Alcohol and Tuberculosis

Most American adults try alcohol at least once in their lifetime, although a recent study found that about 30 percent of American adults never drink, and another 30 percent consume less than one drink per week. However, the study found that the top 10 percent of American adults drink 74 servings of alcohol in one week on average, which is more than 10 beverages per day. This means about 24 million people in the United States, ages 18 and older, drink very heavily.

The definition of heavy drinking is more than two drinks per day for men and more than one drink per day for women. People who drink this much in the course of a week also likely binge drink on one or more days. Binge drinking is defined as four or more beverages in the course of two hours since the liver can only process one serving of alcohol per hour.

There are many risks associated with all forms of excessive drinking, especially alcohol use disorder (AUD). Heavy drinking and binge drinking put one at risk of many severe problems, ranging from car crashes while drunk to liver failure or cancer. One risk associated with excessive drinking is tuberculosis. BMC Public Health notes that tuberculosis has long been associated with alcohol abuse for several reasons.

What Is Tuberculosis (TB)?

Tuberculosis is a bacterial infection in the lungs, which can be life-threatening. The disease is spread through droplets of saliva or mucous when one person coughs or sneezes near others. The disease has been rare in developed countries, although rates of tuberculosis have been on the rise since 1985. In part, this correlates with the rise and rapid spread of HIV/AIDS, a viral infection that harms the immune system and allows secondary infections to take hold. Since improvements in the treatment of HIV around 1993, rates of tuberculosis have been going down again in the US. Even so, the condition remains a concern since anyone with a suppressed immune system can contract the disease.

People with healthy immune systems may come in contact with tuberculosis bacteria, but your immune system will be able to fight off the infection easily. Alcohol and drug abuse is associated with damage to the immune system, especially over years of addiction and substance abuse. Tuberculosis is one of many harmful infections that you may contract if you drink too much over many years, or if you have been exposed to TB and it has been suppressed for years, substance abuse like alcohol use disorder may eventually harm your immune system to the point that symptoms of the infection surface.

TB Symptoms

Symptoms of active TB include:

• Coughing that lasts for three or more weeks
• Chest pain or difficulty taking full breaths
• Unintentional weight loss
• Exhaustion or fatigue
• Coughing up blood
• Fever and chills
• Night sweats
• Loss of appetite

This infection can eventually harm other parts of the body, including the kidneys, spinal cord, and brain. If tuberculosis spreads outside of the lungs, symptoms will indicate where the bacteria have moved. For example, TB in the spinal cord will be indicated by back pain. Long-term complications associated with untreated TB include:

• Chronic back pain
• TB arthritis, which can hurt the joints, especially the hips and knees
• TB meningitis, or the swelling of membranes around the brain that puts pressure on the organ
• Liver and kidney damage
• Infection in the heart, leading to damage, heart attack, and circulatory problems

About one-third of the world’s population has tuberculosis, according to the World Health Organization (WHO). While the bacteria are present in many places, it is hard to contract if you are healthy. If there is anything making you unhealthy, like another disease, addiction, or prescription that affects your immune system, you may be at risk of contracting TB.

How Does Alcohol Impact Tuberculosis?

Tuberculosis in people struggling with alcohol use disorder is not just exacerbated by damage to the immune system. Because people who abuse alcohol are less likely to get treatment for symptoms and heavy drinking can cause harm to many parts of the body, often making the person feel sick when they are not drinking, people who struggle with alcohol dependence and addiction are more likely to keep drinking to ignore or temporarily alleviate symptoms rather than seek medical treatment.

WHO reports that alcohol abuse increases the risk of contracting tuberculosis threefold, and the condition becomes worse because people who struggle with alcohol abuse are less likely to adhere to a treatment plan to get rid of the disease. People who abuse alcohol are less likely to eat regular, healthy meals; malnutrition adds additional risk to those who may contract TB.

A 2017 meta-analysis of numerous medical studies found that there were about 10.4 million incidents of TB around the world in 2015, and it was associated with about 1.4 million deaths. In all studies, heavy consumption of alcohol was closely associated with higher rates of tuberculosis; on average, abusing alcohol increased the risk of contracting TB by 35 percent. The BMC Public Health study reported that people who drank more than 40 grams of alcohol per day dramatically increased their risk of contracting tuberculosis; one standard drink contains about 10 grams of alcohol, for reference, so drinking more than four standard drinks per day can cause severe harm, and represents excessive drinking. Studies examining the concurrence of TB among people with AUD in Australia, Canada, Russia, Switzerland, and the United States found rates of overlap ranging from 10 percent to 50 percent.

One study from 2013 found that moderate alcohol consumption could help boost the immune system or at least the body’s response to vaccinations. However, before claiming that alcohol can improve health, it is important to understand what moderate drinking means. While the Centers for Disease Control and Prevention (CDC) defined heavy and binge drinking, moderate drinking is typically considered to be one drink or less per day for women, and no more than two drinks per day for men, with “abstinent” days at least once a week. Drinking more than this can risk harm to the immune system and trigger compulsive behaviors that may lead to addiction to alcohol.

Studies on binge drinking, for example, have shown that drinking too much in one day can lower the immune system’s response to infection. Within the first 20 minutes of drinking excessively, the study found that participants’ immune response kicked into high gear, as the toxins in alcohol began to affect body systems. At the two-hour and five-hour marks, however, the percentage of immune system cells in the blood dropped below what they were when participants were sober. The study indicated that people who drank more than moderately, especially in one evening, were at greater risk of contracting infections or having a harder time overcoming existing infections.

TB Treatment and Alcohol Use Disorder

Because people who struggle with AUD or problem drinking are at higher risk of contracting tuberculosis, along with other infections, recent medical literature recommends that physicians and addiction specialists make screening for TB part of the intake process when a person enters treatment to overcome AUD. Screening for AUD or problem drinking is not inherently part of routine exams or visits, but clinics that treat TB, or doctors who diagnose TB in their patient, should consider screening for excessive alcohol consumption when they get positive TB results.

Treating tuberculosis involves prescription antibacterial drugs, which the CDC notes are usually a combination of:

• Isoniazid (INH)
• Rifampin (RIF)
• Ethambutol (EMB)
• Pyrazinamide (PZA)

A typical course of treatment is 6-9 months. At the same time, the National Institute on Drug Abuse (NIDA) recommends that a person overcoming addiction remain in treatment for at least 90 days, or three months. If you struggle with alcohol abuse and contract TB, you must safely detox from alcohol with medical supervision, stick to your physician’s treatment plan for tuberculosis, and enter a rehabilitation program that can manage medication for concurrent, secondary infections alongside behavioral therapy.