Consequences of Alcohol Use

The widespread and increasing use of alcohol in many parts of the world is drawing attention to the public health consequences of the consumption.

International studies show that alcohol-related death and disability impact is substantial. The harmful effects on health and the possibility of developing dependence have been recognized as issues of great concern for a long time.

New evidence underscores the need to recognize alcohol use as one of the risk factors for many communicable and non-communicable diseases as well as for accidents, injuries, domestic and social violence.

There is also growing emphasis on different patterns of drinking, influencing the type of outcomes, e.g. long-term, high quantity drinking causing liver damage, while acute intoxication (binge drinking) is linked to accidents and injuries.

Alcohol use usually starts as a social phenomenon. Some individuals over time develop a pattern of use which can be labelled as harmful use or alcohol abuse and some go on to develop alcohol dependence. Individuals with alcohol dependence are usually the focus of discussions as the complications of alcohol use are very obvious. However, the occurrence of alcohol-related problems is not necessarily limited to those labeled as “addicts” or “drunkards”. In fact, the average person with alcohol-related problems may be neatly dressed, may not show signs of alcohol withdrawal, may have a job and good family support, but may still have significant physical, psychiatric, social or family complications due to excessive consumption of alcohol.

Consequences Related to Alcohol Use Pattern

Occasional use of alcohol for recreational purposes or on social occasions is considered as “normal” and acceptable by many communities and this permissiveness has been increasing during recent times. Adding to the permissiveness are scientific reports about the protective effect of small quantities of alcohol for the heart. This seems to have generated a mistaken belief that alcohol is good for health. There is little awareness that even the occasional or social use of alcohol does carry a risk of road traffic or industrial accidents. This possibility is not as uncommon as it may seem, and often may go unrecognized or unnoticed. Intoxication from occasional use can lead to violence or socially inappropriate or embarrassing behaviour.

Medical and Psychiatric Consequences of Alcohol Use

Alcohol is absorbed from the stomach and the small intestines, and gets distributed to every organ, tissue, and cell in the body through blood circulation. Most of the alcohol circulating in the blood is absorbed by the liver at a rapid pace. It gets broken down to carbon dioxide, water and energy. These chemicals, which are excreted through the kidneys, account for 95 to 98 per cent of the alcohol consumed. The other 2 to 5 per cent escapes unchanged through sweat, breath and urine.

Alcohol adversely affects multiple organs of the body. Medical complications due to alcohol use can range from acute damage to the lining of the stomach to severe chronic liver damage, sterility and loss of intellectual functions. Some complications are acute and occur soon after alcohol consumption; others are chronic and occur after prolonged use. Some complications can be reversed or treated after stopping alcohol use, but some may become irreversible and permanent.

Gastro-intestinal Complications
Gastritis and acid peptic disease: Although alcohol is absorbed mainly from the small intestine, the direct effect on the lining of the stomach leads to its damage called acute gastritis. Attacks of acute gastritis often lead to vomiting and usually occurs with instances of heavy drinking. Repeated bouts of acute gastritis can occur in excess alcohol consumers and is aggravated by the neglect of food. Repeated damage to the lining of the stomach leads to and is called acid peptic disease.

Alcoholic liver disease: The effect of alcohol on the liver is the most common and the most serious complication of long-term alcohol use. The stages of alcoholic liver disease have been identified as alcoholic fatty change (Stage 1 – liver enlargement due to deposition of fat in the liver), alcoholic hepatitis (Stage 2 – progressive liver damage leading to jaundice), alcoholic pre-cirrhosis (Stage 3 – liver cells get damaged), alcoholic cirrhosis (Stage 4 – permanent liver damage)

Cirrhosis-related deaths have been considered as one of the indirect indicators of the magnitude of alcohol-related problems in a country. Most persons with alcohol-related harm do manifest alcoholic liver disease and some of these persons progress from Stage 1 to Stage 4. Liver dysfunction of the first three stages can reverse after a period of 3-4 weeks of abstinence from alcohol. The fourth stage is irreversible. Cirrhosis can lead to further complications like fluid in abdomen, vomiting of blood, enlargement of spleen, liver cancer and death.

Malabsorption syndrome: This refers to the inability to digest food due to damage of the lining of the stomach, intestines and pancreas. Foul smelling, bulky stools are passed. Inability to absorb the essential nutrients from the food results in malnutrition, which is further aggravated by neglect of food by such people.

Pancreatitis: Acute damage to the pancreas called pancreatitis is often triggered by a heavy bout of drinking, presenting as excruciating pain in the belly. Chronic pancreatitis has also been known to be associated with long-term heavy alcohol use. This results in an inability to digest food.

Alcohol and diet: Adding to the adverse effects of prolonged alcohol consumption is poor diet and chronic illness. This is particularly important in poor communities where alcohol of poor quality, which is frequently adulterated, is consumed. The health of these people is further affected leading to a vicious cycle of alcohol and poor health.

The affluent class can consume fairly substantial amounts of alcohol along with a rich diet and have no direct complications from alcohol. However, heavy alcohol consumption and rich diet frequently leads to obesity and its complications, such as diabetes and high blood pressure.

Cardiovascular Complications

Long-term alcohol use causes damage to the heart muscles called alcoholic cardiomyopathy, with symptoms ranging from chronic shortness of breath to heart failure. These complications seem to be in contradiction to the reported protective role from consumption of small quantities of alcohol daily. The evidence for the protective role of alcohol is discussed later.

Haematological Complications

Alcohol exerts multiple, acute and chronic effects on blood cells. There can be a fall in the level of haermoglobin called anaemia. Long-term alcohol use can lead to decreased production of white blood cells, thereby leading to decreased immunity and a predisposition to infections.
Neuromuscular Complications
Damages to nerves, called peripheral neuropathy, can occur due to alcohol. This is characterized by numbness, tingling and burning sensation in the soles and feet. In addition to the direct damages to nerves due to alcohol, thiamine deficiency and poor diet also contribute to these changes, which are reversible with abstinence from alcohol.
Damage to the muscles called alcoholic myopathy is a condition, which is generally characterized by acute pain in the thigh muscles and raised levels of an enzyme named creatine phosphokinase in the blood. Rarely, the urine may turn red from damaged muscle cells being excreted in the urine.
Endocrinological Abnormalities and Sexual Dysfunction
Male heavy drinkers are liable to two distinct endocrine abnormalities. These are feminization and shrinking of their genital organs due to acquisition of the characteristics induced by the female hormone (estogen). The shrinking of genital organs result in reduced sperm production reduced ejaculatory volume of semen. Decreased sperm count and ultimately infertility. Failure of androgen production results in reduced libido. The sexual changes induced by alcohol may have profound effects on male patients.

Neurological Complications
Blackouts: An episode of heavy drinking may be accompanied by forgetting all or part of what occurred during drinking. The blackout is temporary and involves a short period of time. Blackout occur in 0-40 per cent of men. At times, the forgotten incidence may neither be remembered while one is in a sober state but may be remembered during a subsequent drinking bout.

Wernicke`s syndrome: This consists of a combination of confusion, difficulty in walking and standing and paralysis of eye muscles. It is caused by deficiency of thiamine, and perhaps of niacinamide, and is treated with thiamine supplement. The patient can recover if treated in time.

Korsakow´s syndrome: This is characterized by profound short-term memory loss in which the person is unable to remember recent happenings. This state often occurs following Wernicke´s syndrome. One-fourth of Korsakow´s syndrome patients achieve full recovery, one half experience partial recovery, and the other one-fourth show no improvement even with thiamine.

Intellectual deficits and dementia: Long-term alcohol use is known to lead to deterioration in intellectual functioning. The deficits occur in abstracting ability, judgement, social behaviour, perception and memory. These deficits have found to be correlated with structural changes in the brain detectable on CT and MRI scans. These deficits, as well as CT and MRI changes, have been found to be reversible with abstinence. Even in social drinkers, similar reversible intellectual deficits have been demonstrated. A more severe and manifest form of these intellectual deficits are called alcoholic dementia in which all meaningful intellectual and social functioning is lost.
Damage to other areas of the brain: The degenerative changes in the cerebellum in some long-term alcohol users results in progressive problems of walking, balancing and eye movements.

Psychiatric Complications

Alcohol-induced mood disorders and suicide: Persons who abuse alcohol can have a variety of depressive symptoms, both during intoxication and during withdrawal from alcohol. It is found that about 50-60 per cent of alcoholics have depressive symptoms like sadness, feeling low, lack of interest and pessimistic thoughts. However, in only half of them are the symptoms severe enough to be diagnosed as depressive illness, which require active treatment with anti-depressants and other supportive therapy.

Suicide rates among alcohol abusing persons are higher than among the general population. It has been found that about 10-15 per cent alcoholics commit suicide, especially when they are also suffering from depressions at the same time.

Alcohol-induced psychotic disorder: About 3 per cent of chronic heavy drinkers develop psychotic symptoms. These symptoms are varied and may range from transient fleeting elementary hallucinations to persistent hallucinations and delusions. The presence of hallucinations and delusions results in behavioural problems and socio-occupational impairment.
Foetal Alcohol Syndrome
This is a disorder that affects infants whose mothers have been taking excessive amounts of alcohol during pregnancy. The condition consists of facial abnormalities, small teeth, small head with mental retardation, poor coordination of movements and growth deficiency. Between 25 and 35 per cent of children born to chronic alcoholic women show evidence of foetal alcohol syndrome.

Methanol Poisoning
This is usually accidental, and occurs due to ingestion of methyl alcohol instead of ethyl alcohol. Methyl alcohol is used as a substitute during the manufacture of illicit alcohol. Instances of methanol poisoning occur more in situations of total prohibition and during periods of very tight legal controls. The adverse effects of methanol occur due to two poisonous products: formaldehyde and formic acid, which are formed when methanol is digested in the body. The toxicity of these two compounds is most pronounced on the eyes and may lead to blindness. At times death can occur due to inability to breathe.

Purported Health Benefits of Alcohol Use
There is a belief that daily consumption of small quantities of alcohol is beneficial for physical health, especially in preventing heart attacks. Such beliefs mistakenly tend to perpetuate or encourage alcohol use as a health-promoting strategy. There is some evidence from USA and Europe, which shows that amongst persons in the community, those with daily consumptions of small quantities of alcohol have lower rates of heart attacks as compared to non-drinkers. However, the research papers documenting these findings clearly state that daily alcohol use is not and cannot be recommended as a public health strategy for protection against heart attacks. A problem with daily consumption of “small quantities” of alcohol is that the quantity of consumption frequently increases to damaging levels leading to the development of alcohol dependence. The evidence of the protective role of small quantities of alcohol does not support the idea of starting to drink alcohol or prescribing alcohol for possible benefits to the heart.

Social, Occupational, Legal and other Consequences of Alcohol Use
The ill effects of alcohol drinking behaviour affect not only the index drinker but the entire family and the society as well. In today’s context, alcohol-related problems are seen as a disease affecting the whole family and/or as a social problem and the evidence of the role of the family and society in both the etiology and management of the disease compels us to examine the psychosocial aspects of alcohol-related problems.
The Family

The relationship between an alcohol abuser and his/her family is complex. Family members report experiencing guilt, shame, anger, grief and isolation due to the presence of an alcohol abuser in the family. They are often subjected to moderate to severe forms of harassment, conflict and tense atmosphere when they confront the drinking behaviour of their alcohol-abusing family member. Spouses in families where there is chronic, excessive use of alcohol are frequently separated. Children of alcohol abusing persons report a higher incidence of emotional and school-related problems. Another complication seen in families of alcohol abusers is that of co-dependence which is a term that describes a condition wherein the partner or spouse of an alcohol abuser is affected and the spouse develops an unhealthy pattern of coping with life and often unconsciously maintain the abuser’s condition despite being troubled about the condition at a conscious level. Other complications in the family include long absences from home, destruction of household objects in rage, lack of communication between the alcohol abuser and the remaining family members, hostility and criticism that marginalise the alcohol abuser, and domestic accidents. 

One of the frequently occurring, but not adequately recognized affects of alcohol abuse is domestic violence. This is known to occur across all strata of the society, but is believed to occur more commonly in the lower strata and with more significant impact on women and children who are the victims. The contribution of alcohol use to the overall phenomenon of domestic violence is large.

Traffic Accidents

Another complication with regard to alcohol consumption is the number of traffic accidents related to people driving under the influence of alcohol. Both developed and developing societies report high rates of traffic accidents related to alcohol consumption. The loss of property, destruction of automobile and the more significant loss of productive members of the society as well as the burden of disability faced by persons following alcohol-related traffic accidents are serious concerns for any society.

Campaigns against drunken driving and mobilizing public opinion against it has been found effective in the West. Successful campaigns of this nature are good examples of “harm reduction strategies” since the focus is not on preventing people from using alcohol, but on preventing them from driving under the influence of alcohol, thus focussing specifically on reducing the harm that is caused by drunken driving.

Occupational Impairment

Excess alcohol consumption results in high degree of absenteeism, unpunctuality, poor work efficiency, loss of dexterity in skilled jobs or accidents while working with heavy machines, which can permanently cripple a worker. Alcoholism among the work force directly affects the output and income generated by the industrial sector adversely. People with alcohol abuse are known to engage in petty quarrels or fights and maintain strained relationships with peers and superiors further affecting their performance at work. Not infrequently, these problems culminate in the loss of a job, which further complicates the family’s financial situation.

Social and Legal Aspects

Other areas where frequent complications are seen due to alcohol abuse are the social and legal areas. Frequent brawls following intoxication, encounter with the police and other law enforcement agencies following thefts etc. to obtain money to maintain regular intake of alcohol are common. Crimes committed following inebriation, including rape, sexual and/or physical assaults, exploitation of women in commercial sex work and homicide makes societies with high prevalence of alcohol abuse crime-laden and unsafe for living.

Financial Implications

Alcohol imposes a high economic cost on society. One estimate puts the yearly economic cost of alcohol abuse in the United States to be 148 billion US dollars, including 19 billion US dollars for health care expenditures.

Studies in other countries have estimated the cost of alcohol-related problems to be around one per cent of the gross domestic product.

Existing International Evidence Suggests….

  • the social cost of alcohol consumption amounts to between 1 and 3 per cent of gross domestic product in countries in the European Union
  • about 20 per cent of the total cost represent the amount actually spent on medical, social and judicial services
  • about 10 per cent of the total cost is spent on material damage
  • about 70 per cent of total cost represents lost earnings of individuals who die prematurely or are unable to perform their productive tasks in the way they would have, had they not been consuming alcohol.

Pay-day Drinking

One of the common psychosocial complications affecting many persons and families is referred to as “pay-day” drinking, which involves a heavy drinking pattern on the day that persons with blue-collar jobs receive their wages. The common pattern of weekly or monthly wages being distributed in cash leads to persons with propensity for alcohol abuse to spend significant amounts of the ready cash available on the day, leading to scarcity of money for clothes, food, education of children, health and other essential family needs. Often people have to borrow money at high rates of interest and can be driven into poverty. These binge drinking episodes can also lead to domestic violence, road traffic accidents, absenteeism and other such problems.

Other Psychosocial Complications

In countries where people of the lower socioeconomic status consume excessive amounts of illicit or homebrewed alcohol, there have been many instances of poisoning and mass deaths following consumption of poor quality of liquor. Often the standards of brewing and preparation are poor in order to make country liquor inexpensive and affordable. Such tragedies devastate entire families which loss their productive members. Other examples of psychosocial consequences of alcohol use include tragedies suicide and homicide following intoxication.

Thus the repercussions of alcohol abuse on the individual, the family and society are multi-dimensional and the extent to which each of these areas is affected adversely will depend on the severity of alcohol abuse, personality of the individual, level of social and occupational functioning prior to the onset of the alcohol abuse habit, financial status, and available social support.