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Alcohol – A Health Malefactor

Many people consider alcohol as a social drink because its associated with parties, relaxation and adventures. Since the dawn of civilization, mankind has been aware of the benefits and harms of alcohol. Today, for some alcohol is part of an everyday complete meal. Because evidence has proven alcohol a health benefactor when consumed moderately, some people tend to consume more than their body needs, which turns it into an insidious substance. While the health benefits of alcohol are being promoted since it prevents coronary heart disease and stimulates the circulatory system when consumed moderately, those benefits should not be encouraged because not only does alcohol increase the risk factors of many internal organs, it aggravates many environmental problems.

Alcohol consumption has been part of many cultures. Before the European colonization, the native population of the territory that would eventually become the United States used to produce weak beers or other fermented. In the past, alcohol was used as a trading medium, often bartered for highly sought-after animal skins and other natural resources such as indigo. During the colonial era, however, not only was alcohol used for medicinal purposes, it was also employed for religious ceremonies. For example, until the twentieth century, alcohol was the only painkiller generally available in western civilizations. In addition, alcohol was applied to help people recover their health and to reduce the risk of certain diseases including flu. Furthermore, liquor was associated with transcendental experiences and other cultural rituals that were purported to put people in contact with supernatural forces.

The peyote ritual is a prime example of these ceremonies. Peyote ritual is a sacrament intended to put one in communication with spiritual forces to instill harmony in ones life. The ritual follows a prescribed structure: it is composed of a leader called a Roadman who makes certain rules and regulations that are to be precisely followed. Finally, the Roadman uses a variety of sensory stimuli [including] cedar smoke and sprinkled water to prevent participants from drifting off into a disconnected state of conscientiousness. In fact, the peyote ritual is often used within Indian communities for the treatment of alcohol abuse.

Moderate consumption of alcohol lowers the risks for coronary heart disease. According to the United States Department of Agriculture and Human Services, moderate consumption is defined as no more than two drinks per day for men and no more than one drink per day for women. Ideally, a drink is defined as 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. In order for the cardio-vascular system to function properly, the tissue that constitutes the bulk of the heart requires frequent supplies of oxygen containing blood, which is delivered to the heart through the arteries. Cholesterol and other fatty substances can accumulate within the coronary arteries and ultimately block the flow of blood. Normally, this blood clotting condition is known as a CHD (coronary heart disease) attack. Alcohol plays a momentous role in facilitating the circulation of blood throughout the body. For example, alcohol prevents the formation of blood clots. In addition to cholesterol and other fatty substances impeding blood circulation, clotting also occurs from chemicals released into the blood through the arterial wall. Moreover, alcohol not only suppresses fibrin, the substance that promotes clotting, it produces certain substances that preclude the clotting process. Alcohol basically prevents the risk of CHD by eliminating most of the contributing factors.

In addition, alcohol consumption might play an important role in stimulating the cardio-vascular system. For example, laboratory research has demonstrated alcohols usage as a positive factor in preventing arterial narrowing in mice. Arterial narrowing in the human body occurs in the blood concentration of certain fatty substances that influence the deposition of cholesterol within the coronary arteries. In addition, alcohol may prevent the formation of clots within already narrowed arteries. For instance, analyses of blood samples of many individuals indicate that alcohol consumption increases blood levels of anti-clotting factors and decreases the stickiness of the platelets, the specialized blood cells that clump together to form clots. Other laboratory research suggests that alcohol might help protect against reperfusion injury, which is a form of blood flow to heart muscles weakened by lack of oxygen. Alcohol can be considered something of paramount importance since it enhances the cardio-vascular system.

In contrast, alcohol consumption has detrimental effects. It impairs bone development. To begin with, alcohol has some harmful effects on the two types of bone the human skeleton encompasses: cortical bone, which is dense and thick, forms the outer layer of bone and the shafts of the long bones of the arms and legs and cancellous bone, which is a porous meshwork of thin plates [which shape the vertebral column]. Alcohol is harmful for both types of bone although the most crucial effects occur in cancellous bone. Medically speaking, the process of skeletal growth and maturation involves three general phases: growth and modeling, consolidation and remodeling. Heavy alcohol consumption interferes with the growth-and-modeling phase by stopping the longitudinal growth rate and the rate of proliferation of bone. Moreover, usage of alcoholic beverages affects parathyroid, the hormone that regulates the calcium metabolism.

Overindulgence of alcohol causes adverse effects, particularly on women. For example, alcohol might indirectly affect bone through estrogen since the deficiency of such a hormone is a major contributing factor of osteoporosis. Over the last decade, many studies have shown an obtrusive relationship between the consumption of alcohol and bone loss. Specifically, a 1997 study conducted by a group of researchers showed that women aged sixty-five and older who were heavy alcohol consumers had an increased risk of vertebral deformity compared to moderate alcohol drinkers. Another study investigated the influence of moderate alcohol consumption on ovariectomized rats to imitate menopause. Subsequently, the rats that had their ovaries removed for the experimentation exhibited a diminished bone density and volume compared to nonovariectomized rats. Because fewer osteoblasts are found in the alcohol-fed animals, this finding leads to the conclusion that moderate alcohol consumption has no absolute health benefits since it inhibits bone quality.

Heavy alcohol consumption may lead to the necessity of liver transplantation. Because the liver is the largest organ in the body, it performs a variety on tasks, namely digesting, absorbing, and processing food. Moreover, the liver stores vitamins, synthesizes cholesterol, controls blood fluidity and regulates blood-clotting mechanisms. A liver disease is one of the most serious medical consequences of long-term alcohol consumption. In 1991, 25,000 Americans died mainly from liver cirrhosis, making it the elevenths nation leading killer. Another study demonstrates approximately one half of cirrhosis deaths have been ascribed to alcohol usage. Moreover, long-term alcohol consumption is the most prevalent single cause of illness and death from liver disease in the United States since the only possible cure is a liver-transplantation, which is a risky undertaking. In addition, the liver is so fragile that a single occurrence of heavy drinking is enough to dispose fat in the liver and may lead to alcoholic hepatitis, a severe inflammation of the liver characterized by nausea, weakness, pain, loss of appetite, weight loss and fever. Finally, alcoholic cirrhosis is the most advanced form of liver injury. The disease is characterized by progressive development of scar tissue that blocks the blood vessels and distorts the livers internal structure, impairing the liver’s function. Basically, liver disease compromises the body’s ability to perform multiple functions essential to life.

Furthermore, alcohol consumption can damage the nervous system. Because alcohol is a toxic substance, it can cause alcoholic and chronic drinkers to suffer from abnormalities in their mental functioning and changes in behaviors associated with brain impairment. Alcohol consumption can have direct or indirect effects in the neurological system, which makes it even more dangerous to consume casually or regularly. Over the past twenty-five years, images of the brain created with modern neurological techniques, such as Magnetic Resonance Imaging (MRI) and Computer Tormography (CT), generally show a [clear] relationship between prolonged alcohol consumption and changes in the brains structure. For example, MRI and CT results have shown brain shrinkage and brain lesions or tissue damage in some alcohol consumers.

In addition, alcohol has some adverse effects on many other neurological processes. While moderate alcohol consumption of alcohol lowers body temperature, severe intoxication in cold weather may lead to hypothermia, a massive, life-threatening decline in temperature. Moreover, alcohol usage can interfere with normal sleep patterns. Light consumption of alcohol can cause early sedation of sleepiness, awaking during the night and suppression of Rapid-Eye-Movement (REM). Psychologically speaking, REM is the dreaming state of sleep and when it occurs near wakefulness, it often produces vivid hallucinations. Another severe consequence of alcoholism is the Korsokoffs Syndrome (KS), a devastating memory disorder in which a person forgets the incidents throughout the course of his day or as they occur. Hence, because of this dramatic loss of short-term memory (also called anterograde amnesia), patients with KS virtually live in the past.

Not only is alcohol consumption detrimental for the user but for others in his path. Drunk driving is one of the nations leading killers. Over the past decade, drunk drivers have killed more than 42,000 people on a yearly basis. According to the Insurance Institute for Highway Safety, alcohol significantly increases the changes of fatal car accidents. In 1997, more than 17,000 Texans died mainly from drunk driving accidents. Another study of the same year shows more than 30 percent of driving fatalities involved alcohol consumption. Most shocking of all, teenage drivers represent less than 7 percent of the total population; however, the damage of teenage drunk drivers is more than 13 percent of motor vehicle deaths. In order to minimize driving fatalities, most states have now adopted the Zero Tolerance policy in compliance with the National Highway Systems Designation Act of 1995. Fortunately, with the new law in place, more than 17,000 lives are being saved every year.

In addition, alcohol plays a causal role in violence. Over the past forty years, many studies have shown a conspicuous relationship between alcohol consumption and violent events. According to these studies, alcohol is linked to one-half to two-thirds of homicides, in one-fourth to nearly one-half of serious assaults. In addition, alcohol consumption appears to be connected with sexual assault. For example, police reports have demonstrated 24 percent of a group of identified sexual offenders and 31 percent of their victims had been drinking. Moreover, although many people consume alcohol moderately and responsibly, studies show that a number of people drink to get drunk and therefore, their behaviors create some serious problems for people around them. For example, alcoholics and people who frequently binge drink usually have problems with friends, marriage, home-life, work and finances. Statistically speaking, 5 percent of drinkers reported that their drinking affected their finances. Furthermore, heavy drinking can have major social costs on society including lost of productivity in the workplace, family violence, which in most cases, leads to a divorce, accidental injuries and even death.

Although there are opposing viewpoints on the effects of alcohol, there is one factor on which researchers can agree: Heavy consumption of alcohol is harmful. From some researchers standpoint, moderate consumption of alcohol can also be harmful because it can interfere with the normal functioning of the liver, impede bone formation and most importantly inhibit the nervous system. Medically speaking, alcohol has no health benefits without negative externalities.

In summary, although some have found that moderate alcohol consumption has some benefits, the actual adverse impact that it has on society is far from being beneficial. In order to circumvent being affected by the deleterious chain-of-reaction that comes along drinking, society has to understand one fact: the best way to prevent something is never to start.

References

Alcohol and Coronary Heart Disease.

National Institute of Alcohol Abuse and Alcoholism. Oct. 1999. Sirs Researcher. 09 May 2001. http://sks.sirs.com.

Alcohols Harmful Effects on Bone.

Alcohol Health and Research World. 22 (Summer 1998). Health Reference Center Academic. 04 May 2001. [http://www.ccla.lib.fl.us].

Alcohol Use and Its Consequences.

Canadian Social Trend. Fall 1995. Sirs Researcher. 08 May 2001. http://sks.sirs.com.

American Indian and Alcohol.

Sirs Researcher. 22 (1998). National Institute on Alcohol Abuse and Alcoholism. 06 May 2001. http://sks.sirs.com.

Drunk Drivers Beware.

State Legislatures. November 1999. Sirs Knowledge Source. 07 May 2001. http://sks.sirs.com.

The Epidemiology of Alcohol-Related Interpersonal Violence.

National Institute on Alcohol Abuse. 16 (1992). Sirs Government Reporter. 08 May 2001. http://sks.sirs.com.

Hunter, Beatrice Trum.

Some Effects of Alcohol. Consumers Research Magazine. 82 (Mar. 1999). Academic Search Elite. 09 May 2001. [http://www.ccla.lib.fl.us].

Liver Transplantation for Alcoholics With Terminal Disease.

Alcohol Research and Health. Winter 1997. Sirs Researcher. 07 May 2001. http://sks.sirs.com.

New Benefits and Concerns about Alcohol. John Hopkins Medical Letter After 50. June 1997. Sirs Researcher. 04 May 2001. http://sks.sirs.com.

Oscar-Berman, Marlene et al.

Impairment of Brain and Behavior. National Institute on Alcohol Abuse and Alcoholism. 21 (1997). EBSCO Academic Search Elite. 03 May 2001. [http://www.ccla.lib.fl.us].

Alcohol’s Effects in the Brain

Alcohol can make you laugh or it can make you cry, it can make you lively or make you sleepy, it can boost your confidence or make you act the fool. How can alcohol have all these different effects on people? If we want to know how alcohol affects our moods and behaviors we must first understand a bit about how the brain works.

The human brain is made up of about 100 billion nerve cells (also known as neurons). Everything that we think, feel or do is the result of electrical signals passing back and forth between neurons. These electrical signals require the help of chemicals called neurotransmitters in order to pass from neuron to neuron. Scientists have identified around 60 different neurotransmitters so far and tell us that there are probably many more yet to be identified.

Different neurotransmitters have different effects in the brain. For example, serotonin is connected with mood. People suffering from clinical depression tend to have a shortage of serotonin in their brains, and medications like Prozac can help to alleviate depression by increasing the availability of serotonin in the brain. Endorphins are a class of neurotransmitters which act as the brain’s natural painkillers.

Electrical signals in the brain are transmitted in the following manner: The neuron which is sending the electrical signal releases a neurotransmitter, and the neuron which is receiving the electrical signal accepts the neurotransmitter at a site which is called a receptor. When the neurotransmitter from the first neuron chemically binds to the receptor of the second neuron the electrical signal is transmitted. Neurotransmitters and receptors work like locks and keys: there is at least one different receptor for each different neurotransmitter. For example, an endorphin receptor can only be triggered by and endorphin, a serotonin receptor can only be triggered by serotonin, and so on. Different neurons have different receptors. Some neurons will only be triggered by serotonin, some only by an endorphin, and so on for all the different neurotransmitters.

Okay–now what does all of this have to do with alcohol?

Every mood altering substance from heroin to coffee has an effect on the neurotransmitter system of the brain. Some psychoactive drugs affect only one specific neurotransmitter system, whereas others affect many. Morphine, for example, mimics the neurotransmitter beta-endorphin–a natural painkiller found in the brain. Morphine is shaped like beta-endorphin and binds to the beta-endorphin receptors thus acting as a painkiller and also giving rise to feelings of pleasure. Caffeine is shaped like Adenosine and acts on the adenosine receptors. Alcohol on the other hand affects many different neurotransmitters, not just one, Why is this?

Morphine and caffeine are both large molecules. Neurotransmitters are also large molecules. Morphine and caffeine have the effects which they do because of their similarity in shape to neurotransmitters which occur naturally in the brain. Alcohol on the other hand is a quite small molecule. Alcohol does not mimic a neurotransmitter. So then how does alcohol affect neurotransmitters?

Alcohol is a fat soluble molecule. Fats (called lipids) are a major component of all cell membranes, including the cell membranes of neurons. Alcohol enters the cell membranes of neurons and changes their properties. Receptors are located on cell membranes and this means that receptor properties are altered by the presence of alcohol. Cell membranes also control the release of neurotransmitters and this means that the release of neurotransmitters is also affected by the presence of alcohol.

The effects of alcohol on receptors and neurotransmitters have been well documented for several neurotransmitters and their corresponding receptors. These effects are summarized in Table 1.

Table 1: Alcohol’s Effect on Neurotransmitters and Receptors

  • Glutamate
    • Alcohol inhibits glutamate receptor function
    • This causes muscular relaxation, discoordination, slurred speech, staggering, memory disruption, and blackouts
    • Ether and chloroform have similar effects on the glutamate system
  • GABA (gamma-aminobutyric acid)

    • Alcohol enhances GABA receptor function
    • This causes feelings of calm, anxiety-reduction and sleep
    • Valium has a similar effect on the GABA system
  • Dopamine

    • Alcohol raises dopamine levels
    • This leads to excitement and stimulation
    • Cocaine and amphetamine have similar effects on the dopamine system
  • Endorphins

    • Alcohol raises endorphin levels
    • This kills pain and leads to an endorphin “high”
    • Morphine and heroin have similar effects on the endorphin system

Drugs like morphine or cocaine have been referred to as “chemical scalpels” because of their very precise effects on just one neurotransmitter system. Alcohol on the other hand is much more like a chemical hand grenade in that it affects just about all parts of the brain and all neurotransmitter systems. Alcohol affects all these systems at the same time. When people drink alcohol they become lively and excited because alcohol raises dopamine levels just as cocaine does, although alcohol does not raise dopamine levels anywhere near as much as cocaine does. When people drink alcohol they feel calm and lose their anxieties because alcohol makes the GABA receptors function more efficiently just like valium does. The reason that people tend to fall asleep after drinking alcohol or taking valium is also due to this effect on the GABA receptor. And alcohol has a painkilling effect like morphine and produces a high similar to morphine because it causes a release of endorphins into the brain thus raising the endorphin levels. (Note that the effect of morphine is different from alcohol in its mechanism–morphine imitates endorphins and binds to endorphin receptors whereas alcohol increases the amounts of the endorphins in the brain.) Finally we come to glutamate. Alcohol greatly inhibits the functioning of the glutamate receptor. Glutamate is responsible for the formation of new memories as well as for muscular coordination. It is alcohol’s effect on the glutamate receptor which leads to slurred speech, and staggering in people who have consumed alcohol, as well as the inability to remember what one did that night when the morning after comes. Perhaps the only positive effect of this effect on the glutamate receptor is a feeling of muscular relaxation. Many negative effects of alcohol such as automobile fatalities due to drunk driving are the result of the loss of coordination caused by alcohol’s effect on the glutamate receptor. Even small amounts of alcohol have a major impact on coordination–so never, never drink and drive.

You have probably observed that alcohol seems to have different effects on different people. Some people quickly become sleepy after drinking just a little alcohol whereas others become animated and want to just go, go, go. Research on mice suggests that this difference is genetic. Scientists have been able to breed strains of mice which quickly go to sleep after ingesting alcohol. They have also been able to breed strains of mice which become very active after ingesting alcohol. This strongly suggests that genetics determines which neurotransmitter system is most strongly affected by alcohol in which individual. Individuals who become sleepy soon after drinking probably have their GABA system more strongly affected by alcohol. And individuals who become lively and excited after drink probably have their dopamine system most strongly affected.

The effects of alcohol on the brain do not end when alcohol is completely metabolized and out of the system–what happens next is something called neurotransmitter rebound. This rebound effect is most easily illustrated if we look at what happens to many people when they use a drink or two as a sleep aid. These people often tend to wake up in the middle of the night and find themselves unable to fall back asleep. What is happening is this–alcohol has enhanced the functioning of the GABA system and has made these people feel relaxed and sleepy. The entire time that alcohol is present the GABA system is struggling to overcome the effects of alcohol and return to normal functioning. When all the alcohol is finally out of the body, the GABA system overshoots the mark and leaves people feeling restless and wide awake. This is why alcohol is not a good sleep aid. Large quantities of alcohol can keep a person asleep longer, but drinking large quantities of alcohol has its own negative effects. Neurotransmitter rebound seems also to be implicated in symptoms of hangovers such as hyper-sensitivity to light and in alcohol withdrawal syndrome giving rise to feelings of anxiety and panic and other symptoms as well.

Some medications used to treat alcohol abuse such as campral and naltrexone work by affecting the neurotransmitter systems. Naltrexone (also called revia) is an opioid receptor antagonist. Naltrexone works by binding to the endorphin receptors (which are sometimes also called opioid receptors) and blocking them off so that opiates cannot bind to these receptors. Unlike opiates or endorphins naltrexone has no painkilling effects and no pleasurable effects. Naltrexone simply blocks off the endorphin receptors so that neither opiates nor endorphins can have their painkilling or pleasurable effects. Naltrexone is highly effective with people who use opiates such as morphine or heroin since these drugs have no effect at all when the receptors are blocked by naltrexone. Naltrexone has some effect in helping people to abstain from alcohol or to moderate their use, however it is not as effective with alcohol as with opiates because alcohol affects many different neurotransmitters. The downside of naltrexone is that the body’s natural painkillers, the endorphins, are unable to do their job when it is present. People taking naltrexone are advised to wear medic-alert bracelets so that doctors will know that painkillers are ineffective on these people.

Campral (also known as acamprosate) is a glutamate receptor modulator. Campral helps eliminate cravings for alcohol in long term heavy drinkers. It is hypothesized that long term heavy drinking upsets the glutamate neurotransmitter system and that campral helps to restore this to normal.

No discussion of alcohol and the brain would be complete without a mention of possible brain damage caused by alcohol abuse. It is likely that we have all heard that drinking kills brain cells. However, does scientific evidence bear out this common folk saying? A 1993 study by Jensen and Pakkenberg published in Lancet titled “Do alcoholics drink their neurons away?” compared the brains of alcoholics to the brains of non-alcoholics. This study found that the white matter of the brains of alcoholics was significantly depleted. The gray matter, however, was the same in both alcoholics and non-alcoholics. This is interesting since it is the gray matter that does the thinking. The gray matter has been compared to a network of computers, and the white matter to the cables linking them together. The brain does not produce new gray matter to replace that which is lost. The brain can, however, produce new white matter to replace white matter which has been lost. The researchers concluded that loss of white matter do to heavy drinking may possibly not constitute irreparable damage.

There is, however, a form of irreparable brain damage which can be caused by long term heavy drinking. This is Wernicke-Korsakoff Syndrome, also known as “wet brain”. Wernicke-Korsakoff Syndromeis not caused by a loss of brain cells–it is caused by a deficiency of vitamin B1 (also known as thiamine). Wernicke-Korsakoff Syndrome can have several causes including extreme malnutrition, prolonged periods of vomiting due to morning sickness or an eating disorder, kidney dialysis, stomach stapling, or alcohol abuse. The vast majority of cases of Wernicke-Korsakoff Syndrome which occur in the United States are caused by severe, long-term, heavy drinking. Alcohol can lead to Wernicke-Korsakoff Syndrome because it blocks the absorption of thiamine. Symptoms of Wernicke-Korsakoff Syndrome include amnesia, inability to form new memories, confusion, hallucinations, and confabulation. Some of the more severe symptoms of Wernicke-Korsakoff Syndrome can be treated with thiamine, however in most cases many of the symptoms persist for a lifetime.

Have scientists discovered everything that there is to know about alcohol’s effects on the brain? It seems that this is clearly not the case. Scientists believe that alcohol likely affects many more neurotransmitters than the four discussed in this article. There is constant and ongoing research to discover how alcohol might affect other neurotransmitters. The future is likely to bring us much new knowledge about alcohol and the brain.

Understanding The Signs Of Alcoholism and Alcohol Abuse

Facing the facts and realizing that you are one of your loved ones are dealing with an alcohol abuse problem can be hard and unpleasant. It may be easy for some people to realize that they are abusing alcohol, as evidenced by hangovers, work problems, and the deterioration of relationships due to drinking too much, those same people may find it hard to tell if they are actual alcoholics. If you or someone you love is worried about a drinking problem, perhaps it is time to ask yourself some difficult questions regarding whether or not you are an alcoholic.

Alcohol abuse and related issue do not crop up over night; rather they usually are a result of other problems. Many things may contribute to the alcohol problems, including genetics, social conditions, life stressors, and the family environment. There are also people with mental health issues who use alcohol to self-medicate and do not even realize it. Sometimes people whose families have history of alcoholism, alcohol abuse, and social drinking can end up having struggles with alcohol. Sometimes the dangers of alcohol are masked by using alcohol to socialize or release emotional tension in a family setting.

No matter why some starts to have a drinking problem, there is nothing good about alcohol abuse. Many times it results in self loathing, frustration and despair. Not only that, but the family of the alcoholic is always affected by these problems, as are friendships and the work environment. Alcohol abuse is self -destructive and can break up marriages cause social rejection, the loss of one’s job, the neglect of one’s children and other responsibilities, legal troubles, and poor health.

There are a lot of things that can indicate that someone is suffering from alcohol abuse. However, not every alcoholic will have the same signs of alcohol abuse because the substance has different effects on different people.

When you are trying to figure out if you or a loved one is struggling with alcohol abuse, here are some things you can look for.

1. Being able to drink large quantities of alcohol without showing any signs of being intoxicated.

2. An obsession with alcohol and drinking.

3. Blacking out or lapses in memory.

4. Neglecting your responsibilities.

5. Using alcohol to feel better. This includes using it for calming their nerves or quieting the mind.

6. Not being able to sleep through the night, or suffering from insomnia

7. Binge drinking. This includes consuming large amounts of alcohol two or more times each week.

8. Soothing a hangover by consuming alcohol.

9. Consuming alcohol to feel childlike or carefree.

10. Using alcohol to relieve social anxiety or because of peer pressure.

11. Hiding or sneaking alcohol.

12. Drinking before social events and gatherings.

13. Losing job or receiving reprimands from employer due to drinking.

14. Having a turbulent relationship or marriage caused by too much drinking. For example, your partner threatens to leave, or does, because of drinking problems.

15. Friends, family, etc complaining about drinking too much or inappropriately.

16. Having medical problems or other issues because of alcohol consumption

17. Being hospitalized or institutionalized because of something caused by alcohol intake.

18. Getting arrest because of drunk driving or other alcohol related incidents, including arguments, altercations, and disturbing the peace.

19. Being a completely different person when influenced by alcohol. This includes becoming aggressive or violent, being sexually promiscuous, or being rash.

20. Feeling guilt or shame after consuming alcohol.

21. Losing friends or other social issues because of too much alcohol intake.

22. Consuming alcohol in the morning.

23. Not taking care of self, evidenced by lack of hygiene

24. A history of alcohol abuse in the family history.

25. Getting drunk a lot. Drinking to the point of intoxication two or more times in a week

26. Drinking all alone.