Alcoholism

The alcoholism is the dependence with the alcohol (ethanol) contained in the alcoholic drinks. This chronic pathology is characterized by the loss of control of the alcohol consumption, the presence of a physical dependence (pharmacodépendance, syndrome of weaning) and of a tolerance (required to increase the amounts because the body is accustomed). The alcoholism, considered as a dependence, is at the origin of physical, psychic and social damage. The progression in time is one of the major characteristics of this addiction. The use without damage precedes the mésusage (with harmful use and use at the risk) without dependence then finally the dependence. The alcohol is a psychoactive substance at the origin of a dependence but is also a substance Toxique inducing harmful effects on health.

The Abstinence is often preached in order to stop the evolution of the dependence and to return to a normal life.

One distinguishes two great forms from alcoholism among various types:

  • a consumption continues not very alcoholic beverages; this form is in general not accompanied by a feeling of guilt, the person considers that it has a “normal” consumption;
  • a consumption attends very alcoholic beverages; this form is accompanied by a strong feeling of guilt, the person denies to have a problem.

The only way of stopping its progression would be a total abstinence. Weaning can be carried out at the time of a cure in hospital (there exist dedicated services in Alcoologie).

If weaning is too brutal, it can occur a Délirium tremens, with hallucinations and tremors, being able to lead to the death.

Many a association S can help the alcoholic, abstemious patient or not. These associations are often MAB (movements of former drinkers).

Terminology

In medical language , alcoholism has several less known synonyms, which are not same pejorative. One employs thus the expressions oenolism , alcoholism , exogénose or intoxication OH .

The Alcoologie is the science which treats effects of alcohol on health and the means of curing it.

Health issues induced by alcohol

in the short run

  • acute intoxication: state of intoxication, deceleration of the reflexes, state of euphoria or, on the contrary, sadness, bad appreciation of the situations, disorders of balance, Vasodilatation, until the ethyl Coma; this situation can bring to the Décès
  • gastrite
  • alcoholic backward flow gastro œsophagien
  • acute hepatitis
  • nauseas, vomiting

in the medium and long term

  • Nervous system: alcoholic neuropathy, bulbar retro optical neuritis, hepatic encephalopathy, alcoholic insanities (Korsakoff, marchiava bignami, Wernicke)
  • Liver: Cirrhosis with hépatocellulaire insufficiency, Cancer
  • Pancreas: pancréatite acute or chronic, pancreatic insufficiency exocrine (badly digestion) and endocrine (diabetes)
  • cardiovascular system: arterial hypertension, cardiopathy, hypertension portale with gastric varixes and œsophagiennes, venous insufficiency
  • cancers of the higher aérodigestives ways: Language, Cavum, Lips, esophagus, Stomach
  • Conclusions of International Research Center on Cancer (CIRC): A woman consuming 50g alcohol per day (5 pints of beer, 5 wine glasses) increases her risk to develop a breast cancer by 50%. For 18g/jour (2 glasses) its risk is seen increased by 7%.

Biological modifications related to chronic alcoholism

  • Reached hepatic: hepatic cytolysis, macrocytose, increase in the gamma-WP, hépatocellulaire insufficiency: hypoalbuminemy, lowers factors of coagulation, thrombopénie.
  • reached pancreatic: increase in the enzymes amylase and lipase, pancreatic exocrine and endocrine insufficiency
  • hyper triglyceridemy
  • vitamin deficiencies (group B)

The alcoholic Syndrome of weaning

It occurs 6 to 12 noon after the last alcohol catch and evolves spontaneously to the cure in one week.

In the minor forms, one notes, in a more or less associated way, nauseas, the Céphalée S, an agitation, Trémulation S, a Tachycardie, a arterial Hypertension, sweats, a fever, Symptôme S anxious and depressive, disorders of the concentration.

In the severe forms, there are convulsives crises with or without Hallucination S. the most severe form of the complications is the Délirium tremens which can be mortal in the absence of treatment. These severe forms can be inaugurated by eye trouble, auditive and sensitive, supported by sensory Stimuli (gene of the light, noise, itchings), delirious and hallucinatory ideas.

The elements which make it possible to detect the severe forms, thus allowing a location with an aim of the best dealt with, are: the prolonged consumption of significant amounts in alcohol, the antecedents of convulsives crises and Delirium tremens, need for quickly drinking alcohol after the alarm clock in order to relieve the forms beginners of weaning.

The administration of Benzodiazépine remains the treatment of choice to prevent the Délirium tremens.

Pharmacology of prevention of the relapse

Alcohol and pregnancy

The principal risk related to alcohol during the pregnancy is the Syndrome of fetal alcoholization.

Statistics

The alcoholism touches in France 5 million people (either more 7  800 people for 100  000 inhabitants), of which 600  000 women; according to a recent study, each French consumed on average 9,3 liters of alcohol in 2003. In France, one estimates that 20% of the industrial accidents are ascribable with alcohol and 10% of the employees have a problematic alcohol consumption. These Statistiques is particularly prone to guarantee: the rigorous evaluation is very difficult because of a denial quasi-constant of the facts.

It causes approximately 750.000 per annum dead in the world (approximately 12 per 100.000 inhabitants), of which 45  000 in France (73 for 100  000 inhabitants):

  • 23  000 direct deaths
  • 22  000 indirect deaths (turbid mental, cardiovascular diseases, accidents…).
Every year, 5  000 with 7  000 babies are born in France with serious malformations because of the alcoholization of the mother; in the Pas-de-Calais, that accounts for 1 birth on 3  000.

In France, one can consider that the alcoholism is the third cause of mortality after the Obésité and the tobacco, and in front of the infectious illness and the road accidents.

The risks of cirrhosis of the liver and accident are well-known majority of the French, but it is not the same cancer risks and cardiovascular diseases.

For the cardiovascular diseases, the scientific studies show that a moderate consumption (glass per day) decreases the cardiovascular risk, but that a consumption of more than three glasses increases it quickly.

The alcohol excess also creates deficiencies in vitamins, which decreases resistance to the diseases.

Association alcohol - tobacco is a factor of aggravation of the risk, which then becomes higher than the sum of the risks of alcohol and taken tobacco the separately.

Legal aspects

the Council of Europe

Texts

Article 5 of the European Convention of the human rights (known as “European convention of the human rights”) lays out: “ Any person is entitled to freedom and safety. No one cannot be private of its freedom, except in the following cases and according to the legal channels:

if it is about the regular detention of a person likely to propagate a contagious Maladie, of a lunatic, an alcoholic, a drug addict or a vagrant;

Any person stopped must be informed, as soon as possible and in a Langue which it includes/understands, of the reasons of its arrest and any charge carried against it.

Any individual of its freedom by arrest or detention has the right to make an appeal in front of a Tribunal, so that it rules in the near future on the legality of its detention and orders its release if detention is illegal.
Any person victim of an arrest or a detention under contrary conditions with the provisions of this article is entitled to repair. ”

This text does not impose that the detention of an alcoholic is decided by an legal authority: indeed, the provision of this article according to which “ Any person stopped or held, under the conditions envisaged in the paragraph 1.c of this article, must be at once translated in front of a judge or another magistrate entitled by the law to exert legal functions and has the right to be judged within a reasonable delay, or released during the procedure ” applies only to the people “ stopped and held in order to be led in front of the qualified legal authority, when there are plausible reasons to suspect which made an infringement or which there are reasons reasonable to accept the need L for preventing from committing an offense or of to flee after the achievement of this one ”.

Jurisprudence of the European Court of the human rights

  • Stop Witold Litwa C. Poland, April 4th 2000: “ the people whose control and behavior under the influence of alcohol constitute a threat for the law and order or themselves, even if no diagnosis of “alcoholism” were posed with regard to them, can be held at ends of protection of the public or in their own interest, for example their health or their safety personnelle.
    62. It should not be deduced from it that article 5 § 1 E) of the Convention can be interpreted as authorizing the detention of an individual simply because it consumes alcohol. However, for the Court, in the text of article 5, nothing indicates that this provision prohibited in a State to take this measurement with regard to an individual who misuses alcohol in order to restrict the harmful effects of his consumption for itself and the company, or to prevent a dangerous behavior after the alcohol ingestion.     ”

Alcoholism in arts

In literature

With the cinema

See too

External bonds

Official organizations and associations

  • French company of Alcoologie
  • Federation of the actors of the alcoology and addictology F3A
  • ANPAA National association of prevention in alcoology and addictology (France)

Various documents

  • File of the inserm

  • Scientific Consensus on Alcohol and Health a summary by GreenFacts of a report/ratio of WHO

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