Excessive users of alcohol have been shown to suffer in varying degrees from both acute and chronic diseases. Worldwide, morbidity due to alcohol abuse is on a par with malaria and unsafe sex, greater than that from smoking, and far greater than morbidity from illegal drug use. These numbers place alcoholism in the front rank of public-health problems. Among alcoholics, mortality is 2.5 times the expected. Heavy smoking shortens life by roughly 8 years—alcoholism shortens it by 15 years. In the United States, active alcoholics account for as many as 25 percent of the patients in general hospitals.
Although the magnitude of social and psychological pathology associated with alcoholism is more difficult to calculate—in part because of public denial—it is enormous. The number of patients hospitalized for depression and personality disorder resulting from alcoholism, often undiagnosed, is large if uncalculated. Alcoholism in parents vastly increases the chances that their children will fail in school, become delinquent, or misuse drugs.
Acute diseases
Alcohol intoxication produces a wide variety of disturbances of neuromuscular and mental functions and of body chemistry. In addition, the intoxicated person is more liable to accidents and injuries. Alcoholics—who chronically experience severe intoxication—are said to be 30 times more liable to fatal poisoning, 16 times more liable to death from a fall, and 4.5 times more liable to death in a motor-vehicle accident. Risk of death by suicide, homicide, fire, and drowning are roughly doubled. These liabilities reflect not only the effects of immediate intoxication but also poor self-care by alcoholics.
Other acute conditions associated with alcoholism are those that occur in the postintoxication state—the alcohol-withdrawal syndromes. The most common and least debilitating of these syndromes is the hangover—a general malaise typically accompanied by headache and nausea. After a prolonged bout of drunkenness, however, severe withdrawal phenomena often supervene. These phenomena include tremulousness, loss of appetite, inability to retain food, sweating, restlessness, sleep disturbances, seizures, and abnormal changes in body chemistry (especially electrolyte balance).
In cases of severe alcohol withdrawal, it is common for seizures, mental clouding, disorientation, and hallucinations (both visual and auditory) to occur during the first 48 hours. Depending on the amount and quality of care and treatment as well as on the possible occurrence of additional disease, delirium tremens can develop, usually after 36 hours. Delirium tremens involves a gross trembling of the whole body, fever, and frank delirium. It can last from 3 to 10 days, with a reported fatality rate, if untreated, ranging from 5 to 20 percent. Rarely, chronic alcoholic hallucinosis develops, with or without preceding delirium tremens, and can persist for weeks to years.
Prolonged drinking that interferes with an adequate diet may lead to Wernicke disease, which results from an acute complete deficiency of thiamin (vitamin B1) and is marked by a clouding of consciousness and abnormal eye movements. It also can lead to Korsakoff syndrome, marked by irreversible loss of recent memory, with a tendency to make up for the defect by confabulation, the ready recounting of events without regard to the facts. Vitamin deficiency associated with alcoholism can also lead to polyneuropathy, a degenerative disease of the peripheral nerves with symptoms that include tenderness of calf muscles, diminished tendon reflexes, and loss of vibratory sensation. Inflammation and fatty infiltration of the liver are common, as are disorders of the gastrointestinal tract (gastritis, duodenal ulcer, and, less often, severe pancreatitis).
Chronic diseases
The chronic disorders associated with alcoholism are psychological, social, and medical. Among the psychological disorders are depression, emotional instability, anxiety, impaired cognitive function, and, of course, compulsive self-deleterious use of alcohol. After some six months of abstinence, the mild cortical atrophy and impaired cognition often associated with alcoholism disappear. After an extremely variable period of abstinence, ranging from weeks to years, there is usually marked improvement on tests assessing chronic depression and anxiety.
Among the social disorders associated with alcoholism are 2- to 10-fold increases in driving and sexual offenses, petty crime, child and spousal abuse, and divorce. Homicide, homelessness, and chronic unemployment are several times more common among alcoholics than nonalcoholics.
Many of the chronic medical consequences of alcoholism are caused by dietary deficiencies. Alcohol provides large numbers of calories, but, like those from refined sugar, they are empty calories—that is, devoid of vitamins and other essential nutrients, including minerals and amino acids. The small amounts of vitamins and minerals present in beers and wines are insufficient for dietary needs. During bouts of heavy drinking, alcoholics neglect normal eating or, because of digestive difficulties, cannot absorb enough of the essential food elements. These nutritional defects are the cause of many of the chronic diseases associated with alcoholism.
In long-lasting alcoholism, one or more of the chronic nutritional-deficiency diseases may develop. Probably most common are the more severe effects of long-term thiamin deficiency—degeneration of the peripheral nerves (with permanent damage in extreme cases) and beriberi heart disease. Another nutritional disease in alcoholism is pellagra, caused by deficiency of niacin. Other diseases include scurvy, resulting from vitamin C deficiency; hypochromic macrocytic anemia, caused by folate deficiency, vitamin B12 deficiency, or certain chemotherapeutic agents; and pernicious anemia, resulting from vitamin B12 deficiency. Severe open sores on the skin of alcoholic derelicts whose usual drink is the cheapest form of alcohol—low-quality fortified wines—are sometimes miscalled “wine sores,” but they result from a combination of multiple nutritional deficiencies and poor hygiene.
The classic disease associated with alcoholism is cirrhosis of the liver (specifically, Laënnec cirrhosis), which is commonly preceded by a fatty enlargement of the organ. Genetic vulnerability, the strain of metabolizing excessive amounts of alcohol, and defective nutrition influence the development of alcohol-related cirrhosis. In its severest form, Laënnec cirrhosis can be fatal; the successful treatment of cirrhosis or the retardation of its progress is impossible in an alcoholic who cannot be stopped from drinking. Alcohol abuse also increases the risk of other liver conditions, including fatty liver disease and alcoholic hepatitis, as well as the risk of certain types of cancer, including head and neck cancer (e.g., oral cancer, pharyngeal cancer), esophageal cancer, liver cancer, breast cancer, and colorectal cancer.
In addition to the mental symptoms that may accompany pellagra, other mental disorders more specifically related to the consumption of alcohol include mild dementia, which may persist for up to six months after cessation of alcohol ingestion, and a relatively uncommon chronic brain disorder called Marchiafava-Bignami disease, which involves the degeneration of the corpus callosum, the tissue that connects the two hemispheres of the brain. Other brain damage occasionally reported in alcoholics includes cortical laminar sclerosis, cerebellar degeneration, and central pontine myelinolysis. Alcoholics, especially older ones, frequently experience enlargement of the ventricles as a result of atrophy of brain substance caused in part by the direct effects of alcohol on the central nervous system. In some cases, however, brain atrophy is the result of damage caused by accidents and blows. Many of those who survive long years of alcoholism show a generalized deterioration of the brain, muscles, endocrine system, and vital organs, giving an impression of premature old age.
Finally, chronic alcohol abuse heightens the risk of stroke and heart disease through cardiomyopathy, high blood pressure, and failed smoking cessation. It also greatly increases the risk of diabetes (by placing stress on the pancreas), of unwanted pregnancy and sexually transmitted diseases (through unsafe sex practices), and of infection (by alcohol-induced suppression of the immune system).