Alcohol
Learn more about alcohol, the prominent depressant served legally throughout much of the world.
Overview
Common Nicknames
Ethanol, booze, liquor, spirits
Drug Class
Depressant
Drug Form
Drinks
Route of Administration
Ingested (drunk)
What is the science of Alcohol?
Alcohol is absorbed into the blood, partially from the stomach but mainly from the small intestine. Absorption is usually at its maximum 30-45 minutes after consumption. When alcohol reaches the brain it temporarily affects the transduction of signals, causing several behavioural, cognitive, and emotional changes.
Alcohol influences certain neurotransmitters. It stimulates GABA activity and suppresses glutamate activity, resulting in relaxation, calmness, stress reduction, and pleasure. Alcohol also stimulates dopamine release and induces a surge of serotonin, which intensifies the pleasurable effects. Dopamine plays a key role in the brain’s reward system; it induces good feelings like euphoria, relaxation, and pleasure. This surge in dopamine reinforces the behaviour, which means that consumers are likely to seek out alcohol again to experience those feelings.
What are the risks?
Drinking alcohol comes with a variety of risks, determined by the dosage, drinking patterns and individual health conditions. The risks of drinking alcohol can be divided into short-term and long-term risks.
In the short term, consumption of alcohol increases the risk of injuries (with vehicles, falling, or drowning) and the risk of violence (assault, suicide, and homicide). In the case of alcohol poisoning, there is an increased risk of seizures, unconsciousness, and death.
In the long term, regular alcohol use increases the risk of a variety of health conditions. Moderate alcohol consumption already increases the risk of developing certain types of cancer, liver diseases, hypertension, heart diseases, chronic pancreatitis, mental health issues like depression and anxiety, and an overall weaker immune system.
How might the drug make you feel?
The effects of alcohol are determined by a number of factors, most importantly the dose, gender, and recent food intake.
In low doses, alcohol increases relaxation and sociability, impairs muscle coordination, increases drowsiness, and impairs judgement, vision, and balance. In a social context, it can help people feel happier and more confident, whereas at home it can help people relax more. Alcohol also has diuretic effects, which means that it promotes water and electrolyte loss through urine production.
At higher doses, alcohol can cause slurred speech, apathy, nausea and vomiting, sleepiness and confusion. Alcohol also influences perception and thought in a way that impairs emotion regulation. People under the influence of alcohol can respond more emotionally or aggressively than when not intoxicated.
In extremely high doses, alcohol can produce loss of consciousness, incontinence, and death. Alcohol is a depressant that slows the functions of the nervous system, and thereby also diminishing involuntary processes like breathing and heart rate. Severe alcohol intoxication can slow down the breathing so much that it stops, causing the person to die.
When the effects of alcohol wear off and the concentration of alcohol in the blood lowers, alcohol users can experience what is called a “hangover.” This is a combination of negative mental and physical symptoms, including fatigue, nausea, headache, and concentration problems, low mood and anxiety.
Is Alcohol addictive, and what are the long-term effects?
Alcohol dependence is the result of cumulative responses to alcohol exposure, the genetic make-up of an individual, and environmental circumstances. This means that it can be highly addictive, but not everyone who drinks alcohol is equally at risk of becoming dependent. Factors that increase the risk of alcohol dependence are a genetic predisposition (different way of processing alcohol, mental health conditions (like anxiety and depression), and social / environmental factors (like drinking culture, access, and family members drinking).
Alcohol is particularly damaging to the brain, as excessive alcohol consumption can result in brain shrinkage and neuronal damage. Although some types of brain damage are partially reversible after someone quits drinking, prolonged alcohol abuse can lead to permanent cognitive impairments, including memory loss, difficulties with decision-making, and decreased motor coordination. In older drinkers, alcohol contributes to dementia. Long-term alcoholism in combination with malnourishment can cause Korsakoff’s syndrome, which is characterised by profound amnesia, gait abnormalities and false memories.
Besides physical harm, increased alcohol consumption also causes social harm to the drinker. This includes family disruption, problems at the workplace, criminal convictions, and financial problems. Long-term alcohol use doesn’t only create harm for the drinker themselves, but also for the people around them. This consists of deaths and hospitalizations (e.g., traffic injuries because of driving under the influence), child abuse or neglect, and domestic or other assaults.
Finally, excessive alcohol use also has negative long-term effects on mental health. Hazardous alcohol consumption can lead to a variety of stressful scenarios, like tension in home / work environments, which can lead to poor mental health. Besides, alcohol is also known to influence neurotransmitter functioning and reducing brain volume, which are both related to developing major depression. Mental health and alcohol intake have a dynamic relationship: poor mental health can increase alcohol intake and increased alcohol intake can negatively influence mental health.
Harm Reduction and Drug-Drug Interactions
Although there is no completely safe level of drinking, there are ways to lower the risks of harm to your health.
Firstly, it is important to be aware and in control of what and how much you are drinking. This makes it easier to manage your intake and therefore easier to know when you are reaching your limit. It is recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more. This means around 6 medium glasses of wine, or 6 pints of 4% beer.
Secondly, it is important to drink water or other hydrating drinks when you are drinking. This helps to maintain your mental capacity and helps pacing your alcohol intake. It is also advised to eat before and while you drink, as having food in the stomach slows the absorption of alcohol into the blood, allowing for a more gradual increase in blood alcohol concentration (BAC) and reducing the intensity of its effects. This can help prevent becoming overly intoxicated too quickly and make drinking a safer and more manageable experience. Eating before and while drinking does not, however, reduce the physical harm of alcohol on the body and does not mean you can drink more than the advised number of drinks safely.
Thirdly, it is important to ensure a safe drinking environment. As drinking alcohol impairs your judgement and can blur boundaries, it is important to be surrounded by people who you can trust and who will not take advantage of you. In addition, it is important to have planned a safe mode of transportation, as drinking alcohol makes it unsafe to drive.
Lastly, when someone is showing signs of alcohol poisoning, it is important to help them as it can be life-threatening. Signs of alcohol poisoning can consist of confusion and vomiting, but also seizures, irregular or slow breathing, slow heart rate or unconsciousness.
When you recognise one or more of these signs in someone, there are a few things you should do:
Place the person on their side so that their airway is not blocked when they vomit.
Do not leave the person alone, as their condition might get worse.
Keep them warm with a jacket or blanket.
Monitor the person and if they a) become unresponsive; b) vomit while unconscious; or c) have slow breathing, make sure to call emergency services.
Medical Uses
Moderate alcohol (ethanol) intake has been associated with health benefits, like reduced risks for cardiovascular disease and type-2 diabetes, and prevention of thrombosis of the heart. It also holds important recreational and leisure benefits through its mood- and sociability-enhancing effects. Although there are some health benefits associated with drinking alcohol, these are outweighed by the risks and negative effects on health.
Ethanol can also be used as an antidote, when someone is suffering from methanol poisoning. Although the preferred antidote is fomepizole, ethanol can also be used. It occupies the enzyme in the liver that metabolises methanol, preventing methanol from being metabolised into its toxic byproducts.
One of the primary medical uses of alcohol is as an antiseptic and disinfectant. Both ethanol and isopropanol are used to disinfect surfaces, medical instruments, and skin. Alcohol kills bacteria, fungi, and viruses effectively.
Myths and Misconceptions
Alcohol warms you up
Alcohol causes the blood vessels to dilate, which increases the blood flow to the skin, causing a warm sensation. Although you may feel warm temporarily, this causes your body to lose heat. Because alcohol also depresses the nervous system, your brain does not always know that your body is cooling down, increasing the chance of hypothermia.
A cold shower of coffee helps sober you up
Both having a cold shower and drinking coffee are commonly seen as ways to sober someone up. It is true that these methods can make you feel more alert and awake, masking the effects of alcohol. However, neither of these methods decrease the percentage of alcohol in your blood. This means that they do not sober you up, only time can do that.
Mixing drinks influences the effects
‘Beer before liquor, never been sicker; liquor before beer, you’re in the clear,’ is a commonly used expression, implying that the order of drinks influences the effect of alcohol. The truth is however, that the order of drinks and the mixing of drinks does not necessarily influence the level of alcohol in your blood. The risk of mixing drinks is that it makes you lose track of how much you have drunk, increasing the chance of drinking too much.
Alcohol Dependence
Alcohol dependence makes people more vulnerable to the variety of health problems alcohol can cause. Increased alcohol consumption is an important risk factor for many health problems. It entirely or partly causes numerous infectious diseases, cancer, diabetes, neuropsychiatric diseases, cardiovascular disease, liver and pancreas disease, and intentional and unintentional injury.
Mildly addicted people suffer psychologically when they quit alcohol. They may get cravings and feel anxious or miserable without drinking. More severe cases of alcohol withdrawal start within a few hours of stopping and are characterised by a number of symptoms. These include sweating, headache, nausea, shaking, photo- and phono-phobia (intolerance of light and sound), anxiety and a high temperature, blood pressure and pulse. Severe withdrawal can involve extreme vomiting, seizures and delirium tremens, a confusional state characterised by agitation, paranoia and visual hallucinations
For people suffering from alcohol dependence, withdrawal can cause dangerous symptoms and situations. The primary danger is that it can be fatal, both because of the physical symptoms like seizures and delirium tremens, but also because of harm caused by hallucinations. Withdrawal for severe alcohol addictions should only be attempted in medical environments, in which the safety of the patient is guaranteed.