“Everything in Moderation, Including Moderation” – Oscar Wilde | Alcohol Use Disorder

Most of us have overindulged in alcohol at someone point in our lives; however, the bulk of us know that binge drinking isn’t a healthy habit to carry out on a regular basis. This is why most Americans try to adopt moderation when drinking. This could mean having a drink here and there or even one beer to relax at night. While this may seem harmless, a recent study has shown that even moderate drinking can take a toll on our health. The question is where do we draw the line? Do new guidelines and limits need to drawn up in order to educate and inform the public of this new discovery; and how serious are the consequences that accompany even moderate drinking?

Alcohol Use Disorder

Alcohol Use Disorder is a newly coined term to describe people who participate in the drinking of alcohol. The age old term alcoholism is starting to be used less and less because it describes a more specific group of people. While the two terms can be used in interchangeably at times, they do not always go hand in hand. Alcohol abuse can be seen in many forms.

Alcohol Use Disorder allows the consumption of alcohol to affect aspects of your life. While alcoholism creates a desire and need for alcohol at all times, Alcohol Use Disorder doesn’t always have to be to this extreme. The individual may start to drink more but still in social settings. There can also be an increase in tolerance and a worsening of withdrawal, or hangover symptoms. These can all point to the development of a bigger issue.

One of the more common forms of alcohol consumption is binge drinking. This is the most common form of Alcohol Use Disorder. Binge drinking is the excessive consumption of alcohol over a short amount of time. The amount that it takes to classify binge drinking differs between men and women. Women must consume 4 drinks over the course of 2 hours, while men must consume 5. The effects of this alcohol abuse can be obvious short term; but long term effects are a still a strong possibility. When discussed binge drinking sounds quite severe, however, going out on a weekend night and drinking “a lot “ with friends can be considered almost causal and moderate drinking.

What classifies as a drink:

  • 12 oz. of beer
  • 8 oz. of malt liquor
  • 5 oz. of table wine
  • 5 oz. of 80 proof liquor

In 2015, approximately 6.2 percent or 15.1 million adults in the United States ages 18 and older had Alcohol Use Disorder. Alcohol Use Disorder occurs when the urge to drink or the act of drinking too much starts to have an impact on your life. While not every American who drinks suffers from Alcohol Use Disorder, it almost seems as though even casual drinking is going to have to be included in this spectrum now. If even moderate drinking does have an effect on your health then it is possible that it could fall under the umbrella of Alcohol Use Disorder.

Where is the Limit?

There are many arguments about the limitations we should set on drinking. What are the limits that need to be set to protect our physical and mental health? Depending on whom you ask, “moderate” drinking can mean two completely different things.

According to the U.S. Dietary Guidelines, moderate alcohol consumption can be ok as long as it is limited to 1 drink a day for women and 2 drinks a day for men. This sounds very moderate, however when the weekend comes around, usually 1 or 2 drinks turns into many more. Another different recommendation that you may come across is one from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NIAAA states that there needs to be limits set on drinking to prevent a risk of alcohol dependency later in life. According to the NIAAA, this means no more than 3 drinks in a single day or a total of 7 drinks per week for women and no more than 4 drinks a day or 14 total drinks a week for men.

While these guidelines are set out differently, they essentially equal out to be the same. One drink a day set by the U.S. Dietary Guidelines is equivalent to 7 drinks a week as we see in the standards recommended by the National Institute on Alcohol Abuse and Alcoholism. How effective are these guidelines compared to not drinking? Dr. George Koob, the director of the NIAAA believes that the current evidence that is available to us does not show any significant difference between someone who abides by these guidelines and someone who doesn’t drink at all. Some case studies even defend that a glass of wine a day can be beneficial to cardiovascular health.

The Effects of Moderate Dinking

If the above information is not enough to cause you to begin analyzing your own drinking habits or those of someone you love, maybe the results of a 30 year – that’s right, three decades – long study, conducted by the University of Oxford and University College London, both in the U.K. and published in the BMJ, will. The objective of the study was to investigate the link between moderate alcohol consumption and deterioration of brain health and mental function and whether moderate alcohol consumption has a favorable or adverse association or, possibly, no association with brain structure and function.

The study included 550 healthy, nondependent, men and women over a period of 30 years; starting in 1985. The average age of the participants at the beginning of the study was 43. Weekly data was analyzed for alcohol intake and cognitive performance throughout the entire 30 year-long study. In addition, over the last three years of the study, each participant had to undergo regular MRI scans and other brain function tests. The main factors considered in the outcome measures were structural brain measures (which generally measure anatomical connections linking a set of neural elements and are commonly measured as a set of undirected links – including hippocampal atrophy, grey matter density, and white matter microstructure) and functional measures ( which generally are obtained from time series observations, and describes patterns of statistical dependence among neural elements – including cognitive decline over the study and cross sectional cognitive performance at the time of scanning).

The study was broken into phases and designed to focus on alcohol variables which were collected in each phase which included units drunk per week, frequency of drinking a week in comparison to the previous year and the results of screen questionnaires. The standards for analyzing the data were based off of existing literature and the following UK 2016 guidelines on alcohol consumption:

how much alcohol is in a standard drink

Results:

After assembling 30 years of data and taking additional variable factors account which could have influenced the results of the study, including age, sex, education, social class, physical and social activity, smoking, stroke risk and medical history, the researchers found there is, in fact, a link between moderate alcohol consumption and deterioration of brain health and mental function. Specifically the some of the findings, resulting over the length of the study, included the following:

  • Higher consumption of alcohol was associated to increased risk of a form of brain damage which affects memory and spatial navigation known as hippocampal atrophy.
  • Participants who consumed over 30 units of alcohol a week were three times more likely to have hippocampal atrophy compared to those who abstained from consuming alcohol.
  • Interestingly, there was no significant effect of light drinking over abstinence.
  • Higher consumption of alcohol resulted in poorer white matter integrity which is a major and critical to cognitive function.
  • Higher consumption of alcohol also resulted in a quicker decline in language fluency.

In summary, the results of the study indicate alcohol consumption, not solely limited to higher levels but also in moderate levels, is linked to adverse brain outcomes. While the authors of the study indicate the nature of the study was observational and therefore no firm conclusions can be drawn about cause and effect, their findings without doubt highlight the significant and important health implications associated with high alcohol consumption and the long term, irreversible effects such consumption has on our brain. Which means you can take this next sentence quite literally – start thinking about what consumption of alcohol means to your future before you lose the ability to “think” at all.

“We all use rationalisations to justify persistence with behaviours not in our long term interest. With publication of this paper, justification of “moderate” drinking on the grounds of brain health becomes a little harder.” Killian Welch, consultant neuropsychiatrist at the Royal Edinburgh Hospital.

Why it matters:

While most (or possibly some) of us believe and overall truly accept that drinking too much is bad for you – something we may or may not have learned first-hand.  Or this knowledge can be attributed to our government’s dietary guidelines which are commonly known among the general population and state in summary that alcohol can be consumed but only in moderation. As noted herein, in the United States the government defines moderate drinking as one drink a day for women and two for men. This may or may not seem reasonable to you. However, the above study found drinking at these levels – according to our governments established guidelines – consumption of 8 to 12 drinks per week – is directly associated with certain measures of cognitive decline – these results are irrefutable – they appeared on brain scans. It matters! It really matters!

Advertising & Reality

Speaking of rationalizations to justify our behaviors, the advertising industry in America does an excellent job of creating a rosy picture of moderate drinking and its perks. A majority of alcohol ads depict hip and young looking people consuming alcohol with a handful of friends that look like they’re having a hell of a time in a sunny, warm environment. For anyone that has been to enough post-work “happy hour” outings, every once in a while there’s that one person that doesn’t understand the concept of moderation and ends up saying or doing embarrassing things.

Advertising is heavily protected by the First Amendment, which essentially allows people to say something ignorant without legal repercussions. Additionally, alcohol ads depict paradoxical situations where drinking alcohol in them would be objectively irresponsible. Coors Light’s recent “Whatever your Mountain” campaign is the most recent culprit. That particular campaign is a series of video clips of people completing impressive feats of strength and agility. One scene depicts three hikers ascending a mountain that would require a set of lightweight hiking gear and superb physical fitness. I don’t think those hikers have room in their hiking packs for a couple of Coors Light’s.

Everything in Moderation

They say that too much of a good thing can take its toll. While more data needs to be generated to truly understand the effects of moderate alcohol use on our bodies and minds, we can all agree that moderation is key. As with anything in our lives, we need to practice self-control. The argument is not whether we should give up drinking all together or not, but how much alcohol is too much. It seems that the view of “moderation” has become skewed. The goal as a society should be to practice a true moderation according to guidelines created through scientific discoveries. Only through that can we avoid significant negative impacts on our health and the health of those we love. As highlighted herein, the importance of seeking treatment for an alcohol use disorder cannot be ignored. Your health, your brain, quite possibly, your life depends on it.

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