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The maxim "everything in moderation" is especially applicable to the use of alcohol.

The effects of alcohol on the nervous system are numerous. These can be divided into three categories: acute intoxication, chronic usage, and withdrawal.

Alcohol acts as a depressant on the brain and other nerve tissue. That is to say it slows down the functioning of nerve cells. The feeling of euphoria or loss of inhibition is not stimulation. Rather it is the suppression of certain areas of the brain that normally control judgment, reasoning, and instincts that produced this feeling. This acute depressant effect is the reason for the alcohol related carnage on our roads. Impaired judgment, slowed reaction time, impaired vision and alertness, as well as decreased coordination makes driving and drinking a lethal combination. The inner ear and cerebellum are areas of the brain involved in coordination and balance. These can be affected by alcohol producing difficulty with walking, hand-eye coordination and reaction time. Sobriety tests of straight-line walking and touching one's finger to their nose show this impairment, although as we all know everyone's tolerance to the effects of alcohol are different.

Many people think that a drink helps them sleep at night and small amounts can initially be sedating but overall it disrupts sleep. The latter part of sleep is often more fragmented. Nightmares and restless leg syndrome can be aggravated as can sleep apnea. The so-called alcoholic blackout is a loss of consciousness that may be due to several factors. While not a medical term, it is a real phenomenon.

Factors causing this may be the obtundation from the alcohol itself, amnesia for events that occur during intoxication or head injury. Either way it is directly or indirectly due to the depressant effects of alcohol on the brain.

The effects of chronic alcoholism reflect its "cytotoxic" or cell poisoning effect. Although the alcohol itself can cause damage, there are many other factors adding to its negative effects. Nutritional and in particular vitamin deficiencies, head injury, and liver disease to name a few.

Memory loss and dementia are effects of long-term alcohol abuse. These are usually mild, but they tend to be permanent. While the acute effect of alcohol on the cerebellum is temporary unsteadiness, the chronic effects are not temporary, and can cause permanent imbalance. Stopping alcohol, thiamine and multivitamin supplements may help stop the continued worsening cognition and imbalance, but does not usually reverse the damage that has already been done.

At the other end of the body, alcohol can cause damage to nerves of the feet and legs. This is called a peripheral neuropathy, which produces lack of sensation in the feet, which contributes to unsteadiness. One can also experience numbness, pain, burning and tingling. These get worse until the alcohol is stopped and a good diet is reestablished. Chronic alcohol abuse can also damage muscles. This is usually a painless weakness in the large muscles of the upper legs and pelvic area. Difficulty going upstairs, getting off a chair, or getting up from the floor are some of the symptoms. About 50 percent of alcoholics have some degree of muscle weakness.

Stopping chronic over usage of alcohol is vital to the treatment of all of the above conditions, but sudden cessation can produce a number of serious and potentially life-threatening conditions. These withdrawal symptoms are usually after days of binging or after chronic heavy usage. After 6 to 12 hours of cessation, tremor, agitation, impaired concentration, and insomnia occur. In a small percentage of people seizures can occur. While these are usually self-limited they can be followed in 24 to 72 hours by a state of confusion, agitation, hallucinating, increased blood pressure and pulse, and muscle damage. This is called delirium tremens, and can go on for a week or more but usually lasts about three days. During this time, however it is a potentially life-threatening condition and requires hospitalization with intravenous fluids, sedation, monitoring of the vital signs and protection from self injury.

While small amounts of alcohol used in a responsible fashion can be enjoyable for many, it must be kept in mind that alcohol is a drug with many potential side effects and ramifications just like any drug. Different, however, from many other drugs, it is available without a prescription, can be abused and have short and long term effects on the individual and those around them.

Questions or comments can be addressed to Stuart N. Kieran, MD, c/o Bitterroot Neurology, 1019 West Main Street, Hamilton, MT 59840.