FROM AN $800 BOTTLE OF DE LA Romance-Conti, vintage 1978, to the
crudest, rudest moonshine, alcohol impairs far more than our judgment and
coordination. While we absorb the active ingredient of many psychoactive
drugs in minuscule quantities -- an ant can carry a few hits of LSD
comfortably on its back -- a drinker literally floods the body with
alcohol. "Alcohol is problematic in part because it's so impotent,"
points out John Morgan, M.D., pharmacologist at City University Medical
School in New York. "Other mood-altering substances are active in the
bloodstream at literally thousands of magnitudes below what is required
for alcohol."
As a result, alcohol -- particularly in alcoholics, who can tolerate
large amounts of liquor -- exerts its toxic effect on virtually every organ
system in the body, says Anthony Verga, M.D., medical director of Long
Island's Seafield Center. The repercussions range from W.C. Fields's
perpetually red nose to a torqued and failing liver common in
alcoholics.
The liver, in fact, is the body's main line of defense against
intoxication. But the fight is hardly fair. The organ's supply of alcohol
dehydrogenase -- the enzyme that helps break alcohol down into harmless
water and carbon dioxide -- can only handle about one drink's worth of
alcohol an hour. Worse, the process produces acetaldehyde, a highly toxic
chemical that attacks nearby tissues. The result is a variety of
disorders. One of the gravest, cirrhosis, kills 26,000 Americans each
year. But the liver is by no means the only casualty of
alcoholism:
o After a few years of heavy drinking, some alcoholics develop
pancreatitis, a painful inflammation of the pancreas.
o The heart wastes away, a condition called alcoholic
cardiomyopathy.
o Drinking impairs blood flow. Heavy drinking can increase risk of
stroke.
o A pregnant woman who drinks heavily can give birth to a baby with
Fetal Alcohol syndrome (FAS), one of the leading causes of mental
retardation. FAS occurs in up to 29 out of every 1,000 live births among
known alcoholic mothers. Babies suffer lifelong neurological, anatomical,
and behavioral problems. Some of them never learn to speak. Recent
research indicates the casualty rate may be higher than once thought:
Even babies appearing normal in infancy often grow up to manifest FAS
disabilities.
o Alcohol takes its greatest toll on the brain. A small percentage
of alcoholics may, after years, develop such severe brain damage that
they remain permanently confused or become psychotic, suffering from
auditory hallucinations. At least 45 percent of alcoholics entering
treatment display some difficulty with problem solving, abstract
thinking, psychomotor performance, and difficult memory tasks. About one
in 10 suffers severe disorders like dementia.
Why can't a drunk brain think? Is there any way to correct the
misfiring that chronic alcohol use induces? Alcohol appears to stimulate
GABA in the brain: "What GABA does is slow down the firing of the cell on
which the receptor is located," says Kranzler. This neuronal inhibition
may contribute to the telltale signs of intoxication, from slurred speech
to nodding off in mid-sentence. And, while Valium and barbiturates are
distinctly different drugs than alcohol, they also target the GABA(A)
receptor, suggesting a kinship.
Alcohol cuts a far wider swath than GABA; it alters other receptors
in the human brain:
o Drinking inhibits two of the three receptors for glutamate, the
primary brain fuel and GABA's chemical opposite.
o Alcohol increases levels of a chemical messenger known as cyclic
AMP, crucial for the healthy functioning of brain cells. To compensate,
the brain reduces cyclic AMP levels, and over the long term, cells
require alcohol to achieve normal levels.
o Levels of dopamine and serotonin, which contribute to behavioral
reinforcement, also rise with alcohol consumption. Their increase may
explain how alcohol tightens its grip on a drinker's habit.
o Alcohol increases levels of the brain's natural opiates,
endorphins and enkephalins. This may be the key to the eternal, if
politically incorrect, question: Why is drinking so much fun?
Alcohol addiction is real, and withdrawal from alcohol can require
a period of unpleasant detoxification. During that period, a former
drinker can suffer acute anxiety, irritability, insomnia, increased blood
pressure and body temperature, and severe, though temporary, confusion.
Acute symptoms may fade after a week, but subtler symptoms of unease and
insomnia may persist for months, making it difficult to remain
alcohol-free.
Until recently, it has been an axiom of alcoholism treatment that
withdrawal requires a (usually) month-long intensive in-patient treatment
regimen, and then often a modified regimen where former drinkers live in
halfway houses for up to six months. During the intensive phase, the
alcoholic can detoxify from the drug while immersed in 24-hour support
with other recovering alcoholics and counselors (often former alcoholics
themselves). Group therapy is a feature of these programs, designed to
break through the alcoholics' wall of denial and help set them on the
straight and narrow path to a substance-free life. These programs can
cost $16,000 or more per month.
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