Spandana Nursing Home is an exclusive tertiary Psychiatric Centre with liaison of other medical departments which caters to the mental well-being of an individual and the community at large.This centre is tucked in a quite place in Rajajinagar amidst the shade of the trees which has weathered the test of time.Spandana stands for more than five decades and continues to serve with values.
Alcohol addiction is a staggering problem faced by the society. It do causes socio-economic-psychological breakdown of both patient and the caregivers. Many times the desire to quit alcohol is high, but alcohol exposure accidently during the abstinent period causes relapse of problem and the alcohol intake starts as previous pattern. Intake of alcohol is associated with relief of stress in this patients. So this people find it difficult to control drinking once the reexposure has occured.
Alcohol is used in every part of the country including in those states which have enforced prohibition. At the national level, about 2.7% of population (2.9 crore individuals) is affected by alcohol dependence. Overall in the country, about 5.2% of population aged 10-75 years (about 5.7 crore individuals) need help for their alcohol use problems (i.e. they consume alcohol in a harmful or dependent pattern).
Scientific evidence-based treatment needs to be made available for people with substance use disorders – at the required scale
Disulfiram inhibits the enzyme aldehyde dehydrogenase, thus preventing complete metabolism of alcohol in the liver. This results in an accumulation of the toxic intermediate product, acetaldehyde, which causes the alcohol–disulfiram reaction.
The therapeutic effect of disulfiram is thus mediated by its incompatibility with alcohol, resulting in alcohol aversion. Supervised medication optimises compliance and contributes to effectiveness.
The intensity of the intolerance reaction is dose-dependent, both with regards to the amount of alcohol consumed and the dose of disulfiram. However it is thought that much of the therapeutic effect is mediated by the mental anticipation of the aversive reaction, rather than the pharmacological action itself.
Thus Alcohol aversion therapy works on principle of learning theory where if a behaviour is followed by negative consequence the frequency of behaviour decreases.
At Spandana after explaining about the pros and cons of the therapy, consent is taken. After consent patient is investigated properly to rule out any contraindication for therapy. The management plan consist of starting patient on tab disulfiram. Patient during his stay in hospital is started on medication. After starting on medication patient is given 3 trials of alcohol aversion under observation. Vital parameter are monitored. During the trial patient do develop Symptoms like throbbing headache, flushing, dizziness, nausea, vomiting, blurred vision, hypotension, tachycardia and hyperventilation. Based on severity of symptom the aversion is stopped and patient is explained about risks of taking alcohol while on medication. The aversive experiment is repeated 2-3 times basedon severity of reaction.
Patient after discharge from hospital is maintained on disulfiram and under regular follow up counselling session done and motivated to remain abstinent. Existing literature recommends disulfiram based aversive therapy in motivated patient. The therapy does wonders in few and patient do well and remain abstinent for years on the medication. Over follow up the medication may be stopped after discussing the opt
