What is alcoholism?
The term "alcoholism" refers to a disease known as alcohol addiction syndrome , the most serious stage among the various problems related to the consumption of alcoholic beverages, which begins with the so-called " binge drinking " or "alcohol binge" 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 quantity of alcohol contained in them. Different types of beer, wine or malt liquor can in fact contain different amounts of alcohol. For example, many light beers have almost the same amount of alcohol as a normal beer:
- normal beer: 5% (approximately) of alcohol content (by law over 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%
That's why it's important to know how much alcohol our drink contains.
To measure the amount of alcohol present in the glass, and the possible effects that it can determine on the organism and on performance, the concept of standard alcoholic unit (UA) 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, or for 15.2 (or 12.7) its alcohol content expressed in milliliters (% Vol) must therefore be divided by 12 (or 10). 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 alcoholic unit. Another way to call the alcoholic unit is "standard drink" or "standard drink".
Classification of the types of drinkers
Alcohol addiction is due to a number of factors, which can be grouped into:
- physical (genetic, metabolic, neurological);
- psychics (mental disorders of various kinds that cause suffering and facilitate the search for alcohol as a comfort);
- social (culture of drinking, social pressure, habits and lifestyle).
Taken individually, the factors described above do not create the disturbance; therefore, in order for the problem to manifest itself, we need more predisposing factors activated by an occasional triggering cause.
In 1960 Jellinek identified five different categories of alcohol consumers and defined them as follows:
- alpha drinker: it is the one who uses the effects of alcohol to disinhibit or to find relief from physical and emotional suffering;
- beta drinker: he is the classic occasional drinker, who uses drinking as a moment of socialization, friendship;
- gamma drinker: he is an individual who is able to abstain from drinking, but if he starts drinking he does so uncontrollably;
- delta drinker: it is the one who is properly defined as an alcoholic. These individuals undergo withdrawal symptoms, 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 out of control. This type of drinker also includes subjects who drink compulsively repeatedly until they get drunk.
The gamma, delta and epsilon drinkers - although they do not present a condition of dependence - run in this sense a greater risk than the general population.
Years later, alcoholics were divided into two subgroups by Cloninger (1987), depending on genetic-environmental or only genetic characteristics:
- type I: the onset of alcohol dependence begins late, after 30 years. Generally, type I is not accompanied by aggressive behavior or legal or social complications due to alcohol abuse;
- type II: it occurs mainly in males and has an early onset, before the age of 25. It is generally linked to social and legal problems.
Ways of drinking
Experts have shown that moderate drinking can hardly lead to a disorder related to alcohol consumption. The levels of alcohol that can be taken and that would present a low risk of developing a disease related to it, differ between men and women and are:
- for men: no more than 4 drinks in one day and no more than 14 drinks per week;
- for women: no more than 3 drinks in one day and no more than 7 per week.
Even within these limits, problems can occur if you drink very quickly or have other concomitant disorders. To keep the risk of developing alcohol-related problems low, you need to make sure that you drink slowly and combine alcohol consumption with solid food.
Some individuals should completely avoid drinking, including those who plan to drive in the following hours, take drugs that interfere with alcohol, have a health situation that alcohol can aggravate, are in the gestation period I have planned to have a child.
For the health of the individual in general, excessive drinking means consuming in a day more than has been estimated you can drink daily or, worse still, weekly. About one in four people who drink this way, or above the levels mentioned above, develops an alcohol addiction syndrome or alcohol addiction problems.
Binge drinking means drinking so much, in a time of up to 2 hours, that the concentration of alcohol in the blood reaches 0.08g / dL. For women, this generally happens after 4 drinks and for men after about 5. Drinking in this way can put the health and safety of the individual 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
To learn more: Symptoms Alcoholism
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 of 50 (LD50) equal to 8g / kg, therefore it is a slightly toxic substance (class 2). The symptoms of acute ethanol poisoning vary depending on the concentration of alcohol in the blood; can be distinguished:
- alcohol content 0.3-0.5 g / l: psychomotor excitation phase with disinhibition, euphoria and talkativeness; anxiolytic effect; alteration of memory, judgment, concentration and slight motor disturbances;
- alcohol content 0.5-2 g / l: phase in which motor incoordination, decrease in muscle strength, amnesia and mental confusion, dysarthria, perceptual alterations, mydriasis, vomiting, drowsiness and drowsiness appear;
- alcoholemia> 4 g / l: at this stage 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 are 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 it works. It has been hypothesized that the development of alcohol dependence involves a series of chemical changes in the brain; phenomenon that was explained by the concept of neuroplasticity . This term refers to the brain's ability to compensate for the lesions it encounters and to adapt to new situations or changes in the body (eg chronic exposure to alcohol), through the formation of new connections between neurons or by altering the activity of pre-existing neurons. Adaptation processes can also affect neurotransmitters, the receptors with which they interact and many other molecules.
Following chronic exposure to alcohol, neuronal changes reflect the appearance of the typical behavioral effects of addiction, such as increased anxiety, stress and the appearance of tolerance.
The term "tolerance" refers to a decrease in the positive reinforcing effects of alcohol, whereby an individual needs higher amounts of 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 withdrawal symptoms.
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 occur with functional and morphological alterations that can also lead to neuron death.
- At heart level: drinking a lot for a long time, or too much on individual 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, slightly reducing the risk of developing coronary heart disease.
- At the liver level: 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 of cancer development: drinking a lot of alcohol can also increase the risk of developing certain types of cancer, including cancer of the mouth, esophagus, throat, liver and breast.
- Immune system: consuming large amounts of alcohol can weaken the immune system, making the human body more vulnerable to disease. Chronic drinkers - compared to individuals who do not drink much - 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 even 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 around 2.5 million deaths every year and represents the third risk factor in the world for the development and aggravation of other diseases.
The symptoms of alcoholism include:
- the desire, the urgency and the need to drink, more commonly called craving;
- loss of control: inability to stop drinking once it has begun to do so;
- physical dependence: onset of withdrawal symptoms - such as nausea, sweating, tremor and anxiety - after drinking has stopped;
- tolerance: 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. Precisely because of drinking, those who use uncontrolled alcohol are no longer able to fulfill their responsibilities at home, at work or at school. Often these individuals put their own lives and those of others in dangerous conditions (for example driving in a state of drunkenness) or have problems of a social or legal nature (for example, stories of arrests or family disputes) due to their problem with alcohol .
Like many other diseases, alcoholism is generally considered to be chronic, that is, a disease that persists throughout the life of the individual who is affected. Epidemiological studies have shown that more than 70% of individuals who develop alcohol dependence have a single episode that lasts an average of 3-4 years. The same survey data shows 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 unites more members of the same family and you can read scientific studies that talk about the "alcoholism gene". Genetics certainly influences the likelihood of developing alcoholism or not, even if the story is not so simple. Studies show that genes are responsible for about half of the risks related to alcoholism. Thus, genes alone do not determine whether or not a person will develop alcohol addiction syndrome. The environmental factors, as well as the interactions between genes and the environment, are responsible for the remaining part of the risk.
A multiplicity of genes contributes to a person's risk of developing alcoholism. There are genes that for example favor risk and others that reduce it, directly or indirectly. For example, some Asian subjects are carriers of a gene variant that alters their way of metabolizing alcohol, causing symptoms such as hot flushes, nausea or acceleration of heart rate when they drink. Many people who experience these effects to say the least unpleasant, avoid alcohol and this helps them prevent the development of alcoholism.
It has also been shown that genes can also influence the effectiveness of treatments for alcoholism. For example, drugs like 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. It has been shown that alcoholic patients who present a variation in a specific gene 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 influence 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 takes significant amounts of alcohol. Although there are no safe quantities of alcohol for the fetus, about 20-30% of women use alcohol during the gestation period. Alcohol can alter the development of the fetus at any time during pregnancy, especially during the early stages of pregnancy. Studies show that binge drinking, which as described initially means drinking 4 or more drinks per single occasion, and drinking heavily on a regular basis, favor the development of serious fetal problems.