The truth about caffeine, alcohol abuse and tobacco / smoking


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4. The Truth about Caffeine, Alcohol and Tobacco

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The Truth about Drugs - book on drug addiction by Dr Patrick Dixon - published by Hodder 1998

Caffeine, alcohol and tobacco are used almost universally, with exceptions in countries or areas with strict religious restrictions, for example the ban on alcohol in most Islamic states.These substances set the stage for all drug abuse so require the closest examination.

Caffeine is a mild stimulant. High doses can make someone feel jittery or on edge and may prevent sleep. Very large doses may cause flashes of light or odd noises. As with other stimulants, the greater the high, the greater the fall. It also can increase heart rate and blood pressure, is a weak diuretic (encourages urine formation) and increases the respiratory rate.

coffee is drunk in every country of the world and is a mainstay of most offices in the Europe and the US.The standard dose needed for stimulant effects is 200mg, or the equivalent of two cups of strong coffee or three cans of soft drink.As many as 30% of coffee drinkers say they "couldn't do without it" and are probably mildly addicted. Tolerance can develop rapidly.

Death from caffeine has been known, but only after doses of around 10 grams, the same as 100 cups of coffee. High doses of caffeine may affect the size of babies at birth.The foetus is especially likely to be harmed in the last three months of pregnancy, when the mother's ability to get rid of caffeine is reduced.Low birth weight, miscarriage and withdrawal symptoms in babies (breathing difficulties) have all been described.

Mothers who are heavy drinkers of coffee or cola drinks in pregnancy have twice the risk of their babies dying suddenly, even when other factors are allowed for such as age at motherhood, smoking and bottle feeding. Heavy caffeine intake also increases the risk of sudden death of babies after birth.Tea, coffee and cola should therefore be avoided in large doses in pregnancy.

Caffeine increases the effect on the unborn of other substances, such as tobacco and alcohol, shutting down the blood supply to the placenta, starving the foetus of oxygen and increasing the risk of low birth weight or malformations.However caffeineis harmless to the human fetus when intake is moderate and spread out over the day.

A possible reason for increased cot death in babies of heavy caffeine consuming mothers is that caffeine stimulates respiration and when this is removed, the baby has less drive to breath. That may make all the difference when it comes to fighting off infection or other problems.

"I'm dying for a cup of coffee" is a very familiar refrain, repeated perhaps a million times a day in Britain alone - usually half in jest.But what is the reality? Someone used to drinking six or seven cups of strong coffee a day will begin to experience withdrawal symptoms on waking and then every two to three hours after the last coffee drink. Caffeine withdrawal results in headaches and a range of other mildly unpleasant symptoms including drowsiness and lethargy.

So then, tea, coffee and cola can't be given a completely clean bill of health.What about alcohol?

It is impossible to read through the list of links between alcohol and accidents, violence, murder or other criminal behaviour in Chapter 2 without concluding that alcohol abuse is one of the greatest threats to civilised life in many cities.The sheer scale of destruction of life, property, relationships and communities by this drug is hard to comprehend.Alcohol abuse is a major epidemic.It is therefore bizarre that the cost of alcohol has become progressively cheaper over twenty years as consumption has soared, further encouraged by ever longer licensing hours and growing numbers of places where alcohol can be bought.

Indeed, the continued acceptance of alcohol abuse as normal, despite the havoc that results, is one of the strongest arguments in favour of the legalisation of Marijuana.After all, in contrast Marijuana (at first) appears a friend not an enemy.What is better? Relaxed and stoned, or violently drunk?

The biggest problem with alcohol use is where to draw the line with this substance which appears naturally in all fermenting liquids, and which in small to moderate doses is not only a relaxant and a social lubricator, but also a health tonic.

Alcohol is the most widely accepted drug in the world, and is part of many social settings.It changes a person's mood, reduces inhibitions, helps us feel more confident and less anxious.It is often a part of celebrations and can be used to drown out unpleasant feelings.

Alcohol abuse often begins when a person feels that without alcohol he or she will not be able to enjoy the occasion or will be less able to cope with an unchanging situation. Dependency follows when the body becomes used to a certain level of blood alcohol.Withdrawal in someone who's heavily dependent should not be undertaken without medical supervision.

Alcohol is a carbohydrate, a relative of sugar, and is therefore a potent source of energy for drinkers, supplying up to half of a heavy drinker's energy requirements in a day. It is created by yeasts which in the absence of oxygen get the energy they need by converting sugar to alcohol.

Alcohol is absorbed rapidly from the stomach - in five to ten minutes without food.The effects last several hours, related to body weight which is why many women are more affected by the same dose than men.

One unit is 8 grams of alcohol - equivalent to half a pint of normal beer, cider or lager, a standard glass of wine or a pub measure of spirits. After four or five units, most people feel relaxed and comfortable.Eight units causes slurred speech and clumsiness, with exaggerated emotions.Higher doses cause double vision, dizziness, staggering, loss of balance, nausea, vomiting.Beyond that alcohol can cause blindness, loss of consciousness, and loss of memory for events at the time.

The biggest danger is from injury caused by intoxication.In 1990 15% of all road accidents were alcohol related and 32% of all pedestrians killed on the road were under the influence of alcohol.Drinkers may also choke on their own vomit while unconscious. Although such sudden deaths are uncommon, this is a real hazard in police cells or in a side room in an emergency ward.

A hangover may follow, caused by dehydration and toxic metabolites.Mixing alcohol with other depressant drugs such as barbiturates or heroin is particularly dangerous as the effects are additive.

· Liver damage - alcohol is destroyed by the liver but liver cells are also casualties (see below)

· Brain damage caused directly by alcohol in the blood - in severe cases causing Korsakoff's psychosis, a permanent memory loss

Liver cirrhosis is common and deadly.It kills more than 23,000 a year in the US.It is the third commonest cause of death in men in their fifth decade. The commonest cause is alcohol abuse.There is probably a genetic reason why only 15% of heavy drinkers develop the problem.Once cirrhosis is diagnosed it is often too late to prevent death and 30% die in a year.

As the liver becomes progressively damaged it is no longer able to do its job as a food store, as a maker of digestive enzymes, and as a waste-disposal unit for toxins.The result is that the liver becomes enlarged with fatty tissue, the person becomes ill and jaundiced (yellow) and blood pressure rises in blood vessels draining into the liver, causing for example life-threatening bleeds of veins lining the gullet.This happens in 40% of those with cirrhosis.These bleeds cause sudden, violent, catastrophic vomiting. Death follows in minutes in almost half of those who are unfortunate enough to have one.

The World Health Organisation and governments have recently revised their guidelines about so-called safe limits for alcohol consumption in both men and women. The current accepted limits vary from expert to expert but are around 21 units for men and 14 units for women. The problem is that these are general guides and do not tell us what the actual damage to an individual's health will be.

Evidence is growing that alcohol in moderate doses increases life expectancy.This discovery was made following a series of large-scale studies comparing, for example the health of teetotallers with moderate and heavy drinkers.One of the protective effects appears to be on the heart and blood supply, with a reduction in strokes and heart attacks.At first the beneficial effect was attributed to some mysterious ingredients in red wine, but we now know that the therapeutic action is related to alcohol itself, independent of the method of production.

The discovery that drinking alcohol can be good for health brought alarm calls from those concerned that the news would encourage abuse. It certainly undermined the case for absolute abstention.

There are two main patterns of alcohol abuse: regular and binge. The regular abuser drinks every day or most days. The binge drinker rarely sees himself as an alcoholic because he often goes for days or weeks without touching alcohol.However once he starts, he cannot stop.

A habit may start with social drinking over a meal, before progressing with higher consumption.As the liver gets used to destroying alcohol, the person needs more to achieve the same level of intoxication.Typically the next step may be private drinking, in secret, drinking alone at any time of the day or night.

In advanced cases the person wakes feeling jittery and vulnerable, and has alcohol instead of breakfast " to calm the nerves".A classic sign of a deteriorating situation can be when the person stops eating breakfast, partly because the stomach is often so raw from alcohol-induced irritation the night before.

Sudden withdrawal in a heavy drinker can cause sweating, anxiety and trembling or in extreme cases fits and delirium.Complete withdrawal in a very heavy drinker is therefore dangerous without medical help.

Getting someone to admit he or she has a drinking problem can be extremely difficult, and presents one of the greatest challenges. Alcoholism is made far more difficult to treat because social drinking is found almost everywhere.For someone with a past addiction, even the smell of alcohol can induce an intense craving, which can become almost irresistible.

Alcohol is the most widely abused drug at work and the commonest cause of drug-related sickness and lost productivity.It is surprising therefore that so few companies address the issue directly.We look elsewhere at the issue of using urine and hair samples for drug testing, but electronic breathalysers are cheap to buy, fast, and cost nothing per test.Random tests at work with instant discipline for any worker over the legal driving limit could be a powerful disincentive.Part of the discipline process should be an offer of counselling and treatment, in cases where addiction is suspected.

As with any other addiction, breaking it may require several attempts.Support and help are vital as a problem drinker begins to rebuild a normal life.As the addiction is laid to one side, some of the precipitating problems may come to the surface and need dealing with.A key step is releasing the person to be fully responsible and in control of his or her own life again.

In summary then, alcohol abuse is a scourge on society.It needs to be tackled far more seriously than in the past with comprehensive measures which are outlined later.Failure to deal with alcohol as a problem will lead without doubt to Marijuana being legalised.How can one possibly justify an aggressive stand against Marijuana at the same time as the enthusiastic promotion of alcohol to a nation already reeling from excess?These two issues are linked and those who seek to hold them apart play into the hands of those who want no restrictions at all.

Nicotine is probably as addictive as heroin and on a national scale far more dangerous to health.It kills 120,000 every year in Britain alone and if tobacco were reaching the market today for the first time would without question be banned outright as a highly dangerous, addictive substance.

In America tobacco use is the leading preventable cause of death, killing 400,000 a year at a cost of $50 billion in direct medical bills.Smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides and fires combined.

The medical effects of tobacco are far wider than could possibly be covered in a book of this size. Most people need no convincing of the dangers.The problem is that the addiction is even more powerful than their fears of illness or early death.And teenage smokers are usually particularly relaxed in the knowledge that any health problems will take years to emerge.

Nicotine is a stimulant and a sedative. Nicotine reduces anxiety and makes users feel calm.It is physically and psychologically addictive.Smoking causes an almost immediate "kick" due to triggering adrenaline release and other hormones. Nicotine only takes seconds to reach the brain from the lungs and affects the body for around half an hour. Repeated stimulation leads to depression and fatigue so the user needs more. Research shows that nicotine users regulate their blood levels of nicotine so that levels rarely fall below a certain level - even if it means waking for a cigarette in the night.

Cigarette smoke consists of a dozen gases, mainly carbon monoxide, as well as nicotine and tar - which varies from 7 - 15 mg.The tar causes cancer, emphysema and other lung disease, while carbon monoxide damages the cardiovascular system and heart.Nicotine also affects both heart and lungs.Tar from tobacco causes cancers of the lung, oesophagus, mouth, lips, and larynx.

Pregnant smokers have a greater risk of underweight babies at birth, stillbirths and premature labour as well as of sudden infant deaths. Every time a pregnant woman smokes a cigarette it reduces the blood supply to the developing baby, hence smaller birth weight.

Women who smoke also suffer more from strokes and heart attacks when using the pill - especially if over thirty. Nicotine gum and patches can be helpful to replace tobacco when a person is seeking to change behaviour, but the nicotine addiction still needs to be broken.