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Publishing Date : 12 February, 2019

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Booze vs. Body (Weighing the Risks)

Welcome back! Last week we learnt some simple screening tools.  This week we will look at what constitutes a drink, how to measure our alcohol consumption, and its effects on the body.
So, what is in an alcoholic drink? Well, one Standard drink is equivalent to 10 grams of pure alcohol, which raises Blood Alcohol Concentration (BAC) by 0.02. This is commonly taken as 1 can of beer (330ml at 5 %), a single shot of spirits (40ml at 40%), a glass of wine (140 ml at 12% or 90ml at 18%), or a small liqueur or aperitif (70 ml at 25%). Each milliliter of Ethanol is the equivalent of 0.79 gm of pure ethanol.

One of these standard drinks per hour will raise your BAC by about 0.01-0.03g%. Your BAC is more likely to rise at a greater rate if you are female, a fast drinker, have a low body weight, have not eaten recently, and if you are drinking highly carbonated drinks (e.g. champagne).  The liver breaks down alcohol at an average rate of approximately one standard drink per hour, which may vary between different individuals. A liver damaged, for example by hepatitis, will break down alcohol more slowly.

To prevent your BAC rising further doesn’t drink more than one standard drink per hour.  The only reliable method of reducing your BAC is to wait out the time for the alcohol to go through your system. Cold showers, black coffee, fresh air, exercise, vomiting and other home remedies will help you feel more alert but will not reduce your BAC.

How does alcohol consumption affect my body?  There is totally no consumption of alcohol without a risk. There is a correlation between your BAC and the degree of impairment, intoxication and depression of Central Nervous System
(CNS). Death may occur at about 20-30 BAC, dependent on the physiology of the person (age, gender, state of liver etc).

Lets breakdown alcohol’s effect on behavior.  Drinking up to 0.05g% will likely cause the drinker to be talkative, relaxed and be more confident. Up to 0.08g% the talkativeness continues, she acts and feels confident, judgment and movement are impaired and inhibitions are reduced. At 0.15g% speech is slurred, balance and coordination are dodgy, reflexes are slowed, visual attention is impaired, emotions become unstable, and usually some nausea and vomiting. Guzzling up to 0.30g% there’s no walking without help, you feel apathetic, sleepy, you have labored breathing, inability to remember events, loss of bladder control and possible loss of consciousness. Pushing it over 0.30g% could sadly result in a Coma or Death!

While the symptoms above might result from a night of festivities, the long term effects can consist of brain damage, addiction and stroke, blurred vision, slurred speech, a bleeding throat, heart disease and an irregular heart beat, stomach ulcers, liver disease and liver failure, muscle weakness, intestinal cancer, intestinal ulcers, impotence in men, infertility in women and osteoporosis!

You may also need to be aware of the link between alcohol use and quarrels, bad moods, a depressed mood, tiredness, irritability & poor appetite. High risk drinking also leads to leads to lower cognitive functioning in decision making, planning, regulation of emotions, motivation, memory (storage, retention and retrieval) and motor control. Other behaviours that could be associated with metabolic changes include the inability to learn from previous mistakes/to detect a previously committed error (Dutch pilot study), and difficulties with abstract concepts of time and money.

Now, let’s redefine and rate the risks of our drinking habits.

Abstinence: Botswana, like most other African countries, has high alcohol abstention rates among men (54.3%) and women (85%) [WHO Global Status Report on Alcohol and Health 2011]. However, among the drinkers, there is significant drinking to intoxication (binge drinking).

Low-risk: No more than 2 drinks a day, no more than 5 days week (WHO). The US agency National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines low-risk drinking for women as no more than 3 drinks on any single day and no more than 7 drinks per week. For men, no more than 4 drinks on any single day and no more than 14 drinks per week.

High-risk drinking e.g. Binge Drinking: NIAAA defines binge drinking as a pattern of drinking that brings BAC levels to 0.08 g%. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.  Alcoholism/Dependency: You should stop drinking if i) You have tried to cut down but not been successful OR ii) You suffer from morning shakes. To be noted, the 2015 DSM-5 now talks Alcohol Use Disorder Diagnostic Criteria as:  

a problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least TWO of the following within a 12-month period.

Alcohol is often taken in larger amounts or over a longer period than was intended.
Persistent desire or unsuccessful efforts to cut down or control alcohol use.
Spending a great deal of time in activities necessary to obtain alcohol use or recover from its effects.
Craving or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in the failure to fulfill major role obligations.
Continued alcohol use despite persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of alcohol.
Important social, occupational or recreational activities are given up or reduced because of alcohol use.
Recurrent use in situations in which it is physically hazardous.
Alcohol use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Tolerance as defined by either  (a) a need for markedly increased amounts of alcohol to achieve intoxication or the desired effect, and (b) a markedly diminished effect with continued use of the same amount of alcohol.
Withdrawal is evident by (a) the Classic withdrawal syndrome, specifically described, and (b) when Alcohol (or a closely related substance) is taken to relive or avoid withdrawal symptoms.
Our topic of weighing the risks of alcohol intake will be continued next week. For now remember:
“The best way to avoid these problems is to cut down on frequency and quantity of your drinking or to abstain completely from alcohol”.

If you are in any way worried about your drinking, there are resources in the community that can help.  You can learn more or get the help you need at Botswana Substance Abuse Support Network (Bosasnet), Gaborone HYPERLINK "http://www.bosasnet.com/" http://www.bosasnet.com/ Cell: +267 72659891, Tel: +267 395 9119/ 391 3490

As well as from
Alcoholics Anonymous (AA), Francistown: 73576244
AA Gaborone:     7232 0827
AA Palapye:         71240895
AA Mahalapye:     72846889

See you next week as we learn more about alcohol!
By Team Holistic Health


AUDIT-Guidelines for use in primary care-WHO  "http://www.alcohol-phaseiv.com/" www.alcohol-phaseiv.com

Project NEADA (Nursing Education in Alcohol and Drug Abuse) kit from www.health.org

NASD(National Alcohol Screening Day) sponsored by NIAAA (National Institute on Alcohol Abuse and Alcoholism) "http://www.niaaa.nih.gov/" www.niaaa.nih.gov

SAMHSA(Substance Abuse and Mental Health Services Administration)  "http://www.samhsa.gov/" www.samhsa.gov

 "https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking" https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

“Specifying alcohol-related brain damage among heavy social drinkers”   "http://www.eurekalert.org/pub_releases/2004-04/ace-sab040704.php" http://www.eurekalert.org/pub_releases/2004-04/ace-sab040704.php

DSM V Criteria  "https://dsm.psychiatryonline.org/" https://dsm.psychiatryonline.org/



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