Phew, finally some time to get back to this thread, very sorry if anyone wanted a more prompt response and subsequently lost interest
I have been doin' the runaround lately and only had a finite time to make a few short blurbs.
First I think I'll preface this with a brief discussion into the metabolism of alcohol. All alcohols are metabolized in the the liver by an enzyme Alcohol dehydrogenase. this enzyme oxidized the OH- group of the alcohol into its corresponding aldehyde..i.e methanol [one carbon] is turned to formaldehyde ethanol is turned into [acetaldehyde] ethaldhyde.
Aldehyde are for the most part toxic to cells..and while small intermittent exposures to even relatively large amounts of alcohol is dealt with via the above pathway with the aldehydes being eliminated constant exposure fills the active site of the enzyme and causes a sort of backlog on the metabolism of alcohol. Also, this reaction since it is a reduction/oxidation type of reaction depends on the agent NADH [nicotinamide adenine dinucleotide] Nicotinic acid it is an electron acceptor and it's precursor is an important vitamin [nicotinic acid] and therefore also has a role in preventing cellular damage. the backlog and the depletion of important vitamins is what is responsible for the cellular toxicity of alchohol this... and also its excretion with both aldehyde and alcohol being directly toxic to the kidneys in large amounts ...the above is the primary reason alcohol is dangerous to the body in excess amounts Cellular damage [brain cells and nerve cells, kidney cells liver cells, skin etc.]
Another problem faced is the fact that people who drink tend to have poor diets and do not receive adequate amounts of nutrients [especially thiamine] this can result in impaired mental function and at its worst dementia this can result in something called Wernicke's encephalopathy
[alcohol dementia].
After hearing such facts well some might say well then just stop drinking, but that not so easy... these are the reasons why
1. co-morbid problems usually result with alcoholism...usually depression/ anxiety and that can lower all incentives to stop in fact these problems may precipitate the onset of chronic drinking in the first place
2. Withdrawal can be dangerous for folks that have been doing so in large amounts for long periods resulting in delirium or even seizure and coma
3. social awareness of alcoholism as [and all substance abuse] is not present in the general public and having such a problem carries with it a stigma
4.treatments involves patient compliance and without treatment of co-morbid factors [like depression] often goes undone.
5. As Gingernut has said there is usually a strong factor of denial [and denial is more than just a river in Africa]
causes even the best treatments to go downstream with out much efficacy
Treatment:
well, firstly one should attmept to address any comorbid fctors such as depression
A strong yet nonjudgmental social support network [like alcoholic anonymous]
is also key
One point is that aversive methods [apomorphine or antabuse] although a valid clinical option requires a strong will from the patient [they really all do Hence Gingernut's frustration]
To deal with the inevitable withdrawal [and this will present a problem for pilots] Diazepam [no, I don't work for Eli Lilly
] in high doses may have to be given especially to patients with an advanced course up to 10mg every four hours and this mediaction especially in high doses is aDdictive but may be ABSOLUTEY NECESSARY TO PREVENT A DANGEROUS EVEN LIFE THREATENING WITHDRAWAL.
Lastly, I will add there must be a strong motivation on the part of the person with alcoholism to stop drinking that's the hard part
Once again, I'm sorry for my tardy reply and when I nsaid I'll start the EKG thread 'sometimes early next month well I didn't realize it was still august I really meant early in October
The Choice Between (i) Hitting The Ground With The Nose Up... or (ii) Hitting the Ground With The Nose Down...D.P.D Taken way Outta Context
rhov
