Pronunciation: AL-kuh-hall

Chemical Abstracts Service Registry Number: 64-17-5 Formal Names: Ethanol, Ethyl Alcohol, Hydroxy Ethane Informal Names: Liquor Type: Depressant. See p. 19 Federal Schedule Listing: Unlisted

USA Availability: Freely available to adults; various jurisdictions limit access to minors; some pharmaceutical preparations are prescription

Uses. Various kinds of alcohol exist; many are poisonous, such as wood alcohol, and are not intended for drinking. Those types are not substances of abuse and are not discussed in this book.

In former times physicians prescribed alcohol as a treatment for assorted afflictions. That usage is largely outmoded, but alcohol is still a common ingredient in cough remedies, is applied to skin as a disinfectant, and is a component of some injectable solutions. Alcohol is used as a partial antidote for methanol poisoning associated with inhalant abuse, and it is used to combat glycol poisoning. In some medical procedures alcohol is administered to create a form of anesthesia called a nerve block. Around 1970 at one hospital a combination of alcohol and chloral hydrate was routinely given to make pregnant women unconscious during labor, although alcohol is also a treatment for stopping premature labor. The substance can be a sleep aid (a "nightcap" drink), but researchers have found that it interferes with dreaming, which is an important component of sleep. Tolerance can develop to sleep-inducing actions, and dream content can become disturbing for awhile after usage stops. Some persons drink alcohol to cope with stress. Evidence exists that moderate consumption of wine may help people live longer by reducing risk of heart disease and cancer.

Drawbacks. As with many other drugs, moderate recreational use can be pleasurable while causing little harm. In contrast, excessive use can not only have psychological effects harmful to family and social functioning but also injure the stomach, liver, kidneys, heart, and brain. Rat experiments have demonstrated damage to the pancreas, damage that is boosted by cigarette smoke. A study found that men with spinal osteoporosis, a disease increasing the likelihood of broken bones, drink more alcohol than persons without the dis ease; this finding does not mean that alcohol causes the affliction, but it does indicate the need for further research. Alcohol does not make peaceful individuals rageful, but it can lower inhibitions while leaving a person able to act out urges. Thus violent and criminal acts are commonly associated with alcohol intoxication. Impairment of mental and physical activity can occur during acute intoxication, making operation of dangerous machinery (such as automobiles) hazardous. During intoxication sensory perceptions are blunted, reducing awareness of tastes, smells, sounds, and pain.

Lesser known problems are associated with alcohol. Male users experience a decline in testosterone levels, and females may experience menstrual difficulties. The nerve inflammation disease beriberi has been linked with alcoholism, and research has raised the possibility that alcoholism can worsen Alzheimer's disease. Some studies report that drinkers have a slightly higher chance of developing cataracts, but a very large study involving 77,466 women found little, if any, relationship between the substance and cataracts. Experiments show that a drink of alcohol encourages more cigarette consumption and that persons who use both alcohol and nicotine tend to drink more when cigarettes are unavailable. Although alcohol can make a person feel hotter, that effect is superficial; the substance actually lowers body temperature, making alcohol counterproductive if a chilled person is trying to warm up; the substance should not be given to persons injured by exposure to cold temperatures. Alcoholics commonly have memory trouble, and small studies find that heavy-drinking nonalcoholics have impaired thinking skills even while sober.

Abuse factors. In addition to being a potent intoxicant, alcohol is one of the most addictive substances. Tolerance ("holding your liquor") and dependence may occur. Withdrawal can be dangerous, with death occurring (typically from difficulties leading to convulsions) despite intense medical supervision. The withdrawal syndrome is called delirium tremens. Its symptoms are similar to those of barbiturate withdrawal: weariness, nervousness, perspiration, tremors, vomiting, cramps, high blood pressure, accelerated heartbeat, convulsions, and hallucinations. Symptoms may be worse in elderly persons.

Women tend to be more affected by alcohol than men are because, among other reasons, the drug has more bioavailability in females (more of a given dose is used in females, so they need less quantity than men do in order to reach the same level of effect).

Drug interactions. Alcohol lengthens the duration of effects from chlordi-azepoxide, diazepam, and lorazepam. Cocaine worsens liver damage caused by alcohol. When rats receiving morphine or methadone drink alcohol, the alcohol blood level takes longer to increase but then lasts longer, a result suggesting that a human opiate user might have to drink more in order to get an alcohol effect and would then stay intoxicated longer than someone who does not use opiates. Rat studies indicate that steady opiate consumption may intensify alcohol dependence. In rats, alcohol, chlordiazepoxide, and pen-tobarbital all have cross-tolerance with one another, meaning that one will substitute for the other to some extent. So many drugs interact dangerously with alcohol that a person should always check information labels on drug containers before using the substances simultaneously with alcohol.

Cancer. Most laboratory tests give no indication that alcohol has a potential for causing cancer. Nonetheless, mice experimentation indicates that long-term use of alcohol can cause liver cancer. Human reports indicate an increased risk for prostate cancer. Women who take more than two drinks a day have an increased risk of breast cancer. A study of 8,006 Japanese men in Hawaii found an association between alcohol and cancer of the lungs and rectum, but "association" is not the same as cause and effect. Evidence indicates that saliva might transform alcohol in ways that promote oral cancer.

Pregnancy. A study of 430 couples in Denmark found fertility to decline among women as their alcohol consumption increased, but no effect was observed on male fertility. In contrast, a study of farm couples in Canada found no difference in fertility between women who did or did not drink alcohol. Still another study, in the Netherlands, found male alcohol consumers to have higher fertility as consumption increased, with no difference in fertility rate between women who drank different amounts. Such findings of sometimes yes, sometimes no, are a classic sign of an "invalid variable," which in this case would mean that no difference in fertility can be attributed to alcohol (although more studies would be needed to reach a firm conclusion, and some authorities say the trend of research indicates that alcohol does reduce female fertility).

A study found that premature infants were more likely among pregnant teenagers who drank alcohol than among those who did not. That effect was not seen among older pregnant women who drank. Other research has noted lower birthweights among children delivered by pregnant alcohol consumers.

A human experiment documented fetal response to two glasses of wine drunk by women whose pregnancies were close to time of delivery: In that experiment fetal respiration and sleep were disturbed—which did not surprise researchers because heavy consumers of alcohol frequently give birth to infants having sleep difficulties. Such newborns may also have tremors and poor reflexes and cry more than normal. Children can be born dependent on the drug.

Alcohol is a well-known cause of birth defects. In mice the substance is known to cause a facial deformity called holoprosencephaly, and a human case report suggests that heavy dosage can do the same in humans. Less dramatic facial characteristics are common after substantial prenatal exposure to alcohol. Other human birth defects attributed to alcohol include kidney, heart, and brain trouble. More subtle damage has been measured as a slight decline in IQ among schoolchildren of mothers who took two or more drinks a day during pregnancy. Male exposure to some drugs can produce birth defects, and researchers have found problems in behavior and thinking skills among children of alcoholic fathers as well as among offspring of pregnant alcoholics. Fetal alcohol syndrome (FAS) is a collection of afflictions observed in children typically born to women who had six or more drinks a day while pregnant. The syndrome may include low birthweight, defective vision, delayed development, specific facial characteristics, trouble with muscles and joints, heart abnormality, and mental retardation. Problems can be long-lasting and even permanent. Prenatal exposure to alcohol can delay motor skill development in children, cause difficulties in maintaining balance, and limit growth in height. Such children may be more impulsive and aggressive. A study of adolescents compared two groups, one born with FAS and another whose mothers drank little or no alcohol during pregnancy. The FAS group showed impairment in some types of memory, attention, thinking, and learning—findings supported by other research as well. Some researchers believe that fetal exposure to alcohol has more to do with teenage drinking than family environment does. Comparing adults with heavy prenatal alcohol exposure to those without such exposure, a small study measured significant psychiatric differences, particularly with the alcohol subjects being more depressed and fearful.

Fetal damage from maternal alcohol use is unquestionable, but the amount of use necessary to cause damage is less certain and can be affected by a woman's general physical condition and lifestyle (including nutrition and other drug usage). Occasional binge drinking and routine heavy drinking are certainly hazardous to fetal development, but for many years pregnant women have used alcohol in moderation without apparent effect on offspring. Nonetheless, in general, women are now advised to avoid any alcohol consumption during pregnancy.

Experimenters note that alcohol consumption reduces mothers' milk production but does not affect energy provided by the milk. Alcohol levels in milk are similar to a mother's blood levels. A nursing infant may be sickened by milk from a mother who abuses alcohol—an infant has not yet developed the proper body chemistry to break down alcohol, so a dose lasts longer in an infant than in an older child or adult.

Additional information. Beverage alcohol is a powerful intoxicant. Alcohol is also probably the most familiar drug, used so freely that many persons regard it solely as a beverage rather than as a drug. Indeed, for many years excessive drunkenness was considered a moral failing rather than a disease, and not until the 1950s was alcoholism officially recognized as an affliction appropriate for medical treatment.

By the 1800s drunkenness had become a major public concern in the United States. Temperance societies, organizations whose members pledged to avoid beverage alcohol and to discourage consumption by other persons, became politically powerful. Before the Civil War such groups had been able to get laws passed outlawing the sale of beverage alcohol in various communities and sometimes throughout entire states. Shortly after World War I this agitation culminated in the Eighteenth Amendment to the Constitution of the United States, giving the federal government power to ban manufacture and sale of beverage alcohol. Although purchase and consumption remained legal, the majority of Americans became so displeased with Prohibition that the Twenty-first Amendment to the Constitution was passed in the 1930s repealing the earlier one.

Additional scientific information may be found in:

Chasan-Taber, L. et al. "A Prospective Study of Alcohol Consumption and Cataract

Extraction among U.S. Women." Annals of Epidemiology 10 (2000): 347-53. Curtis, K.M, D.A. Savitz, and T.E. Arbuckle. "Effects of Cigarette Smoking, Caffeine

Consumption, and Alcohol Intake on Fecundability." American Journal of Epidemiology 146 (1997): 32-41.

Florack, E.I., G.A. Zielhuis, and R. Rolland. "Cigarette Smoking, Alcohol Consumption, and Caffeine Intake and Fecundability." Preventive Medicine 23 (1994): 175-80.

Gronbaek, M., et al. "Type of Alcohol Consumed and Mortality from All Causes, Coronary Heart Disease, and Cancer." Annals of Internal Medicine 133 (2000): 411-19.

Jensen, T.K. "Does Moderate Alcohol Consumption Affect Fertility? Follow up Study among Couples Planning First Pregnancy." BMJ 317 (1998): 505-10.

Kraus, L., et al. "Prevalence of Alcohol Use and the Association between Onset of Use and Alcohol-Related Problems in a General Population Sample in Germany." Addiction 95 (2000): 1389-1401.

Moore, M.H., and D.R. Gerstein, eds. Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington, DC: National Academy Press, 1981.

Phillips, B.J., and P. Jenkinson. "Is Ethanol Genotoxic? A Review of the Published Data." Mutagenesis 16 (2001): 91-101.

Pihl, R.O., M. Smith, and B. Farrell. "Individual Characteristics of Aggressive Beer and Distilled Beverage Drinkers." International Journal of the Addictions 19 (1984): 689-96.

Pollack, E.S. "Prospective Study of Alcohol Consumption and Cancer." New England Journal of Medicine 310 (1984): 617-21.

Weinberg, N.Z. "Cognitive and Behavioral Deficits Associated with Parental Alcohol Use." Journal of the American Academy of Child and Adolescent Psychiatry 36 (1997): 1177-86.

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