Alcohol: Complications of Problem Drinking

Alcohol is a legal drug for adults over 21 years of age. Yet drinking large amounts of alcohol over long periods can cause many medical complications. There is almost no organ system that alcohol does not damage. Alcohol affects how cells function throughout the body and the brain. Some effects of alcohol occur immediately, while others occur only after many years of heavy drinking.

The Liver

The liver is the largest internal organ of the human body and its functions are essential to life. The human liver has a remarkable resilience and capacity to recover after injury or illness. But this is true only up to a certain point. If illness pushes a person's liver beyond its ability to perform, she or he will die.

The liver performs many complex functions and is justly called the laboratory of the human body. Its most important functions include: (1) helping process and store nutrients, including fats, sugars, proteins, and vitamins; (2) producing substances necessary for blood clotting and healthy immune function; (3) filtering and cleansing the blood of various substances that are poisonous if allowed to accumulate; and (4) providing quick bursts of energy when needed. Many diseases can seriously damage the liver and interfere with its important functions. Taken in large quantities over a long period of time, alcohol can be directly poisonous to liver cells. Alcoholism is one of the most serious ways in which permanent liver damage can occur.

The number of deaths from liver damage caused by alcoholism is very high. Chronic heavy drinking can damage the liver in several ways:

Alcoholic Fatty Liver. Fat accumulation in the liver occurs in the majority of heavy drinkers. The liver cells become loaded with bubbles of fat. This condition may present no symptoms, but in an examination of the abdomen, a doctor may notice that the liver is enlarged. A biopsy reveals the presence of fat in the liver cells. In most cases, a fatty liver does not affect the patient's health. However, it is an early warning of further liver damage if the person continues to drink. This condition can be reversed if the patient stops drinking.

Alcoholic Hepatitis. The word "hepatitis" means liver inflammation, or swelling. While hepatitis can be due to an infection (such as hepatitis A, hepatitis B, and hepatitis C), it can also occur when the liver becomes inflamed due to damage from alcohol. Alcoholic hepatitis is a potentially more serious form of alcoholic liver disease, in which there is an accumulation of white blood cells and the death of some liver cells. The liver becomes less able to cleanse the blood of toxins. Some patients with alcoholic hepatitis experience no symptoms. Others may have a swollen and painful liver, fever, and mental disturbance. People with alcoholic hepatitis often become jaundiced; that is, the whites of their eyes and their skin become yellow, due to bile leaking into the bloodstream. Repeated episodes of drinking and alcoholic hepatitis can lead to the last stage of alcoholic liver disease—cirrhosis.

Alcoholic Cirrhosis. Once a liver becomes cirrhotic, the liver cannot become normal again. Damaged liver tissue is replaced by scar tissue that cannot perform any of the liver's normal functions. Scar tissue interferes with blood circulation in the liver and increases the pressure in the blood vessels. Increased blood pressure in these blood vessels makes them prone to bursting, leading to major hemorrhage (uncontrollable bleeding). Cirrhosis can be fatal. Although a number of other conditions can also cause cirrhosis, alcoholism is by far its most common cause.

Mental Disorders

In addition to its effects on the body, heavy drinking can also have negative effects on a person's mental health. Alcoholism is associated with several mental disorders.

1. People with antisocial personality disorder (APD) often have problems with alcoholism as well. In fact, alcoholics are 21 times as likely to also fulfill the criteria for diagnosing antisocial personality disorder. People with APD often disregard and repeatedly violate the rights of others. A person with APD may engage in bullying, violence, vandalism, and lying, and show no remorse for these actions. As much as 2 percent of the male population of the United States are diagnosed as having both APD and alcoholism. Antisocial alcoholics generally begin problem drinking at an early age, have a family history of alcoholism, and have symptoms of other psychiatric disturbances, such as drug abuse, depression, and suicide attempts.
2. Alcoholism is sometimes linked to depression . Heavy drinkers are more likely to suffer from depression than are people who do not abuse alcohol. The relationship between alcohol use and depression is complex. Like the old question, "Which came first, the chicken or the egg?," experts continue to explore whether using alcohol can cause or increase feelings of depression, or whether a person with depression drinks alcohol to relieve symptoms of depression he or she is already experiencing. (The use of alcohol to try to get rid of troublesome symptoms is sometimes referred to as self-medication.)
3. Alcohol has long been used to relieve anxiety, a feeling of nervousness and fear that strikes nearly everyone at various times in their lives. Some individuals are diagnosed with anxiety disorders, which include generalized anxiety disorder, panic disorder, and phobias. For these people, anxiety overwhelms their ability to function normally. They may feel that alcohol provides temporary relief from some of their symptoms. Alcohol, however, can in fact contribute to anxiety disorders. Many individuals with these anxiety disorders are also alcoholics. Unfortunately, while alcohol may relieve symptoms of anxiety in some people and at some times, it also can greatly increase the symptoms of anxiety, particularly during the period when the effects of the alcohol are beginning to wear off.
4. Adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) have higher rates of drug abuse and alcoholism. Again, researchers are unclear why this is the case. Do some people have differences in brain chemistry that cause them to have symptoms of both ADHD and substance abuse? Or do people with ADHD use alcohol to self-medicate, that is, to relieve some of the symptoms of ADHD?
5. Alcohol is involved in at least 50 percent of completed suicides (i.e., suicide attempts that actually result in death). Studies of completed suicides show that, prior to the suicide, some people may have confused and conflicted feelings about going through with the act. Alcohol or substance abuse may become the weight that tips the scale toward suicide.
6. Chronic alcoholism can cause delirium and dementia . Abrupt withdrawal from alcohol can cause delirium tremens. When someone drinks alcohol regularly, for a long time, it begins to destroy brain cells. If the liver also becomes damaged and unable to remove certain poisons from the bloodstream, these poisons may circulate into the brain, further damaging it. Delirium is an on-again-off-again condition in which a person is confused, forgetful, and "out of it." Dementia is a permanent condition in which an individual no longer has good

   DIRECT AND INDIRECT HEALTH COMPLICATIONS DUE TO ALCOHOL
   Primary Causes of Deaths Directly Due to Alcohol
   Brain diseases (alcoholic psychoses, alcoholic polyneuropathy)	388
   Alcoholism (alcohol dependence syndrome and nondependent abuse of alcohol)	6,005
   Heart disease (alcoholic cardiomyopathy)	878
   Stomach inflammation (alcoholic gastritis)	90
   Liver scarring (alcoholic cirrhosis)	11,868
   Alcohol poisoning (excessive blood level of alcohol, accidental poisoning)	213
   Total	19,442
   Secondary Causes of Death Directly Due to Alcohol
   Lung diseases (respiratory tuberculosis, pneumonia and influenza)	4,022
   Cancers (malignant neoplasm of lip, cavity, pharynx, esophagus, stomach, and/or liver)	17,411
   Heart disease (cerebrovascular disease, hypertension)	10,401
   Diabetes mellitus	2,423
   Liver diseases (chronic hepatitis, cirrhosis of liver, biliary cirrhosis, chronic liver damage, and portal hypertension)	6,387
   Diseases of esophagus, stomach, and duodenum	892
   Diseases of the pancreas (acute pancreatitis, chronic pancreatitis)	1,033
   Total	42,569
   Combined Total	62,011
   source: Analysis by The Lewin Group based on data from the National Institute on Alcohol Abuse and Alcoholism.
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   control over his or her behavior, thoughts, and ability to remember, understand, and learn. Delirium tremens is a condition that occurs specifically around the time that someone stops using alcohol. Because the person's brain has become dependent on the presence of alcohol in order to function, abruptly cutting off the presence of alcohol can make the individual temporarily confused, agitated, and shaky.

The Central Nervous System

Alcohol is a depressant of the central nervous system, which is made up of the brain and spinal cord. Because of these depressant effects, a blood alcohol concentration (BAC) above the legal limit (for adults over 21, in most states, the limit is 0.08 grams of alcohol per deciliter of blood) typically impairs a person's ability to drive and operate machinery. Even relatively low BACs can affect hand-eye coordination, selective attention (for example, concentrating on making a turn rather than watching other cars speed by), and decision making. Intoxication can increase risk-taking, aggressive, or dangerous behaviors because of a loosening of inhibitions. As the amount the person drinks increases, he or she loses the ability to evaluate the consequences of his or her actions. As a result, intoxication is frequently associated with severe injuries, including traumatic brain injuries, and is a common cause of fatal motor vehicle accidents and violent incidents.

A binge of heavy drinking can lead to memory lapses or alcoholic blackouts, in which the individual is unable to remember events that took place while he or she was drunk. Drinking below the legal limit of intoxication can also affect a person's ability to remember new information. Studies of the brain structures of chronic alcoholics reveal an atrophy of the cortex and low brain weight. Some studies even show loss of cerebral tissue in moderate drinkers.

The Cardiovascular System

Alcoholism can cause serious damage to the heart muscle. Alcoholics who have a history of heart problems often have high blood pressure and arrythmias (abnormal heart rhythms). In alcoholics who have had at least one episode of heart failure, alcohol can lead to further heart failure. The symptoms of heart failure—such as weakness, fatigue, blood clots, and abnormal heartbeat—generally disappear if the person stops drinking. Even small amounts of alcohol affect the cardiovascular system. When nonalcoholics drink alcohol, the alcohol causes the heart to pump less blood per contraction. This is one of alcohol's depressant effects.

The Endocrine and Reproductive System

The body communicates with itself through two different systems: the nervous system and the endocrine system. The nervous system handles communications that are important for thinking and for controlling the immediate actions of our muscles. The nervous system communicates directly to the target cells through nerve cells. In contrast, the endocrine system uses chemical messengers called hormones. Hormones flow in the bloodstream to handle more long-term communications, such as controlling growth and sexual differences. Examples of hormones are insulin, estrogen, and testosterone.

Research has shown that alcohol causes problems in hormonal function in chronic heavy drinkers. Chronic heavy drinking prevents the release of hormones necessary for sexual functioning. Male alcoholics commonly experience impotence, a decrease in sperm count or complete absence of sperm, infertility, and decreased sex drive. In young females, alcohol abuse can cause amenorrhea (absence of menstruation) and can prevent ovulation. Women who drink heavily for many years may experience early menopause. During pregnancy, alcoholism increases the risk of spontaneous abortion (miscarriage). Babies born to alcoholic mothers may have fetal alcohol syndrome (FAS), a condition in which children have facial abnormalities and problems with growth and development. Alcohol's suppression of the sex hormone progesterone may be related to the development of FAS.

The Immune System

Alcohol can interfere with the functioning of the body's immune system, the system that fights off infection. Chronic drinking decreases the body's resistance to infections, particularly those caused by bacteria. For example, alcoholics are at increased risk of pockets of infection in the lungs (known as abscesses), tuberculosis, and infections of the lining of the abdomen (called peritonitis).

Increasing evidence suggests that chronic drinking not only damages the body's defenses against bacteria but also against cancer cells. A strong association exists between alcohol use and cancers of the esophagus, pharynx (in the throat), and mouth. Chronic heavy drinkers have more cases of esophageal cancer than the general population. The risk increases as alcohol consumption increases. There is no evidence that alcohol itself is a carcinogen, that is, a cancer-causing substance. However, alcohol appears to increase the carcinogenic effects of other chemicals, such as those in tobacco. The cancers with which alcohol is most closely associated are also cancers associated with smoking. This relationship suggests that alcohol enhances the carcinogenic effects of smoking.

Nutrition

The body needs energy for its actions, protein to build and maintain cells, and a variety of micronutrients to support function. People who drink heavily often eat less than is necessary for health. Some heavy drinkers take in as much as 50 percent of their daily calorie needs as alcohol. As a result, they do not consume enough essential nutrients, protein, carbohydrate, and fat. Their bodies are deprived of the energy intake and materials needed to build tissues.

Alcohol interferes with nutrition by affecting digestion and the way the body uses, stores, and excretes nutrients. Alcohol prevents nutrients from breaking down into substances the body can use. It also slows the absorption of nutrients by damaging cells in the stomach and intestines, and interferes with the transport of some micronutrients into the blood from digested foods.

Alcohol also affects blood sugar levels. An undernourished person who drinks alcohol can develop hypoglycemia. Hypoglycemia, or decreased blood sugar, can cause serious injury even if it is only temporary. When there is no food to supply energy, the sugar that is stored in the body decreases. As a result, the brain and other organs do not get the amounts of glucose (sugar) needed for energy and proper functioning.

Chronic heavy drinking causes deficiencies—inadequate amounts— of vitamins A, E, and D. Vitamin D deficiency can cause bone loss; vitamin A deficiency can cause night blindness; deficiencies of vitamins A, C, D, E, K, and B can interfere with wound healing and cell functions. Deficiencies of various vitamins can cause damage to the brain and nervous system.

The Health Risks of Drinking Alcohol

Many people have a casual attitude toward drinking, but it is important to understand the real health and safety risks that alcohol presents. Small amounts of alcohol can temporarily affect normal functioning in body and brain. Heavy drinking can have serious, permanent consequences. Understanding that alcohol can have both short- and long-term health effects can help people make informed choices about their drinking habits.

see also Accidents and Injuries from Alcohol; Alcohol: Chemistry; Alcohol: Poisoning; Alcohol: Psychological Consequences of Chronic Abuse.