Researchers are casting doubt or outright rejecting pretty much every study that suggests alcohol has health benefits. Meanwhile, deaths in the U.S. related to alcohol consumption are on the rise. And while experts say harm typically hinges on how much people drink, increasingly they say there’s “no safe amount” of alcohol.
While earlier studies suggested low to moderate alcohol consumption — one or two drinks a day — could reduce heart disease risk, Dr. Spencer Hansen, a board-certified addiction psychiatrist at LDS Hospital, said those findings have been reexamined and show the beneficial effects might be overestimated and could have resulted from other factors entirely.
The same people who control their drinking, he said, “generally live a healthier lifestyle than individuals who cannot control their drinking, so they’re also able to control their diet, or their various physical health lifestyle choices that contribute to overall health.”
Alcohol consumption poses different risks for individuals, depending on factors like genetics, psychological makeup, environment, social background and life experiences, both Hansen and Christina Zidow, chief operating officer of Odyssey House of Utah, which also treats people with substance use disorders, told Deseret News.
“Some people, one drop of alcohol or one drink of alcohol is too much,” Hansen said, “and it can begin a cascade of drinking that results in significant harm.”
It’s estimated that for about 1 in 5 people, drinking leads to significant alcohol use disorder. But others may develop related health problems.
“If you’re telling yourself my glass of wine is making my heart healthier, so I’m going to have a glass of wine every day instead of eating a balanced diet that has a lot of food that grows and getting outside for some vitamin D and 30-minute exercise, I’m going to take the healthy food and the exercise over the glass of wine for what’s good for my heart any day,” Zidow said.
New thinking about alcohol
The World Health Organization recently published a statement that risky drinking begins with the first drop of alcohol.
That, Hansen added, despite efforts by the alcohol industry to work with WHO and the World Trade Association to influence international trade policy. The industry, he said, has tried to promote the idea of responsible drinking, which could lead some to believe “there must be a healthy level of drinking if you’re responsible.”
When the Journal of Studies on Alcohol and Drugs recently looked at studies that claimed health benefits for alcohol use, they found “substantial scientific limitations,” as USA Today reported. Studies with better designs didn’t find the same benefits.
Mark Petticrew, a researcher at the London School of Hygiene & Tropical Medicine, told The Guardian, “One reason why there’s a public belief in these protective effects is because the industry has funded and promoted research, like the tobacco industry did.”
He referred to a 2021 analysis of 60 reviews of alcohol and cardiovascular disease. Fourteen of them were funded by the alcohol industry or involved researchers with direct links to it. “All 14 concluded that small amounts of drink could protect against cardiovascular disease,” the article said.
Scientific support for the notion that a daily drink leads to long life “looks to be gradually fading,” the article said.
But concerns about alcohol, even in smaller amounts, and health are growing.
The Centers for Disease Control and Prevention said that between 2016 and 2021, the most recent full datasets available, “the average number of U.S. deaths from excessive alcohol use increased by more than 40,000 (29%), to 178,000 per year.” Researchers noted an average of 488 Americans died every day from excessive drinking in both 2020 and 2021.
The National Institute on Alcohol Abuse and Alcoholism said alcohol-linked liver disease kills about 22,000 people in the U.S. annually and the number is climbing.
Alcohol has typically had lethal results more often when men drink, but that’s surging now for women drinkers, too. “Men drink a lot more, they drink more often. They drive drunk more, they are injured and die more. They go to the hospital more,” Aaron M. White, senior scientific advisor to the director of the National Institute on Alcohol Abuse and Alcoholism, told Deseret News in 2020. “But women are catching up; the gap is narrowing.”
White was the lead author on a study in Alcoholism: Clinical and Experimental Research that found from 1999 to 2017, deaths involving alcohol rose 85% for women and 35% for men.
In January, a study in the Journal of the American Heart Association found that while deaths from heart disease decreased during the first two decades of this century, heart-disease deaths related to substance use increased about 4% a year. Alcohol played a role in 65% of those deaths.
There are many ways that alcohol contributes to deaths, from alcoholic liver disease or over-intoxication to alcohol’s part in heart disease and stroke, and deaths related to alcohol use, such as those caused by drunk drivers.
Potential harms abound
StatNews reported that 11% of the U.S. population have an alcohol use disorder and up to 20% will develop one at some point. That goes hand in hand with anxiety and mood disorders (up to 40% who have those also have alcohol use disorders) and 6 in 10 who seek treatment for alcohol use also have post-traumatic stress disorder.
The World Health Organization calls alcohol toxic, a carcinogen linked to certain cancers that falls just behind tobacco products and obesity for causing cancers. Per WHO, more than 75,000 U.S. cancer cases and 20,000 cancer deaths each year link back to alcohol. “A mountain of evidence suggests even low levels of alcohol (within the one to two drinks per day range recommended by U.S. dietary guidelines) could lead to certain cancers because of how the substance damages DNA as it courses through the body,” per StatNews.
In women, breast cancer is the malignancy most linked to alcohol use. A share of mouth and pharynx cancers in men and esophageal cancers in women are also associated with imbibing. Alcohol use is associated with greater risk of heart disease, congestive heart failure, atrial fibrillation, hypertension and dementia. It increases risk of stomach and gastric disease, including reflux, ulcers and colon cancer. It aggravates mental and behavioral disorders. Drink and use tobacco, too, and the potential risks skyrocket. Alcohol use has been linked to obesity, liver damage, brain damage and dementia, among others.
A large study in the Annals of Oncology found even light drinking raises risk of mouth, intestinal and breast cancer, compared to those who abstain from alcohol.
The World Health Organization’s “Global status report on alcohol and health and treatment of substance use disorder” found that an estimated 400 million people lived with alcohol use disorders globally. Of those, 209 million are dependent on alcohol.
“Substance use severely harms individual health, increasing the risk of chronic diseases, mental health conditions, and tragically resulting in millions of preventable deaths every year. It places a heavy burden on families and communities, increasing exposure to accidents, injuries and violence,” said Dr. Tedros Adhanom Ghebreyesus, WHO director-general. “To build a healthier, more equitable society, we must urgently commit to bold actions that reduce the negative health and social consequences of alcohol consumption and make treatment for substance use disorders accessible and affordable.”
The report said the greatest share of deaths attributable to alcohol (13%) in 2019 were in young people ages 20 to 39.
Knowing when to get help
There are people who have a family history where any alcohol — even a very small amount — “is playing with fire,” Zidow said. “And when we look at multigenerational substance use and alcoholism and those types of things, there’s a huge genetic predisposition there that for folks who are aware of it and paying attention to it, it’s not worth the risk. In terms of, ‘I’m going to do the things that are good for my body and healthy and health sustaining,’ alcohol’s not a panacea for anything.”
Zidow said many people don’t know their family history or how their bodies will respond to alcohol or another substance. That creates some risk. “If you don’t ever have a drink, you don’t become an alcoholic,” she said.
There are a number of signs that alcohol use is begging for real help, but it’s complicated by societal norms, Hansen said. “Our society and culture has sanctioned the use of alcohol, so we allow people to get intoxicated in a bar and then trust their own judgment, which they no longer have when they’re intoxicated, to get themselves home. And we’ve accepted and assumed that risk; we do have some legal parameters and barriers to try and prevent (bad things) from happening.”
Impaired judgment is not just what happens to people with alcohol use disorder, either. “I can’t think of another commercialized commodity where that’s the case — where death can begin with just a few drinks,” Hansen said.
Smoking kills more people overall, but when he pulls up in his car next to someone who’s smoking, he said he doesn’t worry that the vehicle will swerve into him.
Just one drink
People complain that anything used to excess can be harmful, but Hansen said alcohol is its own category. “This is the thing with alcohol, that the death can begin within the first drink or two, and the damage can begin within the first drink or two. And also the intrusion of domestic violence can begin with the first few drinks.”
“A lot of chocolate doesn’t do that,” Hansen said.
“I think we’re starting, particularly with alcohol use, to understand that it is a symptom of a larger system of problems — mental health problems and behavioral health problems that need different kinds of support,” Zidow said. “It’s a coping strategy and once someone finds a coping strategy that helps to numb what’s going on, it can be really, really difficult to move away from that coping strategy and to healthier things. I think there’s kind of the snowball effect that happens when we have a mental health condition or concern and we’re using things like alcohol to manage those feelings.”
Zidow and Hansen both said they only see people with a recognizable substance use problem or at least worry that they have one. And it’s rare that a person can simply cut back at that stage, Hansen said. “By the time they get to excessive drinking, it’s almost impossible for them to moderate their drinking to any level, because if they go back to just one drink, it suddenly turns into five or 10,” he said.
“That to me is confirmation that there has to be some changes to the brain that are happening with excessive alcohol intake, where it’s they no longer have the capacity to exercise control,” Hansen said. “And I see that again and again.”
Alcohol is attracted to water, so it rapidly penetrates every tissue in the body, which is mostly water. Most medications don’t penetrate that thoroughly, he said. The effect on the brain is rapid, as is the effect on the heart and the liver. The brain in particular drives addiction, adapting to the presence of alcohol “in a way that’s very hard to heal from,” Hansen said.
Zidow acknowledged that alcohol is “an important part of many families in many cultures, and so it’s about finding the balance and finding what is safe for you and for your health. If your family involves the history of substance use, it’s probably not a very wise choice.”
Underused medications
Hansen suggests that people approach loved ones with alcohol use disorder with some compassion. “It’s really, really hard at that point to call it a choice because your brain now has adapted to the alcohol and it’s a craving,” he said, noting the drive to drink is as strong or stronger than thirst for water.
When talking to patients, Hansen sometimes likens it to cancer, because of parallels patients can understand related to treatment and relapse and remission. And risk.
What’s underused, he said, is medication. He notes that the Food and Drug Administration has approved three drugs specifically to help people overcome alcohol disorder — not a cure, but offering real hope. And some off-label medications have helped people drink less or stop drinking.
For folks worried about their own alcohol use or that of a loved one — or those about whom someone else is concerned — Hansen has a plea: “Just please, please know that medications can help you a lot. They’re underused. They’ll give you some hope.”