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Substance abuse
Alcohol
Within five minutes of consuming alcohol, it enters the blood stream via the stomach. The effects can last for several hours. Alcohol is a nervous system depressant and after three units, makes people less socially inhibited and generally more relaxed.

 
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Appearance and use in South Africa

Alcohol is freely available in an estimated 230 000 liquor outlets in South Africa. South Africans consume over 5 billion litres of alcoholic beverages per year, according a report by the Medical Research Council (MRC).

This boils down to 120 litres per person per year. This statistic is per capita and when one keeps in mind that large sections of the population do not drink at all, it becomes apparent how much the rest must be drinking.

The MRC predicts an increase in alcohol consumption as the spending power among low income groups increases. It is also expected that many more women will become regular abusers of alcohol.

Recently, there was a scandal in South Africa when it was revealed that several cheaper brands of alcoholic beverages sold widely in liquor stores contained highly poisonous industrial methanol (alcohol with one Carbon molecule instead of the two of ethyl alcohol) rather than the more palatable and legal ethanol.

In the Western Cape especially, the legacy of the ‘dop’ system is still felt , where labourers on many farms were paid partly by being given alcohol.

Alcohol drinking is thought to go back almost as far as the human race does. It has been part of many religious and social rituals through the ages in many different societies.

Alcohol is produced by the fermentation of fruits, vegetables or grains. Water and ethanol make up the body of most alcoholic drinks. All alcoholic beverages display their percentage of alcoholic content on the labels.

Effects of alcohol
Within five minutes of consuming alcohol, it enters the blood stream via the stomach. The effects can last for several hours. Alcohol is a nervous system depressant and after three units, makes people less socially inhibited and generally more relaxed. A unit contains eight grams of alcohol and consists of one large beer, one glass of wine or one pub measure of spirits.

After eight units, most people will slur their speech and become clumsy, uncoordinated and sometimes very emotional – generally known in South Africa as ‘dronkverdriet’. If more alcohol is consumed, double vision, nausea, loss of balance and vomiting can occur. Further drinking may lead to unconsciousness and memory loss.

Many things influence the effects alcohol has on particular people: their body weight, the speed with which the alcohol was consumed, how full or empty the stomach of the drinker was, their emotional state, their drinking habits and their personality or surroundings.

Alcohol is often used in conjunction with other drugs and this can greatly influence the effects of both substances.

The symptoms of alcoholism

Alcohol is metabolised very quickly by the body. Alcohol needs no digestion and is quickly absorbed. It affects every organ of the body, but its most dramatic impact is on the liver. Over the long-term, alcohol metabolism permanently changes liver cell structure, which impairs the liver’s ability to metabolise fats. This is why alcoholics develop "fatty livers".

The liver can metabolise about one unit of alcohol per hour. If more arrives, it continues to circulate in the body until the liver can accommodate it. This is how it affects all other parts of the body.

The impact excessive alcoholic intake has on the body, is huge. The following are only some of the physical effects alcoholics can experience: Gouty arthritis, cirrhosis of the liver, increased cancer risk, heart disease, kidney failure, malnutrition, dementia, and obesity and depression.

There are also many psychological symptoms associated with excessive alcoholic intake, many of which become apparent in someone’s workplace or personal life. These include a deterioration of personal hygiene, constant bouts of colds or flu, poor eating and sleeping habits, inappropriate behaviour in social situations, mood swings, poor concentration, irritibility, irregular work performance, constant lies to cover up the drinking, financial problems, harbouring resentments, victim thinking (poor me) and frequent job changes.

Withdrawal symptoms
Withdrawal from alcohol dependence is dramatic and highly unpleasant. These include from mild hangovers to total withdrawal, including convulsions, dangerous high blood pressure and hallucinations.

Hangovers, after a single bout of excessive drinking, can consist of headaches, sleep disturbances, anxiety, nausea, tremors and vomiting.

More severe withdrawal include all of the above with the further possibility of convulsions, loss of consciousness, hallucinations and delirium tremens. These delusions are often terrifying and may produce violent behaviour.

There is a 10 – 20 percent mortality rate associated with the final stages of withdrawal from severe addiction to alcohol. This withdrawal usually requires medical supervision.

Many alcoholics are predisposed to their condition by genetic factors and very subtle differences in brain functioning and structure. Psychological factors such as self-centredness also play a role. It should be remembered that alcoholism is NOT a reflection of weak willpower or a weak character.

- Reviewed by Peter Powis, Stepping Stones, (021) 783 4230, March 2006

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