Weaning alcohol-dependent patient (alcohol withdrawal syndrome – preventive and curative treatment)

Weaning is the cessation of alcohol consumption, whether accidental at the initiative of the subject or it is part of a therapeutic perspective in the alcohol-dependent patient. Withdrawal from the alcohol-dependent patient, whether it is a weaning or unplanned weaning, is to be distinguished from “detoxification”. The term cure suggests external intervention and healing. Therapeutic weaning only makes sense when it is part of a comprehensive care strategy for the alcohol-dependent subject. It is an unavoidable and essential step. It ensures the prevention and treatment of the symptoms of physical dependence and the complications induced by the brutal suppression of alcohol. It also has the function of engaging the patient in an ongoing process of care in the hope of maintaining abstinence, failing a long-term clinical improvement. At a time of rupture, it promotes and reinforces the detoxing from alcohol  awareness of the dependence on alcohol, a prelude to the recon quest of autonomy and the implementation of a new existential project.

Clinical sociology

The withdrawal syndrome (definition of the DSM-4 classification [ 6 ] ) is defined by stopping or reducing alcohol consumption that was high and prolonged,

Two or more of the following criteria of detoxing from alcohol  occurring within a few hours to a few days after criterion 1: autonomic hyperactivity, tremor of extremities, insomnia, hallucinations or transient visual, tactile or auditory illusions, nausea or vomiting, psychomotor agitation, anxiety, convulsive seizures, grand mal ,the symptoms of Criterion 2 result in clinically significant impairment or resonance in personal or social life, The symptoms cannot be explained by another pathology.

The withdrawal syndrome is defined by symptomatic manifestations occurring in the immediate or delayed consequences until the 10th day after stopping the consumption of alcohol. These manifestations reflect a state of psychic, behavioral and physical lack. The first descriptions of alcohol dependence considered the physical symptoms of alcohol withdrawal as one of the essential features of the syndrome. Recent international classifications reflect a conceptual evolution. They no longer consider these physical symptoms as essential to the diagnosis of alcohol dependence which also covers other manifestations

Psychic: compulsive desire to drink alcohol that makes the subject unable to control his consumption;

Behavioral: search for alcohol consumption that overrides most of the subject’s activities

Avoidance phenomenon: the subject consumes alcohol often in the morning with the intention of preventing or suppressing the symptoms of withdrawal,

The gradual establishment of alcohol consumption patterns dictated by the need to maintain a sufficient blood alcohol level,

Increased tolerance causing the dependent subject to consume increasing amounts of alcohol.

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