In medicine, exogenosis reflects the phenomenon of chronic alcoholism. In Europe – the world’s leading producer of wine – nearly one in four adults exceed alcohol consumption benchmarks. However, the more or less short-term consequences of alcohol on health no longer need to be demonstrated. How to diagnose alcoholic exogenous disease? What are the risks ? The answers of Dr Gonzague De Larocque, addictologist doctor in Paris.
Definition and etymology of exogenosis: alcoholic’s disease
From Greek root, the term exogenosis comes from the words exô, translation of “outside”, gennân for “to generate” and finally ôsis meaning “impulse”, “cause”. In medicine, exogenosis corresponds to intoxication caused by a foreign body, and the word is usually used for alcohol intoxication, therefore by extrapolation, for alcoholism. “However, it is a word that is practically no longer used in the medical context, since today we speak of Alcohol Use Disorders or AUD.” indicates Dr. De Larocque.
What is chronic or acute exogenosis in medicine?
Chronic exogenosis is therefore the consequence of alcohol addiction, or chronic alcoholism. There are 4 categories of people depending on their consumption and their relationship to alcohol:
- Abstainers, who do not drink, whether by taste, by religion, by choice;
- Those who have moderate and reasonable consumption, under the sole risk. “These thresholds are set on average at less than two drinks per day, with at least one alcohol-free day per week.” indicates Dr. De Larocque;
- Those who have excessive alcohol consumption, called “at risk”. Their life expectancy is reduced due to this consumption;
- “Problem” people: who have excessive alcohol consumption to which are added other resulting problems, such as depression, absenteeism, neuropathies, etc.
However, not everyone who drinks excessively is an alcoholic. There are two definitions of alcohol addiction: the first concerns loss of control, “the person loses their freedom not to consume” summarizes the addictologist. The second definition describes the fact that, despite a good knowledge of the negative consequences of their consumption, the addicted person is unable to stop using.
“Addiction is a neurobiological disease, namely linked to neurological damage” indicates the addictologist. It causes lasting neurobiological changes in the brain, which notably affect the reward, motivation, decision-making and impulse control systems. “The addicted person is in denial of the negative consequences of their addiction, they develop a whole bunch of automatic thoughts to make themselves short-sighted to the risks of their consumption. So she continues to drink impulsively. We talk about “craving”” he explains. And the more the person consumes, the more this system amplifies and gets carried away. The reward circuit is altered and we are no longer able to take pleasure other than by consuming.
However, some people will never develop an addiction, even if they drink a lot. “We now know that there is not necessarily a continuum between excessive alcohol consumption and alcoholism.” indicates Dr. De Larocque.
Diagnosis: what is the assessment for alcoholic exogenosis?
The first diagnostic tool intended for professionals is Early Identification and Brief Intervention (RPIB). Its objective is to identify consumption of risky psychoactive substances (here alcohol) among patients and users they support in order to move towards a reduction in this consumption.
An audit questionnaire, aimed directly at the patient, can allow them to self-assess their consumption of alcoholic beverages.
Alcohol addiction can then be confirmed by clinical signs, such as an abnormally high gammaGT value, depression, or damage to the liver, heart, nervous system, and other organs.
“Indeed, as long as we have less than two or three glasses per day, the body is able to eliminate the alcohol absorbed. Beyond that, it is likely to cause damage to vital organs.” underlines the addictologist.
What are the symptoms of alcoholic exogenosis?
Chronic alcoholism can be completely asymptomatic for a while.
“The first signs are often a change in behavior, with a slightly aggressive state, irritability, and a tendency toward depression.” describes Dr De Larocque. The person dependent on alcohol then generally has difficulty managing their daily life, with alcohol taking a central place in their life. A lack of concentration and memory can also be felt, as well as ‘a progressive deterioration of social relations and an abandonment of other sources of interest and pleasure.’The culmination of the manifestation of alcoholism is withdrawal syndrome” adds the addictologist. When they stop drinking or reduce their consumption, alcoholics can experience withdrawal symptoms such as tremors, sweating, nausea, insomnia, anxiety and in severe cases, convulsions or hallucinations.
The consequences on the liver of chronic alcoholism
The liver is the main target of the toxic effects of alcohol. The first consequence of chronic alcohol consumption is steatosis, which corresponds to a deposition of fats inside the liver cells. Most of the time, this fatty liver disease is reversible if alcohol consumption is stopped early.
On the other hand, if alcohol consumption continues, or even increases, steatosis can develop into inflammation, then necrosis of liver cells: this is then cirrhosis. Alcohol is the cause of more than 70% of cases of cirrhosis, itself responsible for 10 to 15 thousand deaths in Europe each year.
Excessive alcohol consumption is also responsible for alcoholic hepatitis, which is inflammation of the liver. It can be acute or chronic.
This alcoholic hepatitis manifests itself by abdominal pain, jaundice, fatigue, loss of appetite and fever. If left untreated, alcoholic hepatitis can progress to more serious liver disease. Finally, chronic alcoholism is a major risk factor for the development of hepatocellular carcinoma, which is the most common type of liver cancer. People with cirrhosis due to alcoholism have an increased risk of developing liver cancer.
Withdrawal: how to cure chronic alcoholism?
The management of alcohol addiction – like that of any addiction – generally involves a multidisciplinary approach that combines medical interventions, behavioral therapies and social support.
It generally begins with a thorough medical assessment, aimed at assessing the damage caused by alcoholism to the patient’s health, whether physical or mental. It may include blood tests to monitor liver function, psychological evaluations, and physical alcohol dependence.
For people who are very physically dependent on alcohol, medically supervised detoxification may be necessary to manage withdrawal symptoms and prevent potentially serious complications. But total withdrawal is no longer the absolute rule in cases of beginning alcoholism. “A few years ago, there was an injunction to completely stop drinking alcohol in cases of alcohol dependence. In recent years, we have worked on reducing risks and, when the disease is not at too advanced a stage, the patient can maintain controlled consumption.” indicates the addictologist.
Certain medications may be prescribed to help reduce alcohol cravings, prevent relapse, and ease withdrawal symptoms. The most commonly used include benzodiazepines for withdrawal management, disulfiram, naltrexone, and acamprosate for relapse prevention. “Furthermore, in the event of withdrawal syndrome, it is especially important not to stop drinking alcohol suddenly as this risks triggering an epileptic attack. Anti-epileptic medications are therefore essential” specifies the specialist.
Behavioral therapies are often used to help people with alcoholism understand and change their thought patterns, behaviors, and habits related to alcohol use. This may include cognitive behavioral therapy (CBT), motivational therapy or even family therapy.
Social support is an important part of alcoholism treatment. Support groups such as Alcoholics Anonymous (AA) offer mutual support, advice, and strategies for staying sober. Rehabilitation and social reintegration programs can also help people rebuild their lives without alcohol.
“The certainty we have is that the best predictive indicator of recovery is the quality of follow-upi” insists Dr. De Larocque. Treatment of alcoholism is in fact often a long-term process. It requires regular follow-up with health professionals and continued participation in support programs helping to prevent relapse and to maintain long-term sobriety.