Alcohol has long been an integral part of American culture, tightly woven into the fabric of society and many distinct social groups. It appears at almost every celebration, and most adults drink alcohol drink moderately and responsibly, without complications.
At the same time, alcohol-related problems among adults and adolescents—which result from drinking too much, too fast, or too often— are among the most significant public health issues in the United States and internationally.
We’ve been getting a lot of mixed messages about alcohol. On one hand, moderate amounts have been linked to health benefits. On the other, it is addictive and highly toxic when we drink too much of it, and it’s overuse is all to often associated with poor life choices.
The truth is the health effects of alcohol are actually quite complex. They vary between individuals, and depend on the amount consumed and the type of alcoholic beverage used.
So, how does alcohol affect health?
According to the NIH, each year in the United States,
- More than 88,000 people die from alcohol-related causes, making it the third leading preventable cause of death in our country. The first is tobacco, and the second is poor diet and physical inactivity.
- Alcohol misuse costs the United States about $249 billion per year.
- Approximately 15 million people had alcohol use disorder in 2016.4
- More than 10 percent of U.S. children live with a parent with alcohol problems, according to a 2017 study.5
According to WHO, globally,
- Alcohol misuse is the seventh leading risk factor for premature death and disability.
- 3 million deaths every year result from harmful use of alcohol, this represent 5.3 % of all deaths.
- The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.
- Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs).
- Alcohol consumption causes death and disability relatively early in life. In the age group 20–39 years approximately 13.5 % of the total deaths are alcohol-attributable.
There is a causal relationship between harmful use of alcohol and a range of mental and behavioral disorders, other noncommunicable conditions as well as injuries.
The latest causal relationships have been established between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS.
Beyond health consequences, the harmful use of alcohol brings significant social and economic losses to individuals and society at large.
What is alcohol?
The active ingredient in most alcoholic beverages is called ethanol. Generally referred to as “alcohol,” ethanol is the substance that makes you drunk. Ethanol is produced by yeasts when they digest sugar in certain carb rich foods, such as grapes (wine) or grains (beer).
Alcohol is the most popular recreational “drug” in the world. It can have very powerful effects on your mood and mental state.
Alcohol can reduce self-consciousness and shyness, making it easier for people to act without inhibition. At the same time, it can impair judgment and make people do things they end up regretting.
What are the Truths About Alcohol
Some people drink small amounts at a time, while others tend to binge drink. Binge drinking involves drinking large amounts at a time, in order to get drunk. Alcohol is a psychoactive substance with dependence-producing properties that has been widely used globally for centuries.
Alcohol is Neutralized by the Liver
The liver is a remarkable organ with hundreds of functions in the body. One of its main functions is to neutralize all sorts of toxic substances we consume. For this reason, the liver is particularly vulnerable to damage by alcohol intake.
Liver diseases caused by alcohol consumption are collectively called alcoholic liver diseases. The first of these to appear is fatty liver, characterized by increased fat inside liver cells. Fatty liver develops in 90% of those who drink more than 16 g (about half an ounce) of alcohol per day and is usually symptomless and fully reversible.
In heavy drinkers, binge drinking may cause the liver to become inflamed. In worst case scenarios, liver cells die and get replaced with scar tissue, leading to a serious condition called cirrhosis. Cirrhosis is irreversible and associated with many serious health problems. In advanced cirrhosis, getting a new liver (a liver transplant) may be the only option.
Alcohol and the Brain
Excessive alcohol consumption can have numerous adverse effects on the brain. Ethanol basically reduces communication between brain cells, a short-term effect responsible for many of the symptoms of being drunk.
Binge drinking may even lead to a blackout, a phenomenon characterized by memory loss (amnesia) during a heavy drinking episode. These effects are only temporary, but chronic alcohol abuse may cause permanent changes in the brain, often leading to impaired brain function.
The brain is actually very sensitive to damage caused by chronic alcohol abuse, which may increase the risk of dementia and cause brain shrinkage in middle-aged and elderly people. In worst case scenarios, the severity of brain damage may impair people’s ability to lead an independent life.
Conversely, drinking moderately has been linked with reduced risk of dementia, especially in elderly people.
Alcohol and Depression
The association of alcohol intake and depression is close but complex. While alcohol intake and depression seem to increase the risk of each other simultaneously, alcohol abuse may be the stronger causal factor.
Many people suffering from anxiety and depression drink intentionally to reduce stress and improve mood. This may work for a few hours, but will worsen overall mental health and lead to a vicious cycle.
Heavy drinking has actually been shown to be a major cause of depression in some individuals, and treating the alcohol abuse leads to big improvements.
Alcohol and Body Weight
Obesity is a serious health concern. Alcohol is actually the second most energy rich nutrient after fat, providing about 7 calories per gram.
Beer contains a similar amount of calories as sugary soft drinks, ounce for ounce, whereas red wine contains twice as much. However, studies investigating the link between alcohol and weight have provided inconsistent results.
It seems that drinking habits and preferences may play a role. For example, moderate drinking is linked to reduced weight gain,, whereas heavy drinking is linked to increased weight gain. Also, drinking beer regularly may cause weight gain, whereas wine consumption may reduce it.
Alcohol and Cardiovascular Health
Cardiovascular disease is the leading causes of death in modern society. It is actually a broad category of diseases, the most common of which are heart attacks and strokes.
The relationship between alcohol and cardiovascular disease is complex, and seems to depend on several factors. Light to moderate drinking is linked to reduced risk of cardiovascular disease, while heavy drinking appears to increase the risk.
There are several possible reasons for the beneficial effects of drinking moderately. Moderate alcohol consumption may:
- Raise HDL (the “good”) cholesterol in the bloodstream.
- Decrease blood pressure, a major risk factor for heart disease.
- Lower the concentration of fibrinogen in the blood, a substance that contributes to blood clots.
- Cut the risk of diabetes, another major risk factor of heart disease.
- Reduce stress and anxiety temporarily.
Alcohol and Type 2 Diabetes
Type 2 diabetes is a common metabolic disease, currently affecting about 8% of the world’s population. Characterized by abnormally high blood sugar, type 2 diabetes is caused by reduced uptake of glucose (blood sugar) by cells, a phenomenon known as insulin resistance.
Drinking alcohol in moderation appears to reduce insulin resistance, helping to fight the main symptoms of diabetes. As a result, drinking alcohol with meals may cut the rise in blood sugar by 16-37% compared to water. Blood sugar between meals (fasting blood glucose) may also go down.
In fact, the overall risk of diabetes tends to be reduced with moderate alcohol consumption. However, when it comes to heavy drinking and binge drinking, the risk is increased.
Alcohol and Cancer
Cancer is a serious disease caused by abnormal growth of cells. Alcohol consumption is a risk factor for cancers of the mouth, throat, colon, breast, and liver.
The cells lining the mouth and throat are especially vulnerable to the harmful effects of alcohol. Not surprising, since they are directly exposed to the stuff. Even light alcohol consumption, 1 drink per day, is linked to a 20% increased risk of mouth and throat cancer.
The risk increases with the daily amount consumed. More than 4 drinks daily appear to cause a five-fold increase in the risk of mouth and throat cancer, and also increase the risk of breast, colon and liver cancer.
Drinking During Pregnancy May Cause Birth Defects
Alcohol abuse during pregnancy is the leading preventable cause of birth defects in the US. Binge drinking early in pregnancy is particularly risky for the developing baby. In fact, it may have adverse effects on development, growth, intelligence, and behavior, which may affect the child for the rest of its life.
Alcohol is Addictive, Leading to Alcoholism in Predisposed Individuals
Some people become addicted to the effects of alcohol, a condition called alcohol dependence (alcoholism). An estimated 12% of Americans are believed to have been dependent on alcohol at some point in their life.
Alcohol dependence is one of the main causes of alcohol abuse and disability in the US and a strong risk factor for various diseases. Numerous factors can predispose people to problem drinking, such as family history, social environment, mental health, and genes.
Many different subtypes of alcohol dependence have been defined, characterized by alcohol cravings, inability to abstain, or loss of self-control when drinking. As a rule of thumb, if alcohol is causing problems in your life, then you may have a problem with alcohol dependence or alcoholism.
Alcohol and Risk of Death
Abraham Lincoln once said, “It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing.” Interestingly, there appears to be a grain of truth in his words. Studies suggest that light and moderate consumption of alcohol may to cut the risk of premature death, especially in Western societies.
At the same time, alcohol abuse is the third main cause of preventable death in the US, being an important cause of chronic diseases, accidents, traffic crashes, and social problems.
Factors affecting alcohol consumption and alcohol-related harm
A variety of factors have been identified at the individual and the societal level, which affect the levels and patterns of alcohol consumption and the magnitude of alcohol-related problems in populations.
Environmental factors include economic development, culture, availability of alcohol, and the comprehensiveness and levels of implementation and enforcement of alcohol policies. For a given level or pattern of drinking, vulnerabilities within a society are likely to have similar differential effects as those between societies. Although there is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the person is to develop alcohol-related problems as a result of alcohol consumption.
The impact of alcohol consumption on chronic and acute health outcomes in populations is largely determined by 2 separate but related dimensions of drinking:
- the total volume of alcohol consumed, and
- the pattern of drinking.
The context of drinking plays an important role in occurrence of alcohol-related harm, particularly associated with health effects of alcohol intoxication, and, on rare occasions, also the quality of alcohol consumed. Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes in individuals.
There are gender differences in alcohol-related mortality and morbidity, as well as levels and patterns of alcohol consumption. The percentage of alcohol-attributable deaths among men amount to 7.7 % of all global deaths compared to 2.6 % of all deaths among women. Total alcohol per capita consumption in 2010 among male and female drinkers worldwide was on average 19.4 litres for males and 7.0 litres of pure alcohol for females.
Ways to reduce the burden from harmful use of alcohol
The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and requires actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health.
Countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Substantial scientific knowledge exists for policy-makers on the effectiveness and cost-effectiveness of the following strategies:
- regulating the marketing of alcoholic beverages (in particular to younger people);
- regulating and restricting the availability of alcohol;
- enacting appropriate drink-driving policies;
- reducing demand through taxation and pricing mechanisms;
- raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies;
- providing accessible and affordable treatment for people with alcohol-use disorders; and
- implementing screening and brief interventions programs for hazardous and harmful drinking in health services
What is the Real Harm in Consuming Alcohol?
The use of alcohol can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of alcohol results in a significant health, social and economic burden on society at large.
Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions.
A significant proportion of the disease burden attributable to alcohol consumption arises from unintentional and intentional injuries, including those due to road traffic crashes, violence, and suicides, and fatal alcohol-related injuries tend to occur in relatively younger age groups.
The latest causal relationships on the rise are those between harmful drinking and incidence of infectious diseases, such as tuberculosis, as well as the incidence and course of HIV/AIDS. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications.
The health effects of alcohol range from “possibly good” to “absolutely disastrous.” Alcohol is one of those things that depend entirely on the individual — good for some, disastrous for others.
Drinking small amounts, especially of red wine, appears linked to various health benefits. On the other hand, alcohol abuse and alcohol addiction are linked to severe negative effects on both physical and mental health.
If you enjoy alcohol and you can truly be moderate in its use, you might continue to do what you are doing. However, if you tend to drink excessively, or alcohol causes problems in your life, then consider avoiding it.