Alcohol, it seems, is everywhere we turn: on TV, in the movies, on billboards, at the grocery store. For some, enjoying a glass of wine with dinner or having a couple of beers at the baseball game is a part of life – and for most people, it’s perfectly fine. But if that one glass of wine turns to five and those beers become a six-pack, that’s a warning sign that it’s time to slow down – or stop altogether.
April is Alcohol Awareness Month, a time to talk about alcohol, its effect on the body and what happens when someone drinks too much. Drinking alcohol only in moderation, if at all, is one of the most important things we can do to stay healthy and reduce risk of a variety of diseases and chronic health conditions.
Some people drink too much and find it difficult or impossible to stop or cut back. Alcohol use disorder – or as it is also known, alcoholism – is a disease that must be treated. At the same time, many people who do not have alcohol use disorder still drink too much, putting their health at risk. Privia Medical Group North Texas physicians want you to have the facts about alcohol and what it does to our bodies.
How Does Alcohol Affect the Body?
Alcohol, also known as ethanol or ethyl alcohol, is found in beer, wine and liquor. When alcohol is consumed, it is absorbed into the bloodstream from the small intestine and stomach. The liver works to metabolize the alcohol but can only handle a small amount at a time. This results in excess alcohol circulating throughout the body, leading to intoxication.
Alcohol’s intoxicating effects on the body are significant. It serves as a depressant to the central nervous system, affecting the brain, speech and motor reflexes. It slows the body’s response time, can blur vision and make it difficult to walk and talk. The potent effects of intoxication are why it is so dangerous to drink and drive.
Alcohol impacts people differently. Age, gender, weight and how much we have had to eat are all factors that affect alcohol’s interaction with our bodies, as well as how much it takes to reach the point of intoxication.
Drinking too much alcohol can result in dehydration, exhaustion, headaches and nausea. These are side effects that can extend to the next day, a condition commonly referred to as a hangover.
Heavy drinking’s negative impact on the body isn’t gone when the hangover goes away, however. Repeated excessive drinking can leave lasting health problems, including:
Heart disease: Heart problems related to heavy alcohol consumption include high blood pressure, cardiomyopathy (stretching of the heart muscle), stroke and arrhythmia (irregular heart beat). Even one episode of heavy drinking can cause the heart to beat irregularly.
Liver problems: These include cirrhosis (scarring) of the liver, fatty liver and alcoholic hepatitis.
Pancreatitis: This is an inflammation of the pancreas that causes digestive problems.
Cancer: Excessive alcohol consumption has been linked to several forms of cancer in men and women, including cancers of the breast, liver, mouth, esophagus and larynx.
Cognitive problems: Alcohol can change how the brain works, affecting behavior and memory over time.
Immune system problems: Excessive alcohol consumption compromises the immune system, increasing risk for illness.
Weight gain: Alcoholic drinks contain a lot of calories and contribute to weight gain.
How Much is OK?
“Before we can talk about how many drinks are ok, we first need to understand what ‘a drink’ is,” says Dr. Mark Bernhard, a primary care physician.
The following equate to one drink:
A 12-ounce beer
A 4.5-ounce glass of wine
A 1-ounce shot of liquor, such as whiskey, vodka or tequila
“All of the above contain the same amount of alcohol, which is why they are all considered one drink,” explains Dr. Karen Grant, a primary care physician. “Therefore, a margarita with two ounces of tequila in it equals two drinks. A large wine glass filled two-thirds full is closer to two drinks than one. And a beer served in a pint glass equals 1 ¼ drinks.”
“For people who drink alcohol, men should not have more than two drinks in one day and women should not have more than one,” says primary care physician, Dr. Melissa McFadden. “These are daily limits and should not be interpreted as weekly averages. If I don’t drink for three days, that doesn’t mean I can quadruple my alcohol intake on the fourth day.”
Excessive drinking is generally classified a few different ways, none of which are mutually exclusive.
Binge drinking is when a person consumes a large amount of alcohol at one time. Five drinks for men and four for women within a two-hour period is considered binge drinking. These also represent the number of drinks, on average, that causes a person’s blood alcohol level to rise to 0.8 percent, at which point a person is considered legally intoxicated in all 50 states. Keep in mind, everyone is different and it’s possible to become legally intoxicated after fewer drinks.
Heavy drinking, as defined by the U.S. Centers for Disease Control and Prevention (CDC) occurs when a man has 15 or more drinks within one week and a woman has 8 or more drinks within a week.
Heavy alcohol use, as defined by The National Institute on Alcohol Abuse and Alcoholism (NIAAA), is binge drinking five or more times within a month.
While binge drinking and heavy drinking are harmful to our health and should be avoided, they do not necessarily indicate the medical definition of an alcohol use disorder. In fact, the CDC reports that 90 percent of people who are heavy drinkers and/or binge drinkers do not meet the criteria for a severe alcohol use disorder.
“While frequent heavy drinking does not necessarily mean an alcohol use disorder is present, it’s still dangerous,” warns Dr. Lynne Tilkin, a primary care physician. “Binge drinking and heavy drinking increase the risk for numerous chronic health problems and disease, such as cancer. The intoxication that results from binge drinking can lead to poor judgment and decision making, injury and even death.”
Who Should Avoid Alcohol
While anyone who does drink needs to limit alcohol consumption to recommended levels, there are some who should avoid drinking altogether. This group includes:
Anyone under the age of 21
Anyone who will be driving or operating heavy machinery that day
Anyone with a medical condition that alcohol may exacerbate
Anyone on a prescription medication that interacts with alcohol
Women who are pregnant or trying to become pregnant. There is no safe level of alcohol that may be consumed during pregnancy. Alcohol use during pregnancy increases the risk of birth defects and other complications.
Alcohol Use Disorder
Alcohol Use Disorder (AUD), also known as alcoholism or alcohol dependence, is classified as a chronic brain disease. Signs of AUD include compulsive alcohol consumption, a lack of control over the amount of alcohol consumed and a craving for alcohol when not drinking.
“Unfortunately, AUD has a stigma associated with it that can deter people from seeking help,” says Dr. Mark Hammonds, a primary care physician. “AUD can be influenced by heredity, so sometimes people have limited ability on their own to control the desire for alcohol. If someone is dependent on alcohol, they need professional help and should not be afraid to seek it.”
While there is not a clear-cut test or exam to diagnose AUD, there are a number of characteristics people with the disorder tend to exhibit. The NIAAA offers the following guidance for people who may be wondering if they are drinking too much:
“To assess whether you or loved one may have AUD, here are some questions to ask. In the past year, have you:
- Had times when you ended up drinking more, or longer than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over the aftereffects?
- Experienced craving — a strong need, or urge, to drink?
- Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?”
If you answer “yes” to two or more of the above questions, you should visit with your health care provider. The more “yes” answers to these questions, the more serious the drinking issue is. Your physician can help.
“Many people are unable to stop drinking on their own. Alcohol can be highly addictive for some, which is why it’s important to seek help if you are drinking too much and unable to stop,” says Dr. John Staniland, a primary care physician. “There is no shame in seeking help and there is a lot of support available.”
Common treatments for AUD include behavioral treatments, prescription medication and mutual support groups. These include groups such as Alcoholics Anonymous, which provide peer support to help people quit drinking.
“While it can seem intimidating to seek help and may be difficult to quit, what’s most important is to take the first step,” says Dr. Luis Vargas, a primary care physician. “You don’t have to figure out exactly what you are going to do to stop drinking and how you are going to do it, you just need to ask for help. For most people, the best way to take that first step is to have a conversation with your primary care physician.”
Youth and Alcohol
Among the many things parents worry about for their children are the dangers of alcohol. Alcohol is the most commonly used drug among American youth. According to the CDC’s 2015 Youth Risk Behavior Survey, 33 percent of high school students drank alcohol in the last 30 days and 18 percent binge drank within the same timeframe. Even more alarming, one in five high school students reported riding with a driver who had been drinking.
Teen drinkers are at greater risk for later developing AUD than people who wait until adulthood to begin drinking. They also tend to have problems in school and become sexually active earlier than their peers who do not drink. And they are at greater risk of injury or death, due to driving drunk or riding with someone who is intoxicated.
It is important parents talk with their teens about the dangers of alcohol and the reasons to avoid it. “The most important thing we can do as parents is to set a good example. If we drink, we should only do so in moderation, as our kids notice everything we do,” says Dr. Lynda Tang, a pediatrician.
"In order to help our children succeed in a world of peer pressure and help them learn to resist temptation, we must give them the tools to do so,” says Dr. Michelle Kravitz, a pediatrician. “We must first make sure they understand that the glamour and fun portrayed in alcohol ads are not at all what they seem; we must remind them of the unpleasant side effects of alcohol, such as hangovers, as well as the life-altering or ending possibilities of drunk driving.”
“Then we must give them concrete help, such as devising plans to help them out of dangerous situations where alcohol is involved,” continues Dr. Kravitz. “One such example is having a safe word text where the teen can text a code word to the parent, and the parent knows to immediately call the teen and state that the teen is needed at home and the parent is coming to get him. We must also have an understanding with our teen that whatever rules we have laid out regarding drinking, if the teen has either drunk herself or her companions have, the teen can call her parents and know that they will always provide a safe ride home, no matter the hour."
What About Those “Benefits” of Alcohol?
It seems that every other week, we hear about a new study that says we’ll improve our heart health or live longer by drinking moderate levels of alcohol. “The best advice I can give my patients is that taken together, these studies are inconclusive as to any benefit that may be derived from drinking alcohol,” explains Dr. Tilkin. “What is not up for debate is that too much alcohol is bad for us. And while moderate consumption of alcohol is OK for most people, no one should think they should start drinking for health benefits that may not be real.”
Ask for Help
If you’ve noticed your alcohol consumption has increased over time and you are exceeding a drink a day for women or two for men, that’s a warning sign that it is time to slow down – or stop. Some people arrive at that realization and are able to stop just fine on their own. Others need more help. If you think you may drink too much and are having a hard time cutting back, make an appointment to visit with your physician today. He or she can help you.
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