This month's edition of Psychiatric Annals, guest edited by Mark Gold, MD, focuses on the problem of alcohol abuse, both among the general public and within specific groups such as medical students and adolescents. We see that while the rate of alcohol abuse in physicians is the same as in the general population, it takes the same toll in disability and comorbidity, and that physicians who successfully complete treatment and maintain follow up have an impressively higher rate of sustained sobriety.
Alcohol occupies a particular place in our society. It is a potent drug with many powerful effects on the brain and body that has been a fixture in civilization since Noah got inebriated on wine after successfully piloting his ark through the great flood. It is a legal substance in Western societies, unlike other mind-altering substances, which may cause less medical morbidity. Some of the fathers of our country, like Thomas Jefferson, have sung its praises.
As potent a drug as alcohol is, anyone can easily self-prescribe it — for any purpose. It is a common “treatment” for insomnia and social phobia, as well as other anxieties. It is often self-prescribed to “treat” depression and mood swings. In every case, however, prolonged use of alcohol will make the condition worse, not better.
When we think of the risks associated with psychoactive medications, they usually pale in comparison with the risks associated with alcohol. When it comes to comorbidity with psychiatric illnesses, alcohol ranks number one in its capacity to worsen the outcome of any disorder as well as increasing the risk of suicide.
Yet alcohol remains attractive, with its rapid dopaminergic and opioid system effects that lead to pleasure system enhancement and short-lived anxiolysis as well as a decrease of inhibitions and sedation progressing to amnesia. An ideal psychotropic drug! The longer-term effects of abuse, inhibition of judgment, and performance as well as the development of tolerance and neurological toxicity often manifest later over time — buy now and pay later!
Given its social and legal acceptance and its far-ranging and potent pharmacologic properties, alcohol may be the world's most powerful drug. It's interesting that a drug associated with such morbidity isn't something fiendishly constructed in the laboratory of a mad scientist. Rather, it is the product of natural fermentation of growing plant life, just as opium and cannabis are natural substances. Would our world have been better without them? Or rather: is alcohol a social lubricant and “medication” that Western society needs in order to function?