Medical and Social Consequences

Alcohol consumption can have a wide range of adverse effects – medical, personal and social.  These depend on both the overall amount of alcohol consumed and on the pattern of consumption.

Binge drinking – the consumption of large quantities of alcohol at a single session resulting in intoxication – is a particularly dangerous pattern of consumption.  The nature and severity of the problems it causes depends on how frequently it occurs and over how long a period it is maintained.  The social consequences of binge drinking are also affected by the circumstances in which it takes place.

Medical Problems

Alcohol Poisoning
The acute toxic effects of alcohol are generally related to blood alcohol concentrations.

Severe intoxication causes marked muscular inco-ordination; blurred or double vision, sometimes stupor and hypothermia; occasionally hypoglycaemic (low blood sugar concentration); convulsions; depressed reflexes; respiratory depression; hypotension; coma.  Death may occur from respiratory or circulatory failure or as the result of aspiration of stomach contents in the absence of a gag reflex.

The sever hypoglycaemia that can accompany alcohol intoxication, and which may result in coma, occurs more commonly in adolescents than in adults.  Although adequate statistics are hard to come by, deaths from alcohol poisoning appear to occur most often when relatively inexperienced drinkers consume very large amount of alcohol in a short time.

Blood alcohol levels of > 300-400 mg% carry a high risk of death in the naïve drinker.  This much can be obtained by drinking 150-200g of alcohol, equal to 6-8 pints of strong lager or 2/3 bottle of vodka.

Gastrointestinal Tract
Repeated binge drinking can cause damage to the oesophagus resulting in acute haemorrhage.

Binge drinking can also cause acute gastritis, resulting in nausea and vomiting and acute pancreatitis which can result in severe abdominal pain, metabolic complications and even death.

Cardiovascular System
Any beneficial effects of alcohol consumption in regard to cardiovascular health arise from a ‘little and often’ drinking pattern and in any case are restricted to the middle aged and elderly.  Binge drinking does not have the same protective effects, and indeed substantially increases the risks of some conditions.

Blood Pressure
Alcohol consumption at least in excess of 3-4 units per day appear to increase blood pressure.  Binge drinking can cause a surge of blood pressure not found in those consuming the same quantity over a longer period.

Strokes
Alcohol intoxication and binge drinking increase the risks of acute haemorrhagic and ischemic strokes by up to ten fold.  The increased risk of haemorrhagic stroke is mediated by acute increases in blood pressure and spasm of the cerebral arteries.  The increased risk of ischemic stroke is mediated by emboli from the heart that are likely to result from cardiac arrhythmias.  Subarachnoid haemorrhage particularly affects the young to middle-aged.

Heart Diseases
Alcohol intoxication diminishes myocardial contraction, which can reduce output and increase the risk of acute heart failure.  Alcohol intoxication at least doubles the risk of heart arrhythmias, particularly arterial fibrillation, which can lead to heart failure and sudden death.  The increased risk of sudden cardiac death occurs in the absence of pre-existing heart disease.  Studies have found that 30-60% of all cases of arterial fibrillation, with other causes excluded, are due to alcohol, particularly in younger men.  One quarter of sudden cardiac deaths in young men are due to alcohol intoxication.

Cancer

Breast Cancer
Alcohol is a cause of breast cancer, the increase in risk being directly proportional to the amount consumed.  It is feared that the increase in binge drinking amount young women will lead to a significant increase in breast cancer in the next half century.  Once drink a day increases a woman’s risk of getting the disease by 6 percent; drinking up to 14 units a week increases the risk by 20 percent.  Most at risk are the increasing number of young binge drinkers who have four or more drinks on a night out.  Their risk of breast cancer is estimated to increase to 40 percent.

Oral Cancer
Binge drinking combined with smoking is responsible for a rise in oral cancer in men and women in their twenties and thirties.  Tobacco, alcohol and poor diet and major risk factors for mouth cancer, and the younger people start smoking and drinking the greater the risk.

Skeletal Muscle Damage
Binge drinking can cause acute myopathy typical symptoms being muscle pain, usually around the hip and shoulder girdles and in the calves; muscle swelling, and progressive weakness, particularly in the legs.

Accidents, Violence and Criminal Behaviour
 Alcohol affects cognitive, perceptual and motor functions and there is a causal role of alcohol intoxication for almost all types of accidents and violent behaviours.

Alcohol intoxication and accidents
Consumption patterns are reflected in hospital casualty statistics and hospital emergency room data.  In emergency rooms, self-reported alcohol consumption with six hours of admission is higher for injured that uninjured attendees.  20-40% of emergency admissions are intoxicated; the night-time rate is higher at 80%.  In general population surveys, dose-response relationships between the frequency of heavy drinking and non-fatal injuries have been observed.

High-quantity drinking has been clearly associated with drinking and driving.  Driving after having “had perhaps too much to drink” during the past month is 30 times more likely among survey respondents who consumed five or more drinks in a day at least once during the previous month.  Similarly, drivers who had been stopped at roadside sobriety checkpoints and had a BAC above 0.5g/l reported typically consuming a larger number of drinks at one sitting and more frequent intoxication than other drivers.  Among teenage males and females, the risk of self-reported impaired driving rises significantly with the frequency of binge drinking.

Dose-response relationships between blood alcohol and the risk of road traffic accidents are strong.  Summaries of findings from the United States show that at a blood alcohol concentration of 0.8g/l the risk of vehiclar crashers increase two-fold; at 1.0g/l, seven-fold; at 1.5g/l, ten-fold; and at 2.0g/l, twenty-fold.  Further, the greater the level of alcohol intoxication, the greater is the severity of the accident.

Alcohol intoxication has also been shown to be a factor in deaths from drowning, and by fire.

Violence and Crime
The prevalence of offending is substantially higher among binge drinkers then amount non-binge drinkers.  Young binge drinkers are almost three times more likely to report committing an offence than those who drink but do not normally get drunk, and five times more likely than non-drinkers of the same age.  The differences are particularly marked for fights and other violent offences.

Effects on functioning and performance
Hangover resulting from binge drinking has been shown to have adverse effects in regard to a number of aspects of human performance:

A single episode of binge drinking has been shown to cause significant impairment of memory during hangover in healthy subjects.

Physical performance of healthy subjects and athletes is significantly reduced during hangover.

Hangover related absenteeism and poor job performance was estimated to cost the US economy $148 billion in 1998.

In the USA teenage binge drinking has been linked to impaired mental and social development, reduced school performance and attainment and increased likelihood of school drop-out.