Introduction
Today, people introduce different reasons for their decision to drink alcohol. Some individuals find alcohol helpful in reducing stress and dealing with low self-esteem. Men and women of different ages cannot avoid alcohol because of family history or poor supervision. Sometimes, alcohol is considered a good means of entertainment or a commonly available relaxing activity. In other words, a personal choice is usually related to a final decision about drinking without thinking about possible complications and health problems.
According to the National Center for Drug Abuse Statistics (NCDAS, 2023), American adults drink alcohol at least once in their lifetime, while 6.7% of those older than 12 years develop alcohol use disorder (AUD). During the last several decades, alcohol abuse has been introduced as a serious public health concern affecting men and women of all races, including Whites, Blacks, and Hispanics. People are free to develop their attitudes toward alcohol, but the main fact is that alcohol changes human lives and families. This paper aims to analyze alcohol abuse comprehensively, with special attention to its pharmacological properties, gender and racial factors, associated disorders, and ethical principles to be applied in treatment.
Societal Reaction to Alcohol Abuse
The development of a personal opinion about alcohol is a crucial step in understanding the impact of this abuse on society and formulating individual attitudes. In my opinion, our society tries to react negatively to those who abuse or become dependent on alcohol. Still, these attempts are not correctly identified and remain unthoughtful, making it possible for alcohol to put human life at risk.
I have several reasons to explain my point of view. First, people like to think they succeed in independent decision-making and follow their free and democratic beliefs. Such confidence results in the inability to see the truth and their vulnerability to the environment.
Many advertisements are created to promote alcohol, even in an innocent way. The examples vary, including alcohol consumption in movies, marketing campaigns, and even drinks on the house. Many young people do not notice the moment when they cross the line and buy a Cosmopolitan cocktail, preferred by the characters in Sex and the City, or a bottle of Corona, favored by Dominic in the Fast and Furious franchise.
Second, many modern people do not recognize their weaknesses but are concerned with the mistakes or misconduct of others around them. As a result, it is normal for a person to drink one or two bottles of beer and neglect behavioral or emotional changes. However, when the same person sees a relative or a close friend drinking alcohol or changing their behavior, a negative reaction emerges.
Finally, there is always an evident statistical absurdity about alcohol abuse and people’s beliefs. Although more than 80% of the US population is aware of alcohol risks and related deaths, 60-70% of the same group continue drinking alcoholic beverages regularly (NCDAS, 2023). Professional organizations introduce serious numbers to prove alcohol is dangerous and share recommendations for safe drinking. In many guidelines, it is noted that two drinks in one day do not provoke irreversible damage to human health, including 10-140 g/week for women and 10-280 g/week for men (Palzes et al., 2020). Still, even this information seems insufficient for people to understand when and how to take alcohol safely.
When people become dependent on alcohol consumption, AUD with different severity levels is diagnosed. Some patients are eager to get treatment and visit alcoholic anonymous (AA) meetings to discuss current community problems, share personal experiences, and observe each other’s behaviors (McCrady & Flanagan, 2021). This kind of help does not consider shamefaced or ineffective, and alcoholics can find support and care.
However, more questions or concerns are raised when another person finds out about the AA status. It is interesting to understand why people are not able to control their drinking habits and resist alcohol on their own. Unfortunately, some genetic factors, the environment, and health conditions affect the way alcohol is consumed and how it affects a person.
Psychopharmacological Properties
Nowadays, people have wide access to different alcoholic beverages in various forms, but they lack knowledge about the fundamental psychopharmacological properties of the substance. Psychopharmacology focuses on understanding a substance’s effects on the human body, behavior, and other cognitive abilities. Without addressing scientific literature, people can observe how alcohol changes their habits and skills in a short period. At the same time, the severity of these impacts depends on personal characteristics, the environment, and physiology. The main area of impact of alcohol is the human brain.
According to Nutt et al. (2021), alcohol intake is associated with reducing myelination, a process in which additional layers of myelin affect neuronal axons and their electrical action potential transmission. Although these reductions are reversible, the brain needs time to restore proper functioning. In this case, age is a crucial factor because an older human brain is more vulnerable to the effects of alcohol, and the alterations in the brain structure provoke additional harm to the system.
The use of alcohol can be dangerous for the human heart and the cardiovascular system in general. Goel et al. (2018) found that alcohol consumption has a controversial and multi-dimensional nature, provoking such health problems as ischemic heart disease, stroke, heart failure, hypertension, atrial fibrillation, and cardiomyopathy. Alcohol affects the heart and peripheral vasculatures and destroys the major muscular tissue of the heart, the myocardium, decreasing the contraction function (Dguzeh et al., 2018).
Other complications include the enlargement of the heart and the inability to pump blood properly. The main threat of this pharmacological property is the absence of evident clinical symptoms. At the same time, researchers reveal the cardioprotective benefits of alcohol, like red wine (Goel et al., 2018). Some polyphenolic compounds and resveratrol of red wine taken moderately decrease oxidative stress and increase the cholesterol level (Dguzeh et al., 2018). These controversies play an important role in formulating a final decision about taking alcohol and defining its protective measures.
Many other parts of the body are negatively affected by alcohol consumption, including the liver and the skeletal system. When people think about the consequences of drinking, the effect on the liver is the most commonly discussed topic. Addressing its psychopharmacological properties, one should understand that frequent alcohol consumption cannot be properly metabolized, and many toxic metabolites continue circulating in the body (Goel et al., 2018).
The liver is responsible for alcohol metabolism and detoxification of harmful elements, a process known as oxidation (Dguzeh et al., 2018). Like any organ in the body, the liver needs time to restore and improve its functions, but if the use of alcohol is long-lasting, it is hard to complete the task properly. As a result, the liver is damaged due to a number of scars (cirrhosis) caused by alcohol. In addition, vitamin D and calcium deficiencies are observed, leading to nutrient loss and low bone density (Dguzeh et al., 2018). Thus, alcohol intake should be rational and never exceed the recommended levels, which are continuously examined and discussed.
Alcohol Abuse in Terms of Gender and Ethnicity
Alcohol consumption varies in different groups, and recent research has paid attention to such factors as gender and ethnicity. Although men drink more alcohol and experience severe health problems, women remain more susceptible to alcohol-driven complications like memory blackouts and cardiovascular disease (White, 2020). In modern society, males become regular drinkers and alcoholics who seek professional help, and gender gaps and inconsistencies need to be addressed. Still, gender differences are not the only issues for analysis, and Mulia and Bensley (2020) continue the same trend and expand their studies about alcohol-related disparities in terms of their races and ethnicities. Thus, alcohol abuse in terms of gender and ethnicity should be separately examined in this paper to introduce a comprehensive analysis of the topic.
Gender
Talking about gender differences in drinking alcohol, people like to believe that males are more exposed to related problems. In fact, statistics prove this fact and create a solid background for creating additional policies and treatment plans based on male physiology and health peculiarities. For example, The Lancet (2022) reports that approximately 1.34 billion people drink alcoholic beverages, including 1.03 billion males and 0.312 billion females.
Men are usually three times as likely as women to have alcohol abuse that leads to death (NCDAS, 2023). The World Health Organization (2020, as cited in Khamis et al., 2022) admits that about 7.1% of global diseases due to alcohol are diagnosed in men and 2.2% in women. All these statistics prove that alcohol is more harmful to men.
However, one should recognize that some physiological differences make females more vulnerable to alcohol than males. For example, women are more likely than men to have relapses and alcohol-provoked stressful events (White, 2020). Women also have a lower body water volume and a higher body fat volume than men, which explains better metabolism in the latter group (Greaves et al., 2022). Other factors include lower gastric emptying times in females, hepatic clearance, and higher plasma volumes in women (Greaves et al., 2022). Therefore, the National Institute of Alcoholism and Alcohol Abuse (2007, as cited in Palzes et al., 2020) developed its recommendation for alcohol consumption: no more than four drinks and three drinks per day for men and women, respectively.
Still, primary care reports show that most individuals neglect these guidelines (Palzes et al., 2020). The reasons for women to increase their alcohol intake are partner violence, sexual assaults, social aggression, and unequal treatment (Greaves et al., 2022). Additional questions about the correctness of alcohol consumption as the male prerogative rise with time. There are also specific details about gender-based alcohol consumption with respect to their ethnicity.
White Women
There is a common belief that Caucasians consume alcohol more often than other ethnic groups. Addressing the gender differences, the national survey reveals that White women have the highest risks for alcohol dependence (Mulia & Bensley, 2020). About 71% of White women have continued developing their drinking habits and become heavy drinkers during the last several years. In comparison, the number of White female drinkers did not prevail by 40% in 2013 (Murray, 2022). It means that binge drinking has already become an epidemic among White women, provoking not only mental disorders and dependence but also affecting the liver, blood pressure, and cognitive skills.
White Men
Despite an increased number of White women with AUD, the male statistics are even more damaging. The American Addiction Centers (2022b) states that White men usually outnumber White women regarding alcohol-related problems. Caron Staff (2022) examined the findings from the Centers for Disease Control and Prevention, the 2019 National Survey on Drug Use and Health, and other organizations to show that 74% of White males consume alcohol.
For example, in the United States, more than nine million White men older than 12 were diagnosed with AUD in 2019 (Caron Staff, 2022). White males do not find it dangerous to drink heavily, even if they are aware of alcohol-related problems. Their alcohol consumption may have different causes, from a simple desire to severe dependence.
Black Women
The reasons for alcohol consumption among Black women vary, depending on the existing racial and gender grounds. On the one hand, the number of Black female drinkers is not as high as that of Whites, and includes about 47%. On the other hand, comparing the increase from 2013 (no more than 10%), alcohol dependence is also high and serious (Murray, 2022). In addition, Black women are at a greater risk for diabetes, cardiovascular problems, and cancer. Thus, even an insignificant number of AUDs in Black women can result in serious health problems and the need for interventions.
Black Men
The frequency of drinking alcohol among Black men is lower than among White men. Blacks take fourth place in the rating of alcohol consumption, with about 63% of men (Caron Staff, 2022). Thousands of African Americans live in poverty, and it is hard for a man who has problems with alcohol to find a good job or be educated about cancer or cardiovascular risks (American Addiction Centers, 2022b). Despite the possibility of controlling their heavy drinking habits, the outcomes of alcohol are more severe in Black men compared to other groups in terms of health and quality of life.
Hispanic Women
During the last several decades, Hispanics have been introduced as one of the fastest-growing ethnic groups in the world. More than 65% of this population lacks health insurance, which creates additional challenges in addiction treatment (American Addiction Centers, 2022b). Only 4% of Hispanic women suffer from alcohol dependence, and most of them are 40 years or older (Mulia & Bensley, 2020). However, this number continues to grow due to increased stress factors, household responsibilities, and caregiving challenges.
Hispanic Men
Ethnic demographics on alcohol use remain inconsistent when talking about Hispanic male interests. On the one hand, the chosen group takes the second-highest rate, with about 70% of Latino males consuming alcohol. On the other hand, there is a positive tendency in Hispanic men to reduce alcohol consumption: about 35% reported abstinence from alcohol (American Addiction Centers, 2022a). Thus, compared to other gender groups, Hispanic men are less vulnerable and more resistant to alcohol abuse.
Ethnicity
Understanding the differences in age and gender is important, but it is also necessary not to forget that the representatives of various ethnic groups might also experience specific outcomes from alcohol consumption. According to Khamis et al. (2022), alcohol consumption is associated with such factors as family or socioeconomic backgrounds and religion. For example, Agrawal et al. (2017, as cited in Khamis et al., 2022) report that religious beliefs affect both Black and White individuals in terms of avoiding alcohol. Many Blacks and Hispanics are exposed to racial discrimination and unfair treatment, which may cause them to drink alcohol and increase their self-esteem and self-efficacy (Nalven et al., 2021). Still, ethnic-specific characteristics go far beyond religion or social inequalities.
Racial and cultural backgrounds affect the way people treat alcohol abuse and seek necessary treatment. According to the American Addiction Centers (2022b), the prevalence of alcohol consumption differs among the representatives of Hispanics (8.6%), African Americans (7.4%), and Caucasians (8.4%). The Hispanic population is one of the fastest-growing groups in America and is characterized by the highest alcohol rates. Still, Whites have high ratings in developing AUD compared to Hispanics and Blacks (Nalven et al., 2021). The same group reports binge or heavy drinking more often compared to other ethnicities, and a similar prevalence is observed in all age groups (American Addiction Centers, 2022b).
Although there is a belief that Black or Hispanic Americans develop regular drinking habits, their social and economic factors affect their choices. More than 22% of the Black population and 20% of the Hispanic population live in poverty, without health insurance coverage. They cannot afford to buy alcohol regularly or officially report alcohol-related problems and ask for specific treatment. Thus, the evaluation of racial disparities explains why some individuals cannot deal with alcohol dependence while others are less exposed to health-related problems like AUD.
Whites
Ethnic characteristics define the quality of further treatment and the ability to manage safe alcohol consumption. At this moment, Whites or Caucasians demonstrate the highest rate of AUD, and more than 57% of individuals older than 12 years drink alcohol (American Addiction Centers, 2022b). The major risk factors include family history and economic stability, which make White populations more exposed to various alcohol problems and concerns.
Blacks
African Americans drink less than White Americans because of social and financial inequality. However, the risk for behavioral health problems cannot be ignored due to the possibility of abusing more than one drug at a time (American Addiction Centers, 2022b). As a result, frequent mental disorders, abusive behaviors, and increased needs for treatment are observed in this ethnic group. Blacks must improve their health insurance to get the required professional help when necessary.
Hispanics
Compared to other ethnic groups, Hispanics do not suffer from a high level of alcohol dependence. On the contrary, these individuals address their cultural norms and traditions, which may be related to the use of alcohol as a part of their history (American Addiction Centers, 2022a). The lack of health insurance and the absence of health insurance in many families explain the increased number of undiagnosed AUD among Hispanics and underline the necessity to offer effective treatment interventions.
Alcohol Impact on Families
When a person decides to drink an alcoholic beverage, several outcomes have to be considered, including the reaction of a family and the quality of interpersonal relationships. On the one hand, family members are significantly affected by the behavior of a person under the influence of alcohol. Emotional changes, financial concerns, and overall responsibilities are hard to predict and follow. On the other hand, a family is a social unit where most habits and attitudes are created and supported.
Family background is one of the critical aspects of human life because it predetermines a preferred lifestyle and contributes to the formation of personality (Khamis et al., 2022). For example, women report harm due to their partners’ aggression provoked by alcohol consumption more often than men. At the same time, they use male aggression as an explanation for a frequent desire to take alcohol and increase their self-esteem or deal with emotional or physical pain (White, 2020). Such interconnectedness of alcoholism as an outcome and as a reason for family problems becomes a core issue in current research discussions.
In many families, alcohol contributes to the growth of marital issues and complications in relationships. Some people affected by drinking start neglecting their duties, face legal problems, and challenge family functioning as a whole (McCrady & Flanagan, 2021). With time, it becomes impossible for a person to stop drinking and gain control over their needs and desires to take another alcoholic beverage.
In addition to alcohol abuse, families experience severe financial needs because alcohol is not free. Drinkers’ impulsivity provokes irrational decisions: people quit their jobs, neglect education, and forget to develop their skills and knowledge (McCrady & Flanagan, 2021). As a result, families do not pay their house bills, get into debt, lose friends, and deteriorate their emotional and physical well-being.
In addition to behavioral changes among family members, alcohol plays an important role from a genetic and biological point of view. If a woman continues taking alcohol during pregnancy or does not stop taking it because of her unawareness of pregnancy, there is a risk of developing fetal alcohol syndrome (FAS). This condition is defined as one of the causes of cognitive or behavioral impairment in a child because of prenatal alcohol exposure (Subramoney et al., 2018).
Thus, when alcohol abuse is noticed in a family, its potential risks should not be limited to the direct participants (drinkers) but may include all potential victims, like children. FAS may be developed in a variety of forms due to prenatal alcohol exposure. For example, children with FAS have certain decreased functions in orientation, habituation, arousal, and muscle tone. Together with delays in cognition and physiology, alcohol intake provokes increased irritability, poor emotional regulation, and difficult temperament (Subramoney et al., 2018). Shifts characterize each stage of FAS development, and parents are responsible for offering their children the best treatment options.
Treatment Options
Poorly controlled alcohol consumption leads to the progression of severe diseases like AUD, heart failure, or stroke. Palzes et al. (2020) define a frequent co-occurrence of AUDs and psychiatric disorders, which affect the progression and severity of the disease: from depression and anxiety to schizophrenia and suicidal attempts. Different problems require specific diagnostic help and therapy because not everyone can recognize their treatment needs.
In general, there are several stages for alcoholics to take and recover from their dependence. First, organizational changes are important to clarify their intentions, avoid the temptation to drink, and find alternatives during AA meetings. Second, cognitive behavioral therapy (CBT) and family engagement are required to examine environmental stimuli and provide positive consequences. Finally, pharmacological interventions are developed to optimize outcomes with the help of medications (Palzes et al., 2020). All these steps can be taken separately or in combination, depending on the severity of alcoholism and the presence/absence of additional support.
One of the main aspects of choosing a treatment approach is understanding the worth of personal changes and available alternatives. The American Addiction Centers (2022b) inform that not all racial minorities follow the same requirements. For example, most Hispanics neglect a need for treatment due to their cultural norms, language barriers, or a lack of treatment services. Black Americans usually have more than one substance abuse issue and elevated risks of drinking-related issues, but limited treatment options due to poverty, homelessness, and incarceration (American Addiction Centers, 2022b).
Thus, White Americans get more access to various services and may choose specialized treatment programs. Their treatment should begin with regular AA meetings and communication with an expert to identify alcoholism as a serious problem that affects personal life and family relationships. Then, evaluating needs and possibilities is necessary to identify future steps. Finally, visits to local bars or alcohol shops should be restricted to avoid reminding oneself of that harmful habit.
CBT is another way to recover from alcoholism and safely stabilize physiological needs and moods. The essence of CBT is to change the patient’s cognition and behavior, resolve distorted thoughts, and decrease drinking antecedents. Enhanced communication skills allow family members to discuss problems and offer solutions through regular interactions and cooperation. Patients analyze their drinking patterns and develop new skills through implementing positive beliefs and sharing thoughts (McCrady & Flanagan, 2021). When family members are involved, it is easier for alcoholics to understand what goes wrong and how to achieve the desired outcomes.
Finally, if CBT and reorganizing daily activities are insufficient and do not bring positive results, pharmacological interventions can be added to a treatment plan. Primary or emergency care departments aim at evaluating alcohol-related harms, screening patients, and offering the most effective medications (White, 2020). One of the current innovations in medical treatment is intranasal oxytocin, which blocks motivation for alcohol and decreases the desire to take another drink (McCrady & Flanagan, 2021).
Low doses of acamprosate, topiramate, disulfiram, and naltrexone are effective for treating alcohol dependence and reducing alcohol consumption. These medications provoke ethanol-related reactions, like nausea, hypertension, vomiting, and sweating, and patients experience fear of taking alcohol (Kranzler & Soyka, 2018). Although not all patients agree to take medications on their own, healthcare providers recognize new ways to help alcoholics and their families and predict ethical or legal issues.
Ethical Principles
Despite the patient’s condition or other supplementary factors, the task of any healthcare practitioner is to ensure the best care services. In medicine and health care, there are four common ethical principles: justice, autonomy, beneficence, and nonmaleficence (Erdmann et al., 2021). The current review shows that not all patients get equal and impartial AUD treatment due to racial and gender disparities (American Addiction Centers, 2022b; White, 2020).
However, each principle has its purpose and impact on care outcomes and human well-being. Thus, patients with AUD should receive care with justice, meaning no favoritism, discrimination, or subjective opinions (Erdmann et al., 2021). Multiple attempts are necessary to maximize patient autonomy, but additional decision-making and evaluations are required if there is a need to go against the patient’s will.
According to the principle of beneficence, healthcare providers must do good for their patients, and AUD patients must access the best treatment and follow lifestyle issues (Erdmann et al., 2021). Finally, nonmaleficence is similar to the previous principle as it means not harming the patient. It is important to gather patient data before treatment to succeed in treating people with AUD.
Conclusion
Alcohol abuse is a common public health problem in the United States and across the globe. Some people do not recognize the impact that they can be found under after regular and heavy alcohol consumption. The current analysis reveals differences in the psychopharmacological properties of alcohol to prove changes in the brain and other body systems. Although there is evident diversity based on gender and racial factors, it has been proven that all patients with AUD deserve the right to get equal and fair treatment. Alcohol abuse changes human lives in various ways, including health, family relationships, and overall social image.
Alcohol is dangerous not only to the person who takes it but also to family members and unborn children, leading to diseases such as FAS, depression, and suicidal risks. Therefore, it is not enough to admit that alcohol is dangerous and follow professional recommendations. It is more important to ensure that modern populations can access pharmacological and non-pharmacological care interventions and treatment based on the ethical principles of justice, autonomy, beneficence, and nonmaleficence.
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