Out of Control - Heavy drinking can lead to alcohol addiction, which changes
the brain’s circuits and causes mood swings, dementia and liver diseases.

Nights out and booze go hand in hand for many people.

But piling on the drinks, whether one is a social or heavy drinker, can lead to alcohol addiction.

The road to this addiction starts when the reward centre in the brain (the part of the brain that records
pleasure) gets “screwed up”, said Associate Professor Munidasa Winslow, a psychiatrist at Raffles Hospital.

“The reward centre in the brain gets pleasure from the drinking, so there is a craving for more,” he said.
“But after a certain point, the body becomes dependent on alcohol to function normally.”

He explained that someone having crossed this point will need to drink more alcohol, usually on the
sly, to keep up with work and family activities. There will otherwise be withdrawal symptoms.

These include tremors, anxiety, tension and anger – suppressed only by imbibing more alcohol.

A chronic drinker will then develop tolerance to alcohol and require greater levels to feel normal.

Agreeing, Dr Desmond Wai, a consultant gastroenterologist and hepatologist at the Asian Centre for Liver Diseases and Transplantation, said the classic signs of alcoholism include craving, loss of control over the
habit, withdrawal symptoms and alcohol tolerance.

There may also be displays of uncharacteristic anger and irritability – and in some people, violence.

All this is due to the effect alcohol has on overriding logic, said Dr Tan Hwee Sim, an associate
consultant psychiatrist at the National Addictions Management Service, Institute of Mental Health
(IMH).

“Alcohol affects the central nervous system. It can sedate – or blackout – the brain such that emotions
can take over,” she said.

Many alcoholics cannot recall their strange behaviour later because of this blackout they experience, she added.

Depression
There is more: because alcohol is a depressant, excessive drinking can lead to alcohol-induced mood
disorder in the long run.

Such people are constantly in a depressed mood and show a lack of interest in daily activities, Dr Tan
said, adding that the symptoms mimic that of depression.

Alcohol addiction affects not just the mind. The body suffers too.

Liver damage
Alcoholic drinks can burn the stomach lining, which is why some people have abdominal discomfort when
they consume a large amount of alcohol within a short time, said Dr Wai.

The stomach can usually recover quickly from this but not the liver, which can be hit with lasting damage. This is because toxic substances are produced when the liver has to break down alcohol.

Alcohol is absorbed in the stomach and intestines and is transported to the liver to be broken down, Dr Wai explained. “The end product of this process is not toxic, but the middle products are.”

The initial effect is to cause fat to accumulate in the liver, which may later become inflamed. Eventually, liver diseases develop, such as hepatitis and cirrhosis, where liver cells die and are replaced with fibrous tissue, resulting in scarring.

Although the liver is incredibly resilient and can recover on its own, often, the only option for severe cirrhosis is a liver transplant.

“Fatty liver and mild forms of alcoholic hepatitis are usually reversible but liver scarring is not,” said Dr Yang
Wei Lyn, a senior consultant gastroenterologist at Tan Tock Seng Hospital.

Dr Wai added that about half of the patients with cirrhosis die within two years. He also said that while it takes about 10 years of regular drinking for liver trouble to emerge, it is always wise to quit drinking early.

“Every person has a different point of no return. We will not know what that is until he quits drinking,” he said. “About one-third of patients won’t improve even after they have stopped drinking as they have crossed that point.”

Women at higher risk
Female drinkers are more susceptible to alcohol-related diseases due to their smaller body size and liver volume, said Dr Yang.

The treatment for liver ailments is simple – quit drinking.

“If you quit drinking, it’s as good as having a liver transplant because there’s a high chance that the liver
will recover,” said Dr Wai.

Apart from liver damage, alcohol can also cause inflammation of the pancreas, sexual dysfunction in
men, nutritional deficiencies and dementia, added Dr Yang.

Long road to recovery
As alcohol addiction is also a psychological illness – because the brain becomes wired to depend on alcohol
– counselling is integral to recovery.

Here, education is the key, said psychiatrist Dr Chan Keen Loong, the department head of psychological
wellness at Alexandra Hospital.

This includes getting the message across to addicts that there are harmful effects on their health, family
relationships, finances, social life and work.

“The counsellor’s job is to get the person to look at his addiction honestly and change his attitude; to
offer support and a listening ear,” he said, adding that sessions may be held in groups or individually.

Even so, counselling can only do so much. Patients have to first shed their self-denial, said Dr Tan.
“Such denial in some people can be so strong that they fail to acknowledge that they have a drinking
problem even when it’s obvious to everyone else,” she said.

In such cases, family and friends can step in. For example, they can point out matter-of-factly to their loved one how alcohol has affected his behaviour.

“They can say, ‘last time when you drank, you did this’, as the person may be too drunk to remember anything,” said Dr Tan. “Family is a major component of counselling– they need to provide the right kind
of support.”

The IMH receives about 300 new cases of alcoholic addicts yearly and 90 per cent are men. However,
Dr Tan said more female cases are surfacing recently.

After they have faced up to their problem, addicts need to resolve to stay away from alcohol completely.
Otherwise, they will suffer a relapse, said Dr Wai.

“I tell recovered patients they should never touch a drop of alcohol again and avoid friends who drink,”
he said. “I have seen many who tried so hard to quit but easily went back to square one.”

There is a saying, “Once an addict, always an addict”. Therein lies the challenge for an alcoholic.

Dr Chan said: “Quitting is easy. Staying off alcohol is the hard part.”

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