Alcohol: Addiction and Study

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Alcohol: Addiction and Study
Rehearsal
ARN 2014
Mexico

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Thanks
To our Professor for accepting our project and encouraging us to surpass ourselves in
knowledge and responsiveness.
To my colleagues, partners and friends Lucero and Elías who as a team have become a
molecule of knowledge and have tirelessly invested more than 300 man-hours in defining,
building, researching, contributing, delimiting and grounding all aspects of this project.
To the National Polytechnic Institute (IPN), to the National School of Medicine and
Homeopathy (ENMH), which shelters us and allows us as students (universitas magistrorum
et scholarium), to self-analyze from our perspective and approach the medical challenges,
which under its tutelage, preparation and confidence, we are doctors, contributors and actors
of a firm and sustained, well-founded and scientific solution.
Thank you
The day that as doctors and scientists, we investigate under the sole premise of wanting to
help humanity, that day knowledge will be obtained as clear as water and as solid as
diamond. ARN 2014

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Content
1.- Definition
2.- Concept
3.- Theories
4.- Current situation: •World, •Latin America, •Mexico
5.- WHO classification of the disease
6.- Risk factors
7.- Etiology
8.- Anatomy
9.- Anthropology
10.- Physiology
11.- Neurobiology of addiction
12.- Complications
13.- Signs and symptoms
14- Diagnosis
15.- Prevention
16- Treatment
17.- Background (not included)
18.- Problem statement
19.- Protocol objectives
20.- Variables
21.- Hypothesis
22.- Justification
23.- Research design (not included)
24.- Schedules
25.- Procedure
26.- Results (not included)
27.- Analysis of the results (not included)
28.- Discussion of the results
29.- Conclusion of the results
30.- General conclusion and results
31.- Suggestions

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1.- Definition
Currently, the harmful use of alcohol and drug consumption is one of the biggest public
health problems in the world, due to its high social and economic cost; registering in youth.1
The concept of alcoholism encompasses both addictive behavior to alcohol, as well as the
set of somatic and psychological problems or disorders caused by the use/abuse and
dependence on this substance.
It is considered one of the toxins that accompany and sometimes destroy the bio-psycho-
social environment of the individual and his own life; alcohol addiction is a major physical
health problem.2
The World Health Organization (WHO) states the following: ―Alcoholics are those heavy
drinkers whose dependence on alcohol has reached such a degree that they present notable
mental disorders or interference with their mental or physical health, with their interpersonal
relationships and their social functioning. and economic, or they have clear signs of a
tendency to orient themselves towards such symptoms. That is why, then, such people
require treatment.
2.- Concept
As a more current concept of alcoholism we can cite the proposal by Edwards (1986a) who
points out that alcoholism supposes the establishment of the subject's dependence on
drinking, which manifests itself with the following symptoms:
• Loss of control over drinking, which can manifest itself at the start of consumption
or at the end of consumption once started.
• Need to consume alcohol on an empty stomach, to drink at various times of the
day and to do so before events that cause stress.
• Onset of withdrawal syndrome when you stop drinking, which disappears when you
resume drinking.
• Alcohol tolerance.
• Progressive abandonment of other sources of satisfaction.
• Loss of job, family or friends due to drinking, is
1 V. Vinet Eugenia; Faundez Ximena. Alcohol and drug use in adolescents evaluated through
the MMPI-A. Mental Health 2012.
2 National Autonomous University of Mexico. Alcoholism. Notions, Consequences and Self-assessment

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In other words, consumption persists despite its harmful consequences.
• Short-term memory deficit.
• Loss of awareness of reality and denial of the disease.
3.- Theory
Alcoholism is a problem that has little to do with the type of alcohol consumed, how long one
has been drinking, or the exact amount of alcohol consumed. However, alcoholism has a lot
to do with the person's uncontrollable urge to drink. This definition of alcoholism helps us
understand why for most alcoholics a "little bit of willpower" is not enough to stop drinking.
In science, there are many possible causes of alcoholism. As Marty, M (1969) refers -...it
seems that alcoholism, like fever, is symptomatic of an almost unlimited variety of causes...-
Alcoholism has an origin, for some scientists, physiological; while for another group of
scientists, its origin comes from a psychological factor.
In order to explain the factors that can influence or determine the appearance of alcoholism,
various psychological, sociocultural and biological theories have been elaborated; from
which fundamental conclusions are obtained, being impossible to generalize to the social
stratum, race, creed, age, sex, profession, in a single theory. 3
In countries like Africa and Asia, a large part of the old social controls that existed have been
lost, while in Western countries a lifestyle characterized by excessive consumption has
developed, which has resulted in nearly 70% of The world population consumes beverages
in different proportions. However, alcohol consumption varies by geographic area, being
more common in urban areas than in rural areas.
Social costs appear among people of any socioeconomic level, having a high prevalence
among people of high social classes. As much as in the direct and indirect purchase and
sale, they have been estimated at more than 150 billion dollars,
3 Andres Bello Catholic University. Alcoholism: Generating Factor of Criminogenic Behaviors in
the Intrafamily Environment. March, 2003

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fundamentally valued in losses in production, health care, accidents and crimes.
More men than women consume alcohol in most countries, however these figures have
been equalizing in recent years, since currently for every three men a woman also drinks. In
men, alcoholism is more intense between the ages of 18 and 20 approximately; while in
women the rate of alcohol consumption varies between the ages of 25 and 29.4
These theories are not mutually exclusive, since they allow us to realize that we are facing
a disease with serious repercussions, which causes alterations in the organism and the
psyche of any subject that suffers from it.
1. Psychological Theories.
They study the relationship between disorders and alcoholism. However
psychological differences are found among alcoholics.
Among these are:
a. Anxiety Reduction Theory.
They are based on the ability of alcohol to eliminate tensions; however, the
effect of the drink is not the same in all people, since the effects of alcohol
depend on the dose of ethanol, the social circumstances and the individual's
point of the alcoholic curve.
Some alcoholics and regular drinkers say that alcohol helps them relax and
feel safe in difficult situations.
b. Reinforcement Theories.
They are based on the premise that people start drinking, abusing alcohol, or
simply drink because alcohol gives them satisfaction. Counting two types of
reinforcement. Positive reinforcement can be found in the approval of
friendships, social relationships, stress relief, and the feeling of
independence and power it produces. However, the negative reinforcement
is found in the self-destructive tendency, elimination of unpleasant memories
and violations of any kind.
4 Martinez H, Alejandra. Female Alcoholism: Social Problems. The Window, No. 16/ 2002.

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c. Transactional Theories.
The onset of alcoholism and its persistence are due to communication
problems, which worsen as the disease progresses. Alcoholism is a form of
interaction between the alcoholic and his family, who use alcohol and its
consequences as an excuse for his behavior.
d. Psychodynamic Theories.
This approach coincides with behaviorist theories by stating that the alcoholic
tries to satisfy some personal need with the drink.
Some other theories attribute the origin of alcoholism to the desire to
overcome feelings of inferiority or experience a sense of power. As well as
the need that human beings have for affection and to feel that others care
about them.
e. Personality theories.
They are based on the statement that alcoholism is associated with various
personality traits, having many points in common with Psychodynamic
Theories.
Some investigations have found that alcoholic individuals have a marked
elevation of depression and psychopathic disorders. Some other jobs reflect
problems of aggressiveness and difficulty controlling their impulses.
2. Sociocultural theories.
This model is applied to the study of the historical aspects of alcohol abuse, to the
comparative study of different cultures, to the analysis of its meaning, and to the
promotion of and for society.
Sociocultural theories can be related to drinking habits, and problems arising as a
result of it.
3. Biological Theories.
a. Physiological Theories.

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Alcoholics present too many physiological alterations, since the deterioration
occurs as a consequence of prolonged alcohol intake and a deficient diet;
just as the chemical substances present in alcohol induce a substance similar
to morphine in the brain, which would be responsible for alcoholic addiction.
b. Genetic theories.
Various theories try to explain the etiology of alcoholism from a genetic point
of view; however, it has not been possible to verify even after various studies
have been carried out, since more than anything it affects a psychological,
sociocultural influence.
4.- Current situation
4.1.- World
According to the latest report published by the UN Office on Drugs and Crime (UNODC
2012), global estimates indicate that the prevalence of alcohol use during the month prior to
data collection is 42% (taking into account account that alcohol consumption is legal in most
countries), a figure that is eight times higher than the annual prevalence of illicit drug use
(5.0%). The prevalence of heavy episodic weekly alcohol use is eight times higher than
problematic use of illegal drugs. Drug use accounts for 0.9% of total disability-adjusted life
years lost globally, or 10% of total life years lost as a result of the use of psychoactive
substances (drugs, alcohol and tobacco). 5
Europe is the region of the world where more alcohol is consumed, despite the decrease
observed in relation to the data known for the 70s, which placed the consumption of pure
alcohol per adult/year at 15 litres. European adults aged 15 and over consume an average
of 12.5 liters of alcohol, more than anywhere else in the world, according to a recent joint
study by the World Health Organization and the European Commission.6
5 Erickson, F.: Qualitative Research Methods on Teaching. In MC Wittrock (Ed.), The Research of Teaching.
Madrid. Piados-MEC. 1989.
6 Anderson P, Lars M, Gauden G 2012

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The study divides Europe into four subregions between which there are differences: the
eastern and central countries consume 14.5 liters of alcohol per year, while in the Nordic
area consumption is 10.4 liters per year. In the last 40 years, we have also witnessed a
harmonization of consumption levels in the and although most Europeans consume
alcoholic beverages, more than 55 million adults (15%) abstain. 7
Almost half of this alcohol is consumed in the form of beer (44%), dividing the rest between
wine (34%) and spirits (23%). Within the European Union (EU), the Nordic and central
countries drink mostly beer, while southern Europe drinks mostly wine (although Spain may
be an exception). This is a relatively new phenomenon, with a trend towards harmonization
being observed within the EU in the last 40 years. In most countries, around 40% of
consumption occasions are concentrated at dinner, although, in southern countries, it is
much more likely to consume alcohol at lunchtime than in other regions. While there is also
a north-south gradient in the level of daily consumption, the frequency of non-daily
consumption (eg, drinking several times a week,
According to the 2007 World Health Report, alcohol causes 4% of the burden of disease,
representing 58.3 million disability-adjusted life years (DALYs lost) and 3.2% (1.8 million) of
all deaths. in the world in 2000. Among the 26 risk factors evaluated by the WHO, alcohol
was the fifth most important risk factor for premature death and disability in the world.
Probably the best known international epidemiological study is the so-called Epidemiology
Catchment Area (ECA), carried out in the United States by the National Institute of Mental
Health (NIMH). In this research, a large sample of the population over 18 years of age was
interviewed to determine the prevalence of
7 Sarabia, Bernabe and Zarco, Juan. Qualitative methodology in Spain. Methodological Notebooks
No 22. edited by CIS, Spain. 1997.
8 Anderson P, Lars M, Gauden G. Alcohol in the European Union. Consumption, harm and policy
approaches. Edit. QUIEN. Copenhagen, 2012.

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different mental disorders among which were alcohol abuse and dependence.
The results indicate that 13.5% of the population of that country presented, or had presented
throughout their lives, a disorder due to the use of this substance. Of this percentage, 7.9%
met the dependency criteria, while 5.6% did so for alcohol abuse. Regarding the prevalence
in a period of six months, there was a rate of 4.8%; of which 2.8% presented dependency
and 1.9% abuse. Lastly, in the last month at the time of the interview, 2.8% met the criteria
for either of the two disorders; while 1.7% did so for dependency and 1.1% for the diagnosis
of alcohol abuse9.
In a subsequent study also carried out in the United States, the National Comorbidity Survey,
the percentages are even higher.10 On this occasion, a representative sample of the general
population between 15 and 54 years of age was interviewed and it was found that 14.1% of
the population has presented dependence on alcohol throughout their lives while 9.4% have
been affected at some point by the abuse of this substance. Regarding the prevalence in
the last year, 7.2% also met the criteria for dependency in that period, while 2.5% had
presented abuse. If the results are analyzed according to sex, it is found that in the case of
men the percentage of those affected throughout life by alcohol dependence amounts to
20.1%, while alcohol abuse among them amounts to 12, 5%. Instead,
9 (Regier, Farmer, Rae, Locke, Keith, Judd, & Goodwin, 1990
10 Kessler, McGonagle, Zhao, Nelson, Hughes, Eshleman, Wittchen, and Kendler, 1994
eleven World Health Organization. Global Status Report: Alcohol and Young People. Geneva: WHO; 2007.

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12 Health Secretary. Action Program: Addictions. Alcoholism and Abuse of Alcoholic Beverages.

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4.2.- Latin America
In the year 2000, alcohol was the most important risk factor for health in the Americas in
low- and middle-income countries (including Brazil, Mexico, and most Latin American
countries). Alcohol consumption in Latin America is approximately 40% higher than the
world average. 13
Despite wide subregional variations, the average value of per capita alcohol consumption,
weighted by population, in the Americas is 8.7 liters, which is well above the global average
of 6.2 liters of per capita consumption.14
The Region is diverse when it comes to alcohol consumption. Substance-related burden
refers to at least two distinct dimensions of use: average volume and patterns of use.
Therefore, in order to understand and reduce the burden, both dimensions must be taken
into consideration. fifteen
In developing countries with low mortality rates such as Brazil, Mexico, Chile and others, per
capita consumption is similar to that of developed countries (9.0 of pure alcohol per capita
for persons 15 years of age or older). The estimated percentage of heavy drinkers is slightly
lower (9.1%), with a similar average per capita consumption (14.1 liters per drinker).16
In developing countries with high mortality rates, such as Bolivia and Peru, the average per
capita consumption is lower (5.1 liters of pure alcohol per capita for people 15 years of age
or older), the percentage of heavy drinkers is lower (2.7) as well as the average consumption
(7.61), although the average intake pattern is as high as that of other developing
countries.17
13Marcia Russell, Ph.D. RSA Conference Series, 2010, Epidemiology of Alcohol Use, Abuse,
Dependence, and Morbidity and Mortality; 3-7, 2010
14 Rehm and Monteiro 2009
fifteen Alfredo Saavedra and Javier Mariategui; "Epidemiology of Alcoholism in Latin America" ; 151-
156, 2009 16 Alfredo Saavedra and Javier Mariategui; “Epidemiology of Alcoholism in Latin
America” 120-150, 2009 17 Alfredo Saavedra and Javier Mariategui; "Epidemiology of Alcoholism
in Latin America" ; 113-115, 2009

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4.3.- Mexico
In Mexico, more than 32 million people between the ages of 12 and 65 consume alcoholic
beverages. 19.1 million are men and 13.3 are women.
In Mexico, according to data from the federal government (Secretary of Health and the
National Council Against Addictions), practically eight out of ten men (79%) and five out of
ten women (53%) have consumed alcohol at some time in their lives. . In the country there
are more than 32 million people between 12 and 65 years of age who are drinkers. Are
19.1 million men and 13.3 million women.
But that's not the problem, it's this: three out of ten men (31%) and 6% of women drink
excessive amounts (at least five drinks on each occasion). There are more than 14 million
people (14.2 million) who drink alcohol "under patterns that put their health and that of third
parties at risk." Of that number, more than three million Mexicans drink excessively at least
once a week.
And the most serious: another 3.3 million Mexicans have "severe dependence" on alcohol.
Of the total number of addicts, more than a million and a half require not only "outpatient
treatment" (for example, Alcoholics Anonymous meetings), but also "residential treatment"
(admissions to detoxification and rehabilitation clinics), since their "high-grade" addiction "
causes them a huge "social dysfunction".
Taking care of them would represent for the Mexican State (only three out of ten alcoholics
receive external or internal treatment) a cost of 1.2 billion pesos per year. That is, one
hundred million pesos a month, 3.2 million pesos a day.
This public health problem has severe economic and health consequences:
-One in ten pesos spent by the health sector in the country is allocated to treat conditions
associated with alcohol abuse, such as cirrhosis of the liver, injuries from vehicle accidents,
dependency, and homicides.

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-Four out of ten people who have attempted suicide (44%) have done so under the influence
of alcohol. In seven out of ten completed suicides (77%) the victim was intoxicated with
alcohol.
-The main cause of violence against women is excessive alcohol consumption: in six out of
ten cases of violent women, his partner, he, or both, were drunk.
-In five out of ten homicides the victim was drunk.
-One in ten Mexicans claims to have labor problems due to their alcohol consumption. In
fact, in 10% of deaths due to work accidents, the person affected had ingested alcohol.
-The first cause in Mexico of the so-called Days Lived with Disability (DALY'S), according to
the WHO, is alcohol abuse (6.2% of cases). They are followed by arterial hypertension and
smoking.
-In Mexico, an average of 400,000 traffic accidents are reported each year (Pan American
Health Organization, PAHO), 1,95 every day, 45 every hour, at least one every 1.8 minutes.
-Six out of ten fatal traffic accidents (60%) are related to alcohol abuse: the victims had high
levels of liquid in their blood. 54% of these mishaps occurred Thursday, Friday and Saturday.
- Accidents, which have grown 600% in 15 years, represent the fourth leading cause of
national death: 36 thousand people killed per year, 98 per day, four every hour, one every
15 minutes.
-For every death, more than two additional people are disabled (WHO): 90 thousand a year,
246 per day, ten every hour, one every 7.5 minutes.

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- 35% of traffic accidents with serious injuries are also caused by excess alcohol. 43% of
the injured take up to a year to return to work.
-In nine out of ten accidents where drunken people are involved, there is some type of
physical damage to those affected: pilot, co-pilot, passengers, or third parties, such as
drivers of other vehicles and pedestrians (National Institute of Public Health).
-Losses due to crashes represent up to 2% of the Gross Domestic Product.
-The hospital cost to care for the victims of these 400,000 annual crashes is 6,600 million
pesos a year, 18 million pesos every day, 753,000 pesos per hour.
-Four out of ten accidents (45%) on public roads (not counting vehicular ones) are related
to people under the influence of alcohol.
-One in five people (21%) who enter the emergency services in the country have alcohol in
their blood, practically double that in the United States (11%). Among those who came to
hospitals for trauma and injury, 27% of men and 4% of women had alcohol in their blood.
As an example, in the Federal District, according to the Forensic Medical Service, 848
people died in 2006 under "ethyl intoxication." There were two people a day, one every 12
hours. Why did they die? In the first place, due to traffic accidents (32.7%).
Second, for homicide (quarrels, assaults, revenge, 23.2%). In fourth place, due to suicide
(13.7%).
In third place there were 156 "natural" deaths (18.5%) where people were under the
influence of "ethyl intoxication or other substances". That is to say, it is presumed that they
died... of a drunkenness or a passion. Thirteen people a month died like this. Three every
week.

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Our country has extensive experience in epidemiological and qualitative research on alcohol
consumption. Since the 1970s, studies have been carried out in Mexico with the same
methodology, using uniform collection and analysis techniques for each type of population
studied, which allow us to know the global panorama of the phenomenon of drug use in
different scenarios such as such as the home, schools, and treatment centers.18
Below are the results produced by various institutions as well as by studies carried out in
the country, as a preamble and reference to the results found in the National Survey of
Addictions 2011. 19
Household Surveys20
Various household surveys have been carried out in our country in relation to the use of
substances. Some of them are nationally representative, such as the National Addiction
Survey (ENA) (Secretaría de Salud, 1990, 1994, 1998, 2003, 2009).
Surveys have also been carried out in different cities of the Republic such as Tijuana, Ciudad
Juárez, Monterrey, Querétaro and Yucatán, in 2005.21
The ENA, carried out periodically, has the purpose of measuring the evolution of substance
use and other mental health problems. The last survey carried out in 2008 shows that in
terms of alcohol, abuse/dependence increased from 4.1% in 2002 to 5.5% in 2008. By sex,
both had significant increases (8.3% to 9.7% in men and 0.4% to 1.7% in women).
Student Surveys22
In the country, unfortunately there is still no recent national survey on students. However,
the work with various states has made it possible to have surveys on middle, high school
and college students in Nuevo León (2006), Jalisco and the State of Mexico (2009), as well
as in Mexico City, which has
18 Rodriguez, G.; Gil, J. And García, E.: Qualitative Research Methodology. Cistern Editorial. Spain.
1999. 19 Calderón, G. Campillo, C. Suárez, C. Community Responses to Alcohol-Related
Problems. Mexico: WHO-IMP Monograph.
twenty Gutiérrez R. Databases on alcohol statistics. Alcohol Information Center. Mexican Institute of
Psychiatry. Mexico City, Mexico.
twenty-one Rojas, Fleiz, Villatoro, Gutiérrez & Medina-Mora, 2009
22 Epidemiology of Alcohol Consumption UN (UNODC 2012); 36-39, 2010

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with periodic measurements (every 3 years). There is another group of surveys in this
population that have been reported in the 2008 National Survey of Addictions.
The measurement carried out in Nuevo León23 reports, in relation to alcohol
consumption at some time, this was 43.9% where 44.6% were men and 43.2% women.
For its part, in Jalisco24 it was found with respect to alcohol consumption at some time, its
prevalence in the population was 65.1%, 65.3% in men and 64.9% in women.
In the survey of the State of Mexico25 it is reported in relation to alcohol consumption at
some time, the prevalence in students was 70.8%, with women registering a higher alcohol
consumption (71.9%) in relation to men (69.7%). .
Finally, the measurements of 2006 and 2009 carried out in Mexico City26 regarding alcohol
consumption at some time, in 2006 the prevalence was 68.8% (men 68.2% and women
69.4%); for 2009 this figure increased to 71.4%, being the same percentage for both sexes.
Employee Surveys27
The consumption of psychoactive substances is widespread in the general population, with
the most prevalent consumption being legal substances such as alcohol. In addition to the
strictly health consequences, consumption has repercussions in other areas, including the
social and economic and more specifically in the labor situation and employment and work
conditions.
Focusing on the work environment, alcohol consumption can have important repercussions
for workers, both because it affects the performance of the tasks they have to carry out in
their work environment and because of the socio-sanitary problems that it can generate in
the workplace. family and individual. In addition, in some cases the consumption of these
substances can affect third parties, contributing to cause accidents at work.
23 Villatoro, Gutiérrez, Quiroz, Juárez & Medina Mora, 2007
24 Chávez, Villatoro, Robles, Bretón, Sánchez, et al., 2010
25 Martín del Campo, Villatoro, Mosqueda, Gaytán, López, et al., 2009
26 Villatoro et al, 2009; 2011
27 Epidemiology of Alcohol Consumption UN (UNODC 2012);24-27, 2010

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Some studies show that job insecurity has considerable effects on alcohol use, while the
characteristics of the activity itself have smaller effects. The complex relationship between
employment and consumption of psychoactive substances is, at present, of special interest,
as a result of the economic crisis we are experiencing, which could influence how the
population behaves towards drug consumption. 28
The results of the survey confirm that, as in the general population, alcohol is the most
consumed psychoactive drug in the working population. The prevalence of consumption at
some point in life is 92.7% in men and 87.6% in women, in the last 12 months it is 82.4% in
men and 71.3 in women, in the last 30 days it is 73 7% in men and 53.8% in women and
daily consumption is 15.3% and 4.7% in men and women respectively.
Risk drinkers (more than 20 cc/day for women and more than 30 cc/day for men) are
considered 12.2% of men and 4.9% of women and high-risk drinkers (> 50cc/ day men and
> 30 cc/day women) 5.0% of men and 2.3% of women. 26.5% of men and 14.0% of women
have gotten drunk in the last year. Alcohol binge drinking or binge drinking (consumption of
5 or more standard units of alcohol in an approximate interval of two hours) stands at 19.7%
and 7.7% in men and women respectively.29
The prevalences of all indicators of alcohol consumption are higher among men than among
women. There are no great differences in the prevalence of consumption in life, in the 12
months, in the 30 days or during the weekends according to age group (16-34 and 35-64).
However, the prevalence of daily or weekday consumption is higher in the older age group,
and the prevalence of binge eating and drinking is higher among the youngest.
In the bivariate analysis, the following appear to be clearly associated with daily alcohol
consumption: a low level of income, a low level of education, and working in the primary
sector, in the
28 Cabildo, HM; "Epidemiological considerations on alcoholism and drug addiction in the
Mexican Republic". Neurology, Neurosurgery-Psychiatry, (Mexico), 67: 21-23, 2007
29 From some alcoholisms and some knowledge. Eduardo Menéndez, CIESAS, Othón de
Mendizábal Collection, Mexico, Casa Chata Editions, Mexico

19
construction or hospitality. On the other hand, working in construction and having a night
shift seem to be associated with binge drinking or drunkenness.
Both daily alcohol consumption and high-risk consumption in men is higher among
managers/professionals. In women, the differences are smaller and no significant
differences are found after adjusting for age, educational level, marital status and country of
origin (except in skilled manual workers who consume significantly less than managers and
professionals). 30
Men with part-time/part-time have a greater consumption of high-risk alcohol. In women, this
type of consumption is concentrated in a continuous shift in the afternoon and a
continuous/rotary shift at night. 31 The men who say they perform dangerous tasks or in
painful conditions (heat, cold, bad smells, uncomfortable postures, etc.) are also the ones
who state they consume more alcohol, especially high-risk drinkers or daily alcohol
consumers. Women show a similar pattern. In relation to psychosocial risks, a very
consistent pattern can be seen in men, with alcohol consumption always being higher among
workers who declare that they are exposed to said risks. However, employment conditions
(salary and job security) appear to have little influence on alcohol consumption.
Nearly half of the working population believes that the consumption of alcohol and other
drugs in the workplace is a very important problem that, in addition, can affect productivity
or work performance, lead to bad relationships between colleagues and a bad work
environment, and even , increase the risk of accident at work. However, 8 out of 10
interviewees state that they do not know, or have not known, a partner who consumes
alcohol or other drugs excessively. 32
Alcohol consumption is associated with increased risk of accidents, physical violence, risky
sexual behavior, breast cancer, and causes loss of productivity, family problems, and
cognitive decline in advanced ages. In Mexico, the use of
30 Beary, MD, Lacey, JH, & Merry, J. (1986). Alcoholism and eating disorders in women of fertile
age. British Journal of Addiction, 81, 685-9.
31 Medina-Mora ME., Tapia R., Sepúlveda J., Rascón ML., Mariño MC., Villatoro J. Patterns of
alcohol consumption and symptoms of dependence in the urban population of the Mexican
Republic. Annals 2, Mexican Institute of Psychiatry, 133-137.
32 Calderon. G. and Calbido HM; “Aspects related to the problem of alcoholism in Mexico”,
report presented to the Study Group on Epidemiological Research on alcoholism problems, San
José. Costa Rica, June 2009

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Alcohol is the fourth leading cause of mortality (8.4%),8 involving cirrhosis of the liver,
intentional and unintentional injuries, motor vehicle accidents, and homicides. This
document aims to analyze alcohol consumption in Mexican adolescents and adults with
information from ENSA 2000 and ENSANUT 2006 and 2012 to assist in the design of public
policies for its prevention and control.
Teenagers
The prevalence of alcohol consumption was defined as consumption of an alcoholic drink
on a daily or occasional basis in the last year. Between the years 2000 and 2012, there is
no statistically significant change in the total percentage of adolescents who consume
alcohol (24.8% in 2000; 25% in 2012). 33
In 2012, 28.8 and 21.2% of men and women, respectively, reported consuming alcohol. No
changes were observed in consumption compared to the year 2000.34
Adults
Alcohol consumption among adults was defined as daily or occasional consumption.
Between 2000 and 2012, an increase in the total percentage of adults who consume alcohol
is observed (39.7% in 2000, 34.1% in 2006 and 53.9% in 2012). Among men, the increase
was from 56.1% in the year 2000 to 53.1% in 2006, and to 67.8% in 2012, and among
women from 24.3% in the year 2000 to 18.5% in 2006, and to 41.3% in 2012.35
5.- WHO classification of the disease
Doctor Jellinek establishes as a definition of the alcoholic five groups or categories that, with
the classification established, in his typology, by Professor Don Francisco Alonso
Fernández, have served as a pattern to establish the diagnosis of the individuals who
observe this pathology.36
33 Aubà, J. and Villalbí, JR Consumption of alcoholic beverages in adolescence. Primary Care
3. 4Aubà, J. and Villalbí, JR (2011). Consumption of alcoholic beverages in adolescence. Primary
Care, 11, 26-31.
35 Medina-Mora ME, Natera G. Borges G. Alcoholism and abuse of alcoholic beverages. In:
Mexican observatory on tobacco, alcohol and other drugs. Editor; CONADIC, Ministry of Health,
Editorial; 15-25.
36 Epidemiology of Alcohol Consumption UN (UNODC 2011); 45-48, 2010

21
5.1.-Classification of Alcoholics
According to Professor Don Francisco Alonso Fernández
Regular Heavy Drinker or Habitual Drinker:It is one who often ingests, often on a daily
basis, an amount of alcohol that carries health risks, without ever or almost never becoming
drunk. They regularly and chronically abuse alcohol.
alcoholic drinker:They are those who indulge in alcoholic beverages with irregular
frequency until they cannot take it anymore or culminate at least in a state of intoxication.
The alcoholic is an impulsive drinker. Presents mental dependence for the drink. For the
alcoholic drink represents fighting unpleasant experiences of loneliness, despair, etc.
Mentally ill drinker:that is delivered to the drink in order to modify the experiences and
emotional tensions, produced by a mental illness. Depressed, psychopathic, oligophrenic,
etc.37
5.1.1.-Classification of Alcoholism
According to Dr. Jellinek
Given the different nuances that arise when faced with a unitary definition of alcoholism, it
is for this reason that one should speak of "Alcoholisms" (in the plural, or alcoholic
existences), and not of "Alcoholism" (in the singular, or alcoholic organism), due to the
existence of several species of alcoholism.38
Type <<Alpha>>:Undisciplined and rebellious, no loss of control or ability to refrain.
Psychological dependency. I would agree, with mentally ill drinkers. Type <<Beta>>: Drink as
a social pattern, out of habit, there may be somatic symptoms, such as gastritis, liver cirrhosis,
etc. There is no physical or mental dependence. No withdrawal syndrome. It would be
included within the regular excessive drinkers.
Type <<Gamma>>:Alcohol-adapted metabolism. Physical dependence with accompanying
withdrawal syndrome. Lost of control. There are possibilities of passing from the ―alpha‖ or
―beta‖ types to the ―gamma‖ types, comparable to the type of ―alcohol addict‖ of Alonso
Fernández.
Type <<Delta>>:Great physical dependence, severe withdrawal syndrome "Regular
excessive drinkers" by Alonso Fernández.
37 National Institute on Alcohol Abuse and Alcoholism. The physicians' guide to helping patients with alcohol
problems. Washington, DC: Government Printing Office,
38 Allan, C. (1995). Alcohol problems and anxiety disorders. A critical review, Alcohol and
Alcoholism, 30, 145-51.

22
Type <<Epsilon>>:It is a periodic or intermittent form, ascribing it, in part, to the old
"dipsomania (intermittent form)". Dipsomania, which would be a syndrome in which
occasional episodes of alcohol ingestion stand out, in individuals who, in reality, are not
alcoholics or who are at least in a completely different way from others; in popular language,
"quarterly drinkers".
5.2.-Classification according to Psychology39
All people are alcoholics and are grouped into the following types:
Teetotaler:Those who do not enjoy or show a taste for alcoholic beverages do not generate
interest in continuing consumption.
Social drinkers:They are considered the second type and consume alcohol in activities
such as weddings, fifteen years, however, drinking is not the focus of their meeting and they
do not tolerate getting drunk.
Social Alcoholics:Those who usually get drunk at parties maintain some control over their
behavior, frequent places where they are customers, and drinking does not interfere with
their family or work.
alcoholics:Who are obviously identified by their behaviors associated with alcohol
consumption, unkempt physical appearance and total irresponsibility in the main areas of
their lives.
One of the objectives of this work is to offer information that is as accurate and accessible
as possible on alcoholism so that it can be used not only by professionals and other people
whose work directly affects the recovery of alcoholic patients, but also as informative guide
and for the action of the patients themselves and their families; as well as anyone who
wishes to delve into the subject.
5.3.-Practical Classification
That is why we consider it prudent to offer a classification of alcoholism that serves as a
reference to know the process of evolution of the disease and the individual location point.
Although we know the classifications of Jellinek, Marconi and
39 Allan, C. (1991). Psychological symptoms, psychiatric disorder and alcohol dependence among
men and women attending a community based voluntary agency and an Alcohol Treatment Unit.
British Journal of Addiction, 86, 419-427.

23
others existing in the world, we will only expose here the proposal by Ricardo Gonzáles
Menéndez and Ochoa (1992). For this the easiest understanding and assimilation. This
classification has the following order:
1. Total abstinent:It's the guy who never drinks. Represented by approximately half of
the world's population.
2. Exceptional drinker:It is the subject who drinks occasionally in a limited amount, 1
or 2 drinks, and in very special situations that do not exceed 5 in a year.
3. Social Drinker:This is the name given to subjects who drink without transgressing
social norms and do not meet the toxic and deterministic criteria, since alcohol does
not produce harmful bio-psychosocial effects and they maintain their freedom from
it. Marconi, with criteria of quantity and frequency of consumption, refers to a
category equivalent to this, which adjusts to environments with high rates of
alcoholism but which in Cuba we consider very flexible in its upper limit. This
category, which he calls moderate alcohol consumption or moderate drinker, accepts
drinking more than three times a week, less than the equivalent of a quarter bottle of
rum, a bottle, a bottle of wine or half bottles of beer low graduation, and also includes
up to no less than 12 states of light intoxication per year.
4. Abusive drinker without dependency:It exceeds in quantity and frequency the
socially indicated limits. This is especially important because when exceeding the
referred amount, more than 20% of the calories of the diet are consumed in alcohol,
which shortly leads to the establishment of physical dependence and the move to
the next category.
5. Uncomplicated alcoholic dependent: Physical dependence is established, which
is clinically expressed by the appearance during withdrawal of severe tremors,
nervousness, insomnia, headache, sweating, diarrhea, or subacute Delirium
pictures. However, there are still no complications whose appearance signals the
establishment of the next category.
6. Complicated alcoholic dependent:Psychic complications such as delirium
tremens, alcoholic hallucinosis, alcoholic jealousy delusions and Korsakov's
psychosis set in, or somatic complications such as polyneuritis, cirrhosis,
cardiomyopathies and gastritis appear.

24
7. Complicated alcoholic dependent in final phase:At this stage the physical, mental
and social deterioration is notable and the patient follows the prototype of the skyde
row or the clochard, English and French names for homeless alcoholics. There is
here a reduction in tolerance to the poison and the occasional appearance of
convulsive pictures. Also included here are patients with severe malnutrition and
those with digestive localization cancer as a consequence of the local irritant and
carcinogenic dissolving effect of alcohol.
We must also add that depending on the evolution of alcoholism this can be:
1. Continuous: The abusive behavior is maintained without stages of mitigation.
2. Intermittent: Periods of attenuation or abstinence are achieved for months.
3. Remitter: Prolonged stages of alcohol withdrawal are achieved where the patient
regains his freedom from alcohol.
Now, obviously, one is not born an alcoholic nor does a human being become an alcoholic
in a short time. The development of alcohol dependence can emerge over a period of 5 to
25 years, followed by a relatively consistent progressive pattern. Initially, the individual
experiences a phase of tolerance to alcohol, which results in the ability to consume a large
amount before its adverse effects are noticed.
6.- Risk factors
6.1.- Psychological factors:
The need for comfort for anxiety, conflicts in personal relationships, low self-esteem, etc.
The psychological factors proposed by Bandura and Walters, which emphasize learning by
observing models. The influence exerted by the model depends on its characteristics, such
as its social position, competence, perceived similarity, attractiveness and the existing
relationship with the observer. Bandura points out that those people with whom one interacts
habitually establish behavior patterns that, when observed repeatedly, tend to be learned
more quickly. 40
6.2.- Social factors:
40Alterman, A., Erdlen, F. & Murphy, E. (1981). Alcohol abuse in the psychiatric hospital population.
Addictive Behaviors, 6, 69-73.

25
Certain environments favor alcohol consumption more than others. In certain regions, going
out for wine is the most performed daily social activity. The same can be said of parties for
adolescents in which alcohol consumption is favored and rewarded.
Alcohol consumption and its effects on life and health will not be understandable and
therefore modifiable if it is not seen as a process through which society and culture shape
the ―alcoholization process‖, defined by Eduardo Menéndez. as ―the economic-political
and sociocultural processes that operate in a historically determined situation to establish
the dominant characteristics of the use and consumption of alcohol (including non-use and
non-consumption) by subjects and social groups‖. 41
Anthropology helps to reflect on alcohol consumption as a cultural process. Anthropological
studies on alcohol consumption are abundant. In the case of damages and risks, the
discussion is how they can be avoided or controlled, and for this it is essential to know the
―uses‖ and ―abuses‖ that societies give to alcohol.
The extensive list of situations and properties that are given to alcohol vary from one society
to another and we highlight the following situations, as they explain why alcoholism is such
a frequent phenomenon in our societies:
Thus, we have rites linked to the life cycle: at marriage, at birth, at birthdays, at death, there
is an almost obligatory use of intoxicating drinks.
Alcohol consumption is also a means to formalize agreements, such as when the healer
recommends that spouses in conflict resolve their differences by exchanging bottles of
brandy.42
It is part of initiation rites, for example, at puberty, since drinking or smoking gives adult
status or gender identity rites: a "real man who does not quit", does not refuse alcohol
consumption, or the new image of the self-sufficient woman who drinks alcohol as a symbol
of freedom.
41 American Psychiatric Association, (1980). Diagnostic and statistical manual of mental disorders
(3rd ed.). Washington, DC APA.
42 Aragón, CM and Miquel, M. (1995). Alcoholism. In A Belloch, B Sandin, F Ramos (Eds.).
Manual of Psychopathology. Madrid. Mc Graw Hill.

26
It is a remedy for certain diseases, or it is used to withstand cold, fatigue, pain and even to
ward off hunger. It is given the property of food, appetizer and digestive, which is why it is
common for it to be a daily part of the subject's diet.
Due to its effects on the nervous system, it gives a sense of security and facilitates social
coexistence in the case of family or public parties.
The pleasurable effect of sexual disinhibition causes "escapes" or permissions that
otherwise would not be allowed. 43
Let's add to this mix the publicity and the enormous (giant) profits of the alcohol industry and
governments, since it gives them political control and foreign exchange income through
taxes.
So far we have the two extreme situations where the limits between one and the other are
very indefinite. On the one hand, the consumption of alcohol in a “moderate” and socially
controlled way that has social functions and possible benefits.44
And, on the other hand, alcoholism with an enormous social and human cost that is much
more than a medical problem that causes enormous economic losses (for example work
absenteeism), material damage (accidents), violence, social and family disintegration.
Excessive alcohol consumption has been associated with factors that have become
accentuated in modern societies such as: high levels of stress due to demands,
individualism and competitiveness; enormous loads of frustration in the face of unresolved
needs or expectations; a consumer culture that falsely tries to solve problems45 and that
have their origin in bad relationships and bad social conditions; a powerful alcohol industry
like the tobacco industry and “sophisticated” forms of political control.
43 Baca-Baldomero, E. (1999). Preface. In: M. Bernardo Arroyo and M. Roca Bennasar (Eds.).
Personality disorders. Evaluation and treatment. Barcelona. Masson.
44 Bibb, J. & Chambless, D. (1986). Alcohol use and abuse among diagnosed agoraphobics.
Behavior Research and therapy, 24, 49-58.
Four. Five Bertera, JH and Parsons, OA (1978). Impaired visual search in alcoholics. Alcoholism:
Clinical and Experimental Research,2, 9-14.

27
6.3.-Educational and family factors:
The habits of the parents influence the children. If they grow up in an environment where
alcohol is celebrated as something related to partying, well-being and euphoria, while
reducing fear and anxiety.
The habits of family members and people close to the adolescent have an influence when
setting, maintaining or eliminating their own behavioral patterns. Various authors include
modeling processes as determining factors in the consumption process.46 The role played
by models in the acquisition and maintenance of certain behaviors such as the consumption
of toxic substances or violent behaviors.
Recent studies have found a positive relationship between adolescent alcohol use and that
of their friends, siblings, and parent, in that order.47
In the majority of explanatory models for the initiation of alcohol consumption, having parents
and friends who are consumers are included as a risk factor.
Various theoretical48 and empirical49 studies have confirmed the influence of the
consumption habits of parents and friends on the consumption behavior of adolescents.
Muñoz and Graña found in the case of legal drugs that maternal and paternal figures exert
similar influences on their children's consumption. In the use of psychotropic drugs, the
maternal figure had a greater influence.
It has been observed that adolescents whose models drink are generally more likely to try
alcohol and other drugs. Generally, the consumption of illegal drugs is well preceded by the
consumption of legal substances, the usual process being: alcohol-tobacco-marijuana-other
illegal drugs.
46 Muñoz-Rivas and Graña, 2001; Hombrados and Dominguez, 2004
47 Espada, Pereira and García-Fernández, 2008
48 Becoña, Espada and Mendez
49De la Villa, Rodríguez and Sirvent, 2007; Martinez and Robles; Pons, Secades and
Fernández-Hermida; Font- Mayolas and Plans

28
6.4.- Biological factors: Alcoholism seen as a gender issue
Alcoholism and its consequences take a different form for men and women. This form is
determined, in part by biological issues, but, in a very special way, it is given by social and
cultural issues.
According to the National Survey of Addictions, since adolescence alcohol consumption
begins to be more frequent in men than in women. In the group from 12 to 17 years old, in
the urban environment 35% of the men and 25% of the women consumed a full glass of
alcoholic beverage in the last year and in the rural environment it was 18 and 9.9%, for men
and women respectively. In turn, considering the consumption of 5 drinks or more, it was
more frequent in urban men (10.5%) than in urban women (3.4%), following the same
behavior in rural areas.
Men in a greater proportion consumed alcohol in the last year, drink in greater quantities
and their patterns of consumption, more frequently than in women, are: moderate, high and
customary. In turn, the prevalence of alcohol dependence is more frequent in men than in
women.
It should also be noted that alcohol consumption is experienced differently by men and
women. From the biological point of view, it has been pointed out that women are more
susceptible to acute alcohol intoxication, as well as developing serious liver disease or
breast cancer. From a social and cultural point of view, the experience of alcohol
consumption is also different for men and women. It highlights that the woman suffers from
the alcoholism of the man through the increase in abuse. In the 2002 National Survey of
Addictions, the problems produced by having drunk most frequently reported by men were
precisely those related to arguments or fights with their partner.
In turn, the social stigmatization of drinking is more intense in women than in men, and family
losses are also more frequent. In a study with AA people it was found that 33% of the women
were divorced and only 19% of the men were. In turn, it has been found that women's risk
of suffering physical abuse from their husbands is 3.3 times greater when he is a heavy
drinker.
The harmful effects of alcohol consumption exceed in number and severity the damage
caused by the consumption of other drugs. In recent years, an equalization has been
detected in the patterns of alcohol consumption of adolescent boys and girls,

29
In some cases, there is even a reversal in the trend in favor of greater risk consumption
among them. This fact is worrisome due to the differential aspects of alcohol metabolization
between both sexes that means that, for the same consumption, women reach higher blood
concentrations than men and, therefore, are more affected. This fact is mainly explained by
two factors: a lower activity in women of the alcohol-dehydrogenase (ADH) enzyme
responsible for metabolizing alcohol and a lower amount of water in the female body, which
facilitates a higher rate of absorption of the substance. .fifty
The age, sex and other biological characteristics of the consumer determine the different
degrees of risk. The degree of exposure to alcoholic beverages and the circumstances and
context in which ingestion occurs also come into play. Thus, alcohol consumption ranks third
in the world among risk factors for disease and disability; in the Western Pacific and the
Americas it ranks first, and in Europe, second. In addition, some 320,000 young people
between the ages of 15 and 29 die of alcohol-related causes, representing 9% of mortality
in this age group. In pregnant women, alcohol consumption can cause fetal alcohol
syndrome and complications related to preterm birth, which impair the health and
development of newborns.
7.- Etiology
There is no defined cause of alcoholism but there are factors that may play a role in its
development. People with an alcoholic family member are more likely to develop alcoholism
than others who do not.
8.- Anatomy
A few minutes after ingesting alcohol, it passes into the bloodstream where it can remain for
several hours and from which it exerts its action on the various organs of the body.
Firstly, ethanol affects the normal functioning of the brain, as it interferes with the normal
activity of various neurotransmitters (chemical compounds used by nerve cells to
communicate with each other). Fundamentally aminobuteric acid (gamma, dopamine and
serotonin). This explains the effects felt by all
fifty Franciscus, 2007

30
people when they consume it in abundance. When the concentration is 0.1% (100 milligrams
per 100 milliliters of blood) most individuals present euphoria and disinhibition. As the levels
increase and the figures are 0.2% to 0.3%, its depressant effects are evident with excessive
sleepiness. Values above 0.35% are potentially lethal as they affect the nerve centers that
control breathing. Contrary to what may be believed, alcohol is not a stimulant of the Central
Nervous System but a depressant of it, since the initial sensation of euphoria and
disinhibition is followed by a state of drowsiness with blurred vision, muscular incoordination,
increased time response, decreased ability to attend and understand, muscle fatigue, etc.
.
Ethanol affects the entire body, however one of the most affected organs is the liver. This
fulfills the mission of transforming alcohol into other substances that are not dangerous for
the subject, but it has a limited capacity: it can metabolize between 20 and 30 grams of
alcohol per hour and meanwhile the drink circulates through the blood, damaging the rest of
the body. organs through which it passes.
Excessive alcohol consumption causes heartburn, vomiting, diarrhea, drop in body
temperature, thirst, headache, dehydration, etc. If the ingested doses have been very high
- in the case of acute ethylic intoxication - it can induce respiratory depression, ethylic coma
and occasionally death.
8.1.- Brain:degeneration and atrophy. As the fluidity of neural membranes is modified, the
functioning of the nervous system is impaired.
8.2.- Blood:Anemia: This disease is caused by a lack of red blood cells. Because vitamin
B12 is lacking, the bone marrow does not have all the elements necessary to make the
proper number of red blood cells.
Alcohol abuse that increases resistance to blood flow and can cause disorders in the
circulatory system and bleeding.
8.3.- Heart:The full range of cardiac abnormalities. (Myocarditis).
8.4.- Liver:Liver cirrhosis: it is produced by a degeneration of the cells that make up the
liver. This disease evolves slowly and when it has advanced, it

31
characterized by swelling of the abdomen. In the short or long term, cirrhosis leads to death.
Alcohol-related hepatitis can cause death if the affected person persists in drinking alcohol.
Between 10 and 20 percent of people who consume high amounts of alcohol develop alcohol
cirrhosis or liver damage. But, if you stop taking it, this condition is often reversible.
8.5.- Stomach:Ulcers: corresponds to the partial or total destruction of lining tissues (that
upholster or cover certain organs). Tissue destruction can occur in the skin, stomach, small
intestine, etc. The serious thing about ulcers is that they can injure blood vessels, causing
internal bleeding.
Chronic gastritis: corresponds to an inflammation of the stomach mucosa. Some symptoms
are: intense thirst and loss of appetite, cramps, belching, headache and general body
fatigue.
8.6.- Pancreas:inflammation and degeneration. Pancreatitis: corresponds to an acute
inflammation of the pancreas. This causes poor digestion of food, especially fats. In some
alcoholics, an irreversible alteration of liver function occurs, which can prevent adequate
glycogen storage and favor the tendency to hypoglycemia (decrease in blood sugar) due to
the inability to mobilize glucose.
8.7.- Intestine:Disorders in the absorption of vitamins, hydrates and fats that cause
deficiency symptoms.
Avitaminosis B (lack of vitamin B): the presence of alcohol determines a deficiency of vitamin
B in the body, probably due to poor absorption of it in the intestine and/or its storage in the
liver. Avitaminosis B can cause heart failure in the person, the heart is unable to deliver to
the body all the blood that the body needs. It can be treated by injecting vitamin B.
8.8-. Nerve inflammation:the most characteristic symptoms are muscular disorders. The
person has problems walking and also sensitivity disorders, resulting in tingling on the skin.

32
8.9.- Cancer:Heavy alcohol use over a long period of time increases the risk of developing
certain forms of cancer, especially cancers of the esophagus, mouth, throat, vocal cords,
colon, and rectum. 75% of these types of cancers are attributed to alcohol consumption. In
addition, alcohol enhances the carcinogenic effects of other substances such as tar and
nicotine, so the combination of alcohol with tobacco significantly increases the chances of
cancer. Other studies have shown that women are at a slightly higher risk of developing
breast cancer if they drink two or more drinks a day.
8.10.- Skin disorders:Muscle and bone: severe alcoholism is associated with osteoporosis,
wasting of the muscles with swelling and pain, skin wounds and itching.
8.11.- Sexuality and reproduction:Drunk men lose sexual potency and women are
inhibited desire. Drinking causes major hormonal and menstrual disorders. Thus the
alcoholic is generally impotent, in addition to suffering from other disorders such as
premature ejaculation and delayed ejaculation. The female body contains 5 to 10 percent
less water than the male. This explains why the same dose of alcohol, being more
concentrated in the tissues, has a greater toxic effect. With the same amount ingested, a
woman's blood contains a higher alcohol level than a man's, and hence the intoxication is
faster. In it, the period of time between the first drinking problems and physical dependence
is also shorter. Alcohol decreases fertility, that is,
8.12.- Congenital defects in babies:Alcohol consumed during pregnancy can cause a
number of birth defects in babies, the most serious of which is fetal alcohol syndrome.
Children born with alcohol-related birth defects have learning and behavior problems for the
rest of their lives. In such children, the syndrome is characterized by the presence of a series
of very typical newborn lesions: they are low-birth-weight children, premature, with smaller
heads and eyes, and small palpebral openings, with different types of brain injuries that
cause mental retardation,

33
inadequate development, with a cry different from that of the normal child, with high mortality
and with other associated malformations. It is common for them to present manifestations
of alcoholic deprivation, such as tremors, convulsions, irritability, and frequently the
pregnancy ends in abortion.
As we have seen, alcohol affects all body systems. Causes irritation of the gastrointestinal
tract and erosion of the stomach lining, causing nausea and vomiting. Vitamins are not
absorbed properly, leading to nutritional deficiencies due to prolonged alcohol consumption.
You can also develop liver disease, called cirrhosis of the liver; the cardiovascular system
can be affected by cardiomyopathy; sexual dysfunction presents as erectile dysfunction in
men and with cessation of menstruation in women and, finally, alcohol consumption during
pregnancy can cause problems in the development of the fetus, which is known as
alcoholism syndrome fetal.
9.- Anthropology
Lhe word alcohol is derived from the word “alkehal”, which means the finest, most refined,
and its distillation is ancient. Since ancient times, man has observed that a sweetened fruit
juice exposed to the open air for a few days turns into a concoction that has special
psychotropic properties. Thus he learned to ferment grains and juices to obtain a substance
that gave him a special state. A state that varied in different people according to the amount
ingested and according to the motivations for his interference. We refer to the state of
alcoholic intoxication.
Ethnologists say that there is no town that has not managed to produce fermented
beverages containing alcohol. This fermentation process is probably one of the first
chemical reactions that man knew how to carry out. However, alcoholic beverages can be
obtained by fermentation or distillation, the oldest being fermented, since distillation was
not known until the Middle Ages, which provided stronger drinks.
Many are already the years of history of alcohol and its consumption. According to
archaeological findings, prehistoric man discovered the way to make it around 6,400 BC,
during the Neolithic period. This is how they were born

34
wine and beer, as well as numerous traditional beverages. Existing written reports on the
use of beer, wine and other alcoholic beverages date back to approximately 3000 years BC
and their use has been mainly due to their tonic and euphoric effects that produce feelings
of well-being and joy. Perhaps it is because of these same sensations that fermented drinks
have been the object of simultaneous glorification and abomination.
Due to its properties and the mysteries that were woven around fermentation for many
years, this drink began to be used for mystical or sacred purposes. We can cite as an
example the cult of Dionysus or Bacchus, or the conversion of wine into blood in the
Catholic mass. In the Bible, for example, and especially in the Old Testament, wine is
referred to nearly five hundred times, either to praise it or, on the contrary, to alert men
against its curse. Its excessive use, drunkenness or drunkenness, was considered a vice,
a sin, associated with madness, degeneration and violence.
Fermentation had accompanied man not only in religious rituals but also in those activities
where the effort was greater. Alcohol was the first drug and perhaps this history has
contributed to its legalization.
Despite its customary presence in the history of mankind, it was not until the fifteenth
century that Basil Valentin called..."spirit of wine" that state of euphoria and excitability into
which people "fell". Lowitz being in 1796 the one who first obtained alcohol in its most pure
state, although the distillation process applied to fermented beverages dates back between
the year 800 and 1100 of our era, where the distillation processes appeared, which made
it possible to create spirits with a high alcoholic content, such as whiskey, vodka, rum or
brandy, among others.
Ethyl alcohol or ethanol, with the formula C2H5OH, is a clear, colorless liquid with a burnt
taste and a characteristic pleasant odor that is concentrated by distillation of dilute solutions
where certain dehydrating agents extract the water and produce absolute ethanol. It has a
melting point of -114.1°C, a boiling point of 78.5°C, a relative density of 0.789 at 20°C, and
a freezing point below -40°C. These features greatly expand its use. Most ethanol not
intended for human consumption is synthetically prepared, both

35
from ethanol (acetaldehyde) from ethyne (acetylene), as well as from petroleum ethene. It
is also made in small quantities from wood pulp. The oxidation of ethanol produces ethanol
which in turn is oxidized to ethanoic acid. On dehydration, ethanol forms diethylether.
Butadiene, used in the manufacture of synthetic rubber, and chloroethane, a local
anesthetic, are other of the many chemicals made from ethanol. It is an effective solvent for
a large number of substances and is used in the production of perfumes, lacquers, celluloids
and explosives.
Many opinions and many criticisms have been raised about the properties of alcohol; while
some considered it as something essential to give vigor and youth, in addition to curing a
multitude of diseases, others said that it only causes pathological disorders.
The truth is that in the middle of the 19th century the Swedish doctor Magnus Huss coined
a term on which we have a special interest in this work: Alcoholism. Used to designate the
common denominator of diseases whose cause was ethyl alcohol. The ending in "ism" had
the advantage that it no longer had that affective charge that until then had fatally
condemned those who "liked" it, if they were already doing it for pleasure at that time in
their lives, from the state of intoxication.
By that epoch appear numerous jobs clinical that described
thetoxic consequences of alcoholism, and some sociological aspects, within the
French school Legrain (1889), Garnier (1890), Mignot (1905), etc., and the German
school, at the beginning of this century: Kraepeling, Heilbronner, A Florel, E. Bleuler, etc.
However, at the same time, at the end of the 19th century, a whole pseudo-scientific
literature emerged that obscured the problem of the etiology and pathogenesis of
alcoholism, with moralizing and passionate considerations linked to the reigning theory on
degeneration: alcoholism. it became a vice and an attribute of degeneration.
10.- Physiology
10.1.- Ethanol metabolism

36
Alcohol, like any substance that can be ingested and has a series of effects on the body,
undergoes a series of transformations. The processes of absorption, distribution,
metabolism and elimination of ethanol are briefly described below.
10.2. Absorption
The absorption of ethanol takes place for the most part in the digestive tract. That is, it can
access the bloodstream from the oral cavity, esophagus, stomach, and intestines. However,
it is mainly in the small intestine where absorption takes place. This is due to the presence
in this organ of microvilli that greatly increase the absorption surface.51
The average duration of the gastric ethanol absorption process is 1.7 minutes. However, it
must be taken into account that the absorption time increases depending on the dose. In
addition, there are other factors that affect the bioavailability of this substance, that is, its
concentration in the blood. In the first place, ethanol can remain more or less time in the
stomach; For example, the presence of food slows its passage to the intestine, while mixing
it with soft drinks speeds up this process. In this way, if ethanol remains in the stomach for
a longer time, its metabolism will begin in this organ, based on the enzymes found there.52
On the other hand, genetic differences also influence the enzymatic capacity to metabolize
alcohol and, therefore, the bioavailability of this substance. This implies the existence of
differences based on sex and race. Thus, women having less of the enzyme alcohol
dehydrogenase (ADH) have higher ethanol concentrations for the same consumption than
men. Likewise, there are also racial differences, since a lower activity of this enzyme has
been found in the body of Orientals compared to Caucasians. 53
51 Aragon, Miquel, Correa and Sanchis-Segura, 2002
52 Holford, 1987
53 Aragon et al., 2002

56
Aragon et al., 2002
37
Along the same lines, the level of concentration of the different alcoholic beverages
It also produces differences in the rate of absorption. There is an inverted "U" relationship
between the concentration of the ethyl preparation and said speed, in such a way that it is
when the ethanol concentration is around 40% that absorption is faster.54
10.3.- Distribution
Ethanol is an amphipathic substance, that is, it has a partition coefficient of 0.5, so it
dissolves in lipid and aqueous media. However, it dissolves much better in water, so its
distribution is similar to that of water in the body.
This characteristic of ethanol translates again into differences based on sex. Thus, due to
the differences in the proportion of fat between men and women, the volume of distribution
is different for both (0.7 L/Kg in men compared to 0.6L/Kg in women).
In short, female subjects, due to the higher proportion of fat and the aforementioned lower
expression of the ADH enzyme, in addition to the fact that they generally have a lower body
weight, have higher blood ethanol concentrations for identical consumptions. .55
10.4. Elimination
Although most of the elimination of ethanol occurs through metabolism, there is a small
percentage (approximately 1%) that is eliminated without undergoing any transformation
through its incorporation into urine, feces, sweat and exhaled air.
There is great inter-individual variability, but it is estimated that on average between 10 and
20 mg is eliminated. of ethanol per 100 ml. of blood and time However, various factors affect
this speed, such as: genetic factors, the consumption of sugars, some medicines or tobacco,
and some phenomena linked to tolerance.56
54 Holford, 1987
55 Aragon et al., 2002

59
Julkunen, Tannenbaum, Baraona and Hare,
1985
38
10.5.- Metabolism
The process of ethanol metabolism occurs mainly in the liver, which
oxidizes between 85% and 90% of the ethanol ingested.57 However, as already mentioned,
the process begins in the stomach and small intestine where what is called the first
metabolic step takes place.58 However , the percentage of alcohol eliminated in this first
step, is not irrelevant compared to that metabolized in the liver. In addition, it has been seen
that after chronic administration of ethanol the gastric activity of ADH is reduced, which
further decreases the relevance of this first metabolic step.59
Ethanol is mainly metabolized by oxidation, transforming it into acetaldehyde through the
main work of the alcohol dehydrogenase (ADH) enzyme. There are also two other enzymatic
systems in the liver that make this same reaction possible and that become relevant when
faced with very high levels of alcohol or some deficiency of the main system. These two
systems are the catalase-hydrogen peoxide complex and the ethanol oxidative microsomal
system (MEOS). Next, the acetaldehyde resulting from the previous process is metabolized
to acetate. This function is performed largely by hepatic aldehyde dehydrogenase (ALDH).
10.5.1. Alcohol Dehydrogenase (ADH)
This enzyme has a major role in the metabolization of ethanol. Its mechanism of action
consists of catalyzing the reversible conversion of alcohols to their corresponding aldehydes
and ketones using NAD (Nicotinamide-Adenine-Dinucleotide) as a cofactor.
Human hepatic ADH is a metalloenzyme consisting of two polypeptide chains containing
four grams of Zn per mole of enzyme. In reality, it is an enzymatic complex and, depending
on the amino acids that make up each enzyme, up to 6 different subtypes have been
identified, each one dependent on genes, or at least, different alleles. In fact, the genetic
polymorphism referring to this enzyme complex is what explains the interracial differences
secondary to alcohol consumption already mentioned.60
57 Agarwal, 1998
58 Mezei, 1985

39
10.5.2. catalase
Catalase, in the presence of hydrogen peroxide, catalyzes the oxidation of ethanol to
acetaldehyde.61 Experimental work that tries to clarify the degree of intervention of catalase
in ethanol metabolism is controversial.62 However, it seems that it is in conditions of chronic
consumption when this enzyme intervenes.63
10.5.3. The microsomal ethanol oxidation system (Meos)
The Meos, or microsomal ethanol oxidation system, is located in the endoplasmic reticulum
of cells. This enzyme system is first described by Lieber and DeCarli in 1968, belongs to
the P450 family of microsomal cytochromes, and is often referred to as P450 CYP2E1.
The exact mechanism by which ethanol induces this enzyme is not yet known. Up to now,
the experimental data support a post-transcriptional induction through the stabilization of
the protein as its rapid degradation phase is abolished.64
Likewise, at present it is not possible to determine exactly the contribution of Meos to the
general metabolism of ethanol since, on the other hand, it seems to depend on the type of
consumption. Thus, while in an acute administration of ethanol, this system would contribute
little to its metabolism,65 after chronic administration it would account for 22% of the total
metabolism.66
On the other hand, it should be noted that the genetic polymorphism of this enzymatic
system and its involvement in the differential predisposition to alcoholism is a subject
pending study.67
60 Yin, 1998
61 Keilin, Hartree, 1936, 1945
62 Sanchis, 2000
63 Hawkins and Kalant, 1972
64 Hu, Ingelman-Sundberg, and Lindros, 1995
65 Thurman and Handler, 1989
66 Song, 1996
67 Sanchis, 2000

40
10.5.4. Aldehyde Dehydrogenase (ALDH)
In a second phase, acetaldehyde, which is produced by the oxidation of ethanol from any
of the enzymatic systems described, is in turn metabolized into acetate by the hepatic
aldehyde dehydrogenase enzyme.
In humans, 12 genes encoding different types of ALDH with distinct amino acid sequences
have been isolated. However, there are only two hepatic isoenzymes: cytosolic ALDH1 and
mitochondrial ALDH2; the rest is distributed in other tissues.
Regarding the functioning of this enzyme, it is interesting to mention the contributions of
genetic research. Thus, it has been discovered that there is a genetic variant of ALDH2,
ALDH2*2, which has been found in 40% of Orientals and less than 10% of Caucasians.68
This variant has a low specific activity, therefore , in the individuals that present it, the
oxidation of acetaldehyde is very deficient, producing accumulations of this even with a
moderate consumption of alcohol. Thus, the accumulation of acetaldehyde causes strong
toxic effects and causes the so-called alcohol sensitivity syndrome (flushing response). This
reaction that occurs frequently in Orientals,
10.6 Neurobiology of alcohol use
The neurobiology of alcoholism is a very recent field of knowledge. Studies on the subject,
although more and more numerous, date mainly from the last decade. The marked increase
in research on the neurobiology of addictions is largely explained by the significant
development experienced by brain neuroimaging techniques.
The study of the human brain using brain neuroimaging techniques is making it possible to
obtain new representations of this organ in vivo. On the one hand, structural neuroimaging
offers insight into brain size, such as the degree of dilation of the cerebral ventricles and the
volume of the sulci and fissures of the cortex.
68 Lieber, 1997
69 Erikson, 2001

41
brain, which are indicators related to the degree of brain atrophy. Structural neuroimaging
tests are computerized axial tomography (CT) and magnetic nuclear resonance (NMR).
These techniques, although useful for understanding how alcoholism affects the brain as a
whole, provide less information regarding the processes of acquisition and maintenance of
addiction.
In this sense, the revolution has come from functional neuroimaging techniques that provide
a measure of brain activity, using different indicators. In this way, these tests study cerebral
blood flow (CBF), related to neuronal metabolism and general brain functionalism. Likewise,
they evaluate cerebral blood oxygenation and the distribution of neurotransmitters in the
brain, by measuring the number of receptors or the neurotransmitter transporter. Functional
neuroimaging tests include positron emission tomography (PET), single photon emission
computed tomography (SPECT), and functional magnetic resonance imaging (FMR).
Based on these techniques, the knowledge of the mechanisms of action of ethanol in the
brain has been deepened, the knowledge of the Cerebral Reward System has been
improved and it has been possible to determine, at least in part, which are the
neurotransmitters involved.
10.6.1.- Mechanism of action
Alcohol consumption affects neural communication systems in multiple ways, from simple
individual interneuronal communication to the complex neural pathways that interconnect
different brain areas and constitute a higher level of complexity within the nervous system.
Although for years it has been considered that ethanol lacked specific neuronal receptors,
proposing the effect of this substance on the cell membrane itself as a mechanism of action,
these approaches are currently being modified.
Thus, ethanol interacts with certain proteins that are located in the neuronal membrane and
are responsible for signal transmission. Most of the actions of ethanol are due to two specific
receptors: the receptor

42
GABAA (or GABAA -ionophore CI-) of the amino acid GABA and the NMDA (N-methyl-D-
aspartate) receptor of glutamate. GABA is the inhibitory neurotransmitter par excellence of
the Central Nervous System, that is, the neurons that use it temporarily decrease the
responses of other neurons to subsequent stimuli. For its part, glutamate (together with
aspartate) is the excitatory neurotransmitter par excellence, thus, the response of neurons
innervated by glutamatergic neurons is increased. Ethanol potentiates the action of GABA
and antagonizes the action of glutamate, so that at the brain level ethanol potentiates the
inhibitor and inhibits the excitator. Therefore, its actions are properly those of a depressant
of the CNS.70
10.6.2.- The theory of alteration of the neuronal membrane
Since Chin and Goldstein (1981) published a study carried out with mice, the hypothesis of
impaired membrane fluidity has gained enormous importance. This work analyzed the "in
vivo" and "in vitro" biophysical effects of ethanol on the synaptic and erythrocyte membranes
of mice to which ethanol was administered both acutely and prolonged. This hypothesis
proposed that the acute effects of ethanol are due to to an increase in the fluidity of the
neuronal membrane, so that chronic consumption would compensatoryly increase the
rigidity of the membrane, with the consequent alteration of functions.
However, although there have been many subsequent studies aimed at testing this
hypothesis, there is as much evidence for as against it.71
The starting point of this model resides in the fact that the special composition of the ethanol
molecule gives it the possibility of being soluble in water and in lipids at the same time. Due
to these characteristics, effects on the physicochemical and biological properties of
neuronal membranes are attributed to alcohol.
In any case, it seems that the main support for this theory resided in the fact that no specific
receptors for ethanol had been found, so it was thought that its ability to influence the CNS
was based on its ability to alter the membrane of the neuron itself. thanks to its lipid solubility.
However, some authors discard this model due to its inability to explain
70 Nutt, 1999
71 Sanchis, 2000

43
the most characteristic alcoholic actions such as intoxication, blackouts, the tolerance
phenomenon and hyperexcitability present in the withdrawal syndrome.72 Likewise, other
authors affirm that the interaction of alcohol with the lipid membrane does not justify the
alterations that occur after alcohol use. consumption of small doses, such as the anxiolytic
effect, euphoria, cognitive deficit or lack of coordination.73
Likewise, against the hypothesis of membrane alteration, the results of recent studies can
be used that provide data on the existence of the two specific receptors for alcohol
mentioned above, which are detailed below.
10.6.3.- The GABA receptor
The GABAA receptor-CI ionophore complex is a protein made up of five subunits,
assembled to form a channel inside it, which crosses the neuronal membrane.
The GABAA receptor has specific binding sites, including the site on which GABA acts, the
benzodiazepine binding site, and the site on which barbiturates act. Ethanol does not act
directly on these three sites but enhances the actions of compounds that act on any of them.
Consequently, ethanol favors the flux of chlorine induced by GABA, benzodiazepines, and
barbiturates, not because it opens the channel per se, but because it potentiates the action
of the substances that open it. In parallel, the antagonists of these substances tend to
antagonize the action of ethanol.
It should be noted that GABA potentiation by ethanol does not occur in all brain regions, nor
in all cell types of the same region, nor even in all GABAA receptors of the same neuron.
One possible explanation lies in the heterogeneity of the subunits that make up the GABAA
receptors.74
Lastly, it should be noted that the role of these receptors in alcoholism may
72 Diamond and Gordon, 1997
73 Grace, 1989; Goldstein, 1996
74 Ayesta, 2002

44
be key even in the development of this disease. Thus, some researchers have confirmed a
decrease in the number of GABA receptors in the cerebellum and cortical regions of
alcoholics.75 However, the interpretation of this data is not clear, since it may be the result
of years of abuse or constitute a marker of vulnerability prior to alcoholism.
In this sense, studies on children of alcoholics, who are a risk group for the development of
alcoholism, are useful. Some studies report that these subjects have decreased sensitivity
to alcohol and an increased euphoric response to benzodiazepines (BZDs), suggesting a
shared vulnerability to both alcohol dependence and BZDs in these subjects.76
10.6.7.- The NMDA receptor
The NMDA receptor, one of the main glutamate receptors, is coupled to a cation channel.
Its activation leads to an increase in the permeability of NA+, K+, and Ca 2+, which causes
depolarization of the neuronal membrane. The acute action of ethanol on this receptor is to
decrease the flow of Ca+ through the channel, which is the opposite action to that of
aspartate.77
The antagonistic action of ethanol against NMDA receptors occurs at concentrations above
100mg/dl and is responsible for part of the effects of alcohol intoxication, such as
blackouts.78
In any case, it is unknown exactly how the effect of ethanol on the NMDA receptor is
produced, since the blocking action does not seem to be exerted on the glutamate binding
site or on the modulatory sites known at the moment. Likewise, as in the GABAa receptor,
there is great local and regional variability in the actions of ethanol on the NMDA receptor.79
75 Abi-Dargham, Cristal, Anjilvel, Scanley, Zoghbi, Baldwin et al., 1998
76 Schuckit and Smith, 1996
77 Wirkner, Poelchen, Koles, Muhlberg, Scheiber, Allgaier, and Illes, 1999.
78 Eckardt, File, Gessa, Grant, Guerra, Hoffman, Kalant, Koob, Li, & Tabakoff, 1998
79 Ayesta, 2002

45
10.7.- The brain reward system
Ethanol, like any substance capable of generating dependency, has intrinsic reinforcing
properties. Half a century ago, it was clearly documented that drugs of abuse could act as
reinforcers and it was also verified that their mechanism of action was very similar to that of
natural reinforcers.80
Thus, although at the beginning it was thought that the basic motivation to consume any
drug was to avoid withdrawal syndrome or some underlying pathology, the hypothesis was
subsequently consolidated that the reinforcing effects of these substances are more related
to their ability to stimulate the systems brain reward.81
The "Brain Reward System" (CRS) was described for the first time by Olds and Milner in
1954, with a methodology of intracranial electrical stimulation. These authors, in their studies
with experimental animals, verified how they struggled to achieve electrical stimulation of
certain brain areas.The model of brain stimulation reward opened an important field of study
on the interaction between the action of a drug and the activation of the CRS.Subsequent
studies confirmed that some of the substances of abuse increased the sensitivity of animals
to electrical stimulation in some brain areas.82
It is currently accepted that drugs act on a certain neurobiological substrate, which is the
CRS, which explains their ability to powerfully influence individual behavior. These brain
circuits that are involved in the genesis and maintenance of addictive processes include
different brain regions and pathways. The mesolimbic dopaminergic system has special
importance, within which the medial prosencephalic bundle stands out, formed by a group
of dopaminergic neurons that connect the ventral tegmental area with the prefrontal cortex,
passing through the nucleus accumbens, which plays a central role in the circuit. Although
the involvement of dopamine in this circuit is essential, non-dopamine neurons are also
involved, such as encephalinergic and/or GABAergic ones.
80 Nichols, Headlee, and Coppock, 1956
81 Jiménez, Ponce, Rubio and Palomo, 2003a
82 Killam, Olds and Sinclair, 1957

46
In any case, other brain structures are also involved in addictive behaviors. Among them,
amygdala and hippocampus, some motor structures, Meynert's basal nucleus, the
pedunculo-pontine nucleus and the locus coeruleus.
Therefore, the SRC includes a set of closely connected brain nuclei forming a functional and
anatomical circuit that has been called the limbic-motor reinforcement circuit.83 Among the
various connections that it includes, the following can be highlighted:84
• The ventral tegmental area sends dense projections to the nucleus
accumbens, the medial frontal cortex, and the lateral hypothalamus.
• The medial prefrontal cortex, the lateral hypothalamus, and the hippocampus send
powerful impulses to the nucleus accumbens.
• The nucleus accumbens and the frontal medial cortex project to the ventral
tegmental area.
• The nucleus accumbens projects to the lateral hypothalamus.
10.8.- Neurotransmitters involved
At the neurochemical level, the neurotransmitters involved in the drug addiction
phenomenon have been analysed. These substances are amino acids that have a
fundamental role in the transmission of nerve impulses between neurons and therefore
intervene in one way or another in all brain processes. There are 100 different types of
neurotransmitters, several of which are involved in the effect of alcohol on the brain.
On the one hand, as has already been pointed out, in alcohol dependence there is a
hyperfunction of GABAergic neurotransmission, that is, of gamma-aminobutyric acid, which
seems to have an important weight in the reinforcing effect of ethanol.85 On the other hand,
the exact function of the glutamate neurotransmitter is still poorly understood. In any case,
it has been seen that the chronic administration of ethanol induces a decrease in GABAergic
neurotransmission and an increase in glutamatergic neurotransmission that contributes to
neuronal hyperexcitability and convulsive crises that can appear during alcohol withdrawal
syndrome.86
83 Watson, Trujillo, Herman, and Akil, 1989
84 Jimenez et al., 2003a
85 Guard, Segura, Gonzalo, 2000
86 Guardia and Prat, 1997

47
There are fewer studies on the role of glycine. This amino acid is like GABA, an inhibitory
neurotransmitter of the Nervous System. Alcohol has been shown to increase the functions
of glycine-strictin receptors without altering the fluidity of the lipid phase of the neuronal
membrane, which may explain part of the acute effects of ethanol consumption.87
10.8.1.- Dopamine
In any case, dopamine has undoubtedly been the most studied neurotransmitter in
addictions. This has been the case since the discovery that the medial prosencephalic
bundle, the central core of the CRS, is mainly made up of dopaminergic neurons, which
attributes an essential role to them in the experimentation of reinforcement associated with
drug use. Subsequently, it has been found that this neurotransmitter is also involved in the
desire to consume and therefore in relapses, as well as in the appearance of withdrawal
syndrome.
So, dopamine also seems to be involved in the craving effect. Various studies have
determined that the alterations in the dopaminergic neurotransmission system, which occur
as a consequence of the chronic consumption of psychoactive substances, could constitute,
at least in part, the neurobiological substrate of the intense and prolonged desire for a drug.
In fact, the results of several studies suggest that low levels of dopamine in the synapses of
the basal ganglia, or a higher density of D2 dopamine receptors, could be related to early
relapse in alcoholic patients, which in turn could be related to mediated by the craving
effect.88
In their attempt to explain why the desire to consume persists for so long that it precipitates
relapses, Robinson and Berridge (1993) develop the theory of incentive sensitization. This
model explains how the intermittent administration of drugs causes lasting modifications in
the systems involved in the motivational processes of incentive and reward. These
modifications are due to neuroadaptive changes that leave neurotransmission systems
hypersensitive to drugs and related stimuli. This increases the ability of the stimulus to be
attractive to the individual based on the
87 Valenzuela and Harris, 1997
88 Guardia et al., 2000

89
Jiménez, Ponce, Rubio and Jiménez,
2003b
90
Wise, 1996
48
previous experience, which is called ―incentive salience‖. This process induces a
compulsive pattern of consumption so that once it has started, the subject loses control.
This model suggests that there is a fundamental difference between the process of desiring
an incentive "salience" and the process of liking an incentive "pleasure", which would be
mediated by different neurobiological substrates. It is interesting to note that addicts report
that although the subjective pleasure "like" a drug remains constant or even decreases with
prolonged use, the craving "desire" increases with experience. Robinson and Berridge
(2000) provide evidence that the mesotelencephalic dopaminergic system mediates the
desire for the incentive and not the pleasure produced by it,
In summary, sensitization is considered by these authors as the progressive increase in the
reinforcing effects of drugs during the acquisition of behavior, which implies a change in the
salience of the incentive (desiring) and that increases with repeated exposure to the drugs.
drugs. This is attributed to the sensitization of the mesocorticolimbic dopaminergic system
whose overactivity represents the breakdown of homeostasis and triggers the craving
experience.89
On the other hand, some studies have highlighted the role of dopamine in mediating the
withdrawal syndrome. The neuroadaptation processes subsequent to the continued
administration of drugs seem to be related to the phenomenon of dopaminergic depletion
that occurs after cessation of ethanol consumption and which is related to the "rebound
effect" of depression of the CRS.90
In any case, it seems clear that ethanol increases the firing of dopaminergic neurons in the
ventral tegmental area, as well as the release of dopamine in the nucleus accumbens. On
the other hand, in line with what was mentioned with the GABA receptors, there could also
be some kind of vulnerability marker here. Thus, in animal studies it has been shown that
rats with a high preference for ethanol release more dopamine in the nucleus accumbens
than rats with a low preference.91

95
Schulteis and Koob,
1994
96
Guardia et al., 2000
49
10.8.2.- The opioid system
On the other hand, the brain synthesizes opioid peptides, such as endorphins or
enkephalins, which act as endogenous transmitters in the opioid receptors involved in
different functions such as appetite, pain or the stress response.92
The opioid system is also implicated in alcohol addiction.93 It seems to have a role as a
mediator of the reinforcing effects of alcohol and as a modulator of its consumption, being
also involved in the effect of lack of control. It should be noted that the involvement of the
opioid system in addictive phenomena occurs largely through its incidence in the activation
of the dopaminergic reward system,94 which, as has been seen, is key in almost all
addictive processes.
Dopaminergic activity through two different mechanisms: a direct inhibitory effect on these
cells, and an increase in the synthesis and release of dopamine in the cells of the ventral
tegmental area that project onto the accumbens and in turn inhibit it.95
When ethanol is administered acutely, it causes activation of opioid receptors, which is
probably due to the release of endogenous opioids, particularly p-endorphin. On the other
hand, its chronic administration can produce changes in opioidergic neurotransmission,
altering the sensitivity of opioid receptors.96
Thus, it seems that this substance, through an indirect effect of activating certain opioid
receptors, produces the release of dopamine in the nucleus accumbens, which again is
related to the craving effect and alcohol-seeking behaviour. In fact, the administration of
opioid antagonists (naloxone, naltrexone) reduces the oral administration of ethanol,
indicating that certain
endogenous opioid peptides increase ethylic reinforcement.97
91 Ayesta, 2002
92 Nutt, 1996
93 Davis and Walsh, 1970
94 Jimenez et al., 2003b

102
Tomkins and Sellers,
2001
50
10.8.3.- Serotonin
Serotonin also appears to be involved in alcohol dependence processes.98 Different studies
suggest that serotonergic dysfunction may increase biological vulnerability to alcohol
dependence. Thus, a low level of serotonin reuptake in the CNS (measured with 5HIAA
levels in CSF) has been associated with the genesis of alcohol abuse and impulsive-
aggressive behavior. Likewise, in early-onset alcoholics this finding is associated with a
more severe course of alcoholism and impaired social functioning.99
On the other hand, it seems that chronic alcohol intoxication reduces the density of the
serotonin transporter, which is associated with anxiety and depression, which in turn
increases the risk of relapse in alcoholics.100
11.- Neurobiology of addiction
11.1.- Brain reward circuit and drugs of abuse
Addiction to drugs of abuse can be considered a disease of the brain reward system.101
Substances of abuse are capable of modulating this circuit, which is essential in the initiation
and maintenance of behaviors that are important for survival, such as eating or sexual
activity. The medial telencephalic fasciculus, which connects the ventral tegmental area with
the nucleus accumbens, were the first structures identified in this system. Also involved in
the circuit are projections from the ventral tegmental area and the nucleus accumbens that
innervate other limbic (such as the amygdala) and cortical areas of the brain important for
expressing emotions, reacting to certain stimuli, and the ability to make plans. and make
judgments.102
Although the medial telencephalic tract is made up of neurons containing dopamine,
serotonin, and norepinephrine, it is dopaminergic projection that has been
97 Di Chiara, Acquas and Tanda, 1996
98 Camí and Farré, 2003
99 Heinz, Highley, Gorey, Saunders, Jones, Hommer et al., 1998
100 Guardia et al., 2000
101 Vetulani, 2001

107
Laviolette and Van der Kooy, 2003; LeMoal et al, 1979; Pettit et al, 1984; Rassnick et al,
1993a,b
51
classically more involved in reinforcement. Thus, both natural (food, sex) and artificial (drugs
of abuse) reinforcers activate this pathway (also known as
―dopaminergic mesocorticolimbic pathway‖), thus producing an increase in dopamine
release in the nucleus accumbens.103 Dopaminergic neurons are activated by stimuli that
lead the animal to perform or repeat a specific behavior (motivational stimulus).104
From an evolutionary point of view, the brain reward circuit increases survival because it
gives priority to essential actions for living beings, such as reproduction or feeding; globally,
this system plays an essential role in cognitive, reinforcement, and motivational
processes.105 However, naturally pleasurable activities are controlled by feedback
mechanisms that activate aversive centers and put an end to those behaviors, while those
restrictions do not. appear in the case of drugs of abuse. There are several groups of
substances that activate the reward circuit and that can lead to drug dependence, which in
humans is a chronic and recurring disease, characterized by an absolute loss of control over
the drug, and in which craving, desire (in English,
Despite the great importance played by the dopaminergic mesocorticolimbic system, in
recent years it has been shown that the acute reinforcing properties of various drugs of
abuse are independent of the dopaminergic system, since rodents that inactivate this
system continue to show positive reinforcement. after the administration of alcohol, heroin
and nicotine.107 There is currently a consensus that addiction, at the brain level, is the
product of progressive dysregulation and multiple pathophysiological changes in many brain
structures and systems, not just the mesolimbic dopaminergic system. Thus, the striatal-
palidal-thalamic circuit participates in the transition from motivation to
103 Tomkins and Sellers, 2001
104 DiChiara, 1997
105 Lupica and Riegel, 2005
106 Vetulani, 2001

112
Vetulani, 2001; Weiss and Porrino, 2002; LeMoal and Koob,
2007
52
action,108 while the prefrontal cortex has an important role in the self-regulation of behavior
and its pathology in self-control problems.109 On the other hand, a primary aspect in
emotion and motivation depends on the assessment of external environmental stimuli.
Interconnected brain areas such as the amygdala, ventral striatum, and prefrontal cortex
depend on this assessment.110 In addition, stress brain circuits are involved in initial
vulnerability to drugs of abuse, negative reinforcement associated with withdrawal—both
acute late- and stress-induced relapse.111
11.2.- Alcohol as a drug of abuse
Caffeine and nicotine aside, alcohol is by far the most commonly used legal drug. The
addictive behavior associated with alcoholism is characterized by a compulsive
preoccupation with obtaining alcohol, loss of control over consumption, and the
development of tolerance and dependence, as well as deterioration in social and work
relationships. Like other addictive disorders, alcoholism is associated with a chronic
vulnerability to relapse after cessation of alcohol use. The reasons that lead to excessive
alcohol consumption in some individuals and not in others are complex, since they respond
to the interactions that occur between genetic, psychosocial, environmental and
neurobiological factors.112
11.3.- Pharmacology of alcohol
Ethyl alcohol or ethanol (CH3-CH2-OH) is a clear, colorless, volatile, flammable, water-
soluble and fat-soluble liquid, although to a lesser extent. Regarding its nutritional value, 1
gram of alcohol provides the body with 7.1 Kcal; however, this energy contribution is not
accompanied by a nutritional contribution, such as minerals, proteins or vitamins. Although
the main responsible for the actions is alcohol, other compounds that are present in
alcoholic beverages can contribute to increase the damage when drunk in excess; among
them are low molecular weight alcohols (methanol, butanol), aldehydes, esters, histamine,
phenols, tannins, iron, lead, and cobalt.113
108 Kelly, 2004; Mogenson et al, 1980
109 Arnsten and Li, 2005; Dalley et al, 2004; Miller and Cohen, 2001
110 Cardinal etal, 2002
111 Goders, 1997; Kreek and Koob, 1998; Piazza et al, 1996; Piazza and Le Moal, 1997, 1998

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