Alcoholism is the diseased condition caused by the continued, habitual, and excessive use of any alcoholic drink. It is a compulsive addiction that requires medical treatment to restore a healthy life. Nobody is born as an alcoholic, but some people become alcoholic over the years, due to their bad habits. This condition creates a strong need for alcohol, so that there is a physical dependency on it, manifested through certain withdrawal symptoms when intake is not possible. The alcoholic has no control over the boundaries of his or her consumption, which increase the tolerance towards this drug.
Characteristics of Alcoholism
So far, there is no common cause of alcoholism, although several factors may play a role in its development. Evidence shows that having a father or mother with alcoholism increases one's chances of developing the disease. Other causes may be stress or personal problems that motivate a person to begin drinking alcohol excessively.
Some other factors associated with this condition include the need to relieve anxiety, conflict in interpersonal relationships, depression, low self-esteem, and social acceptance of alcohol consumption.
Up to 80% of alcoholic patients also suffer from associated psychiatric disorders, and can therefore be regarded as patients with dual pathology.
Genetic Predisposition to Alcoholism
With the development of techniques for the study of DNA, certain genes have been linked to the existence of specific sequences or SNPs (single changes of a nitrogenous base present in a small part of the population), which would prove a genetic tendency to develop alcoholism determined by the genome itself. This trend may be based on differences in certain molecular methylation statuses of certain CpG islands (DNA regions which comprise approximately 40% of promoters of mammalian genes) and can be studied by analyzing SNPs.
Types of Alcoholism
Type I Alcoholism is characteristic of adults who may have a specific intake stage, separated by periods of abstinence; abstinence periods continue to decrease until a person achieves a high dependency, progressively accompanied by the development of liver disease.
Type II Alcoholism develops in men during adolescence and is often associated with a history of violence and police arrest. Type II is not characterized by a progressive increase in the consumption of alcohol. Some studies have found a lower expression of the enzyme monoamine oxidase in this group, which has been correlated with decreased production of serotonin (relaxation and activation of the sympathetic nervous system) in the central nervous system.
Symptoms of Alcoholism
People who suffer from alcoholism or alcohol abuse often have the following symptoms:
They continue to drink, even though it adversely affects their health, work, and family.
They drink alone.
When they drink, they become violent.
They become hostile when they are questioned about their alcohol consumption.
They are unable to stop or reduce alcohol consumption.
They make excuses for drinking alcohol.
They leave work or school to drink alcohol.
They lower their job performance.
They try to get alcohol by any means necessary.
They stop taking part in family or social activities due to alcohol consumption.
They need to drink alcohol most days to feel "fine."
They do not eat well. Neither do they care about proper nutrition.
They do not mind not being well dressed and lose interest in personal hygiene.
They try to hide the fact that they consume alcohol.
They tremble in the morning or after periods without drinking.
Signs of Alcohol Dependence Include:
Memory lapses (gaps) after binge drinking.
A growing need for more and more alcohol to feel drunk.
Alcohol withdrawal symptoms when they have not had a drink for a while.
Alcohol-related diseases, such as Alcoholic Liver Disease.
Social Impact of Alcoholism
Alcoholism is a serious health hazard that often carries the risk of premature death from liver diseases -(such as cirrhosis of the liver or liver cancer), internal bleeding, alcohol poisoning, accidents, or suicide.
Alcoholism is not determined by the quantity consumed in a given period; people affected by this disease may follow very different patterns of behavior, with some consuming large amounts of alcohol daily and others drinking weekly, monthly, or without a fixed periodicity. Although, the degenerative process tends to shorten the time between each intake.
Excessive and prolonged use of this substance forces the body to need or require progressively increasing amounts to feel the same effects; this is called "increased tolerance" and triggers an adaptive mechanism of the body, until it reaches a limit in which it reverses the supposed resistance and then "assimilates less." Therefore, the toleration of more alcohol in itself is a risk for severe alcohol addiction.
Deaths from alcohol-related accidents (vehicle collisions, pedestrian accidents, and suicide) rank first among the causes of death in many countries. It is believed that ethanol (the form of alcohol used in alcoholic beverages) causes millions of deaths each year from drunk poisoning and traffic accidents. Alcohol abuse is associated with 70% of deaths in traffic accidents and is the leading cause of death among people aged 15 to 30 years old.
How is Alcoholism Diagnosed
To diagnose alcoholism, some questions are used to determine if the person is an alcoholic. When a patient visits the doctor, the doctor asks about the consumption of alcohol. The doctor may also obtain records through family history, or those provided by third parties. A physical examination may be used to identify physical problems related to alcohol consumption. The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to assess alcohol abuse and dependence:
- Do you ever drive when you have been drinking?
- Do you have to drink more than before to get drunk or feel the desired effect?
- Have you felt you should stop drinking?
- Have you ever had blackouts after drinking?
- Have you ever missed work or lost a job because of drinking?
- Is there someone in your family worried about your drinking?
In addition, there are lab tests that detect alcoholism. Among them are a toxicology screening ( a test to measure blood alcohol level) or a liver function test.
Treatment of Alcoholism
To treat alcoholism, the therapist establishes a series of goals to achieve, because the end of any therapeutic program aims to motivate the patient to continue treatment, and once the goal is met, to remain abstinent, if possible, throughout life.
The motivation for the patient is to show him or her that decreasing alcohol consumption will result in better health and quality of life. This is achieved by improving the nervous system and digestive system, which have been affected by alcohol ingestion. An improved quantity and quality of sleep is also a positive motivator. Finally, improving relationships with family, friends, and co-workers is perhaps one of the greatest motivators..
In order to achieve full recovery of the alcoholic patient, the therapist must set goals for the short, medium, and long terms. Then, the patient must progressively perform and complete these goals, for which will be employed all therapeutic possibilities that are available, both pharmacological, psychological, or psychosocial, as standard.
The alcoholic patient must make two important steps:
The first step is to stop drinking at this time; this will put the alcoholic patient into a withdrawal syndrome, which must be properly treated. This stage of treatment is known as “alcohol detoxification.”
The second step is to stop drinking for the rest of life, applying pharmacological or psychological therapy, as needed. This phase of treatment is known as “alcoholic quit.”
All of these therapeutic processes are based on three points:
Self Help Groups
Stop Drinking Alcohol
This is the first step to be taken by the addict, and it involves the immediate and complete withdrawal of alcoholic beverages, which will lead to the appearance of a withdrawal syndrome that must be prevented or treated.
This process is carried out on an outpatient primary level, although there are a number of circumstances that will require that the process is carried out in a hospital setting, as follows:
- Absence of a responsible person controlling the whole process
- Coexistence of severe organic or psychiatric pathology in the affected person
- Personal history of seizures or delirium during alcohol dependence
- Multiple failures in previous attempts at detoxification on an outpatient level
- Presence of a severe withdrawal syndrome, despite all the means to prevent its occurrence
To perform this detoxification, the patient will need help, which consist of the following:
Provision of liquids that replace the absence of alcohol, which will be supplemented with vitamin B, and if a deficit thereof occurs, this can be accompanied by folic acid and iron.
Treatment of withdrawal by drug therapy, which has a calming and selective effect on the patient; there is a wide battery of drugs for this purpose, including the following:
Clomethiazole: Binds to alcohol's calming agent; an anticonvulsant action
Tetrabamate: Safer and does not potentiate the effects of alcohol
Other compounds: These include dipotassium clorazepate, diazepam, lorazepam, and Tiapride.
Maintaining Abstinence in Therapy for Alcoholics
This is the second phase of treatment, and possibly the most important and difficult to follow.
At this stage, we try to make the situation of non-consumption, achieved by the previous phase, possible to maintain for a long period of time. In the best case, we will try to continue abstinence throughout at patient's lifetime. To do this, we will try to act on multiple aspects of the patient and the surrounding environment, including family, as well as work or social spheres, in order to break free from alcoholic behavior, and this behavior is further consolidated.
Pharmacotherapy for the Alcoholic Patient
Pharmacotherapy is complementary to other commonly used therapeutic practices for treating alcoholism. Among the pharmacological possibilities are included the following:
Use of anti-craving drugs in the treatment of alcoholics
Use of therapy for the prevention of relapse in alcoholic patients
There are mainly two types of drugs: Acamprosate and Naltrexone.
Use of Acamprosate in the Treatment of Alcoholics
This is a drug whose mechanism of action is the inhibition of neuronal excitability through antagonism of the activity of the excitatory amino acids (particularly glutamate), and also by a reduction of calcium flux by blocking the transport channels thereof.
In this way, suppression of the desire for alcohol consumption is achieved due to induced abstinence.
Acamprosate is a safe and very well tolerated drug, with the most frequent side effects being gastrointestinal or dermatological, but with transient duration. There is no risk of abuse of this drug, as it lacks muscle anxiolytics, hypnotics, or relaxing effects. The treatment period is approximately one year.
Use of Naltrexone in the Treatment of Alcoholics
This substance is an antagonist (non-selective) for opioid receptors, having prolonged action.
It is now known that endogenous opioids are related to the processes of extinction of emotional impulses by the appearance of rewarding events. However, in alcoholics high risk addicts, all control processes are altered, causing continuation of the intake. This produces a cut in the activity of the opioid system by this substance, thereby resulting in the desired control mechanisms. Blocking these receptors prevent the presence of the euphoric or rewarding effects of alcohol.
Several studies have found that the administration of naltrexone, accompanied by psychotherapy, is very valid in reducing alcohol consumption. Additionally, it allows the reduction of other medications taken by the patient, such as anxiolytic or antihypertensive drugs.
In conclusion, this substance gives important therapeutic benefits with low risks (side effects include nausea, headache, dizziness, etc.) when accompanied by psychological or psychosocial therapies. Naltrexone is recommended for use with a minimum treatment period of three months.
Using Serotonergic Agents in the Treatment of Alcoholics
The results of serotonergic agents in the treatment of alcoholism without concomitant psychiatric disorders are modest, and no large studies support this treatment method. These agents are used in the treatment of concomitant pathologies, such as depressive symptoms.
Drug Use Interdictors or Aversives
Substances are aimed at the following:
Prevention and discouragement of drinking alcohol
Covering of the early periods of abstinence
Reinforcement of the decision to stop drinking
We must assume that these drugs do not suppress the desire for alcohol consumption, but are rather a "help" in the abstinence process, and if we find the drug, a patient may need to continue taking this medication throughout the detoxification process.
Among these drugs, there are two substances that are primarily used: Disulfiram and Calcium Cyanamide. These medicines produce allergic symptoms typical to poisoning from acetaldehyde when alcohol is ingested. The patient experiences generalized vasodilatation with flushing, headache, tachycardia, orthostatic hypotension, vomiting, dyspnea, dizziness, and blurred vision; symptoms are more obvious with disulfiram than calcium cyanamide.
Clinical data from several studies point out that these drugs or aversive interdictors are useful in motivated patients, especially if other strategies to facilitate compliance with the program are used.
Psychotherapy for Alcoholic Patients
This type of therapy results from the belief that alcohol consumption is based on a learned behavior, a number of causes that led to its inception, and a series of consequences that perpetuated consumption.
This behavior must be modified by acting on the individual who is the primary goal of therapy, and the patient must be encouraged at all times to avoid situations or places of consumption, and with the complicity of family or friends to support the alcoholic patient in his or her task.
Unfortunately, it seems that, although rapid recoveries are achieved, the risk of relapse is great, so the patient is trained in various techniques, such as relaxation, handling social situations, and completing appropriate assertive behaviors, such that there is no relapse in alcohol consumption.
Group Psychotherapy for Alcoholics
Often, the support of others motivates us and increases our strength for achieving specific goals. It is on this principle that psychotherapy is based. When a patient who increases interpersonal relationships he or she will be motivated to observe any defects he or she may have.
The topics covered in the group of therapeutic importance are as follows:
Gaining information on aspects of the disease.
Developing feelings of hope.
Observing that alcoholism affects other people, thus reducing feelings of guilt or anxiety
Learning new skills and experiencing social cohesion
Family or Couple Psychotherapy for Alcoholics
With this therapy, it is assumed that the patient is a reflection of the family environment, and family problems act as inducers of alcoholic problems. This therapy will be implemented to act on the individual and his or her family, reorganizing its system performances.
There are several self-help groups available for individuals struggling with alcoholism (Alcoholics Anonymous, Alcoholics Rehabilitated, etc..); these groups act by strengthening the alcoholic's decisions and encouraging the avoidance of contact with alcohol.
They are based on the group member's inability to cope on his or her own with the problems of alcoholism and encourage openness between the components and finding hope of recovery. The average age of group members is 30 years, and there is a higher percentage of women in the groups, as well as persons with concomitant addictions.