Alcoholism is a chronic disease characterized by behavioral, physical, and mental alterations caused by the compulsive consumption of large amounts of alcohol.
Alcohol dependence, or alcoholism, is characterized by compulsive drinking behavior and by habituation and tolerance (to achieve a certain desired effect, the individual is forced to drink increasing amounts of alcoholic beverages). As with any substance addiction, the abrupt interruption of alcohol consumption causes the withdrawal syndrome, which is characterized by tachycardia, tremors, nausea and vomiting, agitation, hallucinations, seizures. The effects of alcoholism severely interfere with a person's health and his or her work, relational and social life.
Alcoholism is defined by the presence of:
- Loss of control of alcohol consumption: ineffective attempts to control the urge and continuation of compulsive behavior despite the serious consequences associated with consumption.
- Craving: compulsive desire to consume alcohol.
- Dependence: inability to give up the intake of alcohol and consequent effort to obtain it, due to the irresistible desire linked to the pleasure of the assumption (psychological dependence), with the tendency to increase the dosage to maintain the same effect (tolerance) and the fear of the onset of organic symptoms of deprivation or withdrawal (physical dependence).
- Change in lifestyle: tendency to isolation and deterioration of usual social relationships up to the loss of them.
- Social problems: family, social network, work.
Causes and risk factors
There are several conditions that could be a risk factor for alcoholism:
- gender: men are affected twice as much as women;
- age: those who start drinking at a very young age (adolescence) are more at risk of alcohol-related diseases or alcoholism;
- family history of alcoholism: those who have one or both parents who are alcoholics are at higher risk for alcoholism; having a partner or close friend with an alcohol problem also increases the risk of alcoholism;
- the presence of other psychiatric illnesses: depression, bipolar disorder, some personality disorders (borderline and antisocial disorder are the most common) and post-traumatic stress disorder;
- a very stressful lifestyle or one that exposes to a high number of social events;
- low self-esteem;
- traumatic experiences in childhood and adulthood (domestic violence and/or sexual abuse);
- difficulty in emotional regulation: alcohol abuse would aim to alter a negative emotional state but it does so through a dysfunctional strategy of avoidance of unwanted emotional experiences (self-medication). In fact, alcohol can increase the perception of positive emotions, as well as alleviate that of negative states.
Damages
The effects of alcoholism are very serious. The main impairments concern the liver and can lead to the development of cirrhosis and hepatic neoplasms. Diabetes, stroke, and gastrointestinal and cardiovascular disease can occur. Those who drink large amounts of alcohol over a long period of time run the risk of developing severe and permanent brain changes. The damage may be the result of: alcohol's direct effects on the brain; the indirect result consists in a poor overall health or a serious liver’s disease, which is the organ primarily responsible for metabolizing alcohol.
A thiamine (vit. B1) deficiency commonly occurs in individuals with alcoholism and is usually the consequence of poor general nutrition. Some individuals may develop severe disorders that result in confusion, paralysis of the ocular nerves, difficulty with muscle coordination, and persistent learning and memory problems.
Alcoholism and relapse
Alcoholism is a chronic condition with a high risk of relapse. Patients with alcoholism have difficulty initiating change on their own and, as in other addiction problems, the central problem is maintaining the change over time. In the pathway to relapse, the inactive alcoholic performs a series of seemingly insignificant acts that progressively bring him or her closer to alcohol, so relapse occurs even before the first actual use of alcohol, and so it continues. The determinants of relapse are: "high risk" situations such as negative emotional states (anger, anxiety, depression, frustration, boredom); interpersonal conflicts; social pressure (being with other people who are drinking); or even positive emotional states (desire to intensify pleasurable emotions).
The possibility of relapse depends on what will be the patient's response to the high-risk situation they are in, and that response is determined by their ability to cope with the exposure situation. In patients with inactive alcoholism the failure in the coping process of "high-risk situations" causes the assumption of the first dose of alcohol, triggering the "abstinence violation effect" ("first drink effect") which is followed by feelings of failure and loss of control of the situation and, almost inexorably, relapse. Negative emotional conditions and interpersonal conflicts represent higher and more frequent risk situations than social occasions or pressures.
Treatment
Once addiction is established, it is no longer possible for the alcoholic to return to being a social drinker, so a conscious choice to abstain from any alcoholic substance is necessary.
Alcoholism is a disease and as such should be treated with a multidisciplinary approach. Alcohol detoxification involves an initial phase of medical and psychiatric evaluation, in which the patient undergoes a series of routine and specific examinations, as well as some psychological tests. The treatment for alcoholism may include medicines based on Disulfiram, which in association with alcohol causes a series of adverse physical reactions, and based on Naltrexone, which helps to reduce the desire to drink. Hospitalization in a protected structure for a previously determined period of time may be essential along the pharmaceutical therapy: here intensive treatment is accompanied by psychological and psychotherapeutic support.