PROBLEMS RESULTING FROM THE IRRESPONSIBLE USE OF ALCOHOL

Although most people drink alcoholic beverages in a mature and responsible manner, many use alcohol in an irresponsible manner, thereby causing problems for themselves, their friends, their families, and society.

Alcohol abuse or problem drinking is usually defined as acute intoxication or binge drinking that results in problems with family, friends, job, or the law.

Problem drinking is similar to alcoholism, with the exception that the person abusing alcohol is often too physically dependent upon the substance.

The rate of problem drinking also is apt to be higher in the 15-to-24-year-old age group. Alcohol abuse is often defined in relation to alcohol-related problems such as fighting, crime, and driving while intoxicated.

Surveys find that the persons who are most likely to be problem drinkers are males under 25, white, city residents who have moved from rural areas, whose childhoods were disrupted by a broken home, who are Roman Catholic, and who are single or divorced.

This profile is characteristic of many university students. Alcoholism, on the other hand, is usually defined as loss of control of drinking and is more often found in older groups.

However, even among university age students, about one in tn who drink may be alcoholic.

     

Physical Effects of Excess Drinking and Irresponsible Alcohol Use

Hangovers. More than half of all college students have reported a hangover, and 70 percent have reported nausea and vomiting from drinking too much within the preceding 12 months.

Hangovers, which are thought to result from an excessive intake of alcohol, are characterized by upset stomach, fatigue, thirst, headache, and sometimes trembling.

The basis of hangovers is not clear, but they are thought to be related to congeners found in many alcoholic beverages. Fatigue and tension and stress while drinking may contribute to hangovers, and some people feel that hangovers might be caused by slight withdrawal symptoms. There is no safe way of curing a hangover.

Sleep and perhaps aspirin will alleviate some of the discomfort of a hangover.

The Heart. Heart disease is the principal cause of death in this country, but alcohol is not a significant risk factor associated with coronary heart disease. It has been found that small amounts of alcohol - up to about two to three drinks per day for men and one to two for women may prevent heart disease.

The incidence of coronary heart disease has been found to be lower in individuals who were light drinkers compared to those who abstained or who were former drinkers in many studies.

On the other hand, there is a direct relationship between heavy drinking and cardiomyopathy - a disease of the heart muscle. This condition results in congenital heart failure and elevated diastolic blood pressure.

Because heavy drinkers are often heavy smokers, it is thought that the higher incidence of heart disease in alcoholics and heavy drinkers is probably caused by smoking and not by the alcohol in itself.

The Central Nervous System. Alcohol works as a depressant on the central nervous system, depending upon the amount consumed. Chronic excessive drinking, along with these effects, can cause serious damage to the central nervous system.

Wernicke's encephalopathy is the first serious manifestation of heavy chronic drinking.

The person exhibits nystagmus (uncontrollable eye movement), jerky and unbalanced movement, and mental confusion. The next step in nervous system damage is Korsakoff's psychosis, in which there are defects in retentive memory, apathy, and inertia.

Alcoholic polyneuropathy can occur, in which there is weakness and pain or numbness in the legs and arms. Alcoholic pellagra causes mental and nervous confusion, and diarrhea and skin eruptions can occur. Some of these diseases, however, may be caused by deficiency in B vitamins, as alcoholics often are malnourished.

The Liver. Cirrhosis of the liver is a major cause of incapacitating illness and premature death among alcoholics. However, an excessive intake of alcohol by itself is not sufficient to produce cirrhosis, and it is thought that poor nutritional states contribute to this condition.

The most common effect in the liver after continued high alcohol intake is the development of fatty liver, in which lipids or fat accumulate in the liver. Deaths can occur suddenly from this problem, and it is considered an important cause of death in individuals age 25 to 44 who are heavy drinkers. After the onset of this condition, alcoholic hepatitis can occur.

It involves an inflammatory reaction of the fatty liver and has a mortality rate of up to 30 percent. This condition usually occurs after a bout of heavy drinking causing an alteration in the structure of the liver. Continued drinking then leads to scarring cirrhosis, in which the liver is unable to detoxify alcohol and other toxic substances, and in which there might be a sudden hemorrhage. In some cases, poor nutrition is thought to contribute to general liver deterioration in chronic heavy drinkers.

On the other hand, a small daily amount of alcohol is thought to help prevent gall bladder disease.

Cancer. The risk of developing cancer of the mouth, throat, and other parts of the body having direct contact with alcohol appears to be increased by chronic heavy drinking. The risk is especially increased if heavy drinking is combined with heavy smoking.

Primary liver cell cancer, while not common in North America, is more often seen in persons with heavy alcohol consumption, perhaps because of altered metabolism of carcinogens in the liver. Chronic heavy drinking is thought to irritate tissue so that carcinogenic substances in cigarettes or in the congeners present in alcoholic beverages may make these individuals more susceptible to cancer.

Malnutrition associated with chronic heavy drinking may cause weakness in the mucosa so as to enable carcinogenic substances to react more readily with the damaged tissue. Much research is still being done in this area of alcohol in relation to cancer.

Sleep. Too much alcohol before bedtime decreases the amount of REM sleep. After drinking for a while before bedtime and then stopping, a slight REM increase occurs, which is a rebound phenomenon. The greater the dose of alcohol, the more prolonged the block in REM sleep. The usual consequences of deprived REM sleep are impaired concentration and memory as well as anxiety, irritability, and fatigue.

Withdrawal. As with other depressants, abrupt withdrawal from alcohol can cause serious consequences. In the case of alcohol, death may even occur from convulsions unless the person is hospitalized.

With someone who has built up tolerance and a dependency upon alcohol, abrupt withdrawal after eight to nine hours produces tremors, insomnia, lack of appetite, hallucinations, and sometimes mild seizures.

After two to four days, delirium tremors (D.s.) may occur, in which there is severe agitation, fever, rapid heartbeat, sweating, delusions, hallucinations, profound mental confusion, and severe convulsions.

Death can occur during this stage from continuous convulsions unless other medications, usually tranquilizers or barbiturates, are administered.

ALCOHOLISM

Alcoholism/problem drinking is a complex, chronic process with many definitions. It is North America's most serious drug abuse problem and causes serious health consequences for the individual, his or her family, and society in general.

About one in ten persons who drinks becomes an alcoholic. Most alcoholics are not "skid row bums." Only about 5 percent fall into this category, whereas the rest are your relatives, friends, teachers, doctors, and boy and girl friends. Alcoholism tends to be more common in individuals past their late thirties, but it appears to be increasing among younger individuals.

Alcoholic persons have both a physical and psychological dependency upon alcohol and usually -

1. have a loss of control over their drinking. They find that they are drinking when they did not intend to drink or drink more than they planned.

2. have functional or structural damage with social, economic, or domestic problems. There are often job and family problems among alcoholics, along with various alcohol-related illnesses.

3. use alcohol as a way to escape from various problems that threaten to deteriorate their lives.

4. continue the negative drinking behavior even though it causes problems.

Alcoholic persons usually deny they have a problem with their drinking. They often go through changes of personality, drinking patterns, and serious health and social problems such as job loss and divorce still denying that alcohol is the basic cause of their problems.

As stated previously, alcoholics are usually middle-class individuals, with only about 3 to 5 percent being "skid row bums."

In the 1950s, E.M. Jellinek proposed phases and stages in the development of alcoholism based upon several thousand males undergoing rehabilitation for late stage alcoholism. However, these stages may not occur among all problem drinkers.

1. Prealcoholic Phase. During the prealcoholic phase, the individual is usually engaged in controlled or cultural drinking. He or she may use alcohol for occasional escape from tension, but drinking is starting to become more purposeful. Next the individual may begin to drink more and more to escape from tensions and start to develop a tolerance to alcohol.

2. Early alcoholic or Prodromal Stage. Blackouts or temporary alcoholic amnesia occurs in which the person cannot remember what happened and may wake up in a strange bed in a strange place.

This is a serious sign, and at this point serious consideration to one's drinking patterns should be considered. Along with blackouts there is often a preoccupation with alcohol. The individual may feel guilty and attempt to abstain from alcohol for a time, or to change drinking habits such as time, place, or types of alcohol consumed.

3. Middle Stage. The alcoholic loses control of his or her drinking and is unable to stop when he or she wishes during the middle stage. Jobs and personal relationships begin to deteriorate.

At this point the person may begin to neglect food and begin to have morning tremors and engage in early morning drinking to remove them. There may also be a decrease in alcohol tolerance and physical debilitation.

4. Late Stage. During the late stage, the individual suffers from impaired thinking, physical and mental damage, and complete obsession with drinking. If drinking is not continued, Dts will occur. The person usually neglects food, and most interpersonal relationships are all but destroyed. Benders are common, in which long bouts of drinking occur.

TYPES OF ALCOHOLISM

There appear to be several different types of alcoholism, which may have different causes. Moreover, there is much debate as to the nature of the different types and how they should be classified. In general, alcoholics can be grouped into four broad categories.

1. Physiological. This type of alcoholic is common in alcohol-producing countries such as France and Italy, where alcohol is considered to be an essential part of the meal. Over the years the individual who drinks several glasses of wine per day may become physiologically dependent upon the substance and may go into withdrawal symptoms when deprived of alcohol. The individual may not have family, work, psychological, or legal problems.

2. Psychological or "North American." This type of alcoholism is common in the United States, Canada, the British Isles, and the Scandinavian countries. The person starts off as a social drinker, and over a period of several years he/she gradually begins to drink more and more, especially when in a negative psychological state. Family, job, and legal problems generally begin to occur.

3. Primary. In primary alcoholism, the condition develops rapidly, usually while the person (generally a male) is in his teens or early twenties. There are often serious problems in the family, including alcoholism or other addictions, legal problems, and child abuse. The individual may have been hyperactive as a child.

4. Secondary. Individuals with secondary alcoholism generally have an underlying condition such as schizophrenia, cyclic depression, or manic depressive reaction. They use alcohol to medicate themselves. Once the underlying cause is treated, the alcohol abuse often goes away. Only a small percentage of the population is considered to have this type of alcoholism.