Alcohol use disorder includes the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism. It is characterized by an impaired ability to stop or control alcohol use despite negative social, occupational, or health consequences.
Alcoholism is more prevalent in men and typically starts in the late second or early third decade. If the onset happens later in life, especially after the age of 40, an underlying cause should be investigated.
Clinical types
Jellinek claims that alcoholism can be classified into five different “species” based on usage patterns rather than severity.
A. Alpha
Drinking excessively and sensibly to numb pain, either emotional or physical.
· No loss of control.
· Ability to abstain present.
B. Beta
· Excessive and appropriate drinking.
Physical side effects brought on by ingesting alcohol and eating poorly in the culture, such as cirrhosis, gastritis, and neuritis.
· No dependence.
C. Gamma; also called as malignant alcoholism.
· Progressive course.
Physical addiction accompanied by tolerance and withdrawal symptoms.
A psychological dependence that results in uncontrollable drinking
D. Delta
· Inability to abstain.
· Tolerance.
· Withdrawal symptoms.
It is possible to regulate alcohol consumption.
· Social disruption is minimal.
E. Epsilon
· Dipsomania (compulsive-drinking)
· Spree- drinking.
According to genetic and environmental factors, Cloninger divided alcoholism into Type-1 and Type-11 categories.
Causes
Biological factors.
Approximately four times as many children of alcoholics develop alcoholism than do children of non-alcoholics, and more than 40% of people have at least one alcoholic parent in their family, typically the father.
• Personality disorder or a co-occurring mental illness.
· Co-morbid medical disorders.
· Withdrawal effects and craving.
Biochemical factors.
An individual is predisposed to alcoholism by genetically determined endorphin deficiency.
Psychological factors:
Curiosity; the desire to seek out novelty.
All-around disobedience and social disobedience.
Early attempts to imitate tobacco and alcohol.
· Poor impulse control.
· Sensation-seeking (high).
· Low self-esteem (anomie).
· Concerns regarding personal autonomy.
· Poor stress management skills.
· Childhood trauma or loss.
Relieving of boredom or exhaustion.
· Escape from reality.
A disregard for traditional objectives.
· Psychological distress.
Social factors:
The influence of peers is frequently more significant than parental influences.
Setting a good example and modeling others’ desirable behavior.
· Ease of availability.
· Strictness of law enforcement.
· Intrafamilial conflicts.
· Religious reasons.
· Poor social/familial support.
Within the family, there is a “perceived distance.”
· Permissive social attitudes.
· Rapid urbanization.
Symptoms
In order to determine whether a person has an alcohol use disorder, the DSM-5 lists 11 symptoms.
Alcohol is frequently consumed in greater or longer doses than intended.
There is an ongoing desire to reduce or control alcohol consumption, as well as ineffective attempts to do so.
Activities required to obtain, use, or recover from alcohol’s effects take up a significant amount of time.
A strong urge or desire to consume alcohol, also known as a craving.
Repeated alcohol consumption that prevents a person from performing important tasks for work, school, or home.
Persistent or frequent alcohol use despite social or interpersonal issues that are brought on by or made worse by alcohol’s effects.
Alcohol use results in the reduction or cessation of significant social, professional, or recreational activities.
Consistent drinking in potentially dangerous situations.
Despite being aware of a physical or psychological issue that is likely to have been triggered or made worse by alcohol, alcohol use is still being engaged in.
The ability to drink alcohol without becoming intoxicated or experiencing the desired effect; or b. The ability to continue drinking alcohol at the same level despite experiencing a markedly diminished effect.
Withdrawal as shown by one of the following: a. The typical withdrawal syndrome for alcohol, or b. the use of alcohol (or a drug closely related to it, like a benzodiazepine), to treat or prevent withdrawal symptoms.
Periods of drinking and withdrawal symptoms can both be a part of an alcohol use disorder.
Alcohol intoxication :With alcohol use, there is initially a brief period of excitation followed by a generalized central nervous system depression. As intoxication progresses, there is a progressive loss of self-control and frank disinhibited behavior.
With blood levels of 150–200 mg%, intoxication is typically evident; at 300–450 mg%, respiratory depression and coma set in; and at 400–800 mg%, death occurs. The length of intoxication depends on the quantity and speed of alcohol consumption.
An acute intoxication caused by a small amount of alcohol is occasionally possible in some people.pathological intoxicationThe emergence of amnesia or blackouts is a further characteristic that can occur during acute intoxication.
Withdrawal syndrome:The most typical symptom of withdrawal syndrome is handover the following morning, along with mild tremors, nausea, vomiting, weakness, irritability, insomnia, and anxiety. Occasionally, delirium tremens, alcoholic seizers, or alcoholic hallucinations may accompany less mild withdrawal symptoms, making the withdrawal syndrome more severe.
A. Delirium tremens
The most severe alcohol withdrawal syndrome, delirium tremens, typically develops within 2-4 days of abstaining completely or significantly from drinking heavily, occurring in about 5% of patients as opposed to 34% of patients who experience acute tremulousness.
This is a brief acute organic brain syndrome (delirium), with recovery taking place in 3–7 days, and characterized by:
Confusion brought on by being out of place and time.
Distractibility and a short attention span.
vivid and frightening visual (and sometimes auditory) hallucinations and illusions, including the possibility of tactile hallucinations of insects crawling over the body.
Significant autonomic dysregulation accompanied by tachycardia, fever, hypertension, sweating, and pupillary dilation.
· Psychomotor agitation and ataxia.
An altered sleep-wake cycle caused by insomnia.
· Dehydration with electrolyte imbalance.
Occasionally, co-occurring medical conditions like pneumonia, fractures, liver diseases, or pulmonary tuberculosis may complicate the clinical picture, as can death, which can occur in 5-10% of patients with delirium tremens and is frequently caused by cardiovascular collapse, infection, hyperthermia, or self-inflicted injury.
B. Alcoholic seizures
About 10% of alcohol-dependent patients experience generalized tonic-clonic seizures, which typically start 12–48 hours after a heavy drinking session and are frequently the result of years of heavy drinking.
Status epilepticus may occasionally be precipitated, and multiple seizures (2–6 at once) are more frequent than single seizures. Delirium tremens follows in about 30% of cases.
C. Alcoholic hallucinations
Alcoholic hallucinations, which affect about 2% of patients, are characterized by the presence of hallucinations, typically auditory, during periods of partial or total abstinence following routine alcohol consumption.
Recovery usually takes place within one month, and the duration is very rarely longer than six months. These hallucinations continue after the withdrawal syndrome has passed, and typically occur while the patient is conscious.
HOMOEOPATHIC REMEDIES
When it comes to ALCOHOL USE DISORDER, there are many effective medicines available in homoeopathy; however, the selection depends on the individuality of the patient, taking into account mental and physiological factors. Homoeopathy is currently a rapidly growing system that is being practiced all over the world. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual.
ANGELICA :Additionally, it will treat dyspepsia, nervous headaches, atony of various organs, and disgust for alcohol.
APOCYNUM CANNABINUM:Effective for treating extreme alcohol cravings, severe nausea and vomiting, low spirits, anxiety, and depression. The patient also has a hard time passing urine and it takes a long time. The urine is hot, turbid, mixed with thick mucus, and it burns in the urethra after urinating.
ARSENIC ALBUM :Patients who take arsenic alb report having delirium tremens, extreme anxiety, restlessness, and a fear of dying. Arsenic alb also helps to lessen the negative effects of excessive alcoholism.
CAMPHOR :When Angelica’s attempts to control her alcoholism failed, camphor should be tried because it causes a burning sensation to follow a cold sensation in the stomach.
CAPSICUM ANNUM :When a patient has vomiting and diarrhea, capsicum annum is prescribed in an effort to control their strong desire for alcohol.
CHINA OFFICINALIS:If a drunkard wants to change, China will take away their desire for alcohol. The stomach and abdomen are internally cold, and the liver and spleen are enlarged. The patient also has flatulence, belches bitter fluid, and regurgitates food without any relief.
QUERCUS GLANDIUM SPIRITUS:There are dropsy and liver affections, and Quercus is thought to be a specific for alcoholism. It will counteract the negative effects of alcohol.
STERCULIA :It improves digestion and appetite while reducing alcohol cravings, making it a potent treatment for alcoholism.
STRYCHNINUM NITRICUM :Any type of alcohol craving is eliminated by strychninum nitricum.
SULPHURIC ACID : –One of the best treatments for alcoholism is sulphuric acid, which is prescribed when water causes coldness of the stomach and must be mixed with liquors. The patient experiences heartburn, sour eructation’s, and sour vomiting. The relaxed feeling in the stomach is relieved by heat application. The patient has an aversion to the smell of coffee.
SULPHUR :When Chinese medicine fails, sulphur should be tried. The patient has a strong desire to drink alcohol constantly, wanting to do so from morning until evening or until they are awake. The patient also has a complete loss of appetite and needs to eat something at around 11 a.m.
HOMOEOPATHIC REMEDIES FOR THE BAD EFFECTS OF ALCOHOLISM
ANTIMONIUM TARTARICUM:Alcoholics with white-coated tongues are given antimonium tart to prevent vomiting.
AVENA SATIVA:Alcoholics who experience insomnia and anxiety are given avena sativa, which also eliminates the desire for alcohol, as a prescription.
CARBONEUM SULPH:Impotence, color blindness, and other ailments can be treated by carboneum sulph, which is very beneficial for people who have been damaged by alcohol abuse.
CARDUS MARIANUS:For liver issues, liver pain, and the constipation and diarrhea experienced by chronic alcoholics, particularly beer drinkers, Cardus mar. is very effective.
COFFEA CRUDA:Alcohol-related headache, which feels like nails are being driven into the head and is worse outside, as well as sleeplessness, convulsions, and vivacity can all be treated with coffee cruda.
CROTALUS HORRIDUS :Chronic drinkers often develop liver diseases, which are treated with crotalus hor.
CHIMAPHILA UMBELLATA 30Chronic alcoholics who have kidney and liver disease can benefit from taking chimaphila umbellate to treat their conditions.
GELSEMIUM SEMPERVIRENS:Gelsemium is prescribed when the patient exhibits a lack of muscular coordination, excessive trembling, and nervous symptoms that are more prominent in alcoholics.
LACHESIS:Patients with lachesis tend to be ill-mannered, violently inclined, vindictive, jealous, and envious, as well as talkative before and while intoxicated.
NUX VOMICA:When a patient experiences giddiness and restlessness after consuming alcohol, heavy vomiting afterward, nausea and trembling after consuming alcohol, nervousness as a result of consuming wine or liquor, a tendency toward envy and jealousy, and a tendency to commit suicide by shooting or stabbing, nux vomica is prescribed.
OPIUM:Delirium trembles repeatedly; face shows signs of fright or terror; breath is labored; dreams include visions of ghosts and animals; face is dark red.
PETROLEUM:When drunk people are seen to lack motivation, willpower, and ability to resist a glass of wine, to vomit after even a small amount of drinking, and to talk excessively while intoxicated, petroleum is effective.
RANUNCULUS BULBOSUS:In addition to treating coma brought on by excessive alcohol consumption and other negative effects of alcohol, ranunculus bulbosus is effective for treating drunken people’s mental attacks.
SECALE CORNUTUM:Alcohol-related insomnia is treated with secale cor.
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