Stages of alcoholism

Chronic alcoholism (alcoholic disease) is a progressive disease that occurs as a result of long-term systematic abuse of alcoholic beverages and is characterized by three main manifestations:
1.         altered endurance (tolerance) to alcohol;
2.         pathological attraction (addiction) to alcohol intoxication;
3.         alcohol withdrawal syndrome (a symptom complex of mental, somatovegetative and neurological disorders that occur after stopping alcohol consumption). The most important symptom is a pathological craving (addiction) to alcohol intoxication. According to the international classification of diseases, alcoholism is considered a disease characterized by alcohol dependence syndrome, i.e. the need (strong or irresistible) to drink it.

The first stage of alcoholism:

The first stage of alcoholism begins with a sharp increase in the desire for intoxication. When intoxicated, it is stronger than when sober. Due to the sharp increase in desire, it becomes difficult or impossible to control the amount of alcoholic beverages consumed in a normal situation. However, the dose that leads to the loss of quantitative control can be quite large (300-400 ml of vodka). Only a situation that excludes continued alcohol consumption can interrupt drunkenness, i.e. situational control, unlike quantitative control, is not lost. When sober, the desire for intoxication is not very strong, although subjectively it is not assessed as something alien. Doubts arise whether to drink alcohol or refuse to drink. Quite often, in connection with the upcoming feast, there is a general revival, activity increases. A failed feast often causes dissatisfaction, irritation, discontent. Cravings in a sober state can be suppressed by food. Gradually, the need for intoxication becomes the meaning-forming motive of behavior. Other motives begin to be pushed aside, although they are still significant. Alcohol users continue to work, study, and experience pleasure from the implementation of their hobbies. Thoughts about self-restraint from drunkenness do not arise. Alcohol consumption, no matter how often it occurs, is not considered a deviation from the norm. At the same time as the desire grows, tolerance to alcohol grows. Both single and daily doses increase. During intoxication, the activating effect of alcohol is noticeable at first, the ability for purposeful activity is preserved, and appetite is increased. During intoxication, positive emotions predominate, but negative ones also appear for a short time. Drinking alcohol in large doses no longer leads to vomiting. The feeling of satiety with alcohol disappears completely. As a result, states of deep intoxication often occur. Drunkenness can last for many days. If a large amount of alcohol is consumed, an asthenic state occurs after drinking stops. Work becomes tiring, productive activity is replaced by conversations. Some stupidity is combined with enthusiasm and a good mood. Sleep comes quickly, but early awakenings begin. Morning discomfort can be eliminated with alcohol, but patients prefer to stimulate themselves with tea, coffee, and take a shower in the morning. Increased sensitivity to overloads makes it difficult to adapt to new working conditions. In the first stage of alcoholism criticism of alcohol abuse is usually absent. Patients either deny drunkenness or downplay the frequency of its use and the dosage of alcohol. Each case of intoxication is explained by special circumstances. References to the worst examples, customs, the need to maintain contacts at a business level are used. Psychological defense mechanisms underlie the lack of criticality. Often there is a desire to blame others for the troubles that arose in connection with drunkenness. In the vast majority of cases, the family is unable to limit drinking, and only the threat of financial and social collapse forces drinkers to seek medical help. However, even in these cases, awareness of the disease is usually absent. Patients explain that they are healthy people, but they just cannot control their drinking.ü the amount of alcohol consumed.
In the first stage of alcoholism, behavior often changes. Typical are   reactions that are not entirely adequate to the situation, a free manner of holding oneself, and carelessness in clothing. The voice becomes loud, speech is excessively expressive, harsh intonations appear, and emotional overtones disappear. At the same time, stereotypical turns of phrase are noted, some difficulty in choosing words, especially in the first days after stopping drinking. The first stage of alcoholism is far from always followed by the stage of the advanced disease. If this happens, the duration of the initial stage ranges from 2-3 to 15 years or more.

The second stage of alcoholism

The second stage of alcoholism is diagnosed in almost 90% of patients registered in drug treatment centers. It is characterized by the maximum increase in tolerance (resistance) to alcohol. Both single and daily doses of alcohol increase. Patients drink at least 500 ml of vodka or a corresponding amount of other alcoholic beverages per day. During periods when tolerance reaches its maximum (tolerance plateau), up to 2 liters of vodka are sometimes drunk per day, the usual dosage ranges from 500 to 1200 ml. Daily tolerance fluctuates depending on the physical condition, mood, it often changes after long periods of abstinence from alcohol. In a sober state, the craving may not be very intense. After consuming a certain dose of alcohol (critical dose), the craving reaches such a strength that it is impossible to control the amount of alcohol consumed (compulsive craving). As alcoholism develops, the dose that leads to the loss of quantitative control decreases. Pathological craving for intoxication can be accompanied by the appearance of asthenic symptoms with lethargy, fatigue, irritability. In other cases, affective disorders predominate, most often dysphoric subdepression occurs. Sometimes the craving for intoxication is accompanied by ideational disorders: constant memories of a drinking party, of any circumstances related to alcohol consumption. It is not always possible to get rid of these vivid, emotionally charged ideas by an effort of will. Usually the craving appears and then disappears. It often arises in connection with external stimuli (associated craving), in other cases the actualization of craving occurs according to some internal patterns. At a certain stage of development, craving may not be realized or poorly realized, but it manifests itself in the content of dreams (most often, in a dream, patients either drink alcohol or refuse to drink). In other cases, conscious craving is preceded by changes in mood and behavior, conversations on alcohol topics, meetings with people who abuse alcohol. Unreasonable fussiness, irritability, anger appear. If the intensity of craving is not very great, a period of resistance to the craving for alcohol is observed. The realization of the craving depends not only on its intensity, but also on the patient's personality traits and situational influences. In people with increased excitability and other pathological character traits, the craving can arise almost paroxysmally and reach such a strength that its realization occurs immediately.
As the disease progresses, situational control is lost. Due to the increased craving for alcohol, increasing personality changes, patients completely or almost completely lose the ability to control alcohol consumption in any situation.

Gradually, alcohol withdrawal syndrome develops, the appearance of which allows us to diagnose the second stage of alcoholism. At first, patients are forced to sober up after drinking large doses of alcohol the day before, then comes a stage when this becomes necessary after drinking medium and small doses of alcohol. As the disease progresses, the hangover syndrome occurs after decreasing periods of time: first after 8-10 hours, then after 1.5-2 hours after drinking alcohol. The shorter this latent period, the more severe the condition. The duration of the withdrawal syndrome is initially 1-2 days, then increases to 3-4 days (average duration) and sometimes reaches a maximum of 6-10 days.

The third stage of alcoholism

The second stage of alcoholism can be observed over a long period of time.x years. If it is replaced by the third stage of alcoholism, then this occurs approximately 10-15 years after the formation of alcohol withdrawal syndrome. The cardinal sign of the third stage of alcoholism is a persistent decrease in tolerance to alcohol. Along with this, a slowdown in the disappearance of alcohol from the blood, an increase in the titer of anti-brain antibodies, and the disappearance of the reaction of the brain vessels to nitroglycerin are noted. Epileptic seizures occur more often, neurological signs of alcoholic encephalopathy are more often detected. Therefore, the third stage of alcoholism is sometimes referred to as encephalopathic.
The primary attraction (attraction in a sober state) and secondary (intoxication) intensifies, it can become cyclical and paroxysmal. The withdrawal syndrome often becomes more severe, longer lasting, often accompanied by adynamia and a persistent decrease in mood. In other cases, melancholy or anxiety with unmotivated fear, suspiciousness, the appearance of short-term deceptions of perception or disorientation prevail. Psychoses, including delirium, develop 2 times more often than in the second stage of alcoholism. Intoxication occurs with brutality, aggressiveness or is characterized by passivity and stupor, lack of euphoria, total amnesia of events during intoxication is more often noted. The form of alcohol consumption changes: true binges, intermittent drunkenness prevail, and pseudo-binges and episodic alcohol consumption are found only in 16% of drinkers. The formation of true binges goes through several stages: first, tolerance to alcohol falls at the end of the binge, then in the middle of the binge. In some cases, it becomes constantly low. Then a transition to daily alcohol consumption in small doses is possible. Almost 80% of drinkers show alcoholic personality degradation and distinct intellectual and mnestic disorders (memory and attention disorders, decreased generalization, loss of the ability to abstract, stupidity). Some degree of family, social and work maladjustment is characteristic. 60% of drinkers show liver pathology, and disorders such as alcoholic myocardial dystrophy and chronic pancreatitis become more frequent. 40% of drinkers show signs of multiple sclerosis, and 75% are diagnosed with polyneuropathy.
In the third stage of alcoholism, a tendency toward a decrease in the severity of alcohol abuse is observed: true binges become shorter and occur less frequently, intermittent drunkenness can be replaced by pseudo-binges, alternating with episodic alcohol consumption. The longer the third stage of alcoholism exists, the greater the degree of social and labor maladaptation increases and the tendency to develop superficial dementia increases.
This pattern does not apply to the stage of reducing the severity of alcohol abuse, when the frequency of remissions increases, during which insufficient differentiation and poverty of interests, hobbies, limited social contacts, and the presence of mental disorders (from asthenic syndrome to gross intellectual and mnestic disorders) are noted.
Regredient tendencies in the course of alcoholism, characteristic of the third stage of alcoholism, are manifested in the fact that in about 20% of drinkers, the desire becomes less intense, the doses of alcohol are reduced, the ability to partially control the amount of alcohol consumed appears, although at the previous stage, this was impossible, the severity of the withdrawal syndrome decreases. Another 10% of drinkers, along with moderate severity of withdrawal syndrome and incomplete loss of quantitative control, do not have pronounced social and labor maladjustment, 80% of them only have an exacerbation of characterological features and only 20% have alcoholic degradation.
After 60 years, there is a tendency to weaken the craving for alcohol, reduce and reduce the frequency of binges, and switch to episodic drunkenness. There is no elevated mood when intoxicated, and the physical condition deteriorates sharply after the end of intoxication. In these cases, complete abstinence from alcohol is possible, especially in the presence of concomitant somatic and neurological diseases. It is this circumstance that primarily explains the almost complete absence of people over 60 years of age registered with drug addiction clinics.
Somatic changes in chronic alcoholism (alcoholic visceropathies). Starting from the second stage of alcoholism, the frequency of damage to internal organs increases. This is associated with the effects of alcohol itself, its metabolites, hypovitaminosis, and nutritional deficiencies. As a rule, I findthere are multiple changes in the internal organs, which is called alcoholic visceropathy. Most often, gastritis, gastric ulcer and duodenal ulcer, hepatitis, liver cirrhosis, pancreatitis, alcoholic myocardial dystrophy, changes in the lungs, kidneys, and endocrine glands are found. Alcoholics are much more likely to suffer from pulmonary tuberculosis, which is more malignant in them than in teetotalers. Due to impaired immunity, various infectious diseases occur more often, and pneumonia is more severe. Injuries to the extremities and head are much more common.
It is believed that the average life expectancy of alcoholics is reduced by 10-15 years. This occurs largely due to the emergence and aggravation of somatic diseases, the increase in vascular diseases, the occurrence of myocardial infarctions, cerebral strokes, violent deaths as a result of injuries, poisoning, and suicides.