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Many people who develop alcohol dependence
do so fairly soon after their first drink:
50% in less than 5 years
24% in lessthan 2 years
14% in lessthan
1 year
U.S.DEPARTMENTOFHEALTHANDHUMANSERVICES•NationalInstitutesofHealth•NationalInstituteonAlcoholAbuseandAlcoholism
FEATURE
YOUAREWHATYOUEATANDDRINK:NEWRESEARCHFOCUSESONALCOHOLANDNUTRITIONMoreandmoreresearchersareinvestigatinghowalcoholandnutritioninteracttoimpactourbiology,ourbehavior,andourhealth.Inadditiontodependence,alcoholcantriggerahostofhealthproblems,includingcertaincancers,cardiovasculardisease,liver
These images compare the synapse formation (appears in red) in the neurons from two mouse fetuses. The one on the left is from the fetus that had sufficient DHA during gestation while the one on the right is from the fetus that did not. The neurons derived from the DHA-deficient mouse fetus show 50 percent fewer synapses. The inhibited synapse formation due to DHA-deficiency may have significant implication in developing depression and alcohol dependence.
Photo courtesy of Dr. Hee-Yong Kim, NIAAA intramural program of (Journal of Neurochemistry. 2009 Oct;111(2):510-21).
disease,andfetalalcoholsyndrome.Researchersareinterestedinwhatrolenutritioncanplayinpreventingandtreatingthesealcohol-relatedhealthoutcomes.
“Whenyouthinkaboutalcoholaspartofyouroveralldiet—afoodlikeanyotherthatyouconsumewithotherfoods,itleadstolotsofquestions—likedoesalcoholconsumptionchangefoodintake,doesfoodintakechangealcohol
intake,andhowdovariouspatternsofalcoholandfoodconsumptiontogetherinfluencetheriskofchronicdisease?”saidDr.RosalindBreslow,anepidemiologistinNIAAA’sDivisionofEpidemiologyandPreventionResearch.
Dr.BreslowrecentlycollaboratedwithresearchersattheNationalCancerInstitute(NCI)andtheU.S.DepartmentofAgriculture(USDA)toinvestigatesomeoftheconnectionsbetweenalcoholanddiet.SheledateamthatanalyzeddatacollectedfromparticipantsintheNationalHealthandNutritionExaminationSurvey(NHANES)andfromscoresontheHealthyEating
Index-2005(HEI).NHANESisasurveyofnationallyrepresentativesamplesoftheU.S.populationthattheU.S.DepartmentofHealthandHumanServices’CentersforDiseaseControlandPreventionconductsonanongoingbasis.TheUSDAcreatedHEItomeasurehowhealthyourdietsarebasedonhowcloselytheyconformtothe2005U.S.dietaryguidelinesforAmericans.
INTHISISSUEFEATURES
1YouAreWhatYouEatandDrink:NewResearchFocusesonAlcohol andNutrition
2Alcohol’sHealthEffectsGoBeyondHangovers
CHARTICLE3HowLongDoesItTakeAlcoholDependenceToDevelop?
PHOTOESSAY4IntheLineofDuty:HowtheLiverBecomesDamagedasItDegradesAlcohol
NEWSFROMTHEFIELD5ModerateDrinkersMayLiveLongerThanNon-Drinkers
5MoreAdultsDrinking…andinWaysThatIncreaseRisk
6NewCompoundImprovesObesity-RelatedHealthComplications
7Half-hourInterventionsCanHelpReducePeerViolenceandAlcoholConsequencesAmongTeens
5QUESTIONSWITH...7SamZakhari,Ph.D.
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Dr.Breslowandherteamfoundthatheavierdrinkerstendtoeatlessfruitandconsumemorecaloriesfromacombinationofalcoholicbeveragesandfoodshighinunhealthyfatsandaddedsugars.Meninparticularwhoconsumedalotofcaloriesfromalcoholalsoatelesswholegrains,animportantsourceofdietaryfiber,andlesslow-fatdairyproducts,includingmilk,yogurt,cheese,andsoybeverages,importantsourcesofcalciumandothernutrients.WomenwhodranktoomuchalsohadlowerHEI-2005scores.
Overall,theresearchersfoundthatasastudyparticipant’saveragedailynumberofdrinkswentup,theirHEI-2005scorewentdown.Thismaybeonereasonwhyheavydrinkersaremoresusceptibletoalcohol’snegativehealtheffects,includingcertaincancers,livercirrhosis,andheartdisease.
Peoplewhodrinkmorealsoconsumelessomega-3fattyacids,whicharefatsthathelpcomposeourbrainandarecriticalforbrainfunction.Thesefatsarefoundinfishlikesalmon,sardines,andtuna.What’smore,alcoholactivelydepletesomega-3sfromthebrain.
“Wecanonlygetomega-3fattyacidsthroughourdiets.Alcoholicshaveverylittleomega-3sgoinginandalotofthemgoingout,”saidJosephHibbeln,M.D.,apsychiatristandactingchief,SectiononNutritionalNeurosciences
atNIAAAandcaptain,U.S.PublicHealthService.
Alcoholcandepleteoneparticulartypeofomega-3fattyacidinthebrain,docosahexaenoicacid,orDHA,byhalf.
Dr.Hibbeln’sresearchismovingtowardunderstandingtheconsequencesofthisDHAdeficiencyforeveryone,includingalcoholics.Forexample,lowDHAlevelscanresultindepression,aggression,andimpulsivity.AsHibbelnstated,“Mymorethan20yearsofresearchindicatesthatpeoplewhoeatlittlefishareatmuchgreaterriskofdepression.”
AlackofDHAinthebraincanalsorundowndopaminelevels.“Itiswellknownthatchronicaddictedstatesarecharacterizedbydopaminedepletion,”explainedHibbeln.Dietsdeficientinomega-3scanlowerdopaminelevelsbyhalf.Arecentstudyintroducedmicewithadietlowinomega-3stolowlevelsofamphetamines.Themicereleaseddopamineatlevelssimilartoachronicallyaddictedanimal.Hibbelnattributesthisdopaminedeficiencytotheir“baddiet.”
Insufficientomega-3scanalsolinkdirectlytoacycleofaddiction.Toolittleomega-3s,coupledwithtoomanyomega-6fattyacids,whicharefatsinabundanceinthetypicalAmericandiet,canleadtoexcessfoodintake,excess
alcoholintake,andaninabilitytofeelsatiated.Thisimbalanceincreasesthecravingforalcohol,andcausesthosewhoaresusceptibletodrinktoomuch.
Onerecentstudyillustratesthepotentialforpositivelyimpactingalcoholdependencebyincreasingomega-3sinthediet.
Dr.Hibbelnoffered2gramsofomega-3sto96alcoholicsinearlyrecovery.Heverifiedthatparticipantsweretakingtheomega-3sbymeasuringthelevelsoffattyacidsintheirspinalfluid.Overthe90daysofthestudy,alcoholicswhotookomega-3shadanaverageofabout3.2drinkingdayscomparedtothe17.5drinkingdaysintheplacebogroup.
“Thisstudyof96alcoholicsprovidespromisingpilotdataforpotentialbenefitsofensuringadequatebrainnutritionamongalcoholicsinrecovery,”Hibbelnsaid.
Hibbelnplanstofocusfuturestudiesonevaluatingwhethertheseresultscanbereplicated.
Hibbeln’sandBreslow’sworkarejusttwoexamplesoftheresearchinvestigatingtheconnectionsbetweenalcoholandnutrition.
AsBreslowsaid,“It’saveryexcitingarea,withimplicationsforbothpublichealthandbasicresearch.”
Continued from page 1
FEATURE
ALCOHOL’SHEALTHEFFECTSGOBEYONDHANGOVERSAlcoholispartofourculture—weuseittocelebrateandsocialize,anditispartofmanyofourreligiousceremonies.
Butdrinkingtoomuch—onasingleoccasionorovertime—canhaveseriousconsequencesforourhealth.Theseconsequencesgofarbeyondhavingaheadacheandahangoverthat
makeusuncomfortable,butgoawayrelativelyquickly.
Mostpeoplerecognizethatexcessivedrinkingcanleadtoaccidentsanddependence,andevenliverdisease.Butthat’sonlypartofthestory.Unlikeotherdrugs,alcoholdispersesinallbodytissuesandthereforehasthepotentialtoharmmanyorgansystems.
Alcoholabusecandamageorgans,weakentheimmunesystem,andcontributetocancers.
Plus,muchlikesmoking,alcoholaffectsdifferentpeopledifferently.Genes,environment,andevendietcanplayaroleinwhetheryoudevelopanalcohol-relateddisease.
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Ontheflipside,somepeoplemayactuallybenefitfromdrinkingalcoholinsmallquantities.
Alcohol’seffectonyourheartisthebestexampleofalcohol’sdualeffects.
Drinkingalotoveralongtimeortoomuchonasingleoccasioncancauseheartproblemsincludinghighbloodpressure,strokes,arrhythmia,andcardiomyopathy,aconditionthatcausesyourheartmuscletoweakenanddroop.Butresearchalsoshowsthat
healthypeoplewhodrinkmoderateamountsofalcoholmayhavealowerriskofdevelopingcoronaryartery
diseasethanpeoplewhoneverdrinkatall.
Whiledrinkinginmoderationmaynotaffectthehealthofyourliver,heavydrinkingcandefinitelytakeitstoll.Yourliverhelpsridyourbodyofsubstancesthatcanbedangerous—includingalcohol.Bybreakingdownalcohol,yourliverproducestoxicbyproductsthatdamagelivercells,promoteinflammation,andweakenthebody’snaturaldefenses.Thiscanmakeconditionsripefordisorderslikesteatosis,fibrosis,andcirrhosis,anddangerousinflammationslikehepatitistodevelop.
Pancreaticinflammationscanalsodevelopinresponsetodrinkingtoomuch.Alcoholcausesthepancreastoproducetoxicsubstancesthatcaneventuallycauseinflammationandswellingintissuesinbloodvessels.Thisinflammation,calledpancreatitis,preventsthepancreasfromdigestingfoodandconvertingitintofueltopoweryourbody.
Asidefromdamagingyourorgans,drinkingtoomuchalcoholcanalsoincreaseyourriskofdevelopingcertaincancers,includingthoseofthemouth,esophagus,pharynx,larynx,liver, andbreast.
Alcoholalsocanweakenyourimmunesystem,makingyourbodyamucheasiertargetfordisease.Drinkingalotonasingleoccasionslowsyourbody’sabilitytowardoffinfections—evenupto24hoursaftergettingdrunk.Chronicdrinkersaremorelikelytocontractdiseaseslikepneumoniaandtuberculosisthanpeoplewhodonotdrinktoomuch.
Tolearnmoreaboutthehealtheffectsofalcohol,pleasedownloadNIAAA’snewestpublication,Beyond Hangovers: Understanding Alcohol’s Impact on Your Health. http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm
CHARTICLE
HOWLONGDOESITTAKEALCOHOLDEPENDENCETODEVELOP?About1in7adultswhohavehadalcoholdependence,commonlyknownasalcoholism,developeditlessthanayearafterhavingtheirfirstdrink,accordingtoanationwidesurveyofU.S.adultsaged18orolder.1Aboutaquarterofpeoplewhohavehadalcoholdependencedevelopeditlessthan2yearsaftertheirfirstdrink,aboutathirdinlessthan3years,andabouthalfinlessthan5years.1
IntheUnitedStates,mostpeoplehavehadtheirfirstdrinkbythetimetheyleavehighschool.2Thisfact,combinedwiththerelativelyrapidonsetofdependenceinmanydrinkers,helpstoexplainwhyalcoholdependenceisfoundmostcommonlyinyoungadults.About1in9peopleaged18–24havealcoholdependence,morethantwicetheproportionofanyotheragegroup.3
Many people who develop alcohol dependence
do so fairly soon after their first drink:
50% in less than 5 years
24% in lessthan 2 years
14% in lessthan
1 year
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Thesurveyalsoshowsthatalcoholdependenceoccursonlyrarelyamongdrinkerswhoalwaysstaywithintheselimits:formen,nomorethan4drinksonanysingledayand14perweek;forwomen,nomorethan3drinksonanydayand7perweek.4
(1)UnpublisheddatafromtheNationalEpidemiologicSurveyonAlcoholandRelatedConditions(NESARC).
(2)FadenVF.TrendsininitiationofalcoholuseintheUnitedStates1975-2003.Alcoholism: Clinical and Experimental Research.2006June;30(6):1011-22.
(3)UnpublisheddatafromtheNESARC.
(4)DawsonDA,etal.Quantifyingtherisksassociatedwithexceedingrecommendeddrinkinglimits.Alcoholism: Clinical and Experimental Research.2005May;29(5):902-8.
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INTHELINEOFDUTY:HOWTHELIVERBECOMESDAMAGEDASITDEGRADESALCOHOL
Thereprobablyisn’tamorevital—yetunderappreciated—organinthehumanbodythantheliver.Whilewemayrecognize,inthemostgeneralterms,therolethattheliverplays,manyofusdon’tfullyunderstanditsmanyfunctionsorvulnerabilities,particularlywithregardtoalcohol.Andyetthealcohol-liverconnectioniscritical,asmorethan2millionAmericanssufferfromliverdiseasecausedbyalcohol.
Byperformingmorethan500differentfunctions,theliverisessentialtoourhealth.Itsprimaryroleistofilterallthebloodinourbodiesbybreakingdownandeliminatingtoxinsandstoringexcessbloodsugar.Italsoproducesenzymesthatbreakdownfats,manufacturesproteinsthatregulatebloodclotting,andstoresanumberofessentialvitaminsandminerals.Alltold,theliverkeepsusalivebyenablingustodigestfood,absorbnutrients,controlinfections,andgetridoftoxicsubstancesinourbodies.
Whileliverproblemscanbeinherited,ordevelopedinresponsetocertainvirusesorchemicals,excessivealcoholuseplaysamajorrole.Tothehumanbody,alcoholisatoxinthatisbrokendownby
theliverasthebodybeginstheprocessofgettingridoftheseforeigncomponents.However,chronicheavydrinkingcausesthelivertobecomefatty.Thisconditionmakesthelivermorevulnerabletodangerousinflammation,suchasalcoholichepatitis,anditsassociatedcomplications.Withcontinueddrinking,persistentinflammationcausesthelivertobefibrotic,whichpreventsthenecessarybloodsupplyfromreachingthelivercells.Withouttheoxygenandothernutrientssuppliedbythisblood,thelivercellseventuallydieandarereplacedwithscartissue,creatingaconditionknownascirrhosis.Inmildcases,thelivercanactuallymakerepairsandcontinuetofunction.However,advancedcirrhosiscausescontinueddeteriorationandliverfailure.
Insomecases,lifestylechangescanhelptreatalcohol-liverproblems.Abstinencefromalcohol,alongwithbetternutritionandquittingsmoking,canhelppreventfurtherinjuryandkeepliverdiseasesincheck.Inextremecases,however,alivertransplantmaybetheprimarytreatmentoption.
PHOTOESSAY
Insert shows a portion of a liver scarred by cirrhosis, in comparison with a healthy liver.
Formoreinformationabouttheeffectsofalcoholontheliverandotherorgans,pleaseseethenewNIAAAbooklet,Beyond Hangovers: Understanding Alcohol’s Impact on Your Health. http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm
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NEWSFROMTHEFIELD
MODERATEDRINKERSMAYLIVELONGERTHANNON-DRINKERS
When compared to abstainers or heavy drinkers, moderate drinkers have the lowest mortality risk.
AnewstudypublishedonlineinAlcoholism: Clinical and Experimental Researchhasshownthatmoderatedrinkingamongolderadultsis
associatedwithlowermortalityratesthanthoseobservedinadultswhodidnotdrinkatall.Whatmakesthisstudydifferentfrompreviousstudieswithsimilarfindingswasthatthe
researcherscontrolledforadditionalfactors,mostnotablynon-drinkerswhopreviouslydrankproblematically.Insimilarstudiesthatdonotcontrolforthehealthproblemscausedbypreviousheavydrinking,theinterpretationoffindingsregardingthepotentialbenefitofmoderatedrinkingismoredifficult.
Thestudy,ledbyCharlesJ.Holahan,Ph.D.,oftheUniversityofTexasatAustin,included1,824adultsbetweentheagesof55and65,andcontrolledforformerproblemdrinkingstatus,existinghealthproblems,andimportantsociodemographicandsocial-behavioralfactors.Whencontrolledforthesefactors,thedatashowedthatnon-drinkershada45percentincreasedmortalityriskovermoderatedrinkers.Additionally,heavy
drinkersshoweda51percentgreatermortalityriskthanmoderatedrinkers.
Theauthorsnotethat,“Theapparenthealth-protectiveeffectsofmoderatealcoholconsumptioncomparedtoabstentionmayberelatedtoreductionsincardiovascularillness.”Theauthorscaution,however,thatthesehealth-protectiveeffects“appeartobelimitedtoregularmoderatedrinking.Heavyepisodicdrinking—evenwhenaverageconsumptionremainsmoderate—isassociatedwithincreasedcardiovascularrisk.”Thearticleabstractcanbefoundhere:
Late-Life Alcohol Consumption and 20-Year Mortality. http://www.ncbi.nlm.nih.gov/pubmed/20735372
NEWSFROMTHEFIELD MOREADULTSDRINKING…ANDINWAYSTHATINCREASERISK
Studies reveal a significant increase in the proportion of men and women who drink.
ArecentanalysisofchangesfromtheNIAAA’s1992NationalLongitudinalAlcoholEpidemiologicSurvey(NLAES)tothe2002NationalEpidemiologicSurveyofAlcoholandRelatedConditions(NESARC)showsthatalargerproportionofU.S.adultsofallethnicities(White,Black,andHispanic)andbothsexeswerecurrentdrinkersin2002,withlittlechangeintheaveragenumberofdrinkspermonth.Notingincreasesinadultmaleswhodrinkfiveormoredrinksadayatleastonceamonth(Whites,Blacks,andHispanics)ordrinktointoxication(WhitesandBlacks),thestudysuggestsa“liberalization”ofattitudes
towardalcoholanddrinkingpracticeslinkedtoriskforalcoholusedisorderandotherconsequences.
Inadditiontoexaminingthe1992to2002trends,RaulCaetanoandco-authorsattheUniversityofTexasSchoolofPublicHealthandtheUniversityofNorthTexasHealthScienceCenteralsolookedatsociodemographicfactorsthatmightinfluencethem.TheiranalysiswaspostedonlineinthejournalAlcoholism: Clinical and Experimental ResearchandwillappearinitsOctober2010issue.
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NEWSFROMTHEFIELD:More Adults Drinking. . . Continued from page 5
Amongthefindings:
•
•
•
Adultmenwhowerecurrentdrinkersincreasedfromabout 53percentin1992to59percent(64percentofWhitemen, 60percentofHispanicmen,and53percentofBlackmen)in2002.
About36percentofadultwomen(47percentofWhitewomen,32percentofHispanicwomen,and30percentofBlackwomen)werecurrentdrinkersin2002,anincreasefrom28percentin1992.
Twoindicatorsofat-riskdrinkingroseamongmenwhoreportedthosepatternsatleastonceamonth:
drinkingfiveormoredrinks/dayincreasedamongWhite,Black,andHispanicmen,anddrinkingtointoxicationincreasedamongWhiteandBlackmen.
•Asinearlierstudies,malegender,singlestatusorlivingalone,U.S.birth,lowereducationallevel,andunemploymentwereassociatedwithhigherdrinkinglevels.
Althoughthestudycontrolledforage,maritalstatus,education,andincome,unknownsociodemographicfactorsmayhavecontributedtotheresults.“Understandingthecomplexreasonsforethnicandgenderdifferenceswill
requirecontinuousmonitoringandfurtheranalyses,”saysDr.Caetano.“Suchmonitoringisessentialfortargetedpreventionandmeaningfulpublicpolicy.”
Thearticleabstractcanbefoundhere:
Sociodemographic Predictors of Pattern and Volume of Alcohol Consumption Across Hispanics, Blacks, and Whites: 10-Year Trend (1992–2002). http://www.ncbi.nlm.nih.gov/pubmed/20645935
NEWCOMPOUNDIMPROVESOBESITY-RELATEDHEALTHCOMPLICATIONSNEWSFROMTHEFIELD
A compound developed by a trans-NIH team and others may block endocannabinoid activity without causing mental health problems.
resultfromblockingendocannabinoidreceptorsinthebrain.Theydevelopedsuchacompound,testeditinobesemice,andfoundthatsuchmiceshowedimprovementsinglucoseregulation,fattyliver,andplasmalipidprofiles.Theyalsofoundthatthecompounddidnotaffectbehavioralresponsesthataremediatedbyendocannabinoidreceptorsinthebrain.
“Thesepreliminaryfindingsareveryencouragingandwarrantfurthertestingofthiscompoundasapotentialpharmacotherapyforthemetabolicsyndromeassociatedwithobesity,”saidDr.Tam.
Thearticleabstractcanbefoundhere:
Peripheral CB1 Cannabinoid Receptor Blockade Improves Cardiometabolic Risk in Mouse Models of Obesity. http://www.ncbi.nlm.nih.gov/pubmed/20664173 Freefulltextofthearticleisavailableat: http://www.jci.org/articles/view/42551
Anexperimentalcompoundappearstoimprovemetabolicabnormalitiesassociatedwithobesity,accordingtoa
preliminarystudyledbyresearchersatNIAAA.AreportofthestudyappearedintheAugust2010issueoftheJournal of Clinical Investigation.
Previousstudieshaveshownthat
compoundsthatblocktheactivityofendocannabinoids—chemicalmessengersinthebodythathelpregulatemanybiologicalfunctions—canleadtoweightlossandimprovemetaboliccomplicationsofobesitysuchasdiabetesandinsulinresistance,changesinbloodlipidcomposition,andfattyliver.However,theclinicaladvancementofsuchcompoundshasbeenstymiedbybehavioralsideeffectsassociatedwiththeiruse,suchasanxiety,depression,andsuicidalthoughts.
GeorgeKunos,M.D.,Ph.D.,NIAAAscientificdirectorandthestudy’sseniorauthor,andfirstauthorJosephTam,D.D.S.,Ph.D.,oftheNIAAALaboratoryofPhysiologicStudies,collaboratedwithateamofscientistswithinandoutsideNIHtoinvestigateacompounddesignedtoavoidthosesideeffectswhilepreservingthebeneficialeffectsofblockingendocannabinoidactivity.
Dr.Kunosexplainedthatendocannabinoidreceptorsarepresentinthebrainaswellasinperipheraltissues,includingtheliver,skeletalmuscles,pancreas,andfattytissues.Activationofperipheralendocannabinoidreceptorscontributestoobesity-relatedmetabolicandhormonalabnormalities.
Theresearchersreasonedthatacompoundthatisunabletogetintothebrainwouldselectivelyblocktheactivityofendocannabinoidreceptorsinperipheraltissues,andthereforemightalleviatemetabolicandhormonalproblemsrelatedtoobesitywhileavoidingthebehavioralproblemsthat
5QUESTIONSWITH...
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NEWSFROMTHEFIELD HALF-HOURINTERVENTIONSCANHELPREDUCEPEERVIOLENCEANDALCOHOLCONSEQUENCESAMONGTEENS
Six months after receiving a brief intervention in the emergency department, participants maintain reduction in alcohol consequences.
ResearchersaffiliatedwiththeUniversityofMichiganhavefoundthatabriefinterventioninanemergencydepartment(ED)settingcanhelpreducepeerviolenceandtheconsequencesofalcoholuseinadolescents.Theresearchersscreenedpatientsbetweenages14and18todeterminetheiruseofalcoholandexperiencewithpeeraggressionbothasperpetratorandvictim.Thosewhohadexperienced
5QUESTIONSWITH...
1. Ingeneral,doyoubelievethatAmericanstrulyappreciateallofthewaysthatalcoholcanimpacttheirhealth?
Generally,no.Weseemtounderstand,atleastin
generalterms,thedangersofdrinkinganddriving,andtheeffectsofchronicdrinkingontheliverandtheriskofdependence.Butthoseareonlypartofthefullpicture;ourresearchshowsthatalcohol’seffectsarewideranging,affectingeveryorganfromthebrain(cognitiveandbehavioraldeficits)
totheheart(cardiomyopathyandhypertension),andfrompancreatitistosuppressionoftheimmunesystem,andeventocancerrisk.Forexample,itmightsurprisepeopletoknowthatpeoplewhodrinkheavilyonholidaysdevelopwhatiscalled“holidayheartsyndrome”wheretheheartbeatsirregularly(knownasarrhythmias)—thisconditioncanbefatal.Drinkingtoomuchonanemptystomachafterfastingchangesthechemistryoftheblood,causingwhatiscalledlactacidosisandketoacidosis(especiallyindiabetics)andcanearnyouatriptotheemergencyroom.
Inaddition,it’simportanttoknowthatalcoholaffectsdifferentpeopledifferently,dependingongenes,environment,andevendiet.Forexample,halfofthepopulationofAsiandescenthasadefectiveenzymethatmetabolizesacetaldehyde,thefirstproductofalcoholbreakdown,leadingtotheaccumulationofacetaldehyde,whichcausesthemtoflush,havenauseaandfastheartrate,sweat,andsimplyfeelmiserable.Thisisnotabadthingbecause,inmostcases,thisisaprotectivemechanismfromdevelopingalcoholism.
SAMZAKHARI,PH.D.Dr. Zakhari is the director of the NIAAA Division of Metabolism and Health Effects
bothaggressionandalcoholusewererandomizedtoreceivea35-minuteinterventiondeliveredeitherbyacomputeroratherapist.Acontrolgroupreceivedabrochure.Thebriefinterventionincludedreviewofgoals,tailoredfeedback,decisionalbalanceexercise,roleplays,andreferrals.TheirfindingswerepublishedintheAugust4,2010,issueoftheJournal of the American Medical Association.
Theresearchersfollowedupwithparticipants3monthsand6monthslater.Atthe3-monthfollowup,theyfoundthatparticipantswhoreceivedthebriefinterventionfromatherapistwerelesslikelytoreportseverepeeraggression,experienceofpeerviolence,andviolenceconsequenceswhencomparedwiththecontrolgroup.Atthe6-monthfollowup,thoseinboththetherapistandcomputerinterventiongroupsshowedreductionsinalcohol
consequencescomparedwiththoseinthecontrolgroup.
ManyadolescentsseekcareintheED,particularlyun-orunder-insuredindividualsandthosewhobelievetheyaretoooldforpediatriccarebutwhohavenotsoughtoutregularadultmedicalcare.Becauseviolenceisaleadingcauseofmorbidityandmortalityinthisagegroup,theauthorsbelievethat,“adolescentsseekingcareintheEDareanimportantpopulationforinjurypreventionbasedonincreasedriskofproblemsrelatedtoalcoholandviolence.”
Thearticleabstractcanbefoundhere:
Effects of a Brief Intervention for Reducing Violence and Alcohol Misuse Among Adolescents: A Randomized Controlled Trial. http://www.ncbi.nlm.nih.gov/pubmed/20682932
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Alcoholcanevendamageinnocentfetuses,whodonotdrinkvoluntarily.Whenapregnantmotherdrinks,alcoholcouldcausemorphological,structural,andfunctionaldamagetothebrainandotherorgansoftheunborn.Themostseverecaseiscalledfetalalcoholsyndrome,wherethechildhassmallphysicalandbrainsizeandamultitudeofcognitiveandbehavioraldeficitsthatmayputhimorherinconflictwiththelaw.
Overall,Ithinkweknowquitealotaboutalcoholandhealth,butweneedtogobeyondthecurrentunderstandingsowecanmakeinformeddecisionsaboutourdrinking.
2.Whataresomethingsweneedtoconsideraboutalcoholasweage?
That’sanimportantquestion,becausedifferentalcoholissuesseemtotakeprecedenceatdifferentstagesacrossthelifespan.Foryouthandyoungadults,theconsequencesofbingedrinkingareprominent.Itisnottrueatallthattheyoungareinvincibletoalcohol’seffects—justlookatthealmost2,000liveslostannuallyoncollegecampusesacrosstheNationduetounbridleddrinking.Thosewhoareluckyenoughnottosuccumbmaycausedamagetotheirendocrinesystem,resultinginirregularorabsentmenstrualcycleinwomenandadecreaseinspermcountinmen.It’salsothetimethatmanypeoplebegintodevelopdependence;thosewhostartdrinkingattheyoungageof18toearlytwentieshaveahighriskofdevelopingalcoholdependence.
Asweage,otherissuesbegintoemerge.Forexample,afteralong,harddayofwork,peopletendtodrinktounwindandrelaxandtorelievestress.Interestingly,alcohol’sphysiologicaleffectsonthestressaxis(hypothalamic-pituitary-adrenalaxis)mimicstress.So,notonlydoesalcoholnotrelievestress,butconsumedinhighamounts,alcoholcanrobthebodyofimportantvitaminsandmineralsthatareessentialforenzymaticactivities.Inaddition,peoplewhotendtotreatahangoverwithacetaminophencancauseirreparabledamagetotheirliver.
Seniorsnotonlymetabolizealcoholataslowerratethanyoungadultsbutinvariablyaremorelikelytotakeoneormoremedicationsthatinteractwithalcohol.Excessivealcoholconsumptionmayincreasethetoxicityofsomemedications(e.g.,antihistamines,antidepressants,anxiolytics)ordecreasetheefficacyofothers(e.g.,antidiabetics,antihypertensives).Furthermore,drinkingtoomuchcanimpairgaitandmayresultinfallsandbreakingofbrittlebones.
3.We’relearningmoreaboutgenderdifferencesaswell.Arethere
anyspecificissuesthatwomenshouldconsider?
Yes.Ingeneral,womenaremoresusceptibletoalcohol-inducedtissuedamagethanmen.Imaginea120-poundwomansittingnexttoa350-poundlinebackeratabar,andbothhaveadrink.Thealcohollevelinherbloodwillbehigherbecauseofhersizeandlowerwatercontentofherbody.Asaresult,womenaremoresusceptibletoalcohol-induceddamagetothebrain,heart,andliver.Moderatedrinking,therefore,isdefinedasnomorethanonedrinkadayforawomanandnomorethantwodrinksadayforaman.
Inaddition,womenwhoarepregnantortryingtoconceiveshouldabstainfromdrinkingsincethatcouldharmthefetus.Itcouldresultinfetalalcoholsyndromeoramilderformofbehavioralandcognitivedysfunction.Alcoholalso
increasestheriskofbreastcancer,especiallyinsusceptiblewomen.
4. Therehasalwaysbeenmuchdebateaboutthepotentialhealthbenefitsofmoderatedrinking.Canyoushedanylightonthisissue?
Numerousepidemiologicalstudieshaveshownthatmoderatedrinkingdecreasestheriskofcoronaryarterydiseaseandischemicstroke,protectsagainstcongestiveheartfailureandtype-2diabetes,reducesmortalityaftermyocardialinfarction,andenhancescognition.However,theseeffectsaremanifestedonanindividualbasis,andnoteveryonemayhavethesamebenefits.Iwouldurgeindividualstoconsultwiththeirphysicianbeforedrinking,sincepeoplewithafamilyhistoryofalcoholismmaybeathigherriskfordevelopingalcoholism.
5. Yourbackgroundisinpharmacology.Ifyouweren’tinthisresearchfield,whatothercareerpathmightyouhavechosen?
WhenIwasinhighschoolmypassionwasinmathandphysics.However,duetocircumstancesoutofmycontrol,Iendedupinthemedicalfield.Thatwasgreatbecauseithelpedmedealwithvariousmedicalsituationsinthefamily,andheightenedmyawarenessofhealthyfood.Iverymuchenjoygourmetcookingand,afterretirement,Iamlookingforwardtousingthistalenttohavefamilyandfriendsenjoymoderatedrinkingwithspecialmeals!
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CONTACT USNational Institute on Alcohol Abuse and Alcoholism (NIAAA)5635FishersLane,MSC9304Bethesda,MD20892-9304Communications/PublicInfo:301–443–3860 http://www.spectrum.niaaa.nih.gov
