Complications

Alcoholism reduces life expectancy by 10 - 12 years. Next to smoking, it is the most common preventable cause of death in America. Although studies indicate that adults who drink moderately (about one drink a day) have a lower mortality rate than their nondrinking peers, their risk for untimely death increases with heavier drinking. The earlier a person begins drinking heavily, the greater their chance of developing serious illnesses later on. Once one becomes dependent on alcohol, it is very difficult to quit.

Alcoholism and Early Death

Alcohol can affect the body in so many ways that researchers have a hard time determining exactly what the consequences are from drinking. Interestingly, although heavy drinking is associated with earlier death, studies suggest it is not from a higher risk of the more common serious health problems, such as heart attack, heart failure, diabetes, lung disease, or stroke. It is well known, however, that chronic consumption leads to many problems that can increase the risk for death:

• In general, people who drink regularly have a higher rate of death from injury or violence.
• Alcohol overdose can lead to death. This is a particular danger for adolescents who may want to impress their friends with their ability to drink alcohol but cannot yet gauge its effects. However, alcohol overdose doesn't only occur from any one heavy drinking incident, but may also occur from a constant infusion of alcohol in the bloodstream.
• Severe withdrawal and delirium tremens. Delirium tremens occurs in about 5% of alcoholics. It includes progressively severe withdrawal symptoms and altered mental states. In some cases, it can be fatal.
• Frequent, heavy alcohol use directly harms many areas in the body and produce dangerous health conditions (liver damage, pancreatitis, anemia, upper gastrointestinal bleeding, nerve damage, and impotence).
• Alcohol abusers who require surgery have an increased risk of postoperative complications, including infections, bleeding, insufficient heart and lung functions, and problems with wound healing. Alcohol withdrawal symptoms after surgery may impose further stress on the patient and hinder recuperation.

The Effects of Hangover

Although not traditionally thought of as a medical problem, a 2000 review of studies found that hangovers have significant consequences that include changes in liver function, hormonal balance, and mental functioning and an increased risk for depression and cardiac events. Hangovers can impair job performance, increasing the risk for mistakes and accidents. Interestingly, hangovers are generally more common in light-to-moderate drinkers than heavy and chronic drinkers, suggesting that binge drinking can be as threatening as chronic drinking. Any man who drinks more than 5 drinks or any woman who has more than 3 drinks is at risk for a hangover.

Accidents, Suicide, and Murder

Alcohol plays a large role in accidents, suicide, and crime.

• In a 2002 study, nearly half of all drunken drivers were alcohol dependent, and alcohol plays a major role in more than half of all automobile fatalities.
• Alcohol-related automobile accidents are the leading causes of death in young people.
• Less than 2 drinks can impair the ability to drive.
• One study of emergency room patients found that having had more than 1 drink doubled the risk of injury, and more than 4 drinks increased the risk by 11 times.
• Another study reported that among emergency room patients who were admitted for injuries, 47% tested positive for alcohol and 35% were intoxicated. Of those who were intoxicated, 75% showed evidence of chronic alcoholism.
• Alcoholism is the primary diagnosis in one-quarter of all people who commit suicide.
• Alcohol is implicated in 67% of all murders.

Domestic Violence

Alcoholic households are less cohesive and have more conflicts, and their members are less independent and expressive than households with nonalcoholic or recovering alcoholic parents. Domestic violence is a common consequence of alcohol abuse.

Effect on Women. Research suggests that for women, the most serious risk factor for injury from domestic violence may be a history of alcohol abuse in her male partner.

Effect on Children. Alcoholism in parents also increases the risk for violent behavior and abuse toward their children. Children of alcoholics tend to do worse academically than others, have a higher incidence of depression, anxiety, and stress and lower self-esteem than their peers. One study found that children who were diagnosed with major depression between the ages of 6 - 12 were more likely to have alcoholic parents or relatives than were children who were not depressed. In addition to their own inherited risk for later alcoholism, one study found that 41% of children of alcoholics have serious coping problems that may last their entire life.

Adult children of alcoholic parents are at higher risk for divorce and for psychiatric symptoms. One study concluded that the only events with greater psychological impact on children are sexual and physical abuse.

Increased Risk for Other Addictions

Researchers are finding common genetic factors in alcohol and nicotine addiction, which may explain, in part, why alcoholics are often smokers. Alcoholics who smoke compound their health problems. More alcoholics die from tobacco-related illnesses, such as heart disease or cancer, than from chronic liver disease, cirrhosis, or other conditions that are more directly tied to excessive drinking.

Liver Disorders

Alcoholic Hepatitis and Cirrhosis. Alcohol is absorbed in the small intestine and passes directly into the liver, where it becomes the preferred energy source. The liver, then, is particularly endangered by alcoholism. In the liver alcohol converts to toxic chemicals, notably acetaldehyde, which trigger the production of immune factors called cytokines. In large amounts, these factors cause inflammation and tissue injury.

Cirrhosis is a chronic liver disease that causes damage to liver tissue, scarring of the liver (fibrosis; nodular regeneration), progressive decrease in liver function, excessive fluid in the abdomen (ascites), bleeding disorders (coagulopathy), increased pressure in the blood vessels (portal hypertension), and brain function disorders (hepatic encephalopathy). Excessive alcohol use is the leading cause of cirrhosis.

Even moderate alcohol intake can produce pain in the upper right quarter of the abdomen -- a possible symptom of liver involvement. In many cases, such symptoms may be an indication of fatty liver or alcohol hepatitis, which are reversible liver conditions.

Between 10 - 20% of people who drink heavily (5 or more drinks a day) develop cirrhosis, a progressive and irreversible scarring of the liver that can eventually be fatal. Alcoholic cirrhosis (also sometimes referred to as portal, Laennec’s, nutritional, or micronodular cirrhosis) is the primary cause of cirrhosis in the US. It is estimated to be responsible for between 44 - 80% of deaths from cirrhosis in North America. [See In-Depth Report #75: Cirrhosis.]

Not eating when drinking and consuming a variety of alcoholic beverages increase the risk for liver damage. Nevertheless, the amount of alcohol consumed and the patterns of drinking are only weak predictions of risk. Up to 90% of heavy drinkers do not develop advanced irreversible liver disease. Other risk factors have been identified that may increase the danger to the liver in heavy drinkers:

• Obesity is a major factor for all stages of liver disease.
• Women develop liver disease at lower quantities of alcohol intake than men.
• Genetic factors that regulate the immune responses also play role.

Viral Hepatitis B and C. People with alcoholism tend to have lifestyles that put them at higher risk for hepatitis B and C, which are caused by viruses. Chronic forms of viral hepatitis pose risks for cirrhosis and liver cancer, and alcoholism significantly increases these risks. People with alcoholism should be immunized against hepatitis B. They may need a higher-than-normal dose of the vaccine for it to be effective. There is no vaccine for hepatitis C. [See In-Depth Report #59: Hepatitis.]

Gastrointestinal Problems

Alcoholism can cause many problems in the gastrointestinal tract. Violent vomiting can produce tears in the junction between the stomach and esophagus. Alcoholism poses a high risk for diarrhea and hemorrhoids. It increases the risk for ulcers, particularly in people taking the painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It can also cause inflammation of the esophagus (esophagitis), which can lead to bleeding in heavy drinkers.

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Alcohol can contribute to serious and chronic inflammation of the pancreas (pancreatitis) in people who are susceptible to this condition. There is some evidence of a higher risk for pancreatic cancer in people with alcoholism, although this higher risk may occur only in people who are also smokers.

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Effect on Heart Disease and Stroke

Benefits of Moderate Drinking. The effects of alcohol on heart disease and stroke vary depending on consumption. Evidence strongly suggests that light-to-moderate alcohol consumption (1 or 2 drinks a day, especially of red wine) protects the heart and also helps prevent stroke. The benefits are strongest in people at high risk for heart disease and may be fairly small in those at low risk.

Adverse Effects of Heavy Drinking. Heavy drinking harms the heart. In fact, cardiovascular disease is the leading cause of death in alcoholics. The following are negative effects on the heart and the circulatory system from high alcohol consumption:

• Evidence suggests that people who consume more than 3 drinks per day have abnormal blood clotting factors.

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• Heavy drinking was associated with atherosclerosis (hardening of the arteries) in a 2003 study.

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• Between 5 - 10% of cases of hypertension are due to alcoholism. Heavy alcohol consumption can raise blood pressure even in people with no history of heart disease. The more alcohol someone drinks, the greater the increase in blood pressure, with binge drinkers (people who have 9 or more drinks once or twice a week) being at greatest risk.

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• One study found that binge drinkers had 2.5 times the risk for heart-related emergencies than nondrinkers.

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• Heavy alcohol use, particularly a recent history of drinking, is associated with a higher risk of both ischemic and hemorrhagic stroke.

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• Large doses of alcohol can trigger potentially dangerous irregular heartbeats, most often those called atrial fibrillation, which is a common heart rhythm problem in people with alcoholism.

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• Alcohol abuse has also been associated with, and may actually be a cause of, idiopathic dilated cardiomyopathy, a condition in which the heart enlarges and its muscles weaken, putting the patient at risk for heart failure. Scientists have identified a genetic factor that appears to be responsible for this condition in certain people with alcoholism. Not all heavy drinkers develop heart failure and, in fact, moderate drinking can be protective.

Click the icon to see an image of alcoholic cardiomyopathy.

Cancer

As with heart disease, light-to-moderate consumption of alcohol, particularly red wine, may protect against cancer. Cancer, however, is the second leading cause of death in alcoholics (after cardiovascular disease), and alcoholics have a rate of carcinoma 10 times higher than that of the general population. Alcohol is probably not the direct cause of cancer in such cases, but most likely it increases the effects of other factors that contribute to certain cancers. The following are some examples:

• Alcohol produces enzymes in saliva that may be carcinogenic and increase the risk of upper digestive cancers in certain individuals.
• Studies suggest that alcohol, in combination with tobacco smoke, causes genetic damage that is associated with the development of cancer in the upper airways, the esophagus, the pancreas, and the liver.
• Use of alcohol has also been associated with a higher risk for breast cancer, possibly because of increased estrogen levels or because the liver overproduces certain carcinogenic growth factors in response to alcohol. The more a woman drinks, the higher the risk. Even moderate drinking poses a higher risk, although it is modest compared to heavy drinking. (Women who drink and are also taking hormone replacement therapy are at the highest risk.)
• Alcoholism is also highly associated with invasive cervical and vaginal cancers. This high risk, however, may be due to behaviors associated with both alcoholism and these cancers (smoking, promiscuity, use of hormonal contraception, and dietary deficiencies).

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Effects on the Lung

Pneumonia. Alcoholism is strongly associated with very serious pneumonia. Over time, chronic alcoholism can cause severe reductions in white blood cells, which increase the risk for infections, particularly those in the lung. A 2006 study suggested that alcoholism is a significant risk factor for community-acquired pneumonia (pneumonia acquired outside of hospitals or nursing homes). Patients who abuse alcoholism have a greater risk for developing severe pneumonia. Doctors recommend that patients with alcohol dependence should receive an annual pneumococcal pneumonia vaccination. The initial signs of pneumococcal pneumonia are high fever, cough, and stabbing chest pains. Immediately contact your doctor if you experience these symptoms.

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Acute Respiratory Distress Syndrome. One study indicated that intensive care patients with a history of alcohol abuse have a significantly higher risk for developing acute respiratory distress syndrome (ARDS) during hospitalization. ARDS is a form of lung failure that can be fatal. It can be caused by many of the medical conditions common in chronic alcoholism, including severe infection, trauma, blood transfusions, pneumonia, and other serious lung conditions.

Skin, Muscle, and Bone Disorders

Severe alcoholism is associated with osteoporosis (loss of bone density), muscular deterioration, skin sores, and itching. Alcohol-dependent women seem to face a higher risk than men for damage to muscles, including muscles of the heart, from the toxic effects of alcohol. Peripheral neuropathy, damage to the nerves in the limbs, occurs in 5 - 15% of people with alcoholism. Such injuries cause tingling, pain, and numbness in the hands, feet, arms, and legs.

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Effects on Reproduction and Fetal Development

Effects Sexual Function and Fertility. Alcoholism increases levels of the female hormone estrogen and reduces levels of the male hormone testosterone, factors that possibly contribute to impotence in men and infertility in women. Such changes may also be responsible for the higher risks for absent periods and abnormal uterine bleeding in women with alcoholism.

Drinking During Pregnancy and Effects on the Infant. Even moderate amounts of alcohol can have damaging effects on the developing fetus, including low birth weight and an increased risk for miscarriage. High amounts can cause fetal alcohol syndrome, a condition that can cause mental and growth retardation. One study indicated a significantly higher risk for leukemia in infants of women who drank any type of alcohol during pregnancy. A 2003 study also suggested that children of mothers who drink during pregnancy have a higher risk for alcohol dependence as they grow older.

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Effect on Weight and Diabetes

Moderate alcohol consumption may help protect the hearts of adults with type 2 diabetes. Heavy drinking however is associated with obesity, which is a risk factor for this form of diabetes. In addition, alcohol can cause hypoglycemia, a drop in blood sugar, which is especially dangerous for people with diabetes who are taking insulin. Intoxicated diabetics may not be able to recognize symptoms of hypoglycemia, a potentially hazardous condition.

The Effect on Central Nervous System and Mental Functioning

Drinking too much alcohol can cause immediate mild neurologic problems in anyone, including insomnia and headache. Long-term alcohol use may even physically affect the brain. Except in severe cases, however, any neurologic damage is not permanent, and abstinence nearly always leads to eventual recovery of normal mental function.

Effect on Mental Functioning. Studies have reported less blood flow in the frontal lobes of the brain, which may reflect links to deeper levels. In one study, even recent high alcohol use (within the last 3 months) was associated with some loss of verbal memory and slower reaction times. Researchers are also interested in the effects on the hippocampus. This region in the brain is associated with learning and memory and the regulation of emotion, sensory processing, appetite, and stress. A 2000 study suggests that during adolescence the hippocampus is particularly vulnerable to the adverse effects of alcohol.

Moreover, a 2002 report indicated that over time chronic alcohol abuse can impair so-called "executive functions," which include problem solving, mental flexibility, short-term memory, and attention. These problems are usually mild to moderate and can last for weeks or even years after a person quits drinking. In fact, such persistent problems in judgment are possibly one reason for the difficulty in quitting. Alcoholic patients who have co-existing psychiatric or neurologic problems are at particular risk for mental confusion and depression.

Wernicke-Korsakoff Syndrome. Wernicke-Korsakoff syndrome is a serious consequence of severe thiamin (vitamin B1) deficiency in alcoholism. Symptoms of this syndrome include severe loss of balance, confusion, and memory loss. Eventually, it can result in permanent brain damage and death. Once the syndrome develops, oral supplements have no effect, and only adequate and rapid intravenous vitamin B1 can treat this serious condition.

Peripheral Neuropathy. Vitamin B1 deficiencies can also lead to peripheral neuropathy, a condition that causes pain, tingling, and other abnormal sensations in the arms and legs.

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Vitamin and Mineral Deficiencies

People with alcoholism should be sure to take vitamin and mineral supplements. Even apparently well-nourished people with alcoholism may be deficient in important nutrients. Deficiencies in vitamin B are particularly health risks in people with alcoholism. Other vitamin and mineral deficiencies, however, can also cause widespread health problems.

Folate Deficiencies. Alcohol interferes with the metabolism of folate, a very important B vitamin, called folic acid when used as a supplement. Folate deficiencies can cause severe anemia. Deficiencies during pregnancy can lead to birth defects in the infant. Folate deficiencies and alcoholism have also been associated with a higher risk for cancer and heart disease, particularly in women under 60.

Vitamin B1 Deficiencies. Many of the B vitamins are essential for nerve protection. Severe deficiencies are common in alcoholism and can have serious consequences on the central nervous system, notably peripheral neuropathy and, in very severe cases, Wernicke-Korsakoff syndrome.

Drug Interactions

The effects of many medications are strengthened by alcohol, while others are inhibited. Of particular importance is alcohol's reinforcing effect on anti-anxiety drugs, sedatives, antidepressants, and antipsychotic medications. Alcohol also interacts with many drugs used by people with diabetes. It interferes with drugs that prevent seizures or blood clotting. It increases the risk for gastrointestinal bleeding in people taking aspirin or other nonsteroidal inflammatory drugs (NSAIDs) including ibuprofen and naproxen. Chronic alcohol abusers have a particularly high risk for adverse side effects from consuming alcohol while taking certain antibiotics. These side effects include flushing, headache, nausea, and vomiting. In other words, taking almost any medication should preclude drinking alcohol.

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Review Date: 12/3/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital