This is the conclusion of a 2 part article which was in our October issue.
As stated earlier, this study is specific to ailments relating to the liver, pancreas and brain. It has always been thought that alcohol and smoking would have the greatest effect on the lungs, throat, larynx, and esophagus. While that is true, studies have also found that smoking combined with alcohol is detrimental to one’s pancreas (Pfutzer & Singer, 2005). Therefore, this study’s stated purpose would not be complete without an examination of the combined effects of alcohol and smoking on the alcoholic.
Heavy drinking and smoking combined is the most common cause of preventable death in the Western World (Edwards, 2004). More than 90% of alcohol abusers are smokers, and the heaviest drinkers tend to smoke the most. Studies in treatment centers have shown ranges of 86% to 97% of males as smokers and 82% to 90% for women (Burling &.Ziff, 1988). In 2005 Pfutzer and Singer found that alcoholics who smoke significantly increased their chances of acquiring chronic pancreatitis, as did other researchers (Maissoneuve, et al, 2005 and Talamini, et al, 1996). This is thought to be because of the synergistic pathophysiological mechanisms in alcohol and nicotine appear to create a circumstance that the two actions together create more than each do individually (Ait-Daoud, et al, 2005).
In general, the literature regarding the ailments of long-term sober alcoholics is sparse and tends to be dated. While the effects of alcohol abuse are evident and highly studied, the view towards those who have changed their lives over long periods of time is less investigated. The results below may give an inkling as to why that is so.
This study included the sober characteristics of five individuals with more than twenty years of sobriety. The average number of years of sobriety in the group was 31.2 years, with a mean of 29 years. The longest period of sobriety in the group was forty-two years. The ages of those participating in the study were from forty-nine to seventy-four. The average age was 61.8 years, and the mean was 62 years. The average age at which the five individuals became abstinent was 30.4 years old, with a mean of 32 years. The oldest person at the beginning of sobriety was thirty- five, the youngest was twenty-one. There were four men and one woman. All five participants were Caucasian.
While there were common characteristics among the subjects, each of the five had their own unique stories. Our oldest subject consumed his last alcoholic beverage in 1969 at the age of 32. Besides alcohol this subject was also addicted to a variety of pills. He was also a heavy smoker. This subject has had some substantial physical consequences due to his alcoholism. Being a smoker for many years, he ultimately developed emphysema. He attributes this to the combination of drinking and smoking as he stated that he smoked more when he drank. In sobriety the patient has also suffered through the deterioration and replacement of his teeth due to his lifestyle. Finally, he stated that he has a 10% loss of his liver function. This has not progressed further in sobriety and is currently dormant. He has been told by his doctor that this will remain so as long as he continues to be abstinent.
Our next subject got sober in 1976, at the age of 31. He was strictly an alcoholic, with no other drug or mind-altering substance use. This subject suffered through many afflictions while he was drinking. They included liver enzyme elevation, hypertension, severe abdominal pain which was related to a hiatal hernia that developed through his alcoholism. In sobriety the only alcohol-related health issue he has had is regarding his white blood cell count, which has been consistently at the borderline for a dangerous area. The third subject is the only woman in the group. She got sober at the age of 33. Her drugs of choice were alcohol and benzodiazepines. At the age of fifteen she was involved, as the driver, in a drunk driving accident where she was almost killed. She suffered severe injuries to her legs, snapping her tibia and shattering her ankle. Nearly fifty years later she continues to suffer the consequences of that accident as she recently had her ankle operated on again to relieve the pain. This subject has had no new alcohol related physical issues in sobriety.
The fourth subject became sober at twenty-one years old, and was our youngest participant. While he used many different drugs, alcohol was his first choice. He has a long history in Alcoholics Anonymous as he went to his first meeting at the age of 4, meeting founder Bill Wilson at the age of six. His father and brother are both recovering alcoholics. He stated that he had to make the choice of sobriety or jail. This subject appears to have achieved sobriety at such a young age that he has had no enduring physical problems from his alcohol use. In fact, at the age of 48 he was covered by health insurance for the first time in his life.
Our final subject stated that while he used every drug he could get his hands on, alcohol was always involved and was his first love. He got sober at the age of 35. Toward the end of his alcohol and drug use he stated that he would use drugs for four or five consecutive days without any sleep, finally passing out for three to five days. This subject suffered a stroke approximately seven years before he achieved sobriety. He also suffered from severe headaches, constant bronchitis, and sinus problems while he was active in the disease. In sobriety this subject suffers from both short-term memory loss and memory loss from different periods of his past. This is in contrast to the fact that he never “blacked out” when he was drinking or using drugs and had no memory issues then. Additionally, this subject stated that he lost all his teeth in sobriety due to the abuse caused by alcohol and drugs. He also suffers from hypertension and sleep apnea.
It is interesting to note that while this test group has certainly had consequences from their alcohol and drug use, the consequences have not been so severe that they caused any organ failure or affected their ability to live normal lives. This is thought to be for two reasons: a) they achieved sobriety at a relatively young age, all 35 or under; and, b) because they got sober young they drank for shorter periods of time and therefore, had less of an opportunity to do the damage that leads to the catastrophic consequences mentioned in this study.
The findings of this study imply that long-term abstinent alcoholics often continue to suffer from alcohol-related affliction even twenty years after they’ve become abstinent. However, the afflictions they suffer from did not occur suddenly, but were identified while they were still active in their alcoholism or soon thereafter. This is in sharp contrast with research outlined earlier by Diehl which discusses liver disease being dormant for decades and then re-occurring (Diehl, 2002). Further, this study shows that what was identified at the beginning of their abstinence as a physical or mental problem will, more than likely, not get worse. Improvement is not guaranteed, nor will someone’s physical or mental state return to its pristine state prior to alcohol abuse. The alcoholic’s age and the number of years of their abuse appear to be a major factor in this instance. No evidence came to light in the study showing that individuals experienced sudden negative surprises as to their conditions and that any ailments that continue to exist or proceed appear to be fairly predictable. Both the research and the study show that long-term abstinent alcoholics who have not reached the more extreme conditions such as alcoholic hepatitis, cirrhosis, or end-stage liver disease experience an improvement of their condition through long-term sobriety. The study is severely limited by the small number of participants. However, the research accompanying it implies that an alcoholic who stops drinking will stop the progression towards an alcoholic death unless the conditions above exist. There is one major exception to this statement, however is in alcoholics who are heavy smokers. The only member of the study group who was a heavy smoker was also the member who suffered the most severe consequences. He was also the only member who could be characterized as having had significant long term consequences that were hidden for many years before the symptoms came to light. This appears to agree with the alcoholic/ smoker research which is detailed in the Literature Review.
This study and the attendant research necessary have been enlightening. The stated reasons for the study have yielded what I believe are important answers to me personally. While a larger study may have shown some of the expected results, the actual results speak for themselves. Alcoholics in long- term sobriety experience an improved life both physically and mentally. How much improvement appears to be based on the length of time the alcoholic was abusing alcohol and the age when they became abstinent. Long-term abstinent alcoholics may still suffer from ailments that they acquired during their active abuse. However, the incidences of a condition “sneaking up on them” seem to be rare. Therefore, I believe that devoting a dissertation to this subject is not warranted at this time. Perhaps in the future more information will come to light that will make such a study more useful.
That being said, I do believe that there is a related study that would yield important information. Performing the research into this study has shown the significant impact that smoking combined with alcoholism has on various forms of cancer. In many cases it appears that this does sneak up on a long-term abstinent alcoholic, due in part to the fact that they have continued to smoke after they became abstinent. I believe a study discussing the precipitating effect of alcoholism combined with smoking promoting oral, throat and esophageal cancer would be an interesting study. There is a vast amount of research that already exists, but not a lot of public knowledge on it.
Tony Foster is the Director of therapy at the Beachcomber Outpatient Services Treatment Center located in Boynton Beach, Florida.