This article is about ethanol as a recreational or psychoactive substance. For the chemical class, seeAlcohol (chemistry). For types and characteristics of alcoholic beverages, seeAlcoholic beverage. For medical uses of alcohols, seeAlcohols (medicine). For the substance in general, seeEthanol.
Constant-rate elimination at typical concentrations:[7][8][6] • Range: 10–34 mg/dL/hour • Mean (men): 15 mg/dL/hour • Mean (women): 18 mg/dL/hr At very high concentrations (t1/2): 4.0–4.5 hours[5][4]
Alcohol has been produced and consumed by humans for its psychoactive effects since at least 13,000 years ago, when the earliest known beer was brewed by theNatufian culture in theMiddle East.[20][21][22] Alcohol is the second most consumedpsychoactive drug globally, behindcaffeine.[23][24] Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. However, there are often restrictions on alcohol sale and use, for instance aminimum age for drinking and laws against public drinking and drinking and driving.[25] Alcohol has considerable societal and cultural significance and has important social roles in much of the world.Drinking establishments, such as bars andnightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Alcohol is related to varioussocietal problems, includingdrunk driving, accidentalinjuries,sexual assaults,domestic abuse, andviolent crime.[26] Alcohol remains illegal for sale and consumption ina number of countries, mainly in theMiddle East. While some religions, includingIslam,prohibit alcohol consumption, other religions, such asChristianity andShinto, utilize alcohol insacrament andlibation.[27][28][29]
Ethanol is commonly consumed as a recreational substance by mouth in the form ofalcoholic beverages such asbeer,wine, andspirits. It is commonly used in social settings due to its capacity to enhance sociability. Alcohol consumption while socializing increases occurrences ofDuchenne smiling, talking, and social bonding, even when participants are unaware of their alcohol consumption or lack thereof.[30] In a study of the UK, regular drinking was correlated with happiness, feeling that life was worthwhile, and satisfaction with life. According to a causal path analysis, alcohol consumption was not the cause, but rather satisfaction with life resulted in greater happiness and an inclination to visit pubs and develop a regular drinking venue. City centre bars were distinguished by their focus on maximizing alcohol sales. Community pubs had less variation in visible group sizes and longer, more focused conversations than those in city centre bars. Drinking regularly at a community pub led to higher trust in others and better networking with the local community, compared to non-drinkers and city centre bar drinkers.[31] Research on the societal benefits of alcohol is rare.[31]
TheUS Department of Agriculture (USDA) uses a figure of 6.93kilocalories (29.0 kJ) per gram of alcohol (5.47 kcal or 22.9 kJ per mL) for calculatingfood energy.[32] Fordistilled spirits, a standard serving in the United States is 44 mL (1.5 US fl oz), which at 40% ethanol (80proof), would be 14 grams and 98 calories. Alcoholic drinks are consideredempty calorie foods because other than food energy they contribute noessential nutrients. However, alcohol is a significant source offood energy for individuals with alcoholism and those who engage in binge drinking. For example, individuals withdrunkorexia engage in the combination of self-imposed malnutrition and binge drinking.[33][34] Inalcoholics who get most of their daily calories from alcohol, a deficiency ofthiamine (vitamin B1) can produceKorsakoff syndrome, which is associated with serious brain damage.[35]
Whenfomepizole is not available, ethanol can be used to treat or preventmethanol orethylene glycol poisoning.[36][37] The rate-limiting steps for the elimination of ethanol are in common with these substances, so itcompetes with other alcohols for thealcohol dehydrogenase enzyme. Methanol itself is not highly toxic, but its metabolitesformaldehyde andformic acid are; therefore, to reduce the rate of production and concentration of these harmful metabolites, ethanol can be ingested or injected.[38] This avoid toxicaldehyde andcarboxylic acid derivatives, and reduces the more serious toxic effects of the glycols whencrystallized in thekidneys.[39] Ethylene glycol poisoning can be treated in the same way.
Alcohol has a long association of military use, and has been called "liquid courage" for its role in preparing troops for battle,anesthetize injured soldiers, and celebrate militaryvictories. It has also served as a coping mechanism forcombat stress reactions and a means of decompression from combat to everyday life.[40]
A group of merry, dancing invalids discarding their medicines in favour of alcohol as a cure. Coloured aquatint by G. Hunt, 1827, after T. Lane.
Alcohol can haveanalgesic (pain-relieving) effects, which is why some people withchronic pain turn to alcohol toself-medicate and try to alleviate their physical discomfort.[41]
People withsocial anxiety disorder commonly self-medicate with alcohol to overcome their highly set inhibitions.[42] However, self-medicating excessively for prolonged periods of time with alcohol often makes the symptoms of anxiety or depression worse. This is believed to occur as a result of the changes inbrain chemistry from long-term use.[43][44][45] A 2023systematic review highlights the non-addictive use of alcohol for managingdevelopmental issues, personality traits, andpsychiatric symptoms, emphasizing the need for informed, harm-controlled approaches to alcohol consumption within a personalized health policy framework.[46]
Baby with fetal alcohol syndrome, showing some of the characteristic facial features.
Ethanol is classified as ateratogen[47][48][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 offetal 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.[49] 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.[50]
In patients who have apeptic ulcer disease (PUD), the mucosal layer is broken down by ethanol. PUD is commonly associated with the bacteriaHelicobacter 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.[51] 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.[52] A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.[52]
Ethanol-containing beverages can cause alcohol flush reactions, exacerbations ofrhinitis and, more seriously and commonly,bronchoconstriction in patients with a history ofasthma, and in some cases,urticarial skin eruptions, and systemicdermatitis. Such reactions can occur within 1–60 minutes of ethanol ingestion, and may be caused by:[55]
genetic abnormalities in the metabolism of ethanol, which can cause the ethanol metabolite,acetaldehyde, to accumulate in tissues and trigger the release ofhistamine, or
trueallergy reactions toallergens occurring naturally in, or contaminating, alcoholic beverages (particularly wine and beer), and
Symptoms of varying BAC levels. Additional symptoms may occur.
The amount of ethanol in the body is typically quantified byblood alcohol content (BAC); weight of ethanol per unit volume of blood. Small doses of ethanol, in general, arestimulant-like[62] 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 acentral nervous system (CNS)depressant,[62] producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death.
Thelong-term effects of alcohol have been extensively researched. The health effects of long-term alcohol consumption vary depending on the amount consumed. Even light drinking poses health risks,[18] but atypically small amounts of alcohol may have health benefits.[65]Alcoholism causes severe health consequences which outweigh any potential benefits.[66]
Conversely, light intake of alcohol may have some beneficial effects. The association of alcohol intake with reduced cardiovascular risk has been noted since 1904[73] and remains even after adjusting for knownconfounders. Light alcohol intake is also associated with reduced risk oftype 2 diabetes,[74]gastritis, andcholelithiasis.[75] However, these are only observational studies and high-quality evidence for the beneficial effects of alcohol is nonexistent.[76]
The 2010DrugScience study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was rated to be the 4th most harmful drug to users, the drug most harmful to others, and the most harmful drug overall.[77]
Alcohol causes a plethora of detrimental effects in society.[26] Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged indelphic analysis regarding 20 popular recreational substances. Alcohol was ranked 6th in dependence, 11th in physical harm, and 2nd in social harm.[78] Alcohol use is stereotypically associated with crime,[79] more so than other drugs likemarijuana.[26] Manyemergency room visits involve alcohol use.[26] 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.[26]Drunk dialing refers to an intoxicated person making phone calls that they would not likely make if sober. Alcohol availability and consumption rates and alcohol rates are positively associated with nuisance, loitering,panhandling, and disorderly conduct in open spaces.[79]
Binge drinking, or heavy episodic drinking, is drinkingalcoholic beverages with an intention of becomingintoxicated by heavy consumption of alcohol over a short period of time. Specific definitions vary considerably.[80] Binge drinking is associated with risks such as suicide, sexual assault, cardiovascular issues, and brain damage, more acutely than alcohol use in general.
Alcoholism or its medical diagnosisalcohol 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.[26][60] Alcohol dependence is linked to alifespan that is reduced by about 12 years relative to the average person.[26] In 2004, it was estimated that 4% of deaths worldwide were attributable to alcohol use.[60] Deaths from alcohol are split about evenly between acute causes (e.g., overdose, accidents) and chronic conditions.[60] The leading chronic alcohol-related condition associated with death isalcoholic liver disease.[60] Alcohol dependence is also associated withcognitive impairment andorganic brain damage.[26] Some researchers have found that even one alcoholic drink a day increases an individual's risk of health problems by 0.4%.[81]
Two or more consecutive alcohol-free days a week have been recommended to improve health and break dependence.[82][83]
Symptoms of ethanoloverdose may include nausea, vomiting, CNS depression, coma,acute respiratory failure, or death. Levels of even less than 0.1% can cause intoxication, with unconsciousness often occurring at 0.3–0.4%.[86] Death from ethanol consumption is possible when blood alcohol levels reach 0.4%. A blood level of 0.5% or more is commonly fatal. The oralmedian lethal dose (LD50) of ethanol in rats is 5,628 mg/kg. Directly translated to human beings, this would mean that if a person who weighs 70 kg (150 lb) drank a 500 mL (17 US fl oz) glass of pure ethanol, they would theoretically have a 50% risk of dying. The highest blood alcohol level ever recorded, in which the subject survived, is 1.41%.[87]
Alcohol-induceddose dumping (AIDD) is an unintended rapid release of large amounts of a given drug, when administered through amodified-release dosage while co-ingesting ethanol.[88] This is considered a pharmaceutical disadvantage due to the high risk of causing drug-induced toxicity by increasing the absorption and serum concentration above thetherapeutic 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. Particular drugs of concern areantipsychotics and certainantidepressants.[86]
Disulfiram inhibits the enzymeacetaldehyde dehydrogenase, which in turn results in buildup of acetaldehyde, a toxic metabolite of ethanol with unpleasant effects. The medication or drug is commonly used to treat alcohol use disorder, and results in immediate hangover-like symptoms upon consumption of alcohol, this effect is widely known asdisulfiram effect.
Metronidazole is an antibacterial agent that kills bacteria by damaging cellular DNA and hence cellular function.[89] Metronidazole is usually given to people who have diarrhea caused byClostridioides difficile bacteria. Patients who are taking metronidazole are sometimes advised to avoid alcohol, even after 1 hour following the last dose. Although older data suggested a possible disulfiram-like effect of metronidazole, newer data has challenged this and suggests it does not actually have this effect.
The concomitant use ofNSAIDs with alcohol and/or tobacco products significantly increases the already elevated risk ofpeptic ulcers during NSAID therapy.[90][better source needed]
Ethanol enhances thebioavailability ofmethylphenidate (elevated plasmadexmethylphenidate).[93]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.[94] However, only a small percent of the consumed methylphenidate is converted to ethylphenidate.[95]
Whilenicotinis 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.[96]
Controlled animal and human studies showed thatcaffeine (energy drinks) in combination with alcohol increased the craving for more alcohol more strongly than alcohol alone.[97] These findings correspond to epidemiological data that people who consumeenergy drinks generally showed an increased tendency to take alcohol and other substances.[98][99]
Ethanol interacts withcocainein vivo to producecocaethylene, another psychoactive substance which may be substantially morecardiotoxic than either cocaine or alcohol by themselves.[100][101]
In combination withcannabis, ethanol increases plasmatetrahydrocannabinol levels, which suggests that ethanol may increase the absorption of tetrahydrocannabinol.[102]
Excessive use of alcohol is known to affect the metabolism of warfarin and can elevate the INR, and thus increase the risk of bleeding.[103] The U.S.Food and Drug Administration (FDA) product insert on warfarin states that alcohol should be avoided.[104] TheCleveland 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".[105]
Use of isoniazid should be carefully monitored in daily alcohol drinkers since they may be more likely to develop isoniazid-associated hepatitis.[106][107]
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. Onestandard 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,[113] but has been implicated in causing hangovers.[114][115] 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.
Ethanol is also known chemically as alcohol, ethyl alcohol, or drinking alcohol. It is a simplealcohol with amolecular formula of C2H6O and amolecular weight of 46.0684 g/mol. The molecular formula of ethanol may also be written as CH3−CH2−OH or as C2H5−OH. The latter can also be thought of as anethyl group linked to ahydroxyl (alcohol) group and can be abbreviated as EtOH. Ethanol is avolatile,flammable,colorless liquid with a slight characteristicodor. Aside from its use as a psychoactive and recreational substance, ethanol is also commonly used as anantiseptic anddisinfectant, a chemical and medicinalsolvent, and afuel.
Lucas test: negative (left) with ethanol and positive witht-butanol.
Ethanol is only one of several types ofchemical alcohols, and has a variety ofanalogues. Most other alcohols are considered poisonous.[11] In general, higher alcohols are less toxic.[116] Alcoholic beverages are sometimeslaced with toxic alcohols.
The toxicity of isopropyl alcohol is about twice that of ethanol;[116]a mild, brief exposure to isopropyl alcohol is unlikely to cause any serious harm, although ingesting significant quantities can lead to vomiting, abdominal pain, and internal bleeding. Methanol is the most toxic alcohol[116] and can cause blindness or death even in small quantities, as little as 10–15 milliliters (2–3 teaspoons).[citation needed] Manymethanol poisoning incidents have occurred through history.n-Butanol is reported to produce similar effects to those of ethanol and relatively low toxicity (one-sixth of that of ethanol in one rat study).[117][118] However, itsvapors can produceeye irritation and inhalation can causepulmonary edema.[116]Acetone (propanone) is aketone rather than an alcohol, and is reported to produce similar toxic effects; it can be extremely damaging to thecornea.[116]
Alcohol is one of the oldestrecreational drugs. Alcoholic beverages have been produced since theNeolithic period, as early as 7000 BC in China.[121] Alcohol was brewed as early as 7,000 to 6,650 BCE innorthern China.[122] The earliest evidence ofwinemaking was dated at 6,000 to 5,800 BCE inGeorgia in theSouth Caucasus.[123] Beer was likely brewed frombarley as early as the 13,000 years ago in the Middle East.[20]Pliny the Elder wrote about thegolden age of winemaking inRome, the 2nd century BCE (200–100 BCE), whenvineyards were planted.[124]
TheGin Craze was a period in the first half of the 18th century when the consumption ofgin increased rapidly in Great Britain, especially in London. By 1743, England was drinking 2.2gallons (10 litres) of gin per person per year. TheSale of Spirits Act 1750 (commonly known as the Gin Act 1751) was anAct of theParliament of Great Britain (24 Geo. 2. c. 40) which was enacted to reduce the consumption ofgin and otherdistilled spirits, a popular pastime[125] that was regarded as one of the primary causes ofcrime in London.[126]
Navy personnel on liberty at Mogmog Island. Enlisted men lounge about a tiny island with plenty of beer.
Therum ration (also called the tot) was a daily amount ofrum given to sailors onRoyal Navy ships. It started 1866 and wasabolished in 1970 after concerns that the intake of strong alcohol would lead to unsteady hands when working machinery.
TheAndrew Johnson alcoholism debate is the dispute, originally conducted among the general public, and now typically a question for historians, about whether or notAndrew Johnson, the 17th president of the United States (1865–1869), drank to excess.
TheBratt System was a system that was used in Sweden (1919–1955) and similarly inFinland (1944–1970) to control alcohol consumption, byrationing 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 atSystembolaget (in Sweden) andAlko (in Finland).[127] A similar system also existed inEstonia between July 1, 1920, to December 31, 1925.[128] 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 consumption of alcohol is deeply embedded in social practices and rituals, often celebrated as a cornerstone of community gatherings and personal milestones.Drinking culture is the set of traditions and social behaviours that surround the consumption of alcoholic beverages as a recreational drug andsocial lubricant.
Alcohol consumption is fully legal and available in most countries of the world.[129] Home made alcoholic beverages with low alcohol content like wine, and beer is also legal in most countries, but distillingmoonshine outside of a registered distillery remains illegal in most of them.
In addition, there are regulations on alcohol sales and use in many countries throughout the world.[129] For instance, the majority of countries have a minimumlegal drinking age to purchase or consume alcoholic beverages, although there are often exceptions such as underage consumption of small amounts of alcohol with parental supervision. Also, some countries have bans on public intoxication.[129] Drinking while driving or intoxicated driving is frequently outlawed and it may be illegal to have an open container of alcohol or liquor bottle in anautomobile, bus oraircraft.[129]
Religion and alcohol have a complex history. The world's religions have had different relationships with alcohol, reflecting diverse cultural, social, and religious practices across different traditions. While some religions strictly prohibit alcohol consumption, viewing it as sinful or harmful to spiritual and physical well-being, others incorporate it into their rituals and ceremonies. Throughout history, alcohol has held significant roles in religious observances, from the use of sacramental wine in Christian sacraments to the offering and moderate drinking of omiki (sacramental sake) in Shinto purification rituals.
A study in 2015 found that alcohol and tobacco use combined resulted in a significant health burden, costing over a quarter of a billiondisability-adjusted life years. Illicit drug use caused tens of millions more disability-adjusted life years.[133]
According toThe Lancet, 'four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year'.[134] In 2024, theWorld Health Organization published a report including these figures.[135][136]
Qualitative analysis reveals that thealcohol industry likely misinforms the public about the dangers of alcohol, similar to thetobacco industry. The alcohol industry influences alcohol policy and health messages, including those for schoolchildren.[138]
Thealcohol consumption recommendations (orsafe limits) varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The WHO published a statement inThe Lancet Public Health in April 2023 that "there is no safe amount that does not affect health."[18]
Astandard 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 theWorld Health Organization (WHO)Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example,[139] and has been adopted by more countries than any other amount.[140]
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