Stress, Social Drinking, And Alcoholism



KEY WORDS: susceptibility to alcohol, heredity vs. environment, Indians vs. Eskimos, stress, diet, gender differences, French Paradox, health benefits, hazards

A number of intriguing observations and speculations have been made about the interrelationships between stress and alcohol consumption. Do people drink to excess because they are under stress, or are they stressed out because they drink too much? Like the chicken and the egg, it's often hard to say which came first, especially when you see someone who is a confirmed chronic alcoholic.

Some individuals are undoubtedly driven to drink because they perceive they are subjected to overwhelming stress. They are more apt to drink alone, and at any time of day. Others may consume almost as much during a 24 hour period, but under very different circumstances. They might have a few cocktails before dinner with family or friends, which could also include several glasses of wine, and some brandy or other after dinner drink. It's not that you drink, but rather why that may be more important.

There are other connections. Stress can be the spice of life or the kiss of death. A little stress now and then makes life exciting. However, too much can kill you - and the same can be said for alcohol. Increased stress can increase productivity and pleasure - up to a point, after which things go downhill. That's also true for booze.

Some find that an evening drink with friends improves their mood and makes the cares of the day fade away more quickly than taking a tranquilizer. A few glasses of wine a day also has been found to reduce risk for a heart attack. This is usually attributed to its antioxidant content, but grain alcohol and beer are also cardioprotective. At the other extreme, excessive intake can lead to a life of despondency, despair, and distress, not only for the alcoholic, but friends and family as well.

People can become addicted to stress as well as alcohol, and our susceptibility for both also varies tremendously. Certain individuals simply can't cope with stress, while others appear to be intrinsically impervious to the slings and arrows of outrageous fortune, or have developed coping skills that make them more resilient. Similarly, some get high as a kite on two drinks, while others have a "wooden leg" and seem sober despite consuming huge amounts.

Stress and alcohol can be two edged swords, Some people thrive on life in the fast lane, and a time urgent pressure cooker existence that poses constant challenges. That would prove extremely distressful for those who simply want a non threatening job well within their capabilities, and shun having to be responsible for the welfare of others. One man's meat can be another's poison with respect to both stress and alcohol.

Alcohol can also affect each of us very differently. Some become sentimental and amorous, or display unsuspected talents once their inhibitions disappear. Others turn from being a polite Dr. Jekyll into a hostile Hyde, and can be downright nasty and repulsive, revealing a dark side of their character that had been completely kept under wraps.

How well we handle stress may influence how we react to alcohol, and vice versa. The nature of stress responses may provide clues to drinking behaviors and our resistance or susceptibility to developing chronic alcoholism. Teaching people how to cope with stress more effectively might prevent many drinking problems. Conversely, reducing dependency on alcohol and learning how to drink in a more responsible manner could reduce stress for those who constantly turn to alcohol as a crutch.

Is It Heredity Or Environment?

Both drinking behavior and how we respond to stress are determined by a combination of genetic and environmental influences. Heritable factors are undoubtedly important, since there seem to be significant racial differences. The American Indian's unusual sensitivity was so great that alcohol was called "fire water", and legislation was enacted banning its sale to native Americans. However, heredity may not be the sole explanation for this susceptibility, and some believe that dietary habits may be equally important.

Many of the Indian tribes encountered by early explorers and settlers led a nomadic existence because of their need to forage for food. They tended to consume a diet high in carbohydrates and low in fat, that largely consisted of corn, fruits and vegetables. Although unusual sensitivity and addiction to alcohol was common, this was not a problem for their anthropological brothers living in Arctic regions, who subsisted primarily on whale blubber and fatty meats, rather than high carbohydrate crops. Although their genetic makeup is much like that of the American Indian, Eskimos don't seem to show the same sensitivity to alcohol.

Similarly, while alcohol Consumption is high in Italy, Spain, and other Mediterranean countries, it is not associated with a corresponding increase in addictive behaviors or unusual sensitivity. This may also be due to the fact that their diet is high in olive oil and other fats that may provide such protection. Support for this comes from the observation that alcoholism became a serious problem when individuals from these countries began to settle in parts of South America. Alcohol turned into "fire water" and addiction became prevalent for many, especially those in Argentina, whose diet was predominantly the products of the pampas and other high carbohydrate foods.

The reason for this may be that alcohol and sugar are the only substances absorbed directly from the stomach. A rapid and marked increase in blood sugar triggers the secretion of insulin to return levels to normal. In some individuals, this response can be excessive, resulting in a cascade of other endocrine responses that are designed to maintain homeostasis.

If the blood sugar level falls too low, other hormonal responses are quickly called into play, the most important being increased secretion of adrenaline from the adrenal medulla. Adrenaline rapidly makes glucose available by breaking down carbohydrates via a process known as glycolysis. There is also increased secretion of cortisone-like steroid hormones from the adrenal cortex that derive glucose from protein stores by gluconeogenesis. In some individuals, especially those with so-called reactive hypoglycemia, this response can also overshoot the mark so that blood glucose levels are increased, again triggering the release of insulin that results in a vicious cycle. Low blood glucose also causes a craving for sugar and sweets, and consuming these further complicates the body's efforts to restore normalcy by smoothly coordinated activities.

Hypoglycemia, Hormonal Responses to Stress, And Homeostasis

As a result, blood sugar levels can see-saw back and forth before they become stabilized, which can take hours. The intermittent secretion of adrenaline can cause palpitations, fluctuating hypertension, migraine headaches, and disturbing vasomotor responses due to sympathetic nervous system stimulation. Patients with such puzzling symptoms that have no obvious cause are usually assumed to be suffering from some emotional disorder, or "stress". The correct diagnosis can readily be established by a glucose tolerance test that is extended to six hours, during which symptoms usually recur as rapid rises and falls in blood sugar evoke hormonal and nervous system responses.

The treatment for this condition is to avoid carbohydrates and adhere to a diet of frequent small meals high in fat and protein, which are metabolized much more slowly from the small intestine. These also increase blood glucose more gradually than carbohydrates, and to a lesser extent, so that abrupt rises do not occur and metabolic adjustments are more orderly. Some physiologists believe that rapid falls in blood glucose and/or low blood levels may cause cravings for alcohol, which, like sugar, is also rapidly absorbed.

It has been proposed that a similar dietary regimen might reduce alcohol craving, and some studies support this notion. Several decades ago, researchers demonstrated that many alcoholics tended to respond to a sugar solution with the same wide swings in blood glucose levels as patients with reactive hypoglycemia. They also reported that alcohol cravings disappeared after patients were started on a high fat, high protein diet, and avoided carbohydrates. Concomitant administration of cortisone-like drugs resulted in further improvement.

Adrenal cortical steroids have also been used to treat other addictive disorders, and may be particularly effective in reducing withdrawal symptoms. As with alcoholism, many substance abuse problems may be due to chronic stress. Since persistent stress results in exhaustion of the adrenal cortex and a markedly diminished secretion of its hormones, there would appear to be a logical rationale for such replacement therapy.

The response to stress is complex and involves activation of thyroid and many other hormonal activities that have widespread metabolic and physiologic effects. These are further amplified by a cascade of autonomic nervous system responses which also affect smooth muscle tone, the breakdown of carbohydrate, fat and protein stores, cardiovascular and gastrointestinal activities, and the function of the kidneys as well as many other organs and systems. Alcohol can also exert important influences on metabolism, the central nervous system, and other vital body systems and organs, especially the heart and liver.

When acute stress or alcohol intake is transient, or not excessive, normal regulatory responses are usually able to maintain homeostasis with few resultant permanent consequences. Persistent stress and chronic alcoholism are much more insidious and also more injurious. In addition to causing direct damage to various organs, both can produce serious emotional and central nervous system disturbances, including depression, anxiety, insomnia, and impairment in memory and learning. Both can also significantly impair immune system function, resulting in increased susceptibility to infectious diseases and a host of other illnesses. These changes come on gradually, and are often not recognized until it is too late to correct the damage.

The American Institute of Stress.

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