What Is Alcoholism?

Important Notice

This text is for informational purposes and does not replace medical advice. If you are struggling with addiction, please contact an addiction counseling center or your doctor.

Introduction

There are varying statistics on the extent of alcoholism — meaning alcohol abuse, alcohol dependence, and alcohol-related secondary damage. What is undisputed is the fact that alcohol is the number one drug of the people.

In Germany, dependence on legal and illegal drugs has now reached epidemic proportions and is the third largest health problem after cardiovascular disease and cancer.

• Estimated number of people requiring treatment for alcohol dependence: 2.5 million
• Approximately 40,000 people die each year from the consequences of alcohol abuse
• Alcohol is involved in approximately 20% of traffic accidents

Historical Background

Alcohol has been known for its positive as well as negative properties since time immemorial. People who stood out due to excessive drinking behavior were and continue to be stigmatized as “drunkards,” weak of character, or lacking willpower.

• 1849: Huss was the first to describe alcoholism as a disease
• 1915: Alcohol addiction was recognized as a disease by the Imperial Insurance Code
• Third Reich: Alcoholism was grounds for forced sterilization
• 1968: Alcoholism was once again recognized as a disease in West Germany

Definition of Alcoholism

The Diagnostic and Statistical Manual (DSM III) distinguishes between:

• Alcohol abuse
• Alcohol dependence
• Alcohol-related secondary damage

Characteristics According to Jellinek

According to Jellinek, an alcoholic has the following characteristics:

• Withdrawal symptoms
• Tolerance (increasing amounts of alcohol needed for the same effect)
• Loss of control
• Inability to abstain

Alcohol Abuse

According to ICD 9, alcohol abuse is defined as a “psychological, sometimes also physical condition that arises from alcohol consumption and is characterized by behaviors that always include the urge to consume alcohol constantly or periodically in order to experience its psychological effects.”

Characteristics of Alcohol Abuse (ICD 9)

• Excessive alcohol consumption
• Alcohol intoxication and acute alcohol poisoning
• With no symptoms of dependence present

Criteria According to DSM III-R

The following criteria must be met for a diagnosis of alcohol abuse:

1. Presence of characteristics of pathological alcohol consumption
2. Continued alcohol consumption despite awareness of alcohol-related social or occupational impairment
3. Duration of consumption or impairment of at least one month

Pathological Alcohol Consumption Includes

• Need for daily alcohol consumption
• Loss of control
• Attempts to reduce consumption through temporary abstinence
• Drinking binges (at least two days)
• Blackouts following acute alcohol intoxication
• Continuation of alcohol consumption despite worsening physical conditions
• Consumption of denatured alcohol

Alcohol Dependence

Alcohol dependence refers to the presence of alcohol abuse plus either tolerance or withdrawal symptoms.

Tolerance

Increasing amounts of alcohol must be consumed to achieve a psychological or physical effect.

Withdrawal Symptoms

After stopping or reducing alcohol, the following symptoms occur:

• Coarse tremor
• Nausea and vomiting
• Feeling of weakness
• Autonomic hyperactivity
• Anxiety and depression

9 Criteria for Alcohol Dependence (DSM III-R)

At least three of the following criteria must be met (repeatedly over an extended period or for at least four weeks):

1. Alcohol consumption in larger amounts or over longer periods than intended
2. Persistent desire or unsuccessful attempts to reduce consumption
3. Significant time spent on activities to obtain alcohol or recover from its effects
4. Frequent intoxication or withdrawal symptoms during expected duties
5. Important activities are given up or reduced because of alcohol
6. Continued drinking despite knowledge of alcohol-related problems
7. Marked tolerance development to alcohol
8. Characteristic alcohol withdrawal symptoms
9. Frequent alcohol consumption to relieve or avoid withdrawal symptoms

Insidious Alcoholism

Attention

Even without the classic criteria of abuse and dependence, somatic and brain-organic damage can occur — so-called “insidious alcoholism” (consumption with a habitual character).

The Concept of Addiction

The word “Sucht” (addiction) in German derives from “siech” (sick). It was presumably first used to describe illness in the sense of “epidemic.”

• 1968: The addiction concept was removed from the official WHO terminology
• Replaced by the terms abuse and dependence

Dependence is divided into:

• Psychological dependence: An irresistible craving to consume alcohol
• Physical dependence: Increased tolerance and withdrawal symptoms

Types of Alcoholics According to Jellinek

Type	Name	Characteristics
Alpha	Relief drinker	Psychologically dependent, drinks to resolve conflicts, no tolerance increase
Beta	Occasional drinker	No dependence, but organic damage from frequent consumption
Gamma	Binge drinker	Psychologically and physically dependent, loss of control, episodic drinking
Delta	Maintenance drinker	Physically dependent, cannot abstain, must maintain a “level”
Epsilon	Periodic drinker	Episodic drinking with loss of control, abstinent in between

Note

In Europe, the Gamma and Delta types are predominantly found.

Phases of Alcohol Dependence

1. Pre-Alcoholic Phase

• Alcohol for relaxation
• Tolerance increase
• Duration: months to years

2. Initial Phase

• Secret drinking
• Thoughts revolve around alcohol
• First memory lapses (blackouts)
• Avoidance of conversations about alcohol
• Guilt feelings

3. Critical Phase

• Loss of control occurs
• Attempts at explanation and self-reproach
• Aggressive behaviors
• Morning drinking
• First physical breakdowns
• Loss of interest
• Social problems (marriage, work)

4. Chronic Phase

• Multi-day binges
• Physical and mental decline
• Alcohol psychoses possible
• Collapse of the alibi system
• Life crises

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Sources: DSM III-R, ICD 9, Jellinek, WHO, German Central Agency for Addiction