Alcohol abuse:
Playing Russian roulette
It started innocently enough.
Richard Chester was 12 years old when his uncle offered him “a little taste.” It wasn’t much, but it was enough to quickly become a problem.
“I liked it,” he said.
And that was the problem.
He started with cheap wines and beer, and developed a taste for vodka and orange juice. By the time he got to high school, alcohol had started to do its damage. His grades steadily dropped, but he was still able to run track.
In his mind, everything was still good — even though he hid little nips in his gym bag.
“I didn’t care,” he recalls. “My focus was on getting high.”
And that he did. A former track coach hadn’t seen Chester in a while and noticed that he had lost weight, mostly muscle. “What happened to you?” Chester remembers the track coach asking incredulously.
It got worse.
A woman, once interested in possible romance, bluntly told him: “You used to be fine. Now look at you.”
Ouch. That hurt so bad that Chester, already shaking from the previous night’s drinking, said he needed to find money “to get a drink.”
At this point, problem drinkers end up in the office of someone like Dr. Tim Benson, the medical director of the McLean Center at Fernside, an alcohol and drug treatment program of McLean Hospital.
“It could be the person has been arrested for drunk driving,” Benson said. “It could be that a loved one asked them to get help. There are a lot of reasons for how they get here. The important thing is that they are here and what we can do to help.”
Benson knows that a variety of factors can contribute to the individual’s struggle with alcohol, but it is necessary to first understand how the person views his or her drinking.
“I first try to get an assessment,” Benson said, “of not what the friends or the relatives or the courts have to say about a person’s drinking, but rather what the person has to say about their drinking.
“I ask, ‘OK, such and such a thing has happened to you, or so-and-so person says you have a problem. Do you think you have a problem?’ From that answer, I can gauge on a scale of one to 10 where we are,” Benson said.
The next question, a function of the first answer, goes to the degree to which a person wants to do something about their problem.
“Some people have told me that they know they have a serious problem, but have no idea how to conquer such a part of their lives,” Dr. Benson said. “Others may understand they have a problem but don’t feel they should necessarily do anything about it.”
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an arm of the National Institutes of Health, women who drink more than seven drinks a week and men who drink more than 14 drinks a week may be at risk for alcohol-related problems.
And for the record, at least according to Benson, varying amounts of alcohol can pose a potential health hazard.
Drinking is more than a social thing.
Alcohol affects every organ in the body. It depresses the central nervous system and is quickly absorbed into the bloodstream. Alcohol is metabolized by the liver but only in small amounts at a time, leaving the excess to circulate throughout the body.
Depending on the amount consumed, the effects of alcohol are almost immediate — loss of inhibition and impaired judgment; dizziness, blurred vision and slurred speech; uncoordinated movements and increased reaction time.
For most people, moderate drinking — up to two drinks per day for men and one drink per day for women and older people — cause few or no problems.
But long-term binge or heavy drinking takes a toll and can lead to the development of chronic diseases, neurological impairments and social problems. Alcohol can cause high blood pressure and heart failure; cancer of the mouth, esophagus, larynx and liver; dementia and disordered thinking; depression; numbness of the hands and feet; and inflammation of the pancreas and lining of the stomach.
Hepatitis and cirrhosis of the liver — the irreversible destruction and scarring of the liver — are serious complications, with often fatal outcomes.
Although blacks have comparable and even lower rates of heavy or binge drinking and alcohol dependence than whites, they often experience more adverse health consequences of alcohol. Cancer of the esophagus and larynx is more common in blacks than whites, especially for those who smoke as well. In addition, African Americans — even those who do not drink — have a higher incidence of cardiovascular diseases, such as high blood pressure, stroke and heart failure — all complications of overindulgence in alcohol.
Heavy drinking can lead to risky sexual behaviors. The increased incidence of HIV is partly attributed to unprotected sex, sex with multiple partners and increased risk of sexual assault due to the influence of alcohol.
Often, substance abuse goes hand-in-hand. Those who abuse alcohol are more likely to abuse illicit drugs and smoke heavily as well.
A study cited by the NIAAA found that “people who are dependent on alcohol are three times more likely than those in the general population to be smokers.”
What’s worse is that alcohol is the third leading lifestyle-related cause of death in the United States. Tobacco and obesity are the first two.
By 25, Chester had already fallen off a roof, was well acquainted with blackouts and very familiar with morning shakes, and knew he had a problem.
He was an alcoholic.
“It gets pretty intense,” he said. “You drink with people you can’t stand. Your spiritual values change. It gets progressively worse as you go along. You compromise your values to continue drinking. After a while you stop going to school, stop working, you just waste time. Then you get to the point when you don’t care anymore and begin to make excuses or offer explanations.”
Indifference is one thing; becoming a potential danger to society is another.
The National Highway Traffic Safety Administration determined that in 2006, more than 35 percent of all traffic fatalities were alcohol-related. Alcohol is also a leading trigger for acts of violence such as domestic abuse and homicide.
In 2003 alone, excessive alcohol use caused over 2 million hospitalizations and over 4 million emergency room visits. It is estimated that the yearly economic cost of alcohol misuse in this country is $185 billion.
Heavy drinking falls into two categories — alcohol abuse and alcohol addiction or dependence, commonly referred to as alcoholism. Nationally, in 2005-2006, almost 8 percent of the population, or 19 million people, abused or were dependent on alcohol.
Those who abuse alcohol continue to drink after failing to fulfill responsibilities at school, work or home; drink and drive and have legal problems related to alcohol, such as physical abuse.
Addiction to alcohol, on the other hand, is a chronic disease for which there is no cure. An alcoholic demonstrates the same behavior as an abuser, but lacks the ability to limit or stop drinking. He or she craves liquor, and requires increasing amounts to feel its effects.
More significant, the alcoholic becomes ill when attempting to stop.
Delirium tremens — a state of confusion and visual hallucinations — is a medical emergency, and can result in death if treatment is not rendered.
Alcohol abuse can lead to alcohol dependence.
The exact cause of alcoholism is not always known, but several factors come into play — including stress, depression and social and cultural demands. Family history and genetics also play a role.
One thing is clear: A significant barrier to treating alcoholics is the inability of a person to recognize their problem with drinking — denial. Most people don’t know they have a drinking problem.
Chester was one of them.
“It takes a lot of courage to stop,” he said.
The final straw for him came when he saw blood in his vomit.
“I thought to myself, ‘Why is this pink? I wasn’t drinking Wild Irish Rose,’” he recalled. “My life started flashing in front of me. It scared the living daylights out of me.”
He went cold turkey.
He suffered through a real bad period for four days. He was shaky, but had no hallucinations. It took about a month to get back to normal. He stayed away from his drinking buddies. He never drank again.
“The hard part about drinking again is that you don’t know when the compulsion will hit you,” he explained. “That’s why people make the mistake of thinking that they can hold their liquor. You might be able to have one or two and be all right, but once the compulsion to drink kicks in again, you can’t control it. It’s like playing Russian roulette.”
Chester, 57, has been clean and sober now for 30 years.
He is now a mental health counselor and works with alcohol-addicted people. |
(top) Alcohol is the most commonly used substance in this country. In 2006, more than 50 percent of the U.S. population aged 12 or older purported to have had at least one drink in the past 30 days.
(bottom) Even a small amount of alcohol can harm the baby of a woman who drinks while pregnant. Alcohol can cause fetal alcohol syndrome, one of the leading causes of mental retardation. |
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Timothy G. Benson, M.D.
Medical Director,
The McLean Center at Fernside
Instructor in Psychiatry,
Harvard Medical School
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