ALCOHOL, HEALTH EFFECTS OF

In the year 2000, total per capita alcohol consumption was 9.5 liters in the countries in the European Union, 7.7 liters in Australasia, 7.0 liters in Eastern Europe, 6.7 liters in North America, 4.1 liters in Latin America, and 2.3 liters in the rest of the world. Compared with the figures for 1990, consumption decreased in the richer regions and increased in the poorer regions. These estimates are based on 58 countries with reliable data. Alcohol from home production and other non-registered sources is not included, although these can be important sources of alcohol in poor countries. Although wide differences exist, there is a general trend toward homogenization of per capita alcohol consumption and of the relative shares of beer, wine, and spirits worldwide.

Distribution of Alcohol Consumption

The distribution of alcohol consumption in a population is typically skewed, with a minority (e.g., 10%) accounting for the bulk (e.g., 50%) of the total consumption. On average men consume much more alcohol than women do. By age, consumption peaks among young adults and then gradually decreases, except among alcoholics, who usually increase their consumption with age (progressively or with fluctuations). Some manage to become ex-drinkers or moderate drinkers. The proportion of abstainers varies greatly by country, ranging from as low as about 10 percent in countries with high alcohol consumption to practically 100 percent in countries that shun alcohol.

Effects on Health and Mortality

Alcohol intake influences the risk of death, disease, injuries, and mental illness. In general populations the relationship between alcohol intake and total mortality is curvilinear. Abstainers have slightly higher mortality than do moderate drinkers, and heavy drinkers have much higher mortality than do the other two groups. On average mortality among drinkers equals that among abstainers at the level of 40 grams per day of alcohol for men and 20 grams per day for women. (One drink contains approximately 12 grams of alcohol.) The relationship between alcohol intake and the overall occurrence of diseases, hospital admissions, and leaves of absence is also curvilinear.

Mortality among alcoholics after treatment is from two to six times the level of the general population. Such death rates shorten the lifespan of this group by 6 to 18 years. Excess mortality is due partly to tobacco use and unhealthy living habits.

Heavy alcohol intake increases strongly the incidence of liver cirrhosis, respiratory and gastrointestinal tract cancer, hemorrhagic stroke, hypertension, and injuries. Less strong but clear increases can be found for chronic pancreatitis and cancers of the liver, colon, and rectum. Heavy drinking also causes cardiomyopathy, peripheral neuropathy, myopathy, and hepatitis. Alcohol drinking is not related to the incidence of ischemic stroke and peptic or duodenal ulcers.

Alcohol weakens sensorimotor coordination. Thus, alcohol use, especially at levels producing intoxication, increases the risk of accidents, violence, and self-harm. The probability of becoming involved in a serious or fatal traffic accident increases with rising blood alcohol concentration. Some but not all studies show an exponential increase in that risk.

Several studies have found an increased risk of (female) breast cancer among drinkers compared with abstainers, but the low relative risk and the multitude of potential confounding factors make it difficult to draw any firm conclusions about causality.

The risk of spontaneous abortion, intrauterine growth retardation, premature birth, and fetal alcohol syndrome is increased by alcohol intake. The available data are not sufficient to indicate whether there is a safe limit for cognitive developmental deficits. The only absolutely safe course is to abstain during pregnancy.

Research strongly supports the view that moderate alcohol intake decreases the risk of coronary heart disease. Compared with abstainers, the lowest relative risk of coronary heart disease is 22 percent lower at the level of consumption of 29 grams per day, according to high-quality studies. Most of the decrease in coronary heart disease risk is due to an increase in high-density lipoprotein (HDL) cholesterol. A moderate intake of alcohol seems to decrease the risk of dementia, diabetes, and gallstones. Blood pressure is likely to increase with an alcohol intake exceeding 25 grams per day. Heavy drinkers show increased atherosclerosis, an increased risk of tachyarrhythmias, and decreased variability of heart rhythm.

Moderate drinkers have better emotional and social adjustment and fewer psychiatric hospital admissions than abstainers. These differences may, however, be due to the inclusion of people with mental problems in the group of abstainers. Alcohol is likely to be harmful for the mentally ill because it may aggravate their symptoms and interfere with drug treatment.

Some observations suggest that wine may be especially beneficial for health, but others disagree. The differences in health effects between alcohol consumed as beer, wine, and spirits might be explained by varying drinking patterns related to different beverages.

No definite safe or optimal levels of alcohol intake can be ascertained because self-reports of alcohol intake tend to be underestimates. Potential benefits and harm from alcohol intake vary between individuals, depending on their drinking patterns and other risk factors. For a moderate intake level and pattern of use, the evidence suggests that the health benefits outweigh the risks.

See also: Diseases, Chronic and Degenerative; Tobacco-Related Mortality.

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Kari Poikolainen