Why are adults obsessed with drinking alcohol?




Dr. Erich Mayer-Fally


Alcoholism as a disease

  What is alcoholism?

Alcoholism means that a person becomes mentally and physically dependent on alcohol. The physical dependency is characterized by physical withdrawal symptoms during drinking breaks, the emotional dependency by the compelling desire for further alcohol consumption. The consumption of alcoholic beverages has priority for the person concerned over behaviors that previously had a higher priority, so that psychosocial and physical damage occurs as a result. In this case it is called alcohol sickness.


  When is a person alcoholic?

A person is alcoholic, though

  • after consuming a small amount of alcohol, he has an indomitable desire for more alcohol,
  • he continues to drink even though he knows he should stop
  • he always needs more alcohol to achieve the same effect,
  • he drinks secretly and alone,
  • he accepts organ damage through his alcohol consumption,
  • he disturbs the relationship with his fellow human beings through his drinking behavior,
  • he drinks to alleviate withdrawal symptoms
  • there is a centering of thinking and striving for alcohol and this leads to a progressive neglect of social life or other interests.


  When is one at risk of getting alcoholic?

You don't get alcoholic overnight. This disease develops insidiously and no alcoholic drinker is immune from it.

The situation becomes critical when

  • Alcohol is simply part of eating or going out and is indispensable,
  • is drunk when there is psychological or social stress,
  • the idea of ​​abstinence for some time causes discomfort,
  • Only after a few glasses do you feel really balanced and comfortable.

If several of these points apply, you should fundamentally rethink your drinking behavior. A daily quantity of up to 16 g of pure alcohol for women and 24 g for men (20 g corresponds to half a liter of beer or a quarter of wine) is considered harmless according to the current state of science (harmlessness limit). If the daily consumption exceeds 20-40 g for women or 60 g for men, one speaks of alcohol abuse, which entails a significantly increased risk of consequential damage (risk limit). The World Health Organization (WHO) is currently making efforts to reduce the tolerance limit to 7 g.


  How many people are affected in Austria?

Even if the general public does not perceive the problem as such, alcohol is clearly the "number 1 popular drug" in Austria. Only around a sixth of adults are abstinent, a quarter drinks daily and 40% take a glass at least once a week. Around 330,000 people are considered to be alcoholic and almost 900,000 Austrians consume alcohol to an extent that is harmful to health. In turn, these numbers mean that around 20% of adults have a drinking problem. Around 8,000 people die each year in Austria as a result of alcohol consumption. Mr and Mrs Austrians prefer to drink beer, followed by wine. Basically, the type of drink is not decisive for alcoholism - in the end, it only depends on the amount of pure alcohol consumed. The average alcoholic is male (a third of alcoholics are female) and between 30 and 50 years old. It takes an average of 10 years to develop alcohol addiction.


Development and manifestations of alcohol sickness

Alcohol sickness can develop in phases. According to the current model by Prof. E.M. Jellinek, this development begins with:

  • Pre-alcoholic phase: 
    Occasional to frequent relief drinking is increasingly becoming a substitute for other problem-solving options. Relief drinking is gradually becoming a habit and casual drinking turns into abuse. It follows the:
  • Introductory phase: 
    In this, the thoughts of the person concerned revolve more and more around alcohol, which is increasingly moving into the center of thinking and acting. This then leads to secret drinking, larger stocks of alcohol are created and well hidden. If alcohol is mentioned, those affected try to avoid the topic. In addition, feelings of guilt arise due to drinking behavior.
  • Critical phase:
    Increasingly, there is a loss of control over drinking. People in this situation often promise abstinence and try to keep it, which they do not succeed in the long run. Significant changes in personality lead to more frequent conflicts in private and professional areas (change of job). The alcoholic "lives" in this phase of self-deception and thereby loses contact with the environment. The first physical consequences - such as hand tremors, sweats, and sexual disorders - occur
  • Chronic phase:
    Every form of alcohol is drunk, and there are days of full noise and massive impairment of perception. The organic disorders increase, a clear physical dependency and the rapid social decline characterize this phase.


  What are the manifestations of alcoholism?

The most common classification and division also goes back to Jellinek. The pioneer in research into alcoholic disease describes five types (identified by Greek letters), which differ from one another in terms of the severity and type of alcohol consumption.

  • Alpha type:
    This guy uses alcohol to fight internal tension and conflict. The amount you drink depends on the respective stressful situation. Thus there is a risk of psychological dependence. The ability to abstain is there because no physical addiction has yet occurred.

  • Beta type:
    These are so-called occasional drinkers, people who drink a lot on social occasions, but remain socially and psychologically inconspicuous. However, the frequent consumption of alcohol will soon have health consequences.

  • Gamma type:
    The term "heavy drinker" is common for this type, as phases of heavy intoxication alternate with longer periods of abstinence. It is typical of the gamma alcoholic that once he has started to drink he can no longer stop, even if he already feels that he has had enough. This is known as loss of control. The ability to keep to longer periods of abstinence lulls the representatives of this type of alcoholic into a deceptive security - they are convinced that they are not dependent.

  • Delta type:
    This means the "mirror drinker". He remains socially inconspicuous for a long time because he is seldom recognizably drunk. However, he is very physically dependent, so he has to consume alcohol constantly to avoid withdrawal symptoms. Constant drinking causes numerous consequential physical damage.

  • Epsilon type:
    The more common name for this type is "quarterly drinker", because he experiences excessive alcohol consumption at irregular intervals - sometimes in phases that last for days. In between he can stay abstinent for months.


What are the physical consequences of alcohol abuse?

  • Acute alcohol intoxication (intoxication):
    The tolerance of alcohol and its effects have a very broad individual spectrum, depending on the tolerance level. With a blood alcohol concentration of around 3 per thousand, most people show the picture of severe alcohol intoxication (after behavioral coordination and articulation disorders, the state of consciousness is impaired, from pronounced sleepiness to coma). As a rule, a fatal outcome is to be expected from 5 per mille.

  • Withdrawal symptoms occur when the alcoholic interrupts or greatly reduces alcohol intake.

The following symptoms are possible:

  1. Gastrointestinal disorders (nausea, diarrhea, etc.)
  2. Circulatory disorders (tendency to collapse, "racing heart" etc.)
  3. sleep disorders
  4. Heavy sweating
  5. Neurological disorders (tremors, speech disorders, severe nervousness or epileptic seizures)
  6. Mental disorders (restlessness, depressive mood, hallucinations or anxiety states)
  • Alcohol delirium (delirium tremens):
    This is the most severe form of alcohol withdrawal syndrome. It is a life-threatening disease (up to 20% deaths) and requires immediate inpatient treatment. The signs are impaired consciousness, pronounced anxiety states, severe restlessness, disorientation and hallucinations (the famous "white mice").
  • Personality and brain performance disorders (organic psychosyndrome): The breakdown of brain matter leads to disorders of memory, fine motor skills, attention and concentration. As a result, depression, phobias (states of fear) and paranoid disorders with a high risk of suicide can also develop.
  • Damage to the nerve tracts (polyneuropathies):
    About 20 percent of alcoholics experience numbness, sensations such as "ants tingling" (paresthesia), muscle weakness or cramps, and nerve pain. The clumsy, unsteady gait often observed in alcoholics is also due to damage to the nerve tracts.
  • Upper digestive tract disorders:
    1. Gastritis
    2. Inflammation of the esophagus (esophagitis)
    3.Mallory-Weiss syndrome (tears in the mucous membrane in the transition from the esophagus to the stomach, which can be caused by vomiting and which can very easily lead to bleeding)
    4. Esophageal and stomach cancer

  • Absorption disordersthat cause a deficiency in vitamins (especially vitamin B) and other important substances (e.g. folic acid).

  • Inflammation of the pancreas (chronic and acute pancreatitis)

  • Liver disorders:
    Toxic alcohol limits for the liver vary from person to person, but are around 60 g of pure alcohol for men (equivalent to 1.5 liters of beer or 0.75 l of wine) and around 40 g for women (1.0 l beer or 0.5 l wine). If these limit values ​​are continuously exceeded, fatty liver will develop. At first this does not cause any symptoms, but there is often a noticeable enlargement of the liver.

    As a further consequence, alcohol consumption can lead to fatty liver hepatitis. This, too, usually remains symptom-free at first, but after some time there is loss of appetite, nausea, weight loss, pain in the right upper abdomen, increased temperature and yellowing of the sclera (dermis of the eye) and the skin.

    Liver cirrhosis is characterized by the destruction of liver cells and their replacement by simple tissue. Initially, no symptoms have to appear here either, but subsequently the cirrhosis leads to the symptoms just described. In addition, ascites (accumulation of water in the abdominal cavity), skin changes, gynecomastia (breast growth in men) and erectile dysfunction often develop. The median survival time of patients with cirrhosis is about twelve years, the cause of death is often coma due to liver failure.

  • Alcohol toxic cardiomyopathy:
    Pathological enlargement of the heart that leads to decreased performance (heart failure).

  •  Hypoglycemia (Hypoglycemia)

  • Alcohol-toxic embryopathy: The increased consumption of alcohol during pregnancy causes damage to the embryo.


What therapy options are there?

The therapy of alcoholic people must be designed individually in each case. It is not possible to treat everyone equally. The most effective treatment possible requires a concept that is open in many directions. The phase model, which describes the classic course of a therapy, forms the framework for these individual concepts:

1. Contact phase:
The patient seeking help usually turns to the resident doctor or an advice center. In this phase, the situation of the person, his insight and motivation must be clarified. The survey of the psychosocial background is of the utmost importance for the design of the individual therapy offer. Furthermore, it must be weighed whether withdrawal symptoms are to be expected and whether the following treatment should be carried out on an inpatient or outpatient basis. An additional task of the advice centers is to make information about how to proceed further accessible to all persons directly and indirectly affected.

2nd detox phase:
With the help of medication and under medical supervision (mostly inpatient), detoxification is carried out within about 10 days if there is physical dependence.

3. Weaning phase:
In-patient or out-patient weaning includes not only medication but also psychotherapeutic treatment, occupational therapy and social care. It is also important to include family members.

4th rehabilitation phase:
After the weaning phase, which extends over an approximately 8-week program, a certain stability is usually achieved. The patient feels comfortable and is convinced that they can remain abstinent. But when he is back in his familiar surroundings, he is often caught up with known psychological, social or family problems. Often these are even more evident because they are no longer "cushioned" by the alcohol after weaning. An example is the significantly higher divorce rate among "dry" alcoholics compared to drinkers.

It is therefore necessary in the rehabilitation phase to initiate changes at various levels. This is now the task of the counseling centers, which turn to those affected with offers such as individual, family or group therapy, accompaniment, referral to self-help groups, psychological and medical advice. Often the patient and his environment believe that abstinence will solve all problems. However, the weaned must bear in mind that the circumstances that led to alcohol abuse often require a lifelong commitment in order to be finally overcome. A point of contact in the event of a possible crisis or relapse is extremely important in this phase.

An essential prerequisite for a successful therapy is the sincere desire to stop and the strength of will to get through this difficult time. Therapy can only take effect if there is sufficient motivation and support from the social environment. The abstinence offers a solid basis for further developments. However, relapses are not to be equated with therapeutic failure. Rather, one must be aware that alcoholism is a chronic condition that often requires a lifelong effort. The "dry" alcoholic must remember that every new glass creates a well-known cycle. Often the efforts to remain abstinent are not very much appreciated by people who consume alcohol (see folk drug number 1): "Go, don't spoil the fun, a glass won't do anything!" But also alcohol-free beer (contains small amounts of alcohol), drugs containing alcohol (most "drops") or "high-proof" pralines can provoke a renewed addiction and a desire for more alcohol.

Statistically, around 50% of alcoholics are still abstinent a year and a half after they have been successfully weaned.


How do I know if someone around me is drinking too much?

  Signs of an alcohol problem arise from behavioral problems in the person concerned and from physical characteristics.

  • Physical characteristics:
    In addition to the open increased consumption of alcohol, consumption that is kept secret (as is often the case with women) leads to the well-known bad breath (flag). Often attempts are made to cover this up with chewing gum or similar aids. The organic damage becomes more and more evident, the alcoholic often loses weight, is often without appetite, complains of nausea, sweats easily and tends to change the skin (e.g. Spider naevi).
  •  General behavior:
    The alcoholic person withdraws more and more, especially from abstainers, they are often aggressive towards those around them, are easily irritable and show a reduced tolerance for frustration. Often he appears opinionated and brags about his ability to drink. When asked about his problem, he is often sensitive and tries to minimize it. The addict strives to have constant access to alcohol and often hoards a certain amount of drinking supplies. As a result, he neglects his external appearance more and more, and withdrawal symptoms appear even after short periods of abstinence (tremors and nausea in the morning).

It is important to remember that these changes do not have to be evidence of an alcohol problem. Only the frequent occurrence of these signs can be an indication. Perception is also subject to certain distortions, especially when there is a certain emotional concern. Early detection does not serve to "expose" or "punish" alcoholic people, but rather to provide them with adequate help.


  What does codependency mean?

Relatives of alcoholics are often in a difficult situation. On the one hand, they should be able to withstand the personality changes, outwardly keep appearances, protect the children and be loyal and loyal to the alcoholic. On the other hand, they want to protect the partner from the risk of addiction. In this dilemma, the family member has to fight on many fronts and is usually lonely. Of course, one wants the addict to give up his addiction, but (unconscious) behavior often emerges that protects the alcoholic and supports his drinking. Such a phenomenon is called codependency. This codependency often takes place in phases:

  • Protector and explanation phase: She is characterized by forbearance and understanding. Changes in the alcoholic are ignored and denied. One tries not to burden the person concerned, because he is not doing well anyway.
  • Urge to help or control phase:
    You excuse and tolerate alcohol problems, but address them and expect that the person concerned will drink less in the future. In this phase, responsibility for the alcoholic is assumed. He demands affection and compassion from his surroundings, but refuses to change his drinking behavior despite increased promises. This leads to frustration among the relatives, who often react with an increased effort.
  • Disposal phase:
    The efforts in the helper phase did not bring the desired success, which is why observation, surveillance and aggression towards the addict now dominate. Out of frustration, the relatives try to distance themselves, the alcoholic turns from "victim" to "perpetrator" in his eyes.

The relatives must be aware that they are part of the alcoholic disease and thus also an important part of the therapy.


  Why do you become addicted to alcohol and is it your own fault?

As already mentioned, alcohol consumption in Austria is an important part of social life. There is hardly an occasion on which the glass is not picked up, and there are hardly any restrictions on the amount. The consumption of alcoholic beverages is still seen as masculine, "casual" and adult. On the other hand, the alcoholic is socially ostracized and viewed as a weak-willed, unstable and volatile person. The World Health Organization (WHO) regards alcoholism as a disease and therefore sees the behavior and characteristics of the alcoholic as an expression of his disorder. However, this does not mean that he is free from responsibility for what he does.

So it is important neither as a "perpetrator" - the disease "addiction" robs them of their free will to decide to abstain - nor as a "victim" - it is their responsibility to do everything in their power to to overcome his disorder (with help) - to see. The reasons why some people become dependent and others not are not yet fully understood. It is clear that in addition to physical requirements on the one hand, personality and depth psychological factors (neurotic disorders, ego function deficits, autoaggression) play an important role. On the other hand, socio-psychological circumstances, such as the anchoring of the addict in the immediate and wider social environment (family, friends and work), and the social attitude towards certain intoxicants also play a key role. Children of alcoholic parents are three times more likely to develop addiction themselves than children of non-dependent parents. This appears to be due to the factors described above. A suspected genetic cause has not yet been proven.

This bundle of causes, which encompasses many factors, makes it clear that the alcoholic should receive individual consideration and treatment.