The Health Effects of Alcohol and Alcohol Use Disorders

What are the health effects of alcohol? And when can a person be said to have a problem with alcohol consumption?

It is now a fact that those who drink alcohol in excess and on a regular basis expose themselves to serious health risks in the short, medium, and long term. According to the Center for Disease Control and Prevention, this excess leads to the deaths of 95,000 people per year and a total loss of 2.8 million years of accumulated life potential. Preventing all of these premature deaths is a colossal public health challenge.

Alcohol Abuse

Short- and long-term risks

First, a few notes on risks. In the short term, alcohol abuse can cause injuries of varying severity, such as car crashes, falls, drownings, or accidents in everyday life. It also increases the risk of violence and thus the risk of homicide, sexual assault, domestic violence, and death. Above a certain limit, alcohol can put the drinker into a coma. In addition, forgetting to protect oneself against sexually transmitted diseases by the means available can lead to risky sexual behavior. Finally, for pregnant women alcohol increases the risk of miscarriages and stillbirths.

In the long run, chronic alcohol consumption raises your blood pressure, a risk factor for cardiovascular disease, and can lead to an increased risk of heart attack, stroke, liver disease, and digestive disease. The risk of cancer is also increased specifically for cancers of the breast, mouth, throat, esophagus, liver, and colon. Alcohol also impairs the efficiency of your immune system, making you more likely to get sick if you are attacked by a pathogen. Problems with memory, learning, depression, anxiety, and social problems are also worsened by chronic alcohol consumption. Some people feed the drink, which makes it even more problematic.

The classification of alcoholism and alcohol-related disorders has changed considerably since the 1970s. First, it should be noted that there are two international classifications for alcohol-related disorders. The American classification through the Diagnostic and Statistical Manual of Mental Disorders (DSM) attempts to classify alcohol use disorders into one with degrees of severity. The International Classification of Diseases (ICD) of the World Health Organization (WHO) divides them into two levels, distinguishing between the behavioral dimension (harmful use) and the actual dependence (physical symptoms). There are therefore lists of certain specific criteria that must be met in order to diagnose an alcohol-related disorder.

In the early 1970s, alcohol dependence syndrome was referred to as alcoholism; today, the appropriate terminology is alcohol use disorders. In the 1970s, pharmacological dependence syndrome was discovered in the context of withdrawal. Prior to that, iatrogenic (i.e., medically induced) mortality was high, and this discovery brought purely biological theories of substance use to the forefront. In the fight against opiates, for example, the prevailing belief is that use is not behavioral but is a purely biological phenomenon.

But then, what led us to believe today that the behavioral aspect is most important? We realized that it was ultimately related to addiction rather than just the pharmacological and physical symptoms.

When discussing alcohol use disorders and their definition, it is important to distinguish between two types of prognosis. First, the so-called overall physical prognosis in the short, medium, and long term. It includes physical consequences related to the doses of alcohol consumed, such as mortality. In this context, one could cite the famous J-shaped effect (in terms of the shape of the curve) of alcohol-related mortality which shows that not drinking alcohol at all would be more harmful than drinking it sensibly, at least in terms of mortality.

In reality, there are confounding factors that taint these associations. For example, people who do not drink alcohol at all may have health problems that worsen when they drink alcohol, and therefore have a lower life expectancy as a result of their illness. In addition, people of certain religious denominations abstain from alcohol and their denomination correlates with lower socioeconomic status, which is the factor that best explains the increased mortality. Then there is what is known as addiction prognosis. This represents a person’s chances of coming out of their addiction. Here, factors such as the daily dose consumed are relevant, but to a lesser extent than behavioral and psychosocial factors, such as job loss, social isolation, or various personal problems.

What does it mean? In short, it’s the long-term chronic dose used that matters for health outcomes, although early studies on the consequences of binge drinking reported more frequent accidents and long-term cardiovascular and neurological damage. Thus, physical dependence is not everything, and as such, it would seem that it is better to be physically dependent with a favorable psychosocial environment than vice versa.

How do we treat these disorders today?

Today, we have strategies and tools to work with beforehand to identify people who are at risk for developing alcohol use disorders. We also do outreach with the general population. We try to educate people about the risk of alcohol. Early interventions are carried out with young people to raise awareness and maintain an attitude of understanding. It is important to avoid lecturing at all costs so as not to be seen as an adversary to the young adults and their desire to party.