The Demon Drink
Alcohol brings out the best, and the worst, in writers.
Poets have hymned its praises as a stimulant, an aphrodisiac and, sometimes, almost as a way of life. Literature abounds with extravagant descriptions of alcoholic drinks: wine has been called 'the nectar of the gods'; and the Gaelic word for whisky means 'the water of life'.
These impressive descriptions and a wealth of folklore about drink's 'medicinal' qualities suggest that alcohol must be one of the most valuable medicines available to man. Yet in modern medical treatment the value of ethyl alcohol (the methylated variety causes blindness and insanity if it is drunk) is pretty limited: as a pure liquid it is sometimes used as an antiseptic; as a drink it may be given as a tranquillizer or to dilate small arteries in the body. There are many other substances, however, which can do these jobs much more effectively.
Why has such a relatively unimportant medicine gained such an impressive reputation?
One reason must be the quite false belief that alcohol is a stimulant. The reality is that it is a depressant and acts on the brain in much the same way as do the anesthetics used in the operating theater.
Given in large enough quantities alcohol can induce sleep or even kill.
This depressant effect of alcohol appears quite clearly in laboratory experiments.
Scientific tests of behavior show that an increasing level of alcohol in the bloodstream causes a steady deterioration of performance in all those tests that need skill or patience in their execution. As the blood level of alcohol rises, logical thought and purposeful activity also grow progressively disorganized and the drinker progressively loses his sense of restraint and discrimination. As this happens, his personality will usually become more expansive and vivacious , although in a few people it may become more morose and inward looking.
At very high concentrations, alcohol - like any other anesthetic - produces unconsciousness. At even higher concentrations it may depress the brain center which controls breathing. If it does, breathing will stop and the drinker will die. As the lethal blood concentration is very close to that which produces unconsciousness, the drinker who 'passes out' should never be neglected. Absorption of more alcohol from his stomach might raise the blood concentration to a lethal level.
With all this evidence to show that it acts as a depressant, why has alcohol earned a reputation as a stimulant? This reputation probably grew from the immediate changes in personality that occur in people who have had a few drinks- most of them are more likely to grow noisy and expansive than morose. This appearance of stimulation occurs because alcohol first knocks out the more sophisticated - and therefore more complex - centers in the brain. The less complicated centers are affected only at higher concentrations of alcohol in the blood. The first centers to be depressed are the sophisticated ones which normally put a brake on the lower centers of instinctive animal behavior. These sophisticated centers normally control our behavior in terms of judgement, discrimination, restraint, self-control and other qualities which make men civilized animals. When their control on the lower centers is depressed, the release of more instinctive, animal-like and noisy behavior gives a false impression of stimulation.
The saying that people reveal what they are really like after a few drinks is very near the truth. Alcohol reveals how they behave without the control by the higher centers. And the reputation that alcohol has as a mild pain killer is probably due to its power to alter a person's attitude to pain or distress.
The precise chemical changes that alcohol produces in the brain cells when it depresses their activity are not known.
We do know, however, that whatever the chemical changes are, they are greatly enhanced when certain drugs- particularly sleeping tablets and tranquillizers - are taken at the same time.
Regular consumption of alcohol produces tolerance to the effects of the drug more has to be taken to produce an effect - but tolerance to alcohol never develops to the same extent as it does with other drugs of addiction. By making a conscious effort most people can resist the effects of small amounts of alcohol and regular drinkers learn to compensate for them. Many people, however, believe that they can fight off the effects of drinking more effectively than others with less 'hard heads'. This belief is often an illusion.
Because the brain centers giving judgement are the first to be knocked out, a drinker will often think he is behaving more soberly than in fact he is. What is a hangover? Most drinkers know what it feels like but scientists don't know exactly what it is. The word 'hangover' is used to describe different after effects of alcohol which may occur singly or in combination. The commonest is headache.
Most hangover headaches are probably caused by the over-smoking that usually accompanies drinking and by the fact that drinking often takes place in unventilated and smoky places. The second most common component of a hangover, an upset stomach, is caused by the irritating effect of alcohol on the lining of the stomach - an effect that can be reduced if food is taken with the drink or before drinking begins. Food not only dilutes the drink and makes it less irritating to the sensitive stomach lining, it also delays the absorption of alcohol into the blood stream.
Commonly, a hangover is a combination of headache, nausea, dizziness, lethargy, and a feeling of 'being hit by a truck'.
Most of these symptoms are the result of dehydration and are more likely to occur after the drinking of beer than of wine or spirits. The body becomes dehydrated - short of water - after drinking, because alcohol is a diuretic, a substance that stimulates the kidney to filter water from the blood stream. Because of this diuretic effect a person drinking alcohol will pass more water than he consumes; and although a beer drinker may have consumed seven or eight pints in an evening, he will pass more than this quantity of water in his urine. The following morning his blood will be short of water, and this 'thickening' of the blood fluid will increase the concentration in it of various mineral salts. This increased concentration is almost certainly the cause of most of the 'dehydration symptoms' in a hangover and one of the best ways of preventing a hangover after drinking several pints of beer is to drink a pint of water before going to bed.
Another 'hangover cure' is aspirin -preferably in soluble form so that it irritates the stomach less - which often relieves the headache and pains in the limbs. Other 'morning after' treatments like vitamin C, a 'hair of the dog', Bloody Marys and Prairie Oysters seem to work better in some people than in others and their effectiveness may depend on the faith with which they are taken.
Alcoholism - as opposed to occasional alcoholic excess - is true addiction to alcohol and is a disease. The alcoholic gets no pleasure out of drinking, but feels he can't survive without a drink. Alcoholism is three times more common in men than in women, and is much commoner in cities than in country areas.
Alcohol is a particularly dangerous drug to which to become addicted because it can produce severe damage in different parts of the body- the stomach, the liver, the nerves in the limbs - and can cause irreversible damage to the brain and the intellectual capacity of the addict.
A tendency to alcoholism can be inherited but heredity is probably less important a cause than used to be thought. It is much less important than a person's occupation.
Alcoholism is common among barmen, commercial travelers, journalists, and those who work in hot and dusty industries than in other occupations. Social surroundings are also important. Sordid housing, boring work or an unhappy family life can all play their part in inducing alcoholism. More important than either the social or the occupational causes, however, is the mental make-up of the individual. A man usually becomes an alcoholic by coming to rely on alcohol as an easy way of escaping from difficulties which other people put up with or overcome.
People who have been alcoholics for some time don't get 'drunk' in the ordinary sense and are often able to take amounts of alcohol which would produce marked effects in a normal person. The main signs of alcoholism are progressive psychological and physical deterioration of the addict. As the psychological deterioration progresses, the alcoholic grows more and more irritable and his mental ability starts to fall off. The quality of his work starts to deteriorate; he becomes careless and unpunctual and can't summon up the mental concentration needed to finish a job he doesn't want to do.
Although many can get through their work only with the help of alcohol they have very little insight into this and resist any suggestion that their failings may be due to alcohol. Sometimes, a chronic alcoholic can become very skilled at disguising the psychological deterioration and many become severely depressed. This depression may lead to attempts at suicide.
The physical deterioration often starts with the alcoholic growing fat and flabby but, in the later stages of the disease, he may lose weight rapidly both because of under-nourishment and because of the effects of alcohol on the liver. Because the alcoholic can raise most of the energy his body needs from alcohol, he very often survives on an inadequate and unbalanced diet. Alcohol seems to affect the absorption of vitamin B from the diet, so many alcoholics show signs of a vitamin B deficiency.
A lack of fresh fruit and vegetables in his diet may lead to vitamin C deficiency.
As more alcohol is taken the lining of the stomach and bowel becomes chronically irritated, cells in the liver die and are replaced with fibrous tissue - a condition called cirrhosis of the liver- and the heart muscle and nerves in the limbs may deteriorate because of inadequate nutrition.
Because their resistance is so low, alcoholics are more likely than other people to get infections such as pneumonia and tuberculosis and, of course, their debilitated condition makes recovery difficult.
Alcoholism also produces its own symptoms.
Perhaps the best known is delirium tremens, which usually follows a debauch or comes on when the alcoholic catches an infection or suffers a severe injury. It begins with restlessness and sleeplessness, which develops into a delirium after a day or two. The most striking features of the delirium are terrifying hallucinations, which often take the form of animals such as snakes and rats from which the alcoholic tries to escape.
Sometimes he may recognize people he knows. More often he misidentifies them.
The delirium usually lasts between three and five days and then the sufferer falls into a deep sleep. When he wakes up he has only a slight memory of the delirious period. When delirium threatens it may be averted by immediate doses of alcohol, and alcoholics who have been drinking should always be given alcohol if they are suddenly taken ill or sustain an injury.
The only effective treatment of alcoholism is for the addict to stop drinking. Methods used by doctors to help him do this include drugs which make the alcoholic sick every time he has a drink, and 'aversion therapy'. Aversion therapy is designed to produce in the patient an unpleasant reaction to the sight, smell and taste of alcohol. By using drugs under hospital care, the patient is conditioned to feel sick whenever alcohol is produced.
Because the success of treatment depends on the addict's resolution to break his addict ion, treatment should be given to sustain this resolution. The most valuable development in this approach has been the emergence of Alcoholics Anonymous, an organization run entirely by alcoholics who have stopped drinking. The success of Alcoholics Anonymous is largely due to the understanding that a reformed drinker has of an alcoholic's problems and the way in which an individual's problems that drive him to drink are much more easily managed if they are handled by a group.
Drugs can be used to counteract the physical deterioration that occurs in alcoholism. Vitamin B injections can be given into a vein to replace that which is not absorbed from the intestine. Drugs can also be used to treat the psychological causes which may have predisposed the alcoholic to drinking and to ease him over withdrawal effects. But no drugs can halt deterioration if drinking continues. Alcoholism should not be confused with dipsomania, which is a condition where a patient suffers attacks of acute alcoholism.
Between attacks the dipsomaniac may be an apparently normal individual, but with each attack comes an uncontrollable craving for alcohol which must be satisfied at all costs. Dipsomania is often inherited and usually occurs in middle age.
Yet the dangers should not be over-exaggerated; alcohol has an enormous part to play in society, lubricating the social machinery.
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