“One key symptom of alcoholism is that the individual comes to need a drink for every mood-one to calm down, one to perk up, one to celebrate, one to deal with disappointment and so on”.
Phyllis A. Balch
Alcohol has been with us since age unkown, fermented fruits such as grapes have already been in use to make alcohol since thousands of years. In India around 3000-4000 BC, distilled form of rice called Sura was used.
Although consuming alcohol in moderate amounts has been shown to cause very less harm to the physiological function of the human body, but the definition of what amount is moderate is narrow.
Clinical Controversy – One drink or less per day for women and two drinks per day for men has been recommended, controversy is because of the limited amount of studies on moderate consumption. Major limitation is the fact that studies are basically observational and it can not establish a cause and effect relationship
Worldwide reported deaths include around 1.8 million deaths annually. Then there are direct and indirect cost associated with alcohol related health issues and deaths due to drunk driving is also high.
Clinical Indicators of Chronic Alcohol Abuse
The questionnaire CAGE when correctly used can be a useful tool for individuals who are more likely to be abusing the substance ( alcohol ).
The questions are :-
- Do you ever feel the need to cut down on your alcohol use?
- have you ever been annoyed by others telling you that you drink too much?
- have you ever felt guilty about your drinking or something you did while drinking?
- Do you ever have an “EYE Opener”
A positive response to two or more of these four questions suggests an increased likelihood of alcohol dependency or abuse. It has a sensitivity of 43% to 94% and a specificity of 73% to 90%.
Alcohols come in variety of strengths, and commercially it is labelled as XX% weight/volume. Just to put things in perspective, there is approximately 14 grams of alcohol in a 350 ml of beer so that is roughly 5% weight/volume , and one shot of whiskey which is 30 ml. Full consumption of this amount will raise the blood level by 20-25 mg/dL in a healthy adult male. The food consumed and how fast you consume it will vary the time frame.
Lethal dose would be around 400-500 mg/dL, death can occur at this level.
The CNS depressant effect is the very visible in a person who has just drank it. A typical dose dependent action is seen , where sedation progresses to sleep, then unconsciousness, coma, surgical anesthesia, and finally fatal respiratory depression and cardiovascular collapse. People feel good after drinking, it is because it induces the endogenous opioids, that high feeling is very nice but not the after effects.
When a person takes large amount then it is a dangerous situation where bolus quantity is taken and due to the excess amount the user may pass out before the toxic dose can be ingested. If the person vomits, it can reduce the reservoir from the stomach and he or she can get rid of it, and continued absorption to lethal levels will reduce.
- Slurred speech and ataxia
- Hallucinations can ensue
- delirium and seizures ( severe )
- Nystagmus (rapid movement of eyes)
- tachycardia, diaphoresis, hyperthermia
A Blood alcohol concentration test can be done to understand the amount of impairment.
0.10 – 0.125 – Significant impairment of motor co ordination
0.13- 0.15 – Gross motor impairment and lack of physical control, blurred vision and major loss of balance, euphoria is reduced , dysphoria is beginning to appear
0.16-0.2 – Dysphoria (anxiety, restlessness) predominates, nausea can appear, the drinker has the appearance of a sloppy drunk
0.25- needs assistance in walking, total mental confusion, dysphoria with nausea and some vomiting
0.3 – loss of consciousness
=, > 0.4- Onset of coma, possible death caused by respiratory arrest.
The blood alcohol level of 150 mg/dL corresponds to 0.15% BAC, so most hospitals report BAC in units of milligrams per deciliter.
The hardest part is abstinence from a habit. After detoxification, to remain away from it is very difficult. Despite the availability of pharmacological agents to decrease the craving after the treatment, usefulness is still argued. Acamprosate, naltrexone and disulfiram remain in the grey zone. Relapse after the therapy is a menace and studies have failed to give an effective conclusion.
To conclude, leaving a habit largely depends on the person’s will. If the person is really determined to do it, he or she will do it. Use of alcohol is completely accepted in our society, it is only when we begin to abuse them that people start to notice how big of a problem it has become.
We will try to highlight the pharmacological agents in the next post.