According to the Office of Disease Prevention and Health Promotion (ODPHP), which released Dietary Guidelines for 2015-2020, moderate alcohol consumption is considered up to one drink per day for women and up to two drinks per day for men. This standard helps to reduce the risk of long-term health problems, including heart disease, liver damage, and some cancers, if people stick to it.
Problematic alcohol consumption leads to tens of thousands of deaths every year, from drunk driving, chronic health problems, and alcohol poisoning. The Washington Post reported that, in 2014, almost 31,000 Americans died from complications related to alcohol intoxication; this represents a 37 percent increase since 2002.
Reportedly, 30 percent of Americans do not drink at all while another 30 percent consume one drink per week or less. However, the top 10 percent of Americans consume up to 74 drinks per week or around 10 drinks per day. That 10 percent represents 24 million American adults.
The term alcoholic in everyday speech means a person who has problems with alcohol consumption. Public health organizations typically do not use the term alcoholic anymore, and instead divide problem drinking into three basic categories: binge drinking, heavy drinking, and alcohol use disorder. These conditions can all lead to long-term health problems or sudden death, so it is important to understand the symptoms of each one.
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines binge drinking as consuming five or more servings of alcohol per occasion. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) adds that binge drinking is a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) up to 0.08 within about two hours. The liver processes one serving of alcohol per hour, so rapidly consuming alcohol in less time can be dangerous.
Binge drinking is sometimes called heavy episodic drinking because people do not have to drink every day, or struggle with alcohol dependence, to participate in this risky form of alcohol abuse. Instead, it is characterized by consuming a large amount of alcohol quickly, followed by a period of abstinence. Sometimes, this period of abstinence can be a mere one or two days, but it can also be a week, a month, or a few years.
In 2015, the Centers for Disease Control and Prevention (CDC) found that 23.4 percent of adults ages 18 and older had at least one episode of binge drinking in the past year. People who binge drink are at a much higher risk of suffering alcohol poisoning.
- Stupor (being conscious but unresponsive)
- Falling unconscious
- Slow or irregular breathing
- Hypothermia (low body temperature)
It is extremely important to call 911 in the event of alcohol poisoning. Leaving a person alone to “sleep it off” puts the individual at greater risk of death.
People who engage in binge drinking may not have obvious symptoms. They are less likely, compared to heavy drinkers or people struggling with alcohol use disorder, to be consistently intoxicated or in withdrawal. However, people who frequently go to bars, nightclubs, or house parties with the excuse of socializing are more likely to engage in binge drinking.
This form of problem drinking is one that few people realize is dangerous. The CDC defines heavy drinking along gender guidelines because men and women metabolize alcohol differently:
People who drink heavily are less likely to suffer alcohol poisoning or acute problems because they slowly build up a tolerance to alcohol in their bodies. However, this puts them at much greater risk for alcohol-related chronic health issues. These include:
- Anemia: This is signified by a low number of oxygen-carrying red blood cells. Symptoms include fatigue, shortness of breath, dizziness, or lightheadedness.
- Cancer: Most common cancers related to heavy drinking include cancer of the mouth, throat, voice box, esophagus, liver, bowel, colorectal, or breast.
- Cardiovascular disease: Platelets are more likely to clump, which can cause blood clots leading to heart attacks or strokes. Heavy drinking can also weaken the heart muscle, leading to cardiomyopathy.
- Cirrhosis: Scar tissue forms on the liver as metabolizing alcohol damages the organ. This can stop the liver from working well.
- Dementia: Heavy drinking increases the speed at which the brain shrinks with age, which can lead to memory loss, cognitive problems, and dementia. It also reduces a person’s ability to solve problems, plan, or make judgments. At worst, chronic drinking problems can lead to Wernicke-Korsakoff syndrome, a pattern of memory loss and physical dysfunction due to a thiamine (B12) deficiency.
- Depression: Alcohol is linked to many co-occurring disorders, including anxiety and bipolar disorder; however, people who struggle with depression are also more likely to drink, and people who drink heavily are more likely to develop depression.
- Gastritis: This is inflammation of the stomach lining that can lead to acid reflux and ulcers.
- Gout: This involves the formation of uric acid crystals in the joints, which is typically hereditary but can be exacerbated by heavy drinking.
- High blood pressure: The presence of a lot of alcohol in the blood can change how the blood vessels constrict and dilate, which can lead to chronic changes over time.
- Neuropathy: Alcohol is toxic to nerve cells throughout the body, and heavy drinking can lead to nerve damage. This can cause a pins-and-needles or numb sensation in the extremities, along with muscle weakness, constipation, incontinence, and other nerve-related problems.
- Pancreatitis: This is inflammation of the pancreas that interferes with digestion. Chronic pancreatitis causes diarrhea and abdominal pain.
- Seizures: Even without delirium tremens – a life-threatening risk of some alcohol withdrawal – seizures can occur because of the brain pathways impacted by drinking.
Heavy drinkers may not believe they have a drinking problem until they develop chronic health issues.
Alcohol Use Disorder
One in four people who drink heavily has a diagnosable alcohol use disorder. To meet the criteria for this medical diagnosis, a person must meet at least two of 11 listed criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in a one-year (12-month) period. Statements used to diagnose AUD are:
- Consuming more alcohol than intended or drinking longer than intended
- Trying to cut down on drinking more than once but could not
- Spending a lot of time drinking or experiencing after effects from too much alcohol
- Craving alcohol or having a strong urge to drink
- Drinking, or being sick after drinking, interfering with work, school, or family responsibilities
- Continuing drinking after family or friends express concern or drinking causes problems with friends and family
- Cutting back on important activities or hobbies to drink
- Performing risky behaviors while drunk, such as driving, walking in an unsafe area, or having unprotected sex
- Continuing drinking in spite of depression, anxiety, or health problems
- Noticing that more alcohol is needed to experience the original level of intoxication
- Experiencing withdrawal symptoms like shakiness, restlessness, nausea, sweating, cravings, trouble sleeping, anxiety and depression, or hallucinating people or things that were not there while drinking
While binge drinking and heavy drinking are not considered alcohol use disorder, they can cause acute and chronic health problems, and they can develop into alcohol dependence or AUD. Seeking out alcohol or experiencing intense cravings for alcohol may indicate a developing problem.
The urban legend of the high-functioning alcoholic is pervasive, and many people who have drinking problems but do not experience too many consequences may claim that they are a functional alcoholic. People in this category allegedly maintain normal lives, like regular work, academic achievements, happy families, mortgages, bills, etc. They think they can balance the demands of life with drinking a lot. Cravings do not bother them because they can drink easily, and they are likely to have friends who are willing to join them for drinks quite often.
Drinking too much or experiencing a problem with alcohol consumption does not automatically mean a person will hit rock bottom. They will not suddenly lose their job, all their relationships, and their home, to end up on the street. However, this stereotype of an alcoholic allows too many people with drinking problems to be in denial. If they are accomplished, maintain a job, and have friends, then how could they have a problem?