Alcoholism is a disease in which there is a physical and mental dependence on alcohol. It is accompanied by an increased craving for alcohol, an inability to regulate the amount of alcohol consumed, a tendency to binge drinking, the appearance of a pronounced withdrawal syndrome, a decrease in control over one’s own behavior and motivations, progressive mental degradation and toxic damage to internal organs. Alcoholism is an irreversible condition, the patient can only completely stop taking alcohol. The use of the slightest doses of alcohol, even after a long period of abstinence, causes a breakdown and further progression of the disease.
ICD 10
F10.2 Addiction syndrome
General information
Alcoholism is the most common type of substance abuse, mental and physical dependence on the intake of ethanol-containing beverages, accompanied by progressive degradation of personality and characteristic damage to internal organs. Experts believe that the prevalence of alcoholism is directly related to an increase in the standard of living of the population. In recent decades, the number of alcoholism patients has been growing, according to WHO, there are currently about 140 million alcoholics in the world.
The disease develops gradually. The probability of alcoholism depends on many factors, including the characteristics of the psyche, social environment, national and family traditions, as well as genetic predisposition. Children of people suffering from alcoholism become alcoholics more often than children of non-drinking parents, which may be due to certain character traits, hereditary metabolic features and the formation of a negative life scenario. Non-drinking children of alcoholics often show a tendency to codependent behavior and form families with alcoholism patients. Alcoholism is treated by specialists in the field of narcology.
Pathogenesis
The main component of alcoholic beverages is ethanol. Small amounts of this chemical compound are part of the natural metabolic processes in the human body. Normally, the ethanol content is no more than 0.18 ppm. Exogenous (external) ethanol is rapidly absorbed in the digestive tract, enters the bloodstream and affects nerve cells. The maximum intoxication occurs 1.5-3 hours after taking alcohol. When taking too much alcohol, a gag reflex occurs. As alcoholism develops, this reflex weakens.
About 90% of the alcohol consumed is oxidized in the cells, broken down in the liver and excreted from the body as the end products of metabolism. The remaining 10% is excreted unprocessed through the kidneys and lungs. Ethanol is excreted from the body for about a day. In chronic alcoholism, intermediate products of ethanol breakdown remain in the body and have a negative effect on the activity of all organs.
The development of mental dependence in alcoholism is due to the influence of ethanol on the nervous system. After taking alcohol, a person feels euphoria. Anxiety decreases, the level of self-confidence increases, it becomes easier to communicate. In fact, people are trying to use alcohol as a simple, affordable, fast-acting antidepressant and anti-stress agent. As a “one-time help”, this method sometimes really works – a person temporarily relieves tension, feels satisfied and relaxed.
However, alcohol intake is not natural and physiological. Over time, the need for alcohol increases. A person, not yet being an alcoholic, begins to drink alcohol regularly, without noticing gradual changes: an increase in the required dose, the appearance of memory lapses, etc. When these changes become significant, it turns out that psychological dependence is already combined with physical dependence, and it is very difficult or almost impossible to refuse to take alcohol on their own.
Alcoholism is a disease closely related to social interactions. At the initial stage, people often drink alcohol due to family, national or corporate traditions. In a drinking environment, it is more difficult for a person to remain a teetotaler, since the concept of “normal behavior” is shifting. In socially well-off patients, alcoholism may be due to a high level of stress at work, the tradition of “washing” successful transactions, etc. However, regardless of the root cause, the consequences of regular alcohol intake will be the same – alcoholism will occur with progressive mental degradation and deterioration of health.
Symptoms of alcoholism
Prodrome
There are three stages of alcoholism and prodrome – a condition when the patient is not yet an alcoholic, but regularly drinks alcohol and belongs to the risk group for the development of this disease. At the stage of prodrome, a person willingly takes alcohol in company and, as a rule, rarely drinks alone. Alcohol consumption occurs in accordance with the circumstances (a celebration, a friendly meeting, a rather significant pleasant or unpleasant event, etc.). The patient can stop taking alcohol at any time without suffering from any unpleasant consequences. He has no desire to continue drinking after the end of the event and easily returns to a normal sober life.
The first stage
The first stage of alcoholism is accompanied by an increased attraction to alcohol. The need to drink alcohol resembles hunger or thirst and worsens in adverse circumstances: quarrels with loved ones, problems at work, an increase in the overall level of stress, fatigue, etc. If a patient suffering from alcoholism fails to drink, he is distracted and the craving for alcohol temporarily decreases until the next unfavorable situation. If alcohol is available, a patient with alcoholism drinks more than a person at the prodrome stage. He tries to achieve a state of pronounced intoxication by drinking in company or taking alcohol alone. It is harder for him to stop, he strives to continue the “holiday” and continues to drink even after the event ends.
Characteristic features of this stage of alcoholism are the extinction of the gag reflex, aggressiveness, irritability and memory lapses. The patient takes alcohol irregularly, periods of absolute sobriety may alternate with isolated cases of alcohol consumption or be replaced by binge drinking lasting several days. Criticism of one’s own behavior is reduced even during sobriety, an alcoholic patient tries in every possible way to justify his need for alcohol, finds all sorts of “worthy reasons”, shifts responsibility for his drunkenness to others, etc.
The second stage
The second stage of alcoholism is manifested by an increase in the amount of alcohol consumed. A person takes more alcohol than before, while the ability to control the intake of ethanol-containing beverages disappears after the first dose. Against the background of a sharp refusal of alcohol, withdrawal syndrome occurs: tachycardia, increased blood pressure, sleep disorders, trembling fingers, vomiting when taking fluids and food. It is possible to develop delirium tremens, accompanied by fever, chills and hallucinations.
The third stage
The third stage of alcoholism is manifested by a decrease in alcohol tolerance. To achieve intoxication, it is enough for a patient suffering from alcoholism to take a very small dose of alcohol (about one glass). When taking subsequent doses, the condition of the patient with alcoholism practically does not change, despite the increase in the concentration of alcohol in the blood. There is an uncontrolled craving for alcohol. Alcohol consumption becomes constant, the duration of binge drinking increases. When refusing to take ethanol-containing beverages, alcoholic delirium often develops. Mental degradation is noted in combination with pronounced changes in internal organs.
Complications of alcoholism
Alcohol has a depressing effect on the nervous system. At first, euphoria occurs, accompanied by some excitement, a decrease in criticism of one’s own behavior and the events taking place, as well as a deterioration in coordination of movements and a slowdown in reaction. Subsequently, excitement is replaced by drowsiness. When taking large doses of alcohol, contact with the outside world is increasingly lost. Progressive distraction of attention is noted in combination with a decrease in temperature and pain sensitivity.
The severity of motor disorders depends on the degree of intoxication. With severe intoxication, there is a gross static and dynamic ataxia – a person cannot maintain an upright position of the body, his movements are highly uncoordinated. The control over the activity of the pelvic organs is violated. When taking excessive doses of alcohol, respiratory weakness, cardiac disorders, constipation and coma may occur. Possible fatal outcome.
In chronic alcoholism, there are typical lesions of the nervous system caused by prolonged intoxication. Alcoholic delirium (delirium tremens) may develop during withdrawal from binge drinking. Alcoholic encephalopathy (hallucinosis, delusional states), depression and alcoholic epilepsy are diagnosed somewhat less frequently in patients suffering from alcoholism. Unlike alcoholic delirium, these conditions are not necessarily associated with an abrupt cessation of alcohol consumption. In patients with alcoholism, gradual mental degradation, narrowing of the circle of interests, disorders of cognitive abilities, decreased intelligence, etc. are revealed. In the late stages of alcoholism, alcoholic polyneuropathy is often observed.
Typical disorders of the gastrointestinal tract include pain in the stomach, gastritis, erosion of the gastric mucosa, as well as atrophy of the intestinal mucosa. Acute complications are possible in the form of bleeding caused by ulceration of the stomach or violent vomiting with ruptures of the mucosa in the transitional section between the stomach and esophagus. Due to atrophic changes in the intestinal mucosa in patients with alcoholism, the absorption of vitamins and trace elements worsens, metabolism is disrupted, vitamin deficiency occurs.
Liver cells in alcoholism are replaced by connective tissue, cirrhosis of the liver develops. Acute pancreatitis, which has arisen against the background of alcohol intake, is accompanied by pronounced endogenous intoxication, may be complicated by acute renal failure, cerebral edema and hypovolemic shock. Mortality in acute pancreatitis ranges from 7 to 70%. The characteristic disorders of other organs and systems in alcoholism include cardiomyopathy, alcoholic nephropathy, anemia and immune disorders. Alcoholism patients have an increased risk of developing subarachnoid hemorrhages and some forms of cancer.
Treatment of alcoholism
Measures for the treatment of alcoholism can be emergency or planned, carried out at home, outpatient or inpatient conditions. Drug therapy, psychotherapeutic methods of influence and combined techniques are used. In severe cases, rehabilitation in inpatient conditions is required after treatment of alcoholism. Depending on the specific circumstances, a patient with alcoholism may be recommended personal or family psychotherapy, visits to support groups, etc.
Withdrawal from binge drinking
Emergency measures for the treatment of patients suffering from alcoholism include withdrawal from binge drinking and elimination of withdrawal symptoms. At the initial stages of alcoholism and with short binge drinking, treatment at home is possible. In other cases, transportation to a drug treatment clinic is necessary. A patient with alcoholism is transfused with saline solutions, vitamins, antioxidants, sedatives and antipsychotics are injected, as well as drugs to normalize the work of the heart, liver, pancreas and brain. With binge drinking lasting 2-3 days, the volume of infusion therapy is 600-800 ml, with binge drinking up to 7-10 days – 800-1000 ml, with binge drinking over 10 days – 1000-1200 ml.
Coding
Planned treatment of alcoholism can be medicamental or non-medicamental. When using drug coding methods for alcoholism, a drug is injected into the patient’s body that causes pronounced negative consequences when taking alcohol. It is possible to insert a capsule or intravenous administration of a drug (usually disulfiram). Non-drug treatment involves influencing the patient’s psyche in order to create a mindset to refuse to drink alcoholic beverages, awareness of the seriousness of the consequences of alcoholism, etc. Currently, combined methods of treatment are often used – the introduction of medications in combination with hypnosugessive psychotherapy. It is possible both outpatient treatment and hospitalization for therapy aimed at restoring the functions of various organs.
Rehabilitation
The final stage of treatment for alcoholism is social rehabilitation. Currently, this area is poorly developed in Russia, but every year more and more clinics, along with treatment, begin to offer rehabilitation programs. The group program “12 steps” (Alcoholics Anonymous community) is becoming increasingly popular. Within the framework of this program, people suffering from alcoholism provide mutual assistance and support to each other. It should be noted that participation in AA programs without using other methods of treatment is effective only at the initial stage of alcoholism. At stage 2-3, before entering AA, it is necessary to undergo treatment with a narcologist.
Forecast
The prognosis depends on the duration and intensity of alcohol intake. At the first stage of alcoholism, the chances of a cure are quite high, but at this stage patients often do not consider themselves alcoholics, so they do not seek medical help. In the presence of physical dependence, remission for a year or more is observed in only 50-60% of patients. Narcologists note that the probability of long-term remission increases significantly with the active desire of the patient to refuse to take alcohol.
The life expectancy of patients suffering from alcoholism is 15 years less than the population average. The cause of death is typical chronic diseases and acute conditions: alcoholic delirium, stroke, cardiovascular insufficiency and cirrhosis of the liver. Alcoholics are more likely to suffer from accidents and more likely to commit suicide. Among this population group, there is a high level of early disability due to the consequences of injuries, organ pathology and severe metabolic disorders.
