Drink?: The New Science of Alcohol and Your Health

by David J. Nutt

The first thing alcohol does is to turn on the calming GABA system, so you start to feel relaxed. Valium works on the same system. This is why we drink. And it’s especially why a lot of us drink at parties. Most of us have some level of social anxiety, and alcohol removes our fear and inhibitions. Alcohol’s calming effect is also the reason why, as soon as the seatbelt sign is turned off on an aeroplane, the drinks trolley is wheeled down the aisle. It’s because many people are anxious about flying. However, if you turn the GABA system on too much, it can switch off parts of the brain you don’t want switched off, for example your judgement or even your consciousness. And if you drink a great deal of alcohol and the GABA system is maximally potentiated, it turns off your brain, in the same way as an anaesthetic, so you stop breathing. That’s one way you can die from alcohol. This is what we call alcohol poisoning.

As your blood alcohol concentration rises, it affects new and different neuromodulators too. And each one will have its own specific influences in different parts of the brain. There are three that are the most important. Firstly, a rising blood alcohol level increases the effects of serotonin, a mood enhancer that also makes you more empathetic. Its pro-serotonin effect is also what makes other people seem more attractive – so-called ‘beer goggles’. In that way, it has a similar effect to MDMA or ecstasy. It’s the stimulation of a different serotonin receptor, one in the nerves of the stomach, that makes you sick.

Secondly, drinking releases dopamine, which is involved in drive, motivation and energy. This is a factor in alcohol’s stimulant effect, which makes you feel exhilarated, more active, gives you feelings of energy and enthusiasm. Dopamine makes you louder – this is an effect people get from cocaine, too. Dopamine is one of the transmitters that also lays down behavioural patterns, so it’s important in addiction. Dopamine release may be the reason people get locked into habits that start off being fun, or at least not damaging, but then become so, for example hair-twisting and nail-biting. Dopamine is also why you get into stupid arguments about irrelevant things when you’re drunk, but can’t stop yourself.

Thirdly, the high you get from alcohol comes from endorphins. These are your body’s natural opioids, the brain’s natural pain-reducing system, also the source of the runner’s high. This reward system gives you a chilled sort of pleasure and, in some people, may also be a key factor in their addiction. Several studies have shown that when the effects of endorphins are blocked with the anti-drinking medication nalmefene, some addicts are able to stop drinking.1 Using sophisticated brain imaging, we have been able to see that this effect is related to the interactions between endorphins and dopamine in the brain.

Before modern anaesthetics existed, if a sailor had to have an injured limb removed, he’d be made legless first. There’s some good reason for this: alcohol does dampen down the pain – as well as the memory.

It’s thought at least one in five cases of dementia is probably due to alcohol.

Suicide People who have committed suicide often have high blood alcohol levels. And close to half of all people who commit suicide are intoxicated. This could be due to needing ‘Dutch courage’ to go through with it, or it could be that they attempt suicide because they are disinhibited by alcohol.

Alcohol dehydrates your whole body, but your skin is where you’ll see it. In fact each unit of alcohol – that is, 8g – makes you pee out roughly 80ml extra of urine. So if you drink one 175ml glass of 13.5 per cent wine, you’ll pee out nearly 200ml extra.

Dehydration not only makes your skin look less plump but it also makes dark eye bags more visible, because it dilates blood vessels (vasodilation). This is also why drinking often leads to spider veins and to rosacea, which looks like flushing and redness on the cheeks.

Shakespeare had the measure of alcohol and sex. In Macbeth, Macduff says: ‘It provokes the desire, but it takes away the performance; therefore much drink may be said to be an equivocator with lechery: it makes him, and it mars him; it sets him on, and it takes him off’.

Prepare an explanation as to why you’re not drinking, or not as much as usual. You could say: ‘I don’t want to get drunk because I don’t want to embarrass myself.’ Or: ‘I am only drinking one glass because I believe that, for me, it’s the right amount.’ Or even: ‘I feel good, I’ve reached the level of relaxation I was aiming for tonight.’ If you are an alcoholic, you could simply say that. This would be a very powerful statement indeed. A softer way to approach not drinking is: ‘I’m monitoring my drinking.’ After all, it’s similar to monitoring calories and there’s no shame in that. Or you could frame it in terms of calories, ‘I’m trying to lose weight and I’ve used up my calorie allowance.’ If all else fails, and you’re still being asked, follow the advice of this saying: ‘No is a complete sentence.’