To the Editor: A 44-year-old man admitted to our psychiatric service with psychotic symptoms reported that he often consumed illegally distilled grain alcohol, or "moonshine." The treatment team had assumed that moonshine production, or "bootlegging," once common and lucrative in the early part of this century, had become irrelevant since the 1937 repeal of Prohibition. This letter discusses moonshine use and possible associated psychiatric complications.
Few articles about moonshine use have been published. Most have focused on rural populations of Alabama, Georgia, South Carolina, and Mississippi. A retrospective review of moonshine-related cases in West Alabama concluded that older males living in rural settings may be most at risk (1). Several articles, however, reveal that consumption is not limited to the Southeast or to rural populations. Incidental findings of moonshine use in urban populations have been reported in the District of Columbia, Michigan, Pennsylvania, and Virginia.
Moonshine use carries health risks that extend beyond those of legally distilled liquor. Lead toxicity is the best-known complication of moonshine consumption and may cause peripheral neuropathies, hematological disturbances, gastrointestinal problems, and endocrine dysfunction. Psychiatric problems are also known to occur, but no articles were found that specifically examined the psychiatric sequelae of moonshine use. The toxic effects of chronic lead exposure from other sources probably represent the best profile of symptoms and include confusion, anger, tension, and fatigue. Neurobehavioral impairments of verbal skills, visual motor performance, and memory are often found as well (2).
Poor water quality accounts for small amounts of lead in moonshine. Larger quantities, however, are derived from the construction materials used in the distilling apparatus itself. The bootlegging operation is especially suspect if one component is a car radiator, used as a condenser, or if lead-containing solder is used at tubing joints. As fluids and vapors flow through the still at various temperatures, lead and other heavy metals leach into the distillate and become concentrated in the end product. Because arsenic is also sometimes present in radiators it, too, may leach into the distillate. A less direct manner of induction occurs when arsenic used to control rodents near grain stores contaminates the mash (3).
Other moonshine contaminants also pose significant risks. Copper and zinc are elemental compounds that have been found at potentially toxic concentrations in samples of moonshine (3,4). A case of fatal ingestion of paraquat, presumably mixed in some illicit moonshine, has been reported (5). Although no articles have reviewed the psychiatric complications of these nonlead contaminants when derived from moonshine, the consideration of toxic concentrations in known moonshine users is prudent. The manifestations of Wilson's disease (copper toxicosis) and the cognitive blunting associated with arsenic poisoning are two possible psychiatric complications.
Moonshine consumption is a continuing phenomenon. Lead and other heavy metals have been associated with its production and use. Toxic effects from these elements and other contaminants should be considered in patients who report drinking illicitly distilled alcohol. Since moonshine use may be underreported, clinicians should be alert to its possibility.
Dr. Montgomery is a first-year resident in psychiatry at the University of California, Davis, School of Medicine. Dr. Finkenbine is assistant professor in the department of psychiatry at West Virginia University in Morgantown.