:Alcohol (drug)

{{See also|Drinking culture}}

Ethanol is commonly consumed as a recreational substance by mouth in the form of alcoholic beverages such as beer, wine, and spirits. It is commonly used in social settings due to its capacity to enhance sociability. Alcohol consumption while socializing increases occurrences of Duchenne smiling, talking, and social bonding, even when participants are unaware of their alcohol consumption or lack thereof.{{cite journal | vauthors = Sayette MA, Creswell KG, Dimoff JD, Fairbairn CE, Cohn JF, Heckman BW, Kirchner TR, Levine JM, Moreland RL | title = Alcohol and group formation: a multimodal investigation of the effects of alcohol on emotion and social bonding | journal = Psychological Science | volume = 23 | issue = 8 | pages = 869–878 | date = August 2012 | pmid = 22760882 | doi = 10.1177/0956797611435134 | pmc = 5462438 }} In a study of the UK, regular drinking was correlated with happiness, feeling that life was worthwhile, and satisfaction with life. According to a causal path analysis, alcohol consumption was not the cause, but rather satisfaction with life resulted in greater happiness and an inclination to visit pubs and develop a regular drinking venue. City centre bars were distinguished by their focus on maximizing alcohol sales. Community pubs had less variation in visible group sizes and longer, more focused conversations than those in city centre bars. Drinking regularly at a community pub led to higher trust in others and better networking with the local community, compared to non-drinkers and city centre bar drinkers.{{cite journal | vauthors = Dunbar RI, Launay J, Wlodarski R, Robertson C, Pearce E, Carney J, MacCarron P | title = Functional Benefits of (Modest) Alcohol Consumption | journal = Adaptive Human Behavior and Physiology | volume = 3 | issue = 2 | pages = 118–133 | date = June 2017 | pmid = 32104646 | doi = 10.1007/s40750-016-0058-4 | pmc = 7010365 | doi-access = free }} Research on the societal benefits of alcohol is rare.

{{see also|Apéritif and digestif|Wine and food pairing}}

The US Department of Agriculture (USDA) uses a figure of {{convert|6.93|kcal|lk=in|}} per gram of alcohol ({{convert|5.47|kcal|disp=or|abbr=on}} per mL) for calculating food energy.{{cite web |date=August 2013 |title=Composition of Foods Raw, Processed, Prepared USDA National Nutrient Database for Standard Reference, Release 26 Documentation and User Guide |url=http://www.ars.usda.gov/sp2UserFiles/Place/12354500/Data/SR26/sr26_doc.pdf |url-status=live |archive-url=https://web.archive.org/web/20140925044006/http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR26/sr26_doc.pdf |archive-date=2014-09-25 |access-date=2014-02-03 |publisher=USDA |page=14}} For distilled spirits, a standard serving in the United States is 44 mL (1.5 US fl oz), which at 40% ethanol (80 proof), would be 14 grams and 98 calories. Alcoholic drinks are considered empty calorie foods because other than food energy they contribute no essential nutrients. However, alcohol is a significant source of food energy for individuals with alcoholism and those who engage in binge drinking. For example, individuals with drunkorexia engage in the combination of self-imposed malnutrition and binge drinking.{{Cite journal |vauthors=Osborne VA, Sher KJ, Winograd RP |year=2011 |title=Disordered eating patterns and alcohol misuse in college students: Evidence for "drunkorexia"? |url=https://works.bepress.com/rachel-winograd/31/download/ |journal=Comprehensive Psychiatry |volume=52 |issue=6 |pages=e12 |doi=10.1016/j.comppsych.2011.04.038 |archive-date=25 September 2024 |access-date=15 April 2024 |archive-url=https://web.archive.org/web/20240925145556/https://works.bepress.com/rachel-winograd/31/download/ |url-status=dead }}{{cite web |date=October 17, 2011 |title='Drunkorexia:' A Recipe for Disaster |url=https://www.sciencedaily.com/releases/2011/10/111017171506.htm |publisher=ScienceDaily}} In alcoholics who get most of their daily calories from alcohol, a deficiency of thiamine (vitamin B₁) can produce Korsakoff syndrome, which is associated with serious brain damage.{{cite journal |vauthors=Kopelman MD, Thomson AD, Guerrini I, Marshall EJ |date=2009 |title=The Korsakoff syndrome: clinical aspects, psychology and treatment |journal=Alcohol and Alcoholism |volume=44 |issue=2 |pages=148–154 |doi=10.1093/alcalc/agn118 |pmid=19151162 |doi-access=free}}

{{main|Alcohols (medicine)}}

When fomepizole is not available, ethanol can be used to treat or prevent methanol or ethylene glycol poisoning.{{cite book|title=British National Formulary: BNF 69|date=2015|publisher=British Medical Association|isbn=978-0-85711-156-2|pages=42, 838|edition=69th }}{{cite journal | vauthors = Mégarbane B | title = Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole | journal = Open Access Emergency Medicine | volume = 2 | pages = 67–75 | date = 2010-08-24 | pmid = 27147840 | pmc = 4806829 | doi = 10.2147/OAEM.S5346 | doi-access = free }} The rate-limiting steps for the elimination of ethanol are in common with these substances, so it competes with other alcohols for the alcohol dehydrogenase enzyme. Methanol itself is not highly toxic, but its metabolites formaldehyde and formic acid are; therefore, to reduce the rate of production and concentration of these harmful metabolites, ethanol can be ingested or injected.{{cite journal | vauthors = McCoy HG, Cipolle RJ, Ehlers SM, Sawchuk RJ, Zaske DE | title = Severe methanol poisoning. Application of a pharmacokinetic model for ethanol therapy and hemodialysis | journal = The American Journal of Medicine | volume = 67 | issue = 5 | pages = 804–7 | date = November 1979 | pmid = 507092 | doi = 10.1016/0002-9343(79)90766-6 }} This avoid toxic aldehyde and carboxylic acid derivatives, and reduces the more serious toxic effects of the glycols when crystallized in the kidneys.{{cite journal |vauthors=Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA |title=American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning |journal=Journal of Toxicology. Clinical Toxicology |volume=40 |issue=4 |pages=415–46 |date=2002 |pmid=12216995 |doi=10.1081/CLT-120006745 |s2cid=26495651}} Ethylene glycol poisoning can be treated in the same way.

{{main|Dutch courage}}

Alcohol has a long association of military use, and has been called "liquid courage" for its role in preparing troops for battle, anesthetize injured soldiers, and celebrate military victories. It has also served as a coping mechanism for combat stress reactions and a means of decompression from combat to everyday life.{{cite journal |vauthors=Jones E, Fear NT |date=April 2011 |title=Alcohol use and misuse within the military: a review |journal=International Review of Psychiatry |volume=23 |issue=2 |pages=166–172 |doi=10.3109/09540261.2010.550868 |pmid=21521086}}

File:A group of merry, dancing invalids discarding their medicine Wellcome V0011166.jpg

Alcohol can have analgesic (pain-relieving) effects, which is why some people with chronic pain turn to alcohol to self-medicate and try to alleviate their physical discomfort.{{cite journal |vauthors=Riley JL 3rd, King C |date=September 2009 |title=Self-report of alcohol use for pain in a multi-ethnic community sample. |journal=The Journal of Pain |volume=10 |issue=9 |pages=944–52 |doi=10.1016/j.jpain.2009.03.005 |pmc=2734914 |pmid=19712901}}

People with social anxiety disorder commonly self-medicate with alcohol to overcome their highly set inhibitions.{{cite journal |vauthors=Carrigan MH, Randall CL |date=March 2003 |title=Self-medication in social phobia: a review of the alcohol literature |url=http://pubs.niaaa.nih.gov/publications/arh26-2/130-135.htm |url-status=dead |journal=Addictive Behaviors |volume=28 |issue=2 |pages=269–284 |doi=10.1016/S0306-4603(01)00235-0 |pmc=6683821 |pmid=12573678 |archive-url=https://web.archive.org/web/20180131204846/http://pubs.niaaa.nih.gov/publications/arh26-2/130-135.htm |archive-date=31 January 2018 |access-date=5 April 2024}} However, self-medicating excessively for prolonged periods of time with alcohol often makes the symptoms of anxiety or depression worse. This is believed to occur as a result of the changes in brain chemistry from long-term use.{{cite journal |vauthors=Wetterling T, Junghanns K |date=December 2000 |title=Psychopathology of alcoholics during withdrawal and early abstinence |journal=European Psychiatry |volume=15 |issue=8 |pages=483–488 |doi=10.1016/S0924-9338(00)00519-8 |pmid=11175926 |s2cid=24094651}}{{cite journal |vauthors=Cowley DS |date=January 1992 |title=Alcohol abuse, substance abuse, and panic disorder |journal=The American Journal of Medicine |volume=92 |issue=1A |pages=41S–48S |doi=10.1016/0002-9343(92)90136-Y |pmid=1346485}}{{cite journal |vauthors=Cosci F, Schruers KR, Abrams K, Griez EJ |date=June 2007 |title=Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship |journal=The Journal of Clinical Psychiatry |volume=68 |issue=6 |pages=874–880 |doi=10.4088/JCP.v68n0608 |pmid=17592911}} A 2023 systematic review highlights the non-addictive use of alcohol for managing developmental issues, personality traits, and psychiatric symptoms, emphasizing the need for informed, harm-controlled approaches to alcohol consumption within a personalized health policy framework.{{cite journal |vauthors=Müller CP, Schumann G, Rehm J, Kornhuber J, Lenz B |date=July 2023 |title=Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment |journal=Molecular Psychiatry |volume=28 |issue=7 |pages=2683–2696 |doi=10.1038/s41380-023-02074-3 |pmc=10615763 |pmid=37117460}}

{{main|Fetal alcohol spectrum disorder}}

File:Photo of baby with FAS.jpg

Ethanol is classified as a teratogen{{cite journal | vauthors = Popova S, Dozet D, Shield K, Rehm J, Burd L | title = Alcohol's Impact on the Fetus | journal = Nutrients | volume = 13 | issue = 10 | page = 3452 | date = September 2021 | pmid = 34684453 | pmc = 8541151 | doi = 10.3390/nu13103452 | doi-access = free }}{{cite journal | vauthors = Chung DD, Pinson MR, Bhenderu LS, Lai MS, Patel RA, Miranda RC | title = Toxic and Teratogenic Effects of Prenatal Alcohol Exposure on Fetal Development, Adolescence, and Adulthood | journal = International Journal of Molecular Sciences | volume = 22 | issue = 16 | page = 8785 | date = August 2021 | pmid = 34445488 | pmc = 8395909 | doi = 10.3390/ijms22168785 | doi-access = free }}{{medical citation needed|date=February 2016}}—a substance known to cause birth defects; according to the U.S. Centers for Disease Control and Prevention (CDC), alcohol consumption by women who are not using birth control increases the risk of fetal alcohol spectrum disorders (FASDs). This group of conditions encompasses fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, static encephalopathy, and alcohol-related birth defects.{{cite web|date=April 16, 2015|title=Facts about FASDs|url=https://www.cdc.gov/ncbddd/fasd/facts.html|url-status=live|archive-url=https://web.archive.org/web/20150523194618/http://www.cdc.gov/ncbddd/fasd/facts.html|archive-date=23 May 2015|access-date=10 June 2015|df=dmy-all}} The CDC currently recommends complete abstinence from alcoholic beverages for women of child-bearing age who are pregnant, trying to become pregnant, or are sexually active and not using birth control.{{cite web |url=https://www.cdc.gov/media/releases/2016/p0202-alcohol-exposed-pregnancy.html|title=More than 3 million US women at risk for alcohol-exposed pregnancy|work=Centers for Disease Control and Prevention|date=2 February 2016|access-date=3 March 2016 |quote='drinking any alcohol at any stage of pregnancy can cause a range of disabilities for their child,' said Coleen Boyle, Ph.D., director of CDC's National Center on Birth Defects and Developmental Disabilities.}}

In patients who have a peptic ulcer disease (PUD), the mucosal layer is broken down by ethanol. PUD is commonly associated with the bacteria Helicobacter pylori, which secretes a toxin that weakens the mucosal wall, allowing acid and protein enzymes to penetrate the weakened barrier. Because alcohol stimulates the stomach to secrete acid, a person with PUD should avoid drinking alcohol on an empty stomach. Drinking alcohol causes more acid release, which further damages the already-weakened stomach wall.{{cite web | vauthors = Peters GL, Rosselli JL, Kerr JL | url = http://www.medscape.com/viewarticle/734791_2 | title = Overview of Peptic Ulcer Disease: Etiology and Pathophysiology | work = Medscape.com | access-date = 27 April 2013 }} Complications of this disease could include a burning pain in the abdomen, bloating and in severe cases, the presence of dark black stools indicate internal bleeding.{{cite web | vauthors = Dumain T | veditors = Pathak N | url = http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease | title = Peptic Ulcer Disease (Stomach Ulcers) Cause, Symptoms, Treatments | work = Webmd.com | access-date = 27 April 2013 }} A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.

File:The Alcohol Flushing Response.png heterozygous showing the reaction.{{cite journal |vauthors=Brooks PJ, Enoch MA, Goldman D, Li TK, Yokoyama A |title=The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption |journal=PLOS Medicine |volume=6 |issue=3 |pages=e50 |date=March 2009 |pmid=19320537 |pmc=2659709 |doi=10.1371/journal.pmed.1000050 |doi-access=free}}{{Cite book |url=https://books.google.com/books?id=ldQLhklj3m0C&dq=Alcohol-related%20crime&pg=PA37 |title=Alcohol-Related Violence: Prevention and Treatment| vauthors=McMurran M |date=3 October 2012 |publisher=John Wiley & Sons |isbn=978-1-118-41106-3 |page=37}}]]

{{Main|Alcohol-induced respiratory reactions|Alcohol flush reaction|Alcohol intolerance}}

{{See also|Short-term effects of alcohol consumption#Allergic reaction-like symptoms|Potomania|Red wine headache}}

Ethanol-containing beverages can cause alcohol flush reactions, exacerbations of rhinitis and, more seriously and commonly, bronchoconstriction in patients with a history of asthma, and in some cases, urticarial skin eruptions, and systemic dermatitis. Such reactions can occur within 1–60 minutes of ethanol ingestion, and may be caused by:{{cite journal | vauthors = Adams KE, Rans TS | title = Adverse reactions to alcohol and alcoholic beverages | journal = Annals of Allergy, Asthma & Immunology | volume = 111 | issue = 6 | pages = 439–45 | date = December 2013 | pmid = 24267355 | doi = 10.1016/j.anai.2013.09.016 }}

• genetic abnormalities in the metabolism of ethanol, which can cause the ethanol metabolite, acetaldehyde, to accumulate in tissues and trigger the release of histamine, or
• true allergy reactions to allergens occurring naturally in, or contaminating, alcoholic beverages (particularly wine and beer), and
• other unknown causes.

Alcohol consumption can cause hypoglycemia in diabetics on certain medications, such as insulin or sulfonylurea, by blocking gluconeogenesis.{{cite web|access-date=2022-11-30|url=https://diabetes.org/healthy-living/medication-treatments/alcohol-diabetes|title=Alcohol & Diabetes – ADA|website=American Diabetes Association }} Alcohol increases insulin response to glucose promoting fat storage and hindering carbohydrate and fat oxidation.{{cite journal |vauthors=Metz R, Berger S, Mako M |date=August 1969 |title=Potentiation of the plasma insulin response to glucose by prior administration of alcohol. An apparent islet-priming effect |url=http://diabetes.diabetesjournals.org/content/18/8/517.full.pdf |url-status=live |journal=Diabetes |volume=18 |issue=8 |pages=517–522 |doi=10.2337/diab.18.8.517 |pmid=4897290 |s2cid=32072796 |archive-url=https://web.archive.org/web/20140222232949/http://diabetes.diabetesjournals.org/content/18/8/517.full.pdf |archive-date=2014-02-22 |access-date=2014-02-11}}{{cite journal |vauthors=Shelmet JJ, Reichard GA, Skutches CL, Hoeldtke RD, Owen OE, Boden G |date=April 1988 |title=Ethanol causes acute inhibition of carbohydrate, fat, and protein oxidation and insulin resistance |journal=The Journal of Clinical Investigation |volume=81 |issue=4 |pages=1137–1145 |doi=10.1172/JCI113428 |pmc=329642 |pmid=3280601}} This excess processing in the liver acetyl CoA can lead to fatty liver disease and eventually alcoholic liver disease. This progression can lead to further complications, alcohol-related liver disease may cause exocrine pancreatic insufficiency, the inability to properly digest food due to a lack or reduction of digestive enzymes made by the pancreas.{{cite journal | vauthors = Leeds JS, Oppong K, Sanders DS | title = The role of fecal elastase-1 in detecting exocrine pancreatic disease | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 8 | issue = 7 | pages = 405–415 | date = May 2011 | pmid = 21629239 | doi = 10.1038/nrgastro.2011.91 }}

{{Main|Health effects of alcohol|Alcoholism#Moderate drinking}}

{{See also|Health effects of wine}}

File:Deaths from alcohol and drug use disorders, OWID.svg and drug use disorders.]]

Alcohol has a variety of short-term and long-term adverse effects. Alcohol has both short-term, and long-term effects on the memory, and sleep. It also has reinforcement-related adverse effects, including alcoholism, dependence, and withdrawal. Alcohol use is directly related to considerable morbidity and mortality, for instance due to intoxication and alcohol-related health problems.{{cite book | vauthors = Friedman HS |title=The Oxford Handbook of Health Psychology |url=https://books.google.com/books?id=J3-78PdF83kC&pg=PA699|date=26 August 2011|publisher=Oxford University Press, USA|isbn=978-0-19-534281-9 |pages=699–}} The World Health Organization advises that there is no safe level of alcohol consumption. Many of the toxic and unpleasant actions of alcohol in the body are mediated by its carcinogenic byproduct acetaldehyde.{{cite book | vauthors = Burcham PC | title=An Introduction to Toxicology|url=https://books.google.com/books?id=qH-8BAAAQBAJ&pg=PA42|date=19 November 2013|publisher=Springer Science & Business Media|isbn=978-1-4471-5553-9|pages=42–}}

{{Main|Short-term effects of alcohol consumption|Subjective response to alcohol}}

File:Symptoms of BAC, 0.02% to 0.50% concentration.svg

The amount of ethanol in the body is typically quantified by blood alcohol content (BAC); weight of ethanol per unit volume of blood. Small doses of ethanol, in general, are stimulant-like{{cite book | vauthors = Hendler RA, Ramchandani VA, Gilman J, Hommer DW | title = Behavioral Neurobiology of Alcohol Addiction | chapter = Stimulant and sedative effects of alcohol | series = Current Topics in Behavioral Neurosciences| volume = 13 | pages = 489–509 | year = 2013 | pmid = 21560041 | doi = 10.1007/7854_2011_135 | isbn = 978-3-642-28719-0 }} and produce euphoria and relaxation; people experiencing these symptoms tend to become talkative and less inhibited, and may exhibit poor judgement. At higher dosages (BAC > 1 gram/liter), ethanol acts as a central nervous system (CNS) depressant, producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death.

File:Pohmelye.jpg

{{main|Hangover}}

A hangover is the experience of various unpleasant physiological and psychological effects usually following the consumption of alcohol, such as wine, beer, and liquor. Hangovers can last for several hours or for more than 24 hours. Typical symptoms of a hangover may include headache, drowsiness, concentration problems, dry mouth, dizziness, fatigue, gastrointestinal distress (e.g., nausea, vomiting, diarrhea), absence of hunger, light sensitivity, depression, sweating, hyper-excitability, irritability, and anxiety (often referred to as "hangxiety").{{cite journal | vauthors = Stephens R, Ling J, Heffernan TM, Heather N, Jones K | title = A review of the literature on the cognitive effects of alcohol hangover | journal = Alcohol and Alcoholism | volume = 43 | issue = 2 | pages = 163–170 | date = 23 January 2008 | pmid = 18238851 | doi = 10.1093/alcalc/agm160 | doi-access = free }}{{Cite web |publisher=The State of Queensland |department=Queensland Health |date=2023-07-26 |title=Hangxiety: why alcohol can leave you feeling anxious |url=https://www.health.qld.gov.au/newsroom/features/hangxiety-why-alcohol-can-leave-you-feeling-anxious |access-date=2024-10-02 |website=Queensland Health |language=en-AU}}

{{Main|Long-term effects of alcohol}}

The long-term effects of alcohol have been extensively researched. The health effects of long-term alcohol consumption vary depending on the amount consumed. Even light drinking poses health risks,{{cite web |date=4 January 2023 |title=No level of alcohol consumption is safe for our health |url=https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health |website=World Health Organization |language=en |access-date=2025-04-23}} but atypically small amounts of alcohol may have health benefits.{{cite journal | vauthors = Bryazka D, Reitsma MB, Griswold MG, Abate KH, Abbafati C, Abbasi-Kangevari M, etal | collaboration = GBD 2020 Alcohol Collaboration|title=Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020 |journal=The Lancet |date=July 2022 |volume=400 |issue=10347 |pages=185–235 |doi=10.1016/S0140-6736(22)00847-9|pmid=35843246 |pmc=9289789 }} Alcoholism causes severe health consequences which outweigh any potential benefits.{{cite journal|author=National Institute on Alcohol Abuse and Alcoholism (NIAAA)|title=Health risks and benefits of alcohol consumption|journal=Alcohol Res Health|volume=24|issue=1|pages=5–11|year=2000|pmid=11199274|pmc=6713002|url=http://pubs.niaaa.nih.gov/publications/arh24-1/05-11.pdf|doi=10.4135/9781412963855.n839|isbn=9781412941860|access-date=2006-07-31|archive-date=2020-11-11|archive-url=https://web.archive.org/web/20201111230707/https://pubs.niaaa.nih.gov/publications/arh24-1/05-11.pdf|url-status=dead}}

Long-term alcohol consumption is capable of damaging nearly every organ and system in the body.{{cite book| veditors = Caan W, de Belleroche J |title=Drink, Drugs and Dependence: From Science to Clinical Practice|url=https://archive.org/details/drinkdrugsdepende00caan|url-access=registration|edition=1st|date=11 April 2002 |publisher=Routledge |isbn=978-0-415-27891-1 |pages=[https://archive.org/details/drinkdrugsdepende00caan/page/19 19]–20}} Risks include malnutrition, cirrhosis, chronic pancreatitis, erectile dysfunction, hypertension, coronary heart disease, ischemic stroke, heart failure, atrial fibrillation, gastritis, stomach ulcers, alcoholic liver disease,{{cite journal|author=Cargiulo T|title=Understanding the health impact of alcohol dependence|journal=Am J Health Syst Pharm|volume=64|issue=5 Suppl 3|pages=S5–11|date=March 2007|pmid=17322182|doi=10.2146/ajhp060647}} certain types of dementia, and several types of cancer, including oropharyngeal cancer, esophageal cancer, liver cancer, colorectal cancer, and female breast cancers.{{cite web|url=https://www.scientificamerican.com/article/alcohol-consumption-increases-risk-of-breast-and-other-cancers-doctors-say/|title=Alcohol Consumption Increases Risk of Breast and Other Cancers, Doctors Say|author= Cheryl Platzman Weinstock|publisher=Scientific American|date=8 November 2017|access-date=13 November 2018|quote=In fact, alcohol consumption is known to increase the risk of several cancers, including head and neck, esophageal, liver, colorectal and female breast cancers.}} In addition, damage to the central nervous system and peripheral nervous system (e.g., painful peripheral neuropathy) can occur from chronic heavy alcohol consumption.{{cite journal|vauthors=Müller D, Koch RD, von Specht H, Völker W, Münch EM|title=Neurophysiologic findings in chronic alcohol abuse|language=de|journal=Psychiatr Neurol Med Psychol (Leipz)|volume=37|issue=3|pages=129–132|date=1985|pmid=2988001}}{{cite journal|author=Testino G|title=Alcoholic diseases in hepato-gastroenterology: a point of view |journal=Hepatogastroenterology |volume=55 |issue=82–83 |pages=371–377 |year=2008 |pmid=18613369}} There is also an increased risk for accidental injuries, for example, those sustained in traffic accidents and falls. Excessive alcohol consumption can have a negative impact on aging.{{cite journal|author=Stevenson JS|title=Alcohol use, misuse, abuse, and dependence in later adulthood|journal=Annu Rev Nurs Res|volume=23|pages=245–280|year=2005|pmid=16350768|doi=10.1891/0739-6686.23.1.245|s2cid=24586529}}

Conversely, light intake of alcohol may have some beneficial effects. The association of alcohol intake with reduced cardiovascular risk has been noted since 1904{{cite journal |author=Cabot, R.C. |title=The relation of alcohol to arteriosclerosis |journal=Journal of the American Medical Association |year=1904 |volume=43 |issue=12 |pages=774–775|doi=10.1001/jama.1904.92500120002a |url=https://zenodo.org/record/1447273 }} and remains even after adjusting for known confounders. Light alcohol intake is also associated with reduced risk of type 2 diabetes,{{cite journal |vauthors=Schrieks IC, Heil AL, Hendriks HF, Mukamal KJ, Beulens JW |title=The effect of alcohol consumption on insulin sensitivity and glycemic status: a systematic review and meta-analysis of intervention studies |journal=Diabetes Care |volume=38 |issue=4 |pages=723–732 |date=2015 |pmid=25805864 |doi=10.2337/dc14-1556 |s2cid=32005728 |doi-access=free }} gastritis, and cholelithiasis.{{cite journal|vauthors=Taylor B, Rehm J, Gmel G |title=Moderate alcohol consumption and the gastrointestinal tract |journal=Dig Dis |volume=23 |issue=3–4 |pages=170–176 |year=2005 |pmid=16508280 |doi=10.1159/000090163|s2cid=30141003 }} However, these are only observational studies and high-quality evidence for the beneficial effects of alcohol is nonexistent.{{cite journal | vauthors = Fekjær HO | title = Alcohol-a universal preventive agent? A critical analysis | journal = Addiction | volume = 108 | issue = 12 | pages = 2051–2057 | date = December 2013 | pmid = 23297738 | doi = 10.1111/add.12104 | doi-access = free }}

{{Further|Alcohol-related crime}}

File:HarmCausedByDrugsTable.svg study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was rated to be the 4th most harmful drug to users, the drug most harmful to others, and the most harmful drug overall.{{cite journal | vauthors = Nutt DJ, King LA, Phillips LD | title = Drug harms in the UK: a multicriteria decision analysis | journal = Lancet | volume = 376 | issue = 9752 | pages = 1558–65 | date = November 2010 | pmid = 21036393 | doi = 10.1016/S0140-6736(10)61462-6 | s2cid = 5667719 | citeseerx = 10.1.1.690.1283 }}]]

Alcohol causes a plethora of detrimental effects in society.{{cite book |author2-link=Jill M. Hooley | vauthors = Butcher JN, Hooley JM, Mineka SM |title=Abnormal Psychology|url=https://books.google.com/books?id=_aksAAAAQBAJ&pg=PA370|date=25 June 2013 |publisher=Pearson Education|isbn=978-0-205-97175-6|page=370}} Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational substances. Alcohol was ranked 6th in dependence, 11th in physical harm, and 2nd in social harm.{{cite journal | vauthors = Nutt D, King LA, Saulsbury W, Blakemore C | title = Development of a rational scale to assess the harm of drugs of potential misuse | journal = Lancet | volume = 369 | issue = 9566 | pages = 1047–53 | date = March 2007 | pmid = 17382831 | doi = 10.1016/s0140-6736(07)60464-4 | s2cid = 5903121 }} Alcohol use is stereotypically associated with crime, more so than other drugs like marijuana. Many emergency room visits involve alcohol use. As many as 15% of employees show problematic alcohol-related behaviors in the workplace, such as drinking before going to work or even drinking on the job. Drunk dialing refers to an intoxicated person making phone calls that they would not likely make if sober. Alcohol availability and consumption rates and alcohol rates are positively associated with nuisance, loitering, panhandling, and disorderly conduct in open spaces.{{cite encyclopedia | vauthors = Sunga HE |chapter=Alcohol and Crime|date=2016|encyclopedia=The Blackwell Encyclopedia of Sociology|pages=1–2|publisher=American Cancer Society|doi=10.1002/9781405165518.wbeosa039.pub2|isbn=9781405165518}}

{{main|Binge drinking}}

Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages with an intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. Specific definitions vary considerably.{{cite journal | vauthors = Renaud SC | title = Diet and stroke | journal = The Journal of Nutrition, Health & Aging | volume = 5 | issue = 3 | pages = 167–172 | year = 2001 | pmid = 11458287 }} Binge drinking is associated with risks such as suicide, sexual assault, cardiovascular issues, and brain damage, more acutely than alcohol use in general.

[[File:Alcohol use disorders world map-Deaths per million persons-WHO2012.svg|thumb|left|Alcohol use disorders deaths per million persons in 2012

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{{Main|Alcoholism|Alcoholism in adolescence|Alcoholism in family systems}}

Alcoholism or its medical diagnosis alcohol use disorder refers to alcohol addiction, alcohol dependence, dipsomania, and/or alcohol abuse. It is a major problem and many health problems as well as death can result from excessive alcohol use. Alcohol dependence is linked to a lifespan that is reduced by about 12 years relative to the average person. In 2004, it was estimated that 4% of deaths worldwide were attributable to alcohol use. Deaths from alcohol are split about evenly between acute causes (e.g., overdose, accidents) and chronic conditions. The leading chronic alcohol-related condition associated with death is alcoholic liver disease. Alcohol dependence is also associated with cognitive impairment and organic brain damage. Some researchers have found that even one alcoholic drink a day increases an individual's risk of health problems by 0.4%.{{Cite news |url= https://www.nytimes.com/2018/08/27/health/alcohol-drinking-health.html |title=How Much Alcohol Is Safe to Drink? None, Say These Researchers|newspaper=The New York Times |date=27 August 2018 |access-date=2018-09-17|language=en| vauthors = Bakalar N }}

Two or more consecutive alcohol-free days a week have been recommended to improve health and break dependence.{{cite news | vauthors = Tomlinson A |title=Tips and Tricks on How to Cut Down on the Booze |url=https://thewest.com.au/lifestyle/health-wellbeing/tips-and-tricks-on-how-to-cut-down-on-the-booze-ng-b88782698z |access-date=22 March 2019 |work=The West Australian |publisher=Seven West Media (WA) |date=26 June 2018}}{{cite web |title=Alcohol |url=https://www.britishlivertrust.org.uk/liver-information/looking-after-your-liver/alcohol/ |publisher=British Liver Trust |access-date=22 March 2019 |archive-date=11 July 2019 |archive-url=https://web.archive.org/web/20190711180415/https://www.britishlivertrust.org.uk/liver-information/looking-after-your-liver/alcohol/ }}

File:Boite de librax44.jpg (trade name Librium) is the most commonly used benzodiazepine for alcohol detoxification.{{cite journal |vauthors=Ashworth M, Gerada C |date=August 1997 |title=ABC of mental health. Addiction and dependence – II: Alcohol |journal=BMJ |volume=315 |issue=7104 |pages=358–360 |doi=10.1136/bmj.315.7104.358 |pmc=2127236 |pmid=9270461}}]]

{{Main|Alcohol withdrawal syndrome|Alcoholic hallucinosis|Delirium tremens|Substance-induced psychosis}}

Discontinuation of alcohol after extended heavy use and associated tolerance development (resulting in dependence) can result in alcohol withdrawal. Alcohol is one of the more dangerous drugs to withdraw from.{{cite book |title=Encyclopedia of substance abuse prevention, treatment, & recovery |date=2009 |publisher=SAGE |isbn=978-1-4522-6601-5 |veditors=Fisher GL, Roget NA |location=Los Angeles |page=1005 |chapter=Withdrawal: Alcohol |chapter-url=https://books.google.com/books?id=DFR2AwAAQBAJ&pg=PT1059 |archive-url=https://web.archive.org/web/20151222091556/https://books.google.ca/books?id=DFR2AwAAQBAJ&pg=PT1059 |archive-date=2015-12-22 |url-status=live}} Alcohol withdrawal can cause confusion, paranoia, anxiety, insomnia, agitation, tremors, fever, nausea, vomiting, autonomic dysfunction, seizures, and hallucinations. In severe cases, death can result.{{Citation needed|date=March 2025}}

Delirium tremens is a condition of people with a long history of heavy drinking that requires undertaking an alcohol detoxification regimen.{{Citation needed|date=March 2025}}

File:Number of deaths from substance use disorders, OWID.svg

{{Main|Alcohol intoxication}}

Symptoms of ethanol overdose may include nausea, vomiting, CNS depression, coma, acute respiratory failure, or death. Levels of even less than 0.1% can cause intoxication, with unconsciousness often occurring at 0.3–0.4%. Death from ethanol consumption is possible when blood alcohol levels reach 0.4%. A blood level of 0.5% or more is commonly fatal. The oral median lethal dose (LD₅₀) of ethanol in rats is 5,628 mg/kg. Directly translated to human beings, this would mean that if a person who weighs {{cvt|70|kg}} drank a {{cvt|500|mL|USoz}} glass of pure ethanol, they would theoretically have a 50% risk of dying. The highest blood alcohol level ever recorded, in which the subject survived, is 1.41%.{{Cite web |title=Drunkest driver in SA arrested |url=https://www.sowetanlive.co.za/news/2010-12-24-drunkest-driver-in-sa-arrested/ |access-date=2024-04-12 |website=SowetanLIVE |language=en-ZA}}

{{Main|Dose dumping}}

Alcohol-induced dose dumping (AIDD) is an unintended rapid release of large amounts of a given drug, when administered through a modified-release dosage while co-ingesting ethanol.{{Cite journal | vauthors = D'Souza S, Mayock S, Salt A |date=December 2017 |title=A review of in vivo and in vitro aspects of alcohol-induced dose dumping |journal=AAPS Open |language=en |volume=3 |issue=1 |doi=10.1186/s41120-017-0014-9 |issn=2364-9534|doi-access=free }} This is considered a pharmaceutical disadvantage due to the high risk of causing drug-induced toxicity by increasing the absorption and serum concentration above the therapeutic window of the drug. The best way to prevent this interaction is by avoiding the co-ingestion of both substances or using specific controlled-release formulations that are resistant to AIDD. Particular drugs of concern are antipsychotics and certain antidepressants.{{cite journal|url=http://my.lecom.edu/library/internetresources/journal%20articles/Acute%20Care%20for%20Alcohol%20Intoxication.pdf|archive-url=https://web.archive.org/web/20101214113109/http://my.lecom.edu/library/internetresources/journal%20articles/Acute%20Care%20for%20Alcohol%20Intoxication.pdf|archive-date=14 December 2010|title=Acute care for alcohol intoxication|journal=Postgraduate Medicine Online| vauthors = Yost DA |volume=112|issue=6|year=2002|access-date=29 September 2007}}

File:Sekakaytto2.JPG often involve alcohol.]]

Alcohol can intensify the sedation caused by hypnotics and sedatives such as barbiturates, benzodiazepines, sedative antihistamines, opioids, nonbenzodiazepines/Z-drugs (such as zolpidem and zopiclone).

{{Main|Disulfiram-like drug}}

Disulfiram inhibits the enzyme acetaldehyde dehydrogenase, which in turn results in buildup of acetaldehyde, a toxic metabolite of ethanol with unpleasant effects. The medication or drug is commonly used to treat alcohol use disorder, and results in immediate hangover-like symptoms upon consumption of alcohol, this effect is widely known as disulfiram effect.

Metronidazole is an antibacterial agent that kills bacteria by damaging cellular DNA and hence cellular function.Repchinsky C (ed.) (2012). Compendium of pharmaceuticals and specialties, Ottawa: Canadian Pharmacists Association.{{full citation needed|date=February 2014}} Metronidazole is usually given to people who have diarrhea caused by Clostridioides difficile bacteria. Patients who are taking metronidazole are sometimes advised to avoid alcohol, even after 1 hour following the last dose. Although older data suggested a possible disulfiram-like effect of metronidazole, newer data has challenged this and suggests it does not actually have this effect.

The concomitant use of NSAIDs with alcohol and/or tobacco products significantly increases the already elevated risk of peptic ulcers during NSAID therapy.{{cite journal | vauthors = Agrawal N | title = Risk factors for gastrointestinal ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) | journal = The Journal of Family Practice | volume = 32 | issue = 6 | pages = 619–624 | date = June 1991 | pmid = 2040888 }}{{Better source needed|reason=The current source is old (1996) and only an abstract is available for it, making it impossible to verify its claims|date=March 2024}}

The risk of stomach bleeding is still increased when aspirin is taken with alcohol or warfarin.{{cite web |url=https://www.drugs.com/aspirin.html |title=Aspirin information from Drugs.com |publisher=Drugs.com |access-date=8 May 2008 |url-status=live |archive-url=https://web.archive.org/web/20080509163105/http://www.drugs.com/aspirin.html |archive-date=9 May 2008}}{{cite web |url=http://www.personalmd.com/drgdb/3.htm |archive-url=https://web.archive.org/web/20000918231717/http://personalmd.com/drgdb/3.htm |archive-date=18 September 2000 |title=Oral Aspirin information |access-date=8 May 2008 |publisher=First DataBank }}

Ethanol enhances the bioavailability of methylphenidate (elevated plasma dexmethylphenidate).{{cite journal | vauthors = Patrick KS, Straughn AB, Minhinnett RR, Yeatts SD, Herrin AE, DeVane CL, Malcolm R, Janis GC, Markowitz JS | title = Influence of ethanol and gender on methylphenidate pharmacokinetics and pharmacodynamics | journal = Clinical Pharmacology and Therapeutics | volume = 81 | issue = 3 | pages = 346–353 | date = March 2007 | pmid = 17339864 | pmc = 3188424 | doi = 10.1038/sj.clpt.6100082 }} Ethylphenidate formation appears to be more common when large quantities of methylphenidate and alcohol are consumed at the same time, such as in non-medical use or overdose scenarios.{{cite journal | vauthors = Markowitz JS, Logan BK, Diamond F, Patrick KS | title = Detection of the novel metabolite ethylphenidate after methylphenidate overdose with alcohol coingestion | journal = Journal of Clinical Psychopharmacology | volume = 19 | issue = 4 | pages = 362–366 | date = August 1999 | pmid = 10440465 | doi = 10.1097/00004714-199908000-00013 }} However, only a small percent of the consumed methylphenidate is converted to ethylphenidate.{{cite journal | vauthors = Markowitz JS, DeVane CL, Boulton DW, Nahas Z, Risch SC, Diamond F, Patrick KS | title = Ethylphenidate formation in human subjects after the administration of a single dose of methylphenidate and ethanol | journal = Drug Metabolism and Disposition | volume = 28 | issue = 6 | pages = 620–624 | date = June 2000 | doi = 10.1016/S0090-9556(24)15139-2 | pmid = 10820132 }}

{{Main|Nicotini}}

While nicotinis mimic the name of classic cocktails like the appletini (their name deriving from "martini"), combining nicotine with alcohol is a bad idea. Tobacco and nicotine actually heighten cravings for alcohol, making this a risky mix.{{cite journal | vauthors = Verplaetse TL, McKee SA | title = An overview of alcohol and tobacco/nicotine interactions in the human laboratory | journal = The American Journal of Drug and Alcohol Abuse | volume = 43 | issue = 2 | pages = 186–196 | date = March 2017 | pmid = 27439453 | pmc = 5588903 | doi = 10.1080/00952990.2016.1189927 }}

{{main|Caffeinated alcoholic drink}}

Controlled animal and human studies showed that caffeine (energy drinks) in combination with alcohol increased the craving for more alcohol more strongly than alcohol alone.{{cite journal | vauthors = Curran CP, Marczinski CA | title = Taurine, caffeine, and energy drinks: Reviewing the risks to the adolescent brain | journal = Birth Defects Research | volume = 109 | issue = 20 | pages = 1640–1648 | date = December 2017 | pmid = 29251842 | pmc = 5737830 | doi = 10.1002/bdr2.1177 }} These findings correspond to epidemiological data that people who consume energy drinks generally showed an increased tendency to take alcohol and other substances.{{cite journal | vauthors = Arria AM, Caldeira KM, Kasperski SJ, O'Grady KE, Vincent KB, Griffiths RR, Wish ED | title = Increased alcohol consumption, nonmedical prescription drug use, and illicit drug use are associated with energy drink consumption among college students | journal = Journal of Addiction Medicine | volume = 4 | issue = 2 | pages = 74–80 | date = June 2010 | pmid = 20729975 | pmc = 2923814 | doi = 10.1097/ADM.0b013e3181aa8dd4 }}{{cite web |title=Energy drinks and risk to future substance use |url=https://www.drugabuse.gov/news-events/news-releases/2017/08/energy-drinks-risk-to-future-substance-use |website=www.drugabuse.gov |publisher=National Institute on Drug Abuse |access-date=29 March 2019 |language=en |date=8 August 2017 |archive-date=18 February 2020 |archive-url=https://web.archive.org/web/20200218230546/https://www.drugabuse.gov/news-events/news-releases/2017/08/energy-drinks-risk-to-future-substance-use }}

{{main|Coca wine}}

File:Peruvian Wine of Coca.png

Ethanol interacts with cocaine in vivo to produce cocaethylene, another psychoactive substance which may be substantially more cardiotoxic than either cocaine or alcohol by themselves.{{cite journal |vauthors=Laizure SC, Mandrell T, Gades NM, Parker RB |title=Cocaethylene metabolism and interaction with cocaine and ethanol: role of carboxylesterases |journal=Drug Metabolism and Disposition |volume=31 |issue=1 |pages=16–20 |date=January 2003 |pmid=12485948 |doi=10.1124/dmd.31.1.16}}{{cite journal |vauthors=Pergolizzi J, Breve F, Magnusson P, LeQuang JA, Varrassi G |title=Cocaethylene: When Cocaine and Alcohol Are Taken Together |journal=Cureus |volume=14 |issue=2 |date=February 2022 |pages=e22498 |pmid=35345678 |pmc=8956485 |doi=10.7759/cureus.22498 |doi-access=free}}

In combination with cannabis, ethanol increases plasma tetrahydrocannabinol levels, which suggests that ethanol may increase the absorption of tetrahydrocannabinol.{{cite journal | vauthors = Lukas SE, Orozco S | title = Ethanol increases plasma Delta(9)-tetrahydrocannabinol (THC) levels and subjective effects after marihuana smoking in human volunteers | journal = Drug and Alcohol Dependence | volume = 64 | issue = 2 | pages = 143–9 | date = October 2001 | pmid = 11543984 | doi = 10.1016/S0376-8716(01)00118-1 }}

{{main|Warfarin}}

Excessive use of alcohol is known to affect the metabolism of warfarin and can elevate the INR, and thus increase the risk of bleeding.{{cite journal | vauthors = Weathermon R, Crabb DW | title = Alcohol and medication interactions | journal = Alcohol Research & Health | volume = 23 | issue = 1 | pages = 40–54 | year = 1999 | pmid = 10890797 | pmc = 6761694 }} The U.S. Food and Drug Administration (FDA) product insert on warfarin states that alcohol should be avoided.{{cite web |title = PRODUCT INFORMATION COUMADIN |work = TGA eBusiness Services |publisher = Aspen Pharma Pty Ltd |date = 19 January 2010 |access-date = 11 December 2013 |url = https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-02588-3 |format = PDF |url-status = live |archive-url = https://web.archive.org/web/20151017135417/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-02588-3 |archive-date = 17 October 2015 }} The Cleveland Clinic suggests that when taking warfarin one should not drink more than "one beer, 6 oz of wine, or one shot of alcohol per day".{{cite web|url=https://my.clevelandclinic.org/health/drugs/16182-warfarin-a-blood-thinning-drug-what-you-need-to-know-|title=Warfarin Anticoagulant Medication|access-date=30 June 2020|archive-date=1 July 2020|archive-url=https://web.archive.org/web/20200701125620/https://my.clevelandclinic.org/health/drugs/16182-warfarin-a-blood-thinning-drug-what-you-need-to-know-|url-status=live}}

{{main|Isoniazid}}

Use of isoniazid should be carefully monitored in daily alcohol drinkers since they may be more likely to develop isoniazid-associated hepatitis.{{cite web | title=Isoniazid tablet | website=DailyMed | date=18 October 2018 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1553312b-ed76-421c-a055-2579bdcf366c | archive-url=https://web.archive.org/web/20190313234259/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1553312b-ed76-421c-a055-2579bdcf366c | archive-date=13 March 2019 | url-status=live | access-date=24 January 2020 }}{{cite journal | vauthors = Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, Nolan CM, Peloquin CA, Gordin FM, Nunes D, Strader DB, Bernardo J, Venkataramanan R, Sterling TR | title = An official ATS statement: hepatotoxicity of antituberculosis therapy | journal = American Journal of Respiratory and Critical Care Medicine | volume = 174 | issue = 8 | pages = 935–952 | date = October 2006 | pmid = 17021358 | doi = 10.1164/rccm.200510-1666ST | s2cid = 36384722}}

{{Main|Pharmacology of ethanol}}

File:Ethanol and GABA Receptor.png

Alcohol works in the brain primarily by increasing the effects of γ-Aminobutyric acid (GABA),{{cite journal |vauthors=Lobo IA, Harris RA |title=GABA(A) receptors and alcohol |journal=Pharmacology Biochemistry and Behavior |volume=90 |issue=1 |pages=90–94 |date=July 2008 |pmid=18423561 |pmc=2574824 |doi=10.1016/j.pbb.2008.03.006}} the major inhibitory neurotransmitter in the brain; by facilitating GABA's actions in the GABA_A receptor, alcohol suppresses the activity of the central nervous system. Alcohol also directly affects a number of other neurotransmitter systems including those of glutamate, glycine, acetylcholine, and serotonin.{{cite journal |vauthors=Narahashi T, Kuriyama K, Illes P, Wirkner K, Fischer W, Mühlberg K, Scheibler P, Allgaier C, Minami K, Lovinger D, Lallemand F, Ward RJ, DeWitte P, Itatsu T, Takei Y, Oide H, Hirose M, Wang XE, Watanabe S, Tateyama M, Ochi R, Sato N |title=Neuroreceptors and ion channels as targets of alcohol |journal=Alcoholism: Clinical and Experimental Research |volume=25 |issue=5 Suppl ISBRA |pages=182S–188S |date=May 2001 |pmid=11391069 |doi=10.1097/00000374-200105051-00030}}{{cite journal | vauthors = Olsen RW, Li GD, Wallner M, Trudell JR, Bertaccini EJ, Lindahl E, Miller KW, Alkana RL, Davies DL | title = Structural models of ligand-gated ion channels: sites of action for anesthetics and ethanol | journal = Alcoholism: Clinical and Experimental Research | volume = 38 | issue = 3 | pages = 595–603 | date = March 2014 | pmid = 24164436 | pmc = 3959612 | doi = 10.1111/acer.12283 }} The pleasurable effects of alcohol ingestion are the result of increased levels of dopamine and endogenous opioids in the reward pathways of the brain.{{cite book | vauthors = Charlet K, Beck A, Heinz A | title = Behavioral Neurobiology of Alcohol Addiction | chapter = The dopamine system in mediating alcohol effects in humans | series = Current Topics in Behavioral Neurosciences| volume = 13 | pages = 461–88 | year = 2013 | pmid = 21533679 | doi = 10.1007/7854_2011_130 | isbn = 978-3-642-28719-0 }}{{cite journal | vauthors = Méndez M, Morales-Mulia M | title = Role of mu and delta opioid receptors in alcohol drinking behaviour | journal = Current Drug Abuse Reviews | volume = 1 | issue = 2 | pages = 239–52 | date = June 2008 | pmid = 19630722 | doi = 10.2174/1874473710801020239 }}

After oral ingestion, ethanol is absorbed via the stomach and intestines into the bloodstream. Ethanol is highly water-soluble and diffuses passively throughout the entire body, including the brain. Soon after ingestion, it begins to be metabolized, 90% or more by the liver. One standard drink is sufficient to almost completely saturate the liver's capacity to metabolize alcohol. The main metabolite is acetaldehyde, a toxic carcinogen. Acetaldehyde is then further metabolized into ionic acetate by the enzyme aldehyde dehydrogenase (ALDH). Acetate is not carcinogenic and has low toxicity,{{cite web |title=Acetate, Ion chromatography standard solution, Safety Data Sheet |url=https://assets.thermofisher.com/DirectWebViewer/private/document.aspx?prd=ALFAA42563~~PDF~~MTR~~AGHS~~EN~~2024-04-01%2013:42:53~~Acetate%20%20Ion%20chromatography%20standard%20solution%20%20Specpure%c2%ae%20%20CH3CO2(1- |publisher=Thermo Fisher Scientific |page=4 |date=1 Apr 2024}} but has been implicated in causing hangovers.{{cite journal | vauthors = Maxwell CR, Spangenberg RJ, Hoek JB, Silberstein SD, Oshinsky ML | title = Acetate causes alcohol hangover headache in rats | journal = PLOS ONE | volume = 5 | issue = 12 | pages = e15963 | date = December 2010 | pmid = 21209842 | pmc = 3013144 | doi = 10.1371/journal.pone.0015963 | bibcode = 2010PLoSO...515963M | doi-access = free }}{{cite web | url = https://www.newscientist.com/article/dn19942-is-coffee-the-real-cure-for-a-hangover.html | title = Is coffee the real cure for a hangover? | vauthors = Holmes B | work = New Scientist | date = 15 January 2011 | pages = 17 }} Acetate is further broken down into carbon dioxide and water and eventually eliminated from the body through urine and breath. 5 to 10% of ethanol is excreted unchanged in the breath, urine, and sweat.

{{Main|Ethanol|Ethanol (data page)}}

{{See also|Alcohol (chemistry)}}

Ethanol is also known chemically as alcohol, ethyl alcohol, or drinking alcohol. It is a simple alcohol with a molecular formula of C₂H₆O and a molecular weight of 46.0684 g/mol. The molecular formula of ethanol may also be written as CH₃−CH₂−OH or as C₂H₅−OH. The latter can also be thought of as an ethyl group linked to a hydroxyl (alcohol) group and can be abbreviated as EtOH. Ethanol is a volatile, flammable, colorless liquid with a slight characteristic odor. Aside from its use as a psychoactive and recreational substance, ethanol is also commonly used as an antiseptic and disinfectant, a chemical and medicinal solvent, and a fuel.

{{See also|Comparison of psychoactive alcohols in alcoholic drinks|Fusel alcohol|Congener (beverages)|Surrogate alcohol}}

File:Lukastest etoh tbutoh.JPG: negative (left) with ethanol and positive with t-butanol.]]

Ethanol is only one of several types of chemical alcohols, and has a variety of analogues. Most other alcohols are considered poisonous. In general, higher alcohols are less toxic. Alcoholic beverages are sometimes laced with toxic alcohols.

The toxicity of isopropyl alcohol is about twice that of ethanol;{{cite book | vauthors = Philp RB |title=Ecosystems and Human Health: Toxicology and Environmental Hazards, Third Edition|url=https://books.google.com/books?id=rcuhCgAAQBAJ&pg=PA216|date=15 September 2015|publisher=CRC Press|isbn=978-1-4987-6008-9|pages=216–}}

a mild, brief exposure to isopropyl alcohol is unlikely to cause any serious harm, although ingesting significant quantities can lead to vomiting, abdominal pain, and internal bleeding. Methanol is the most toxic alcohol and can cause blindness or death even in small quantities, as little as 10–15 milliliters (2–3 teaspoons).{{citation needed|date=June 2023}} Many methanol poisoning incidents have occurred through history. n-Butanol is reported to produce similar effects to those of ethanol and relatively low toxicity (one-sixth of that of ethanol in one rat study).{{SIDS-ref | name = n-Butanol | id = 71363 | date = April 2005}}.{{cite journal | vauthors = McCreery MJ, Hunt WA | title = Physico-chemical correlates of alcohol intoxication | journal = Neuropharmacology | volume = 17 | issue = 7 | pages = 451–61 | date = July 1978 | pmid = 567755 | doi = 10.1016/0028-3908(78)90050-3 | s2cid = 19914287 }} However, its vapors can produce eye irritation and inhalation can cause pulmonary edema. Acetone (propanone) is a ketone rather than an alcohol, and is reported to produce similar toxic effects; it can be extremely damaging to the cornea.

Although ethanol is the most prevalent alcohol in alcoholic beverages, alcoholic beverages contain several types of psychoactive alcohols, that are categorized as primary, secondary, or tertiary. Primary, and secondary alcohols, are oxidized to aldehydes, and ketones, respectively, while tertiary alcohols are generally resistant to oxidation.{{cite web | vauthors = Clark J, Farmer S, Kennepohl D, Kabrhel J, Ashenhurst J, Ashenhurst J |title=17.7: Oxidation of Alcohols |url=https://chem.libretexts.org/Bookshelves/Organic_Chemistry/Organic_Chemistry_(Morsch_et_al.)/17%3A_Alcohols_and_Phenols/17.07%3A_Oxidation_of_Alcohols |website=Chemistry LibreTexts |language=en |date=26 August 2015}} The Lucas test differentiates between primary, secondary, and tertiary alcohols. The tertiary alcohol tert-amyl alcohol (TAA), also known as 2-methylbutan-2-ol (2M2B), has a history of use as a hypnotic and anesthetic, as do other tertiary alcohols such as methylpentynol, ethchlorvynol, and chloralodol. Unlike primary alcohols like ethanol, these tertiary alcohols cannot be oxidized into aldehyde or carboxylic acid metabolites, which are often toxic, and for this reason, these compounds are safer in comparison.{{cite book | vauthors = Carey F | title = Organic Chemistry | edition = 4 | url = https://archive.org/details/organicchemistr000care | access-date = 5 February 2013 | isbn = 0-07-290501-8 | year = 2000 | publisher = McGraw-Hill }} Other relatives of ethanol with similar effects include chloral hydrate, paraldehyde, and many volatile and inhalational anesthetics (e.g., chloroform, diethyl ether, and isoflurane).

{{Further|Ethanol#Production|Brewing|Winemaking|Distillation}}

Ethanol is produced naturally as a byproduct of the metabolic processes of yeast and hence is present in any yeast habitat, including even endogenously in humans, but it does not cause raised blood alcohol content as seen in the rare medical condition auto-brewery syndrome (ABS). It is manufactured through hydration of ethylene or by brewing via fermentation of sugars with yeast (most commonly Saccharomyces cerevisiae). The sugars are commonly obtained from sources like steeped cereal grains (e.g., barley), grape juice, and sugarcane products (e.g., molasses, sugarcane juice). Ethanol–water mixture which can be further purified via distillation.

File:Parable of the Good Samaritan (detail) by Cornelis van Haarlem.jpg (1627) showing the Samaritan pouring oil and wine on the injured man's wounds]]

{{Main|Alcoholic drink#History}}

{{for|evidence of fermented drinks found in ancient civilizations|History of alcoholic drinks}}

Alcohol is one of the oldest recreational drugs. Alcoholic beverages have been produced since the Neolithic period, as early as 7000 BC in China.{{cite book | vauthors = Vidrih R, Hribar J | chapter = Mead: The Oldest Alcoholic Beverage |date=2016 | title = Traditional Foods |pages=325–338 | veditors = Kristbergsson K, Oliveira J |chapter-url=http://link.springer.com/10.1007/978-1-4899-7648-2_26 |access-date=2024-12-19 |place=Boston, MA |publisher=Springer US |language=en |doi=10.1007/978-1-4899-7648-2_26 |isbn=978-1-4899-7646-8 }} Alcohol was brewed as early as 7,000 to 6,650 BCE in northern China.{{cite journal | vauthors = McGovern PE, Zhang J, Tang J, Zhang Z, Hall GR, Moreau RA, Nuñez A, Butrym ED, Richards MP, Wang CS, Cheng G, Zhao Z, Wang C | title = Fermented beverages of pre- and proto-historic China | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 101 | issue = 51 | pages = 17593–8 | date = December 2004 | pmid = 15590771 | pmc = 539767 | doi = 10.1073/pnas.0407921102 | bibcode = 2004PNAS..10117593M | doi-access = free }} The earliest evidence of winemaking was dated at 6,000 to 5,800 BCE in Georgia in the South Caucasus.{{cite journal | vauthors = McGovern P, Jalabadze M, Batiuk S, Callahan MP, Smith KE, Hall GR, Kvavadze E, Maghradze D, Rusishvili N, Bouby L, Failla O, Cola G, Mariani L, Boaretto E, Bacilieri R, This P, Wales N, Lordkipanidze D | title = Early Neolithic wine of Georgia in the South Caucasus | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 48 | pages = E10309–E10318 | date = November 2017 | pmid = 29133421 | doi = 10.1073/pnas.1714728114 | pmc = 5715782 | bibcode = 2017PNAS..11410309M | doi-access = free }} Beer was likely brewed from barley as early as the 13,000 years ago in the Middle East. Pliny the Elder wrote about the golden age of winemaking in Rome, the 2nd century BCE (200–100 BCE), when vineyards were planted.{{cite book | vauthors = Brostrom GG, Brostrom JJ |title=The Business of Wine: An Encyclopedia: An Encyclopedia|url=https://books.google.com/books?id=tEqx2zwuq-gC&pg=PA6|date=30 December 2008|publisher=ABC-CLIO|isbn=978-0-313-35401-4|pages=6–}}

Image:William Hogarth - Gin Lane.jpg by William Hogarth, 1751]]

The Gin Craze was a period in the first half of the 18th century when the consumption of gin increased rapidly in Great Britain, especially in London. By 1743, England was drinking 2.2 gallons (10 litres) of gin per person per year. The Sale of Spirits Act 1750 (commonly known as the Gin Act 1751) was an Act of the Parliament of Great Britain (24 Geo. 2. c. 40) which was enacted to reduce the consumption of gin and other distilled spirits, a popular pastime{{Cite web |title=History of Alcohol |url=http://file.zums.ac.ir/ebook/101-Drink%20-%20A%20Cultural%20History%20of%20Alcohol-Iain%20Gately-1592404642-Gotham-2009-560-$18.pdf |archive-url=https://web.archive.org/web/20130821023217/http://file.zums.ac.ir/ebook/101-Drink%20-%20A%20Cultural%20History%20of%20Alcohol-Iain%20Gately-1592404642-Gotham-2009-560-$18.pdf |archive-date=21 August 2013 |access-date=11 May 2015}} that was regarded as one of the primary causes of crime in London.{{cite encyclopedia |title=Gin Act |encyclopedia=Britannica Online Encyclopedia |url=http://www.britannica.com/EBchecked/topic/233872/Gin-Act}}

File:Navy personnel on liberty at Mogmog Island. Enlisted men lounge about a tiny island with plenty of beer. - NARA - 520730 (cropped).jpg

The rum ration (also called the tot) was a daily amount of rum given to sailors on Royal Navy ships. It started 1866 and was abolished in 1970 after concerns that the intake of strong alcohol would lead to unsteady hands when working machinery.

The Andrew Johnson alcoholism debate is the dispute, originally conducted among the general public, and now typically a question for historians, about whether or not Andrew Johnson, the 17th president of the United States (1865–1869), drank to excess.

The prohibition in the United States era was the period from 1920 to 1933 when the United States prohibited the production, importation, transportation, and sale of alcoholic beverages. The nationwide ban on alcoholic beverages, was repealed by the passage of the Twenty-first Amendment to the United States Constitution on December 5, 1933.

The Bratt System was a system that was used in Sweden (1919–1955) and similarly in Finland (1944–1970) to control alcohol consumption, by rationing of liquor. Every citizen allowed to consume alcohol was given a booklet called a motbok (viinakortti in Finland), in which a stamp was added each time a purchase was made at Systembolaget (in Sweden) and Alko (in Finland).{{Cite web |title=Motbok |trans-title=Counter book |url=https://fho.sls.fi/uppslagsord/19892/motbok/ |access-date=2022-11-03 |work=Förvaltningshistorisk ordbok |language=sv |trans-work=Administrative history dictionary}} A similar system also existed in Estonia between July 1, 1920, to December 31, 1925.{{Cite web |date=2008-11-08 |title=Alkoholikeeldudest Eestis |trans-title=Alcohol bans in Estonia |url=https://www.postimees.ee/47256/alkoholikeeldudest-eestis |access-date=2024-03-27 |website=Postimees |language=et |vauthors=Arjakas K}} The stamps were based on the amount of alcohol bought. When a certain amount of alcohol had been bought, the owner of the booklet had to wait until next month to buy more.

The Medicinal Liquor Prescriptions Act of 1933 was a law passed by Congress in response to the abuse of medicinal liquor prescriptions during Prohibition.

Gilbert Paul Jordan (aka The Boozing Barber) was a Canadian serial killer who is believed to have committed the so-called "alcohol murders" between 1965–{{circa|2004}} in Vancouver, British Columbia.

{{main|Alcohol and society|Drinking culture}}

The consumption of alcohol is deeply embedded in social practices and rituals, often celebrated as a cornerstone of community gatherings and personal milestones. Drinking culture is the set of traditions and social behaviours that surround the consumption of alcoholic beverages as a recreational drug and social lubricant.

{{Main|Alcohol law}}

Alcohol consumption is fully legal and available in most countries of the world.{{cite book | vauthors = Boyle P |title=Alcohol: Science, Policy and Public Health|url=https://books.google.com/books?id=wNsJuM6KqGoC&pg=PA363|date=7 March 2013|publisher=OUP Oxford|isbn=978-0-19-965578-6|pages=363–}} Home made alcoholic beverages with low alcohol content like wine, and beer is also legal in most countries, but distilling moonshine outside of a registered distillery remains illegal in most of them.

Some majority-Muslim countries, such as Saudi Arabia, Kuwait, Pakistan, Iran and Libya prohibit the production, sale, and consumption of alcoholic beverages because they are forbidden by Islam.{{cite web|title=Getting a drink in Saudi Arabia|url=http://news.bbc.co.uk/1/hi/world/middle_east/1160846.stm|website=BBC News|publisher=BBC|access-date=7 July 2015|date=8 February 2001}}{{cite web|title=Can you drink alcohol in Saudi Arabia?|url=http://livinginsaudiarabia.org/268/can-you-drink-alcohol-in-saudi-arabia/|access-date=7 July 2015|date=1 August 2012|archive-date=12 November 2012|archive-url=https://web.archive.org/web/20121112151901/http://livinginsaudiarabia.org/268/can-you-drink-alcohol-in-saudi-arabia/|url-status=dead}}{{cite web|title=13 Countries With Booze Bans|url=http://www.swifty.com/lifestyle/5322/13-countries-with-booze-bans|publisher=Swifty.com|access-date=7 July 2015|archive-date=2 July 2015|archive-url=https://web.archive.org/web/20150702234325/http://www.swifty.com/lifestyle/5322/13-countries-with-booze-bans|url-status=dead}} Also, laws banning alcohol consumption are found in some Indian states as well as some Native American reservations in the U.S.

In addition, there are regulations on alcohol sales and use in many countries throughout the world. For instance, the majority of countries have a minimum legal drinking age to purchase or consume alcoholic beverages, although there are often exceptions such as underage consumption of small amounts of alcohol with parental supervision. Also, some countries have bans on public intoxication. Drinking while driving or intoxicated driving is frequently outlawed and it may be illegal to have an open container of alcohol or liquor bottle in an automobile, bus or aircraft.

{{Main|Religion and alcohol}}

Religion and alcohol have a complex history. The world's religions have had different relationships with alcohol, reflecting diverse cultural, social, and religious practices across different traditions. While some religions strictly prohibit alcohol consumption, viewing it as sinful or harmful to spiritual and physical well-being, others incorporate it into their rituals and ceremonies. Throughout history, alcohol has held significant roles in religious observances, from the use of sacramental wine in Christian sacraments to the offering and moderate drinking of omiki (sacramental sake) in Shinto purification rituals.

A study in 2015 found that alcohol and tobacco use combined resulted in a significant health burden, costing over a quarter of a billion disability-adjusted life years. Illicit drug use caused tens of millions more disability-adjusted life years.{{cite journal | vauthors = Peacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, Giovino GA, West R, Hall W, Griffiths P, Ali R, Gowing L, Marsden J, Ferrari AJ, Grebely J, Farrell M, Degenhardt L | title = Global statistics on alcohol, tobacco and illicit drug use: 2017 status report | journal = Addiction | volume = 113 | issue = 10 | pages = 1905–1926 | date = October 2018 | pmid = 29749059 | doi = 10.1111/add.14234 | hdl = 11343/283940 | url = https://discovery.ucl.ac.uk/id/eprint/10049286/ | hdl-access = free }}

According to The Lancet, 'four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year'.{{Cite journal |type=Editorial |date=23 March 2023 |title=Unravelling the commercial determinants of health |journal=The Lancet |volume=401 |issue=10383 |page=1131 |doi=10.1016/S0140-6736(23)00590-1 |pmid=36966781 |doi-access=free |author= }} In 2024, the World Health Organization published a report including these figures.{{Cite web |title=Just four industries cause 2.7 million deaths in the European Region every year |url=https://www.who.int/azerbaijan/news/item/12-06-2024-just-four-industries-cause-2.7-million-deaths-in-the-european-region-every-year |publisher=World Health Organization |date=12 June 2024 |access-date=12 June 2024 |quote=Four corporate products – tobacco, ultra-processed foods, fossil fuels and alcohol – cause 19 million deaths per year globally, or 34% of all deaths.}}{{cite news | vauthors = Bawden A, Campbell D |title=Tobacco, alcohol, processed foods and fossil fuels 'kill 2.7m a year in Europe' |url=https://www.theguardian.com/society/article/2024/jun/12/tobacco-alcohol-ultra-processed-foods-fossil-fuels-deaths |work=The Guardian |date=12 June 2024 |access-date=12 June 2024}}

Many Native Americans in the United States have been harmed by, or become addicted to, drinking alcohol.{{cite journal |vauthors=Szlemko WJ, Wood JW, Thurman PJ |title=Native Americans and alcohol: past, present, and future |journal=The Journal of General Psychology |volume=133 |issue=4 |pages=435–451 |date=October 2006 |pmid=17128961 |doi=10.3200/GENP.133.4.435-451 |publisher=Heldref Publications |s2cid=43082343}}

Qualitative analysis reveals that the alcohol industry likely misinforms the public about the dangers of alcohol, similar to the tobacco industry. The alcohol industry influences alcohol policy and health messages, including those for schoolchildren.{{cite journal | vauthors = Petticrew M, Maani Hessari N, Knai C, Weiderpass E | title = How alcohol industry organisations mislead the public about alcohol and cancer | journal = Drug and Alcohol Review | volume = 37 | issue = 3 | pages = 293–303 | date = March 2018 | pmid = 28881410 | doi = 10.1111/dar.12596 | url = https://researchonline.lshtm.ac.uk/id/eprint/4363466/3/PetticrewHow_alcohol_industry_mislead_public.pdf }}

{{Main|Alcohol measurements|Standard drink|Alcohol consumption recommendations}}

The alcohol consumption recommendations (or {{em|safe limits}}) varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The WHO published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health."

A standard drink is a measure of alcohol consumption representing a fixed amount of pure ethanol, used in relation to recommendations about alcohol consumption and its relative risks to health. The size of a standard drink varies from 8g to 20g across countries, but 10g alcohol (12.7 millilitres) is used in the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example,{{Cite web|url=https://apps.who.int/iris/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a.pdf?sequence=1&isAllowed=y|title=AUDIT The Alcohol Use Disorders Identification Test (Second Edition)|date=2001|website=WHO|format=pdf|access-date=2020-01-02}} and has been adopted by more countries than any other amount.{{cite journal | vauthors = Kalinowski A, Humphreys K | title = Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries | journal = Addiction | volume = 111 | issue = 7 | pages = 1293–1298 | date = July 2016 | pmid = 27073140 | doi = 10.1111/add.13341 | doi-access = free }}

{{Portal|Medicine}}

• Alcohol myopia
• Rum-running
• GABAergics
• GABRD (δ subunit-containing receptors)
• Pigovian taxes, which are to pay for the damage to society caused by these goods.
• Sin taxes are used to increase the price in an effort to lower their use, or failing that, to increase and find new sources of revenue.
• Binge drinking
• Holiday heart syndrome
• Drug-related crime
• List of countries by alcohol consumption per capita

{{Reflist}}

• {{cite book | author = IARC Working Group on the Evaluation of Carcinogenic Risks to Humans |title=Alcohol Drinking |url=https://www.ncbi.nlm.nih.gov/books/NBK531657/ |publisher=International Agency for Research on Cancer |date=1988}}

• {{cite web |title=ETOH Database Search |url=https://www.hazelden.org/websearch/etohsearch |website=hazelden.org}}
• The National Institute on Alcohol Abuse and Alcoholism maintains a database of alcohol-related health effects. [https://web.archive.org/web/20080509125317/http://etoh.niaaa.nih.gov/Archive.htm ETOH Archival Database (1972–2003)] Alcohol and Alcohol Problems Science Database.
• {{cite web |title=Harmful Interactions | work = National Institute on Alcohol Abuse and Alcoholism (NIAAA) |url=https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines }}
• [https://www.who.int/news-room/fact-sheets/detail/alcohol WHO fact sheet on alcohol]
• [http://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:16236 ChEBI – biology related]
• Kyoto Encyclopedia of Genes and Genomes signal transduction pathway: [http://www.genome.jp/kegg-bin/show_pathway?hsa05034+2354 KEGG – human alcohol addiction]

{{Alcohol and health}}

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{{Acetylcholine receptor modulators}}

{{GABAA receptor positive modulators}}

{{Glycine receptor modulators}}

{{Ion channel modulators}}

{{Ionotropic glutamate receptor modulators}}

{{Nicotinic acetylcholine receptor modulators}}

{{Purine receptor modulators}}

{{Serotonin receptor modulators}}

{{Hidden end}}

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