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What happens when you drink

Dr. Satparkash

It all depends on what you mean by 'a drink'. A small amount of alcohol does you no harm and can be enjoyable. But if it is more than a small amount and if it is a regular thing, may be it is not quite as harmless as you think. Drinking too much alcohol or even drinking a little at the wrong time can cause serious damage to your health, to your family and to your self-esteem, not to mention your pocket. Whenever you drink you are affected. But if you only drink a little and if you don't drink very frequently, the risks are very small. However, the more you drink and the more frequently you drink, the risks become higher.

If you have to know the amount of alcohol that you consume in a day or a week you have to have some idea about the amount of alcohol in your drink. The beers and lagers that are usually available in Bangladesh contain about 3 to 6 percent alcohol content by volume, which can be about 3-5 units of alcohol per bottle. The wines that are available contain 11-16 percent alcohol content by volume, having about 11-13 units of alcohol per bottle. The spirits that commonly contain about 40 percent alcohol content by volume, and its approximate availability of alcohol is 30 units per bottle. Home measures are often much more generous than the club measures and you need to look carefully at how much you drink in your glass.

Women who consume more than 14 units and men who take more than 21 units of alcohol in a week are likely to enter the zone of risk for ill-health. If the consumption goes beyond 35 units for a woman and 50 units for a man it is definitely considered harmful. Alcohol is distributed throughout the body fluids in people, and in men the alcohol is 'diluted' because they have a larger amount of fluids than women.

You would be surprised to know how wrong you can be, if you take a guess on how much you drink. If you have to know how much you drink quite accurately, you have to fill in a 'drinking diary' for a week, every day.

On an average, it takes one hour for the body to get rid of the alcohol in one unit. Some of the early signs of problem drinking are 'tolerance' (increasing level of alcohol is needed to achieve the same effect or same amount of alcohol gives decreasing effect), drinking more alcohol for longer periods, presence of withdrawal symptoms (use of similar substances as a substitute to avoid withdrawal symptoms), spending a great deal of time and effort to obtain alcohol, persistent desire and unsuccessful attempts to curb abuse, avoiding important social, occupational, or recreational events because of alcohol use, and continued use of alcohol despite exacerbation of health problems.

What happens when you drink?
The outer, convoluted layer of brain tissue, called the cerebral cortex or the gray matter, controls most complex mental activities (see figure). Just beneath it are the nerve fibres, called the white matter, that connect different cortical regions and link cortical cells with other structures deep inside the brain (subcortical regions).

The Schematic drawing below of the human brain, showing regions vulnerable to alcoholismrelated abnormalities.

Areas of the brain that are especially vulnerable to alcoholism--related damage are the cerebral cortex and subcortical areas such as the limbic system (important for feeling and expressing emotions), the thalamus (important for communication within the brain), the hypothalamus (which releases hormones in response to stress and other stimuli and is involved in basic behavioral and physiological functions), and the basal forebrain (the lower area of the front part of the brain, involved in learning and memory). Another brain structure that has recently been implicated is the cerebellum, situated at the base of the brain, which plays a role in posture and motor coordination and in learning simple tasks.

People who abuse alcohol tend to develop chronic fatigue, poor nutritional status, poor appetite, sleep disturbance, fits, and failure to fulfil major obligations at work and home. They may also have interpersonal problems, recurrent legal problems, accidents and suicide attempts, and abuse alcohol during work. Alcohol abuse every day at higher levels is likely to cause damage to various organs in the body, while intermittent abuse of alcohol at higher levels results in dangerous and destructive behaviour.

Alcohol affects many organs in the body. The brunt of the damage is however borne by the brain, liver, heart and gastro-intestinal system. It causes an array of illnesses related to these organs, often requiring help from different specialists simultaneously. When alcohol is withdrawn, it results in a period of hyper-excitability, the severity and duration of which varies from person to person. During the initial stages of treatment for alcoholism, your doctors are generally controlling your withdrawal symptoms and taking care of the medical damages to your body. This stage is difficult and has high risk. Hence, most alcoholics are admitted for a brief period in the hospital during this stage. The long-term treatment for alcoholism starts after the initial stage is successfully completed. This stage is prolonged and lasts about a year. Most alcoholics are treated as outpatients during this phase. Many strategies of treatment have to be evaluated before the most suitable strategy is identified for the individual's requirements. During this stage, the success of the treatment often depends on the extent of support from the family to assist your doctor in maintaining your abstinence. A vast majority of the alcoholics who relapse after detoxification, start drinking again before six months are over. A lesser number of people relapse during the second six months. Very few, who have been abstinent during the entire year, relapse after the year is over.

Disulfuram is a medicine, which is sometimes used to help stop your drinking. This medicine produces a sensitivity to alcohol that results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol. Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism, after Disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone.

Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to as the Disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both Disulfiram and alcohol, will persist as long as alcohol is being metabolised. Disulfiram does not appear to influence the rate of alcohol elimination from the body.

Disulfiram plus even small amounts of alcohol produces flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions, there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The intensity of the reaction may vary with each individual but is generally proportional to the amount of disulfiram and alcohol ingested. In the sensitive individual, mild reactions may occur when the blood alcohol concentration is increased to as little as 5 to 10 mg/100 mL. At a concentration of 50 mg/100 mL symptoms are usually fully developed, and when the concentration reaches 125 to 150 mg/100 mL unconsciousness may occur.

The duration of the reaction is variable, from 30 to 60 minutes in mild cases, up to several hours in more severe cases or as long as there is alcohol remaining in the blood. Disulfiram is slowly absorbed from the gastrointestinal tract and is slowly eliminated from the body. Ingestion of alcohol may produce unpleasant symptoms 1 or even 2 weeks after a patient has taken his last dose of disulfiram.

Prolonged administration of disulfiram does not produce tolerance. The longer a patient remains on therapy the more sensitive he becomes to alcohol.

Used alone, without proper motivation and without supportive therapy, disulfiram is not a cure for alcoholism, and it is unlikely that it will have more than a brief effect on the drinking pattern of the chronic alcoholic. However, as an aid in the management of selected chronic alcoholic patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage, Disulfiram has a valuable role to play.

Disulfiram implant, which appears to give effective blood levels for twelve weeks on an average. It is usually inserted under local anaesthetic after detoxification is over and 2 3 doses of the oral Disulfiram have been given. It is inserted through a 1 cm incision in the lower abdomen or at the back of the upper arm. The implant is inserted 3-4mm under the skin.

*Makes relapse almost impossible while the implant is effective
*Avoids the need to supervise Disulfiram and the arguments it can cause.
*Makes it impossible to 'forget' to take Disulfiram
*Reduces craving even more than oral Disulfiram because there is no point in craving for what you can't have

*Involves (minor) surgery and a small scar with temporary tenderness and bruising
*Occasional local infection or inflammation of implant site, usually responding to antibiotics.
*Initially more expensive than oral Disulfiram.
*Risk of turning to other drugs as a substitute. (Applies as much to oral Disulfiram)

The writer is the Consultant of Prottoy Medical Clinic Ltd. Gulshan, Dhaka.

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