By analogy with other mental diseases, alcoholism can be attributed to multifactorial, polyetiological diseases with complex pathogenetic mechanisms affecting various levels of the functional activity of organs and systems of the body.
Existing theories of the etiology of chronic alcoholism can be divided into three main groups: biological, psychological and sociological. Each of them has a certain meaning, but cannot fully explain the occurrence of the disease. An integrated approach to this problem is more effective.
Some authors provide evidence on the role of heredity in the occurrence of chronic alcoholism as a genetically determined defect in enzymatic mechanisms. People with a father or mother abusing alcohol often suffer from alcoholism. A higher concordance in alcoholism was observed in identical male twins (L. Kau, 1960; cit. Nq P. Zvolsky, 1977). Some metabolic features were found in children born to patients with alcoholism.
Thus, there is reason to believe that alcohol abuse creates prerequisites for the offspring to more quickly develop a pathological craving for alcohol.
It is believed that the transmission of alcoholism by inheritance is of a recessive nature, and environmental factors play a decisive role in its occurrence, since people with different heredities, including unburdened, become ill with alcoholism. Studies have been conducted in which there were no significant differences in the incidence of alcoholism in children in which one of the parents suffered or did not suffer from alcoholism if these children were brought up and lived outside the family (A. Roe, 1945; cited by P. Zvolsky, 1977).
The prerequisites for the rapid development of chronic alcoholism may be the special condition of certain metabolic systems in the body, genetically determined or acquired (A. A. Portnov, I. N. Pyatnitskaya, 1971). It is difficult to prove this in humans, since in patients with alcoholism metabolic changes can be largely a consequence of the disease. In animal experiments, it was shown that mice and rats with a higher level of hepatic alcohol dehydrogenase were more likely to drink alcohol than animals in the control group (E. Hoff, 1966; cited by P. Zvolsky, 1977). In male rats, the endogenous level of ethanol is n 2 times lower than in females. After the introduction of ethanol in males, its concentration in the blood during growth and stabilization is lower and decreases faster; in castrated males, testosterone plays the role of a motivator for ethanol consumption (L.M. Andronova et al., 1981).
From the above data it is seen that in the development of the biological component of the pathological attraction to alcohol, a certain role is played by the sexual characteristics of the metabolism.
The psychological factor, including premorbid personality traits, is essential in the development of alcoholism. There is a higher risk of getting alcoholism in people with a lack of intellectual and affective-volitional functions, especially if there is a feeling of inferiority, loneliness, difficulty in contact with others, insufficient control of emotional reactions, in the absence of anticipation of the consequences of their behavior. But the premorbid personality type specific to alcoholism does not exist (N. N. Ivanets, A. L. Igonin, 1981). Individuals with a disorganized structure, primitive, immature, resort to alcohol as a means of relieving nervous tension, and quickly get used to it (A. A. Portnov, I. N. Pyatnitskaya, 1971). An increased tendency to alcoholization and painful addiction to alcoholic beverages is noted in persons suffering from neurosis, with accentuation or psychopathy, intellectual deficiency developed as a result of organic brain damage (I.V. Strelchuk, 1966; I.N. Pyatnitskaya, N. K. Permyakov, 1974; I.G. Urakov, V.V. Kulikov, 1977). According to the data of these authors and our observations, the listed personality disorders can play a significant role only in case of insufficient development of moral attitudes, a sense of duty, personal, family, industrial and social responsibility, as well as in combination with domestic, micro-social and production factors unfavorable in this sense.
I.G. Urakov and V.V. Kulikov (1977) believe that predisposing factors of alcoholism should be evaluated in their totality, taking into account the level of education, socio-professional status, marital status, age, temperament, typological characteristics of a person (rigidity – lability, poise – imbalance, extravert-introvert), the degree of adaptability to the environment, traumatic brain injury. One cannot underestimate the role of active consciousness, the socially required activity of an individual and his responsibility.
The individual and socio-psychological characteristics of the personality, acting as predisposing to alcoholism, are directly related to the conditions of upbringing in the family and other microsocial groups that determine habits, emotional reactions, moral attitudes, the form of interpersonal contacts, and the system of value orientation. A. A. Portnov, I. N. Pyatnitskaya (1971), B. S. Bratus, P. I. Sidorov (1984) consider the conditions of family education as the most important factor in the formation of personality, its personality traits, promoting the use of alcohol to relieve stress and the development of alcoholism.
When examining a group of young people with deviant behavior, we also found that alcohol abuse and alcoholism are more often observed in people from incomplete, disorganized families with severe alcohol habits. At the same time, a significant part of patients showed signs of neuropsychiatric insufficiency due to previous injuries, neuroinfections, and severe somatic diseases.
According to P. Zakrzewski (1977), in individuals who began to abuse alcohol in adolescence and youth (first got into a detox at the age of 16-20 years), a complex of behavior with signs of social inability is traced from childhood. The families in which they were brought up are characterized by a low educational and professional level of the parents, a high frequency of alcohol abuse and alcoholism among one of the parents (during the childhood of the patient), irregular employment of the father and the allocation of an insignificant amount of money to support the family, and lack of interest from the father in the child and his upbringing, the use of predominantly physical punitive measures, the beating of the mother by the father, the connection of the father with other women, drinking at home with drinking companions, and committing the crime by the father Nij and being in custody of the child to the joint involvement of drinking, using it for making money on booze. If the mother suffered from alcoholism, then the degree of family disorganization reached even greater proportions (change of partners, neglect of the household). In addition, a number of patients in childhood were brought up without a father or had one of the parents, who was distinguished by a severe character, had a physical or mental illness.
Based on our own data, we came to the conclusion that they begin to drink alcohol, as a rule, under the influence of others in imitation, maintaining companies or on someone’s advice, for courage, improving mood, in order to “forget”. When examining patients with alcoholism, I.G. Urakov and E.A. Yaskevich (1980) found that the reason for the systematic use of alcoholic beverages was the negative influence of their immediate environment and the desire to mitigate the resulting severe personal reactions by drinking alcohol. when conducting epidemiological studies, it was shown that alcohol abuse is caused not only by belonging to a specific microsocial and professional group, marital status, but also by place of residence VA, national traditions (A.K. Kachaev, I. G, Urakov, 1981; A. X Imamov, 1981).
The predisposing psychological causes of drunkenness and alcoholism also include the complication of interpersonal relationships and the growth of psychoemotional stress in the context of urbanization and scientific and technological progress, which creates difficulties in adapting to the social environment, inadequate desires for opportunities and a sense of inferiority.
Psychological factors can be divided into individual and socio-psychological, and among the latter we can single out especially significant multisocial factors. In socio-psychological terms, the situation of irresponsibility, undemanding and carelessness is usually important for the development of a painful craving for alcohol, usually resulting from the condescending, forgiven or indifferent attitude of relatives, close friends, study and work comrades, educators, production managers to alcohol abusers . Touching on this issue, Zd. Falicki (1975) noted that in various segments of the population drunk people and alcohol abuse are treated with feelings of either squeamishness, or pity and sympathy, or indifference, and true abstinence with feelings of distrust, wariness, and hostility.
M. Butora (1979, 1980) suggests considering alcoholism as a social deviation, since its emergence and development depends on many social and socio-economic factors, including the traditional attitude to the use of alcoholic beverages and population migration. R. Boles (cited by M. Butora, 1980) in the “social definition” of alcoholization and alcoholism assigned a significant role to the attitude of society as a whole or of individual population groups to alcohol consumption; abstinence, ritual, pyrogenic (companionable) and utilitarian (drinking alcohol as a “medicine”). The last two relationships are most conducive to the spread of alcoholism and reduce the stability of remission after treatment. As M. Butora notes, in some countries and among certain population groups, complete abstinence from alcohol is considered an abnormality, alcoholism is not mistaken for a disease, therefore, “secondary withdrawal symptoms” (a person who abstains from alcohol after treatment) is in such a difficult situation and in the power of this often begins to drink again.
Some foreign psychiatrists, who hold psychoanalytic and existentialist positions, explain the cause of the disease by using psychological factors. For example, L. Kolb (1968), based on the concept of the psychogenesis of alcoholism, wrote that patients with alcoholism often live in dysfunctional families, parents who oppress their guardianship or conflict have adequate psychosexual development of the child, psychologically traumatizing him in the early years of life, delaying its development at the “oral stage” and interfering with the development of a stable “Super-I”. Pointing to the heterogeneity of alcoholism (participation in its occurrence of socio-cultural, psychological and somatic factors), T. Lemperier and A. Feline (1977) consider imitation (imitation), compensation, rejection (deviation), autoallergy and painful impulsivity as psychological mechanisms of its development a person with traits of immaturity, intolerance to frustration, with a sense of insecurity and independence.