Therapeutic apheresis in addiction

Underlying diseases of this profile is a psychological dependence – addiction to alcohol, drugs or certain pharmacological or toxic substances (substance abuse). However, in the body thus arises also some kind of metabolic processes violation, the normal flow which is impossible without the inclusion of the substances or their derivatives. Depriving them induced severe withdrawal syndromes, often with fatal outcome. In all cases there is a severe mental disorders – hallucinations, delusions, phobic state, often pushing these persons to the crime.

Alcoholism (alcohol disease) is the most common type of addiction. According to various statistical studies of them suffer from 4 to 45% of the population. It is believed that dose daily use of alcohol (in terms of absolute alcohol) 20-60 grams for men and 10-40 grams for women are relatively safe, but the real need of the organism in alcohol does not exceed 10 grams per day, and it is entirely covered at the expense of endogenously produced alcohols, like most of our “smaller brothers” – animals, which none, even the most careful owner, does not consider it necessary to add to their daily diet of any alcohol additives.
However, exceeding even this moderate level increases the risk of toxic lesions, especially at the level of individual failure ferment of alcohol dehydrogenase that breaks down alcohol. With an excess of alcohol included catalase and monooxygenase oxidation with activation of peroxides, oxidation of lipids and the overproduction of acetaldehyde, and if there is a non-wealth also acetaldehydrogenase (ferment that destroys the last one), there is the onset of acute or chronic alcohol intoxication. Particularly dangerous cheap liquors alcohols from non-food materials (hydrolysis or petroleum distillates) which contain toxic impurities – aldehydes, ketones, ethers, methanol, propanol, acids, etc. [Moiseyev VS, cucumbers, PP, 1997].

And yet, despite the danger of a direct toxic damage of the body with occasional admission of high doses of alcohol, deceit disease  is getting used to it, that prolongs this toxemia and causes even more severe health problems to the development of fatty and protein liver disease with the outcome of cirrhosis, damage to other organs.
At the moment there is a tendency to weighting of alcoholabstinence syndrome. At the same time appointed of drugs often lead to various side effects and aggravate the condition of patients. There for It this warranted inclusion in the protocol binding membrane plasmapheresis procedures at admission of patients in a state of alcohol chronic intoxication and at the peak of acute withdrawal disorder (second or third day, and on the 10th day of his treatment).

In addition, chronic alcohol intoxication there is accompanied by immuno-suppression. At the same time, even ordinary respiratory infections are more malignant, more difficult runs also peritonitis, which requires emergency detoxification using plasmapheresis [Loktin EM et al., 2010].
Drugs and other toxicants are even more foreign to the body, and also contribute to the development of severe chronic endotoxemia. In the pathogenesis of diseases of the central nervous system under the influence of the drug plays an important role activation and destruction of catecholamine release – norepinephrine and dopamine in the presynaptic level structures. In this case, length-tional drug use leads to a deficiency of these catecholamines. However with abrupt cessation of drug reception level of decay comes to normal, but their synthesis is still accelerated, leading to a significant increase in the level of dopamine in the brain. Excessdopamineassociated withneuropeptides, becoming moretoxic properties[Morozov G.V. et al. 1981]. In opium addictionviolatedalsolipid peroxidationwiththe inhibition of antioxidant defense system[Chirco al., 1994].

Recentyears have been characterizedby steadygrowth in the numberof patients suffering
fromalcoholism and drug addictionwith all the ensuingheavysocial and demographicconsequences. But thetragedy of the situationis not so muchin a constantincrease in the numberof personsinvolved intheseaddictions, asthe inability toachieve a stablerecovery.It is promotednot onlylimited possibilitiesof drug therapyandvarious psychotherapeuticeffects, but significantmetabolicdisordercausing the accumulationin the bodynot onlyexogenoustoxicants, but also secondaryand no less toxicpathologicalmetabolitesthat supporta persistentdesireevenin remission. Here  are also the violation ofneurotransmitterexchangewith shiftslevelsof endorphinsand otherneuropeptides, catecholamines andserotonin.
Violations ofthe corticalactivityaswell asthe adrenal medullaleadto disordersof protein, mineraland carbohydrate metabolism. Prolonged exposure toexogenous and endogenoustoxicantskeepsin constant tensionenzymesystem in the liver, lipid peroxidationandproteolysis, immune defense mechanisms. Chronicendotoxemialeads toexhaustion,and thensuppressdetoxification systemswith the emergenceof a number ofvicious circlesto break out ofwhich the bodyis no longer able. The situation is exacerbatedas viralhepatitis,carried forwardby manydrug addicts,orchronic hepatitisduring long-termalcohol dependence.

An important rolein the formation ofdependence todrugsplaysalso immunologicaldisorders. Thus, inpatients with opiumaddictiondiscoveredsuppression of T-cell immunity and increasethe functionalactivity of B-lymphocytes, which are producers ofantibody. AppearIgM-antibodies to morphinewithboosting ofcirculated immune complexeswhich may havea damaging effectnot only on thestructure of the centralnervoussystem, but alsoto other organs.It is believed thatthe formation of antibodiesoccurs in the presenceof even small amountsof antigen, but growing up constantly. In addictionsuchasmorphineactsantigenassociated withplasma proteins[Malin D.I.,1997].

Therefore, up to the beginning oftreatment, manypatients there areable tonot onlysevereexogenous, but also endogenoustoxicityandimmunosuppression. Even in casesof effectivepsychotherapeutics impactwith the elimination ofpathologicaldrivehealth statusof such a personremains extremelyupset.In addition,without removing thephysical addictionallimpacton the psyche ofthe patientdo not providea lasting effect.
Treatment ofthese diseasesisextremelycomplex problem, sinceinthe usualtherapeuticmeasures, "coding", "stitch" and other methods there are practicallyineffective.Since thebodybeing woundmetabolism disorder, remainsan irresistibleattraction todrugsand removingpsychological dependencedoes not exempt fromthe physical. Elimination ofphysical dependence, in turn,alsonot releasefrommental. Memories ofthe resulting"high"irresistiblypushes, even against the will, torelapse.

Under these conditions,onlythe consistent application ofefferent therapyand psychotherapycancontribute to the success[Chirco al., 1994; al.,1995].Plasmapheresis,asat the heightof withdrawal symptoms(2-3 day after the drugs cancellation) and in the finalstages(5-6 days), contributes to a morerapidreductionalgic, somatic vegetativeandpsychopathological symptomsof withdrawal syndrome[Malin D.I.,KostitsinN.V.,1998].Whereinthere is usedalsohemosorption  (hemocarboperfusion) [Kirkovski VVet al.1997].

Most effective and safestmethod provedcontinuousmembrane plasmapheresisinthe treatment of acutepsychotic statesandabstinence, especially in severeconcomitantdisorders of the cardiovascularsystem, lungdisease, liver and kidney pathology [Strelets al., 1999]. Plasmapheresisparticularlyindicated for patientswith opioid addictionin casesof increasinglevels ofIgM-antibodies and the CICof 2or more times [Gamaleja N… al.,1995].Therapeutic apheresisisindicatedalsofor the relief ofreactionswhile takingnaltrexonein patientsabusingfentanylderivatives("methadone") –oppressionconsciousness,bradipnoe, bradycardia, and hypotension. Thegreatesteffectatthesametimeprovidedhemosorption.
Given the possibility of performing of plasmapheresis sessions in a day, it is advisable to supplement this by introducing an additional therapy of hemosorption session on the second day of treatment (between the first and second sessions of plasmapheresis). Then, at the crucial first period of treatment the patient will be practical continuously perform cleansing the body of pathological metabolites, and subsequently breaks one day will have it easier to endure [Voinov V.A., 1999].

Additionally, there are uses various mechanisms of action of these methods. In particular hemosorption there is more effective in the activation of the sympathetic division, and plasmapheresis – parasympathetic part of vegetative nervous system. Infusion of ozonated solutions of sodium chloride enhances the detoxifying effect of therapeutic apheresis in these patients.
In addition to removing themselves narcotic drugs and their derivatives, therapeutic apheresis helps to normalize also other metabolic disorders and endogenous toxemia, which are constant companions of these states. There are arrive disorders of dopamine regulation. For example, blood levels of dopamine over 180% there are correspond to the hard abstinence, and at 250-300% may develop delirious state. Often, these are patients have also the accompanying severe organ failure - the liver, kidneys, myocardium, central and peripheral nervous system, secondary toxic immunosuppression. Therefore, in complex of therapeutic apheresis methods it is necessary to include quantum immune correction and indirect electrochemical oxidation of the blood. Only then it come the more qualitative rehabilitation of patients, restoring their health and performance. 
Most often in patients with drug occurs infection with hepatitis B, C, and even HIV [Walsh N., Maher L., 2013; Bonar E.E. et al., 2014; Wiessing L. et al., 2014], which is in itself an indication for plasmapheresis to prevent the development of chronic hepatitis. In the case of the upcoming surgery in patients with heroin addicts also suitable active detoxification [Sivolap Y.P., et al., 1995].
Our little experience in treating patients with substance (19) and alcohol (27) abuse shows a relatively high efficiency of the complex course of the therapeutic apheresis and immune correction. In all cases, up to the end of the course there was  the gradual elimination of symptoms of withdrawal syndrome and occurred normalization and somatic-vegetative disorders – the restoration of normal sleep, appetite, psycho-emotional status. Most of the patients at the end of the course passed to specialists for subsequent psychotherapy.

The appearance in recent years of sufficiently effective Russian plasmafilters, simplicity and safety methods of membrane plasmapheresis and even hemosorption on a portable device Hemofenix [Voinov V.A., 2010], given the possibility of therapeutic apheresis in the broadest network of medical institutions, up to the municipal level. In addition, such procedures can be successfully carried out even on an outpatient basis (within a day hospital). This opens up the possibility of a wider use of therapeutic apheresis  in Addiction.


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