Alcohol: Know your stuff, NZ with KnowYourStuffNZ

You’re probably familiar with alcohol – the drug we see advertised almost everywhere as a seductive social lubricant. It’s typically consumed as beer, wine, or spirits in social and celebratory settings due to its ability to produce both relaxation and euphoria.

Four out of five Kiwis use alcohol, making it our most popular recreational drug. It’s easy to see why; it makes us feel social, reduces inhibitions, and is short-lived, so taking it isn’t an all-night commitment. It’s also deeply embedded in our social traditions – when we gather with whānau and friends, alcohol is usually there too.

While alcohol (or ethanol, if you want to be scientific) is ubiquitous and legal, it’s still a psychoactive drug that causes both short- and long-term adverse effects on our bodies and to society. But it’s true that what matters is ‘how we’re drinking’, as there can be positive effects on our health from moderate drinking (the equivalent of one-two standard drinks in a day, no more than four days a week). Moderate consumption can lower the risk of heart disease, heart attacks, and strokes, and has also been linked with an increased sensitivity to insulin.

Head to the Harvard School of Public Health website for more info about balancing the risks and benefits of alcohol.

A range of factors relate to how it will affect you, so you shouldn’t assume that one person’s ‘safe limit’ is the same as yours. These factors are your:

  • genetic make-up
  • sex
  • age
  • body
  • usual frequency of alcohol intake
  • hauora/health.

Alcohol and your body

Our body absorbs alcohol into the blood, mostly through the intestine and partly through the stomach. Eating before and/or during alcohol consumption can therefore help to dilute the alcohol in the stomach and reduce the amount that then enters your liver. The liver is the main organ that breaks down alcohol – usually at a pace of about one standard drink an hour.

You’re likely to feel the effects within about 30 minutes, depending on things like how fast you drink, any other drugs you’ve taken, and how full your stomach is. A small dose can calm the brain, which is why you’ll probably initially feel relaxed and cheerful. At higher doses, it impairs cognition, memory, and motor functions. In other words, you’re likely to become less coherent, coordinated, and alert the more you drink (nope, not get sexier).

The liver does most of the work in processing alcohol, while the gut converts some of it into a toxic substance called acetaldehyde. Image credit: American Addiction Centre.

Regularly drinking past your low-risk limit can damage various parts of your brain and body. It can lower your immune response, which increases the risk of infection and getting sick. Over time, excessive drinking can damage the brain and cause neurobehavioral deficits, which can lead to conditions like dementia. Damage to liver cells can also result in liver disease and cancer.

600-1000 Deaths every year in New Zealand are believed to be caused by alcohol
50% of these deaths are from injuries
25% are caused by cancer
25% are due to chronic diseases
Statistics are from a factsheet on the Ministry of Health website, with estimates made between 2005-9.

Alcohol doesn’t play well with other drugs

These consequences for your health are caused by alcohol alone, but it’s common to take other drugs with alcohol that will have their own impacts on the body. Mixing alcohol with other drugs counts as polydrug use, and is dangerous in the following ways:

  1. Alcohol is a depressant that suppresses breathing – increasing the risk of damage to organs or the brain due to a lack of oxygen. Mixing alcohol with other depressants like benzodiazepines, gamma hydroxybutyrate (GHB), or opioids that can cause breathing problems is courting suffocation
  2. The interaction between alcohol and cocaine in the liver forms a different psychoactive substance called cocaethylene, which is thought to be more toxic in the body than either drug alone
  3. Your liver may not be able to keep up with metabolising both MDMA/ecstasy and alcohol, increasing the risk of damage to several organs including the brain.
  4. Using alcohol with stimulants like methamphetamine, cocaine, or MDMA reduces the perceived effect of the alcohol, so while you may feel euphoric and less sedated – your performance will still be impaired. This could lead to drinking way more than you intended then experiencing a wave of alcohol impairment when the stimulants wear off.

Remember your MDMA won’t feel as strong when you’ve also drunk alcohol but the biological effect is still the same even if the psychological effects aren’t. We recommend against redosing if combining with alcohol as you can still get serotonin syndrome, even if you aren’t feeling the psychoactive effects of MDMA.

Check out a simple guide to different drug combinations on TripSit’s website.

A good night doesn’t have to come at the expense of tomorrow!

An important thing to consider is that one standard drink doesn’t necessarily equate to one drink you might pour yourself or get from a bartender. For example, a 500ml bottle of beer is actually almost two standard drinks or about 20 grams of alcohol. Try ordering a half-pint of beer or a single-shot spirit as a way to pace yourself, and keep a count of how many drinks you’ve had because you won’t be able to tell simply based on how drunk you feel.

Check out the Health Promotion Agency website’s tool for finding out how many standard drinks are in typical glasses.

One drink isn’t always one standard drink, as shown in this guide from the Ministry of Health website

If you’re feeling anxious in a social situation and feel like chugging your drinks, think about the greater anxiety you’re going to feel the next day or two when hungover.

Alcohol blocks our glutamate, which is the main transmitter in our brains responsible for exciting us, so when we stop drinking our brain tries to rebalance things by boosting production of glutamate. Simultaneously, alcohol stimulates the Gaba function in the brain (responsible for the nice chill state) that our brains will try to bring back down to normal. This low Gaba function, paired with a spike in glutamate is what leads to anxiety. Instead of getting drunk and setting up yourself for ‘hangxiety’, see if you can have a better time in the blissful relaxation that a drink or two can produce.

Read Professor David Nutt’s description of why alcohol gives you a hangover and anxiety on The Guardian website

Try to remember to hydrate yourself with non-alcohol drinks when drinking alcohol as this will also help to prevent a hangover. The other liquids will also help to dilute the alcohol in your blood, stomach, and liver, and subsequently reduce the likelihood of damage to the liver tissue from a toxic byproduct of the metabolism of alcohol.

Read how alcohol is broken down in the body in the Alcohol Research and Health journal on the NCBI website

Another way you can reduce the likelihood of a hangover is to avoid drinks that have more congener compounds in them. Congeners are responsible for most of the taste, colour, and smell in distilled alcohol beverages, and are in larger quantities in red wine, brandy, and whisky. Generally, the clearer a spirit is, the lower the congeners – so the more refined and transparent options are likely to pose a more ‘bearable’ hangover.

Let your medication do what it needs to without alcohol interfering

People who have diabetes should also stick to particular drinks like light beer and dry wine, to keep blood glucose at a safe level.

Read the Johns Hopkins Medical overview of safer drinking when you have diabetes on their website.

Alcohol affects the way your body responds to a wide range of medicines (including medicinal herbs), so make sure you check if you can drink while taking it.

It can also alter the effects of cannabis – often not in a desirable way. Due to alcohol’s ability to absorb tetrahydrocannabinol (THC) faster, the body may try and remove this drug cocktail by inducing nausea, sweating, and potentially vomiting – what’s known as ‘greening out’.

Some people think greening out is linked to a low blood sugar level because cannabis regulates insulin activity, so a sweet drink like fruit juice may help to diminish nausea. Try to keep someone company if you see them looking pale and sweaty after consuming both drugs because anxiety and panic attacks are also symptoms, and that can be scary.

Chances are, the interaction between alcohol and the prescribed drugs/medicine will be bad. You could potentially end up in a coma from a cocktail of alcohol and opiate-based painkillers, and will be at higher risk of excessive blood loss from an injury if you’ve taken anti-inflammatory medication – especially since alcohol is an anticoagulant (ie it helps to stop blood clots from forming).

We strongly discourage drinking alcohol if you’re pregnant as alcohol crosses the placenta into the foetus.

Also drinking and driving is just bloody stupid, but you knew that already.

An unconscious person probably needs more than just a blanket!

Many people will have seen someone overdosing on alcohol and will know that it can be messy, disruptive, and scary.

Symptoms of overdose/alcohol poisoning are wide-reaching and include slurred speech, vomiting, impaired consciousness/coma, and shallow and/or slow breathing.

If someone’s passed out drunk, don’t assume that an unconscious person will be fine by sleeping it off. Alcohol acts as a depressant that stops signals in the brain that control automatic responses, like the gag reflex. If someone can’t gag but they have a higher chance of vomiting from alcohol irritating the stomach, fatally choking on vomit becomes a real risk to an acutely drunk person.

This is why it’s important not to force someone to vomit if they’ve overdosed, but if they naturally vomit then try to help them to sit up or turn their head to the side. Put them in the recovery position if they need to lie down.

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