The Alcoholism

**counselor** Mon Oct 15, 2012 11:05 am

The Alcoholism

The a. should be considered primarily as a behavioral disorder due to the abuse of a toxic substance that causes damage on both the psychic and organic. The World Health Organization provides a definition of a. according to which must be considered alcoholics those heavy drinkers whose dependence on alcohol has attained such high levels as to have given rise to major mental disorders, or interfere with their mental and physical health, with their interpersonal relationships and their harmonious development social and economic. In the definition of a. must be considered central phenomena of tolerance and dependence. The tolerance, addiction is the phenomenon as a result of which the body gets used to a certain substance, so with time it is necessary to assume an increasing quantities to maintain the same initial effects. Most of the so-called big drinkers has acquired such alcohol tolerance, albeit variable. Addiction, however, is limited when compared to other drugs of alcohol, as alcohol dehydrogenase enzyme induction is quite low. Characteristic of alcoholism, compared to other pipelines tossicomaniche, is the phenomenon of intolerance dell'etilista a chronic tolerance decreases progressively with the evolution of intoxication, as it produces liver damage so large as to disrupt the enzyme heritage of the subject. Most often disease alcoholic and alcohol dependence co-exist and mutually reinforce one another: the concept of a. is highly correlated with that of alcohol dependence, provided that inevitably leads to a pathology psychic and somatic with high levels of disablement. However, not all individuals with a disease alcohol are alcohol-dependent, but still show a high risk of developing an addiction. Alcohol dependence is defined (WHO), a psychic and usually also physical, characterized by a compulsion to take alcohol on a continuous or periodic in order to prove its psychic effects and avoid the discomfort of its absence. The DSM-IV-R includes addiction to alcohol use disorders among psychoactive substances, providing a specific pattern of diagnostic orientation in the form of symptom criteria, timing and outcome. This approach is a useful application in clinical practice because it proves adaptable to almost all clinical forms, independently both by the geographical and socio-cultural, but also from individual variables. The DSM-IV-R provides a syndrome of alcohol dependence criteria established by specific symptom that rely on the presence of an alteration of the drinking habits of an altered relationship between the individual and a physical dependence on alcohol. Next to the concept of addiction have emerged in recent years clinical prognostic criteria innovative framing the disease in terms of alcohol abuse and risk. The concept of abuse of the DSM-IV-R provides for a usage mode pathological, that features a use of alcohol applicant, even in situations physically risky, for the presence of recurrent legal problems, the inability to fulfill work tasks and the use of the substance in the knowledge that they have social and interpersonal problems that are exacerbated by alcohol itself. The data relating to real spread of alcoholism are quite inaccurate, due to the lack of definitions nosographic unique or homogeneous diagnostic models. In recent years there has been a significant increase in the consumption of alcohol. A number of factors in the etiopathogenesis of alcoholism and, therefore, the aetiological theories are based on both biological hypotheses and, especially, of socio-cultural and psychological factors and psychodynamic. Indeed, in addition to the probable familial predisposition in terms of conditioning even more than the inheritance, and to the fact that alcohol produces antidepressant and anxiolytic action often favoring one of his regular employment as a medicine, has recently paid particular attention to two aspects in particular, which are located next to the traditional analytical models of interpretation: the pre-alcoholic personality and psychiatric disorders such as anxiety and depression. The personality traits described in the literature refer almost exclusively to patients with alcohol dependence, among them, seem to be the most typical traits of passivity, emotional-affective instability, rigidity and ease the frustration. You can briefly outline three basic types of character structures that influence motivation alcohol abuse: structures neurotic-anxious, depressive caratteropatie and structures. In the first case the main motivation is anxiety, in the second case the abuse assumes the characteristics of a protest solitary and silent towards the other, in the third case the conduct alcolomanica seems to be linked to a boost self-destructive, a kind of slow suicide. It is not possible to date to determine whether the anxiety disorder is the effect or the consequence of a pipeline alcoholic. In some cases, however, the secondary alcohol dependence seems to anxiety disorder and in particular to anxiety type of panic and phobic. This is of relevance to preventive and therapeutic. Has been studied in more detail the relationship between alcohol abuse and depression, both in terms of familial transmission is symptomatic, physiological and biochemical changes with the hypothesis of a common to the two diseases. If, on the one hand, the biological basis and psychological play a very important role in the etiopathogenesis of the disorder, other factors intervene significantly in determining a condition of dependency, in particular those socio-environmental. Alcohol acts in fact as a mechanism of social compensation in so-called anxiety-producing, performing a function of adaptation in the face of dominant values all'inaccessibiltà. Western cultural models accept and promote the use of alcohol as a vehicle for social integration; risk factors for a. are considered loneliness, unemployment, young age and low educational level. The ethanol, taken with regularity and at high doses, is able to determine a series of pathophysiological changes at various levels. This mechanism makes it particularly evident in the central nervous system, such as direct effect on neuronal membranes. His action, as well as express themselves in simple drunkenness represented classic acute effects (state of psychomotor excitement, followed by a residual state of dullness and malaise), is a major problem especially for chronic effects. In fact, the long-term abuse of alcohol can lead to serious damage on the internist, the personality of the individual and complications of type psicorganico. The main medical conditions caused by alcohol are represented by gastritis, esophageal cancer, alcoholic pancreatitis, alcoholic liver disease, diseases of the cardiovascular system (with miocardiosclerosi cardiomegaly, congestive heart failure, hypertension) and diseases of the nervous system (polinevriti, optic neuritis retrobulbar combined degeneration of the spinal cord, funicular myeloma, generalized seizures grand mal). The psychological damages are represented by both a significant influence on personality traits with important behavioral changes, and alterations to psicorganiche which can also lead to severe psychiatric disorders. With regard to the effects of psychological and behavioral attitude often prevails extrovert with hilariously unjustified tendency to joke, to logorrhea and foul language, or are seeing introversion with unexplained sadness, difficulty in making speeches and ideational slowdown, victimization sometimes exaggerated and dramatic. The person loses in both cases the control over the correctness of their behavior, their privacy and dignity. Becomes distracted easily, the processes of association showed a certain superficiality, the ability to critically flattens out. The deterioration of inhibitions highlights some of the worst sides of the character, such as irritability and litigiousness, tendency to lie, humor bottom rather unstable, sometimes, dysphoria with irritability or euphoria un'inconsistente and, sometimes, an apathetic depression . The emotion becomes superficial and uncontrolled: the easy emotions alternating fits of rage and aggressive reactions. Over time, the deterioration of the personality shows a deficit affective-volitional, a marked decline of the highest human interests (ethical-religious, social), depletion and crystallization patterns of life. The behavior becomes so rigid, fixed, stereotyped, the speeches are boring, long-winded, reasoning loses in depth and penetration with more or less serious disorders of memory. The alcoholic is proving increasingly incapable of taking responsibility and maintain their social obligations, work and family. It is also unable to adapt to new situations and is very vulnerable to events of both a psychological and somatic. The main complications are represented psicorganiche alcohol intoxication, alcohol abstinence, which may be complicated in a withdrawal delirium (delirium tremens), dall'allucinosi alcohol, the amnesic disorder (Korsakoff's psychosis) and dementia associated with dependence syndrome alcoholic. The appearance of intoxication is represented by a maladaptive behavior that develops after alcohol ingestion (mood lability, impaired critical, aggressive behavior and inappropriate) in the presence of incoordination, slurred speech, unsteady walking, attention deficit, stupor or coma. Less frequent, but more serious, is contrary to the picture of delirium resulting from abstinence. It occurs about 2-3 days after cessation of alcohol consumption and can follow a simple withdrawal syndrome. It is represented by an altered state of consciousness (dream-was confused with disorientation) with deficits in mental functions (memory loss, incoherence ideational, distractibility) and the presence of abnormal phenomena dispercettivi (especially hallucinations zooptiche, or small animals or large size, or corpiccioli or objects that scared the patient tries to grab). To complicate the disorder also intervene severely impaired autonomic (sweating and hyperpnea, tachycardia, hypotension, mydriasis). More frequently, delirium tends to resolve after a few days after a period of prostration with lethargy, but evolution, albeit rarely, it can also be lethal. The Alcoholic hallucinosis is a framework that begins within 48 hours of abstinence, in patients with a long history of abuse and may or may not follow a delirium. It is characterized by the presence of auditory hallucinations (voices directed to the patient or dialoguing, usually threatening content) lived in terms of clarity of consciousness, which may correlate of persecutory delusions. The amnestic disorder follows a prolonged vitamin deficiency (complex B) and is represented by a deficit in short-term memory, accompanied by a marked tendency to confabulation meaning of compensatory (Korsakoff's psychosis). Sometimes concomitano alteration of consciousness with confusion and disorientation, ophthalmoplegia and ataxia (Wernicke encephalopathy). On the somatic level, in addition to signs of a. chronic, there may be a partial or diffuse polyneuropathy. A limited number of alcoholics can even be affected by alcoholic dementia, probably due both to the direct toxic effects of alcohol on the central nervous and metabolic imbalance and deficiency. Signs demented make their way slowly and symptoms include: marked impairment of memory fixation, worsening impairment of judgment and criticism, progressive temporo-spatial disorientation and disorders of higher cortical functions (aphasia, apraxia, agnosia). Impairment in social functioning and family and a decline in self-care and habits of life, associated with a severe organic deterioration, leading to the complete loss of self. The therapeutic approach of a. need to be articulated, it is necessary to intervene at different levels (medical, social-familial and psychopathology). Drug treatment tends mainly to control direct and indirect damage of alcohol at the organism level and to promote a stable abstention from alcohol. The specific drugs are represented by substances acting essentially with a repulsive mechanism aversive, which causes a substantial and lasting increase of acetaldehyde in the blood, in consequence of which may occur, if the patient takes even modest amounts of alcohol, several side effects, also of considerable gravity (vasodilation, tachycardia, nausea, and vomiting). Other preparations are the metadoxina, whose main function is to protect the structure from damage liver alcohol-determined, and the range OH butyrate, whose function is to reduce the phenomena of abstinence acting on GABAergic mechanisms. Nonspecific drugs are represented by neuroleptics, benzodiazepines and antidepressants. These are used for the frequent detection of primary or secondary depression associated and for the prevention of suicide risk, particularly high in alcoholics with major depression. Finally, of course, in any therapeutic protocol should be assured an adequate supply of vitamins (especially B group) and dietician. The psychotherapeutic approach can be realized on different levels. Basically, it is the most significant intervention, although it, too, can articulate on many fronts (classical psychoanalytic intervention, type of intervention behavioral, group therapy, family sociological intervention, model of self-help groups). The aim of psychotherapy as part of a project riabilitatvo, is to allow the alcoholic, at first, to recognize his conduct alcolomanica that generalmene not apparent, accepting his inability to bear the alcohol: it must be separated illusion of omnipotence produced by alcohol, moving towards its found or residual capacities and possibilities, promoting emotional maturity through which reorganize his life. Most of the time psychotherapy should be extended to the family, whose relationship dynamics are always strongly disturbed. Some group psychotherapies would seem more effective than individual approaches, regarding a function of partial resocialization within the group itself. In this regard, have been particularly effective in terms of practical outcomes associations of ex-drinkers (Alcoholics Anonymous, Alcoholics in Treatment Centers). These groups are self-managed and act as a meeting point where you look for a response in comparison with the same problems as others, trying to avoid relapse and hospitalization. While achieving the socialization of a need, drinking, and his control, but this approach does not allow a definitive resolution of the causes of abuse. Motivated individuals who have achieved stable abstention can be also recommended a psychotherapeutic intervention individually.