Today, the amount of binge drinking that goes on in middle age is, Angus suggests, pretty comparable to rates among our younger colleagues. Because for your big night out to qualify as a “binge”, you need only sink six units if you’re a woman (that’s two large glasses of wine or a couple of strong cocktails), or eight units if you’re a man (about three pints of cider, four of normal strength beer or five bottled beers).
The other thing to be aware of is that one size does not fit all. “I really think the definition of binge drinking should be different for older adults,” says Tony Rao, visiting researcher at King’s College London. “We currently have the same definition of binge drinking for a 20-year-old as we do for a 70-year-old, and that’s not good for public education or health.”
Susan Laurie, who delivers workplace webinars on mindful drinking, agrees. “Once I hit 40, the impact of alcohol really cranked up a gear or three,” she says. “The older you get, the less forgiving your body and mental health are. My ‘hangxiety’ – those anxious feelings the morning after – would be sky-high.”
The danger of midlife bingeing
“The fancy name for the problem here is ‘zero-order kinetics’,” says Rao. “Basically, no matter how much you drink, your liver will always process it at the same rate.”
That rate is roughly one unit an hour. “If you have binged on eight units of alcohol, it’s only going to be fully metabolized after eight hours. After an hour, you’ll still have seven units of alcohol in your bloodstream.”
The extent to which this is risky, he suggests, varies from person to person, increasing for women, those with a brain injury, heart or liver disease – and older people. The liver shrinks and its function deteriorates with age. “The older you get, the smaller your liver, especially among women, so the rate at which you metabolize alcohol is probably even slower. Toxins therefore stay in our blood for longer, doing more damage to our health.
“Your brain also becomes much more sensitive to alcohol, so you’ll be sedated much more quickly. Plus, you have less water in your blood, so the alcohol is more concentrated.”
What happens that night
You’ve dusted off your glad rags, dashed to the office party, and propped yourself up at the bar. Things are looking up. “When we drink alcohol, one of the first regions of the brain affected is the prefrontal cortex, which is responsible for our higher thought processes, such as decision-making,” says Sally Adams, associate professor at the University of Birmingham’s school of psychology , who specializes in the areas of alcohol use and hangovers.
In some ways, this is great: less-inhibited-me is so much more fun… except bingeing clearly leaves you at greater risk of accidents caused by impaired judgment and co-ordination (the so-called “acute risks” of drinking ) than imbibing the same quantity of alcohol across a week. The most probable type of risk changes as you get older, too. You may have matured out of Foster’s fueled bar fights, but as Angus points out: “Older people are more likely to binge drink at home and are more susceptible to acute risks, like falling down the stairs while doing so.”
Other potential, well… downers, including the possibility, for men, that heavy drinking will make it difficult to get, and keep, an erection. Have you ever heard of “holiday heart syndrome”? While a heart attack is caused by a lack of blood supply to the heart, HHS occurs when binge drinking disrupts the firing of the electrical impulses that usually regulate our heart function.
This results in irregular beating, leading to a sudden lack of blood supply to major organs such as the brain and kidneys. “Not only does repeated binge drinking – once a week or more – increase the risk of permanently high blood pressure,” says Rao, “but a single episode of binge drinking also raises blood pressure. Both raise the risk of stroke, particularly in older people.”
The morning after
Oh, dear lord… the dry mouth, the pounding head, the seasick stomach. But most of all, the incessant self-questioning: what did I do? What did I say? Welcome to the world of midlife hangxiety.
“The changes we see in neurotransmitters in the brain do not go back to normal after drinking,” explains Adams. “We see a rebound effect, where our brain is trying to bring neurotransmitter activity back to our usual levels, but it overcompensates.” After the high must come the low.
She suggests that we may feel that we experience worse anxiety as we age as we are “out of practice” when it comes to binge or heavy drinking. Rao, though, points to biological reasons for your hellish hangover. Recovering from the acute effects of alcohol on the body takes longer in middle age, he suggests, because of those alterations to our brains, livers and more as we age.
And in the years to come…
What effect will leaning in to the party season now have in a few decades? “Drinking too much heightens your risk of any number of diseases,” says Angus. “But when it comes to cancer, for example, there’s no evidence to suggest that the pattern in which you drink affects your risk. It’s the overall units consumed that counts, regardless of whether you drank them across the week or downed them all on Friday night.”
Phew…although there is one exception. “That’s cardiovascular disease,” he says. “We’re still not entirely sure whether drinking, in small measures, has a protective effect against it – that remains contentious – but what we do know is that binge drinking at least once a month definitely removes that protective effect. In other words, your risk of cardiovascular disease increases purely because of the pattern in which you consume alcohol (in a binge, as opposed to steadily throughout the week).”
The other risk of drinking heavily regularly is that it increases your chances of long-term depression and anxiety, says Rao. Binge drinking, specifically in midlife, has also been associated with an increased risk of dementia.
Finally: “Binge drinking raises the risk of acute liver damage,” he adds, “which can lead to acute liver failure. Repeated binge drinking also raises the risk of long-term liver damage. This means that, for example, drinking 14 units of alcohol across two consecutive days is more dangerous than spreading the same number of units across a week.”
The good news
The process of liver damage starts with acute inflammation, then fatty change (the sugar in the alcohol gets turned into fat and is deposited in the liver), then cirrhosis, which is irreversible. However, Rao points out that if you’re at the stage where you have fatty changes in your liver, this can be reversed, and the liver heals itself if you change your drinking habits. Even those suffering from alcohol-related dementia can see some improvements to memory and other brain functions should they start to abstain.
A good night out
So, there is hope – for you and for the party season. You needn’t live monastically to stay healthy this month. In fact, among the best medicines might be… the humble kebab. “Fat slows down digestion,” says Rao. “We know that some alcohol is absorbed in the stomach, but a lot is absorbed after it passes through the stomach. So if you have fatty food, it will slow down the rate at which alcohol is absorbed. But only to a degree. You can’t eat a kebab, have your eight units, and think everything’s going to be OK.”
Salvation might also come from another unexpected place. “Make a plan before you go out,” suggests Piper, of Alcohol Change UK. “For example, you might decide you want to stick to three pints. Space them out with water.” If you feel self-conscious or “sober-shamed” by friends, blame the cost of living crisis. Use the same tactic for getting out of rounds, which tends to push your consumption up, or take cash instead of a card to limit your spending.
One helpful tactic is to start the evening with two alcohol-free beverages, suggests Dru Jaeger, co-founder of mindful-drinking community Club Soda and author of How to Be a Mindful Drinker. “Having alcohol-free drinks first can help you settle in and make clear decisions about how you want to drink.”
Jaeger says another good approach is to lower the strength of your drink. “Choose a wine with 8 per cent ABV (alcohol by volume) instead of 16 per cent to halve your alcohol consumption. Or choose alcohol-free options, like sparkling