Alcoholism Treatment Lublin

It is not how much or how often someone drinks that decides whether this is addiction, but the set of symptoms on which a doctor bases the diagnosis. In medical classifications alcohol addiction has codes of its own, F10.2 (ICD-10) and 6C40.2 (ICD-11), and like any chronic illness it needs treatment, not just a decision to stop drinking.

Behind the loss of control lies a change in the way the brain works. Years of drinking reset the reward system and the stress response so that alcohol becomes the quickest way to release tension, while the lack of it produces tension by itself. That is where alcohol craving comes from, returning despite an honest resolution not to drink and despite full awareness of the harm it causes.

The diagnosis rests on several symptoms occurring together: a compulsion to drink, no control over the amount or the moment of starting, tolerance, meaning the need for ever larger amounts, withdrawal symptoms after a break, and drinking despite damage to health, work and family life. The more of these symptoms a patient has, the more advanced the illness.

Addiction runs a chronic, relapsing course. A few weeks without alcohol therefore do not end the treatment, and a return to drinking after a break does not mean the earlier work is lost. This is why we plan treatment in months rather than around a single procedure.

The first signal is often a set of rules the patient makes for himself and then does not keep: only at the weekend, only beer, two glasses and no more. Such rules say more about a drinking problem than the number of litres drunk, because they show that drinking has begun to need watching.

Medicine distinguishes three degrees of problem drinking. Risky drinking has not caused damage to health yet, but it raises the risk that it will. Harmful drinking has a category of its own in the classification, F10.1, and means specific damage to health or to family life without a full loss of control. With addiction, that is F10.2, alcohol craving and withdrawal symptoms are added on top of that damage.

An initial assessment can be made with the AUDIT test, a questionnaire developed by the WHO with ten questions about the pattern of drinking and its consequences; the shortened AUDIT-C version has three questions. A positive result is not a diagnosis, only a reason for a medical consultation, at which the doctor assesses whether this is risky drinking, harmful drinking or addiction.

There is no dose of alcohol that is safe for health; the WHO said so plainly in its 2023 statement. Whether drinking has already become a problem is therefore decided not by the fact of drinking itself, but by whether alcohol is starting to set the plans for the day.

Treatment starts with a medical consultation at the practice on Narutowicza 78A. The doctor takes a history, examines the patient's physical condition and assesses whether alcohol can be withdrawn on an outpatient basis, and then proposes a plan: detox if it is needed, medication that supports abstinence, the Esperal implant or psychotherapy.

The rest of the treatment is spread over months. The first weeks mean stabilisation and control of withdrawal symptoms, the following ones work on what triggers drinking, and the last ones maintaining abstinence. We run monthly, quarterly, six-month and yearly packages, so we match the length of treatment to the patient's situation rather than fitting the patient into a ready-made package.

The backbone of the plan is addiction psychotherapy, with medication and procedures supporting it. We describe how it works on the page about addiction therapy in Lublin. Without it, treatment ends at stopping drinking, and such a break rarely lasts long.

We work privately, so we give an appointment within a few days, and we can hold follow-up visits remotely. For many patients from outside Lublin this is the only way not to interrupt treatment because of the distance. Patients sometimes confuse private treatment with anonymous treatment: anonymous it is not, because we keep and store medical records as the law requires, but it is discreet, because without the patient's consent we tell neither the employer nor the family about the treatment.

The choice of setting is decided not by how long someone has been drinking, but by the safety of withdrawal and the patient's situation at home.

When treatment in the practice is enough

We treat patients on an outpatient basis when their health and family situation is stable, when there are no severe complications after they stop drinking and when somebody at home knows about the treatment. We set appointment times outside the patient's working hours, because keeping a job often decides whether the patient finishes the treatment.

Situations in which a patient goes to a residential centre

A residential stay makes sense with long binges, after unsuccessful attempts at outpatient treatment, when abstinence cannot be kept at home, or when a serious illness is added to the addiction. We describe how such treatment works on the page about the addiction treatment centre in Lublin.

Check-ups and prescriptions remotely, examination and procedures in the practice

Remotely we hold follow-up visits and part of the psychotherapy, and we issue prescriptions. Online we cannot assess a patient in acute withdrawal or place the Esperal implant, so the first visit and the procedures take place in the practice.

The Esperal implant contains disulfiram, which halts the breakdown of alcohol at the acetaldehyde stage. After a drink the body reacts strongly and unpleasantly, and it is that reaction which discourages the next glass. We describe the procedure, the qualification and the contraindications on the page about the Esperal implant in Lublin.

Oral medicines have different tasks. Naltrexone reduces the satisfaction a drink brings and the recurring urge to have one. Acamprosate acts on a nervous system unsettled by years of drinking and eases the restlessness that pulls the patient back to alcohol after he stops drinking. Nalmefene is taken occasionally, when the goal is not full abstinence but a smaller amount of alcohol. Disulfiram in tablets causes the same reaction to alcohol as the implant, but the patient has to remember to take it every day.

The choice of medicine belongs to the doctor and depends on the goal of treatment, coexisting illnesses, other medicines taken and what the patient has already tried. This is why pharmacotherapy does not start with a preparation somebody spoke well of, but with an examination and a history.

None of these medicines removes the causes of drinking and none replaces psychotherapy. The implant buys time for therapeutic work and oral medicines reduce alcohol craving, but lasting change comes only from the therapy carried out during that time.

Alcohol detox does not consist in cleansing the body of toxins, whatever the advertisements claim. It means guiding the patient safely through withdrawal, the period in which the body reacts to the absence of alcohol with tremor, sweating, insomnia, a fast pulse and anxiety.

The risk of a severe course of withdrawal grows after a long binge, with large amounts of alcohol and in people who have had seizures or alcohol-related delirium before. These are life-threatening states, so with such a history withdrawal is carried out under medical supervision, not at home. We describe how the procedure goes on the page about alcohol detox in Lublin.

The scale of hospital treatment can be seen in the city's data. In the Lublin psychiatric hospital, diagnoses of disorders caused by alcohol, drugs and other substances accounted for more than one fifth of all admissions: 1,685 patients in 2020 and 1,974 in 2022, out of 6,724 and 7,802 patients treated in total (municipal prevention programme for 2024-2026).

After detox the patient still needs treatment for the addiction itself. Once he stops drinking the withdrawal symptoms subside, yet alcohol craving and the reasons for drinking remain, so the next step is therapy and medication, not a return to everyday life without a plan.

Relapse happens in a chronic illness and does not undo the earlier months of treatment. What matters is how much time passes between the first glass and the phone call to the therapist, because that decides whether it ends with a single drink or with another binge.

Once the patient gets in touch, we establish what preceded the return to drinking: medicines stopped, visits missed, insomnia, a conflict at home, a business trip. Then we correct the plan, sometimes change the medicine, sometimes increase the frequency of sessions for a few weeks. Simply going back to the earlier rhythm, without that correction, rarely works.

What does the most harm is putting off getting in touch after a relapse. Patients delay the call because they are ashamed to admit they drank, and in that time drinking returns to the level from before treatment. This is why we say it plainly: after a relapse we take the patient back without judging him, and we do not start the treatment from scratch.

The risk of a return to drinking is highest in the first months after the patient stops drinking, so care does not end together with the intensive stage. What changes is its rhythm: instead of weekly sessions there are follow-up visits every few weeks.

The core of this stage is relapse prevention. Together with the patient we write down the situations that trigger his drinking, such as family parties, business trips, payday, an argument or insomnia, and we prepare a plan for such a moment so that he does not have to look for a solution on the spot.

Some patients continue pharmacotherapy at this point. Naltrexone or acamprosate is taken for many months if the doctor considers it necessary. Self-help groups complete this stage: the patient has contact with other people between visits, and the groups require neither a referral nor payment.

It is usually the family, not the person who drinks, that comes to us first. After years of living with alcohol at home the whole day is arranged around drinking: checking how much the relative has drunk, explaining his absences at work, taking over his duties, calming one row after another. This is called codependency and it is treated separately.

One decision helps, even though at first it seems unfair: to stop shielding the person who drinks from the consequences of drinking. Relatives learn to set limits, they stop paying off someone else's debts and explaining the drinking to an employer, and they talk about treatment when the patient is sober. Adult children of alcoholics have separate programmes, because their difficulties concern relationships with other people rather than their own drinking.

If the person who drinks refuses treatment, the family can file a request for an obligation to undergo addiction treatment with the municipal commission for solving alcohol problems; what to expect from that route is explained in the questions below. We provide consultations for relatives as part of addiction therapy in Lublin, even when the patient never comes to us at all.

In some patients the addiction comes together with depression, anxiety disorders, post-traumatic stress disorder or persistent insomnia. Alcohol suppresses these symptoms for a few hours and intensifies them over a longer period, so the drinking and the mental illness feed each other.

Treating only the addiction, or only the mental disorder, rarely gives a lasting result. After the patient stops drinking, anxiety or depressive symptoms come to the fore, and that is the moment when he most often returns to drinking if nobody deals with them.

In such a situation we run the treatment on two tracks. The psychiatrist is responsible for diagnosing and treating the mental disorder, the addiction therapist for the work on drinking, and the plan remains one and shared. The choice of medication has to take the addiction into account, so the decision about psychiatric medication is made by a psychiatrist who knows both diagnoses.

Data collected for the municipal prevention programme for 2024-2026 shows who actually enters treatment in Lublin. The average age of a patient with an alcohol-related diagnosis at the municipal addiction treatment facility was 46 in 2021 and 51 in 2022, while among those admitted to the psychiatric hospital, people between 30 and 59 accounted for 82 percent of alcohol-related diagnoses in 2022, against 77 percent in 2020.

These are figures from treatment facilities, not a count of ill residents. All they show is that the people who come for help are usually those who have been drinking for many years. Age does not decide who is admitted to treatment, and it is not too late to start treatment after fifty.