Alcolismo

1 - INTRODUCTION

Alcoholism is the set of problems related to prolonged and excessive consumption of alcohol, is understood as the addiction to overeating and regular alcohol consumption, and all the consequences thereof. Alcoholism is therefore a set of diagnoses. Inside there is alcoholism addiction, abstinence, abuse (overuse, but not continuous), alcohol intoxication (drunkenness). Amnestic syndromes (restricted memory loss), dementia, hallucinations, delusional mood. Anxiety disorders, sexual and sleep disorders nonspecific. Finally delirium tremens, which can be fatal.

So alcoholism is a generic term that indicates a problem, but medically for greater accuracy, it is necessary to point out which of disturbances are present, since there is usually more than one.

2 - Some Definitions

The phenomenon of Dependence (Addiction) is the repeat behavior that meets two basic mechanisms not pathological: positive reinforcement and negative reinforcement. Positive reinforcement refers to the pleasure-seeking behavior: when something is pleasing the person seeking the same stimuli to get the same satisfaction. The negative reinforcement refers to the avoidance behavior of pain or displeasure. When something unpleasant is the person seeking the same means to avoid pain or displeasure caused in a given circumstance. The fixing of a person seeking behavior in alcohol, follows these two mechanisms outlined above. In the beginning the search for pleasure is that the drink provides.

After a period when the person does not achieve more pleasure previously obtained, can not stop anymore because whenever this is attempted arise unpleasant withdrawal symptoms, and to avoid them the person maintains the use of alcohol. The positive and negative reinforcements are normal resources or mechanisms that enable people to adapt to their environment.

The medications in use today act on these phases: naltrexone inhibits the pleasure given by alcohol, inhibiting positive reinforcement; acamprosate reduces the discomfort caused by withdrawal, by inhibiting negative reinforcement. Probably shortly we will have studies evaluating the benefit brought by the combination of these two medications for alcohol dependence who did not obtain satisfactory results with each one separately.

3 - TOLERANCE AND DEPENDENCE

Tolerance and dependence to alcohol are two separate events and inseparable. Tolerance is the need for higher doses of alcohol to maintain the effect of intoxication obtained in the first doses. If at first a shot of whiskey was sufficient for a slight feeling of tranquility, after two weeks (for example) and requires two doses for the same effect. In this situation we say that the individual is developing tolerance to alcohol. Typically, as it increases the dose to the liquor circumvent tolerance, it back into increasingly higher doses. Gradually, five shots of whiskey can become harmless to the individual who is intoxicated with a prior dose. In practice not observed a complete tolerance, but partially. An individual who is intoxicated with a prior dose of whiskey and replaced by a mild intoxication with three doses is tolerant despite having some degree of drunkenness. The alcoholic can not say that is not tolerant to alcohol by systematically introduce a degree of drunkenness. The criterion is not the absence or presence of drunkenness, but the relative loss of the effect of the drink. Tolerance occurs before dependence. The earliest evidence of tolerance does not necessarily mean dependence, but it is a clear sign that addiction is not far away. Dependency is simultaneous tolerance. The dependence will be more intense the more intense the degree of tolerance to alcohol. We say that a person has become addicted to alcohol when she no longer forces itself to stop or reduce the use of alcohol.

The alcoholic "first trip" always got the impression that you can stop when you want and says: "when I want, I stop." This phrase usually conceals incipient alcoholism and sturdy; tough because the patient denies any problem related to alcohol, even if others do not believe he believes himself the illusion he created. The denial of alcoholism itself, when it is not evident or are getting, is a defense of self-image (what the person thinks of herself). Alcoholism, like any psychiatric diagnosis is stigmatizing. Cause a person to recognize his own state of alcohol dependence, it is demanding a sharp drop in self-image and therefore self-esteem. With self-esteem weakened the person no longer has the same willingness to live and thus fight the disease itself. It is a paradoxical situation for which no satisfactory solution has been obtained. Depend on the art of managing each case in particular, depend on the ability of each psychiatrist.

4 - OVERVIEW OF ALCOHOLISM

Early identification of alcoholism is often hampered by the denial of patients regarding their condition of alcoholics. Moreover, in the early stages is more difficult to diagnose because the boundaries between using "social" and dependence are not always clear. When the diagnosis is evident and the patient agrees to treat is because it's been a long time, and several damages were suffered. It is more difficult to reverse the process. Like most mental diagnoses, alcoholism has a strong social stigma, and users tend to avoid this stigma. This natural defense for the preservation of self-esteem just delays in bringing therapeutic intervention. To start a treatment for alcoholism is necessary for the patient at high levels preserve their self-esteem, but without denying their status as an alcoholic, a fact very difficult to achieve in practice. Professionals should be alert to any change in the behavior of patients in the following sense: lack of dialogue with the spouse, frequent temper outbursts with expressions of anger, hostile attitudes, loss of interest in the marital relationship. Alcohol can be sought both to be sexually uninhibited as to avoid sex life. At work colleagues may notice a behavior more irritable than usual, delays and even faults. Car accidents are happening. When these situations happen is a sign that the individual has lost control of the drink: may be waging a lonely fight to reduce alcohol consumption, but usually personal initiatives result in failures. The bodily manifestations usually begin by vomiting in the morning, abdominal pain, diarrhea, gastritis, increased liver size. Small accidents that cause injuries, and other injuries become more frequent and more intense than forgetfulness lapses that