Excessive alcohol use is a well-established risk factor for myriad psychiatric disorders and serious physical health problems. Alcohol is an intoxicating substance that affects every organ in the body. It can impair motor skills and neurologic function, and its abuse can lead to alcoholism. But the effects of moderate drinking are more ambiguous, and depending on the particular study, may be harmful or beneficial.
The 2010 Dietary Guidelines for Americans from the U.S. Department of Health and Human Services (DHHS) define moderate drinking in women as no more than one drink per day and in men as no more than two drinks per day (see www.health.gov/dietaryguidelines). Lower levels are recommended for women because, when it comes to alcohol, men and women are not created equal. Women absorb and metabolize alcohol differently than men; women tend to weigh less, and their bodies contain more fatty tissue and less water. According to research, because alcohol is dispersed in body water, women reach higher serum concentrations than men after drinking equivalent doses of alcohol (see the review by Mumenthaler and colleagues in the January–March 1999 issue of Alcohol Research and Health).
IS DRINKING GOOD FOR THE HEART AND BRAIN?
A substantial body of research supports the health benefits of drinking limited amounts of alcohol. According to the 2010 DHHS guidelines, moderate alcohol consumption is associated with lower allcause mortality among older and middle-aged adults, compared with nondrinkers, and consuming one to two drinks per day also appears to lower the risk of coronary heart disease (CHD); conversely, alcohol consumption doesn't appear to confer any real benefit to younger adults but is linked to higher risks of traumatic injury and death.
“I think it can be said that moderate drinking in the middle-aged and older adult, given certain exceptions, can have a beneficial effect in terms of lowering the risk of CHD,” said Kathy Hager, DNP, APRN, FNP-BC, CDE, an assistant professor of nursing at Bellarmine University in Louisville, Kentucky. “Since CHD is the number one cause of death in this country, that fact is significant.”
The positive link between moderate alcohol intake and CHD has been documented in a large number of prospective studies conducted in diverse populations, and data show that people who have one to three drinks a day lower their risk by 10% to 40%, compared with those who abstain; in a meta-analysis by Rimm and colleagues in the December 11, 1999 BMJ, 42 studies found “strong and consistent evidence” linking moderate alcohol intake with favorable biomarkers such as higher concentrations of high-density lipoprotein cholesterol.
A study published by Le Strat and Gorwood in the May–June 2011 issue of the American Journal on Addictions found that not only were moderate amounts of alcohol associated with a lower likelihood of developing CHD, so were hazardous amounts. Results of other studies have shown other cardiac benefits of moderate drinking, such as improved survival following a complicated myocardial infarction (MI). In a study by Rosenbloom and colleagues in the January 15 American Journal of Cardiology, women who survived an acute MI and who consumed alcoholic beverages had a lower risk of dying from any cause over the next 10 years than women who abstained.
Moderate drinking may also help stave off cognitive decline in women, at least according to some research. Drawing on data from the Nurses’ Health Study, Stampfer and colleagues (in the January 20, 2005, issue of the New England Journal of Medicine) found that “women who consumed up to one drink per day had consistently better cognitive performance [scores] than nondrinkers” and that moderate drinkers had less cognitive impairment. However, this doesn't mean that women who don't currently imbibe should begin drinking alcohol, said Hager, and her assertion is in line with government guidelines. And people who already drink shouldn't increase the amount of alcohol they consume; other effective strategies are available to reduce the risk of heart disease, such as a healthful diet and physical activity.
“I think it's safe to say that when one considers the available data, drinking isn't particularly beneficial,” Hager said. “When [alcohol is] taken in excess—and that amount seems to differ from individual to individual—neurologic manifestations and dementia, liver disease, gastrointestinal irritation and cancer, and alcohol-related accidents are well documented.”
Even when alcohol is consumed in moderation, there are risks to certain populations, such as pregnant women and people taking prescription medications that can interact with alcohol.
WHAT ABOUT CANCER RISK?
A number of studies have linked moderate alcohol consumption to an increased risk of cancer, particularly breast cancer in women. The Million Women Study, which was conducted in the United Kingdom, reported that drinking even just one alcoholic beverage a day elevated the risks of breast, liver, and rectal cancer in middle-aged women. Among those who also smoked, alcohol upped the risk of aerodigestive tract cancers (cancers affecting parts of the body, primarily in the head and neck, that are shared by the digestive and respiratory tracts). In contrast, greater alcohol consumption was associated with statistically significant reductions in the risks of thyroid cancer, non–Hodgkin's lymphoma, and renal cell carcinoma.
Another paper using data from the Nurses’ Health Study, published by Chen and colleagues in the November 2, 2011, issue of JAMA, found a small but significant link between drinking even small amounts of alcohol and a higher risk of breast cancer. As alcohol consumption increased, so did the risk of breast cancer. Women who consumed two or more alcoholic drinks a day had a risk of breast cancer that was about one and a half times that in women who abstained.
According to a new study, alcohol consumption also appears to increase breast density, which is a known risk factor for breast cancer. The study hasn't yet been published, but senior author Susan M. Pinney, PhD, RN, an associate professor in the Department of Environmental Health at the University of Cincinnati College of Medicine, told AJN that the combination of alcohol and hormone replacement therapy (HRT) even further increased the risk. “There was almost a doubling of the risk of increased breast density,” she said, in comparison with women who drank but didn't receive HRT.
The data were also stratified by family history, Pinney said. “The risk of high breast density was increased when there was a family history of breast cancer and alcohol use—it was about twice as high when compared with those without a family history.”
TO DRINK OR NOT TO DRINK—THAT IS THE QUESTION
So what does all this mean? What should nurses tell their patients, who may be confused by the seemingly conflicting data? One place to start is with the patient, said Madeline Naegle, PhD, APRN-BC, FAAN. “We have to examine it on an individual basis and do a thorough patient history. If a patient is concerned about the risk of breast cancer, it's important to know her risk factors and family history.”
“And we wouldn't encourage someone who has been treated for substance abuse of any kind to use alcohol,” said Naegle, who is director of the World Health Organization's Collaborating Center in Geriatric Nursing Education and coordinator of the Advanced Practice Nursing: Psychiatric–Mental, Substance Related Disorders Course Sequence at New York University.
“Basically, if women between the ages of 45 and 65 want to drink in a way that doesn't put their health at any risk,” meaning that they have no history of alcohol abuse or risk factors for breast cancer, “one drink a day is a healthy level,” said Naegle.
There are exceptions, however, Naegle added, such as older women and those taking multiple medications and who have comorbidities.
Pinney agreed that every patient is different and that recommendations on moderate drinking need to be geared to the individual woman. “Consuming red wine may decrease the risk of heart disease, and in a woman with heart disease in her family and no breast cancer, that will be more important.”
Nurses are in an ideal position to educate women regarding alcohol and to help them decipher the information. “This is a wonderful role for nurses,” Pinney emphasized, but added that it's important for all health care professionals to be educated on how to better communicate risk. “Very little time is spent on this, either in medical school or nursing school, and this is a very important area of health promotion.”—Roxanne Nelson
© 2012 Lippincott Williams & Wilkins, Inc.