Alcohol is the oldest and most widely used drug in the world.  Today, despite its deadly consequences, it is legal in our society once a person reaches twenty-one years of age.  Alcohol is addictive, dangerous, and also very entrenched in our society.  Three out of five adults in this country regularly consume alcohol.  One out of three reports to drinking five or more drinks whenever they consume alcohol.  Caucasians and American Indians have the highest drinking rates in the country and Asians have the lowest.  Where you live also makes a difference—people from the Midwest region of the country have the highest rates of alcohol consumption, while the South has the lowest rates.
   
Alcohol Effects

What about the deadly consequences of alcohol?  In 2003 there were over twenty thousand alcohol induced deaths (this doesn’t even count traffic deaths, homicides, and suicides).  In 2006 over twelve thousand people died of liver failure related to alcohol.
   

Alcohol & Suicide

There has long been known a link between alcohol and suicide, even in some of the most creative minds our world has known.  On July 2, 1961 Nobel prize winning author, Ernest Hemingway killed himself in Ketchum, Idaho with a double barrel shotgun.  Hemingway had a longstanding battle with alcoholism.  Alcohol is believed to be involved in up to two out of three suicide attempts.  States with the highest suicide rates per capita also have the highest alcohol sales.  Alcoholics are especially prone to commit suicide in the throes of severe marital or relational difficulties.  Alcohol use among minors puts them at higher risk for suicidal behavior as well.

Alcohol and the brain

“Once you take that drink of alcohol, trillions of potent molecules surge through your blood stream and into your brain. Once there, they set off a cascade of chemical and electrical events, a kind of neurological chain reaction that ricochets around the skull and rearranges the interior reality of the mind.” This is how a writer for Time Magazine graphically described the way alcohol affects the brain.

 Alcohol primarily affects the brain in two ways. The first is as a “downer” or depressant; the second is as an agitator of the central nervous system. An excitable person in a stimulating environment is likely to demonstrate the agitating effects of alcohol by becoming talkative, self-confident, and socially engaging. A more introverted person drinking in a quiet atmosphere, on the other hand, is likely to throw off the excitement of drinking and move into a sleepy, sedated frame of mind.

The depression of alcohol is stronger than its agitation and may generally be observed for two hours after the first drink. The agitating effects last longer, approximately six hours after the drink. The “hangover” and lack of muscle control the next morning after a drinking binge is caused by the residual effect of alcohol’s agitating effects.

Unlike heroin, cocaine and other substances, alcohol does not link to a specific brain receptor but has far-ranging effects on all parts of the brain.

One of the first effects of alcohol on the mind is to increase the concentration of dopamine and serotonin, which in turn release endorphins. These are the feel-good, pleasure chemicals of the body and account for the sense of sublime happiness that many feel when they drink alcoholic beverages. Alcohol also disturbs levels of the “let’s go” glutamate neurotransmitters, which accounts for some of the drowsiness and lack of coherence associated with heavy alcohol use. Finally, alcohol seems to enhance the action of the brain’s primary inhibitory transmitter, GABA (gamma-aminobutyric acid), sedating the brain even more.

By decreasing the excitatory effect of glutamate, alcohol causes unconsciousness and if enough glutamates are suppressed, an overdose of alcohol can cause breathing to slow or cease.
While all of this slowing down of the body functions is taking place, the body is busy trying to get rid of unabsorbed alcohol still remaining in the stomach. Vomiting while unconscious can lead to choking or inhaling the vomit until the person can no longer breathe and ends up dying from absorbing vomited matter into the lungs.

When alcohol is withdrawn from the system, an oversupply of glutamate occurs.  In heavy drinking the glutamate balance doesn’t return to normal for months, even years. The fastest way to break the imbalance is to take another drink, and for too many people it’s a very short trip back to full-blown alcoholism.

What is alcoholism?

Alcoholism is the disease of being addicted to alcohol. The American Society of Addiction Medicine defines alcoholism as...
“...a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.”

As with other addiction-beset individuals, the alcoholic takes as much alcohol into his system as he wishes regardless of the consequences. Motor vehicle crashes, trouble with the law, family problems—none of these matter to the alcoholic as much as feeding the addiction.  As Nora Volkow, another leading researcher in addictions has put it, “An addiction permeates your life; you spend more and more of your time and energy trying to satisfy your craving.”

Can alcoholics recover?

Yes, they can, but the success rates are quite discouraging.
Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism, calls alcohol “the most widespread and damaging substance we have in society.”
What damage does alcohol cause in the “land of the free” to warrant such a condemnation? For starters, alcohol has the potential for damaging every organ of the body, starting with the brain, but also delivering deadly harm to the heart, liver, pancreas, intestines, lungs, and many other body parts.  Ten to twenty percent of hospital admissions today are documented to be directly related in someway to alcohol. Many hospital administrators think the actual number is probably twice this amount.  

The common thread running through every stage of alcohol addiction is denial. It begins from the first drink with many alcoholics.  These people may clearly see the damage alcohol is bringing to their lives, yet they still choose it.  Further down the path denial becomes more forthright.

“I drink to cope with my crummy boss and my lousy marriage,” the drinker may say with some indignation when a friend points out the problem. “I have to drink to survive. It’s my problem, not yours.”

After waking up on the couch swooning from nausea and feeling sick in every pore, the alcoholic moans, “Where am I?” and promptly forgets all about the night before when alcohol flowed freely.  Comedian Robin Williams spoke about his alcohol problems and denial with Larry King when he joked, that he would pass out on his couch and the next morning tell his family that someone must have entered their home during the night and placed an empty vodka bottle in his hand and then peed in his pants!  Denial can be so strong that it may continue even to the point of death in squalid surroundings.

Being addicted is a state of mind that puts all considerations aside except for, “How can I find more?”  Career, family, and financial obligations take a backseat to the quest for finding a drink.  Practicing alcoholics progress to where they no longer care what people think. Let others laugh. Let them preach. All that matters is finding a drink.

Treating alcoholism

Over 19 million people in this country are estimated to have a drinking problem serious enough to need treatment.  Sadly, less than 1 out of 1000 of these Americans ever receive it.  Many are never even diagnosed.
The U.S. government provided minimal funding for researching clinical drugs to treat alcoholism until the last decade.  The pharmaceutical industry pretty much ignored this area of medicine as well.  Thankfully, attitudes have changed and today the government, along with nine pharmaceutical companies, is performing clinical trials on over 50 potential medications to treat alcoholism.

This neglect didn’t happen due to lack of care, but rather lack of science.  Alcoholism has not been traditionally viewed as a disease, but as we progress studying it, the more we see it act as a disease.  Many people still pooh-pooh the notion that alcoholism is a disease.  They reason that since drinking too much alcohol is the cause of alcoholism the solution is simple—just stop drinking!  While that is true it often just doesn’t happen!  Alcoholics may stop for a while, but the compulsion to drink is usually triggered again—days, months, or even years later down the road.  The notion to just stop is akin to telling someone who’s depressed to just stop feeling sad.  Sometimes he can, but without help it usually returns.

Alcoholics Anonymous (AA) was started in the 1930’s by a Wall Street stockbroker and a proctologist, who both had drinking problems.  Alcoholism had such a negative view in society during that era that most people drank in secrecy.  The group actually met in secret and anonymously.  Thankfully these two men had the courage to step out.  Since then AA has helped millions overcome, not just alcoholism, but other addictions as well.

This program, built on a 12 step model, and centered on the belief of a higher power, has shown how group support and hope are powerful forces in changing lives.  While AA is not magical and the majority of members do not attain complete sobriety—it has been effective.  We know dozens of people who swear that AA is the sole reason they are still alive.
There is also a group for those people who are dealing with alcoholic family members—Al-Anon.  They too, meet at various times and places across the community.  The best way to find a group near you is through their official website www.alcoholics-anonymous.org.  (Don’t enter in AA.com unless you want to book a flight on American Airlines.)

Can Medications Help?

Until fairly recently it was assumed that because alcohol was a beverage of choice, only counseling or group support had any chance at all of helping a person trapped in an alcohol addiction. You will still hear highly educated and eloquent people debating the issue of whether or not alcoholism is a treatable disease. Leading examples are George Valliant, author of The Natural History of Alcoholism Revisited, a seminal book on alcoholism as a disease; and Herbert Fingarette, author of Heavy Drinking: The Myth of Alcoholism as a Disease.

In the past few decades, drugs for alcoholism have become a primary focus of pharmaceutical research firms. Three medications—disulfiram, naltrexone, and acamprosate—have been approved for treating alcohol dependency by the U.S. Food and Drug Administration.

Many other compounds are undergoing research for treating alcoholism. The problem is that while some patients seem to benefit from these new medications; others do not respond. None of the medications is overwhelmingly successful. We have learned from research, however, that alcoholics who not only learn coping strategies in counseling or group settings, but also follow a carefully monitored drug therapy regimen are far less likely to relapse into an alcohol-dependent life.