Alcoholism treatment Gdańsk

A doctor who diagnoses alcoholism enters a code from the international classification of diseases into the medical records: F10.2 in ICD-10, or 6C40.2 in the newer ICD-11. Alcohol addiction is therefore a separate disease entity with diagnostic criteria of its own, in the same way as other chronic illnesses.

Years of drinking change the way the reward system and the stress response work in the brain, which is why the need for a drink comes back with tension, tiredness or insomnia. That recurring need is alcohol craving. A resolution not to drink does not switch it off, and the patient loses control over how much and when they drink.

The diagnosis rests on several features occurring together over a longer period, not on a single episode of drinking. They include alcohol craving, loss of control over how much a patient drinks and when they start drinking, tolerance, meaning the need for ever larger doses of alcohol to obtain the same effect, drinking despite the harm it does to their health and despite conflicts at home and at work, and withdrawal symptoms after a break in drinking.

Alcoholism runs a chronic and relapsing course, so we plan treatment over the months ahead, and in the treatment plan we agree in advance what we do if the patient drinks alcohol along the way.

Harmful drinking has its own code in the ICD classification, F10.1. It applies to a person who does not yet meet the criteria for alcohol addiction, while the drinking is already causing damage: blood pressure rises, liver enzymes go up, absences at work and rows at home become more frequent. The earlier stage is risky drinking: no damage is visible yet, but the risk that it will appear keeps growing. We speak of alcohol addiction, that is code F10.2, once alcohol craving appears and the patient loses control over drinking.

The initial assessment uses AUDIT, a questionnaire from the World Health Organization. Everyday practice more often reaches for its shortened version, AUDIT-C: three questions about how often the patient drinks, how much they drink on one occasion and how often they happen to drink a lot at one go. Three questions are enough to pick up drinking that calls for a conversation with a doctor, but the diagnosis is made by a doctor after examining the patient.

No amount of alcohol is safe for health. The World Health Organization announced this in its statement of 2023. At the consultation we therefore ask the patient why they turn to alcohol and what harm the drinking has already caused; a comparison with how much the people around them drink says nothing about the patient's health.

Treatment starts with a medical consultation. We ask about the pattern of drinking, earlier attempts to stop drinking and chronic illnesses, assess the risk of severe withdrawal and set the order of what comes next: whether we begin with detox, with medication or with psychotherapy. In Gdańsk we have no walk-in practice, so we hold consultations remotely and our medical staff travel to the patient for procedures.

Alcoholism treatment lasts for months, which is why we run it in packages: one month, three months, six months or a year. A month is enough to break a binge, stabilise the patient's health and select medication. Changing habits and working on the situations in which the patient has been drinking take considerably longer, so the later packages cover regular sessions of addiction psychotherapy in Gdańsk along with follow-up visits.

Patients ask whether they can go through treatment anonymously. They cannot: we record every appointment, every procedure and every prescription in the medical records, as the regulations require of us. What we do guarantee is discretion, so an employer, neighbours and other outsiders will learn nothing from us. We set the date of the first appointment with the patient within a few days, because we treat privately and keep no waiting list.

We choose the setting first of all according to whether the patient will get through alcohol withdrawal safely outside hospital. Only then do we weigh up how advanced the alcoholism is and whether the patient can maintain abstinence at home.

Outpatient alcoholism treatment in Gdańsk

We propose the outpatient route to patients without severe physical complications who are able to attend appointments regularly. Outpatient treatment requires neither sick leave nor travel away from Gdańsk, and we arrange appointments outside the patient's working hours.

Residential alcoholism treatment for patients from Gdańsk

We consider round-the-clock treatment when the alcoholism is advanced and is accompanied by serious physical illness, when alcohol is constantly available in the patient's flat, or when treatment in a practice ended in a return to drinking after a few weeks. The stay means several weeks under the care of a team, away from the people and places the patient associates with drinking.

Alcoholism treatment online and e-prescriptions in Gdańsk

We hold follow-up visits and some therapy sessions remotely, and we issue e-prescriptions. Acute withdrawal cannot be treated remotely, so a patient who has been drinking daily for several weeks is only qualified for detox after an examination.

The doctor matches the medicine to what the patient wants to achieve over the coming months: to stop drinking altogether, or for now to cut down the amount of alcohol. A patient who at this stage only wants to drink less receives a prescription for nalmefene and takes a tablet as needed, an hour or two before an occasion where they expect alcohol to be served; nalmefene dampens the urge for the next glass after the first one, so they end up drinking less over the course of the evening. A patient who wants to stop drinking completely is prescribed naltrexone or acamprosate. Naltrexone occupies the receptors in the brain through which alcohol brings relaxation and a lift in mood, so a glass no longer delivers the expected relief and alcohol craving weakens. Acamprosate eases the unsettled state of the nervous system which, after years of drinking, persists for many weeks after alcohol is withdrawn: the insomnia, tension and restlessness that most often send the patient back to drinking subside.

Disulfiram, the active substance of the Esperal implant and of tablets with the same action, switches off the enzyme that removes acetaldehyde, the poison produced from alcohol in the liver. Acetaldehyde builds up in the blood, and a dozen or so minutes after alcohol is drunk the skin flushes, the heart pounds, blood pressure drops and vomiting follows. Such a reaction discourages drinking, but it does not treat alcoholism and does not reduce alcohol craving. We describe the preparation for the procedure, its course and the contraindications on the page about the Esperal implant in Gdańsk.

Before writing a prescription the doctor checks liver enzymes and the other medicines the patient is taking, because naltrexone, acamprosate and disulfiram carry different restrictions in liver and kidney disease. A tablet on its own, or an implant on its own, will not cure alcoholism. Medication gives the patient a few calmer months in which psychotherapy has time to work, which is why in Gdańsk we start psychotherapy in the same month as pharmacotherapy.

A body used to the constant presence of alcohol reacts to its absence with a surge of overactivity: the hands start to tremble, sweating turns drenching, the pulse speeds up, and anxiety, insomnia and vomiting appear. That is what withdrawal looks like, and alcohol detox means getting the patient through it safely, under the supervision of medical staff. Detox is not a cleansing of toxins: the body breaks alcohol down and removes it by itself, without any drip.

Breaking off several weeks of drinking from one day to the next can end in seizures and alcohol-related delirium. Seizures and alcohol-related delirium call for immediate medical help, and the risk grows in people who have been drinking daily for weeks, in those whose earlier alcohol withdrawal ended in seizures, in people with chronic illness and in older patients. We book such a patient in for detox first, and start the therapy sessions afterwards.

Detox ends the binge and settles the withdrawal symptoms, while alcohol craving and the reasons why the patient was drinking remain. We describe how the first twenty-four hours go, what tests are done and in which situations a hospital ward is needed, on the page about alcohol detox in Gdańsk.

Drinking during treatment happens to many patients and does not cancel out the earlier months of work. After one evening of drinking it is usually enough to go back to the agreed treatment plan; after a binge lasting several days the withdrawal symptoms can return, and alcohol detox then has to be repeated.

We therefore ask for a phone call within a day or two, before one evening turns into a binge lasting several days. The patient does not have to justify anything to us. We check the state of their health, assess whether alcohol withdrawal is safe, and arrange the nearest appointments.

Then we establish what came before they reached for alcohol. Most often it is a medicine that was stopped, therapy sessions that were missed, insomnia, a row at home or a business trip. We then change the dose of the medicine or the medicine itself, book sessions more frequently for the coming weeks, and add that situation to the treatment plan together with what the patient is to do if it recurs.

The risk of a return to drinking is highest in the first months after alcohol is withdrawn, once the withdrawal symptoms have passed, the patient feels better and considers further care unnecessary. That is why we arrange the care for those months at the first consultation, together with the rest of the treatment.

The patient writes out the situations in which they have been drinking so far, for example coming home after a night shift, a wedding in the family or a row with a partner, and for each of them puts together a plan of action which they then rehearse with the therapist: what they do, who they tell about the temptation, how they get out of such a situation. Without a plan of that kind, a patient in a recurring situation usually reaches for alcohol, despite the earlier decision not to drink.

We continue pharmacotherapy for as long as the doctor considers it necessary; we do not stop the medicines on the day of the last therapy session. We also refer the patient to self-help group meetings; some participants attend them for years, including after the treatment has ended.

In a survey commissioned by the city of Gdańsk, a thousand adult residents answered two twin questions in 2023: whether in their view someone in their immediate family drinks too much, and whether someone among their close acquaintances drinks that way. Excessive drinking in the immediate family was reported by 10.8 percent of respondents, and among acquaintances by 24.6 percent, that is more than twice as many people. These are answers from a survey and the judgement of an outsider rather than a medical diagnosis, but the difference matches what we hear at consultations: an alcohol problem is easier to notice in an acquaintance than in one's own husband, wife or adult child.

With codependency, the household reorganises everyday life around somebody else's drinking: they check how much is left in the bottle, hide the drinking from the wider family, pay off debts run up on alcohol and make excuses at work for the absences of the person who drinks. Such behaviour comes from concern, but it shields the person who drinks from the consequences of drinking and delays the start of treatment.

Relatives can seek treatment for themselves regardless of whether the person who drinks decides on treatment. Codependency therapy teaches how to set limits without an ultimatum, and adult children of alcoholics work on the anxiety, the excessive sense of responsibility and the difficulty in trusting others that they brought out of the family home. If the drinking leads to rows, violence or the neglect of children, relatives can report the matter to the Gdańsk komisja rozwiązywania problemów alkoholowych (the municipal commission that handles alcohol problems). The commission then conducts proceedings of its own, refers the person who drinks for examination by a court expert and can submit an application to the court for an obligation to undergo addiction treatment.

Depression, anxiety disorders and post-traumatic stress disorder occur alongside alcoholism often enough that we ask about them at the first consultation. Alcohol suppresses the symptoms of these disorders for a few hours and then intensifies them, so the drinking and the mental illness reinforce each other.

At the start of treatment it is rarely possible to establish which appeared first, and this does not change what we do. Some depressive and anxiety symptoms subside on their own after a few weeks of abstinence, so we assess the patient's mental state again after three or four weeks without alcohol, before the psychiatrist decides on antidepressants.

We treat both disorders in parallel and within one team: the psychiatrist is responsible for treating the mental disorder, the addiction therapist for the work on drinking, and both specialists know what is going on with the patient between appointments. If we treat only the drinking and the depression is left untreated, after a few weeks the patient goes back to alcohol as the only remedy for low mood and insomnia.

In the same survey from 2023 the researchers asked residents of Gdańsk whether they knew of institutions offering help with addiction, whether to alcohol, to drugs or behavioural. Knowledge of such institutions was declared by 9.4 percent of respondents, roughly one in ten adult residents of the city. What is growing instead is the share of residents of Gdańsk who have come across, in their own surroundings, the work of institutions addressed to people misusing alcohol or using drugs: 16.5 percent against 11.7 percent four years earlier. The survey measures what residents know, not the number of ill people or the number of treatment places in the city.

What it does show, however, is that knowledge of where to get treatment is rarer in Gdańsk than the problem itself. Rather than working out on your own which facility to approach, it is simpler to book a consultation: the psychiatrist assesses the state of health and the risk tied to alcohol withdrawal, and then indicates where the treatment should start. The consultation itself commits the patient neither to a procedure nor to a programme lasting many months.