What it is and how it manifests itself
Alcohol dependence belongs to the group of so-called alcohol-related disorders, which includes all those problems, not only medical, but also family, work and social, that can affect those who use alcoholic beverages.
Alcohol abuse
Alcohol abuse is an intermediate situation between occasional drinking and physical dependence on ethanol; in this phase, the subject - although not presenting a real physical dependence - suffers from repeated interpersonal, work and social problems deriving from excessive consumption alcoholic beverages. In these cases, the dependence on alcohol is purely psychological; thus, the subject clings to the bottle to feel fitter, euphoric, relieved of the problems that afflict him, indulging in occasional excesses or continuous consumption of alcohol despite the problems it entails.
Alcohol addiction
In alcohol dependence the patient has now developed tolerance to the consumption of alcoholic beverages and his relationship with alcohol is experienced as an almost inseparable link, under penalty of physical withdrawal symptoms. Tolerance, or the decrease in the intoxicating effect. of alcohol at the usual doses, determines the need to increase the quantity of alcohol consumed, reaching doses that in the normal subject would cause serious functional alterations.
When physical addiction to alcohol sets in, the subject spends a great deal of time procuring the substance; the final balance is a serious impairment of social life, up to situations of danger for oneself and for others, together with the various medical-legal problems that ensue.
Alcohol addiction according to DSM IV
DSM-IV defines alcohol dependence as a pathological pattern of drug use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following conditions, occurring at any time during the same 12-month period :
- Tolerance, defined as:
- The need for significantly higher doses of the substance to achieve the desired intoxication or effect.
- A significantly diminished effect with continued use of the same amount of substance.
- The need for significantly higher doses of the substance to achieve the desired intoxication or effect.
- Withdrawal, defined as:
- The characteristic alcohol withdrawal syndrome *
- The same substance (or a closely related one) is taken to alleviate or avoid withdrawal symptoms.
- The characteristic alcohol withdrawal syndrome *
- The substance is often taken in larger quantities or for longer periods than expected by the person.
- Persistent desire or unsuccessful attempts to reduce or control the use of the substance.
- A great deal of time is spent on activities necessary to obtain the substance, take it, or recover from its effects.
- Interruption or reduction of important social, work, recreational activities due to the use of the substance.
- Continued use of the substance despite the awareness of having a persistent or recurring problem, of a physical or psychological nature, likely caused or exacerbated by the substance (for example, the subject continues to drink despite the recognition of the worsening of an "ulcer due to the intake of" alcohol).
Alcohol withdrawal syndrome
* Please note: the alcoholic withdrawal syndrome is characterized by a range of symptoms opposite to the acute effects of the substance; these symptoms, of varying severity, can afflict the patient in various ways: tachycardia, sweating, fever, tremor, restlessness, agitation, irritability, poor concentration, poor memory, vomiting, diarrhea, weakness, cramps and nightmares, up to hallucinations, thoughts paranoid, space-time disorientation and delirium tremens in the most severe cases. According to the American psychiatric Association, alcohol withdrawal syndrome includes two or more of the following symptoms:
- Hyperactivity of the autonomic nervous system (rapid heart rate, high blood pressure, rapid breathing rate, increased body temperature, sweating);
- Anxiety;
- Insomnia
- Psychomotor agitation
- Nausea and vomit
- Tremor
- Rarely: transient visual, tactile or auditory hallucinations or illusions
- Rarely: epileptic convulsions
Alcohol withdrawal symptoms may occur within 4 to 8 hours of the drinker quitting alcohol, with the peak of maximum intensity on the second day and improvement by the fifth, although the milder symptoms disappear only after a few months.
How to recognize it?
- Administer specific questionnaires to the patient, such as the "AUDIT (Alcohol Use Disorders Identification Test) which can be done online with immediate response. Unfortunately, these questionnaires have the big limitation of being self-completed, therefore not always responding to the real situation of the patient (the subject with alcohol-related problems hardly admits to having a real pathological problem).
- Pay attention to early signs and symptoms: morning vomiting, abdominal pain, diarrhea, gastritis, alcoholic fatty liver disease.
- Perform specific laboratory tests; in alcoholics the levels of GGT and to a lesser extent of other transaminases increase, the mean globular volume (MCV) increases and the concentrations of carbohydrate-deficient transferrin (CDT) increase.
- Look for objective signs of alcohol dependence on the individual's social experience: frequent anger, loss of the ability to communicate with friends and family (social isolation), irritability, inability to complete projects, delays and absences at work.
