Alcohol
Grog, booze, hooch, moonshine, goon, vino, piss
IMAGE: Age fotostockAlcohol is a depressant. The alcohol that people drink is ethyl alcohol (there are other kinds, all very poisonous). It is made from a mixture of yeast and water, fermented with grains, vegetables or fruits. The fermentation process changes natural sugars into alcohol. Beer and whisky are made from grains, wine and brandy from grapes, vodka from potatoes, cider from apples, and rum from sugar, to name just a few of the most popular alcoholic drinks.
Alcohol concentration varies considerably with the type of drink. In Australia, beer contains 0.9 to 6% alcohol, wine 12 to 14%, fortified wines such as sherry and port around 18 to 20%, and spirits such as scotch, rum, bourbon and vodka 40 to 50%.
People have been drinking alcohol for tens of thousands of years, as part of various religious ceremonies, as a painkiller, and for socialisation and fun. It is the most commonly used and socially acceptable recreational drug in Australia.
How alcohol is used
Alcohol is usually drunk in social situations for its relaxing effects, which tend to reduce people's inhibitions (many people believe it is a stimulant rather than a depressant, because of the mood and behavioural effects of reduced inhibition).
Binge drinking - refer to the binge drinking page for further information
Drink spiking - refer to the drink spiking page for further information
Short-term effects
Alcohol is absorbed rapidly into the bloodstream and affects the brain within about five minutes (absorption may be slower if the person has recently eaten).
Alcohol depresses the central nervous system, slowing down heart rate, breathing and other body functions. Other short-term effects may include:
- reduced inhibitions
- a sense of relaxation
- loss of alertness and coordination, and slower reaction times
- impaired memory and judgement
- nausea, shakiness and vomiting
- blurred or double vision
- disturbed sleep patternsdisturbed sexual functioning (such as difficulty in maintaining an erection).
As consumption continues these effects are increased, which increases the risks involved in driving, using machinery or making decisions affecting safety. The effects gradually wear off as the alcohol is broken down by the gut and liver. It takes about an hour for the body to break down the alcohol in one standard drink, although there is considerable variation between individuals. It takes longer if there is damage to the liver.
Long-term effects
Heavy use of alcohol over a lifetime increases the risks of:
- some oral, throat and breast cancers
- liver cirrhosis
- brain damage and dementia
- some forms of heart disease and stroke.
There is some evidence that drinking at low risk levels may help reduce the risk of heart disease in older people. However, it is important to remember that heavy drinking is always risky. In terms of death and injury, alcohol is second only to tobacco in causing preventable harm in Australia. For example, in 2003 alcohol was considered to have caused 1100 deaths. In 2004-5, 37% of Australians attending drug and alcohol treatment services said that alcohol was their main problem— more than for any other substance.
How common is alcohol use?
The 2007 National Drug Strategy Household Survey found that alcohol is the most widely used recreational drug in Australia, with 83% of people aged 14 or more having at least one drink in that year. Approximately 18% of 16 and 17-year olds, and 41% of 18 and 19-year olds, reported drinking alcohol on a weekly basis. Young females are reversing a historical trend by engaging in more risky drinking practices than young males. The survey defined risky or high-risk drinking as having more than five drinks per day for females and more than seven drinks for males.
Variation in effects
Because of the way alcohol is stored and processed by the body, people with a lower proportion of body fat and a higher proportion of body fluids, and larger people, are generally less affected than others by the same amount of alcohol. This means that some members of the following groups may be more vulnerable to the effects of alcohol:
- women, who are generally smaller than men and usually have a higher proportion of body fat
- older people, who tend to have lower levels of body fluids
- young, physically immature people
- other relatively small people.
A person's general state of health, and whether they have recently eaten, also has an effect.
The hangover
On the day following a drinking session a person may experience more or less severe nausea, headache and fatigue. These are symptoms of dehydration. Alcohol is a diuretic; that is, it causes increased fluid loss. The fluids must be replaced by nonalcoholic drinks if dehydration is to be avoided. Some alcoholic drinks, including brandy, bourbon and red wine, contain substances called congeners, which can also cause symptoms associated with hangover. Smoking, drinking on an empty stomach, and drinking quickly, add to the severity of the hangover.
Alcohol and mental health
Many people who have alcohol-related problems also have mental health problems. For example, people with posttraumatic stress disorder (such as war veterans and people who have experienced violence) are more likely to develop problems with alcohol. There are also strong associations between alcohol problems and anxiety and depression, as well as severe mental disorders (schizophrenia, bipolar disorder and major depression). The use of alcohol, like other self-administered drugs, makes problems arising from mental illnesses worse.
Using alcohol with other drugs
Because alcohol depresses brain activity it should not be used with other drugs or medications that have similar effects on the brain, such as benzodiazepines, cannabis and heroin. Drinking alcohol while using these drugs can cause bodily functions to slow to the point where death occurs. Many heroin overdoses are associated with heavy alcohol use. A person taking a prescription medication should always find out about the possible effects of drinking alcohol at the same time by reading the information that comes with it, and discussing the matter with their doctor or pharmacist.
Dependence
Heavy or regular alcohol use can lead to dependence.
Withdrawal
When a dependent drinker suddenly stops or reduces their drinking they are likely to experience withdrawal symptoms—which makes stopping more difficult. Withdrawal symptoms can be quite mild or quite severe, ranging from insomnia and shakiness to severe seizures and delirium tremens—often called the DTs—which is characterised by gross trembling of the whole body, fever and delirium. Most people do not suffer delirium tremens, but there can be significant risks in withdrawing from alcohol, and people undergoing withdrawal should be monitored.
Most people who are going through withdrawal are treated on an outpatient basis; that is, they are not hospitalised, but they do have medical support. Sometimes medications such as benzodiazepines are prescribed to help reduce the severity of symptoms.
Overdose
If drinking continues for an extended period, bodily functions can decrease to such an extent that the person loses consciousness (blacks out), which can lead to death by suffocation if the person vomits while unconscious.In rare cases, a person's physical functioning may decrease to the point where they stop breathing. This is called alcohol poisoning.
Treatment
Advice from a GP or other health professional can be effective, especially with people who have milder alcohol problems.
For those with more serious problems, other forms of treatment may be required. This may involve withdrawal under medical supervision, followed by psychological or medical treatments to help prevent the person going back to their risky behaviour.
Psychological treatments such as motivational interviewing, cognitive behavioural therapy and contingency management have been found to be effective in treating alcohol disorders. More recent research has found that naltrexone, acamprosate and/or disulfiram in conjunction with psychological treatment can improve recovery.
Support groups may also be an option.
Reducing the harm
Alcohol use and abuse pose a high cost to society through the impact on individual health and workplace productivity. There are also costs related to drink driving and community violence. Research has estimated that in Australia during 2004-05 the social cost of alcohol related harms to the individual was $15.3 billion. Research by the Alcohol, Education and Rehabilitation Foundation (AERF) published in 2010 looked at the cost of alcohol abuse to those other than the drinker. This cost has been estimated at over $20 billion, putting the total cost per year of alcohol-related harms in Australia at $36 billion.
Some suggestions for reducing costs are:
- higher alcohol taxes, with higher taxes for drinks that are most often abused
- partial or complete bans on the advertising and promotion of alcohol
- increased measures to reduce drink driving
- a greater involvement by GPs in explaining risks and risk-reduction strategies to their patients.
The 2005 research also recommended:
- greater control of drinking environments such as clubs and pubs
- alcohol ignition locks on vehicles driven by convicted drink-driving offenders
- guidelines to help people drink at low risk levels
- standard labelling and health warnings on bottles and cans.
