[[Image:Alcohol use disorders world map - DALY -
WHO2002.svg|thumb|
Disability-adjusted life year
for alcohol use disorders per 100,000 inhabitants in 2002.
]]
Total recorded alcohol per capita
consumption (15+), in litres of pure alcohol
The long term effects of alcohol in excessive
quantities is capable of damaging nearly every organ and system in
the body. Regularly consuming alcohol is correlated with an
increased risk of developing
alcoholism,
cardiovascular disease,
malabsorption,
chronic pancreatitis,
alcoholic liver disease, and
cancer. Damage to the
central nervous system and
peripheral nervous system can
occur from sustained alcohol consumption.
Research has found a correlation between light consumption of
alcohol, one to two alcoholic beverages per day, and reduced risk
of
heart disease as well as other
health benefits, including reduction in all-cause mortality.
However, some recent studies found that moderate consumption of
alcohol did not decrease heart disease and that the positive
effects may be due to methodological flaws in research studies.
Many health authorities recommend use of alcohol in low doses,
although other health authorities do not recommend the consumption
of alcohol and set an upper, but no lower, limit on the amount of
alcohol that should be consumed.
The subject is still controversial: the small number of benefits of
alcohol consumption are greatly outweighed by the large amount of
negative effects on health of moderate alcohol consumption
including
injuries,
violence,
fetal damage,
certain forms of
cancer,
liver disease and
hypertension. Moderate alcohol intake is
therefore not recommended by doctors as the risks greatly outweigh
any small benefits.
Scientific studies
Background
The adverse effects of long-term excessive use of alcohol are
similar to those seen with other sedative-hypnotics (apart from
organ toxicity which is much more problematic with alcohol).
Withdrawal effects and dependence are
also almost identical. Alcohol at moderate levels has some positive
and negative effects on health. The negative effects include
increased risk of
liver diseases,
oropharyngeal cancer,
esophageal
cancer and
pancreatitis. Conversely
moderate intake of alcohol may have some benefitial effects on
gastritis and
cholelithiasis. Chronic alcohol misuse and
abuse has serious effects on physical and mental health. Chronic
excess alcohol intake, or alcohol dependence, can lead to a wide
range of
neuropsychiatric or
neurological impairment,
cardiovascular disease,
liver disease, and
malignant neoplasms. The psychiatric
disorders which are associated with alcoholism include
major depression,
dysthymia,
mania,
hypomania,
panic
disorder,
phobias,
generalized anxiety disorder,
personality disorders,
schizophrenia,
suicide,
neurologic
deficits (eg impairments of
working
memory,
emotions,
executive functions,
visuospatial abilities and
gait and
balance) and
brain damage. Alcohol dependence is
associated with
hypertension,
coronary heart disease, and
ischemic stroke,
cancer of the
respiratory system, but also
cancers of the
digestive
system,
liver,
breast and
ovaries. Heavy
drinking is associated with
liver
disease, such as
cirrhosis. Studies
have focused on both men and women, various age groups, and people
of many ethnic groups. Published papers now total in the many
hundreds, with studies having shown correlation between moderate
alcohol use and health that may instead have been due to the
beneficial effects of socialization that is often accompanied by
alcohol consumption. Some of the specific ways alcohol affects
cardiovascular health have been studied.
Modern understanding
Some research in some countries has claimed the all-cause mortality
rates may range from 16 to 28% lower among moderate drinkers (1–2
drinks per day) than among abstainers. New York Times journalist
Roni Caryn Rabin reasons that the statistics of this research are
flawed.
Maximum quantity recommended
Different countries recommend different maximum quantities. For
men, the range is 140g—210g per week. For women, the range is
84g—140g per week. Most countries recommend total abstinence whilst
pregnant or breastfeeding. See
Recommended
maximum intake of alcoholic beverages for details.
Alcohol-related deaths
Over-consumption of alcohol is one of the leading
preventable causes of
death worldwide. One study links alcohol to 1 in every 25
deaths worldwide and that 5% of years lived with disability are
attributable to alcohol consumption.
Countries collect statistics on alcohol-related deaths. Whilst some
categories relate to short-term effects, such as accidents, many
relate to long-term effects of alcohol.
Russia
"Excessive alcohol consumption in Russia, particularly by men, has
in recent years caused more than half of all the deaths at ages
15-54 years."
United Kingdom
Alcohol-related deaths in the United Kingdom are coded using the
Tenth Revision of the
International Classification
of Diseases (ICD-10).
ICD-10 comprises:
- Mental and behavioural disorders due to use of alcohol – ICD-10
F10
- Degeneration of nervous system due to alcohol – ICD-10
G31.2
- Alcoholic polyneuropathy – ICD-10 G62.1
- Alcoholic cardiomyopathy – ICD-10 I42.6
- Alcoholic gastritis – ICD-10 K29.2
- Alcoholic liver disease – ICD-10 K70
- Chronic hepatitis, not elsewhere classified – ICD-10 K73
- Fibrosis and cirrhosis of liver – ICD-10 K74 (Excluding
K74.3-K74.5 – Biliary cirrhosis)
- Alcohol induced chronic pancreatitis – ICD-10 K86.0
- Accidental poisoning by and exposure to alcohol – ICD-10
X45
- Intentional self-poisoning by and exposure to alcohol – ICD-10
X65
- Poisoning by and exposure to alcohol, undetermined intent –
ICD-10 Y15
UK statistical bodies report that "There were 8,724 alcohol-related
deaths in 2007, lower than 2006, but more than double the 4,144
recorded in 1991. The alcohol-related death rate was 13.3 per
100,000 population in 2007, compared with 6.9 per 100,000
population in 1991."
In Scotland, the NHS estimate that in 2003 one in every 20 deaths
could be attributed to alcohol.
A 2009 study found that 9,000 people are dying from alcohol-related
diseases every year, three times the number 25 years
previously.
United States
The
Centers
for Disease Control and Prevention report, "From 2001–2005,
there were approximately 79,000 deaths annually attributable to
excessive alcohol use. In fact, excessive alcohol use is the 3rd
leading lifestyle-related cause of death for people in the United
States each year."
Overall mortality
A 23-year
prospective study of 12,000 male
British
physicians aged 48–78, found that overall
mortality was significantly lower in the group consuming less than
2 "units" (British unit = 8 g) per day than in the
non-alcohol-drinking group. Greater than 2 units per day was
associated with an increased risk of mortality. Alcohol represented
5% of deaths in the sample of physicians.
Cardiovascular system
Moderate alcohol consumption has been argued to be a protective
against cardiovascular disorders. On the other hand, some have
disputed this, claiming that the apparent benefits of alcohol on
cardiovascular function could be explained by improper statistical
analysis, inappropriate questionaires and other serious
methodological problems. A doctor at the
World Health Organisation stated
that recommending moderate alcohol consumption for health benefits
is "ridiculous and dangerous".
In addition to its
psychotropic
properties, alcohol has
anticoagulation properties similar to
Warfarin. Additionally,
Thrombosis is lower among moderate drinkers than
teetotalers.
Ridker, P.,
et al. Moderate alcohol intake may reduce risk
of thrombosis. American Medical Association press release,
September 22, 1994
Peripheral Arterial Disease
"Moderate alcohol consumption appears to decrease the risk of PAD
in apparently healthy men." "In this large population-based study,
moderate alcohol consumption was inversely associated with
peripheral arterial disease in women but not in men. Residual
confounding by smoking may have influenced the results. Among
nonsmokers an inverse association was found between alcohol
consumption and peripheral arterial disease in both men and
women."
Intermittent claudication (IC)
A study found that moderate consumption of alcohol had a protective
effect against
intermittent
claudication. The lowest risk was seen in men who drank 1 to 2
drinks per day and in women who drank half to 1 drink per
day.
Heart attack and stroke
Drinking in moderation has been found to help those who have
suffered a
heart attack survive
it.
However, excessive alcohol consumption leads to an increased risk
of
heart failure. A review of the
literature found that half a drink of alcohol offered the best
level of protection. However, they noted that at present there have
been no randomised trials to confirm the evidence which suggests a
protective role of low doses of alcohol against heart attacks.
There is an increased risk of
hypertriglyceridemia,
cardiomyopathy,
hypertension, and
stroke
if 3 or more standard drinks of alcohol are taken per day.
Compared to abstaining, drinking in moderation is associated with
an increased risk of
stroke. Light drinking
offers no benefits in prevention of stroke.
Cardiomyopathy
Large amount of alcohol can lead to alcoholic
cardiomyopathy, commonly known as "
holiday heart syndrome." Alcoholic
cardiomyopathy presents in a manner clinically identical to
idiopathic
dilated
cardiomyopathy, involving hypertrophy of the musculature of the
heart that can lead to a form of
cardiac arrythmia. These electrical
anomalies, represented on an
EKG, often vary in
nature, but range from nominal changes of the PR, QRS, or QT
intervals to paroxsysmal episodes of
ventricular tachycardia. The
pathophysiology of alcoholic cardiomyopathy has not been firmly
identified, but certain hypotheses cite an increased secretion of
epinephrine and
norepinephrine, increased sympathetic output,
or a rise in the level of plasma free fatty acids as possible
mechanisms.
Hematologic diseases
Alcoholics may have
anemia from several
causes; they may also develop
thrombocytopenia from direct toxic effect
on
megakaryocytes, or from
hypersplenism.
Nervous system
Chronic heavy alcohol consumption impairs brain development, causes
brain shrinkage,
dementia,
physical
dependence, increases neuropsychiatric and cognitive disorders
and causes distortion of the
brain
chemistry. Some studies however have shown that moderate
alcohol consumption may decrease risk of dementia, including
Alzheimer disease, although there are studies which find opposite.
At present due to poor study design and methodology the literature
is inconclusive on whether moderate alcohol consumptions increases
the risk of dementia or decreases it.
Strokes
A 2003
Johns
Hopkins study has linked moderate alcohol use to brain
shrinkage and did not find any reduced risk of stroke among
moderate drinkers.
Brain development
Consuming large amounts of alcohol over a period of time can impair
normal brain development in humans. Deficits in retrieval of verbal
and nonverbal information and in visuospatial functioning were
evident in youths with histories of heavy drinking during early and
middle adolescence.
Heavy alcohol consumption inhibits new brain cell
development.
Nearly half of chronic alcoholics may have
myopathy. Proximal muscle groups are especially
affected. Twenty-five percent of alcoholics may have
peripheral neuropathy, including
autonomic.
Cognition and dementia
One of the organs most sensitive to the toxic effects of chronic
alcohol consumption is the brain. In France approximately 20% of
admissions to mental health facilities are related to alcohol
related cognitive impairment most notably alcohol related dementia.
Chronic excessive alcohol intake is also associated with serious
cognitive decline and a range of neuropsychiatric complications.
The elderly are the most sensitive to the toxic effects of alcohol
on the brain. There is some inconclusive evidence that small
amounts of alcohol taken in earlier adult life is protective in
later life against cognitive decline and dementia. However, a study
concluded, "Our findings suggest that, despite previous
suggestions, moderate alcohol consumption does not protect older
people from cognitive decline."
Acetaldehyde is produced by the liver
during breakdown of ethanol. People who have a genetic deficiency
for the subsequent conversion of acetaldehyde into
acetic acid may have a greater risk of
Alzheimer's disease. "These results
indicate that the
ALDH2 deficiency is a risk
factor for LOAD [late-onset Alzheimer's disease] …"
Essential tremor
Essential tremors can be
temporarily relieved in up to two-thirds of patients by drinking
small amounts of alcohol.
Wernicke-Korsakoff syndrome
Wernicke-Korsakoff
syndrome is a manifestation of
thiamine
deficiency, usually as a secondary effect of alcohol abuse. The
syndrome is a combined manifestation of two eponymous disorders,
Korsakoff's Psychosis and
Wernicke's encephalopathy,
named after Drs.
Sergei Korsakoff
and
Carl Wernicke. Wernicke's
encephalopathy is the acute presentation of the syndrome and is
characterised by a
confusional state while
Korsakoff's psychosis main symptoms are
amnesia and
executive
dysfunction.
Mental health effects
High rates of
major depressive
disorder occur in heavy drinkers and those who abuse alcohol.
Controversy has previously surrounded whether those who abused
alcohol who developed major depressive disorder were self
medicating (which may be true in some cases) but recent research
has now concluded that chronic excessive alcohol intake itself
directly causes the development of
major depressive disorder in a
significant number of alcohol abusers. Alcohol misuse is associated
with a number of mental health disorders and alcoholics have a very
high suicide rate. Studies have shown that alcohol dependence
relates directly to
cravings and
irritability. Another study has shown that
alcohol use is a significant predisposing factor towards
antisocial behavior in children.
Depression, anxiety and panic disorder are disorders commonly
reported by alcohol dependent people. Alcoholism is associated with
dampened activation in brain networks responsible for emotional
processing (
eg the
amygdala and
hippocampus). Evidence that the mental
health disorders are often induced by alcohol misuse via distortion
of brain neurochemistry is indicated by the improvement or
disappearance of symptoms that occurs after prolonged abstinence,
although problems may worsen in early withdrawal and recovery
periods. Psychosis is secondary to several alcohol-related
conditions including acute intoxication and withdrawal after
significant exposure. Chronic alcohol misuse can cause psychotic
type symptoms to develop, more so than with other drugs of abuse.
Alcohol abuse has been shown to cause an 800% increased risk of
psychotic disorders in men and a 300% increased risk of psychotic
disorders in women which are not related to pre-existing
psychiatric disorders. This is significantly higher than the
increased risk of psychotic disorders seen from cannabis use making
alcohol abuse a very significant cause of psychotic disorders.
Prominent
hallucinations and/or
delusions are usually present when a
patient is intoxicated or recently withdrawn from alcohol.Whilst
alcohol initially helps social phobia or
panic symptoms, with longer term alcohol misuse can often worsen
social phobia symptoms and can cause panic disorder to develop or
worsen, during alcohol intoxication and especially during the
alcohol withdrawal
syndrome. This effect is not unique to alcohol but can also
occur with long term use of drugs which have a similar mechanism of
action to alcohol such as the
benzodiazepines which are sometimes
prescribed as tranquillisers to people with alcohol problems.
Approximately half of patients attending mental health services for
conditions including
anxiety
disorders such as
panic disorder
or
social phobia are the result of
alcohol or
benzodiazepine
dependence. It was noted that every individual has an
individual sensitivity level to alcohol or sedative hypnotic drugs
and what one person can tolerate without ill health another will
suffer very ill health and that even moderate drinking can cause
rebound anxiety syndromes and sleep
disorders. A person who is suffering the toxic effects of alcohol
will not benefit from other therapies or medications as they do not
address the root cause of the symptoms.
Digestive system and weight gain
The impact of alcohol on weight-gain is contentious: some studies
find no effect, others find decreased or increased effect on weight
gain.
Alcohol use increases the risk of chronic
gastritis (stomach inflammation); it is one cause
of
cirrhosis,
hepatitis, and
pancreatitis in both its
chronic and
acute forms.
Metabolic syndrome
A study concluded, "Mild to moderate alcohol consumption is
associated with a lower prevalence of the
metabolic syndrome, with a favorable
influence on lipids, waist circumference, and fasting insulin. This
association was strongest among whites and among beer and wine
drinkers." "Odds ratios for the metabolic syndrome and its
components tended to increase with increasing alcohol
consumption."
Gallbladder effects
Research has found that drinking reduces the risk of developing
gallstones. Compared with alcohol
abstainers, the relative risk of gallstone disease, controlling for
age, sex, education, smoking, and body mass index, is 0.83 for
occasional and regular moderate drinkers ( 25 ml of ethanol per
day), 0.67 ... for intermediate drinkers (25-50 ml per day), and
0.58 ... for heavy drinkers. This inverse association was
consistent across strata of age, sex, and body mass index."
Frequency of drinking also appears to be a factor. "An increase in
frequency of alcohol consumption also was related to decreased
risk. Combining the reports of quantity and frequency of alcohol
intake, a consumption pattern that reflected frequent intake (5-7
days/week) of any given amount of alcohol was associated with a
decreased risk, as compared with nondrinkers. In contrast,
infrequent alcohol intake (1-2 days/week) showed no significant
association with risk.”
Consumption of alcohol is unrelated to gallbladder disease. However
one study suggested that drinkers who take
Vitamin C (
ascorbic
acid) might reduce their risk of gallbladder disease.
Liver disease
Alcoholic liver disease is a
major public health problem. For example in the United States up to
two million people have alcohol related liver disorders. Chronic
alcohol abuse can cause
fatty liver,
cirrhosis and
alcoholic hepatitis. Treatment options
are limited and consist of most importantly discontinuing alcohol
consumption. In cases of severe liver disease, the only treatment
option may be a
liver transplant in
alcohol abstinent patients. Research is being conducted into the
effectiveness of
anti-TNF's. Certain
complimentary medications eg
milk
thistle and
silymarin appear to offer
some benefit. Alcohol is a leading cause of
liver cancer in the western world accounting
for 32-45% of hepatic cancers. Up to half a million people in the
United States develop alcohol related
liver
cancer.
Pancreatitis
Alcohol misuse is a leading cause of both
acute pancreatitis and
chronic pancreatitis. Chronic excessive
intake of alcohol can cause destruction of the pancreas resulting
in severe chronic pain, which may progress to
pancreatic cancer. Chronic pancreatitis
often results in
malabsorption
problems and
diabetes.
Other systems
Kidney stones
Research indicates that drinking alcohol is associated with a lower
risk of developing
kidney stones. One
study concludes, "Since beer seemed to be protective against kidney
stones, the physiologic effects of other substances besides
ethanol, especially those of hops, should also be examined."
"...consumption of coffee, alcohol, and vitamin C supplements were
negatively associated with stones." "After mutually adjusting for
the intake of other beverages, the risk of stone formation
decreased by the following amount for each 240-ml (8-oz) serving
consumed daily: caffeinated coffee, 10%; decaffeinated coffee, 10%;
tea, 14%; beer, 21%; and wine, 39%." "...stone formation decreased
by the following amount for each 240-mL (8-oz) serving consumed
daily: 10% for caffeinated coffee, 9% for decaffeinated coffee, 8%
for tea, and 59% for wine." (
CI
data excised from last two quotes.).
Sexual dysfunction
Long term use of alcohol can lead to damage to the
central nervous system and the
peripheral nervous system
resulting in loss of sexual desire and impotence in men.
Hormonal Imbalance
Excessive alcohol consumption can lead to an increase in estrogen
levels. In men, high levels of estrogen can lead to development of
feminine traits including development of male breasts, called
Gynecomastia. In women, high levels of
estrogen have been related to increased risk of
breast cancer.
Diabetes mellitus
Moderate drinkers may have a lower risk of
diabetes than non-drinkers. On the other hand,
binge drinking and high alcohol consumption may increase the risk
of type 2 diabetes in women."
Alcohol consumption promotes
insulin
sensitivity.
Rheumatoid arthritis
Regular consumption of alcohol is associated with an increased risk
of
gouty arthritis. Alcohol
consumption is associated with decreased risk of rheumatoid
arthritis. Two recent studies report that the more alcohol
consumed, the lower the risk of developing rheumatoid arthritis.
Among those who drank regularly, the one-quarter who drank the most
were up to 50% less likely to develop the disease compared to the
half who drank the least.
The researchers noted that moderate alcohol consumption also
reduces the risk of other inflammatory processes such as
cardiovascualar disease. Some of the biological mechanisms by which
ethanol reduces the risk of destructive arthritis and prevents the
loss of bone mineral density (BMD), which is part of the disease
process.
A study concluded, "Alcohol either protects from RA
rheumatoid arthritis or, subjects with
RA curtail their drinking after the manifestation of RA". Another
study found, "Postmenopausal women who averaged more than 14
alcoholic drinks per week had a reduced risk of rheumatoid
arthritis..."
Osteoporosis
Moderate alcohol consumption is associated with higher
bone mineral density in postmenopausal
women. "...Alcohol consumption significantly decreased the
likelihood [of
osteoporosis]."
"Moderate alcohol intake was associated with higher BMD in
postmenopausal elderly women." "Social drinking is associated with
higher bone mineral density in men and women [over 45]."
Skin
Chronic excessive alcohol abuse is associated with a wide range of
skin disorders including
urticaria,
porphyria cutanea tarda,
flushing, cutaneous stigmata of
cirrhosis,
psoriasis,
pruritus,
seborrheic dermatitis and
rosacea.
Immune system, bacterial contamination, viral infections, and
cancer
Bacterial infection
There is a protective effect of alcohol consumption against active
infection with
H pylori In contrast, alcohol intake
(comparing those who drink > 30 gm of alcohol per day to
nondrinkers) is not associated with higher risk of duodenal
ulcer.
Common cold
A study on the common cold found that "Greater numbers of alcoholic
drinks (up to three or four per day) were associated with decreased
risk for developing colds because drinking was associated with
decreased illness following infection. However, the benefits of
drinking occurred only among nonsmokers. ... Although alcohol
consumption did not influence risk of clinical illness for smokers,
moderate alcohol consumption was associated with decreased risk for
nonsmokers."
Another study concluded, "Findings suggest that wine intake,
especially red wine, may have a protective effect against common
cold. Beer, spirits, and total alcohol intakes do not seem to
affect the incidence of common cold."
Cancer
The
International Agency
for Research on Cancer (Centre International de Recherche sur
le Cancer) of the
World Health
Organization has classified alcohol as a
Group 1 carcinogen. Its
evaluation states, "There is sufficient evidence for the
carcinogenicity of alcoholic beverages in humans.... Alcoholic
beverages are carcinogenic to humans (Group 1)."
The
U.S.
Department
of Health & Human Services’ National
Toxicology Program listed alcohol as a
known
carcinogen in 2000.
One study determined that "3.6% of all cancer cases worldwide are
related to alcohol drinking, resulting in 3.5% of all cancer
deaths."
The
World Cancer Research
Fund panel report
Food, Nutrition, Physical Activity and
the Prevention of Cancer: a Global Perspective finds the
evidence "convincing" that alcoholic drinks increase the risk of
the following cancers: mouth, pharynx and larynx, oesophagus,
colorectum (men), breast (pre- and postmenopause).
High concentrations of
acetaldehyde,
which is produced as the body breaks down ethanol, may damage DNA
in healthy cells. The
National
Institute on Alcohol Abuse and Alcoholism have shown that
acetaldehyde reacts with polyamines which are naturally occurring
compounds essential for cell growth—to create a particularly
dangerous type of mutagenic DNA base called a Cr-Pdg adduct.
Alcohol's effect on the fetus
Fetal alcohol syndrome or FAS
is a disorder of permanent
birth
defects that occurs in the offspring of women who drink
alcohol during pregnancy. Drinking heavily
or during the early stages of prenatal development has been
conclusively linked to FAS; the impact of light or moderate
consumption is not yet fully understood. Alcohol crosses the
placental barrier and can stunt
fetal growth or weight, create distinctive facial stigmata, damaged
neurons and brain structures, and cause
other physical, mental, or behavioural problems. Fetal alcohol
exposure is the leading known cause of
mental retardation in the Western
world.
See also
References
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