Alcohol's insidious grip
By Judy Foreman
04/05/1999

She made her first suicide attempt at 16. At 18, in the throes of alcoholic amnesia, she married a man she'd known for two weeks. He turned out to be an alcoholic and a batterer who broke her arm and gave her ``a bunch of bruises'' over the years. She rarely sought care, she says: ``I was too ashamed.''

By 24, she'd had six kids and several more suicide attempts. After the last, she ended up ``dead on arrival'' at a local hospital, where doctors revived her and someone suggested Al-Anon, a program for people affected by other people's drinking.

Nobody asked whether she had a problem herself. But she knew she did. ``I detoxed at AA [Alcoholics Anonymous]. I had the DTs (delerium tremens, severe withdrawal symptoms). No one treated me. I did it by myself, at home . . .At the time I got sober, there was not as much help as there is today.''

Today, there are new medications, better understanding of male-female differences in alcohol metabolism, and research into genes that may trigger alcoholism. Most important, there's the recognition that, as Raymond says, ``you don't have to hit bottom like I did. If you're worried about drinking, get help. Sooner rather than later.''

This Thursday , you can get free alcohol screening at any of 2,000 sites nationwide, including 450 colleges. You just show up, fill out an anonymous questionnaire, then meet confidentially with a clinician for 10 minutes. If he or she thinks you have a problem, you'll get a referral for help.

Modelled on the 9-year-old depression screening day (held each October), the alcohol screening is run by Dr. Shelly Greenfield, medical director of the alcohol and drug abuse outpatient program at McLean Hospital. It is sponsored by the National Institute on Alcohol Abuse and Alcoholism, a government agency, and dozens of professional organizations.

Depression screening has proved that offering a chance to drop in and talk privately with a counsellor turns up a ``big, undiagnosed, untreated population who can be helped,'' Greenfield says. It is hoped the same will hold for people with alcohol problems, she says. And there are many of them.

By government estimates, nearly 14 million Americans have an alcohol use disorder, which includes abuse (impairment but not physical dependence) and dependence (alcoholism), which is characterized by uncontrolled drinking, tolerance for high doses and withdrawal symptoms when drinking stops, among other things.

Granted, moderate alcohol use -- one drink a day for women, two for men (with a ``drink'' defined as 5 ounces of wine, 1.5 oz. of spirits or 12 oz. of beer) -- lowers the risk of heart disease.

This is because alcohol raises HDL, or ``good cholesterol,'' and lowers LDL, or ``bad cholesterol.'' It also makes it harder for platelets to form clots that can block arteries. And some alcohol, notably red wine, contains anti-oxidants that keep LDL from oxidizing; in oxidized form, LDL leads to arterial plaques.

Heavy drinking, on the other hand, can adversely affect not just the drinker -- raising the risk for hypertension, stroke, heart disease, some cancers, violence and suicide -- but family and friends as well. And half of all US adults have or have had a close relative with a drinking problem, government data show.

But researchers are getting an increasingly good grip on how alcohol problems develop and how best to treat them.

The drug Antabuse, for instance, has long been known to help people quit by making them sick if they drink, says Dr. Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism. But the drinker has to be motivated to take it.

A newer approach, using naltrexone (marketed as Revia or Trexan) may help more. In 1992 studies at the University of Pennsylvania and Yale, researchers found it reduced craving and increased abstinence. The drug is now FDA-approved for this use.

Yet another drug, acamprosate, also helps, perhaps by reducing craving.

In addition, anti-depressant drugs such as Zoloft have been shown to reduce drinking in people who have both depression and alcohol problems, though not in those who aren't depressed.

Non-drug treatments work, too. The most famous is the 12-step AA model. But an NIAAA study of 1,726 alcoholics in 1997 found that several types of group therapy are also effective ways to quit and stay abstinent.

For true alcoholics, abstinence is still the only longterm solution. For alcohol abusers, cutting back may work.

Ultimately, scientists hope to find a genetic trigger -- or several -- for alcoholism. The idea that genes play a role is supported by indications that alcoholism, often, though not always, runs in families. If either parent is an alcoholic, you have three to five times the normal risk of becoming one yourself.

More support for the genetic hypothesis comes from the fact that half of Asians who drink experience unpleasant side effects such as flushing, almost ``as if they had Antabuse built in'' to their genes, says Gordis. Just like the drug, this genetic factor seems to protect against alcohol abuse.

But so far, scientists haven't found a single gene related to any alcohol-related behavior, even in animals.

What is clear is that alcohol affects men and women differently. In men and women of equal size who consume equal amounts of alcohol, blood levels of alcohol are higher in women, because women's bodies have less water and more fat, which means alcohol is not diluted as much as it in men. Women also produce lower amounts of a stomach enzyme called alcohol dehydrogenase, which helps digest alcohol.

Women's livers also are more vulnerable to alcohol. Some data suggest it takes five drinks a day to cause cirrhosis, or scarring, in men, but only a glass and a half or so in women.

Breast cancer is another worry for women who drink. A study published last year of pooled data on more than 322,000 women found that the risk of invasive breast cancer is 41 percent higher for women who have two to five drinks a day than for nondrinkers. This is considered a modest increase in risk.

Women are also less likely to seek treatment for alcohol problems and more likely to say their drinking is related to depression or family problems, which means the drinking itself may not get addressed.

Whether you're male or female, if you're worried about your drinking, get screened and get help. Take it from Barbara Raymond, who now counsels alcoholics at McLean.

She's been happily remarried for 12 years. She's earned her bachelor's degree from Bridgewater State and is about to get a master's in social work. And she's been sober -- for 27 years.

SIDEBAR 1:

1. How often do you have a drink containing alcohol?
2. How many alcoholic drinks do you have on a typical day when you are drinking?
3. How often do you have four or more drinks on one occasion?
4. How often during the last year have you found that you were not able to stop drinking once you started?
5. How often during the last year have you failed to do what was normally expected from you because of drinking?
6. How often during the last year have you needed a first drink in the morning after a heavy drinking session?
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
9. Have you or someone else been injured as a result of your drinking?
10. Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down?

SIDEBAR 2:

Bottom line on bottoms up, who has an Alcohol Problem?

• Nearly 14 million Americans meet diagnostic criteria for alcohol use disorders.
• Half of US adults have or have had a close relative with a drinking problem.
• About 74 percent of male drinkers and 71 percent of female drinkers exceed moderate drinking guidelines at least once a year.

Harmful Effects of Alcohol

• Heavy drinking raises the risk for high blood pressure, stroke, heart disease, certain cancers, accidents, violence, suicides, birth defects and overall mortality.
• Economic costs to society are $167 billion annually.
• Harmful drinking is involved in one-third of child abuse cases and many unintentional deaths from falls, burns, and drownings.

Drinking Among Teens and College Students

• Young persons who begin drinking before age 15 are four times more likely to develop alcohol dependence and twice as likely to develop alcohol abuse as those who begin drinking at age 21.
• More than one-third of high school seniors perceive no great risk in consuming four to five drinks a day.
• Alcohol is a factor in about one-half of fatal traffic crashes among persons 18-24 years of age. Among fraternity and sorority residents, 81% report binge-drinking.
• Two to three times as many teenagers and young adults die in alcohol-related crashes as die from illegal drug use.

SOURCE: National Institute on Alcohol Abuse and Alcoholism and Dr. Shelly Greenfield.

Judy Foreman’s column runs every other week. Past columns are available on www.myhealthsense.com.

Listen to her live call-in webcast radio show every Wednesday night from 8:30 to 9:30 EST on http://www.healthtalk.com.