Alcohol Abuse

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What is alcohol abuse?

Alcohol abuse is a pattern of excessive drinking leading to a myriad of serious health risks such as cardiovascular disease, cancer, anemia, dementia, cirrhosis, pneumonia and tuberculosis. According to research, alcohol is causally linked to more than 60 medical conditions and accounts for 4% of the world’s diseases.

Prevalence of Alcohol Abuse

• In 2015, 26.9% of adults 18 and older reported binge drinking in the past month, and 7% reported heavy alcohol consumption in the past month, according to the 2015 National Survey on Drug Use and Health (NSUDH)
• From 2006-2010, about 62,681 men and 25,987 women died from alcohol-related causes, making alcoholism the third leading preventable cause of death in the United States, according to the Centers for Disease Control and Prevention
• About a third of driving fatalities were attributed to alcohol-impaired driving in 2014, according to the United States Department of Transportation
• In 2010, alcohol was the fifth leading cause for premature death and disability around the world, according to the Global Status Report on Alcohol and Health by the World Health Organization (WHO)
WHO reports an estimate of 3.3 million deaths globally in 2012 were attributed to alcohol-related causes

Alcohol Abuse vs. Alcohol Dependence

If you are abusing alcohol, does that mean you’re physically dependent? The answer is no, but there is a fine line. Alcohol dependence is one’s inability to quit drinking, and alcohol abuse is excessive consumption which could lead to serious consequences if the individual does not seek help…so how much is too much? Anything more than one drink (for women) and two drinks (for men) per day would be considered harmful alcohol consumption, according to WebMd. A standard drink, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), contains 14 grams of pure alcohol and is equivalent to:

• 5 ounces of wine
• 12 ounces of beer
• 1.5 ounces of liquor (e.g., tequila or whisky)

Stages of Alcoholism: From Social Drinking to Problematic Drinking

Although genes play a role in the development of alcoholism, anyone can develop alcohol dependence and addiction given certain environmental factors. People start drinking innocuously for various reasons, either to mingle with friends at a party or to destress after a long, hard day. However, warning signs of progression to alcoholism should be noted, and the NIAAA defines drinking levels as follows:

Moderate alcohol consumption
Up to one drink per day for women and two drinks per day for men

Binge drinking
A pattern of drinking that elevates the blood alcohol concentration (BAC) levels to 0.08%. This would be equivalent to four drinks or more within two hours for women and five or more drinks in two hours for men.

Heavy alcohol use
Binge drinking on five or more days within the past 30 days

Binge Drinking – Who’s at Risk?

Men who exhibit risky or impulsive behaviors and have a family history of alcohol use disorder have reported the highest rates of binge drinking in a study published in The American Journal of Psychiatry. Researchers examined the link between binge drinking and alcohol use disorder (AUD) factors in a sample of 159 social drinkers between the ages of 21 and 45. Respondents completed assessments about family history of problem drinking, impulsive behaviors and level of response to alcohol; findings revealed that those who had a family history of alcoholism had a faster rate of binge drinking, and individuals who had all three risk factors (being male, having a family history of AUD and exhibiting impulsive behaviors) had rates of intravenous alcohol administration five times faster than those in the lowest risk group.

Binge Drinking Facts and Statistics
• Adults age 35 and over have reported more binge drinking than younger adults. American adults consume approximately 17.5 billion binge drinks each year. In 2015, about 17.1% of adults (37.4 million) had an average of 53.1 binge-drinking episodes per drinker. Findings reveal that though binge drinking was more common among young adults between the ages of 18 and 34, about half of the binge drinks were consumed by adults aged 35 and over (Kanny, Naimi, Liu, Lu & Brewer, 2015)
• Binge drinking is more common among high-income earners with higher educational levels, but binge drinkers with lower incomes and educational levels consume more binge drinks annually (Kanny et al., 2015)
• Men are twice as likely as women to binge drink (Kanny et al., 2015)

Signs and Symptoms of Alcoholism

Binge drinking is not alcohol dependency or alcoholism, but if binge drinking patterns are left unchecked, it can lead to alcoholism, which is a disease characterized by the following signs and symptoms:

• Drinking more or longer than intended
• Attempts to reduce or stop drinking have failed
• Spending a lot of time drinking or getting sick from alcohol’s effects
• Intense all-consuming psychological cravings
• Drinking habits interfere with personal, academic and job responsibilities
• Declining quality of work/job performance
• Preference for drinking over spending quality time with loved ones
• Alcohol is prioritized above favorite hobbies and pastimes
• Increase in risky behaviors while drinking or after drinking
• Continued drinking despite harm to physical and mental health
• Increased physical tolerance for alcohol

An individual is considered to have a mild alcohol use disorder if he or she has had 2-3 symptoms within the past year. The presence of four to five symptoms indicates a moderate alcohol use disorder, and six or more symptoms is considered severe.

Alcohol Withdrawal Symptoms

Drinking a glass of wine is usually the first thought that comes to mind when people want to unwind and relax. Alcohol relieves anxiety by increasing GABA’s effects, a neurotransmitter responsible for feelings of calmness, and decreasing glutamate, a neurotransmitter that stimulates neural activity and energy levels. The increase of GABA and decrease of glutamate result in euphoria which keeps drinkers coming back for more. As the body gets more accustomed to these changes, it needs increasing amounts of alcohol for the drinker to feel the same effect.

When people suddenly stop drinking, their bodies begin to experience alcohol withdrawal symptoms due to the imbalance of GABA and glutamate in their systems. The body continues to produce more GABA and less glutamate, which leads to a host of alcohol withdrawal symptoms ranging from mild to severe, depending on how long and how much the individual has been drinking.

Mild alcohol withdrawal
Within 6 to 12 hours after the last drink, a heavy drinker may experience:

• Perspiration
• Nausea and vomiting
• Headache
• Insomnia
• Shaky hands
• Mild anxiety
• Loss of appetite
• Clouded thinking

Moderate alcohol withdrawal
Within 12 to 24 hours after the last drink, a chronic drinker may experience the following:

• Hand tremors
• Alcoholic hallucinosis (the drinker can tell the hallucinations are not real)
• Seizures
• Disorientation
• Cognitive confusion
• Difficulty breathing
• Increased blood pressure
• Heart arrhythmia

Severe alcohol withdrawal
Within 24 to 72 hours after the last drink, a chronic drinker may experience these withdrawal symptoms:

• Delirium tremens, a life-threatening condition
• Low-grade fever
• Seizures
• Hypertension
• Hallucinations
• Excessive perspiration
• Hallucinations (the drinker cannot distinguish them from reality)
• Disorientation and confusion
• Heart arrhythmia or rapid heartbeat
• High blood pressure

Consequences of Alcohol Abuse and Intoxication

Without proper treatment for alcohol use disorder, drinkers can reap short- and long-term consequences of alcohol abuse.

Regular consumption of alcohol over time can lead to long-term changes in the brain’s structure, producing anxiety and mood swings while disrupting communication among the brain’s neurotransmitters. For heavy drinkers, excessive consumption can wreak irreversible damage on the brain that persists long after sobriety is achieved. A British study showed that alcohol can actually shrink the brain, reducing brain volume in regions that control learning and cognition. The extent to which alcohol affects the brain depends on a number of factors:

• Frequency of alcohol consumption
• Amount of alcohol consumed
• Individual’s age of onset
• Length of alcohol consumption history
• Risk from prenatal exposure to alcohol
• Individual’s general health status

Alcohol’s short-term effects on the brain can be detected within a few hours or after a few drinks, depending on how much food is in the person’s system when alcohol is ingested. On an empty stomach, quick consumption of large amounts of alcohol can cause a blackout, which is a temporary cognitive impairment that wipes out the person’s memory. During a blackout, the individual is capable of doing anything – even activities he or she would never do while sober – which leads to risky impulsive behaviors such as unprotected sex, drug use, and driving while intoxicated. After the intoxication subsides, the individual will not be able to remember anything that happened during the blackout.

Generally speaking, if people are having appetizers or a meal with alcohol, stages of alcohol intoxication are predictable with incremental levels of blood alcohol concentration (BAC).

Stages of Alcohol Intoxication

Stage 1:

Subclinical Intoxication – At a BAC of 0.01 to 0.05, signs of intoxication are minimal after one or two drinks.

Stage 2:

Euphoria – When a person’s blood alcohol concentration (BAC) reaches 0.03 to 0.12, depending on the drinker’s characteristics, alcohol can turn an otherwise introverted individual into a lively, animated person who feels less inhibited by self-doubt and anxiety. As BAC increases, it negatively impairs cognitive function such as attention, judgment, short-term memory and coordination. A BAC of 0.08 is punishable by law if a driver is caught driving under the influence, because at this point, alcohol intoxication becomes a public health concern that endangers the life of the driver and others on the road.

Stage 3:

Excitement – The third stage of alcohol intoxication renders the drinker extremely vulnerable to serious physical injury and emotional instability. At a BAC of 0.09 to 0.25, a person is considered legally intoxicated; by this point, a man probably has had three to five drinks within an hour and a woman may have had two to four drinks in an hour. In addition to blurred vision and loss of coordination, the person may experience drowsiness, memory impairment and loss of judgment. At stage 3, people become visibly drunk.

Stage 4:

Confusion – When the BAC reaches 0.18 to 0.30 after too many drinks in one hour, individuals may not be able to stand up, but if they try, they may stagger in a drunken stupor, dazed and confused. They could also be extremely emotionally aggressive, overly affectionate, or completely withdrawn. Blackouts may occur during this stage, during which an individual may not experience physical pain, which renders the individual highly susceptible to severe physical injury.

Stage 5:

Stupor – At this level of intoxication, alcohol poisoning has occurred. With a BAC of 0.25 to 0.4, drinkers are completely unable to stand up or walk. They may pass out, throw up, or lose control over bodily functions. They become a danger to themselves as their ability to swallow or breathe is impaired, and they may need medical attention if they choke on their vomit.

Stage 6:

Coma – At a BAC of 0.35 to 0.45, individuals may lose consciousness and enter into a coma state. Their breathing becomes shallow, their body temperature drops, and they become unresponsive to stimuli such as light. When they reach this stage, they are at risk of death.

Stage 7:

Death – When BAC levels reach 0.5 and above, the person stops breathing.

References

Homeyer, A., Nasr, P., Engel, C., Kechagias, S., Lundberg, P., Ekstedt, M., Kost, H., Weiss, N., Palmer, T., Hahn, H. K., Treanor, D., … Lundström, C. (2017). Automated quantification of steatosis: agreement with stereological point counting. Diagnostic pathology, 12(1), 80. doi:10.1186/s13000-017-0671-y

Kanny D, Naimi TS, Liu Y, Lu H, Brewer RD. (2015). Annual Total Binge Drinks Consumed by U.S. Adults, 2015. American Journal of Psychiatry, 54(4), 486-496. Retrieved from https://www.ncbi.nlm.nih.gov

Toshikuni, N., Tsutsumi, M., & Arisawa, T. (2014). Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease. World journal of gastroenterology, 20(26), 8393-406.

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