What is alcohol?

Alcohol is the ingredient found in beer, wine and spirits which causes drunkenness.

Alcohol is formed when yeast ferments (breaks down without oxygen).

Alcohol is classed as a
sedative hypnotic drug, which means it acts to depress the central nervous system at high doses.

At lower doses, alcohol can act as a stimulant, inducing feelings of euphoria and talkativeness, but drinking too much alcohol at one session can lead to drowsiness, respiratory depession (where breathing becomes slow, shallow or stops entirely), coma or even death.

As well as its acute and potentially lethal sedative effect at high doses, alcohol has effects on every organ in the body, and these effects depend on the blood alcohol concentration (BAC) over time.

After a drink is swallowed, the alcohol is rapidly absorbed into the blood (20 percent through the stomach and 80 percent through the small intestine), with effects felt within 5 to 10 minutes after drinking.

It usually peaks in the blood after 30 to 90 minutes, and thus is carried through all the organs of the body.

Most of the metabolism, or breaking down, of alcohol from a toxic substance to water and carbon dioxide is performed by the liver, with the rest excreted through the lungs, through the kidneys (into urine) and in sweat.

The blood alcohol concentration rises, and the feeling of drunkenness occurs, when alcohol is drunk faster than the liver can break it down. 

The blood alcohol concentration level, and every individual
s reaction to alcohol, is influenced by:

The ability of the liver to metabolise alcohol (which varies due to genetic differences in the liver enzymes that break down alcohol.

The presence or absence of food in the stomach (food dilutes the alcohol and dramatically slows its absorption into the bloodstream by preventing it from passing quickly into the small intestine)

The concentration of alcohol in the beverage (highly concentrated beverages such as spirits are more quickly absorbed)

How quickly alcohol is drunk

Body type (heavier and more muscular people have more fat and muscle to absorb the alcohol)

Age, sex, ethnicity (e.g. women have a higher BAC after drinking the same amount of alcohol than men due to differences in metabolism and absorption -since men have on average more fluid in their body to distribute alcohol around than women do; some ethnic groups have different levels of a liver enzyme responsible for the breakdown of alcohol)

How frequently a person drinks alcohol (someone who drinks often can tolerate the sedating effects of alcohol more than someone who does not regularly drink).

Body effects of alcohol
1. Some impairment in motor coordination and thinking ability.
2. Talkativeness

3. Relaxation
4. Altered mood (increased well-being or unhappiness)

5. Friendliness, shyness or argumentativeness
6. Impaired concentration and judgement

7. Sexual disinhibition
8. Slurred speech

9. Unsteady walking
10. Nausea

11. Double vision
12. Increased heart rate

13. Drowsiness

14. Mood, personality and behaviour changes which may be sudden, angry and antisocial

15.300 mg/dL Unresponsive/extremely drowsy
16. Speech incoherent/confused

17. Memory loss
18. Vomiting

19. Heavy breathing
20. Breathing slowed, shallow or stopped
21. Coma

As well as potentially affecting the physical and mental health of individuals in many ways, chronic and heavy alcohol use can increase the risk of death, for example through acute alcohol poisoning or because alcohol causes a fatal disease such as cancer, or indirectly, such as alcohol being a factor in violent death or suicide.

Unintentional injuries from alcohol use often result from falls, burns, motor vehicle accidents, assaults and drowning.

Blood and immune system
Long-term effects of alcohol use

Chronic heavy alcohol use can cause abnormalities in the blood,
leading to anaemia (low hemoglobin, the component of blood that carries oxygen around the body) and low platelets (platelets help prevent bleeding).

Chronic heavy alcohol use also suppresses the immune system
(such as affecting the white blood cells that fight infections), making it more difficult for the body to fight off both viral and bacterial infections.

Bones and muscles
Immediate effects of alcohol use

Alcohol use causes many different types of injuries, including injuries from road traffic accidents, assaults and falls.

This is usually because high levels of blood alcohol impair the brain
s thought processes and the coordination of muscles, causing clumsiness and difficulty in walking.

Common injuries seen at the emergency department include cuts, bruises, sprains and broken bones.

The risk of injury in the six hours after drinking doubles with four standard drinks and increases rapidly the more alcohol is drunk on a single occasion.

Chronic heavy use is also associated with a painful condition where bone tissue dies (osteonecrosis), gout (a type of arthritis or inflammation of the joints, often affecting the joint of the big toe), and muscle wasting and weakness.

Brain and nervous system
Being drunk
impairs judgment, inhibitions and concentration, and in increasing amounts leads to drowsiness and coma.

The loss of memory for a period of drunkenness (alcoholic blackout) can occur in occasional as well as regular heavy drinkers, and is due to alcohol interfering with the laying down of memories.

Chronic heavy alcohol use can also damage the part of the brain responsible for balance and coordination (the cerebellum), leading to instability and problems with walking.

It can also damage peripheral nerves in the body, leading to pain, weakness, numbness and the inability to sense touch.

In rare cases it can damage specific centres in the brain, leading to loss of mental function, inability to walk and death and can lead to the development of epilepsy (chronic fits) and sleep disturbances.

Although individuals suffering from insomnia sometimes use alcohol to treat the insomnia, tolerance to the sedating effect of alcohol is likely to occur, increasing the risk of excessive use.

Also, if more than one or two drinks are taken in the evening, sleep can be disrupted, increasing the chances of a person waking in the night and finding it hard to fall back asleep.

The relationship between alcohol use and stroke, where there is a sudden paralysis, loss of sensation or inability to talk because the blood supply to the brain is interrupted, is complex.

Alcohol increases the risk of hemorrhagic stroke, where the stroke is caused by bleeding in the brain.

However, low to moderate alcohol use (one to two drinks a day) reduces the risk of ischaemic stroke, which is caused by blockage of the blood vessels in the brain, but higher levels of alcohol use increase the risk of ischaemic stroke.

Breasts - Women
Long-term alcohol use increases the risk of breast cancer, with higher use resulting in a higher risk of cancer. A significantly elevated risk is seen from drinking even one or two drinks of alcohol a day.

The risk increases on average by about 10 percent for every one standard drink of alcohol per day.

Being drunk can cause blurred or double vision.

Chronic heavy alcohol use, when coupled with a diet low in vitamin B1 and B12, may lead to decreased vision.
Heart* and blood pressure

Heavy chronic alcohol use is also linked to high blood pressure, particularly in men. Blood pressure increases with drinking more than two or three drinks day on average and restriction of alcohol lowers the blood pressure.

Drinking alcohol in order to
protect the heart is not advisable, since alcohol is an addictive drug that causes cancer, increases the risk of injury and causes damage to the fetus in pregnant women.

People can find it difficult to limit their drinking to one or two standard drinks a day and heavy drinking actually increases the risk of heart disease.

People who have risk factors for or have established heart disease should focus on other factors such as cigarette smoking, high cholesterol, high blood pressure, diabetes, overweight and physical inactivity.

Young and middle-aged adults, especially women, are more likely to experience harm than benefit from alcohol use due to risk from injury and, for women, increased risk from breast cancer.

Long-term effects of alcohol use
Long- term alcohol use can cause cancer of the large bowel/intestines and rectum.

Alcohol can lead to malnutrition and diseases due to low vitamin levels, as it blocks the absorption of many important vitamins and nutrients in the gut.

Kidneys and fluid balance
Alcohol is a diuretic, meaning that it causes water to be lost from the body through the kidneys (into urine), which can lead to dehydration.

Alcohol can also cause the loss of important minerals and salts from the body such as magnesium, calcium, phosphate, sodium and potassium, either directly or because alcohol induces vomiting.

Low levels of these elements can cause many problems ranging from irregular heartbeats to seizures.

Chronic heavy alcohol use can damage the liver, causing alcoholic liver disease. This occurs across spectrum from fatty liver, to acute alcoholic hepatitis, to cirrhosis.

Fatty liver, where fat builds up in the liver cells, is very common in heavy drinkers and is reversible if drinking is reduced.

However, a small percentage of people with fatty liver will develop alcoholic hepatitis, cirrhosis or liver cancer.

Alcoholic hepatitis develops in 10 to 35 percent of heavy drinkers and is an acute injury to the liver which can present with symptoms of feeling unwell, tiredness, jaundice (yellow skin and whites of eyes), swollen stomach and enlarged, tender liver.

Death from liver failure can occur in severe cases. Cirrhosis of the liver develops in 5 to 15 percent of heavy drinkers and is where the liver is permanently damaged and cells are replaced by scar tissue, so the liver can no longer function (to detoxify the body, make vital proteins, store vitamins and sugars, and make chemicals necessary for digestion). Cirrhosis can also lead to death from liver failure.

Treatment for alcoholic liver disease must include stopping the drinking of alcohol.

Alcohol also causes liver cancer, and treatment options are often limited if alcoholic liver disease is present or the cancer has spread widely by the time of diagnosis. This means liver cancer is often quickly fatal.

*The evidence for the effects of alcohol on the heart is mixed and often controversial. This section is a brief summary of the evidence available at the time of publication.

Immediate effects of alcohol use

Being drunk increases the risk of pneumonia (inflammation of the lungs, usually caused by infection from bacteria or viruses).

This is because, at high blood concentrations, alcohol is sedating and relaxes the mouth and throat, suppresses reflexes (like the gag and cough reflexes), and reduces the ability of the lungs to clear mucus and foreign matter, so that vomit, saliva or other substances may enter the lungs and cause inflammation and infection (bronchitis or pneumonia).

Chronic heavy alcohol use is also associated with higher rates of pneumonia, tuberculosis (an infectious disease that affects primarily the lungs but also any other part of the body), and acute respiratory distress syndrome (ARDS
- a life-threatening condition in which the lungs fill with fluid, which occurs as a rare complication of pneumonia, trauma and severe infections).

In addition to the ways in which acute alcohol use can cause pneumonia, chronic heavy alcohol use also impairs the immune system and changes the bacteria present in the mouth to those more likely to cause infections, making people more vulnerable to pneumonia.

Alcohol affects mood in a variety of ways, and can make people feel happy, sad or aggressive, and can also cause moods swing.

However, there is a risk of becoming dependent on alcohol if it is used as a primary means to relieve stress and anxiety without addressing the underlying causes.

Because it removes inhibitions and increases aggression and recklessness, alcohol is often found in the blood of people, who self harm, or attempt or complete suicide.

Long-term effects of alcohol use
Alcohol is addictive and can lead to dependency.

This is where the body requires more alcohol to achieve the desired effect (e.g. altered mood), where use of alcohol interferes with a person
s life (causing legal, work/ study, relationship or social problems), where a person continues to use alcohol despite it causing physical or mental problems, and where, if alcohol is not taken, withdrawal symptoms occur.

The severity of withdrawal symptoms depends on the quantity of alcohol consumed and the length of the drinking session.

Symptoms include shaking of the hands, which commonly occurs the morning after the drinking session and may be relieved by more alcohol.

If alcohol is not taken, symptoms can progress to insomnia, increased heart rate, temperature and blood pressure, sweating, agitation, nausea, flushing of the face, nightmares, hallucinations (seeing, hearing or feeling things that are not present) and fits.

The most serious withdrawal syndrome is
delirium tremens, which develops in about 5 percent of people with alcohol withdrawal (more if fits are not treated) and by definition includes the symptom of delirium (an altered and confused state of mind).

This syndrome has a death rate of around 5 percent.

In people who drink heavily, alcohol commonly causes mood disorders, including depression, anxiety and psychosis (a mental illness defined by changes in personality, a distorted sense of reality, and delusions). 

If these disorders only occur during drinking sessions or withdrawal, they will usually resolve once drinking is stopped. Alcohol abuse and dependency are also common in people with pre-existing mental health conditions.

Mouth and throat
Immediate effects of alcohol use

Being drunk can have various effects on speech, such as making people more friendly, talkative, unreserved, relaxed or argumentative.

Increasing amounts of alcohol can cause aggressive, antisocial, angry, slurred and confused speech.

Alcohol is a carcinogen, meaning that it causes cancers in humans. Regular alcohol use increases the risk of cancers of the mouth, throat and voice box.

Drinking around 50g of alcohol a day (five standard drinks) increases the risk of these cancers by two to three times compared with non-drinkers, but for people who smoke, this risk is increased much more.

Drinking more increases the risk of cancers, and drinking less decreases the risk of cancers.

Pancreas and Digestion of sugar
Immediate effects of alcohol use
Heavy alcohol use on a single occasion can lead to dangerously low blood sugar (hypoglycemia), which can cause symptoms of shaking, sweating, dizziness, blurred vision and, if not treated, brain damage.

The pancreas is a gland that secretes digestive enzymes and releases insulin, which regulates sugar levels in the blood.

Chronic heavy alcohol use can cause acute pancreatitis (sudden inflammation of and damage to the pancreas that resolves over several days) and chronic pancreatitis (inflammation of the pancreas that does not heal and worsens over time).

Acute pancreatitis typically causes abdominal and back pain, nausea and fever and may occur a few hours or up to two days after drinking alcohol.

In 20 to 30 percent of people, acute pancreatitis is a severe, life threatening condition, which requires treatment in hospital.

Chronic pancreatitis typically occurs in people aged 30 to 40 years and can cause abdominal pain, weight loss, diabetes, malnutrition and oily bowel motions (because the pancreas helps to digest fat and when the pancreas is damaged, fats are excreted out of the bowel instead of being absorbed into the body).

The risk of acute and chronic pancreatitis increases with higher alcohol use. Moderate alcohol use is associated with a reduced risk of developing type 2 diabetes, although the exact reason for this is not certain.

Sexual health - Men
Immediate effects of alcohol use
Being drunk increases the chances of having unsafe sex (without a condom), having sex that is later regretted or experiencing sexual assault as alcohol impairs judgment and lowers inhibitions.

These factors are also likely to increase the risk of getting a sexually transmitted infection. Chronic heavy alcohol use can lead to impotence, loss of sex drive, wasting of the testicles and reduced fertility.

This is primarily because alcohol affects testosterone levels.

Chronic heavy alcohol use can lead to reduced fertility and can make periods heavy or irregular or stop altogether.

Consuming alcohol while pregnant may increase the risk of miscarriage, low birth weight, stillbirth and premature birth.

It can also cause significant abnormalities in the unborn, developing baby (fetal alcohol spectrum disorder).

Acute alcohol use can lead to skin flushing and worsen the appearance of skin conditions such as rosacea (a chronic facial skin rash).

Chronic heavy alcohol use, when associated with serious liver disease and liver failure, can also cause yellowing of the skin, decreased body hair and spider veins.

Alcohol is also an appetite stimulant, and people tend to eat more when consuming alcohol with their meals.

However, while theoretically the potential for alcohol to increase weight is clear, and some studies find that alcohol use is associated with increased weight, others find the opposite result.

Alcohol seems more likely to cause weight gain in those who drink intermittently (moderately to heavily), in those who are already overweight, in those eating a high-fat diet, and in men.

For people concerned about their weight, nutritionists advise people to take into account how much energy alcohol is contributing to their diet.

Chronic heavy drinkers are likely to be malnourished as alcohol has little nutritional value and replaces nutritious food in the diet.

Being drunk can lead to nausea and vomiting, diarrhea, heartburn (when acid from the stomach rises up into the food pipe, due to alcohol causing the muscle around the outlet of the stomach to relax) and acute gastritis (inflammation of the lining of the stomach, which causes stomach pain, nausea, loss of appetite and indigestion).

Vomiting and diarrhea can result in dehydration, salt imbalances and the build-up of acids in the body, especially in combination with excessive alcohol intake.

Inhaling vomit can lead to bronchitis or pneumonia (infection of the lungs). Vomit can block the airway and windpipe when blood alcohol is very high and breathing and consciousness are impaired.

Persistent vomiting and retching after heavy use on a single occasion can sometimes (but only rarely) rip the food pipe (a Mallory Weiss tear), which leads to vomiting of blood.

Long-term alcohol use can cause cancer of the food pipe (esophagus) and drinking 50g of alcohol a day (five standard drinks) doubles the risk compared with a non-drinker.

However, the risk is much greater in people who drink alcohol who are also deficient in a liver enzyme that metabolizes alcohol (East Asian populations are commonly deficient in this enzyme).

The risk is also increased in smokers.

Chronic heavy alcohol use can also lead to chronic gastritis but alcohol may protect against infection from Helicobacter pylori, the bacteria that cause ulcers of the stomach.

In cases of advanced liver disease due to prolonged heavy alcohol use, the veins to the stomach and esophagus can swell and may burst, causing life-threatening bleeding.

The relationship between alcohol use and some health conditions is complex.

For example, drinking a small amount of alcohol may be beneficial in preventing heart disease in older adults, but drinking a lot of alcohol can also damage the heart.

For other health conditions, alcohol is the single cause of the condition, such as alcoholic cirrhosis of the liver, fetal alcohol spectrum disorder (FASD) and alcohol-induced pancreatitis.

For many other health conditions, alcohol is one cause, among others, of the condition
- for example, cancers and pneumonia.

Overall, alcohol is a cause of more than 60 different health conditions and, for almost all conditions, heavier alcohol use means higher risk of disease or injury.

Alcohol poisoning
Alcohol poisoning, known in emergency departments as acute intoxication, is when a large amount of alcohol is drunk, followed shortly afterwards by changes in mood or behaviour, impaired judgment or social functioning, and one or more physical signs of drunkenness, such as slurred speech, unsteadiness, lack of coordination, impaired attention or loss of consciousness.

The physical effects of alcohol poisoning are many, from nausea, vomiting and dehydration, which are familiar symptoms to those who may have drunk too much on one occasion, to the worst complication
- death.

The term
alcohol poisoning is sometimes used to describe the most serious and life-threatening complications of alcohol overdose, such as slowed breathing and loss of consciousness.

The lethal dose of alcohol is 5 to 8g/kg (3g/kg for children)[6]
- that is, for a 60kg person, 300g of alcohol can kill, which is equal to 30 standard drinks (about 1 litre of spirits or four bottles of wine).

Health effects of acute alcohol use
A hangover can occur in anyone after a single episode of heavy alcohol use. Symptoms include headache, nausea, vomiting, sweating, fatigue, shakiness, sensitivity to light, and irritability.

Typically, symptoms start a few hours after drinking stops, when blood alcohol is falling, and peak at the time the blood alcohol concentration is zero, but may continue for 24 hours after this.

Alcohol causes hangover symptoms through dehydration (which causes thirst, dizziness and weakness), irritation of the stomach and liver (which causes nausea, vomiting and stomach pain), low blood sugar (which causes fatigue and mood changes), and disturbance of sleep (which causes
jet lag symptoms).

The type of alcohol drunk may increase the chance of getting a hangover. Alcoholic drinks include compounds called congeners that add to the taste, smell or colour of the drink.

Alcohol with fewer congeners, such as gin and vodka, may cause fewer hangover effects than alcohol with more congeners, such as brandy, whisky and red wine.

The only cure for a hangover is time, although drinking water or fruit juice and eating bland food such as toast or crackers may help with dehydration and low blood sugar.

Paracetamol should be avoided as this can be toxic to the liver during a hangover.

Aspirin and anti-inflammatory medicines should also be avoided if nausea or stomach pain is present, as these can aggravate acute gastritis caused by alcohol, but antacids can be useful.

Potential symptoms and complications of acute intoxication or alcohol poisoning, by body part affected.

Body parts affected Symptoms
Mouth Slurred/confused speech

Stomach and food pipe

Nausea, vomiting

Intestines Diarrhea

Pancreas and Sugar digestion

Kidneys and Fluid balance

Depleted salts and minerals

Heart and Blood pressure
Increased heart rate

Irregular heart rate
Lungs Slowed rate and depth of breathing (respiratory depression)

Brain and nervous system

Impaired concentration/attention
Blackouts/memory loss

Impaired consciousness/coma
Mental health Mood and personality changes

Aggression/antisocial behaviour
Suicide and self-harm

Sexual health Unsafe sex/STI/sexual assault
Unplanned pregnancy (females)

Bones and muscles Injuries
Eyes Blurred/double vision

Whole body Injuries

When drunk regularly over time and/or drunk in a pattern of heavy single drinking sessions, alcohol can cause a variety of health conditions.

These include cancers and other conditions such as alcoholic liver disease, which can range from reversible to permanent liver damage due to alcohol.

The risks of alcohol-related cancers and other health conditions caused by alcohol are greatest in those who are dependent on alcohol or drink heavily, and the risks increase with the average amount of alcohol drunk.
Health conditions related to chronic alcohol use

Body part affected Symptoms
Mouth Cancer of mouth, voice box and throat
Stomach and food pipe

Cancer of food pipe (esophagus)
Chronic gastritis

Intestines Cancer of bowel
Liver Cancer of liver

Alcoholic liver disease (fatty liver, hepatitis, cirrhosis)
Pancreas and sugar digestion

Acute and chronic pancreatitis
Heart and blood pressure

Coronary heart disease

Heart failure due to cardiomyopathy
Irregular heartbeat

Blood and immune system

Hepatitis C


Lungs Pneumonia

Brain and nervous system

Brain damage (Wernicke
s encephalopathy, Korsakoffs dementia, etc)
Nerve damage

Sleep disturbances

Mental health Addiction/dependence

Mood disorders
Withdrawal symptoms

Sexual health Impotence

Fetal alcohol spectrum disorder (in children born to women who drink while pregnant)
Premature birth/low birth weight (in babies born to women who drink while pregnant)

Breasts (women) Cancer of breast
Bones and muscles Muscle weakness

Eyes Decreased vision

Skin and fat Malnutrition
Whole body Death

Cardiovascular disease

The relationship between alcohol and cardiovascular disease (coronary artery disease and strokes) is complex.

In summary, low to moderate alcohol use (one to two drinks per day) can reduce the risk of coronary artery disease (where the coronary arteries, which supply blood to the heart, become narrowed or blocked, which leads to angina and heart attacks) and the risk of ischaemic stroke (stroke caused by blocked arteries in the brain) However, higher alcohol use increases the risk of coronary artery disease and ischaemic stroke.

In addition, any alcohol use increases the risk of hemorrhagic stroke (stroke caused by bleeding arteries in the brain).

Both single episodes of heavy alcohol use and chronic heavy use can also increase the risk of hypertension, developing irregular heartbeats and suffering sudden death from a cardiac cause.

The benefit of alcohol in reducing heart disease is primarily for those at risk of heart disease particularly older people and those with a family history of heart disease.

The treatment of alcohol related liver disease, alcohol related pancreatitis, alcohol related mood disorders, alcohol dependence, or brain damage due to alcohol involves stopping alcohol use.

Alcohol may also worsen other health conditions not related to alcohol and temporary reduction or stopping of alcohol use is recommended.

These include any disease of the liver, which can be worsened by alcohol use, infections, as heavy alcohol use can impair the immune system, and sleep disorders, as alcohol interferes with the sleep cycle.

Diabetes mellitus
People with diabetes are advised to discuss alcohol use with their health professional.

Those with well controlled diabetes can safely drink alcohol, although the risk of low blood sugar is increased if alcohol is drunk without food and insulin is used.

People with diabetes are advised to monitor blood sugars when drinking and to wear an alert bracelet.
The effects of drinking alcohol
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The effects of drinking alcohol