drunk man drunk and sleeping on table with a glass of whiskey in hand.
Keywords: Alcohol, Bitters, Alcohol Use Disorder, Addiction, abuse, Alcohol withdrawal symptoms, brain, neurotransmitters wernike syndrome, korsakoff syndrome.
Introduction.
Abuse of Alcohol and Bitters Drinks. What is alcohol addiction? How much of alcohol do Nigerians take? What are Bitters drinks? How much alcohol should one take? Impacts of alcohol in the brain. What are the mental health effects of alcohol use? Can anything be done to help?
Alcohol is embedded in Nigerian culture and many cultures world wide. It serves both as a social beverage and a component in prayers and rituals. So in Nigeria, alcohol consumption is on the rise, partly due to the belief that it enhances happiness.
Many site St. Paul’s advice to Timothy about taking a little wine for the stomach as a justification. Thus, social drinking in clubs and pubs are popular. And there is a prevalent notion that a man who doesn’t drink in untrustworthy. Consequently, it is common for individuals to consume two bottles of red wine in one sitting.
Roughly ten years ago, Bitters beverage made its first entry into Nigeria. Since then, these drinks have steadily risen in popularity with variety of brands now available in Nigeria.
Many Nigerians lack awareness the complexity of alcohol consumption. And they are generally uninformed about the different alcohol content percentages. So for most, there is little difference between locally produced gins and other types of alcohol. To them the primary difference is in the price.
What is alcohol addiction?
Alcohol use disorder:
Alcohol abuse, alcohol addiction and alcohol dependence are now known and called Alcohol Use Disorder (AUD). For someone to be said to have AUD, he or she must have at least 2 from this list. So you can do a self-check from this list to know if you have alcohol use disorder. If you can identify with just 2 from this list, then you have a problem with alcohol use. That means that you are over doing it.
- Having to spend longer time than intended to drink.
- Ever wanted more than once, to reduce or stop drinking.
- Have spent a lot of time drinking or getting over the after effects of drinking.
- Wanted to drink alcohol so badly than anything else.
- Drinking takes preference or interferes with taking care of your family, or caused trouble at school or work.
- Continued drinking despite the trouble it is causing.
- Stopping activities that once gave you joy so that you can focus on drinking.
- Having gotten into trouble because of drinking.
- Continued drinking despite the health challenges it caused.
- Having continued to increase the quantity of the drink in order to get the effects wanted (called tolerance).
- Gets withdrawal symptoms whenever the effects of the alcohol starts to reduce in your body.
What are alcohol withdrawal symptoms?
When someone who has AUD suddenly stops taking alcohol or reduces the quantity, withdrawal symptoms set in. These symptoms include increased heart rate, raised blood pressure, excessive sweating and tremors or shaking of the limbs and body. There could also be convulsions or seizures and even death.
Apart from the physical symptoms there are also psychological symptoms such as depression and anxiety. There could also be sleep problems, irritability, hallucinations and agitations.
These withdrawal symptoms most often causes the person to relapse back into the drinking. And with the relapse, the dose or quantity will be increased.
What causes AUD?
Genetic factor:
Here genetics comes to play. There is actually no single gene implicated in AUD, it is due to a combination of many genes. So if a parent, for example a father has AUD, there is likelihood that one of his sons will also have the problem.
Modeling:
Just being around a family member who drinks often can predispose one to taking excessive alcohol. This is because of the way the alcohol is glamorized.
Age:
The earlier one begins to take alcohol, the more likely that the person will develop AUD. The risk is high if the individual starts consuming alcohol before the age of 15 years.
Mental health conditions:
Those suffering from mental illnesses are more likely to have AUD. These mental illnesses include depression, anxiety and schizophrenia, as well as Post Traumatic Stress Disorder (PTSD), bipolar disorder, etc. This is because they use alcohol to self medicate the symptoms of the mental illness. That is alcohol helps them get temporary relief from their symptoms.
Low self-esteem:
Those suffering from low self esteem and the need for approval are at risk of AUD.
Stress:
Those who are stressed also abuse alcohol.
Peer pressure:
These will include the adolescents and the older persons. Everyone has a peer group that can form a sort of pressure group.
Trauma from Adverse Childhood Experiences:
These cause mental scars that can predisposed one to AUD. These people have been traumatized in their family setting during childhood. So they abuse alcohol to feel better. If parents are unavailable to supervise the child’s behavior, or support the child, the child may feel abandoned. And this may be predisposed to AUD. So growing up from a dysfunctional home is a risk factor
Socioeconomic factors:
These include poverty, loneliness, etc. Such are factors for alcohol abuse. Poverty increases risky drinking while those in the high economic level are more at risk of alcohol abuse. This is because the rich can afford it and can have better access to media.
Cocktails:
Young people may mix alcohol with other substances of abuse. One such mixture is made of codeine, cannabis, tramadol, vodka, and juice or water, called gutter water.
The media:
These information outlets can pressurize young people into AUD. This is because they make use of young people in the media information and the glamorize drinking.
How much alcohol do Nigerians take?
Generally:
Nigerians enjoy partying and when there are no parties to attend, they gather in clubs to drink alcohol and relax. Nigeria thus has a high level of the population who abuse alcohol. About 34.3% of Nigerians abuse alcohol. And men are twice more likely than women to abuse it. Even those in the rural areas are more likely to abuse it than the urban dwellers. So Nigeria ranks 27th globally, when it comes to adult alcohol drinking. Nigerians are also second in Africa among African countries for heavy episodic drinking. And alcohol is the most commonly used or abused drug in Nigeria. All according to researchers.
Students:
Among students in a university in the north central region of Nigeria, 43.6% has consumed alcohol. But students in previous studies who had consumed alcohol ranged from 56.5% to 72%. Research studies carried out in the northern states of Nigeria will give low prevalence of alcohol abuse. And those carried out in the southern parts of Nigeria will give high prevalence due to religious issues. Islam forbids alcohol use.
Research studies have shown that in Delta state, 25% of their adolescents are dependent on alcohol. And in Port Harcourt 30.6% of their secondary students abuse it.
Commercial drivers:
Among commercial drivers alcohol abuse is very high. The prevalence among these set of people in Nigeria is as high as 67.2%. And among these, 47% are heavy drinkers. In Lagos state 60% to 70% of commercial drivers drink and drive, as documented by research papers.
Among tanker drivers, 71.6% abuse alcohol. In a study in 2011, 32% of long distant drivers confirmed that they take alcohol before driving. At motor parks, these alcohol substances are sold as herbal concoctions against malaria, or treatments for back pains. All according to research papers.
Locally produced alcoholic drinks:
These so called medicines containing alcohol are known as opachin, paraga, or fidibodi. Locally produced alcohol from the north are called pinto and burukutu. And from the south, they are called ogogoro, kaikai, akpuru achia and sapele water.
These local gins are consumed more by vigilantes, rebel groups operating in the Niger Delta areas, those involved in insurgencies, etc. Even commercial transport workers use them, where they are sold in motor parks.
What are Bitters drinks?
About ten years ago, the drink called bitters was introduced into the Nigerian market and has soon gained popularity.
Content:
The drinks labeled as bitters are made from very high dose of alcohol, different roots, herbs and flowers. The bitters drinks also contain tree barks and other plant parts.
Functions:
Bitters are claimed to treat malaria, suppress appetite, gives energy, increases libido, erection and sexual performance, etc. Some of these bitters are locally produced while others are imported.
Bitters are actually used in Chinese medicine and in other cultures that use herbs and roots for treatment. For the claims made by the manufacturers of Bitters, some are true. But for many of the claims, more research needs to be done to confirm them. And some of the herbs used maybe harmful to the human body, especially when combined with other medications.
Many Nigerians take the Bitters for the claims and because it is relatively cheap for what it does. Compared to one bottle of beer, one small bottle or sachet of Bitters can be bought for between 100 Naira to 500 Naira. And this one bottle of Bitters can intoxicate as 5 bottles of beer. So it is easily available to students, artisans and commercial drivers as it comes in small bottles of 100ml to 750mls. But some people take the bitters because they have AUD, they can easily hide the bottles and take them on daily basis.
Brand labels:
The bitters that can be found in Nigeria include Almo, Action, Agbara, koboko, Baby Oku, etc. Then there has always been the Campari spirit drink, that is drank by elderly people, and also Orijin bitters.
Adulterated:
Unfortunately many of these Bitters are adulterated. These adulterated versions contain ethanol and caffeine. And some may even contain cannabis as well. Ethanol is a toxic chemical that can cause cancer, destroy kidneys, coma and death.
How much alcohol should one take?
Saint Paul actually advised in the Bible that one needs a little alcohol for the good of his stomach. Well, this will actually show us that not everything in the Bible are spiritual, some were cultural issues. And St. Paul being human, gave us an advice due to the amount of knowledge about health that existed then.
Even up to 2015, researchers still believed that a little alcohol was good for our health. So they went on to advocate that 21 units of alcohol spread throughout the week, was good for men. Then 14 units of alcohol spread throughout the week, was good for women.
What did they actually mean by units of alcohol? One unit of alcohol is equal to 10mls or 8grams of pure alcohol. Actually, 1000mls or 1L of whisky contains 400mls of pure alcohol, ie. 40 units.
Now, as the years went by, research methods became better, and it has been discovered that alcohol is a killer. So, the World Health Organization (WHO), has declared that there is no safe level of alcohol intake.
Most, if not all cancers found in humans, were linked to alcohol consumption. Not only is alcohol linked to many physical health challenges, they also negatively affect mental and neurological health.
Impacts of alcohol in the brain.
The use and abuse of alcohol can affect the brain in so many ways, both structural and functional.
Structural impact:
Alcohol destroys the brain at the grey and white matter areas. And this leads to loss of brain cells in the different parts of the brain.
It is important that we understand that the brain is made up of many brain cells. These brain cells are distributed to different parts of the brain. Each brain cell is made up of a cell body, which is the engine house. Then it has an axon which starts from the cell body and elongates out, like a tail. And then there are dendrites, which connects connect one cell body to the other.
Each brain cell communicates with another brain cell. The message that starts from the cell body, is transmitted through the axon. From the axon, this message gets to the other brain cell through the dendrites. This is because the axon is connected to the dendrites of the next brain cell.
The brain cells are known as the grey matter of the brain. And the axons are known as the white matter.
So, alcohol destroys destroy both the grey and the white mater of the brain, making the brain loose these cells. This affects the brain by making the brains of those who abuse alcohol to be smaller in size and in weight.
There are areas of the brain worse hit by these cell loss. These include the frontal areas, temporal regions and the cerebellum. With chronic use, alcohol can also destroy the part of the brain called the thalamus.
Impact on neurotransmitters:
Alcohol stimulates the production of the neurotransmitter in the brain called Gamma Amino Butyric Acid (GABA). Neurotransmitters are chemicals in the brain through which the brain cells communicate with each other. There are many different neurotransmitters in the brain with different functions.
So the function of GABA in the brain is what we call inhibitory function. By this, it means that GABA reduces or blocks the functions of the other neurotransmitters.
Also, dopamine, another neurotransmitter is also released during alcohol consumption. It is this neurotransmitter that makes people have that feeling of pleasure when they take alcohol.
Functional impact:
Due to the fact that the brain has lost some of its cells, the function also reduces.
The brain areas that are worst hit by alcohol, have reduced functions.
So people who have alcohol use disorder, have problems with thinking, judgement, planning, memory, movement and balance.
What are the mental health effects of alcohol use?
Like already mentioned earlier, alcohol is a killer. It can destroy the consumer from head to toe.
So apart from the physical negative effects such as organ damage, it can affect mental and neurological health.
Mental health issues:
Psychological and psychiatric illnesses –
These include low self-esteem, depression, anxiety, Post-Traumatic Stress Disorder (PTSD), anger issues, irritability, sleep disorder and disinhibition.
When it comes to having sleep disorder, alcohol is a culprit. Unfortunately, many people believe that alcohol induces sleep.
How much alcohol affects sleep, depends on the quantity one takes. Moderate consumption of alcohol, will prevent sleep maintenance. So, you can fall asleep, but you will wake up in the middle of the night. And once you are awake, you may not sleep again.
But for heavy drinkers, alcohol prevents them falling asleep, staying asleep and if they do sleep, they wake early. This is because, alcohol prevents the secretion of melatonin that is required for someone to fall asleep.
Alcohol also brings about snoring. And snoring, prevents one from having good sleep.
Alcohol can initiate sleep for certain people because of GABA, but the person will end up with poor sleep.
When it comes to disinhibition, people who consume alcohol, have it. Alcohol consumption, decreases the ability for someone to restrains from certain behaviors. So such a person may engage in behaviors which are regarded by others as inappropriate or socially unacceptable. The person will engage in such behaviors without considering the consequences.
For example, alcohol can cause the consumer to use inappropriate language when talking. As a man, he may touch a woman at inappropriate places. He or she could end up having sexual intercourse with a stranger.
Alcohol can also predispose one to having psychosis, especially paranoid schizophrenia. In this type of schizophrenia, the person believes that certain people is against him or her. This is known as delusion of persecution.
The person who consumes alcohol, can also break down with a bipolar disorder. Such a person can be swinging from depression to mania, with normal mood in between.
Cognitive issues –
Due to the fact that alcohol destroys brain cells and decreases functions in certain brain areas learning is affected. The brain areas mainly affected in learning are the prefrontal area and the hippocampus.
The prefrontal areas of the brain in concerned with concentration, thinking, judgement, attention, etc. Because alcohol negatively affects this area of the brain, the person will have problem in paying attention and concentration.
Then the hippocampal area of the brain is also negatively affected. This area of the brain is concerned with memory storage and retrieval.
Now if the prefrontal and hippocampal areas of the brain are damaged by alcohol, the person cannot learn. So learning becomes difficult and academics and intelligence drops.
Neurological health issues:
Actually, alcohol intoxication and withdrawal symptoms are part of the neurological effects of alcohol abuse. But in this write up, the chronic effects of alcohol abuse or AUD will be highlighted.
Wernike Syndrome –
It is important to know that the use of alcohol, reduces appetite. It also prevents the absorption of certain nutrients from the gastrointestinal tract.
One of the nutrients that alcohol use prevents its absorption is thiamine. This is vitamin B1 that is required in a lot of body function, especially in the brain and nervous system.
So the person suffering from Wernike Syndrome, has problems with paying attention, memory and problems with speech. He or she will become disoriented and have depression. This depression will make the person less sociable.
There will also be problem with the person’s vision. The eye balls will be jerking and the person will be having double vision. And walking and even sitting will become a problem.
Korsakoff Syndrome –
The thiamine deficiency can present with forgetfulness known as amnesia. So the person can forget even conversations. And because of the forgetfulness, when the person is trying to present the conversation he confabulates. Replacing the story with things that did not transpire is called confabulation. It is not that the person is telling a lie, it is due to not being able to remember the facts.
Marchiafava-Bignami disease –
This is another neurological disease caused by lack of vitamin B1 or thiamine. The person presents with reduced consciousness, slurred speech or dysarthria, and loss of memory.
Alcoholic dementia –
Alcohol can lead to early onset of dementia. It can present that of other forms of dementias. So the person has problems with paying attention, memory, planning, organizing, etc.
Cerebellar Degeneration –
With this disorder, the person is shaking, called ataxia, eye balls are shaking, slurred speech and problems with walking. The person when walking spreads the legs apart in order to get balance. It is due to the damage of the brain part called cerebellum, by alcohol.
Peripheral neuropathies –
This usually starts with numbness or paresthesia at the feet, that progresses upwards. That is there is loss of sensation in the hands and feet. As this symptoms progresses, there is weakness at the toes. It can also affect the hands, as it does the legs. It is actually a nerve issue.
Walking becomes difficult and shaky. As the person walks, he may be striking his feet on the ground because he is unable to feel the ground. When this happens, the person will develop Charcot joint at the ankle, which is a painful or painless joint inflammation. It can occur at the ankle.
Generally, there is numbness and pricking sensations on the hands and feet. There could be difficulty in swallowing and impotence.
Alcoholic myopathy –
In this case the muscles have issues. Muscles become weak stiff and thin out after chronic use of alcohol. Sometimes these muscles can be painful, or have cramps, but in many occasions, they are not painful. So the person has problems climbing stairs and even holding things.
Can anything be done to help?
Prevention is always better. So there should be zero tolerance to alcohol.
But for those who have AUD, treatment is possible and the first thing to do is to stop drinking. Next is to seek professional help. Treatment is usually multidisciplinary. It will usually involve a psychiatrist, a clinical psychologist, neurologists and other consultants in different aspects of medicine. Many a times, depending on the extent of damage, complete recovery of the damaged areas can occur. But in some other cases, recovery is partial. Unfortunately, when the liver is damaged, it is damaged. Complete recovery from alcohol abuse is very possible.
