Dr. Himabrata Das explains the menace of alcohol related disorders and the way out 

In this article the topic of Alcohol has been discussed. We will talk about other substance abuses in the following articles.

Alcohol – The use of alcohol as a product of fermenting fruits or grape have been documented in various civilization. The increased use of alcohol was identified as a public health concern for the first time during industrial revolution. Subsequent attempt at prohibition failed as alcohol has become deeply ingrained in most society. Alcohol related disorder is a major cause of morbidity and premature mortality and it is associated with enhanced risk for serious medical and psychiatry disorders.

Effects of alcohol –   Ethanol rapidly enters the bloodstream via the proximal small intestine and distribute throughout the body because of its water solubility. A standard alcoholic drink contains 10 –12 grams of ethanol which is roughly the amount in 12 oz of beer, 5oz of table wine and about 1.5oz of proof spirit. Wine, beer and distilled spirit have differing concentration of alcohol – 3.6% for beer, 12% for wine and 40% for spirit. For an average 70kg person, one standard drink increases the blood alcohol level by 15- 20 mg/dl. Faster absorption of alcohol occurs on an empty stomach or if alcohol is taken as a carbonated beverage.

Pharmacology – Alcohol is a depressant which induces sleep and decreases neuronal activity by its action on the GABA. Alcohol also increases dopamine or serotonin, these chemicals being responsible for both intoxication and craving.

Tolerance – With repeated administration, larger doses of alcohol are required to produce the same effect. Cross tolerance means the development of tolerance towards other depressive such as benzodiazepines. Alcohol is associated with memory impairment, gait disturbance (unsteadiness), restlessness and degeneration of cerebellum. Alcohol is also associated with chemical neuropathy, GI problems related to liver and pancrease, cardiovascular problem and also different types of cancer. Alcohol consumption by pregnant mother has harmful effect on the fetus. After birth, these infants are at a greater risk of developing congenital abnormalities, low birth weight and low intelligence.

Alcohol intoxication – It follows decent ingestion of ethanol and is associated with impairment in mental function. Blood level of 20-30 mg/dl is associated with slowing of motor performance whereas blood level between 80–200 mg/dl is associated with severe incordination and greater cognitive decline. Blood level of 200-300 mg/dl produce severe slurring of speech and memory impairment. Blood level more than 400 mg/dl are associated with respiratory failure and death.

Alcohol withdrawal – Alcohol withdrawal is produced by a rapid decrease in blood alcohol level. The symptoms of withdrawal are primarily opposite to those of intoxication. These include coarse tremor, insomnia, anxiety, increased heart rate and blood pressure. These symptoms usually begin within 8 hours of abstinence and peak on the 2nd or 3rd day. In severe alcohol withdrawal, there is severe cognitive impairment characterized by altered sensorium and is associated with increased mortality.

Alcohol induced psychiatry disorder – includes anxiety, depression and psychosis. Alcohol induced persistence memory disturbances and alcohol induced persistence dementia are dreaded long term side effects.

Identification in clinical settings is done by obtaining history, asking specific sets of questions and also by performing specific laboratory investigations. Both medical and psychiatric co-morbidities are identified during initial evaluation.

Treatment – There are three basic principles of treatment which includes motivation enhancement, restructuring lifestyle, minimizing relapse.

Detoxification involves managing withdrawal symptoms once the patient stops drinking. Supportive measures such as rest, nutrition, supplementation of vitamins including thiamine also characterized the process of detoxification. Different medications are tried for relieving of withdrawal symptoms.

Rehabilitation – Rehabilitation involves interventions in both indoor and outdoor settings. The intensive phase last 2 – 4 weeks which is followed by 3- 6 months of less frequent out patient basis. The first step involves counselling with aims to educate the patient about the adverse effect of alcohol. The patient is offered help to cope up with the disturbances in his life. Many patients benefit from group therapy. Relapse prevention is achieved by giving more attention to the fact that the person does not start drinking anymore. An important aspect of recovery is the active  involvement of family members. Many patients benefit from self help group like alcoholic anonymous.

In conclusion, alcohol used disorders is a major public health hazards with dire implication on the individual, community and also the society. The combination of medical and psychological interventions promises to the clients suffering from these conditions and also their victimized families.

( Substance abuse disorders constitute a major cause of both medical as well as psychiatric morbidity and mortality in our community. Different categories of substance abuse have been recognized in medical literature, each having a unique neurobiological basis and presentation. The current article highlights the key features of alcohol use disorders.)