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Doctors' Answers to "Frequently Asked Questions" - Alcohol
Living With an Alcoholic [posted 11/13/98]
Answer: Wish I could, happened in my family as well. Sometimes a sit down conference with all the family and an drug counselor can help.
Recovering Alcoholic [posted 11/10/98]
Answer: He restarted drinking as his choice, not due to the medications. Focusing on reasons why people drink or restart assumes they have no control over their lives. For patients with addiction problems and pain the choices are very difficult. Ultram is a synthetic type of narcotic and I suspect long term we will see the same type of addiction problems we see with "natural " narcotics.
Answer: It depends on who you talk to. First of all, defining what alcoholism is the first step. This sounds simple, but is very complex. For example, does it cover occasional binge drinkers? Also, how about people who drink heavily every day, but function well at work. There is no universal definition. Consequently, one cannot define a "disease" without knowing what constitutes that disease entity. There are many alcoholic treatment groups who consider this a disease. There are many reasons for this, mainly in therapeutic orientation. I suspect that we will find a definite propensity, but currently this "gene" has not been defined.
Alcohol and Heart Disease
Answer: Ethanol has several effects on the heart. These can be separated into effects on the electrical system and effects on the muscle itself. In some patients, alcohol will produce irregular beats and can lead to tachyarrthymias(fast beats). This is called holiday heart and is often seen in the emergency room a day or three after holidays like New Years, etc. when people over imbibe. Other individuals will have irregular beats while imbibing, but only seen on monitors not with symptoms. In regards to the muscle, some patients experience what is called alcoholic cardiomyopathy. This is a weakening of the heart muscle with exposure to alcohol leading to heart failure with repeated exposure. The damage is usually dose related, but why certain individuals develop the problem and others do not is not clear. In general, small amounts of alcohol seem to decrease over all mortality from strokes and heart attacks. In repeated studies, 2-3 drinks a day will decrease the risk of infarction (some debate on the stroke angle). This debate on strokes is due to the fact that 1 in 4 Caucasians will have an elevated blood pressure after as little as one to two drinks. This will last 24-36 hours depending on the dose and the individual. This is a short summary of a complicated topic.
Answer: Alcohol has several effects on brain tissue. The first is the acute-or effects while one is taking the drug. This drug effects the ability to come to accurate and speedy mental conclusions-the reason that it is illegal to drive past a certain blood level. It also effects emotions acutely. Alcohol is a depressant drug. This effect will last about 36-40 hours depending on the blood level. Consequently, people will feel depressed, tired, morose etc. This is the reason to avoid alcohol if one is even mildly depressed. Lastly, alcohol effects ones ability to sleep. One can go to sleep more easily-but, will not be able to sleep as long or as deeply. This contributes to the sleep deficit which is part of any hangover. Alcohol also has chronic effects. These occur after taking alcohol for long periods of time. Dementia is clearly one. The exact mechanism is unknown; but, is dose related. Wernickess Encephalopathy is a second distinct syndrome. This occurs after long intake of alochol in the absence of sufficient thiamine in the diet. Damage to the part of the brain that processes memory occurs so that the individual has confusion and confabulation-unable to address the issue at hand. Lastly, is delerium tremors which is contusion, tremors and occasionally seizures on undergoing alcohol withdrawal.
Answer: The end stage depends on whether you have cirrhosis, liver failure, variceal bleeding or brain damage. Each has its own story. However, in general if you could stop drinking you could usually be stabilized-depending on your examination. Also, SRI antidepressants are very useful in some alcoholics-you might see a physician to try them.
Alcohol as a Narcotic
Prescription Drugs & Alcohol
Answer: Alcohol consumption can affect almost every bodily function, as well as oneís physical, social, emotional, and psychological well being. The important points are the extent of consumption, the timing, and whether or not there are any signs of alcohol addiction and/or dependence present. Recent data suggests that a single glass of wine daily, with a meal may actually be beneficial to oneís health. There are several items on your list that warrant caution when contemplating the consumption of alcohol, however. Firstly, the fact that you have diabetes mellitus is a good enough reason for you to avoid alcohol. Alcohol can produce many effects that are ill-advised in diabetics, including dehydration, high blood sugars, metabolic abnormalities, and lower resistance to infection (even if you are not insulin dependent). Consumption of alcohol can make managing your glucose levels extremely difficult, and the results of organ damage from continuously high blood sugar occurs both in the insulin dependent, as well as the non-insulin dependent diabetic. Consumption of alcohol can also interact with the Zoloft you are taking, affecting its metabolism, as well as affecting its ability to control the depression, or other condition, for which it was prescribed. The hydrochlorothiazide, if prescribed for renal stones, is another reason to avoid alcohol. If the thiazide was prescribed, you likely had calcium stones, which will form much more easily in a concentrated urine. Although while you are drinking, the alcohol will dilute your urine, once you get dehydrated, your urine will concentrate, thus making stone formation more likely. Further discussion with your health care provider may give you additional information, to help you make the decision that is right for you.
Pregnancy & Alcohol
Answer: Alcohol consumption can affect almost every bodily function, as well as oneís physical, social, emotional, and psychological well being. The important points are the extent of consumption, the timing, and whether or not there are any signs of alcohol addiction and/or dependence present. It sounds like there is may be a component of ìbingeî drinking with your friend. The situation with your friend is even more worrisome, now that there is a small child involved. You are in fact taking the first, and appropriate step towards helping your friend, and she is fortunate to have you as a friend, as well. By trying to access as much information as possible about alcohol and the terrible consequences of its overuse, you can go to your friend and at least try to convince her to consider cutting back, if not quitting alcohol altogether. Your
friendís ability to care for her child would certainly be impaired if excessive alcohol consumption altered her mental state to too great an extent. Long term alcohol abuse can lead to chronic inflammation of the liver, which can ultimately lead to liver failure and scarring (ìcirrhosisî). In turn, liver failure leads to bleeding problems, intestinal bleeding, bleeding from the esophagus (ìfood pipeî), and stomach, confusion, swelling of the abdomen, tremor, redness of the palms, as well as blood vessel abnormalities in the skin. Chronic alcohol abuse can also lead to abnormalities in brain function, seizures, heart failure, deceased resistance to infection, and problems with the bone marrow, where the cells of the blood are made. Of equal importance, are
the emotional, social, and psychological problems that arise due to alcohol abuse. Potential loss of friends, family, loss of a job, and the loss of a happy and functional life, are all pitfalls that may await the individual who overuses alcohol, if left unchecked. Perhaps expressing to your friend your concerns about her, and to do so in the company of as many of her friends and family as possible, would be of benefit. Perhaps a counselor or support group would be helpful, and your health care provider, or any social service office, can provide you with additional resources that may prove helpful.
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