Despite its association with everyday socialising and its legal status, alcohol is in fact a drug that can be every bit as dangerous as illicit drugs. Alcohol relieves anxiety, lifts inhibitions and is pleasantly mildly euphoric but when used to excess it is dangerous causing misery, illness and death. Is it a friend or foe? Surprisingly alcohol is not particularly addictive; unlike cocaine or heroin and for the vast majority of people who drink, it does not become a problem. However, alcohol abuse and dependency are real issues for about 8% of the adult population with significant consequences for themselves, their families and society as a whole.
In a study in the Lancet, the world's leading general medical journal, alcohol was considered to be more harmful than heroin or crack when the overall dangers to the individual and society are considered. The study ranked 20 drugs, including alcohol, on 16 measures of harm to users and to wider society. Alcohol was worse overall.
Over 90% of the adult population are not dependent on alcohol but nevertheless some may have problems from drinking too much or inappropriately. The UK Government, along with many other governments in the Western World, has produced guidelines on sensible drinking and the unit system gives a fair estimation of how much is drunk and how safe it is.
The limits are: 21 units for men per week and 14 units for women. More recent advice has included a daily limit of 4 units for men with 2 days abstinence weekly and 3 units daily for women with 2 days a week with no alcohol. Pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk.
It is important to note here that there is a fundamental difference between the male and the female body. A lower proportion of the female body is made up of water compared to men, so women are therefore at greater risk from the effects of alcohol on their bodies.
What are ‘units’ of alcohol?
One unit of alcohol is 10 ml (1 cl) by volume, or 8g by weight, of pure alcohol. Calculating the amount of units you are drinking is easy. A fairly accurate guide is one litre of the alcoholic beverage is equal in units to the percentage alcohol of the drink. One litre of beer of 4.6% alcohol is 4.6 units; one litre of Gin at 40% alcohol is 40 units. Spirits are sold in of 25 ml measures and there are 40 measures in a litre bottle. Therefore 1 single measure of spirit is equal to 1 unit of alcohol. Simple isn’t it?
The average man can safely drink 21 single measures of spirits or 4 litres of 5% ABV beer per week and a woman can drink 14 single measures of spirits or 1½ litres of 12% wine. A word of caution: These drinks should be spread evenly across the week and there should be at least two alcohol free days per week. The setting and time of drinking is also important when assessing safety. The unit system is only a guide and does not represent a definition of when drinking is acceptable on health. For some people, just a couple of drinks triggers a change in personality, affecting relationships and to drink before driving always impairs performance and judgement. For these people, avoiding alcohol altogether is probably the best policy.
Although alcohol is not a particularly addictive drug it can in time lead to dependency. The route to alcohol dependency is not a predictable one; the drinker often cannot foresee it. Damage to relationships, poor work performance and a bad health record are a few of the signs of addictive behaviours. If you have lost the ability to say ‘no’ to a drink and you can’t stop when you start, you have a serious problem that needs to be addressed.
One final word of caution: binge drinking is an extremely dangerous occupation for drinkers of all ages. For drinkers under the age of 23 or 24 it has further hidden dangers in that the human brain is still developing up until this age and excessive use of alcohol can lead to under-development of the brain. Often this leads to under achievement and potential never been reached.
Why these recommendations?
Your liver, which processes alcohol, can only cope with so much at a time. Drinking more alcohol than the liver can cope with can damage liver cells and produce toxic by-product chemicals. The speed of the process varies from person to person but on average it takes one hour for the liver to process one unit of alcohol. Drinking more than one unit of alcohol per hour causes a backlog in the body's system leading to intoxication.
Alcohol gets to a baby through the placenta if a pregnant woman drinks alcohol. A baby cannot process alcohol very well. So, any alcohol in your baby stays in their body much longer than in you. This is known to be a risk for causing serious problems such as: a low birth weight; learning, behavioural, and thinking (cognitive) problems; defects of the heart and other organs; abnormal facial features. When these problems are severe, the condition is called foetal alcohol syndrome.
Abuse or Dependency?
Alcohol abuse is described as any "harmful use" of alcohol. The Diagnostic and Statistical Manual of Mental Disorders IV (the handbook used by Doctors and Psychiatrists in making diagnosis of illnesses) describes alcohol abusers as those who “drink despite recurrent social, interpersonal, and legal problems as a result of alcohol use. Harmful use implies alcohol use that causes either physical or mental damage.”
Those who are alcohol dependent meet all of the criteria of alcohol abuse, but they will also exhibit some or all of the following:
- There is a strong desire or compulsion to drink, which overrides other everyday activities; family, friends, work and hobbies are neglected.
- They neglect the alternative pleasures of life as the alcohol drinking becomes the major focus for the individual.
- Alcohol normally has a physical withdrawal state when the drinking stops. Nausea, sweating, shakiness and anxiety are typical symptoms.
- There is a degree of tolerance requiring higher doses to have the same psychological effect.
- There are difficulties in controlling the amount of use so consumption escalates.
- The user continues to consume alcohol despite evidence of harm such as ill health, debts, relationship difficulties or psychological problems.
It is often difficult to determine when the line between abuse and dependency has been crossed and a professional assessment is usually necessary to accurately make the correct diagnose. There are however, self-administered questionnaires which help identify when a problem may be developing and can be a useful tool. One of these tools is ‘CAGE’ which consists of four questions related to behaviour surrounding drinking. Another useful self-administered tool is the ‘AUDIT’ Questionnaire. Both self-administered questionnaires are available on the Internet.
Typically, those drinkers who are diagnosed as only alcohol abusers can be helped with a brief intervention, including education concerning the dangers of binge drinking and alcohol poisoning and the use of a drink diary.
Those who have become alcohol dependent usually require outside help to stop drinking including detoxification, medical treatment, professional rehab and self-help group support.
The people most at risk of alcohol dependency are those who use alcohol as an “escape mechanism” for life’s problems rather than confronting them. There is an increased risk for those who are shy, with low self-esteem and have problems with family/work. There are genetic risks for susceptibility to addiction. Research shows that the risk for developing alcohol addiction does run in families. The genes a person inherits partially explain this pattern but lifestyle and psychological environment are also factors. However, a genetic predisposition to alcohol addiction does not mean it is inevitable. Some people develop alcoholism even though no one in their family has a drinking problem.
Effects on the Body & Brain
Alcohol causes Liver disease, Pancreatitis, seizures, impotence, severe short term memory loss, hypertension (which can lead to a stroke), enlarged heart, cancer and many other physical and psychological problems.
Drinking too much alcohol affects your skin. Alcohol dries out your skin and can lead to wrinkles and premature aging. If you drink heavily you may develop acne rosacea, a skin disorder that starts with a tendency to blush and flush easily and can progress to facial disfiguration, a condition known as rhinophyma.
Drink enough alcohol, and you are likely to damage your liver. This can happen quickly or over a longer period. Up to one in three adults drinks enough alcohol to create a risk of developing alcohol-related liver disease.
There are two patterns of liver disease, acute (known as acute alcoholic hepatitis) and chronic, which reflect whether it develops over a matter of months or years respectively.
There are four stages of chronic liver disease.
- The commonest and mildest form of liver damage is a ‘fatty’ liver. This can be identified by blood tests, and is reversible with abstinence from alcohol.
- The next step, identified by a liver biopsy, will show inflammation in addition to the excess fat. This is steatohepatitis. In severe cases, jaundice may develop. A diagnosis of acute alcoholic hepatitis can then be made (see below).
- At the next stage, fibrosis (scar tissue) is present. Again, this cannot be detected by blood tests or routine scans.
- Cirrhosis occurs when the fibrosis reaches the stage when the normally soft liver is divided into thousands of pea-sized pockets of liver tissue, wrapped in fibrosis. Once cirrhosis develops, the prognosis partly depends on whether or not you continue drinking. People with compensated cirrhosis – meaning they have no symptoms – and who then stop drinking, have an 80% chance of being alive after 10 years. The majority of those with decompensated cirrhosis – displaying symptoms – will die within three years.
Acute Liver Disease- known as Acute Alcoholic Hepatitis is caused by heavy drinking over a period of months. It is potentially reversible with no long-term effects if you recover and stop drinking alcohol completely. However, 70-90% of patients with acute alcoholic hepatitis – likely to be those who have been drinking for longer and therefore unlikely to be young people - will have cirrhosis. Jaundice is the usual first symptom. In hospitalised cases, there’s a mortality rate of around 50% associated with acute alcoholic hepatitis. Liver transplants are usually not an option, partly because of the history of recent alcohol abuse.
Alcohol misuse is an important factor in a number of cancers, including liver cancer and mouth cancer, both of which are on the increase. Alcohol is second only to smoking as a risk factor for oral and digestive tract cancers. Evidence suggests that this is because alcohol breaks down into a substance called acetaldehyde, which can bind to proteins in the mouth. This can trigger an inflammatory response from the body –cancerous cells can develop.
Chronic pancreatitis is another disease associated with heavy drinking. It’s caused when your pancreas becomes inflamed and cells become damaged. Diabetes is a common side effect of chronic pancreatitis. There’s evidence that heavy drinking can reduce the body’s sensitivity to insulin, which can trigger type 2 diabetes.
While studies suggesting that alcohol can help heart disease often hit the headlines, the reality is that the jury’s still out on the extent of any benefits. And it is clear that any benefits which there may be are limited to very low levels of consumption – probably no more than 1 unit alcohol per day.
Drinking a very large amount at one time can lead to unconsciousness, coma and even death. Vomiting while unconscious can lead to death by asphyxiation (suffocation).
Alcohol is implicated in a large number of fatal road accidents, assaults and incidents of domestic violence. Drinking too much too often will cause physical damage, increase the risk of getting some diseases and make other diseases worse.
While alcohol has a wide range of effects on the body, the brain is a primary target.
Alcohol can affect several parts of the brain, but in general, alcohol contracts brain tissue depresses the central nervous system and destroys brain cells - brain cells do not regenerate. Excessive drinking over a prolonged period of time can cause serious problems with cognition and memory.
To understand how alcohol interferes with brain function, it is necessary to know a little bit about it. The brain is the control centre of the body - it controls all the systems including your muscular system, your respiratory system and your digestive system. It controls them by using a series of chemical, electrical and physical signals from cell to cell. These chemical signals are called neurotransmitters.
The gap between cells where neurotransmitters are active is called the synapse. When alcohol is introduced to the synapse, the normal neurotransmission may be affected.
The cerebral cortex processes information from your senses, processes thoughts, initiates the majority of voluntary muscle movements and has some control over lower-order brain centres. In the cerebral cortex, alcohol can:
- Affect thought processes, leading to potentially poor judgement.
- Depresses inhibition, leading one to become more talkative and more confident.
- Blunts the senses and increases the threshold for pain.
As the Blood Alcohol Content (BAC) increases, these effects get more pronounced.
The limbic system controls memory and emotions. The effect of alcohol on this system is that the person may experience some memory loss and may have exaggerated states of emotion.
The cerebellum coordinates muscle movement. The cerebral cortex initiates the muscular movement by sending a signal through the medulla and spinal cord to the muscles. As the nerve signals pass through the medulla, they are influenced by nerve impulses from the cerebellum, which controls the fine movements, including those necessary for balance. When alcohol affects the cerebellum, muscle movements become uncoordinated.
The hypothalamus controls and influences many automatic functions of the brain (through the medulla), and coordinates hormonal release (through the pituitary gland). Alcohol depresses nerve centres in the hypothalamus that control sexual arousal and performance. With increased alcohol consumption, sexual desire increases - but sexual performance declines.
The medulla (brain stem) influences or controls body functions that occur automatically, such as your heart rate, temperature and breathing. When alcohol affects the medulla, a person will start to feel sleepy. Increased consumption can lead to unconscious. Needless to say, alcohol's effect on the medulla can be fatal if it is excessive.
Treatment of Alcohol Dependence
For those with dependence there is usually a repeated pattern of failed attempts to give up without seeking help. There will be a need to be admitted into a treatment centre in order to address the underlying personal issues which have promoted the dependency and to counteract the effects of the illness itself. Invariably once this stage of dependency is reached, the user will never be able to control alcohol use again and abstinence is the only way forward. A return to drinking will cause a return to the original patterns of use and the vicious circle continues. In-patient treatment looks at all factors hidden behind the dependency, such as relationship problems, previous psychological trauma or self-esteem issues.
Some dependency is in conjunction with other psychiatric disorders such as depression. Often the user does not recognise the harm that alcohol is doing to themselves or others (denial) or the social isolation that it is causing. The illness is accompanied by guilt/shame so there is a reluctance to accept help. The therapeutic environment enables the return to previous attributes and the ability to ask for help when there is trouble so that they can view the future with confidence without returning to mind-altering substances. Family relationships, which are also damaged by the illness, can be repaired with the help of treatment.
Treatment is for life and after either in or outpatient care it is essential for continuous aftercare. This can include Community-based recovery groups such as Alcoholics Anonymous (AA) that use a 12-step programme. AA is helpful to people trying to sustain abstinence. Participants may benefit from supportive fellowship and from sharing with those experiencing common problems and issues.
It is important that patients receive services that match all of their treatment needs. For example, if a patient is unemployed, it may be helpful to provide vocational rehabilitation or career counselling along with addiction treatment. If a patient has marital problems, it may be important to offer couples counselling.
Andrew Vincent and Alex Flood form the Clinical Team and are co-founders of Nova Vida Recovery Centre, Algarve, Portugal. They have been successfully delivering their unique therapeutic programme to the addictive population since 2007. Professionally trained and qualified in the United Kingdom and the USA, and with continuous professional development, they strive to ensure the best treatment is delivered to those who seek help.
Sally Vincent is responsible for all non clinical aspects at Nova Vida Recovery Centre including all patients’ needs. Together with Andrew and Alex she ensures the whole treatment experience is as comfortable and beneficial as possible.
CONTACT INFONova Vida Recovery Centre