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Alcoholism

alcoholism (GB)
alcoholisme (N)
alcoolismo (PO)
alcolismo (I)
alcoolisme (F)
alkoholismo (ES)

Alcoholism (also alcohol dependence, ethylism, dipsomania, potomania, drunkenness, alcohol addiction, alcoholism or alcohol use disorder) is the dependence on the psychotropic substance ethanol. The mental and/or physical dependence on alcohol is mostly a social and human problem of the individual, but experience shows that it also has a negative effect on his or her environment such as family and profession. Throughout history, there have been and still are alcohol prohibitions in various forms in individual countries or even in entire cultural areas, such as Islam, to prevent alcohol abuse or in principle alcohol consumption for various reasons through strict prohibitions. A significant example of the dubious success of alcohol prohibition is Prohibition in the USA from 1920 to 1933.

Alkoholismus - Mann im Glas, Hand mit Handschelle und Glas)

At what point is one an alcoholic?

The boundary is fluid - there is no measurable no/yes point. According to Prof. Dr. Wilhelm Feuerlein (head of the Psychiatric Polyclinic, Max Planck Institute for Psychiatry in Munich and author of recognised standard works) there are five definition criteria from a clinical point of view. These are 1. abnormal drinking behaviour, 2. somatic alcohol-related damage, 3. psychosocial alcohol-related damage, 4. development of tolerance and withdrawal syndrome (physical alcohol dependence) and finally 5. development of "withdrawal syndromes on the subjective level" with, in extreme cases, total loss of control, as well as the centring of thinking and striving for alcohol (psychological alcohol dependence).

If only the first four criteria are fulfilled, one speaks of alcohol abuse (alcohol abuse), with the fifth criterion of alcohol dependence. According to estimates by the German Centre against the Dangers of Addiction, about eight million Germans (10%) are considered to be at risk of alcohol abuse, of which 2.5 million are alcoholics. 20% of accidents at work and 20% of traffic fatalities are due to alcohol influence. These data can be proportionally converted to the population of Austria (almost 9 million).

Classification or types of alcoholics

A typological classification comes from Professor E. M. Jellinek. The US psychiatrist is considered the "Pope" of alcoholism research; his main work "The disease concept of alcoholism" from 1940 led to the general recognition of alcoholism as a disease, the typology of alcoholism was published in 1960. Jellinkek assumes four or five types, which he describes as follows:

Alpha and beta alcoholics.

These are "non-addicted alcoholics", whereby the alpha type is the conflict drinker who drinks for relaxation and relief, but can stop at any time. The beta type is the occasional and social drinker, to which practically every non-abstinent person belongs. The groups of gamma, delta and epsilon alcoholics are classified as "addicted alcoholics". The development of addiction takes place slowly via the prodomal phase (precursor phase, period between increased alcohol consumption and loss of control, duration is several months to several years) to the critical phase, associated with loss of control.

In order to maintain the appearance of an intact family, the partner's alcohol problem is very often ignored, played down or concealed. As a result, larger and larger amounts of drinking are consumed. The beginning of this phase is characterised by the occurrence of regular gaps in memory as well as irritable reactions when the environment brings up the subject of alcohol as a result of the onset of feelings of guilt from the self-recognition that one's own drinking behaviour is not normal. In the further course, the progressive disturbance of the metabolic processes slowly leads to the physical and psychological development of addiction, combined with a loss of control.

Gamma alcoholics

In a pre-alcoholic phase, drinking behaviour is inconspicuous and socially motivated, it takes place in company. There is increasing relief in drinking, alcohol is increasingly drunk to balance the mood, with higher and higher doses being required. Memory gaps occur. Drinking is done alone and in secret, which is the beginning of social isolation. In the following critical phase, there is a loss of control. The smallest amounts of alcohol increase the urge to drink more. The attempt to stop drinking is marked by physical withdrawal symptoms (sweating, restlessness, trembling). Self-esteem is increasingly lost. In the chronic phase, excessive drinking goes on for days, with the result of ever-increasing mental, physical and social degradation.

Delta alcoholic

Also colloquially known as mirror drinkers - mostly (still) without loss of control. To avoid physical withdrawal syndromes, a permanent blood alcohol level must be maintained. This can often remain hidden from the environment due to non-regular consumption.

Epsilon alcoholic

This type of drinker (also quarter drinker) can go for weeks without alcohol, but in crises or depressions there is a loss of control and often excessive alcohol consumption for several days. This is followed by a more or less long period of abstinence, which can last for several months (quarter).

Physical damage

The primary metabolic product acetaldehyde, a biologically very reactive cell poison, is considered to be the cause of the physical damage caused by alcohol abuse. Damage includes fatty liver, liver cirrhosis, alcoholic hepatitis, gastritis, stomach and intestinal ulcers, chronic pancreatitis (see also under diabetic wine), neurological damage and epileptic seizures. This leads in extremis to alcohol hallucinosis "delirium tremens" (drunken madness), the most severe form of alcohol withdrawal, in which optical and acoustic sensory illusions, disorientation and severe trembling of the hands (tremor) occur, and the "Korsakov syndrome" (after the Russian psychiatrist Sergei Sergeyevich Korsakov), the most severe, irreversible form of brain damage caused by alcohol, with extensive loss of memory and orientation due to the death of entire brain cell regions.

Therapies against alcohol addiction

A successful therapy against alcohol addiction is not possible without the admission of the person affected that he or she is alcoholic. After an in-patient or out-patient physical withdrawal, which is partly supported by medication, a psychological and social-therapeutic treatment follows, in which self-help groups play a major role. The chances of success of therapy are very good, at about 50% (one in two). The big difference between a moderate consumption of wine and alcohol abuse that is dangerous to health is beautifully described in an essay by the Austrian poet Peter Rosegger (1843-1918). Although he wrote a prosaic declaration of love for wine, so to speak, he preaches a moderate approach to it.

An often asked question is whether alcoholics/dependents may drink non-alcoholic beer or wine (up to 0.5%) or low-alcohol wine (up to 5.0%). This is not only a question of the alcohol content, but also depends on the mental condition of the alcoholic. There is no generally valid limit for all people above which it becomes "dangerous". These non-alcoholic or low-alcoholic alcoholic drinks (which are defined by wine law) hardly differ from alcoholic drinks in terms of smell, taste and colour.

An abstinent or "dry" alcoholic can get a "taste" for alcohol again and start consuming higher-percentage drinks again. Even a beer/wine with 0.0% can be dangerous - because the taste and smell can (not necessarily) have an animating effect. As stated above, a beer up to 0.5% is considered "alcohol-free" (although strictly speaking it is not alcohol-free); only a drink with 0.0% may be declared "without alcohol".

Amount of alcohol acceptable to health

Ideally, alcohol should not be consumed at all. The quantities that are justifiable from a health point of view or are presumably (sic) not harmful to health when consumed regularly are explained under the heading Health. Further information is available on ADH (alcohol degradation), ADI (Acceptable Daily Intake), allergy, blood alcohol concentration (calculation of alcohol level), hangover, headache and vinotherapy.

Alcohol warnings

In 2023, the Republic of Ireland decided to require mandatory health warnings on the labels of alcoholic beverages. See Label and Health.

Etikett - Alkohol Warnhinweis Schwangerchaft

Further information

The topic of alcohol abuse from antiquity to modern times with anecdotes, bizarre stories and prominent protagonists can be found under intoxication and drinking culture. For more information on this topic, see also Alcohol Consumption.

Text source: Alkohollexikon ALEX
Man in a glass: by Sarah Richter on Pixabay
Handcuff and glass: by Лечение наркомании on Pixabay.
Pregnancy warning: istockphoto - MrsWilkins

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