This book is dedicated to my family, particularly my wife, who allowed me the time and provided me with invaluable assistance in completing this book.
I would also like to thank my children, who had to put up with my preoccupation with this book for so many weekends.
It is also dedicated to the many patients that I have had the privilege to treat. I am constantly surprised and impressed by their persistence in the face of adversity.
Finally, my hope is that this book may prove useful to not only patients and their families, but to physicians and other healthcare providers who continue to struggle with understanding this unusual disease.
Charles Herrick, MD
I want to express the honor and pleasure that I have experienced by co editing a book with my son, Charles Herrick. I am a proud mother!
I want to thank my husband, Bob Herrick, and Chuck's father for his support and patience in helping us to see this project to fruition.
Most of all I would like to thank Ana Cristina Herrick, Chuck's wife, for being the liaison between the co-authors. She coordinated our efforts, provided editorial comments and contributed creative ideas to explore the issues. She was the "lynch pin" who made it come together!
Charlotte A. Herrick, PhD, RN
I. The Basics
What is alcohol?
Is alcohol a drug?
When and how was alcohol discovered?
What is alcohol?
Alcohol is a simple organic chemical that consists of carbon, oxygen, and hydrogen. Organic chemicals all contain carbon, hydrogen, and oxygen as their essential makeup and typically come from organisms, but there are many synthetic products that make our lives more convenient. Plastic, oil, and the general makeup of the human body are all organic chemicals. Alcohol, which yeast (a type of fungus) produces, is essentially a waste product from its consumption of sugar. All alcoholic beverages contain predominantly water, secondarily alcohol, and finally, depending on the initial substance used in the fermentation process, a variety of other organic chemicals that give each particular beverage its unique color and flavor. Fermentation can lead to only an alcohol content of 10% to 15% because any concentration over that will kill the yeast. To increase the alcohol concentration beyond 15%, one needs to boil it off from the water — hence the development of distilled spirits.
Is alcohol a drug?
When considering whether alcohol is a food or a drug one must ask what is the meaning of the term "drug?" Most people view a drug as a mind-altering chemical, illegally obtained and consumed and potentially dangerous (e.g., heroin, cocaine, methamphetamine, marijuana, and LSD). Drugs have a pejorative connotation. Alternatively, any particular pill that a physician might prescribe is viewed as a medication. The connotation of medication is "health giving" or "healing." Thus, antibiotics, antidepressants, antihypertensives, analgesics, and chemotherapeutic agents are thought of as medications and not drugs. Cancer chemotherapeutic agents are prescribed to kill cancer cells. These agents, however, do not know the difference between a cancer cell and a normal cell. Fortunately, cancer cells grow faster than most normal cells, and these agents kill the faster growing cells more than the slower growing cells. Otherwise, they are rather indiscriminate killers, which is why they have terrible side effects and are quite dangerous. They are some of the most toxic substances known to humans; however, they are not thought of as drugs or poisons. Instead, they are considered to be medications that have the power to heal.
In fact, such categorical distinctions between a drug, a medication, and a socially acceptable substance are purely a product of culture and have nothing to do with the properties inherent in any of these particular substances. All of the categories that these substances fall under have the potential for mind-altering effects. The clinical term for mind altering is literally psychotropic. Even antibiotics have been known to cause mind-altering effects; however, some substances have known predictable, psychotropic effects and are sought specifically for that purpose.
Historically, Americans have not considered alcohol, caffeine, and tobacco to be drugs or medications. Consequently, they are viewed socially and legally differently from drugs or medications.
The cultural construction of substances provides the link between the pejorative term "drug" and its psychotropic effects, which is the reason for the public's misunderstanding about psychiatric medications. The assumptions are as follows: All drugs are psychotropic. All drugs are addictive. All psychiatric medications are psychotropic; therefore, all psychotropic medications used in psychiatry to treat mental illness are addictive. This statement is false (see Question 14 for another description with respect to the definition of dependence).
If you were to examine the etymological root of medications or drugs (as they should be synonymously regarded), you would be rather shocked. The term "pharmakos," from which the words pharmacy and pharmaceutical are derived, was originally used to identify the human sacrifice that was offered to "cure" societal ills. With time, the word pharmakos increasingly became associated with the various poisons that were ingested by the pharmakos as part of the sacrifice and eventual "cure." These poisons, when ingested, then had a dual role — to kill (the pharmakos) and to cure (society). Now that modern medicine has the ability to understand disease processes and the mechanisms of drug actions, "pharmakos" has unwittingly been liberated from the pejorative term "poison." Prescription medications kill more individuals in America every year than poisons and street drugs combined. Thus, in the end, alcohol is like any of the pharmakos used past and present. It is a medicine, a drug, and a food. Which particular category alcohol falls into is as much a matter of the person using it as it is society's perception of that person and the substance of alcohol.