Alcohol is a central nervous system depressant
It is the most abused drug in our society - past, present, and probably future
It can cause intoxication, unconsciousness, and in some cases death
It is as potent as many of the illegal drugs and can be potentially fatal when mixed with other drugs
Drinking and driving are a particularly danger mix - impairment occurs well before the point of legal intoxication
Alcohol can cause severe damage to a developing fetus
Alcoholism is a very treatable illness
Alcohol is the most widely used, the most widely accepted drug known to mankind, past, present and probably future. It is the simplest of all the psychoactive drugs, C2H5OH, (comprised of the most basic elements in nature, carbon, hydrogen and oxygen). It is also known as ethanol, ethyl alcohol, or ETOH. Alcohol is a depressant drug, similar to the anesthetic drug ether (if you were to take two molecules of ETOH, add heat [thereby driving away a molecule of water], you would be left with the compound C4H10O, ether).
Alcohol is the only nonmedical drug taken "only" by mouth. Whereas other drugs have multiple methods of use, alcohol is predominately a drug taken orally. You could indeed soak your feet in a vat of brandy and raise your blood alcohol level, but this is not something that could be done with much social grace. You can inject alcohol directly into the vein, but the physical harm this could cause might be life threatening. There are also reported cases of late-stage alcoholics who can no longer drink alcohol due to the destruction of their intestinal system and get drunk by giving themselves vodka "enemas," but again this would not lend itself to the social aspects of drinking.
Alcohol is the only drug with which a large number of those who use it do not become physically dependent upon it - it is estimated that 10% of the drinking population are dependent on alcohol - approximately 15 million Americans. Many other drugs have addiction rates as high as 50 to 60% of those who use them (e.g. marijuana, heroin and cocaine). Because of this fact, the majority of drinkers view alcohol as being relatively safe and tend to not view alcohol as a drug.
By definition, a drug is anything that alters the normal course of body functioning. A psychoactive drug is something that not only changes the way the body works, but also alters the mood, emotions, and psychological process of the brain. Alcohol, being a depressant drug, changes the physical body in many ways. It slows the heart rate, slows breathing, it can even put various body systems to sleep, causing them to stop functioning for a period of time. As alcohol depresses the brain, it not only causes changes in the physical activities of the brain, but by causing such depression it actually causes a change in feelings, emotions, and rational thinking.
Alcohol is the only drug that contains calories, yet these are wasted calories. Beers and wines are "clarified." This process removes the spent yeast and mash (grain or fruit mash), which also removes the vitamins and nutritional value of the beverage. Many late-stage alcoholics who rely solely on alcohol for their daily food intake suffer serious medical problems related to malnutrition because of this.
When we talk about alcohol, we are talking about beverage alcohol, ethanol. The common varieties of beverage alcohol are:
| Beer, both the regular and low-calorie "light beers", made from various cereal grain products such as barley, rye, corn and wheat. The process of making beer is referred to as brewing, in which grains are converted from a cereal broth starch to fermentable sugar, fermented, then stored and aged for a certain period of time. The resulting product contains from 3 to 6% alcohol by volume, with the typical "regular beer" (also known as lager beer) containing approximately 4% alcohol. Light beers generally contain about 3.25 alcohol. Malt liquor has a more delicate, aromatic flavor and contains between 4 and 5% alcohol. Ale, stout and porter beers are more bitter with a "full-bodied" taste and alcohol content between 6 and 7%. |
| Wine, made from the fermented juice of grapes or other fruits. A variety of wine products exist on the market today. "Soda pop" wines (Boone’s Farm, TJ Swann, etc.) have an alcohol content of about 8%. "Wine coolers" (fruit-flavored wines) range from 4% up to 9% alcohol by volume. Table wines (red, white, rose, sparkling or champagne) contain from 10 to 14%. Fortified wine (e.g. MD 2020) contain up to 21% alcohol. Dessert or cocktail wines (sherry, port, Madeira, vermouth) range from 15 to 24% alcohol by volume by adding neutral distilled spirits or brandy to table wines. Some of the cheapest table wines manufactured in Europe may also have alcohol concentrations of up to 24% by taking wine and "fortifying" it with distilled spirits or some other form of alcohol, most commonly methanol or "wood" alcohol. |
| Distilled spirits, made from a variety of fermented mixtures that are heated in a still. Whiskey, vodka, gin and brand are mixtures of cereal grains or fruits; Rum is derived from molasses, and tequila is made from the fermented juice of the mescal cactus plant. Alcohol has a lower boiling point than the other substances in the fermented mixture. It boils off; the vapors are collected, cooled and condensed. These distilled fluids have a relatively high alcohol content, along with some water and flavors from the fermented mixture. The alcohol content generally ranges from 40-50%, or 80-100 proof (proof is twice the alcohol content). No distilled beverage can be 100% pure ethanol because alcohol is so toxic it will dilute itself with water from the air around it at about 98% pure. |
Box A.1 - Proof
The belief behind the use of the term "proof" comes from sailors of old - to determine the purity of the rum they would buy, they would mix gunpowder with the rum and ignite it. Poor quality rum had more water - less alcohol - therefore the mixture would fizzle. If there were less water, more alcohol, the mixture would explode and go "POOF", thereby signaling a better batch of rum.
As noted, each major type of alcoholic beverage has different alcohol content. Nevertheless, a typical serving of any one of these beverages contains approximately the same amount of ethyl alcohol. Referred to as the "equivalent amount," each of the following drinks contains approximately one-half ounce of ethyl alcohol:
| 1-12 oz. can of beer, 4% alcohol content; |
| 1- 4 oz. glass of wine, 12% alcohol content, |
| 1 mixed drink containing 1 and one-quarter ounce of 40% liquor (80 proof). |
Based on these equivalences, alcohol is alcohol, but a drink is not a drink. Beer is generally prepackaged in cans, but wine and distilled spirits are bottled, meaning the serving size will vary, depending on who pours them. It is important to recognize these equivalences, as alcohol intoxication is dependent upon the amount of ethyl alcohol consumed, not the number of drinks consumed.
Ethyl alcohol is the only form of alcohol that may be consumed with any degree of safety, but it is not the only form of alcohol. These additional types of alcohol are as follows:
| Methyl, Methanol, or wood alcohol (one carbon instead of two, CH5OH) - drinking methanol can cause blindness because it leaves the body more slowly than ethanol (1/5 as fast) - found in cleaning products, shellac, and is used to make formaldehyde - when methanol is taken into the body, the breakdown element is actually formaldehyde, thus its toxic effect; |
| Isopropyl, Isopropanol, or rubbing alcohol (three carbons instead of two, C3H5OH) - not as dangerous as methanol but causes serious gastrointestinal distress as well as damage to the lungs. Eight ounces of pure isopropyl can be fatal; |
| Butyl alcohol (four carbons instead of two, C4H5OH). Made from the molasses of beets - used in lacquer, tanning products, film production; |
| Denatured alcohol - ethyl alcohol with additives (methanol or acetone) to make it "undrinkable" - used industrially as a solvent. |
The mistaken belief that the term alcohol refers to a single substance rather than a group of related substances has cost many lives in the U.S. Too often, people, especially young drinkers and chronic alcoholics, believe that a product that contains alcohol can be consumed for the purpose of intoxication. This belief can be fatal.
To understand how people use alcohol, it is first important to define some key terms.
First, what is a drinker? This concept alone accounts for numerous discussions and arguments when it comes to defining the problem of alcohol use in our society. To simplify matters, we will use the following classification as outlined by the federal government.
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DRINKING CLASSIFICATIONS ACCORDING TO THE U.S. GOVERNMENT |
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Classification |
Drinking behavior |
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Abstainers |
Do not drink or drink less than once a year. |
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Infrequent Drinkers |
Drink once a month at most and drink small amounts per typical drinking occasion. |
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Light Drinkers |
Drink once a month and drink medium amounts per typical drinking occasion, or drink no more than three to four times a month and drink small amounts per typical drinking occasion. |
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Moderate Drinkers |
Drink at least once a week and small amounts per typical drinking occasion or three to four times a month and medium amounts per typical drinking occasion or no more than once a month and large amounts per typical drinking occasion. |
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Moderate/Heavy Drinkers |
Drink at least once a week and medium amounts per typical drinking occasion or three to four times a month and large amounts per typical drinking occasion. |
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Heavy Drinkers |
Drink at least once a week and large amounts per typical drinking occasion. |
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Small amounts = 1 Drink or less per drinking occasion Medium amounts = 2 to 4 drinks per drinking occasion Large amounts = 5 or more drinks per drinking occasion
Drink = 1-12 oz. can of beer, 4% alcohol content; 1-4 oz. glass of wine, 12% alcohol content, 1 mixed drink containing 1 and one-quarter ounce of 40% liquor (80 proof). Each of these drinks contains approximately one-half ounce of ethyl alcohol. |
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From the U.S. Department of Health and Human Services: Alcohol and Health: Fourth Special Report to the U.S. Congress, Washington, D.C., 1981, DHHS Pub No. ADM 81-1080. |
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Now, on to some important definitions.
"Alcohol use" - the consumption of beverage alcohol within some socially prescribed or ritualistic context.
Societies around the world have many ways of defining the appropriate use of beverage alcohol. Indeed, the term "happy hour" is used to define social use of alcohol, and is also found in Webster’s Dictionary. Alcohol is one of three social, legal (when one reaches the correct age) drugs associated with fun and good times. Wine with communion, champagne on New Years Eve, and a toast to the bride and groom are accepted rituals that center on alcohol.
"Alcohol misuse" - unintentional or inappropriate use of beverage alcohol resulting in the impaired physical, mental, emotional or social well being of the user.
While many people consume one or two alcoholic drinks at a setting with no ill effect, many consume to the point of intoxication. The very nature of alcohol as a toxin and an irritant tends to create physical distress at this level. Additionally, there are a variety of ways that moderate use of alcohol enhances the physical and psychological process, while more than this would actually become harmful. For example, many physicians recommend two glasses of wine with a meal to aid digestion. This amount of alcohol begins to irritate the stomach, causing the release of digestive enzymes and juices. Add food and the digestion is improved. However, three or more drinks would actually prevent the release of these enzymes, thus causing problems with digestion. Similarly, two drinks before bedtime would aid sleep. Three or more, however, actually prevents REM (dreaming) sleep, which is the part of sleep in which we recover.
"Alcohol abuse" - deliberate or unintentional use of beverage alcohol which results in any degree of physical, mental, emotional, or social impairment of the user, the user’s family, or society in general.
By definition, an adolescent who drinks any form of alcoholic beverage is abusing the drug, simply because of its illegal nature. But what about those who drink legally? Many people who drink socially have tolerance to alcohol, that is, there are able to drink certain amounts with seemingly no adverse effects. Legal intoxication (the level of alcohol in the system that society deems unacceptable to be driving or out in public) is .10 BAC (blood alcohol concentration). Most people reach this level between their third and fourth drink in one hours time. Yet this level does not mean that the person is out of control, falling down drunk. Many people continue to function, and many people drive in this condition. By the very nature of the law, this is alcohol abuse.
Because many people assume that a drink is a drink, there are many problems caused by unintentional abuse. Certain drinks, like Long Island Iced Tea, may actually have up to 7 oz. of distilled spirits. A single drink can cause intoxication above the legal level, resulting in DWI’s, arguments, physical discomfort, psychological distress, and so on. Abuse of alcohol is common in our society, but does not mean that the drinker has the more serious problem of alcoholism.
"Alcohol dependence" - psychological and/or physical need for beverage alcohol - characterized by compulsive use, tolerance, and physical dependence manifest by withdrawal syndrome.
This is but one possible definition of alcohol dependence, or alcoholism. One major problem with this definition is with regards to withdrawal syndrome. Many people who have both a physical and psychological need for alcohol do not suffer from physical withdrawal. This fact may allow them to continue to delude themselves into thinking that alcohol is not a problem for them, that they can take it or leave it. Alcoholics tend to return to drinking after going on the wagon, thus having "proved" that they don’t have a problem. A more recent definition by the American Medical Association will be given in a later section along with further discussion on the definition of alcoholism.
Today, we know the following facts - of the total adult population:
| 90% have tried alcohol during their lifetime; |
| 60% are classified as regular drinkers (consuming alcoholic beverages more than once a month); |
| 40% are non-drinkers for a variety of reasons, including religious beliefs, family beliefs, ethnic background, and the like; |
| 7% of the drinking population age 18 and older drink alcohol on a daily basis, yet these 7% consume almost half of all alcohol drunk in this country; |
| 10 to 11% of those who drink develop alcoholism. |
Alcohol is the oldest drug known to mankind. It is made through the simple process of fermentation. All that is required is a source of sugar, yeast, and a source of heat. Probably when ancient man left a bowl of fruit or berries in the sun too long, alcohol was discovered (sugar from the fruit, yeast from the air, heat from the sun). When he found his bowl now contained a smelly, foul tasting fluid, his curiosity took control. After consuming the liquid and finding the intoxicating effect of the beverage, he found that the beverage was actually quite appealing. From that point on, various sources of sugar were used to make this beverage, and over the years, various refinements took place. Wines and mead (fermented honey) were probably the first alcoholic beverages, with beers to follow.
12-14% alcohol by content is the most that Mother Nature can provide. At that percentage, alcohol kills the yeast, thereby stopping the fermentation process. It was not until the process of distillation was discovered that the percentage of alcohol in a beverage was increased. An Arabic physician, Rhazes, discovered the use of a still in the year 800 A.D. He was looking for a way to release "the spirit of the wine" when he found that alcohol had a lower boiling point than water. Heating the mixture, collecting, cooling, and condensing the vapor produced the more purified form of alcohol. The term alcohol comes from the Arabic "al kohl" which means "the essential spirit of wine." Distillation increases the alcoholic content of a beverage by 400-500% (14% to 50%).