5. You can increase your rate of metabolizing
alcohol by exercise or by taking caffeine
A. True
B. False
True
False
0%0%
6. Alcohol’s Effects
• Alcohol acts on the
cerebrum affecting
▫ Judgment
▫ Reasoning
▫ Inhibitions
▫ Motor activity
▫ Impairs the senses
• Mouse Party
7. Alcohol primarily impacts this part of
the brain:
A. Limbic system
B. Cerebellum
C. Cerebral cortex
D. Basal ganglia
Lim
bicsystem
Cerebellum
Cerebralcortex
Basalganglia
0% 0%0%0%
8. Alcohol sedates by increasing
glutamate’s action – an agonist
response.
A. True
B. False
True
False
0%0%
9. Alcoholism
• Alcoholism
▫ Condition in which an individual loses control over
intake of alcohol
• Substance Use Disorder
▫ Physical, social, intellectual, emotional, or financial
problems resulting from the use of alcohol
▫ Withdrawal symptoms
▫ Tolerance
▫ Blackouts
10. Alcoholism
• Some consider alcoholism to be a disease
▫ Compared to heart disease or diabetes
▫ 1956 American Medical Association declared it a
disease
▫ Disease can be used as a legal defense
▫ Receive treatment rather than punishment
11. Do you agree alcoholism is a disease?
A. Yes
B. No
C. I’m not sure
Yes
No
I’m
notsure
0% 0%0%
12. Alcoholism
• Genetics
▫ 50-60% of alcoholism vulnerability has a genetic
basis
▫ Environmental factors affect the impact of
genetics
13. Alcoholism
• Psychosocial factors
▫ 20% of alcoholics have a mood or anxiety disorder
▫ Individuals are more likely to drink heavily when
in a group
▫ Expectations about alcohol are predictors of
dependence
▫ Associated with a greater number of sexual
partners
17. Family Effects
• Children of alcoholics
▫ Often experience sleep difficulties, depression,
loneliness, and stomach problems
▫ Alienated from parents, have poor communication
skills, less trust, and more emotional longing
▫ Attention deficit hyperactivity disorder (ADHD)
• Adult children of alcoholics (ACOAs)
▫ Feelings of failure and self-deprecation
▫ Feel a great need to be in control
18. Addict
• Behaviors
▫ Use of
chemicals
▫ Abusive
▫ Controlling
▫ Withdrawal of
love, attention,
affection
▫ Blaming
▫ Anger
▫ Self-
righteousness
Underlying
feeling:
SHAME
25. Which do you most identify with?
A. Addict
B. Co-dependent
C. Hero
D. Scapegoat
E. Lost Child
F. Mascot
AddictCo-dependent
Hero
Scapegoat
LostChild
M
ascot
22%
0%
11%
33%
11%
22%
26. Correlations with
Violence
As alcohol use escalates,
so does violence
▫ Domestic partner
violence 66%
▫ Sexual Assault 37%
▫ Homicides 40%
▫ Child abuse 70%
http://www.ph.ucla.edu/sciprc/pdf/ALCOHOL_AND_VIOLENCE.pdf
27. Suicide
▫ About 7% of alcoholics commit
suicide
▫ 16% of men and 10% of women
entering alcohol treatment have
contemplated suicide
▫ 38% of people who hanged
themselves had alcohol in their
system
▫ 32% of veterans who attempted
suicide were diagnosed with
alcohol abuse or disorder
30. Prohibition
• Temperance
Movement – view of
alcohol
• Prohibition
• States 1851
• Federal 1919
• Repealed in 1933
• Since 1933, states
regulate alcohol
• Federal taxation
32. Who drinks and why
• Cultural Differences
• Trends in US
• Regional Differences
• Gender Differences
• Drinking Among College Students
33. Most college students reduce their
binge drinking after graduating
from college.
A.True
B.False
True
False
0%0%
34. The younger one is when drinking
alcohol for the first time, the more
likely one will become a problem
drinker.
A.True
B.False
True
False
0%0%
35. Underage Drinking
• Underage drinking is associated
with premature death, disease,
injury, property damage, motor
vehicle crashes, alcohol-related
crime and loss of productivity
• There is a significant
relationship between drinking
before age 13 and suicide
attempts
36. Underage Drinking
• High school students who engaged in binge
drinking were six times more likely to drink and
drive
▫ 7.2% of 8th-grade students binge drink
▫ 16.3% of 9th-grade students binge drink
▫ 23.2% of 12th-grade students binge drink
37. Moderate alcohol drinkers have
lower rates of cardiovascular
disease than abstainers.
A.True
B.False
True
False
0%0%
39. When someone passes out from
alcohol use:
A. Put them on their
back
B. Put them to bed
and let them sleep
it off
C. Put them on their
side Putthem
on
theirback
Putthem
to
bed
and
let...Putthem
on
theirside
0% 0%0%
41. There is a safe level of alcohol to
consume while pregnant
A. True
B. False
True
False
0%0% Response
42. Physiological
Toxicity - Brain
• Wernicke-Korsakoff
syndrome develops
because alcohol impedes
the body’s ability to
utilize thiamine (a B vitamin)
• Alcohol use is associated with psychological
symptoms: depression, anxiety
43. Physiological Toxicity - Liver
• Three main conditions associated
with alcohol:
▫ Fatty liver
▫ Alcohol hepatitis
▫ Cirrhosis
• Cirrhosis is irreversible, even if
alcohol use stops
44. Physiological Toxicity – Digestive System
• In moderate amounts, alcohol aids digestion by
increasing gastric juice in the stomach
• Too much alcohol can irritate
the stomach, leading to internal
bleeding
• Heavy alcohol use is implicated in acute pancreatitis
• Alcoholics often have malnutrition because alcohol
interferes with the body’s ability to utilize nutrients
45. Physiological Toxicity – Circulatory System
• Moderate alcohol use reduces risk of heart
disease, boosts good (HDL) cholesterol and
helps prevent type 2 diabetes
• Effects of heavy alcohol use:
▫ Degeneration of the heart muscle
▫ High blood pressure
▫ Cardiac arrhythmias
▫ Ischemic heart disease
▫ Strokes
46. Physiological Toxicity – Immune System
• Studies show that
moderate alcohol use
reduces immunity
• Alcohol interferes
with white blood
cells, particularly
T-lymphocytes,
which help to resist
infections
Editor's Notes
Fermentation = the production of alcohol from sugars through the action of yeasts
Forms the basis of all alcoholic beverages
Fruits + yeast = fermentation will begin
Fruits naturally contain sugar
Cereal grains contain starch, which must be converted to sugar by malt before fermentation can begin
Yeast has a limited tolerance for alcohol
When the concentration reaches a certain percentage (15% is possible, but standard for wine is about 12%) the yeast dies and fermentation ceases.
Distillation = evaporation and condensing of alcohol vapors to produce beverages with alcohol content higher than 15 percent
Perhaps first used in Arabia around AD 800
Introduced into Europe in about the 10th century
In U.S., began on a large scale at the end of the 18th century
Grain neutral spirits—clear, tasteless, nearly pure alcohol (190 proof) produced by distillation
May be sold as Everclear or used in research
Ethanol is used in commercial products as a gasoline additive, cleaner, solvent
Used to make various beverages
Gin: distillate filtered through juniper berries and then diluted with water
Vodka: mixture of grain neutral spirits and water
Contains relatively few congeners
Whiskey = distillate of fermented malted barley
Early U.S. distiller from Bourbon County, KY, gave beverage its name
Distilled at a lower proof (160) and so contains more congeners and some flavor from the grain used
Rye whiskey, corn whiskey (bourbon), blended whiskey
Usually aged for at least two years
Liqueurs or cordials
Alcohol content 20 to 25 percent
Originally made from brandy mixed with flavorings from herbs, berries, or nuts
Now typically made from flavored, diluted grain neutral spirits
Proof = alcohol content of a distilled beverage; twice the percentage of alcohol by weight
90-proof whiskey is 45 percent alcohol
Beer
Made by adding barley malt to other cereal grains
Hops are added with yeast to give beer its distinctive flavor
Lager—uses a type of yeast that settles to the bottom of the mash to ferment
Most common type in United States
Ale—uses a top-fermentation yeast, warmer fermentation temperature, more malt and hops
Light beer—fermented longer at a cooler temperature
More sugar is converted to alcohol, then water added
Result is a beverage with similar alcohol content but less sugar (and fewer calories) than regular beer
Most beer sold in the United States is mass-produced by the two largest brewers
Imported beers and microbreweries are growing in popularity
WINE
Made from fermented grapes
Produced by both small and large wineries
Most wines contain about 12% alcohol
Factors in quality include selection and cultivation of grapevines, good weather, timing of harvest, and careful monitoring of fermentation and aging
Generics vs. varietals
Determined by type of grapes and flavor
Red vs. white
Sweet vs. dry
Sparkling wines
Fortified wines
Alcohol content near 20 percent
Absorption
Some absorbed in the stomach, most in the small intestine
Absorption is slower if there is food or water in the stomach
Absorption is faster in the presence of carbonated beverages
Factors that affect rate of absorption:
Food in the stomach slows absorption
Wine and beer absorbed slower than distilled spirits
Carbonation increases absorption
Strong emotions increase absorption
Males absorb alcohols slowly and break it down quickly
Women absorbs alcohol more quickly during the premenstrual phase
Women who take birth control pills absorb alcohol more quickly
Distribution
Blood alcohol concentration (BAC) is a measure of the concentration of alcohol in blood, expressed as a percentage in terms of grams per 100 ml
Alcohol is distributed throughout body fluids
Alcohol is less distributed in fatty tissues, so a lean person will have a lower BAC than a fatter person of the same weight
Metabolism: Liver metabolizes about 0.25 ounces of alcohol per hour
If rate of intake = rate of metabolism, BAC is stable
If rate of intake exceeds rate of metabolism, BAC climbs
Standard drink has about 0.5 ounces of pure alcohol
12 ounces of beer
4 ounces of wine
1 ounce of100-proof spirits
Women tend to be more susceptible than men to the effects of alcohol after consuming the same amount
Alcohol dehydrogenase (a stomach enzyme) is more active in men
Women absorb a greater proportion of the alcohol they drink
Women tend to weigh less and have a higher proportion of body fat
“Tank” into which alcohol is added is smaller
About 2 percent of alcohol is excreted unchanged
About 90 percent is metabolized in the liver
Exercise, coffee, and other strategies do not speed up the rate of metabolism
Liver responds to chronic intake of alcohol by increasing enzyme activity
Contributes to tolerance among heavy users
Can result in cross-tolerance to other depressants
MECHANISM OF ACTION
Central nervous system depressant
Used as anesthetic until the late 19th century
Alcohol has many effects on the brain and the mechanisms are difficult to pin down
Similar to barbiturates and benzodiazepines, it enhances the inhibitory effect of GABA at the GABA-A receptor
At high doses, it blocks the effects of the excitatory transmitter glutamate
It affects dopamine, serotonin, and acetylcholine neurons
Alcohol in the body is transformed by the liver into acetaldehyde, then further broken down into acetate, then water and carbon dioxide
Alcohol leaves the body at a rate of about 3/4 ounce per hour
One ounce of distilled spirits, a bottle of beer, and a glass of wine all have about the same amount of alcohol
Blood alcohol concentration (BAC):
Percentage of alcohol in the bloodstream
Rises when alcohol is consumed at a rate exceeding the rate at which it is metabolized or leaves the body
As BAC increases, behavioral and subjective effects become more pronounced
Drinking too much alcohol in a short time can be fatal
15% to 30% of nursing home patients are admitted because of permanent alcohol-induced brain damage
Five to six drinks daily adversely affects cognitive functioning
Time out from day-to-day expectations
Driving under the influence
Sexual behavior
Blackouts
Blood alcohol concentration determines effects
At low effective blood levels: complex and abstract behaviors disrupted
At higher blood levels: simpler behaviors also affected
Mood changes can include euphoria, reduced anxieties, and reduced inhibitions
Effects are greater when BAC is rising
A higher BAC is needed to impair a chronic heavy drinker
Expectations (placebo effects) explain many of the effects on social behavior
Alcohol use serves as a social signal for a time-out from responsibilities, work, and seriousness
Intoxicated individuals focus on the here and now, with little care for future consequences (alcohol myopia)
DRIVING UNDER INFLUENCE
Less than 40 percent of all traffic crash fatalities are linked to alcohol use
Risk of a fatal crash is dose-related
Single-vehicle fatalities are more likely to involve alcohol than are multiple-vehicle fatalities
Alcohol-related fatalities are more likely to occur during dark hours and on weekends
Men are more likely than women to be involved in an alcohol-related fatal crash
Anyone who drinks and drives (not just problem drinkers) is a potential threat
Current efforts
Keep repeat offenders off the road
Publicize the dangers of drinking and driving
Target younger drinkers for special prevention efforts
Sexual behavior
Alcohol use enhances interest in sex but impairs physiological arousal
Linked to unsafe sex
Blackouts
A danger sign of excessive alcohol use
Crime and violence—alcohol use is statistically related to violence
Homicide
Assault, including family violence, sexual assault, and date rape
Suicide
Peripheral circulation: Dilation of peripheral blood vessels means that drinkers lose body heat but feel warm
Fluid balance: Alcohol has a diuretic effect that can lower blood pressure in some people
Hormonal effects: Chronic abusers of alcohol can develop a variety of hormone-related disorders
Crime and violence
Physiological Effects
An alcoholic is a problem drinker, but a problem drinker is not necessarily an alcoholic
Alcoholics are dependent on alcohol – a problem drinker has interpersonal, financial, or social problems from drinking
The problem drinker may drink infrequently, but has problems when consuming alcohol
A common symptom of problem drinking is blackouts, characterized by temporary memory loss
Common elements of alcoholism
Alcoholics are unable to control their drinking
Some physical, social, or psychological consequence will result from their drinking
Genetics is not destiny
The family affected by alcoholism is not a normal family
Responsibility and blame for an alcoholic family do not rest with them
Growing up in an alcoholic household, although painful, can be a learning experience
ACOAs have to acquire skills to form healthy relationships
Guilt, self-hatred, helplessness, despair
Hurt, exhaustion, fearful, anxious, betrayed
Internalized messages
I will take care of everyone
I’m okay if I do well
I’m responsible for everything
I must look good at all costs
Underlying feeling: INADEQUACY
Payoff: Honor/worth
PAYOFF: REMOVE FOCUS FROM REAL PROBLEM, TARGET FOR PAIN
Internalized messages
I’ll show you
I don’t need anyone
I don’t care
I won’t feel
You can’t hurt me
PAYOFF: RELIEF OF RESPONSIBILITY
Internalized Messages
I don’t matter
I am invisible
I have no self
I am worthless
PAYOFF: FUN, DISTRACTION
Internalized Messages
I laugh instead of cry
If they laugh, they like me
I can fix it
I’m not worth taking seriously
I will stay little
According to the Violent Death Reporting System, in 2004 73% of suicides also tested positive for at least one substance (alcohol, cocaine, heroin or marijuana).
http://www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-F1EC-3F66462866FCB4E6
Leading cause of death 15-20 years is motor vehicle crashes Highest rate of drunk driving fatalities is 21-24. in pedestrian fatalities, 48% involved alcohol.
Moped drivers is higher than that of automobile or motorcycle drivers, mortality rate is higher
38% of women and 48 % of men admitted to ERs tested positive for drugs, alcohol the most prevalent
In fire fatalities, victims were more likely to have high BAC than survivors
20% of boating fatalities are from alcohol related accidents
40% of drownings (Canada)
HISTORY
Alcoholic beverages have been consumed for thousands of years, at least as far back as 6400 BC (beer and berry wine)
Grape wine has existed for over 2,000 years
Mead may date back to the Paleolithic Age, around 8000 BC
Beer was consumed by Native Americans at the time of Columbus’s landing
Before American Revolution
People drank more alcohol than water
Drunkenness was viewed as misuse of positive product
After American Revolution
Alcohol itself viewed as the cause of serious problems, an active agent of evil
Alcohol was first psychoactive substance to become demonized in American culture
Benjamin Rush (1745-1813)
Heavy drinking = health problems
Alcohol use damages morality
Alcohol addiction = a disease
Temperance societies
Initially promoted abstinence from distilled spirits and moderate consumption of beer and wine
Later promoted total abstinence
Became fashionable to “take the pledge” (see right)
States began passing prohibition laws in 1851
By 1917, 64 percent of Americans lived in “dry” territory
Laws reflected issues of class, ethnicity, religion, immigration, and politics
People still drank illegally in speakeasies and private clubs and legally through purchase of patent medicines
Federal prohibition
18th Amendment to the U.S. Constitution, banning the sale of alcohol, was ratified in January 1919
National prohibition went into effect in January 1920
People continued to buy and sell alcohol illegally, and enforcement was challenging and expensive
Organized crime became more organized and profitable
Alcohol dependence and alcohol-related deaths declined
REPEALED
Concerns that widespread disrespect for Prohibition laws encouraged a general sense of lawlessness
Taxation: Alcohol taxes had been a major source of revenue
Repealed by the 21st Amendment
Ratified in 1933
Alcohol per capita sales and consumption increased slowly until after World War II, when they returned to pre-Prohibition levels
Regulation after 1933
Some states remained dry after national prohibition ended, but most allowed at least beer sales
Laws were slowly relaxed until the last dry state, Mississippi, became wet in 1966
Drinking ages were lowered in some states but raised again to 21 following concerns over increased drinking rates and alcohol-related traffic accidents
Taxation
Federal and state taxes and licensing fees = about half the price of an alcoholic beverage
When taxes go up, consumption goes down, but not dramatically
Colonial Times:
Pilgrims anchored at Plymouth because their supply of beer and spirits was becoming depleted
Attitudes of early settlers toward alcohol were positive
Two important factors: sanitation and nutrition
1640: Dutch opened the first distillery on Staten Island
Rum trade was New England’s most profitable business
Consumption peaked during Jefferson’s presidency
1784: Dr. Benjamin Rush described harmful effects
Early 1800s: movement to curb the escalating rate of alcohol use and abuse
Alcohol was seen as a major cause of crime and violence
Temperance movement sought to modify alcohol use, not to eliminate it
1808: independent organizations formed temperance groups
1826: American Society for the Promotion of Temperance
1830 to 1840, annual per capita use of alcohol declined from about 7 gallons per adult to about 3 gallons
Following the Civil War, the temperance movement became strong again
Three influential groups in alcohol reform:
Women’s Christian Temperance Union (WCTU)
Anti-Saloon League
National Prohibition Party
1880 to 1889: 7 states passed prohibition laws
1907 to 1919: 34 states passed similar legislation
1920: U.S. Senate adopted the 18th Amendment (Volstead Act) which prohibited the manufacturing and sale of alcohol
Problems:
Illegal trade of alcohol
Organized crime
Enforcement problems
Toxic adulterants in black market alcohol
Home brewing was not illegal
Regional differences in the United States
Stress index: Drinking rates higher in states where people experience a great deal of social stress and tension
Drinking norms: Drinking rates higher in states where people tend to approve of the use of alcohol to relieve stress
Gender differences: Males more likely to drink than females, and more likely to drink more
Women’s drinking patterns:
Women who are unemployed, looking for work, or employed part-time outside the home
Women who are divorced, separated, or not married but living with a partner
Heavy drinking after a health problem such as depression or reproductive difficulties
Drinking among college students
College students drink more than their nonstudent peers
Many campuses have banned sale and advertising of alcohol, and many fraternities have banned keg parties
Alcohol use and drinking behavior hasn’t changed significantly in response
Today’s college students are less likely to drink and drive compared to students in the early 1980s
Student drinking patterns:
Australia: almost one-half of students drank to harmful or hazardous levels
Germany: 80% of university students drank heavily and 20% displayed problem drinking
37% of college students binge drink
44% reported being drunk within the past 30 days
Binge drinking:
Consuming five or more drinks (men) or four (women) in a short period of time
Typically starts at an early age and increases during adolescence
Motivations change as people age
Influenced by the perception of others’ use of alcohol
The highest rate of alcohol consumption is in the West while the lowest rate of consumption is in the South
Abstinence is increasing for men and women
Rates of abstinence and heavy drinking are greater in rural areas
The proportion of heavy drinkers in their 20s has increased slightly, along with problems related to alcohol dependency
Variables correlated with drinking patterns:
College students who are fraternity and sorority members have higher alcohol consumption rates
Gay men and lesbians are more likely to drink heavily
Binge drinking is more common in households with an annual income above $75,000
Adolescents who are victims of bullying are more likely to drink as a coping mechanism
European adolescents living in rural areas binge drink more than urban adolescents
People who engage in binge eating are more likely to engage in binge drinking
Drinking patterns by ethnicity:
Whites begin drinking at an earlier age than Blacks and Hispanics, and progress faster to alcohol dependence
Alcohol-related mortality is greater for Black and Hispanic men than for White and Asian American men
Mexican Americans had more alcohol-related problems than those of Puerto Rican or Cuban origin
Drinking patterns are affected by acculturation
Asian students resist social pressure to drink alcohol better than Caucasians
Native Americans have the highest rates of alcohol-related deaths of all ethnicities in the US
Cultural influences on drinking—ethnic and social factors
Trends in U.S. alcohol consumption
Use peaked in 1981, followed by a decline, mirroring patterns of illicit drug use
Decline particularly significant for distilled spirits
About one-third of Americans abstain
Average consumption among drinkers = about 3 drinks per day—but most drink far less
Half of all alcohol consumed in the United States is consumed by about 10 percent of the drinkers
Regional differences in the United States
Stress index: Drinking rates higher in states where people experience a great deal of social stress and tension
Drinking norms: Drinking rates higher in states where people tend to approve of the use of alcohol to relieve stress
Most people who drink today are social drinkers who are able to abstain from alcohol at will
People who cannot abstain and develop medical and social difficulties are called problem drinkers or alcoholics
A person can abuse alcohol and not be an alcoholic
Alcohol is a legal drug
Leads to belief that effects are not negative or severe
Belief that, if alcohol were bad, the government would limit its availability
Parents and other role models consume alcohol as part of their lifestyle
As costs increase, consumption levels decrease
An increase in taxes on alcohol appears to reduce consumption, especially among underage drinkers
A decline in alcohol drinking since the early 1980s has been reflected largely in less use of distilled spirits such as whiskey, vodka, gin, and rum
The definition of moderate drinking for men is no more than two alcoholic drinks per day – for women, no more than one alcoholic drink per day
There is no standard definition of heavy drinking
Binge drinking is consumption of five or more drinks at one sitting for men and four or more drinks for women
Alcohol overdose (poisoning) is common and dangerous
If someone drinks enough to pass out
Place her or him on side and monitor breathing or take to ER immediately
Do not leave the person alone
If someone drinks enough to vomit
He or she should stop drinking
Vomiting reflex indicates a rapidly rising BAC but is suppressed at BACs above 0.20 percent
HANGOVER
Symptoms: upset stomach, fatigue, headache, thirst, depression, anxiety, and general malaise
Possible causes: alcohol withdrawal, exposure to congeners, cellular dehydration, gastric irritation, reduced blood sugar, and/or the accumulation of acetaldehyde
Moderate drinking is the only way to avoid a hangover
LONG TERM RISKS
Brain tissue loss and intellectual impairment
Liver disease: hepatitis, fatty liver, cirrhosis (see right)
Heart disease: cardiomyopathy, heart attack, hypertension, stroke
Alcohol’s effects on HDL may reduce heart attack risk among moderate drinkers
Cancer
Impaired immunity
FAS = a collection of physical and behavioral abnormalities caused by the presence of alcohol during fetal development
Diagnostic criteria
Growth retardation before and/or after birth
Pattern of abnormal features of the face and head
Evidence of central nervous system abnormality
Fetal alcohol spectrum disorders (FASD):
Various effects that occur as a result of women who drink alcohol while pregnant
Effects can be behavioral, physical, and/or mental
Leading known cause of mental retardation
Fetus is especially vulnerable during the first trimester of pregnancy
Smaller brain at birth, head and facial anomalies, retarded growth, central nervous system problems, and malformations of major organs, eye problems
Alcohol use is associated with neurotic and psychotic symptoms from depressive reactions to generalized anxiety disorders and panic attacks
Wernicke-Korsakoff syndrome is a brain disorder due to thiamine (vitamin B1) deficiency.
Causes
Wernicke encephalopathy and Korsakoff syndrome are different conditions. Both are due to brain damage caused by a lack of vitamin B1.
Lack of vitamin B1 is common in people with alcoholism. It is also common in persons whose bodies do not absorb food properly (malabsorption), as sometimes occurs with a chronic illness or after obesity (bariatric) surgery.
Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke symptoms go away. Wernicke encephalopathy causes brain damage in lower parts of the brain called the thalamus and hypothalamus. Korsakoff psychosis results from permanent damage to areas of the brain involved with memory.
Symptoms
Symptoms of Wernicke encephalopathy include:
Confusion and loss of mental activity that can progress to coma and death
Loss of muscle coordination (ataxia) that can cause leg tremor
Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping
Alcohol withdrawal
Symptoms of Korsakoff syndrome:
Inability to form new memories
Loss of memory, can be severe
Making up stories (confabulation)
Seeing or hearing things that are not really there (hallucinations)
Exams and Tests
Examination of the nervous/muscular system may show damage to many nerve systems:
Abnormal eye movement
Decreased or abnormal reflexes
Fast pulse (heart rate)
Low blood pressure
Low body temperature
Muscle weakness and atrophy (loss of tissue mass)
Problems with walk (gait) and coordination
The person may appear poorly nourished. The following tests are used to check a person's nutrition level:
Serum albumin (relates to person's general nutrition)
Serum vitamin B1 levels
Transketolase activity in red blood cells (reduced in people with thiamine deficiency)
Liver enzymes may be high in people with a history of long-term alcohol abuse.
Other conditions that may cause vitamin B1 deficiency include:
AIDS
Cancers that have spread throughout the body
Extreme nausea and vomiting during pregnancy (hyperemesis gravidarum)
Heart failure (when treated with long-term diuretic therapy)
Long periods of intravenous (IV) therapy without receiving thiamine supplements
Long-term dialysis
Very high thyroid hormone levels (thyrotoxicosis)
A brain MRI may show changes in the tissue of the brain. But if Wernicke-Korsakoff syndrome is suspected, treatment should start immediately. Usually a brain MRI exam is not needed.
Treatment
The goals of treatment are to control symptoms and to prevent the disorder from getting worse. Some people may need to stay in the hospital early in the condition to help control symptoms.
Monitoring and special care may be needed if the person is:
Comatose
Lethargic
Unconscious
Vitamin B1 may be given by injection into a vein or a muscle, or by mouth. It may improve symptoms of:
Confusion or delirium
Difficulties with vision and eye movement
Lack of muscle coordination
Vitamin B1 usually does not improve loss of memory and intellect that occur with Korsakoff psychosis.
Stopping alcohol use can prevent more loss of brain function and damage to nerves. Eating a well-balanced, nourishing diet can help, but it is not a substitute for stopping alcohol use.
Outlook (Prognosis)
Without treatment, Wernicke-Korsakoff syndrome gets steadily worse, and can be life-threatening. With treatment, it is possible to control symptoms (such as uncoordinated movement and vision difficulties). This disorder can also be slowed or stopped.
Some symptoms, especially the loss of memory and thinking skills, may be permanent. Other disorders related to alcohol use may also occur.
http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm
The liver is the main site of metabolism of alcohol
Heavy drinkers are prone to infections such as pneumonia and peritonitis
Alcohol dependence reduces immunity to diseases such as HIV
Research links alcohol abuse with cancers of the nasopharynx, esophagus, larynx, and liver
Risk of colon cancer is 26% higher for people who have more than two alcoholic drinks per day
Drinking red wine has been associated with reduced risk of prostate cancer and kidney cancer
Cancers of the lower gastrointestinal tract associated with beer consumption may be attributable to congeners