Alcohol and Alcoholism (Part Two)

In recent years, between the late 19th century and the early 20th century, the spread of alcohol consumption and abuse has been felt in the cultural developments of many countries. In countries where the absolute use of alcoholic beverages was strictly prohibited, such as in most Islamic countries, there have been social controversies, and intoxication has been considered punishable, but the possibility of drinking alcohol without getting drunk was a source of pride.

In some Latin countries such as Italy, Spain, and Portugal, regular consumption of large amounts of alcohol is considered shameful, while occasional, even increased, but limited consumption on special occasions (festivals) is usually considered normal.

Between the late 19th century and the early 20th century, the first attempts to correct and treat alcoholics began. In this case, the United States, along with some Northern European countries, has been at the forefront, where the problem was more sensitive. June 10, 1935, is considered the founding date of the Alcoholics Anonymous society in the United States, and later, this spread worldwide. According to the history of this society, this date corresponds to the day when Robert Smith, a doctor and member of the Oxford Group, drank alcohol for the last time after 30 days of work with Bill Wilson to create a treaty on abstinence from alcohol. The Oxford Group was the first organization, inspired by Evangelical Christianity, composed of former alcoholics who engaged in the fight against alcoholism, called the Alcoholics Anonymous Society.

The second half of the 20th century and the first decade of the 21st century have been characterized by an increasingly deeper understanding of the mechanisms of addiction and alcohol abuse, as well as the pathogenesis of alcohol-induced damage in many organs and tissues of the body. From another perspective, strategies and techniques of increasingly aggressive commercial propaganda have been emphasized, aiming to condition the consumption of alcoholic beverages, replacing customs and traditions. Health and administrative authorities in many countries have occasionally implemented restrictive measures on the consumption of alcoholic beverages by informing consumers about the potential harms. However, irregularities have been recorded from one country to another even in these cases.

In the United States, for a long time, labels on alcoholic beverages have contained warnings about the care and harm they can cause, while in European countries, such as Italy, not only are these precautions not provided, but very strict limits are set on the publication of alcoholic beverages in communication networks. Only occasionally, as a result of some dramatic event provoked by alcohol abuse, can a voice be raised to provide consumers with more extensive information about the relative risks of excessive alcohol consumption.

The history of alcohol consumption and its consequences dates back to ancient times and has no end. The use of alcoholic beverages induces pleasure, leading individuals to seek a different feeling within themselves. Therefore, the tendency for consumption may show signs of reduction in some places, but it remains constant or increases in others, even where it is strictly prohibited, relative increases are observed in that part of the population at risk, such as adolescents, women, or the sick.

Effects of Alcohol on Mood and Humor

The use of alcoholic beverages is a pleasure. Regardless of the various effects caused by beer, wine, spirits, aperitifs, and various cocktails with different doses and alcohol concentrations, the overall experience is that the majority feel good. In moderate doses, a calming effect and a sense of well-being are felt. In another medical treatise in 2002, alcohol is described as a substance that can be easily abused, and the effects of tranquility, euphoria, and a sense of well-being are considered only the beginning of problems: they seek to drink to experience these positive feelings, but this habit creates a connection that will accompany them throughout their lives, causing serious damage to their bodies.

As we will see later, the effects of alcohol on mood and humor, as well as on behavior, are explained by mechanisms that originate in the brain. By using alcoholic beverages for a long time, an addiction to alcohol is created, which favors abuse. Addiction is a behavioral disorder that, from a simple and common thing, reaches an exaggerated and pathological pursuit to obtain pleasure from alcohol. This leads to pathology. A person who has developed addiction loses the ability to control their lifestyle.

Alcohol Dependence

According to the World Health Organization, alcoholics "are drinkers with an alcohol dependence that has reached such high levels that they manifest a pronounced physical disorder or an intervention in their physical and mental health, with reactions felt in their social and economic development, or in subjects showing initial signs of pathological collapse." Addiction is, therefore, a key aspect of alcoholism and is what transforms a habit of living into a pathological syndrome.

Mechanisms of Alcohol Dependence

Substances that can be abused can be "stimulants" or "inhibitors." Cocaine is one of the first, alcohol is the second. In the meantime, there are also other substances that can be abused, such as nicotine or cocaine, which affect specific receptors of the nervous system. Alcohol does not have a specific receptor that can act, but "transversal" mechanisms begin, which include many neurotransmitter systems, molecules that transmit stimuli to the nervous system. (Bona 2002).

Dopamine has been considered as the "pleasure mediator" because it is released in several brain centers. The release of dopamine in the "nucleus accumbens" gives different stimuli. Some are physiological, such as the feeling of hunger, sleep, and sexual activity. Others are behaviors that provoke violent emotions, such as risky games or eating and then vomiting their food. This last behavior is characteristic of the effect of bulimia, a disorder of eating habits. Even the form of substance abuse, such as alcohol, opiates (cocaine, heroin), or cannabis (hashish or marijuana extracts from cannabis sativa), all these cause dopamine to be released.

Many studies have shown the mechanisms by which alcohol modifies the transmission of stimuli involving dopamine (Tupala 2004; Soderpalm 2009; Koob 2011). But the biological mechanisms of alcohol dependence also include many other neurotransmitter systems: those of endogenous opiates (Rodriguez-Arias 2010), serotonin (Johnson 2004), glutamine, and gamma-aminobutyric acid (GABA) (Colombo 2004; Bleich and Hillemacher 2009; Heinz 2009). In particular, based on the GABA transmission system, chronic alcohol use reduces the receptor functions of gamma-aminobutyric acid. (Koob 2011).

But the biological roots of alcohol dependence do not only include neurotransmitter mediators. The endocrine system is also involved: through experimental routes, it has been confirmed that the control mechanism linked to the functions of the hypothalamus, pituitary, and adrenal glands are involved and affect individuals who have developed alcohol dependence. Less known but very interesting are the effects on some hormones such as leptin, adiponectin, resistin, and ghrelin, which participate in energy metabolism (those that control calorie consumption).

The information we have presented so far shows and demonstrates how deep the biological roots of alcohol dependence are within the human body, how complex the mechanisms involved are, and this also explains the difficulties that may be encountered in recovery.

One Substance - Two Dependencies

Like other forms of dependence, dependence on alcohol is a disease. A bad habit can be modified through strong individual and environmental motivation. To eliminate dependence on a substance that is abused, not only the "willpower" is sufficient, but various interventions are also necessary: from psychological and social support to the use of medications when deemed necessary. The subject's motivation is crucial to fight dependence, but this does not diminish the value of various interventions, because every measure used goes against some phenomena that may favor dependence.

The chronic habit of consuming alcoholic beverages is characterized by two forms of dependence: "psychological" dependence and "biological" dependence. The first consists of the tendency that the person shows to repeat the positive experiences they have lived through alcohol use. If the consumption of an alcoholic beverage has helped ease a tense situation after a busy working day, or has helped to get out of a situation where one felt like a stranger, into another state where one feels good and satisfied in society, it pushes the person to like the drink even more. In the initial phase, this may be just a habit, over time the individual feels stronger and stronger, the need to drink, an abnormal need, even if the person himself does not perceive it as such. These are the first signs to move from psychological dependence to biological dependence.

Continuous or repeated consumption of alcohol has created mechanisms in the central nervous system, such that the brain "feels the need" for alcohol to function (Hillemacher 2011) and encourages the individual to use it. In fact, the decisive signal for the presence of dependence is the appearance of an anxious and spasmodic craving for alcoholic beverages, which in English is defined as "craving" (desire even for a sip).

The World Health Organization ranks alcohol first for social damages, second for physical-organic mortality, and third for mental health disorders.

"Alcoholism is significantly increasing the number of patients with mental health problems, increasing the cost of pharmacological treatment of bio-organic pathologies, while alcoholic dependence is causing overall regression," says the head of the Alcoholism Treatment Clinic (Alcoholism Service) at the University Hospital Center "Mother Teresa" in Tirana, Dr. Shpëtim Doksani. But the worrying fact is that this phenomenon is affecting a serious percentage of the active population, aged 30-60 years.

Referring to previous data, (in Albania), although contradictory, speak of around 30% alcoholic consumers (light, moderate, and problematic), 15% problematic, abusive, and dangerous consumers, and about 4% alcoholic dependents.

The social consequences of alcohol consumption are affecting Albanian families and society. In addition to health problems, alcohol is causing an increase in family violence, accidents, but also crime, say specialists.

Recent studies conducted by the Ministry of Health and the Institute of Public Health in the field of Albanian alcoholology show that approximately 340,000 people consume alcohol, of which 58% drink alcohol beyond the allowed limit, and about 20% of them (about 2% of the population) are addicted to it, while about 9% of chronic illnesses are the result of prolonged alcohol abuse. On the other hand, it remains alarming that about 4.8% of women of childbearing age have been regular consumers of alcohol.

From Habit to Dependence

Another study, which stands between genetics and psychology, is the one that says that those people who feel more pleasure from alcohol due to the production of dopamine and other hormones are at the greatest risk of creating dependence. Some other people are less predisposed to feel pleasure from these hormones, and this makes them seek more alcohol or other substances that can be abused because their endogenous mechanisms are not able to produce them.

In the search for factors that favor the development of alcohol dependence, social-cultural, economic, and family aspects have also been assessed. In some countries, the law of drinking is considered "acceptable" and not punishable. In other countries or in other social environments, the law of alcohol use is punishable to the extent that the one who has this habit is considered a victim of a social disorder.

Another study takes into account psychological factors and, in particular, aspects of the individual's personality that favor the manifestation of alcohol dependence. The tendency of all studies is to clarify and highlight which factors cause dependence. Changing the way of life is difficult, but eliminating dependence is even more difficult. Such a difficult goal can only be achieved through combined personal and health efforts as well as social support.

The idea that the consumption of alcoholic beverages should be prohibited does not find fertile ground in the modern world. And it would not be realistic because, in addition to the enjoyment of alcohol, alcoholic beverages also have beneficial effects on health, and a ban on their use would limit the range of pleasure and health.

The Use of Alcohol in Various Cultures

The use of alcoholic beverages has accompanied man throughout history and is closely related to the cultures of peoples. In some cultures, alcoholic beverages are considered a source of pleasure, joy, and relaxation, while in others, they are considered harmful and damaging. Alcohol has been used in various religious rituals, as a symbol of joy, as well as in various social and family events.

Each culture has its own traditions and customs related to the use of alcoholic beverages. For example, in Mediterranean cultures, wine is an integral part of meals and social gatherings. In some Eastern European cultures, the consumption of strong alcoholic beverages is common in social events and celebrations. In many Western countries, beer is a popular beverage consumed in various social contexts.

However, the cultural acceptance of alcohol consumption does not negate the potential harms associated with excessive and irresponsible drinking. The challenge lies in finding a balance between cultural traditions and promoting responsible alcohol consumption to prevent the negative consequences of alcohol abuse.

In conclusion, the use of alcoholic beverages is a complex and multifaceted phenomenon deeply rooted in human history and culture. While it can bring pleasure, relaxation, and a sense of socialization, it also poses risks and challenges, especially when consumed irresponsibly. Understanding the cultural, social, and psychological factors associated with alcohol use is essential for developing effective strategies to address alcohol-related issues and promote a healthier relationship with alcohol in societies around the world.

faqe    1 2

This article has been sent by: Dr. Viktor QERESHNIKU