Alcoholism

Edited by Dr. Sarah Beggiato

What is alcoholism?

The term "alcoholism" refers to a disease known as syndrome from alcohol addiction, the most serious stage among the various problems related to the consumption of alcoholic beverages, which begins with the so-called "binge drinking" and which can evolve into the most serious alcohol abuse.

What is a standard drink?

Many people are surprised when they learn how a drink is rated. The amount of liquid in our glass, or in the bottle, does not necessarily correspond to the amount of alcohol contained in them. Different types of beer, wine or malt liqueurs can in fact contain different amounts of alcohol. For example, many light beers have nearly the same amount of alcohol as a regular beer:

• regular beer: 5% (approximately) alcohol content (by law more than 3.5%)
• light or light beer: alcohol content greater than 1.2% but less than 3.5%
• non-alcoholic beer: alcohol content less than 1.2%

This is why it is important to know how much alcohol our drink contains.

To measure the amount of alcohol present in the glass, and the possible effects it can have on the body and performance, the concept of standard alcohol unit (AU) was introduced, corresponding to 12 grams of pure alcohol (or 10 grams according to other sources) To obtain the number of alcoholic units contained in the drink, its alcohol content expressed in grams must be divided by 12 (or 10), or by 15.2 (or 12.7) its alcohol content expressed in milliliters (% Vol). For example, a can of beer (330 ml), a glass of wine (125 ml), an alcoholic aperitif (80 ml) or a small glass of spirits (40 ml) each correspond to an alcohol unit. Another way to call the "alcoholic unit" it is "standard drink" or "standard drink".

Calculation of alcoholic units

To calculate the alcoholic units contained in an alcoholic drink, enter the quantity consumed expressed in milliliters, the alcohol content shown on the label (% Vol.) And click on the calculate button

Classification of the types of drinkers

Alcohol dependence is due to a number of factors, which can be grouped into:

• physical (genetic, metabolic, neurological);
• psychic (psychic disorders of various kinds that cause suffering and facilitate the search for alcohol as a comfort);
• social (drinking culture, social pressure, habits and lifestyle).

Taken individually, the factors described above fail to create the disturbance; therefore, for the problem to manifest itself, more predisposing factors are needed, activated by an occasional triggering cause.
Jellinek in 1960 identified five different categories of alcohol users and defined them as follows:

• alpha drinker: he is the one who uses the effects of alcohol to disinhibit himself or to find relief from physical and emotional suffering;
• beta drinker: it is the classic occasional drinker, who uses drinking as a moment of socialization, friendship;
• gamma drinker: is an individual who is able to refrain from drinking, but if he begins to drink he does so uncontrollably;
• delta drinker: he is the one who is properly defined alcoholic. These individuals undergo withdrawal crises, need hospitalization and show a tendency to relapse;
• epsilon drinkers: they are episodic consumers who can abstain from drinking for long periods, but who can then suddenly start in an uncontrolled way. This type of drinker also includes subjects who repeatedly drink compulsively until they get drunk.

Gamma, delta and epsilon drinkers - although not addictive - are at greater risk than the general population.
Years later, alcoholics were divided into two subgroups by Cloninger, depending on their genetic-environmental or genetic characteristics only:

• type I: the onset of alcohol dependence begins late, after age 30. Generally type I is not accompanied by aggressive behaviors or by legal or social complications due to alcohol abuse;
• type II: occurs mainly in males and has an early onset, before the age of 25. It is generally related to social and legal problems.

Ways to drink

Moderate drinking

Experts have shown that moderate drinking is unlikely to lead to an alcohol-related disorder. The alcohol levels that can be taken and which would present a low risk of developing a related disease, differ between men and women and are:

• for men: no more than 4 drinks in a single day and no more than 14 drinks per week;
• for women: no more than 3 drinks in a single day and no more than 7 per week.

Even within these limits, you can have problems if you drink very fast or have other concomitant ailments. To keep the risk of developing alcohol-related problems low, make sure you drink slowly and combine alcohol consumption with solid food.
Some individuals should avoid drinking altogether, including those who plan to drive for the next few hours, take medications that interfere with alcohol, have a health situation that alcohol can aggravate, are in their gestation period or have planned to have a child.

Drinking excessively

For the health of the individual in general, excessive drinking means consuming more in a day than it has been estimated that one can drink daily or, even worse, weekly. About one in 4 people who drink in this way, or above the levels previously mentioned, develop alcohol addiction syndrome or alcohol addiction problems.

Binge drinking

Binge drinking means drinking so much, within 2 hours, that the blood alcohol concentration reaches 0.08g / dL. For women, this generally happens after 4 drinks and for men after about 5. Drinking in this way can put an individual's health and safety at risk, increasing the likelihood of car accidents and damage to health. In the long run, for example, bingedrinking can damage the liver and other organs.

Effects of Alcohol on the Body

For further information: Alcoholism Symptoms

Drinking too much, on individual occasions or over time, can create serious health problems. The acute effects associated with alcohol consumption strongly depend on the biological and genetic characteristics of the individual.

Ethanol has a lethal dose 50 (LD50) equal to 8g / kg, therefore it is a slightly toxic substance (class 2). The symptoms of acute ethanol poisoning vary according to the concentration of alcohol in the blood; we can distinguish:

• alcohol level 0.3-0.5 g / l: psychomotor excitation phase with disinhibition, euphoria and talkativeness; anxiolytic effect; impaired memory, judgment, concentration and mild motor disturbances;
• alcoholemia 0.5-2 g / l: phase in which motor incoordination, decrease in muscle strength, amnesia and mental confusion, dysarthria, perceptual changes, mydriasis, vomiting, drowsiness and numbness appear;
• alcohol> 4 g / l: in this phase the concentration of alcohol in the blood can be fatal because it causes anesthesia, motor and respiratory depression, hypothermia, coma and death.

Some of the effects that alcohol can produce in the body will be briefly described below.

Effects on the central nervous system (CNS)

Alcohol interferes with the different communication systems of the brain and can affect the way the brain works. It has been hypothesized that the development of alcohol addiction involves a series of chemical changes in the brain; phenomenon that has been explained with the concept of neuroplasticity. This term refers to the brain's ability to compensate for injuries it undergoes and to adapt to new situations or changes in the body (for example, chronic exposure to alcohol), by forming new connections between neurons or by altering the activity of pre-existing neurons. Adaptation processes can also affect neurotransmitters, the receptors they interact with and many other molecules.

Following "chronic exposure to alcohol", the neuronal changes reflect the appearance of the behavioral effects typical of addiction, such as increased anxiety, stress and the onset of tolerance.

The term "tolerance" refers to a decrease in the positive reinforcing effects of alcohol, whereby an individual needs more alcohol to achieve the same effects previously experienced at lower doses. In an individual with a high tolerance level, abstention from alcohol consumption can precipitate the withdrawal syndrome.
Alcohol has a biphasic action on the brain: it is a substance that depresses the central nervous system, although behavioral stimulation is observed at low blood levels. Prolonged use of alcohol can cause a series of changes in the brain that manifest themselves with functional and morphological alterations that can also lead to the death of the neuron.

Effects at the peripheral level

• At the heart level: Drinking a lot for a long time, or too much on single occasions, can damage the heart, causing problems such as cardiomyopathies, arrhythmias (irregular heartbeat), heart attack and high blood pressure. However, scholars have also shown that drinking moderate amounts of alcohol - especially if made from red wine - can protect an individual's health by slightly reducing the risk of developing coronary heart disease.
• Liver: Drinking large amounts of alcohol can cause a wide range of liver problems, including inflammation, such as steatosis or fatty liver, alcoholic hepatitis, fibrosis and cirrhosis.
• At the pancreatic level: alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation that leads to swelling of the blood vessels in the pancreas, thus preventing proper digestion.
• Incidence for developing cancer: Drinking a lot of alcohol can also increase the risk of developing certain cancers, including cancer of the mouth, esophagus, throat, liver and breast.
• Immune System: Consuming high amounts of alcohol can weaken the immune system, making the human body more vulnerable to disease. Chronic drinkers - compared to individuals who don't drink a lot - are particularly susceptible to diseases such as pneumonia and tuberculosis. Drinking a lot on a single occasion makes the body less effective in its ability to respond to infections for up to 24 hours after drinking.

Alcohol Consumption Disorders

Alcohol consumption disorders represent a real pathological condition, which the doctor can diagnose when drinking causes harmful effects and distress in the individual.

Alcohol addiction is widespread. According to data reported by the World Health Organization, alcohol abuse causes about 2.5 million deaths each year and represents the third risk factor in the world for the development and aggravation of other diseases.
Symptoms of alcoholism include:

• the desire, urgency and urge to drink, more commonly called craving;
• loss of control: inability to stop drinking once one has started drinking;
• physical dependence: onset of withdrawal symptoms - such as nausea, sweating, tremor and anxiety - after you stop drinking;
• tolerance: the need to drink more alcohol to experience the same positive effects that drive the individual to drink

People with alcoholism often spend a great deal of time drinking. Because of drinking, those who use alcohol uncontrollably are no longer able to fulfill their responsibilities at home, at work or at school. Often such individuals put their own life and that of others in danger (eg driving under the influence) or have social or legal problems (eg stories of arrests or family quarrels) due to their alcohol problem. .
Like many other diseases, alcoholism is generally considered chronic, that is, a disease that persists throughout the life span of the individual who is affected. Epidemiological studies have shown that more than 70% of individuals who develop alcohol dependence have a single episode lasting an average of 3-4 years Data from the same survey show that many people who undergo conventional treatment are able to remain alcohol-free, and many others recover without conventional treatment.

Alcoholism and genetics

How can genes influence alcoholism?

Alcoholism often brings together several members of the same family and you can read scientific studies that talk about the "alcoholism gene". Genetics certainly affects the likelihood of developing alcoholism or not, although the story is not that simple. Studies show that genes are responsible for about half of the risks associated with alcoholism. Therefore, genes alone do not determine whether or not a person will develop alcohol addiction syndrome. Environmental factors, as well as interactions between genes and the environment, are responsible for the remaining part of the risk.
A multiplicity of genes contribute to a person's risk of developing alcoholism. There are genes that, for example, favor the risk and others that reduce it, directly or indirectly. For example, some Asian subjects carry a gene variant that alters the risk. their way of metabolizing alcohol, causing symptoms such as hot flashes, nausea, or a racing heart when they drink. Many people who experience these unpleasant effects, to say the least, avoid alcohol and this helps prevent the development of alcoholism.
It has also been shown that genes can also influence the effectiveness of alcohol treatments. For example, drugs such as naltrexone have been shown to be effective in helping some, but not all, individuals who have developed alcohol addiction to reduce the desire to drink alcohol. Alcoholic patients with a variation in a specific gene have been shown to respond positively to treatment with naltrexone, while patients who do not carry this genetic variation do not respond to treatment. Therefore, a full understanding of how genes affect drug characteristics will help doctors prescribe the most effective treatment for each individual patient.

Fetal Alcoholic Syndrome

Fetal alcohol syndrome occurs when a pregnant woman consumes significant amounts of alcohol. Although there are no safe amounts of alcohol for the fetus, about 20-30% of women use alcohol during the gestation period. Alcohol can alter the development of the fetus in any period of gestation, especially during the early stages of pregnancy. Studies show that binge drinking, which as initially described means drinking 4 or more drinks on a single occasion, and drinking regularly in heavily, they favor the development of serious problems to the fetus.