Cheers to the rest of your life

"Alcohol is a common cause of death among the working age population. 13% of working age Finns die from alcohol-induced diseases and alcohol poisoning. If we also take into account alcohol-related cancerous diseases, cardiac and cerebral events, and alcohol-induced accidents, the effects on mortality associated with alcohol are even greater," says Professor Tiina Laatikainen at the University of Eastern Finland and the Finnish Institute for Health and Welfare (THL).

The term ‘alcohol-induced disease’ refers to diseases that are solely or primarily caused by alcohol abuse, such as alcoholic liver disease, alcohol-induced pancreatitis and alcoholic cardiomyopathy. Alcohol is also a carcinogen. Long-term alcohol use increases the risk of several cancers, including gastrointestinal and colorectal cancer, liver cancer and breast cancer. "There is growing scientific evidence suggesting that even moderate drinking increases the risk of cancer and that the risk increases in direct relation to alcohol consumption. It is difficult to set a safe limit for alcohol consumption when it comes to the risk of getting cancer."

Setting risk limits will not make drinking safe

Laatikainen points out that there are two types of risk drinking. "Long-term risk drinking increases morbidity and mortality, however, getting drunk also involves acute risks which affect occasional drinkers as well."

Drinking alcohol raises one’s blood pressure and heart rate, and increased amounts may cause arrhythmia. Scientific research has also shown that binge drinking – i.e. four or more drinks per occasion for women, and six or more drinks per occasion for men – increases the risk of morbidity and mortality due to coronary heart disease and stroke, no matter how much alcohol the person consumes over time. "International comparative studies have shown that Finns drink on fewer occasions compared to Italians, for example, but people in Finland still have a habit of drinking with the intention of becoming intoxicated. One-fourth of Finns get drunk at least once a month."

The definitions of risk limits for drinking vary between countries, and they are updated whenever new scientific evidence becomes available on risk factors associated with alcohol use. Finland’s Current Care Guidelines for the treatment of alcohol abuse defines the limit for high-risk drinking requiring urgent intervention to be 12–16 units of alcohol per week for women and 23–24 units of alcohol per week for men. Drinking less than these amounts, however, does not mean that one’s alcohol consumption is at a safe level. Just to make the risks clearer, a level of moderate drinking was added to the guidelines a few years ago. The weekly limits for moderate drinking are 7 units of alcohol for women and 14 units of alcohol for men. Moderate drinking has also been observed to lead to elevated levels of CGT, the biomarker of liver dysfunction. Based on the Drinking Habits Survey carried out by the Finnish Institute for Health and Welfare (THL), warnings on the risks of alcohol use seem to have fallen on deaf ears as 58 per cent of high risk drinkers consider themselves to be moderate drinkers.

A meta-analysis of more than 80 studies recently showed that consuming eight units of alcohol per week is enough to start decreasing one’s life expectancy. "The current trend is towards setting stricter limits for risk and moderate drinking. For example, the expert panel of the new Dietary Guidelines for Americans recommends that both men and women should not have more than one drink per day," says Laatikainen.

Alcohol tolerance starts to lower at forty

Alcohol tolerance lowers with age, which is why the limits for risk drinking for people over 65 are two drinks on a single occasion and seven drinks per week. However, already at the age of 40, alcohol tolerance is lower than before. For men, alcohol consumption is at its highest at this age.

Alcohol use is in many ways linked to lifestyle diseases that become more common at middle age, such as type 2 diabetes. For one thing, the calories from alcohol can easily cause weight gain. "What’s more, diabetes medication and alcohol are a bad combination. Combining alcohol and metformin, which is the first-line medication for the treatment of type 2 diabetes, may cause lactic acidosis, which can be lethal," says Laatikainen.

Depression and sleep disorders are chronic diseases that can be aggravated and caused by risk drinking. "Heavy drinking also weakens the immune system, which is why alcoholism is the most common factor causing pneumonia in working age people."

According to the statistical report Numerot puhuvat compiled by the Finnish Association for Substance Abuse Prevention EHYT, the annual costs for Finnish workplaces related to alcohol are at least 500 million euros, and they are especially due to sick leaves and reduced work efficiency. On the other hand, it is estimated that risk drinkers’ absence from work would be reduced by half if they were to cut down from 24 drinks per week to 16 drinks per week.

The number of deaths from alcohol is the highest among people aged 45– 64. "People who die from alcohol-related causes are more likely to be unemployed than the rest of the population. On the other hand, a study focusing on the work history of people who died from alcohol-related causes showed that 17 years earlier these people were as likely as others to be in working life, at which point the adverse effects of alcohol could have been prevented. As it stands, risk drinking too often remains unidentified and the drinker is left without help," says Laatikainen.

Alcohol impairs brain function – long-term use may cause skewed thinking

What actually happens when alcohol goes to your head? "Alcohol has an impairing effect on the brain. It starts in the cortical brain regions, which control our behaviour and display of emotions. The effects are exactly what drinkers often expect to get from alcohol: lack of restraint and decreased social inhibition," says Senior Researcher Olli Kärkkäinen.

"When we drink more, we often lose too much of control and other areas of our brain also become affected. The effects include staggering, slurred speech and memory blackouts, and heavy drinking may finally lead to unconsciousness and respiratory failure."

People who are used to drinking alcohol may seem sober even after they have had several drinks, because long-term alcohol use changed the way our brain functions. "Fighting the effects of alcohol, the brain tries to maintain normal activity. This is why heavy drinkers need to drink more in order to induce the same effect that lower doses have on other people. The delirium during alcohol withdrawal is partly caused by a change in the brain when the impairment from alcohol is replaced by a hyperactive state."

Long-term heavy drinking appears to alter the structure of the brain and the functioning of neurotransmitters. "Some changes that are considered to reinforce addiction occur in the dopamine system, which controls motivation, among other things, and in the serotonin system involved in regulating emotions. Decision-making becomes skewed, so that the motivational role of alcohol increases while other factors that are usually considered rewards, such as food, sex and social life, lose their appeal," says Kärkkäinen.

Decreased brain volumes have recently been observed in middle-aged moderate drinkers as well. In a study conducted in Kuopio, heavy but socially acceptable drinking among young adults has been linked to loss of grey matter in the brain, and in men, to loss of white matter connecting brain areas. "It is unclear, however, whether there are other background and individual factors involved, and how the structural changes are linked to the risk of dementia later in life, for example."

The CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) Dementia Risk Score tool showed an increased risk of dementia for drinkers with the APOE4 genotype. Approximately one-third of Finns have this genotype.

Even if alcohol is not a problem at a younger age, it can slowly take control over the years. "Alcohol use at a young age, when the areas of the brain related to self-regulation have not yet fully developed, appears to increase the risk of alcohol addiction later in life. Childhood traumas are also a contributing factor to addiction, and when alcoholism runs in the family, one might be better off not using alcohol at all."

Kärkkäinen has studied the consequences of heavy drinking, for example, by examining post mortem brains of persons with alcohol dependence. In recent years, he has been using metabolomic profiling to study the effects of alcohol on small molecules in blood samples. "The goal is to find markers that will enable us to identify the risk of alcohol addiction or organ failure early on. New markers could also help select the most suitable way to treat alcohol addiction."

Further reading:

Peer learning boosts well-being among the elderly

It is possible to work with dementia

Learning throughout life