Problem drinking: It may be more serious than you think

The results of a recent study published in Nature Communications show that even just a few glasses of wine or beer a week can be harmful. An international team led by the University of Pennsylvania analyzed data from more than 36,000 adults and found that both light and moderate drinking can lead to a reduction in total brain volume; and the more you drink, the stronger this relationship is. Among them, among people aged 50, as the average individual alcohol consumption increases from 1 unit of alcohol per day (about 240 ml of beer) to 2 units, the change in brain volume is equivalent to two years of aging. The increase in alcohol consumption from 2 units to 3 units in people aged 50 is equivalent to aging for 3 and a half years.

It is an indisputable fact that "wine culture", as an important part of our traditional culture, has lasted for thousands of years. In modern society, drinking has become a behavior that is generally accepted by all sectors of society. Especially now that many people are in home isolation due to the impact of the new crown epidemic, smoking and drinking are naturally indispensable. From the perspective of public health and medicine, should we drink alcohol? What harm does alcohol pose to our lives and lives? In an interview with the media, Professor Hu Jian, member of the Standing Committee of the Psychiatric Physicians Branch of the Chinese Medical Association and leader of the Psychiatry Department of Harbin Medical University, and Xia Yan, deputy chairman of the Alcohol-Related Disorders Branch of the Chinese Association for the Prevention and Treatment of Drug Abuse and a master's supervisor at the Mental Health Center of the First Affiliated Hospital of Harbin Medical University, talked about their views.

Professor Xia Yan, Director of the First Ward of Mental Health Center, First Affiliated Hospital of Harbin Medical University, Master Supervisor

Excessive drinking is really not allowed. Professor Xia Yan pointed out that as a psychoactive substance that is widely prevalent in the world, alcohol abuse has risen to the top three public health issues in the world, second only to cardiovascular and cerebrovascular diseases and malignant tumors. According to the "2018 Global Report on Alcohol and Health", there are 2.3 billion drinkers in the world, with an average daily intake of 32.8 grams of pure alcohol per person; and from the global alcohol-related death rate (male) perspective: those aged 69 or above account for 7.2%; those aged 20-29 account for 13.5%; and those aged 15-49 account for 12.2%. This shows that no matter from the perspective of national habits, geographical differences, or prevalence, it is difficult to get rid of the consequences of alcohol.

Similarly, the drinking population in my country is very large, and alcohol consumption is also "rising". The drinking rates of men, women and the total drinking rate of ordinary people (15 years old and above) are 74.93%, 38.8% and 59.0% respectively; the per capita alcohol consumption in 2005, 2010 and 2016 were 4.1 liters, 7.1 liters and 7.2 liters respectively, that is, from 2005 to 2016, the people of the country drank an extra 5 billion liters of alcohol each year. The consequence is that 6% of male and 1% of female residents in China died from alcohol-related diseases. According to the 2019 publication in The Lancet-Psychiatry, the prevalence of alcohol use disorder among mental disorders in my country reached 4.4%, ranking third.

How to define alcohol use problems? The World Health Organization's standard is that each alcohol unit (standard cup) contains 10 grams of pure alcohol; the standard set by the National Institute on Alcohol Abuse and Alcoholism in the United States is that each alcohol unit is 14 grams of pure alcohol. Professor Hu Jian explained that moderate drinking means that women drink no more than 1 standard cup (a bottle of beer or half a liang of 50-proof liquor) a day, and men do not exceed 2 standard cups; heavy drinking means drinking more than 60 grams of pure alcohol (about 3 liang of 50-proof liquor) at a time; alcoholism means that men drink 5 cups or more within 2 hours, and women drink 4 cups or more; and for pregnant women and those under 21 years old, any alcohol intake is considered "excessive."

There is no doubt that the consequences of alcohol abuse can cause serious physical or mental damage. Professor Xia pointed out that if the daily drinking volume exceeds 4 standard cups (1 standard cup equals 10 grams of pure alcohol), or if the drinking volume exceeds 6 standard cups at a time, the dangers brought by alcohol will increase significantly. When drinking a small amount of alcohol, alcohol first inhibits the cerebral cortex, causing the subcortical release, resulting in a sense of relaxation, which relieves physical and mental stress. As the amount of alcohol consumed increases, the inhibition is further deepened, entering the so-called drunken state, with slower mental activity, language and motor function reactions, and dull sensations. When drinking excessively, the high alcohol concentration in the body may lead to coma, affect breathing and heartbeat, and even death.

For long-term drinkers, due to the significant change in their dietary structure, they cannot take in enough vitamins, proteins, minerals and other essential substances in their bodies, which leads to physical diseases such as alcoholic cirrhosis, liver cancer, chronic gastritis, gastric ulcer, pancreatitis, anemia, etc. Professor Xia pointed out that long-term heavy drinking can also easily lead to a decline in intelligence, manifested as memory impairment, thinking impairment, comprehension and judgment impairment, personality abnormality, and some patients suffer from aphasia, agnosia, and insomnia due to extensive damage to the cerebral cortex. Once they enter the stage of "alcoholic dementia", it will be irreversible for life.

Professor Hu Jian Director of the Mental Health Center of the First Affiliated Hospital of Harbin Medical University, second-level professor, first-level chief physician, doctoral supervisor

There are standards for judging alcohol dependence. Professor Hu Jian introduced that the DSM-V standard is commonly used in clinical diagnosis of alcohol use disorder (AUD) and its severity in my country, which can be divided into three levels: mild, moderate and severe. When two of the following standards appear, it can be considered mild, four to five of them appear, it is moderate, also known as "problem drinking", and six or more of them appear, it is severe.

The specific criteria are as follows: 1. Intake of more alcohol than expected, longer drinking time than expected; 2. Trying to limit or stop drinking, but failing; 3. Spending too much time drinking, becoming ill and developing sequelae of alcohol intake; 4. Strong desire for alcohol; 5. Drinking or becoming ill due to drinking, making it impossible to handle housework and children's affairs normally, or causing difficulties in work or school; 6. Continuing to drink despite problems with family and partner; 7. Stopping drinking for drinking or only sporadically participating in something that was once very enjoyable or important; 8. The probability of injury has increased many times during drinking; 9. Often forgetting things or having a blank mind during drinking, but still continuing to drink; 10. Due to increased tolerance, the amount of drinking has to be increased to get the desired results. (This result is rarely caused by the usual amount of drinking); 11. When stopping alcohol intake, insomnia, difficulty falling asleep, upset, nervousness, sadness, stomach discomfort, nausea, sweating and other problems come one after another.

Whether the level of "alcohol dependence" has been reached can be determined by referring to the following diagnostic criteria: First, a strong desire or impulse to use alcohol; second, difficulty in controlling the start, end and dosage of drinking behavior; third, a physiological withdrawal state occurs when drinking is terminated or reduced; fourth, other pleasures or interests are gradually ignored due to drinking behavior, and the time spent on obtaining, using alcohol or recovering from its effects gradually increases; fifth, the basis of tolerance, higher doses of alcohol must be consumed to obtain the effects of lower doses in the past; sixth, stubborn drinking regardless of its obvious harmful consequences, such as damage to the liver caused by excessive drinking, depression caused by periodic large-scale drinking, or cognitive impairment related to alcohol. If you have experienced or shown any of the following 3 during certain periods of the past year, you can be identified as "alcohol dependent."

Some people may say that it is not easy to avoid falling into the "quagmire" of alcohol dependence? Why not drink more red wine instead of white wine, or have one or two bottles of beer every day? Professor Xia Yan seriously warned that from the perspective of physical health, there is no safe dose of drinking. It is absolutely misleading to say that drinking 1-2 cups a day is good for health! Whether it is white wine, foreign wine, beer, wine or rice wine, they all contain alcohol. The key is to control the amount of drinking.

Xia Yan introduced that previous studies have shown that a small amount of alcohol has a certain preventive effect on ischemic heart disease, that is, the relationship between alcohol consumption and total cardiovascular mortality is a J- or U-shaped curve, that is, if the weekly alcohol consumption is less than 7-8 units, the cardiovascular disease mortality rate will decrease. However, the view of The Lancet magazine is that although a small amount of alcohol has a certain protective effect on cardiovascular disease, it will be completely offset by other health risks. For example, the pleasure brought by drinking can help temporarily relieve anxiety and depression, and improve sleep quality in the short term, but this "reward effect" will soon disappear after the alcohol is metabolized, and sleep disorders and emotional problems will come back.

As an expert in basic and clinical research on alcohol dependence, Director Xia suggested that if alcohol use disorder causes physical and mental harm to alcoholics and they are unable to extricate themselves, they must seek help from psychiatrists or psychologists in a timely manner. Currently, alcohol sensitizers, benzodiazepines, and anti-alcohol craving drugs can be used clinically to help patients quit drinking. Most alcohol withdrawal patients experience withdrawal hallucinations, but the delusional symptoms do not last long. They can take antipsychotic drugs such as haloperidol or perphenazine orally or by injection. In addition, some new antipsychotic drugs such as risperidone and quetiapine also have good therapeutic effects.

Professor Hu Jian emphasized that in my country, the difference between alcohol and tobacco is that the country has begun to promote and designate designated smoking areas in cities across the country, warning that smoking affects health; while there are no measures to restrict the purchase and use of alcohol, and the prime-time advertisements of mainstream media are still occupied and flooded by various famous wine brands, and the most negative news related to alcohol is nothing more than celebrity drunk driving incidents. It can be said that alcohol use disorder is a major public health and health issue that has been neglected. It must arouse the high attention of the whole society, and it is necessary to increase national mental health education and sense of responsibility education, and deeply understand the serious harm of alcohol abuse. At the same time, Professors Hu Jian and Xia Yan suggested referring to major health commemorations such as World No Tobacco Day and International Day Against Drug Abuse, and setting up "Anti-Alcohol Abuse Day" at home and abroad in a timely manner to sound the alarm for those who drink excessively!