Alcohol (drug)

Ethanol

Clinical data
Pronunciation	/ˈɛθənɒl/
Other names	Absolute alcohol; Alcohol (USPTooltip United States Pharmacopeia); Cologne spirit; Drinking alcohol; Ethanol (JANTooltip Japanese Accepted Name); Ethylic alcohol; EtOH; Ethyl alcohol; Ethyl hydrate; Ethyl hydroxide; Ethylol; Grain alcohol; Hydroxyethane; Methylcarbinol
Pregnancy category	X (Contraindicated in pregnancy)
Dependence liability	Physical: Very High General anesthetic; Sedative
ATC code	V03AZ01 (WHO)
Legal status
Legal status	AU: Unscheduled BR: Unscheduled CA: Unscheduled DE: Unscheduled NZ: Unscheduled UK: General sales list (GSL, OTC) US: Unscheduled UN: Unscheduled EU: Unscheduled In general: Legal for Muslim countries of Middle East and parts of North Africa, and South Asia
sweat (5–10%)[6][4]
Identifiers
IUPAC name ethanol
JSmol)	Interactive image
Density	0.7893 g/cm3 (at 20 °C)[10]
Melting point	−114.14 ± 0.03 °C (−173.45 ± 0.05 °F) [10]
Boiling point	78.24 ± 0.09 °C (172.83 ± 0.16 °F) [10]
Solubility in water	Miscible mg/mL (20 °C)
SMILES CCO
InChI InChI=1S/C2H6O/c1-2-3/h3H,2H2,1H3 Key:LFQSCWFLJHTTHZ-UHFFFAOYSA-N

Alcohol, sometimes referred to by the chemical name ethanol, is one of the most widely consumed psychoactive drugs in the world and falls under the depressant category.^[11][12] The term "Alcohol and Other Drugs" (AOD) emphasizes this inclusion by grouping alcohol with other substances that alter mood and behavior. It is classified by the World Health Organization (WHO) as a toxic, psychoactive, dependence-producing, and carcinogenic substance.^[13]

While the terms "drug" and "medicine" are sometimes used interchangeably, "drug" can have a

The normalization of alcohol consumption,^[16] along with past misconceptions about its health benefits, also promoted by the industry,^[17] 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.^[18][19] This contradicts the perception some hold of alcohol being a harmless substance.

Alcohol is found in

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".^[13] 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.

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; in 2016, excessive alcohol use was responsible for 3.0 million deaths worldwide.^[23]

Despite being a widespread issue, social stigma around problematic alcohol use or alcoholism discourages over 80% from seeking help.^[24]

Alcohol works in the brain primarily by increasing the effects of

Dutch courage

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.^[26]: 200 However, a recent trend called "dry dating" is gaining popularity to replace "liquid courage", which involves going on dates without consuming alcohol.^[27][28][29]

Consuming alcohol prior to visiting female sex workers is a common practice among some men.^[30] Sex workers often resort to using drugs and alcohol to cope with stress.^[31] 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.^[31]

Alcohol when consumed in high doses is considered to be an anaphrodisiac.^[32]

Criminal

Albeit not a valid

Alcohol has a long association of military use, and has been called "liquid courage" for its role in preparing troops for battle,

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.^{[36][37][38][39]}

Food energy

The use of alcohol as a

Spiritus fortis is a medical term for ethanol solutions with 95% ABV.

When taken by mouth or

Common drinking styles include moderate drinking, social drinking, and binge drinking.

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

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.^[51] 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.^[52][53]

Moderate, responsible, and social drinking

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".^[13] 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.^[54] However, moderate drinking is associated with a further slight increase in cancer risk.^[55][56] Also, moderate drinking may disrupt normal brain functioning.^[57]
• Responsible drinking - as defined by
  alcohol industry standards, often emphasizes personal choice and risk management, unlike terms like "social drinking" or "moderate drinking."^[58]
  • Critics argue that the alcohol industry's definition does not always align with official recommendations for safe drinking limits.[58]
• 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).^[59]
  • 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

The therapeutic index for ethanol is 10%.^[60]

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.^[61]

People with

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.[67] 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

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."^[68]

In

Drinking alcohol will not prevent or cure COVID-19,^[76] contrary to some claims.^[77] Instead, drinking alcohol may cause subclinical immunosuppression.^[78]

Spiritual

faith of Haiti.

This section needs expansion. You can help by adding to it. (March 2024)

Contraindication

In the US, alcohol is subject to the FDA drug labeling

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]

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

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

Drinking of alcohol by parents is linked to

Alcohol has a variety of short-term and long-term

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

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 > 1 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

Alcohol causes generalized CNS depression, is a

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

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

A

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

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

Positional alcohol nystagmus (PAN) is

Ethanol-containing beverages can cause alcohol flush reactions, exacerbations of

• 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

Due to the

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

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.^[120][90] Alcohol dependence is linked to a lifespan that is reduced by about 12 years relative to the average person.^[120] 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.^[120] Some researchers have found that even one alcoholic drink a day increases an individual's risk of health problems by 0.4%.^[121]

Stigma surrounding alcohol use disorder is particularly strong and different from the stigma attached to other mental illnesses not caused by substances.^[122] People with this condition are seen less as truly ill, face greater blame and social rejection, and experience higher structural discrimination risks.^[123]

Two or more consecutive alcohol-free days a week have been recommended to improve health and break dependence.^[124][125]

Dry drunk is an expression coined by the founder of Alcoholics Anonymous^[126] that describes an alcoholic who no longer drinks but otherwise maintains the same behavior patterns of an alcoholic.^[127]

A high-functioning alcoholic (HFA) is a person who maintains jobs and relationships while exhibiting alcoholism.^{[128][129][130]}

Many Native Americans in the United States have been harmed by, or become addicted to, drinking alcohol.^[131]

Brain damage

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

Alcohol-related dementia (ARD) is a form of

Consuming more than 30 grams of pure alcohol per day over an extended period can significantly increase the risk of developing alcoholic liver disease.^[134] 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

Alcoholic beverages have been classified as carcinogenic by leading health organizations for more than two decades, including the WHO's IARC (Group 1 carcinogens)^[22] and the U.S. NTP,^[135] raising concerns about the potential cancer risk associated with alcohol consumption.

Drinking alcohol increases the risk for breast cancer.^[136] 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.^[56][137]

Qualitative analysis reveals that the

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.^[139]

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.^[140] 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.^[139][141]

The World Heart Federation (2022) recommends against any alcohol intake for optimal heart health.^[142][143]

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.^[143]

Cardiomyopathy

Alcoholic cardiomyopathy (ACM) is a disease in which the long-term consumption of alcohol leads to heart failure.^[144] 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

Alcohol, classified as an

Children with fetal alcohol spectrum disorder (FASD) are at an increased risk of having hearing difficulties.

Withdrawal syndrome

Discontinuation of alcohol after extended heavy use and associated

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.

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.^[151]

Nitrous oxide has been shown to be an effective and safe treatment for alcohol withdrawal.^[152] The gas therapy reduces the use of highly addictive sedative medications (like benzodiazepines and barbiturates).

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

There is a strong association between

Alcoholic ketoacidosis (AKA) is a specific group of symptoms and metabolic state related to alcohol use.^[156] Symptoms often include abdominal pain, vomiting, agitation, a fast respiratory rate, and a specific "fruity" smell.^[157] Consciousness is generally normal.^[158] Complications may include sudden death.^[158]

Mental disorders

Alcohol is a

Alcohol misuse often coincides with mental health conditions. Many individuals struggling with psychiatric disorders also experience problematic drinking behaviors.[160]

Austrian syndrome

Alcoholic polyneuropathy is a

Specific population

Pregnant women

Babies exposed to alcohol, benzodiazepines, barbiturates, and some antidepressants (SSRIs) during pregnancy may experience neonatal withdrawal.^[162]

The onset of clinical presentation typically appears within 48 to 72 hours of birth but may take up to 8 days.^[163][164]

Other effects

Alcohol consumption is associated with lower sperm concentration, percentage of normal morphology, and semen volume, but not sperm motility.^[165]

Frequent drinking of alcoholic beverages is a major contributing factor in cases of hypertriglyceridemia.^[166]

Excess alcohol use is frequently associated with porphyria cutanea tarda (PTC).^[167]

Alcohol consumption is a risk factor for Dupuytren's contracture.^[168][169]

The majority of those with aspirin-exacerbated respiratory disease experience respiratory reactions to alcohol.^[170]

Social issues

Alcohol-related crimes

Alcohol use is stereotypically associated with crime,

Public-order crimes caused by drinking include drunk driving, domestic violence, and alcohol-related sexual assaults.

Automobile accidents

A 2002 study found 41% of people fatally injured in traffic accidents were in alcohol-related crashes.^[182] Misuse of alcohol is associated with more than 40% of deaths that occur in automobile accidents every year.^[120] The risk of a fatal car accident increases exponentially with the level of alcohol in the driver's blood.^[183]

Most countries have passed laws prohibiting driving a

Negligence in alcohol consumption can have a ripple effect on environmentally responsible behavior. Examples:

• Consuming
  alcoholic beverages, which increases urine production and reduces social inhibitions
  , can lead to public urination. Public urination is illegal in most areas.
• Improper disposal of alcohol bottles is a common problem. Many are not recycled or left behind in public spaces. Discarded alcoholic beverage containers, especially broken glass shards that are difficult to remove, does not only create an eyesore but may also cause flat tires for cyclists, injure wildlife or kids.
• Alcohol consumption can contribute to nighttime noise pollution, especially through loud music played by intoxicated individuals. This disrupts sleep and relaxation for nearby residents, impacting health and productivity. Municipal noise ordinances often establish quiet hours and penalties for violations.
• People under the influence may forget to extinguish outdoor fireplaces, which may create a fire hazard since unchecked fires can escalate into wildfires.
• Drunk cyclists can only be charged if they ride dangerously, cause a crash, or behave disruptively.^[187] However, cycling under the influence increases the risk of severe injury, hospital resource use, and even death, according to a study highlighting the importance of safe cycling practices.^[188]

Public drunkenness

Public drunkenness or intoxication is a common problem in many jurisdictions. Public intoxication laws vary widely by jurisdiction, but include public nuisance laws, open-container laws, and prohibitions on drinking alcohol in public or certain areas. The offenders are often lower class individuals and this crime has a very high recidivism rate, with numerous instances of repeated instances of the arrest, jail, release without treatment cycle. The high number of arrests for public drunkenness often reflects rearrests of the same offenders.^[176]

Sexual assaults

Rape is any sexual activity that occurs without the freely given consent of one of the parties involved. This includes alcohol-facilitated sexual assault which is considered rape in most if not all jurisdictions,^[189] or non-consensual condom removal which is criminalized in some countries (see the map below).

A 2008 study found that rapists typically consumed relatively high amounts of alcohol and infrequently used condoms during assaults, which was linked to a significant increase in STI transmission.^[190] This also increase the risk of pregnancy from rape for female victims. Some people turn to drugs or alcohol to cope with emotional trauma after a rape; use of these during pregnancy can harm the fetus.^[191]

Alcohol-facilitated sexual assault

One of the most common date rape drugs is alcohol,^{[193][194][195]} administered either surreptitiously^[196] or consumed voluntarily,^[193] rendering the victim unable to make informed decisions or give consent. The perpetrator then facilitates sexual assault or rape, a crime known as alcohol- or drug-facilitated sexual assault (DFSA).^{[197][189][198]} However, sex with an unconscious victim is considered rape in most if not all jurisdictions, and some assailants have committed "rapes of convenience" whereby they have assaulted a victim after he or she had become unconscious from drinking too much.^[199] The risk of individuals either experiencing or perpetrating sexual violence and risky sexual behavior increases with alcohol abuse,^[200] and by the consumption of caffeinated alcoholic drinks.^[201][202]

Non-consensual condom removal

Non-consensual condom removal, or "stealthing",^[203] is the practice of a person removing a condom during sexual intercourse without consent, when their sex partner has only consented to condom-protected sex.^[204][205] Purposefully damaging a condom before or during intercourse may also be referred to as stealthing,^[206] regardless of who damaged the condom.

Consuming alcohol can be risky in sexual situations. It can impair judgment and make it difficult for both people to give or receive informed sexual consent. However, a history of sexual aggression and alcohol intoxication are factors associated with an increased risk of men employing non-consensual condom removal and engaging in sexually aggressive behavior with female partners.^[207][208]

Wartime sexual violence

The use of alcohol is a documented factor in wartime sexual violence.

For example, rape during the liberation of Serbia was committed by Soviet Red Army soldiers against women during their advance to Berlin in late 1944 and early 1945 during World War II. Serbian journalist Vuk Perišić said about the rapes: "The rapes were extremely brutal, under the influence of alcohol and usually by a group of soldiers. The Soviet soldiers did not pay attention to the fact that Serbia was their ally, and there is no doubt that the Soviet high command tacitly approved the rape."^[209]

While there was not a codified international law specifically prohibiting rape during World War II,

Violent crime

The World Health Organization has noted that out of social problems created by the harmful use of alcohol, "crime and violence related to alcohol consumption" are likely the most significant issue.^[180] In the United States, 15% of robberies, 63% of intimate partner violence incidents, 37% of sexual assaults, 45–46% of physical assaults and 40–45% of homicides (murders) involved use of alcohol.^[212][178] A 1983 study for the United States found that 54% of violent crime perpetrators, arrested in that country, had been consuming alcohol before their offenses.^[176] In 2002, it was estimated that 1 million violent crimes in the U.S. were related to alcohol use.^[120] More than 43% of violent encounters with police involve alcohol.^[120] Alcohol is implicated in more than two-thirds of cases of intimate partner violence.^[120] Studies also suggest there may be links between alcohol abuse and child abuse.^[171] In the United Kingdom, in 2015/2016, 39% of those involved in violent crimes were under alcohol influence.^[213] A significant portion, 40%, of homicide victims tested positive for alcohol in the US.^[214] International studies are similar, with an estimate that 63% of violent crimes worldwide involves the use of alcohol.^[178]

The relation between alcohol and violence is not yet fully understood, as its impact on different individuals varies.^[

Methanol laced alcohol

Main articles: List of methanol poisoning incidents and Alcohol congener analysis

methanol poisoning have occurred when methanol is used to lace moonshine (bootleg liquor).^[216] This is commonly done to bulk up the original product to gain profit. Because of its similarities in both appearance and odor to ethanol

(the alcohol in beverages), it is difficult to differentiate between the two.

Methanol is a toxic alcohol. If as little as 10 mL of pure methanol is ingested, for example, it can break down into formic acid, which can cause permanent blindness by destruction of the optic nerve, and 30 mL is potentially fatal,^[217] although the median lethal dose is typically 100 mL (3.4 fl oz) (i.e. 1–2 mL/kg body weight of pure methanol^[218]). Reference dose for methanol is 2.0 mg/kg/day.^[219] Toxic effects take hours to start, and effective antidotes can often prevent permanent damage.^[217]

India has a thriving moonshine industry, and methanol-tainted batches have killed over 2,000 people in the last 3 decades.

Alternative routes of administration

Alternative methods of alcohol administration like alcohol enema, alcohol inhalation, vodka eyeballing, or using alcohol powder (which can be added to water to make an alcoholic beverage, or inhaled with a nebulizer), all carry significant health risks.

Binge drinking

Main article: Binge drinking

public health issue.^[119]

Binge drinking is more common in males, during adolescence and young adulthood. Heavy regular binge drinking is associated with adverse effects on

fetal alcohol spectrum disorders.^[223] Binge drinking during adolescence is associated with traffic accidents and other types of accidents, violent behavior as well as suicide. The more often a child or adolescent binge drinks and the younger they are the more likely that they will develop an alcohol use disorder including alcoholism. A large number of adolescents who binge-drink also consume other psychotropic substances.^[224]

̈́

Emotional issues

In

defense mechanisms are linked to placing a higher value on junk food, alcohol, and television.^[226]

There is a two-way street between loneliness and drinking. People who drink more than once a week tend to feel lonelier, according to a study on Japanese workers during the COVID-19 pandemic.^[227] On the other hand, feelings of loneliness can also lead people to drink more, as shown in a separate study.^[228] Loneliness is a major risk factor for depression and alcoholism.^[229]

Hurtful communication

Alcohol may cause hurtful communication.

Drunk dialing

Main article: Drunk dialing

Drunk dialing refers to an intoxicated person making phone calls that they would not likely make if sober, often a lonely individual calling former or current love interests.

A 2021 study, that examined the relationship between drunk texting and emotional dysregulation, found a positive correlation. The findings suggest that interventions targeting emotional regulation skills may be beneficial.^[230]

In vino veritas

Main article: In vino veritas

In vino veritas is a Latin phrase that means 'in wine, there is truth', suggesting a person under the influence of alcohol is more likely to speak their hidden thoughts and desires.

Risky sexual behavior

Main article: Alcohol and sex

Some studies have made a connection between hookup culture and substance use.^[231] Most students said that their hookups occurred after drinking alcohol.^{[231][232][233]} Frietas stated that in her study, the relationships between drinking and the party scene and between alcohol and hookup culture were "impossible to miss."^[234]: 41

Studies suggest that the degree of alcoholic intoxication in young people directly correlates with the level of risky behavior,^[235] such as engaging in multiple sex partners.^[236]

In 2018, the first study of its kind, found that alcohol and caffeinated energy drinks is linked with casual, risky sex among college-age adults.^[237]

Sexually transmitted infections and unintended pregnancy

Alcohol intoxication is associated with an increased risk that people will become involved in risky sexual behaviors, such as unprotected sex.^[238] Both men,^[239] and women,^[240] reported higher intentions to avoid using a condom when they were intoxicated by alcohol.

Coitus interruptus, also known as withdrawal, pulling out or the pull-out method, is a method of birth control during penetrative sexual intercourse, whereby the penis is withdrawn from a vagina or anus prior to ejaculation so that the ejaculate (semen) may be directed away in an effort to avoid insemination.^[241][242] Coitus interruptus carries a risk of STIs and unintended pregnancy. This risk is especially high during alcohol intoxication because lowered sexual inhibition can make it difficult to withdraw in time.

Women with unintended pregnancies are more likely to smoke tobacco,^[243] drink alcohol during pregnancy,^[244][245] and binge drink during pregnancy,^[243] which results in poorer health outcomes.^[244] (See also: fetal alcohol spectrum disorder)

Societal damage

multi-criteria decision analysis

" found that alcohol scored highest overall and in Economic cost, Injury, Family adversities, Environmental damage, and Community harm.

Alcohol causes a plethora of detrimental effects in society.

emergency room visits involve alcohol use.^[120] Alcohol availability and consumption rates and alcohol rates are positively associated with nuisance, loitering, panhandling, and disorderly conduct in public space.^[171]

A 2011 study challenged the perception of heroin as the more dangerous substance. The research suggests, when considering the wider social, physical, and financial costs, alcohol may be more harmful.^[247]

Individuals who engage with or share alcohol-related content on social networking services tend to exhibit higher levels of alcohol use and related issues.^[248] Overwork is linked to an increased risk of unhealthy alcohol consumption.^[249] Also, unemployment can heighten the risk of alcohol consumption and smoking.^[250] As many as 15% of employees show problematic alcohol-related behaviors in the workplace, such as drinking before going to work or even drinking on the job.^[120]

College

Main article: Alcohol use among college students

Many

alcoholic beverages. The laws and social culture around this practice vary by country and institution type, and within an institution, some students may drink heavily whereas others may not drink at all. In the United States, drinking tends to be particularly associated with fraternities

.

Alcohol abuse among college students refers to unhealthy alcohol drinking behaviors by college and university students. While the legal drinking age varies by country, the high amount of underage students that consume alcohol has presented many problems and consequences for universities. The causes of alcohol abuse tend to be peer pressure, fraternity or sorority involvement, and stress. College students who abuse alcohol can suffer from health concerns, poor academic performance or legal consequences. Prevention and treatment include campus counseling, stronger enforcement of underage drinking or changing the campus culture.

Recent research indicates that the abundance of alcohol retailers and the availability of inexpensive alcoholic beverages are linked to heavy alcohol consumption among college students.^[251]

Poverty

Alcohol consumption can contribute to secondary poverty (where people fall back into poverty after escaping it). The Bureau of Labor Statistics found that "the average American consumer dedicates 1 percent of all their spending to alcohol".^[252]

Unsustainable tourism

Some popular tourist destinations, are cracking down on the

Sant Antoni in Ibiza, where late-night sales of alcohol will be banned. This comes after years of issues with rowdy tourists and the negative impacts it has on local residents.^[253]

Suicide

Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide,^[254] with alcoholism present in between 15% and 61% of cases.^[255] Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide.^[256] About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide.^[256] Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past.^[255] In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.^[257]

Interactions

Disorders

Covid

A 2023 study suggests a link between alcohol consumption and worse COVID-19 outcomes. Researchers analyzed data from over 1.6 million people and found that any level of alcohol consumption increased the risk of severe illness, intensive care unit admission, and needing ventilation compared to non-drinkers. Even a history of drinking was associated with a higher risk of severe COVID-19. These findings suggest that avoiding alcohol altogether might be beneficial during the pandemic.^[258]

Diabetes

See the insulin section.

Heptatitis

Alcohol consumption can be especially dangerous for those with pre-existing liver damage from hepatitis B or C. Even relatively low amounts of alcohol can be life-threatening in these cases,^[23] so a strict adherence to abstinence is highly recommended.^[259]

Hitamine intolerance

Alcohol may release histamine in individuals with histamine intolerance.^[260]

Mental disorders

Mental disorders can be a significant risk factor for alcohol abuse.

self-medicate with drugs or alcohol may also have an increased likelihood of suicidal ideation.^[266]

Peptic ulcer disease

In patients who have a peptic ulcer disease (PUD), the mucosal layer is broken down by ethanol. PUD is commonly associated with the bacteria Helicobacter pylori, which secretes a toxin that weakens the mucosal wall, allowing acid and protein enzymes to penetrate the weakened barrier. Because alcohol stimulates the stomach to secrete acid, a person with PUD should avoid drinking alcohol on an empty stomach. Drinking alcohol causes more acid release, which further damages the already-weakened stomach wall.^[267] Complications of this disease could include a burning pain in the abdomen, bloating and in severe cases, the presence of dark black stools indicate internal bleeding.^[101] A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.^[101]

Dosage forms

Alcohol induced dose dumping (AIDD)

Main article: Dose dumping

Alcohol-induced

therapeutic window

of the drug. The best way to prevent this interaction is by avoiding the co-ingestion of both substances or using specific controlled-release formulations that are resistant to AIDD.

Drugs

See also:

Poly drug use

Alcohol can intensify the sedation caused by

antipsychotics, and certain antidepressants.^[269]

Alcohol combined with cannabis (not to be confused with tincture of cannabis which contains minute quantities of alcohol) — known as cross-fading and may easily cause spins in people who are drunk and smoke potent cannabis; Ethanol increases plasma tetrahydrocannabinol levels, which suggests that ethanol may increase the absorption of tetrahydrocannabinol.^[270]

TOMSO is a lesser-known psychedelic drug and a substituted amphetamine. TOMSO was first synthesized by Alexander Shulgin. According to Shulgin's book PiHKAL, TOMSO is inactive on its own and requires consumption of alcohol to become active.^[271]

Hypnotics/sedatives

Alcohol can intensify the sedation caused by

Z-drugs (such as zolpidem and zopiclone).^[269]

Disulfiram-like drugs

Main article: Disulfiram-like drug

Disulfiram

disulfiram effect

.

Metronidazole

Clostridium difficile

Insulin

Alcohol consumption can cause

Controlled animal and human studies showed that

Ethylphenidate formation appears to be more common when large quantities of methylphenidate and alcohol are consumed at the same time, such as in non-medical use or overdose scenarios.^[282] However, only a small percent of the consumed methylphenidate is converted to ethylphenidate.^[283]

While nicotinis mimic the name of classic cocktails like the appletini (their name deriving from "martini"), combining nicotine with alcohol is a bad idea. Tobacco and nicotine actually heighten cravings for alcohol, making this a risky mix.^[284]

Methanol and ethylene glycol

The rate-limiting steps for the elimination of ethanol are in common with certain other substances. As a result, the blood alcohol concentration can be used to modify the rate of metabolism of toxic alcohols, such as methanol and ethylene glycol. Methanol itself is not highly toxic, but its metabolites formaldehyde and formic acid are; therefore, to reduce the rate of production and concentration of these harmful metabolites, ethanol can be ingested.^[285] Ethylene glycol poisoning can be treated in the same way.

Warfarin

Excessive use of alcohol is also known to affect the metabolism of warfarin and can elevate the INR, and thus increase the risk of bleeding.^[286] The U.S. Food and Drug Administration (FDA) product insert on warfarin states that alcohol should be avoided.^[287] The Cleveland Clinic suggests that when taking warfarin one should not drink more than "one beer, 6 oz of wine, or one shot of alcohol per day".^[288]

Special population

Isoniazid

Levels of liver enzymes in the bloodstream should be frequently checked in daily alcohol drinkers, pregnant women, IV drug users, people over 35, and those who have chronic liver disease, severe kidney dysfunction, peripheral neuropathy, or HIV infection since they are more likely to develop hepatitis from INH.^[289][290]

Pharmacology

The pharmacology of ethanol involves both pharmacodynamics (how it affects the body) and pharmacokinetics (how the body processes it). In the body, ethanol primarily affects the central nervous system, acting as a depressant and causing sedation, relaxation, and decreased anxiety. The exact mechanism remains elusive, but ethanol has been shown to affect ligand-gated ion channels, particularly the GABA_A receptor.

After oral ingestion, ethanol is absorbed via the stomach and intestines into the bloodstream. Ethanol is highly water-soluble and diffuses passively throughout the entire body, including the brain. Soon after ingestion, it begins to be metabolized, 90% or more by the liver. One standard drink is sufficient to almost completely saturate the liver's capacity to metabolize alcohol. The main metabolite is acetaldehyde, a toxic carcinogen. Acetaldehyde is then further metabolized into ionic acetate by the enzyme aldehyde dehydrogenase (ALDH). Acetate is not carcinogenic and has low toxicity,^[291] but has been implicated in causing hangovers.^[292][293] Acetate is further broken down into carbon dioxide and water and eventually eliminated from the body through urine and breath. 5 to 10% of ethanol is excreted unchanged in the breath, urine, and sweat.

Alcohol also direct affects a number of other neurotransmitter systems including those of

Symptoms of ethanol

Ethanol is classified as a

Ethanol is also known chemically as alcohol, ethyl alcohol, or drinking alcohol. It is a simple

Homebrewing is the brewing of beer or other alcoholic beverages on a small scale for personal, non-commercial purposes. Supplies, such as kits and fermentation tanks, can be purchased locally at specialty stores or online. Beer was brewed domestically for thousands of years before its commercial production, although its legality has varied according to local regulation. Homebrewing is closely related to the hobby of home distillation, the production of alcoholic spirits for personal consumption; however home distillation is generally more tightly regulated.

Moonshine

Although methanol is not produced in toxic amounts by fermentation of sugars from grain starches,^[302] it is a major occurrence in fruit spirits.^[303] However, in modern times, reducing methanol with the absorption of a molecular sieve is a practical method for production.^[304]

Analogues

Ethanol has a variety of

The Lucas test differentiates between primary, secondary, and tertiary alcohols.

Society and culture

Usage

Consumption recommendations

The recommended maximum intake (or safe limits) of alcohol varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The World Health Organization published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health".^[13]

According to the U.S. Department of Agriculture, based on

Ethanol is typically consumed as a recreational substance by mouth in the form of alcoholic beverages such as beer, wine, and spirits. It is commonly used in social settings due to its capacity to enhance sociability.

Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. Many students attending colleges, universities, and other higher education institutions consume alcoholic beverages. However, there are often restrictions on alcohol sale and use, for instance a minimum age for drinking and laws against public drinking and drinking and driving.^[310] A 2024 meta-analysis found that alcohol consumption increased on average each year, with the most significant rise occurring between the ages of 12 and 13. Drinking peaked around 22 years old, then began to decline at 24.^[311]

Alcohol holds considerable societal and cultural significance, playing a role in social interactions across much of the world.

The relationship between religion and alcohol exhibits variations across cultures, geographical areas, and religious denominations. Some religions emphasize moderation and responsible use as a means of honoring the divine gift of life, while others impose outright bans on alcohol as a means of honoring the divine gift of life. Moreover, within the same religious tradition, there are many adherents that may interpret and practice their faith's teachings on alcohol in diverse ways. Hence, a wide range of factors, such as religious affiliation, levels of religiosity, cultural traditions, family influences, and peer networks, collectively influence the dynamics of this relationship.

The levels of alcohol use in spiritual context can be broken down into:

• Prohibition: Some religions, including Islam^[314] prohibit alcohol consumption.
• Symbolic use: In some Christian denominations, the sacramental wine is alcoholic, however, only a sip is taken, and it does not raise the blood alcohol content, and other denominations are using nonalcoholic wine. See also Libation.
• Discourage consumption: Hinduism does not have a central authority which is followed by all Hindus, though religious texts generally discourage the use or consumption of alcohol.
• Inebriating spiritual use: See the spiritual section.
• Recreational use: Recreational drug use of alcohol in moderation to celebrate joy, is allowed in some religions.

Christian views on alcohol are varied. For example, in the mid-19th century, some Protestant Christians moved from a position of allowing moderate use of alcohol (sometimes called moderationism) to either deciding that not imbibing was wisest in the present circumstances (abstentionism) or prohibiting all ordinary consumption of alcohol because it was believed to be a sin (prohibitionism).^[315]

During the Jewish holiday of Purim, Jews are obligated to drink (especially Kosher wine) until their judgmental abilities become impaired according to the Book of Esther.^{[316][317][318]} However, Purim has more of a national than a religious character.

Law

Legal status

Alcohol consumption is fully legal and available in most countries of the world.[319] Home made alcoholic beverages with low alcohol content like wine, and beer is also legal in most countries, but distilling moonshine outside of a registered distillery remains illegal in most of them.

Some majority-

In Iran, consumption of alcohol (one glass) is punished by 80 lashes, but repeated offences may lead to death penalty, although rarely exercised. In 2012, two men were sentenced to death after a third offense in Khorasan.[323]^[324]

Alcohol packaging warning messages

Alcohol packaging warning messages (alcohol warning labels, AWLs

A World Health Organization report, published in 2017, stated:^[326]

Alcohol product labelling could be considered as a component of a comprehensive public health strategy to reduce alcohol-related harm. Adding health labels to alcohol containers is an important first step in raising awareness and has a longer-term utility in helping to establish a social understanding of the harmful use of alcohol.

Criticism of the alcohol industry

A 2019 survey conducted by the American Institute for Cancer Research (AICR) showed that only 45% of Americans were aware of the associated risk of cancer due to alcohol consumption, up from 39% in 2017.^[327] The AICR believes that alcohol-related advertisements about the healthy cardiovascular benefits of modest alcohol overshadow messages about the increased cancer risks.^[327]

Drinking alcoholic beverages increase the risk for breast cancer. Several studies indicate that the use of marketing by the alcohol industry to associate their products with breast cancer awareness campaigns, known as pinkwashing, is misleading and potentially harmful.^{[328][329][330][331]}

The alcohol industries have marketed products directly to the LGBT+ community. In 2010, of the sampled parades that listed sponsors, 61% of the prides were sponsored by the alcohol industry.^[332] A study found that alcohol consumption within LGBTQ+ communities presents a challenge for health promotion efforts. The positive association with alcohol within these communities makes it harder to reduce alcohol-related health issues.^[333]

Standard drink

A standard drink is a measure of alcohol consumption representing a fixed amount of pure ethanol, used in relation to recommendations about alcohol consumption and its relative risks to health. The size of a standard drink varies from 8g to 20g across countries, but 10g alcohol (12.7 millilitres) is used in the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example,^[334] and has been adopted by more countries than any other amount.^[335]

Sober curious

Sober curious is a cultural movement and lifestyle of consuming no or limited alcohol that started in the late 2010s.^{[citation needed]} It differs from traditional abstinence in that it is not founded on asceticism, religious condemnation of alcohol or previous alcohol abuse, but motivated by a curiosity of a sober lifestyle. Markets have reacted by offering a wider selection of non-alcoholic beverages.^[336]

Sober curiosity is often defined as having the option to question or change one's drinking habits, for mental or physical health reasons.^[337] It may be practised in many ways, ranging from complete abstinence to more thought about when and how much is consumed.^[338]

Since the onset of the COVID-19 pandemic, more people in Europe have reduced their alcohol consumption.^[339]

History

The consumption of alcohol has a long human history. Beginning with the Gin Craze, excessive drinking and drunkenness developed into a major problem for public health.^[340][341] Prohibition marked a turning point, as alcohol transitioned from widely accepted to strictly controlled, recognized as a dangerous drug. After its repeal, societal views softened dramatically. Alcohol consumption became normalized, and for many years, the public remained largely unaware of the well-established dangers, including its carcinogenic and teratogenic properties. However, a recent shift has brought these risks back to light. The WHO's 2023 declaration that no amount of alcohol consumption is entirely safe served as a wake-up call.

Ancient World

Since antiquity, prior to the development of modern agents, alcohol was used as a general anaesthetic.^[342]

Beer is one of the earliest known ingredients for wound healing. A medical prescription from Mesopotamia describes a method for healing wounds:^[343][344]

Pound together fur-turpentine, pine-turpentine, tamarisk, daisy, flour of inninnu strain; mix in milk and beer in a small copper pan; spread on skin; bind on him, and he shall recover.

Late Middle Ages

Alcohol has been used as an antiseptic as early as 1363 with evidence to support its use becoming available in the late 1800s.^{[citation needed]}

Early modern period

The popular story dates the etymology of the term Dutch courage to English soldiers fighting in the Anglo-Dutch Wars^[345] (1652–1674) and perhaps as early as the Thirty Years' War (1618–1648). One version states that jenever (or Dutch gin) was used by English soldiers for its calming effects before battle, and for its purported warming properties on the body in cold weather. Another version has it that English soldiers noted the bravery-inducing effects of jenever on Dutch soldiers.^[346][347]

The

The Andrew Johnson alcoholism debate is the dispute, originally conducted among the general public, and now typically a question for historians, about whether or not Andrew Johnson, the 17th president of the United States (1865–1869), drank to excess.

The Bratt System was a system that was used in Sweden (1919–1955) and similarly in Finland (1944–1970) to control alcohol consumption, by rationing of liquor. Every citizen allowed to consume alcohol was given a booklet called a motbok (viinakortti in Finland), in which a stamp was added each time a purchase was made at Systembolaget (in Sweden) and Alko (in Finland).^[350] A similar system also existed in Estonia between July 1, 1920 to December 31, 1925.^[351] The stamps were based on the amount of alcohol bought. When a certain amount of alcohol had been bought, the owner of the booklet had to wait until next month to buy more.

The Medicinal Liquor Prescriptions Act of 1933 was a law passed by Congress in response to the abuse of medicinal liquor prescriptions during Prohibition.

The rum ration (also called the tot) was a daily amount of rum given to sailors on Royal Navy ships. It started 1866 and was abolished in 1970 after concerns that the intake of strong alcohol would lead to unsteady hands when working machinery.

Gilbert Paul Jordan (aka The Boozing Barber) was a Canadian serial killer who is believed to have committed the so-called "alcohol murders" between 1965–c. 2004 in Vancouver, British Columbia.

Alcohol as a gateway drug

Alcohol and nicotine prime the brain for a heightened response to other drugs and are, like marijuana, also typically used before a person progresses to other, more harmful substances."^[352]

A study of drug use of 14,577 U.S. 12th graders showed that alcohol consumption was associated with an increased probability of later use of tobacco, cannabis, and other illegal drugs.^[353]

This section needs expansion. You can help by adding to it. (June 2024)

See also

• Alcohol myopia
• Cannabis (drug)
• Lean (drug)
• Rum-running
• Responsible drug use
• GABAergics
• GABRD (δ subunit-containing receptors)
• Pigovian taxes
  , which are to pay for the damage to society caused by these goods.
• Speedball (drug)
• Sin taxes are used to increase the price in an effort to lower their use, or failing that, to increase and find new sources of revenue.

References