What Is Alcohol Addiction & Why Makes Us Drunk?

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As Homer once said, this infamous molecule is both “the cause of, and the solution to, all of life’s problems”.

OK, it was Homer Simpson who said that rather than the classical bard, but it’s no less true or profound for that. Sometimes, the rubbish you come out with when you’re drunk really is quite clever, or funny, or both, so long as you can remember it properly the next morning.

Our ambiguous relationship with alcohol is older than civilisation – in fact there’s a strong argument that it was the cause of civilisation itself. We’ve been drinking it since our dawn as a species, and it probably helped us evolve into humans in the first place. It may even have played a role in the very creation of life on earth. No, I’m not drunk. This is proper science.

For all that time, alcohol has been, as Simpson said so beautifully, both a cause of great pleasure and, for a minority, colossal pain. Our relationship as a society with alcohol swings on a pendulum over time between celebrating the positives and deploring the negatives, and right now we’re over on the temperance side. Between 1785 and 1985, The Times used the term “binge drinking” a total of 49 times. The same paper ran over 300 stories about binge drinking in 2004 alone. Which is odd, because people were drinking much less in 2004 than their ancestors had been at pretty much any point in the preceding two centuries.

This means we live in an age of alarmist misinformation about the perils of booze, with a growing belief that any level of consumption of this “poison” is potentially harmful. If there were any truth to this claim, given the quantities we used to drink in the past, the human race would have been extinct long ago.

So what does alcohol really do to us? And how does it do it? The truth is, neuroscientists are still in the process of figuring this out. To a significant degree, it depends on who you are, what your relationship with alcohol is, what and how you’re drinking, and also, ultimately, what you mean by “drunk”.

Let’s look at the physiological effects first. The active component in booze is ethanol, which as molecules go, has all the sly charm of one of those beery lads who can worm his way past the velvet ropes of any bar in the world. Water soluble and small enough to pass through and between cell walls, ethanol is drawn first to the liver, which immediately begins to break it down. But the liver only works so fast, so surplus ethanol shoots on through to every part of the body and ends up in the brain within minutes. It does all sorts of stuff to our digestive system, our motor functions, our need to pee and much more, but it’s the feeling of drunkenness that fascinates us.

Information and instructions are carried around the brain by neurons – excitable cells that carry data. Neurons don’t touch, but communicate across tiny gaps known as synapses, using chemicals known as neurotransmitters. Simplistically, these fall into two types: “excitatory impulses”, which tell us to do stuff and are carried by glutamate, and “inhibitory signals” which tell us to do less, and travel via gamma-aminobutyric acid, or Gaba. Trillions of these signals are happening all the time, and their net effect is the mind itself, and our sense (some would say illusion) of consciousness.

Ethanol gleefully speeds into the synapses, cascading into the gaps between the neurons, and then sidles up to them, puts its arms around their shoulders and assures them it’s their best mate in the whole world. You might be suspicious if a stranger did this to you in a pub unless you were already gattered, but your neurons totally believe the ethanol molecules, and scientists still don’t really know why.

When it binds to glutamate, ethanol slows it down and stops it from acting, like the pub bore who pins you in the corner and gives you an episode-by-episode recap of Game of Thrones even though you keep saying yes, you’ve seen it, and you really have to go because you just remembered you left the babysitter in the oven. But it behaves quite differently with the depressive Gaba, basically convincing it to switch to shots, grab a kebab and then go on to a club and do Jägerbombs.

A reveller stops to help her friend after leaving a bar in Bristol City Centre on October 15, 2005 in Bristol, England
‘Loss of motor function, memory loss, nausea and so on often only kick in at high blood alcohol concentrations.’ Photograph: Matt Cardy/Getty Images

This double-bind effect – dulling the active signals and amplifying the sedative ones – is what we really mean when we say alcohol is a depressant: it doesn’t make you depressed – at least not at low levels – but it slows down and depresses your active functions, making the brain slower and more sedate and, given enough time and reinforcements, can accelerate the process until you pass out, or in very extreme cases, forget to breathe. But at the same time, ethanol also jacks up the release of dopamine, exciting the part of the brain that perceives reward. Your brain tells you this reward is related to the ethanol you consumed, so you consume more, depressing your brain function while increasing your sense of euphoria.

Loss of motor function, memory loss, nausea and so on often only kick in at high blood alcohol concentrations. The vast majority of drinking is more moderate, and here, perceptions of tipsiness are not as straightforward as simple brain chemistry. From the 1970s onwards, psychologist Alan Marlatt developed a series of experiments where the taste of a placebo was indistinguishable from that of an alcoholic drink. He gave the placebo to half the subjects and alcohol to the other half. But then he cut the group in half the other way too, telling half they were drinking alcohol and half they were not. So, you had people expecting alcohol and getting it, people expecting alcohol and not getting it, and vice versa with those not expecting alcohol.

Consistently, those who believed they were drinking alcohol – whether they actually were or not – showed signs of intoxication including flushed faces, more animated behaviour and slurring of speech. Those who thought they were not drinking alcohol – even alcoholics, in some of the experiments – did not. Marlatt also showed that the perceived effects of intoxication were far more pronounced in social situations than when subjects were drinking alone.

Why does alcohol make us drunk? When you look at the history of our relationship with it in light of Marlatt’s research, the smart-ass, know-it-all-on-the-bar-stool answer has to be: “Because we want it to.”

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States Ease More Restrictions To Physician Assistants As Team Care Takes Hold

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More states are lifting restrictions and regulatory hurdles to allow physician assistants to work more “collaboratively” with physicians as the team-based approach to healthcare takes hold.

Historically, states have required physicians to more closely monitor physician assistants (PAs) in what some have said led to redundant tasks or slowed the ability of patients to get the care they needed in a timely fashion.

But physician assistants — like nurse practitioners — are successfully convincing lawmakers and governors to break down regulatory hurdles to their patients for a variety of reasons, including the physician shortage and general comfort U.S. patients have with being treated by someone other than a doctor. Such changes to regulations, or scope of practice laws, are the result of state legislative sessions that are just wrapping up this spring.

In New Mexico and Tennessee, for example, new changes to regulations involve replacing the phrase “supervision” with “collaboration” to define how physicians and PAs work together, according to a legislative update from the American Academy of PAs.

And in Washington D.C., regulations now allow scope of practice to be determined in the doctor’s practice, following a general trend of the last decade when nine states changed laws or regulations to allow scope of practice to be determined at the practice. In all, 38 states and the District of Columbia allow PA scope of practice to be determined at the practice site .

PAs and lawmakers passing such legislation say they are essentially granting physician assistants the ability to do what they are trained to do. Most have a two-year master’s degree, often from a program that runs about two years and includes three years of healthcare training.

“The PA profession has really reached a pivotal moment in its history,” American Academy of PAs CEO Jenna Dorn . “As PAs continue to play an increasing role in healthcare, states across the country are recognizing that breaking down barriers to PA-practice is simply the common sense thing to do.”

Changes to scope of practice for physician assistants is also happening thanks to the move from fee-for-service medicine to value-based care, which emphasizes getting care in the right place, in the right amount and at the right time.

Under the team-based approach to healthcare delivery, physician assistants are increasingly an integral part of accountable care organizations (ACOs) and other care models that contract with insurers, Medicare and Medicaid programs. The ACO shares in money that is saved from the costs of keeping a population of patients healthy.

Major insurers including Aetna, Anthem, Cigna, Humana and UnitedHealth Group are paying the bulk of the medical care providers they work with via value-based models.

PAs work in doctor’s offices, retail clinics and other locations and their work includes diagnosing illnesses, writing prescriptions and counseling patients on preventive care. There are now more than 40 states that have implemented “full prescriptive authority” for PAs with the addition in the last year of Maine and Florida.

This year, there were “16 states that have made improvements to PA practice,” the Academy said in a statement.

In many cases, state rules date back to a time when there were few PAs and patients got their care mostly from a physician. Today there are more than 115,000 PAs compared to 20,000 in 1990. “We look forward to supporting our state chapters as they work on behalf of PAs to ensure they are prepared to meet the needs of patients across the country,” Dorn said.

, I write about healthcare business and policy

For more information on healthcare, read Bruce Japsen’s book, Inside Obamacare: From Barack And Michelle To The Affordable Care Act.

These Everyday ‘Drugs’ Cause More Harm Than the Illegal Ones, Study Says

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Worldwide, alcohol and tobacco cause much more death, disability and addiction than illegal drugs, according to a new review.

The review analyzed data from 2015 on global drug use — both overall and in 21 different regions — using data from the World Health Organization, the United Nations Office on Drugs and Crime, and the Institute for Health Metrics and Evaluation, as well as other sources. The researchers examined both the prevalence of drug use as well as the “health burden,” in the form of death and disability tied to drugs.

The researchers found that, worldwide, an estimated 18 percent of people reported “heavy” alcohol use in the last month (heavy use corresponds to more than 60 grams of alcohol, or about four standard drinks, on one occasion). In addition, 15 percent reported daily tobacco smoking, 3.8 percent reported marijuana use in the past year, 0.77 percent reported amphetamine use in the past year, 0.37 percent reported non-medical opioid use in the past year and 0.35 percent reported cocaine use in the past year.

Some of the highest levels of alcohol consumption were in Central, Eastern and Western Europe, where the per-capita consumption was 11 to 12 liters (about 3 gallons) of pure alcohol a year, compared with about 6 liters (1.5 gallons) a year per capita worldwide. These regions also had the highest levels of daily tobacco smoking, with around 21 to 24 percent of those populations reporting daily smoking, according to the review. [Here’s How Much Alcohol Is OK to Drink in 19 Countries]

Regarding addiction, an estimated 63 million people worldwide were dependent on alcohol in 2015, with about 843 cases of  alcohol dependence per 100,000 people. For comparison, about 20 million people were dependent on marijuana (260 cases per 100,000 people) and 17 million were dependent on opioids (220 cases per 100,000 people) in 2015.

However, the rates of marijuana and opioid dependence were almost threefold higher in the United States and Canada (a region called “high-income North America” in the report) than in the rest of the world, with an estimated 749 cases of marijuana dependence and 650 cases of opioid dependence per 100,000 people.

Tobacco smoking was tied to the greatest rate of death. For every 100,000 deaths in 2015, 110 were tied to tobacco, while just 33 were related to alcohol and seven to illegal drug use.

The researchers also calculated how many years of life were lost by people who died from drug use, or who were living with disability from drug use (which together were called “disability-adjusted life years,” or DALYs). They found that tobacco smoking cost the human population 171 million DALYs, compared with 85 million DALYs for alcohol and 28 million DALYs for illegal drug use.

“Alcohol use and tobacco smoking are far more prevalent than illicit substance use, globally and in most regions,” the researchers wrote in the May 11 issue of the journal Addiction.

And tobacco smoking accounted for most of the health burden due to drugs, they said. Still, the health toll of illegal drugs may be underestimated because available data on these drugs is limited.

For example, some countries and regions (including Africa, the Caribbean, Latin America and Asia) have little or no data on substance use and its associated health burden, the researchers said.

“Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately” the disease burden from substance use worldwide,” the researchers said.