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Alcohol – the Body & Health Effects A brief overview 23

3 Contents

5 Introduction 21 Mental health conditions

5 What is ? 22 Alcohol and interactions

6 Body effects of alcohol 23 Effects of alcohol on other people

9 Overall body effects 23 The unborn child

9 and 23 Children and families

9 and muscles 24 Effects of alcohol on population groups

9 and 24 Women

10 Breasts – women 24 Men

10 Eyes 25 Young people

10 Heart and blood pressure 25 Older people

11 Intestines 26 Low-risk alcohol drinking advice

11 Kidneys and fluid balance 26 How much?

11 Liver 27 Advice for parents of children and young people under 18 years 12 Lungs 27 What is a standard drink? 12 Mental health 28 When not to drink 12 Mouth and throat 28 Tips for low-risk drinking 13 Pancreas and digestion of sugar 28 Background to drinking advice Acknowledgements 13 Sexual health – men 29 Where to find support and further information 13 Sexual health – women The Alcohol Advisory Council of New Zealand (ALAC) would like to thank Dr Fiona Imlach Gunasekara, Public 30 Glossary Health Medicine Specialist, for preparing the summaries of the health and body effects of alcohol in this resource. 14 Skin and fat 32 References ISBN 978–1–927138–41–0 (print) 14 Stomach and food pipe (oesophagus)

978–1–927138–42–7 (online) 15 Health effects of acute alcohol use TABLES 15 Alcohol poisoning 7 Table 1: Symptoms of drunkenness at different 17 levels of blood alcohol concentration (BAC)

Alcohol Advisory Council of New Zealand 18 Health conditions related to chronic alcohol use 16 Table 2: Potential symptoms and complications Kaunihera Whakatupato Waipiro o Aotearoa of acute intoxication or alcohol poisoning, by 20 Cancers body part affected PO Box 5023 20 Cardiovascular disease Wellington 19 Table 3: Potential conditions and complications New Zealand 6145 21 Existing health conditions – impact of alcohol of chronic and/or heavy episodic alcohol use, by body part affected alac.org.nz | waipiro.org.nz | June 2012 21 Diabetes mellitus 5 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Introduction

This resource provides a brief What is alcohol? overview of the health and body Alcohol ( or ethyl alcohol) is the ingredient effects of alcohol. It is a series found in beer, wine and spirits which causes of short summaries based on drunkenness. Alcohol is formed when yeast ferments available evidence rather than (breaks down without oxygen) the sugars in different foods; for example wine is made from the sugar in a comprehensive literature grapes, beer from the sugar in malted barley (a type of review. Areas covered include grain), cider from the sugar in apples, and vodka from the effects of alcohol on body the sugar in potatoes, beets or other plants.[1] parts, the health effects of acute alcohol use, the health conditions related to chronic alcohol use, and the effects of alcohol on other people and populations. Low-risk drinking advice is also outlined in this resource along with information about where to find support and further information. 6 7 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Body effects of alcohol

Alcohol is classed as a ‘sedative The BAC rises, and the feeling of drunkenness occurs, when alcohol is drunk faster than the liver can break ’ drug,[2] which means Table 1: Symptoms of drunkenness at different levels of blood alcohol concentration (BAC) it acts to depress the central it down. Table 1 shows the relationship between BAC and symptoms of drunkenness – the higher the BAC, nervous system at high doses. the greater the effects on the body. However, BAC does BAC Symptoms not correlate exactly with symptoms of drunkenness <50 mg/dL Some impairment in motor coordination and thinking ability At lower doses, alcohol can act as a ,[3] and different people have different symptoms even Talkativeness inducing feelings of and talkativeness, after drinking the same amount of alcohol. The BAC Relaxation but drinking too much alcohol at one session can level, and every individual’s reaction to alcohol, is lead to drowsiness, respiratory (where influenced by: [1,2,7] breathing becomes slow, shallow or stops entirely), 50-150 mg/dL Altered mood (increased well-being or unhappiness) coma or even .[4–6] • the ability of the liver to metabolise alcohol (which Friendliness, shyness or argumentativeness varies due to genetic differences in the liver enzymes Impaired concentration and judgement As well as its acute and potentially lethal sedative that break down alcohol)[7] Sexual disinhibition effect at high doses, alcohol has effects on every • the presence or absence of food in the stomach organ in the body, and these effects depend on 150-250 mg/dL Slurred speech (food dilutes the alcohol and dramatically slows the blood alcohol concentration (BAC) over time.[7] Unsteady walking its absorption into the bloodstream by preventing Nausea After a drink is swallowed, the alcohol is rapidly it from passing quickly into the small intestine) Double vision absorbed into the blood (20 percent through the • the concentration of alcohol in the beverage Increased stomach and 80 percent through the small intestine), (highly concentrated beverages such as spirits Drowsiness with effects felt within 5 to 10 minutes after drinking.[6] are more quickly absorbed) Mood, personality and behaviour changes which may be It usually peaks in the blood after 30 to 90 minutes,[6] sudden, angry and antisocial and thus is carried through all the organs of the body. • how quickly alcohol is drunk • body type (heavier and more muscular people have 300 mg/dL Unresponsive/extremely drowsy Most (90 percent) of the , or breaking more fat and muscle to absorb the alcohol)[2] Speech incoherent/confused down, of alcohol from a toxic substance to water Memory loss • age, sex, ethnicity (e.g. women have a higher BAC and carbon dioxide is performed by the liver,[6] Vomiting after drinking the same amount of alcohol than men with the rest excreted through the lungs (allowing Heavy breathing alcohol breath tests), through the kidneys (into urine) due to differences in metabolism and absorption – and in sweat.[8] since men have on average more fluid in their body >400 mg/dL Breathing slowed, shallow or stopped to distribute alcohol around than women do; some Coma The liver can break down only a certain amount ethnic groups have different levels of a liver enzyme Death of alcohol per hour, which for an average person responsible for the breakdown of alcohol) is around one standard drink (which raises the • how frequently a person drinks alcohol (someone BAC about 15 to 20 mg/dL[8] – the current limit who drinks often can tolerate the sedating effects for driving in New Zealand is 80 mg/dL). of alcohol more than someone who does not regularly drink).[6] Adapted from: Table 163.1 in Brust, J. C. M. (2005). . In L. P. Rowland (Ed.), Merritt’s neurology (11th ed.). Philadelphia: Lippincott Williams & Wilkins.[4] and Table 1 in Vonghia, L., Leggio, L., Ferrulli, A., Bertini, M., Gasbarrini, G., Addolorato, G., et al. (2008). Acute . European Journal of Internal Medicine, 19(8), 561–567.[5] 9 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Overall body effects cells that fight ), making it more difficult for Body effects of alcohol the body to fight off both viral and bacterial infections. > Alcohol affects all parts of the body including: People who drink heavily over a long time are more Summary of main effects • blood and immune system likely to suffer from infections after , burns, trauma, hepatitis C , HIV/AIDS, meningitis, blood • bones and muscles Alcohol affects all parts tuberculosis and pneumonia (acute inflammation Alcohol is absorbed into the • brain and nervous system of the body including: bloodstream and can have of the lung, usually due to infection).[4,14,15] some long-term effects. • breasts (in women) • eyes brain and mental health nervous system • heart and blood pressure Bones and muscles Alcohol can be used to Alcohol impairs judgement • intestines relax but it is also addictive and concentration. Long-term Immediate effects of alcohol use and can lead to dependency. alcohol use can damage the • kidneys and fluid balance Alcohol use causes many different types of injuries, brain and nerves. • liver eyes including injuries from road traffic accidents, assaults Being drunk can • lungs and falls.[9] This is usually because high levels of blood cause blurred vision. lungs Being drunk and chronic • mental health alcohol impair the brain’s thought processes and skin heavy alcohol use can • mouth and throat the coordination of muscles, causing clumsiness and Alcohol use can have direct and increase the risk of difficulty walking.[16] Common injuries seen at the infections of the lungs. • pancreas and digestion of sugar indirect effects on the skin. emergency department include cuts, bruises, sprains • sexual and reproductive system – men and broken bones.[17,18] The risk of injury in the six mouth and throat heart • sexual and reproductive system – women hours after drinking doubles with four standard drinks Being drunk can cause Alcohol use at low levels may slurred speech. be beneficial for the heart in • skin and fat and increases rapidly the more alcohol is drunk on some people but is harmful for • stomach and food pipe (oesophagus). a single occasion.[19] breasts everyone at high levels. (in women) As well as potentially affecting the physical and mental Long-term effects of alcohol use Long-term alcohol liver health of individuals in many ways, chronic and heavy Moderate alcohol use may protect against osteoporosis use increases the Long-term alcohol use alcohol use can increase the risk of death[9] either (thinning of the bones, which makes the bones more risk of breast cancer. can cause damage to the directly, for example through acute alcohol poisoning liver in a variety of ways. likely to break).[20] However, chronic heavy alcohol or because alcohol causes a fatal disease such as bones and muscles use interferes with the absorption of calcium and Alcohol immediately affects pancreas cancer,[10] or indirectly, such as alcohol being a factor formation and can actually lead to osteoporosis.[20,21] coordination and increases Alcohol use, particularly in violent death or . Alcohol contributes to a Chronic heavy use is also associated with a painful the likelihood of injury, while when heavy, can cause high burden of disease in society in terms of years that acute or chronic pancreatitis condition where bone tissue dies (osteonecrosis),[22] ongoing heavy alcohol use people spend with disability or in poor health because can have other health effects. (inflammation and damage gout (a type of arthritis or inflammation of the , to the pancreas). of alcohol-related illnesses or injuries.[11,12] Unintentional often affecting the of the big toe),[13] and muscle kidneys injuries from alcohol use often result from falls, burns, wasting and weakness.[4,23] Alcohol has an effect on motor vehicle accidents, assaults and drowning.[9] the kidneys’ functions. stomach and food pipe Too much alcohol can have intestines short- and long-term effects Brain and nervous system Both the small intestine and on the oesophagus (food Blood and immune system large intestine can be affected pipe) and the stomach. by long-term alcohol use, Immediate effects of alcohol use Long-term effects of alcohol use including cancer risk. Being drunk impairs judgment, inhibitions and sexual health Chronic heavy alcohol use can cause abnormalities concentration, and in increasing amounts leads Alcohol use can affect in the blood, leading to anaemia (low haemoglobin, judgment and increases the to drowsiness and coma.[4] The loss of memory chance of unwanted sexual the component of blood that carries oxygen around for a period of drunkenness (alcoholic blackout) experiences. It can also affect the body) and low (platelets help prevent can occur in occasional as well as regular heavy sexual performance in men. bleeding).[13] Chronic heavy alcohol use also suppresses drinkers, and is due to alcohol interfering with the immune system (such as affecting the white blood the laying down of memories.[4,8] 10 11 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Long-term effects of alcohol use cardiomyopathy). Dilated cardiomyopathy leads Chronic heavy alcohol use can damage the brain and to heart failure, where the heart can no longer pump nerves in a variety of ways. Some damage to the brain, Breasts – Women blood around the body effectively.[9,27,32,34] Liver from mild to severe, occurs in around half of chronic Long-term effects of alcohol use Heavy chronic alcohol use is also linked to high blood Long-term effects of alcohol use heavy alcohol drinkers.[24] This may be a result of pressure, particularly in men.[9,34,35] Blood pressure Long-term alcohol use increases the risk of breast Chronic heavy alcohol use can damage the liver, thiamine ( B1) deficiency (secondary to alcohol increases with drinking more than two or three drinks cancer, with higher use resulting in a higher risk of causing . This occurs across use, either because of poor diet or because alcohol a day on average and restriction of alcohol lowers the cancer.[9,27,28] A significantly elevated risk is seen a spectrum from fatty liver, to acute alcoholic reduces the absorption of thiamine from the gut and blood pressure.[35] interferes with how thiamine is used in the body).[25] from drinking even one or two drinks of alcohol a day. hepatitis, to cirrhosis.[1] [10] The risk increases on average by about 10 percent Drinking alcohol in order to ‘protect the heart’ is not Fatty liver, where fat builds up in the liver cells, is very Thiamine deficiency can cause an acute, severe, life- for every one standard drink of alcohol per day.[29] advisable, since alcohol is an addictive drug that causes common in heavy drinkers and is reversible if drinking threatening disorder called Wernicke’s encephalopathy, cancer, increases the risk of injury and causes damage to is reduced. However, a small percentage of people with which usually presents with symptoms of abnormal the fetus in pregnant women. People can find it difficult fatty liver will develop alcoholic hepatitis, cirrhosis or paralysed eye movements, difficulty walking to limit their drinking to one or two standard drinks a day or liver cancer. and confusion. It also causes a chronic condition of Eyes and heavy drinking actually increases the risk of heart memory loss (variously called Korsakoff’s syndrome, disease and.[34] People who have risk factors for or Alcoholic hepatitis develops in 10 to 35 percent of Immediate effects of alcohol use or ), where loss of old memories have established heart disease should focus on other heavy drinkers and is an acute injury to the liver Being drunk can cause blurred or double vision.[4] occurs and difficulties in laying down new memories factors such as cigarette smoking, high cholesterol, which can present with symptoms of feeling unwell, may be profound.[4,24,25] Both of these disorders are Long-term effects of alcohol use high blood pressure, diabetes, overweight and physical tiredness, jaundice (yellow skin and whites of eyes), ultimately fatal without treatment with thiamine.[4] inactivity. Young and middle-aged adults, especially swollen stomach and enlarged, tender liver. Death Chronic heavy alcohol use, when coupled with a diet low women, are more likely to experience harm than from liver failure can occur in severe cases. Chronic heavy alcohol use can also damage the part in vitamin B1 and B12, may lead to decreased vision.[4,30] benefit from alcohol use due to risk from injury and, of the brain responsible for balance and coordination Cirrhosis of the liver develops in 5 to 15 percent of for women, increased risk from breast cancer.[36,37] (the cerebellum), leading to instability and problems heavy drinkers and is where the liver is permanently with walking.[4,25] It can also damage peripheral nerves damaged and cells are replaced by scar tissue, so the * in the body, leading to pain, weakness, numbness and Heart and blood pressure liver can no longer function (to detoxify the body, the inability to touch.[4,26] In rare cases it can make vital proteins, store and sugars, Long-term effects of alcohol use Intestines damage specific centres in the brain, leading to loss and make chemicals necessary for digestion). of mental function, inability to walk and death[8] and The evidence for the effect of alcohol on the heart Long-term effects of alcohol use Cirrhosis can also lead to death from liver failure. can lead to the development of epilepsy (chronic fits)[9] is mixed. There is an opinion that light to moderate Long- term alcohol use can cause cancer of the large Treatment for alcoholic liver disease must include and disturbances. Although individuals suffering alcohol use (up to one standard drink per day for bowel/intestines and rectum.[9,38,39] Alcohol can stopping the drinking of alcohol. Alcohol also causes from sometimes use alcohol to treat the women and up to two standard drinks per day for lead to malnutrition and diseases due to low vitamin liver cancer, and treatment options are often limited insomnia, tolerance to the sedating effect of alcohol men) can, in older age groups, reduce the risk of levels, as it blocks the absorption of many important if alcoholic liver disease is present or the cancer has is likely to occur, increasing the risk of excessive use.[3] developing and dying from coronary artery disease vitamins and nutrients in the gut.[23] spread widely by the time of diagnosis. This means Also, if more than one or two drinks are taken in (narrowing and blockage of the arteries supplying liver cancer is often quickly fatal.[9,40,41] the evening, sleep can be disrupted, increasing the blood to the heart resulting from the build-up chances of a person waking in the night and finding of fatty deposits inside the walls of the arteries it hard to fall back asleep.[8] (atherosclerosis), which can cause angina and heart Kidneys and fluid balance attacks). This appears to be because small quantities The relationship between alcohol use and stroke, of alcohol alter the lipids and clotting factors in the Immediate effects of alcohol use where there is a sudden paralysis, loss of sensation or blood to make them protective against heart disease. Alcohol is a , meaning that it causes water to inability to talk because the blood supply to the brain [9,31,32,33] be lost from the body through the kidneys (into urine), is interrupted, is complex. Alcohol increases the risk which can lead to dehydration.[35] Alcohol can also of hemorrhagic stroke, where the stroke is caused However, heavy drinking (both chronic and a pattern of cause the loss of important minerals and salts from by bleeding in the brain. However, low to moderate heavy drinking sessions) increases the risk of coronary the body such as , calcium, phosphate, alcohol use (one to two drinks a day) reduces the risk artery disease.[9,34] Heavy drinking (chronic and/or sodium and potassium,[13] either directly or because of ischaemic stroke, which is caused by blockage of the at a single session) is also associated with sudden alcohol induces vomiting. Low levels of these elements blood vessels in the brain, but higher levels of alcohol death from heart failure, with irregular heartbeats can cause many problems ranging from irregular use increase the risk of ischaemic stroke.[9] and with chronic disease of the heart muscle (dilated heartbeats to .[5] *The evidence for the effects of alcohol on the heart is mixed and often controversial. This section is a brief summary of the evidence available at the time of publication. 12 13 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Long-term effects of alcohol use Long-term effects of alcohol use Lungs Alcohol is addictive and can lead to dependency. This Alcohol is a carcinogen, meaning that it causes cancers Moderate alcohol use is associated with a reduced is where the body requires more alcohol to achieve the in humans. Regular alcohol use increases the risk of risk of developing type 2 diabetes, although the exact desired effect (e.g. altered mood), where use of alcohol cancers of the mouth, throat and voicebox.[9,29,47] Immediate effects of alcohol use reason for this is not certain.[9] interferes with a person’s life (causing legal, work/ Drinking around 50g of alcohol a day (five standard Being drunk[9] increases the risk of pneumonia study, relationship or social problems), where a person drinks) increases the risk of these cancers by two (inflammation of the lungs, usually caused by continues to use alcohol despite it causing physical to three times compared with non-drinkers, but for infection from bacteria or viruses).[5] This is because, or mental problems, and where, if alcohol is not taken, people who smoke, this risk is increased much more. Sexual health – Men at high blood concentrations, alcohol is sedating withdrawal symptoms occur. [10,47] Drinking more increases the risk of cancers, and Immediate effects of alcohol use and relaxes the mouth and throat, suppresses reflexes drinking less decreases the risk of cancers. (like the gag and cough reflexes), and reduces the The severity of withdrawal symptoms depends on Being drunk increases the chances of having unsafe ability of the lungs to clear mucus and foreign matter, the quantity of alcohol consumed and the length of sex (without a condom), having sex that is later so that vomit, saliva or other substances may enter the drinking session. Symptoms include shaking of the regretted or experiencing sexual assault [51,52] as the lungs and cause inflammation and infection hands, which commonly occurs the morning after the Pancreas and alcohol impairs judgment and lowers inhibitions. (bronchitis or pneumonia). drinking session and may be relieved by more alcohol. digestion of sugar [4] These factors are also likely to increase the risk of If alcohol is not taken, symptoms can progress to getting a sexually transmitted infection.[53] Long-term effects of alcohol use insomnia, increased heart rate, temperature and blood Immediate effects of alcohol use Long-term effects of alcohol use Chronic heavy alcohol use is also associated with pressure, sweating, agitation, nausea, flushing of the Heavy alcohol use on a single occasion can lead to higher rates of pneumonia, tuberculosis (an infectious face, nightmares, hallucinations (seeing, hearing or dangerously low blood sugar (hypoglycaemia), which Chronic heavy alcohol use can lead to impotence, disease that affects primarily the lungs but also any feeling things that are not present) and fits.[4,13,45,46] can cause symptoms of shaking, sweating, , loss of sex drive, wasting of the testicles and reduced other part of the body),[9] and acute respiratory The most serious withdrawal syndrome is ‘ blurred vision and, if not treated, brain damage.[4,5] fertility.[35,54] This is primarily because alcohol affects distress syndrome (ARDS – a life-threatening condition tremens’, which develops in about 5 percent of people testosterone levels. Long-term effects of alcohol use in which the lungs fill with fluid, which occurs as a with alcohol withdrawal (more if fits are not treated) rare complication of pneumonia, trauma and severe and by definition includes the symptom of delirium The pancreas is a gland that secretes digestive infections).[42] In addition to the ways in which acute (an altered and confused state of mind).[46] This enzymes and releases insulin, which regulates sugar Sexual health – Women alcohol use can cause pneumonia, chronic heavy syndrome has a death rate of around 5 percent.[46] levels in the blood.[48] alcohol use also impairs the immune system and Chronic heavy alcohol use can cause acute pancreatitis Immediate effects of alcohol use changes the bacteria present in the mouth to those In people who drink heavily, alcohol commonly causes (sudden inflammation of and damage to the pancreas Being drunk increases the chances of having unsafe more likely to cause infections, making people more mood disorders, including depression, and that resolves over several days)[9,48] and chronic sex (without a condom), having sex that is later vulnerable to pneumonia.[9] psychosis (a mental illness defined by changes in personality, a distorted sense of reality, and delusions). pancreatitis (inflammation of the pancreas that regretted or experiencing sexual assault [51,52] as [8] If these disorders only occur during drinking does not heal and worsens over time).[48,49] Acute alcohol impairs judgment and lowers inhibitions.[4] sessions or withdrawal, they will usually resolve once pancreatitis typically causes abdominal and back pain, Such sexual experiences are also likely to increase Mental health drinking is stopped.[8] and dependency nausea and fever[49] and may occur a few hours or the risk of getting a sexually transmitted infection are also common in people with pre-existing mental up to two days after drinking alcohol.[48] In 20 to 30 [53] or having an unplanned pregnancy. Immediate effects of alcohol use health conditions. percent of people, acute pancreatitis is a severe, life- Many people use low doses of alcohol for relaxation threatening condition, which requires treatment in Long-term effects of alcohol use and to relieve tension, nervousness and stress.[2,8] hospital.[50] Chronic heavy alcohol use can lead to reduced fertility However, in some people alcohol creates rather than and can make periods heavy or irregular or stop Chronic pancreatitis typically occurs in people aged reduces stress through stimulating stress hormones.[43] Mouth and throat altogether.[19,35] Consuming alcohol while pregnant 30 to 40 years and can cause abdominal pain, weight Alcohol affects mood in a variety of ways, and can may increase the risk of miscarriage,[55,56] low birth Immediate effects of alcohol use loss, diabetes, malnutrition and oily bowel motions make people feel happy, sad or aggressive, and can weight,[13] stillbirth and premature birth.[9,57] It can (because the pancreas helps to digest fat and when also cause moods swing.[4,8] However, there is a risk Being drunk can have various effects on speech, such also cause significant abnormalities in the unborn, the pancreas is damaged, fats are excreted out of the of becoming dependent on alcohol if it is used as a as making people more friendly, talkative, unreserved, developing baby (fetal alcohol spectrum disorder). bowel instead of being absorbed into the body).[48] primary means to relieve stress and anxiety without relaxed or argumentative. Increasing amounts of [4,13,57,58] The risk of acute and chronic pancreatitis increases addressing the underlying causes. Because it removes alcohol can cause aggressive, antisocial, angry, slurred with higher alcohol use.[9] inhibitions and increases aggression and recklessness, and confused speech.[4,5] alcohol is often found in the blood of people who self- harm, or attempt or complete suicide.[44] 14 15 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support

Skin and fat+ Stomach and food pipe (oesophagus) Immediate effects of alcohol use Health effects Acute alcohol use can lead to skin flushing and Immediate effects of alcohol use worsen the appearance of skin conditions such Being drunk can lead to nausea and vomiting, as rosacea (a chronic facial skin rash).[59] diarrhoea, heartburn (when acid from the stomach of acute rises up into the food pipe, due to alcohol causing the Long-term effects of alcohol use muscle around the outlet of the stomach to relax) Chronic heavy alcohol use, when associated with and acute gastritis (inflammation of the lining of the serious liver disease and liver failure, can also cause stomach, which causes stomach pain, nausea, loss alcohol use yellowing of the skin, decreased body hair and spider of appetite and indigestion).[4,5,23,38] Vomiting and veins.[40,60] diarrhoea can result in dehydration, salt imbalances The relationship between Alcohol poisoning Alcohol is a high-calorie beverage. One standard drink and the build-up of acids in the body, especially in alcohol use and some health Alcohol poisoning, known in emergency departments (100ml of wine, 30ml of spirits or 280ml of standard combination with excessive alcohol intake.[5] Inhaling conditions is complex. as acute intoxication, is when a large amount of beer) contains 290kJ, close to half the energy of a vomit can lead to bronchitis or pneumonia (infection alcohol is drunk, followed shortly afterwards by can of fizzy drink. Alcohol is also an , of the lungs). Vomit can block the airway and windpipe For example, drinking a small amount of alcohol may changes in mood or behaviour, impaired judgment and people tend to eat more when consuming when blood alcohol is very high and breathing and be beneficial in preventing heart disease in older or social functioning, and one or more physical signs alcohol with their meals.[61] However, while are impaired.[5] adults, but drinking a lot of alcohol can also damage of drunkenness, such as slurred speech, unsteadiness, theoretically the potential for alcohol to increase the heart. For other health conditions, alcohol is Persistent vomiting and retching after heavy use lack of coordination, impaired attention or loss of weight is clear, and some studies find that alcohol the single cause of the condition, such as alcoholic on a single occasion can sometimes (but only rarely) consciousness.[5] cirrhosis of the liver, fetal alcohol spectrum disorder use is associated with increased weight,[62,63] rip the food pipe (a Mallory Weiss tear), which leads (FASD) and alcohol-induced pancreatitis. For many The physical effects of alcohol poisoning are many, others find the opposite result.[64,65] to vomiting of blood. other health conditions, alcohol is one cause, among from nausea, vomiting and dehydration, which Alcohol seems more likely to cause weight gain in Long-term effects of alcohol use others, of the condition – for example, cancers and are familiar symptoms to those who may have those who drink intermittently (moderately to heavily), pneumonia.[9] Overall, alcohol is a cause of more drunk too much on one occasion, to the worst in those who are already overweight, in those eating Long-term alcohol use can cause cancer of the food than 60 different health conditions and, for almost all complication – death. a high-fat diet, and in men.[63,66,67] For people pipe (oesophagus) and drinking 50g of alcohol a day conditions, heavier alcohol use means higher risk of concerned about their weight, nutritionists advise (five standard drinks) doubles the risk compared with The term ‘alcohol poisoning’ is sometimes used disease or injury.[9,27] people to take into account how much energy alcohol a non-drinker.[9,29,69] However, the risk is much to describe the most serious and life-threatening is contributing to their diet.[68] greater in people who drink alcohol who are also complications of alcohol overdose, such as slowed deficient in a liver enzyme that metabolises alcohol breathing and loss of consciousness. Chronic heavy drinkers are likely to be malnourished (East Asian populations are commonly deficient in this The lethal dose of alcohol is 5 to 8g/kg (3g/kg as alcohol has little nutritional value and replaces enzyme).[7,29] The risk is also increased in smokers. for children)[6] – that is, for a 60kg person, 300g nutritious food in the diet.[23] [70] Chronic heavy alcohol use can also lead to chronic of alcohol can kill, which is equal to 30 standard gastritis but alcohol may protect against infection drinks (about 1 litre of spirits or four bottles of wine). from Helicobacter pylori, the bacteria that cause ulcers of the stomach.[16,38,71] In cases of advanced liver Table 2 summarises, by body part affected, the various disease due to prolonged heavy alcohol use, the veins symptoms and complications that can occur from to the stomach and oesophagus can swell and may drinking too much alcohol on a single occasion. This burst, causing life-threatening bleeding. includes symptoms caused directly by the excess alcohol, such as nausea, slurred speech and mood changes, but also health problems caused indirectly by alcohol, such as injuries and unsafe sex.

+ The evidence related to alcohol and fat is evolving. This section is a brief summary of the evidence available at the time of publication. 16 17 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support

Hangover

Table 2: Potential symptoms and complications of acute intoxication A hangover can occur in anyone after a single episode or alcohol poisoning, by body part affected of heavy alcohol use. Symptoms include headache, nausea, vomiting, sweating, fatigue, shakiness, Body part affected Symptoms sensitivity to light, and .[4] Typically, Mouth Slurred/confused speech symptoms start a few hours after drinking stops, when blood alcohol is falling, and peak at the time the blood Stomach Nausea, vomiting alcohol concentration is zero, but may continue for 24 and food pipe Heartburn hours after this. Alcohol causes hangover symptoms Gastritis through dehydration (which causes thirst, dizziness Intestines Diarrhoea and weakness), irritation of the stomach and liver Pancreas and Pancreatitis (which causes nausea, vomiting and stomach pain), sugar digestion Hypoglycaemia low blood sugar (which causes fatigue and mood changes), and disturbance of sleep (which causes Kidneys and Dehydration fluid balance Depleted salts and minerals ‘jet lag’ symptoms).[72]

Heart and Increased heart rate The type of alcohol drunk may increase the chance blood pressure Irregular heart rate of getting a hangover. Alcoholic drinks include compounds called congeners that add to the taste, Lungs Slowed rate and depth of breathing (respiratory depression) Pneumonia/bronchitis smell or colour of the drink. Alcohol with fewer congeners, such as gin and vodka, may cause fewer Impaired concentration/attention Brain and hangover effects than alcohol with more congeners, Blackouts/memory loss nervous system such as brandy, whisky and red wine.[72] Impaired consciousness/coma The only cure for a hangover is time, although drinking Mental health Mood and personality changes Aggression/antisocial behaviour water or fruit juice and eating bland food such as Suicide and self-harm toast or crackers may help with dehydration and low blood sugar. Paracetamol should be avoided as this Unsafe sex/STI/sexual assault Sexual health can be toxic to the liver during a hangover. Aspirin Unplanned pregnancy (females) and anti-inflammatory medicines should also be Bones and muscles Injuries avoided if nausea or stomach pain is present, as these Eyes Blurred/double vision can aggravate acute gastritis caused by alcohol, but can be useful.[72] Whole body Injuries Death 18 19 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support

Table 3: Potential conditions and complications of chronic and/or heavy episodic alcohol use, by body part affected

Health conditions Body part affected Symptoms Mouth Cancer of mouth, voicebox and throat

Stomach Cancer of food pipe (oesophagus) related to chronic and food pipe Chronic gastritis Intestines Cancer of bowel

Liver Cancer of liver alcohol use Alcoholic liver disease (fatty liver, hepatitis, cirrhosis) Pancreas and Acute and chronic pancreatitis Potential complications of chronic alcohol use sugar digestion Heart and blood Coronary heart disease For some people, alcohol is a regular or occasional drink enjoyed pressure Hypertension Heart failure due to cardiomyopathy at social occasions that causes no apparent harm. However, even Irregular heartbeat moderate alcohol use carries some risks, as alcohol causes breast Blood and Anaemia cancer even at low doses, can damage the developing fetus before immune system HIV/AIDS Hepatitis C a woman even knows she is pregnant and can lead to addiction Tuberculosis Infections and dependence in any individual. Lungs Pneumonia

Brain and Brain damage (Wernicke’s encephalopathy, Korsakoff’s dementia, etc) When drunk regularly over time and/or drunk in a pattern of nervous system Nerve damage heavy single drinking sessions, alcohol can cause a variety of Epilepsy Sleep disturbances health conditions. These include cancers and other conditions Stroke such as alcoholic liver disease, which can range from reversible to Mental health Addiction/dependence Mood disorders permanent liver damage due to alcohol. The risks of alcohol-related Withdrawal symptoms cancers and other health conditions caused by alcohol are greatest Sexual health Impotence Infertility in those who are dependent on alcohol or drink heavily, and the Fetal alcohol spectrum disorder (in children born to women who drink while pregnant) risks increase with the average amount of alcohol drunk. Premature birth/low birth weight (in babies born to women who drink while pregnant) Cancer of breast Table 3 lists some of the conditions and complications of Breasts (women) Bones and muscles Muscle weakness chronic and/or heavy episodic alcohol use.[9] Gout

Eyes Decreased vision

Skin and fat Malnutrition

Whole body Death 20 21 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support

Cancers Cardiovascular disease# Alcohol is now recognised as a carcinogen – it is known The relationship between alcohol and cardiovascular Existing health to increase the risk of several different types of cancer. disease (coronary artery disease and strokes) is This is based on assessments from the World Health complex. In summary, low to moderate alcohol Organization International Agency for Research on use (one to two drinks per day) can reduce the risk Cancer (IARC) Monograph Working Group, a group of coronary artery disease (where the coronary arteries, conditions – of expert scientists who review published studies which supply blood to the heart, become narrowed and evaluate the evidence that alcohol increases or blocked, which leads to angina and heart attacks) the risk of cancer.[10,29,70] and the risk of ischaemic stroke (stroke caused by impact of alcohol blocked arteries in the brain)[31]. Alcohol increases the risk of developing cancers of the: However, higher alcohol use increases the risk of • mouth, throat and voicebox The treatment of alcohol- coronary artery disease and ischaemic stroke [9]. related liver disease, alcohol- • oesophagus (food pipe) In addition, any alcohol use increases the risk of Mental health conditions • large bowel and rectum hemorrhagic stroke (stroke caused by bleeding related pancreatitis, alcohol- The relationship between alcohol use and mental • breast (in women) arteries in the brain) [9]. Both single episodes related mood disorders, alcohol health conditions is somewhat complicated in that of heavy alcohol use and chronic heavy use can dependence, or brain damage • liver. heavy or problem drinking can cause some mental also increase the risk of hypertension, developing due to alcohol involves health conditions; and conversely, some mental The risk of developing cancer increases irregular heartbeats and suffering sudden death stopping alcohol use. health conditions may cause problematic drinking.[43] with a higher use of alcohol. from a cardiac cause.[9,27,32,34] People with mental health conditions are more likely In contrast, there is evidence that use of alcohol The benefit of alcohol in reducing heart disease Alcohol may also worsen other health conditions not to use alcohol than those without. Alcohol is strongly does not cause cancer of the kidney or non-Hodgkin is primarily for those at risk of heart disease related to alcohol and temporary reduction or stopping associated with social and anxiety, as it can lymphoma (a cancer of the lymph cells). – particularly older people and those with a family of alcohol use is recommended. These include any help people with anxiety to feel they function better history of heart disease.[36] disease of the liver, which can be worsened by alcohol use, infections, as heavy alcohol use can impair the in social situations, but this is also associated with immune system, and sleep disorders, as alcohol a risk of . Alcohol problems are interferes with the sleep cycle.[19] more common in people who are depressed and heavy alcohol use in people with depression is associated with higher risk of suicide, self-harm and poor outcomes. Alcohol use worsens the severity Diabetes mellitus of bipolar disorder. Heavy alcohol use is common People with diabetes are advised to discuss alcohol use among people with schizophrenia and may increase with their health professional.[19] Those with well- the severity of symptoms. controlled diabetes can safely drink alcohol, although All people with a mental health condition are the risk of low blood sugar is increased if alcohol is advised to discuss their alcohol use with their health drunk without food and insulin is used.[19,73] People professionals, as it may have a negative impact on with diabetes are advised to monitor blood sugars their illness and/or interact with that is when drinking and to wear an alert bracelet or similar taken to treat their illness.[19] identification (alerting others of their diabetes in an emergency) because the symptoms of low blood sugar, which is life threatening but quickly treatable, and drunkenness are very similar.[74]

# Note that the evidence of the relationship between alcohol and cardiovascular disease is mixed and often controversial. This section is a brief summary of the evidence available at the time of publication. 22 23 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Alcohol Effects of and drug alcohol on interactions other people

Alcohol interacts with many Prescription that interact with alcohol Drinking alcohol can affect not drink alcohol. Alcohol is also best avoided while drugs, including prescribed include , opiates, paracetamol, other people, in particular breastfeeding, as alcohol can pass through the milk and over-the-counter medicines, , , , unborn children and children to the baby and affect development.[57] anti-inflammatory drugs, hypoglycaemic agents, herbal medicines and warfarin, and some heart medicines. and families. illegal drugs. Anyone starting or using one of these medicines Alcohol also impacts on other people through should seek advice from their health professional Children and families Alcohol can react with different medicines and drugs crime, assault and sexual assault. about how alcohol may interact with the drug and Children in families where an adult abuses alcohol in different ways, such as increasing the sedating whether reduction or temporary stopping of alcohol is It features in many statistics relating to crime, or drinks heavily are known to be vulnerable to a effect of sleeping tablets and opiate-based pain relief, necessary. People who are driving a motor vehicle or assault and sexual assault in New Zealand and variety of negative effects. As well as the risk of being increasing the potential for aspirin to irritate the operating heavy machinery must take particular care overseas and alcohol has been shown to impair affected by FASD, these children, compared with stomach or increasing the potential of paracetamol to when starting a new medicine that has a potential judgment and increase aggression in some people.[27] children in families without a parent or caregiver who damage the liver. Also, chronic and/or heavy episodic interaction with alcohol.[2,19] drinks heavily, are at higher risk of injury, poisoning drinking activates the liver enzymes that are involved and hospitalisation, eating disorders (for females), in breaking down prescription medicines, which can When combined with illegal drugs, alcohol can have depression and anxiety, conduct disorders, aggression, lead to these medicines being metabolised faster than various effects depending on the type of illegal drug. The unborn child attention deficit/hyperactivity, lower educational usual and being less effective.[7] It may increase the risk of when mixed with other sedating drugs, or counteract the effect of Drinking alcohol at any stage during pregnancy achievement and heavy alcohol use in adolescence. stimulant drugs. When alcohol is taken with , can affect the development of the unborn baby Some of the reasons for these negative effects include driving ability is significantly impaired, even more than (the fetus) as alcohol passes through the placenta higher rates of conflict between parents, greater when alcohol is drunk alone.[75] from the blood of the mother to the fetus. The most absence of parents, violence against children, higher extreme consequence of alcohol affecting the fetus stress and economic deprivation, and less parental is a miscarriage or stillbirth. In other cases, the baby supervision.[76] can be born with significant permanent effects.[57] Alcohol, especially when drunk in large amounts, The range of effects on a child caused by alcohol is can also contribute to domestic violence. It seems to called fetal alcohol spectrum disorder (FASD). These do this by increasing aggressiveness, particularly in effects include premature birth, restricted growth, people already feeling hostile towards their partners, birth defects, brain damage, developmental delay, and although whether alcohol leads to violence depends social, emotional, behavioural and mental deficits. on personality, cultural and situational factors.[77,78] [35,57] In an older child, this can manifest as low IQ, Alcohol abuse has featured in a significant number of poor social skills, inattention, and problems with homicides involving couples and children in aggressive and impulsive behaviour. New Zealand.[79] As there is no known safe level for using alcohol during any stage of pregnancy, it is advised that any woman who is pregnant or wishing to get pregnant should 24 25 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Effects of alcohol on population groups

Women Men Young People Older People

Women have higher blood alcohol levels Patterns of alcohol use differ between men Children and young adults are more Alcohol use often declines in older age but after drinking the same amount of alcohol and women in New Zealand, with men still vulnerable to negative impacts of alcohol older people may be at risk of developing as men, so can get drunk faster and can being overall more likely to drink compared on memory and learning, as the brain is still problem drinking – alcohol abuse or suffer the toxic and lethal effects of alcohol with women. Among drinkers, men are more developing up until the 20s.[82] dependency – often triggered by significant poisoning at a lower dose. This is because likely to drink daily or several times a week, life events such as loss of a loved one, Young people up to the age of 25 years are at women on average: drink heavily on a single occasion and drink loneliness, retirement, insomnia, illness a higher risk of harm from alcohol use than • are smaller than men so have less fluid in heavily more often.[80] Men are at higher or pain. older adults. This is because young adults their bodies to distribute alcohol around risk of experiencing harm from their own have the greatest risk of injury and accidents Older people are less tolerant to the effects (having a higher fat to water ratio) drinking and physical assault related to related to alcohol use, an increased risk of of alcohol. As a result of aging, alcohol is not alcohol [80,81] and experience more • probably have less of the enzyme needed alcohol dependence and a lower tolerance broken down by the body as efficiently. The from alcohol-related causes.[82] to break down alcohol in the liver.[37] to alcohol than older adults.[19] Other ratio of body water to fat tends to fall and Women who drink alcohol are at increased harms that affect young people more than alcohol has a faster effect on the brain, risk of developing breast cancer[9] and adults include unprotected and unwanted meaning it takes less alcohol to become drinking while pregnant increases the risk sex, assault, arrests, and harmful effects on drunk and this increases the risk of falls of harm to the unborn baby.[35,57] social life, finances or work/study.[80,82] and injury. Older people who drink alcohol and drive are at much higher risk of traffic accidents than those who do not drink. Alcohol interacts with many common prescription medicines and this may be a reason for many older people to avoid or restrict their alcohol use.[83] 26 27 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support Advice for parents of children and young people Low-risk under 18 years For children and young people under 18 years, not drinking alcohol is the safest option. alcohol • Those under 15 years of age are at the greatest risk of harm from drinking alcohol and not drinking in this age group is especially important. • For young people aged 15 to 17 years, the safest drinking advice option is to delay drinking for as long as possible. If 15 to 17 year olds do drink alcohol, they should The Alcohol Advisory Council Reduce your long-term health risks by drinking be supervised, drink infrequently and drink at of New Zealand’s (ALAC) alcohol no more than: levels usually below and never exceeding the drinking advice is designed to • 2 standard drinks a day for women adult daily limits. and no more than 10 standard drinks a week help people make an informed • 3 standard drinks a day for men choice and help keep their risk and no more than 15 standard drinks a week. What is a standard drink? How many SDs of alcohol-related accidents, AND at least two alcohol-free days every week. injuries, diseases and death low. A standard drink contains 10 grams of pure alcohol. in different drinks? Reduce your risk of injury on a single occasion of drinking by drinking no more than: 330ml CAN 440ml CAN 330ml BOTTLE 330ml BOTTLE Low risk is not, however, no risk. Even when drinking OF BEER @ OF BEER @ OF BEER @ OF LITE BEER @ within the low-risk limits, a range of factors can affect • 4 standard drinks for women on any single occasion 4% ALC 4.2% ALC 5% ALC 2.5% ALC your level of risk, including drinking too quickly, your • 5 standard drinks for men on any single occasion. body type or genetic makeup, your gender, existing Advice for pregnant women or those healthLow problems, andrisk your age. alcohol planning to get pregnant • no alcohol. There is no known safe level of alcohol Thedrinking following graphic visually adviceexplains It is important to note that drink serving sizes are use at any stage of pregnancy. low-riskFor adults drinking advice for adults often more than one standard drink. The label on an container provides the number 1 1.5 1.3 0.7 of standard drinks in the container. Reduce your long-term health risks Reduce your risk of injury Pregnant women To work out the number of standard drinks in what 750ml BOTTLE 600ml pint 100ml GLASS you are drinking use this formula: OF BEER @ of beer @ OF TABLE WINE 4% ALC 4.5% ALC @ 12.5% ALC Amount of drink in litres (Vol) x Percent by volume of alcohol (%) x Density of ethanol at room No more than... No more than... No alcohol temperature (0.789)

For example: 2 3 4 5 0 500ml of beer which is 5 percent alcohol by volume: STANDARD DRINKS STANDARD DRINKS STANDARD DRINKS STANDARD DRINKS STANDARD DRINKS 0.5 x 5 x 0.789 = 1.97 (approx 2 standard drinks) Daily On any single occasion standard and no more and no more There is no 2.4 2.1 1 drinks than 10 a week than 15 a week known safe level of alcohol use at And any stage of pregnancy at least 2 alcohol-free days per week

What is a standard drink?

Standard drinks measure *rtd (ready to drink) the amount of pure alcohol you are drinking. One standard drink equals 10 grams of pure alcohol.

330ml CAN 100ml GLASS 335ml BOTTLE 750ml BOTTLE 1000ml BOTTLE 3 LITRE CASK OF BEER @ OF TABLE WINE OF RTD* SPIRITS OF WINE @ OF SPIRITS @ OF WINE @ 4% ALC @ 12.5% ALC @ 8% ALC 13% ALC 47% ALC 12.5% ALC

standard 1 1 2.1 7.7 37 30 drinks 28 29 Introduction Body Effects Health & Conditions Impact of Alcohol Drinking Advice & Information Support When not to drink • Australian Guidelines to Reduce Health Risks from Drinking Alcohol (published in February 2009) It’s advisable not to drink if you: (http://www.nhmrc.gov.au/your-health/alcohol- • are pregnant or planning to get pregnant guidelines)[19] • are on medication that interacts with alcohol • in Canada: A Summary of Evidence and Guidelines for Low-risk Drinking Where to • have a condition that could be made worse (completed in November 2010 and published by drinking alcohol in November 2011) (http://www.ccsa.ca/2011%20 • feel unwell, depressed, tired or cold, as alcohol CCSA%20Documents/2011-Summary-of-Evidence- could make things worse find support and-Guidelines-for-Low-Risk%20Drinking-en.pdf). • are about to operate machinery or a vehicle [84] or do anything that is risky or requires skill. Both these guidelines were developed by a committee If you are not sure or are concerned, of experts, informed by research literature reviews and and further check with your doctor. studies conducted by Dr Jurgen Rehm and colleagues [9,12,16], peer reviewed by international experts and informed by consultation. information Tips for low-risk drinking The 2009 Australian guidelines have the same limits for both men and women.[19] ALAC’s drinking advice, It is possible to drink at a level that is less risky, while like the Canadian guidelines,[84] has different limits still having fun. There are a number of things you can for men and women. These gender differences reflect do to make sure you stay within low risk levels and the impact of alcohol on women, due to factors such don’t get to a stage where you are no longer capable as body size and composition, ability to metabolise of controlling your drinking. alcohol, and the higher risk of developing a range of For support and treatment health conditions. These include: to reduce alcohol intake, talk ALAC’s revised drinking advice about children and • Know what a standard drink is young people under 18 years also draws on the UK to your doctor or call the • Keep track of how much you drink – daily and weekly Department of Health’s guidance document: Guidance The Alcohol Drug Helpline • Set limits for yourself and stick to them Alcohol Drug Helpline: on the Consumption of Alcohol by Children and Young provides free and confidential • Start with non-alcoholic drinks and People (published in December 2009).[85] 0800 787 797 information and self-help alternate with alcoholic drinks ALAC’s previous ‘upper limits for responsible drinking’ material, advice and referrals to • Drink slowly were developed in 1994 by a group consisting of local drug and alcohol services. • Try drinks with a lower alcohol content alcohol producers, health promoters and problem • Eat before or while you are drinking intervention and treatment workers that sought a consensus approach. The upper limits, which are • Never drink and drive frequently referred to as ‘ALAC guidelines’, were • Be a responsible host reviewed and replaced by revised drinking • Talk to your kids about alcohol. advice because:

• considerably more evidence has emerged since 1994, particularly for the effect of alcohol For further information and resources Background to on the developing brain of adolescents about alcohol, including an online version drinking advice • ALAC has a legislated responsibility to provide of this resource, visit alac.org.nz up-to-date scientific evidence on the risks ALAC’s alcohol drinking advice was revised in 2011. of drinking alcohol The revised advice is based on the most current and a corresponding change to guidelines has best available scientific research and evidence using • been made in comparable jurisdictions such the primary resource material, including: as Australia and Canada. 30 31

Glossary Fetal alcohol spectrum Disorder caused by alcohol passing from a pregnant woman to her unborn child and disorder (FASD) resulting in a range of possible effects on the child including premature birth, restricted growth, birth defects, brain damage, developmental delay and social, emotional, Alcohol dependency A physical or psychological dependence on alcohol, where the body requires more behavioural and mental deficits. alcohol to achieve the desired effect (e.g. of altered mood): use of alcohol interferes Gastritis Inflammation (irritation and swelling) of the lining of the stomach, leading to symptoms with a person’s life (causing legal, work/study, relationship or social problems); a person of stomach pain, nausea, loss of appetite and indigestion. continues to use alcohol despite alcohol causing physical or mental problems; and, if alcohol is not taken, withdrawal symptoms occur. Heartburn Burning pain in the chest caused by acid from the stomach entering the food pipe. Also known as reflux (gastro-oesophageal reflux). Alcohol poisoning When a lot of alcohol has been drunk in a short time, blood levels of alcohol are high and symptoms of extreme drunkenness are present, such that breathing has slowed, Hypoglycaemia Low blood sugar. the individual is only partially conscious or is unconscious, or some other complication is Korsakoff’s syndrome, A chronic condition of memory loss where loss of old memories occurs and difficulties in present that presents a serious danger to health. Also known as ‘Acute intoxication’. psychosis or dementia laying down new memories may be profound. Alcoholic hepatitis An acute injury to the liver from chronic heavy drinking which can present with Mallory Weiss tear A tear in the join between the stomach and the food pipe due to prolonged or violent symptoms of feeling unwell, tiredness, jaundiced (yellow skin and whites of eyes), retching or vomiting. swollen stomach and enlarged, tender liver. Oesophagus Food pipe, which takes food and fluid from the back of the mouth to the stomach. Anaemia Low haemoglobin, the component of blood that carries oxygen around the body, which causes symptoms of tiredness and weakness. Osteoporosis Thinning of the bones which makes them more likely to break.

Acute respiratory distress A life-threatening condition in which the lungs fill with fluid, which occurs as a rare Pancreatitis Inflammation of the pancreas, an organ that helps in digestion, which can be an acute, syndrome (ARDS) complication of pneumonia, trauma and severe infections. sudden or chronic, longstanding condition.

Blood alcohol concentration Concentration of alcohol in the blood, used to determine level of drunkenness for legal Pneumonia Inflammation of the lungs usually caused by infection with bacteria or a virus, which (BAC) or medical purposes. The current limit for driving in New Zealand is 80 mg/dL. causes shortness of breath, cough and fever.

Burden of disease The impact of diseases, health problems, injuries, etc measured by economic cost, Psychosis A mental illness defined by changes in personality, a distorted sense of reality and mortality, morbidity, years of life lost to disability or ill health or other indicators. delusions.

Carcinogen A substance that has been shown to cause cancer. Respiratory depression Slowing of the rate and/or depth of breathing to a point where breathing is insufficient to supply oxygen around the body. Cirrhosis Disease of the liver where cells are permanently damaged and replaced by scar tissue, so the liver can no longer function (to detoxify the body, make vital proteins, store vitamins Sedative A type of drug that calms, and reduces excitability and anxiety. and sugars, and make chemicals necessary for digestion). Standard drink Different types of alcoholic drinks contain different concentrations of alcohol. The Congeners Compounds added to alcohol that adds to the taste, smell or colour of the drink. standard drink measures the amount of pure alcohol in a drink so the amount of alcohol across different volumes and concentrations of alcoholic drink can be compared. One Coronary artery disease A condition where the coronary arteries, which supply blood to the heart, become standard drink equals 10 grams (g) of pure alcohol. For example, a 330ml can of 4 percent narrowed or blocked because of the build-up of fatty deposits inside the walls of the alcohol beer, 30ml of straight spirits and 100ml glass of table wine are all approximately arteries (atherosclerosis). This leads to angina and heart attacks. 10g of alcohol and one standard drink. The most severe alcohol withdrawal syndrome, which by definition includes the Stroke Sudden damage to brain cells due to the interruption of the blood supply to symptom of delirium (altered and confused state of mind) and usually also sweating, the brain, causing loss of function, such as paralysis or loss of speech. Also known tremors, anxiety and sometimes fits. as cerebrovascular accident (CVA). Dilated cardiomyopathy Chronic disease of the heart muscle that leads to heart failure, where the heart can no Teratogen A substance that can damage the fetus while it is developing inside a pregnant woman. longer pump blood around the body effectively. Alcohol is a teratogen or is teratogenic. Diuretic An agent that causes fluid to be lost from the body through the kidneys. Wernicke’s encephalopathy An acute, severe, life-threatening disorder that usually presents with symptoms Fatty liver Disorder of the liver where fat builds up in the liver cells, which is reversible and usually of abnormal or paralysed eye movements, difficulty walking and confusion caused causes no symptoms but may progress to other forms of alcoholic liver disease. by thiamine deficiency (secondary to chronic heavy alcohol use). 32 33

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AL802 | June 2012