A colourless liquid, also called ethanol or ethyl alcohol, produced by the fermentation of carbohydrates by yeast. Medically, alcohol is used as a solvent and an antiseptic; recreationally it is a widely used drug, taken in alcoholic drinks to give a pleasant taste as well as to relax, reduce inhibitions, and increase sociability. Taken to excess, alcohol causes much mental and physical harm – not just to the individual imbibing it, but often to their family, friends, community and work colleagues.
Alcohol depresses the central nervous system and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person's reflexes and concentration, potentially dangerous effects when, for example, driving or operating machinery. Drunkenness causes slurred speech, muddled thinking, amnesia (memory loss), drowsiness, erectile IMPOTENCE, poor coordination and dulled reactions. Disinhibition may lead to extreme euphoria, irritability, misery or aggression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to COMA and respiratory failure.
Persistent alcohol misuse leads to physical, mental, social and occupational problems, as well as to a risk of DEPENDENCE. Misuse may follow several patterns: regular but controlled heavy intake, ‘binge’ drinking, and dependence (alcoholism). The first pattern may lead to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease and impotence. The second is most common among young men and usually leads to mainly social and occupational problems – getting into fights, jeopardising personal relationships, overspending on alcohol at weekends, and missing days off work because of hangovers. The third pattern – alcohol dependence – is the most serious, and can severely disrupt health and social stability.
Many researchers consider alcohol dependence to be an illness with a genetic component probably passed on as a vulnerable personality but it is hard to disentangle genetic, environmental and social factors. In the UK there are estimated to be around a million people suffering from alcohol dependence and a similar number who have difficulty controlling their consumption (together about 1:30 of the population).
Alcohol use produces tolerance (that is, regular use results in needing greater quantities to gain the same effect) and both physical and psychological dependence (see DEPENDENCE for definitions). Dependent drinkers classically drink early in the morning to relieve overnight withdrawal symptoms such as anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threatening delirium tremens (DTs), with severe tremor, hallucinations (often visual – seeing spiders and monsters, rather than the pink elephants of romantic myth), and CONVULSIONS. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe INCOORDINATION and double-vision, can occur in WERNICKE'S ENCEPHALOPATHY, a serious neurological condition due to lack of the B vitamin thiamine (whose absorption from the stomach is markedly reduced by alcohol). If not treated urgently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsakoff's psychosis, with severe amnesia. Finally, prolonged alcohol misuse can cause a form of dementia.
In addition to these severe neurological disorders, the wide range of life-threatening problems caused by heavy drinking includes HEPATITIS, liver CIRRHOSIS, pancreatitis (see PANCREAS, DISORDERS OF), gastrointestinal haemorrhage, suicide and FETAL ALCOHOL SYNDROME; pregnant women should probably not drink alcohol, but there is some uncertainty as to whether small amounts are harmless. The social effects of alcohol misuse – such as marital breakdown, family violence and severe debt – can be equally devastating.
In 2011, there were 1.2 million admissions to English hospitals by patients with alcohol-related conditions, of whom 15,000 died. Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are initially managed by doctors who fail to spot, or never ask about, heavy drinking. Secondly, attempts at treating alcohol dependence by detoxification or ‘drying out’ (substituting a tranquillising drug for alcohol and withdrawing it gradually over about a week) are not always followed-up by adequate support at home, so that drinking starts again. Home support by community alcohol teams comprising doctors, nurses, social workers and, when appropriate, probation officers may have better results. Many drinkers find the voluntary organisation Alcoholics Anonymous (AA) and its related groups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from alcohol is encouraged by intensive psychological and social support from fellow ex-drinkers.
Current England & Wales Department of Health guidance is that for the risk of alcohol-related conditions to be low, no more than 14 units should be taken each week. One unit is equivalent to 1 measure of spirits, one glass of wine or ½ pint of beer. One reason for the advice is that the lifetime risk of cancer increases with increased alcohol consumption. For example, women who drink fewer than 14 units have a risk of breast cancer of about 1 in 10. Drinking more than 35 units weekly doubles this risk. There is a similar doubling of risk for bowel cancer in men.
Useful contacts are: Alcoholics Anonymous; Al-Anon Family Groups UK and Eire (including Alateen); Alcohol Concern; Alcohol Focus Scotland; and Alcohol and Substance Misuse.
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