The glittery glow of liquor advertisements, the fizz of the champagne opened by a victorious sportsman, the gushing froth from the beer bottle in the hands of a macho hero – all add a touch of style and sophistication to alcohol. Freedom. Fun. Comraderie. Social bonding. These are the enduring symbols of alcohol etched in our minds. We drink when we are happy and then we also drink to forget sorrow.
Ask a teenager – to him, alcohol is a symbol of liberation, a sign of revolt, a freedom from control, frustration and anguish.
A couple of years later, what remains as the enduring symbols of alcohol for most people are loss of self esteem and health. And destruction – of self, and family.
Many people start as occasional party drinkers, sure in their minds they'd stop, the minute they sense they are getting out of control. Some of them can stop; but for some, things can go awry. That's because some people are more susceptible to alcohol abuse than others. Researchers differ in their opinions why it is so. Is it genetic, psychological, or pathological? Or a mix of all the three, with a dash of environment to spice it up?
When Poornima accompanied her friends to have a week-end blast at a local pub, she accepted the Bloody Mary her friends offered her, because she did not want to be prudish and say “Oh sorry, I am on mineral water!" As fuzzy warmth melted her inhibitions, she went on to accept more, slowly replacing the Bloody Mary with gin and Peachschnappe. When she sobered up the next day, she began looking forward to the next weekend, to be free again.
Over the next two years, Poornima developed both physical and psychological dependence on alcohol. Her body started ‘tolerating’ alcohol and required more alcohol to get the desired effect. Alcohol became so central to her thoughts, emotions, and activities that she could not control the craving for drink – she was psychologically hooked to the bottle.
As Poornima recalls her journey from spirited friends to sanitized hospitals to spiritual counselors, she says that despite the warnings she received at work and home, she could not stop. She was sacked from the office; but she continued to drink, stealing money from home to meet the bills. When she could not steal, she would lie, beg and justify her obsession with emotional tales of frustration. Slowly she started turning violent and was herself aghast when she dashed her mother’s head on the wall. That incident broke her ‘spirited’ denial of the problem and she finally agreed to go with her parents to visit the de-addiction centre at the Bangalore’s NIMHANS hospital.
After a month-long detoxification treatment of the “withdrawal symptoms", such as sleeplessness, nausea, anxiety, nervousness and tremors and several months of counseling she finally traced her painful steps back to sobriety.
Dr. Pratima Murthy, Associate Professor at the deaddiction centre of NIMHANS, says that teenagers and women are at a higher risk than men. Since women's bodies contain less water than men, and retain higher concentration of alcohol in the blood, it takes shorter time for complications to develop among women. Dr. Pratima cautions women that alcohol can affect the growth of the fetus during pregnancy.
What Happens when you Drink Alcohol? Alcohol produces certain toxins in the body and the body attempts to protect itself by producing enzymes to metabolize and remove them. Your kidneys and liver require water to dilute and process the toxins. As you are drinking alcoholic beverages, your body is actually losing fluids. Alcohol acts as a diuretic, which means that it increases the release of urine from the body. If water and fluids are not readily available to aid in this detoxification process, the body will redistribute whatever water is available. All parts of the body are impacted by this redistribution of fluid, even the brain. That's why your head hurts!!
By losing more fluids than usual, you are also losing important vitamins and nutrients. Lack of quality sleep contributes to the general grumpiness and fatigue you feel as part of a hangover. When you fall asleep - or pass-out - after a bout of heavy drinking, the high levels of alcohol in your system drug the brain and prevent it from performing some of its routine tasks, such as managing your sleep pattern. You are unable to enter the important REM (Rapid Eye Movement) stage of sleep, which is a critical element to a good night's slumber. The next day, you may feel fatigued and listless due to the lack of proper rest.
Daily drinking of alcohol is associated with a wide range of medical complications. Damage to the liver later resulting in cirrhosis of the liver; irritation of stomach; high blood pressure; nutritional deficiencies; loss of memory and other effects on the brain; tingling numbness of legs and hand due to damage to nerves are some of the effects of long term alcohol abuse.
Addiction – the Brain Pickled in Alcohol? Not all people react similarly to alcohol. Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted.
Dr. Ashok Rau, chief of Freedom Foundation, a treatment cum rehabilitation centre for alcoholics in Bangalore explains the process of addiction. Right after you take the first sip of your martini or gin, a cascade of chemical and electrical events triggers the neurons in the brain to release dopamine. Dopamine provides feelings of enjoyment and motivation to do the pleasurable activities. A healthy individual has the ability to balance the dopamine-based reward reinforcement system with the serotonin-based behavior inhibition system which is responsible providing satisfaction, which is why a normal person can stop after a few pegs of the intoxicating drink.
As the person drinks habitually, the nervous system adjusts itself to the excess levels of dopamine in the body caused by alcohol. Now it requires more and more alcoholic stimulation to get the same level of pleasure. This explains the phenomenon called tolerance.
Alcohol Dependence and Theories Galore…. No one knows for sure what causes alcohol dependence. Both environmental and genetic factors may contribute to the chemical imbalance that prevents normal stimulation of the pleasure centre. Growing up in a dysfunctional home environment where a child is deprived of healthy nurturing may indirectly alter the pathways that stimulate the pleasure centre of the child's brain.
The genetic model notes that certain addictions run in the family. The cultural model recognizes the strong influence of culture - for example, the rarity of alcoholism among Saudi Arabians, where obtaining alcohol is difficult and the prevalence of gambling addictions in the gaming-industry-dominated North America.
Recent research shows that apart from the above factors people with personality or conduct disorder such as childhood history of attention deficit hyperactivity disorder are also prone to addiction.
The cognitive model argues that addiction is not inherited but is a learned behavior. The more one consumes the more likely one is to be become addicted. Addiction can thus happen to anyone and can be unlearned by psychological therapy that treats underlying personality problems, such as impulsive, anxious and aggressive behavior.
Treating Alcohol Dependence The patient needs to be hospitalized in order to ensure safe withdrawal. Coming off alcohol quickly can result in disorientation, sleeplessness, restlessness and delirium tremens, which can be a fatal condition and must be treated carefully.
Most rehabilitation centers have an outlined residential program. The inmates are required to stay off the alcohol, while doctors prescribe drugs that modify the neurotransmitter system and treat withdrawal symptoms of anxiety and depression and help maintain abstinence.
Once the pharmacological treatment is over, psychotherapy starts. The patients are helped to analyze themselves, confront defensive behavior and learn how to cope up with stress. The alcoholics are taught specialized assertive techniques to refuse drinks under social pressure from friends. The patient is trained to be his own behavior therapist, analyzing behavior interactions, planning appropriate modification strategies and implementing his plan of action.
Along with the patients, the family members are also counseled. Often the family is abused by the addict; so it is essential to explain to them why alcoholics are not in control of themselves.
Apart from the emotional support from family, self-help groups like Alcoholics Anonymous (AA) can help the person remain free from alcohol use. This group conducts weekly meetings presided by former alcoholic addicts, where people share their experiences with each other. The only requirement for membership is a ‘desire to stop drinking’. The AA approach is to accept that one is ‘powerless over alcohol’ and to put oneself in the hands of ‘God, as we understand him’.
Uma Shankari is a Bangalore-based freelance writer, passionate about development issues