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Pagalba priklausomam nuo alkoholio: būtinas visiškas susilaikymas ar įmanoma gerti saikingai?

Priklausomybė nuo alkoholio yra smegenų liga, kurią būtina gydyti. Alkoholis yra daugiau kaip 60 įvairių ligų ir traumų rizikos faktorius. Priklausomybei nuo alkoholio atsirasti yra svarbus paveldimumas ir aplinkos veiksniai; apskaičiuota, kad genetiniai veiksniai gali lemti 60 proc. ligos atsiradimo rizikos. Pagrindinis šios priklausomybės požymis yra dažnas labai stiprus noras vartoti alkoholį. Žmonėms, priklausomiems nuo alkoholio, sunku kontroliuoti išgeriamo alkoholio kiekį ir jie toliau vartoja alkoholį nepaisydami žalingų pasekmių. Per pastaruosius keletą metų pasaulyje pradėtas taikyti naujas gydymo būdas – alkoholio vartojimo mažinimas iki mažos gėrimo rizikos lygio tiems, kurie negali arba nenori siekti visiško susilaikymo nuo alkoholio.

Daugeliui nuo alkoholio priklausomų pacientų jo vartojimo sumažinimas yra priimtinesnis ir lengviau pasiekiamas tikslas nei visiškas jo atsisakymas.

 Alkoholis didina ligų riziką

Per didelis alkoholio vartojimas būdingas daugeliui pasaulio šalių. Ypač ši problema aktuali Europoje, kur daugiau kaip 14 milijonų žmonių yra priklausomi nuo alkoholio. Lietuvoje tokių žmonių yra apie 128 tūkstančiai, o per metus mūsų šalyje vienas gyventojas išgeria net 13 litrų gryno (100 proc.) alkoholio!4 Alkoholis neigiamai veikia daugelį žmogaus organų. Be to, nustatyta, kad ilgalaikis sergamumas ir mirtingumas tiesiogiai susijęs su suvartojamo alkoholio kiekiu, t. y. kuo daugiau išgeriama, tuo didesnė ligų atsiradimo ir socialinė rizika. Priklausomybę nuo alkoholio gali diagnozuoti gydytojas. Įtarti, kad žmogus yra priklausomas, galima tuomet, kai yra keli žemiau išvardyti simptomai (pagal Tarptautinę ligų klasifikaciją, TLK-10):

  • stiprus noras ar poreikis vartoti alkoholį;
  • negalėjimas kontroliuoti išgeriamo alkoholio kiekio ar žinoti, kada sustoti;
  • atsiradusi tolerancija, kai reikia išgerti vis daugiau, kad pasireikštų toks pat poveikis;
  • nutraukimo simptomų, tokių kaip prakaitavimas, drebulys, pykinimas ar nemiga, atsiradimas stengiantis mažinti arba nutraukti alkoholio vartojimą;
  • kitų interesų nepaisymas: mažiau laiko skiriama kitai veiklai, kuri yra svarbi ar anksčiau buvo maloni; nuolatinis alkoholio vartojimas, nepaisant pasikartojančių fizinių ar psichinių problemų.

 Rizikingas ir nerizikingas alkoholio kiekis

Alkoholio gėrimo rizika paprastai įvertinama pagal išgeriamą alkoholio kiekį, kuris matuojamas standartiniais alkoholio vienetais (SV). Pagal Pasaulio sveikatos organizacijos (PSO) rekomendacijas vienas SV yra 10 g gryno (100 proc.) alkoholio. Priklausomai nuo alkoholio koncentracijos, viename butelyje alaus yra maždaug 2, vyno – 8, stipraus alkoholio – 20 SV. Maža gėrimo rizika nustatoma, jei vyras išgeria vidutiniškai mažiau kaip 4, o moteris – mažiau kaip 2 SV per dieną. Didelė alkoholio gėrimo rizika yra, kai vyras vidutiniškai išgeria daugiau kaip 6, o moteris – daugiau kaip 4 SV per dieną. Toks suvartojamo alkoholio kiekis tampa žalingas fizinei ar psichinei sveikatai.

 Naujas gydymo būdas

Deja, kvalifikuotą specialisto pagalbą gauna mažiau nei kas dešimtas sergantis šia liga.Tokia prasta situacija susidarė dėl keleto priežasčių. Pirma, ligos pradžioje, kol žmogus turi darbą, šeimą, nepatiria sunkesnių sveikatos sutrikimų, jis paprasčiausiai nepripažįsta, kad negali kontroliuoti alkoholio gėrimo ir niekur nesikreipia. Alkoholizmas nėra „madinga“ liga, ir žmonės stengiasi nuslėpti šią problemą. Be to, ne kiekvienas specialistas gali suteikti kvalifikuotą pagalbą. Pavyzdžiui, šiandien Lietuvoje pagal galiojančią tvarką bendrosios praktikos ar šeimos gydytojas gali tik įtarti, kad žmogus serga priklausomybe nuo alkoholio, ir  privalo nusiųsti tokį pacientą pas psichiatrą ar priklausomybės ligų specialistą. Antra priežastis – mažas vaistų pasirinkimas. Anksčiau gydymo vaistais tikslas buvo palengvinti rytą po „sunkaus“ išgėrimo arba siekti visiško susilaikymo. Ir nors visiškas susilaikymas yra pati geriausia išeitis pacientui, tokio tikslo bent pusė pacientų arba nenori, arba negali pasiekti, o iš pradėjusių taip gydytis didesnė dalis patiria atkrytį, t. y. toliau vartoja alkoholį dideliais kiekiais. Daugeliui nuo alkoholio priklausomų pacientų jo vartojimo sumažinimas yra priimtinesnis ir lengviau pasiekiamas tikslas. Toks gydymas pradėtas taikyti visai neseniai, kai buvo sukurtas naujas vaistas siekiantiems sumažinti alkoholio vartojimą iki mažos gėrimo rizikos lygio, kuris pagal PSO rekomendacijas yra mažiau kaip 40 g gryno (100 proc.) alkoholio per dieną vyrams ir mažiau kaip 20 g/d. moterims. Šis vaistas yra dalis naujos gydymo koncepcijos, apimančios ir nuolatinę psichosocialinę pagalbą, nukreiptą į alkoholio vartojimo mažinimą, ir gydymo nurodymų laikymąsi. Tyrimais nustatyta, kad pradėjus gydymą nauju vaistu, alkoholio suvartojimas sumažėjo maždaug perpus, o nemaža dalis pradėjusių mažinti alkoholio vartojimą vėliau visiškai nustojo gerti. Priklausomybė nuo alkoholio yra sunki liga, ir pats žmogus be kvalifikuoto specialisto pagalbos labai retai gali laiku sustoti. Dažnai priklausomas nuo alkoholio asmuo pirmiausia patenka pas medicinos specialistus dėl kitų sveikatos sutrikimų, pvz., širdies ir kraujagyslių, onkologinių ir kitų ligų ar jų komplikacijų. Tačiau kiekvienas medikas turėtų paklausti pacientą, ar šis vartoja alkoholį, ir nukreipti jį pas specialistą, jei kyla įtarimas, kad žmogus alkoholio geria per daug.

 Pasitarkite su gydytoju, jeigu kada nors:

  • pagalvojote, kad reikėtų vartoti mažiau alkoholio;
  • susierzinote, kai kas nors jus kritikavo dėl alkoholio vartojimo;
  • jautėte kaltę ar gėdą dėl alkoholio vartojimo;
  • gėrėte iš ryto, kad nusiramintumėte ar pagerintumėte savijautą.<img 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Šaltinis | Dietinis gydymas bendrojoje praktikoje | Gydytoja dietologė Jūratė Dobrovolskienė