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, disorderly the neuronal membranes and increasing the mobility of the molecules present in the brain.

Taking small amounts daily has been proven to improve health and protect against heart disease, while also producing a sensation 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, and of Maintaining continued consumption can lead to dependence on this substance, also known as alcoholism, that if maintained over a period of at least twelve months that can cause injuries to various brain areas.

What is dependency?

Dependence is understood to be that condition characterized by the existence of the acquisition of a notable tolerance, necessitating an increase in the amount of substance to achieve the effects. desired symptoms, the presence of withdrawal symptoms, prolonged use of the substance beyond what the user intended, the persistent desire to suppress or control the behavior, deterioration of other activities due to the continuous performance of activities to obtain the substance and the taking of substance despite knowing the affectation that this causes on one's own person.

In the case of alcohol dependence, This dynamic of constant drinking of alcoholic beverages tends to lead to a series of neurological injuries.

These lesions occur in the corpus callosum, pons, and limbic system, which explains the existence of memory problems and intense emotional reactions. Likewise, the density of the dendrite connections of neurons and the number of these in 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 people.

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

1. Alpha drinkers

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

2. Beta drinkers

In this type of drinkers there is also no true alcohol dependence. Social drinkers are included in this classification, who consume excessively something that can cause them a somatic injury.

3. Gamma-type alcoholism

These types of individuals present a true addiction, manifesting a clear loss of control over drinking, craving or excessive desire to access it, tolerance to alcohol and adaptation to its metabolites. Chronic alcoholic subjects would be found within this group.

4. Delta-type alcoholism

The subjects included in this category also present an addiction to alcohol, presenting an inability to maintain abstinence but without presenting a loss of control over drinking. In other words, they need to drink regularly, but without getting drunk.

5. Epsilon-type alcoholism

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

Disorders derived from alcoholism

The abusive use of alcohol can cause serious physical and mental health problems of consumers.

Alcohol intoxication

Among them, alcohol poisoning stands out, is caused by the recent ingestion of a high amount of alcohol (or consumed with excessive speed) and is characterized by the presence of changes psychic and behavioral such as aggressiveness, euphoria, poor muscle control, mental and physical slowing down, spluttering, impaired memory, perception and attention. It can go from simple drunkenness to alcoholic coma and death.

Abstinence syndrome

Another disorder related to alcohol use is the withdrawal syndrome. This syndrome, which occurs before the abrupt cessation or interruption in chronic users, 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 quantity of frequent consumption, being able to present seizures 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 urgent medical help, since 20% of cases are fatalities if they do not go 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 above symptoms worsen and tremors and profuse sweating appear.
• Third phase: hallucinations, disorientation, tachycardia, delusions and stupor.

Alcohol-induced amnesias

They are also known blackout, or partial amnesias, which can be classified as state-dependent amnesia (in which actions performed during drunkenness are forgotten that are only remembered in a drunken state), fragmentary (amnesia of what happened during the drunkenness with some intermediate moments preserved) or en bloc (total forgetfulness of what happened during the drunkenness).

Habitual alcohol abuse causes many neurons in the hippocampus to die, and as a consequence there are problems creating memories about what happens when the blood alcohol level he is tall. At once, declarative memory problems they can stay in the long run.

Sleep disorders

They also occur sleep difficulties, decreasing REM sleep and increasing phases 2 and 3 of non-REM sleep to produce in the second half of the night a rebound in REM sleep that can wake up the individual.

Chronic disorders

Apart from these acute disorders, chronic disorders such as Wernicke-Korsakoff syndrome, cognitive alterations (memory loss, impaired judgment and planning or impaired attention, among others) or sexual, personality dysfunctions (including pathological jealousy in relationships) and other neurological disorders and liver

Established effective treatments

At the pharmacological level, different medications are used to treat alcohol dependence. The use of disulfiram to produce an aversive response to taking alcohol and naltrexone to slow down the craving or desire for consumption.

Regarding psychological treatment, Over time, multiple programs and treatments have been created in order to combat alcoholism. Among them, some of the most effective at present are the approach to community reinforcement, cognitive behavioral therapy and family and couples therapy.

1. Community Reinforcement Approach (CRA)

Program devised taking into account the importance of the family and society in 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, communication skills training, job search techniques training, non-recreational activities compatible with alcohol and training in contingency management to resist social pressure to drink through awareness covert. This is the program with the highest level of proven effectiveness.

2. Cognitive behavioral therapy

It includes social skills training and coping and relapse prevention.

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

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

3. Family and couples therapy

Essential component in treatment programs. Por by itself 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 correctly.

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 it has been achieved in more than 65% of the treated cases to keep abstinence under control. However, it is necessary to detect the problem in time and start treatment as quickly as possible to avoid damaging the nervous system.

In some cases, in addition, the withdrawal of alcohol consumption must be done in a controlled and supervised manner by doctors, since withdrawal symptoms can lead to many problems or even 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 forgeting in the alcoholic Korsakoff syndrome and Alzheimer-type dementia. Neuropsychologia, 29, 737-747.

• Marlatt, G.A. (1993). 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.; Izquierdo, S.; Roman, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE PIR Preparation Manual, 02. CEDE. Madrid.