Dipali Rinker, Visiting Lecturer, Biostatistics and Public Health, American University of the Caribbean Medical School; Colin Michie, Paediatrician.
Ah! Our beautiful island of St. Maarten: The beautiful waters; sun-drenched beaches; flaming flamboyant trees; soca rhythms; fabulous cuisine; endless supply of beers, wines, rums, myriad of cocktails – and not to leave out festive sorrel!
Alcohol is available everywhere you go; mixology is a popular art form. Between the markets, bars, restaurants and lolos, there is no shortage of access to booze. When does this become a health problem? Isn’t a little alcohol good for us? What can you do if you are concerned about your own drinking or the drinking of a loved one?
Alcohol or ethanol is a simple molecule with which we have a complex relationship. It is created by fermenting grain, fruits or vegetables with a yeast fungus. This product may be distilled to increase the alcohol content.
From Grey Goose to Guavaberry rum or Jose Cuervo, all alcohols are made this way. Fermentation produces small amounts of other alcohols too, called congeners or fusel alcohols that add characteristic flavours. And what variation there is in ethanol’s presentation, not to mention marketing!
Alcohol seems to have always been used by humans. It helps most of us relax, socialise, celebrate – and might even get some of us through tough times. This is because alcohol works by temporarily increasing the production of “feel-good” brain chemicals called dopamine and serotonin.
This is also what makes alcohol so addictive, delivering powerful impacts on wider society. Small amounts of alcohol can improve some aspects of health, but crossing the line to regular drinking is likely to lead to physical problems, bad singing, climbing onto police cars and general bad behaviour...
Drinking alcohol is one of the most common addictive behaviours. For young people in the developed world, it is the most commonly abused drug. Addictive behaviours are those that you might feel compelled to engage in over and over again, despite negative consequences.
Addictive behaviours were once considered “character flaws” or personal failings. Today, we know that addictions are highly complicated, interweaving our personal neuroscience, psychology and environment.
What does alcohol do to our bodies?
Alcohol is absorbed into the bloodstream through the stomach and small intestines. The rate of absorption can vary depending on the strength of the drink. The liver breaks alcohol down at a fixed rate that cannot be altered (0.016% an hour).
Even black coffee cannot help with this! If you have a blood alcohol level of 0.08, the legal driving limit in the UK and USA, it will take five hours to remove it all (0/08/0.016).
Alcohol can cause poisoning if taken rapidly in excess. This can cause of death, particularly following binge drinking (five drinks for a man or four for a woman in a short space of time). Most people who binge drink are not dependent on alcohol.
Over longer periods of time, it can cause addiction or dependence. Women should not drink more than two-three units a day regularly, or 14 units a week. Men should not regularly drink more than three-four units a day, or 21 units each week. Both sexes should have a minimum of two alcohol-free days each week.
The effect of alcohol on your brain depends on how much you’ve had to drink, how fast you have been drinking, whether you have been eating, your age, and whether you are a man or a woman.
At all levels of consumption, it impacts on the brain’s communication pathways, disrupting mood and behaviour, making it harder to think clearly or quickly and to coordinate physical movements or speech.
This is why alcohol consumption is so dangerous, and is linked to accidents at work, at home and in vehicles, aggression and violence, unsafe sex, sexual assaults and suicide. Over time, alcohol can damage the processes of learning, memory and communication; it can cause anxiety and depression.
Alcohol leads to inflammatory changes in most of our organs. It reduces the effectiveness of the immune system and can damage the liver, leading to hepatitis, liver scarring (fibrosis) and eventually cirrhosis.
Alcohol use is associated with cancers of the mouth, throat, oesophagus and liver; risks of colon and breast cancer are significantly increased. The link with breast cancer is particularly strong in young women.
It can also lead to heart problems, ulcers of the stomach and pancreatitis (inflammation of your pancreas). In men, alcohol reduces testicular production of testosterone. It can cause muscle weakness including weakness of the heart muscle. In pregnant mothers, alcohol damages the foetal brain and can increase the risk of miscarriage and stillbirth.
When does alcohol become a problem?
What is “too much drinking?” Estimates from the USA suggest some 4.5 % of men are dependent on alcohol, 2.5% of women are in the same position. The following questions may be useful as a personal checklist.
Are you drinking more, or longer, than you intended? Are you trying to cut down drinking, but cannot? Have you gotten into situations while or after drinking, more than once, that increased your chances of getting hurt (such as driving, walking in a dangerous area, or having unsafe sex)?
Do you have to drink more than you once did to get the effect you want? Have you continued to drink even though it was making you feel depressed, anxious or affecting your health such as causing blackouts (periods of memory loss while under the influence of alcohol)?
Have you spent a lot of time drinking or hungover? Have you continued to drink even though it was causing trouble with your family or friends? Have you found that drinking or being hungover often interfered with taking care of your home or family, caused job troubles, or problems at school?
Have you given up or cut back on activities that were important or interesting to you in order to drink? Have you experienced legal problems, e.g., being arrested or detained, because of your drinking?
Have you found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, a seizure, or suffered hallucinations?
I’m concerned about my drinking or the drinking of my loved one
Something can be done about it! Choose to cut down, take steps to be safer while drinking, or perhaps stop drinking altogether. Consider these practical options:
- Keeping track of how much you drink.
- Knowing the units of alcohol in standard drink sizes, so you can count your drinks accurately.
- Setting goals, such as deciding how many days a week you want to drink and how many drinks you'll have on those days.
- Finding alternatives to drinking, such as hobbies, relationships, or renewing ones you've missed.
- Avoiding your "triggers” for drinking, such as certain people, places or daily routines.
- Planning how to handle urges, such as reminding yourself of your reasons for changing.
- Knowing your limit.
- Consider selecting a designated driver, or take a cab.
- Avoid walking in a dangerous area, swimming, or driving a boat during or after drinking.
- If you choose to quit drinking altogether, consider seeking social support.
- You should not drink at all if you are pregnant, under 21, have health problems or a job that requires careful coordination.
- Reducing your alcohol intake in 2020, whatever it is, will reduce your carbon footprint and help you stay healthy.
Useful resources:
www.niaaa.nih.gov/sites/default/files/publications/Rethinking_Drinking.pdf
www.cdc.gov/alcohol
www.rethinkingdrinking.niaaa.nih.gov
