Alcoholism is a serious disease that shortens life by 19 years on average. In Austria, approximately one million people are alcoholics or in danger of becoming ones.
When do we speak of alcoholism?
There is no risk-free alcohol consumption. Nevertheless, alcohol consumption is classified as a “low-risk” below a certain limit and “risky” above it. However, these limits are only indicative. They differ internationally, and they cannot be applied to all people uniformly (pregnant women, adolescents, …)
Acute intoxication or a hangover is no sign of harmful alcohol use yet. Alcohol abuse is considered harmful only when a demonstrable detriment to a person's mental or physical health has occurred due to chronic alcohol consumption.
Characteristics of alcoholism
At least three of the following criteria must be met in order to speak about alcoholism (Source ICD-10):
A strong desire or a kind of compulsion to consume alcohol
- Difficulty in controlling the intake (regarding the beginning, completion and the amount of consumption)
- A physical withdrawal syndrome when the substance is reduced or discontinued, as evidenced by alcohol-specific withdrawal symptoms, or [the attempt] to ingest the same or a closely related substance to avoid or mitigate alcohol withdrawal symptoms
- Development of tolerance to the effects of the substance
- Progressive neglect of alternative pleasures or interests because of alcohol consumption; much time is used to obtain alcohol, to consume it, or to recover from its consumption
- On-going use of alcohol despite evidence of clearly harmful consequences, such as liver damage from excessive drinking, depressive mood due to heavy alcohol consumption; it should be made sure that the consumer is actually aware of the nature and extent of the harmful consequences, or that this is at least to be assumed.
The physical withdrawal symptoms mentioned above comprise symptoms such as tremor, restlessness, sweating, insomnia and circulatory problems, as well as anxiety and depression.
Who is affected?
In Austria, the probability of become an alcoholic over the course of one’s life is 10 % (14 % in men, 6 % in women). The total number of alcoholics has remained the same in recent years, whereby the proportion of women increases, while the proportion of men decreases slightly. Contrary to common assumptions, teenagers are not the main problem group. While it is true that an increase in alcohol consumption is observed among young people, this is probably related to the earlier onset of puberty in our days.
Reasons of alcoholism
The individual risk of alcoholism depends on the one hand on genetic, on the other part on social and psychological factors. Pre-existing mental illnesses such as depression or anxiety disorders likewise affect the development of an addiction.
Some standardized questionnaires are available in order to diagnose alcoholism. In addition, blood, urine and exhaled air can be tested for appropriate biomarkers, as is known e.g. from traffic controls. Here the problem is that alcohol degrades rapidly in the organism and is no longer detectable after a few hours. However, there are metabolites, which can still be found several days later. To rule out accidental alcohol intake (e.g. from fruit, sauerkraut, etc.), such examinations should be repeated after 24 hours. Chronic alcohol consumption can be measured in the hair of the person concerned. This also allows conclusions as to the amount consumed.
Depending on the severity of the condition, various forms of therapy are applied, which often build on each other:
- Short-term interventions: Can be carried out in a non-specialized setting, e.g. by general practitioners as well. They serve primarily to provide counseling and guidance to affected persons, and to define an individual objective.
- Physical detoxification: The aim here is to treat physical deficits and complications caused by alcohol. If withdrawal symptoms occur during detox, these are to be alleviated as much as possible by the attending therapist.
- Qualified Withdrawal Treatment (QWT): QWT goes beyond the purely physical detoxification and also takes psychosocial factors into account. This aims to stabilize abstinence and include the affected persons into social support structures that can continue to accompany them after the treatment (social work, self-help groups, psychotherapy, etc.).
- Abstinence treatment / rehabilitation: After detoxification and QWT, the rehabilitation phase follows. Occupational therapy, psychosocial support, and inclusion of the family members characterize this process. Complete abstinence cannot always be achieved, but at least significant reduction of alcohol consumption can.
- Redesigning life: If an addict is separated from his or her drug, he or she also loses an important purpose in life, a source of vitality. Now it is crucial to find alternatives that give pleasure and enable affected persons to lead their lives so that they are beautiful, joyful, and thereby self-determined – that is, free of addiction.
In support of the withdrawal treatment, medication can be used. They help to reduce or relieve withdrawal symptoms, but it is important to ensure that no “addiction shift” develops. Depending on the indication, various drugs are used, e.g. benzodiazepines or anticonvulsants to prevent withdrawal-related seizures. The individually appropriate medication is to be discussed with the physician.
Musalek Michael, Ferdin Wolfgang (2015): Diagnostik und Therapie der Alkoholsucht [Diagnosis and treatment of alcohol addiction]. In: Ärzte Magazin 27/2015
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