In the year 2004, WHO estimated that around 2 billion people worldwide consumed alcoholic beverages and that around 76 million had diagnosable alcohol use disorder. Clearly this is a significant global issue as alcohol consumption results in a number of harmful behavioural changes even when drunk in normal quantity. These include euphoria, loss of inhibition, impaired higher functions (i.e. judgment, memory, concentration and coordination), impaired senses (i.e. vision, smell, taste and hearing), disorientation, slurred speech, reduced fine motor skills & slow reaction time. 

But when drunk in large quantity, it is much worse causing extreme mood swings, violent behavior and memory black outs and in severe cases respiratory depression, inhalation of vomit, coma and even death. When large quantity of alcohol is consumed chronically, people can develop a condition called alcohol dependence syndrome. Once they reach this stage, they develop a strong urge or a sense of compulsion to drink alcohol. They find it difficult to control their drinking behavior in terms of its onset, termination or level of use. They may develop a tolerance to the effects of alcohol, which means that they have to drink larger quantity of alcohol to get the same effects that they got from smaller quantity in the past. They may also develop an alcohol withdrawal state after several hours of not drinking. This could put them in a distressing state of anxiety, shaking of the body and limbs, agitation, sense of dread facing people, nausea, retching, sweating and insomnia. In extreme cases they can experience misperceptions, hallucinations and even epileptic seizures. As a result they could develop a habit of drinking alcohol as an eye opener to get a relief from these withdrawal symptoms. This kind of relief that they get leads them to a belief that alcohol has a medicinal value in resolving their intolerable physical and mental state. In the later stages of alcohol dependence, their daily routines change to a fixation on obtaining alcohol, drinking it, getting under its influence, being in a withdrawal sate and further drinking to get a relief from this state. They struggle to function effectively in most areas of their life including work, family life and personal interests. Despite having harmful consequences, they find themselves unable to stop their alcohol usage. 

 Chronic alcohol abusers can also develop personality changes and serious mental disorders. They could become increasingly self-centred with a lack of consideration for others, resulting in a neglect of their responsibilities. There is usually a decline in the standard of their conduct and they could start becoming dishonest and deceitful. They could frequently experience anxiety and depression along with significant sleep difficulties, sexual dysfunction and suicidal ideation which may even progress to suicide attempts. In the later stages of alcohol abuse their brain could get atrophied causing problems in their memory and attention. 

Progressively, these effects could cause significant adverse consequences for these individuals themselves, their families, workplaces and the society. When their routines revolve around alcohol, people often start distancing themselves from friends. They frequently get a bad social reputation due to their misbehaviour with others, constant borrowing, inability to return the borrowed money and involvement in fights, often leading to exclusion from social circles. At work there tends to be inefficiency, conflicts with colleagues, neglect of duties and there by poor performance. This frequently leads to loss of respect from employers and colleagues and eventually, suspensions and job losses. When under the influence of alcohol they are more likely to get in to trouble with the law, such as disobeying rules, drunken driving, thefts, petty crimes, involvement with criminal gangs, arrests, court cases, convictions and imprisonments. Their families experience a heavy burden due to frequent fights, episodes of physical violence, neglect of family duties, increased expenditure on health problems, increased incidence of spousal abuse and abuse of children and siblings. All these along with increased incidence of gambling and other addictive behaviours lead to significant financial hardship and poor quality of life for family members. Depression tends to occur more frequently in family members as there are often stigmatized and isolated from the community. 

Looking at all these effects of alcohol, it is not at all surprising that in the year 2000, WHO estimated the disease burden of alcohol in disability adjusted life years (DALY) as a total of 4 potential years of life lost in the population due to premature death, poor health and disability. 

Dr Aju Abraham, Consultant Psychiatrist
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