Alcohol - Friend or Foe?

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Alastair Cooke RMN CPN  Clinical Nurse Specialist (Alcohol & Drugs)

About Alcohol

Units

Why do we drink?

Physical Effects

Psychological Effects

Social Consequences

What is Alcoholism?

The 4 Stages of Alcoholism

Treatment

Approaches to limiting Intake

Alcohol Awareness Quiz

Alcohol Links

About Alcohol

What is Alcohol?

The drinking version is called ethyl alcohol which is colourless, has a weak smell and a strong burning taste.  It is produced during manufacturing by the action of yeast on certain sugars in fruit and vegetables.

Alcohol is a legal drug unlike heroine, cocaine and cannabis etc which are all illegal drugs.  Alcohol is a depressant drug, which means it dulls the working of the brain, you lose some of your inhibitions and it lowers your efficiency at tasks such as driving.

What are its uses?

A social lubricant

An anaesthetic (in the old west)

A solvent

A cooking aid

Paint and dye manufacture

How strong can it be?

It varies from 0.03% by volume (non-alcoholic lagers) to 44.8% (some Polish and Russian vodkas)

The colour, taste and bouquet of drinks are obtained by the addition of congeners.  These congeners can in part be attributed to the "hangover effect" therefore clear drinks such as vodka and white wine cause less of the hangover effect as opposed to brandy and whiskey.

 

Units

Alcoholic drinks come in a wide variety of flavours, smells and appearances

The common factor with all these drinks is that they contain alcohol

The following drinks contain one unit of alcohol

Half a pint of average strength beer or cider

(Quarter of a pint of strong lager)

One glass of table wine

One glass of sherry

One single whiskey (25mls) or any other spirit  

It is recommended that a man should not exceed 21 units per week

A woman should not exceed 14 units per week

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Why do we Drink?

Approximately 45% of problem drinkers' parents are or have been alcohol abusers

Men with a serious alcohol related problem outnumber women by 4 to 1.  Men are able to drink openly alone without attracting much attention which is not often the case for a woman.  Once established though, women appear to suffer more physical damage and social consequences from heavy drinking than men.

Occupation  -  some occupations have a particularly high incidence of alcohol abuse.  These include barmen, doctors, travelling salesmen and accountants.  The people at particular risk are those who work in a job where alcohol is sold or made, where there are high stress levels, where alcohol is used in the course of business, when the person is away from home for long periods, or where the groups of employees regularly meet for social activities.

Availability  -  Alcohol is legal and widely available.  There are few restrictions and these are often flouted (eg under age drinking)

Relative Cost  -  Contrary to popular belief, the relative cost of alcohol has decreased in recent years.  Standards of living have increased and a higher disposable income has contributed to doubling the sale of alcohol over the past 30 years.

Stress  -  Alcohol is used in an attempt to relieve tension

Personal Factors  -  Feelings of low self esteem and anxiety which alcohol helps to overcome

Peer Groups  -  These establish their own approved drinking levels and patterns amongst members.  They may re-inforce harmful and excessive drinking patterns.

Self Medication  -  Alcohol has a powerful anti-anxiety effect and may be used by people who experience anxiety or depression or other mental health problems

 

Physical Effects of Alcohol

Alcohol is readily digested and spread throughout the body.  The rate of absorption is dependant upon the relative concentration of alcohol in the drink and whether there is food in the stomach

Alcohol is de-toxified by the liver and excreted fairly slowly.  It takes approximately one hour to dispose of one unit of alcohol

Alcohol has a depressant effect on the central nervous system.  This means that after your first drink, your co-ordination, balance and response times will be affected.  After only one drink you are already under the influence of alcohol

Alcohol irritates the lining of the stomach

Alcohol suppresses the body's anti-diuretic hormone which means you pass more water leading to dehydration

Excessive consumption of alcohol during a short period leads to classic signs of intoxication eg. blurred vision, staggering, memory loss, sleepiness, nausea and vomiting.

Hangover  -   this is due to the toxic effects of the alcoholic drink, dehydration and gastritis.

Death  -  At high levels of blood alcohol concentration, exceeding 800mgs per 100mls, death is possible from suppression of the respiratory centre (breathing) or inhalation of vomit.  This would equate to drinking a bottle of spirits in a short space of time.     

Death may also occur over a longer period of alcohol abuse due to liver failure or other damage to the body's vital organs.

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Psychological Effects of Alcohol

Alcohol is a very potent anxiolytic (it reduces anxiety)

People feel more relaxed, cheerful, friendly and chatty

In moderation, the consumption of alcohol can be a pleasant experience and makes social occasions go with a swing

In larger amounts, the effects of alcohol are more pronounced.  This means that alcohol exaggerates the persons mood.  If the person is already feeling unhappy, then they are likely to feel even more depressed.  If they feel happy, then they are likely to become joyful and merry

As the level of alcohol rises, the person tends to lose insight and may do or say things that they would not normally display

The person may become irritable and angry which may lead to verbal and/or physical abuse

Remembering these events after drinking may be very hard or impossible

 

Social Consequences of Alcohol

Suicide   -  Alcohol is frequently associated with acts of self harm.  People with long term drinking problems also have a higher suicide risk

Physical Ill-Health -  Alcohol is generally known to be associated with cirrhosis of the liver.  It also, however, is known to cause a wide range of serious physical health problems, Eg. peptic ulcers, cancer of the mouth, cancer of the throat, liver and stomach cancer

Family and Personal Suffering  -  Long term alcohol dependency causes a great deal of misery and suffering to the person and their family.  Alcohol often plays a role in sexual abuse, divorce, verbal and physical abuse

Industry and Workplace  -  In the UK, at least 14 million working days are lost each year due to absenteeism and sickness due to drinking alcohol to excess.  At least 2% of the workforce suffer problems related to alcohol or other substance abuse.  Many people are 'carried' by their work mates.  At work their output is low and they may have a high accident rate

Convictions for Drunkenness  -  In the United Kingdom this exceeds 110,000 per year.   A high re-conviction rate exists and some people are charged repeatedly.   Alcohol is often linked with crimes of violence and assault.

Road Traffic Accidents  -  Approximately 1 in 5 car drivers and 1 in 4 pedestrians are killed in the UK in road accidents where drivers have blood alcohol levels exceeding the legal limit  (80mg per 100mls of blood  -  2 pints of beer for men, less for women)

Hospital Admissions  -  At least 10% of people admitted to general hospitals in the UK are estimated to have alcohol related problems without their alcohol dependency being recognised.

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What is Alcoholism?

Every one of us is potentially an alcohol addict as alcohol is an addictive substance quite unlike most others.  Laboratory animals have become alcohol dependent and can be bred to crave alcohol.

There are many lengthy definitions of what constitutes being an alcoholic, but I prefer to use the following definitions as a guideline during assessment.

An alcoholic is a person who regularly experiences alcohol related problems in one or more departments of ones life -  Eg.  relationships, health, financial, occupational or legal

 

Tolerance and Alcohol

Tolerance means that over a period of time the brain needs more and more of an addictive drug such as alcohol to achieve the same mood altering effect.  Many of us have experimented with alcohol in our teens when a glass or two of wine or a pint or two of beer was suffice to make us feel intoxicated and merry.   As we use alcohol more, we require a greater quantity to achieve the same effect.   By the time were are in our late teens we might need 3 or 4 pints of beer.   This is what is meant by the development of tolerance.

Many people who drink alcohol will have at some time in their lives experienced withdrawal effects to varying degrees.  Most of us are aware of the adage 'hair of the dog that bit you'.  This means that following a nights drinking, the body is experiencing withdrawal effects in the form of a hangover, but if another alcoholic drink is consumed then the depression that this causes can disappear - as the level of alcohol in the bloodstream is raised thus giving us a lift to our mood, and dispelling the withdrawal symptoms that we are suffering.

Tolerance and withdrawal are of a different order in the later stages of alcoholism, but the same principles apply.

 

Inherited Aspects

There is a high likelihood of inherited ability chiefly dependent on 2 factors

The greater the number of alcoholics in the family history, the greater the chances of someone developing alcoholism in the present generation

The more closely one is related to an existing alcoholic, the more likely it is that one will develop alcoholism

Twins  -  when one fraternal (non-identical) twin is an alcoholic in 30% of cases, his twin is also found to be an alcoholic, but in identical twins, the figure may be as high as 60%

Adoption  -  Studies in Denmark and Sweden in the early 70s, showed that when sons of alcoholics are adopted by non-alcoholic families, they are just as likely to become alcoholic when they grow up, as are those reared by their biological families.  They are 4 times more likely to develop alcoholism than their peers in the general population

 

The 4 Stages of Alcoholism

The Pre-Alcoholic Stage  -  This is characterised by what we would call social drinking, for example, to relax

Early Alcoholic Stage  -  At this point, the drinker has his first blackouts, may become defensive about drinking and feel guilty about it.  In this particular phase, the characteristic sneaking of drink begins.  The alcoholic makes sure that he orders the drinks, so that extra ones can be consumed, for example, he may have one just while he is waiting for the round to be completed, he always has the first empty glass and becomes impatient with companions when drinking too slowly.

Addiction Phase  -  The alcoholic is now physically dependent.  He experiences loss of control over his drinking and his mounting financial and relationship problems become a rationale for further drinking.

Chronic Alcoholism  -  this is the final stage and the organs of the alcoholic's body are now becoming badly damaged.  He may die or become incapacitated  by liver or heart disease.  The brain is gradually becoming damaged and delirium tremens ('DTs') alcoholic psychosis of some of the brain misfunction may deprive the drinker of his sanity and eventually of life itself.

The disease may progress slowly in some individuals and they may remain in the early alcoholic phase for 20 - 30 years.  On the other hand, it may be only 2 - 3 months before they progress to the addiction phase.   Regardless of the time factor, it is only a matter of time before the disease progresses unless the drinker becomes aware of the problem, acknowledges it, and takes remedial action.

If the alcoholic is in the phase of addiction, I would suggest that only by complete abstinence will the physical and mental decline be reversed.  Some people prefer to try another option - controlled drinking.   I can only say that in my experience in trying to help people with an alcohol related problem,  I have found very few people able to adopt this path of action successfully.

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Treatment

Prevention is Better than Cure -  I hope that the information here has made you think about your own alcohol intake, or that of a relative and/or significant other.

Education is a powerful weapon with regard to substance abuse, and hopefully steps can be taken to prevent one's downward spiral before alcohol takes a hold on one's life.

Following Assessment, it may be deemed necessary to advise the client that total abstention from alcohol is indicated in order to improve their situation.

Alcohol consumption should not be stopped abruptly unless it is supervised by a trained clinician (general practitioner or nurse).  Suddenly stopping drinking will throw the body into turmoil, and could lead to serious withdrawal problems (severe shakes, fits and hallucinations)

To minimise the risks of these problems,  a Detoxification (detox) Programme may be advised which includes the use of a tranquilliser for a short period (up to approximately 7-9 days) and daily visits by the clinician.

The Detoxification may take place in the client's home or in hospital, depending on the individual's circumstances.

Some people find it very hard to remain alcohol free and are often tempted to succumb to the 'magnetic type' force that alcohol has.  This may result in several relapses and the client feels that he or she requires a more radical approach.

A form of medication is available called Antabuse.  This drug is taken on a daily (or alternate daily) basis, and is used to help the client overcome the temptation to drink.  If alcohol is consumed, the client will experience a number of very unpleasant physical effects such as profuse vomiting, headache and palpitations.

Another medication can reduce the craving for alcohol - Acamprosate (Campral) - which is normally taken 3 times a day.

Alcoholics Anonymous (AA) has been in existence for many years.  It is a well established support group throughout the world, and most towns and cities have regular meetings at one or more venues.  Some people attend on a regular basis, several times a week in some cases, or just once a week may suffice.  Other people attend once, and do not return as it does not meet their individual needs.

I can only suggest that if you have a problem with alcohol, do not listen to other people's opinions with regard to support groups such as AA, but attend a meeting and arrive at your own conclusions.  Remember 'One man's meat is another man's poison' or vice-versa. 

I must stress that these treatment methods are just a few options open to the problem drinker and each client will be assessed individually.

 

Approaches to Limiting Alcohol Intake and Regaining Control

Do not drink daily

Set a weekly consumption level  -  21 units for men and 14 units for women

Plan drinking sessions in advance, not on impulse

Do not drink when taking other drugs

Arrange other activities that do not involve doing to the pub

Eat before drinking

Arrive at the pub later

Limit the amount of money you take

Do not drink alone

Do not drink at lunchtime

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Alcohol Awareness Quiz

Only people who are alcoholics can have a problem with their drinking

False

Some people may only drink at the weekends, but drink to excess and possibly cause harm to themselves and their families.  Others may drive their cars whilst they are over the 80mg limit, and may have an accident.  Neither of these examples might be alcoholics, but they do have problems with their drinking.

Different kinds of alcoholic drinks contain different kinds of alcohol

False

All alcoholic drinks contain the same kind of alcohol - ethyl alcohol

People who are dependent on alcohol are usually of weak character

False

ANYONE who drinks can become dependent on alcohol

Most alcohol consumed passes out of the body when you go to the toilet

False

At most, only 2% of alcohol consumed is actually lost through going to the toilet or by sweating.  The rest is broken down by the liver

Drinking too much alcohol can kill a person

True

Drinking too much alcohol on one occasion can poison the body and lead to death.  So can drinking too much alcohol over a period of time.

Alcohol reduces stress

False

Alcohol is a depressant drug.  It may relax you in the short term, but it can produce more stress and worries in the long term

Alcohol is a depressant

True

Alcohol depresses the central nervous system.  The reason for the misunderstanding is that at first, alcohol seems to make a person feel stimulated and light-headed, but what it is actually doing is depressing the brain

Food in the stomach slows down the rate at which alcohol has its effects

True

If the stomach contains food when the alcohol arrives, this will act as a kind of 'dam' and slow down the rate at which alcohol gets into the bloodstream

2 pints of beer affects a small person more than a larger person

True

A person's weight does affect the extent to which he or she is affected by alcohol.  Generally speaking, we can say that the smaller a person is, the more he or she is affected by alcohol.

The effects of one pint of beer (on a person) wear off after half an hour

False

Although the initial effects of 1 pint of beer can be felt after about 10 minutes, it takes up to one hour for the maximum effect to develop

Alcohol is a drug

True

Alcohol is a mood altering drug.  It is a depressant which means that it has the ability to slow down the action of the brain, affecting the person's ability to think clearly and do things properly

2 pints of beer do not affect a person's driving skills

False

Alcohol is a depressant drug and it has been shown that drinking 2 pints of beer can double the person's chance of having an accident

It makes sense to drink alcohol in colder weather because alcohol warms you up

False

Alcohol widens the blood vessels nearest to the skin, allowing more blood to be close to the surface.  In cold surroundings, more heat will be lost from the body and although a person may FEEL warmer after drinking alcohol, his body will in fact lose heat and the cold will affect him more

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Links

Alcohol Links
Alcoholics Anonymous - Guernsey
GADAC - Guernsey Alcohol and Drug Advisory Council 

 

 

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17 March 2002

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