The Self-Induced CNS Disorder
Bill Loving, MD
The major part of the CNS (central nervous system) is the brain. Drugs of abuse and alcohol do what they do by stimulating parts of the brain. The "good" effects, or those wanted by the user, include the "high" and the ability to change unwanted emotions to cope with stress. The "bad" effects include such things as slurred speech, poor balance, poor judgment, disinhibition, blackouts, and others. When alcohol and drugs are ingested they effect the whole brain so you cannot have the "good" effects without experiencing some of the "bad" effects.
The "bad" effects are really side effects because, for example, no one takes drugs or drinks to stagger, embarrass themselves, have blackouts, or get DWIs. These are "bad" effects that come along with the desired effects, and are disordered or pathological effects of the brain. The side effects happen while the drug is in the system, but also linger after use is stopped.
Encephalopathy is a term used by neurologists to refer to a brain sickness (encephalo = brain and pathy = sickness). A person is said to be encephalopathic when their behavior or function is disrupted by a sick brain. Encephalitis is a brain disorder caused by an infection or inflammation (such as seen in the brain's involvement in meningitis which is caused by a bacteria or virus.) Alcoholism and chemical dependence are not infections, yet they cause a person to be encephalopathic due to immediate or ongoing drug use. The encephalopathy is easily seen in the acute phase of detoxification. For instance, the first week off of alcohol a heavy drinker's brain is so sick it may be at risk for seizures, tremors, hallucinations, confusion, anxiety, depression, and other serious central nervous system problems. After this acute phase with the drug or alcohol still stopped, the post acute phase or protracted abstinence phase begins, sometimes lasting weeks or months. The encephalopathy then is seen as poor concentration, mood swings, poor memory, and levels of confusion.
People are also encephalopathic when waking up from anesthesia after surgery. Anesthesia has a lot of the same side effects as alcohol and drugs. Patients can be out of control in behavior (just like a chemically dependent person), while coming out of the effects of anesthesia, so they are closely monitored and supervised in a special room called the recovery room. Doctors and nurses all have amusing recovery room stories like the story of the church lady who curses like a sailor when coming to, or the prim and proper judge removing his clothes and pinching the nurses. These stories are amusing and the people are easily forgiven for their antics because the drugs were given by a doctor in a socially acceptable way.
In anesthesia the drugs that effect the brain are given by professionals for the purpose of getting through surgery. In chemical dependency and alcoholism, the substances are self-administered for a very self-centered purpose and is not so easily excused. The changes in behavior in both cases are very much the same because the substances cause an encephalopathy. The brain doesn't go back to normal functioning immediately after the drug is stopped. If the alcohol and/or drugs are used for a prolonged time, the encephalopathy will linger long after they are stopped. Alcoholism and chemical dependency cause encephalopathy and the problem is a self-induced CNS disorder.