Alcohol and Substance Abuse

Dr. M.K.Debnath
MBBS (Cal), DPM (Vienna), FRSTM&H (London), Fellow, Royal Society of Medicine, London, Ex-Expert, Inter American Drug Abuse Control Commission, USA.
Alcohol and other Illicit Substance abuse is a Bio-Socio-Economic problem. Though it is a global problem; most of the countries around the world has a comprehensive ‘Anti-Substance Abuse Program’ incorporated in their health services or social services. As a result of that Substance abuse is in control now and in fact it is declining elsewhere in the world.
There are many substances that people abuse. The most abused substances are-
• Alcohol- Cerebral Depressant
• Marijuana-Hashish-Bhang etc.- Hallucinogenic/euphoric agent
• Cocaine- Initially Euphoric then depressive agent
• Narcotics-Heroin, opium, Morphine, Codeine etc.-depressive agent
• Other hallucinogenic agents – LSD etc- Euphoric agent
• Euphoric agents- Sniffing gasoline or other petroleum products.
• Tobacco
• Anxiolytics- Benzodiazepines (Diazepam, Lorazepam, Alprazolam etc)
Alcohol- Chemically known as Ethyl Alcohol is a chemical substance mainly used in many medicinal products as a preservative. Highly concentrated Methyl Alcohol is used as an antiseptic agent.

Ethyl Alcohol in its different forms has been used since the dawn of human civilization. Mainly people start using it as an entertainment agent in social gatherings. Some use it, as they find it very handy to forget the life’s stress, though the effect is short lived.
The dangerous part of Alcohol abuse is its Tolerance formation and ultimate Psychological and Physical dependence.

Tolerance-
Once someone starts abusing alcohol socially in company of friends on a regular basis, soon they find it difficult to have the same Psychological impact (a state of altered state of consciousness mainly characterized by initial euphoria followed by confusion and drowsiness) with the same amount of Alcohol. They go on increasing the amount and this process is known as Tolerance and it goes on increasing up to a dangerous level; detrimental to Physical, Mental and social health.

Psychological Dependence-
With Tolerance comes the Psychological Dependence- It is a mental state where the Alcohol Abuser find it very difficult to resist the temptation of going to the drinking spells mostly in company of familiar buddy’s. A particular time of the day; mostly evening hours after work, meeting with an old buddy, having a break from job, going for a picnic or party, a cricket match, some time just passing in front of a familiar drinking place usually trigger off drinking spells.

Once the Psychological Dependence is established, Physical Dependence is sure to occur.

Physical Dependence- is a state where the person cannot function at all without the help of Alcohol intake. He needs alcohol to do his daily work (though at this stage most of them do not function properly and actually non-productive in work place) and to keep his biological functions going (most of the biological system starts getting damaged by now). The person needs “Eye Opener”-(One or two shots of Alcohol) early in the morning to start the day). He does not seek for company to drink any more but prefer to have his pegs while relaxing on the couch at home. At this stage if a drastic medical intervention is not done the eventual prognosis is DEATH.

Biological Effects-
There is hardly any system of the body which does not get an adverse effect of Alcohol. It is produced as a toxic effect of Acetaldehyde (a poison), a byproduct of Ethyl Alcohol after it passes through liver. The following is the summery-
Alcoholic Encephalopathy- Main characteristics are-

Loss of memory
Visual hallucination- Seeing objects which are not there.
Auditory Hallucination–Hearing voices when no one is speaking.

Change of personality
Liver Cirrhosis- It is a condition where the liver cells are totally destroyed and the function of the liver is ceased. It also causes Portal Hypertension a condition which is very difficult to control. Bouts of blood vomiting at this stage are a life threatening situation and needs urgent admission to hospital.

Kidney damage – This leads to total dysfunction of both the Kidneys and need regular dialysis for survival.
Diabetes- Most Alcoholic end up having uncontrolled diabetes and there by additional adverse effect of high blood sugar on the body.
Sexual Dysfunction- Contrary to popular belief almost all heavy alcohol drinker becomes sexually impotent.

Paranoid personality Disorder- Most of the Alcoholics ultimately end up with a personality where suspecting others for ganging up against them becomes a part of his personality. This suspicion becomes more focused towards the wife when an alcoholic feels that his sexually starved (as he is now impotent) is having an affair with someone else. In some instances they end up killing his wife. (Othello Syndrome- named after Shakespeare’s drama ‘Othello’).

Social and economic Damage- An alcoholic is usually treated like a disgusting fellow by his nearest one. He is somewhat out cast both at family and at large. No boss likes his alcoholic subordinate and no low ranking employee respects his alcoholic superiors. Most family members hate him and the spouse loses their respect and love. The children start hating their father when quarrel ensue at home almost every night after a drunken boisterousness.

Most alcoholics are discarded as an economic burden to an organization and also in a family as they produce very little economically. Alcoholics are more prone to suicide and road traffic accidents than any others.

Other Substances of Abuse-
Other substances that are widely abused, mentioned before are also detrimental for a normal life.

Cocaine out of Coca leaf is a predominant problem in Western countries.

LSD – (Lysergic acid) is banned all over the world and not produced any more.

Narcotics- Morphine, Codeine and some other opium derivatives are of much medical value and hugely used in medical practice. Morphine is a life saving drug used in medical emergencies. Opium in its crude form are abused by many people in South East Asia since ages. Codeine is an antitussive agent and sedative. But when these medically important drugs are procured illegally and abused it creates many many physical side effects; sometimes precipitating an emergency.

Tobacco- The untoward effects of Tobacco are many. Importantly, it is a Carcinogenic agent. Percentage of Cancer patients among the Tobacco users are much more than any other group. Tobacco when inhaled (smoking) cause Cancer in the Lungs and when chewed cause cancer of the stomach and particularly mouth. Incident of oral cancer is particularly higher in India than other country of the world. Chewing Supari+Tobacco mixed is a deadly practice, practiced by thousands all over India.

Anxiolytics- Benzodiazepines are the medication used for treating the patients who suffers from Anxiety disorder, Panic disorders and in some cases along with anti depressants. These are valuable drugs mostly prescribed by the Psychiatrists. Most patient with these problems suffers from severe sleeping problems and are necessary for their treatment. But ethical dispensing practice makes these drugs available to anyone who just wants to sleep and get without the prescriptions of a Psychiatrist. This way these medications are hugely abused and some patients get addicted to it. Fortunately, these medications do not have very serious side effects excepting that taken in a large quantity at one time may cause sudden death or sleep for a prolonged period.

What can be done?

It is an established fact that the substances mentioned earlier when abused it creates havoc in the society. How to tackle this menace?

Is it the sole responsibility of the Administration, or the society or the family? It is the joint responsibility.

There will always be people who will abuse these substances as it is going on from time immemorial. Let us try to find out how we can handle this problem.

Responsibility of the family- The person who abuses these substances lives within a family circle. The parents and other family members have the utmost duty towards its one of the member who may drift away from normal way of life. Any bad habit should be tackled as early as possible. When there is a gathering at home for any occasion or in a picnic, if Alcohol is available for a group of people (usually the grown up), it will be impossible for the younger ones to join the wagon sooner or later. Elder family members should have some moral and ethical value which they should translate to the younger ones. If the parents indulge in wrong doing they cannot expect the others to be otherwise. This writer in his thirty years of life abroad has never attended a social gathering where the invitation card stipulated that “No children please”. Everyone should remember ‘Charity begins at home”.

Responsibility of the Society- The days has gone when the society had a strong influence on its individual members. In olden days wrong doers were made outcast, means avoided by the other members of the society. In today’s world of human rights those principles are unthinkable. Everyone has the liberty to do what he or she thinks; not that what he or she is permitted to do in a society. When this writer was very young, in his remote village, he witnessed that an young man was made outcaste (no one will talk to him, no one will do business with him, no one will sale anything to him, he was not welcome in any home) because he drank alcohol and misbehaved with his friend. Only after few weeks he apologized to every one of the village and has never drank alcohol again in his life. Now, we cannot do that to anyone, because the day of society’s rule has gone. We accept everything and each anti social behavior that range from giving and taking bribe, taking away some one’s wife, cheating any one, calling a corrupted officer ‘sir’, folding hands in front of a politician who only think about himself and not for the ordinary folks etc etc. But in spite of all that shortcomings we still can start considering drug abuse as a social menace and get together to raise an unified voice against it.

In Psychology there is a rule called “Reward and punishment”. Give a pat on the back of someone who is doing good things and raise voice against some one who is a wrongdoer.

Responsibility of the Administration- When the family and the society at large is failing to discharge their responsibility, then it falls on the administration to come forward to stop this evil of drug abuse. There are two methods- (1) Demand reduction (2) Supply reduction
Demand reduction- It is a process by which a well planned program for public education and awareness is done. It should be professionally managed and a sustained program. Formation of ‘Alcoholic Anonymous’ in different parts of the country is a must. There can be NGO’s involvement in this program.

Supply reduction- This is totally the responsibility of the Govt. administration. If the law enforcement agency does not take a proactive stand nothing can be done in this field. If the supply is not curtailed no ‘demand Reduction’ ever will work. This writer during his tenure as the head of the Demand reduction team of the ‘Inter American Drug Abuse Control Commission” in Washington DC.USA, achieved a significant reduction in the drug abuse only through the concerted effort of the local administration by curtailing the supply of the drugs. There are many measures that can be taken to reduce the supply. Once the supply is reduced definitely the consumption will be reduced. It is a simple mathematical equation and any one can understand that.

When the administration itself goes into the business of supplying the drugs (alcohol) with lots of excuses attached with it, there is no way anyone can reduce the consumption. Regular increased supply of Alcohol by any administration will never stop production of ‘local made alcohol’ but only encourage it to produce more. The resultant effect is, more supply of alcohol through administration-more production locally= more free consumption.

In our study in the ‘Inter-American Drug Abuse control Commission” we have found that ‘Abuse of drugs (Alcohol) is directly proportionate to its supply’.