6 July 2020

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Alcoholism is a disease in which causes physical and mental dependence on alcohol. It is accompanied by an increased craving for alcohol, an inability to regulate the amount of consumed alcohol, a tendency to binges, the occurrence of a pronounced withdrawal syndrome, a decrease in control over a person's behavior and motivation, progressive mental degradation and toxic damage to internal organs. Alcoholism is an irreversible condition. The patient can only completely stop alcohol consumption. The intake of the smallest doses of alcohol, even after a long period of abstinence, causes a breakdown and further progression of the disease.

Alcoholism is the most common type of toxicomania, mental and physical dependence on the consuming ethanol-containing drinks, accompanied by progressive degradation of the personality and characteristic damage to internal organs. Experts believe that the prevalence of alcoholism is directly related to an increase in the living standard of the population. In recent decades the number of patients with alcoholism has been growing; according to WHO, there are currently around 140 million alcoholics in the world.

The disease develops gradually. The likelihood 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 with alcoholism become alcoholics more often than children of non-drinking parents, which may be associated with certain character traits, hereditarily conditioned features of metabolism and the formation of a negative life scenario. Non-drinking children of alcoholics often show a tendency to codependent behavior and form families with alcoholics. The treatment of alcoholism is carried out by narcologists.

Ethanol metabolism and dependence development

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 not more than 0,18 ppm. Exogenous (external) ethanol is rapidly absorbed in the digestive tract, enters the bloodstream and affects nerve cells. The maximum alcohol intoxication occurs within 1,5-3 hours after alcohol intake. Too large alcohol dose induces vomiting reflex. As alcoholism develops, this reflex weakens.

About 90% of the consumed alcohol is oxidized in the cells, decomposed in the liver and excreted from the body in the form of end products of metabolism. The remaining 10% is excreted unprocessed via the kidneys and lungs. Ethanol is excreted from the body in about a day. In chronic alcoholism, the intermediate products of ethanol decomposition remain in the body and harm the activity of all organs.

The development of mental dependence in alcoholism is conditioned by ethanol  influence on the nervous system. After alcohol intake, a person feels euphoric. Anxiety decreases and self-confidence level increase. It becomes easier to communicate. Essentially, people try 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 stress, feels satisfied and relaxed.

However, alcohol intake is not natural and physiological. Over time, the need for alcohol increases. A person who is not yet an alcoholic begins to drink alcohol regularly, without noticing gradual changes: increasing the necessary dose, memory dips, etc. When these changes become significant, it turns out that psychological dependence is already combined with physical dependence. To abandon alcohol consumption independently is very difficult or almost impossible.

Alcoholism is a disease closely associated with social interactions. At the initial stage, people often consume alcohol due to family, national or corporate traditions. In a drinking environment, it is more difficult for a person to stay a teetotaler, since the concept of «normal behavior» shifts. Socially prosperous patients drink alcohol because of a high-stress work, the tradition of «washing» successful transactions, etc. However, regardless of the root cause, the consequences of regular alcohol consumption will be the same – alcoholism with progressive mental and common health degradation will occur.

The consequences of alcohol consumption

Alcohol exerts a depressing effect on the nervous system. At first, there is an euphoria accompanied by some excitement, a decrease in criticism of a person’s behavior and current events, as well as a deterioration in the coordination and a slowdown in reaction. Subsequently, excitement is replaced by drowsiness. In the case of large alcohol doses, contact with the outside world is increasingly lost. There is a progressive distraction in combination with a decrease in temperature and pain sensitivity. 

The severity of motor disorders depends on the degree of alcohol intoxication. With severe alcohol intoxication, gross static and dynamic ataxia is observed – a person cannot maintain a vertical position of the body, his movements are very uncoordinated. The control over the activity of the pelvic organs is violated. In the case of excessive alcohol doses, respiratory depression, cardiac disturbances, stupor and coma may occur. The lethal outcome is possible.

Chronic alcoholism causes typical damage to the nervous system due to prolonged intoxication. During exit from a binge, alcoholic delirium (delirium tremens) may develop. Rarely patients suffering from alcoholism are diagnosed with alcoholic encephalopathy (hallucinosis, delusional conditions), depression and alcoholic epilepsy. Unlike alcohol delirium, these conditions are not necessarily associated with a sudden cessation of alcohol consumption. Patients with alcoholism have gradual mental degradation, narrowing of the circle of interests, cognitive impairment, decreased intelligence, etc. In the late stages of alcoholism, alcoholic polyneuropathy is often observed.

Unlike alcoholic delirium, these conditions are not necessarily associated with an abrupt cessation of alcohol consumption. Alcoholics have a gradual mental degradation, the narrowing of the range of interests, disorders of cognitive abilities, decreased intelligence, etc. In the later 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 and atrophy of the intestinal mucosa. Acute complications in the form of bleeding due to gastric ulcer or vomiting with tearing of the mucosa in the transitional section between the stomach and esophagus are possible. Due to atrophic changes in the intestinal mucosa, the absorption of vitamins and minerals deteriorates, metabolism is disturbed, vitamin deficiency occurs in patients with alcoholism.

With alcoholism Liver cells are replaced by connective tissue, cirrhosis of the liver develops. Acute pancreatitis accompanied by severe endogenous intoxication, can be complicated by acute renal failure, cerebral edema and hypovolemic shock. Mortality in acute pancreatitis ranges from 7 to 70%. Characteristic disorders of other organs and systems include cardiomyopathy, alcoholic nephropathy, anemia and immune disorders. For patients with alcoholism, the risk of developing subarachnoid hemorrhages and some forms of cancer is increased.

Symptoms and stages of alcoholism

There are three stages of alcoholism and prodrome which is a condition when the patient is not yet an alcoholic, but regularly drinks alcohol and is at risk of disease developing. At the prodrome stage, a person eagerly takes alcohol in a company and, as a rule, rarely drinks alone. Alcohol consumption occurs under the circumstances (a celebration, a friendly meeting, a significant pleasant or unpleasant event, etc.). The patient can stop alcohol intake anytime without suffering from any unpleasant consequences. He does not want to continue drinking after the event and easily returns to his usual sober life.

The first stage of alcoholism is accompanied by an increased attraction to alcohol. The need for alcohol intake resembles hunger or thirst and is aggravated in negative circumstances: in case of quarrels with close people, problems at work, increased general stress level, fatigue, etc. If a patient suffering from alcoholism is unable to drink, he is distracted and craving for alcohol temporarily reduced up to the next negative situation. If alcohol is available, an alcoholic patient drinks more than a person at the prodrome stage. He tries to achieve a state of severe intoxication by drinking in the company or consuming alcohol alone. It is more difficult for him to stop, he seeks to continue the «holiday» and drinks even after the end of the event.

Characteristic features of this stage are the extinction of the vomiting reflex, aggressiveness, irritability and memory lapses. The patient drinks irregularly, periods of absolute sobriety can alternate with isolated cases of alcohol consuming or be replaced by binges which may last  several days. A person’s criticism of his or her behavior is reduced even during sobriety. An alcoholic  tries to justify his need for alcohol in every possible way, finds all kinds of “worthy reasons”, transfers responsibility for his drunkenness to others, etc.

The second stage of alcoholism is manifested by an increase in the amount of consumed alcohol. A person drinks more alcohol than before, while the ability to control the intake of ethanol-containing beverages disappears after the first dose. Against the background of acute rejection of alcohol, withdrawal symptoms arise: tachycardia, increased blood pressure, sleep disorders, trembling fingers, vomiting when taking liquid and food. The development of delirium tremens, accompanied by fever, chills and hallucinations is possible.

The third stage of alcoholism is manifested by a decrease in alcohol tolerance. To achieve intoxication for a patient suffering from alcoholism it is enough to take a very small dose of alcohol (about one glass). When taking subsequent doses, the condition of the patient with alcoholism remains practically unchanged, despite an increase in the concentration of alcohol in the blood. An uncontrolled craving for alcohol occurs. The use of alcohol becomes constant, the duration of binge increases. When refusing to take ethanol-containing beverages, alcohol delirium often develops. Mental degradation in combination with marked changes in internal organs is noted.

Treatment and rehabilitation for alcoholism

Measures for the alcoholism treatment can be emergency or planned, carried out at home, on an outpatient or an inpatient basis. Medicamentous therapy, psychotherapeutic methods of exposure and combined methods are used. After treatment for alcoholism, rehabilitation on an inpatient basis is required in severe cases. Depending on the specific circumstances, a patient with alcoholism may be recommended personal or family psychotherapy, support groups attending, etc.

Emergency measures for the patient’s treatment with alcoholism include removal from binge and the elimination of withdrawal syndrome. At the initial stages of alcoholism and with short binges, treatment at home is possible. In other cases, transportation to a narcological clinic is necessary. Salt solutions are transferred to the body of a patient, vitamins, antioxidants, sedatives and antipsychotics, as well as medications for normalizing the work of the heart, liver, pancreas and brain.

Scheduled treatment of alcoholism can be medicated or non-medicated. When using medicated coding methods for alcoholism, a medication that causes mentioned negative consequences after drinking is introduced into the patient's body. Capsule suturing or intravenous administration of the medication is possible. Non-medicated treatment involves the impact on the patient's psyche to create an attitude toward refusing to alcohol intake, realizing the seriousness of the consequences of alcoholism, etc. Currently, combined methods of treatment are often used – the introduction of medications in combination with hypnosuggestive psychotherapy. Both outpatient treatment and hospitalization for therapy aimed at restoring the functions of various organs are possible.

The final stage of alcoholism treatment is social rehabilitation. The «12 steps» group program (community of anonymous alcoholics) has increasing popularity. As part of this program, people with alcoholism provide each other with mutual assistance and support. 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 stages 2-3, before joining AA, it is necessary to undergo treatment by a narcologist.

The prognosis for alcoholism

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, therefore they do not seek medical help. In case of physical dependence, remission for a year or more is observed in only 50-60% of patients. Narcologists note that the likelihood of prolonged remission increases significantly with the active desire of the patient to abandon alcohol.

The life expectancy of patients suffering from alcoholism is 15 years less than the average for the population. The cause of lethal outcome can be typical chronic diseases and acute conditions: alcohol delirium, stroke, cardiovascular failure and cirrhosis. Alcoholics more often suffer from accidents and commit suicide. There is a high level of early disability among this population group due to the consequences of injuries, organ pathology and severe metabolic disorders.

 

 

Valeologist

of the 4th Clinical Hospital named after M. Saŭčanka             U. Čarnoŭ

Information is compiled using medical literature