Regularly having more than two drinks a day increases the risk of developing alcoholism, alcoholic liver disease, and some forms of cancer. Having between one to two alcoholic drinks a day has been shown to have positive effects on health, unless contradicated, chiefly because of its cardiovascular effects. A few researchers have questioned the extent of positive effects as most studies compare moderate drinkers' health to non-drinkers, but fail to take into account the number of people who abstain because they are already ill, rather than lack of alcohol causing their ill-health.
The relationship between alcohol
consumption and health
has been the subject of formal scientific research
since at least 1926, when Dr. Raymond Pearl
published his book, Alcohol and Longevity
. Since that time data have come in from all over the world. Studies have focused on both men and women, various age groups, and people of many ethnic groups. Published papers now total in the many hundreds, but many studies are not simply correlated, or time sequenced in nature. Some of the ways alcohol affects cardiovascular health are now understood.
Research in various countries has found the all-cause mortality rates range from 16 to 28% lower among moderate drinkers than among abstainers.
The U.S. National Institute on Alcohol Abuse and Alcoholism
(NIAAA) has completed an extensive review of current scientific knowledge about the health effects of moderate alcohol consumption. It found that the lowest death rate from all causes occurs at the level of one to two drinks per day. That is, moderate drinkers have the greatest longevity.
A 23-year prospective study of 12,000 male British physicians aged 48–78, found that overall mortality was significantly lower in the group consuming an average of 2–3 "units" (British unit = 8 g) per day than in the non-alcohol-drinking group (relative risk 0.81, confidence interval 0.76–0.87, P = 0.001). The authors noted that the causes of death that are already known to be augmentable by alcohol accounted for only 5% of the deaths (1% liver disease, 2% cancer of the mouth, pharynx, larynx, or oesophagus, and 2% external causes of death) and were significantly elevated only among men consuming >2 units/day.
In a 1996 American Heart Association scientific statement, Thomas A. Pearson, MD, PhD noted:
A large number of observational studies have consistently demonstrated a U-shaped relation between alcohol consumption and total mortality. This relation appears to hold in men and women who are middle aged or older. The lowest mortality occurs in those who consume one or two drinks per day. In teetotalers or occasional drinkers, the rates are higher than in those consuming one or two drinks per day. In persons who consume three or more drinks per day, total mortality climbs rapidly with increasing numbers of drinks per day.
effects of consistent, moderate alcohol intake are perhaps the most studied and the most widely-accepted. The World Health Organization
Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted. Consumption of red wine
may be particularly favourable, since red wines contain certain polyphenol antioxidants
associated with cardiovascular
health. One study determined that the potential long-term benefits of moderate alcohol consumption on cardiovascular health surpassed all other factors except the cessation of smoking.
Alcohol appears to be hormetic. Medical research demonstrates that, consumed in moderation, alcohol increases HDL (“good cholesterol”), decreases thrombosis (blood clotting), reduces fibrinogen (a blood clotter), increases fibrinolysis (clot dissolving), reduces artery spasm from stress, increases coronary blood flow and increases insulin sensitivity -- all good for heart health. Additionally, Thrombosis is lower among moderate drinkers than teetotalers.
Moderate drinkers are less likely to suffer heart attacks
than total abstainers or heavy drinkers. The first scientific study of the relationship between alcohol consumption and atherosclerosis
was published in the Journal of the American Medical Association in 1904. A review of major heart disease studies has found that:
"Alcohol consumption is related to total mortality in a U-shaped manner, where moderate consumers have a reduced total mortality compared with total non-consumers and heavy consumers"
The risk of a heart attack among moderate drinkers with diabetes is 52 percent lower than among nondrinkers and that the risk of dying in the four years after a heart attack is 32 percent lower among those who were moderate drinkers in the year before the attack.
Coronary Heart Disease
Pearson reviewed the evidence supporting the effect of alcohol consumption on coronary heart disease
(CHD): "More than a dozen prospective studies have demonstrated a consistent, strong, dose-response relation between increasing alcohol consumption and decreasing incidence of CHD. The data are similar in men and women in a number of different geographic and ethnic groups. Consumption of one or two drinks per day is associated with a reduction in risk of approximately 30% to 50%. Studies of coronary narrowings defined by cardiac catheterization or autopsy show a reduction in atherosclerosis in persons who consume moderate amounts of alcohol. In general, the inverse association is independent of potential confounders, such as diet and cigarette smoking. Concerns that the association could be an artifact due to cessation of alcohol consumption in persons who already have CHD have largely been disproved.
Another study found that when men increased their alcohol intake from very low to moderate, they significantly reduced their risk of coronary heart disease. The study monitored the health of 18,455 males for a period of seven years.
Coronary Vascular Disease
Moderate drinking has been found to reduce the risk of angina pectoris
. In heart attack patients, treated with alcohol, the tissues affected by low blood flow are healthier and stronger, than those who receive no alcohol, because of alcohol's positive effects on artery walls. Drinking alcoholic beverages in moderation may help patients recover from coronary stenting, as healing appears to be promoted by its anti-inflammitory effects.
Peripheral Arterial Disease
"Moderate alcohol consumption appears to decrease the risk of PAD in apparently healthy men.". "In this large population-based study, moderate alcohol consumption was inversely associated with peripheral arterial disease in women but not in men. Residual confounding by smoking may have influenced the results. Among nonsmokers an inverse association was found between alcohol consumption and peripheral arterial disease in both men and women.
A study concluded, "Our data are consistent with a protective effect of moderate alcohol consumption on IC risk, with lowest risk observed in men consuming 13 to 24 g/d (1 to 2 drinks/d) and in women consuming 7 to 12 g/d (0.5 to 1 drink/d).
Heart attack and stroke
Drinking in moderation has been found to help those who have suffered a heart attack
survive it. To determine if moderate drinkers have fewer heart attacks because they might lead more healthful lifestyles than do abstainers or heavy drinkers, Harvard scientists recently reported their study of only healthy men who led healthful lifestyles. For up to 16 years the doctors monitored the health of 8,867 men who did not smoke, were of normal weight, exercised at least 30-60 minutes per day, and ate a balanced healthful diet. Among these healthy men with healthy lifestyles, those who consumed anywhere from 1/2 to two alcoholic drinks of beer, wine or liquor per day had significantly decreased risk of heart attacks. Those who averaged slightly more (one to two drinks per day) had the lowest risk.
Compared to abstaining, drinking in moderation is associated with a reduced risk of stroke, whereas abusing alcohol is associated with an increased risk of stroke. A study of over 22,000 male physicians aged 40-84 years old over an average of 12 years, concluded, "Light-to-moderate alcohol consumption reduces the overall risk of stroke and the risk of ischemic stroke in men. The benefit is apparent with as little as one drink per week. Greater consumption, up to one drink per day, does not increase the observed benefit.
Large-quantity consumption of alcohol can lead to alcoholic cardiomyopathy
, commonly known as "holiday heart syndrome." Alcoholic cardiomyopathy presents in a manner clinically identical to idiopathic dilated cardiomyopathy
, involving hypertrophy of the musculature of the heart that can lead to a form of cardiac arrythmia
. These electrical anomales, represented on an EKG
, often vary in nature, but range from nominal changes of the PR, QRS, or QT intervals to paroxsysmal episodes of ventricular tachycardia
. The pathophysiology of alcoholic cardiomyopathy has not been firmly identified, but certain hypotheses cite an increased secretion of epinephrine
, increased sympathetic output, or a rise in the level of plasma free fatty acids as possible mechanisms.
Alcoholics may have anemia
from several causes; they may also develop thrombocytopenia
from direct toxic effect on megakaryocytes
, or from hypersplenism
of 35 previous studies of the effect of alcohol consumption on stroke risk found that:
"Compared with abstainers, consumption of more than 60 g of alcohol per day (i.e., over four standard drinks -- heavy drinking) was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke.
These findings have been disputed. A 2003 Johns Hopkins study has linked moderate alcohol use to brain shrinkage and did not find any reduced risk of stroke among moderate drinkers.
Consuming large amounts of alcohol over a period of time can impair normal brain development in humans. Deficits in retrieval of verbal and nonverbal information and in visuospatial functioning were evident in youths with histories of heavy drinking during early and middle adolescence.
Heavy alcohol consumption inhibits new brain cell development.
Nearly half of chronic alcoholics may have myopathy. Proximal muscle groups are especially affected. Twenty-five percent of alcoholics may have peripheral neuropathy, including autonomic.
Cognition and dementia
Research has found moderate drinking to be associated with lower risk of dementia
, including Alzheimer’s disease
. A study concluded, "Compared with abstention, consumption of 1 to 6 drinks weekly is associated with a lower risk of incident dementia among older adults. Another study concluded, "These findings suggest that light-to-moderate alcohol consumption is associated with a reduced risk of dementia in individuals aged 55 years or older. The effect seems to be unchanged by the source of alcohol. "In a representative elderly cohort over an average of 7 years, a pattern of mild-to-moderate drinking, compared to not drinking, was associated with lesser average decline in cognitive domains over the same period." "Alcohol drinking in middle age showed a U shaped relation with risk of mild cognitive impairment in old age. Risk of dementia increased with increasing alcohol consumption only in those individuals carrying the apolipoprotein e4 allele. "Alcohol abuse is associated with increased prevalence of cognitive dysfunction among older subjects; however, a daily alcohol consumption of less than 40 g for women and 80 g or less for men might be associated with a decreased probability of cognitive impairment. This possible protective effect of alcohol consumption should be further assessed by prospective studies. "This study suggested that light to moderate alcohol drinking might protect against dementia and Alzheimer's disease among old people, although the possibility that such an association may be due to information bias cannot be totally ruled out. "Our data suggest that in women, up to one drink per day does not impair cognitive function and may actually decrease the risk of cognitive decline. "Moderate levels of alcohol intake are associated with somewhat better cognition, which may be expressed most strongly in functions related to verbal knowledge and phonemic fluency. However, our observational study cannot rule out confounding associations with unmeasured factors. "The moderate drinkers reported less depression, had higher self-reported health, performed better on instrumental everyday tasks, had stronger memory self-efficacy, and used more strategies to improve memory performance. In addition, these women had higher performance on tests of executive function: attention, concentration, psychomotor skills, verbal-associative capacities, and oral fluency.
"In patients with mild cognitive impairment, up to 1 drink/day of alcohol or wine may decrease the rate of progression to dementia.
"…there is no medical rationale to advise people over 65 to quit drinking wine moderately, as this habit carries no specific risk and may even be of some benefit for their health. Advising all elderly people to drink wine regularly for prevention of dementia would be however premature at this stage.
"Researchers found that people who were heavy drinkers [defined as more than two drinks per day] developed Alzheimer’s 4.8 years earlier than those who
were not heavy drinkers.
"Of people who reported drinking alcohol in the past year, those who consumed at least one drink in the past week, compared with those who did not, were significantly less likely to have poor cognitive function. … However, the relations were weakened when social position was added to the model. The authors concluded that for middle-aged subjects, increasing levels of alcohol consumption were associated with better function regarding some aspects of cognition. Nonetheless, it is not proposed that these findings be used to encourage increased alcohol consumption.
Another study concluded:
"After adjustment for age, education, and smoking status, men with CVD [cardiovascular disease]/diabetes and low-to-moderate alcohol intake had a significantly lower risk for poor cognitive function (MMSE £ 25) than abstainers (odds ratios of 0.3 for less than one drink and 0.2 for one to two drinks per day). Alcohol intake was not associated with cognitive decline. … Alcohol may result in an acute beneficial effect on cognitive function among those with CVD/diabetes. However, selection bias and unmeasured confounding should be of concern when evaluating these results.
A further study concluded, "We report a positive association between moderate alcohol intake among middle-aged men and subsequent cognitive performance in later life. However, it is possible that the health risks associated with drinking outweigh any potential benefits for many elderly persons.
A French study concluded:
"Among men, neuropsychological test scores were not associated with alcohol consumption in either univariate or multivariate analysis; nor did
the proportion of high cognitive performers vary by alcohol consumption. In contrast, among women, significant positive associations between alcohol consumption and cognitive performance were observed for most tests in multivariate analysis. … These findings suggest that, among women, moderate alcohol consumption may have a beneficial effect on cognitive function.
"Abstainers have poorer cognitive function than light drinkers and further investigation is needed to determine what factors contribute to this. "A range of demographic and physical function measures were found to explain partially the finding of abstainers having lower cognitive test scores. The effects of independent variables were largest in the 60–64-year-old age group with a trend for physical variables such as lung function and grip strength to become more important in the older age groups. In the 20–24-year-olds, the majority of the effect remained unexplained. There is evidence that poorer cognitive test performance by abstainers reflects in part selection effects and poorer physical functioning, but does not appear to be due to mental or physical health conditions or personality.
A review states, "There is some evidence to suggest that light-to-moderate alcohol consumption (up to three alcoholic drinks a day, or between one and seven drinks a week) may reduce the risk of cognitive impairment in the elderly compared with those who abstain. Drinking in moderation may contribute to some brain atrophy, but it may also reduce the number of silent infarcts in the brain, a known risk factor for cognitive impairment. In addition, light drinking may reduce blood clotting and blood serum lipid levels, as well as stimulate acetylcholine production in the brain.
can be temporarily and dramatically relieved in up to two-thirds of patients by drinking small amounts of alcohol, thus avoiding the serious side effects of the most effective and expensive medications or the dangers of surgery.
Wernicke-Korsakoff syndrome is a manifestation of thiamine
deficiency, usually as a secondary effect of alcohol abuse. The syndrome is a combined manifestation of two eponymous disorders, Korsakoff's Psychosis
and Wernicke's encephalopathy
, named after Drs. Sergei Korsakoff
and Carl Wernicke
. Wernicke's encephalopathy is the acute presentation of the syndrome and is characterised by a confusional
state while Korsakoff's psychosis main symptoms are amnesia
and executive dysfunction
Studies have shown that alcohol dependence relates directly to cravings
. Another study has shown that alcohol use is a significant predisposing factor towards antisocial behavior
in children. Depression, anxiety and panic disorder are disorders commonly reported by alcohol dependent people. The mental health disorders are often induced by alcohol misuse via distortion of brain neurochemistry as the disorders typically improve or disappear with prolonged abstinence although temporarily worsening in early withdrawal and recovery. Psychosis is secondary to several alcohol-related conditions including acute intoxication and withdrawal after significant exposure. Prominent hallucinations
are usually present when a patient is intoxicated or recently withdrawn from alcohol. Chronic alcohol misuse can cause psychotic type symptoms to develop, more so than with other drugs of abuse. A study found that there is an 8 fold increased risk of psychotic disorders in alcohol misusing men and 3 fold increased risk in alcohol misusing women. DSM-IV-TR
criteria for a alcohol-related psychotic disorder are as follows:
- *Hallucinations or delusions are present. Hallucinations are false sensations and are often visual. Delusions are false ideas. Paranoia and occasionally grandiosity may be the delusions engaged here.
- * Evidence from the history, physical examination, or laboratory findings indicates either that the hallucinations or delusions developed during or within a month of substance intoxication or withdrawal or that medication use is etiologically related to the disturbance.
- * The disturbance is not better accounted for by a psychotic disorder that is not substance-induced. Evidence that the symptoms are better accounted for by a psychotic disorder that is not substance-induced might include the following:
- *The symptoms precede the onset of the substance or medication use.
- *The symptoms persist for a substantial period of time after cessation of acute withdrawal or severe intoxication, or the symptoms are substantially in excess of what would be expected given the type or amount of the substance use or the duration of use.
- *Other evidence suggests the existence of an independent non–substance-induced psychotic disorder.
- *The disturbance does not occur exclusively during the course of a delirium.
Digestive system and weight gain
Except from pancreatitis and liver disease, there is uncertainty whether alcohol is detrimental or beneficial to the gastrointestinal system. Its impact on weight-gain is contentious: some studies find no effect, others find decreased or increased effect on weight gain.
Alcohol use increases the risk of chronic gastritis (stomach inflammation); it is one cause of cirrhosis, hepatitis, and pancreatitis in both its chronic and acute forms.
A study concluded, "Mild to moderate alcohol consumption is associated with a lower prevalence of the metabolic syndrome
, with a favorable influence on lipids, waist circumference, and fasting insulin. This association was strongest among whites and among beer and wine drinkers. "Odds ratios for the metabolic syndrome and its components tended to increase with increasing alcohol consumption.
Consumption of alcohol is unrelated to gallbladder disease. However one study suggested that drinkers who take Vitamin C
) might reduce their risk. "After adjustment for potential confounding variables, use of ascorbic acid supplements among drinkers was associated with a decreased prevalence of gallbladder disease … and cholecystectomy …. Use of ascorbic acid supplements among non-drinkers was not significantly associated with either prevalence of gallbladder disease or cholecystectomy. Further study is necessary to confirm our findings and, specifically, to examine the combined effects of ascorbic acid and alcohol on cholesterol metabolism.
Research has found that drinking reduces the risk of developing gallstones
. Compared with alcohol abstainers, the relative risk of gallstone disease, controlling for age, sex, education, smoking, and body mass index, is 0.83 for occasional and regular moderate drinkers (< 25 ml of ethanol per day), 0.67 … for intermediate drinkers (25-50 ml per day), and 0.58 … for heavy drinkers. This inverse association was consistent across strata of age, sex, and body mass index. Frequency of drinking also appears to be a factor. "An increase in frequency of alcohol consumption also was related to decreased risk. Combining the reports of quantity and frequency of alcohol intake, a consumption pattern that reflected frequent intake (5-7 days/week) of any given amount of alcohol was associated with a decreased risk, as compared with nondrinkers. In contrast, infrequent alcohol intake (1-2 days/week) showed no significant association with risk.”
Urinary system: Kidney stones
Research indicates that drinking alcohol is associated with a lower risk of developing kidney stones
. One study concludes, "Beer consumption was inversely associated with risk of kidney stones; each bottle of beer consumed per day was estimated to reduce risk by 40% …. Since beer seemed to be protective against kidney stones, the physiologic effects of other substances besides ethanol, especially those of hops, should also be examined. "…consumption of coffee, alcohol, and vitamin C supplements were negatively associated with stones. "After mutually adjusting for the intake of other beverages, the risk of stone formation decreased by the following amount for each 240-ml (8-oz) serving consumed daily: caffeinated coffee, 10%; decaffeinated coffee, 10%; tea, 14%; beer, 21%; and wine, 39%. "…stone formation decreased by the following amount for each 240-mL (8-oz) serving consumed daily: 10% for caffeinated coffee, 9% for decaffeinated coffee, 8% for tea, and 59% for wine." (CI
data excised from last two quotes.).
Endocrine system: Diabetes
Moderate drinkers may have a lower risk of diabetes
than non-drinkers. "Alcohol intake increases insulin sensitivity and may partly explain both the J-shaped relationship between the prevalence of diabetes and the amount of alcohol consumption and the decreased mortality for myocardial infarction. "Compared with abstainers men who drank 30.0-49.9 g of alcohol daily had a relative risk
of diabetes of 0.61. "Consumption of 30 g/d of alcohol (2 drinks per day) has beneficial effects on insulin and triglyceride concentrations and insulin sensitivity in nondiabetic postmenopausal women. After adjustment for age, randomized treatment assignment, smoking, physical activity, and body mass index
, the relative risk estimates of diabetes for those reporting alcohol use of rarely/never were 1.00 (referent), 1 to 3 drinks per month 1.03, 1 drink per week 0.89, 2 to 4 drinks per week 0.74, 5 to 6 drinks per week 0.67, and 1 or more drinks per day 0.57. "The results of this study suggested that moderate alcohol consumption may reduce the risk of type 2 diabetes. On the other hand, binge drinking and high alcohol consumption may increase the risk of type 2 diabetes in women.
Endocrine system: Rheumatoid arthritis
Alcohol consumption is associated with decreased risk of rheumatoid arthritis. Two recent studies report that the more alcohol consumed, the lower the risk of developing rheumatoid arthritis. Among those who drank regularly, the one-quarter who drank the most were up to 50% less likely to develop the disease compared to the half who drank the least.
The researchers noted that moderate alcohol consumption also reduces the risk of other inflammatory processes such as cardiovascualar disease. Some of the biological mechanisms by which ethanol reduces the risk of destructive arthritis and prevents the loss of bone mineral density (BMD), which is part of the disease process.
A study concluded, "Alcohol either protects from RA rheumatoid arthritis
or, subjects with RA curtail their drinking after the manifestation of RA". Another study found, "Postmenopausal women who averaged more than 14 alcoholic drinks per week had a reduced risk of rheumatoid arthritis…
Moderate alcohol consumption is associated with higher bone mineral density in postmenopausal women. "…alcohol consumption significantly decreased the likelihood [of osteoporosis]. "Moderate alcohol intake was associated with higher BMD in postmenopausal elderly women. "Social drinking is associated with higher bone mineral density in men and women [over 45].
Immune system, bacterial contamination, viral infections, and cancer
Drinking strong alcoholic beverages with a meal may offer some protection against bacterial contamination. The antibacterial activity of red and white wine against enteropathogens, (e.g. Shigella
) may protect against bacterial diarrhoea in a similar way to bismuth salicylate.
There is a protective effect of alcohol consumption against active infection with H pylori In contrast, alcohol intake (comparing those who drink > 30 gm of alcohol per day to nondrinkers) is not associated with higher risk of duodenal ulcer.
A study on the common cold found that "Greater numbers of alcoholic drinks (up to three or four per day) were associated with decreased risk for developing colds because drinking was associated with decreased illness following infection. However, the benefits of drinking occurred only among nonsmokers. … Although alcohol consumption did not influence risk of clinical illness for smokers, moderate alcohol consumption was associated with decreased risk for nonsmokers.
Another study concluded, "Findings suggest that wine intake, especially red wine, may have a protective effect against common cold. Beer, spirits, and total alcohol intakes do not seem to affect the incidence of common cold.
The NIAAA states that "Although epidemiologic studies have found a clear association between alcohol consumption and development of certain types of cancer, study findings are often inconsistent and may vary by country and by type of cancer." The U.S. Department of Health & Human Services’
Program listed alcohol as a known carcinogen
in 2000 .
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that "Although there is no evidence that alcohol itself is a carcinogen, alcohol may act as a cocarcinogen by enhancing the carcinogenic effects of other chemicals. For example, studies indicate that alcohol enhances tobacco's ability to stimulate tumor formation in rats (Garro & Lieber). In humans, the risk for mouth, tracheal, and esophageal cancer is 35 times greater for people who both smoke and drink than for people who neither smoke nor drink (Blot et al.), implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens (Garro & Lieber)." One study determined that "3.6% of all cancer cases worldwide are related to alcohol drinking, resulting in 3.5% of all cancer deaths. The NiAAA suggests that "considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol."
The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence "convincing" that alcoholic drinks increase the risk of the following cancers: mouth, pharynx and larynx, oesophagus, colorectum (men), breast (pre- and
Alcohol's effect on the fetus
Fetal alcohol syndrome
or FAS is a disorder of permanent birth defects
that occurs in the offspring of women who drink alcohol
during pregnancy. Drinking heavily or during the early stages of prenatal development has been conclusively linked to FAS; the impact of light or moderate consumption is not yet fully understood. Alcohol crosses the placental barrier
and can stunt fetal growth or weight, create distinctive facial stigmata, damaged neurons
and brain structures, and cause other physical, mental, or behavioural problems. Fetal alcohol exposure is the leading known cause of mental retardation
in the Western world.
- Trevisan, M., et al. Drinking pattern and mortality: a longitudinal study; Gaziano, J. M., et al. A prospective cohort study of moderate alcohol consumption and sudden death in the Physicians' Health Study. Abstract . The Canadian Journal of Cardiology, June, 1997, volume 13, Supplement B.
- Kaltourina, D., and A. Korotayev. Potential for Alcohol Policy to Decrease the Mortality Crisis in Russia // Evaluation & the Health Professions, Vol. 31, No. 3, 272-281 (2008).