Is alcoholism common among narcissists

Health today

Alcohol addiction (Alcoholism, alcohol addiction): In addition to nicotine, one of the most common addiction disorders, around 4% of the German population are alcoholic, 70% of them are men.

A Alcohol abuse is when the alcohol consumption has led to psychological and physical damage. A Alcohol addiction exists if at least three of the following six criteria are met:

  • Craving (compulsive cravings for alcohol)
  • Decreased control over alcohol consumption
  • Persistent consumption despite negative effects on psyche, body or social life
  • Neglect of hobbies, interests and social contacts in favor of alcohol
  • Development of physical tolerance towards alcohol
  • Withdrawal symptoms when abstaining from alcohol.

Excessive alcohol consumption causes severe and permanent dependence as well as psychological and physical complications. Alcohol dependence is often fatal, 16,000 deaths occur in Germany every year (with an enormous number of unreported cases), with cirrhosis of the liver being the most common single alcohol-related cause of death with 9,500 deaths.

Because of the lifelong high potential for dependence on alcohol, the long-term and absolute renunciation of alcoholic beverages and food (and also medication!) Is propagated. In order to achieve this goal, the person affected needs long-term support from self-help groups and psychotherapy. Even so, the relapse rates after weaning are high.

Leading complaints

Psychological complaints:

  • Loss of control over beginning, ending and amount of alcohol consumption
  • Irritability, restlessness, anxiety
  • Hallucinations (uncommon)
  • Thoughts revolve around alcohol all the time
  • Alcohol for breakfast ("morning drink")
  • Alcohol stocks are always within reach
  • Loss of interest and neglect of social contacts.

Physical complaints:

  • Morning (hand) tremors, sweating
  • Inability to drive, lack of concentration
  • Inability to complete tasks that require a high level of coordination or the pathological avoidance of such activities
  • Withdrawal symptoms when stopping alcohol such as gastrointestinal and circulatory disorders, sleep disorders, sweating, tremors, articulation disorders
  • Calf cramps
  • Nausea, loss of appetite.

The illness

Numerous factors play a role in the development of alcohol addiction:

Inheritance. The hereditary predisposition to drinking has been scientifically proven: Close relatives of alcoholics have a four-fold higher risk of developing alcohol dependence.

Family factors. Alcoholics often come from families in which at least one member has had or has alcohol problems, and there are often negative role models in the parental home or in broken families.

Social factors. The unemployed are twice as likely to have alcohol problems as those in employment. Although sometimes job loss is a result of alcohol abuse, many unemployed people (out of frustration with their situation) develop alcohol dependence only after they have lost their job.

Social acceptance. In a social environment in which alcohol is accepted and readily available as a stimulant, more people develop alcohol dependence than in countries or circles in which alcohol consumption (e.g. for religious reasons) is not common or is strictly limited to a few occasions.

Depending on the patient and their personal conditions, alcohol addiction has a different appearance.

  • Alpha drinker ("conflict and relief drinker"): psychologically dependent, capable of abstinence, no loss of control
  • Beta drinker ("occasional drinker"): is neither physically nor psychologically dependent, no loss of control, capable of abstinence
  • Gamma drinker ("addicted drinker"): is first psychologically, then physically dependent, loss of control, temporary ability to abstain
  • Delta drinker ("habit or mirror drinker"): is physically dependent, not capable of abstinence
  • Epsilon drinker ("quarter drinker", "quarter drinker"): is psychologically dependent, excesses lasting several days with loss of control.

The development of alcohol dependence runs in several phases: At the beginning problems and stress from alcohol consumption become more bearable, alcohol tolerance increases. If the drinking behavior changes, i.e. if people drink secretly and alone and the thoughts mainly revolve around alcohol, the next level of alcohol dependence has been reached. Finally, the critical phase is characterized by a loss of control, physical consequences such as hand tremors become visible. The chronic phase is reached when people drink regularly in the morning and attempts to take alcohol-free days fail. The physical complications caused by liver damage weaken the person affected. After all, the addict is no longer able to exercise a job and take responsibility in a family. Social decline, divorce or loneliness are usually the consequences.

Alcohol addiction does not arise suddenly, but in a creeping process that takes years.
Copyright: www.salevent.de, Michael Amarotico, Munich

Chronic alcohol abuse leads to serious damage to the organs:

The liver, pancreas, but also the esophagus, the central nervous system and the circulatory system are particularly affected. Alcoholics also suffer particularly from anxiety disorders and depression. In addition, the brain becomes inflexible: Alcohol addicts learn new relationships just as well as healthy people, but have problems transferring this knowledge to other, previously unknown situations. Because of this, it is often difficult for alcohol addicts to transfer the findings from psychotherapy to everyday life and to change their behavior permanently, even though they are aware of the negative effects of their addictive behavior.

Suicide risk! Alcoholics are at high risk of suicide, especially in a social environment that has just collapsed. 10% of all alcohol addicts attempt suicide, 2% die by suicide.

The doctor or therapist does that

Alcohol addiction often goes undetected, which of course is also due to the tendency of the patient to trivialize the addiction. In the case of complaints such as nervousness, restlessness, mood swings, concentration and sleep disorders, the doctor should consider alcohol addiction. Otherwise, the diagnosis is based on drinking behavior (amount, frequency), dependence and alcohol-related physical damage such as B. an enlarged liver or cirrhosis of the liver.

Contact and motivation phase. The focus is on establishing contact and motivating the patient, e. B. through advice centers, doctors, family, friends and through early diagnosis. The sooner the alcoholic tries to get his drinking problem under control (and recognizing it as a serious problem), the better the chances of staying “dry”. Much of the resulting physical damage, such as alcoholic fatty liver, regresses when people are abstinent.

Withdrawal and detox

The at withdrawal and the detoxification Severe withdrawal symptoms that occur are treated with medication. The withdrawal syndrome usually begins 4–12 hours after the last drink, reaches its greatest severity on the second day of abstinence and disappears after another 4–5 days. The various complaints of those affected are summarized by doctors in three groups:

  • The internal symptoms of the withdrawal syndrome with severe malaise, lack of appetite, stomach pain, diarrhea, pulse racing, increased blood pressure, hypoglycaemia, dry mouth, sweating and itching
  • The neurological symptoms with shaking hands, speech disorders, muscle and headaches, sensory, gait and visual disorders, and occasionally even seizures
  • The psychological symptoms with fear, irritability, inner restlessness, insomnia, depressive moods, concentration and memory disorders, hallucinations, the thoughts often revolve around the acquisition of new alcohol.
Sometimes the symptoms are so severe that the person affected can no longer think clearly and becomes violent to himself and to others. The doctor speaks of delirium, a life-threatening state of confusion that requires immediate admission to a clinic, because if left untreated it can be fatal (more about delirium).

The physical withdrawal, which is usually carried out as an inpatient, lasts 1–2 weeks. Since around 75% of patients relapse within 3 months after detoxification, the concept of “qualified motivational withdrawal treatment (QMET)”, which, in addition to passive detoxification, also contains psychotherapeutic elements, especially “motivational work”, is increasingly gaining acceptance.

weaning

Normal is around six months weaning in specialist clinics. However, weaning is also carried out on a semi-inpatient or outpatient basis. In addition to psychotherapeutic procedures, medication can also be provided here.

The classic detoxification is first carried out using clomethiazole, carbamazepine or benzodiazepines. If symptoms of withdrawal are severe, haloperidol can also be prescribed.

After the detoxification, the medication is switched to so-called alcohol aversives. They are supposed to curb the craving for alcohol. Classic active ingredients are naltrexone, acamprosate, disulfiram and calcium carbide.

The alcohol cessation drug nalmefene (Selincro) has recently been on the market. On request, it can be reimbursed for 3 months by the health insurances (in exceptional cases also 6 months). It should reduce the uncontrollable craving for alcohol (craving) and the frequency of "drinking over thirst". The benefit is currently controversial in view of the frequent side effects.

Follow-up care and rehabilitation. The aim is to achieve long-term stabilization and the development of a professional and social existence. Helpful are z. B. outpatient care by counseling centers and self-help organizations or psychotherapy.

Psychotherapy. Psychotherapeutic techniques can be found in all treatment phases, from the initial “motivational work” to inpatient psychotherapy in the weaning phase to outpatient psychotherapeutic further treatment. In the weaning phase, behavioral treatment techniques and training programs are used in individual and group therapies. Often the aim is to develop strategies with which the patient can protect himself from the impending relapse in tempting situations, e.g. B. by learning self-control, problem-solving strategies and self-confidence training. In addition, couple conversations or family therapies are offered.

Unfortunately, most of those affected are only ready to begin therapy for alcohol dependence when their lives are almost entirely composed of problems and minor and medium-sized disasters. The path to rehabilitation is correspondingly long. The treatment procedure shown here has proven itself.
Copyright: www.salevent.de, Michael Amarotico, Munich

forecast

In the case of long-term addicts who may have already had several withdrawal treatments, the relapse rate is up to 80%, especially if the detoxification is not followed by any further therapy.

Self help

One of the best-known and oldest self-help groups are the Alcoholics Anonymous, which were founded in the USA in 1936 and are now represented in every major city in Germany. Alcoholics Anonymous assumes that the "drinker" remains addicted and endangered by alcohol for life. It is also postulated that alcohol is stronger than the effort of will, it is difficult to get rid of it alone and only alcoholics can help other alcoholics. Only drinkers, no healthy "helpers" are accepted. The concept also includes the principle of taking small steps with the help of a 12-step program so as not to overwhelm those affected.

Church organizations and health authorities also offer support groups and hotline helplines, as well as associations such as the Guttempler or the Blue Cross.

Additional information

  • www.anonyme-alkoholiker.de - Official website of Alcoholics Anonymous e. V. (Germany, Austria, Switzerland, South Tyrol): Offers addresses, information about group work and offers for relatives.
  • www.blaues-kreuz.de - Website of the Blue Cross e. V. für Suchtkranke, Wuppertal: Provides information about addiction, its prevention as well as therapy and counseling options.
  • www.sucht.org - Website of the Gesamtverband für Suchtkrankenhilfe e. V., Berlin: Self-help and information offers in the Diakonisches Werk of the Evangelical Church in Germany.
  • www.al-anon.de - Website of the Al-Anon family groups, Essen: Provides self-help groups and information for relatives and friends of alcoholics. Al-Anon is the only worldwide self-help community for families and friends of alcoholics, it has existed in Germany for 30 years.
  • R. Merkle: I'll stop, honestly! A practical guide for those affected and their families. Pal-Verlag, 2006. The guide focuses on avoiding relapses and changing [drinking] habits.
  • W. Feuerlein; F. Dittmar: When alcohol becomes a problem. Helpful information for relatives and those affected. Trias, 1999. Information is conveyed in a question-and-answer style; the authors have cared for alcoholics themselves for years.