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Saturday, July 24, 2010

How Serious Is Alcoholism?

How Serious Is Alcoholism?

About 100,000 deaths a 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 non-drinking peers, their risk for untimely death increases with heavier drinking. Any protection that occurs with moderate alcohol intake appears to be confined to adults over 60 who have risks for heart disease. The earlier a person begins drinking heavily, the greater their chance of developing serious illnesses later on. Alcoholism can kill in many different ways, and, in general, people who drink regularly have a higher rate of deaths from injury, violence, and some cancers.

Overdose.

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.

Accidents, Suicide, and Murder.

Alcohol plays a major role in more than half of all automobile fatalities. Less than two drinks can impair the ability to drive. Alcohol also increases the risk of accidental injuries from many other causes. One study of emergency room patients found that having had more than one drink doubled the risk of injury, and more than four drinks increased the risk eleven times. Another study reported that among emergency room patients who were admitted for injuries, 47% tested positive for alcohol and 35% were intoxicated. Of those who were intoxicated, 75% showed evidence of chronic alcoholism. This disease is the primary diagnosis in one quarter of all people who commit suicide, and alcohol is implicated in 67% of all murders.

Domestic Violence and Effects on Family.

Domestic violence is a common consequence of alcohol abuse. Research suggests that for women, the most serious risk factor for injury from domestic violence may be a history of alcohol abuse in her male partner. Alcoholism in parents also increases the risk for violent behavior and abuse toward their children. Children of alcoholics tend to do worse academically than others, have a higher incidence of depression, anxiety, and stress and lower self-esteem than their peers. One study found that children who were diagnosed with major depression between the ages of six and 12 were more likely to have alcoholic parents or relatives than were children who were not depressed. Alcoholic households are less cohesive, have more conflicts, and their members are less independent and expressive than households with nonalcoholic or recovering alcoholic parents. In addition to their own inherited risk for later alcoholism, one study found that 41% of children of alcoholics have serious coping problems that may be life long. Adult children of alcoholic parents are at higher risk for divorced and for psychiatric symptoms. One study concluded that the only events with greater psychological impact on children are sexual and physical abuse.

Medical Problems.

Alcohol can affect the body in so many ways that researchers are having a hard time determining exactly what the consequences are of drinking. It is well known, however, that chronic consumption leads to many problems, some of them deadly. Heart Disease. Large doses of alcohol can trigger irregular heartbeats and raise blood pressure even in people with no history of heart disease. A major study found that those who consumed more than three alcoholic drinks a day had higher blood pressure than teetotalers. The more alcohol someone drank, the greater the increase in blood pressure. People who were binge drinkers had the highest blood pressures. One study found that binge drinkers (people who have nine or more drinks once or twice a week) had a risk for a cardiac emergency that was two and a half times that of nondrinkers. Chronic alcohol abuse can also damage the heart muscle, which leads to heart failure; women are particularly vulnerable to this disorder. Contrary to many previous reports, a recent study suggested that moderate to heaving drinking (more than two bottles of beer or two glasses of wine day) was a greater risk factor for coronary artery disease than smoking. As in other studies, light drinking (two to six drinks a week) was protective. More research is needed to confirm or refute this new study. In any case, moderate drinking does not appear to offer any heart benefits for people who are at low risk for heart disease to begin with.
Cancer. Alcohol may not cause cancer, but it probably does increase the carcinogenic effects of other substances, such as cigarette smoke. Daily drinking increases the risk for lung, esophageal, gastric, pancreatic, colorectal, urinary tract, liver, and brain cancers, lymphoma and leukemia. About 75% of cancers of the esophagus and 50% of cancers of the mouth, throat, and larynx are attributed to alcoholism. (Wine appears to pose less danger for these cancers than beer or hard liquor.) Smoking combined with drinking enhances risks for most of these cancers dramatically. When women consume as little as one drink a day, they may increase their chances of breast cancer by as much as 30%.
Liver Disorders. The liver is particularly endangered by alcoholism. About 10% to 35% of heavy drinkers develop alcoholic hepatitis, and 10% to 20% develop cirrhosis. In the liver, alcohol converts to an even more toxic substance, acetaldehyde, which can cause substantial damage. Not eating when drinking and consuming a variety of alcoholic beverages are also factors that increase the risk for liver damage. People with alcoholism are also at higher risk for hepatitis B and C, potentially chronic liver diseases than can lead to cirrhosis and liver cancer. 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. [See also Well-Connected, Report #59, Hepatitis.]
Gastrointestinal Problems. Alcohol can cause diarrhea and hemorrhoids. Alcohol can also contribute to serious infections of the pancreas and to ulcers in people taking the painkillers known as nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen).
Pneumonia and Other Infections. Alcohol suppresses the immune system, so people with alcoholism are prone to infections. In particularly, acute alcoholism is strongly associated with very serious pneumonia. One study on laboratory animals suggests that alcohol specifically damages the bacteria-fighting capability of lung cells.
Mental and Neurologic Disorders. Alcohol has widespread effects on the brain. One study that scanned the brains of inebriated subjects suggested that while alcohol stimulates those parts of the brain related to reward and induces euphoria, it does not appear to impair cognitive performance (the ability to think and reason). Habitual use of alcohol, however, eventually produces depression and confusion. In chronic cases, gray matter is destroyed, possibly leading to psychosis and mental disturbances. Alcohol can also cause milder neurologic problems, including insomnia and headache (especially after drinking red wine). Except in severe cases, neurologic damage is not permanent and abstinence nearly always leads to recovery of normal mental function. Alcohol may increase the risk for hemorrhagic stroke (caused by bleeding in the brain), although it may protect against stroke caused by narrowed arteries.
Skin, Muscle, and Bone Disorders. Severe alcoholism is associated with osteoporosis, wasting away of muscles with swelling and pain, skin sores, and itching. In addition, alcohol-dependent women seem to face an increased risk for damage to muscles, including muscles of the heart, from the toxic effects of alcohol.
Hormonal Effects. Alcoholism increases levels of the female hormone estrogen and reduces levels of the male hormone testosterone, factors that contribute to impotence in men.
Smoking. Alcoholics who smoke face 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 more directly tied to excessive drinking.
Diabetes. 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 particularly hazardous condition.
Malnutrition and Wernicke-Korsakoff Syndrome. A pint of whiskey provides about half the daily calories needed by an adult, but it has no nutritional value. In addition to replacing food, alcohol may also interfere with absorption of proteins, vitamins, and other nutrients. Of particular concern in alcoholism is a severe deficiency in the B-vitamin thiamin, which can cause a serious condition called Wernicke-Korsakoff syndrome. Symptoms of this syndrome include severe loss of balance, confusion, and memory loss. Eventually, it can result in permanent brain damage and death. Another serious nutritional problem among alcoholics is deficiency of the B vitamin folic acid, which can cause severe anemia.
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 is can by caused by many of the medical conditions common in chronic alcoholism, including severe infection, trauma, blood transfusions, pneumonia, and other serious lung conditions.
Drug Interactions. The effects of many medications are strengthened by alcohol, while others are inhibited. Of particular importance is its reinforcing effect on antianxiety 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 including ibuprofen and naproxen. In other words, taking almost any medication should preclude drinking alcohol.

Pregnancy and Infant Development.

Even moderate amounts of alcohol may have damaging effects on the developing fetus, including low birth weight and an increased risk for miscarriage. High amounts can cause fetal alcohol syndrome, which can result in mental and growth retardation. One study indicates a significantly higher risk for leukemia in infants of women who drink any type of alcohol during pregnancy.

Complications in Older People.

As people age, it takes fewer drinks to become intoxicated, and organs can be damaged by smaller amounts of alcohol than in younger people. Also, up to one-half of the 100 most prescribed drugs for older people react adversely with alcohol.

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