Patterns Of Alcohol Consumption According To Jellinek

Elvin Morton Jellinek was an American physiologist and specialist in biostatistics considered the father of scientific studies on alcoholism. Their research contributed to a better understanding of this disease and to the consequent establishment of patterns of alcohol consumption.

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

In the 1930s, the physiologist worked at a Massachusetts hospital where the Alcohol Problems Research Council commissioned him to conduct research on alcoholism. Based on this research, he released his first book, published in 1942, O Vício em Álcool eo Alcoolismo Chronic .

In 1941 he went to work at Yale University and was editor-in-chief of the journal “Quarterly Journal of Studies on Alcohol”.  He was later employed by the WHO as an alcoholism consultant in 1952 in Geneva. During this period, he made important contributions on alcoholism to the Mental Health Expert Committees.

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

His most famous book is The Alcoholic Disease (1960). In it, he describes various types of alcoholics based on different types of drinking patterns. However, Jellinek did not try to include the greatest number of people within the alcoholic disease, quite the opposite; he claimed that those who can be grouped in his classification are alcoholics, but not all are sick alcoholics.

To consider an alcoholic ill, he must have an inability to abstain or a loss of control, and these circumstances do not exist in all types.

Jellinek’s Alcohol Consumption Patterns

Jellinek stated that alcoholism develops in 4 distinct phases (pre-alcoholic, symptomatic prodromal, crucial or critical and chronic), each with a series of characteristic symptoms.

alpha alcoholism

These are individuals who suffer from physical or psychological illnesses; therefore, his alcoholism is a consequence of that. They are symptomatic drinkers who consume to lessen the effects of a mental or medical illness. They would be mainly people with epilepsy, schizophrenia, paranoia or very unsure of themselves, among others.

As such, these types of individuals have an ongoing psychological dependence to counteract bodily or emotional pain. On the other hand, they tend to be undisciplined in alcohol consumption (they do not follow social rules regarding the time, occasion, place, quantity and effect of the drink).

They do not show lack of control or inability to abstain, nor do they show signs of a progressive process or disorders resulting from alcohol suppression. However, they can evolve into the gamma type.

Alpha alcoholism is also known as avoidance drinking.

beta alcoholism

People with beta alcoholism do not have a real physical or psychological dependence ; therefore, stopping drinking does not cause a withdrawal syndrome. However, it is true that they present organic repercussions of the habit (alcoholization) and complications such as polyneuropathies, gastritis or liver cirrhosis.

This type of alcoholism can drift in gamma or delta and causes a general deterioration in health and a reduction in life expectancy.

alcoholism epsilon

It is periodic alcoholism or dipsomania. They are people who endure long periods of abstinence until, unexpectedly, they give in to compulsive and intensive consumption (excessive alcohol consumption).

Epsilon alcoholism is associated with twilight states, semi-automatic behaviors and subsequent amnesia, in addition to epileptic or cyclothymic dysthymia.

gamma alcoholism

This pattern of alcohol consumption has the following characteristics:

• Progressive tissue tolerance;
• Adaptation of cell metabolism;
• Physical dependence recorded in the form of signs of withdrawal or lack of control.

The defining fact is the drive for drunkenness. In fact, there is a control issue when you start drinking, as episodes usually don’t end until health or financial problems start to stop you from continuing to drink.

In gamma alcoholism, there are periods of daily intoxication for months or weeks between which there is abstinence or moderate drinking. It is common in countries with high alcohol consumption, such as the United States and Great Britain; therefore, it is also called Anglo-Saxon alcoholism.

delta alcoholism

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 the compulsion to exceed the quantity.

The ability to control the amount of drink consumed is generally unaffected. It has the characteristics of gamma plus the inability to abstain.

This alcoholism differs from gamma in that the person cannot go without drinking and without experiencing withdrawal symptoms.

Alcohol consumption patterns by Alonso Fernández

Professor Alonso Fernández made a classification in which we found a correspondence with Jellinek’s patterns of alcohol consumption.

First step

• Regular excessive drinker : he often drinks amounts of alcohol a day that are dangerous for his health, but he never or almost never gets drunk. There is no drive for drunkenness or lack of control over consumption. It is the type of drinker who most often develops biological dependence. Corresponds to the beta (though no dependency) and delta types of the Jellinek classification.
• Psychically ill drinkers : people with mental illnesses who indulge in drinking to modify the experiences and emotional tensions that their illness produces. Corresponds to Jellinek’s alpha and epsilon (periodic form) types.
• Alcohol Consumer : Individuals with an irresistible addiction to alcohol. They present a delivery of irregular intervals of time to drink and until reaching complete intoxication. Early onset (adolescence, even childhood) with shorter and shorter intervals. It coincides with the gamma alcoholism of the Jellinek classification.

Second stage

This is a chronic alcoholic drinker with organic consequences arising from the consumption of the substance. At this stage, any of the above three can converge here.

It would be similar to Jellinek’s beta type for physical complications.

Alcoholism treatment

There are different types of treatment for alcoholism as they involve interventions at various levels. Thus, therapeutic intervention targets both alcohol dependence and abstinence, combining both individual and group psychotherapy with psychopharmacological intervention (disulfiram or naltrexone, among others).

Therapy programs differ in that they are multidisciplinary and the treatment is carried out in the long term to achieve satisfactory abstinence. As much as possible, they will not only focus on the person who has a problem with alcohol, but also on their family and their partner.

Based on the cognitive-behavioral model, it is assumed that alcohol is a potent reinforcer, which, in turn, depends on the historical context and current availability of the substance. However, this perspective does not necessarily seek total abstinence for life, depending on the situation.

Psychological treatment focuses on changing behaviors directly related to alcohol consumption. In this way, responsibility is assigned to the individual for their problem. In addition, you are educated in social skills and relapse prevention and coping.

• In the first phase, the objective is for the person to learn to deal with situations that can trigger the urge to drink, through training in social skills and preparation for change.
• Later, work is done to prevent relapse. At this stage, a distinction is made between the concept of falling (drinking once) and relapse (restoring the drinking habit). In this way, the effect of violating abstinence is avoided.

As we can see, the treatment seeks to reduce the person’s interest in alcohol, while increasing their preference for other activities and improving management in complicated situations or with certain difficulties.

This type of therapy provides a dimensional continuity between substance use and substance abuse. For this reason, in some individuals it may be appropriate to advocate a strategy of controlled consumption rather than complete abstinence.

Treatments are not carried out in a hospital regime, but in the person’s environment. However, when she decides to stop drinking and is consuming large amounts, she will suffer from withdrawal syndrome. For this reason, it may be necessary to perform an inpatient or outpatient detox initially, usually with tranquilizers.

An important aspect is the support of the partner or family in case of outpatient detoxification, both because of the physical symptoms and because of the absurd and extremely intense desire to go back to drinking.