What is heavy drinking, how to drink in moderation or not to drink at all - which should you choose?
There is an ambivalent attitude towards alcohol and its consumption in our society: on the one hand, "drinking is bad for your health! ", and on the other hand, "who doesn't drink now? ". In our opinion, this is due to the fact that alcohol consumption is often considered by medicine from two extreme positions: the norm (sobriety) and the disease (alcohol dependence). At the same time, teetotalers are a minority in society: from 40% of the total population (including minors and the elderly) to 10-15% of the adult population. In this regard, many people have a question: "Is drinking alcohol so harmful, if it is so common, and doctors themselves, constantly talking about its harms, are hardly teetotalers? " Therefore, the purpose of this article is not just to talk about the real dangers and harms of excessive alcohol consumption, but also about what constitutes its consumption with minimal risk to health.
Let's start with some important definitions. What is Alcohol Consumption, Abuse and Dependence? By itself, alcohol consumption, like many other substances, is a type of human behavior. The difference between alcohol (and tobacco) and many other food products is related to their ability to influence a person's mental activity: emotions, behavior, thinking. Therefore, alcohol is referred to as psychoactive substances (which act on the psyche), which also include drugs (opioids, psychostimulants and cannabis), psychotropic drugs (barbiturates, benzodiazepines) and toxic substances (glue, gasoline, solvents). Alcohol and most psychoactive substances can cause abuse and dependence in people. Abuse is understood as a type of consumption that harms a person's physical (increased blood pressure, damage to the liver, heart and nerves) and mental health (insomnia, depression, anxiety), and may also hinder the professional (dismissal), family member (divorces, scandals) and public (arrests, drunk driving) a person's life.
Abuse is already a painful condition and requires the intervention of a doctor, but more importantly, at this stage it can also be a general therapist or neurologist who has skills in short-term intervention for alcohol problems. Alcohol addiction is already a disease, like anxiety or depression, in the presence of which a person needs the help of other doctors - a narcologist or a psychotherapist.
Alcohol dependence includes a combination of disturbances in behavior, thinking and physical body functions that develop after repeated use of alcohol. The main symptoms of alcohol addiction are a strong compulsion to "drink" ("desire"); violation of the ability to control alcohol intake (the beginning and end of intake and dose) ("no brakes, binge"); desire or unsuccessful attempts to reduce or control alcohol consumption; a withdrawal state (withdrawal syndrome, "waste") when you stop or reduce your alcohol intake and relieve this condition by drinking; tolerance - a gradual increase in the dose of alcohol consumed; ignoring other interests and increasing drinking time; and, finally, the continuation of drinking, with its obvious harm to health. A diagnosis of addiction can be made if three or more of these signs are present within one month of the previous year (e. g. heavy drinking weekly on a Friday day after work or heavy drinking for four weeks a year).
If in society 5-10% of the population abuse alcohol and another 4% of the population (2% of women and 6% of men) are alcohol dependent, then among the rest of the population, about 10-20% more detect the excessive alcohol consumption. According to the WHO definition, excessive (dangerous or risky) consumption of alcohol is considered to be those levels or types of alcohol that, if continued, will cause harm to health (i. e. , what will later become abuse).
It is now believed that the amount of alcohol consumed directly determines the likelihood of developing various alcohol problems (dangerous drinking, abuse and dependence), after which withdrawal from the binge may be required. Non-alcoholic adults consume no more than 20 g of ethyl alcohol per day to minimize the risk of developing problems. At the same time, alcohol intake should not be more than 5 days a week, with 2 days of sobriety mandatory. According to the WHO, 10 g of ethyl alcohol is taken equal to 1 standard unit (dose) of alcohol. One dose of alcohol is contained in 330 ml. beer with a content of 5%; in 140ml. dry wine (9-11%); in 70ml. fortified wine (18%); and in 35 ml of brandy (40%). To calculate the amount of ethyl alcohol in grams in an alcoholic beverage, it is necessary to multiply the volume of the beverage by its strength and by a conversion factor of 0. 79 (each milliliter of pure ethyl alcohol contains 0. 79 g).
However, in some situations, even having one or two drinks of alcohol a day is undesirable: if you drive a vehicle, if you are pregnant or breastfeeding, when you are taking certain medications, with many illnesses and when you cannot control your drinking (or i. e. you have one of the signs of addiction).
What problems does alcohol cause?
Alcohol problems are not only harmful to health and psyche, but also several professional, family and social consequences of excessive consumption.
A low risk of alcohol problems is seen with 3-4 drinks a day for men (20 drinks a week) and 2-3 drinks a day for women (15 drinks a week). The average risk of problems is seen with 25-35 doses per week for men and 15-25 doses for women. A high risk of alcohol problems is seen when drinking more than 35 drinks per week for men and more than 25 drinks per week for women. A further increase in consumption indicates abuse and markedly increases (by 6. 5 times) the risk of developing alcohol dependence and associated somatic diseases. Thus, it is possible to calculate the amount of alcohol consumed in the last 7 days, which can be considered an indicator of the average consumption of alcohol in general. And then you can assess how much risk your drinking poses to you and also if it is already painful.
In addition to the amount of alcohol consumed, an individual's likelihood of developing alcohol abuse and dependence is also affected by hereditary, personal, and social factors; they are also called risk factors. Hereditary (genetic) risk factors include parental alcohol dependence (risk increases by 3-4 times) and other addictions (drug addiction - a 4-5 fold increase in risk and mother's smoking - by 2-3 times) . Currently, many genes responsible for the development of alcohol dependence have been identified, however, they determine only 30-40% of the risk of its occurrence. Those ones. 60-70% of the risk of alcoholism depends on the person's personality and environment.
Genetic differences also affect the physiological and psychological characteristics of people in relation to alcohol consumption. The following characteristics were revealed: a) unusual (slow or accelerated) metabolism (processing) of ethanol - "I get drunk quickly or completely drunk"; b) accelerated development of tolerance - "does not drink vodka"; c) altered reactions to alcohol (irritability, aggression and depression).
What characteristics of a person increase the risk of developing alcohol dependence? The main ones are male, early first consumption, young age (16-19 years), life outside of marriage (single, divorced or widowed), low income, lack of work, retirement. Psychological problems that often predispose to the development of alcohol dependence at a young age (before age 25) are emotional instability (mood swings, irritability, aggressive behavior), altered drunkenness, hyperactivity, and risky behavior (stimulation seeking behavior). - gambling, having many sexual partners) as well as higher levels of alcohol consumption at young age.
The psychological problems that often predispose to the development of alcohol dependence in adulthood (after age 30) are increased levels of anxiety and depression, impaired communication skills (shyness), difficulty in changing, fear of being abandoned, avoidance of problems , lack of meaning for existence and prospects. Social risk factors for alcoholism include high family stress for women and job stress for men, low family social status (poverty, poor housing), disruption of family structure and function (incomplete - for women).
What can be advised for a person who consumes alcohol moderately, but has risk factors for developing alcohol dependence, that is, may become an alcoholic?
In these people, even drinking alcohol at the moderate risk level can cause the same problems as drinking low-risk alcohol in people without these factors. Therefore, they need to prevent the development of alcohol abuse and dependence, and this can only be achieved by consistently adhering to moderate alcohol consumption limits. Even single doses of high doses of alcohol (more than 5 drinks per day) can contribute to the development of alcohol-related problems associated with intoxication - poisoning, injury, accidents, violence; and long-term consumption of small amounts of alcohol (3-5 drinks per day) increases the risk of dependence by 2-3 times compared to those who do not have these hereditary, personal and social risk factors. Therefore, for them, excessive doses are unacceptable.
What can you advise a person who drinks moderately and has no risk factors for developing alcohol dependence but is still at risk of becoming an alcoholic? In such people, maintaining the same level of alcohol consumption, the risk of developing dependence is minimal. However, if they are exposed to unfavorable external factors (dismissal, divorce, retirement) or internal (illness, anxiety and depression), and if they allow alcohol excesses (drinking large amounts of alcohol - more than 5 drinks a day for 3-7 days ) or increasing the amount of alcohol consumed regularly, addiction and abuse can develop in a short time.
And finally, what advice can you give a person who consumes alcohol in dangerous or harmful amounts? What to say to a patient like that? The advice is pretty simple - try drinking less, or if that doesn't work, stop drinking alcohol. How to drink less? Dilute alcoholic beverages, replace alcohol with soft drinks; eat before and after drinking. Try to distract yourself from the glass and drink more slowly; do something else to drink less; start later than usual; do alcohol fasting days: two or three or even four days a week are best. Try not to get into high-risk situations where you can lose control: campaigns, with friends, after work, on holidays, after pay, on weekends. Try not to drink when you are bored or lonely, irritable, tense and in a bad mood, with insomnia and anxiety; and if you find yourself in such a situation - get out, refuse. Try other forms of entertainment and recreation; and, most importantly, learn to refuse. It is important to find those people who use moderately and are ready to support you in your efforts to resolve your alcohol problems.
The final question that this article will attempt to answer is: what should a person and their family members do with an existing addiction to alcohol (alcoholism)?
Cessation of consumption is necessary if you have a frequent desire to drink (even if it is to relax, de-stress, have fun); can't control how much you drink suffer from a hangover the day after drinking too much and need a drink to improve your well-being; You need more and more alcohol to get drunk or get back to "normal". It is also necessary to stop drinking if you suffer from high blood pressure (alcohol does not cure blood pressure, but, on the contrary, increases the risk of hypertensive crises and strokes), liver disease, pancreatitis and are taking drugs incompatible with alcohol (antibiotics, for the heart, blood pressure medication, etc. ). If you cannot give up on your own, do not despair, now there are enough qualified specialists - psychotherapists and narcologists who anonymously: without registration, job advertisement and deprivation of a driver's license, will provide effective assistance. The main thing to remember is that alcoholism is curable, but the result of its treatment is not the restoration of the "ability to drink again in the company like everyone else is 100 grams", but the effective preservation of sobriety for a long time.