Alcoholism
Alcoholism is addiction to alcohol (ethanol) content in alcoholic beverages. WHO recognizes alcoholism as a disease and defined as mental disorders and behavioral disorders associated with the use of alcohol.
This loss of control is usually a physical dependence characterized by a withdrawal syndrome at the stop of consumption (drug), a psychological dependence and tolerance (the need to increase doses to achieve the same effect).
The progression in time is a major feature of this addiction. The use without damage (called single use) before use risk and harmful use (without dependence), and then addiction. Alcohol is a psychoactive substance to the origin of this dependence, but it is also a toxic substance causing adverse health effects. The alcohol is causing physical, psychological and social.
Abstinence is often advocated to stop the development of dependence and return to "normal" life. The chronic disease is you do not talk about "healing" but "restoration".
Terminology
The term alcoholism or drunkenness have become archaic. Today, he prefers the term alcohol or alcoholic disease. In medical language, alcohol has many lesser-known synonyms that do not have the same pejorative. It employs expressions œnolisme, alcoholism, or poisoning exogenose OH.
The Swedish physician Magnus Huss was one of the first in 1849 to place the alcohol in the disease and out of its connotation of vice. He introduced under the term chronic alcoholism. In the 1950s, Pierre Fouquet alcoholic patients described as "one who has lost the freedom to refrain from drinking."
Alcohol is a term used to designate the current ethanol. Dependence on alcohol means in full dependence on the ethanol content in alcoholic beverages. The concentration of ethanol depends on the drink. An alcohol concentration of X% or X ° is 0, X liters of ethanol per liter of beverage.
The alcohol is the science that deals with the effects of alcohol on health and ways to remedy them.
Classification
Alcoholism is classified according to World Health Organization (ICD-10) in two types: the acute form, acute alcoholism and chronic alcoholism for a regular and chronic, more or less excessive. The WHO defines the state of dependency where "some symptoms of the disorder has persisted at least a month or have occurred repeatedly over an extended period, at least three events [as a list of 6 items] are present at the same time during the past year. .
The acute form is characterized by occasional, more or less intense (as the "binge drinking") and does not usually dependent phenomenon, contrary to chronic alcoholism. The chronic form is characterized by repeated consumption (daily, generally) and usual, beyond the threshold of toxicity (2 to 3 standard drinks per day), and not necessarily as a major objective drunkenness .
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies alcohol disorders in the use of a substance (alcohol). It characterizes the disease as alcohol dependence. According to the DSM-IV, the "addiction is a form of inappropriate use of a substance, causing distress or dysfunction clinically significant, as evidenced by three (or more) events [as a list of 7 items], occurring any time over the same period of twelve months. " The classification of DSM-IV makes a distinction between physical dependence (signs of tolerance or withdrawal) and physical dependence (no evidence of tolerance or withdrawal).
Other forms of the disease classifications of alcohol, here is an example. A form associated with impulsive and antisocial conduct, at intakes of other toxic (heroin, cocaine), with early onset, coupled with family history and probably many underpinned by genetic factors (Cloninger Type II); a to later onset, antisocial or without use of toxic and without family history, possibly underpinned by environmental factors (Cloninger Type I).
History
Alcohol pipes are very old pipes. There are traces of these lines in both the mythology in the stories of ancient peoples.
The intoxication of Dionysus (god of the vine, wine and its excesses) and Noah are famous. In 3000 BC. JC, the Sumerians had invented pictographs and beer brewer. In Egyptian hieroglyphics, the word meal is represented by the combination of bread and beer.
At Pompeii, about 200 taverns are still identifiable. Marc Anthony was known for his alcoholism. Horace is the source of the Latin proverb: "Nunc est bibendum" meaning "it now must drink."
Tiberius was nicknamed Biberius Caldius Mero: The Wine Drinker pure, warm and Attila died of a syndrome Mallory-Weiss.
The Gauls were supplied with wines by the Greeks and the Romans. Sometimes was traded an amphora of wine against a slave. The first winemakers were the veterans of the Roman army who at the time of their military retirement, received land to cultivate. The Gauls experts invented the iron barrel.
In the eighteenth century, alcoholic drinks are expensive. Two opposing modes of consumption. The masters and their servants have a regular alcohol while people s'alcoolise holidays, ie Sunday.
On the eve of the French Revolution, the price of wine is three times higher when it reaches the door of Paris. On 12 July 1789, the wall of the farmers general (barriers to granting the pay at the entrance of Paris) was looted and the wine can go freely for several days. After the revolution, the price of wine increases again.
The industrial revolution disrupted production patterns of alcohol and its modes of transport (with the advent of the railway), causing a massive increase irreversibly sales. Separated populations of rural areas are housed in poor conditions. The former industrial areas are also the first areas where alcohol mass appears.
During the First World War, the wine is called pinard in the trenches and the spirits called gnole combatants. These products are particularly popular on the battlefield because of its anxiolytic properties and desinhibitrices.
From ancient times until the middle of the twentieth century, life expectancy is low, the impact on long-course pipes alcohol was in fact. The late-onset diseases such as cancers of the upper aerodigestive tract, etc. cirrhosis. were health problems much less widespread than some famine or epidemics. With increasing life expectancy, these health problems became an increasingly important role in society to be currently the second leading cause of avoidable death in France after the consumption of tobacco.
Alcohol and pregnancy
The main risk associated with drinking is that the effects of fetal alcohol (EFA), which refer to disorders of learning and / or behavior during early childhood, whose occurrence is linked to or taken occasional alcohol by the mother (whatever that is) during her pregnancy. More rare is the Fetal Alcohol Syndrome (FAS), and sometimes observed at birth in children born to a mother suffering from a chronic alcohol problem, which results in a set of clinical and morphological neurological, may cripple the child's future.
Broadly speaking, the amount of alcohol may be harmful to an unborn child is unknown, and the risk may exist even for small quantities. It is recommended for pregnant women to abstain from consumption during pregnancy (all quarters) and during lactation. The idea that low consumption of some alcohol, including champagne, would be less harmful is an urban myth with no scientific foundation.
Alcoholism and smoking
There is a strong correlation between alcohol dependence and smoking (% to state). Drink want to smoke: brain stimulation of alcohol is lower than that related to the absorption of nicotine and low stimulation induces always want more smoke.
Some techniques of smoking cessation may be useful for weaning to alcohol. In case of joint care, it can be considered to stop smoking at the same time, before or after alcohol. It depends on the situation.
Accidents and troubles caused
Consumption of alcohol may be responsible for violent deaths, especially by accident, homicide or suicide. In France, between 2002 and 2003 deaths by road accident due to alcohol intoxication are a total of 2 200 people.
Alcohol withdrawal syndrome
It occurs 6 to 12 hours after the last dose of alcohol in a person dependent and spontaneously to the disappearance of physical dependence in a week. It may nevertheless be a psychological dependence. The latter can be strong and lead to a relapse or realcoolisation.
In mild forms, there is, more or less associated with nausea, headache, agitation, tremor, tachycardia, hypertension, sweating, fever, symptoms of anxiety and depressive disorders of concentration.
In severe forms, there are seizures with or without hallucinations. The most severe complications is delirium tremens can be fatal if untreated. These severe forms can be opened by visual, auditory and sensory, aided by sensory stimuli (gene of light, noise, itching), delusions and hallucinatory.
Items that can detect severe forms, thus enabling identification in order to better care, are the prolonged consumption of large quantities of alcohol, a history of seizures and delirium tremens, the need to drink quickly of alcohol after the alarm clock to alleviate the forms to start weaning.
The administration of benzodiazepine, a cellular hydration, a vitamin and in some cases administration of small amounts of alcohol are still the treatments of choice for preventing delirium tremens.
Weaning alcohol
Because of the dependence induced, weaning is often delicate, with a significant risk of relapse. It is easier if the alcohol is accompanied by socially and medically, if the withdrawal is scheduled and if the alcohol has already lived the experience of withdrawal and relapse. Abstinence final result as a learning process.
Weaning is done as an outpatient in most cases, in hospitalizations for the most at risk of complications (there are specialist services in alcohol). Many associations can help the sick alcoholic, sober or not. These associations are often the movements of former drinkers. The use of groups of words (the best known is Alcoholics Anonymous, Golden Cross, Blue Cross, Living Free, New Way, Alcohol Assistance) is somehow effective in maintaining abstinence in long term.
Pharmacology for the prevention of relapse
Specialty drug available for the prevention of alcohol consumption have several objectives:
* Research the effect of Antabuse.
Disulfiram Antabuse has an effect: the absorption of alcohol then causes unpleasant side effects but sometimes dangerous. This medication is used less and less because of its danger in case of alcohol consumption and low efficiency.
* Decrease in appetite.
The acamprosate and naltrexone reduce the appetite for alcohol. However, despite almost twenty years of using these drugs on millions of subjects alcohol, no reduction in mortality or morbidity of alcoholism has been reported and the rate of relapse for patients who manage to become sober is about 90%.
Other molecules are being tested, such as baclofen. It is a muscle relaxant indicated for the treatment of muscle spasticity, a benign disorder but highly uncomfortable as seen for example in the aftermath of a stroke, among paraplegics, or palsy brain, patients with multiple sclerosis but also in the mere spasmodic torticollis. It is marketed under the brand name Lioresal but generated since the 1980s. It is prescribed since 1966 as a treatment for comfort. The AMM allows up to 80 milligrams per day. Beyond 80 milligrams per day, we speak of high doses. Baclofen has been tested as a treatment for comfort for benign disorders in doses of 300 milligrams per day for several consecutive years in adults and 180 milligrams per day (eg for torticollis in children) without limiting side effects. They stress never encountered any significant side effects. The most common are drowsiness and muscle weakness that both still in decline 24 or 48 hours without ever leaving a legacy.
The effectiveness of baclofen is taken with great caution. The few studies towards a decrease in alcohol consumption by baclofen treatment did not have a high enough scientific evidence.
Other therapies
The treatment of addiction to alcohol is not only pharmacologically, it is also psychological. The support of the person addicted to alcohol is important, whatever the level of abstinence. The use of psychotherapy may be a possibility.
Prevention
Education, regulation of advertising, but also higher prices for alcoholic beverages (taxation) are ways to reduce overall consumption.
Alcoholism and mortality
Alcohol has caused about 1 800 000 deaths worldwide per year to 2004 (at around 3% of deaths), including 45 000 in France (second cause of avoidable death in France after the Tobacco) (73 per 100 000 inhabitants):
000 * 23 direct deaths
11 000 cancers of the lips, mouth, pharynx and larynx,
9 000 cirrhosis,
o 2 500 by alcohol,
* 22 000 indirect deaths (mental disorders, cardiovascular diseases, accidents ...).
Every year 5 000 to 7 000 babies born in France with serious birth defects (fetal alcohol syndrome) because of the alcohol from the mother, in the Pas-de-Calais, this represents 1 birth in 3 000.
In France, we can consider that alcoholism is the third leading cause of death after obesity and tobacco, and to infectious diseases and road accidents.
The risk of liver cirrhosis and accidents are well known to the majority of French, but it is not the same risk of cancer and cardiovascular disease.
For cardiovascular disease, scientific studies show that moderate consumption (one glass per day) reduces cardiovascular risk, but that consumption of more than three glasses increases rapidly.
Excess alcohol also leads to vitamin deficiency, which reduces resistance to disease.
The association alcohol - smoking is a factor of aggravation of risk, which becomes greater than the sum of the risks of alcohol and tobacco taken separately.
Read also Bipolar Disorder
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