Criteria and classification of alcoholism

  • Classification of the canadian psychiatrist E. Jellinek
  • Types of alcohol or drinking on M Sherfey
  • Classification of alcoholism I. Century of Strelchuk
  • Classification C. M. Banshchikova and C. P. Korolenko
  • Classification, M. Entin
  • Classification of alcoholism A. A. Portnov and I. N. Pyatnitskaya
  • The inconsistency in the interpretation of the terms of alcoholism, the complexity and versatility of this problem is difficult to develop one clear criteria for delimitation of drunkenness and alcoholism and forced domestic and foreign researchers continue to search for various diagnostic criteria of alcohol and to offer various classifications of the disease. Even harder to differentiate drunkenness as excessive consumption of alcoholic beverages from "moderate" consumption of alcohol.
    Where is the end of the so-called moderate or traditional alcohol and begins abuse (drunkenness), leading to addiction (alcoholism), followed deployed picture of chronic alcoholism? This question is not only important medico-social, but also a legal value (compulsory treatment, and so on). In other words, who are to be referred to the category of alcohol abuse in the broad sense of the word, and based on what criteria? Current definitions and classifications of alcoholism does not give an exhaustive answer to this question. "On classification of alcoholism and alcoholic psychosis so far not achieved a unity of views" [Lukomsky And. And., 1974].
    Consider with medical and social positions of some criteria and modern classification of alcoholism, which attempt to define the boundaries of alcohol abuse.
    Famous ancient Roman philosopher Seneca in one of his works he wrote: "Poseidon says that the word "drunk" is used in two ways: in one case about a person, Nakashima wine and lost control of himself, and in another case of someone who used to get drunk and become a slave to the habit. You, of course, acknowledge that there is a big difference between a person who is drunk, and a drunkard. The one that currently drunk, may be in this state for the first time and may not have such habits, while the drinker is not often free from intoxication" [CIT. on Strelchuk I. Century, 1971]. Already in ancient times tried to draw the line between accidental intoxication and binge drinking as a habit, like a disease.
    Description of alcoholism in a classic guides [Korsakov S., 1913; B. N. Osipov, Fishermen F. E., 1917; Kraepelin, 1927, etc.] begins with an expanded form of the disease. Description of alcoholism emphasize the importance of individual diagnostic features, such as lower tolerance, the emergence of amnestic forms of intoxication, the presence of the syndrome hangover etc. [Rosenstein L. M., 1916; Giljarovsky Century A., 1935; Zhislin, S., 1935; Gurevich, M. O., 1949; Strelchuk I. Century, 1956; Malakhov A. N., Ruchalski Yu. E., 1959; Portnov A. A., Fedotov apartment houses, 1965, and others]. So, S. G. Zhislin (1935) believes that a major diagnostic criterion of chronic alcoholism is psychopathological and somatovegetative hangover syndrome, in which "obviously are the symptoms of chronic alcoholism".


    In other studies as a major diagnostic criterion of onset elected one symptom: the continuity of actions alcohol [Rodionov S. M., 1934]; the definition percent of calories coming to accept alcohol, in relation to the total caloric intake [Marconi J., 1959, and others]; frequent use of large quantities of alcohol to harm themselves and others [Mayer-W. Gross, E. Slater, Roth M, 1954; G. Wilson, 1974, and others]. So, S. M. Rodionov (1934) sees between alcohol and drunkenness only a quantitative difference, relating to alcoholism all cases of prolonged drinking. S. Ammar (1972) argues that the human body is relatively well carries the daily dose of alcohol 1 g/kg of body weight on the condition of its reception with a sufficient quantity of food. When the excess dose of this is, according to the author, in the body is the destruction of alcohol increases blood levels of intermediate degradation products (alcohol acetaldehyde and derivatives grape acid), which leads to the defeat of the liver, kidneys, heart, brain and other organs and systems. According to A. Plendl (1979), the adult human body with a mass of 60-80 kg able to assimilate 146-195 g of alcohol a day. Daily use of such doses of alcohol, according to the author, is critical limit the risk of developing alcoholism depending on the individual characteristics of the organism. G. Wilson (1974) believes that every suffering from alcoholism can discover three characteristic features: the use of alcohol in large quantities; somatic and emotional or social problems associated with alcoholism; loss of self-control.
    These criteria, as well as many others (intoxication, distribution techniques of alcohol on time, and so on), taken in isolation from the peculiarities of the personality, specific social conditions and clinical data do not represent the diagnostic value to establish the beginning of alcohol abuse.
    A number of studies reported signs that reflect changes in personality traits alcoholics [R. Bates, 1963; Maxwell M, 1966] and appear in the later stages of the disease, and therefore have no essential value for definition of onset.
    Of particular interest are the works devoted to studying initial stages of alcoholism [Borisevich centuries, Pyatnitskaya I. N., 1959; Portnov A. A., Pyatnitskaya I. N., 1971, 1973; Salamano Yu Century, 1975; Pyatnitskaya I. N., Ivanov Century I., 1980]. In order to recognize the disease and to evaluate the depth of pathology, according to A. A. Portnov and I. N. Pyatnitskaya (1971), "must be able to deal not one, not two, but many biological criteria... Very important is the dynamic principle of assessment of individual characteristics... Only the presence of alcohol abuse syndrome and its dynamic assessment allow us to separate household alcohol, even if, in the course of alcoholism has not developed yet somatoneurologic complications". It is stressed that the subjective assessment of individual symptoms at onset of alcohol abuse often leads to erroneous diagnoses of asthenic syndrome, psychopathy and other diseases of the nervous system.
    Comprehensive assessment of the initial signs of alcoholism (syndromes of altered reactivity and psychological dependence), as noted by I. N. Pyatnitskaya and B. I. Ivanov (1980), increases the accuracy of the diagnosis, however, does not specify "the boundaries between abuse and disease." The authors believe that the initial boundary disease will perform prominent, if there will be introduced the concept of prodrome alcoholism. Signs of prodrome, according to the authors, are an attempt of self-control for alcohol abuse and zichronos (violation of physiological rhythms of the organism).
    Some researchers point to the need for wider use of social criteria for the diagnosis of alcoholism. So, B. M. Pakhomov (1960), V. M. bath attendants (1971), G. M. Entin (1972) and others point out that such an early sign of formation of alcoholism, as situational understandable increased alcohol consumption, accompanied by violations of public order and work discipline, as a rule, out of the sight of doctors. Through the medical sobering-up stations are persons who clearly abusing alcohol. Among them there are sick with alcoholism.