Just Say No To Alcohol ?

Many people think it’s okay to have two or three beers or a few glasses of wine when they come home from work or while watching a ballgame on the weekend. But experts disagree. Alcohol misuse and alcohol use disorder (AUD) cause suffering, disease, and loss of life. Sometimes consuming a few drinks transforms into an alcohol dependency.

Recent surveys indicate that 29.5 million people ages 12 years and older had an AUD in the past year in the United States. “Drinking guidelines are being re-evaluated," reports Professor Teresa Rummans, board certified in internal medicine and psychiatry, and Professor of Psychiatry at the Mayo Clinic in Rochester, Minnesota, and Jacksonville, Florida, "Alcohol is found to contribute to more illnesses, especially cancer, (gastrointestinal and even breast cancer) than was known before, but the exact relationship is still not known.”

Teresa Rummans, MD

Source: Mayo Clinic

COVID 19 Triggered More Drinking

Alcohol consumption increased dramatically during the pandemic, making apparent the need to rethink alcohol consumption, prevention, guidelines, early intervention, and treatment for AUD.

Nielsen pollsters reported in March 2020 that alcohol sales in the U.S. increased by 55% compared to the previous year. Online alcohol sales increased 234% from April 2019 to 2020. Alcohol delivery services like Drizly saw a 485% increase in sales. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) also noted significant changes in drinking patterns spurred by the pandemic.

A RAND survey reported that during the pandemic, frequency of alcohol consumption among men increased by 14%. Women experienced a 17% increase. Additionally, heavy drinking among women (four or more drinks within a couple of hours) increased by 41%. Experts attribute the increases to greater stress, anxiety, social isolation, fear, boredom, and disruptions to daily routines caused by the pandemic. Younger adults and those with higher incomes reported bigger alcohol consumption increases compared to other groups.

The pandemic has ended, but elevated drinking levels persist for many individuals.

Alcohol and Health Issues

Accumulating evidence on health risks associated with alcohol led the World Health Organization (WHO) to report there is no "safe" level of alcohol consumption that does not affect health. In collaboration with international partners, WHO spearheaded SAFER: A World Free from Alcohol-Related Harms (SAFER), a 2019 initiative providing technical guidelines for alcohol control, with the goal of reducing harmful alcohol use by 10% by 2025.

Canada has radically revised its recommendations for alcohol consumption, saying zero alcohol is the only risk-free approach.

It's clear alcohol consumption is a contributor to many serious health problems.

Cancer and Alcohol

Studies link alcohol consumption and cancer, particularly breast, liver, colorectal, esophageal, and oral cancers. Even moderate drinking is associated with increased cancer risks. According to the American Cancer Society, researchers have found that alcohol consumption causes about 5% of cancers and 3% of cancer deaths. Cancer statistics vary by state; from 2013 to 2016, alcohol-related cancer cases, such as oral/pharyngeal cancers, ranged from a low of 36% in Utah to a high of 62.5% in Delaware. Delaware also had the highest rate of alcohol-related cancers while Utah had the lowest.

Cardiovascular Health

The biggest change in expert opinion concerns whether alcohol could help the heart. Earlier studies had suggested that moderate alcohol consumption could have cardiovascular benefits; more recent research challenges this view. It's now clear that risks for hypertension and other cardiovascular issues can increase with alcohol use.

Liver Disease

Alcohol is a significant risk factor for liver diseases, including fatty liver, hepatitis (liver inflammation, not infectious hepatitis), and cirrhosis. The risk is present even at low levels of consumption. NIAAA estimates that 40% of liver transplants are due to alcohol-related illness. Some transplant centers may be unwilling to perform a transplant on patients with alcohol-related liver disease, fearing that the new liver would be destroyed by continued alcohol consumption.

Mental Health and Cognitive Decline

Alcohol consumption is linked to mental health issues such as depression and anxiety. AUD can cause depression, but psychiatric illnesses such as panic-anxiety, generalized anxiety, or depression, sometimes precede development of AUD. Additionally, AUD can contribute to cognitive decline and increase risk for dementia, which should prompt many middle-aged and older adults to rethink drinking.

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Accidents and Injuries

Alcohol consumption increases the risk of accidents, falls, injuries, and violent altercations. This is particularly the case for younger populations but is also valid for older drinkers.

Pregnancy

According to the CDC, there is no safe time to drink alcohol during pregnancy, including even before a woman knows she is pregnant. (As a result, a woman who knows she wants to become pregnant should immediately stop drinking.) Alcohol can cause problems for the fetus at every pregnancy stage, including birth defects, miscarriage, and stillbirth. Binge drinking, or consuming large amounts of alcohol in a short period, is a particular concern during pregnancy.

Overall Mortality

Recent large-scale studies have shown that risks associated with alcohol consumption outweigh any potential benefits. The studies have contributed to a shift in public health recommendations towards more stringent guidelines on alcohol use. A large body of evidence has shown that even low levels of alcohol consumption are associated with increased risk of all-cause deaths.

A New Thinking about Alcohol

Prevention efforts are slowly changing public attitudes toward alcohol. Health initiatives, such as Dry January, help people explore their relationship with alcohol. At the same time, some individuals are shifting from alcohol to THC-infused beverages. (THC is the intoxicating substance in marijuana.)

Public Health Initiatives

Dry January is a preventive, harm-reduction public health initiative encouraging people to abstain from alcohol for the month of January. The challenge began in 2012 as a British charity initiative, and millions of people participate each year. The goal of Dry January is to give the body a chance to reset and for people to re-evaluate their relationship with alcohol. It's not a detox for people with dependency but rather for people who may drink too much, too often, without realizing the effects the alcohol may have on their health and on others.

Cannabis-Infused Beverages

One popular new category of alcohol-free beverages is cannabis-infused beverages. 0sober is an informal term used to describe people who either abstain from alcohol or moderate their drinking and avoid all drugs other than cannabis. Some people include psychedelic drugs such as psilocybin and LSD in their definition of Cali sober (California sober.).

Conclusion

Current alcohol guidelines are being reevaluated as new data details medical risks of alcohol use. Use, excessive consumption, and AUD are significant contributors to morbidity and mortality in the United States. Many people do not realize the contribution of alcohol to diseases like cancer. Consider risks when drinking. Some people have higher genetic risk for AUD or cancer than others and should avoid alcohol altogether.