Alcohol Use and Health Risks

Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. Alcohol is produced by the fermentation of yeast, sugars, and starches.

Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes; however, the liver can only metabolize a small amount of alcohol at a time, leaving the excess alcohol to circulate throughout the body. The intensity of the effect of alcohol on the body is directly related to the amount consumed.

Why do some people react differently to alcohol than others?

Individual reactions to alcohol vary, and are influenced by many factors, including but not limited to

• Age.
• Gender.
• Race or ethnicity.
• Physical condition (weight, fitness level, etc).
• Amount of food consumed before drinking.
• How quickly the alcohol was consumed.
• Use of drugs or prescription medicines.
• Family history of alcohol problems.

What is a standard drink in the United States?

A standard drink is equal to 13.7 grams (0.6 ounces) of pure alcohol or

• 12-ounces of beer.
• 8-ounces of malt liquor.
• 5-ounces of wine.
• 1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

Is beer or wine safer to drink than liquor?

No. One 12-ounce beer has about the same amount of alcohol as one 5-ounce glass of wine, or 1.5-ounce shot of liquor. It is the amount of ethanol consumed that affects a person most, not the type of alcoholic drink.

What does moderate drinking mean?

There is no one definition of moderate drinking, but generally the term is used to describe a lower risk pattern of drinking. According to the Dietary Guidelines for Americans,1 drinking in moderation is defined as having no more than 1 drink per day for women and no more than 2 drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days.

Is it safe to drink alcohol and drive?

No, alcohol use slows reaction time and impairs judgment and coordination, which are all skills needed to drive a car safely.2 The more alcohol consumed, the greater the impairment.

What does it mean to be above the legal limit for drinking?

The legal limit for drinking is the alcohol level above which an individual is subject to legal penalties (e.g., arrest or loss of a driver's license).

• Legal limits are measured using either a blood alcohol test or a breathalyzer.
• Legal limits are typically defined by state law, and may vary based on individual characteristics such as age and occupation.

All states in the United States have adopted 0.08% (80 mg/dL) as the legal limit for operating a motor vehicle for drivers aged 21 years or older. However, drivers under age 21 years are not allowed to operate a motor vehicle with any level of alcohol in their system.

Note: Legal limits do not define a level below which it is safe to operate a vehicle or engage in some other activity. Impairment due to alcohol use begins to occur at levels well below the legal limit.

How do I know if it’s okay to drink?

The current Dietary Guidelines for Americans1 recommend that if you choose to drink alcoholic beverages, you do not exceed 1 drink per day for women and 2 drinks per day for men. These guidelines also specify that there are some people who should not drink alcoholic beverages at all, including

• Children and adolescents.
• Individuals of any age who cannot limit their drinking to low levels.
• Women who may become pregnant or who are pregnant.
• Individuals who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination.
• Individuals taking prescription or over-the-counter medications that can interact with alcohol.
• Individuals with certain medical conditions.
• Persons recovering from alcoholism.

What do you mean by heavy drinking?

For men, heavy drinking is typically defined as consuming an average of more than 2 drinks per day. For women, heavy drinking is typically defined as consuming an average of more than 1 drink per day.

What is binge drinking?

According to the National Institute on Alcohol Abuse and Alcoholism, binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or above. This pattern of drinking usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.

What is the difference between alcoholism and alcohol abuse?

Alcoholism or alcohol dependence is a diagnosable disease characterized by several factors, including a strong craving for alcohol, continued use despite harm or personal injury, the inability to limit drinking, physical illness when drinking stops, and the need to increase the amount drunk to feel the effects.4

Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. Certain manifestations of alcohol abuse include failure to fulfill responsibilities at work, school or home; drinking in dangerous situations, such as while driving; legal problems associated with alcohol use; and continued drinking despite problems that are caused or worsened by drinking. Alcohol abuse can lead to alcohol dependence.

What does it mean to get drunk?

“Getting drunk” or intoxicated is the result of consuming excessive amounts of alcohol. Binge drinking typically results in acute intoxication.

Alcohol intoxication can be detrimental to health for a variety of reasons, including, but not limited to

• Impaired brain function resulting in poor judgment, reduced reaction time, loss of balance and motor skills, or slurred speech.
• Dilation of blood vessels causing a feeling of warmth but resulting in rapid loss of body heat.
• Increased risk of certain cancers, stroke, and liver diseases (e.g.,, cirrhosis), particularly when excessive amounts of alcohol are consumed over extended periods of time.
• Damage to a developing fetus if consumed by pregnant women.5
• Increased risk of motor-vehicle traffic crashes, violence, and other injuries.

Coma and death can occur if alcohol is consumed rapidly and in large amounts because of depression of the central nervous system.

How do I know if I have a drinking problem?

Drinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a drinking problem, consult your personal health care provider.

What can I do if I or someone I know has a drinking problem?

Consult your personal health care provider if you feel you or someone you know has a drinking problem. Other resources include the National Drug and Alcohol Treatment Referral Routing Service available at 1-800-662-HELP. This service can provide you with information about treatment programs in your local community and allow you to speak with someone about alcohol problems.

What health problems are associated with excessive alcohol use?

Excessive drinking both in the form of heavy drinking or binge drinking, is associated with numerous health problems, including but not limited to

• Chronic diseases such as liver cirrhosis (damage to liver cells); pancreatitis (inflammation of the pancreas); various cancers, including liver, mouth, throat, larynx (the voice box), and esophagus; high blood pressure; and psychological disorders.
• Unintentional injuries, such as motor-vehicle traffic crashes, falls, drowning, burns and firearm injuries.
• Violence, such as child maltreatment, homicide and suicide.
• Harm to a developing fetus if a woman drinks while pregnant, such as fetal alcohol spectrum disorders.
• Sudden infant death syndrome (SIDS)
• Alcohol abuse or dependence.

I’m young. Is drinking bad for my health?

Yes.7,8 Studies have shown that alcohol use by youth and young adults increases the risk of both fatal and nonfatal injuries.9,10,11 Research has also shown that youth who use alcohol before age 15 are five times more likely to become alcohol dependent than adults who begin drinking at age 21.12 Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.

Is it okay to drink when pregnant?

No, there is no safe level of alcohol use during pregnancy. Women who are pregnant or plan on becoming pregnant should refrain from drinking alcohol.16 Several conditions, including Fetal Alcohol Syndrome Disorders have been linked to alcohol use during pregnancy. Women of child bearing age should also avoid binge drinking to reduce the risk of unintended pregnancy and potential exposure of a developing fetus to alcohol.

General Information on Alcohol Use and Health

There are approximately 79,000 deaths attributable to excessive alcohol use each year in the United States.1 This makes excessive alcohol use the 3rd leading lifestyle-related cause of death for the nation.2 In the single year 2005, there were over 1.6 million hospitalizations3 and over 4 million emergency room visits4 for alcohol-related conditions.

The Standard Measure of Alcohol

In the United States, a standard drink is any drink that contains 0.6 ounces (13.7 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in

• 12-ounces of regular beer or wine cooler.
• 8-ounces of malt liquor.
• 5-ounces of wine.
• 1.5-ounces of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

Definitions of Patterns of Drinking Alcohol

• Binge drinking

o For women, 4 or more drinks during a single occasion. o For men, 5 or more drinks during a single occasion.

• Heavy drinking

o For women, more than 1 drink per day on average. o For men, more than 2 drinks per day on average.

Excessive drinking includes heavy drinking, binge drinking or both.

Most people who binge drink are not alcoholics or alcohol dependent.5

According to the Dietary Guidelines for Americans, if you drink alcoholic beverages, do so in moderation, which is defined as no more than 1 drink per day for women and no more than 2 drinks per day for men.6 However, there are some persons who should not drink any alcohol, including those who are

• Pregnant or trying to become pregnant.
• Taking prescription or over-the-counter medications that may cause harmful reactions when mixed with alcohol.
• Under the age of 21.
• Recovering from alcoholism or are unable to control the amount they drink.
• Suffering from a medical condition that may be worsened by alcohol.
• Driving, planning to drive, or participating in other activities requiring skill, coordination, and alertness.

Immediate Health Risks

Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions. These immediate effects are most often the result of binge drinking and include the following:

• Unintentional injuries, including traffic injuries, falls, drownings, burns and unintentional firearm injuries.7

• Violence, including intimate partner violence and child maltreatment. About 35% of victims report that offenders are under the influence of alcohol.8 Alcohol use is also associated with 2 out of 3 incidents of intimate partner violence.8 Studies have also shown that alcohol is a leading factor in child maltreatment and neglect cases, and is the most frequent substance abused among these parents.9

• Risky sexual behaviors, including unprotected sex, sex with multiple partners, and increased risk of sexual assault. These behaviors can result in unintended pregnancy or sexually transmitted diseases.10,11

• Miscarriage and stillbirth among pregnant women, and a combination of physical and mental birth defects among children that last throughout life.12,13

• Alcohol poisoning, a medical emergency that results from high blood alcohol levels that suppress the central nervous system and can cause loss of consciousness, low blood pressure and body temperature, coma, respiratory depression, or death.

Long-Term Health Risks

Over time, excessive alcohol use can lead to the development of chronic diseases, neurological impairments and social problems. These include but are not limited to:

• Neurological problems, including dementia, stroke and neuropathy.15,16
• Cardiovascular problems, including myocardial infarction, cardiomyopathy, atrial fibrillation and hypertension.17
• Psychiatric problems, including depression, anxiety, and suicide.18
• Social problems, including unemployment, lost productivity, and family problems.19,20
• Cancer of the mouth, throat, esophagus, liver, colon, and breast.21
• In general, the risk of cancer increases with increasing amounts of alcohol.
• Liver diseases, including:

o Alcoholic hepatitis. o Cirrhosis, which is among the 15 leading causes of all deaths in the United States.22 o Among persons with Hepatitis C virus, worsening of liver function and interference with medications used to treat this condition.23

• Other gastrointestinal problems, including pancreatitis and gastritis.

Excessive Alcohol Use and Risks to Men's Health

Men are more likely than women to drink excessively. Excessive drinking is associated with significant increases in short-term risks to health and safety, and the risk increases as the amount of drinking increases. Men are also more likely than women to take other risks (e.g., drive fast or without a safety belt), when combined with excessive drinking, further increasing their risk of injury or death.

Drinking levels for men

• Approximately 62% of adult men reported drinking alcohol in the last 30 days and were 2 times more likely to binge drink than women during the same time period.5
• Men average about 12.5 binge drinking episodes per person per year, while women average about 2.7 binge drinking episodes per year.3
• Most people who binge drink are not alcoholics or alcohol dependent.6,7
• It is estimated that about 17% of men and about 8% of women will meet criteria for alcohol dependence at some point in their lives.

Injuries and deaths as a result of excessive alcohol use

• Men consistently have higher rates of alcohol-related deaths and hospitalizations than women.1,9,10
• Among drivers in fatal motor-vehicle traffic crashes, men are almost twice as likely as women to have been intoxicated (i.e., a blood alcohol concentration of 0.08% or greater).11
• Excessive alcohol consumption increases aggression and, as a result, can increase the risk of physically assaulting another person.12
• Men are more likely than women to commit suicide, and more likely to have been drinking prior to committing suicide.

Reproductive Health and Sexual Function

Excessive alcohol use can interfere with testicular function and male hormone production, resulting in impotence, infertility, and reduction of male secondary sex characteristics such as facial and chest hair.16, 17

Excessive alcohol use is commonly involved in sexual assault. Impaired judgment caused by alcohol may worsen the tendency of some men to mistake a women’s friendly behavior for sexual interest and misjudge their use of force. Also, alcohol use by men increases the chances of engaging in risky sexual activity including, unprotected sex, sex with multiple partners, or sex with a partner at risk for sexually transmitted diseases.

Cancer

Alcohol consumption increases the risk of cancer of the mouth, throat, esophagus, liver, and colon in men.18,19,20

There are a number of health conditions affected by excessive alcohol use that affect both men and women.

Excessive Alcohol Use and Risks to Women’s Health

Although men are more likely to drink alcohol and drink in larger amounts, gender differences in body structure and chemistry cause women to absorb more alcohol, and take longer to break it down and remove it from their bodies (i.e., to metabolize it). In other words, upon drinking equal amounts, women have higher alcohol levels in their blood than men, and the immediate effects occur more quickly and last longer. These differences also make women more vulnerable to alcohol’s long-term effects on their health.

Reproductive Health

• National surveys show that about 6 out of every 10 women of child-bearing age (i.e., aged 18–44 years) use alcohol, and slightly less than one-third of women who drink alcohol in this age group binge drink.2
• In 2002, about 10% of pregnant women used alcohol, and 2% drank excessively.3
• Excessive drinking may disrupt menstrual cycling and increase the risk of infertility, miscarriage, stillbirth, and premature delivery.4,5
• Women who binge drink are more likely to have unprotected sex and multiple sex partners. These activities increase the risks of unintended pregnancy6 and sexually transmitted diseases

Alcohol and Pregnancy

• Women who drink alcohol while pregnant increase their risk of having a baby with Fetal Alcohol Spectrum Disorders (FASD)]. The most severe form is Fetal Alcohol Syndrome (FAS), which causes mental retardation and birth defects.
• FASD are completely preventable if a woman does not drink while pregnant or while she may become pregnant.
• Studies have shown that about 1 of 20 pregnant women drank excessively before finding out they were pregnant.8 No amount of alcohol is safe to drink during pregnancy. For women who drink during pregnancy, stopping as soon as possible may lower the risk of having a child with physical, mental, or emotional problems.
• Research suggests that women who drink alcohol while pregnant are more likely to have a baby die from Sudden Infant Death Syndrome (SIDS). This risk substantially increases if a woman binge drinks during her first trimester of pregnancy.9
• The risk of miscarriage is also increased if a woman drinks excessively during her first trimester of pregnancy.

Other Health Concerns

• Liver Disease: The risk of cirrhosis and other alcohol-related liver diseases is higher for women than for men.11
• Impact on the Brain: Excessive drinking may result in memory loss and shrinkage of the brain.12 Research suggests that women are more vulnerable than men to the brain damaging effects of excessive alcohol use, and the damage tends to appear with shorter periods of excessive drinking for women than for men.13
• Impact on the Heart: Studies have shown that women who drink excessively are at increased risk for damage to the heart muscle than men even for women drinking at lower levels.14
• Cancer: Alcohol consumption increases the risk of cancer of the mouth, throat, esophagus, liver, colon, and breast among women. The risk of breast cancer increases as alcohol use increases.15,16,17,18
• Sexual Assault: Binge drinking is a risk factor for sexual assault, especially among young women in college settings. Each year, about 1 in 20 college women are sexually assaulted. Research suggests that there is an increase in the risk of rape or sexual assault when both the attacker and victim have used alcohol prior to the attack.19,20

Related Videos

A key question when it comes to alcohol abuse is How Much is Too Much. To learn more, we talked to Dr. Mark Willenbring, the Director of the Treatment and Recovery Research Division in the National Institute on Alcohol Abuse and Alcohol:

(Video donated by NIH)

References

Questions and Answers

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2. National Highway Traffic Safety Administration. Available at http://www.nhtsa.dot.gov/. Accessed March 28, 2008.

3. National Institute of Alcohol Abuse and Alcoholism. NIAAA council approves definition of binge drinking (PDF–1.6Mb) NIAAA Newsletter 2004;3:3.

4. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.

5. Centers for Disease Control and Prevention. Fetal alcohol spectrum disorders. Available at http://www.cdc.gov/ncbddd/fas/default.htm. Accessed March 31, 2008.

6. Substance Abuse and Mental Health Services Administration. Available at http://www.samhsa.gov/treatment/treatment_public_i.aspx. Accessed March 28, 2008.

7. National Research Council and Institute of Medicine. Reducing Underage Drinking: A Collective Responsibility.* Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press; 2004.

8. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. Rockville, MD: U.S. Department of Health and Human Services; 2007. Available at http://www.surgeongeneral.gov/topics/underagedrinking/. Accessed March 28, 2008.

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13. Substance Abuse and Mental Health Services Administration. A Comprehensive Plan for Preventing and Reducing Underage Drinking. Washington, DC: 2006. Available at http://www.stopalcoholabuse.gov/media/underagedrinking/pdf/underagerpttocongress.pdf (PDF). Accessed March 28, 2008.

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General Information on Alcohol Use and Health

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6. United States Department of Agriculture and United States Department of Health and Human Services. In: Dietary Guidelines for Americans. Chapter 9—Alcoholic Beverages. Washington, DC: US Government Printing Office; 2005, p. 43–46. Available at http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm. Accessed March 28, 2008.

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8. Greenfield LA. Alcohol and crime: An analysis of national data on the prevalence of alcohol involvement in crime. Report prepared for the Assistant Attorney General’s National Symposium on Alcohol Abuse and Crime. Washington, DC: U.S. Department of Justice, 1998. Available at http://www.ojp.usdoj.gov/bjs/pub/pdf/ac.pdf (PDF). Accessed March 31, 2008.

9. The National Center on Addition and Substance Abuse at Columbia University, 1999. No safe haven: Children of substance-abusing parents. Available at http://www.casacolumbia.org/Absolutenm/articlefiles/No_Safe_Haven_1_11_99.pdf* (PDF). Accessed March 31, 2008.

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13. American Academy of Pediatrics, Committee on Substance Abuse and Committee on Children with Disabilities. 2000. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics 2000;106:358–361.

14. Sanap M, Chapman MJ. Severe ethanol poisoning: a case report and brief review. Crit Care Resusc 2003;5(2):106–108.

15. Corrao G, Rubbiati L, Zambon A, Arico S. Alcohol-attributable and alcohol-preventable mortality in Italy. A balance in 1983 and 1996. European J Public Health 2002;12:214–223.

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20. Leonard KE, Rothbard JC. Alcohol and the marriage effect. J Stud Alcohol Suppl 1999;13:139–146.

21. Baan R, Straif K, Grosse Y, Secretan B, et al. on behalf of the WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of alcoholic beverages. Lancet Oncol. 2007;8:292–293.

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Excessive Alcohol Use and Risks to Men's Health

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3. Naimi TS, Brewer RD, Mokdad A, Clark D, Serdula MK, Marks JS. Binge drinking among US adults. JAMA 2003; 289(1):70–75.
4. Nolen-Hoeksema S. Gender differences in risk factors and consequences for alcohol use and problems. Clinical Psychology Review 2004;24:981.
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Excessive Alcohol Use and Risks to Women’s Health

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