Why drink thyself to death .....

Dr. Mona Nongmeikapam *

What constitutes 'drug abuse' or 'addiction' is a controversial question and has many interpretations as per social, cultural, administrative, legal, political, metaphysical and physiological context. The use of many drugs like opium, cannabis, alcohol or tobacco is an integral part of the daily lives of certain communities. Closer home, many of our womenfolk in certain villages brew alcohol in their own homes and consume it and not even an eyebrow is raised. In many a Hindu festival, the widespread use of 'ganja' is a well-known fact, oft highlighted in many a Bollywood number.

Then in the more modern families, where substance use is considered a lifestyle choice, questions are raised over individual rights and that it cannot be called a problem unless this does not infringe over the rights of others.

Cause

It's not clear why some people abuse alcohol or become addicted to it and others do not. Alcoholism often runs in families (genetic), but your drinking habits also are influenced by your environment and life situations, such as friends or stress levels. One study done in Imphal shows that the prevalence rate of psychiatric co-morbidity in alcohol-dependent subjects to be 92% . The most common disorders were depression, antisocial personality disorder (ASPD) and phobia. So many people do tend to drink to cope or more like, self-medicate themselves for a co-existing psychiatric or personality issue. It is altogether a different issue that drinking may lead to many a psychiatric symptom onprolonged usage. More like a question of what came first: the hen or the egg.........

Symptoms

Signs of alcohol abuse

o You have problems at work, such as being late or not going at all.
o Drinking becomes a priority and everything else takes a back-seat.
o You drink in risky situations, such as before or while driving a car.
o After drinking, you can't remember what happened while you were drinking (blackouts).
o You have legal problems because of your drinking, such as being arrested for harming someone or driving while drunk (intoxicated).
o You get hurt or you hurt someone else when you are drinking.
o You keep drinking even though you have health problems that are caused or made worse by alcohol use, such as liver disease (cirrhosis).
o Your friends or family members are worried about your drinking.

Signs of alcohol dependence or addiction

o You cannot quit drinking or control how much you drink.
o You need to drink more to get the same effect.
o You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety to begin with. Seizures (rum fits) and delirium tremens are more extreme manifestations and even proved fatal.
o You spend a lot of time drinking and recovering.
o You have given up other activities so you can drink.
o You keep drinking even though it harms your relationships and causes health problems.

Other signs include:

o Early morning drinking or 'eye-openers', often drunk for long periods of time, or drinking alone.
o Switching to harder drinks or increasing the quantity to get the 'kick'
o Feeling guilty after drinking.
o Making excuses for your drinking or do things to hide your drinking.
o Physical signs of alcohol dependence, such as weight loss, a sore or upset stomach (gastritis), or redness of the nose and cheeks.

Do you have a drinking problem?

You might not realize that you have a drinking problem. You might not drink large amounts when you drink. Or you might go for days or weeks between drinking episodes (this is called DIPSOMANIA or binge-drinking and by no account, is less injurious). But even if you don't drink very often, it's still possible to be abusing alcohol and to be at risk for becoming addicted to it.

Complications of drinking:

Alcohol is poisonous to many types of human cells. In small quantities it can suppress their activity. In large doses, it can kill them. While most drugs that act on the brain stimulate production of brain hormones like serotonin and dopamine, alcohol actually reduces levels of these chemicals while increasing levels of some others. At higher doses, alcohol is in fact toxic. The main symptoms are vomiting, stupor, behavioural changes, and major impairment of the central nervous system followed by dehydration and a whopping headache. At high doses, alcohol can be fatal by shutting down breathing or stopping the heart.

Even non-lethal doses can kill. Aspiration pneumonia is a condition that occurs when people, sleeping off a very heavy night's drinking, suffocate when their own vomit is inhaled into their lungs. There is a gag reflex that should automatically prevent this, but it can malfunction when the nervous system is depressed.

Anyone who drinks alcohol after going a long time without food can have an attack of hypoglycemia, a sudden shortage of blood sugar, causing nervous symptoms like stupor or abnormal behaviour and, in severe cases, coma or convulsions. If your stomach is empty enough, you could end up in hospital with hypoglycemia despite being under the legal driving limit. This is especially dangerous if you have diabetes and are already taking insulin to lower your blood sugar.

Long-term heavy drinking can cause a range of chronic problems. These include:
o arrhythmias - abnormal heart rhythms that can instantly kill even young people if they are abusing alcohol
o beriberi (vitamin B1 deficiency) - lack of vitamin B1 (thiamine), is common in those dependent on alcohol and can accelerate heart damage and mental degeneration
o brain damage - alcohol kills brain cells
o diabetes
o heart damage (cardiomyopathy) involving changes in the heart's size and structure
o hypertension (high blood pressure)
o liver disease such as cirrhosis
o loss of feeling in hands, feet, and elsewhere due to effects on nervous system
o stomach ulcers and gastritis (inflamed lining of the stomach)
Quite a mouthful, but does not even cover half of the probable medical complications. Added to this long list, are the altered personality and other psychiatric complications that arises out of long term usage and one cannot help wondering, what makes one invite onto oneself such dire consequences?

So before all the festivities intervened, we saw the basic action of alcohol on the human body, its harms, and the difference between social drinking, harmful pattern and alcohol dependence. To rewind slightly, alcohol is a depressant drug that
* slows down the activity of the brain
* contains absolutely no nutrients
* does not help relieve tension, induce sleep or solve problems.

It is a toxic substance that can affect each and every organ of the human body and lead to several medical and psychiatric complications.

All said and done, alcohol consumption has been on the rise, especially in developing countries like ours, with an estimated number of 62.5 million users in our country. India is also considered the third largest market for alcoholic beverages. Changing social norms, urbanization, increased availability, high intensity mass marketing and relaxation of overseas trade rules along with poor level of awareness related to alcohol has contributed to increased alcohol use.

Alcohol dependence is defined as a cluster of physiological, behavioural, and cognitive phenomena in which the use of alcohol takes on a much higher priority for a given individual than other behaviours that previously had greater value. A central characteristic is the desire (often strong, sometimes perceived as overpowering) to drink alcohol. Return to drinking after a period of abstinence is often associated with rapid reappearance of the features of the syndrome (priming).

BRIEF INTERVENTION FOR HARMFUL DRINKING:

The acronym FRAMES captures the essence of the interventions commonly tested under the terms 'brief intervention' and 'motivational interviewing':
o Feedback: about personal risk or impairment
o Responsibility: emphasis on personal responsibility for change
o Advice: to cut down or abstain if indicated because of severe dependence or harm
o Menu: of alternative options for changing drinking pattern and, jointly with the patient, setting a target; intermediate goals of reduction can be a start
o Empathic interviewing: listening reflectively without cajoling or confronting; exploring with patients the reasons for change as they see their situation
o Self efficacy: an interviewing style which enhances peoples' belief in their own ability to change.

MANAGEMENT OF ALCOHOL DEPENDENT SYNDROME:

Absolute indications for abstinence:
o alcohol related organ damage
o severe dependence (eg morning drinking to stop the shakes or previous failed attempts to control drinking)
o significant psychiatric disorders
Relative indications for abstinence:
o epilepsy
o social factors (eg legal, employment, family)

COMMONLY ENCOUNTERED TERMS IN DE-ADDICTION:

Detoxification

Detoxification refers to the planned withdrawal of alcohol. Alcohol withdrawal carries risks and requires careful clinical management. It can be done as an out-patient or in-patient facilities. Hospital detoxification is advised if the patient:
o is confused or has hallucinations
o has a history of previously complicated withdrawal
o has epilepsy or a history of fits
o is undernourished
o has severe vomiting or diarrhea
o is at risk of suicide
o has severe dependence coupled with unwillingness to be seen daily
o has a previously failed home-assisted withdrawal
o has uncontrollable withdrawal symptoms
o has an acute physical or psychiatric illness
o has multiple substance misuse
o has a home environment unsupportive of abstinence.

Benzodiazepines are the commonly preferred line of medication universally for alcohol detoxification. Other supportive therapy, including nutritional deficits, other comorbidities, short-term antipsychotics and epileptics as warranted are used. Management of the acute withdrawal reactions and averting the life-threatening crises is the most crucial part of the treatment.

ANTICRAVING MEDICATION:

Various medications are available in the market, which to some extent allay craving and reduce the urge to use the substance, which is the largest reason for relapse. These medications have their fair share of pros and cons and may be beneficial for specific group of patients. Hence a careful discussion with the treating team and the party before starting medications is essential to ensure compliance and also reduce patient discomfort. A written informed consent is required while using adversive agents like Disulfiram which cause severe discomfort on consumption of alcohol. Many physicians do not favour the usage of these form of therapy, due to possible fatal outcome.

Medications and hospitalisation is definitely not the answer and panacea for this problem. Locking them away in rehabs for months, even a year or more, like miscreants, is not the solution either. Alcohol dependence is mental health issue and a disorder and the sooner this fact is accepted, the better. So along with the drug therapy, a little amount of soul-searching and environmental manipulation is needed to ensure ABSTINENCE. What were the factors that led the patient to drink in the first place........…social issues, to cope with stress, peer groups, escapism, may be just plain boredom??

If despite all other treatment, if the patient returns to the same situation which "provoked" him to drink in the first place, the chance of their relapse is very high, its just the matter of sooner or later. Branding them, being overtly critical should be avoided. Group therapy and regular therapy sessions heal, as they get a chance to voice their anguish and their daily struggle also their little milestones with a person who has or had faced similar challenges. One should also pay heed that alcohol use earlier took a huge chunk of their time, which would be void, then might lead to a relapse to fill up the sheer vacuum.

Lastly, one must also realize that most of them are perfectly healthy individuals, just going through a bad phase and deserve all the dignity and support that any other recuperating person deserves and gets. Lets aim at spreading the word, there are illnesses that man has fought many a struggle against and won, there are illnesses we are still trying to figure cures for; let's do away with this purely avoidable, very selfish and self-indulgent illness that we human expose ourselves and our families to, by being aware!