Health risks of alcohol use | Substance Abuse Problems

Table of Contents

1. Also called: Drinking
2. Frequently Asked Questions
3. Alcohol Facts
4. Nutrition and healthy eating
5. Understanding alcohol’s impact on your health
6. Overview of Alcohol Consumption
7. What Is A Standard Drink?
8. Discussing Drinking. A Back-to-School Conversation You Need to Have
9. Health risks of alcohol use
10. Alcohol use and safe drinking
11. Responsible drinking
12. Do you have a drinking problem?
13. Harmful Interactions
14. Wine and heart health
15. Alcohol and Cancer Risk
16. Talking to your teen about drinking
17. Women and Drinking

01.- Also called: Drinking

If you are like many Americans, you drink alcohol at least occasionally. For many people, moderate drinking is probably safe. It may even have health benefits, including reducing your risk of certain heart problems. For most women and for most people over 65, moderate drinking is no more than three drinks a day or seven drinks per week. For men under 65, it is no more than four drinks a day or 14 drinks per week.
Some people should not drink at all, including alcoholics, children, pregnant women, people taking certain medicines, and people with certain medical conditions. If you have questions about whether it is safe for you to drink, speak with your health care provider.
Anything more than moderate drinking can be risky. Heavy drinking can lead to alcoholism and alcohol abuse, as well as injuries, liver disease, heart disease, cancer, and other health problems. It can also cause problems at home, at work, and with friends.
NIH: National Institute on Alcohol Abuse and Alcoholism

02.- Frequently Asked Questions

Introduction to alcohol
• What is alcohol?
• How does alcohol affect a person?
• Why do some people react differently to alcohol than others?
• What is a standard drink in the United States?
• Is beer or wine safer to drink than hard liquor?
Drinking levels
• What does moderate drinking mean?
• Is it safe to drink alcohol and drive?
• What does it mean to be above the legal limit for drinking?
• How do I know if it’s okay to drink?
Excessive alcohol use
• What is excessive alcohol use?
• What is binge drinking?
• What do you mean by heavy drinking?
• What is the difference between alcoholism and alcohol abuse?
• What does it mean to get drunk?
Drinking problems
• How do I know if I have a drinking problem?
• What can I do if I or someone I know has a drinking problem?
• What health problems are associated with excessive alcohol use?
Special populations
• I’m young, is drinking bad for my health?
• Is it okay to drink when pregnant?
What is alcohol?
Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. Alcohol is produced by the fermentation of yeast, sugars, and starches.
How does alcohol affect a person?
Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes; however, the liver can only metabolize a small amount of alcohol at a time, leaving the excess alcohol to circulate throughout the body. The intensity of the effect of alcohol on the body is directly related to the amount consumed.
Why do some people react differently to alcohol than others?
Individual reactions to alcohol vary, and are influenced by many factors; such as:
• Age.
• Gender.
• Race or ethnicity.
• Physical condition (weight, fitness level, etc).
• Amount of food consumed before drinking.
• How quickly the alcohol was consumed.
• Use of drugs or prescription medicines.
• Family history of alcohol problems.
What is a standard drink in the United States?
A standard drink is equal to 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in
• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5-ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).
Is beer or wine safer to drink than liquor?
No. One 12-ounce beer has about the same amount of alcohol as one 5-ounce glass of wine, or 1.5-ounce shot of liquor. It is the amount of alcohol consumed that affects a person most, not the type of alcoholic drink.
What does moderate drinking mean?
According to the Dietary Guidelines for Americans,1 moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 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. The Dietary Guidelines also state that it is not recommended that anyone begin drinking or drink more frequently on the basis of potential health benefits because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes.
Is it safe to drink alcohol and drive?
No. Alcohol use slows reaction time and impairs judgment and coordination, which are all skills needed to drive a car safely.2 The more alcohol consumed, the greater the impairment.
What does it mean to be above the legal limit for drinking?
The legal limit for drinking is the alcohol level above which an individual is subject to legal penalties (e.g., arrest or loss of a driver's license).

• Legal limits are measured using either a blood alcohol test or a breathalyzer.
• Legal limits are typically defined by state law, and may vary based on individual characteristics, such as age and occupation.
All states in the United States have adopted 0.08% (80 mg/dL) as the legal limit for operating a motor vehicle for drivers aged 21 years or older. However, drivers younger than 21 are not allowed to operate a motor vehicle with any level of alcohol in their system.
Note: Legal limits do not define a level below which it is safe to operate a vehicle or engage in some other activity. Impairment due to alcohol use begins to occur at levels well below the legal limit.
How do I know if it’s okay to drink?
The current Dietary Guidelines for Americans1 recommend that if you choose to drink alcoholic beverages, do not exceed 1 drink per day for women or 2 drinks per day for men. According to the guidelines, people who should not drink alcoholic beverages at all include the following:
• Children and adolescents.
• Individuals of any age who cannot limit their drinking to low level.
• Women who may become pregnant or who are pregnant.
• Individuals who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination.
• Individuals taking prescription or over-the-counter medications that can interact with alcohol.
• Individuals with certain medical conditions.
• Persons recovering from alcoholism.
According to the Dietary Guidelines for Americans, it is not recommended that anyone begin drinking or drink more frequently on the basis of potential health benefits because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes.
What is excessive alcohol use?
Excessive alcohol use includes binge drinking, heavy drinking, any alcohol use by people under the age 21 minimum legal drinking age, and any alcohol use by pregnant women.
What is binge drinking?
According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or more. This pattern of drinking usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.3
What do you mean by heavy drinking?
For men, heavy drinking is typically defined as consuming 15 drinks or more per week. For women, heavy drinking is typically defined as consuming 8 drinks or more per week.
What is the difference between alcoholism and alcohol abuse?
Alcohol abuse4 is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. Manifestations of alcohol abuse include the following:
• Failure to fulfill major responsibilities at work, school, or home.
• Drinking in dangerous situations, such as drinking while driving or operating machinery.
• Legal problems related to alcohol, such as being arrested for drinking while driving or for physically hurting someone while drunk.
• Continued drinking despite ongoing relationship problems that are caused or worsened by drinking.
• Long-term alcohol abuse can turn into alcohol dependence.
Dependency on alcohol, also known as alcohol addiction and alcoholism4, is a chronic disease. The signs and symptoms of alcohol dependence include—
• A strong craving for alcohol.
• Continued use despite repeated physical, psychological, or interpersonal problems.
• The inability to limit drinking.
What does it mean to get drunk?
“Getting drunk” or intoxicated is the result of consuming excessive amounts of alcohol. Binge drinking typically results in acute intoxication.
Alcohol intoxication can be harmful for a variety of reasons, including—
• Impaired brain function resulting in poor judgment, reduced reaction time, loss of balance and motor skills, or slurred speech.
• Dilation of blood vessels causing a feeling of warmth but resulting in rapid loss of body heat.
• Increased risk of certain cancers, stroke, and liver diseases (e.g., cirrhosis), particularly when excessive amounts of alcohol are consumed over extended periods of time.
• Damage to a developing fetus if consumed by pregnant women.5
• Increased risk of motor-vehicle traffic crashes, violence, and other injuries.
Coma and death can occur if alcohol is consumed rapidly and in large amounts.
How do I know if I have a drinking problem?
Drinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a drinking problem, consult your personal health care provider.
What can I do if I or someone I know has a drinking problem?
Consult your personal health care provider if you feel you or someone you know has a drinking problem. Other resources include the National Drug and Alcohol Treatment Referral Routing Service available at 1-800-662-HELP. This service can provide you with information about treatment programs in your local community and allow you to speak with someone about alcohol problems.6
What health problems are associated with excessive alcohol use?
Excessive drinking both in the form of heavy drinking or binge drinking, is associated with numerous health problems, including—
• Chronic diseases such as liver cirrhosis (damage to liver cells); pancreatitis (inflammation of the pancreas); various cancers, including liver, mouth, throat, larynx (the voice box), and esophagus; high blood pressure; and psychological disorders.
• Unintentional injuries, such as motor-vehicle traffic crashes, falls, drowning, burns and firearm injuries.
• Violence, such as child maltreatment, homicide, and suicide.
• Harm to a developing fetus if a woman drinks while pregnant, such as fetal alcohol spectrum disorders.
• Sudden infant death syndrome (SIDS).
• Alcohol abuse or dependence.
I’m young. Is drinking bad for my health?
Yes.7, 8 Studies have shown that alcohol use by youth and young adults increases the risk of both fatal and nonfatal injuries.9, 10, 11 Research has also shown that youth who use alcohol before age 15 are five times more likely to become alcohol dependent than adults who begin drinking at age 21.12 Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.13, 14, 15
Is it okay to drink when pregnant?
No. There is no safe level of alcohol use during pregnancy. Women who are pregnant or plan on becoming pregnant should refrain from drinking alcohol.16 Several conditions, including Fetal Alcohol Spectrum Disorders have been linked to alcohol use during pregnancy. Women of child bearing age should also avoid Binge drinking to reduce the risk of unintended pregnancy and potential exposure of a developing fetus to alcohol.
References
1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010.[PDF-2.89 MB]. 7th Edition, Washington, DC: US Government Printing Office; 2010.
2. National Highway Traffic Safety Administration. Available at http://www.nhtsa.dot.gov/.
3. National Institute of Alcohol Abuse and Alcoholism. NIAAA council approves definition of binge drinking [PDF-1.6MB]. NIAAA Newsletter 2004;3:3.
4. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), published by the American Psychiatric Association, Washington D.C., 1994.
5. Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorders. Available at http://www.cdc.gov/ncbddd/fas/default.htm.
6. Substance Abuse and Mental Health Services Administration. Substance Abuse Treatment Facility Locator. Available at http://www.samhsa.gov/treatment/treatment_public_i.aspx.
7. Bonnie RJ and O’Connell ME, editors. National Research Council and Institute of Medicine. Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press; 2004.
8. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. Rockville, MD: U.S. Department of Health and Human Services: 2007.
9. Hingson RW, Heeren T, Jamanka A, Howland J. Age of onset and unintentional injury involvement after drinking. JAMA 2000;284(12):1527–1533.
10. Hingson RW, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001. Annu Rev Public Health 2005;26:259–79.
11. Levy DT, Mallonee S, Miller TR, Smith GS, Spicer RS, Romano EO, Fisher DA. Alcohol involvement in burn, submersion, spinal cord, and brain injuries. Medical Science Monitor 2004;10(1):CR17–24.
12. Office of Applied Studies. The NSDUH Report: Alcohol Dependence or Abuse and Age at First Use. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2004.
13. Substance Abuse and Mental Health Services Administration. A Comprehensive Plan for Preventing and Reducing Underage Drinking [PDF-513KB]. Washington, DC; 2006.
14. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC.
15. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85.
16. Department of Health and Human Services. U.S. Surgeon General Releases Advisory on Alcohol Use in Pregnancy; urges women who are pregnant or who may become pregnant to abstain from alcohol. Washington, DC; 2005.

03.- Alcohol Facts

Drinks like beer, malt liquor, wine, and hard liquor contain alcohol. Alcohol is the ingredient that gets you drunk.
Hard liquor—such as whiskey, rum, or gin—has more alcohol in it than beer, malt liquor, or wine.
These drink sizes have about the same amount of alcohol in them:
• 1 ½ ounces of hard liquor
• 5 ounces of wine
• 8 ounces of malt liquor
• 12 ounces of beer
Being drunk can make a person feel very silly, angry, or sad for no reason. It can make it hard to walk in a straight line, talk clearly, or drive.
Some slang names for alcohol are:
• Booze
• Juice
• Hooch
• Sauce
• Rotgut

04.- Nutrition and healthy eating

Alcohol use can be a slippery slope. Moderate drinking can offer some health benefits. But heavy drinking can have serious consequences.
By Mayo Clinic Staff
It sounds like a mixed message: Drinking alcohol may offer some health benefits, especially for your heart. On the other hand, alcohol may increase your risk of health problems and damage your heart.
So which is it? When it comes to drinking alcohol, the key is doing so only in moderation. Certainly, you don't have to drink any alcohol, and if you currently don't drink, don't start drinking for the possible health benefits. In some cases, it's safest to avoid alcohol entirely — the possible benefits don't outweigh the risks.
Here's a closer look at the connection between alcohol and your health.
Moderate alcohol consumption may provide some health benefits. It may:
• Reduce your risk of developing and dying from heart disease
• Possibly reduce your risk of ischemic stroke (when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow)
• Possibly reduce your risk of diabetes
Even so, the evidence about the possible health benefits of alcohol isn't certain, and alcohol may not benefit everyone who drinks.
If you choose to drink alcohol, do so only in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
Examples of one drink include:
• Beer: 12 fluid ounces (355 milliliters)
• Wine: 5 fluid ounces (148 milliliters)
• Distilled spirits (80 proof): 1.5 fluid ounces (44 milliliters)
Moderate alcohol use may be of most benefit if you're an older adult or if you have existing risk factors for heart disease. If you're a middle-aged or younger adult, some evidence shows that even moderate alcohol use may cause more harm than good. You can take other steps to benefit your cardiovascular health besides drinking — eating a healthy diet and exercising, for example.
In certain situations, the risks of alcohol use may outweigh the possible health benefits. For example, use alcohol only with great care and after consulting your doctor if:
• You're pregnant or trying to become pregnant
• You've been diagnosed with alcoholism or alcohol abuse, or you have a strong family history of alcoholism
• You have liver or pancreatic disease
• You have heart failure or you've been told you have a weak heart
• You take prescription or over-the-counter medications that can interact with alcohol
• You've had a hemorrhagic stroke (when a blood vessel in your brain leaks or ruptures)
Keep in mind that even moderate use isn't risk-free. For example, drinking and driving is never a good idea.
Heavy drinking is defined as more than three drinks on any day or more than seven drinks a week for women and for men older than age 65, and more than four drinks on any day or more than 14 drinks a week for men age 65 and younger. Binge drinking is defined as four or more drinks within two hours for women and five or more drinks within two hours for men.
While moderate alcohol use may offer some health benefits, heavy drinking — including binge drinking — has no health benefits. Excessive drinking can increase your risk of serious health problems, including:
• Certain cancers, including breast cancer and cancers of the mouth, pharynx, larynx and esophagus
• Pancreatitis
• Sudden death if you already have cardiovascular disease
• Heart muscle damage (alcoholic cardiomyopathy) leading to heart failure
• Stroke
• High blood pressure
• Liver disease
• Suicide
• Accidental serious injury or death
• Brain damage and other problems in an unborn child
• Alcohol withdrawal syndrome
The latest dietary guidelines make it clear that no one should begin drinking or drink more frequently on the basis of potential health benefits. So don't feel pressured to drink alcohol. But if you do drink alcohol and you're healthy, there's probably no need to stop as long as you drink responsibly and in moderation.

References

1. Rethinking drinking. National Institute on Alcohol Abuse and Alcoholism. http://rethinkingdrinking.niaaa.nih.gov/default.asp. Accessed Sept. 10, 2013.
2. Mukamal KJ. Overview of the risks and benefits of alcohol consumption. http://www.uptodate.com/home. Accessed Sept. 10, 2013.
3. Tangney CC, et al. Cardiovascular benefits and risks of moderate alcohol consumption. http://www.uptodate.com/home. Accessed Sept. 10, 2013.
4. Mukamal KJ, et al. A 42-year-old man considering whether to drink alcohol for his health. JAMA. 2010;303:2065.
5. Robert Post (expert opinion). U.S. Department of Agriculture, Alexandria, Va. Aug. 8, 2011.
6. Kloner RA, et al. To drink or not to drink? That is the question. Circulation. 2007;116:1306.
7. O'Keefe JA, et al. Alcohol and cardiovascular health. Journal of the American College of Cardiology. 2007;50:1009.
8. Dietary Guidelines for Americans, 2010. U.S. Department of Health and Human Services. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm. Accessed Sept. 10, 2013.
9. Drinking and driving: A threat to everyone. Centers for Disease Control and Prevention. http://www.cdc.gov/Features/VitalSigns/DrinkingAndDriving/index.html. Accessed Sept. 10, 2013.
10. Hoffman HS, et al. Management of moderate and severe alcohol withdrawal syndromes. http://www.uptodate.com/home. Accessed Sept. 13, 2013.

05.- Understanding alcohol’s impact on your health

Beyond Hangovers

A brightly colored cosmopolitan is the drink of choice for the glamorous characters in Sex and the City. James Bond depends on his famous martini—shaken, not stirred—to unwind with after confounding a villain. And what wedding concludes without a champagne toast?
Alcohol is part of our culture—it helps us celebrate and socialize, and it enhances our religious ceremonies. But drinking too much—on a single occasion or over time—can have serious consequences for our health. Most Americans recognize that drinking too much can lead to accidents and dependence. But that’s only part of the story. In addition to these serious problems, alcohol abuse can damage organs, weaken the immune system, and contribute to cancers. Plus, much like smoking, alcohol affects different people differently. Genes, environment, and even diet can play a role in whether you develop an alcohol-related disease. On the flip side, some people actually may benefit from drinking alcohol in small quantities. Sound complicated? It sure can be. To stay healthy, and to decide what role alcohol should play in your life, you need accurate, up-to-date information. This brochure is designed to offer you guidance based on the latest research on alcohol’s effect on your health.

A LITTLE GOES A LONG WAY: KNOW THE AMOUNTS

Knowing how much alcohol constitutes a “standard” drink can help you determine how much you are drinking and understand the risks. One standard drink contains about 0.6 fluid ounces or 14 grams of pure alcohol. In more familiar terms, the following amounts constitute one standard drink:
• 12 fluid ounces of beer (about 5% alcohol)
• 8 to 9 fluid ounces of malt liquor (about 7% alcohol)
• 5 fluid ounces of table wine (about 12% alcohol)
• 1.5 fluid ounces of 80-proof distilled spirits (40% alcohol)
Research demonstrates “low-risk” drinking levels for men are no more than 4 drinks on any single day AND no more than 14 drinks per week. For women, “low-risk” drinking levels are no more than three drinks on any single day AND no more than seven drinks per week. To stay low-risk, you must keep within both the single-day and weekly limits.
Even within these limits, you can have problems if you drink too quickly, have health conditions, or are over age 65. Older adults should have no more than three drinks on any day and no more than seven drinks per week.
Based on your health and how alcohol affects you, you may need to drink less or not at all. People who should abstain from alcohol completely include those who:
• Plan to drive a vehicle or operate machinery
• Are pregnant or trying to become pregnant
• Take medications that interact with alcohol
• Have a medical condition that alcohol can aggravate

Effects on the brain

You’re chatting with friends at a party and a waitress comes around with glasses of champagne. You drink one, then another, maybe even a few more. Before you realize it, you are laughing more loudly than usual and swaying as you walk. By the end of the evening, you are too slow to move out of the way of a waiter with a dessert tray and have trouble speaking clearly. The next morning, you wake up feeling dizzy and your head hurts. You may have a hard time remembering everything you did the night before.
These reactions illustrate how quickly and dramatically alcohol affects the brain. The brain is an intricate maze of connections that keeps our physical and psychological processes running smoothly. Disruption of any of these connections can affect how the brain works. Alcohol also can have longer-lasting consequences for the brain—changing the way it looks and works and resulting in a range of problems.
Most people do not realize how extensively alcohol can affect the brain. But recognizing these potential consequences will help you make better decisions about what amount of alcohol is appropriate for you.

WHAT HAPPENS INSIDE THE BRAIN?

The brain’s structure is complex. It includes multiple systems that interact to support all of your body’s functions—from thinking to breathing and moving.
These multiple brain systems communicate with each other through about a trillion tiny nerve cells called neurons. Neurons in the brain translate information into electrical and chemical signals the brain can understand. They also send messages from the brain to the rest of the body.
Chemicals called neurotransmitters carry messages between the neurons. Neurotransmitters can be very powerful. Depending on the type and the amount of neurotransmitter, these chemicals can either intensify or minimize your body’s responses, your feelings, and your mood. The brain works to balance the neurotransmitters that speed things up with the ones that slow things down to keep your body operating at the right pace.
Alcohol can slow the pace of communication between neurotransmitters in the brain.

DISCOVERING THE BRAIN CHANGES

There still is much we do not understand about how the brain works and how alcohol affects it. Researchers are constantly discovering more about how alcohol interrupts communication pathways in the brain and changes brain structure, and the resulting effects on behavior and functioning. A variety of research methods broaden our understanding in different ways:
• BRAIN IMAGING – Various imaging tools, including structural magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and positron emission tomography (PET), are used to create pictures of the brain. MRI and DTI create images of brain structure, or what the brain looks like. fMRI looks at brain function, or what the brain is doing. It can detect changes in brain activity. PET scans look at changes in neurotransmitter function. All of these imaging techniques are useful to track changes in the alcoholic brain. For example, they can show how an alcoholic brain changes immediately after drinking stops, and again after a long period of sobriety, to check for possible relapses.
• PSYCHOLOGICAL TESTS – Researchers also use psychological tests to evaluate how alcohol-related brain changes affect mental functioning. These tests demonstrate how alcohol affects emotions and personality, as well as how it compromises learning and memory skills.
• ANIMAL STUDIES – Testing the effect of alcohol on animals’ brains helps researchers better understand how alcohol injures the human brain, and how abstinence can reverse this damage.

DEFINING THE BRAIN CHANGES

Using brain imaging and psychological tests, researchers have identified the regions of the brain most vulnerable to alcohol’s effects. These include:
• CEREBELLUM – This area controls motor coordination. Damage to the cerebellum results in a loss of balance and stumbling, and also may affect cognitive functions such as memory and emotional response.
• LIMBIC SYSTEM – This complex brain system monitors a variety of tasks including memory and emotion. Damage to this area impairs each of these functions.
• CEREBRAL CORTEX – Our abilities to think, plan, behave intelligently, and interact socially stem from this brain region. In addition, this area connects the brain to the rest of the nervous system. Changes and damage to this area impair the ability to solve problems, remember, and learn.

ALCOHOL SHRINKS AND DISTURBS BRAIN TISSUE

Heavy alcohol consumption—even on a single occasion—can throw the delicate balance of neurotransmitters off course. Alcohol can cause your neurotransmitters to relay information too slowly, so you feel extremely drowsy. Alcohol-related disruptions to the neurotransmitter balance also can trigger mood and behavioral changes, including depression, agitation, memory loss, and even seizures.
Long-term, heavy drinking causes alterations in the neurons, such as reductions in the size of brain cells. As a result of these and other changes, brain mass shrinks and the brain’s inner cavity grows bigger. These changes may affect a wide range of abilities, including motor coordination; temperature regulation; sleep; mood; and various cognitive functions, including learning and memory.
One neurotransmitter particularly susceptible to even small amounts of alcohol is called glutamate. Among other things, glutamate affects memory. Researchers believe that alcohol interferes with glutamate action, and this may be what causes some people to temporarily “black out,” or forget much of what happened during a night of heavy drinking.
Alcohol also causes an increased release of serotonin, another neurotransmitter, which helps regulate emotional expression, and endorphins, which are natural substances that may spark feelings of relaxation and euphoria as intoxication sets in. Researchers now understand that the brain tries to compensate for these disruptions. Neurotransmitters adapt to create balance in the brain despite the presence of alcohol. But making these adaptations can have negative results, including building alcohol tolerance, developing alcohol dependence, and experiencing alcohol withdrawal symptoms.

WHAT FACTORS MAKE A DIFFERENCE?

Different people react differently to alcohol. That is because a variety of factors can influence your brain’s response to alcohol. These factors include:
• HOW MUCH AND HOW OFTEN YOU DRINK – The more you drink, the more vulnerable your brain is.
• YOUR GENETIC BACKGROUND AND FAMILY HISTORY OF ALCOHOLISM – Certain ethnic populations can have stronger reactions to alcohol, and children of alcoholics are more likely to become alcoholics themselves.
• YOUR PHYSICAL HEALTH – If you have liver or nutrition problems, the effects of alcohol will take longer to wear off.

ARE BRAIN PROBLEMS REVERSIBLE?

Abstaining from alcohol over several months to a year may allow structural brain changes to partially correct. Abstinence also can help reverse negative effects on thinking skills, including problem-solving, memory, and attention.

OTHER ALCOHOL-RELATED BRAIN CONDITIONS

LIVER DAMAGE THAT AFFECTS THE BRAIN
Not only does alcoholic liver disease affect liver function itself, it also damages the brain. The liver breaks down alcohol—and the toxins it releases. During this process, alcohol’s byproducts damage liver cells. These damaged liver cells no longer function as well as they should and allow too much of these toxic substances, ammonia and manganese in particular, to travel to the brain.These substances proceed to damage brain cells, causing a serious and potentially fatal brain disorder known as hepatic encephalopathy.
Hepatic encephalopathy causes a range of problems, from less severe to fatal.These problems can include:
• Sleep disturbances
• Mood and personality changes
• Anxiety
• Depression
• Shortened attention span
• Coordination problems, including asterixis, which results in hand shaking or flapping
• Coma
• Death
Doctors can help treat hepatic encephalopathy with compounds that lower blood ammonia concentrations and with devices that help remove harmful toxins from the blood. In some cases, people suffering from hepatic encephalopathy require a liver transplant, which generally helps improve brain function.
FETAL ALCOHOL SPECTRUM DISORDERS
Alcohol can affect the brain at any stage of development—even before birth. Fetal alcohol spectrum disorders are the full range of physical, learning, and behavioral problems, and other birth defects that result from prenatal alcohol exposure. The most serious of these disorders, fetal alcohol syndrome (FAS), is characterized by abnormal facial features and is usually associated with severe reductions in brain function and overall growth. FAS is the leading preventable birth defect associated with mental and behavioral impairment in the United States today. The brains of children with FAS are smaller than normal and contain fewer cells, including neurons. These deficiencies result in life-long learning and behavioral problems. Current research is investigating whether the brain function of children and adults with FAS can be improved with complex rehabilitative training, dietary supplements, or medications.

Effects on the heart

Americans know how prevalent heart disease is—about 1 in 12 of us suffer from it. What we don’t always recognize are the connections heart disease shares with alcohol. On the one hand, researchers have known for centuries that excessive alcohol consumption can damage the heart. Drinking a lot over a long period of time or drinking too much on a single occasion can put your heart—and your life—at risk. On the other hand, researchers now understand that drinking moderate amounts of alcohol can protect the hearts of some people from the risks of coronary artery disease.
Deciding how much, if any, alcohol is right for you can be complicated. To make the best decision for yourself, you need to know the facts and then consult your physician.

KNOW THE FUNCTION:

Your cardiovascular system consists of your heart, blood vessels, and blood. This system works constantly—every second of your life—delivering oxygen and nutrients to your cells, and carrying away carbon dioxide and other unnecessary material.
Your heart drives this process. It is a muscle that contracts and relaxes over and over again, moving the blood along the necessary path. Your heart beats about 100,000 times each day, pumping the equivalent of 2,000 gallons of blood throughout your body.
The two sides, or chambers, of the heart receive blood and pump it back into the body. The right ventricle of the heart pumps blood into the lungs to exchange carbon dioxide from the cells for oxygen. The heart relaxes to allow this blood back into its left chamber. It then pumps the oxygen-rich blood to tissues and organs. Blood passing through the kidneys allows the body to get rid of waste products. Electrical signals keep the heart pumping continuously and at the appropriate rate to propel this routine.

KNOW THE RISKS:

ALCOHOLIC CARDIOMYOPATHY
Long-term heavy drinking weakens the heart muscle, causing a condition called alcoholic cardiomyopathy. A weakened heart droops and stretches and cannot contract effectively. As a result, it cannot pump enough blood to sufficiently nourish the organs. In some cases, this blood flow shortage causes severe damage to organs and tissues. Symptoms of cardiomyopathy include shortness of breath and other breathing difficulties, fatigue, swollen legs and feet, and irregular heartbeat. It can even lead to heart failure.
ARRHYTHMIAS
Both binge drinking and long-term drinking can affect how quickly a heart beats.The heart depends on an internal pacemaker system to keep it pumping consistently and at the right speed. Alcohol disturbs this pacemaker system and causes the heart to beat too rapidly, or irregularly. These heart rate abnormalities are called arrhythmias. Two types of alcohol induced arrhythmias are:
• ATRIAL FIBRILLATION – In this form of arrhythmia, the heart’s upper, or atrial, chambers shudder weakly but do not contract. Blood can collect and even clot in these upper chambers. If a blood clot travels from the heart to the brain, a stroke can occur; if it travels to other organs such as the lungs, an embolism, or blood vessel blockage, occurs.
• VENTRICULAR TACHYCARDIA – This form of arrhythmia occurs in the heart’s lower, or ventricular, chambers. Electrical signals travel throughout the heart’s muscles, triggering contractions that keep blood flowing at the right pace. Alcohol-induced damage to heart muscle cells can cause these electrical impulses to circle through the ventricle too many times, causing too many contractions. The heart beats too quickly, and so does not fill up with enough blood between each beat. As a result, the rest of the body does not get enough blood. Ventricular tachycardia causes dizziness, lightheadedness, unconsciousness, cardiac arrest, and even sudden death. Drinking to excess on a particular occasion, especially when you generally don’t drink, can trigger either of these irregularities. In these cases, the problem is nicknamed “holiday heart syndrome,” because people who don’t usually drink may consume too much alcohol at parties during the holiday season. Over the long-term, chronic drinking changes the course of electrical impulses that drive the heart’s beating, which creates arrhythmia.
STROKES
A stroke occurs when blood cannot reach the brain. In about 80 percent of strokes, a blood clot prevents blood flow to the brain. These are called ischemic strokes. Sometimes, blood accumulates in the brain, or in the spaces surrounding it. This causes hemorrhagic strokes.
Both binge drinking and long-term heavy drinking can lead to strokes even in people without coronary heart disease. Recent studies show that people who binge drink are about 56 percent more likely than people who never binge drink to suffer an ischemic stroke over 10 years. Binge drinkers also are about 39 percent more likely to suffer any type of stroke than people who never binge drink.
In addition, alcohol exacerbates the problems that often lead to strokes, including hypertension, arrhythmias, and cardiomyopathy.
HYPERTENSION
Chronic alcohol use, as well as binge drinking, can cause high blood pressure, or hypertension. Your blood pressure is a measurement of the pressure your heart creates as it beats, and the pressure inside your veins and arteries. Healthy blood vessels stretch like elastic as the heart pumps blood through them. Hypertension develops when the blood vessels stiffen, making them less flexible. Heavy alcohol consumption triggers the release of certain stress hormones that in turn constrict blood vessels.This elevates blood pressure. In addition, alcohol may affect the function of the muscles within the blood vessels, causing them to constrict and elevate blood pressure.
KNOW THE BENEFITS:
Research shows that healthy people who drink moderate amounts of alcohol may have a lower risk of developing coronary heart disease than nondrinkers. Moderate drinking is usually defined as no more than two drinks in a given day for men and one drink per day for women who are not pregnant or trying to conceive.
A variety of factors, including diet, genetics, high blood pressure, and age, can cause fat to build up in your arteries, resulting in coronary heart disease. An excess of fat narrows the coronary arteries, which are the blood vessels that supply blood directly to the heart. Clogged arteries reduce blood supply to the heart muscle, and make it easier for blood clots to form. Blood clots can lead to both heart attacks and strokes.
According to recent studies, drinking moderately can protect your heart from these conditions. Moderate drinking helps inhibit and reduce the build-up of fat in the arteries. It can raise the levels of HDL—or “good” cholesterol—in the blood, which wards off heart disease. It can help guard against heart attack and stroke by preventing blood clots from forming and by dissolving blood clots that do develop. Drinking moderately also may help keep blood pressure levels in check.
These benefits may not apply to people with existing medical conditions, or who regularly take certain medications. In addition, researchers discourage people from beginning to drink just for the health benefits. Rather, you can use this research to help you spark a conversation with your medical professional about the best path for you.

Effects on the liver

KNOW THE FACTS:

Liver disease is one of the leading causes of illness and death in the United States. More than 2 million Americans suffer from liver disease caused by alcohol.
In general, liver disease strikes people who drink heavily over many years.
While many of us recognize that excessive alcohol consumption can lead to liver disease, we might not know why. Understanding the connections between alcohol and the liver can help you make smarter decisions about drinking and take better control of your health.

KNOW THE FUNCTION:

Your liver works hard to keep your body productive and healthy. It stores energy and nutrients. It generates proteins and enzymes your body uses to function and ward off disease. It also rids your body of substances that can be dangerous—including alcohol.
The liver breaks down most of the alcohol a person consumes. But the process of breaking alcohol down generates toxins even more harmful than alcohol itself. These by-products damage liver cells, promote inflammation, and weaken the body’s natural defenses. Eventually, these problems can disrupt the body’s metabolism and impair the function of other organs.
Because the liver plays such a vital role in alcohol detoxification, it is especially vulnerable to damage from excessive alcohol.

KNOW THE CONSEQUENCES:

Heavy drinking—even for just a few days at a time—can cause fat to build up in the liver. This condition, called steatosis, or fatty liver, is the earliest stage of alcoholic liver disease and the most common alcohol-induced liver disorder. The excessive fat makes it more difficult for the liver to operate and leaves it open to developing dangerous inflammations, like alcoholic hepatitis.
For some, alcoholic hepatitis does not present obvious symptoms. For others, though, alcoholic hepatitis can cause fever, nausea, appetite loss, abdominal pain, and even mental confusion. As it increases in severity, alcoholic hepatitis dangerously enlarges the liver, and causes jaundice, excessive bleeding, and clotting difficulties.
Another liver condition associated with heavy drinking is fibrosis, which causes scar tissue to build up in the liver. Alcohol alters the chemicals in the liver needed to break down and remove this scar tissue. As a result, liver function suffers.
If you continue to drink, this excessive scar tissue builds up and creates a condition called cirrhosis, which is a slow deterioration of the liver. Cirrhosis prevents the liver from performing critical functions, including managing infections, removing harmful substances from the blood, and absorbing nutrients.
A variety of complications, including jaundice, insulin resistance and type 2 diabetes, and even liver cancer, can result as cirrhosis weakens liver function.
Risk factors ranging from genetics and gender, to alcohol accessibility, social customs around drinking, and even diet can affect a person’s individual susceptibility to alcoholic liver disease. Statistics show that about one in five heavy drinkers will develop alcoholic hepatitis, while one in four will develop cirrhosis.

KNOW THERE’S A BRIGHT SIDE:

The good news is that a variety of lifestyle changes can help treat alcoholic liver disease. The most critical lifestyle change is abstinence from alcohol. Quitting drinking will help prevent further injury to your liver. Cigarette smoking, obesity, and poor nutrition all contribute to alcoholic liver disease. It is important to stop smoking and improve your eating habits to keep liver disease in check. But when conditions like cirrhosis become severe, a liver transplant may be the primary treatment option.

Effects on the pancreas

KNOW THE FACTS:

Each year, acute pancreatitis sends more than 200,000 Americans to the hospital. Many of those who suffer from pancreatic problems are also heavy drinkers. Habitual and excessive drinking damages the pancreas, and commonly causes pancreatitis.
Learning more about the links between alcohol and pancreatic problems can help you make better decisions to protect your health.

KNOW THE FUNCTION:

The pancreas plays an important role in food digestion and its conversion into fuel to power your body. It sends enzymes into the small intestine to digest carbohydrates, proteins, and fat. It also secretes insulin and glucagon, hormones that regulate the process of utilizing glucose, the body’s main source of energy. Insulin and glucagon control glucose levels, which helps all cells use the energy glucose provides. Insulin also ensures that extra glucose gets stored away as either glycogen or fat.
When you drink, alcohol damages pancreatic cells and influences metabolic processes involving insulin. This process leaves the pancreas open to dangerous inflammations.

KNOW THE RISKS:

A pancreas unaffected by alcohol sends enzymes out to the small intestine to metabolize food. Alcohol jumbles this process. It causes the pancreas to secrete its digestive juices internally, rather than sending the enzymes to the small intestine. These enzymes, as well as acetaldehyde—a substance produced from metabolizing, or breaking down the alcohol—are harmful to the pancreas. If you consume alcohol excessively over a long time, this continued process can cause inflammation, as well as swelling of tissues and blood vessels.
This inflammation is called pancreatitis, and it prevents the pancreas from working properly. Pancreatitis occurs as a sudden attack, called acute pancreatitis. As excessive drinking continues, the inflammation can become constant. This condition is known as chronic pancreatitis.
Pancreatitis is also a risk factor for the development of pancreatic cancer.
A heavy drinker may not be able to detect the build-up of pancreatic damage until the problems set off an attack.
An acute pancreatic attack causes symptoms including:
• Abdominal pain, which may radiate up the back
• Nausea and vomiting
• Fever
• Rapid heart rate
• Diarrhea
• Sweating
Chronic pancreatitis causes these symptoms as well as severe abdominal pain, significant reduction in pancreatic function and digestion, and blood sugar problems. Chronic pancreatitis can slowly destroy the pancreas and lead to diabetes or even death.
While a single drinking binge will not automatically lead to pancreatitis, the risk of developing the disease increases as excessive drinking continues over time.
These risks apply to all heavy drinkers, but only about 5 percent of people with alcohol dependence develop pancreatitis. Some people are more susceptible to the disease than others, but researchers have not yet identified exactly what environmental and genetic factors play the biggest role.

TREATMENT HELPS—BUT DOES NOT CURE

Abstinence from alcohol can slow the progression of pancreatitis and reduce its painful symptoms.A low-fat diet also may help. It is also critical to guard against infections and to get supportive treatment. Treatment options, including enzyme-replacement therapy or insulin, can improve pancreatic function. In some cases, surgery is necessary to relieve pain, clear blockages, and reduce attacks.
The effects of alcoholic pancreatitis can be managed, but not easily reversed.

Cancer risks

KNOW THE RISKS:

Genetics, environment, and lifestyle habits can all heighten your risk of getting cancer. We can’t do anything to change our genes, and we often can’t do much to change our environment. But lifestyle habits are a different story.
Drinking too much alcohol is one lifestyle habit that can increase your risk of developing certain cancers. This does not mean that anyone who drinks too much will develop cancer. But numerous studies do show the more you drink, the more you increase your chances of developing certain types of cancer.
For example, a group of Italy-based scientists reviewed more than 200 studies examining alcohol’s impact on cancer risk.The collective results of these studies clearly demonstrate that the more you drink, the higher your risk for developing a variety of cancers.The National Cancer Institute identifies alcohol as a risk factor for the following types of cancer:
• Mouth
• Esophagus
• Pharynx
• Larynx
• Liver
• Breast
At least 7 out of 10 people with mouth cancer drink heavily. Drinking five or more drinks per day can also increase your risk of developing other types of cancers, including colon or rectal cancer. In fact, summary estimates from the recent World Cancer Research Fund report indicate that women who drink five standard alcohol drinks each day have about 1.2 times the risk of developing colon or rectal cancer than women who do not drink at all.
People who drink are also more likely to smoke, and the combination increases the risk significantly. Smoking alone is a known risk factor for some cancers. But smoking and drinking together intensifies the cancer-causing properties of each substance. The overall effect poses an even greater risk.
The risk of throat and mouth cancers is especially high because alcohol and tobacco both come in direct contact with those areas. Overall, people who drink and smoke are 15 times more likely to develop cancers of the mouth and throat than nondrinkers and nonsmokers. In addition, recent studies estimate that alcohol and tobacco together are responsible for:
• 80 percent of throat and mouth cancer in men
• 65 percent of throat and mouth cancer in women
• 80 percent of esophageal squamous cell carcinoma, a type of esophagus cancer
• 25 to 30 percent of all liver cancers

WOMEN AND CANCER

One recent, groundbreaking study followed the drinking habits of 1.2 million middle-aged women over 7 years. The study found that alcohol increases women’s chances of developing cancers of the breast,mouth, throat, rectum, liver, and esophagus. The researchers link alcohol to about 13 percent of these cancer cases.
In addition, the study concluded that cancer risk increases no matter how little or what kind of alcohol a woman drinks. Even one drink a day can raise risk, and it continues to rise with each additional drink. While men did not participate in this study, the researchers believe this risk is likely similar for men.
This study also attributes about 11 percent of all breast cancer cases to alcohol. That means that of the 250,000 breast cancer cases diagnosed in the United States in 2008, about 27,000 may stem from alcohol.

KNOW THE REASONS:

Scientists are still trying to figure out exactly how and why alcohol can promote cancer. There are a variety of possible explanations.
One explanation is that alcohol itself is not the primary trigger for cancer.We know that metabolizing, or breaking down, alcohol results in harmful toxins in the body. One of these toxins is called acetylaldehyde. Acetylaldehyde damages the genetic material in cells—and renders the cells incapable of repairing the damage. It also causes cells to grow too quickly, which makes conditions ripe for genetic changes and mistakes. Cancer can develop more easily in cells with damaged genetic material.
In addition, recent animal studies have shown that as cells try to break down alcohol, they cause the body to produce additional amounts of a protein called vascular endothelial growth factor (VEGF). VEGF promotes the growth of blood vessels and organ tissue. But, the flip side of having too much VEGF is that it allows blood vessels to grow in cancer cells that would die on their own. This allows the cancer cells to develop into tumors.
We also know that alcohol can damage the liver, causing cirrhosis. Cirrhosis results when too much scar tissue builds up within the liver and leaves it unable to perform its vital functions. One of the many complications that can result from cirrhosis is liver cancer.
Hormones may be the link between alcohol and breast cancer. Alcohol can increase the amounts of some hormones in the body, including estrogen. An excess of estrogen may lead to breast cancer.
Finally, genetics may play a role in preventing some heavy drinkers from developing cancer. A European research team examined 9,000 people with similar lifestyle habits to determine why some of them developed mouth and throat cancers, and some did not. Of the participants who were heavy drinkers, those who did not develop cancers had a particular genetic alteration that enabled them to break down alcohol about 100 times faster than in those without it. The study suggested that this gene is the reason why some people are less likely to develop cancer in response to heavy drinking.

KNOW THERE’S A BRIGHT SIDE:

Fortunately, studies show that you can reduce your risk for cancer by drinking less. A recent Canadian report analyzed studies from 1966 through 2006 and concluded that risk reduction is possible, specifically for head and neck cancers.The study found that as people abstained from drinking, their risk for developing cancer plunged. After 20 years of abstinence, former drinkers had the same risk for head and neck cancers as people who never drank.

Effects on the immune system

Germs and bacteria surround us everywhere. Luckily, our immune system is designed to protect our bodies from the scores of foreign substances that can make us sick. Drinking too much alcohol weakens the immune system, making your body a much easier target for disease. Understanding the effect alcohol can have on your immune system can inform the decisions you make about drinking alcohol.

KNOW THE FACTS:

Your immune system is often compared to an army. This army defends your body from infection and disease. Your skin and the mucous that lines your respiratory and gastrointestinal tracts help block bacteria from entering or staying in your body. If foreign substances somehow make it through these barriers, your immune system kicks into gear with two defensive systems: innate and adaptive.
The innate system exists in your body before you are exposed to foreign substances like bacteria, viruses, fungi, or parasites. These substances, which are called antigens, can invade your body and make you sick. The components of the innate system include:
• WHITE BLOOD CELLS – White blood cells form your first line of defense against infection.They surround and swallow foreign bodies quickly.
• NATURAL KILLER (NK) CELLS – Natural Killers are special white blood cells that detect and destroy cells infected with cancer or viruses.
• CYTOKINES – White blood cells send out these chemical messengers directly to an infected site. Cytokines trigger inflammatory responses, like dilating blood vessels and increasing blood flow to the affected area. They also call on more white blood cells to swarm an infected area.
The adaptive system kicks in after you are exposed to an infection for the first time. The next time you encounter the same infection, your adaptive system fights it off even faster and more efficiently than the first time. The components of the adaptive system include:
• T-LYMPHOCYTE CELLS – T-cells reinforce the work of white blood cells by targeting individual foreign substances.T-cells can identify and destroy a vast array of bacteria and viruses.They can also kill infected cells and secrete cytokines.
• B-LYMPHOCYTE CELLS – B-cells produce antibodies that fight off harmful substances by sticking to them and making them stand out to other immune cells.
• ANTIBODIES – After B-cells encounter antigens, they produce antibodies.These are proteins that target specific antigens and then remember how to combat the antigen.

KNOW THE RISKS:

Alcohol suppresses both the innate and the adaptive immune systems. Chronic alcohol use reduces the ability of white blood cells to effectively engulf and swallow harmful bacteria. Excessive drinking also disrupts the production of cytokines, causing your body to either produce too much or not enough of these chemical messengers. An abundance of cytokines can damage your tissues, whereas a lack of cytokines leaves you open to infection.
Chronic alcohol use also suppresses the development of T-cells and may impair the ability of NK cells to attack tumor cells. This reduced function makes you more vulnerable to bacteria and viruses, and less capable of destroying cancerous cells.
With a compromised immune system, chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. There is also data linking alcohol’s damage to the immune system with an increased susceptibility to contracting HIV infection. HIV develops faster in chronic drinkers who already have the virus.
Drinking a lot on a single occasion also can compromise your immune system. Drinking to intoxication can slow your body’s ability to produce cytokines that ward off infections by causing inflammations.Without these inflammatory responses, your body’s ability to defend itself against bacteria is significantly reduced. A recent study shows that slower inflammatory cytokine production can reduce your ability to fight off infections for up to 24 hours after getting drunk.

STILL LOOKING FOR THE BRIGHT SIDE

At this point, scientists do not know whether abstinence, reduced drinking, or other measures will help reverse the effects of alcohol on the immune system. Nevertheless, it is important to keep in mind that avoiding drinking helps minimize the burden on your immune system, particularly if you are fighting a viral or bacterial infection.

06.- Overview of Alcohol Consumption

People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people – and throughout history, we’ve struggled to understand and manage alcohol’s power. Why does alcohol cause us to act and feel differently? How much is too much? Why do some people become addicted while others do not?
Here at NIAAA, we are constantly researching the answers to these, and many other questions about alcohol. Here’s what we know:
Alcohol’s effects vary from person to person, depending on a variety of factors, including:
• How much you drink
• How often you drink
• Your age
• Your health status
• Your family history
While drinking alcohol is itself not necessarily a problem – drinking too much can cause a range of consequences, and increase your risk for a variety of problems.
Consequences of drinking too much
Alcohol enters your bloodstream as soon as you take your first sip. Alcohol’s immediate effects can appear within about 10 minutes. As you drink, you increase your blood alcohol concentration (BAC) level, which is the amount of alcohol present in your bloodstream. The higher your BAC, the more impaired you become by alcohol’s effects. These effects can include:
• Reduced inhibitions
• Slurred speech
• Motor impairment
• Confusion
• Memory problems
• Concentration problems
• Coma
• Breathing problems
• Death
Other risks of drinking can include:
• Car crashes and other accidents
• Risky behavior
• Violent behavior
• Suicide and homicide
People who drink too much over a long period of time may experience alcohol’s longer-term effects, which can include:

07.- What Is A Standard Drink?

Many people are surprised to learn what counts as a drink. The amount of liquid in your glass, can, or bottle does not necessarily match up to how much alcohol is actually in your drink. Different types of beer, wine, or malt liquor can have very different amounts of alcohol content. For example, many light beers have almost as much alcohol as regular beer – about 85% as much. Here’s another way to put it:
• Regular beer: 5% alcohol content
• Some light beers: 4.2% alcohol content
That’s why it’s important to know how much alcohol your drink contains. In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in:
• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol
• 1.5 ounces of distilled spirits, which is about 40% alcohol

How do you know how much alcohol is in your drink?

Even though they come in different sizes, the drinks below are each examples of one standard drink:
Although the "standard" drink amounts are helpful for following health guidelines, they may not reflect customary serving sizes. For example, a single mixed drink made with 80-proof spirits (whiskey, gin, rum, vodka, tequila, etc.) can contain 1 to 3 or more standard drinks, depending on the type of spirits and the recipe.

08.- Discussing Drinking. A Back-to-School Conversation You Need to Have

As college students arrive on campus this fall, it's a time of new experiences, new friendships and making memories that will last a lifetime. Unfortunately for many, it can also be a time of excessive drinking and dealing with its aftermath-vandalism, violence, sexual aggression and even death. For those beginning their college experience, a rapid increase in heavy drinking over a relatively short period of time can cause serious problems with the transition to college. Alcohol abuse can also be a problem for high school students. Fall semester is a good time to sit down with your child to have a frank discussion about drinking.
We go through many changes in our teen years. Relationships change as our bodies and brains mature. Recent research has shown that the human brain continues to develop into a person's early 20's.
This period is also marked by taking risks. This can include risky drinking. And early drinking is associated with other risky behavior, such as academic failure, unsafe sexual behavior and drug use. Over the long-term, early drinking is associated with an increased risk of developing an alcohol use disorder at some time during the life span.
The consequences of excessive drinking by young people are more significant, more destructive and more costly than many parents realize. According to the College Drinking Task Force report to NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA), drinking by 18- to 24-year old college students contributes to an estimated 1,700 student deaths, 599,000 injuries and 97,000 cases of sexual assault or date rape each year.
Students form their expectations about alcohol from their environment and from each other. As they face the insecurity and stresses of establishing themselves in a new social setting, environmental and peer influences combine to create a culture of drinking. This culture actively-or at least passively -promotes drinking through tolerance, or even unspoken approval, of college drinking as a rite of passage.
The transition to college can be difficult, with about 1 of 3 first-year students failing to enroll for their second year. Anecdotal evidence suggests that the first 6 weeks of the first semester are critical to a first-year student's academic success. Many students begin drinking heavily during these early days of college, and this can interfere with their successful adaptation to campus life.
But parents can still play a major role in preventing alcohol problems. The time to start is before your child leaves for college. As the fall semester begins, prepare your college-age children by talking with them about the consequences of drinking. Stay involved during the crucial early weeks of college. Inquire about campus alcohol policies, and ask your children about their roommates and living arrangements.
High school students can also come under pressure to drink from their peers at school. It's important to talk to your high school students about peer pressure and how to resist it. They need to know that alcohol can harm their judgment, coordination and reflexes. It can cause them to lose control, take chances and do things they never would do otherwise. In fact, alcohol is linked with an estimated 5,000 deaths in people under age 21 each year-more than all illegal drugs combined.
When you sit down to talk with your child about the consequences of drinking, discuss the penalties for underage drinking as well as how alcohol use can lead to date rape, violence and academic failure. Underage drinking has also been linked with deaths and injuries from burns, falls, alcohol poisoning and suicide.
Discuss drinking and driving. Motor vehicle crashes are the leading cause of death in people aged 15 to 20. Deadly crashes involving alcohol are twice as common in teens compared with people 21 and older.
Now's the time to talk to your children about the dangers of alcohol. Help prevent them from doing something that they-and you-might regret for the rest of their life.

Alcohol Poisoning

When you sit down to talk to your children about the dangers of alcohol abuse, take a few minutes to help them recognize the signs of alcohol poisoning. It could mean the difference between life and death for them or one of their friends.
What Is Alcohol Poisoning? Too much alcohol can shut down the parts of the brain that control breathing and the gag reflex, which prevents choking. Someone who drinks a fatal dose of alcohol will eventually stop breathing. Even if someone survives an alcohol overdose, the experience can cause irreversible brain damage. Rapid binge drinking is especially dangerous because victims can continue drinking beyond a fatal dose before they lose consciousness.
A person who appears to be sleeping it off may still be in real danger. Blood alcohol levels can continue to rise even after someone’s passed out, since alcohol in the stomach and intestine can continue to enter the bloodstream and circulate throughout the body.
What Should I Look For? Critical signs of alcohol poisoning include mental confusion, unconsciousness, vomiting, seizures, slow (fewer than 8 breaths per minute) or irregular (10 seconds or more between breaths) breathing and hypothermia (low body temperature, bluish skin color and paleness).
What Should I Do? Know the danger signals. If you suspect someone has alcohol poisoning, don’t wait for all the critical signs to be present. If you suspect an alcohol overdose, call 911 immediately for help.

09.- Health risks of alcohol use

Beer, wine, and liquor all contain alcohol. If you are drinking any of these, you are using alcohol. Your drinking patterns may vary, depending on who you are with and what you are doing.
You probably already know that drinking too much can cause many health problems. But even responsible drinking patterns can lead to health issues and other problems in your everyday life.

Alternative names

Alcoholism - risks; Alcohol abuse - risks; Alcohol dependence - risks; Risky drinking - risks

Alcohol use and your health

Long-term use of alcohol increases your chances of:
• Bleeding from the stomach or esophagus (the tube the food travels through from your mouth to your stomach).
• Swelling and damage to the pancreas. Your pancreas produces substances your body needs to work well.
• Damage to the liver. When severe, liver damage often leads to death.
• Poor nutrition.
• Cancer of the esophagus, liver, colon, head and neck, breasts, and other areas.
Even responsible drinking can lead to high blood pressure in some people.
• If you already have high blood pressure, drinking can make it harder to control with medicines.
• Using alcohol for a long time can lead to high blood pressure, which can then cause the heart to weaken and become enlarged.
Alcohol can affect your thinking and judgment each time you drink. Long-term alcohol use damages brain cells. This can lead to lasting damage to your memory, thinking, and the way you behave.
Damage to nerves from alcohol use can cause many problems, including
• Numbness or a painful "pins and needles" feeling in your arms or legs.
• Problems with erections in men.
• Leaking urine or having a hard time passing urine.
Drinking during pregnancy can harm the growing baby. Severe birth defects or fetal alcohol syndrome (FAS) may occur.

How alcohol use can affect your life

Oftentimes, people drink to make themselves feel better or to block feelings of sadness, depression, nervousness, or worry. But alcohol can:
• Make these problems worse over time
• Cause sleep problems or make them worse
• Increase the risk of suicide
Families are often affected when someone in the home uses alcohol. Violence and conflict in the home is much more likely when a family member is abusing alcohol. Children who grow up in a home where alcohol abuse is present are more likely to:
• Do poorly in school
• Be depressed and have problems with anxiety and low self-esteem
• Have marriages that end in divorce
Drinking too much alcohol even once can harm you or others. It can lead to:
• Car accidents
• Risky sex habits, which may lead to unplanned or unwanted pregnancy, sexually transmitted infections (STIs), and sexual assault or rape
• Falls, drowning, and other accidents
• Suicide
• Violence and homicide

What you can do

First, ask yourself what type of drinker you are?
Even if you are a responsible drinker, drinking too much just once can be harmful.
Be aware of your drinking patterns. Learn ways to cut back on drinking.
If you cannot control your drinking or if your drinking is becoming harmful to yourself or others, seek help from:
• Your doctor
• Support and self-help groups for people who have drinking problems

References

American Psychiatric Association.Diagnostic and statistical manual of mental disorders
National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder: a comparison between DSM-IV and DSM-5. November 2013. http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf.Accessed on May 11, 2014.
O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Sherin K, Seikel S. Alcohol use disorders. In: Rakel RE, Rakel DP, eds.Textbook of Family Medicine

10.- Alcohol use and safe drinking

Alcohol use involves drinking beer, wine, or hard liquor.

Information

Alcohol is one of the most widely used drug substances in the world.
TEEN DRINKING
Alcohol use is not only an adult problem. Most American high school seniors have had an alcoholic drink within the past month, despite the fact that the legal drinking age is 21 years old in the U.S.
About 1 in 5 teens are considered "problem drinkers." This means that they:
• Get drunk
• Have accidents related to alcohol use
• Get into trouble with the law, family members, friends, school, or dates because of alcohol
THE EFFECTS OF ALCOHOL
Alcoholic drinks have different amounts of alcohol in them:
• Beer is about 5% alcohol, although some beers can have more.
• Wine is usually 12 to 15% alcohol.
• Hard liquor is about 45% alcohol.
Alcohol gets into your bloodstream quickly.
The amount and type of food in your stomach can change how quickly this occurs. For example, high-carbohydrate and high-fat foods can make your body absorb alcohol more slowly.
Certain types of alcoholic drinks get into your bloodstream faster. A carbonated (fizzy) alcoholic drink, such as champagne, will be absorbed faster than a non-carbonated drink.
Alcohol slows your breathing rate, heart rate, and how well your brain functions. These effects may appear within 10 minutes and peak at around 40 to 60 minutes. Alcohol stays in your bloodstream until it is broken down by the liver. The amount of alcohol in your blood is called your "blood alcohol level." If you drink alcohol faster than the liver can break it down, this level rises.
Your blood alcohol level is used to legally define whether or not you are drunk. The blood alcohol legal limit usually falls between 0.08 and 0.10 in most states. Below is a list of blood alcohol levels and the likely symptoms.
• 0.05 -- reduced inhibitions
• 0.10 -- slurred speech
• 0.20 -- euphoria and motor impairment
• 0.30 -- confusion
• 0.40 -- stupor
• 0.50 -- coma
• 0.60 -- respiratory paralysis and death
You can have symptoms of "being drunk" at blood alcohol levels below the legal definition of being drunk. Also, people who drink alcohol frequently may not have symptoms until a higher blood alcohol level is reached.
HEALTH RISKS OF ALCOHOL
Alcohol increases the risk of:
• Alcoholism or alcohol dependence
• Falls, drownings, and other accidents
• Head, neck, stomach, and breast cancers
• Motor vehicle accidents
• Risky sex behaviors, unplanned or unwanted pregnancy, and sexually transmitted infections (STIs)
• Suicide and homicide
Drinking during pregnancy can harm the developing baby. Severe birth defects or fetal alcohol syndrome are possible.
RESPONSIBLE DRINKING
If you drink alcohol, it is best to do so in moderation. Moderation means the drinking is not getting you intoxicated (or drunk) and you are drinking no more than 1 drink per day if you are a woman and no more than 2 if you are a man. A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
Here are some ways to drink responsibly, provided you do not have a drinking problem, are of legal age to drink alcohol, and are not pregnant:
• Never drink alcohol and drive a car.
• If you are going to drink, have a designated driver, or plan an alternative way home, such as a taxi or bus.
• Do not drink on an empty stomach. Snack before and while drinking alcohol.
If you are taking medication, including over-the-counter drugs, check with your doctor before drinking alcohol. Alcohol can make the effects of many medicines stronger. It can also interact with other medicines, making them ineffective or dangerous or make you sick.
Do not drink if you have a history of alcohol abuse or alcoholism.
If alcoholism runs in your family, you may be at increased risk of developing alcoholism yourself, so you may want to avoid drinking alcohol altogether.
CALL YOUR HEALTH CARE PROVIDER IF:
• You are concerned about your personal alcohol use or that of a family member
• You are interested in more information regarding alcohol use, alcohol abuse, or support groups
• You are unable to reduce or stop your alcohol consumption, in spite of attempts to stop drinking
Other resources include:
• Local Alcoholics Anonymous or Al-anon/Alateen groups
• Local hospitals
• Public or private mental health agencies
• School or work counselors
• Student or employee health centers

Alternative Names

Beer consumption; Wine consumption; Hard liquor consumption; Safe drinking

References

National Institute on Alcohol Abuse and Alcoholism. Alcohol and health. Available at: http://www.niaaa.nih.gov/alcohol-health.Accessed on February 24, 2014.
O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Sherin K, Seikel S. Alcohol use disorders. Rakel RE, Rakel DP, eds.Textbook of Family Medicine
U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Available at: http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcmisuserfinalrs.htm.Accessed on February 24, 2014.

11.- Responsible drinking

If you drink alcohol, doctors advise limiting how much you drink. This is called drinking in moderation, or responsible drinking.
Responsible drinking means more than just limiting yourself to a certain number of drinks. It also means not getting drunk and not letting alcohol control your life or your relationships.

Alternative names

Alcohol use disorder - responsible drinking; Drinking alcohol responsibly; Drinking in moderation

What you need to know

The tips in this article are for people who:
• Do not have a drinking problem, now or in the past
• Are old enough to drink legally
• Are not pregnant
Healthy men, up to age 65, should limit themselves to:
• No more than 4 drinks a day
• No more than 14 drinks a week
Healthy women of all ages and healthy men over age 65 should limit themselves to:
• No more than 3 drinks a day
• No more than 7 drinks a week
Other habits that will help you be a responsible drinker include:
• Never drinking alcohol and driving.
• Having a designated driver if you are going to drink. This means riding with someone in your group who has not been drinking, or taking a taxi or bus.
• Not drinking on an empty stomach. Have a snack or meal before you drink and while you are drinking.
If you take any medicines, including ones you bought without a prescription, check with your doctor before you drink. Alcohol can affect the way your body uses some drugs. A drug may not work correctly, or it could be dangerous or make you sick if combined with alcohol.
If alcoholism runs in your family, you may be at a higher risk of becoming an alcoholic yourself. Not drinking at all might be best for you.

Can responsible drinking improve your health?

Many people drink now and then. You may have heard about some health benefits from moderate drinking. Some of these benefits have been proven more than others. But none of them should be used as a reason for drinking.
Some of the possible benefits of moderate drinking that have been studied are:
• Reduced risk of heart disease or a heart attack
• Reduced risk of strokes
• Lower risk of gallstones
• Lower risk of diabetes

When to call the doctor

Call your doctor if:
• You are concerned about your own drinking or a family member's drinking.
• You would like more information about alcohol use or support groups for problem drinking.
• You are unable to drink less or stop drinking, even though you've tried.

References

American Psychiatric Association.Diagnostic and statistical manual of mental disorders
National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder: a comparison between DSM-IV and DSM-5. November 2013. http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf.Accessed on May 11, 2014.
O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Sherin K, Seikel S. Alcohol use disorders. In: Rakel RE, Rakel DP, eds.Textbook of Family Medicine

12.- Do you have a drinking problem?

Alcohol use; Alcohol abuse; Alcoholism

Description

Many people with alcohol problems cannot tell when their drinking is out of control. An important first step is to be aware of how much you are drinking and how your alcohol use may be harming your life and those around you.
One drink equals one 12-ounce can or bottle of beer, one 5-ounce glass of wine, 1 wine cooler, 1 cocktail, or 1 shot of hard liquor. Think about:
• How often you have an alcoholic drink
• How many drinks you have when you do drink
• How any drinking you are doing affects your life or the lives of others

Responsible drinking

Here are some guidelines for drinking alcohol responsibly, as long as you do not have a drinking problem.
Healthy men up to age 65 should limit themselves to:
• No more than 4 drinks in 1 day
• No more than 14 drinks in a week
Healthy women up to age 65 should limit themselves to:
• No more than 3 drinks in 1 day
• No more than 7 drinks in a week
Healthy women of all ages and healthy men over age 65 should limit themselves to:
• No more than 3 drinks in 1 day
• No more than 7 drinks in a week

When you start to drink too much

Doctors consider your drinking medically unsafe when you drink:
• Many times a month, or even many times a week
• 3 to 4 drinks (or more) in 1 day
• 5 or more drinks on one occasion monthly, or even weekly
You can use the AUDIT-C questionnaire to help you decide if your drinking is risky. Your doctor can advise and help you cut down or even quit.

Knowing when you have a drinking problem

You may have a drinking problem if you have at least 2 of the following characteristics:
• You do not do what you are expected to do (at home, work, or school) as a result of drinking.
• You use alcohol in situations where your drinking could injure or endanger you or someone else.
• You have trouble or conflict with your family, friends, or coworkers because of the effect alcohol has on you.
• You need to drink more to get the same effect from alcohol.
• You have not been able to cut down or stop drinking alcohol on your own, even though you've tried or you want to.
• You have symptoms of withdrawal when you try to quit or cut down, such as tremors, sweating, nausea, or insomnia.
• You crave alcohol, meaning you have a strong desire or urge to use it.
• You continue to drink, even though alcohol is causing emotional or physical problems for you, or problems with your family, friends, or job.
• You spend a lot of time drinking, thinking about drinking, or recovering from drinking.
• You spend less time on other activities that used to be important or that you enjoyed.

When to call the doctor

If you or others are concerned, make an appointment with your doctor to talk about your drinking. Your doctor can help guide you to the best treatment.
Other resources include:
• Alcoholics Anonymous (AA) -- aa.org
• National Council on Alcoholism and Drug Dependence (NCADD) -- ncadd.org/index.php/learn-about-alcohol

References

American Psychiatric Association.Diagnostic and statistical manual of mental disorders
National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder: a comparison between DSM-IV and DSM-5. November 2013. http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf.Accessed on May 11, 2014.
O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Sherin K, Seikel S. Alcohol use disorders. In: Rakel RE, Rakel DP, eds.Textbook of Family Medicine

13.- Harmful Interactions

Mixing Alcohol With Medicines

You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.
Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.
This pamphlet lists medications that can cause harm when taken with alcohol and describes the effects that can result. The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication.
Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Did You Know…

Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.

Medicines may have many ingredients

Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking.

Some medicines contain alcohol

Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.

Alcohol affects women differently

Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.

Older people face greater risk

Older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.

Timing is important

Alcohol and medicines can interact harmfully even if they are not taken at the same time.

Remember...

Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.

14.- Wine and heart health

Studies have shown that adults who drink light to moderate amounts of alcohol may be less likely to develop heart disease than those who do not drink at all or are heavy drinkers. However, people who do not drink alcohol should not start just because they want to avoid developing heart disease.

Information

There is a fine line between healthy drinking and risky drinking. Do not begin drinking or drink more often just to lower your risk of heart disease. Heavier drinking can harm the heart and liver. Heart disease is the leading cause of death in people who abuse alcohol.
Health care providers recommend that if you drink alcohol, drink only light to moderate amounts:
• For men, limit alcohol to one to two drinks a day.
• For women, limit alcohol to one drink a day.
One drink is defined as:
• 4 ounces of wine
• 12 ounces of beer
• 1½ ounces of 80-proof spirits
• 1 ounce of 100-proof spirits
Though research has found that alcohol may help prevent heart disease, much more effective ways to prevent heart disease include:
• Controlling blood pressure and cholesterol
• Exercising and following a low-fat, healthy diet
• Not smoking
• Maintaining an ideal weight
Anyone who has heart disease or heart failure should talk to their health care provider before drinking alcohol. Alcohol can make heart failure and other heart problems worse.

Alternative Names

Health and wine: Wine and heart disease: Preventing heart disease - wine; Preventing heart disease - alcohol

References

Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ
Lange RA, Hillis LD. Toxins and the heart. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
United States Department of Agriculture. Center for Nutrition Policy and Promotion.Dietary Guidelines for Americans. 2010

15.- Alcohol and Cancer Risk

What is alcohol?

Alcohol is the common term for ethanol or ethyl alcohol, a chemical substance found in beer, wine, and liquor, as well as in some medicines, mouthwashes, household products, and essential oils (scented liquids taken from plants). Alcohol is produced by the fermentation of sugars and starches by yeast.
The main types of alcoholic drinks and their alcohol content are as follows:
• Beers and hard ciders: 3-7 percent alcohol
• Wines, including sake: 9-15 percent alcohol
• Wines fortified with liquors, such as port: 16-20 percent alcohol
• Liquor, or distilled spirits, such as gin, rum, vodka, and whiskey, which are produced by distilling the alcohol from fermented grains, fruits, or vegetables: usually 35-40 percent alcohol (70-80 proof), but can be higher
According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic drink in the United States contains 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in
• 12 ounces of beer
• 8 ounces of malt liquor
• 5 ounces of wine
• 1.5 ounces or a "shot" of 80-proof liquor
The federal government’s Dietary Guidelines for Americans 2010 defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men. Heavy alcohol drinking is defined as having more than three drinks on any day or more than seven drinks per week for women and more than four drinks on any day or more than 14 drinks per week for men.

What is the evidence that alcohol drinking is a cause of cancer?

Based on extensive reviews of research studies, there is a strong scientific consensus of an association between alcohol drinking and several types of cancer (1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen. The research evidence indicates that the more alcohol a person drinks—particularly the more alcohol a person drinks regularly over time—the higher his or her risk of developing an alcohol-associated cancer. Based on data from 2009, an estimated 3.5 percent of all cancer deaths in the United States (about 19,500 deaths) were alcohol related (3).
Clear patterns have emerged between alcohol consumption and the development of the following types of cancer:
• Head and neck cancer: Alcohol consumption is a major risk factor for certain head and neck cancers, particularly cancers of the oral cavity (excluding the lips), pharynx (throat), and larynx (voice box) (4). People who consume 50 or more grams of alcohol per day (approximately 3.5 or more drinks per day) have at least a two to three times greater risk of developing these cancers than nondrinkers (4). Moreover, the risks of these cancers are substantially higher among persons who consume this amount of alcohol and also use tobacco (5).
• Esophageal cancer: Alcohol consumption is a major risk factor for a particular type of esophageal cancer called esophageal squamous cell carcinoma (2). In addition, people who inherit a deficiency in an enzyme that metabolizes alcohol have been found to have substantially increased risks of alcohol-related esophageal squamous cell carcinoma.
• Liver cancer: Alcohol consumption is an independent risk factor for, and a primary cause of, liver cancer (hepatocellular carcinoma) (6). (Chronic infection with hepatitis B virus and hepatitis C virus are the other major causes of liver cancer.)
• Breast cancer: More than 100 epidemiologic studies have looked at the association between alcohol consumption and the risk of breast cancer in women. These studies have consistently found an increased risk of breast cancer associated with increasing alcohol intake. A meta-analysis of 53 of these studies (which included a total of 58,000 women with breast cancer) showed that women who drank more than 45 grams of alcohol per day (approximately three drinks) had 1.5 times the risk of developing breast cancer as nondrinkers (a modestly increased risk) (7). The risk of breast cancer was higher across all levels of alcohol intake: for every 10 grams of alcohol consumed per day (slightly less than one drink), researchers observed a small (7 percent) increase in the risk of breast cancer.
The Million Women Study in the United Kingdom (which included more than 28,000 women with breast cancer) provided a more recent, and slightly higher, estimate of breast cancer risk at low to moderate levels of alcohol consumption: every 10 grams of alcohol consumed per day was associated with a 12 percent increase in the risk of breast cancer (8).
• Colorectal cancer: Alcohol consumption is associated with a modestly increased risk of cancers of the colon and rectum. A meta-analysis of 57 cohort and case-control studies that examined the association between alcohol consumption and colorectal cancer risk showed that people who regularly drank 50 or more grams of alcohol per day (approximately 3.5 drinks) had 1.5 times the risk of developing colorectal cancer as nondrinkers or occasional drinkers (9). For every 10 grams of alcohol consumed per day, there was a small (7 percent) increase in the risk of colorectal cancer.

Research on alcohol consumption and other cancers:

Numerous studies have examined the association between alcohol consumption and the risk of other cancers, including cancers of the pancreas, ovary, prostate, stomach, uterus, and bladder. For these cancers, either no association with alcohol use has been found or the evidence for an association is inconsistent.
However, for two cancers—renal cell (kidney) cancer and non-Hodgkin lymphoma (NHL)—multiple studies have shown that increased alcohol consumption is associated with a decreased risk of cancer (10, 11). A meta-analysis of the NHL studies (which included 18,759 people with NHL) found a 15 percent lower risk of NHL among alcohol drinkers compared with nondrinkers (11). The mechanisms by which alcohol consumption would decrease the risks of either renal cell cancer or NHL are not understood.

How does alcohol increase the risk of cancer?

Researchers have identified multiple ways that alcohol may increase the risk of cancer, including:
• metabolizing (breaking down) ethanol in alcoholic drinks to acetaldehyde, which is a toxic chemical and a probable human carcinogen; acetaldehyde can damage both DNA (the genetic material that makes up genes) and proteins
• generating reactive oxygen species (chemically reactive molecules that contain oxygen), which can damage DNA, proteins, and lipids (fats) through a process called oxidation
• impairing the body’s ability to break down and absorb a variety of nutrients that may be associated with cancer risk, including vitamin A; nutrients in the vitamin B complex, such as folate; vitamin C; vitamin D; vitamin E; and carotenoids
• increasing blood levels of estrogen, a sex hormone linked to the risk of breast cancer
Alcoholic beverages may also contain a variety of carcinogenic contaminants that are introduced during fermentation and production, such as nitrosamines, asbestos fibers, phenols, and hydrocarbons.

How does the combination of alcohol and tobacco affect cancer risk?

Epidemiologic research shows that people who use both alcohol and tobacco have much greater risks of developing cancers of the oral cavity, pharynx (throat), larynx, and esophagus than people who use either alcohol or tobacco alone. In fact, for oral and pharyngeal cancers, the risks associated with using both alcohol and tobacco are multiplicative; that is, they are greater than would be expected from adding the individual risks associated with alcohol and tobacco together (5, 12).

Can a person’s genes affect their risk of alcohol-related cancers?

A person’s risk of alcohol-related cancers is influenced by their genes, specifically the genes that encode enzymes involved in metabolizing (breaking down) alcohol (13).
For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH. Many individuals of Chinese, Korean, and especially Japanese descent carry a version of the gene for ADH that codes for a "superactive" form of the enzyme. This superactive ADH enzyme speeds the conversion of alcohol (ethanol) to toxic acetaldehyde. As a result, when people who have the superactive enzyme drink alcohol, acetaldehyde builds up. Among people of Japanese descent, those who have this superactive ADH have a higher risk of pancreatic cancer than those with the more common form of ADH (14).
Another enzyme, called aldehyde dehydrogenase 2 (ALDH2), metabolizes toxic acetaldehyde to non-toxic substances. Some people, particularly those of East Asian descent, carry a variant of the gene for ALDH2 that codes for a defective form of the enzyme. In people who have the defective enzyme, acetaldehyde builds up when they drink alcohol. The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol. Therefore, most people with the defective form of ALDH2 have a low risk of developing alcohol-related cancers.
However, some individuals with the defective form of ALDH2 can become tolerant to the unpleasant effects of acetaldehyde and consume large amounts of alcohol. Epidemiologic studies have shown that such individuals have a higher risk of alcohol-related esophageal cancer, as well as of head and neck cancers, than individuals with the fully active enzyme who drink comparable amounts of alcohol (15). These increased risks are seen only among people who carry the ALDH2 variant and drink alcohol—they are not observed in people who carry the variant but do not drink alcohol.

Can drinking red wine help prevent cancer?

Researchers conducting studies using purified proteins, human cells, and laboratory animals have found that certain substances in red wine, such as resveratrol, have anticancer properties (16). Grapes, raspberries, peanuts, and some other plants also contain resveratrol. However, clinical trials in humans have not provided evidence that resveratrol is effective in preventing or treating cancer (17). Few epidemiologic studies have looked specifically at the association between red wine consumption and cancer risk in humans.

What happens to cancer risk after a person stops drinking alcohol?

Most of the studies that have examined whether cancer risk declines after a person stops drinking alcohol have focused on head and neck cancers and on esophageal cancer. In general, these studies have found that stopping alcohol consumption is not associated with immediate reductions in cancer risk; instead, it may take years for the risks of cancer to return to those of never drinkers.
For example, a pooled analysis of 13 case-control studies of cancer of the oral cavity and pharynx combined found that alcohol-associated cancer risk did not begin to decrease until at least 10 years after stopping alcohol drinking. Even 16 years after they stopped drinking alcohol, the risk of cancer was still higher for ex-drinkers than for never drinkers (18).
In several studies, the risk of esophageal cancer was also found to decrease slowly with increasing time since stopping alcohol drinking. A pooled analysis of five case–control studies found that the risk of esophageal cancer did not approach that of never drinkers for at least 15 years after stopping alcohol drinking (18).

Is it safe for someone to drink alcohol while undergoing cancer chemotherapy?

As with most questions related to a specific individual’s cancer treatment, it is best for a patient to check with their health care team about whether or not it is safe to drink alcohol during or immediately following chemotherapy treatment. The doctors and nurses administering the treatment will be able to give specific advice about whether drinking alcohol is safe with particular chemotherapy drugs and/or other medications prescribed along with chemotherapy.

Selected References

1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Alcohol consumption and ethyl carbamateExit Disclaimer. IARC Monographs on the Evaluation of Carcinogenic Risks in Humans 2010;96:3-1383.
2. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens.Exit Disclaimer IARC Monographs on the Evaluation of Carcinogenic Risks in Humans 2012;100(Pt E):373-472.
3. Nelson DE, Jarman DW, Rehm J, et al. Alcohol-attributable cancer deaths and years of potential life lost in the United States. American Journal of Public Health 2013;103(4):641-648.
4. Baan R, Straif K, Grosse Y, et al. Carcinogenicity of alcoholic beveragesExit Disclaimer. Lancet Oncology 2007;8(4):292-293.
5. Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiology, Biomarkers & Prevention 2009;18(2):541-550.
6. Grewal P, Viswanathen VA. Liver cancer and alcohol. Clinics in Liver Disease 2012;16(4):839-850.
7. Hamajima N, Hirose K, Tajima K, et al. Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. British Journal of Cancer 2002;87(11):1234-1245.
8. Allen NE, Beral V, Casabonne D, et al. Moderate alcohol intake and cancer incidence in women. Journal of the National Cancer Institute 2009;101(5):296-305.
9. Fedirko V, Tramacere I, Bagnardi V, et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Annals of Oncology 2011;22(9):1958-1972.
10. Bellocco R, Pasquali E, Rota M, et al. Alcohol drinking and risk of renal cell carcinoma: results of a meta-analysis. Annals of Oncology 2012;23(9):2235-2244.
11. Tramacere I, Pelucchi C, Bonifazi M, et al. A meta-analysis on alcohol drinking and the risk of Hodgkin lymphoma. European Journal of Cancer Prevention 2012;21(3):268-273.
12. Turati F, Garavello W, Tramacere I, et al. A meta-analysis of alcohol drinking and oral and pharyngeal cancers: results from subgroup analyses. Alcohol and Alcoholism 2013;48(1):107-118.
13. Druesne-Pecollo N, Tehard B, Mallet Y, et al. Alcohol and genetic polymorphisms: effect on risk of alcohol-related cancer. Lancet Oncology 2009;10(2):173-180.
14. Kanda J, Matsuo K, Suzuki T, et al. Impact of alcohol consumption with polymorphisms in alcohol-metabolizing enzymes on pancreatic cancer risk in Japanese. Cancer Science 2009;100(2):296-302.
15. Yokoyama A, Omori T. Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancersExit Disclaimer. Alcohol 2005;35(3):175-185.
16. Athar M, Back JH, Tang X, et al. Resveratrol: a review of preclinical studies for human cancer prevention. Toxicology and Applied Pharmacology 2007;224(3):274-283.
17. Patel KR, Scott E, Brown VA, et al. Clinical trials of resveratrol. Annals of the New York Academy of Sciences 2011;1215:161-169.
18. Rehm J, Patra J, Popova S. Alcohol drinking cessation and its effect on esophageal and head and neck cancers: a pooled analysis. International Journal of Cancer 2007;121(5):1132-1137.

16.- Talking to your teen about drinking

Alcohol use is not just an adult problem. Most American high school seniors have had an alcoholic drink within the past month.
About 1 in 5 teens are considered problem drinkers. This means they:
• Get drunk
• Have accidents related to drinking
• Get into trouble with the law, their families, friends, schools, or people they date because of their drinking
The best time to begin talking with your teen about drugs and alcohol is now. Children as young as 9 years old may become curious about drinking, and they may try alcohol.

By saying nothing, you are saying something

Saying nothing to your children about drinking may give them the message that teen drinking is OK. Most children choose not to drink because their parents talk with them about it.
The best way for your children to be comfortable talking with you about drinking is to be honest and direct. You may want to prepare and think about what you will say ahead of time.
Tell your child how you feel about them possibly using alcohol. Once you have started talking with your teenager, continue to bring it up at times when you are talking about related issues.

Free and curious

Puberty and the teenage years are a time of change. Your child may have just started high school or may have just gotten a driver's license. Your children may have a sense of freedom they never had before.
Teenagers are curious. They want to explore and do things their own way. But pressure to fit in might make it hard to resist alcohol if it seems like everyone else is trying it.
When talking with your teen:
• Encourage your teen to talk to you about drinking. Remain calm when listening and try not to judge or criticize. Make it comfortable for your teen to talk honestly.
• Let your child know you understand that taking chances is a normal part of growing up.
• Remind your teen that drinking comes with serious risks.
• Emphasize that your teen should never drink and drive or ride with a driver who has been drinking.

How problems at home might influence children to drink

Risky drinking or alcohol use in the home can lead to the same habits in children. At an early age, children become aware of the drinking patterns of their parents.
Children are more likely to drink if:
• Conflict is present between parents or caregivers
• Parents are having money problems or are stressed from work
• Abuse is occurring at home or the home does not feel safe in other ways
If alcohol abuse runs in the family, it is very important to talk with your child. Do not keep secrets. Your child should know what the risks of drinking are. Talk honestly about how drinking has affected family members, and talk about the effects of alcohol on your own life.
Set a good example by drinking responsibly. If you have a problem with alcohol abuse, make the decision to get help quitting.

Get help for your child

If you think your child is drinking but will not talk with you about it, get help. Your child's health care provider may be a good place to start. Other resources include:
• Local hospitals
• Public or private mental health agencies
• Counselors at your child's school
• Student health centers
• Programs such as Alateen, part of the Al-Anon program -- www.al-anon.org/for-alateen

References

American Academy of Pediatrics, Committee on Substance Abuse. Alcohol use by youth and adolescents: a pediatric concern. Pediatrics.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders.
National Institute on Alcohol Abuse and Alcoholism and American Academy of Pediatrics. Alcohol screening and brief intervention for youth: a practitioner's guide. 2011. http://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf.Accessed on May 14, 2014.
Sherin K, Seikel S. Alcohol use disorders. Rakel RE, Rakel DP, eds.Textbook of Family Medicine

17.- Women and Drinking

Exercise, diet, hormones, and stress: keeping up with all the health issues facing women is a challenge.
Alcohol presents yet another health challenge for women. Even in small amounts, alcohol affects women differently than men. In some ways, heavy drinking is much more risky for women than it is for men.
With any health issue, accurate information is key. There are times and ways to drink that are safer than others. Every woman is different. No amount of drinking is 100 percent safe, 100 percent of the time, for every woman. With this in mind, it’s important to know how alcohol can affect a woman’s health and safety.

How Much Is Too Much?

Sixty percent of U.S. women have at least one drink a year. Among women who drink, 13 percent have more than seven drinks per week.
For women, this level of drinking is above the recommended limits published in the Dietary Guidelines for Americans, which are issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. (The Dietary Guidelines can be viewed online at www.nutrition.gov.)
The Dietary Guidelines define moderate drinking as no more than one drink a day for women and no more than two drinks a day for men.
The Dietary Guidelines point out that drinking more than one drink per day for women can increase the risk for motor vehicle crashes, other injuries, high blood pressure, stroke, violence, suicide, and certain types of cancer.
Some people should not drink at all, including:
• Anyone under age 21
• People of any age who are unable to restrict their drinking to moderate levels
• Women who may become pregnant or who are pregnant
• People who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination
• People taking prescription or over-the-counter medications that can interact with alcohol.
Why are lower levels of drinking recommended for women than for men? Because women are at greater risk than men for developing alcohol-related problems. Alcohol passes through the digestive tract and is dispersed in the water in the body. The more water available, the more diluted the alcohol. As a rule, men weigh more than women, and, pound for pound, women have less water in their bodies than men. Therefore, a woman’s brain and other organs are exposed to more alcohol and to more of the toxic byproducts that result when the body breaks down and eliminates alcohol.

What is a drink? A standard drink is:

One 12-ounce bottle of beer or wine cooler
One 5-ounce glass of wine
1.5 ounces of 80-proof distilled spirits
Keep in mind that the alcohol content of different types of beer, wine, and distilled spirits can vary quite substantially.

Moderate Drinking: Benefits and Risks

Moderate drinking can have short- and long-term health effects, both positive and negative:

Benefits

Heart disease: Once thought of as a threat mainly to men, heart disease also is the leading killer of women in the United States. Drinking moderately may lower the risk for coronary heart disease, mainly among women over age 55. However, there are other factors that reduce the risk of heart disease, including a healthy diet, exercise, not smoking, and keeping a healthy weight. Moderate drinking provides little, if any, net health benefit for younger people. (Heavy drinking can actually damage the heart.)

Risks

Drinking and driving: It doesn’t take much alcohol to impair a person’s ability to drive. The chances of being killed in a single-vehicle crash are increased at a blood alcohol level that a 140-lb. woman would reach after having one drink on an empty stomach.
Medication interactions: Alcohol can interact with a wide variety of medicines, both prescription and over-the-counter. Alcohol can reduce the effectiveness of some medications, and it can combine with other medications to cause or increase side effects. Alcohol can interact with medicines used to treat conditions as varied as heart and blood vessel disease, digestive problems, and diabetes. In particular, alcohol can increase the sedative effects of any medication that causes drowsiness, including cough and cold medicines and drugs for anxiety and depression. When taking any medication, read package labels and warnings carefully.
Breast cancer: Research suggests that as little as one drink per day can slightly raise the risk of breast cancer in some women, especially those who are postmenopausal or have a family history of breast cancer. It is not possible, however, to predict how alcohol will affect the risk for breast cancer in any one woman.
Fetal Alcohol Syndrome: Drinking by a pregnant woman can harm her unborn baby, and may result in a set of birth defects called fetal alcohol syndrome (FAS).

Fetal Alcohol Syndrome

Fetal alcohol syndrome (FAS) is the most common known preventable cause of mental impairment. Babies with FAS have distinctive changes in their facial features and they may be born small. The brain damage that occurs with FAS can result in lifelong problems with learning, memory, attention, and problem solving. These alcohol-related changes in the brain may be present even in babies whose appearance and growth are not affected. It is not known if there is any safe drinking level during pregnancy; nor is there any stage of pregnancy in which drinking—at any level—is known to be risk free. If a woman is pregnant, or wants to become pregnant, she should not drink alcohol. Even if she is pregnant and already has consumed alcohol, it is important to stop drinking for the rest of her pregnancy. Stopping can reduce the chances that her child might be harmed by alcohol.
Another risk of drinking is that a woman may at some point abuse alcohol or become alcoholic (alcohol dependent). Drinking four or more drinks on any given day OR drinking eight or more drinks in a typical week increases a woman’s risk of developing alcohol abuse or dependence.
The ability to drink a man—or anyone—under the table is not a plus: it is a red flag. Research has shown that drinkers who are able to handle a lot of alcohol all at once are at higher—not lower—risk of developing problems, such as dependence on alcohol.

Heavy Drinking

An estimated 5.3 million women in the United States drink in a way that threatens their health, safety, and general well-being. A strong case can be made that heavy drinking is more risky for women than men:
• Heavy drinking increases a woman’s risk of becoming a victim of violence and sexual assault.
• Drinking over the long term is more likely to damage a woman’s health than a man’s, even if the woman has been drinking less alcohol or for a shorter length of time than the man.
The health effects of alcohol abuse and alcoholism are serious. Some specific health problems include:
• Alcoholic liver disease: Women are more likely than men to develop alcoholic hepatitis (liver inflammation) and to die from cirrhosis.
• Brain disease: Most alcoholics have some loss of mental function, reduced brain size, and changes in the function of brain cells. Research suggests that women are more vulnerable than men to alcohol-induced brain damage.
• Cancer: Many studies report that heavy drinking increases the risk of breast cancer. Alcohol also is linked to cancers of the digestive track and of the head and neck (the risk is especially high in smokers who also drink heavily).
• Heart disease: Chronic heavy drinking is a leading cause of cardiovascular disease. Among heavy drinkers, women are more susceptible to alcohol-related heart disease, even though women drink less alcohol over a lifetime than men.
Finally, many alcoholics smoke; smoking in itself can cause serious long-term health consequences.

Alcohol in Women’s Lives: Safe Drinking Over a Lifetime

The pressures to drink more than what is safe—and the consequences—change as the roles that mark a woman’s life span change. Knowing the signs that drinking may be a problem instead of a pleasure can help women who choose to drink do so without harm to themselves or others.

Adolescence

Despite the fact that drinking is illegal for anyone under the age of 21, the reality is that many adolescent girls drink. Research shows that about 37 percent of 9th grade girls—usually about 14 years old—report drinking in the past month. (This rate is slightly more than that for 9th grade boys.) Even more alarming is the fact that about 17 percent of these same young girls report having had five or more drinks on a single occasion during the previous month.

Consequences of Unsafe Drinking

• Drinking under age 21 is illegal in every State.
• Drunk driving is one of the leading causes of teen death.
• Drinking makes young women more vulnerable to sexual assault and unsafe and unplanned sex. On college campuses, assaults, unwanted sexual advances, and unplanned and unsafe sex are all more likely among students who drink heavily on occasion—for men, five drinks in a row, for women, four. In general, when a woman drinks to excess she is more likely to be a target of violence or sexual assault.
• Young people who begin drinking before age 15 have a 40-percent higher risk of developing alcohol abuse or alcoholism some time in their lives than those who wait until age 21 to begin drinking. This increased risk is the same for young girls as it is for boys.
Alcohol’s Appeal for Teens. Among the reasons teens give most often for drinking are to have a good time, to experiment, and to relax or relieve tension. Peer pressure can encourage drinking. Teens who grow up with parents who support, watch over, and talk with them are less likely to drink than their peers.
Staying Away From Alcohol. Young women under age 21 should not drink alcohol. Among the most important things parents can do is to talk frankly with their daughters about not drinking alcohol.

Women in Young and Middle Adulthood

Young women in their twenties and early thirties are more likely to drink than older women. No one factor predicts whether a woman will have problems with alcohol, or at what age she is most at risk. However, there are some life experiences that seem to make it more likely that women will have drinking problems.
Heavy drinking and drinking problems among White women are most common in younger age groups. Among African American women, however, drinking problems are more common in middle age than youth. A woman’s ethnic origins—and the extent to which she adopts the attitudes of mainstream vs. her native culture—influence how and when she will drink. Hispanic women who are more “mainstream” are more likely to drink and to drink heavily (that is, to drink at least once a week and to have five or more drinks at one time).
Research suggests that women who have trouble with their closest relationships tend to drink more than other women. Heavy drinking is more common among women who have never married, are living unmarried with a partner, or are divorced or separated. (The effect of divorce on a woman’s later drinking may depend on whether she is already drinking heavily in her marriage.) A woman whose husband drinks heavily is more likely than other women to drink too much.
Many studies have found that women who suffered childhood sexual abuse are more likely to have drinking problems.
Depression is closely linked to heavy drinking in women, and women who drink at home alone are more likely than others to have later drinking problems.

Stress and Drinking

Stress is a common theme in women’s lives. Research confirms that one of the reasons people drink is to help them cope with stress. However, it is not clear just how stress may lead to problem drinking. Heavy drinking by itself causes stress in a job and family. Many factors, including family history, shape how much a woman will use alcohol to cope with stress. A woman’s past and usual drinking habits are important. Different people have different expectations about the effect of alcohol on stress. How a woman handles stress, and the support she has to manage it, also may affect whether she uses alcohol in response to stress.

Consequences of Unsafe Drinking

• The number of female drivers involved in alcohol-related fatal traffic crashes is going up, even as the number of male drivers involved in such crashes has decreased. This trend may reflect the increasing number of women who drive themselves, even after drinking, as opposed to riding as a passenger.
• Long-term health problems from heavy drinking include liver, heart, and brain disease; suppression of the immune system; and cancer.
• Because women are more likely to become pregnant in their twenties and thirties, this age group faces the greatest risk of having babies with the growth and mental impairments of fetal alcohol syndrome, which is caused by drinking during pregnancy.

Older Women

As they grow older, fewer women drink. At the same time, research suggests that people born in recent decades are more likely to drink—throughout life—than people born in the early 1900s. Elderly patients are admitted to hospitals about as often for alcohol-related causes as for heart attacks.
Older women may be especially sensitive to the stigma of being alcoholic, and therefore hesitate to admit if they have a drinking problem.

Consequences of Unsafe Drinking

• Older women, more than any other group, use medications that can affect mood and thought, such as those for anxiety and depression. These “psychoactive” medications can interact with alcohol in harmful ways.
• Research suggests that women may be more likely to develop or to show alcohol problems later in life, compared with men.
Age and Alcohol. Aging seems to reduce the body’s ability to adapt to alcohol. Older adults reach higher blood levels of alcohol even when drinking the same amount as younger people. This is because, with aging, the amount of water in the body is reduced and alcohol becomes more concentrated. But even at the same blood alcohol level, older adults may feel some of the effects of alcohol more strongly than younger people.
Alcohol problems among older people often are mistaken for other aging-related conditions. As a result, alcohol problems may be missed and untreated by health care providers, especially in older women.
Staying Well. Older women need to be aware that alcohol will “go to their head” more quickly than when they were younger. Also, caregivers need to know that alcohol may be the cause of problems assumed to result from age, such as depression, sleeping problems, eating poorly, heart failure, and frequent falls.
The National Institute on Alcohol Abuse and Alcoholism recommends that people ages 65 and older limit their consumption of alcohol to one drink per day.
An important point is that older people with alcohol problems respond to treatment as well as younger people. Those with shorter histories of problem drinking do better in treatment than those with long-term drinking problems.

Women and Problem Drinking

Fewer women than men drink. However, among the heaviest drinkers, women equal or surpass men in the number of problems that result from their drinking. For example, female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics, including deaths from suicides, alcohol-related accidents, heart disease and stroke, and liver cirrhosis.

An Individual Decision

A woman’s genetic makeup shapes how quickly she feels the effects of alcohol, how pleasant drinking is for her, and how drinking alcohol over the long term will affect her health, even the chances that she could have problems with alcohol. A family history of alcohol problems, a woman’s risk of illnesses like heart disease and breast cancer, medications she is taking, and age are among the factors for each woman to weigh in deciding when, how much, and how often to drink.

What Are Alcohol Abuse and Alcoholism?

Alcohol abuse is a pattern of drinking that is harmful to the drinker or others. The following situations, occurring repeatedly in a 12-month period, would be indicators of alcohol abuse:
• Missing work or skipping child care responsibilities because of drinking
• Drinking in situations that are dangerous, such as before or while driving
• Being arrested for driving under the influence of alcohol or for hurting someone while drunk
• Continuing to drink even though there are ongoing alcohol-related tensions with friends and family.
Alcoholism or alcohol dependence is a disease. It is chronic, or lifelong, and it can be both progressive and life threatening. Alcoholism is based in the brain. Alcohol’s short-term effects on the brain are what cause someone to feel high, relaxed, or sleepy after drinking. In some people, alcohol’s long-term effects can change the way the brain reacts to alcohol, so that the urge to drink can be as compelling as the hunger for food. Both a person’s genetic makeup and his or her environment contribute to the risk for alcoholism. The following are some of the typical characteristics of alcoholism:
• Craving: a strong need, or compulsion, to drink
• Loss of control: the inability to stop drinking once a person has begun
• Physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking
• Tolerance: the need for increasing amounts of alcohol to get “high.”

Know the Risks

Research suggests that a woman is more likely to drink excessively if she has any of the following:
• Parents and siblings (or other blood relatives) with alcohol problems
• A partner who drinks heavily
• The ability to “hold her liquor” more than others
• A history of depression
• A history of childhood physical or sexual abuse.
The presence of any of these factors is a good reason to be especially careful with drinking.

How Do You Know if You Have a Problem?

Answering the following four questions can help you find out if you or someone close to you has a drinking problem.
• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
One “yes” answer suggests a possible alcohol problem. If you responded “yes” to more than one question, it is very likely that you have a problem with alcohol. In either case, it is important that you see your health care provider right away to discuss your responses to these questions.
Even if you answered “no” to all of the above questions, if you are having drinking-related problems with your job, relationships, health, or with the law, you should still seek help.

Treatment for Alcohol Problems

Treatment for an alcohol problem depends on its severity. Women who have alcohol problems but who are not yet alcohol dependent may be able to stop or reduce their drinking with minimal help. Routine doctor visits are an ideal time to discuss alcohol use and its potential problems. Health care providers can help a woman take a good hard look at what effect alcohol is having on her life and can give advice on ways to stop drinking or to cut down.

Research Directions

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a component of the National Institutes of Health (NIH), supports about 90 percent of the Nation’s research on alcohol use and its effects. The goal of this research is to better understand the causes and consequences of alcohol abuse and addiction, and to find new ways to prevent and treat alcohol problems.
Finding out what makes some women drink too much is the first step to preventing alcohol problems in women. Scientists are studying the role of genetics and family environment in increasing or decreasing the risk of alcohol problems. They also are studying other features of a woman’s life, such as the type of job she has; whether she combines family and work; life changes like marriage, divorce, and the birth and departure of children; infertility; relationship and sexual problems; and ethnic background.
Scientists want to know why women in general seem to develop long-term health problems from drinking more quickly than men. Researchers are examining issues like alcohol and breast cancer in women, and the extent to which alcohol may lower the risk of heart disease, and possibly osteoporosis, in some women.
Finally, research is helping determine how to identify women who may be at risk for alcohol problems, and to ensure that treatment will be effective.
The Office of Research on Women’s Health (ORWH) serves as the focal point for women’s health research at NIH. ORWH works in a variety of ways to encourage and support researchers to find answers to questions about diseases and conditions that affect women and how to keep women healthy, and to establish a research agenda for the future. ORWH encourages women of all racial and ethnic backgrounds to participate in clinical studies to help increase knowledge of the health of women of all cultures, and to understand the health-related similarities and differences between women and men. The office also provides opportunities and support for the advancement of women in biomedical careers.

Getting Help and More Information

Alcoholics Anonymous (AA) World Services
Internet address: www.aa.org
Phone: 212–870–3400
Makes referrals to local AA groups and provides informational materials on the AA program. Many cities and towns also have a local AA office listed in the telephone book.
Al-Anon Family Group Headquarters
Internet address: www.al-anon.alateen.org
For locations of Al-Anon or Alateen meetings worldwide, call 888–4AL–ANON (888–425–2666), Monday through Friday, 8 a.m.–6 p.m. (EST)
For free informational materials, call 757–563–1600, Monday through Friday, 8 a.m.–6 p.m.
Makes referrals to local Al-Anon groups, which are support groups for spouses and other significant adults in an alcoholic person’s life. Also makes referrals to Alateen groups, which offer support to children of alcoholics.
National Association for Children of Alcoholics (NACoA)
Internet address: www.nacoa.net
E-mail: nacoa@nacoa.org
Phone: 888–554–COAS or 301–468–0985
Works on behalf of children of alcohol- and drug-dependent parents.
National Clearinghouse for Alcohol and Drug Information (NCADI)
Internet address: www.ncadi.samhsa.gov
Phone: 800–729–6686
Provides alcohol and drug abuse information produced by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
National Council on Alcoholism and Drug Dependence (NCADD)
Internet address: www.ncadd.org
Phone: 800–NCA–CALL (800–622–2255)
Provides telephone numbers of local NCADD affiliates (who can provide information on local treatment resources) and educational materials on alcoholism.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
Bethesda, Maryland 20892–9304
Internet address: www.niaaa.nih.gov
Phone: 301–443–3860
Offers a free 12-minute video, Alcohol: A Woman’s Health Issue, profiling women recovering from alcohol problems and describing the health consequences of heavy drinking in women. Other publications also are available from NIAAA and feature information on a wide variety of topics, including fetal alcohol syndrome, the dangers of mixing alcohol with medications, family history of alcoholism, and preventing underage drinking. See "Additional Reading," below, for information on ordering NIAAA materials.
Substance Abuse Treatment Facility Locator
Internet address: www.findtreatment.samhsa.gov
Phone: 800–662–HELP (800–662–4357)
Offers alcohol and drug information and treatment referral assistance. (This service is provided by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.)

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