Alcohol (drug)
Alcohol, sometimes referred to by the chemical name ethanol, is the active ingredient in alcoholic drinks such as beer, wine, and distilled spirits. Alcohol is a central nervous system depressant, decreasing electrical activity of neurons in the brain, which causes the characteristic effects of alcohol intoxication. Among other effects, alcohol produces euphoria, decreased anxiety, increased sociability, sedation, and impairment of cognitive, memory, motor, and sensory function.
Alcohol has a variety of adverse effects. Short-term adverse effects include generalized impairment of neurocognitive function, dizziness, nausea, vomiting, and symptoms of hangover. Alcohol is addictive 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, cardiovascular disease, polyneuropathy, alcoholic hallucinosis, long-term impact on the brain, and cancers; alcohol and some of its metabolites are IARC group 1 carcinogens. The adverse effects of alcohol on health are most significant when it is used in excessive quantities or with heavy frequency. However, in 2023, the World Health Organization published a statement in The Lancet Public Health that concluded, "no safe amount of alcohol consumption for cancers and health can be established." In high amounts, alcohol may cause loss of consciousness or, in severe cases, death. Many governmental agencies and organizations issue alcohol consumption recommendations.
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. Alcohol is the second most consumed psychoactive drug globally, behind caffeine, with global sales of alcoholic beverages exceeding $1.5 trillion in 2017. 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. 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. Alcohol is related to various [|societal problems], including drunk driving, accidental injuries, sexual assaults, domestic abuse, and violent crime. Alcohol remains illegal for sale and consumption in a number of countries, mainly in the Middle East. While some religions, including Islam, prohibit alcohol consumption, other religions, such as Christianity and Shinto, utilize alcohol in sacrament and libation.
Uses
Recreational
Ethanol is commonly consumed as the recreational active substance of alcoholic beverages such as beer, wine, and spirits. Consumption in social settings may enhance sociability, since it increases occurrences of Duchenne smiling, 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 uses a figure of per gram of alcohol for calculating food energy. For distilled spirits, a standard serving in the United States is 44 mL, which at 40% ethanol, 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. In alcoholics who get most of their daily calories from alcohol, a deficiency of thiamine 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 crystallized 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, 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.Self-medication
Alcohol can have analgesic 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. 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. 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.
Contraindications
Pregnancy
Ethanol is classified as a teratogen—a substance known to cause birth defects; according to the U.S. Centers for Disease Control and Prevention, alcohol consumption by women who are not using birth control increases the risk of fetal alcohol spectrum disorders. 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, 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 allergens occurring naturally in, or contaminating, alcoholic beverages, and
- other unknown causes.
Diabetes