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Indiana Prevention Resource Center (IPRC)

Alcohol Awareness

Alcohol is a legal drug and one that has long been accepted and part of our society. Though it is legal for persons ages 21 and above, it is still a drug with the potential for risk and harm. For example, 31% of all traffic-related deaths in the United States are due to alcohol-impaired drivers (Centers for Disease Control). The alcohol industry is very strategic in its advertisement and placement of outlets in order to target certain groups. The media, social norms, and the influence of social networks have all contributed to exacerbating alcohol problems and increasing risks of misuse and abuse. April is Alcohol Awareness Month, and it is a good time to think about ways of minimizing those risks.

Low risk drinking recommendations are all based on the concept of the “standard drink.” Containing about 14 grams of pure alcohol, a standard drink is defined as about 12 ounces of regular beer, 8-9 ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of distilled spirits (National Institute on Alcohol Abuse and Alcoholism). It is important to recognize, however, that a drink served in a bar or poured at home may well contain alcohol equivalent to several “standard drinks.” This lack of standardization can make it easy to consume more alcohol than expected or desired.

Low risk drinking for women is “no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week” (National Institute on Alcohol Abuse and Alcoholism). Moderate drinking levels, however, are more simplistic and are up to one drink per day for women and up to two drinks per day for men.  

Consumption at levels above these “moderate” and “low risk” amounts brings up a range of specific and sometimes overlapping terms including alcohol misuse, alcohol abuse, alcohol dependence, and binge drinking. Alcohol misuse would be classified as consuming more than the moderate drinking level suggestions (Centers for Disease Control). Alcohol consumption can be risky at almost any level, but it becomes more dangerous as the number of drinks increase. When drinking begins to harm one’s health, relationships, or ability to work, alcohol abuse has occurred. Alcohol abuse can lead to failure to complete major responsibilities, driving under the influence, legal problems, or continued drinking even after experiencing relationship problems (Centers for Disease Control). If alcohol abuse continues to progress, it can turn into a dependence or addiction. This is a chronic disease: a life-long struggle that includes a strong craving for alcohol, continued use despite repeated physical, psychological, or interpersonal problems, and the inability to reduce drinking (Centers for Disease Control). Binge drinking can occur with any type of alcohol misuse and is defined as having a blood alcohol concentration (BAC) level of 0.08% or more. This usually means consuming five or more drinks for men and four or more drinks for women within about a two hour period (Centers for Disease Control). “In 2012, 24.6% of people ages 18 or older reported that they engaged in binge drinking in the past month” (National Institute on Alcohol Abuse and Alcoholism).

Alcohol misuse and abuse can damage virtually every organ and system in the body. Because alcohol is a depressant, it can affect one’s mood and behavior. It can also interfere with the brain’s communication pathways, making it harder to think clearly or make coordinated movements. This can lead to accidents, falls, and dangerous behavior choices. Frequent or excessive drinking can also put strain on the heart, causing cardiomyopathy (the stretching and drooping of the heart muscle), irregular heartbeats, a stroke, or high blood pressure (National Institute on Alcohol Abuse and Alcoholism). The liver and pancreas can be damaged by heavy alcohol use. In the liver, steatosis (having a fatty liver), alcoholic hepatitis, fibrosis, or cirrhosis can be caused from heavy drinking. In the United States in 2009, alcohol-related liver disease was the primary cause of almost 1 in 3 liver transplants (National Institute on Alcohol Abuse and Alcoholism). Pancreatitis can occur as well, causing severe pain, inflammation, and digestive problems. Nearly half of all cases of pancreatitis are alcohol-related (National Institute on Alcohol Abuse and Alcoholism). Drinking too much alcohol can weaken the immune system, putting the drinker at greater risk for developing many different illnesses. Heavy drinking also increases the risk for developing many types of cancer, including mouth, esophageal, throat, liver, and breast (National Institute on Alcohol Abuse and Alcoholism).

Heavy alcohol use or substance abuse is strongly associated with interpersonal violence and deaths by suicide. Alcohol consumption is also a significant factor in terms of interpersonal violence (being either a perpetrator or a victim of the violence) (World Health Organization).

It is important to note that while anyone can develop problems associated with alcohol consumption, there are some populations who are more at-risk to progress to high risk drinking patterns or who experience more negative consequences from drinking. These populations include youth under age 21, college-age young adults, senior citizens, women, or ethnic and racial minorities (National Institute on Alcohol Abuse and Alcoholism). Whether deliberate or accidental, the interaction of alcohol with other drugs can be potentially dangerous and life-threatening. The elderly are particularly vulnerable. This can happen, for example, when a senior citizen forgets he or she has taken a prescribed drug. People with mental illness, e.g., depression or certain psychiatric disorders, or who engage in other types of substance abuse, and people with a chronic physical condition, disability, or illness such as HIV/AIDS are also at increased risk. Persons who experience simultaneous or co-existing mental health and substance abuse disorders are said to have co-occurring disorders (SAMHSA, Definitions and Terms Relating to Co-occurring Disorders). Individuals with any of these risk factors may also want to avoid any alcohol use, or be much more cautious about their consumption. Additionally, even though moderate or low risk drinking reduces or eliminates most health risks, there are some populations for whom abstinence is the only safe option. These populations include pregnant women and people taking certain medications. Other groups or religions may choose to abstain from alcohol as well.

One prevention technique that has been implemented is SBIRT. This stands for Screening, Brief Intervention, Referral to Treatment, and it screens all patients for risky or harmful substance use and categorizes them into the appropriate level of care (Indiana SBIRT). While SBIRT does refer high risk drinkers to treatment, its main focus is on identifying those drinkers who are using alcohol in the potentially risky/alcohol misuse range. While these drinkers have probably not yet experienced significant harm from their alcohol use, the potential for harm exists if the drinking continues or increases. Because this group is not addicted to or dependent upon alcohol, a brief intervention, or a conversation about their drinking patterns, can help them to reduce the risk of experiencing alcohol-related consequences. This intervention is beneficial because it allows those individuals who are not heavy drinkers to become aware of the potential problems that can arise from alcohol use, ranging from minor problems such as sleep disturbances and headaches to more significant consequences involving one’s career, relationships, health, or legal standing.

Several alcohol awareness campaigns have been implemented in order to help get the message out about problem drinking. One of the more prominent campaigns targets young people ages 9 to 15 and their parents. “Talk. They Hear You.” provides parents with the resources and information they need to establish an open discussion with their children about alcohol and underage drinking.  Several resources are available online that can guide parents and make the conversation more engaging for children (Talk. They Hear You.).

Environmental strategies such as laws or policies have also been found effective but need to be utilized more consistently. For instance, some states have high alcohol taxes in order to discourage people from purchasing alcohol. In 2012, alcohol excise taxes in the 50 states ranged from $0 to $26.70 per gallon (CNS News). Indiana is the tenth lowest alcohol taxing state at $2.68 per gallon and maintained that level of taxation through 2014. Higher alcohol taxes, resulting in higher prices, have been consistently shown to decrease alcohol sales, especially among younger populations. Implementing environmental strategies can help to reduce alcohol-related health risks, suffering, and deaths.

It is important to be informed about the potential risks to oneself and others of excessive alcohol consumption and of illegal use. In our society where alcohol use is considered the norm (and where, in fact, the majority of adults consume alcohol at least occasionally), it is vital that everyone understands moderate and low risk drinking and avoids higher risk drinking patterns. Many alcohol prevention and education programs are available at national, state, and local levels. For people who are already drinking at potentially risky levels, education, support, and treatment programs are also available. Prevention and intervention efforts save lives.

*[For more resources on the topics covered in this article, see the IPRC HOME library e-Resources accessible from IPRC homepage or at http://www.drugs.indiana.edu/search/home-library.aspx].

By Heather Dolne 4/6/2015