The 5 types of alcoholism (and associated disorders)
Alcohol . This word refers to one of the most popular and consumed legal psychoactive substances in the world. This substance acts as a depressant of the central nervous system, messing up the neuronal membranes and increasing the mobility of the molecules present in the brain.
It has been proven that taking small daily amounts improves health and protects against heart disease, also producing arousal, decreasing the level of anxiety and heart and respiratory rates. However, in higher doses, the level of consciousness and psychomotor coordination, among other effects, decreases. maintaining a continuous consumption can lead to a dependence on this substance, also known as alcoholism , that of being maintained throughout a period of at least twelve months that can cause injuries in diverse cerebral areas.
What is dependency?
Dependence is understood to be that characterized by the existence of the acquisition of a remarkable tolerance, needing to increase the amount of substance to achieve the desired effects, the presence of withdrawal symptoms, the prolonged use of the substance beyond what the consumer intended. , the persistent desire to suppress or control behavior, the deterioration of other activities due to the continuous performance of activities to obtain the substance and the intake of substance despite knowing the affectation that this causes on the person.
In the case of alcohol dependence, this dynamic of constant drinking of alcoholic beverages tends to lead to a series of neurological lesions .
These lesions occur in the corpus callosum, the protuberance and the limbic system, which explains the existence of memory problems and intense emotional reactions. It also decreases the density of neuron dendrite connections and the number of neurons in the cerebellum and hippocampus, which affects the ability of motor coordination and learning.
Types of alcoholism according to the Jellinek classification
There are a large number of causes and patterns of alcohol consumption in dependent persons.
In this sense a large number of classifications have been established, highlighting the proposal by Jellinek . This author classifies the drinkers and alcoholics into five different groups, in order to indicate the social and therapeutic problems of each group.
1. Alpha type drinkers
This type of drinker performs an exaggerated and excessive consumption in order to mitigate the effects of a mental illness or medical In these drinkers there is no real dependence, with which in reality this classification would not fall within the concept of alcoholism.
2. Drinkers type Beta
In this type of drinkers there is no real alcohol dependence either . Social drinkers are included in this classification, who consume excessively something that can cause somatic injury.
3. Gamma-type alcoholism
This type of individuals present a true addiction, manifesting a clear loss of control before drinking , craving or excessive desire to access it, tolerance to alcohol and adaptation to its metabolites. Within this group would be the chronic alcoholic subjects.
4. Delta-type alcoholism
The subjects included in this category also have an alcohol addiction , presenting an inability to maintain abstinence but without presenting a loss of control over drinking. In other words, they need to drink assiduously, but without getting drunk.
5. Alcoholism type Epsilon
The so-called periodic alcoholism occurs in subjects who have loss of control over drinking and behavioral problems , but consuming sporadically, spending long periods between taking and taking.
Disorders derived from alcoholism
The abusive consumption of alcohol can cause serious problems in physical and mental health of consumers.
Alcohol intoxication
Among them stresses the alcoholic intoxication , is caused by the recent ingestion of a high amount of alcohol (or consumed with excessive speed) and is characterized by the presence of psychic and behavioral changes such as aggression, euphoria, poor muscle control, mental and physical slowing, sputtering, alterations of memory, perception and attention. It can go from simple drunkenness to ethyl coma and death.
Abstinence syndrome
Another one of the disorders related to the consumption of alcohol is the syndrome of abstinence . This syndrome, which occurs before the cessation or abrupt interruption in chronic consumers, usually begins with tremors between seven and forty eight hours the last consumption.
Anxiety, agitation, tremor, insomnia, nausea and even hallucinations are frequent.The alterations of this syndrome depend to a great extent on the time and amount of frequent consumption, and seizures and epileptic seizures, alcoholic hallucinosis or even delirium tremens may occur as one of the most severe manifestations of abstinence.
In the case of delirium tremens, it is very important to resort to medical help urgently, since 20% of cases are fatal in case of not going to the hospital, and even with the intervention of specialists, 5% of people die . This clinical picture appears in 3 phases :
- First phase: anxiety, tachycardia, insomnia and dizziness.
- Second phase: 24 hours later, the previous symptoms worsen and tremors and abundant sweating appear.
- Third phase: hallucinations, disorientation, tachycardia, delusions and stupor.
Amnesias induced by alcohol
They are also known blackout, or partial amnesias, which can be classified as amnesia dependent on the state (in which actions performed during drunkenness that are remembered only in a drunken state), fragmentary (amnesia of what happened during intoxication with some intermediate moments preserved) or in block (total forgetting of what happened during the drunkenness).
The habitual abuse of alcohol causes many neurons in the hippocampus to die, and as a consequence there are problems when it comes to creating memories about what happens when the blood alcohol level is high. Both, the declarative memory problems They can remain in the long term.
Sleep disorders
There are also sleep difficulties, decreasing REM sleep and increasing phases 2 and 3 of non-REM sleep to occur in the second half of the night a rebound of REM sleep that can awaken the individual.
Chronic disorders
Besides these disorders of an acute nature, chronic disorders such as Wernicke-Korsakoff syndrome, cognitive alterations (loss of memory, decreased judgment and planning or deterioration of attention among others) or sexual dysfunctions can also occur. personality (including pathological jealousy in couple relationships) and other neurological and hepatic disorders.
Effective treatments established
At the pharmacological level, different medications are used to treat alcohol dependence . Highlights the use of disulfiram to produce an aversive response to alcohol and naltrexone to stop the craving or desire to consume.
Regarding psychological treatment, Over time, multiple programs and treatments have been created to combat alcoholism . Among them, some of the most effective at present are the approach to community reinforcement, cognitive-behavioral therapy and family and couple therapy.
1. Approach to community reinforcement or "Community Reinforcement Approach" (CRA)
Program designed taking into account the importance of the family and society when it comes to reinforcing the sobriety of the alcoholic. Motivational techniques and positive reinforcement are used in it. The main objective of the program is to reduce consumption and increase functional behavior .
Disulfiram is used, training in communication skills, training in job search techniques, play activities not compatible with alcohol and training in contingency management to resist the social pressure to drink through covert awareness. It is the program with the highest level of proven effectiveness.
2. Cognitive-behavioral therapy
Includes training in social skills and coping and relapse prevention.
The first step is to produce an increase in the ability to manage situations that trigger the desire to drink, preparing for change, teaching coping skills and generalizing them to everyday life.
Regarding relapse prevention, the possibility that the subject returns to drink on one occasion (fall), differentiating it from relapse (reinstatement of the habit) so that there is no effect of the violation of abstinence (creating cognitive dissonance and personal self-attribution of addiction, which eventually causes a guilt that facilitates relapse).
3. Family and couple therapy
An essential component in treatment programs. Por yes, it is also very effective . Regardless of the problem itself, it focuses on how it affects the relationship and reinforces communication, negotiation and activities that facilitate maintaining the relationship correctly.
In conclusion
Although alcoholism is a chronic problem, in a large number of cases the prognosis once the behavior is normalized is positive: It has been observed that it has been achieved in more than 65% of treated cases to maintain controlled abstinence . However, it is necessary to detect the problem in time and start a treatment as quickly as possible to prevent the nervous system from being badly damaged.
In some cases, in addition, the withdrawal of alcohol consumption should be done in a controlled manner and supervised by doctors, since the withdrawal syndrome can lead to many problems or even lead to death.
Bibliographic references:
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
- Hunt, G.M. and Azrin, N.H. (1973). A community-reinforcement approach to alcoholism. Behavior Research and Therapy, 11, 91-104
- Jellinek, E.M. (1960). The disease concept of alcoholism. New Brunswick: Hillhouse Press
- Kopelman, M.D. (1991). Non-verbal, short-term forging in the alcoholic Korsakoff syndrome and Alzheimer-type dementia. Neuropsychologia, 29, 737-747.
- Marlatt, G.A. (1993). The prevention of relapses in addictive behaviors: a cognitive-behavioral treatment approach. In Gossop, M., Casas, M. (eds.), Relapse and relapse prevention. Barcelona: Ed.Neurosciences.
- Santos, J.L; García, L.I .; Calderón, M.A .; Sanz, L.J .; de los Ríos, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Thief, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE Preparation Manual PIR, 02. CEDE. Madrid.
