Ethanol: Beer, Wine, and Spirits
Often referred to as alcohol or spirits, ethanol is also called ethyl alcohol or drinking alcohol. A volatile, flammable liquid produced by the fermentation of sugars by yeasts, ethanol is also used as a solvent, an antiseptic, and a fuel. When consumed, ethanol is considered a psychoactive, neurotoxic drug.
Alcohol is also one of the oldest recreational drugs used by humans; evidence indicates the preparation of alcoholic drinks dating as far back as 8,000 BC. Due to the destructive nature of alcohol abuse, warnings regarding the dangers of alcohol consumption have persisted for as long as alcohol has been available, if you know an alcoholic and you’re wanting them to cut down or stop for their own safety, you can try deter them with a hair follicle test or something similar.
The TCM Take On Booze
From the point of view of Traditional Chinese Medicine, all alcoholic beverages are considered warming. In general, it could be said that the higher the alcohol content, the warmer the drink. In small amounts, alcohol can supplement and move qi/blood, scatter cold, and vitalize
the spirit. Like coffee, it would be best (better) to think of alcohol as a medicinal substance to be used with respect, and its use should be dictated by the individual’s constitution.
Similar to coffee, alcohol is a potent yet short-lived mover of qi. Cravings for alcohol can be explained by this concept. For instance, one might crave a stiff drink after a 3-hour attempt at hearty discourse on Facebook that’s destroyed by an inane catalog of fallacies by a ‘friend’ who decides to troll an otherwise good thread. Put simply, the more stagnant the qi, the stronger the cravings for substances that move qi. Common qi-moving substances include cigarettes, alcohol, coffee, and spicy food. The warm, acrid nature of all of the above make them efficient movers of stuck qi (this is, by no means, an exhaustive list of qi-moving substances; these things just happen to be the ‘easy’ ones that we, as a culture, have a tendency to reach for when stuff gets… stuck).
Types of Alcohol, According to TCM
Beer: Beer is considered the coolest type of alcohol, although this is dependent on what kind of beer you’re drinking (craft beers, especially those with a higher alcohol content, fall into the “warm” category, whereas a Miller Light would be considered much more cooling). Drinking too much beer will overwhelm the spleen and create dampness. Those who misuse alcohol in the form of beer often present with mixed patterns of heat and cold in the body. The liver gets agitated and hot, the spleen becomes deficient, dampness collects (most often as damp heat in the middle and lower burner), and the Kidneys can become doused by the sheer volume of liquid consumed.
Wine: Wine is considered acrid, sweet, and sour. In small amounts, in can support the spleen, warm the digestive center, expel wind-cold, and promote circulation of blood and qi. Red wine is more warm than white; mulled red wine is a traditional remedy (across the world) to help remove “cold” from the body. When wine is infused with medicinal herbs, it can enhance the tonic effect of those herbs; medicinal wines are commonly used in Traditional Chinese Medicine.
Spirits: Liquor is intensely hot and moving due to it’s concentrated alcohol content. The most potent of alcoholic qi-movers, liquor can quickly become toxic to the body, stressing the liver and creating excessive heat.
A Note on Moderation and Binge-Drinking
So, what does moderate consumption of alcohol look like? Tough question for a couple of reasons, the first being that according to Traditional Chinese Medicine, “moderate” would not necessarily be the same for any two people. For those blood deficient, yin deficient, or dealing with issues of damp-heat, a single drink could be too much. However, for those of a more robust constitution, ‘moderate’ would be a quantity that wouldn’t leave an imbalance in its wake.
I’ve always found it interesting that most people, when asked, will naturally advocate for moderate alcohol consumption, yet find it difficult to follow in practice (for transparency’s sake, I’ve been guilty of this in the past).
Essentially, alcohol’s short-term and long-term effects on the brain involve a decrease in prefrontal cortex control. The prefrontal cortex is the part of the brain that enables us to make rational, sound decisions. In other words, the more drinks consumed in one sitting, the more difficult it becomes to make rational choices. For most people, it becomes harder to self-regulate when under the influence of alcohol.
I mean – duh! It’s like asking Madame President Decision-Maker (who lives in your brain and is usually ON IT) to walk a balance beam once she’s been blindfolded and spun around on a tire swing 35 times. So, if you want to increase your chances of making sound, rational decisions at all times…well, you should steer clear of alcohol seeing it essentially blindfolds your inner logician.
This brings us to the topic of binge drinking. Though some people do not drink on a daily basis, they will occasionally drink a lot in a small amount of time (i.e. party). A January 2012 report from the CDC (Centers for Disease Control and Prevention) noted that more than 38 million adults in the United States binge drink about four times a month (uhh, Saturday night?), and that the largest number of drinks per binge is an average of 8. The CDC report shows that the age group 18 to 34 years has the most binge drinkers, but that the age group that binge drinks the most often includes people age 65 and older.
Binge drinking, no matter how frequent, is considered a toxic activity that can acutely overwhelm the body, and over time, greatly detract from health…which is nicely illustrated by that day-after binge-drinking feeling.
Alcohol Abuse: Social Factors and Policy
It’s impossible (or simplistic, rather) to examine addiction from only one angle. Conversations about addiction too often focus on the pharmacological “potency” of the substance, and little to no attention is given to other powerful variables that affect a person’s likelihood to become addicted. For instance, the likelihood of individuals without preexisting vulnerabilities succumbing to long-term addiction is slim. Addiction, unlike use, is heavily concentrated in our poorest communities.
…the most vulnerable individuals in our poorest communities…have networks that entrench their problems rather than offering solutions. Their decision making will tend to prioritise immediate benefit rather than long-term consequences. The multiplicity of overlapping challenges they face gives them little incentive to avoid high risk behaviours.
Together these factors make it more likely that, instead of carefully calibrating their drug use to minimize risk, they will be prepared to use the most dangerous drugs in the most dangerous ways. And once addicted, motivation to recover and the likelihood of success is weakened by an absence of family support, poor prospects of employment, insecure housing and social isolation.
In short what determines whether or not drug use escalates into addiction, and the prognosis once it has, is less to do with the power of the drug and more to do with the social, personal and economic circumstances of the user.
-Paul Hayes, Hon. Professor Drug Policy at London School of Hygiene & Tropical Medicine (see full article here)
Then there is the issue of drug policy. Carl Hart, associate professor of psychology and psychiatry at Columbia University (and first tenured African American professor of sciences at Columbia University), is known for his research in drug abuse and drug addiction. Though his research, Hart wanted to address the issues facing marginalized black communities like his own – but what he discovered, after years and years of research, changed the very roots of his understanding. If you’re interested, read more about Carl Hart here and here.
When we think about drug effects, I want people to understand that they have less to do with pharmacology and more to do with context: the history of the user, the dose of the drug, etc. That’s not to negate the role of pharmacology, but I do want people to understand the importance of context in trying to evaluate drug effects. We often talk about a drug as if it alone is causing all of these social harms. I want people to think about it in a more nuanced way. -Carl Hart
I thought that I was going to solve the problem of drug addiction,” he told the New York Times. “But it turns out that drug addiction wasn’t the biggest problem; the biggest problem, I found out, was actually drug policy. – Carl Hart
The quick summary: You can’t understand addiction without examining highly influential factors that increase or decrease risk, like the person (or group of persons) socioeconomic status. Also, we must don our critical thinking hats when thinking about this (often) fear-based topic, to assure that we avoid a common tendency to moral panic. We must differentiate myth from reality, which is essential to producing more reasoned social policy and laws.
So! Now that we understand those hugely important points that must not be forgotten or purposefully ignored when considering the complex topic of addiction, or when designing policy with the ultimate goal of alleviation and/or prevention of a problem rather than targeting certain populations… let us take a closer look at the brain.
Addiction and The Brain
“You’re in denial.”
The addict is often told this, even though it’s inaccurate. Denial refers to a psychological defense, or justification for a negative behavior, which is not the same as a loss of rational brain functioning that can occur with addiction.
Long-term addiction can cause changes to the prefrontal cortex (the part of the brain that enables us to make rational decisions). When the pre-frontal cortex is not functioning correctly, impulsivity and compulsivity are usually present. Impulsivity occurs during the early stages of addiction – during this phase, people impulsively act on strong urges to experience the pleasure of their addiction. As the regular use of alcohol continues, a shift can occur, and the impulsive urge transforms into the compulsive aspect of addiction. When this occurs, people are no longer engaging with the substance solely for pleasure – the person feels compelled to engage in their addiction to relieve anxious, uncomfortable feelings. At this later compulsive stage, “pleasure” comes in the form of relief from these anxious, uncomfortable feelings.
Though the language may sound a bit different, the TCM take on addiction and addictive behavior acknowledges a person’s “constitutional tendencies” (including acquired genetics), but also takes into account daily lifestyle choices and a person’s context. Desires for strong substances that lead to addictions are considered to originate within imbalance, usually in the form of mental/physical/spiritual/contextual stagnations and blockages (that you may have inherited, or have been faced to deal with due to the circumstances that you were born into). Please see this article on Acupuncture for Addiction and PTSD for information regarding how acupuncture can help with recovery.