Any discourse on medicines will be incomplete unless it includes alcohol. Alcohol is probably more misused than any other substance in history and billions of rupees worth of alcohol is consumed daily. Nevertheless, this does not decrease its value as an effective and basically useful medicinal substance. Infused discreetly, it can serve as a very useful therapeutic tool. However only a small fractions is used for medicinal purposes.

Is it a stimulant? It is generally believed that alcohol is a stimulant but this belief is only a myth. It is not a stimulant of the nervous system; rather, it has a definite depressant action. In adequate doses it promotes sleep, and in very high doses, it may depress most of the areas in the brain and cause respiratory arrest and even death. This is a common cause of death due to ingestion of large quantities of alcohol.

The general impression that alcohol is an excitant, is due to the fact that it also depresses the areas of the brain responsible for playing an inhibitory role. We all have our inhibitions which guide our conduct and behaviour, according to the circumstances and environment. Our behaviour, choice of words, and responses vary considerably when we are in the presence of our teachers and parents on the one hand, and our friends and colleagues on the other. Under the effect of alcohol, the inhibitions which keep our true behaviour masked in the presence of seniors, are suppressed and the true self emerges. This aberration of cultivated social behaviour or, more truly speaking, the exposure of our true self, is generally mistaken as the result of the stimulant action of alcohol. However, all available scientific evidence indicates that it has a depressant action.

Does Alcohol Benefit Heart? Yes and no! Yes, because regular intake of small amount (one drink) raises heart-protective cholesterol fraction (HDL-C) and decreases activation of LDL-C (which is harmful). This may be the cause of lower (15 to 30%) rate of occurrence of heart attacks. This protective effect is lost if intake is over 3 drinks per day. Moderate intake also raises blood pressure and directly weakens the heart muscles. Heart rhythm irregularities are common in chronic alcoholics. Wines (red wine) have antioxidants and are considered to provide better protection than other preparations.

Does It Affect Acquired Skills? Most habitual consumers of alcohol boast that their performance of skilled tasks is not adversely affected by alcohol, but this is not true. In vehicle driving, the judgement is impaired, the reaction time increases, and alcohol is the major cause of road accidents. The same is true for typing or marksmanship, where the speed may increase but inaccuracies multiply.

Does It Affect Behaviour? The behavioural pattern of the individual is dependent on the blood cencentration of alcohol, which, in its turn, is primarily dependent on the quantity ingested and the frequency of intake. If the blood concentration of alcohol is within 0.1 %, the behaviour of the person is apparently normal, self-confidence increases, shyness disappears, after-dinner speeches come easy, and he is altogether delightful company. In higher concentration, up to 0.3%, he become emotionally unstable and his thoughts get disoriented. There is motor incoordination, loss of all self-control; the speech gets slurred and the gait (walking) is affected. Higher concentrations may result in unconsciousness, coma, and eventually death.

Is Alcohol a Sexual Stimulant? It is a general impression that alcohol is a sexual stimulant. It is true a large number of sex offences are related to the influence of alcohol but it does not necessarily mean that alcohol is a sexual stimulant. Alcohol, by dulling inhibitions, removes shyness and promotes sexual advances (which would not otherwise be made) but the sex act, if it takes place at all, suffers. Shakespeare writes in Macbeth (Act 2, Scene 3): ‘It provokes the desire but takes away the performance’. This is a fact.

How to Manage Alcohol Intoxication: Quite often one faces a situation when someone has taken too much alcohol and his condition is bad. If a doctor is not available, some simple measure can be take? The first thing to do is to remove unabsorbed alcohol from the stomach. If the patient is conscious, he should be encouraged to vomit it out by putting two fingers on the back part of the tongue and pressing it. This should be followed by giving him a preparation containing about 100 mg of caffeine. Alternatively, one or two cups of strong tea or coffee may be given. If he has vomitted, he should be given plenty of fluids to make up the fluid loss.

Chronic Alcoholism

Habitual indulgence in alcohol in excess is easily understandable when one considers that it is taken not only for its local effects on the organs of taste and on the mucous membrane of the mouth and stomach, but also for its action on the brain in dulling the consciousness of unhappiness. This weakening of the higher sensibilities by alcohol, is generally the objective sought by a compulsive alcoholic. Under the influence of alcohol, the habitual depression disappears; one loses the sense of degradation and remorse which maybe lacking when sober; there is a false sense of courage and a sense of adequacy is inspired which may normally be lacking otherwise. As has been so aptly expressed by Samuel Johnson; ‘In the bottle, discontent seeks for comfort, cowardice for courage, and shyness for confidence’. The depression and senses of frustration and inadequacy return in exaggerated form after the effects of alcohol have worn off, and though they can be removed again by the same means, the habit is formed, each successive dose being rendered necessary by the depression produced by its predecessor. This descent into chronic drunkenness is facilitated by the lessening of self-control owing to the action of alcohol on the brain. The victim may form the best of resolutions, but his impaired will-power and self-control prevent him from carrying them out.

Excessive and prolonged use of alcohol (chronic alcoholism) may cause weakening of the mucous membranes of the throat, stomach, and intestines. There are frequent attacks of sore throat (chronic catarrh) and poor absorption of nutrients from the intestines. Other organs affected are the liver and heart. In these organs, there is degeneration of tissues with deposition of fat (fatty degeneration). The liver appears to be more susceptible. In the advanced stage, cirrhosis of the liver may occur with a fatal outcome. The chemical ‘aldehyde’ formed in the liver and loss of protective materials (gluthathione) in the presence of deficiency of nutrients is the cause of liver fibrosis. However, in Scotland, where the consumption of whisky is high, cirrhosis is very rare. It may have something to do with the nutrition as chronic alcoholism is associated with the poor absorption of nutrients.

Useful Applications of Alcohol

  1. As a skin antiseptic, 70% alcohol is very useful. Quite often people use rectified spirit (which is 95% alcohol) for this purpose, which is not right. This high concentration of alcohol does not penetrate and is a poor antiseptic. Three parts of rectified spirit should be diluted with one part of water to make it 70%, before application.
  2. Alcohol in a concentration of50%, if rubbed, prevents development of bed sores in bed­ ridden patients.
  3. A drink or two, prior to dinner, can be useful to stimulate appetite and improve digestion. A glass of beer is recommended for those who wish to put on weight.
  4. It is a good preservative. Alcohol in 5% concentration is used to preserve other drugs in solution form.
  5. It can be rubbed over the skin in case of sprains and joint pains.
  6. Doctors inject alcohol around the nerves in trigeminal neuralgia.

Methyl Alcohol Poisoning

Every now and then we read in the newspapers about death due to hooch consumption. The number of people who become blind or disabled is huge. These tragedies occur due to consumption of illicit liquor containing poisonous methanol liquids (methyl alcohol), or ethylene or propylene glycol (antifreeze used in cars). These liquids are indistinguishable from alcohol as their smell, taste, and effects are similar to it. The only difference is of fatal toxic effects on the eyes and vital organs of the body. Since there is no excise duty on these agents they are cheaper and mixed in illicit beverages by unscrupulous elements.

The treatment of poisoning due to the intake of any form of illicit liquor is similar. In order to save a life or prevent a disability, it is important to know what measures can be taken in case there is any delay in consulting a doctor. There are two areas of treatment: to precipitate the excretion of the poison and to prevent acidosis. An amount of 60-120 ml of alcohol, in the form of ordinary whisky, gin, or rum can be given every 6-8 hours for a week or so to accelerate excretion of the poison. A teaspoon of soda bicarbonate given every 2-4 hours neutralizes the increased acids in the body. It can be mixed with juice or a sweet drink to make it palatable. However, it is imperative that a doctor should be consulted at the earliest.

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