We don’t know the exact period when humans started consuming an addictive substance like alcohol. It is being estimated that humans started drinking alcohol 12000 years ago, when we begun settling down as civilizations.
Man figured out the recreational element in alcohol from drinking accidentally fermented sugary fruits. Gradually, he learnt to do fermentation and started to produce alcohol for recreational purpose.
We have found written records dating back to 1800 BC regarding alcohol consumption in Sumeria. Sumerians considered Ninkasi as the goddess of beer and they had written devotion for her.
Early evidence for alcohol consumption among humans had been discovered in China, when traces of alcohol has been found in 7000 years old clay glasses and jars.
In India, alcohol consumption is dated back to Vedic era during 1500 BC. In Vedic texts, it had been mentioned as ‘somam’ (സോമം)
It is always a perplexing question that why human beings are always attracted towards addictive substances. The answer is: our brain and its reward center mechanism.
The reward center mechanism is the result of evolution in order to help us in our survival and procreation. It is also known as Hedonic hot spots.
Our brain is a mysterious, wonderful organ consists of 73% of water. Human brain works on an organized communication mechanism between neurons. There are billions of neurons in our brain connected to each other and the connection between neurons is called synapses.
Synapses are carried out by brain chemicals known as neurotransmitters namely Serotonin, Dopamine, Acetylcholine etc. Simply put, neurotransmitters stimulate the reward system of the brain.
Food, sex, rest, music and literature can trigger feel good neurotransmitters like Dopamine in our brain and also make us want more of it often.
Reward pathways can be compared to a token machine. Addictive substances like alcohol, drugs and tobacco target reward pathways. While we get natural stimulation from activities like eating food and having sex; addictive substances creates a shortcut and triggers an immense stimulation of the reward system of the brain. It is like a robber robbing the token machine.
An addictive substance like alcohol can stimulate the reward system of our brain ten times more than any other normal stimulants like food or sex.
Apart from alcohol or other addictive drugs, addictive behavior consists of internet, social media, gaming, gambling and pornography.
Children especially teenagers are prone to peer pressure and also they are psychologically inclined towards emulating their elders especially celebrities. Curiosity to experiment the effect of an addictive substance adds fuel to the fire.
The first stage of addiction is known as liking. Simply put, brain likes the stimulation of alcohol and it triggers craving for more. So, liking leads to repeated use of the substance.
The ability of neurons to make new connections with other neurons is called neuroplasticity. Our ability to create new memories as well as to learn new skills is attributed to neuroplasticity. It is also known as rewiring.
Alcohol consumption in early stages causes only temporary rewiring but repeated as well as prolonged usage turn it into permanent one. In short, ‘liking’ changes to ‘wanting’ by developing alcohol tolerance in drinker.
In regulated relapse stage, a person can come out of alcoholism without much complications but may experience withdrawal symptoms.
Compulsive relapse is the stage in which a person started drinking continuously. Metaphorically, the drink took the man. A person’s submission to alcohol is complete in this stage. Even though the alcoholic think about stopping the habit, he is incapable of doing it.
Alcohol is basically a depressant and can cause chemical imbalance in the brain. This chemical imbalance causes acute withdrawal symptoms like Delirium tremens in an alcoholic. Classical symptoms of Delirium tremens are visual hallucinations, anxiety, trembling, seizures, sleeplessness, mood disorders and suicidal tendency. Alcohol is also capable of inducing psychotic disorders like Othello syndrome. These symptoms vary according to individuals.
Thiamine, also known as vitamin B1 is very essential for the development and growth of neurons in our brain. Regular intake of alcohol causes it’s deficiency. Alcohol can also reduce serotonin levels in brain and low level of serotonin leads to depression, a common consequence of alcoholism.
These are the stages through which an addict has to undergo to free himself from addiction. It is also known as transtheoretical model of change devised by Prochaska and DiClemente.
An alcohol addict doesn’t have plan or thought to stop his drinking habit during pre-contemplation stage. In contemplation stage, he desire to stop but he doesn’t know how to do it. He enters the preparation stage when he decided to stop the habit and start working towards the goal. In action stage, he stopped or replaced the habit for good. In maintenance stage, an addict is in recovery and also struggling to prevent relapse. Relapse is the stage in which an addict returns to his addictive behavior and start using the addictive substance of his choice.
Treatment Phases for Alcoholics
The addiction treatment of alcoholism consists of three phases: Detoxification, Maintenance and Rehabilitation
Normally, an addict reaches the rehabilitation center in a state of medical emergency or in an acute withdrawal state. Typical detoxification phase includes medication to suppress withdrawal symptoms and can last up to two weeks.
Maintenance phase consists of psychological intervention like motivation enhancement therapy (MET) along with the assistance of anti-craving medicines as well as aversion therapy. It can last up to one or two months. It is strictly advised to carry out maintenance phase at the rehabilitation center.
What is aversion therapy?
When ethanol is ingested in our body, it is metabolized into Acetaldehyde and Acetic Acid or Acetate. The conversion of alcohol to Acetaldehyde is done by an enzyme called Alcohol Dehydrogenase. The conversion of ethanol to acetic acid is done by Acetaldehyde Dehydrogenase.
Acetic acid is soluble, harmless and expelled from our body through urine or sweat. Acetaldehyde is the reason behind hangover symptoms as it takes much longer to become soluble and gets expelled from body.
Disulfiram, the medicine used in aversion therapy suppress Acetaldehyde Dehydrogenas causing the conversion of ethanol mostly to Acetaldehyde. This led to the development of hangover symptoms as soon as the ingestion of alcohol. Gradually, the addict loses interest in drinking alcohol.
In reality, aversion therapy is a double edged sword. If a person under Disulfiram uses alcohol more than his regular intake, it can even lead to his death. So, it should be prescribed and administer with an alcoholic’s consent and knowledge.
A successful maintenance phase can transform an alcoholic to a sober person. In fact, the transformation happened only to the alcoholic. But, the environment especially the social circle that can trigger relapse remains intact.
Rehabilitation phase, that has has two major purposes, take care of this issue. Firstly, to maintain motivation in an alcoholic to promote a lifestyle free from alcohol. Secondly and most importantly, the prevention of relapse.
In this stage, the alcoholic is advised to frequently visit the rehabilitation center for motivation or help. Social workers are also employed to visit the alcoholic and provide necessary guidance.
Myth: Single use makes a person addicted to an addictive.
Truth: Single use never makes a person an addict. It is the repeated use that induce addiction.
Myth: Social drinking is safe.
Truth: Social drinking is not safe as it just a doorway towards addiction.
Myth: Alcoholics can stop drinking at any time.
Truth: People making those claims can stop drinking but only for a specific period of time. After that, they start drinking again. This is called regulated relapse and a sign of addiction.
Myth: Alcoholism can be treated in retreat centers through prayer meetings and counseling. Medication is harmful to body.
Truth: Since alcohol brings structural changes in brain, at times, medication is required. It is better to use a treatment method combining both counseling as well as medication. Retreat centers never employ scientific methods and are never a solution for the menace of alcoholism.
Myth: Alcohol boosts creativity. Number of famous artists consume alcohol.
Truth: Alcohol, basically a depressant, never boosts creativity. There is no scientific evidence to support this claim. Some artists use alcohol or drugs to eliminate stage fright, shyness and fatigue or they are just addicted to alcohol or any other form of drugs.
Myth: Alcohol increases sexual performance
Truth: Alcohol increases sexual desire but diminishes sexual performance.
Myth: Consuming small amount of alcohol daily is good for health.
Truth: Even consuming alcohol in small amounts regularly is a habit that can induce alcohol dependency or addiction in future. So better avoid alcohol altogether. It is possible to live happily even without alcohol.
Myth: Alcohol consumption is considered as a taboo in our country and legal restrictions are imposed on it. These are promoting alcoholism in our country.
Truth: Pattern of alcohol consumption in our country is very different from western countries. Drinking is an inseparable part of western culture. Our society requires legal restrictions on alcohol because of our reckless drinking habit.
Myth: Cannabis is safer than alcohol.
Truth: It is scientifically proven that the effect of both cannabis and alcohol is similar to our physical and psychological health. Cannabis can also induce psychotic episodes in users which is also known as hemp insanity.
Rather than considering the intake of alcohol as an immoral activity or a cardinal sin, it should be educated as a dreadful menace to psychological, economical and physical health of human beings to youth especially teenagers. Addiction, in real sense, is a brain disease.
Take our life as an addiction and say NO to drugs.
(This write-up is based on an hour long talk by Dr. Hareesh Krishnan titled മായാമോഹനം on the topic, addiction and brain organized by esSense Global Palakkad. Apart from alcoholism, he also shed light on abuse of cannabis and inhalant or volatile substances, hemp insanity, nicotine replacement therapy and harm reduction strategies. The reader can watch the video below.)