In the first annual report on Alcohol and. Health to Congress (December,
1971), the then HEW Secretary Elliot L. Richardson called alcohol 'the
most abused drug in the United States'. The report revealed that nine
million Americans are alcohol abusers and that alcoholic individuals
represent almost 10 % of the nation's work force. With spreading
alcoholism, the incidence of physical damage due to alcohol has greatly
increased. A question which is often raised is 'in which way does an
alcoholic differ from a non-alcoholic?' Inquiries have focused on
psychological make-up, behavioural differences and socioeconomic
factors. More recently, however, physical differences have been
delineated. Prior to the development of various disease entities,
chronic ethanol exposure results in profound biochemical and
morphological changes. Consequently an alcoholic does not respond
normally to alcohol, or other drugs or even other toxic agents. Some of
these persistent biochemical and morphological changes are the
consequences of the injurious effects of ethanol, whereas others may
represent the possible adaptive responses to the profound changes in
intermediary metabolism which are a direct and im- mediate consequence
of the oxidation of ethanol itself. Differentiation between the effects
of ethanol directly linked to its oxidation, and the adaptive and
injurious effects of ethanol are not simple, and overlap is common. In
general, however, metabolic effects are associated with the presence of
relatively low ethanol concentrations, whereas injurious effects occur
with high ethanol concentrations and/or after prolonged intake. High
ethanol con- centrations also produce so-called pharmacological effects.
