Effects of Reducing or Ceasing Alcohol Consumption on Cancer Risk

In 2020, it was estimated that 741,300 new cancer cases worldwide were caused by alcohol consumption. This represents 4.1% of all new cancer cases, with 6.1% among men and 2.0% among women (1). 

An independent group of international experts convened by the International Agency for Research on Cancer (IARC) reviewed the existing literature to assess the effectiveness of reducing or stopping alcohol consumption in decreasing the risk of alcohol-related cancers, such as cancers of the oral cavity, pharynx, larynx, esophagus, colorectal area, liver, and female breast. Additionally, the group identified and evaluated the mechanisms of alcohol-induced carcinogenesis that may be reversed with cessation of consumption (2).

The IARC classifies alcoholic beverages, ethanol in these beverages, and acetaldehyde associated with alcohol consumption as carcinogens for humans. In addition to ethanol and acetaldehyde, alcoholic beverages may contain various toxins derived from raw materials used or that may arise during the production process.

There are several mechanisms linking alcohol to cancer, one of the most well-understood scientifically being genotoxicity, where acetaldehyde causes damage to our DNA, such as breaks and structural changes. These alterations can lead to errors in DNA replication, resulting in mutations. Over time, these mutations can accumulate and lead to cancer development, especially in parts of the body that come into direct contact with alcohol, such as the mouth, throat, and esophagus (2).

An important measure used is the Population Attributable Fraction (PAF), which helps understand how many cancer cases can be attributed to alcohol consumption in a population. To calculate PAF, researchers use data on: how much people drink; the cancer risk associated with alcohol; how many cancer cases exist. However, there are limitations, such as incomplete data, underreporting of alcohol consumption, other factors affecting the data (like smoking), and population differences. Despite these limitations, PAF is useful for understanding and preventing alcohol-related cancers.

CISA, in its annual report “Alcohol and Brazilian Health,” uses these fractions to calculate the burden of alcoholic beverages on the Brazilian population. To learn more, download the report for free on our website.

According to the study conducted by the IARC, reducing or ceasing alcohol consumption is associated with a lower risk of oral and esophageal cancers, with sufficient evidence to support this conclusion. There is limited evidence suggesting a reduction in the risk of laryngeal, colorectal, and breast cancers with the cessation of alcohol consumption. However, there is inadequate evidence to indicate that reducing or ceasing alcohol consumption lowers the risk of pharyngeal and liver cancers. Overall, researchers conclude that stopping alcohol consumption may be beneficial for reducing the risks of certain types of cancer, but the strength of the evidence varies among different cancer types.

References:

1. Rumgay, H., Shield, K., Charvat, H., Ferrari, P., Sornpaisarn, B., Obot, I., Islami, F., Lemmens, V. E. P. P., Rehm, J., & Soerjomataram, I. (2021). Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. The Lancet. Oncology, 22(8), 1071–1080. https://doi.org/10.1016/S1470-2045(21)00279-5
2. International Agency For Research On Cancer. IARC Handbooks of Cancer Prevention: volume 20A - Reduction or cessation of alcoholic beverage consumption. Lyon: IARC, 2024

Brief Intervention to Reduce Risky Alcohol Consumption Has Proven Effective in the Elderly

A study conducted by researchers from the University of São Paulo (USP) in Ribeirão Preto observed a reduction in risky alcohol consumption among the elderly through a brief intervention protocol.

Harmful alcohol use among the elderly population leads to serious health complications and can even result in death. It is known that alcohol is the 7th largest risk factor for the total disease burden among individuals aged 50 to 69 years and the 10th for those over 70 years old (1). 

According to the WHO (World Health Organization), brief intervention (BI) is one of the most cost-effective measures for treating harmful alcohol use (2). This therapeutic approach, widely used in the treatment of alcoholism, can also be applied to other mental health disorders. It consists of a set of practices aimed at identifying a real or potential problem related to alcohol use and motivating the person to take action about it.

Recently, researchers from the University of São Paulo (USP) in Ribeirão Preto assessed the effectiveness of brief intervention in reducing risky alcohol consumption among elderly individuals attended to in Primary Health Care (3). The study, conducted in the city of Ribeirão Preto, in Brazil, involved individuals aged 60 or older who reported alcohol use and scored between ≥ 5 and ≤ 19 on the AUDIT (Alcohol Use Disorders Identification Test) scale. Most participants were male, married, with a family income between 1 and 3 minimum wages, and some were retired, with 1 to 4 years of schooling. 

According to the author of the research, the characteristics of BI for the elderly may include providing information about health behaviors and the risks associated with their level of consumption; interpreting screening results and discussing reasons for drinking and its potential consequences; understanding their support networks; and negotiating a plan for reducing alcohol consumption.

Sociodemographic results of the research showed that 46.5% (n=234) of participants had low-risk alcohol consumption; 44.5% (n=224) had risky drinking patterns, and 9.1% (n=46) were potential dependents. For individuals who displayed risky drinking patterns, the study evaluated the brief intervention protocol, analyzing alcohol consumption patterns, the amount of drinks, frequency, and binge drinking behavior in these individuals before and after they were subjected to the intervention or the delivery of informational pamphlets (control group).

As the main outcome, the study showed a significant reduction in alcohol consumption patterns in the group that underwent the brief intervention over time (between 3 to 6 months). Additionally, a decrease in habitual consumption and binge drinking behavior was observed. Therefore, the study concludes with the recommendation of the brief intervention protocol for elderly individuals with risky alcohol consumption who are assisted by Primary Health Care.

Alcohol is one of the leading risk factors for the global disease burden in people aged 50 and older, and the consequences of harmful alcohol use during this stage include cognitive and intellectual functioning deficits, as well as the recurrence of other age-related health issues. For this reason, care by healthcare professionals tailored to this population is essential to understand this behavior and its consequences, so that proper guidance and treatment can be developed for the best care of the elderly's health.

To discuss more about this research and the impact of the brief intervention protocol for elderly individuals with risky alcohol consumption, CISA spoke with Deivson Wendell da Costa Lima, the principal investigator of the study. Here’s what he had to say:

1. What are the main advantages of brief intervention (BI) for elderly individuals with risky alcohol consumption? Was any specificity identified both regarding the risky use and the application of the protocol for this age group?

The implementation of BI for the elderly was strategic within the context of Primary Health Care (PHC) as it emphasized a preventive action in the community, addressed different health problems and interactions with medications that could be related to alcohol use, evaluated the elderly’s motivation to change their alcohol consumption, and helped understand the need to reduce consumption from risky levels to low risk or no consumption. It also involved working with Community Health Agents (ACS), who contributed to the development of the protocol.

The brief intervention took place through a scheduled home visit by a single researcher with a nursing background, conducted individually, face-to-face, in a location chosen by the elderly person within their home.

The home visit proved to be an appropriate tool for addressing alcohol consumption and preventing alcohol-related risks in the elderly’s home environment, as it made early intervention easier and provided insight into their health conditions and family and social dynamics.

Our brief intervention was carried out by a researcher with a nursing degree, specialized in mental health, and trained in alcohol and drug research. This researcher was the sole person who led the brief intervention protocol, following the guidelines for each phase. Studies show that elderly individuals assisted by nurses in PHC settings, who receive brief interventions, are less likely to engage in risky drinking than those who do not receive this approach.

Shorter questions regarding health conditions and then about alcohol consumption were part of the initial interview approach and served as an alternative for the elderly to feel more comfortable discussing their relationship with alcohol consumption.

The session lasted an average of 30 minutes, which seems to be more acceptable for the target population. Researchers have shown that shorter counseling sessions tend to have a greater additional effect on brief interventions for reducing alcohol consumption.

Our brief intervention protocol involved motivational interviewing techniques based on Cognitive Behavioral Theory, which facilitated discussions about risky drinking. Researchers agree that this engagement can help reduce complications arising from alcohol’s interaction with medications, mitigate health problems exacerbated by alcohol consumption, and improve quality of life.

The mere fact that the elderly person agreed to participate in the brief intervention may have been the start of a positive behavior change process regarding alcohol consumption. Elderly individuals seem more willing to engage in research than the general population and are more likely to participate in follow-up protocols compared to younger populations.

Each phase of our brief intervention protocol provided age-appropriate care with specific guidance, questions, and complexities unique to people aged 60 and older. It’s worth noting that there was not just one key element of the protocol, but several interconnected factors. More research is needed to understand the most effective components of brief alcohol interventions for the elderly.

2. What were the main challenges encountered in applying the screening protocol and BI in the units studied?

Alcohol consumption is often a behavior that health professionals rarely question, and as a result, drinking patterns are not assessed. The risks associated with alcohol consumption are often discovered only when elderly individuals seek consultations for other health issues.

Elderly individuals are less likely to access or seek help, either from PHC or specialized care, for alcohol-related problems. They often have difficulty recognizing the health risks of alcohol consumption, and may attribute symptoms related to this psychoactive substance to other comorbidities or aging-related complaints, rather than to alcohol itself.

Healthcare professionals lack training in screening tools and in strategies for appropriate interventions for elderly individuals, whether in-person or online. They also need more time to address the alcohol-related needs of the elderly.

Other challenges in this study include an emphasis on self-reported data regarding alcohol consumption history. There is a likelihood of underreporting when elderly individuals are asked to recall their drinking habits. Responses may only reflect socially acceptable behaviors, without revealing the full extent of their issues. In general, emotional state and memory problems can also impact elderly individuals' ability to provide accurate reports.

3. In your opinion, would it be important to expand this screening protocol and brief intervention to other locations and age groups? What challenges would need to be overcome for this to advance in our country?

The steps prior to the brief intervention—pre-screening and screening—were necessary to raise awareness among ACS workers and nurses about participating in our research. The pre-screening was done using a single question about alcohol consumption, already included in the elderly person’s individual record used by ACS workers in Family Health Units. This screening was brief and easy to administer. The responses from the elderly contributed to updating their records and identifying those classified as having risky drinking patterns.

The pre-screening strategy allowed data collection from the entire eligible population. A positive aspect of this strategy was that it avoided sample selection bias, such as only recruiting elderly individuals who consumed large quantities of alcohol more frequently.

Another option for the pre-screening process could be the use of the AUDIT-C in future research and clinical practice. In the context of Primary Health Care, the initial alcohol consumption assessment through AUDIT-C could be incorporated into the individual registration forms used by ACS workers, as well as during routine consultations with nurses and other health professionals. After evaluating the responses, elderly individuals who score ≥ 4 on the AUDIT-C could then receive the full AUDIT to determine their level of risk and any signs of possible dependence.

References:

1. Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Oct;396(10258):1223–49.
2. WHO. SAFER - Brief interventions and treatment [Internet]. www.who.int. Available from: https://www.who.int/initiatives/SAFER/brief-interventions-and-treatment
3. Lima DW da C. Efetividade da intervenção breve para redução do consumo de risco de álcool em idosos na atenção primária à saúde [Internet]. www.teses.usp.br. 2023 [cited 2023 Nov 23]. Available from: https://www.teses.usp.br/teses/disponiveis/22/22131/tde-09082023-164723/en.php

Use of Stimulants in the Treatment of ADHD and the Risks of Alcohol Consumption

Stimulants include both prescribed medications and illicit drugs. They act on the central nervous system (CNS), increasing its activity by interacting with neurotransmitters such as dopamine and norepinephrine. These effects promote greater alertness, energy, and focus (1).

Prescribed stimulants, such as dextroamphetamine, methylphenidate, and lisdexamfetamine, may be indicated for the treatment of ADHD (attention-deficit/hyperactivity disorder) and narcolepsy. Although effective, they can cause various adverse effects. Among the most common are sleep problems, reduced appetite, weight loss, increased heart rate and blood pressure, irritability, mood swings, and, in more severe cases, aggression or muscle tremors (1).

Many individuals mix these substances with alcohol in an attempt to enhance euphoria or reduce the unwanted side effects of alcohol (2). However, the interaction between stimulants and alcohol can mask alcohol intoxication, leading to excessive alcohol consumption. Additionally, it amplifies cardiovascular effects, such as elevated blood pressure, increased heart rate, and a higher risk of arrhythmias and heart attacks (3).

For individuals with ADHD, studies suggest that proper treatment with prescribed stimulants can reduce the risk of alcohol and substance abuse disorders (4). This protective effect occurs because individuals with ADHD often exhibit greater impulsivity and a dysregulated reward system, characteristics that increase the likelihood of seeking immediate relief through risky behaviors, such as alcohol and drug use (5).

Although the risks associated with mixing alcohol and stimulants for ADHD treatment are already known, there is still a need for further studies to fully understand the interaction mechanisms between these substances and their long-term consequences. Future research may help clarify these effects and contribute to more effective strategies for the prevention and management of patients using these medications.

References:

1. Farzam K, Faizy RM, Saadabadi A. Stimulants. [Updated 2023 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539896/
2. Barrett, S. P., & Pihl, R. O. (2002). Oral methylphenidate-alcohol co-abuse. Journal of clinical psychopharmacology, 22(6), 633–634. https://doi.org/10.1097/00004714-200212000-00020
3. Barkla, X. M., McArdle, P. A., & Newbury-Birch, D. (2015). Are there any potentially dangerous pharmacological effects of combining ADHD medication with alcohol and drugs of abuse? A systematic review of the literature. BMC psychiatry, 15, 270. https://doi.org/10.1186/s12888-015-0657-9
4. Hammerness, P., Petty, C., Faraone, S. V., & Biederman, J. (2017). Do Stimulants Reduce the Risk for Alcohol and Substance Use in Youth With ADHD? A Secondary Analysis of a Prospective, 24-Month Open-Label Study of Osmotic-Release Methylphenidate. Journal of attention disorders, 21(1), 71–77. 
5. Luderer, M., Ramos Quiroga, J. A., Faraone, S. V., Zhang James, Y., & Reif, A. (2021). Alcohol use disorders and ADHD. Neuroscience and biobehavioral reviews, 128, 648–660. https://doi.org/10.1016/j.neubiorev.2021.07.010