Dipsomania

DIPSOMANIA (from the Greek dipsa-thirst and mania-madness), an irresistible craving for alcohol, a binge drinking episode that occurs in certain people from time to time without any apparent external causes. An attack of binge drinking usually begins amidst what appears to be complete health with a disturbance of mood; at this time some feel intense thirst, while others note headaches, dizziness, etc. Soon, and sometimes simultaneously, the desire to 'drink' appears and quickly grows. The patient tries to fight this need, but the strength for such a struggle does not last long. During the attack, the patient mostly does not eat, barely sleeps, yet remains on his feet for a long time without acute signs of intoxication. Only at the very end does his endurance weaken, trembling appears in the limbs and throughout the body, there is an unsteady gait, diarrhea and vomiting. The binge ends abruptly, the patient's mood returns to equilibrium, and he returns to his usual activities. Dipsomania usually begins in the third decade of life, with women suffering from it comparatively rarely (for details see Alcoholism). Nosologically, dipsomania does not represent a specific disease, but only a symptom complex. Kraepelin, Gaupp, Aschaffenburg and others tried to prove that dipsomania is merely a form of epilepsy, while other authors (Rarrepheim, Rybakov, V. Osipov) connect it with circular psychosis. Osipov observed several attacks of dipsomania under conditions where it was impossible to obtain alcohol, and it turned out that they proceeded as typical circular depressions. Finally, cases have been described where dipsomania developed after head injuries or other gross exogenous influences, as well as in arteriosclerotics, chronic alcoholics (as a stage following habitual alcoholism - Sukhanov) and others. Apparently different authors use the term dipsomania in different scopes, some even speak of 'pseudodipsomania,' giving this word also each its own special meaning. In any case, exogenously caused attacks of binge drinking hardly can be classified as true dipsomania. On the contrary, there is no reason to deny the possibility of equivalent development of dipsomania instead of epileptic seizures or circular phases. Most often, however, dipsomania is simply a periodic form of manifestation of the pathological craving of certain psychopaths from the epileptoid group for artificial excitation, a craving that is a direct consequence of mood disorders. It is necessary to recall that dipsomania is best characterized by 'primary, periodically recurring, purely endogenous mood disorders with secondary alcoholic excesses' (Gaupp). The prognosis in dipsomania is not always poor: sometimes with age, if the patient does not develop chronic alcoholism, the attacks of dipsomania become less frequent and even completely disappear. In treatment, preventive measures are most important: complete elimination of alcoholic beverages from the patient's daily life and a proper work regimen. Treatment is divided into two parts: 1) fighting the already developed attack and 2) re-education of the dipsomaniac's personality. It is best at the very beginning of a binge (and if possible even during the prodromal period) to place the patient in a medical institution - a special sanatorium for alcoholics or a psychiatric hospital. In case a considerable period of time has passed since the beginning of the attack, the question arises of how to withdraw alcohol: abruptly or gradually. As an objection against abruptly breaking off the binge, the possibility of developing an attack of delirium tremens or collapse is sometimes mentioned. Although cases of delirious outbreaks following rapid alcohol withdrawal have been observed in binge drinkers, in hospital conditions these outbreaks proceed relatively easily and are quickly eliminated. As for the danger of acute cardiac failure, it is usually exaggerated. Be that as it may, at present the method of gradual withdrawal with slow dose reduction is practiced extremely rarely; only in exceptional cases with threatening cardiac weakness is the patient given small doses of alcohol (15.0-20.0) several times a day in the days immediately following withdrawal. It is much more reasonable to prescribe large doses of hypnotics during the period of acute phenomena, preferably from among narcotic fatty series substances (paraldehyde is best, then chloral hydrate), which一方面 alleviate the general condition of dipsomaniacs, subjectively seemingly even replacing the absent alcohol for the patient, and另一方面 reduce the phenomena of psychological excitement, conserve the physical strength of the patient and give rest to his cardiovascular system. The abrupt treatment is tolerated very well, and after just a few days, relatively good health returns. Subsequently, a more or less long-term strengthening treatment accompanied by psychotherapy is indicated. Of the latter methods, hypnosis is found to be very appropriate in most cases. No less important is the carrying out of the second part of treatment - educational - also within the walls of the sanatorium. This part of treatment should aim to strengthen the patient's will, create in him a habit of work and develop interests that could (at least to some extent) replace or at least weaken his passion for intoxication. A dipsomaniac should be discharged from the sanatorium only after a firm attitude toward abstinence has been established in him, i.e., practically - not earlier than 2-3 months of his stay in the institution.