3. ALCOHOLICS ANONYMOUS (A.A.):
A.A. has never attempted to keep formal membership lists. It is extremely difficult to obtain completely accurate figures on total membership at any given time. Therefore the following record of membership by the General Service Office of A.A., as of January 1, 1996, are not definitive. The total reported, plus an average allowance for groups that have not reported their membership is: 1,922,269 members and 95,166 groups.
4. "ORDINARY KNOWLEDGE COMMON TO THE COMMUNITY" has no relevance for the alcoholic and the disease of alcoholism.
There are an estimated 10.5 million people in the country suffering from the disease of alcoholism.
One out of ten people who drink become an alcoholic. An alcohol-related family problem strikes one of every four American homes. Individuals who are close to an alcoholic need and deserve appropriate help to recover as well.
In the workplace, 47% of industrial injuries and 40% of industrial fatalities can be linked to alcohol consumption.
Use of alcohol and other drugs is associated with the leading causes of death and injury among teenagers and young adults (e.g. motor vehicle crashes, homicides, suicides).
Violent behavior attributed to alcohol use accounts for approximately 49% of murders, 52% of rapes, 21% of suicides, and 60% of cases of child abuse. Of all fatal accidents on the roads, over 50% involve alcohol.
Alcohol contributes to 100,000 deaths annually, making it the third leading cause of preventable mortality in the United States, after tobacco and diet/activity patterns.
Alcohol, the most widely used psychoactive drug in the United States, has unique pharmacological effects on the person drinking it.
Among 8,541 deaths attributed to non-medical use of other drugs in 1993, 40% also involved alcohol.
In 1992, more than seven percent of the population ages 18 years and older—nearly 13.8 million Americans—had problems with drinking, including 8.1 million people who are alcoholic. Almost three times as many men (9.8 million) as women (3.9 million) were problem drinkers, and prevalence was highest for both sexes in the 18-to-29 years old age group.
About 43% of US adults--76 million people—have been exposed to alcoholism in the family: they grew up with or married an alcoholic or problem drinker or had a blood relative who was ever an alcoholic or problem drinker.
63% of high school seniors report that they have been drunk; nearly 30% say that have had five or more drinks in a row during the last two weeks.
From 1985 to 1990, the economic cost of alcoholism and alcohol-related problems rose 40% to $98.6 billion. Reduced or lost productivity and premature death accounted for 71% of this cost; medical care for more than 10%; and crime for nearly 6%.
Nearly one-fourth of all persons admitted to general hospitals have alcohol problems or are undiagnosed alcoholics being treated for consequences of their drinking.
On average, untreated alcoholics incur general health care costs at least 100% higher than those of nonalcoholics, and this disparity may exist as long as 10 years before entry into treatment.
Studies of suicide victims in the general population show that about 20% of such suicide victims are alcoholic.
Alcohol is typically found in the offender, victim or both in about half of all homicides and serious assaults, as well as in a high percentage of sex-related crimes, robberies, and incidents of domestic violence, and alcohol-related problems are disproportionately found among both juvenile and adult criminal offenders.
Fetal alcohol syndrome (FAS), which can occur when women drink during pregnancy, is the leading known environmental cause of mental retardation in the Western World.
5. THE ALCOHOL BEVERAGE INDUSTRY IS RESPONSIBLE AND IS ACCOUNTABLE FOR THIS GENOCIDE AND BURDENSOME COST TO THE AMERICAN SOCIETY?
It seems that the American people are being held responsible, mainly the alcoholic and the heavy user of alcoholic beverages. Abraham Lincoln in his Gettysburg Address said that ours is a "government of the people, by the people, for the people." More strictly speaking, ours is a government by the "consent" of the people-a government agreed to by the people through a written contract called a constitution. It seems that the United States Government has formed a giant consortium with the alcohol beverage industry and the advertising world, too powerful to overcome, in the name of taxes, profit, and personal gain. Are they not responsible and accountable to the American people for the product (agent) alcohol that has destroyed so many lives?
In 1981 the alcohol beverage industry (wine, spirits, and beer) invested $1,014.9 million for advertising. Consumer consumption for 1980 was 28.35 gallons per capita consumption at an expenditure of $50.81 billion. Federal excise taxes for 1980 were: beer - $1.5 billion, spirits - $3.9 billion, and wine - $.021 billion. In 1975 it was reported for Federal State, and Local Taxes - $9.685 billion. Add to the above revenues the federal tax on tobacco for 1980 (the federal tax on cigarettes was doubled in 1982), $2.5 billion and corporate tax of $72 billion, one can readily see why the government went into business with companies that manufacture ADDICTIVE PRODUCTS. Take note of the fact that the alcohol beverage manufacturers also have as subsidiaries major tobacco manufacturers and vice versa.
The "Ad hominem" defense seems to apply in any case of argument brought against the alcohol beverage industry by an individual or group. It is a Latin meaning, "To the Man". The term is used to refer to an argument made against an opponent personally instead of against his argument. The argument is: That the alcohol beverage industry produce, bottle and sell alcoholic beverages for consumption by the public and have for many years past.
The alcohol beverage industry advertise their products in order to create a demand therefor. That the alcohol beverage industry "KNOWS OR SHOULD HAVE KNOWN" that alcohol is a deleterious drug and a poison, which is addictive, but despite such knowledge promoted its sale by deceptive marketing practices and by subliminal as well as overt advertising, knowing that alcohol is dangerous to a substantial portion of the population. The judiciary, in its decisions and opinions, reverses the argument and places the onus on the plaintiff (alcoholic or damaged party), using such statements as "The article sold must be dangerous to an extent beyond that which would be contemplated by the "ordinary" consumer who purchases it, with the "ordinary knowledge common to the community as its characteristics". "That the plaintiff (Alcoholic) knew or should have known that the amount of alcohol consumed was potentially lethal." " That the plaintiff knew or should have known of the product's dangerous propensities." "That there is no liability of the dangerous propensities." "That there is no liability of the danger is or should have been known to the user.
6. PRODUCT LIABILITY
It is the responsibility of the manufacturer or seller to pay for harm caused by a defective product. To determine the extent of this responsibility the law considers three theories of product liability; a defendant can be held responsible cause of negligence, breach of warranty, or strict liability. For this law suit, the rule of strict liability will be litigated and how it applies to the alcoholic. Strict liability means that the defendant is responsible even if he was not directly at fault. For example, a manufacturer may be liable for injuries caused by a defective product even if the plaintiff cannot prove that the manufacturer was careless. The principle of strict liability developed because the limitation placed on plaintiffs by both negligence and breach of warranty were sometimes used to prevent people who had been injured by defective products from gaining satisfaction in court. Under strict liability, an innocent consumer who knows nothing about disclaimers and the requirements of giving notice to a manufacturer with whom he did not deal cannot be prevented from suing. The rule awards the technical limit of privity, which can create an extensive chain of lawsuits back to the party that originally put the defective product into the mainstream of commerce. It takes the burden of cost of an injury off the innocent consumer and puts it on the manufacturer, who can spread the cost of an occasional injury among all his customers by adding to the price of each product in the first place. This rule of Strict Product Liability is now recognized as law in almost every state. Anyone who sells a product in a defective or dangerous condition is legally liable for any physical harm caused to the user or his property - if the seller regularly sells such products and the consumer receives the product without substantial changes having been made in its condition. The seller (whether a salesperson or manufacturer) is liable even though he has been careful in handling the product and even if the consumer bought the product somewhere else and did not deal directly with him.
7. INADEQUATE LABELING AND FALSE ADVERTISING
"Improper labeling, instructions, or warnings on a product or its container can make a product defective, too. A drug or a poison must be labeled with its correct name. Dangerous products should carry warnings that explain how they should be used, under what circumstances they have caused harm, and what steps to take in an emergency. Warnings can give an antidote for accidental poisoning"..."A manufacturer who creates a demand for goods through print and broadcast media is strictly liable for making sure his product has the qualities advertised to the general public". The manufacturer's or seller's duty to include safeguards, take precautions, and give instructions and warnings has the effect of making some unavoidably unsafe products marketable. Drugs illustrate this principle because they can be dangerous if their use is uncontrolled. If strict liability were applied, drug manufacturers might take beneficial drugs that are high-risk and/or create serious side effects off the market.
8. ALCOHOL-THE DRUG AND THE POISON
Alcohol is a drug (a sedative) one most frequently used and abused. The drug ethanol (alcohol) can be classified with other sedative drugs doctors normally prescribed, such as Librium R, Valium R, or barbiturate, such as Phenobarbital, Seconal R, Nembutal R, or minor tranquilizers, such as Equanil R, Miltown R, or bromide sedatives, such as Miles Nervine R. When alcohol is taken with other drugs, the combination may produce an effect which is greater than the sum of what the effect of each individual drug might be. An effect known as supra-addictive interaction or "Synergism." This synergistic effect may be two to four times greater than the effect of alcohol alone or the pill alone. This greater effect can be very dangerous if the quantities consumed for each drug is high. The synergistic effect depresses heart action and respiration which frequently leads to death. One expert suggested that "...Alcoholism is the name of a disease that should more properly be called "sedativism." It doesn't matter which sedative you use, including alcohol, they all do the same thing to the brain...you could take one away and replace it with another and the brain wouldn't know. A patient with a drinking problem may hide that fact from his doctor. He will complain of feeling anxiety, tension, pain, and sleeplessness. Doctors know from drug companies that sedatives and tranquilizers are made to treat these symptoms. What doctors may not know, nor are they informed by suppliers, is that most sedatives have what is known as a "half-life". This half-life of a drug is the length of time it takes the body to excrete or metabolize half of the given dose. One of the most frequently prescribed drugs in use has an average half-life of twenty four hours. The average prescription is for 10mg to be taken four times a day. A simple computation reveals on day one, the user consumes 40mg. On day two, there is still 20mg of the drug active in the body. This amount added to another day;'s 40mg leaves the patient with 60mg on day three-a dosage not contemplated by the doctor. Many doctors are unaware of this half-life action or of the addictive potential of sedative drugs. No one informs them. Most education on sedative drugs comes from the manufacturer who, in many cases, is silent on the subject.
9. ALCOHOL AS A POISON
In sufficient quantities alcohol is a cell poison which is capable of bringing all life functions to a halt in any organism. In smaller amounts alcohol depresses the functions of living cells. In animals like ourselves the depressant effects of alcohol are most readily apparent in the case of the cells of the central nervous system. In the activity of the cells which produce blood, bone, or skin is temporarily diminished there is no way whereby the owner of these cells can subjectively identify this fact.
10. ALCOHOLISM THE DISEASE
In Las Vegas, Nevada, 1966, the American Medical Association drafted the official resolution that was passed a year later, in Houston, Texas, declaring alcoholism a disease. The official 1967 resolution introduced by the Colorado delegation, resolved that the American Medical Association identified alcoholism as a complex disease and as such recognizes that the medical components are medicine's responsibility. Alcoholism and addiction are no longer concepts, they are facts of life. Alcohol addiction (alcoholism) as a disease is marked by a group of characteristics (symptoms and signs) which define a recognizable entity. This disease has a predictable course characterized by remissions and recurrences as well as a predictable outcome of increasing disability and death if left untreated. Illness and death may be related directly to the primary disorder as in overdoses and motor vehicle accidents or related to a host of secondary disorders such as cirrhosis (scarring of the liver), pancreatitis (inflamation of pancreas), bleeding disorders and heart or brain disorders. All of this evidence would indicate that alcoholism is a disease not unlike diabetes or hypertension with an inherited vulnerability activated by host and or environmental factors. This concept of alcoholism as a disease has created a remarkable although, at times, subtle changes in attitude of non-alcoholic toward the alcoholic and the alcoholic toward him/herself.
11. NCADD ADOPTS NEW DEFINITION OF ALCOHOLISM
Alcoholism is a primary, chronic disease with genetic, psychological, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic; impaired control over drinking; preoccupation with drug alcohol; use of alcohol despite adverse consequences and distortion of thinking, most notably denial.
PRIMARY refers to the nature of alcoholism as a disease entity in addition to and separate from other pathopysiologic states which may be associated with it. "Primary" suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.
DISEASE means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena's are associated with a specified common set of characteristics by which these individuals differ from the "norm", and which places them at a disadvantage.
OFTEN PROGRESSIVE AND FATAL means that the disease persists over time and that physical, emotional and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, organic complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.
IMPAIRED CONTROL means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.
PREOCCUPATION in association with alcohol use indicates excessive, focused attention given the drug alcohol, its effects, and/or its use. The relative value thus assigned to alcohol by the individual often leads to a diversion of energies away from important life concerns.
ADVERSE CONSEQUENCES are alcohol related problems or impairments in such areas as: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behavior): interpersonal functioning (e.g., scholastic or job problems): and legal, financial, or spiritual problems.
DENIAL is used here not only the psychoanalytic sense of a singled psychological defense mechanism disavowing the significance of events, but more broadly to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual's problems. Denial becomes an integral part of the disease and a major obstacle to recovery.
12. ADDICTION
Dependence on a chemical substance to the extent that a physiologic and/or psychologic need is established. This may be manifested by any combination of the following symptoms: tolerance, preoccupation with obtaining and using the substance, use of the substance despite anticipation of probable adverse consequences, repeated efforts to cut down or control substance use, and withdrawal symptoms when the substance is unavailable or not used.
13. LABELING
In 1972 the Center for Science in the Public Interest (CSPI) looked into what seemed a peculiar oversight of American law: of all foods and beverages, (not to mention dog food and shampoo) sold in the United States, one large class, alcohol beverages, bore no ingredient labels. The Federal Food, Drug, and Cosmetic Act, passed in 1938, made no exception for beer, wine, or liquor. The cause of the "oversight" was that neither federal agency ostensibly in charge of alcohol beverages, not Food and Drug Administration (FDA) which enforces the 1938 law, and not the Bureau of Alcohol, Tobacco, and Firearms (BATF) to which the FDA in 1940 voluntarily surrender responsibility for labeling alcoholic beverages, had fully enforced the law for thirty four years. Which meant almost every brewer, winemaker and distiller in the United States appeared to have been violating the law for all those years. "The consumers' right to know, and in some cases, the need to know the ingredients of all food products", as put by a former director of the BATF is a time honored American tradition. "...It is an equally time honored tradition that alcoholic beverages are among the only foods or beverages in the United States for which manufacturers have not been compelled to disclose ingredients". Full ingredient labeling is only one of several things that should be stated on the label. Most importantly, label notices should remind consumers that alcohol promotes certain cancers, Fetal Alcohol Syndrome, brain damage, dangerous driving and other serious problems. The BDM Corporation, a consulting firm, was hired in 1979 by the BATF to study the health impact of ingredients in alcoholic beverages and the cost of listing those ingredients on labels. BDM estimated that from 475,000 to 1,700,000 Americans are allergic to ingredients in alcoholic beverages. Without informative labels, these persons become tee-totalers, or run the risk of allergic reactions. In addition to allergy-causing substances, BDM reviewed hundreds of research papers concerning some 18 ingredients that could cause adverse effects. According to BDM's report: "Some of the adverse effects appear to be severe and presumably affect a 100,000 or more individuals. The majority of effects are not severe, although they often will result in some cost to the consumer."
14. ADVERTISING
The alcohol beverage industry invests over a billion dollars a year to advertise their products. The heavy user and the alcoholic are the prime targets that their advertising is aimed at. Though they rarely admit it; the knowledge that the media, distillers, brewers, and the wine makers have about their consumer is vastly beyond anything available at NIAAA or any university library. The Brand Rating index, (BRI), one of the fanciest and most expensive of media's national research organizations offered this description of the Heavy User.
" Purely and simply, heavy users are the most important customer you have. They are the men and women who consume well beyond the average...the men and women who account for a markedly disproportionate share of product purchases and usage. As a rule these heavy users represent an unusually small percentage of the total population. In other words, this active buying minority is the "vital purchasing core" of the prime market for luxury products and quality merchandise."
These heavy consumers can be easily correlated and analyzed into complex psycho graphic and demographic profiles. Virtually all alcohol advertising employs subliminal stimuli. One reason certainly, is that heavy consumers of any product at whom most media content is directed, are likely to be highly susceptible to subliminal stimuli used in relation to that product. Subliminal stimuli are insidious and believed responsible for attitudinal frames of reference, moods, emotional predisposition, and residual value systems. There is no possibility of rational decision making or defense, since consciousness is bypassed completely. Both conscious and unconscious motives lie behind every human communication situation. In order for maximum effectiveness, a message must relate to motives or goal seeking behavior at both ends of the communication. However, motives can exist in a repressed state within the brain unconscious mechanism. Many theorist maintain that most of an individual's "real" motives operate at this unconscious level. Conscious or stated motives are usually evasion, camouflage, or frequently mere rationalization serving superficial ego needs. Motives, generally defined, involve reasons for action or attention, goals to be pursued, or purposes to be served. Unconscious but omnipresent motives rarely involve simply the quality or price of a product. They more often relate to the prospect's ego needs, such as status, dominance, security or recognition. Most unconscious motives apparently involve how an individual sees other people seeing him. The most utilitarian motives in communication relate to man's inexhaustible need to support and reinforce his ego. Some research suggests that subliminal stimuli appear to operate much like post-hypnotic suggestions. A substimulus is induced at the unconscious level and surfaces consciously at a later date, say, at the moment of a purchasing decision. The actual reason for the decision, however, is never known to the subject, who may verbalize a complex, even bizarre rational for his behavior, as do most addicts trapped in compulsive behavior.
15. HUMAN PERCEPTUAL DEFENSES
Among Sigmund Freud's major contribution were his early studies on limits of man's conscious behavior; these have been developed and expanded by scores of modern writers on psychological phenomena. In order to avoid anxiety, we construct perceptual defense mechanisms that either limit or distort our perception of reality. Perceptual defenses include repression, isolation, regression, fantasy formation, sublimation, denial, projection and introjection - possibly all describe different aspects of the same mechanism. These defenses erase memories of upsetting experiences, prevent disturbing conscious memory associations, inhibit certain emotions from relating to experiences, or modify the perception of a drive, wish, or fantasy, transforming a drive stimulus which produces guilt into a more acceptable form. Repression is often termed the central mechanism of perceptual defense. R.E. Laing's simple definition is often useful: "We forget something then forget we have forgotten." Though unavailable at the conscious level, repressed information does affect, behavior, usually in ways impossible to consciously recognize. These defenses, unconscious ways in which conscious awareness excludes information that might provoke anxiety, are compulsive acts. Indeed, there is no control over a perceptual defense, nor even any conscious awareness such a defense is in operation. They operate automatically and invisibly, and appear related to individual adjustments within cultures or subcultures. Each culture uniquely confronts its members with an effort to control or manage basic drives. These defensive perceptual strategies actually make it possible for an individual to adapt to a society's imposed restrictions. One of the most unsettling discoveries anyone researching sub-stimuli must eventually confront that once the subliminal information is pointed out, it is easy to perceive consciously. From the point of discovery, in fact, even years after the discovery, it is the primary feature that will be dealt with consciously. Sub-stimuli have a powerful effect upon memory. The artists do not really hide anything! It is always available to anyone who could consciously deal with the information. Viewers actually hide the taboo images from their own conscious awareness, lest they arouse culturally forbidden memories, feelings, or perceptions. This view of human perception is profoundly disturbing to many, especially to those with highly repressed views of themselves and their social and sexual behavior. The United States may well be one of the most repressed societies on earth, purposefully educated in vast areas of reality avoidance. This is an extremely dangerous condition that could threaten both individual and national, if not world, survival. But one thing is apparent at this point: the alcohol beverage industry knows a good deal more than do its consumers, and even the medical profession, about why individuals continue to drink.
16. WHAT CAUSES ALCOHOLISM
Several studies on the problems of maturing have cautioned against the use of alcohol by children and young people. These have been based on the accepted thesis that the average person does not fully mature until they are about 25 years of age. Insurance Companies are concerned about the young and immature driver and for this reason the insurance rates are extremely high until the driver becomes 26 years of age. The maturing process revolves around the development of a small but vital organ located in the brain. This organ known as the hypothalamus, is vitally effected by alcoholic beverages be they beer, wine or liquor. The eminent Dr. Jorge Valles, M.D., a psychiatrist extensively involved in therapy work with alcoholics and vitally concerned as to "what causes the alcoholic" points out in his book "From Social Drinking to Alcoholism" that: "The younger the age at which an individual starts to ingest alcohol, the greater the chances that he will develop into a chronic alcoholic. For the action of the alcohol is channeled directly toward the adolescent's imbalanced hypothalamus and autonomic nervous system, thereby obstructing his emotional maturation on both psychological and physiological levels. The regular or frequent ingestion during adolescence may produce a permanent imbalance of the hypothalamus and a concomitant irreversible malfunctioning of the autonomic nervous system, thereby leading to the development of chronic alcoholism. In brief, the direct action of the alcohol on the hypothalamus produces chronic alcoholism."
17. HEREDITY
Medical research has shown that alcoholism runs in families. Family histories taken from patients indicate that 95% of the time, the mother or father had a drinking problem, or an uncle or brother. Usually when there is an alcoholic in a family, you will find many more in the background. Heredity studies, done all over the world, clearly show that genetics is the most significant single factor determining whether or not an individual will be an alcoholic. Medical science has found an abnormality in the body chemistry of the predispositioned alcoholic. Discovered in the brain of the chronic alcoholic is a substance that is closely related to heroin. This substance has long been known to scientists as Tetrahydrosoquinoline or THIQ for short. Heroin when shot into the body, breaks down and turns into THIQ. When the "normal" adult drinker takes a drink, it is metabolized at the rate of one drink per hour. The body first converts the alcohol to acetaldehyde which is extemely toxic. If it were to build up one would get violently sick and could die. The body gets rid of acetaldehyde by changing it into acetic acid, and then changes it a couple of more times into carbon dioxide and water which is then eliminated throughout the kidneys and the lungs. When the alcoholic takes a drink something additional happens to the above sequence of events. A very small amount of poisonous acetaldehyde is not eliminated, instead it enters the brain, where, through a very complicated biochemical process, it becomes THIQ. THIQ is manufactured in the brain, and it occurs only in the brain of the alcoholic drinker, it does not happen in the "normal" drinker. THIQ is also highly addictive. During the Second World War THIQ was going to be used as a pain killer but it was found to be more addictive than morphine so the scientists had to abandon the use of it. Once THIQ is in the brain it stays. An alcoholic could be sober for 10 or 25 years and then start drinking again. An example of this is an individual, who is alcoholic, sober for 15 years and 65 years of age, taking Geritol for an iron deficiency. The sober alcoholic innocently taking a prescription, sold over the counter, is consuming an iron supplement that has an alcohol content. The THIQ factor becomes activated and the alcoholic will show the same symptoms displayed years before. The alcoholic says, "I don't know why I started again. Drinking was the last thing from my mind". This is the progressiveness of the disease. Families who have a predisposition of alcoholism, an abnormality in the family body chemistry, which is more clearly seen as a predisposition toward making THIQ, have no way of knowing this THIQ making chemistry is inherited. Most "normal" Americans take a drink now and then, and the young alcoholics-to-be want to be normal also. So they take a drink now and then, too. As time goes on the "normal" drinker stays with moderation - the alcoholic's-to-be brain is building a cache of THIQ and drinking more and more until the "invisible line" is crossed into alcoholism. Predisposed people cross this line while they are teenagers or earlier, some
it may occur when they are 30 or 40 or maybe even retired. But once it does happen, the alcoholic will be addicted to alcohol as he would have been addicted to heroin, if he had been shooting that instead, and for very similar chemical reasons. Now its chronic, progressive, incurable nature is obvious to practically everyone who knows the alcoholic. Now it's all too clearly a disease. "The alcoholic cannot be held responsible for his/her heredity."
18. ALCOHOL USE AND ITS MEDICAL CONSEQUENCES
Most of the acute pharmacological effects of ethyl alcohol are manifestered through the central nervous system (CNS). Ethanol can be described as a primary, functional, irregularly descending CNS depressant. Depression of the mid-brain functions interferes with spinal reflexes and temperature regulation. Ultimately, the medulla also succumbs and death results from a paralysis of the medullary centers.
As the blood alcohol concentration (BAC) rises so also does the concentration in the CNS resulting in a continuous spectrum of effects. The euphoric stage of intoxication is the goal of the social drinker. It is characterized by talkativeness, increased self confidence, decreased inhibitions (but not increased sexual appetite per se), diminution of attention and judgement and loss of efficiency in finer performance tests. The excitement phase begins for most individuals at the BAC accepted as the legal criterion of intoxication. The individual now exhibits emotional instability, impairment of memory and concentration, and some muscular incoordination. In the stage of confusion the individual may be disoriented, dizzy, have exaggerated emotional states (fear, anger, grief), diplopia, ataxia and slurred speech. In the stage of stupor there is marked muscular incoordination with an inability to stand or walk, the response to sensory stimuli is markedly decreased, vomiting and incontinence are common. In the stage of coma, reflexes may be totally abolished. This stage of general anesthesia may progress to the terminal event which is death in respiratory failure.
Ethanol does enhance cutaneous blood flow, and a flush is a common sign of mild intoxication. This effect will accelerate heat loss. In addition the thermoregulatory center is impaired in severe intoxication. Thus, drinking when one is exposed to cold is irrational and dangerous. Ethanol should never be given to victims of hypothermia. In addition, chronic abuse may, by unknown mechanisms, produce myocardiopathy. A skeletal muscle myopathy may also be a consequence of chronic ethanol abuse. Ethanol stimulates the secretion of gastric juices by complex mechanisms, that may involve psychic, neural and humoral factors. Alcohol abuse is etiologically associated with acute and chronic pancreatitis, fatty changes in the liver, inflammation of the liver, cirrhosis and esophagitis. Heavy users of alcoholic beverages have an increased incidence of carcinoma of the pharynx, larynx and esophagus.
Alcohol may aggravate or reactive peptic ulcer. It may exacerbate pre-existing liver disease, and patients with liver disease may be especially sensitive to ethanol because of an impaired ability to metabolize it. Ethanol may trigger seizures in epileptics. Ethanol can potentiate the CNS depressant effects of other drugs, and such combinations should be avoided.
Hypoglycemia may occur in people who drink heavily after a period of not eating. Their hepatic glycogen stores are already depleted, and the increased ration of NADH/NAD as a consequence of ethanol oxidation decreases gluconeogenesis from alpha-glycerophosphate, lactate and pyruvate, and amino acids via oxalacetate. The hypoglycemia may be severe and rarely even fatal. Intoxicated persons may pass from intoxication into hypoglycemic coma. Eventually with chronic excessive abuse of ethanol, physical dependence will develop to the point where an unambiguous withdrawal reaction can be recognized. Minor withdrawal reactions are characterized by insomnia, irritability and tremor whereas major withdrawal reactions include anxiety, agitation, sweating delirium and disorientation. Withdrawal seizures ("rum fits") may occur in the 12 to 48 hour period after the start of abstinence. The combination of delirium with tremor gave rise to the name delirium tremors (DT's) which in its most serious form includes vivid, terrifying hallucinations, tachycardia, fever, sweating and a profoundly hyper metabolic state.
19. ALCOHOL AND THE LIVER
Alcohol is the major cause of liver cirrhosis in developed nations. Ingestion of large quantities of ethanol may be associated with damage to many cells and organs. Chief among these are liver cells which are primarily responsible for ethanol metabolism. Liver damage clearly is related to the degree and duration of ethanol use, even though other environmental and genetic factors may modulate development of cirrhosis or other serious liver injury. Classically, three major categories of liver change or damage have been recognized in association with heavy ingestion (five drinks per day) of ethanol - Fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. The fatty change is completely reversible. Therefore, if alcoholic hepatitis or cirrhosis has not supervened, the prognosis is excellent as long as abstinence or moderation (Three drinks per day) can be maintained. Alcoholic hepatitis is a disease which takes a fairly long time to develop (months to years of excess ethanol) and which is characterized by smoldering necrosis and inflammation. The cornerstones of therapy for alcoholic hepatitis are abstinence, rest and good nutrition. It is not surprising that abstinence might favorably affect the sequella of alcoholic hepatitis. Some authorities say that 80 percent of patients who continue to drink will develop cirrhosis in 1-12 years. Alcoholic cirrhosis, simply states, is a cirrhosis caused by prolonged heavy ingestion of ethanol. Its seems probable that alcoholic hepatitis is a necessary precursor of alcoholic cirrhosis. Because fatty infiltration and active alcoholic hepatitis so often accompany alcoholic cirrhosis, the liver of the alcoholic cirrhotic is more likely to be enlarged, at least at the earlier stages of disease.
At the later stages, the liver may shrink and become indistinguishable from the liver of post-necrotic cirrhosis, due to viral hepatitis or drug-induced liver injury. The principles of management of alcoholic cirrhosis are similar to those for cirrhosis of any etiology, with the added proviso that patients should abstain from further ethanol intake. The complications of alcoholic cirrhosis are due mainly to diminished liver cell function and to marked abnormalities in portal and liver blood flow. This may lead to development of varices and hemorrhoids, as there is enlargement of alternative collateral channels between the splanchnic and systemic circulations. These dilated collaterals may rupture, producing GI bleeding. The bleeding may be exacerbated by accompanying defects in blood coagulation due to liver cell failure or to consumptive coagulopathy (DIC). Other complications of cirrhosis include ascites, edema, renal tubular acidosis, functional renal failure, increased incidence of peptic ulcer, increased incidence of pigment gallstones, diabetic-like glucose intolerance, increased absorption of iron from the GI tract, coagulopathy, impaired immune function, impaired leukocyte function, hypersplenism, and development of hepatoma. Alcoholic cirrhosis is a serious disease; particularly if the cirrhosis is "decompensated" as evidence by jaundice, acites, functional renal insufficiency, and/or variceal hemorrhage. The prognosis can be improved by abstinence, especially if the disease is not already far advance.
20. HEMATOLOGIC COMPLICATIONS OF ALCOHOL
Alcohol affects virtually all products of the hematopoietic system. Its effects on erythropoiesis leads to anemia. Folic acid deficiency results from decreased ingestion, impaired absorption and abnormal folate metabolism. Patients with alcoholism have an increased susceptibility to infection. Such infections are usually more severe than in the non-alcoholic patient and are associated with higher mortality. Although the lung is the most common site of infection, there is an increased incidence of other life-threatening infections such as septicemia, septic arthritis, meningitis, and peritonitis.
21. ALCOHOL AND THE ALIMENTARY TRACT
Heavy ethanol consumption and cigarette smoking significantly increase the risk of developing esophageal cancer. Evidence is inconclusive on whether ethanol alone is carcinogenic or whether it enhances the carcinogenic effect of tobacco. There may be a direct damaging effect on the mucosa exposed to high concentrations of ethanol. Nutritional deficiencies associated with chronic alcoholism may induce metaplasia in the esophageal mucosa, making it more sensitive to carcinogenic stimulation. Other substances in the alcoholic beverage, such as Nitrosomonas and polycyclic hydrocarbons, may also play a role. One of the most important consequences of alcoholic cirrhosis is the development of portal hypertension and esophageal varices. Bleeding from esophageal varices may be life threatening. Chronic ethanol use may lead to varying degrees of chronic gastritis. The frequency may be influenced by other factors such as cirrhosis, age, malnutrition, medications, and concomitant systemic disease.
22. ALCOHOL AND THE PANCREAS
The precise incidence of ethanol-related pancreatitis varies depending on the population studied. In the U.S.A. and other developed countries the etiology is about 1/3 from ethanol, 1/3 from gallstones and 1/3 from all other causes. The typical patient with alcoholic chronic pancreatitis is a middle-aged man who has drunk heavily for 10-25 years. Blood and urine glucose may be increased. Other signs of chronic alcoholism (hematologic, neurologic, hepatic, etc.,) may be apparent. Some people are constitutionally resistant to the development of alcoholic pancreatitis despite years of heavy drinking. 50 percent of chronic heavy drinkers at post mortem will have evidence of chronic pancreatitis. A minority of patients suffer clinically overt chronic pancreatitis and even smaller portion die from pancreatitis per se.
23. ALCOHOL: PREGNANCY AND THE FETAL ALCOHOL SYNDROME
"Behold, thou shalt conceive and bear a son: and now drink no wine or strong drinks." (Judges, 13:7)
"Foolish, drunken and hair-brained women most often bring forth children like unto themselves, morose and languid." (Aristotle) Since earliest times, maternal alcohol use during pregnancy has been suspected to have an adverse effect on the developing fetus. Drs. Kenneth L. Jones and David W. Smith reported that they had identified a "characteristic pattern of malformation" in 8 children of alcoholic women. This pattern was characterized by a concurrent triad of signs: growth deficiency, altered morphagenesis (especially facial), and mental retardation. The pattern was termed "fetal alcohol syndrome" (FAS). Since FAS was first identified, maternal drinking has been linked to a broad spectrum of fetal effects that range from subtle to severe. These include not only the full fetal alcohol syndrome, but intrauterine growth retardation, increased risk of anomalies, effects on behavior and intelligence and increased mortality. Major effects of ethanol by trimester of pregnancy are, trimester: (1) major morphologic abnormalities, (2) increased risk of spontaneous abortion, (3) decreased fetal growth. No "safe" dose of alcohol in pregnancy has been identified. Further more, there does not appear to be a "safe" period of pregnancy. Rapid fetal growth, especially of the brain, in the third trimester makes this a vulnerable period as well. FAS children are generally below the third percentile in height, weight, and/or head circumference. They often eat poorly, with poor sucking in infancy. They may be hospitalized for failure to thrive. Other physical findings often seen in FAS are: eye anomalies such as ptosis and strabismus, ear anomalies, prominent palatine ridges, cardiac defects, pictus excavatum, external genital anomalies (labial hypopiasia), aberrant palmer creases, and hemangiomas. Mental retardation is the most debilitating feature of fetal alcohol syndrome. The average IQ score for children with FAS is around 2 standard deviations (30 points) below the normal mean IQ of 100. The mental deficiency and microcephaly seen in children with FAS have been attributed to diminished brain growth. In general, the more severe the physical signs of FAS, the more profound is the accompanying mental retardation. The monetary cost of providing life-time medical and custodial care and remedial education for the cohort of expected FAS and FAE cases in the State of New York in 1978 was estimated to be over $155 million. When this estimate was extrapolated to the country as a whole, these direct costs of all FAS and FAE cases in the United States exceed a billion dollars each year. Added to this are huge social costs, including lost productivity, permanent physical, mental and behavioral disabilities, and the enormous burden on the child and the family associated with fetal alcohol effects. Yet these effects are completely preventable.
24. ENDOCRINE AND METABOLIC EFFECTS OF ALCOHOL
Both acute and chronic ingestion of alcohol often have distinct effects on various endocrine and metabolic systems. Liver disease and malnutrition associated with alcoholism may also have adverse endocrine effects.
Male alcoholics may complain of decreased libido and/or impotence. Gynecomastia is often found. Examination also frequently reveals atrophy of testes. Other sexual characteristics are usually intact, although some patients may develop a female escutcheon. In one study of 50 hospitalized men with alcoholic liver disease, over half had testicular atrophy and even more had a female escutcheon. Both a decreased sperm count and decreased serum testosterone concentration are common findings. The chronic alcoholic woman may have infrequent periods or even total cessation of cyclic menstrual flow. Decreased fertility has also been reported. It is thought that alcohol may have a direct toxic effect on the ovaries as well as on the secretion of gonadotropin by the pituitary gland. In addition, both malnutrition and chronic disease may cause amenorrhea, probably via a hypthalmamic effect.
25. CONCLUSION
Alcoholism, like crime and mental illness, seems to run in families. Few who have known an alcoholic are likely to argue that an alcoholic's behavior will have no impact on his or her family. Partly for this reason, the relatively high rate of alcoholism found among children of alcoholics has often been interpreted in social-psychological terms. Over the last two decades, however, evidence has mounted to suggest a genetic component in the development of alcoholism. Whether genetic factors placing a person at risk for alcoholism will produce alcoholism seems to depend, at least in part, on the environment.
As stated in the beginning of this action, 10 to 15 million American people were documented as being alcoholics and another 35 million are affected as family members or other victims. Other statistics are as follows:
a- There are approximately 500,000 men and women in local, state, and federal prisons. 50 to 70% are incarcerated because of alcohol related crimes. Homicide - 64%; Assaults - 41%; Rape - 34%; Robbery - 72%.
b- Suicide - 30%; Child abuse - 60%; Fire fatalities - 53%; Drowning - 68%.
c- Alcohol is responsible for the majority of family breakups.
d- Alcohol is responsible for the majority of battered women and children. 38% of child abusing parents have a history of drinking problems.
Each and every statistic is or was a family member: THE FAMILY IS AMERICA!
"THEY KNEW OR SHOULD HAVE KNOWN", the burden, responsibility, and accountability should be that of the alcohol beverage industry. The primary financial responsibility is that of the alcohol beverage industry to reimburse society for the devastation their product generates. Not only does the alcohol beverage industry have the duty to warn and reimburse, they must also provide the public with the facts about the true, scientific consequences of drinking alcoholic beverages. The consumer has not been properly informed and has been denied his or her right to know. Any member of our American Society, hurt by alcohol consumption, has a right to be paid for his or her damages.