Alcohol use and abuse

Drinking a small amount of alcohol can make you feel more relaxed or happy, but alcohol is
actually a depressant. This means it:

 slows down the messages that travel between your brain and your body
 affects the way you think, feel and behave.

How alcohol travel through your body?

When you drink alcohol, you don’t digest alcohol. It passes quickly into your bloodstream
and travels to every part of your body. Alcohol affects your brain first, then your kidneys,
lungs and liver. The effect on your body depends on your age, gender, weight and the type of
alcohol.

Alcohol unit:

Alcoholic drinks have different strengths. The number of units in one drink is based on the
quantity of drink and the alcohol strength. One unit is 10ml or eight grammes of pure alcohol.
Most adults can process this amount of alcohol in an hour.

An alcohol unit is not a standard measurement. In other countries, one unit might contain
more pure alcohol.

One unit equals 10ml or 8g of pure alcohol, which is around the amount of alcohol the
average adult can process in an hour.

This means that within an hour there should be, in theory, little or no alcohol left in the blood
of an adult, although this will vary from person to person.

The number of units in a drink is based on the size of the drink, as well as its alcohol strength.

For example, a pint of strong lager contains 3 units of alcohol, whereas the same volume of
lower-strength lager has just over 2 units.

Knowing your units will help you stay in control of your drinking.

To keep health risks from alcohol to a low level if you drink most weeks:

 men and women are advised not to drink more than 14 units a week on a regular basis
 spread your drinking over 3 or more days if you regularly drink as much as 14 units a
week
  if you want to cut down, try to have several drink-free days each week

14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of lower-strength

wine.

Your bloodstream distributes alcohol quickly to your brain, kidney, lungs and liver. On
average, your liver takes an hour to break down one unit of alcohol. This can depend on:

 your weight
 your gender
 your age
 how quickly your body turns food into energy
 how much food you’ve eaten
 the strength and type of alcohol
 any medicine you’re taking

Weight
If your weight is low, you feel the effects of alcohol more quickly because you have less
tissue to absorb alcohol.

Age
Most children and young people are smaller and weigh less than adults. Alcohol can affect
them quickly. Children and young people’s brains are still developing, so even small amounts
of alcohol can be damaging.

Your body changes as you reach old age. You have increased body fat and decreased body
water. This affects how your body processes alcohol. If you still drink the same amount of
alcohol you drank in adulthood, you feel the effects more severely. Older people who drink
too much alcohol are at greater risk of physical and mental health problems including:

 stroke
 heart disease
 cancer
 depression
 confusion
 dementia
Gender
Alcohol affects women more quickly than men. Women are usually smaller and weigh less
than men, and have less tissue to absorb alcohol.

A woman’s body has more fat and less water than a man’s body. If a man and woman are the
same size and drink the same amount, the alcohol is stronger in the woman's blood than in the
men. The woman will get drunk more quickly and feel the effects for longer.

Alcohol also stays in women’s blood for longer. They have lower levels of the enzyme that
breaks down alcohol.

Women feel the effects of alcohol more quickly before a period and during ovulation. The
contraceptive pill can have the opposite effect – it takes longer for alcohol to leave the body.
A woman in this situation might drink more than she realises before she feels the effects.

Stomach
You absorb 20 per cent of alcohol into your bloodstream through your stomach and the rest
into your bloodstream through your small intestine.

Drinking a small amount of alcohol stimulates your appetite because it increases the flow of
stomach juices. A large amount of alcohol dulls your appetite and can cause malnutrition.

You can develop a stomach ulcer by drinking too much alcohol. This can happen when the
stimulated gastric juices mix with the high alcohol content and irritate your stomach lining.

Bloodstream
When alcohol enters your bloodstream, it widens your blood vessels. This causes:

 blushing, as there is a greater flow of blood to the skin surface

 a temporary feeling of warmth
 heat loss and a rapid decrease in body temperature
 a drop in blood pressure

Brain
Alcohol dulls the parts of your brain that control how your body works. This affects your
actions and your ability to make decisions and stay in control. Alcohol influences your mood
and can also make you feel down or aggressive.
As the concentration of alcohol in your bloodstream increases, your behaviour and body
functions change. At first, you may feel happy and less inhibited, but after several drinks
you'll probably:

 slur your words

 have blurred vision
 lose your coordination

There is no immediate way to sober up. It takes time for your body to process alcohol. The
morning after a heavy night’s drinking, you are likely to have a high concentration of alcohol
in your bloodstream.

You may not be sober or safe to drive a vehicle. The legal alcohol limit for driving measures
the amount of alcohol in your breath, blood or urine.

Kidneys
Alcohol is a diuretic and increases urine production. When you drink alcohol, you need to
urinate more often. This causes thirst and dehydration.

Lungs
When alcohol is fizzy, you can inhale this. From your lungs, alcohol goes quickly into your
bloodstream.

Liver
When you drink alcohol, your liver oxidises 95 per cent of it. This means your liver converts
alcohol into water and carbon monoxide. Your liver can only oxidise one unit of alcohol an
hour.

Drinking with an empty or full stomach

If you drink alcohol with an empty stomach, the alcohol passes directly into your
bloodstream. If you’ve eaten before drinking, the rate of alcohol absorption slows down but
doesn’t stop.

Profile of an alcohol user:

Alcohol abuse is more complicated than merely drinking too much. According to Penn State
researchers, there may be five separate types of problem drinkers with each one may be more
common at different stages of life. In the study, Penn State researchers discovered five
distinct classes or “profiles” among people with alcohol use disorder, with each profile
defined by a specific set of symptoms. While each profile can exist during any time in a
person’s life, certain profiles are more common at different stages of life than others.

Also, according to the study, ‘For example, young adults were more likely to fit the profile
characterized by drinking too much and experiencing hangovers and other withdrawal
symptoms. Meanwhile, older adults in their late fifties to sixties were more likely to struggle
with cutting back on their alcohol use”.

European Americans have higher rates of drinking than African Americans and Asian
Americans. Native Americans are found to be less sensitive to the intoxicating effects of
alcohol. Asian Americans may be less prone to alcohol abuse because they have less level of
enzyme (dehydrogenase). 50 percent of Americans aged 12 or older being current drinkers in
2008. 14 percent are current but infrequent 6 percent were former. 9 percent were former but
infrequent.

Physical effects of alcohol consumption:

Alcohol and brain: Alcohol interferes with the brain’s communication pathways and can
affect the way the brain looks and works. Alcohol makes it harder for the brain areas
controlling balance, memory, speech, and judgment to do their jobs, resulting in a higher
likelihood of injuries and other negative outcomes. Long-term, heavy drinking causes
alterations in the neurons, such as reductions in their size.

The developing brain is particularly vulnerable to effects of alcohol. Misuse of alcohol during
adolescence and early adulthood can alter the trajectory of brain development, resulting in
long-lasting changes in brain structure and function.

One significant consequence of alcohol misuse is alcohol-induced blackouts. Blackouts are

gaps in a person’s memory for events that occurred while they were intoxicated. These gaps
happen when a person drinks enough alcohol to temporarily block the transfer of memories
from short-term to long-term storage—known as memory consolidation—in a brain area
called the hippocampus.

Continuing to drink despite clear signs of significant impairments can result in an alcohol
overdose. An alcohol overdose occurs when there is so much alcohol in the bloodstream that
areas of the brain controlling basic life-support functions—such as breathing, heart rate, and
temperature control—begin to shut down. Symptoms of alcohol overdose include mental
confusion, difficulty remaining conscious, vomiting, seizure, trouble breathing, slow heart
rate, clammy skin, dulled responses such as no gag reflex (which prevents choking), and
extremely low body temperature. Alcohol overdose can lead to permanent brain damage or
death.

Alcohol and Gastrointestinal:

Alcohol has many different effects on the body, both short- and long-term. It can affect how
the body breaks down nutrients, irritate the gut, and speed up the digestive system. All of
these effects can lead to a bowel movement.

Some alcoholic drinks have more of an effect on the body than others. The more a person
drinks, the more likely they are to experience such effects. Eating a meal before drinking
alcohol and drinking in moderation can help protect the gut and allow more regular, healthier
bowel movements.

Gastritis is inflammation of the stomach lining. Alcohol can cause gastritis by irritating the
lining of the stomach.

Gastritis can happen while you are drinking, causing pain and sickness.

Gastritis can also be a long-lasting condition.

Symptoms include:

 tummy pain
 heartburn
 losing your appetite
 nausea (feeling sick)
 vomiting (getting sick)

Sometimes gastritis doesn’t cause any symptoms.

If left untreated, gastritis can lead to stomach ulcers which can result in death Acidic
digestive juices in the stomach can come up into the oesophagus (gullet). This is called
reflux. It can happen if you drink too much.

Reflux causes an uncomfortable burning sensation known as heartburn.

Alcohol and immune system and endocrine system:

its communication with the nervous system, immune system and body’s circadian
mechanism. Chronic consumption of a large amount of alcohol disrupts the communication
between nervous, endocrine and immune system and causes hormonal disturbances that lead
to profound and serious consequences at physiological and behavioural levels. Some drugs
may have an effect on the endocrine system. Steroids and performance-enhancing drugs are
known for causing both reversible and irreversible damage. Some of this damage includes
beard growth and male pattern baldness in women, as well as shrinking of testicles and
infertility in men.

Hormones need to be released into the body in a timely manner, but some substances disrupt
this process. Alcohol is a drug that can interrupt the endocrine system as it tries to do its job.
For example, it causes:

 A rise in blood sugar: This causes the pancreas to release more blood sugar, and it
could even cause hypoglycaemia, or low blood sugar, in some people. This can cause
problems for diabetics and others who use medication to decrease their blood sugar
levels.
 Disruption in the absorption of nutrients: Excess alcohol consumption may interrupt
how the body absorbs calcium and increase the risk of osteoporosis in some people.
 Loss of testosterone: This is a risk for men and boys who drink alcohol to access.

Alcohol and cardiovascular system:

The heart and blood vessels form part of the cardiovascular system.1Blood is pumped around
the body by the heart, via these blood vessels through arteries, capillaries and veins.2 The
blood delivers nutrients and other materials to all parts of the body, including alcohol, which
is absorbed directly into the blood stream mainly via the stomach and small intestine.

The cardiovascular system is affected by alcohol. At the time of drinking, alcohol can cause a
temporary increase in heart rate and blood pressure. In the long-term, drinking above the
guidelines can lead to on-going increased heart rate, high blood pressure, weakened heart
muscle and irregular heartbeat. All of which can increase the risk of alcohol-caused heart
attack and stroke.

Alcohol and pregnancy:

Alcohol in the mother’s blood passes to the baby through the umbilical cord. Alcohol use
during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical,
behavioural, and intellectual disabilities. These disabilities are known as fetal alcohol
spectrum disorders (FASDs). Children with FASDs might have the following characteristics
and behaviours:

 Abnormal facial features, such as a smooth ridge between the nose and upper lip (this
ridge is called the philtrum)
 Small head size
 Shorter-than-average height
 Low body weight
 Poor coordination
 Hyperactive behaviour
 Difficulty with attention
 Poor memory
 Difficulty in school (especially with math)
 Learning disabilities
 Speech and language delays
 Intellectual disability or low IQ
 Poor reasoning and judgment skills
 Sleep and sucking problems as a baby
 Vision or hearing problems
 Problems with the heart, kidney, or bones

there is no safe time for alcohol use during pregnancy. Alcohol can cause problems for the
baby throughout pregnancy, including before a woman knows she is pregnant. Alcohol use in
the first three months of pregnancy can cause the baby to have abnormal facial features.
Growth and central nervous system problems (e.g., low birthweight, behavioural problems)
can occur from alcohol use anytime during pregnancy. The baby’s brain is developing
throughout pregnancy and can be affected by exposure to alcohol at any time.
It is never too late to stop alcohol use during pregnancy. Stopping alcohol use will improve
the baby’s health and well-being.

Psychosocial consequences:

 For someone experiencing anxiety, a drink might help them feel more at ease, but this
feeling is short-lived. The so-called ‘relaxed’ feeling somebody may say they
experience after having a drink is due to the chemical change's alcohol causes in the
brain. But these effects wear off fast. Relying on alcohol to mask anxiety could also
lead to a greater reliance on it to relax. A likely side-effect of this is the increased risk
of building up a tolerance to alcohol. Over time you will need to drink more alcohol
to get the same feeling. And, in the medium to longer term, this pattern often leads to
alcohol dependence.
 Alcohol can cause people to lose their inhibitions and behave impulsively, so it can
lead to actions they might not otherwise have taken – including self-harm and even
suicide.13 There is a strong association between drinking heavily (either chronic or
acute alcohol misuse) and suicidal thoughts, suicide attempts, and death from suicide.
 Extreme levels of drinking (such as drinking more than 30 units per day for several
weeks) can occasionally cause psychosis, which is a severe mental illness where
hallucinations and delusions – of persecution, for example – occur. Psychoses can be
caused by both acute intoxication and withdrawal, and can be more common in cases
when drinkers who are dependent on alcohol suddenly stop drinking.

Psychological consequences:

Prolonged alcohol use can lead to psychological damage. Research has demonstrated a strong
association with alcohol misuse and mood disorders particularly depression and anxiety. The
reciprocal implications of this suggests that alcohol on one hand may be used in an attempt to
self-medicate against various mood disorders, while on the other hand it can also exacerbate
mood disorders if used in excess (Prince, Akinci Gil, Hoover, Walkup, Bilder, Crystal, 2009;
Agabo, Marras, Gessa, & Carpiniello, 2007).

For example, studies have found that people with alcohol disorders often suffer from some
kind of depression whereby to relieve the symptoms of the depression, they will often embark
in excessive alcoholic use; which in turn exacerbates their depression. The prevalence of
depression in alcohol abusing/dependent individuals range from 15 to 70%, including
primary depression. Depression ranks high among mood disorders that are comorbid with
excessive alcohol use (Butcher, Mineka and Hooley, 2005).

The literature surrounding anxiety suggests that individuals with social phobia often feel a lot
more comfortable in social settings if they have used alcohol (Abrams, Kushner, Reinertsen,
2002). Comorbidity of social phobia in excessive alcohol users is quite common. Changes in
personality such as increased irritability, impaired reasoning and poor judgment are said to be
consequences of excessive alcohol use (Butcher, Mineka & Hooley, 2005).

There is also a well-established comorbidity between schizophrenia and heavy alcohol use
too (National Health and Research Council, 2009). It is suggested that heavy alcohol use may
increase the severity of common symptoms associated with schizophrenia such as
hallucinations.

Drug treatment:

Aversion therapy, sometimes called aversive therapy or aversive conditioning, is used to help
a person give up a behaviour or habit by having them associate it with something unpleasant.

Aversion therapy is most known for treating people with addictive behaviours, like those
found in alcohol use disorder. Most research has been focused on its benefits relating to
substance use. This type of therapy is controversial and research is mixed. Aversion therapy
isn’t often a first-line treatment and other therapies are preferred. How long the therapy lasts
for has also been criticized, as outside of the therapy, relapse may occur.

Relapse prevention therapy:

One of the main goals of therapy at this stage is to help clients understand what self-care
means and why it is important. The need for self-care varies from person to person. A simple
reminder of poor self-care is the acronym HALT: hungry, angry, lonely, and tired. For some
individuals, self-care is as basic as physical self-care, such as sleep, hygiene, and a healthy
diet. In addiction treatment, a "relapse" refers to a reoccurrence of the addictive behaviour,
following an attempt at recovery. It is helpful to specifically address relapse during recovery
efforts. Statistically speaking, most individuals making a recovery effort will experience
relapse at some point. Without advance preparation, cravings will inevitably lead to relapse.
When a relapse occurs, feelings of guilt and self-blame may only worsen the situation.
Relapse Prevention Therapy (RPT, Marlatt & Donovan, 2005) is a type of cognitive-
behavioural therapy. RPT aims to limit or prevent relapses by helping the therapy participant
to anticipate circumstances that are likely to provoke a relapse. You can develop strategy to
cope with these high-risk situations in advance. This is termed a relapse prevention plan. For
instance, therapy participants learn that certain feelings are common triggers for relapse. We
summarize these feelings with the acronym BHALT: bored, hungry, angry, lonely, and tired.
Relapse prevention therapy teaches therapy participants to be alert for these types of feelings
and to have a plan of action for coping with them.