Chronic alcoholism medico psycho social care
Addiction rarely occurs before the age of 25-30. It is therefore more a question of misuse, often linked to psycho-social factors and which is generally part of a general malaise, hence the creation of consultations dedicated to “young consumers” which are more suited to young adults. .
If the person is uncomfortable sharing their problem with alcohol with their doctor, addict logy consultations are available from the age of 25.
In general, most of the patients who consult in these centers are in their forties or more, more rarely before, mainly because the addiction is not fully established and the damage (family, professional, legal or physical) is still limited. The physical consequences (cardiovascular diseases, liver disease, etc.) or their visibility, awareness of dependence, the accumulation of various problems caused by high-risk consumption occur after approximately 45 years.
The management is multidisciplinary, because the consequences of chronic alcoholism are multi factorial (medico-psycho-social). This means that the patient will receive help for the various difficulties linked to his alcohol consumption: doctor, psychologist, social worker… significant help can be provided by support groups for “former drinkers” who can help. concretely share their experience.
The first consultation is usually carried out by an addict logiest, doctor or psychologist in order to take stock of the consumption and its complications. As the consultations progress, he will be able to distinguish an addiction from excessive consumption and help the patient find the keys to getting out of it.
If consumption is excessive, a few consultations are usually sufficient to provide advice (reduce daily consumption, do not consume during the week and limit consumption on weekends, consume less strong alcohol, keep a consumption diary, etc.) or anti-craving drugs (such as nalmefene or baclofen…). The person thus manages to reduce consumption below an acceptable and safe threshold.
In the event of dependence, the addictologist’s support is reinforced, with the help of a psychologist, a social worker, etc. Short weaning is offered, during short hospital stays (5 to 10 days) or extended in Follow-up Care and Rehabilitation in Addictology, for people alone or without work, those who must isolate themselves for a certain period of time. their sociology-professional situation. The care will always be followed by a prolonged outpatient care (day hospital, consultations). On the other hand, for people who are well inserted and who cannot interrupt their activities for very long, addictologists can prescribe medication, always associated with psychological care; the drug alone not being able to solve the problem of alcohol dependence.
Acamprosate (a glutamate antagonist) is an older drug used for the treatment of alcohol dependence. Natrexone is an opioid inhibitor. These two molecules have a Marketing Authorization (AMM) in “helping to maintain abstinence”. Both have little or no interest in a person who continues to drink alcohol. Disulfiram is also available but little used: it is a drug with a so-called “anti-abuse” effect which makes you sick if you drink alcohol. Above all, it has a deterrent effect. Other drugs allow a reduction in consumption. This is the case with nalmefene (an opioid receptor antagonist) which reduces the well-being and discomfort associated with the consumption and lack of alcohol. Baclofen can also be used to reduce consumption and maintain abstinence under certain conditions.
The results with anti-craving drugs are mixed. They are considered to be a help, but which can be very important in some patients.