Alcohol use disorders – an integrated approach

Alcohol was always a part and parcel of social and cultural life of mankind as evidenced from history.  Its judicious use has been explained in several contexts throughout. Its improper use contributesto many problems at medical, familial, legal, social, cultural aspects. One-fifth of all psychiatric problems have associative substance abuse, mainly alcohol.Dr.Jithesh, through his expertise in handling mental health disorders, explains to us about the health consequences of alcohol addiction and how it can be managed through integrated treatment.

Alcohol interferes with the brain’s communication pathways, and can affect itsfunctioning. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination. Drinking a lot over a long period of time or too much on a single occasion can damage the heart, liver,pancreas, causing problems like hypertension, irregular heart beat or arrhythmias, fatty liver, alcohol hepatitis, cirrhosis, gastritis, pancreatitis and more. The US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen. Excessive drinkingresults in infections likepneumonia and tuberculosis.

Health consequences

Alcohol misuse and alcohol use disorders (AUDs) are often ignored by healthcare providers in primary clinics. Data show that early identification and brief intervention for alcohol misuse in these settings can effectively reduce alcohol consumption and its medical sequelae. Alcohol abuse is defined by the consequences that can incur from drinking, including disruptions in work, school, social obligations, inter-personal relationships, legal problem, and physical hazards of drinking. Alcohol dependence is the most severe gradation of alcohol abuse, the hallmark of which is a physiological need for alcohol that, when unmet, results in withdrawal symptoms. Alcohol misuse is the most common substance misuse disorder encountered in medical settings, especially in accident and emergency departments.

Multitude effects of Acohol use

  • Familial – Alcohol misuse contributes to as many as one-third of divorces, and domestic suffering and violence
  • Economic – Alcohol is expensive, and the family budget suffers accordingly.
  • Job – Alcoholic employees usually develop a poor work record with frequent absences due to sickness, erratic time-keeping, low productivity
  • Crime – As many as 60% of prisoners report of significant alcohol problems which is their main cause of crime
  • Accidents – drinking while driving causes a lot of accidents
  • Medical problems – contributes a lot of medical problems
  • Life expectancy – reduced by almost 10 years in average

Alcohol Use Disorders (AUD)

AUD is a chronic relapsing disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. If the pattern of drinking results in repeated significant distress and problems functioning daily life, one have AUD. It may include periods of alcohol intoxication and symptoms of withdrawal.

  • Alcohol intoxicationresults as the amount of alcohol in the blood  stream increases resulting in functional impairment. It causes behavior problems and mental changes, including inappropriate behavior, unstable moods, impaired judgment, slurred speech, impaired attention or memory, and poor coordination, blackouts and even coma.
  • Alcohol withdrawaloccurs when alcohol use is heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later due to hyper excitability of central nervous system or due to lack of alcohol. Signs and symptoms include sweating, rapid heartbeat, hand tremors, sleeping problems, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionall seizures. Symptoms can be severe enough to impair the ability to function at work or in social situations.

Madya and Madatyaya

Any substance which leads or contributes to a state of mada ie. elated mood or bouts of happiness is termed as “madya”. Several drinks with various modes of preparations are explained in the Ayurvedic parlance for regular use, which are not currently available. Also, madya was used for medicinal purpose in the form of alcoholic extract, termed as arishtas or asavas. Such medicines are known for their rapid absorption and sudden action. They enhance agni or the mechanism of digestion and absorption and also leads to patency of the srotus or the channels of transport in the body.

The group of diseases resulting from the non- judicious or excess use of madya leads to a group of disorders termed as “Madatyaya” which is explained by almost all the scholars of Ayurveda. It results in physical as well as psychological manifestations.The severity depends on the duration of intake, degree of intake, general health status, age of the patient as well as familial history of alcohol use. The excess intake disturbs all the three doshas of the body, mainly Vata and Pitta. It also results in diminishing the status of agni and hence ama state, leading to several other health problems. Along with the same, the ojus or the immunological representative is negatively affected due to the qualities of madya.

Diagnosis of madatyaya based on doshas

Vata Bodily ache, muscle pain , head ache, tremor, stiffness, lack of sleep, talkative
Pitta Excess sweat, anger, dryness of mouth, blackouts, diarrhoea
Kapha Nausea, heaviness, vomiting, distaste, lack of appetite

Management.

The physician is in a particularly good position to provide education about the adverse effects of substance misuse and to use the patient’s concern for their health as a motivating factor for behavioral change. The management includes mainly three steps – management of alcohol withdrawal symptoms, management of any other associative physical conditions and the rehabilitation measures to get rid of relapse. In the alcohol withdrawal syndrome, initially nasya or sirodhara is recommended so that the patient gets rid of the symptoms and also gets sufficient sleep as associated insomnia seems to worsen the symptoms. Suitable internal medicines are also used as per the dosha assessment. This maybe continued upto 1 week or as and when the symptoms subside.

Alcohol dependence needs a detailed inpatient treatment. Here, in the initial stages, pachana treatment is done so as to enhance agni and also get rid of the possible ama. Then snehapana is done usually upto 7 days after which, the gritha selection is done based on the status of the three doshas.This is usually followed by sweda and either vamana or virechana. In dominance of Kapha, Vamana is ideal and in the case of Vata and Pitta, virechana is planned with suitable medicines. Then nasya is done for the sodhana of uttamanga ie. the head followed by sirodhara with medicated oils, medicated ksheera or takra based on the condition. This is followed by administration of suitable rasayana drugs.

The associated physical conditions are managed with their respective management protocols, which is not detailed here. The prevention of relapse is the next key area where we have to use the other techniques rather than medicines. Here, the patient is sent to interactional group therapy called Alcoholic Anonymous, where they will share their experiences with the similarly affected, once a week. One of the other areas is Yoga therapy, where the patient practises relaxation exercises, selected Yogasana techniques, deep relaxation technique, nadeesudhi pranayama etc. after the assessment by a Yoga therapist. The intervention by the psychologist with techniques such as Cognitive Behavioural Therapy, where the systematic learning process provided to the patient in several sitting contributes to “unlearning” the behavior of alcoholic intake. The patient is helped to recognize the vulnerable situations, avoid such situations and to cope effectively with the problems with alcohol abuse and also to learn healthier skills and habits. The other components include behavioral couple’s therapy, family therapy, aversion therapy etc. by trained personnel.

Conclusion

Alcohol used disorders and their impact on healthy human living are on the rise. It may be dealt with in a more serious manner at the primary clinics as early intervention is more worthy. Ayurveda has explained the conditions and their management possibilities in detail which whenever adopted is reported as highly effective as well as safe. An integrated approach along with the Ayurvedic medicines, Yoga therapy, psychological approaches such as CBT, when adopted together not only enhance the efficacy, but also prevents further relapses. Further evidence- based studies are awaited in this regard which may definitely help the affected.

Dr JitheshMadhavanMD(Ay) PhD,

Professor and Head,

PG Department of Manasroga,

VPSV Ayurveda College,

Kottakkal,

India,

09447882885,

drjitheshm@gmail.com

 

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