Women and Alcohol: The Importance of Brief Intervention in Primary Health Care, by Janaina Soares

Alcohol consumption among women has increased in recent decades, becoming an important public health issue. Historically, alcohol use was more prevalent among men, but social, cultural, and economic changes have contributed to narrowing this gap. This scenario demands greater attention from health services, especially Primary Health Care (PHC), which serves as the main entry point to the health system and plays a strategic role in the early identification and management of risky alcohol use among women.

Effects of alcohol on the female body

According to Brazil’s Ministry of Health, one standard drink corresponds to approximately 10 grams of pure alcohol. In practice, this equals about 250 ml of beer, 100 ml of wine, or 30 ml of distilled spirits. In general, the higher the alcohol content of a beverage, the smaller the volume that corresponds to a standard drink.

For women, low-risk consumption is defined as up to one standard drink per day, with at least two alcohol-free days per week recommended. These intervals are important to reduce the development of tolerance—a phenomenon in which increasing amounts of alcohol are needed to achieve the same effects—which can contribute to progression toward dependence. For men, the low-risk limit is typically up to two drinks per day.

This difference is related to biological characteristics of the female body. In general, women have a lower proportion of body water, lower average body weight, and lower activity of the enzyme alcohol dehydrogenase in the gastric mucosa, which is responsible for part of alcohol’s initial metabolism. Since ethanol is distributed primarily in body water, these factors result in higher blood alcohol concentrations in women compared to men after consuming equivalent amounts.

Because of this greater systemic exposure, women are more vulnerable to alcohol’s effects and may develop health damage in a shorter period of time. Key consequences associated with alcohol use include liver and cardiovascular diseases, mental health disorders, increased risk of certain cancers, and significant impacts on reproductive health and pregnancy.

Consequences of excessive alcohol use

Beyond biological effects, alcohol consumption among women is also associated with important psychosocial factors. Work overload, violence, gender inequalities, psychological distress, anxiety, and depression can contribute to harmful drinking as a coping mechanism. In the context of pregnancy or reproductive planning, alcohol use poses additional risks, including adverse fetal outcomes such as fetal alcohol spectrum disorders.

Strategic tools for prevention

In this context, brief intervention is an effective, low-cost, and widely applicable strategy for preventing and reducing risky alcohol consumption. It is a structured approach, typically delivered in just a few minutes during a consultation, involving targeted counseling, personalized feedback on drinking patterns, and encouragement of critical reflection on the risks associated with alcohol use. It also includes collaboratively developing a menu of options to address risky behavior and strengthening the individual’s self-efficacy to promote change.

It is essential that this approach be conducted in an empathetic and nonjudgmental manner, fostering a trusting environment where individuals feel comfortable discussing their alcohol use and related challenges. The healthcare professional’s attitude should encourage open dialogue and active listening, helping individuals reflect on their behaviors and consider possible changes.

This strategy can be carried out by different members of the healthcare team and has strong evidence supporting its effectiveness in reducing alcohol consumption, particularly among individuals who have not yet developed dependence.

Brief intervention in Primary Health Care

In Primary Health Care, brief intervention can be integrated into routine women’s health visits, such as reproductive planning consultations, prenatal care, gynecological follow-ups, and health promotion activities. Systematic screening using standardized tools, such as the Alcohol Use Disorders Identification Test (AUDIT) or its abbreviated version (AUDIT-C), allows for the identification of risky drinking patterns and the direction of appropriate interventions.

Incorporating these strategies into PHC services contributes to more comprehensive care for women’s health, enabling not only early identification of harmful alcohol use but also strengthening the relationship between healthcare providers and patients. It also facilitates addressing other social and emotional determinants associated with alcohol use—such as caregiving burden, experiences of violence, psychological distress, and structural gender inequalities—promoting more holistic and gender-sensitive care.

Final considerations

Strengthening the capacity of Primary Health Care to conduct screening and brief interventions for alcohol use among women is a key strategy to prevent health problems, reduce harm, and promote better living conditions for the female population.

Legal Blood Alcohol Limits and Traffic Mortality: What Data from 165 Countries Reveal

Driving under the influence of alcohol remains one of the leading preventable causes of traffic deaths worldwide. It is estimated that about 27% of all road traffic fatalities are related to alcohol use, with a disproportionate impact on low- and middle-income countries.¹ Against this backdrop, researchers from Yale School of Medicine conducted a groundbreaking study analyzing 165 countries to understand how legal blood alcohol concentration (BAC) limits relate to alcohol-attributable traffic mortality rates, and which national factors influence this relationship.¹

The World Health Organization (WHO) recommends a maximum BAC limit of 0.05 g/dL for the general population and 0.02 g/dL for drivers. To give a practical sense, a 68 kg (150 lb) man reaches approximately 0.05 g/dL after consuming about three standard drinks over two hours, while women reach this level with significantly less alcohol due to biological differences in metabolism.¹ Despite these guidelines, the study found that around 51 of the 165 countries analyzed maintained limits above the WHO recommendation, highlighting a significant gap between scientific evidence and legislative practice.¹

Brazil, in this regard, ranks among the strictest countries: its “Lei Seca” (Dry Law — Law No. 11.705/2008, amended by Law No. 12.760/2012) establishes a zero-tolerance policy, meaning a BAC of 0.00 g/dL—going even further than WHO recommendations. In the study, countries with zero-tolerance policies were classified in the most restrictive category, and the data indicate that lower BAC limits are associated with lower traffic mortality rates.¹

One of the most revealing findings concerns differences between men and women. Men showed mortality rates about five times higher than women, and the relationship between higher BAC limits and increased deaths was significantly stronger among men. This reflects the fact that men are more likely to engage in risk behaviors such as heavy drinking and driving under the influence, making them disproportionately vulnerable when laws are more lenient.

Beyond the numeric legal limit, the study demonstrated that structural factors within each country strongly influence the effectiveness of traffic policies. Countries with lower national income, greater gender inequality, and higher per capita alcohol consumption had higher mortality rates. In low- and middle-income countries, challenges such as weak enforcement systems, lack of roadside alcohol testing equipment, and limited access to emergency medical care exacerbate the problem, meaning that even strict laws may have reduced real-world impact.

Healthcare infrastructure also plays a crucial role. Countries with stronger health systems—featuring robust emergency response capacity and coordinated trauma care—showed smaller gender disparities and a less steep relationship between BAC limits and mortality. This suggests that effective healthcare systems can act as a safety net, reducing deaths even when accidents occur, while also supporting prevention and public education efforts about the risks of drinking and driving.

The experience of some countries illustrates how integrated approaches can make a difference. Lithuania, for example, combined higher alcohol taxes, restricted sales hours, advertising bans, and expanded public health programs, resulting in significant reductions in traffic injuries and deaths between 2004 and 2019. Similarly, Scotland implemented a minimum unit pricing policy for alcohol in 2018, and within 32 months, alcohol-attributable deaths fell by 13.4%, with the greatest reductions seen among men and socioeconomically vulnerable populations.¹

The authors emphasize that public education campaigns should clarify that legal BAC limits are regulatory thresholds—not indicators of physiological safety. Measurable impairment in driving ability can occur even at lower concentrations, especially among women. In addition, recent global trends show increasing risky drinking behaviors among women, narrowing the historical gender gap in alcohol-related harm and requiring continued attention from public policy.

In summary, the study reinforces that lowering BAC limits is an important but insufficient measure when implemented in isolation. Maximizing reductions in traffic deaths requires that laws be accompanied by reliable enforcement, access to emergency care, reductions in per capita alcohol consumption, and targeted prevention strategies—particularly for male populations and countries with greater structural inequalities.¹ In the Brazilian context, these findings serve as an important warning: although the country’s zero-tolerance law places it among the most restrictive in the world, international evidence shows that legislation alone is not enough. Strengthening roadside enforcement, investing in emergency and trauma care, and promoting awareness campaigns—especially aimed at men, who are historically the most affected—are essential steps to ensure that zero tolerance on paper translates into lives saved in practice.

References:

1. Jimenez Chavez CL, Peltier MR, Mokwuah AA, Bin-Mahfouz A, Verplaetse TL, Zakiniaeiz Y, et al. Legal blood alcohol concentration limits and alcohol-attributable traffic mortality rates: an analysis across 165 countries. eClinicalMedicine. 2026;93:103794. Disponível em: https://doi.org/10.1016/j.eclinm.2026.103794
2. Brasil. Lei nº 11.705, de 19 de junho de 2008. Diário Oficial da União. 20 jun 2008. Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/lei/l11705.htm

Episodic Heavy Drinking and Mortality in Older Adults: What a Large Canadian Study Teaches Us

Episodic heavy drinking, known as binge drinking, is not a behavior limited to young people. Among adults aged 50 and older, this practice has been increasing in recent decades, and its health consequences are more serious than many realize. A new Canadian study published in 2026 analyzed more than 129,000 adults and showed that those who frequently drink large amounts on a single occasion have a significantly higher risk of premature death, even after accounting for factors such as chronic diseases, overall health status, and lifestyle habits.

When discussing alcohol and aging, attention is usually focused on daily consumption, liver disease, or dependence. Binge drinking—defined as consuming four or more drinks on a single occasion for women, and five or more for men—is still commonly associated, in popular perception, mainly with adolescents and young adults. However, this perception is outdated. Recent research has shown that this pattern of drinking is actually increasing among older adults, and its health consequences are underestimated by both the public and healthcare systems.

It is within this context that a recent study published in the journal Alcohol by MacNeil and colleagues (2026)¹ stands out. Researchers from the University of Toronto used data from one of Canada’s largest national health surveys, the Canadian Community Health Survey, collected between 2005 and 2014 and linked to the country’s mortality database. The final sample included approximately 129,470 adults aged 50 or older who consumed alcohol at least once per month. Participants were followed until the end of 2017, allowing researchers to determine who died and when, and to compare these outcomes with the drinking patterns reported at the start of the study.

What the study measured

Participants were classified into four groups based on how often they reported binge drinking episodes in the previous year: never; less than once a month; one to three times per month; and once a week or more. The authors then applied survival analysis models, specifically Cox regression analyses, to estimate the risk of death associated with each pattern of consumption, progressively adjusting for sociodemographic factors (such as age, sex, income, and education) and health-related variables (including chronic diseases, self-reported health, smoking, physical activity, and mental health).

Of the participants, 60.1% reported no binge drinking episodes in the previous year. Another 21.2% drank this way less than once a month, 10.7% did so one to three times per month, and 8% reported heavy drinking at least once a week. Among those who died during the follow-up period (about 14,740 individuals), drinking patterns and health profiles differed significantly.

What the results showed

The study’s central finding is clear: older adults who engage in binge drinking at least once a week have a significantly higher risk of premature death than those who never drink this way. Even after adjusting for variables such as chronic diseases, smoking, physical inactivity, mental health, and socioeconomic status, individuals who reported no binge drinking in the past year had a 19% lower risk of death compared to frequent heavy drinkers. This is important because it shows that the association cannot be explained solely by the fact that people with more illnesses drink more, or that healthier individuals drink less. The drinking pattern itself carries an independent impact on mortality risk.

The study also identified a graded relationship: the more frequent the binge drinking, the higher the risk of death. Those who drank heavily less than once a month had a 17% lower risk than weekly binge drinkers; those who drank one to three times per month had a 12% lower risk. This dose–response pattern is an important epidemiological indicator, strengthening the argument that there may be a causal relationship—not just a statistical association—between binge drinking and premature mortality in older adults.

Why this matters for public health

To better understand this, imagine a study comparing people who drink moderately with those who do not drink at all. At first glance, it might seem that non-drinkers die earlier. However, there is a key detail: many people in the “abstainer” group stopped drinking because they were already ill. This creates a misleading impression—known as the “sick quitter bias”—that non-drinkers are less healthy, when in fact the group includes individuals who already had poor health and stopped drinking for that reason.

To address this issue, the researchers focused only on people who already consumed alcohol, avoiding comparisons with lifelong abstainers or those who quit due to illness. They also adjusted for self-reported health status. Even after removing this confounding factor, the data showed that binge drinking (consuming large amounts in a short time, such as “getting drunk” on weekends) remains a real risk to life, regardless of other factors. Excessive alcohol consumption does, in fact, shorten lifespan.

Another important point is that the study highlights a group often overlooked in public health campaigns: adults over 50 who drink heavily. Data cited by the authors show that binge drinking increased by 19% among Americans aged 50 and older between 2005 and 2014. In Brazil, where population aging is advancing rapidly and alcohol is deeply embedded in the culture, this discussion is urgent.

Specific risks of binge drinking in older age

The bodies of older adults do not metabolize alcohol in the same way as younger individuals. The proportion of body fat increases with age, while water content decreases, leading to higher blood alcohol concentrations even with similar amounts consumed. In addition, liver metabolism becomes less efficient, and the presence of multiple chronic conditions along with the use of medications increases the risk of harmful interactions. Falls, fractures, acute cognitive impairment, and drug interactions are particularly concerning in this age group, and binge drinking—due to its concentrated consumption pattern—amplifies all of these risks at once.

What to do with this information

The study’s authors rightly argue that alcohol-related interventions have focused too heavily on young people and acute risks such as accidents and violence, while neglecting the chronic effects on older adults. Family physicians and geriatricians play a central role in changing this: systematic screening of alcohol consumption patterns among patients over 50 remains underutilized in clinical practice. Asking about how a person drinks—not just whether they drink—should be a routine part of medical consultations.

There is also an important cultural dimension to this issue. Excessive alcohol consumption among older adults is often normalized or even romanticized as part of an active social life in later years. At the same time, stigma surrounding alcohol problems in this age group may lead both patients and healthcare professionals to avoid the topic. Breaking this invisibility is essential for ensuring that interventions reach those who need them.

Finally, it is worth noting that the study does not advocate total abstinence as the only solution. The authors recognize the importance of meeting people where they are and supporting any reduction in drinking patterns, rather than demanding immediate radical change. Reducing the frequency of binge drinking—even without completely eliminating alcohol consumption—already represents a meaningful health benefit. This is a more practical and humane perspective than messages based solely on abstinence, and it is exactly the kind of approach public health needs when addressing alcohol use and aging.

In summary, the study indicates that:

• Binge drinking is a present and growing behavior among adults aged 50 and older, and should not be treated as a problem exclusive to youth;
• The frequency of binge drinking episodes is gradually associated with an increased risk of premature death in this age group;
• This association persists even after controlling for chronic diseases, mental health, smoking, and other relevant factors;
• Physicians, healthcare professionals, and prevention campaigns need to broaden their focus and include older adults in alcohol screening and intervention strategies.

References:

1. MacNeil A, Lung Y, Fuller-Thomson E. Binge drinking and mortality among older adults: Findings from the Canadian Community Health Survey linked to the Canadian Vital Statistics Death Database. Alcohol. 2026;131:38–45. https://doi.org/10.1016/j.alcohol.2026.02.002.

Alcohol and Anabolic Steroids

The use of anabolic steroids is often associated with the pursuit of physical performance and aesthetic changes, while alcohol consumption is frequently seen as routine and socially acceptable. However, combining the two raises a warning sign. More recent studies show that, although there are still gaps in understanding the exact mechanisms of this interaction, the concurrent use of alcohol and anabolic steroids may increase the burden on the liver and be part of a broader context of risk behaviors, with consequences that go beyond liver health and include cardiovascular, hormonal, and psychiatric effects.

The non-medical use of anabolic androgenic steroids has grown in various contexts, far beyond professional sports. Today, this use is seen among gym-goers, amateur bodybuilders, and individuals motivated by aesthetic changes or improved physical performance. At the same time, alcohol remains one of the most widely consumed psychoactive substances in the world. When these two exposures overlap, an important public health concern arises: the potential combined effect on the body, especially on the liver¹.

Anabolic steroids alone are already associated with a range of adverse effects. Among the most well-known are hormonal changes, infertility, acne, gynecomastia, increased blood pressure, and mood changes. The liver is also a major concern. Recent reviews show that prolonged use at supraphysiological doses can lead to elevated liver enzymes, cholestasis, hepatic vascular alterations, and even benign or malignant liver tumors in some cases².

Alcohol, in turn, also has toxic effects on the liver and is associated with a broad spectrum of damage, ranging from steatosis to more severe forms of liver disease³. When a potentially hepatotoxic substance such as anabolic steroids is used in an organism already exposed to harmful alcohol consumption, clinical concern becomes even greater.

One of the most well-known studies on the topic analyzed data from the Drug-Induced Liver Injury Network (DILIN) in the United States, focusing on patients with drug-induced liver injury. The authors observed that among individuals with heavy alcohol consumption, anabolic steroids were prominent among the identified causes of drug-induced liver injury. This finding is relevant because it suggests that heavy alcohol use may be more common in groups where anabolic steroids already represent a risk factor for liver damage.

At the same time, the study raised an important point: the authors did not find clear evidence that heavy drinkers necessarily had worse final outcomes—such as liver-related death or the need for transplantation—compared to non-drinkers in that cohort. This does not mean the combination is safe. In practice, the findings suggest that the relationship between alcohol and anabolic steroid–related liver injury is complex and likely involves both biological and behavioral factors.

This point deserves attention. Part of the association between alcohol and anabolic steroids may reflect a broader context of risk behaviors, such as using substances without prescription, high-dose cycles, combining different compounds, and limited medical supervision²⁴. In other words, it is often not just the sum of two potentially harmful agents, but a pattern of use that already increases vulnerability to multiple health problems.

Recent literature also reinforces that the adverse effects of anabolic steroids extend far beyond the liver. A meta-analysis published in 2025 showed that abuse of these substances among athletes and physically active individuals is associated with significant increases in blood pressure and LDL cholesterol, highlighting their cardiovascular impact⁴. This broadens the discussion: individuals who use anabolic steroids and consume excessive alcohol may be exposing themselves to a combination of hepatic, metabolic, and cardiovascular risks simultaneously.

Another recent review highlighted that androgen abuse is associated with increased mortality and multisystem adverse effects, including cardiovascular toxicity, infertility, hypogonadism, hepatotoxicity, and mental health disorders³. This helps dispel the idea that anabolic steroids produce only “aesthetic” or “hormonal” effects. In reality, these substances can have wide-ranging impacts on the body, especially when used outside a medical context.

It is also important to distinguish between supervised therapeutic use and non-prescribed use. Recent studies show that individuals who use anabolic steroids without medical indication experience more adverse events than those undergoing clinically supervised testosterone therapy. This reinforces that risk is particularly concentrated in recreational, aesthetic, or performance-oriented use—often done without clinical monitoring, regular testing, or appropriate dosing, and sometimes involving unsafe combinations.

From a mental health and behavioral perspective, this combination also warrants caution. Recent reviews describe associations between anabolic steroid abuse and mood changes, aggression, impulsivity, and other psychiatric effects. Since alcohol is also linked to reduced self-control and increased exposure to accidents, violence, and risky decisions, the combination of these substances should not be viewed solely as a liver issue, but as a broader health concern.

From a prevention standpoint, the main message is clear: although more studies are needed to precisely define the biological interaction between alcohol and anabolic steroids, the existing body of evidence is sufficient to treat this combination with seriousness. It is not a trivial combination, especially when it involves heavy alcohol consumption, prolonged steroid use, oral compounds, and lack of medical supervision.

In summary, current evidence indicates that:

• Non-medical use of anabolic steroids is associated with risk of liver injury and other significant systemic adverse effects;
• Heavy alcohol consumption remains an important factor in liver damage;
• The combination of alcohol and anabolic steroids deserves special attention, both because of potential biological overload and the broader context of risk behaviors in which it often occurs.

Informing the public about these risks is essential to counter the normalization of anabolic steroid use and excessive alcohol consumption. In public health, waiting for absolute certainty about every mechanism before issuing warnings is often a mistake. When signals of harm are already consistent, prevention remains the best course of action.

References:

• 1. Dakhoul, L., Ghabril, M., Gu, J., Navarro, V., Chalasani, N., & Serrano, J. (2018) Heavy Consumption of Alcohol is Not Associated With Worse Outcomes in Patients With Idiosyncratic Drug-induced Liver Injury Compared to Non-Drinkers.
  2. Petrovic A, Vukadin S, Sikora R, Bojanic K, Smolic R, Plavec D, et al. Anabolic androgenic steroid-induced liver injury: An update. World J Gastroenterol. 2022;28(26):3071-3080.
  3. Grant B, Hyams E, Jenkins N, Jayasena CN. Androgen abuse: Risks and adverse effects in men. Ann N Y Acad Sci. 2024;1538(1):56-70.
  4. Liu M, Yu Y. Adverse effects of anabolic androgenic steroid abuse in athletes and physically active individuals: A systematic review and meta-analysis. Subst Use Misuse. 2025;60(6):873-887.
• Journal Impact Factor: 7,683
• D.O.I.: https://doi.org/10.1016/j.cgh.2017.12.036

Pancreas Under Pressure: The Silent Enemy of Alcohol Excess

For a long time, science has tried to unravel a major mystery: why does only a small minority of people who drink large amounts of alcohol develop acute pancreatitis?¹ The answer tells an intriguing story about how our bodies react to excess. It is important to emphasize that alcohol-related acute pancreatitis is strongly associated with chronic, heavy alcohol consumption. Moderate or occasional drinking does not cause pancreatitis. Prolonged heavy drinking leads to changes that make the pancreas vulnerable to an acute crisis.

Alcohol itself, or even the substances produced when the body processes it, cannot cause the disease on their own.² Instead, intense and prolonged alcohol consumption acts silently, reducing the pancreas’s natural chemical signaling and causing its fluids to become highly concentrated, acidic, and thick.

This situation is worsened because long periods of alcohol use are often accompanied by poor nutrition and low water intake.¹ This dehydration and relative fasting contribute to the formation of “sludge” or small protein plugs that temporarily block the tiny ducts through which pancreatic and bile fluids should flow. The danger may also arise when a person stops drinking, because after interrupting alcohol consumption and returning to normal eating—especially heavier or fatty foods—the body sends a strong signal and overstimulates the pancreas, which had been operating at a reduced pace.³ It is not the interruption of drinking or the return to normal eating that causes the crisis; rather, the crisis is triggered by the heavy alcohol intake that occurred beforehand.

Imagine a hose running at maximum pressure but with its end blocked. This is essentially what happens in the pancreas: it is forced to produce and secrete digestive juices intensely against blocked ducts.¹ Unable to flow out, these enzymes begin to act within the organ itself, effectively digesting pancreatic tissue, damaging cells, and triggering a cascade of severe inflammation. To make matters worse, continuous alcohol use weakens the pancreas’s natural defense mechanisms against this stress—an effect that is even stronger in people who also smoke.⁴

Symptoms of acute pancreatitis (severe abdominal pain, nausea, vomiting) may not appear immediately after the last drink. Pain can occur hours—or even one or two days—after excessive alcohol intake. During this interval, the person may have already stopped drinking and even tried to eat normally before symptoms become severe enough to require hospitalization. Returning to a normal diet, especially one high in fat, may simply worsen the symptoms of an already developing pancreatitis.

Acute pancreatitis is a serious medical emergency, and although medicine continues to search for treatments that can halt the disease at its origin, rapid diagnosis combined with intensive hospital support remains the most effective and safest way to stabilize the patient and save their life.

References

1. Nordback, I., Paajanen, H., & Pandol, S. (2026). Understanding How Alcohol Induces Human Acute Alcoholic Pancreatitis. The American journal of pathology, 196(1), 68–77. https://doi.org/10.1016/j.ajpath.2025.03.008
2. Apte MV, Pirola RC, Wilson JS: Alcohol and the pancreas. Pancreapedia: Exocrine Pancreas Knowledge Base; 2016. Disponível em: https://pancreapedia.org/reviews/alcohol-and-pancreas, acessado em 1 de dezembro de 2024
3. Deng, X., Wood, P. G., Eagon, P. K., & Whitcomb, D. C. (2005). Rapid adaptation of pancreatic exocrine function to short-term alcohol feeding in rats. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 5(2-3), 183–195. https://doi.org/10.1159/000085270
4. Pallagi, P., Tóth, E., Görög, M., Venglovecz, V., Madácsy, T., Varga, Á., Molnár, T., Papp, N., Szabó, V., Kúthy-Sutus, E., Molnár, R., Ördög, A., Borka, K., Schnúr, A., Kéri, A., Kajner, G., Csekő, K., Ritter, E., Csupor, D., Helyes, Z., … Hegyi, P. (2024). Heavy metals in cigarette smoke strongly inhibit pancreatic ductal function and promote development of chronic pancreatitis. Clinical and translational medicine, 14(6), e1733. https://doi.org/10.1002/ctm2.1733