The Jellinek Classification Of Alcoholism

The alcohol consumption patterns presented by Jellinek help us understand that not all people who drink are alcoholics and that not everyone who we call alcoholics is sick.
The Jellinek classification of alcoholism

Elvin Morton Jellinek was an American physiologist and biostatistician considered the father of scientific studies on alcoholism. The Jellinek classification has helped to improve knowledge of this disease.

Jellinek was born in New York in 1890. Between 1908 and 1910, he studied biostatistics and physiology at the University of Berlin and for two years he studied philosophy, anthropology, philology and theology at the Joseph Fourier University of Grenoble. He also studied linguistics, cultural history and several languages. In fact, Jellinek spoke nine languages.

In the 1930s, the physiologist worked in a Massachusetts hospital, where he was commissioned by the Alcohol Problems Research Council to study alcoholism. From this research his first book was born in 1942, Alcohol Addiction and Chronic Alcoholism.

In 1941 he began working at Yale University and became editor-in-chief of the Quarterly Journal of Studies on Alcohol . Later, he was hired by the WHO as a consultant on alcoholism in 1952 in Geneva. During this time, he made important contributions on alcoholism to mental health expert committees.

In the late 1950s, he retired from WHO and returned to the United States, where he worked at the universities of Toronto, Alberta and Stanford. In 1952 Jellinek stated that alcoholism was a disease that evolved progressively in stages and that these could be identified with some ease.

Alcohol bottles.

His most famous book is The Disease Concept of Alcoholism (1960). In it, Jellinek describes various types of alcoholics according to different consumption patterns. However, he did not try to include the greatest number of people in alcoholic illness, but rather the opposite.

In fact, he claimed that those who can be grouped in his classification are alcoholics, but not all alcoholics are sick.

Thus, to consider an alcoholic to be ill, he must be unable to abstain from alcohol or show loss of control; not in all cases these circumstances occur.

The Jellinek classification

Jellinek explained that alcoholism generally develops in four distinct phases (pre-alcoholic, symptomatic prodromal, crucial or critical, and chronic). Each of these phases presents a set of characteristic symptoms. Let’s see which ones.

Alpha alcoholism

These are individuals who suffer from a physical or psychological illness, so their alcoholism is a consequence of it. They are symptomatic drinkers who drink to mitigate the effects of a mental or medical illness. They would mainly be people with epilepsy, schizophrenia, paranoia or very unsure of themselves.

These individuals have constant psychological dependence in order to neutralize physical or emotional pain. Also, they tend to be unruly when they drink alcoholic beverages (they do not follow social rules regarding the time, occasion, place, quantity and effect of the drink).

They show no lack of control or inability to abstain, nor do they show signs of a progressive process or disturbances due to alcohol suppression. However , they can evolve in range. Alpha alcoholism is also known as avoidance drinking or problem drinking .

Alcoholism Beta

People with beta alcoholism do not have true physical or psychological dependence. Discontinuation of the drug therefore does not cause a withdrawal syndrome. It is also true that they have organic repercussions of habit (alcoholization) and complications such as polyneuropathies, gastritis or liver cirrhosis.

This type of alcoholism can lead to gamma or delta alcoholism. It presents a general deterioration of health and a reduction in life expectancy.

Epsilon alcoholism in the Jellinek classification

Epsilon alcoholism is a type of periodic alcoholism or dipsomania. They are people who can resist long periods of abstinence until, unexpectedly, they indulge in compulsive and intense drinking ( binge drinking ).

It is associated with crepuscular states, with semi-automatic behavior and subsequent amnesia. It can also lead to epileptic or cyclothymic dysthymia.

Gamma alcoholism

This pattern of alcohol consumption has the following characteristics:

  • Progressive tolerance of fabrics.
  • Adaptation of cellular metabolism.
  • Physical addiction recorded in the form of signs of withdrawal or lack of control.

The hallmark is the desire to get drunk. In fact, there is a control problem when the person starts drinking. Episodes do not usually end until health or financial problems arise that prevent further drinking.

In gamma alcoholism there are periods of daily drunkenness for months or weeks between which there is abstinence or moderate consumption. It is common in countries where liquor is drunk, such as the United States and Great Britain. For this reason it is also called the Anglo-Saxon model.

Delta alcoholism in the Jellinek classification

In this type of alcoholism there is tolerance, physical dependence and withdrawal syndrome. It is characterized by a high volume of daily alcohol consumption, but without intoxication and without compulsion to exceed the amount.

The ability to control the amount of drink ingested is usually not impaired. It has the characteristics of the range with the addition of the inability to abstain.

This alcoholism differs from gamma alcoholism in that it is unable to last a single day without drinking and without showing withdrawal symptoms.

Person looking at glass with liqueur.

Alcohol Consumption Patterns by Alonso Fernández

Professor Alonso Fernández, also , made a classification in which we match to Jellinek consumption patterns.

First stage

  • Regular drinker : ingests many times a day amounts of alcohol that pose health risks, never or hardly ever reaching drunkenness. There is no drive for drunkenness and no lack of control over consumption. It is the drinker who most often develops biological addiction. Corresponds to the beta (although not addictive) and delta types of the Jellinek classification.
  • Drinker with mental disorders : These are people with mental illnesses who turn to alcohol to change the experiences and emotional tensions that the disease causes in them. Coincides with Jellinek’s alpha and epsilon types (periodically).
  • An alcoholic who were part of such individuals with an irresistible inclination towards alcohol. They have an irregular interval of alcohol intake until they reach complete drunkenness. Early onset (adolescence, even childhood) with shorter and shorter intervals. Coincides with gamma alcoholism in Jellinek’s classification.

Second phase

It is a chronic alcohol drinker with systematic consequences deriving from the consumption of the substance. In this phase, any of the previous cases can converge. Similar to Jellinek’s beta type due to physical complications.

Alcoholism treatment

There are several treatments for alcoholism, as it involves interventions at various levels. The therapeutic intervention is aimed at both alcohol dependence and abstinence. Both individual and group psychotherapy and psychopharmacological intervention (eg disulfiram or naltrexone) are combined.

Therapy programs stand out in that they are multidisciplinary. In fact, the treatment is carried out in the long term to achieve satisfactory abstinence. As far as possible, they focus not only on the person who has a drinking problem, but also on his or her family and partner.

From the cognitive-behavioral model, it is assumed that alcohol acts as a reinforcer which in turn depends on the historical context and availability of the substance. However, this perspective does not necessarily seek complete lifelong abstinence, depending on the situation.

Psychological treatment focuses on changing behaviors directly related to alcohol consumption. In this way, the individual is held accountable for his or her problem. Additionally, the subject is educated on social skills, coping, and relapse prevention.

  • In the first phase, the aim is for the person to learn to manage situations that can trigger his desire to drink. All this through the formation of social skills and the preparation for change.
  • Then, work is done on relapse prevention. In this phase, a distinction is made between the concept of falling (drinking during a single occasion) and relapse (re-establishing the habit of drinking). This prevents the abstinence violation effect.

Conclusions

Treatment seeks to decrease the person’s interest in alcohol, while increasing their propensity for other activities and management in complicated situations or with certain difficulties.

This type of therapy conceives a dimensional continuum between substance use and abuse. Thus , in some individuals, it may be appropriate to support a controlled drinking strategy rather than complete abstinence.

Treatment does not take place in a hospital setting, but in the reference setting. However, when a person decides to stop drinking and has been drinking a lot, they will inevitably suffer from withdrawal symptoms. For this reason, detoxification may need to be done initially in the hospital or on an outpatient basis, usually with tranquilizers.

An important aspect is partner or family support in the case of an outpatient detox, both for physical symptoms and craving.

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