Alcohol . This word refers to one of the most popular and consumed legal psychoactive substances worldwide. This substance acts as a depressant of the central nervous system, disrupting the neuronal membranes and increasing the mobility of the molecules present in the brain.

It has been proven that taking small daily amounts improves health and protects against heart disease. It also produces a feeling of excitement, lowering anxiety levels and reducing heart and breathing rates. However, in higher doses, the level of consciousness and psychomotor coordination decreases, among other effects, and of maintaining continuous consumption can lead to a dependency on this substance, also known as alcoholism , which if maintained over a period of at least twelve months can cause lesions in various areas of the brain.

What is dependency?

Dependence is understood to be a condition characterised by the existence of the acquisition of a notable tolerance needing to increase the quantity of the substance to achieve the desired effects, the presence of withdrawal symptoms, the prolonged use of the substance beyond what the consumer intended, the persistent desire to suppress or control the behaviour, the deterioration of other activities due to the continuous performance of activities to obtain the substance and the taking of the substance in spite of knowing the effect it has on the person.

In the case of alcohol dependence, this dynamic of constant drinking tends to lead to a series of lesions at the neurological level .

These lesions occur in the corpus callosum, the lump and the limbic system, which explains the existence of memory problems and intense emotional reactions. It also decreases the density of the dendrites connections of the neurons and the number of these in the cerebellum and hippocampus, which affects the capacity of motor coordination and learning.

Types of alcoholism according to Jellinek’s classification

There are a large number of causes and patterns of alcohol consumption in dependent people.

In this sense, a large number of classifications have been established, highlighting the one proposed by Jellinek . This author classifies drinkers and alcoholics into five different groups, in order to indicate the social and therapeutic problems specific to each group.

1. Alpha-type drinkers

This type of drinker consumes excessively in order to mitigate the effects of mental illness or medical illness. In these drinkers there is no real dependence, so in reality this classification would not fall within the concept of alcoholism.

2. Beta drinkers

In this type of drinkers there is no real alcohol dependency either . Included in this classification are social drinkers, who consume excessively something that may cause them a somatic injury.

3. Gamma-type alcoholism

This type of individuals present a true addiction, manifesting a clear loss of control over drinking , craving or excessive desire to access it, tolerance to alcohol and adaptation to its metabolites. This group includes chronic alcoholic subjects.

4. Delta-type alcoholism

The subjects included in this category also present an addiction to alcohol , presenting an inability to maintain abstinence but without a loss of control over their drinking. In other words, they need to drink assiduously, but without becoming drunk.

5. Epsilon-type alcoholism

The so-called periodic alcoholism occurs in subjects who present loss of control over their drinking and behavioural problems , but who consume sporadically, spending long periods between drinks.

Alcoholism-related disorders

Alcohol abuse can lead to serious physical and mental health problems for consumers.

Alcohol intoxication

Among them stands out the ethyl intoxication , which is caused by the recent ingestion of a high amount of alcohol (or consumed with excessive speed) and is characterized by the presence of psychic and behavioral changes such as aggressiveness, euphoria, poor muscle control, mental and physical slowing, babbling, alterations in memory, perception and attention. It can range from simple drunkenness to alcoholic coma and death.

Withdrawal syndrome

Another alcohol use disorder is withdrawal syndrome . This syndrome, which occurs when chronic users stop drinking, usually begins with tremors between seven and forty-eight hours after the last drink.

Anxiety, agitation, trembling, insomnia, nausea and even hallucinations are common. The alterations of this syndrome depend largely on the time and amount of frequent consumption. Convulsions and epileptic seizures, alcoholic hallucinosis or even delirium tremens may occur as one of the most serious manifestations of withdrawal.

In the case of Delirium Tremens, it is very important to seek medical help urgently, as 20% of cases are fatal if the patient does not go to hospital, and even with the intervention of specialists, 5% of people die. This clinical picture appears in 3 phases :

  • First phase: anxiety, tachycardia, insomnia and dizziness.
  • Second phase: 24 hours later, the above symptoms worsen and tremors and abundant sweating appear.
  • Third phase: hallucinations, disorientation, tachycardia, delusions and stupor.

Alcohol-induced amnesias

Also known are the blackout , or partial amnesias, which can be classified as state-dependent amnesia (in which actions performed during drunkenness are forgotten and only remembered while intoxicated), fragmentary (amnesia of what happened during drunkenness with some moments in between preserved) or block amnesia (total oblivion of what happened during drunkenness).

Habitual alcohol abuse causes many hippocampal neurons to die, and as a result, problems arise in creating memories of what happens when the blood alcohol level is high. At the same time, declarative memory problems can remain in the long term.

Sleep disorders

Sleep difficulties also occur, with a decrease in REM sleep and an increase in non-REM sleep phases 2 and 3, leading to an upsurge in REM sleep in the second half of the night that can wake the individual.

Chronic disorders

Apart from these acute disorders, chronic disorders such as Wernicke-Korsakoff Syndrome, cognitive disorders (memory loss, reduced capacity for judgement and planning or deterioration of attention, among others) or sexual and personality dysfunctions (including pathological jealousy in relationships) and other neurological and hepatic disorders may also occur.

Established effective treatments

At the pharmacological level, different medications are used to treat alcohol dependence . The use of disulfiram to produce an aversive response to drinking alcohol and naltrexone to stop the craving or desire to drink is noteworthy.

With respect to psychological treatment, over time multiple programs and treatments have been created to combat alcoholism . Among them, some of the most effective at present are the approach to community reinforcement, cognitive-behavioral therapy and family and couple therapy.

Community Reinforcement Approach (CRA)

This program was designed taking into account the importance of family and society in reinforcing the sobriety of the alcoholic. Motivational techniques and positive reinforcement are used. The main objective of the program is to reduce consumption and increase functional behavior .

Disulfiram, communication skills training, job-seeking skills training, non-alcoholic leisure activities, and contingency management training are used to resist social pressure to drink through covert awareness. This is the program with the highest level of proven effectiveness.

2. Cognitive-behavioral therapy

It includes training in social and coping skills and relapse prevention.

The first step is to increase the ability to handle situations that trigger the desire to drink, preparing for change, teaching coping skills and generalizing them to everyday life.

With respect to relapse prevention, emphasizes the possibility of the subject returning to drinking on one occasion (fall), differentiating it from relapse (re-establishment of the habit) so that the effect of the violation of abstinence does not occur (creating cognitive dissonance and personal self-attribution of the addiction, which in the long run causes guilt that facilitates relapse).

3. Family and couples therapy

Essential component in treatment programs. P or alone is also very effective . Apart from the problem itself, it focuses on how the problem affects the couple’s relationship and reinforces communication, negotiation and activities that facilitate maintaining the relationship in a correct way.

In conclusion

Despite the fact that alcoholism is a chronic problem, in a large number of cases the prognosis once behaviour is normalised is positive: it has been observed that more than 65% of the cases treated have managed to keep abstinence under control . However, it is necessary to detect the problem in time and start treatment as quickly as possible to prevent the nervous system from being severely damaged.

In some cases, moreover, withdrawal from alcohol consumption must be done in a controlled and medically supervised manner, as withdrawal can lead to many problems or even death.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Hunt, G.M. and Azrin, N.H. (1973). A community-reinforcement approach to alcoholism. Behaviour Research and Therapy,11, 91-104
  • Jellinek, E.M. (1960). The disease concept of alcoholism. New Brunswick: Hillhouse Press
  • Kopelman, M.D. (1991). Non-verbal, short-term forgeting in the alcoholic Korsakoff syndrome and Alzheimer-type dementia. Neuropsychology, 29, 737-747.
  • Marlatt, G.A. (1993). Relapse prevention in addictive behaviors: a cognitive-behavioral treatment approach. In Gossop, M., Casas, M. (eds.), Relapse and relapse prevention. Barcelona: Ed.Neurosciences.
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