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Doctors' Answers to "Frequently Asked Questions" - Alcohol

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Living With an Alcoholic [posted 11/13/98]
Question: My 67 year old father is an alcoholic. For as long as I can remember my dad has been a heavy drinker. He has never been violent or abusive but he just pretty much drinks all the time. Recently, my mom has been worried about him trying to make him understand he is killing himself, but he won't listen. My sister and I are trying to find out if there is anything we can do to help him. Can you give us any ideas or direction?

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]
Question: I have a friend who is a recovering alcoholic/addict. He has a degenerative back disease and has chronic pain except when he is sleeping. His doctor, also a recovering addict/alcoholic perscribed him loratab for pain. He began drinking again as a result of the effects of the perscribed medication. I have heard that ultram is a safe alternative pain med. Considering that his physician is in recovery, I felt that he made a serious error putting my friend on loratab. He is going to set up an appointment with another Addictionologist/MD. But my friend would like to know in advance about alternatives. My friend is in a lot of pain and was told that surgery was no guarantee of sucess,according to his doctor I hope that you have the time to give some advice. Thank you very much.

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.

Question: Is alcoholism considered a disease? What has been the most recent evidence for or against this disease model? Has there been a gene proven to cause alcoholism or is it environmentally determined?

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
Question: I am an elementary education major taking an alcohol use and abuse class. I have a presentation to do on alcohol and its effects on the heart and heart disease, but I can't find any information on the subject. The only information that I have found was from the American Heart Association, and that was only a paragraph on the subject. I need to do a 20 min. presentation on the subject.

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.

Question: What effects of this disease have on the person's mental ability such as memory, behavior, emotions, etc.?

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.

Alcohol Abuse
Question: I am a 52 y. o. w. m. alcoholic. I have been abusing alcohol for 30 + years and believe that my days are numbered. With the best of intentions I have attended, conservatively, 3,000 AA meetings, have been "successfully" through 3, 28 -day residential treatment programs, and have tried Anatabuse. My liver is hard and hurts continuously, as do my legs hurt. I have hundreds of scabs on my scalp and head. I'm having intermittent difficulty with my vision. My arms bruise easily producing many bright red scabs, and I feel terrible continuously. Just about only time I do not feel an overwhelming urge to drink is on those very few occasions I smoke marijuana. ( I cannot afford it and, even here in California I have not heard of a physician who will recommend it for alcoholism. The welfare system here is such that, since I own my home with a neighbor who is a joint tenant, I cannot get Medi-Cal without a lien being put on the property. Thus, I have not had medical care for more than ten years and my diagnosis of cirrhosis is my own. AA is frank that it cannot help everyone, and, as an agnostic, I fall through the cracks. Is anything available for those for whom "faith healing" does not work? (I understand that behavior modification/aversion therapy is both expensive and not very successful.) If not, could you describe end-stage alcoholism, so I can get my affairs in order and, perhaps, find the means to end it before I lose control.

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
Question: If alcohol was a controlled substance and classified by the FDA, in your opinion would it be considered a narcotic?

Answer: No.

Prescription Drugs & Alcohol
Question: Do the following conditions render it inadvisable for me to consume alchohol? Type II diabetic NID Medications:Amaryl Xanex Zoloft hydrochlorothiazide (for kidney stones, not hypertension)

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
Question: Can you please help me. My friend has continued to drink during her pregnancy and now the baby is 3 1/2 months and she stll continues to do so. She thinks its ok to have a beer or two a day. The other night she had 5. Can you please tell me any facts that may convince her to stop?

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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