Health is Wealth
August 1, 2022 / Mental Health
Be honest, be safe and don’t blame yourself
It starts with a beer, a glass of wine or a cocktail. Then there’s another … and another … and another. You watch as your family member or friend slowly changes with each tip of the bottle.
It’s a routine you’ve witnessed repeatedly — and it never gets less painful to watch. So, what can you do? Addiction psychiatrist Akhil Anand, MD, offers these tips to help you persevere.
Caring about someone with an alcohol addiction can lead to worry and sleepless nights. You might spend a lot of time thinking about your actions as it relates to their addiction, says Dr. Anand.
If that describes you, take a step back. “You are not responsible for what someone else does,” reassures Dr. Anand. “It’s their decision to use alcohol. Don’t carry that weight.”
“Angry drunk” isn’t just a phrase. It’s often a reality that grows more concerning with every downed glass. Studies show that the risk of a situation turning violent is five times higher when alcohol enters the mix.
If you’re going to engage someone who’s been drinking and shown flashes of violence, don’t do it alone. Bring someone you can trust with you, advises Dr. Anand.
And if you feel threatened, call the police. “Don’t put yourself in danger,” stresses Dr. Anand.
Being close to someone addicted to alcohol can bring an immense amount of stress into your life. A lot of emotions — frustration, sadness, bitterness and more — may whirl through your mind.
Talking to an addiction counselor can help you better understand the situation and work through your feelings. Programs like Al-anon, Alateen and Families Anonymous offer opportunities for emotional support.
“Don’t forget to take care of yourself,” says Dr. Anand. “It’s not easy when your life intersects with someone dealing with an addiction. It’s important to find an outlet where you can talk about it.”
When someone gets too drunk or hungover to fulfill their basic responsibilities in life, they often rely on those around them to get the job done. And all too often, their friends and family pick up the slack.
But that attempt to be helpful can send the wrong message: “If you take care of problems for them over and over again, they never see or feel the consequences of their drinking,” explains Dr. Anand.
So, take a step back and let them deal with the after-effects of their addictive behavior.
Did a night of excessive drinking leave cans or bottles littering your living room floor? Or splatters of vomit in the bathroom? Don’t rush to clean it up. Let the person who made that mess see it.
“It’s not your duty to hide the results of their drinking so they avoid feeling any sort of embarrassment,” says Dr. Anand.
It’s natural to want someone you care about to stop drinking so heavily. Odds are, your desire is no secret, either — which is why you should be wary if that person tries to “trade” a change in addictive behavior for something.
“You cannot negotiate someone into sobriety,” says Dr. Anand. “They need to take the action — and it should not be dependent on you somehow making it worthwhile for them.”
Don’t make excuses for someone’s addiction or downplay it. “Be open and honest,” encourages Dr. Anand. “Communicate in a way that is calm and constructive but not emotional.”
Celebrate if a friend or loved one with an addiction takes a step toward rehabilitation … but don’t be surprised by a stumble. Relapse rates are common among those who seek treatment for an addiction.
An addiction is a brain disorder, after all, and not something that’s easily resolved. It can take 10 or more attempts at treatment before someone makes progress on overcoming an addiction.
“It’s best to know that going in,” says Dr. Anand, “because it’s very hard to watch it happen.”
Coping with someone addicted to alcohol isn’t easy. It can test your patience and shatter your feelings. But try to separate the person from the addiction. Do your best to understand that they’re dealing with an illness.
“Let them know that you care,” says Dr. Anand. “Offer unconditional love and give them positive affirmations. Be there for them as much as you can — but make sure you take care of yourself, too.”
To hear more from Dr. Anand on this topic, listen to the Health Essentials Podcast episode “How To Help Someone With an Alcohol Addiction.” New episodes of the Health Essentials Podcast are available every Wednesday.
In the study shown above, females start to accrue an increased risk at greater than two drinks per day on average and males at greater than four drinks per day.
These findings shouldn’t come as a surprise to anyone.
Surprisingly, on average, individuals who consume less than two drinks per day appear to have better outcomes than those who do not drink at all. This is where things start to get a little counterintuitive, and the story of alcohol being beneficial for you starts to appear.
This relationship is known as a ‘U’ shaped curve where those in the middle have the best outcomes, and those on the edges have worse outcomes. A kind of ‘Goldilocks’ relationship; “Not too hot. Not too cold. Just right.”
How might we explain this?
Enter the darling of the 1990s, Resveratrol. This compound in red wine spawned the mantra that red wine was ‘good for your heart’. This was based on research that suggested that it might reduce cholesterol levels, among other things.
But to consume the levels of Resveratrol tested in some of the animal studies that demonstrated benefit, you would have to drink 40 litres of wine…… Per day.
Not exactly a feasible strategy. Even with the best will in the world.
Let’s look at a more plausible explanation.
Data on alcohol consumption and outcomes are almost always based on observational data, not randomised controlled trials. This means that other factors or ‘confounders’ may explain the difference between the groups, not the alcohol consumption alone.
When you look at the trials that suggest a benefit of modest alcohol consumption, you will often find that this group tend to exercise more, smoke less, be in a higher socioeconomic bracket etc. This is referred to as a ‘healthy user bias’ and is likely to explain the difference between the groups.
Most trials try to correct or adjust for these confounders, but in truth, it is very hard to do. A recent publication looked at this problem and attempted to (as much as possible) correct for these ‘healthy user’ bias factors and then compare outcomes between alcohol consumption groups. The results were a little more in line with what we might expect.
Those in the lowest alcohol consumption category had the best lifestyle factors overall. When these healthy factors were corrected for, any benefit seen with modest alcohol consumption disappeared. What remained was a linear relationship between alcohol consumption and coronary artery disease5. Much more what you might expect.
Research like this and other studies is where the more recent media reports of ‘any’ alcohol being bad for you have come.
So, alcohol is a toxin. But, as Paracelsus notes:
“The dose makes the poison.”
Even water consumed to excess can be lethal.
We know that excess alcohol consumption is harmful. But I don’t think there was any great uncertainty around that point.
The key takeaway is that modest alcohol consumption is unlikely to be ‘beneficial’ to you. As much as you loved the idea that red wine was good for your heart, we can say with reasonable confidence that this is not the case.
The real question we need to answer is whether consuming modest amounts of alcohol is considerably worse for you when it comes to heart disease and death from any cause.
Based on the literature to date, it seems that the incremental risk for modest amounts of weekly alcohol consumption is likely to be small. But that doesn’t mean there are no downsides.
Sleep
One of the main reasons I significantly reduced my alcohol consumption was its effect on my sleep. If I drink more than one drink, I find that the quality of my sleep gets worse. I am much more likely to wake in the middle of the night and feel the effects the following day. But that’s just my personal experience.
Although alcohol is likely to make you fall asleep faster, it impacts your sleep quality6. Additionally, alcohol also reduces the percentage of REM sleep a person gets overnight7.
A workaround for me is to consume any alcohol during the daytime, so my sleep is unlikely to be affected, and if I am going to have a drink, I make sure it is worthwhile. I.e. I am with friends, or it is a high-quality drink. No more drinks on airplanes for me. Mainly because you lose about 30% of your sense of smell and taste in a pressurised cabin and therefore you are less likely to enjoy your drink8. Why do you think they serve you tomato juice and the fact that you think it’s tolerable?!
Humans have been consuming alcohol as far back as the ancient Egyptians, and some evidence suggests the Chinese were consuming alcohol as far back as 7000 B.C. So I don’t see alcohol disappearing any time soon.
The question we all need to ask is:
How much are we realistically drinking on a daily or weekly basis &
Is it likely to be doing us harm?
Only you can answer that question.
The only way to be certain you are doing no harm is to eliminate alcohol entirely. But life is full of risks, some of which we can control, some we cannot.
And some risks are worth taking.
Want to eliminate all road traffic accidents worldwide?
Simple.
Ban cars.
But at what cost?
The risks of driving are a risk most of us are willing to take.
Alcohol has risks.
We must all aim to minimise those risks.
Whatever that means for you, only you can decide.
Mokdad, A.H.; Marks, J.S.; Stroup, D.F.; and Gerberding, J.L. Actual causes of death in the United States, 2000. JAMA 291(10):1238–1245, 2004. Erratum in JAMA 293(3):298, 2005.
Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2011–2015 Alcohol-Attributable Deaths Due to Excessive Alcohol Use, All Ages.
Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies. Arch Intern Med.2006;166(22):2437–2445. doi:10.1001/archinte.166.22.2437
Biddinger KJ, Emdin CA, Haas ME, et al. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022;5(3):e223849. doi:10.1001/jamanetworkopen.2022.3849
Britton, A., Fat, L.N. & Neligan, A. The association between alcohol consumption and sleep disorders among older people in the general population. Sci Rep 10, 5275 (2020). https://doi.org/10.1038/s41598-020-62227-0
Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013 Apr;37(4):539-49. doi: 10.1111/acer.12006.
Burdack-Freitag, Andrea & Bullinger, Dino & Mayer, Florian & Breuer, Klaus. (2010). Odor and taste perception at normal and low atmospheric pressure in a simulated aircraft cabin. Journal für Verbraucherschutz und Lebensmittelsicherheit. 6. 95-109. 10.1007/s00003-010-0630-y.
Even when we have the best of intentions, we can tend to overindulge in … well, everything. Whether it’s a second helping of dinner, snacking on sweets or a venti-sized coffee, we often go a little too far. And that’s especially true — and risky — when it comes to alcohol.
Overdoing it with booze occasionally, like at a wedding or birthday party, might be fine (though your headache the next morning might make you think otherwise). But when does drinking frequently cross the line into being problematic? And what are the health risks of alcohol overconsumption? To gain some insight into these concerns, we spoke with hepatologist Jamile Wakim-Fleming, MD.
It’s first best if we understand some of the dietary guidelines around alcohol. The U.S. Department of Agriculture and U.S. Department of Health and Human Services’ “Dietary Guidelines for Americans, 2020-2025” recommends adults of the legal drinking age should either not drink or limit their drinking to two drinks a day or fewer for men and one drink a day or fewer for women.
The guidelines say those who shouldn’t consume any alcohol under any circumstances include:
As for how much alcohol is considered standard, the guidelines define a standard drink as:
There are nuances to consider with these guidelines, though. While major American brands of beer have a 5% ABV measurement, many popular craft beers have higher alcohol content. That IPA you love might have an ABV of 7% or higher, so keep an eye on it when you’re knocking them back at your next summer barbecue.
But, as Dr. Wakim-Fleming explains, we also have to be cautious when applying these guidelines to our own habits for several reasons that go beyond the alcohol content of your beverage.
According to Dr. Wakim-Flemings, there are a few factors to consider when it comes to alcohol affecting you because each person is different. She outlines the following as the main ones when weighing alcohol consumption.
Those factors are largely outside of our control. But other things we can control should also be considered, Dr. Wakim-Fleming advises. For instance, she says, “Drinking on an empty stomach is more toxic than if you’ve had something to eat. There’s no food to help absorb the alcohol so more goes into your blood system.”
And, again, there’s that percentage of alcohol to consider. “Remember that the percentages of alcohol vary among the types of alcohol,” she says. “Drinking 12 ounces of wine contains far more alcohol than 12 ounces of most common beers.”
Taking into account all of these factors, Dr. Wakim-Fleming says there are still ways to figure out where a person crosses the line into overindulging in alcohol, and separating what’s considered “binge” drinking, “heavy” drinking and “excessive” drinking.
Studies have shown that even if you only occasionally drink alcohol, drinking regularly over a long period can have negative outcomes on your health. “It’s a cumulating effect caused by drinking over time,” says Dr. Wakim-Fleming.
But a more present danger is binge drinking. According to the U.S. Centers for Disease and Prevention (CDC), binge drinking is classified for men as consuming five or more standard drinks within a few hours and four or more standard drinks within a few hours for women.
That kind of alcohol consumption can lead to severe reactions in your body, including:
The loss of judgment that comes from binge drinking can cause you to make poor choices, too, including driving under the influence, physical altercations and even further physical injury.
Dr. Wakim-Fleming says excessive drinking is essentially the same as binge drinking. The CDC also includes underage drinking and drinking by women who are pregnant.
Most excessive drinking — more than 90%, according to the CDC — is binge drinking. Additional statistics on binge drinking from the CDC include:
Excessive drinking is something that’s thought of more in the short term, but can still be extremely damaging to your body, especially as it becomes a habit and potentially leads to more long-term, heavy drinking.
While considered part of excessive drinking by the CDC, heavy drinking is applied to drinking over a longer period than binge drinking; while binge drinking is measured in an increment of two-to-three hours, heavy drinking is measured over a week.
“For women, heavy drinking is eight standard drinks a week or more,” says Dr. Wakim-Fleming, “While for men, it’s 15 drinks a week or more.” And, yes, multiple binges within a week do equal heavy drinking.
And no matter which category you fall into, there are consequences. “You subject your body to more health risks, to more toxicity and you begin a cycle of withdrawal problems,” she adds.
So, more about those consequences. “Alcohol affects the body in two ways,” says Dr. Wakim-Fleming. “The initial stage occurs right after drinking. Drinking causes inflammation of your swallowing tube [esophagus], stomach and gastrointestinal tract. Additionally, your liver is also inflamed which causes it to become enlarged and tender.”
If you stop drinking at this stage, she says, that inflammation is reversible. But if you continue to drink excessively over time or become a heavy drinker, that leads to serious complications.
“If your drinking and inflammation continues daily, it leads to scarring and becomes irreversible, as in cirrhosis, which can lead to cancer,” notes Dr. Wakim-Fleming.
Both the American Cancer Society and the American Society of Clinical Oncology advise that alcohol directly raises the risk of cancer. The types of cancer of the gastrointestinal system that drinking alcohol can lead to include:
“The important thing to remember is that these organizations consider alcohol a modifiable risk factor for cancer, which means you can do something about it,” adds Dr. Wakim-Fleming. “That means following their guidelines and avoiding drinking.”
You may not realize it, but the most common consequence of overconsumption of alcohol — the hangover — is the alcohol directly affecting your brain. In the immediate aftermath, your hangover can include poor concentration, lagging reflexes, headache, nausea and vomiting.
Over time, though, excessive amounts of alcohol do far more damage to your brain, resulting in consequences beyond just an unpleasant morning after. “You can end up with alcohol dementia and a type of nerve damage we call neuropathy,” cautions Dr. Wakim-Fleming.
Some of the symptoms of neuropathy include:
Chronic alcoholism has also been linked to poor diets, which deprive your body of necessary vitamins and nutrients, which can compound issues with many parts of your body, including your brain and central nervous system.
Alcohol can adversely affect muscles, and your heart is a muscle. Heavy drinking can lead to a poor diet, which means your muscles are using empty calories from alcohol rather than healthy foods.
The result can be a dilated heart muscle and, eventually, dilated cardiomyopathy. Your heart weakens and can’t pump blood as strongly, which can cause your kidneys to retain more fluid. That can lead to fluid build-up in your extremities and lungs, and even to congested heart failure.
Excessive and heavy drinking can lead to cirrhosis and liver cancer. But, says Dr. Wakim-Fleming, the risks go beyond that.
Cirrhosis of the liver, which causes scar tissue that prevents your liver from functioning properly, is often caused by alcoholism. “Because that scarring affects the ability of the liver to function, it can lead to life-threatening conditions. And that’s why alcohol is one of the most common reasons for a liver transplant.”
Excessive drinking in one night can lead to acute damage and cause alcohol poisoning, which has severe consequences including, at its most extreme, death.
But if you drink only occasionally and in moderation — say, a glass of wine with dinner or a beer at a ballgame — it’s not going to create long-term damage. It’s all about moderation and avoiding chronic use, says Dr. Wakim-Fleming.
And while following recommended guidelines is important, it’s also about knowing yourself and your limits. “We don’t have personalized medicine when it comes to alcohol because everyone responds differently,” she says.
Even if you’re not overdoing it, consider taking a break or several breaks throughout the year. “Any break is good because your body needs time to reduce that inflammation. Taking a month or two off from consuming alcohol can help,” she suggests.
“Know your body, know your personal and family history and know your limits,” she continues. “Know what’s good for you because what works for others won’t necessarily work for you. Take charge of your health and if you need, seek help, whether from family, friends or other support groups and always discuss with your doctor.”
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