Who Should Not Drink Alcohol?

You've heard the old saying, “Everything in moderation,” right? Well, when it comes to alcohol, that adage doesn't always hold true. In some scenarios, health conditions, and lifestyles, even moderation might be too much. We're not just talking about avoiding excess; in many cases, the most mindful way to drink is to not drink at all. It’s all about making informed choices, understanding the impact of alcohol, and becoming the best advocate for our own health.

How Alcohol Works in Our Bodies

Alcohol affects us by being absorbed into our bloodstream, where it is transported through our bodies. That warm, fuzzy feeling of intoxication we get from alcohol? It happens when the alcohol-laden blood reaches our brain and starts releasing feel-good chemicals. The lack of coordination and slower response time? That comes from alcohol entering our central nervous system and slowing down our reflexes.

Our blood travels to every corner of our body — as a result, the effects of alcohol are considered systemic. All parts of us work together to help us function, so when we have a hitch in any part of our body, it tends to affect the others. So, what happens when you toss alcohol into the mix as well?

Physical Health Considerations

Alcohol impacts every aspect of our physical health. Even in low doses, alcohol wreaks havoc on our stomach, kidneys, bones, teeth, gut, liver, skin, and more. In fact, when it comes to prioritizing our health, there is no “safe” amount of alcohol.

While there are many reasons not to drink if we are concerned about our health, some of us choose to include alcohol as part of our lives, perhaps being mindful to drink responsibly to limit its negative effects. Even for the most mindful drinkers among us, though, some health conditions are particularly dangerous to mix with alcohol. Let’s look at a few common ones and talk about why we shouldn’t drink if they apply to us.

Liver Conditions

Alcohol is processed through the liver. The average liver can process about one drink per hour, although this is not always the case if liver function is compromised. Not only does alcohol cause liver damage, it also exacerbates existing liver conditions like hepatitis, cirrhosis, and liver cancer. If you have liver failure, avoid alcohol entirely

When we drink alcohol with a liver condition, our liver can’t properly filter the alcohol out of our blood. This causes alcohol to accumulate in our bodies for a longer period, giving it more time to damage our organs.

Heart Conditions

Alcohol is stressful on the heart. For those of us who already have heart conditions, alcohol adds even more troubles for it to deal with.

• Hypertension. Alcohol raises your blood pressure, which is particularly dangerous if you have hypertension or are at risk for things like clotting.
• Arrhythmias. Alcohol raises your heart rate. Any condition involving a high heart rate will be exacerbated or triggered by alcohol, including arrhythmias like atrial fibrillation (AFib). In fact, alcohol is the number one reported trigger of AFib episodes.
• Cardiomyopathy. The increased stress from alcohol can worsen cardiomyopathy or cause it to progress to heart failure.

Diabetes

When we drink alcohol, our liver shifts focus away from blood sugar regulation and towards alcohol digestion. Diabetes requires careful management of insulin: when our levels become unbalanced due to heavy drinking, we put ourselves at risk of hypoglycemia. The symptoms of hypoglycemia and alcohol intoxication are very similar. The biggest difference? Hypoglycemia does not go away with time alone; in fact, it can be deadly.

Alcohol use can also cause type 2 diabetes. Heavy drinking can trigger acute pancreatitis or exacerbate chronic pancreatitis — major risk factors for diabetes. Likewise, because alcoholic drinks are often high in calories, the more we drink, the greater our risk of becoming overweight, which also increases our risk of type 2 diabetes. Sugary drinks and beer especially contain more carbs, and a high-carb diet is another risk factor for developing diabetes.

Gastrointestinal Disorders

Since alcohol is ingested and absorbed through our digestive tract, that’s often the first place it causes problems. Nausea and vomiting are common side effects of binge drinking. But what about more serious conditions?

• Acid reflux. Alcohol consumption stimulates the production of stomach acid. For people with acid reflux, this can worsen symptoms. Alcohol can also irritate the lining of the esophagus, exacerbating symptoms of mild acid reflux.
• IBS and IBD. Depending on the person and the context in which it is used, alcohol can either slow down or speed up gut motility. Constipation or diarrhea are common symptom. Alcohol can be particularly problematic for individuals with Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD).
• Peptic ulcer disease. Alcohol increases the risk of bleeding in the GI tract, particularly in people with existing sensitivities like peptic ulcer disease.

Kidney Disease

Kidneys are the great filter of our bloodstream, eliminating the toxins that remain in our bodies after the liver has digested them. This means that alcohol puts a big strain on the kidneys, which have to work extra hard to filter alcohol toxins on top of their normal duties.

For people with kidney disease (including kidney stones, kidney infection, and kidney failure), alcohol is particularly dangerous. When the kidneys don’t filter properly, alcohol-related toxins spend more time in our bodies causing damage. In addition, alcohol is a diuretic: it causes us to urinate more, disrupting our body’s fluid balance, which is critical in managing kidney disease.

Mental Health Considerations

Alcohol is known to be bad for our mental health. Besides wreaking havoc on our brain chemistry, it beats up our gut microbiome. Some 95% of our serotonin — the natural chemical that creates our sense of wellness — is produced in our gut. A functioning microbiome is essential for healthy serotonin production, and it can help protect against anxiety and depression.

• Anxiety. Alcohol inhibits the proper function of excitatory chemicals in our brains, causing us to experience increased anxiety. This can manifest as generalized anxiety, “hangxiety,” or social anxiety. If you have been diagnosed with anxiety disorder, avoid alcohol.
• Depression. When we drink alcohol, our brain releases dopamine. This chemical makes us feel happy immediately after we drink; it also activates our rewards system and encourages us to drink more. Over time, our brain adjusts its expectations and requires more and more dopamine to feel good or even “normal.” This process of chasing happiness is called the hedonic treadmill. It makes depression worse and can be a hard cycle to escape — but it is possible!
• Psychosis. Alcohol can cause or exacerbate psychosis, which is characterized by delusional thinking and persistent hallucinations.
• Schizophrenia. While this complex condition is not well understood, there is a strong connection between alcohol and schizophrenia. Between 30% to 70% of people diagnosed with schizophrenia also report alcohol use disorder, although it’s not clear whether one causes the other.

In general, alcohol sends our brains into chemical chaos, which has implications for just about every mental health condition. Likewise, alcohol interacts with many medications used to treat mental health conditions, like antidepressants and antipsychotics. When trying to improve our mental health, quitting alcohol and other substance use is a good place to start.

Special Populations and Situations

• Drinking and driving. Drinking alcohol and driving is not only illegal, but it’s incredibly dangerous — both for the driver and for everyone else on the road. Alcohol impairs judgment and reflexes, making it more difficult for drivers to respond to signs, stoplights, pedestrian crossings, and anything or anyone on the road.
• Pregnancy. There are many negative alcohol effects on pregnancy — pregnant women should never drink. Alcohol affects every part of a growing baby, and it has serious implications for organ development, especially the brain. Drinking any amount of alcohol puts the baby at risk of Fetal Alcohol Syndrome and is associated with more subtle conditions like developmental disabilities, low IQ, attention deficit and hyperactivity disorder (ADHD), and vision or hearing problems.
• Drinking at work. Drinking at work is never a good idea, since it impairs judgment and prevents us from showing up as our best selves. However, it is particularly dangerous for people in skilled professions like medicine or the trades. There are many ethical and legal implications for drinking in most jobs, and they can cause job loss or even legal consequences — even if nothing goes wrong.
• Underage drinking. Alcohol affects the developing brain much more than it does the adult brain; whatever effects alcohol has, they are worse in adolescent and underage drinkers. Alcohol use in adolescence is associated with a lower IQ, ADHD, and an increased risk of alcohol use disorder (AUD).
• Medications. Alcohol interacts with many medications. When the liver is busy digesting alcohol, it cannot properly digest medications metabolized in the liver. This means they won’t work quite as well — and if you’re taking medication, you probably want it to work!

Alternative Options

Choosing an alcohol-free lifestyle may seem extreme, in part because alcohol plays a role in so many situations — social events, office parties, family celebrations, or just quiet evenings at home. Quitting drinking benefits everyone, not just those who fit into any of the categories discussed above. Let’s look at some ways to stay mindful about our consumption and prioritize our own health and safety when considering whether or not to drink.

• Explore non-alcoholic alternatives. Experiment with mocktails and other non-alcoholic beverages during social events and celebrations.
• Create new rituals. Replace your usual alcohol-related activities with new rituals, like a special tea for quiet evenings or a morning walk to celebrate milestones.
• Develop a support network. Be open with your friends and family about your reasons for not drinking, and surround yourself with people who support you.
• Engage in new hobbies. Engage in hobbies and activities that don’t center around alcohol, such as sports, art, or volunteering.
• Be mindful. Regularly reflect on the benefits you experience from living without alcohol. Be compassionate with yourself, and thank yourself for making smart decisions about your health and safety.
• Plan for triggers. Identify situations where you may be tempted to drink, and plan ahead on how to handle triggers. Be ready with an appropriate response to social pressure, and develop healthy coping skills so you can respond to whatever life throws at you.

You’ve Got the Power!

Deciding to live alcohol-free is an empowering act of radical self-care. Whether or not you fall into one of the categories above, it’s likely that at some point in your life one of these factors will affect you or someone you love. Keep all this in mind the next time you’re choosing to drink, and consider educating others about these special considerations — after all, knowledge is power!