Alcohol

Alcohol (also called ethanol or ethyl alcohol) is a colorless volatile flammable liquid produced by fermentation and is the intoxicating constituent of wine, beer, liquor, and other beverages.

Fermentation is a process by which yeast is used to break down sugars (from fruits, grains, and other foods) into alcohol. Liquor is produced by the further process of distillation.

Wine comes from grapes, beer from barley, cider from apples, vodka from potatoes or other plants, whiskey from barley or rye, etc.

Alcohol Is a Drug

After tobacco, it is the most commonly used drug in the world.

Two major classes of drugs are stimulants and depressants. Alcohol is in the depressant category since it depresses the central nervous system of the user. Small doses can act as a stimulant. Larger doses cause drowsiness, intoxication, and sleep, while excessive doses can cause unconsciousness, poisoning, coma, and death.

Alcohol is in heavy use in most countries all over the world as a “social drug” to reduce anxiety or smooth human relations. Many use alcohol in moderation, but like any drug, alcohol affects different people in different ways. Its effects can range from euphoria, lowered inhibitions, slurred speech, numbness, slowed reaction time, altered perception, to severe lapses in judgment, delusion, paranoia, aggression, sexual assault, and violence.

Millions of people develop alcohol dependence (alcoholism), and the drug is responsible for a long list of medical conditions including liver disease, heart problems, and cancer. Alcoholism is connected to domestic strife child neglect, and abuse, spousal abuse, suicide, and crime. Alcohol poisoning (toxic levels of alcohol) can kill, as can mixing this substance with other drugs. Certain withdrawal symptoms after long-term abuse can also be deadly without proper medical supervision. Drinking and driving are responsible for countless deaths and sorrows globally.

Some cultures and religions swear off alcohol entirely, and due to the drug’s long history of misery and death, it is easy to understand why. Many people have an occasional drink without harmful consequence. The recovering alcoholic, however, to avoid falling back into the cycle of abuse, in most cases must maintain complete sobriety – and in a culture where alcohol is omnipresent, this can be challenging to say the least.

Statistics

Some shocking statistics about alcohol abuse in the United States:

  • A 2015 study from the University of Texas at Austin reported that advertising had increased by 400% in the 40 years between 1971 and 2011, while per capita consumption had stayed roughly the same.
  • The website statistica.com reports that for the year 2016 in the US, traditional media advertising dollars for alcohol breaks down as $1.59 billion for beer, $376M for spirits (liquor), $168M for ciders (and similar drinks), and $124M for wine – totaling over $2.25 billion.

From the National Highway Traffic Safety Administration (NHTSA):

Every day, almost 29 people in the United States die in alcohol-impaired vehicle crashes—that’s one person every 50 minutes in 2016. Drunk-driving fatalities have fallen by a third in the last three decades; however, drunk-driving crashes claim more than 10,000 lives per year. In 2010, the most recent year for which cost data is available, these deaths and damages contributed to a cost of $44B per year.”

From the National Council on Alcoholism and Drug Dependence (NCADD):

  • 88,000 deaths are annually attributed to excessive use.
  • Alcoholism is the 3rd leading lifestyle-related cause of death in the nation.
  • Excessive use is responsible for 2.5 million years of possible life lost annually, or an average of about 30 years of potential life lost for each death.
  • Up to 40% of all hospital beds in the United States (except for those being used by maternity and intensive care patients) are being used to treat health conditions that are related to consumption.

From the National Institute on Alcohol Abuse and Alcoholism (NIAAA):

  • In 2010, misuse cost the United States $249.0 billion.
  • In 2012, 3.3 million deaths, or 5.9 percent of all global deaths (7.6 percent for men and 4.0 percent for women), were attributable to consumption.
  • More than 10 percent of U.S. children live with a parent with alcohol problems, according to a 2012 study.
  • In 2015, of the 78,529 liver disease deaths among individuals ages 12 and older, 47.0 percent involved alcohol.

The History

Mankind has attempted to induce euphoric states, induce sleep, and numb pain for thousands of years, and alcohol is one of the oldest endeavors in this regard. Evidence exists of alcoholic drinks in China as early as 7000 BC. Fermented beverages were used in ancient Egypt, while in India between 3000 and 2000 BC, a drink distilled from rice, called “sura” or “surāh,” was used for intoxication and as an anesthetic. Mead or “honey wine” has been made for millennia throughout Europe, Africa, and Asia.

The Greeks recognized Dionysus, and the Romans Bacchus, the god of the grape harvest, winemaking, ritual madness, and ecstasy. Greek literature warned of the inherent problems of alcohol. The career soldiers of Sparta were warned of the dangers of excessive drinking to their war readiness. The Code of Hammurabi (Babylonian king c. 1700 BC) placed strict requirements on tavern-keepers to avoid serving alcohol to criminals.

The Babylonians, Celts, Zulu, Aztec, Sumerians, Norse, and other cultures acknowledged and worshiped gods of alcohol, deities to be respected and feared. This was not surprising, knowing that it wielded not only medicinal value but great potential for merriment and for human suffering.

How it was Created

Alcohol was created through fermentation for centuries, while the Middle Ages saw the advent of the distillation process to produce liquor. Brandy (made from fruit) and other liquors were used as medicine, but by around 1500 these were in wider circulation.

In the early 18th century, the British parliament passed legislation to encourage the distillation of grain for spirits, and by the mid-1700s in Britain, gin consumption reached 18 million gallons, and alcohol dependence (alcoholism) became a widespread problem.

The temperance movement gained ground through the 19th century, with a political foothold in the US, Russia, Norway, Iceland, Canada and elsewhere. Laws prohibiting alcohol arose in some countries. In 1920, the US passed Prohibition, banning the manufacture, sale, import, and export of alcohol. The distribution and sale of liquor were taken over by criminal gangs throughout the 1920s and early ’30s, and in 1933 Prohibition was repealed.

Today, alcohol is promoted widely through television, film, print, billboards, and on the internet – often targeted toward young people. It represents billions in sales, advertising, and taxation.

Different Types

Different types of alcoholic drinks contain different levels of alcohol content, affecting the blood alcohol content (BAC) of the consumer and rate of intoxication.

Liquor is an alcoholic drink produced by distilling the alcohol produced from fermented grain, fruit, etc. Drinks that have an alcohol content of at least 20% alcohol by volume (ABV) are called spirits.

Typical alcoholic content breaks down as follows:

  • Beer 2–6% alcohol
  • Cider 4–8% alcohol
  • Wine 8–20% alcohol
  • Tequila 40% alcohol
  • Rum 40% or more alcohol
  • Brandy 40% or more alcohol
  • Gin 40–47% alcohol
  • Whiskey 40–50% alcohol
  • Vodka 40–50% alcohol
  • Liqueur 15–60% alcohol

Fermented drinks, such as beer and wine, contain anywhere between 2% to 20% alcohol. Distilled drinks (liquor, spirits) may contain 40% to 50% or more alcohol.

The Effects

Within minutes of drinking, it travels via blood vessels to the brain, where it slows the functions of the central nervous system. The bloodstream carries the alcohol to the liver, which has the job of metabolizing, or breaking down, the alcohol so it is no longer toxic to a person’s body. The liver of an individual can process only so much at a time, while the remainder is still circulating through the body.

  • The liver can break down about one standard drink per hour.
  • A long-term, heavy user or alcoholic has put so much wear and tear on the liver that it can become damaged or diseased, called cirrhosis. About 90% of the alcohol is metabolized by the liver, with the rest going through the lungs, kidneys, and skin (sweat). Alcohol is generally out of the user’s body within about 24 hours, while organ damage and many other effects continue long after usage has ceased.

  • Continued alcohol consumption will build up tolerance where the person requires more alcohol to get the intended result.
  • Since alcohol is a depressant, it can slow down the respiratory system, and the user can overdose, similar to opioids (painkillers), resulting in unconsciousness, coma or death. This is called alcohol poisoning.

  • Combining this substance with other drugs, such as opioids or other depressants, can be fatal.
  • Drinking to “blackout” indicates a state where the person loses memory of what happened during the blackout period. During a blackout, they still walk around and converse with people. They may appear “normal” or intoxicated. But the following day they have no recollection of what they did or said during the blackout. Some heavy drinkers and alcoholics get blackout drunk on a regular, even nightly basis.

    Experiencing a hangover after drinking (particularly after heavy drinking) is extremely common. Symptoms include thirst, dizziness, shakiness, headache, nausea, vomiting, stomach pain, sweating, fatigue, exhaustion, sensitivity to light, and irritability. Typically, symptoms start within a few hours after drinking or the following morning and may continue for 24 hours.

    Causes of a Hangover

    Primary causes of a hangover are dehydration, irritation of the stomach and liver, low blood sugar, and disruption of sleep. A heavy drinker or alcoholic can get so used to hangovers that it becomes part of their life, but it can result in absences from work, lowered productivity, workplace accidents, auto accidents, and an overall depressed mental state.

    Anyone experiencing a hangover should drink a lot of water. The effects of alcohol can be tempered (to varying degrees) by drinking water and staying hydrated.

    A young person’s body does not process alcohol in the same way as an adult.  An adolescent or teenager’s brain is still developing, which continues into young adulthood. Consumption can drastically affect a youth’s judgment, memory, and motor skills, and can cause permanent damage to brain function.

    Effects On an Unborn Child

    When consumed by pregnant mothers, alcohol enters the bloodstream, passes through the placenta and enters the fetus (unborn child), potentially damaging the child at any stage of pregnancy, with the most serious risks being in the first few months (first trimester). There is an array of birth defects attributed to the mother’s alcohol use called fetal alcohol spectrum disorders (FASDs) or fetal alcohol syndrome (FAS). These include craniofacial (skull and face) abnormalities, developmental difficulties, and problems with perception and coordination.

    A woman can cause unintentional damage to her unborn child by drinking in the early stages of pregnancy when she does not know she’s pregnant. Therefore any woman who suspects she might be pregnant should stop drinking, test for pregnancy, and not resume any alcohol consumption unless she knows she is not pregnant.

    Regarding a mother’s alcohol use and breast milk, the Centers for Disease Control and Prevention (CDC) reports:

    Not drinking is the safest option for breastfeeding mothers. Generally, moderate alcohol consumption by a breastfeeding mother (up to 1 standard drink per day) is not known to be harmful to the infant, especially if the mother waits at least 2 hours after a single drink before nursing. However, exposure to alcohol above moderate levels through breast milk could be damaging to an infant’s development, growth, and sleep patterns.

    This substance can be abused in many ways, including:

    • Drinking and driving
    • Underage drinking
    • Drinking on the job or while operating heavy machinery
    • Binge drinking
    • Mixing alcohol with other drugs
    • Use by pregnant mothers
    • Dependence
    • Addiction
    • Alcoholism

    Consumption has been linked to 60 different health conditions, and for almost all of them, heavier use equates to a higher risk of damage or disease.

    In the United States, one “standard” drink contains roughly 14 grams of pure alcohol.

    A family can have a history of alcoholism. Some research points to environmental causes, behaving similarly to friends, siblings or parents. Others studies have pointed to possible genetic or hereditary traits. Regardless, simply because one’s friends, siblings or parents have abused alcohol does not automatically predispose one to do the same.

    Alcohol’s Short-Term Effects

    Alcohol’s immediate effects depend on the quantity consumed, the user’s tolerance, age, sex, weight, health, and other factors.

    The short-term effects include:

    • Slurred speech
    • Intoxication
    • Drowsiness
    • Upset stomach, vomiting, diarrhea
    • Headaches
    • Hangover
    • Low blood sugar
    • Numbness
    • Dehydration
    • Sexual problems
    • Breathing difficulties
    • Distorted perceptions (vision, hearing)
    • Impaired judgment
    • Poor coordination
    • Tunnel vision
    • Injurious or fatal auto accidents falls, burns, drowning
    • Firearm injuries or assault
    • Sexual assault, rape
    • Child neglect or abuse
    • Violence, manslaughter, homicide
    • Suicide
    • Blackout
    • Unconsciousness, coma
    • Alcohol poisoning (fatal overdose)

    Long-Term Effects

    Long-term alcohol can result in any of the above effects but in greater severity or frequency.

    It can also result in a host of mental problems, familial tumult, impaired health, and diseases, including:

    • High blood pressure
    • Stroke, other heart-related diseases
    • Liver disease (cirrhosis)
    • Nerve damage
    • Anemia (loss of red blood cells)
    • Sexual dysfunction
    • Permanent damage to the brain
    • Vitamin and mineral deficiency
    • Ulcers
    • Gastritis (inflammation of stomach walls)
    • Malnutrition
    • Cancer of the mouth or throat
    • Dementia
    • Cardiovascular problems
    • Depression
    • Anxiety
    • Dependence, alcoholism (addiction)
    • Injurious or fatal auto accidents, falls, burns, drowning
    • Firearm injuries or assault
    • Absence from work, loss of productivity
    • Broken marriages, familial strife
    • Sexual assault, rape
    • Child neglect or abuse
    • Violence
    • Suicide
    • Manslaughter
    • Homicide
    • Repeated blackout
    • Unconsciousness
    • Coma
    • Alcohol poisoning (fatal overdose)

    Mixing with Other Drugs

    According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 25% of substance-related emergency room admissions involve a combination of drugs and alcohol.

    Many drugs have warnings against consuming booze while using the drug, yet these don’t necessarily stop people from doing it. Certain drug combinations can be deadly. The “speedball” of cocaine and heroin is an example of a stimulant and a depressant. The stimulant can mask what the depressant is doing and vice versa, and the result can be a fatal heart attack.

    Combining depressants can kill someone outright by slowing or stopping the person from breathing (respiratory depression).

    Asphyxiating on one’s one vomit while unconscious and unable to wake up is another drug or alcohol-related cause of death.

    There are many unadvisable combinations of drugs and alcohol, and one should always heed the warning labels of prescription drugs while avoiding illicit use of drugs altogether.

    Certain combinations are however particularly dangerous:

    • Mixed with Benzodiazepines

    The benzodiazepine drug class includes a wide range of drugs prescribed to quell anxiety or induce sleep. All these drugs are depressants and include their own side effects, some of them quite severe. These include Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam) and many others. Using them with alcohol can be lethal due to slowing down the central nervous system, loss of coordination, overdose and death.

    • Mixed with Opiates

    Opiates (also called opioids) include heroin, morphine, and prescription painkillers like OxyContin (oxycodone) and Vicodin. Vicodin is a combination of hydrocodone and acetaminophen (Tylenol). Both alcohol and acetaminophen are known for their adverse effects on the liver. Alcohol combined with opiates can inhibit the coughing reflex, cause respiratory depression and fatal overdose.

    • Mixed with Stimulants

    Stimulants include cocaine, crystal meth (methamphetamine), Ritalin (methylphenidate), and Adderall (amphetamine and dextroamphetamine). Stimulants can mask the depressive effect of alcohol, while alcohol can dull the “edge” of stimulants, increasing the risk of overdose. Since both drugs are affecting the body in essentially opposite ways, the body’s various systems become “confused,” comparable to overloading a circuit board.  When cocaine is mixed with this substance, the liver produces a byproduct called cocaethylene, a dangerous chemical compound that increases the chances of overdose.

    • Overdose (Alcohol Poisoning)

    All psychoactive drugs are essentially poisons to the body, but alcohol can be consumed to a toxic level. It’s called acute intoxication or alcohol poisoning and is more common than you might think.

    The Centers for Disease Control and Prevention (CDC) reported in 2015:

    • An average of 6 people die of poisoning each day in the US.
    • There are 2,200 poisoning deaths in the US each year.
    • Most people who die are 35-64 years old.
    • Most people who die from alcohol abuse are men.
    • Most poisoning deaths are among non-Hispanic whites. Although a smaller share of the US population, American Indians/Alaska Natives have the most poisoning deaths per million people of any of the races.
    • Alcohol dependence (alcoholism) was identified as a factor in 30% of alcohol poisoning deaths.

    In addition to any of the effects listed above, symptoms of poisoning can include nausea, vomiting, dehydration, blackout, unconsciousness (full or partial), coma, respiratory depression, death.

    You can consult a medical professional or take a class to learn what to do in case of alcohol poisoning or overdose. If you suspect someone is experiencing poisoning, call 911 immediately.

    Alcohol and Driving

    Driving while under the influence of drugs is not only a bad idea, stupid and dangerous, it’s illegal.

    From the Insurance Information Institute (I.I.I.):

    • Based on data from the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA), there was an alcohol-impaired traffic fatality every 50 minutes in 2016.
    • Alcohol-impaired crashes are those that involve at least one driver or a motorcycle operator with a blood alcohol concentration (BAC) of 0.08 percent or above, the legal definition of impaired driving.
    • According to NHTSA, 10,497 people died in alcohol-impaired crashes in 2016, up 1.7 percent from 10,320 in 2015. In 2016 alcohol-impaired crash fatalities accounted for 28 percent of all crash fatalities.
    • The Federal Bureau of Investigation estimates 1,017,808 drivers were arrested for driving under the influence of alcohol or narcotics in 2016. The arrest rate works out to one arrest for about every 215 licensed drivers in the United States.
    • Campaigns against alcohol-impaired driving especially target drivers under the age of 21, repeat offenders and 21-to 34-year-olds, the age group that is responsible for more alcohol-related fatal crashes than any other.
    • To make sellers and servers of liquor more careful about to whom and how they serve drinks, 42 states and the District of Columbia have enacted laws or have case law holding commercial liquor servers legally liable for the damage, injuries, and deaths an alcohol-impaired driver causes.

    Underage Drinking

    When teens drink, it is usually binge drinking where their intent is to get drunk, consuming four or five or more drinks in a short period of time. In fact, binge drinking represents about 90% of the alcohol consumed by those under age 21 in the United States. This is commonly where incidents of sexual assault and rape occur. When teens drink and drive, it is not uncommon for the results to be accidents, injury or death.

    Research has determined that young people who begin drinking before age 15 are four times more likely to develop alcohol dependence than those who start drinking at the legal age of 21.

    From the Centers for Disease Control and Prevention (CDC):

    • Excessive drinking is responsible for more than 4,300 deaths among underage youth each year, and cost the U.S. $24 billion in economic costs in 2010.
    • Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States. More than 90% of this is consumed in the form of binge drinks.
    • In 2010, there were approximately 189,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.

    Youth who drink are more likely to experience:

    • School problems, such as higher absence and poor or failing grades.
    • Social problems, such as fighting and lack of participation in youth activities.
    • Legal problems, such as arrest for driving or physically hurting someone while drunk.
    • Physical problems, such as hangovers or illnesses.
    • Unwanted, unplanned, and unprotected sexual activity.
    • Disruption of normal growth and sexual development.
    • Physical and sexual assault.
    • Higher risk for suicide and homicide.
    • Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
    • Memory problems.
    • Abuse of other drugs.
    • Changes in brain development that may have life-long effects.
    • Death from poisoning.

    Dependence and Addiction (Alcoholism)

    Alcoholism goes by many names: dependence, addiction, alcoholism, or alcohol use disorder (AUD).

    Dependence and addiction can be the same thing but are often separated where dependence can be psychological and/or physical, while addiction is a later stage where a person’s lifestyle and interpersonal relations are severely affected by their habit. Alcoholism is a common word that refers to alcohol dependence and addiction.

    The cycle of alcoholism can take years, and usually goes something like this: 1) Increased use. 2) Increased tolerance. 3) Increased dependence. 4) Addiction or alcoholism.

    Tolerance is a big part of the winding road to alcoholism. The user requires more and more of the drug to obtain the desired result. It is not uncommon for a long-term alcoholic to consume a quart of vodka per day, plus several beers, and get blackout drunk nightly. The amount of booze “necessary” to sustain a heavy drinking problem is not always comprehensible to those unfamiliar with the subject.

    Duff McKagan, bassist for Guns N’ Roses and Velvet Revolver, wrote of his descent into alcoholism:

    Every day I made sure I had a vodka bottle next to my bed when I woke up. I tried to quit drinking in 1992, but started again with a vengeance after only a few weeks. I just could not stop. I was too far gone. My hair began falling out in clumps, and my kidneys ached when I pissed. The skin on my hands and feet cracked, and I had boils on my face and neck. I had to wear bandages under my gloves to be able to play my bass.

    There are many different ways to come out of a funk like that. Some people go straight to rehab, some go to church. Others go to AA, and many more end up in a pine box, which is where I felt headed.

    And for the most part I did stay off the coke, though it was by no means a clean break. There were slipups. I also switched from vodka to wine.

    Downshifting to wine was all well and good, but the volume of wine quickly sky-rocketed till I was drinking 10 bottles a day. I was getting bad heartburn from the wine, taking Tums all the time. I wasn’t eating, but I was badly bloated; my body felt awful.”

    McKagan eventually wound up in a Seattle hospital with an exploded pancreas. He miraculously recovered, quit for good, and wrote about his decent and recovery in his book “It’s So Easy: And Other Lies.”

    Research indicates that less than 10% of those suffering from alcoholism receive the help they need.

    Withdrawal Symptoms

    Withdrawal from alcohol for a long-term heavy user can be traumatic if not medically supervised. In fact, it comes as a surprise to some that it can even be deadly. This is due to delirium tremens, or DTs. Delirium tremens, in Latin, means “trembling delirium” and is defined as “a psychotic condition typical of withdrawal in chronic alcoholics, involving tremors, hallucinations, anxiety, and disorientation.”

    The National Library of Medicine (NLM) of the National Institutes of Health (NIH) details delirium tremens as follows:

    • Delirium tremens is a severe form of withdrawal. It involves sudden and severe mental or nervous system changes.
    • The DTs can occur when you stop drinking after a period of heavy drinking, especially if you do not eat enough food.
    • Delirium tremens may also be caused by head injury, infection, or illness in people with a history of heavy alcohol use.
    • It occurs most often in people who have a history of alcohol withdrawal.
    • It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of “hard” alcohol every day for several months.
    • Delirium tremens also commonly affects people who have used for more than 10 years.
    • Symptoms most often occur within 48 to 96 hours after the last drink. But, they can occur 7 to 10 days after the last drink.

    Symptoms may get worse quickly, and can include:

    • Delirium, which is sudden severe confusion
    • Body tremors
    • Changes in mental function
    • Agitation, irritability
    • Deep sleep that lasts for a day or longer
    • Excitement or fear
    • Hallucinations (seeing or feeling things that are not really there)
    • Bursts of energy
    • Quick mood changes
    • Restlessness, excitement
    • Sensitivity to light, sound, touch
    • Stupor, sleepiness, fatigue

    Seizures (may occur without other symptoms of DTs):

    • Most common in the first 12 to 48 hours after the last drink
    • Most common in people with past complications from alcohol withdrawal
    • Usually generalized tonic-clonic seizures [In the tonic phase the body becomes rigid, and in the clonic phase there is uncontrolled jerking.]

    The goals of treatment are to:

    • Save the person’s life
    • Relieve symptoms
    • Prevent complications

    Withdrawal and its possible complications should be treated with professionally supervised medical detoxification procedures. Alcohol withdrawal and detox can be done safely and with minimal discomfort for the person.

    Treatment for Alcoholism

    Once an alcoholic has safely detoxed from alcohol, the next steps are rehabilitation. This road can be long and is best done in a residential setting with help from professionals and support from friends and family.

    Some rehab systems prescribe the recovering alcoholic other drugs such as benzodiazepines or antidepressants. These drugs have long lists of side effects and can be highly addictive themselves. While some medication may be needed in the detox process, the ideal state for a recovering addict or alcoholic is to be FREE from the burden of ALL drugs.

    Facilities which offer a combination of evidence-based and comprehensive treatment options can in many cases provide exactly what a recovering alcoholic needs. A thorough aftercare program is also vital for continued sobriety.

    Through effective detoxification and rehabilitation, combined with perseverance, a person can be freed from the shackles of abuse and live a healthy, happy and productive life.  It is a cultural and individual problem that continues to cause devastation in people’s lives in many ways.

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