Nationwide, nearly one in 13 people over the age of 12 has a drinking problem, including alcohol abuse or dependence. Millions more engage in risky drinking behaviors that jeopardize their health, relationships, productivity, and general well-being. Even moderate drinking — a drink or two per day — is now considered to be “low-risk” drinking, since any amount of alcohol may be risky in certain people under certain circumstances.
This report explores the many factors to consider when deciding how much (if any) alcohol is safe for you, including your age, gender, family history, and any medical conditions you may have. It also details the dangers of alcohol misuse, from drunk driving to chronic, life-threatening health conditions. This report also offers information on medications for alcohol use disorders, evidence-based therapies to support recovery, self-help groups, and ways to help a family member who may have a drinking problem.
Prepared by the editors of Harvard Health Publications in collaboration with Hilary Smith Connery, Ph.D., M.D., Clinical Director, Alcohol and Drug Abuse Treatment Program, McLean Hospital, and Instructor at Harvard Medical School. 45 pages. (2011)
Moderate drinking: Putting the benefits in perspective
Over the past few decades, a number of studies have shown that people who drink small to moderate amounts of alcohol have a lower risk of heart disease and ischemic stroke (the type caused by a blood clot in the brain). Possible explanations for these observations include alcohol’s ability to boost “good” HDL cholesterol while decreasing the risk of blood clots.
But experts caution that observational studies that compare drinkers to nondrinkers can be difficult to interpret because of the many confounding factors. For example, people who don’t drink include lifelong teetotalers as well as those who have quit drinking, often for health reasons, which means that on the whole, abstainers aren’t necessarily a representative comparison group. People who drink also tend to have fewer risk factors for heart disease than nondrinkers. In general, drinkers tend to be wealthier and healthier, more likely to be physically active, and less likely to be obese than nondrinkers. On the other hand, drinkers are also more likely to smoke — one of the strongest risk factors for developing heart disease.
The type of alcohol you drink may also make a difference, although perhaps not for the reasons you might assume. You’ve probably heard that red wine is the best choice for heart health because it contains resveratrol, a substance found in red grape skins as well as certain berries, nuts, and other plants. Studies show resveratrol has various beneficial effects that protect the arteries and the heart. But you’d have to drink 300 glasses of red wine to get the amount of resveratrol used in these studies. Even if there’s something special about red wine, it’s hard to tease out the contribution of what people eat with their drink of choice. A Danish study found that people who buy wine are also likely to buy heart-healthy foods such as olives and olive oil, whereas beer drinkers are more likely to buy less-healthy foods, such as chips and soft drinks.
Your drinking pattern — how and when you drink — also appears to have an influence. One study found a 30% higher likelihood of death from cardiovascular disease among men who had five or more drinks on the days they consumed alcohol compared with the men who had just one. On the other hand, men who drank more frequently (120 days per year or more) had a 20% lower risk of cardiovascular death than the men who drank no more than 36 days out of the year. Another study, which compared the drinking habits of men in France and Ireland over a decade, found that the French men drank an average of 1.2 ounces of alcohol per day, versus 0.75 ounces for the Irish men. While 75% of the French men drank every day, only 12% of the Irish men did. But binge drinking — five or more drinks at least one day a week — was more common among the Irish than the French (9% vs. 0.5%). After controlling for factors such as smoking, blood pressure, and other risks, the researchers found that men who drank moderate, regular amounts of alcohol (as is typical in France) had a lower risk of heart disease than those with a binge drinking pattern (as is more common in Ireland).
Other research has examined the effects of starting to drink in midlife. One study involved 7,359 people ages 45 to 64 who had no history of cardiovascular disease and were nondrinkers at the start of the 10-year observation period. During the initial six years of the study, 6% of the subjects began drinking moderately. Over the subsequent four years, these new drinkers were 38% less likely to have experienced a cardiovascular event than the subjects who continued to abstain. But the two groups showed no significant difference in the rate of death from all causes. The beneficial alcohol effect was more marked in the people who reported drinking only wine than in those drinking beer or mixed drinks. Even though the authors of the study concluded that initiating moderate alcohol use in midlife appears to be safe and may offer cardiovascular benefits, they urged caution. The study was not long enough to reveal a potential increase in cancer rates among the drinkers, and it was not designed to take into account other behaviors or environmental influences that may affect outcomes for drinkers versus abstainers.