Alcoholism. Causes, types, symptoms, stages

What is alcoholism?

Alcoholism is a form of substance abuse that is characterized by addiction to drinks containing ethyl alcohol. Alcoholism is characterized by social maladaptation, the development of mental and physical dependence.

Today, alcoholism is one of the common causes of death among adults. So, over the past decade, life expectancy among the male population has decreased by more than 7 years, and among women - by 10 years. It is worth noting that previously such a massive loss of the working-age population was characteristic only for the period of wars. Moreover, mortality in alcoholism in some countries is so high that it outstrips population growth.

Such a high percentage of alcoholization of the population is explained not only by a poor-quality healthcare system and psycho-emotional stress, but also by a wide variety of alcoholic beverages, most of which are highly toxic.

Alcoholism Statistics

According to statistics for 2014 in the Russian Federation more than 3 million people are alcoholics. Often, alcohol dependence begins to form in adolescence. Among the alcoholics surveyed, 65 percent say that they first tried alcohol at the age of 10 to 20 years.

In 2014, the World Health Organization published the "Alcohol Consumption Report", which published data on the amount of alcohol consumed per capita (over 15 years). Russia takes 4th place in this list, and the volume of alcohol consumed is 15.1 liters. The leading first place according to the study belongs to the Republic of Belarus (17.5 liters). The second place is taken by Moldova (16.8 liters), the third - Lithuania (15.4 liters). Portugal closes the top ten (12.9 liters). A total of 188 countries were included in the report. The last place is occupied by Afghanistan (0.02 liters).

Alcoholism is a social problem, since the actions of people suffering from this disease often harm others. So, if we consider traffic accidents, then 85 percent of them happen due to the fault of drunk drivers.

More than 3 million people die every year due to alcoholism. The main cause of death due to alcohol is the accident (29.6 percent). Common causes of death include liver cirrhosis (16.6 percent) and cardiovascular disease (14 percent), which develop amid alcoholism.

Interesting Facts

The problem of alcoholism has been known to mankind since ancient times. The first document on alcohol abuse was published in China in 1116 BC. It is called the "Notice of Alcoholism" and contains information on the dangers of alcoholism. In Russia, the first punishments for drunkards were introduced by Peter the Great. Also, the first work houses were built by this king to correct those who were excessively addicted to alcohol. In ancient Rome, wine was forbidden to drink for those under 30 years old. Also, women were not allowed to drink alcohol, regardless of age. The remaining residents drank wine only in diluted form (two-thirds of the water per one-third of the wine). Drinking pure wine was considered a sign of alcohol addiction.

Causes of alcoholism

It is generally accepted that alcoholism is a psychosocial illness. It affects not only the physical and mental health of a person, but also affects all aspects of his life. Therefore, the causes of alcoholism are divided into social, psychological and biological.

Social causes of alcoholism

The social causes of alcoholism include many factors affecting both the ethnic characteristics of the individual and his personal level of development.

The social causes of alcoholism include:

• personal education level;
• the level of culture of the environment where the individual lives;
• the presence in this culture of certain prohibitions or beliefs regarding the benefits or harms of alcohol (most often this is due to religion);
• environmental factors that influence personality development.

So, each nation or race has its own moral principles that affect the individual. Often, one of the factors in the development of alcoholism is a misconception about the healing or stimulating effect of alcohol. An important role in the formation of alcoholism is played by "alcoholic" customs, which are associated with certain spiritual equivalents. For example, representatives of such an ethnic group as Sherpa (who lives in the mountains of Nepal) have an increased commitment to alcohol. In their rites, they use only rice wine or beer. It is known that the most severe forms of drunkenness are in those ethnic groups where the fear of supernatural forces dominated. At the same time, in countries that live according to Sharia law, the use of alcohol is strictly prohibited. So, in Saudi Arabia (the country with the strictest religious orders), drinking alcohol in the country is punishable by imprisonment. This explains the lowest level of alcoholism in Islamic countries - less than 0.25 liters of alcohol per capita in Saudi Arabia, 0.02 liters in Afghanistan, 0.06 liters in Pakistan. For comparison, in Moldova this figure is 18.22 liters, in the Czech Republic - more than 16, in Russia - more than 15, in Ukraine - 15.60.

Most studies on the ethnocultural characteristics of alcoholism have been conducted in the United States of America. The largest number of psychosocial risk factors for alcoholism were identified in white Americans.

Social factors also include the economic and political situation in the country. However, the influence of these factors is ambiguous. For example, a highly developed country like Switzerland is ahead of the less developed countries such as Cuba, Vietnam, India in the amount of alcohol per capita. This fact is explained by the phenomenon of urbanization and a certain lifestyle in developed countries. So, in many industrialized countries, a fashion for the use of alcohol and drugs is forming. Moreover, there are certain trends that affect both the level of consumption and the choice of a toxic substance.

Depending on the geographical location of the countries, the northern and southern types of alcoholism are conditionally distinguished. The northern version of alcoholization (Scandinavian countries, Russia) involves the use of such drinks as vodka and beer, while the southern version (Italy, Spain) - wine.

Psychological causes of alcoholism

The psychological causes of alcoholism are the presence of certain personality defects that impede social adaptation.

Some personality traits that impede a person's social adaptation are:

1. timidity and self-doubt;
2. impatience
3. increased irritability;
4. hypersensitivity;
5. anxiety;
6. egocentrism.

It is much more difficult for people with such defects to adapt in society and socialize. They do not find support in the eyes of others, and they have the feeling that "no one understands them." It is more difficult for egocentrics to find work, and if they find it, then not for long. Difficulties in making contacts are one of the reasons people find solace "at the bottom of the glass."

It is especially hard for individuals with great claims, but insufficient achievement of their goals. In this case, alcohol gives a feeling of success. One way or another, a positive attitude towards alcohol is formed.

Constantly depressed mood and dissatisfaction with oneself also lead to the need for a drink. Alcohol in this case has a euphoric effect, as it compensates for these negative emotions. Thus, very often alcohol becomes a tool for pleasure and positive emotions.

Biological causes of alcoholism

These causes of alcoholism take into account all kinds of neuropsychiatric diseases, as well as the genetic component. It is believed that children of alcoholics have a four times higher risk of developing alcoholism than other children. Of course, the intrafamily factor is also taken into account when the need for alcohol becomes a kind of behavior model for children. But also takes into account the fact that under the influence of alcohol in the body there are a number of changes at the metabolic level. This, in turn, leads to the development of increased susceptibility to alcohol. Therefore, in a pregnant woman suffering from alcoholism, children are born with metabolic disorders that predetermine increased susceptibility to alcohol in the future.

An equally important role is played by the personality type and temperament inherited from the parents. So, some pathological character traits, combined with certain metabolic disorders, can form a child's pathological attraction to alcohol.

Biological factors also include the deficiency of certain enzymes involved in the metabolism of ethyl alcohol. Once in the body, ethyl alcohol decomposes under the action of enzymes to carbon dioxide and water. However, when there is a lot of it, intermediate metabolic products are formed. These include phenols, which cause intoxication of the body. With the systematic use of alcohol, the body is completely poisoned.

Low activity of alcohol dehydrogenase (an enzyme that is involved in the neutralization of alcohol in the body) was observed in American Indians and northern peoples, which served as a prerequisite for their rapid alcoholization. Numerous studies have also shown that due to the ethnic enzymatic characteristics of the inhabitants of the Far North, alcohol in their body oxidizes to phenols much faster. This, in turn, leads to massive poisoning. For representatives of the Caucasian race, this process is carried out tens of times slower, which leads to less rapid alcoholization.

The question of the heredity of alcoholism is still controversial. In order to put an end to this issue, a study was conducted that traced the fate of children born in alcoholic families, but who were subsequently brought up under normal conditions. Despite the favorable situation in the sheltering family, the risk of developing alcoholism in these children was still ten times higher than in other children of this family.

Psychology of alcoholism (mechanisms of psychological defense)

The vast majority of alcoholics deny the presence of any problems with alcohol. In medicine, this phenomenon is called alcoholic anosognosia, that is, the denial of the disease in oneself. This is due to the development of psychological defense, which is formed at a subconscious level. At the beginning of the disease, complete disregard for drunkenness prevails. The patient is sure that everyone around is wrong and unfair to him.

Then there is a shift in emphasis. Patients play down the problem and believe that although they occasionally drink alcohol, they can quit it at any time. People who abuse alcohol initially try to motivate themselves before drinking or to justify themselves.

Motivations are:

• The traditional reason is that alcohol is consumed in connection with a holiday or some more or less significant event;
• Pseudocultural reason - an alcoholic drink is used to attract the attention of others with a complex cocktail recipe or rare wine;
• Atactic reason - alcohol is consumed in order to "relieve stress";
• Hedonistic reason - alcohol is used to enjoy and a state of euphoria;
• Submissive reason - patients drink because they are not able to confront friends, the excuse is the phrase "I do not want to be a black sheep."

At the final stage of the disease, patients move to the stage of motivational rationalization. A patient with alcoholism begins to give a lot of reasons and reasons to justify his drunkenness.

Types of Alcoholism

There are several types of alcoholism. Each species has its own peculiarities of the flow.

Some types of alcoholism are:

• social alcoholism;
• family alcoholism;
• beer alcoholism.

Social alcoholism

It is believed that social alcoholism is a plague of the 21st century, which poses a danger not only to the current generation, but also to the future. For many countries, the problem of alcoholism is a national disaster, as per capita alcohol consumption is growing every year. The causes of social alcoholism are many. This is the lack of demand for the adult generation (many start drinking when they find themselves without work or without a family), and the early degradation of the young generation. However, not only lonely and unemployed people resort to alcohol consumption. Many people claim that circumstances force them to drink. These are numerous corporate parties, meetings with business partners, gatherings with friends.

The evolution of social alcoholism

The current rhythm of life is such that a person is in constant tension. A burden of responsibility always lies on his shoulders, and it does not matter whether it is a woman or a man. Therefore, as often happens, a glass of cognac (or vodka) becomes a daily means to relieve stress. They drink a little, but every day. Often a glass of vodka helps to cope with such a frequent ailment as insomnia. At the same time, sleep occurs, but from the physiological one he turns into a narcotic one. As a result of this, the body does not rest, and the next day, closer to dinner, a person already feels tired. To take it off, he again runs to the glass. Thus, a vicious circle is formed. People are constantly trying to relieve fatigue, which is often the result of drinking alcohol.

Gradually getting used to the daily consumption of alcohol, a person quietly begins to increase the dose. Instead of one glass, he drinks two or three. To get a feeling of lightness and relieve fatigue, doses of alcohol are constantly increasing.

Over time, a person begins to look forward to Friday to "relieve stress". This phenomenon is called Friday syndrome. Thus, speaking in a popular language, "the soul asks for the next dose." The most dramatic situation becomes when a person has always hidden a "medicine" in case of stress at home or at work. Wine or champagne is no longer alcohol, but "pampering"; people prefer stronger drinks. Now the attraction to alcohol becomes intrusive. Control over drunk alcohol is constantly decreasing, and resistance to it is constantly growing. To eliminate the stress of the day, one glass is no longer enough.

A novice alcoholic becomes unsettling, irritable, and conflicting. Often the reason for the first binge is a dismissal from work or a conflict situation in the family.

Family alcoholism

Family alcoholism - this is the case when alcohol addiction is formed in both spouses. This dependence can be formed both simultaneously and sequentially.

Several factors can contribute to the simultaneous formation of dependence. For example, if people with an already formed dependence enter into marriage, which only intensifies during their joint residence. It may also be that addiction is formed in marriage. Very often, the impetus for this is some unfavorable situation associated with a family member (for example, death or illness of a child). In order to reduce stress and pain, spouse resort to alcohol. Such regular drinking leads to the formation of family alcoholism.

The variant is not less common when the dependence is formed in the spouse of an already formed alcoholic. This type of family alcoholism is also called co-dependent. Often, the wives themselves bring their husband a drink home, so that he drinks at home "under control". In this case, the spouse herself begins to keep company with the spouse, maintaining a conversation with him and drinking.

Since women are most vulnerable to the effects of alcohol, other motives will soon join, for example, to relieve fatigue. Alcohol addiction in women forms very quickly. Often the severity of the disease, the wife begins to "overtake" her husband. Studying the topic of family alcoholism, experts identified three types of families.

The types of families in which family alcoholism occurs include:

1. sociopathic type of family;
2. neurotic type of family;
3. oligophrenic type of family.

Sociopathic type of family

This type of family is characterized by early and rapid alcoholization and the malignant course of the disease. Family relationships are characterized by a violation of all social roles and a psychopathic response. Wives often have hysterical reactions, husbands - explosive. Social norms in such families are rudely violated, an early tendency to group forms of alcohol consumption is formed. The antisocial type of behavior quickly affects all aspects of life - family-household, social and labor. Spouses interrupt their work, jointly commit illegal actions, can not cope with educational activities.

Neurotic type of family

These families combine a neurotic type of relationship and alcoholism. Here, alcohol is the main means of relieving post-conflict stress.

Oligophrenic Family Type

This type of family is characterized by underdevelopment of all spheres of life. Initially, both spouses have a low level of education and spiritual and moral development. The systematic use of alcohol leads to even greater degradation and social maladaptation. Drinking alcohol together in such a family is based on alcohol traditions ("for order" or "respect relatives").

Beer Alcoholism

It should be noted that in narcology there is no such term as "beer alcoholism". However, the relevance is such that a painful addiction to beer has long been a separate form of drunkenness. One reason for this is the uncontrolled propaganda of beer in the media.

The reasons for the development of beer alcoholism are:

• intensive advertising;
• positive image of beer compared to other alcoholic drinks;
• lack of self-criticism and "public condemnation";
• maximum availability; beer is sold everywhere;
• relatively low price.

Features of beer alcoholism

Few people know that beer also contains ethyl alcohol. However, due to the presence of gases in it and a pleasant taste, this fact is not perceived objectively. Daily use of beer, even in small quantities, increases tolerance to ethyl alcohol. This means that even if a person does not drink hard liquor, his alcohol resistance will increase. Thus, according to narcologists, the role of beer in the development of alcoholism is the same as the role of weak drugs in the development of drug addiction.

Despite the fact that beer alcoholism develops much more slowly than other types, it is accompanied by irreversible somatic (bodily) disorders. This primarily concerns organs such as the liver and heart. On the heart, the constituents of beer have a direct damaging effect, leading to a disorganization of the structural elements. With the systematic use of beer, the so-called "beer heart syndrome" develops. This syndrome is characterized by a non-inflammatory lesion of the heart muscle, which is expressed in metabolic disorders. This syndrome will manifest itself in a rapid heartbeat, shortness of breath, impaired heart rhythm. On the roentgenogram, the heart seems to "sag", and the pump function is lost irreversibly.

The second target organ for beer is the liver. Regular consumption of beer leads to the development of fatty liver. Recently, the World Health Organization (WHO) recently published data according to which beer abuse is a risk factor in the development of colon cancer. Beer acts specifically on the male body. It causes suppression of the secretion of male sex hormones (in particular methyltestosterone) and increased production of female hormones (namely estrogen). This is the reason that in men the mammary glands begin to grow and the pelvis becomes wider. In general, beer leads to an increase in body weight and the development of obesity.

Beer is most dangerous for teens. There are several reasons for this. Firstly, it is a quick and inconspicuous addiction to this drink. The so-called "usual dose" for an adult is toxic to a growing adolescent organism. Secondly, the lability (instability) of the endocrine and emotional system, which is observed in the teenage period, makes the body most vulnerable to the effects of harmful factors, including the action of beer. Very often, teens combine daily beer consumption with smoking, which further enhances the toxic effect on the nervous system of the body.

Many studies in this area have shown that adolescents already in the first year of "beer life" develop mental dependence. Further, after a couple of years, physical dependence is also formed, which leads to the development of teenage alcoholism.

Also, alcoholism can be classified by gender or age.

Types of alcoholism by gender are:

• male alcoholism;
• female alcoholism.

Types of alcoholism by age are:

• child alcoholism;
• adolescent alcoholism;
• alcoholism in the adult generation.

Alcohol syndromes

At the second and third stages of alcoholism, the risk of developing alcoholic psychoses is high. Alcoholic psychoses are a group of mental disorders that most often develop during the period of abstinence from alcohol. There are a large number of alcoholic psychoses, which may be acute or chronic in duration.

Types of alcoholic psychosis in alcoholism are:

1. alcohol delirium;
2. delusional psychosis;
3. alcoholic hallucinosis.

Alcoholic delirium or delirium tremens

This is the most common psychosis, which has received the popular name delirium tremens. This name is associated with two factors. First, this psychosis arises when drinking "40 percent white wine" (or vodka). The second factor is associated with a high rise in temperature to 40 - 41 degrees Celsius.

Most often, delirium develops in people 40 to 50 years old who have been suffering from alcoholism for more than 10 years. The onset of delirium tremens is acute - it develops several hours after drinking alcohol amid a severe hangover. The first symptoms are insomnia, excessive sweating, and trembling hands (tremors). These symptoms are quickly joined by signs of arousal - fast and inconsistent speech of an incoherent character.

The mood becomes unstable and quickly moves from euphoria to depression and vice versa. Pronounced autonomic disorders appear - increased palpitations, increased sweating. Against the background of these symptoms, visual hallucinations appear. As a rule, these are visual images of various animals - mice, rats, cats. The appearance of visual hallucinations in the form of deceased relatives or snakes is very characteristic. Patients begin to come into motor excitement. They hide, hide, try to defend themselves. All this is driven by a sense of fear and anxiety. Patients become dangerous to others, as they begin to sweep away and destroy everything on their own. There is a disorientation in time and space. However, in their own personality, patients, as a rule, remain oriented.

These periods of dullness can be accompanied by bright intervals. So, against the background of complete disorientation, patients can suddenly come to their senses (the so-called "bright windows"). However, by evening, their condition worsens again. The behavior of patients is constantly changing and depends on the type of hallucinations. As a rule, during delirium tremens hallucinations of a frightening type are observed, which leads to defensive and aggressive behavior of a person.

The duration of delirium tremens averages from two to seven days. In rare cases (5 - 10 percent), it is delayed up to 10 - 14 days. Recovery also occurs abruptly and suddenly as the delirium began. Typically, the patient wakes up after a deep sleep. Sometimes, the exit from delirium can be delayed and take a phased character. In both cases, recovery ends with deep asthenia (weakness).

The severity of alcohol delirium is determined by the presence of concomitant somatic (bodily) disorders. The heavier the bodily ailment, the worse the delirium tremens proceeds. At the same time, characteristic excitement and aggression are not observed. In this case, the clinical picture is dominated by stupor and agitation within the bed. Such delirium is called "mussitiruyuschim" or "muttering." Mumbling delirium is very difficult to treat and is observed mainly in the elderly.

Alcoholic hallucinosis

This is the second most common alcoholic psychosis. Hallucinosis is a mental disorder with a predominance of auditory, visual or tactile hallucinations. Against the background of these hallucinations, hallucinatory delirium and arousal develop.

Like delirium tremens, this psychosis develops during the period of withdrawal amid a severe hangover. Hallucinatory images, as a rule, appear in the evening or at night, often during the period of falling asleep. Most often, auditory hallucinations ("voices") appear that are frightening in nature. Voices can threaten, comment on some actions, order. The most dangerous are peremptory (ordering) hallucinations, which cause the patient to perform certain actions. Voices can also offend, blame or tease. Alcoholic hallucinosis is accompanied by severe motor agitation, autonomic disorders (increased sweating, palpitations). Patients rush around, try to hide from visual and verbal hallucinations. Against the background of constant voices, the patient has delusions of persecution. It seems to them that someone is constantly following them, trying to do harm. Delusions often apply to family members. The duration of alcoholic hallucinosis is from 2 to 4 days. Long alcoholic psychoses, which last a longer time, are called chronic. The frequency of chronic alcoholic hallucinosis varies from 5 to 10 percent of cases. In the picture of chronic hallucinosis constant verbal hallucinations prevail, often in the form of a dialogue.

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Alcoholic Delusional Psychosis

Alcoholic delirium is much less common than the previous two psychoses. Like previous psychoses, it develops against the background of abstinence. However, it can also be lingering. Most often, delusions of persecution, delusions of influence, delusions of relationships arise. Patients are obsessed with the idea that they want to rob and kill them. The behavior takes an impulsive character - the patients hide, run away and defend themselves from the "persecutors". A separate option for alcoholic delirium is alcoholic delirium of jealousy or alcoholic paranoia.

There is a delirium of jealousy more often in men of mature age. Moreover, they become obsessed with the ideas of adultery. Initially, ideas arise only at the time of intoxication or a hangover (that is, occasionally), and then they take on a permanent character. Suspicions of treason become constant. Subsequently, the delirium becomes systematized - theories of evidence and verification are developed, the patient interprets each gesture of the spouse in his own way. Very often, against the background of this nonsense, delusions of poisoning develop. It seems to the patient that the wife and her lover want to poison him. The mood is always alarming, with a tendency to aggression. As a rule, alcoholic delirium is chronic in nature with periodic exacerbations.

Symptoms of Alcoholism

Alcoholism is a pathology that is accompanied by a systematic and prolonged intoxication of the body with ethanol. Therefore, the symptoms of alcoholism are reflected in all organs and systems of the body.

The manifestations of alcoholism are:

• damage to the cardiovascular system;
• damage to the digestive system;
• kidney damage
• neurological complications.

Signs of alcoholism from the cardiovascular system

Disruption of the cardiovascular system is observed in 95 percent of alcohol abusers. The severity of the lesion, like the frequency, increases as the disease progresses. So, in the first stage of alcoholism, only 37 percent of patients have cardiac disorders, while in the third stage, 95 percent already.

Ethanol has a direct and indirect toxic effect on the heart muscle, leading to the development of obesity and dystrophy in it. The myocardium (heart muscle) becomes flabby. The indirect toxic effect of ethanol is a violation of the metabolism of B vitamins, magnesium and potassium salts. For this reason, very early signs of impaired myocardial contractility.

Sometimes a single intoxication can lead to severe damage to the heart muscle. At the same time, patients complain of pain in the region of the heart, heart palpitations, interruptions in the work of the heart (arrhythmia). When the disease progresses, edema appears, high blood pressure.

Alcohol abusers experience a "young heart attack" (heart attack at the age of 50). However, alcoholics most often suffer from hypertension (high blood pressure). They have this pathology observed twice as often as the rest of the population. Against the background of arterial hypertension, strokes are frequent, which lead to even greater disability of the patient.

The consequences of damage to the cardiovascular system in alcoholism are:

• high blood pressure;
• young myocardial infarction;
• strokes.

Signs of alcoholism from the digestive system

Most often, alcohol leads to toxic damage to the pancreas, liver and intestines. There are several mechanisms that cause damage to the digestive system in alcoholism.

The mechanisms of damage to the digestive system in alcoholism include:

• direct contact of alcohol with the mucous membrane of the oral cavity, esophagus, stomach and intestines, which has an irritating effect on the mucosa itself;
• the effect of ethanol at the cellular level, which leads to disruption of the structure and organization of cells;
• food hygiene disorders accompanying the state of intoxication (the use of spicy and often poor-quality foods);
• increased gastric secretion, which leads to the development of gastritis.

Alcoholic bowel disease

A bowel injury in alcoholism is the cause of impaired absorption and insufficient absorption of the main constituent elements of food. First of all, the absorption of vitamins, as well as potassium, sodium, magnesium, phosphates, folic acid, is disrupted. This leads to deficiencies of these vitamins, that is, to vitamin deficiency. Vitamin deficiency, in turn, is accompanied by anemia, encephalopathy, cardiac arrhythmia. Often, intestinal damage is manifested by diarrhea, which leads to severe deficiency of body weight.

Alcohol damage to the pancreas

Systematic drinking is the cause of chronic pancreatitis in 40 to 90 percent of cases. Acute pancreatitis occurs much less frequently, at 5 to 20 percent. The most dangerous consequence of the action of ethyl alcohol on the pancreas is pancreatic necrosis. Pancreatic necrosis is the death of pancreatic cells, leading to death. Most often, damage to the pancreas affects men aged 30 to 40 years. However, this pathology does not bypass women either. With regular consumption of ethanol, damage to the pancreas develops in 5 to 10 years.

Alcoholic liver damage

Liver damage is the most common pathology in alcoholics. There are several reasons for this. The first is the direct toxic effect of ethanol on liver cells (hepatocytes). The second reason is due to the fact that the oxidation of alcohol occurs in the same liver. All this leads to the occurrence of alcoholic hepatitis and cirrhosis. The term "alcoholic hepatitis" was introduced by the World Health Organization (WHO) to refer to numerous liver pathologies caused by alcohol.

Studies in this area have established that liver damage does not depend on the type of alcoholic drink, but is determined by the percentage of alcohol in them. Experts believe that in most cases, cirrhosis of the liver is caused by ethanol intoxication. The frequency of liver cirrhosis in alcoholics is 5 times greater than in people who do not drink alcohol.

The risk of developing alcoholic hepatitis is directly dependent on the dose of alcohol consumed. Pathology is extremely difficult and is constantly progressing. Jaundice and ascites quickly appear (the appearance of fluid in the abdomen). Mortality from cirrhosis is about 30 percent. Since cirrhosis is considered a precancerous condition, it can transform into liver cancer. This rarely happens, in about 5 to 15 percent of cases. In women, alcoholic hepatitis develops much faster. Due to the fact that they have an increased sensitivity of the liver to the action of alcohol, they have liver diseases even with a low level of ethanol in the blood.

Signs of alcoholism by the kidneys

In alcoholism, kidney damage develops due to the direct action of alcohol and its metabolites on the renal tubules and renal parenchyma. Kidney damage can occur in acute or chronic form. Glomerulonephritis and pyelonephritis are more common.

There are complaints about a decrease in the amount of urine excreted (oliguria), the urine becomes dark in color. Due to fluid retention in the body, renal edema develops. The most severe kidney damage develops when alcohol substitutes are used, namely, perfumery products (colognes, perfumes). You need to know that the composition of these fluids includes substances that have increased tropism (effect) to the kidneys, that is, "kidney poisons." With the use of these funds, acute renal failure rapidly develops.

Neurological complications of alcoholism

The most common symptom of alcoholism from the nervous system is alcoholic polyneuropathy. It is noted in every third alcoholic. This complication is the destruction of peripheral nerve fibers. This destruction is due to the prolonged toxic effects of alcohol along with a deficiency of B vitamins and nicotinic acid. At the third stage of alcoholism, liver damage also joins these reasons, which further enhances the toxic effect of ethyl alcohol on the nervous system.

Clinically, alcoholic polyneuropathy is primarily manifested by a violation of sensitivity. This is manifested by symptoms such as a burning sensation, tingling, creeping goosebumps. Later, unpleasant sensations in the form of muscle contraction join, and a sharp weakness appears in the legs. Sometimes the weakness is so pronounced that it completely immobilizes the patient. Further, polyneuropathy is accompanied by a loss or decrease in pain, tactile and temperature sensitivity. Fiber degeneration occurs in the calf muscles, which leads to the appearance of a "cock's gait".

Alcohol and pregnancy

Alcohol has a negative effect on the health of both the pregnant woman and the formation of the fetus. There are two mechanisms by which the negative effects of alcohol are realized.

The mechanisms of the toxic effects of alcohol on the fetus are as follows:

• the first mechanism is associated with pathological changes in the germ cells themselves (sperm and egg) in alcoholism;
• the second mechanism is associated with the direct toxic effect of alcohol on the fetus.

It is known that men who abuse alcohol more often than others develop infertility and decrease sex drive. In women, in 40 percent of cases, ovarian function is impaired.

The effect of ethanol on the fetus depends on the period in which it is carried out. So, in the prenatal period, two periods are distinguished: embryonic (first two months of pregnancy) and fetal (from the third month before the birth of the baby).

If alcohol acts on the fetus during the first period, then it causes an embryotoxic effect. Since the laying of the neural and digestive tubes, as well as the formation of the placenta itself occurs in this period, disturbances occur in these areas. Anomalies of the nervous, digestive, reproductive systems develop. Very often, this leads to spontaneous abortion and fetal death.

If the greatest effect of alcohol occurs during the fetal period, then numerous fetopathies develop. These include heart fibroelastosis, calcification of arteries, fetal hypoxia. Children are born prematurely, with low body weight and signs of oxygen starvation.

Children born to alcoholic mothers often gain weight poorly and are prone to infections. Mental retardation in such children is recorded in 60 percent of cases.

Forms of alcoholism

In order to better understand the clinic of alcoholism, several options for drinking alcohol are conditionally distinguished.

So, chronic alcoholism is always preceded by household alcoholism. Household alcoholism is called the periodic use of alcohol with harmful consequences. It distinguishes several types of drinking people.

Types of household alcoholism are:

1. abstinents - persons who consume alcohol on average 2–3 times a year, 100 grams of wine each;
2. random drinkers - persons who drink strong drinks from several times a year to several times a month;
3. moderate drinkers - persons who drink up to 3-4 times a month, an average of 150 milliliters of vodka;
4. systematically drinkers - people who drink alcohol 1 - 2 times a week for 200 - 500 milliliters;
5. habitually drinkers - persons who drink alcohol (more than 500 milliliters) more than 3 times a week.

Acute alcohol intoxication and chronic alcoholism are also distinguished.

Acute alcohol intoxication

Acute alcohol intoxication is also called alcohol intoxication. This term refers to a complex of autonomic, neurological and mental syndromes that appear under the influence of alcohol. It must be remembered that alcohol is, first and foremost, a psychotropic drug, so the clinic of alcohol intoxication is very variable. Depending on the course of intoxication, several forms of acute alcohol intoxication are distinguished.

Forms of alcohol intoxication are:

• simple alcohol intoxication;
• atypical alcohol intoxication;
• pathological alcohol intoxication.

Simple alcohol intoxication

This form is characterized by a feeling of physical and mental comfort. Slight fluctuations in the emotional background are noted. A person becomes talkative, excited and disinhibited. Vegetative symptoms are clearly expressed - red and wet skin, frequent heartbeat and breathing. Criticism of one's own condition is declining, and a reassessment of one's own capabilities is noted. Neurological symptoms present during severe alcohol intoxication. Ataxia (uncertain and shaky gait), dysarthria (speech impairment), muscle weakness appears. Vestibular disorders quickly increase, namely dizziness, nausea, and vomiting. A dangerous symptom is the appearance of epileptic (convulsive) seizures. Since alcohol inhibits the respiratory center, death from paralysis of the respiratory center is possible.

The duration of this period depends on the volume of alcohol consumed, as well as on the weight and age of the patient. Also, the length of the intoxication period depends on the metabolic rate in the body. As a rule, the next morning there is complete amnesia (memory loss) of the intoxication period itself, and there are multiple post-toxic effects.

Post-toxic effects are:

• Strong headache;
• thirst;
• poor appetite;
• nausea and vomiting;
• weakness and a feeling of weakness;
• dizziness;
• shaky gait;
• tremor (trembling) of the limbs;
• maximum decrease in performance.

Unlike a hangover syndrome in people with chronic alcoholism, post-toxicity syndrome is not accompanied by a desire to hangover. The mere mention of alcohol causes unpleasant sensations in non-alcoholic people.

Atypical alcohol intoxication

Atypical alcohol intoxication is called alcohol intoxication, in which there is a sharp increase or, conversely, a weakening of any functions. This can happen if a person has previously had some kind of head injury or there is a pathological personality development. This is due to the fact that everything depends on the "soil" on which alcohol acts. Most often, this atypia is manifested in mental functions.

Three variants of atypical alcohol intoxication are conditionally distinguished - dysphoric, depressive and hysterical. In the dysphoric variant, instead of characteristic euphoria, aggression and irritability develop. Dysphoria is a form of mood, which is characterized by maliciousness and aggressive behavior. This option of intoxication is more often observed in people with an organic type of personality or with a history of craniocerebral injuries (medical history). In the depressive variant, instead of classical euphoria from taking alcohol, a sharply reduced mood, melancholy, depression develops. The drunk person begins to cry, becomes dissatisfied with himself. This option is very dangerous, since it is characterized by the appearance of suicidal behavior. The hysterical version of intoxication is manifested by demonstrative behavior. People begin to behave very emotionally, theatrically wring their hands, and faint.

Pathological alcohol intoxication

In fact, this type of pathological intoxication is a transient psychosis caused by the intake of a small amount of alcohol. A distinctive feature of this condition is that the dose of alcohol can be very small. This condition proceeds with pronounced excitement against the background of a narrowed consciousness. In more than 80 percent of cases, intoxication is accompanied by illegal actions.

The patient becomes completely disoriented in time and space, exhibits aggressive behavior. Sharp motor excitement with chaotic behavior is noted. The patient rushes about, his actions are not focused. He shouts out individual phrases and words, sometimes they take the character of commands or threats. Sometimes the patient is characterized by delusional behavior, which develops against the background of bright hallucinations of a frightening type. Patients at this moment are not contacts at all, they cannot be stopped or "reasoned". They perform all their actions alone, which also distinguishes them from chronic alcoholics.

An interesting fact remains that, as a rule, intoxication symptoms do not accompany this condition. The severity of unlawful acts can range from minor hooliganism to the commission of a serious crime. After an episode of pathological intoxication, total amnesia sets in. Patients do not remember anything from what happened to them the day before. As a rule, after that they find themselves in places unfamiliar to themselves, in complete ignorance of how they found themselves there.

Forensic examination of this condition is very difficult. A person who first finds himself in this state and does not know about his pathological reaction to alcohol is not criminally liable.

Stages of chronic alcoholism

alcoholism is a disease during which several stages are distinguished.

The stages of alcoholism are:

• first stage;
• second stage;
• third stage.

The first stage of chronic alcoholism

The duration of the first stage of alcoholism can vary from 5 to 10 years. Many of its symptoms are determined by the personality characteristics of a person. But, at the same time, there are a number of features that characterize the first stage of alcoholism and are not found in subsequent ones.

The characteristics of the first stage of alcoholism are:

• mental addiction;
• increased tolerance to alcohol;
• decreased situational control;
• memory impairment;
• personality changes.

Mental addiction

The first stage of alcoholism is characterized by the development of mental dependence. It is characterized by a constant need for a certain dose of alcohol. That is, a person does not feel the need for alcohol itself, but for the euphoric effect that it gives. Over time, the dose of alcohol, which gives this effect, increases. In order to get positive emotions and good mood, the volume of alcoholic beverages is constantly growing, and the periods between abstinence are reduced. These periods are characterized by a constant attraction to alcohol, which has the character of obsession. During periods of abstinence, patients are in constant psychological discomfort. However, having satisfied their need, their mood rises. This reflects mental dependence.

Increased Alcohol Tolerance

The main characteristic of the first stage is the constant increase in alcohol tolerance. This means that the dose that intoxicates a person and has an euphoric effect is constantly increasing. Along with the increase in tolerance, a decrease in situational control is developing. A person cannot fully control the situation and own it. An irresistible craving for alcohol becomes intolerable with moral and ethical considerations. At this stage of alcoholism, a change in the nature of intoxication is noted. The changes relate to the period of excitation and inhibition. So, at the first stage, the duration of excitement increases - during intoxication, alcoholics are excited and aggressive. Characterized by rapid mood swings. Alcoholics become conflicting, explosive and begin to pester others.

Another distinctive feature of this period is the disappearance of vomiting during an overdose of alcohol. Vomiting is one of the main signs of intoxication and a barrier to further intake of alcohol. However, when alcohol resistance rises 2–3 times, this important symptom disappears. Therefore, intoxication proceeds without visible manifestations for the patient.

Impaired memory

Also, this stage of alcoholism is characterized by periodic memory lapses. These dips relate to individual episodes of a period of intoxication. At the same time, the man in the morning cannot remember what happened to him the day before. In narcology, such periods are called palimpsests. At the end of the first stage, episodic binges become permanent.

Personality Changes in Alcoholism

The first stage of alcoholism is characterized by initial personality changes. The term personality is understood as a set of characterological features that determine the personality of an individual. This set of traits is stable and does not change over the course of life. However, under the influence of toxic alcohol, these features are distorted and new features appear that were not previously inherent in humans. These features are self-doubt, loss of previous interests, explosive nature. Some decline certain moral and ethical standards; sometimes people become deceitful and hypocritical. Over time, all of these emerging features are fixed so that they form new stereotypes in behavior.

The second stage of chronic alcoholism

For the second stage of alcoholism, both the progression of previous symptoms and the appearance of new ones are characteristic. Progressing personality decay, social maladaptation, and memory disorders. But, at the same time, at this stage a number of new signs appear.

Symptoms of the second stage of alcoholism include:

1. maximum tolerance to alcohol;
2. physical dependence;
3. withdrawal syndrome (popularly hangover).

Maximum alcohol tolerance

Resistance to alcohol in the second stage reaches its maximum. Along with this, maximum intoxication of the body occurs. There are jumps in blood pressure, heart rhythm disturbances, tremors in the limbs. As much as possible, this reflects on the mental function of the alcoholic. Changes are beginning, which are called "alcohol degradation." It is characterized by a decrease in individual activity, up to its complete loss. A social and professional decline is developing, a person loses interest in everything that is not related to alcohol. The level of critical attitude towards oneself is also reduced. A person suffering from alcoholism is trying to find an excuse for his behavior. He blames his family or service for his addiction. However, at the same time, he denies the presence of the disease and is constantly looking for circumstances that lead him to drink.

The second stage of alcoholism is also characterized by an exacerbation of chronic diseases and a general decrease in immunity. However, new diseases are also characteristic, which are associated with a toxic effect on the nervous, cardiovascular, and liver systems. Such diseases are alcoholic psychoses, hepatitis, myocarditis.

Physical addiction

It is known that alcoholism is characterized by mental and physical dependence. Mental dependence appears in the first stage of the disease and progresses to the last. It is characterized by an irresistible craving of the patient for alcohol. Physical dependence appears only on the second. She is characterized by the development of withdrawal symptoms during alcohol withdrawal. An abstinence syndrome is a set of physical manifestations that appear at the moment when alcohol ceases to enter the body.

The manifestations of withdrawal symptoms in the second stage of alcoholism are:

• excessive sweating;
• heart palpitations and heart rhythm disturbances;
• feeling of weakness and weakness;
• increase in blood pressure;
• nausea, vomiting;
• tremor of limbs;
• fear and anxiety.

All these symptoms appear when, for some reason, a person suddenly begins to abstain from alcohol. The reason for all of the above symptoms is the fact that in the second stage of alcoholism, ethanol becomes part of the patient's metabolism. The metabolism changes so much that alcohol becomes necessary to maintain the basic metabolic processes. Therefore, when it is not there, the body experiences a severe physical condition. Alcoholics in the second stage feel unwell, not because they consumed a lot yesterday, but because they have not yet drunk today.

The duration of withdrawal symptoms is from several hours to several days.

The third stage of chronic alcoholism

The third stage is the final stage of alcoholism, which is characterized by severe damage to internal organs and the development of encephalopathy. A distinctive feature of this stage is a persistent decrease in tolerance (resistance) to alcohol. A person begins to get drunk on much less alcohol. Abstinence syndromes that appear in the third stage are very difficult. They are characterized by the appearance of fear, suspicion, a persistent decline in mood. The concentration of alcohol in the blood decreases, and the titer of the brain cells increases.

The characteristics of the third stage of alcoholism are:

• persistent decrease in tolerance;
• changes in the very form of drunkenness;
• development of Wernicke encephalopathy;
• polyneuropathy.

Persistent decline in tolerance

Alcohol tolerance refers to the degree of resistance to it. So, in the first and second stages, this stability is constantly growing. To get the desired effect of euphoria, a person consumes alcohol more and more. However, this does not always continue. In the third stage of alcoholism, the body's resistance to alcohol begins to decline. And so a person begins to get drunk from a much smaller volume of alcohol. Even a small dose of alcohol is intoxicating. However, these doses are needed by an alcoholic every day, because without them he feels bad.

Physical dependence in the third stage of alcoholism reaches its maximum extent. It is accompanied by severe withdrawal symptoms with the development of alcoholic psychoses.

Changes in the very form of drinking

At the third stage of alcoholism, true binges prevail, and episodic drinking is found in only 15 percent of cases. Drunkenness itself proceeds without the effect of euphoria with a predominance of passivity and stupor. There is no high spirits, which was so characteristic of the initial stages of alcoholism. Even during intoxication, a decreased mood, depression and dissatisfaction are noted. Sometimes these periods of depression and apathy can lead to a complete cessation of alcohol consumption. However, this condition does not last long. Being by this time an integral part of metabolism, the body experiences a constant need for alcohol.

Brutality and aggression are sometimes noted. As a rule, there is a shift to daily alcohol consumption. These daily bouts lead to complete social degradation and maladaptation.

Wernicke Encephalopathy

Encephalopathy is an acquired irreversible damage to the brain, which is accompanied by various symptoms. The cause of the development of encephalopathy is both the toxic effect of alcohol and the impaired metabolism of B vitamins. It is known that nerve cells take the first blow from the action of alcohol. Becoming an integral part of metabolism, alcohol interferes with the synthesis of proteins, fats and carbohydrates, and also disrupts the metabolism of vitamins. As a result, nerve impulse conduction is impaired, and symptoms characteristic of encephalopathy develop. It manifests itself with symptoms such as sleep disturbance, impaired consciousness, frequent dizziness, and noise in the head. Irreversible cognitive (mental) disorders occur, which manifest themselves in the form of impaired memory and attention. Pronounced mental and physical weakness develops, patients become deprived of initiative. Encephalopathy is always accompanied by numerous neurological symptoms. It can be twitching of the muscles of the face, athetoid movements or spasms. At the third stage of alcoholism, muscle tone always changes, hyperkinesis occurs (involuntary muscle movements). Pupillary disorders often occur - miosis (narrowing of the pupil), anisocoria (different diameter of the pupils), weakening of the reaction to light.

Before use, consult a specialist.

By: Noam Harel, MD