Alcohol Misuse and Health
“Santé!” “Salute!” “Za vashe zdorovye!” “Chuc suc khoe!” Whether in France, Italy, Russia, or Vietnam, similar salutations ring out before friends take a drink together: “Good health!” Yet, paradoxically, millions of people worldwide are drinking themselves into the grave.
ALCOHOL misuse is a multifaceted problem that includes hazardous use, harmful use, and dependence. Hazardous use, as defined by the World Health Organization, is “a pattern of alcohol consumption carrying with it a risk of harmful consequences,” physical, mental, or social. It includes drinking more than the limits recommended by health authorities or imposed by the law. Harmful use, also called alcohol abuse, involves drinking that is already provoking either physical or mental damage but has not yet led to dependence. Dependence has been described as “the loss of control to abstain from drinking.” An alcohol-dependent person craves alcohol, continues to drink despite various alcohol-induced problems, and suffers from withdrawal in its absence.
No matter what your age, gender, or nationality, you are not free from the risks of hazardous drinking. Just what does alcohol do to the body? What are the health dangers of overdrinking? And what is generally considered a safe level of alcohol consumption?
Dangerous for the Mind
Ethanol, the chemical compound present in most alcoholic drinks, is a neurotoxin—that is, a substance that can damage or destroy the nervous system. Someone who is drunk is, in fact, suffering from a form of poisoning. In large quantities ethanol causes coma and death. For instance, among students in Japan, the practice of ikkinomi, or alcohol chugging, causes deaths every year. The body is able to convert ethanol into harmless substances, but this is not accomplished immediately. If alcohol is consumed at a faster rate than the body can handle it, ethanol builds up in the system and begins to interfere noticeably with brain function. In what way?
Speech, vision, coordination, thought, and behavior are all connected with an incredibly complex series of chemical reactions in the brain’s neurons, or key cells. The presence of ethanol modifies those reactions, suppressing or enhancing the role of certain neurotransmitters—chemicals that relay signals from neuron to neuron. The stream of information in the brain is thus altered, preventing the brain from functioning normally. That is why when a person drinks too much, he or she develops slurred speech, blurred vision, sluggish movement, and weakened behavioral restraints and inhibitions—all common symptoms of intoxication.
With prolonged exposure to alcohol, brain chemistry adapts to counter the poisonous effect of ethanol and to maintain normal nerve function. This leads to tolerance, whereby the same amount of alcohol has less of an effect than it would have had previously. Dependence occurs when the brain has adapted so much to the presence of alcohol that it cannot operate properly without it. The body craves alcohol to maintain the chemical balance. When a person is deprived of alcohol, his brain chemistry is totally destabilized and withdrawal symptoms, such as anxiety, trembling, or even seizures, set in.
Besides causing modifications of brain chemistry, alcohol abuse can lead to cell atrophy and destruction, altering the brain’s very structure. While partial recovery is possible with abstinence, some of this damage seems to be irreversible, further affecting memory and other cognitive functions. Damage to the brain is not just the result of long-term exposure to alcohol. Research seems to indicate that even relatively short periods of alcohol abuse can be harmful.
Liver Disease and Cancer
The liver plays a vital role in metabolizing food, combating infection, regulating blood flow, and removing toxic substances, including alcohol, from the body. Prolonged exposure to alcohol damages the liver in three stages. During the first stage, the breaking down of ethanol slows the digestion of fats, causing them to build up in the liver. This is called steatohepatitis, or fatty liver. In time, chronic inflammation of the liver, or hepatitis, sets in. While alcohol can cause hepatitis directly, it also appears to lower the body’s resistance to hepatitis B and hepatitis C viruses.* If unchecked, inflammation causes cells to burst and die. Compounding this damage, alcohol seems to trigger the natural system of programmed cell death called apoptosis.
The final stage is cirrhosis. The vicious cycle of continuous inflammation and cell destruction causes irreversible scarring. Eventually, the liver becomes lumpy, instead of remaining spongy. Finally, scar tissue prevents blood from flowing normally, leading to liver failure and death.
Alcohol’s effect on the liver has another insidious side effect—the liver is less capable of playing its defensive role in counteracting the effect of cancer-forming agents. In addition to favoring the development of cancer of the liver, alcohol greatly increases the risk of cancer of the mouth, the pharynx, the larynx, and the esophagus. What is more, alcohol makes the mucous membranes in the mouth more easily penetrated by cancerous substances in tobacco, elevating the risk for smokers. Women who drink daily are at greater risk of breast cancer. According to one study, the risk for those who drank three or more alcoholic beverages per day was 69 percent higher than that of nondrinkers.
A particularly tragic outcome of alcohol abuse is its effect on the unborn. “Alcohol is far worse for the developing fetus than any other abused drug,” reports the International Herald Tribune. When a pregnant woman drinks, her developing child also drinks, and the toxic effect of alcohol is especially devastating at this formative stage of the fetus. Alcohol causes irreversible damage to its central nervous system. Neurons do not form properly. Cells are killed off. Other cells end up located in the wrong place.
The result, fetal alcohol syndrome (FAS), is the foremost cause of mental retardation in newborns. Difficulties encountered by FAS children include intellectual impairment, language problems, developmental delay, behavioral dysfunction or deficit, slow growth, hyperactivity, and hearing and sight disorders. Many FAS babies are also born with characteristic facial deformities.
In addition, children whose mothers drank even moderate amounts of alcohol during pregnancy can suffer from certain disabilities, including behavioral problems and learning deficits. “You don’t have to be an alcoholic to hurt your baby,” remarks Professor Ann Streissguth, of the fetal alcohol and drug unit at the University of Washington, “you just have to be drinking enough and pregnant.” The report of the French National Institute of Health and Medical Research Alcool—Effets sur la santé notes: “The absorption of alcohol is deleterious during the whole gestational period, and no minimal dose has ever been established below which there are no risks.” Consequently, the wisest course for women who are pregnant or planning a pregnancy may be not to drink any alcohol at all.*
The list of health risks mentioned above is by no means exhaustive. In 2004 an article in Nature magazine pointed out that “even small amounts of alcohol increase the risk of injury and boost the chances of developing about 60 diseases.” In view of this, what constitutes safe drinking? Today millions of people worldwide safely enjoy having an occasional drink. The key to good health is moderation. But just what is moderation? Most people would consider their personal consumption to be moderate, perhaps reasoning that as long as they do not get drunk or are not alcohol dependent, there is no problem. Nevertheless, in Europe 1 man out of 4 has an alcohol consumption rate that is considered hazardous.
Various sources define moderate drinking as 0.70 ounce [20 g] of pure alcohol per day, or two standard drinks for men, and 0.35 ounce [10 g], or one drink, for women. French and British health authorities suggest “sensible limits” of three drinks per day for men and two for women. The U.S. National Institute on Alcohol Abuse and Alcoholism further recommends that “people aged 65 and older limit their consumption of alcohol to one drink per day.”* However, we all react differently to alcohol. In some cases, even these lower limits may be too high. For example, “moderate amounts of alcohol can be harmful to people with mood and anxiety disorders,” notes the 10th Special Report to the U.S. Congress on Alcohol and Health. Age, medical history, and physique are factors to be taken into consideration.—See the box “Limiting the Risk.”
What help is available for those who misuse alcohol? The following article will answer this question.
According to a study in France, the risk of developing cirrhosis is twice as high in patients infected with hepatitis C virus (HCV) who are heavy drinkers as it is in HCV patients who are moderate drinkers. It is recommended that HCV-positive individuals drink very little alcohol or none at all.
Women who are breast-feeding should be aware that after they drink, alcohol builds up in their breast milk. In fact, the concentration of alcohol in breast milk is often higher than in blood, since there is more water in the milk to absorb the alcohol than there is in blood.
Since what is termed a “drink” varies from place to place, the amount of alcohol in a glass will reflect local standard servings and should be considered before consumption.
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ONE FOR THE ROAD?
Restrictions on driving under the influence of alcohol have existed nearly as long as cars have. The first country to introduce such legislation was Denmark in 1903.
When you drink on an empty stomach, the alcohol in your blood reaches its highest level within about half an hour after it is ingested. Contrary to popular opinion, drinking coffee, taking in fresh air, and doing physical exercise will not help you to sober up. The only thing that will reduce the effect of alcohol on your body is the passing of time. Don’t forget, too, that “a drink is a drink is a drink.” That is, if you have a standard drink of wine, beer, or spirits, the alcohol content is the same.*
Even small amounts of alcohol can impair your driving ability. Alcohol affects your eyesight. Road signs appear to be smaller. Peripheral vision as well as your ability to judge distances and to focus on distant objects is reduced. Information processing, reflexes, and coordination are slowed down.
If you have an accident after having imbibed alcohol, your injuries are likely to be more serious than if you had been sober. Moreover, your chances of surviving any emergency surgery diminish because of the effect of alcohol on the heart and the circulation. “Thus, contrary to generally accepted ideas, the majority of alcohol-related deaths are of drunk drivers themselves,” notes a report by the French National Institute of Health and Medical Research. In view of the dangers, the report gives the following recommendations:
▪ Don’t drink and drive.
▪ Don’t get into a car with a driver who has been drinking.
▪ Don’t let friends or parents drive under the influence of alcohol.
Generally speaking, about seven grams [0.25 ounce] of alcohol are eliminated per hour. A standard drink varies from country to country. The World Health Organization defines a standard drink as containing 10 grams (0.35 ounce) of pure alcohol. This is the approximate equivalent of 250 milliliters of beer [8 ounces], 100 milliliters of wine [3.4 ounces], or 30 milliliters [1 ounce] of spirits.
These drinks contain roughly the same amount of alcohol
A bottle of regular beer (330 ml [11 ounces] at 5% alcohol)
A single shot of spirits (whiskey, gin, vodka) (40 ml [1.4 ounces] at 40% alcohol)
A glass of wine (140 ml [5 ounces] at 12% alcohol)
A small glass of liqueur (70 ml [2.4 ounces] at 25% alcohol)
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ALCOHOL DEPENDENCE—IS IT IN THE GENES?
In a bid to find a treatment for alcoholism, scientists have striven to understand the role that genes play in its genesis and evolution. Scientists have since discovered several genes that seem to influence one’s reaction to alcohol. However, genetic factors are not the only ones in alcoholism. Even if some people do have a certain genetic predisposition, dependence is not inevitable. Environmental components are involved. Poor parenting, alcohol abuse in the home or by peers, situations involving conflict, emotional difficulties, depression, aggressiveness, thrill seeking, high resistance to alcohol’s effects, or addiction to another substance have all been cited as risk factors. These and other elements open the way for dependence.
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Studies estimate that the number of people who abuse alcohol is some five million, of which between two and three million are alcohol dependent
According to the Lagos newspaper Daily Champion, “over 15 million Nigerians are alcoholics”—that is nearly 12 percent of the population
This country has one of the world’s highest per capita consumptions of pure alcohol. The Lisbon newspaper Público reports that 10 percent of the population suffer from “serious disabilities related to alcohol”
According to the 10th Special Report to the U.S. Congress on Alcohol and Health, “approximately 14 million Americans—7.4 percent of the population—meet the diagnostic criteria for alcohol abuse or alcoholism”
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LIMITING THE RISK
The following definitions of low-risk limits were published by the Department of Mental Health and Substance Dependence of the World Health Organization. Low risk does not mean no risk. Individual reactions to alcohol vary.
▪ No more than two standard drinks a day*
▪ On at least two days of the week, do not drink
In the following circumstances, even one or two drinks can be too much:
▪ When driving or operating machinery
▪ When pregnant or breast-feeding
▪ When taking certain medications
▪ When you have certain medical conditions
▪ If you cannot control your drinking
One standard drink equals 0.35 ounce [10g] of alcohol per unit or per glass.
Source: Brief Intervention for Hazardous and Harmful Drinking
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ALCOHOL—GOOD FOR THE HEART?
Scientists suspect that chemicals in red wine (polyphenols) inhibit a chemical that causes blood vessels to constrict.
Furthermore, alcohol in general has been linked to increased levels of so-called good cholesterol. It also reduces substances that can cause blood clots.
Any benefits from alcohol seem to involve drinking small amounts spread throughout the week, rather than the total amount all at once on a night out. Exceeding two drinks per day is linked to increases in blood pressure, and heavy drinking raises the risk of stroke and can cause swelling of the heart as well as irregular heartbeat. Immoderate drinking causes these and other health risks to outweigh any positive effects of alcohol on the cardiovascular system. Too much of a good thing is precisely that—too much.
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HOW ALCOHOL CAN DAMAGE YOU
Cell loss, memory loss, depression, aggressive behavior
Vision, speech, coordination impairment
Cancer of throat, mouth, breast, liver
Muscle weakness, potential heart failure
Fatty, then enlarged, then scarred (cirrhosis)
Poor immune system, ulcers, inflammation of pancreas
Risk of deformed or retarded babies
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“Alcohol is far worse for the developing fetus than any other abused drug”