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Patient education: Risks and benefits of alcohol (Beyond the Basics)

Patient education: Risks and benefits of alcohol (Beyond the Basics)
Author:
Kenneth J Mukamal, MD
Section Editor:
Joann G Elmore, MD, MPH
Deputy Editor:
Jane Givens, MD, MSCE
Literature review current through: Nov 2022. | This topic last updated: Jul 26, 2022.

INTRODUCTION — Is alcohol good or bad for your health?

For many reasons, this is a question without simple or clear-cut answers. Drinking too much alcohol contributes to accidents and injuries and can lead to liver disease, high blood pressure, various cancers, and congenital anomalies (problems that affect a baby at birth), among other health problems. However, limited or moderate alcohol use may provide certain health benefits for adults, such as possible reduced risk of coronary heart disease, although this has not been definitively proven. Understanding the potential risks and benefits of alcohol is essential to make an informed decision about alcohol use.

Alcohol use disorder is discussed separately. (See "Patient education: Alcohol use — when is drinking a problem? (Beyond the Basics)".)

DEFINITIONS OF AMOUNTS OF ALCOHOL USE — Alcoholic drinks come in multiple forms and contain differing amounts of pure alcohol (also called ethanol). In the United States, one portion of alcohol is defined as approximately 10 to 15 grams of ethanol, which can be found in:

One 12 ounce bottle or can of beer (roughly equivalent to the 330 mL cans of beers sold in some countries)

One 5 ounce serving of wine (about 150 mL)

One shot (1.5 ounces) of 80-proof distilled spirits (about 50 mL)

Other countries have varying definitions for what constitutes a "standard" portion of alcohol.

Drinking-related definitions vary according to age, sex, and other factors. The 2020 to 2025 United States Department of Agriculture Dietary Guidelines suggest that, if a person chooses to drink alcohol, they should consume no more than one drink per day for females (and no alcohol during pregnancy) and no more than two drinks per day for males. The recommendations differ based on biological sex because, in general, females take longer to metabolize alcohol.

Other general definitions include:

"Heavy" drinking: For females, more than three drinks in a day or more than seven drinks per week. For males, more than four drinks in a day or more than 14 drinks per week.

"Binge" drinking: Four or more drinks for females, or five or more drinks for males, within about two hours.

The National Institute on Alcohol Abuse and Alcoholism has its own definition of what amount of alcohol constitutes "low risk for developing alcohol use disorder":

For people who are not pregnant, and those older than age 65: No more than three drinks on any single day, and no more than seven drinks per week.

For males up to age 65 years: No more than four drinks on any single day, and no more than 14 drinks per week.

Even if you drink a lot or have a history of heavy drinking, you can still reduce your risks of alcohol-associated problems. If you think you might have a drinking problem, you can get help. (See "Patient education: Alcohol use — when is drinking a problem? (Beyond the Basics)".)

Some people should avoid alcohol altogether. (See 'Reasons to avoid alcohol' below.)

HEALTH CONDITIONS AND ALCOHOL — Multiple studies suggest that drinking alcohol can affect your risk of developing certain health conditions.

Cardiovascular disease — Cardiovascular disease, including disorders of the heart, blood vessels, and blood circulation, is the leading cause of death in the United States. Several studies suggest that moderate alcohol use, as compared with heavy drinking or abstaining (avoiding alcohol completely), decreases the risk of coronary heart disease (CHD). However, this has not been definitively proven, and any possible benefit can be eliminated with even occasional episodes of binge drinking. As a result, the American Heart Association advises that adults should not consume alcohol specifically to improve their cardiovascular health.

High blood pressure — People who consume more than two drinks per day have up to a twofold increase in the incidence of high blood pressure compared with nondrinkers. However, the effect of drinking less than two drinks per day on high blood pressure remains less clear. (See "Patient education: High blood pressure in adults (Beyond the Basics)".)

Heart attack — Drinking a moderate amount of alcohol has been associated with lower risk of having a heart attack. (See "Patient education: Heart attack recovery (Beyond the Basics)".)

Atrial fibrillation — Having several drinks at a single occasion, even for people who usually only drink in moderation, can cause abnormal heart rhythms, including atrial fibrillation (the most common chronic heart rhythm disturbance). Cutting back on drinking has been proven to reduce episodes of atrial fibrillation among moderate to heavy drinkers. There may be a slightly increased risk of atrial fibrillation among moderate drinkers, although it is still uncertain if this may result from occasional binges in otherwise moderate drinkers or occurs even within recommended limits of alcohol use. (See "Patient education: Atrial fibrillation (Beyond the Basics)".)

Stroke — Alcohol has been shown to affect the risk of stroke in contradictory ways, depending upon the amount of alcohol consumed and the type of stroke. A stroke occurs when brain tissue dies as a result of a sudden, severe disruption of blood flow and insufficient oxygen. Strokes may be due to a blockage (ischemic stroke) or rupture and leakage (hemorrhagic stroke) of one of the blood vessels supplying the brain.

Heavy alcohol use is associated with increased risks of both ischemic and hemorrhagic stroke. Light alcohol use is associated with fewer ischemic strokes; the risk appears to be lowest in people who consume less than one drink per day. By contrast, the risk of hemorrhagic stroke appears to rise even with minimal alcohol use.

Breast cancer — There is consistent evidence that breast cancer risk is higher in females who drink alcohol, and that the risk increases steadily with greater alcohol consumption. (See "Patient education: Factors that affect breast cancer risk in women (Beyond the Basics)".)

Taking folic acid (folate) may reduce the effect of alcohol consumption on breast cancer, suggesting that females who drink alcohol may benefit from a daily multivitamin fortified with folic acid.

Cancers of the head and neck and digestive tract — Alcohol use has been linked to several types of cancer of the head and neck and digestive (gastrointestinal) tract, even at low levels of consumption. People who drink and smoke have a greater risk than would be expected from either factor alone.

Cancer arising within liver cells (hepatocellular carcinoma) has been linked to alcohol use. This may be related to liver scarring (ie, cirrhosis) that occurs in people who consume excessive amounts of alcohol since cirrhosis is associated with an increased risk for hepatocellular carcinoma. (See "Patient education: Cirrhosis (Beyond the Basics)".)

However, even at low levels, drinking may increase the risk of hepatocellular cancer in people with inflammation of the liver (hepatitis) due to infection with certain viruses (eg, hepatitis C virus). People with chronic hepatitis should avoid alcohol. (See "Patient education: Hepatitis C (Beyond the Basics)".)

Alcoholic liver disease and cirrhosis — Excessive alcohol consumption is associated with a range of liver diseases, including alcoholic fatty liver disease (with or without steatohepatitis), alcoholic hepatitis, and cirrhosis. People who drink heavily are at increased risk of cirrhosis. Low levels of alcohol are not clearly associated with cirrhosis in the absence of other factors.

Gallstones — Moderate alcohol use has been associated with a lower risk of gallstones. However, heavy drinking may eliminate this benefit. (See "Patient education: Gallstones (Beyond the Basics)".)

Pancreatitis — Heavy drinking is associated with increased risks of both sudden (acute) and long-term (chronic) inflammation of the pancreas, also called pancreatitis. (See "Patient education: Acute pancreatitis (Beyond the Basics)" and "Patient education: Chronic pancreatitis (Beyond the Basics)".)

Osteoporosis — Heavy drinking is associated with an increased risk of hip fractures because it increases the risk of both osteoporosis (in which the bones become weak and brittle) and falls.

Pregnancy — Experts advise completely avoiding alcohol during pregnancy. There is a significant risk of birth defects related to use of alcohol during pregnancy. Heavy drinking can cause fetal alcohol syndrome, which prevents normal growth and may cause intellectual disability, malformations of the skull and face, and other problems. Even light alcohol consumption may also be harmful, although this is a matter of some controversy. There is no known benefit of alcohol use during pregnancy.

Perception of health and quality of life — Excessive and frequent alcohol use reduces quality of life for individuals, their families, and others around them, potentially leading to problems at work or school, relationship issues, and physically dangerous situations. On the other hand, some people may feel that limited or moderate alcohol consumption, particularly in social settings, improves their quality of life.

Accidents and trauma — Alcohol use increases the risks and severity of injury from motor vehicle accidents.

Exposure to alcohol is generally measured in blood alcohol concentration (BAC) rather than drinks per day or week. In most of the United States, the legal BAC limit for driving is 0.08 percent, which corresponds to about four drinks for a 200 pound male and 2.5 drinks for a 150 pound female. However, the risk of having an accident while driving doubles at a BAC of only 0.05 percent, and driving ability is impaired with a BAC as low as 0.02 percent.

Alcohol also increases the risk of other types of injury. It has been shown to impair a pilot's ability to fly and an operator's ability to control a boat, bicycle, or snowmobile. In addition, occupational injuries, falls, drownings, burns, and hypothermia are more common in those who use alcohol, particularly in heavy drinkers.

Violence — Alcohol is involved in at least half of all sexual assaults, at least one-half of serious assaults, and one-half to two-thirds of all homicides.

Suicide — Alcohol abuse is associated with an increased risk of suicide. Although moderate drinking does not appear to raise suicide risk, episodes of heavy drinking cause disinhibition that can increase suicide risk.

Get help right away if you are thinking of hurting or killing yourself! — Sometimes, people who abuse alcohol think of hurting or killing themselves. If you ever feel like you might hurt yourself, help is available:

In the United States, contact the 988 Suicide & Crisis Lifeline:

To speak to someone, call or text 988

To talk to someone online, go to www.988lifeline.org/chat

Call your doctor or nurse and tell them that it is an emergency

Call for an ambulance (in the United States and Canada, call 9-1-1)

Go to the emergency department at your local hospital

If you are worried that your partner might hurt themselves, get them help right away.

IS ALCOHOL SAFE FOR ME? — The bottom line is that it is difficult to weigh the benefits and risks of alcohol. Nevertheless, several important conclusions can be drawn:

Beginning to drink alcohol may be inappropriate for people who have never been drinkers. There is no evidence that lifelong abstainers who begin drinking in middle or older age will lower their risk of any disease.

The diseases that may be prevented by moderate drinking (eg, coronary heart disease [CHD] and ischemic stroke) are most prevalent in older adults, males, and people with CHD risk factors (eg, high blood pressure, high cholesterol, smoking, diabetes mellitus). For these groups, moderate alcohol use may reduce their risk of these conditions, but this needs to be balanced against the other potential harms of alcohol use and the known risks of heavy drinking; therefore, drinking with the specific goal of preventing these diseases is not recommended.

For young to middle-aged adults, particularly females, moderate alcohol use increases the risk of the most common causes of death, such as breast cancer and trauma. Males under age 45 years also may experience more harm than benefit from drinking. In these younger age groups, moderate alcohol use is very unlikely to reduce the risk of dying.

Consuming less than one drink daily appears to be safe for most adults, assuming it is not done before (or while) driving or operating heavy equipment. However, keep in mind that the definition of "one drink" depends on serving size and type of alcohol; using a larger glass or putting more alcohol in a mixed drink will result in more than a standard single drink (see 'Definitions of amounts of alcohol use' above). In addition, even a small amount of drinking can be dangerous for some people (see 'Reasons to avoid alcohol' below).

Reasons to avoid alcohol — Alcohol use is not recommended for people who:

Are younger than the legal drinking age

Are pregnant or trying to get pregnant

Have a personal or strong family history of alcohol use disorder

Have a medical condition that alcohol can aggravate (eg, liver or pancreatic disease related to alcohol, or precancerous conditions of the digestive tract)

Operate potentially dangerous equipment or machinery (including cars, boats, planes, or construction equipment)

Use medication known to interact with alcohol

Wine versus other alcoholic beverages — Some research suggests that wine provides the strongest protection against cardiovascular disease, possibly due to naturally occurring compounds known as flavonoids. In France, for example, death from CHD is lower than would be expected from the high rate of smoking and saturated fats in the diet; this "French paradox" has been attributed to frequent red wine consumption.

However, other studies indicate that all alcoholic beverages offer cardioprotective benefits. Whether beverage type matters for specific diseases other than CHD remains uncertain, although most evidence suggests that it does not.

A safe dose of alcohol — As mentioned above, for some people, no amount of alcohol is considered safe (see 'Reasons to avoid alcohol' above). However, for individuals without such conditions, the healthiest "dose" of alcohol appears to be below one alcoholic drink daily, so long as the person does not, even occasionally, drink to excess.

What is the best approach in my case? — The following guidelines may help in making an informed decision about alcohol use:

Talk with your health care provider to understand the specific risks and benefits of alcohol use. Multiple factors must be considered, including age, sex, personal medical history, family history, diet, physical fitness, and certain lifestyle choices such as smoking, among others.

Avoid alcohol completely if you are pregnant; in addition, experts advise avoiding alcohol if you are trying to conceive.

Never consume alcohol before or while driving or operating any potentially dangerous equipment.

If you are female or over age 65, you should consume no more than one drink on any single day. If you are male and age 65 or younger, you should never consume more than two drinks on any single day. Following these guidelines will reduce your risk of several alcohol-related conditions and is consistent with the advice established by the Dietary Guidelines for Americans and most international organizations.

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Alcohol use — when is drinking a problem? (The Basics)
Patient education: Alcohol poisoning (The Basics)
Patient education: Alcohol withdrawal (The Basics)
Patient education: Marijuana use and addiction (The Basics)
Patient education: Fetal alcohol syndrome (The Basics)
Patient education: Cocaine use disorder (The Basics)
Patient education: Alcohol and drug use in pregnancy (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Alcohol use — when is drinking a problem? (Beyond the Basics)
Patient education: High blood pressure in adults (Beyond the Basics)
Patient education: Heart attack recovery (Beyond the Basics)
Patient education: Peripheral artery disease and claudication (Beyond the Basics)
Patient education: Factors that affect breast cancer risk in women (Beyond the Basics)
Patient education: Cirrhosis (Beyond the Basics)
Patient education: Hepatitis C (Beyond the Basics)
Patient education: Gallstones (Beyond the Basics)
Patient education: Acute pancreatitis (Beyond the Basics)
Patient education: Chronic pancreatitis (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Ambulatory management of alcohol withdrawal
Cardiovascular benefits and risks of moderate alcohol consumption
Clinical manifestations and diagnosis of alcohol-associated fatty liver disease and cirrhosis
Hepatitis C and alcohol
Identification and management of unhealthy alcohol use in the perioperative period
Management of moderate and severe alcohol withdrawal syndromes
Overview of the chronic neurologic complications of alcohol
Overview of the risks and benefits of alcohol consumption
Pathogenesis of alcohol-associated liver disease
Alcohol use disorder: Psychosocial treatment
Substance use during pregnancy: Screening and prenatal care
Screening for unhealthy use of alcohol and other drugs in primary care

The following organizations also provide health information that patients can use.

National Library of Medicine

(www.medlineplus.gov/healthtopics.html)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

(www.niaaa.nih.gov and www.collegedrinkingprevention.gov)

American Academy of Family Physicians

(www.familydoctor.org)

Substance Abuse and Mental Health Services Administration (SAMHSA)

(www.samhsa.gov)

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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