Alcoholism

Synonyms: Alcohol addiction
German: Alkoholsucht

1 Definition

Alcoholism is prevalent, if at least 3 of the following criteria apply:

• Craving
• Loss of control
• Physical withdrawal syndrome after interrupted consumption
• Tolerance
• Neglect of other interests ending in dereliction
• Continued consumption despite clear indications of negative physical, mental or social consequences, e.g.:
  • Consumption at unsuitable time
  • Consumption without regard of social consequences.

2 Classification

According to Jellinek, 5 types of alcoholics are classified.

3 Statistics

The prevalence of alcoholism in Germany is approximately 3%, and an additional 5% abuse alcohol (alcohol abuse). The ratio between men and women is approximately 3 to 1, but due to social stigmatization, the estimated number of unknown cases in women is presumably high.

The peak of age is between the 30th and 50th years, while there is an inclination for addiction in younger people. The mortality rate in men is 30 and in women 10 per 100,000 inhabitants per year.

4 Etiology

Like in other addictions, the causes of alcoholism are complex. It is a multicausal process, which includes physical, mental and social factors.

• In approximately 80% of the cases, primary alcoholism occurs due to constitutional personality structure and social circumstances. A lower density of the D2 receptors in the brain is presumably one of the causes.
• In an additional 20% of the cases, secondary alcoholism occurs on the basis of preexisting psychiatric diseases, e.g. depression.

5 Mental and physical effects

• Neuropsychiatric:
  • Acute alcohol intoxication
  • Alcohol withdrawal syndrome
  • Wernicke-Korsakoff syndrome
  • Epileptic seizures
  • Brain atrophy
  • Pellagra
  • Polyneuropathy
  • Alcohol psychoses
  • Atrophy of the cerebellar cortex
  • Central pontine myelinolysis
  • Alcoholic myopathy
  • Mental intra- and inter-individual conflicts
  • Increased suicide rate
  • Social descent
• Gastrointestinal:
  • Decayed teeth
  • Mallory-Weiss syndrome
  • Reflux esophagitis (GERD or gastroesophageal reflux)
  • Malabsorption syndrome
  • Malnutrition
  • Carcinomas: mouth, esophagus and stomach
• Hepatic:
  • Alcoholic fat liver
  • Alcoholic steatohepatitis
  • Alcoholic cirrhosis of the liver
  • Primary liver cell carcinoma
  • Zieve’s syndrome
• Pancreas:
  • Acute pancreatitis
  • Chronic calcifying pancreatitis
• Cardiovascular system:
  • Holiday heart syndromes
  • Dilatative cardiomyopathy caused by alcoholism
  • Arterial hypertension
  • Apoplexy
  • Coronary heart disease
• Metabolism:
  • Hypertriglyceridemia
  • Hyperuricemia
  • Hypoglycemia
  • Porphyria cutanea tarda
  • Hyperchromic anemia in folic acid deficiency
• Immune system:
• Immune deficiency with consecutive infection susceptibility
• Endocrine:
  • Loss of libido and impotence in men due to testosterone deficiency
  • Oligorrhea / amenorrhea in women due to estrogene deficiency
  • Pseudo-Cushing’s syndrome
• Pregnancy:
  • Alcohol embryopathy
• Higher incidence of malign diseases
• In addition, often nicotine abuse.

6 Diagnosis

• Autoanamnesis and foreign anamnesis with standardized questionnaire, e.g. the frequently used CAGE test. The results of autoanamnesis have to be critically assessed by the physician, since patients frequently deny or play down consumption.
• Typical disease pattern
• Increased liver enzymes.

7 Therapy

This is a chronic disease, which cannot be "healed". The aim of addiction therapy is to reach a lifelong abstinence. The course of the therapy is structured as follows:

• Contact and motivation phase
• Detoxification phase
• Withdrawal phase
• Aftercare phase

8 Prognosis

Without therapeutic intervention, the average life expectancy is lowered by approximately 15 years. By consistent therapy, up to 70% of alcohol addicts can be fully rehabilitated. The prognosis worsens with the increased length of addiction and is reversely proportionate to the age when the disease started.