How many symptoms it takes before drinking counts as alcohol addiction
Alcohol addiction has a code of its own in the international classification of diseases: 6C40.2 in ICD-11 and F10.2 in the earlier ICD-10. The diagnosis is made by a doctor after taking a history and examining the patient, and it rests on a set of symptoms that persist over a longer period, not on the amount of alcohol drunk in a single week.
Tolerance means that the same amount of alcohol produces a weaker and weaker effect, so the patient drinks more. After a break in drinking, withdrawal symptoms appear: trembling hands, sweating, anxiety and insomnia, which subside after the next glass. Alcohol craving returns despite earlier resolutions not to drink, and the patient loses control over when they start drinking and how much they will drink. They carry on drinking although they know what drinking has already done to their health, their family and their job. A diagnosis requires several such symptoms occurring together.
These symptoms come from changes in the way the brain works. Regular drinking disrupts the reward system and the body's response to stress. Once alcohol is withdrawn, tension and irritability set in, and the urge to drink comes back of its own accord. Alcohol addiction runs a chronic course, with periods of abstinence and returns to drinking, which is why we plan treatment to run over months.
When drinking already has its own code in the ICD classification
With risky drinking the doctor does not yet find any damage to health, although the risk is growing: increasingly large drinks on every occasion, a drink to help them fall asleep, a glass before driving or before work. For harmful drinking the ICD-10 classification provides a separate code, F10.1: physical or mental harm has already occurred, while the patient still decides when and how much to drink. We diagnose alcohol addiction, that is F10.2, only once alcohol craving, tolerance and withdrawal symptoms are added to that harm.
Drinking can be assessed initially with the AUDIT questionnaire, drawn up by the World Health Organization. The first three of its ten questions ask how much and how often the patient drinks and make up the shortened AUDIT-C version. The remaining seven cover loss of control over drinking, guilt, gaps in memory and alcohol-related injuries. A high score is a reason for a medical consultation, but it does not replace a diagnosis.
In its 2023 statement the World Health Organization confirmed that there is no safe amount of alcohol to drink. At the consultation we therefore do not compare the patient with their friends; we ask about the harm that drinking has already caused and about the reason the patient reaches for alcohol every day.
From the first consultation to the end of the alcoholism treatment plan
The first visit to the practice on Torowa 16 is a medical consultation. We ask about the pattern of drinking and earlier attempts at treatment, examine the patient, order blood tests and assess whether withdrawal from alcohol needs medical supervision. The treatment plan for the coming weeks follows from that assessment.
The plan has three parts. It starts with stabilising the patient's health: detox for someone breaking a long binge, and correcting vitamin and electrolyte deficiencies. Then we start oral medication or place the Esperal implant for the first months without alcohol. The longest part is addiction therapy in Opole, during which the patient learns to recognise the situations that push them towards drinking and to get through them without alcohol. We write plans for one, three, six or twelve months, and we match the length of the plan to the patient's health and family situation.
The question of confidentiality comes up at almost every first visit. We record the patient's details in medical records, because every facility has a statutory duty to keep and store them. Treatment is therefore discreet, though it is not anonymous: we need the name for a prescription, for a referral for tests and for a certificate, and only a written authorisation signed by the patient decides who else, apart from the patient, may see the records. We arrange the first appointment within a few days of the enquiry, because we work privately.
What decides whether the patient stays at home or goes to a residential centre
We choose the treatment setting after the first consultation. We assess whether the patient will safely get through withdrawal from alcohol, how advanced their alcohol addiction is and whether abstinence can be maintained in their home.
Outpatient alcoholism treatment in Opole
We keep to visits at the practice alone when withdrawal from alcohol is unlikely to cause the patient complications and when fixed appointment times can be arranged. The patient then stays at home and at work, without sick leave and without leaving Opole, and we set the appointments around their shifts.
Residential alcoholism treatment in Opole
Patients with advanced alcohol addiction, with coexisting illnesses, or whose treatment at the practice ended in a return to drinking, qualify for a residential centre. A stay away from alcohol and from the people the patient drank with gives time to get through withdrawal and to begin psychotherapy, and we describe the conditions of the stay on the page about the addiction treatment centre in Opole.
Online alcoholism treatment and e-prescriptions in Opole
Remotely we monitor the course of treatment, hold part of the psychotherapy sessions and issue e-prescriptions. We treat this way above all patients travelling in from the districts around Opole and those whose work keeps them on the road. Remotely we cannot examine the patient, judge how severe the withdrawal symptoms are or carry out a procedure, so in acute withdrawal we see the patient at the practice.
How disulfiram, naltrexone, acamprosate and nalmefene work
The Esperal implant consists of sterile disulfiram tablets, which we place under the patient's skin during a short procedure. As long as disulfiram circulates in the blood, drinking alcohol ends in a severe reaction: reddening of the skin, palpitations, a drop in blood pressure and vomiting. That reaction discourages the patient from reaching for alcohol, but it removes neither the alcohol craving nor the reasons for drinking. We describe the preparation for the procedure, how it goes and the contraindications on a separate page about the Esperal implant in Opole.
Oral medicines work differently:
- naltrexone closes off the opioid receptors in the brain through which alcohol brings relief and relaxation; a drink then fails to lift the mood, so it is easier for the patient to stop after the first glass;
- acamprosate dampens the excessive excitation of nerve cells that persists for many weeks after alcohol is withdrawn, which lowers the risk of relapse in those first months;
- nalmefene is taken as needed, on a day when the patient expects a situation that raises the risk of drinking; it then reduces the amount of alcohol drunk, which is why we propose it to patients who want to cut down first rather than give up alcohol at once;
- disulfiram in tablets produces the same reaction to alcohol as the implant, but it protects only for as long as the patient takes the tablets every day.
We choose the medicine on the strength of liver function test results and after going through everything the patient already takes; we also ask whether they are set on full abstinence or on cutting down first. Pharmacotherapy on its own will not cure alcohol addiction: medicines reduce the risk of reaching for a drink in the months when the patient is doing the work of psychotherapy.
Which symptoms make alcohol detox in Opole necessary
Alcohol detox means guiding the patient through withdrawal under the supervision of medical staff. The name itself is misleading: the body breaks alcohol down without our help, and what we treat are the symptoms that appear as the level of alcohol in the blood falls.
Supervision is needed when a patient stops drinking after breaking a binge of several days, or after drinking every day for several weeks. It is required without exception for every patient whose earlier withdrawal from alcohol ended in seizures or delirium. Caution is also needed for patients with heart failure or liver disease, and for elderly patients. Stopping drinking abruptly after a long binge carries a risk of seizures and of alcohol withdrawal delirium. Both states call for immediate medical help.
After detox the withdrawal symptoms subside, but alcohol craving returns in the weeks that follow, and the situations in which the patient drank stay the same. That is why we set the date of the first psychotherapy session before the detox itself. We describe which tests we carry out before detox and what we give in the drip on the page about alcohol detox in Opole.
What to do in the first day after a return to drinking
The first twenty-four hours after a drink decide whether it ends with a single evening. For a patient who rings us the same day or the next, adjusting the treatment plan is usually enough, with no second detox. After several days of drinking we are already talking about a binge, and a binge calls for withdrawal from alcohol under medical supervision. So we ask patients to ring at once, even if they have only had a drink on one occasion.
A relapse is usually preceded by earlier warning signs. The patient stops taking their medication, cancels one therapy session after another, goes back to company where people drink every day, stops sleeping or says nothing about a conflict at home. We write these signals down together with the patient, so that they recognise them in themselves earlier than we do.
After a relapse we examine the patient, check what happened in the days before the drink, and correct the treatment plan: we change the medicine, add sessions for the coming month, sometimes refer the patient for a psychiatric consultation. The patient carries on with psychotherapy from the stage at which they broke off treatment and does not repeat the earlier sessions.
What care looks like in the first year without alcohol
The risk of relapse is highest in the first months after alcohol is withdrawn: the physical symptoms have gone, while the patient's home, job and friends have stayed the same. So after the intensive stage of treatment we stay in contact with the patient until the end of the treatment plan, only less often: a visit every few weeks instead of a weekly session. In a twelve-month plan these less frequent visits take up most of the time.
The work then centres on relapse prevention. Together with the therapist the patient writes down the situations after which they used to reach for alcohol: the end of a shift, payday, a family wedding, a row at home. For each one they prepare a ready-made plan for how to respond and practise it in advance, because in a moment of tension it is hard to come up with something new.
We run pharmacotherapy for longer than intensive psychotherapy. Naltrexone or acamprosate stays in the plan for many months after the last session, and the decision to stop the medicine is taken at a follow-up visit. Outside the practice the patient also has self-help groups, above all Alcoholics Anonymous meetings. They do not replace psychotherapy, but between visits they put the patient in touch with people who have been through the same thing.
What changes when the family stops shielding the person who drinks
We recognise codependency when relatives start to arrange the whole day around someone else's drinking: they watch how much is left in the bottle, ring the workplace with an excuse, pay off the debts run up by the person who drinks and quieten rows before the neighbours hear them. Such behaviour protects the person who drinks from the consequences of drinking and puts off the moment when they decide on treatment.
The family regains influence over the situation when it stops standing in for the person who drinks: the debts stay their debts, an unexcused absence from work stays their absence, and relatives talk about the drinking while everyone is sober, not in the middle of a row. In codependency therapy relatives settle what they will no longer do for the person who drinks, and they learn to say it calmly, without threats. Any adult member of the household can sign up, including when the person who drinks refuses treatment.
The family can also notify the gminna komisja rozwiązywania problemów alkoholowych (the municipal commission for solving alcohol problems) in the area where the person who drinks lives. The commission conducts proceedings of its own, and it is the commission that files the application for an obligation to undergo addiction treatment with the district court.
Why we do not treat alcohol addiction and depression one after the other
We ask every patient at the first consultation about symptoms of depression, about anxiety and about the consequences of past trauma, because in some patients it is precisely these disorders that keep the drinking going. Alcohol suppresses anxiety for a few hours and makes falling asleep easier, and the next day the anxiety and the insomnia come back stronger, so the patient reaches for alcohol more often.
At the first visit it is usually impossible to settle whether the patient drank because of depression or whether the depression grew out of the drinking. Symptoms that followed from drinking weaken after a few weeks without alcohol; those that remain need psychiatric treatment. This is why we assess the patient's mental state again once abstinence is stable.
With two diagnoses we run the treatment in parallel. The psychiatrist is responsible for the diagnosis and the medication, the patient works on the drinking with an addiction therapist, and we write the appointments with both into one treatment plan. If the depression is left untreated, the patient usually goes back to drinking, because alcohol is still the quickest way for them to bring the tension down.
Who comes for help at the municipal information points in the region
In 2024 the gminne punkty informacyjno-konsultacyjne (municipal information and counselling points run by local authorities) in the Opole Voivodeship received 1,634 people with an alcohol problem and 1,147 adult members of their families, including codependent relatives and adult children of alcoholics. Relatives made up 41.2% of the two groups taken together, while across the country their share came to 29.4%. Such a point operated in 54 of the 71 municipalities in the region, and 69 municipalities sent in a report, so the figures are an underestimate.
A point of this kind gives information, talks with the person who comes in and directs them onwards, but it does not provide treatment. These figures therefore do not show how many relatives went through codependency therapy. At Nasz Gabinet Opole relatives most often ask how to persuade the person who drinks to start treatment, and some of them then begin codependency therapy themselves. The data comes from municipal reports, not from a medical register, and covers the whole voivodeship together with Opole.
