Alcoholism
 
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Alcoholism means a mental and / or physical dependence on the drug alcohol. According Feuerlein there are 5 clinical definition criteria:

  1. abnormal drinking behavior
  2. somatic alcohol-referred damages
  3. psychosocial alcohol-referred damages
  4. development of tolerance and withdrawal syndrome ("physical dependence")
  5. development of "withdrawal syndromes on the subjective level" (loss of control, centring of thinking and striving on alcohol: "psychological dependence"

If only the first 4 criteria are given, it is called an alcohol abuse, including the last criterion it is an alcohol dependence.

A typologic classification comes from Jellinek: alpha and beta alcoholics are so-called "not-addicted alcoholics", whereby the type of alpha is the so-called conflict drunkard, who drinks for relaxation and discharge, however, he can stop drinking at any time. The type of beta is the opportunity and society drunkard, to which practically everyone belong if he is not an abstinente. As "addicted alcoholics" the gamma, delta and epsilon alcoholic are classified.

Gamma alcoholics

Craze drunkards, whose drinking behavior are in an before-alcoholic phase inconspicuous and socially motivated. There is an increased easement when drinking. The alcohol increased the tendency of reconciliation, whereby ever higher dosages are necessary.

It follows the prodomal phase, which is characterized by the occurrence of memory gaps. They secretly drunk alone and the social isolation begins. Because of the risen alcohol tolerance no remarkableness exists in the surrounding field.

In the following critical phase it comes to the loss of control. Smallest alcohol quantities increase the urge after further alcohol. The surrounding field reacts increasingly rejecting. The attempt to stop with drinking is accompanied by physical withdrawal symptoms (sweat, unrestness).

The self value feeling is lost. In the chronic phase they drink excessive over a several day-long period, with the consequence of increasing mental, physical and social dismantling.

Delta alcoholics

Level drunkard without control losses. For the avoidance of physical withdrawal syndromes, a permanent blood alcohol level must be kept upright.

Epsilon alcoholics

Quarter drunkard. This type of drunkard can get along for weeks without any alcohol, however, with crises or depressions it comes to a loss of control and excessive consumption of alcohol, often oven a period of several days.

More modern psychiatric classifications take place according the ICD-10 F10.xx (international classification of diseases) or according DSM-IV (diagnostic and statistic manual of psychiatric illnesses). The latter contains a coding and a criteria catalag. The partner often gets the state of a so-called "co-alcoholic": In order to play the role of an intact family, the alcohol problem of the partner is ignored, played down or completly covered.

Genesis

The craze development takes place slowly over the so-called prodomal phase followes by the critical phase, connected with loss of control. For the development of alcoholism both genetic factors and environmental factors are discussed. As important environmental factor stress is considered. In the bioassay a hormone could be proven (a corticotropine releasing hormone, CRH), which is set free under stress situations and which reacts in specific receptor places (CRHR1) in the brain. With genetically caused disturbances (no formation of the receptor) it came in the bioassay to strengthened alcohol admission. Same applies to certain Glutamate receptors in the brain (NR2B-Receptor) with increased training (source: Max-Planck company PRI B 21/2002).

In May 2004 researchers of the University of Illinois, Chicago, discovered a gene location which produces a receptor protein (CREB, Cyclic AMP responsive element binding proteine), wich regulates the brain function during the process of learning and development. Laboratory mice, with lack of this gene, drank excessive alcohol quantities, prefered alcohol instead of water and showed fear conditions.

Damages

As a cause for the physical damages mainly the primary metabolism product acetaldehyde is considered, which is biologically a very reactive cellular poison. Of importance are in particular liver deseases, such as fatty liver, liver cirrhosis and alcohol hepatitis. Furthermore, chronic pancreas inflammation and gastritis, stomach and intestine ulcers and neurological damages as well as epileptic accumulations could arise.

From the psychiatric point of view, the alcohol halluzinose is to be mentioned up to the Delirum tremens and the Korsakow syndrome. For alcohol-dependent women the risk of an abortion exists as well as the risk of deformations for the embryo (Fetal alcoholic syndrome,FAS). See also physiology

Therapy

A successful therapy is without the confession of the concerning to be dependent from alcohol not possible. After a stationary or ambulatory physical withdrawal, partly medicine-supported (Antabus, Campral), followed a psychological and socialtherapeutic therapy. Groups of self-help (see link list) play an important role. The therapy chances of success are very well with approx. 50 per cent.

Newest trend (Duke Univ., Durham) is the development by plasters against alcohol dependence, similarly as they are in use for the nicotine withdrawal. The active substance is Mecamylamine, which was used in former times against hypertension. By blocking the messenger Dopamine in the brain it shoud help to reduce the consumption of alcohol.

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Last Update: 10/29/2010 - IMPRINT - FAQ