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alcohol

Alcohol is a widely-used legal substance. Alcohol is a central nervous system (CNS) depressant which means it slows down your breathing, heart rate, and communication between your brain and body. This is why it can affect your speech, coordination, and judgement.

According to the 2018 National Survey on Drug Use and Health (NSDUH), 86.3 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.0 percent reported that they drank in the past year; 55.3 percent reported that they drank in the past month.

According to the Health, United States, 2018 – Data Finder, 48% of women had used alcohol in the last month. White women ages 26-34 had the highest rate of use.

 

Alcohol is in beer, wine, malt beverages, liquor, and some medicines.

In the United States you have to be 21 years or older to purchase alcohol.

According to the Centers for Disease Control's (CDC) dietary guidance on alcohol "moderate drinking" is up to one drink a day for women and 2 a day for men.

Drinking at levels above the moderate drinking guidelines significantly increases the risk of short-term harms, such as injuries, as well as the risk of long-term chronic health problems. 

- CDC website

One serving of alcohol
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Pharmacology

Pharmacology is a branch of science that deals with the study of drugs and their actions on living systems - that is, the study of how drugs work in the body.

Alcohol is a Central Nervous System depressant. 


Acute effects and side effects are euphoria, relaxation, decreased inhibition, poor balance, poor decision making, poor memory, slurred speech, nausea/vomiting, dehydration, and respiratory depression. 


Long-term effects are tolerance, dependence, anorexia, liver disease, and gastrointestinal disease. 

Alcohol metabolism varies widely by gender, weight, and body composition. 
Metabolism occurs primarily in the liver, and excretion of alcohol's metabolites occurs primarily via urine (1).

 


 

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How does alcohol make you drunk?

Ethanol: this molecule, made of little more than a few carbon atoms, is responsible for drunkenness. Often simply referred to as alcohol, ethanol is the active ingredient in alcoholic beverages. So how exactly does it cause drunkenness, and why does it have dramatically different effects on different people? Judy Grisel explores alcohol's journey through the body.

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Treatment

Treatment for people with alcohol dependence can include counseling, group therapy, and medication assisted treatment with disulfiram, naltrexone, or acamprosate (2). Naltrexone hasn't been studied in pregnant people with alcohol use disorder, but we do have some information on its safety when used with pregnant people with opioid use disorder.

Visit Rethinking Drinking.

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Pregnancy 

Women have historically used alcohol at rates far below their male counterparts, but that gap has been narrowing in recent years (3). 

According to the Centers for Disease Control (CDC), 75% of people who are trying to get pregnant do not stop drinking alcohol, and the national prevalence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be between 2-5% (4). 

FASD does not appear in every person prenatally exposed to alcohol. More research is needed to identify other risk factors and precise etiology (5). 


FASD effects are permanent, except for the characteristic facial features, which fade with age, if they were present (5). 


The effects can include physical anomalies, low birth weight (LBW), organ defects, and intellectual disability (5). 


There is insufficient evidence to establish a dose dependent response *, or a period of pregnancy with reduced risk (5). 

Other than FASD, risks of alcohol exposure include miscarriage, stillbirth (5), as well as placental dysfunction such as decreased placental size and impaired flow of blood and nutrients (6). 


Chronic alcohol use is associated with decreased intestinal absorption, which can lead to malnutrition and deficiencies of many nutrients, including folic acid (1).
 

* If the effects of the substance change when the dose of the substance is changed, the effects are said to be dose-dependent. But with alcohol, the risk of a baby developing fetal alcohol spectrum disorders varies widely. Some people whose babies develop FASD drank moderately during their pregnancy. Some people who binge drink deliver babies who are unaffected. That is why the guidance states that "there in no known safe amount" of alcohol use during pregnancy.

Binge drinking is defined as a pattern of drinking that brings a person's blood alcohol concentration (BAC) to 0.08 g/dl or above. This typically happens when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours.  Most people who binge drink do not have a severe alcohol use disorder.

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Lactation

Alcohol is present in the milk of people who drink it, and has been linked to many of the same problems as prenatal exposure (7). 


Alcohol does not increase milk production or let-down (7). 


It is recommended to wait 3-4 hours after a single drink before providing milk to the baby (7, 8).

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Overdose

Acute alcohol overdose causes changes in many systems simultaneously, and the cumulative result is death if untreated. 


Temperature, respiratory rate, and blood pressure drop as the body becomes dehydrated. 


Loss of consciousness is combined with nausea, vomiting and a decreased gag reflex. 
Death or injury may result from respiratory arrest, cardiac arrest, electrolyte imbalance, aspiration of emesis, falls or other traumatic injury. 


Alcohol overdose is a medical emergency and requires immediate treatment (1).

Avoid Dangerous Combinations
If you use these substances together you are at danger of overdosing or drug poisoning.
We care about your health and wellbeing.         Please don't combine these substances.
 
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NOTE:  If you are using more than one of these medications at the same time you can work closely with your prescriber to maximize the positive therapeutic benefits of these drug combinations while being careful to minimize the risks of taking them together.
 
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Withdrawal

Acute alcohol withdrawal symptoms include shakiness, dizziness, nausea, insomnia, anxiety, sweating, seizures, hallucinations, increased blood pressure, irregular heart rate, and delirium tremens. Withdrawal symptoms can escalate rapidly and may cause death (9). 


Acute alcohol withdrawal is a medical emergency requiring hospitalization. 
Alcohol withdrawal is treated with benzodiazepine medications, typically with doses adjusted to the severity of the patient's symptoms (9).


There is inconclusive data on the safety of benzodiazepine use in pregnancy, however, the risks are likely outweighed by the proven risks of continuing alcohol use or unmedicated withdrawal. 

See Benzodiazepine section for more information.
 

References:

1.    Molina, P. E., Gardner, J. D., Souza-Smith, F. M., & Whitaker, A. M. (2014). Alcohol abuse: critical pathophysiological processes and contribution to disease burden. Physiology (Bethesda, Md.), 29(3), 203–215. https://doi.org/10.1152/physiol.00055.2013 


2.    Wolters Kluwer.  (2010). Nursing 2010 drug handbook. Ambler, PA: Lippincott, Williams, and Wilkins. 


3.    Slade, T., Chapman, C., Swift, W., Keyes, K., Tonks, Z., & Teesson, M. (2016). Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression. BMJ open, 6(10), e011827. https://doi.org/10.1136/bmjopen-2016-011827


4.    Centers for Disease Control (CDC) (2016). Alcohol use in pregnancy. Vital Signs. Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/mm6504a6.htm


5.    Riley, E. P., Infante, M. A., & Warren, K. R. (2011). Fetal alcohol spectrum disorders: an overview. Neuropsychology review, 21(2), 73–80. https://doi.org/10.1007/s11065-011-9166-x 


6.    Burd, L., Roberts, D., Olson, M., & Odendaal, H. (2007). Ethanol and the placenta: A review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 20(5), 361–375. https://doi.org/10.1080/14767050701298365


7.    American College of Obstetricians and Gynecologists. Committee on Health Care for Underserved Women (2011). Committee opinion no. 496: At-risk drinking and alcohol dependence: obstetric and gynecologic implications. Obstetrics and gynecology, 118(2 Pt 1), 383–388. https://doi.org/10.1097/AOG.0b013e31822c9906


8.    Liston J. (1998). Breastfeeding and the use of recreational drugs--alcohol, caffeine, nicotine and marijuana.

Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia, 6(2), 27–30.


9.    McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psychiatry. 2008;79(8):854-862. doi:10.1136/jnnp.2007.128322