What is Comorbidity?
A comorbidity is when 2 or more illnesses are present within a single person, which can be medical or psychiatric conditions.1 This includes substance use disorders such as alcoholism, or an alcohol use disorder.1
According to the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), alcohol increases the risk of over 200 diseases and health conditions, including:2,3
- Colon, liver, mouth, breast, throat, and esophagus cancer.
- Various cardiovascular problems.
- Gastrointestinal issues.
- Liver disease.
- Weakening of the immune system.
While two or more conditions may occur in a person, it does not necessarily mean that one caused the other, even when one comes first.1 At times, alcoholism and a comorbid condition can be caused by unknown, separate conditions.1 Other times, it may simply be a coincidence.1
Regardless of the cause, alcohol misuse and medical or psychiatric comorbidities often worsen each other’s symptoms.1 Learn more about how patients suffering from alcoholism and other chronic medical conditions are at an increased risk of worsening current disorders or cause new ones to develop.
Find more information on mental health comorbidities that are commonly seen with alcoholism here.
Chronic Pain and Alcoholism
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), up to 28% of people with chronic pain use alcohol to relieve their symptoms.4 Similarly, between 43% and 73% of people with alcohol use disorder (AUD) report having chronic pain.5 Chronic pain may be caused by numerous sources, including the natural aging process, injuries, as well as underlying diseases, such as fibromyalgia, cancer or rheumatoid arthritis.6
Extended periods of alcohol use can actually induce symptoms of pain as well as exacerbate chronic pain, making it worse over time.4 Chronic alcohol use may also contribute to the development of small-fiber peripheral neuropathy, which manifests in different ways, including weakness and pain in the feet or hands.4,7
Though alcohol use has been shown to alleviate certain types of pain in clinical studies, alcohol’s use as a means for effective pain management may be short-lived, as regular alcohol use will eventually lead to tolerance, where an individual must consume more alcohol to get the same desired effect.
This could put a person at risk of binge drinking, which is typically considered as 5 drinks for men and 4 drinks in for women in a 2-hour time period, or heavy drinking, which is considered more than 4 drinks on any day for men or more than 3 drinks for women.8 These levels of drinking may put individuals at risk for a number of other alcohol-attributable illnesses and injuries, including an alcohol use disorder.8
Alcohol consumption can also cause dangerous reactions when paired with both narcotic and over-the-counter pain relievers or sedatives, which can also reduce perceptions of pain. For example, mixing alcohol with:4,9
- Prescription opiates heightens many of the drug’s sedative, analgesic and reinforcing effects which may lead to a physical dependency on the drug and increase the risk of overdose.
- Benzodiazepines, which are sometimes prescribed for the treatment of pain, have an additive effect on depressing the body’s central nervous system, leading to decreased mental function, slow and difficult breathing, and/or a loss of coordination.
- Acetaminophen (Tylenol) can lead to acute liver failure.
- Aspirin can increase
the risk of gastric bleeding.
In addition to the dangers associated with mixing substances, withdrawal and detoxification from alcohol increases pain sensitivity, making detoxification especially difficult for people suffering from chronic pain.
Comorbid Medical Conditions Commonly Seen with Alcoholism
Alcohol’s effects extend to nu
merous organs and body systems. Alcohol may not directly cause a person’s comorbid medical disorder, but it may contribute to its development and/or worsen the symptoms and course of it.
Alcohol’s effects on the body include:
High alcohol consumption and binge drinking has also been shown to increase the risk of Type II diabetes.10 In addition, alcohol abuse has shown to worsen blood sugar control in both Type I and Type II patients, regardless
of diet.11 In patients with a healthy diet, long-term alcohol use raises levels of blood sugar, while it has the opposite effect on patients that are poorly nourished.11 Both have serious consequences such as ketoacidosis (which may cause a diabetic coma) or hypertriglyceridemia (which may cause pancreatitis or a hardening of the arteries).11
Diabetics who are heavy drinkers are also at an increased risk for medical complications such as:11
- The buildup of acid in the blood.
- Disturbances in fat metabolism.
- Nerve damage.
- Eye disease.
- Cardiovascular diseases.
Chronic heavy drinkers have an increased risk of contracting and spreading sexually communicable diseases like HIV, which may be due to impaired judgement and risky sexual behavior.12 Alcohol abuse also negatively affects the efficacy of HIV/AIDS detection and treatment in various ways, including:12,13
- Causing someone to postpone getting tested or seek treatment. Early detection and intervention with HIV/AIDS is crucial in effective treatment.
- Making it harder for patients to follow the complex and strict treatment regimen required for treating HIV/AIDS.
- Damaging the liver which can lead to an HIV infection spreading faster.
- Increases the susceptibility of a person with AIDS getting tuberculosis, hepatitis C, pneumonia, and AIDS-related brain damage and dementia.
Studies have shown that HIV/AIDS patients with alcohol use disorder that give up drinking have more successful outcomes than those who do not.13
Cardiovascular Conditions and Diseases
Excessive drinking has complex effects on the cardiovascular system and can worsen existing cardiovascular conditions.14 Conditions that may be caused or influenced by alcohol use include coronary heart disease, cardiomyopathy, stroke, hypertension, and peripheral arterial disease.15
Along with unhealthy diets, tobacco use, and a lack of physical activity, alcohol use is one of the main behavioral risk factors of heart disease and stroke.14 Other physiological effects due to excessive alcohol use include oxidative stress, changes in circulation, inflammatory response, mitochondrial dysfunction, cell death, and anatomical damage to the cardiovascular system.15
However, many cardiovascular diseases can be prevented or improved by addressing the behavioral factors that may have led to these conditions in the first place (i.e., abstaining from or limiting the amount of alcohol consumed).14,15
Liver Damage and Disease
Liver disease is one of the possible severe medical consequences of chronic alcohol use.16 The liver may become inflamed and/or scarred over time with consistent alcohol abuse.16 Conditions such as alcoholic hepatitis, fibrosis, fatty liver, cirrhosis or even liver cancer may develop. 16,17,18
However, not all heavy drinkers will develop alcoholic liver disease; but the chances go up the longer you have been drinking and the more your drink.16 For many people, fatty liver disease is the first sign of a potentially larger problem with this vital organ.18
It’s important to note the symptoms of liver disease in order to prevent further damage or seek treatment early on. Some symptoms may include:19
- Weight loss.
- Nausea and vomiting.
- Appetite loss.
- Jaundice (yellowing of the skin and eyes)
- Fluid build-up in the belly.
- Bleeding in the intestines.
- Liver cancer.
For the liver to fix some of the damage caused by alcohol, individuals must quit drinking altogether.19 A treatment program may be required or encouraged if the damage is attributable to heavy and uncontrollable drinking. Though the scarring from cirrhosis is sometimes partially reversible, when liver tissue loss is severe enough, the damage may be permanent.19
Pancreatitis and Gastrointestinal Issues
When alcohol is consumed, it passes through the gastrointestinal (GI) tract first and gets absorbed into the bloodstream.20 The gastrointestinal system is uniquely susceptible to the damaging effects of alcohol.20 Excessive alcohol use is associated with injury to all parts of the GI tract, with chronic pancreatitis being a significant cause of illness and mortality.6,20
Alcohol use can lead to a number of complications and GI diseases:20,21
- Disrupt the movement of stomach muscles and impedes gastric acid secretion.
- Inhibit the ability of the intestines to pass food along.
- Prevent the absorption of nutrients in the intestines.
- Cause gastroesophageal reflux disease by slowing esophageal movement.
- Inflame the intestines and changes the composition of microorganisms and impedes the immune system of intestinal mucosa, which lines the intestinal tract.
- Can lead to esophageal, gastric, oropharyngeal, and colon cancer.
Endocrine and Reproductive Issues
Alcohol use disorder has been associated with harmful effects on bone health, specifically decreased bone mass and an increased risk of skeletal fractures. Excessive drinking also increases the risk for developing osteoporosis later in life.6,22 Chronic heavy drinking impedes calcium absorption and diminishes production of vitamin D, further weakening bones.22 People with AUD disproportionately suffer hip and vertebral fractures when compared with the general population.22
Alcohol abuse also affects hormone production in both men and women.22 People with alcohol use disorder often have high levels of cortisol, which causes bone breakdown and slows bone development.23 In men, alcohol may inhibit testosterone production, which is vital in producing osteoblasts (the cells that stimulate bone formation).22
Alcohol consumption also may make a woman’s menstrual cycle irregular, reducing estrogen levels and putting them at a higher risk for osteoporosis.22 In pregnant women, a higher incidence of miscarriages, placental abruption, preterm deliveries, and stillbirths can occur in those with higher intakes of alcohol.6 As few as 1 to 5 drinks a week in a Danish study and about one drink a week in an American study was associated with infertility.6
Brain and Central Nervous System Conditions
Alcohol also negatively impacts brain function well beyond the temporary impairments of drunkenness. Chronic heavy drinking can lead to cognition and memory problems.23,24 The most serious effect of alcohol on the brain is Korsakoff’s syndrome, an inability to remember recent events or to learn new information.1 In the U.S., this type of alcohol-related brain damage makes up approximately 10% of adult dementias.1 However, with abstinence, milder attention and memory deficits may improve gradually.1
Many of the mechanisms by which alcohol damages the brain are still unknown; however, researchers have discovered that excessive consumption stifles the central nervous system, kills brain cells, and contracts brain tissue.25
Epilepsy is a common comorbidity with alcohol use disorder.26 In fact, when compared to the general population, patients with an alcohol dependency are estimated to be 3 times as likely to have epilepsy.26 Heavy alcohol consumption has also been shown to increase the risk of seizures in epileptic people.27
Treating Comorbid Medical Conditions and Alcohol Use Disorder
Research shows that treating individuals with substance use disorders and co-occurring physical or mental health issues have better outcomes when an integrated approach to treatment is taken.28 In other words, simultaneous treatment of alcoholism as well as a person’s chronic pain is more effective than a singular focus on one or the other.28,29
If you or a loved one is suffering with alcoholism, consider reaching out to an American Addiction Centers (AAC) admissions navigator for information about treatment. Alcohol.org is a subsidiary of AAC, a nationwide provider of addiction treatment centers.
Our facilities are well-equipped to provide treatment for people dealing with addiction alongside both physical comorbidities and co-occurring mental disorders. Call us to learn more about our approach to treatment, get more information on our facilities or speak to someone about your insurance coverage. All calls are 100% confidential and there is no obligation to make a decision right away.
. National Institute on Alcohol Abuse and Alcoholism (1991). Alcoholism and Co-occurring Disorders. Alcohol Alert. 14(302).
. World Health Organization. (2018). Alcohol.
. Centers for Disease Control and Prevention. (2021). Alcohol Use and Your Health.
. National Institute on Alcohol Abuse and Alcoholism. (2013). Using alcohol to relieve your pain: what are the risks?
. Witkiewitz, K., & Vowles, K. E. (2018). Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcoholism, clinical and experimental research, 42(3), 478–488.
. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
. Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of neurology, 266(12), 2907–2919.
. Centers for Disease Control and Prevention. (2019). Binge Drinking.
. Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A review. The mental health clinician, 6(3), 120–126.
. Calsson, S., Hammar, N., Grill, V., & Kaprio, J. (2003). Alcohol Consumption and the Incidence of Type 2 Diabetes. Diabetes Care. 26(10): 2785-2790.
. Emanuele, N. V., Emanuele, M. A., & Swade, T. F. (1998). Consequences of alcohol use in diabetics. Alcohol Health and Research World. 22(3): 211–219.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). HIV/AIDS.
. National Institute on Alcohol Abuse and Alcoholism. (2002). Alcohol and HIV/AIDS.
. World Health Organization. (2017). Cardiovascular diseases.
. Piano M. R. (2017). Alcohol’s Effects on the Cardiovascular System. Alcohol Research: Current Reviews, 38(2), 219–241.
. MedlinePlus. (2019). Alcoholic liver disease.
. Centers for Disease Control and Prevention. (2018). Liver Cancer.
. National Institute on Alcohol Abuse and Alcoholism (NIAA). (n.d.). Alcohol’s Effects on the Body.
. Johns Hopkins Medicine. (n.d.). Alcohol-induced liver disease.
. Christiane Bode, Ph.D., J. Christian Bode, M.D. (1997). Alcohol’s Role in Gastrointestinal Tract Disorders. Alcohol Health & Research World, Vol 21, 86-83.
. Bishehsari, F., Desai, V., Forsyth, C. B., Keshavarzian, A. Magno, E., & Swanson, G. (2017). Alcohol and Gut-Derived Inflammation. Alcohol research: current reviews. 38(2): 163–171.
. National Institute on Alcohol Abuse and Alcoholism. (2018). What people recovering from alcoholism need to know about osteoporosis.
. National Institute on Alcohol Abuse and Alcoholism. (2003). What Happened? Alcohol, Memory Blackouts, and the Brain.
. National Institute on Alcohol Abuse and Alcoholism. (2001). Cognitive Impairment and Recovery from Alcoholism.
. Mukherjee S. (2013). Alcoholism and its Effects on the Central Nervous System. Current Neurovascular Research. 10(3): 256-62.
. McIntosh C., Chick J. (2004). Alcohol and the Nervous System. Journal of Neurology, Neurosurgery & Psychiatry. 75(3): 16-21.
. Ghaeni, L., Hamerle, M., Holtkamp, M., Kowski, A., & Weissinger, F. (2018). Alcohol Use and Alcohol-Related Seizures in Patients with Epilepsy. Frontiers in neurology. 9(401).
. National Institute on Drug Abuse. (2020). What are the Treatments for Comorbid Substance Use Disorder And Mental Health Conditions?
. National Institute on Drug Abuse. (2018). Principles of effective treatment.