Alcohol

Alcohol - where do we draw the line

The continued acceptance of alcohol abuse as normal, despite the havoc that results, is one of the strongest arguments in favour of the legalisation of Marijuana.After all, in contrast Marijuana (at first) appears a friend not an enemy.What is better? Relaxed and stoned, or violently drunk?

The biggest problem with alcohol use is where to draw the line with this substance which appears naturally in all fermenting liquids, and which in small to moderate doses is not only a relaxant and a social lubricator, but also a health tonic.

Alcohol is the most widely accepted drug in the world, and is part of many social settings.It changes a person's mood, reduces inhibitions, helps us feel more confident and less anxious.It is often a part of celebrations and can be used to drown out unpleasant feelings.

Alcohol abuse often begins when a person feels that without alcohol he or she will not be able to enjoy the occasion or will be less able to cope with an unchanging situation. Dependency follows when the body becomes used to a certain level of blood alcohol.Withdrawal in someone who's heavily dependent should not be undertaken without medical supervision.

What is it?

Alcohol is a carbohydrate, a relative of sugar, and is therefore a potent source of energy for drinkers, supplying up to half of a heavy drinker's energy requirements in a day. It is created by yeasts which in the absence of oxygen get the energy they need by converting sugar to alcohol.

Alcohol is absorbed rapidly from the stomach - in five to ten minutes without food.The effects last several hours, related to body weight which is why many women are more affected by the same dose than men.

One unit is 8 grams of alcohol - equivalent to half a pint of normal beer, cider or lager, a standard glass of wine or a pub measure of spirits. After four or five units, most people feel relaxed and comfortable.Eight units causes slurred speech and clumsiness, with exaggerated emotions.Higher doses cause double vision, dizziness, staggering, loss of balance, nausea, vomiting.Beyond that alcohol can cause blindness, loss of consciousness, and loss of memory for events at the time.

The biggest danger is from injury caused by intoxication.In 1990 15% of all road accidents were alcohol related and 32% of all pedestrians killed on the road were under the influence of alcohol.Drinkers may also choke on their own vomit while unconscious. Although such sudden deaths are uncommon, this is a real hazard in police cells or in a side room in an emergency ward.

A hangover may follow, caused by dehydration and toxic metabolites.Mixing alcohol with other depressant drugs such as barbiturates or heroin is particularly dangerous as the effects are additive.

Other effects

Alcohol has many other effects on the body.

1· Stomach irritation - can cause ulcers

2· Liver damage - alcohol is destroyed by the liver but liver cells are also casualties (see below)

3· Mouth and throat - cancers are more common in heavy drinkers

4· Nutritional damage caused by neglect of a proper diet

5· Brain damage caused directly by alcohol in the blood - in severe cases causing Korsakoff's psychosis, a permanent memory loss

Liver cirrhosis is a serious problem

Liver cirrhosis is common and deadly.It kills more than 23,000 a year in the US.It is the third commonest cause of death in men in their fifth decade. The commonest cause is alcohol abuse.There is probably a genetic reason why only 15% of heavy drinkers develop the problem.Once cirrhosis is diagnosed it is often too late to prevent death and 30% die in a year.

As the liver becomes progressively damaged it is no longer able to do its job as a food store, as a maker of digestive enzymes, and as a waste-disposal unit for toxins.The result is that the liver becomes enlarged with fatty tissue, the person becomes ill and jaundiced (yellow) and blood pressure rises in blood vessels draining into the liver, causing for example life-threatening bleeds of veins lining the gullet.This happens in 40% of those with cirrhosis.These bleeds cause sudden, violent, catastrophic vomiting. Death follows in minutes in almost half of those who are unfortunate enough to have one.

Defining use and abuse

Is there a safe limit?

The World Health Organisation and governments have recently revised their guidelines about so-called safe limits for alcohol consumption in both men and women. The current accepted limits vary from expert to expert but are around 21 units for men and 14 units for women. The problem is that these are general guides and do not tell us what the actual damage to an individual's health will be.

Alcohol can be good for you

Evidence is growing that alcohol in moderate doses increases life expectancy.This discovery was made following a series of large-scale studies comparing, for example the health of teetotallers with moderate and heavy drinkers.One of the protective effects appears to be on the heart and blood supply, with a reduction in strokes and heart attacks.At first the beneficial effect was attributed to some mysterious ingredients in red wine, but we now know that the therapeutic action is related to alcohol itself, independent of the method of production.

The discovery that drinking alcohol can be good for health brought alarm calls from those concerned that the news would encourage abuse. It certainly undermined the case for absolute abstention.

Classic features of abuse

There are two main patterns of alcohol abuse: regular and binge. The regular abuser drinks every day or most days. The binge drinker rarely sees himself as an alcoholic because he often goes for days or weeks without touching alcohol.However once he starts, he cannot stop.

The slide down

A habit may start with social drinking over a meal, before progressing with higher consumption.As the liver gets used to destroying alcohol, the person needs more to achieve the same level of intoxication.Typically the next step may be private drinking, in secret, drinking alone at any time of the day or night.

In advanced cases the person wakes feeling jittery and vulnerable, and has alcohol instead of breakfast " to calm the nerves".A classic sign of a deteriorating situation can be when the person stops eating breakfast, partly because the stomach is often so raw from alcohol-induced irritation the night before.

Sudden withdrawal in a heavy drinker can cause sweating, anxiety and trembling or in extreme cases fits and delirium.Complete withdrawal in a very heavy drinker is therefore dangerous without medical help.

Special issues

Problems of acknowledgement

Getting someone to admit he or she has a drinking problem can be extremely difficult, and presents one of the greatest challenges. Alcoholism is made far more difficult to treat because social drinking is found almost everywhere.For someone with a past addiction, even the smell of alcohol can induce an intense craving, which can become almost irresistible.

Workplace epidemic

Alcohol is the most widely abused drug at work and the commonest cause of drug-related sickness and lost productivity.It is surprising therefore that so few companies address the issue directly.We look elsewhere at the issue of using urine and hair samples for drug testing, but electronic breathalysers are cheap to buy, fast, and cost nothing per test.Random tests at work with instant discipline for any worker over the legal driving limit could be a powerful disincentive.Part of the discipline process should be an offer of counselling and treatment, in cases where addiction is suspected.

Other alcohol issues

As with any other addiction, breaking it may require several attempts.Support and help are vital as a problem drinker begins to rebuild a normal life.As the addiction is laid to one side, some of the precipitating problems may come to the surface and need dealing with.A key step is releasing the person to be fully responsible and in control of his or her own life again.

In summary then, alcohol abuse is a scourge on society.It needs to be tackled far more seriously than in the past with comprehensive measures which are outlined later.Failure to deal with alcohol as a problem will lead without doubt to Marijuana being legalised.How can one possibly justify an aggressive stand against Marijuana at the same time as the enthusiastic promotion of alcohol to a nation already reeling from excess?These two issues are linked and those who seek to hold them apart play into the hands of those who want no restrictions at all.