Imagine what it would be like to have a serious disease--obvious to everyone around you--that you couldn't recognize yourself. That's the problem for people with alcoholism or alcohol dependence. They not only deny that they have a problem with alcohol, but also actually believe this is true.
People with alcoholism experience such powerful cravings for alcohol that their lives revolve around getting and consuming it. For many, their dependence on alcohol demands that they consume it almost continuously or they will experience unpleasant--and potentially dangerous--withdrawal symptoms.
Alcoholism is the most severe form of alcohol problem, and it is not the only one. A far more common problem is that of alcohol abuse. Although people who abuse alcohol don't experience the same severe cravings, they still consume excessive amounts on a regular basis, or engage in occasional binge drinking.
A recent survey of Los Angeles County residents found that 23% of men and 7% of women reported binge drinking--defined as consuming five or more drinks on one occasion--in the last month.
Everyone is familiar with the most obvious problems related to alcohol abuse and dependence, especially the injuries and deaths caused by drunk drivers, and the families destroyed by alcoholism. Too few are aware of the more subtle, but no less devastating, medical effects of excessive alcohol intake.
Alcohol can have serious consequences on organs throughout your body. Heavy drinking can cause inflammation of the liver that can lead to permanent scarring and liver failure. Inflammation of the pancreas can also occur, producing a potentially life-threatening condition called pancreatitis. Alcohol can inflame and destroy the delicate membrane that lines the stomach and contribute to stomach ulcers.
People who drink heavily are about 10 times more likely to develop cancer than individuals who don't drink at all or who drink only modestly. Their risk of cancer of the mouth, throat, voice box and esophagus is increased most dramatically. For women, alcohol appears to also increase the risk of breast cancer. Alcohol can damage the nervous system, including the brain. This damage can be clearly seen in images of the brain made with PET scans and MRIs, as well as on tests that measure a person's ability to think. Memory loss similar to that seen in Alzheimer's disease has also been linked to heavy drinking.
In some people, alcohol can cause blood pressure and cholesterol levels to rise; in others, it can cause irreversible enlargement of the heart. The bottom line: Heavy drinking shortens life expectancy in both men and women.
But what about moderate drinking? How much is too much? These are difficult questions to answer, because moderate alcohol intake is associated with some benefits as well as risks. For example, modest drinking reduces the chances of developing heart disease and can result in beneficial changes in cholesterol levels.
Drinking and driving, however, even after only a couple of drinks, greatly increases your chances of an accident. To determine if your drinking may be creating a problem for you, start by examining the amount of alcohol you consume. Ask yourself the following questions: How frequently do you drink? When you drink, how many drinks do you typically have? What is the most you will drink on any one occasion?
As a rule of thumb, an average of more than two drinks per day for a man and one per day for a woman, or more than four drinks per occasion for a man or three drinks for a woman puts you at risk of alcohol-related problems.
Next consider if your drinking is having any negative consequences on your life:
* Is your drinking causing problems with your job?
* Are your relationships with your spouse, children or friends suffering as a result of your drinking?
* Has your drinking gotten you in trouble with the law?
* Are you experiencing any medical problems that might be caused or aggravated by your drinking?
If you answered yes to one or more of these questions but continue to drink, you may have an alcohol-related problem and should immediately consider giving up drinking completely. Quitting is difficult to do alone, so get help. A good person to start with is your physician, who can help you evaluate your drinking more extensively to make appropriate treatment recommendations.
People with alcohol-related problems aren't the only ones who should abstain from using alcohol. Alcohol should be avoided by women who are pregnant or who are trying to get pregnant. Drinking during pregnancy places the unborn baby at risk for fetal alcohol syndrome--a group of physical and behavioral abnormalities. Although fetal alcohol syndrome is usually seen only in infants born to mothers who drink heavily, no safe level of alcohol consumption has been established during pregnancy.
Women who drink when they are trying to become pregnant may also find it harder to conceive. In one study, women consuming one to five drinks a week were 39% less likely to get pregnant over a six-month period than women who didn't drink at all.
Alcohol should also be avoided by people with medical conditions that could be aggravated by drinking, such as liver disease or ulcer disease, as well as individuals taking a medication that interacts with alcohol. Many drugs, including many over-the-counter products such as acetaminophen, can produce dangerous side effects when mixed with alcohol.
Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at email@example.com. Our Health runs the second and fourth Mondays of each month.