Bianca Nogrady
Hang around an inner-city emergency department on a Friday night and you will see the damage binge drinking can cause. Bloody knuckles, broken noses, black eyes and worse — fractured limbs and fractured lives.
The toll that binge drinking takes on our society is well known, but perhaps less obvious is the impact of the more socially acceptable twin; steady, regular drinking.
A leading alcohol researcher has an expression he uses to describe the different attitudes to drinking from the more laid-back regular daily intake favoured by southern Europeans, to the more hard-core bingeing undertaken by northern Europeans: the French kill their livers and the Finns kill their lovers.
“I’ve been in France early in morning and people, generally men, order a coffee and have a nip of brandy or whisky, and they top up regularly during the day,” said Dr Alex Wodak, Emeritus Consultant at the Alcohol and Drug Service in Sydney’s St Vincent’s Hospital.
“They’re never intoxicated but there’s a formidable physical toll from all of that.
“In the north of Europe, that kind of drinking style is very uncommon and what’s much more common is for people to have two-thirds of a bottle of spirits once a week and they set fire to a soccer stadium or slash train seats or belt their wife up or someone in the street they don’t like the look of.”
Myth of beneficial drinking
Most of us are well aware of the risks posed by binge drinking, but there is still some confusion about the health impact of having just one or two alcoholic drinks per day.
The notion that moderate alcohol consumption is benign, even beneficial, has been around for decades and was first floated by the godfather of evidence-based medicine, the late, Archie Cochrane.
In a 1979 study, Cochrane and colleagues tried to work out what exactly was responsible for the differing rates of death from heart disease across the world.
Their analysis suggested a link between increasing alcohol consumption — specifically of wine — and decreasing rates of heart disease.
This finding was bolstered by other studies that all pointed to a ‘sweet spot’ for alcohol consumption where the benefits outweighed the harms.
Then researchers decided to take a closer look at all the evidence and realised the method of many of these observational studies was fatally flawed.
The assumption underpinning many studies suggesting a health benefit from moderate alcohol consumption was that non-drinkers were a homogenous, health-conscious group of people who had always shunned alcohol.
In fact this population includes a significant number of people who have had to stop drinking for health or addiction reasons.
As a result, this group contains a larger-than-usual number of people with major health problems, either as a result of prior excessive drinking or as a result of health conditions that prevent them from drinking in the first place.
When compared to people who might enjoy a glass or two a few times a week, the non-drinkers looked like they were suffering from the absence of alcohol when in fact their health problems were part of the reason they were not drinking in the first place.
How much is safe?
What we now know is that alcohol consumption can never be justified on health grounds. Our understanding of its harms is all too clear — it is not a question of ‘if’ but a question of ‘how much’.
“The relationship between how much alcohol and how much harm differs for different kinds of harm,” Dr Wodak said.
“In some cases it seems to be linear, that is ‘x’ amount of drinking equals ‘y’ amount of harm, ‘2x’ amount of drinking equals ‘2y’ amount of harm.”
But in other cases, particularly heart disease, the risk associated with alcohol increases exponentially, so doubling your alcohol intake does a far greater amount of damage to the heart.
Similarly for the liver — which the French are credited with abusing by steady, regular alcohol intake — alcohol-induced cirrhosis, or scarring of the liver, cannot be undone and eventually leads to liver failure.
Long-term heavy alcohol consumption is also linked to an increased risk of cancer of the mouth, bowel, liver, prostate and breast.
The brain also suffers from heavy regular alcohol consumption, although it can be difficult to separate the harm caused by alcohol from the harm caused by other behaviours and lifestyle factors that often go hand-in-hand with regular excessive drinking.
Different types of harm
So which is worse — binge drinking or regular heavy intake? Professor Steve Allsop says league tables of tragedy miss the point — both are harmful, it is just different types of harm.
“It’s like telling somebody that’s just been run over by drunk driver [that] it’s not as bad as liver cirrhosis,” said Professor Allsop, director of the National Drug Research Institute at Curtin University.
The common perception of a dangerous drinker is the stereotypical alcoholic; the heavy, regular, dependent drinker with a bottle in the bottom drawer of their desk.
“But if you ask people in the community what concerns them most about drinking, a lot say drink driving, noise, the threat of violence, disturbed sleep, feeling unsafe in town on Friday night — these are all problems of intoxication rather than heavy regular use,” Professor Allsop says.
“You might never have drunk alcohol before, but if you go out and drink 12 beers, any number of severe consequences can happen.”
This is the Finnish side of the European alcohol spectrum; the kind of drinking that often lead to people becoming either the victim or perpetrator of violence, and which is the cause of much road trauma.
Drinking guidelines tackle both
These two paradigms of harm are the reason why Australian drinking guidelines recommend not only limiting alcohol consumption to no more than two standard drinks on any day, but also specifically advise against drinking more than four standard drinks on a single occasion.
In total, there are more than 200 diseases and injuries that can be linked to alcohol consumption, including 30 that are caused only by alcohol.
“We hear so much about ice and we hear relatively little about alcohol, although if you count the bodies in the morgue, many more bodies are there from alcohol than there are from ice,” Dr Wodak says.
“If we look at the families whose lives are shattered by a loved ones’ drinking, again many more families affected by alcohol than affected by ice.”