The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 16

Table 3. Health Risks Associated
with Excessive Use of Alcohol 5
Hypertension
Stroke
Cardiomyopathy
Cirrhosis
Pancreatitis
Brain Atrophy
Hypogonadism With Osteoporosis
Sexual Dysfunction
Gastroesophageal Reflux
Esophagitis
Peptic Ulcer
Seizures
Arrhythmias
Diabetes Mellitus
Hiv
Cancer
review and meta-regression analysis, adjusting
for “abstainer bias and quality-related study char-
acteristics,” found no significant reduction in all-
cause mortality risk for low-volume drinkers (<1
drink per day). By abstainer bias is meant that
previous studies included subgroups of persons
who had severe medical illnesses that resulted
in abstention – biasing the results towards in-
creased mortality among abstainers. 7
With regard to the cognitive effects of alco-
hol, it is well-known that alcohol is a neurotoxin.
Brain changes include atrophy of the cerebral
cortex, reduced white matter volume, enlarged
ventricles, and atrophy of subcortical structures
including the hypothalamus and cerebellum. The
frontal lobes, limbic system, and cerebellum ap-
pear to be particularly vulnerable, with changes
producing abnormalities in the frontotemporal
and basal ganglia circuits.
Alcohol is a central nervous system depres-
sant with effects like those of tranquilizing and
hypnotic drugs. Alcohol abuse is frequently co-
morbid with abuse of other substances. Effects
vary with factors such as duration and quantity of
use, premorbid nutritional status, other substanc-
es used, and underlying neuropathology.
While cerebral atrophy is commonly seen,
it is not a reliable predictor of cognitive dysfunc-
tion. Still, commonly seen cognitive deficits with
heavy use include diminished: executive func-
tioning, psychomotor speed, and complex visual
spatial abilities. Memory deficits are common,
but far from universal. Language and arithmetic
abilities remain relatively unimpaired. Significant
improvements are often seen within the first few
weeks and months of abstinence following heavy
use. However, age is a limiting factor. Older adults
improve to some extent, but more slowly. Many
remain relatively impaired.
Alcohol-related dementia involves wide-
spread cognitive deterioration, including memory
and executive dysfunction. Behavioral dysfunc-
tion is often the result of frontal lobe pathology.
By definition, activities of daily living are impaired.
Wernicke–Korsakoff syndrome is a serious
risk for very heavy alcohol users. Wernicke’s en-
cephalopathy (delirium) is directly associated with
thiamine deficiency and usually follows a bout of
very heavy use – at least two weeks. It may be
exacerbated by alcohol withdrawal delirium. If
treated promptly in the acute stage with thiamine,
the syndrome can be ameliorated. However, 80%
of those with Wernicke’s will experience residual
effects known as Korsakoff syndrome, which usu-
ally leads to persisting dementia. This persisting
dementia is distinct from the alcohol dementia of
chronic abuse without history of Wernicke’s. 8
In addition to the physical and cognitive ef-
fects of heavy drinking, there are emotional and
social effects. Most mental disorders, including
major depressive disorder, have consistent asso-
ciations with alcohol use.
Use of Other Substances
Though older adults tend to reduce their al-
cohol use as they age, alcohol remains the most
commonly used substance. However, the rates
of use of illicit substances doubled between 2002
and 2012 among 50 to 65-year-olds. Cannabis
use by older adults is considerably more prevalent
than other drugs. Prescription medication misuse
is increasing.
2.9 million adults aged 50+ reported non-
medical use of psychotherapeutic medications
in 2012. 1.4% of adults aged 50+ had used
prescription opioids non-medically in the last
year – higher than sedatives, tranquilizers, and
stimulants (all <1%). Estimates of prescription
medication misuse among older women average
11%. Older females are prescribed benzodiaz-
epines and other psychoactive medications 37%
more often than men, and so, older females are
160 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
more likely to abuse prescription drugs. Prescrip-
tion medication misuse is often complicated by
simultaneous alcohol use and by the fact that older
adults are vulnerable to confusing their medica-
tions and instructions for dosing. 1
In summary, the risks of alcohol and sub-
stance use among older adults are substantial, but
often minimized. Greater awareness and vigilance
among health care providers is warranted.

References
1. Kuerbis A, Sacco P, Blazer DG, Moore AA. Sub-
stance abuse among older adults. Clinical Geri-
atric Medicine 2014; 30(3): 629-654.
2. Grant, BF, Chou SP, Saha TD, Pickering RP, Ker-
ridge BT, Ruan WJ, Huang B, Jung J, Zhang H,
Fan A, Hasin DS. Prevalence of 12-month alco-
hol use, high-risk drinking, and DSM-IV alcohol
use disorder in the United States, 2001-2002 to
2012-2013: results from the national epidemio-
logic survey on alcohol and related conditions.
JAMA Psychiatry 2017 Sep 1; 74(9): 911-923.
3. American Psychiatric Association. Diagnostic
and Statistical Manual of Mental Disorders-5 th
ed. 2013.
4. Centers for Disease Control and Prevention. Fact
Sheet – Alcohol Use and Your Health. Alcohol
and Public Health. www.cdc.gov/alcohol/fact-
sheets/alcohol-use.htm. Last updated: Janu-
ary 3, 2018. Accessed: March 22, 2018.
5. Rehm, J, Baliunas D, Borges GLG, Graham K,
Irving H, Kehoe T, Parry CD, Patra J, Popova S,
Poznyak V, Roerecke M, Room R, Samokhvalov
AV, Taylor B. The relation between different di-
mensions of alcohol consumption and burden
of disease-an overview. Addictions 2010 May;
105(5): 817-843.
6. LoConte NK, Brewster AM, Kaur JS, Merrill, JK,
Alberg AJ. Alcohol and cancer: a statement of
the American Society of Clinical Oncology. J Clin
Oncology 2017; 35.
7. Stockwell T, Zhao J, Panwar S, Roemer A, Naimi
T, Chikritzhs T. Do “moderate” drinkers have
reduced mortality risk? A systematic review
and meta-analysis of alcohol consumption and
all-cause mortality. J Stud Alcohol Drugs 2016
Mar;77(22):185-98.
8. Lezak, MD, Howieson, DB, Bigler ED, Tranel
D. Neuropsychological Assessment-5 th ed.
2012.
VOLUME 115