The 5 types of alcoholism (and associated disorders)

Alcohol dependence and disorders resulting from habitual alcohol consumption.

Alcohol. This word refers to one of the most popular and widely consumed legal psychoactive substances in the world. This substance acts as a central nervous system depressant, disrupting neuronal membranes and increasing the mobility of molecules present in the brain.

It has been proven that the intake of small daily amounts improves health and protects against heart disease, also producing a feeling of excitement, decreasing the level of anxiety and heart and respiratory rates. However, in higher doses it decreases the level of consciousness and psychomotor coordination, among other effects. continued consumption can lead to a dependence on this substance, also known as alcoholism.If maintained over a period of at least twelve months, it can cause lesions in various areas of the brain.

What is dependence?

Dependence is understood as that condition characterized by the existence of the acquisition of a notable 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 was intended by the consumer, the persistent desire to suppress or control the behavior, the impairment of other activities due to the continuous performance of activities to obtain the substance and the taking of the substance despite knowing the effect that it causes on the person himself/herself.

In the case of alcohol dependence, this dynamic of constant intake of alcoholic beverages tends to lead to a series of neurological lesions..

These lesions occur in the corpus callosum, the pons and the limbic system, which explains the existence of memory problems and intense emotional reactions. Likewise, the density of neuron dendrite connections and the number of neurons in the cerebellum and hippocampus also decreases, which affects the capacity for motor coordination and learning.

Types of alcoholism according to Jellinek's classification

There are a large number of causes and patterns of alcohol consumption in dependent persons.

In this regard, a large number of classifications have been established, the one proposed by Jellinek being the most important.. This author classifies drinkers and alcoholics into five different groups, in order to indicate the social and therapeutic problems specific to each group.

Alpha type drinkers

This type of drinker engages in excessive and exaggerated consumption in order to mitigate the effects of a mental or medical illness. or medical illness. In these drinkers there is no real dependence, so in reality this classification would not fall under the concept of alcoholism.

2. Beta type drinkers

In this type of drinkers there is no real alcohol dependence either.. Included in this classification are social drinkers, who drink excessively, which can cause somatic injury.

3. Gamma type alcoholism

This type of individual presents a true addiction, manifesting a clear loss of control before the drink, craving or excessive desire to access it, tolerance to alcohol and adaptation to its metabolites. This group includes chronic alcoholics.

4. Delta type alcoholism

Subjects included in this category also present an addiction to alcohol, presenting an inability to maintain abstinence but not a loss of control over drinking.They are unable to maintain abstinence but do not have a loss of control over their drinking. In other words, they need to drink assiduously, but without becoming drunk.

5. Epsilon-type alcoholism

The so-called periodic alcoholism occurs in subjects who present loss of control over drinking and behavioral problems, but consume sporadically.but consuming sporadically, passing long periods between drinks.

Disorders derived from alcoholism

Abusive alcohol consumption can cause serious problems in the physical and mental health of consumers. of consumers.

Alcohol intoxication

These include alcohol 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 psychological and behavioral changes such as aggressiveness, euphoria, poor muscle control, mental and physical slowing, gibbering, memory, perception and attention disturbances. It can range from simple drunkenness to ethyl coma and death.

Withdrawal syndrome

Another of the disorders related to alcohol consumption is the abstinence syndrome.. This syndrome, which occurs when chronic consumers stop or abruptly stop drinking, usually starts with tremors between seven and forty-eight hours after 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, with the possibility of convulsions and epileptic seizures, alcoholic hallucinosis or even delirium tremens as one of the most serious manifestations of withdrawal.

In the case of delirium tremens, it is very important to seek medical help urgently, since 20% of cases are fatal if not taken to 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 profuse sweating appear.
• Third phase: hallucinations, disorientation, tachycardia, delirium and stupor.

Alcohol-induced amnesias

Also known as blackoutThese can be classified into state-dependent amnesia (in which actions performed during drunkenness are forgotten and only remembered when intoxicated), fragmentary amnesia (amnesia of what happened during drunkenness with some intermediate moments preserved) or block amnesia (total forgetfulness of what happened during drunkenness).

Habitual alcohol abuse causes many neurons in the hippocampus to die, and as a consequence, problems appear when creating memories of what happens when the Blood alcohol level is high. At the same time, declarative memory problems may remain in the long term.

Sleep disorders

Sleep difficulties are also produced, decreasing REM sleep and increasing phases 2 and 3 of non-REM sleep to produce in the second half of the night a rebound of REM sleep that can awaken the individual.

Chronic disorders

In addition to these acute disorders, chronic disorders such as Wernicke-Korsakoff syndrome, cognitive disorders (memory loss, impaired judgment and planning or impaired attention, among others), sexual dysfunction, personality disorders (including pathological jealousy in relationships) and other neurological and hepatic disorders may also occur.

Established effective treatments

At the pharmacological level, different medications are used to treat alcohol dependence. Of particular note is the use of disulfiram to produce an aversive response to drinking alcohol and naltrexone to curb craving. craving or desire to consume.

Regarding psychological treatment, multiple programs and treatments have been created over the years to combat alcoholism.. Among them, some of the most effective at present are the community reinforcement approach, cognitive-behavioral therapy and family and couple therapy.

Community Reinforcement Approach or "Community Reinforcement Approach" (CRA)

Program designed taking into account the importance of the family and society in reinforcing the alcoholic's sobriety. It employs motivational techniques and positive reinforcement. The main objective of the program is to reduce consumption and increase functional behavior..

Disulfiram, communication skills training, job search skills training, non-alcohol compatible recreational activities, and contingency management training to resist social pressure to drink through covert sensitization are used. This is the program with the highest level of proven efficacy.

2. Cognitive-behavioral therapy

It includes training in social and coping skills and relapse prevention.

In the first step, the aim is to produce an increase in the capacity to manage the situations that trigger the desire to drink, preparing for change, teaching coping skills and generalizing them to everyday life.

Regarding relapse prevention, we focus on the possibility that the subject may drink again on one occasion (fall), differentiating it from relapse (reinstatement of the habit). (reinstatement of the habit) so that there is no abstinence violation effect (creating cognitive dissonance and personal self-attribution of the addiction, which in the long run causes guilt that facilitates relapse).

3. Family and couples therapy

Essential component in treatment programs. Pon its own it is also highly effective. Apart from the problem itself, it focuses on how it affects the couple's relationship and reinforces communication, negotiation and activities that facilitate maintaining the relationship in the right way.

In conclusion

Despite the fact that 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 in more than 65% of the cases treated, abstinence has been maintained under control.. However, it is necessary to detect the problem early and initiate treatment as soon as possible to avoid serious damage to the nervous system.

In some cases, moreover, withdrawal from alcohol consumption should be done in a controlled manner and supervised by physicians, since withdrawal syndrome can give rise to many problems or even lead to death.

Bibliographical 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. Behaviour 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 forgetting in the alcoholic Korsakoff syndrome and Alzheimer-type dementia. Neuropsychologia, 29, 737-747.

• Marlatt, G.A. (1993). Relapse prevention in addictive behaviors: a cognitive-behavioral treatment approach. In Gossop, M., Casas, M. (eds.), Relapse and relapse prevention. Barcelona: Ed.Neurociencias.

• Santos, J.L; García, L.I.; Calderón, M.A.; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Román, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Psicología Clínica. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.