Alcohol Abuse and Rehabilitation

Alcohols usually refer to ethyl alcohol, which are manufactured by the fermentation of the molasses, a byproduct of sugar industry. There are large verities of alcoholic beverages, which are classified as

Alcoholic Beverages

Malted liquors in which alcoholic content low as 3-6%.e.g.Beer, stout.
Wines produced by fermenting of grapes and fruits has content of 9-22% which includes port, cider, champagne etc.
Sprits are alcohols, which are distilled after fermentation, contain 40-60% alcohol content. Examples are wine, whisky, brandy, rum and gin.
Other form of alcohol is absolute alcohol, rectified spirits etc.

Alcohol is primarily a neuronal depressant. Apparent excitation and euphoria are produced at lower plasma concentration. Moderate amount of alcohol drinking has been found responsible for 15-35% lower incidence of coronary heat disease by raising high-density lipids and lowering low-density lipids. Alcohol produces a sense of warmth and help to combat cold and also be reputed as an aphrodisiac.

Diseases caused by alcohol abuse

Liver: Alcohol cause fatty change, acute alcohol hepatitis, and cirrhosis of liver. Chronic alcoholism leads to massive enlargement of liver and cellular necrosis.

Nervous System: Ataxia, disturbed cognition, opthalmoplegia, wernicke syndrome and korsakoff syndrome. At conc. 30-100mg/dl of plasma causes excitation and increasing conc. of 100-150mg/dl causes mental clouding, disorganizing of thought and impairment of memory and at 200-300mg/dl stupor and unconsciousness prevails and medullary centers are paralyzed and death may occur.

Heart: Chronic alcoholism causes hypertension and lead to cardiomyopathy. Atrial fibrillation and other cardiac arrhythmias occur.



Gastrointestinal Tract: Chronic Gastritis, Acute and Chronic pancreatitis are due to alcoholism. Acute pancreatisis is due to heavy drinking.

Skeletal muscle: Alcohol produces a little direct effect. Fatigue is allayed by small doses but weakness pain and myopathy result to chronic alcoholism.

Reproductive system: Though an aphrodisiac, chronic alcohol decreases fertility in both men and women. Testicular atrophy in men and spontaneous abortion in women are some adverse effects seen

Other complications

Fetal alcohol syndrome: It is caused by the maternal consumption of ethanol at levels of only one drink per day. The syndrome produces microcephaly, facial dysmorphology and malformation of brain and growth retardation. This is the most common type of mental retardation in United States and it affects 1200 children per year.

Alcoholic palimpsests: condition seen among alcoholics, behaviour resembling blackouts in anoxaemia. This may result in loss of memory of a period during a drinking spell. Amnesia may be fragmentary or total. During such state a person may perform a criminal act and may not remember after he recovers from intoxication.

Food Value: alcohol requires no digestion and rapidly metabolized producing 7cal/g energy, which cannot be stored. Thus alcohol is an imperfect and expensive food.

Fatal Dose and Period: 150 to 250 ml of absolute alcohol consume in one hour. Fatal period is 12 to 24 hours.

Alcohol addiction and withdrawal


Alcolhol addicts are those who cannot stop drinking for long or who experience withdrawal symptom, if they do. It results in impaired social and occupational functioning.

Withdrwal symptom appears after 12-24 hrs after reduction in alcohol intake.
The essential features are tremor of hand tongue and eyelids. In association with nausea and vomiting, malaise weakness tachycardia anxiety hallucination headache and insomnia. Alcoholic treatment of withdrawal symptoms is controlled by chlorodiazepoxide or diazepam.

Alcohol and Traffic accidents

A blood level concentration of 80-100 mg/dl is the legal definition of driving under the influence of alcohol in many states. At or before 100mg all individual are affected and accidents are common, at 150mg driving becomes impaired and 200mg and above most persons are intoxicated and risk of accidents occur.

Alcoholic Treatment

Psychological and medical supportive measures are needed during withdrawal. During past CNS depressants were been used but now benzodiazepines are preferred now. Recent involvement of opioids antagonists in the alcoholic treatment is seen. It has reduced craving and chances of heavy drinking. Naltrexone is approved by US-FDA for use as an adjuvant. Drugs like Disulfiram have an aversion technique in chronic alcoholics.

Safe Drinking

On average 1-2 drinks per day are safe and not more than 3 drinks on an occasion. Do not engage in hazardous activity or driving after drinking. Safe limits are lower in women because metabolism is slower and bioavailiabilty is higher in women.
Note 1 drink = 50ml of spirits = 150ml of wines = 400ml of beer all have 18-20 g of alcohol.

Alcoholic rehabilitation

Alcoholics Anonymous is an international voluntary agency which has branches throughout everywhere. It consist of mainly ex-alcoholics who usually meet once a week, share their experience and try to encourage one another to abstain from alcohol.

Can Alcohol can cause Sudden Death

Yes, alcohol can be cause of sudden death. In some persons alcohol has an effect on the myocardium, predisposing to and producing arrhythmias. An intoxicated person during the struggle or most commonly immediately after it, suddenly becomes unresponsive, develops cardiopulmonary arrest and dies. No anatomical cause of death is found in autopsy. Catecholamines are released during struggle, which in combination with alcohol may produce cardiac arrhythmias and death.

Occasionally the person has a physiological lesion of the conductive system of the heart predisposing to and cause arrhythmias, which can be aggravated by alcohol and release of Catecholamines. Peak levels of Catecholamines are reached immediately after the struggle.

After a violent struggle, the victim may be restrained in such a way, that the breathing is impaired, producing a relative hypoxia. In some persons, death may result, when this is combined with alcohol and the release of Catecholamines. The cause of death is certified as "Cardiopulmonary Arrest" caused by a violent struggle. Intoxicated person who is severely beaten about the face may collapse and die. Death in this case occurs from a combination of CNS depression due to alcohol and diffuse axonal injury from beating.

Are you in this High Risk Group of consuming alcohol?

Consumption of alcohol should be avoided

In Peptic ulcer, hyperacidity and in gastro esophageal reflux patients because alcohol consumption can increase gastric secretion and relaxes Lower Esophageal Tone.

In Epileptics, alcohol may precipitate seizures and in severe Liver Disease Patients

In Pregnant women , even moderate drinking has found to produce "Fetal alcohol syndrome" resulting in intrauterine and postnatal growth retardation, low IQ, facial and other abnormalities and immunological impairment-increased susceptibility to infections. Heavy drinking of mother in addiction increases the incidence of miscarriage, stillbirth and low birth weight babies

Unstable personalities are likely to abuse it and become excessive drinkers.

Why do People get addicted?

Researches have shown the involvement of opium system in the pleasurable reinforcement effects of alcohol. This takes place probably by blunting dopamine mediated reward function. Trials among post alcoholic addicts have shown that the long acting opium antagonist helps in the alcoholic treatment by preventing relapse of alcoholism. It had reduced the withdrawal symptoms like alcohol craving, number of drinking days and chances of resumed heavy drinking.

Physiological effects and relative concentrations of alcohol

Physiological effects at blood alcohol concentration

0 to 50mg%: No significant effect or mild euphoria

50 to 100mg%: Decreased inhibitions, increased self confidence, decreased attention span, mild incoordination, alteration of judgment, nystagmus

100 to 150mg%: Some mental confusion, emotional instability, loss of critical judgment, ataxia, impaired memory, sleepiness, slowed reaction time

150 to 300mg%: Loss of muscular coordination, staggering gait, marked mental confusion, drowsiness, exaggeration of emotions, dizziness, decreased pain response, disorientation, and thickened speech.

300 to 400mg%: Stupor, marked incoordination, marked decreased in response to stimuli, possibly coma

400 mg% or more: Anesthesia, depression of responses, respiratory, failure, deep coma, and death


Relative concentration of alcohol at equilibrium

Whole Blood: 1.00
Plasma or serum: 1.12 to 1.2
Brain: 0.85
Spinal fluid: 1.1 to 1.27
Vitreous: 1.2
Urine: 1.3
Liver: 0.85
Alveolar air: 0.021

Can alcohol elicit Criminal Behaviour?

A strong relationship exists between the abuse of alcohol and the occurrence of accidents and acts of violence. As the suppressed feeling of aggression and hostility are released, the drinker goes into a state of artificial display of bravery. Tasks, which require control of speed and sensorimotor coordination in keeping a vehicle on its course and braking in impaired at 50 mg%. The driver experiences an increase in boldness and impulsiveness, this results in a tendency to drive faster and more erratically. Acute alcohol intoxication is a factor in suicides and homicides.

Alcohol slows the reactions of the victim and he may not be able to protect himself in time form an assault. He may be struck with a minimum or no defense injuries. Alcohol causes dilation and congestion of blood vessels, so that injuries will result in greater an prolonged bleeding, If there is chronic alcoholic liver disease which impairs the clotting of blood, the bleeding will be more extensive. If a victim is severely intoxicative, he may die from inhalation of blood or vomit while lying on his back following injuries, especially of the head or face.

Do you know your Safe Driving Limit?

Progressive loss of driving ability is seen as the blood alcohol level rises. The safe driving is interfered because alcohol increases your reaction time, creates a false confidence, impairs concentration, dulls judgment, decreases muscular coordination and decreases visual and auditory acuity.

Safe limits of alcohol concentration

Below 50 mg% concentration of blood alcohol, majority of drivers are not affected, as regards road safety. At 60 mg% the driver of a vehicle is twice as likely to be involved in an accident as compared to a sober driver. Risk of accident begins to increase markedly at 80mg%; by 100mg% risk is 12-fold and at levels of over 150mg% this becomes 25 times more likely.













Apart from alcohol the drugs which affect driving are tranquillizers, opiates, barbiturates, cannabis, hallucinogens, anti-histaminic, anti-depressants and anti-psychotics

Pathology caused by alcohol drinking

Delirium tremors: This results from the long continued action of the poison on the brain. It occurs in chronic alcoholics due to
(1) Temporary excess (2) sudden withdrawal (3) shock after receiving an injury, such as fracture of a bone, or (4) from acute infection, such as pneumonia, influenza, erysipelas etc

It typically begins 72 to 96 hours after the last drink. There’s an acute attack of insanity in which the main symptoms are coarse muscular tremors of the face, tongue and hands, insomnia, restlessness, loss of memory, agitation, confusion, disorientation, uncontrollable fear and has tendency to commit suicide, homicide or violent assault or to cause damage to property. Other symptoms are diarrhea, dilated pupils, fever, tachycardia, tachyapnoea and hypertension. There is disorientation as to time and place and a peculiar kind of delirium of horrors owing to hallucination of the sight and hearing. The patient imagines that insects are crawling under the skin, or snakes are crawling on his bed it is considered unsoundness of mind and not intoxication. Death occurs in about 5 to 5$ of the cases. To control agitation diazepam should be given

Alcoholic Polyneuritis and Korsakoff’s Psychosis: The symptoms of Polyneuritis are weakness; pain in the extremities, wrist and food drop, unsteady gait, loss of deep reflexes and tenderness of muscles of arms and legs

Alcoholic paranoia: In this there are fixed delusions but no hallucinations. The person becomes deeply suspicious of he motives and actions of those he meets and of his family members.

Acute Alcoholic hallucinations: Persistent hallucinations develop within 48 hours after cessation of alcohol intake. The hallucinations may be auditory or visual and their content is usually unpleasant and disturbing. The disorder may last several weeks or months

Alcoholic epilepsy: seizures occur after a say or more of the terminations of as drinking session Sometimes the attack may occur while the patient is actually drinking

Wernicke Encephlopathy: This results from a brain or spinal cord lesion due to heavy drinking, Vitamin B1 deficiency occurs

Symptoms include disturbance of consciousness, drowsiness, amnesia, peripheral neuropathy, external ocular palsies and stupor. It has a high mortality and can cause death in 24 hours. If untreated it can progress to a more chronic condition called Korsakoff psychosis, in which impairment of short term memory with inability to learn new information and confabulation (recitation of imaginary experiences to ill gaps in the memory) are seen


Cardiac dysrhythmias: In alcohol withdrawal tachyrhythmias are common probably because of high adrenergic nervous system activity, which may cause sudden death.

Marchiafava Syndrome: Degeneration of the corpus callosum may occur in alcoholics.

Mallory-Weiss Syndrome: Ruptured esophagus with mediastinitis occurs

Other pathologies include Malnutrition, Gastric and peptic ulcer, Cirrhosis, Myocarditis pancreatitis and Mental illness

Five distinct subtypes of alcoholism identified

Analyses of a national sample of individuals with alcohol dependence (alcoholism) reveal five distinct subtypes of the disease, according to a new study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).
Our findings should help dispel the popular notion of the typical alcoholic, notes first author Howard B. Moss, M.D., NIAAA Associate Director for Clinical and Translational Research.We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes. More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes.

Clinicians have long recognized diverse manifestations of alcoholism, adds NIAAA Director Ting-Kai Li, M.D,and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not. The classification system described in this study will have broad application in both clinical and research settings. A report of the study is now available online in the journal Drug and Alcohol Dependence.

Previous efforts to identify alcoholism subtypes focused primarily on individuals who were hospitalized or otherwise receiving treatment for their alcoholism. However, recent reports from NIAAA's National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a nationally representative epidemiological study of alcohol, drug, and mental disorders in the United States, suggest that only about one-fourth of individuals with alcoholism have ever received treatment. Thus, a substantial proportion of people with alcoholism were not represented in the samples previously used to define subtypes of this disease.

In the current study, Dr. Moss and colleagues applied advanced statistical methods to data from the NESARC. Their analyses focused on the 1,484 NESARC survey respondents who met diagnostic criteria for alcohol dependence, and included individuals in treatment as well as those not seeking treatment. The researchers identified unique subtypes of alcoholism based on respondents family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional substance abuse and mental disorders:

Young Adult subtype: 31.5 percent of U.S. alcoholics. Young adult drinkers, with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, and who rarely seek any kind of help for their drinking.

Young Antisocial subtype: 21 percent of U.S. alcoholics. Tend to be in their mid-twenties, had early onset of regular drinking, and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder, and anxiety problems. More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one-third of these alcoholics seek help for their drinking.

Functional subtype: 19.5 percent of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.

Intermediate Familial subtype: 19 percent of U.S. alcoholics. Middle-aged, with about 50 percent from families with multigenerational alcoholism. Almost half have had clinical depression, and 20 percent have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent ever sought treatment for their problem drinking.

Chronic Severe subtype: 9 percent of U.S. alcoholics. Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine, and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.
The authors also report that co-occurring psychiatric and other substance abuse problems are associated with severity of alcoholism and entering into treatment. Attending Alcoholics Anonymous and other 12-step programs is the most common form of help-seeking for drinking problems, but help-seeking remains relatively rare.