 and welcome to Health Issues. Karl Balbisek in July 31, 2019 in an article on alcoholism defines alcoholism as the most severe form of alcohol abuse and involves the ability to manage drinking habits. It is also commonly referred to as alcohol use disorder. Alcohol use disorder is organized into three categories, mild, moderate, and severe. Each category has various symptoms and can cause harmful side effects. If left untreated, any type of alcohol abuse can spiral out of control. This is the Health Issues of TVUP, and we are here today to discuss important topics of health in our society today. This is Dr. Teddy Herbosa, your host for Health Issues. In this episode on alcohol abuse, we have our expert family medicine practitioner and toxicologist, Dr. Alan Junisha of the Department of Family and Community Medicine and the National Poison Management and Control Center. He detoxifies persons with substance use disorder, has special interest in counseling families with addicted members. Hello, Alan, and welcome to Health Issues. Hello, good day, good day. Thank you for the invitation. We haven't seen each other for some time, right? Yes, you've been missing in action at the Philippine General Hospital. We were neighbors in your office. It's just beside the Division of Trauma at the Philippine General Hospital. But you've been doing good things for UP, so keep doing that. So let's start. What is alcohol abuse, Alan? Well, there are criteria for alcohol use disorder, okay? But just so that we can simplify everything, okay? If you have been taking alcohol regularly for a year at least, and then after that, you know, there are adverse consequences to your life because of the use of alcohol, you've got a disorder. But for example, if because of your drinking, you already, you isolate yourself from your family, if because of your drinking, you're getting low grades, or if you're working, then you come late, your work is suffering. And all of these things are precisely because you're taking alcohol, you've got a problem. So I take alcohol, I attend social events, they'll hand me a glass of wine, a glass of scotch, and I take this, sometimes I take more than I can handle. So is there like a standard drink that will prevent me from abusing alcohol? Well, it's a mix, no, okay? So you have healthy, unhealthy effects of alcohol, okay? As opposed to those, the addictive effect of alcohol. So when we talk about the addictive effects of alcohol, it doesn't really matter how much you take, what matters is the effect on your life. So if you have adverse consequences, because of continued drinking, adverse consequences to your life, then you have a use disorder. On the other hand, if we're talking about health effects, okay, so they have this, you mentioned standard drinks. One standard drink is supposed to be either a regular bottle of beer, or a shot of, a regular glass of wine, or a regular shot glass, shot glass, okay, of these hard liquors. So I can drink all three? So I can drink all three, and I will, okay? Oh, I'm going to define this now. So when they say pa-shot-shot lang tayo, but kalahaping basu yan, that's not a shot. The shot is a jigger. The shot is a jigger, which is about 30 to 45 ml. So that's one standard drink. Wait, no. Alcohol has different, I know for a fact that my shot of whiskey has different alcohol content than my glass of wine, red wine, and my bottle of beer. So generally, beer would be anywhere from three to six percent alcohol? Three to six percent. And then after that, wine would be maybe 12 to 14 percent. Doubles already. And then after that, for the gin or whiskey, we're talking about 40 percent alcohol. Not one. So that's a percentage of alcohol in that particular drink, the amount of alcohol that my body takes. But you've heard 80 proof? Correct. Now that's not that. So what's 80 proof? What's 40 proof? That's a traditional way of, it started in, it started in India. Either I prove or volumes percent. Yeah, so percent is the, that's the scientific metric way of doing it. But a long time ago, in order to be able to prove the potency, for example, your whiskey, because it's in the hand of wine. So, but then they decided to give a number to it. And so 80 proof actually corresponds to 40 percent. So I drink, I drink whether I drink beer or red wine or whiskey, I drink it to a level of what I call myself tipsy, which is enough for a social event for me to talk. Well, with the guests and with other people in your social event. Can you define medically what is intoxicated? Yeah. But the nice thing about alcohol is that we call it, there's a dose dependent relationship. We need to say that if this is the dose, we know that these are the effects. Okay. And you can actually extrapolate backwards. These are the effects and you'll probably, this is the dose. And so like driving, for example, anything above 50 milligrams per deciliter in the blood. Okay. 50 milligrams per deciliter would be equivalent to how many drinks? You'd probably, because of the, the standard drink would be about, if, for men, okay, two standard drinks per day, that's about it. So either two beers and two beers or a mixture. And if someone, and if I'm caught by the police or the MMDA and they do a breath analyzer in me, they will detect that I'm beyond the limit. You'll probably, it depends because there are people who drink chronic, who are regular drinkers, they metabolize it faster. Okay. Okay. And there are people who don't drink and they, they get hit rather quickly. So they can take one shot and the effects of intoxication. Yeah, that's right. That's right. And you have people who drink 10 glasses of beer, 10 bottles. But they, They're okay. They seem okay. But that's also because, usually, because these guys are chronic drinkers. And the, Their liver is adjusted. The drug metabolizing enzymes are. Yes. Alternatively, alternatively, they actually, because there are Asians generally, they don't handle the alcohol. Alcohol dehydrogenase deficiency. Right. Right. So again, it depends. So we have an enzyme, right? That's right. Alcohol dehydrogenase. And Asians are known, Filipinos, including Filipinos, start to flare up and become red and sneeze and all these. There's actually, there are two enzymes here. The first one is alcohol dehydrogenase. And that one converts it to this chemical called acetaldehyde. Acetaldehyde. That's the one that causes you to flush. Flushing. Okay. The redness. It's not an allergy, but it's because of a lot of acetaldehyde in your blood. And then there's that second enzyme that converts it now so that eventually it becomes just water and carbon dioxide. Now, it's that second enzyme that generally a lot of Asians are lacking. I see. So that's the Asian, they call it something Asian dehydrogenase flush. And that's why the consumption of alcohol of Asians at a small level start to flush. Yeah, but that does stop Asians from drinking anyway. I know. The consumption. We're still one of the highest. Tokyo, Japan. Korea. We're supposed to be one of the biggest beer drinkers in the world. Gin. Gin drinkers. Gin drinkers. Not beer, but gin. So when do you say a person is intoxicated? So the first manifestation of intoxication is actually a pleasant one. That's the one I like. Yeah. Just tipsy and lightheaded. You become more talkative. Talkative, yes. Inhibited. That's why they serve punch parties or cocktails so that all of a sudden people, you know, people... Social life's better. Yeah. They lose their shyness. Inhibitions. Yeah. And that's because alcohol inhibits the inhibitions. Yeah. So if you're a normal person without alcohol, you're shy. You're a lady. You're shy. Yeah. But with a shot of alcohol, you lose that inhibition. There's that saying that, you know, before you're going to have to drink, you're not going to drink first. Before you drink, you're just going to, you know... The inside is stronger. Correct. So that's that effect. The effect on the inhibition of the inhibited behavior. You depress the inhibition so that what ordinarily you would not laugh at, you find funny this time. Correct. Okay. And then you can say things that... There are also people that are talkative and when you give them alcohol, they just sit there quietly. Yeah, there are those. No, so the effects can vary. But generally, so this one, it also gives you a feeling of euphoria, at least that. Euphoria. Okay. And so you're feeling good, you know. But if you drink more and you get the levels of 100 to 300 milligrams per deciliter, that's the classic, right? Drunk. When you get drunk, you get drunk, right? That's the one that goes to my ER with a positive lumbar test. Yeah, that's the one. You can walk or you watch the movies, right? I'm not drunk. That's the kind of class that's going to be successful then. He's unsteady in his gait. So it affects the rebellor movement, it affects your gait, it affects your speech and it's no longer normal. Yes. In fact, that becomes pretty dangerous now because if you're drunk, you're driving. Your reaction time is delayed. Yes, that's right. Okay. In fact, you can fall asleep. Then if for example, if you get to levels of 300 milligrams per deciliter, then this is the part where you can have seizures or you can lose consciousness. And when you get to 500 milligrams per deciliter or more, that's the time that you, you know, people die at that level. Those are the cases we see in the emergency department with alcoholic encephalopathy, correct? They're not going to coma. We have to reverse it. We give them the 50-50, you close to reversing. And thiamine and vitamin B. But some people, some of the young people, you understand, they're supposed to be for the young people. Correct. So they don't realize that alcohol is actually a poison. Correct. And like, again, it's, it's, it has a social function, but this guy named Paracel, so he's the father of, the, the, the great, great grandfather of toxicology. He said, the difference between a medicine and a poison is the dose at which it's given. So given. The difference between a medicine and a poison is the dose at which it's given. Yes. Yes. So for example. And I was young too. And our drinking were binge drinking. That's right. Which is about dose. No, binge drinking, they say is, if you, if you drink and then you reach levels of, I'm not saying of 50 is that's the euphoria, talk at the 100. That's the time when you start having difficulty keeping your balance. Okay. If you drink and you reach 80, okay, that's already considered a binge. Wow. So, so is there like a safe level of drinking? This is the advice of, of at least for, this is for Caucasians. Okay. So we have to extrapolate for, for, for Asians. But for Caucasians, okay. So we have to determine, doctors determine that you want to stay within two standard drinks per day. Two drinks. For men. Okay. And one standard drink per day for women. Why is there a gender difference? Well, the men because they are bigger. They're bigger. They're bigger. So it's about. In terms of weight. In terms of muscle mass, it's bigger. So they can handle more. The dose is dose by weight, right? Yeah. So if you have a bigger body mass index, you probably can take more alcohol. Now, and here's the deal, okay. Two drinks per day. Correct. But if you don't, it's not like a sick leave, the one where you can accumulate it. I didn't drink for six days on day seven. I can have 14 drinks. So on Friday, I can get more drinks now. It's not that. You use it or lose it. Okay. So it's at that single moment that when you drink, you're allotted two drinks and beyond that, most likely. And anything beyond that, then you start tempting fate. That's when harmful effects can happen. You can either get violent. You can either get driving. Well, it depends on people. It depends on how people's constitution. But that would be pretty much the safe, okay? And so there is some truth to the statement that there are some heart benefits, cardiac benefits for people who drink wine. Yeah. You're allotted by the French winemakers. Although there's some debate, is it the alcohol or is it really, you know, the antioxidants you find in wine? The tannins in the red, right? So but when you go beyond two drinks for men and one drink for women per day, then you lose that benefit. Now I said we have to extrapolate for age. Asians are smaller. Correct. Okay. And I don't think there have been studies yet that have determined what is a healthy level for Asians. So there's still no widespread study on what is the safe level for Asians? Because of the absence of that enzyme that metabolizes. And most of the studies really have been done on Europeans, North Americans. Even they will say that this is not, let me be clear, okay? When I say this is the recommended level, okay, this is the recommended level for people who are already drinking. But if you're not drinking, the doctors will say don't start. And if you're not drinking, if you're a kid, don't start, right? But if you are drinking already, then stay within this level because this is the level at which, you know, generally it's safe. So Alan, when we talk... So that's enough. That's enough. Okay. When we talk about alcohol, the specific alcohol we'll talk about is not isopropyl alcohol, right? No, no, no, no. It's ethanol. Ethanol. Ethanol. Just last couple of months ago in the Christmas season, we had Christmas parties where several people were poisoned because... Not several, 500. More than 500. 500 people from Laguna and Quezon were poisoned by methanol contained in lambanol. I heard you were the one on duty at the Philippine general hospital at that time. Can you tell me your experience? Okay, let's talk about this methanol toxicity and poisoning. Well, so methanol is an alcohol, okay? Ethanol is an alcohol, but it's ethanol that we drink. Yes, the alcohol. That's the one that's why you're beer, wine, and whiskey, and et cetera, et cetera. Methanol is toxic. Now methanol, that's the toxic one. That's toxic to the human body. It's one of those... It's called a toxic alcohol. Correct. That's why it's so toxic is because when you... The same enzyme that breaks down our ethanol, okay, from beer and wine, that's the same one that breaks down methanol, except that instead of producing relative acetaldehyde, it produces formaldehyde, a.k.a. formalin. And that's toxic to the human body. Yeah, that's toxic, yes. Oh, and then this formalin is converted further to formic acid. It destroys your eyesight. So you go blind, you just expect the heart, you get comatose, you know, and there were mortalities here. People died. And how did methanol get into the lambanog? Well, I'm not an expert in distilling, but I was informed, okay, by somebody who does it. It's that when you... It's really one of those things that are formed in the process of the distillation to lambanog. So you really have methanol and methanol? So there is a certain amount. There is a certain amount, okay. And I was informed that the people who do, they are actually able to process it so they'll separate it out. They'll redistill it, they said, redistill it to several steps so that all the methanol is removed. So the methanol is gone. But in this case, I think a big order was taken for a party that was scheduled. Now the interesting thing, there's another source of methanol. Yes. The other source is that there are people who actually add it, no? Add the methanol. Yes. That's not good. Okay. But this is... Again, we don't know if this is what happened, okay, but we are aware that it has happened in the past. Yes. Okay. Where because... It's referred to your center, right? The lambanog also is, no, it's expensive. Correct. So if you sell it, you know, it's a lot of money, so what you have to do, what people do then is they get some lambanog and they mix it now with ethyl alcohol, okay? And so that has a lambanog flavor, okay? But it's not pure lambanog, so it's ethyl alcohol. And then this is the one that they now retail. What I heard is if you add other things, that's not considered lambanog because the process of lambanog should be actually a natural process of fermentation. But let me ask you, one interesting thing that happened there was the director of Philippine General Hospital at that time ordered several boxes of vodka and gin. Initially vodka and then later on gin because they run out of vodka. Well, vodka was too expensive, so we decided to go to gin. Vodka was too expensive, but gin became the order. Can you explain why PG-87, I'm sure there was a Christmas party that time, but it wasn't going to be used for the party, right? No, it's going to be used for the methanol patients. Okay, so how is gin or vodka useful for the methanol toxicity? Well, because like I said, there's an enzyme that breaks down the alcohol, the ethanol, okay? The same enzyme also breaks down methanol. But between methanol and ethanol, that enzyme likes ethanol better. So it's a competitive inhibition, so you give the patient, they shot it? So give the patient ethanol? How many drinks were given to them? More than two. We had to compute it. We had to calculate it at a level that was, they couldn't drive, you know. So we don't have to do that, but basically the treatment, the antidote for methanol poisoning is ethanol or alcohol that we're talking about. That's the one, that's the one. Interesting, it's a paradox, huh? So the, of course, our patients, you know, they were, you know, they were high-ranked because they said, what? We just drank, they're going to be giving us gin or vodka. So they took it orally? So they took it, yeah, but they took it in a measured dose. Yes, now as a medication. Every six, every four hours. This is given as a medication. To compete with the, very interesting. So, tell me now, let's go back to regular alcohol. Your beer, your wine, your whiskey and all other vodka and gin. Are the effects to people the same or are there different effects? It depends, yeah, because there are people who are hit right away with it. Okay, and like, there's this case that he just takes one bottle of beer, you know, he's wild. And so that's already harmful drinking adverse effect. Correct. But if he continues drinking in spite of that, then you know that he's got a problem, he's got the use disorder. There are people that can take. So that's called use disorder because they cannot hold a drink. Well, because bad things happen in their lives because of the drinking and they continue to do it anyway. Correct. And then you've got people. That's a very common excuse of, in the ER, the domestic violence. The husband always says, But that's also a reason why it's supposed to be a term for it. It's an alcohol disorder. In law, if you're under the influence of alcohol, it's aggravating. Aggravating circumstance. It's an aggravating circumstance instead of mitigating. Yes, mitigating. Now, when do you overdose on ethanol or alcohol percent? I drink beer. How many beers should I drink the whole case before I overdose? Like I said, because people metabolize it differently. If you're not a drinker, then you're a slower metabolizer of alcohol. If you drink a lot, then you're a faster metabolizer of alcohol. And the reason for that is because alcohol, if you keep exposing the liver to a regular dose of alcohol, then the liver says there's plenty of poison in my body. I better increase the number of enzymes I have to deal with it. And so you develop a certain tolerance for it. So you have the typical war stories about drinking. I can take two cases and still be okay. Sounds like my famous last words. But that's because your liver has responded to the presence of toxin in your body. Correct. And it's trying to save you from dying by increasing the number of the activity and the amount of enzymes to metabolize it. And so because of this, there's some variation about why other people are faster, why others are slower. So it depends partly on the degree of tolerance you develop. It also depends partly on your genetic makeup. Is there a definition of who an alcoholic is? If there's alcoholism, which we defined earlier. If I like to drink and I like to drink, when do you say I am an alcoholic? Well, first there's that term, when are you a heavy drinker? Okay. And here we're talking about health effects, okay, not yet addiction, not yet in disorder. But a heavy drinker for men, we're talking about in one week, 15 drinks, 15 standard drinks. 15 drinks. So two drinks a day. So if I drank every day the two drinks, I become that level. Well, if you drink two a day for seven days, that's just 14. Yeah, that's one more. So if you drink more than that then, you know, okay, for women it's eight. I see. So can a person become dependent without being addicted to alcohol? Yes. Well, no. Dependence and addiction will consider that synonyms. Okay. But can you be a heavy drinker and not be addicted and not be dependent? Yeah, there are. There are people, there are people who can drink a lot and then when they don't want to drink, they just stop. They just stop. But there are people who don't look for it. They don't have their 15 drinks. Or yeah, there are people who start drinking and then they can't stop. Correct. And the typical story there is they can't understand why people leave half a glass of beer or half a glass of wine and not finish it, you know, because they need to finish it. And then they drink to the point of where they drink the point of drunkenness. Drunkenness. To the point of drunkenness. Is alcohol the same considered ADC? Yes. Okay. In fact, the current view now is that it is a chronic relapsing disease. Chronic relapsing. Yes. In other words, if you have this condition, if you have this disorder, then even if you've stopped, okay, there is still a big possibility that you might drink again. You might do the kind of harmful drinking that you were doing before. So, you know, it's like smoking. When you smoke, you stop and then you can restart anytime you're back to it again. So same thing here. My dad was in your definition an alcoholic because he had like a bottle of gin every night. Can I inherit? Yes, you can. Yes, you can. Alcoholism. In fact, there are about 13 genes now that are associated with heavy drinking, okay, and or alcohol use disorder. So alcohol use disorder is genetically transmitted to children? There is a genetic component. So if you have an alcoholic, for example, with one generation, then don't be surprised if there's another alcoholic in the next generation. But it's not the mathematical kind of genetic. Correct. That you see, for example. There's the Mendelian principles of gin transmission. White-eyed fruit flies and things like that. Correct. So it's certainly more complicated than that. And you can imagine a situation where you have the genes that will make you vulnerable to being an alcoholic. But if you grow up in an environment where alcohol is not available, okay, or you convert to a religion. And you don't also have the psychological environment for it. It will not manifest. You probably won't be an alcoholic. So you said alcoholism is a disease, right? You said that earlier. Can it be cured? Okay. So we come back to that term chronic relapsing. Chronic relapsing. Relapsing. Disorder. Disorder. And here's a metaphor, a metaphor, a partial metaphor that I use, because there's certainly some basis to it. When you use alcohol or methamphetamine, marijuana, et cetera, et cetera, and you use these things repeatedly, essentially what happens is that your brain recables itself. Now, the brain is supposed to be a whole bunch of cables that are connected to each other. I thought the brain was wireless. So what happens here is that, we'll take a step back first. Let's not talk about alcoholism. We'll talk about musicians. Yes. Okay, musicians. For example, musicians left and right brain have to keep talking to each other. And so there is that part of the brain that connects left and right. The corpus calliosum. That is thicker among professional musicians compared to those who aren't. That's the corpus calliosum. Yes, that's right. And the reason for that is because of the repetition, reading the notes, playing, the left and right brain keep talking to each other. The brain responds by making the cables thicker and making the cable connections greater. Okay? Now, we're talking here. Four genes. Five genes. We're talking here about musicians. Okay. Which is music. Which is a good thing. Okay? Accountants will form cables for accounting. Doctors will form it for making diagnoses. Engineers, same thing. Okay? The key here is repetition. Okay? You form the cables so that what you keep repeating becomes very efficient. No? Here's the problem. You do it often enough. You form the cables. The cables don't go away. Okay? So you have a musician. It's like a scar. Yeah. Well, like you probably learned to ride a bike when you were a kid. And if you haven't ridden a bike for years and years, I'll give you a bike. Okay? You'll be wobbly, but you'll learn. Correct. You'll go back. Because you're cable-ready. Okay? So this is the chronic relapsing thing. So same thing. Same thing. You've got a person, for example, has alcohol use disorder. He has the cables. He's been off alcohol for ten years, etc. He's identified. He's gone through rehabilitation. Then all of a sudden, you know, he gets triggered. There's exposure. There's access. He has a psychological environmental setting for it. He drinks again. He'll have problems. What's the relapsing for alcoholics? It's hard to tell. But what I do know is this. Any rehab center who says that their relapse-free rate is great. It's greater than 60%. It's probably doing a great deal of marketing. Oh, that high, huh? 60%. What usually, because relapse says sometimes are the rule. Although there's this jargon among rehabilitation centers that you have to distinguish a relapse from a slip. Okay? Because for example, the rehab center is supposed to teach you how to deal with your triggers. Your desire to take. And if, for example, if you drink, but you realize, oh my God, it happened again. So I have to go back to the stuff that my rehab taught me. Then that's called a slip. But if you drink and you forget everything and you go back to what you're doing, that's a relapse. But these are the jargon by the rehab center. There's also such a thing that I learned in med school as alcohol withdrawal. Yes. When your body becomes accustomed to the present, the cells of your body become accustomed to the constant presence of alcohol. And alcohol is a depressant. Okay? And that's the reason why you go to sleep. Sleep, okay, you have coma. Because there's that constant presence of a chemical depressant in your system. Your brain knows, your brain tries to adapt by increasing the chemicals in your brain to wake you up. So these are the excitatory neurotransmitters to counteract the depressant effects of alcohol. Now, what happens is because you have to function. Okay? So you've got levels of alcohol constantly present. Your brain increases the number, the amount of your excitatory neurotransmitters to wake you up. If you suddenly remove the alcohol, this one doesn't go down. It remains high for a few days. Maybe three to five. And because you've got a lot of excitatory neurotransmitters in your brain, then you get the tremor. Hallucination. Hallucinations. You can't sleep. You're very irritable. Irritable, irritable. So those are the symptoms of withdrawal. Those are the symptoms of withdrawal. How do you treat withdrawal symptoms? Well, what we do now is... Dose. Because there's no more alcohol, right? So we now have to give a depressant. Another depressant. So you should give the asipam. To calm the... Yes. And then as the neurotransmitters go down, we decrease the dose of the asipam until it's... Until the withdrawal symptoms is over. Yes. And you're detoxified. By that time, the withdrawal symptoms are... That's defined as detoxification. Yes, you're detoxified. Okay? But apart from that, you have to take a look at the organs in the body that are affected by the alcohol. And that's part of the detoxification process. The liver, the other parts. The liver. If you have ulcers, you're bleeding because of the alcohol. So you're correct all of that. Plus the withdrawal, then you're detoxified. But the detoxification doesn't deal with the cables. Correct. No? Rehab will deal with that. That's where you need rehab. Now... What is rehab problem? The good rehabilitation centers are actually... These are training programs. Okay? They're... It's because of repetition that you develop these cables, these habits of drinking. And the cables will actually connect. Things like if you're sad, then you drink, you feel happier. You keep repeating that pretty soon. You have a cable that connects sadness with drinking. So once you're sad, you automatically drink. You automatically look for a drink. Or there are other triggers. Some people, when they feel angry, they have to calm down. Now you have a cable connecting anger with drinking. And they're depressed. Yes. They call their friends and they go drinking. Then there are also external things. Like for example, the friend says, oh, you drink. Then you... Peer pressure. Then that becomes connected as well. You do it often enough. Then you form the cables for it. So the hard part here though is... So you have to identify what these triggers are. And then the good rehabilitation centers will now train you to deal with them in a different way. In a different way. So that's what you have. But that's what you have. So instead of I'm angry with my wife and so I drink, I'm angry with my wife and so I count 20. I write down the issues. I phrase what I'm going to say. I talk to her, call me. So you want to repeat that over and over and over again. So now you develop the cables for dealing with anger that way instead of drinking. In a sense, like the metaphor here would be you're trying to develop bypass cables. So that you don't use your alcohol cables, you use these other ones that are better for you. So we have this really more of behavior modification. It's really a program to modify behavior regarding the use or this... The alcohol disordered use. And the behavior is modified by one repetition of these new skills. And also by giving people a new way to look at life and a new way of dealing with their problems. A new way of looking at themselves. So there's some insight that has to take place apart from the behavior modification. I'd like to say let's drink to that, but it's probably not the correct thing. Alan, do you have any other message to our young people who view these episodes and talk about whether alcohol should be an important part of their health consciousness? Well, I think that if you... I think there's wisdom to the... There's wisdom to the practice in some countries. Not to let young people drink until they're 21. It's strictly enforced the 18 and above. 21. That's for your ID, the U.S., right? You have to have an ID. It's because of the part of your brain that is responsible for judgment, for prudential things. It's not yet developed before that. Yes, so you have to wait until your age, 19, 20, 21, before that things will be developed. And if, for example, you drink and you influence it with alcohol or these other mind-altering substances, then you might actually do something bad to the development of that part of your brain. So just avoid it for a while. And then when you do drink, stay within the healthy levels of drinking. Thank you very much, Alan. That's been a very interesting discussion on alcohol disorder, alcohol use disorder. And I'm sure our viewers out there have learned many points about this particular health issue and health problem, the disease of alcoholism and how to cure it. And I've only one advice for the viewers, drink moderately. Thank you, Alan. Okay, thank you.