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When Drinking is a Disease

Posted by on Monday, October 27, 2014 in Health, Nashville.

This week (October 27-31) is Drug and Alcohol Awareness week at Vanderbilt. Definitely check out all of the events going on. The following is an account of one of my recent experiences.

Last week while using public transportation in Nashville (MTA rides are free for undergrads), I found myself chatting with a couple of homeless men at a bus stop. One man, called “Chief” by his buddies, had short greasy hair and dirty white sneakers. Look at these, he said, pointing to the shoes. Look at how disgusting I am.

His voice dropped to a cracked whisper and his brown eyes looked into mine. Today I’m drinking my last beer. He peeled back the brown paper from a glass bottle. You don’t believe me, I know you don’t. But this is my last beer.

Chief is one of over 17 million alcoholics in the United States. Like many people who face alcohol addiction, he feels ashamed and guilty about his drinking habits and is simultaneously unable to control them. While we were talking, he reminisced about his previous jobs and his previous houses; his life has followed a pattern common among alcoholics. Their wives leave them, their children shun them, their bosses fire them.

As an alcoholic, his body looks different from mine. Chief’s brain, heart, liver, and pancreas are damaged by the toxic effect of alcohol. He may suffer from memory loss and impaired executive control as alcohol shrinks key areas of the brain. His heart muscles may weaken and contract with irregularity, and he may develop high blood pressure as a result. His liver may accumulate extra fat or even become scarred from the ravaging effects of alcohol. His pancreas may become inflamed, disrupting digestion. Chief’s t-shirt––HE SAVES––rounded over his beer belly, which takes shape when the body stores the extra calories in alcohol as visceral fat. This abdominal fat is implicated in a person’s risk for type 2 diabetes and cardiovascular disease.

If Chief were to stop drinking alcohol, he would face a lengthy withdrawal period. He would sweat, his hands would shake, and he would feel sick to his stomach. He would also feel agitated, anxious, and irritable. To drink more alcohol is the easiest way to relieve the suffering, so Chief’s friends buy him a beer every morning. He starts his day with drinking just to be able to function. Chief told me that he could get Valium for free from the hospital to help him with the detoxification process, but he said it’s just a temporary fix. Hospitals provide benzodiazepines like Valium, which calm patients who are experiencing symptoms of alcohol withdrawal, but it’s not a solution. He joked about wishing he could just check in, get the sedative, and leave.

While we were talking, a man selling street papers nearby walked over to beg for sips of Chief’s beer. Those few sips of warm, carbonated liquid sent ethyl alcohol into his bloodstream almost immediately. The small CH3CH2OH molecule diffused into his organs and tissues within minutes, including his brain. Perhaps he began to feel a sense of well-being, confidence, and camaraderie. Meanwhile, his liver degraded alcohol into acetaldehyde and then acetate, supplying him with nutrition-less energy.

Chief walked to a gas station across the street to pick up a pack of Marlboro Lights for his companion Carl. As they unwrapped their beer and cigarettes, they told me never to fall into drinking and smoking. A beer every once in awhile is fine, but don’t become like us, living on the streets.

So what happens when that one beer becomes someone’s fifth (or tenth)? Why do some people become alcoholics? In the average drinker, the stimulating, feel-good effects of alcohol give way to sedation after a few drinks, and the person stops drinking. In the ten percent of people that develop alcoholism, however, the liver cannot metabolize alcohol normally. The acetaldehyde reacts with chemicals in the brain to create opiate-like substances, an effect which is not present in normal drinkers.

People can also be predisposed to alcohol dependence by a number of hereditary factors. In fact, genes are responsible for half of a person’s risk for alcoholism, and people who have a family history of alcoholism are three to four times more likely to become alcoholic themselves. Some genes affect a person’s initial reaction to the taste of alcohol, while others affect an individual’s ability to deal with stress on a biological level. Researchers have linked a dysfunctional endorphin system in the brain to alcoholism in people whose parents also drank.

Twice while I was waiting, a police car drove by, the officer inside eyeing the scene. Each time Chief waved. They all know him, nodded Carl. They check on him, ask him if he’s drunk. Chief interjected, I tell ‘em, “Nope, but I’m working on it!” Carl said they come back a few hours later to put him in the jail for the night. Chief expects that he will get drunk every day, whether he likes it or not; he has no choice.

When the bus finally arrived at the stop, the men shook my hand good-bye. If anyone messes with you, come find us. No one messes with us. With that, Chief gave a pneumonia-induced cough. Accordingly, alcoholics often encounter health complications related to the ravaging effects of alcohol. Heavy drinkers have been found to die two decades earlier than nonalcoholics, on average. Chief is 52 years old, so according to these statistics, he has just ten years left.

Long gone are the days when alcoholism was pegged as a moral failure. Doctors and psychiatrists now understand it as a physiological disease that leaves victims without control. To treat alcoholism, they might prescribe the drug Antabuse (disulfiram), which blocks the liver’s metabolism of acetaldehyde into acetate. The build-up of acetaldehyde induces headaches and vomiting, thereby helping the alcoholic’s motivation to stop drinking. The same chemical that created an opiate-like effect in the brain now becomes ruinous when the liver is unable to degrade any acetaldehyde. Another drug is naltrexone, which reduces an individual’s craving for alcohol by eliminating its sedating effects on the brain. Of course, a drug regimen is only part of a more comprehensive treatment, which includes receiving counseling and attending support groups such as Alcoholics Anonymous.

Chief probably won’t have the opportunity to receive this holistic treatment; homelessness gives him few options. He will wake up tomorrow morning, drink his beer, and tell everyone that this, this is his last beer.

Note: Go here for resources on alcohol and other drug dependency for Vanderbilt students.

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