Alcohol dependence (sometimes called alcoholism) is a chronic disease in which a person drinks more than intended, repeatedly tries unsuccessfully to stop drinking, and drinks despite the harmful consequences for relationships with the environment and at the workplace.
TREATMENT OF ALCOHOLISM: General | Causes | Biological Effects | Treatment | Questions and Answers | Sources/references
Alcohol addiction is widespread. Nearly 8 percent of adults in the United States have a drinking problem. Men become addicted four times more often than women. Alcohol addiction affects people of all ages.
More and more often, children and adolescents also have severe problems due to alcohol. Alcohol causes mental and physical dependence, which usually affects a person's relationships with others and his ability to work, and his behavior becomes disruptive in all areas of his life.
Picture: Alcohol causes mental and physical addiction.
Alcoholic addicts get drunk often, sometimes even every day. Drunkenness has a devastating effect on relationships in the family and elsewhere, resulting in frequent divorces. Due to frequent absences from work, many people with an addiction remain unemployed. People with an addiction are unable to control their behavior, drive under the influence of alcohol, and are often injured in falls, fights, or traffic accidents. Some people addicted to alcohol become violent.
Effects of alcohol on non-alcoholics:
| Blood alcohol concentration | Effect |
| 0.5 per mille (0.5 mg/kg) | playfulness, calmness |
| 0.8 per mille (0.8 mg/kg) | worse coordination of movements (reduced mental and physical abilities), slowed reflexes (both of which reduce driving abilities) |
| 1 per mille (1 mg/kg) | noticeably impaired coordination |
| 2 per mille (2 mg/kg) | confusion, memory problems, severe disability (cannot stand) |
| Three ppm (3 mg/kg) | loss of consciousness |
| Four ppm (4 mg/kg) and above | coma, death |
They also write as dependent personalities who look for support in their relationship with others and only have difficulty taking care of themselves. Some people get upset quickly over little things and have poor control over their sexual needs. Such drugs help control behavior. However, most of these personality traits appear to be the result of long-term addiction and were not present in people with an addiction before becoming addicted.
Sometimes, family members or friends behave in a way that encourages the person with an addiction to continue abusing alcohol and drugs. Such people are called co-addicts, and they usually organize the addict's sick leave or excuse him in various ways.
Video content: How to reduce intake, desire, and need for alcohol?
The addict's friend, for example, he defends it like this: "Peter didn't want to break the equipment in the pub, he was just angry because they didn't want to serve him any more drinks." The co-addict often begs the person with an addiction to stop drinking or drugs but rarely does anything practical to help the person with an addiction change his behavior.
Family members and friends who don't care what happens to the person with an addiction should encourage him to stop using drugs and get treatment. If the person with an addiction refuses treatment, family members should threaten to disown him or divorce him. This seems a bit cruel, but such behavior should be agreed with a specialist who can take him for treatment.
A pregnant woman who is addicted also drugs the fetus. He often does not even tell the doctor that he is taking drugs. Thus, the fetus also becomes physically dependent on the drug. Such a newborn falls into a withdrawal crisis shortly after birth. Newborns who survive it can have a host of other problems. It also happens that the illicit drug is not what it is sold for. It can be of inferior quality and of varying strength, which can be very dangerous for the person with an addiction.
Causes
The causes of alcohol addiction are unknown, but drinking is certainly not the only factor. About 10 percent of people who drink alcohol are dependent on it. Close relatives of alcohol addicts are more at risk than others of becoming addicted themselves.
Also, children of addicted parents are more likely to develop alcohol dependence than their adopted children, suggesting that alcohol dependence may be related to a genetic or biochemical defect. Some research shows that people who are more prone to alcohol dependence have a much harder time getting drunk than non-addicts. This means that their brains are less sensitive to the effects of alcohol.
Image: Alcohol addicts often feel rejected.
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In addition to genetic defects, the environment from which a person originates and a person's personality traits also influence the development of addiction. Alcohol addicts often come from dysfunctional families and have disturbed relationships with their parents.
Alcohol addicts often feel rejected, alone, scared, depressed, or hostile. They often behave in self-destructive and personality and sexually immature ways. However, there is no specific type of personality that becomes addicted to alcohol more often than others. On the contrary, there are all kinds of personalities among those addicted to alcohol.
Biological effects
Alcohol is absorbed very quickly through the small intestine into the bloodstream. Because alcohol is absorbed faster than it is metabolized and eliminated from the body, its level rises rapidly. A small amount of alcohol in the blood is excreted unchanged through urine, sweat, and exhaled air. Most alcohol is processed in the liver.
Alcohol has an immediate effect on brain functions. The higher the amount of alcohol in the blood, the more it affects the brain. The amount of alcohol can be measured directly in the blood or estimated by measuring it in exhaled air. Laws in most states limit the amount of alcohol in the blood of drivers. In Slovenia, the legal limit is 0.5 ppm of alcohol in the blood.
Image: Prolonged consumption of excessive amounts of alcohol damages many organs in the body.
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Prolonged consumption of excessive amounts of alcohol damages many organs in the body, especially the liver, brain, and heart. Like other drugs, alcohol increases tolerance, so that people who regularly drink more than two drinks a day can drink more alcohol than non-drinkers without getting drunk.
Alcohol addicts can also become desensitized to sedatives; e.g., those taking barbiturates or benzodiazepines require higher doses to achieve a therapeutic effect. Less sensitivity, however, does not affect the way alcohol is metabolized or eliminated, which affects the brain and other tissues to get used to it.
Consequences of long-term alcohol abuse:
| Type of effects | Effects |
| low folic acid | anemia, congenital disabilities |
| low iron | anemia |
| low niacin | pellagra (skin changes, diarrhea, depression) |
| esophagus | inflammation (esophagitis), cancer |
| stomach | inflammation (gastritis), ulcer |
| liver | inflammation (hepatitis), cirrhosis, cancer |
| heart | abnormal heartbeat (arrhythmia), heart failure |
| blood vessels | high blood pressure, arteriosclerosis, stroke |
| pancreatitis | inflammation (pancreatitis), low blood sugar, cancer |
| brain | confusion, decreased coordination, poor short-term memory (poor recall of events that just happened), psychosis |
| nerves | damage to the nerves in the arms and legs that control movement (reduced ability to walk) |
If an alcoholic suddenly stops drinking, they may go into a withdrawal crisis, a withdrawal syndrome that usually begins 12 to 48 hours after they stop drinking alcohol. Mild symptoms include tremors, weakness, sweating, and nausea.
Some people get seizures (alcoholic epilepsy). Heavy drinkers may experience alcoholic hallucinosis when they stop drinking. It means that they hear voices that sound accusatory and threatening, further causing fear and violence. Alcoholic hallucinosis can last for several days. It can be treated with antipsychotic drugs such as chlorpromazine or thioridazine, and in Slovenia, we already use newer drugs of this type.
If treatment does not occur at all, abstinence can cause more severe symptoms called delirium tremens. Delirium usually does not appear immediately; it occurs 2 to 10 days after stopping drinking. It usually begins with a feeling of tightness and continues with increasing confusion, insomnia, nightmares, excessive sweating, and deep depression.
Mental symptoms usually accompany physical palpitations and fever. But everything can escalate to short-term hallucinations and illusions that cause fear and restlessness. At the same time, one does not find oneself in time and place. Confusion and disorientation are getting worse. Sometimes, a person in delirium feels that the floor is moving, walls are falling, or the room is spinning. As the delirium progresses, the hands start shaking, sometimes spreading to the head and body, and the person becomes completely uncoordinated. Delirium can be fatal, especially if left untreated.
Other problems are directly related to the toxic effect of alcohol on the brain and liver. Due to alcohol, the affected liver is no longer able to cleanse the body of toxic substances, which can lead to hepatic coma. A person in a hepatic coma is numb, sleepy, and confused. Unusual hand tremors are also characteristic. Hepatic coma is life-threatening and requires immediate treatment.
Video content: How to help someone with alcohol addiction.
Korsakoff's syndrome (Korsakoff's amnestic psychosis) usually occurs in people who regularly drink large amounts of alcohol, especially those who are malnourished and have a deficiency of B vitamins (especially thiamine). A person with Korsakoff's syndrome loses memory of current events.
Her memory weakens so much that she often makes up stories to cover up her memory impairment. Korsak's syndrome is sometimes followed by delirium, and some develop Wernicke's encephalopathy. Signs of this brain damage include abnormal eye movements, confusion, uncoordinated movements, and abnormal nerve activity. Korsakov's syndrome can be fatal if thiamine deficiency is not treated immediately.
Pregnant women with a history of chronic, heavy drinking can have severe congenital disabilities in their babies, such as low birth weight, short height, small head size, heart and muscle defects, and impaired mental development. H Moderate social drinking (e.g., two glasses of wine per day) does not cause problems yet.
Treatment
Alcohol addicts who fall into an abstinence crisis know how to help themselves by simply drinking alcohol. Some people seek medical help either because they want to stop drinking altogether or because withdrawal symptoms become too severe.
In both cases, the doctor determines whether the patient has any disease or head injury that could further worsen the health condition. He then tries to define a range of withdrawal symptoms and find out how much the patient usually drinks and when he stops drinking.
Since vitamin deficiency can cause life-threatening withdrawal symptoms, doctors in emergency departments give such patients large doses of vitamins C and B, especially thiamine, intravenously. They also receive a liquid with magnesium and glucose through a vein, preventing withdrawal symptoms and body fluid loss. Doctors often prescribe a benzodiazepine or some other sedative to calm agitation (restlessness) and prevent withdrawal symptoms.
Alcoholic hallucinosis, which only rarely affects alcohol addicts, is treated with antipsychotic drugs. Delirium, which can threaten the patient's life, is treated more decisively and with larger doses of medication, as they want to control high body temperature and severe agitation. By injection into a vein, such patients are given fluids with drugs that reduce high body temperature (such as paracetamol) and sedatives. Constant monitoring and care of the patient is also necessary. With such treatment, delirium usually subsides within 12 to 24 hours.
Image: The AA program provides a framework for self-examination and a path to alcohol-free recovery.
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Once all urgent medical problems are resolved, the patient's detoxification begins, and a rehabilitation program is created for him. In the first phase of treatment, the patient eliminates all alcohol from the body. Then, the alcoholic must change his behavior. Staying sober is very difficult. Without help, most return to their old ways within days or weeks. It is generally believed that group treatment is more successful than individual treatment. No matter what, the treatment should be tailored to the individual. Of course, the participation of the patient's loved ones in his treatment program is also essential.
Drug treatment
Some people with an addiction can be helped to stop drinking alcohol by certain drugs, such as disulfiram. It works by stopping alcohol metabolism in the body at the acetaldehyde stage. The latter is poisonous, and if a person drinks alcohol after taking disulfiram, within 5 to 15 minutes, he experiences flushing, a severe headache, rapid heart rate, rapid breathing, and sweating. After 30 to 60 minutes, nausea and vomiting may follow. These unpleasant and sometimes dangerous reactions last from 1 to 3 hours. Because they are so unpleasant, few people with an addiction take the risk of drinking alcohol after taking disulfiram.
At the beginning of treatment, an alcoholic should not take disulfiram immediately after stopping drinking but only after a few days of sobriety. Namely, disulfiram can affect the metabolism of alcohol for 3 to 7 days after the last dose of the drug. Because of the severe reactions to alcohol associated with treatment, disulfiram should only be prescribed to treat alcoholics who are serious about getting help and willing to work with their doctor and counselors. Pregnant women and people with any severe illness should not take disulfiram.
Video content: Alcohol use disorder and treatment.
Another drug is naltrexone, which helps reduce alcohol dependence when used as part of a treatment program that includes counseling. It alters the effects of alcohol on certain endorphins in the brain, which may be related to alcohol cravings and drinking. The significant advantage of naltrexone over disulfiram is that it doesn't make people sick. The downside is that a person taking naltrexone can continue to drink. Naltrexone should not be taken by people who have hepatitis or other liver disease.
Alcoholics Anonymous
No way is as successful and effective as the help that people with an addiction give themselves when they participate in Alcoholics Anonymous (AA). These groups operate according to religious principles, but alternative organizations exist for those who want more secular rules.
The alcoholic must feel comfortable in a particular group, and in addition, the members of a particular group should also be united by common interests, not just a common disease. In some big cities, e.g., there are groups of alcoholics anonymous, in which there are only doctors and dentists or people of some other professions or with specific hobbies, but also groups of single or homosexual men and women.
Image: Recovery from alcohol or other drug addiction is a process that can take a long time.
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Alcoholics Anonymous groups meet in suitable places where they can socialize without drinking alcoholic beverages. They hang out to support each other when someone is in trouble or when they might turn to alcohol again. In such a group, the alcoholic listens to other people with the same experiences as himself and who, like him, struggle every day to drink something. Last but not least, a person in the Alcoholics Anonymous group regains his lost self-confidence when he helps others survive without alcohol.
Questions and answers
How do we know that we are addicted to alcohol?
Signs of alcohol dependence include:
- inability to function without alcohol
- drinking has become essential or the most essential thing in life
- continuing to drink despite negative consequences for you or your loved ones
- difficulty controlling the amount of time you drink
- difficult to stop drinking when you want to
- you cannot always plan with certainty how much you will drink on a given occasion
- drinking increasing amounts of alcohol
- alcohol cravings or withdrawal symptoms
- does not appear to be intoxicated after heavy drinking
How long does alcohol addiction treatment take?
According to the National Institute on Drug Abuse (NIDA), less than 90 days of inpatient or outpatient treatment has limited effectiveness, so much more extended periods of treatment are recommended.
Can alcohol addiction recur even after effective treatment?
Recovering from addiction to alcohol or other drugs is a process that can take time but a long time. Relapse is part of recovery from alcohol and other drug addiction and can often be a feature of recovery.
Which consequence of alcoholism is the most dangerous?
In the long term, it can damage the heart and cause problems, including cardiomyopathy, arrhythmias, stroke, and cirrhosis of the liver.
What treatment is most effective for alcoholism?
Cognitive behavioral therapy is a talk therapy that uses an alcohol addiction problem-solving approach. The approach involves identifying unhelpful, unrealistic thoughts and beliefs that may be contributing to your alcohol addiction.
Sources and references
Extensive health manual for home use, Youth Book Publishing House
- Signs of alcohol dependence - https://www2.hse.ie
- How Long Is Alcohol Rehab? Alcohol Detox and Rehab Lengths - https://americanaddictioncenters.org
- Relapse - https://adf.org.au
- Alcohol's Effects on Health - https://www.niaaa.nih.gov
- Treatment - https://www.nhs.uk
