The most significant of the possible long-term effects of ethanol Results of a 2010 study ranking the levels of damage caused by drugs, in the opinion of drug-harm experts. When harm to self and others is summed, alcohol was the most harmful of all drugs considered (scoring 72%). Radar plot showing relative physical harm, social harm, and dependence of alcohol
The sensible use of alcohol in the short term is extremely unlikely to have any positive or detrimental effects on one's physical health. However, despite the widespread use and alcohol's legality in most countries, many medical sources tend to describe any level of alcohol intoxication as a form of poisoning due to ethanol's damaging effects on the body in large doses.
The long-term effects of alcohol consumption range from cardioprotective health benefits for low to moderate alcohol consumption in industrialized societies with higher rates of cardiovascular disease to severe detrimental effects in cases of chronic alcohol abuse.
High levels of alcohol consumption are associated with an increased risk of alcoholism, malnutrition, chronic pancreatitis, alcoholic liver disease, and cancer. In addition, damage to the central nervous system and peripheral nervous system can occur from chronic alcohol abuse. The long-term use of alcohol is capable of damaging nearly every organ and system in the body. The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol. In addition, the developing fetal brain is also vulnerable, and fetal alcohol syndrome (FAS) may result if pregnant mothers consume alcohol.
Alcoholic drinks are classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen (carcinogenic to humans). IARC classifies alcoholic drink consumption as a cause of cancer for female breast, colorectum, larynx, liver, esophagus, oral cavity, and pharynx; and as a probable cause of pancreatic cancer. Alcohol in soft drinks is absorbed faster than alcohol in non-carbonated drinks.
Recommended maximum intake of alcoholic beverages
According to The World Health Organization, The World Heart Federation and Nordic Nutrition there is no safe amount that does not affect health.
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".
Short-term effects
Wine, beer, distilled spirits, and other alcoholic drinks contain ethyl alcohol and alcohol consumption has short-term psychological and physiological effects on the user. Different concentrations of alcohol in the human body have different effects on a person. The effects of alcohol depend on the amount an individual has drunk, the percentage of alcohol in the wine, beer or spirits and the timespan that the consumption took place, the amount of food eaten and whether an individual has taken other prescription, over-the-counter or street drugs, among other factors.
Drinking enough to cause a blood alcohol concentration (BAC) of 0.03%-0.12% typically causes an overall improvement in mood and possible euphoria, increased self-confidence and sociability, decreased anxiety, an alcohol flush reaction (red appearance in the face) and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC from 0.18% to 0.30% causes profound confusion, impaired speech (e.g., slurred speech), staggering, dizziness and vomiting. A BAC from 0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia, vomiting (death may occur due to inhalation of vomit (pulmonary aspiration) while unconscious) and respiratory depression (potentially life-threatening). A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning. As with all alcoholic drinks, drinking while driving, operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties against drunk driving.
Ethanol is often used to facilitate sexual assault or rape. It is the most commonly used date rape drug.
Rehydration therapy before going to bed or during hangover may relieve dehydration-associated symptoms such as thirst, dizziness, dry mouth, and headache.
Alcohol intoxication****Lethal dosage
Death from ethanol consumption is possible when blood alcohol levels reach 0.4%. A blood level of 0.5% or more is commonly fatal. Levels of even less than 0.1% can cause intoxication with unconsciousness often occurring at 0.3–0.4%.
It is strongly recommended that one use harm reduction practices when using this substance.
Long-term effects
Both alcoholic and non-alcoholic red wine may boost heart health.
The main active ingredient of wine, beer and distilled spirits is alcohol. Drinking small quantities of alcohol (less than one drink in women and two in men per day) is debated to decreased the risk of heart disease, stroke, diabetes mellitus, and early death. Drinking more than this amount, however, increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke. The risk is greater in younger people due to binge drinking which may result in violence or accidents. About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year. Alcoholism reduces a person's life expectancy by around ten years and alcohol use is the third leading cause of early death in the United States. No professional medical association recommends that people who are nondrinkers should start drinking wine.
Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide, with alcoholism present in between 15% and 61% of cases. Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide. About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide. Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past. In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.
Another long-term effect of alcohol usage, when also used with tobacco products, is alcohol acting as a solvent, which allows harmful chemicals in tobacco to get inside the cells that line the digestive tract. Alcohol slows these cells' healing ability to repair the damage to their DNA caused by the harmful chemicals in tobacco. Alcohol contributes to cancer through this process.
While lower quality evidence suggests a cardioprotective effect, no controlled studies have been completed on the effect of alcohol on the risk of developing heart disease or stroke. Excessive consumption of alcohol can cause liver cirrhosis and alcoholism. The American Heart Association "cautions people NOT to start drinking ... if they do not already drink alcohol. Consult your doctor on the benefits and risks of consuming alcohol in moderation."
Tolerance and addiction potential
The chronic use of this compound can be considered extremely addictive with a high potential for abuse and is capable of causing psychological dependence among certain users. When addiction has developed, cravings and withdrawal effects may occur if a person suddenly stops their usage.
Alcohol tolerance
Tolerance to many of the effects of alcohol develops with prolonged and repeated use. This results in users having to administer increasingly large doses to achieve the same effects. After that, it takes about 3 - 7 days for the tolerance to be reduced to half and 1 - 2 weeks to be back at baseline (in the absence of further consumption). Alcohol presents cross-tolerance with all GABAgenic depressants, meaning that after the consumption of alcohol all depressants will have a reduced effect.
Alcoholism
Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in mental or physical health problems. It was previously divided into two types: alcohol abuse and alcohol dependence. In a medical context, alcoholism is said to exist when two or more of the following conditions is present: a person drinks large amounts over a long time period, has difficulty cutting down, acquiring and drinking alcohol takes up a great deal of time, alcohol is strongly desired, usage results in not fulfilling responsibilities, usage results in social problems, usage results in health problems, usage results in risky situations, Alcohol withdrawal syndrome|withdrawal occurs when stopping, and alcohol tolerance has occurred with use. Risky situations include driving under the influence|drinking and driving or having unsafe sex among others. Alcohol use can affect all parts of the body but particularly affects the brain, heart, liver, pancreas, and immune system. This can result in mental illness, Wernicke–Korsakoff syndrome, an arrhythmia|irregular heart beat, cirrhosis|liver failure, and an increase in the risk of cancer, among other diseases. Drinking during pregnancy can cause damage to the baby resulting in fetal alcohol spectrum disorders. Generally women are more sensitive to alcohol's harmful physical and mental effects than men.
Heavy alcohol use is defined differently by various health organizations. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides gender-specific guidelines for heavy drinking. According to NIAAA, men who consume five or more US standard drinks in a single day or 15 or more drinks within a week are considered heavy drinkers. For women, the threshold is lower, with four or more drinks in a day or eight or more drinks per week classified as heavy drinking. In contrast, the Substance Abuse and Mental Health Services Administration (SAMHSA) takes a different approach to defining heavy alcohol use. SAMHSA considers heavy alcohol use to be engaging in binge drinking behaviors on five or more days within a month. This definition focuses more on the frequency of excessive drinking episodes rather than specific drink counts.
Chronic excess alcohol intake can lead to a wide range of neuropsychiatric or neurological impairment, cardiovascular disease, liver disease, and malignant neoplasms. The psychiatric disorders which are associated with alcoholism include major depression, dysthymia, mania, hypomania, panic disorder, phobias, generalized anxiety disorder, personality disorders, schizophrenia, suicide, neurologic deficits (e.g., impairments of working memory, emotions, executive functions, visuospatial abilities, gait, and balance) and brain damage. Alcohol dependence is associated with hypertension, coronary heart disease, ischemic stroke, and also cancers of the respiratory system, the digestive system, liver, breast, and ovaries. Heavy drinking is associated with liver disease, such as cirrhosis.
Withdrawals
When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage. The severity of withdrawal can vary from mild symptoms such as sleep disturbances and anxiety to severe and life-threatening symptoms such as delirium, hallucinations, and autonomic instability.
Withdrawal usually begins 6 to 24 hours after the last drink. To be classified as alcohol withdrawal syndrome, patients must exhibit at least two of the following symptoms: increased hand tremors, insomnia, nausea or vomiting, transient hallucinations (auditory, visual or tactile), psychomotor agitation, anxiety, tonic-clonic seizures, and autonomic instability.
The severity of symptoms is dictated by a number of factors, the most important of which is a degree of alcohol intake, length of time the individual has been using alcohol, and previous history of alcohol withdrawal. Symptoms are also grouped together and classified:
Alcohol hallucinosis: Patients have transient visual, auditory, or tactile hallucinations but are otherwise clear.
Withdrawal seizures: Seizures occur within 48 hours of alcohol cessation and occur either as a single generalized tonic-clonic seizure or as a brief episode of multiple seizures.
Delirium tremens: Hyperadrenergic state, disorientation, tremors, diaphoresis, impaired attention/consciousness, and visual and auditory hallucinations usually occur 24 to 72 hours after alcohol cessation. Delirium tremens is the most severe form of withdrawal and occurs in 5 to 20% of patients experiencing detoxification and 1/3 of patients experiencing withdrawal seizures.
Withdrawal symptoms and management
Signs and symptoms of alcohol withdrawal occur primarily in the central nervous system. The severity of withdrawal can vary from mild symptoms such as sleep disturbances and anxiety to severe and life-threatening symptoms such as delirium, hallucinations, and autonomic instability.
Withdrawal usually begins 6 to 24 hours after the last drink. It can last for up to one week. To be classified as alcohol withdrawal syndrome, patients must exhibit at least two of the following symptoms: increased hand tremor, insomnia, nausea or vomiting, transient hallucinations (auditory, visual or tactile), psychomotor agitation, anxiety, tonic-clonic seizures, and autonomic instability.
The severity of symptoms is dictated by a number of factors, the most important of which is degree of alcohol intake, length of time the individual has been using alcohol, and the previous history of alcohol withdrawal. Symptoms are also grouped together and classified:
Alcohol hallucinosis: patients have transient visual, auditory, or tactile hallucinations, but are otherwise clear.
Withdrawal seizures: seizures occur within 48 hours of alcohol cessations and occur either as a single generalized tonic-clonic seizure or as a brief episode of multiple seizures.
Delirium tremens: hyperadrenergic state, disorientation, tremors, diaphoresis, impaired attention/consciousness, and visual and auditory hallucinations. This usually occurs 24 to 72 hours after alcohol cessation. Delirium tremens is the most severe form of withdrawal and occurs in 5 to 20% of patients experiencing detoxification and 1/3 of patients experiencing withdrawal seizures.
Benzodiazepines are effective for the management of symptoms as well as the prevention of seizures. In those with severe symptoms inpatient care is often required. In those with lesser symptoms treatment at home may be possible with daily visits with a health care provider.
Patients in alcohol withdrawal are typically also given thiamine and folic acid. These vitamins are not treatments for withdrawal per se. Instead, long-term consumption of alcohol tends to deplete these nutrients and lead to additional neurological issues such as Wernicke encephalopathy.
Anti-addictive drugs
Disulfiram-like drugs: disulfiram, calcium carbimide, cyanamide; see Wikipedia page for a somewhat complete list. This class of drugs enhance subjective unpleasantness of alcohol by inhibiting ALDH2, causing accumulation of acetaldehyde. This same mechanism also enhances the physical harm of alcohol.
Ibogaine - Rezvani reported reduced alcohol dependence in three strains of "alcohol preferring" rats in 1995.
Naltrexone - Naltrexone has been best studied as a treatment for alcoholism. Naltrexone has been shown to decrease the amount and frequency of drinking. It does not appear to change the percentage of people drinking. Its overall benefit has been described as "modest".The Sinclair method is a method of using opiate antagonists such as naltrexone to treat alcoholism. The person takes the medication about an hour (and only then) before drinking to avoid side effects that arise from chronic use. The opioid antagonist blocks the positive-reinforcement effects of alcohol and allows the person to stop or reduce drinking.
Interactions****Dangerous interactions
Ethanol can intensify the sedation caused by other central nervous system depressant drugs such as barbiturates, benzodiazepines, opioids, nonbenzodiazepines/Z-drugs (such as zolpidem and zopiclone), antipsychotics, sedative antihistamines, and certain antidepressants. It interacts with cocaine in vivo to produce cocaethylene, another psychoactive substance. Ethanol enhances the bioavailability of methylphenidate (elevated plasma dexmethylphenidate).
Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).
Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.
Depressants (1,4-Butanediol, 2M2B, alcohol, benzodiazepines, barbiturates, GHB/GBL, methaqualone, opioids) - This combination potentiates the muscle relaxation, amnesia, sedation, and respiratory depression caused by one another. At higher doses, it can lead to a sudden, unexpected loss of consciousness along with a dangerous amount of depressed respiration. There is also an increased risk of suffocating on one's vomit while unconscious. If nausea or vomiting occurs before a loss of consciousness, users should attempt to fall asleep in the recovery position or have a friend move them into it.
Dissociatives - This combination can unpredictably potentiate the amnesia, sedation, motor control loss and delusions that can be caused by each other. It may also result in a sudden loss of consciousness accompanied by a dangerous degree of respiratory depression. If nausea or vomiting occurs before consciousness is lost, users should attempt to fall asleep in the recovery position or have a friend move them into it.
Stimulants - Stimulants mask the sedative effect of depressants, which is the main factor most people use to gauge their level of intoxication. Once the stimulant effects wear off, the effects of the depressant will significantly increase, leading to intensified disinhibition, motor control loss, and dangerous black-out states. This combination can also potentially result in severe dehydration if one's fluid intake is not closely monitored. If choosing to combine these substances, one should strictly limit themselves to a pre-set schedule of dosing only a certain amount per hour until a maximum threshold has been reached.
Cannabis - In combination with cannabis, ethanol increases plasma tetrahydrocannabinol levels, which suggests that ethanol may increase the absorption of tetrahydrocannabinol. It is recommended that users who wish to combine these two substances start by consuming cannabis first as this reduces the chances of experiencing nausea, dizziness and double vision.
Amphetamines - Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.
AMT - aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable
MDMA - Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA
Nitrous - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.
SSRIs - Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills."]
Cocaine - Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.
MAOIs - Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.
PCP - Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.
Benzodiazepines - Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.
DXM - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally, CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.
GHB/GBL - Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.
Ketamine - Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.
MXE - There is a high risk of memory loss, vomiting and severe ataxia from this combination.
Opioids - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely
Tramadol - Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.
Non-psychoactive medicine interactions:
ALDH2 inhibitors - A number of drugs are "disulfiram-like": they inhibit ALDH2, which breaks down the acetaldehyde, a toxic intermediate in the breakdown of alcohol. The result is a highly unpleasant and physically dangerous reaction on the consumption of alcohol, with symptoms such as vomiting, nausea, and shortness of breath. Disulfiram, a drug of this class, has intentionally been used as an aversive aid for discontinuing alcohol. Other drugs with a similar activity are:
Disulfiram-like antibiotics: The list of antibiotics with a disulfiram-like action has been historically overinflated. Antibiotics with evidence of having this activity include cefamandole, cefmetazole, cefoperazone, cefotetan, and ceftriaxone. The unifying property is the inclusion of either a MTT or MTDT sidechain. Latamoxef (moxalactam) has the same sidechain and should also be avoided. This side chain may also inhibit the body's vitamin K system independently of alcohol.
Acetaldehyde is not only acutely toxic, but also carcinogenic in humans. Alcoholics with a genetic ALDH2 deficiency have higher chances of upper digestive tract cancer.
Hepatotoxic drugs - Some hepatotoxic drugs, specifically ketoconazole, griseofulvin, isoniazid, and pyrazinamide, cause additive hepatotoxicity when consumed with alcohol. Avoid this combination to reduce liver damage.
Alcohol reduces the efficacy of some antibiotics. Chronic alcoholics break down doxycycline much faster, requiring increased dosing frequency. Alcohol delays the absorption of erythromycin, reducing its AUC. Avoid taking alcohol with these drugs to maintain their efficacy.
Alcohol induced dose dumping (AIDD)
Alcohol may be dangerous to combine with modified-release dosage medications.
This dose dumping effect is an unintended rapid release of large amounts of a given drug, when administered through a modified-release dosage while co-ingesting ethanol. This is considered a pharmaceutical disadvantage due to the high risk of causing drug-induced toxicity by increasing the absorption and serum concentration above the 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.
Disease interactions
Alcohol is contraindicated in people with hepatic disease, gastrointestinal ulcer, cardiac or skeletal myopathy, pregnancy, and individuals previously addicted to ethanol.
Gastrointestinal diseases
Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption will stimulate acidic secretions normally intended to digest protein molecules. Consequently, excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer which prevents the stomach from essentially digesting itself. However, in patients who have peptic ulcer disease (PUD), this mucosal layer is broken down. PUD is commonly associated with the bacteria H. pylori. H. pylori secrete a toxin that weakens the mucosal wall, which as a result leads to acid and protein enzymes penetrating 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 would cause more acid release which would further damage the already-weakened stomach wall. Complications of this disease could include burning pain in the abdomen, bloating and in severe cases, the presence of dark black stools indicate internal bleeding. A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.
Allergic-like reactions
Ethanol-containing beverages can cause skin problems and bronchoconstriction in patients with a history of asthma. These reactions occur within 1–60 minutes of ethanol ingestion. A deficiency of ALDH2 increase the likelihood of such events.
ALDH2 deficiency
About 50% of East Asians have a genetic deficiency of the ALDH2 enzyme, causing the accumulation of toxic acetaldehyde even without the ingestion of disulfiram-like drugs. The symptoms are similar: vomiting, nausea, and shortness of breath. There's also increased flushing, the so-called "Asian flush".
