June 27, 2014
News Review From Harvard Medical School -- CDC: Alcohol Linked to 1 in 10 Deaths
About 1 out of 10 deaths of working-age U.S. adults is linked to excess drinking of alcohol, health officials report. The study came from the Centers for Disease Control and Prevention. It estimated the number of U.S. deaths attributed to alcohol among adults ages 20 to 64. The study covered the years 2006 through 2010. Excess drinking for a man was defined as more than 14 drinks a week, on average, or more than 4 at one sitting (binge drinking). For women, it was defined as more than 7 drinks a week or more than 3 at one sitting. About 71% of the alcohol-linked deaths were among men. About half of the alcohol-related deaths were linked with binge drinking. Most of these were caused by traffic accidents. The most common long-term condition linked with excess alcohol use was alcoholic liver disease. But researchers told HealthDay News that alcohol use plays a role in at least 54 conditions that can cause death. They include pancreatitis, esophageal cancer, breast cancer, mouth cancer, falling injuries, suicide and drowning. Alcohol-related death rates varied greatly from state to state. The journal Preventing Chronic Disease published the study. HealthDay and MedPage Today wrote about it June 26.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
One out of 10 deaths among working-age adults (ages 20-64) is caused by alcohol. This is found in a new report from the U.S. Centers for Disease Control and Prevention (CDC). Some of the deaths are from motor vehicle accidents. But most are from medical illnesses, such as liver disease or heart failure.
Americans may be seriously surprised by this statistic. But as a doctor, I am not surprised at all. Alcohol abuse is commonly a well-hidden habit. An alcoholic who is functioning well may be able to hide the extent of his or her drinking. When not functioning well, an alcoholic may become disengaged and isolated from family and friends. But we doctors see the heavy drinkers. We see them in the hospital, in the emergency room and in the clinic.
Family members often remark that their family member seemed "too intelligent" or had "too many resources" to become an alcoholic. But alcoholism can happen to anyone. Some of the people I have known who died from alcoholic liver failure were remarkable successes before their heavy drinking. They included a lawyer, an author and a newspaper editor.
Alcohol does not discriminate. Except in one way -- heavy drinking is more likely to cause illness and death in women. Why is this? Women absorb alcohol more easily into their bloodstreams. When a woman drinks the same amount of alcohol as a man, she will have roughly double the blood alcohol level.
Most doctors say drinking is safe when kept to these limits:
- For men, an average of 2 drinks per day (no more than 14 drinks per week), and never more than 4 drinks at a time
- For women, an average of 1 drink per day (no more than 7 drinks per week), and never more than 3 drinks at a time
What Changes Can I Make Now?
If you are dependent on alcohol and you don't stop drinking, your life expectancy may be shortened by up to 30 years, the CDC says.
But quitting alcohol is not easy. A long-term support program, such as Alcoholics Anonymous, is likely to be helpful. About half of the people who visit their first AA meeting find it helpful or appealing enough to remain active with the group for at least several months. A hospital alcohol "detox" program is also a good way to quit. Treatment for depression is needed if this part of what has led to your alcohol abuse.
Some drinkers take prescription medicines to help them quit. A report published May 14 in the Journal of the American Medical Association summarizes the research on how effective these drugs are. Researchers analyzed the results of 123 studies. One drug, disulfiram (Antabuse) did not score well. This drug creates unpleasant symptoms after a person drinks alcohol. It has been used often in the past to treat alcohol dependence. But researchers said there's not enough evidence of benefit to make it a good choice today.
Two drugs have the most proven benefit:
- Acamprosate (Campral) reduces heavy drinking and risk of relapse. It can also reduce withdrawal symptoms.
- Naltrexone (ReVia, Depade) blunts the amount of pleasure that alcohol triggers in the brain. It reduces cravings and gives people more control over urges to drink. In at least 2 studies, people taking naltrexone pills were twice as likely to remain off alcohol for 6 months or longer as people who were given a placebo pill.
These 2 drugs seem to have a roughly equal benefit. Both prevent relapse in about 1 out of 12 people treated. Both can also help alcoholics to avoid heavy binge drinking, even if they relapse to some drinking.
One of the most important first steps you can take to stop drinking is to share your planning with another person. This may be a family member, close friend or your doctor. If you join an AA group, it may be your AA sponsor. It is easy to drink when you are alone, but it is hard to break away from drinking when you are alone.
What Can I Expect Looking to the Future?
Nalmefene (Selincro) is a drug that became available in some European countries a year ago. It is not currently sold in the United States in pill form, but this might occur soon. Nalmefene is intended to reduce the amount of alcohol a person drinks. It does not help someone quit completely. This has made it an attractive option to people who only want to cut down how much they drink. This pill is taken once daily on days when people feel they are likely to drink. It blocks opioid receptors on brain cells. This blunts the emotional feeling of "reward" that can come with drinking.
Nalmefene seems to successfully reduce the number of heavy-drinking days per month and number of drinks on drinking days. One out of 12 people taking this medicine had to stop because of side effects such as nausea, dizziness, headache, insomnia or confusion. Side effects were more common with this drug than with naltrexone. If nalmefene becomes available in the United States, there is a chance it may reduce early deaths from alcohol.