Short and Long Term Damage of Alcohol Abuse

Thank you to Luxury Beach Rehab for inviting me to write this article for their website.  I’m a public health nurse based in the UK who has nursed patients impacted by the short and long term effects of alcohol abuse and dependency.  I am also in long term recovery myself and chose to live alcohol free on 21st September 2013.

The impact of alcohol on the human body is widespread affecting almost every aspect of the mind and body.  Alcohol is, first and foremost, a toxic poison and the body has to work hard to process and eliminate the waste products of alcohol, the two most toxic of which are acetaldehyde and acetic acid.  This processing is done primarily by the liver which manages 80-90% of the work and in doing so liver cells are destroyed.  The remaining 10-20% is not broken down, so 5-15% of alcohol is excreted in our breath and urine and the other 5% is metabolized by our gut and leaves the body after 7-12 hours.

Drinking within recommended guidelines is a way of minimizing the damage that alcohol can do to the body, though it should be noted that these guidelines vary between countries.  If we drink over those guidelines the impact of alcohol begins to get worse and a large volume of alcohol over a short period of time increases the risk of alcoholic poisoning, where the body is unable to process the volume of toxins.  The side effects of alcohol poisoning can include confusion, vomiting, fits, slow breathing and cold, clammy pale-bluish skin as the body temperature drops dangerously causing hypothermia.  In severe cases, alcohol poisoning can cause unconsciousness, coma and death.

Another acute impact of alcohol on the body is called pancreatitis.  This is caused by inflammation of the pancreas which sits next to the liver and is part of the hepatic or biliary tree (see diagram below).  This is also a serious medical condition that requires immediate intervention. Symptoms of this condition are: severe upper abdominal burning pain going round to the back, nausea and vomiting that gets worse on eating.  Acute pancreatitis can become chronic, meaning it lasts over many years. Alcohol is the largest cause of chronic pancreatitis.

Biliary or hepatic tree (source: pandbt.blogspot.com)

On the hospital ward I worked on, patients who were admitted as a result of chronic alcohol misuse and dependency were considered to be in need of acute management and given a full medical detox. This was where a patient was admitted for observations while supportive medications were given to ensure that they withdrew from alcohol safely, therefore reducing the risk of epileptic fits.  We would also use this as an opportunity to treat the chronic malnutrition that is often associated with alcohol misuse.  Because the body is getting enough calories from alcohol the person often forgets to eat, resulting in malnutrition which can be life-threatening long-term.  Patients would be given multi-vitamins, folic acid and thiamine (vitamin B1) due to the body being lacking is these. Alcohol prevents the uptake, use and storage of thiamine and long term lack of vitamin B1 can result in alcoholic brain disease, because nerve cells and other supporting cells (such as glial cells) of the nervous system require thiamine.

Patients might also be admitted with serious injuries; because they had been injured during an alcohol-induced violent altercation, such as a stabbing or shooting.

At this point I would like to make a distinction between long-term and short-term effects.  I never became physically dependent on alcohol although I was very definitely psychologically dependent, and what I mean by that is I used alcohol to manage/suppress my emotions or ‘numb out’. I had the beginnings of symptoms associated with alcohol misuse and dependency which included night sweats, bleeding gums and poor healing wounds.  The night sweats are thought to be caused by the toxic overload of alcohol on the liver and is the body’s way of trying to speed up getting rid of the toxins.  Bleeding gums are because alcohol interferes in the blood’s ability to clot properly so you get thinning of the blood hence excess bleeding.  Poor healing wounds are caused since the body’s immune system is compromised by alcohol, so you are less able to heal and repair yourself and to fend off any viruses or infections.

I also want to highlight that the step from psychological dependence to physical dependence happens without warning and quickly, perhaps over the period of a couple of weeks.  Past a certain level of alcohol consumption the brain’s biochemistry is altered such that alcohol is required for the body and brain to function and feel ‘normal’.  Those patients who we saw with chronic alcohol-related problems were physically dependent on alcohol.  The chronic or long-term impacts of alcohol misuse and dependence are many and varied.  The liver has no nerve endings so a person will not feel any pain.  By the time patients present with chronic problems invariably the damage is done and cannot be undone.  I will focus on the conditions that we saw regularly on the ward and which included gastro-intestinal bleeding, collection of fluid in the abdomen and end-stage liver disease.  These primarily impacted on the body but there were some patients who were admitted due to alcohol-induced dementia where the long term effect of alcohol was being experienced primarily by the brain.

Many patients were admitted because they had started to bleed internally as a result of chronic excessive alcohol consumption.   The bleeding may be caused by a gastric or duodenal ulcer where the acidity of alcohol has eroded the lining of the wall of the gastro-intestinal tract.  It may also be caused by a raised blood pressure in the vessels that supply the liver and biliary tree which causes stretching and bursting of the veins walls that supply the esophagus or gullet, known as esophageal varices.  All three of these are medical emergencies that require urgent treatment to prevent excessive blood loss and death.

Another complication of liver disease is where fluid collects in the abdominal cavity, called ascites.  It is believed to be related to high blood pressure in the vessels supplying the liver where because there is a lower pressure in the abdominal cavity next to it the fluid moves from a place of high pressure to low pressure and the lack of albumin, a  protein carried in the blood, allows this to happen.  Large volumes can collect in the abdomen and I have seen up to 35 litres drained from the abdomen of one patient.  The proteins that are lacking are then replaced with an albumin infusion as part of the treatment process.  This collection of fluid is ongoing and drainage needs to be done every couple of weeks once started and until a liver transplant is possible if this is an option.

Patients are also admitted with alcohol-induced dementia which is caused by a build-up of ammonia in the large bowel.  Because the liver is not able to process this toxin effectively it collects in the gut and the patient becomes confused because of the toxicity caused to the brain by its presence.  The treatment is to give medication to help the patient have their bowels open thereby clearing the ammonia and the confused state recedes as they eliminate more toxins from their bowel.

There were many other ways that patients could present to us.  They could present with alcohol induced cardiac failure, so the heart would be failing.  They could present with extreme malnutrition, called re-feeding syndrome, where we would have to correct the salts in their bloods and then feed them via a tube passed into the nose and down into the stomach until it was safe for them to eat normally.  They could develop numbness in the feet and hands caused by damage to the nervous system caused by alcohol.

Patients who are unable to stop drinking would eventually go into liver failure which then triggers multi-organ failure and our role was then to care for them until they died.  At this point the damage was irreversible and each bodily system would shut down until death.

The question that is often asked of me as a person who is now in recovery and who has cared for this client group is how did you feel about it at the time?  Firstly, I worked on this ward 10 years ago and at that point in my life my drinking did not feel as if it had progressed sufficiently for me to identify with those who I cared for.  Maybe my drinking was more like theirs than I wanted to admit to myself and so I was in denial.  The primary emotion I felt was concern and frustration that they were unable to stop drinking when it was destroying their health and their lives.  But now I know better; I know that alcohol addiction becomes more than a want: it becomes a need that has to be fulfilled first and foremost at the cost of everything else.

I stopped drinking because I had seen the damage that alcohol can do to you physically and mentally.  It is a progressive disease and I did not know if this future lay in store for me.  If you are concerned about your drinking reach out to someone and ask for help.  It is better to ask sooner rather than leaving it too late.

Louise Rowlinson

Louise Rowlinson

Louise is a public health nurse who wanted to offer an aid to help with reducing alcohol intake or quitting the booze.  My blog and resources are based on my own experience and from all the knowledge and skills I've acquired as a general nurse with alcoholic liver disease experience, psychology graduate, research assistant to Consultant Clinical Psychologist, Samaritan volunteer, post graduate specialist community public health nurse but most importantly as a person who was psychologically dependent on alcohol and who is now in the early stages of recovery.
Louise Rowlinson

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