Hidden in Plain Site – The Impact of Alcohol Disorders on Health and Rehabilitation

This is a topic that may be disturbing to some readers and in my opinion, it should be. As a psychologist Board Certified by the American Psychological Association in the Diagnosis and Treatment of Alcohol and Other Substance Use Disorders, I see and hear on a daily basis, both here at Helen Hayes Hospital and in my private practice, the extent to which alcohol overuse causes widespread harm, yet remains an accepted and even celebrated part of our leisure time activities. Over the past two decades, there has certainly been an increased focus on the dangers of child and adolescent alcohol abuse, excessive drinking by college aged students, the dangers of drinking and driving and even the awareness that alcohol abuse is a risk factor in the elderly population. In rehabilitation, we frequently see the relationship between alcohol intoxication and spinal cord injuries, traumatic brain injuries and in patients sustaining multi-trauma injuries from motorized vehicle accidents, falls, assaults and from self injurious behavior both accidental and intentional. We also see many patients whose chronic alcohol overuse has caused damage to the body in ways that contributed to their disability and that negatively impact the extent of recovery that is possible.

According to the National Institute on Alcohol Abuse and Alcoholism, 88,000 Americans die each year with alcohol overuse as the direct cause. It is estimated that roughly four times that number become significantly disabled annually as a result of an alcohol related illness or injury. For people aged 15-45, alcohol overuse is the leading factor in causing premature death and disability.

While these numbers are distressing, this is only the tip of the iceberg in terms of the physical and mental health issues, the social and economic issues that are created by alcohol misuse. Alcohol use by pregnant women can lead not only to Fetal Alcohol Syndrome, but to the child having significant learning and emotional/behavioral problems. Alcohol overuse interferes with parenting in subtle ways having to do with emotional availability, consistency and in creating a safe and nurturing environment for children. It is a factor in excessive corporal punishment, physical, emotional and sexual abuse. Parental alcoholism impacts a child’s ability to learn and this too has lifelong and widespread consequences. Childhood emotional illnesses of depression, anxiety, obsessive-compulsive disorder and post-traumatic stress can result from living in a home where alcohol abuse creates chronic tension between parents, chronic fighting and anger or violence, even if this is intermittent. While we know that genetics is a significant factor in alcoholism (if one parent is alcoholic, their child has a 40% likelihood of developing alcoholism; when both parents are alcoholic, the risk of the child becoming alcoholic is 70% greater), so too is watching parents use alcohol as the preferred way of relaxing or coping with problems.

Alcohol overuse is a factor in 27% of motor vehicle fatalities and present in over 38% of completed suicides. Studies that examine the prevalence of alcohol abuse syndromes in the accidents leading to spinal cord and traumatic brain injury suggest that approximately 30% of patients requiring rehabilitation for their injuries meet the criterion for alcohol dependence (alcoholism) or other drug abuse diagnoses. A return to drinking or drug use after rehabilitation for a catastrophic injury is not uncommon, and it is also a predictor of difficult and protracted psychological adaptation, a process that often takes three to five years when addiction issues are not a factor. In addition, a return to addictive behaviors in individuals with spinal cord and traumatic brain injuries increases the likelihood of additional accidents and a worsening of the original disabling condition.

Alcohol is a neurotoxin. No matter how little or how much one drinks, alcohol damages nerves. For those whose consumption is modest, the neurotoxic effects of the alcohol rarely become problematic. In people whose alcohol consumption is chronically higher, there is a clear and predictable deterioration in emotional, behavioral and cognitive function. Alcohol causes neuropathy or nerve pain. It leads to a loss of control over emotions, often irritability, anger and rage. It causes mood changes. Attention, concentration and memory can be impaired. Judgment and insight deteriorate. Damage to the liver, the pancreas, the stomach and esophagus and the heart are well known consequences of chronic alcohol abuse. Alcohol overuse can lead to a state of delirium, a condition of confusion, disorientation and vivid visual hallucinations. It may also lead to dementia, a condition of progressive memory loss. Withdrawal from chronic alcohol abuse is known as delirium tremens, a life threatening, though treatable condition. Ingestion of large quantities of alcohol in a short period of time can cause alcohol poisoning leading to coma and death.

I recall hearing a presentation many years ago in which the case of an adolescent girl was discussed. Out partying with friends, she drank to the point of being unconscious, was driven home by “friends,” carried to the stoop of her house where she was found by her parents after the friends rang the door bell and drove away. In the emergency room, their daughter critically ill in a coma from alcohol poisoning, the parents were told that alcohol abuse almost killed their daughter, to which they replied, “thank god it wasn’t drugs.”

Whether true or made up, the story sums up nicely our societies’ view of alcohol. Alcohol is and has been responsible for far more death, disability, physical and emotional illness, suicide, violence against others, sexual assaults and rape, childhood learning and adjustment problems, lost wages from absenteeism and diminished productivity than any other substance. And most disturbingly, the things that I am writing about alcohol misuse are well known, not the least bit controversial. The damage attributable to alcohol overuse is hidden in plain site, no different really than smoking, yet with far more serious and widespread consequences. Alcohol misuse is a manageable, but chronic disease. The behaviors of addiction can with great effort and commitment, be controlled and indeed, there are some studies suggesting that medications to dull or even eradicate urges to drink or to block the positive feelings one gets from drinking are available, and may see more widespread use.

Those of us who work in rehabilitation with people whose lives have been profoundly injured in some way have an obligation to not allow alcohol misuse to hide. It must be examined, approached and discussed in the light of day, no differently than any other medical condition. Though often uncomfortable to discuss, alcohol abuse and dependence are public health calamities that do more harm than most anyone is willing to address. Let us begin, one person at a time, one day at a time.

– Dr. Bruce Lowenstein