ALCOHOL

Alcohol is the most widely used substance in the world, and has been for thousands of years. It is a psychoactive drug that has a depressant effect. High blood alcohol content is usually considered to be legal drunkenness because it reduces attention and slows reaction speed. Alcohol is a potentially addictive substance; addiction to alcohol is known as alcoholism.

Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption. In particular, such laws specify the minimum age at which a person may legally buy or drink them. This minimum age varies between 16 and 25 years, depending upon the country and the type of drink. Most nations set it at 18 years of age.

Types of alcohols in India

Indian Made Foreign Liquors‘[IML] – Whisky, Brandy, Rum, Vodka, Gin etc manufactured in India
Beers of different strengths and wine
Country liquor – manufactured in government-licensed factories, commonly called arrack‘
Illicit drinks are illegal, but consumed widely. Examples are toddy, mahua and chang
Methanol is the most dangerous adulterant in illicit alcohol and is often the cause of life threatening ―hooch tragedies

Drinking Practices in India
Most commonly consumed alcoholic beverages	Arrack, palm wine, beer, imported liquors
Drinking predates European contact	Yes, but not particularly central to social life
Women’s drinking pattern	95 % abstinent
Men’s drinking pattern	Highly variable according to regions
Context of drinking occasions	No regular context established
Evidence of concerns of young people drinking	Increasing
Extent of major concerns about alcohol related problems	Increasing problems seen in health, social, and economic areas

How Alcohol Travels Through the Body

Alcohol is metabolized extremely quickly by the body. Unlike foods, which require time for digestion, alcohol needs no digestion and is quickly absorbed. Alcohol gets absorbed and metabolizes before most other nutrients in the body. About 20 percent is absorbed directly across the walls of an empty stomach and can reach the brain within one minute.

Once alcohol reaches the stomach, it begins to break down with the alcohol dehydrogenase enzyme. This process reduces the amount of alcohol entering the blood by approximately 20%. In addition, about 10% of the alcohol is expelled in the breath and urine.

Alcohol is rapidly absorbed in the upper portion of the small intestine. The alcohol-laden blood then travels to the liver via the veins and capillaries of the digestive tract, which affects nearly every liver cell. The liver cells are the only cells in our body that can produce enough of the enzyme alcohol dehydrogenase to oxidize alcohol at an appreciable rate.

Though alcohol affects every organ of the body, its most dramatic impact is upon the liver. When alcohol is present, the liver cells are forced to first metabolize the alcohol, letting the fatty acids accumulate, sometimes in huge amounts. Alcohol metabolism permanently changes liver cell structure, which impairs the livers ability to metabolize fats.

The liver is able to metabolize about ½ ounce of ethanol per hour (approximately one drink, depending on a person’s body size, food intake, etc.). If more alcohol arrives in the liver than the enzymes can handle, the excess alcohol travels to all parts of the body, circulating

How does alcohol act?

until the liver enzymes are finally able to process it.
Alcohol depresses the normal functions of the brain. Some of alcohol’s effects disappear overnight – while others can stay a lot longer, or indeed become permanent.

From the second one takes first sip, alcohol starts affecting the body and mind. At first it depresses the part of the brain that controls inhibitions. After one or two drinks one may start feeling more sociable. In small amounts: seems to calm down and relieves anxiety.

In higher doses: basic human functions such as walking and talking become much harder. One might also start saying things which don’t mean and behaving out of character, talkativeness, boisterousness.

At even higher doses: increased sedation, loss of control and balance. And finally: unconsciousness, coma and even death.

Mental health

Alcohol alters the brain’s chemistry and increases the risk of depression. It is often associated with a range of mental health problems. Heavy drinking often leads to work and family problems, which in turn can lead to isolation and depression

Effect of alcohol on health

Alcohol consumption has numerous health and social consequences. It is an important contributor to death and disability. Worldwide, alcohol causes 1.8 million deaths each year
It adversely affects multiple organs of the body.

Medical complications due to alcohol use can range from acute damage to the lining of the stomach to severe chronic liver damage, sterility and loss of intellectual functions.
Some complications are acute and occur soon after alcohol consumption; others are chronic and occur after prolonged use. Some complications can be reversed or treated after stopping alcohol use, but some may become irreversible and permanent

Health Effects of Alcohol Consumption

Arthritis	Increases risk of gouty arthritis
Cancer	Increases the risk of cancer in the liver, pancreas, rectum, breast, mouth, pharynx, larynx and oesophagus
Foetal Alcohol Syndrome	Causes physical and behavioural abnormalities in the foetus
Heart Disease	Raises blood pressure, blood lipids and the risk of stroke and heart disease in heavy drinkers. Heart disease is generally lower in light to moderate drinkers.
Hyperglycaemia	Raises blood glucose
Hypoglycaemia	Lowers blood glucose, especially for people with diabetes
Kidney Disease	Enlarges the kidneys, alters hormone functions, and increases the risk of kidney failure
Liver Disease	Causes fatty liver, alcoholic hepatitis and cirrhosis
Malnutrition	Increases the risk of protein-energy malnutrition; lowers intake of protein, calcium, iron, vitamin A, vitamin C, thiamine, vitamin B6 and riboflavin, and impaired absorption of calcium, phosphorus, vitamin D and zinc.
Nervous Disorders	Causes neuropathy and dementia; impairs balance and memory
Obesity	Increases energy intake, but not a primary cause of obesity
Psychological disturbances	Causes depression, anxiety and insomnia

Everybody responds differently to drinking alcohol so it is not possible to say what effects having a certain number of drinks have on a person. Instead blood alcohol concentration (BAC) can be used as a guide to what affects alcohol may have on behaviour.

Effects on Behaviour

Stages	Blood Alcohol Concentration (BAC)	Likely Effects
Feeling of well-being	Up to .05 g%	Talkative Relaxed More confident
Some raised risk	.05-.08 g%	Talkative Acts and feels self-confident Judgment and movement impaired Inhibitions reduced
Moderately raised state	.08-.15 g%	Speech slurred Balance and coordination impaired Reflexes slowed Visual attention impaired Unstable emotions Nausea, vomiting
Very elevated risk	.15-.30 g%	Unable to walk without help Apathetic, sleepy Laboured breathing Unable to remember events Loss of bladder control Possible loss of consciousness
Death	Over .30 g%	Coma Death

How does alcohol cause addiction?

Alcohol use usually starts as a social phenomenon. Some individuals over time develop a pattern of use which can be labeled as harmful use or alcohol abuse and some go on to develop alcohol tolerance and dependence. Tolerance means that they feel less effect than they used to with the same amount of alcohol.

Dependence means that the alcohol becomes central in their life and they continue to drink despite being aware of the harms caused through that consumption. Alcohol like other addictive substances activates and affects the brain's pleasure circuit. Over time, the brain actually changes in certain ways so that a powerful urge to use alcohol controls the person’s behaviour. A lot of time is spent thinking about alcohol, obtaining it, consuming it and recovering from it. The person will find it difficult to stop drinking or to control the amount consumed.

Consequences of alcohol drinking
Intoxication is the most common cause of alcohol-related problems, leading to injuries and premature deaths. As well as deaths, short-term effects of alcohol result in illness and loss of work productivity (e.g. hangovers, drink driving offences). In addition to health problems, alcohol also impacts on relationships, finances, work, and contributes to criminal behaviour resulting in legal problems.

Consequences of intoxication

Road accidents / Motor vehicle crashes. Alcohol complicates diagnosis of trauma-related injury, may mask or mimic the signs of a head injury and complicate treatment.
fire injuries
falls and drowning
Domestic violence
child abuse cases
suicides
Workplace accidents
Enlargement of heart due to alcohol consumption

Social problems
Excessive alcohol use can affect all areas of a person's life, including family, work and personal relationships.

Family problems: Alcohol destroys the home much before it destroys the liver. Marital disharmony and domestic violence, neglect of children, unsafe sex, financial problems, criminal behavior such as driving offences, breach of the peace, shoplifting
Work problems: drinking alcohol at work and hangovers can lead to poor performance and accidents at work, while illness can result in absenteeism.
Legal problems: drink-driving may lead to fines, loss of license and even imprisonment.

Psychosocial Complications of Alcohol Use

Financial

Occupational

Familial

Social

Legal

Spending money on alcohol instead of essential needs

Financial obligations not full filled

Exhausting savings

Borrowing money

Financial bankruptcy and destitution

Inefficiency due to decreased performance

Unpunctuality

Fights, quarrels, theft

Absenteeism

Accidents at work place

Suspension/ loss of job

Frequent changes in job

Loss of skills

Unsuitability for employment

Poor relationship with colleagues

Arguments over alcohol use

Neglect of family obligations

Role change & conflict

Co – dependence

Quarrels & physical violence

Divorce

Peer alienation

Misbehaving with others

Arguments / fights

Decreased social reputation

Loss of position

Social isolation

Violation of rules

Driving under intoxication

Thefts and crimes

Arrests and court cases

Involvement with criminal gangs

Conviction

Imprisonment

Withdrawal Symptoms
Alcohol withdrawal refers to a group of symptoms that may occur from suddenly stopping the use of alcohol after chronic or prolonged ingestion.

Alcohol withdrawal is usually seen in adults, but also in teenagers and occasionally children. Alcohol Withdrawal usually occurs within 5-24 hours after the last drink, and may last as long as 7-10 days. Alcohol Withdrawal is more likely to occur when larger quantities of alcohol are consumed regularly, but also if the person has other medical conditions. Raised levels of agitation and difficulty with sleep may persist for weeks or months in some cases.

In people who drink heavily on a regular basis, the brain becomes tolerant to alcohol. Having developed an alcohol tolerance the brain becomes highly overactive if its usual dose of alcohol is suddenly withdrawn. This over activity of the brain results in direct effects such as epileptic seizures, memory damage, and alcohol withdrawal symptoms in the body. Increased adrenaline release in the body occurs as a result of this overactivity, resulting in excessive sweating and shaking, the typical alcohol withdrawal symptoms.

Mild to moderate psychological symptoms:

Feeling of jumpiness or nervousness
Feeling of shakiness
Anxiety /agitation
Irritability or easily excited
Emotional volatility, rapid emotional changes
Depression

Mild to moderate physical symptoms:

Headache - general, pulsating
Sweating, especially the palms of the hands or the face
Nausea and Vomiting
Loss of appetite
Insomnia, sleeping difficulty
Paleness
Rapid heart rate (palpitations), Increased pulse, Elevated blood pressure
Eyes, pupils different size (enlarged, dilated pupils)
Abnormal movements
Tremor of the hands
Involuntary, abnormal movements of the eyelids
Fatigue, Malaise or weakness

Sometime one could have severe withdrawal symptoms and may have

A state of confusion and hallucinations (visual) -- known as delirium tremens
Disorientation, Illusions and delusions
Agitation
Fever
Convulsions
"Black outs" -- when the person forgets what happened during the drinking episode

Does alcohol have protective properties?

Incidence of heart disease in those who consume moderate amounts of some kinds of alcohol (an average of 1 to 2 drinks per day) has been shown to be lower than that in nondrinkers in some countries. However with increased consumption the bad effects on health are many more and serious

For the person beginning to drink alcohol, alcohol addiction and alcoholism is a real threat. It is NOT advisable to issue guidelines that may lead some persons to increase intake of alcohol or start drinking if they do not already do so.

To Drink or Not to Drink?

Do you have a problem with Alcohol?
Have you ever felt you should cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink the first thing in the morning to steady your nerves or get rid of a hangover?

If you answered yes to one question, you may have a problem with alcohol. More than one yes answer makes it highly likely that a problem exists.
If you feel you have a problem with alcohol, please see your health professional right away. Effective treatment is available.

The treatment of alcohol dependence includes

Detoxification
Medications to Decrease Craving
Management of Relapse
Group Therapy
Family Counseling