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close this bookAlcoholism: Prevention and Cure by Dr Courtejoie J., MD and Pierre, B (Bureau of Study and Research for the Promotion of Health; 1983; 175 pages)
View the documentIntroduction
close this folderPart 1: General Knowledge of Alcoholism
View the documentChapter 1: Alcohol and alcoholic drinks
View the documentChapter 2: Alcoholism and the effects of alcohol on the organism
View the documentChapter 3: The fight against alcoholism
View the documentPart 2: The flip-chart and slide show "alcoholism" and how to use it
Open this folder and view contentsPart 3: Suggested didactic material
Open this folder and view contentsPart 6: Slideshow: The damaging effects of alcohol
Open this folder and view contentsPart 7: Slideshow: Preventing alcoholism
View the documentPart 8: List of the pictures
View the documentPart 9: Anecdotes, simple health education talks
 

Chapter 2: Alcoholism and the effects of alcohol on the organism

How can we explain the variety and the popularity of alcoholic drinks in most of the countries of the world ?

We cannot deny that drinking a small amount of alcohol gives a pleasant sensation. A person who has drunk a little bit of alcohol is more relaxed. He smiles and talks more easily. When we are together in a group, it creates a good mood which is conductive friendly conversation. That is why alcohol is served at most of our traditional happenings: engagement announcements, presenting dowries, christenings, deaths, circumcisions, and other ceremonies. It cheers the hearts of the guests. It is part of the gifts that we exchange. It is also used a lot to finalize palavers between families.

There are many ways to amuse oneself rather than by drinking beer.

But where there is good, there is also evil: this enjoyable feeling a person experiences can encourage him to continue drinking in order to feel even better, or so he thinks He then falls into a state called alcohol intoxication or drunkenness, many symptoms of which are very well known to all of us. The situation becomes more serious when one makes a habit of drinking too much regularly, always seeking to produce this same feeling of well-being in one's everyday life. The person enters a state of chronic intoxication known as chronic alcoholism which is a form of drug addiction. In other words, the person slowly becomes a slave to alcohol, he becomes dependent on it, he constantly needs it to assure his physical and psychological stability. But such stability is quite artificial, for the alcohol has been silently making havoc in his body.

This, then is a summary of the problem of alcoholism. We shall come back to it and discuss it in more detail later. The important thing is that we distinguish between being intoxicated and being a chronic alcoholic. One can very well be a chronic alcoholic without ever being drunk.

Let us now consider the alcohol's action on the organism in more detail.

Alcohol is a poison; that is a fact no one can deny Alcohol is a caustic, i.e., it has a burning effect. If we put a drop of pure alcohol on the tongue of a person or on a wound, he will feel a burning sensation. If, through an unlucky circumstance, a drop of pure alcohol goes into one's eye, it will burn and the white of the eye will quickly become red. If 80 grammes of pure alcohol are injected into the veins of a 10-kg dog, the dog will die very quickly. pure alcohol added to a glass jar containing fish or mosquito larvae will quickly kill them. In medicine, pure alcohol is used as an external antiseptic because it can destroy all forms of life, like bacteria, viruses, protozoa and the cells of our bodies.

Before operating, the surgeon sterilises his hands and kills the bacteria they carry by rinsing them in pure alcohol.

Since alcoholic drinks are not made of pure alcohol, their effect is not as serious. What is important, as we have already said, is the degree of alcohol. The higher the degree of alcohol, the more dangerous the alcoholic drink. But take notice! Weak drinks (like beer and palm wine) are generally consumed in greater quantities, in bigger glasses than stronger alcoholic drinks (like whisky), which means that the total amount of alcohol drunk may actually be the same.

1. Acute alcoholism

We will study what happens to the alcohol from alcoholic drinks in our body, our organism.

All the alcohol which is drunk is absorbed in the digestive tract: 20 % in the stomach, and 80 % in the small intestine. It is not found at all in the stools. After entering the body, alcohol spreads through the blood stream, is rapidly diluted in the blood stream and other body fluids, in all the water that makes up a large part of our body. Absorption in the intestine is very rapid. The higher the degree of alcohol, the faster the alcohol is absorbed. (The alcohol in whisky is absorbed more rapidly than the alcohol in beer). Five e minutes after drinking alcohol, a person already has alcohol in his or her blood. The quantity in the blood (called alcohol level) reaches its peak one to two hours after one has drunk. Then the level drops slowly (if the person does not continue to drink). It is important to note that the absorption of alcohol is slowed down if there is also food in the digestive tube.

A small part of the alcohol ( 10 % ) that enters the body is eliminated in the air that is exhaled (that gives one's breath the smell of alcohol) and in the urine Thus, 90 % stays in the body, where it is slowly destroyed. The liver is the organ that does this job. It transforms the alcohol into fat, or water and carbon dioxide But its possibilities are limited: the liver of am adult can break down only 10 grammes of alcohol on average per hour (this rate varies from one individual to the next). We are talking about the quantity of alcohol in a large glass of beer or palm wine, or a very small (25 ml) glass of whisky. For a given person, the rate at which alcohol is metabolised is constant. Even if the alcohol level in the bloods is very high, the rate will not increase. We do not know of any medicine, product, of way to speed up the destruction of the alcohol. For example, if we drink a liter of 8-proofbeer quickly 40 grammes of alcohol will be in the body. 90% of this alcohol will be destroy" very slowly by the liver, in about 4 hours. This means that if we continue to drink before the end of the 4-hour period the alcohol will accumulate in the body and its level in the blood will quickly rise. In terms of figures (which we will explain right away), one hour after a person drinks one liter of beer his blood will contain one gramme of alcohol per liter. If we don't want the level of alcohol in the blood to increase we must not drink more than I glass of beer (= 10 grammes) per hour!

The liver is also the first organ exposed to the poisonous effects of alcohol. Busy neutralizing the alcohol, the liver neglects its other tasks. Now, the liver supplies the blood with amounts of sugar it needs.
That is why drinking a large quantity of alcohol on an empty stomach may result in a exceptionally low blood sugar level (glycemia), which can lead to a coma (called a hypoglycaemis coma). This coma, which can result in death, must be treated by giving the patient sugar intravenously

The other immediate effect of alcohol is its toxic action on the central nervous system, that is to say the brain. The brain is the organ that allows us to think and reason. It is the instrument of intelligence and will. It allows us to think before we act or speak. It commands our muscles and controls our movements. All these functions will be impaired. Contrary to what is commonly believed, alcohol is not a stimulant, but a depressant of the central nervous system. Alcohol's action on the brain depends of the amount of alcohol in the blood and varies from one person to the next.

The blood's alcohol level is higher the greater the quantity of alcohol drank, the faster it is drunk, and the higher the percent of alcohol contained in the drink. Remember that alcohol is absorbed more slowly in the intestine If there is food in the digestive tract. The level of alcohol in the blood thus rises faster if a person drinks on a empty stomach; it rises more slowly if the alcohol is drunk during a meal.

Generally speaking, the effects of the following levels of alcohol are as follows:

A. One-half to two grammes of alcohol per liter of blood

0,5 grammes of alcohol per liter of blood produces that feeling of well-being, of glibness, that we have already mentioned. If the level increases, in other words, if the subject continues to drink faster than the liver is able to break down the alcohol, he starts to lose touch with reality. His worries, his problems and the constraints of everyday life are forgotten. Anxiety and distress are calmed.

Euphoria is felt. The person is happy, he smiles and laughs at the slightest occasion. He feels free and sure of himself. The alcohol itself gives the impression, the illusion of being strong and healthy.
But this is not at all true. In a group of workers, those who have drank seem at first to be in good shape. They sing and laugh. After a while they are already tired. Whereas those who have not drunk keep all of their strength.

What is more, the movements of those who drink are less precise, even if they are not drunk, even if they can still walk straight. The hunter who drinks has difficulty in hitting his target. It is very serious if a person who has drunk operates a complicated machine (tram, crane, bulldozer....), especially if he drives a lorry or other vehicle, for he will take great risks without even realising it. He is excited and will drive roughly and too fast. He will be reckless, overconfident and too daring. He will try to pass when it is too dangerous, and he will not obey the rules of the road. Or, contrary to what he thinks, his judgment will not be as good, his eyesight and reflexes will be less sharp. For example, danger suddenly emerges he will brake more slowly than if he had not drunk and will have an accident.

Studies prove that between 40 and 60 % (sometimes more) of car accidents are caused by drinking The statistics in certain countries show that the victims of these accidents are usually those who were sober (passengers of hit cars, pedestrians).

Actually, the risk already starts at a level of 0.3 g/l which is reached by drinking half a liter of beer during a meal. Starting from 0.5 g/1 the danger is real for all: drivers, passengers and innocent pedestrians. At 0.8 g/l the number of accidents on the road rises sharply. This level is easily reached after drinking one to two liters of beer in succession In many countries driving a car is forbidden if you have more than 0.8 grammes of alcohol per liter in your blood stream (3). A recent study in United States shows that when the driver has 0.8 g/l of alcohol in his blood the number of accidents is 3.3 times higher and the number of fatal accidents is 4.4 times higher than if the driver had not drunk. At 1.2 g/1 the number of accidents is 6 times higher and the number of fatal accidents is 9.3. times higher than if the driver had not drunk. It is remarkable that most drivers know that it is very dangerous to drive after drinking on an empty stomach. When these same drivers have drunk and get behind the wheel of a car, many of them contradict themselves and claim they are quite able to drive safely. So we see to what point alcohol diminishes our ability to reason!

(3) In Sweden and many European Countries,, the maximum level allowed is 0.5 gramme per liter; in Poland, it must absolutely be... 0!

All of this justifies the wise saying: "If you drive, do not drink! if you drink, do not drive"! The English put if more succinctly and brutally: Drink and die! Another well-known slogan is "Health Safety Sobriety". if, in spite of everything, a driver lets himself drink too much, he should wait a few hours before getting behind the wheel.

Besides motor vehicle accidents, there is a long list of other accidents often due to alcohol: work accidents, on the fields or in the factories, accidental wounds, falling out of palm trees, hunting accidents, drownings, fires, and so on

When he set out on the rood this morning after drinking some glasses of beer on a empty stomach, did this driver realize the risk she was ranning?

B. Two grammes of alcohol per liter of blood

This level results in drunkenness (or intoxication). The person does not know what he does or what he says. He speaks less clearly than usual, stutters and repeats the same sentences, the same words, over and over. He talks at random, he exaggerates, he makes mistakes, he does not reason well, he tells stories that do not make any sense. His language is no longer that of an intelligent person. He do not recognize people any more, he speaks to things. He has difficulty in keeping his balance, he has little control over his legs, he cannot walk a straight line. His vision is not good. At times he seems double. He gradually loses his sense of right and wrong and his social conscience, his memory and his will.

He forgets the principles he learned while growing up. He becomes quick-tempered and brutal, beat his wife, children and friends, break his furniture (and, without realizing it, even commit very serious crimes such as stealing, rape, incest and murder). Finally, he dares to say everything and anything: he goes as far as making threats, insults or simply betraying secrets; he says things that hurt, that are impolite, disrespectful, uncharitable and contrary to tradition. The next day the subject will have completely forgotten everything that happened and everything he said the day before, he will be completely ashamed if we tell him. But the people whom he makes suffer (his wife, children, parents and friends) have better memories and will harbour resentment over this. One drunken episode may break a friendship or start a family quarrel. This level of alcohol will make some people vomit. Others are no longer happy but sad, discouraged; they cry.
Others tend to sleep.

C. Three grammes of alcohol per liter of blood

This high a level produces complete weakness, a deep sleep (one is "dead drink").

D. Four grammes will induce a coma.

At this stage, we could operate on the subject without using another anesthesia!

E. Five grammes causes certain death

(It has been noticed that a coma hepaticum lasting more than 12 hours always ends in death). The liver is not able to break down such a dose of alcohol rapidity It may be concluded from this last point that a man can die from drinking a bottle of whisky rapidly! Luckily, this hardly ever happens. Most of the time the person falls asleep completely drunk. That saves him by preventing him from drinking more and increasing the alcohol level in his blood.

The day after the drunkenness, after being "plastered", one wakes up with a severe headache ("a hangover") and digestive problems (nausea, vomiting), but everything soon returns to normal. If this experience is not or very rarely repeated, the consequences are not too serious for the body.

However, we must stress the long list of misfortunes resulting from drunkenness: family and social quarrels; car accidents, work accidents and others.

F. Myths about the virtues of alcohol

At this stage we can destroy a certain number of deep-rooted myths, erroneous beliefs attributing various virtues to alcohol. Actually, they have no scientific basis.

1. "Small doses of alcohol improve mental performance"
One often hears people say, 'Let's have a drink, it will help us to see things more clearly " This is absolutely wrong. It has been scientifically proven that the abilities to concentrate, reason, and remember are rapidly affected, diminished by alcohol. Students know very well they have to give up drinking during exam sessions if they want to pass.

2. "Small doses of alcohol give strength and reduce tiredness"
One hears people say, "I am tired, I am going to take a 'pick me up' "
This is also absolutely wrong. Alcohol lessens the feeling of tiredness, rather than the tiredness itself, through the feeling of well-being it produces. Alcohol gives one the impression of being stronger although, as we previously said, strength is quickly diminished. A serious athlete knows he must not drink at all before a match or race,

3. "Alcohol makes you forget your troubles"
This is true. alcohol makes you forget troubles, but it does not eliminate them. Alcohol neither solves problems nor brings solutions, it just temporarily hides them behind a curtain. Actually, it is likely to create even more difficulties, for someone who drinks is kept from coming to grips with his problems and eradicating the roots of his problems, from "taking the bull by horns".
Alcohol can only lead him to continue drinking in order to further escape reality. But, because of the phenomenon of tolerance we will be needed to produce the same effect. The need for alcohol will become stronger and stronger, so that the subject is likely, little by little, to become a chronic alcoholic.

4. "Alcohol warms you up"
One sometimes hears people say, "Let's have a drink it will warm us up"
This is also wrong. Alcohol creates a warm feeling by dilating the arteries in the skin. The skin is thus supplied with more blood and becomes warmer. In the long run, the heat coming from inside the body is lost at the surface of the skin, so that the body's temperature may actually drop.

5. "Alcohol is necessary for the growth and functioning of the body"
This is totally wrong. Alcohol is a very bad food. It has very little nutritional value. It contains none of the minerals, vitamins and proteins which the body needs. The body does not need alcohol since animals instinctively refuse to drink it and millions of good labourers throughout the world, Muslims in particular, never drink alcohol

6. "Alcohol is good for the heart and the circulation"
This is utterly wrong. We will talk about this later on.

7. "Alcohol quenches the thirst"
This is wrong it has quite the opposite effect. Everyone knows that after you have an alcoholic drink you quickly feel the need to urinate.
Alcohol increases the volume of urine; you urinate more than you drink so that in the end you are even thirstier. This is even more evident in the case of hard liquor: one is thirstier after drinking than before.
Imagine two men who are very thirsty after a long walk in the sun, one drinks palm wine while the other drinks water. The one who drinks palm wine will need to drink much more than his companion. In hot countries it is thus advisable to slake one's thirst with non-alcoholic liquids like water, soda or fruit juices.

8. "Alcohol stimulates the appetite and helps digestion"
This is absolutely wrong. We will go into more detail about this when we discuss chronic alcoholism. The virtues attributed to alcoholic aperitifs, which are supposed to give one an appetite, are nonsense.
Aperitifs help create a good atmosphere for the meal but they do not stimulate the appetite.

9. 'He who cannot drink is not a man. Fruit juices and sodas are good for "wealdings", that is to say women, children and weak, puny and sickly individuals.
Real athletes will tell you the contrary. Great athletes, international champions never drink or drink only very little alcohol with their meals. Many of them have stated this publicity. They know if they start drinking more it will weaken them and they will not be great anymore Who would dare say that these champions are not men because they do not drink ?

10. "Alcohol increases sexual performance"
It is true that alcohol increases sexual desire. However, the wish is not the deed. On the contrary, it has been observed that drinking alcohol during a feast, for example, diminishes sexual performance.
Everyone knows that heavy drinkers become sexually impotent in the -long run and get better as soon as their alcohol intake is cut. It has been proven that regular alcohol consumption lowers production of the male hormone (testosterone) in the testicles.

11. "European wines and spirits are drinks of prestige. Drinking them is a sign of wealth and development"
Indeed, these drinks are very expensive, but one could hardly consider them a sign of development. When one is aware of the terrible consequences of alcoholism in Europe, of the active anti-alcoholism campaigns being waged in Europe, one understands what a pity it would be to adopt such a harmful custom in Africa.

12. Alcohol is a medicine"
While alcohol does soothe pain, it has no other therapeutic properties

13. There are a large number of other virtues attributed to alcohol, which vary from one region to the next. Here are some of these "virtues", which are all equally false

“Whisky dilates the arteries of the heart."

"Wine is a most wholesome and hygienic drink because it is a natural substance, " (Here it should be pointed out that curare, hemlock, atropine and digitalin, which are fearsome poisons, are also natural substances!).

"Beer is excellent for breastfeeding mothers "

14. Sometimes one can also hear the following:

"It is very easy to eliminate the effects of alcohol or to sober somebody up with, for example, a few cups of coffee, a cold shower or a walk in the fresh air"

All these means are useless. The only thing to do is to wait while the liver slowly breaks down all the alcohol.

"The thing is never to get drunk" That is completely wrong. We will answer this question in the next chapter.

Now that we have talked about acute alcoholism, we shall discuss chronic alcoholism But before doing so, we must study how one becomes a chronic alcoholic. We are thus going to speak about the drinking habit.

2. The drinking habit

Even if, for once, the feeling of well-being produced by alcohol does not have permanent harmful effects on the body, it still is dangerous since a person who has had this pleasant feeling is likely to wish to re-experience it by drinking again. He may thus get into the habit of drinking every day.

Do we get into the habit of drinking only for the sake of the pleasant feeling produced by alcohol ? No we do not, there are many other reasons People drink because they feel blue, are discouraged, have protracted problems, or want to forget their failures, disappointments, lack of work, loneliness, age, poverty, or poor family and social conditions. But most of the time people Start getting accustomed to drinking without noticing it, out of habit.

Indeed, opportunities for drinking are frequent. When the family or friends gather they USUALLY take a drink. Any occasion is good.

Offering a drink has even become a proof of friendship; omitting it is sometimes felt as a lack of consideration! it is curious that when we lift up our glass we wish each other "good health" when this gesture, if repeated too often, is likely to ruin our health!

People drink because they believe in the "virtues" of alcohol, which we have disproved), in misleading advertising (showing, for example, a happy couple or even athletes having a beer together); people may drink simply due to idleness, to "kill time", or because they do not dare to refuse a drink, because they have weak characters, are shy, or want to hide their embarrassment or feelings of inferiority. They may also drink to show they have either as much or more money than someone else: they buy rounds of drinks to show that they are rich and generous. People may go to the bar to show they have become "more advanced". Men sometimes drink to prove their manhood, as though drinking were a sign of virility.

Similarly, young men may drink "to imitate the elders" (by the way, it would be better to copy their qualities rather than their flaws!) Some young people boast about having often 'plastered" The sicker, the better. They get the impression of superiority, of being more adult. The young are often place in difficult situations amidst the current upheavals in our societies. They are torn between traditional and modem life styles, they fear the future. That is why they enjoy meeting each other for a drink they understand each other, while the alcohol makes things lively, helps them forget their troubles and talk more easily (don't such discussions around a bottle of beer quickly become artificial ?).

The danger for-young people is that they think they are strong and healthy; they do not fear alcohol and want to ignore its effects on their health and its harmful influence on drivers; they think that their youth will protect them from alcoholism. This is absolutely wrong, On the contrary, it has been observed that a person who starts drinking before the age of 20 becomes an alcoholic more quickly than someone who starts drinking later Some girls drink to prove "they are just as good as boys" However, as far as alcohol is concerned, women are less resistant than men, they get drunk more quickly and their livers are affected more quickly.

Young people often think that being in the prime of life protects them from the dangers of alcohol, but that is absolutely wrong

As we have seen, there are many reasons for getting into the habit of drinking. However, someone who starts drinking alcohol every day will notice that while one drink is enough to produce a feeling of well-being on the first day, he will soon need two, then three, then more and more drinks to achieve the same effect. This phenomenon is called tolerance. The subject is then likely to take higher and higher doses of alcohol. He is on a dangerous path, because another phenomenon appears: dependence. He soon realizes that it is difficult for him to do without alcohol he needs it more and more to live. He becomes a slave to alcohol, is headed toward chronic alcoholism He will protest, saying, "I'm never drunk." That may be true. But a drunk is not necessarily an alcoholic (although an alcoholic may also have bouts of drunkenness). Some people whom we see dead drunk from time to time can be less intoxicated than others who have never been seen drunk. An alcoholic is someone in whom a real need to drink alcohol has developed; he feels uncomfortable as long as he has not had his ''fix'', his regular ration. The alcoholic has lost the freedom to live without drinking. One can become an alcoholic without getting drink The affirmation "the important thing is not to get drank" is absolutely incorrect.

3. Chronic alcoholism or true alcoholism, alcoholism per se

Alcohol will exert its toxic action on the habitual drinker over a long period of time. Although its effects will be more discrete, less visible, less spectacular than those of acute alcoholism, they will be more dangerous: indeed, in a few years' time they will gradually, almost treacherously result in definitive lessons in many organs. It is worth mentioning that at the beginning, during the first months and sometimes years, when the individual is only on the path to alcoholism, these disorders are absolutely reversible, that is to say that the patient can be completely cured quite rapidly if he stops drinking or drastically lowers his alcohol intake.

Let us go over the effects of prolonged ingestion of alcohol on the organism Actually all the organs are affected by alcohol, but some more than others.

A. Effects on the liver

Liver function is considerably altered by alcohol. Indeed, this organ gradually becomes "specialised" in breaking down alcohol. It devotes all its energy to this task, to the detriment of its other functions.

In this way the liver manage to increase its ability to break down alcohol; it breaks down the alcohol more rapidly. Indeed, those who are used to drinking alcohol can better withstand alcoholic drinks. It takes longer for them to get drunk. This is called "tolerance" to alcohol. Heavy drinkers are often proud of their ability to tolerate alcohol; they consider it to be a proof of strength. Sadly, they are sometimes admired for this. But it is most important to understand that this advantage is dearly won, at the price of some serious disadvantages.

First of all, the liver of a person who is used to drinking increases in volume because it rapidly swells with fat. This is known as "fatty hver" or "hepatic steatosis". if we palpate the belly, we can feel this increase in the liver's volume. This fat comes from the wastes of the alcohol which has been broken down by the liver. It eventually enters the blood stream and causes other problems we will describe later on.

The metabolism of some medicines by the liver is disturbed. So, if a habitual drinker must have surgery he will resist general anaesthesia; it will be difficult to put him to sleep.

The alcohol breakdown products eventually kill the liver cells. This phenomenon causes an inflammation known as "alcoholic hepatitis". it is accompanied by serious digestive disorders (loss of appetite, nausea, vomiting). The liver increases in volume and is painful. The eyes turn yellow (icterus). If the hepatitis is serious, the patient's eyes become more and more yellow and he may go into a coma, an "coma hepaticum", and die. If the hepatitis is not as serious, destruction of the liver cells is followed by fibrous scarring. This is how cirrhosis of the liver progressively appears (4), resulting from multiple scarring; the liver becomes a hard, fibrous nodular mass. At first, its volume increases, then it Slowly atrophies. Cirrhosis of the liver is a very serious, incurable disease. The patient loses his appetite, loses weight and becomes weak. His belly is swollen with water: this is called ascites, which is very difficult to treat. The spleen increases in volume. The patient becomes anaemic because he has intestinal hemorrahages in the oesophagus and stomach: The patient vomits blood and there is dark blood in his stoals. These losses of blood can be abundant and sudden, and cause death. If the patient does not die from hemorrhages he is doomed to die within a few years in a miserable, emaciated state.

(4) Studies carried out in France clearly show that men who ingest more than 100 grammes of alcohol per day (equivalent to 3 'liters of 8 - proof beer or palm wine) and women who ingest more than 75 grammes have a fifty-fifty chance of developing cirrhosis of the liver.

He could also die from another complication: liver cancer. It has been proven that primitive liver cancer often develops in cirrhotic livers.

This painful ailment is also very well known: it leads to emaciation and death within a few months.

B. Effects on the other organs of the digestive tract

1. Alcohol is an important risk factor in all digestive tract cancers (cancer of the tongue, pharynx, oesophagus, stomach. intestine)

2, Effects on the stomach: a chronic alcoholic suffers from chronic gastritis (stomach inflammation), especially if he drinks on an empty stomach This leads to abdominal pains, loss of appetite (anorexia), digestive upset with nausea (desire to vomit) and vomiting, and gradual weight loss. Hemorrhkages develop in the stomach and bring about vomiting of blood. These hemorrhages may aggravate the hemorrhages due to possible cirrhosis. In the morning, the patient often vomits a bit of shiny liquid, called pituita, on a empty stomach in the case of gastritis, the alcoholic's tongue is dry and is covered by a whitish coating. A stomach lesion, called an ulcer, may develop, causing violent pain.

3. Effects on the pancreas: it has been noticed that chronic alcoholism is often associated with chronic pancreatitis (inflammation of the pancreas), characterized by digestive upset, ballooning of the belly, diarrhoea, weight loss and abdominal pain. This condition eventually leads to a very serious disease, diabetes.

C. Effects on nutrition

1. If the alcoholic continues to eat well, the large quantities of fat resulting from the transformation of the alcohol (which is high in calories) will be used as the body's food reserves. The well-fed alcoholic thus becomes obese; his face becomes puffy. Most well-fed heavy drinkers are fat, and many of them take satisfaction in this because they consider it a sigh of good health, a source of prestige and respect. Actually obesity is the source of various disorders: susceptibility to high blood pressure (arterial hypertension), cardiac decompensation, obstructed artenes, diabetes, and rheumatism.

We should like to point out that a well-fed alcoholic whose diet is well balanced in proteins is not at all protected from alcohol's harmfull effects on the liver, even if his obese condition apparency makes him look healthy.

2. However, it has often been observed that malnutrition and vitamin deficiencies are associated with chronic alcoholism. Indeed, as we have said previously, an alcoholic often experiences loss of appetite and has difficulty digesting as a result of gastritis, pancreatitis, or cirrhosis of the liver. He will thus eat less, which leads to malnutrition, all the more so as his intoxicated intestine will absorb certain foods, such as glucose, proteins, calcium, and some vitamins (vitamin B2, folic acid) with more difficulty. He will lose weight, become increasingly anaemic and weak, and will be less resistant to infections. Some alcoholics make this situation worse by spending all of the family's money to buy alcoholic drinks. They cam no longer afford to buy adequate food.

D. Effects on the heart and blood vessels

Alcoholics often have palpitations. Their hearts tend to beat more quickly and irregularity. They are subject to cardiac decompensation, and they quickly become out of breath due to physical exertion.

Their arteries are affected more easily. They often suffer from arteriosclerosis. This disease results from fatty build-up on the arteries' inside walls. The arteries then become hard and brittle, leading to poor circulation. They can become blocked. If this happens in the brain, the person will be paralyzed (often in one half of the body); if it happens in the heart, the person can die from a heart attack, (infarction). Alcoholics often have high blood pressure (arterial hypertension), too. This condition strains the heart and causes cerebral hemorrages (strokes) which can leave their victims paralyzed.

E. Effects on the body's general resistance

Even if it is fatter, the alcoholic's body is weaker, and less resistant to attack from the environment, infections in particular.

Actually, alcoholism exacerbates all diseases and increases vulnerability to many of them.

Alcoholics age prematurely.

Moreover, alcohol is incompatible with many medicines. Some patients taking pain-killers (phenacetine, pyrazols, etc.) cannot take alcohol without vomiting, palpitations, distress, etc. (5). Or alcohol may intensify the effect of some medicines, which then become toxic even in small doses. It is strictly forbidden for persons taking tranquilizers (Valium, etc), sleeping pills (barbiturates; etc), or antihistamines to drink alcohol, because the effects of these medicines are increased by alcohol. This concerns driver of motor vehicles and machine operators in particular, as they run the risk of feeling drowsy and even falling asleep. (5) rhis effect is sometimes used in certain medicines which are alcohol deterrents, such in disulfiram (Antabuse, Abstinyl, Esperal).

F. Effects on the respiratory system

Alcohol is a risk factor in the development of cancers of the pharynx and larynx. As we have already said, alcohol lowers body temperature.

Moreover, it weakens the resistance of the bronchial tubes to infections. That is why alcoholics often suffer from bronchitis. Their bronchial tubes can no longer prevent the germs from reaching the lungs alcoholics thus contract bronchopnenmonia very easily. This disease causes fever, coughing and phlegm, suffocation, and sometimes death.

We have said that an alcoholic often neglects his diet, so that he becomes malnourished and weak, with very low resistance to infection.

That is why chronic alcoholism provides such favourable ground for the development of so fearsome a disease as pulmonary tuberculosis (phthisis): in order to fight against tuberculosis one must be well fed, well dressed, and warm and sheltered at night, which is rare in the case of an alcoholic. One could say that 'alcoholism makes the bed that tuberculosis lies in'.

G. Effects on the nerves

Alcohol has a toxic effect on all the nerves in the body in the form of a disease called polyneuritis This is characterized by pins-and-needles, cramps, sometimes violent pain in the limbs, particularly in the lower limbs, at night. The upper limbs tremble; such tremors can be seen very clearly when the alcoholic streches out his hands. He is thus not able to do precision work. The tongue also trembles. The muscles are very weak. In serious cases, reduced sight, locomotor disorders and even paralysis of legs are observed. Taking B-complex vitamins will improve some of these conditions, but that does nor, however mean that vitamin

B protects against alcoholism.

H. Effects on the blood

As we said earlier, alcoholism can lead to anaemia, that is to say a drop in the number of red blood cells. On the other hand, an alcoholic may have an abnormally high volume of red blood cells. A drop in the number of other blood cells called platelets is also often observed.. We also said that there is an increase in the amount of fat in the blood, which has harmful consequences for the arteries. The alcoholic s blood tends to be acid.

Well before many disorders become visible, an excessive alcohol intake modifies certain substances in the blood, to the point where a technician analyzing the blood of a person in a well-equipped laboratory can assert with certitude that this person usually drinks too much alcohol, even if the blood donor did not drink that very day and thus had no alcohol in his blood! We should Point out that this analysis can be used for early screening for alcoholism.

I. Effects on the joints

Alcohol abuse can give rise to an articular disease called gout, which is manifested as very painful attacks and deformation of the joints. It may also be accompanied by the formation of little stones, known as calculi, in the urinary canals. We should also remember that obese alcoholics often suffer from rheumatism.

J. Effects on the genital orgasms

As we already said, in the long run, alcohol makes men impotent, that IS to say unable to perform the complete normal sexual act. Moreover, it has also been proven that chronic alcoholism brings about a drop in testosterone (the male hormone) secretion levels by the testicles.

K. Effects on the brain and behaviour

Together with the harmful effects on the liver, the effects of chronic alcoholism on the brain are the most serious.

Alcohol, as we said, is a drug and chronic alcoholism is a form of drug addiction, that is to say that a person who is used to drinking excessive amounts of alcohol every day gradually becomes dependent on alcohol. Finally, after several years (5 to 25 years) he is no longer able to resist the urge to drink, he has become a slave to alcohol. He cannot go without it, he needs his daily "fix". That is what is known as dependence or addiction. If he is deprived of alcohol, he feels physically and mentally unwell and will do anything in order to get some. This addiction we should add a phenomenon we already talked about concerning the liver - tolerance. This means that the brain becomes used to the alcohol, and that bigger and bigger doses of alcohol (not just one drink, but 3 or 4, then 5 or 6, etc.) are necessary to produce the same feeling of well-being, the euphoria that we spoke about in the case of acute alcoholism.

Can one bosh work well and be an alcoholic ? NO

But let us start at the beginning.

The person who drinks excessive amounts of alcohol every day looks like a cheerful fellow, for he is usually talkative and slightly animated.

The years go by and his character changes drastically. He is less and affectionate towards his family, sometimes he gives the impression of having become unconcerned, he does not worry any more about either his wife or children. Eventually he cannot bear them any more. He gets more and more quick-tempered, he gets angry quickly. At home, he quarrels all day long. He is even brutal, beating his wife and children without reason. His family eventually cast him out and grow apart morally and sometimes even leave the house.

He loses all willpower: he becomes carefree, untruthful, boastful and hypocritical. He neglects his personal hygiene and appearance, becomes increasingly dirty, untidy and crude.

He is less active, becomes bored and disgusted with working. His productivity drops. He is always tired, often ill and thus is often absent from work. Being under the influence of alcohol, he makes mistakes and can cause accidents. His reflexes are slower. Injuries, cuts, bums, falls are more frequent in alcoholics. If he has plantations, he neglects them and does not look after them any more. If he has palm trees, he will tap them to get palm wine and the palm will no longer yield good fruits. Whenever his family or his friends scold him, he will apologise and promise to do better and stop drinking.

However, alcohol will have destroyed all his willpower. If some fellows take him to a bar, he will no longer have the strength to refuse and will start drinking again despite his promises. After a while, his employer will have to let him go.

His memory fails him, he cannot remember as well what people tell him.

His attention span diminishes; he can no longer fix his attention, concentrate or properly reason. At night, he has difficulty falling asleep. During the day he is exhausted, drowsy, good for nothing. At other times, he can no longer control himself: he may commit crimes such as stealing, offenses against public morals (rape, incest, etc.), assault and battery, arson and even murders. A high proportion of the people put in jail are alcoholics. During the day, an alcoholic stays feeble doing nothing. (Living Universel)

He feels guilty, inferior to the others. He is ashamed of himself. He tries to escape his responsibilities. He invents thousands of excuses for his need to drink: family and professional worries, tiredness, nervousness, migrains, etc.

He becomes more and more pessimistic, discouraged, anxious and lonesome. Instead of solving his problems, alcohol increases them. He consequently tries to drown his sorrows in alcohol and is caught in a vicious circle. He may attempt suicide. Suicides are more frequent among alcoholics.

This is how he gradually goes into a physical and moral decline. Little by little, his family, friends, work and social and moral duties become secondary to alcohol, and eventually will not interest him at all. At the end, he no longer resists his need to drink; he cannot live without alcohol. His life is dominated by this obsession:

"How can I get my ration of alcohol today ?" if he is still working, it is only to achieve this goal. He borrows money to drink, he goes into debt. It is difficult for him to stop drinking as it is for a driver to stop his lorry without brake. He must drink to get going. He even reaches the Point where he drinks as soon as he gets up, never starting the day without having a drink to calm the discomfort (stomach cramps, trembling) he feels when he gets up. Once he takes his first drink, he cannot stop, he does not drink in little sips, but in one go, in great gulps. He does not drink with his fellows but alone, on a empty stomach.

He becomes a burden for his family and the society as a whole. He does not earn a good living, all his money is spent on drink He gives no more money to his wife. He beats his children, who are poorly fed, dressed and educated. At night, they wait in anguish for their father, who went out to get drunk, to return. His wife is also beaten, abandoned and unhappy. His house has become a hell and is going to ruin. "A drinkers home is a troubled home".

Sometimes when he has caused a serious accident or a great tragedy, he may receive such a psychological shock that he will decide to stop drinking once for all, but at what a price!

In the most serious cases, the alcoholic's tolerance drops after a few years. The drinker cannot take alcohol any more. He becomes drunk after one drink. He gives way to madness, insanity. He has hallucinations, he thinks he sees little animals (rats, mice, snakes, toads) threatening him, he hears terrible noises. He is afraid, tries to escape, becomes furious, hits about wildly. He may have convulsions or epileptic fits. Or he is mistakenly convinced that his wife is deceiving him, that his children are Laughing at him, that neighbours are saying bad things about him, are trying to cast a spell on him, steal from him, hurt him or do him harm. He may then try to take revenge and becomes dangerous. Then again, other alcoholics lose their memories and intelligence. They become like children. They do not recognise their surroundings, will say anything or become indifferent. These serious mental disorders (called psychoses) are known as delirium tremens, korsakoff s syndrome or Gayet Wernicke's encephalopathy in medical circles.

L. Effects on offspring

1. When a pregnant woman drinks alcohol, even without getting drunk, the alcohol in her blood enters the blood of the child she is carrying. However, a child, and even more a foetus, is much more sensitive to alcohol than an adult is. A pregnant woman who drinks alcohol regularly runs the risk of giving birth to a stillborn child, a premature child or an underweight child who is thus fragile, or even a child with deformities (on the face ùhazelipsù, in the joints, the hearts, the genitalia, etc.). The enfant of an alcoholic woman feeds and sleeps very little. He is often very nervous and trembles. He has a higher risk of dying in the days immediately following his birth.

Later on, if he survives, he is very likely to have low intelligence.

That is the reason why it is absolutely necessary to maintain the custom existing in several areas of Zaire which forbids a pregnant woman to drink palm wine, beer or any alcohol drink. This also applies to the breastfeeding mother, because alcohol passes into her milk, which then becomes toxic for her child.

2. Alcoholism's effect on men's reproductive abilities, on their children's physical state is less well known. But what is certain is that less than an hour after a man drinks a liter of palm wine, his sperm contains alcohol.

3. Children growing up in a family where the father more rarely the mother is an alcoholic encounter all kind of difficulties in life.

Living in an atmosphere of tears, quarrels and anger, having separated or divorced parents and rapidly becoming orphans, they feel insecure, lack affection and kind educational paternal authority. Neglected, victims of the family's financial difficulties, they are likely to suffer from malnutrition with all its consequences (stunted growth and intelligence, predisposition to tuberculosis, etc.) and may be compelled to quit school. Sometimes they have only one wish: to run away from home, without even thinking about how they will live afterwards. Morever, their father's bad behaviour drives them to act like him. Thus the children of alcoholics often meet all the requirements for becoming socially maladjusted (rejection of the family, school, society, personality problems), they sink into deliquancy and eventually become alcoholics themselves.

4. It is absolutely recommended not to give children the slightest drop of alcohol (after what has preceded, one can easily understand this), even during celebrations, until they are 14 to 16 years old.

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