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An alcoholic beverage is a drink containing consumable alcohols, mostly ethyl alcohol (ethanol, EtOH). Alcoholic beverages are divided into three general classes for taxation and regulation of production: beers, wines, and spirits (or distilled beverage). They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption.^[3] In particular, such laws specify the minimum age at which a person may legally buy or drink them. This minimum age varies between 16 and 25 years, depending upon the country and the type of drink. Most nations set it at 18 years of age.^[3] Other alcohols than ethanol are usually present only in small quantities in alcoholic beverage and thus are not prohibited by law or regulated by taxation in most if not all countries.

In the human body, ethanol affects the gamma-aminobutyric acid (GABA) receptors and produces a depressant (neurochemical inhibitory) effect. Ethanol is similar to other sedative-hypnotics such as barbiturates and benzodiazepines both in its effect on the GABA_A receptor, although its pharmacological profile is not identical. It has anxiolytic, anticonvulsant, hypnotic, and sedative actions similar to many other sedative-hypnotic drugs. Ethanol is also cross-tolerant with benzodiazepines and barbiturates.^[4]

However, alcohol is the most widely abused substance and its chronic consumption causes neurobehavioral disorders.^[5] Alcohol dependence is known as alcoholism, a neurodegenerative disease which may lead to physical dependency that can be fatal in alcohol withdrawal syndrome due to its propensity to induce withdrawal convulsions.

The production and consumption of alcohol occurs in most cultures of the world, from hunter-gatherer peoples to nation-states.^[6]^[7] Alcoholic beverages are often an important part of social events in these cultures.

Beverages

Distilled beverage

A distilled beverage, spirit, or liquor is an alcoholic beverage containing ethanol that is produced by distilling (i.e., concentrating by distillation) ethanol produced by means of fermenting grain, fruit, or vegetables.^[8] The term hard liquor is used in North America to distinguish distilled beverages from undistilled ones (implicitly weaker).

Freeze distillation can concentrate methanol and fusel alcohols (by-products of fermentation which true distillation separates out) in applejack to unhealthy levels. As a result, many countries prohibit such applejack as a health measure.^[9] However, reducing methanol with the absorption of 4A molecular sieve is a practical method for production.^[10]

Distilled beverages excludes undistilled fermented beverages such as beer, wine, and cider. Vodka, gin, baijiu, tequila, whisky, brandy, and soju are examples of distilled beverages.

Rectified spirit

A rectified spirit, rectified alcohol, or neutral spirit is highly concentrated ethanol which has been purified by means of repeated distillation, a process that is called rectification. It typically contains 95% alcohol by volume (ABV). Rectified spirits are used in mixed drinks, in the production of liqueurs, for medicinal purposes, and as a household solvent.

In chemistry, a tincture is a solution that has alcohol as its solvent.

Neutral grain spirit

Neutral grain spirit (also called pure grain alcohol (PGA) or grain neutral spirit (GNS)) is a clear, colorless, flammable liquid that has been distilled from a grain-based mash to a very high level of ethanol content. The term neutral refers to the spirit's lacking the flavor that would have been present if the mash ingredients were distilled to a lower level of alcoholic purity, and also lacking any flavoring added to it after distillation (as is done, for example, with gin). Other kinds of spirits, such as whisky, are distilled to a lower alcohol percentage in order to preserve the flavor of the mash.

Mixed drinks

Mixed drinks include alcoholic mixed drinks (cocktails, beer cocktails, flaming beverages, fortified wines, mixed drink shooters and drink shots, wine cocktails) and non-alcoholic mixed drinks (including punches).

Blending and caffeinated alcoholic drinks may also be called mixed drinks.

Ready to drink

Alcopops

Fermented beverages

Beer and wine are produced by fermentation of sugar- or starch-containing plant material. Beverages produced by fermentation followed by distillation have a higher alcohol content and are known as liquor or spirits.

Chemical composition

Alcohols

Alcohol is a general term for any organic compound in which a hydroxyl group (-O H) is bound to a carbon atom, which in turn may be bound to other carbon atoms and further hydrogens. Alcohols other than ethanol (such as tert-Amyl alcohol (t-AmOH) and propanol) also appear in alcoholic beverages.

Congeners

Congeners are biologically active chemicals (chemicals which exert an effect on the body or brain) and are often contained in alcoholic beverages, in addition to ethanol, the key biologically active ingredient of alcoholic beverages. Bourbon has 37 times the amount of congeners that vodka has.^[11] It has been suggested that some of these substances contribute to the symptoms of a hangover.^[12] Complex organic molecules with toxic effects that occurs only in small trace quantities includes acetone and acetaldehyde. Chiefly components include:

Furfural

Furfural is a congener that inhibits yeast metabolism. It may be added to alcoholic beverages during the fermentation stage. Although it occurs in many foods and flavorants, furfural is toxic with an LD₅₀ of 65 mg/kg (oral, rat).^[13]

Tannins

Tannins are congeners found in wine. Tannins contain powerful antioxidants such as polyphenols.

Fusel alcohol

Fusel alcohols, also sometimes called fusel oils, or potato oil in Europe, are a mixture of several alcohols (chiefly 2-methyl-1-butanol) produced as a by-product of ethanol fermentation.^[14]

The term fusel is German for "bad liquor".^[15]

For example, traces of propanol in ethanol (drinking alcohol) beverages, or traces of ethanol in propanol beverages, are both fusel alcohols respectively.

Ethanol is the active ingredient in common alcoholic beverages and it is always produced by fermentation. Two other alcohols whose uses are relatively widespread (though not so much as ethanol) are propanol and butanol. Like ethanol, they can be produced by fermentation processes. However, the fermenting agent is a bacterium, Clostridium acetobutylicum, that feeds on cellulose, not sugars like the Saccharomyces yeast that produces ethanol. Saccharomyces yeast are known to produce these higher alcohols at temperatures above 75 °F (24 °C). It is possible to produce virtually any higher alcohol by various fermentations with strain specific cultures.

Fusel oils may be shown to contain up to 50 different components, where the chief constituents are isobutanol (2-methyl-1-propanol), propanol, and above all, the pair of isoamylalkohols: 2-methyl-1-butanol and 3-methyl-1-butanol.^[16] During the past decade numerous values have been recorded for the higher alcohols in beers, and their effects of the flavour of beer has contrinued to receive considerable attention^[17] Occurrence of flavour compounds and some other compounds in alcoholic beverages for beer, wine, and spirits, are listed in hundreds in a document.^[18]

Highly toxic compounds

Methanol - Methanol are a commonly found toxic alcohol from ethanol fermentation in trace quantities but should never been consumed in pure form.

Other compounds

The compounds involved are chiefly:^{[citation needed]}

Amyl alcohol (various isomers)
1-propanol
2-propanol
butanol (various isomers)

Excessive concentrations of these fractions may cause off flavours, sometimes described as "spicy", "hot", or "solvent-like". Some beverages, such as rum, whisky (especially Bourbon), incompletely rectified vodka (eg Siwucha), and traditional ales and ciders, are expected to have relatively high concentrations of fusel alcohols as part of the flavour profile. This also indicate that different fusel alcohols are not interactive. However, in other beverages, such as Korn, vodka, and lagers, the presence of fusel alcohols is considered a fault.^[19]

Beverages by fermentation ingredients

The names of some alcoholic beverages are determined by their base material. In general, a beverage fermented from a grain mash will be called a beer. If the fermented mash is distilled, then the beverage is a spirit.

Wine and brandy are usually made from grapes but when they are made from another kind of fruit, they are distinguished as fruit wine or fruit brandy. The kind of fruit must be specified, such as "cherry brandy" or "plum wine."

Beer is made from barley or a blend of several grains.

Whiskey (or whisky) is made from grain or a blend of several grains. The type of whiskey (scotch, rye, bourbon, or corn) is determined by the primary grain.

Vodka is distilled from fermented grain. It is highly distilled so that it will contain less of the flavor of its base material. Gin is a similar distillate but it is flavored by juniper berries and sometimes by other herbs as well.

In the United States and Canada, cider often means unfermented apple juice (sometimes called sweet cider), and fermented apple juice is called hard cider. In the United Kingdom and Australia, cider refers to the alcoholic beverage.

Applejack is sometimes made by means of freeze distillation.

Grains

Source	Name of fermented beverage	Name of distilled beverage
barley	beer, ale, barley wine	Scotch whisky, Irish whiskey, shōchū (mugijōchū) (Japan)
rye	rye beer, kvass	rye whiskey, vodka (Poland), Korn (Germany)
corn	chicha, corn beer, tesguino	Bourbon whiskey; and vodka (rarely)
sorghum	burukutu (Nigeria), pito (Ghana), merisa (southern Sudan), bilibili (Chad, Central African Republic, Cameroon)	maotai, gaoliang, certain other types of baijiu (China).
wheat	wheat beer	horilka (Ukraine), vodka, wheat whisky, weizenkorn (Germany)
rice	beer, brem (Bali), huangjiu and choujiu (China), Ruou gao (Vietnam), sake (Japan), sonti (India), makgeolli (Korea), tuak (Borneo Island), thwon (Nepal)	aila (Nepal), rice baijiu (China), shōchū (komejōchū) and awamori (Japan), soju (Korea)
millet	millet beer (Sub-Saharan Africa), tongba (Nepal, Tibet), boza (the Balkans, Turkey)
buckwheat	shōchū (sobajōchū) (Japan)

Fruit juice

Source	Name of fermented beverage	Name of distilled beverage
juice of grapes,	wine	brandy, Cognac (France), Vermouth, Armagnac (France), Branntwein (Germany), pisco (Peru, Chile), (Grozdova) Rakia (The Balkans, Turkey), singani (Bolivia), Arak (Syria, Lebanon, Jordan), törkölypálinka (Hungary)
juice of apples	cider (U.S.: "hard cider"), Apfelwein	applejack (or apple brandy), calvados, cider
juice of pears	perry, or pear cider; poiré (France)	Poire Williams, pear brandy, Eau-de-vie (France), pálinka (Hungary), Krushova rakia / Krushevitsa (Bulgaria)
juice of plums	plum wine	slivovitz, țuică, umeshu, pálinka, Slivova rakia / Slivovitsa (Bulgaria)
juice of apricots		Kaisieva rakia (Bulgaria)
juice of pineapples	tepache (Mexico)
junipers		borovička (Slovakia)
bananas or plantains	Chuoi hot (Vietnam), urgwagwa (Uganda, Rwanda), mbege (with millet malt; Tanzania), kasikisi (with sorghum malt; Democratic Republic of the Congo)
gouqi	gouqi jiu (China)	gouqi jiu (China)
coconut	Toddy (Sri Lanka, India)	arrack, lambanog (Sri Lanka, India, Philippines)
ginger with sugar, ginger with raisins	ginger ale, ginger beer, ginger wine
Myrica rubra	yangmei jiu (China)	yangmei jiu (China)
pomace	pomace wine	Raki/Ouzo/Pastis/Sambuca (Turkey/Greece/France/Italy), tsipouro/tsikoudia (Greece), grappa (Italy), Trester (Germany), marc (France), orujo (Spain), zivania (Cyprus), aguardente (Portugal), tescovină (Romania), Arak (Iraq)

Vegetables

Source	Name of fermented beverage	Name of distilled beverage
juice of ginger root	ginger beer (Botswana)
potato	potato beer	horilka (Ukraine), vodka (Poland and Germany), akvavit (Scandinavia), poitín (poteen) (Ireland)
sweet potato		shōchū (imojōchū) (Japan), soju (Korea)
cassava/manioc/yuca	nihamanchi (South America), kasiri (Sub-Saharan Africa), chicha (Ecuador)
juice of sugarcane, or molasses	basi, betsa-betsa (regional)	rum (Caribbean), pinga or cachaça (Brasil), aguardiente, guaro
juice of agave	pulque	tequila, mezcal, raicilla

Other ingredients

Source	Name of fermented beverage	Name of distilled beverage
sap of palm	coyol wine (Central America), tembo (Sub-Saharan Africa), toddy (Indian subcontinent)
sap of Arenga pinnata, Coconut, Borassus flabellifer	Tuak (Indonesia)	Arrack
honey	mead, horilka (Ukraine), tej (Ethiopia)	distilled mead (mead brandy or honey brandy)
milk	kumis, kefir, blaand	arkhi (Mongolia)
sugar	kilju and mead or sima (Finland)	shōchū (kokutō shōchū): made from brown sugar (Japan)

Flavoring

Alcohol is a moderately good solvent for many fatty substances and essential oils. This attribute facilitates the use of flavoring and coloring compounds in alcoholic beverages, especially distilled beverages. Flavors may be naturally present in the beverage’s base material. Beer and wine may be flavored before fermentation. Spirits may be flavored before, during, or after distillation.

Sometimes flavor is obtained by allowing the beverage to stand for months or years in oak barrels, usually American or French oak.

A few brands of spirits have fruit or herbs inserted into the bottle at the time of bottling.

Tax regulated classes

Beer

Beer is one of the world's oldest^[6]^[20] and most widely consumed^[7] alcoholic beverages, and the third most popular drink overall after water and tea.^[21] It is produced by the brewing and fermentation of starches which are mainly derived from cereal grains — most commonly malted barley although wheat, maize (corn), and rice are also used.

Alcoholic beverages that are distilled after fermentation, or are fermented from non-cereal sources (such as grapes or honey), or are fermented from unmalted cereal grain are not classified as beer.

The two main types of beer are lager and ale. Ale is further classified into varieties such as pale ale, stout, and brown ale, whereas different types of lager include black lager, pilsener, and bock.

Most beer is flavored with hops, which add bitterness and act as a natural preservative. Other flavorings, such as fruits or herbs, may also be used.

The alcoholic strength of beer is usually 4% to 6% alcohol by volume (ABV), but it may be less than 2% or greater than 25%. Beers having an ABV of 60% (120 proof)^{[citation needed]} have been produced by freezing brewed beer and removing water in the form of ice, a process referred to as "ice distilling".

Beer is part of the drinking culture of various nations and has acquired social traditions such as beer festivals, pub games, and pub crawling (sometimes known as bar hopping).

The basics of brewing beer are shared across national and cultural boundaries. The beer-brewing industry is global in scope, consisting of several dominant multinational companies and thousands of smaller producers, which range from regional breweries to microbreweries.

Wine

Wine is produced from grapes, and from fruits such as plums, cherries, or apples. Wine involves a longer fermentation process than beer and also a long aging process (months or years), resulting in an alcohol content of 9%–16% ABV. Sparkling wine can be made by means of a secondary fermentation.

Fortified wine is wine (such as port or sherry), to which a distilled beverage (usually brandy) has been added.

Spirits

Unsweetened, distilled, alcoholic beverages that have an alcohol content of at least 20% ABV are called spirits.^[22] Spirits are produced by the distillation of a fermented base product. Distilling concentrates the alcohol and eliminates some of the congeners. For the most common distilled beverages, such as whiskey and vodka, the alcohol content is around 40%.

Spirits can be added to wines to create fortified wines, such as port and sherry.

Distilled alcoholic beverages were first recorded in Europe in the mid-12th century. By the early 14th century, they had spread throughout the European continent.^[23] They also spread eastward from Europe, mainly due to the Mongols, and began to be seen in China no later than the 14th century.^{[citation needed]}

Paracelsus gave alcohol its modern name, which is derived from an Arabic word that means “finely divided” (a reference to distillation).

Fortified wine

Fortified wine is wine with an added distilled beverage (usually brandy).^[24] Fortified wine is distinguished from spirits made from wine in that spirits are produced by means of distillation, while fortified wine is simply wine that has had a spirit added to it. Many different styles of fortified wine have been developed, including Port, Sherry, Madeira, Marsala, Commandaria wine and the aromatized wine Vermouth.^[25]

Alcohol powder

Alcohol powder is molecular encapsulated alcohol. The powder will produce an alcoholic drink when mixed with water. Alcohol powder can simply be made by molecular encapsulation in cyclodextrin, a sugar which can absorb an estimated 60 percent of its own weight.^[26]

Accessibility

Standards

Alcohol concentration

The concentration of alcohol in a beverage is usually stated as the percentage of alcohol by volume (ABV) or as proof. In the United States, proof is twice the percentage of alcohol by volume at 60 degrees Fahrenheit (e.g. 80 proof = 40% ABV). Degrees proof were formerly used in the United Kingdom, where 100 degrees proof was equivalent to 57.1% ABV. Historically, this was the most dilute spirit that would sustain the combustion of gunpowder.

Ordinary distillation cannot produce alcohol of more than 95.6% ABV (191.2 proof) because at that point alcohol is an azeotrope with water. A spirit which contains a very high level of alcohol and does not contain any added flavoring is commonly called a neutral spirit. Generally, any distilled alcoholic beverage of 170 proof or higher is considered to be a neutral spirit.^[27]

Most yeasts cannot reproduce when the concentration of alcohol is higher than about 18%, so that is the practical limit for the strength of fermented beverages such as wine, beer, and sake. However, some strains of yeast have been developed that can reproduce in solutions of up to 25% ABV.^{[citation needed]}

Alcohol-free definition controversy

The term alcohol-free (eg alcohol-free beer) is often used to describe a product that contains 0% ABV; As such, it is permitted by Islam, and they are also popular in countries that enforce alcohol prohibition, such as Saudi Arabia, Kuwait and Iran.

However, alcohol is legal in most countries of the world where alcohol culture also is prevalent. Laws vary in countries when beverages must indicate the strength but also what they define as alcohol-free; Experts calling the label “misleading” and a threat to recovering alcoholics.^[28]

In the EU the labeling of beverages containing more than 1.2% by volume of alcohol must indicate the actual alcoholic strength by volume, i.e. showing the word "alcohol" or the abbreviation "alc." followed by the symbol "% vol."^[29]

Most of the alcohol-free drinks sold in Sweden’s state-run liquor store monopoly Systembolaget actually contain alcohol, with experts calling the label “misleading” and a threat to recovering alcoholics.^[28] Systembolaget define alcohol-free as a drink that contains a maximum of 0,5 percent alcohol by volume.^[30] Interestingly, the drug policy of Sweden is based on zero tolerance.

Standard drinks

A standard drink is a notional drink that contains a specified amount of pure alcohol. The standard drink is used in many countries to quantify alcohol intake. It is usually expressed as a measure of beer, wine, or spirits. One standard drink always contains the same amount of alcohol regardless of serving size or the type of alcoholic beverage.

The standard drink varies significantly from country to country. For example, it is 7.62 ml (6 grams) of alcohol in Austria, but in Japan it is 25 ml (19.75 grams).

In the United Kingdom, there is a system of units of alcohol which serves as a guideline for alcohol consumption. A single unit of alcohol is defined as 10 ml. The number of units present in a typical drink is printed on bottles. The system is intended as an aid to people who are regulating the amount of alcohol they drink; it is not used to determine serving sizes.

In the United States, the standard drink contains 0.6 US fluid ounces (18 ml) of alcohol. This is approximately the amount of alcohol in a 12-US-fluid-ounce (350 ml) glass of beer, a 5-US-fluid-ounce (150 ml) glass of wine, or a 1.5-US-fluid-ounce (44 ml) glass of a 40% ABV (80 proof) spirit.

Serving sizes

In the United Kingdom, serving size in licensed premises is regulated under the Weights and Measures Act (1985). Spirits (gin, whisky, rum, and vodka) are sold in 25 ml or 35 ml quantities or multiples thereof.^[31] Beer is typically served in pints (568 ml), but is also served in half-pints or third-pints.

In Ireland, the serving size of spirits is 35.5 ml or 71 ml. Beer is usually served in pints or half-pints ("glasses"). In the Netherlands and Belgium, standard servings are 250 and 500 ml for pilsner; 300 and 330 ml for ales.

The shape of a glass can have a significant effect on how much one pours. A Cornell University study of students and bartenders' pouring showed both groups pour more into short, wide glasses than into tall, slender glasses.^[32] Aiming to pour one shot of alcohol (1.5 ounces or 44.3 ml), students on average poured 45.5 ml & 59.6 ml (30% more) respectively into the tall and short glasses. The bartenders scored similarly, on average pouring 20.5% more into the short glasses. More experienced bartenders were more accurate, pouring 10.3% less alcohol than less experienced bartenders. Practice reduced the tendency of both groups to over pour for tall, slender glasses but not for short, wide glasses. These misperceptions are attributed to two perceptual biases: (1) Estimating that tall, slender glasses have more volume than shorter, wider glasses; and (2) Over focusing on the height of the liquid and disregarding the width.

Alcohol consumption

History

Alcoholic beverages have been drunk by people around the world since ancient times. Reasons that have been proposed for drinking them include:

They are part of a people's standard diet
They are drunk for medical reasons
For their relaxant effects
For their euphoric effects
For recreational purposes
For artistic inspiration
For their putative aphrodisiac effects

Archaeological record

Chemical analysis of traces absorbed and preserved in pottery jars from the neolithic village of Jiahu in Henan province in northern China has revealed that a mixed fermented beverage made from rice, honey, and fruit was being produced as early as 9,000 years ago. This is approximately the time when barley beer and grape wine were beginning to be made in the Middle East.

Recipes have been found on clay tablets and art in Mesopotamia that show people using straws to drink beer from large vats and pots.

The Hindu ayurvedic texts describe both the beneficial effects of alcoholic beverages and the consequences of intoxication and alcoholic diseases.

The medicinal use of alcohol was mentioned in Sumerian and Egyptian texts dating from about 2100 BC. The Hebrew Bible recommends giving alcoholic drinks to those who are dying or depressed, so that they can forget their misery (Proverbs 31:6-7).

Wine was consumed in Classical Greece at breakfast or at symposia, and in the 1st century BC it was part of the diet of most Roman citizens. Both the Greeks and the Romans generally drank diluted wine (the strength varying from 1 part wine and 1 part water, to 1 part wine and 4 parts water).

In Europe during the Middle Ages, beer, often of very low strength, was an everyday drink for all classes and ages of people. A document from that time mentions nuns having an allowance of six pints of ale each day. Cider and pomace wine were also widely available; grape wine was the prerogative of the higher classes.

By the time the Europeans reached the Americas in the 15th century, several native civilizations had developed alcoholic beverages. According to a post-conquest Aztec document, consumption of the local "wine" (pulque) was generally restricted to religious ceremonies but was freely allowed to those who were older than 70 years.

The natives of South America produced a beer-like beverage from cassava or maize, which had to be chewed before fermentation in order to turn the starch into sugar. (Beverages of this kind are known today as cauim or chicha.) This chewing technique was also used in ancient Japan to make sake from rice and other starchy crops.

Alcohol in American history

In the early 19th century, Americans had inherited a hearty drinking tradition. Many types of alcohol were consumed. One reason for this heavy drinking was attributed to an overabundance of corn on the western frontier, which encouraged the widespread production of cheap whiskey. It was at this time that alcohol became an important part of the American diet. In the 1820s, Americans drank seven gallons of alcohol per person annually.^[33]^[34]

During the 19th century, Americans drank alcohol in two distinctive ways. One way was to drink small amounts daily and regularly, usually at home or alone. The other way consisted of communal binges. Groups of people would gather in a public place for elections, court sessions, militia musters, holiday celebrations, or neighborly festivities. Participants would typically drink until they became intoxicated.

Routes of administration

Intravenous

Recreational
- Distilled ethanol beverages are sometimes used by intravenous drug users, occasionally when they are cut of supply of other drugs and there are to little ethanol to get intoxicated orally. However, another alcohol, ethchlorvynol, is not compatible with intravenous injection and serious injury or death can occur when it is used in this manner^[35]
Medical
- Ethylene glycol poisoning: Doctors saved a poisoned tourist using vodka drip.^[36] Pharmaceutical grade ethanol is usually given intravenously as a 5 or 10% solution in 5% dextrose, but it is also sometimes given orally in the form of a strong spirit such as whisky, vodka, or gin.^[37]
- Methanol poisoning: A 10% ethanol solution administered intravenously is a safe and effective antidote for severe methanol poisoning.^[38]

Uses

In many countries, people drink alcoholic beverages at lunch and dinner. Studies have found that when food is eaten before drinking alcohol, alcohol absorption is reduced^[39] and the rate at which alcohol is eliminated from the blood is increased. The mechanism for the faster alcohol elimination appears to be unrelated to the type of food. The likely mechanism is food-induced increases in alcohol-metabolizing enzymes and liver blood flow.^[39]

At times and places of poor public sanitation (such as Medieval Europe), the consumption of alcoholic drinks was a way of avoiding water-borne diseases such as cholera. Small beer and faux wine, in particular, were used for this purpose. Although alcohol kills bacteria, its low concentration in these beverages would have had only a limited effect. More important was that the boiling of water (required for the brewing of beer) and the growth of yeast (required for fermentation of beer and wine) would tend to kill dangerous microorganisms. The alcohol content of these beverages allowed them to be stored for months or years in simple wood or clay containers without spoiling. For this reason, they were commonly kept aboard sailing vessels as an important (or even the sole) source of hydration for the crew, especially during the long voyages of the early modern period.

In cold climates, potent alcoholic beverages such as vodka are popularly seen as a way to “warm up” the body, possibly because alcohol is a quickly absorbed source of food energy and because it dilates peripheral blood vessels (peripherovascular dilation). This is a misconception because the “warmth” is actually caused by a transfer of heat from the body’s core to its extremities, where it is quickly lost to the environment. However, the perception alone may be welcomed when only comfort, rather than hypothermia, is a concern.

Alcohol consumption by country

Alcohol and health

Short-term effects of alcohol consumption include intoxication and dehydration. Long-term effects of alcohol include changes in the metabolism of the liver and brain and alcoholism (addiction to alcohol).

Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. Alcohol stimulates insulin production, which speeds up glucose metabolism and can result in low blood sugar, causing irritability and (for diabetics) possible death. Severe alcohol poisoning can be fatal.

A blood alcohol content of 0.45% in test animals results in a median lethal dose of LD₅₀. This means that 0.45% is the concentration of blood alcohol that is fatal in 50% of the test subjects. That is about six times the level of ordinary intoxication (0.08%), but vomiting or unconsciousness may occur much sooner in people who have a low tolerance for alcohol.^[42] The high tolerance of chronic heavy drinkers may allow some of them to remain conscious at levels above 0.40%, although serious health dangers are incurred at this level.

Alcohol also limits the production of vasopressin (ADH) from the hypothalamus and the secretion of this hormone from the posterior pituitary gland. This is what causes severe dehydration when large amounts of alcohol are drunk. It also causes a high concentration of water in the urine and vomit and the intense thirst that goes along with a hangover.

Stress, hangovers and oral contraceptive pill may increase the desire for alcohol because these things will lower the level of testosterone and alcohol will acutely elevate it.^[43] Tobacco has the same effect of increasing the craving for alcohol.^[44]

Alcohol abuse prevention programs

0-1-2-3

The Army at Fort Drum has taken the “0-0-1-3” and exchanged it for the new “0-1-2-3” described in the Prime-For-Life Program, which highlights the ill effects of alcohol abuse as more than just an individual’s “driving while intoxicated.” The Prime-For-Life program identifies alcohol abuse to be a health and impairment problem, leading to adverse legal as well as health outcomes associated with misuse.

The 0-1-2-3 now represents low-risk guidelines:

0 – Zero drinks for those driving a vehicle.
1 – One drink per hour
2 – No more than two drinks per day
3 – Not to exceed three drinks on any one day

Recommended maximum intake

Binge drinking is becoming a major problem in the UK. Advice on weekly consumption is avoided in United Kingdom.^[45]

Since 1995 the UK government has advised that regular consumption of 3–4 units a day for men, or 2–3 units a day for women, would not pose significant health risks, but that consistently drinking four or more units a day (men), or three or more units a day (women), is not advisable.^[46]

Previously (from 1992 until 1995), the advice was that men should drink no more than 21 units per week, and women no more than 14.^[47] (The difference between the sexes was due to the typically lower weight and water-to-body-mass ratio of women.) This was changed because a government study showed that many people were in effect "saving up" their units and using them at the end of the week, a phenomenon referred to as binge drinking.^{[citation needed]} The Times reported in October 2007 that these limits had been "plucked out of the air" and had no scientific basis.^[48]

Mortality rate

A report of the United States Centers for Disease Control estimated that medium and high consumption of alcohol led to 75,754 deaths in the U.S. in 2001. Low consumption of alcohol had some beneficial effects, so a net 59,180 deaths were attributed to alcohol.^[49]

In the United Kingdom, heavy drinking is blamed for about 33,000 deaths a year.^[50]

A study in Sweden found that 29% to 44% of "unnatural" deaths (those not caused by illness) were related to alcohol. The causes of death included murder, suicide, falls, traffic accidents, asphyxia, and intoxication.^[51]

A global study found that 3.6% of all cancer cases worldwide are caused by alcohol drinking, resulting in 3.5% of all global cancer deaths.^[52] A study in the United Kingdom found that alcohol causes about 6% of cancer deaths in the UK (9,000 deaths per year).^[53]

ISCD

A 2010 study by the Independent Scientific Committee on Drugs, led by David Nutt, Leslie King and Lawrence Phillips, asked drug-harm experts to rank a selection of illegal and legal drugs on various measures of harm both to the user and to others in society. These measures include damage to health, drug dependency, economic costs and crime. The researchers claim that the rankings are stable because they are based on so many different measures and would require significant discoveries about these drugs to affect the rankings.^[54]

Despite being legal more often than the other drugs, alcohol was considered to be by far the most harmful; not only was it regarded as the most damaging to societies, it was also seen as the fourth most dangerous for the user. Most of the drugs were rated significantly less harmful than alcohol, with most of the harm befalling the user.

The authors explain that one of the limitation of this study is that drug harms are functions of their availability and legal status in the UK, and so other cultures' control systems could yield different rankings.

Alcohol expectations

Alcohol expectations are beliefs and attitudes that people have about the effects they will experience when drinking alcoholic beverages. They are largely beliefs about alcohol's effects on a person’s behaviors, abilities, and emotions. Some people believe that if alcohol expectations can be changed, then alcohol abuse might be reduced.^[55]

The phenomenon of alcohol expectations recognizes that intoxication has real physiological consequences that alter a drinker's perception of space and time, reduce psychomotor skills, and disrupt equilibrium.^[56] The manner and degree to which alcohol expectations interact with the physiological short-term effects of alcohol, resulting in specific behaviors, is unclear.

A single study found, if a society believes that intoxication leads to sexual behavior, rowdy behavior, or aggression, then people tend to act that way when intoxicated. But if a society believes that intoxication leads to relaxation and tranquil behavior, then it usually leads to those outcomes. Alcohol expectations vary within a society, so these outcomes are not certain.^[57]

People tend to conform to social expectations, and some societies expect that drinking alcohol will cause disinhibition. However, in societies in which the people do not expect that alcohol will disinhibit, intoxication seldom leads to disinhibition and bad behavior.^[56]

Alcohol expectations can operate in the absence of actual consumption of alcohol. Research in the United States over a period of decades has shown that men tend to become more sexually aroused when they think they have been drinking alcohol, — even when they have not been drinking it. Women report feeling more sexually aroused when they falsely believe the beverages they have been drinking contained alcohol (although one measure of their physiological arousal shows that they became less aroused).^{[citation needed]}

Men tend to become more aggressive in laboratory studies in which they are drinking only tonic water but believe that it contains alcohol. They also become less aggressive when they believe they are drinking only tonic water, but are actually drinking tonic water that contains alcohol.^[55]

Genetic differences

Alcohol flush reaction

Alcohol flush reaction is best known as a condition that is experienced by people of Asian descent. According to the analysis by HapMap project, the rs671 allele of the ALDH2 gene responsible for the flush reaction is rare among Europeans and Africans, and it is very rare among Mexican-Americans. 30% to 50% of people of Chinese and Japanese ancestry have at least one ALDH*2 allele.^[58] The rs671 form of ALDH2, which accounts for most incidents of alcohol flush reaction worldwide, is native to East Asia and most common in southeastern China. It most likely originated among Han Chinese in central China,^[59] and it appears to have been positively selected in the past. Another analysis correlates the rise and spread of rice cultivation in Southern China with the spread of the allele.^[60] The reasons for this positive selection aren't known, but it's been hypothesized that elevated concentrations of acetaldehyde may have conferred protection against certain parasitic infections, such as Entamoeba histolytica.^[61]

American Indian alcoholism

While little detailed genetic research has been done, it has been shown that alcoholism tends to run in families with possible involvement of differences in alcohol metabolism and the genotype of alcohol-metabolizing enzymes.

Gender differences

There are many differences in alcohol consumption between men and women.

Sensitivity

Several biological factors make women more vulnerable to the effects of alcohol than men.^[62]

Body fat. Women tend to weigh less than men, and—pound for pound—a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, alcohol remains at higher concentrations for longer periods of time in a woman’s body, exposing her brain and other organs to more alcohol.
Enzymes. Women have lower levels of two enzymes—alcohol dehydrogenase and aldehyde dehydrogenase—that metabolize (break down) alcohol in the stomach and liver. As a result, women absorb more alcohol into their bloodstreams than men.
Hormones. Changes in hormone levels during the menstrual cycle may also affect how a woman metabolizes alcohol.

Metabolism

Females demonstrated a higher average rate of elimination (mean, 0.017; range, 0.014-0.021 g/210 L) than males (mean, 0.015; range, 0.013-0.017 g/210 L). Female subjects on average had a higher percentage of body fat (mean, 26.0; range, 16.7-36.8%) than males (mean, 18.0; range, 10.2-25.3%).^[63]

Alcoholism

Based on combined data from SAMHSA's 2004-2005 National Surveys on Drug Use & Health, the rate of past year alcohol dependence or abuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%).^[64]

The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a 2-hour period.

According to the National Institute on Alcohol Abuse and Alcoholism [NIAAA], men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.)^[65]

Depression

The link between alcohol consumption, depression, and gender was examined by the Centre for Addiction and Mental Health (Canada). The study found that women taking antidepressants consumed more alcohol than women who did not experience depression as well as men taking antidepressants. The researchers, Dr. Kathryn Graham and a PhD Student Agnes Massak analyzed the responses to a survey by 14,063 Canadian residents aged 18–76 years. The survey included measures of quantity, frequency of drinking, depression and antidepressants use, over the period of a year. The researchers used data from the GENACIS Canada survey, part of an international collaboration to investigate the influence of cultural variation on gender differences in alcohol use and related problems. The purpose of the study was to examine whether, like in other studies already conducted on male depression and alcohol consumption, depressed women also consumed less alcohol when taking anti-depressants.^[66] According to the study, both men and women experiencing depression (but not on anti-depressants) drank more than non-depressed counterparts. Men taking antidepressants consumed significantly less alcohol than depressed men who did not use antidepressants. Non-depressed men consumed 436 drinks per year, compared to 579 drinks for depressed men not using antidepressants, and 414 drinks for depressed men who used antidepressants. Alcohol consumption remained higher whether the depressed women were taking anti-depressants or not. 179 drinks per year for non-depressed women, 235 drinks for depressed women not using antidepressants, and 264 drinks for depressed women who used antidepressants. The lead researcher argued that the study "suggests that the use of antidepressants is associated with lower alcohol consumption among men suffering from depression. But this does not appear to be true for women."^[67]

Short-term effects of alcohol

Blood ethanol concentration (BEC)

Vehicle operation

The number of serious errors committed by pilots dramatically increases at or above concentrations of 0.04% blood alcohol. This is not to say that problems don't occur below this value. Some studies have shown decrements in pilot performance with blood alcohol concentrations as low as the 0.025%.^[68] Also, a BEC of ≥0.080 or more is legally intoxicated for driving in MOST states. And, ≤0.050 is considered NOT impaired in most.^[69]

Calculation

Estimated peak blood alcohol concentration (EBAC) can be formulated ((0.806 * SD * 1.2)/(BW * Wt) - (MR * DP)) * 10 where 0.806 is a constant for body water in the blood (mean 80.6%), SD is the number of standard drinks containing 10 grams of ethanol, 1.2 is a factor in order to convert the amount in grams to Swedish standards set by The Swedish National Institute of Public Health, BW is a body water constant (0.58 for men and 0.49 for women), Wt is body weight (kilogram), MR is the metabolism constant (0.017), DP is the drinking period in hours and 10 converts the result to permillage of alcohol.^[70]

Useful tools:

"Interactive blood ethanol calculator"
"BAC Comparison Over Time" Chart

Binge drinking

In most jurisdictions a measurement such as a blood alcohol content (BAC) in excess of a specific threshold level, such as 0.05% or 0.08% defines the offense. Also, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) define the term "binge drinking" as any time one reaches a peak BAC of 0.08% or higher as opposed to some (arguably) arbitrary number of drinks in an evening.^[71]

Pleasure zone

Known as pleasure zone, the positive exceeds the negative effects typically between 0.030–0.059% blood ethanol concentration (BEC), but contrary at higher volumes.

BEC chart

The data below apply specifically to ethanol, not other alcohols found in alcoholic beverage.

Progressive effects of alcohol^[72]
BAC (% by vol.)	Behavior	Impairment
0.010–0.029	Average individual appears normal	Subtle effects that can be detected with special tests
0.030–0.059	Mild euphoria Relaxation Joyousness Talkativeness Decreased inhibition	Concentration
0.06–0.09	Blunted feelings Disinhibition Extroversion	Reasoning Depth perception Peripheral vision Glare recovery
0.10–0.19	Over-expression Emotional swings Anger or sadness Boisterousness Decreased libido	Reflexes Reaction time Gross motor control Staggering Slurred speech Temporary erectile dysfunction Possibility of temporary alcohol poisoning
0.20–0.29	Stupor Loss of understanding Impaired sensations Possibility of falling unconscious	Severe motor impairment Loss of consciousness Memory blackout
0.30–0.39	Severe central nervous system depression Unconsciousness Death is possible	Bladder function Breathing Dysequilibrium Heart rate
0.40–0.50	General lack of behavior Unconsciousness	Breathing Heart rate Positional Alcohol Nystagmus
>0.50	High risk of poisoning Possibility of death

Standard drink chart (U.S.)^[73]
Alcohol	Amount (ml)	Amount (fl oz)	Serving size	Alcohol (% by vol.)	Alcohol
80 proof liquor	44	1.5	One shot	40	0.6 US fl oz (18 ml)
Table wine	148	5	One glass	12	0.6 US fl oz (18 ml)
Beer	355	12	One can	5	0.6 US fl oz (18 ml)

Male Female	Approximate blood alcohol percentage (by vol.)^[74] One drink has 0.5 US fl oz (15 ml) alcohol by volume
Drinks	Body weight
	40 kg	45 kg	55 kg	64 kg	73 kg	82 kg	91 kg	100 kg	109 kg
	90 lb	100 lb	120 lb	140 lb	160 lb	180 lb	200 lb	220 lb	240 lb
1	– 0.05	0.04 0.05	0.03 0.04	0.03 0.03	0.02 0.03	0.02 0.03	0.02 0.02	0.02 0.02	0.02 0.02
2	– 0.10	0.08 0.09	0.06 0.08	0.05 0.07	0.05 0.06	0.04 0.05	0.04 0.05	0.03 0.04	0.03 0.04
3	– 0.15	0.11 0.14	0.09 0.11	0.08 0.10	0.07 0.09	0.06 0.08	0.06 0.07	0.05 0.06	0.05 0.06
4	– 0.20	0.15 0.18	0.12 0.15	0.11 0.13	0.09 0.11	0.08 0.10	0.08 0.09	0.07 0.08	0.06 0.08
5	– 0.25	0.19 0.23	0.16 0.19	0.13 0.16	0.12 0.14	0.11 0.13	0.09 0.11	0.09 0.10	0.08 0.09
6	– 0.30	0.23 0.27	0.19 0.23	0.16 0.19	0.14 0.17	0.13 0.15	0.11 0.14	0.10 0.12	0.09 0.11
7	– 0.35	0.26 0.32	0.22 0.27	0.19 0.23	0.16 0.20	0.15 0.18	0.13 0.16	0.12 0.14	0.11 0.13
8	– 0.40	0.30 0.36	0.25 0.30	0.21 0.26	0.19 0.23	0.17 0.20	0.15 0.18	0.14 0.17	0.13 0.15
9	– 0.45	0.34 0.41	0.28 0.34	0.24 0.29	0.21 0.26	0.19 0.23	0.17 0.20	0.15 0.19	0.14 0.17
10	– 0.51	0.38 0.45	0.31 0.38	0.27 0.32	0.23 0.28	0.21 0.25	0.19 0.23	0.17 0.21	0.16 0.19
Subtract approximately 0.01 every 40 minutes after drinking.

Long-term effects of alcohol

Adverse effects of binge drinking (0.08% BAC or higher)

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently redefined the term "binge drinking" as any time one reaches a peak BAC of 0.08% or higher as opposed to some (arguably) arbitrary number of drinks in an evening.^[71]

Alcohol withdrawal syndrome

The severity of the alcohol withdrawal syndrome can vary from mild symptoms such as mild sleep disturbances and mild anxiety to very severe and life threatening including delirium, particularly visual hallucinations in severe cases and convulsions (which may result in death).^[75] This is sometimes referred to as alcohol-induced physical dependency; Sedative hypnotic drugs such as alcohol, benzodiazepines, and barbiturates are the only commonly available substances that can be fatal in withdrawal due to their propensity to induce withdrawal convulsions.

Alcoholism

Proclivity to alcoholism may be partially genetic. Persons who have this proclivity may have an atypical biochemical response to alcohol, although this is disputed.

Alcoholism can lead to malnutrition because it can alter digestion and the metabolism of most nutrients. Severe thiamine deficiency is common in alcoholism due to deficiency of folate, riboflavin, vitamin B₆, and selenium ; this can lead to Korsakoff's syndrome. Alcoholism is also associated with a type of dementia called Wernicke-Korsakoff syndrome, which is caused by a deficiency in thiamine (vitamin B₁).^[76] Muscle cramps, nausea, loss of appetite, nerve disorders, and depression are common symptoms of alcoholism. Osteoporosis and bone fractures may occur due to deficiency of vitamin D.

Cognition

Moderate drinkers tend to have better cognitive function than both abstainers and heavy drinkers.^[77]

Cancer

Alcohol consumption has been linked with seven types of cancer: mouth cancer, pharyngeal cancer, oesophageal cancer, laryngeal cancer, breast cancer, bowel cancer and liver cancer.^[53] Heavy drinkers are more likely to develop liver cancer due to cirrhosis of the liver.^[53] The risk of developing cancer increases even with consumption of as little as three units of alcohol (one pint of lager or a large glass of wine) a day.^[53]

A global study found that 3.6% of all cancer cases worldwide are caused by drinking alcohol, resulting in 3.5% of all global cancer deaths.^[52] A study in the United Kingdom found that alcohol causes about 6% of cancer deaths in the UK (9,000 deaths per year).^[53] A study in China found that alcohol causes about 4.40% of all cancer deaths and 3.63% of all cancer incidences.^[78] For both men and women, the consumption of two or more drinks daily increases the risk of pancreatic cancer by 22%.^[79]

Women who regularly consume low to moderate amounts of alcohol have an increased risk of cancer of the upper digestive tract, rectum, liver, and breast.^[80]^[81]

Red wine contains resveratrol, which has some anti-cancer effect. However, based on studies done so far, there is no strong evidence that red wine protects against cancer in humans.^[82]

Recent studies indicate that Asian populations are particularly prone to carcinogenic effects of alcohol. It's been noted that ethanol's byproducts in metabolism results in acetaldehyde. In non-Asian populations, an enzyme called alcohol dehydrogenase that quickly converts acetaldehyde into acetate. Asian populations have a variant form of alcohol dehydrogenase which prevents conversion of the acetaldehyde. This substance has been indicated to have strong interactions with DNA and thereby causing carcinogenic effects.^[83]^[84]

Dementia

Excessive drinking has been linked to dementia; it is estimated that 10% to 24% of dementia cases are caused by alcohol consumption, with women being at greater risk than men.^[85]^[86]

Alcoholism is associated with a type of dementia called Wernicke–Korsakoff syndrome, which is caused by a deficiency in thiamine (vitamin B₁).^[76]

In people aged 55 or older, daily light-to-moderate drinking (one to three drinks) was associated with a 42% reduction in the probability of developing dementia and a 70% reduction in risk of vascular dementia.^[87] The researchers suggest that alcohol may stimulate the release of acetylcholine in the hippocampus area of the brain.^[87]

Diabetes

If both parents have type 2 diabetes, this increases to a 45 percent chance.^[88]

Hip fracture

An international study^[89] of almost 6,000 men and 11,000 women found that persons who reported that they drank more than 2 units of alcohol a day had an increased risk of fractures compared to non-drinkers. For example, those who drank over 3 units a day had nearly twice the risk of a hip fracture.

Obesity

Biological and environmental factors are thought to contribute to alcoholism and obesity.^[90] The physiologic commonalities between excessive eating and excessive alcohol drinking shed light on intervention strategies, such as pharmaceutical compounds that may help those who suffer from both. Some of the brain signaling proteins that mediate excessive eating and weight gain also mediate uncontrolled alcohol consumption.^[90] Some physiological substrates that underlie food intake and alcohol intake have been identified. Melanocortins, a group of signaling proteins, are found to be involved in both excessive food intake and alcohol intake.^[91]

Alcohol may contribute to obesity. A study found frequent, light drinkers (three to seven drinking days per week, one drink per drinking day) had lower BMIs than infrequent, but heavier drinkers.^[92] Although calories in liquids containing ethanol may fail to trigger the physiologic mechanism that produces the feeling of fullness in the short term; long-term, frequent drinkers may compensate for energy derived from ethanol by eating less.^[93]

Health effects of moderate drinking

Longevity

A meta-analysis found with data from 477,200 individuals determined the dose-response relationships by sex and end point using lifetime abstainers as the reference group. The search revealed 20 cohort studies that met our inclusion criteria. A U-shaped relationship was found for both sexes. Compared with lifetime abstainers, the relative risk (RR) for type 2 diabetes among men was most protective when consuming 22 g/day alcohol (RR 0.87 [95% CI 0.76–1.00]) and became deleterious at just over 60 g/day alcohol (1.01 [0.71–1.44]). Among women, consumption of 24 g/day alcohol was most protective (0.60 [0.52–0.69]) and became deleterious at about 50 g/day alcohol (1.02 [0.83–1.26]).^[94]

Interestingly, ethanol has been found to double the lifespans of worms feed 0.005% ethanol but does not markedly increase at higher concentrations. Supplementing starved cultures with n-propanol and n-butanol also extended lifespan.;^[95] 1-Propanol (n-propanol) is thought to be similar to ethanol in its effects on human body, but 2-4 times more potent. However, this seems to be statistically significant for humans when compared to the previous study discusses; Human macronutrients in food consist mainly of water and the Dietary Reference Intake (DRI) for water is 3.7 litres (3700 mL x 0.005% EtOH = 18.5 mL EtOH) for 19-70 year old males, and 2.7 litres (2700 mL x 0.005% EtOH = 13.5 mL) for 19-70 year old women.

Because former drinkers may be inspired to abstain due to health concerns, they may actually be at increased risk of developing diabetes, known as the sick-quitter effect. Moreover, the balance of risk of alcohol consumption on other diseases and health outcomes, even at moderate levels of consumption, may outweigh the positive benefits with regard to diabetes.

Additionally, the way in which alcohol is consumed (i.e., with meals or bingeing on weekends) affects various health outcomes. Thus, it may be the case that the risk of diabetes associated with heavy alcohol consumption is due to consumption mainly on the weekend as opposed to the same amount spread over a week.^[96] In the United Kingdom "advice on weekly consumption is avoided".

In a 2010 long-term study of an older population, the beneficial effects of moderate drinking were confirmed, but abstainers and heavy drinkers showed an increase of about 50% in mortality (even after controlling for confounding factors).^[97]

Diabetes

Daily consumption of a small amount of pure alcohol by older women may slow or prevent the onset of diabetes by lowering the level of blood glucose.^[98] However, the researchers caution that the study used pure alcohol and that alcoholic beverages contain additives, including sugar, which would negate this effect.^[98]

People with diabetes should avoid sugary drinks such as dessert wines and liqueurs.^[99]

Heart disease

Alcohol consumption by the elderly results in increased longevity, which is almost entirely a result of lowered coronary heart disease.^[100] A British study found that consumption of two units of alcohol (one regular glass of wine) daily by doctors aged 48+ years increased longevity by reducing the risk of death by ischaemic heart disease and respiratory disease.^[101] Deaths for which alcohol consumption is known to increase risk accounted for only 5% of the total deaths, but this figure increased among those who drank more than two units of alcohol per day.^[101]

One study found that men who drank moderate amounts of alcohol three or more times a week were up to 35% less likely to have a heart attack than non-drinkers, and men who increased their daily alcohol consumption by one drink over the 12 years of the study had a 22% lower risk of heart attack.^[102]

Daily intake of one or two units of alcohol (a half or full standard glass of wine) is associated with a lower risk of coronary heart disease in men over 40, and in women who have been through menopause.^[103] However, getting drunk one or more times per month put women at a significantly increased risk of heart attack, negating alcohol's potential protective effect.^[104]

Increased longevity due to alcohol consumption is almost entirely the result of a reduced rate of coronary heart disease.^[100]

Neurotoxin

As a neurotoxin, ethanol has been shown to induce nervous system damage and affect the body in a variety of ways. Among the known effects of ethanol exposure are both transient and lasting consequences. Some of the lasting effects include long-term reduced neurogenesis in the hippocampus,^[105]^[106] widespread brain atrophy,^[107] and induced inflammation in the brain.^[108] Of note, chronic ethanol ingestion has additionally been shown to induce reorganization of cellular membrane constituents, leading to a lipid bilayer marked by increased membrane concentrations of cholesterol and saturated fat.^[109] This is important as neurotransmitter transport can be impaired through vesicular transport inhibition, resulting in diminished neural network function. One significant example of reduced inter-neuron communication is the ability for ethanol to inhibit NMDA receptors in the hippocampus, resulting in reduced LTP (long-term potentiation) and memory acquisition.^[110] NMDA has been shown to play an important role in long-term potentiation (LTP) and consequently memory formation.^[111] With chronic ethanol intake, however, the susceptibility of these NMDA receptors to induce LTP increases in the mesolimbic dopamine neurons in an inositol 1,4,5-triphosphate (IP3) dependent manner.^[112] This reorganization may lead to neuronal cytotoxicity both through hyperactivation of postsynaptic neurons and through induced addiction to continuous ethanol consumption. It has, additionally, been shown that ethanol directly reduces intracellular calcium ion accumulation through inhibited NMDA receptor activity, and thus reduces the capacity for the occurrence of LTP.^[113]

In addition to the neurotoxic effects of ethanol in mature organisms, chronic ingestion is capable of inducing severe developmental defects. Evidence was first shown in 1973 of a connection between chronic ethanol intake by mothers and defects in their offspring.^[114] This work was responsible for creating the classification of fetal alcohol syndrome; a disease characterized by common morphogenesis aberrations such as defects in craniofacial formation, limb development, and cardiovascular formation. The magnitude of ethanol neurotoxicity in fetuses leading to fetal alcohol syndrome has been shown to be dependent on antioxidant levels in the brain such as vitamin E.^[115] As the fetal brain is relatively fragile and susceptible to induced stresses, severe deleterious effects of alcohol exposure can be seen in important areas such as the hippocampus and cerebellum. The severity of these effects is directly dependent upon the amount and frequency of ethanol consumption by the mother, and the stage in development of the fetus.^[116] It is known that ethanol exposure results in reduced antioxidant levels, mitochondrial dysfunction (Chu 2007), and subsequent neuronal death, seemingly as a result of increased generation of reactive oxidative species (ROS).^[117] This is a plausible mechanism, as there is a reduced presence in the fetal brain of antioxidant enzymes such as catalase and peroxidase.^[118] In support of this mechanism, administration of high levels of dietary vitamin E results in reduced or eliminated ethanol-induced neurotoxic effects in fetuses.^[119]

Self-medication

Alcohol and sedative/hypnotic drugs, such as barbiturates and benzodiazepines, are central nervous system (CNS) depressants, which produce feelings of relaxation, and sedation, while relieving feelings of depression and anxiety. Alcohol also lowers inhibitions, while benzodiazepines are anxiolytic. Though they are generally ineffective antidepressants, as most are short-acting, the rapid onset of alcohol and sedative/hypnotics softens rigid defenses and, in low to moderate doses, provides the illusion of relief from depressive affect and anxiety.[1][2] As alcohol also lowers inhibitions, alcohol is also hypothesized to be used by those who normally constrain emotions by attenuating intense emotions in high or obliterating doses, which allows them to express feelings of affection, aggression, and closeness.[8][2]

Anxiolytics/Antidepressant

Alcohol and sedative/hypnotic drugs, such as barbiturates and benzodiazepines, are central nervous system (CNS) depressants that lower inhibitions via anxiolysis. Depressants produce feelings of relaxation and sedation, while relieving feelings of depression and anxiety. Though they are generally ineffective antidepressants, as most are short-acting, the rapid onset of alcohol and sedative/hypnotics softens rigid defenses and, in low to moderate doses, provides relief from depressive affect and anxiety.^[120]^[121] As alcohol also lowers inhibitions, alcohol is also hypothesized to be used by those who normally constrain emotions by attenuating intense emotions in high or obliterating doses, which allows them to express feelings of affection, aggression and closeness.^[121]^[122] People with social anxiety disorder commonly use these drugs to overcome their highly set inhibitions.^[123]

Self medicating excessively for prolonged periods of time with benzodiazepines or alcohol often makes the symptoms of anxiety or depression worse. This is believed to occur as a result of the changes in brain chemistry from long-term use.^[124]^[125]^[126]^[127]^[128] Of those who seek help from mental health services for conditions including anxiety disorders such as panic disorder or social phobia, approximately half have alcohol or benzodiazepine dependence issues.^[129]

Sometimes anxiety precedes alcohol or benzodiazepine dependence but the alcohol or benzodiazepine dependence acts to keep the anxiety disorders going, often progressively making them worse. However, some people addicted to alcohol or benzodiazepines, when it is explained to them that they have a choice between ongoing poor mental health or quitting and recovering from their symptoms, decide on quitting alcohol or benzodiazepines or both. It has been noted that every individual has an individual sensitivity level to alcohol or sedative hypnotic drugs, and what one person can tolerate without ill health, may cause another to suffer very ill health, and even moderate drinking can cause rebound anxiety syndrome and sleep disorders. A person suffering the toxic effects of alcohol will not benefit from other therapies or medications, as these do not address the root cause of the symptoms.^[129]

Insomnia

Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headaches, the need to urinate, dehydration, and excessive sweating. Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping him/her from reaching the deepest levels of sleep.^[130] Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal REM sleep is typically exaggerated as part of a rebound effect.^[131]

Stroke

A study found that lifelong abstainers were 2.36 times more likely to suffer a stroke than those who regularly drank a moderate amount of alcohol beverages. Heavy drinkers were 2.88 times more likely to suffer a stroke than moderate drinkers.^[132]

Alcohol laws

Alcohol laws are laws in relation to the manufacture, use, influence and sale of ethanol (ethyl alcohol, EtOH) or alcoholic beverages that contains ethanol.

Alcohol laws often seek to reduce the availability of alcoholic beverages, often with the stated purpose of reducing the health and social side effect of their consumption. This can take the form of age limits for alcohol consumption, and distribution only in licensed stores or in monopoly stores. Often, this is combined with some form of alcohol taxation.

Alcohol and religion

The current Arabic name for alcohol in The Qur'an, in verse 37:47, uses the word الغول al-ġawl —properly meaning "spirit" or "demon"—with the sense "the thing that gives the wine its headiness."^[133] The term ethanol was invented 1838, modeled on German äthyl (Liebig), from Greek aither (see ether) + hyle "stuff.".^[134] Ether in late 14c. meant "upper regions of space," from Old French ether and directly from Latin aether "the upper pure, bright air," from Greek aither "upper air; bright, purer air; the sky," from aithein "to burn, shine," from PIE root *aidh- "to burn" (see edifice).^[135]

Monastic beer production

Trappist beer is brewed by Trappist breweries. Eight monasteries — six in Belgium, one in the Netherlands and one in Austria — currently brew beer and sell it as Authentic Trappist Product.

The designation "abbey beers" (Bières d'Abbaye or Abdijbier) was originally used for any monastic or monastic-style beer. After the introduction of an official Trappist beer designation by the International Trappist Association in 1997, it came to mean products similar in style or presentation to monastic beers.

Some abbeys have a lighter, less alcoholic versions of the beers for the internal consumption (Petite Orval or Chimay Dorée) called patersbier.

Consumption

Some alcoholic beverages have been invested with religious significance, as in the ancient Greco-Roman religion, such as in the ecstatic rituals of Dionysus (also called Bacchus). Some have postulated that pagan religions actively promoted alcohol and drunkenness as a means of fostering fertility. Alcohol was believed to increase sexual desire and to make it easier to approach another person for sex. For example, Norse paganism considered alcohol to be the sap of Yggdrasil. Drunkenness was an important fertility rite in this religion.

Many Christian denominations use wine in the Eucharist or Communion and permit alcohol in moderation. Other denominations use unfermented grape juice in Communion and either abstain from alcohol by choice or prohibit it outright.

Judaism uses wine on Shabbat for Kiddush as well as in the Passover ceremony, Purim, and other religious ceremonies. The drinking of alcohol is allowed. Some Jewish texts, e.g. the Talmud, encourage moderate drinking on holidays (such as Purim) in order to make the occasion more joyous.

Prohibition

Some religions forbid, discourage, or restrict the drinking of alcoholic beverages for various reasons. These include Islam, Jainism, the Bahá'í Faith, 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 Hinduism.

The Pali Canon, the scripture of Theravada Buddhism, depicts refraining from alcohol as essential to moral conduct because alcohol causes a loss of mindfulness. The fifth of the Five Precepts states, "Surā-meraya-majja-pamādaṭṭhānā veramaṇī sikkhāpadaṃ samādiyāmi." The English translation is, "I undertake to refrain from fermented drink that causes heedlessness." Technically this prohibition does not cover drugs other than alcohol. But its purport is not that alcohol is an evil but that the carelessness it produces creates bad karma. Therefore any substance (beyond tea or mild coffee) that affects one's mindfulness is considered to be covered by this prohibition.^{[citation needed]}

Alcohols

Toxicology by alcohol group

Alcoholic beverages has been consumed by humans since prehistoric times for a variety of hygienic, dietary, medicinal, religious, and recreational reasons.

Primary alcohols (R-CH₂-OH) can be oxidized either to aldehydes (R-CHO) (eg acetaldehyde which may cause hangonver) or to carboxylic acids (R-CO₂H), while the oxidation of secondary alcohols (R¹R²CH-OH) normally terminates at the ketone (R¹R²C=O) stage. Tertiary alcohols (R¹R²R³C-OH) are resistant to oxidation.

Tertiary alcohols are unable to be metabolised into aldehydes^[136] and as a result they cause no hangover or toxicity through this mechanism. Some secondary and tertiary alcohols are less poisonous than ethanol because the liver is unable to metabolise them into these toxic by-products. This makes them more suitable for recreational^[137]^[138] and medicinal^[139] use as the chronic harms are lower. tert-Amyl alcohol found in alcoholic beverages are a good example of a tertiary alcohol which saw both medicinal and recreational use.

Consumable alcohols

Chemical alcohol classification	Consumable alcohol found in beverages	Acronym	Chemical abbreviation	% chief congener in ethanol beverage^[19]	Color/Form^[140]	Odor^[140]	Taste^[140]	Moderate loading dose	BAC poisoning	% equipotent ethanol intoxication (% chief congener in ethanol beverages x Potency compared to EtOH)	Therapeutic index (Potency compared to EtOH/EtOH LD50:LD50 ratio)	Potency compared to EtOH	EtOH LD50:LD50 ratio	LD50 in rat, oral^[13]
Primary	Ethyl alcohol	Ethanol	EtOH	Rectified spirit	Clear, colorless, very mobile liquid	Mild, rather pleasant; like wine or whiskey. Weak, ethereal, vinous odor.	Burning	20-50 mL/40%	0.4%	-	-	-	-	7060 mg/kg
Primary	Isobutyl alcohol	Isobutanol	2M1PAOL	0.9% (mean) in Rye mash cistern room: 534–1197 mg/100 mL	Colorless, oily liquid. Clear, colorless, refractive, mobile liquid.	Suffocating odor of fusel oil. Slightly suffocating; nonresidual alcoholic. Sweet, musty odor	Sweet whiskey taste	?	?	?	?	?	?	2460 mg/kg
Primary	Isopentyl alcohol	Isopentanol	3M1BAOH	1.5% (mean) in French Brandy: 859–2108 mg/100 mL	Oily, clear liquid. Colorless liquid.	Characteristic, disagreeable odor. Disagreeable odor.	Pungent, repulsive taste	?	?	?	?	?	5.4	1300 mg/kg
Primary	1-Propyl alcohol	1-Propanol	1-PrOH	2.8% (mean) in Jamaican rum: 2384–3130 mg/100 mL. Up to 3500 mg/L (0.35%) in spirits.^[141]	Colorless liquid	Similar to ethanol	Characteristic ripe, fruity flavor. Burning taste	?	?	8.4%	0.8 (mean): 0.5-1.1	3 (mean): 2-4	3.8	1870 mg/kg
Secondary	Active amyl alcohol	2-Methyl-1-butanol	2M1BTOH	1.2% (mean) in Bourbon: 910–1390 mg/100 mL	Oily, clear liquid. Colorless liquid	Characteristic, disagreeable odor.	Pungent, repulsive taste	?	?	?	?	?	1.7	4170 mg/kg^[142]
Tertiary	tert-Amyl alcohol	t-Amylol	t-AmOH	0.7% in beer: 70 mg/100 mL	Colorless liquid	Characteristic odor. Camphor odor	Burning taste	2.0-4.0 gram	?	14%	2.8	20	7.1	1000 mg/kg
Tertiary	tert-Butyl alcohol	t-Butanol	t-BuOH	Identified, not quantified, in beer^[143]	Colorless liquid or solid (crystals) (above 78 degrees F)	Camphor-like odor	?	?	?	?	?	?	2.6	2743 mg/kg

Ethyl alcohol

Ethanol (CH₃CH₂OH) is the active ingredient in alcoholic beverages (although novelty inebriating drinks have been made from alternate alcohols such as 2-Methyl-2-butanol^{[citation needed]}). When produced for use in a beverage, ethanol is always produced by means of fermentation, i.e., the metabolism of carbohydrates by certain species of yeast in the absence of oxygen.

Etymology

The term ethanol was invented 1838, modeled on German äthyl (Liebig), from Greek aither (see ether) + hyle "stuff.".^[144] Ether in late 14c. meant "upper regions of space," from Old French ether and directly from Latin aether "the upper pure, bright air," from Greek aither "upper air; bright, purer air; the sky," from aithein "to burn, shine," from PIE root *aidh- "to burn" (see edifice).^[145]

Toxicology

Ethanol's toxicity is largely caused by its primary metabolite; acetaldehyde (systematically ethanal)^[146]^[147] and secondary metabolite; acetic acid.^[147]^[148]^[149]^[150] All primary alcohols are broken down into aldehydes then to carboxylic acids, and whose toxicities are similar to acetaldehyde and acetic acid. Metabolite toxicity is reduced in rats fed N-acetylcysteine^[146]^[151] and thiamine.^[152]

When compared to other alcohols, ethanol is only slightly toxic, with a lowest known lethal dose in humans of 1400 mg/kg (about 20 shots for a 100 kg person), and an LD₅₀ of 9000 mg/kg (oral, rat). Nevertheless, accidental overdosing of alcoholic drinks, especially those containing a high percentage of alcohol, is risky, especially for women, lightweight persons, and children. These people have a smaller quantity of water in their bodies, so that the alcohol is less diluted.

Excessive consumption of ethanol may cause a delayed effect that is called a hangover. Various factors contribute to it, including the toxication of ethanol to acetaldehyde, the direct toxic effects and toxication of impurities called congeners, and dehydration. The hangover starts after the euphoric effects of ethanol have subsided, typically in the night and morning after alcoholic drinks were consumed. However, the blood alcohol concentration may still be substantial and above the limit imposed for automobile drivers and operators of heavy equipment. The effects of a hangover subside over time. Various treatments to cure hangover have been suggested, many of them pseudoscientific.

Chemistry

Liquor that contains 40% ABV (80 US proof) will catch fire if heated to about 79 °F (26 °C) and an ignition source is applied to it. This is called its flash point.^[153] The flash point of pure alcohol is 63 °F (17 °C).^[154] The flash points of alcohol concentrations from 10% ABV to 96% ABV are shown below:^[155]

5%: 144 °F (62 °C)—beer
10%: 120 °F (49 °C)—wine
20%: 97 °F (36 °C)—fortified wine
30%: 84 °F (29 °C)
40%: 79 °F (26 °C)—typical whiskey
50%: 75 °F (24 °C)—strong whiskey
60%: 72 °F (22 °C)
70%: 70 °F (21 °C)—absinthe
80%: 68 °F (20 °C)
90%: 63 °F (17 °C)—neutral grain spirit
96%: 63 °F (17 °C)

Beverages that have a low concentration of alcohol will burn if sufficiently heated and an ignition source (such as an electric spark or a match) is applied to them. For example, wine cooked with food at 400 °F produces ethanol vapor that autoignites and causes minor explosions.^[156]

Propyl alcohol

Ethanol has been found to double the lifespans of worms feed 0.005% ethanol but does not markedly increase at higher concentrations. Supplementing starved cultures with n-propanol and n-butanol also extended lifespan.^[95]

No epidemiological studies are available to assess the long-term effects, including the carcinogenicity, of 1-propanol in human beings. The most likely acute effects of 1-propanol in man are alcoholic intoxication and narcosis. The results of animal studies indicate that 1-propanol is 2 - 4 times as intoxicating as ethanol. Animal toxicity data are not adequate to make an evaluation of the human health risks associated with repeated or long-term exposure to 1-propanol. However, limited short-term rat studies suggest that oral exposure to 1-propanol is unlikely to pose a serious health hazard under the usual conditions of human exposure.^[157] As of 2011, only one case of lethal 1-propanol poisoning was reported.^[158]

tert-Amyl alcohol

tert-Amyl alcohol (t-Amylol, t-AmOH), or 2-Methyl-2-butanol (2M2B), is an alcohol which is around 20 times more potent than ethanol found in beer and other alcoholic beverages.^{[citation needed]} By virtue of its production from fermentation of sugar it has been used for thousands of years. It was discovered as a fusel alcohol 1910.^[159]

In humans it possesses sedative, hypnotic, and anticonvulsant effects similar to ethanol through ingestion or inhalation, and was previously used in medicine for this purpose.^[160] t-Amylol has been used recreationally because of its lack of toxic aldehyde metabolites.^[161]^[162]

Highly poisonous alcohols

Some alcohols are substantially more poisonous than ethanol (highly toxic fusel alcohols), partly because they take much longer to be metabolized and partly because their metabolism produces substances that are even more toxic:

Isopropyl alcohol

Isopropyl alcohol is oxidized to form acetone by alcohol dehydrogenase in the liver but have occasionally been abused by alcoholics, leading to a range of adverse health effects.^[163]^[164]

Methanol (methyl alcohol, wood alcohol)

As little as four milliliters can cause blindness and 80 to 150 milliliters can be fatal; about half a milliliter per kilogram of weight is deadly. Drinking methanol causes effects similar to common alcohol, such as an upset stomach and dizziness, with the addition of pronounced vision problems. After these effects disappear, they reappear six to 30 hours later, only with much greater severity. Severe symptoms tend to appear 18 to 24 hours after consumption. The relapse time makes it imperative to seek medical help as soon as possible.^[165]

Methanol itself, while poisonous (LD50 5628 mg/kg, oral, rat^[13]), has a much weaker sedative effect than ethanol. Methanol is oxidized to formaldehyde and then to the poisonous formic acid in the liver by alcohol dehydrogenase and formaldehyde dehydrogenase enzymes, respectively; accumulation of formic acid can lead to blindness or death.^[166] Likewise, poisoning due to other alcohols such as ethylene glycol or diethylene glycol are due to their metabolites, which are also produced by alcohol dehydrogenase.^[167]^[168] An effective treatment to prevent toxicity after methanol or ethylene glycol ingestion is to administer ethanol. Alcohol dehydrogenase has a higher affinity for ethanol, thus preventing methanol from binding and acting as a substrate. Any remaining methanol will then have time to be excreted through the kidneys.^[166]^[169]^[170]

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External links

Alcohol, Health-EU Portal
BBC Headroom: Drinking too much?
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?
Food and alcoholic drinks - Hebrew blog about alcohol

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@@ Line 747: / Line 747: @@
 =====Longevity=====
-A meta-analysis found with data from 477,200 individuals determined the dose-response relationships by sex and end point using lifetime abstainers as the reference group. The search revealed 20 cohort studies that met our inclusion criteria. A U-shaped relationship was found for both sexes. Compared with lifetime abstainers, the relative risk (RR) for type 2 diabetes among men was most protective when consuming 22 g/day alcohol (RR 0.87 [95% CI 0.76–1.00]) and became deleterious at just over 60 g/day alcohol (1.01 [0.71–1.44]). Among women, consumption of 24 g/day alcohol was most protective (0.60 [0.52–0.69]) and became deleterious at about 50 g/day alcohol (1.02 [0.83–1.26]).
+A meta-analysis found with data from 477,200 individuals determined the dose-response relationships by sex and end point using lifetime abstainers as the reference group. The search revealed 20 cohort studies that met our inclusion criteria. A U-shaped relationship was found for both sexes. Compared with lifetime abstainers, the relative risk (RR) for type 2 diabetes among men was most protective when consuming 22 g/day alcohol (RR 0.87 [95% CI 0.76–1.00]) and became deleterious at just over 60 g/day alcohol (1.01 [0.71–1.44]). Among women, consumption of 24 g/day alcohol was most protective (0.60 [0.52–0.69]) and became deleterious at about 50 g/day alcohol (1.02 [0.83–1.26]).<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768203/</ref>
+Interestingly, ethanol has been found to double the lifespans of worms feed 0.005% ethanol but does not markedly increase at higher concentrations. Supplementing starved cultures with ''n''-propanol and ''n''-butanol also extended lifespan.;<ref name="plosone.org"/> [[1-Propanol]] (''n''-propanol) is thought to be similar to ethanol in its effects on human body, but 2-4 times more potent. However, this seems to be statistically significant for humans when compared to the previous study discusses; Human macronutrients in food consist mainly of water and the Dietary Reference Intake (DRI) for water is 3.7 litres (3700 mL x 0.005% EtOH = 18.5 mL EtOH) for 19-70 year old males, and 2.7 litres (2700 mL x 0.005% EtOH = 13.5 mL) for 19-70 year old women.
 Because former drinkers may be inspired to abstain due to health concerns, they may actually be at increased risk of developing diabetes, known as the sick-quitter effect. Moreover, the balance of risk of alcohol consumption on other diseases and health outcomes, even at moderate levels of consumption, may outweigh the positive benefits with regard to diabetes.
@@ Line 754: / Line 756: @@
 In a 2010 long-term study of an older population, the beneficial effects of moderate drinking were confirmed, but abstainers and heavy drinkers showed an increase of about 50% in [[Mortality rate|mortality]] (even after controlling for confounding factors).<ref>{{cite journal |last1=Holahan |first1=Charles J. |last2=Schutte |first2=Kathleen K. |last3=Brennan |first3=Penny L. |last4=Holahan |first4=Carole K. |last5=Moos |first5=Bernice S. |last6=Moos |first6=Rudolf H. |title=Late-Life Alcohol Consumption and 20-Year Mortality |journal=Alcoholism: Clinical and Experimental Research |volume=34 |issue=11 |pages=1961–71 |year=2010 |doi=10.1111/j.1530-0277.2010.01286.x |pmid=20735372}}</ref>
-Ethanol has been found to double the lifespans of worms feed 0.005% ethanol but does not markedly increase at higher concentrations. Supplementing starved cultures with ''n''-propanol and ''n''-butanol also extended lifespan.;<ref name="plosone.org"/> [[1-Propanol]] (''n''-propanol) is thought to be similar to ethanol in its effects on human body, but 2-4 times more potent.
 =====Diabetes=====

v t e Anxiolytics (N05B)
5-HT_1ARTooltip 5-HT1A receptor agonists	Buspirone Gepirone Tandospirone
GABA_ARTooltip GABAA receptor PAMsTooltip positive allosteric modulators	Benzodiazepines: Adinazolam Alprazolam Bromazepam Camazepam Chlordiazepoxide Clobazam Clonazepam Clorazepate Clotiazepam Cloxazolam Diazepam^# Ethyl loflazepate Etizolam Fludiazepam Halazepam Ketazolam Lorazepam^# Medazepam Nordazepam Oxazepam Pinazepam Prazepam; Others: Alpidem^‡ Barbiturates (e.g., phenobarbital) Carbamates (e.g., meprobamate) Carisoprodol Chlormezanone^‡ Ethanol (alcohol) Etifoxine
Hypnotics	Zopiclone
Gabapentinoids (α₂δ VDCC blockers)	Gabapentin Gabapentin enacarbil Phenibut Pregabalin
Antidepressants	SSRIsTooltip Selective serotonin reuptake inhibitors (e.g., escitalopram) SNRIsTooltip Serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine) SARIsTooltip Serotonin antagonist and reuptake inhibitors (e.g., trazodone) TCAsTooltip Tricyclic antidepressants (e.g., clomipramine^#) TeCAsTooltip Tetracyclic antidepressants (e.g., mirtazapine) MAOIsTooltip Monoamine oxidase inhibitors (e.g., phenelzine); Others: Agomelatine Bupropion Tianeptine Vilazodone Vortioxetine
Antipsychotics	Quetiapine Flupentixol
Sympatholytics (Antiadrenergics)	Alpha-1 blockers (e.g., prazosin) Alpha-2 agonists (e.g., clonidine, dexmedetomidine, guanfacine) Beta blockers (e.g., propranolol)
Others	Benzoctamine Cycloserine Fabomotizole Hydroxyzine Lorpiprazole Mebicar Mepiprazole Nicotine Opipramol Oxaflozane^‡ Phenaglycodol Phenibut Picamilon Selank Tiagabine Tofisopam Validolum
^#WHO-EM ^‡Withdrawn from market Clinical trials: ^†Phase III ^§Never to phase III

v t e Neurotoxins
Animal toxins	Batrachotoxin Bestoxin Birtoxin Bungarotoxin Charybdotoxin Conotoxin Fasciculin Huwentoxin Poneratoxin Saxitoxin Tetrodotoxin Vanillotoxin Spooky toxin (SsTx) Epibatidine Zetekitoxin AB Dendrotoxin
Bacterial	Botulinum toxin Tetanospasmin
Cyanotoxins	Anatoxin-a Guanitoxin BMAA Saxitoxin
Plant toxins	Aconitine Bicuculline Penitrem A Picrotoxin Strychnine Tutin Rotenone Ginkgotoxin Cicutoxin Oenanthotoxin Thujone Volkensin Veratridine
Mycotoxins	Ibotenic acid Muscarine Muscimol
Pesticides	Fenpropathrin Tetramethylenedisulfotetramine Bromethalin Crimidine Methamidophos Endosulfan Fipronil Phenylsilatrane Chlorophenylsilatrane Sulfuryl fluoride Mipafox Schradan Dimefox
Nerve agents	Cyclosarin EA-3148 Novichok agent Sarin Soman Tabun VE VG VM VP VR VX GV EA-3990 EA-4056 T-1123 Octamethylene-bis(5-dimethylcarbamoxyisoquinolinium bromide) Fluorotabun Chinese VX EA-2192
Bicyclic phosphates	TBPS TBPO IPTBO
Cholinergic neurotoxins	Acetylcholine mustard Catecholine Choline mustard Ethylcholine mustard Hemicholinium mustard
Other	Dimethylcadmium Dimethylmercury Toxopyrimidine IDPN Tetraethyllead