Two of the most popularly underrated threats to the health of Australians are alcohol abuse and social isolation (with or without loneliness). Combine them and the synergy is devastating and lethal. Itβs what killed my brother, Jason, the day after his 61st birthday.
Much is said and written about the effects of alcohol abuse on others β namely violence from or among abusers, dangerous driving, work accidents, alienating family. This is all valid, but the longer-term effects on health need greater consideration. These include gradual liver damage and the effects on the brain that may start with mild memory lapses but become much more significant later in life. Alcohol abuse also exacerbates or triggers long-term anxiety and depression by disrupting mood regulation and the balance of brain chemicals.
There are also the metabolic effects that promote fat accumulation, whole-body inflammation, insulin resistance and a higher risk of type 2 diabetes. The digestive system can become chronically inflamed, resulting in ulcers, pancreatitis and liver disease. My brother had debilitating diarrhoea in the last two to three years of his life, and he died with (but not because of) small bowel cancer.
Alcohol is also classed as a Group 1 carcinogen by the International Agency for Research (part of the World Health Organisation). Heavy alcohol use can increase the risk of contracting mouth, throat, oesophageal and laryngeal cancers by five times. Liver, colorectal and breast cancer risk also increases, as does pancreatic cancer when chronic pancreatitis has set in (as occurred with another dead brother, also a heavy drinker).
Often people split hairs on the defining points between a βheavy drinkerβ and an alcoholic. The term βfunctional alcoholicβ is frequently bandied about, often jokingly. In my brotherβs case, he was probably considered βfunctionalβ by doctors and colleagues only because he could hold on to a job (albeit often getting up 20 minutes before working from home). This was misleading, as absolutely nothing else was functional about his life β household management, health management, social connections or family and community interaction.
After living in the same area for 26 years, the names most often seen around his home were Dan Murphy, Jack Daniels and Charles Lindeman.
For the heavy drinker, the danger of social isolation is that there is no accountability. Heavy drinkers with plenty of social contacts either in or out of the home may tend to have at least some accountability to the times they drink, the amounts they drink, their behaviour, health, hygiene and day-to-day responsibilities β which may be for others, or even just themselves. These can all get lost for the heavy drinker in social isolation.
Perspective is lost β with time (βIβll give up β¦ soonβ); with wellbeing (βIβm sick/not feeling well/I stumbledβ as opposed to βI fell because I was drunkβ); with limits to drinking, social behaviour and self-control. It is too easy to lie to other people about the scale and volume of the drinking, which in turn makes it easier for the drinker to lie to themselves. There is no distraction from the psychological pull of alcohol β and it is a behavioural habit and psychological addiction as much as it is physical.
This is a detail that can slip past family and medical staff alike. My brother spent four months in hospital in 2025, so it was possibly assumed that sobriety would stick once he returned home, since the physical symptoms of alcohol withdrawal tend to peak 24 to 72 hours after the last drink (although they may linger for a few weeks). The psychological symptoms, however, may kick on for several months.
The situation becomes more dire in social isolation. With no distraction, everything in life can be centred around or an excuse for the habit of drinking. Without other people, the drinking becomes the reward, the consoler, the comfort, the companion, even β in extreme cases such as my brother β when the alcohol is the cause of the problems the drinker is attempting to escape from or address. In his case, it was the alienation of morbid obesity, then diabetes, then cancer. In all these cases, heavy alcohol use interfered with or worked against drug therapy.
The worst was when my brother turned up for a new, extremely expensive and time-sensitive nuclear medicine treatment for his cancer, only for medical staff to find that his potassium levels and liver function were too low for treatment due to his wholehearted return to drinking after being discharged from hospital.
In social isolation, the heavy drinker has no sense of responsibility to anything other than fuelling the next drinking session. The vicious cycle might include functioning at a job and other tasks required to finance and maintain a nice, safe, comfortable environment for drinking where the drinker wonβt be judged or interrupted. Alcohol is the fuel to maintain a routine, but social isolation is the dangerous spark for fiery self-destruction.
Dominic Cadden is a health writer and accredited clinical exercise physiologist. His late brother, Jason Cadden, was a Herald desk editor. This piece is published with the permission of Jasonβs other two siblings.
Dominic Cadden is a health writer and a clinical exercise physiologist.