It is clear that alcohol consumption is widespread in Spain, with approximately six out of ten adults consuming alcoholic beverages more or less regularly (76% of men, compared to 53% of women). It is considered that around 2.5% of the general population has a problem of alcoholism (alcohol dependence), with an approximate figure of 5% being habitual heavy drinkers. Dr. Antón Fructoso, expert in Psychiatry, talks about this addiction and how to know if you suffer from it.
What is alcoholism
Alcoholism is understood as a chronic behavioral disorder manifested by excessive preoccupation with alcohol, harmful effects on physical and psychological health, loss of control when the patient starts drinking, self-destructive attitude in interpersonal relationships and in different life situations. Unlike other drugs, prolonged periods of abusive alcohol intake are required for a person to become an alcoholic.
Currently, two types of alcohol problems are distinguished: alcohol abuse or harmful drinking and alcohol dependence.
Alcohol abuse occurs when alcohol is habitually consumed above the established limits (abusive doses are considered to be more than 60 g/day for men and more than 40 g/day for women). In these cases, there is no clear dependence and life seems normal, but alcohol intoxication begins, which is the main manifestation of abuse.
In drunkenness there is usually an initial sensation of relaxation and pleasant euphoria (with certain disinhibition), but the individual suffers a lengthening of reaction time and slowing of reflexes (with the consequent difficulties, for example in driving vehicles). If intoxication progresses, consciousness levels are altered and coma may occur.
Behavior of a patient addicted to alcohol
Alcohol dependence goes beyond abuse. It assumes that the organism has become habituated to alcohol by developing tolerance. In other words, it needs increasing doses of alcohol to produce the same effect. When dependence exists, if the habitual alcohol intake is reduced or suppressed, withdrawal syndrome will occur (it can be mild, with anxiety and irritability, as happens to some alcoholics in the morning, until they ingest the first drink; or it can be of severe intensity, with nausea and vomiting, tremors, perceptive alterations or convulsions that require urgent treatment). These patients have lost control over their consumption, generally in large quantities, even if they minimize the problem, and their life is organized around alcohol. They cannot stop even if they try.
How to diagnose a patient with alcoholism
The alcoholic patient often tends to minimize his problem and, sometimes, may deny it, in spite of the evidence of his repeated consumptions. This defensive attitude of the patient must be dismantled and the patient must be placed in his or her conflictive reality with alcohol. There are a number of key questions (the CAGE test for diagnosing alcoholism), which help to identify the problem:
- Have you ever thought that you should cut down on your alcohol consumption?
- Have you ever been angry because people have criticized your drinking?
- Have you ever felt guilty or bad about drinking?
- Have you had a drink in the morning when you woke up to relieve a hangover or tension?
If there are 2 or 3 affirmative answers, suspect alcohol problems. If the score is 4, the alcohol dependence is verifiable.
Causes of alcohol addiction
Once the disease has been accepted, it is advisable to investigate the factors that may have influenced its development. It is easy to verify that there are certain environmental factors in the motivations for alcoholism that are causing persistent stress in the patient (economic, occupational or family, where alcohol is a resource to appease the stress.
Other factors are more related to the patient’s personality. Thus, for example, feelings of loneliness and hopelessness can play an important role in the genesis of alcohol dependence. People with a certain emotional dependence experience loneliness with great anguish and turn to alcohol to “overcome” the unbearable discomfort, in the same way the feeling of hopelessness (negative attitude or failure in the future) has an important influence on the onset of alcohol dependence.
Treatment for patients with alcohol dependence
It is clear that the treatment should be carried out by means of a comprehensive psychotherapy of the patient, analyzing the biographical elements that may have influenced the development of the disease and thus be able to provide certain orientations and establish objectives that help to overcome the dependence. Along with psychotherapeutic activity, pharmacological therapy is also necessary, generally with anxiolytic and antidepressant drugs, as well as vitamins. The use of interdictor drugs, which produce a rapid aversive response to alcohol consumption, is often effective.
Measuring harmful drinking
It is important to be clear about the limits of risky and harmful alcohol consumption. The Standard Drinking Unit (SBU), equivalent to 10 g of pure alcohol (a glass of wine or a glass of beer is equivalent to 10 g -1 SBU); a distilled beverage is equivalent to 20 g (2 SBU), a bottle of wine is equivalent to 70 g (7 SBU), and so on.
According to these measures, for a healthy and well-nourished adult population, the safe intake for men would be between 0-40 g/day and for women between 0-20 g/day. Risk consumption for men would range from 41-60 g/day, and for women from 21-40 g/day. Harmful consumption for men would be more than 60 g/day and for women more than 40 g/day.
As can be seen, the risk thresholds for women are lower. The vulnerability of women is confirmed by their physiology: lower weight, lower proportion of water in their bodies (to dilute alcohol) and more fat in their tissues (it is more difficult for them to eliminate alcohol, as it is fat-soluble). All this makes women a factor of greater vulnerability, so that with equal consumption, they are more likely than men to suffer physical problems (hepatic and neurological) and to develop alcohol addiction more quickly.