Para muitos, cerveja, vinho e destilados estão associados a encontros sociais e momentos de diversão. No entanto, o álcool é um depressor do sistema nervoso central e pode alterar facilmente o comportamento, podendo levar, em alguns casos, à dor emocional e à desintegração física causadas pelo vício em álcool, conhecido popularmente como alcoolismo. Especialistas continuam a debater os benefícios e riscos do consumo de álcool, discutindo intensamente se a moderação ou a abstinência total é a melhor opção para quem enfrenta o alcoolismo.
O Transtorno por Uso de Álcool (TUA) é caracterizado por um padrão de consumo desordenado que resulta em sofrimento significativo. Entre os sintomas estão a síndrome de abstinência, dificuldade para cumprir responsabilidades diárias, conflitos em relacionamentos e comportamentos de risco que colocam a própria pessoa ou outros em perigo. De acordo com dados da Organização Mundial da Saúde (OMS) e estudos nacionais, estima-se que cerca de 5% a 10% da população brasileira sofra com o transtorno por uso de álcool, o que equivale a aproximadamente 10 a 20 milhões de pessoas.
Sinais, sintomas e diagnóstico
O alcoolismo, ou Transtorno do Uso de Álcool (TUA), é um padrão problemático de consumo de álcool que leva a sofrimento e comprometimento na vida diária. O diagnóstico, baseado no DSM-5, classifica o TUA em leve, moderado ou grave, dependendo do número de sintomas presentes. Os sintomas incluem consumo excessivo e incontrolável, dificuldade em reduzir ou interromper o consumo, tempo significativo dedicado ao consumo e recuperação, desejo intenso (craving), negligência de obrigações, afastamento social, tolerância e abstinência. A presença de dois ou mais sintomas em 12 meses indica TUA, com gravidade classificada em leve (2-3 sintomas), moderada (4-5) ou grave (6+). Sinais de alerta precoces incluem rotinas rígidas em torno do álcool, irritabilidade, oscilações de humor, deterioração de relacionamentos, declínio profissional e perda de interesse. A distinção entre consumo excessivo e alcoolismo é complexa, com uma “zona cinzenta” onde o consumo causa problemas sem atingir gravidade clínica. O TUA é subdiagnosticado devido a comorbidades, relutância em abordar o tema e negação do problema. O diagnóstico deve ser feito por um profissional de saúde.
Identificando o alcoolismo:
Identificar o alcoolismo, ou Transtorno do Uso de Álcool (TUA), envolve reconhecer padrões de consumo excessivo e comportamentos relacionados. O uso pesado de álcool é um indicador-chave, mas sua definição varia. O Instituto Nacional sobre Abuso de Álcool e Alcoolismo considera consumo excessivo mais de quatro doses diárias ou quatorze semanais para homens, e mais de três doses diárias ou sete semanais para mulheres. Já a SAMHSA define como consumo excessivo beber em excesso em cinco ou mais dias no mês anterior.
O Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) estabelece critérios para diagnosticar o TUA. Pelo menos três dos seguintes fatores devem estar presentes por doze meses:
- Aumento da tolerância ao álcool (exceto em casos de danos metabólicos, como no fígado).
- Continuar a beber apesar das consequências negativas.
- Passar muito tempo pensando, consumindo ou obtendo álcool.
- Sintomas de abstinência, como náusea, ansiedade, insônia ou nervosismo ao não beber.
- Incapacidade de parar de beber, mesmo com a intenção de fazê-lo.
- Consumir álcool por mais tempo do que o planejado.
- Abandonar atividades sociais ou hobbies que antes eram valorizados.
Esses critérios ajudam a identificar o TUA, uma condição que requer atenção e tratamento adequados.
Tipos de transtorno por uso de álcool
O NIAAA identificou cinco subtipos que podem ajudar você a entender melhor o transtorno por uso de álcool e como ele afeta diferentes indivíduos.
Eles incluem: 9
- Antissocial jovem: Pessoas com personalidades antissociais que desenvolvem o transtorno se encaixam nessa categoria. Elas geralmente começam a beber cedo para lidar com suas diferenças de personalidade.
- Adulto jovem: esta categoria inclui adultos jovens que desenvolveram a condição devido ao consumo excessivo de álcool.
- Funcional: Esta categoria compreende pessoas de meia-idade que normalmente são educadas e empregadas.
- Crônico grave: Pessoas nesta categoria apresentam sintomas graves de transtorno de uso de álcool. Elas geralmente têm problemas de saúde mental ou outros problemas emocionais, sociais ou financeiros.
- Familiar intermediário: Pessoas que têm familiares próximos que também apresentam a condição se enquadram neste subtipo.
Causas, fatores e genética
O transtorno do uso de álcool (TUA) é um vício complexo, resultante da interação entre fatores biológicos, psicológicos e sociais. A predisposição genética desempenha um papel significativo, contribuindo com cerca de metade do risco de desenvolver alcoolismo. Indivíduos com histórico familiar de problemas com álcool, predisposição a transtornos mentais como ansiedade e depressão, impulsividade e necessidade de maiores quantidades de álcool para sentir seus efeitos, apresentam maior vulnerabilidade.
Fatores psicológicos, como traumas e transtornos não diagnosticados, podem levar ao uso do álcool como mecanismo de enfrentamento. Experiências traumáticas na infância, como abuso e negligência, aumentam o risco de alcoolismo na vida adulta, pois o álcool pode ser utilizado para lidar com sentimentos de raiva, depressão, ansiedade, solidão e tristeza. A terapia pode auxiliar no enfrentamento desses desafios e no desenvolvimento de habilidades de enfrentamento saudáveis.
Fatores sociais também influenciam o consumo de álcool. A disfunção familiar e a cultura da bebida podem contribuir para o desenvolvimento do TUA. Além disso, a busca por recompensas, o alívio do estresse, as normas sociais e experiências positivas passadas com o álcool podem motivar o consumo inicial, que pode evoluir para o alcoolismo.
Efeitos do álcool
O álcool é uma substância de efeitos complexos, capaz de gerar tanto experiências positivas quanto negativas. A dependência do álcool pode levar a desafios significativos para a saúde mental e física.
Efeitos no cérebro
O consumo excessivo de álcool pode causar alterações cerebrais, afetando a memória, o aprendizado, o planejamento, a tomada de decisões e a regulação emocional. Cerca de metade dos indivíduos com alcoolismo apresentam problemas de pensamento e memória. No entanto, a recuperação pode levar a melhorias nessas áreas.
Criatividade
Embora controverso, alguns estudos sugerem que o álcool pode aumentar a criatividade, possivelmente por suprimir a memória de trabalho e estimular o pensamento “fora da caixa”.
Humor
O álcool influencia o humor de forma complexa. Inicialmente, libera endorfinas que podem causar sentimentos de euforia e energia. No entanto, o álcool é um depressor e pode levar a fadiga, inquietação e depressão. O consumo excessivo pode levar à dependência do álcool para regular o humor.
Consequências para a saúde
O consumo excessivo de álcool está associado a uma redução da expectativa de vida e a um maior risco de doenças cardiovasculares, como derrame, doença coronária, insuficiência cardíaca e hipertensão arterial. A relação causal entre álcool e problemas de saúde é complexa, e outros fatores de estilo de vida também podem influenciar os resultados.
Tratamento e Recuperação do Alcoolismo: Um Caminho Possível
A recuperação do transtorno do uso de álcool (TUA) é um processo multifacetado, com diversas abordagens disponíveis. Em alguns casos, a desintoxicação supervisionada é o primeiro passo, seguida por diversas opções de tratamento.
Abordagens de Tratamento:
- Programas de Apoio: Grupos como Alcoólicos Anônimos (AA) oferecem suporte entre pares e um programa de 12 passos.
- Terapia Cognitivo-Comportamental (TCC): Disponível presencialmente ou online, a TCC auxilia na mudança de padrões de pensamento e comportamento.
- Modelos de Redução de Danos: Abordagens como o Moderation Management visam reduzir o consumo em vez da abstinência total.
- Intervenções Clínicas: Entrevista motivacional e SBIRT (Triagem, Intervenção Breve, Encaminhamento e Tratamento) são ferramentas úteis.
Superando Barreiras:
- A vergonha e o estigma são obstáculos comuns, mas muitos programas abordam essas questões.
Reduzindo o Consumo por Conta Própria:
- Estratégias como educação, grupos de apoio, desafios de sobriedade e práticas de mindfulness podem auxiliar.
- A entrevista motivacional e o SBIRT também são opções eficazes.
Escolhendo um Centro de Tratamento:
- Busque centros com triagem rigorosa, tratamento integrado, acompanhamento pós-tratamento, prevenção de abandono, envolvimento familiar, equipe qualificada e credenciamento.
Apoiando um Ente Querido:
- Compreendendo a Negação: A negação é comum, com argumentos como “Eu bebo menos que meus amigos”.
- Intervenção Consciente: Pesquise sobre o TUA, escolha o momento certo para conversar, expresse preocupação e ofereça ajuda concreta.
- Auxiliando na Recuperação: Estabeleça limites, informe-se sobre o alcoolismo, trate comorbidades e busque apoio.
- Lidando com o Álcool: Converse abertamente sobre a presença de álcool e respeite a decisão do indivíduo em recuperação.
A recuperação é um processo contínuo, que exige paciência, compreensão e apoio mútuo.
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