ALCOHOL AND LIVER DISEASE
Before looking at the psychological effects of alcohol dependency, it is useful to be aware of other factors which may influence a person's behaviour and contribute to psychological effects. SUCH FACTORS ARE :-
 Physical Effects
 Extent Of The Individual's Drinking Problem
 Individual's Economic Status
 Individual's Social/Marital/Relationship Positions
 Cultural Aspects
 Personality
 Age
 Employment
All of the above factors may influence the psychological or behavioural effects of any individual's consumption of alcohol.

DEFINITIONS OF DIFFERENT KINDS OF DRINKERS SOCIAL DRINKER
Someone who drinks usually not more than 2 - 3 units of alcohol a day and does not become intoxicated, is not likely to harm him/herself or family through drinking. The amounts that can be drunk without harm vary widely between individuals, but greater amounts than this are associated with increasing risk of harm.

HEAVY DRINKER Someone who regularly drinks more than 6 units of alcohol a day but without apparent immediate harm.

PROBLEM DRINKER Someone who experiences phsical, psychological, social, family occupational, financial or legal problems attributable to drinking.

DEPENDENT DRINKER Someone who has a compulsion to drink; takes roughly the same amount of alcohol each day; has increased tolerance to alcohol in the early stages and reduced tolerance later; suffers withdrawal symptoms if alcohol is stopped which are relieved by taking more; in whom drinking takes precedence over other activities and who tends to resume drinking after a period of abstinence.

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH ALCOHOL DEPENDENCY
CENTRAL NERVOUS SYSTEM (CNS) Within minutes of first being consumed, alcohol begins to have an effect on the brain. It first depresses the inhibitory centres of the brain - consequently a person may feel more confident, more able to relax and "let themselves go". This is why people believe that alcohol acts as a stimulant, because the depressant effect results in behaviour which is usually attributable to stimulants. This lessening of inhibitions can also initially result in the person being able to approach people of the opposite sex more confidently, so appearing to increase their sexual desire and attractiveness. With moderate consumption these effects can appear to be quite positive for a person. However, as tolerance to alcohol increases, a person will need to consume larger amounts to achieve the required positive effects.

This then has a negative rebound effect, whereby aspects of a person's character e.g. depression, poor self-image, guilty and anxiety which drinking has repressed, return with greater intensity when a person stops drinking There then evolves a vicious circle whereby a person consumes increasing amounts to prevent increasing psychological problems.

ANXIETY This presents both in people who drink to submerge anxiety which was present prior to their drinking, and in people who suffer from anxiety through withdrawal. Alcohol is known to increase rather than decrease anxiety. Added to this is the effect that drinking can have on life situations, which can exacerbate anxiety.

DEPRESSION Either as a primary state, where alcohol has been used to self-medicate, or as a consequence of alcohol dependency, or both. A huge incidence of suicide or suicide attempts (15% of all suicides) are related to alcohol misuse. Depression may also be a result of negative life situations resulting from an individual's drinking behaviour.

GUILT Usually presents as a consequence to problems and damage caused through alcohol dependence, but alcohol may also be used as a way of dealing with guilt.

POOR SELF-IMAGE Self respect is often lost through drinking. However, alcohol is also used by people with a low self-image as a means of improving or disguising it.

EXTREME OR PATHOLOGICAL JEALOUSY This can exist in intimate relationships where there is alcohol dependency. This can be exacerbated by increasing unattractiveness of drinker to partner.

DENIAL/NON-ACCEPTANCE This is a common initial mechanism, due either to social reinforcement of alcohol use, where many social groups drink heavily; or fear of being "labelled" or "stigmatised"; fear of job loss; marital breakdown; or inability to face up to the problem..

PARANOID ATTITUDE This may be found in an intoxicated state, or in alcohol withdrawal syndromes such as Delirium Tremens. This can also be associated with disinherited behaviour or suspicion of others whom they feel may be aware of their problem.

SOCIAL INADEQUACY This could cover young people from a particularly poor or insecure early background eg experience of parental disharmony. It can also be a consequence of addictive behaviour, where loss of coping mechanisms are transferred into alcohol use as an alternative coping mechanism. Social skills may also be eroded.

EMOTIONAL DISTURBANCE Violence, aggression, agitation.

SOCIAL WITHDRAWAL Drinkers becoming increasingly isolated.

MANIPULATIVE BEHAVIOUR Either as a learned behaviour pattern, in order to blame others and reinforce drinking, by manipulating the environment and other people, or simply to obtain alcohol itself. This behaviour can also be linked to avoiding responsibility for the problem, by putting other people into situations where the drinker may appear to be the victim.

PHOBIC STATES These can occur, particularly with people who drink either alone or at home, usually both. This is closely linked with anxiety.

PSYCHOLOGICAL STATES WITH A PATHOLOGICAL CAUSE ASSOCIATED WITH PROLONGED ALCOHOL ABUSE
HALLUCINATIONS These can occur during withdrawal and are commonly visual, although they can be of touch or hearing. High levels of alcohol in the blood can result in a slowing of normal brain waves, which can lead to a state of delirium in which hallucinations can occur. They quickly disappear once the stage of withdrawal passed and the blood alcohol level decreases.

DELIRIUM TREMENS This is a result of high levels of alcohol in the blood. It is a serious disorder which can occur 2 - 5 days after alcohol withdrawal. Its onset is abrupt and symptoms include trembling, agitation, confusion and hallucinations. The condition usually subside after 2 -3 days, but has a significant mortality rate due to injuries sustained during confusion; dehydration and circulatory collapse, hypothermia and inter-current pneumonia.

WITHDRAWAL SEIZURES These can occur 12 - 48 hours after alcohol withdrawal. Isolated or repeated epileptic fits may occur.

BLACKOUTS Drinkers may lose their memory for a period during which consciousness is impaired. Alcoholic "blackouts" may develop consisting of less memory for several hours or days during which time the person may seem to be behaving relatively normally.

WERNICKE'S SYNDROME (OR WERNICKE'S ENCEPHALOPATHY) Caused by a deficiency of vitamin B. When recognised early, this condition responds well to thiamine therapy and can be rectified. Symptoms include confusion, memory loss, delirium, difficulties in walking and with eye movement.

KORSAKOFF'S SYNDROME Also caused by vitamin deficiency which affects the nervous system. It results in severe short-term memory loss and often confabulation to compensate for loss of memory. A person is unable to process and store information and often develops a characteristic shuffle. Whilst this condition can be treated with thiamine therapy, only 20% of people fully recover. The disease is progressive, leading to full nursing care being required in the latter stages.

ALCOHOLIC CEREBELLAR DEGENERATION Can occur after 10 - 20 years of very heavy drinking. Attacks the region of the brain which controls movement, and results in the sufferer developing a slow lurching gait.

PERIPHERAL NEUROPATHY Occurs in relation to nutritional deprivation, usually associated with a deficiency of vitamin B. Symptoms include burning discomfort or pain in the feet, combined with loss of sensation. Can be rectified with thiamine therapy.

CHRONIC HEPATOCEREBRAL DISEASE Results from longstanding liver disease where the brain is affected by toxins circulating in the bloodstream. The brain becomes scarred, which leads to dementia, impairment of speech and sometimes bizarre movements. Brain tissue cannot be repaired, so any loss of function is permanent.

NEUROPYSCHOLOGICAL IMPAIRMENT After many years of prolonged heavy drinking, a person may suffer from overall intellectual impairment, i.e. increased inability to solve problems, perform tasks, grasp concepts. Such defects will improve with abstinence from alcohol.