Download alcohol - Michael Cohen Psychologist

ALCOHOL
In General:
Alcohol is certainly the oldest of the sedative-hypnotic agents having
been used since the time of genesis. It is ingested to ease anxiety,
tension and agitation and to lull the imbiber into a soporific state. Other
than providing calories, alcohol has no nutritional value and with heavy use
the person will slowly develop vitamin deficiencies and nutritional
diseases. It is the second most widely used psychoactive substance in
the world, caffeine being the first.
Alcohol is not an aphrodisiac and low doses may appear to cause some loss
of restraint but as Shakespeare said in Macbeth, ‘It promotes the desire,
but it takes away the performance’. Mental expectations and the physical
setting become progressively less important at increasing doses because
the sedative effects increase and behavioural activity decreases.
Alcohol affects the circulation and the heart; it dilates the blood vessels
in the skin, producing a warm flush and a decrease in body temperature.
Thus it is pointless and possibly dangerous to drink alcohol when one is
exposed to cold weather.
Overcoming addictions, whether drug, alcohol, gambling or overeating,
always required accepting and living in a greater truthfulness. At the
heart of every addiction was an anaesthetised old hurt, seeking to be
released. Some chemical or self-destructive behaviour reinforced the lie
and made it more difficult to correct. Accepting the painful truth,
rather than running from it, was the beginning of sobriety. Nothing less
succeeded.
Michael Cohen. C.Psychol.
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Pharmacology of Alcohol:
Ethyl, alcohol – ethanol
Psychoactive drug – a depressant.
Main difference from other depressant drugs is that it is used primarily
for recreational purposes. It is soluble in both water and fat and is
diffused easily through biological membranes. It is absorbed easily in the
gastrointestinal tract – mostly in the upper intestine due to its large
surface area. Blood – brain barrier is freely permeable to alcohol almost
immediately.
Alcohol is freely distributed from a pregnant woman’s blood to the
foetus. Foetal alcohol levels become those of the drinking mother.
Alcohol can become detected in the amniotic fluid and in the baby’s blood
during pregnancy and even on the baby’s breath at birth. 30% - 50% of
all babies born to alcoholic mothers have serious birth defects – low
intelligence, mental retardation, anatomical abnormalities etc.
It was presumed that alcohol acted as a general depressant through
nerve membranes and synapses but this theory has been replaced by
newer concepts concerned with excitatory and inhibitory nerve receptors,
which are affected, causing the physical dependence. Alcohol inhibits the
release of acetylcholine in the CNS which is why it might contribute to
impairment of cognition and memory. It can also cause the dopamine
receptors to fire more often in certain areas of the brain. When one
stops drinking alcohol, withdrawal is often accompanied by a prolonged
period of hyperactivity and the possibility of seizure.
Michael Cohen. C.Psychol.
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Tolerance and Dependence:
1.
Metabolic tolerance – this is where the liver increases its
amount of drug metabolizing enzyme. The rate of metabolism
of alcohol in the liver is unusual because it is independent of the
concentration of alcohol in the blood; it is linear with time and
hardly increased by raising the concentration of alcohol in the
blood.
2.
Neurons in the brain adapt to the amount of drug present.
Side Effects and Toxicity:
Liver damage is the most serious physiological long-term consequence.
85% of alcohol is metabolized in the liver. 75% of all deaths attributed
to alcoholism are from cirrhosis of the liver. It is the seventh most
common cause of death in the USA.
It can cause destruction of the nerve cells in the brain resulting in
dementia known as Korsacoff’s syndrome.
Heavy drinking appears to increase the risk of certain cancers, as
drinkers tend to smoke more and alcohol may promote tumour growth.
Alcoholism:
This is a relatively recent term and was not recognised as an illness by
the medical profession until the late 1950s. Jellineck was the first to
present the hypothesis that alcoholism is a disease.
Alcoholism is a primary, chronic disease with genetic, psychosocial and
environmental factors influencing its development and manifestations.
The disease is often progressive and fatal. It is characterised by
impaired control over drinking, preoccupation with the drug alcohol, use
of alcohol despite adverse consequences, and distortion in thinking, most
notable denial.
Goodwin (1955) has suggested that a good deal of evidence now indicates
that many, if not most, alcoholics do not have primary alcoholism. Their
addiction is associated with other psychopathology, for example anxiety
and stress disorders and including addiction to other drugs. Many
individuals have used alcohol as a self-prescribing medicant to treat their
primary disorder. Therefore dual diagnosis must always be presumed,
until proven otherwise.
Michael Cohen. C.Psychol.
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Drugs used to treat Alcoholism:
Benzodiazepines:
When alcohol ingestion is stopped, it rapidly is metabolized, precipitating
rapid withdrawal symptoms. It can be a very dangerous drug to withdraw
from and substituting a longer-acting drug such as chlordiazepoxide
(Librium) or diazepam (Valium) may allow the person to withdraw more
gradually and therefore safely.
Antabuse makes the person nauseous, can cause vomiting, flushes and
generally feelings of being unwell. Most people cannot drink for 3 – 4
days after using this drug.
Campral, anti-craving effect by modulating excitatory synapses operated
by glutamic acid. This drug might be an effective adjunct to a
psychosocial rehabilitation program.
Naltraxone reduces the dopamernergic activity in certain parts of the
brain.
In General:
Almost any ‘dependent drinker’ can stop drinking temporarily if given the
safety of a medically supervised detoxification. However, the real
challenge is to remain abstinent. Out-dated views are that defining the
problem of addiction was a physical dependence and detoxification was
seen as a principal treatment for addiction and unfortunately is still seen
as an answer by the medical profession. Free the individual from the
clutches of the drug by assisting them through withdrawal and the grip
of addition was broken.
A more contemporary view of addiction treatment was necessitated by
the observation that most individuals who go through detoxification
eventually relapse
Michael Cohen. C.Psychol.
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