3 Addictions

Drinking alcohol in moderation should not pose any serious health problems. However, regular heavy drinking may cause your body to become dependent on alcohol. Any time you try to reduce your drinking or stop it altogether, you will experience alcohol withdrawal symptoms. These tend to be very uncomfortable, making it much harder to control your drinking habits.

What are the symptoms of alcohol withdrawal?

• Insomnia
• Trembling
• Mild anxiety
• Headache
• Stomach upset
• Palpitations
• Excessive sweating
• Anorexia
• Hallucinations (visual, auditory, or tactile)
• Seizures
• Tachycardia (heart rate of over 100 beats per minute)
• High blood pressure
• Fever
• Agitation
• Disorientation
• Delirium tremens (DTs)

Mild symptoms, such as trembling, headache, and stomach upsets, generally happen within 6 to 12 hours of your last drink. Hallucinations and seizures can occur within 24 to 48 hours. The worst symptoms, such as delirium tremens (DTs) and intense hallucinations, may develop after 48 to 72 hours.

DTs constitute a medical emergency. Thus, if you or someone you know is experiencing this, call for medical help immediately. If DTs is not treated promptly, it may turn life-threatening.

What causes alcohol withdrawal?

Alcohol interferes with the normal function of the brain. As a depressant, it slows down activity in the brain, promoting relaxation. If you drink frequently, your brain will soon become used to the effects of alcohol. Consequently, to keep the brain functioning, it will have to work harder to keep you alert.

Once you cut down on alcohol or stop drinking, the brain is still in that hyperactive state. Without alcohol to slow the brain down, withdrawal symptoms like anxiety, trembling, restlessness, and seizures kick in. The cause is an overactive brain.

How is alcohol withdrawal treated?

Benzodiazepines are commonly used medications to treat withdrawal symptoms like seizures, insomnia, and anxiety. These drugs, also known as “benzos”, are central nervous system depressants. In other words, they slow down the activity of the brain, effectively calming you down. You may even feel drowsy or sleepy while taking benzos.

Both benzos and alcohol are depressants, and both have addictive potential as well. Benzos also carry other side effects, including dizziness, confusion, and muscle weakness. Thus, benzos need to be taken carefully and only with medical supervision to be effective.

Three benzos are often used in alcohol withdrawal treatment. These are:

• Chlordiazepoxide (Librium)
• Diazepam (Valium)
• Lorazepam (Ativan)

These drugs are tightly regulated, and you cannot get them without prescriptions. Thus, they are only used in proper treatment settings. These medications are often part of alcohol detox, which can either be inpatient or outpatient.

Inpatient rehab settings give the best results for detoxing with benzos. Here, you get 24/7 care from medical professionals, so in case you feel anything strange, uncomfortable, or painful, you can get help right away. But benzos have also seen success when prescribed in outpatient rehab programs.

Because of their potential side effects, the dosing of benzos need to be carefully monitored and controlled. Which benzo you will be given, and how much, depends on the withdrawal symptoms you have, the severity of your alcohol dependence, and whether you are in an inpatient or an outpatient rehab setting.

There are three methods mainly used when prescribing benzos for alcohol detox.

Symptom-Triggered Regimen (STR)

In STR, your benzo dosage depends on how you rate your level of pain. If your pain rating is higher, you get a bigger dose. Several other criteria are also assessed before any medication is prescribed.

For STR to work safely, you can only undergo this regimen in an inpatient rehab facility. You will need direct supervision from doctors and consistent monitoring.

The main advantages of STR is it shortens the length of treatment and lets you take less medication overall. The risk of under- or overmedication is also smaller.

Fixed Tapering Dose Regimen (FTDR)

In FTDR, your dosage is fixed regardless of the severity of your withdrawal symptoms. FTDR can be used in outpatient settings, as consistent monitoring will not always be required. Also, this regimen works best if you have mild withdrawal symptoms.

Also, as the name implies, your dose will be tapered down with time. Benzos are only temporary medications, as using them for a long time can lead to addiction.

Loading Dose Regimen (LDR)

LDR uses long-acting benzos, which stay in your body for several days. It works best in preventing seizures, and it is only done in inpatient rehab settings. Monitoring is important in LDR, so it cannot be administered in outpatient rehab programs.

Other medications

Aside from benzodiazepines, other drugs may also be used to manage alcohol withdrawal symptoms. Anticonvulsants like gabapentin and carbamazepine are also helpful, especially in preventing seizures. Additionally, some studies have shown that anticonvulsants can help with reducing alcohol cravings.

The good thing about anticonvulsants is their lack of addictive potential. With that, they are safer than benzodiazepines. However, using anticonvulsants alone may not be enough to effectively manage alcohol withdrawal symptoms. Thus, both kinds of medications may be used in combination.

Adrenergic drugs, like clonidine, are also used when detoxing from alcohol. These drugs lower your blood pressure and heart rate if they are high. Adrenergic drugs do not treat seizures or DTs, though.

Are medications always needed in treating alcohol withdrawal?

Medications are not always necessary. Before doctors prescribe you anything, they will assess your condition first. Not all cases of withdrawal warrant medication.

Doctors often use what is known as the CIWA-AR (Clinical Institute Withdrawal Assessment – Alcohol Revised) scale to find out how severe your withdrawal symptoms are. If you score zero to 8 points on this scale, medications may not be necessary for you. But if you score 9 and above, you will be prescribed medications.

If you do not need medication, supportive care will be given to you for up to 36 hours. After that time, it is highly unlikely that you will develop worse withdrawal symptoms.

To ensure that withdrawal does not bother you again, it is best to stay away from alcohol. Continuing to drink will significantly increase the chances that you will experience withdrawal again in the future.

Drinking alcohol is a popular social activity for many people. However, it does have a lot of negative health effects. Alcohol can affect your liver, heart, kidneys, muscles, and even your testosterone levels.

Read on to find out more of alcohol’s effects on testosterone in detail.

What is testosterone?

Testosterone is a hormone produced in the testicles. It’s a predominantly male hormone, though women also produce small amounts of it in their ovaries. Testosterone is mainly responsible for regulating sex drive and sperm production. Other effects include influencing bone and muscle mass, fat storage, and red blood cell production. It can also affect mood.

Low levels of testosterone in men can cause the following:

• Infertility
• Erectile dysfunction
• Loss of muscle mass
• Low libido
• Lethargy
• Loss of body hair or facial hair
• Development of breasts
• Loss of bone mass
• Poor concentration
• Hot flashes

In women, low testosterone can cause:

• Low sex drive
• Brittle bones

This hormone requires three glands to be made. These are the hypothalamus, the anterior pituitary gland, and the testes. Here is the process:

1. Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus.
2. GnRH stimulates the anterior pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
3. FSH and LH stimulate the testes (or ovaries in women) to produce testosterone.

Alcohol disrupts the function of all these glands, inhibiting the production of testosterone.

What are the short-term alcohol effects on testosterone?

When you drink, alcohol affects your pituitary gland and hypothalamus. Without GnRH, FSH, and LH, the testes cannot produce testosterone. Based on research, testosterone levels drop as quickly as 30 minutes after drinking.

In another study, healthy men were made to drink one pint of whiskey every day for 30 days. Their testosterone levels were then compared to those of men suffering from alcohol use disorder. After 30 days, the testosterone levels of the healthy men were nearly identical to those of the men with alcohol use disorder.

What are the long-term alcohol effects on testosterone?

If you drink heavily for a long time, you are more likely to have poor testicular function than people who drink moderately. In turn, your testosterone levels will be lower than theirs. Also, you will be more likely to be afflicted with erectile dysfunction and low libido.

Aside from interfering with the hypothalamus and pituitary gland, alcohol can also damage the Leydig cells of the testes. These cells are responsible for producing testosterone. The damage is more pronounced when it’s a product of long-term drinking.

But if you drink only moderately, it should have no long term effects on your testosterone levels.

Does alcohol affect sperm production?

Alcohol disrupts the function of certain cells in your testes called Sertoli cells. These play a big role in sperm production, particularly in helping sperm mature. With the Sertoli cells affected, sperm cannot develop properly.

Also, testosterone and FSH have roles in sperm development. Alcohol decreases the levels of both these hormones, thus it negatively affects the growth of sperm. It may even lead to spermatogenic arrest, which is interrupted development of sperm. In turn, there will be a low concentration of sperm in the semen.

According to studies, about 50 percent of men who drink heavily were affected with spermatogenic arrest. Only 20 percent of men without alcohol problems had this issue. The studies additionally found that men who drank heavily had smaller testicles than other men.

Other studies have found out that heavy drinking may even turn the precursor molecules of testosterone into estrogen, increasing the levels of estrogen in men. Normally, this hormone is higher in females as it is responsible for maintaining the female reproductive system and controlling the menstrual cycle. If estrogen is high in men, it will affect sperm production, leading to smaller concentrations of sperm in the semen.

Additionally, high estrogen levels in men may cause these conditions.

Gynecomastia

This condition is marked by unusually large fat tissues in the breasts of men. In turn, their breasts enlarge and appear like the female counterparts.

Erectile dysfunction

Maintaining an erection requires a balance of hormones in the male body. If estrogen levels are high, this balance is disrupted, making it harder to stay erect. This condition is made worse when combined with low testosterone levels.

Stunted growth

Adolescent boys who drink alcohol are more likely to not grow tall. Increased levels of estrogen would stop them from growing in height. Also, high estrogen concentrations will cause the epiphyseal plates in their bones to close early, permanently stunting their growth.

How do I prevent these conditions when drinking alcohol?

Most studies show that moderate consumption of alcohol does not negatively affect testosterone production. That means you need to limit your alcohol intake to two drinks per day (for men) or one drink a day (for women).

Based on the Dietary Guidelines for Americans, one standard drink is defined as:

• 12 ounces of beer (normally at 5% alcohol)
• 5 ounces of wine (normally at 12% alcohol)
• 5 ounces (or one shot) of vodka, whiskey, gin, rum, or other distilled spirits (normally at 40% alcohol)

Any more than one or two of those drinks is considered heavy drinking, which raises your risk of developing testosterone-related problems.

The more you can limit your drinking, the better it will be not just for your testosterone levels, but for your overall health as well.

If you have alcohol use disorder and cannot stop drinking, get professional help right away. Talk to your primary care doctor or an alcohol addiction specialist, who will help you create a treatment plan that’s just right for your needs.

You may have to enroll in a rehab program, and if your condition is serious, you may need to live inside a rehab facility for one to three months. Recovery takes a while, but if you’re focused and committed to it, the outcomes are good. After rehab, you will be able to live a sober life once again.