Alcoholism

Alcoholism is defined as a chronic addiction to alcoholic beverages. It is manifested through a strong desire for liquor, loss of control when drinking, symptoms of physical withdrawal, and increased alcohol tolerance. Alcohol addiction is a severe psychological disorder, because a pathological process which changes the way in which the brain functions occurs.

In the long run, alcoholism causes many serious health problems like liver cirrhosis, alcohol poisoning, heart disease, kidney disease, and several psychological disorders, the most famous of which is Korsakoff’s psychosis. In children born by alcoholic mothers, an entire array of malformities has been noted, which occur more often than with the children born of mothers who were addicted to heavy drugs.

There are many indirect consequences of alcoholism such as traffic accidents, workplace accidents, as well as the increased crime rate, considering that a frequent alcohol intake is an important criminogenic factor.
Development

We can divide the causes of alcoholism into biological, psychological, and sociological.

• Biological: in the group of biological contributors, genetic theories are the most common. They observe alcoholism as a hereditary disease. All kinds of different genetic parameters certainly create differences in reaction to alcohol, different brain sensitivity and other bodily systems to alcohol, the speed in which the alcohol is eliminated from the body, gaining tolerance and physical addiction.

• Psychological: psychological theories observe alcoholism as an individual psychological problem, and social factors can more or less affect the development. Oral fixation and a halt in personality development are being mentioned as the most important traits of primary alcoholism. These fixations later result in infantilization, increased addiction, narcissism, and passivity.

•  Sociological: sociological view on alcoholism considers concepts and theories such as the primary and the secondary family, but also, very often, the family alcoholism.

None of the theories can be excluded, since alcoholism is an extremely complex problem which envelops all of the factors of different branches of knowledge. Therefore, each individual branch of causes participates with at least one factor in creating alcoholism. Alcoholism is never a result of one factor alone.

Risk factors

Propensity towards alcoholism can be determined by looking at certain risk factors which are:

• Sex (male alcoholics outnumber the female by 3-5 to 1),

• Family tendency,

• Certain professions (waiters, writers, actors, alcohol factory workers)

• Religious, ethnical, and geographical factors (Muslims and Jews rarely drink, the French, the Finns, and the Swedes drink more)

• Persons with lower levels of serotonin are more prone to alcoholism, but it also depends on activity levels of ADH and ALDH enzymes.

Diagnosis

Alcoholism occurs when the alcoholic beverage tolerance is increased, when a person is losing control, and when a person always drinks until inebriated. All these are clear signs of alcoholism.

Eventual early signs of alcoholism can, in the beginning, be an increased daily intake of alcohol. That is followed by objections in the family and in the workplace, which is followed by the first signs of family and work negligence.
CAGE questionnaire (Cut, Annoyed, Guilty, Eye-opener) can provide us with a “speedy” assessment of potential alcoholism:

• Have you ever felt like you have to cut down on drinking?

• Have you ever been annoyed by people criticizing your drinking?

• Have you ever felt guilty because of your drinking?

• Have you ever felt like you needed a drink in the morning to calm yourself down, or to alleviate boredom?

If the subject answers at least two of these questions with “yes”, that would be a signal of potential alcoholism and further testing would be required.

Besides this one, there are other tests:

Urine and blood tests show the current condition in which a person is in, but cannot differentiate between an alcoholic and a momentarily intoxicated person. However, alcoholics have certain distinctions in their bodies like macrocytosis, increased gamma (GGT – gamma-glutamyl transferase), elevated AST and ALT and their ratio AST: ALT = 2: 1, elevated CDT.

EEG can also show that alcoholics have higher frequency beta-waves (13-30Hz), and the entire EEG is desynchronized.

Stages of alcoholism

• The social drinker stage – the body gets used to alcohol. Repeated intake increases the body’s tolerance towards alcohol so the consumer keeps increasing the intake in order to achieve the same effect.

• The alcoholism stage – Alcohol addiction is marked with the constant need for repeated alcohol consummation in order to achieve pleasure or to avoid the abstinence crisis.

• The stage of irreparable harm – The body has a decreased alcohol resistance. Even a small quantity of alcohol can induce inebriation.

Fetal alcohol syndrome – FAS

Fetal alcohol syndrome occurs in mothers who consume alcohol during pregnancy; it is a damaged fetus, which manifests in visual and abstract plan, mostly in the form of damage to the central nervous system, physical facial changes, and growth issues.

Alcohol reaches the fetus through the mother’s blood, when the fetus is not yet capable of successfully metabolizing alcohol. In some cases, alcohol level in fetus’s blood can be up to ten times as high as the mother’s. If the damage occurs in the first six weeks of pregnancy, we call it alcohol embryopathy, and if it occurs in the period after the 6th week, it is called alcohol fetopathy. Damaged growth is a significant deviation from the average, in both weight and height, and they don’t necessarily occur right after birth.

Abnormalities of face and forehead, like microcephaly, hypertelorism (eyes too far apart), narrow palpebral fissure, hypoplastic (undeveloped) upper jaw, flat nose, reduced joint mobility. The upper lip is significantly thinner than normal, and the section between the nose and the upper lip is also flat, the nose root isn’t visible, and the nose is aligned with the forehead while the tip of the nose is twisted upwards.

The eyes are shaped in a distinctive way – narrow palpebral fissures and the distance between them are different. Hands can develop minor deformities of the little finger. Clear facial abnormalities also indicate brain damage, which can cause slight or severe mental retardation.

The damage can be structural, neurological, or functional in its nature. An infant with the FAS has significantly smaller and deformed brain. In the first stage of pregnancy, alcohol can disrupt the allocation of cells, which causes structural deformation. In the second stage, hippocampus can be damaged, and it is responsible for memory, learning abilities, emotions, and the coding of visual and audio information.

Neurologically speaking, damages to the peripheral nervous system and the autonomic nervous system can occur. More severe damages, which can come up, are epilepsy and similar syndromes. Other signs are bad fine motor skills, sound detection defects, clumsiness, bad hand-eye coordination, and damaged sensory system.

Functionally speaking, many complex cognitive and behavioral disorders can occur. These include learning difficulties, impulse control, social perception (integration) and communication, math skills, memory, judgment, attention disorder and hyperactivity (ADHD), mental retardation, inability to differentiate between imagination and reality, confusion under pressure and many more different functional disorders.

Alcoholism and family

A place where the alcoholism is first manifested is family. In that case, we can speak of family alcoholism, since both partners, and sometimes even children, participate in alcoholism. Most alcoholics who are undergoing treatment are married with two kids. Fewer are divorced, with divorce often having been caused by alcoholism, and even fewer are young people.

Facts about alcoholism

•  One third of all marriages fall apart because of alcoholism.

• Alcoholism causes people to neglect their family duties and children, but the worst case scenario is when both parents are alcoholics.

• Alcoholism causes families to become poorer, both emotionally and materially.

• Alcoholism leads to aggression and violence in the family, where the children are also victims, and it causes the so-called dysfunctional family, which results in separation or the premature death of the alcoholic.

• Alcoholism’s effect on the population policy is negative.

• Alcoholism leads to psychological disorders within the family, mostly and most importantly with children.

• Alcoholism is a problem of the entire family and the environment, and children have a hard time dealing with it, especially if they are going through development or if they are in sensitive stages of their lives.

Anonymous alcoholics – AA

Groups of anonymous alcoholics (AA) were founded in the US in 1930s. Their function was to help each other during abstinence and progress, and the alcoholics’ wives and children formed their own groups some time afterwards. Today, there are around 50.000 of such groups. In a group of anonymous alcoholics, about 60-70% of them achieve the one-year abstinence.

In the clubs of treated alcoholics, they use a 12 couple principle. The club represents a part of the system designed to support families of alcoholics (healthcare, social security, and state institutions participate in the system). A family visits the club of treated alcoholics once a week, and it is suggested that they should continue with that activity for at least five years.

Recidivism is present in alcoholics who do not receive the adequate treatment, without family therapy and the club of treated alcoholics. Without long-term support, an alcoholic quickly goes back to his old ways that are approved, or even encouraged, by his environment. The source of drinking can be the family which has such customs and has passed them on from generation to generation, or the society which tolerates behavior disorders and alcoholism.