Where alcohol craving comes from and what a doctor checks before diagnosing alcoholism
Alcoholism is a recognised illness with its own code in the International Classification of Diseases: 6C40.2 in ICD-11 and F10.2 in the older ICD-10. A doctor makes the diagnosis by asking about the pattern of drinking, examining the patient and checking how many symptoms of the illness occur together.
The recurring urge to drink comes from changes in the brain. Regular alcohol use alters the parts of the brain responsible for pleasure and for reacting to stress, so after years of drinking a patient reaches for a glass to ease tension, anxiety and their morning hand tremor.
The diagnosis rests on symptoms that persist for months and occur together:
- alcohol craving, a recurring urge to drink stronger than any resolution not to,
- loss of control over how much they drink and when they stop,
- tolerance, meaning the need for increasingly larger amounts of alcohol for the same effect,
- withdrawal symptoms after a break in drinking: hand tremor, sweating, anxiety, insomnia,
- drinking despite worsening health and problems at home and at work that the patient already recognises.
The more of these symptoms occur together, the deeper the addiction. Alcoholism runs a chronic course and returns even after long periods of abstinence, which is why we plan treatment in months rather than around a single visit.
Three categories of problem drinking and the AUDIT screening test
Since 2023 the World Health Organization has stated that no amount of alcohol is safe for health. At a consultation we therefore ask about the harm drinking has already caused and why the patient reaches for alcohol; the number of drinks in a week decides nothing on its own.
The classification of diseases has a separate category for harmful drinking, coded F10.1: alcohol has already caused damage to health or to family life, yet the patient still decides when and how much they drink. The earlier stage is risky drinking: alcohol has not yet damaged the patient, but the amount and frequency of drinking are already high enough to cause lasting changes to the liver and heart in many people. We diagnose addiction, F10.2, once alcohol craving, growing tolerance and withdrawal symptoms after a break in drinking appear alongside the damage already done.
A patient can assess their own drinking with the AUDIT questionnaire, developed by the World Health Organization as a screening test. They complete it alone, at their own pace, and decide for themselves who sees the result. A high score is not a diagnosis, only a signal to book a medical consultation.
The scope of treatment depends on which of the three categories applies, so we establish this at the first appointment, before proposing medication or psychotherapy.
What a patient does in the following months of treatment in Elbląg
The first step is a medical consultation at our practice on Grobla Świętego Jerzego. The doctor asks about the drinking history, assesses the patient's health and the risk of complications after stopping alcohol, then decides whether to start with detox or with pharmacotherapy and psychotherapy.
We plan care over a month, three months, six months or a year, because that is how long alcoholism treatment realistically takes depending on the patient's condition. In the first month the patient stops drinking and their health stabilises. The following months are spent changing daily habits, returning to work and rebuilding relationships at home; no medication shortens that stage.
Addiction psychotherapy takes up the most time, because it is what teaches the patient to cope with tension and alcohol craving without reaching for a glass. We describe how it works on the page about addiction therapy in Elbląg. The Esperal implant, oral medication and detox reduce the risk of a return to drinking during this time, but none of them replaces the therapeutic work.
We work privately and keep the treatment discreet, but we do not offer anonymous treatment: we open and keep medical records as the law requires, and only the patient and the people they authorise can see them.
Who treatment at the practice in Elbląg suits, and who needs a round-the-clock stay
We decide on the setting for treatment at the medical consultation. It depends on the expected course of withdrawal, illnesses linked to the drinking and the conditions in which the patient lives.
Outpatient alcoholism treatment in Elbląg
We treat patients on an outpatient basis when they have no severe health complications and there is no alcohol constantly available at home. The patient comes in for consultations, procedures and therapy sessions, and otherwise carries on working as before. Outpatient treatment does not require sick leave or leaving Elbląg.
Alcoholism treatment at a residential centre in Elbląg
We suggest a round-the-clock stay when the patient drinks in binges lasting several days, when a serious physical illness has developed alongside the drinking, or when alcohol is constantly within reach where they live. The centre provides care around the clock and cuts the patient off from places associated with drinking. We describe the conditions of a stay on the page about the addiction treatment centre in Elbląg.
Online alcoholism treatment and e-prescriptions in Elbląg
We hold follow-up visits and part of the psychotherapy remotely, and we also issue e-prescriptions. Remote visits are chosen mainly by patients travelling to Elbląg from the surrounding communes and by people who often travel for work. We do not treat severe alcohol withdrawal syndrome remotely, so we ask a patient who has been drinking daily for several weeks to come to the practice first.
Which medicines form part of the treatment plan, and what the Esperal implant is for
The Esperal implant is a disulfiram implant placed under the skin; the same disulfiram also comes in tablet form. Disulfiram halts the breakdown of alcohol at the acetaldehyde stage, so after a drink the body reacts strongly: flushed skin, a racing heart, a drop in blood pressure and vomiting. The reaction discourages drinking, but it does not treat alcoholism, which is why we offer the procedure to patients who attend psychotherapy alongside it. We describe the preparation, the procedure and the contraindications on the page about the Esperal implant in Elbląg.
Oral medication serves a different purpose from the implant. Naltrexone weakens the effect alcohol has on the brain: the first drink no longer lifts the mood the way it once did, so it less often leads to another, and alcohol craving weakens. Acamprosate calms a nervous system left overactive by years of drinking, easing the physical unease that can otherwise push a patient back to alcohol in the first months after stopping. Nalmefene is taken as needed, before a situation in which the patient usually drinks, for example a family occasion; this medicine is meant to reduce how much alcohol patients drink when they are not yet ready for full abstinence.
The doctor chooses the medicine: they check the state of the liver, coexisting illnesses and every other medicine the patient takes. None of these medicines removes alcohol addiction; they reduce the risk of reaching for a drink enough for psychotherapy to take effect.
Who is at risk of severe alcohol withdrawal after stopping drinking
Alcohol detox is a few days during which medical staff guide the patient through withdrawal, the symptoms that appear once drinking stops. Adverts describe detox as clearing toxins from the body, yet the body removes alcohol by itself, without help. What needs treatment is the nervous system's reaction to stopping alcohol.
After a binge lasting several days, suddenly stopping alcohol can end in seizures or delirium tremens; both need immediate medical help. The risk rises in people who have been drinking daily for weeks, in patients who have already been through a complicated withdrawal, in those with heart or liver disease, and in older people. In such situations we do not book a first therapy session; we start with detox led by medical staff.
Detox stops the drinking and removes withdrawal symptoms, but it does not reduce alcohol craving or change the habits linked to drinking, so we set out the further treatment plan before detox even ends. We describe the tests, the first day and the conditions of detox with transport on the page about alcohol detox in Elbląg.
What we do when a patient reaches for alcohol again after a break
Relapse happens often enough in alcoholism treatment that we agree a plan for it with the patient in advance. We ask them to call on the same day they drink and not wait until one evening turns into a binge lasting several days.
Once the patient gets in touch, we first check whether stopping alcohol again puts their health at risk, then establish what came before the drink. It is usually medication the patient stopped taking on their own, missed sessions, insomnia, a conflict at home or a business trip. We pick the treatment plan up from the point where it broke off, adjust the pharmacotherapy and book more frequent therapy sessions for the following weeks.
The sooner the patient gets in touch, the fewer stages of the plan we have to repeat. After one evening of drinking we return to treatment within a few days; after a binge lasting several weeks we start again from stabilising their health and adjusting medication. When we return to the plan, we correct the element that failed: we add sessions in the weeks when the patient is left alone, or we switch to a medicine the patient does not need to remember to take every day.
What a patient does after finishing treatment to avoid returning to drinking
Most relapses fall in the first months after stopping alcohol, once withdrawal symptoms have passed and the patient feels well enough to no longer see a reason for further visits. That is why we do not end care after the intensive stage: appointments become less frequent, and sessions focus on something else.
At this stage we work on relapse prevention: together with the therapist, the patient lists the situations in which they used to drink, for example payday, the end of a shift or a lonely evening, and decides what they will do instead of drinking in each one. They then practise these responses in sessions, because the intention alone rarely holds in that moment.
We also continue pharmacotherapy at this stage, for longer than the intensive treatment itself. The patient takes naltrexone or acamprosate for as long as the doctor recommends; the end of therapy sessions is not a signal to stop the medicine. Self-help groups operate independently of the practice, for example Alcoholics Anonymous: meetings are free and held regularly, and the groups themselves publish current dates. Attending them does not replace psychotherapy, but it brings contact with people in a similar situation.
When it is the family, not the person drinking, who asks for help
The call for help most often comes from a wife, husband or adult child, rarely from the person who drinks themselves. The question is almost always the same: how to persuade someone who insists they have no problem with alcohol to start treatment.
After years of living with a person who drinks, relatives arrange their whole day around the drinking: checking how much is left in the bottle, explaining absences from work, paying off debts and doing everything to avoid a row. This is codependency, and we treat it separately, whether or not the person who drinks starts treatment themselves. Adult children of alcoholics, in turn, come to us with difficulties carried over from their family home that do not go away on their own.
Relatives help most when they stop shielding the person who drinks from the consequences of drinking and set limits they can actually keep, instead of more ultimatums. If the person who drinks refuses treatment and the drinking is breaking the family apart, relatives can report it to the gminna komisja rozwiązywania problemów alkoholowych (the municipal commission for solving alcohol problems) in Elbląg, which runs proceedings and refers the case to the district court.
When depression, anxiety or the effects of trauma are treated alongside alcoholism
At the first consultation we ask about sleep, mood, anxiety and any earlier psychiatric treatment, because depression, anxiety disorders and post-traumatic stress disorder occur alongside alcoholism in a large proportion of patients. Some started drinking to blunt the symptoms of these disorders; in others the disorders appeared only after years of drinking.
Untreated depression undoes the effect of addiction therapy: the patient finishes treatment and returns to alcohol within a few weeks, because the depressive symptoms never lifted. The reverse order fails just as often: as long as the patient drinks, alcohol disturbs their sleep and it is impossible to tell which symptoms belong to the mental illness and which to withdrawal.
That is why a psychiatrist and an addiction therapist treat the patient together, as one team. The psychiatrist is responsible for diagnosing and treating the mental disorder, the addiction therapist for the work on drinking, and each knows what the other has established. We reassess some symptoms after a few weeks of abstinence, once we can see what has resolved along with stopping alcohol and what needs separate treatment.
How often drinking in Elbląg ends in police intervention
In 2024 the police in Elbląg intervened 2,332 times in connection with alcohol misuse, an average of more than six times a day, and more than in the two previous years. In the same year, 720 people were held to sober up, over forty percent fewer than in 2022, when 1,258 people were detained. Because of alcoholism, social services in Elbląg supported 139 families, in which 156 people lived.
A police intervention is not a medical diagnosis, and a fall in the number of detentions does not necessarily mean people in Elbląg are drinking less. What these figures show is the stage at which drinking becomes visible to those around: only once someone cannot get home under their own steam. We diagnose alcoholism much earlier, on the basis of a history and a medical examination, and the sooner a patient comes in for a consultation, the less often treatment has to start with detox.
