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August 7, 1981, Vol 246, No. 6 >
ARTICLE | August 7, 1981

Health Hazards Associated With Alcohol Consumption FREE

Michael J. Eckardt, PhD; Thomas C. Harford, PhD; Charles T. Kaelber, MD, DPH; Elizabeth S. Parker, PhD; Laura S. Rosenthal; Ralph S. Ryback, MD; Gian C. Salmoiraghi, MD, PhD; Ernestine Vanderveen, PhD; Kenneth R. Warren, PhD
[+] Author Affiliations

Authors are listed in alphabetical order.

An earlier version of this article was prepared for inclusion in the scientific sections of a report to the President and the Congress, Health Hazards Associated With Alcohol and Methods to Inform the General Public of These Hazards, submitted by the US Department of the Treasury and the US Department of Health and Human Services, November 1980. The present version has been modified and updated to include recent scientific findings of importance to physicians.

Reprint requests to National Clearinghouse for Alcohol Information, Box 2345, Rockville, MD 20852.


JAMA. 1981;246(6):648-666. doi:10.1001/jama.1981.03320060050022
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References

Ethanol is a drug that is classified as a general CNS depressant. Long-term exposure can result in tolerance and physical dependence. Ethanol consumption can affect the pharmacologic and therapeutic actions of prescription drugs, over-the-counter drugs, and illicit drugs. Ethanol-drug interactions have been reported to be the most frequent cause of drug-related medical crises in the United States.

Alcohol misuse has a pervasive and potentially detrimental effect on the body from its point of entry through the gastrointestinal tract, to related organs such as the liver and the pancreas. The liver is one of the organs most significantly damaged and physiologically deranged as a result of alcohol ingestion. The two most common hepatic complications of alcoholism are hepatitis and cirrhosis. Cirrhosis was the seventh most common cause of death in the United States in 1975.

Alcohol abuse interacts with physiological and metabolic processes of digestion to contribute to nutrient deficiency. Alcohol abuse has been suggested as the most common cause of vitamin and trace element deficiency in adults in the United States. Alcohol-derived nutritional deficiencies result in suboptimal health and are contributory to such abnormalities as anemia, convulsions, small-bowel dysfunction, and overt disorders such as Wernicke's encephalopathy.

Brain dysfunction has been estimated to be present in from 50% to 70% of detoxified alcoholics entering treatment. Abstracting and adaptive abilities of social drinkers who had consumed no alcohol for 24 hours at the time of testing were found to be negatively associated with the amount of alcohol normally consumed per drinking occasion. Alcohol consumption alters numerous functions of the endocrine system, and excessive consumption has been implicated in impotency and early onset of postmenopausal amenorrhea.

Recent evidence suggests that alcoholism may be a multifactorial genetically influenced disorder. In addition to genetics, social and environmental influences play significant roles. There is an association between alcoholism and depression in both men and women. Alcoholics often have high levels of depression and alcohol itself can increase depression. A disproportionately high number of people with drinking problems commit suicide, and more than a third of suicides involve alcohol. A propensity for suicide is thought to be associated with certain alcohol-related conditions such as depression, anxiety, mood fluctuations, and deteriorated social integration.

Alcoholism has been associated with a number of adverse effects on the cardiovascular system, including a specific cardiomyopathy, low mean cardiac output, and depressed myocardial contractility. The drinking of large amounts of alcohol is associated with significant increases in blood pressure. Noncardiac myopathy has also been related to alcohol consumption.

Heavy drinking increases the risk of cancer developing in the tongue, mouth, oropharynx, hypopharynx, esophagus, larynx, and liver. In the United States, these sites represent 6.1% to 9.1% of all cancer in the white population and 11.3% to 12.5% in the black population.

In the broadest scope, alcohol abuse appears to be a risk factor in adverse fetal outcome. Fetal alcohol syndrome (FAS) has been identified among some children of alcoholic women. Fetal alcohol syndrome is characterized by CNS dysfunction, growth deficiency, a specific cluster of facial abnormalities, and other malformations, particularly skeletal, urogenital, and cardiac. It has been suggested that FAS is one of the leading causes of birth defects associated with mental retardetion. Short of the full complement of defects that characterize FAS, heavy alcohol use by women has been associated with birth anomalies. These effects of alcohol are independent of likely confounding variables, including smoking. Decreased birth weight is frequently associated with increased neonatal risk and has been observed among the children of women who consume an average of 30 mL of absolute alcohol per day (two standard drinks). Teratogenesis has also been noted in studies using alcohol-consuming animal models in whom the human condition is mimicked.

Laboratory experiments have found that alcohol significantly impairs performance on sensory-motor and cognitive tasks at blood alcohol levels as low as 40 mg/dL. Such acute alcohol effects may contribute to other health hazards that may require medical treatment. For example, one third of all traffic fatalities are alcohol related; a significant number of industrial accidents, drownings, burns, and falls have been attributed to drinking; and a relatively high involvement of alcohol has been reported in assault, rape, child abuse and neglect, child molestation, and family violence in general.

(JAMA 1981;246:648-666)

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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
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2 +
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Rubin E, Lieber CS:  Fatty liver, alcoholic hepatitis, and cirrhosis produced by alcohol in primates . N Engl J Med 1974;;290:128-135.
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US Vital Statistics, 1975. National Center for Health Statistics, Government Printing Office, 1975.
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The source of these data are the official legal death certificates, not hospitals' or physicians' clinical records.
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Day N: Alcohol and Mortality . Report prepared for National Institute on Alcohol Abuse and Alcoholism under contract No. NIA 76-10CP, 1977;.
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Lieber CS: Alcohol-nutrition interactions, in Li TK, Schenker S, Lumeng L (eds): Alcohol and Nutrition, National Institute on Alcohol Abuse and Alcoholism research monograph 2. Government Printing Office, 1979, pp 47-63.
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Shanbour LL: Effects of ethanol on the determinants of intestinal transport, in Li TK, Schenker S, Lumeng L (eds): Alcohol and Nutrition, National Institute on Alcohol Abuse and Alcoholism research monograph 2. Government Printing Office, 1979, pp 103-112.
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Halsted CH:  Folate deficiency in alcoholism . Am J Clin Nutr 1980;;33:2736-2740.
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Halsted CH, Ott J, Reisenauer AM, et al: Effect of ethanol on folate absorption, in Li TK, Schenker S, Lumeng L (eds): Alcohol and Nutrition, National Institute on Alcohol Abuse and Alcoholism research monograph 2. Government Printing Office, 1979, pp 207-219.
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Rudman D:  Deficiency of carnitine in cachectic cirrhotic patients . J Clin Invest 1977;; 60:716-723.
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Russell RM:  Vitamin A and zinc metabolism in alcoholism . Am J Clin Nutr 1980;;33:2741-2749.
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Beard JD: Effect of ethanol on magnesium metabolism, in Li TK, Schenker S, Lumeng L (eds): Alcohol and Nutrition, National Institute on Alcohol Abuse and Alcoholism research monograph 2. Government Printing Office, 1979, pp 165-171.
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The Hospital Discharge Survey (HDS) collects information from a sample of nonmilitary, non-Veterans Administration, noninstitutional short-stay hospitals. The multistage probability sample-frame takes into account hospital size, type of ownership, and region of the country. More than 400 hospitals of more than 7,000 are included in the survey. The information contained on the discharge summary abstract is coded by the National Center for Health Statistics; the discharge diagnoses are coded according to the International Classification of Diseases Adapted Codes-8 with some modifications. For each discharge, up to five conditions mentioned on the discharge summary are coded. There is no identification of individual patients; the unit of analysis is a hospitalization. Thus, there could be repeated discharges for the same person. On the other hand, the HDS probably underestimates (perhaps seriously so for some diagnoses) the occurrence of alcohol-related events that result in hospitalization. United States society still tends to stigmatize alcohol-related difficulties so that patients may minimize or conceal the involvement of alcohol in their disease or injury from their physicians. Furthermore, even if physicians are aware of the involvement of alcohol, they may be reluctant to report it in a hospital discharge summary record.
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.
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BMJ 2010;341:c5893-c1494.
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