Health implications of excessive alcohol intake

What is an alcohol?

According to Hull and Stone (2004), alcohol is a legal sedative drug which changes the way we feel. Pure alcohol is colourless, odourless and inflammable. Alcohol as a drug does not contain any nutrient in the body.

Foundation for a Drug-Free World (2006) describes alcohol is a drug. It is classed as a depressant, meaning that it slows down vital functions—resulting in slurred speech, unsteady movement, disturbed perceptions and an inability to react quickly. As for how it affects the mind, it is best understood as a drug that reduces a person’s ability to think rationally and distorts his or her judgment.

Although classified as a depressant, the amount of alcohol consumed determines the type of effect. Most people drink for the stimulant effect, such as a beer or glass of wine taken to “loosen up.” But if a person consumes more than the body can handle, they then experience alcohol’s depressant effect. They start to feel “stupid” or lose coordination and control.

Alcohol overdose causes even more severe depressant effects (inability to feel pain, toxicity where the body vomits the poison, and finally unconsciousness or, worse, coma or death from severe toxic overdose). These reactions depend on how much is consumed and how quickly.

There are different kinds of alcohol. Ethyl alcohol (ethanol), the only alcohol used in beverages, is produced by the fermentation of grains and fruits. Fermenting is a chemical process whereby yeast acts upon certain ingredients in the food, creating alcohol.

Types of alcohol

Alcohol beverages have been a popular drinking medium for celebrations, parties and whatever else we can find an excuse to drink them for a long period of time in our history here on this planet. These alcohol beverages are usually classified according to Hull and Stone (2004) into two main categories;

Undistilled or fermented alcohol beverages
Distilled alcohol beverages

Fermented or undistilled alcohol

The different fermented and undistilled alcoholic beverages include beer, palm wine, sake, wine, etc.

Types of Beer

This is one of the oldest forms of fermented alcoholic beverages. As people across the globe consumed different forms of beer, there are actually many sub-types of beer.

Fruit beer: Fruits like cherry, raspberry and peach are commonly used in brewery these types of beer. Most of the breweries add a flavour of these fruits instead of fermenting them.
Wheat beer: This type of beer is produced by mixing a large proportion of wheat when compared to the malted barley content. This type of beer has its origin in Austria and Germany.
Palm wine: Palm wine is a type of alcoholic beverage consumed in Asia and Africa. This is produced from the sap of the palm tree.
Sake: This is a fermented alcoholic beverage made in Japan by fermenting rice at a particular temperature.
Wine: This is a type of alcoholic beverage that is made from fermented grapes. During the fermentation process, yeast absorbs the sugar in the grape juice and converts it into alcohol. It contains 8 – 20% of alcohol.

Distilled alcohol beverages

Distilled alcoholic beverages have many types as discussed below but just a few.

Gin: This is a type of distilled spirit that is made from juniper berries. There are different types of gins like Bamson Gin and Sloe Gin. Bamson Gin is hugely popular in Britain and it contains 40 – 47% of alcohol.
Whiskey: This is a distilled alcoholic beverage that is made by forming a combination of different grains including barley, rye, corn and wheat. The fermented whiskey is then allowed to age in wooden casks and it has alcoholic content of 40 – 50%.
Brandy: this is distilled beverage that is made by distilling wine. It has an alcoholic content that ranges between 30% and 60%.

Alcohol content

An important class of alcohols are the simple acyclic alcohols, the general formula for which is C_nH_2n+1OH. Of these ethanol (C₂H₅OH) is the alcohol found in alcoholic beverages; in common speech the word alcohol refers to ethanol. Fermented drinks, such as beer and wine, contain from 2% alcohol to 20% alcohol. Distilled drinks, or liquor, contain from 40% to 50% or more alcohol. The energy level of alcohol is very high for example; 100 ml of vodka contain about 257 kcal. The usual alcohol content for different brands of alcohol is:

Beer 2–6% alcohol

Cider 4–8% alcohol

Wine 8–20% alcohol

Tequila 40% alcohol

Rum 40% or more alcohol

Brandy 40% or more alcohol

Gin 40–47% alcohol

Whiskey 40–50% alcohol

Vodka 40–50% alcohol

Liqueurs 15–60% alcohol

(Foundation for a Drug-Free World, 2006)

How alcohol affects the body

Alcohol is absorbed into the bloodstream via small blood vessels in the walls of the stomach and small intestine. Within minutes of drinking alcohol, it travels from the stomach to the brain, where it quickly produces its effects, slowing the action of nerve cells. Approximately 20% of alcohol is absorbed through the stomach. Most of the remaining 80% is absorbed through the small intestine.

Alcohol is also carried by the bloodstream to the liver, which eliminates the alcohol from the blood through a process called “metabolizing,” where it is converted to a nontoxic substance. The liver can only metabolize a certain amount at a time, leaving the excess circulating throughout the body. Thus the intensity of the effect on the body is directly related to the amount consumed. When the amount of alcohol in the blood exceeds a certain level, the respiratory (breathing) system slows down markedly, and can cause a coma or death, because oxygen no longer reaches the brain. (Bruun, 1975)

When is alcohol abused?

Alcohol abuse, as a psychiatric diagnosis describing the recurring use of alcoholic beverages despite its negative consequences. Alcohol abuse is sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse. There are two types of alcoholics: those who have anti-social and pleasure-seeking tendencies and those who are anxiety-ridden people who are able to go without drinking for long periods of time but are unable to control themselves once they start. (Babor, 1992).

How much alcohol is termed excessive

According to Baum-Baicker (1985), when trying to determine if your drinking habits are worrisome, you’ll likely wonder: How much is too much? Millions of people drink alcoholic beverages on a regular basis without ever developing a drinking problem; they do not become alcohol abusers, alcohol dependent, or alcoholics. But how do you know if you are drinking at a safe level? How much alcohol can you drink and still be considered a low-risk drinker? How much is puts you in the high-risk group?

According to extensive research by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), less that 2% of drinkers who fall within the following guidelines ever develop alcohol use disorders:

Four or fewer drinks for men

For men, low-risk alcohol consumption is drinking four or fewer standard drinks on any single day and less than 14 drinks during any given week. According to the NIAAA, to remain low risk, both the daily and weekly guidelines must be met.

In other words, if you are a man and you drink only four standard drinks per day, but you drink four every day, you are drinking 28 drinks per week — twice the recommended level for low-risk alcohol consumption. Likewise, drinking four drinks a day four times a week would also exceed the guidelines.

Three or fewer drinks for women

Research has shown that women develop alcohol problems at lower levels of consumption than men. Therefore, the guidelines for low-risk drinking are lower for females. The NIAAA guidelines for women are three or fewer standard drinks a day and no more than seven drinks per week.

As for men, both the daily and weekly standards must be met to remain in the low-risk category. If you drink only two drinks a day, but drink them every day, that is 14 drinks a week — twice the recommended amount for low-risk consumption.

‘Low risk’ does not mean ‘no risk’

There are some situations in which no level of drinking can be considered low-risk. Depending on your age, health and other circumstances, you may need to drink even less or not drink at all. Here are some circumstances in which you may need to stop drinking altogether:

You plan to drive or operate heavy equipment.
You are pregnant or planning to become pregnant.
You have certain medical conditions, such as cirrhosis of the liver, hepatitis C, chronic pain, certain heart conditions and mental disorders such as bipolar disorder.
You are taking certain medications that negatively interact with alcohol.

Health effects of excessive alcohol intake

Ferrer (1998), opined, that drinking too much – on a single occasion or over time – can take a serious toll on your health. Here’s how alcohol can affect your body:

Brain:

Alcohol interferes with the brain’s communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behaviour, and make it harder to think clearly and move with coordination.

Heart:

Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including:

Cardiomyopathy – Stretching and drooping of heart muscle
Arrhythmias – Irregular heart beat
Stroke
High blood pressure

Research also shows that drinking moderate amounts of alcohol may protect healthy adults from developing coronary heart disease.

Liver:

Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver inflammations including:

Steatosis, or fatty liver
Alcoholic hepatitis
Fibrosis
Cirrhosis

Pancreas:

Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.

Cancer:

Drinking too much alcohol can increase your risk of developing certain cancers, including cancers of the:

Mouth
Oesophagus
Throat
Liver
Breast

Immune system:

Drinking too much can weaken your immune system, making your body a much easier target for disease. Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single occasion slows your body’s ability to ward off infections – even up to 24 hours after getting drunk.

Psychological effects of excessive use of alcohol

Kessler et al., (1996) wrote extensively on the psychological effects of excessive use of alcohol as follows;

Alcohol and depression

Alcohol numbs what you feel, including your emotions. You don’t feel as down, and loneliness is less oppressive. The empty hours seem to pass by more quickly. Irritation is easier to cast aside. If you’re under the influence, alcohol gives relief: you just don’t care as much. In the long run, however, it doesn’t help. The bad feelings come right back once the alcohol wears off.

‘Drowning’ unpleasant feelings is not a solution. Over the long term alcohol can increase, or even cause, feelings of depression!
Alcohol is a notorious cause of depression. Often when you stop drinking, this depression will get better.

Only a small group of people still have symptoms of depression a few weeks after quitting drinking. This can be treated with medication or therapy. However, as long as you keep drinking depression cannot be effectively treated.

A final point: negative feelings – having a rotten day, irritations, bad news, low energy, feeling alone – are part of life. If you stop drinking, you’ll notice it’s easier to get over these things, put them into perspective and find the courage to look for positive experiences.

Alcohol, fear and anxiety

Feeling fearful can be very useful; it’s a natural response to a threatening situation. It keeps you on your toes and protects you. However, sometimes the fear gets too powerful and starts to run your life. You may panic or you may become afraid to go out of doors.

Drinking alcohol may have become a means of dealing with your fear. You dare to do more under the influence, since it depresses your feelings of fear. However, it’s only treating the symptom. After a while, you’ll notice that you need more and more alcohol to get the desired effect.

If you really want to make a change and learn to deal with your fear, you may need to change your relationship to alcohol so that you no longer rely on it to deal with anxiety.

Repeated exposure to feared situations along with thought monitoring and challenging are the most effective ways of reducing or eliminating most anxiety states. Your GP will be able to advise you and possibly refer you for psychological help with this.

Alcohol and psychosis

Psychosis entails losing touch with reality. Hallucinations (seeing or hearing things that are not really there) can occur and people can feel anxious or threatened. Thought processes can be disturbed; so that the person thinks about or suspects conspiracies, stalking, brainwashing or their phone being tapped.

People who have (or have had) psychotic symptoms are advised not to drink alcohol. The effects of alcohol are unpredictable and can trigger a psychotic episode. This is also true for non-prescribed drugs as well, most notably cannabis in those prone to psychosis.

Alcohol can also make people confused. If someone has drunk so much that psychotic symptoms appear, it’s called an alcohol psychosis.
After a period of heavy drinking, there is always the risk that the drinker will become confused. He or she will be restless, see things that aren’t there (such as the famous pink elephants) and pick at things such as their clothing or blankets.

A psychosis can be life-threatening and rates of suicide are high, therefore it is important to seek medical help if any of the above symptoms appear.

Alcohol and aggression

Alcohol removes inhibitions. We develop inhibitions to keep our behaviour towards each other civilised, but under the influence of alcohol these inhibitions may no longer be present. Drinking alcohol can lead to outbursts of aggression. Alcohol plays a role in many cases of domestic violence. Perpetrators of ‘violence’ are often acting under the influence of alcohol.

Alcohol makes you more irritable. You may react to small annoyances with violent outbursts. Your ability to see things in perspective or not take a comment personally is impaired.

For those around you, your behaviour gets more difficult to predict and they may keep more distance from you. If you find that you can’t control your aggression once you’ve been drinking, it can be a good reason to change your drinking habits, not only for your own sake, but for those around you.

Alcohol and sleep

Alcohol seems to be a frequently used sedative. However, it has strings attached, since you need more and more to get the same effect. That one little drink can gradually become more and more.

Alcohol interferes with healthy sleep. The processes that go on in your brain during sleep don’t go as smoothly when you’ve drunk alcohol.

Waking and getting up is always nicer if alcohol hasn’t affected your sleep. If you’re used to going to sleep under the influence, you’ll find it’s indeed harder to go to sleep when sober. Therefore it is important to realise that your body needs time to adjust to a healthy sleep pattern after you’ve quit drinking.

There is also a great deal of individual variation within healthy sleeping patterns. Some people always lie awake for an hour before they fall asleep. Others sleep lightly and are easily woken by things like noises. If you sleep badly, relaxation exercises can help.

Social effects of excessive alcohol intake

Excessive alcohol intake carries with it a host of social problems. Both the drinker and the family unit are affected. Excessive alcohol intake can have devastating effects on the family. Numerous marriages have been destroyed by alcohol, both emotionally and financially. Children of alcoholics are emotionally fractured by alcoholic parents. Approximately 20 percent of adults grew up with a family member with an alcohol problem. These adults themselves are at risk for developing substance abuse problems. Emotional issues such as guilt, depression, and relationship problems are often found in children of alcoholics (Klingemann & Gmel, 2001)

Gmel and Rehm (2003) stated that alcoholics may have additional problems that compound the alcohol issue. Drugs, both prescription and illegal, may cause a synergistic effect in which the overall whole effect of the combined substances is greater than the sum of the parts. This, of course, can have devastating, even fatal, consequences. Psychological problems ranging from depression to schizophrenia are often seen in the alcoholic. These people may attempt to self-medicate with alcohol, not realizing that alcohol may exacerbate the symptoms of their mental illness.

In addition, communities suffer the cost of alcohol abuse. An enormous amount of money is lost each year in the workplace because of alcohol. Insurance costs, decreased productivity, workplace injuries, and work-related grievances are just a few of many problems associated with alcohol. Alcohol is also a leading factor in motor vehicle accidents and injuries. Alcohol-related vehicular accidents are especially prevalent among teenagers and young adults, for whom they are the leading cause of accidental death. Falls, fires, drowning, and suicides are also frequently associated with alcohol.

Health Benefits of Alcohol Intake

According to the Dietary Guidelines for Americans, “moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days.”

Now, we’ve all heard the reasons why alcohol is bad for you, but what about the benefits? Here is our list of seven ways that drinking alcohol in moderation (when you’re of the legal drinking age of course) might benefit your health.

1. It can lower your risk of cardiovascular disease

Edwards et al., (1994) stated that the School of Public Health at Harvard University found that “moderate amounts of alcohol raises levels of high-density lipoprotein, HDL, or ‘good’ cholesterol and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting….Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke.” This finding is applicable to both men and women who have not been previously diagnosed with any type of cardiovascular disease.

2. It can lengthen your life

Drinking occasionally could add a few years to your life. A study by the Catholic University of Campo basso reported that drinking less than four or two drinks per day for men and women respectively could reduce the risk of death by 18 percent, as reported by Reuters. “Little amounts, preferably during meals, this appears to be the right way (to drink alcohol),” said Dr. Giovanni de Gaetano of Catholic University, another author on the study. “This is another feature of the Mediterranean diet, where alcohol, wine above all, is the ideal partner of a dinner or lunch, but that’s all: the rest of the day must be absolutely alcohol-free.”

3. It can improve your libido

Contrary to prior beliefs, newer research has found that moderate drinking might actually protect against erectile dysfunction in the same way that drinking red wine might benefit heart disease. In a 2009 study published in the, Journal of Sexual Medicine, researchers found that the chances of erectile dysfunction were reduced by 25 to 30 percent among alcohol drinkers. The lead researcher, Kew-Kim Chew, an epidemiologist at the University of West Australia, conducted the study with 1,770 Australian men. In his study, Chew cautiously noted that he and his team in no way are advising men to hit the bottle, and that further research is needed to accurately connect impotence and alcohol consumption.

4. It helps prevent against the common cold

The Department of Psychology at Carnegie Mellon University found that while susceptibility to the common cold was increased by smoking, moderate alcohol consumption led to a decrease in common cold cases for non-smokers. This study was conducted in 1993 with 391 adults. In 2002, according to the New York Times, Spanish researchers found that by drinking eight to 14 glasses of wine per week, particularly red wine, one could see a 60-percent reduction in the risk of developing a cold. The scientists suspected that this had something to do with the antioxidant properties of wine.

5. It can decrease chances of developing dementia

In a study that included more than 365,000 participants since 1977, as reported in the journal Neuropsychiatric Disease and Treatment, moderate drinkers were 23 percent less likely to develop cognitive impairment or Alzheimer’s disease and other forms of dementia. “Small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate amounts stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia,” said Edward J. Neafsey, Ph.D., co-author of the study, as reported by Science Daily. “We don’t recommend that nondrinkers start drinking,” Neafsey said. “But moderate drinking — if it is truly moderate — can be beneficial.”

6. It can reduce the risk of gallstones

Drinking two units of alcohol per day can reduce the risk of gallstones by one-third, according to researchers at the University of East Anglia. The study found that those who reported consuming two UK units of alcohol per day had a one-third reduction in their risk of developing gallstones. “Researchers emphasized that their findings show the benefits of moderate alcohol intake but stress that excessive alcohol intake can cause health problems,” according to the study.

7. Lowers the chance of diabetes

Results of a Dutch study showed that healthy adults who drink one to two glasses per day have a decreased chance of developing type 2 diabetes, in comparison to those who don’t drink at all. “The results of the investigation show that moderate alcohol consumption can play a part in a healthy lifestyle to help reduce the risk of developing diabetes type 2,” researchers said in a statement to Reuters.

Nutritional effects of alcohol intake

Your body process alcohol with the help of its stored nutrients; when your liver runs out of the nutrients it needs for this job, it pulls additional nutrients from other areas through your bloodstream. Even in regular drinkers who are not alcoholics, the increased nutritional demands of alcohol processing can lead to significant deficiencies in essential nutrients such as vitamin A, Vitamin B₉ (folate or folic acid) vitamin B₁₂, mineral and calcium. The presence of significant amounts of alcohol in your body can also directly destroy all members of the B vitamin family. In addition to B₉ and B₁₂, this family include B₅ (panotothemic acid), B₂ (riboflavin), B₃ (niacin), B₁ (thiamine) and B₆ (pyridoxine). At the same time, the relatively high calorie content in alcohol (which ranks second only to the calorie content of various forms of fats can easily lead to weight gain in non-alcoholics who drink regularly. In alcoholics, damage to the liver, pancreas and stomach degrades the body’s normal ability to process essential dietary nutrients, and therefore increases the intensity of the deficiencies sometimes found in non-alcoholics regular drinkers. Problems grow even worse for long term alcoholics who decrease their food intake and consciously or unconsciously start using increased alcohol intake to replace the missing nutrients in their diet. Eventually, this pattern of usage will lead to a considerable weight loss and the onset of clinical malnutrition.

Treatment

Nutritional needs of persons with heavy alcohol intake will vary depending on the presence of hepatitis, cirrhosis, hepatic encephalopathy, acute pancreatitis or combined condition that may require medical nutrition therapy.

Goals should include the following;

Eliminating alcohol
Consuming a well balanced diet which includes fruits, vegetables, whole grains and protein sources to meet nutritional snacks available.
A multivitamin with minerals sometimes is needed, based on nutritional assessment and laboratory analysis.
It is often helpful to reduce sugar to maintain stable blood sugar levels and prevent hypoglycaemia which is common in alcoholics.
In case of vomiting and diarrhoea, fluids should be given to patient to prevent dehydration.

(Lieber, 2003).

Conclusion

The available data substantially emphasize the health implications of excessive alcohol use. New sources of information should be developed to better measure the extent of these problems. Educating people about the problems of excessive use of alcohol is important, but this must be accompanied by other approaches if significant progress is to be made in reducing excessive drinking. Community controls of alcohol sales and availability are often more effective than attempts to convince individuals to voluntarily change their behaviour. Effective policies would include reducing access to alcohol by price increases and restrictions of the amount of alcohol an individual is allowed to purchase and consume on retail outlets.

Recommendations

Excessive alcohol consumption is a major risk factor to the health of the individual, his family members and the society at large. It the light of this, the following recommendations are made to manage issues of excessive use of alcohol.

Support state, tribal, local and territorial implementation and enforcement of alcohol control policies.
Create environments that discourage people from excessive use of alcohol.
Identify alcohol abuse disorders early and provide intervention, referral and treatment.
Reduce inappropriate access to and use of alcohol.

References

Babor, T.F. (1992) The Nature of Alcohol and Drug Related Problems. New York: Oxford University Press.

Baum-Baicker, C. (1985). The Psychological Benefits of Moderate Alcohol Consumption: A Review of the Literature. Drug Alcohol Dependence 15(4):305–322.

Bruun, K. (1975). Alcohol Control Policies in Public Health Perspective. Vol. 25. Helsinki, Finland: Finnish Foundation for Alcohol Studies.

Edwards, G.; Anderson, P.; Babor, T.F.; Casswell, S.; Ferrence, R.; Giesbrecht, N.; Godfrey, C.; Holder, H.D.; Lemmens, P.; Makela, K .; Midanik, L.T.; Norstrom, T.; Osterberg, E.; Romelsjo, A.; Room, R.; Simpura, J. & Skog, O (1994). Alcohol Policy and the Public Good. New York, NY: Oxford University Press.

Ferrer, H.P. (1998). Alcohol Consumption and Mortality. Characteristics of Drinking Groups. Addiction 93(2):183–203.

Foundation for a Drug-Free World (2006). The Truth about Alcohol. Retrieved on March 31^st, 2014, from http://www.drugfreeworld.org/drugfacts/alcohol.html

Gmel, G., Rehm, J. (2003). Harmful Alcohol Use. Alcohol Res Health. 27(1):52-62.

Hull, J.G. & Stone, L.B. (2004). Alcohol and Self-regulation. Handbook of Self-regulation, pp 466-491. London: the Guilford Press.

Kessler, R.C.; Nelson, C.B.; McGonagle, K.A.; Edlund, M.J.; Frank, R.G. & Leaf, P.J. (1996). The Epidemiology of Co-occurring Addictive and Mental Disorders: Implications for Prevention and Service Utilization. American Journal of Orthopsychiatry 66(1):17–31.

Klingemann, H. & Gmel, G. (2001) Mapping the Social Consequences of Alcohol Consumption. Dordrecht, Kluwer Academic Publishers

Lieber, C.S. (2003). Relationship between Nutrition, Alcohol Use and Liver Disease. Alcohol Res. Health 27(3):220-31.