List of references

1.National Institute for Health and Clinical Excellence. The Guidelines Manual. NICE; 2007.2.National Institute for Health and Clinical Excellence. The Guidelines Manual. London: NICE; 2009.3.NHS Information Centre, Lifestyle Statistics. Statistics on Alcohol: England, 2009. UK: Health and Social Care Information Centre; 2009.4.Pirmohamed M, Brown C, Owens L, et al. The burden of alcohol misuse on an inner-city general hospital. QJM.2000;93(5):291–295. ]5.Royal College of Physicians. Alcohol – can the NHS afford it? Recommendations for a coherent alcohol strategy for hospitals. A report of a working party of the Royal College of Physicians. Royal College of Physicians; 2001.6.Caetano R, Clark CL, Tam T. Alcohol consumption among racial/ethnic minorities: theory and research. Alcohol Health & Research World. 1998;22(4):233–241. 7.Stinson FS, Grant BF, Dufour MC. The critical dimension of ethnicity in liver cirrhosis mortality statistics. Alcoholism: Clinical & Experimental Research. 2001;25(8):1181–1187. 8.Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British Journal of Addiction. 1989;84(11):1353–1357. 9.Lukan JK, Reed DN Jr, Looney SW, et al. Risk factors for delirium tremens in trauma patients. Journal of Trauma-Injury Infection & Critical Care. 2002;53(5):901–906. [10.Duka T, Townshend JM, Collier K, et al. Impairment in cognitive functions after multiple detoxifications in alcoholic inpatients.Alcoholism: Clinical & Experimental Research. 2003;27(10):1563–1572. ]11.Malcolm R, Roberts JS, Wang W, et al. Multiple previous detoxifications are associated with less responsive treatment and heavier drinking during an index outpatient detoxification. Alcohol. 2000;22(3):159–164. 12.Schuckit MA, Tipp JE, Reich T, et al. The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects. Addiction. 1995;90(10):1335–1347. 13.Wetterling T, Driessen M, Kanitz RD, et al. The severity of alcohol withdrawal is not age dependent. Alcohol & Alcoholism.2001;36(1):75–78. 14.Wetterling T, Kanitz RD, Besters B, et al. A new rating scale for the assessment of the alcohol-withdrawal syndrome (AWS scale). Alcohol & Alcoholism. 1997;32(6):753–760. 5.Booth BM, Blow FC. The kindling hypothesis: further evidence from a U.S. national study of alcoholic men. Alcohol & Alcoholism. 1993;28(5):593–598. 16.Kraemer KL. The cost-effectiveness and cost-benefit of screening and brief intervention for unhealthy alcohol use in medical settings. Substance Abuse. 2007;28(3):67–77. 17.Lechtenberg R, Worner TM. Relative kindling effect of detoxification and non-detoxification admissions in alcoholics. Alcohol & Alcoholism. 1991;26(2):221–225. 18.Lechtenberg R, Worner TM. Total ethanol consumption as a seizure risk factor in alcoholics. Acta Neurologica Scandinavica.1992;85(2):90–94. 19.Palmstierna T. A model for predicting alcohol withdrawal delirium. Psychiatric Services. 2001;52(6):820–823. [PubMed]20.Ferguson JA, Suelzer CJ, Eckert GJ, et al. Risk factors for delirium tremens development. Journal of General Internal Medicine. 1996;11(7):410–414. 21.Kraemer KL, Mayo SM, Calkins DR. Independent clinical correlates of severe alcohol withdrawal. Substance Abuse.2003;24(4):197–209. 22.Kraemer KL, Mayo SM, Calkins DR. Impact of age on the severity, course, and complications of alcohol withdrawal. Archives of Internal Medicine. 1997;157(19):2234–2241. 23.Vinson DC, Menezes M. Admission alcohol level: a predictor of the course of alcohol withdrawal. Journal of Family Practice.1991;33(2):161–167. 24.Parrott S, Godfrey C, Heather N, et al. Cost and outcome analysis of two detoxification services. Alcohol & Alcoholism.2006;41(1):84–91. []25.EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16(3):199–208.

Recommended Action for alcohol abuse

I do not think any one program is the best prevention of alcohol abuse. There are so many factors involved, society, family, and personal all play a part in the problem. So where to begin? Most people believe prevention is the best method of action, but based on the “just say no” crusade of the 1980’s, it seems to have little effect. I believe we need a cultural shift towards a more utopia society-people looking to help one another rather than help themselves. I believe the root of the alcohol problem is our “me first” attitude in society, and if we start to get people to think about others we will not have as much need for alcohol. In AA it is taught that self centered fear is the root of the alcoholic problem, I believe this stems in most chemical abuse cases. The 12th step in AA is helping others, without it most relapse, so thinking about others one of the main focuses of recovery. We can preach about prevention and about the harms alcohol can harm, but if the individual is wired to be concerned with only themselves, then prevention only goes so far. My recommended course of action is starting with the children at a young age to learn empathy. In our country so much is stressed on personal accomplishments, I think we need to start emphasizing others, not individuals. Based on my personal experience in recovery from alcohol, and those of millions of others, this has been the method which has worked.

 

Approaches to prevention of Alcohol

There have been numerous methods of the prevention of alcohol abuse. Prohibition was tried twice in our country with no results. Other methods to reform alcoholics have included electric shock therapy and LSD. Many different therapies and rehabilitation techniques have been tried. But unfortunately most methods have failed to reform alcoholics. According to the NIAAA prevention programs for our youth is one of the leading methods in our country. These are the steps in how they try to help:

  • Correct the misperception that everybody is drinking.
  • Teach youth ways to say no to alcohol.
  • Use interactive teaching techniques (e.g., small-group activities, role plays, and same-age leaders).
  • Involve parents and other segments of the community.
  • Revisit the topic over the years to reinforce prevention messages.
  • Provide training and support for teachers and students.
  • Are culturally and developmentally on target for the students they serve.

How effective these methods are is inconclusive, statistics have not changed much in the past 20 years, except for the fatalities of drinking and driving.  The minimum age of 21 to consume alcohol does not seem to persuade college age people from drinking any less, they lead the nation in drinking consumption.

The recommended approach from the Government is prevention methods. Given the high costs of alcohol abuse and dependence to both people and society, evidence-based approaches for preventing harmful alcohol use are key. Prevention efforts are especially important for young people, a group at particular risk for the consequences of alcohol use. Communities, schools, and workplaces provide essential venues for reaching risky drinkers with prevention messages and strategies. Research continues to support the development of new approaches and new ways of delivering effective prevention messages.

Personal Alcohol Use

I have written on our discussion boards that I am a recovering alcoholic, so it is probably not a surprise that I am not a fan of alcohol and it’s consequences. Because I have seen the destruction in my own life, and continue to see the destruction of it in so many others, it affects me greatly. As the result of my drinking I ended up in Jails and Prison, hospitals, Psych wards, and homeless on the street. I lost jobs, friends, and most importantly my soul.  It may be argued that I chose to drink, and I am not opposed to that argument, I was the one who drank the alcohol. But, what factors led to my drinking? I grew up in an alcoholic household, so that is what I saw. I also witnessed alcohol in every social gathering that I attended. I do not blame anyone for my issues, I take full responsibility, but I would like to see our society take a harsher view of alcohol in our world. It has killed and damaged millions of people. I watched a childhood friend die of cirrhosis at the age of 39, by the time anyone reached him it was too late. Why did he drink himself to death? I don’t know, but it is a problem in our society that I think needs to be addressed.

 

Overall Health impact of Alcohol

Based on my other blogs alcohol has a huge role on the health impact of our society.  Each year in the United States, nearly 85,000 people die from alcohol-related causes, making it the third leading preventable cause of death in our country.  Globally, alcohol use is the fifth leading risk factor for premature death and disability; among people between the ages of 15 to 49, it is the first.

  • 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor vehicle crashes.
  • 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
  • 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape.
  • An estimated 17 million Americans have an AUD—a medical term that includes both alcoholism and harmful drinking that does not reach the level of dependence.  (Hingson, R.W.; Zha, W.; and Weitzman, E.R. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005. Journal of Studies on Alcohol and Drugs (Suppl. 16):12–20, 2009.)

If these statistics do not prove the lethal effects of alcohol I don’t what will. Because alcohol is so widely consumed it’s negative effects on the health of our country are widespread. I would assume we all have seen the negative effects of alcohol in our own bodies and minds, so I hope we can learn from it.

 

 

Current beneficial uses of Alcohol

After all of my rants on the concerns of use of alcohol, I will give you a few benefits on alcohol.  It does have health benefits if consumed in small quantaties. According to Medical Daily they list 7 benefits from drinking alcohol.

1. It can lower your risk of cardiovascular disease.

2.It can lengthen your life.

3. It can improve you libido.

4. It helps prevent against the common cold.

5. It can decrease the risk of dementia.

6. It can reduce the risk of gallstones.

7. It lowers the chance of diabetes.

(Medical Daily,  Sabrina Bachai, Jul 10, 2013)

These findings were based on consuming 1 drink per day, which probably eliminates half of our population.  So if consumed moderately it does have some benefits, but I think the negatives far out weigh the positives.

 

Causes for concern with Alcohol

Alcohol is highly toxic, both acutely and chronically. It has a high dependence rate and can cause major social problems. The history of alcohol use has shown us that it is a major problem in our country and worldwide, the damage it has done over the years is tragic.  Here is a poem I found on the damage of alcohol:

“I am more powerful than the armies of the world. I have destroyed more men than all wars of the nation. I have caused millions of accidents and wrecked more homes than all the floods, tornadoes and hurricanes put together. I am the worlds slickest thief. I steal billions of dollars each year. I find victims among the rich and poor alike, the young and the old, the strong and the weak. I loom up to such proportions that I cast a shadow over every field of labor. I am relentless, insidious, unpredictable. I am everywhere: in the home, on the street, in the factory, in the office, on the sea an in the air. I bring sickness, poverty, and death. I give nothing and I take all. I am your worst enemy. I am alcohol.”-Author unknown

Though this poem may seem extreme, I do not think it is, I have seen the destruction first hand by alcohol. I watched a good friend die at the age of 39 from cirrhosis of the liver, and families break up from alcohol abuse.

Statistics show death by alcohol is a major problem in our country.  A recent report by NBC news reported this:

A stunning one in 10 deaths in working-age adults may be due to excessive alcohol consumption, a new government study shows.

That adds up to 88,000 deaths per year from 2006 to 2010, according to the report released Tuesday by the Centers for Disease Control and Prevention. Put another way, that means that binge drinking and heavy regular drinking cut 30 years off the lives of those who died.

Some of those deaths were due to the long-range effects of chronic alcohol consumption at a rate of 15 or more drinks a week for men and 8 or more drinks a week for women. Those included mortality from breast cancer, liver disease and heart disease, CDC researchers reported.

Other deaths were associated with binge drinking—five or more drinks in a single bout for men and 4 or more for women. The top three causes of death included motor vehicle crashes (25 percent), homicides (16 percent) and falls (15 percent).

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That adds up to 2.5 million years of potential life lost, according to the researchers’ calculations.

The new data are very concerning, said the report’s lead author, Mandy Stahre, who was a CDC researcher when the study was being conducted and is now an epidemiologist with the state of Washington.

“We looked at deaths from 2001 to 2005 and those numbers were high also,” Stahre said. “So it’s been going on for at least the past 10 years. It’s the third leading cause of preventable death. I don’t think it gets a much attention as tobacco which is the leading cause.”

David Jernigan suspects that the new numbers will be a surprise to most Americans.

“The big problem isn’t the addicts, but the binge drinkers who so far outnumber those who are addicted. Anybody can have a problem if they drink to excess on a single occasion.”

“When people think about alcohol problems, they think about addiction and motor vehicle crashes, but this shows that there are many ways to die from alcohol,” said Jernigan, an associate professor at the Johns Hopkins Bloomberg School of Public Health.

“The big problem isn’t the addicts, but the binge drinkers who so far outnumber those who are addicted. Anybody can have a problem if they drink to excess on a single occasion. You don’t have to be addicted to crash your car into a tree or fall into a pool or off a hotel balcony.”

(NBC News, June 26th 2014,  LINDA CARROLL)

Social problems from alcohol abuse effect all of us in some shape or manner. According to the University of West Virginia it has major effects:

Social Problems

Alcoholism carries with it a host of social problems. Both the drinker and the family unit are affected. Alcohol can have devastating effects on the family. Numerous marriages have been destroyed by alcohol, both emotionally and financially. Children of alcoholics are emotionally fractured by alcoholic parents. Approximately 20 percent of adults grew up with a family member with an alcohol problem. These adults themselves are at risk for developing substance abuse problems. Emotional issues such as guilt, depression, and relationship problems are often found in children of alcoholics.

Alcoholics may have additional problems that compound the alcohol issue. Drugs, both prescription and illegal, may cause a synergistic effect in which the overall whole effect of the combined substances is greater than the sum of the parts. This, of course, can have devastating, even fatal, consequences. Psychological problems ranging from depression to schizophrenia are often seen in the alcoholic. These people may attempt to self-medicate with alcohol, not realizing that alcohol may exacerbate the symptoms of their mental illness.

Communities suffer the cost of alcohol abuse. An enormous amount of money is lost each year in the workplace because of alcohol. Insurance costs, decreased productivity, workplace injuries, and work-related grievances are just a few of many problems associated with alcohol. Alcohol is also a leading factor in motor vehicle accidents and injuries. Alcohol-related vehicular accidents are especially prevalent among teenagers and young adults, for whom they are the leading cause of accidental death. Falls, fires, drownings, and suicides are also frequently associated with alcohol.

(UWV, 2014 Robert C Byrd)

I think there is reason for great concern based on the statistical evidence over time. Alcohol has contributed to way to many early deaths, broken up too many homes, and hindered the true both of too many individuals.

 

 

Pharmacology and effects of Alcohol

Alcohol is primarily almost always consumed by drinking,  but can also be shot intravenously. The physiological effects of alcohol in our body are strong, and effect many different parts in our system.  Here are the findings by the NIAAA on how they effect children and adults:

The damage that long-term heavy alcohol consumption can do to the health of adults is well documented. Some research suggests that, even over the shorter time frame of adolescence, drinking alcohol can harm the liver, bones, endocrine system, and brain, and interfere with growth. Adolescence is a period of rapid growth and physical change; a central question is whether consuming alcohol during this stage can disrupt development in ways that have long-term consequences.

Liver disease is a common consequence of heavy drinking. More severe alcohol-related liver disease typically reflects years of heavy alcohol use. However, elevated liver enzymes that are markers of harm have been found in adolescents with alcohol use disorders and in overweight adolescents who consume more modest amounts of alcohol.

During puberty, accelerating cascades of growth factors and sex hormones set off sexual maturation, growth in stature and muscle mass, and bone development. Studies in humans have found that alcohol can lower the levels of growth and sex hormones in both adolescent boys and girls. In animals, alcohol has been found to disrupt the interaction between the brain, the pituitary gland (which regulates secretion of sex hormones), and the ovaries, as well as systems within the ovaries that are involved in regulating sex hormones. In adolescent male animals, both short- and long-term alcohol administration suppresses testosterone; alcohol use also alters growth hormone levels, the effects of which differ with age.

Studies on alcohol and adolescent bone development are limited. In studies of male and female rats, chronic alcohol consumption (an alcohol diet) for the length of adolescence was found to stunt limb growth. One study found that feeding female rats alcohol in a way that mimics binge drinking resulted in either increases in bone length and density or in no change with more frequent bingeing. In human adolescent males but not females, studies have found that alcohol consumption decreases bone density.

The brain also is changing during adolescence. Adolescents tend to drink larger quantities on each drinking occasion than adults; this may in part be because adolescents are less sensitive to some of the unpleasant effects of intoxication. However, research suggests that adolescents may be more sensitive to some of alcohol’s harmful effects on brain function. Studies in rats found that alcohol impairs the ability of adolescent animals more than adult animals to learn a task that requires spatial memory. Research also suggests a mechanism for this effect; in adolescents more than adults, alcohol inhibits the process in which, with repeated experience, nerve impulses travel more easily across the gap between nerve cells (i.e., neurons) involved in the task being learned. The reasons for these differences in sensitivity to alcohol remain unclear.

Research also has found differences in the effects of bingelike drinking in adolescents compared with adults. Normally, as people age from adolescence to adulthood, they become more sensitive to alcohol’s effects on motor coordination. In one study, however, adolescent rats exposed to intermittent alcohol never developed this increased sensitivity. Other studies in both human subjects and animals suggest that the adolescent brain may be more vulnerable than the adult brain to chronic alcohol abuse.

Young people who reported beginning to drink at age 14 or younger also were four times more likely to report meeting the criteria for alcohol dependence at some point in their lives than were those who began drinking after age 21. Although it is possible that early alcohol use may be a marker for those who are at risk for alcohol disorders, an important question is whether early alcohol exposure may alter neurodevelopment in a way that increases risk of later abuse. Research in rats has found that prenatal or early postnatal exposure to alcohol results in a greater preference for the odor and consumption of alcohol later in life. Social experiences associated with youthful drinking also may influence drinking later in life. Additional research is needed to resolve the question of whether and how early alcohol exposure might contribute to drinking problems years down the road.

NIAAA(2013) http://pubs.niaaa.nih.gov/publications/arh283/125-132.htm

Alcohol greatly effects our physiological system, both acutely and chronically, it impairs our judgments and can lead to permanent damage to our bodies.  Because it is so widely used many of the dangerous effects of alcohol are overlooked, but the statistics show how dangerous a drug it really is.

 

 

Alcohol use/misuse in the U.S.

As stated in my earlier blogs, alcohol has been used in our country  since its inception, and civilizations for 10,000 years. In fact Christopher Columbus had alcohol on the Santa Maria when he arrived in America.  The use and misuse of alcohol has been prominent since it was developed, and the number of deaths from alcohol has always been a high percentage in our country.  The number of deaths between 2006-2010 in the United States from alcohol was 620,259 (Your Health-Nancy Shute, June 26, 2014)

Trends it the past 10-15 years have held steady for consumption, but alcohol related deaths by drinking and driving have decreased.

Proportions of alcohol caused deaths by those of a blood concentration of .08 and higher went from .35 in 1982, to .20 in 2005.(Source: U.S. Department of Transportation, National Highway Traffic Safety Administration, Traffic Safety Facts 2005, p. 34.)

  • Slightly more than half (52.1 percent) of Americans aged 12 or older reported being current drinkers of alcohol in the 2012 survey, which was similar to the rate in 2011 (51.8 percent). This translates to an estimated 135.5 million current drinkers in 2012.
  • Nearly one quarter (23.0 percent) of persons aged 12 or older in 2012 were binge alcohol users in the 30 days prior to the survey. This translates to about 59.7 million people. The rate in 2012 was similar to the rate in 2011 (22.6 percent).
  • In 2012, heavy drinking was reported by 6.5 percent of the population aged 12 or older, or 17.0 million people. This percentage was similar to the rate of heavy drinking in 2011 (6.2 percent).
  • Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2012

    Figure 3.1

(Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.)

We can see that use is still high for binge drinking, nearly 1/4 of people ages 12 and older binge drink, which come out to almost 60 million people overall.

 

History of Alcohol

Alcohol is a product that has provided a variety of functions for people throughout all history. From the earliest times to the present, alcohol has played an important role in religion and worship. Historically, alcoholic beverages have served as sources of needed nutrients and have been widely used for their medicinal, antiseptic, and analgesic properties. The role of such beverages as thirst quenchers is obvious and they play an important role in enhancing the enjoyment and quality of life. They can be a social lubricant, can facilitate relaxation, can provide pharmacological pleasure, and can increase the pleasure of eating. Thus, while alcohol has always been misused by a minority of drinkers, it has proved to be beneficial to most.

Here is a timeline on the history of alcohol:

Timeline: History of Alcohol

Visit the new World Alcohol and Drinking History Timeline. This timeline presents events in the history of alcohol and drinking over the past 12,000 years.

 

While no one knows when beverage alcohol was first used, it was presumably the result of a fortuitous accident that occurred at least tens of thousands of years ago. However, the discovery of late Stone Age beer jugs has established the fact that intentionally fermented beverages existed at least as early as the Neolithic period (cir. 10,000 B.C.) (Patrick, 1952, pp. 12-13), and it has been suggested that beer may have preceded bread as a staple (Braidwood et al, 1953; Katz and Voigt, 1987); wine clearly appeared as a finished product in Egyptian pictographs around 4,000 B.C. (Lucia, 1963a, p. 216).

The earliest alcoholic beverages may have been made from berries or honey (Blum et al, 1969, p. 25; Rouech, 1960, p. 8; French, 1890, p. 3) and winemaking may have originated in the wild grape regions of the Middle East. Oral tradition recorded in the Old Testament (Genesis 9:20) asserts that Noah planted a vineyard on Mt. Ararat in what is now eastern Turkey. In Sumer, beer and wine were used for medicinal purposes as early as 2,000 B.C. (Babor, 1986, p. 1).

Brewing dates from the beginning of civilization in ancient Egypt (Cherrington, 1925, v. 1, p. 404) and alcoholic beverages were very important in that country. Symbolic of this is the fact that while many gods were local or familial, Osiris, the god of wine, was worshiped throughout the entire country (Lucia, 1963b, p. 152). The Egyptians believed that this important god also invented beer (King, 1947, p. 11), a beverage that was considered a necessity of life; it was brewed in the home “on an everyday basis” (Marciniak, 1992, p. 2).

So we can see alcohol has been around for ages, and probably is not going anywhere soon.  It has been entrenched in our society and is a blood line for our cultures, for better or worse.