Notes From the ER logo Did You Know



When Death Approaches

The Curse of the Miracle Drug

Imagine the best drug in the world. It helps people laugh, relax, share their feelings, and escape their inhibitions. It is a part of a healthy diet and it improves longevity. It is so revered that it is used as a sacrament in major religions.

Now imagine the worst drug, the scourge of humanity. It makes people cry, makes them ashamed of themselves, and makes them tell self-destructive lies. It incites violence and is an accessory to thousands of murders. It maims and kills its dependent victims insidiously. It is condemned as a tool of the devil by major religions.

It is the oldest and most widely used drug in the world, an integral ingredient of almost all human cultures. It is a multi-billion-dollar industry. It is a part of our lives whether we use it or not. It is a drug that demands understanding and respect.

Ethyl alcohol is a ridiculously simple molecule: a few bonded atoms of carbon, hydrogen, and oxygen. This drug occurs naturally as a waste product of the one-celled organism called yeast when it digests the sugar contained in any plant.

Over the course of our history, humans have learned to domesticate this process. We have a symbiotic relationship with the yeasts; they create our favorite drug, we feed them more sugar.

In their crudest forms, alcoholic beverages can be dangerously contaminated by other toxic chemicals. They taste horrible and serve only to induce escapist delirium. At their most refined, they are an art form to be celebrated and savored in moderation, elixirs that serve to delight the palate. In between are millions of gallons of beers, wines, and liquors that are by far the most enjoyed and most dangerous drugs available.

In the ER, alcohol is a fact of life, a drug we know all too well. Its effects contribute to many visits to the emergency department every day. A most democratic drug, its victims come from all walks of life.

One common patient is someone with an alcohol-associated injury. Alcohol slows down the brain. Although many find this effect pleasurable, it spells danger for those who try to operate machines while intoxicated. The automobile is, of course, the most common machine with which we kill and maim ourselves and others when we are drunk.

In case you haven't heard the statistics recently, 17,000 people died in the United States in 2003 as a result of alcohol-related car accidents. The number of injured is harder to pin down, but it is certainly in the hundreds of thousands.

You don't need to drive in order for alcohol to hurt you. Another common group of our “customers” suffer as a result of the psychological effects of alcohol. Disinhibition of some of our basic instincts routinely leads to senseless violence. The crime of assault is often fueled by alcohol.

Less dramatic--but just as dangerous--alcohol is frequently misused to escape the gnawing agony of depression. But it only worsens the situation and masks the real problem; in doing so, it leads to a whirlpool of hopelessness and suicidal thoughts.

And then there is the massive problem of dependency. Approximately 18 million Americans fit a reasonable definition of an alcoholic: that is, a person who depends on the drug in his or her system to avoid very unpleasant and potentially deadly withdrawal symptoms. Although it is not commonly known, alcohol withdrawal is far more dangerous to the body than heroin withdrawal.

Over years of addiction, alcohol slowly damages the body, causing bleeding from the digestive system, atrophy of the brain, and the insidious scarring and destruction of the liver which is known as cirrhosis. Any of you who have witnessed the slow horror of watching an alcoholic person die have good reason to respect this drug.

So why do we tolerate alcohol in our society? The answer is simple - the majority of us like it. As a chapter in our nation's history proved 70 years ago, this drug is an integral part of our culture. The ongoing challenge is to find the proper balance between personal liberties and social controls, to allow its use, but to minimize the severe price we all pay for its many deleterious effects.

< Back to Essays page


My Life As a Doctor
The Choices We Make