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.

Alcoholism in the Irish Culture

Introduction:

Experience with alcoholics has put this writer in touch with various clients of Irish decent, all of whom have shared similarities in their descriptions of alcohol in their Irish culture. They describe that alcohol is drunk in excess at weddings, at funerals, on holidays, and on sad days. Alcohol is most appropriate on Saturdays and Sundays; and Mondays, Tuesdays, Wednesdays, Thursdays, and Fridays. Sober clients who are otherwise not so careful with “people, places, and things” still avoid the Irish Day Parade like the plague. What is the relationship between Ireland and Alcohol in context of history, social aspects, and medical considerations?

Historical Context:

As will be explained, the retail price of alcoholic drinks has consistently been considered an important regulator of alcohol consumption and by implication, a method of controlling the amount of excessive drinking. Regulating alcohol patterns has been a debated issue in Ireland as far back as 1791 when it was actually debated in the Irish parliament. Apparently the problems of alcoholism were rampant in Ireland already back then. At that time, the “Gin Act” in England was used as a proof that a parliament could regulate production and sales to help sober a country. This issue has never been resolved and while at the beginning of last century poverty was blamed for excessive drinking, nowadays affluence is frequently mentioned as a cause. These days, the popular mindset is described in the expression, “Alcoholism comes in people and not in bottles.” Irish parliament is still very much uninvolved in alcoholic litigation for various cultural, religious, and political reasons. These will all be touched upon again in farther discussion on the causes and trends of Irish drinking habits (Blaney, 1974).

How much do the Irish drink?

It is significant to mention that in spite of the numbers supporting the notion of higher alcohol consumption with Irish drinkers, a significant proportion of the Irish population do not drink any alcohol at all. In numerous studies, almost three times as many Irish citizens reported that they had not consumed any alcohol at all during the past 12 months than as in any Scandinavian countries and almost twice the abstinence rate as those reported in Germany, UK, France, and Italy (Ramstedt & Hope, 2003).

While Ireland has the highest level of abstinence amid the aforementioned countries, it also boasts twice as high levels of alcohol consumption compared to those same countries. This means that those who do drink in Ireland drink much higher quantities per person as other regions (Ramstedt & Hope, 2003). The most recent statistics of the World Health Organization (2011) reports that Irish drinkers consume an average of 14.41 liters of alcohol per year, the highest among all countries mentioned thus far. This amount is measured in the amount of pure ethyl alcohol. In comparison, the average drinker in the United States only consumes 9.44 liters. That is approximately 5 liters of alcohol less per person than drinkers in Ireland. Amongst the Irish that do drink, the heaviest drinking occurs with Irish second generation (Mullen, Williams, & Hunt, 1996). Ramstedt & Hope (2003) state that the higher overall level of drinking in Ireland is directly associated with higher alcohol-related mortality related to deaths from liver cirrhosis, accidents, and homicide.

Amazingly, daily drinking in the same countries mentioned is lowest in Ireland in spite of the high alcohol consumption per year. Only 1.6% of Irish men drink every day. Comparatively, 42% of men drink every day in Italy, 21% in France, and 12% in Germany. These percentage differentiations are similar among women as well (Ramstedt & Hope, 2003). This would seem to suggest that while the Irish may not drink every day, when they do drink it is in vastly greater quantities per drink.

Why do Irish Drink? Causes and Trends:

Blaney (1974) describes various explanations as to why there is such a link between the Irish and Alcohol. Irish weather and climate is commonly believed to be an important cause of Irish overindulgence. The basic idea is that the damp climate and inclement weather cause people to seek modes of stimulation such as alcohol. This theory was especially prevalent in the mid nineteenth-century.

Lack of quality food has also been blamed. Theorists seek to show how the Irish have a general tendency for substitute drinking for eating in response to certain situations. Additionally, a lack of alternative drinking establishments has long been blamed in Ireland for excessive consumption of alcohol. It is believed that the development of the Cafe and Coffee-House Movement towards the end of the last century occurred in direct response to this association. The political rhetoric of the time included statements like “there are few places to go except the pub” and “there is nothing else for young people to do on Friday nights than to start drinking.”

Another cultural dynamic in Ireland is the pervasive availability of open alcohol eateries known as “public houses” or “pubs.” Ireland also has very loose legal constraints monitoring public alcohol sales in groceries. The corresponding modern view is that availability of alcohol in public houses and supermarkets leads to excessive drinking – especially in women. On these fronts, licensing laws regulating the availability of alcohol are rapidly re-evolving and researchers are closely following correlations between alcohol litigation and excessive drinking trends.

Obviously, these considerations of pinpointing availability of alcohol – or unavailability of other beverages – as the causes of excessive use of alcohol in Ireland is somewhat faulty. While these may explain the continuation or perpetuation of high rates of alcoholism in second generation Irish youth, it fails to explain how the evolution of an exclusive cultural relationship with alcohol was initiated to begin with. These factors are significant however, in understanding causes for new trends of alcoholism in modern Irish culture.

There is another popular theory that Irish people are physically and psychologically prone to alcoholism. No specific genetic theories have yet become available, but at least one researcher states that “the taste of alcohol in the mouth is more attractive to the Irish than to others.” Recent psychological studies point to an “Irish Psychological Constitution” that causes an actual predisposition to alcoholism (Blaney, 1974).

It will be explained further that Bales (1962) understood that the social patterns of Irish drinking actually predisposes the culture to higher rates of alcoholism. In this context, Irish political forces are attempting to counteract the Irish practice of drinking in large groups where each person gets a turn to buy the rest of the group a round of drinks. This is an old Irish social custom which is still being implicated today and seen as a large hurdle in the fight against alcoholism.

Religion:

Butler & Jordan (2006) explain the religious influence of alcoholism in Ireland. Ireland is a Catholic based country. Catholicism considers Protestants as one of the largest threats to traditional Catholic culture. The idea of self-control, temperance, and abstinence is a very Protestant initiative and traditional Catholicism is quite skeptical of the entire notion. In fact, it will be explained later how the Irish Church was against the establishment of AA for this very reason.

Mullen, Williams, and Hunt (1996) explore the common stereotype of the Irish and heavy drinking within this religious context as well. Quoting O’Connor (1978) it is posited that the historical ideas about the medical treatment for alcoholism in both the Irish and the English cultures were similar as both were eventually affected heavily by the religiously orientated temperance movement. As was mentioned, this is in spite of resistance from the Irish Catholic Church (Butler & Jordan, 2006). Mullen, Williams, and Hunt (1996) quote other studies as well finding Irish and English drinking in American cities to be fairly similar. Differences were mainly in comparison with Italians and Jews and with English from a rural or southern Protestant background with strong Baptist and Methodist affiliations. This strongly suggests that religion plays a role as well in drinking patterns and would therefore be an important clinical factor. Indeed, based on data from two studies carried out Ireland, one quantitative, the other qualitative, significant differences according to religious affiliation is shown.

The association of the Irish with Catholicism is strong if not overwhelming in many areas. Religious identity is stronger in Ireland than political identity and conflict in Ireland is more often religious than political. Theorists do in fact hypothesize a close link between Catholic culture and the Irish drinking. Studies show that in Irish-American communities, Irish Catholic drinking practices and problems were seen to relate to a somewhat tolerant normative religious structure which begins a cycle of abusive drinking and “reinstatements” like confession, forgiveness, and re-incorporation into group life that is easily transferable from religious to secular domains. Similar to Butler & Jordan (2006), Mullen, Williams, and Hunt (1996) also quote clear research literature showing that high levels of alcohol consumption are often assumed with Catholic subcultures being viewed as encouraging permissive drinking norms while the Protestant cultures are more ambivalent.

Irish and Jews:

Levin (1995) explains that while we have seen how the Irish have both high levels of consumption as well as significantly high levels of abstinence, Jews were found to exhibit neither high levels of consumption or abstinence. While Jews were found to drink almost exclusively at home with family or as part of religious ceremonies, the Irish rarely drink at home as the majority of drinking done in Ireland is in public houses, as has previously been mentioned. Lastly, the Irish mindset states that getting drunk is excusable and a socially acceptable form of relief and escape, while traditional Jewish values suggests that to get drunk in this manner is “unjewish.” Jewish drinking is sacred, formal, and ceremonial.

Bales (1962) studied and compared the ‘convivial’ or ‘utilitarian’ drinking of the Irish with the ‘ritual’ drinking of the Jews. He defines four categories or attitudes. They are abstinence, ritual, convivial, and utilitarian. Defining Irish as convivial and utilitarian means that there is no significance to one’s drinking outside of social solidarity and self gratification. The ritual consumption of Jewish drinkers however represents the use of alcohol as a symbolism of communion with God. The theory is that ritual drinking patterns can inhibit and even inoculate members against alcoholism, while utilitarian drinking may actually predispose the drinkers in that culture to eventual abuse and dependency. This theory seeks to explain how the differences in mindset evolved within these cultures.

Alcoholics Anonymous:

The Irish religious arena played a central role in the early foundation of AA in Ireland as well. Butler & Jordan (2006) explain the exact relationship in detail. Historically, AA was quickly accepted in strong Protestant-oriented traditions. Ireland is predominantly Roman-Catholic or Irish- Catholic. Catholicism however, took issue with AA on a few fronts. First and foremost was the fact that AA was conceived through tenants of a non denomination Christian group called the Oxford Group.
Additionally, Irish Catholic bishops favored a centralized teaching authority and found the AA approach heterodoxical. This was because of AA’s use of a Higher Power and “God as we understood him” in addition to individual group autonomy and the group conscience. These were seen as a rival to the structure and moral monopoly of the Catholic Church in Ireland.

Lastly, all religious elements in Ireland – even the more “progressive” Catholic Temperance League – were apposed to the disease concept of alcoholism. Traditional belief understands alcoholism as volitional in nature. People drink because they chose to. If they chose otherwise, they could become and remain abstinent if they so desired – particularly by using their Church membership to invoke God’s help.

On November 18, 1946 an AA member from Philadelphia, Connor F., established the first AA meeting in Dublin. This was the very first AA meeting held in all of Europe. Connor however, faced the following large hurdles. He first approached religious clergy who informed him there are no alcoholics in Ireland. He then approached medical hospitals who told him to take his [big] book and never come back.

Although Connor himself was protestant, ninety five percent of Ireland at the time was Catholic. No Catholic church was willing to host an AA meeting and no Catholic was willing to even enter a protestant church – even if only to attend an AA meeting. AA could not find any clergy or newspaper to give them positive publicity. The fact that AA originated in the USA was an additional hurdle. The Irish considered the US to be “the land of freak religions” and wanted no part in this new American movement.

The secretary of Dublin’s AA group was a man named Sackville who had been asked to retire from the English Army prematurely because of his pervasive alcoholism. In January 1972, Sackville and an English Catholic member of AA obtained a private audience with Pope Paul VI. The Pope described AA as “fine work, a real apostolate.” He gave AA his blessing and stated that he would keep AA in his prayers. With endorsement from the Pope, AA in Ireland no longer had any real fear of being censured by the local Catholic Church.

Bibliography:

Bales, R. F. (1962). Attitudes Towards Drinking in the Irish Culture, 157-187. Found in Pittman, D. & Snyder, C. Society, Culture, and Drinking Patterns. Wiley.
Blaney, R. (1974). Alcoholism in Ireland: Medical and Social Aspects. Journal of the Statistical and Social Inquiry Society of Ireland 23(1). Retrieved March 2, 2011
Butler, S. and Jordon, T. (2006) Alcoholics Anonymous in Ireland: AA’s first European Experience. Addiction, 102(6), 879 – 886 Retrieved March 2, 2011
Levin, J. D. (1995). Introduction to Alcoholism Counseling: a Bio-Psycho-Social Approach. Taylor & Francis.
Mullen K., Williams R., and Hunt K. (1996) Irish descent, Religion, Alcohol, and Tobacco Use. Addiction, 1996, 91(2), 243-254. Retrieved March 2, 2011
O’Connor, J. (1978). The Young Drinkers. London, Tavistock.
Ramstedt M. & Hope A. (2003). The Irish Drinking Culture – Drinking and Drinking-Related Harm, a European Comparison. Retrieved March 2, 2011
World Health Organization (2011). Global Status Report on Alcohol and Health. WHO Press. Switzerland. Retrieved March 2, 2011