The simplest available classification of alcoholism, according to the amount of alcohol consumed and the presence of signs of chronic alcoholism, includes the following groups of people: non-drinkers, moderate drinkers, and heavy drinkers.
This classification also reflects some of the evolutionary aspects of alcoholism as a pathology. Alcohol consumption changes over time from moderate to chronic abuse, which in turn causes the so-called chronic alcoholism- a pathological condition characterized by severe alcohol dependence and the presence of signs of damage internal organs.
Chronic alcoholism is characterized by signs of mental and somatic disorders caused by chronic alcohol abuse. The most striking manifestations of this condition are a change in sensitivity to alcohol, the disappearance of the body's defense reactions when consuming a large amount of alcohol (for example, vomiting), a pathological craving for being in a state of alcoholic intoxication, and the development of an abstinence syndrome after stopping alcohol consumption.
Simplistically, the stages of alcohol addiction can be represented as follows: Stage one: characterized by the emergence of mental dependence on alcohol. At this time, there is a so-called obsessive (that is, obsessive, but surmountable) craving for alcohol. Stage two: a qualitatively new state appears - physical dependence on alcohol with the replacement of obsessive (obsessive) attraction with compulsive (irresistible, not subject to will and sound reasoning attraction associated with obsessions that occur in the motor sphere - behavior aimed at searching for alcohol, no matter what) to alcohol drinks and a complex of somatovegetative withdrawal symptoms (against the background of not taking alcohol) disorders. Stage three: the craving for alcohol is irresistible. The manifestations of the withdrawal syndrome (alcohol withdrawal syndrome) are aggravated. Situational control is lost - a person can drink before work, he does not care what others think, and so on ...
An important sign is a sharp decrease in tolerance to alcohol. If earlier it increased, then at this stage intoxication occurs with significantly small doses - 50-100 gr. vodka. Alcoholic dementia (dementia) is on the rise. Somatic complications become more severe and life-threatening.
The classification proposed by A.G. Hoffmann: I stage alcoholism can be diagnosed in the presence of a pathological craving for alcohol and the loss of quantitative control.
II stage diagnosed with the occurrence of alcohol withdrawal syndrome (AAS):
a) constantly occurring AAS (only after drinking medium or large doses of alcohol),
b) constantly occurring AAS, not accompanied by the appearance of perceptual delusions or pronounced affective disorders,
c) constantly occurring AAS, accompanied by the appearance of perceptual delusions or severe affective disorders,
d) extended hangover syndrome, combined with pronounced changes nervous system or internal organs, as well as the psyche, caused by alcoholism.
III stage diagnosed with a drop in tolerance to alcohol:
a) decrease in tolerance to the end of binge;
b) a constant decrease in tolerance;
c) "true" binges;
d) the presence of pronounced changes in the nervous system, internal organs or psyche (up to dementia).
IV stage is diagnosed at the age of involution (senile) with a decrease in the intensity of craving for alcohol, a decrease in periods of alcohol abuse, a reduction in their duration:
a) a decrease in the duration of periods of alcohol consumption, their more rare occurrence;
b) the transition to episodic alcohol consumption with a sharp weakening or disappearance of craving for it;
c) stop drinking alcohol.
According to the classification of alcoholism by A.A. Portnov and I.N. Pyatnitskaya, an expanded understanding of the drug addiction syndrome is given. The following stages of the disease have been identified.
I stage initial or neurasthenic, which is characterized by the appearance of an attraction to alcohol and a state of intoxication (psychic dependence), an increase in tolerance (resistance) to the doses of alcohol taken and an asthenic symptom complex (fatigue, irritability, emotional lability, insomnia, early morning awakening, etc.) .
At this stage, the form of alcohol consumption changes (the transition from episodic to its systematic intake).
II stage medium or drug addiction, which is accompanied by an increase in craving for alcohol, an altered form of intoxication (frequent amnesias - palimpsests, amnesia of the finale), and most importantly - loss of control, the appearance of withdrawal syndrome, pseudo-drunk drinking. At this stage, there are certain, more pronounced mental disorders, damage to internal organs and the nervous system.
III stage original or encephalopathic, in which binge drinking develops, endurance to alcohol decreases, more severe neuropsychiatric disorders and diseases of the internal organs and nervous system are noted, alcoholic psychoses occur more often.
Classification of "domestic drunkenness" according to E.I. Bechtel:
1. Abstinents - not drinking alcohol for at least a year or using them so rarely and in such small quantities that it can be neglected (up to 100 g of wine 2-3 times a year).
2. Casual drinkers - usually consuming 50-150 ml of vodka (maximum 250 ml) from several times a year to several times a month.
3. Moderate drinkers - drinking 100-150 ml (maximum 300-400 ml) of alcoholic beverages 1-4 times a month.
4. Systematically drinking - drinking 200-300 ml of vodka (maximum 500 ml) 1-2 times a week.
5. Habitual drinkers - those who use 300-500 ml of vodka (maximum 500 ml or more) 2-3 times a week.
Further development of the understanding of the characteristics of alcoholism as a disease is largely associated with Jellinek's research. They were shown that the initial use of alcohol is usually due to psychological and social factors. The latter cause a change in alcoholic behavior, contribute by the mechanism of "problem resolution" to the formation of mental dependence on alcohol, which becomes a kind of " magic wand”, which replaces real relations with reality. Alcohol becomes a means of relieving psychological, physiological and social stresses and tensions, including those that arise due to the very fact of alcohol abuse. Thus a vicious circle is created. In the future, symptoms of physical dependence are formed: increased tolerance, hangover, inability to refrain from drinking alcohol, loss of control. At this stage, the author defines a person who abuses alcohol as an “alcohol addict”, whose alcohol behavior is a painful process. Jellinek proposed a classification of alcoholism based on the identification of a form with psychological dependence (alpha alcoholism), three forms of alcoholism with physical dependence (gamma, delta and epsilon), as well as a beta form, which meant damage to the brain and internal organs by alcohol. The allocation of beta-alcoholism, from our point of view, violated the basic principle of classification - the division of types of alcoholism according to the type of dependence.
There is no doubt that alcohol damage to various organs and systems is possible in any of its forms, sometimes even in people who do not suffer from this disease, for example, in case of accidental poisoning with alcohol or its derivatives. The principle of differentiating the forms of alcoholism based on the characteristics of its main syndrome - the syndrome alcohol addiction— was used in our classification.
Jellinek's classification was expanded by highlighting new forms of alcoholism with phenomena of mental dependence (eta, iota and kappa), forms with physical dependence (zeta). The beta form was excluded from the classification.
Alcoholic damage to the brain according to its severity was taken into account in the allocation of stages of alcoholism: cerebrasthenic, encephalopathic and partial dementia. Introducing into the classification of alcoholism, along with drug addiction symptoms, the characteristics of organic changes in the brain, as well as disorders in various organs and systems caused by the toxic effect of alcohol, is also necessary. All these changes should be taken into account when conducting anti-alcohol treatment.
Let's bring short description selected forms and stages of alcoholism.
Alpha alcoholism is a form of mental dependence on alcohol. The content of mental dependence lies in the desire to relieve emotional stress with alcohol, to get rid of unpleasant thoughts, to get away for some time from the need to make a difficult decision. Alcohol is used as a means of temporarily eliminating disorders that do not reach a neurotic level. With alpha alcoholism, there is usually a tendency to increase the frequency of drinking, which begins to become more and more habitual. Any difficulty can cause a desire to consume alcohol.
Alpha alcoholism often develops in people who, as a result of improper upbringing, have a passive attitude towards life. When faced with difficulties, they easily experience emotional stress, which reflects a violation of mental adaptation. The tendency to use alcohol in alpha alcoholism increases, as our studies show, in an environment of rarely changing stimulation, both when it increases and when it decreases. The social consequences of this form concern interpersonal relationships. Family and work suffer.
This alcoholism- a form with the phenomena of mental dependence. Drinking alcohol is masked by "traditions" with their expansion and exaggeration. Drinking occurs in the company of people who are well known. There is no clear motivation for drinking alcohol. In these cases, any entertainment, the usual forms of communication between people are accompanied by the intake of alcohol. The use of alcoholic beverages becomes a way of establishing business and personal contacts. The attraction to drinking is actually associated with the desire for pleasure, due to the joint time spent in a state of intoxication. There is a destruction of constructive motivations, their replacement by a stereotype of behavior, leading to a decrease in the general level of the individual, his interests, culture, and social usefulness. Characterized by detachment from reality, a tendency to unproductive, fruitless fantasy.
Iota alcoholism- a form with phenomena of mental dependence on alcohol. As with alpha alcoholism, the content of psychic dependence lies in the desire to remove an unusual mental state, emotional stress. However, with the iota form, these disorders reach a neurotic level. Constant drinking is necessary to relieve obsessive fears or other long-term neurotic and neurosis-like symptoms, including impotence. Dependence on alcohol is initially closely associated with a neurotic state, but later becomes less distinct.
Kappa alcoholism is a fairly rare form of alcoholism that develops in some mental illnesses. Mental dependence on alcohol is due to the desire to change one's mental state, to get rid of difficult psychotic experiences at least temporarily.
Epsilon alcoholism least studied. Alcohol addiction cannot be described solely in terms of psychology. Alcohol abuse is intermittent, but extremely intense. The intervals between alcoholic excesses can reach several years.
In the normal state, there is no attraction to alcohol. During periodic excesses, individuals who subside with epsilon alcoholism can cause great harm to themselves, their families, and society. Epsilon alcoholism should not be confused with another form - gamma.
Some researchers admit that epsilon alcoholism occurs in individuals suffering from recurrent mood changes, manifested in gloominess, irritability, malice, melancholy, in great tension of these negative emotional states. The probability of connection of such violations with changes in the epileptic nature is being studied. The relative rarity of such cases and, obviously, their heterogeneity do not allow us to draw a final conclusion.
Gamma alcoholism - a form with phenomena of physical dependence on alcoholism. The main symptom of physical addiction is a loss of control. Loss of control is sometimes misunderstood as any uncontrolled drinking, "out of control drinking." Meanwhile, the exact definition of the symptom of loss of control is of great importance for assessing the conditions inherent in gamma alcoholism.
The symptom of loss of control is that the consumption of almost any initial dose of alcohol leads to an uncontrolled chain of events, consisting in the intake of subsequent doses until the development of severe intoxication, usually with impaired consciousness in the form of a stupor or even a soporous state. Drinking alcohol in the presence of a symptom of loss of control does not lead to the expected effect, based on previous experience, or the latter is extremely short-lived. For example, the expected sedation, relaxation does not occur, the mood does not improve. On the contrary, there is anxiety, anxiety, mood drops sharply, hands begin to tremble, and twitching of individual muscles is often observed. Characterized by suspicion of others.
Alcohol intoxication with a symptom of loss of control differs sharply from ordinary alcohol intoxication. The latter is usually accompanied good mood, playfulness, gaiety. Talkativeness, pseudo-philosophizing, boastfulness, fantasizing, sometimes tearfulness, exaggerated sentimentality are characteristic. In cases of the symptom of loss of control, the picture of intoxication is completely different. Anxiety comes to the fore, focus on one's condition, contact with others is formal, interest is limited to the desire to drink more and as soon as possible. Patients have a subjective feeling that "you need to drink more, and everything will be fine," which is why there is a strong craving for alcohol. However, taking subsequent doses, if it alleviates the condition, is only for a very short time. As a result, drinking continues.
In cases where there is no alcohol, various surrogates can be drunk. The symptom of loss of control is defined by the American psychiatrist Oloart as "loss of freedom" in relation to the use of alcohol after taking its first dose. Our observations show that people with loss of control dramatically change the style of drinking alcohol, they stop, in particular, drinking in old companies, fearing to discredit themselves by the fact that they cannot, as before, maintain a conversation, withstand the time intervals between drinking, and the inevitable the finale - severe intoxication with the inability to even get home on their own. Alcohol use by persons with loss of control often occurs alone, in very small circles, or in the company of persons with obvious alcohol degradation. The appearance of a symptom of loss of control causes anxiety ("something happened to me"), for some - the desire to experiment with alcohol: to try if they can hold the drink on some dose. These "experiments", as a rule, end with another alcoholic excess. Even if, at the cost of extremely strong-willed efforts, the patient stops drinking, then the next day or a little later, under the influence of an illusory feeling of “victory over himself,” he tries to drink “as before” and becomes an inveterate drunkard again.
It should be borne in mind that persons with incipient gamma alcoholism may initially reduce the number of drinks, fearing their consequences. Their behavior is characterized by increasingly frequent absences from work for several days, usually after the weekend, which they try to justify in every possible way with “objective reasons”.
Gamma alcoholism is also characterized by the presence of an alcoholic hangover syndrome, which is not relieved by the use of small doses of alcohol, since the loss of control leads to the development of the next alcoholic excess. With gamma alcoholism, social consequences are sharply expressed in the sphere of family and industrial relations.
Zeta alcoholism - a form with a physical dependence on alcohol. It is characterized by frequent, but not regular, doses that cause pronounced intoxication phenomena.
In this form, the symptom of loss of control occurs only when taking relatively large doses of alcohol and is not established after small and medium doses. This allows the patient to some extent manage their behavior while drinking. In some cases, drinking is limited to taking doses of alcohol that do not cause loss of control. In the process of removing the hangover syndrome, the symptom of loss of control does not develop, which makes it possible to stop withdrawal symptoms with small doses of alcohol. The social consequences of zeta-alcoholism are different, interpersonal relationships are violated, social and financial situation can deteriorate sharply.
Delta alcoholism - a form with a physical dependence on alcohol. It is characterized by the inability to refrain from repeated alcohol intake, regular intake of individually different doses that do not cause pronounced intoxication. In connection with the formation of the withdrawal syndrome, there is a need to be in a state of intoxication all the time. However, at the same time, the ability to control the amount of alcohol consumed in each individual case remains. For a relatively long time, delta-alcoholism can be hidden. Previously, it was believed that delta alcoholism mainly consumed alcoholic beverages with a low alcohol content: grape wines, beer. However, in the last decade, even in regions that traditionally produce grape wines, such as in the countries of southern Europe, the use of high-alcohol drinks has increased within the style inherent in the delta form of alcoholism. In countries with absolute freedom to drink alcohol, such as France, there are a large number of hidden cases of delta alcoholism, as evidenced by alcoholic psychoses, which often develop in people who claim that they "have never really been drunk at all", however, they regularly consumed relatively small doses of alcoholic beverages.
A chronic, gradually progressive disease characterized by a pathological attraction to alcohol, a change in the reaction (tolerance) to alcohol intake, the development of somatic and neurological complications and characteristic personality changes up to degradation.
Risk factors. The origin of the disease is multifactorial. Men are more likely to suffer from alcoholism, but women can be equally affected. Factors in the development of addiction include:
hereditary burden;
Young age up to 35 years;
Psychosocial factors: the role of emotional stress;
Incomplete family, negative parental example, negative socio-cultural influence (availability of alcoholic beverages, advertising, negative examples of idols and significant others);
The presence of a personality disorder (asocial, borderline, schizoid, anxious, constitutionally depressive, dependent), post-traumatic stress disorder, bipolar disorder, depression, schizophrenia, organic brain pathology, oligophrenia.
Types and types. There are two types of alcoholism:
Type 1. It has a late onset and little social impact. this type of alcoholism is formed mainly under the influence of environmental factors.
Type 2. An early onset against the background of burdened heredity is characteristic. It is predominantly observed in men, often accompanied by polytoxomania.
Clinical manifestations. The central disorder is an irresistible pathological craving for alcohol with mental and physical dependence. The development of mental disorders is a consequence of alcohol abuse (acute alcohol intoxication with disinhibition, impaired orientation, gait, balance, speech; delirium tremens, or delirium; withdrawal syndrome; alcoholic hallucinations).
There are four stages in the development of alcoholism:
1. Changing the mode of alcohol consumption;
2. Pronounced stage of loss of control;
3. Stage of onset of social consequences;
4. Pronounced mental and physical dependence.
There are three stages in Russian narcology:
Compensated(domestic drunkenness, mild, pre-alcoholic, prodromal stage). It often forms before the age of 30 and lasts up to 6 years. Characteristic is the frequent use of alcohol to alleviate feelings, a decrease in the ability to endure mental stress, an increase in alcohol tolerance, a loss of control over the amount drunk with a loss of satiety. At high doses that cause severe intoxication, memory disorders (alcoholic amnesia) may occur.
Subcompensated(medium, extended, critical). The main symptom is physical dependence on alcohol, or withdrawal (hangover) syndrome, which is associated with the need for a hangover. Gradually, the need for a hangover takes on a persistent character. Tolerance continues to increase, reaching a maximum, and remains at this level for several years (tolerance plateau). This stage is characterized by the transition to strong drinks, loss of control over the situation, the dominance of craving for alcohol among other motives of behavior, lack of awareness and criticism of the disease, the appearance of palimpsests (systematic forgetfulness of periods of intoxication). Somatic diseases develop: diseases of the liver, stomach, heart.
Decompensation(chronic, severe, encephalopathic stage). It is formed within 10-20 years of systematic alcohol consumption. This stage is characterized by an increase in physical dependence and a decrease in tolerance to alcohol, a complete loss of situational control: the patient stops at nothing to get a drink. Against the background of withdrawal phenomena, convulsive seizures and alcoholic psychoses occur. Memory, thinking are disturbed, intelligence is reduced. There are severe somatic disorders.
Diagnostics. It is carried out by a narcologist with the help of a clinical and psychopathological examination based on modern diagnostic standards, including international diagnostic criteria for disorders due to the use of psychoactive substances according to ICD-10 (F10).
Diagnosis of alcoholism is based on the identification of alcohol withdrawal syndrome, indirect signs of alcohol dependence and prolonged alcohol abuse, somatic and neurological consequences - since the disease is diagnosed, as a rule, at stage 2 of alcoholism.
Treatment. The strategy and tactics depend on the stage of alcoholism, the presence of a critical attitude to the disease, and previous treatment experience. It necessarily includes the stage of relief of withdrawal symptoms and the treatment of alcoholic psychosis.
Outpatient active anti-alcohol therapy, psychoprophylaxis with participation in the work of groups of anonymous alcoholics. Patients with the second stage of alcoholism are mainly treated on an outpatient basis. The duration of this stage without treatment is 5-12 years, with treatment it can increase up to 15-20 years without moving to the third stage.
Hospital treatment necessary to eliminate life-threatening intoxication, in the event of withdrawal symptoms and acute alcoholic psychoses (alcoholic delirium, paranoid, hallucinosis, amnestic psychosis) and severe complications of acute Gaye-Wernicke encephalopathy, as well as in the treatment of drinking bouts that occur during exacerbation of another mental disorder.
observation. Long-term monitoring of the mental, neurological and somatic state is required, since alcoholism often complication is encephalopathy, polyneuropathy, ataxia, pancreatitis, liver cirrhosis, alcoholic cardiomyopathy, arrhythmia attacks, arterial hypertension, frequent injuries and other pathologies.
Alcohol addiction
According to their physiological and psychological characteristics, patients with alcoholism differ from each other in a whole range of individual characteristics.
After all, no two people are the same. Therefore, each case of alcoholism is a unique phenomenon with the characteristics inherent in this disease. In view of the fact that some of the symptoms of alcohol dependence are present in almost all drinkers, the use of the term alcoholism has gained wide popularity.
However, it would be a mistake to assume that a "real" or "typical" alcoholic should be similar to the stereotype generally accepted in society. In cases where a person cannot identify with the common alcoholic archetype, he runs the risk of falling into the trap of denying his illness and not being aware of the problems. A simple example This is the fact that some people simply cannot imagine the alcoholic as different from the conventional image.
Forms of alcoholism according to E. Jellinek
In practice, the most famous and widespread classification of forms of alcoholism is presented by E. Jellinek, who based it on three factors:
- Etiological moments (psychological, physiological, socio-cultural and economic);
- The nature of the alcoholic process (tolerance, the nature of dependence on alcohol, etc.);
- The nature of the harm associated with the use of alcohol.
Beta alcoholism
Alcohol abuse, both quantitatively and in frequency, is associated with the customs of the corresponding social environment of the individual. There is no physical or psychological dependence in beta alcoholism. There are the usual physiological consequences of alcohol abuse. Nutritional deficiencies and target organ damage (cirrhosis and gastritis) are not excluded.
People in this category are often found in public hospitals, where their health problems are typical diseases that are treated without eliminating the causes that caused them. The causes of alcoholism are largely socio-cultural or situational, a common trend where "everyone" gets drunk usually on weekends. Antisocial behaviors are observed.
With these two forms of alcoholism, control over the amount of alcohol consumed is maintained. The ability to abstain from the use of alcoholic beverages is preserved.
Gamma alcoholism
This is a chronic progressive type of alcoholism. Usually, it starts with a psychological addiction and gradually progresses to a physical addiction. It is characterized by a loss of control over the amount of alcohol consumed. With the exception of the initial stage of alcoholism, there is the possibility of choosing the place and time of the drinking process, however, after even the slightest dose of alcohol, control over the process is immediately lost, which then proceeds according to the principle: "one bottle is too much, but two is not enough."
An increase in tolerance is observed, and in the middle stage of alcoholism it can reach a maximum level. There is a possibility of loss of coordination of movements or tremor for several days after the refusal. In the later stages, serious withdrawal symptoms are observed, and tolerance is irrevocably reduced to its original level (even the usual dose is toxic to the body). After another long-term abuse, there may be periods of withdrawal from alcohol.
Gamma alcoholism is a classic example of alcoholism, where habitual passion is a disorder. Searching for the causes of alcoholism is redundant: they drink because they are addicted to alcohol. This form of alcoholism is predominantly inherent in countries where strong alcoholic beverages are traditionally consumed.
Delta alcoholism
This form of alcoholism characterizes a person who is an alcoholic who is unable to refrain from drinking alcohol. The physical dependence on alcohol prevails, which subsequently turns into a mental one. The ability to control the amount of alcohol consumed is retained, but alcoholic beverages are consumed almost constantly. Unlike Gamma alcoholism, it is difficult for a person to give up alcohol even for a short period, but they are rarely in a state of severe intoxication. Such people are characterized by increased tolerance, in some cases there are cases of manifestations of serious withdrawal symptoms, even when they have never been drunk. Public opinion and local customs encourage regular drinking.
The disease progresses gradually slowly but surely. Delta alcoholics are often not even aware of some disorders in their body, in most cases they feel stable. Family relationships usually strained, but no one recognizes the obvious problems with alcohol, since their daily use rarely outstrips the crisis. Alcoholics of this form are unable to identify with negative examples of alcoholism and sometimes with the amusing experiences that other alcoholics report from their drunken scenes. Delta alcoholism is typical for countries where grape wines are consumed and made.
Epsilon alcoholism
The peculiarity of this form of alcoholism is the presence of long-term cyclic binges, with severe alcoholic consequences. There is no clear description of other aspects of the disease. Previously, the term was called the usual binge, but so far this interpretation has been abandoned. Epsilon alcoholics may abstain from alcohol for some time (up to several months), but eventually return to binge drinking again. The disease is not fully understood. Sometimes it is called cyclical alcoholism, which differs from the rest in heavy binges. The patient periodically experiences an irresistible desire to drink, along with a feeling of irritability and confusion. It is not uncommon for such people to organize alcohol marathons, which can take a period of time, followed by being intoxicated for several days. During the binge phase, patients lose control of themselves, drink uncontrollably and suffer from memory lapses.
The disadvantages of the classification of alcoholism with E. Jellinek is the vagueness in the wording, which creates the basis for various and ambiguous interpretations of alcohol dependence.
In our opinion, the most successful classification of alcoholism is the classification of A. A. Portnov, I. N. Pyatnitskaya (1973). It expands the concept of drug addiction syndrome, provides clearer boundaries of alcoholism as a nosological unit, which favorably distinguishes this classification from others. A. A. Portnov, I. N. Pyatnitskaya distinguish the following stages of the disease:
I. The initial, or neurasthenic, stage, which is characterized by the appearance of an attraction to alcohol and a state of intoxication (psychic dependence), an increase in tolerance (resistance) to the doses of alcohol taken and an asthenic symptom complex (fatigue, irritability, emotional lability, insomnia, early morning awakening and etc.). At this stage, the form of alcohol consumption changes (transition from episodic to systematic use). The authors establish the diagnosis of this stage only on the basis of the leading symptoms - signs of the drug addiction syndrome: dependence and altered reactivity (increased tolerance, loss of control);
II. The middle, or drug addict, stage, which is accompanied by an increase in craving for alcohol, an altered form of intoxication (frequent amnesias), and most importantly, a loss of control, the manifestation of an abstinence syndrome, pseudo-drunk drinking. At this stage, certain, characteristic, more pronounced mental disorders, damage to internal organs and the nervous system appear.
III. The initial, or encephalopathic, stage, in which drunkenness develops, alcohol tolerance decreases, more severe neuropsychiatric disorders and diseases of the internal organs and nervous system are noted, and alcoholic psychoses occur more often.
Recognizing the importance and practical significance of the classifications diagnostic criteria, especially for recognizing the initial stages of alcoholism, it should be noted that these signs are not enough to identify people who abuse alcoholic beverages, but without signs of alcoholism, without symptoms of alcoholic disease, i.e. "habitual" drunkards.
Identification of alcohol abusers in a broader sense (sick and drunkards) requires a medical and social approach and a comprehensive assessment of such abuse phenomena as the frequency of drinking, the amount of alcohol and the reason for drinking alcoholic beverages, behavior while intoxicated, the presence and severity of physical or mental dependence from alcohol.
According to the frequency of drinking alcoholic beverages and the degree of their abuse, we propose to distinguish the following groups of people.
1st. Drinking alcoholic beverages rarely (mainly on holidays and family celebrations - on average no more than once a month), in small quantities (several glasses of wine or shots of strong alcoholic beverages). This also includes persons who do not consume alcoholic beverages at all; there are very few such people.
2nd. Drinking alcoholic beverages moderately (1-3 times a month, but not more than once a week), in relatively small quantities (up to 200 g of strong drinks or 400-500 g of wine; age, sex and other characteristics of the individual should be taken into account). Holidays are the reason for drinking alcohol. family traditions, meetings with friends and other socially explicable situations. Persons belonging to this group, as a rule, “know their limits”, and in a state of intoxication do not allow antisocial acts. 3rd. Alcohol abusers: a) without signs of alcoholism a, i.e. drunkards who drink alcohol frequently (several times a week), in large quantities (more than 200 g of spirits or more than 0.5 liters of wine). In most cases, the reason for drinking alcohol is socially inexplicable (“for the company”, “without any reason”, “I wanted to and got drunk”), and alcoholic beverages are drunk mainly in random places. This group of alcohol abusers is characterized by antisocial behavior when intoxicated: conflicts in the family, absenteeism from work, violations of the rules of public order. The consequences are delivery to a sobering-up station, drives to the police, etc. There may be indistinct signs of mental dependence on alcohol. In accordance with, this group can be classified as abusing with a "non-drug form of alcoholism";
b) c initial signs alcoholism - in the presence of mental dependence and changed to alcohol (attraction to alcohol and the state of intoxication, loss of control over the amount of drinks consumed, increased tolerance, etc.), which corresponds to stage I of alcoholism according to A. A. Portnov, I. N. Pyatnitskaya;
c) with pronounced signs of alcoholism, when there are signs of physical dependence on alcohol, in particular, withdrawal syndrome, characteristic of stage II of the disease.
With such consideration of the various manifestations of alcoholism, several basic (axial) criteria can be distinguished for differentiating people who consume alcohol. These groups differ from each other in the frequency of drinking alcoholic beverages, in their behavior when intoxicated, and in the presence of mental and physical dependence on alcohol. Thus, the defining feature that makes it possible to separate those who rarely drink alcohol from those who use it moderately (groups 1 and 2) is the frequency of drinking alcohol without antisocial acts while intoxicated. Such an important diagnostic feature as the amount of drinks consumed, in this case, has a relative value, since it can vary significantly depending on gender, belonging to one or another group. social group, biological characteristics of the individual. This sign should be considered as an additional one.
The most difficult and at the same time most important in practical terms is to determine the boundary between moderate or traditional consumption of alcoholic beverages (Group 2) and alcohol abuse without signs of alcoholism, i.e. drunkenness (Group 3, subgroup "a" ). This issue can be resolved only on the basis of a comprehensive assessment involving such social criteria as the frequency and amount of drinks consumed, the most frequent reason for drinking them, and behavior when intoxicated.
The determining factor for assigning a given person to the 3rd group of subgroup "a" is the frequency (uses often) and the loss of control over their actions in a state of intoxication (or, in the language of clinicians, a change in the nature of intoxication with uncontrolled behavior), which results in drives to police, delivery to the sobering-up station, absenteeism, conflicts in the family. Signs of mental dependence on alcohol at this stage of abuse are absent or not clearly expressed. If alcohol abusers have signs of mental and physical dependence, it is necessary to decide whether such persons should be assigned to the group of the 3rd subgroup "b" or "c".
The proposed classification of alcoholism and drunkenness most fully reflects the socio-hygienic aspect of the problem, takes into account the degree of alcohol abuse and makes it possible to differentiate alcoholism from drunkenness, and drunkenness from the traditional "moderate" use of alcoholic beverages.
The diagnostic criteria for alcohol abuse, which formed the basis of this classification, were used in the study of the prevalence of alcoholism and drunkenness among certain occupational groups of the population.
