What is drinking a lot, how to drink in moderation, or should you not drink at all - what should you choose?
There is an ambivalent attitude towards alcohol and its consumption in our society: on the one hand, "drinking is harmful to 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 the doctors themselves, constantly talking about its harm, are hardly teetotalers? "Therefore, the purpose of this article is not only to talk about the real dangers and harms of excessive alcohol consumption, but also about what constitutes its consumption with minimal health risk.
Alcohol abuse
Let's start with some important definitions. What is Alcohol Consumption, Abuse and Alcohol Dependence? In 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 its ability to influence a person's mental activity: emotions, behavior, thinking. Therefore, alcohol is referred to as psychoactive (acting on the psyche) substances, 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 the physical (increased pressure, damage to the liver, heart and nerves) and mental health of a person (insomnia, depression, anxiety), and can also disrupt professional (dismissal), family (divorces, scandals) andpublic (arrests, drunk driving) life of a person.
Abuse is already a painful condition and requires the intervention of a doctor, but, importantly, at this stage it may also be a general therapist or neurologist who has skills in short-term intervention for alcohol problems. Alcohol addiction is already a disease, the same as 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 functions of the body that develops after repeated use of alcohol. The main symptoms of alcohol addiction are a strong compulsion to "drink" ("craving"); violation of the ability to control alcohol intake (the beginning and end of drinking and the dose) ("no brakes, binges"); desire or unsuccessful attempts to reduce or control drinking; a state of withdrawal (withdrawal syndrome, "waste") when you stop or reduce alcohol intake and alleviate this condition when drinking; tolerance - a gradual increase in the dose of alcohol consumed; ignoring other interests and increasing the time of drinking; and, finally, the continuation of drinking with their obvious harm to health. An addiction diagnosis can be made if three or more of these signs are present within one month in the past year (eg, weekly one-day heavy drinking on Fridays after work, or four week-long binge drinking per year).
If in society 5 to 10% of the population abuse alcohol and another 4% of the population (2% of women and 6% of men) are dependent on alcohol, then among the remaining part of the population, about 10-20% more detect excessive alcohol consumption. According to the WHO definition, excessive (dangerous or risky) alcohol consumption is considered to be those levels or types of alcohol that, if continued, will lead to damage to health (that is, 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 consumption, abuse and dependence), after which withdrawal from binge may be required. Non-alcoholic adults have been shown to 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 be for no more than 5 days a week with obligatory 2 sober days. According to 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 strength of 5%; in 140 ml. dry wine (9-11%); in 70 ml. fortified wine (18%); and in 35 ml of spirits (40%). To calculate the amount of ethyl alcohol in grams in an alcoholic beverage, it is necessary to multiply the volume of the drink 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 taking one or two doses of alcohol per day is undesirable: if you drive a vehicle, if you are pregnant or breastfeeding, when you are taking certain medications, with many diseases, and when you cannot control your drinking (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 various professional, family and social consequences of excessive drinking.
A low risk of alcohol problems is seen with 3-4 drinks per day for men (20 per week) and 2-3 for women (15 drinks per 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 observed when drinking more than 35 drinks per week for men and more than 25 for women. A further increase in consumption indicates abuse and sharply (by 6. 5 times) increases the risk of developing alcohol dependence and associated somatic diseases. Thus, you can calculate the amount of alcohol consumed in the last 7 days, which can be considered an indicator of the average alcohol consumption in general. And then you can assess how much risk your drinking brings you and whether 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 dependence on alcohol in parents (the risk increases by 3-4 times) and other addictions (drug addiction - an increase in risk by 4-5 and mother's smoking - by 2-3 times). Currently, many genes have been identified that are responsible for the development of alcohol dependence, however, they determine only 30-40% of the risk of its occurrence. Those. 60-70% of the risk of alcoholism depends on the personality of the person and his environment.
Genetic differences also affect the physiological and psychological characteristics of people in relation to alcohol consumption. The following features 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 take 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 sex, early first drinking, young age (16-19 years), life outside of marriage (single, divorced or widower), low income, lack of work, retirement. Psychological problems often predisposing to the development of alcohol dependence at a young age (before 25 years) are emotional instability (mood swings, irritability, aggressive behavior), altered drunkenness, hyperactivity and risky behavior (stimulus-seeking behavior - gambling, havingmany sexual partners), as well as higher levels of alcohol consumption at a young age.
Psychological problems that often predispose to the development of alcohol dependence in adulthood (after 30 years) are increased levels of anxiety and depression, impaired ability to communicate (shyness), difficulty changing, fear of being abandoned, avoidance of problems, lack of meaning for existence and prospects. The social risk factors for alcoholism include a high level of stress in the family for women and stress at work for men, low social status of the family (poverty, poor housing conditions), disruption of the structure and function of the family (incomplete - for women).
What can be advised to a person who drinks alcohol moderately, but has risk factors for developing alcohol dependence, i. e. can become an alcoholic?
In these people, even alcohol consumption at the moderate risk level can cause the same problems as low risk alcohol consumption in people without these factors. Therefore, they need to prevent the development of alcohol abuse and dependence, and this can only be achieved by constantly adhering to the limits of moderate consumption of alcohol. Even single doses of high doses of alcohol (more than 5 doses per day) can contribute to the development of alcohol problems associated with intoxication - poisoning, injuries, accidents, violence; and long-term consumption of even small amounts of alcohol (3-5 drinks per day) increases the risk of addiction by 2-3 times compared with those who do not have these hereditary, personal and social risk factors. Therefore, for them, excess doses are unacceptable.
What can be advised to a person who drinks alcohol moderately and has no risk factors for developing alcohol dependence, but still risks becoming an alcoholic? In such people, while maintaining the same level of alcohol consumption, the risk of developing addiction is minimal. However, if they are exposed to unfavorable external (dismissal, divorce, retirement) or internal factors (illness, anxiety and depression), and if they allow alcoholic excesses (taking large amounts of alcohol - more than 5 doses per day for3-7 days) or increase the amount of regularly consumed alcohol, addiction and abuse may develop within a short time.
And, finally, what advice can be given to a person who consumes alcohol in dangerous or harmful amounts? What to say to such a patient? The advice is quite simple - try drinking less, or if that doesn't work, stop drinking alcohol. How to drink less? Dilute alcoholic drinks, 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 fasting days from alcohol: two or three or even four days a week are better. Try not to get into high-risk situations where you can lose control: in campaigns, with friends, after work, on holidays, after pay, on weekends. Try not to drink when you are bored or lonely, you are irritated, tense and in a bad mood, with insomnia and anxiety; and if you find yourself in such a situation - leave, 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 solve your alcohol problems.
The last question that this article will try to answer is: what should a person and his family do with an already existing dependence on alcohol (alcoholism)?
Cessation of consumption is necessary if you experience a frequent desire to drink (even if for the purpose of relaxing, de-stressing, having fun); can't control how much you drinksuffer from a hangover the day after heavy drinking and need a drink to improve your well-being; You need more and more alcohol in order to get drunk or come back to "normal". It is also necessary to stop drinking if you suffer from high blood pressure (alcohol does not cure pressure, but, on the contrary, increases the risk of hypertensive crises and strokes), liver disease, pancreatitis, and are taking medications that are incompatible with alcohol (antibiotics, heart medications, medicines forpressure, etc. ). If you cannot quit on your own, then do not despair, now there are enough qualified specialists - psychotherapists and narcologists who anonymously: without any registration, job announcement and deprivation of a driver's license, will provide you with 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.