Unhealthy Alcohol Use | Substance Use and Addiction Medicine | JAMA

Unhealthy alcohol use refers to drinking that can lead to negative health effects.

Risky Alcohol Use and Alcohol Use Disorder

Unhealthy alcohol use encompasses a range of alcohol use from risky drinking to alcohol use disorder. Risky alcohol use is drinking that can lead to health consequences and may develop into alcohol use disorder. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines risky alcohol use for men aged 65 years or younger as having more than 4 drinks on any day or more than 14 standard drinks per week. For women or men older than 65 years, risky alcohol use is defined as having more than 3 drinks on any day or more than 7 standard drinks per week. A standard drink is 12 oz of beer, 8 to 9 oz of malt liquor, 5 oz of wine, or 1.5 oz of distilled spirits. Binge drinking is when blood alcohol concentration meets or exceeds 0.08%, which typically occurs when women have 4 or more drinks and men have 5 or more drinks within about 2 hours.

Alcohol use disorder is a pattern of drinking that significantly impairs health and functioning. The following 11 criteria are used to diagnose alcohol use disorder, and severity is based on the number of criteria met. A score of 2 to 3 is mild, 4 to 5 is moderate, and 6 or more is severe alcohol use disorder.

• Drinking in larger amounts or for longer than intended

• Wanting to cut down or stop drinking but not able to do so

• Spending a lot of time to get alcohol, to drink, or to recover from drinking

• Experiencing a strong urge or craving to drink

• Inability to fulfill commitments at school, work, or home due to drinking

• Continuing to drink when it causes problems in relationships

• Giving up important work or social activities due to drinking

• Alcohol use in situations that could be dangerous (eg, driving)

• Continuing to drink even if it worsens physical or psychological problems

• Needing to increase amount of drinking to get the same effect

• Experiencing withdrawal symptoms when not drinking (eg, nausea, restlessness, irritability, trouble sleeping)

Nearly 1 in 3 US adults have risky alcohol use according to NIAAA estimates. Alcohol use disorder has been estimated to affect 29% of adults in the US in their lifetimes.

Health Effects of Unhealthy Alcohol Use

Unhealthy alcohol use can contribute to the development or worsening of many medical conditions, including high blood pressure, cardiovascular disease, liver disease, pancreatitis, and cancers of the mouth, throat, esophagus, liver, and breast. Risky drinking is also linked to risk for and worsening of psychiatric disorders, including anxiety, depression, and posttraumatic stress disorder, and is associated with other substance use disorders. Alcohol use during pregnancy can result in fetal alcohol spectrum disorder, the most common preventable cause of birth defects and developmental disabilities.

Unhealthy Alcohol Use and Mortality

Excessive alcohol use is the third most common cause of preventable death in the US and is estimated to cause 1 in 10 deaths among working-age adults in the US. Alcohol-related deaths are often due to medical conditions that are caused or worsened by alcohol, accidental deaths, or suicide.

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For More Information

• NIAAA
  www.niaaa.nih.gov/alcohol-health/

• Centers for Disease Control and Prevention
  www.cdc.gov/alcohol/index.htm

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Office of the Surgeon General. Facing Addiction in America. DHHS; 2016.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

Stahre M, Roeber J, Kanny D, et al. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014;11:E109. doi:10.5888/pcd11.130293

Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder. JAMA Psychiatry. 2015;72(8):757-766. doi:10.1001/jamapsychiatry. 2015.0584

What doctors wish patients knew about unhealthy alcohol use

At the start of the pandemic, stay-at-home orders were in place across the country to curb the spread of COVID-19. Disrupted routines combined with the uncertainty of the pandemic led many people to feeling isolated at home while experiencing greater stress. As a result, some people became their own bartenders and progressed into heavier drinking patterns to cope with pandemic anger, stress and anxiety. 

According to an American Psychological Association report (PDF), nearly one in four adults reported drinking more alcohol to cope with the stress of the COVID-19 pandemic. And for those who are parents with early elementary schoolchildren, that proportion jumps to 52%.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.   

For this installment, with many Americans going back to work in person, two AMA members took the time to discuss what patients need to know about unhealthy alcohol use and how to break the cycle of comfort or binge drinking. They are: 

• Alёna A. Balasanova, MD, director of addiction psychiatry education and co-director of the addiction psychiatry consultation-liaison service at the University of Nebraska Medical Center in Omaha.
• Avani K. Patel, MD, MHA, a psychiatry resident at the University of Mississippi Medical Center in Jackson.

“It can range from risky drinking to an actual disorder. But even with risky alcohol use, that can lead to health consequences,” Dr. Patel explained, noting that “you would think that you don’t really have health consequences until it becomes a disorder, but that’s not necessarily true.”

“The thing to remember is that one in three adults in the United States actually engage in risky use, so this is super common,” said Dr. Balasanova. “That’s just something for people to be aware of—it’s not an isolated issue. It’s not unique to you. This is a super common thing that we need to be addressing because it is ubiquitous.”

“A narrative at the beginning of the pandemic was social distancing—and that term alone basically means isolation like you’re distanced from others,” said Dr. Balasanova. “There was a grassroots effort to change that to physical distancing because realistically we need to be more socially connected than ever, particularly when we’re physically distanced.

“When you can’t sit next to somebody, a loved one, you need to engage socially with them in other ways—through the telephone, through other modalities using technology as a platform,” she added. “But that narrative contributed to this idea of isolation because it’s like we were being instructed to isolate. We were being instructed to distance ourselves and that takes a toll.”

“JAMA Network Open actually published a recent study that found that as the COVID pandemic surged, alcohol consumption in adults increased by 14% from 2019 to 2020,” said Dr. Patel, adding that “the reasons for this included increased stress, increased alcohol availability—because with pandemic places were stocking up—and boredom.

“Other issues also included unemployment, working on the front lines—because that’s very stressful— working from home and having to manage children at home with their schooling and keeping them entertained all day,” she added. Increased drinking was also associated with “losing people who you love and even just losing some of your support, whether that’s financial or social.”

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“The U.S. Preventative Task Force recommends one drink per day for a woman or two drinks per day for a man, although recent evidence suggests it should be one drink per day for everybody, even for men,” said Dr. Balasanova. “If you drink outside of those limits, you are engaging in risky drinking or hazardous drinking.”

“Binge drinking is defined as more than four drinks in one sitting for a woman or more than five drinks in one sitting for a man,” she explained. “And so that is also considered risky drinking.”

But it is also important to keep in mind the definition of a standard drink, which is “a 12-ounce beer, eight to nine ounces of malt liquor and five ounces of wine—which isn’t a whole lot when you think about it—or 1. 5 ounces of anything distilled,” Dr. Patel explained.

Learn more from the JAMA Patient Page “Unhealthy Alcohol Use,” co-written by Drs. Balasanova and Patel.

“We have seen a significant growth in the number of people needing evaluation for liver transplants—at least here in our facility because our team does those evaluations,” said Dr. Balasanova. “You can absolutely develop liver disease and eventually end stage liver disease such that you need a transplant.

“Alcohol-related liver disease is a leading cause of a need for transplant,” she added, noting that drinking large amounts can “also impact your heart. You can get cardiomyopathy and increased blood pressure, which then, of course, can increase your risk for having strokes.”

There is also “the mental health impact” which “can lead to anxiety, depression, and sometimes even suicide,” Dr. Balasanova said, noting that “about half of people die by suicide while they’re actively intoxicated.”

“It can also worsen your psychiatric disorders if you’re experiencing anxiety or depression,” or even post-traumatic stress disorder (PTSD), said Dr. Patel. “It actually worsens PTSD and can be associated with other substance-use disorders, so you may pick up another substance to supplement what you’re already doing.

“Then in pregnancy, you can get fetal alcohol spectrum disorder that affects your baby, particularly with birth defects, developmental disabilities and even intellectual disabilities,” she added.

Discover what doctors wish patients knew about post-COVID anxiety.

“With my consult service, at the very beginning of the pandemic, it was really busy—a lot of people were getting hospitalized for alcohol-related problems,” said Dr. Balasanova. “Then it kind of died down as things were getting better.”

“Now it’s picking back up again. And I don’t know if that’s because of the Delta variant or what, but it started to pick up before then,” she said, noting that “a part of that was actually the social reintegration and this idea of going back into society was really anxiety-provoking for people, so then they just drank more, which led to all sorts of negative health outcomes. ”

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“A really good thing to do is to take inventory of your alcohol use” such as keeping “a journal or a diary,” Dr. Balasanova recommended. “On a calendar, write down how much you’re drinking every day just so you know where you’re at,” as well as what is going on at the time.

“Once you have at least two weeks, you have an idea where you’re at and can start making incremental goals to reduce that use,” she said. For example, “if you are seeing that a bottle of wine is lasting you two days, you can always make a goal where you make it last three days and then see how well that goes for a week or two. If that seems to go well, see if you can make it last for days.”

Additionally, “take a look at what your family history of alcohol problems are because it’s very much genetic and linked,” said Dr. Patel. “And then check out any medications that are contraindicated with alcohol. It’ll help give you a clearer picture of what your life is like and where alcohol may or may not fit. ”

“So many people do use alcohol as a crutch and what I would caution folks about is if they are using it as a maladaptive coping mechanism, we need to find some healthy coping mechanisms to replace it with,” said Dr. Balasanova. “If we eliminate it altogether, then you have no coping skills and that’s not going to work either.

“If there’s something you like to do—scrapbooking, knitting or whatever—try to engage more in those activities,” she added. “Also making sure you’re getting enough sleep is crucial—so the basics of sleep, diet, making sure you’re hydrated.”

“These are things everybody overlooks because they’re like, oh, that’s too simple. But it matters,” said Dr. Balasanova. “It matters if you’re hydrated, if you’re sleeping well, if you’re eating right and not just eating fast food all the time—eating nutritious foods and vegetables.”

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By “keeping track of your urges and cravings, you can identify what your triggers are, which can be people, places, things, times of the day that offer drinking opportunities or remind you of drinking,” said Dr. Patel. “Other things can be internal triggers that just kind of pop up, so I recommend that you take the time to question the urge, think about why and challenge it.

“It’ll allow you to become more aware and use that healthier coping mechanism that you’ve developed instead,” she added. “Remember that urges and cravings come in waves. It’s like an ocean wave and it will pass.”

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“We have three medications that are FDA-approved, including one that’s not even a pill—it’s an injection that you get once a month, so you really don’t even have to deal with taking pills every day,” Dr. Balasanova explained. “Then we have our psychosocial treatments. We also have community peer-support  groups, so overall we have a variety of services.”

“It’s not a cookie cutter, one size fits all because in the past that’s what people would associate with,” she said, noting that the assumption was “you go to rehab and that’s what you have to do. That’s not the case anymore.”

“First and foremost, if you really feel like things are out of control, please seek help. Talk to your doctor and talk to your primary care provider,” said Dr. Balasanova. “Or if you have a psychiatrist or mental health specialist, talk to them.

“But honestly, this is something you can talk to your primary care about and just say, ‘I really have been drinking a lot more lately. I’m really struggling. What can be done on that end?’” she added.

“The most important thing is if you’re struggling, tell somebody. Don’t go through that alone,” Dr. Patel echoed. “There are so many resources out there, particularly for substance use because it’s a big area of prevention and it’s just as much of an illness as anything else is.”

Table of Contents

1. Risky alcohol use is common
2. Isolation during pandemic took a toll
3. Why binge drinking is a concern
4. Drinking a lot affects your health
5. Social reintegration is stressful
6. Take inventory of your alcohol
7. Find healthy coping mechanisms
8. Cravings come in waves
9. Treatments are available
10. Talk with your doctor

What threatens the daily use of alcohol

Alcoholism is a serious danger. The disease destroys a person’s life, destroys his family relationships and spoils his health. Addiction pretty soon starts to cause a lot of problems. Alcohol has a detrimental effect on all spheres of human life.

How addiction is formed

Everyone can become addicted to alcohol: for this it is not necessary to use strong alcohol. The body reacts to any ethanol-containing drink – alcohol poisoning occurs. Over time, a physical attraction develops. The value of the level of alcohol in the blood is similar, whether it is 100 grams of vodka or 2 liters of beer.

For each person, the maximum dose of ethanol is individual. A manifestation of the disease is the loss of control over the drink. At the same time, there is no critical perception of one’s condition when drinking alcohol.

Natural biochemical processes change over time. Physical cravings are formed when a person needs ethanol constantly. However, this does not happen immediately, but after the appearance of psychological dependence. Initially, drinking is needed to overcome complexes or in an attempt to cope with problems, relieve stress. Over time, this decision becomes the only acceptable one.

Without the opportunity to drink, a person’s mood and well-being become worse. Therefore, the frequency of drinking alcoholic beverages, the dose of ethanol increases. The craving for alcohol becomes out of control, pathological. All new doses are needed already to overcome the withdrawal syndrome, while the pleasure of drinking becomes less and less. The emotional reaction to alcohol-containing drinks changes.

Effects of daily alcohol consumption on the body

Alcohol-containing products tend to cause cravings that are very difficult to overcome in the future. The composition contains many harmful impurities that have a harmful effect on the entire body. Gradually, the destruction of tissues and cells of almost all systems occurs.

Ethyl alcohol, when used systematically, causes both physiological and social damage. The consequences are manifested in the form of serious damage to all body systems and the development of chronic diseases.

Physiological changes

When ethanol gets inside, it interacts with the nervous tissue: its protection is destroyed. Just 1 liter of beer or a bottle of wine leads to serious consequences – the death of up to 10 thousand brain cells that cannot be restored. Subsequently, this affects mental activity and general health.

Ethyl alcohol also disrupts the conduction of impulses through nerve cells. For the central nervous system, this manifests itself in the form:

• problems in the emotional sphere;
• appearance of speech defects;
• violations of the organs of vision, hearing;
• problems with coordination, etc.

Alcohol affects the cardiovascular system. The tissues of the organs are connective tissue, the elasticity of which is lower. This affects the work of the heart and blood vessels: there are problems with pressure, there is a violation of the contractile function of the myocardium.

The whole organism suffers, there are no exceptions. Ethyl alcohol harms the walls of the stomach, so the risk of ulcer formation is high. There is a change in acidity, which also negatively affects the digestion process.

Frequent dizziness and headaches are also common consequences of alcoholism.

External signs of a drunk person

The visual manifestations of a drunkard become noticeable not immediately. Signs begin to develop gradually. With each subsequent stage in the development of the disease, the traces on the face of an alcoholic become more pronounced. Most of them are reflected in the appearance:

• due to improper outflow of bile, the whites of the eyes and skin become yellow;
• the face turns red as the pressure rises rapidly after drinking alcohol;
• skin covered with pimples, rash;
• the area under the eyes suffers – the so-called bags are formed, spoiling the appearance.

Dryness of the epidermis, accelerated appearance of wrinkles are also signs of drinking people. Often the face is covered with a thin vascular network.

The nose becomes burgundy red. Much changes in facial expressions: the muscles of the mouth relax excessively, the forehead tenses. As a result: the face takes on a rather strange expression, as if always slightly surprised.

People who drink lose weight and their skin looks unhealthy. In this case, swelling of the face is characteristic.
It is these signs that will help to recognize a drunkard at first sight.

Mental changes

Long-term use of ethanol-containing drinks is fraught with significant mental disorders. The risk of developing alcoholic hallucinosis is high. Often patients hear voices that offend them, say unpleasant things, often threatening.

The most common disorder is delirium, otherwise known as delirium tremens. With hallucinosis, there is no disturbance of consciousness. The patient continues to navigate in time. In some patients, the disease becomes chronic.

Degradation of personality is a rather frequent companion of addiction. Intellectual abilities and stress resistance are significantly reduced. The drinker is secretive, not talkative. An ever-increasing dose of alcohol negatively affects the possibility of an adequate perception of reality. In the morning, the patient does not remember what happened the day before, while he was aggressive or unconscious.

How long do alcoholics live?

The life expectancy of those who suffer from alcoholism is significantly reduced. More than 50 years live 20% of patients. Acute heart failure often causes early death of drunkards under the age of 40. A dangerous habit is fraught with a considerable deterioration in quality and a decrease in life expectancy. The risk of leaving this world prematurely increases.
There is no single answer to the question of how long alcoholics live. Much depends on the age at which a person developed a harmful addiction, whether there are associated problems, etc. That is, the life expectancy of a drinking person is determined by the strength of the body. Sudden deaths before the age of 30 are not uncommon. The average life expectancy is 48-55 years. However, this is under fortunate circumstances. 25% of dependent people do not live up to the specified age mark.

Only by quitting drinking in a timely manner does a sick person get a chance to prolong life. However, in many cases, medical attention is indispensable. Then a person can cope with addiction, get rid of addiction.

A matter of habit…

Bad habits are ruining us, 8,000 people die from them every day, and each next generation is born obviously unhealthy.

While you are young, healthy, beautiful and active, don’t take the wrong path! Bad habits are ruining us, 8 thousand people die from them every day, and each next generation is born obviously unhealthy.

We often hear that alcohol is a food product; moderate doses of alcohol are harmless; if you drink “culturally”, then there is nothing wrong with that, but on the contrary – cognac and vodka dilate blood vessels; for pain in the heart, this is the best remedy, etc. However, alcohol is a drug that undermines the health of the population. No matter how different alcoholic beverages are in appearance, taste, smell and price, they all consist of only two components: ethyl alcohol and water. To increase the attractiveness, dyes, flavors, sugar, carbon dioxide are added to some drinks. They do not matter much, because alcohol is consumed solely for the effect that alcohol has on the body. The main thing that distinguishes some alcoholic beverages from others is the concentration of ethyl alcohol.

Ethyl alcohol is a poisonous technical liquid that is used in the chemical industry as a solvent, and it is also the strongest psychoactive ingredient. Although alcohol is considered a universal gift, it is not worth ruining people’s lives.

The use of alcohol is fraught with many dangers. Some of them: lapses in memory or its temporary loss; toxic effects on the liver, heart, pancreas, gastrointestinal tract; increased susceptibility to various diseases; cirrhosis of the liver; with excessive alcohol consumption, there is a danger of death as a result of disruption of the respiratory and cardiovascular systems; increases the likelihood of bodily injury or death when driving while intoxicated; increases the risk of miscarriage and premature birth during pregnancy, and alcohol syndrome in pregnant women.

Make your choice, make it right!

Recommendations for a healthy lifestyle ›

Which is more harmful: hookah or cigarettes?

Many people think that smoking hookah and cigarettes should not be put in the same row – they say, in the case of hookah, tobacco is better, and there are no many chemicals – plus you will not smoke hookah as often as cigarettes. Proponents of hookahs find dozens of excuses for their addiction, very often without realizing that the harm from this habit, as a rule, comes out even more than from smoking cigarettes. The main myth about hookah is that, passing through water / juice / milk, the smoke is cleared of harmful substances. This statement has nothing to do with the truth. Carbon monoxide, heavy metals and tar remain in the smoke and do not disappear – the only difference is that the smoke is enriched with glycerin, which makes it a little sweeter, but this does not affect the degree of harm. Some hookahs use cotton filters or a special plastic mesh designed to reduce harm, but according to a report from the World Health Organization, such products do nothing to reduce the relative harm of tobacco smoke.