Alcohol diseaseF10.2

Primary, chronic disease with genetic, psychosocial and environmental factors that influence the development and forms of the disease. The disease is often progressive and fatal. It is characterized by physical, psychological and social problems and leads to a number of consequential damages. It is characterised by loss of control for drinking, for mental concentration on the drug alcohol, for continued alcohol consumption despite known adverse effects. Most alcoholics seek help from a doctor without addressing their alcohol consumption as the main problem, quite a few even in ignorance of the links between their suffering and their drinking habits. This results in diagnostic problems in the etiological classification of symptoms as well as difficulties in the therapeutic consequences.

For a diagnosis according to F10.2 (ICD-10) 3/>3 of the following 6 criteria must be fulfilled within 12 months:

• Carving (strong craving for alcohol)
• loss of control over the start, end or amount of alcohol consumption
• Physical withdrawal syndrome
• Tolerance development towards the alcohol effect (dose increase)
• neglect of other interests
• Persistent alcohol consumption despite clear harmful consequences (physical, mental, social)

Typology of alcoholic patients according to Jellinek

• Alpha drinker: Conflict and relief drinker
• Beta drinker: occasional drinker
• Gamma drinker (alcoholic who has lost control over his drinking behaviour)
• Delta drinker (habitual drinker with psychological and physical dependence but without loss of control - mirror drinker -).
• Epsilon drinker (periodic drinker with loss of control = quarterly drinker)

About 1.3 million people in Germany are alcohol dependent. In France, 50% of all hospital beds are used for the care of patients suffering from alcoholism. 40% of the total health expenditure must be spent on this. English data show that 30% of the patients of general internal medicine wards suffer from diseases caused, substantially contributed to or aggravated by alcohol. In Russia up to 40% of men die from alcohol abuse.

There are certain criteria for the diagnosis of alcohol dependence. If a person meets a certain number of these criteria, he or she is considered to be dependent. The transitions from "still normal" to high-risk or harmful consumption and dependence are fluid.

Alcoholism is a complex disorder in which etiopathogenetic, cultural, sociological, pharmacological, psychological and genetic (children of alcoholics have a 4 times higher risk of developing an alcohol disorder) aspects play an essential role.

Acute alcohol consumption has an immediate toxic effect on the body, an intoxication that occurs shortly after consumption and depends on the dosage. Individual alcohol tolerance varies according to tolerance levels. However, a blood alcohol concentration >5 per thousand is fatal.

Acute alcohol intoxication (intoxication) is characterized by acute neuropsychiatric reactions such as:

• disinhibition (reduction of shyness or increased aggressiveness), the urge to talk, high spirits, concentration and memory disorders, sometimes aggressive, foreign or self-endangering behaviour, fear or depressive mood, disturbance of consciousness with disorientation, somnolence and even coma. Risk of aspiration, bolus death, respiratory depression, hypothermia.

Chronically excessive (pathological) alcohol consumption over a long period of time causes chronic organ damage, which is individually different, and which can appear after months or years. These include:

• Neuropsychiatric disorders: Polyneuropathy (20% of alcoholics develop a symptomatic polyneuropathy with distal, leg-stressed sensomotor disorders), Wernicke's encephalopathy due to chronic vitamin B1 deficiency (disturbances of consciousness, paresis of the eye muscles, ataxia), Korsakow's syndrome (organic anamnestic syndrome), Alcohol psychoses (jealousy, phobias, hallucinations, paranoid disorders), atrophic brain changes, dementia syndrome, cerebellar cortex atrophy (1% of alcoholics), central pontine myelinolysis (rare), alcoholic myopathy (alcohol myopathy).
• Liver: alcoholic fatty liver disease = AFLD(alcoholic fatty liver, alcoholic fatty liver hepatitis, alcoholic micronodular liver cirrhosis)
• Pancreas: acute pancreatitis, chronic calcifying pancreatitis
• Carcinomas, especially tumours of the oral cavity, throat, liver and female breast
• Gastrointestinal tract: reflux esophagitis, increased risk of Barrett's esophagus and esophageal carcinoma; acute gastritis possibly gastric bleeding due to erosive gastritis Mallory-Weiss syndrome (ruptures of the mucous membrane in the esophageo-cardiac transition area)
• Diseases of the cardiovascular system: cardiac arrhythmia (holiday heart syndrome), paroxysmal cardiac enlargement, arterial hypertension, alcohol-toxic dilated cardiomyopathy
• Coronary heart disease: with moderate alcohol consumption, reduction in total mortality; with higher alcohol consumption, significant increase in total mortality.
• CNS: increased risk of stroke with significantly increased alcohol consumption (>30g/day).
• Metabolism: hypertriglyceridemia; hyperuricemia, porphyria cutanea tarda; folic acid deficiency with consecutive hyperchromic anaemia.
• Endocrine disorders: Men: loss of libido with potency disorders (testosterone ↓), pseudo-Cushing's syndrome. Women: oligo- or amenorrhoea (estrogen ↓).
• Immunodeficiencies: increased susceptibility to infections (pneumonia, tuberculosis).

Gamma-_GT↑↑; MVC ↑; CDT (Carboanhydrate Deficient-Transferrin) ↑, in advanced state of chronic alcoholism organ-related laboratory changes, e.g. signs of liver cirrhosis with signs of synthesis disorder and gfls. cholestasis parameters.

Basically 4 therapy phases are distinguished. In each phase an attempt is made to adapt the treatment to the individual situation of the person concerned.

• Contact phase: The affected persons contact counselling centres, a self-help group or a doctor in order to receive detailed information. In this phase it is important to name the drinking behaviour of the addict as a problem and to motivate the alcoholic to work on the solution on his own responsibility.
• Reduction phase: The treatment aims to reduce the amount of alcohol at first and later to avoid alcohol altogether.
• Withdrawal phase: If the reduction in drinking cannot be achieved in a stable way or for medical reasons, physical detoxification is often necessary. If the drug is no longer available to the body, physical (e.g. confusion, sweating, high blood pressure, accelerated heartbeat, mild nausea, trembling) and psychological withdrawal symptoms (e.g. psychomotor agitation, irritability, anxiety) are the result. Alcohol withdrawal usually takes place under inpatient conditions (risk of life-threatening delirium with disturbances of consciousness up to coma, hallucinations, cardiovascular system disorders, which may require immediate emergency medical intervention).
• Weaning phase: Weaning treatment usually takes place over a period of several weeks to months (preferably in a specialist clinic. The aim is to introduce the affected person to a daily life without alcohol. In addition, the alcoholic's desire to remain abstinent must be stabilised.
• Aftercare and adaptation phase: The transition from the often in-patient withdrawal treatment back into everyday life can be problematic, as the alcoholic patient is confronted again with the previously existing worries and problems. Help through self-help groups can be another important supporting component.

Internal medication: Acamprosat, naltrexone, nalmefen are approved in Germany. However, such drugs cannot replace counselling and therapy, but only supplement them.

Alcoholism is a chronic disease. It is not curable. The risk of an addiction shift to medication must be considered. The disease can only be brought to a halt by lifelong abstinence.

First and foremost is ignorance of the complex symptomatology caused by chronic alcoholism. Medical experience, particularly in recent years, leads to the conclusion that there is hardly any internal clinical picture in which alcohol cannot play a potential role as an etiological factor. In daily medical practice, alcohol-related diseases are diagnosed and treated according to the concepts of modern medicine, which are essentially based on natural science. Therapy is geared to the current illness; addictive behaviour itself, as a significant disease-causing factor, is not usually the subject of general medical intervention. Alcoholics often appear anxious, unstable, irresponsible, unreliable; irritable, aggressive - characteristics that intuitively cause many treating physicians to take a defensive stance. A negative, emotionally charged atmosphere can often develop in the doctor/patient conversation, which makes it impossible even for the dedicated doctor to establish trustful, effective communication. Thus, many therapy attempts fail at an early stage.

An alcohol addiction often runs its course in certain stages, each with characteristic and therefore objectifiable behaviour. Although the individual forms of the disease often differ greatly, the following course is considered characteristic:

First of all, personal coping with problems, increasing the frequency of alcohol consumption. Daily alcohol consumption can be the consequence. An alcohol intoxication does not have to occur.

In the next stage, alcohol increasingly takes on an obsessive mental significance. The subject of drinking, secretly obtaining alcohol, hiding one's own drinking habits from friends, family and colleagues increasingly dominates thinking and behaviour. In addition, there is a progressive loss of control. Compulsively, people resort to alcohol. Other interests, duties and social contacts are neglected because of compulsive alcohol consumption. The attempt to reduce the usual amount consumed leads to withdrawal symptoms.

Finally, alcohol addiction largely dominates the daily routine as well as the behaviour of those affected. Mental abilities such as the ability to criticise and judge are noticeably reduced. It is not uncommon for there to be a continuous social decline.

There is no such thing as risk-free alcohol consumption! Even small amounts of alcohol are harmful, but the risk of secondary diseases increases with increasing consumption.

Low-risk alcohol consumption: women: < 12 g / day, men < 24 g of pure alcohol. Exceeding this amount is classified as hazardous consumption. Continued consumption increases the risk of harmful consequences. This applies to women with regular consumption > 40 g/day of alcohol or to men with consumption > 60 g/day.

Note: 1 glass of beer with 0.33 litre is equivalent to about 13 g alcohol. A glass of wine of about 0.2 litres is equivalent to about 16 g. Alcohol consumption is always considered to be risky if there are less than 2 non-consumption days per week.