Alcohol and its effects on the health - Essay Example

Alcohol and Its Effects on Your Health Introduction The use of alcohol is known to be a risk factor for liver cirrhosis, accidental death and certain types of malignancy, as well as being a direct cause of death by poisoning. Alcohol use and misuse among young people are connected with a broad range of high-risk behaviors that can have profound health, economic, and social consequences. These behaviors comprise drinking and driving, contribution in unexpected peer groups, misuse of other drugs, insecure sexual interaction, interpersonal aggression, demolition of private property, and poor school performance. The use of alcoholic drinks is entrenched in the social structure of the people and, for many youths, learning to drink has turn out to be a service of passage and a sign of developing self-government. For these causes, studying drinking behavior has assisted developmentally paid attention investigators recognize the fundamental environment of cognitive, emotional, and social growth underlying the change from childhood to adolescence, and after that to adulthood (Jessor & Jessor, 1977; Kandel, 1980). At the same time, alcohol investigators have paid attention very heavily on this developmental period to recognize the surfacing of drinking-related behaviors, including how patterns of alcohol use are acquired and maintained, how expectations about drug taking are formed, how social weight and individual differences shape the development of different drinking patterns, and how environmental factors influence use. Research on the use of alcohol by young people and its deterrence is necessarily driven by a public-health concern. Alcohol is implicated in the behavior disorder of greatest commonness in the U.S. population: alcohol misuse/dependence (Regier et al., 1990). Because for most individuals, drinking practices are initiated during adolescence and because the commonness of problem drinking is very high in this age group, the potential gains from intervention activities that target young people are also especially great. We define alcoholism as a chronic behavioral disorder which is manifested by undue preoccupation with alcohol to the detriment of physical and mental health, by a loss of control when drinking has begun (although it may not be carried to the point of intoxication), and by a self-destructive attitude in dealing with personal relationships and life situations. Alcoholism, we believe, is the result of disturbance and deprivation in early infantile experience and the related alterations in basic physiochemical responsiveness; the identification by the alcoholic with significant figures who deal with life problems through the excessive use of alcohol; and a socio-cultural milieu which causes ambivalence, conflict, and guilt in the use of alcohol. Your health A question not often addressed directly in studies of the relationship between alcohol use and health is the nature of the probably link, and its implications for measurement. In many societies and cultures, the drinking habits of individuals change over their lifetimes, sometimes in association with changes in their social and family responsibilities, or, for example, experience of health problems which need not be related directly to alcohol use. Hence the current drinking habits of an individual may only be a rough guide to his or her overall lifetime use of alcohol, which is implicitly the relevant aspect of exposure in terms of risk of chronic disease. The problems of measuring contemporary use are difficult enough, and this may be one factor deterring investigators from attempting to elicit lifetime use. (Duffy, 1992) Alcohol and mortality The use of alcohol is known to be a risk factor for liver cirrhosis, accidental death and certain types of malignancy, as well as being a direct cause of death by poisoning. However, as will be seen in later chapters, the probably causal role of alcohol in illnesses accounting for the major proportion of total mortality is still at an early stage of investigation. The position is further complicated by the continuous nature of alcohol use and by the resulting need to estimate not just a single value of relative risk but a dose-response relationship. There is also the question of deciding what is to be considered as the dose or level of exposure -- lifetime use or current use? More controversially, the possibility that alcohol use may offer some protection against risk of death from cardiovascular disease could lead to a 'credit' side of the mortality account. Alcohol Use and Liver Cirrhosis Although the connection between alcohol use and liver damage was noted as long ago as the eighteenth century (Jolliffe and Jellinek, 1941), there was little epidemiological research in this area until the 1970s, stimulated by developing interest in social and medical problems of alcohol use. During the immediate post-war period, various etiological explanations were advanced in which the association between cirrhosis and alcohol use arose from nutritional deficiencies connected with heavy drinking, rather than a hepato-toxic effect of alcohol. While nutritional factors may indeed be connected with both alcohol use and liver damage, consensus opinion now holds that such confounding is not sufficient to account for the relation between alcohol and cirrhosis observed in studies on both animals and humans, and that alcohol per se has a toxic effect on the liver (Lieber, 1975). Nevertheless, alcohol is not the only cause of liver cirrhosis. Viral hepatitis may facilitate the development of cirrhosis by affecting the ability of the liver to regenerate. A number of chemical and pharmaceutical agents are also known to induce chronic liver disease (Maddrey, 1983). Alcohol-Drinking and Mortality from Diseases of Circulation Mortality due to diseases of the circulatory system includes various types of heart disease, such as ischemic heart disease and hypertension, diseases of the arteries and veins, and cerebrovascular disease. Alcohol and Cancer Risk There is considerable proof for the carcinogenicity of alcohol in humans. The International Agency for Research on Cancer presented the findings of an expert working group in a monograph (1988), including site-specific reviews and informally summarizing a substantial body of material. The conclusion is that alcohol is fundamentally related to cancers of the oral cavity, pharynx, larynx, esophagus and liver. The IARC (1988) monograph concluded that alcohol is fundamentally related to cancers of the oral cavity, pharynx, larynx, esophagus and liver. This work is in agreement with that conclusion and suggests that breast cancer should probably be added to the list of cancers caused by alcohol-drinking. The size, however, of the effect of alcohol-drinking on breast cancer risk is heterogeneous between studies and indicates that further work is needed. It may well be that there is an underlying effect of alcohol on breast cancer risk but that an unobserved confounding variable, probably dietary, is varying significantly among the populations in which the various studies are carried out. Carefully-conducted prospective studies are necessary to achieve a consensus on the effect of alcohol use on risk of breast cancer. It is also probably that drinking alcohol increases the risks of cancers of the large bowel and possibly the stomach. Again, however, effects vary significantly from study to study. Approximate quantitative overviews suggest that alcohol use as a whole is responsible for about 3500 deaths per year in the US from cancers of the mouth, pharynx, larynx, esophagus and liver. If the results on breast cancer and colorectal cancer are correct, the number of cancer deaths per year attributable to alcohol would be about 9500. Alcohol and Damage to the Fetus and Reproductive System In contrast to the effects on the reproductive system, there is considerable research about the impact on the fetus, including case reports and prospective cohort epidemiological surveys attempting to distinguish the causal contribution of alcohol to various birth defects. There has been little emphasis on developing indicators of either incidence or commonness of these types of harm. Reported effects of chronic alcohol misuse on the reproductive system include loss of libido, damaged testicular function, infertility, impotence, hypogonadism (secretory deficiency of the gonads) and gynaecomastia (abnormal enlargement of the male breast). Although these are often sequelae of liver cirrhosis, they have been reported among alcoholics without liver disease (van Thiel and Lester, 1974). Amenorrhea, anovulation, luteal phase dysfunction and ovarian pathology have been noted in alcohol dependent women, but there are no reliable estimates of the commonness of these disorders (Mello et al., 1989). Very heavy alcohol use is connected with damage to the reproductive system in both males and females and with fetal damage. More moderate drinking is connected with fetal damage and probably with menstrual disorders in women. It is improbably to gauge with any accuracy the commonness or incidence of such damage in the United States. Alcohol and Non-malignant Gastrointestinal Disease The major contributor to morbidity and mortality from this group of diseases is pancreatitis. Research reports in this field are difficult to interpret because the diagnostic criteria for pancreatitis are not used consistently across studies. Estimates of the incidence of acute pancreatitis vary widely across studies, but rates of around 100 cases per million population per year may be causable. Mortality rates increase with age, rising from around 20 per million per year at age 40-45 to over 40 per million per year at age 60-65 for men; the equivalent figures for women are 5 and 20. By age 80-85, women's mortality exceeds men's, with both being over 100 per million per year. Although there is very clear proof of the importance of alcohol use as a causative factor for some types of pancreatitis, it is not clear from the published research how much of either the morbidity or mortality due to pancreatitis can be attributed to alcohol. Comparing diseases of the pancreas with those of the liver, it seems that diseases of the pancreas attributable to alcohol may contribute more to acute hospital admissions, but alcoholic liver disease is a much commoner cause of death. Alcohol is also implicated in chronic gastritis. However, there seems to be no published work which quantifies this. Conclusion There are clearly other areas in which the use of alcohol may be connected with the development of problems, notably accidents, crime, psychiatric illness, employment and interpersonal relations. In each of these, there are considerable difficulties of estimating the probably causal contribution of alcohol use. At the same time, for causes of public policy formation, there is considerable pressure on investigators to produce estimates of amounts such as 'total mortality due to alcohol use', 'life years lost due to alcohol use', 'cost to society of alcohol-related problems and damage' and so on. Effective deterrence programs are fundamentally about changing society. Social change regarding alcohol use requires changes in public policy -- facing the economic and political power of alcohol producers and sellers, who have a vested interest in encouraging alcohol use. It requires addressing the anomie, limited opportunity structure, and lack of social integration of large numbers of young people in our society. Deterrence programs must now increase their efforts in this broader social environment to achieve continued success in reducing alcohol-related health and social problems among young people. References Gayle M. Boyd, Jan Howard, Robert A. Zucker. 1995, Alcohol Problems among Young people: Current Directions in Deterrence Research. Lawrence Erlbaum Associates. Hillsdale, NJ. International Agency for Research on Cancer (1988) Alcohol drinking (monograph no. 44), Lyon: IARC. Jessor R. & Jessor S. L. (1977) Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic John C. Duffy, 1992, Alcohol and Illness: The Epidemiological Viewpoint. Edinburgh University Press. Edinburgh. Jolliffe N. and Jellinek E. M. (1941) "Vitamin deficiencies and liver cirrhosis in alcoholism, Part VII: Cirrhosis of the liver", Quarterly Journal of Studies on Alcohol 2: 544-83 Kandel D. B. (1980) "Drug and drinking behavior among youth". In J. Coleman, A. Inkeles, & N. Smelser (Eds.), Annual review of sociology (Vol. 6, pp. 235-285). Palo Alto, CA: Annual Reviews, Inc Lieber C. S. (1975) "Alcohol and the liver: transition from metabolic adaptation to tissue injury and cirrhosis", in Khanna J. M., Israel Y. and Kalant H. (eds) Alcoholic Liver Pathology, Toronto: Addiction Research Foundation. Maddrey W. C. ( 1983) "Drug-induced chronic active hepatitis", in Cohen S. and Soloway R. D. (eds) Chronic Active Liver Disease, Edinburgh: Churchill-Livingstone Mello N. K., Mendelson J. H. and Teoh S. K. (1989) "Neuroendocrine consequences of alcohol misuse in women", Annals of the New York Academy of Science 562: 211-40 Regier D. A., Farmer M. E., Rae D. S., Locke B. Z., Keith S. J., Judd L. L., & Goodwin F. K. ( 1990). "Comorbidity of mental disorders with alcohol and other drug misuse". Journal of the American Medical Association, 264, 2511-2518 Van D. H. Thiel and Lester R. (1974) "Sex and alcohol", New England Journal of Medicine 291: 251-3. Read More