Alcohol has the property of calming anxiety, disinhibiting and providing a certain feeling of euphoria. “The person is convinced that all his problems will be solved by consuming alcohol”, observes Dr Cécile Prévost, general practitioner specializing in addictology at the CSAPA (Centre for care, support and prevention in addictology) in Bourg-la-Reine, dependent on the Paul-Guiraud hospital in Villejuif (94).
But this is only an illusion. “Over the long term, alcohol promotes depression. It’s a real vicious circle. The person drinks to calm their anxiety and discomfort, then their morale drops to the bottom. Suddenly, she drinks again, which only feeds her depression. This spiral draws him down,” continues the addictologist.
Added to this psychological dependence are physical signs: obsessive desires to drink “who take your whole body” according to Cécile Prévost, tremors, nausea, vomiting….
In this context, you need a good dose of motivation to start a weaning process. “When these people have gone too far in their drinking, they find the motivation to stop drinking. In general, there is no click, but they perceive that there is a problem: either those around them have made remarks to them, or they have put their health in danger, or they are afraid of losing their family, their children or their work. There are many sources of motivation. But to be able to wean yourself, you have to be able to change. Not all patients have this ability at first, as it involves leaving all landmarks. In psychotherapy, motivational interviews will help them on this path. explains Dr. Prévost.
Taking the plunge, accepting to question one’s life, is far from simple. These motivational interviews, conducted by a health professional (doctor, nurse, psychologist, social worker, etc.), help support the person and help them find the necessary motivation to begin withdrawal.
Women generally take longer than men to seek help. “They arrive in care later because, at home, shame and social stigma weigh heavily. But they are generally very motivated, especially by the fear of losing their children, and in the end they do better than men at the same level of health”, underlines the addictologist.
The request for help may come from the drinker himself or from those around him. In all cases, the attending physician is the first point of contact. They can advise, support and, if necessary, refer them to a structure specializing in addictology such as a CSAPA (Centre for care, support and prevention in addictology) or a Young consumer consultation for an alcohol problem involving a teenager or a young adult. The list of these different structures is available on drugs-info-service And alcohol-info-service.
The alcohol problem can also be detected during hospitalization for another reason. In this case, an addictology liaison and care team (ELSA) can, on the report of a doctor, go to the bedside of the person and offer him care.
“I would advise against weaning yourself alone. It is better to be accompanied by a doctor. This care does not necessarily take place in the hospital. Some patients can be accompanied on an outpatient basis, that is to say by coming to see us for consultation twice a week. Belgium is even experimenting with weaning in teleconsultation”, replies Dr. Prévost.
Solo withdrawal, without medical and psychological support, can be dangerous. Without drug treatment, the sudden lack of alcohol will trigger reactions in the body which can, if they are not counteracted, lead to serious pathologies, or even to the death of the patient.
The most dreaded are Korsakoff’s and Gayet-Wernicke’s encephalopathies, which seriously affect memory.
Deprived of alcohol, the brain finds itself in a state of hyper-excitability which requires the prescription of benzodiazepines, powerful anxiolytics (see below). These drugs prevent the risk of convulsions and hallucinations, the famous delirium tremens.
Moreover, at the time of weaning, the body draws on its reserves to support the lack of alcohol, which causes significant deficiencies in vitamins B1, B6 and PP. “During weaning, a very strong oxidative reaction occurs, with the production of free radicals. To simplify, let’s say that these vitamins will allow them to be trapped”, explains the addictologist. In some patients, these vitamins must be administered by infusion, hence the need to hospitalize them.
Addictologists have specific criteria for advising the most appropriate treatment.
Outpatient weaning is only possible if the patient has stable accommodation and is well cared for, if one of his relatives can call the fire brigade or the Samu if necessary and if his state of health allows (no associated diseases: psychiatric disorders, cirrhosis of the liver, malnutrition, etc.).
On the other hand, it is better for the patient to be hospitalized during withdrawal if he is socially isolated or too fragile from a medical point of view.
In general, it takes at least 15 days to wean off alcohol. The first five days are the hardest: “The patients are very tired. They experience episodes of sadness, lack of motivation, pessimism and anxiety. They may have insomnia. And above all, the desire for alcohol is significant, “ observes Dr. Prévost.
But the situation is gradually improving, as evidenced by the addictologist: “After a few days, patients no longer have headaches or hangovers. Their face becomes less puffy, their skin is more beautiful and their voice stabilizes. Often, the first thing they say to us is: I feel more coherent. »
Some people decide to completely stop drinking alcohol overnight, others prefer to gradually reduce their consumption. Both approaches are valid and lead equally effectively to withdrawal.
You should know, however, that certain diseases (acute pancreatitis, cirrhosis of the liver, etc.) require a complete and immediate cessation of alcohol.
In all cases, the approach will be more effective if it is accompanied by drug treatment and supported on a medical, psychological and social level. “Medications are not enough to wean yourself off alcohol. We have to re-learn how to be a society”, explains Dr. Prévost.
Benzodiazepines such as diazepam (marketed under the name Valium) are prescribed during withdrawal, at doses which are gradually reduced. “These drugs have a sedative and relaxing effect. They are powerful anxiolytics. recalls Dr. Prévost. In case of delirium tremens, ie hallucinations, more powerful neuroleptics may be indicated.
After this withdrawal phase, another strategy is adopted to avoid relapse. Several drugs are available and have marketing authorization:
– Disulfiram (marketed under the name of Espéral). “It’s a kind of alcohol antidote that makes you sick when you drink alcohol. It is very little used today for ethical reasons,” observes the addictologist.
– Acamprosate (Aotal and generics) and naltrexone (Revia and generics) act on certain neuronal receptors, reducing the desire to drink.
Baclofen (Baclocur) and nalmefene (Selincro) act on the irrepressible urge to drink, what addictologists call craving. They can be prescribed to patients who wish to reduce their consumption or to help maintain abstinence after withdrawal.
In December 2022, the French Office for Drugs and Addictive Tendencies (OFDT) published numbers on the number of alcohol-dependent people receiving drug treatment between 2019 and 2021. Baclofen is among the main ones.
The craving gradually subsides during weaning. In addition to drugs such as baclofen or nalmefene, hospitalization is sometimes the best solution to avoid giving in to the temptation to take another drink. “In France, alcohol is readily available everywhere. Some people are in such pain that they need to be temporarily placed in a protected environment,” recalls Dr. Prévost.
On this path, associations of former drinkers and patient-experts provide valuable assistance. All have had the same experience and can provide advice or interface with the nursing staff. Cécile Prévost points out that “the discussion groups work very well, in general, among women”.
Here again, addresses are available on the sites drugs-info-service And alcohol-info-service.
Some people are successful in quitting alcohol on the first try. For others, it will take longer. “After hospital withdrawal, which therefore concerns the sickest patients, only 30% remain abstinent the first year”, observes Cécile Prévost.
This relapse is not, however, a failure. “Often it takes a relapse for the patient to realize they are sick and realize they can’t handle alcohol,” specifies the addictologist.
After weaning, the most dependent patients should avoid all contact with alcohol, otherwise they will relapse. Others may allow themselves a few drinks occasionally. But this fragility vis-à-vis alcohol will persist throughout their lives. “So I advise them to be careful and stay vigilant,” concludes Dr. Prévost.
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