Alcoholism

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Alcoholism

JoAnn Guest

Aug 15, 2006 16:50 PDT

 

 

An in-depth report on the causes, diagnosis, and treatment of

alcoholism.

 

 

Complications

About 100,000 deaths per year can be wholly or partially attributed

to

drinking, and alcoholism reduces life expectancy by 10 to 12 years.

Next

to smoking, it is the most common preventable cause of death in

America.

Although studies indicate that adults who drink moderately (about

one

drink a day) have a lower mortality rate than their nondrinking

peers,

their risk for untimely death increases with heavier drinking.

 

The earlier a person begins drinking heavily, the greater their

chance

of developing serious illnesses later on. Once one becomes dependent

on

alcohol, it is very difficult to quit. In one study, after five

years,

two-thirds of people with alcoholism were still dependent.

 

Alcoholism and Early Death

Alcohol can affect the body in so many ways that researchers have a

hard

time determining exactly what the consequences are from drinking.

 

Interestingly, although heavy drinking is associated with earlier

death,

studies suggest it is not from a higher risk of the more common

serious

health problems, such as heart attack, heart failure, diabetes, lung

disease, or stroke. It is well known, however, that chronic

consumption

leads to many problems that can increase the risk for death:

 

In general, people who drink regularly have a higher rate of death

from

injury or violence.

 

Alcohol overdose can lead to death. This is a particular danger for

adolescents who may want to impress their friends with their ability

to

drink alcohol but cannot yet gauge its effects. It is important to

note

that alcohol overdose doesn't only occur from any one heavy drinking

incident, but may also occur from a constant infusion of alcohol in

the

bloodstream.

 

Severe withdrawal and delirium tremens. Delirium tremens occurs in

about

5% of alcoholics. It includes progressively severe withdrawal

symptoms

and altered mental states. In some cases, it can be fatal.

 

 

Frequent, heavy alcohol use directly harms many areas in the body

and

produce dangerous health conditions (e.g., liver damage,

pancreatitis,

anemia, upper gastrointestinal bleeding, nerve damage, and

impotence).

 

Alcohol abusers who require surgery have an increased risk of

postoperative complications, including infections, bleeding,

insufficient heart and lung functions, and problems with wound

healing.

Alcohol withdrawal symptoms after surgery may impose further stress

on

the patient and hinder recuperation.

 

The Effects of Hangover

 

Although not traditionally thought of as a medical problem, a 2000

review of studies found that hangovers have significant consequences

that include changes in liver function, hormonal balance, and mental

functioning and an increased risk for depression and cardiac events.

 

Hangovers can impair job performance, increasing the risk for

mistakes

and accidents. Interestingly, hangovers are generally more common in

light to moderate drinkers than heavy and chronic drinkers,

suggesting

that binge drinking can be as threatening as chronic drinking. Any

man

who drinks more than five drinks or any woman who has more than

three

drinks is at risk for a hangover.

 

 

Increased Risk for Other Addictions

Researchers are finding common genetic factors in alcohol and

nicotine

addiction, which may explain, in part, why alcoholics are often

smokers.

Alcoholics who smoke compound their health problems.

 

More alcoholics die from tobacco-related illnesses, such as heart

disease or cancer, than from chronic liver disease, cirrhosis, or

other

conditions that are more directly tied to excessive drinking.

 

Liver Disorders

Alcoholic Hepatitis and Cirrhosis. Alcohol is absorbed in the small

intestine and passes directly into the liver, where it becomes the

preferred energy source.

 

The liver, then, is particularly endangered by alcoholism. In the

liver

alcohol converts to toxic chemicals, notably acetaldehyde, which

trigger

the production of immune factors called cytokines.

 

In large amounts, these factors cause inflammation and tissue injury.

 

Even moderate alcohol intake can produce pain in the upper right

quarter

of the abdomen--a possible symptom of liver involvement.

 

In many cases, such symptoms may be an indication of fatty liver or

alcohol hepatitis--which are reversible liver conditions.

 

Between 10% to 20% of people who drink heavily (five or more drinks

a

day) develop cirrhosis, a progressive and irreversible scarring of

the

liver that can eventually be fatal.

 

Alcoholic cirrhosis (also sometimes referred to as portal, Laennecs,

nutritional, or micronodular cirrhosis) is the primary cause of

cirrhosis in the US.

 

It is estimated to be responsible for between 44% and 80% of deaths

from

cirrhosis in North America. [seeWell-Connected Report #75 Cirrhosis.]

 

Not eating when drinking and consuming a variety of alcoholic

beverages

certainly increase the risk for liver damage. Nevertheless, the

amount

of alcohol consumed and the patterns of drinking are only weak

predictions of risk.

 

Up to 90% of heavy drinkers do not develop advanced irreversible

liver

disease. Other risk factors have been identified that may increase

the

danger to the liver in heavy drinkers:

 

Obesity is a major factor for all stages of liver disease.

Women develop liver disease at lower quantities of alcohol intake

than

men.

 

Genetic factors that regulate the immune responses also play role.

 

Viral Hepatitis B and C. People with alcoholism tend to have

lifestyles

that put them at higher risk for viral hepatitis B and C, which are

caused by viruses. Chronic forms of viral hepatitis pose risks for

cirrhosis and liver cancer, and alcoholism significantly increases

these

risks.

People with alcoholism should be immunized against hepatitis B; they

may

need a higher-than-normal dose of the vaccine for it to be

effective.

There is no vaccine for hepatitis C. [see Well-Connected Report #59

Hepatitis.]

 

Gastrointestinal Problems

Alcoholism can cause many problems in the gastrointestinal tract.

 

Violent vomiting can produce tears in the junction between the

stomach

and esophagus. Alcoholism poses a high risk for diarrhea and

hemorrhoids.

 

It increases the risk for ulcers, particularly in people taking the

painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs)

such

as aspirin or ibuprofen.

 

It can also cause inflammation of the esophagus (esophagitis), which

can lead to bleeding in heavy drinkers.

 

Alcohol can contribute to serious and chronic inflammation of the

pancreas (pancreatitis) in people who are susceptible to this

condition.

 

 

There is some evidence of a higher risk for pancreatic cancer in

people

with alcoholism, although this higher risk may occur only in people

who

are also smokers.

 

Effect on Heart Disease and Stroke

Benefits of Moderate Drinking. The effects of alcohol on heart

disease

and stroke vary depending on consumption.

 

Evidence strongly suggests that light to moderate alcohol

consumption

(one or two drinks a day, especially of red wine) protects the heart

and

also helps prevent stroke.

 

The benefits are strongest in people at high risk for heart disease

and

may be fairly small in those at low risk.

 

Adverse Effects of Heavy Drinking. It should be strongly noted that

heavy drinking harms the heart. In fact, cardiovascular disease is

the

leading cause of death in alcoholics.

 

The following are negative effects on the heart and the circulatory

system from high alcohol consumption.

 

Evidence suggests that people who consume more than three drinks per

day

have abnormal blood clotting factors.

 

Heavy drinking was associated with atherosclerosis (hardening of the

arteries) in a 2003 study.

 

Between 5% and 10% of cases of hypertension are due to alcoholism.

Heavy

alcohol consumption can raise blood pressure even in people with no

history of heart disease.

 

The more alcohol someone drinks, the greater the increase in blood

pressure, with binge drinkers (people who have nine or more drinks

once

or twice a week) being at greatest risk.

 

One study found that binge drinkers had a risk for cardiac

emergencies

that was two and a half times that of nondrinkers.

 

Heavy alcohol use, particularly a recent history of drinking, is

associated with a higher risk of both ischemic and hemorrhagic

stroke.

 

Large doses of alcohol can trigger potentially dangerous irregular

heartbeats, most often those called atrial fibrillation, which is a

common heart rhythm problem in people with alcoholism.

 

Alcohol abuse has also been associated with, and may actually be a

cause

of, idiopathic dilated cardiomyopathy, a condition in which the

heart

enlarges and its muscles weaken, putting the patient at risk for

heart

failure.

 

Scientists have identified a genetic factor that appears to be

responsible for this condition in certain people with alcoholism.

 

Not all heavy drinkers develop heart failure and, in fact, moderate

drinking can be protective.

 

Cancer

As with heart disease, light to moderate consumption of alcohol,

particularly red wine, may protect against cancer. Cancer, however,

is

the second leading cause of death in alcoholics (after

cardiovascular

disease), and alcoholics have a rate of carcinoma 10 times higher

than

that of the general population.

 

Alcohol is probably not the direct cause of cancer in such cases,

but

most likely it increases the effects of other factors that

contribute to

certain cancers. The following are some examples:

 

Alcohol produces enzymes in saliva that may be carcinogenic and

increase

the risk of upper digestive cancers in certain individuals.

Studies suggest that alcohol,

 

in combination with tobacco smoke, causes genetic damage that is

associated with the development of cancer in the upper airways, the

esophagus, the pancreas, and the liver.

 

Use of alcohol has also been associated with a higher risk for

breast

cancer, possibly because of increased estrogen levels or because the

liver overproduces certain carcinogenic growth factors in response

to

alcohol.

 

The more a woman drinks, the higher the risk. Even moderate drinking

poses a higher risk, although it is modest compared to heavy

drinking.

(Women who drink and are also taking hormone replacement therapy are

at

the highest risk.)

 

Alcoholism is also highly associated with invasive cervical and

vaginal

cancers. This high risk, however, may be due to behaviors associated

with both alcoholism and these cancers (e.g., smoking, promiscuity,

use

of hormonal contraception, and dietary deficiencies).

 

Effects on the Lung

Pneumonia. Alcoholism is strongly associated with very serious

pneumonia. Over time, chronic alcoholism can cause severe reductions

in

white blood cells, which increase the risk for infections,

particularly

those in the lung. One study on laboratory animals suggests that

alcohol

specifically damages the bacteria-fighting capability of lung cells.

 

(Chronic alcoholism also causes changes in the immune system,

although

in people without any existing medical problems these changes do not

appear to be significant.)

 

Acute Respiratory Distress Syndrome. One study indicated that

intensive

care patients with a history of alcohol abuse have a significantly

higher risk for developing acute respiratory distress syndrome

(ARDS)

during hospitalization. ARDS is a form of lung failure that can be

fatal.

 

It can be caused by many of the medical conditions common in chronic

alcoholism, including severe infection, trauma, blood transfusions,

pneumonia, and other serious lung conditions.

 

Skin, Muscle, and Bone Disorders

Severe alcoholism is associated with osteoporosis (loss of bone

density), muscular deterioration, skin sores, and itching.

Alcohol-dependent women seem to face a higher risk than men for

damage

to muscles, including muscles of the heart, from the toxic effects

of

alcohol.

 

Peripheral neuropathy, damage to the nerves in the limbs, occurs in

5%

to 15% of people with alcoholism. Such injuries cause tingling,

pain,

and numbness in the hands, feet, arms, and legs.

 

Effects on Reproduction and Fetal Development

Effects Sexual Function and Fertility. Alcoholism increases levels

of

the female hormone estrogen and reduces levels of the male hormone

testosterone, factors that possibly contribute to impotence in men

and

infertility in women. Such changes may also be responsible for the

higher risks for absent periods and abnormal uterine bleeding in

women

with alcoholism.

 

Drinking During Pregnancy and Effects on the Infant. Even moderate

amounts of alcohol can have damaging effects on the developing

fetus,

including low birth weight and an increased risk for miscarriage.

High amounts can cause fetal alcohol syndrome, a condition that can

cause mental and growth retardation. One study indicated a

significantly

higher risk for leukemia in infants of women who drank any type of

alcohol during pregnancy.

 

A 2003 study also suggested that children of mothers who drink

during

pregnancy have a higher risk for alcohol dependence as they grow

older.

 

Effect on Weight and Diabetes

Moderate alcohol consumption may help protect the hearts of adults

with

type 2 diabetes. Heavy drinking however is associated with obesity,

which is a risk factor for this form of diabetes.

 

In addition, alcohol can cause hypoglycemia, a drop in blood sugar,

which is especially dangerous for people with diabetes who are

taking

insulin. Intoxicated diabetics may not be able to recognize symptoms

of

hypoglycemia, a potentially hazardous condition.

 

The Effect on Central Nervous System and Mental Functioning

Drinking too much alcohol can cause immediate mild neurologic

problems

in anyone, including insomnia and headache.

 

Long-term alcohol use may even physically affect the brain. Except

in

severe cases, however, any neurologic damage is not permanent, and

abstinence nearly always leads to eventual recovery of normal mental

function.

 

Effect on Mental Functioning. Studies have reported less blood flow

in

the frontal lobes of the brain, which may reflect links to deeper

levels. In a 1999 study, even recent high alcohol use (i.e., within

the

last 3 months) was associated with some loss of verbal memory and

slower

reaction times. Researchers are also interested in the effects on

the

hippocampus.

 

This region in the brain is associated with learning and memory and

the

regulation of emotion, sensory processing, appetite, and stress. One

2000 study suggests that during adolescence the hippocampus is

particularly vulnerable to the adverse effects of alcohol.

 

Moreover, a 2002 report indicated that over time chronic alcohol

abuse

can impair so-called " executive functions, " which include problem

solving, mental flexibility, short-term memory, and attention. These

problems are usually mild to moderate and can last for weeks or even

years after a person quits drinking.

 

In fact, such persistent problems in judgment are possibly one

reason

for the difficulty in quitting. Alcoholic patients who have co-

existing

psychiatric or neurologic problems are at particular risk for mental

confusion and depression.

 

Wernicke-Korsakoff Syndrome. Wernicke-Korsakoff syndrome is a

serious

consequence of severe thiamin (vitamin B1) deficiency in alcoholism.

Symptoms of this syndrome include severe loss of balance, confusion,

and

memory loss.

 

Eventually, it can result in permanent brain damage and death. Once

the

syndrome develops, oral supplements have no effect, and only

adequate

and rapid intravenous vitamin B1 can treat this serious condition.

 

Peripheral Neuropathy. Vitamin B1 deficiencies can also lead to

peripheral neuropathy, a condition that causes pain, tingling, and

other

abnormal sensations in the arms and legs.

 

Vitamin and Mineral Deficiencies

People with alcoholism should be sure to take vitamin and mineral

supplements. Even apparently well-nourished people with alcoholism

may

be deficient in important nutrients.

 

Deficiencies in vitamin B are particularly health risks in people

with

alcoholism. Other vitamin and mineral deficiencies, however, can

also

cause widespread health problems.

 

Folate Deficiencies. Alcohol interferes with the metabolism of

folate, a

very important B vitamin, called folic acid when used as a

supplement.

Folate deficiencies can cause severe anemia. Deficiencies during

pregnancy can lead to birth defects in the infant.

 

Folate deficiencies and alcoholism have also been associated with a

higher risk for cancer and heart disease, particularly in women

under

60.

 

Vitamin B1 Deficiencies. Many of the B vitamins are essential for

nerve

protection. Severe deficiencies are common in alcoholism and can

have

serious consequences on the central nervous system, notably

peripheral

neuropathy and, in very severe cases, Wernicke-Korsakoff syndrome.

 

Drug Interactions

The effects of many medications are strengthened by alcohol, while

others are inhibited. Of particular importance is alcohol's

reinforcing

effect on anti-anxiety drugs, sedatives, antidepressants, and

antipsychotic medications.

 

Alcohol also interacts with many drugs used by diabetics. It

interferes

with drugs that prevent seizures or blood clotting. It increases the

risk for gastrointestinal bleeding in people taking aspirin or other

nonsteroidal inflammatory drugs (NSAIDs) including ibuprofen and

naproxen.

 

Chronic alcohol abusers have a particularly high risk for adverse

side

effects from consuming alcohol while taking certain antibiotics.

These

side effects include flushing, headache, nausea, and vomiting. In

other

words, taking almost any medication should preclude drinking alcohol.

 

At a Glance: Effects of Alcohol

Medical Problem

Risks and Benefits form Light-Moderate Drinking

Risks from Binge Drinking and Hangovers

Risks from Heavy Chronic Drinking

 

Liver Disorders

 

Changes in liver function.

Alcoholic hepatitis. Fatty liver. Cirrhosis.

 

Gastrointestinal Problems

Benefits: May be protective against gallstones. (Binge drinking or

heavy drinking is not protective.)

Diarrhea.

Diarrhea. Hemorrhoids. Pancreatitis. Bleeding in the intestines and

stomach. Tears in the esophagus from violent vomiting.

 

Heart Disease

Benefits: May reduce risk for heart disease caused by blockage of

arteries.

High blood pressure. Increased heart rate. Heart rhythm disturbances.

High blood pressure. Weakened heart muscles leading to failure.

 

Stroke

Benefits: Moderate drinking may help reduce risk for ischemic stroke

(strokes caused by blockage in the arteries to the brain.)

Hemorrhagic stroke (caused by bleeding into the brain).

Strokes caused by bleeding (hemorrhagic) or blocked arteries

(ischemic).

 

Cancer

Risks. Associated with higher risk for breast cancer in women.

 

Cancers in the head and neck, esophagus, stomach, liver, pancreas,

cervix, and vagina. (Such cancers may be related to smoking,

however.)

Effect of heavy drinking on breast cancer is unclear.

 

Neurologic or Mental Disorders

Benefits: May be protective against dementia.

 

Risks: Insomnia. Headache.

 

Memory impairment and problems in thinking and concentration.

Nerve damage from severe vitamin deficiencies. Impairment in mental

functioning and memory. Emotional disorders, psychosis.

 

Loss of restorative sleep. Dementia. Peripheral neuropathy.

 

Genital and Reproductive Problems

Risks: Although increases sexual drive, even modest drinking can

cause

impotence in men. Even moderate drinking during pregnancy increases

risk

for birth defects.

Any drinking during pregnancy increases risk for birth defects.

Impotence in men. Menstrual disorders and infertility in women.

Drinking during pregnancy increases risk for birth defects.

 

Immune System

 

 

Increased susceptibility to infections.

 

Skin, Muscle, and Bone Disorders

 

 

Osteoporosis. Muscular deterioration from malnutrition. Skin sores.

Itching.

 

 

Diabetes

Benefits. May protect against type 2 diabetes.

 

Risks: Associated with hypoglycemia.

Hypoglycemia.

Hypoglycemia.

 

Weight gain may increase risk for type 2 diabetes.

 

Blood

Benefits: Chemicals in red wine, called polyphenols, may reduce the

risk for blood clots.

 

Anemia from folate deficiencies. Low white cell count (increased

risk

for infection). Low platelet count.

 

Lung Disorders

 

 

Acute respiratory distress syndrome. Pneumonia.

 

 

Article Page Navigation

Introduction

Causes

Risk Factors

Complications

Diagnosis

Treatment for Alcoholism

Treatment for Alcohol Withdrawal

Therapy

Medications

Resources

 

http://adam.about.com/reports/000056_3.htm?terms=alcoholism

 

JoAnn Guest

mrsjo-

www.geocities.com/mrsjoguest/Diets