Humans have been consuming alcohol since the Stone Age. Archeologists have found the world’s oldest brewery with residue of 13,000-year-old beer in a prehistoric cave near Haifa, Israel. Evidence for the integration of alcohol into social life exists at the beginning of written history. Yet there are still disagreements about when, where, and how it should be used. Recent advances in neuroscience have provided new insights into these issues, and hopefully sharing them will mitigate some of those disagreements.
First, the good general news from 30,000 feet. Early this year the National Academies of Sciences, Engineering, and Medicine (NASEM) published a comprehensive examination of the existing literature on the impact of alcohol on health. (Review of Evidence on Alcohol and Health).
The committee concluded with moderate certainty “that compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality.” A parallel evaluation on cardiovascular diseases (CVD) reached a similar conclusion. In short, a glass of wine or a beer every so often might help people live a little longer.
However, not all the news is good. The committee also concluded — again with moderate certainty — that compared with never consuming alcohol, consuming a moderate amount of alcohol was associated with a higher risk of breast cancer. And among moderate alcohol consumers, higher versus lower amounts of alcohol consumption were associated with a higher risk of breast cancer — this time with low certainty. Interestingly, in a similar analysis of colorectal cancer, the committee was unable to draw a conclusion about the impact of alcohol on all-cause mortality, but with moderate certainty concluded that more alcohol consumption increased the threat. Thus, for breast and colorectal cancer, the more alcohol consumed, the higher the risk.
Consuming alcohol “moderately” is not as easy as it sounds. It is likely that the same NASEM scientists who wrote that report would classify alcohol as a potentially addictive substance. By definition, that means that, for many individuals, alcohol is very difficult to consume in moderation. National statistics suggest that at least 10% of adults have an alcohol substance disorder which means that moderation is not easy for them. I could not find numbers for Marblehead, but most professionals who are in positions to observe (physicians. psychologists, social workers, clergy, etc.) that I have spoken with believe Marblehead may be above average. We asked about alcohol on the recently completed CAHM wellness survey. Very preliminary unofficial review of the results indicated that alcohol was a concern for about 20% of the responders.
Some individuals are more prone to addictive behaviors than others. The differences are probably caused by a mix of genetic and environmental factors. Research on twins shows that probably close to 50-60% of the risk for alcoholism comes from inherited factors. Several studies have shown that youths living with a parent or caregiver with substance use disorder (SUD) are more likely to themselves show SUDs and psychopathology than those raised in a non-SUD home.
The NASEM report does not deal with adolescent issues, but the news coming from other sources about alcohol consumption in the younger population is not good. Youth mental health is in a crisis situation with substance use a major factor and alcohol being the predominant substance. Twenty percent of adolescents aged 14-15 have consumed alcohol at least once in their lifetime, and 5.6 million adolescents aged 12-20 reported drinking alcohol beyond “just a few sips” in the past month.
The primary reason that youths are in much more jeopardy from alcohol than adults is that adolescent brain is undergoing major transformations as it matures. The terms “plastic” or “malleable” are sometimes used to describe the brain during this period. That dynamic makes the brain much more susceptible to external influences such as alcohol during this period. Fortunately, a very new book published in October (Effects of Alcohol on the Brain Across the Lifespan) is a great resource for understanding the current science of this process. There are two summary statements — bottom lines — that jump out from the chapters on adolescent brain development:
1) “Evidence from preclinical models shows that adolescent alcohol interferes with the development of prefrontal circuitry” and
2) “Alcohol consumption in adolescents is associated with a variety of long-term behavioral consequences and alterations in prefrontal neurobiology.”
The prefrontal cortex is the area of the brain behind the forehead which is responsible for higher cortical functions like planning, prioritizing, and decision-making. It seems pretty obvious that messing with the anatomy, physiology, and chemistry of the prefrontal cortex of our young people is not a very smart thing to do. So, what should we do about it?
The best answer I have found comes from a book (Never Enough) written by a highly respected addiction scientist who also happens to be a recovering substance abuser. Her assessment is: “The impact of a high alcohol concentration during this ‘plastic’ period leads to lasting alterations in brain structure and function and is more likely to result in an alcohol use disorder. The converse is also true: One of the most effective ways to curtail the risk of addiction is to avoid intoxication during periods of rapid brain development. People who begin drinking in their early teens… are at least four times more likely to meet the criteria for an alcohol use disorder. In fact, the lifetime risk for substance abuse and dependence decreases about 5% with each additional year (before the young person begins drinking) between ages 13 and 21.”
This simple recommendation — Keep Kids Away From Alcohol — seems obvious and pretty straightforward, but like many suggestions regarding alcohol-related behaviors, implementation is more difficult than it should be. The positive social conventions around drinking are long-standing and difficult to change. But the costs of not persevering are becoming greater as well.
The primary goal of this column was to try to introduce the reader to the complexity of alcohol use especially for adolescents. I hope my presentation of it was understandable and helpful. If there are questions or comments, please email me at thomasmassarombhd@gmail.com.
Thank you.
Tom Massaro is a Marblehead resident and Chair of the Board of Health.
