April meets us with renewed hope: a new month to rejuvenate, to refresh our goals, with promises of Spring and increasing COVID-19 vaccine availability, so we can get back to our lives. April also meets us with National Alcohol Awareness Month in the United States.
Every year, the National Council for Alcoholism and Drug Dependence sponsors this special month to increase awareness and understanding surrounding alcohol use. In a “normal” year (when there isn’t a global pandemic facing us), alcohol is the #1 public health problem in the U.S. Alcohol misuse costs the U.S. about $249 billion per year in health care, lost productivity, and crime. Alcohol is also the third leading cause of preventable death in the U.S. This means that the 95,000 deaths from alcohol-related harms that happen every year could have been prevented.
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In 2019, about 14.5 million people living in the U.S. had alcohol use disorder (AUD). During the COVID-19 pandemic, alcohol sales increased by 54% in stores and over 262% online, suggesting that the rates of AUD are higher now than ever before. What is AUD? The DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders Version 5 – the handbook used by health care professionals to diagnose mental health conditions) characterizes AUD based on 11 different symptoms. These include consuming alcohol in larger amounts or for longer than intended, unsuccessful efforts to reduce alcohol use, spending a lot of time obtaining alcohol or recovering from drinking too much, and the development of tolerance (needing to drink more to get the same effects) or withdrawal. To have mild alcohol use disorder, a person needs to express only 2-3 of these symptoms.
Whether or not a person is diagnosed with AUD, even light or moderate drinking can become problematic. The short-term effects of alcohol consumption are obvious: feeling less inhibited, intoxication, drowsiness, motor impairments and slurred speech, and even nausea, vomiting, and blackouts. While a drink or two can relieve anxiety and feel relaxing, alcohol is dehydrating, disrupts absorption of nutrients, and ruins the depth and quality of sleep. This leads to more anxiety and stress later on, and prevents the brain and body from repairing as they normally do. Even light alcohol use has internal, unseen consequences, and outwardly ages us: the skin loses its healthy glow and wrinkles and pores become more obvious.
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The long-term effects of alcohol are harder to spot because they accumulate slowly over time. In the body, high blood pressure, liver disease, ulcers, gastritis, pancreatitis, and many types of cancer are just some of the consequences that accumulate silently over time with regular alcohol consumption. Many people think that these effects don’t apply to them, because they are young, healthy, and otherwise take care of themselves. However, chronic regular drinking, and especially binge drinking, puts people of any age at high risk for pancreatitis and liver disease. Acute alcohol pancreatitis is unpredictable and can be a life-threatening condition. Because the liver processes ~90% of alcohol, cirrhosis, or scarring, of the liver can occur as a result of repeated alcohol use, long before any symptoms are noticed.
Alcohol affects not only the body but also the brain, which governs all that we think, feel, and do. Brain scans reveal that weekly alcohol consumption is related to atrophy of the brain. This means that white matter, or the connections between parts of the brain, shrink and change, while the fluid-filled spaces in the brain (the ventricles) grow larger. Blood flow to the brain, and especially to parts of the frontal cortex, is decreased, and brain cell metabolism falls. As a result, forming new memories and recalling old ones can become increasingly difficult with chronic alcohol consumption. Attention and motivation also change, and many things that were once exciting or interesting may be less so. Some of these negative effects are even more pronounced in women, and occur at lower levels of consumption.
What is a safe amount to drink to avoid these negative consequences? The answer to this question depends on many factors and varies widely from person to person, depending upon their genetics, personal and family history, biology, and more. However, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), defines one standard drink as follows: 12 ounces of regular beer (5% alcohol), 5 ounces of wine (12% alcohol), or 1.5 ounces of spirits (40% alcohol). This means that if your wine glass is full to the top, you are actually having 2-3 drinks instead of one. A margarita also counts as two drinks, and a cosmopolitan counts as 4 drinks. Moderate drinking is defined as 1 drink per day for women and 2 per day for men. Binge drinking occurs when blood alcohol levels reach 0.08 grams of alcohol per deciliter or higher. For women, this is after about 4 drinks in 2 hours, and for men about 5 drinks. No amount of alcohol is safe for pregnant women, because alcohol easily passes to the fetus and dangerously disrupts development.
What can you do if you drink too much or want to drink less? While 12-step programs and psychosocial therapy help many people, your options are not limited. There are many medications and treatments that are effective in helping people reduce or stop drinking. One common medication is Antabuse (or Disulfiram), which works by blocking the breakdown of alcohol in the body, making people feel awful if they consume alcohol (like a rapid hangover). Other options include Campral (Acamprosate), Revia (Naltrexone), Topamax (Topiramate), and Zofran (Ondansetron). Each of these medications has a different mechanism of action in the body and may work differently in different people. However, all have been scientifically shown to reduce alcohol intake and/or promote abstinence in people with AUD. In addition to the medications listed above, promising studies are currently underway with non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS).
TMS is a non-invasive, painless procedure that involves tiny magnetic pulses to the brain, which coordinate and improve brain activity. TMS is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression, obsessive-compulsive disorder (OCD) and smoking cessation. TMS is also very effective as an “off-label” treatment for many psychiatric conditions, including drug and alcohol use. At GIA Miami, our doctors and mental health professionals have had great success in treating AUD and reducing drinking using TMS. We develop a personally tailored TMS protocol for every client’s unique needs. Because we take a whole brain-body approach to mental health, we encourage the use of TMS alongside therapy, and medication if needed, to maximize every client’s potential and help them achieve the best outcomes.
If you or a loved one is concerned about alcohol use or would like to reduce or stop drinking, GIA can help.
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