Excerpts from "Under The Influence"

[Butterfly Woman]

Thought i'd bring these over from another site 'cuz it is good info

I am grateful to the individual who took the time to post these.

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Things to ponder while you are considering
if recovery is for you.

These are excerts from the book by Milam & Ketcham
"Under The Influence"

There is also a sequel
"Beyond The Influence"


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Under The Influence

Page 21
1.
Once in the blood stream, alcohol is distributed throughout the body in simple diffusion. Its small and relatively simple molecular structure allows it to pass right through cell membranes and mix in the entire water content of the body. The brain, liver, heart, pancreas, lungs, kidneys, and every other organ and tissue system are infiltrated by alcohol within minutes after it passes into the bloodstream.

Alcohol's immediate effect on the brain is most unusual. The brain is usually protected from chemicals and drugs by an electrical-chemical filter system known as "the blood/brain barrier," which makes sure that only very simple molecules such as those of oxygen and water can pass through. The simple molecular structure of alcohol allows it to penetrate this selective screen and gain easy access to the brain and its extension, the spinal cord.

Consequently, alcohol has immediate and profound effects on behavior. At low doses, alcohol stimulates the brain cells, and the drinker feels happy, talkative, energetic, and euphoric. After one or two drinks, the normal drinker may experience some improvement in thought and performance. As the BAL rises, however, the amount of alcohol in the brain also rises, and alcohol begins to disrupt the brain's electrical and chemical circuitry, causing complicated behavior changes.

With large amounts of alcohol surging through the brain's labyrinthine passageways, the central nervous system cells can no longer function normally. The brain malfunctions, and the major visible effect is a change in the drinker's psychological and emotional state. After several drinks, the normal drinker may begin to show signs of intoxication. He may become emotionally demonstrative, expressing great joy, sadness, or anger. He may also begin to show signs of motor incoordination, staggering slightly when he walks, knocking his drink over as he leaves the table, or slurring his words. If he continues to drink, his vision may blur, and his emotions, thoughts and judgement may become noticeably disordered.

When blood alcohol concentrations reach very high levels, the brain's control over the respiratory system may actually be paralyzed. A .30 BAL is the minimum level at which death can occur; at .40 the drinker may lapse into a coma. At .50 BAL, respiratory functions and heartbeat slow drastically, and at .60 most drinkers are dead.



Page 22
1.
The body, in the meantime, is doing its best to eliminate alcohol. Small amounts are eliminated in the urine, sweat, and breath, but the primary site of alcohol elimination is the liver, which is located behind the ribs on the right side of the body. This vital organ is responsible for numerous life-sustaining processes, including the control and elimination of drugs and chemicals which are toxic to the body's cells and the conversion of various nutritional substances into materials which can be used in the life processes of cells -- processes such as eliminating wastes, making repairs, and creating new cells.

The process of elimination begins as soon as alcohol enters the liver. An enzyme called alcohol dehydrogenase (ADH) attacks the alcohol molecule, quickly removing two hydrogen atoms to create a new substance called acetaldehyde. Since acetaldehyde is a highly toxic agent which can produce nausea, rapid heart beat, dizziness, headache, and mental confusion if present in the body in large quantities, the liver quickly initiates the second step in the elimination process.

It employs another enzyme with a similar name, aldehyde dehydrogenase, to transform acetaldehyde into acetate. Acetate is then converted to carbon dioxide and water and eventually eliminated from the body. During these two steps in alcohol oxidation, a great deal of energy is released. In fact, with ordinary rates of alcohol metabolism, almost the entire energy needs of the liver can be satisfied. Most of the acetate is passed into the blood stream and oxidized to carbon dioxide and water in other organs. The energy produced in these reactions contribute to the energy needs of the entire body. In the alcoholic, up to two-thirds of the body's total energy needs may be satisfied by substituting alcohol for other foods. This explains why alcoholics often neglect eating for several weeks at a time.

The conversion of alcohol into acetaldehyde and acetate is an efficient process in most drinkers. The liver works at maximum efficiency, converting alcohol at the rate of approximately one-half ounce per hour, until all the alcohol in the body is broken down and its energy released to the cells. The liver is then able to return to its other duties.

If alcohol is present in the body in large amounts for long periods of time, however, the liver must work constantly to break it down and flush it out. The liver's preoccupation with alcohol results in the neglect of its other duties and, as a result, toxins accumulate and nutritional functions are disrupted. The health and vitality of the body's cells, tissues, and organs begins to suffer.

[Butterfly Woman]

{Page 25}
If it were not for these stimulating effects of alcohol, most people would soon lose interest in drinking. In fact, when alcohol's sedative effects begin to take over after several drinks, the pleasure and excitement of drinking are gradually cancelled out, and the average drinker simply stops drinking. A built-in deterrent to overdrinking seems to be working in most drinkers, somewhat like the natural deterrent to overeating which most people have, although the mechanism is different. The average person enjoys sweets, for example, and will eat a candy if it is offered. Some people will eat two or three, and a few will gobble down the whole box. Most people, however, will feel sick if they eat more than a small amount of concentrated sweets.

Likewise, the average drinker is unable comfortably to drink more than a few beers, a glass or two of wine, or several mixed drinks. The benefits of drinking are usually available only with low doses of alcohol, and when sedation begins to override the stimulation, the average drinker ceases drinking. Another deterrent is the toxic effect of several drinks in the normal drinker -- the nausea, dizziness, sweating, and other unpleasant sensations.

The point at which alcohol's stimulating effects are overshadowed by the sedative and toxic effects varies from drinker to drinker. For some people, one drink is the limit. Others can drink four, five and more drinks and still experience alcohol's stimulating and euphoric effects. Alcoholics develop an increased physical resistance to alcohol's effects (called "tolerance"), and some can drink many times more than nonalcoholics while continuing to behave as if they were on their first few drinks. Thus alcohol remains stimulating and pleasurable for alcoholics even after they have drunk amounts which would cause nonalcoholics acute discomfort.

For alcoholic and well as nonalcoholic drinkers, however, alcohol's stimulating effects will eventually be erased with continued drinking. After several drinks -- again, depending on the initial tolerance of the drinker -- the average person will begin to experience a slowing down in his mental and physical reactions. He may not be able to grasp the thread of a conversation; his reflexes will be somewhat delayed, his speech slurred, and his gait unsteady. As he continues to drink, the alcohol increasingly depresses the central nervous system, and sleepiness, mental sluggishness, and physical incoordination intensify.

Only rarely, however, will a normal, nonalcoholic drinker take in enough alcohol to lose consciousness. This is fortunate, for alcohol taken in large enough quantities to cause unconsciousness is dangerously near the amount needed to paralyze the respiratory center, shut off the breathing aparatus, and kill the drinker. As an anesthetic or pain killer, therefore, alcohol is inferior because it numbs the senses only at extremely high, nearly lethal doses.

[Butterfly Woman]

{Page 27}
Alcohol, then, belongs in a category somewhere between the habit-forming and addiction-producing drugs. The WHO labelled it "intermediate in kind and degree" between the two categories of drugs, but even this label is inaccurate.

The fact is that the effects of alcohol simply cannot be generalized for both alcoholics and nonalcoholics.

For most drinkers, alcohol is not addictive; yet for the minority who are alcoholics, the criteria for true drug addiction are fulfilled; an increased tissue tolerance to the drug, a physical dependence on the drug with physical withdrawal symptoms, and an irresistable need for the drug when it is withdrawn.

The only way to clear up the confusion is to label alcohol a selectively addicting drug. It is addictive only for those individuals who are physically susceptible.

{Page 29}
Alcohol's energy "kick" is therefore its most beneficial and potentially its most deadly characteristic. As normally consumed, alcohol is usually in the body in small amounts and for relatively short periods of time, and its effects are therefore temporary. Furthermore, in small amounts, alcohol's benefits are noticeable and the penalties non-existant; the cells receive a quick jolt of energy, the hearthbeat accelerates, the brain cells speed up their communications, and the drinker feels euphoric and stimulated. The chemical causing these pleasurable effects is easily eliminated in an orderly and efficient manner, and the body then returns to normal activities. The brain cells quickly recover from their alcohol bath, the liver cells return to their everyday functions, nutritional materials once again flow in adequate proportions and amounts to the cells, and waste materials are efficiently eliminated.

In large and continuous amounts, however, the penalties of drinking far outweigh the initial benefits. The drinker is taking in so many calories from alcohol that he will automatically require fewer calories from other, more nutritious foods. Alcohol also disrupts the cells' ability to take in and use nutrients from other foods. It interferes with the absorption of various vitamins from the gastrointenstinal tract, inhibits the absorption of numerous amino acids, and increases the loss of certain vitamins in the urine, including thyamine, pyridoxine, and pantothenic acid. As a result, even if an alcoholic is eating well, alcohol denies him the full nutritional benefit of what he eats. Put another way, alcohol literally robs his body of those substances which are essential for life. Thus all alcoholics develop malnutrition regardless of what or how much they eat.

[Butterfly Woman]

{Page 33}
At some point, however, the drinking patterns of both groups begin to diverge. The alcoholic starts to drink more, and more often. He does not want to stop drinking once he has started. In the later stages of his drinking, he may keep a six-pack of beer in his desk drawer or a pint of whisky in the glove compartment. He may stop regularly at the corner tavern for a few quick ones after work. He may gulp his first drink or switch to martinis or straight whisky.

The alcoholic appears to be using alcohol to solve his problems. His drinking appears to be an effort to drown his depression, forget work or marriage difficulties, obliterate loneliness and insecurities, and ease mounting tensions.

The reality, however, is very different from the appearance. In reality, an abnormal physiological reaction is causing the alcoholic's increasing psychological and emotional problems. Something has gone wrong inside.

{Page 34}
In other words, while psychological, cultural, and social factors definitely influence the alcoholic's drinking patterns and behavior, they have no effect on whether or not he becomes alcoholic in the first place.

Physiology, not psychology, determines whether one drinker will become addicted to acohol and another will not. The alcoholic's enzymes, hormones, genes, and brain chemistry work together to create his abnormal and unfortunate reaction to alcohol.

{Page 35 & Others}
(I'm going to grab a few things here and there starting on page 35)

Acetaldehyde, the intermediate byproduct of alcohol metabolism, appears to be one of the major villians in the onset of alcoholic drinking. The trouble probably begins in the liver ...

... found that the same amount of alcohol produced very different blood acetaldehyde levels in alcoholics and nonalcoholics. Much higher levels were reached in alcoholics. Lieber theorized that this unusual buildup of acetaldehyde was caused in part by a malfunctioning of the liver's enzymes.

... took this acetaldehyde difference in alcoholics one step further. His studies confirmed that, in alcoholics, the breakdown of acetaldehyde into acetate -- the second step in alcohol metabolism -- is performed at about half the rate of "normal" i.e. nonalcoholic metabolism. It is this slowdown in metabolism which apparently causes acetaldehyde to accumulate.

... Heredity is clearly implicated in these studies ...

In summary, addiction to alcohol may, in part, be traced back to a liver enzyme malfunction which results in a buildup of acetaldehyde throughout the body. In the brain, these large amounts of acetaldehyde interact with the brain amines to create the isoquinolines. These mischievous substances may trigger the alcoholic's need to drink more and more alcohol to counter the painful effects of the progressive buildup of acetaldehyde.

... Accumulated evidence clearly indicates that alcoholism is hereditary ...

... The weight of evidence clearly links alcoholism to heredity ...

Goodwin's studies provide compelling evidence that alcoholics do not drink addictively because they are depressed, lonely, immature, or dissatisfied. They drink addictively because they have inherited a physical susceptibility to alcohol which results in addiction if they drink.

Furthermore, this evidence has profound implications for treatment. While it may be possible to teach the problem drinker how to drink in a more responsible way, the alcoholic's drinking is controlled by physiological factors which cannot be altered through psychological methods such as counseling, threats, punishment, or reward.

In other words, the alcoholic is powerless to control his reaction to alcohol.

{Page 48}
Because the early alcoholic shows no sign of disease, the logical but wholly mistaken idea persists that alcoholism begins only when the drinker does suffer from drinking and does show some deterioration in physiological functioning, such as severe withdrawal symptoms, personality disintegration, or inability to control his intake.

Before these visible symptoms appear, most people assume that alcoholics and nonalcoholics experience precisely the same physical reaction to alcohol. In fact, they do not. The alcoholic reacts physically in an abnormal way to alcohol, and his disease begins long before he behaves or thinks like an alcoholic.

The reactions or adaptations of the body's cells to alcohol remain hidden in the early stages of the disease, but they are nevertheless happening. In months or years, the cells will have been so altered by alcohol that the alcoholic's behavior and thought processes will be affected. Then the disease will no longer be hidden, and the alcoholic will clearly be in trouble with alcohol.

In the early stage, however, the disease is subtle and difficult to recognize. It is characterized by adaptations in the liver and central nervous system, increased tolerance to alcohol, and improved performance when drinking.

[Butterfly Woman]

{Page 49 & Others}
In the onset of alcoholism, adaptation is central. Alcoholics initially experience physical stress whenever they drink. Their enzymes, hormones, and numerous chemical processes are thrown out of balance by alcohol, and the normal ebb and flow of materials into and out of the cells is upset.

To counteract this confusion, the cells make certain changes in their structures. These adaptations gradually allow the cells to work smoothly and efficiently even when alcohol is present in the body in large quantities. In fact, the alcoholic's cells become so competent at using alcohol for energy that they choose alcohol over other energy, or food, sources.

... Gradually alcohol attacks the cells, destroying their delicate chemical balances, eating away at the membranes, and deforming the cell innards ...

The critical point, however, is this: the preliminary adaptation begins before the alcoholic starts drinking heavily and, in fact, causes the heavier drinking. Adaptation does not occur because a person drinks too much. On the contrary, when a person starts drinking more, and more often, and the pattern persists, he is displaying one of the first symptoms of alcoholism.

... A viscious cycle begins when the alcoholic must drink more to maintain a level of alcohol sufficient to override and block the devastating effects of the rising level of acetaldehyde. This is the basis of the alcoholic's "physiological imperative" to keep drinking once he starts that is regularly mistaken for a psychological compulsion to drink ...

{Page 54 & Others}
... Researchers conclude that large and continuous doses of alcohol stimulate the cells to adjust the structure and thus the functioning of their membranes. The cells now welcome alcohol and adjust to its toxic aftereffects. As a result, the cells are able to cope with increasingly large doses of alcohol; they become, in other words, tolerant to alcohol.

If the alcoholic continues to drink in large quantities, however, the toughened membranes are continually battered and gradually damaged by alcohol's poisonous aftereffects ... The results are catastrohpic ... The destruction of cell membranes is linked with many of the conditions which afflict alcoholics in the late stage of their disease, including severe withdrawal symptoms, such as convulsions, hallucinations, and delerium tremens, and damage to the heart muscle (alcoholic cardiomyopathy).

The ability to tolerate large amounts of alcohol can develop over a period of weeks or years, depending on the individual. Some alcoholics experience a subtle gradual shift from normal drinking to a drinking pattern of increased frequency and stepped-up amounts over a period of many years. Most alcoholics, however, experience a more immediate change in their tolerance level and are able to drink more than their friends and show less impairment soon after they first start drinking.

Tolerance is actually responsible for the alcoholic's continued and increasingly large intake of alcohol. In fact, an increase in the amount and frequency of drinking is the typical symptom of a developing tolerance to alcohol and one of the first warning signs of alcoholism.

When the alcoholic become tolerant to alcohol's effects, he is responding to changes which are occurring inside him. He is not responsible for initiating theses changes. He is not even conscious that these changes are taking place.

{Page 58 & Others}
Something completely different happens when the early-stage alcoholic drinks. Alcoholics in the early, adaptive stage of their disease also show improvement of functioning as the blood alcohol level begins to rise. But unlike the nonalcoholic, this improvement continues with additional drinking.

Even when blood alcohol remains at fairly high levels -- levels which would overwhelm the nonalcoholic, causing him to stumble, stutter, and sway -- the early alcoholic is often able to talk coherently, walk a straight line, or skillfully maneuver a car. Only when the alcoholic stops drinking and his BAL descends, does his performance deteriorate -- and it does so very rapidly.

Most alcoholics discover "maintenance drinking" early on in their drinking careers, and they learn ways to protect themselves against the disasterous drop in blood alcohol level ... "... keep a bottle in the car to maintain him until he gets home ... pick a tavern closer to home and gulp a last drink just before leaving ..."

Maintenance drinking is not gluttony or irresponsible drinking, but a protective device whereby the alcoholic delays the drop in BAL until he is safely off the road and back in bed. By drinking continuously but never overdrinking, he attempts to hold on to the benefits of drinking while forestalling the penalties.

Tragically, the alcoholic can only temporarily control his drinking behavior. Over a period of years, the cells' dependence on alcohol becomes more firmly entrenched until, at some point, the alcoholic no longer has a choice. He needs alcohol to function, and he suffers terribly when he stops drinking. The benefits of adaptation are gradually overshadowed by the penalties of deterioration.

[Butterfly Woman]

{Page 67 & Others}
The hangover can be excruciating for the non-alcoholic, but it becomes much worse for the alcoholic in the later stages of the disease. As one expert put it, "[Hangovers]... are so extreme for the alcoholic that they really should have a different name. No normal drinker would recognize them as what he has."

The source of the physical and mental pain of the alcoholic hangover is, to repeat, the state of hyperactivity in the central nervous system caused by the withdrawal of alcohol. The cells, which are accustomed to the presence of alcohol and dependent on it for energy, stimulation, and sedation, become agitated when it is suddenly not available. The cells' distress is experienced by the alcoholic as the headache, eyeache, dizziness, nausea, and anguish characteristic of the hangover, ("anguish" is an older term than "anxiety" and refers to both mental and physical pain or suffering -- "anxiety" refers only to psychological conflict or tension).

Alcoholics feel physically wretched during a hangover, but they also feel deeply and profoundly ashamed. From past experience, they know better, but they got drunk anyway -- why? Ignorant of the powerful workings of the addiction, the alcoholic can only blame himself. Remorse, self-loathing, and guilt therefore go hand in hand with the throbbing headache and queasy stomach ... "... the emotional pain which accompanies them -- the guilt, anxiety, self-accusation, the sense of hopelessness and despair ..." ... a very real and very painful physiological disorder.

The increasing misery of the alcoholic hangover is directly caused by the drinker's physical dependence on alcohol. As this goes by and the alcoholic drinks more, and more often, the withdrawal symptoms -- experienced in those minutes, hours, or days without a drink -- become more severe. He begins to feel shame and remorse when he repeatedly fails in his efforts to stop drinking or control his intake. He cannot make good his intentions to drink as everyone else does, and this personal failure causes great guilt and despair. The alcoholic believes that he should be able to control himself by a sheer force of will. He does not know that the physical addiction is in command of his every thought and action and subverts his persistent efforts to control it.

... The alcoholic's most cherished values -- his honesty, integrity, self-discipline, even his love for his family -- are repeatedly overthrown because he cannot reliably predict or control his own drinking behavior. Any normal human being would feel disgust and self-loathing at this seemingly pathetic inability to exert control and exercise will power; and so does the alcoholic, who may be normal in every respect except his reaction to alcohol.

The alcoholic's guilt, depression, self-loathing , and despair are therefore understandable reactions to a bewildering and mysterious inability to stop the ravages of drinking. Neither the alcoholic nor those around him know that his cells have become abnormal, for the physical dependence and cellular addiction have worked inside him for months or perhaps years, invisible and unnoticed. No wonder the alcoholic believes he is weak-willed and pathetic. No wonder many of the people who observe his behavior believe that he is psychologically unstable, self-destructive, and perhaps suicidal. Without an understanding or knowledge of his addiction, they have no way of knowing that the alcoholic's irrational behavior is beyond his control.

{Page 108 & Others}

The middle-stage alcoholic has probably been having blackouts from time to time. Blackouts are a very distinctive feature of alcoholism, and one symptom that clearly distinguishes alcoholics from non-alcoholics. The events which occur during an alcoholic blackout are not forgotten; they are simply not stored or are imperfectly stored in the brain. There is nothing there to be recalled later.

During a blackout, the alcoholic may be functioning normally and aware of everything that is happening around him. He continues to talk, walk, eat, drive a car, conduct a business deal, or make love to his wife. Yet on sobering up, he has no memory trace of what occurred during a certain time period -- it could be a minute, an hour, or even several days. In the early stages of the disease, blackouts are relatively infrequent, but as the disease progresses, they occur more often and last for longer periods of time.

Jack attended a series of weekend meetings held in a city 90 miles from his home. The last meeting ended in midafternoon, and Jack retired to the bar with several friends. It was happy hour, and the bartender announced a special on martinis: six ounces of gin for just $2.00. Jack drank four specials and then decided to order dinner before he drove home. With dinner, he drank a bottle of wine. It was late when he started driving, but he remembered watching the moon rise over the low hills. The next thing he knew and could later recall, he was travelling 110 mph and was 25 miles past his exit. He had driven 100 miles in a blackout.

It is not difficult to imagine how frightening blackouts can be. The alcoholic may wake up in the morning with no recall of the events of the previous evening. He gets out of bed, afraid to inspect his clothes -- did he get sick? Then the question occurs to him: "How did I get home?" He looks out the window, fearful that the car will be missing. He does not remember driving home.

The car is there, and he has another, even more frightening thought: "Did I hit something or someone?" He runs outside and looks at the front end. He searches the seats for clues to help him piece the lost time back together. Humiliating thoughts race through his mind: "Did I disgrace myself? Will my friends talk to me? How can I find out what happened when I am too embarrassed to admit that I don't remember?"

Blackouts can be so frightening that they make the alcoholic question his sanity. For the first time he may realize that he is in deep trouble with alcohol. Despite his increasing problems, however, the middle-stage alcoholic rarely considers giving up drinking...