Alcohol is found in most social gatherings, and is a popular nutrient that is consumed in many parts of the world. 1 The alcoholic beverages that people drink contain the alcohol, ethanol. The major problems that it is causing due to alcohol consumption are becoming prevalent all over the world. 2-4 In this assignment, I am going to investigate and describe the physiological effects of alcohol consumption in the body, the social and physical problems that can arise from binge drinking, and the key aspects of doctor/patient communication when dealing with a sixteen year old female binge drinker.
2. Effects of Excessive Consumption
This section will cover both the physical (structural) and physiological (functional) problems linked with binge drinking. Although research shows that the consumption of alcohol in moderation, such as red wine, can be beneficial to one's health, 5 excessive drinking on a regular basis can cause a lot of chronic damage. Binge drinking is when one excessively drinks over a set period of time. The amount that is classified as binge drinking varies from individual to individual, due to sex, weight, metabolism rates and various other factors.
2.1 Physiological Effects
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One of the most common diseases that are acquired from excess alcohol consumption is liver damage. This is because as ethanol cannot be excreted, it must be metabolised by the liver first. Ethanol can be metabolised in the liver by two pathways. 6 7 For one pathway, the liver must firstly oxidize the ethanol into acetaldehyde by the use of the enzyme, alcohol dehydrogenase (Figure 1), 7 which takes place in the cytoplasm of the hepatocytes. In the second step, the acetaldehyde is oxidized to acetate by aldehyde dehydrogenase, which takes place in the mitochondria of the hepatocytes (Figure 2). 7 As you can see from the two figures, the metabolism of ethanol leads to an accumulation of NADH. This high concentration stops the oxidation of lactate to pyruvate in the Cori cycle (Figure 3), 8 as gluconeogenesis is inhibited. In fact, the high concentration of NADH will cause the reverse reaction to predominate, and lactate will accumulate. The consequences may be hypoglycemia and lactic acidosis. 7 9 10 The NADH glut also inhibits fatty acid oxidation. 7 The metabolic purpose of fatty acid oxidation is to generate NADH for ATP generation by oxidative phosphorylation, but an alcohol consumer's NADH needs are met by ethanol metabolism. 7 In fact, the excess NADH signals that conditions are right for fatty acid synthesis. Hence, triacylglycerols accumulate in the liver, leading to a condition known as "fatty liver". 7 11
The other way that ethanol can be metabolised is the ethanolinducible microsomal ethanol-oxidizing system (MEOS). 6 7 Because it uses oxygen, this pathway generates free radicals that damage tissues. Moreover, because the system consumes NADPH, the antioxidant glutathione cannot be regenerated, exacerbating the oxidative stress. 7 Liver damage from excessive ethanol consumption occurs in three stages. The first stage is the aforementioned development of fatty liver. 7 If you have a fatty liver and continue to drink, you have up to a one in three chance of getting alcoholic hepatitis. 12 This means the liver has become inflamed and, in its extreme form, can be fatal. Around 10% of people with alcoholic hepatitis will develop a permanently scarred and damaged liver, known as cirrhosis. The more you drink the more likely you are to develop cirrhosis. 13 Cirrhosis, caused by thickening of the normal tissue, causes progressive damage and impaired function of the liver. There are numerous causes including viruses, obesity or genetic problems - but excess alcohol is the main culprit. 14
The effect of alcohol on different organs of the body is not the same; in some people the liver is affected, in others the brain or muscle. The differences may be genetically determined. 3 4 The acute depressive effects and addiction produced by alcohol are hypothesized to be related to fluidization of membrane phospholipids and altered signal transduction.15 Alcohol is a very small molecule and is soluble in "lipid" and water solutions. Because of these properties, alcohol gets into the bloodstream very easily and also crosses the blood brain barrier. Some of the neurochemical effects of alcohol are: increased turnover of norepinephrine and dopamine; decreased transmission in acetylcholine systems; increased transmission in GABA systems; and increased production of beta-endorphin in the hypothalamus. 16
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Severe myopathy with muscle pain, necrosis and myoglobinuria occurs in acute alcoholic excess. 17 A similar syndrome occurs in daimorphine and amphetamine addicts. A subacute proximal myopathy occurs with chronic alcohol abuse.17
2.2 Physical Effects
Physical effects of alcohol can range from annoying to life-threatening.18 The short term effects of alcohol consumption not only have consequences for the drinker, but can impact those around him or her as well. For example, the physical effects of alcohol can be experienced with only one or two drinks, and impaired judgment and coordination needed to safely operate a car can result in the drinker having an accident.18 Here are seven of the short term effects of alcohol consumption:
1. Reduced Inhibitions - consuming alcohol changes behaviour. At a blood alcohol level of 0.05, the drinker's behaviour begins to change and be noticeable. Physical effects of alcohol and reduced inhibitions can mean the drinker becomes more likely to engage in activities they would otherwise not participate in like sexual activity, continued drinking, drinking and driving or illegal drug use.18
2. Loss of Muscle Control - at the level of 0.10, slurred speech will likely be one of the physical effects of alcohol. Impaired judgement and poor coordination are short term effects of alcohol abuse that can lead to falls and accidents.18
3. Memory Loss and/or Blackouts - since alcohol depresses the brain's control mechanisms, as blood alcohol levels increase, periods of time and certain situations and events may not be remembered afterward.18
4. Nausea, Vomiting - excessive alcohol consumption can result in the body attempting to protect itself by getting rid of the alcohol. Also, alcohol adversely affecting a person's sense of balance and orientation can lead to a feeling of nausea.18
5. Headaches, Hangovers - these short term effects of alcohol can be felt a few hours after consuming alcohol. Hangovers are partially due to the body becoming dehydrated due to alcohol consumption.18
6. Stupor - at a blood alcohol concentration of 0.40, a person can hardly function, acting seriously disoriented and confused.18
7. Coma - at a blood alcohol level of 0.50, a person is at risk for coma, a life-threatening condition. And at this level or higher, respiratory paralysis and death become very much a possibility.18
2.3 Social Effects
You are more likely to find yourself in dangerous situations if you have been drinking a lot, as alcohol affects your judgment and you may do things you would not consider doing when sober. For example, a recent report showed that a quarter of all young prisoners had been drinking when they committed their crime. 19 When misusing alcohol the following effects are likely to occur:
- Increased family tension;
- Increased levels of quarrelling and violence;
- Destabilised relationships.
- Partners may become anxious, depressed, socially withdrawn and may drink excessively themselves;
- Detrimental effects on the children leading to behavioural problems and underperformance at school;
- Increased rates of divorce. 20
In terms of work, there may be deterioration in performance, conflict with colleagues, an increase in workplace accidents and a worsening attendance record. This is likely to result in repeated dismissals ultimately leading to long-term unemployment.20
Excessive drinking is associated with crimes that include petty theft, driving offences, fraud, sexual offences and crimes of violence.20 Social effects of alcohol misuse that may indicate moderate disability include:
- Social isolation.
- Contact with other people is confined to other drinkers.
- Legal problems such as theft and crimes of violence.
Other high-risk behaviour associated with heavy alcohol consumption is:
- casual and unprotected sex, which can lead to unplanned pregnancy or sexually transmitted infection,
- fights and arguments,
- accidents at home and on the road.19,20
The longer a person abuses alcohol over time, the higher the chances of long-term physical effects of alcohol being experienced and alcohol dependency developing. The most severe form of alcoholism is called 'alcohol dependency'. Alcohol dependency can include an increased tolerance to the short term effects of alcohol, withdrawal symptoms when alcohol consumption is interrupted and by alcohol-related illnesses and diseases.18
3. The Key Aspects of Doctor/Patient Communication
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In the UK, the legal age of presumed competence to consent to treatment is 16. Below this age, those with parental responsibility are the legal proxies of their children and usually consent to treatment on their behalf.17 Although the minor is 16, doctors must also consider parents and others close to them; but their patient must be the doctors first concern. 21 A doctor should encourage young people to involve their parents in making important decisions, but you should usually abide by any decision they have the capacity to make themselves.21 You should also consider involving other members of the multi-disciplinary team, an independent advocate or a named or designated doctor for child protection if their involvement would help young people in making desicions.21
Relationships based on openness, trust and good communication will enable you to work in partnership with your patients to address their individual needs.22 A doctor must safeguard and protect the health and well-being of children and young people. They should also offer assistance to children and young people if you have reason to think that their rights have been abused or denied.22 When communicating with a child or young person you must:
- Treat them with respect and listen to their views
- Answer their questions to the best of your ability
- Provide information in a way they can understand
When dealing with this particular patient, the doctor should try and get to the root of the problem (the binge drinking) by approaching questions such as why and how. The doctor should also find out if the binge drinking is occasional, chronic, or even binging at all. The doctor must also make sure that there is no other risk taking involved that could be linked to binge drinking, such as drugs, abuse or sexual activity. If the patient was pregnant, then the doctor would have to take the welfare of the baby into account, as foetal alcohol syndrome could become a possibility.
The doctor should then have a diagnosis for the patient after bringing together all the evidence he or she has gathered from observations and conversing with the patient. They should then come up with a care plan and evaluation for the patient if the doctor decides that the patient is at risk. The doctor should then ask the patient to attend a follow-up consultation to see if the patient is following the care plan and getting better.
Effective communication between doctors and young people is essential to the provision of good care.21 A doctor should find out what young people and their parents want and need to know, what issues are important to them, and what opinions or fears they have about their health or treatment.21
Alcohol is something that we will come across quite often in our lives. If consumed responsibly and in moderation, it can be something that is enjoyed, and has also been proven to cause benefits to one's health. However, when consumed recklessly and with a lack of respect to the problems it can cause, it can be harmful, and the damage that it can cause to the body may be chronic. Doctors should be aware of these problems and should know how to approach the issues that they come across, so that they can relate to the patient who may be suffering and deal with them appropriately.