Toxicologic changes from excess intake In addition to its familiar adverse effects on brain function (Table 1), hazardous drinking can be responsible for a multitude of other negative effects on the body (Table 2). The time factor ranges from days to years. Disinhibitory behavior Acutely, alcohol removes inhibition of normally controlled or suppressed behaviors. This commonly leads to:
* Nonsexual aggression, fighting, injuries, manslaughter, incarceration * Sexual aggression leading to rape and having consequences including conviction of a felony * Risky sexual behavior, HIV or other STDs, unintended pregnancy * Risk-taking leading to vehicular accidents, death by drowning, fatal falls, and nonfatal injuries--"unknown partying injuries," with causes often obscured by amnesia; legal outcomes that include loss of driving privilege, jail, and/or civil suits, financial liability * Verbally risky or foolhardy speech, causing immediate assault or later retribution, and potential loss of employment, liberty, or life * Drinking to overdose, with severe or fatal toxicity, criminal/civil legal consequences Health impacts Despite data supporting a positive benefit from low-level exposure to alcohol, life expectancy is more of-ten reduced by alcohol abuse/dependence in various ways (Table 3). Causes of injury and death differ within various cultures. For example, in 1999 the rate of drownings while intoxicated reached epidemic proportions in Russia--10+ times higher than in the United States, where boating accidents while drunk are a much greater cause of injuries and deaths. Alcoholic hepatitis About 85% of those chronically abusing alcohol do not develop cirrhosis of the liver. This suggests that other factors besides consumption of large quantities of alcohol determine the pathogenesis of alcoholic cirrhosis. Among the factors that may contribute are viral hepatitis infections, especially HVC, protein-calorie malnutrition, and immunologic factors. A greater vulnerability of women than men has been blamed on whatever feature(s) of their immune system it is that also makes women more susceptible to various autoimmune diseases. Despite claims for various agents, e.g., SAMe (S-adenosylmethionine) and milk thistle (plus 17 other herbs!), not one of them has provided a convincing improvement in the prognosis of patients with alcoholic hepatitis. Thus, strong efforts to promote abstinence are needed to prolong life. This comprises a clear demand for new, effective drugs to prevent relapse. Alcohol-associated increase of morbidity Besides the hazards shown in Tables 2 and 3, there is an increased risk among alcoholics not only for pneumonia but for tuberculosis, cutaneous infections, and cellulitis. The results of multifaceted lowering of immunity follow: * Humoral immune functions are lowered because antibodies have a shorter half-life. * Leukopenia occurs in 8% of patients. * Neutrophil migration is impaired, probably because of poor adherence to the endothelium. * Cellular immune function is impaired, NK cell activity is reduced, phagocytosis is lower, and T-cells are selectively inhibited. Recovery may occur in the early days of abstinence. Diabetes mellitus and drinking There has long been concern for adverse effects of drinking on metabolic control for Type 1 diabetics. Recent evidence has shown there also is a dose-dependent association with Type 2 diabetes mellitus. Moderate intake--no more than one or two drinks daily--may lower insulin resistance. Heavier drinking increases insulin resistance; research has led to estimates that this may be responsible for 25% of cases of Type 2 DM among men. Causative factors in alcohol problems
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