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ALCOHOL A colourless liquid, also called ethanol or ethylalcohol, produced by the fer­mentation of carbohydrates by yeast. Medi­cally, it is used as a solvent and an antiseptic. Recreationally, it is a widely used drug, taken in alcoholic drinks to give a pleasant taste and to relax, reduce inhibitions, and increase socia­bility. Taken to excess alcohol causes much mental and physical harm not just to the individual imbibing it but often to his or her family, friends, community and working col­leagues.

Alcohol depresses the central nervous sys­tem and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person's reflexes and concentration, potentially dangerous effects when, for exam­ple, driving or operating machinery. Drunken­ness causes slurred speech, muddled thinking, amnesia, drowsiness, erectile impotence, poor co-ordination, and dulled reactions thereby making driving or operating machinery espe­cially dangerous. Disinhibition may lead to extreme euphoria, irritability, misery, or ag­gression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to coma and respiratory failure.

Persistent alcohol misuse leads to physical, mental, social, and occupational problems, as well as a risk of dependence. Misuse may follow several patterns - regular but controlled heavy intake, binge drinking, and dependence (alcoholism). The first pattern usually leads to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease, and impotence. The second is commonest among young men and usually leads to mainly social and occupational problems - getting into fights, jeopardizing personal relationships, overspend­ing on alcohol at weekends, and missing days off work because of hangovers. The third pattern - alcohol dependence - is the most serious, and can severely disrupt health and social stability.

Many researchers consider alcohol depend­ence to be an illness that runs in families, with a genetic component which is probably passed on as a vulnerable personality. But it is hard to disentangle genetic, environmental, and social factors in such families. In the UK there are estimated to be around one million people suffering from alcohol dependence and a simi­lar number who have difficulty controlling their consumption (together about one in 30 of the population).

Alcohol causes tolerance and both physical and psychological dependence (see depend­ence for definitions). Dependent drinkers clas­sically drink early in the morning to relieve overnight withdrawal symptoms. These symp­toms include anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threat­ening delirium tremens (DTs), with severe tremor, hallucinations (often visual - seeing spiders and monsters, rather than the pink elephants of romantic myth), and convulsions. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe incoordination and double vision can occur in Wernicke's en­cephalopathy, a serious neurological condi­tion due to lack of the В vitamin thiamine (whose absorption from the stomach is mark­edly reduced by alcohol). If not treated ur­gently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsakoff's psychosis, with severe amnesia. Finally, prolonged alco­hol misuse can cause a form of dementia.

In addition to these severe neurological dis­orders, the wide range of life-threatening prob­lems caused by heavy drinking includes hepatitis, liver cirrhosis, pancreatitis (see pancreas, dis­eases of), gastrointestinal haemorrhage, sui­cide and fetal alcohol syndrome; pregnant women should not drink alcohol as this syn­drome may occur with more than a glass or wine or half pint of beer a day. The social effects of alcohol misuse - such as marital breakdown, family violence, and severe debt -can be equally devastating.

Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are treated in the short term by doctors who fail to spot or never ask about heavy drinking. Second, attempts at treating llvnhol dependence by detoxification or drying HUl («ubstituting a tranquillizing drug for alco­hol end withdrawing it gradually over about a week) are not always followed up by adequate tupport at home, and drinking starts again. Hume support by community alcohol teams fOmprising doctors, nurses, social workers and, Whtn appropriate, probation officers is a re-HtM development that may have better results. Muny drinkers find the voluntary organization Alcoholics Anonymous (AA) and its related Ifeups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from ileohol is encouraged by intensive psychological end social support from fellow ex-drinkers.

I standart drink=     1 unit

=   1 pint of beer

=   1 measure of spirits

=   1 glass of sherry or vermouth

=   1 glass of wine

Limit! within which alcohol is believed not to cause long-term health risks:

Women up to 2 units a day, 14 a week

(Pregnant women should avoid alcohol completely. If this is too difficult, 1 unit a day seems to be safe for the baby.)

Men up to 3 units a day, 21 a week Women absorb alcohol more quickly than men.

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