While alcohol is a depressant, the initial effect of alcohol is that of stimulation and excitement because the inhibitory pathways are getting depressed. Eventually that stimulation goes away when the drug takes over the rest of the CNS and the dominant effect is depression. It also causes cutaneous vasodilation (the skin gets flushed red) and analgesia.
The risk of toxicity is respiratory depression, when the CNS is so depressed normal breathing does not occur.
Pathology of Chronic Alcohol Use
What could happen to an individual overusing alcohol?
Changes in visual perception
Polyneuropathy: Losing sensation and feeling, especially in the extremities.
Wernicke’s Disease: Reversible memory loss treated with B vitamins. Why do alcoholics lack B vitamins? Cause their diet sucks. When they need fluids in a hospital, they get those yellow “banana bags” for the IV which have water and B vitamins in them. About 15 years ago, legislation wanted B vitamins to be added to beer and wine so alcoholics won’t have this problem.
Korsakoff’s Syndrome: This is a progressive problem that results in irreversible memory and learning loss.
Cardiovascular disease: Cardiac muscle is replaced by fat and the person can go into heart failure because there’s not enough muscle in the heart.
GI/Hepatic Diseases: Prone to gastritis and ulcers. Little blood vessels in the esophagus can burst and bleed out.
Cirrhosis of the liver: The liver stops working because instead of it being a spongy organ is becomes a rock. The liver is meant to detoxify and metabolize but it can’t do any of that so waste products build up in the blood stream.
Hepatic Encephalopathy: Cirrhosis is often the condition that precedes hepatic encephalopathy. As the waste products build up, the body can’t get rid of them and one of the waste products is ammonia which goes to the brain and the brain starts swelling up.
What about the consequences of infrequent use?
Fetal Alcohol Syndrome: If you are pregnant at all, never drink. Studies have shown that having 2 drinks on any given day during pregnancy increases the chance of fetal alcohol syndrome.
Inhibition of Antidiuretic Hormone: When a person is dehydrated and the fluid levels are low in the blood stream, ADH (Vasopressin) is released from the pituitary gland to signal our kidneys to retain the water. On a really hot day, when people are dehydrated, what drink do people love to have? A cold beer. But alcohol blocks ADH. So you’re taking in some fluid and it lets that fluid in but lets even more out. If you overdo it, you run into cardiovascular circulatory collapse. But the point is, alcohol is not the appropriate drink on a hot summer day.
Withdrawal is potentially life threatening and includes agitation, tremors, anxiety, insomnia, hallucinations and seizures (deleterious tremors).
This is why alcohol withdrawal treatment is necessary in order to avoid disastrous complications.
Alcoholism Treatment / Abstinence Therapy
Disulfiram (Antabuse) – p.o. – This is a drug that scares a person so that they won’t drink. This drug competes with the same metabolic pathway that alcohol utilizes for elimination. Alcohol normally metabolizes into acetylaldehyde. Disulfiram blocks any metabolism of acetylaldehyde and the body can’t get rid of it. As a result, if a person drinks alcohol, they’ll potentially undergo flushing, vomiting, decreased respiration, syncope (fainting cause of low BP), arrhythmia, cardiovascular collapse, and seizures which means they may die. So when somebody is given this drug, they have to sign a paper that says “If I drink, I die.” You’ll also find people that when they get methadone for their narcotic addiction, they also get disulfiram so they are very restricted.
Disulfiram side effects (without alcohol): depression, headache, metallic taste.
Prescription Warning: Never prescribe an elixir to a person on disulfiram because that could accidentally kill them.