Definition of the disease. Causes of the disease
Alcoholism is a mental and physical dependence of a person on the intake of drinks containing ethanol. They become necessary because they help to relieve mental stress or improve the physical condition, which has worsened just because of the withdrawal or long non-consumption of alcohol.
The harm of alcohol to the human body
Alcoholism leads to progressive degradation of personality and characteristic lesions of internal organs: liver (hepatitis, hepatocholecystitis, cirrhosis of the liver), gastrointestinal tract (pancreatitis, gastritis, stomach and duodenal ulcer), heart (cardiomyopathy, hypertension, myocardiodystrophy, cardiosclerosis), lungs (tuberculosis due to decreased immunity). Patients mentally degrade, their range of interests narrows, cognitive abilities are impaired, intelligence decreases.
Organs that are affected by alcoholism
Alcohol dependence is the most common type of disorders associated with the use of psychoactive substances. According to the World Health Organization, 2.5 million people die every year worldwide due to alcohol abuse[14].
Men, as a rule, drink more often and more than women, so their risk of developing alcoholism is much higher[14]. The DNA of men is arranged differently, which is why the ability of the male body to cover up unfavorable recessive signs is much weaker than in women.
Why do some people become alcoholics and others don’t
Hereditary (genetic) factor affects the rate of damage to metabolic processes in the body. When fragments of genes involved in alcohol metabolism are disrupted, the body’s ability to compensate for damage and regulate other processes decreases. This increases the risk not only of developing alcoholism, but also of diseases associated with this dependence (for example, cirrhosis of the liver) [16].
Dependence is formed in relation to those substances that, by their chemical structure, resemble substances of the body itself or can take part in metabolic processes. In connection with the intake of such toxic substances, the activity of natural enzymes is disrupted, and after a break in the intake of alcohol, tension arises. To remove it, addicted people compensate for the lack of natural enzymes with another portion of alcohol.
The ethnological factor should also be included among the unfavorable factors leading to the formation of dependence. The rate of metabolic disorders in the indigenous peoples of Europe is much lower. In small Northern peoples, indigenous peoples of Asia and American Indians, the gene pool allows addictions to develop much faster.
What factors accelerate the development of alcoholism
The development of alcoholism is influenced by such factors as [16]:
domestic disorder, difficulties in the professional sphere and personal life;
dysfunctional, drinking environment;
depression and other personality disorders.
In general, alcohol abuse can provoke any psychogenic factor — both positive and negative. The main indicator in this case is the frequency of use adopted in a particular environment.
Is female alcoholism really harder than male alcoholism
Alcohol dependence in women has its own specifics and it must be taken into account when choosing treatment tactics. The main tasks at the first stage of treatment consist in the formation of psychogenic factors that contribute to the creation of the necessary microsocium, what is considered to be a normal family. The first stage of treatment is the compensation of deficiency conditions and the exclusion of provoking factors.
Claims that alcoholism develops faster in women and is treated more difficult are absolutely unprofessional. The development of alcohol and any other dependence in women is difficult due to the specificity of their gene pool, which can cover up unfavorable (recessive) signs. Apparently, this explains a fairly constant relatively small proportion of women among those suffering from alcohol addiction. However, in recent years, the gap between men and women suffering from alcoholism has been narrowing.
warning
If you find similar symptoms, consult a doctor. Do not self-medicate – it is dangerous for your health!
Symptoms of alcoholism
Alcohol affects certain systems and structures of the brain, causing addiction syndrome[2][3][19]. It is this syndrome that is the core of the clinical picture of alcoholism. It is not the fact of excessive alcohol consumption itself that comes to the fore, but problems at work, in family relationships, etc.
How to distinguish an alcoholic from a drinker
The main sign of alcohol addiction is a growing need for alcohol during periods of stress, unpleasant situations. Any factor that increases a person’s stress level can become a motive for use.
The monthly biological rhythm plays an important role in the formation of primary attraction. Its task is to help the body adapt to living conditions. When taking alcohol for a month, the metabolic rate changes, and with it the rate of enzyme synthesis. Most often, against the background of such a decrease, binge drinking is formed — prolonged drunkenness, which is problematic to stop not only for others, but also for the patient himself.
Personality changes, the main signs of alcoholism
In the absence of alcohol or other psychoactive substance, a person becomes exhausted, nervous, dysphoric — gloomy, irritable. As alcoholism progresses, it is more difficult for a person to control the situation and the amount of alcohol consumed, amnesia begins to form for the period of intoxication, behavior changes, and the emotional state worsens.
To get a person out of a binge, relatives often resort to psychological help. But if the disease progresses, only medication can stop the binge.
Alcoholic psychoses, or delirium
Delirium in alcoholism is a condition that is formed when separation (deprivation) from alcohol on the third or fifth day. Patients with insomnia, decreased appetite, tremor and other painful manifestations “hear” sounds, “see” images, usually frightening, and feel the persecution of animals. Visions are vivid, absolutely relevant for patients and determining their behavior.
Alcoholic hallucinations, symptoms
With hallucinosis, perception is disrupted — auditory, visual, tactile. Violations alarm the patient. Hallucinoses can develop into delirium, or become chronic.
Delusional psychoses in alcoholism
Delusional psychoses, the most severe type of development of alcoholic illness, develops in people with borderline mental states, closer to mental illness, are very difficult to treat. The most striking example is the delirium of jealousy. Any event is interpreted by patients, despite the absurdity, as a violation of marital fidelity.
Alcoholic encephalopathy, symptoms
Alcoholic encephalopathies are formed against the background of damage to brain structures, can be characterized by weakness of intellectual activity, dementia, against their background less vivid, but chronic development of psychoses.
Pathological intoxication
This condition does not depend on the amount of alcohol taken. With pathological intoxication, the patient acts aggressively towards others and can move in space, poorly controlling himself. When you exit this state, as a rule, you can’t tell anything about it. The so-called twilight states are being formed. Pathological intoxication develops in people with borderline mental states.
Pathogenesis of alcoholism
The development of alcoholism is associated with a violation of metabolism — metabolism in the body. It occurs against the background of long—term abuse of a psychoactive substance – ethanol.
This agent is actively involved in metabolism, disrupting the main function of this process — synthesis, i.e. the production of substances necessary for vital activity, including dopamines, catecholamines and others[9][11][12]. In this regard, people very quickly become addicted not only to ethanol, but also to other types of psychoactive substances.
With sufficient frequent and prolonged alcohol consumption, a biochemical defect occurs in the patient’s body, which leads to a decrease in the natural alcohol background — a small dose of ethyl, which is produced by the body itself.
Conditionally , the process of alcohol assimilation can be divided into three phases:
the first phase is alcohol intake;
the second phase is the formation of a vascular poison in the body — acetaldehyde;
the third phase is the assimilated alcohol, which has become part of the body.
Phases of alcohol assimilation in the body
A healthy person does not notice the first two phases, they pass quickly. In the body of patients, due to a violation of synthesis and other processes, the second phase becomes prolonged, a person experiences unpleasant sensations, the level of which depends on the depth of the violations.
To improve the condition, it is necessary to reduce the level of vascular poison, which was formed during the processing of alcohol. To do this, you need to change one of the links:
either the concentration of the final product is the patient’s body itself, without medical help, can not do;
or the concentration of the initial product — for this you just need to take an additional dose of alcohol, i.e. “hangover”.
Dependent people choose the second option. After the next dose of alcohol, the biochemical balance shifts, the condition is relieved until the new dose is processed, after which the second phase begins again. Due to the artificial improvement of the condition with the help of alcohol, the biochemical defect is growing. This leads to the need to increase the dose of alcohol, which entails an increase in the level of painful conditions formed in the absence of alcohol intake. So there is a vicious circle.
This cycle can only be interrupted by some strong psychogenic factor or medical care. Otherwise, the body will not refuse to take alcohol — it can end in different ways, not excluding a fatal outcome.
Classification and stages of alcoholism development
There are three stages of alcoholism.
The first stage of alcoholism is preclinical (initial)[6]. Its main feature is the informal presence of narcological problems. With the positive influence of work and family, a person can more or less successfully solve or extinguish moments of social tension without outside help.
During this period, a person drinks alcohol irregularly. He has cases of pseudo—drinking – control over the amount of alcohol is lost. Tolerance (degree of tolerance) to alcohol increases [1][13]. Euphoria prevails in the picture of intoxication. The level of attraction coverage is relatively low. The influence of family and others can help or force the patient to stop drinking.
The physical and intellectual state of a person does not deteriorate significantly, since the enzyme system and the utilization of psychoactive substances are poorly disturbed. Such patients rarely seek drug treatment.
The second stage of alcoholism is the formation of physical dependence. At this stage, the patient’s condition does not allow him to refuse to take alcohol, since the body needs to compensate for the internal deficit. A reliable sign is amnesia of intoxication.
In the second stage, alcohol intake becomes more regular. In this regard, the number of problems and conflicts in the family or at work increases. Physical and intellectual abilities are relatively preserved[1][13].
Against the background of high tolerance and loss of quantitative control of the drunk, euphoria in the picture of intoxication is gradually replaced by inhibition or irritability. During this period, the personality itself changes: outside of alcohol intake and during periods of intoxication, the patient becomes nervous, there is a lowered or elevated mood that is not associated with external stimuli, unjustifiably vivid emotional reactions appear. The patient is forced to consult a doctor by the desire to maintain the stability of his environment.
Too vivid emotions in alcoholism
In preventing an alcoholic episode at this stage, a struggle of motives can play an important role — a state when the patient feels that the decision to take alcohol contradicts his other needs — the preservation of family, work, etc. The level of attraction coverage increases rapidly before binge drinking and falls after drinking alcohol.
As a rule, in the second stage, the patient is still sufficiently preserved to work and participate in family affairs, begins to give an adequate assessment of his painful condition during periods of sobriety and, with a certain level of external influence, can postpone alcohol consumption.
The form of drunkenness in the second stage is true binge drinking. They are associated with high voltage of enzyme systems[9]. Signs of alcohol withdrawal are formed, which patients are forced to stop with an additional intake of alcohol or by medication.
The third stage of alcoholism is the stage of degradation. During this period, the patient is unable to solve the problems that have arisen — the family breaks up, due to periodic absenteeism, they are fired from work. Alcohol intake becomes almost constant, only the intensity changes. At the third stage of alcoholism, the level of attraction coverage is high. Alcohol becomes necessary in order to maintain vital enzyme systems[10].
Tolerance is relatively reduced due to the large amount of alcohol consumed throughout the time. The picture of intoxication is dominated by inhibition. The struggle of motives, as such, no longer affects the decision to drink alcohol.
Due to the toxic nature of drunkenness, not only the level of metabolism changes, but also the work of individual organs and systems deteriorates. Significant somatic and intellectual disorders occur. Personality changes are total in nature. Encephalopathy, polyneuropathy, dementia develops, while the level of working capacity decreases — informal disability occurs. It is called informal because patients, despite their actual disability, rarely seek medical help.
Visually, the level of attraction to alcohol at each stage can be depicted as a sine wave. In a healthy person, the phases of the biological rhythm are located above the conditional line of health. In a patient with alcoholism, the sinusoid in relation to the conditional line of health gradually falls down. Clinically, it looks like an increase in the duration of alcoholic episodes associated with increased tolerance[1][4][5].
Biological rhythm at different stages of alcoholism
Stages of alcoholism in men and women
The first stage of alcoholism is a condition that can be controlled using psychogenic levers. At this stage, psychogenic influence from others (relatives, employers, etc.) can interrupt an alcoholic episode. In women, depending on their place in the social structure, it can be more successful than in men.
The second stage of alcoholism is a condition that requires not only psychogenic effects, but also medication to interrupt an alcoholic episode. At this stage, women are more likely to drink alcohol alone, so that as few people as possible know about it.
The third stage of alcoholism is a condition when alcohol consumption is necessary to support vital functions. There are no differences at this stage depending on gender.
Complications of alcoholism
In chronic alcoholism, the nervous system is affected due to prolonged intoxication. Therefore, when coming out of a binge, an alcoholic may have delirium tremens — delirium tremens. Sometimes there are hallucinations, delusional states, depression and alcoholic epilepsy. These conditions, unlike delirium tremens, are not always associated with a sharp rejection of alcoholic beverages.
Gradually, patients mentally degrade, their range of interests narrows, cognitive abilities are impaired, intelligence decreases, etc. The collapse of the family, the lack of regular work, the formation of an appropriate environment quite often lead to a promiscuous sexual life [18] and infection with sexually transmitted diseases, AIDS, decreased immunity and increased risk of banal infections.
The most vulnerable organs and systems always suffer[14]:
liver — hepatitis, hepatocholecystitis, cirrhosis of the liver;
Gastrointestinal tract — pancreatitis, gastritis, stomach and duodenal ulcer;
heart — cardiomyopathy, hypertension, myocardiodystrophy, cardiosclerosis;
lungs — tuberculosis (due to decreased immunity).
Complications of alcoholism
These disorders begin to develop from the first days of alcohol abuse, and they occur more often in women than in men[18]. They usually become chronic and require long-term hospital treatment. Their severity and irreversibility depends on the stage of alcoholism.
In addition, the risk of developing cancer of the oropharynx, esophagus, stomach, liver, colon and rectum increases[14][15][18].
In the later stages of alcoholism, alcoholic polyneuropathy is often found. First, there are changes in the legs — muscle weakness occurs, a feeling of numbness or tingling appears. If alcohol intake does not stop, then it can reach encephalopathy — memory deteriorates, attention decreases, thinking slows down, fatigue quickly sets in, dizziness occurs, headache [19].
Being under the influence of alcohol, addicted people often get injured, get into dangerous situations that can end in disability or death.
Diagnosis of alcoholism
The main criterion for the diagnosis of “alcoholism” is an appropriate anamnesis. At the same time, not only the patient can be interviewed, but also people who know him, who in one form or another contribute to the formation of alcohol dependence — habitual drunkenness in the family or at work, external stimuli that cause tension and habitual drunkenness.
When collecting anamnesis, the CAGE questionnaire is used. It consists of four questions[16]:
Have you ever thought that you need to drink less?
Were you annoyed when people criticized your addiction to alcohol?
Has there been a sense of guilt due to alcohol abuse?
Was there a desire to drink in the morning after the previous alcohol consumption?
If the patient answered three questions in the affirmative, then this indicates a possible systematic use of alcohol. Four positive responses indicate alcoholism. Alcoholism differs from the harmful use of alcohol by the presence of an addiction syndrome.
Additionally, the results of the study of biological samples in toxicological laboratories and tests for a certain list of narcotic substances may be required.
In drug treatment clinics and dispensaries, blood tests are carried out for the presence of CDT — a marker of chronic alcohol abuse. Its concentration increases if a person consumes more than 40 g of alcohol for 1-2 weeks. With alcoholism, CDT will be higher than 1.6%. With the help of this study, you can check the success of the treatment provided.
Blood sampling to determine CDT
Usually, addicted people do not need laboratory diagnostics: it is necessary with an atypical clinical picture and simultaneous abuse of other types of psychoactive substances.
Differential diagnosis is performed with bipolar, panic and anxiety disorders[16].
Treatment of alcoholism
Modern methods of treating alcoholism are aimed at eliminating the consequences, i.e. changing the final links of pathogenesis. Psychogenic techniques are most often used for this, but they usually do not reduce the level of tension[7]. With stress therapy or hypnosis, the tension can be relieved, but temporarily. This is due to the biological rhythm.
Drug therapy is also aimed at the consequences of alcoholism. For this purpose, drugs are prescribed that affect the release of substances that reduce or increase emotional activity [2][3]. Such treatment always leads to an imbalance of homeostasis (constancy of the internal environment) and reduces the level of working capacity. Therefore, it is not the best option for relieving addiction.
It is possible to get rid of alcoholism only with a competent combination of possible methods and strict adherence to the principles of treatment.
Can a person independently recover from addiction
If this is really an addiction formed as a result of alcohol consumption, then it can. This requires a microsocium that will constantly slow down the possibility of alcohol consumption – family, children, the need to provide for the family, the need to participate in labor, social processes, etc.
But an internal deficit will be present and this, as a rule, affects communication with others to one degree or another.
Is it possible to force a person to be treated for alcohol addiction
The basic principle of alcoholism treatment is voluntary. It is usually believed that people who are addicted to alcohol do not want to be treated. In fact, there is a desire to get rid of alcoholism (it is a desire, not consent), but it has a wave-like character.
For successful treatment, it is necessary to preserve the patient’s desire for recovery. For this purpose, psychocorrection is carried out, namely hypnosis. It does not always prolong the desire to get rid of alcoholism, besides, not everyone is subject to it.
Another way to maintain the desire for recovery is medication. In order for it to have the proper effect, the attending physician must have knowledge of the biorhythm and the method of maintaining the minimum tension of enzyme systems.
Principles of alcoholism treatment
A comprehensive approach to treatment. In addition to emotional disorders, diseases of internal organs and systems often worsen in people with alcoholism. They have more pronounced vegetative reactions — the body’s response to pain. Such patients require not only narcological methods, but also therapeutic, psychiatric treatment.
Individual approach to the elimination of addiction. Patients whose level of somatic (bodily) disorders is not so high as to become the main reason for providing medical care most often turn directly to narcologists. Therefore, treatment is carried out on an outpatient basis, i.e. at home. Only in these conditions it is possible to achieve extremely individual treatment. This allows us to take into account not only the somatic condition of the patient, but also the environment in which he lives.
The medical art consists in the fact that when choosing a treatment method, he should take into account not only the somatic and mental individuality of the patient, his attitudes and biological rhythm, but also the attitudes and possibilities of his environment.
Hospitalization is necessary only for urgent conditions — withdrawal syndrome, intoxication, etc. In other cases, hospitalization is not justified, since after the patient falls out of artificially created conditions (forced alcoholic “starvation”) he usually starts drinking alcohol again, only in even greater quantities. This is due to the fact that the deficit tends to accumulate.
Maximum somatic and psychological comfort. Many people mistakenly assume that to give up alcohol, you need “willpower”, i.e. the strength to do what you don’t want. In relation to the patient, this is violence. With this approach, he retains the internal state of the struggle of motives, obsessions. He is constantly in tension, which, when accumulated, can result in compulsion — obsessive behavior.
More correct in relation to the patient and his condition is the principle of treatment, which allows the patient to feel more comfortable in conditions of non-consumption of alcohol than when using it. To do this, medications and non-drug therapy are used, as well as curation of the environment in which the patient lives: reducing the number of factors that may remind of drunkenness.
The main tasks of such treatment are:
reducing drug problems and compensating for the state of deficiency;
formation of other life experiences, habits and stereotypes.
The first task is solved by taking medications that are taken by the patient for a long time in accordance with the monthly biological rhythm. Such treatment does not interfere with work, does not cause difficulties. It is financially accessible to absolutely all groups of the population. The necessary medicines are always available in the pharmacy network.
The second task is solved by the formation of states when it is unpleasant for the patient not only to drink alcohol, but also the thought of it is unpleasant. He should feel that it is better for him to live without alcohol. Only when forming a comfortable state of the patient, this “attitude” will become his conviction.
Such a result is possible due to psychogenic effects. It is possible only when the main problems are solved, the deficit states are compensated. Relatives who are interested in the recovery of the patient necessarily take part in the treatment.
As practice shows, such a medical tactic leads to the formation of other, more pragmatic life priorities and a person’s own belief in the correctness of a new life.
Overcoming withdrawal syndrome, detoxification
Detoxification is more suitable for medical tactics in case of poisoning. Assistance in the treatment of withdrawal syndrome consists in solving the following tasks:
normalization of cardiovascular activity;
elimination of substances from the body that were formed as a result of the assimilation of alcohol and became a poison for it, normalization of acidity in the biological environment of the body;
the use of funds that compensate for the internal deficit.
Socio-psychological rehabilitation in a specialized center and post-rehabilitation period
As soon as patients fall out of the artificially created conditions of a specialized center, sooner or later an internal deficit makes itself felt, and disrupted interpersonal relationships become a subjective motive for resuming alcohol intake.
If the patient receives supportive (compensatory) treatment for a sufficient period, and then fits into society, into professional activity and feels comfortable, then after a certain time, new priorities are formed that do not allow him to slip back into drunkenness.
Forecast. Prevention
As the personal 20-year experience of using the described treatment method shows, 90% of patients do not drink alcohol for one year after therapy, 80% — for two years, about 70% — for five years.
Of course, the sooner the patient or his relatives seek help, the less metabolic disorders will accumulate in the body. At the first stage, psychogenic effects will be required to a greater extent, at the third stage — medication.
What to do if a loved one has problems with alcohol
Much of the treatment depends on the relatives of the patient. Most often, they themselves suffer from the drunkenness of a family member and try to treat him. But sometimes they have similar problems or conditions close to them.
Any violation of the relationship, the cause of which was drunkenness, must be perceived as a call — urgent action is needed, since prolonged alcohol consumption will sooner or later lead to the formation of addiction.
The first thing to do is to determine the reasons that serve as an excuse for drunkenness for a person. They can be the influence of the drunken relatives themselves, dissatisfaction with family relationships, the influence of friends, work colleagues, etc. If it has not yet reached the disease, then a strong psychogenic effect is enough to solve the problem of drunkenness.
Others do not always notice people with alcohol addiction: up to the third stage of the disease, they seem to be quite healthy individuals. Their flaw is seen only in the fact that they behave badly with their loved ones, work poorly, etc. Therefore, you need to be attentive to all relatives and friends who drink alcohol in order to detect their addiction in time.
The basis for the prevention of alcoholism is the influence of the family. Children absorb everything they see nearby, without analysis. Their life credo very rarely differs from the credo of their parents and others. For example, if children understand that parents can cheat or are involved in other nefarious deeds, then they will behave the same way. Similarly with alcohol. Therefore, the prevention of alcoholism should begin not only with the absence of an example of the use of psychoactive substances in the family, but also with the education of cleanliness in life situations.
