Why Alcohol Can Cause Anxiety the Day After Consumption

Many people report feeling anxious after excessive alcohol consumption, especially the morning after a binge. This phenomenon, sometimes called “hangxiety” (a combination of the words hangover and anxiety), refers to the feelings of unease, nervousness, and discomfort that occur during a hangover. In fact, a hangover includes not only physical symptoms (such as headache, nausea, fatigue) but also negative emotional and cognitive effects (1).

Anxiety and irritability are among the mood symptoms reported during a hangover, although they occur less frequently compared to physical symptoms. For example, in a study with 1,837 young adults, about 22.6% reported feeling anxious during a hangover (in comparison, 34.2% reported feeling depressed) (2). This "hangover anxiety" can worsen the discomfort of the following day and interfere with daily activities, making it important to understand why it happens and how to prevent it.

Biological Mechanisms Involved

Several biological mechanisms help explain why alcohol can leave the body in an anxious state. Initially, during intoxication, alcohol acts as a depressant on the central nervous system (CNS), increasing the activity of the inhibitory neurotransmitter GABA and reducing the activity of the excitatory neurotransmitter glutamate. The body tries to compensate for this effect: after a period of repeated or intense consumption, it reduces the sensitivity/quantity of GABA receptors and increases the number of glutamate receptors to counterbalance the sedation caused by alcohol.

Thus, when alcohol leaves the bloodstream, a rebound effect occurs, with low GABAergic inhibitory signaling and excess glutamatergic excitatory activity, leaving the brain in a hyper-stimulated state. This state of "hyper-excitation" manifests in a manner similar to a mild withdrawal syndrome, activating the body's alert system and leading to symptoms such as tremors, sweating, increased heart rate, and anxiety. In other words, after the initial depressant effect of alcohol, the CNS "fires up," generating feelings of anxiety the next day due to the imbalance between inhibitory and excitatory neurotransmitters.

Another key factor involves the hypothalamic-pituitary-adrenal (HPA) axis, responsible for the stress response. High alcohol consumption can activate the HPA axis and elevate cortisol levels, the stress hormone. Normally, cortisol follows a daily rhythm (higher in the morning and decreasing in the evening), but alcohol disrupts this rhythm, and this misalignment can contribute to feelings of anxiety.

Recently, science has highlighted the role of the corticotropin-releasing factor (CRF) system, a neuropeptide central to the stress response, in modulating alcohol’s effects on mood. Specifically, two CRF receptors (known as CRF1 and CRF2) have opposite functions in the context of alcohol consumption. According to a study in an animal model of binge drinking, immediately after an intense drinking episode, animals showed anxiolytic (anxiety-reducing) and even antidepressant responses mediated by the activation of CRF2 receptors. However, after 24 hours, the same animals exhibited clear signs of anxiety and depression, this time related to the activation of CRF1 receptors (3).

Tips for Minimizing the Effects of Post-Alcohol Anxiety

Fortunately, it is possible to adopt strategies to reduce the chances of experiencing anxiety after drinking or at least lessen its intensity. Here are some practical tips:

• Take it easy on consumption: The most effective way to prevent hangover anxiety is to avoid excessive alcohol consumption. Know your limits and prefer to drink moderately, spacing the drinks over time.
• Stay hydrated and well-fed: Alcohol causes dehydration (it is diuretic) and can lead to low blood sugar and other imbalances that worsen discomfort. Alternate alcoholic drinks with water and avoid drinking on an empty stomach – have light meals before and during consumption.
• Don’t try to relieve symptoms with more alcohol: It may be tempting to have a drink when you wake up to alleviate the symptoms, but this is not recommended. While it may provide temporary relief (because alcohol will again activate GABA receptors, producing a sedative effect for a short period), this only masks the problem and can reinforce a dangerous cycle of consumption.
• Seek support if needed: If you find that you frequently experience intense anxiety after drinking or are using alcohol to cope with pre-existing anxiety, consider seeking professional help. A doctor or psychologist can guide you, whether to manage anxiety (with therapy or medication if indicated) or to adjust your drinking habits.

Feeling anxious the day after consuming alcohol is a relatively common experience, especially after episodes of excessive drinking. While intoxication may provide an apparent calming effect (anxiolytic), this is temporary – and even deceptive – because it will be followed by the discomfort of the hangover when alcohol is gone. Moderation or abstinence from alcohol consumption and simple health practices (hydration, rest) can make a significant difference in the quality of the following day and long-term mental well-being.

References:

1. Mackus, M., Loo, A. J. V., Garssen, J., Kraneveld, A. D., Scholey, A., & Verster, J. C. (2020). The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover. Journal of clinical medicine, 9(11), 3421. https://doi.org/10.3390/jcm9113421 
2. van Schrojenstein Lantman, M., Mackus, M., van de Loo, A. J. A. E., & Verster, J. C. (2017). The impact of alcohol hangover symptoms on cognitive and physical functioning, and mood. Human psychopharmacology, 32(5), e2623. https://doi.org/10.1002/hup.2623 
3. Simon, B., Thury, A. Á., Török, L., Földesi, I., Csabafi, K., & Bagosi, Z. (2023). The effects of alcohol on anxiety-like, depression-like, and social behavior immediately and a day after binge drinking. Alcohol (Fayetteville, N.Y.), 112, 17–24. https://doi.org/10.1016/j.alcohol.2023.05.004

Brazilian Study Highlights the Relationship Between Alcohol Consumption and Suicide in São Paulo Metro area

The harmful use of alcohol is a known risk factor for various forms of impulsive and violent behavior, including suicide. An observational study conducted in Brazil analyzed the relationship between blood alcohol levels and suicide cases in towns of the São Paulo metropolitan area, revealing associations between alcohol consumption and suicide deaths.

A recent study (1) with data from the Forensic Medical Institute of the State of São Paulo (IML-SP) and published in the journal Forensic Science, Medicine and Pathology investigated the relationship between alcohol consumption and suicides in four municipalities of Greater São Paulo: Franco da Rocha, Caieiras, Mairiporã, and Francisco Morato. The research analyzed data from 805 autopsies performed between 2001 and 2017, of which 41 cases were identified as suicides. The aim was to assess the presence of alcohol in the blood of the individuals and its possible influence on the suicidal act.

The results showed that 92.68% of the suicide victims had elevated blood alcohol concentrations (above 0.3 mg/dl), with particularly high averages in cases of hanging (2.3 mg/ml). Furthermore, the data indicated that most of the victims were male (85.36%), predominantly young adults aged 18 to 23 years. Among women, the most affected age group was 12 to 23 years, highlighting a concerning pattern of vulnerability among adolescents.

The researchers also observed that the use of more lethal methods, such as firearms and sharp objects, was associated with higher blood alcohol levels. These findings support the hypothesis that harmful alcohol consumption can increase impulsivity and lower inhibitions against self-destructive behavior.

Based on the findings, some recommendations are important:

• Prevention and Awareness: Suicide prevention programs should include strategies to address harmful alcohol use, especially among adolescents and young adults, who are at higher risk.
• Restriction of Access to Lethal Means: Measures such as controlling access to firearms, pesticides, and neurotropic medications can reduce the lethality of methods used in suicide attempts.
• Use of Peripheral Biomarkers: Screening individuals with suicidal ideation using peripheral biomarkers (biological substances in body fluids that indicate physiological processes, diseases, or responses to treatments) can be a valuable tool to identify those at risk.
• Protection in Public Spaces: Structures such as viaducts and bridges should be designed with safety measures to prevent intentional falls.

These recommendations are particularly relevant for regions with high socio-economic inequality, where alcohol consumption and suicide rates tend to be higher. The World Health Organization (WHO) emphasizes that the prevention of harmful alcohol use is an important factor that can significantly contribute to reducing suicide rates.

References:

1. Miziara, I.D., Miziara, C.S.M.G. Suicide victims and alcohol-related consumption in Brazil: An observational study and a narrative review of the literature. Forensic Science, Medicine and Pathology , 2023. https://doi.org/10.1007/s12024-023-00766-4.

How Many People Suffer from Alcoholism in Brazil and Around the World?

Alcohol Use Disorder (AUD), commonly known as alcoholism, is one of the most prevalent mental health conditions worldwide. However, its true extent is difficult to predict, as many cases remain undiagnosed (1) due to limited access to specialized healthcare services in various countries.

Global Alcohol Consumption and Health Impacts

Alcohol Use Disorder (AUD) is characterized by a problematic pattern of alcohol consumption, leading to significant distress or impairment in various areas of life, such as work, relationships, and physical health. In 2019, it was estimated that around 400 million people aged 15 years and older were living with alcohol use disorders, with 209 million (52.3%) diagnosed with dependence. Globally, the prevalence of AUD was 5.1%, with a marked gender difference: 8.6% of men and 1.7% of women were affected in 2016 (2).

The prevalence of AUD tends to be higher in high-income countries (8.4%) and upper-middle-income countries (5.4%), suggesting the influence of socioeconomic factors on consumption patterns and alcohol availability. In contrast, low-income countries generally have lower prevalence rates, but may suffer from limited access to treatment and a higher prevalence of alcohol-related deaths.

The Situation in Brazil

Alcohol Use Disorder (AUD) also affects a significant portion of the Brazilian population. According to data from the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (2024), presented on the platform Our World in Data (3), approximately 3.3% of the Brazilian population had alcohol use disorder in the 2010s. However, this rate has slightly decreased over recent decades, standing at about 2.9% in 2021. This reduction may reflect changes in access to information, public policies, and consumption patterns, although the prevalence remains high compared to other mental health disorders.

As with the prevalence of AUD, alcohol-attributable deaths in Brazil have also shown a trend of reduction over the last decade. According to the CISA publication Álcool e Saúde dos Brasileiros - Panorama 2024, the alcohol-attributable death rate fell from 36.7 to 30.4 per 100,000 inhabitants between 2010 and 2019. However, this trend was interrupted by the COVID-19 pandemic, with a significant increase starting in 2020, reaching 32.5 per 100,000 inhabitants in 2022. These data emphasize the importance of sustainable and continuous public policies to address the impacts of alcohol on public health.

Facing the Problem: Challenges and Opportunities

Despite the existence of effective treatments, such as cognitive-behavioral therapies and medications, access to these interventions remains limited. In Brazil and other countries, addressing alcohol use disorder requires:

• Reducing stigma: Awareness campaigns can help promote a more informed and compassionate view of the disorder.
• Improving screening: The use of simple tools in primary healthcare units can facilitate early diagnosis.
• Investing in accessible treatments: Expanding specialized services and including innovative therapies is essential.

Alcohol Use Disorder is a public health issue with profound implications for individuals, families, and societies. Understanding its prevalence and associated factors is crucial for developing effective prevention and treatment policies. By addressing stigma, improving screening, and expanding access to health care, it is possible to significantly reduce the impact of AUD on global health.

Remember, those suffering from this issue in Brazil can seek free help at any Basic Health Unit (health clinic) linked to the SUS (Unified Health System) or at units of the Psychosocial Care Centers for Alcohol and Drugs (CAPS-AD).

References:

1. Divya Ayyala-Somayajula, Jennifer L. Dodge, Adam M. Leventhal, et al. Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study. Ann Intern Med. [Epub 12 November 2024]. doi:10.7326/ANNALS-24-02157
2. Rehm J, Shield KD. Global Burden of Alcohol Use Disorders and Alcohol Liver Disease. 2019 Dec 13;7(4):99. doi: 10.3390/biomedicines7040099. PMID: 31847084; PMCID: PMC6966598. 
3. IHME, Global Burden of Disease (2024) – with major processing by Our World in Data. “Share of population with an alcohol use disorder”. IHME, Global Burden of Disease, “Global Burden of Disease - Prevalence and Incidence” [original data]. Retrieved January 27, 2025 from https://ourworldindata.org/grapher/share-with-alcohol-use-disorders

American Review Study Suggests That Moderate Alcohol Consumption is Associated with a Reduced Risk of Mortality from All Causes

Consumption of alcoholic beverages is widely practiced across various cultures, but scientific evidence shows that its harmful use is associated with a range of health risks. A review of evidence analyzed the impacts of alcohol consumption on several health conditions, including mortality from all causes, cardiovascular diseases, cancer, and neurocognitive effects.

A recent study (1) compiled by the National Academies of Sciences, Engineering, and Medicine, an entity of the United States Government, systematically reviewed the evidence on the impacts of alcohol on health. The methodology followed strict standards for systematic review, including searching recognized databases, selecting studies with predefined quality criteria, and assessing the risk of bias (study quality) by independent reviewers, following the highest standard in terms of scientific evidence. The goal was to evaluate the relationship between moderate alcohol consumption and various health outcomes, based on high-quality studies and systematic reviews.

An important requirement of the study was to establish a comparison group that did not include both people who have never drunk and former drinkers, as this could create an "abstinence bias." This bias could lead to misleading results, as the reasons for abstinence can vary significantly between these two groups, including people who have never drunk for religious reasons, and others who may have stopped drinking due to health issues. This bias could create a misleading impression that the health of non-drinkers is worse than that of moderate drinkers. By excluding this bias from the selected studies, the chances of obtaining more reliable results regarding the effects of moderate use on health are greater.

The results highlighted significant associations between alcohol consumption and various health conditions, including:

• Mortality from all causes: Moderate alcohol consumption was associated with a 16% reduction in the risk of mortality from all causes compared to abstainers (RR 0.84, 95% CI 0.81-0.87).
• Cardiovascular diseases: Moderate consumption was associated with a lower risk of myocardial infarction (RR 0.88, 95% CI 0.68-0.90) and ischemic stroke (RR 0.88, 95% CI 0.86-0.90).
• Cancer: Moderate alcohol consumption was associated with a 10% increase in the risk of breast cancer (RR 1.10, 95% CI 1.02-1.19), while evidence for other types of cancers remained inconsistent.
• Neurocognitive effects: The impact of alcohol consumption on neurocognition still shows conflicting results, with some evidence suggesting a negative relationship with cognitive decline.

Recommendations:

• Avoid excessive consumption: Moderation is essential to minimize the associated health risks.
• Attention to specific conditions: Individuals with pre-existing conditions such as liver diseases (cirrhosis, hepatitis), cardiovascular diseases (hypertension, heart failure), gastrointestinal diseases (gastritis, pancreatitis), neurological disorders (epilepsy), psychiatric conditions (depression, anxiety), diabetes, kidney diseases, or autoimmune diseases should avoid alcohol consumption, as it can affect treatment and the progression of these conditions, as well as pose additional health risks.
• Awareness of risks: It is important to inform the population about the impacts of alcohol consumption, even in moderate amounts.

These recommendations are particularly relevant for individuals in high-risk situations, such as those with cardiovascular diseases or a family history of cancer. The World Health Organization (WHO) emphasizes that no amount of alcohol is absolutely safe. Pregnant women and minors, in particular, should completely avoid alcohol consumption due to the significant risks associated with these conditions.

References:

1. National Academies of Sciences, Engineering, and Medicine. Review of Evidence on Alcohol and Health. Washington, DC: The National Academies Press, 2025.

Drinking Alcohol and Flying: Health Risks During Long Flights

Consumption of alcoholic beverages on flights is a common practice, especially on long trips. However, studies show that this practice can pose health risks due to the combination of alcohol and the specific conditions in the aircraft cabin.

A study (1) conducted by the Institute of Aerospace Medicine at the German Aerospace Center investigated the effects of moderate alcohol consumption under simulated flight conditions. The goal was to analyze how the combination of alcohol with the specific conditions of the aircraft cabin, such as low pressure and reduced oxygenation, affects health and well-being, particularly during sleep.

Participants went through two experimental nights: on one, they consumed alcohol before sleeping; on the other, no alcohol was consumed. The sessions were carried out both under simulated flight conditions and at sea level. The results showed that those who consumed alcohol had a higher frequency of hypoxia (reduced oxygen levels in the blood) and increased heart rate during sleep. Additionally, the combination of alcohol and low atmospheric pressure intensified known negative effects, such as reduced sleep quality and oxygen saturation.

How Alcohol Affects the Body During a Flight:

• Dehydration: Alcohol contributes to dehydration, which is already exacerbated by the low humidity inside aircraft cabins.
• Reduced Oxygenation: The study indicates that alcohol consumption in low-pressure conditions (simulating cruising altitude) significantly reduces blood oxygen saturation (SpO2), potentially leading to prolonged periods of hypoxia (oxygen levels below 90%).
• Cardiovascular Changes: Alcohol combined with hypobaric conditions (2) (the reduction of atmospheric pressure at high altitudes) increases heart rate, placing more strain on the cardiovascular system.
• Impact on Sleep: Although alcohol helps with falling asleep, it reduces deep sleep phases, making rest less restorative. Additionally, alcohol can impair breathing during sleep, increasing the incidence of apnea and snoring episodes, contributing to worsened fatigue symptoms by the end of the flight (3).

Recommendations:

• Avoid alcohol consumption before and during the flight: This practice helps prevent dehydration, hypoxia, and excessive fatigue.
• Stay hydrated: Drinking plenty of water is essential to minimize the effects of low cabin humidity.
• Prioritize rest: Avoid substances that could interfere with sleep quality, such as alcohol, coffee, and other caffeinated drinks, especially on long flights.

These precautions are particularly important for individuals with pre-existing conditions, such as respiratory or cardiovascular diseases (4). Raising passenger awareness about the risks associated with alcohol consumption during flights can be an effective measure to improve the safety and comfort of air travel.

References:

1. Trammer RA, Rooney D, Benderoth S, Wittkowski M, Wenzel J, Elmenhorst EM. Effects of moderate alcohol consumption and hypobaric hypoxia: implications for passengers' sleep, oxygen saturation and heart rate on long-haul flights. Thorax. 2024 Sep 18;79(10):970-978. doi: 10.1136/thorax-2023-220998. PMID: 38830667.
2. Petrassi FA, Hodkinson PD, Walters PL, Gaydos SJ. Hypoxic hypoxia at moderate altitudes: review of the state of the science. Aviat Space Environ Med. 2012 Oct;83(10):975-84. doi: 10.3357/asem.3315.2012. PMID: 23066620.
3. Park SY, Oh MK, Lee BS, Kim HG, Lee WJ, Lee JH, Lim JT, Kim JY. The Effects of Alcohol on Quality of Sleep. Korean J Fam Med. 2015 Nov;36(6):294-9. doi: 10.4082/kjfm.2015.36.6.294. Epub 2015 Nov 20. PMID: 26634095; PMCID: PMC4666864.
4. Seccombe LM, Peters MJ. Physiology in medicine: acute altitude exposure in patients with pulmonary and cardiovascular disease. J Appl Physiol (1985). 2014 Mar 1;116(5):478-85. doi: 10.1152/japplphysiol.01013.2013. Epub 2013 Dec 26. PMID: 24371015.

Health Care During the Summer Holidays

Summer holidays are a time for relaxing, but they also require extra attention to health. CISA – the Center for Information on Health and Alcohol – highlights the importance of practices that promote well-being and prevent excesses that could compromise health and enjoyment during this special period.

Despite the relaxed atmosphere, the holidays can bring challenges when it comes to maintaining healthy habits. From food and drink choices to managing rest time, taking care of your health is essential to celebrate with vitality and energy. Here are some tips for enjoying the holidays in a healthy way:

• Moderation in food and alcohol consumption: Opt for lighter, balanced meals paired with good hydration, especially on hotter days. When it comes to alcoholic beverages, it's important to respect your limits and alternate with water.
• Attention to rest: The holidays are marked by many activities and gatherings, but it's essential to prioritize adequate sleep. A good night's rest helps maintain energy and emotional balance.
• Practice empathy and inclusion: Not everyone drinks alcohol or follows the same habits. Be inclusive and respectful, creating a comfortable environment for everyone.
• Care with heat: Outdoor moments require special attention to hydration. Water and natural juices are the best options for combating the heat without overloading your body.
• Plan ahead: Organizing your commitments well helps avoid overload and allows you to make the most of each moment. Remember to take breaks and respect your limits.

With these simple measures, the summer holidays can be enjoyed with health and safety. Enjoy every moment, but don’t forget that taking care of yourself is essential to start the new year with energy and vitality.

Dry January: Learn How to Reduce Alcohol Consumption

A campaign launched in the United Kingdom, Dry January, which encourages a month without alcohol, can motivate the adoption of healthier habits.

Year-end celebrations are often accompanied by champagne and followed by hangovers in the days after. In addition to excessive alcohol, it’s also common to overindulge in fatty and sugary foods during this time, which increases health risks and causes many people to start the year not feeling their best. Therefore, January can be a great time to set new goals and objectives for a healthier lifestyle, which may include temporarily stopping alcohol consumption.

The challenge of Dry January is simple: stay sober for all 31 days of the month. Although it is a short period, this change can bring health benefits, especially after the excesses of the holidays.

Main Benefits

Taking a break from alcohol can bring numerous physical and mental benefits, such as better sleep quality, clearer skin, and more energy throughout the day.

These benefits will depend on how much and how often a person drinks. If a person regularly drinks large amounts, a sudden change may cause irritation before they start feeling better. For those who drink less, the benefit is more immediate, with increased energy and improved mood after a few days of sobriety.

Additionally, the break can help with weight loss, reduce blood pressure, and improve liver function.

Challenges

It is increasingly common for people to decide to take periodic breaks from alcohol consumption. These pauses can be important for individuals to assess the role alcohol plays in their lives and make changes if they find their relationship with the substance is unhealthy. However, the break is useless if it is followed by excessive drinking afterward. Some people think that because they went a month without drinking, they can drink as much as they want afterward. This will undo the benefits they achieved. Therefore, maintaining healthy behavior over time is more difficult than the short break itself. For this, more than a month without drinking, discipline, commitment, and willpower are required.

Changing habits abruptly, especially if alcohol consumption is part of one’s routine, is not easy. To support this process, CISA highlights five tips that can make a difference:

1. If you’ve decided it’s time to reduce or stop drinking, don’t delay. Set a date and start.
2. Share your intention to reduce or stop drinking. This can motivate your family and friends to support you.
3. Stay away from places that remind you of alcohol or trigger cravings to drink, such as bars, liquor stores, or the alcohol section of a supermarket. It’s also useful to avoid having alcohol at home.
4. Fill your free time with hobbies and activities that don’t involve alcohol.
5. Remember that adopting other healthy habits will also help in this process: try to eat well, get a good night’s sleep, exercise, and drink water.

The difficulty in reducing or stopping alcohol consumption will depend on an individual’s personal characteristics, how much they typically drink, and whether they already experience emotional, physical, or interpersonal complications from alcohol use. If difficulties arise during this process, seeking help from a trusted healthcare professional for a detailed assessment is recommended.

Holiday Heart Syndrome: The Impact of Excessive Alcohol Consumption on Cardiac Arrhythmias

Studies indicate that excessive alcohol consumption is directly linked to cardiac arrhythmias such as atrial fibrillation (AF) (1). Understand how this affects young and healthy individuals and the challenges in treatment.

Excessive alcohol consumption has complex effects on cardiovascular health, influencing the risk of conditions such as hypertension, coronary artery disease, stroke, peripheral artery disease, and cardiomyopathy. These associations are shaped by various factors, including behavioral, genetic, and biological variations. Additionally, the dose and pattern of alcohol consumption also seem to play a crucial role in modulating this relationship (2). Consuming five or more drinks within a two-hour period can have serious health consequences, including for the heart.

"Holiday Heart Syndrome" (HHS) is named for its association with the occurrence of cardiac arrhythmias triggered by episodes of excessive alcohol consumption, which often occur during weekends and holidays, periods marked by increased relaxation and celebrations. Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia among patients with HHS. AF is widely known for increasing the risk of morbidity and mortality, primarily due to strokes (CVA) and heart failure, representing a significant burden on healthcare systems.

Atrial fibrillation caused by excessive alcohol consumption occurs due to various mechanisms that disrupt the heart's functioning. Alcohol can interfere with calcium regulation inside cardiac cells, disrupting its release and causing electrical changes that may lead to irregular heartbeats (3). Additionally, a hangover increases the activity of the nervous system, making the heart more sensitive and decreasing the time it needs to recover between beats, which facilitates arrhythmias (4). Alcohol also causes the loss of important electrolytes due to its diuretic effect and can damage heart cells through the accumulation of toxic substances, contributing to the development of AF (5).

Treatment of Holiday Heart Syndrome goes beyond initial stabilization in the emergency room. It is essential to understand the reasons behind excessive alcohol consumption, and evaluation with a mental health professional is recommended. Reducing the effects of alcohol consumption can only be achieved with the collaboration of a well-coordinated interdisciplinary team (6).

References:

1. Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler PM. Alcohol and Atrial Fibrillation: A Sobering Review. J Am Coll Cardiol. 2016 Dec 13;68(23):2567–76. 
2. Piano M. R. (2017). Alcohol's Effects on the Cardiovascular System. Alcohol research : current reviews, 38(2), 219–241.
3. Yan, J., Thomson, J. K., Zhao, W., Gao, X., Huang, F., Chen, B., Liang, Q., Song, L. S., Fill, M., & Ai, X. (2018). Role of Stress Kinase JNK in Binge Alcohol-Evoked Atrial Arrhythmia. Journal of the American College of Cardiology, 71(13), 1459–1470. https://doi.org/10.1016/j.jacc.2018.01.060
4. Marcus, G. M., Dukes, J. W., Vittinghoff, E., Nah, G., Badhwar, N., Moss, J. D., Lee, R. J., Lee, B. K., Tseng, Z. H., Walters, T. E., Vedantham, V., Gladstone, R., Fan, S., Lee, E., Fang, C., Ogomori, K., Hue, T., Olgin, J. E., Scheinman, M. M., Hsia, H., … Gerstenfeld, E. P. (2021). A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in Atrial Electrophysiology. JACC. Clinical electrophysiology, 7(5), 662–670. https://doi.org/10.1016/j.jacep.2020.11.026
5. Tonelo, D., Providência, R., & Gonçalves, L. (2013). Holiday heart syndrome revisited after 34 years. Arquivos brasileiros de cardiologia, 101(2), 183–189. https://doi.org/10.5935/abc.20130153
6. Jain A, Yelamanchili VS, Brown KN, et al. Holiday Heart Syndrome. [Updated 2024 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537185/

"Know Your Numbers": An Approach to Reduce Heavy Alcohol Consumption in Young Adults

A recent study highlights that, although the "Know Your Numbers" (KYN) model has the potential to raise awareness about alcohol consumption, more prolonged and robust interventions are necessary to significantly impact young adults.

Harmful alcohol consumption, such as binge drinking, is a common issue among young adults, and current interventions like individual therapeutic programs, brief interventions, and modifying expectations regarding alcohol use have shown positive, albeit modest, effects. In general, research on current interventions suggests that there is little significant long-term behavioral change.

A promising alternative is the "Know Your Numbers" (KYN) model, successfully used to modify risk behaviors in campaigns related to cardiovascular diseases, such as American Heart Association´s campaigns. In this model, providing quantitative feedback, such as cholesterol levels, has been shown to be effective in raising awareness. However, no study has yet combined the KYN model with alcohol biomarkers (such as PEth—a blood biomarker for alcohol consumption, known as phosphatidylethanol) and AUDIT (Alcohol Use Disorders Identification Test) scores to create a quantitative risk indicator related to alcohol consumption.

A recent study evaluated the feasibility, acceptability, and preliminary effectiveness of a four-week intervention based on the KYN model to motivate young adults to reduce dangerous levels of alcohol consumption. The main hypothesis proposed that awareness of AUDIT values and PEth levels would encourage positive behavioral changes. The goals included evaluating recruitment and retention strategies, examining the impact of the intervention on motivation for change, and measuring its preliminary effectiveness in reducing alcohol consumption. Additionally, the study aimed to analyze the acceptability of the KYN approach through focus groups (sessions where participants discuss their experiences with the intervention to provide qualitative feedback), which also offered suggestions for improvement.

Ninety-four young adults aged 18 to 30 who reported binge drinking in the past month were recruited. Participants with specific conditions, such as psychiatric treatment, a history of substance dependence, pregnancy, BMI over 30, or seizure disorders, were excluded. Overall, the strategy was effective, with 82.26% of individuals recruited and 76.9% retained after four weeks.

During the intervention, participants received personalized feedback based on PEth levels and AUDIT scores. A subgroup participated in reinforcement sessions after two weeks, and focus groups were held at the end to evaluate the experience. Motivation for change was measured by the Alcohol Contemplation Ladder, which showed a significant 62% increase (p < 0.001) from the beginning to the end of the intervention. However, despite this, many participants still showed indecision about changing behaviors. There was also a significant reduction in AUDIT scores, with 61% of participants reducing at least one point. Furthermore, the proportion of drinkers classified as "low risk" increased from 18% to 33%. However, there were no significant changes in average PEth levels, although 38% of participants reduced their consumption levels. Additionally, the frequency and intensity of binge drinking episodes remained unchanged.

Focus groups identified three main themes: satisfaction with the quantitative model, the need for more information about the risks associated with alcohol consumption, and a desire for a better understanding of PEth levels and their relationship to behavior. These results highlight the acceptance of the KYN model, which was considered feasible and met recruitment and retention goals. However, objective outcomes, such as reductions in binge drinking and changes in biomarkers, were limited. Factors such as the short duration of the intervention, seasonality, and participants' difficulty in understanding biometric data may have influenced the results, according to the article.

In conclusion, the KYN approach showed promise in raising awareness about alcohol consumption among young adults. It is important to note that longer and more robust interventions are necessary to achieve a greater impact on biomarkers and reduce binge drinking. The study authors recommend conducting randomized studies lasting 6 to 8 weeks and using technologies like real-time tracking apps, in addition to integrating behavioral strategies, such as goal setting and personalized reminders. They also emphasize that translating biometric data into practical and accessible actions is essential to increase the effectiveness of this approach for the young adult population.

References:

Piano, M. R., Hwang, C.-L., Adair, M., Muhimpundu, S., Dietrich, M. S., & Phillips, S. A. (2024). A pilot study of a quantitative approach to reduce binge drinking in young adults: Know your numbers. Journal of Studies on Alcohol and Drugs, 85(6), 788–793.

New Considerations on the Treatment of Alcohol Use Disorder: Problems and Solutions

A recent study (1) suggests that alcohol use disorder (AUD) remains underdiagnosed, despite the availability of effective therapies and medications. Key points highlighted include addressing stigma, improving screening, and investing in new approaches to increase access to treatments.

Alcohol use disorders (AUDs) are a large-scale public health issue, affecting more than 29 million people in the United States and leading to over 140,000 deaths annually. The most severe form of these disorders is alcoholism. It is described by a heuristic model encompassing three interconnected stages: heavy drinking/intoxication, withdrawal/negative affect, and concern/anticipation. This model provides a framework to understand the complexity of the disorder and its various manifestations in relation to treatment.

Defined as a chronic and recurring disorder, alcoholism is characterized by compulsive consumption, loss of control, and negative emotional states in the absence of alcohol. AUDs are classified as mild, moderate, or severe. In the neurobiological realm, AUDs involve three main domains: incentive salience/pathological habits, negative emotional states, and executive function, which are linked to the activation of brain circuits such as the basal ganglia, extended amygdala, and prefrontal cortex. The article also highlights that excessive alcohol consumption deregulates the brain's reward system and alters stress systems, reinforcing the cycle of dependence.

Despite the existence of effective treatments, such as behavioral interventions and approved medications, these resources remain widely underused, highlighting the need for actions to address existing gaps, including broadening the criteria for medication approval, increasing the use of screening and brief interventions, combating stigma, defining a clear and culturally sensitive “recovery” criterion, and promoting both public and professional education.

Evidence-based treatments include a wide range of behavioral therapies, such as cognitive-behavioral therapy, motivational interviewing, acceptance/mindfulness-based approaches, and the 12-step approach, used by mutual aid groups like Alcoholics Anonymous. Combining therapies and medications enhances treatment efficacy, helping to modify alcohol-related attitudes and behaviors.

Among FDA-approved medications, disulfiram, naltrexone, and acamprosate stand out for their different methods of reducing consumption and promoting abstinence. While disulfiram causes severe adverse reactions to alcohol consumption to create unpleasant sensations during drinking, but also making adherence to treatment more difficult, naltrexone blocks the rewarding effects of alcohol; both have proven efficacy in reducing excessive consumption. Acamprosate, on the other hand, helps maintain abstinence by alleviating severe withdrawal symptoms. Additionally, repurposed “off-label” medications such as topiramate and gabapentin also show efficacy, reducing excessive consumption and aiding sleep initiation and maintenance.

Despite the proven effectiveness of treatments, fewer than 8% of adults with AUD receive any form of intervention, and less than 2% have access to approved medications. Significant barriers, such as a lack of public policies, inadequate screening, and stigma, further hinder access. Although the SBIRT model (Screening, Brief Intervention, and Referral to Treatment) is effective for early detection, it remains underused and still rarely implemented by healthcare professionals, whether in public or private systems. Additionally, the lack of appropriate facilities, delays in the approval of new medications, and insufficient investment by the pharmaceutical industry in developing addiction treatments compared to other areas represent additional challenges.

The stigma associated with AUD is particularly damaging, as individuals with this disorder often face judgment that holds them accountable for their condition, which negatively impacts their willingness to seek help. This contributes to fewer than 1 in 10 individuals with AUD receiving treatment annually, while about 20% avoid seeking help due to the fear of being stigmatized. Stigma also affects patients in need of liver transplants and can limit participation in clinical trials due to prejudice.

The article emphasizes that, to address these challenges, it is essential to develop a variety of treatments that recognize individual responses to different approaches, whether behavioral therapies or medications. The definition of recovery has been refined to include not only the remission of AUD but also the cessation of excessive alcohol consumption and biopsychosocial well-being. Early diagnoses and interventions at the initial stages of AUD can prevent its progression to more severe forms, while educational resources such as the Healthcare Professional’s Core Resource on Alcohol and platforms like Rethinking Drinking offer tools to raise awareness among healthcare professionals and the general public.

Finally, the three-stage model of AUD highlights intervention targets at each stage, with assessments covering executive function, incentive salience, and negative emotionality, allowing for more personalized treatments. Research to identify new targets for medications and overcome challenges in the pharmaceutical industry is crucial to driving the development of new treatment options. This approach proposes a more comprehensive neuroscientific understanding, aiming to offer individualized and effective treatments.

References:

1. Divya Ayyala-Somayajula, Jennifer L. Dodge, Adam M. Leventhal, et al. Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study. Ann Intern Med. [Epub 12 November 2024]. doi:10.7326/ANNALS-24-02157