American medical association journal (The American Medical Association Journal) determines alcoholism as "the primary, chronic disease, being characterized by violation of monitoring over alcohol intake, drinking habit, alcohol consuming, despite the negative consequences, and thinking distortion”.
DSM-IV (diagnostics standard in psychiatry and physiology) defines abuse of alcohol as the repeating intake, despite recurrent negative consequences.
According to APA Dictionary of Psychology alcoholism — this daily name for the term alcoholic dependence. It is necessary to consider that there is a dispute on what dependence here means: physical (it is characterized by abstinence syndrome), psychological (is based on a reinforcement of a conditioned reflex) or both that, and another.
Etiology (disease origin)
Origin and development of alcoholism depends on volume and frequency of alcohol intake, and also personal factors and features of an organism. Some people are subject to bigger risk of development of alcoholism in view of a specific social and economic surrounding, emotional and/or mental predisposition, and also the hereditary reasons. Dependence of cases of severe alcoholic psychosis is set on variety of a gene of hSERT (encodes protein of a carrier сserotonin). However so far it has not been revealed specific mechanisms of implementation of addictive properties of alcohol.
Pathogenesis (development of disease)
Main article: Ethanol toxicology
In 76 % of cases alcoholization begins till 20 years, including 49 % at teenage age. Alcoholism differs in increasing of symptoms of mental violations and specific alcoholic disorders in internal parts of the body. Pathogenetic mechanisms of influence of alcohol on an organism are mediated by several types of effect of ethanol on living tissues and, in particular, on a human body. The main pathogenetic link of the psychoactive effect of alcohol is activation of different neuromedia systems, especially catecholamine system. At different levels of the central nervous system these substances (catecholamines and endogenous opiates) define different effects, such as increase of a threshold of painful sensitivity, formation of emotions and behavioral responses. Disorder in activities of these systems owing to chronic consuming of alcohol causes development of alcoholic dependence, an abstinent syndrome, change of the critical attitude to alcohol and so forth.
In case of alcohol oxidation in an organism the poisonous substance acid aldehyde appears, that causes development of chronic intoxication of an organism. Especially the strong toxic action acid aldehyde renders on walls of vessels (stimulates an atherosclerosis progression), liver tissues (alcoholic hepatitis), brain tissues (alcoholic encephalopathy).
Chronic alcohol intake leads to an atrophy of a mucous membrane of a gastrointestinal tract and vitamin deficiency development.
Stages of disease
Alcoholism is characterized by the strong mental and physical dependence on alcohol (alcoholic dependence). Alcoholism as pathology comes through some stages of development which are characterized by stage-by-stage increase in alcoholic dependence, reduction of possibility of self-checking concerning the use of alcohol drinks, and also progressive development of the different somatic disorders caused by chronic intoxication with alcohol.
The simplest differentiation of alcoholism is based on the presence of clinical and mental signs of alcoholic dependence, and also frequency and amount of used alcohol. The following groups of people are defined:
The people who are not taking alcohol
The people moderately consuming alcohol
The people abusing alcohol (development of alcoholic dependence)
Without symptoms of alcoholism
With initial symptoms of alcoholism (loss of situation-dependent and dose monitoring, drinking-bout)
With expressed symptoms of alcoholism (the regular drinking-bouts, disorder of internal organs, the mental disorder peculiar to alcoholism)
From the above-stated classification it is possible to note that alcoholic dependence develops from accidental episodes of alcohol intake before development of heavy alcoholism.
In development of alcoholism they distinguish precursory symptom and three main stages:
The precursory stage
The "Precursory stage" is considered to be a "zero" stage of alcoholism — at this stage still there is no illness, but there is «a home alcoholism». The person takes alcoholic drinks «on a situation», as a rule, with friends, but rarely gets drunk before loss of memory or to other serious consequences. While the precursory stage doesn't pass to alcoholism, the person can stop the use of alcoholic beverages for any time without harm for the mentality. In case of precursory stage the person in most cases indifferently treats, whether there will be soon a binge or won't be. Having drunk in the company, the person, as a rule, doesn't require continuation, and doesn't drink then on his own. However in case of daily alcoholism, as a rule, the precursory stage naturally passes to the first stage of alcoholism in 6 — 12 months.
The first stage
At the first stage of alcoholism of the patient often feels formidable desire to take alcohol. In case of impossibility of the use of alcohol the feeling of an attraction for a while passes, however in case of alcohol intake monitoring to quantity drunk quickly falls. At this stage of a disease the state of intoxication is quite often accompanied by excessive irritability, aggression and even cases of loss of memory in a state of intoxication. At the alcoholic the critical relation to alcoholism disappears and there is a tendency to justify each case of consuming of alcohol. At the end of the first stage tolerance growth (acceptability of alcohol) begins. The first stage of alcoholism gradually passes to the second.
The second stage
At the second stage of alcoholism endurance (tolerance) to alcohol considerably increases. The abstinence syndrome is noted. The attraction to alcohol becomes more than strong, and self-checking weakens. After the use even light doses of alcohol the patient loses ability to control quantity of the drunk. In a drunk status he, as a rule, behaves unpredictably and at times it is dangerous to people around. Alcoholic psychosis appears, the person has hallucinations.
The third stage
At the third stage of alcoholism endurance to alcohol falls, and consuming of alcohol becomes almost daily. The considerable degradation of the identity of the patient with irreversible changes of mentality is watched. Disorders from an internal organs increases and becomes irreversible (alcoholic hepatitis, alcoholic encephalopathy, etc.). Also there are irreversible changes in the nervous system, bringing to paresis and paralyses, to conditions when pseudo-hallucinations proceed for the long time (Kandinsky-Klerambo syndrome).