Alcohol and health

Question

This piglix contains articles or sub-piglix about Alcohol and health

Answer 1

Alcohol intoxication

Alcohol intoxication

Alcohol intoxication (also known as drunkenness among other names) is a physiological state (that may also include psychological alterations of consciousness) induced by the ingestion of ethanol (alcohol).

Alcohol intoxication is the result of alcohol entering the bloodstream faster than it can be metabolized by the liver, which breaks down the ethanol into non-intoxicating byproducts. Some effects of alcohol intoxication (such as euphoria and lowered social inhibitions) are central to alcohol's desirability as a beverage and its history as one of the world's most widespread recreational drugs. Despite this widespread use and alcohol's legality in most countries, many medical sources tend to describe any level of alcohol intoxication as a form of poisoning due to ethanol's damaging effects on the body in large doses; some religions consider alcohol intoxication to be a sin.

Symptoms of alcohol intoxication include euphoria, flushed skin, and decreased social inhibition at lower doses, with larger doses producing progressively severe impairments of balance, muscle coordination (ataxia), and decision-making ability (potentially leading to violent or erratic behavior) as well as nausea or vomiting from alcohol's disruptive effect on the semicircular canals of the inner ear and chemical irritation of the gastric mucosa. Sufficiently high levels of blood-borne alcohol will cause coma and death from the depressive effects of alcohol upon the central nervous system.

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Answer 2

Paddington alcohol test

The Paddington alcohol test (PAT) was first published in the Journal of Accident and Emergency Medicine in 1996. It was designed to identify alcohol-related problems amongst those attending accident and emergency departments. It concords well with the Alcohol Use Disorders Identification Test (AUDIT) questionnaire but is administered in a fifth of the time.

When 40–70% of the patients in an accident and emergency department (AED) are there because of alcohol-related issues, it is useful for the staff of the AED to determine which of them are hazardous drinkers so that they can treat the underlying cause and offer brief advice which may reduce the health impact of alcohol for that patient. In accident and emergency departments it is also important to triage incoming patients as quickly as possible, to reduce staff size and cost. In one study, it took an average of 73 seconds to administer the AUDIT questionnaire but only 20 seconds for the PAT.

The working version of the PAT is reviewed at St Mary's Hospital based on feedback from frontline doctors in the emergency department (A&E) (see below). There is also a modified version in use for an English multi-site programme research (Screening and Intervention Programme for Sensible Drinking, SIPS).

The latest version of the PAT is available on the UK Department of Health website, the Alcohol Learning Centre.

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Answer 3

Passive drinking

Passive drinking, like passive smoking, refers to the damage done to others as a result of drinking alcoholic beverages. These include the unborn fetus and children of parents who drink excessively, drunk drivers, accidents, domestic violence and alcohol-related sexual assaults

On 2 February 2010 Eurocare, the European Alcohol Policy Alliance, organised a seminar on “The Social Cost of Alcohol : Passive drinking”. On 21 May 2010 the World Health Organization reached a consensus at the World Health Assembly on a resolution to confront the harmful use of alcohol.

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Answer 4

Recommended maximum intake of alcoholic beverages

There is no global consensus on recommended maximum intake (or safe limits) of the drug alcohol. The guidelines provided by health agencies of governments are varied and are shown below. These recommendations concerning maximum intake are distinct from any legal restrictions (e.g. driving after consuming alcohol) that may apply in those countries. The American Heart Association recommends that those who do not already consume alcoholic beverages should not start doing so because of the negative long-term effects of alcohol consumption.

The guidelines are general guidelines applying to a typical person. However, there are some people who should not consume alcohol, or limit their use to less than guideline amounts. These are:

The standard guidelines may be too high when:

Countries express alcohol intake in units or standard drinks when recommending maximum alcohol intake. In increasing order of unit size a unit or standard drink is defined as:

The standard drink size is given in brackets.

Therefore, these countries recommend limits for men in the range 20–40 g per day.

These countries recommend a weekly limit, but intake on a particular day may be higher than one-seventh of the weekly amount.

Therefore, these countries recommend limits for men in the range 27.2–32 g of ethanol per day and 168–210 g of ethanol per week.

Women trying to become pregnant should look at the guidelines for pregnant women given in the next section.

Therefore, these countries recommend limits for women in the range 10–30 g per day.

These countries recommend a weekly limit, but your intake on a particular day may be higher than one-seventh of the weekly amount.

Therefore, these countries recommend limits for women in the range 14–27.2 g per day and 98–140 g per week.

Excessive drinking in pregnancy is the cause of Fetal alcohol syndrome (BE: foetal alcohol syndrome), especially in the first eight to twelve weeks of pregnancy. Therefore, pregnant women receive special advice. It is not known whether there is a safe minimum amount of alcohol consumption, although low levels of drinking are not known to be harmful. As there may be some weeks between conception and confirmation of pregnancy, most countries recommend that women trying to become pregnant should follow the guidelines for pregnant women.

In short, all countries listed above now recommend that women abstain from alcohol consumption if they are pregnant or likely to become pregnant.

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Answer 5

Subjective response to alcohol

Subjective response to alcohol (SR) refers to an individual's unique experience of the pharmacological effects of alcohol and is a putative risk factor for the development of alcohol use disorder. Subjective effects include both stimulating experiences typically occurring during the beginning of a drinking episode as breath alcohol content (BAC) rises and sedative effects, which are more prevalent later in a drinking episode as BAC wanes. The combined influence of hedonic and aversive subjective experiences over the course of a drinking session are strong predictors of alcohol consumption and drinking consequences. There is also mounting evidence for consideration of SR as an endophenotype with some studies suggesting that it accounts for a significant proportion of genetic risk for the development of alcohol use disorder.

The Low Level of Response Model proposes that individuals who are less sensitive to the effects of alcohol are at greater risk for developing alcohol use disorder. One explanation for this phenomenon is that the experiences of elevated intoxication constitutes a feedback mechanism, which prompts drinking cessation. Low-level responders need to consume more alcohol than high responders to achieve a similar level of intoxication and experience the aversive effects of alcohol; consequently, these individuals must consume more alcohol to trigger the negative feedback loop. Escalating alcohol consumption may ultimately contribute to the development of tolerance, which further dampens sensitivity to alcohol's unpleasant effects. Notably, there is no population-level demarcation separating low from high responders and so level of response is arbitrarily defined (generally in terciles) within a given sample.

Early studies compared SR in individuals (mostly males) with (FH+) and without (FH-) a history of alcohol dependence in order to demonstrate that individual differences in SR could be considered genetically-linked determinants of alcohol use disorder. Non-placebo controlled studies conducted by Schuckit and colleagues found that FH+ males experienced less of the aversive effects of alcohol as compared to FH- males matched on key demographic and body mass variables. Furthermore, FH+ young males and their fathers showed similar SR after reaching peak BAC, suggesting that SR is a heritable risk factor for the development of alcohol use disorder. Schuckit's placebo-controlled studies generally reported lower SR among FH+, as compared to FH-, subjects along declining BAC, with differences more evident among men than women. Additional studies found that FH+ subjects who experienced low-level of response were more than 4 times as likely to meet criteria for alcohol use disorder at 10-year follow-up as compared to FH- subjects who reported the same SR pattern. Subsequent follow-up studies conducted primarily by Schuckit's group established that low-level of response is a genetically-linked risk factor for alcohol use disorder, which is not better explained by robust confounding factors such as age of first drink, current alcohol use and impulsivity. A 1992 meta-analysis further buttressed the Low Level of Response Model by reporting that sons of alcoholics exhibited lower responses to alcohol on both the ascending and descending limbs of the BAC curve. Importantly, differences in SR by family history were significant only in the alcohol condition and not the placebo condition, suggesting that SRs observed in the alcohol condition could be attributed to the pharmacological effects of alcohol, rather than to a confounding factor. A 2011 meta-analysis revealed that FH+ individuals reported lower SR in comparison to FH- individuals across both limbs of intoxication, consistent with the Low Level of Response Model. These findings were more robust along the descending limb of the BAC curve where sedative effects of alcohol are more prevalent and among males who comprised the overwhelming majority of participants in early SR studies.

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Answer 6

Alcohol and weight

The relationship between alcohol and weight is the subject of inconclusive studies. Findings of these studies range from increase in body weight to a small decrease among women who begin consuming alcohol. Some of these studies are conducted with a large number of subjects; one involved nearly 80,000 and another 140,000 subjects.

Findings are inconclusive because alcohol itself contains 7 calories per gram, but research suggests that alcohol energy is not efficiently used. Alcohol also appears to increase metabolic rate significantly, thus causing more calories to be burned rather than stored in the body as fat (Klesges et al., 1994). Other research has found consumption of sugar to decrease as consumption of alcohol increases.

According to Dr. Kent Bunting, the research results do not necessarily mean that people who wish to lose weight should continue to consume alcohol because consumption is known to have an enhancing effect on appetite. Due to these discrepancies in findings, the relationship between alcohol and weight remains unresolved and requires further research.

Biological and environmental factors are thought to contribute to alcoholism and obesity. The physiologic commonalities between excessive eating and excessive alcohol drinking shed light on intervention strategies, such as pharmaceutical compounds that may help those who suffer from both. Some of the brain signaling proteins that mediate excessive eating and weight gain also mediate uncontrolled alcohol consumption. Some physiological substrates that underlie food intake and alcohol intake have been identified. Melanocortins, a group of signaling proteins, are found to be involved in both excessive food intake and alcohol intake.

Alcohol may contribute to obesity. A study found frequent, light drinkers (three to seven drinking days per week, one drink per drinking day) had lower BMIs than infrequent, but heavier drinkers. Although calories in liquids containing ethanol may fail to trigger the physiologic mechanism that produces the feeling of fullness in the short term, long-term, frequent drinkers may compensate for energy derived from ethanol by eating less.

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