DRINKING ALCOHOL

Drinking alcohol is considered normal, social behavior. And for most people it is a way of relaxing and enjoying the effects of alcohol. This page will address some of the pros and cons of drinking as well as other related issues.

Drinking Statistics for 2007

• Rates of binge alcohol use in 2007 were 1.5 percent among 12 or 13 year olds, 7.8 percent among 14 or 15 year olds, 19.4 percent among 16 or 17 year olds, 35.7 percent among persons aged 18 to 20, and peaked among those aged 21 to 25 at 45.9 percent. The rate decreased beyond young adulthood from 35.1 percent of 26 to 34 year olds to 18.9 percent of persons aged 35 or older.
• The rate of binge drinking was 41.8 percent for young adults aged 18 to 25. Heavy alcohol use was reported by 14.7 percent of persons aged 18 to 25. These rates are similar to the rates in 2006 (42.2 and 15.6 percent, respectively).
• Persons aged 65 or older had lower rates of binge drinking (7.6 percent) than adults in other age groups. The rate of heavy drinking among persons aged 65 or older was 1.4 percent.
• The rate of current alcohol use among youths aged 12 to 17 was 15.9 percent in 2007. Youth binge and heavy drinking rates were 9.7 and 2.3 percent, respectively. These rates are essentially the same as the 2006 rates (16.6, 10.3, and 2.4 percent, respectively).
• Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2007 survey (51.1 percent). This translates to an estimated 126.8 million people, which is similar to the 2006 estimate of 125.3 million people (50.9 percent).
• More than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2007. This translates to about 57.8 million people. The rate in 2007 is similar to the rate in 2006 (23.0 percent).
• In 2007, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.0 million people. This percentage is the same as the rate of heavy drinking in 2006 (6.9 percent).
• In 2007, rates of current alcohol use were 3.5 percent among persons aged 12 or 13, 14.7 percent of persons aged 14 or 15, 29.0 percent of 16 or 17 year olds, 50.7 percent of those aged 18 to 20, and 68.3 percent of 21 to 25 year old. Among older age groups, the prevalence of current alcohol use decreased with increasing age, from 63.2 percent among 26 to 29 year olds to 47.6 percent among 60 to 64 year olds and 38.1 percent among people aged 65 or older.
• Rates of binge alcohol use in 2007 were 1.5 percent among 12 or 13 year olds, 7.8 percent among 14 or 15 year olds, 19.4 percent among 16 or 17 year olds, 35.7 percent among persons aged 18 to 20, and peaked among those aged 21 to 25 at 45.9 percent. The rate decreased beyond young adulthood from 35.1 percent of 26 to 34 year olds to 18.9 percent of persons aged 35 or older.
• The rate of binge drinking was 41.8 percent for young adults aged 18 to 25. Heavy alcohol use was reported by 14.7 percent of persons aged 18 to 25. These rates are similar to the rates in 2006 (42.2 and 15.6 percent, respectively).
• Persons aged 65 or older had lower rates of binge drinking (7.6 percent) than adults in other age groups. The rate of heavy drinking among persons aged 65 or older was 1.4 percent.
• The rate of current alcohol use among youths aged 12 to 17 was 15.9 percent in 2007. Youth binge and heavy drinking rates were 9.7 and 2.3 percent, respectively. These rates are essentially the same as the 2006 rates (16.6, 10.3, and 2.4 percent, respectively).
• In 2007, 56.6 percent of males aged 12 or older were current drinkers, higher than the rate for females (46.0 percent). However, among youths aged 12 to 17, the percentage of males who were current drinkers (15.9 percent) was similar to the rate for females (16.0 percent).
• Among adults aged 18 to 25, an estimated 57.1 percent of females and 65.3 percent of males reported current drinking in 2007. These rates are similar to those reported in 2006 (57.9 and 65.9 percent, respectively). Driving Under the Influence
• In 2007, an estimated 12.7 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has dropped slightly since 2002, when it was 14.2 percent. The 2007 estimate corresponds to 31.4 million persons. From 2006 to 2007, the rate of driving under the influence of alcohol among young adults aged 18 to 25 decreased from 24.4 to 22.8 percent.
• Driving under the influence of alcohol was associated with age in 2007. An estimated 7.8 percent of 16 or 17 year olds, 18.3 percent of 18 to 20 year olds, and 25.8 percent of 21 to 25 year olds reported driving under the influence of alcohol in the past year. Beyond age 25, these rates showed a general decline with increasing age.
• Among persons aged 12 or older, males were nearly twice as likely as females (16.6 vs. 9.0 percent) to drive under the influence of alcohol in the past year.

Trends in drinking

• United States per capita consumption of ethanol from all alcoholic beverages combined in 2005 was 2.24 gallons, representing a 0.4 percent increase from 2.23 gallons in 2004. The increase is due to the increase in per capita consumption of wine (from 0.35 to 0.36 gallons ethanol) and spirits (from 0.68 to 0.70 gallons ethanol). However, per capita consumption of beer decreased (from 1.21 to 1.19 gallons ethanol)
• Between 2004 and 2005, changes in overall per capita consumption of ethanol included increases in 29 states, decreases in 20 states and the District of Columbia, and no change in two states
• Analysis of overall per capita alcohol consumption by census region between 2004 and 2005 indicated increases in the Northeast (0.4 percent), the West (0.4 percent), and the Midwest (1.8 percent), and a decrease in the South (0.5 percent)
• Healthy People 2010 has set the national objective for reducing per capita alcohol consumption to no more than 1.96 gallons ethanol. However, there has been an increasing trend in per capita consumption since 1999. To meet the 2010 objective, per capita alcohol consumption will need to decrease by 12.5 percent, or about 3 percent per year from 2006 through 2010.

Moderate drinking

Moderate drinking is difficult to define because it means different things to different people. The term is often confused with "social drinking," which refers to alcohol drinking patterns that are accepted by the society in which they occur. However, social drinking is not necessarily free of problems. Moderate drinking may be defined as drinking that does not generally cause problems, either for the drinker or for society. Since there are clearly both benefits and risks associated with lower levels of drinking, this Alcohol Alert will explore potentially positive and adverse effects of "moderate" drinking.

It would be useful if the above definition of moderate drinking were bolstered by numerical estimates of "safe" drinking limits. However, the usefulness of quantitative definitions of moderate alcohol drinking is compromised by the likelihood that a given dose of alcohol may affect different people differently. Adding further complexity, the pattern of drinking is also an important determinant of alcohol-related consequences. Thus, while epidemiologic data are often collected in terms of the "average number of drinks per week," one drink taken each day may have different consequences than seven drinks taken on a Saturday night.

Despite the complexity, numerical definitions of moderate alcohol drinking do exist. For example, guidelines put forth jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services define moderate drinking as no more than one drink a day for most women, and no more than two drinks a day for most men. A standard drink is generally considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. Each of these drinks contains roughly the same amount of absolute alcohol--approximately 0.5 ounce or 12 grams.

These guidelines exclude the following persons, who should not consume alcoholic beverages: women who are pregnant or trying to conceive; people who plan to drive or engage in other activities that require attention or skill; people taking medication, including over-the-counter medications; recovering alcoholics; and persons under the age of 21. Although not specifically addressed by the guidelines, alcohol use also is contraindicated for people with certain medical conditions such as peptic ulcer.

The existence of separate guidelines for men and women reflects research findings that women become more intoxicated than men at an equivalent dose of alcohol. This results, in part, from the significant difference in activity of an enzyme in stomach tissue of males and females that breaks down alcohol before it reaches the bloodstream. The enzyme is four times more active in males than in females. Moreover, women have proportionately fatter and less body water than men. Because alcohol is more soluble in water than in fat, a given dose becomes more highly concentrated in a female's body water than in a male's.

Since the proportion of body fat increases with age, Dufour and colleagues recommend a limit of one drink per day for the elderly.

Risks of Moderate Drinking

There are risks that might offset the benefits of moderate drinking. Research shows that adverse consequences may occur at relatively low levels of consumption.

Stroke and drinking

A review of epidemiologic evidence concludes that moderate alcohol consumption increases the potential risk of strokes caused by bleeding, although it decreases the risk of strokes caused by blocked blood vessels.

Motor vehicle crashes

While there is some evidence to suggest that low blood alcohol concentrations (BACs) bear little relationship to road crashes, impairment of driving-related skills by alcohol has been found to begin at 0.05 percent BAC or lower, with rapidly progressing deterioration as the BAC rises. A man weighing 140 pounds might attain a BAC of 0.05 percent after two drinks.

Benefits of moderate drinking

A review of the literature suggests that lower levels of alcohol consumption can reduce stress; promote conviviality and pleasant and carefree feelings; and decrease tension, anxiety, and self-consciousness. In the elderly, moderate drinking has been reported to stimulate appetite, promote regular bowel function, and improve mood.

Cardiovascular benefits of moderate drinking

There is a considerable body of evidence that lower levels of drinking decrease the risk of death from coronary artery disease (CAD). This effect has been demonstrated in a broad range of older epidemiologic studies. More recently, found that white American men who reported in 1959 that they consumed an average of fewer than three drinks per day were less likely to die during the next 12 years than men who reported abstinence. This finding was due primarily to a reduction in CAD. In a similar study using a wide range of ethnic groups, De Labry and colleagues found that rates of overall mortality were lowest for men who consumed fewer than three drinks per day over a 12-year period.

Similar results have been obtained with female subjects. Stampfer and colleagues analyzed data on middle-aged women and determined that consumption of approximately one drink per day decreases the risks of coronary heart disease. Razay and colleagues, using a random population sample, found consumption of up to two drinks per day to be associated with lower levels of cardiovascular risk factors in women. In postmenopausal women, the apparent protective effect of alcohol may be explained in part by an alcohol-induced increase in estrogen levels.

Various researchers have suggested that moderate drinking is not protective against CAD, arguing that higher mortality among abstainers results from including among them people who have stopped drinking because of ill health. Higher mortality among these "sick quitters" would explain the comparative longevity of moderate drinkers. However, studies investigating the "sick quitter" effect do not support that conclusion; including "sick quitters" in the abstinent category cannot completely explain the apparent protective effect of moderate drinking against CAD.

Alcohol drinking and Interactions with medications

Alcohol may interact harmfully with more than 100 medications, including some sold over the counter. The effects of alcohol are especially augmented by medications that depress the function of the central nervous system, such as sedatives, sleeping pills, anticonvulsants, antidepressants, antianxiety drugs, and certain painkillers. There is a consequent increased danger of driving an automobile after even moderate drinking if such medications are taken. In advanced heart failure, alcohol may not only worsen the disease, but also interfere with the function of medications to treat the disease.

Cancer and alcohol drinking

Although most evidence suggests an increased risk for certain cancers only among the heaviest drinkers, moderate drinking may be weakly related to female breast cancer. In one study, breast cancer was approximately 50 percent more likely to develop in women who consumed three to nine drinks per week than in women who drank fewer than three drinks per week. Although evidence concerning large bowel cancer is conflicting, one study suggests the possibility of a weak relation to consumption of one or more drinks per day.

Birth defects from drinking

Several ongoing studies are exploring the fetal risks associated with low levels of alcohol consumption. In one study, children whose mothers reported consuming an average of two to three drinks per day during pregnancy were smaller in weight, length, and head circumference and had an increased number of minor physical anomalies when examined at intervals through the age of 3. In addition, mothers' self-reported consumption of as few as two drinks per day during pregnancy was found to be related to a decrease in IQ scores of 7-year-old children.

The question of whether moderate drinking is a risk factor for the fetus is not altogether settled; because mothers' self-reports of alcohol consumption may be underestimates. However, animal research provides additional evidence for adverse fetal effects from low levels of drinking. Nervous system abnormalities occurred in monkeys whose mothers were exposed weekly to low doses of alcohol. An effect occurred at a maternal BAC as low as 0.024 percent. A 120-pound woman might attain this BAC after one drink. Similarly, low prenatal alcohol doses produced biochemical and physiological changes in rat brains.

Shift to heavier drinking. Recovering alcoholics, as well as people whose families have alcohol problems, may not be able to maintain moderate drinking habits. Once a person progresses from moderate to heavier drinking, the risks of social problems (for example, drinking and driving, violence, trauma) and medical problems (for example, liver disease, pancreatitis, brain damage, reproductive failure, cancer) increase greatly.

Alcohol drinking and diet

Unhealthy alcohol drinking patterns may go hand-in-hand with unhealthy eating habits, according to a new study by researchers at the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health and the U.S. Department of Agriculture. Examining diet quality of individuals who drink any kind of alcoholic beverage, researchers found that people who drink the largest quantities of alcohol - even infrequently - have the poorest quality diets. Conversely, people who drink the least amount of alcohol - regardless of drinking frequency - have the best quality diets. A report of the findings appears in the February 15, 2006 issue of the American Journal of Epidemiology.

"This is a very useful finding that refines our understanding of the relationship between patterns of alcohol drinking and other aspects of health behavior," notes NIAAA Director Ting-Kai Li, M.D.

Drinking Impairment Chart, Women & Men