Young women are particularly vulnerable to the physical health consequences of binge drinking, writes Dr Gerard A Clarke.
Everyone is familiar with alcohol abuse's psycho-social effects in young people. Much is written about accidents, pregnancies, sexually transmitted infections and violent deaths.
But the physical health consequences receive much less media attention. Because of this, these grave potential costs hardly impinge on the consciousness of young people who drink.
No one can know prospectively whether they are susceptible or resistant to damage, and complications of youthful alcoholism are stealthy and insidious, which means adverse consequences may not manifest until middle age or later.
Then it is too late to turn back the clock. Young women, now expressly targeted by the drinks industry, are intrinsically more vulnerable than men and it is gravely disquieting that alcohol consumption is rising in this group.
Most people tend to associate alcohol excess with cirrhosis of the liver. Indeed, so synonymous have both become in popular perception that patients with non-alcoholic cirrhosis often react with anger to their diagnosis and require reassurance that they are not suspected of alcoholism.
But about one in three of all cases of cirrhosis in the West are attributable to alcohol and approximately one-third of those drinking to excess will develop cirrhosis over many years. Subsequently, they will develop its associated complications, including liver cancer, eventually leading to death or the necessity of liver transplantation.
Cirrhosis is only one of several alcohol-related diseases that affect the liver. The most dramatic condition is an acute hepatitis. This usually follows a protracted binge and occurs only in people with an inborn susceptibility.
The symptoms can show themselves just days after the binge has ended and include jaundice, problems with blood clotting, accumulation of fluid within the abdomen and confusion or coma.
While a full recovery is possible with specialised medical care, fatalities may occur. This binge behaviour, now so prevalent among the young, is essentially a dice with death.
Patients with other relatively common liver diseases such as chronic hepatitis C and genetic iron overload (haemochromatosis) who misuse alcohol will generally experience more severe disease than those who do not drink or who consume very little alcohol. Tragically, these conditions generally go undiagnosed in the young.
Alcohol can kill by injuring the pancreas gland. It can be associated with both acute episodes of pancreatic inflammation and chronic scarring and destruction of the organ. Acute pancreatitis, a binging disease, is a dramatic and catastrophic illness characterised by very severe abdominal pain and vomiting.
The severity depends on the amount of pancreatic tissue that dies during the episode and whether the dead tissue becomes infected. Without specialised medical care, it can lead to multi-organ failure and death.
Chronic pancreatitis, associated with longer-term abuse, is associated with very severe, long-term pain which may be difficult to control despite advanced medical interventions. Impairment of digestive functions also occurs. Complications such as internal bleeding may lead to sudden death in this condition.
And if liver and pancreatic problems do not follow alcohol abuse, heart damage may lie in wait. This may occur with both alcohol binges and more prolonged drinking.
Symptoms range from the development of a fast, irregular heartbeat called atrial fibrillation, to a situation of overt cardiac failure called cardiomyopathy, although not every irregular heartbeat is alcohol-related and non-alcoholic diseases may bring about identical heart conditions.
Some people may despair and think, why bother giving up alcohol if the damage is already done? But abstinence will always help and expert medical care can improve quality of life, complications and survival.
Paradoxically, everyone is familiar with the benefit that modest drinking brings to the levels of the "good" cholesterol fraction, HDL. Unfortunately, this positive effect is of no benefit to the under 40s because of the very low incidence of coronary disease in this age group. However, excessive alcohol has deleterious effects on the triglyceride fats that circulate within the bloodstream and also leads to high blood pressure causing strokes - even in younger patients.
Excess drinking causes cancer of the mouth, throat, larynx and oesophagus and there is a strong synergy with tobacco. The drink in one hand and the cigarette in the other is a combination tailor-made for this type of cancer.
How many of the sassy, sophisticated, young women drinkers portrayed in alcohol commercials are aware that even moderate alcohol consumption is a significant risk factor for breast cancer?
How many young sportsmen know that the "après-match scoop", if taken to excess, can indirectly lead to primary liver cancer?
The problem is also compounded by the fact that young people themselves, their friends, relatives and indeed healthcare providers have difficulty in recognising problem drinking.
It is time to look not just at the sociological aspects of problem drinking but at the serious health risks involved and to ask if "self-regulation" by the industry has proved satisfactory in containing this burgeoning crisis.
Better education of physicians as well as the populace as a whole is clearly necessary. Cynical strategies which target the young, such as "happy hours", should be prohibited and a ban placed on all alcohol advertising and sports sponsorship as a matter of urgency. Consideration should be given to raising the rate of excise duty on alcoholic beverages, particularly beverages favoured by young people such as the so-called "alco-pops".
Finally, if any reader is concerned that they have a problem with alcohol or is worried that they may have developed one or more of the complications listed above, they should contact their family or student doctor, who is in the best position to assess and advise them.
Gerard A Clarke MD, FRCPI, is consultant gastroenterologist in Portiuncula Hospital and was previously consultant gastroenterologist and hepatologist/senior lecturer in medicine at the University Hospitals of Leicester.