].

Remedy

Apart from anti-alcohol agents, as a drug substance that suppresses the desire to drink itselfAcamprosate(Product name --Legtect) began to be used in Japan in 2013. When taking it, it is effective and desirable to use it in combination with a self-help group or psychotherapy.

  • Acamprosate --Relieves the excessive desire in the brain caused by glutamic acid, a transmitter in the brain (a substance that switches on the desire to drink). That is, acamprosate prevents the transmission of desire commands by blocking the receptors of nerve cells (the department that accepts commands by switches) and preventing the attachment of the transmitter glutamate molecule to the receptors. This glutamate is particularly abundant in the brains of alcoholics (cause unknown). Acamprosate has been used to treat alcoholics with some success, although not all patients have benefited.[25][27].
  • : Taking it before drinking has the effect of reducing the amount of alcohol consumed.It is effective for treatment aimed at reducing alcohol consumption, and was approved in Japan in 2019 (trade name: Serincro).[33].
  • [25][27]
  • Baclofen --Effectiveness has been reported overseas. Alcohol addiction is not indicated in Japan.
  • Zonisamide - Antiepileptic drug,Parkinson's diseaseTherapeutic drug. Effectiveness has been reported overseas. Alcohol addiction is not indicated in Japan.
  • BenzodiazepinesHelps manage acute alcohol withdrawal, but exacerbates alcoholism when used for long periods of time[7].. According to the guideline, it should be within 7 days in principle.Prolonged withdrawal syndromeMust not exceed XNUMX weeks even in the case of[7].. Chronically prescribing benzodiazepines for alcoholism is less likely to achieve alcohol discontinuity than in non-dose cases. However, this type of drug is generally prescribed to alcoholics for the management of insomnia and anxiety.[34].. Benzodiazepine orSedative hypnoticPatients who received the drug during the recovery process were more than four times more likely to relapse after being prescribed a sedative hypnotic. Long-term users of benzodiazepines should not be abruptly withdrawn. It can cause severe anxiety and panic and is known to be a risk factor for the recurrence of alcohol abuse. 4-6 months drug reduction has been found to reduce withdrawal intensity and be most successful[35][36].
  • A retrospective analysis of six studies from the 1960s and 1970s showsLSDAdjuvant psychotherapy has potential as a treatment for alcoholism[37].

Multiple addiction

Alcohol dependence may also require other psychotropic drug dependence treatments[2][38].. The most common dependence on patientsBenzodiazepine addictionAnd in the study, 10-20% of alcoholicsBenzodiazepine abuseWas also occurring. Benzodiazepines increase the desire for alcohol and increase alcohol consumption[39].. Benzodiazepine dependenceBenzodiazepine withdrawal syndromeAnd other health problems need to be carefully reduced to avoid.

Dependence on other sedative hypnotics,Zolpidem,Zopiclone,OpiateAnd illegal drugs are also common in alcoholism.

alcohol TheSedative hypnoticAndBarbituric acid,Benzodiazepines, Cross-resistant with other sedative hypnotics such as non-benzodiazepines.催眠鎮静薬からの離脱は医学的に重症であり、慎重な管理なしではWithdrawal from hypnotic sedatives is medically severe and without careful managementMental illnessorSeizuresThere is a risk of.

Epidemiology

WHO estimates in 2010 that there will be 2 million alcoholics worldwide (800% of the population aged 15 and over)[40][41].

The number of patients in the United States is estimated to be 200 million, with 8.8 deaths each year.[2].

In the UK, more than 24% of the adult population is associated with dangerous drinking patterns, with 4% of adults being alcoholic (6% male and 2% female), but only about 6% per year leading to treatment.[3]..労働者のアルコール依存による労働時間逸失は、英国では年間およそ110万日(12億ポンド)に上ると推定されているIt is estimated that workers lose about XNUMX million days (£ XNUMX billion) a year in the UK due to alcohol dependence.[42].

In Japan, the number of inpatients due to "mental and behavioral disorders due to alcohol use" at a psychiatric hospital in 2003 was 2,751.[43]..アルコール依存によるDue to alcohol dependenceWelfareThe number of beneficiaries was about 1, and the average age was 57 years old (2015).[44].

prognosis

2002年に米国国立アルコール乱用・依存症研究所は、アルコール依存症の会合に参加する4,422人のグループに対して調査を行った。結果、1年後には一部の人々は低リスクの飲酒を行っていると著者は判断したが、いまだ25.5%のグループは治療を受けていた。詳細は、25%は未だ依存のまま、27.3%はいくつか症状が残っており部分寛解、11.8%は症状が現れることなく飲酒を続けている(飲酒は再発可能性を増加させる)、35.9%完全回復、17.7%は低リスク飲酒者、18.2%は断酒[45].

Social situation

France,スウェーデンAnd moreDeveloped countryInCompanyAlcoholic beverages by TV commercialsSales PromotionThe law prohibits you from doing so.北欧諸国では、アルコールはIn the Nordic countries, alcoholState-owned enterprisebyMonopoly systemIs.なお酒類の自動販売機は日本にしか存在しないAlcoholic beverage vending machines only exist in Japan[4].

Alcoholism has become a social problem in Belarus[47]According to WHO statistics in 2010, the proportion of alcoholics was 11% of the total population, which was the highest among the 190 countries covered by the statistics, and the deviation value was 1.Due to the problem of unemployed people due to alcoholism, a new decree was passed in 102.1 to impose fines on people who have not been employed for at least half a year and have not paid taxes.罰金は少なくとも2015米ドル(約252万円)で、支払わない場合は拘束され、地域社会での奉仕活動が命じられるThe fine is at least US $ 3 and will be detained if not paid and ordered to serve the community.[48]

In Japan in January 2014Basic Law for Alcohol Health DisordersWas established, and the national and prefectural governments were required to formulate countermeasure plans for the alcohol problem (Articles 12 and 14).また国民は、アルコール関連問題(アルコール健康障害およびこれに関連して生ずるCitizens also have alcohol-related problems (alcohol health problems and related problems).Drunk driving, Violence, abuse, suicide, etc.), and efforts must be made to take necessary precautions to prevent alcohol health disorders (Article 7). From November 11th to 10th is designated as Alcohol-related Problem Awareness Week (Article 16).

Works on the theme of alcoholism

footnote

[How to use footnotes]
  1. ^ (Excel) Global health estimates: Leading causes of DALYs (Report). who(2020-12). Download the data> GLOBAL AND BY REGION> DALY estimates, 2000–2019> WHO regions. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys NovemberBrowse.. 
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