Alcohol, you and the festive season

Alcohol has been associated with fun, frolic, funerals and a host of culture-specific religious and other rituals.

As we approach the holiday season of Christmas and New Year, it is wise to remember alcohol use is a double-edged sword. Small to moderate amounts, taken slowly and with food, can be handled satisfactorily by the healthy body, but excess quantities, when drunk quickly and on an empty stomach, may result in a person increasing his/her risk of loss of control operating simple or complex machinery, at home, at work, or in public.

Alcohol dissolves completely in water and as our bodies are about two-thirds water, alcohol can affect every organ system in the body. In general, the effects of alcohol depend on factors relating to alcohol itself, factors relating to the person using it and the social environment and expectations of the user.

Alcohol-related factors include the strength and type of the alcohol, the amount of alcohol taken and the speed at which it is taken.

Person-related factors include the general health, the state of the liver, and gender (males with a larger body mass than females can drink larger amounts of alcohol before the blood levels rise and the effects become noticeable and, conversely, women will show the effects of their alcohol intake earlier and with smaller quantities).

The liver breaks down alcohol efficiently, with the normal rate of breakdown being one ounce of alcohol per hour. The presence of food or milk in the stomach slows the rate of absorption.

The social environment affects the alcohol-user in various ways – a person at a party where all is gaiety would usually be similarly inclined, while a solitary drinker may succumb to moodiness. In both instances, it may lead to overuse.

Alcohol and the brain: The effects vary depending on the amount, frequency and chronicity of use. Alcohol depresses the brain. This fact may surprise some people, because they associate alcohol use with high spirits and other activities that do not fit in with a central nervous system depressant. In reality, alcohol starts by depressing the centres of the brain which control our social controls and our conscience. Thus a staid, quiet man or woman, after a few drinks, may become the ‘life and soul’ of a party.

As the depression of the brain continues, the person starts to have difficulty in thinking, judgment becomes poorer, and coordination is lessened. This is intoxication.

Under such conditions, people under the influence may feel it is OK to drive, but they expose themselves and other road users to great danger. Death during the holiday season is particularly hard for survivors to bear as every year, the reminder is there.

The lack of judgment may also result in arguments and verbal and/or physical attacks may be directed to partners, children, acquaintances or strangers. Injury, homicide or murder-suicide may be the result. Increasing depression of the brain causes drowsiness and eventually coma and death would occur, but the body has a mechanism – vomiting – to get rid of really dangerous excesses of alcohol.

Two conditions may result from chronic alcohol use. One, Wernicke’s Encephalopathy, involves confusion, unsteady gait and weakness of the eye muscles. The affected individual complains of difficult, unsteady walking, drooping eyelids and double vision or constant side to side movements of the eyes (nystagmus).

The other involves memory loss for recent events and the person often makes up some story to fill the memory gap. If the condition which is called Korsakoff syndrome is not recognised and treated with high doses of thiamine, it remains or progresses to dementia.

The condition is known as alcohol-induced persisting dementia. It presents in the same way as Alzheimer’s disease and may respond to similar treatment with anti-cholinergic drugs, because it affects parts of the brain that use acetylcholine as the transmitter of nerve impulses.

Alcohol and the liver: The liver is the primary source for the breakdown or metabolism of alcohol. Unchanged alcohol is eliminated via the skin, the lungs and breath, as anyone who is in close proximity to a drinker can attest. The liver, though, contains enzymes which break down alcohol first into acetaldehyde and water and then into acetic acid and finally into water and carbon dioxide.

Dr. Loraine Barnaby is a psychiatrist based in the Cayman Islands.

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