Alcohol as a psychotropic agent acts as a sedative, a tranquilizer, an anti-anxiety agent, or a hypnotic as it is a central nervous system depressant. As such, it diminishes environmental awareness, reduces responsiveness to external stimulation, impairs cognitive functioning, hinders coordination, and reduces physical activity. At high doses it induces sedation, lethargy, amnesia, antiseizure activity, and anesthesia. Next to caffeine, alcohol is the second most widely used psychoactive substance in the world.

The health-related impact of alcohol consumption can vary depending of the amount and chronic use with its consumption. Heavy ingestion of alcohol over time can lead to a variety of serious physiological and neurological disorders (e.g., vitamin and mineral deficiencies, liver damage, destruction of nerve cells that can induce a dementia, pancreatitis, chronic gastritis, and certain cancers such as tongue, mouth, throat, voice box, liver, stomach, intestinal, breast). Drinking more than five drinks per day (about 10 ounces) can damage the heart muscle and result in possible heart failure and increase one’s the risk of ischemic stroke.

Alcohol use by the elderly leads to a rate of hospitalization that is similar to rate of hospitalization for heart attacks. Elderly have higher sensitivity to alcohol and metabolize in more slowly. Drinking alcohol can contribute to congestive heart failure and hip fractures. Indeed, 1 in 10 Medicare beneficiaries reports unhealthy drinking patterns that are associated with higher education, higher income, being male, younger age, smoking, and self-reported depressive symptoms.

One the other hand, long-term ingestion of low-to-moderate amounts (2-4 ounces per day) of alcohol does not appear to produce dramatic physiological, psychological, or behavioral changes. In fact, low-to-moderate doses of alcohol appear to reduce the risk of coronary artery disease and reduce the incidence of ischemic strokes probably by increasing high-density lipoprotein, decreasing low-density lipoprotein, and the aspirin-like decrease in platelet aggregation. So is alcohol protective against cognitive decline? Are low-to-moderate amounts of alcohol a health supplement?

Two recent studies address this issue. One published in the journal Neurology suggested that moderate drinking slows progression of dementia more that abstinence. The other study published in the American Journal of Epidemiology found no association between low-to-moderate consumption of alcohol and rate of cognitive decline. Fortunately, the second study provides guidance in sorting out this issue. The authors make the point that abstainers in most studies include both those who have rarely or never drank much and former drinkers (who tend to be less healthy than moderate drinkers). Their abstainers did not include former drinkers. If these findings are confirmed, there is neither harm nor benefit from low-to-moderate consumption of alcohol on the risk of cognitive decline. It’s not unhealthy to abstain.

What I take from this is that drinking 4 oz or less of alcohol per day is neither a poison nor a healthy dietary supplement. Low-to-moderate consumption of alcohol has no effect on the risk for cognitive decline whereas greater consumption increases risk for many ailments including dementia. I also wonder whether the cardiovascular benefits of abstaining from alcohol may also be the result of including former drinkers in the abstaining group.