Alcohol is the most frequently used psychoactive substance in the world. It figures prominently in our cultures and its use has been closely connected to the history of society. Alcohol, like all sedatives, hypnotics and analgesics, belongs to the category of central nervous system depressants.
Ethanol (the psychoactive substance in alcohol) is transmitted by the blood directly from the digestive system to the brain. The ingestion of alcohol produces a general impairment of the functioning of the central nervous system, causing a state of euphoria, calm, relaxation, drowsiness, reduced motor coordination and a slower respiratory rate. At a very high dose, alcohol can even cause coma.
Cognitive functions and the ability to make judgments are also affected by this impairment to the central nervous system, which can explain the indirect dangers associated with alcohol use, namely, car accidents, traumas, falls and injuries. When used chronically or abusively, alcohol directly impacts a person’s physical health, putting them at risk of developing liver disorders such as cirrhosis of the liver, among other illnesses.
In North America, the lifetime prevalence rate for alcohol-related disorders in the population is 13.6% (Regier et al., 1990). The Canadian national rate is estimated to be about the same (Rush et al., 2008). Approximately one out of every seven hospitalizations involves people with alcohol-related health problems. Therefore, everyone is likely to be acquainted with someone who is an “alcoholic”.
Drinking alcohol is not a problem in itself. Society views alcohol consumption as a normal activity. The repeated use of alcohol is neither an anomaly nor a symptom of a disease, but it can cause problems and suffering in a minority of people.
To avoid calling everything alcoholism, it is essential to distinguish between alcohol use and addiction and to refrain from associating everything with a hypothetical disease. According to the Centre for Addiction and Mental Health, alcohol use falls along a continuum that goes from low-risk use to alcohol-related disorders, i.e., abuse or dependence, and a person can move in one direction or the other along the spectrum. Therefore, when speaking about alcohol abuse, it is important to differentiate between use and misuse, risks and harms, and disadvantages and benefits. Hence, the Canadian Centre on Substance Use and Addiction’s guidelines recommend, when applicable, no more than 2 standard drinks a day for women and three for men and a maximum of 10 standard drinks per week for women and 15 for men. In Canada a standard drink is 13.45 g or 17.05 ml of ethanol, i.e., a 341 ml bottle (about 12 oz.) of beer, cider or cooler with an alcohol content of 5%, a 142 ml (about 5 oz.) glass of wine with an alcohol content of 12% or 43 ml (about 1.5 oz.) of hard liquor with an alcohol content of 40%.
Alcoholism, like any addictive behaviour, results from the interaction between risk and vulnerability factors related to the individual, the social-environmental context and the object of the addiction. Long-term use of alcohol leads to tolerance and dependence, which causes users to increase the amount consumed to continue to feel its effects and to avoid withdrawal symptoms. If users stop drinking, they go into withdrawal: a state of agitation, insomnia, dysphoria and anxiety that, for some users, in rare cases, can be accompanied by convulsions. It should be noted that alcohol withdrawal is one of the most dangerous types of withdrawal for a person’s health. For chronic users, withdrawal can lead to delirium tremens (DTs), which can be lethal. Delirium tremens is characterized by sensory perceptual disturbances (illusions or hallucinations), tremors, agitation, lack of alertness, autonomic hyperactivity and delirium, defined as extreme inattentiveness and unawareness of one’s environment. Even after stopping drinking, the person may have an irrepressible need to have alcohol, which can become increasingly powerful (craving or appetence).
According to Acier (2016), “the diagnosis of alcoholism consists primarily of five dimensions and places the alcoholic person on a continuum of severity: loss of freedom, presence of negative consequences, existence of tolerance, physical or psychological withdrawal and craving.”
Chronic alcohol use also has significant cognitive and psychiatric implications. In fact, several psychiatric disorders are caused by alcohol such as mood, anxiety and psychotic disorders. In addition, there is a high prevalence of comorbid affective, anxiety and psychotic disorders in people with problems related to alcohol use. On the cognitive level, chronic alcohol users demonstrate, among other things, deficits in executive functioning, the ability to focus, verbal memory, visual memory, working memory and visual-spatial skills.
Alcohol is a neurotoxic substance that can cause an increase the rate of neuronal death in several regions of the brain, including the prefrontal cortex, the thalamus, the hippocampus and the cerebellum. The functioning of the hippocampus, a brain structure involved with memory, is particularly disrupted by alcohol use, which explains the occurrences of blackouts during alcohol intoxication. Lastly, alcohol can produce irreversible cognitive damage, as can be seen in Korsakoff syndrome, which is characterized by memory, judgment, behaviour and mood disorders.
The American Society of Addiction Medicine (ASAM) and the Canadian Society of Addiction Medicine (CSAM) consider alcoholism and substance dependence to be primary, chronic and potentially fatal diseases involving genetic, psychosocial and environmental factors. This disease affects the brain’s reward, memory and motivation pathways. Clinical manifestations are biological, psychiatric, psychosocial and spiritual.
Studies show that 40 to 60% of patients treated for disorders related to alcohol use resume active use of substances in the year following discharge from treatment and about 40% start treatment again in the first six months (Moore et al., 2014).
Alcoholism affects a person in all areas of their life – professional, family, legal, social, physical and psychological. Before the beginning of every treatment, the Clinique Nouveau Départ team carries out a careful assessment of the individual’s usage profile, their risk for withdrawal, various co-occurring physical, emotional and behavioural conditions, as well as the factors that could help or hinder rehabilitation. The levels of care are tailored to the specific conditions of the patient. Through its medical approach, Clinique Nouveau Départ can sometimes, in addition to psychotherapy, resort to using drug therapy for people with dependence, both for acute withdrawal and during the post-withdrawal period (prolonged withdrawal or maintenance phase).