Potpourri- Hazards Of Alcohol

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Hazards Of Alcohol

By Dr K Shantibala Devi

Introduction:

Alcohol is a psychotropic substance containing ethanol as its active ingredient or molecule. The ubiquitous nature of alcohol use or abuse in today’s world has attained the status of a truism. Ink has run freely to document the social, economic and psychological burden of this modern day pandemic. The use of alcohol for pleasure is known from antiquity. Unfortunately, it also produces several unwanted effects. The economic costs of alcohol-related effects are alarming with lost of productivity in the workplace, academic years, health costs and treatment besides the various alcohol-related damage. Alcoholism can be defined as a chronic and progressive disease characterized by a loss of control over the use of alcohol with subsequent social, legal, psychological and physical consequences.

With repeated use of alcohol, larger and larger doses are required to produce the desired effects known as ‘tolerance’ which results from behavioral tolerance, pharma-cokenitic tolerance and cellular tolerance in medical parlance. There is also a condition referred to as ‘reverse tolerance’ particularly seen in older persons and person with brain damage as in head injury. In such groups there is increased sensitivity to alcohol which may be explained due to decrease rate of metabolism in the liver along with enhanced sensitivity of the neurons of the brain.

Alcohol is highly soluble in water and to some extent in fat and as a result is distributed to almost every body system and body membranes and brain neurons. The taste of the alcoholic drink is determined by the congeners which consist of methanol, butanol, aldehydes, phenols, tannins, lead, cobalt, iron and other substances which are toxic to our body. One standard drink contains 7.87 grams of ethanol. And liver metabolized only one drink an hour. On empty stomach, the rate of absorption of alcohol is faster. Between 2 and 10% of the alcohol is excreted unchanged from the lungs or the kidneys or through sweat and the remaining is metabolized by the brain.

Acute effects of alcohol:

The acute effects of alcohol depend on the level of blood alcohol concentration (BAC). Usually the blood alcohol concentration peak in 30 to 60 minutes after consuming alcohol on an empty stomach. The presence of food especially carbohydrates delay the absorption and peaking of the blood alcohol concentration. Alcohol depresses the central nervous system and in small amount it sedates and relieves anxiety and at times it may give a sense of strength resulting in boisterous behavior. The behavioral manifestations of alcohol also depend on the company the person drinks, whereby alcohol uncovers the individual’s moods and the amount consumed. Alcohol impairs judgment by reducing conscious, self-control during the period of intoxication coupled with lack of insight; the individual may undertake risky activities such as driving cars, operating machines, and social indiscretions. The accepted index to define drunk driving is the blood alcohol level of 80 mg/dl or after drinking 3 or more 30 ml whiskies within an hour. At a level of BAC less than 80 mg/dl, there is euphoria, relaxed feeling, freely talking, clumsy movement of hands and legs and reduced alertness. At more than 80mg/dl, the person becomes noisy, moody, with lack of judgment and impaired driving ability. At a level of 100 – 200 mg/dl, there is blurred vision, unsteady gait, incoordination, slurred speech, aggressive and quarrelsome. Amnesia occurs at a level of 200-300 mg/dl with coma at 300-350 mg/dl and death may occur at a blood alcohol concentration level of 350-600.

The effects of alcohol begin within 15 minutes after consumption and last for several hours. There are also delayed effects which are unpleasant, usually the morning after drinking known as hangover and consist of symptoms of throbbing headache, giddiness, tremors, weakness, fatigue, gastritis with nausea and vomiting and labile blood pressure.

Alcohol intoxication develop during or shortly after ingestion of alcohol is characterized by clinically significant maladaptive behavior or psychological changes such as inappropriate sexual or aggressive behavior, changing moods, impaired judgment, and impaired social or occupational functioning. It is accompanied by slurred speech, incoordination, unsteady-gait mystaga-mus, impairment in attention or memory and stupor or coma.

The acute effect of alcohol on heart includes change in blood pressure depending on the dose – blood pressure usually falls/decrease with small or extremely large-doses but actually increases with moderate doses. There is dilatation of the blood vessels causing warm, flushed skin and a feeling of warmth. There is loss of heat from the body which increases the risk of hypothermia (a condition of fall of body temperature below normal). This sometimes caused death to many drunken persons found death in the open usually during winter. The acute effect of alcohol also include increased heart rate (kachy-cardia) and with huge doses, decrease in heart rate (bradycardia).

On the respiratory system small doses of alcohol cause increased breathing rate while large doses cause respiratory depression. The gastro-intentional (stomach-intestines) effects of alcohol are the irritation of the stomach lining. At large dose, it may induce vomiting and gastric bleeding. In the urinary system, alcohol cause increased urination in the early stage but later on may have sodium retention.

Effects of long term alcohol use:

Daily drinking of alcohol is associated with a wide range of medical complications and the long term alcohol use has ill effects on various organ system of our body.

Gastro-intestinal problems:

Next to the nervous system, the gastro-intestinal system is most severely affected by heavy drinking and the common problem associated is acute and severe inflammation of the esophagus or the stomach accompanied by vomiting and bleeding. Gastritis with dilated esophageal veins induces potentially lethal bleeding and death may occur. It can affect the pancreas which can be abdominal emergency of acute pancreatitis or a chromic irreversible condition of pancreatic destruction. Liver is an organ especially vulnerable to alcoholic ill effects. It can present as ‘fatty liver’ where there is accumulation of fats and protein in the liver cells, inflammation of the liver cells known as ‘hepatitis’ and finally ‘cirrhosis’ with accumulation of fluid in the abdomen known as ascites as the damage progress. As liver failure progresses, secondary cognitive disturbances can develop leading to ‘hepatic encephalopathy’. The short term mortality of alcoholic hepatitis may be as high as 20-60%. The daily consumption of up to 160 gls (200 ml of ethanol) of alcohol over a 15 years duration has the risk of developing cirrhosis. However if there are other contaminants or toxic substance present in the alcoholic drinks, the duration may be short. The progress to cirrhosis is a gradual process and symptoms begin as loss of appetite, weight loss, abdominal discomfort and low grade fever. Jaundice, parotid gland enlargement, spider angiomata, enlargement of spleen, ascites, bleeding etc. develops as the damage progresses. Hormonal dysfunction seems as enlargement of breast, impotence and testicular atrophy in man and cessation of menstrual flow in females occurs. Persons with liver cirrhosis have risk of developing liver cancer and more so if there is Hepatitis ‘B’ infection.

Hepatic encephalopathy is a complication of alcoholic hepatitis and can occur in persons with liver cirrhosis. The symptoms and signs include agitation, mood swings, inappropriate behavior, confusion disorientation and alteration in sleep pattern. This is followed by tremor with increased reflex and rigidity, frank delirium and if left untreated goes into coma and death ensues.

The effect of alcohol on small intestines is that it increases the motility leading to diarrhea. In the small intestine, there is absorption of water, sodium, glucose, amino acids, folic acid and thiamine which the alcohol interferes leading to decrease absorption.

Nutritional deficiencies:

Alcohol has a direct appetite suppressant effect and because of its high caloric content it is often substituted for food. Alcohol interferes with absorption of various nutrients leading to a state of protein-calorie malnutrition. An alcoholic person-gets easily fatigued, is lethargic and there is weight loss. Chronic alcohol abuse leads to multiple vitamin deficiency especially that of thiamine, pyridoxine, vitamin A, niacin, folic and ascorbic acids. Peripheral neuropathy, Wernicke-Korsakoff syndrome and high output cardiac failure as a result of thiamine deficiency.

Disorders of blood (Heamatological):

Alcohol by itself has a depressant action on the bone marrow and can cause anemia. Acute or chronic blood loss from the gastro-intestinal tract can also produce anemia. Due to diminished production of vitamin K, bleeding problem may arise. Alcohol also decreases the production of white blood cells and the immune system.

Cardiac (Heart) problem:

Alcohol directly affects the heart muscles resulting in alcoholic cardiomyopathy with signs/symptoms of irregular heart beats and signs of heart failure seen after prolong use of alcohol with the initial symptoms of easy fatigability. Moderate to heavy drinking is associated with hypertension or high blood pressure, which also interferes with anti-hypertensive medications and usually fails to respond to standard anti-hypertensive treatment. The risk of myocardial infarction and thrombosis is high among alcohol users.

Cancer:

Cancers in the head, neck, esophagus, stomach, liver, intestines and lungs are associated wit alcohol use.

Fetal alcohol effect: In women particularly pregnant women, use of alcohol can have ill effects on the developing fetus. Alcohol easily cross the placental barrier and use of high dose of alcohol can produce fetal death and spontaneous abortion. Those infant who survived may suffer from mental retardation, small head, diminished physical size, facial abnormalities, congenital heart defects and deformities of limbs. The problem is irreversible.

Nervous system:

Chronic alcohol use can produce a significant alteration in the functioning of both central and peripheral nervous system and the complications results from the direct neurotoxic effect of alcohol as well as due to the co-existing thiamine deficiency which is common in alcoholics.

Blackout:

40 per cent of men in their teens and 20’s have incidence of blackouts during a drinking bout. In this condition there is memory impairment for a period of time when the person drinks heavily but remained awake (and the person fails to recall what happened that last time).

Sleep impairment:

Alcohol perhaps induces sleep quickly but normal sleep pattern is disturbed and the person do not get the quality sleep which is restorative.

Peripheral neuropathy:

After years of heavy drinking, 10% of alcoholic develop this serious and potentially permanent problem. The combination of vitamin deficiencies and the direct effects of alcohol or its metabolites cause deterioration of the nerve functioning of the hands and feet called peripheral neuropathy. There is pain, decreased sensation, numbness, tingling and weakness of hands and feet particularly of the lower extremities. Alcohol might affect the autonomic nerves resulting in impotence, postural hypo-tension and bladder or bowel dysfunction.

Alcoholic myopathy:

Chronic use of alcohol is also associated with progressive muscle weakness, manifest as difficulty in climbing staircases or walking on an uneven ground, difficulty in getting up from squatting position without support etc.

Alcoholic dementia:

Chronic alcoholics have intellectual difficulties with symptoms of forgetfulness, decreased attention span and concentration, inability to learn new material, indecisiveness, etc which may progress to frank dementia with change in personality, social behavior, memory lapses and intellectual decline. There may be shrinking of the brain mass too.

Wernicke-Korsakoff Syndrome:

The cause of this disorder in alcoholic is due to thiamine deficiency. The initial clinical presentation of Wernicke encephalopathy is usually acute with signs of abnormal eye movement, instability of low limbs and global confusion associated with mental abnormalities of disorientation, memory lapses and state of general apathy. If no prompt treatment is instituted, death occurs in about 20% of cases if Wernicke’s encephalopathy. Even after treatment, memory difficulties persist, the condition referred to as Korsakoff syndrome.

Alcoholic cerebellar degeneration:

Seen in chromic alcoholic due to nutritional deficiencies, there is cerebellar degeneration affecting the trunk and lower limbs present with a broad based stance and gait difficulty. During an acute binges or alcohol withdrawal starts, the symptoms become more prominent.

Psychiatric syndromes:

Varieties of psychiatric disorder are encountered during alcohol intoxication and withdrawal. It may also be a co-existing state. Depressed mood, severe anxiety and symptoms of psychosis may be seen. Panic disorder, anxiety neurosis, delusional disorder and frank psychosis are also seen after abstinence too.

Other problems:

Alcohol can hasten the development of osteoporosis especially among women drinkers. Alcohol reduces bone mass with reduction in the density of the trabecular bone, hence leading to fracture of bones even with minor injury or fall. Alcohol also affects the immune system and lowers resistance to infection. Tuberculosis is frequently seen amongst alcoholics.

Alcohol and accidents:

There is a three fold increase in accident rate among alcoholics besides road traffic accidents, alcoholics are at risk for accidents at home and at workplaces. In India, it is reported that 20% of related head injury is associated with recent alcohol consumption which is true as seen in hospital attendance for head injury.

Conclusion:

Significant research findings point towards a host of multifactorial causes at the root of genesis of alcohol abuse behavior such as individual or personality factor, biological or heredity factor, psychological attributes, influences of the environment and the larger social factors.

Prevention of abuse of alcohol can be aimed at three levels – (i) Primary prevention – of, occurrence of abuse in the vulnerable population and among the general public; (ii) Secondary prevention - early detection and treatment of those already affected by alcohol problem and (iii) Tertiary prevention – rehabilitation and integration into society.

In the primary level of prevention, two fundamental ways of prevention of alcohol use would be:-

(i) To decrease availability of the alcoholic beverages (supply reduction).

(ii) To decrease the need for alcohol in the population thereby decreasing demand (demand reduction).

Many surveys and scientific studies suggest an increased prevalence of alcohol problem in contemporary society and it is estimated that alcoholism is about 1.5 times more prevalent than diabetes in the community. Thus it is clear that alcohol related problems are major national health concern. The need of the day is ‘positive health movements’ and increasing awareness and consciousness among the general public and doctors towards ‘health promotion’.

(Courtesy: The Sangai Express)

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