Alcohol and Health

Short-term effects

Long-term effects

Alcoholic liver

Excessive alcohol consumption can cause damage to the liver, a vital organ that performs myriad functions in the body, from the filtering of toxins to the storage of energy, vitamins, and minerals.

There are three types of alcoholic liver disease, sometimes thought of as stages of a progressive disease:

1. Fatty liver disease: the abnormal accumulation of fat in hepatocytes (the main functional liver cells), often leading to inflammation and scarring of the liver. Fatty liver disease has few noticeable symptoms but is thought to be present in 90% of heavy drinkers.^[2] Fatty change—the build-up of fat in the liver—can occur after just a few days of heavy drinking.^[3]
2. Alcoholic hepatitis: inflammation of the liver as a result of excessive alcohol intake. When chronic, it leads to the ballooning and necrosis of liver cells and their replacement by scar tissue. In severe acute cases, it can be fatal. Around a third of chronic drinkers develop alcoholic hepatitis, identified by jaundice (yellowing of the skin and whites of the eyes), abdominal tenderness and swelling, nausea and vomiting, and a low-grade fever.
3. Fibrosis/cirrhosis: fatty liver disease and hepatitis can lead to the death of liver cells and their replacement with scar tissue, known as fibrosis. Scar tissue doesn’t function as liver cells do and can block blood flow, leading to more cell death. When fibrosis is widespread, it’s known as cirrhosis, which can lead to liver failure and liver cancer. Around 10% to 20% of heavy drinkers will develop cirrhosis, usually after years of drinking.

Alcoholic gastritis

Excessive alcohol consumption can irritate, inflame, and eventually corrode the stomach lining. This causes a gnawing, burning feeling in your stomach, acid reflux, a bloated or full feeling, nausea, vomiting, belching, hiccuping, loss of appetite, ulcers, and blood in vomit and stool.

Gastritis can contribute to the malnutrition frequently associated with alcoholism. Bleeding in the gastrointestinal system can cause anemia. Gastritis can also increase the risk of stomach cancer.^[4]

Alcoholic neuropathy

High alcohol consumption and associated nutritional deficiencies, especially of thiamine (vitamin B1), can cause damage to peripheral nerves, which may be irreversible.

Alcoholic neuropathy usually starts in the feet before spreading to the hands and up the arms and legs. Damage to sensory nerves causes tingling, burning pain, hypersensitivity, and loss of sensation. Damage to motor nerves can cause muscle weakness, ataxia (loss of coordination), gait impairment, loss of balance, trouble swallowing, speech difficulties, and muscle atrophy.

In severe cases, the nerves that control automatic bodily processes can be affected, leading to dizziness, impairment of bowel and bladder function, and erectile dysfunction.^[5]

Neuropathy is one of the most common adverse effects of alcoholism, affecting between 25% and 66% of heavy drinkers.^[6]

Alcoholic heart disease

Alcohol can cause coronary heart disease, in which fatty deposits build up on the walls of the arteries in the heart, potentially leading to a heart attack.

Heavy drinking also causes hypertension (high blood pressure), the most important risk factor for a heart attack or stroke. Excessive drinking can also contribute to obesity, putting further strain on the cardiovascular system.

In around 1% to 2% of alcoholics, drinking can weaken and damage the muscles of the heart, a condition known as alcoholic cardiomyopathy. This means the heart can’t blood as efficiently and can lead to heart failure and death.^[7]

Alcoholic hepatitis

Most people recognize hepatitis from the viral infections hepatitis B and C. But hepatitis simply means liver inflammation, and it can also be caused by alcohol consumption. Alcoholic hepatitis is a type of alcoholic liver disease and one that a third of alcoholics will develop.

In severe acute cases, alcoholic hepatitis can be fatal, causing death in 40% to 50% of cases within a month.^[8] Chronic cases cause liver cell death and the formation of scar tissue (fibrosis).

Symptoms of alcoholic hepatitis include jaundice, abdominal tenderness and swelling, and nausea and vomiting. In severe cases, people may experience hepatic encephalopathy, brain dysfunction caused by liver failure.

Additionally, alcohol abuse makes contracting hepatitis C more likely, for reasons scientists don’t fully understand. The liver damage from hepatitis C then amplifies the damage from drinking.^[9]

Pancreatitis

Pancreatitis is inflammation of the pancreas. Heavy alcohol use can cause acute pancreatitis. Multiple cases of acute pancreatitis can lead to chronic pancreatitis, where the pancreas has been damaged by long-term inflammation and stops working properly.

Symptoms of acute pancreatitis include:

• burning pain in the upper left abdomen, radiating to the back
• nausea and vomiting, especially after eating fatty foods
• high temperature
• fast heartbeat
• rapid breathing

Mild cases can resolve with treatment, but severe acute pancreatitis causes death in 2% to 9% of cases.^[10]

In chronic pancreatitis, people experience recurrent abdominal pain. Eventually, damage means the pancreas is unable to produce digestive juices, making it hard for the body to break down fats. This can lead to jaundice, weight loss, oily and smelly stools, and ongoing nausea and vomiting. As insulin is produced in the pancreas, damage to this organ can cause diabetes. Chronic pancreatitis can also cause pancreatic cancer.^[11]

Alcoholic ketoacidosis

Alcoholic ketoacidosis is a life-threatening condition in which high doses of alcohol combined with malnutrition leads to a build-up of acids known as ketones in the blood.

If you’re not eating, your liver will use up its store of glucose, a sugar that provides your cells with energy. Your blood sugar levels will drop, your body will decrease the amount of insulin it produces and begin breaking down fat cells for energy. Fat cells, when broken down, release ketones, which can make your blood too acidic. Pancreatitis, reducing the pancreas’s ability to produce insulin, can also induce alcohol ketoacidosis.

Symptoms of alcoholic ketoacidosis include:

• fruity breath
• nausea and vomiting
• abdominal pain
• fast breathing
• fast heart rate
• confusion

Without treatment, ketoacidosis can cause shock, heart attack, seizures, pulmonary edema, kidney failure, and death.^[12]

Alcoholism and pregnancy

During pregnancy, alcohol consumed by the mother passes from her bloodstream to the baby through the umbilical cord. Therefore, there is no safe level of alcohol use during pregnancy. Women who are pregnant or trying to get pregnant should completely abstain from drinking.

Alcohol use during pregnancy can increase the risk of miscarriage and stillbirth. It can also leave the child with lifelong physical, mental and behavioral disabilities, known as fetal alcohol spectrum disorders (FASD).

Children with FASD may have the following traits and difficulties:

• distinctive facial features, including an indistinct philtrum (the groove between the nose and upper lip), thin upper lip, low nasal bridge, small eye openings, and a flat midface
• small head
• shorter-than-average height
• low body weight
• difficulty with coordination and balance
• hyperactivity
• problems with attention
• poor memory
• speech and language delays
• intellectual disability
• difficulty managing emotions
• poor reasoning and judgment
• vision and eye problems
• issues with joints, bones, muscles, and organs including the kidneys and heart^[13]

Alcoholism and appearance

Many people have experienced bloodshot eyes, dark circles, a puffy face, and dry skin after a big night out, effects that fade when you rehydrate and get a good night’s sleep. But long-term alcohol abuse can have lasting effects on your appearance.

• weight gain: Alcohol is calorie-packed and many drinks are also high in sugar. As our body works to metabolize alcohol, it’s unable to burn fat, contributing to weight gain. Drinking also makes us crave high-fat foods, one recent study suggests because it stimulates the same neurons in the brain that are activated by starvation.^[14]
• weight loss: As alcoholism progresses the individual eats only occasionally or not at all. Ketoacidosis can contribute to the burning of fat reserves, leaving them looking withered. Neuropathy can cause the atrophy of muscles, especially in the limbs.
• dry, wrinkled skin: Alcohol dehydrates, and dry skin wrinkles more quickly and looks gray. Alcohol’s diuretic effect and the malnutrition that accompanies it means you lose nutrients such as vitamin A that are important for maintaining the skin.
• redness in the face: Alcoholism can enlarge blood vessels, leading to redness and spider veins, especially on the nose and cheeks. Alcoholism can also trigger or aggravate skin conditions such as acne and psoriasis in some people.
• loose and missing teeth: Heavy drinking can cause periodontitis, and inflammation of the gums, which can destroy the bones that support the teeth.
• bad odor: The liver processes 80% of the alcohol we drink, but the rest exits the body through breath, sweat, and urine.
• yellow skin tone: If your liver isn’t properly working, bilirubin will build up, discoloring your skin and the whites of your eyes.
• unkept, tired appearance: Alcoholics often neglect basic grooming and hygiene. Dehydration and poor sleep can contribute to dark circles and bloodshot eyes.

Alcoholic dementia

Chronic exposure to ethanol has been shown to cause neuronal loss and structural damage throughout the brain.^[15] This can cause widespread cognitive deterioration, often with impairments in executive function, IQ, attention, visuospatial skills, and speed of processing.

Some people exhibit particular damage to the frontal lobes of the brain, causing disinhibition, lack of concern for consequences, and apathy. This frontal lobe damage can sometimes be difficult to distinguish from depression.^[6]

Additionally, thiamine (vitamin B1) deficiency in alcoholics causes Wernicke encephalopathy and Korsakoff syndrome, often diagnosed together as Wernicke–Korsakoff syndrome (WKS).

Wernicke encephalopathy, also known as wet brain, is characterized by three symptoms:

• change in mental state, often confusion, apathy, sluggishness, inability to concentrate, lack of awareness of surroundings, and, if untreated, coma and death
• ataxia, or lack of coordination of muscle movements, often leading to an unsteady gait
• ocular abnormalities^[17]

Korsakoff syndrome causes:

• long-term memory gaps
• inability to remember recent events
• confabulation (invented memories)
• apathy
• difficulty learning new information^[18]

In the early stages, some symptoms of alcohol-related dementias may be reversed with nutritional supplementation and abstinence.

If untreated, Wernicke encephalopathy causes death in around 20% of cases. In around 75% of cases of Korsakoff syndrome, the person is left with permanent brain damage with severe short-term memory loss. 25% of patients with KS are affected enough to require long-term institutionalization.^[19]

Alcoholism and mental health

Drinking can have serious effects on the brain’s chemistry, signaling, and functioning, aggravating existing mental illnesses and creating new ones.

As many as two-thirds of alcoholics could meet the diagnostic criteria for depression, and in around half of these drinkers, the depression lifts with sobriety. That suggests alcohol itself produces depression, likely by reducing the brain’s production of dopamine.

Alcohol—or more specifically, withdrawal from it—can also produce anxiety. Alcohol stimulates GABA receptors in the brain, producing feelings of calmness that are very seductive for people with anxiety.

However, the brain reacts by decreasing levels of GABA and increasing levels of the excitatory neurotransmitter glutamate. In occasional drinkers, this creates the anxiety associated with hangovers. In alcoholics, it can produce chronic anxiety, especially when their blood alcohol concentration level falls and they enter withdrawal.

Around 3% of alcoholics experience psychosis—delusions and hallucinations—during acute intoxication or withdrawal, with and without delirium tremens (DTs). Rarely, in long-term alcoholics, drinking can also cause two psychotic disorders: alcohol hallucinosis and alcoholic paranoia. Alcoholic hallucination is colloquially known as “seeing pink elephants.”

Alcoholic psychosis can be difficult to distinguish from schizophrenia but usually remits with abstinence.^[20]

Alcoholism also disorders lives, causing strained relationships, health problems, and financial and legal difficulties, all of which can cause and contribute to mental illness.