Alcohol

Alcohol

There are many considerations when it comes to alcohol.  Even though alcohol is legal at the legal age, it does not mean that it is safe. Individuals must make educated decisions in order to protect their health and wellness and the health and wellness of others.  Part of the challenge with this is that alcohol inhibits the ability to make good decisions. Alcohol consumption can impact the brain and most body organs. Areas of the brain that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our higher brain functions, including problem solving and decision making), the hippocampus (important for memory and learning), and the cerebellum (important for movement coordination). Research also shows us that perceptions of safety are higher when something is legal. Thus, youth tend to discount potential danger.  As adults, how we model attitudes and behaviors toward alcohol can be very influential when it comes to youth.

What is a “drink”?

In the United States, a standard drink contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in

  • 12-ounces of beer (5% alcohol content).
  • 8-ounces of malt liquor (7% alcohol content).
  • 5-ounces of wine (12% alcohol content).
  • 1.5-ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

What is excessive drinking?

Excessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.

  • Binge drinking, the most common form of excessive drinking, is defined as consuming
    • For women, 4 or more drinks during a single occasion.
    • For men, 5 or more drinks during a single occasion.
  • Heavy drinking is defined as consuming
    • For women, 8 or more drinks per week.
    • For men, 15 or more drinks per week.

Most people who drink excessively are not alcoholics or alcohol dependent.

What is moderate drinking?

The Dietary Guidelines for Americans defines moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men.4 In addition, the Dietary Guidelines do not recommend that individuals who do not drink alcohol start drinking for any reason.

However, there are some people who should not drink any alcohol, including those who are:

  • Younger than age 21.
  • Pregnant or may be pregnant.
  • Driving, planning to drive, or participating in other activities requiring skill, coordination, and alertness.
  • Taking certain prescription or over-the-counter medications that can interact with alcohol.
  • Suffering from certain medical conditions.
  • Recovering from alcoholism or are unable to control the amount they drink.

By adhering to the Dietary Guidelines, you can reduce the risk of harm to yourself or others.

Short-Term Health Risks

Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions. These are most often the result of binge drinking and include the following:

  • Injuries, such as motor vehicle crashes, falls, drownings, and burns
  • Violence, including homicide, suicide, sexual assault, and intimate partner violence.
  • Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
  • Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
  • Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.

Long-Term Health Risks

Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including:

  • High blood pressure, heart disease, stroke, liver disease, and digestive problems.
  • Cancer of the breast, mouth, throat, esophagus, liver, and colon.
  • Learning and memory problems, including dementia and poor school performance.
  • Mental health problems, including depression and anxiety.
  • Social problems, including lost productivity, family problems, and unemployment.
  • Alcohol dependence, or alcoholism.

By not drinking too much, you can reduce the risk of these short- and long-term health risks.

Dangers of Mixing Alcohol and Caffeine

  • The Dietary Guidelines for Americans cautions against mixing alcohol with caffeine.
  • When alcohol is mixed with caffeine, the caffeine can mask the depressant effects of alcohol, making drinkers feel more alert than they would otherwise. As a result, they may drink more alcohol and become more impaired than they realize, increasing the risk of alcohol-attributable harms.
  • Caffeine has no effect on the metabolism of alcohol by the liver and thus does not reduce breath or blood alcohol concentrations (it does not “sober you up”) or reduce impairment due to alcohol consumption.

Dangers of Mixing Alcohol and Energy Drinks

  • Energy drinks typically contain caffeine, plant-based stimulants, simple sugars, and other additives.
  • Mixing alcohol with energy drinks is a popular practice, especially among young people in the United States.
  • Drinkers aged 15 to 23 who mix alcohol with energy drinks are 4 times more likely to binge drink at high intensity (i.e., consume 6 or more drinks per binge episode) than drinkers who do not mix alcohol with energy drinks.
  • Drinkers who mix alcohol with energy drinks are more likely than drinkers who do not mix alcohol with energy drinks to report unwanted or unprotected sex, driving drunk or riding with a driver who was intoxicated, or sustaining alcohol-related injuries.

Energy Drink Warning

Caffeinated Alcoholic Beverages

  • Caffeinated Alcoholic Beverages (CABs) were premixed beverages popular in the 2000s that combined alcohol, caffeine, and other stimulants. They were malt or distilled spirits-based beverages and they usually had a higher alcohol content than beer (e.g., 12% alcohol by volume compared to 4% to 5% for beer).
  • CABs were heavily marketed in youth-friendly media (e.g., social media) and with youth-oriented graphics and messaging that connected the consumption of these beverages with extreme sports or other risk-taking behaviors.
  • In November 2010, the US Food and Drug Administration (FDA) told the manufacturers of seven CABs that their drinks could no longer stay on the market in their current form, stating that “FDA does not find support for the claim that the addition of caffeine to these alcoholic beverages is ‘generally recognized as safe,’ which is the legal standard.” Producers of CABs responded by removing caffeine and other stimulants from their products.

Prevention Strategies

  • The Community Preventive Services Task Force recommends effective population-based strategies for preventing excessive alcohol consumption and related harms, including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host (dram shop) liability for service to underage or intoxicated customers.
  • States and communities have also developed educational strategies to alert consumers to the risks of mixing alcohol with energy drinks. At least one community enacted an ordinance requiring retailers to post warning signs informing consumers of the risks of mixing alcohol and energy drinks.
  • Monitoring and reducing youth exposure to alcohol advertising through “no-buy” lists could also help reduce underage drinking. No-buy lists identify television programming that advertisers can avoid to improve compliance with the alcohol industry’s self-regulated alcohol marketing guidelines.

Consequences of Underage Drinking

Youth who drink alcohol are more likely to experience

  • School problems, such as higher absence and poor or failing grades.
  • Social problems, such as fighting and lack of participation in youth activities.
  • Legal problems, such as arrest for driving or physically hurting someone while drunk.
  • Physical problems, such as hangovers or illnesses.
  • Unwanted, unplanned, and unprotected sexual activity.
  • Disruption of normal growth and sexual development.
  • Physical and sexual assault.
  • Higher risk for suicide and homicide.
  • Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
  • Memory problems.
  • Abuse of other drugs.
  • Changes in brain development that may have life-long effects.
  • Death from alcohol poisoning.

In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink. Early initiation of drinking is associated with development of an alcohol use disorder later in life.

Prevention of Underage Drinking

Reducing underage drinking will require community-based efforts to monitor the activities of youth and decrease youth access to alcohol. Recent publications by the Surgeon General1 and the Institute of Medicine outlined many prevention strategies for the prevention of underage drinking, such as enforcement of minimum legal drinking age laws, national media campaigns targeting youth and adults, increasing alcohol excise taxes, reducing youth exposure to alcohol advertising, and development of comprehensive community-based programs.

Binge Drinking

Binge drinking is a serious but preventable public health problem.

Binge drinking is the most common, costly, and deadly pattern of excessive alcohol use in the United States. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours. Most people who binge drink are not alcohol dependent.

Who binge drinks?

  • One in six US adults binge drinks about four times a month, consuming about seven drinks per binge. This results in 17 billion total binge drinks consumed by adults annually, or 467 binge drinks per binge drinker.
  • Binge drinking is most common among younger adults aged 18–34 years, but more than half of the total binge drinks are consumed by those aged 35 and older.
  • Binge drinking is twice as common among men than among women. Four in five total binge drinks are consumed by men.
  • Binge drinking is more common among people with household incomes of $75,000 or more and higher educational levels. Binge drinkers with lower incomes and educational levels, however, consume more binge drinks per year.
  • Most people younger than age 21 who drink alcohol report binge drinking, often consuming large amounts.

 Binge drinking has serious risks.

Binge drinking is associated with many health problems, including the following:

  • Unintentional injuries such as car crashes, falls, burns, and alcohol poisoning.
  • Violence including homicide, suicide, intimate partner violence, and sexual assault.
  • Sexually transmitted diseases.
  • Unintended pregnancy and poor pregnancy outcomes, including miscarriage and stillbirth.
  • Fetal alcohol spectrum disorders.
  • Sudden infant death syndrome.
  • Chronic diseases such as high blood pressure, stroke, heart disease, and liver disease.
  • Cancer of the breast, mouth, throat, esophagus, liver, and colon.
  • Memory and learning problems.
  • Alcohol dependence.

Binge drinking costs everyone.

  • Drinking too much, including binge drinking, cost the United States billions of dollars. These costs resulted from losses in workplace productivity, health care expenditures, criminal justice costs, and other expenses. Binge drinking was responsible for 77% of these costs.

Preventing binge drinking

The Community Preventive Services Task Force recommends evidence-based interventions to prevent binge drinking and related harms. Recommended strategies include:

  • Using pricing strategies, including increasing alcohol taxes.
  • Limiting the number of retail alcohol outlets that sell alcoholic beverages in a given area.
  • Holding alcohol retailers responsible for the harms caused by illegal alcohol sales to minors or intoxicated patrons (dram shop liability).
  • Restricting access to alcohol by maintaining limits on the days and hours of alcohol retail sales.
  • Consistently enforcing laws against underage drinking and alcohol-impaired driving.
  • Maintaining government controls on alcohol sales (avoiding privatization).
  • Screening and counseling for alcohol misuse.

Preventing Excessive Alcohol Use

Excessive alcohol use includes

  • Binge drinking (defined as consuming 4 or more alcoholic beverages per occasion for women or 5 or more drinks per occasion for men).
  • Heavy drinking (defined as consuming 8 or more alcoholic beverages per week for women or 15 or more alcoholic beverages per week for men).
  • Any drinking by pregnant women or those younger than age 21.

The strategies listed below can help communities create social and physical environments that discourage excessive alcohol consumption thereby, reducing alcohol-related fatalities, costs, and other harms.

The Community Preventive Services Task Force Recommendations 
The Community Preventive Services Task Force, an independent, nonfederal, volunteer body of public health and prevention experts, recommends several evidence-based community strategies to reduce harmful alcohol use.

Recommendations

  • Increasing Alcohol Taxes
    Alcohol excise taxes may include wholesale, excise, ad valorem, or sales taxes, all of which affect the price of alcohol. Taxes can be levied at the federal, state, or local level on beer, wine or distilled spirits.
  • Dram Shop Liability
    Dram shop liability, also known as commercial host liability, refers to laws that hold alcohol retail establishments liable for injuries or harms caused by illegal service to intoxicated or underage customers.
  • Electronic Screening and Brief Intervention (e-SBI)
    e-SBI uses electronic devices (e.g., computers, telephones, or mobile devices) to facilitate delivery of key elements of traditional screening and brief interventions. At a minimum, e-SBI involves screening individuals for excessive drinking, and delivering a brief intervention, which provides personalized feedback about the risks and consequences of excessive drinking.

Recommended against

  • Privatization of Retail Alcohol Sales
    The privatization of retail alcohol sales refers to the repeal of government (such as state, county, or city) control over the retail sales of one or more types of alcoholic beverages.

US Preventive Services Task Force Recommendation
The U.S. Preventive Services Task Force (USPSTF) is an independent panel of non-Federal experts in prevention and evidence-based medicine and comprises primary care providers. The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services and develops recommendations for primary care clinicians and health systems.

 How Can I Contribute to the Prevention of Excessive Alcohol Use?

Everyone can contribute to the prevention of excessive alcohol use.

You can:

  • Choose not to drink too much yourself and help others not do it.
  • If you choose to drink alcohol, follow the U.S. Dietary Guidelines on moderate alcohol consumption (no more than one drink per day for women and no more than 2 drinks per day for men).
  • Support effective community strategies to prevent excessive alcohol use, such as those recommended by the Community Preventive Services Task Force.
  • Not serve or provide alcohol to those who should not be drinking, including children or teens and those who have already drank too much.
  • Talk with your health care provider about your drinking behavior and request counseling if you drink too much.

States and communities can:

  • Implement effective prevention strategies for excessive alcohol use, such as those recommended by the Community Preventive Services Task Force.
  • Enforce existing laws and regulations about alcohol sales and service.
  • Develop community coalitions that build partnerships between schools, faith-based organizations, law enforcement, health care, and public health agencies to reduce excessive alcohol use.
  • Routinely monitor and report the prevalence, frequency, and intensity of binge drinking (whether or not adults binge drink, how often they do so, and how many drinks they have if they do).