Decoding the Spirit of Life

Dr. Raviteja Innamuri MD (CMC Vellore),

Consultant Psychiatrist.

Where did the journey begin?

The journey of mankind’s journey with alcohol or for that matter any substance is time immemorial. Man’s quest to understand, his biological need to quench his curiosity that maybe a result of the expanding frontal brain always led him to one thing – substance. For some, it helped to expand their experiential horizons and gave us spiritual masters and musical bands. For some, it allowed some entertainment in a world that is spinning around itself in void. For others, it brought doom.

Many of us including teetotallers have a close relationship with substances as they occur naturally, are regularly synthesized in our bodies and are even consumed without our notice.

Did you know that coca-cola had traces of cocaine and 7up had traced of Lithium before they were identified and were asked to be removed. No wonder, they got so popular. From a scientific perspective, which brain wouldn’t enjoy a little bit of stimulant (cocaine).

My journey with alcohol began during my second year of MBBS training when I accidently stumbled upon the chapter on CNS depressants in the popular pharmacology textbook – Katzung. The naïve me couldn’t understand why alcohol, the spirit that supposedly makes people dance in the movies and pubs was classified under CNS depressant!

Decoding the pharmacology and impact

The simplest layman explanation of this complex interaction, is that, alcohol is actually a depression causing chemical (GABA agonist). However, because of its initial interaction with other CNS depressants, there is initial euphoria/happiness. Later, alcohol inevitably brings the devdas out!

To add more spice to the story, not all spirits are made equal. Hence they are compared based on the amount of pure alcohol in each drink that gives us an equation something like this – 10ml pure ethanol = 1 pint beer = 30ml whiskey = 100ml wine, etc. While doctors maybe busy calculating the required benzodiazepine to substitute it during detoxification/deaddiction treatment, the experience of the patient is a more important factor to be considered.

Jokes apart, the impact of alcohol is far greater than any other substance because it’s legal, states treasury depends on its sales, easily available and promotes social bonding among us social beings as we lose a bit of our inhibitions.

Alcohol mainly affects the brain and liver. In the brain, it mainly targets frontal brain (loss of inhibition and executive functions) and the cerebellum (motor coordination – remember the drunken gait!) In the long run, it causes a wide variety of problems – from causing shrinking of the liver (cirrhosis) to shrinking the brain (dementia).

Understanding its impact as a psychiatrist

As a medical student, we are well aware of the physical damage caused due to use of alcohol in dependence pattern (a neuroadaptive state caused because of continuous exposure of the brain to alcohol). However, what really shook me is the lesser visible but far worser psychological complications that lead to the breakdown of families – domestic violence, accidents, childhood trauma and disturbances in the society. What’s worse is that this cycle is perpetual – alcohol abusers create more abusers, either intentionally or unintentionally.

About an year ago, I relocated from CMC Vellore to the lesser known Nizamabad in Telangana state. Owing to higher unemployment, socio-cultural reasons and availability, I noted that the prevalence of alcohol use is far higher. What’s worse is the permitted local liquor called ‘Gulpharm’ that is a dangerous concoction of long acting benzodiazepines, fermented palm sap and other partially known ingredients. One example of its grave consequence is frequent presentation of withdrawal seizures immediately after delivery as the lady is abstinent from Gulpharm during her labor! It gives me jitters even to continue this train of thought – poor neonatal adaptation, ADHD or lower IQ and subsequently possible anti-social personality traits and disturbances in the society etc.

The Kaliyug

We consume various foods daily. We may be satisfied with the same quantity of rice or rotis for a few months or years but substances do not follow that pattern. However, when it comes to alcohol or any other substances, our brains gradually require greater amounts to produce the same affect while worsening the damages physically and psychologically. But there is only so much alcohol our body can consume and there is so much damage we can take, as finite beings and as a civilised society. That is something worth pondering upon.

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