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alcoholism, 04/00 disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is the most prevalent of the nation's addictions (see drug addiction and drug abuse).
The understanding of alcoholism, and hence its definition, continues to change. Many terms, often with hazy differences in meaning, have been used to describe different stages and manifestations of the disease. In 1992 the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published a definition reflecting the current understanding of the disease: “Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.” This definition recognizes alcoholism as a disease, i.e., as an involuntary disability. It accepts a genetic vulnerability in some people and identifies the phenomenon of denial as both a psychological defense mechanism and a physiological outcome of alcohol's effect on the memory.
Although anyone can become intoxicated while drinking, the alcoholic is less likely to recognize the signs and control his or her intake. Intoxication is produced by alcohol as it circulates in the blood and acts to depress the central nervous system (see depressant). Alcohol can pass directly into the bloodstream. The absorption rate depends principally on the concentration of the drug in the stomach and small intestine. This concentration is limited by the presence of alcohol dehydrogenase. Because women normally carry less alcohol dehydrogenase in their intestines, they usually consume less alcohol than men before showing its effects.
Alcohol is not stored in the body or excreted but is metabolized in the liver at a fixed rate of between 0.25 and 0.33 oz (7.1–9.4 grams) per hour, varying with the individual. Thus alcohol is found in the bloodstream and signs of intoxication appear when the rate of alcohol consumption is greater than the rate at which it is metabolized in the liver. At a blood level of about .05%, alcohol impairs concentration, visual function, psychomotor performance, and reaction time. For many years the legal standard for drunkenness in most states was a blood alcohol level of .10%, but in many states it now is .08%. The lethal level, often given as .60%, may be as low as .40% in some people. Blood alcohol concentrations are measured by breath (the Breathalyzer test), blood, or urine tests.
Effects of Chronic Use
Alcohol abuse can result in broad range of medical problems. Alcohol can reduce production of the sex hormone testosterone in males, resulting in impotence and testicular atrophy. Alcohol has a high caloric value but a low nutritional value. Its “empty calories” may allow the alcoholic to feel satisfied while actually progressing toward a state of serious malnutrition. Ailments that can result from alcohol consumption include cirrhosis, a liver ailment; diseases of the digestive system; damage to the heart; lowered resistance to infection; and cancer (larynx, esophagus, liver). Women who consume alcohol during pregnancy are at risk of delivering children with fetal alcohol syndrome, a syndrome of physical, developmental, and psychological problems.
Although the medical effects of alcoholism have long been known, the study of how alcohol acts on the brain to produce intoxication, dependence, and tolerance is still new. Most studies focus on the effect of alcohol on cellular communication. These have found that different regions of the brain differ in their sensitivity to alcohol. In addition, alcohol affects many different kinds of receptors (see nervous system) and neurotransmitters, such as GABA, glutamate, and serotonin, creating different effects in each case. Whatever the exact mechanism, it is accepted that chronic consumption of alcohol results in disconnection of the fibers that connect brain cells, producing memory lapses, impaired learning ability, motor disturbances, and general disorientation. Two organic brain disorders, alcoholic dementia, characterized by general loss of intellectual abilities, and Wernicke-Korsakoff's syndrome, characterized by such symptoms as loss of physical coordination, incoherence, and mental confusion, are frequently seen in alcoholics.
The treatment of alcoholism depends on how far the disease has progressed. Treatment typically begins with professional advice or self-motivation to abstain, often coupled with medical efforts to achieve sobriety. In the presence of withdrawal symptoms, antianxiety drugs such as benzodiazepines may be prescribed. A next step is often enrollment in a treatment program suitable to the severity of the disease and patient's social stability. Residential programs offer a supportive atmosphere and a structured environment in which the patient can begin to learn how to restructure his or her life and develop new habits. Many programs educate the family as well, alerting them to patterns within the family that may have enabled the patient to keep drinking. Because alcoholism is a chronic recurring and relapsing disease, treatment programs are usually followed by membership in a support group such as Alcoholics Anonymous.
Medical treatment to help ensure continued sobriety includes self-administration of drugs such as Antabuse, which produces severe discomfort if present in the system when alcohol is consumed. Naltrexone, a drug formerly used in heroin abuse, and acamprosate are also now approved for use in the treatment of alcoholism. Naltrexone minimizes both the craving for alcohol and the “high” produced by its consumption. Acamprosate reduces the craving for alcohol in people who have stopped drinking. In addition to these standard treatments, many alcoholics are aided by alternative treatments such as acupuncture and hypnosis.
Costs to Society
See P. G. Bourne and R. Fox, ed., Alcoholism (1980); E. L. Gomberg et al., ed., Alcohol: Science and Society Revisited (1982); M. Grant and B. Ritson, ed., Alcohol: The Prevention Debate (1983); M. Elkin, Families under the Influence (1984); D. Gallant, Alcoholism: A Guide to Diagnosis, Intervention, and Treatment (1987).
alcoholismthe consumption of alcohol to excess, leading to psychological and physical dependency and addiction (see DRUG ADDICTION OR DRUG DEPENDENCY). Among other diseases associated with excessive consumption of alcohol over a long period are cirrhosis of the liver and heart disease.
Alcoholism(religion, spiritualism, and occult)
Alcoholism and other forms of escapist drug addiction are associated primarily with the planet Neptune and, secondarily, with Pisces, the sign ruled by Neptune. Neptune is associated with sensitivity to the subtle dimensions of existence. When strong and positively situated in a natal chart, Neptune can manifest as musical sensitivity, mystical sensitivity, and so forth. When negatively aspected, however, Neptunian sensitivity will manifest as deceptiveness or escapism.
Charles E. O. Carter, an important astrologer of the early twentieth century, discussed alcoholism and drug addiction in An Encyclopedia of Psychological Astrology. Carter associated alcoholism and drug addiction with a number of different factors. In the birth chart of an alcoholic, according to Carter, the Sun and the Moon are almost always weak by sign and house position, “or else they are badly afflicted, especially in or from Fire or Water, or both.” Furthermore, “the fifth house (the house of pleasure and entertainment) is nearly always afflicted by Neptune or by planets in watery signs, and Mars is very frequently afflicted by Neptune, in or from Pisces.”
A more recent study, reported in Ann Parker’s Astrology and Alcoholism, confirmed the importance of Neptune. Parker, however, also found that the planet Uranus was significantly represented in the horoscopes of alcoholics, especially Moon-Uranus aspects. She explains this unusual finding by pointing out that a Moon-Uranus contact, “even linked in good aspect, represents great emotional excitability and self-will, both charcteristic of the alchoholic.” When linked by a hard aspect, “these planets produce states of fear and anxiety, extreme self will, a craving for sensation, restlessness, and a tendency to exaggerate and magnify things,” all of which are associated with alcoholic personalities.
a disease caused by the systematic use of alcoholic beverages and characterized by an attraction to them which leads to mental and physiological disorders and disturbs the social relations of the sufferer. The term alcoholism was first used in 1849 by the Swedish physician and public figure M. Huss to designate an aggregate of changes arising in an organism affected by the use of alcoholic beverages. As it is now understood, the biological and medical meaning of the term alcoholism is inseparable from the social content. However, hard drinking (immoderate consumption of alcoholic beverages) as a form of antisocial behavior should not be equated with alcoholism as a disease. Hard drinking gives rise to alcoholism but is not a disease. Alcoholism is characterized by certain symptoms which distinguish it from so-called habitual or social hard drinking.
Poisoning through the alcohol in beverages and also in household and commercial liquids—that is, acute alcoholic intoxication—is characterized by the weakening of the basic nervous processes and, primarily, of inhibitions, with a decisive influence on the correctness of a person’s behavior, thinking, and speech. This takes the form of a rising disturbance in the ability to assimilate external impressions, to judge them, and to remember them. In the initial stage of alcoholic intoxication, personal powers and capacity for work seem to the intoxicated person to be heightened, although it has been established through experiments that even the most insignificant quantities of alcohol noticeably lower the capacity for physical and mental work. Ideas become fuzzy; subtle details and the connections between them escape attention; and fatigue sets in more quickly. The idea that alcoholic beverages fortify people who are weak or have an insufficient capacity for work is basically incorrect.
Other areas of mental activity also suffer, primarily the volitional sphere. At first there is an easy excitability with a weakening of the acute physiological mechanisms which in daily life constantly regulate a person’s behavior and actions with great precision. The intoxicated person becomes more lighthearted, and careless and speaks and acts more freely and with less circumspection. With the subsequent development of intoxication, the good humor, heightened feeling, and serene, gay, and cheerful mood are replaced by irritability, tactlessness, lack of discipline, rudeness, and bursts of anger, sometimes accompanied by socially dangerous actions. Then speech becomes incomprehensible, and disturbances of coordination and unsteady gait appear. Thereafter, in the course of heavy intoxication, apathy and drowsiness with consequent loss of memory (amnesia) develop. With large doses of alcohol, a narcotic intoxication may set in; it is characterized by deep sleep and a weakening of tendinous, cutaneous, and other reflexes; a sharp drop in heart activity and disturbances in breathing are possible and may threaten life. Systematic abuse leads to persistent disturbances, constituting the picture of chronic alcoholism.
Chronic alcoholism. The characteristic symptom is an unhealthy need for alcohol, an attraction to it, and the hangover syndrome (also called the withdrawal or abstinence syndrome) immediately after periods of immoderate hard drinking. The hangover syndrome manifests itself in disorders of mood—depression, melancholy, guardedness, anxiety. Not infrequently it seems to the sufferer that everyone scorns and condemns him for his drinking; he is inclined to self-condemnation. Later, sleep disorders arise; sleep comes with difficulty and is superficial, not refreshing, with unpleasant dreams. Sweating and trembling of the hands are so strong that work is impeded. All these phenomena disappear or lessen after even small doses of alcohol—“taking a drink the morning after.” Because of this, alcoholism is sometimes considered a form of drug addiction. However, the hangover syndrome differs in certain ways from the withdrawal reaction to other narcotics, and therefore the classification of alcoholism as drug addiction by a number of scholars (e.g., the Committee of Experts of the World Health Organization) gives rise to objections. Other symptoms of alcoholism are the changing tolerance of the organism for alcohol (in order to become intoxicated, ever-increasing doses of alcohol are required) and the loss of control over the quantity of alcohol consumed. Other early symptoms of alcoholism are found less consistently.
Persistent and progressive changes in the entire organism occur with the progress of alcoholism. Chronic gastritis, with reduced hydrochloric acid in the gastric juice, and cirrhosis of the liver, a state in which the functioning elements of the liver are replaced by fat, are often connected with alcoholism. Cirrhosis of the liver, which develops as a consequence of other diseases, becomes particularly dangerous in alcoholics. Alcoholism contributes to a quicker development and more malignant course in vascular diseases—for example, hypertonic ailment. As a result of alcoholism the assimilation of vitamins is upset, causing wrinkles to appear prematurely, nails to break, and teeth and hair to fall out; the skin loses its elasticity and becomes sallow.
Alcohol has the heaviest impact on the nervous system. Of the diseases connected with alcoholism, alcoholic polyneuritis (multiple inflammation of the nerves) is met with most often, showing up as sensitivity disorders and later as paralysis of peripheral nerves—as well as alcoholic encephalitis (diseases of the brain). Alcoholic psychoses are among the serious complications of chronic alcoholism. In all cases, alcoholism entails a persistent and progressive reduction of mental faculties and personality changes—coarseness and relaxation of restraining influences, leading to systematic violation of norms of behavior and not infrequently to crime. In processing closed criminal cases, it has been established that 66.5 percent of those investigated committed murder in a condition of intoxication (A. Gertsenzon, 1966).
In the development of alcoholism, relatively small importance is attached to heredity and the constitutional factor, except in a nonspecific “instability” for the temptations of drinking, which in certain conditions may lead to alcoholism. Parental alcoholism plays a greater role as an environmental factor—children who witness systematic hard drinking from an early age frequently begin to imitate the actions of adults and sometimes fall under their direct influence. The alcoholism of parents is very seriously reflected in the emotional equilibrium of children and in the formulation of their personalities.
The growth of traumatism is connected with alcoholism. In a person under the influence of alcohol, equilibrium, coordination, and perception are disturbed, making for frequent accidents among alcoholics, and leading to incapacity for work. According to the statistical data of the Central Institute of Traumatology and Orthopedics, in Moscow about 20 percent of domestic and 46 percent of street traumas are connected with alcoholism. With modern machinery, demanding alertness, accuracy and coordination, intoxicated workers damage equipment and allow waste; drunkenness often causes catastrophes and accidents. In the USA the loss of capacity for work by alcoholics, according to official statistics, amounts to 30 million workdays a year; every year 400,000 traumas connected with alcoholism are registered.
The fight against alcoholism. Prohibition on the manufacture and sale of alcoholic beverages, a law in the USA (until 1933), Iceland, Finland, and other countries, did not attain its desired end. In Belgium, France, Norway, and other countries at various times prohibitory laws against beverages of certain strength were put into effect. In Sweden the so-called Góteborg system was adopted in 1865; it was later introduced with modifications in the other Scandinavian countries. According to this system, the sale of alcoholic beverages was permitted only with hot food, and the restaurant owner received income only from the sale of food. In 1919 the card system (the so-called Bratt system) was introduced, limiting the consumption of alcoholic beverages by a family to four liters a month. During 1955–57 the Bratt system gradually disappeared, and the government agency—“the Swedish department of temperance”—was reduced to a statistical institution.
In Russia prohibition on the manufacture and sale of alcoholic beverages was introduced in 1914 and continued until 1925. However, the prohibitory measures led to evasion of the law, with various substitutes coming into use (“home brew,” raw brandy, etc.), instead of wine and vodka purified of fusel oils, producing a still more harmful effect on the organism.
In Soviet society alcoholism is considered an evil, and the fight against it is carried on by the state, Party, Trade-Union, and Komsomol organizations and health agencies. Great importance is attached to measures of social influence, to raising the cultural level of the population, and to overcoming the so-called alcoholic traditions which exert an influence on the youth. In the socialist countries the prevention of alcoholism among the younger generation is carried out both by legislation (e.g., the law on judicial responsibility for the drunkenness of minors in the Polish People’s Republic) and by educational work.
Soviet criminal law states that a person who has committed a crime while intoxicated is not exempt from criminal responsibility (e.g., Criminal Code of the RSFSR, art. 12). Moreover, a crime committed in an intoxicated state and involving a source of heightened danger—for example, drunken driving—is considered a circumstance aggravating responsibility (Criminal Code of the RSFSR, art. 39). In addition to penalties, compulsory medical treatment is prescribed for those alcoholics who have committed criminal offenses.
The legislation of a number of Union republics (for example, Decree of the Presidium of the RSFSR Supreme Soviet of Apr. 8, 1967) provides for special measures to combat alcoholism. Persistent drunkards (alcoholics) who evade voluntary treatment or continue hard drinking after treatment and violate labor discipline, social order, and rules of the socialist community—despite measures of social or administrative influence adopted in their respect—may be assigned to medical labor dispensaries for compulsory treatment and work reeducation for one to two years. Assignment for such treatment, carried out by the people’s court (district or city), does not entail convictions.
Treatment of alcoholism. Treatment is administered in both hospitals and outpatient clinics. In specialized medical institutions of the USSR and other socialist countries, a medical-labor regime is established. In the first stage of treatment, disorders of sleep and mood and other phenomena which are painful to the patient are broken down. Then measures for overcoming the patient’s attraction to alcohol are applied: the creation of a negative reflex on taking alcohol (the introduction of alcoholic beverages in combination with emetics), remedies which sensitize the patient to alcohol with the aim of evoking an aversion to alcohol, and psychotherapy, especially hypnosis. The last step in the treatment of alcoholism is the consolidation of the results of treatment and the prevention of relapses—the most prolonged stage. Follow-up treatment includes medicine and an educational program that includes the patient’s family and associates to protect him from the harmful influences which had driven him to alcoholism once. This task is put into practice through psychoneurological clinics and several other out-of-hospital institutions with wide community involvement.
REFERENCESZhislin, S. G. Ob alkogol’nykh rasstroistvakh. Voronezh, 1935.
Lukomskii, I. I. Lechenle khronicheskogo alkogolizma. Moscow, 1960.
Strel’chuk, I. V. O straia i khroni cheskaia intoksikatsiia alkogolem. Moscow, 1966.
Alkogolizm—put’ k prestupleniia. Moscow, 1966.
Segal, B. M. Alkogolizm. Moscow, 1967.
I. I. LUKOMSKII