Treatment for Alcohol Abuse

Aversion therapy is applied from time to time. It uses classical conditioning. Conditioned stimulus might be images, smells or taste of alcohol. The unconditioned stimulus are pharmacological emetics. There have also been attempts of hidden impact that is a combination of thoughts related to alcohol and its consumption with the idea of discomfort or accompanying the other unpleasant scenes of drunkenness.

The purpose of this method is to develop a persistent negative reaction against the use of alcohol by causing physical alcohol intolerance. This therapy is usually used in the third stage of alcoholism treatment - the stabilization phase of remission.

Aversion therapy is based on the use of medications that dramatically increase the body's sensitivity to alcohol. Most commonly, drugs of disulfiram group are used to influence the sensitivity of the body (teturamum, essperal, radoter). This drug is designed to reduce the metabolism of ethanol in the body and thus, causes a toxic reaction to the use of alcohol, which, in turn, leads to the formation of persistent reflection on the use of alcohol products. As a result, acetaldehyde accumulates in the body causing a lot of very unpleasant symptoms and making it impossible to continue alcohol consumption. It is called acetaldehyde syndrome. Various reactions develop  in 5-10 minutes after drinking that causes a rise in blood pressure, tachycardia, nausea and vomiting, flushing of the skin and pain in the heart, throbbing headache, tinnitus, dizziness, blurred vision, anxiety and fear of death. Hypertension may change the fall in blood pressure with the development of complications from reversal of the cardiovascular system in the severe disulfiram-alcohol reaction. Currently, a composite drug Lidevin and Cyanamide can be used for aversion therapy, besides various forms of disulfiram. Disulfiram effects can also be in some anti-protozoal and anti-parasitic drugs (Metronidazole, Decaris, etc.) (Azrin et al., 1982).

A patient was born in 1972 and suffered from schizophrenia. He was known for drug and alcohol intake. The male patient was taken to the hospital because of the occurecne of severe disorders of the cardiovascular and respiratory systems, edema and convulsions. The overdose of Disulfiram caused such symptoms, because the man wanted to make suicide. He reported the doctors that he had drunk nothing. After the close examination the doctors conducted detoxification therapy, the introduction of analeptics, symptomatic therapy. The man was kept in the hospital with coma for 12 months. After the recovery he informed the stuff that he could move his arms and legs.

Psychotherapeutic intervention improves effectiveness of the aversion therapy. By this it is meant that therapeutic program should include the trainings with stimuli monitoring, role-playing, communication skills and regular counseling that will significantly improve the outcomes of disulfiram therapy. The effectiveness of aversion therapy is significantly increasing in motivated patients, as well as during the psychotherapeutic intervention (Kristenson, 1995). Behavioral therapy should include behavioral training for strengthening motivation, "contract" with the patient and significant relation, social support (Allen, 1992).

According to Saxon (1998), “ It is prudent to monitor transaminase levels before starting disulfiram treatment and every 3 to 6 months during disulfiram treatment, but the mild elevations in liver transaminase levels associated with alcoholism are not necessarily contraindications” ( p. 61).

Holding the disulfiram-alcohol tests is among the most difficult and time consuming methods of treating alcohol dependence. There may be such dangerous disorders during the trial as circulatory collapse, or hypertensive crisis, fainting, etc. Disulfiram-alcohol reaction to alcohol may occur even after a long aftercessation of disulfiram.

Thus, in 5-10 minutes after alcohol consumption patients treated with disulfiram will have such toxic effects as sense of heat and then flushing of the body, caused by the expansion of blood vessels. All this is accompanied by a pulsating headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. In more severe cases there may be pain in the chest, shortness of breath, severe hypotension and confusion.