Insights on Alcohol Use and Related Health Effects

Definitions

Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) is a chronic brain condition marked by an inability to control alcohol consumption despite its adverse effects on relationships, work, and health. AUD can be mild, moderate, or severe, but recovery is possible at any stage.

Previously, the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) classified alcohol issues into two categories: alcohol abuse and alcohol dependence. However, the DSM-5 merged these into one condition – AUD – and now categorizes it by severity.

Binge Drinking

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as consuming enough alcohol to raise blood alcohol concentration (BAC) to 0.08 g/dL – typically after four drinks for women or 5 for men within 2 hours.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines binge drinking as five or more drinks for men or four or more for women on a single occasion, at least once in the past month.

Heavy Alcohol Use

SAMHSA identifies heavy alcohol use as binge drinking on five or more days within the past month.

Low-Risk Drinking and AUD

NIAAA defines low-risk drinking as:

• Women: No more than three drinks per day and 7 per week.
• Men: No more than four drinks per day and 14 per week.

Studies show that only about 2% of people who stay within these limits develop AUD.

Alcohol-Impaired-Driving Fatality

This term refers to a death caused by a crash where the driver or motorcycle operator had a BAC of 0.08 g/dL or higher.

Disability-Adjusted Life-Years (DALYs)

DALYs measure the total years lost due to premature death or time lived with a disability that reduces quality of life.

Underage Drinking

Underage drinking refers to alcohol consumption by individuals under 21, which is illegal in the United States.

Alcohol Use in the United States

What is a Standard Drink

In the U.S., a typical drink has about 0.6 ounces (14 grams or 1.2 tablespoons) of pure alcohol. This amount is usually found in:

• 12 ounces of beer with around 5% alcohol
• 8 ounces of malt liquor at about 7% alcohol
• 5 ounces of wine containing 12% alcohol
• 1.5 ounces of distilled spirits or liquor (like vodka, rum, gin, whiskey) that are 80-proof, or 40% alcohol

What is Moderate Drinking?

The Dietary Guidelines for Americans advise that adults of legal drinking age can choose to avoid alcohol or drink in moderation. Moderate drinking means no more than 2 drinks per day for men and no more than 1 drink per day for women on days when alcohol is consumed. These Guidelines also make it clear that people who don’t drink alcohol should not begin drinking for any reason. For those who do drink, having less is better for your health than having more.

There are certain individuals who should not drink alcohol at all, including:

• Anyone under 21.
• Women who are pregnant or could be pregnant.
• People who are driving, plan to drive or are doing tasks that need focus, coordination, or alertness.
• Anyone taking medications – prescription or over-the-counter – that may interact with alcohol.
• Those with specific health problems.
• Individuals recovering from alcohol addiction or who cannot limit their drinking.

Following the Dietary Guidelines helps lower your risk of harming yourself or others.

What is Excessive Drinking?

Excessive alcohol use includes binge drinking, heavy drinking, and any alcohol use by people under 21 or pregnant women.

Binge drinking is the most frequent type of excessive drinking. It means having:

• 4 or more drinks on one occasion for women
• 5 or more drinks on one occasion for men

Heavy drinking is defined as:

• 8 or more drinks per week for women
• 15 or more drinks per week for men

Most individuals who drink excessively are not considered alcohol dependent or alcoholics.

Prevalence of Drinking

The 2015 National Survey on Drug Use and Health (NSDUH) reported that:

• 86.4% of adults (18+) drank alcohol at least once in their lifetime.
• 70.1% drank within the past year.
• 56.0% drank within the past month.

Prevalence of Binge and Heavy Drinking

• 26.9% of adults reported binge drinking in the past month.
• 7.0% reported heavy alcohol use during the same period.

AUD Prevalence in the U.S.

Adults (18+):

In 2015, about 15.1 million adults (6.2%) had AUD, including:

• 9.8 million men (8.4%)
• 5.3 million women (4.2%)

Only 6.7% of those with AUD received treatment.

Youth (12–17):

Approximately 623,000 adolescents (2.5%) had AUD in 2015, with:

• 298,000 males (2.3%)
• 325,000 females (2.7%)

Among adolescents, only 5.2% received treatment.

Alcohol-Related Deaths and Global Impact

Alcohol-Related Deaths in the U.S.

• Approximately 88,000 people die each year from alcohol-related causes, making alcohol the third leading preventable cause of death after tobacco and poor diet/lack of physical activity.
• In 2014, alcohol-impaired driving caused 9,967 fatalities, accounting for 31% of all driving-related deaths.

Economic Burden

In 2010, alcohol misuse cost the U.S. an estimated $249 billion, with binge drinking responsible for 75% of these costs.

Global Burden

In 2012, alcohol was linked to:

• 3.3 million deaths worldwide (5.9% of all deaths).
• 7.6% of deaths among men and 4.1% among women.
• 5.1% of the global burden of disease and injury, equating to 139 million DALYs.

Family Consequences

In 2012, a study revealed that over 10% of U.S. children lived with a parent suffering from alcohol-related problems.

Underage Drinking in the U.S.

Prevalence of Underage Drinking

The 2015 NSDUH reported:

• 33.1% of 15-year-olds had consumed alcohol at least once.
• 20.3% of individuals aged 12–20 drank alcohol in the past month.

Binge and Heavy Drinking Among Youth

• 13.4% of youth aged 12–20 engaged in binge drinking.
• 3.3% reported heavy alcohol use.

Consequences of Underage Drinking

Drinking during adolescence can interfere with brain development and increase the likelihood of developing AUD later in life. Underage drinking is also linked to injuries, sexual assaults, and motor vehicle fatalities.

Alcohol and College Students

Prevalence of Alcohol Use

In 2015:

• 58.0% of full-time college students aged 18–22 drank alcohol in the past month, compared to 48.2% of their non-college peers.

Binge and Heavy Drinking

• 37.9% of college students engaged in binge drinking, compared to 32.6% of non-college peers.
• 12.5% of college students reported heavy alcohol use, compared to 8.5% of non-college peers.

Consequences

Each year:

• One thousand eight hundred twenty-five college students die from alcohol-related injuries, including car crashes.
• Six hundred ninety-six thousand are assaulted by another student who has been drinking.
• 97,000 report alcohol-related sexual assault or date rape.

Alcohol and Pregnancy

Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorders (FASD)

• FAS prevalence in the U.S. is estimated at 0.5 to 3.0 cases per 1,000 births.
• Recent estimates suggest 2–7 cases of FAS and 20–50 cases of FASD per 1,000 births.

Alcohol and the Human Body

Brain

Alcohol disrupts brain communication pathways, affecting mood, behavior, coordination, and cognitive function.

Heart

Excessive alcohol consumption can cause:

• Cardiomyopathy: Stretching and weakening of the heart muscle.
• Arrhythmias: Irregular heartbeat.
• Stroke
• High Blood Pressure

Moderate alcohol consumption may protect against coronary heart disease, but excessive drinking increases heart-related risks.

Liver

Heavy drinking damages the liver, leading to:

• Steatosis (fatty liver)
• Alcoholic hepatitis
• Fibrosis
• Cirrhosis

Pancreas

Alcohol triggers the pancreas to produce toxic substances, leading to pancreatitis, a dangerous inflammation that affects digestion.

Cancer

Excessive alcohol consumption increases the risk of cancers affecting the following:

• Mouth
• Esophagus
• Throat
• Liver
• Breast

Immune System

Alcohol weakens the immune system, making the body vulnerable to infections like pneumonia and tuberculosis. Heavy drinking, even for one day, slows the body’s defense mechanisms for up to 24 hours.

Short-Term Health Risks

Drinking too much alcohol can lead to immediate effects that raise the risk of serious health problems. These effects are usually linked to binge drinking and include:

• Injuries from things like car accidents, falls, drowning, or burns.
• Acts of violence, such as homicide, suicide, sexual assault, or domestic abuse.
• Alcohol poisoning, which is a dangerous condition caused by very high levels of alcohol in the body.
  Unsafe sexual activity, including having unprotected sex or multiple partners, which can lead to unplanned pregnancies or sexually transmitted infections, including HIV.
• Miscarriage, stillbirth, or fetal alcohol spectrum disorders (FASDs) in pregnant women.

Long-Term Health Risks

Drinking too much alcohol over time can lead to long-term health problems and serious diseases, such as:

• High blood pressure, heart issues, stroke, liver damage, and digestive system problems.
• Several types of cancer, including breast, mouth, throat, esophagus, voice box, liver, colon, and rectum.
• A weaker immune system, which makes it easier to get sick.
• Trouble with memory and learning, like poor school performance, or conditions such as dementia.
• Mental health issues like anxiety and depression.
• Problems in daily life, including trouble at work, family conflicts, and even losing a job.
• Alcohol use disorder, which means losing control over drinking.

Limiting alcohol use can help lower your risk of both immediate and long-term health issues.