Alcohol, sometimes referred to by the chemical name ethanol, is the active ingredient in such as beer, wine, and distilled spirits (hard liquor).
Alcohol has a variety of . Short-term adverse effects include generalized impairment of neurocognitive function, dizziness, nausea, vomiting, and symptoms of hangover. Alcohol is addiction and can result in alcohol use disorder, dependence, and withdrawal upon cessation. The long-term effects of alcohol are considered to be a major global public health issue and include liver disease, hepatitis,
Alcohol has been produced and consumed by humans for its psychoactive effects since at least 13,000 years ago, when the earliest known beer was brewed by the Natufian culture in the Middle East.[Rosen, A. M., Liu, L., Bar-Yosef, O., & Weiss, E. (2018). Fermented beverage and food storage in 13,000 y-old stone mortars at Raqefet Cave, Israel: Investigating Natufian ritual feasting. Journal of Archaeological Science: Reports, 21, 783–793. doi:10.1016/j.jasrep.2018.08.020]
Uses
Recreational
Ethanol is commonly consumed as the recreational active substance of alcoholic beverages such as
beer,
wine, and
Liquor. Consumption in social settings may enhance sociability, since it increases occurrences of
Duchenne smile, talking, and social bonding.
While research on the societal benefits of alcohol is rare, in a study from the UK, regular but moderate drinking was correlated with happiness, feeling that life was worthwhile, and satisfaction with life. 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. However, 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.
Food energy
The US Department of Agriculture (USDA) uses a figure of per gram of alcohol ( per mL) for calculating
food energy.
For
, a standard serving in the United States is 44 mL (1.5 US fl oz), which at 40% ethanol (80
Alcohol proof), would be 14 grams and 98 calories. Alcoholic drinks are considered
empty calories 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.
In
Alcoholism who get most of their daily calories from alcohol, a deficiency of
thiamine (vitamin B
1) can produce Korsakoff syndrome, which is associated with serious brain damage.
Medical
When
fomepizole is not available, ethanol can be used to treat or prevent methanol or ethylene glycol poisoning.
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.
This avoids the production of toxic
aldehyde and
carboxylic acid derivatives, and reduces the more serious toxic effects of the glycols when
crystallization in the
kidneys.
Ethylene glycol poisoning can be treated in the same way.
Warfare
Alcohol has a long association of military use, and has been called "liquid courage" for its role in preparing troops for battle,
Anesthesia injured soldiers, and celebrate military
Victory. It has also served as a coping mechanism for combat stress reactions and a means of decompression from combat to everyday life.
Self-medication
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.
People with social anxiety disorder commonly self-medicate with alcohol to overcome their highly set inhibitions.
Contraindications
Pregnancy
Ethanol is classified as a
Teratology—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.
The CDC currently recommends complete abstinence from alcoholic beverages for women of child-bearing age who are pregnant or trying to become pregnant.
Peptic ulcer disease
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.
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.
A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.
Allergic-like reactions
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:
-
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 occurring naturally in, or contaminating, alcoholic beverages (particularly wine and beer), and
-
other unknown causes.
Diabetes
Alcohol consumption can cause
hypoglycemia in diabetics on certain medications, such as
insulin or
sulfonylurea, by blocking
gluconeogenesis.
Alcohol increases
Insulin to
glucose promoting fat storage and hindering carbohydrate and fat oxidation.
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.
Adverse effects
Alcohol has a variety of short-term and long-term
. 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.
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.
Short-term effects
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
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.
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,
Somnolence, concentration problems,
Xerostomia,
dizziness, fatigue, gastrointestinal distress (e.g.,
nausea,
vomiting,
diarrhea), absence of hunger, light sensitivity, depression,
Perspiration, hyper-excitability,
irritability, and
Anxiety attack (often referred to as "
hangxiety").
Long-term effects
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,
but atypically small amounts of alcohol may have health benefits.
causes severe health consequences which outweigh any potential benefits.
Long-term alcohol consumption is capable of damaging nearly every organ and system in the body.
Conversely, light intake of alcohol may have some beneficial effects. The association of alcohol intake with reduced cardiovascular risk has been noted since 1904
Social harms
Alcohol causes a plethora of detrimental effects in society.
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in
Delphi method regarding 20 popular recreational substances. Alcohol was ranked 6th in dependence, 11th in physical harm, and 2nd in social harm.
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.
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,
Begging, and disorderly conduct in open spaces.
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.
Binge drinking is associated with risks such as suicide, sexual assault, cardiovascular issues, and brain damage, more acutely than alcohol use in general.
Alcohol use disorder
[[File:Alcohol use disorders world map-Deaths per million persons-WHO2012.svg|thumb|left|Alcohol use disorders deaths per million persons in 2012
]]
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.
Two or more consecutive alcohol-free days a week have been recommended to improve health and break dependence.
Withdrawal
Discontinuation of alcohol after extended heavy use and associated
drug tolerance development (resulting in dependence) can result in alcohol withdrawal. Alcohol is one of the more dangerous drugs to withdraw from.
Alcohol withdrawal can cause
confusion,
paranoia,
anxiety,
insomnia, agitation,
, fever, nausea, vomiting, autonomic dysfunction,
, and
. In severe cases, death can result.
Delirium tremens is a condition that develops in some cases of severe withdrawal, with onset typically 48–72 hours after discontinuation. It is considered a medical emergency and should be treated in an Inpatient care or intensive care unit.
Overdose
Symptoms of ethanol
Drug 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 (LD
50) of ethanol in rats is 5,628 mg/kg. Directly translated to human beings, this would mean that if a person who weighs drank a 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%.
Interactions
Alcohol-induced dose dumping (AIDD)
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.
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
.
Hypnotics and sedatives
Alcohol can intensify the sedation caused by
and
such as
,
, sedative antihistamines,
, nonbenzodiazepines/
Z-drugs (such as
zolpidem and
zopiclone).
Disulfiram-like drugs
Disulfiram
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
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.] 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.
NSAIDs
NSAIDs and alcohol both increase gastrointestinal events such as gastrointestinal bleeding and
. Taking the two together further increases the risk additively.
The risk of stomach bleeding is still increased when aspirin is taken with alcohol or warfarin.
Methylphenidate
Ethanol enhances the
bioavailability of
methylphenidate (elevated plasma dexmethylphenidate).
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.
However, only a small percent of the consumed methylphenidate is converted to ethylphenidate.
Nicotine
While
mimic the name of classic cocktails like the appletini (their name deriving from "martini"), combining nicotine with alcohol may cause adverse effects. Tobacco and nicotine actually heighten cravings for alcohol, making this a risky mix.
Caffeine
Controlled animal and human studies showed that
caffeine (
) in combination with alcohol increased the craving for more alcohol more strongly than alcohol alone.
These findings correspond to epidemiological data that people who consume
energy drinks generally showed an increased tendency to take alcohol and other substances.
Cocaine
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.
Cannabis
In combination with
cannabis, ethanol increases plasma tetrahydrocannabinol levels, which suggests that ethanol may increase the absorption of tetrahydrocannabinol.
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.
The U.S. Food and Drug Administration (FDA) product insert on warfarin states that alcohol should be avoided.
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".
Isoniazid
Use of isoniazid should be carefully monitored in daily alcohol drinkers since they may be more likely to develop isoniazid-associated hepatitis.
Pharmacology
Alcohol works in the brain primarily by increasing the effects of γ-Aminobutyric acid (GABA),
the major inhibitory
neurotransmitter in the brain; by facilitating GABA's actions in the
GABAA 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.
The pleasurable effects of alcohol ingestion are the result of increased levels of
dopamine and
endogenous in the
of the brain.
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,
Chemistry
Ethanol is also known chemically as alcohol, ethyl alcohol, or drinking alcohol. It is a simple alcohol with a molecular formula of C
2H
6O and a
molecular weight of 46.0684 g/mol. The molecular formula of ethanol may also be written as CH
3−CH
2−OH or as C
2H
5−OH. The latter can also be thought of as an
ethyl group linked to a
hydroxyl 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
Ethanol fuel.
Analogues
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;[.]
Although ethanol is the most prevalent alcohol in alcoholic beverages, alcoholic beverages contain several types of psychoactive alcohols, that are categorized as primary alcohol, secondary, or tertiary alcohol. Primary, and secondary alcohols, are oxidized to aldehydes, and , respectively, while tertiary alcohols are generally resistant to oxidation.
Manufacturing
Ethanol is
natural product as a
metabolite of the
metabolism of
yeast and hence is present in any yeast habitat, including even
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
(e.g.,
barley),
grape juice, and
sugarcane products (e.g.,
molasses,
sugarcane juice). Ethanol–water
mixture which can be further purified via
distillation.
History
Alcohol is one of the oldest recreational drugs. The word "Alcohol" originates from the Arabic word
al-kuhul, which refers to a fine metallic powder that was used to paint the eyelids darker.
Alcoholic beverages have been produced since the
Neolithic period, as early as 7000 BC in China.
Alcohol was brewed as early as 7,000 to 6,650 BCE in
northern China.
The earliest evidence of
winemaking was dated at 6,000 to 5,800 BCE in Georgia in the
South Caucasus.
Beer was likely brewed from
barley as early as 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
were planted.
Early modern period
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
that was regarded as one of the primary causes of crime in London.
Modern period
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).
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– in Vancouver, British Columbia.
Society and 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.
Legal status
Alcohol consumption is fully legal and available in most countries of the world.
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.
In addition, there are regulations on alcohol sales and use in many countries throughout the world.
Religion
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.
Impact
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.
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'.
Many Native Americans in the United States have been harmed by, or become addicted to, drinking alcohol.
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.
Standard drink
The alcohol consumption recommendations (or ) 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,
See also
-
Alcohol myopia
-
Rum-running
-
GABAergics
-
GABRD
-
, which are to pay for the damage to society caused by these goods.
-
are used to increase the price in an effort to lower Demand, 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
Further reading
External links
Notes
