Re: FACTS-Read Chris...

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Common signs and symptoms of alcohol abuse include:

Repeatedly neglecting your responsibilities at home, work, or school because of your drinking. For example, performing poorly at work, flunking classes, neglecting your kids, or skipping out on commitments because youre hung over.
Using alcohol in situations where its physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctors orders.
Experiencing repeated legal problems on account of your drinking. For example, getting arrested for driving under the influence or for drunk and disorderly conduct.
Continuing to drink even though your alcohol use is causing problems in your relationships. Getting drunk with your buddies, for example, even though you know your wife will be very upset, or fighting with your family because they dislike how you act when you drink.
Drinking as a way to relax or de-stress. Many drinking problems start when people use alcohol to self-soothe and relieve stress. Getting drunk after every stressful day, for example, or reaching for a bottle every time you have an argument with your spouse or boss.
Signs and symptoms of alcoholism (alcohol dependence)

ALCOHOLS DAMAGING EFFECTS ON THE BRAIN

Difficulty walking, blurred vision, slurred speech, slowed reaction times, impaired memory: Clearly, alcohol affects the brain. Some of these impairments are detectable after only one or two drinks and quickly resolve when drinking stops. On the other hand, a person who drinks heavily over a long period of time may have brain deficits that persist well after he or she achieves sobriety. Exactly how alcohol affects the brain and the likelihood of reversing the impact of heavy drinking on the brain remain hot topics in alcohol research today.

We do know that heavy drinking may have extensive and farreaching effects on the brain, ranging from simple slips in memory to permanent and debilitating conditions that require lifetime custodial care. And even moderate drinking leads to shortterm impairment, as shown by extensive research on the impact of drinking on driving.

A number of factors influence how and to what extent alcohol affects the brain (1), including

how much and how often a person drinks;
the age at which he or she first began drinking, and how long he or she has been drinking;
the persons age, level of education, gender, genetic background, and family history of alcoholism;
whether he or she is at risk as a result of prenatal alcohol exposure; and
his or her general health status.

This Alcohol Alert reviews some common disorders associated with alcoholrelated brain damage and the people at greatest risk for impairment. It looks at traditional as well as emerging therapies for the treatment and prevention of alcoholrelated disorders and includes a brief look at the hightech tools that are helping scientists to better understand the effects of alcohol on the brain.
BLACKOUTS AND MEMORY LAPSES

Alcohol can produce detectable impairments in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events.

Blackouts are much more common among social drinkers than previously assumed and should be viewed as a potential consequence of acute intoxication regardless of age or whether the drinker is clinically dependent on alcohol (2). White and colleagues (3) surveyed 772 college undergraduates about their experiences with blackouts and asked, Have you ever awoken after a night of drinking not able to remember things that you did or places that you went? Of the students who had ever consumed alcohol, 51 percent reported blacking out at some point in their lives, and 40 percent reported experiencing a blackout in the year before the survey. Of those who reported drinking in the 2 weeks before the survey, 9.4 percent said they blacked out during that time. The students reported learning later that they had participated in a wide range of potentially dangerous events they could not remember, including vandalism, unprotected sex, and driving.

Binge Drinking and Blackouts

Drinkers who experience blackouts typically drink too much and too quickly, which causes their blood alcohol levels to rise very rapidly. College students may be at particular risk for experiencing a blackout, as an alarming number of college students engage in binge drinking. Binge drinking, for a typical adult, is defined as consuming five or more drinks in about 2 hours for men, or four or more drinks for women.

Equal numbers of men and women reported experiencing blackouts, despite the fact that the men drank significantly more often and more heavily than the women. This outcome suggests that regardless of the amount of alcohol consumption, femalesa group infrequently studied in the literature on blackoutsare at greater risk than males for experiencing blackouts. A womans tendency to black out more easily probably results from differences in how men and women metabolize alcohol. Females also may be more susceptible than males to milder forms of alcoholinduced memory impairments, even when men and women consume comparable amounts of alcohol (4).
ARE WOMEN MORE VULNERABLE TO ALCOHOLS EFFECTS ON THE BRAIN?

Women are more vulnerable than men to many of the medical consequences of alcohol use. For example, alcoholic women develop cirrhosis (5), alcoholinduced damage of the heart muscle (i.e., cardiomyopathy) (6), and nerve damage (i.e., peripheral neuropathy) (7) after fewer years of heavy drinking than do alcoholic men. Studies comparing men and womens sensitivity to alcoholinduced brain damage, however, have not been as conclusive.

Using imaging with computerized tomography, two studies (8,9) compared brain shrinkage, a common indicator of brain damage, in alcoholic men and women and reported that male and female alcoholics both showed significantly greater brain shrinkage than control subjects. Studies also showed that both men and women have similar learning and memory problems as a result of heavy drinking (10). The difference is that alcoholic women reported that they had been drinking excessively for only about half as long as the alcoholic men in these studies. This indicates that womens brains, like their other organs, are more vulnerable to alcoholinduced damage than mens (11).

Yet other studies have not shown such definitive findings. In fact, two reports appearing side by side in the American Journal of Psychiatry contradicted each other on the question of genderrelated vulnerability to brain shrinkage in alcoholism (12,13). Clearly, more research is needed on this topic, especially because alcoholic women have received less research attention than alcoholic men despite good evidence that women may be particularly vulnerable to alcohols effects on many key organ systems.
BRAIN DAMAGE FROM OTHER CAUSES

People who have been drinking large amounts of alcohol for long periods of time run the risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may result indirectly, from a poor general health status or from severe liver disease.

For example, thiamine deficiency is a common occurrence in people with alcoholism and results from poor overall nutrition. Thiamine, also known as vitamin B1, is an essential nutrient required by all tissues, including the brain. Thiamine is found in foods such as meat and poultry; whole grain cereals; nuts; and dried beans, peas, and soybeans. Many foods in the United States commonly are fortified with thiamine, including breads and cereals. As a result, most people consume sufficient amounts of thiamine in their diets. The typical intake for most Americans is 2 mg/day; the Recommended Daily Allowance is 1.2 mg/day for men and 1.1 mg/day for women (14).
WernickeKorsakoff Syndrome

Up to 80 percent of alcoholics, however, have a deficiency in thiamine (15), and some of these people will go on to develop serious brain disorders such as WernickeKorsakoff syndrome (WKS) (16). WKS is a disease that consists of two separate syndromes, a shortlived and severe condition called Wernickes encephalopathy and a longlasting and debilitating condition known as Korsakoffs psychosis.

The symptoms of Wernickes encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and difficulty with muscle coordination. For example, patients with Wernickes encephalopathy may be too confused to find their way out of a room or may not even be able to walk. Many Wernickes encephalopathy patients, however, do not exhibit all three of these signs and symptoms, and clinicians working with alcoholics must be aware that this disorder may be present even if the patient shows only one or two of them. In fact, studies performed after death indicate that many cases of thiamine deficiencyrelated encephalopathy may not be diagnosed in life because not all the classic signs and symptoms were present or recognized.
Human Brain

Regions vulnerable to alcohol

Schematic drawing of the human brain, showing regions vulnerable to alcoholism-related abnormalities.

Approximately 80 to 90 percent of alcoholics with Wernickes encephalopathy also develop Korsakoffs psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoffs psychosis are forgetful and quickly frustrated and have difficulty with walking and coordination (17). Although these patients have problems remembering old information (i.e., retrograde amnesia), it is their difficulty in laying down new information (i.e., anterograde amnesia) that is the most striking. For example, these patients can discuss in detail an event in their lives, but an hour later might not remember ever having the conversation.

Treatment

The cerebellum, an area of the brain responsible for coordinating movement and perhaps even some forms of learning, appears to be particularly sensitive to the effects of thiamine deficiency and is the region most frequently damaged in association with chronic alcohol consumption. Administering thiamine helps to improve brain function, especially in patients in the early stages of WKS. When damage to the brain is more severe, the course of care shifts from treatment to providing support to the patient and his or her family (18). Custodial care may be necessary for the 25 percent of patients who have permanent brain damage and significant loss of cognitive skills (19).

Scientists believe that a genetic variation could be one explanation for why only some alcoholics with thiamine deficiency go on to develop severe conditions such as WKS, but additional studies are necessary to clarify how genetic variants might cause some people to be more vulnerable to WKS than others.
LIVER DISEASE

Most people realize that heavy, longterm drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. But people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy (20).

Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma), which can be fatal.

New imaging techniques have enabled researchers to study specific brain regions in patients with alcoholic liver disease, giving them a better understanding of how hepatic encephalopathy develops. These studies have confirmed that at least two toxic substances, ammonia and manganese, have a role in the development of hepatic encephalopathy. Alcoholdamaged liver cells allow excess amounts of these harmful byproducts to enter the brain, thus harming brain cells.

Treatment

Physicians typically use the following strategies to prevent or treat the development of hepatic encephalopathy.

Treatment that lowers blood ammonia concentrations, such as administering Lornithine Laspartate.

Techniques such as liverassist devices, or artificial livers, that clear the patients blood of harmful toxins. In initial studies, patients using these devices showed lower amounts of ammonia circulating in their blood, and their encephalopathy became less severe (21).

Liver transplantation, an approach that is widely used in alcoholic cirrhotic patients with severe (i.e., endstage) chronic liver failure. In general, implantation of a new liver results in significant improvements in cognitive function in these patients (22) and lowers their levels of ammonia and manganese (23).

ALCOHOL AND THE DEVELOPING BRAIN

Drinking during pregnancy can lead to a range of physical, learning, and behavioral effects in the developing brain, the most serious of which is a collection of symptoms known as fetal alcohol syndrome (FAS). Children with FAS may have distinct facial features (see illustration). FAS infants also are markedly smaller than average. Their brains may have less volume (i.e., microencephaly). And they may have fewer numbers of brain cells (i.e., neurons) or fewer neurons that are able to function correctly, leading to longterm problems in learning and behavior.
Fetal Alcohol Syndrome

FAS facial features

Children with fetal alcohol syndrome (FAS) may have distinct facial features.

Treatment

Scientists are investigating the use of complex motor training and medications to prevent or reverse the alcoholrelated brain damage found in people prenatally exposed to alcohol (24). In a study using rats, Klintsova and colleagues (25) used an obstacle course to teach complex motor skills, and this skills training led to a reorganization in the adult rats brains (i.e., cerebellum), enabling them to overcome the effects of the prenatal alcohol exposure. These findings have important therapeutic implications, suggesting that complex rehabilitative motor training can improve motor performance of children, or even adults, with FAS.

Scientists also are looking at the possibility of developing medications that can help alleviate or prevent brain damage, such as that associated with FAS. Studies using animals have yielded encouraging results for treatments using antioxidant therapy and vitamin E. Other preventive therapies showing promise in animal studies include 1octanol, which ironically is an alcohol itself. Treatment with loctanol significantly reduced the severity of alcohols effects on developing mouse embryos (26). Two molecules associated with normal development (i.e., NAP and SAL) have been found to protect nerve cells against a variety of toxins in much the same way that octanol does (27). And a compound (MK801) that blocks a key brain chemical associated with alcohol withdrawal (i.e., glutamate) also is being studied. MK801 reversed a specific learning impairment that resulted from early postnatal alcohol exposure (28).

Though these compounds were effective in animals, the positive results cited here may or may not translate to humans. Not drinking during pregnancy is the best form of prevention; FAS remains the leading preventable birth defect in the United States today.
GROWING NEW BRAIN CELLS

For decades scientists believed that the number of nerve cells in the adult brain was fixed early in life. If brain damage occurred, then, the best way to treat it was by strengthening the existing neurons, as new ones could not be added. In the 1960s, however, researchers found that new neurons are indeed generated in adulthooda process called neurogenesis (29). These new cells originate from stem cells, which are cells that can divide indefinitely, renew themselves, and give rise to a variety of cell types. The discovery of brain stem cells and adult neurogenesis provides a new way of approaching the problem of alcoholrelated changes in the brain and may lead to a clearer understanding of how best to treat and cure alcoholism (30).

For example, studies with animals show that high doses of alcohol lead to a disruption in the growth of new brain cells; scientists believe it may be this lack of new growth that results in the longterm deficits found in key areas of the brain (such as hippocampal structure and function) (31,32). Understanding how alcohol interacts with brain stem cells and what happens to these cells in alcoholics is the first step in establishing whether the use of stem cell therapies is an option for treatment (33).
SUMMARY

Alcoholics are not all alike. They experience different degrees of impairment, and the disease has different origins for different people. Consequently, researchers have not found conclusive evidence that any one variable is solely responsible for the brain deficits found in alcoholics. Characterizing what makes some alcoholics vulnerable to brain damage whereas others are not remains the subject of active research (34).

The good news is that most alcoholics with cognitive impairment show at least some improvement in brain structure and functioning within a year of abstinence, though some people take much longer (3537). Clinicians must consider a variety of treatment methods to help people stop drinking and to recover from alcoholrelated brain impairments, and tailor these treatments to the individual patient.

Advanced technology will have an important role in developing these therapies. Clinicians can use brainimaging techniques to monitor the course and success of treatment, because imaging can reveal structural, functional, and biochemical changes in living patients over time. Promising new medications also are in the early stages of development, as researchers strive to design therapies that can help prevent alcohols harmful effects and promote the growth of new brain cells to take the place of those that have been damaged by alcohol.

Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms of alcohol abuse, but it also involves another element: physical dependence on alcohol. If you rely on alcohol to function or feel physically compelled to drink, youre an alcoholic.
Tolerance: The 1st major warning sign of alcoholism

Do you have to drink a lot more than you used to in order to get buzzed or to feel relaxed? Can you drink more than other people without getting drunk? These are signs of tolerance, which can be an early warning sign of alcoholism. Tolerance means that, over time, you need more and more alcohol to feel the same effects.
Withdrawal: The 2nd major warning sign of alcoholism

Do you need a drink to steady the shakes in the morning? Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism and a huge red flag. When you drink heavily, your body gets used to the alcohol and experiences withdrawal symptoms if its taken away. These include:

Anxiety or jumpiness
Shakiness or trembling
Sweating
Nausea and vomiting
Insomnia



Depression
Irritability
Fatigue
Loss of appetite
Headache

In severe cases, withdrawal from alcohol can also involve hallucinations, confusion, seizures, fever, and agitation. These symptoms can be dangerous, so talk to your doctor if you are a heavy drinker and want to quit.
Other signs and symptoms of alcoholism (alcohol dependence)

Youve lost control over your drinking. You often drink more alcohol than you wanted to, for longer than you intended, or despite telling yourself you wouldnt.
You want to quit drinking, but you cant. You have a persistent desire to cut down or stop your alcohol use, but your efforts to quit have been unsuccessful.
You have given up other activities because of alcohol. Youre spending less time on activities that used to be important to you (hanging out with family and friends, going to the gym, pursuing your hobbies) because of your alcohol use.
Alcohol takes up a great deal of your energy and focus. You spend a lot of time drinking, thinking about it, or recovering from its effects. You have few if any interests or social involvements that dont revolve around drinking.
You drink even though you know its causing problems. For example, you recognize that your alcohol use is damaging your marriage, making your depression worse, or causing health problems, but you continue to drink anyway.

Drinking problems and denial

Denial is one of the biggest obstacles to getting help for alcohol abuse and alcoholism. The desire to drink is so strong that the mind finds many ways to rationalize drinking, even when the consequences are obvious. By keeping you from looking honestly at your behavior and its negative effects, denial also exacerbates alcohol-related problems with work, finances, and relationships.
If you have a drinking problem, you may deny it by:

Drastically underestimating how much you drink
Downplaying the negative consequences of your drinking
Complaining that family and friends are exaggerating the problem
Blaming your drinking or drinking-related problems on others

For example, you may blame an unfair boss for trouble at work or a nagging wife for your marital issues, rather than look at how your drinking is contributing to the problem. While work, relationship, and financial stresses happen to everyone, an overall pattern of deterioration and blaming others may be a sign of trouble.

If you find yourself rationalizing your drinking habits, lying about them, or refusing to discuss the subject, take a moment to consider why youre so defensive. If you truly believe you dont have a problem, why do you feel the need to cover up your drinking or make excuses? Is it possible that your drinking means more to you than youre ready to admit?
Five myths about alcoholism and alcohol abuse

Myth #1: I can stop drinking anytime I want to.

Maybe you can; more likely, you cant. Either way, its just an excuse to keep drinking. The truth is, you dont want to stop. Telling yourself you can quit makes you feel in control, despite all evidence to the contrary and no matter the damage its doing.

Myth #2: My drinking is my problem. Im the one it hurts, so no one has the right to tell me to stop.

Its true that the decision to quit drinking is up to you. But you are deceiving yourself if you think that your drinking hurts no one else but you. Alcoholism affects everyone around youespecially the people closest to you. Your problem is their problem.

Myth #3: I dont drink every day, so I cant be an alcoholic OR I only drink wine or beer, so I cant be an alcoholic.

Alcoholism is NOT defined by what you drink, when you drink it, or even how much you drink. Its the EFFECTS of your drinking that define a problem. If your drinking is causing problems in your home or work life, you have a drinking problem and may be an alcoholicwhether you drink daily or only on the weekends, down shots of tequila or stick to wine, drink three bottles of beers a day or three bottles of whiskey.

Myth #4: Im not an alcoholic because I have a job and Im doing okay.

You dont have to be homeless and drinking out of a brown paper bag to be an alcoholic. Many alcoholics are able to hold down jobs, get through school, and provide for their families. Some are even able to excel. But just because youre a high-functioning alcoholic doesnt mean youre not putting yourself or others in danger. Over time, the effects will catch up with you.

Myth #5: Drinking is not a real addiction like drug abuse.

Alcohol is a drug, and alcoholism is every bit as damaging as drug addiction. Alcohol addiction causes changes in the body and brain, and long-term alcohol abuse can have devastating effects on your health, your career, and your relationships. Alcoholics go through physical withdrawal when they stop drinking, just like drug users do when they quit.
Effects of alcoholism and alcohol abuse

Alcoholism and alcohol abuse can affect all aspects of your life. Long-term alcohol use can cause serious health complications, affecting virtually every organ in your body, including your brain. Problem drinking can also damage your emotional stability, finances, career, and your ability to build and sustain satisfying relationships. Alcoholism and alcohol abuse can also have an impact on your family, friends andthe people you work with.
Effects of alcoholism and alcohol abuse

Alcoholism and alcohol abuse can affect all aspects of your life. Long-term alcohol use can cause serious health complications, affecting virtually every organ in your body, including your brain. Problem drinking can also damage your emotional stability, finances, career, and your ability to build and sustain satisfying relationships. Alcoholism and alcohol abuse can also have an impact on your family, friends andthe people you work with.
The effects of alcoholism and alcohol abuse on the people you love

The effects of alcoholism and alcohol abuse on the people you loveDespite the potentially lethal damage that heavy drinking does to the bodyincluding cancer, heart problems, and liver diseasethe social consequences can be just as devastating. Alcoholics and alcohol abusers are much more likely to get divorced, have problems with domestic violence, struggle with unemployment, and live in poverty.

But even if youre able to succeed at work or hold your marriage together, you cant escape the effects that alcoholism and alcohol abuse has on your personal relationships. Drinking problems put an enormous strain on the people closest to you.

Often, family members and close friends feel obligated to cover for the person with the drinking problem. So they take on the burden of cleaning up your messes, lying for you, or working more to make ends meet. Pretending that nothing is wrong and hiding away all of their fears and resentments can take an enormous toll. Children are especially sensitive and can suffer long-lasting emotional trauma when a parent or caretaker is an alcoholic or heavy drinker.


Even in small amounts, alcohol affects women differently than men, and, in some ways, it can be much more risky. To learn more, see: Women and Alcohol
A HELPGUIDE.org Educational Supplement From Harvard Health Publications
Getting help for alcoholism or alcohol abuse

If youre ready to admit you have a drinking problem, youve already taken the first step. It takes tremendous strength and courage to face alcohol abuse and alcoholism head on. Reaching out for support is the second step.

Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from alcohol addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance. Without support, its easy to fall back into old patterns when things get tough.
Getting sober is only the beginning

Your continued recovery depends on continuing mental health treatment, learning healthier coping strategies, and making better decisions when dealing with lifes challenges. In order to stay alcohol-free for the long term, youll also have to face the underlying problems that led to your alcoholism or alcohol abuse in the first place. Those problems could be depression, an inability to manage stress, an unresolved trauma from your childhood, or any number of mental health issues. Such problems may become more prominent when youre no longer using alcohol to cover them up. But you will be in a healthier position to finally address them and seek the help you need.
Starting down the road to recoveryStarting down the road to recovery

Alcoholism is a complex disorder that can affect every aspect of your life. Overcoming it requires making changes to the way you live, deal with problems, and relate to others. Reducing or stopping drinking takes commitment and support. The good news is that there are many tools that can help you on your journey to sobriety.

Read: Alcohol Help and Treatment: How to Stop Drinking and Start Recovery
Helping a loved one with alcoholism or alcohol abuse

If someone you love has a drinking problem, you may be struggling with a number of painful emotions, including shame, fear, anger, and self-blame. The problem may be so overwhelming that it seems easier to ignore it and pretend that nothing is wrong. But in the long run denying it will be more damaging to you, other family members, and the person with the drinking problem.
What Not To Do

Don't attempt to punish, threaten, bribe, or preach.
Don't try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs.
Don't cover up or make excuses for the alcoholic or problem drinker or shield them from the realistic consequences of their behavior.
Don't take over their responsibilities, leaving them with no sense of importance or dignity.
Don't hide or dump bottles, throw out drugs, or shelter them from situations where alcohol is present.
Don't argue with the person when they are impaired.
Don't try to drink along with the problem drinker.
Above all, don't feel guilty or responsible for another's behavior.

Adapted from: National Clearinghouse for Alcohol & Drug Information

Dealing with a loved ones alcohol problem can be an emotional rollercoaster. Its vital that you take care of yourself and get the support you need. Its also important to have people you can talk honestly and openly with about what youre going through.

A good place to start is by joining a group such as Al-Anon, a free peer support group for families coping with alcoholism. Listening to others with the same challenges can be a tremendous source of comfort and support. You can also turn to trusted friends, a therapist, or people in your faith community.

You cannot force someone you love to stop abusing alcohol. As much as you may want to, and as hard as it is to watch, you cannot make someone stop drinking. The choice is up to them.
Dont expect the person to stop drinking and stay sober without help. Your loved one will need treatment, support, and new coping skills to overcome a serious drinking problem.
Recovery is an ongoing process. Recovery is a bumpy road, requiring time and patience. An alcoholic will not magically become a different person once sober. And the problems that led to the alcohol abuse in the first place will have to be faced.

Admitting that theres a serious problem can be painful for the whole family, not just the alcohol abuser. But dont be ashamed. Youre not alone. Alcoholism and alcohol abuse affects millions of families, from every social class, race, and culture. But there is help and support available for both you and your loved one.




Posted on Jul 26, 2011, 7:11 PM

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  • Re: FACTS-Read Chris.... . on Jul 27, 2011, 2:52 AM