You want me to look in the camera? We asked Dr. Anna Lembke to answer five common questions
she hears about alcohol use: What are the signs of alcoholism? If we look at the 11 criteria in the
diagnostic and statistical manual of mental disorders that we use to diagnose addiction
they can essentially be summarized down to the four c's control, compulsions, cravings,
and consequences. So control is just what it sounds like, using more of the substance than intended,
in this case alcohol or for longer periods than intended. Compulsion means a whole lot of mental
real estate taken up with thinking about using, planning using, maybe hiding use, and also a level
of automaticity to the use- even when we didn't plan to initiate use we found ourselves using.
Craving is an intrusive thought of wanting to use that's quite overwhelming or it can
even be a physical manifestation of that intense desire for alcohol in this case, and then finally
Continued use despite consequences, and those consequences can be very far-ranging from
health consequences, to relationship consequences, professional consequences, even moral consequences.
So those are essentially the core of the definition of alcohol addiction or really any
addiction. I did leave out a couple of physiologic symptoms that are important and highly correlate
and they are tolerance and withdrawal. Tolerance is needing more and more of a substance over time
to get the same effect. So more and more alcohol or more potent forms of alcohol to get the same
effect. And withdrawal is the classic syndrome of alcohol withdrawal, that people get when they
try to reduce or stop use. A lot of people think that you need to have those physical symptoms of
tolerance and withdrawal in order to meet criteria for being addicted to alcohol, or any substance.
But in fact you don't. Even if you don't have that physiologic dependence that's characterized by
tolerance and withdrawal, those four c's alone, which represent the complex biopsychosocial
disease of addiction, can constitute meeting threshold criteria in and of themselves.
How much do you have to drink to be considered an alcoholic? Quantity and frequency of alcohol
consumption really matter. The more you drink and the more often you drink the more likely you are
to meet the diagnostic criteria for addiction, but the diagnosis itself is not dependent
on quantity and frequency. It's dependent on those four c's we talked about.
So we do have these large data sets where we ask people how much do you drink and then we follow
them prospectively in the future to see what their health outcomes were like and what we discovered
is that women who drink more than seven standard drinks per week, or more than three
on any given day, are at greatly increased risk for all cause morbidity and mortality, and are also
more likely to meet criteria for addiction to alcohol. For men those numbers are higher. For
men who drink more than 14 standard drinks per week or more than four drinks on any given day,
their risk of all-cause morbidity and mortality goes way up. Including the risk of addiction.
Why are there differences? There's something about female metabolism that makes drinking
in very large amounts potentially riskier and more dangerous for the organs than in men.
What's a standard drink?
Okay, so let's talk for a second about what a standard drink is because that's really important. Right, so your your glass of wine and my glass of wine
may look really, really different. We define one standard drink as one 12 ounce bottle of beer,
one five ounce glass of wine, or about one to one and a half ounces of hard liquor.
Okay so I've given you the limits, couple caveats there, once men hit the age of 65
their drinking standards come down to where women are. Also these limits are the upper limits.
In fact the healthiest people in the world only have one to two standard drinks
per week. That's really, really important. Okay so if you're brushing up against that seven per week if
you're a woman or that 14 per week if you're a man you're really in a much, much higher risk category.
If you really want to be super healthy, try to keep your alcohol consumption down to
one to two standard drinks per week.
Why are there age-related differences in what people can consume?
We don't really know why, but it looks like as we age we just simply metabolize alcohol differently
and can therefore tolerate less alcohol, which is why the amounts for men decrease at age 65.
For women they stay the same, but in fact it may be that we just don't have enough data and if we
were to look more closely at that we would need to bring those numbers down for women over 65 as well.
Does drinking alcohol have any health benefits? Patients will say, well isn't drinking red wine
good for me? I mean, it has like resveratrol which is going to help me live forever
and the truth of the matter is that there's no real evidence to support this idea that alcohol
in and of itself is healthy. The reason that we have that notion is because in fact it is true
that the healthiest people have no more than one to two standard drinks
per week and they're even healthier than people who drink not at all. So how can that be?
Again one putative conclusion from those data is that alcohol is healthy, but in fact what's
really happened is that group of people who don't drink include a group that we call sick quitters,
and those are individuals who have had to stop drinking because they drank so much that it caused
liver damage, pancreatic damage, heart damage, brain damage, and they change the overall risk category
of people who don't drink at all. If you or someone you love is struggling with alcoholism
please, it's never too late to get help. Check out the links below for more information.