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Ethanol (simply called alcohol) is a psychoactive drug primarily found in alcoholic beverages. Alcohol is one of the most commonly abused drugs in the world (Meropol, 1996) often used for self-medication, and as recreational drug use.

Human consumption

Alcoholic beverages

Ethanol is the principal psychoactive constituent in alcoholic beverages. With depressant effects on the central nervous system, it has a complex mode of action and affects multiple systems in the brain, most notably increasing the activity of GABA receptors. Through positive allosteric modulation, it enhances the activity of naturally produced GABA. Other psychoactives such as benzodiazepines, barbiturates exert their effects by binding to the same receptor complex, thus have similar CNS depressant effects.

Alcoholic beverages vary considerably in ethanol content and in foodstuffs they are produced from. Most alcoholic beverages can be broadly classified as fermented beverages, beverages made by the action of yeast on sugary foodstuffs, or distilled beverages, beverages whose preparation involves concentrating the ethanol in fermented beverages by distillation. The ethanol content of a beverage is usually measured in terms of the volume fraction of ethanol in the beverage, expressed either as a percentage or in alcoholic proof units.

Fermented beverages can be broadly classified by the foodstuff they are fermented from. Beers are made from cereal grains or other starchy materials, wines and ciders from fruit juices, and meads from honey. Cultures around the world have made fermented beverages from numerous other foodstuffs, and local and national classifications for various fermented beverages abound.

Distilled beverages are made by distilling fermented beverages. Broad categories of distilled beverages include whiskeys, distilled from fermented cereal grains; brandies, distilled from fermented fruit juices; and rum, distilled from fermented molasses or sugarcane juice. Vodka and similar neutral grain spirits can be distilled from any fermented material (grain and potatoes are most common); these spirits are so thoroughly distilled that no tastes from the particular starting material remain. Numerous other spirits and liqueurs are prepared by infusing flavors from fruits, herbs, and spices into distilled spirits. A traditional example is gin, which is created by infusing juniper berries into a neutral grain alcohol.

The ethanol content in alcoholic beverages can be increased by means other than distillation. Applejack is traditionally made by freeze distillation, by which water is frozen out of fermented apple cider, leaving a more ethanol-rich liquid behind. Ice beer (also known by the German term Eisbier or Eisbock) is also freeze-distilled, with beer as the base beverage. Fortified wines are prepared by adding brandy or some other distilled spirit to partially fermented wine. This kills the yeast and conserves a portion of the sugar in grape juice; such beverages are not only more ethanol-rich but are often sweeter than other wines.

Alcoholic beverages are used in cooking for their flavors and because alcohol dissolves hydrophobic flavor compounds.

Just as industrial ethanol is used as feedstock for the production of industrial acetic acid, alcoholic beverages are made into vinegar. Wine and cider vinegar are both named for their respective source alcohols, whereas malt vinegar is derived from beer.

Antidote for poisoning by other alcohols

Ethanol is sometimes used to treat poisoning by other, more toxic alcohols, in particular methanol and ethylene glycol. Ethanol competes with other alcohols for the alcohol dehydrogenase enzyme, lessening metabolism into toxic aldehyde and carboxylic acid derivatives, and reducing one of the more serious toxic effect of the glycols to crystallize in the kidneys.

Historical uses

Before the development of modern medicines, ethanol was used for a variety of medical purposes. It has been known to be used as a truth drug (as hinted at by the maxim "in vino veritas"), as medicine for depression and as an anesthetic.

Ethanol was commonly used as fuel in early bipropellant rocket (liquid propelled) vehicles, in conjunction with an oxidizer such as liquid oxygen. The German V-2 rocket of World War II, credited with beginning the space age, used ethanol, mixed with 25% of water to reduce the combustion chamber temperature. The V-2's design team helped develop U.S. rockets following World War II, including the ethanol-fueled Redstone rocket which launched the first U.S. satellite. Alcohols fell into general disuse as more efficient rocket fuels were developed.

Pharmacology

Ethanol binds to α₇-nAChRs as an agonist, GABA receptor (especially the δ subunit) as a positive allosteric modulator, 5-HT3 receptor agonist, NMDA receptor antagonist, AMPA receptor antagonist, Kainate receptor antagonist, glycine receptor agonist and an inhibitor of potassium, sodium and calcium ion channels. It also appears to cause an increase in dopamine through a poorly understood process that may involve inhibiting the enzyme that breaks dopamine down. Ethanol also appears to block the reuptake of adenosine.

The removal of ethanol through oxidation by alcohol dehydrogenase in the liver from the human body is limited. Hence, the removal of a large concentration of alcohol from blood may follow zero-order kinetics. This means that alcohol leaves the body at a constant rate, rather than having an elimination half-life.

Also, the rate-limiting steps for one substance may be in common with other substances. For instance, the blood alcohol concentration can be used to modify the biochemistry of methanol and ethylene glycol. Methanol itself is not highly toxic, but its metabolites formaldehyde and formic acid are; therefore, to reduce the concentration of these harmful metabolites, ethanol can be ingested to reduce the rate of methanol metabolism due to shared rate-limiting steps. Ethylene glycol poisoning can be treated in the same way.

Pure ethanol will irritate the skin and eyes. Nausea, vomiting and intoxication are symptoms of ingestion. Long-term use by ingestion can result in serious liver damage. Atmospheric concentrations above one in a thousand are above the European Union Occupational exposure limits.

Short-term

Effects on the central nervous system

Ethanol is a central nervous system depressant and has significant psychoactive effects in sublethal doses; for specifics, see "Effects of alcohol on the body by dose". Based on its abilities to change the human consciousness, ethanol is considered a psychoactive drug. Death from ethanol consumption is possible when blood alcohol level reaches 0.4%. A blood level of 0.5% or more is commonly fatal. Levels of even less than 0.1% can cause intoxication, with unconsciousness often occurring at 0.3–0.4%.

The amount of ethanol in the body is typically quantified by blood alcohol content (BAC), which is here taken as weight of ethanol per unit volume of blood. The table at the right summarizes the symptoms of ethanol consumption. Small doses of ethanol, in general, produce euphoria and relaxation; people experiencing these symptoms tend to become talkative and less inhibited, and may exhibit poor judgment. At higher dosages (BAC > 1 g/L), ethanol acts as a central nervous system depressant, producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death.

Ethanol acts in the central nervous system by binding to the GABA-A receptor, increasing the effects of the inhibitory neurotransmitter GABA (i.e., it is a positive allosteric modulator).

Prolonged heavy consumption of alcohol can cause significant permanent damage to the brain and other organs. See Alcohol consumption and health.

According to the US National Highway Traffic Safety Administration, in 2002 about "41% of people fatally injured in traffic crashes were in alcohol related crashes". The risk of a fatal car accident increases exponentially with the level of alcohol in the driver's blood. Most drunk driving laws governing the acceptable levels in the blood while driving or operating heavy machinery set typical upper limits of blood alcohol content (BAC) between 0.02% and 0.08%.

Discontinuing consumption of alcohol after several years of heavy drinking can also be fatal. Alcohol withdrawal can cause anxiety, autonomic dysfunction, seizures, and hallucinations. Delirium tremens is a condition that requires people with a long history of heavy drinking to undertake an alcohol detoxification regimen.

The reinforcing effects of alcohol consumption are also mediated by acetaldehyde generated by catalase and other oxidizing enzymes such as cytochrome P-4502E1 in the brain. Although acetaldehyde has been associated with some of the adverse and toxic effects of ethanol, it appears to play a central role in the activation of the mesolimbic dopamine system.

Effects on metabolism

Ethanol within the human body is converted into acetaldehyde by alcohol dehydrogenase and then into the acetyl in acetyl CoA by acetaldehyde dehydrogenase. Acetyl CoA is the final product of both carbohydrate and fat metabolism, where the acetyl can be further used to produce energy or for biosynthesis. As such, ethanol is a nutrient. However, the product of the first step of this breakdown, acetaldehyde, is more toxic than ethanol. Acetaldehyde is linked to most of the clinical effects of alcohol. It has been shown to increase the risk of developing cirrhosis of the liver and multiple forms of cancer.

During the metabolism of alcohol via the respective dehydrogenases, NAD (Nicotinamide adenine dinucleotide) is converted into reduced NAD. Normally, NAD is used to metabolise fats in the liver, and as such alcohol competes with these fats for the use of NAD. Prolonged exposure to alcohol means that fats accumulate in the liver, leading to the term 'fatty liver'. Continued consumption (such as in alcoholism) then leads to cell death in the hepatocytes as the fat stores reduce the function of the cell to the point of death. These cells are then replaced with scar tissue, leading to the condition called cirrhosis.

Drug interactions

Ethanol can intensify the sedation caused by other central nervous system depressant drugs such as barbiturates, benzodiazepines, opioids, non-benzodiazepines (such as Zolpidem and Zopiclone), antipsychotics, sedative antihistamines, and antidepressants. It interacts with cocaine in vivo to produce cocaethylene, another psychoactive substance.

Alcohol and metronidazole

One of the most important drug/food interaction that should be noted is between alcohol and metronidazole.

Metronidazole is an antibacterial agent that kills bacteria by damaging cellular DNA and hence cellular function. Metronidazole is usually given to people who have diarrhea caused by Clostridium difficile bacteria. C. difficile is one of the most common microorganisms that cause diarrhea and can lead to complications such as colon inflammation and even more severely, death.

Patients who are taking metronidazole are strongly advised to avoid alcohol, even after 1 hour after the last dose. The reason is that alcohol and metronidazole can lead to side effects such as flushing, headache, nausea, vomiting, abdominal cramps, and sweating. These symptoms are often called the disulfiram-like reaction. The proposed mechanism of action for this interaction is that metronidazole can bind to an enzyme that normally metabolizes alcohol. Binding to this enzyme may impair the liver's ability to process alcohol for proper excretion.

Alcohol and digestion

A part of ethyl alcohol is hydrophobic. This hydrophobic or lipophilic end can diffuse across cells that line the stomach wall. In fact, alcohol is one of the rare substances that can be absorbed in the stomach. Most food substances are absorbed in the small intestine. However, even though alcohol can be absorbed in the stomach, it is mostly absorbed in the small intestine because the small intestine has a large surface area that promotes absorption. Once alcohol is absorbed in the small intestine, it delays the release of stomach contents from emptying into the small intestine. Thus, alcohol can delay the rate of absorption of nutrients. After absorption, alcohol reaches the liver where it is metabolized.

How Breathalyzers work:
Alcohol that is not processed by the liver goes to the heart. The liver can process only a certain amount of alcohol per unit time. Thus, when a person drinks too much alcohol, more alcohol can reach the heart. In the heart, alcohol reduces the force of heart contractions. Consequently, the heart will pump less blood, lowering overall body blood pressure. Also, blood that reaches the heart goes to the lungs to replenish blood's oxygen concentration. It is at this stage that a person can breathe out traces of alcohol. This is the underlying principle of the alcohol breath testing (or breathalyzers) to determine if a driver has been drinking and driving.

From the lungs, blood returns to the heart and will be distributed throughout the body. Interestingly, alcohol increases levels of high-density lipoproteins(HDLs), which carry cholesterol. Alcohol is known to make blood less likely to clot, reducing risk of heart attack and stroke. This could be the reason why alcohol could produce health benefits when consumed in moderate amounts. Also, alcohol dilates blood vessels. Consequently, a person will feel warmer, and their face turns flush and pink.

Why people lose their sense of balance after drinking alcohol:
When alcohol reaches the brain, it has the ability to delay signals that are sent between nerve cells that control balance, thinking and movement.

Why people frequently urinate after drinking alcohol:
Moreover, alcohol can affect the brain's ability to produce antidiuretic hormones. These hormones are responsible for controlling the amount of urine that is produced. Alcohol prevents the body from reabsorbing water, and consequently a person who recently drank alcohol will urinate frequently.

Alcohol and gastrointestinal diseases

Alcohol stimulates gastric juice production, even when food is not present. In other words, when a person drinks alcohol, the alcohol will stimulate stomach's acidic secretions that are intended to digest protein molecules. Consequently, the acidity has potential to harm the inner lining of the stomach. Normally, the stomach lining is protected by a mucus layer that prevents any acids from reaching the stomach cells.

However, in patients who have a peptic ulcer disease (PUD), this mucus layer is broken down. PUD is commonly associated with a bacteria H. pylori. H. pylori secretes a toxin that weakens the mucosal wall. As a result, acid and protein enzymes penetrate the weakened barrier. Because alcohol stimulates a person's stomach to secrete acid, a person with PUD should avoid drinking alcohol on an empty stomach. Drinking alcohol would cause more acid release to damage the weakened stomach wall. 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. A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.

Magnitude of effects

Some individuals have less effective forms of one or both of the metabolizing enzymes, and can experience more severe symptoms from ethanol consumption than others. However, those having acquired alcohol tolerance have a greater quantity of these enzymes, and metabolize ethanol more rapidly.

Long-term

Birth defects

Ethanol is classified as a teratogen. See fetal alcohol syndrome and fetal alcohol spectrum disorder.

Cancer

IARC list ethanol in alcoholic beverages as Group 1 carcinogens and arguments "There is sufficient evidence for the carcinogenicity of acetaldehyde (the major metabolite of ethanol) in experimental animals.".

Other effects

Frequent drinking of alcoholic beverages has been shown to be a major contributing factor in cases of elevated blood levels of triglycerides.

Ethanol is also widely used, clinically and over the counter, as an antitussive agent.

Recreational

Since ancient times, people around the world have been drinking alcoholic beverages. Reasons for drinking alcoholic beverages vary and include:

• Recreational purposes: Anxiolytic, and euphoric effects
• Artistic inspiration
• Putative aphrodisiac effects
• Medical purposes

In countries that have a drinking culture, social stigma may cause many people not to view alcohol as a drug because it is an important part of social events. In these countries, many young binge drinkers prefer to call themselves hedonists rather than binge drinkers or recreational drug users. Undergraduate students often position themselves outside the categories of "serious" or "anti-social" drinkers. However, about 40 percent of college students in the United States could be considered alcoholics according to new criteria in Diagnostic and Statistical Manual of Mental Disorders 5 but most college binge drinkers and drug users don't develop lifelong problems.

Controversial entheogen

Some religions forbid, discourage, or restrict the drinking of alcoholic beverages for various reasons. These include Islam, Jainism, Sikhism, the Bahá'í Faith, the Church of God In Christ, The Church of Jesus Christ of Latter-day Saints, the Seventh-day Adventist Church, the Church of Christ, Scientist, the United Pentecostal Church International, Theravada, most Mahayana schools of Buddhism, some Protestant denominations of Christianity, some sects of Taoism (Five Precepts (Taoism) and Ten Precepts (Taoism)), and some sects of Hinduism. In some regions with a dominant religion the production, sale, and consumption of alcoholic beverages is forbidden to everybody, regardless of religion. For instance, some Islamic states, including member states of the Organisation of Islamic Cooperation, such as Afghanistan, Bangladesh, Brunei, Iran, Kuwait, Libya, Saudi Arabia, Sudan, and Yemen, prohibit alcoholic beverages because they are forbidden by Islam.

In some religions alcoholic beverages are used for ritual purposes. For example, the Roman Catholic Church uses wine in the celebration of the Eucharist; in Judaism kosher wine is used in holidays and rituals.

Carnival in the Netherlands is historically a Roman Catholic feast which is well known for its excessive drinking of alcohol.

Effects

Short-term effects of alcohol consumption include intoxication and dehydration.

Adverse effects

Short-term effects of alcohol of excessive amounts of alcohol can cause acute alcohol poisoning.

Long-term effects of alcohol include alcoholism (linked onset for Korsakoff's syndrome and many other alcohol related diseases), malnutrition, chronic pancreatitis, alcoholic liver disease, cancer and damage to the central nervous system and peripheral nervous system. IARC list ethanol in alcoholic beverages as Group 1 carcinogens and arguments "There is sufficient evidence for the carcinogenicity of acetaldehyde (the major metabolite of ethanol) in experimental animals.".

Alcohols

In nature all alcohols act as psychoactive drugs which vary in potency and effects. Excessive concentrations of some alcohols (other than ethanol) may cause off-flavors, sometimes described as "spicy", "hot", or "solvent-like".

Some beverages, such as rum, whisky (especially Bourbon), incompletely rectified vodka (e.g. Siwucha), and traditional ales and ciders, are expected to have relatively high concentrations of non-hazardous aroma alcohols as part of their flavor profile; European legislation demands minimum content of higher alcohols in certain distilled beverages (spirits) to give them their expected distinct flavour. However, in other beverages, such as Korn, vodka, and lagers, the presence of other alcohols than ethanol is considered fusel alcohols.

Poly drug products

Caffeinated alcohol

Caffeinated alcoholic drinks combine alcohol, caffeine, and the ingredients of energy drinks into one drink. In 2010 and 2011, this type of beverage faced criticism for posing health risks to their drinkers. Alcohol and caffeine are both psychoactive drugs, drugs that are mixed are referred to as poly drug use. As a response FDA have introduced a caffeinated alcohol drinks ban.

However, to date a few ready to drink product exist including 3 A.M. Vodka.

Tragedies

In 2005 a mother infanticided her month-old baby with a microwave oven by cooking her for 2 minutes. China Arnold claimed to be under the influence of alcohol and Galbraith testified that Arnold told him during his initial questioning: "If I hadn't gotten so drunk, I guess my baby wouldn't have died.". On May 20, 2011, Arnold was sentenced to life imprisonment without parole. Her attorney says they will appeal the decision.

In November 2011, Rehtaeh Parsons, then 15, allegedly went with a friend to a home in which she was reportedly gang raped by 4 teenage boys. The teenagers were drinking vodka at a small party. Parsons had little memory of the event, except that at one point she vomited. While a boy was allegedly raping her, the incident was photographed and the photo became widespread in Parsons' school and town in three days. Afterwards, many in school called Parsons a "slut" and she received texts and Facebook messages from people requesting to have sex with her. The alleged rape went unreported for several days until Parsons broke down and told her family, who contacted an emergency health team and the police. Later the Cole Harbour District High School student, Parsons, attempted suicide by hanging on April 4, 2013, at her home in Dartmouth, Nova Scotia, Canada, leading to a coma and the decision to switch her life support machine off on April 7, 2013.

Legal status

Alcohol laws regulate the manufacture, sale, and consumption of alcoholic beverages. Such laws often seek to reduce the availability of these beverages for the purpose of reducing the health and social effects of their consumption.

In particular, such laws specify the legal drinking age which usually varies between 16 and 25 years, sometimes depending on the type of drink. Some countries do not have a legal drinking or purchasing age, but most set the age at 18 years. This can also take the form of distribution only in licensed stores or in monopoly stores. Often, this is combined with some form of taxation. In some jurisdictions alcoholic beverages have been totally prohibited for reasons of religion (e.g., Islamic countries with certain interpretations of sharia law) or perceived public morals and health (e.g., Prohibition in the United States from 1920 to 1933).

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External links

• Emerald Media Group: About 37 percent of college students could now be considered alcoholics
• Alcohol, Health-EU Portal
• International Center for Alcohol Policies — Website
• International Center for Alcohol Policies — List of Tables
• National Institute on Alcohol Abuse and Alcoholism - What Is a Standard Drink?
• Most Widely Consumed Alcoholic Beverages

Template:Physical dependants