Alcoholism Treatment Wałbrzych

Alcohol addiction is listed in the international classification of diseases under code F10.2 in ICD-10 and 6C40.2 in the newer ICD-11. The diagnosis is made by a doctor, who takes a history of the drinking, examines the patient and assesses the symptoms using the same criteria applied to any other chronic illness.

The symptoms come from changes in the brain. Alcohol stimulates the reward system more strongly than food or a conversation with someone close, and with daily drinking that system shifts towards alcohol and responds more weakly to other sources of pleasure. The stress response is disturbed at the same time, so tension after a day without alcohol builds up instead of easing off. That is where alcohol craving comes from, returning regardless of how many times the patient has promised themselves they would not drink again.

A doctor diagnoses alcohol addiction when several features appear together in a patient. These are a strong urge to drink, loss of control over how much and when alcohol is drunk, tolerance, meaning the need for ever larger amounts, drinking despite illness, conflict at home and problems at work, and withdrawal symptoms after a break in drinking. The more of these features a patient has, the deeper the addiction. The illness runs a chronic, relapsing course, so a decision to stop drinking rarely suffices on its own, and treatment is spread over months.

There is no number of drinks above which illness begins. Medicine distinguishes three situations, and what separates them is the consequences of drinking. Risky drinking has not yet caused damage to health, but it raises the chance that it will. Harmful drinking has its own entry in the ICD classification, F10.1, because damage has already occurred: a damaged liver, high blood pressure, conflict at home. At this stage the patient still controls how much they drink. Alcohol addiction, F10.2, is diagnosed only once alcohol craving, tolerance and withdrawal symptoms are added to that picture.

The pattern of drinking is most easily checked with the AUDIT questionnaire, developed by the World Health Organization. It has ten questions about how often the patient drinks, how much they drink on one occasion and what has happened as a result over the past year. The shortened AUDIT-C version keeps the first three of those questions. A raised score is not a diagnosis, only a signal to book a medical consultation and establish which of the three situations the patient is in.

Since 2023 the World Health Organization has stated plainly that no dose of alcohol is safe for health. That is why, at the consultation, we ask above all why the patient reaches for alcohol and how they cope with days without drinking.

Stopping drinking can be achieved within a few days, but learning to live without alcohol takes months. At the first consultation the doctor takes a history of the drinking, assesses the patient's health, orders tests and decides whether stopping alcohol requires medical supervision. The visit ends with a treatment plan set out for the coming weeks.

Patient safety decides the order of the stages. We stabilise the patient's health first, and for a patient in the middle of a drinking binge we start with alcohol detox. Oral medication or the Esperal implant follows, to protect the first weeks of abstinence. At the same time addiction psychotherapy in Wałbrzych begins, which addresses the reasons behind the drinking and, of all the stages, takes the longest. At Nasz Gabinet Wałbrzych we run one-month, three-month, six-month and twelve-month treatment plans, and their length depends on the patient's health and on how many earlier attempts at treatment there have been.

We work privately, so a first consultation can usually be booked within a few days. A private appointment does not mean anonymous treatment, though. Every consultation and every procedure is recorded in medical documentation, which we keep as the law requires. The patient and anyone they authorise have access to that documentation, and without the patient's consent we do not pass on any information to family or to an employer.

The doctor chooses the setting at the first consultation. They ask how long the current drinking binge has lasted and how earlier attempts to stop drinking ended, check for coexisting illnesses and establish whether alcohol is kept in the patient's home at all times.

Outpatient alcoholism treatment in Wałbrzych

We treat patients at the practice when the doctor does not expect severe withdrawal symptoms. The condition is that the patient can travel to follow-up visits on the agreed dates. The patient then keeps working and does not have to explain a several-week absence to an employer.

Alcoholism treatment at a residential centre in Wałbrzych

We propose a residential stay when someone else at home also drinks or alcohol is kept in plain view, when serious physical illness accompanies the alcohol addiction, and after treatment at the practice has ended with a return to drinking. The conditions of such a stay are described on the page about the addiction treatment centre in Wałbrzych.

Online alcoholism treatment and e-prescriptions in Wałbrzych

We hold follow-up visits and some therapy sessions remotely, and we issue e-prescriptions. We do not, however, start treatment remotely for a patient who has been drinking daily for weeks, because the risk of complications after stopping alcohol cannot be assessed without examining them in person. Acute alcohol withdrawal syndrome requires examination and supervision on site.

Esperal is a disulfiram implant placed under the skin. Disulfiram blocks the enzyme that completes the breakdown of alcohol in the liver, so after drinking even a small amount of alcohol the patient's face flushes, the heart starts to pound, blood pressure drops and vomiting follows. We suggest the procedure to patients who need protection during the first months of abstinence. The implant discourages reaching for alcohol, but it does not treat alcohol addiction on its own. Preparation, the course of the procedure and the contraindications are described on the page about the Esperal implant in Wałbrzych.

Tablets are used when the patient does not want the procedure or when the implant is contraindicated. Each medicine plays a different role. Naltrexone occupies the brain receptors that endorphins released by alcohol act on, so a drink stops improving mood, and alcohol craving weakens along with it. Acamprosate reduces symptoms that persist for weeks after alcohol is stopped: the nervous system stays overstimulated, the patient sleeps poorly and feels irritable. Nalmefene reduces the amount of alcohol drunk, but it is not meant to maintain full abstinence, and the patient takes a tablet as needed, on a day when they expect an occasion to drink. Disulfiram in tablet form causes the same reaction to alcohol as the implant, but it has to be taken every day.

The doctor chooses the medicine after examining the patient and reviewing blood test results: they check the state of the liver, chronic illnesses and any other medication taken, and ask the patient about their goal, full abstinence or a reduction in the amount of alcohol drunk. Pharmacotherapy on its own does not cure alcohol addiction. The medicines reduce alcohol craving and give the patient calmer first months, while psychotherapy deals with the reasons for drinking.

Alcohol detox is treatment for withdrawal syndrome, the symptoms that appear once someone who drinks daily stops drinking. It is not a way of cleansing the body of toxins, whatever many advertisements claim: alcohol leaves the blood within a matter of hours regardless, and what needs treating is the nervous system's reaction to its absence.

People should not stop drinking without medical supervision if they are coming off a drinking binge of several days, have previously had withdrawal seizures or delirium tremens, have heart or liver disease, have epilepsy, or are older. In these situations a sudden stop in drinking can trigger seizures and delirium tremens, and both states require immediate medical help.

Detox breaks the drinking binge and removes withdrawal symptoms, but alcohol craving and the reasons for drinking remain, which is why we set the date of the first therapy session before the detox even takes place. The tests carried out before detox and the course of the procedure are described on the page about alcohol detox in Wałbrzych.

Alcohol addiction runs a relapsing course, and a return to drinking happens to many patients during treatment, so a relapse does not cancel out the earlier months of treatment. We treat a relapse as an event within the course of the illness and go back with the patient to the plan that was interrupted.

The first two or three days decide what happens next. A single drink can usually be managed without interrupting the treatment plan if the patient gets in touch straight away. A drinking binge lasting several days already needs to be broken medically, sometimes with detox, so any delay sets the treatment back by a whole stage. That is why we tell patients plainly to call us as soon as they have had a drink, even if they feel ashamed.

Once a patient gets in touch, we check their health and establish what came before the drink: medication that was stopped, sessions that were missed, conflict at home or several sleepless nights. We then revise the treatment plan at the point where it broke down: we change the medicine, arrange more frequent psychotherapy sessions or add a weekly follow-up visit for the coming month.

A relapse most often happens in the first months without alcohol, when the patient already feels well: alcohol craving weakens, so the patient stops keeping to the rules agreed in psychotherapy. That is why, after the intensive stage of treatment, we schedule visits less often, but care does not stop.

Relapse prevention comes down to two skills that can be practised. The first is recognising the situations after which the patient has reached for alcohol in the past, for example coming home to an empty flat, an argument at home or payday. The second is a ready plan for each of those situations, worked out in advance during a session with the therapist.

We continue pharmacotherapy for as long as the patient's condition requires it. The patient keeps taking naltrexone or acamprosate for further months if the doctor judges that alcohol craving is still returning, and we decide whether to stop the medicine at a follow-up visit. Between visits, self-help group meetings help, because they also take place in the evenings and at weekends, exactly when it is hardest for the patient to hold out without alcohol.

When one member of a household drinks, the rest of the family take over the jobs the drinker used to do, keep track of how much is left in the bottle, make excuses for the drinker's absences from work and pay off the drinker's debts. This pattern of coping is called codependency, and we treat it separately, regardless of whether the person who drinks has started treatment. Children growing up in such homes carry entrenched mistrust and difficulty with close relationships into adulthood. In Poland this group is known by the abbreviation DDA (dorosłe dzieci alkoholików, adult children of alcoholics).

The scale of the most serious cases can be seen in Wałbrzych's foster care reports. At the end of 2024, 564 children were in family foster care in Wałbrzych, and 284 of them had been placed there because a parent was addicted to alcohol or other substances. In 2022 there were 275 such children, in 2023 there were 280, so the number grew by a few children each year. The share of alcohol and other substances among the recorded causes fell from over 55 percent to over 50 percent, but only because family foster care covered more children over that period, 564 against 498 in 2022. In the report alcohol is counted together with other substances, and the cause is recorded by social services and the family court, not by a doctor.

Relatives can come to a consultation on their own. We teach them how to stop shielding the person who drinks from the consequences of their drinking without breaking contact with them. If the addicted person refuses treatment, the family can file a notification with the municipal commission for solving alcohol problems (GKRPA), and the commission refers a request for a court order to undergo addiction treatment to the district court.

We ask every patient about mood, sleep and anxiety at the first consultation, because alcohol addiction is often accompanied by depression, anxiety or the after-effects of trauma. Alcohol suppresses these symptoms for a few hours and makes them worse the next day, so the patient drinks more and more while the symptoms grow stronger.

We do not decide at the first visit which came first. After a few weeks of abstinence the picture becomes clearer: some symptoms fade together with stopping alcohol, while those that persist despite continued abstinence require a separate psychiatric diagnosis.

In that situation the patient has one treatment plan and two clinicians leading it. The psychiatrist is responsible for diagnosing and treating the mental health condition and monitors the medication taken. The addiction therapist deals with the drinking, and both specialists discuss the course of treatment with each other. If only the drinking is addressed while the depression is left untreated, the result usually does not last, because the patient returns to the alcohol they were previously using to suppress the symptoms of their illness.

The Municipal Social Welfare Centre (MOPS) in Wałbrzych reports each year how many adults from families supported by a family assistant had a recorded alcohol addiction, and how many of them started treatment. In 2022 there were 71 such people, and 33 of them started treatment. In 2023 there were 74, and 52 started treatment. In 2024 family assistants recorded 84 people, of whom 24 started treatment. In those years family assistants worked with 213, 206 and 198 families across the city respectively.

These are not medical diagnoses, only a problem recorded by a family assistant within the narrow group of families supported by the municipal social welfare centre. What these figures show is one thing: the number of people with a recorded alcohol problem grows every year, while fewer than half of them start treatment. A record that treatment started shows only the start, not that it was completed, so some of these people come to the practice for a second or third time.