Why do we get drunk? Philosophers and psychologists may debate a dozen rival theories but the literal answer lies in the way a molecule affects the human brain. Ethanol, the most popular form of alcohol, is both water and fat soluble and when we consume it, is rapidly transmitted to multiple organs. In the brain, [...]

The Sundaytimes Sri Lanka

‘Tis the season for high spirits, so take note!

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Why do we get drunk? Philosophers and psychologists may debate a dozen rival theories but the literal answer lies in the way a molecule affects the human brain. Ethanol, the most popular form of alcohol, is both water and fat soluble and when we consume it, is rapidly transmitted to multiple organs.

In the brain, ethanol molecules actively interfere with your brain’s neural circuitry, disrupting the flow of signals and leading to all those symptoms we know so well: from slurred speech to an unbalanced gait. When the consumption of alcohol turns to alcoholism, severe consequences can result.

Few diseases rival the toll that alcoholism takes not just on your health, but on your personal and professional life. This week, Dr.Sanjeewa Aryasingha, Consultant Gastroenterologist and Hepatologist, gives us insight into a possibly fatal disease. Here are 7 things you should know about alcoholism.

Drinking problems cover a spectrum: You may be a binge drinker who downs five or more drinks in a row or you could be someone who abuses alcohol, continuing to drink even when you know the process is wreaking havoc on your professional and personal life. In the most serious manifestation, you could be alcohol dependent and always be craving your next fix. Alcoholism is a progressive disease and so symptoms may appear and worsen gradually.

Dr. Aryasingha has found his patients respond differently as well – some are abject and apologetic, weighed down by guilt over their inability to control their problem. For others accepting they have a problem is itself the first challenge and cause for denial.

Alcoholism has many different causes: Genetic, psychological, environmental and social factors determine the effect alcohol has on your body and behaviour. For instance, research has shown that people who begin drinking at an earlier age are at higher risk of becoming alcoholics. Studies have found that over time, alcoholism can fundamentally alter the way your brain perceives pleasure and exercises control over behaviour, creating a vicious cycle.

Alcoholism affects multiple organs and shortens life-spans: We’re used to thinking of alcoholism taking a toll on the liver and it’s true the liver is affected in several ways says Dr. Aryasinghe. The condition known as fatty liver can progress until it becomes cirrhosis, an advanced liver disease associated with a loss of liver function and liver failure. Alcoholism can also affect the nervous system so that patients complain of numbness in their hands and feet and unsteady gait. Some areas of the brain have also been observed to atrophy or degenerate.

Alcoholism is also known to affect the heart, leading to disorders in the heart rhythm, the risk of an enlarged heart and even heart attacks. Blood pressure can rise and patients who binge risk sudden cardiac death. In the gastro-intestinal system, damage takes the form of ulcers in the stomach, inflammation of the stomach lining, gastritis, acute pancreatitis and has been associated with chronic diarrhoea as well as stomach and oesophageal cancers. Even the blood is not spared – alcoholics can become anaemic, as haemoglobin levels tend to drop. It has been known to cause erectile dysfunction in men and interrupt menstruation in women. Eye problems, bone loss and birth defects too have been linked to alcoholism.

Your tolerance will increase, forcing you to drink more and more to get high: Alcohol is a toxic substance to the body and the body gets rid of it by metabolizing it in the liver, explains Dr. Aryasinghe. The condition known as metabolic tolerance is triggered when the liver begins producing more and more of the enzymes that break down alcohol. This means, the drinker needs to drink ever larger amounts to feel the same results.

Withdrawal symptoms can make quitting hard: Heavy drinkers who decide to quit abruptly, may find it much harder than they expected. Withdrawal symptoms can range from mild to severe and some can even be life threatening, says Dr. Aryasinghe. The onset of withdrawal symptoms bring with them an intense craving for alcohol. The most common symptom is a feeling of shakiness as well as bouts of heavy sweating. Nausea, headache, anxiety accompanied by a rapid heartbeat and increased blood pressure often manifest. Some patients have fits and report hallucinations, often within six to 48 hours of abstinence (many say they feel that ants or some other small insects are climbing all over them.)

It is critical to have medical supervision through this process as symptoms may progress to the state known as delirium tremens (DTs) after a few days without alcohol. These are associated with profound confusion, disorientation, hallucinations, hyperactivity and cardiovascular dysfunction. Strokes or heart attacks during this period are likely and can prove fatal.

Good treatment options exist: Doctors can prescribe medications that convert the taste of alcohol from something wonderful to something revolting, even nausea inducing. Other drugs can be prescribed to help mitigate the craving for a drink. In less severe cases, simple strategies can be employed. If a patient consumes heavy liquor only, he or she could convert to drinking only beer and wine and then be gradually weaned of alcohol. Giving up alcohol is a battle that may need to be fought more than once in a lifetime, as many who quit can also relapse. It’s worth making a support plan and continuing to seek expert help over the long term.

You may need a psychiatrist’s help: If you’re really serious about wanting to quit but are struggling to do so, you should consider seeking the help of a psychiatrist. Dr. Aryasinghe often questions patients to ascertain how keen they are to change. Especially those who are alcohol dependent may find it all but impossible to quit on their own and may require expert assistance.

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