For most individuals, alcohol is a social drink, one to socialize with and drink in moderation. However, for others, alcohol can cause serious health problems. This is the case when a person suffers from alcoholism. Alcoholism (or alcohol use disorder) is where a person’s drinking of alcoholic beverages results in mental or physical health problems, yet despite this the alcoholic cannot seem to stop drinking. While there are many clinical definitions of what makes up alcohol use disorder, it can be summarized simply as abuse of alcohol to the point where one’s drinking begins to affect aspects of their life. Whether it be personal relationships, financially, or failing to meet obligations due to their consumption of alcohol. Usually, those closest to the alcoholic can see the problem long before the alcoholic admits they even have one.
The consequences of a long-term drinking problem can exact a heavy toll on a person’s health. The health risks from long term alcohol abuse range from: liver damage, stroke, various types of cancer, Wernicke-Korsakoff syndrome (also known as wet brain), along with health risks associated with traffic accidents while intoxicated. In general, the human body treats alcohol as a toxin and begins to attempt to eliminate the substance upon ingestion. The body's attempt to quickly process alcohol begins a reaction where it starts to metabolize and excrete the substance. Due to the rapid metabolism the body directly eliminates somewhere between 2-10% of the alcohol without directly passing through the digestive tract and entering the bloodstream via exhalation, sweat, saliva and urine. The remaining 90-98% is processed through the liver and then excreted through the kidneys and lungs.
When speaking of alcohol use disorder, it is important to note that alcohol affects men and women differently. In women, more alcohol enters the blood stream as ethanol than in men. This is in part due to several differences in the biology of men and women. A man and a woman of the comparable size have differences in their bodies. The woman has a lower percentage of water in their body than men and on average a lower muscle content and higher fat content. This lower Body Mass Index (BMI) intensifies the effects of alcohol. In other words, less does more in comparison to a male of the same body size and weight. This lower BMI means that women metabolize a quarter as much alcohol as men. When it takes longer to metabolize into ethyl glucuronide (EtG) the effect of the alcohol has a faster onset and longer length of duration on the body. Furthermore, there are a group of enzymes (alcohol dehydrogenases) that facilitate the break-down of alcohol to metabolize it more efficiently. Females carry less of this particular enzyme in their stomach which is why they metabolize only a quarter as much as males do. Beyond the physical differences in which alcohol is broken down in the body in comparison to men, women have physical differences that place them at different varying risks associated with alcohol abuse and use. When women are about to enter their menstrual cycle (premenstrual cycle) the absorption of alcohol is increased in their bodies. Lengthy use of alcohol can delay a women's menstrual cycle as well. Those women who are heavier drinkers can also raise their chances of infertility and complications of birth during pregnancy. Fetal Alcohol syndrome and having the baby born addicted is also a risk for women who continue to drink into their pregnancy via transfer to the blood brain barrier between them and the child. Studies have also shown an increase in the risk of cancer for long-term heavy alcoholics in men and women with women having the greater risk of developing cancer.
The long-term health risks are bad enough, but what happens when somebody decides they are an alcoholic and wish to stop drinking? If a person has an alcohol abuse disorder, they may have become chemically dependent on alcohol and discontinuing the use will result in withdrawal symptoms. It is never advisable to abruptly stop consuming alcohol without the supervision of medical professionals in a detox or hospital setting. Alcohol withdrawals can in fact be fatal if unmanaged. The withdrawal symptoms may include the following: sweats, nausea, vomiting, speech impairments, difficulty walking, disorientation, seizures and possibly even delirium tremens.
Upon admission to a detox facility, a patient will be evaluated by the clinical practitioner and medical staff. The staff will make an assessment and determination of the proper course of treatment for the withdrawal symptoms depending on the severity. All those entering detox for alcohol abuse will be closely monitored by the facility staff as a precaution due to the severity of the health risks associated with alcohol withdrawals. If the symptoms are severe enough the clinicians will recommend the use of medication. The most common medication protocol for alcohol detox is the use of a slowly metabolized benzodiazepine (such as Ativan, Valium or Librium). This medication will be administered throughout the day every few hours until improvement in the patient’s condition is documented by the clinical staff. The patient would also have their heart rate and blood pressure monitored closely during their stay at detox. Once the client’s symptoms lessen then the medical staff will begin to taper down the dosage of the prescribed benzodiazepine according to the severity of symptoms the client is currently experiencing.
Another medication protocol for alcohol detox is the use of barbiturates such as phenobarbital. The use of barbiturates used to be the standard practice for alcohol withdrawals. However, since the introduction of benzodiazepines they have been used less and less frequently. Barbiturates cause more respiratory and cardiac depression than benzodiazepines. While they bring the heart rate and pulse down quicker the residual side effects are less desired. With barbiturates clients can often lose consciousness and drift into a dreamless sleep as well as a hangover sort of feeling when being tapered off.
It should be noted that neither of these protocols should be administered on an outpatient basis. A patient going through withdrawals from alcohol should be in a medical detoxification or hospitalization setting as they need to be constantly monitored by medical personnel. Alcohol detox can be difficult especially for those who have been drinking for many years.