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ISBN: 978-1-032-24840-0 (hbk)
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DOI: 10.1201/9781003280361
Contents
Foreword by Dr. Jaspreet S. Bains vii
Foreword by Dr. Rakesh K Chadda ix
Preface xi
Epilogue xv
1. Is it the Personality or the Alcohol that Makes one an Addict? 1–14
Karishma, Nisha Phakey and Krishan Kumar
2. Impact of Alcohol on Family Functioning 15–34
Narendra Kumar Singh and Dipanjan Bhattacharjee
3. The Effects of Alcoholism on the Brain 35-52
Ram Singh, Geetanjali and Deepak Mishra
4. Nutritional Deficiencies and Diseases Associated with Alcoholism 53–68
Lakshna Mahajan and Ram Singh
5. Alcohol De-addiction: Application of Body Psychotherapies 69–84
Suhas Shetgovekar
6. Understanding the Role of Probiotics as a Possible Treatment 85–108
Strategy for Alcoholism Induced Liver Dysfunction
Sriram Seshadri
7. Herbal and Natural Medicines for Treatment of Alcoholism and 109–136
Associated Diseases
Jyoti Singh
8. Psychopharmacotherapy for Alcoholism: 137–164
Challenges in Novel Approaches
Rahmat Bano and Ravinder Singh
9. Substance Abuse Disorder and its Management 165–178
Gauri Shanker Kaloiya and Mohit Kumar
10. Prohibition in India: A Study of the Historical &
Contemporary Aspects 179–190
Tanushree
vi Contents
11. Patterns of Alcohol Abuse Among Urban Slums & 191–200
Substandard Settlements: Review of Indian Literature
Towards Implications for Policy Interventions
Sushil Kumar and Gurpreet Kaur
12. Alcoholism: Popular Culture and Narrative Therapy
Interventions 201–210
Ruby
13. Alcoholism Among Adolescents and Juvenile Delinquency 211–226
Annie Khanam (Singh) and Subhasis Bhadra
14, Impact of Alcoholism on Various Aspects of
Wealth Management 227–236
Shweta Anand
15. Chemical Therapeutics for the Treatment of Alcoholism 237-248
Brijesh Rathi and Poonam
16. Alcoholism: A Health and Social Evil 249-256
Dharam Pal Singh and Meenakshi Sindoliya
Foreword
It is estimated that 4% of all the world’s health problems are linked to
excessive alcohol consumption. This form of alcohol use is a major health risk
factor which eventually leads to chronic disability and possible death. Emphasis
should be placed on effective strategies to help people who are dependent
on alcohol. This would help to reduce excessive drinking, maintain sobriety, and
prevent relapse.
Clinical studies have shown that approximately 8% of hospitalized patients
suffer from complications related to alcohol withdrawal. Symptoms present as
life- threatening condition that usually affects people when they try to decrease or
discontinue their alcohol intake.
There have been advancements made in the health sciences for the improved
treatment and rehabilitation of those who are either addicted to alcohol or are
casual drinkers that have decided to quit. The awareness in certain sections of
society has facilitated the formulation of policies or legal measures relating to the
control of the sale and consumption of these substances.
Health care research has shown that a high number of motor vehicle
accidents occur due to the easy availability of alcohol on the main highways.
On 15th December 2016, The Honorable Supreme Court of India decided that all
liquor shops and bars must be moved away from major highways.
During our present time, it is important to aggressively educate people on the
harmful effects of alcohol consumption, involve family members, and bring in
more stringent laws to control this debilitating predicament. Different stakeholders
should come together and suggest ideas to prevent, reduce, control, or rehabilitate
such persons.
This book has presented a very thorough and holistic view of current alcohol
related issues. It includes chapters on social, economic, medical, and rehabilitation
strategies. I believe that individuals, researchers, administrators, educators,
viii Foreword
health care policy planners, and medical professionals will gain insight from the
information presented in this book.
Dr. Jaspreet S. Bains, MD
Department of Psychiatry
University of Pittsburgh Medical Center
(UPMC Altoona), Pennsylvania, U.S.A.
Foreword
Use of alcohol has existed in the society since the ancient period. Adverse effects
of alcohol use have been identified since last many decades and are debated by
health professionals, sociologists, economists, administrators, and psychologists.
In the last few decades, use of alcohol in the society has increased a lot despite
increasing awareness about its ill effects on health, and alcohol being a recognised
cause in a number of accidents. Alcohol consumption is rampant in certain parts
of our country, while some states have taken the route of legislation to ban it or
reduce the harm of its effects. Role of social workers, opinion makers, health
planners, researchers, health professionals and law reinforcement agencies is very
crucial to reduce the harms associated with alcohol
Persons consuming alcohol are at a higher risk of developing diseases due to its
direct toxic effects on different body systems, or indirectly through its effects
on one’s judgment leading to distorted functioning and accidents. Almost every
anatomical and physiological system is adversely affected by the consumption of
alcohol. Use of alcohol is also associated with nutritional deficiencies, leading
to its own adverse consequences. The gastro-intestinal system (including liver
and kidneys), central nervous system and cardio-vascular system are affected
directly, as alcohol has direct toxic effects on these system. Use of alcohol is also
associated with impaired decision making, cognitive deterioration, absenteeism,
unemployment, a range of psychiatric disorders including depression, adjustment
disorders, amnesic disorder, Wenicke encephalopathy, and dementia, and also
increased risk of suicide. It is also a common cause of domestic violence, marital
discord and many road traffic and industrial accidents.
There is a need to create awareness about the ill effects of alcohol in the society
and motivating the alcohol users to stop it. Persons who want to leave it should be
offered all kinds of help and easy access to services offering such help
The book “Alcoholism Causes, Symptoms, Effects and Treatment” edited by VK
Shanwal and BS Chhikara gives a multidimensional view about alcoholism, as
seen by professionals from a range of disciplines The book covers topics like
factors leading to alcohol use disorders, its adverse effects, prohibition policy,
x Foreword
its association with crime and how a person with alcohol problem can be helped.
I commend the editors as well as the authors for their herculean effort and hope
that this book serves as an excellent resource material for the persons interested in
knowing causation, and adverse social and health effects of alcohol.
Dr. Rakesh K Chadda
Professor & Head
Department of Psychiatry and
Chief, National Drug Dependence Treatment Centre
All India Institute of Medical Sciences
New Delhi 110029
Preface
Alcoholism leads to physical, mental, psychological and social degradation of an
individual. An alcoholic person is not only an economic burden on the family
but also a source of continuous psychological strain which leads to disruption
in mutual relationships with family and friends. Remedy to such a problem lies
in combining together psychotherapies, medical care and de-addiction efforts
of family and friends. Research on multi-dimensional aspects of alcoholism
problems is intended in the chapters for a comprehensive solution to the problem.
The chapters cover a wide range of topics on the theme of Alcoholism starting
from health risks involved to the remedial measures available in medical as well
as psychological fields.
Alcoholism may have many causes and people with certain personalities are more
prone to it. Factors such as genetics, childhood influences, antisocial behavior,
and personality traits also contribute towards menace of alcoholism in individuals.
Personality traits like extroversion, neuroticism, conscientiousness, agreeableness
and openness to experience influence the addiction in individuals. Cultural values
and beliefs, and childhood experiences to govern thought process are indirectly
related to earlier stages of alcohol addiction. Family history and life stress have
implications on individual/s susceptibility to alcohol addiction.
Alcoholism not only affects the health of the addicted person but also relationship
with the family members. Chronic intake of alcohol may have varied impact on
the parenting, marital relationship, social image, communication and cohesion.
The family may react to alcoholism differently depending upon the stage/phase
of the drinking behavior; subsequently resulting in disruption of normal family
routine and functions. Family cohesion also has a role to play in the diverse
response towards the addicted person, greater cohesion within the family helps
in prevention of addiction problems. Non-cohesion and over-cohesion both result
in addiction cases. Similarly, communication within a family is also important in
dealing with the addicted person.
The effects of alcoholism on the brain, is a study of the adverse effects of ethanol
or “ethyl alcohol” on brain functioning and development. The sedative and
depressant effects of ethanol results in the damaging of CNS and also may lead to
xii Preface
malfunctioning of other vital organs. Alcohol influences neurotransmitter system
in the brain, memory of the addicted person, behavior etc. Although the amount of
damage depend on a variety of factors like age, gender, quantity of consumption
and drinking pattern, alcoholism is a serious health risk not only for the brain but
also for liver, respiratory system and psychological condition of the individual.
The Nutritional Deficiencies associated with Alcoholism explores the consequences
of alcoholism that may lead to nutritional deficiencies and subsequently diseases.
Lack of vitamins A,D,C,E and K lead to diseases like night blindness, softening of
bones, delayed blood clotting thereby posing serious health risks for individuals
addicted to alcohol. Chronic alcohol consumption results in Alcoholic Liver
Diseases (ALD) like Cirrhosis, Alcoholic Hepatitis and Steatosis, and other serious
health problems such as Alzheimer’s disease, Hematological complications,
Pancreatic problems, Sexual dysfunction and Infertility etc. Alcohol thus, has a
very serious effect on the overall health of the addicted person.
The treatment of alcoholism involves different therapies besides medicines for
comprehensive and smooth recovery of the person. The body psychotherapies
deal with mind and body coordinated therapy covering different de-addiction
techniques/processes available to combat the habit of alcoholism. Since this
therapy involves combining of body and mind aspects in the healing process,
the body-psychotherapies like Bio-energetic Analysis, Mindfulness, Hakomi
and Rebirthing are explored and evaluated as possible alternatives in treating
addiction. However, certain issues like expertise in such techniques, ethical issues,
and adequate information about the addicted person should be kept in mind while
using body-psychotherapies.
Prolonged use of alcohol increases the risks of Chronic Liver Disease, Fatty liver
disease, Fibrosis, Cirrhosis, Alcoholic hepatitis etc. The liver aids in digestion
of food, absorption of nutrients and detoxification, the probiotics meant for liver
health might work as alternative therapy for alcoholism. Probiotics helps in
intestinal immunity and also in epithelial viability. These are also beneficial in
improving overall health and hence used as nutritional supplements. The damage
to liver can be minimized with the use of probiotics.
The de-addiction therapies have different mode of operation. The chemical drugs
might have side effect on patients, so the alternative medicines play a major role
in de-addiction of an alcoholic without inducing side effects. The alternative
medicines, mainly the herbs based Ayurvedic medicines, are highly useful in
alcohol de-addiction therapies. Various herbs available in nature help in recovering
the functioning of brain, nervous system, liver, digestive system and overall body
health. Combination and controlled application of selected herbs help in complete
recovery of the alcoholic patient. The different herbal drugs, formulations and
Preface xiii
combinations have varied impact on the body, so alternative therapy (Ayurveda
and Herbal) should be followed in guidance of experts in field.
Psychopharmacotherapy is meant to develop strong psychological confidence
along with treatment with drugs and when adopted it reflects positive results
in psychosocial behaviour along with anticraving relapse maintenance. The
Pharmacotherapy could be more effective in multimodal approach including
psychological and social support. The section on Psychopharmacotherapy is
a narration about many brain neurotransmitter systems (CNS) activities with
various phases of addiction currently being used for pharmacotherapies and
psychopharmacotherapies along with co-morbid disorders for treatment of
alcoholism.
The management of alcohol and drug abuse go hand in hand with pharmacological
and psychosocial approaches of the treatment. In the treatment of alcoholic
person, the pharmacological (drug supplements) and psychosocial support (self-
determination and family support) remain complementary to each other, and the
best results have generally been obtained by a combined approach involving both
approaches.
In overall, the culture, social norms and portrayal of norms impact the prevalence
or cessation of alcoholism in particular place, state, nation. Heavy drinking
impacts the vital organs of body particularly the liver. The therapies for alcoholism
are wide, and comprehensive results are obtained with combined use of selected
therapies. Alternative therapies might prove beneficial in complete recovering of
addicted person.
Editors
Epilogue
To be or not to be an alcoholic?
Alcohol. There cannot be a better anachronism to describe the vagaries of nature
of mankind as well as the laws of Nature!
Taboo. So say the Puritanists of society. Their viewpoint is justified forever because
intake of alcohol is universally acknowledged as being the prime causative factor
for all acts of crime. All criminal jurisprudence supports this truism of life.
Right. A right to liberate oneself with an innocuous exercise of intake of alcohol.
So say the ones that enjoy this elixir of life. Undoubtedly so. A harmless time pass.
As long as one consumes in one's own hearth or homestead. In moderate quantities
a tonic to relax the nerves - as we all want to believe!
Break of harmony - at home and the entire neighbourhood. Here commences
the concern of all right-thinking leaders of the World. Be they physicians, social
activists, law-makers, makers and marketers of alcoholic beverages of all types,
forms, brands...
Policy of any modern government to prohibit the sale of liquor in public places has
been found to be ridden with holes, a dime a dozen.
To begin with, a certain State in the south of India has a tradition of offering
freebies to poor electorate come election season. It was estimated to cost the
exchequer a whopping twenty eight thousand crores of rupees! But, the clever
ruler sourced this huge sum from an earning of thirty thousand crores of rupees
through sale of alcohol by the State run outlets (including licensing system)! So,
at the end of it all, there was still a savings of two thousand crores of rupees in the
State kitty!!
Social studies reveal that it is the poor people who resort to alcohol and cheap
liquor as a means of battling life's many challenges. The rich in any case enjoy
their wine, liqueurs and consumption of any substance by them does not matter to
pundits of economics, sociology or politics.
Having said this, it is pertinent to note that decadence of an individual starts when
he turns an addict of alcohol. What was once a means to relaxation or 'social'
xvi Epilogue
habit soon gives way to the monsters inhabiting the being of the regular consumer.
Thoughts gallop as race horses in the course but, all benumbed, bodily form turns
as good as a corpse. Nervous wrecks emerge out of a lively being. Sensory organs
go for a walk & no command of the brain is translated by an inebriated person! In
short, a walking dead emerges from the one enslaved to the habit!
So arises the question: can society or a government, police the habitual drunkards?
Yes. Should- to check rise of crime rate. No. It is more of civic sense for both
individuals of the community as well as the society as a whole which ought to self-
regulate this strange addiction which only terminates real life activity. However,
a comprehensive look must be had at the whole gamut of the alcoholism, alcohol-
abuse, alcohol-driven lifestyle of modern day world around us.
Not fully in jest is it often said that an alcoholic is one who drinks more than his
doctor!
Or, that fractures used to heal, even when there were no orthopaedic surgeons!
But, hindsight is a perfect science, so to speak. Hence, let us analyse the need to
banish alcoholism from the lives of youngsters and future generations. For the
good of society and for good of each and every human being.
Utopian ?
Yes. But, very essential.
It is not just societal problems that emanate from alcoholism but physical
impairment of the consumer is bound to occur.
What is the use of existence? - ask the depressed people. They use this as a slogan
to indulge in uninhibited, unrestricted, uncontrollable consumption of alcohol and
indeed, they turn deadwood or live corpses, and life becomes wasted. A vegetative
existence is the beginning of fall of all mankind. Unless there is growth, activity,
development of the personality and society cumulatively, an insect's life appears
to have greater purpose, meaning and interest for the Universe!
So, an ecosystem or the lifestyle adopted by each of us in the society of beasts,
humans and trees determines the intolerance, acceptance or addiction to alcohol as
a style statement of one's mental, economic & social quotient! .
The vulnerable, jobless and curious youngsters become victims of marketing
wizards' bombardment of the fashionable page-3 cocktail circuit which is
dubiously dubbed and propagated as ' up & flying' indication of success.
The horrendous tales of destruction and degenerated mindsets haunt families,
generations and communities - worldwide!
Recovering from downslide is next to impossible. So, beware!
Epilogue xvii
Even those who are addicted and enslaved to alcohol abuse often are heard to
dissuade others in the society from falling prey to the ‘bug of peg’!
A singular measure which can be taken by all of the society and the whole of the
world is to ban prominent adverts with promiscuous looking images goading upon
all to squander their wealth and often hard earned money on alcoholic beverages.
After all, no one can stop you from taking the plunge into an evening or day
of drinking splurge if you choose to, not to forget making a special mention of
the drunken brawls that are often end-result of such uninhibited sessions. Daily
bouts are but bound to result in criminal behaviour or premature death due to liver
Cirrhosis and similar terminal conditions of health...
Such a regulation must be prescribed by every local government and one cannot
await nor expect a 'western' World Health Organisation to dictate the good advice
to the comity of nations across the globe.
Even more importantly, the State must impose heavy taxation on all activities
related to alcohol, not just consumption.
This will act as a double-edged weapon: on one hand, it will fetch greater revenue
for public welfare activities and on the other hand, this will help reduce the number
of wanton consumers off this tantalising substance.
Reams and reams of paper have been utilised to drive better sense among
populations of the country and in other parts of the world - both about the perils of
drinking alcohol as a habit and multiple jeopardy which every consumer is facing.
Many others have cried hoarse about spurious liquor and adulteration becoming
an industry whenever prohibition policy takes shape.
There are little vociferous brigades who cite mythological names as Bacchus,
Shiva & the wine dispensed as 'prasadam' in Catholic Churches after mass prayers!
Little do the dangers evaporate with such arguments of support to one's habits.
Hard core alcoholics soon convert into dipsomaniacs. Their existence revolves
around the bottle, literally speaking. Medicinal effects vanish. Side effects
adversely affect the bodily form. Firmness of grip and solidity of thought process
gets diminished and the person soon turns into a puppet of the drops!
Violence soon forms a part of the psyche - both to the one deprived of alcohol
and the ones who drown & drench themselves into alcohol in their waking hours.
This permeates even in drawing rooms, bedrooms, not to speak of streets and
only bedlam results. All is hell. Life becomes hell. Not just for the victim of this
habit but to all those near & dear ones- be it parents, spouse, children, relatives,
neighbouring people and total strangers!
Banal. Cannot ban it. Abandon it.
xviii Epilogue
A perennial solution can only come from one's strength of character. This often is
molded by one's religion, faith and upbringing.
Prescription and restrictions imposed by religious orders are seldom followed
religiously even by the self-professed devout. So, is it destiny, karmic causes or is
it absolutely a matter of one's decision to keep the tryst with destiny?
This is the signature tune of this universal document. Must one fall prey to an age-
old habit? Or, should one stand strong, be confident and turn a Nelson's eye to this
endangering if enticingly 'cool' habit?
The choice and answer determines your autobiography...
There are cultures where best of business moguls and preachers enjoy their drinks
upon sunset but are up and fresh by sunrise to address a new fresh day's tasks in
full senses. These are few & far – the people who enforce discipline even in such
a cultivated or inherited habit.
And, then there are many more sane ones who indulge in buttermilk, curds and
fresh fruit juices or simply water to thank the night for relieving them of a day's
burden. They are otherwise as free thinking in mind and agile in bodily actions,
day in & day out.
Sad is the case of those who fall prey and seek to indoctrinate rest of world into
their Dracula like mission. They fall soon as dried leaves do, off a treetop !
It would not be out of place to present the fragile argument of those new breed
of young Turks in business & profession who wail that unless social drinking is
indulged in, they would lose out. To these folks, I say,' No, not at all. For, I have
worked long hours and won largest of cases even of royal dynasties that forsake
their cup of joy whenever an appointment with this lawyer was in place. You set
the style of your work space. Do not succumb!’.
The long and short of it all, dear readers, is that alcoholism is a key determinant
of your life: would you like to help it cut short your productive life or counter the
itch & bug to clink glasses, for a happy, peaceful, long lifespan ?
To not fall prey, would enhance both the quality and term of one's lifetime...
– Pamarty Venkataramana
An Eminent Jurist & Poet from New Delhi, India
1
Is it the Personality or the
Alcohol that Makes one an
Addict?
Karishma*, Nisha Phakey* and Krishan Kumar*
Abstract
Alcohol is the most commonly abused substance creating serious
medical, social & psychological problems. It exerts a toll on
world health on a par with unsafe sex, measles and malaria and
greater than tobaccos a total of more than three of quarters of
a millions of deaths in 1990 was related to alcohol and 80% of
it occurred in developing countries. It has been reported that
alcohol was responsible for 6,34,800 deaths, 14.6 million years
of life lost and 32.3 million disability adjusted years of life lost in
1998. The latter measure includes estimates of the impact of non-
fatal alcohol caused injury and illness on general quality of life.
Prevalence of alcohol problem varies across different cultural
and social settings. Macro cultural influences values, beliefs and
social role functions, local economy, customs and dietary habits,
rapid social change and cultural stress do shape and dictate the
way alcohol is used in human societies. There is strong evidence
of several sorts for genetic predisposition, personality factors
and learning to alcoholism. Here, in this chapter we are trying
* Institute of Mental Health, Pt. BD Sharma University of Health Sciences, Rohtak 124001.
India.
