Alcohol, sometimes referred to by the chemical name ethanol, is one of the most widely used and abused psychoactive drugs in the world and falls under the depressant category.[11][12][13] The term "Alcohol and Other Drugs" (AOD) emphasizes this inclusion by grouping alcohol with other substances that alter mood and behavior. Alcohol is classified by the World Health Organization (WHO) as a toxic, psychoactive, dependence-producing, and carcinogenic substance.[14]
While the terms "drug" and "medicine" are sometimes used interchangeably, "drug" can have a negative connotation, often associated with illegal substances like cocaine or heroin,[15] which is why the alcohol industry may argue that "alcohol is not a drug" (Room et al. 2007).[16]
The normalization of alcohol consumption,[17] along with past misconceptions about its health benefits, also promoted by the industry,[18] further reinforces the mistaken idea that it is not a "drug". Even within the realm of scientific inquiry, the common phrase "drugs and alcohol" persists. However, this phrasing implies that alcohol is somehow separate from other drugs.
Paradoxically, despite being legal, alcohol, scientifically classified as a drug, has demonstrably been linked to greater social harm than most illegal drugs.[19][20] This contradicts the perception some hold of alcohol being a harmless substance.
Alcohol is found in fermented beverages such as beer, wine, and distilled spirit[21] – in particular, rectified spirit,[22] and serves various purposes; it is used as a recreational drug, for example by college students, for self-medication, and in warfare. It is also frequently involved in alcohol-related crimes such as drunk driving, public intoxication, and underage drinking. Some esoteric religions and schools incorporate the use of alcohol for spiritual purposes.
For roughly two decades, the International Agency for Research on Cancer (IARC), a World Health Organization (WHO) agency, has classified alcohol as a Group 1 Carcinogen.[23] In 2023, the WHO declared that there is "no safe amount" of alcohol consumption without health risks.[14] This reflects a global shift in public health messaging, aligning with the long-standing views of the temperance movement, which advocates against the consumption of alcoholic beverages. This shift aligns with the global scientific consensus against alcohol for pregnant women due to the known risks of miscarriage, fetal alcohol spectrum disorders (FASDs) and sudden infant death syndrome (SIDS), as well as for individuals under the legal drinking age.
WHO also highlighted a statistic: nearly half of all alcohol-attributable cancers in the WHO European Region are linked to alcohol consumption, even from "light" or "moderate" drinking – "less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week".[14] This new information suggests that these consumption levels should now be considered high-risk. Many countries exceed these levels by a significant margin. Echoing the WHO's view, a growing number of national public health agencies are prioritizing complete abstinence (teetotalism) and stricter drinking guidelines in their alcohol consumption recommendations.
Alcohol has a variety of short-term and long-term adverse effects on health. According to a 2024 World Health Organization (WHO) report, these harmful consequences of alcohol use result in 2.6 million deaths annually, accounting for 4.7% of all global deaths.[24]
Short-term effects from moderate consumption include relaxation, decreased social inhibition, and happiness while binge drinking may result in generalized impairment of neurocognitive function, blackout, and hangover. Excessive alcohol intake causes alcohol intoxication characterized by unconsciousness or, in severe cases, death.
Long-term effects are considered to be a major global public health issue and includes alcoholism, abuse, withdrawal, fetal alcohol spectrum disorder (FASD), liver disease, hepatitis, cardiovascular disease (such as cardiomyopathy), polyneuropathy, hallucinosis, long-term impact on the brain (such as brain damage and dementia), and cancers such as breast cancer and head and neck cancer (especially laryngeal cancer).
Despite being a widespread issue, social stigma around problematic alcohol use or alcoholism discourages over 80% from seeking help.[25]
Alcohol works in the brain primarily by increasing the effects of γ-Aminobutyric acid (GABA),[26] the major inhibitory neurotransmitter in the brain; by facilitating GABA's actions, alcohol suppresses the activity of the CNS.[26]
Uses
[edit]
For non-psychoactive use of alcohol, such as rum-running, see Alcoholic beverage § Uses.
See also: Sconcing
Dutch courage
[edit]
Dutch courage, also known as pot-valiance or liquid courage, refers to courage gained from intoxication with alcohol.
Alcohol use among college students is often used as "liquid courage" in the hookup culture, for them to make a sexual advance in the first place.[27]: 200  However, a recent trend called "dry dating" is gaining popularity to replace "liquid courage", which involves going on dates without consuming alcohol.[28][29][30]
Consuming alcohol prior to visiting female sex workers is a common practice among some men.[31] Sex workers often resort to using drugs and alcohol to cope with stress.[32] Female sex workers in low- and middle-income countries have high rates of harmful alcohol use, which is associated with increased risk of risky sexual behavior.[32]
Alcohol when consumed in high doses is considered to be an anaphrodisiac.[33]
Criminal
[edit]
See also: Alcohol-related crime
For the use of non-intentional offenses, such as drunk walking, see § Alcohol-related crimes.
Albeit not a valid intoxication defense, weakening the inhibitions by drunkenness is occasionally used as a tool to commit planned offenses such as property crimes including theft and robbery, and violent crimes including assault, murder, or rape – which sometimes but not always occurs in alcohol-facilitated sexual assaults where the victim is also drugged.
Warfare
[edit]
Main article: Use of drugs in warfare § Alcohol
See also: § Wartime sexual violence
Alcohol has a long association of military use, and has been called "liquid courage" for its role in preparing troops for battle, anaesthetize 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. However, this reliance on alcohol can have negative consequences for physical and mental health.[34] Military and veteran populations face significant challenges in addressing the co-occurrence of PTSD and alcohol use disorder.[35] Military personnel who show symptoms of PTSD, major depressive disorder, alcohol use disorder, and generalized anxiety disorder show higher levels of suicidal ideation.[36]
Alcohol consumption in the US Military is higher than any other profession, according to CDC data from 2013–2017. The Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel published that 47% of active duty members engage in binge drinking, with another 20% engaging in heavy drinking in the past 30 days.
Reports from the Russian invasion of Ukraine in 2022 and since suggested that Russian soldiers are drinking significant amount of alcohol (as well as consuming harder drugs), which increases their losses. Some reports suggest that on occasion, alcohol and drugs have been provided to the lower quality troops by their commanders, in order to facilitate their use as expendable cannon fodder.[37][38][39][40]
Food energy
[edit]
Drunkorexia is a major risk factor for alcoholic liver disease manifestations such as cirrhosis.
Main article: Food energy
For risk of using alcohol in diabetics, see § Diabetes.
The use of alcohol as a staple food source is considered inconvenient due to the fact that it increases the blood alcohol content (BAC). 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 to avoid weight gain from alcohol, to save money for purchasing alcohol,[41] and to facilitate alcohol intoxication.[42] Also, in alcoholics who get most of their daily calories from alcohol, a deficiency of thiamine can produce Korsakoff's syndrome, which is associated with serious brain damage.[43]
The USDA uses a figure of 6.93 kilocalories (29.0 kJ) per gram of alcohol (5.47 kcal or 22.9 kJ per ml) for calculating food energy.[44] For distilled spirits, a standard serving in the United States is 44 ml (1.5 US fl oz), which at 40% ethanol (80 proof), would be 14 grams and 98 calories.
Alcoholic drinks are considered empty calorie foods because other than food energy they contribute no essential nutrients. Alcohol increases insulin response to glucose promoting fat storage and hindering carb/fat burning oxidation.[45][46] This excess processing in the liver acetyl CoA can lead to fatty liver disease and eventually alcoholic liver disease.
Medical
[edit]
Main article: Alcohols (medicine)
Spiritus fortis is a medical term for ethanol solutions with 95% ABV.
When taken by mouth or injected into a vein ethanol is used to treat methanol or ethylene glycol toxicity[47] when fomepizole is not available.[48]
Ethanol, when used to treat or prevent methanol and/or ethylene glycol toxicity, competes with other alcohols for the alcohol dehydrogenase enzyme, lessening metabolism into toxic aldehyde and carboxylic acid derivatives, and reducing the more serious toxic effects of the glycols when crystallized in the kidneys.[49]
Recreational
[edit]
Further information: § Drinking culture
Main article: Drinking culture
Drinking culture is the set of traditions and social behaviors that surround the consumption of alcoholic beverages as a recreational drug and social lubricant. Although alcoholic beverages and social attitudes toward drinking vary around the world, nearly every civilization has independently discovered the processes of brewing beer, fermenting wine and distilling spirits.[50]
Common drinking styles include moderate drinking, social drinking, and binge drinking.
Drinking styles
[edit]
Current Alcohol Use among Persons Aged 12 to 20 in the United States.
Main article: Drinking culture § Drinking styles
In today's society, there is a growing awareness of this, reflected in the variety of approaches to alcohol use, each emphasizing responsible choices. Sober curious describes a mindset or approach where someone is consciously choosing to reduce or eliminate alcohol consumption, not drinking and driving, being aware of your surroundings, not pressuring others to drink, and being able to quit anytime. However, they are not necessarily committed to complete sobriety.
Binge drinking
[edit]
Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages with an intention of becoming intoxicated by heavy consumption of alcohol over a short period of time, but definitions (see here) vary considerably.[52] Binge drinking is a style of drinking that is popular in several countries worldwide, and overlaps somewhat with social drinking since it is often done in groups.
Drinking games involve consuming alcohol as part of the gameplay. They can be risky because they can encourage people to drink more than they intended to. Recent studies link binge drinking habits to a decline in quality of life and a shortened lifespan by 3–6 years.[53][54]
Moderate, responsible, and social drinking
[edit]
Moderate drinking, responsible drinking, and social drinking are often used interchangeably, but with slightly different connotations:
Moderate drinking - strictly focuses on the amount of alcohol consumed, following alcohol consumption recommendations (typically 1-2 drinks per day). This is called "drinking in moderation".
According to the WHO nearly half of all alcohol-attributable cancers in the WHO European Region are linked to alcohol consumption, even from "light" or "moderate" drinking – "less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week".[14] Light alcohol consumption showed no connection to most cancers, but a slight rise in the likelihood of melanoma, breast cancer in females, and prostate cancer in males was observed.[55] However, moderate drinking is associated with a further slight increase in cancer risk.[56][57] Also, moderate drinking may disrupt normal brain functioning.[58]
Responsible drinking - as defined by alcohol industry standards, often emphasizes personal choice and risk management, unlike terms like "social drinking" or "moderate drinking."[59]
Critics argue that the alcohol industry's definition does not always align with official recommendations for safe drinking limits.[59]
Social drinking - refers to casual drinking of alcoholic beverages in a social setting (for example bars, nightclubs, or parties) without an intent to become intoxicated. A social drinker is also defined as a person who only drinks alcohol during social events, such as parties, and does not drink while alone (e.g., at home).[60]
While social drinking often involves moderation, it does not strictly emphasize safety or specific quantities, unlike moderate drinking. Social settings can involve peer pressure to drink more than intended, which can be a risk factor for excessive alcohol consumption. Regularly socializing over drinks can lead to a higher tolerance for alcohol and potentially dependence, especially in groups where drinking is a central activity. Social drinking does not preclude the development of alcohol dependence. High-functioning alcoholism describes individuals who appear to function normally in daily life despite struggling with alcohol dependence.
Self-medication
[edit]
A group of merry, dancing invalids discarding their medicines in favour of alcohol as a cure. Coloured aquatint by G. Hunt, 1827, after T. Lane.
The therapeutic index for ethanol is 10%.[61]
Alcohol can have analgesic (pain-relieving) effects, which is why some people with chronic pain turn to alcohol to self-medicate and try to alleviate their physical discomfort.[62]
People with social anxiety disorder commonly self-medicate with alcohol to overcome their highly set inhibitions.[63] 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.[64][65][66] 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.[67]
A 2023 study suggests that people who drink for both recreational enjoyment and therapeutic reasons, like relieving pain and anxiety/depression/stress, have a higher demand for alcohol compared to those who drink solely for recreation or self-medication. This finding raises concerns, as this group may be more likely to develop alcohol use disorder and experience negative consequences related to their drinking.[68] A significant proportion of patients attending mental health services for conditions including anxiety disorders such as panic disorder or social phobia have developed these conditions as a result of recreational alcohol or sedative use.
Self-medication or mental disorders may make people not decline their drinking despite negative consequences. This can create a cycle of dependence that is difficult to break without addressing the underlying mental health issue.
Unscientific
[edit]
The World Health Organization warns that drinking alcohol does not protect you against COVID-19 and can be dangerous.[69]
The American Heart Association warn that "We’ve all seen the headlines about studies associating light or moderate drinking with health benefits and reduced mortality. Some researchers have suggested there are health benefits from wine, especially red wine, and that a glass a day can be good for the heart. But there’s more to the story. No research has proved a cause-and-effect link between drinking alcohol and better heart health."[70]
In folk medicine, consuming a nightcap is for the purpose of inducing sleep. However, alcohol is not recommended by many doctors as a sleep aid because it interferes with sleep quality.[71]
"Hair of the dog", short for "hair of the dog that bit you", is a colloquial expression in the English language predominantly used to refer to alcohol that is consumed as a hangover remedy (with the aim of lessening the effects of a hangover). Many other languages have their own phrase to describe the same concept. The idea may have some basis in science in the difference between ethanol and methanol metabolism. Instead of alcohol, rehydration before going to bed or during hangover may relieve dehydration-associated symptoms such as thirst, dizziness, dry mouth, and headache.[72][73][74][75][76][77]
Drinking alcohol may cause subclinical immunosuppression.[78]
Spiritual
[edit]
See also: § Alcohol and religion, and Alcohol and religion
Sake offered on a sanbo altar
Spiritual use of moderate alcohol consumption is found in some religions and schools with esoteric influences, including the Hindu tantra sect Aghori, in the Sufi Bektashi Order and Alevi Jem ceremonies,[79] in the Rarámuri religion, in the Japanese religion Shinto,[80] by the new religious movement Thelema, in Vajrayana Buddhism, and in Vodou faith of Haiti.
Contraindication
[edit]
Pregnancy
[edit]
Baby with fetal alcohol syndrome, showing some of the characteristic facial features.
Main article: Fetal alcohol spectrum disorder
In the US, alcohol is subject to the FDA drug labeling Pregnancy Category X (Contraindicated in pregnancy).
Minnesota, North Dakota, Oklahoma, South Dakota, and Wisconsin have laws that allow the state to involuntarily commit pregnant women to treatment if they abuse alcohol during pregnancy.[81]
Risks
[edit]
Fetal alcohol spectrum disorder
[edit]
Main article: Fetal alcohol spectrum disorder
Ethanol is classified as a teratogen[82][83][medical citation needed]—a substance known to cause birth defects; according to the U.S. Centers for Disease Control and Prevention (CDC), alcohol consumption by women who are not using birth control increases the risk of fetal alcohol spectrum disorders (FASDs). This group of conditions encompasses fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, static encephalopathy, and alcohol-related birth defects.[84] The CDC currently recommends complete abstinence from alcoholic beverages for women of child-bearing age who are pregnant, trying to become pregnant, or are sexually active and not using birth control.[85]
Miscarriage
[edit]
Miscarriage, also known in medical terms as a spontaneous abortion, is the death and expulsion of an embryo or fetus before it can survive independently.
Alcohol consumption is a risk factor for miscarriage.[86]
Sudden infant death syndrome
[edit]
Main article: Sudden infant death syndrome
Drinking of alcohol by parents is linked to sudden infant death syndrome (SISD).[87] One study found a positive correlation between the two during New Years celebrations and weekends.[88] Another found that alcohol use disorder was linked to a more than doubling of risk.[89]
Adverse effects
[edit]
Main articles: Alcohol and health and Alcoholism § Moderate drinking
See also: Health effects of wine
Deaths from alcohol and drug use disorders.
Alcohol has a variety of short-term and long-term adverse effects. Alcohol has both short-term, and long-term effects on the memory, and sleep. It also has reinforcement-related adverse effects, including alcoholism, dependence, and withdrawal; The most severe withdrawal symptoms, associated with physical dependence, can include seizures and delirium tremens, which in rare cases can be fatal. Alcohol use is directly related to considerable morbidity and mortality, for instance due to intoxication and alcohol-related health problems.[90] The World Health Organization advises that there is no safe level of alcohol consumption.[91]
A study in 2015 found that alcohol and tobacco use combined resulted in a significant health burden, costing over a quarter of a billion disability-adjusted life years. Illicit drug use caused tens of millions more disability-adjusted life years.[92]
Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder.[93]
Alcohol is a common cause of substance-induced psychosis or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions.[94] Research has shown that excessive alcohol use causes an 8-fold increased risk of psychotic disorders in men and a 3-fold increased risk of psychotic disorders in women.[95][96] While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent.[94] Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia.[97]
An inability to process or exhibit emotions in a proper manner has been shown to exist in people who consume excessive amounts of alcohol and those who were exposed to alcohol while fetuses (FAexp).[98] Also, a significant portion (40–60%) of alcoholics experience emotional blindness.[99]
Short-term effects
[edit]
Main articles: Short-term effects of alcohol consumption and Subjective response to alcohol
Symptoms of varying BAC levels. Additional symptoms may occur.
The amount of ethanol in the body is typically quantified by blood alcohol content (BAC); weight of ethanol per unit volume of blood. Small doses of ethanol, in general, are stimulant-like[100] and produce euphoria and relaxation; people experiencing these symptoms tend to become talkative and less inhibited, and may exhibit poor judgement. At higher dosages (BAC > 1Â gram/liter), ethanol acts as a central nervous system (CNS) depressant,[100] producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death. Ethanol is commonly consumed as a recreational substance, especially while socializing, due to its psychoactive effects.
Central nervous system impairment
[edit]
A young man lying comatose after a binge drinking session
Alcohol causes generalized CNS depression, is a positive allosteric GABAA modulator and is associated and related with decreased anxiety, decreased social inhibition, sedation, impairment of cognitive, memory, and sensory function, cognitive, memory, motor, and sensory impairment. It slows and impairs cognition and reaction time and the cognitive skills, impairs judgement, interferes with motor function resulting in motor incoordination, numbness, impairs memory formation, and causes sensory impairment.
Binge drinking can cause generalized impairment of neurocognitive function, dizziness, analgesia, amnesia, ataxia (loss of balance, confusion, sedation, slurred speech), general anaesthesia, decreased libido, nausea, vomiting, blackout, spins, stupor, unconsciousness, and hangover.
At very high concentrations, alcohol can cause anterograde amnesia, markedly decreased heart rate, pulmonary aspiration, positional alcohol nystagmus, respiratory depression, shock, coma and death can result due to profound suppression of CNS function alcohol overdose and can finish in consequent dysautonomia.
Gastrointestinal effects
[edit]
A 1681 painting depicting a person vomiting
Alcohol can cause nausea and vomiting in sufficiently high amounts (varying by person).
Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption stimulates acidic secretions normally intended to digest protein molecules. Consequently, the excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer that prevents the stomach from, essentially, digesting itself.[101]
Ingestion of alcohol can initiate systemic pro-inflammatory changes through two intestinal routes: (1) altering intestinal microbiota composition (dysbiosis), which increases lipopolysaccharide (LPS) release, and (2) degrading intestinal mucosal barrier integrity – thus allowing LPS to enter the circulatory system. The major portion of the blood supply to the liver is provided by the portal vein. Therefore, while the liver is continuously fed nutrients from the intestine, it is also exposed to any bacteria and/or bacterial derivatives that breach the intestinal mucosal barrier. Consequently, LPS levels increase in the portal vein, liver and systemic circulation after alcohol intake. Immune cells in the liver respond to LPS with the production of reactive oxygen species, leukotrienes, chemokines and cytokines. These factors promote tissue inflammation and contribute to organ pathology.[102]
Hangover
[edit]
One of the signs of a severe hangover is a headache
Main article: Hangover
A hangover is the experience of various unpleasant physiological and psychological effects usually following the consumption of alcohol, such as wine, beer, and liquor. Hangovers can last for several hours or for more than 24 hours. Typical symptoms of a hangover may include headache, drowsiness, concentration problems, dry mouth, dizziness, fatigue, gastrointestinal distress (e.g., nausea, vomiting, diarrhea), absence of hunger, light sensitivity, depression, sweating, hyper-excitability, irritability, and anxiety.[103]
Though many possible remedies and folk cures have been suggested, there is no compelling evidence to suggest that any are effective for preventing or treating hangovers.[104][105] Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover.[104] The socioeconomic consequences of hangovers include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. A hangover may also impair performance during potentially dangerous daily activities such as driving a car or operating heavy machinery.[106]
Holiday heart syndrome
[edit]
Electrocardiographic image depicting atrial fibrillation (top, red arrow) and normal heart rhythm (bottom)
Main article: Holiday heart syndrome
Holiday heart syndrome, also known as alcohol-induced atrial arrhythmias, is a syndrome defined by an irregular heartbeat and palpitations[107] associated with high levels of ethanol consumption.[108][109] Holiday heart syndrome was discovered in 1978 when Philip Ettinger discovered the connection between arrhythmia and alcohol consumption.[110] It received its common name as it is associated with the binge drinking common during the holidays.[111] It is unclear how common this syndrome is. 5-10% of cases of atrial fibrillation may be related to this condition, but it could be as high 63%.[112]
Positional alcohol nystagmus
[edit]
Main article: Positional alcohol nystagmus
Positional alcohol nystagmus (PAN) is nystagmus (visible jerkiness in eye movement) produced when the head is placed in a sideways position. PAN occurs when the specific gravity of the membrane space of the semicircular canals in the ear differs from the specific gravity of the fluid in the canals because of the presence of alcohol.[113]
Allergic-like reactions
[edit]
Facial flushing. Before (left) and after (right) drinking alcohol. A 22-year-old East Asian man who is ALDH2 heterozygous showing the reaction.[114][115]
Main articles: Alcohol-induced respiratory reactions, Alcohol flush reaction, and Alcohol intolerance
See also: Short-term effects of alcohol consumption § Allergic reaction-like symptoms, Potomania, and Red wine headache
Ethanol-containing beverages can cause alcohol flush reactions, exacerbations of rhinitis and, more seriously and commonly, bronchoconstriction in patients with a history of asthma, and in some cases, urticarial skin eruptions, and systemic dermatitis. Such reactions can occur within 1–60 minutes of ethanol ingestion, and may be caused by:[116]
genetic abnormalities in the metabolism of ethanol, which can cause the ethanol metabolite, acetaldehyde, to accumulate in tissues and trigger the release of histamine, or
true allergy reactions to allergens occurring naturally in, or contaminating, alcoholic beverages (particularly wine and beer), and
other unknown causes.
Alcohol flush reaction has also been associated with an increased risk of esophageal cancer in those who do drink.[114][117][118]
Long-term effects
[edit]
How alcohol affects your body
Main article: Long-term effects of alcohol
Due to the long term effects of alcohol abuse, binge drinking is considered to be a major public health issue.[119]
The impact of alcohol on aging is multifaceted. The relationship between alcohol consumption and body weight is the subject of inconclusive studies. Alcoholic lung disease is disease of the lungs caused by excessive alcohol. However, the term 'alcoholic lung disease' is not a generally accepted medical diagnosis.
Alcohol's overall effect on health is uncertain. While some studies suggest moderate consumption might have some benefit, others find any amount increases health risks. This uncertainty is due to conflicting research methods and potential biases, including counting former drinkers as abstainers and the possibility of alcohol industry influence. Because of these issues, experts advise against using alcohol for health reasons. For example, in 2023, the World Health Organization (WHO) stated that there is currently no conclusive evidence from studies that the potential benefits of moderate alcohol consumption for cardiovascular disease and type 2 diabetes outweigh the increased cancer risk associated with these drinking levels for individual consumers.[14]
According to The Lancet, 'four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year'.[120] In 2024, the World Health Organization published a report including these figures.[121][122]
Alcoholism
[edit]
Main articles: Alcoholism, Alcoholism in adolescence, and Alcoholism in family systems
See also: Quit lit (alcohol cessation)
Alcohol use disorders deaths per million persons in 2012
  0–0
  1–3
  4–6
  7–13
  14–20
  21–37
  38–52
  53–255
Alcoholism or its medical diagnosis alcohol use disorder refers to alcohol addiction, alcohol dependence, dipsomania, and/or alcohol abuse. It is a major problem and many health problems as well as death can result from excessive alcohol use.[123][90] Alcohol dependence is linked to a lifespan that is reduced by about 12 years relative to the average person.[123] In 2004, it was estimated that 4% of deaths worldwide were attributable to alcohol use.[90] Deaths from alcohol are split about evenly between acute causes (e.g., overdose, accidents) and chronic conditions.[90] The leading chronic alcohol-related condition associated with death is alcoholic liver disease.[90] Alcohol dependence is also associated with cognitive impairment and organic brain damage.[123] Some researchers have found that even one alcoholic drink a day increases an individual's risk of health problems by 0.4%.[124]
Stigma surrounding alcohol use disorder is particularly strong and different from the stigma attached to other mental illnesses not caused by substances.[125] People with this condition are seen less as truly ill, face greater blame and social rejection, and experience higher structural discrimination risks.[126]
Two or more consecutive alcohol-free days a week have been recommended to improve health and break dependence.[127][128]
Dry drunk is an expression coined by the founder of Alcoholics Anonymous[129] that describes an alcoholic who no longer drinks but otherwise maintains the same behavior patterns of an alcoholic.[130]
A high-functioning alcoholic (HFA) is a person who maintains jobs and relationships while exhibiting alcoholism.[131][132][133]
Many Native Americans in the United States have been harmed by, or become addicted to, drinking alcohol.[134]
Brain damage
[edit]
Brain and nerve cells in their healthy state and after injury by alcohol.
Main articles: Alcohol-related brain damage, Long-term impact of alcohol on the brain, and Neurotoxin
While many people associate alcohol's effects with intoxication, the long-term impact of alcohol on the brain can be severe. Binge drinking, or heavy episodic drinking, can lead to alcohol-related brain damage that occurs after a relatively short period of time. This brain damage increases the risk of alcohol-related dementia, and abnormalities in mood and cognitive abilities.
Alcohol can cause Wernicke's encephalopathy and Alcoholic Korsakoff syndrome which frequently occur simultaneously, known as Wernicke–Korsakoff syndrome.[135] Lesions, or brain abnormalities, are typically located in the diencephalon which result in anterograde and retrograde amnesia, or memory loss.[135]
Dementia
[edit]
Main article: Alcohol-related dementia
Alcohol-related dementia (ARD) is a form of dementia caused by long-term, excessive consumption of alcohol, resulting in neurological damage and impaired cognitive function.[136]
Liver damage
[edit]
Depiction of a liver failure patient
Main articles: Alcoholic liver disease, Alcoholic hepatitis, Cirrhosis, Hepatotoxin, Fatty liver disease, Mallory body, and Zieve's syndrome
Consuming more than 30 grams of pure alcohol per day over an extended period can significantly increase the risk of developing alcoholic liver disease.[137] During the metabolism of alcohol via the respective dehydrogenases, nicotinamide adenine dinucleotide (NAD) is converted into reduced NAD. Normally, NAD is used to metabolize fats in the liver, and as such alcohol competes with these fats for the use of NAD. Prolonged exposure to alcohol means that fats accumulate in the liver, leading to the term 'fatty liver'. Continued consumption (such as in alcohol use disorder) then leads to cell death in the hepatocytes as the fat stores reduce the function of the cell to the point of death. These cells are then replaced with scar tissue, leading to the condition called cirrhosis.
Cancer
[edit]
Main article: Alcohol and cancer
Alcoholic beverages have been classified as carcinogenic by leading health organizations for more than two decades, including the WHO's IARC (Group 1 carcinogens)[23] and the U.S. NTP,[138] raising concerns about the potential cancer risk associated with alcohol consumption.
Drinking alcohol increases the risk for breast cancer.[139] Alcohol is also a major cause for head and neck cancer, especially laryngeal cancer. This risk is even higher when alcohol is used together with tobacco.[57][140]
Qualitative analysis reveals that the alcohol industry likely misinforms the public about the alcohol-cancer link, similar to the tobacco industry. The alcohol industry influences alcohol policy and health messages, including those for schoolchildren.[141]
Cardiovascular disease
[edit]
Main article: Alcohol and cardiovascular disease
Excessive daily alcohol consumption and binge drinking can cause a higher risk of stroke, coronary artery disease, heart failure, fatal hypertensive disease, and fatal aortic aneurysm.[142]
A 2010 study reviewed a bunch of research on alcohol and heart disease. They found that moderate drinking did not seem to worsen things for people who already had heart problems. But importantly, the researchers did not say that people who do not drink should start in order to improve their heart health.[143] Thus, the safety and potential positive effect of light drinking on the cardiovascular system has not yet been proven. Still alcohol is a major health risk, and even if moderate drinking lowers the risk of some cardiovascular diseases it might increase the risk of others. Therefore starting to drink alcohol in the hope of any benefit is not recommended.[142][144]
The World Heart Federation (2022) recommends against any alcohol intake for optimal heart health.[145][146]
It has also been pointed out that the studies suggesting a positive link between red wine consumption and heart health had flawed methodology in the form of comparing two sets of people which were not actually appropriately paired.[146]
Cardiomyopathy
[edit]
Main article: Alcoholic cardiomyopathy
Idiopathic cardiomyopathy.
Alcoholic cardiomyopathy (ACM) is a disease in which the long-term consumption of alcohol leads to heart failure.[147] ACM is a type of dilated cardiomyopathy. The heart is unable to pump blood efficiently, leading to heart failure. It can affect other parts of the body if the heart failure is severe. It is most common in males between the ages of 35 and 50.
Hearing loss
[edit]
Alcohol, classified as an ototoxin (ear toxin),[148] can contribute to hearing loss sometimes referred to as "cocktail deafness" after exposure to loud noises in drinking environments.[149][150]
Children with fetal alcohol spectrum disorder (FASD) are at an increased risk of having hearing difficulties.
Withdrawal syndrome
[edit]
Chlordiazepoxide (trade name Librium) is the most commonly used benzodiazepine for alcohol detoxification.[151]
Main articles: Alcohol withdrawal syndrome, Alcoholic hallucinosis, Delirium tremens, and Substance-induced psychosis
Discontinuation of alcohol after extended heavy use and associated tolerance development (resulting in dependence) can result in withdrawal. Alcohol withdrawal can cause confusion, paranoia, anxiety, insomnia, agitation, tremors, fever, nausea, vomiting, autonomic dysfunction, seizures, and hallucinations. In severe cases, death can result.
Delirium tremens is a condition that requires people with a long history of heavy drinking to undertake an alcohol detoxification regimen.
Alcohol is one of the more dangerous drugs to withdraw from.[152] Drugs which help to re-stabilize the glutamate system such as N-acetylcysteine have been proposed for the treatment of addiction to cocaine, nicotine, and alcohol.[153]
Cohort studies have demonstrated that the combination of anticonvulsants and benzodiazepines is more effective than other treatments in reducing alcohol withdrawal scores and shortening the duration of intensive care unit stays.[154]
Nitrous oxide has been shown to be an effective and safe treatment for alcohol withdrawal.[155] The gas therapy reduces the use of highly addictive sedative medications (like benzodiazepines and barbiturates).
Cortisol
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Main article: Alcohol and cortisol
Research has looked into the effects of alcohol on the amount of cortisol that is produced in the human body. Continuous consumption of alcohol over an extended period of time has been shown to raise cortisol levels in the body. Cortisol is released during periods of high stress, and can result in the temporary shut down of other physical processes, causing physical damage to the body.
Gout
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Gout in the big toe of left foot, compared to the healthy right foot
There is a strong association between gout the consumption of alcohol, and sugar-sweetened beverages,[156] with wine presenting somewhat less of a risk than beer or spirits.[157][158]
Ketoacidosis
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Main article: Alcoholic ketoacidosis
Alcoholic ketoacidosis (AKA) is a specific group of symptoms and metabolic state related to alcohol use.[159] Symptoms often include abdominal pain, vomiting, agitation, a fast respiratory rate, and a specific "fruity" smell.[160] Consciousness is generally normal.[161] Complications may include sudden death.[161]
Mental disorders
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Alcohol is a cause of mental disorders. Alcohol may play a role in depression, with up to 10% of male depression cases in some European countries linked to alcohol use.[162]
Alcohol misuse often coincides with mental health conditions. Many individuals struggling with psychiatric disorders also experience problematic drinking behaviors.[163]
Austrian syndrome
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Scanning Electron Micrograph of Streptococcus pneumoniae
Main article: Austrian syndrome
Austrian syndrome, also known as Osler's triad, is a medical condition that was named after Robert Austrian in 1957. The presentation of the condition consists of pneumonia, endocarditis, and meningitis, all caused by Streptococcus pneumoniae. It is associated with alcoholism due to hyposplenism (reduced splenic functioning) and can be seen in males between the ages of 40 and 60 years old.[164] Robert Austrian was not the first one to describe the condition, but Richard Heschl (around 1860s) or William Osler were not able to link the signs to the bacteria because microbiology was not yet developed.
The leading cause of Osler's triad (Austrian syndrome) is Streptococcus pneumoniae, which is usually associated with heavy alcohol use.
Polyneuropathy
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Main article: Alcoholic polyneuropathy
Alcoholic polyneuropathy is a neurological disorder in which peripheral nerves throughout the body malfunction simultaneously. It is defined by axonal degeneration in neurons of both the sensory and motor systems and initially occurs at the distal ends of the longest axons in the body. This nerve damage causes an individual to experience pain and motor weakness, first in the feet and hands and then progressing centrally. Alcoholic polyneuropathy is caused primarily by chronic alcoholism; however, vitamin deficiencies are also known to contribute to its development.