by Julian Martin Dollente, RN, Edited by Christopher Cirino, DO MPH
Table of Contents
Alcohol: The Most Harmful Drug
People have been drinking alcohol since ancient times. It has served the people a variety of purposes throughout all history. The reason why drinkers choose alcoholic beverages as thirst quenchers may vary. For some, they play an essential role in increasing the enjoyment of life. They can also be a social lubricant that helps people be more comfortable on social occasions. However, frequent consumption of alcohol has underlying risks and side effects that can threaten our health.
Today, alcohol is one of the most significant health threats worldwide. The Independent Scientific Committee on Drugs ranked alcohol above all others as the most harmful drug (harm score of 72) compared to 19 others, including second-ranked heroin (harm score of 55) (Nutt, 2010). Many adults regularly and legally expose themselves to the health and safety risks that alcohol causes. An estimated one in five (18.4%) adults worldwide has had heavy alcohol use in the past month (2015).
This article outlines the harms of alcohol use on the body and brain. Hopefully, it will generate discussion and review of what an acceptable alcohol intake is, and how embedded it is within the culture and lifestyle of much of the global population.
What is Alcohol?
When talking about alcohol, it usually pertains to the alcohol in beer, wine, and spirits. The main ingredient for these drinks is called ethanol (ethyl alcohol), which is the substance that makes you “drunk.”
Yeast ferments (breaks down without oxygen) the sugars in grains, fruits, and vegetables and produces alcohol as a byproduct. For example, beer comes from sugars in grains, wine from sugars in grapes, and vodka from sugars in potatoes.
Globally, alcohol is one of the most popular psychoactive substances, meaning it alters mood and mental state.It can reduce people’s self-consciousness and shyness that may encourage them to act without inhibition.
The Global Ramifications of Alcohol Abuse
Global Alcohol Consumption
Our World in Data published a journal in 2018 that shows alcohol consumption from across the world. According to that journal, the average alcohol consumption of people older than 15 years is 6.5 liters per year.
To make the 6.4 liters average more understandable, we will express it in bottles of wine. Wine contains around 12% of pure alcohol per volume, so one liter of wine should have about 0.12 liters of pure alcohol. In other words, this amounts to every person 15 years and older drinking up to 53 bottles of wine annually or around 1 liter of wine per week.
This WHO chart depicts the annual individual consumption of alcohol among nations. Lithuanians come in first as the top drinkers (a yearly average of 13.22 liters or 2 liters of wine per week.) The Germans are a close second with 12.91 liters.
In Asia, South Koreans are the most prolific drinkers. Koreans, on average, drink approximately 10 liters of alcohol a year. Soju, a popular fermented rice drink, likely represents the bulk of the alcohol intake in this country.
Global Alcohol Dependence
An estimated 1.4% of the global population suffers from alcohol use disorder. The chart shows the prevalence of alcohol use disorders at a country level ranging from 0.5 to 5 percent. For example, the 4.7% prevalence rate in Russia equates to almost 1-in-20 people having alcohol dependence. Globally, around 1.7 million people have an alcohol use disorder.
Alcohol-related traffic accidents and injuries
The World Health Organization (WHO) estimated that 1.3 million people die every year due to road traffic crashes. The percentage of alcohol-related fatalities, however, varies between countries.
In the United States, 29 people die in motor vehicle crashes involving an alcohol-impaired driver every day. That is one dead American every 50 minutes. Meanwhile, in South Africa, more than half of all road traffic fatalities are attributable to alcohol consumption. In the Philippines, the author’s country, alcohol is responsible for only 1.4% of all traffic deaths, which pales compared to other western countries.
Drinking and driving are not a safe combination for many reasons. No matter how much or how little alcohol is in your bloodstream, it can negatively impact your ability to drive safely. Safe driving requires concentration, good judgment, and quick response to situations. However, driving under the influence of alcohol affects these skills, putting yourself and others in danger.
Alcohol and the Brain and Body
Many of us may favor having a glass of our favorite ‘poison,’ but this moniker bears a stark truth. We need to be mindful of the harm alcohol can do to our health. Alcohol is a drug, and like other drugs, it affects the way your brain and body works- on a cellular level. It is a substance that can be both toxic and create dependence– even in moderation.
Anyone who drinks alcohol can be affected. How much you drink, your health, age, and other factors determine how it affects you. Therefore, the effects of alcohol may vary from person to person.
Alcohol in small amounts can make you feel more relaxed or happy because alcohol is a depressant. This means it:
- Slows down the messages that travel between your brain and your body
- It affects your thoughts, mood, and behavior
Regardless of how much alcohol you can take, it will have its effects on your body, in one way or another.
Below are some of the organs that are affected by alcohol consumption:
The human gut is responsible for the digestion and absorption of nutrients and the secretion of waste. Alcohol absorption occurs in the upper intestinal tract and then enters the liver passing through the portal vein.
The bacteria in your gut help metabolize alcohol. Any changes in the number of these helpful bacteria would affect how well your body can tolerate and detoxify alcohol.
Here are some interesting facts about alcohol and the gut:
- Alcohol inhibits the body’s ability to produce digestive enzymes and juices
- The decrease in the production of these enzymes makes it difficult for the body to break down, digest, and absorb nutrients from food.
If you drink, do you notice that you might experience bloating, gas, and loose stools afterward? That is because excessive fermentation in your gut occurs from partially digested food.
- Too much alcohol can cause inflammation to your gut, resulting in the permeability of the wall in your gut lining. When this happens, larger food particles may be able to cross the gut lining and enter your bloodstream.
- Bacterial overgrowth and dysbiosis and the overall composition of the gut microbiome occur after long-term alcohol consumption.
Your liver is a powerhouse of an organ with hundreds of essential functions. Here is a YHF article on the liver. One of its roles is to neutralize toxic substances, making this the reason your liver is more vulnerable to damage by alcohol intake.
The liver’s resiliency is what makes it capable of regenerating itself. However, some of the liver cells die every time your liver filters alcohol. The ability of the liver to regenerate is significantly reduced with prolonged alcohol misuse or drinking too much. Over the years, if you continue to consume large amounts of alcohol, your liver can no longer develop new cells. Severe liver disease and permanent damage can ensue.
These liver diseases caused by alcohol misuse are collectively known as Alcohol-related liver disease (ARLD). ARLD has three main stages, although the overlap happens quite often.
Below are explanations of these stages.
Alcoholic fatty liver disease
Excessive alcohol consumption, even just for a few days, increases fat build-up inside liver cells. Fatty liver is the first stage of ARLD.
Fatty liver develops gradually and is usually without symptoms and is fortunately fully reversible. Your liver should return to normal if you stop your alcohol intake for two weeks.
However, fatty liver is a significant warning sign that you’re already drinking at a harmful level.
Alcoholic hepatitis is unrelated to infectious hepatitis. It is a potentially serious condition that results from chronic alcohol misuse.
Binge drinking or drinking large amounts of alcohol in a short period may lead to alcoholic hepatitis, although it is uncommon.
With mild alcoholic hepatitis, chances are it is still reversible with alcohol cessation. However, alcoholic hepatitis can be severe and life-threatening. What’s more troubling is that some people only find out they have liver damage when their condition is already at this stage.
In ARLD, cirrhosis is the stage where the liver has become significantly scarred. There may not be any apparent symptoms even at this stage, and it could easily be mistaken for other diseases and illnesses.
Generally, the changes of cirrhosis are permanent and irreversible. However, immediate abstinence from alcohol may prevent further damage and significantly increase your life expectancy. People with alcohol-related cirrhosis who refuse to abstain from drinking have less than a 30% chance of living for at least five more years.
Your brain is an intricate organ that must maintain a careful balance of chemicals. These chemicals are called neurotransmitters, which are vital for your brain to function correctly. Drinking large amounts of alcohol disrupts this delicate balance, disturbing the brain’s natural equilibrium.
Ethanol in alcoholic beverages can reduce the communication between brain cells, which is a short-term effect responsible for the several symptoms of being drunk.
During a heavy drinking episode, people who binge drink often experience an alcohol-induced blackout, a phenomenon characterized by amnesia or memory loss. A blackout can temporarily make you unable to form new long-term memories while relatively maintaining other skills such as talking, walking home, or even driving. It probably is not an exaggeration when people say that they are ‘too drunk to remember.’
Even though these effects are only temporary, alcohol abuse causes permanent changes in your brain that lead to impaired brain function over time. These impairments caused are collectively known as alcohol-related brain damage (ARBD).
What are the different types of ARBD?
There are different types of ARBD, depending on the symptoms. Some of them include:
- Alcohol-related dementia
- Wernicke-Korsakoff syndrome (also called amnestic syndrome)
- Traumatic brain injury
- Alcohol-related stroke
Since your brain is sensitive to damage, regularly drinking too much alcohol over the years increases your risk of dementia.
Epidemiological studies explore the association of alcohol consumption with dementia. A review indicated that in patients with dementia, there is a 9% to 22% prevalence of alcohol abuse, while alcohol abusers have a 10% to 24% prevalence of having dementia.
Conversely, drinking in moderation may reduce the risk of dementia — particularly among older adults. In worse-case scenarios, severe ARBD may impair your ability to lead an independent life.
The Bone Marrow
Alcohol has potential risks that can damage the gut, liver, and brain, but did you know that alcohol can also affect your body right down to the blood cell? Indeed, there is no doubt that alcohol abuse takes a toll on your entire body.
The dysfunction occurs to all cell lines:
White Blood Cells
Essential for your body’s resistance to infection. Healthy white blood cells are crucial in strengthening your immune system.
Red Blood Cells
Vital for energy and transporting of oxygen throughout your body. These cells play an essential role in keeping your other organs healthy and functional.
Your bone marrow is responsible for producing white blood cells, red blood cells, and platelets. Now, imagine how damaged bone marrow can set off a cascade of immune responses to the other organs of your body. Your organs would not be able to survive without oxygen. When you have a weak immune system, you are more susceptible to diseases and illnesses.
Frequent and excessive alcohol intake can cause bone marrow suppression and contribute to low red cell count, white cell count, and low platelets. Alcohol abuse is associated with the death of your body’s blood cells responsible for keeping you healthy.
Fortunately, bone marrow suppression is reversible and usually occurs only in people with severe alcoholism.
Neuroscience of Alcohol Addiction
Alcohol’s Effect on the Brain
Why does drinking alcohol have such profound effects on the brain, especially mood, thoughts, and behavior? And why does alcohol dependence develop and persist in some people and not in others?
In an attempt to address these questions, scientists turn to neuroscience or the study of the brain, where both alcohol intoxication and dependence begin. A better understanding of how alcohol changes the brain and how those changes can influence certain behaviors may be possible with thorough research.
As the brain adapts to the prolonged presence of alcohol, a chronic heavy drinker may begin to respond to alcohol differently than someone who drinks occasionally.
Alcoholism or alcohol dependence occurs when you become addicted to the effects that alcohol does on your body.
The development of alcoholism or alcohol dependence has the following characteristics:
- Frequent episodes of intoxication
- Preoccupation with alcohol
- Use of alcohol despite adverse consequences
- A compulsion to seek and consume alcohol
- Loss of control in limiting alcohol intake
- The emergence of a negative emotional state in the absence of alcohol
The ‘double effect’ associated with alcohol dependence
Alcohol changes the brain in many ways and its effects vary depending on several factors. However, the two tangible pieces of evidence of alcohol’s influence on the brain are:
As the brain’s exposure to alcohol increases, it may become tolerant or insensitive to the effects of alcohol. Thus, if you continue to drink heavily, you may develop alcohol tolerance or simply need to drink more than usual to become intoxicated.
A collection of symptoms occurs when an alcohol-dependent person suddenly stops drinking or significantly reduces their alcohol intake. The symptoms of withdrawal can be severe, especially during the first 48 hours of abstinence.
Typical symptoms include:
- Profuse sweating
- Increase heart rate
- Feelings of restlessness
With all of this evidence that suggests how harmful alcohol can be, getting your intake under control, or better yet, abstaining completely, should be your priority.
How Much Is Too Much?
So really, how much is too much? Is there even a safe alcohol level at all?
Alcohol recommendations come from the number of standard drinks per day. The problem, however, is that many of us have no idea what qualifies as a ‘standard drink.’ Additionally, every country has its official definition of a standard drink.
In the United States, one standard drink is any drink that contains 14 grams of pure ethanol.
If you ask the Centers for Disease Control and Prevention (CDC), they would recommend that adults of legal drinking age should avoid drinking entirely. However, if you were to drink, you should drink in moderation by having a daily limit of 2 drinks or less for men and one drink or less for women.
A recent study by a group of scientists at Oxford University in England shifts away from this perspective.
According to the study, there’s no dose of alcohol that is safe for the brain. Even moderate drinking is associated with more adverse effects than previously recognized. The study’s authors stated that the impact of alcohol on the brain calls to question the current guidelines for what is ‘low risk’ drinking.
Closing: Rethinking Alcohol
Alcohol’s adverse effects greatly outweigh the benefits. Recent studies even refute those potential benefits. Therefore, we must ask ourselves what place does alcohol have in our lives. If you think you may have alcohol dependence, the first step is to acknowledge it and seek professional advice.
If you enjoy the infrequent drink, while not binge-drinking, this may not be an immediate health concern for you. However, if you want to avoid potential harm and permanent damage to the brain and body, be mindful of the amount of alcohol you drink. More significant stress sometimes signals the brain to increase the dose. Even light drinking presents the possibility of escalating and using it cope.
If you are one of those people who does not drink, there’s no reason for you to start now. You can still have fun at social gatherings without being intoxicated by alcohol. You can still find the courage and overcome your shyness without being drunk.
What is important is that you keep a healthy lifestyle to live long enough and enjoy life to the fullest.
Linked in the article
Nutt D, et al. Drug harms in the UK: a multicriteria decision analysis. The Lancet. 2010. Vol 376(9752):1558-1565.