A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

What are the physical consequences of alcoholism?

September 11, 1981

Dear Cecil:

Everything I read on alcoholism, even from the AMA, focuses on social and familial trauma, with maybe a bit of liver damage thrown in. Could you approach alcoholism from a physical/vanity angle? To wit, the gum damage that tells a dentist you imbibe. The ever-drooping "alcoholic's ass" and other physical effects. The blotchy skin and red nose. I think such a rundown would be more effective than the usual warnings. Which of these conditions are reversible? Also, can you explain physiologically how "blackout" comes to happen more often and require less booze? Is this brain damage or lowered tolerance or what?

Cecil replies:

If it's gory details you want, Cecil is happy to oblige. Let's start with delirium tremens, which is marked by tremulousness, hallucinations, and localized or grand mal seizures, profuse sweating, rapid heartbeat, dilation of the pupils, and fever. Death rates among persons exhibiting these symptoms range as high as 15 percent. Next (and somewhat less commonly) we have Korsakoff's psychosis, a reduction of learning ability and memory span (particularly short-term memory), and Wernicke's disease, a reduction in mental acuity, characterized by disorientation, clouding of consciousness, poor comprehension, and weakness or paralysis of the eye muscles.

Moving along, we have alcoholic amblyopia, partial loss of sight. The most dramatic instance of this is the sudden and permanent blindness that often accompanies the drinking of wood (methyl) alcohol. However, a slower-acting but equally serious form of amblyopia is often caused by nutritional deficiencies associated with ordinary grain alcohol. What happens is you substitute vitaminless booze for more wholesome foodstuffs, giving rise to numerous disorders. Another example of this is alcoholic polyneuropathy, a disease of the peripheral nervous system characterized by (among other things) numbness in the toes and fingers, a burning sensation on the soles of the feet, and tenderness of the calf muscles. In the severest cases you can lose the use of the hands and feet. Alcoholics can also get beriberi, a result of thiamine deficiency.

Then we have a number of generalized syndromes usually lumped under the catchall term alcoholic deterioration, including various combinations of the following: dilation of the facial capillaries, especially in the nose (the W.C. Fields effect), cirrhosis of the liver, alcoholic hepatitis, degeneration of the heart muscles resulting in eventual congestive heart failure, bloated appearance, flabby muscles (including alcoholic's ass), chronic stomach inflammation (in extreme cases, bleeding ulcers), pancreatitis, anemia and other bone marrow problems, low blood sugar (sometimes leading to sudden death), tremors (shaky hands), seizures, paranoia, emotional and behavioral problems, and so on. Some researchers believe that excessive alcohol produces premature aging, noting that many alcohol-related problems, such as gum disease, mental deterioration, etc., are similar to certain infirmities of the elderly.

How much of the above is reversible is open to question. With treatment most conditions can be improved, but some impairment usually remains. Interestingly, while we often think of alcoholics as people who've been hitting the bottle for years, there is evidence to suggest that very heavy drinking over a relatively short period — say, in college — can produce identical results, including permanent brain damage. Brain damage, incidentally, may well account for the increasing incidence of blackouts, but researchers aren't sure. Stick to tomato juice.

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