What Should Therapists Know about the Risks of Alcohol?

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What Should Therapists Know about the Risks of Alcohol?       

Jim Windell

 

            Earlier this month the U.S. Surgeon General Dr. Vivek Murthy released a new advisory on alcohol and cancer risks. This report outlines the direct link between alcohol consumption and increased cancer risk. Alcohol consumption is the third leading preventable cause of cancer in the U.S., after tobacco and obesity. The use of alcohol increases the risk for at least seven types of cancer. While scientific evidence for this connection has been growing over the past four decades, less than half of Americans recognize it as a risk factor for cancer.

           Murthy’s advisory includes a series of recommendations to increase awareness to help minimize alcohol-related cancer cases and deaths, including updating the existing Surgeon General’s health warning label on alcohol-containing beverages.

           Recently Neha Pathak, M.D., talked with George Koob, Ph.D., a prominent neuroscientist known for his research on the neurobiology of stress, addiction, and the underlying mechanisms of emotional disorders. He is also the Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and has made significant contributions to understanding how stress and alcohol affect the brain. In the conversation, Pathak and Koob discussed alcohol consumption and its impact on health.

            To begin the conversation, Pathak asked Koob about the latest recommendations for safe alcohol consumption.

            “We adhere to and support the dietary guidelines of a maximum of two drinks daily for males (14 drinks per week) and one drink daily for females (7 drinks per week),” Koob said. “But you have to use common sense; you're not supposed to consume all 14 drinks on a Friday night.”

            Pathak followed this up by inquiring about emerging evidence about the harms of alcohol. Koob replied that some people probably shouldn't drink at all. “This includes those who are pregnant or thinking about becoming pregnant, and those who already have an underlying condition that is exacerbated by alcohol — ranging from acute respiratory distress syndrome to pancreatitis to liver disease,” Koob said. “Some individuals metabolize alcohol differently. They don't feel well when they drink alcohol. That’s one piece. The other piece is the fact that harm risk increases with the number of drinks consumed. An average of only one drink a day increases the probability of breast cancer in females by a small percentage.”

            “Many of my primary care patients believe that red wine is part of a healthy diet, and it prevents disease. How should we counsel our patients about that?” Pathak asked.

           “It's a myth that red wine per se confers health benefits; any benefits realized are more likely related to dietary or socioeconomic factors,” Koob said. “Higher-income groups tend to drink more red wine compared with lower-income groups. No evidence exists to show that the antioxidants in red wine convey any major beneficial effect.

           “Wine is alcohol, contrary to popular belief in some quarters. And the more you drink, the higher the risk for problems associated with alcohol. Some of the original studies that claimed beneficial effects of red wine used abstainers as the control group. Unfortunately, those individuals are often already ill and that's why they abstain from alcohol. When you use people with low alcohol intake rather than abstainers as the control group, these differences fall apart.

           “We see a dose-dependent increase even in cardiovascular problems such as arrhythmias and hypertension. I spoke with a Mayo Clinic cardiologist when I was giving a talk there not too long ago. He considers screening for alcohol misuse a key part of his treatment of hypertension now.” 

           Pathak went on to ask Koob if he had any sort of insights or information beyond what he had already said about personalizing alcohol counseling based on the risk for the patient.

           “We now know that 200 different diseases and conditions are exacerbated by alcohol,” Koob replied. “I've already listed some of them, but what many Americans probably don't know is that 4%-6% of cancer is now attributed to alcohol. Alcohol is the third most preventable cause of cancer in the United States; the leading cause is tobacco, and the second is being overweight.

           “People need to realize that alcohol affects every part of your body, more or less – acute respiratory distress syndrome; pancreatitis; gastrointestinal bleeds; the cardiovascular effects I mentioned such as arrhythmias and hypertension, not to mention falling off ladders. One third of accidents associated with water sports involve alcohol.”

           Koob added that two years ago the NIAAA brought out The Healthcare Professional’s Resource on Alcohol. This publication, he said, includes 14 units that should be useful to primary care doctors or anyone in the health professions. “You can get CME credits for them,” Koob said. “There is a section on screening, brief intervention, and referral to treatment, which should be a key part of patient intake for any physician, because alcohol misuse is a window on many medical conditions.”

           To read the original resources for this blog, find them with these references:

U.S. Department of Health & Human Services. (2025). U.S. Surgeon General Issues New Advisory on Link Between Alcohol and Cancer Risk. Retrieved from: www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html

Pathak, N. (2025). Making Sense of Mixed Messages on Drinking. Medscape.

 

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