Alcoholism (of chronic alcoholism, alcoholic disease, alcohol dependence, utilism) is a chronic progressive disease characterized by pathological attraction to alcohol (mental and physical dependence development of withdrawal symptoms when you stop drinking alcohol and in advanced cases – persistent somatic, neurological disorders and mental degradation.
The term “Chronic alcoholism” is excluded from use in medical classifications, instead, ICD-10 introduced the term “Alcohol dependence syndrome”.
The formation of alcoholism as a disease is usually preceded by a stage of irregular use or abuse of alcohol referred to in the national drug abuse as “drunkenness”, “domestic drunkenness” or “domestic alcoholism”. No more than 10% of adult populations in developed countries refers to absolute teetotaler – completely abstaining from alcoholic beverages. Alcoholism usually develops after several years of drinking (a malignant form – even in 1-2 years). However, in some individuals, long-term drinking may not lead to the development of alcoholism. Repeated or even regular use of alcohol in doses that cause a marked and even a strong intoxication in itself is not alcoholism as a disease, if not accompanied by the characteristic for this disease symptoms. In the United States received recognition of the classification of forms of alcohol abuse, proposed by E. Jellinek.
As the leading criteria it considers social factors, behavioral characteristics, customs, consumption of drinks, etc. and five forms:
- Alpha alcoholism – alcohol is used as a means to eliminate the negative psychological phenomena, and unpleasant somatic sensations. There is an increase in tolerance in the absence of serious changes in mental state and social behavior. Is not a disease.
- Beta alcoholism – alcohol abuse is associated with practices of the relevant social environment. No mental and physical dependency on alcohol.
- Gamma alcoholism – mental and physical dependence on alcohol, loss of quantitative control, the emerging of the abuse of spirits. Form of abuse recurring. For progressive, pronounced social exclusion.
- Delta-alcoholism – the prevalence of psychological dependence in the form of constant drinking and maintaining control over the use of alcohol (mainly in the form of grape wine). Characterized by slow progression of the disease, with long-term preservation of social adaptation.
- Epsilon-alcoholism – dipsomania in the form of cyclically recurring drinking bouts.
Europe applies a different classification of alcoholism:
- separate alcoholic excesses;
- pseudotype (situation due to depending on external causes);
- constant drunkenness on the background of the high tolerance;
- intermittent alcoholism;
- constant drunkenness on the background of low tolerance;
- true binges (dipsomania) are characterized by intermittent painful attacks of craving for alcohol that lasts a few days, sometimes weeks, during which alcoholic beverages are absorbed in large quantities, and ends abruptly due to the coming of an aversion to alcohol.
In the classifications adopted in our country, are leading the clinical signs of addiction and its consequences. Classification usually is based on three principles: stage of alcoholism form alcohol abuse, progression. In ICD-10 in category Flx.2 “dependency Syndrome” with the relevant symbol identifies initial, middle, final stage of alcohol dependence.
Main clinical indications I (initial) stage of alcoholism
1. Pathological attraction to alcohol (often referred to as “primary”) and psychological dependence are chief among the early signs. Alcohol becomes a necessary means to cheer up, to feel confident and free, to forget about troubles and tribulations, to facilitate contact with others, emotionally drained. Updating the primary attraction to alcohol is the cause of the formation of psychological dependence, which may initially wear obsessive (“obsessive”) character, revealing the elements of the struggle of motives – “to drink or not to drink.” In the future, mental dependence becomes more and more overvalued in nature. The use of alcoholic beverages becomes the main interest in life: all thoughts are focused on alcohol, invented reasons, sought the company, every event is seen primarily as a reason for drinking. For this thrown other things to do, entertainment, Hobbies, promising feasts, Dating. On alcohol spent money meant for necessities. Typical emotional reactions associated with alcoholism: the euphoria when thinking about the use of alcohol and on the eve of booze and dysthymia when it is impossible alcohol abuse.
2. The syndrome of altered reactivity to alcohol includes several attributes. The growth of tolerance to alcohol to achieve intoxication requires elevation taken doses of alcohol, as the former doses do not cause euphoria. Already at the I stage, and intoxication requires a dose 2-3 times higher compared to the original. However, after a long period of drinking tolerance may drop. In adolescence and early adulthood it can grow without alcoholism due to the physical development, increasing of body weight. The most accurate estimate of tolerance can be made on the minimum alcohol content in the blood, when the first obvious signs of intoxication. In the US, the tolerance is increased if no clinical signs of intoxication when the alcohol concentration in the blood is 1.5 g/L.
The passing away of the protective gag reflex (when the concentration of alcohol in the blood there is vomiting, in which stomach removed part of alcohol) evidence of tolerance to large doses due to the occurring in the body changes in metabolism. However, 5-10% of people this reflex may initially be absent. Then very early there is a loss of quantitative control over the intake of alcohol and eliminates the feeling of fullness alcohol. Occasionally, for example, when epileptic psychopathy and accentuation of character, found the initial lack of quantitative control: from the first openany occurs an uncontrollable desire to drink “before the blackout”. Taken large doses of alcohol cause a deep sleep, and also the state of stupor or coma due to an overdose. Loss of quantitative control may be caused by the formation of the so-called secondary attraction to alcohol that manifests increased intoxication pathological attraction to alcohol. Starting to drink, people can’t stop and get drunk to severe intoxication. Severe intoxication lead to partial amnestic forms of intoxication, the so-called blackawton (palimpsests). From the memory drop of individual events and behavior during the period of intoxication during which retained the ability to act and speak and not even giving others an impression of a heavily drunken. This phenomenon often appears in those who have suffered a traumatic brain injury or are ill with epilepsy, and in epileptic psychopathy and accentuation of character.
3. The change in the pattern of intoxication is expressed in the gradual decrease in the phase of euphoria in a state of alcoholic intoxication and the appearance of atypical forms of intoxication with restlessness, aggressiveness or psychomotor retardation, as well as the frequency and weighting amnestic forms of intoxication.
4. The change of use of alcoholic beverages with the transition from occasional drinking to regular drinking. Most often this is expressed in the form of alcoholic excesses with a duration of 1-2 days, followed by fatigue and interruptions in alcoholism for a few days or daily administration of small doses of alcohol.