OVERVIEW

What is chronic alcoholism?

Chronic alcoholism, also known as "chronic alcohol intoxication syndrome," refers to various physical and mental disorders that occur after long-term heavy drinking (typically over 10 years). Symptoms may include limb tremors, mental delusions, hallucinations, delirium, dementia, and some irreversible pathological damage, such as alcoholic myocarditis, liver dysfunction or cirrhosis, polyneuropathy, degeneration of the central nervous system, or brain atrophy.

Are chronic alcoholism and alcohol dependence the same condition?

No.

The former refers to chronic physical damage caused by long-term alcohol consumption or acute harm from excessive alcohol concentration in the body, while the latter is the body's reaction to reduced alcohol levels. The latter can be significantly alleviated or eliminated when the patient consumes a certain amount of alcohol, whereas the former does not have this characteristic.

Is chronic alcoholism common?

Chronic alcohol intoxication syndrome is common among long-term drinkers, though its severity varies.

SYMPTOMS

What are the common manifestations of chronic alcoholism?

Individuals with chronic alcoholism may exhibit various physical and mental symptoms:

• Mental disorders associated with chronic alcoholism:

  • Patients may display mental agitation, irritability, delirium, or hallucinations (primarily auditory). Their auditory hallucinations can vary, initially presenting as simple sounds like knocking or voices, often accompanied by unease and fear.
  • Long-term alcohol use can also lead to delusions of jealousy or persecution, such as baseless suspicions of a spouse's infidelity or beliefs that others intend to harm them. Alcohol dependence is often present. Chronic heavy drinkers may develop alcohol-induced dementia, characterized by slowed reactions, memory decline, and reduced cognitive and learning abilities.
  • Those with chronic alcoholism may experience mood fluctuations. If you suffer from chronic alcoholism, managing symptoms alongside lifestyle adjustments like meditation, exercise, or counseling can help improve emotional well-being. If someone you know struggles with chronic alcoholism, offer them understanding and support.

• Korsakoff syndrome:

  • Prolonged alcohol consumption can cause severe vitamin B₁ deficiency, leading to brain damage and significant short-term memory impairment. Patients may struggle to recall recent names, places, or numbers, often unconsciously fabricating events or misplacing past memories (confabulation).
  • Disorientation and cognitive disturbances may also occur. These symptoms collectively constitute Korsakoff syndrome, frequently accompanied by neuritis and muscle weakness due to vitamin deficiencies.

• Neurological complications of chronic alcoholism:

  • Chronic drinkers may develop cerebellar ataxia, manifesting as unsteady gait, clumsiness, and tremors, with imaging revealing cerebellar atrophy. Alcoholic peripheral neuropathy is also common, primarily causing numbness, pain, or sensory loss in a "glove-and-stocking" distribution, alongside muscle atrophy, spasms, swelling, and tenderness (alcoholic myopathy).
  • Brain structures like the pons and corpus callosum may also be affected.

• Alcoholic liver disease: Long-term alcohol use can lead to liver conditions such as fatty liver, alcoholic hepatitis, and cirrhosis. Symptoms may include jaundice, fatigue, peripheral edema, abdominal distension, hematemesis, or melena.

• Alcoholic cardiomyopathy: Chronic drinking may cause dilated cardiomyopathy, characterized by left ventricular enlargement and reduced ejection fraction. Patients may experience dyspnea, orthopnea, or paroxysmal nocturnal dyspnea, occasionally accompanied by palpitations, chest pain, or even syncope.

How does chronic alcoholism progress?

Chronic alcoholism develops insidiously, progresses slowly, and may persistently worsen.

What are the severe consequences of chronic alcoholism?

Severe cases can lead to dire outcomes: psychiatric symptoms may result in harm to self or others; neurological complications like pontine damage may cause impaired consciousness; liver damage can progress to cirrhosis or failure; and cardiac impairment may trigger heart failure, severe arrhythmias, or syncope.

CAUSES

Why Does Chronic Alcoholism Occur?

• Alcohol, also known as ethanol, places an increased burden on the liver in long-term heavy drinkers, leading to pathological changes in the liver, such as cirrhosis, and may also directly damage the myocardium and skeletal muscles.
• On the other hand, while ethanol provides energy, it lacks essential nutrients like protein and vitamins. Long-term heavy drinkers often consume significantly less food and experience poor gastrointestinal absorption, leading to malnutrition and vitamin deficiencies. A lack of B vitamins can cause various neurological complications.
• Moreover, ethanol can cross the blood-brain barrier, directly damaging brain tissue, inhibiting brain activity, and causing atrophy and death of neurons in the cerebral cortex.

Under What Conditions Does Chronic Alcoholism Easily Occur?

Chronic alcoholism is more likely to develop in individuals who engage in long-term heavy drinking, typically over ten years, especially when the body and mind become dependent on alcohol.

DIAGNOSIS

How is chronic alcoholism diagnosed?

It is generally diagnosed based on a typical history of long-term heavy alcohol consumption, along with related physical or mental symptoms and signs of chronic alcoholism, combined with auxiliary examinations.

What tests are needed to diagnose chronic alcoholism?

The diagnosis of chronic alcoholism mainly relies on the collection of clinical history. The purpose of testing is primarily to assess the extent of damage caused by alcoholism to the body and to rule out other similar conditions.

• Blood tests (e.g., complete blood count, liver and kidney function, electrolytes, cardiac enzymes, blood gas analysis): Long-term drinkers often exhibit liver dysfunction, myocardial damage, elevated white blood cell counts, and acid-base or electrolyte imbalances.
• Imaging (e.g., MRI or CT of the head): Alcoholism can lead to brain tissue damage and atrophy, which can be assessed through imaging.
• Electroencephalogram (EEG), electromyogram (EMG), or video EEG: These assist in diagnosing suspected peripheral nerve damage or epilepsy.
• Alcohol use screening questionnaires: Such scales help evaluate alcohol consumption and related physical or mental health issues. A psychiatrist may assist in ruling out other similar mental disorders.

What should be noted for a blood gas analysis test?

A blood gas analysis requires drawing arterial blood, typically from the radial artery in the wrist, the dorsalis pedis artery on the foot, or the femoral artery in the groin. The procedure can be relatively painful, and since arterial bleeding is harder to stop, pressure must be applied for at least 10 minutes after the puncture to ensure hemostasis.

TREATMENT

Which department should be consulted for chronic alcoholism?

Depending on the main symptoms, patients may visit neurology, psychiatry, gastroenterology, cardiology, etc.

Can chronic alcoholism be cured?

When the damage is mild, the pathological harm caused by alcohol may be reversible. In severe cases, it cannot be fully reversed, and long-term complete abstinence is required.

How is chronic alcoholism treated?

Treatment involves comprehensive approaches, mainly including:

• First, achieving complete and lasting abstinence with the help of family and society through health education, psychotherapy, and medication;
• Second, symptomatic treatment for physical damage and vitamin deficiencies caused by alcohol, along with supportive care for vital signs and electrolyte imbalances;
• Third, antipsychotic treatment for psychiatric symptoms.

Do chronic alcoholism patients need hospitalization?

Mild to moderate cases can be treated outpatient, while moderate to severe cases require hospitalization, with all alcohol sources eliminated during the stay.

How can chronic alcoholism patients avoid relapse?

Abstinence is the only effective way to prevent relapse. Patients should be supported through social, psychological, medical, and family assistance to successfully quit drinking.

DIET & LIFESTYLE

What dietary precautions should patients with chronic alcoholism take?

Patients with chronic alcoholism syndrome may experience symptoms such as tremors, palpitations, sweating, and loss of appetite during alcohol withdrawal. It is recommended to consume easily digestible foods high in protein and calories, replenish fluids and multiple vitamins, and ensure sufficient caloric intake and electrolyte balance.

For those exhibiting psychiatric symptoms like agitation or delirium, precautions should be taken to avoid choking while eating, and severe cases require immediate medical attention. Patients with significant liver or heart dysfunction may have additional specific dietary requirements.

What lifestyle precautions should patients with chronic alcoholism take?

• Patients experiencing alcohol withdrawal symptoms may become irritable due to tremors, mood disorders, or other systemic discomforts. A quiet environment is advisable, but close family supervision is necessary to prevent accidents like aspiration from vomiting.
• Those with psychiatric symptoms, such as delirium or hallucinations, may exhibit self-harm or harm to others. Family members should provide 24-hour supervision, use soft restraints if necessary, and seek medical help promptly.
• Patients with neurological symptoms, such as unsteady gait, require enhanced supervision to prevent falls. Assistive devices like walkers may be needed.
• Patients with heart dysfunction should avoid strenuous exercise and rest quietly.

PREVENTION

Can Chronic Alcoholism Be Prevented? How to Prevent Chronic Alcoholism?

Chronic alcoholism is entirely preventable:

• Maintaining healthy drinking habits or abstaining from alcohol can prevent the onset of this syndrome.
• Long-term drinkers should be alert to possible alcohol dependence and withdrawal symptoms when experiencing mild withdrawal manifestations (such as hand tremors, palpitations, restlessness, sleep disturbances, etc., occurring within 24–48 hours after stopping drinking). It is necessary to promptly reduce alcohol intake or quit drinking.
• Those who must drink long-term due to work or life demands should also undergo regular check-ups of the liver, heart, peripheral nerves, brain, etc., to monitor for any structural or functional damage.