Types of alcoholism

Based on clinical observations, four main types of the course of alcoholism are distinguished: progressive, stationary, relapsing and regressive.

The progressive type of course is evidenced by alcohol abuse, which practically does not stop for several years. Treatment in most such cases turns out to be ineffective; the period of abstinence from drinking after treatment is no more than 6 months. Observe the progression of the main alcoholic symptoms with the transition to new stages of the pathological process.

The stationary course of alcoholism is characterized by the slow formation of stage II of the disease (10-15 years or more), while professional performance, social and family connections are preserved for a long time. Drunkenness is relatively moderate, alcoholic psychosis usually does not occur, however, remissions are also short-lived.

The relapsing course of alcoholism is accompanied by relatively long remissions (both therapeutic and spontaneous) - from 6 months. up to 1 year or more. However, there is no reverse development of alcohol symptoms. This type of course is relatively favorable, but the prognosis depends on the effectiveness and timeliness of therapeutic measures.

The regressive type of flow can be defined as favorable. It is often a consequence of effective treatment and preventive measures. Therapeutic or spontaneous remissions are long-term (at least a year) and are accompanied by a reverse development of alcohol symptoms. The occurrence of spontaneous remissions is facilitated by certain constitutional and typological personality traits, deterioration of somatic condition, and active intervention of the microsocial environment. During short-term relapses, alcohol symptoms do not reach the severity that was observed in remission. The absence of exacerbations for 3 years or more is assessed as conditional recovery, which gives grounds to consider the issue of deregistration from drug treatment. When addressing this issue, it should be remembered that, despite the restoration of social functions and the leveling of alcoholic deformations of personality and behavior, a number of pathogenetic mechanisms remain in such individuals that determine readiness for relapse in the event of alcohol consumption. Therefore, it is advisable to consider this situation as recovery, but only as long-term remission.

Remissions and relapses

During the development of alcoholic illness, more or less long-term remissions are possible: spontaneous and after treatment. Most often they are observed in the initial stages of alcoholism: in stages I and II. Conventionally, such remissions can be divided into two groups: a conscious reluctance to further alcoholism and the inability to drink alcohol due to exacerbation of somatic diseases. Remissions in alcoholism cannot be equated with recovery, because in the case of alcohol consumption, even after a long remission (10-20 years), symptoms of physical dependence quickly appear. So some scientists consider alcoholism an incurable disease.

The following types of remissions are distinguished:

2. subcompensated remission (more than one year) with affective reactions, actualization of pathological craving for alcohol, pseudo-abstinence syndrome, belonging to relapses of dangerous clinical situations.

3. Remissions (more than one year) with the absence of clinically pronounced affective reactions and actualization of pathological craving for alcohol are compensated. With such remissions, in some cases short-term (no more than 2 weeks), mildly expressed involuntary or situationally provoked mood swings are observed.

The stability of remission increases if the patient understands the value of sobriety, the impossibility of moderate consumption of alcoholic beverages and filling free time with other meaningful activities (work, hobbies, sports, etc.).

The causes of relapse of the disease can be both external and internal. The first includes the influence of the drinker’s company (sometimes taking the form of outright pressure) and constant reminders from the environment about the patient’s alcoholism (at home, at work, former friends). Internal causes include hormonal fluctuations (especially in women), affective fluctuations (in the direction of both pleasant and unpleasant sensations), states of hunger, physical and mental fatigue.

Separately, it is worth considering the spontaneous craving for alcohol and the activation of the alcoholic dynamic stereotype. Most often this occurs in the form of an “influx” of thoughts about the desire to drink (most often in the evening and at night) and dreams on an alcoholic theme. Usually these dreams are vivid and thematically related to preparation for drinking alcoholic beverages. At the initial stages of sobriety, such experiences can lead to the appearance of pseudo-withdrawal syndrome: psychopathological and somatovegetative disorders resembling this condition. Activation of the alcoholic dynamic stereotype can be caused by any memory of drinking alcohol: a similar place, situation, visit to a store, etc.

It must be borne in mind that the causes of relapse never exist separately and are not always recognized by the patient. To prevent relapses, it is recommended to carry out special psychotherapeutic treatment in the form of courses for 0.5-2 years.

Remission of alcoholism refers to various conditions. In a number of foreign countries, any improvement in the condition is often interpreted as remission. Therefore, remissions include a less frequent occurrence of binges, their shortening, a decrease in daily dosages of alcoholic beverages consumed, employment, a decrease in aggressive tendencies in intoxication, and the absence of previously encountered conflicts with the law.

In the USSR, these indicators were taken into account after the cessation of compulsory treatment for alcoholism, but were regarded not as the onset of remission, but as positive results of the therapy (often only temporary). In domestic narcology, remission is usually called a condition in which there is complete abstinence from drinking alcohol.

Since the course of alcoholism very often includes periodic alcohol abuse and more or less long periods of absolute sobriety, by remission most researchers mean such abstinence from alcohol consumption, which is measured for a period of no less than 3 months.

However, remissions differ not only in the duration of abstinence from alcohol, but also in their quality. Conventionally, short remissions are considered to be periods of abstinence from 3 to 6 months, medium-duration remissions are periods of abstinence from 6 months to 1 year, and long remissions are periods of sobriety lasting over 1 year. Sometimes remissions that last only more than 2 years are called long-term.

The quality of remissions varies, so along with the duration of abstinence, other manifestations of the disease are taken into account.

Incomplete remission

Incomplete indicates remission, which is characterized by the persistence, despite abstinence from alcohol consumption, of a constantly present or periodically appearing desire for intoxication (consumption of alcoholic beverages). During incomplete remission, mood swings are often observed with the emergence of melancholy-anxious, dysphoric or melancholy-apathetic affect.

Some patients experience a constantly low mood (hypotymia) with complaints of lack of or decreased interests. Little gives pleasure, activity is reduced, some talk about the joylessness of existence, sometimes the state corresponds to what is understood as existential depression. In the anamnesis, some patients, even before the onset of alcohol abuse, had a tendency to mood swings, while others, before the formation of alcoholism, had always had a stable mood.

One of the variants of mood disorders is the appearance of anxious and melancholy affect, often with hypochondriacal inclusions. There are concerns about the physical condition, the desire to be examined by doctors of different specialties. Anxiety can also be expressed in the emergence of fears regarding social prospects. Often, an anxious affect occurs at the beginning of remission, then it is replaced by a hypothymic state.

Dysphoric affect is expressed in the appearance of increased irritability, anger, and a tendency to verbal or physical aggression. As the duration of remission increases, irritability decreases.

As a rule, severe dysphoria is observed in those patients who, even before the formation of alcoholism, were characterized by a tendency to increased irritability for minor reasons. Among those prone to dysphoria, a certain percentage is occupied by patients who have suffered a closed craniocerebral injury.

Melancholy-apathetic affect is less common in remission than anxious-sad and dysphoric. It is usually observed with many years of alcohol abuse, the presence of signs of alcoholic encephalopathy, as well as in the third stage of alcoholism, at the stage of a pronounced decrease in tolerance to alcohol.

In remission, sleep disturbances naturally occur, especially in the first time after quitting alcohol consumption. Sleep becomes restless, the duration of night sleep is shortened due to early awakening or late falling asleep (especially in anxiety states). Gradually, sleep disturbances smooth out, but dreams with “alcoholic” content periodically appear.

In dreams, patients take part in a feast, buy alcohol, drink alcohol, or refuse to consume it. In anxiety states, nightmares often occur.

Appetite in the initial stage of remission is reduced, then it is restored, sometimes becoming increased.

With incomplete remission, the desire for intoxication periodically or constantly arises. The attraction is especially intense at the beginning of remission, then it weakens. Some patients avoid contact with drinking buddies and refuse to participate in the feast.

Along with conscious and intense attraction, there are other types of attraction. Thus, causeless mood swings may indicate an exacerbation of desire. This is also evidenced by dreams with “alcoholic” content. With extreme intensity of desire in the morning, after corresponding dreams, sensations reminiscent of a hangover arise (unpleasant taste in the mouth, slight trembling of the hands, sweating, tachycardia). These conditions are referred to as pseudo-withdrawal syndrome or “dry hangover” (literal translation of the English term “dry drunk”). Some researchers interpreted these conditions as delayed withdrawal syndrome.

Complete remission

Complete remission- this is abstinence from drinking alcohol and other psychoactive substances with the disappearance of the desire for intoxication, normalization of mood, sleep, appetite, and the absence of manifestations of delayed withdrawal syndrome. During complete remission, memory and attention impairments smooth out or disappear, performance increases or is restored, and former interests return.

Intermission They call complete remission, lasting at least a year, accompanied by complete restoration of social and family status, the absence of personality changes characteristic of alcoholism, and the disappearance of observed cognitive disorders. During intermissions that last a number of years, the restoration of all functions occurs with such completeness that, without having medical history data, it is difficult to imagine why alcohol dependence with signs of typical personality changes (degradation) was previously diagnosed.

During intermissions, a critical attitude towards the period of alcohol abuse is noted. In this way, intermissions differ significantly from incomplete ones. remissions, when criticism of drunkenness is often incomplete or absent.

Spontaneous remission

Spontaneous remission is called that arose without special therapeutic intervention. Therapeutic remission is considered to be remission that occurs after special therapeutic intervention.

A complete contrast between spontaneous and therapeutic remissions is hardly justified, since in both cases similar circumstances may be observed that forced patients to decide to stop drinking. Long-term intermissions, which occur after special therapeutic intervention and spontaneously, usually occur in people with similar characterological and personal characteristics.

At any stage of alcoholism, similar reasons for the onset of remission are known. One of the reasons may be a deterioration in physical condition with fears for one’s life. These may be myocardial infarction, convulsive seizures, a sharp worsening of the condition during a hangover, or severe somatic illnesses (hepatitis, pancreatitis).

Factors contributing to remission in alcoholism

Factors contributing to the onset of remission are known. These include the absence of pronounced alcoholic personality changes, accompanied by a loss of criticism of drunkenness. If there is a semi-critical attitude towards alcohol abuse or a complete criticism towards drunkenness, the occurrence of remissions is facilitated.

A sufficiently high level of social and labor adaptation, good family and marital relationships, higher education or high professional qualifications, as well as some personal characteristics contribute to the cessation of alcohol abuse.

Factors supporting remission

There are factors that support long-term abstinence from alcohol. These include the following: reasonable use of free time (hobbies, sports, family responsibilities), satisfaction from work, participation in public life, pleasure from acquiring new knowledge (reading), cultural entertainment, high significance of one’s social position, absence of psychological trauma, in including constant psychologically traumatic situations at home and at work, a complete severance of relationships with drinking buddies, support from loved ones to abstain from alcohol consumption, participation in self-support groups (therapeutic communities, including Alcoholics Anonymous groups), long-term contact with a doctor, psychotherapist, psychologist.

There may be a pre-relapse period between the end of remission and the onset of relapse. Pre-relapse, or a period of controlled alcohol consumption, is a period of time when the patient resumes drinking alcohol, but in small doses (not usually causing second-degree intoxication), which does not lead to days of heavy drinking and the appearance of withdrawal symptoms. This period of controlled alcohol consumption is usually short-lived, but sometimes extends for several years.

Published by: Goffman A.G. Remissions in patients with alcoholism // Questions of Narcology. – No. 4. – 2013. – P. 110-118.

Alcohol brings joy and sorrow.
Imaginary joy, real grief.
(A.V. Melnikov)

Remission(Latin remitto - let go, weaken). A stage in the course of the disease characterized by a temporary decrease in severity or weakening of psychopathological symptoms. A distinction is made between spontaneous remissions, caused by pathogenesis and occurring without treatment, and therapeutic remissions, occurring as a result of treatment.

The absence of exacerbations of pathological craving for alcohol with the patient’s successful functioning in all spheres of life (somatic, mental, social) means high-quality remission.

Ivanets N.N. defines the state of remission as dynamic, at different stages of which certain manifestations of the syndrome of pathological attraction, affective fluctuations, neurotic states, etc. are observed. Readiness for relapse basically reflects the insufficiency or instability of the patient’s compensatory capabilities at the clinical, personal and social levels.

From the various definitions of remission it is clear that a common component of this condition is abstinence from psychoactive substances without any serious psycho-emotional and somato-vegetative disorders. There is no unified classification of remissions, since this is a subjective state that does not have clear boundaries of manifestation and completion.

The prognosis of remission is determined by the premorbid state and degree of alcoholism, the nature of personality changes (motivation, degree of fixed behavior, affective disorders).

Spontaneous remissions more often occur in middle-aged people with minor personality changes when they show criticism of their condition at the end of stage 2 of alcoholism.

The formation of therapeutic remissions is determined by the quality of treatment and rehabilitation measures, including the timely start of anti-alcohol treatment, its completeness, regularity of maintenance therapy, improvement of microsocial conditions, and employment. Therapeutic remission is influenced by the severity of the disease, duration, stage, course, severity of biological and social consequences. (Ivanets N.N., 1980; Morozov G.V., 1970; Altshuler V.B., 1979).

In general, patients with alcoholism who experience long-term spontaneous or therapeutic remissions are distinguished not only by their characterological characteristics, but also by the poorly progressive course of the disease (no pronounced personality changes occur, no severe work and family disadaptation).

A.G. Goffman highlights reasons for remission, which are characteristic of any stage of alcoholism:

• deterioration of physical condition;
• disappearance of the desire for intoxication (third stage);
• disappearance of the euphoric effect of alcohol;
• deterioration of health after alcoholic excess (after 60 years);
• the presence of another mental illness (schizophrenia, endogenous affective disorders);
• influence of social factors (threat of losing family, job, social status, material well-being).

O.F. Eryshev et al. (1990, 1993, 2002) distinguish three stages of remission in alcohol dependence:

1. stage of remission (begins 1-2 weeks after stopping alcohol consumption and lasts from 3-4 to 6 months),
2. remission stabilization stage (lasts up to 1 year or more)
3. and the stage of formed remission with varying degrees of compensation (resistance to biological, psychological and social stress).

Each of these stages is characterized by certain factors that contribute to the occurrence of relapse. At the first stage, biological factors (psychopathological manifestations, affective disorders, dysphoria, anxiety, as well as the fact of treatment with psychotropic drugs) are of leading importance. To predict the stage of stabilization of remission, personal-psychological influences (personality changes, the severity of anxiety, the patient’s attitude to various types of therapy, his attitudes, etc.) are more significant. At the stage of established remission, factors of adaptation and attitudes (social) acquire important prognostic significance.

Tiganov A.S. states that the patient’s adherence to a regime of complete sobriety, that is, absolute abstinence from drinking alcohol, in the presence of signs of a partial exacerbation of the pathological craving for alcohol (“fluctuation” of symptoms) means a lower quality of remission.

A.G. Hoffman means a number of factors contributing to the onset of remission:

• absence of pronounced alcohol-induced personality changes;
• the presence of at least partial criticism of the disease;
• a fairly high level of social and labor adaptation, good family relationships;
• having higher education or high qualifications.

The combination of several factors is especially favorable.

Maintains remission duration the following factors:

1. reasonable use of free time (hobbies, sports, family responsibilities),
2. job satisfaction,
3. participation in public life,
4. enjoyment of cultural entertainment,
5. absence of psychological trauma (including constant psychologically traumatic situations at home and at work),
6. a complete break in relations with drinking buddies,
7. participation in the work of a self-support group (therapeutic communities),
8. long-term contact with a doctor, psychotherapist, psychologist.

Terence T. Gorsky highlights main internal events provoking relapse:

• 1) self-destructive or irrational thoughts,
• 2) painful emotions or painful “memories of unfulfilled things.”

Common external inciting incidents are situations of severe stress and tense relationships with other people. The relationship between a certain number of high-risk factors and the intensity of precipitating events determines whether or not a person will engage in unreasonable behavior.

With few high-risk factors in people's lives, it will take greater stress to trigger internal dysfunction.
The opposite is also true: with a larger number of high-risk factors, even a minor episode can trigger internal dysfunction.

Sometimes the harbingers of an internal breakdown appear due to an increase in the number of stress factors affecting the nervous system, previously undermined by prolonged use of drugs or alcohol. As internal dysfunction grows, the ability to navigate real life and manage its course decreases. A vicious circle starts.

Maintaining remission is a labor-intensive and multifactorial process involving all the resources of the individual. Those in recovery must be aware of their chemical dependency, analyze themselves daily, and address problems as they arise. The essence of recovery lies in spiritual growth, otherwise there is a great danger of failure. Recovery is a lifelong process.

Maintaining remission begins from the moment those in recovery realize that they have achieved freedom from their past. They no longer suffer from pain, guilt and shame regarding their vicious habit. They began to break free from self-destructive habits learned in childhood. They are ready to grow. From now on, the focus of recovery shifts to the search for a decent life.

Terence T. Gorsky identifies the main methods for maintaining stable alcoholic remission, as well as the conditions that ensure relapse:

1. Continuation of the recovery program.

Maintenance will never end. The disease is alcoholism, not “alcoholic” behavior (respectively, drug addiction, not “drug-addictive behavior”). The disease will almost disappear, but will never be cured. Without active and ongoing spiritual growth, most chemically dependent people will relapse into vicious thinking, inability to control emotions, and self-destructive behavior, regardless of how long they have been sober. These preconditions can create conditions for a breakdown.

2. The ability to live “day by day.”

The life of those in recovery is not free from difficulties, but addicted individuals have the skills to overcome their problems. 0din of the members of A.A. formulated this process this way: “Recovery is nothing more than a series of problems following one another. We are never free from problems. Recovery seems to me to be the replacement of one set of problems with another, easier, set of problems. I evaluate the degree of my recovery not how many problems I have, but how well I deal with them."

3. Continuous growth and development.

The human brain, not burdened with alcohol or other drugs, is focused on searching for the truth. Positive evolution for those in recovery means not having to constantly pay attention to the little things. Change [for the better] means consciously choosing a life in which there is reflection, the ability to control feelings and control actions. They admit their imperfections, but continue to strive to improve as much as they can within their capabilities.

4. The ability to effectively adapt to changes in life.

Every person changes throughout life. The first half of life usually refers to the time when people learn about the world around them and things outside themselves. In the second half of life, people mainly shift their focus to themselves, making a spiritual excursion of self-discovery.

During the maintenance stage, people begin to think about life outcomes. People with alcoholism anticipate the changes they will experience as they age. They embrace change.

Thus, we can identify the following factors for successfully overcoming and maintaining remission (according to Gorsky) - critical moments are overcome through consistent actions:

• "Recognize that problems exist."
  To admit means to be fully aware that a problem exists and you are faced with it.

• “Recognize that it’s normal to have problems.”
  You accept that it is normal that you have problems and that you are perplexed by them; there is no point in feeling shame or guilt about it.

• “Step back to see the real perspective.”
  Unable to solve problems alone, those in recovery risk making things worse by stumbling in the same place again and again. Those who make good progress in their recovery find a better perspective - they hand over their problems to a Power greater than themselves.

• "Accept help."
  This means the ability to turn to others for help. Those in recovery turn to a Higher Power (as they understand it; it does not have to be God, much less a deity of any particular religion) for courage, strength and hope and to other people for help and support.

• “Respond by changing behavior.”
  Problems don't just go away; they require our attention. Those in successful recovery act in positive ways to overcome obstacles.

Those in recovery with low quality sobriety (some of whom eventually relapse) try to circumvent critical moments by avoiding or denying the problem. This causes tension, which they also deny or blame on something outside themselves or someone else.

Often times stress triggers other compulsive behaviors such as overeating, workaholism, excessive exercise, hypersexuality, or codependent relationships. This behavior may reduce tension in the short term, but overall it weakens people. Addicts may feel better for a while, but it will all take its toll later.

The result of such a replacement of dependence on chemical substances with an obsession with something else is the development and aggravation of symptoms of tension.

Terence T. Gorsky dwells in detail on the signals and harbingers of a breakdown and builds psychotherapeutic work taking them into account. The prognosis of remission depends on the condition of fulfilling the factors of successful interaction. Analysis of psychological factors allows us to identify ways of psychocorrectional work.

The concepts of maintaining remission within the framework of the idea of ​​self-regulation help to understand the depth and complexity of the rehabilitation of drug addicted patients. According to M.F. Timofeev, an alcoholic patient develops an ethanol-dependent functional system, which is activated by both exogenous and endogenous releasing factors. The smell of alcohol is one of the most significant irritants for this system.

Within the framework of the proposed hypothesis, the problem of establishing remission and predicting the stability of remission of alcohol dependence can be considered as a process of self-organization of a dynamic ethanol-dependent system - the human body under conditions of alcohol deprivation, taking into account transformations of the golden ratio and Fibonacci numbers. The problem of establishing remission of alcoholism turns out to be related to the patterns of self-organization of the human body, the peculiarities of human nature as a system.

The degree of stability of remission is influenced psychological problem associated with the stereotype of an alcoholic. Within the framework of alcoholic pathology, a stereotype imposes psychological pressure in the microsocial climate and often provokes repeated excesses.

An alcoholic always appears in our imagination with a bottle of vodka or alcohol. Unshaven, scary and scourge-like. A socially undesirable image often leads to non-acceptance of oneself and rejection from others.

The alcoholic stereotype is associated with elements of conformism. The phenomenon of intragroup bias can also be conditionally attributed to stereotypes. It is expressed in a higher assessment of members of the group to which we ourselves belong, and a lower assessment of members of other groups. The effectiveness of this stereotype is expressed even when belonging to one or another group is determined by random factors, this includes the group of alcoholics. The tendency of alcoholic patients to reach for alcohol abuse is identified as a risk factor.

The problem of beer alcoholism is especially relevant. Many patients during remission drink beer, citing the fact that it is a low-alcohol drink and will not form an addiction. Doctors say that it is more difficult to fight the craving for beer than the craving for vodka. This attraction can be very obsessive.

Beer alcoholism creates a false impression of well-being. In public opinion, beer is almost not alcohol. After beer, fights, hooliganism and sobering-up stations are rare. But beer alcoholism develops unnoticed, and once developed, it immediately turns into a severe form. Beer alcoholism is a difficult to treat variant of alcoholism. With beer alcoholism, brain cells are affected more severely than with vodka alcoholism, so intelligence is more quickly impaired, and severe psychopathic-like changes are detected.

Vodka and wine, beer are sold on every corner without restrictions, at any price and around the clock, so this is the main provoking factor for relapse.

A tendency to worsen the condition (instability of remissions) develops in cases where the patient’s personality has a genetic burden, social vulnerability, residual organic defect, or comorbid pathology.

The transformation of the personality of patients with alcoholism during the period of remission occurs under the influence of a number of factors, the effectiveness of which will determine the well-being of patients:

1. psychotherapeutic and psychocorrectional measures,
2. drug therapy,
3. presence/absence of psychogenic situations in the microsocial environment of patients,
4. level of stress and frustration,
5. self-regulation.

Makarov Viktor Viktorovich claims that those suffering from alcohol addiction in remission become passionate hoarders and collectors. They can accumulate material values ​​or become followers of one of the many directions of understanding a healthy lifestyle, and engage in strengthening their own health and the health of those around them. Or they become ardent saviors of other addicts.

These and other substitution addictions allow patients not only to maintain remission, but also to fill their lives with new content and realize their potential.

With serious psychocorrectional work, patients with alcoholism during remission can acquire socially desirable, positive qualities that strengthen the structure of the “I-concept” and expand the potential of the individual. Remission forecast is determined by personal characteristics, hierarchy of values, mental qualities, as well as the level of self-organization of the individual and the degree of formed desire for treatment and changes, which in turn depend on the social environment of the patient.

Analyzing the problem of predicting remission, it can be noted that there are static (unchangeable) factors (for example, accentuations, fixed behavior) and dynamic factors (for example, the level of situational anxiety, motivation, self-esteem). In the opinion of Baranenko A.V. , It seems promising to identify precisely dynamic prognosis factors, as well as to find means and methods for their correction.

V.Ya. Semke notes that the absence of emotional tension and increased identification with one’s social status provide long-term therapeutic remissions.

Among factors contributing to alcohol abuse, most often called: negative influence of the immediate environment, family troubles, preserved alcoholic traditions.

The occurrence of relapses is directly related to a dysfunctional microsocial environment and “pressure” from the outside: returning to their previous environment after a course of therapy, the patient is subjected to persistent psychological treatment by his former drinking buddies.

There are no clear enough criteria to identify the initial symptoms of alcoholism, so it is extremely advisable during mass examinations to take into account the role of the “alcohol triangle” - decompensation in everyday life, decompensation at work (absenteeism), decompensation in a broad social sense (hooliganism). In each individual case, the cause of decompensation is alcohol abuse.

Knowledge of these relationships helps to successfully carry out preventive and rehabilitation work. Improvement and changes in the microsocial climate and the establishment of a new positive dynamic stereotype (developing healthy hobbies, studying, sports, art) are of great importance.

Identification of mental characteristics and psychodiagnostic examination in the early stages of remission make it possible to monitor the quality of life of patients and their psychological potential, create an individual work plan and identify risk factors for relapse. Trends in the mental sphere of patients determine the outcome and pattern of remission. In some cases, it is possible to achieve stabilization of the condition due to a timely and complete picture of the psychological state of the patients.

Taking into account the information received and qualitative analysis of the results, as well as specific knowledge about the emotional, personal sphere of patients, groups of risk and protective factors during the period of remission can be formulated. Factors can influence (favorably/negatively) a person, taking into account mental characteristics (sharpening of premorbid traits, temperament, level of development of cognitive processes.

The more combinations of factors that increase the quality of remission are present in an individual’s life, the greater the chance of success and a favorable outcome of difficulties associated with alcoholism. I.D. Darensky found that the combination of risk factors for developing a drug addiction disease has a geometrically progressive effect; in the presence of two risk factors, the risk of developing a drug addiction disease increases fourfold.

Mental characteristics in the formation of relapses of alcoholism are mediated only through socially determined mechanisms. In the remission of alcoholism, a special role belongs to social and socio-psychological factors, including the microsocial environment. Communication disorders consist in the fact that the social connections of a drug treatment patient are narrowed to contacts with members of the reference addictive group; eliminating contacts with this kind of group is the key to successful remission.

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Types of remissions
Spontaneous remissions are heterogeneous both in duration (they can be short-term and long-term) and in the reasons for their occurrence. In some cases, the reasons are visible to the naked eye, in others it is simply impossible to understand why a person stopped drinking. Let's consider options for spontaneous remissions.
1. Psychogenic remission
Typically, such remission is based on the psychological shock that an alcoholic experiences when he learns about his own “exploits” while intoxicated. For example, being very drunk, he chased his wife and children with a knife. The next morning, having woken up and sobered up, he does not remember anything and, at first with disbelief, and then with a feeling of shame, listens to the stories of eyewitnesses. If the information is truly shocking, the response may be to stop drinking. Or, let’s say, he got behind the wheel while heavily drunk, crashed the car, ended up in the hospital with injuries, lost his license, and incurred large expenses. After such events, the decision to start a new life seems quite natural. The factor restraining alcoholism here is the fear of losing control over oneself while intoxicated.
2. Somatogenic remission
A sharp deterioration in health can prompt sobriety. For example, people often stop drinking after a myocardial infarction. Decision-making is influenced not so much by the objective severity of the disease as by the drinker’s subjective assessment of the danger of the disease and the risk of drinking alcohol. Alcoholics often stop drinking after being hungover, usually on public transport, and experiencing an attack of lightheadedness with a feeling of shortness of breath, palpitations, and fear of loss of consciousness or death. The person understands that the attack is triggered by alcohol abuse. A strong fright experienced can make you forget about alcohol for a long time. By the way, if you try alcohol sooner or later, the attacks will recur.
3. Forced situational remission
In this case, the alcoholic does not strive for sobriety as a desired goal. He would willingly leave everything as it is, but external circumstances force him to temporarily give up alcohol. When the wife puts the question bluntly (“Either you stop drinking, or ...”), and the drinking man knows her tough temper and believes in the seriousness of the threats, he has to choose the lesser of two evils. Being in forced remission, alcoholics often cannot hide their dissatisfaction; they do not enjoy a sober life; they are irritated by any trifles. Forced remissions are not permanent. Another example of forced remission is when a brigade goes to work and prohibition is introduced for this period. Hard work distracts from alcohol, and abstinence is tolerated calmly, but upon returning home the drinking person goes into a rampage.
4. Post-intoxication remission
This is the most mysterious type of remission. Those around him are amazed by the event when an inveterate alcoholic, whom everyone has given up on, suddenly stops drinking. Precisely suddenly, because before this no significant changes occurred in the life of this person. His state of health remained the same, he had not experienced any shock experiences recently, his relatives had long ago given up fruitless attempts to set him on the right path. And it cannot be said that the man himself instantly became a convinced teetotaler. He just stopped drinking. Why? Surprisingly, even he himself cannot really explain why he suddenly stopped drinking. When he is offered a drink, he simply and calmly, and at the same time firmly, replies: “I don’t want to.”
This simple “I don’t want to” most accurately characterizes the situation - the person has lost interest in alcohol. Spontaneous remission of this type is based on the factor of excessive alcohol intoxication. At some point, the accumulating chronic alcohol poisoning reaches such a degree that the alcoholic is no longer able to continue drinking alcohol. Alcohol becomes tasteless, like wet bread, the smell of alcohol can cause discomfort, including nausea and vomiting. The craving for alcohol in such a situation may disappear for years. And then no one and nothing will force you to drink.
An example of short-term post-intoxication remissions are periods of sobriety in binge drinkers. With true binge drinking, at some point alcohol stops bringing relief, and attempts to drink end in vomiting. After quitting a binge, the body usually does not physically tolerate alcohol for several months due to severe poisoning. This time is not wasted, it is spent on accumulating strength for the next binge. When the body regains the ability to absorb alcohol, a new breakdown occurs.
5. Motivational remission
This is the best option of all possible remissions, this is a healthy lifestyle as a result of a conscious choice, this is sobriety by conviction. Motivational remission is preceded by a clear understanding of the threat of complete life collapse due to alcohol abuse. Usually a drinking person passes some critical point when he clearly realizes that the only way for him to live normally is complete sobriety. In accordance with this conviction, he organizes his life in such a way as to completely eliminate the possibility of a relapse into alcoholism; he protects his sobriety, like an elderly mother protecting her long-awaited first-born baby. A sober life makes a former alcoholic a completely happy person. Comparing his previous life with his present one, if there is one thing he regrets, it is that he did not stop drinking sooner. The stable motivation to maintain sobriety makes these remissions the most persistent. Remissions of 20, 30 or more years are only motivational. Confidence in the correctness of one's choice is a characteristic feature of motivational remission. This is fundamentally different from forced remission. I wish everyone reading these lines the most lasting motivational remission. Let this become your dream, which you will make into reality with your own hands.