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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Alcohol

What is alcohol?

Alcohol is produced by fermentation of liquids containing sugar and starch. Alcoholic drinks vary in colour and taste because of the ingredients used in them. The alcohol we drink is called ethyl alcohol.

 

Why do effects of alcohol vary from person to person?

Alcohol is directly absorbed into the blood stream through the stomach and small intestine. Food in the stomach slows down the rate at which alcohol is absorbed but does not prevent intoxication or drunkenness. Alcohol is distributed throughout the water in the body and not into fatty tissue.

The effects of alcohol vary from person to person. It depends upon many factors like

  • How much you drink (more you drink, higher the effects)
  • How quickly you drink (faster you drink more the effects)
  • If alcohol is consumed along with other drugs both illicit and prescription drugs.
Age  health status
weight Mood
Gender  How used the person is to drinking alcohol

 

Effects of alcohol on the body?

Contrary to common beliefs alcohol is a depressant drug and not a stimulant. It slows down the activity of the brain and affects concentration and coordination. 

Immediate effects

  1. First few drinks, feel happy and more relaxed, less concentration and reflexes slowed.
  2. Few more , less inhibitions, more confidence, less coordination, speech is slurred, mood fluctuates
  3. Few more – confusion ,blurred vision, poor muscle control
  4. More- nausea, vomiting ,sleep
  5. It can cause coma or death if drinking continues.

It will make you unfit for driving and using machinery.

 

Long term effects

If you drink heavily for a long period of time alcohol can cause damage to various parts of the body. It can affect every system of the body.

Nervous system

  • Memory disturbances
  • Tingling and numbness in the palms and feet
  • Confusion 
  • Psychological problems

Like depression, psychosis, suicide rates are higher

Liver

  • Liver becomes enlarged
  • Hepatitis
  • Liver failure
  • liver cancer

Heart

  • Enlarged heart
  • high blood pressure

Lungs

  • Higher chances of infection like tuberculosis

Pancreas

Inflamed pancreas causing pain

Sex Organs

Male:

  • Impotency
  • Testis becomes smaller
  • Damaged or less sperms

Female: damage to the foetus if pregnant

Blood  

Changes to the red blood cells

Stomach

Ulcers

  • Bleeding

Intestines

Ulcers

 

Symptoms of alcohol dependence?

Symptoms of alcohol dependence are

  • If your hands and limbs start to shake and have tremors
  • If you have to drink more and more to get the desired effect
  • If you start spending a lot of your time thinking about alcohol and how to get it
  • If you have withdrawal symptoms like loss of appetite, nausea, anxiety , disturbed sleep, irritability, at times convulsions , hallucinations etc
  • Your work and relationships start to suffer
  • You carry on drinking in spite of the problem it causes
  • You start to drink earlier and earlier
  • Other things become less important than alcohol 

What is a standard drink?

A standard drink is defined as one that contains 10 grams of pure alcohol.

The following are all equal to approximately to one standard drink.

  • Low alcohol beer (3.5 %) – 375 ml
  • Beer   4.9 % -285 ml
  • Wine 12% --   100 ml
  • Spirits (40%) - 30ml

What is low risk drinking?

Drinking alcohol will affect your body irrespective of how little you drink. However research has shown that the risk increases if the quantity of alcohol consumption increases.

Standard drinks per day

 

Scale of risk Low Harmful Hazardous
Female Up to 2 SD 3-4 SD >4  SD
Male Up to 4 SD 4-6 SD >6 SD

SD= Standard drink

Remember drinking is harmful to the body IF YOU DO NOT START YOU WILL NOT HAVE TO QUIT. So say no to alcohol every time.

 

What are the differences between men and women drinking alcohol?

Research has shown that alcohol affects men and women differently.

If a man and women drink exactly the same amount of alcohol the women will have a higher blood alcohol level concentration (BAC). A women body contains more fat tissue and less water than a man’s body and they are often smaller than men. Hence the alcohol will be more concentrated in women’s body, producing a higher BAC. Women also breakdown alcohol more slowly than men.

Women may develop liver damage and other health problems at lower levels of alcohol consumption than men.

Women who take the contraceptive pill may take longer to get rid of alcohol in their bodies than women who are not taking the pill.

 

What is the effect of alcohol on pregnancy?

Alcohol crosses the placenta to the baby. It can cause problems in pregnancy such as bleeding, miscarriage, stillborn and premature birth. It is not known whether or not there is a safe level of alcohol in pregnancy.

Babies who are born to mothers heavily dependent on alcohol can have withdrawal symptoms after birth like tremors, irritability, fits and bloated abdomen.

Remember in pregnancy no alcohol is the safest approach.

 

How to drink less?

A few techniques to reduce drinking are as follows

  1. Start with a soft drink : you will drink much faster if you are thirsty so quench your thirst before you start drinking alcohol
  2. Use standard drinks : monitor how much you drink by converting everything you drink into standard drink, it helps in keeping track
  3. Drink slowly: take sips and not gulps. Put your glass down between sips
  4. Eat before or while drinking: eating fills you up and slows your drinking pace the absorption of alcohol also slows down. 
  5. Avoid salty snacks : salty snacks like chips or nuts make you thirsty so you drink more
  6. Do not get involved in drinking contests
  7. Drink at your own pace and not someone else pace.
  8. One drink at a time. Do not let someone top up your drinks. It is hard to keep track of how much alcohol is drunk.
  9. Take a non alcoholic drink every alternative drink. Pace yourself.
  10. Do something between drinks if possible –don’t just sit and drink.
  11. Try the low alcohol alternatives.
  12. Have alcohol free days.  At least 2-3 days a week.       
    Like how lot of people have no non vegetarian days.
  13. Keep a diary and maintain how much you drink every day.
  14. Be assertive do not be pressured into drinking more. Learn to say no.

 

How to help a person to seek help from doctors for drinking problems?

This is a common problem family members and carers face when dealing with people who are dependent on alcohol.

  1. 1 Get the person to a doctor in context of the problem and defocus from his problem
    Eg: marital issue in context of alcohol dependence, try to get the person to see a doctor for the marital issue and not the alcohol issue. The doctor will try and work on the alcohol problem when he sees him.
    Eg: tell him to see the doctor for his sexual problem and the doctor will work on his alcohol problem also.
  2. Get a person who has some influence on the patient to talk to him.
  3. Ask the person to consider one appointment with the doctor and leave the person to decide regarding future appointments.

Remember for the treatment to work we need to have a person motivated to stop drinking alcohol. 

What is the CAGE questionnaire?

This is a questionnaire to screen persons for alcoholism. The questionnaire asks the following questions

  1. Have you ever felt you need to Cutdown on your drinking?
  2. Have people annoyed you for criticizing you about your drinking?
  3. Have you ever felt guilty about your drinking?
  4. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of your hangover?

If you have 2 yes to the above questions, you must be investigated for alcohol dependence.

 

What is the treatment for alcohol dependence?

Alcohol dependence is treated in two stages.

Stage 1: medications will be given to reduce the withdrawal symptoms and the medications will gradually be tapered off.

Injections will be given to replenish the loss of vitamins due to drinking.

Stage 2 :  medications will be given to reduce the craving for alcohol and if the patient is suitable medication will be given which causes an unpleasant reaction if the patient drinks alcohol while on the medications.

During this stage cognitive behaviour therapy will be adviced which will help patient to stay away from alcohol and also handle the issues that lead to the person drinking alcohol.

Remember many people have gone through the treatment and have stopped alcohol permanently, you also can.

 

Can alcohol dependence be treated on outpatient basis?

Alcohol dependence can be treated on outpatient basis and it is as effective as in patient care. The patient must be motivated to stop alcohol and he must have a good support system.

 

Who should be admitted to a rehabilitation centre?

If a person has tried numerous times to stop drinking alcohol by himself, with medical supervision both outpatient and inpatient then it would be worth to try a rehabilitation center were the patient can stay for a few months.

Remember to admit the patient to a centre which has a psychiatrist supervising the treatment process and always do your research regarding the rehabilitation center before admitting the patient there.