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Are You Drinking Too Much?

Stress from the pandemic and upcoming holiday season may be causing people to drink more than they normally would. Are a few extra glasses of wine on the weekends that big a deal?

Lamia Haque, MD, Yale New Haven Hospital hepatologist and Director of the Yale Clinic for Alcohol and Addiction Treatment in Hepatology, said the amount of alcohol adults can safely consume depends on a number of factors. She recommends looking that the guidelines outlined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Alcohol guidelines

People who are healthy and do not have medical or psychiatric issues that could be exacerbated by alcohol exposure should stick to what the NIAAA considers “low risk” drinking. For women or anyone 65 and older, that is no more than three drinks on a given day and no more than seven total drinks in a week. For men under 65, low risk drinking is no more than four drinks on a given day and no more than 14 drinks total for the week.

Dr. Haque stresses that one drink is considered:

  • 12 ounces of beer
  • 5 ounces of wine
  • 1.5 ounces of distilled spirits

“People do not usually measure out to the ounce how much is being consumed,” Dr. Haque said. “One drink could actually be two or three, and this can lead to health consequences.”

Risks of drinking alcohol

In the short term, alcohol use that exceeds the low risk guidelines could lead to alcohol poisoning, impaired cognition, falls, accidents and risky decision-making. In the long term, excessive alcohol consumption can lead to a variety of chronic conditions including but not limited to high blood pressure, heart disease, stroke, various cancers and liver disease.

“Liver disease from alcohol occurs on a spectrum,” Dr. Haque said.

The vast majority of people who consume alcohol regularly, especially those who exceed the lower risk guidelines, accumulate fat in the liver, called steatosis. If the person stops drinking, that is reversible and the liver can return to normal.

However, injury from alcohol over time can lead to scarring of the liver, which in a subset of individuals can progress to cirrhosis and eventually decompensated cirrhosis. Decompensated cirrhosis, or end stage liver disease, is associated with a poorer prognosis.

Another liver-related risk of chronic, unhealthy alcohol use is alcohol-associated hepatitis. That can occur in patients with or without cirrhosis but can lead to life-threatening inflammation of the liver in severe cases.

In the early stages of alcohol associated liver injury, patients may not have any symptoms and the only way to detect abnormalities in the liver is through testing. In more severe cases, people can develop jaundice, which is yellowing of the eyes, changes in mental status, bleeding in the gastrointestinal tract, or ascites and edema, which is fluid buildup in the abdomen or legs.

Getting help for alcoholism 

In addition to liver disease, another significant long-term effect of excessive drinking is addiction, or alcohol use disorder. Some common signs of alcohol addiction include:

  • Drinking alcohol in larger quantities or for longer periods of time than intended
  • Trying to quit or reduce alcohol consumption unsuccessfully
  • Spending a lot of time drinking or trying to recover from alcohol use
  • Having symptoms of withdrawal such as irritability, tremors, anxiety, agitation, headache, nausea, vomiting, sweats, hallucinations or seizures when stopping
  • Having symptoms of tolerance such as needing more alcohol over time to achieve the same effect
  • Using alcohol in dangerous circumstances such as driving
  • Consuming alcohol despite knowing personal health risks
  • Consuming alcohol despite its effects on relationships with others
  • Alcohol use affecting the ability to complete important tasks or leading to decreased participation in important activities
  • Feeling compelled or having cravings to consume alcohol

Anyone concerned about their alcohol intake should speak with their primary healthcare provider who can help guide them to the treatment right for them. For example, the Yale Clinic for Alcohol and Addiction Treatment in Hepatology treats patients for liver disease and alcohol addiction at the same time.

“Alcohol use disorder is a treatable chronic condition just like many other conditions we care for in medical settings,” Dr. Haque said. “Individuals should feel empowered to ask for help and providers should be ready to deliver that care or refer patients to places where they can receive it.”

Even adults who do not exceed the low risk guidelines may want to look at their drinking patterns going in to the holiday season. Dr. Haque recommends evaluating your own health risks, be mindful of how much alcohol is in the glass; and always plan for a safe way home.