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24-hour emergency medical assistance at home

24hrs a day - 7 days a week

Telephone: +371 23777300
E-mail:  centrs@atkariba.lv

About us

      Our medical company combines highly skilled and certified specialists in narcology, psychiatry and reanimatology, as well as certified nurses. Medical centre offers the following services:  
  • Home visits by a qualified anaesthetist
  • Anaesthetist services for healthcare establishments
  • Emergency care in cases of intoxication and poisoning
  • Pain relief therapy in community setting for acute and chronic pain,
  • We provide emergency medical assistance in the community for alcohol withdrawal cases, and if required provide assistance with admission to hospital
  • We offer highly skilled specialists in narcology in psychiatry for further planned follow-up treatment in the community
  • Specialists providing further outpatient treatment follow deontology principles and ethics. Treatment process is fully confidential. All our staff are certified professionals with years of experience in treatment of alcohol dependenceOur medical company combines highly skilled and certified specialists in narcology, psychiatry and reanimatology, as well as certified nurses. 
  • Mild or moderate alcohol withdrawal syndrome
  • Mild or moderate alcohol intoxication
Prolonged (several days) alcohol substance abuse can lead to development of alcohol withdrawal syndrome, where symptoms include hand tremor, anxiety, nausea, vomiting, diarrhoea and insomnia; in some cases in may lead to hallucinations. Alcohol withdrawal syndrome can be dangerous and provoke development of further psychotic (hallucinations), cardiogenic (hypertensive crisis, myocardial infarctions) and neurological complication. Therefore, sudden abstinence from alcohol can be very difficult and dangerous for people with tendency for alcohol addiction and underlying health problems. Mild alcohol withdrawal syndrome can often be deal with without medical assistance. In cases of moderate to severe withdrawal syndrome medical help, either in the community or in the hospital, is highly desirable – especially if patient has underlying health conditions.
Always remember that not every patient can benefit from home detoxification. If the doctor deems that treatment at home can be dangerous and ineffective, patient will be strongly advised to make use of hospital services as an inpatient.
      Our on-duty doctor will contact you shortly after receiving a phone call or a filled-in questionnaire (typically within 30 minutes after the phone call or within 12 hours after the questionnaire)
  • You should be ready to answer the following questions:
  • How old you are?
  • What is your weight?
  • Do you have any underlying health conditions?
  • Do you have known allergies to any medication?
  • How long have you used alcohol (or other psychotropic substances) for?
  • What and how much of it have you used?
  • When was the last time you have used it?
  • Do you consent to the treatment?
  • It is mandatory for the patient receiving the treatment to consent to it.
  • The doctor assesses the answers and decides on the suitability of home detoxification. The doctor has the right to refuse a home visit and forward the patient to the emergency medical assistance if client’s health condition is severe and requires hospitalisation
  • The home visit takes place:
  • In Riga – typically within 1 hour after the call back from the on-duty doctor
  • In areas surrounding Riga – typically within 1,5 hours after the call back from the on-duty doctor
  • In Latvia – typically within 2-4 hours after the call back from the on-duty doctor
  • In the Baltic states and the rest of EU – timescales agreed on a case-by-case basis
  • Patient’s physical examination
  • Drug therapy (IV fluids, oral or IV drugs)
  • Monitoring of patient’s condition
  • Counselling help to patient and their family to help dealing with dependency issues
  • Arrangement of further outpatient treatment.

Tests

A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

a. Recurrent alcohol use resulting in failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).

b. Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).

c. Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).

d. Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).

2. These symptoms must never have met the criteria for alcohol dependence.

DSM-IV Criteria for Alcohol Dependence:

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:

1. Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

b. Markedly diminished effect with continued use of the same amount of alcohol.

2. Withdrawal, as defined by either of the following:

a. The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).

b. Alcohol is taken to relieve or avoid withdrawal symptoms.

3. Alcohol is often taken in larger amounts or over a longer period than was intended.

4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.

5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.

6. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

7. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Alcoholism and Alcohol Abuse - Management

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

Alcohol dependence is a major problem in the EU.

Alcohol misuse is also an increasing problem in children and young people.

Approach to patient with suspected alcohol related problem

Be honest and non-judgemental.

Many patients drink in secret and may not want to discuss the issue.

The patient needs to accept that there is a problem before therapy can start. Detoxification should be discussed.

Information regarding local Alcoholics Anonymous groups should be offered.

Assessment

It is necessary to decide if the patient has an alcohol problem and, if so, whether the patient is a dependent drinker. The patient has a problem if he or she answers yes to any of the 'CAGE' questions (= C ut down, A nnoyed, G uilty, E ye-opener) and/or scores highly on the Alcohol Use Disorders Identification Test (AUDIT). Specialist advice should be sought if they score more than 15 on AUDIT assessment.

The Alcohol Use Disorders Identification Test

    1. How often do you have a drink containing alcohol?
        never (may skip to Questions 9 and 10 )
        Monthly or less
        2 to 4 times a MONTH
        2 to 3 times a WEEK
        Four or more times a week
    2. How many drinks containing alcohol do you have on a typical day when you are drinking
        1 or 2
        3 or 4
        5 or 6
        7 to 9
        10 or more
    3. How often do you have six or more drinks on one occasion
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    AUDIT-C Score (/12): 
    complete full questionnaire if score is 3 or more
    4. ?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    5. How often during the last year have you failed to do what was normally expected from you because of drinking?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    6. How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    7. How often during the last year have you had a feeling of guilt or remorse after drinking?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    9. ##Были ли вы или кто-нибудь другой ранены в результате употребления алкоголя##?
        No, never
        Yes, but not in the last year
        Yes, during the last year
    10. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
        No, never
        Yes, but not in the last year
        Yes, during the last year
    Score (/40) = 0
    Scores of 8 or more are considered an indicator of hazardous and harmful alcohol use.

Dependent drinkers are characterized by:

An overwhelming desire for alcohol. Drinking out of control.

A need for increasing amounts of alcohol. Withdrawal symptoms experienced.

Having little interest in other leisure activities.

Continuing to drink even when the harm being done is made clear.

These can be formally assessed using a validated tool such as the Severity of Alcohol Dependence Questionnaire (SADQ).

A comprehensive assessment should be carried out when a person scores 15 or more on the AUDIT. This should address a range of potential needs. A clinical interview should assess:

Alcohol use (consumption, historical and recent patterns of drinking), using validated clinical tools.

Level of dependence. Alcohol-related problems.

Other drug misuse (including over-the-counter medication).

Physical health problems. Psychological and social problems.

Cognitive function - although formal measures of cognitive functioning (eg the Mini Mental State Examination) are usually only performed if impairment persists after a period of abstinence or a significant reduction in alcohol intake.

Readiness and belief in ability to change.

If possible, information could also be sought from a family member or career.

This is one unit of alcohol:
        Half pint of regular bear, lager or cider
        1 small glass of wine
        1 single measure of spirits
        1 small glass of sherry
        1 single measure of aperitifs
    Each of these is more than one unit:
        Pint of regular beer, lager or cider (2 units)
        Pint of premium beer, lager or cider (3 units)
        Alcopop or can, bottle of regular lager (1.5 units)
        Glass of Wine (175 ml) (2 units)
        Bottle of Wine (9 units)

AUDIT-C

    How often do you have a drink containing alcohol?
        Never
        Monthly or less
        2 - 4 times per month
        2 - 3 times per week
        4+ times per week
    How many units of alcohol do you drink on a typical day when you are drinking?
        1 - 2
        3 - 4
        5 - 6
        7 - 9
        10+
    How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive
    Score: 


    This is one unit of alcohol:
        Half pint of regular bear, lager or cider
        1 small glass of wine
        1 single measure of spirits
        1 small glass of sherry
        1 single measure of aperitifs
    Each of these is more than one unit:
        Pint of regular beer, lager or cider (2 units)
        Pint of premium beer, lager or cider (3 units)
        Alcopop or can, bottle of regular lager (1.5 units)
        Glass of Wine (175 ml) (2 units)
        Bottle of Wine (9 units)

AUDIT - PC

    How often do you have a drink containing alcohol?
        Never
        Monthly or less
        2 - 4 times per month
        2 - 3 times per week
        4+ times per week
    How many units of alcohol do you drink on a typical day when you are drinking?
        1 - 2
        3 - 4
        5 - 6
        7 - 9
        10+
    How often during the last year have you found that you were not able to stop drinking once you had started?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    How often during the last year have you failed to do what was normally expected from you because of your drinking?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
        Not at all
        Yes, but not in the last year
        Yes, during the last year
    A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-PC positive
    Score: 0
    How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    How often during the last year have you had a feeling of guilt or remorse after drinking?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    How often during the last year have you been unable to remember what happened the night before because you had been drinking?
        Never
        Less than monthly
        Monthly
        Weekly
        Daily or almost daily
    Have you or somebody else been injured as a result of your drinking?
        Not at all
        Yes, but not in the last year
        Yes, during the last year
    Score: 
    • 0 – 7 Lower risk
    • 8 – 15 Increasing risk
    • 16 – 19 Higher risk
    • 20+ Possible dependence
Maximum score 7

    How often do you have a drink containing alcohol?
        Never
        Monthly or less
        Two to four times a month
        Two to three times a week
        Four or more times a week
    How many drinks containing alcohol do you have on a typical day when you are drinking
        1 or 2
        3 or 4
        5 or 6
        7 to 9
        10 or more
    Have people annoyed you by criticizing your drinking?
        Not at all
        Yes
    Have you ever felt bad or guilty about your drinking?
        Not at all
        Yes
    Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang-over?
        Not at all
        Yes

Score: 
      Please recall a recent month when you were drinking in a way, which for you was fairly typical of a heavy drinking period
Section 1

    I wake up feeling sweaty
        almost never
        some-times
        often
        nearly always
    My hands shaking first thing in the morning
        almost never
        some-times
        often
        nearly always
    My whole body shakes violenty first thing in the morning, if I don't have a drink
        almost never
        some-times
        often
        nearly always
    I wake up absolutely drenched in sweat
        almost never
        some-times
        often
        nearly always
    I dread waking up in the morning
        almost never
        some-times
        often
        nearly always
    I am frightened of meeteng people first thing in the morning
        almost never
        some-times
        often
        nearly always
    I feel on the edge of despair when i wake up
        almost never
        some-times
        often
        nearly always
    I feel very frightened when I wake up
        almost never
        some-times
        often
        nearly always
    I like to have a morning drink
        almost never
        some-times
        often
        nearly always
    I always gulp down my morning drink as quickly as possible
        almost never
        some-times
        often
        nearly always
    I drink in the morning to get rid of the shakes
        almost never
        some-times
        often
        nearly always
    I have a very strong craving for a drink when I wake up
        almost never
        some-times
        often
        nearly always
    I drink more than ¼ bottle of spirits or 4 pints beer or 1 bottle of wine per day
        almost never
        some-times
        often
        nearly always
    I drink more than 1/2 bottle of spirits or 8 pints beer or 2 bottles wine per day
        almost never
        some-times
        often
        nearly always
    I drink more than 1 bottle of spirits or 15 pints beer or 4 bottles of wine per day
        almost never
        some-times
        often
        nearly always
    I drink more than 2 bottles of spirits or 30 pints beer or 8 bottles of wine per day
        almost never
        some-times
        often
        nearly always

Section 2

For the next 4 questions:
Imagine you have been abstinent for a few weeks, then drink heavily for a couple of days

    The morning after would you start to sweat?
        Not at all
        Slightly
        Moderately
        A lot
        I haven't been abstinent for that long, so it's hard to say
    The morning after would your hands shake?
        Not at all
        Slightly
        Moderately
        A lot
        I haven't been abstinent for that long, so it's hard to say
    The morning after would your body shake?
        Not at all
        Slightly
        Moderately
        A lot
        I haven't been abstinent for that long, so it's hard to say
    The morning after would you be craving a drink?
        Not at all
        Slightly
        Moderately
        A lot
        I haven't been abstinent for that long, so it's hard to say

Score: 
• A score of less than 3 indicates no alcohol dependence
• A score between 4 and 20 indicates mild dependence
• A score between 20 and 30 indicates moderate dependence
• A score over 30 indicates severe dependence
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00:00 - 24:00

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