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Yıl:2010; Cilt: 3; Sayı: 1>> Özet
TAM METİN
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2010;3(1):28-38
Alkol ve Madde Bağımlılığında Tedavi ve Genel Ilkeleri
Z Arıkan
Gazi Üniversitesi Tıp Fakültesi, Ankara
Bağımlılığın geçmişteki ahlaka dayalı değerlendirmeleri 20. Yüzyılda değişim göstermiş, yüzyılın başında bağımlılık kişilik zemininde bir zaaf olarak görülerek ahlaki görüş yumuşatılmıştır. Bağımlılık sendromunun kişilik yapısına ikincil olmadığının anlaşılması ve ayrı bir klinik sendrom olarak tanımlanması bu alandaki çalışmaları hızlandırmış ve aynı zamanda da özgül tedavi yöntemlerinin gelişmesine ön ayak olmuştur. Bağımlılık sendromlarının tedavisi ile ilgili çeşitli modeller ortaya atılmış ve uygulamalar başlatılmıştır. Bu tedavi modellerinin hangisinde daha iyi sonuç alındığı ve tedavi uyumunun nasıl olduğuna ilişkin birçok çalışma vardır.Tüm tedavi modellerinde 3 aşama vardır. Bunlar şunlardır: 1. Hastanın yoksunluk belirtileri, fiziksel ve ruhsal sorunlarına yönelik müdahaleler yapılır. Bu dönemde hasta ve yakınları sorunu konusunda eğitilir, hastanın yakınmaları gerekirse ilaç ile giderilir ve davranış modifikasyonları uygulanır. 2. Hastanın ayık yaşama uyum sağlaması için gerekli bilgi ve beceriler geliştirilmeye çalışılır. 3. Nüksün önlenmesi için gerekli psikoterapötik yaklaşımlar ve ilaç tedavilerinden yararlanılır. Bu aşamada destek gruplarından da [adsız alkolikler (AA), adsız narkotikler (NA) vs] yararlanılır. Tedavi modelleri hem farmakolojik yöntemleri hem de psikoterapötik yöntemleri kendine göre birleştirerek çok yönlü yaklaşımları sergilemektedirler. Kendine yardım grupları da burada önemle yerlerini almaktadır.
Alcohol and Substance Dependence, Management and General Principles
The moral related association of dependency in the past has been changed in the early [year]s of XX. th century and dependency has been accepted mostly as a weakness in personality. The generally accepted concept that dependency syndrome is not secondary to personality but a different clinical syndrome, has been accelerated the studies in this area and also leaded to improve spesific management strategies and various treatment modalities have been brougt up and clinically applied. There are many studies looking for the success and rate of tolerance of these treatments. All treatment models have three steps. 1. Interventions for the symptoms of the abstinence, physical and psychologic problems are done. In this period the patient and the close relatives are educated about the issue. If it is needed medication can be used to relieve the symptoms and behavioral modifications are done. 2. Necessary knowledge and skills are given to adapt the patient to sobriety 3. Psychotherapautic approaches and drug therapies are used to prevent recurrence. In this step benefit of supporting groups such as AA, NA etc is significant. Treatment models by merging pharmacologic and psychotherapautic methods display many sided approaches. Self helping groups have also an important role in these models

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