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Clinical dataPronunciation/ˈɛθənɒl/ Other namesAbsolute alcohol; Alcohol (USP); Cologne spirit; Drinking alcohol; Ethanol (JAN); Ethylic alcohol; EtOH; Ethyl alcohol; Ethyl hydrate; Ethyl hydroxide; Ethylol; Grain alcohol; Hydroxyethane; MethylcarbinolPregnancy
category
  • US: C (Risk not ruled out)
Dependence
liability
Moderate[1]Addiction
liability
Moderate (10–15%)[2]Routes of
administration
Common: by mouth, topical
Uncommon: suppository, inhalation, ocular, insufflation,[3] injection[4]Drug classAnalgesic; Depressants; Sedatives; Anxiolytics; Euphoriants; GABAA receptor positive modulatorsATC codeLegal statusLegal status
Pharmacokinetic dataBioavailability80%+[5][6]Protein bindingWea

Alcohol, sometimes referred to by the chemical name ethanol, is a psychoactive drug that is the active ingredient in drinks such as beer, wine, and distilled spirits (hard liquor).[13] It is one of the oldest and most common recreational substances, causing the characteristic effects of alcohol intoxication ("drunkenness").[14] Among other effects, alcohol produces a mood lift and euphoria, decreased anxiety, increased sociability, sedation, impairment of cognitive, memory, motor, and sensory function, and generalized depression of central nervous system function. Ethanol is only one of several types of alcohol, but it is the only type of alcohol that is found in alcoholic beverages or commonly used for recreational purposes; other alcohols such as methanol and isopropyl alcohol are significantly more toxic.[13] A mild, brief exposure to isopropanol, being only moderately more toxic than ethanol, is unlikely to cause any serious harm. Methanol, being profoundly more toxic than ethanol, is lethal in quantities as small as 10-15 milliliters (2-3 tsp).

Alcohol has a variety of short-term and long-term adverse effects. Short-term adverse effects include generalized impairment of neurocognitive function, dizziness, nausea, vomiting, and hangover-like symptoms. Alcohol can be addictive to humans, as in alcoholism, and can result in dependence and withdrawal. It can have a variety of long-term adverse effects on health, for instance liver damage,[15] brain damage,[16] and its consumption is the fifth leading cause of cancer.[17][failed verification] The adverse effects of alcohol on health are most important when it is used in excessive quantities or with heavy frequency. However, some of them, such as increased risk of certain cancers, may occur even with light or moderate alcohol consumption.[18] In high amounts, alcohol may cause loss of consciousness or, in severe cases, death.

Alcohol works in the brain primarily by increasing the effects of a neurotransmitter called γ-aminobutyric acid, or GABA.[19] This is the major inhibitory neurotransmitter in the brain, and by facilitating its actions, alcohol suppresses the activity of the central nervous system.[19] The substance also directly affects a number of other neurotransmitter systems including those of glutamate, glycine, acetylcholine, and serotonin.[20][21] The pleasurable effects of alcohol ingestion are the result of increased levels of dopamine and endogenous opioids in the reward pathways of the brain.[22][23] Alcohol also has toxic and unpleasant actions in the body, many of which are mediated by its byproduct acetaldehyde.[24]

Alcohol has been produced and consumed by humans for its psychoactive effects for almost 10,000 years.[25] Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. However, there are often restrictions on alcohol sale and use, for instance a minimum age for drinking and laws against public drinking and drinking and driving.[26] Alcohol has considerable societal and cultural significance and has important social roles in much of the world. Drinking establishments, such as bars and nightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Its use is also related to various societal problems, including driving accidents and fatalities, accidental injuries, sexual assaults, domestic abuse, and violent crime.[27] Alcohol remains illegal for sale and consumption in a number of countries, mainly in the Middle East.

Use and effects

Ethanol is typically 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.

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[28] 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 g/L), ethanol acts as a central nervous system depressant,[28] producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death. Ethanol is commonly consumed as a recreational substance, especially while socializing, due to its psychoactive effects.

Caloric content

Ethanol is a source of energy and pure ethanol provides 7 calories per gram. 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. Wine and beer contain a similar range of ethanol quantity for servings of 150 ml (5 US fl oz) and 350 ml (12 US fl oz), respectively, but these beverages also contain non-ethanol food energy. A 150 ml serving of wine contains 100 to 130 calories. A 350 ml serving of beer contains 95 to 200 calories. According to the U.S. Department of Agriculture, based on NHANES 2013–2014 surveys, women in the US ages 20 and up consume on average 6.8 grams/day and men consume on average 15.5 grams/day.[29] Ignoring the non-alcohol contribution of those beverages, the average energy contributions are 48 and 108 cal/day, respectively. Alcoholic beverages are considered empty calorie foods because other than food energy they contribute no essential nutrients.

Drug harmfulness

Alcohol has a variety of short-term and long-term adverse effects. It also has reinforcement-related adverse effects, including addiction, dependence, and withdrawal.

Social harm

A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was found to be the overall most dangerous drug, and the only drug that mostly damaged ot

Alcohol has a variety of short-term and long-term adverse effects. Short-term adverse effects include generalized impairment of neurocognitive function, dizziness, nausea, vomiting, and hangover-like symptoms. Alcohol can be addictive to humans, as in alcoholism, and can result in dependence and withdrawal. It can have a variety of long-term adverse effects on health, for instance liver damage,[15] brain damage,[16] and its consumption is the fifth leading cause of cancer.[17][failed verification] The adverse effects of alcohol on health are most important when it is used in excessive quantities or with heavy frequency. However, some of them, such as increased risk of certain cancers, may occur even with light or moderate alcohol consumption.[18] In high amounts, alcohol may cause loss of consciousness or, in severe cases, death.

Alcohol works in the brain primarily by increasing the effects of a neurotransmitter called γ-aminobutyric acid, or GABA.[19] This is the major inhibitory neurotransmitter in the brain, and by facilitating its actions, alcohol suppresses the activity of the central nervous system.[19] The substance also directly affects a number of other neurotransmitter systems including those of glutamate, glycine, acetylcholine, and serotonin.[20][21] The pleasurable effects of alcohol ingestion are the result of increased levels of dopamine and endogenous opioids in the reward pathways of the brain.[22][23] Alcohol also has toxic and unpleasant actions in the body, many of which are mediated by its byproduct acetaldehyde.[24]

Alcohol has been produced and consumed by humans for its psychoactive effects for almost 10,000 years.[25] Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. However, there are often restrictions on alcohol sale and use, for instance a minimum age for drinking and laws against public drinking and drinking and driving.[26] Alcohol has considerable societal and cultural significance and has important social roles in much of the world. Drinking establishments, such as bars and nightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Its use is also related to various societal problems, including driving accidents and fatalities, accidental injuries, sexual assaults, domestic abuse, and violent crime.[27] Alcohol remains illegal for sale and consumption in a number of countries, mainly in the Middle East.

Ethanol is typically 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.

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[28] 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 g/L), ethanol acts as a central nervous system depressant,[28] producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death. Ethanol is commonly consumed as a recreational substance, especially while socializing, due to its psychoactive effects.

Caloric content

Ethanol is a source of energy and pure ethanol provides 7 calories per gram. 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. Wine and beer contain a similar range of ethanol quantity for servings of 150 ml (5 US fl oz) and 350 ml (12 US fl oz), respectively, but these beverages also contain non-ethanol food energy. A 150 ml serving of wine contains 100 to 130 calories. A 350 ml serving of beer contains 95 to 200 calories. According to the U.S. Department of Agriculture, based on NHANES 2013–2014 surveys, women in the US ages 20 and up consume on average 6.8 grams/day and men consume on average 15.5 grams/day.[29] Ignoring the non-alcohol contribution of those beverages, the average energy contributions are 48 and 108 cal/day, respectively. Alcoholic beverages are considered empty calorie foods because other than food energy they contribute no essential nutrients.

Drug harmfulness

Alcohol has a variety of short-term and long-term adverse effects. It also has reinforcement-related adverse effects, including addiction, dependence, and withdrawal.

Social harm

A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was found to be the overall most dangerous drug, and the only drug that mostly damaged others.[30]

Alcohol causes considerable societal damage including suppression of psychological inhibitions, which may increase the risk for activities such as impulsive sex, drunk dialing, and alcohol-related crimes such as public intoxication, and drunk driving.

Alcohol causes a plethora of detrimental effects in society, both to the individual and to others.[27] It is highly associated with automobile accidents, sexual assaults, and both violent and non-violent crime.[27] About one-third of arrests in the United States involve alcohol abuse.[27] Many emergency room visits also involve alcohol use.[27] 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.[27] Heavy drinking is associated with vulnerability to injury, marital discord, and domestic violence.[27] Alcohol use is directly related to considerable morbidity and mortality, for instance due to overdose and alcohol-related health problems.[31]

Alcohol-related crimes

Automobile accidents

A 2002 study found 41% of people fatally injured in traffic accidents were in alcohol-related crashes.[32]

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[28] 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 g/L), ethanol acts as a central nervous system depressant,[28] producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death. Ethanol is commonly consumed as a recreational substance, especially while socializing, due to its psychoactive effects.

Ethanol is a source of energy and pure ethanol provides 7 calories per gram. 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. Wine and beer contain a similar range of ethanol quantity for servings of 150 ml (5 US fl oz) and 350 ml (12 US fl oz), respectively, but these beverages also contain non-ethanol food energy. A 150 ml serving of wine contains 100 to 130 calories. A 350 ml serving of beer contains 95 to 200 calories. According to the U.S. Department of Agriculture, based on NHANES 2013–2014 surveys, women in the US ages 20 and up consume on average 6.8 grams/day and men consume on average 15.5 grams/day.[29] Ignoring the non-alcohol contribution of those beverages, the average energy contributions are 48 and 108 cal/day, respectively. Alcoholic beverages are considered empty calorie foods because other than food energy they contribute no essential nutrients.

Drug harmfulnessAlcohol has a variety of short-term and long-term adverse effects. It also has reinforcement-related adverse effects, including addiction, dependence, and withdrawal.

Social harm

psychological inhibitions, which may increase the risk for activities such as impulsive sex, drunk dialing, and alcohol-related crimes such as public intoxication, and drunk driving.

Alcohol causes a plethora of detrimental effects in society, both to the individual and to others.[27] It is highly associated with automobile accidents, sexual assaults, and both violent and non-violent crime.[27] About one-third of arrests in the United States involve alcohol abuse.[27] Many emergency room visits also involve alcohol use.[27] 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.[27] It is highly associated with automobile accidents, sexual assaults, and both violent and non-violent crime.[27] About one-third of arrests in the United States involve alcohol abuse.[27] Many emergency room visits also involve alcohol use.[27] 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.[27] Heavy drinking is associated with vulnerability to injury, marital discord, and domestic violence.[27] Alcohol use is directly related to considerable morbidity and mortality, for instance due to overdose and alcohol-related health problems.[31]

A 2002 study found 41% of people fatally injured in traffic accidents were in alcohol-related crashes.[32] Abuse of alcohol is associated with more than 40% of deaths that occur in automobile accidents every year.[27] The risk of a fatal car accident increases exponentially with the level of alcohol in the driver's blood.[33] Most drunk driving laws in the United States governing the acceptable levels in the blood while driving or operating heavy machinery set typical upper limits of legal blood alcohol content (BAC) at 0.08%.[34]

Sexual assault

Alcohol is often used to facilitate sexual assault or rape.[35][36] Over 50% of reported ra

Alcohol is often used to facilitate sexual assault or rape.[35][36] Over 50% of reported rapes involve alcohol.[clarification needed][27] It is the most commonly used date rape drug.[37]

Violent crime

Over 40% of all assaults and 40 to 50% of all murders involve alcohol.[27]Over 40% of all assaults and 40 to 50% of all murders involve alcohol.[27] More than 43% of violent encounters with police involve alcohol.[27] Alcohol is implicated in more than two-thirds of cases of intimate partner violence.[27] In 2002, it was estimated that 1 million violent crimes in the United States were related to alcohol use.[27] Alcohol is more commonly associated with both violent and non-violent crime than are drugs like marijuana.[27]

Health consequences

Alcohol causes generalized central nervous system depression and associated cognitive, memory, motor, and sensory impairment. It slows and impairs cognition and reaction time, impairs judgement, interferes with motor function resulting in motor incoordination, loss of balance, and slurred speech, impairs memory formation, and causes sensory impairment. At high concentrations, amnesia, analgesia, spins, stupor, and unconsciousness result.

At very high concentrations, anterograde amnesia, markedly decreased heart rate, pulmonary aspiration, positional alcohol nystagmus (PAN), respiratory depression, and death can result due to profound suppression of central nervous system function and consequent dysautonomia.

Gastrointestinal effects

compare
Diagram of mucosal layer

Alcohol can cause nausea and vomiting in sufficiently high amounts (varies by person).

Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption stimulates acidic secretions normally intended to digest protein molecules. Consequently, the excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer that prevents the stomach from, essentially, digesting itself. However, in patients who have a peptic ulcer disease (PUD), this mucosal layer is broken down. PUD is commonly associated with the bacteria H. pylori. H. pylori secrete

At very high concentrations, anterograde amnesia, markedly decreased heart rate, pulmonary aspiration, positional alcohol nystagmus (PAN), respiratory depression, and death can result due to profound suppression of central nervous system function and consequent dysautonomia.

Alcohol can cause nausea and vomiting in sufficiently high amounts (varies by person).

Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption stimulates acidic secretions normally intended to digest protein molecules. Consequently, the excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer that prevents the stomach from, essentially, digesting itself. However, in patients who have a peptic ulcer disease (PUD), this mucosal layer is broken down. PUD is commonly associated with the bacteria H. pylori. H. pylori secrete a toxin that weakens the mucosal wall, which as a result lead to acid and protein enzymes penetrating the weakened barrier. Because alcohol stimulates a person's 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.[40] Complications of this disease could include a burning pain in the abdomen, bloating and in severe cases, the presence of dark black stools indic

Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption stimulates acidic secretions normally intended to digest protein molecules. Consequently, the excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer that prevents the stomach from, essentially, digesting itself. However, in patients who have a peptic ulcer disease (PUD), this mucosal layer is broken down. PUD is commonly associated with the bacteria H. pylori. H. pylori secrete a toxin that weakens the mucosal wall, which as a result lead to acid and protein enzymes penetrating the weakened barrier. Because alcohol stimulates a person's 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.[40] 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.[41] A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.[41]

Ingestion of alcohol can initiate systemic pro-inflammatory changes through two intestinal routes: (1) altering intestinal microbiota composition (dysbiosis), which increases lipopolysaccharide (LPS) release, and (2) degrading intestinal mucosal barrier integrity – thus allowing this (LPS) to enter the circulatory system. The major portion of the blood supply to the liver is provided by the portal vein. Therefore, while the liver is continuously fed nutrients from the intestine, it is also exposed to any bacteria and/or bacterial derivatives that breach the intestinal mucosal barrier. Consequently, LPS levels increase in the portal vein, liver and systemic circulation after alcohol intake. Immune cells in the liver respond to LPS with the production of reactive oxygen species (ROS), leukotrienes, chemokines and cytokines. These factors promote tissue inflammation and contribute to organ pathology.[42]

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:[43]

  • 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.

Long-term effects