Alcoholism

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A drawing from 1883, showing the problems of alcoholism; the drawing is called at her feet

Alcoholism is the medical condition of people who often drink too much alcohol. Some people who suffer from alcoholism feel that they have to drink alcohol, even when it causes health and social problems. Alcoholism means addiction to alcohol. People who suffer from it are called alcoholics. As the condition goes on, those who suffer from it change their habits: obtaining alcohol and consuming it becomes more important. Very often, other interests disappear. Many alcoholics do not think they have a problem with drinking alcohol. With time, they better support bigger quantities, and their personality changes.

Medically, there are two different conditions:

  1. Drinking too much alcohol, and seeing the negative effects of this behaviour
  2. Being dependent on alcohol

According to the World Health Oranization, there are approximately 140 million people with alcoholism worldwide.[1][2] In the United States and Western Europe, ten to twenty percent of men and five to ten percent of women at some point in their lives will meet criteria for alcoholism.[3]

Alcoholism is called a "dual disease": There are both mental and physical components.[4] The biological mechanisms that cause alcoholism are not well understood. Social environment, stress,[5] mental health, family history, age, ethnic group, and gender all influence the risk for the condition.[6][7] Consuming large amounts of alcohol produces changes in the brain's structure and chemistry. Some changes occur very early, even when small amountas of alcohol are consumed, in a short time. Examples are tolerance and physical dependence. Because of the changes, it is very difficult for an alcoholic to stop drinking, as this would result in alcohol withdrawal syndrome if the person stops.[8] Alcohol damages almost every organ in the body, including the brain. Chronic alcohol abuse can cause both medical and psychiatric problems.[9]

Alcoholism is a condition with a social stigma. As a result, people suffering from it, avoid being diagnosed or treated, as this may be shameful, or have social consequences. The evaluation responses to a group of standardized questioning is a common method for diagnosing alcoholism. These can be used to identify harmful drinking patterns, including alcoholism.[10] In general, problem drinking is considered alcoholism when the person continues to drink despite experiencing social or health problems caused by drinking.[11]

Stages[change | edit source]

The drunkards progress, an illustrationfrom 1846: The stages:
Step 1. A glass with a friend.
Step 2. A glass to keep the cold out.
Step 3. A glass too much.
Step 4. Drunk and riotous.
Step 5. The summit attained. Jolly companions. A confirmed drunkard.
Step 6. Poverty and disease.
Step 7. Forsaken by Friends.
Step 8. Desperation and crime.
Step 9. Death by suicide.

Generally, there are different stages to alcoholism.

  1. Drinking alcohol starts in a social setting, on occasion, together with friends. With time progressing, the potential alcoholic feels relieved when he drinks. This relief is usually attributed to the situation, or the people, not the alcohol. With the time people seek out occasions where "social drinking" occurs. People also develop tolerance. This means over time, they need a larger quantity of alcohol to get the same feeling of relief.
  2. In the next phase, the drinker has problems remembering things. The alcoholic may be completely normal, but they cannot remember certain events, or how certain events occurred. This is independent of a feeling of drunkenness. The patient also begins to see that he drinks more alcohol than other people. For this reason, drinking is often done in secret. The first glasses are consumed more quickly; this is done so as to not stand out, and to get the feeling quicker. There are feelings of guilt; the patient tries to avoid talking about alcohol for this reason.
  3. The alcoholic is no longer able to control his drinking. He may not drink for a long time, but once he gets a tiny bit of alcohol, he is unable to stop until he is either drunk, or too sick to continue; this is called craving. The patient thinks this is just a lack of resolve, but in truth he is dependent on alcohol. Excuses are found for the drinking habit. To the patient it is important to be able to explain, because except for alcohol, there are no other solutions to problems. Because of this behaviour there are problems with the rest of his family. There are whole families who get isolated, because they try to hide the drinking problem of a family member. This is called co-dependence.

Treatment options[change | edit source]

The overuse of alcohol has different causes, and there are different forms of treatment available. Some of these treatments are:

  • Detoxification: Alcohol use is stopped abruptly. The alcohol is sometimes replaced with other drugs that have similar effects, to prevent withdrawal symptoms.
  • Therapy: Various therapies are available.
  • Moderation: Alcohol use is lowered and lowered.
  • Drugs: Some drugs can help the transition to drinking less, or are very dangerous if they are consumed with alcohol.

Detoxification[change | edit source]

Treatment of alcoholism takes several steps. Direct withdrawal leads to medical problems. For this reason, the process of withdrawal needs to be controlled carefully. Alcohol detoxification often involves the use of special drugs; benzodiazepines such as diazepam are used frequently.[12] Sometimes, people with alcoholism also have other addictions. Benzodiazepines are addictive. If the person is addicted to both alcohol, and benzodiazepines, this step gets more complicated.[13] After detoxification, other support such as group therapy or self-help groups are used to help the person remain sober.[14][15] Thombs (1999) states according to behavioural sciences alcoholism is described as a “maladaptive behaviour”. He explains this must not be confused with “misbehaviour”. Behavioural scientists explain that addicts have a behaviour pattern that may lead to destructive consequences for themselves, their families and society. This does not label addicts as bad or irresponsible.[16] Compared with men, women are more sensitive to alcohol's harmful physical, cerebral, and mental effects.

Different types of alcoholics[change | edit source]

Elvin Morton Jellinek identified different types of people drinking alcohol:[17]

  • Alpha-type: these people drink alcohol to cope with difficult situations. The amount of alcohol consumed mainly depends how difficult the situation is perceived. Alpha-types are not alcoholics, but they run they risk of psychical addiction.
  • Beta type: Given the right occasion, these people drink a large quantity of alcohol. Socially and psychically speaking, they usually do not get noticed easily. They simply have a lifestyle which often gives the opportunities to drink. They suffer some consequences from their frequent alcohol consumption. They are neither psychically nor physically dependent, but often at risk of becoming so.
  • Gamma-type: These people have longer phases of being abstinent. These phases alternate with phases of being very drunk. One of the characteristic of people o this type is the loss of control: Such people cannot stop drinking, even when they have the feeling to have drunk enough. They feel safe because of the longer phases of not drinking alcohol, but they are in fact alcohol-dependent.
  • Delta-tye: People of this type try to keep a "level" of alcohol during the day, and the night. The level is usually quite low, but increases as the illness progresses. This is also because a kind of tolerance develops; in other words, the same amount of alcohol will not have the same effect, after some time. For a long time, addicts can function in society, because they rarely "look drunk". There is a strong physical dependence; these people need to constantly drink alcohol to counter withdrawal symptoms. There are health problems related to the constant drinking. Delta types are not capable of being without alcohol, and of alcohol-dependent.
  • Epsilon-type: These people drink alcohol excessively, in irregular intervals. When drinking, they lose control. These intervals can last days to months. Between two intervals, usually no alcohol is consumed. Epsilon-types are alcohol dependent.

C. Robert Cloninger only listed two types, in 1981:[18]

  • Type-I: Also called milieu-determined alcoholism: Sufferers can be of either sex. Alcohol abuse can be mild or heavy. The illness usually gets wors rapidly. People with a lower social status suffer more markedly. Those who suffer try to "keep harm away", they are dependent on a "reward". Usually, people suffer from Clinical depression and phobias, which they try to fight with drinking alcohol. There is little genetic disposition towards alcohol-dependence.
  • Type-II: This type only affects men. Alcohol abuse is moderate, but shows early. Mothers of such alcoholics tend to be non-nondescript, but their fathers usually developed alcohol dependence before they turned 25. In addition, such people are often criminals. Those affected often show antisocial behavior; they also like to take risks. Usually they use alcohol to get euphoric, but often also have a problem with other drugs. Probably genetic dispostion is more important in this type, than social factors.

S. Y. Hill added a third type in 1992:[19]

  • Type-III: Very much influenced by genetic disposition, as Type II. Unlike Type II, Type III does not show antisocial behavior.

References[change | edit source]

  1. Dr Gro Harlem Brundtland (19 February 2001). "WHO European Ministerial Conference on Young People and Alcohol". World Health Organisation. http://www.who.int/director-general/speeches/2001/english/20010219_youngpeoplealcohol.en.html.
  2. Ms Leanne Riley (31 January 2003). "WHO to meet beverage company representatives to discuss health-related alcohol issues". World Health Organisation. http://www.who.int/mediacentre/news/releases/2003/pr6/en/index.html.
  3. "alcoholism". Encyclopædia Britannica. 2010. http://www.britannica.com/EBchecked/topic/13448/alcoholism.
  4. "DEFINITIONS" (PDF). USA: AMA. http://www.ama-assn.org/ama1/pub/upload/mm/388/alcoholism_treatable.pdf.
  5. Glavas MM, Weinberg J (2006). "Stress, Alcohol Consumption, and the Hypothalamic-Pituitary-Adrenal Axis". In Yehuda S, Mostofsky DI. Nutrients, Stress, and Medical Disorders. Totowa, NJ: Humana Press. pp. 165–183. ISBN 978-1-58829-432-6.
  6. Agarwal-Kozlowski, K.; Agarwal, DP. (Apr 2000). "[Genetic predisposition for alcoholism]". Ther Umsch 57 (4): 179–84. PMID 10804873.
  7. Chen, CY.; Storr, CL.; Anthony, JC. (Mar 2009). "Early-onset drug use and risk for drug dependence problems". Addict Behav 34 (3): 319–22. doi:10.1016/j.addbeh.2008.10.021. PMC 2677076. PMID 19022584.
  8. Hoffman, PL.; Tabakoff, B. (Jul 1996). "Alcohol dependence: a commentary on mechanisms". Alcohol Alcohol 31 (4): 333–40. PMID 8879279.
  9. Caan, Woody; Belleroche, Jackie de, eds. (11 April 2002). Drink, Drugs and Dependence: From Science to Clinical Practice (1st ed.). Routledge. pp. 19–20. ISBN 978-0-415-27891-1. http://books.google.com/?id=nPvbDUw4w5QC.
  10. Kahan, M. (Apr 1996). "Identifying and managing problem drinkers". Can Fam Physician 42: 661–71. PMC 2146411. PMID 8653034.
  11. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 31 July 1994. ISBN 978-0-89042-025-6. http://books.google.com/?id=W-BGAAAAMAAJ.
  12. Blondell, RD. (Feb 2005). "Ambulatory detoxification of patients with alcohol dependence". Am Fam Physician 71 (3): 495–502. PMID 15712624.
  13. Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I (November 2003). "Dependence on legal psychotropic drugs among alcoholics" (PDF). Alcohol Alcohol. 38 (6): 613–8. doi:10.1093/alcalc/agg123. ISSN 0735-0414. PMID 14633651. http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613.
  14. Morgan-Lopez, AA.; Fals-Stewart, W. (May 2006). "Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions". Exp Clin Psychopharmacol 14 (2): 265–73. doi:10.1037/1064-1297.14.2.265. PMID 16756430.
  15. Soyka, M.; Helten, C.; Scharfenberg, CO. (2001). "[Psychotherapy of alcohol addiction—principles and new findings of therapy research]". Wien Med Wochenschr 151 (15–17): 380–8; discussion 389. PMID 11603209.
  16. Thombs, Dennis L. Thombs (1999). Introduction To Addictive Behaviors 2ed. London: The Guildford Press. pp. 8–9.
  17. E. M. Jellinek: The Disease Concept of Alcoholism, Hillhouse, (New Haven) 1960
  18. C. R. Cloninger, M. Bohman, S. Sigvardsson: Inheritance of alcohol abuse: cross-fostering analysis of adopted men. In: Archives of General Psychiatry 1981, 38: pp 861–869.
  19. S. Y. Hill: Absence of Paternal Sociopathy in the Etiology of Severe Alcoholism: Is There a Type III Alcoholism? Journal of Studies Alcohol 1992; 53: S. 161–169