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THE PROBLEM OF CHRONIC ALCOHOLISM REMAINS ONE OF THE MOST
PRESSING ISSUES OF OUR TIME DUE TO ITS HIGH PREVALENCE AND SEVERE
MEDICAL AND SOCIAL CONSEQUENCES
1
Izzatova Farangiz Komiljon qizi
2
Javliyev Faxriddin Salohiddin o‘g‘li
3
Sharapova Dilfuza Nematillayevna
1-2
Student of group 505 of the Faculty Medical Pedagogy of Samarkand State Medical
University, Samarkand, Republic of Uzbekistan
3
Course of Psychiatry, Clinical ordenator, Samarkand State Medical University, Samarkand,
Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.14926670
Abstract.
Alcoholism is a chronic, progressive disease characterized by a pathological
craving for alcoholic beverages, leading to both psychological and physical dependence. It is
accompanied by the development of withdrawal syndrome when alcohol consumption is
discontinued, as well as persistent somatoneurological disorders and progressive mental
degradation. The long-term effects of alcoholism include severe damage to multiple organ systems,
cognitive decline, emotional instability, and significant impairment in social and occupational
functioning. Additionally, the disorder contributes to an increased risk of psychiatric
comorbidities, including depression, anxiety disorders, and personality changes, further
complicating the treatment process and overall prognosis.
Keywords:
chronic disease, progressive disease, pathological craving, alcoholic
beverages, psychological dependence, physical dependence.
Introduction.
Nowadays, alcoholism, like many other diseases, is viewed from a
multifactorial perspective, considering the interplay of genetic predisposition and social influences
in determining both the onset and severity of the pathology. Research has demonstrated that
hereditary factors significantly contribute to an individual's susceptibility to alcohol dependence,
while environmental and social conditions, such as family upbringing, peer influence,
socioeconomic status, and cultural attitudes toward alcohol consumption, play a crucial role in
shaping drinking behaviors and addiction risk [1-3].
Given current trends, realistic forecasts for the near future indicate the inevitable increase
in the significance of alcohol and other psychoactive substance dependence as a major public
health issue.
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The growing prevalence of substance abuse, coupled with its profound medical,
psychological, and socioeconomic consequences, underscores the urgent need for comprehensive
prevention, early intervention, and effective treatment strategies to mitigate the rising burden of
addiction on individuals and society as a whole [4-7].
The issue of alcoholism has always been a subject of great concern for specialists from
various fields, as it is a complex and multifaceted problem that affects individuals and society on
multiple levels. Psychiatrists and addiction specialists have traditionally viewed alcoholism
primarily as a psychiatric disorder, emphasizing its classification as a chronic mental illness
characterized by compulsive alcohol consumption, loss of control over drinking behavior, and
withdrawal symptoms upon cessation [8-10].
Objective:
This article provides an in-depth discussion on alcoholism, including its
psycho-physiological and social consequences, as well as the neuroendocrine changes associated
with it. The pathological, psychological, and physical dependencies resulting from alcoholism, the
contributing factors, and the approaches to treatment and therapy are analyzed.
Psychologists, on the other hand, have focused on the role of personality pathology and
psychological predispositions, investigating how emotional distress, trauma, and cognitive-
behavioral factors contribute to the development of alcohol dependence. From a sociological
perspective, alcoholism has been considered a social disease, as its prevalence is heavily
influenced by cultural norms, family dynamics, peer pressure, and socioeconomic conditions [11-
14].
Meanwhile, physicians and internists have contributed to the understanding of alcoholism
from a medical standpoint, coining the term "alcoholic disease" to describe the wide range of
physiological and systemic complications associated with chronic alcohol consumption, including
liver damage, cardiovascular disorders, and neurological impairments [15-18].
This diverse and interdisciplinary approach to studying alcoholism reflects not only the
complexity and ambiguity of its origins and progression but also its significant medical and social
implications. The interplay of genetic, psychological, social, and environmental factors highlights
the necessity of a comprehensive, multidimensional strategy for the prevention, diagnosis, and
treatment of alcohol dependence [19].
There are several factors that determine the structural and dynamic forms of a disease: the
toxic factor, the addictive factor, and the hereditary factor, which combines the genetic and
constitutional traits of patients. These elements interact in such a way that the disease can manifest
differently depending on the individual’s genetic predispositions and constitutional traits.
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Thus, stable characterological differences could serve as the foundation for the typology of
clinical variants of the disease, which may differ significantly from one another across various
patient groups. These variants may be influenced by factors such as environmental conditions,
lifestyle, and underlying genetic or constitutional characteristics, leading to a diverse clinical
presentation among individuals with the same disease [20-24].
The clinical presentation and treatment of alcoholism are largely influenced by the
constitutional characteristics of the hypothalamic-pituitary-adrenal (HPA) axis response. This
system plays a critical role in the div's reaction to stress, and its functioning may vary based on
individual physiological traits. Furthermore, there is a background factor that takes into account
the life situations in which the disease develops [25-27]. These include the influence of an
antisocial or adverse social environment, psychotrauma, and reactive formations. Additionally, the
forms and effectiveness of previous alcohol-related treatments, as well as the disease's
pathomorphosis (the changes in tissue structure and function over time), are important factors.
Such variables interact to shape the course of alcoholism, highlighting the need for
personalized approaches to treatment that consider both the biological and social aspects of the
condition [28-31].
The high prevalence of chronic alcoholism around the world is evident. According to
literature, approximately 40% of men and 10% of women who are admitted to therapeutic hospitals
suffer from alcoholism. Unselected screening of patients entering therapeutic departments reveals
that 33% of men of working age regularly consume alcoholic beverages in doses that are hazardous
to health. This behavior is directly or indirectly linked to somatic pathology that results from
chronic intoxication. The long-term effects of alcohol abuse can lead to a range of physical health
issues, such as liver disease, cardiovascular problems, and neurological damage [32-35].
Furthermore, the persistent nature of alcoholism means that it not only affects the
individual's health but can also impact their ability to function in daily life, contributing to social
and occupational dysfunction. This highlights the urgent need for early detection and targeted
interventions to address both the physiological and psychological aspects of alcoholism [36-38].
Considering that patients suffering from substance abuse make up a significant portion of
the psychiatric hospital population, it becomes clear that this issue is one of the most pressing
challenges today. The impact of drug addiction extends beyond just physical health; it involves
severe psychological, social, and behavioral consequences. Individuals affected by substance use
disorders often experience a range of psychiatric symptoms, including mood disorders, anxiety,
and psychosis, which further complicate their treatment and recovery [39-42].
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795
Moreover, drug addiction often intersects with other social issues, such as poverty, crime,
and family instability, making it a multifaceted problem that requires comprehensive intervention.
Therefore, addressing drug addiction in psychiatric settings is not just about treating the
addiction itself but also tackling the broader mental health and societal factors that contribute to it
[43-45].
According to the World Health Organization (WHO) data from 1997, approximately 10%
of men and 3-5% of women worldwide abuse alcoholic beverages. In total, there are nearly 120
million people suffering from alcoholism globally. For every person with alcohol addiction, there
are 4-5 individuals who abuse alcohol without meeting the full criteria for addiction. The situation
regarding alcohol consumption varies across different countries. For instance, in the United States,
10% of men and 3.5% of women are affected by alcoholism. The global pattern of alcohol abuse
reflects various social, cultural, and economic factors that influence drinking habits and patterns.
While some regions may have higher rates of alcohol-related disorders, others may have
lower prevalence but still face significant challenges in terms of alcohol misuse and its related
consequences, including health problems, social dysfunction, and economic costs. Therefore,
addressing alcohol abuse requires a comprehensive, culturally sensitive approach that takes into
account the unique circumstances of each country or community [46-49].
In the European region, countries with the highest levels of alcohol consumption include
Russia, Latvia, Estonia, Finland, Ireland, Poland, and Lithuania. These countries also have the
highest rates of alcohol-related psychosis, a severe mental disorder caused by chronic alcohol
abuse. The prevalence of alcohol-related psychiatric conditions in these nations reflects the
widespread abuse of alcohol, which not only affects the individuals but also puts a strain on
healthcare systems, social structures, and the overall economy. On the other hand, countries with
lower alcohol consumption include Israel, Armenia, Georgia, and Norway. In these nations,
alcohol abuse is less prevalent, and they often implement stricter regulations and public health
measures to curb excessive drinking. The differences in alcohol consumption patterns across
countries can be attributed to a combination of cultural, social, and economic factors, as well as
varying policies and education on the risks associated with alcohol. This highlights the need for
tailored interventions and prevention programs that are sensitive to the specific context of each
country [50-54].
According to the data from narcological dispensaries, the incidence of alcoholic psychosis
increased fourfold between 1991 and 2000, rising from 10.5 per 100,000 population in 1991 to
42.4 per 100,000 in 2000.
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In 2000, the rate of new diagnoses of alcoholic psychosis was nearly 36% higher compared
to the previous year. This significant increase in the number of cases of alcoholic psychosis reflects
the worsening condition of patients suffering from chronic alcoholism, indicating a rise in both the
frequency of alcohol consumption and the deterioration of its quality. As alcohol abuse continues
to increase, the severity of alcohol-related mental health disorders also escalates, resulting in more
frequent and severe cases of psychosis. This trend underscores the urgent need for improved
preventive measures, early intervention, and comprehensive treatment strategies aimed at
addressing the root causes of alcoholism and its devastating psychological consequences [55-58].
At the beginning of 2002, more than 3 million people, or 2% of the population of the
Russian Federation, were under the supervision of narcological institutions due to the consumption
of psychoactive substances. The majority of these individuals were alcohol consumers. This
statistic highlights the widespread nature of substance abuse, with alcohol being the most
commonly abused psychoactive substance in the country. The large number of individuals under
medical supervision indicates the significant public health challenge posed by substance abuse in
Russia. Furthermore, the dominance of alcohol consumption among those affected suggests a
deep-rooted societal issue that involves not only addiction but also its associated psychological
and social consequences. These individuals often face a range of health problems, including
chronic illnesses, mental disorders, and social issues, all of which contribute to the overall burden
on healthcare and social support systems. The need for comprehensive treatment and prevention
strategies to address alcohol abuse and related problems is evident.
Like any other disease, alcoholism arises and develops as a result of a combination of
various factors, including age, gender, an individual's psychophysiological constitution, and
geographical and climatic conditions. These factors interact in complex ways, influencing the
onset and progression of alcoholism. Age and gender can play significant roles in susceptibility,
as certain age groups or genders may be more predisposed to developing alcohol-related disorders.
The psychophysiological constitution refers to an individual’s mental and physical
characteristics, which can affect their ability to cope with stress, emotions, and social pressures,
potentially leading to substance abuse. Furthermore, geographical and climatic factors can
influence drinking patterns, as cultural norms and environmental conditions may either encourage
or discourage alcohol consumption. For example, regions with harsher climates or higher stress
levels may see higher rates of alcohol use as a coping mechanism. Understanding these
contributing factors is crucial in developing effective prevention and treatment strategies for
alcoholism.
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The literature contains numerous studies dedicated to the common neuroendocrine changes
associated with alcohol and other types of addiction, as well as stress reactions. For instance, it has
been shown that a high concentration of corticotropin-releasing hormone (CRH) in the brain,
particularly in the amygdala, can enhance fear-induced behavioral reactions. In post-traumatic
stress disorder (PTSD), the elevated levels of CRH in the brain contribute to excessive arousal,
which in turn amplifies the euphoric effects of certain psychoactive substances, such as CNS
stimulants, and increases the severity of withdrawal symptoms. This intensifies the desire of
individuals to continue using these substances. Conversely, when substance use is discontinued,
an increase in CRH concentration is observed in the brain, which exacerbates symptoms of
hyperarousal, encouraging individuals to relapse and return to substance use. This creates a vicious
cycle, where substance abuse begins as a way to cope with stress, leading to further neuroendocrine
disruptions and addiction. Thus, the interplay of neurobiological factors and psychological stress
can perpetuate the cycle of addiction, making it difficult for individuals to break free without
appropriate intervention and support [44-46].
Noradrenergic dysregulation has also been observed during the withdrawal from alcoholic
beverages and other psychoactive substances. In acute withdrawal syndrome, patients suffering
from long-term alcoholism show an increase in the concentration of norepinephrine and its
metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), in both blood plasma and cerebrospinal
fluid. This rise in norepinephrine levels is associated with the heightened physical and
psychological symptoms that occur during withdrawal, such as anxiety, agitation, tremors, and
increased heart rate. The dysregulation of the noradrenergic system during withdrawal may
contribute to the difficulty in managing withdrawal symptoms, thereby reinforcing the cycle of
addiction and making it harder for individuals to stop using alcohol or other substances.
Understanding this neurobiological mechanism is crucial for developing more effective
treatments for withdrawal syndromes and addiction, focusing on normalizing the function of the
noradrenergic system to alleviate the distressing symptoms of withdrawal [47-49].
In animals, the level of activity of the noradrenergic system has been significantly linked
to the severity of withdrawal symptoms. These findings have encouraged clinicians to use
clonidine in the treatment of opioid withdrawal and post-traumatic stress disorder (PTSD).
Recently, it has been suggested that one of the mechanisms underlying the brain’s ability
to preserve changes during stress may involve the influence of norepinephrine on the dopaminergic
system.
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798
Norepinephrine’s interaction with dopamine, which is a key neurotransmitter involved in
reward, motivation, and mood regulation, can contribute to the physiological and psychological
effects of stress. This relationship suggests that norepinephrine may play a role not only in the
acute stress response but also in the longer-term changes that occur in the brain during addiction
and trauma-related disorders. Targeting the interaction between norepinephrine and dopamine may
offer new therapeutic approaches for managing withdrawal symptoms and treating stress-related
conditions, potentially improving outcomes for patients suffering from addiction or PTSD [50-
52].
Undoubtedly, the system that releases corticotropin-releasing hormone (CRH) and the
noradrenergic system in the brain mutually modulate each other. According to G.F. Koob's
findings, their interaction in the brain, under certain conditions, can act as a forward-shifting
system that leads to a progressive amplification of the stress response due to repeated exposure to
stress, which is characteristic of post-traumatic stress disorder (PTSD). This process involves the
cumulative effect of stress on the brain, where repeated exposure to stressors results in an
increasingly heightened response over time. The dysregulation of these systems may contribute to
the development and persistence of PTSD, as the brain becomes hypersensitive to stress, leading
to heightened arousal and emotional dysregulation. Understanding the interaction between the
CRH and noradrenergic systems can provide insight into the underlying neurobiological
mechanisms of stress disorders and open up potential avenues for therapeutic intervention, such
as the development of treatments that target these systems to reduce the impact of chronic stress
[53-56].
Specifically, stress, including stress related to self-medication or the withdrawal of
psychoactive substances, can stimulate the release of corticotropin-releasing hormone (CRH) in
the blue spot (locus coeruleus) of the brain. This activation leads to the release of norepinephrine
in the cerebral cortex, which in turn can further stimulate the release of CRH in the hypothalamus
and amygdala. This cascade effect creates a feedback loop, where the activation of the
noradrenergic system intensifies the release of CRH, amplifying the stress response and emotional
arousal [57-59]. The interplay between CRH and norepinephrine in these brain regions plays a
critical role in regulating the div's response to stress and can contribute to the development of
stress-related disorders, such as anxiety, depression, and addiction. Understanding this complex
neurobiological mechanism is essential for developing targeted treatments that can modulate the
activity of these systems and help manage the emotional and physiological effects of stress and
withdrawal [60-62].
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799
The interaction between the noradrenergic system and the corticotropin-releasing hormone
(CRH) system in the central nervous system can contribute to the hyperarousal symptoms observed
in post-traumatic stress disorder (PTSD), including exaggerated startle reflexes. In individuals
with PTSD, there is a tendency for the abuse of central nervous system depressants, which reflect
an attempt to interrupt the direct interaction between the CRH system and the noradrenergic system
by suppressing the activity of the locus coeruleus. By dampening the activity of the locus
coeruleus, these substances reduce norepinephrine release, which in turn alters the heightened
response of the brain regions involved in stress regulation, such as the hypothalamus and amygdala
[63-66]. This disruption of the normal communication between these systems can be seen as an
attempt to alleviate the excessive arousal and emotional dysregulation associated with trauma.
However, the continued use of depressants can perpetuate a cycle of addiction and
emotional instability, complicating the recovery process. This underscores the need for targeted
therapies that can normalize the balance between these neurobiological systems, addressing both
the underlying trauma and the neurochemical imbalances contributing to PTSD and substance
abuse.
Conclusion:
Alcoholism is a complex and multifaceted disease, with its development
influenced by genetic, psychological, social, and environmental factors. Neuroendocrine systems,
particularly the interaction between the corticotropin-releasing hormone (CRH) system and the
noradrenergic system, play a critical role in the progression and recovery process of alcoholism.
Understanding the neurobiological mechanisms of psychoactive substances is crucial for
developing effective treatment strategies based on personalized approaches.
Moreover, combating alcoholism requires prevention, early diagnosis, and coordinated
treatment systems. Treatment strategies should emphasize personalized approaches that consider
the interplay between healthcare systems and social environments, as well as focus on restoring
the normal functioning of neurotransmitter systems. Additionally, social and psychological factors
contribute significantly to the development of addiction, which means that treatment should not
only account for biological aspects but also address psychological and social factors.
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