Keywords: Alcohol, Bitters, alcohol use disorder, neurotransmitters, alcohol safe limits, percentage of alcohol, units of alcohol, Nigeria.

Introduction.

Alcohol and Bitters Drinks – How Safe – Nigeria? What is the role of alcohol in the brain? Why do manufacturers write percentages on alcoholic bottles? For the lovers of alcohol, are there safe amounts they can take? Is alcohol harmful to the human body? Can alcohol use disorder or addiction be prevented? Can those who are suffering from alcohol addiction be treated?

Alcohol Use Disorder (AUD} is a growing concern in Nigeria, with many young Nigerian becoming addicted to alcohol. Nigerians are second in Africa among African countries for heavy episodic drinking. And alcohol is the most commonly used or abused drug in Nigeria. In Delta state, 25% of their adolescents are dependent on alcohol, while in Portharcourt 30.6% of their secondary students abuse it. And commercial drivers are not let out, with 60% to 70% of commercial drivers drink and drive in Lagos state.

Over the years, drinks called the Bitters have flooded the Nigerian market. The drinks labeled as bitters are made from very high dose of alcohol, different roots, herbs and flowers. The bitters drinks also contain tree barks and other plant parts. And many Nigerians who have AUD hide under its use with the claim that it is medicinal.

With the proliferation of the alcohol use and abuse this could contribute to the proliferation of health challenges. These include both mental and physical health conditions in the country. Fortunately, alcohol abuse is preventable and treatable, but requires all hands on deck. Thus the need for this topic – Alcohol and Bitters Drinks – How Safe – Nigeria?

The effects of alcohol on the brain?

Alcohol suppresses the activities of the central nervous system by interfering with the brain neurons communications. So different areas of the brain are negatively affected. These areas include the speech, memory, the areas of the brain involved judgment and planning, etc. Alcohol reduces the size of the brain neurons, so that there are less brain cells. So the brain mass and weight of those with AUD, is smaller than those who do not abuse alcohol.

The long term use of alcohol disturbs the balancing of the neurotransmitters in the brain. The neurotransmitters involved include serotonin, dopamine, norepinephrine, GABA, glutamate, etc. It is the imbalance of the neurotransmitters that reinforces the drinking habit and cause withdrawal symptoms. It also causes mental illness such as depression, anxiety, sleep issues, etc.

 Alcohol and Bitters Drinks – How Safe – Nigeria?          

Are there safe limits to alcohol intake? Most people consume alcohol without looking at the alcohol content. What they normally use as the measure of quantity is the number of bottles, cans or cartons taken.

The quantity of alcohol taken should be measured by percentage in the alcohol volume. The percentage in each volume of alcohol is written on the bottle, can or sachet.

Alcohol percentage in standard drinks:

Light beer has 2.7% alcohol/vol. in 425ml. Mild strength beer has 3.5% alcohol/vol. in 375ml. Full strength beer has 4.9% alcohol /vol. in 285ml. Wines have 13% alcohol/vol. in 100ml. Fortified wines have 20% alcohol/ vol. in 60ml. Spirits have 40% alcohol/vol. in 30ml

So for the beer brands available in Nigeria:

Star lager beer in the 600ml bottle, contains 5.10% of alcohol. Legend Extra Stout in the 600ml bottle has 75% alcohol. 33 Export beer in the 600ml bottle contains 5% alcohol. Harp beer of 600ml bottle contains 5.15% alcohol. Gulder in the 600ml has 5.20% alcohol.

For the Bitters, each bottle contains between 35% to 45% of alcohol. The contents are not made to be emptied at a go. The volume of each bottle of bitters range from 100ml to 750ml. They are made to be taken as small quantities in drops and mixed with water or other non alcoholic drinks. But unfortunately, Nigerians drink it straight from the bottle every morning.

Any safe limits?:

The World Health Organization (WHO) documented that there are no safe limits of alcohol. This means that there are no units of alcohol one can take and remain healthy.

Prior to 2016, there have been certain units of alcohol approved for one to take. But the intake of alcohol is not approved for people who have health conditions such as hypertension, heart diseases, diabetes, etc.

So for those who do not have health challenges and who would want to take alcohol, these are the recommendations. Men and women are advised to take 14 or less units of alcohol per week. This is for those who take alcohol on regular basis. The 14 units are to be spread over the week and not taken at a sitting. This is because taking more than 14 units of drink per week are associated with health challenges.

To calculate the units of drink to take:

Percentage alcohol × volume of alcohol  ÷1000 = units.

E. g. One bottle of Star beer contains   5.10% × 600ml  ÷ 1000  =  3.06 units.

One glass of wine contains  13% × 200ml ÷ 1000  = 2.6 units.                                                                         

One bottle of Bitter of 200ml contains   40% × 200ml ÷ 1000  = 8 units.

But when Bitters are taken as directed in drops, the alcohol content is very minimal. For example, it is recommended that the dose of Bitters to be ¼ to ½ teaspoon 3 to 6 times a day. One teaspoon is 5ml. Then ¼ of it is 1.25ml. The unit equivalent is 0.05, using 40% alcohol content.  Then 0.05 × 6 is 0.3 units.

Thus it is important to not only know the bottle or can volumes, but also the volumes of the glasses used. The volume of the glass will be used to calculate when drinking with a glass.

What are the complications from alcohol abuse?

Alcohol is harmful to the entire human anatomy, beginning from the head to the toes, affecting the organs as well. The negative effects range from physical, to psychological and even socioeconomically. To answer the question of alcohol and bitters drinks – how safe – Nigeria? Just know that ALCOHOL IS DANGEROUS no matter how it comes, be it beer, wine, spirit, vodka, and Bitters when taken as recommended.

Physical and neurological effects:

Complications include heart issues and stroke, liver cirrhosis, pancreatitis, and stomach issues with problems in absorbing nutrients and bleeding. Others include blackouts and fainting, road traffic accidents, and even death from suicide. Alcohol can harm the unborn baby in several ways. Drinking alcohol beverages raise the risk of cancers, according to reports from Centre for Disease Control (CDC). Such cancers include mouth and throat, larynx, esophagus, colon and rectum. Others are liver cancers and breast cancers in women. Globally, alcohol causes 320 deaths every hour.

The neurological issues include convulsions or seizures and wernicke-korsakoff syndrome. This syndrome affects the brains, the eyes, and movements.

Alcohol can increase your confidence and sexual desire, but it has a negative effect on sexual performance. Excessive alcohol intake makes it difficult for erection to be achieved and maintained. There is also problem with ejaculation i.e. release of sperms. Ejaculation may come too fast or delayed. This is because it decreases the activities of the brain. Long term uses of excessive alcohol can decrease the penis size and the size of the testes.

For men, the sperm count will also reduce and for women, they may stop ovulating. And overall fertility is reduced even with small amounts of alcohol. There is also an increased risk to sexually transmitted diseases.

Psychological:

These include depressive disorders, anxiety disorder, bipolar disorders and schizophrenia. Others include are memory loss, dementia, delirium, low self esteem, sleep issues, etc. These mental health conditions can be brought about by the use and abuse of alcohol. But alcohol can also make the already existing mental health conditions, worse.

Alcohol for young people is a gateway for them to abuse other substances. They will then mix alcohol with other substances like codeine, cannabis, etc. This will increase the risk for side effects and death.

Socioeconomic issues:

Alcohol use disorder does not only affect the individual, but also the family, friends and the community. Socially it can cause relationship problems in the family that can lead to divorce or separation. These include violence between the couple and towards the children. Thus the children can be abused in so many ways, including incest and other forms of child sexual abuse. Their families are actually dysfunctional.

Crimes are easier to commit while on substance, these include homicide, and theft. They do steal so as to finance their addiction. This could include official embezzlement, fraud, etc. They also get into trouble with the law from their sexual escapades and rape.

There are also problems in school and at work with loss of man hour. The young ones can drop out of school, while those working will miss days of work, etc. And they most often end up losing their jobs. Thus they will fall down the economic ladder and become poor. This economic issue does not only affect the individual, but also the family and the country as a whole.

Prevention of alcohol addiction.

The role of the individual:

Stay safe when drinking, whether the drinking is done at home or in the public place. It is important to drink responsively and behave in a manner to show respect to others.

There is need to count the units of alcohol taken each time. And when drinking, sip the drink, this will endure that the alcoholic beverage is taken in slowly. Be conscious and do not allow friends to top up the drink. Topping it up indiscriminately will not allow the counting of the units.

Before taking the alcohol, ensure that the stomach has food in it.  Or as the drinking is ongoing, there is food be taken with it. This is because when the stomach is full, alcohol is absorbed slowly. But avoid salty foods, because they will increase drinking.

Do not be pressured into drinking more alcohol. Rather if there is need for more drinks top up the alcohol taken with non alcoholic drinks. There may even be need to start the drinking with a non alcoholic beverage before the alcohol beverage. Using a light beer will be preferable. And do not allow spiking of the drink.

When making use of Bitters, adhere to instructions. Never drink it out of the bottle. Add the drops to juice water or take it straight from the spoon or drops.

The government or policy makers:

There is need to reduce students’ access to alcohol, especially around the school area. There is need to limit operating hours for such outlets.

Increasing the price of alcoholic drinks will also reduce affordability and thus the number of people who take it. There maybe need to place taxes on them.

There is need to scrap the sale of alcohol sachets and prohibit the sale of alcohol beverages at motor parks. Even the sale of Bitters should be regulated and sold in pharmacy shops and not at roadside stalls. Even the sale of alcoholic drinks in joints should be regulated.

There are some existing regulations on the sales of alcohol in the country. These regulations should be enforced.

Treatment of Alcohol Use Disorder.

Alcohol abuse is treatable.  There is need to consult professionals. The treatment requires the expertise of the psychiatrist and the clinical psychologist and if possible, a social worker.

The psychiatrist will use the method of detoxification to stop the alcohol intake. He/she will also treat the person the mental health condition associated with the alcohol misuse.

The clinical psychologist will make use of psychological therapy to treat the person. There are many psychological therapies available. These include motivational therapy, individual therapy, couple therapy, family therapy, etc. The 12 steps of Alcoholic Anonymous is also used.

The social worker is there to do home visits. Their duties include counseling not only in the hospital, but also at the homes of the person.

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