CHAPTER 13

Just Socially?

How much is too much when it comes to alcohol, marijuana, caffeine and other mood-altering substances?

PART 1 Raising How Many Glasses?

Conventional wisdom and most medical advice defines “moderate” alcohol drinking as no more than one drink a day for a woman or two drinks a day for a man. However, not everyone metabolizes alcohol the same way. Surely you know a person who gets silly after a few sips, and maybe he shouldn't have two glasses of wine! Is having four drinks one night and none the next OK? The answers go beyond simple addition. READ MORE

Alcohol's effects are physical, social and psychological. Focusing solely on how one of these factors is affected by drinking is of limited usefulness. But the rule about one drink for women and two drinks for men isn't completely arbitrary. It does tell an important part of the story. “In general, higher levels of drinking than those advised are associated with higher risks of medical and mental complication,” says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University and author of The Lonely Patient and The Addict. “Of course metabolism matters, as does body size, and even how quickly one drinks. As important for judging hazardous alcohol use is whether one's drinking pattern is causing problems with family, at work, socially, legally or medically. Many health conditions, such as depressive symptoms, high blood pressure, and esophageal reflux, can be worsened with relatively low levels of alcohol intake.” LESS

PART 2 What is Addiction?

Use of alcohol, caffeine or any other substance that alters your mood or perception must be carefully managed. However, safely enjoying legal stimulants and depressants is not always unhealthful. When out-of-control cravings for the substance cause you to use it even after its effects begin to cause damage in your life, that's addiction. READ MORE

People can become dependent on certain substances, including alcohol and many other drugs. In the medical profession, this usually means that if the substance being abused were taken away, the person would suffer uncomfortable or even debilitating symptoms of withdrawal. The term addiction is more likely to be used to signify the negative consequences from using a substance. A person who continues to drink, snort cocaine or inject heroin, even though it has destroyed his or her marriage, career, friendships and health, is said to be addicted. Arguably, the person would not have to be physically dependent on the substance in order to be addicted, although the two most often go hand in hand. Also, one need not be addicted to suffer ill effects from substance abuse. With alcohol use, even rare binge drinking (4 or 5 drinks over a few hours) can be deadly. Accidents, crimes and alcohol poisoning have resulted after a single binge-drinking episode. LESS

PART 3 Battle Scars

You Try It

Are You a User, or an Abuser?

Even if you are not addicted to alcohol or drugs, there can be lasting damage to your body from regular heavy use. Your liver can turn fatty, become scarred or just function poorly if you drink to excess. Some drugs alter your rewards pathway in such a way that you do not derive pleasure from simple things in the same way you would if you had avoided drugs. READ MORE

Long-term heavy alcohol users run the risk of brain damage that effects their ability to form new memories or concentrate, even years after they stop drinking. Depending on which substance they abused, former addicts are more likely to experience depressive symptoms and other mood disorders long after they cease using the drug. In addition to brain damage and emotional damage, abusers risk the following serious physical effects.

Pancreatitis
Long term alcohol abuse is the most common cause of this painful and potentially fatal inflammation of the pancreas. When chronic pancreatitis strikes, digestive enzymes from the organ attack the pancreas as well as nearby tissue. The condition can be painful, and lead to digestive problems, diabetes, and even pancreatic cancer. Survivors may need to use synthetic pancreatic enzymes in order to get enough nutrients from their food. Anyone with chronic pancreatitis must quit drinking altogether.

Mental health
Sometimes, a mental disorder precipitates alcohol abuse. People with bipolar disorder, for example, have a much higher rate of alcoholism than the general population. On the flip side, chronic alcohol abuse can alter the brain's physiology, causing depression, anxiety or dementia. Regardless of which disorder was experienced first, both must be treated in order to restore a person's health.

Heart disease
Alcohol abuse can cause enlargement of the heart, also known as cardiomyopathy. An enlarged heart cannot pump enough oxygenated blood to other organs of the body, because it works less efficiently than a healthy heart. Heavy drinking can also cause an irregular heartbeat, or arrhythmia.

Liver disease
Alcohol overconsumption can cause the formation of toxic chemicals in the liver. This vital organ can then become swollen and inflamed, a condition known as hepatitis. Over time, an inflamed liver develops scarring, or cirrhosis. This interferes with blood circulation through the liver, formation of clotting factors and enzymes, and other vital functions of the organ. If you stop drinking before the liver is irreversibly scarred, the organ can recover from initial damage.

Sexual dysfunction
Alcohol abuse damages blood flow to the genitals and alters sex hormone levels. Alcohol's depressive effects slows the sensory response, and chronic use can cause peripheral neuropathy, which is damage of nerves in the extremities. This can cause erectile dysfunction and women can experience interruption of the menstrual cycle. LESS