Healthcare providers have always been under pressure to ensure a good outcome for their patients. However, while they can control the care they give, providers can never guarantee the positive results of a patient’s treatment.
Substance use, poor diet, noncompliance, difficulty accessing follow-up care, and other social factors can all play a role in patient outcomes. Providers can adjust their treatment plans to account for these but ultimately can’t control them.
Here’s a look at one aspect of patient behavior that can affect outcomes, the effects that drinking alcohol can have on wound healing.
What Normal Wound Healing Looks Like
No matter the cause of the injury, there are four stages that all wounds go through as they heal. A good analogy to think about these stages is comparing them to repairing a damaged house.
Hemostasis. Platelets aggregate, and blood vessels constrict forming clots to stop the wound from bleeding. This is like utility workers capping off the broken utilities at a damaged home.
Inflammation. A type of white blood cell called a neutrophil enables the breakdown of damaged tissues. This is your contractor directing laborers to remove debris from the site.
Proliferation. Various types of cells go to work to fill in the wound and close it. These are your subcontractors starting work on repairs in their areas (electric, plumbing, etc.).
Remodeling. The cells in your body that produce connective tissue use collagen to strengthen the wounded area. This is like completing the interior finishing work on your newly repaired home.
As you can imagine, if something interrupts these processes, the wound may not heal well or possibly at all.
The Increasing Incidence of Alcohol Abuse
Approximately 7% of adults in the United States meet the criteria for having an alcohol use disorder. This includes both consistent overuse and occasional binge drinking. That number is still growing.
Researchers agree that the events of 2020 have led to increased alcohol consumption. A Johns Hopkins-University of Maryland-Baltimore survey found that about 60% of participants reported drinking more alcohol after March 2020 than they had previously.
Most people are aware of the negative impacts that it can have on your liver, but they might not know that alcoholism affects all the organs in your body. This includes your skin and its ability to heal after injuries.
The Effects of Alcohol on Wound Healing
Patients who heavily consume alcohol may have trouble with wound healing even if the care provided to them is within the standard of care.
Malnutrition. Wounds require a variety of nutrients to heal correctly. These include vitamin C, vitamin A, vitamin E, magnesium, zinc, and iron. Chronic alcohol consumption can cause malnutrition. Alcohol causes you to consume fewer calories, impairs absorption, and increases the excretion of nutrients from the body. Over time, this malnutrition results in your body lacking the necessary building blocks to repair wounds.
Elevated blood sugar. Chronic alcohol abuse impairs the pancreas’ ability to secrete insulin and potentially leads to elevated blood sugar levels. Over time, high glucose leads to narrowing of the blood vessels. This reduces oxygen and blood flow to the skin and slows wound healing. Additionally, your immune system doesn’t function properly with elevated glucose levels. This puts you at greater risk for infection.
Decreased collagen. Collagen is the main protein that gives structure to the connective tissues in your body, including the skin. The elevated blood sugar that results from chronic alcohol overuse can impair wound healing, but the body’s response to that high glucose level also causes problems. Your body attempts to regulate with a spike in insulin. This lowers sugar but also produces inflammation and enzymes that can cause collagen to break down.
While a patient’s history of substance abuse is never an excuse for substandard care, it can influence the outcome of their case. This can occur even when a healthcare provider follows standards of care.
Providers can protect themselves by documenting a thorough assessment of factors, including alcohol abuse, that could interfere with a patient’s healing. Documentation of education and attempts to intervene with any non-adherence may be mitigating factors if the outcome is less than ideal.