Alcohol - When is it too much?

An occasional alcoholic beverage is typically not harmful to the average healthy patient and in fact, does have some health benefits. But it is common knowledge that excess intake of the substance has the potential to lead to disastrous health effects.

Alcohol abuse is a pattern of drinking that results in harm to one's health, ability to work, or interpersonal relationships.

What constitutes a standard drink varies in opinion from country to country. In the United States, a standard drink size is about 14 grams of pure alcohol. This is equal to one 12-ounce beer, 5 ounces of wine, or 1.5 ounces of 80 proof liquor.The definition of "moderate" and "heavy" drinking is generally set at these parameters:

Moderate drinking - low risk for alcohol abuse

• Women: less than 2 drinks per day
• Men: less than 3 drinks per day
• People over 65: less than 2 drinks per day

Heavy drinking, or Risky Use, has known detrimental health consequences and those who partake in this amount is at risk for developing an alcohol use disorder. (1) This is described as:

• Women: greater than 7 drinks per week, or 3 drinks per occasion
• Men: greater than 7 drinks per week, or 3 drinks per occasion

Binge drinking is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as "drinking so much within about two hours that blood alcohol concentration levels reach 0.08g/dL." In women, this is usually 4 or more drinks in one occasion and in men, 5 drinks per occasion. (1) Binge drinking may be associated with increased cardiovascular risk and has been found to lead to acute intoxication injuries. (2)

Why some people abuse alcohol is not certain but usually is a combination of factors including genetics, environmental influences such as peer pressure and family issues, personality traits such as impulsivity, and cognitive disorders. (3-6)

Alcohol abuse can affect every organ and system in the body, and can cause (7):

• Anxiety
• Depression, suicidality
• Eating disorders
• Other drug-abuse disorders
• Trauma
• Hypertension
• Heart disease (cardiomyopathy)
• Pneumonia
• Liver disease (cirrhosis and elevated liver enzymes)
• Gastrointestinal disease (chronic diarrhea, esophageal varices, esophagitis)
• Pancreatitis
• Several cancers, including those of the mouth, esophagus, throat, breast, and liver
• Chronic insomnia and sleep disturbances
• Neurologic symptoms (tremors, encephalopathy)
• Suppression of bone marrow
• Social problems
• Legal problems

Excessive alcohol consumption is the third leading preventable cause of death in the US. (8) In 2012, more than 10,000 died in alcohol-related driving crashes. (9) The suicide rate among frequent alcohol users is greater than in the US general population (7 versus 1 percent). (10) 

When to be concerned that a friend or family member is drinking "too much," an alcohol use disorder, look for these signs (11):

• Frequent drinking resulting in inability or refusal to fulfill a role obligation (for example, motherhood, fatherhood, employee)
• Continued drinking despite social or interpersonal problems related to the alcohol use
• Tolerance to alcohol
• Drinking in progressively larger amounts or over longer periods of time than initially intended
• Drinking in hazardous situations
• A large amount of time spent obtaining / preparing, drinking, or recovering from alcohol
• Skipped or missed important activities, deadlines, meetings due to alcohol
• Unsuccessful attempts to stop or reduce alcohol intake
• Craving alcohol
• Continued drinking despite knowledge of problems caused by alcohol, such as physical or mental issues or social conflict

Michele Brannan is a certified Physician Assistant of Internal Medicine and has been in practice in the River Bend area for over 10 years.

The health information provided herein is not intended to replace the advice or discussion with a healthcare provider and is for educational purposes only. Before making any decisions regarding your health, speak with your healthcare provider.

REFERENCES:
1. National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: A clinician’s guide. NIH Publication no. 05-3769, Bethesda, MD 2005.
2. Goslawski M, Piano MR, Bian JT, et al. Binge drinking impairs vascular function in young adults. J Am Coll Cardiol 2013; 62:201.
3. Rose RJ, Dick DM, Viken RJ, et al. Drinking or abstaining at age 14? A genetic epidemiological study. Alcohol Clin Exp Res 2001; 25:1594.
4. Andrews JA, Tildesley E, Hops H, Li F. The influence of peers on young adult substance use. Health Psychol 2002; 21:349.
5. Sher KJ, Grekin ER, Williams NA. The development of alcohol use disorders. Annu Rev Clin Psychol 2005; 1:493.
6. Corral M, Holguín SR, Cadaveira F. Neuropsychological characteristics of young children from high-density alcoholism families: a three-year follow-up. J Stud Alcohol 2003; 64:195.
7. Moss HB, Chen CM, Yi HY. Prospective follow-up of empirically derived Alcohol Dependence subtypes in wave 2 of the National Epidemiologic Survey on Alcohol And Related Conditions (NESARC): recovery status, alcohol use disorders and diagnostic criteria, alcohol consumption behavior, health status, and treatment seeking. Alcohol Clin Exp Res 2010; 34:1073.
8. Harwood H. Updating estimates of the economic costs of alcohol abuse in the United States: Estimates, update methods, and data. NIH Publication no. 00-1583, National Institute on Alcohol Abuse and Alcoholism; Rockville, MD 2000.
9. National Highway Traffic Safety Administration (NHTSA). http://www.nhtsa.gov/Impaired (Accessed 29 October 2015).
10. Yaldizli O, Kuhl HC, Graf M, et al. Risk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: a subgroup analysis from the WHO/ISBRA study. Drug Alcohol Rev 2010; 29:64.
11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.

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