And then, there's the chronic phase of alcohol use disorder.
And what we're seeing in the chronic phase is that we start to see some physiological changes.
Meaning that the organs now are becoming involved.
We have physiological changes in the liver.
We may have some physiological changes in the digestive system, in the colon, in the brain.
One of the things to keep in mind is that for a person who has alcohol use disorder,
there is a much higher incidence of colon cancer
and that is because of the organ involvement due to alcohol use disorder.
We also see withdrawal.
We see where the person, once they cannot get alcohol,
start having physiological changes, sweating, tremors, perhaps hallucinations.
Peripheral neuropathy is also what we end up seeing once we have body organ involvement.
Thinking of peripheral neuropathy,
you're thinking about the periphery of your bodies, your fingers, your toes and neuropathy
means that the feeling, the sensation goes down
or you might have some tingling in your fingers and toes.
Consider the impact of peripheral neuropathy
if you are inebriated and you bang into something
or you cut a toe or you are outside and it is very cold.
Since you can't feel the pain that would normally feel in your fingers or toes,
there's an opportunity for the person to have some real damage done.
We also have Wernicke's encephalopathy.
When you think of Wernicke encephalopathy,
you're thinking about the brain and you're thinking about the Wernicke area of the brain
which is controlling speech.
And so, when that is impacted, that person has a problem with word retrieval, with ability to speak.
They also have myopathy, alcohol myopathy.
So, it's involving their muscles where they start having pain in their muscles and Korsakoff's psychosis.
Now, this is an important one and it is very, very end-stage.
But Korsakoff's psychosis is when we see the person actually having psychotic reactions
where they are having delusions,
where they are having hallucinations related to their alcohol use disorder.
again, remember, I said, multiple organs are involved.
So, they may have cardiomyopathy.
So, their heart now is becoming involved.
Esophagitis is not uncommon in a person who has chronic use of alcohol
and has the alcohol use disorder.
Esophagitis because when a person has consumed too much alcohol
and if the person has not eaten or eaten bad food and they vomit,
it causes the esophagus to get very irritated and we see esophagitis.
They also may have Leukopenia which is a blood disorder
and also Thrombocytopenia which is also their blood disorder.
So, these are people who are not going to be able to fight off disease.
Their white blood cells are going to be very low and they are more likely to have problems with clotting.
Oftentimes, people do not understand that substance use disorder,
alcohol use disorder has a direct impact on sexual functions.
That a person who has substance use disorder
and specifically now as we're talking about alcohol use disorder
also has a very high likelihood for hepatitis and ascites.
So, you see the abdomen beginning to swell.
You see the person becoming jaundiced. Their liver is involved.
They have some sort of sweating with salty, like a salty covering
and their abdomen becomes very, very, very large.
The pancreas is also involved in alcohol use disorder.
And so, we find people with pancreatitis.
Their chronic liver diseases like cirrhosis and portal hypertension and ascites
which we just mentioned with the hepatitis.
And then, those esophageal varices.
So, only once in my life did I see a person who had esophageal varices
who ruptured the esophageal varices and had projectile vomiting of blood
that went clear across the room.
It is one of those things that the person can die very quickly.
So, we want to know and we want to make sure that when we have a person
who is admitted with alcohol use disorder
that we are ruling out the impact of the use of alcohol overtime
chronically on the multiple body organs.
And then, there is the hepatic encephalopathy.
So, that person because of their liver involvement becomes disoriented, confused.
They have a problem because keep in mind, the disorder itself is a brain disorder.
It is the brain that is making the person not be able to stop.
That as the person moves through these different stages
and alcohol becomes more and more and more important,
it is not important because they want it to be important.
It's important because their brain does not allow them to disengage from it.
And as they give in and as they are part of this disease
and this progression of this terrible disease, it affects the brain.
There are physiological changes and the brain begins to affect the way the whole body works.