The most commonly used mind-altering and addictive substance by Americans is alcohol, the National Council on Alcoholism and Drug Dependence (NCADD) publishes. Almost 140 million people in the United States (who were at least 12 years old) were considered to be current users of alcohol at the time of the National Survey on Drug Use and Health (NSDUH) in 2014, which equates to more than half of the adult population. Alcohol is legal for those of drinking age (21 and older), socially acceptable, fairly inexpensive, and easily accessible. Drinking a beer, a glass of wine, or a cocktail in the evening or in a social situation is considered a norm, and for most, it does not constitute a problem. The issue comes when too much alcohol is consumed, and the risk factors are compounded with continued and ongoing alcohol abuse.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines a standard drink as one 12-ounce beer at about 5 percent alcohol by volume, one 5-ounce glass of wine at about 12 percent alcohol by volume, one 8-9-ounce glass of malt liquor at around 7 percent alcohol by volume, or 1.5 ounces of 80-proof liquor at about 40 percent alcohol by volume. The Dietary Guidelines for Americans publishes that one drink a day for a woman or two for a man is considered moderate drinking, generally acceptable, and without extreme health risks.
Alcohol has even been touted to have health benefits when consumed in moderate amounts, as Harvard Health reports; alcohol may help to improve functions of the heart and circulatory system, thus helping to prevent cardiovascular disease, type 2 diabetes, and gallstones. Going beyond moderate alcohol consumption, however, can create a plethora of health risks and potential problems that outweigh its possible benefits.
Alcohol Intoxication and Patterns of Abuse
According to NIAAA, alcohol enters the bloodstream and becomes active as a psychoactive substance rather quickly, in about 10 minutes or so and can have a range of effects on the mind and body. Slurred speech, impaired motor coordination, sluggish movements, increased sociability, decreased inhibitions, higher incidence of risk-taking behaviors, short-term memory lapses, altered cognitive functions, and questionable decision-making are all potential signs and side effects of alcohol abuse. Accidents from falling down, sexual encounters that may be regretted later, impaired driving, violence, self-harming behaviors, or criminal behavior may also be the result of alcohol intoxication. For instance, Harvard Health publishes that one out of every three violent crimes in the United States involves alcohol as a contributing factor.
Alcohol raises a person’s blood alcohol concentration level, or BAC. Generally speaking, the higher the BAC, the higher the level of intoxication. There are several factors at play when it comes to why one person may get drunk faster on smaller amounts of alcohol than another, including:
- Age: As people age, their metabolism slows down, so an elderly person may become intoxicated faster and with less alcohol than a young adult.
- Gender: Men tend to metabolize alcohol quicker than women, meaning that it may take more for a man to get drunk than a woman.
- Ethnicity: Some races may have more difficulties metabolizing alcohol than others; for example, some Asian populations may have a variation of enzymes in the body that slow alcohol metabolism, resulting in quicker intoxication, NIAAA
- Food consumption: Food can positively impact alcohol metabolism, helping to break down toxins and slowing intoxication.
- Tolerance and alcohol dependence levels: Someone who drinks alcohol regularly likely needs more alcohol to get drunk than someone who doesn’t based on the levels of tolerance and dependence that have built up over time.
- Illness or biological factors: A person’s biological makeup can impact how alcohol is metabolized and at what rate.
- Genetics: Alcohol dependence is heritable and may account for around half of the risk for developing an alcohol use disorder, also affecting alcohol tolerance and dependence, NCADD
- Rate of consumption: The faster a person drinks in a short period of time, the more likely they are to become more quickly intoxicated.
- Use or abuse of other substances: Medications or other drugs can influence the rate that alcohol is absorbed and metabolized in the brain and body and thereby influence intoxication levels.
Drinking at higher than moderate drinking levels is often referred to as alcohol abuse, and NIAAA defines two main detrimental patterns of alcohol consumption that can have negative consequences: binge drinking and heavy drinking. Binge drinking is defined as raising the BAC to or above 0.08 g/dL, which is around the equivalent of five drinks for a man, or four for a woman, in about two hours or so. Heavy drinking is when someone drinks five drinks (or more) in a sitting at least five days in a month. Almost a quarter of the US adult population (aged 18 or older) reported binge drinking in the month leading up to the 2014 national survey, while over 6.5 percent admitted to heavy drinking in the same time period.
Alcohol Poisoning and Alcohol-Related Deaths
Alcohol is considered to be the fourth highest cause of preventable death in America, being involved in close to 90,000 fatalities each year, according to NIAAA. Almost 6 percent of all deaths around the world are related to alcohol use or abuse, the World Health Organization (WHO) publishes. More than one person every hour dies from a motor vehicle crash involving a driver who is under the influence of alcohol; this amounts to 28 people a day. In 2014, almost 10,000 people in the United States died as a result of an alcohol-impaired driving crash, the Centers for Disease Control and Prevention (CDC) reports. Alcohol slows reaction time, impairs decision-making abilities and coordination, decreases concentration, makes it difficult to track items, interferes with perceptions and information processing in the brain, and impedes a person’s ability to sense danger and safely control a vehicle. Different jurisdictions have various thresholds for what BAC is deemed a “safe” alcohol level, although the CDC generalizes that it is typically between 0.02 and 0.04 g/dL.
Alcohol poisoning is another big killer, with around six people dying from alcohol poisoning every day in the United States, the CDC publishes. Alcohol poisoning is basically the result of an alcohol overdose, wherein alcohol reaches toxic levels in the bloodstream and can no longer be broken down and metabolized safely. Alcohol is a central nervous system depressant, lowering body temperature, slowing heart rate, blood pressure, and respiration rates. Mayo Clinic warns that the following are possible signs of alcohol poisoning:
- Slowed or irregular breathing
- Nausea and vomiting
- Significant mental confusion
- Hyperthermia (low body temperature)
- Tremors or seizures
- Blue color to skin, nails, and/or lips
- Extreme drowsiness or loss of consciousness
Alcohol poisoning is deemed a medical emergency, as it can be life-threatening without quick medical attention and care. Using other drugs while consuming alcohol can exacerbate the side effects of both substances and potentially lead to overdose or other significant consequences more rapidly.
Damage to Body from Perpetuated Alcohol Abuse
As a contributing factor in more than 200 different health conditions involving injury or disease, WHO reports that alcohol accounts for over 5 percent of the global burden of disease. Alcohol can interfere with the body’s natural ability to fight off infections and the immune system, potentially opening the door for health problems. The medical journal BMC Public Health warns of an increased risk for contracting tuberculosis for those who drink heavily or are dependent on alcohol, for example. HIV/AIDS may progress more quickly in someone who consumes alcohol as well. Sexually transmitted diseases (STDs) may be more rapidly spread among individuals who binge drink, as drinking alcohol can lower a person’s inhibitions and potentially increase sexual contact without regard to adverse consequences. The journal Alcoholism Clinical & Experimental Research found that women studied who engaged in binge drinking quadrupled their risk for contracting the STD gonorrhea when compared to their peers who abstained from alcohol consumption. Sexual assault and unwanted pregnancy may also be side effects of alcohol abuse.
Episodes of alcohol abuse can also have many additional negative health ramifications, including:
- Steatosis (fatty liver): This first stage of liver disease happens when alcohol causes fat to build up in liver cells. The individual may feel weak, tired, and suffer from abdominal pain.
- Alcoholic hepatitis: This involves mild scarring, inflammation, and fat buildup in the liver, which may be mild or severe. It can cause liver to fail and be fatal. The American Liver Foundation reports that in heavy drinkers, around 35 percent likely develop alcoholic hepatitis. Symptoms include those of fatty liver as well as a yellowish tinge to skin, nausea, general malaise, and loss of appetite.
- Cirrhosis: This is the most severe form of liver disease caused by alcohol. It is indicated by significant scar tissue and present in 10-20 percent of heavy drinkers, the American Liver Foundation publishes. Cirrhosis can lead to additional complications, like kidney failure, an enlarged spleen, bleeding in the stomach, liver cancer, fluid buildup in the abdomen, liver failure, or death. In addition to symptoms named above, itchy skin, insomnia, dizziness, irregular heart rate, hair loss, weight loss, staggering gait, dark urine, being easy to bruise, bleeding nose or gums, loss of sex drive, vomiting blood, and personality changes may signify liver cirrhosis in the end stage, which is potentially fatal.
- Cardiomyopathy: This is a disease of the heart that is caused by enlargement of the heart muscle or weakening of it. It may cause shortness of breath, chest pain, weakness or numbness, fatigue, nausea, or heartburn.
- Arrhythmias: These are irregularities in heart rate and functions, which may have no symptoms or may cause noticeable changes in heart rate (i.e., racing heart).
- Sudden cardiac death or heart failure: This is a potentially fatal stoppage of the heart. It may lead to swelling of the legs, fatigue, rapid heart rate, difficulties catching breath, loss of consciousness and possible death.
Brain damage: Alcohol depletes essential vitamins, interferes with circulation and oxygen levels, and can lead to lasting brain damage as a result. The deficiency of thiamin (vitamin B1) can be especially damaging, resulting in a form of dementia called Wernicke-Korsakoff syndrome (WKS), which is actually two different disorders broken down as follows:
Pancreatitis: This involves inflammation of blood vessels, causing damage to the pancreas and leading to nausea, vomiting, sensitivity, and loss of appetite.
- Obesity: Weight gain is common with alcohol abuse, and high levels of alcohol consumption may cause a person to become significantly overweight.
- Electrolyte imbalance: Alcohol can cause dehydration and throw off the balance of electrolytes and other essential vitamins and minerals in the body.
- Increased risk for developing type 2 diabetes: This results from alcohol consumption and subsequent malnutrition.
Alcohol Dependence and an Alcohol Use Disorder
Alcohol temporarily alters the chemistry in the brain, elevating levels of dopamine (which increases pleasure) and GABA (gamma-aminobutyric acid, which has sedative effects). In so doing, alcohol interferes with emotional regulation, impulse control, decision-making processes, problem-solving abilities, memory, and learning functions. The more often one drinks alcohol, the higher the likelihood that brain circuitry is negatively impacted.
Regular alcohol consumption at certain levels can cause a person to become tolerant to the substance. When tolerance occurs, the person must then drink more each time in order to keep feeling alcohol’s effects the way they may want to. Increasing consumption regularly can heighten the risk factors and potential negative side effects of alcohol and also possibly lead to alcohol dependence. When the brain becomes accustomed to the changes made by alcohol, a physical dependence may form, making it difficult to stop drinking as intense, and even potentially dangerous, withdrawal symptoms may set in when alcohol wears off.
Alcohol dependence is influenced by several factors, including biology, genetics, environmental aspects, high levels of stress or trauma, and any co-occurring mental or medical issues. If someone starts drinking alcohol before their brain is fully developed, this may make it more likely that they will develop problems with alcohol or drug addiction later in life as well.
Alcohol is the most commonly abused substance by young adults and teenagers, NCADD reports. It can lead to future problems with drugs or alcohol, and also further affect judgment and impulsivity, lead to bigger risk-taking behaviors, and possibly damage the developing brain, causing memory and learning issues and difficulties regulating moods. The National Institute on Drug Abuse (NIDA) publishes the Monitoring the Future (MTF) survey, which indicates that as of 2015, over a quarter of all 8th graders had drank alcohol, close to half of all 10th graders had, and nearly 65 percent of all 12th graders had consumed alcohol at some time in their lifetime.
An alcohol use disorder is defined as the inability to control one’s use of alcohol despite attempts to do so and with full knowledge of its negative effects. According to NSDUH in 2014, approximately 17 million Americans (over age 11) battled an alcohol use disorder. Alcohol use disorders can lead to a perpetuation of alcohol abuse and therefore compound all of alcohol’s potentially negative side effects that may be physical, emotional, behavioral, social, interpersonal, financial, or legal.
NIAAA publishes that men who drink fewer than four drinks per day (or 14 drinks in a week) or women who drink fewer than three drinks a day (or seven drinks in a week) are at a low risk for developing an alcohol use disorder.
Alcohol Withdrawal and Delirium Tremens
Alcohol withdrawal affects at least half of those who battle an alcohol use disorder (AUD) and attempt to stop drinking. Symptoms may range from mild to severe, the New England Journal of Medicine (NEJM) publishes. The New York Times breaks alcohol withdrawal down into the following timeline.
- Irregular heart rate
- Nausea and/or vomiting
- Stomach pain and cramps
- High blood pressure
- Muscle weakness
- Inability to feel pleasure
- Cravings for alcohol
- Extreme confusion
This is the most severe form of alcohol withdrawal. NEJM estimates DTs occurs in about 3-5 percent of all alcohol withdrawal cases. The New York Times publishes DTs is fatal about 15 percent of the time. DTs constitutes a medical emergency, and immediate medical attention is needed.
Alcohol withdrawal is uncomfortable, unpredictable, and potentially life-threatening, as the brain struggles to restore balance after functions of the central nervous system have been used to being suppressed by alcohol. These functions, like heart rate, body temperature, respiration, and blood pressure, may become hyperactive with the removal of alcohol. In a similar fashion, the brain’s chemical messengers will also take time to return to previous levels after alcohol is removed. Low levels of dopamine can significantly impact moods for up to several weeks.
In general, the majority of alcohol withdrawal symptoms typically peak within 1-3 days, according to the National Library of Medicine (NLM). Alcohol is one of those substances that should not be stopped suddenly and without medical intervention once a dependence is present. Medical personnel should be on hand to monitor vital signs and provide medical assistance when needed. Medical detox, which uses both supportive care and pharmacological methods, is the safest option for withdrawal from alcohol.