Too much is too much: dependency and excess
The harmful effects of abusive drinking on the human body occur under two different circumstances. Where there is alcohol dependency, the effects are chronic and result from heavy, regular drinking. Where there is excess, the effects are acute and result from individual occasions of immoderate drinking; the risk is proportionate to the amount of alcohol in the blood.
People who have an alcohol dependency are certainly endangering their health. Among other things, they risk developing cirrhosis of the liver, a very serious disease. What is less well known is that even occasional excessive drinking can damage almost every organ in the body.
It takes the right information to make the right decision
Alcohol may produce pleasurable effects, but it also causes problems. When we choose to drink, we must remain aware and attentive. Physically speaking, is drinking good for us or bad for us?
The effects of abusive drinking on…
The internal organs
Alcoholics risk damaging just about every major system in their bodies, either through alcohol dependency or excessive drinking.
Liver diseases are the most common problems related to alcohol abuse. Because the liver bears the greatest responsibility for metabolizing alcohol, it inevitably suffers the impact of intoxication.
When a person drinks more than the liver can process, lesions begin to form. Alcohol-related liver disease progresses from a relatively benign condition of fat cell accumulation known as “fatty liver” (hepatic steatosis) to more serious inflammation (alcoholic hepatitis) and finally cirrhosis. Both hepatic steatosis and alcoholic hepatitis are reversible conditions that in some cases may improve without longterm consequences if the person stops drinking completely. However, if drinking continues, the once-reversible conditions will develop into severe hepatitis or cirrhosis in 25% of cases. Both of the latter are very serious diseases with a 5-year survival rate of 20% to 60%.
Alcohol’s toxic effect on the liver can first be seen with what is considered moderately excessive drinking. The risk of cirrhosis becomes significant when alcohol intake reaches 30 grams a day (3 drinks) for women or 50 grams a day (5 drinks) for men, and continues at that level for at least 10 years for women and 15 years for men.
In 80% to 90% of all cases, alcohol is the cause of both acute and chronic forms of pancreatitis. Acute pancreatitis can be treated and healthy function restored, but chronic pancreatitis causes permanent scarring that results in long-term impairment of pancreatic function and the possibility of multiple complications.
Acute pancreatitis is often an indicator of a chronic condition to come. Regular heavy drinking continues to take its toll on the pancreas, sometimes causing a permanent inflammation that can seriously impair the exocrine (glandular) function of the pancreas.
Acute pancreatitis generally results from “autodigestion,” a process whereby pancreatic enzymes destroy the tissue of the organ itself, leading to inflammation. The main symptoms of acute pancreatitis are abdominal pain and vomiting, which may persist even after the person quits drinking.
Chronic pancreatitis may present as an acute episode of the same symptoms (abdominal pain, nausea and vomiting). In some serious cases, there may also be serious metabolic disorders and acute circulatory complications that can be fatal.
Some people may develop pancreatic disease from drinking moderately (less than two drinks a day), while others may have up to 25 drinks a day before the symptoms appear. Still others will never develop pancreatitis, no matter how much they drink.
In high-risk people, chronic pancreatitis will develop with prolonged alcohol use, i.e. more than 10-15 years for women and 15-20 years for men. Each individual’s vulnerability to alcohol is a determining factor in pancreatic disease.
People who abuse alcohol are at risk for developing a condition called gastroesophageal reflux disease, or GERD (commonly known as gastric reflux). Normally, food passes from the esophagus to the stomach and into the intestine. Gastric reflux causes a back flow of acidic fluid from the stomach into the esophagus, resulting in an uncomfortable burning sensation.
Gastric reflux can lead to reflux esophagitis, a more advanced condition involving inflammation of the esophageal mucosa and more severe acid back flow.
Esophagitis may be acute (severe, sudden and short-lived) or chronic (develops and worsens over a long period of time). The burning sensation may be provoked by food, alcohol or hot liquids.
In alcoholics, chronic esophagitis can lead to ulcers in the esophagus. Heavy, regular drinkers may also develop a tear in the mucous lining at the point where the esophagus joins the stomach. The tearing is caused by repeated, prolonged retching that, in 5% of cases, leads to digestive hemorrhaging, in which the person vomits blood (hematemesis) in quantities that can be considerable and fatal.
Chronic alcoholism is the primary contributing factor in cancer of the esophagus, and the risk is increased significantly by smoking.
Alcohol intoxication can cause an inflammation in the stomach mucosa – the lining that protects the stomach walls. This condition is called acute gastritis. Heavy drinking can cause heartburn, nausea, vomiting (sometimes with blood) and pain in the upper abdominal area (epigastric pain). The symptoms generally disappear two or three days after the person stops drinking.
Regular abusive drinking can result in chronic gastritis, which is often asymptomatic and very difficult to cure, as it develops slowly over many years. It is generally accompanied by anemia and malnutrition; sometimes, it is seen in conjunction with gastric reflux (see above). Alcoholics may also develop digestive hemorrhaging, due primarily to ruptures in the esophageal veins, or the deterioration or ulceration of the gastric mucosa.
Alcohol impairs the body’s ability to absorb various nutrients, including amino acids, vitamins A and C, minerals and glucose. It also damages the cells lining the intestinal tract and affects the production of secretions essential for transporting nutrients to the blood. One of the effects is diarrhea, observed in 10% to 50% of alcoholics. The effects of alcohol on the intestines are generally moderate and, with the help of nutritional and vitamin support, can disappear 2 to 6 weeks after the person quits drinking.
The circulatory system
Alcoholics risk also damaging their circulatory system, either through alcohol dependency or excessive drinking.
The more you drink, the higher your blood pressure. The relationship between alcohol and blood pressure is even more obvious in drinkers over the age of 40. Systolic pressure increases on average by 2.7 mmHg in those who have 4 to 6 drinks a day, and by 4.6 mmHg in those who have at least 7 drinks a day. Alcohol-related hypertension (high blood pressure) tends to disappear when the person quits drinking, but returns if drinking resumes.
Hypertension can cause a variety of health problems, including angina and heart rhythm disturbances.
Regular, heavy drinking over at least 10 years can weaken the heart muscle and prevent it from pumping blood efficiently (a condition called alcoholic cardiomyopathy). In some drinkers, the disease may be asymptomatic and be discovered only accidentally. In others, it causes chest pain, palpitations, night coughing, and abnormal fatigue, difficulty breathing and sometimes even cardiac arrest from arrhythmia.
Alcoholics suffering from cardiomyopathy often experience heart rhythm problems (tachycardia, palpitations) when they drink an excessive amount. In most cases, normal heart rhythm returns spontaneously within 24 hours.
In cases of extreme intoxication, even non-alcoholics with healthy hearts can have heart rhythm disturbances.
Cerebrovascular accidents (CVA)
Abusive drinking is a risk factor in cerebrovascular accidents (CVA), also known as strokes. Chronic heavy drinking increases the risk of death from a cerebral hemorrhage, while episodes of intoxication can obstruct the flow of blood to the brain, which can also cause a stroke.
The nervous system
All excessive drinking has neurological consequences. In low doses, alcohol has mild stimulant effect that is exciting and even disinhibiting. In higher doses, it acts as a sedative and can cause reduced attentiveness, loss of balance, speech impairment and mental confusion.
Chronic, abusive drinking can cause a variety of disturbances in the central and peripheral nervous systems:
- Some problems may result from the malnutrition that often plagues alcoholics.
- Some neurological complications may be linked to liver malfunction.
- Alcohol can be a primary cause of specific neurological problems.
- Some neurological problems, such as acute alcoholic delirium (delirium tremens), occur when an alcoholic stops drinking.
One of the most serious problems resulting from continued excessive drinking is Wernicke-Korsakoff syndrome, which is caused by a significant thiamine (vitamin B1) deficiency.
Wernicke’s encephalopathy is a severe syndrome characterized by confusion, lack of coordination (ataxia), paralysis of the eye muscles and sometimes even stupor and coma. These clinical conditions may develop suddenly or over several days.
Individuals diagnosed with Korsakoff’s psychosis usually have symptoms of anterograde and retrograde amnesia (severe memory loss), as well as temporal disorientation, false recognition and confabulation (invented memories). Korsakoff’s psychosis generally follows Wernicke’s encephalopathy, which is why both are often considered as a single syndrome. Such cases are quite spectacular, and fortunately very rare.
Alcoholic polyneuritis is the most common neurological complication caused by chronic alcoholism. Multiple nerves become inflamed, involving a breakdown of the myelin (the sheath around the nerve) and the impairment of the peripheral nervous system. The condition usually starts insidiously, with symptoms including unusual numbness or prickly sensations (dysesthesia), cold feet, cramps, particularly in the calves, and reduced walking endurance. It is caused by the toxic effect of alcohol and its metabolites, and is exacerbated by thiamine deficiency. In more severe cases, it may spread to the upper limbs. Polyneuritis is slowly reversible after the person stops drinking.
Optic neuritis is a lesion in the optic nerve that can be caused by chronic alcohol intoxication. The condition is characterized by a progressive and bilateral reduction in visual acuity. Field of vision is reduced and patients have difficulty distinguishing colours. The condition is reversible if the person stops drinking – and smoking – and takes the proper vitamins.
Abusive drinking can cause a variety of psychiatric disorders. Studies show that alcoholics have more mental problems than non-alcoholics. The term psychiatric comorbidity is used when an individual displays maladaptive drinking behaviour, along with mental or psychiatric problems that are caused neither by acute intoxication nor withdrawal.
Three major types of psychiatric problems affect alcoholics to a much greater degree than non-alcoholics:
People who have drinking problems suffer from the full range of personality disorders. For example, antisocial personality disorder is ten times more common among alcoholics than among the general population. There is also a strong connection between alcoholism and all kinds of eating disorders, particularly among women.
Mood disorders and anxiety
This category includes bipolar disorder and depression, the latter being extremely common among alcoholics. Depression must be taken very seriously: suicide – one of its consequences – is eight to ten times more common among alcoholics than among the general population.
While there is no link between schizophrenia and intoxication or withdrawal, this very serious disease is observed more among alcoholics than non-alcoholics. Most psychotic problems observed among alcoholics are related to alcohol intoxication, as described above in Effects on the nervous system.
The social environment
Abusive drinking leads to social problems with serious social and medical consequences that are frequently underestimated.
Too much alcohol causes disturbances in the brain, the central nervous system and the hormonal system, which, in turn, affects cognitive and physiological processes. When people are drunk, everything suffers: response time, muscle control, dexterity, hand-eye coordination, short and mediumterm memory, and problem-solving capacity.
In other words, the mortality rate is higher among alcoholics not only because of the particular diseases and conditions caused by alcohol, but also because alcohol increases the normal risk of suicide, homicide and injury resulting from car accidents and violence, for example.
In Quebec, alcohol is a primary cause of road deaths. The problem is particularly tragic among young people, but is not limited to them. In 2000, nearly 40% of drivers who died on Quebec roads had been drinking. From 1995 to 2003, 1,655 Quebecers died in road accidents in which at least one of the drivers was under the influence of alcohol.
While it is wrong to believe that alcohol directly causes violence, the fact remains that, in our society, alcohol intoxication has a direct impact on violent behaviour and the resulting injuries. Because one of the neurological effects of drinking is a loss of inhibition, alcohol is a determining factor in the kind of violence often associated with the removal of inhibition, such as sexual and physical assault.
Victims are often also intoxicated when violence occurs. In some cases, drinking makes people more vulnerable to aggressive behaviour, and in others it makes them provoke an attack.
Abusive drinking by one partner in a couple often leads to an escalation of conflict that can result in physical violence. The risk of conjugal violence increases with frequency of intoxication. In Canada, 41% of female victims and 25% of male victims said that their partner was under the influence of alcohol when the violence occurred. According to Statistics Canada, 26% of men and 55% of women who have killed their partners were drunk at the time the murder was committed.
In addition to the physical injury that can result from conjugal violence, studies show that the partners of alcoholics are more likely to suffer from anxiety, insomnia, tension and depression.
Alcohol intoxication, particularly among young people, is linked to unprotected sex, which increases the risk of sexually transmitted diseases (STDs) and unwanted pregnancy.
Alcohol and the fetus
Pregnant women who drink to the point of intoxication risk giving birth to children with fetal alcohol syndrome (FAS). FAS encompasses a host of problems that can include growth retardation, intellectual deficits, heart malformation, an abnormally small head and other facial and skeletal abnormalities.
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