The effect of alcohol on health is complicated. For individuals with a personal or family history of alcoholism, even mild alcohol use carries risks. For others, moderate alcohol use appears to offer a degree of protection against heart disease. For some people (e.g., those who had a heart attack), moderate alcohol use can further damage the heart muscle. And for all people, excessive alcohol use is extremely dangerous to both the drinker and people around him or her. This article helps to sort out the research that has been done on the effects of alcohol on health. It concludes with a self-test for people who are concerned that they may be alcohol dependent.

Present in beer, wine, mixed drinks and a variety of other beverages, alcohol seems to be everywhere. It is offered and consumed at religious, social and other celebratory events around the world. Many people do not think of alcohol as a drug. However, alcohol is a drug that affects the body in various ways, depending on the dose. Small amounts can have a stimulant effect, while larger amounts act as depressants – similar to a sedative or even a hypnotic drug. Alcohol can lead to lack of coordination and personality changes. Like other drugs, excessive amounts of alcohol make the heart work harder and can lead to coma or death.

Blood alcohol concentration (BAC) is the amount of alcohol present in a person’s bloodstream. It is determined by the speed of consumption as well as the drinker’s gender, weight, build and metabolism. As the BAC increases, the brain and spinal cord central system nervous show progressively less activity. A BAC of 50 mg/dL (milligrams per deciliter) of blood, for example, usually leads to a state of mild intoxication. A BAC of 100 to 150 leads to slurring, loss of balance and other signs of intoxication in most people. Coma is likely at a BAC of 350, and death will probably occur at 500.

Through a process called oxidation, alcohol is detoxified and removed from the blood. The higher the blood alcohol concentration (BAC), the longer this process takes and the longer normal bodily function and activity are affected. Alcohol is metabolized (broken down) from the body more slowly than it is absorbed. That means that the more an individual drinks, the harder the metabolism works to break it down so the body can absorb it before intoxication and even poisoning can occur.

In the average adult, 8.5 grams of alcohol are metabolized in the body per hour. The effects of alcohol are also influenced by an individual’s mental and emotional state, individual alcohol tolerance level, and the presence of other medications in the body at the time of consumption. The amount and type of food in the stomach before alcohol consumption is also a factor in the rate of absorption into and elimination from the body.

At this point, medical experts do not recommend that non-drinkers begin drinking alcohol for better cardiovascular health. Research is still being done to clarify the relationship between alcohol and the heart. However, findings in recent years have suggested that moderate alcohol consumption in middle-aged or older men and women may offer some people a degree of protection against heart disease. Moderate drinking is defined as no more than one drink per day for women and no more than two drinks per day for men. One drink is equal to the following: 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

Specific heart-related benefits may include:

• Raising HDL (“good”) cholesterol levels.
  
  
• Lowering blood pressure.
  
  
• Providing antioxidant effects (helping to prevent artery damage caused, in part, by LDL oxidation).
  
  
• Inhibiting the formation of potentially dangerous blood clots in the coronary arteries. Alcohol may help prevent blood clots by breaking up the body’s natural blood-clotters (platelets) and/or by decreasing the “stickiness” (viscosity) of blood. However, these anti-clotting properties can be dangerous in some people because they increase the risk of hemorrhagic stroke from excessive bleeding in the brain.
  
  
• Lowering some people’s risk of sudden cardiac death. Alcohol may help prevent the constriction (narrowing) of coronary arteries, allowing blood to flow more freely.
  
  
• Increasing levels of the hormone DHEA, which has shown cardiovascular protective benefits.

Until the research is clearer, people are urged to avoid excessive drinking and to drink moderate levels of alcohol only after consulting their physician. Preliminary findings suggest a possible ally in the war against heart disease, but alcohol can do more harm than good in some cases.

Moderate or even minimal alcohol use is considered risky for some individuals, including those with a personal or family history of alcoholism or liver disease. For women, use of alcohol is linked to a slightly increased risk of developing breast cancer. Compared with nondrinkers, women who consume one alcoholic drink per day have a small increase in breast cancer risk, and those who drink two to five drinks per day have about one and a half times the risk compared to women who do not drink alcohol. In addition, drinking during pregnancy has been linked to birth defects and is the leading known preventable cause of mental retardation.

Long-term, heavy drinking (three or more drinks a day) increases the risk of liver disease, damage to the brain and pancreas, high blood pressure (hypertension), and hemorrhagic stroke. It can also cause heart disease by damaging the heart muscle itself.

Furthermore, people who have had a heart attack may be at greater risk of developing high blood pressure or further damage to the heart muscle as a result of drinking alcohol. Also, medications such as antidepressants, antibiotics and painkillers do not interact well with alcohol.

Excessive drinking can be a serious health hazard. When an individual drinks, some alcohol is absorbed directly into the stomach lining, some is broken down by enzymes in the stomach and the rest is absorbed from the small intestine into the bloodstream. The alcohol-rich blood then circulates through all the organs of the body, including the heart and brain. Some research has suggested that excessive alcohol use can destroy brain cells, and it has been associated with various types of heart disease. For example, it can lead to alcoholic cardiomyopathy, in which the heart is abnormally enlarged, thickened and/or stiffened, reducing its ability to pump blood to the rest of the body.

Periods of heavy drinking may cause heart rhythm disturbances in some people. Holiday heart syndrome is a condition in which individuals develop a rapid heart rate (atrial fibrillation) after heavy alcohol use. If the person is young and has no other underlying heart disease, including alcoholic heart disease, then the heart rhythm will ordinarily return to normal in a few hours. Treatment is usually unnecessary in these people. If the person does have underlying coronary heart disease, then he or she may be at increased risk for a heart attack once the rapid and abnormal alcohol-induced rhythm develops. Most people experiencing holiday heart syndrome have no real knowledge as to whether they have underlying heart disease. Therefore, anyone experiencing this abnormal heart rhythm (arrhythmia) should seek immediate medical attention.

The liver is another organ that is strongly affected by alcohol. When the liver is breaking down alcohol, it is not performing any of its usual functions. Over time, large amounts of alcohol can contribute to the buildup of toxins and other harmful materials in the liver, causing permanent damage. Eventually, the patient may be diagnosed with cirrhosis of the liver, characterized by scarring, fat clogs (also known as “fatty liver”) and/or impaired blood flow through the liver itself. People only have one liver, and the failure of this organ will lead to death in the absence of a liver transplant.

Other health problems that can result from heavy/binge drinking include high blood pressure, stroke and breast cancer. Furthermore, heavy drinking tends to impair judgment, which could increase the likelihood of domestic violence, driving while intoxicated, having an accident on the job and so forth. Not only could this harm the drinker, but it could also harm other people present at the time of injury. Indirectly, family and friends are often hurt emotionally and financially as well.

The following questions are based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) for alcohol dependence. These questions are not intended to serve as a diagnosis or recommendation for or against treatment. They serve only as a screening tool for your own use to assess your drinking habits.

1. Do you find that the same amount of alcohol no longer gives you the “buzz” that it once did, or that you need to drink more in order to get the same effect?
   
   
2. After not drinking alcohol for a matter of hours or days, do you develop (or drink more to avoid) any of the following symptoms?
   • Nausea or vomiting
   • Shaking or trembling
   • Increased sweating, heart rate or pulse
   • Seeing or hearing things that others cannot perceive
   • Nervousness
   • Restlessness
   • Seizures
   
   
3. Do you find yourself drinking more alcohol or drinking for longer periods of time than you mean to?
   
   
4. Have you wanted or tried to drink less but were unable to?
   
   
5. Do you find yourself spending much of your time getting alcohol, drinking it or recovering from its effects?
   
   
6. Have you chosen to spend time drinking instead of pursuing other interests or obligations?
   
   
7. Do you continue to drink despite having gotten into trouble as a result of it?

People who answer “yes” to three or more questions are encouraged to seek guidance from a physician, psychologist, counselor or religious adviser (e.g., a minister or rabbi). An alcohol problem does not just affect the drinker. Concerned family members, friends and co-workers can avail themselves of the excellent services provided by a local branch of Al-Anon.