Are you an alcoholic - It is not as obvious as you might think

Chances
are you raised a glass of something bubbly during a toast to a Happy
New Year. Chances are you followed that toast with a resolution to make
the year ahead better than the one before. And chances are one of those
vows included cutting back — or out — on the very cheer you used to ring
in a happier, healthier future. Why? Maybe because you’ve spent one too
many nights praying to the porcelain god, one too many mornings
wondering what you did the night before, one more wasted day nursing a
wicked hangover. Maybe it’s because you’re afraid. Afraid you’re
becoming — gulp — an alcoholic. But how can you know for sure? 

Signs and signals 

Dr. Jurgen Rehm, PhD, Director of the Social and Epidemiological Research Department at Toronto’s Centre For Addiction and Mental Health (CAMH), says there are a number of psychological signs of “alcohol
dependence,” a term he prefers over “alcoholic.” These include
preoccupation with the thought of drinking, drinking alone or in secret,
drinking despite knowing the risks and harm. Withdrawal and tolerance
are two of the most important biological criteria. Tolerance is defined
as needing more and more alcohol to satisfy the craving; withdrawal
includes symptoms such as tremors, restlessness and agitation. If you
recognize yourself in any of those symptoms, you could have a problem. 

The
archetype of the bum slumped curbside cradling a bottle inside a brown
paper bag is just one, albeit uncommon, example of an alcoholic. The
other is of a perfectly ordinary person who consumes copious amounts of
booze with seemingly no effect. “The majority of people who are alcohol
dependent in our society are what you would call functional alcoholics,”
Rehm explains. “You would be surprised to learn how many qualify.” 

Sobering stats 

According to
Health Canada, 4 to 5 million of us engage in high-risk drinking. Other
studies estimate 10 per cent of us use alcohol to the extent that it’s a
hazard to our health or relationships, and disrupts work and school. In
fact, Canadians drink a staggering one-and-a-half times the global
average, Rehn confirms. Since more than half the worldwide adult
population abstains from alcohol completely over their lifetime, we’re
obviously working hard to keep the numbers up. And, says Rehm, “A lot of
people from those populations are immigrating to Canada. So if we have
the same level of drinking, that means the drinkers drink more per
drinker because the immigrants are most often abstainers.” 

So
why are we knocking back so much booze, anyway? It’s expensive. It’s
bad for our health. It ruins our sleep and hurts our relationships.
Hangovers are hell. What gives? 

A
lot of us reach for the bottle as a way to cope with stress and
anxiety. It is, in fact, the most common way we self-medicate for
depression. But it so often backfires, because alcohol is a temporary
salve. Once we’re sober, the problems are still there. So we pour
another, and the cycle continues. It’s not a particularly viable coping
strategy, since it doesn’t get at the core of what’s causing the
depression or anxiety. Yet you’d be forgiven for thinking drinkers are
perennially happy and carefree: the cocktail culture is omnipresent in
marketing and advertising, TV and movies, where imbibing is depicted as
not only socially acceptable but often encouraged and rewarded. 

But
while we’re helping boost the bottom lines of the big booze companies,
our bodies are breaking down under the toxic effects of too much
alcohol. Alcohol affects brain function, including memory, focus, mood
and behaviour. It harms the heart, the liver and the pancreas and
increases your risk of cancer. In fact, Rehm outright calls alcohol a
carcinogen. Worse, it’s a factor in 7 per cent of all deaths in Canada.
Not to mention a burden on the public health system, as well as on
friends and families. 

How much is too much? 

Canada’s Low-Risk Alcohol Drinking Guidelines
stipulate a maximum of 10 drinks per week for women, 15 for men (a
drink is defined as 12 ounces of beer/cider/cooler, five ounces of wine,
or one-and-a-half ounces of liquor), with no more than two a day, and
with a couple of drink-free days a week. Pregnant women, anyone on
certain medications or with a family history of alcohol abuse, of
course, should abstain completely. 

Rehm
acknowledges the research that some moderate drinking — one a day or
one every other day — can be beneficial, since it raises good
cholesterol, which lowers the risk of coronary heart disease. 

“If
you religiously drink just one a day, I don’t think health would be a
big concern,” he says. “Unfortunately, less than 1 per cent of Canadians
would drink only one a day, so it’s very rare that people would
actually drink in a way that would be beneficial to their health.” 

In
fact, some experts say alcohol-associated health risks outweigh any
benefits. And if you’ve never been a drinker, there’s no reason to start
based on any perceived advantages. Exercise and a healthy diet are, as
always, far better options for thwarting illness and disease. 

How to quit

Even
if you’re the slightest bit concerned you’re drinking too much, you
might want to put a cork in it now. After all, New Year’s resolutions
don’t come out of the blue. Chances are you’ve been mulling the idea
long before the clock struck midnight on Jan. 1.

Quitting
isn’t easy. You’ll have to face some hard truths; you may feel guilt,
shame, weak. But admitting you have a problem truly is the first,
perhaps hardest, step. The rest will range from difficult to hell, and
will determine whether you go it alone or seek help. 

“If
there is a manifest dependence or problem, it would be good to consult a
specialist,” says Rehm, “and there are a lot of therapies that don’t
require that you go overnight or quit your job.” 

The
important thing is that you do something. Rehm notes that just one out
of 10 problem drinkers in Ontario goes into treatment, because it’s so
stigmatized. “It’s the lowest of any chronic disease. With diabetes,
nine out of 10 get treatment.” But yet both conditions can be
self-inflicted. 

“We
don’t stigmatize someone who has blood pressure over 140, but where do
you think high blood pressure comes from? Surely not from eating
correctly or having enough exercise.” 

So
what does modern detox look like? Rehm says a combination of
psychotherapy, motivational enhancement therapy and cognitive
behavioural therapy will likely be suggested in order to identify why
you drink and teach you how to avoid triggers. Anti-alcohol drugs might
also be a part of the treatment to block the effects of alcohol and/or
ease withdrawal. 

For
mild or moderate dependence, urges and cravings are often short-lived
and controllable. If you can distract yourself long enough for them to
pass, you’re ahead of the game. Adopt the “recognize-avoid-cope”
approach used in cognitive behavioural therapy to change harmful
patterns: Recognize your triggers; avoid tempting situations; employ
coping mechanisms when the first two fail. While you wait for the urge
to pass, try meditating, calling someone, going for a walk, diving into a
hobby, taking a bath, having a bowl of ice cream or cup of tea. Remind
yourself why you’re making this change, and applaud yourself for it. 

Before
you know it, the hankering will fade and you truly will have a happy
(and healthy) new year. And that’s something to celebrate.

How do painkillers know where you hurt

"Show me where it hurts."

Once that painkiller moves from your hand to your mouth and to the inside your body, how does it know where to go?

For all of its painful associations, it's a tender phrase, one we associate with parental love and the occasional doctor's visit. As children, we couldn't use fancy words to describe our scrapes, but we could point and wince, and somehow the medicine knew where we hurt.
Or so it seemed. In reality, painkillers are less magic bullet and more shotgun blast: They cruise through the bloodstream, mixing metaphors and sabotaging the machinery of pain wherever they find it. So, if your head happens to be splitting when you pop a pill for your aching back, you get a twofer.
If you picture your body's nervous system like a series of Civil War telegraph wires, then you can imagine a series of dispatches coming into headquarters reporting damage from all over the country, which the president -- your brain -- experiences as pain. If you want to relieve the president's pain, you need to stop the sender, interfere with the wires or post a spy to intercept the messages. If you get really desperate, you can always knock the president unconscious.
Various pain meds adopt each of these approaches. Analgesics lessen pain without blocking nerve impulses, messing with sensory perception or altering consciousness. They come in many varieties, including anti-inflammatory drugs that reduce pain by shrinking inflammation. Analgesics also include COX inhibitors, which stop the signals, and opioids, which decrease the severity of pain signals in the brain and nervous system. When these just won't do, doctors turn to anesthetics, which just block all sensations, pain or otherwise, by knocking you out or numbing a particular area [sources: Encyclopaedia Britannica; Ricciotti and FitzGerald; Wood et al.].
So these treatments don't zero in on pain; rather, they wander along the transmission right-of-way, looking for pain-carrying messages and then blocking, destroying or intercepting them. To understand how this works, let's take a closer look at the physiology of pain.

Getting the Message

Illustration of the pain pathways

Understanding pain has challenged philosophers, doctors and researchers for centuries. In the Far East, it began with the idea of imbalanced yin and yang forces. The ancient Greeks thought it arose from out-of-kilter bodily humors. The Muslim physician Avicenna saw it as arising from some alteration in physical condition. And, of course, numerous cultures believed that gods doled out pain as punishment and demanded it as penance [source: Encyclopaedia Britannica].
Pain research and theory began in earnest in the 19th and 20th centuries, but the medical and technological advances of the past 40 years have revolutionized the field [sources: Encyclopaedia Britannica; Craig]. A prevalent model of how pain works goes as follows.
Let's say you touch a hot stove and burn your hand. Instantly, your arm recoils and you feel pain because a network of specialized nerves called nociceptors (from the Latin noci- "harm" + receptor) has activated. Unlike other nerve types, nociceptors only trigger when they detect a harmful event, such as too much heat or pressure. When this happens, these nerves convert the noxious stimulus into an electrical signal that zips to the brain with the bad news. How? Their nerve endings change shape, creating pores that let positive ions like sodium and calcium surge in. This influx of ions drops the voltage across cell membranes and generates electrical potential. The worse the injury, the bigger the signal [sources: Wood et al.; Woolf and Ma].
That takes care of how pain nerves alert the brain and spinal cord, but how do nociceptors detect injury in the first place? In several ways, some of which we're still figuring out. Often, they detect wayward chemicals like prostaglandins. These are not "pain molecules." Rather, they are chemical substances that aid in a variety of vital bodily functions. But they should not be out bouncing around where the nociceptors can pick them up unless something has gone wrong, so they make good damage signals [sources: Ricciotti and FitzGerald; Wood et al.].
Nociceptors don't always need such chemicals to do their job; they can also detect some harmful effects directly. Excessive heat, for example, can open signal-producing ion channels on its own. So can the capsaicin in a chili pepper, which explains why, to quote Ralph Wiggum, of "The Simpsons," "it tastes like burning" [source: Wood et al.].
Personal Pain: It's Not Just for Goths
Studies show that people of different sexes, races, experiences and cultures feel pain differently. In part, this is because severe pain can alter your nervous system at a molecular level, especially if you experience it frequently and/or at a young age. Moreover, pain exists entirely in your noggin -- it's how your brain interprets a particular set of nerve signals -- and its intensity keys off emotions and mental states (indeed, psychological factors can cause pain). In short, no two people feel pain the same way [sources: Encyclopaedia Britannica; Cleveland Clinic; Craig].

Haven't Got Time for the Pain

 Pain keeps us out of trouble. When it isn't busy preventing injury, it's lessening it or reminding us to let it heal. But sometimes pain becomes a nuisance, like an alarm bell that keeps clanging away long after the fire dies out.

One way to mute this din is to cut the signal off at the source. That's ibuprofen's party trick: It stops banged-up cells from ginning up or sending out more prostaglandin. Ibuprofen belongs to a whole category of pain medicines called nonsteroidal anti-inflammatory drugs, or NSAIDs. NSAIDs also relieve the swelling and inflammation that can cause pain. NSAIDs include aspirin and naproxen sodium (aka Aleve) [sources: AHFS; McNicol].
Other analgesics ignore the pain signal but muffle the bell. Acetaminophen, aka Tylenol, works in the brain and central nervous system to deaden pain, although researchers do not fully grasp how it works [sources: AHFS; McNicol].
Both NSAIDs and acetaminophen belong to a category called non-opioid analgesics. Most non-opioid analgesics work by inhibiting cyclooxygenase (COX) or COX-2 enzymes, which kick off the process of converting arachidonic fatty acid found in cell walls into the prostaglandins that activate pain nerves. No prostaglandin means no nociceptor activation and therefore no pain [sources: AHFS; McNicol; Ricciotti and FitzGerald].
For more severe short-term pain, as after an operation, or long-term pain, many doctors turn to opioids. Opioid drugs plug into an existing network of receptors located in your brain, spinal cord and body. Under normal conditions, this system works with your body's naturally produced opioids to control all kinds of processes, including pain. Natural opiates, like morphine and codeine, as well as synthetic opioids, mimic the structure of these naturally occurring neurotransmitters and hijack the system. Like spies who knock out the guards and then man the gates, they keep out other signals, including those associated with pain. They also plug into the body's reward system, producing potentially addictive euphoric effects [sources: Encyclopaedia Britannica; Fine and Portenoy; NAABT].
More intense medical procedures, like surgery, involve general, regional or local anesthesia. General anesthesia involves a mixture of drugs that calms patients, keeps them unconscious, lessens or relieves their pain, relaxes their muscles or blocks their memories from forming. Regional anesthesia locks down sensation from a whole section of the body, e.g., from the waist down, while local anesthesia numbs a small portion, like a foot or spot of skin. This might seem highly localized but, again, the painkiller doesn't know where you hurt -- the person applying it does [sources: Encyclopaedia Britannica; Mayo Clinic].

At Least 26 US Kids Die of Flu in Bad Season

A flu shot helps fend off common strains of influenza.

A particularly bad flu is sweeping the United States, killing 26 children so far this season and nearly doubling hospitalizations among people over 65 in the past week alone, officials said Friday.
The reason is the predominant strain of flu this year is H3N2, a variety that has shown itself in prior years to be more virulent than other kinds.
Even more, the vaccine that is supposed to protect against the annual flu is missing its mark because two-thirds of the H3N2 strains that experts are seeing were not included in this year's flu shot, said the US Centers for Disease Control and Prevention.

"It is shaping up to be a bad year for flu," said CDC chief Tom Frieden in a conference call with reporters.
"H3N2 is a nastier flu virus than the other flu viruses."
At week seven of the typically 13-week flu season, the virus "is now widespread in almost the entire country," he said.
Flu typically infects five to 15 percent of the population. It can be dangerous in those with weak immune systems, including the elderly and children.
Frieden said hospitalization rates among people over 65 "are rising sharply," going from 52 per 100,000 last week to 92 per 100,000 this week.
"That is high but typical for H3N2 seasons," Frieden said.
The last H3N2 season was in 2012-2013, and the cumulative hospitalization rate among the elderly that season was 183 per 100,000.
Flu Shots May Not Work Well This Year
"We wouldn't be surprised to see something similar happen this year," Frieden said.
An update on the effectiveness of this year's vaccine will be released in the coming weeks.
While Frieden said he expect to find the vaccine to be weaker than usual, he said authorities are still urging people to get their flu shot because it may offer some protection against other strains of the flu that are circulating.
He also called for doctors to give antiviral drugs, like Tamiflu, to patients if they get sick.
"In the context of an H3N2 predominant season, with a less effective vaccine, treatment with anti-flu drugs is even more important than usual," he said.
Scientists have found that anti-flu drugs can reduce symptoms, shorten the duration of symptoms and reduce the risk of complications, he said.
"Anti-viral flu medications are greatly under-utilized but if you get the flu and you get medicines early they could keep you out of the hospital, they could keep you from having to go into the intensive care unit and they might even save your life."
Most people do not know the anti-viral drugs exist and fewer than one in five high-risk patients get treated, he said.