In various classifications of diseases, the concept of “alcoholism” is identified with the concepts of “chronic alcoholism”, “alcohol dependence syndrome”. This refers to a disease resulting from the systematic abuse of alcohol with increased or decreased tolerance of the body, which is the result of a pathological attraction to it and accompanied by signs of mental and physical alcohol dependence. In the clinical picture of alcoholism, signs of the psycho- and somatotoxic effects of alcohol are observed. Usually, alcoholism is preceded by a stage of habitual (domestic) drunkenness of various durations, but there are also cases of its rapid (within 1-2 years) transition to alcoholism. It should be noted that difficulties arise, as a rule, when delimiting household alcoholism from the initial stage of alcoholism. The ICD of the 9th revision uses the term “chronic alcoholism”, but some WHO experts (M. Keller, 1978) believe that there is no need to clarify the concept of “alcoholism” with the word “chronic”, since acute alcoholism does not exist. J. Skala (cited by N. U. Jahnig, 1979) distinguishes between the following types of drinking: for pleasure, abuse, systematic abuse, habitual massive abuse and alcohol abuse. E. Jellinek (cited by N. U. Jahnig, 1979) in the development of alcohol dependence would benefit from the following stages: 1) alpha-alcoholism (psychological dependence on alcohol while maintaining control and abstinence, but with episodes of disturbance in interpersonal relationships); 2) beta-alcoholism (periodic use of alcohol in high doses with somatic complications, but in the absence of physical and mental dependence); 3) gamma-alcoholism (increased tolerance, the appearance of withdrawal symptoms, loss of control with the development of mental and somatic dependence); 4) delta-alcoholism (physical and mental dependence with a lack of the ability to give up alcohol – the drinker can control the dose, rarely drinks, but is forced to drink daily); 5) epsilon-alcoholism (drinking alcohol in the form of binges – dipsomania). T. Lemperiere and A. Feline (1977) attribute only the last two stages to chronic alcoholism, although one of the main signs is the loss of a calm, indifferent attitude to alcoholic beverages at their sight, which is also noted with gamma-alcoholism. N. Szewczyk (1979) in the definition of alcoholism attaches great importance to the violation of social forms of behavior and the propensity to commit offenses. I.N. Pyatnitskaya and A.M. Stochik (1974) note that the concept of “alcoholism” has gained wide social significance, has become close to the concept of “drunkenness” and in the narrow medical sense is used only in psychiatric literature. I.N. Pyatnitskaya and N.K. Permyakov (1974) considered alcoholism as a disease and described it under the name “chronic alcoholism”. In our opinion, it is inexpedient to single out concepts that reflect, as it were, only the social (“alcoholism”) or medical (“chronic alcoholism”) aspects of alcohol abuse. Frequent or excessive drinking without signs of alcohol dependence is denoted by the term “drunkenness” or “alcohol abuse” (code 305.0 according to the ICD of the 9th revision), and signs of pathological dependence on alcohol by the term “chronic alcoholism” or “alcoholism” (code 303 according to the ICD of the 9th revision). Attempts to improve the definition of alcoholism have been made to date. An important stage in the development of the doctrine of alcoholism should be considered a description of the syndromes of pathological attraction, withdrawal symptoms, the distinction between physical and mental alcohol dependence. The most productive in the diagnostic sense is the concept of alcohol addiction syndrome (A. A. Portnov, 1962; A. A. Portnov, I. N. Pyatnitskaya, 1971). However, the clinical picture of chronic alcoholism is not limited to alcohol addiction syndrome or alcohol dependence syndrome, which It is considered one of the main manifestations of the disease. Chronic alcoholism includes not only specific, but also general, characteristic of all chronic intoxication, signs of damage to the somatoneurological and mental spheres. In the clinical picture of chronic alcoholism, you can find symptoms indicative of chronic toxic damage to the central nervous system, which, depending on the stage of thyroid cancer and the severity of its course, give symptom complexes in the form of asthenic, neurosis, and psychopathic, psychotic and psycho-organic syndromes. Their material substrate is brain damage – from functional disorders to severe toxic encephalopathy, the speed and degree of development of which is determined by age, gender, premorbid state, frequency, dose and type of alcohol abuse, concomitant diseases, injuries. The somatotoxic effect of alcohol is initially characterized by the symptoms of a functional disorder in the activity of organs and systems of the body in the form of tachycardia, instability of blood pressure, impaired cerebral and peripheral circulation, respiratory failure, dyspeptic phenomena, disorders of the autonomic nervous system, and sexual functions. At the beginning of the disease, alcohol endurance (tolerance) increases or is kept at a high level. As the disease progresses, alcohol tolerance decreases. The degree of toxic damage to internal organs becomes more pronounced – there are distinct signs of myocardial dystrophy and coronary heart disease, gastritis and colitis, toxic hepatitis and liver cirrhosis, nephropathy, the endocrine system undergoes changes. The reactivity of the organism and its adaptive capabilities sharply decrease, as a result of which concomitant somatic diseases often arise. Patients often complain of a poor general somatic state and a deterioration in the activity of certain internal organs, a sharp decrease in physical and mental performance. Patients look, as a rule, older than their years. The syndromological characteristic of psychopathological symptoms is determined by the combination of premorbid psychological properties of a person, the severity of asthenization of neuropsychic functions, and organic brain damage. The asthenic syndrome leading at the onset of the disease is accompanied by an exacerbation of characterological features and is manifested by symptoms of increased stamina of mental functions (attention, memory, thought processes, etc.), emotional instability, increased mood dependence on the situation, explosiveness, anger, and obsessive fears. In the stage of organic brain lesion (encephalopathic) in the structure of asthenic syndrome, there are traits of leveling the personality, its psychopathic transformation with a decrease in subtlety, differentiation and adequacy of mental processes, an increase in egocentrism, impoverishment of moral and ethical and labor attitudes, criticism of one’s state and behavior. Characteristic is a decrease in intellectual abilities, the occurrence of dysphoria attacks with aggression or suicidal attempts (K. Seidel et al., 1980). The degradation process, passing the stage of the psycho-organic syndrome, can result in alcoholic dementia and general insanity. The occurrence of alcoholic psychoses, as a rule, serves as an indicator of the transition of the disease from the functional stage to the organic, although often organic changes (alcoholic encephalopathy) are detected long before psychotic conditions. Alcohol addiction syndrome , being one of the main components of the clinical picture of chronic alcoholism, gives it specific features. All stages of alcoholism in one way or another are characterized by the main signs of this syndrome, namely: pathological craving for alcohol (mental and physical dependence); change in initial tolerance; withdrawal symptoms (“hangover syndrome”); psycho-and somatotoxic effects of alcohol consumption. It is customary to understand pathological attraction as a psychopathological phenomenon in the form of an active, involuntary desire to consume alcohol with an inability to abstain from it and loss of control over the amount of alcoholic drinks drunk. Pathological attraction N. N. Ivanets, A. L. Igonin (1983) are subdivided into primary (corresponding to mental dependence on alcohol), which is not associated with either intoxication or withdrawal, occurs spontaneously with the struggle of motives, without a struggle of motives or as irresistible , prevails in stage I of alcoholism, and the secondary, when when intoxicated, the control over the situation and the amount of alcohol consumed is reduced or lost. The desire to get hangover, which corresponds to physical dependence on alcohol, is observed in the II and III stages of alcoholism. The addition of the need for hangover in the framework of withdrawal symptoms indicates the formation of stage II alcoholism. According to A. A. Portnov (1962), the first sign of mental dependence is an increase in activity in the search for an excuse for a drink. With the occurrence of mental dependence, the usual calm, indifferent attitude to alcoholic drinks disappears , episodic or constant obsessive thoughts about drinking arise, initially accompanied by a desire to get rid of them, a struggle of motives, then turning into an irresistible (compulsive) attraction, the dissatisfaction of which causes a state of mental discomfort. With the progression of alcoholism, a secondary pathological attraction in the form of increasing physical dependence joins. The need for a repeat of alcohol intake is due to a deterioration in well-being, the appearance of unpleasant sensations in various parts of the body, and a decrease in working capacity. Aversion to alcohol is transformed into its opposite – the need to ensure temporary and apparent somatic well-being. The protective gag reflex disappears. Alcohol tolerance rises, then falls. Abstinence syndrome is a state of physical and mental discomfort that occurs due to interruption in alcohol intake. There is a feeling of weakness, headache, dizziness, lack of appetite, nausea, insomnia, general tremor, pain in the heart, tachycardia, increased or decreased blood pressure, purple-cyanotic or earthy-gray complexion, increased tendon and periosteal reflexes, convulsive twitching in the muscles. Psychopathological symptoms are initially rudimentary (in the form of asthenic phenomena), then becomes pronounced and diverse: mood instability, pickiness, anger, tendency to hysterical and depressive-hypochondriac reactions or aggression, weak-heartedness, anxiety, anxiety, depression with feelings of guilt, suicides and attempted, disordered thinking with a paranoid installation. Against the background of insomnia, increasing psycho-emotional stress, episodic illusory and hallucinatory disorders appear , which, as a rule, serve as precursors of alcoholic psychosis. The severity of the somatic and psychotoxic effects of alcohol, as well as withdrawal syndrome is associated with the stages of development of chronic alcoholism, the official definition of which is given in the ICD of the 9th revision. So, stage I alcoholism is defined as “alcohol abuse with loss of control over the amount of alcohol consumed, the primary pathological attraction to alcohol (occurring before an alcohol excess), increasing tolerance to alcohol, regular single drinks and rare, situationally determined periods of daily drinking for several days . There are no withdrawal symptoms with hangover. ” This stage is characterized by the use of alcoholic beverages 2-3 times a week with an increase in tolerance by 3-4 times, the ability to drink them for many days without subsequent aversion, the appearance of palimpsests, signs of mental dependence and asthenia (I.N. Pyatnitskaya, 1974). The diagnosis of stage I alcoholism presents certain difficulties in terms of distinguishing it from domestic drunkenness, as patients in the official setting usually stubbornly deny that they have a painful craving for alcohol – obsessive thoughts and memories of drinking, an increased temptation to drink. Objective signs of emerging chronic alcoholism can be considered drinking for the slightest reason, loss of control of the frequency and amount of alcohol consumed, place, time and situation, appearing in public places and at work in a state of intoxication, the occurrence of domestic and production problems in this regard. For relatives, friends and colleagues at work and study, it becomes obvious that a person experiences an excessive attraction to alcohol, despite all the assurances to the contrary. A. A. Portnov and I. N. Pyatnitskaya (1971) consider the loss of quantitative control as an indicator of the formed pathological craving for alcohol. In the ICD of the 9th revision, the second stage of chronic alcoholism is defined as “alcohol abuse with withdrawal conditions, accompanied by somatovegetative disorders, increasing or maximum tolerance to alcohol, multi-day drinking of alcohol in the form of“ pseudo-bouts ”or constant drunkenness. Personality changes are usually limited to sharpening premorbid features. ” From this definition it follows that patients have signs of physical and mental dependence, somatoneurological and psychopathological symptoms of the withdrawal syndrome, and maximum tolerance to alcohol. Alcohol consumption can be daily or for several days in a row with breaks of 1-2 days. Morphofunctional substrate of stage II of chronic alcoholism is the appearance and increase of organic changes not only in the brain, but also in the internal organs. Outside of alcohol intoxication, the clinical picture is characterized by initial or severe signs of diffuse intoxication encephalopathy, an organic psychosyndrome that develops in a psychopathic type, neurological microsymptomatics, and dystrophic changes in internal organs (heart, liver, etc.). Complaints of headache, weakness, increased fatigue, pain in the heart, stomach, liver and other organs, sexual weakness, decreased memory, mental performance and stability of attention, emotional instability, irritability are characteristic. Typically, the association of disease with alcohol abuse is carefully concealed. Alcoholic personality change is manifested mainly in the leveling of differentiated properties and exposure, sharpening premorbid characterological features. This finds expression in psychopathization according to explosive, hysterical, asthenic, paranoid types. Patients are characterized by lying, conflict, accusing others of infringing on their rights, mistrust of them, conflict in work and life, selfishness, despotism and neglect of the interests of the family, rudeness, tactlessness, ignoring generally accepted moral and ethical standards, narrowing the circle of interests, careless and poor-quality performance of production tasks, evasion of social duties, reduction of mental and physical productivity. Intoxication with stage II alcoholism is often difficult, since the patient usually consumes a very large dose of alcohol. Among persons of a balanced or psychasthenic warehouse there are intoxication of the “good-natured” and “euphoric” types. Often observed intoxication is demonstrative-hysterical, dysphoric and paranoid types, accompanied by picky, anger, explosiveness, aggressiveness and revenge. Amnesia during intoxication, about which I.N. Pyatnitskaya writes (1974), is not found as often as alcoholics themselves claim. During intoxication, consciousness is not grossly disturbed, with the exception of cases of severe intoxication and the so-called complicated intoxication, observed in individuals with the consequences of organic brain damage. However, they do not show psychotic changes in consciousness, followed by complete amnesia. If a patient with alcoholism stops drinking, then after 8-10 hours he has an withdrawal syndrome, the symptoms of which disappear after 3-7 days (I.N. Pyatnitskaya, 1974). The individual characteristics of the psychopathological manifestations of chronic alcoholism are first amplified, then overlap, leveled by the symptoms of the actual withdrawal syndrome. 

local_offerevent_note October 23, 2019

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