Although the harm caused by excessive drinking has never been questioned, a number of studies over the past two decades have linked light to moderate consumption of alcohol (especially red wine) with positive health effects, including a reduced risk of diabetes, stroke, kidney disease and especially heart disease.
It’s not hard to conclude from those studies that as long as you aren’t an alcoholic, drinking in moderation is actually good for you. Moderate alcohol consumption is up to one drink per day for women and up to two for men, according to the Dietary Guidelines for Americans created by the U.S. Department of Agriculture and the Department of Health and Human Services. Those guidelines define one drink as 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor. So unless you’re an alcoholic, it’s a good idea to go ahead and have that one 5-ounce glass of merlot every night, right?
Not necessarily. In August 2018, The Lancet published the results of the most comprehensive estimate of the burden of alcohol use ever done. “The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD),” a large-scale, sweeping mega-analysis of nearly 700 data sources, analyzed levels of alcohol use and the health effects of alcohol for men and women in 195 countries from 1990-2016.
The study’s conclusion? The safest amount of alcohol you can drink is none at all. The protective effects of moderate amounts of alcohol for certain conditions are far outweighed by an increased risk of other health dangers, with cancer top among them. It turns out that a drink a day doesn’t keep the doctor away, after all.
This doesn’t unequivocally mean that everyone should abstain from alcohol entirely. Instead, use this information to make the best decision for yourself.
First, some stats from the GBD study: Alcohol is associated with nearly 3 million deaths worldwide every year, including cancer, infectious diseases, violence, car accidents and unintentional injuries such as drowning. It was the seventh leading risk factor for death and disability worldwide in 2016, and was the top risk factor for people 15-49 years old, accounting for 10 percent of deaths. For people aged 50 and over, cancer was the leading cause of alcohol-related deaths. Many of us forget that alcohol has been classified as a carcinogen.
One of the most striking results of the study was that even very small amounts of alcohol could increase this risk, and that the increase in risk is linear: Starting at zero, the more you drink, the more the risk of damaging your health goes up.
So, if you’re an average healthy adult, then you need to weigh your risk of these other negative health outcomes against the protective effects that light to moderate drinking can have. The study acknowledges that moderate drinking can potentially offer some health protections, such as against coronary artery disease. But that benefit must be balanced against the fact that alcohol can increase the risk of more than 60 health conditions. What you need to decide is if alcohol’s rather mild protective effects are worth the increased risk of so many other serious chronic health conditions, including infections, liver diseases, pancreatitis and many cancers.
Some people are especially susceptible to the ill effects of alcohol, and if you fall into that camp, then you need to be especially cautious. Here are four populations who need to be careful about alcohol, if not abstain entirely.
Alcohol can be very harmful to teenagers simply because of their age and stage of development. The human brain keeps developing until the age of 26 or 27. When teenagers drink, they stunt the growth of the frontal lobe, which is involved in decision making. Any amount of alcohol will impact that part of the brain, potentially altering it for life. This is an enormous biological risk, to say nothing of the fact that kids who start drinking in their teens are at much higher risk of developing alcohol addiction than those who wait until later in life to partake. Numerous research has correlated an early “initiation” age of drinking to the development of more severe alcohol use disorders and higher risk of progression to drug use.
Women are more vulnerable to the negative effects of alcohol than men. They have fewer of the enzymes that metabolize alcohol, so more alcohol remains longer in the bloodstream, making women more susceptible to its toxic effects than men of the same size. Not only are they more at risk for accidents and injuries caused by being intoxicated, women who drink alcohol are also more at risk than men for liver damage and cirrhosis. And they’re more prone to develop an addiction.
People who have mental health conditions such as anxiety, depression, bipolar disorder and even ADHD are much more likely to develop an addiction to alcohol. People with these conditions often turn to alcohol to self-medicate. Moreover, there is substantial overlap between the genes that lead to alcohol use disorder and those that lead to mental health disorders. At least 20 percent of people who have social anxiety disorder also suffer from some sort of alcohol use disorder.
For people living with chronic mental health conditions abstinence is encouraged. In addition to the risk of developing an addiction, if you are drinking, the medications prescribed to treat your mental health condition are simply not going to be as effective. And the alcohol creates a trampoline effect: You’re super-anxious, so you drink to dull the anxiety, but then when the alcohol wears off, the rebound anxiety is much worse and causes you to fly up. This is a vicious cycle. The only way to end it is by abstaining from drinking entirely.
The last group especially vulnerable to alcohol is, of course, people who struggle with addiction. That might sound like a tautology, but this group includes people with addiction to substances other than alcohol. The addiction gene is not subject-specific. If a person is addicted to cocaine, for example, and stops using it, he or she will often switch to alcohol, and vice versa. The reality that the addicted mind does not differentiate between addictive substances, often “crossing” from one to another if available, is called “cross addiction.” Because of this concept, people struggling with addiction to both alcohol and drugs need to evaluate their relationship with alcohol with special care.
Many people living with addiction believe in the myth of moderation: that they can simply reduce the amount of the substance they are abusing. This never works. Addicts are people who were born without a stop sign in their brain to signal when they’ve had enough, and this biological fact is not their fault. Moreover, research shows that many folks battling alcohol addiction can break down alcohol very quickly and escape a hangover later. Not only are they genetically predisposed not to suffer negative consequences, they also have more pleasure centers in their brain that light up when using alcohol or another drug. Often, people struggling with alcohol addiction must discover for themselves that total abstinence is the only solution for this deceptive disease.
What we are learning about substance use grows every day, and you should make the most informed decision you can on what the appropriate alcohol limit is for you. Read the GBD study in The Lancet, and find out more about alcohol use in general at the National Institute on Alcohol Abuse and Alcoholism site.
Lauren Grawert, M.D., is a board-certified addiction psychiatrist with the Mid-Atlantic Permanente Medical Group in the Washington, DC, area. She graduated from Medical University of South Carolina College of Medicine in 2009.