Signs of An Alcoholic – Out of Control

Signs of An Alcoholic – Nights out and booze go hand in hand for many people. Drinking is woven into the fabric of many societies—sharing a bottle of wine over a meal, going out for drinks with friends, celebrating special occasions with champagne. But because alcohol is such a common, popular element in many activities, it can be hard to see when your drinking has crossed the line from moderate or social use to problem drinking which can lead to alcohol addiction.

Signs of An Alcoholic – Since drinking is so common in many cultures and the effects vary so widely from person to person, it’s not always easy to figure out where the line is between social drinking and problem drinking. If you consume alcohol simply to feel good, or to avoid feeling bad, your drinking could become problematic. Alcoholism and alcohol abuse can sneak up on you, so it’s important to be aware of the warning signs and take steps to cut back if you recognize them. Understanding the problem is the first step to overcoming it. The bottom line is how alcohol affects you. If your drinking is causing problems in your life, you have a drinking problem.

The road to this addiction starts when the reward centre in the brain (the part of the brain that records pleasure) gets “screwed up”, said Associate Professor Munidasa Winslow, a psychiatrist at Raffles Hospital.

“The reward centre in the brain gets pleasure from the drinking, so there is a craving for more,” he said. “But after a certain point, the body becomes dependent on alcohol to function normally.”

He explained that someone having crossed this point will need to drink more alcohol, usually on the sly, to keep up with work and family activities. There will otherwise be withdrawal symptoms.

These include tremors, anxiety, tension and anger – suppressed only by imbibing more alcohol. A chronic drinker will then develop tolerance to alcohol and require greater levels to feel normal.

Agreeing, Dr Desmond Wai, a consultant gastroenterologist and hepatologist at the Asian Centre for Liver Diseases and Transplantation, said the classic signs of alcoholism include craving, loss of control over the habit, withdrawal symptoms and alcohol tolerance.

Signs of An Alcoholic – There may also be displays of uncharacteristic anger and irritability – and in some people, violence.

All this is due to the effect alcohol has on overriding logic, said Dr Tan Hwee Sim, an associate consultant psychiatrist at the National Addictions Management Service, Institute of Mental Health (IMH).

“Alcohol affects the central nervous system. It can sedate – or blackout – the brain such that emotions can take over,” she said.

Many alcoholics cannot recall their strange behaviour later because of this blackout they experience, she added.

Depression

There is more: because alcohol is a depressant, excessive drinking can lead to alcohol-induced mood disorder in the long run.

Such people are constantly in a depressed mood and show a lack of interest in daily activities, Dr Tan said, adding that the symptoms mimic that of depression.

Alcohol addiction affects not just the mind. The body suffers too.

Liver damage

Alcoholic drinks can burn the stomach lining, which is why some people have abdominal discomfort when they consume a large amount of alcohol within a short time, said Dr Wai.

The stomach can usually recover quickly from this but not the liver, which can be hit with lasting damage. This is because toxic substances are produced when the liver has to break down alcohol.

Alcohol is absorbed in the stomach and intestines and is transported to the liver to be broken down, Dr Wai explained. “The end product of this process is not toxic, but the middle products are.”

The initial effect is to cause fat to accumulate in the liver, which may later become inflamed. Eventually, liver diseases develop, such as hepatitis and cirrhosis, where liver cells die and are replaced with fibrous tissue, resulting in scarring.

Although the liver is incredibly resilient and can recover on its own, often, the only option for severe cirrhosis is a liver transplant.

“Fatty liver and mild forms of alcoholic hepatitis are usually reversible but liver scarring is not,” said Dr Yang Wei Lyn, a senior consultant gastroenterologist at Tan Tock Seng Hospital.

Dr Wai added that about half of the patients with cirrhosis die within two years.

He also said that while it takes about 10 years of regular drinking for liver trouble to emerge, it is always wise to quit drinking early.

“Every person has a different point of no return. We will not know what that is until he quits drinking,” he said. “About one-third of patients won’t improve even after they have stopped drinking as they have crossed that point.”

Women at higher risk

Women who abuse alcohol may do more harm to their brains in a shorter amount of time than men, according to a new study. Researchers found that women experience the same loss of serotonergic function in four years of alcohol abuse as men do in 12.

“We have to be aware that women are more vulnerable to excessive drinking, not just bodily harm but also [harm] to the brain. We also have to be aware that prevalent psychiatric disorders such as depression and anxiety, which are related to imbalance in the serotonin system and which women often are seeking help for, may also be influenced by excessive drinking,” said principal investigator Claudia Fahlke, PhD, of the Department of Psychology, University of Gothenburg, Göteborg, Sweden, in an article on Medscape Medical News.

Female drinkers are more susceptible to alcohol-related diseases due to their smaller body size and liver volume, said Dr Yang.

The treatment for liver ailments is simple – quit drinking.

“If you quit drinking, it’s as good as having a liver transplant because there’s a high chance that the liver will recover,” said Dr Wai.

Apart from liver damage, alcohol can also cause inflammation of the pancreas, sexual dysfunction in men, nutritional deficiencies and dementia, added Dr Yang.

Long road to recovery

As alcohol addiction is also a psychological illness – because the brain becomes wired to depend on alcohol – counseling is integral to recovery.

Here, education is the key, said psychiatrist Dr Chan Keen Loong, the department head of psychological wellness at Alexandra Hospital.

This includes getting the message across to addicts that there are harmful effects on their health, family relationships, finances, social life and work.

“The counselor’s job is to get the person to look at his addiction honestly and change his attitude; to offer support and a listening ear,” he said, adding that sessions may be held in groups or individually.

Even so, counselling can only do so much. Patients have to first shed their self-denial, said Dr Tan.

“Such denial in some people can be so strong that they fail to acknowledge that they have a drinking problem even when it’s obvious to everyone else,” she said.

In such cases, family and friends can step in. For example, they can point out matter-of-factly to their loved one how alcohol has affected his behavior.

“They can say, ‘last time when you drank, you did this’, as the person may be too drunk to remember anything, said Dr Tan. “Family is a major component of counseling – they need to provide the right kind of support.”

The IMH receives about 300 new cases of alcoholic addicts yearly and 90 per cent are men. However, Dr Tan said more female cases are surfacing recently.

After they have faced up to their problem, addicts need to resolve to stay away from alcohol completely. Otherwise, they will suffer a relapse, said Dr Wai.

“I tell recovered patients they should never touch a drop of alcohol again and avoid friends who drink,” he said. “I have seen many who tried so hard to quit but easily went back to square one.”

There is a saying, “Once an addict, always an addict”. Therein lies the challenge for an alcoholic.

Signs of An Alcoholic – Dr Chan said: “Quitting is easy. Staying off alcohol is the hard part.”

By Poon Chian Hui

This article was first published in The Straits Times.

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