Mr. Wilko is a 40-year-old salesperson with a wife and three teenage children. He has recently begun to have a beer at lunch and a few drinks after work to reduce his work-related stress. An economic downturn in the housing industry has reduced the need for new home appliances and his income and sales record has been affected. Several other salespeople have been laid off at his firm. He has been told that if his sales and attendance records do not improve he will be fired. He and his wife are constantly arguing about finances and the children's increasing demands for money. His drinking has increased to several beers at lunch and continued drinking after dinner. When he returns to work with alcohol on his breath, he is dismissed from his job. He continues to consume alcohol during the day as he attempts a job search. His wife is very concerned, as are his teenage children.
Mr. Wilko states he is a social drinker and “can stop at any time.” How accurate is his self-assessment?
What stressors are present in Mr. Wilko's case?
Why does Mr. Wilko continue to increase his alcohol intake?
What changes in liver function can Mr. Wilko expect if he continues to drink large amounts of alcohol?
Mr. Wilko complains to his wife that all the stress is causing “indigestion.” How do stress and alcohol consumption affect GI function?
Why is Mr. Wilko at greater risk of trauma?
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Recent literature shows that alcohol does not cause peptic ulcer disease (PUD) but rather exacerbates existing PUD:
'In the past it was thought that stomach ulcers were caused by certain lifestyle factors, such as spicy foods, stress, smoking and alcohol. However, there is little hard evidence to confirm that this is the case.
It may be that although these types of lifestyle factors do not cause ulcers, they may make the symptoms of ulcers worse'
'There is a protective effect of alcohol consumption against active infection with H. pylori In contrast, alcohol intake (comparing those who drink > 30g of alcohol per day to non-drinkers) is not associated with higher risk of duodenal ulcer.
Aldoori WH, Giovannucci EL, Stampfer MJ, Rimm EB, Wing AL, Willett WC (July 1997). "A prospective study of alcohol, smoking, caffeine, and the risk of duodenal ulcer in men". Epidemiology 8 (4): 420–4. doi:10.1097/00001648-199707000-00012. PMID 9209857.
Alcohol is acidic so adds to the acidity of the digestive juices in the stomach. Thus it can irritate the lining of the stomach and bowel (contributing to IBD inflammatory bowel disease). It also damages the lining of the esophagus, causing pain and discomfort if any acid comes up from the stomach (acid reflux). In conjunction with fatty or spicy foods which are acidic, and foods high in sugar which cause more acid to be produced in the stomach, indigestion caused by alcohol consumption is increased. Such foods are associated with comfort eating, a habit seen in depressed persons, which Mr Wilko is likely to be since losing his job, arguing with his wife and suffering the physical and psychological health effects associated with high alcohol consumption. Nutritional deficiency also occurs as alcohol inhibits the uptake of nutrients into the blood. Malnutrition may also be associated with depression and cause general ill-health.
Alcohol is a poison so stresses the liver in particular which filters poisons from the blood, as well as all other organs of the body. if taken in sufficiently high doses alcohol can cause death by poisoning. Another cause of acute death is the person suffocating on their own vomit whilst they are sleeping, possibly in an alcoholic stupor.
In any 12 step program for overcoming substance abuse, the very first step is admitting that you have a substance abuse problem, in this case alcohol. Mr Wilko's statement that he is a social drinker and can stop at any time is a classic case of denial. He is internally aware that he has a problem and that it is clearly negatively affecting his life, but he cannot bring himself to admit it publicly and seek out help. If he or anyone else were to logically look at the state of his life as a result of the alcohol abuse, they would not continue to drink and elect not to stop drinking. So Mr. Wilko's self assessment is not accurate at all.
The stressors in Mr. Wilko's are the results of his family and his finances. As a spouse and parent, he has a moral and financial responsibility to take care of his family. The economy is poor and his older children are starting to want more money so he is feeling the financial pressures of all that. Then he loses his job, thus throwing his stress level into overdrive. So his stressors are family pressures and finances.
Mr. Wilko continues to increase his alcohol intake because his stress level increases. He is already feeling financial pressures and then to make things worse he loses his job and income. So he increases his alcohol intake to compensate for the increased stress.
Mr. Wilko can expect liver problems if his drinking continues. He will get what is called fatty liver where fatty acids accumulate in his liver. The condition can worsen with time to alcoholic hepatitis and possible even cirrhosis, or a hardening and death of liver cells.
The indigestion he complains of is most likely peptic ulcers in reality. This results from stomach acid producing a lesion in the lining of the stomach or intestines. The acid then burns the tissue underneath, thus causing pain and discomfort. Smoking, stress, alcohol, and certain foods can exacerbate ulcers and gastrointestinal functionality.
While the exact linkage between alcoholism and trauma is not known really known, it has been estimated that between one fifth and one third of cases of emergency room trauma stem from alcohol abuse as the main cause.
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