38 Alcohol

Alcohol Abuse

If you are like many Americans, you drink alcohol at least occasionally. For many people, moderate drinking is probably safe. It may even have health benefits, including reducing your risk of certain heart problems. Moderate drinking is one drink a day for women or anyone over 65, and two drinks a day for men under 65.

Some people should not drink at all, including alcoholics, children, pregnant women, people on certain medicines and people with some medical conditions.

Anything more than moderate drinking can be risky. Binge drinking—drinking five or more drinks at one time—can damage your health and increase your risk for accidents, injuries and assault. Years of heavy drinking can lead to liver disease, heart disease, cancer and pancreatitis. It can also cause problems at home, at work and with friends.

Beyond Hangovers

A brightly colored cosmopolitan is the drink of choice for the glamorous characters in Sex and the City. James Bond depends on his famous martini—shaken, not stirred—to unwind with after confounding a villain. And what wedding concludes without a champagne toast?

Alcohol is part of our culture—it helps us celebrate and socialize, and it enhances our religious ceremonies. But drinking too much—on a single occasion or over time—can have serious consequences for our health. Most Americans recognize that drinking too much can lead to accidents and dependence. But that’s only part of the story. In addition to these serious problems, alcohol abuse can damage organs, weaken the immune system, and contribute to cancers. Plus, much like smoking, alcohol affects different people differently. Genes, environment, and even diet can play a role in whether you develop an alcohol-related disease.

On the flip side, some people actually may benefit from drinking alcohol in small quantities. Sound complicated? It sure can be. To stay healthy, and to decide what role alcohol should play in your life, you need accurate, up-to-date information. This brochure is designed to offer you guidance based on the latest research on alcohol’s effect on your health.

Moderate and Binge Drinking

Moderate or “low-risk” drinking

Research shows that people who drink moderately may be less likely to experience an alcohol use disorder (AUD). These drinking levels, which differ for men and women, are:

For men:

• No more than 4 drinks on any single day AND no more than 14 drinks per week

For women:

• No more than 3 drinks on any single day AND no more than 7 drinks per week

To stay low risk for AUDs, you must keep within both the single-day and weekly limits.

Even within these limits, you can have problems if you drink too quickly or have other health issues. To keep your risk for problems low, make sure you:

• Drink slowly
• Eat enough while drinking

Certain people should avoid alcohol completely, including those who:

• Plan to drive a vehicle or operate machinery
• Take medications that interact with alcohol
• Have a medical condition that alcohol can aggravate
• Are pregnant or trying to become pregnant

Heavy or “at-risk” drinking

For healthy adults in general, heavy drinking means consuming more than the single-day or the weekly amounts listed above. About 1 in 4 people who drink above these levels already has alcohol dependence or alcohol abuse problems.

Binge drinking

Binge drinking means drinking so much within about 2 hours that blood alcohol concentration (BAC) levels reach 0.08g/dL. For women, this usually occurs after about 4 drinks, and for men, after about 5.

Drinking this way can pose health and safety risks, including car crashes and injuries. Over the long term, binge drinking can damage the liver and other organs.

A Little Goes a Long Way: Know the Amounts

Knowing how much alcohol constitutes a “standard” drink can help you determine how much you are drinking and understand the risks. One standard drink contains about 0.6 fluid ounces or 14 grams of pure alcohol. In more familiar terms, the following amounts constitute one standard drink:

• 12 fluid ounces of beer (about 5% alcohol)
• 8 to 9 fluid ounces of malt liquor (about 7% alcohol)
• 5 fluid ounces of table wine (about 12% alcohol)
• 1.5 fluid ounces of hard liquor (about 40% alcohol)

You’re chatting with friends at a party and a waitress comes around with glasses of champagne. You drink one, then another, maybe even a few more. Before you realize it, you are laughing more loudly than usual and swaying as you walk. By the end of the evening, you are too slow to move out of the way of a waiter with a dessert tray and have trouble speaking clearly. The next morning, you wake up feeling dizzy and your head hurts. You may have a hard time remembering everything you did the night before.

These reactions illustrate how quickly and dramatically alcohol affects the brain. The brain is an intricate maze of connections that keeps our physical and psychological processes running smoothly. Disruption of any of these connections can affect how the brain works. Alcohol also can have longer-lasting consequences for the brain—changing the way it looks and works and resulting in a range of problems.

Most people do not realize how extensively alcohol can affect the brain. But recognizing these potential consequences will help you make better decisions about what amount of alcohol is appropriate for you.

What happens inside the brain?

The brain’s structure is complex. It includes multiple systems that interact to support all of your body’s functions—from thinking to breathing to moving.

These multiple brain systems communicate with each other through about a trillion tiny nerve cells called neurons. Neurons in the brain translate information into electrical and chemical signals the brain can understand. They also send messages from the brain to the rest of the body.

Chemicals called neurotransmitters carry messages between the neurons. Neurotransmitters can be very powerful. Depending on the type and the amount of neurotransmitter, these chemicals can either intensify or minimize your body’s responses, your feelings, and your mood. The brain works to balance the neurotransmitters that speed things up with the ones that slow things down to keep your body operating at the right pace.

Alcohol can slow the pace of communication between neurotransmitters in the brain.

Fetal Alcohol Syndrome

Alcohol can affect the brain at any stage of development—even before birth. Fetal alcohol spectrum disorders are the full range of physical, learning, and behavioral problems, and other birth defects that result from prenatal alcohol exposure. The most serious of these disorders, fetal alcohol syndrome (FAS), is characterized by abnormal facial features and is usually associated with severe reductions in brain function and overall growth. FAS is the leading preventable birth defect associated with mental and behavioral impairment in the United States today.

The brains of children with FAS are smaller than normal and contain fewer cells, including neurons. These deficiencies result in life-long learning and behavioral problems. Current research is investigating whether the brain function of children and adults with FAS can be improved with complex rehabilitative training, dietary supplements, or medications.

Alcohol and Heart Disease

Americans know how prevalent heart disease is—about 1 in 12 of us suffer from it. What we don’t always recognize are the connections heart disease shares with alcohol. On the one hand, researchers have known for centuries that excessive alcohol consumption can damage the heart. Drinking a lot over a long period of time or drinking too much on a single occasion can put your heart—and your life—at risk. On the other hand, researchers now understand that drinking moderate amounts of alcohol can protect the hearts of some people from the risks of coronary artery disease.

Deciding how much, if any, alcohol is right for you can be complicated. To make the best decision for yourself, you need to know the facts and then consult your physician.

Cancer Risk

Genetics, environment, and lifestyle habits can all heighten your risk of getting cancer. We can’t do anything to change our genes, and we often can’t do much to change our environment. But lifestyle habits are a different story.

Drinking too much alcohol is one lifestyle habit that can increase your risk of developing certain cancers. This does not mean that anyone who drinks too much will develop cancer. But numerous studies do show the more you drink, the more you increase your chances of developing certain types of cancer.

For example, a group of Italy-based scientists reviewed more than 200 studies examining alcohol’s impact on cancer risk. The collective results of these studies clearly demonstrate that the more you drink, the higher your risk for developing a variety of cancers. The National Cancer Institute identifies alcohol as a risk factor for the following types of cancer:

• Mouth
• Esophagus
• Pharynx
• Larynx
• Liver
• Breast

At least 7 out of 10 people with mouth cancer drink heavily. Drinking five or more drinks per day can also increase your risk of developing other types of cancers, including colon or rectal cancer. In fact, summary estimates from the recent World Cancer Research Fund report indicate that women who drink five standard alcohol drinks each day have about 1.2 times the risk of developing colon or rectal cancer than women who do not drink at all.

People who drink are also more likely to smoke, and the combination increases the risk significantly. Smoking alone is a known risk factor for some cancers. But smoking and drinking together intensifies the cancer-causing properties of each substance. The overall effect poses an even greater risk.

The risk of throat and mouth cancers is especially high because alcohol and tobacco both come in direct contact with those areas. Overall, people who drink and smoke are 15 times more likely to develop cancers of the mouth and throat than nondrinkers and nonsmokers. In addition, recent studies estimate that alcohol and tobacco together are responsible for:

• 80 percent of throat and mouth cancer in men
• 65 percent of throat and mouth cancer in women
• 80 percent of esophageal squamous cell carcinoma, a type of esophagus cancer
• 25 to 30 percent of all liver cancers

Know the Benefits

Research shows that healthy people who drink moderate amounts of alcohol may have a lower risk of developing coronary heart disease than nondrinkers. Moderate drinking is usually defined as no more than two drinks in a given day for men and one drink per day for women who are not pregnant or trying to conceive.

A variety of factors, including diet, genetics, high blood pressure, and age, can cause fat to build up in your arteries, resulting in coronary heart disease. An excess of fat narrows the coronary arteries, which are the blood vessels that supply blood directly to the heart. Clogged arteries reduce blood supply to the heart muscle, and make it easier for blood clots to form. Blood clots can lead to both heart attacks and strokes.

According to recent studies, drinking moderately can protect your heart from these conditions. Moderate drinking helps inhibit and reduce the build-up of fat in the arteries. It can raise the levels of HDL—or “good” cholesterol—in the blood, which wards off heart disease. It can help guard against heart attack and stroke by preventing blood clots from forming and by dissolving blood clots that do develop. Drinking moderately also may help keep blood pressure levels in check.

These benefits may not apply to people with existing medical conditions, or who regularly take certain medications. In addition, researchers discourage people from beginning to drink just for the health benefits. Rather, you can use this research to help you spark a conversation with your medical professional about the best path for you.