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Alcoholism

Alcoholism

Alcohol has been around for quite a while. It is one of the oldest psychoactive substances known to man and has been used to induce feelings of intoxication since before written history. Breweries have been traced back to as far as 6,000 years ago in ancient Egypt and Babylonia. During the Middle Ages, Arabian chemists were able to distill alcohol and create significantly more potent alcoholic beverages. These methods spread throughout Europe and gradually to the rest of the world. Since its introduction to humankind, alcohol has been used as a way to celebrate success, mourn the loss of friends and family, commemorate holidays, and even to help the sick or wounded recover. But what exactly is alcohol and how dangerous can it be?

Alcohol and its effects

According to the FDA, alcohol is classified as a central nervous system depressant, making its effects not unlike other CNS depressants such as opioids and barbiturates. It comes in a variety of forms such as beer, wine, fortified wine, spirits, liquor, and whiskey. The breakdown of the different forms are as follows: Beer (3 to 7 percent ethanol), Malt Liquor (7 to 8 percent), Wine (8 to 14 percent ethanol), Fortified Wine (17 to 22 percent), Spirits (40 and upwards percent), Liquor (40 and upwards percent), and Whiskey (40 and upwards percent).

Inebriation from alcohol creates feelings of dizziness and euphoria. When people drink, they tend to feel pleasure and relaxation for as long as alcohol is consumed. As a CNS depressant, it also creates feelings of drowsiness and sedation. People drinking alcohol will also experience feelings of dizziness, nausea, and vomiting along with significant neurocognitive impairment. The long-term effects of alcohol can be severe. For instance, prolonged alcohol abuse often results in liver damage, which if severe enough can become chronic. Continued alcohol abuse can also cause brain damage and increase your risk of contracting cancer.

Understanding BAC

Understanding blood alcohol content (BAC) is key to understanding how alcohol will affect your body and the dangers of alcohol poisoning. BAC measurements tell us the ratio of alcohol in the blood. So, for example, a BAC of .10 means one part alcohol for every 1000 parts of blood.

BACs and their effects can be summed up as follows:

0.02-0.03: Little effects, slight intensification of mood

0.05-0.06: Feeling warm, relaxed, and mildly sedated, exaggerated emotions and behavior, decreased reaction time, impaired judgement

0.07-0.09: Speech impairment and problems with balance, poor motor functions, impaired hearing and vision, feelings of elation or depression, increased confidence

0.08: Legal definition of intoxication in many states across the U.S.

0.11-0.12: Coordination and balance become worse and there is a distinct hindrance in judgement and cognitive abilities

0.14-0.15: Major impairments of mental and physical controls, speech is slurred, blurred vision, likely needs medical evaluation

0.20: Complete loss of motor control, must have assistance moving

0.40: Unconsciousness, coma, needs hospitalization

0.30-0.60: This level has been measured in people who have died from alcohol intoxication

The risks of alcohol overconsumption

Overconsumption of alcohol is dangerous because it can lead to unconsciousness, or blacking out. When alcohol is consumed in low quantities or roughly one drink per hour, the effects can be minimal, and the danger of “blacking out” is low. However, alcohol reduces inhibition and can cause some people to consume more than a safe amount. When a person blacks out, their frontal lobe ceases to assimilate sensual input into memory, and they will experience temporary amnesia while they continue to act.

This can be deadly, as drunk people may pass out, vomit, and choke due to blocked airways. Alcohol is toxic, so if too much is absorbed into the bloodstream, a person may experience long-term brain and liver damage. It is dangerous to assume that someone who has passed out from alcohol will be fine if they sleep it off. Ethanol will continue to absorb into the body and shut down neurotransmitters, suppressing vital life functions such as breathing and the gag reflex. Moreover, too much alcohol may also inhibit a person’s decision-making skills and lead to them engaging in unsafe behavior.

Consuming alcohol

Ethanol is a relatively small molecule that quickly enters the body and bloodstream. When consumed, it enters the stomach and begins to absorb into the bloodstream. Only about 20 percent of alcohol consumed will go into the blood while the rest is absorbed through the small intestine and expelled. The phrase, “that drink went right to my head” is somewhat accurate. Alcohol will spread throughout the body to achieve equal distribution, but because a substantial amount of blood is being pumped to the brain, this is where the effects are first felt. The rest of the body gradually catches up.

After swallowing alcohol, the drink will enter the stomach and small intestine, where small blood vessels carry it to the bloodstream. Up to 15% of alcohol is absorbed in the stomach while the remaining 80%+ is absorbed through the small intestine.

Alcohol is metabolized by the liver, where enzymes break down the alcohol. In general, the liver processes one ounce of liquor per hour. If you consume more than this, the system can be saturated and additional alcohol will begin to accumulate in the blood until it can be metabolized by the liver. This is why taking shots in rapid succession or playing drinking games can lead to high blood alcohol concentrations and last for many hours.

When alcohol hits the stomach, there’s a gastric enzyme called ADH (alcohol dehydrogenase) that processes up to 15% of alcohol before it hits the liver. Any alcohol not processed by gastric ADH is processed by ADH in the liver. ADH works by converting alcohol to acetaldehyde. NAD (nicotinamide adenine dinucleotide) is necessary to allow ADH to work its magic during this step. The amount of available NAD limits the amount of alcohol that can be metabolized.

Because of the limitations of processing alcohol in the liver, the feeling of being drunk comes about because the blood alcohol level essentially hits this speed bump and compounds, causing drunkenness. When ADH gets to work in the body on the 2nd step, it converts acetaldehyde to acetic acid. During step 3, acetic acid is then broken down into carbon dioxide and water. The energy created during this reaction is in the form of calories.

Ever wonder why a nasty hangover feels so bad? One of the primary reasons is the acetaldehyde buildup. It’s a very toxic chemical, and can be more dangerous than alcohol itself. Luckily the body is prepared to get rid of it during the process, which is what causes the hangover itself.

The absorption of alcohol is based on several physical, genetic, and environmental factors. Physically, because more alcohol is needed to be consumed to achieve the same level of inebriation in a larger person compared to a smaller person. Genetically, because everyone’s metabolism, blood pressure, and neurotransmitters are unique to their body. And environmental, which has entirely to do with how much food and water you consume. Drinking on an empty stomach causes the alcohol to absorb into the body much quicker. Food dilutes the alcohol and causes it to enter the bloodstream more slowly. The higher the concentration of alcohol, the faster and more concentrated it will be once it enters the bloodstream. Therefore, someone who consumes shots will have a higher BAC than a person who drinks the same amount of beer or wine.

Ethanol (ETOH) is ultimately metabolized by the liver, where an enzyme called alcohol dehydrogenase breaks it down into a compound called acetate. This is absorbed into the enzymes and produces the toxic chemical acetaldehyde that creates feelings of nausea and illness. Depending on your genetics, your body expels this chemical at different rates. The prescription medication Antabuse was designed to make the body retain this toxic compound, ensuring that people who drink alcohol while on it will feel intense nausea and gradually come to dislike alcohol. This method was based on the Pavlovian method and has reached no medical consensus as to its efficacy.

The problem of drinking can be even more dangerous when you mix alcohol with other depressants such as Rohypnol, Ketamine, tranquilizers, or sleeping pills. Combining these depressants can multiply and enhance the effects of both drugs leading to an increased likelihood of dealing with those life-threatening problems. Ethanol can’t mix with certain types of medicines, like antidepressants. Some alcohol drinkers will combine their alcohol use with recreational drugs, which have the possibility of boosting the effects of the other by surprise. Anything above 0.12% BAC could have catastrophic effects on the human body via actions and consequences or incredibly high BAC that brings about coma or death.

Do women really get drunk faster?

Women actually have half the ability to process alcohol pre-liver due to a lower amount of a gastric enzyme called ADH that processes up to 15% of ingested alcohol. Any alcohol not processed by gastric ADH is processed by ADH in the liver. Men have larger vascular layouts due to the fact that they have a higher ratio of muscle to fat than women, allowing more dilution of alcohol in the blood. (Fat doesn’t have much blood supply in the body usually.) Since women have a higher body fat amount than men, they concentrate alcohol in plasma more than men, which raises the level in the blood.

What causes hangovers?

One of the most common symptoms of a night spent binge drinking is a hangover. Hangovers are characterized by a pounding headache, nausea, body pain, and general feelings of unpleasantness. For many drinkers, the dreaded hangover is something to be avoided at all costs. The best way to prevent a hangover would be not to consume alcohol, but to minimize the effects of a hangover, there are a few ways to prepare. One is to drink plenty of water as you are consuming alcohol. It is believed that headaches occur as a result of the brain being dehydrated.

As alcohol is expelled from the body, the neurotransmitters that were once blocked will begin to work again, and any pain relief and sedation will gradually be lost. Likewise, dopamine transmitters that were once firing off will deactivate, leaving the person depleted of dopamine and feeling anxiety or unease. There may also be nausea and stomach pain as a result of the leftover toxic chemicals. To ease the pain, some may take Aspirin or Tylenol before going to bed. This can help ward off the onset of pain but should be carefully considered. Combining Tylenol with alcohol can produce a toxic byproduct that will harm the liver. Ibuprofen or Aspirin should be substituted. However, food should also be consumed at the same time to reduce the chances of irritation to the stomach lining.

Is alcohol a drug or poison?

One of the most asked questions about liquor, beer, and wine is whether you’re consuming a drug or if alcohol is in its own category entirely. The short answer is that, yes, alcohol is a drug. Alcohol is a psychoactive substance, just like most other drugs. In fact, it’s the most available drug in our homes and neighborhoods other than cigarettes, prescriptions, and caffeine.

Technically all forms of alcohol are also poisonous. Ethanol, the one consumed by humans recreationally, is the only form that is least poisonous enough to be occasionally consumed. Other types, such as isopropyl alcohol, are stronger and are used as disinfectants. Methanol is another deadly form that is still occasionally consumed and is what you would find in bootleg or moonshine liquor.

Is alcohol a stimulant?

Drinkers commonly report feelings of excitement or stimulation when consuming alcohol. As a central nervous system depressant, this poses a paradox to scientists. However, there are some theories as to why alcohol is a depressant that can also be a stimulant. Alcohol acts on both the GABA and glutamate receptors which are responsible for the excitatory and inhibitory activity. When one cell releases GABA onto the next cell, that cell becomes less active. When glutamate is discharged onto the next cell, this creates action. Alcohol increases GABA activity, but it also increases dopamine transmission, which could cause glutamate also to fire off. The increase in dopamine could account for some of the stimulating effects of alcohol, but this only occurs while alcohol concentration is increasing. For this reason, a person is more likely to be stimulated as they begin to consume alcohol but later grow drowsy and tired.

Alcohol acts on the body as a central nervous system (CNS) depressant and slows down cognitive function while acting as a stimulant at smaller “doses”. The chemical that causes the intoxicating effects is ethanol which is produced during the fermentation process of making your drink of choice. Other drugs like benzodiazepines and GHB are also examples of downers that work in a similar manner to ethanol.

How does alcohol affect the brain?

Brain scanning techniques have offered scientists a window into how alcohol impacts different areas of the brain. For example, long-term abuse of alcohol can cause shrinkage of brain tissue that continues as long as the person is using. Those who stop drinking can reverse this effect. Some areas of the brain are also more susceptible than others. The cortex is the part of the brain that endows us with consciousness and controls our mental functions. The frontal lobe region of the cortex can be temporarily and even permanently damaged by consuming alcohol. The frontal lobe is important because it acts as the executive manager of the brain, monitoring and coordinating its functions. When alcohol is absorbed in the short term, the neurotransmitters of this area are noticeably hampered. Likewise, the mammillary bodies, which are important for memory, may experience temporary shut down. Some studies have shown that there is large nerve cell loss in the region of the brain called the hippocampus

Alcoholics with a long-term history of drinking will display signs of brain shrinkage and possible chronic damage. Short-term and social drinkers will experience shrinkage, but not in as severe quantities. The shrinkage only lasts for the duration of the alcohol consumed and reverts to normal afterward. Studies on animals have shown that binge drinking for as little as two days in a row can cause some cells to die off. These results were even more pronounced in young animals. The most significant impacts occur to the following portions of the brain.

Memory formation

As alcohol affects the frontal lobe, hippocampus, and mammillary bodies, memory is often affected by drinking. Information recall from before drinking is not affected, that is to say, information learned in the past, but an individual with a chronic drinking habit may experience difficulty remembering portions of their day if they have been consuming alcohol. On mental ability tests, chronic drinkers often perform fine in most categories save that of short-term memory recall. This selective memory is a result of continued damage to these portions of the brain.

Abstract thinking

Abstract thinking involves being able to think in ways that are not directly tied to concrete things. For example, when we interpret a piece of art or story, or work on a word puzzle, or solve an algebra problem. Chronic drinkers will find that these abilities are compromised. In studies on abstract thinking, chronic drinkers will be given a set of objects and asked to group them according to characteristics. Non-alcoholics will tend to group these objects according to abstract characteristics such as what they are used for, while alcoholics will tend to group them according to shape, size, and color, in other words purely physical characteristics.

Problem-solving

Chronic drinkers tend to have problems approaching problems from different points of view. Problem-solving requires a degree of mental flexibility to be able to switch up strategies on the go and think big picture. People with a history of chronic drinking will often approach a problem using a particular mode of problem-solving rather than shifting to a new approach. As a result, they take longer to solve problems.

Attention and concentration

Chronic drinkers also display difficulties in paying attention or maintain concentration for prolonged periods of time. In a casual conversation, they may appear to be perfectly functional, but when given a more challenging situation such as understanding a car manual, they could be impaired.

Perception of emotion (empathy)

Chronic drinkers also have difficulty reading social behavior. Alcohol acts on the specific brain functions that allow us to detect attitude and emotion in people’s voices. For alcoholics, relationships and socializing are often difficult, so it could be that alcoholics are hurting themselves when they choose to self-medicate to be more friendly and sociable. Chronic, heavy drinking can significantly reduce one’s ability to read social cues and function correctly in social events

Alcohol abuse

Alcohol abuse can lead to a number of physical and mental problems that can lead to life-threatening issues. For example, some long-term effects of excessive alcohol use can lead to issues such as bleeding from the esophagus, swelling of the pancreas, liver damage, and a number of different types of cancers.

Some common cancers that are associated with excessive alcohol use include the esophagus, liver, colon, head, neck, breasts, and other areas. Increased alcohol use also leads to cardiovascular issues such as high blood pressure and heart problems.

Along with these problems, there is a long list of short-term health risks that can come from excessive alcohol use. For example, injuries such as motor vehicle crash, falls, drownings, and more can all happen during intoxication. Likewise, outbursts of violence can also happen. Excessive alcohol use can also lead to alcohol poisoning, which generally requires medical attention.

What is excessive and binge drinking?

The CDC defines excessive drinking as either binge or heavy drinking: binge drinking being 4 or more drinks per sitting for women and 5 or more for men, heavy drinking being 8 or more drinks per week for women and 15 or more drinks per week for men. Binge drinking causes at least half the deaths from drinking in the US per year.

Excessive drinking causes 1 out of every 10 deaths among 18+ individuals every year. The long-term effects of excessive alcohol use can present themselves as cardiovascular issues, cancer, or liver disease.

Signs of alcoholism

According to the National Institute on Alcohol Abuse and Alcoholism, an estimated 16 million people in the United States suffer from alcohol use disorder. To be diagnosed with alcohol use disorder, a person must meet certain criteria that is outlined in the Diagnostic and Statistical Manual of Mental Disorders. The current DSM has a number of different criteria to help someone determine if they may be dealing with some form of alcohol use disorder.

To determine if you or a loved one may have an alcohol use disorder, the DSM asks you a number of questions.

In the past year have you:

  • Had times when you ended up drinking more or longer than originally intended?
  • Tried to stop or cut drinking but couldn’t?
  • Spent a lot of your time drinking or being sick from the after effects of drinking?
  • Wanted a drink so badly that you couldn’t think of anything else?
  • Found that your drinking interfered with taking care of your family or caused professional problems?
  • Continued drinking even though it is causing problems with your family or friends?
  • Given up or cut back on activities that were once important or interesting to you so that you could drink more?
  • Gotten into situations while or after you were drinking that increased your chances of getting hurt?
  • Continued to drink despite feelings of depression or anxiety or after having a memory blackout?
  • Had to drink more than you once did to get the effects that you wanted?
  • Experienced withdrawal symptoms as the effects of alcohol wore off? Symptoms include trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure.

The presence of at least two of these symptoms indicates an alcohol use disorder. However, the severity of the problem increases depending on the number of symptoms. For example, mild severity is defined as the presence of two to three symptoms, moderate severity for four to five symptoms, and the problem is severe if there are six or more symptoms present.

Fetal alcohol syndrome

A woman who is pregnant and drinks alcohol will be delivering it straight into the developing fetus. A significant amount of blood flow goes to the uterus and developing fetus and research has revealed that the child will receive a higher amount of alcohol concentration than the mother. The infant is at risk for developing fetal alcohol syndrome, which can entail brain damage, growth problems, and facial disfigurement.

Alcohol rehab

Alcohol detox

The first step after going to a drug or alcohol treatment facility is detoxification. Detox is important as it lets you or your loved one safely overcome the withdrawal problems associated with short-term sobriety. This will help patients focus solely on the behavioral treatment after the first few days of treatment. Moreover, alcohol withdrawal can be a very serious problem and can lead to a number of harmful, even life-threatening symptoms.

Behavioral treatment

Following detoxification, patients will likely be exposed to a number of different types of behavioral therapies, both in a one-on-one and group setting. During these sessions, patients will learn more about their specific addiction and trigger that lead to their alcohol or drug use. They will also get the opportunity to learn and hear from others who are suffering from similar issues. Group therapy also provides patients the opportunity to grow their sober support network which will help them on their road to recovery long after inpatient treatment.

MAT for alcoholism

While medication-assisted treatment is still a hotly debated subject in the recovery industry, there is evidence that MAT can be effective in reducing a patient’s craving for drinking and can even help them experience fewer days drinking than those not using MAT. As an example of a drug that’s used to treat alcoholism, naltrexone, also known as Vivitrol, is a medication that works to block the effects of the respective drug. There is evidence that naltrexone can be effective in reducing a patient’s urge to drink, help a patient remain abstinent, and can successfully interfere with a patient’s desire to continue drinking.

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