ON ALCOHOL (AGAIN)...

“Drunkenness is nothing but voluntary madness.” – Seneca

Remember once upon a time when cigarette smoking used to be widespread and nobody would even think of not smoking in public places (well, if not, maybe I am showing my age…)? Before my time, smoking was even recommended as healthful for some disorders! Some definitive epidemiological studies in the 1960s started to link smoking with some deadly diseases including emphysema, cancers of the mouth, throat, lungs, pancreas, cervix, bladder, it increases the risk of dying from a heart attack or from a stroke and increases the risk of getting gangrene. It interferes with normal functioning of almost every organ of the body, decreases libido and increases the ageing processes and wrinkling of the skin.

We are now aware of all of these adverse and often fatal effects and we have legislated to protect as many people as possible. Cigarette smoking in public places is now strictly regulated, tobacco advertising is banned in most countries, warning signs are printed on cigarette packets and smoking is on the point of becoming socially unacceptable.

Alcohol is responsible for almost as many adverse effects and yet it has been resistant to becoming quite so unacceptable as smoking is. “Noah was the first tiller of the soil. He planted a vineyard; and he drank of the wine, and became drunk, and lay uncovered in his tent.” This quote from Genesis 9:20-21, describes graphically alcohol production, its consumption and after-effects! Records of wine and beer making go back 5,000-6,000 years with the Mesopotamians and Egyptians both being well versed in the art of making alcohol in the form of beer and wine. Alcohol or ethanol is produced by the fermentation of carbohydrates by yeasts. It is one of most widely used of recreational drugs and is taken in alcoholic drinks to relax, reduce inhibitions and increase sociability. Taken just before food alcohol will increase gastric secretion and hence enhance the gastric phase of digestion. Alcohol in moderate doses is believed to be safe, and recent research suggests that moderate alcohol consumption will reduce high blood pressure and protect against atheroma.

However, the problem with alcohol is described by the maxim: “Too much of a good thing becomes a very bad thing”. In Australia currently, over 80% of the population report that they consumed alcohol in the previous 12 months, with 11% of males and 6% of females drinking daily. In terms of risk of harm in the long term, 10% of males and 9% of females drank alcohol in a pattern that was risky or high risk. In terms of short-term risk, 24% of males and 17% of females drank at least once a month in a manner that was risky or high risk for short-term harm. Around one-quarter of teenagers put themselves at risk of short-term alcohol-related harm at least once a month. The proportion was higher among females (28.3%) than males (24.5%).

Alcohol is the second largest cause of drug-related deaths and hospitalisations in Australia, after tobacco. Alcohol is the main cause of deaths on Australian roads. In 1998, over 2,000 deaths of the total 7,000 deaths of persons under 65 years, were related to alcohol. In 2004, the age standardised rate for male deaths due to alcoholic liver disease as the underlying cause was 5.5 per 100,000, compared with 1.5 per 100,000 for females. In 2004, the age standardised rate for male deaths with mental and behavioural disorders due to alcohol as the underlying cause was 1.9 per 100,000, compared with 0.4 per 100,000 for females.

Alcohol is a central nervous system depressant and disturbs both mental and physical functioning. Alcohol intoxication causes muddled thinking, slurred speech, drowsiness, poor co-ordination, dulled reactions, erectile dysfunction and amnesia. Disinhibition will lead to feelings of euphoria or misery, irritability and aggression, moodiness or extreme loquacity and sociability, depending on the underlying mood at the start of drinking. Severe intoxication may lead to coma and respiratory failure. Driving under the influence of alcohol or operating machinery is outlawed in most countries because of the extreme dangers associated.

Persistent alcohol abuse leads to physical, mental, social and occupational problems. Misuse of alcohol may take several guises: Regular but controlled heavy intake, binge drinking and dependence (alcoholism). The first pattern is the one that most often leads to severe physical diseases such as cancers of the oesophagus and throat, peptic ulcers, cirrhosis of the liver, pancreatitis, cancer of the pancreas, nervous system degenerations, heart and muscle damage and harmful effects on the unborn baby in pregnant women who drink. The second pattern is most common amongst young people, especially men, and leads mostly to social and occupational problems. The third problem of addiction is the most serious and leads to the most pronounced effects, physical and social. There has been some evidence to suggest that alcohol dependence has a genetic component, however, it is very difficult to disentangle genetic, environmental, psychological and social factors in the families where this propensity is apparent. Prolonged alcohol abuse often will lead to dementia.

In Australia, we may soon have health warning labels on alcoholic drinks, similar to what we see on tobacco products. Our Federal Health Minister Nicola Roxon has proposed this means of trying to curb the diseases and deaths due to alcohol abuse. However, the experience with cigarette smoking has shown that although a deterrent, legislation hardly curbs widespread use of these recreational drugs. The problem with young people abusing alcohol is extremely widespread and perhaps a more effective way of dealing with it would be with education programs and responsible drinking under supervision in the family. I was allowed to drink a little watered down wine with meals ever since I was about 10 years old. Subsequently, I have remained a moderate drinker, do not consume alcohol daily and when I drink I usually do it with my meal. I can only recall being drunk only once in my life (when I was in my early twenties) after which I resolved that I would never allow myself to ever again descend into that state, and it was a promise that I have kept. As Shakespeare says: “O God, that men should put an enemy in their mouths to steal away their brains! That we should, with joy, pleasance, revel, and applause, transform ourselves into beasts!”