View source for Health effects of alcohol

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{{merge from|Health benefits of quitting alcohol|date=May 2025}}
{{Update|reason=It is being widely reported that the US Surgeon General has determined that alcohol use, even in moderation, is a major risk factor for cancer.|date=January 2025}}
{{Use dmy dates|date=March 2019}}
[[Alcohol (drug)|Alcohol]] (also known as [[ethanol]]) has a number of effects on [[health]]. [[Short-term effects of alcohol consumption]] include [[Alcohol intoxication|intoxication]] and [[dehydration]]. [[Long-term effects of alcohol]] include changes in the metabolism of the [[liver]] and [[brain]], with increased risk of [[Alcohol and cancer|several types of cancer]] and [[alcohol use disorder]].<ref>{{Cite journal|display-authors=3 |last1=Williams |first1=Roger |last2=Alexander |first2=Graeme |last3=Aspinall |first3=Richard |last4=Batterham |first4=Rachel |last5=Bhala |first5=Neeraj |last6=Bosanquet |first6=Nick |last7=Severi |first7=Katherine |last8=Burton |first8=Anya |last9=Burton |first9=Robyn |last10=Cramp |first10=Matthew E. |last11=Day |first11=Natalie |last12=Dhawan |first12=Anil |last13=Dillon |first13=John |last14=Drummond |first14=Colin |last15=Dyson |first15=Jessica |date=2018-12-01 |title=Gathering momentum for the way ahead: fifth report of the Lancet Standing Commission on Liver Disease in the UK |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32561-3/fulltext|journal=Lancet |volume=392 |issue=10162 |pages=2398–2412 |doi=10.1016/S0140-6736(18)32561-3 |issn=1474-547X |pmid=30473364|s2cid=53715414 }}</ref> Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. There is an increased risk of developing an alcohol use disorder for teenagers while their brain is still developing.<ref name="Risks of Adolescent Alcohol Use">{{Cite web|date=2018-01-19|title=Risks of Adolescent Alcohol Use|url=https://www.hhs.gov/ash/oah/adolescent-development/substance-use/alcohol/risks/index.html|archive-url=https://web.archive.org/web/20190322105237/https://www.hhs.gov/ash/oah/adolescent-development/substance-use/alcohol/risks/index.html|url-status=dead|archive-date=22 March 2019|access-date=2020-06-03|website=HHS.gov|language=en}}</ref> Adolescents who drink have a higher probability of injury including death.<ref name="Risks of Adolescent Alcohol Use"/> 

Observational studies suggest a correlation between low to moderate alcohol consumption and cardiovascular protective effects.<ref>Haseeb, Sohaib, Bryce Alexander, and Adrian Baranchuk. "[https://pubmed.ncbi.nlm.nih.gov/28993373/ Wine and cardiovascular health: a comprehensive review.]" ''Circulation'' 136, no. 15 (2017): 1434-1448.</ref><ref>Harvard T.H. Chan, School of Public Health. The Nutrition Source, [https://nutritionsource.hsph.harvard.edu/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/ Alcohol: Balancing Risks and Benefits]. (2022).</ref> Several studies and meta-analyses have shown a reduction in overall mortality among light to moderate alcohol drinkers compared to lifetime abstainers.<ref>{{cite journal | url=https://www.jacc.org/doi/10.1016/j.jacc.2017.07.710 | doi=10.1016/j.jacc.2017.07.710 | title=Alcohol and Health | date=2017 | last1=De Gaetano | first1=Giovanni | last2=Costanzo | first2=Simona | journal=Journal of the American College of Cardiology | volume=70 | issue=8 | pages=923–925 | pmid=28818201 }}</ref><ref>Ronksley, Paul E., et al. "[https://www.bmj.com/content/342/bmj.d671 Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis]." Bmj 342 (2011): d671.</ref> A statement from ''The Lancet'' in 2022, based on the 2020 Global Burden of Disease Study, noted that for adults over 40 consuming small amounts of alcohol may reduce risks for cardiovascular disease, stroke, and diabetes.<ref>The Lancet 2022. [https://www.thelancet.com/infographics-do/alcohol-gbd Health Risks of Alcohol Infographic] - Global Burden of Disease Study 2020. </ref>

Even light to moderate alcohol consumption can have negative effects on health,<ref>{{Cite web|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|access-date=2023-02-08|website=www.euro.who.int|language=en}}</ref><ref>{{Cite news|date=2018-08-24|title=No alcohol safe to drink, global study confirms|language=en-GB|work=BBC News|url=https://www.bbc.com/news/health-45283401|access-date=2021-05-21}}</ref><ref>{{Cite web|last=Stories|first=Daily Health|date=2018-11-20|title=Study: No Level of Alcohol is Safe|url=https://newsroom.clevelandclinic.org/2018/11/20/study-no-level-of-alcohol-is-safe/|access-date=2021-05-21|website=Cleveland Clinic Newsroom|language=en-US|archive-date=21 May 2021|archive-url=https://web.archive.org/web/20210521150842/https://newsroom.clevelandclinic.org/2018/11/20/study-no-level-of-alcohol-is-safe/|url-status=dead}}</ref> such as by increasing a person's risk of developing several [[cancer]]s.<ref name="Weinstock2017">{{cite magazine|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|magazine=[[Scientific American]]|date=8 November 2017|access-date=13 November 2018|quote=The ASCO statement, published in the Journal of Clinical Oncology, cautions that while the greatest risks are seen with heavy long-term use, even low alcohol consumption (defined as less than one drink per day) or moderate consumption (up to two drinks per day for men, and one drink per day for women because they absorb and metabolize it differently) can increase cancer risk. Among women, light drinkers have a four percent increased risk of[breast cancer, while moderate drinkers have a 23 percent increased risk of the disease. }}</ref><ref name="LoConte2017">{{cite journal |author=Noelle K. LoConte |author2=Abenaa M. Brewster |author3=Judith S. Kaur |author4=Janette K. Merrill |author5=Anthony J. Alberg |title=Alcohol and Cancer: A Statement of the American Society of Clinical Oncology |journal=[[Journal of Clinical Oncology]] |date=7 November 2017 |volume=36 |issue=1|quote=Clearly, the greatest cancer risks are concentrated in the heavy and moderate drinker categories. Nevertheless, some cancer risk persists even at low levels of consumption. A meta-analysis that focused solely on cancer risks associated with drinking one drink or fewer per day observed that this level of alcohol consumption was still associated with some elevated risk for squamous cell carcinoma of the esophagus (sRR, 1.30; 95% CI, 1.09 to 1.56), oropharyngeal cancer (sRR, 1.17; 95% CI, 1.06 to 1.29), and breast cancer (sRR, 1.05; 95% CI, 1.02 to 1.08), but no discernable associations were seen for cancers of the colorectum, larynx, and liver.}}</ref> A 2014 [[World Health Organization]] (WHO) report found that harmful alcohol consumption caused about 3.3 million deaths annually worldwide.<ref>{{cite web | url=https://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf | title=Global status report on alcohol and health | publisher=World Health Organization | date=2014 | access-date=23 November 2015 | pages=vii}}</ref> Negative effects are related to the amount consumed with no safe lower limit seen.<ref name="Lancet2018GBD">{{cite journal |title=Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 |journal=The Lancet |volume=392 |issue=10152 |pages=1015–35 |date=August 2018 |doi=10.1016/S0140-6736(18)31310-2|pmid=30146330 |pmc=6148333 |display-authors=5 |last1=Griswold |first1=MG |last2=Fullman |first2=N |last3=Hawley |first3=C |last4=Arian |first4=N |last5=Zimsen |first5=SM |last6=Tymeson |first6=HD|last7=Venkateswaran |first7=Vidhya |last8=Tapp |first8=Austin Douglas |last9=Forouzanfar |first9=Mohammad H. |last10=Salama |first10=Joseph S. |last11=Abate |first11=Kalkidan Hassen |last12=Abate |first12=Degu |last13=Abay |first13=Solomon M. |last14=Abbafati |first14=Cristiana |last15=Abdulkader |first15=Rizwan Suliankatchi |last16=Abebe |first16=Zegeye |last17=Aboyans |first17=Victor |last18=Abrar |first18=Mohammed Mehdi |last19=Acharya |first19=Pawan |last20=Adetokunboh |first20=Olatunji O. |last21=Adhikari |first21=Tara Ballav |last22=Adsuar |first22=Jose C. |last23=Afarideh |first23=Mohsen |last24=Agardh |first24=Emilie Elisabet |last25=Agarwal |first25=Gina |last26=Aghayan |first26=Sargis Aghasi |last27=Agrawal |first27=Sutapa |last28=Ahmed |first28=Muktar Beshir |last29=Akibu |first29=Mohammed |last30=Akinyemiju |first30=Tomi}}</ref> Some nations have introduced [[alcohol packaging warning messages]] that inform consumers about [[alcohol and cancer]], as well as [[fetal alcohol syndrome]].<ref>{{cite news |title=Cancer warning labels to be included on alcohol in Ireland, minister confirms |url=https://www.belfasttelegraph.co.uk/news/republic-of-ireland/cancer-warning-labels-to-be-included-on-alcohol-in-ireland-minister-confirms-37357231.html |publisher=[[Belfast Telegraph]]|language=en|date=26 September 2018|newspaper=Belfasttelegraph.co.uk }}</ref> There are several potential ways for light alcohol drinkers to reduce their cancer risk. Research suggests that dietary intake of folate, in amounts commonly found in daily multivitamins, may help protect women from the increased risk of breast cancer associated with light alcohol consumption.<ref>Baglietto, Laura, Dallas R. English, Dorota M. Gertig, John L. Hopper, and Graham G. Giles. " [https://pubmed.ncbi.nlm.nih.gov/16087654/ Does dietary folate intake modify effect of alcohol consumption on breast cancer risk? Prospective cohort study].." Bmj 331, no. 7520 (2005): 807.</ref> Additionally, two large U.S.-based studies on health professionals found no increased cancer risk from light to moderate alcohol consumption in men who do not smoke.<ref>Cao, Yin, Walter C. Willett, Eric B. Rimm, Meir J. Stampfer, and Edward L. Giovannucci. "[https://pubmed.ncbi.nlm.nih.gov/26286216/ Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies]." ''Bmj'' 351 (2015).</ref><ref>Harvard T.H. Chan, School of Public Health. The Nutrition Source, [https://nutritionsource.hsph.harvard.edu/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/ Alcohol: Balancing Risks and Benefits]. (2022).</ref> Some observational studies suggest a potential association between alcohol consumption and a decreased risk of certain cancers, such as kidney cancer, thyroid cancer, and non-Hodgkin lymphoma.<ref>Harvard Public Health “[https://harvardpublichealth.org/policy-practice/is-alcohol-bad-for-you-or-is-alcohol-good-for-you-yes/ Is alcohol good or bad for you? Yes.]”, Kenneth Mukamal and Eric B. Rimm. (August 2024).</ref><ref>Allen, Naomi E., Valerie Beral, Delphine Casabonne, Sau Wan Kan, Gillian K. Reeves, Anna Brown, and Jane Green. "[https://pubmed.ncbi.nlm.nih.gov/19244173/ Moderate alcohol intake and cancer incidence in women]." ''Journal of the National Cancer Institute'' 101, no. 5 (2009): 296-305.</ref><ref>Lee JE, Hunter DJ, Spiegelman D, et al. “[https://pubmed.ncbi.nlm.nih.gov/17505075/ Alcohol intake and renal cell cancer in a pooled analysis of 12 prospective studies].” ''Journal of the National Cancer Institute'' (2007); 99(10):801–810.</ref><ref>Tramacere I, Pelucchi C, Bonifazi M, et al. “[https://pubmed.ncbi.nlm.nih.gov/22357444/ Alcohol drinking and non-Hodgkin lymphoma risk: A systematic review and a meta-analysis].” ''Annals of Oncology'' (2012); 23(11):2791–2798.</ref> Multiple prospective studies suggest a protective effect of light to moderate alcohol consumption on cardiovascular health for both men and women.<ref>Harvard T.H. Chan, School of Public Health. The Nutrition Source, [https://nutritionsource.hsph.harvard.edu/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/ Alcohol: Balancing Risks and Benefits]. (2022).</ref> Several mechanisms have been proposed to explain this association.<ref>Harvard T.H. Chan, School of Public Health. The Nutrition Source, [https://nutritionsource.hsph.harvard.edu/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/ Alcohol: Balancing Risks and Benefits]. (2022).</ref><ref>Rodriguez, Adrianna. 2023. “[https://www.usatoday.com/story/news/health/2023/06/12/drinking-alcohol-study-heart-health/70296729007/ Study reveals how alcohol has heart benefits. Why you should still sip with caution].” ''USA TODAY'', June 12, 2023</ref><ref>Kenechukwu Mezue, Michael T. Osborne, Shady Abohashem, Hadil Zureigat, Charbel Gharios, Simran S. Grewal, Azar Radfar, Alexander Cardeiro, Taimur Abbasi, Karmel W. Choi, Zahi A. Fayad, Jordan W. Smoller, Rachel Rosovsky, Lisa Shin, Roger Pitman, and Ahmed Tawakol. "[https://pubmed.ncbi.nlm.nih.gov/37316112/ Reduced stress-related neural network activity mediates the effect of alcohol on cardiovascular risk.]" ''Journal of the American College of Cardiology'' 81, no. 24 (2023): 2315-2325.</ref> Additionally, alcohol may reduce the risk of clot formation, which can contribute to heart attacks and strokes, and lower the risk of developing diabetes.<ref>Harvard T.H. Chan, School of Public Health. The Nutrition Source, [https://nutritionsource.hsph.harvard.edu/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/ Alcohol: Balancing Risks and Benefits]. (2022).</ref><ref>Haseeb, Sohaib, Bryce Alexander, and Adrian Baranchuk. "[https://pubmed.ncbi.nlm.nih.gov/28993373/ Wine and cardiovascular health: a comprehensive review.]" ''Circulation'' 136.15 (2017): 1434-1448.</ref><ref>Koppes, Lando LJ, Jacqueline M. Dekker, Henk FJ Hendriks, Lex M. Bouter, and Robert J. Heine. "[https://pubmed.ncbi.nlm.nih.gov/15735217/ Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies]." ''Diabetes care'' 28, no. 3 (2005): 719-725.</ref> A 2022 statement from ''[[The Lancet]]'', based on its 2020 Global Burden of Disease Study, said that the health risks associated with alcohol consumption vary by age and region, and that for those over age 40, "consuming a small amount of alcohol ... can provide some health benefits, such as reducing the risk of cardiovascular disease, stroke, and diabetes."<ref>''The Lancet'', July 14, 2022. [https://www.thelancet.com/infographics-do/alcohol-gbd Health Risks of Alcohol Infographic] – Global Burden of Disease Study 2020.</ref>

==Short-term effects==
{{Main|Short-term effects of alcohol consumption}}
The [[short-term effects of alcohol consumption]] range from a decrease in anxiety and motor skills at lower doses to unconsciousness, [[anterograde amnesia]], and [[central nervous system]] depression at higher doses. [[Cell membrane]]s are highly permeable to alcohol, so once alcohol is in the bloodstream it can diffuse into nearly every cell in the body.

The [[concentration]] of alcohol in [[blood]] is measured via [[blood alcohol content]] (BAC). The amount and circumstances of consumption play a large part in determining the extent of [[alcohol intoxication|intoxication]]; for example, eating a heavy meal before alcohol consumption causes alcohol to absorb more slowly.<ref>{{cite journal |vauthors=Horowitz M, Maddox A, Bochner M |display-authors=etal |title=Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption |journal=Am. J. Physiol. |volume=257 |issue=2 Pt 1 |pages=G291–6298 |date=1989 |pmid=2764113 |doi=10.1152/ajpgi.1989.257.2.G291 }}</ref> [[Dehydration|Hydration]] also plays a role, especially in determining the extent of [[hangover]]s. After [[binge drinking]], [[unconsciousness]] can occur and extreme levels of consumption can lead to [[alcohol poisoning]] and death (a concentration in the blood stream of 0.40% will [[median lethal dose|kill half of those affected]]<ref name="BAC">{{Cite web |url=http://apps.carleton.edu/campus/wellness/info/alcohol/bac/ |title=Carleton College: Wellness Center: Blood Alcohol Concentration (BAC) |access-date=29 August 2015 |archive-url=https://web.archive.org/web/20090914152127/http://apps.carleton.edu/campus/wellness/info/alcohol/bac/ |archive-date=14 September 2009 }}</ref>{{medical citation needed|date=November 2015}}). Alcohol may also cause death indirectly, by [[asphyxiation]] from [[vomiting|vomit]].

Alcohol disrupts [[sleep architecture|normal sleep patterns]] thereby reducing sleep quality and can greatly exacerbate sleep problems. During [[abstinence]], residual disruptions in sleep regularity and sleep patterns are the greatest predictors of [[relapse]].<ref name="ReferenceA">{{cite journal |vauthors=Feige B, Scaal S, Hornyak M, Gann H, Riemann D |title=Sleep electroencephalographic spectral power after withdrawal from alcohol in alcohol-dependent patients |journal=Alcohol. Clin. Exp. Res. |volume=31 |issue=1 |pages=19–27 |date=2007 |pmid=17207097 |doi=10.1111/j.1530-0277.2006.00260.x}}</ref>

Heavy alcohol consumption while in a hunger state can cause [[alcoholic ketoacidosis]], a life-threatening metabolic derailment.

The [[median lethal dose]] of alcohol in test animals is a [[blood alcohol content]] of 0.45%. This is about six times the level of ordinary intoxication (0.08%), but [[vomiting]] or unconsciousness may occur much sooner in people who have a low tolerance for alcohol.<ref name="psychopharm">Meyer, Jerold S. and Linda F. Quenzer. Psychopharmacology: Drugs, the Brain, and Behavior. Sinauer Associates, Inc.: Sunderland, Massachusetts. 2005. Page 228.</ref> The high tolerance of chronic heavy drinkers may allow some of them to remain conscious at levels above 0.40%, although serious health hazards are incurred at this level.

Alcohol also limits the production of [[vasopressin]] (antidiuretic hormone) from the [[hypothalamus]] and the secretion of this [[hormone]] from the [[posterior pituitary]] gland. This is what causes severe dehydration when alcohol is consumed in large amounts. It also causes a high concentration of water in the [[urine]] and vomit, and the intense thirst that goes along with a [[hangover]].

==Long-term effects==
{{Main|Long-term effects of alcohol}}
[[File:Intervention alcohol warning labels, Jsad.2020.81.262fig1 (cropped to "Alcohol can cause cancer" label).jpg|thumb|Example of an [[alcohol packaging warning messages|alcohol packaging warning message]] from [[Canada]].]]

According to the World Health Organization's 2018 Global Status Report on Alcohol and Health, there are more than 3 million people who die from the harmful effects of alcohol each year, which amounts to more than 5% of the burden of disease worldwide.<ref>{{Cite web | url=https://www.who.int/substance_abuse/publications/global_alcohol_report/en/ | title=WHO &#124; Global status report on alcohol and health 2018}}</ref> The US [[National Institutes of Health]] similarly estimates that 3.3 million deaths (5.9% of all deaths) were believed to be due to alcohol each year.<ref name=NIH2015Stats>{{cite web|title=Alcohol Facts and Statistics|url=http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|access-date=9 May 2015|archive-date=18 May 2015|archive-url=https://web.archive.org/web/20150518081638/http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|url-status=dead}}</ref>

As per WHO June 2024 report on Alcohol, around 2.6 million deaths were caused by alcohol consumption in 2019 worldwide.<ref name=":0">{{Cite web |title=Alcohol |url=https://www.who.int/news-room/fact-sheets/detail/alcohol |access-date=2024-08-21 |website=www.who.int |language=en}}</ref>

Guidelines in the US and the UK advise that ''if'' people choose to drink, they should drink modestly.<ref>{{cite web |title=Appendix 9. Alcohol — 2015-2020 Dietary Guidelines — health.gov |url=https://health.gov/dietaryguidelines/2015/guidelines/appendix-9/ |publisher=U.S. Department of Health and Human Services |language=en}}</ref><ref>{{cite news |title=New alcohol advice issued |url=https://www.nhs.uk/news/food-and-diet/new-alcohol-advice-issued/ |work=NHS |date=8 January 2016 |access-date=3 September 2018 |archive-date=30 November 2020 |archive-url=https://web.archive.org/web/20201130035635/https://www.nhs.uk/news/food-and-diet/new-alcohol-advice-issued/ |url-status=dead }}</ref>

Even light and moderate alcohol consumption increases a person's cancer risk, especially the risk of developing [[Esophageal cancer#Squamous-cell carcinoma|squamous cell carcinoma of the esophagus]], [[oropharyngeal cancer|cancers of the mouth and tongue]], [[liver cancer]], and [[breast cancer]].<ref name="Weinstock2017"/><ref name="LoConte2017"/> Using alcohol, especially together with [[tobacco]], is a major risk factor for [[head and neck cancer]]. 72% of head and neck cancer cases are caused by using both alcohol and tobacco.<ref name=":6">{{Cite journal |last1=Gormley |first1=Mark |last2=Creaney |first2=Grant |last3=Schache |first3=Andrew |last4=Ingarfield |first4=Kate |last5=Conway |first5=David I. |date=2022-11-11 |title=Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors |journal=British Dental Journal |language=en |volume=233 |issue=9 |pages=780–6 |doi=10.1038/s41415-022-5166-x |issn=0007-0610 |pmc=9652141 |pmid=36369568}}</ref> This rises to 89% when looking specifically at [[laryngeal cancer]].<ref>{{Cite journal |last1=Hashibe |first1=Mia |last2=Brennan |first2=Paul |last3=Chuang |first3=Shu-chun |last4=Boccia |first4=Stefania |last5=Castellsague |first5=Xavier |last6=Chen |first6=Chu |last7=Curado |first7=Maria Paula |last8=Dal Maso |first8=Luigino |last9=Daudt |first9=Alexander W. |last10=Fabianova |first10=Eleonora |last11=Fernandez |first11=Leticia |last12=Wünsch-Filho |first12=Victor |last13=Franceschi |first13=Silvia |last14=Hayes |first14=Richard B. |last15=Herrero |first15=Rolando |date=2009-02-01 |title=Interaction between Tobacco and Alcohol Use and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium |journal=Cancer Epidemiology, Biomarkers & Prevention |language=en |volume=18 |issue=2 |pages=541–550 |doi=10.1158/1055-9965.EPI-08-0347 |issn=1055-9965 |pmc=3051410 |pmid=19190158}}</ref>

[[File:Health risks of alcohol consumption.svg|thumb|Health risks of alcohol consumption]]
A systematic analysis of data from the [[Global Burden of Disease Study]], which was an [[observational study]], found that long-term consumption of any amount of alcohol is associated with an increased risk of death in all people, and that even moderate consumption appears to be risky.<ref name="GBD 2016 Alcohol Collaborators-2018" /> Similar to prior analyses, it found an apparent benefit for older women in [[Alcohol and cardiovascular disease|reducing the risks of death from ischemic heart disease]] and from [[diabetes mellitus]], but unlike prior studies it found those risks cancelled by an apparent increased risk of death from breast cancer and other causes.<ref name="GBD 2016 Alcohol Collaborators-2018">{{cite journal |title=Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 |journal=Lancet |volume= 392|issue= 10152|pages= 1015–35|date=August 2018 |pmid=30146330 |pmc=6148333 |doi=10.1016/S0140-6736(18)31310-2 |author=((GBD 2016 Alcohol Collaborators))}}</ref> A 2016 systematic review and meta-analysis found that moderate ethanol consumption brought no mortality benefit compared with lifetime abstention from ethanol consumption.<ref>{{cite journal |vauthors=Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T |title=Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality |journal=J Stud Alcohol Drugs |volume=77 |issue=2 |pages=185–198 |date=2016 |pmid=26997174 |pmc=4803651 |doi= 10.15288/jsad.2016.77.185}}</ref> Risk is greater in younger people due to heavy episodic drinking which may result in violence or accidents.<ref name=Kee2014>{{cite journal|last1=O'Keefe|first1=JH|last2=Bhatti|first2=SK|last3=Bajwa|first3=A|last4=DiNicolantonio|first4=JJ|last5=Lavie|first5=CJ|title=Alcohol and cardiovascular health: the dose makes the poison...or the remedy.|journal=Mayo Clinic Proceedings|date=2014|volume=89|issue=3|pages=382–393|pmid=24582196|doi=10.1016/j.mayocp.2013.11.005|doi-access=free}}</ref>

Long-term heavy use of alcohol damages nearly every organ and system in the body.<ref>{{cite book|editor1-first=Woody|editor1-last=Caan|editor2-first=Jackie de|editor2-last=Belleroche|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}}</ref> Risks include [[alcohol use disorder]], [[malnutrition]], [[chronic pancreatitis]], [[alcoholic liver disease]] (e.g., [[cirrhosis|permanent liver scarring]]) and several types of [[cancer]]. In addition, damage to the [[central nervous system]] and [[peripheral nervous system]] (e.g., painful [[peripheral neuropathy]]) can occur from chronic alcohol misuse.<ref>{{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=129–32|date=March 1985|pmid=2988001}}</ref><ref>{{cite journal|author=Testino G|title=Alcoholic diseases in hepato-gastroenterology: a point of view |journal=Hepatogastroenterology |volume=55 |issue=82–83 |pages=371–7 |year=2008 |pmid=18613369}}</ref>

The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol.<ref>{{cite journal | last1 = Guerri | first1 = C. | last2 = Pascual | first2 = M.A. | year = 2010 | title = Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence | journal = Alcohol | volume = 44 | issue = 1| pages = 15–26 | doi = 10.1016/j.alcohol.2009.10.003 | pmid = 20113871 }}</ref>

A systematic analysis found in 2022 that the level of alcohol consumption recommended by many existing guidelines is too high in particular for young people in all regions.<ref>{{Cite web |date=2022-07-14 |title=THE LANCET: Alcohol consumption carries significant health risks and no benefits for young people; some older adults may benefit from drinking a small amount of alcohol |url=https://www.eurekalert.org/news-releases/958569 |access-date=2022-07-15 |website=EurekAlert! |language=en}}</ref>

===DNA damage===

[[Acetaldehyde]] is produced when cells process ethanol. Acetaldehyde, is a [[DNA damage (naturally occurring)|DNA damaging]] metabolite that can interact with DNA to crosslink the two strands of the DNA duplex.<ref name="Hodskinson2020">{{cite journal |vauthors=Hodskinson MR, Bolner A, Sato K, Kamimae-Lanning AN, Rooijers K, Witte M, Mahesh M, Silhan J, Petek M, Williams DM, Kind J, Chin JW, Patel KJ, Knipscheer P |title=Alcohol-derived DNA crosslinks are repaired by two distinct mechanisms |journal=Nature |volume=579 |issue=7800 |pages=603–8 |date=March 2020 |pmid=32132710 |pmc=7116288 |doi=10.1038/s41586-020-2059-5 |bibcode=2020Natur.579..603H }}</ref> The mechanisms the cells use for repairing these crosslinks are error prone,<ref name = Hodskinson2020/> thus leading to [[mutation]]s that in the long term can cause cancer.

==Pregnancy==
{{see also|Fetal alcohol spectrum disorders}}
Medical organizations strongly discourage drinking alcohol during pregnancy.<ref name=SG>{{cite web|author1=Vice Admiral Richard H. Carmona|title=A 2005 Message to Women from the U.S. Surgeon General|url=https://www.cdc.gov/ncbddd/fasd/documents/sg-advisory.pdf|access-date=12 June 2015|date=2005}}</ref><ref name=IOM>{{cite book|author=((Institute of Medicine; Committee to Study Fetal Alcohol Syndrome))|title=Fetal alcohol syndrome: diagnosis, epidemiology, prevention, and treatment |editor=Kathleen Stratton |editor2=Cynthia Howe |editor3=Frederick C. Battaglia |date=1995|publisher=National Academy Press|location=Washington, D.C.|isbn=978-0-309-05292-4|url=http://www.nap.edu/catalog/4991/fetal-alcohol-syndrome-diagnosis-epidemiology-prevention-and-treatment|doi=10.17226/4991}}</ref><ref>{{cite web |title=Australian Government National Health and Medical Research Council |url=http://www.nhmrc.gov.au/your-health/alcohol-guidelines |access-date=4 November 2012 |archive-url=https://web.archive.org/web/20121105024533/http://www.nhmrc.gov.au/your-health/alcohol-guidelines |archive-date=5 November 2012 |df=dmy-all }}</ref> Alcohol passes easily from the mother's bloodstream through the [[placenta]] and into the bloodstream of the fetus,<ref name="Nathanson 857">{{cite journal|last=Nathanson|first=Vivienne|author2=Nicky Jayesinghe |author3=George Roycroft |title=Is it all right for women to drink small amounts of alcohol in pregnancy? No|journal=BMJ|date=27 October 2007|volume=335|issue=7625|pages=857|doi=10.1136/bmj.39356.489340.AD|pmid=17962287|pmc=2043444}}</ref> which interferes with brain and organ development.<ref name=NIH2015/> Alcohol can affect the fetus at any stage during pregnancy, but the level of risk depends on the amount and frequency of alcohol consumed.<ref name=NIH2015>{{cite web|title=Fetal Alcohol Exposure|url=http://pubs.niaaa.nih.gov/publications/FAS0DFactsheet/FASDfact.htm|access-date=10 June 2015|date=April 2015}}</ref> Regular heavy drinking and heavy episodic drinking (also called binge drinking), entailing four or more standard alcoholic drinks (a pint of beer or 50 ml drink of a spirit such as [[whisky]] corresponds to about two units of alcohol) on any one occasion, pose the greatest risk for harm, but lesser amounts can cause problems as well.<ref name=NIH2015/> There is no known safe amount or safe time to drink during pregnancy, and the U.S. [[Centers for Disease Control and Prevention]] recommends complete abstinence for women who are pregnant, trying to become pregnant, or are sexually active and not using birth control.<ref name=CDC2015Fact>{{cite web|title=Facts about FASDs|url=https://www.cdc.gov/ncbddd/fasd/facts.html|access-date=10 June 2015|date=16 April 2015}}</ref><ref>{{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|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.|date=2 February 2016}}</ref>

Prenatal alcohol exposure can lead to [[fetal alcohol spectrum disorders]] (FASDs). The most severe form of FASD is fetal alcohol syndrome (FAS).<ref name=CDC2015Fact/> Problems associated with FASD include abnormal facial development, [[low birth weight]], [[stunted growth]], [[microcephaly|small head size]], delayed or uncoordinated [[Motor skill#Development of motor skills|motor skill]]s, [[hearing impaired|hearing]] or [[visual impairment|vision problems]], [[learning disability|learning disabilities]], [[Behavioral disorder|behavior problems]], and inappropriate [[Social skills#Alcohol misuse|social skill]]s compared to [[age appropriate|same-age peers]].<ref name=Cor2013>{{cite journal|last1=Coriale|title=Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment.|journal=Rivista di Psichiatria|date=2013|volume=48|issue=5|pages=359–69|pmid=24326748|doi=10.1708/1356.15062|display-authors=etal}}</ref><ref name=Canadian>{{citation|last=Chudley|title=Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis|journal=CMAJ|volume=172|issue=5 Suppl|pages=S1–S21|year=2005|pmid=15738468|doi=10.1503/cmaj.1040302|pmc=557121|display-authors=etal}}</ref> Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and develop [[substance use disorder]]s like excessive drinking themselves.<ref name=Cor2013/>

==Cardiovascular disease==
{{main|Alcohol and cardiovascular disease}}
In 2010, a systematic review reported that moderate consumption of alcohol does not cause harm to people with cardiovascular disease. However, the authors did not encourage people to start drinking alcohol in the hope of any benefit.<ref>{{cite journal |vauthors=Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G |title=Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis |journal=J. Am. Coll. Cardiol. |volume=55 |issue=13 |pages=1339–47 |date=2010 |pmid=20338495 |doi=10.1016/j.jacc.2010.01.006 }}</ref> In a 2018 study on 599,912 drinkers, a roughly linear association was found with alcohol consumption and a higher risk of [[stroke]], [[coronary artery disease]] excluding [[myocardial infarction]], [[heart failure]], fatal [[Hypertension|hypertensive disease]], and fatal [[aortic aneurysm]], even for moderate drinkers.<ref>{{cite journal |vauthors=Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al.|title=Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. |journal=The Lancet |volume=391 |issue=10129 |pages=1513–23 |date=2018 |pmid= 29676281|doi=10.1016/S0140-6736(18)30134-X |pmc=5899998 }}</ref>{{Primary source inline|date=March 2021}} The [[American Heart Association]] states that people who are currently non-drinkers should not start drinking alcohol.<ref>{{cite web |url=https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/alcohol-and-heart-health |title=Alcohol and Heart Health |publisher=American Heart Association |date=August 15, 2014 }}</ref>

== Insulin response ==
Alcohol is known to potentiate the [[Insulin|insulin response]] of the human body to [[glucose]], which, in essence, "instructs" the body to convert consumed carbohydrates into fat and to suppress carbohydrate and fat oxidation.<ref>{{cite journal|title=Potentiation of the Plasma Insulin Response to Glucose by Prior Administration of Alcohol|author=Robert Metz|journal=Diabetes|year=1969|url=http://diabetes.diabetesjournals.org/content/18/8/517.full.pdf|display-authors=etal|doi=10.2337/diab.18.8.517|pmid=4897290|volume=18|issue=8|pages=517–22|s2cid=32072796|access-date=2014-02-11|archive-date=2014-02-22|archive-url=https://web.archive.org/web/20140222232949/http://diabetes.diabetesjournals.org/content/18/8/517.full.pdf|url-status=live}}</ref><ref>{{cite journal|title=Ethanol Causes Acute Inhibition of Carbohydrate, Fat, and Protein Oxidation and Insulin Resistance|journal=J. Clin. Invest.|year=1988|pmc=329642|pmid=3280601|doi=10.1172/JCI113428|volume=81|issue=4|pages=1137–45 | last1 = Shelmet | first1 = JJ | last2 = Reichard | first2 = GA | last3 = Skutches | first3 = CL | last4 = Hoeldtke | first4 = RD | last5 = Owen | first5 = OE | last6 = Boden | first6 = G}}</ref> Ethanol is directly processed in the liver to [[acetyl CoA]], the same intermediate product as in glucose metabolism. Because ethanol is mostly metabolized and consumed by the liver, chronic excessive use can lead to [[fatty liver]]. This leads to a chronic inflammation of the liver and eventually [[alcoholic liver disease]].

Alcohol consumption can cause [[hypoglycemia]] in [[Diabetes mellitus|diabetics]] on certain medications, such as [[insulin]] or [[sulfonylurea]], by blocking [[gluconeogenesis]].<ref>{{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]] }}</ref>

Alcoholic beverages show a lower [[satiety value]] per calorie.<ref name="n615">{{cite journal | last1=Westerterp-Plantenga | first1=Margriet S | last2=Verwegen | first2=Christianne RT | title=The appetizing effect of an apéritif in overweight and normal-weight humans | journal=The American Journal of Clinical Nutrition | volume=69 | issue=2 | date=1999 | doi=10.1093/ajcn/69.2.205 | doi-access=free | pages=205–212 | pmid=9989681 | url=https://academic.oup.com/ajcn/article-pdf/69/2/205/23934953/205.pdf | access-date=15 December 2024}}</ref>

== Breastfeeding ==
The [[United Kingdom|UK]] [[National Health Service]] states that "an occasional drink is unlikely to harm" a breastfed baby, and recommends consumption of "no more than one or two units of alcohol once or twice a week" for breastfeeding mothers (where a pint of beer or 50&nbsp;ml drink of a spirit such as whisky corresponds to about ''two'' units of alcohol).<ref name=NHSguide/> The NHS also recommends to wait for a couple of hours before breastfeeding or express the milk into a bottle before drinking.<ref name=NHSguide>{{cite web|url=http://www.nhs.uk/chq/pages/958.aspx?CategoryID=54&SubCategoryID=135#close|title=Breastfeeding and drinking alcohol — Pregnancy and baby guide — NHS Choices|first=N. H. S.|last=Choices|date=1 May 2017}}</ref> Researchers have shown that intoxicated breastfeeding reduces the average milk expression but poses no immediate threat to the child as the amount of transferred alcohol is insignificant.<ref>{{cite journal|last1=Haastrup|first1=MB|last2=Pottegård|first2=A|last3=Damkier|first3=P|s2cid=31580580|title=Alcohol and Breastfeeding|journal=Basic & Clinical Pharmacology & Toxicology|date=2014|volume=114|issue=2|pages=168–173|doi=10.1111/bcpt.12149|quote=even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol|pmid=24118767|doi-access=free}}</ref>

==Mental health==

===Mental disorders===
Alcohol misuse often coincides with mental health conditions. Many individuals struggling with psychiatric disorders also experience problematic drinking behaviors.<ref>{{cite journal |last1=Palzes |first1=VA |last2=Parthasarathy |first2=S |last3=Chi |first3=FW |last4=Kline-Simon |first4=AH |last5=Lu |first5=Y |last6=Weisner |first6=C |last7=Ross |first7=TB |last8=Elson |first8=J |last9=Sterling |first9=SA |title=Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population. |journal=Alcoholism: Clinical and Experimental Research |date=December 2020 |volume=44 |issue=12 |pages=2536–44 |doi=10.1111/acer.14477 |pmid=33151592|pmc=7756330 }}</ref>

===Spiritual use of alcohol===
{{main|Alcohol and religion|List of substances used in rituals}}

Most religions prohibit or advise against alcohol use. However, spiritual use of alcohol is found in some religions and schools with esoteric influences, including the Hindu tantra sect [[Aghori]], in the [[Sufi]] [[Bektashi Order]] and [[Alevi]] [[Jem (Alevism)|Jem]] ceremonies,<ref>{{Cite journal | vauthors = Soileau M |date=August 2012 |title=Spreading the ''Sofra'': Sharing and Partaking in the Bektashi Ritual Meal |journal=History of Religions |url=https://www.journals.uchicago.edu/doi/10.1086/665961 |url-access=subscription |volume=52 |issue=1 |pages=1–30 |access-date=June 5, 2021 |doi=10.1086/665961 |jstor=10.1086/665961}}</ref> in the Japanese religion [[Shinto]],<ref>{{Cite book| vauthors = Bocking B |title=A popular dictionary of Shintō|date=1997|publisher=Curzon Press|isbn=0-7007-1051-5|edition=Rev. |location=Richmond, Surrey [U.K.]|oclc=264474222}}</ref> by the new religious movement [[Thelema]], in [[Vajrayana Buddhism]], and in [[Haitian Vodou|Vodou]] faith of Haiti.

==Alcohol education==
{{Main|Alcohol education}}
Alcohol education is the practice of disseminating information about the effects of alcohol on health, as well as society and the family unit.<ref name="MooreGerstein1981">{{cite book |last1=Moore |first1=Mark Harrison |last2=Gerstein |first2=Dean R. |title=Alcohol and Public Policy |url=https://archive.org/details/alcoholpublicpol00moor |url-access=registration |date=1981 |publisher=National Academies |page=[https://archive.org/details/alcoholpublicpol00moor/page/90 90–93] |isbn=9780585119823 |language=en}}</ref> It was introduced into the public schools by [[List of Temperance organizations|temperance organizations]] such as the [[Woman's Christian Temperance Union]] in the late 19th century.<ref name="MooreGerstein1981"/> Initially, alcohol education focused on how the consumption of alcoholic beverages affected society, as well as the family unit.<ref name="MooreGerstein1981"/> In the 1930s, this came to also incorporate education pertaining to alcohol's effects on health.<ref name="MooreGerstein1981"/> Organizations such as the [[National Institute on Alcohol Abuse and Alcoholism]] in the United States were founded to promulgate alcohol education alongside those of the [[temperance movement]], such as the [[American Council on Alcohol Problems]].<ref name="MooreGerstein1981"/><ref name="Martin2014">{{cite book |last1=Martin |first1=Scott C. |title=The SAGE Encyclopedia of Alcohol: Social, Cultural, and Historical Perspectives |date=2014 |publisher=SAGE Publications |isbn=978-1-4833-7438-3 |oclc=907238072}}</ref>

==Alcohol expectations==
'''Alcohol expectations''' are [[belief]]s and [[Attitude (psychology)|attitudes]] that people have about the effects they will experience when drinking alcoholic beverages. ''Alcohol expectancy theory'' posits that drinking behaviors are driven by these expectations, and the individual may be motivated to drink to obtain desired alcohol effects or, alternatively, motivated to refrain from drinking due to the expectation of undesirable effects. Intoxication does have real physiological effects, such as altering a drinker's perception of space and time, reducing psychomotor skills, and disrupting [[Equilibrioception|equilibrium]].<ref name=MacAndrew/> But some effects and the degree of the effects that are attributed to alcohol can be due to the expectations rather than the substance itself,<ref name="Lee2020"/> similar to the [[placebo effect]].<ref>{{cite journal |last1=Testa |first1=Maria |last2=Fillmore |first2=Mark T. |last3=Norris |first3=Jeanette |last4=Abbey |first4=Antonia |last5=Curtin |first5=John J. |last6=Leonard |first6=Kenneth E. |last7=Mariano |first7=Kristin A. |last8=Thomas |first8=Margaret C. |last9=Nomensen |first9=Kim J. |last10=George |first10=William H. |last11=VanZile-Tamsen |first11=Carol |last12=Livingston |first12=Jennifer A. |last13=Saenz |first13=Christopher |last14=Buck |first14=Philip O. |last15=Zawacki |first15=Tina |last16=Parkhill |first16=Michele R. |last17=Jacques |first17=Angela J. |last18=Hayman |first18=Lenwood W. |display-authors=3 |title=Understanding Alcohol Expectancy Effects: Revisiting the Placebo Condition |journal=Alcoholism: Clinical and Experimental Research |date=February 2006 |volume=30 |issue=2 |pages=339–348 |doi=10.1111/j.1530-0277.2006.00039.x|pmid=16441283 |pmc=1403295 }}</ref>

For example, in a laboratory study, men acted more aggressive when they believed their drink contained alcohol, even when it was plain [[tonic water]]. They also were less aggressive when they believed they were consuming a non-alcoholic drink, even if it contained alcohol. This shows that aggression is a result of expectations.<ref>{{cite journal |last1=Lang |first1=Alan R. |last2=Goeckner |first2=Daniel J. |last3=Adesso |first3=Vincent J. |last4=Marlatt |first4=G. Alan |title=Effects of alcohol on aggression in male social drinkers. |journal=Journal of Abnormal Psychology |date=October 1975 |volume=84 |issue=5 |pages=508–518 |doi=10.1037/h0077055|pmid=1194512 }}</ref> The study has been replicated.<ref>{{cite journal |last1=Bègue |first1=Laurent |last2=Subra |first2=Baptiste |last3=Arvers |first3=Philippe |last4=Muller |first4=Dominique |last5=Bricout |first5=Véronique |last6=Zorman |first6=Michel |title=A message in a bottle: Extrapharmacological effects of alcohol on aggression |journal=Journal of Experimental Social Psychology |date=January 2009 |volume=45 |issue=1 |pages=137–142 |doi=10.1016/j.jesp.2008.07.018|url=https://hal.archives-ouvertes.fr/hal-00645180/file/PEER_stage2_10.1016%252Fj.jesp.2008.07.018.pdf }}</ref> Another study found that those who believed that intoxication leads to [[Alcohol and sex|sexual behavior]], rowdy behavior, and aggression tended to act that way when intoxicated. But similarly the belief that intoxication leads to relaxation and tranquil behavior was self-fulfilling.<ref name="The think-drink effect">{{cite journal | last1 = Marlatt | first1 = G. A. | last2 = Rosenow | name-list-style=vanc | year = 1981 | title = The think-drink effect | journal = Psychology Today | volume = 15 | pages = 60–93 }}</ref> As a third example, some societies expect that drinking alcohol will cause disinhibition. However, in societies in which the people do not expect that alcohol will disinhibit, intoxication seldom leads to disinhibition and bad behavior.<ref name=MacAndrew>{{cite book |last1=MacAndrew |first1=C. |last2=Edgerton |first2=R.B. |title=Drunken Comportment: A Social Explanation |publisher=Aldine |location=Chicago |date=1969 |oclc=571244985 }}</ref>

Common positive alcohol outcome expectancies include tension reduction, heightened sociability, increased courage, and enhanced sexual experiences, whereas common negative alcohol outcome expectancies include cognitive and behavioral impairment, risk and aggression, as well as worsened self-perception.<ref name="Lee2020">{{cite journal |last1=Lee |first1=Christine M. |last2=Fairlie |first2=Anne M. |last3=Ramirez |first3=Jason J. |last4=Patrick |first4=Megan E. |last5=Luk |first5=Jeremy W. |last6=Lewis |first6=Melissa A. |title=Self-fulfilling prophecies: Documentation of real-world daily alcohol expectancy effects on the experience of specific positive and negative alcohol-related consequences. |journal=Psychology of Addictive Behaviors |date=March 2020 |volume=34 |issue=2 |pages=327–334 |doi=10.1037/adb0000537|pmid=31804099 |pmc=7360337 }}</ref> The manner and degree to which alcohol expectations interact with the physiological short-term effects of alcohol, resulting in specific behaviors, is unclear. Alcohol expectations vary within a society, and people tend to conform to social expectations.<ref name=Grattan>{{cite journal |last1=Grattan |first1=Karen E. |last2=Vogel-Sprott |first2=M. |title=Maintaining Intentional Control of Behavior Under Alcohol |journal=Alcoholism: Clinical and Experimental Research |volume=25 |issue=2 |pages=192–7 |year=2001 |doi=10.1111/j.1530-0277.2001.tb02198.x |pmid=11236832}}</ref>

===Drug treatment programs===
Most addiction treatment programs encourage people with drinking problems to see themselves as having a chronic, relapsing disease that requires a lifetime of attendance at 12-step meetings to keep in check.{{Citation needed|date=March 2024}}

==Alcohol use disorder==
{{see also|Alcohol abuse|Substance abuse prevention}}The data on global alcohol consumption in 2019 shows that an estimated 400 million people aged 15 years and older live with alcohol use disorders, and an estimated 209 million live with alcohol dependence.<ref name=":0" />[[File:Rational harm assessment of drugs radar plot.svg|thumb|Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in [[Delphi method|delphic analysis]] regarding 20 popular recreational substances. Alcohol was ranked 2nd in social harm, 6th in dependence, and 11th in physical harm.<ref>{{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 }}</ref>]]

===Alcohol misuse prevention programs of the World Health Organization ===
<!-- Is this SAFER initiative notable? Only self-published sources are cited. -->
More than 200 injuries and disease conditions can be caused by alcohol misuse.<ref name="World Health Organization">{{Cite press release |url=http://www.who.int/substance_abuse/safer/launch/en |archive-url=https://web.archive.org/web/20181001235303/http://www.who.int/substance_abuse/safer/launch/en |archive-date=1 October 2018|title=WHO launches SAFER alcohol control initiative to prevent and reduce alcohol-related death and disability |website=World Health Organization |access-date=2019-11-21}}</ref> It is a causative agent influencing maternal health and development, noncommunicable diseases (including cancer and cardiovascular diseases), injuries, violence, mental health, and infectious diseases such as [[tuberculosis]] and [[HIV/AIDS]].<ref>{{Cite book|title=Global status report on alcohol and health 2018 |author=((Management of Substance Abuse Team, World Health Organization)) |isbn=978-92-4-156563-9 |publisher=[[World Health Organization]] |location=Geneva|oclc=1089229677|date=14 February 2019}}</ref> Harmful use of alcohol has been identified as a global health issue, and its management is a priority in the 2030 Agenda for Sustainable Development issued by the [[United Nations]] in 2015.<ref>{{Cite book |date=2015-12-31|chapter=Transforming governance for the 2030 agenda for sustainable development |title=World Public Sector Report 2015 |url=https://www.un-ilibrary.org/democracy-and-governance/world-public-sector-report-2015_e5a72957-en|language=en|pages=73–87|doi=10.18356/e5a72957-en |isbn=9789210541442}}</ref> In 2018, the WHO launched the "SAFER" initiative (an acronym defined from the list of planned actions give below), to decrease the number of deaths, diseases and injuries caused by alcohol misuse.<ref name="World Health Organization"/> Using a set of WHO tools and resources, SAFER was planned to concentrate on the interventions listed below to reduce and prevent alcohol misuse.<ref>{{Cite book|title=Global action plan for the prevention and control of noncommunicable diseases: 2013–2020 |publisher=[[World Health Organization]] |year=2013 |isbn=978-92-4-150623-6|location=Geneva, Switzerland|oclc=960910741}}</ref> The list of interventions were selected for prioritization based on cost effectiveness:<ref name="World Health Organization" />{{not in citation given |reason=It seems clear that the plans for the SAFER program are not described in this 2013 action plan, because the SAFER program did not exist until 2018. |date=December 2024}}

* Strengthen restrictions on alcohol availability.
* Advance and enforce drink driving countermeasures.
* Facilitate access to screening, brief interventions, and treatment.
* Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion.
* Raise prices on alcohol through [[excise taxes]] and pricing policies.

===Recommended maximum intake===
{{Main|Alcohol consumption recommendations}}

Binge drinking has been a significant issue in the United Kingdom. Advice on weekly consumption levels is often avoided in the UK.<ref>{{cite web|url=http://www.aim-digest.com/gateway/pages/guide/articles/biggy.htm |title=Sensible Drinking |publisher=Aim-digest.com |access-date=5 February 2013 |archive-url=https://web.archive.org/web/20101119172727/http://aim-digest.com/gateway/pages/guide/articles/biggy.htm |archive-date=19 November 2010 }}</ref> Official advice from the National Health Service is that for all genders, regularly drinking more than 14 units of alcohol a week "risks damaging your health".<ref>[https://www.nhs.uk/live-well/alcohol-advice/the-risks-of-drinking-too-much/ The risks of drinking too much]. ''NHS''. Retrieved 23 July 2024.</ref>

Since 1995, the UK government has advised that regular consumption of three to four units (one unit equates to 10 mL of pure ethanol) a day for men and or two to three units for women, would not pose significant health risks. However, consistently drinking more than four units a day (for men) and three units (women) is not advisable.<ref>{{cite web |url=http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Alcoholmisuse/index.htm |title=Alcohol misuse: Department of Health |publisher=Dh.gov.uk |access-date=5 February 2013 |archive-date=9 February 2010 |archive-url=https://web.archive.org/web/20100209065111/http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Alcoholmisuse/index.htm |url-status=dead }}</ref>

Previously (from 1992 until 1995), the advice was that men should drink no more than 21 units per week, and women no more than 14.<ref>{{cite web|url=https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/lifestyle/alcohol-and-your-health/ |title=Alcohol and health: how alcohol can affect your long and short term health |publisher=Drinkaware.co.uk |access-date=5 February 2013}}</ref> (The difference between the sexes was due to the typically lower weight and water-to-body-mass ratio of women.) This was changed because a government study showed that many people were in effect "saving up" their units and using them at the end of the week, a phenomenon referred to as [[binge drinking]].<ref>{{cite web | url=https://retreatofatlanta.com/medical-detox-center-rehab-program-atlanta-ga/| title=Medical Detox Center| access-date=2020-05-24 | publisher=Retreatofatlanta.com|date=2021-08-31|language=english|author=Mohsin Beg}}</ref> ''[[The Times]]'' reported in October 2007 that these limits had been "plucked out of the air" and had no scientific basis.<ref>[https://www.thetimes.com/life-style/health-fitness/article/drink-limits-useless-q5g3z97ns5n Drink limits 'useless'], The Times, 20 October 2007</ref>

===Sobriety===
{{Further|Sobriety}}

[[File:Breathalyzer test 0013.png|right|thumb|A [[midshipman]] is subjected to a random [[breathalyzer]] test to determine sobriety.]]
Sobriety is the condition of not having any measurable levels, or effects from [[mood-altering drug]]s. According to WHO "Lexicon of alcohol and drug terms", sobriety is continued abstinence from psychoactive drug use.<ref>{{cite web
 |url=https://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archive-url=https://web.archive.org/web/20040704055537/http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archive-date=4 July 2004 |title=Lexicon and drug terms |publisher=Who.int |date=9 December 2010 |access-date=5 February 2013 }}</ref> Sobriety is also considered to be the natural state of a human being given at a birth. In a treatment setting, sobriety is the achieved goal of independence from consuming or craving mind-altering substances. As such, sustained abstinence is a prerequisite for sobriety. Early in abstinence, residual effects of mind-altering substances can preclude sobriety. These effects are labeled [[post-acute-withdrawal syndrome]] (PAWS). Someone who abstains, but has a latent desire to resume use, is not considered truly sober. An abstainer may be subconsciously motivated to resume drug use, but for a variety of reasons, abstains (e.g. such as a medical or legal concern precluding use).<ref name=basharin>{{cite web
 |url=http://www.video.sbnt.ru/vl/Newspapers/Podsporie/Podsporie_111.pdf |title=Scientific grounding for sobriety: Western experience |author=MD Basharin K.G. |year=2010 |access-date=5 February 2013 }}</ref> Sobriety has more specific meanings within specific contexts, such as the culture of [[Alcoholics Anonymous]], other 12 step programs, law enforcement, and some schools of psychology. In some cases, sobriety implies achieving "life balance".<ref>{{cite book |url=http://www.stopdrinkingexpert.com/pdf/12steps.pdf |title=Twelve Steps and Twelve Traditions |publisher=Alcoholics Anonymous World Services |access-date=31 December 2018 |isbn=978-0-916856-01-4 |date=April 1953 |archive-date=16 January 2017 |archive-url=https://web.archive.org/web/20170116175507/http://www.stopdrinkingexpert.com/pdf/12steps.pdf |url-status=dead }} (Electronic .PDF version, September 2005).</ref>

== Injury and deaths ==
[[Injury]] is defined as physical damage or harm that is done or sustained. The potential of injuring oneself or others can be increased after consuming alcohol due to the certain short term effects related to the substance such as lack of coordination, blurred vision, and slower reflexes to name a few.<ref>{{Cite web|url = https://www.drinkwise.org.au/drinking-and-you/how-is-drinking-affecting-you/|title = Drinkwise Australia|website = DrinkWise Australia}}</ref> Due to these effects the most common injuries include head, fall, and vehicle-related injuries. A study was conducted of patients admitted to the [[Ulster Hospital]] in Northern Ireland with fall related injuries. They found that 113 of those patients admitted to that hospital during that had consumed alcohol recently and that the injury severity was higher for those that had consumed alcohol compared to those that had not.<ref>{{Cite journal|title = Alcohol related falls: an interesting pattern of injuries|vauthors = Johnson J, McGovern S |date =2003|journal = Emergency Medicine Journal|volume = 21|issue = 2|pages = 185–8|doi = 10.1136/emj.2003.006130|pmid = 14988344|pmc = 1726307}}</ref> Another study showed that 21% of patients admitted to the Emergency Department of the [[Bristol Royal Infirmary]] had either direct or indirect alcohol related injuries. If these figures are extrapolated it shows that the estimated number of patients with alcohol related injuries are over 7,000 during the year at this emergency department alone.<ref>{{Cite journal|title = What is the burden of alcohol-related injuries in an inner city emergency department?|vauthors=Hoskins R, Benger J |date=2013|journal = Alcoholism: Clinical and Experimental Research|doi = 10.1111/j.1530-0277.2009.00981.x|pmid = 19485974|pmc=2757258 |volume=33|issue = 9|pages=1532–8}}</ref>

In the United States alcohol resulted in about 88,000 deaths in 2010.<ref>{{cite journal|title=Alcohol-attributable deaths and years of potential life lost — 11 states, 2006–2010|website=Centers for Disease Control and Prevention|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6310a2.htm}}</ref> The [[World Health Organization]] calculated that more than 3 million people, mostly men, died as a result of harmful use of alcohol in 2016. This was about 13.5% of the total deaths of people between 20 and 39. More than 5% of the global disease burden was caused by the harmful use of alcohol.<ref>{{cite news |title=Alcohol |url=https://www.who.int/news-room/fact-sheets/detail/alcohol |access-date=5 November 2018 |publisher=World health Organization |date=21 September 2018}}</ref> There are even higher estimates for Europe.<ref>{{cite journal |vauthors=Korotayev A, Khaltourina D, Meshcherina K, Zamiatnina E |title=Distilled Spirits Overconsumption as the Most Important Factor of Excessive Adult Male Mortality in Europe |journal=Alcohol Alcohol |volume=53 |issue=6 |pages=742–752 |date=November 2018 |pmid=30113627 |doi=10.1093/alcalc/agy054 |url=https://www.academia.edu/41473801}}</ref>

In 2019, total of 298,000 deaths from alcohol-related road crashes were registered, out of which 156,000 deaths were caused by someone else’s drinking.<ref name=":0" />

===Flaming drink===
{{main|Flaming drink}}
[[File:How to pour 5 martinis at the same time while on fire.jpg|thumb|A man pouring five flaming martinis at the same time]]

A [[flaming drink]] is often ignited for aesthetic and entertainment purposes. However, [[Bar (establishment)|bars]] have been shut down specifically due to failure to follow fire codes and [[reckless endangerment]] of patrons. Bartenders have also suffered burns from flaming drinks.<ref name="GuestOfAGuest20101105">{{cite web |url=http://guestofaguest.com/new-york/nightlife/where-to-score-flaming-cocktails-in-new-york-city |title= Where to Score Flaming Cocktails in New York City |last1= Urken |first1= Ross Kenneth |date=5 November 2010 <!-- 13:31 EST -->  |access-date=24 September 2013 <!-- 20:57 PDT -->  }}</ref>

==Genetic differences==

===Alcohol flush and respiratory reactions===
{{see also|Alcohol flush reaction|Alcohol-induced respiratory reactions|Short-term effects of alcohol consumption}}
Alcohol flush reaction is a condition in which an individual's face or body experiences flushes (appears red) or blotches as a result of an accumulation of [[acetaldehyde]], a metabolic byproduct of the catabolic metabolism of alcohol. It is best known as a condition that is experienced by people of Asian descent. According to the analysis by [[HapMap Project]], the rs671 allele of the ALDH2 gene responsible for the flush reaction is rare among Europeans and Africans, and it is very rare among Mexican-Americans. 30% to 50% of people of Chinese and Japanese ancestry have at least one ALDH*2 allele.<ref>{{cite web |url=http://www.snpedia.com/index.php/Rs671 |title=Rs671 |website=SNPmedia }}</ref> The rs671 form of ALDH2, which accounts for most incidents of alcohol flush reaction worldwide, is native to East Asia and most common in southeastern China. It most likely originated among Han Chinese in central China,<ref>{{cite journal|title=Refined Geographic Distribution of the Oriental ALDH2*504Lys (nee 487Lys) Variant|author=Hui Li|journal=Ann Hum Genet |year=2009|pmc=2846302|pmid=19456322|doi=10.1111/j.1469-1809.2009.00517.x|volume=73|issue=Pt 3|pages=335–345|display-authors=et al}}</ref> and it appears to have been positively selected in the past. Another analysis correlates the rise and spread of rice cultivation in Southern China with the spread of the allele.<ref>{{cite journal |author1=Yi Peng |author2=Hong Shi |author3=Xue-bin Qi |author4=Chun-jie Xiao |author5=Hua Zhong |author6=Run-lin Z Ma |author7=Bing Su |title=The ADH1B Arg47His polymorphism in East Asian populations and expansion of rice domestication in history |journal=BMC Evolutionary Biology |volume=10 |page= 15|year=2010 |pmid=20089146 |pmc=2823730 |doi= 10.1186/1471-2148-10-15|issue=1 |doi-access=free |bibcode=2010BMCEE..10...15P }}</ref> The reasons for this positive selection are unknown, but the hypothesis that elevated concentrations of acetaldehyde may have conferred protection against certain parasitic infections, such as ''[[Entamoeba histolytica]]'' have been suggested.<ref>{{cite journal |vauthors=Oota H, Pakstis AJ, Bonne-Tamir B, Goldman D, Grigorenko E, Kajuna SL, et al |s2cid=31026948 |title=The evolution and population genetics of the ALDH2 locus: random genetic drift, selection, and low levels of recombination |journal=Ann. Hum. Genet. |volume=68 |issue=Pt 2 |pages=93–109 |date=2004 |pmid=15008789 |doi= 10.1046/j.1529-8817.2003.00060.x}}</ref> The same SNP allele of ALDH2, also termed glu487lys, and the abnormal accumulation of acetaldehyde following the drinking of alcohol, is associated with the [[alcohol-induced respiratory reactions]] of [[rhinitis]] and [[asthma]] that occur in Eastern Asian populations.<ref>{{cite journal|last1=Adams|first1=KE|last2=Rans|first2=TS|title=Adverse reactions to alcohol and alcoholic beverages|journal=Annals of Allergy, Asthma & Immunology|date=2013|volume=111|issue=6|pages=439–445|doi=10.1016/j.anai.2013.09.016|pmid=24267355}}</ref>
{{alcohol metabolism formulae}}

===Alcohol and Native Americans===
{{main|Alcohol and Native Americans}}
Compared with the United States population in general, the [[Native Americans in the United States|Native American]] population is much more susceptible to alcohol use disorder and related diseases and deaths.<ref name = "May">{{cite book |first=Philip A. |last=May |chapter=Overview of Alcohol Abuse Epidemiology for American Indian Populations |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK233103/pdf/Bookshelf_NBK233103.pdf |editor-first=Gary D. |editor-last=Sandefur |editor2-first=Ronald R. |editor2-last=Rindfuss |editor3-first=Barney |editor3-last=Cohen |title=Changing Numbers, Changing Needs: American Indian Demography and Public Health |publisher=Committee on Population, Commission on Behavioral and Social Sciences and Education National Research Council, National Academy Press |location=Washington, D.C. |date=1996 |isbn=0-585-03246-7 |oclc=42329948 |url=https://nap.nationalacademies.org/catalog/5355/changing-numbers-changing-needs-american-indian-demography-and-public-health }}</ref> From 2006 to 2010, alcohol-attributed deaths accounted for 11.7 percent of all Native American deaths, more than twice the rates of the general U.S. population. The median alcohol-attributed death rate for Native Americans (60.6 per 100,000) was twice as high as the rate for any other racial or ethnic group.<ref name = "MMWR">{{cite journal| pmc=5779340 | pmid=24622285 | volume=63 | title=Alcohol-attributable deaths and years of potential life lost—11 States, 2006–2010 | year=2014 | journal=MMWR Morb Mortal Wkly Rep | pages=213–6 | last1 = Gonzales | first1 = K | last2 = Roeber | first2 = J | last3 = Kanny | first3 = D | last4 = Tran | first4 = A | last5 = Saiki | first5 = C | last6 = Johnson | first6 = H | last7 = Yeoman | first7 = K | last8 = Safranek | first8 = T | last9 = Creppage | first9 = K | last10 = Lepp | first10 = A | last11 = Miller | first11 = T | last12 = Tarkhashvili | first12 = N | last13 = Lynch | first13 = KE | last14 = Watson | first14 = JR | last15 = Henderson | first15 = D | last16 = Christenson | first16 = M | last17 = Geiger | first17 = SD| issue=10 }}</ref> Males are affected disproportionately more by alcohol-related conditions than females.<ref name = "Whitesell">{{cite journal| pmc=4436971 | pmid=22931069 | doi=10.3109/00952990.2012.694527 | volume=38 | title=Epidemiology and etiology of substance use among American Indians and Alaska Natives: risk, protection, and implications for prevention | year=2012 | journal=Am J Drug Alcohol Abuse | pages=376–82 | last1 = Whitesell | first1 = NR | last2 = Beals | first2 = J | last3 = Crow | first3 = CB | last4 = Mitchell | first4 = CM | last5 = Novins | first5 = DK| issue=5 }}</ref>

Native American and Native Alaskan youth are far more likely to experiment with alcohol at a younger age than non-Native youth.<ref name="Beauvais">{{cite journal|pmid=9603273 |doi=10.3109/10826089809062219 |volume=33 |title=Cultural identification and substance use in North America--an annotated bibliography |year=1998 |author=Beauvais F |journal=  Substance Use & Misuse|issue=6 |pages=1315–36}}</ref> Low [[self-esteem]] and [[transgenerational trauma]] have been associated with substance use disorders among Native American teens in the U.S. and Canada.<ref name="Myhra">{{cite journal|pmid=22302280 |doi=10.5820/aian.1802.2011.17 |volume=18 |title="It runs in the family": intergenerational transmission of historical trauma among urban American Indians and Alaska Natives in culturally specific sobriety maintenance programs |year=2011 |author=Myhra LL |journal=  American Indian and Alaska Native Mental Health Research|issue=2 |pages=17–40}}</ref><ref>{{cite journal |last1=Bombay|first1=Amy|last2=Matheson|first2=Kim|last3=Anisman|first3=Hymie |year=2009 |title=Intergenerational trauma: convergence of multiple processes among First Nations peoples in Canada |url=https://jps.library.utoronto.ca/index.php/ijih/article/view/28987/23916 |journal=Journal of Aboriginal Health |volume=5 |issue=3 |pages=6–47 |access-date=2020-07-02 |archive-url=https://web.archive.org/web/20190803205041/https://jps.library.utoronto.ca/index.php/ijih/article/view/28987/23916 |archive-date=2019-08-03 |url-status=live}}</ref>

Native American populations exhibit genetic differences in the alcohol-metabolizing enzymes [[alcohol dehydrogenase]] and [[ALDH]],<ref>{{cite journal| pmc=3860438 | pmid=17718395 | volume=30 | title=Variations in ADH and ALDH in Southwest California Indians | year=2007 | journal=Alcohol Res Health | pages=14–7 | last1 = Ehlers | first1 = CL| issue=1 }}</ref><ref>{{cite journal| pmc=3498484 | pmid=22931071 | doi=10.3109/00952990.2012.694526 | volume=38 | title=ADH and ALDH polymorphisms and alcohol dependence in Mexican and Native Americans | year=2012 | journal=Am J Drug Alcohol Abuse | pages=389–94 | last1 = Ehlers | first1 = CL | last2 = Liang | first2 = T | last3 = Gizer | first3 = IR| issue=5 }}</ref> although evidence that these genetic factors are more prevalent in Native Americans than other ethnic groups has been a subject of debate.<ref name = "Ehlers">{{cite journal |vauthors=Ehlers CL, Gizer IR |title=Evidence for a genetic component for substance dependence in Native Americans |journal=Am J Psychiatry |volume=170 |issue=2 |pages=154–64 |date=February 2013 |pmid=23377636 |pmc=3603686 |doi=10.1176/appi.ajp.2012.12010113 }}</ref><ref>{{cite journal |vauthors=Caetano R, Clark CL, Tam T |title=Alcohol consumption among racial/ethnic minorities: theory and research |journal=Alcohol Health Res World |volume=22 |issue=4 |pages=233–241 |date=1998 |pmid=15706749 |pmc=6761890 }}</ref><ref name = "Ethnicity">{{cite journal |vauthors=Chartier K, Caetano R |title=Ethnicity and health disparities in alcohol research |journal=Alcohol Res Health |volume=33 |issue=1–2 |pages=152–60 |date=2010 |pmid=21209793 |pmc=3887493 |url=https://pubs.niaaa.nih.gov/publications/arh40/152-160.htm}}</ref> According to one 2013 review of academic literature on the issue, there is a "substantial genetic component in Native Americans" and that "most Native Americans lack protective variants seen in other populations."<ref name = "Ehlers"/> Many scientists have provided evidence of the genetic component of alcohol use disorder by the [[biopsychosocial model]] of alcohol use disorder. [[Molecular genetics]] research currently has not found one specific gene that is responsible for the rates of alcohol use disorder among Native Americans, implying the phenomenon may be due to an interplay of multiple genes and environmental factors.<ref>{{cite journal | last1 = Wall | first1 = Tamara L. | last2 = Carr | first2 = Lucinda G. | last3 = Ehlers | first3 = Cindy L. | year = 2003 | title = Protective association of genetic variation in alcohol dehydrogenase with alcohol dependence in Native American Mission Indians | journal = American Journal of Psychiatry | volume = 160 | issue = 1| pages = 41–46 | doi = 10.1176/appi.ajp.160.1.41 | pmid = 12505800 }}</ref><ref>{{cite journal| pmid=15900224 | doi=10.1097/00041444-200506000-00006 | volume=15 | title=Heritability of substance dependence in a native American population | year=2005 | journal=Psychiatr Genet | pages=101–7 | last1 = Wilhelmsen | first1 = KC | last2 = Ehlers | first2 = C| issue=2 | s2cid=5859834 }}</ref> Research on [[alcoholism in family systems|alcohol use disorder in families]] suggests that learned behavior augments genetic factors in increasing the probability that children of people with alcohol use disorder will themselves have problems with alcohol misuse.<ref>{{cite journal| pmc=3872279 | pmid=24386563 | doi=10.1155/2013/410395 | volume=2013 | title=A Framework to Examine the Role of Epigenetics in Health Disparities among Native Americans | year=2013 | journal=Nurs Res Pract | page=410395 | last1 = Brockie | first1 = TN | last2 = Heinzelmann | first2 = M | last3 = Gill | first3 = J| doi-access=free }}</ref>

=== Genetics and amount of consumption ===
Having a particular genetic variant (A-allele of ADH1B rs1229984) is associated with non-drinking and lower alcohol consumption. This variant is also associated with favorable cardiovascular profile and a reduced risk of coronary artery disease compared to those without the genetic variant, but it is unknown whether this may be caused by differences in alcohol consumption or by additional [[confounder|confounding]] effects of the genetic variant itself.<ref name="Holmes et al.">{{cite journal | last1 = Holmes | first1 = Michael V. | display-authors = etal   | year = 2014 | title = Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data | journal = BMJ | volume = 349 | page = g4164 | doi = 10.1136/bmj.g4164 | pmid=25011450 | pmc=4091648}}</ref>

==Gender differences==
Historically, according to the ''[[British Medical Journal]]'', "men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes."<ref name="Women catching up">{{cite press release |title=Women catching up with men in alcohol consumption and its associated harms |work=BMJ Open |date=25 October 2016 |url=http://www.bmj.com/company/wp-content/uploads/2016/10/bmj-open-alcohol-women.pdf}}</ref> However, analysis of data collected over a century from multiple countries suggests that the [[wiktionary:Gender gap|gender gap]] in [[alcohol consumption]] is narrowing, and that young women (born after 1981) are consuming alcohol more than their male counterparts. Such findings have implications for the way in which alcohol-use prevention and intervention programs are designed and implemented.<ref name=Slade2016>{{cite journal |vauthors=Slade T, Chapman C, Swift W, Keyes K, Tonks Z, Teesson M |title=Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression |journal=BMJ Open|date=2016 |volume=6 |issue=10 |pages=e011827 |doi=10.1136/bmjopen-2016-011827 |pmid=27797998 |pmc=5093369 }}</ref>

===Alcohol use disorder===
Alcohol use disorder (AUD) is defined as a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.<ref>{{Cite web |title=Alcohol's Effects on Health: Research-based information on drinking and its impact |url=https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder |access-date=2022-10-29 |website=National Institute on Alcohol Abuse and Alcoholism}}</ref> Excessive alcohol use can lead to health-related illness and continuous alcohol engagement can ultimately lead to death. Behavioral factors of AUD include binge drinking and heavy alcohol use throughout one's day. AUD affects each culture differently, but African Americans are found to be the hardest impacted. Common health-related illnesses that stem from AUD but are prevalent in African American communities are liver disease, cirrhosis, hypertension, heart disease, oral cancer, stroke, and more. In 2020, heart disease ranked number 3 in the leading cause of death for African Americans ages 15–24.<ref>{{Cite web |title=WISQARS: Injury Data Visualization Tools |website=Centers for Disease Control and Prevention |url=https://wisqars.cdc.gov/data/non-fatal/home |access-date=2022-10-30 |language=en}}{{unreliable source?|date=April 2023|reason=database retrieval}}</ref> However, on the, contrary African Americans have been proven to consume less alcohol than other counterparts. According to American's Health Rankings, 15.4% of blacks reported excessive drinking, 19.4% of Hispanics, 19.2% of whites and 16.9% of Native Americans.<ref>{{Cite web |title=Excessive Drinking in United States |url=https://www.americashealthrankings.org/explore/annual/measure/ExcessDrink/state/ALL?edition-year=2020 |access-date=2022-10-30 |website=America's Health Rankings |language=en}}</ref> In the United States, social economic status affects, one's ability to access basic necessities to support one's health, life, and survival. If one has a higher socioeconomic status, their income is higher, they are able to support their living needs and have better access to healthcare. Higher SES status reduces the risk of AUD for all individuals. However, those with a lower socioeconomic status majority of minorities are less fortunate. They are faced with poverty, low income, unemployment, and lack of access to healthier food options, which then contributes to poor health and higher AUD risk. The correlation between levels of socioeconomic status is prominent in alcohol-related health illnesses between cultures.

===Sensitivity===
Several biological factors make women more vulnerable to the effects of alcohol than men.<ref>{{cite web|url=http://www.helpguide.org/harvard/women_alcohol.htm |title=Women & Alcohol: The Hidden Risks of Drinking |publisher=Helpguide.org |access-date=5 February 2013 |archive-url=https://web.archive.org/web/20130103092219/http://www.helpguide.org/harvard/women_alcohol.htm |archive-date=3 January 2013 }}</ref>

* Body fat. Women tend to weigh less than men, and—pound for pound—a woman's body contains less water and more fatty tissue than a man's. Because fat retains alcohol while water dilutes it, alcohol remains at higher concentrations for longer periods of time in a woman's body, exposing her brain and other organs to more alcohol.
* Enzymes. Women have lower levels of two enzymes—alcohol dehydrogenase and aldehyde dehydrogenase—that metabolize (break down) alcohol in the stomach and liver. As a result, women absorb more alcohol into their bloodstreams than men.
* Hormones. Changes in hormone levels during the menstrual cycle may also affect how a woman metabolizes alcohol.

===Metabolism===
Females demonstrated a higher average rate of elimination (mean, 0.017; range, 0.014–0.021 g/210 L) than males (mean, 0.015; range, 0.013–0.017 g/210 L). Female subjects on average had a higher percentage of body fat (mean, 26.0; range, 16.7–36.8%) than males (mean, 18.0; range, 10.2–25.3%).<ref>{{cite journal | pmid = 8872236 | volume=20 | issue=5 | title=Determination of volume of distribution for ethanol in male and female subjects. | date=Sep 1996 | pages=287–90 | journal=J Anal Toxicol | doi=10.1093/jat/20.5.287 | last1 = Cowan | first1 = JM Jr | last2 = Weathermon | first2 = A | last3 = McCutcheon | first3 = JR | last4 = Oliver | first4 = RD| doi-access = free }}</ref> Further explanation for the difference in alcohol metabolism between males and females can be found in higher [[alcohol dehydrogenase]] activity in female livers.<ref>{{Cite journal |last1=Eaton |first1=Shannon E. |last2=Jagielo-Miller |first2=Julia E. |last3=Prendergast |first3=Mark A. |last4=Akins |first4=Chana K. |date=2022-02-18 |title=Sex differences in alcohol dehydrogenase levels (ADH) and blood ethanol concentration (BEC) in Japanese quail |journal=Poultry Science |volume=101 |issue=5 |pages=101790 |doi=10.1016/j.psj.2022.101790 |issn=0032-5791 |pmc=8943298 |pmid=35316649}}</ref>

===Depression===
The link between alcohol consumption, depression, and gender was examined by the Centre for Addiction and Mental Health (Canada). The study found that women taking [[antidepressant]]s consumed more alcohol than women who did not experience depression as well as men taking antidepressants. The researchers, Kathryn Graham and a PhD Student, Agnes Massak, analyzed the responses to a survey by 14,063 Canadian residents aged 18–76 years. The survey included measures of quantity, frequency of drinking, depression, and antidepressant use, over the period of a year. The researchers used data from the GENACIS Canada survey, part of an international collaboration to investigate the influence of cultural variation on gender differences in alcohol use and related problems. The purpose of the study was to examine whether, like in other studies already conducted on male depression and alcohol consumption, depressed women also consumed less alcohol when taking anti-depressants. According to the study, both men and women experiencing depression (but not on antidepressants) drank more than non-depressed counterparts. Men taking antidepressants consumed significantly less alcohol than depressed men who did not use antidepressants. Non-depressed men consumed 436 drinks per year, compared to 579 drinks for depressed men not using antidepressants, and 414 drinks for depressed men who used antidepressants. Alcohol consumption remained higher whether the depressed women were taking antidepressants or not. 179 drinks per year for non-depressed women, 235 drinks for depressed women not using antidepressants, and 264 drinks for depressed women who used antidepressants. The lead researcher argued that the study "suggests that the use of antidepressants is associated with lower alcohol consumption among men with depression. But this does not appear to be true for women."<ref>{{cite journal | doi = 10.1503/cmaj.060446 | pmid=17325328 | pmc=1800314 | volume=176 | title=Alcohol consumption and the use of antidepressants | journal=Canadian Medical Association Journal | pages=633–7  | last1 = Graham | first1 = K. | last2 = Massak | first2 = A.| issue=5 | year=2007 }}</ref>

===Teenage alcohol abuse===
{{see also|Alcoholism in adolescence}}

While most teens understand the negative impacts of drinking a lot of alcohol in one sitting, many believe that consuming some alcohol will not be that risky of a behavior. However, teens who drink alcohol on average consume more alcohol in one sitting than most adults, and nearly half of all teens who consumed some amount of alcohol in the past 30 days had done so in excess.<ref>{{cite web | url=https://www.talkitoutnc.org/blogs/alcohol-consumption/#:~:text=According%20to%20the%20National%20Institute%20on%20Alcohol%20Abuse,typically%20four%20drinks%2C%20and%20for%20men%2C%20it%E2%80%99s%20five | title=Teen Alcohol Consumption: 5 Dangerous Trends Parents Need to Know | date=7 April 2020 }}</ref> Not only are teen drinkers more likely to get drunk, but the effects of drunkenness are worse. The temporarily impaired judgment can lead to permanent consequences such as serious and crippling injury to oneself or others, unplanned pregnancy, or alcoholism later in life.<ref>{{Cite web |title=Effect_of_smoking_and_alcohol_on_ballers_ |url=https://zoliberry.com/Article?title=Effect_of_smoking_and_alcohol_on_ballers_&id=14 |access-date=2024-03-21 |website=zoliberry.com |language=en}}</ref> Even if they were to avoid terrible events, they will still suffer irreversible damage to brain development and be far more likely to abuse other substances in the future.<ref>{{cite web | url=https://www.health.harvard.edu/blog/alcohol-harms-the-brain-in-teen-years-before-and-after-that-too-2021011521758 | title=Alcohol harms the brain in teen years –– before and after that, too | date=15 January 2021 }}</ref>

== See also ==
* [[Dry January]]
* [[Health benefits of quitting alcohol]]
* [[Long-term effects of alcohol consumption]]
* [[Short-term effects of alcohol consumption]]

== References ==
{{Reflist}}

== External links ==
* [https://www.sciencealert.com/global-burden-of-disease-alcohol-assessment-global-death-disability-rate  Massive Study Finds Alcohol Is a Leading Contributor to Death And Disease Worldwide]
{{Health effects of food, drink and lifestyle}}
{{Alcohol and health}}
{{Psychoactive substance use}}
{{Authority control}}

[[Category:Alcohol and health| ]]
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