Drink?: The New Science of Alcohol and Health

by David J. Nutt

The World Health Organization’s Global Status Report on Alcohol and Health 2018 said that in 2016 more than 3 million people died as a result of harmful use of alcohol.

The World Health Organization’s Global Status Report on Alcohol and Health 2018 said that in 2016 more than 3 million people died as a result of harmful use of alcohol.

No other drug both enhances GABA, serotonin, and dopamine and at the same time blocks glutamate and noradrenaline. Alcohol truly produces a cocktail of neurotransmitter effects.

No other drug both enhances GABA, serotonin, and dopamine and at the same time blocks glutamate and noradrenaline. Alcohol truly produces a cocktail of neurotransmitter effects.

Another sensation many people learn to like is the hot feeling you get as alcohol goes down your throat, which will be familiar if you drink spirits and especially if you’ve ever done shots. It can become appealing because your brain knows you’re about to get the pleasurable hit from the alcohol.

Another sensation many people learn to like is the hot feeling you get as alcohol goes down your throat, which will be familiar if you drink spirits and especially if you’ve ever done shots. It can become appealing because your brain knows you’re about to get the pleasurable hit from the alcohol.

Huh

Another sensation many people learn to like is the hot feeling you get as alcohol goes down your throat, which will be familiar if you drink spirits and especially if you’ve ever done shots. It can become appealing because your brain knows you’re about to get the pleasurable hit from the alcohol.

Huh

Second, 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, and 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 behavioral patterns, so it’s important in addiction.

Second, 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, and 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 behavioral patterns, so it’s important in addiction.

A large part of alcohol’s appeal is that, for many people, it fills in the gaps in your personality, making you the person you want to be.

A large part of alcohol’s appeal is that, for many people, it fills in the gaps in your personality, making you the person you want to be.

In the 1960s and ’70s, when I was a student, most lagers and ales in pubs were 3 to 4 percent. Then along came Stella at 5 percent. Now pub beers are routinely 4 to 5 percent. Wine’s strength has also generally gone up, from 11 or 12 percent to 13 or 14.

In the 1960s and ’70s, when I was a student, most lagers and ales in pubs were 3 to 4 percent. Then along came Stella at 5 percent. Now pub beers are routinely 4 to 5 percent. Wine’s strength has also generally gone up, from 11 or 12 percent to 13 or 14.

Cask-aged and matured alcohols have a lot of congeners (which we looked at earlier), and it is thought that these may create worse hangovers.

Alcohol turns on this process because it damages the blood vessels and your gut, so the body then turns on itself. The inflammatory response is unpleasant—symptoms can include nausea, vomiting, headache, confusion, and tremor, as well as clinical depression, which induces mood changes and cognitive impairment, and learning and memory deficits. This is why an anti-inflammatory medicine—for example, ibuprofen—can help the symptoms of hangover.

It’s been shown that a lot of middle-aged “average” drinkers have fatty liver. According to the charity Drinkaware, you are at risk if you drink more than six drinks a day if you are a man and five if you are a woman—for just two or three weeks, which is only as long as a long vacation! NHS (National Health Service, the UK’s publicly funded healthcare system) advice says if you stop drinking for two weeks, you can reverse fatty liver disease (after this, you need to carry on drinking within the guidelines, of course).

A 2018 review in The Lancet, one of the leading medical journals, was called—pretty definitively—“No Level of Alcohol Consumption Improves Health.”22 Their conclusion was that, on balance, any protection would be more than canceled out by the negative effects.

It seems the effect on blood pressure is reversible if you stop drinking. In one study,25 13 out of 18 heavy drinkers saw their blood pressure return to normal levels after one month of abstinence. However, if you’re a heavy drinker, you’ll need to cut down slowly rather than cut it out immediately, or you may get a rebound effect of very high blood pressure from the noradrenaline surge that comes with withdrawal.

This may shock you, but drinking causes brain damage. In fact, the leading preventable causes of dementia are head injury and the damage alcohol does to the brain.

In a 30-year study—the Whitehall II Imaging Study28—which involved over 500 people having their brains scanned and their drinking histories taken, there were increased odds of hippocampal atrophy in those drinking up to 10 drinks weekly, and faster cognitive decline in those drinking up to five drinks weekly. The conclusion? Alcohol consumption, even at moderate levels, is associated with adverse brain outcomes.

As always, there is contradictory evidence, from a cohort study that looked at the drinking habits of 9,000 mainly middle-aged civil servants, and followed them for 23 years. It showed that low levels of alcohol consumption—that is between one and 10 drinks a week—reduced the risk of dementia.

The real reason for the French Paradox is likely not wine, but the mainly Mediterranean diet the French were consuming, which was rich in olive oil and contained more fish and chicken than red meat, as well as lots of fruits and vegetables, wholegrains, and legumes.

No one has done an experiment that has proved definitively that drinking alcohol—red wine or any other form—is protective for cardiovascular health.

This effect is dose related, and usually happens after 10 to 20 years of drinking. Women seem to be more vulnerable than men. We know that alcohol is the most common reason why people get pancreatitis. And once the pancreas is damaged, this can lead to insulin-dependent diabetes.

You may also be unsurprised that four out of five drunk-driving accidents involve male drivers.

Do you know what the 0.08 percent BAC limit means for you? According to the government, it’s impossible to say exactly how many drinks will take you to the limit, as it’s different for each person. It will depend on your weight, age, sex, and metabolism, as well as what you were drinking and what you have eaten.

0.08 percent BAC is a legal threshold—it’s not a safe level. The figure shows that the risks of an accident start to rise almost from when you start drinking, that any level of alcohol can impair driving to some extent.

“How many drinks can I have and drive?” is not the question you should be asking yourself. Because it’s not about staying within the legal limit, it’s about staying safe. I’d advise you, if you are driving, not to drink at all.

The Report of the Review of Drink and Drug Driving Law by Sir Peter North was commissioned by the UK government and published in 2010. It is a comprehensive review of drunk driving, and it states that if you are driving and your blood alcohol concentration is between 0.05 and 0.08 percent, you are six times more likely to die in a collision than if it was zero.

Germany, Italy, Austria, Croatia, Belgium, Greece, Ireland, Portugal, Spain, and France are all 0.05 percent. Estonia, Poland, Sweden, and Norway are all 0.02 percent—which in practical terms means you cannot drink at all.

I am also in favor of in-car Breathalyzers, otherwise known as alcohol ignition interlock devices. These are fitted on the cars of convicted drunk drivers in some countries; they don’t allow the car to start at all if the driver is over the limit. There is a plan to introduce them in all new cars sold in Europe by 2025. Eventually this approach might significantly reduce drunk-driving accidents, though they are not completely fool-proof.14

studies suggest that the likelihood of becoming alcoholic for an adult diagnosed with ADHD is five to ten times higher than in the general population.

ADHD is thought to occur because the top-down control of behavior from the brain’s frontal cortex isn’t sufficient to control the bottom-up drives and impulses. This failure of control may be because the dopamine and noradrenaline systems in the frontal cortex haven’t developed adequately. That’s why the most effective treatments for ADHD are medicines that enhance dopamine function (e.g., amphetamines or Ritalin [methylphenidate]) or those that increase noradrenaline activity (e.g., Strattera [atomoxetine]).

The noradrenaline/adrenaline and cortisol systems work together to provide a coordinated response to stress. The first part of the stress response happens immediately; then, over the next minutes and hours, cortisol rises. If you drink every day, and thus turn on that system repeatedly every morning as you go into mini withdrawal, you’re pushing yourself toward high blood pressure.

Men need low levels of prolactin for sperm production. But if levels rise, you can get breast growth and testosterone levels go down. This is one reason men who drink heavily end up being feminized.

One reason not to become an alcoholic!

Experts agree heavy drinking does decrease male fertility. There are obvious ways: It lowers libido and increases the likelihood of impotence too. Then there is its effect on sperm.

If you keep drinking enough to go into withdrawal every morning, the stress response will accumulate. Then, as well as the spike in noradrenaline, your cortisol levels will go up. This alters your ability to metabolize sugar and can push you toward diabetes or a rise in blood pressure. Cortisol may also drive changes in the brain that underlie depression.

Poor sleep increases ghrelin, the hormone from the stomach that increases your appetite for food and for alcohol too. It also reduces the level of the satiety hormone leptin. (Spikes in ghrelin may be partly responsible for the fact that you feel so hungry the day after drinking too.2)

So if you drink one 5-ounce glass of 13.5 percent wine, you’ll pee out nearly 200 milliliters extra. Which is why it’s a good idea to hydrate before drinking, have a glass of water with every glass of wine, and a pint of water before bed too.

Which brings us to the morning after. Have you ever spent a day slumped at your desk and achieved barely anything? People reckon they are around 40 percent less productive when hungover.

there’s a positive relationship between alcohol and exercise: that is, exercisers are more likely to be moderate drinkers and vice versa. What’s not known is why: Is it due to team sports, or a go-hard-or-go-home living ethos? Or maybe some people exercise because they feel guilty about drinking?

Play hard so you can drink hard

I drank to drown my sorrows, but the damned things learned how to swim. Frida Kahlo

You insist on finishing the bottle of wine. Bottles will keep, at least overnight. But you may find yourself rationalizing that the wine won’t be as good the next day, or it will go off. At this point, you’re beginning to drink for the alcohol rather than enjoying the taste.

Drinking has become your hobby or the only way you socialize. This often happens with retirees or expats.

Yup I have observed this!

Anxiety can lead to addiction: Imagine you are a young man who gets nervous about, for example, talking to girls. When you go out, you drink because you find it reduces your anxiety. This happens because alcohol increases your levels of the neurotransmitter GABA and decreases your levels of glutamate, so you feel relaxed.

Having fun can also lead to addiction; some people get a huge burst of pleasure from drinking—an endorphin rush. As your brain gets tolerant to the increased levels of GABA, it’s also becoming sensitized to the increased dopamine and endorphins. In this case, the more you drink, the bigger the buzz you get. One of the reasons people who respond like this lose control over their drinking is that as the buzz increases, they drink more. Their dopamine system gets turned on, so they continue to seek and desire alcohol and enjoy it

Research shows that people who drink socially—especially those who have a regular local watering hole—tend to have more friends and so more emotional support, a key source of mental health. They also feel more contented and more involved in their local community.6

Drinking may make you less aware of other people’s criticism. But it may also make you feel that people are more positively disposed toward you, at the same time as you become more positively disposed to others too. Good feelings all around!8,9 Research suggests that drinking in groups—in particular binge drinking—takes the positive feelings up a level, to euphoria.

Say no to champagne The same goes for prosecco or any other sparkling wine. You’re often offered it as your first drink on an empty stomach, the bubbles mean you get intoxicated faster, and at 12 percent ABV, it’s relatively strong alcohol.

I didn't know this - very good to know!

Buy expensive alcohol Or at least the most expensive you can. Thinking about how much money you’re pouring down your throat may be a deterrent to drinking more than you want to. And you will hopefully also enjoy the flavor more.

Good one