Treating an Alcoholic With Comorbid Medical Issues

Alcohol abuse and alcohol use disorders represent the most problematic forms of substance use disorders in the United States, according the Substance Abuse and Mental Health Services Administration (SAMHSA). Numerous professional sources have documented the effects of alcohol abuse and the types of comorbid issues that commonly occur as a result of moderate to heavy use and abuse of alcohol. The major types of comorbid issues that occur as a result of having an alcohol use disorder can be broken down in terms of alcohol’s effects on several different organ systems and other areas of functioning.

The Cardiovascular System

Research studies have documented the strong association between significant cardiovascular damage and alcohol abuse. The American Heart Association (AHA) describes several major comorbid issues that occur with alcohol abuse. Despite some research studies that suggest that there is a mild association between low levels of alcohol use and improved cardiovascular functioning, AHA does not recommend that individuals use alcohol as a method of avoiding cardiovascular issues or in an effort to improve their health.

Comorbid cardiovascular issues that may occur as a result of an alcohol use disorder are outlined below.

  • High blood pressure (hypertension) and use of alcohol have been demonstrated to have strong associations over numerous studies. Individuals who abuse alcohol often engage in poor dietary practices and do not get sufficient exercise, compounding this relationship.
  • Elevated levels of cholesterol have also been associated with the use and abuse of alcohol. In addition, there is a relationship between obesity and moderate to heavy alcohol use that compounds this relationship. Being obese is a significant risk factor for numerous cardiovascular issues.
  • Issues with irregular heartbeat (arrhythmia) are also strongly associated with use of alcohol.
  • A condition known as alcoholic cardiomyopathy occurs in some chronic drinkers. Individuals have a weak heart muscle that is ineffective in pumping blood and can lead to symptoms of fatigue, irregular heartbeat, shortness of breath, and swelling in the feet and legs.
  • Moderate to heavy use of alcohol increases the risk for heart attack and/or sudden cardiac death syndrome.
  • Moderate to heavy use of alcohol increases the risk for an individual to have a stroke.
  • Other cardiovascular issues can occur as a result of chronic moderate to heavy use and abuse of alcohol.

Depending on their severity, cardiac issues can significantly affect the life of the individual. Hypertension is often termed one of the “silent killers” in that it is a condition that can contribute to serious and even fatal medical issues, such as stroke and heart attack, but individuals often do not overtly experience sickness as a result of having the condition. Other cardiovascular conditions often vary in their presentation, according to their level of severity.

Organizations, including AHA, report that the cardiovascular damage that occurs as a result of heavy alcohol use may be significantly reversed over time if an individual simply just stops drinking alcohol and engages in positive lifestyle changes; however, certain issues, such as alcoholic cardiomyopathy or damage from a stroke or heart attack, may not fully resolve. Individuals often need to engage in sound dietary habits, exercise programs, and use medications in order to cope with the effects of chronic use of alcohol. Poor health due to cardiovascular problems can also significantly affect an individual’s recovery from an alcohol use disorder.

Alcohol’s Effects on the Liver

Most individuals are aware that chronic use of alcohol can affect the functioning of the liver. The liver is responsible for the removal of waste products and other substances from an individual’s system by filtering them out in the bloodstream. Because pure alcohol is actually a toxin, the liver assigns priority to eliminating alcohol from the bloodstream before working on ridding the body of other substances. When a person drinks excessive amounts of alcohol, the liver works overtime to remove the alcohol from the individual’s system. This situation results in the liver working extremely hard to remove this toxin, and over time, it can result in significant damage to the liver.

Scar tissue forms on the liver, and the liver begins to decline in function. Fatty deposits and scar tissue may build up on the organ and further decrease its ability to perform its function. If sufficient amounts of scar tissue develop, an individual may be diagnosed with a serious condition, such as cirrhosis of the liver. Abstaining from alcohol can result in the liver being able to regain some of its previous level of functioning if there is not significant damage; however, there is a point where the damage will not resolve.

Liver damage as a result of cirrhosis is a serious medical issue that can result in numerous medical conditions, including dementia, organ failure, and death. Individuals who require liver transplants as a result of chronic alcohol abuse are typically not placed very high on organ donor waiting lists, complicating their ability to recover.

Gastrointestinal Issues

Chronic alcohol use and abuse of alcohol can be associated with numerous gastrointestinal issues.  Alcohol is a toxin and can produce significant inflammation in the gastrointestinal tract.

When the lining of the stomach is inflamed, it produces a condition known as gastritis. If gastritis occurs repeatedly over extended periods of time, damage to the stomach and intestines can occur, such as the development of abscesses due to the buildup of excessive acid. When this condition continues, an individual can develop ulcers, which are extremely uncomfortable and can create serious life-threatening conditions.

An individual who experiences gastritis from chronic alcohol use can reverse the situation by simply abstaining from alcohol and getting treatment if the condition has not developed to a severe level. However, scar tissue in the gastrointestinal tract will often remain, and this may result in complications. Obviously, ulcers can complicate an individual’s quality of life as well as their ability to engage in a formal alcohol abuse recovery program.

Alcohol’s Effects on the Skeletal System

Chronic and excessive use of alcohol can interfere with the metabolism of calcium in an individual’s system. This can lead to an increased risk for an individual to develop osteoporosis. Osteoporosis is a medical condition that occurs when an individual’s bones have significantly decreased in density. This makes them more prone to breaking and can result in significant issues with functioning. The condition is more commonly associated with elderly individuals, particularly elderly women; however, alcohol abuse is a significant risk factor for the development of osteoporosis over all age groups.

The most effective way to address osteoporosis is to prevent it from happening. Once osteoporosis has developed, depending on its severity, treatment can reverse the effects to some extent, but people who have developed moderate to severe osteoporosis may have long-term issues with mobility, pain, and susceptibility to bone fractures. Pain and mobility issues can be barriers to effective recovery from an alcohol use disorder.

The Central Nervous System

The central nervous system (CNS) consists of the brain and spinal cord. There is a large body of research evidence that has documented numerous effects of alcohol use on the brain. Alcohol use, even in small amounts, affects the CNS at multiple levels, from the cellular level to specific areas of the brain and networks of neurons that are involved in numerous areas of functioning.

Damage to the nerves (neurons) in the CNS, which can become severe and lead to significant issues with thinking, moving, and emotional control, can occur. In addition, alterations to neural pathways in the central nervous system that can lead to more generalized effects can take place. There are significant associations with numerous types of brain diseases or neurological disorders. The list of neurological conditions associated with alcohol use and abuse is too long to list in its entirety here but includes conditions like:

  • Seizures
  • Brain cancer
  • Increased risk for stroke
  • Significant issues with memory, attention, and problem-solving as a result of brain damage
  • The development of dementia

A neurological condition that many people often associate with excessive use of alcohol is Wernicke-Korsakoff syndrome. The syndrome consists of nystagmus (rapid and uncontrollable of the eyes), issues with gait (walking), confusion, psychosis, and amnesia. The amnesia that occurs as a result of the syndrome is typically a combination of antereograde and retrograde amnesia where the individual displays dense memory issues for past and even recent events.

Retrograde amnesia, where individuals have difficulties explaining or remembering events that occurred in the past and were previously easy to recall, is a condition that indicates there is severe and extensive brain damage. Retrograde amnesia leads to the individual confabulating, or making up stories about past events. Most individuals who have suffered a brain injury will display issues with antereograde amnesia, difficulty forming new memories, and remembering recent information.

Wernicke-Korsakoff syndrome is not caused by alcohol abuse directly, but it is a result of a dietary insufficiency that can occur in some individuals who do not pay attention to their diet as a result of chronic and heavy alcohol abuse. It may also occur in other situations, such as with individuals who have undergone bariatric surgery or have poor dietary habits. The condition is due to a chronic lack of vitamin B1 (thiamine), and if recognized early enough, it can be reversed by vitamin supplementation and diet. However, when the condition continues, the damage to important areas in the brain, such as the thalamus, hippocampus, and other areas, may be irreversible.

When a person develops damage to the CNS as a result of alcohol use, the duration of any functional issues associated with the damage depends on numerous factors. Abstaining from alcohol may result in some recovery and correction in the brain. These changes are typically slow and may not peak until the individual has been totally absent from alcohol for 5-7 years or even longer. The majority of the recovery occurs within the first year of abstinence; however, like the liver, the ability of the central nervous system to repair itself is limited, and significant damage may result in a situation where the damage cannot be repaired. Damage to areas of the central nervous system can also lead to increased vulnerability to develop mental health issues.

Mental Health Issues

The American Psychiatric Association (APA) and the National Institute on Drug Abuse (NIDA) consistently report that having any substance use disorder is associated with an increased risk to develop other mental health conditions, including eating disorders, major depressive disorder, anxiety disorders, bipolar disorder, trauma- and stressor-related disorders, etc. The relationship between alcohol abuse and the development of other psychological issues is bidirectional, such that having an alcohol use disorder can lead to the development of other mental health issues and having some other psychiatric diagnosis can lead to the development of alcohol abuse.

Individuals who have comorbid alcohol use disorders and other psychiatric disorders present specific challenges in treatment and recovery from both issues. These individuals are typically much harder to treat, require specialized attention, and require longer periods of time in treatment in order to experience recovery. When these individuals also have comorbid physical conditions that are associated with alcohol abuse, this situation can become even more complicated.

Comorbid Social Issues

APA, NIDA, and other organizations consistently report that issues associated with alcohol abuse are also associated with various issues that affect an individual’s social functioning. In fact, the diagnosis of an alcohol use disorder by definition infers that the individual is experiencing some level of distress and dysfunction in their social life and occupational functioning.

Issues with social and occupational functioning may occur as a result of an individual’s abuse of alcohol or may be contributing factors to alcohol abuse, depending on the situation. Nonetheless, chronic abuse of alcohol exacerbates an individual’s ability to function in an efficient manner. Individuals who have significant issues with their social and occupational functioning have increased risk to develop other issues, including numerous diseases, other medical issues, and mental health disorders.

Alcohol Abuse: A Very Complicated Situation

Unfortunately, many individuals tend to be under the assumption that individuals who have substance use disorders, including alcohol use disorders, can simply quit drinking and their problems will disappear. While becoming abstinent from alcohol will certainly improve an individual’s situation dramatically, it will not remove all the issues an individual struggles with. The National Institutes of Health (NIH) suggests that the extent of recovery from physical, cognitive, and emotional issues as a result of alcohol abuse depends on several factors, such as:

  • How long the individual abused alcohol
  • The amount of alcohol an individual typically used/abused
  • A person’s family history and genetic makeup
  • If the individual also abused other substances in conjunction with alcohol, including tobacco, prescription medication, illicit drugs, etc.
  • Lifestyle factors, such as an individual’s overall health, diet, exercise habits, etc.
  • Psychiatric, cognitive, social, or medical conditions that are co-occurring with the alcohol use disorder

Ultimately, chronic use and abuse of alcohol can be associated with numerous comorbid conditions, including medical conditions, neurological conditions, psychological conditions, and social issues. Abstaining from alcohol use can result in these issues resolving to some extent, and continuing to use alcohol can only result in these issues being exacerbated. Individuals who suffer issues related to their use of alcohol should seek treatment for both their alcohol use disorder and any other comorbid conditions.