One area that also presents an ongoing challenge for alcoholics is the stigma that is associated with the disease. Many alcoholics feel that their identity is tied to alcohol not only in their own mind, but always present in minds of others as well. Alcoholics may feel that they are often required to prove that their identity is more complex than the stereotypes offered to describe the typical alcoholic.

A recent study looked at the effects of stigma on alcoholics. Smith, Dawson, Goldstein and Grant examined how a former alcoholic deals with the negativity of the disease. The researchers looked at perceived alcoholism stigma effect on racial-ethnic disparities in treatment and quality of life among alcoholics.

The objective of the study was to investigate racial-ethnic differences in a perceived stigmatization of recovering alcoholics and how associations of race-ethnicity were affected. The effects on treatment history and psychological function were also examined as they applied to lifetime alcoholics.

The researchers used data from the National Epidemiologic Survey on Alcohol and Related Conditions. The data was collected from Waves 1 and 2 of the survey, which was a nationally representative sample of U.S. adults aged 18 and older. Logistic regression analyses were used to examine associations within the data.

The study’s results show that stigma scores were lowest for White and Native Americans. Higher scores were shown for Blacks, but the highest stigma scores were indicated for Asians and Hispanics, both within the total population and among lifetime alcoholics.

There was not an association found between race-ethnicity or stigma and treatment utilization.

Psychological function was found to be associated with stigma. The effect of stigma on racial-ethnic differences in psychological function was not found to be statistically significant.

The results of the study indicate that stigma may reduce the overall quality of life for alcoholics. However, there is no clear indication that stigma affects the quality of life in the area of racial-ethnic differences.

The findings of the study are important for treatment centers providing assistance to those struggling with an alcohol addiction. As the stigma associated with alcoholism is better understood, recovering alcoholics can be better counseled on how to achieve a higher quality of life despite their ongoing struggles with the many facets of alcoholism.
 

Jacob Varghese, 40, told Biswas that he began drinking when he was nine years old. He drank cheap local liquor in school, and ended up dropping out of college. He tried to commit suicide twice, landed in rehab centers, and was reduced to begging on the streets at age 32 to fund his addiction.

"Drinking is a disease in Kerala," he told Biswas. "I lost my kin, my respect and all my money chasing alcohol. Everyone encourages you to have it—your friends, the government."

After 17 years of heavy drinking, he was dragged to the local Alcoholics Anonymous chapter by friends. Varghese has been sober for the past eight years, and is now married with children and holds down a job.

"Many of my friends have not been as lucky. So many of my drinking buddies died, and others landed up in mental asylums," he said.

Kerala has the highest per capita consumption of alcohol—more than 1.76 gallons per person a year—in the nation, overtaking traditionally hard-drinking states like Punjab and Haryana.

Shockingly, more than 40% of revenues for Kerala’s annual budget come from booze.

A state-run monopoly sells alcohol. Kerala State Beverages Corporation (KSBC) runs 337 liquor shops, all open seven days a week. Each shop caters on average to an astonishing 80,000 clients.

This fiscal year the KSBC is expected to sell $1bn (£0.6bn) of alcohol in a state of 30 million people, up from $12m when it took over the retail business in 1984.

Similarly, revenues from alcohol to the state’s exchequer have registered a100% rise over the past four years. The monopoly is so professionally run that consumers can even send text messages from their phones to a helpline number to record their grievances.

"If we delay opening any of our shops by even five minutes, clients send us text messages saying that they are waiting to buy liquor," says KSBC chief N. Shankar Reddy.

There are some 600 privately run bars in the state and more than 5,000 shops selling toddy (palm wine), the local brew. There is also a thriving black market liquor trade.

Despite a growing number of people who demand a ban on the sale and consumption of alcohol, there is an equally spirited group of hard-core drinkers who lobby for cheaper and more widely distributed liquor.

One of them is well-known actor N.L. Balakrishnan, a veteran of more than 200 films, who launched a lobby group called Forum for Better Spirit in 1983.

The forum’s manifesto asks the government to provide liquor through the state-subsided public distribution system, boost toddy production, slash prices for elderly drinkers, and supply free alcohol to drinkers over 90.

Balakrishnan, 67, says his father "initiated" him into drinking when he was four. "We used to go to the cinema together. After the show was over, he would take me to a toddy shop where he would drink. He would give me a few spoons of toddy too. It was an amazing experience," he said.

He says when his father died at the ripe age of 98 after a "lifetime of heavy drinking," he wet his lips with liquor and not holy water, as is the Hindu custom.

Balakrishnan says that on his average day out with his drinking buddies he downs 22 shots of his favorite brandy, and "never has any problems.”

"If you have willpower and have enough food to go with your drink, booze will never harm you," he says cheerily.

But drinking is killing a lot of people and exacting a heavy social cost, say doctors and activists.

Rising numbers of divorces in Kerala are linked to alcohol abuse. Johnson J. Edayaranmula, who runs the Alcohol and Drug Information Centre, a leading NGO, puts the figure as high as 80%.

And the majority of road deaths in the state—nearly 4,000 during 2008-2009—are due to drink driving, he says. Hospitals and rehab centers are packed with patients suffering from alcohol-related diseases.

The situation is so grim that the KSBC itself is planning to open a hospital specializing in treating alcohol-related problems. It also runs a campaign to combat alcohol abuse.

Jacob Varghese says it is a "societal problem,” which could mean that drinking liquor is almost a social rite of passage, taken very seriously. But he also cites high unemployment, easy access to alcohol, and the fact that drinking has become a "part of upwardly mobile living.”

Most activists believe that prohibition is not the solution, as it just drives buyers and sellers underground.
"The solution possibly lies in introducing drinks with mild alcohol content. And since drinking is also a cultural problem, people need to be made aware of the havoc that alcohol can wreak on their lives," says Edayaranmula.

The UK’s Guardian reports that the alcohol-related costs to the city’s NHS alone is around the £23m mark, with an estimated half the number of visitors to A&E at the weekend attending because of alcohol-induced problems such as falls.

"Alcohol is a major issue in our A&E departments at both Leeds General Infirmary and St James’s – the weekends and out of hours are particularly bad,” said Kevin Reynard of Leeds Teaching Hospitals Trust.

"I don’t think we ever go through the working week without having to tell the parents of a young person that their son or daughter has died as a result of an incident involving alcohol. When I first started out as a junior doctor, cirrhosis of the liver was almost unheard of among people in their 20s, now it’s commonplace."

Anna Di Bassio, an A&E matron, added: "Friday and Saturday nights are challenging to say the least. There is disruption to the department. Staff trying to get on with their work can be severely disrupted."

Counselors also heard from NHS Leeds about the social issues coming from alcohol misuse, including a rise in the number of domestic violence cases. They were also told of problems with drunk or rowdy behavior, violent crime such as assaults, increasing hospital admissions, concerns over the safety of children, and that deprived areas like Armley and Middleton had twice as many people needing NHS support than in more affluent communities.

Data provided by the NHS showed Leeds was “significantly worse” than the national average when it comes to deaths from alcoholic liver disease, alcohol-related admissions in men, binge drinking, and benefit claimants whose main reason for claiming was alcoholism.

Counselors heard of a number of initiatives and support programs currently being run in Leeds to help alleviate these issues. They also spoke of their frustration over supermarkets selling cheap alcohol and the lack of a statutory minimum price for alcohol.

Meeting chairman counselor Mark Dobson said: "We’ve heard some stark messages today—there are clearly major issues to be tackled in Leeds."

The reports were the third session of the scrutiny board’s ongoing inquiry aimed at considering the role of the council and its partners in dealing with public health—the other issues being considered by the board are improving sexual health, reversing the rise in obesity, and reducing the level of smoking.

"Cytokines are proteins which mediate and regulate the inflammatory reaction in infectious and autoimmune diseases," explained Pilar A. Sáiz, associate professor of psychiatry at the University of Oviedo, Spain and corresponding author for the study.

"Clinical observation of increased circulating levels of pro-inflammatory cytokines such as IL-1 and TNFα in patients with alcohol liver disease suggests that they might play a role on the pathogenesis of the disease. Additionally, these cytokines act in the central nervous system affecting the functionality of the serotoninergic and dopaminergic systems, which have been also related to the pathophysiology of AD, and with the brain reward systems involved in alcohol reinforcement."

Sáiz and her colleagues recruited 200 (169 males, 31 females) AD patients from an outpatient detoxification unit, as well as 420 (216 males, 204 females) healthy individuals without a history of drug/alcohol/psychiatric problems (known as "controls"), from the north of Spain. All of the Spanish Caucasian participants were genotyped for four polymorphisms—IL-1α -889 C/T, IL-1ß +3953 C/T, IL-1RA (86bp)n, and TNFα -308A/G—and assessed at baseline and again at six months for alcohol intake, addiction severity, and biomarkers of alcohol intake.

"We found that AD male patients and healthy control male patients differed in the genotype frequencies of the IL-1RA polymorphism owing to an excess of the A1/A1 genotype in the AD males," said Sáiz. "On the other hand, analysis of the IL-1 gene complex revealed a higher frequency of the IL-1a -889C / IL-1b +3953C / IL-1RA A2 haplotype in the control group than among the AD patients, as well as in the abstainers after six months of follow-up compared to the non-abstinent patients."

A haplotype is a combination of alleles at multiple loci that are transmitted together on the same chromosome, Sáiz explained. Prior research has suggested that the study of single polymorphisms may miss more complex haplotype effects, she added.

"In short, this haplotype seemed to exert a protective effect and was related to better outcomes," said Sáiz. "These findings provide further tentative evidence of the role of the IL-1 gene complex in AD as well as evidence that the nature of the associations may be direct, gender-specific, or involve haplotype effects."

She cautioned readers to remember, however, that AD is influenced by both genetic and environmental factors. "We are talking about a multifactorial polygenic disorder caused by a combination of small variations in different genes, often in concert with environmental factors," she said. "In spite of great efforts, the exact genes related to the pathophysiology of alcoholism are yet unknown. Our work represents a small piece of the puzzle."

Of these, almost one in five drank alcohol because of depression, while 13 percent drank to deal with bereavement. More than one in ten said they most often drank when they were alone.

A separate poll of more than 2,000 adults found that one in tem was concerned about the amount of alcohol consumed by a friend or family member aged 60 and over. Foundation66, the London-based alcohol and drug charity that commissioned the research, said there was an epidemic of “late-onset” alcohol misuse among those over 60.

Research has shown that the number of older people drinking and ending up in the hospital as a result of alcohol abuse is increasing. Sally Scriminger, the chief executive of Foundation66, said, “The older people we see with drink problems come from all walks of life.”

“Many are retired professionals, who have never had issues with alcohol in the past. They don’t even have to leave home to buy alcohol—supermarket delivery services will bring it straight to their door. Because they don’t fit the stereotypes people hold about alcohol misuse, and because they often keep their drinking hidden, there just are not enough services out there to offer them the help they need,” Scriminger said.

She continued, “A huge number of people are clearly worried about the drinking habits of their parents or grandparents. Our own projects have scratched the surface of a huge unmet need among older people, and the problem will only get worse.”
 

Alcoholism and alcohol abuse have always been rampant in the American military. Heavy drinking is commonly said to be central to the soldier’s lifestyle, with the depressive drug serving double duty for its ability to both foster camaraderie and soothe mental pain. However, alcohol abuse and alcoholism are becoming more and more problematic among the enlisted, even by military standards.

Binge drinking (consuming at least five alcoholic beverages in a drinking session, at least once a week) is widespread, especially in the Army and Marine Corps. A 2007 Pentagon report stated that the rate of binge drinking in the Army increased by 30 percent from 2002 to 2005. The episodes frequently result in disorderly conduct, reduced productivity, illness, and addiction. Also, alcohol abuse is usually associated with the disconcerting rise in mental illness among soldiers, which includes a skyrocketing suicide rate.

New data from the United States Army shows that the percentage of active-duty soldiers seeking treatment for alcohol dependency has nearly doubled since 2003. Six years ago, 6 out of every 1,000 soldiers looked for help in dealing with their alcohol problems. New estimates (as of March 31, 2009), put the number at 11 per 1,000. In the years prior to 2003, the statistic remained relatively stable, indicating that the recent spike is unusual.

Many attribute the current rise in alcohol abuse to the drawn-out nature of the wars in Iraq and Afghanistan. The troops who have been repeatedly sent back to the areas are thought to be running low on mental endurance and therefore are turning to alcohol as an escape. Adm. Michael Mullen, chairman of the Joint Chiefs of Staff, has even gone on record about the increasing number of soldiers seeking treatment, saying, “I’m sure there are many factors for the rising numbers … but I can’t believe the stress our people are under after eight years of combat isn’t taking a toll.”

The Army is not the only military branch seeing a problematic rise in alcohol-related issues. The Marine Corps has reported that the number of their soldiers who have tested positive for drug or alcohol problems grew 12 percent between 2005 and 2008. Also, there were almost as many drunken-driving offences filed against Marines in the first half of 2009 as there were in all of 2008.

The Army’s vice chief of staff, General Peter Chiarelli, attributes the alarming trends in part to a lack of proper discipline. Chiarelli visited six Army installations in 2009 and discovered hundreds of cases where soldiers had failed blood-alcohol tests but were not treated or processed for possible discharge, which is the requirement. He said this could be due to commanders trying to maintain sufficient personnel for the continuous deployments into war zones. He warned that this needs to stop and emphasized the importance of treatment for substance abuse problems.

Alcohol’s easy availability and social acceptability in the military make it an ever-present temptation. Various campaigns to curb alcohol abuse within the armed forces have been unsuccessful overall, despite their success in diminishing other kinds of substance abuse.
 

In addition to dopamine and serotonin, neurotransmitters that are important in brain functioning also include histamine, which is well known for regulating allergies and stomach functioning. The extensive histamine system in the brain is also important in regulating the sleep-waking system.

In the study, conducted by Professor Pertti Panula of the Substance Use and Addictions research program of the Academy of Finland, it was observed that the brain histamine content of rats that liked to drink alcohol was higher compared with other rats. The alcohol consumption of the rats was reduced by giving them a drug that blocks the histamine-3 receptor that was discovered in the study. These findings show that the histamine system in the brain is part of the mechanism that regulates alcohol consumption.

Researchers also tested mice that lacked histamine and the histamine-3 receptor, and found that they did not become livelier after consuming alcohol, as did the histamine-containing mice. On the other hand, the rewarding pleasure effect of alcohol was stronger in the histamine-lacking mice compared with normal mice.

The study also found that transmitter histamine also contributes to the transmitting of the stimulating, pleasurable effect of alcohol in the brain. This was determined when the effects of alcohol that cause liveliness and pleasure changed noticeably when a histamine-3 receptor was blocked. This could help scientists develop a drug for alcohol addicts that would help reduce the pleasure received from alcohol.

“Whether these histamine-3 receptor drugs help in the treatment of human alcoholism will probably be clear when the results of the currently ongoing clinical trials become public. The drugs are currently being tested for the treatment of conditions such as observation disorders, sleep disorders and narcolepsy,” said Panula.
 

If you are consistently late for work or other obligations due to painful hangovers; if you dread social events where alcohol won’t be available; if you use alcohol as a way to unwind and decompress every day after work; if you feel guilty about how much you drink, you probably have an alcohol problem. The earlier you recognize the problem and get treatment, the sooner you’ll be able to get healthy and get your life back on track.

To recognize whether you have a problem, take some time to think about your drinking and ask yourself some questions, such as:

How often and how much do you usually drink? How do you feel about this amount?

Would you go to the same social events if alcohol were not available?

Do you feel guilty after drinking?

Have you resolved to cut down on drinking but keep drinking just as much or more?

Do you schedule things around drinking? For example, do you always leave Saturday and Sunday mornings open in case you’ll have a hangover?

Have you tried to stop drinking and found that you couldn’t?

Have friends or family expressed concern over your drinking?

You can also take a series of tests on the Substance Abuse and Mental Health Services Administration website. The tests will help you evaluate whether you have a problem with alcohol, find out how much money you’re spending on alcohol, and determine your blood alcohol content level (BAC).

Think about your answers to these questions as well as the general effect alcohol has on your life. Is your drinking keeping you from having the life you want? Is your drinking keeping you from being happy and healthy? Has your drinking driven away friends and family members?

If you answered yes to any of these, you’ve taken the first step, which is admitting you have a problem with alcohol. The next step is to get help, which is available in many different forms. Talk to your primary care doctor or schedule an appointment at a treatment facility as soon as possible. Remember, the best day to get help is today.
 

“To date, most alcohol and drug abuse initiatives have been directed towards the needs of younger generations. Our evidence points to the fact that many older people and their families also need help with addiction problems, and today they are simply slipping through the net,” says Gerald Lee, director of the charity.

Professor Moira Plant, who co-wrote the report with Professor Martin Plant at UWE’s Alcohol & Health Research Unit, says that the number of older people in the United Kingdom is increasing, and one result of this is that “the costs of caring for those with specific health problems associated with periodic or chronic heavy drinking is likely to mushroom.”

She continued, “Greater acceptability of alcohol consumption in public, particularly amongst women in the Baby Boomer generation and more affordable and widely available alcohol has lead to growing numbers drinking more than the recommended levels. A significant increase in support for (caretakers) and services for older people with alcohol-related healthcare problems will be needed. We need to research the extent of heavy and problem drinking amongst older people, including those residing in residential care facilities. Moreover, training urgently is required to enable (caretakers) to identify and manage (or obtain help to care for) alcohol-related problems amongst older people.”

Plant said that in the next few years, alcohol-related problems amongst older people are likely to affect health and other social services. Alcohol abuse can lead to osteoporosis and a greater risk of bone fractures, liver disease, and interactions with prescription medications. Alcohol combined with sleeping pills or arthritis medication can cause drowsiness; alcohol with diabetes medication can cause headaches; and alcohol with blood thinners can alter the drugs’ effects and increase the risk of bleeds.

Drinking also increases the risk of accidents, hypothermia, depression, dementia, and bereavement.

The report says that people should continue to enjoy habits such as drinking but that regular health assessments should be carried out, particularly when people are taking medication for other illnesses or conditions. “Most importantly,” says Professor Plant, “research could usefully be conducted to examine the extent of heavy drinking and alcohol related problems amongst older people in residential care.”
 

Alcohol has been shown to cause chronic pancreatitis, which can lead to pancreatic cancer, but previous studies had been unable to confirm the association between drinking and pancreatic cancer. However, a recent study published in the journal Cancer Epidemiology, Biomarkers, and Prevention suggests that men and women who consume more than two alcoholic beverages a day could increase their risk of developing the cancer.

Unlike previous studies, the current research pools data collected from 14 research studies, which included 862,664 people. The data was collected prospectively, which means that information about dietary and environmental exposures was collected prior to the pancreatic cancer diagnosis. Of the 862,664, 2,187 were diagnosed with pancreatic cancer during the study.

If an individual consumed approximately two drinks per day (compared with no alcohol per day), their risk of pancreatic cancer was slightly increased. Researchers defined one drink as 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of 80-proof distilled liquor.

Although there was no significant difference between men and women when comparing alcohol intake with the risk of cancer, the association was seen in women at two or more drinks per day. The researchers also observed a higher risk among men who consumed three or more drinks a day.

In addition to chronic pancreatitis and diabetes, smoking is still considered the strongest risk factor for pancreatic cancer. In 2008, there were about 18,910 new cases of pancreatic cancer reported and 34,290 deaths from pancreatic cancer.

"Despite being a deadly disease, there are few known risk factors for developing pancreatic cancer," explains lead author Jeanine M. Genkinger, PhD, an assistant professor at Georgetown University’s Lombardi Comprehensive Cancer Center. She continues, "At this point, it’s important to understand any protective or risk factors for this dangerous disease even if the risks are weak or modest."