| disease | Alcohol-induced Mental Disorders |
Alcohol is a neurotropic substance. A relatively large amount consumed at once can lead to mental abnormalities, and long-term drinking can cause various mental disorders, including dependence, withdrawal syndrome, and symptoms of mental illness. In addition to mental disorders, physical damage symptoms and signs often occur.
bubble_chart Epidemiology
The epidemiological survey conducted in 12 regions of China in December 1982 showed that the prevalence rate of chronic alcoholism was only 0.16%. However, over the past decade, with the rapid increase in alcohol production and consumption in China, the absolute number and proportion of mental disorders caused by alcohol have shown an upward trend. The 1989 epidemiological survey of four occupations in 10 Chinese cities found that the average prevalence rate of chronic alcoholism was 37%. In certain ethnic minority areas, such as the Yanbian Korean Autonomous County in Jilin, the prevalence rate of chronic alcoholism had reached 83.5%, far exceeding the 30.7% among the Han population in inland areas. Abroad, mental disorders caused by alcohol have become the most common mental disorders. In countries such as Germany, the UK, Switzerland, Denmark, and Sweden, the lifetime prevalence rate of chronic alcoholism among males is 3–5%, while among females it is close to 1%. According to recent literature, the lifetime prevalence rate of chronic alcoholism in the general population of the United States is as high as 16%, with 29% among males and 6% among females. Survey data also indicate that the onset age of alcohol-induced mental disorders in Western countries is decreasing year by year, averaging 22 years for males and 25 years for females. Additionally, a small number of patients also use other psychoactive substances, such as opium, marijuana, and cocaine, accounting for more than 50% of all patients with alcohol-induced mental disorders.
bubble_chart EtiologyAlcohol-induced mental disorders, especially the disease cause and mechanism of disease of chronic alcoholism, are extremely complex. It is generally believed to be the result of the interaction between individual biological factors and socio-environmental factors, and cannot be explained by any single factor alone.
1. Genetic factors Survey data confirm that alcoholism exhibits significant familial aggregation. The risk of alcoholism in the children of heavy drinkers is 3–4 times higher than that in the control group. The more severe the parents' alcoholism, the greater the risk of their children developing the same condition. Studies on twins in Nordic countries show that the concordance rate for chronic alcoholism in monozygotic twins is 58%, while in dizygotic twins, it is only about 28%. Adoption studies have found that 22–28% of the sons of alcoholic parents develop the same disorder as adults, which is 3–4 times higher than non-alcoholic adoptees raised elsewhere. Additionally, neuropsychological research suggests that the sons of heavy drinkers often exhibit characteristic neuropsychological deficits, such as impulsivity, overconfidence, hyperactivity, and poor harm-avoidance abilities. These traits, influenced by heredity, make them more prone to developing alcoholism.
2. Generation and transformation abnormalities Alcohol can cause dysfunction in the dopamine (DA) system in certain brain regions. Studies show that administering DA antagonists to experimental animals increases their alcohol consumption, while chemically damaging DA neurons also intensifies alcohol-seeking behavior. These findings suggest that experimental animals consume alcohol to compensate for DA deficiency. Other studies report that heavy drinking is associated with abnormalities in the serotonin (5-HT) system. In heavy-drinking rats, the levels of 5-HT and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in brain regions such as the frontal cortex, striatum, and hippocampus are significantly lower than in the control group. Immunostaining reveals a reduction in the number of 5-HT neurons, accompanied by a compensatory increase in 5-HT1A and HTa receptors.
3. Socio-environmental factors Previous studies indicate that various social, familial, and economic issues are closely related to alcohol-induced mental disorders. Many patients attempt to alleviate stress and anxiety caused by life pressures through drinking, which reinforces their drinking behavior.
Sociocultural factors are also associated with alcohol-induced mental disorders. The prevalence of chronic alcoholism in North America and most European countries is much higher than in China, Japan, and Israel. In China, many ethnic minority regions with high rates of chronic alcoholism have unique drinking cultures and customs. Surveys show that populations living in cold and humid regions for long periods or engaged in heavy physical labor also exhibit higher rates of chronic alcoholism. Additionally, the surge in alcohol production and related advertising are significant social factors that cannot be ignored.
4. Mental disorders Studies on probands with alcoholism reveal that other mental disorders often coexist with alcoholism. Some surveys indicate that nearly 80% of alcoholics suffer from at least one other mental disorder, with depression, anxiety, and antisocial personality disorder being the most common. Alcoholics often experience low mood and anxiety or exhibit antisocial behaviors; antagonism. Conversely, individuals with depression, anxiety, or antisocial personality disorder frequently engage in heavy drinking. These findings suggest that the relationship between alcohol-induced mental disorders and other mental disorders is difficult to determine and may be bidirectional.
Alcohol is absorbed by the stomach and duodenum, primarily metabolized by hepatic enzyme systems into acetaldehyde, and ultimately broken down into carbon dioxide and water. After consumption, alcohol quickly enters the bloodstream and distributes throughout the body, but its concentration varies among tissues and organs, with the highest levels found in the brain, spinal cord, and liver—each exceeding one-third of the plasma alcohol concentration. Consequently, alcohol causes the most severe damage to the nervous system and liver. In acute alcohol poisoning, the cerebral cortex is the first to be inhibited, followed by the subcortical regions, and in severe cases, the medulla oblongata is affected, leading to unconsciousness or even death. Chronic alcohol poisoning can result in a series of pathological brain changes, such as cerebral inflammation, cerebrovascular sclerosis, hemorrhages in the basal ganglia and central gray matter, as well as neuronal fatty infiltration, demyelination, and varying degrees of brain atrophy. Alcohol also significantly damages the liver, with long-term heavy drinking often causing alcoholic hepatitis, fatty liver, and cirrhosis. Additionally, excessive alcohol consumption is associated with conditions such as polyneuritis, myocarditis, gastritis, gastric ulcers, and acute or chronic pancreatitis.
bubble_chart Clinical Manifestations
Mental disorders caused by alcohol consumption are generally divided into two major categories: acute and chronic alcohol intoxication. Based on the nature and clinical characteristics of alcohol intoxication, both acute and chronic alcohol intoxication can be further classified into several subtypes.
(1) Simple Drunkenness
1. Simple drunkenness (simple drunkenness) Simple drunkenness, also known as ordinary drunkenness, is an acute intoxication caused by consuming a large amount of alcohol in a single instance. The severity of clinical symptoms is related to the patient's blood alcohol concentration and the rate of alcohol metabolism. In the initial stage of drunkenness, the drinker's self-control diminishes, speech becomes more frequent, and the content tends to be exaggerated; emotions become excited, displaying joy that may not align with the environment, but the mood is unstable, characterized by irritability and a tendency to vent. Movements also increase during drunkenness, behavior becomes frivolous, often showing provocation, and sometimes disregarding consequences. Clinically, some drinkers may exhibit low spirits, reduced speech, or tearful venting, or may appear drowsy. At the same time, the vast majority of drinkers experience slurred speech, ataxia, unsteady gait, accompanied by increased heart rate, lowered blood pressure, and flushing of the face and skin, sometimes with nausea or vomiting. If drunkenness progresses further, consciousness disorders may occur, such as reduced clarity of consciousness and/or narrowed consciousness, leading to drowsiness, stupor, or even unconsciousness. Except for severe cases, recovery is usually spontaneous and without residual symptoms.
2. Pathological drunkenness (pathological drunkenness) This is a mental disorder triggered by consuming a small amount of alcohol. After drinking, the patient rapidly develops environmental and self-awareness disturbances, often accompanied by fragmented terrifying hallucinations and persecutory delusions. Clinically, this manifests as extreme excitement, intense tension, and fear. Under the influence of hallucinations and delusions, the patient may suddenly exhibit aggression, often violent behavior such as destroying objects, self-harm, or attacking others. This drunken state typically lasts for minutes, hours, or even a full day, ending when the patient falls into a deep sleep. Upon waking, the patient has no recollection of the episode. Unlike simple drunkenness, pathological drunkenness does not involve increased speech, euphoria, or obvious toxic neurological symptoms. These patients have an extremely low tolerance for alcohol, and the amount they consume would not cause intoxication in most people. Additionally, extreme fatigue or chronic severe insomnia may sometimes contribute to the occurrence of pathological drunkenness.
3. Complex drunkenness (complex drunkenness) Patients generally have a history of organic brain disorders or suffer from physical conditions that affect alcohol metabolism, such as epilepsy, cerebrovascular disease, traumatic brain injury, encephalitis, or liver disease. Under these conditions, the patient's sensitivity to alcohol increases, and acute intoxication reactions occur after consuming small amounts of alcohol, leading to significant consciousness disturbances. This is often accompanied by illusions, fragmented persecutory delusions, marked emotional excitement, irritability, and frequent aggressive or destructive behavior, occasionally including aimless repetitive or stereotyped movements. Such episodes typically last several hours, and after resolution, the patient may partially or completely forget the experience.
(2) Chronic Alcohol Intoxication
1. Dependence syndrome (dependence syndrome) This is a special psychological state caused by repeated alcohol consumption. The patient experiences a craving for alcohol and a compulsive need to drink, which may occur continuously or intermittently. If alcohol consumption stops, psychological and physiological withdrawal symptoms will appear.
This syndrome has the following clinical characteristics: ① A craving for alcohol and inability to control drinking; ② A fixed drinking pattern, where the patient must drink at fixed times regardless of the occasion to avoid or alleviate withdrawal symptoms; ③ Drinking becomes the central focus of all activities, significantly affecting work, family life, and social activities; ④ Gradually increasing tolerance, where the patient needs to continuously increase alcohol consumption to achieve the effects initially experienced or to prevent the onset of physiological withdrawal symptoms; ⑤ Recurrent withdrawal syndrome (Withdrawal syndrome). If the patient reduces alcohol intake or extends the intervals between drinking, a drop in blood alcohol concentration leads to withdrawal symptoms. The most common symptoms include tremors in the hands, feet, limbs, and trunk, ataxia, irritability, and an exaggerated startle response; profuse sweating, nausea, and vomiting may also occur. If alcohol is consumed promptly, the above withdrawal symptoms can quickly disappear. Due to the longer duration of nighttime sleep and a significant drop in plasma alcohol concentration, withdrawal symptoms often occur in the early morning. Therefore, most patients drink in the morning to relieve the discomfort caused by withdrawal symptoms. This phenomenon is called "morning drinking" and holds significant diagnostic importance for dependence syndrome. In more severe cases, relative or absolute withdrawal can lead to severe convulsions, confusion, or tremulous delirium; ⑥ After a period of abstinence, patients with alcohol dependence will rapidly re-experience all symptoms of the dependence syndrome if they resume drinking.
2. Tremor delirium (delirium tremens) Patients may rapidly develop transient consciousness disorders after a sudden reduction or cessation of alcohol consumption following prolonged drinking. Tremor delirium can also be triggered by physical illness or psychological stress, though this is less common; some patients experience prodromal symptoms such as low mood, anxiety, and insomnia several days before the episode. During the episode, patients exhibit impaired consciousness, disorientation in time and place, and vivid visual hallucinations with persecutory delusions, leading to extreme fear, restlessness, or impulsive behavior. Additionally, patients may display coarse tremors in the limbs and ataxia, often accompanied by fever, profuse sweating, tachycardia, elevated blood pressure, and dilated pupils. In severe cases, it can be life-threatening. The duration of tremor delirium varies but typically lasts 3 to 5 days. After recovery, patients may partially or completely forget the episode.
3. Alcoholic hallucinosis This is a hallucinatory state caused by long-term alcohol use. Patients experience abundant and vivid hallucinations, primarily visual, within 1 to 2 days after suddenly reducing or stopping alcohol consumption. Common symptoms include elementary visual hallucinations as well as commentary and command auditory hallucinations. On the basis of these hallucinations, fragmented delusions and corresponding tension, fear, or low mood may also occur. During the episode, the patient’s consciousness remains clear, with no significant psychomotor agitation or autonomic hyperactivity. The duration of alcoholic hallucinosis varies, ranging from a few hours to no more than 6 months at most.
4. Alcoholic delusional disorder Patients develop delusions of jealousy or persecution while fully conscious, with the former being more common clinically. They may unjustly suspect their spouse of infidelity, often reacting with intense anger, and may even attack the suspected individuals or their spouse, sometimes leading to violent outcomes. This condition was previously termed alcoholic jealousy. The onset of delusional jealousy is usually related to long-term alcohol-induced sexual dysfunction. Alcoholic delusional disorder has a slow onset and prolonged course, but gradual recovery is possible with sustained abstinence.
5. Alcoholic encephalopathy This is the most severe psychiatric condition resulting from chronic alcohol abuse, caused by long-term heavy drinking leading to organic brain damage. Clinically, it is characterized by delirium, memory deficits, dementia, and personality changes, with most patients unable to fully recover.
(1) Korsakov psychosis: Also known as Korsakov syndrome, it often occurs after one or multiple episodes of tremor delirium or may develop gradually after decades of drinking combined with nutritional deficiencies. The clinical features include prominent anterograde amnesia, difficulty learning new information, and frequent confabulation—patients unintentionally fabricate experiences or misplace distant events to fill memory gaps. In addition to memory impairment, many patients exhibit euphoric expressions, disorientation, and sensory-motor incoordination. Despite the severity, most patients show no significant immediate memory impairment, consciousness disorder, or widespread cognitive dysfunction.
(2) Alcoholic dementia: After prolonged drinking and repeated episodes of tremor delirium, patients may gradually develop dementia, manifesting as impairments in higher cortical functions such as memory, thinking, comprehension, calculation, orientation, and language. Severe cases often affect daily life, rendering patients unable to care for themselves. Personality changes are also notable, with patients becoming selfish, losing self-control, and displaying violent or cruel behavior.
The main basis for diagnosing mental disorders caused by alcohol includes a confirmed history of alcohol consumption and sufficient evidence to determine that the patient's psychiatric symptoms are directly caused by drinking or withdrawal. Acute alcohol intoxication is closely related to the amount of alcohol consumed, often occurring abruptly after a single heavy drinking episode; however, in some cases with underlying brain organic factors, even a small amount of alcohol can trigger severe acute intoxication reactions disproportionate to the amount consumed. Chronic alcohol intoxication is based on long-term drinking, with various clinical syndromes gradually emerging after dependence develops, and symptoms can arise abruptly when alcohol intake is suddenly reduced or stopped. In addition to psychiatric symptoms, both acute and chronic alcohol intoxication involve transient or persistent physical symptoms and signs, as well as manifestations of toxic neurological damage.
On the basis of mastering the diagnostic points of mental disorders caused by alcohol, it is generally not difficult to differentiate them from other mental disorders. Acute alcohol intoxication should be distinguished from: ① acute episodes of certain brain organic diseases, such as epilepsy or cerebrovascular accidents; ② delirium states caused by physical illnesses; ③ mental disorders induced by other psychoactive substances; and ④ manic episodes of affective mental disorders. Hallucinations and delusions caused by chronic alcohol intoxication should be carefully differentiated from schizophrenia and paranoid mental disorders. Korsakoff syndrome and alcoholic dementia should be distinguished from cognitive decline, dementia states, and personality changes caused by other factors.
bubble_chart Treatment Measures
For alcohol-induced mental disorders, especially chronic alcohol intoxication, comprehensive therapy is generally adopted, with basic steps being relatively similar in most countries worldwide.
1. Alcohol Abstinence Abstinence is the key step in determining the success of treatment. Typically, patients should undergo treatment in a hospital setting to cut off access to alcohol. Clinically, the pace of abstinence should be adjusted flexibly based on the severity of the patient's alcohol dependence and intoxication. Mild cases may attempt immediate cessation, while patients with severe alcohol dependence should gradually reduce intake to avoid life-threatening withdrawal symptoms. Whether abstinence is immediate or gradual, close clinical observation and monitoring are essential, particularly during the first week after cessation. Special attention should be paid to the patient's temperature, pulse, blood pressure, consciousness, and orientation, with prompt management of any withdrawal reactions.
Currently, there are no well-established medications for alcohol abstinence. Although naloxone and naltrexone have been tested clinically, further data accumulation is needed before they can be used routinely. Medications targeting the noradrenergic and serotonergic systems for alcohol abstinence are still in the developmental stage.
2. Symptomatic Treatment For symptoms such as anxiety, tension, and insomnia, anti-anxiety medications like diazepam, alprazolam, or hydroxyzine can be used, with the lowest effective dose to control withdrawal symptoms. If spasms occur, intramuscular injections of diazepam (10–20mg) or chlordiazepoxide (50–100mg) can be administered, repeated every 4 hours if necessary. Chlordiazepoxide can also be taken orally at a daily dose of 40–100mg, divided into three doses. Due to the risk of dependence, these medications should only be used short-term. For patients with marked agitation, low doses of chlorpromazine or haloperidol can be administered intramuscularly or orally. Brain metabolic enhancement therapy has also shown good efficacy in alleviating withdrawal symptoms.
3. Supportive Treatment Since most patients have neurological damage and poor nutritional status, neurotrophic medications should be provided, along with high doses of vitamins, especially B vitamins. For patients with concurrent gastritis or liver dysfunction, standard treatments for gastritis and liver protection should be routinely administered.
4. Psychotherapy Clinical practice has shown that behavioral therapy plays a role in helping patients abstain from alcohol. Disulfiram, a drug that blocks alcohol oxidation, causes acetaldehyde accumulation. If a patient drinks while taking disulfiram, they may experience nausea, headache, anxiety, chest tightness, and tachycardia due to acetaldehyde. Disulfiram is commonly used in behavioral therapy to establish an aversion reflex to alcohol. However, due to its toxicity, it should not be used long-term—typically 3–5 days at a daily dose of around 500mg. Additionally, apomorphine-based aversion therapy has yielded satisfactory results both domestically and internationally.
Other psychotherapeutic approaches, such as supportive psychotherapy and cognitive therapy, are also beneficial in helping patients abstain and prevent relapse.
We should actively promote awareness of the harm alcohol causes to the human body and raise the overall level of public understanding. Minors are strictly prohibited from drinking alcohol, and legal supervision and inspection efforts must be strengthened. The production of low-alcohol beverages should be encouraged, while the production of strong liquor should be controlled or banned.
