Alcoholism

When do you become 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 recognized standard works) there are five definition criteria from a clinical point of view. These are 1. abnormal drinking behaviour, 2. somatic alcohol-related harm, 3. psychosocial alcohol-related harm, 4. development of tolerance and withdrawal syndrome (physical alcohol dependency) and finally 5. development of "withdrawal syndromes on the subjective level" with in extreme cases total loss of control, as well as the centering of thinking and striving for alcohol (psychic alcohol dependency).

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

Classification or alcoholic types

A typological classification was developed by Professor E. M. Jellinek. The US psychiatrist is regarded as the "pope" of alcoholism research; his major 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", with the alpha type being the conflict drinker who drinks to relax and relieve stress, but can stop at any time. The beta type is the casual and social drinker, to which practically everyone who is not a teetotaler belongs. The groups of gamma, delta and epsilon alcoholics are classified as "addicted alcoholics". The development of addiction takes place slowly through the prodomal phase (precursor phase, period between increased alcohol consumption and loss of control, lasting from several months to several years) to the critical phase, associated with loss of control.

To keep up the appearance of an intact family, the alcohol problem of the partner is very often ignored, played down or covered up. As a result, ever larger quantities of alcohol are consumed. The beginning of this phase is characterised by the occurrence of regular memory gaps as well as irritable reactions when the environment addresses the topic of alcohol as a result of the incipient feelings of guilt arising from the self-awareness that one's own drinking behaviour is not normal. In the further course of the disease, the progressive disruption of the metabolic processes slowly leads to physical and psychological addiction, combined with loss of control.

Gamma alcoholic
In a pre-alcoholic phase, the drinking behaviour is inconspicuous and socially motivated, it takes place in company. There is an increasing ease of drinking, alcohol is increasingly drunk to balance the mood, with higher and higher doses being required. Gaps in memory 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. Small amounts of alcohol increase the urge to drink more. The attempt to stop drinking is marked by physical withdrawal symptoms (sweating, restlessness, trembling). The self-esteem is increasingly lost. In the chronic phase, excessive drinking is practised for days on end, with the result of ever-increasing mental, physical and social breakdown.

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 be hidden from the environment by irregular consumption.

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

physical damage

The primary cause of the physical damage caused by alcohol abuse is considered to be the primary metabolic product acetaldehyde, a biologically very reactive cell poison. Damage includes fatty liver, cirrhosis of the liver, alcohol hepatitis, inflammation of the stomach lining, stomach and intestinal ulcers, chronic inflammation of the pancreas (see also under diabetic wine), neurological damage and epileptic seizures. This leads in extremis to the alcohol hallucinosis "Delirium tremens" (drunkenness), the most severe form of alcohol withdrawal, in which optical and acoustic sensory illusions, disorientation and severe tremor of the hands (tremor) occur, as well as "Korsakov Syndrome" (according to 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 is not possible without the patient's admission of being an alcoholic. After an inpatient or outpatient physical withdrawal, which is partly drug-supported, psychological and social therapy treatment, in which self-help groups play a large role, follows the withdrawal. The chances of success of a therapy are very good at around 50% (one in two). The big difference between moderate wine consumption and harmful alcohol abuse is well 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 preached moderate drinking.

An often asked question is whether alcoholics/dependent people 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 state of the alcoholic. There is no generally applicable limit above which it becomes "dangerous" for all people. These non-alcoholic or low-alcohol alcoholic beverages (which are defined by wine law) hardly differ from the alcoholic ones in terms of smell, taste and colour.

The dangerous thing about this is that an abstinent or "dry" alcoholic gets a new "taste" from drinking it and starts to consume higher-proof drinks again. This means that even a beer/wine with 0.0% can be dangerous - because the taste and smell can (but does not have to) be stimulating. By the way, as stated above, a beer of 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".

reasonable quantities of alcohol

The quantities of wine or alcohol that are justifiable from a health point of view, or which, if consumed regularly, are probably not harmful to health, are explained under the heading of health. The subject of alcohol abuse from antiquity to modern times with bizarre stories and prominent protagonists can be found under the keywords intoxication and drinking culture. On this topic, see also ADH (alcohol reduction), ADI (Acceptable Daily Intake), prohibition of alcohol, allergy, blood alcohol concentration (BAK = calculation of alcohol level), hangovers, headaches, prohibition, vinotherapy and drinking.

Source: ALEX Alcohol Dictionary
Man in a jar: by Sarah Richter on Pixabay
Cuff and glass: from Лечение наркомании on Pixabay