Nermana MEHIĆ-BASARA (Sarajevo)

DRUŠTVENI I MEDICINSKI PRISTUP ALKOHOLIZMU NEKAD I DANAS

Kroz razli?ite istorijske epohe, a u zavisnosti od društvenog uredjenja i moralnih principa življenja, alkohol je za ?ovjeka imao razli?ita zna?enja, od misti?no-religioznog, iscjeliteljskog, hedonisti?kog pa do štetnog i po zdravlje opasnog. Ako se zna da su njegove osobine vezane za podizanje raspoloženja, sedaciju i relaksiranje, onda ne ?udi što se i danas konzumiranje alkohola smatra društveno prihvatljivim i poželjnim u razli?itim obi?ajima svakodnevnog života.
Iako se za alkohol može re?i da je naj?eš?e upotrebljavana supstanca kako u mentalno zdravih, tako i u mentalno bolesnih, ozbiljniji stru?no-medicinski interes za bolest izazvanu njegovom duževremenom zloupotrebom se javio tek krajem devetnaestog stolje?a.
Od tada do danas, odnos društva prema onima koji piju i/ili "pijanicama" se mijenjao od ignorisanja, osude, nedostatka razumijevanja pa do prihvatanja i zaštite. Bilo o kojem odnosu društvene zajednice prema alkoholi?arima da se radi, osu?uju?em ili zaštitnom, sigurno je da je društveno-politi?ko ure?enje imalo zna?ajan uticaj na kreiranje zdravstvene politike prema ovoj kategoriji bolesnika.
Po?eci organiziranog lije?enja ovisnika o alkoholu u BiH su se javili ranih 60-ih godina prošlog vijeka, a sa formiranjem Zavoda za alkoholizam i druge toksikomanije, 1977. god., zdravstvene ustanove koja je bila na republi?kom nivou, po?inje era modernog psihoterapijskog i socioterapijskog pristupa kojim su bili obuhva?eni svi aspekti alkoholom poreme?enog sistema ovisnika.
Period rata 1992.-1995. god., je privremeno destabilizirao, ali ne i prekinuo rad ove ustanove, koja je i u nevjerovatnim uslovima održala kontinuitet rada.
Sa prestankom rata 1995. god., u BiH je zapo?eo proces reforme mentalno-zdravstvenog sistema u smislu transformisanja institucionalne psihijatrije ka "psihijatriji u zajednici".
Ovaj model, kojeg je Zavod od po?etka podržao i prihvatio, predstavlja uvezivanje raznih sektora u funkcionalnu mrežu institucija sa ciljem postizanja najvišeg nivoa preventivno-terapijskog djelovanja u zajednici.
Uz postoje?i terapijski koncept zasnovan na principima socioterapijskih i rehabilitacionih programa, koji je u osnovi kompatibilan sa reformskim principima mentalnog zdravlja, Zavod je postavio smjernice budu?e strategije svog rada. U skladu s tim, tretman ovisnika o alkoholu je baziran u vanbolni?kim specijalisti?ko-konsultativnim službama kao što su savjetovališta, dnevna bolnica, klubovi i specijalni centri za psihosocijalnu rehabilitaciju u zajednici.
Klju?ne rije?i: alkoholizam, tretman, društvena zajednica, reforma.


SOCIAL AND MEDICAL APPROACH TO ALCOHOLISM, THEN AND NOW

Through different historical epochs, depending on the social organization and moral principles of life, alcohol is for the human being had different meanings, from a mystical-religious, healing, hedonistic to the harmful and hazardous to health. If it is known that its properties are related to the improvement of mood, sedation and relaxation, it is no wonder that today, alcohol is considered socially acceptable and desirable in a variety of customs of everyday life.
Although for the alcohol can be said that it is the most commonly used substance in both the mentally healthy, as well as the mentally ill, serious professional interest in medical illness caused by its long-term abuse occurred at the end of the nineteenth century.
The attitude of society towards those who drink and/or "drunken" was changed since then, from ignoring, condemnation, lack of understanding to the acceptance and protection. Any relation of the community toward alcoholics whether it is a condemning or protective, it is certain that the socio-political system had a significant impact on the creation of health policy toward this category of patients.
The beginnings of organized treatment of alcohol addicts in B&H started in the early 60 of the last century, and with the founding of the Institute for Alcoholism and Substance Abuse in 1977, medical institution, which was at the republic level, begin the era of modern psycho and sociotherapeutic approach which included all aspects of alcohol-impaired system of addicts.
The period of the war 1992 - 1995 temporarily destabilized, but not stopped the work of this institution, which in incredible circumstances kept the continuity of activity.
With the end of the war in 1995, B&H started the mental-health reform process in terms of transforming the institutional psychiatry to "community based psychiatry".
This model, which the Institute from the beginning supported and accepted, represents networking of various sectors in the functional network of institutions in order to achieve the highest levels of preventive-therapeutic work in the community.
With the current therapeutic concept based on sociotherapeuthic principles and rehabilitation program, which is basically compatible with the principles of mental health reform, the Institute has set guidelines for future strategies of work.
Accordingly, treatment of alcohol abuse is based in outpatient specialist consultative services such as counseling centers, day hospitals, clubs and special centers for psychosocial rehabilitation in the community.
Key words: alcoholism, treatment, community, reform

Mr. med. sc. dr. Nermana Mehi?-Basara, neuropsihijatar, JU Zavod za alkoholizam i druge toksikomanije Kantona Sarajevo, 71000 Sarajevo, Bosna i Hercegovina