Alcohol

(alcohol - physiological effects) "Alcohol is neurotoxic to brain development, leading to structural hippocampal changes in adolescence,¹⁶ and to reduced brain volume in middle age.¹⁷ Alcohol is a dependence-producing drug, similar to other substances under international control, through its reinforcing properties and neuro-adaptation in the brain.¹⁸ It is an immunosuppressant, increasing the risk of communicable diseases,¹⁹ including tuberculosis.²⁰ Alcoholic beverages are classifi ed as carcinogenic by the International Agency for Research on Cancer, increasing the risk of cancers of the oral cavity and pharynx, oesophagus, stomach, colon, rectum, and breast in a linear dose-response relation,²¹ with acetaldehyde as a potential pathway.²² Alcohol has a biform relation with coronary heart disease. In low and apparently regular doses (as little as 10 g every other day), alcohol is cardioprotective,²³ although doubt remains about the effect of confounders.²⁴ At high doses, especially when consumed irregularly, it is cardiotoxic.²⁵

(alcohol - liver failure and warnings for acetaminophen and NSAIDS) "... we [the U.S. Food and Drug Administration, HHS] have recent data suggesting that acetaminophen may be the most common cause of acute liver failure in the United States (Ref. 13). Therefore,we believe that the word "severe" is appropriate in the liver warning. In addition, we agree with the submission that the word "severe" is also appropriate in the stomach bleeding warning on OTC NSAID [nonsteroidal anti-inflammatory drug] products."

Editor's Note: The required labeling for acetaminophen and NSAID products in this Federal Register entry was:

"For products containing acetaminophen:
"Alcohol Warning: If you consume 3 or more alcoholic drinks every day, ask a doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage."

"For products containing NSAIDs:
"Alcohol Warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take (name of active ingredient) or other pain relievers/fever reducers. (Name of active ingredient) may cause stomach bleeding."

(alcohol - lethal dose vs other drugs) "The lethal dose of alcohol divided by a typical recreational dose (safety ratio) is 10, which places it closer to heroin (6), and GHB (8) in terms of danger from overdose, than MDMA (“Ecstasy” – 16), and considerably more dangerous than LSD (1000) or cannabis (>1000)."

(history - alcohol) "The first discussion of a relationship between alcohol consumption and motor vehicle collisions to be published in an American scientific journal appeared as an editorial in the Quarterly Journal of Inebriation (1904). The editor had received a communication about 25 fatal crashes of automobile wagons in which 23 occupants died and 14 suffered injuries. Nineteen of the drivers had used alcohol within an hour of the crash. The author of the communication commented that driving automobile wagons was a more dangerous activity for drinkers than driving locomotives. Drinking by on-duty railroad employees had been prohibited since 1843 (Borkenstein, 1985)."

(history - alcohol prohibition) "By all estimates, the Eighteenth Amendment was a costly blunder. Between 1920 and 1930, the federal government spent an average of twenty-one million dollars enforcing the Volstead Act.¹² [the National Prohibition Act - enabling legislation for the 18th Amendment] During the same period, the United States lost an estimated $1.25 billion in potential tax revenues annually.¹³ In spite of the resources consumed by Alcohol Prohibition, it affected only one segment of the nation. National Prohibition cut in half the consumption of spirits by the poor and working classes, but the “consumption of alcoholic beverages by the business, professional and salaried class [was] fully as great . . . as it was prior to prohibition.”¹⁴ While National Prohibition kept the poor dry, it made local organized crime groups wealthy enough to extend their control over entire cities.¹⁵ This success further reflected mainstream America’s implicit rejection of temperance morality. As Al Capone himself so pointedly remarked:

"I make my money by supplying a public demand. If I break the law, my customers, who number hundreds of the best people in Chicago, are as guilty as I am. The only difference between us is that I sell and they buy. Everybody calls me a racketeer. I call myself a business man. When I sell liquor, it’s bootlegging. When my patrons serve it on a silver tray on Lake Shore Drive, it’s hospitality.¹⁶"

(alcohol - toxicity and marketing) "Alcohol thus ranks at the dangerous end of the toxicity spectrum. So despite the fact that about 75 percent of all adults in the United States enjoy an occasional drink, it must be remembered that alcohol is quite toxic. Indeed, if alcohol were a newly formulated beverage, its high toxicity and addiction potential would surely prevent it from being marketed as a food or drug."

Alcohol - Data

(2010 - alcohol - number of current users) "Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2010 survey (51.8 percent). This translates to an estimated 131.3 million people, which was similar to the 2009 estimate of 130.6 million people (51.9 percent)."

(2010 - alcohol - use among 50 year-olds) "Alcohol consumption is relatively high among 50-year-olds, with two thirds (67%) indicating that they consumed at least one alcoholic drink in the prior 30 days, 11% reporting current daily drinking (defined as drinking on 20 or more occasions in the prior 30 days), and 18% indicating recent occasions of heavy drinking (defined as five or more drinks in a row on at least one occasion in the prior two weeks). The rate of recent occasions of heavy drinking is much lower than was exhibited by members of this cohort when they were of high school and college ages."

(2010 - alcohol - driving impairment) "The findings in this report confirm those from the most recent National Roadside Survey, which in 2007 found that only a small percentage of adult drivers are alcohol-impaired. That survey showed that 2.2% of drivers on the road on Friday afternoon or Friday or Saturday night had a BAC of ≥0.08 g/dL (12). Additionally, the findings in this report are consistent with alcohol-impaired driving fatality data. Men accounted for 81% of all alcohol-impaired driving episodes in 2010 and 82% of all alcohol-impaired drivers involved in fatal crashes in 2009 (1). Likewise, men aged 21–34 accounted for 32% of alcohol-impaired driving episodes and 35% of all alcohol-impaired drivers involved in fatal crashes (Tonja Lindsey, National Highway Traffic Safety Administration, personal communication, 2011)."

(2010 - alcohol - number of "heavy" drinkers) "In 2010, heavy drinking was reported by 6.7 percent of the population aged 12 or older, or 16.9 million people. This percentage was similar to the rate of heavy drinking in 2009 (6.8 percent)."

Editor's Note: These are the definitions of "current," "binge" and "heavy alcohol use:

Current (past month) use - At least one drink in the past 30 days.

Binge use - Five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.

Heavy use - Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.

(2010 - alcohol - use by race) "Among persons aged 12 or older, whites in 2010 were more likely than other racial/ethnic groups to report current use of alcohol (56.7 percent) ... The rates were 45.2 percent for persons reporting two or more races, 42.8 percent for blacks, 41.8 percent for Hispanics, 38.4 percent for Asians, and 36.6 percent for American Indians or Alaska Natives."

(2010 - alcohol - number of binge drinkers) "Nearly one quarter (23.1 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2010. This translates to about 58.6 million people. The rate in 2010 was similar to the rate in 2009 (23.7 percent)."

(2009 - alcohol - driving fatalities) "Alcohol-impaired driving fatalities declined 20% from 13,491 to 10,839 from 2006 to 2009, the most recent year for which fatality data are available (7). However, the proportion of all motor vehicle fatalities that involve at least one alcohol-impaired driver has remained stable at about 33%, because non-alcohol-impaired driving fatalities have declined at the same rate as alcohol-impaired fatalities (7). This study indicated that alcohol-impaired driving rates remain disproportionally high among young men, binge drinkers, persons who do not always wear a seatbelt, and persons living in the Midwest."

(2008 - alcohol - use among blacks) "Past month alcohol use, binge alcohol use, and illicit drug use remained relatively stable among black adults between 2002 and 2008 (Figure1).^4,5

"Combined 2004 to 2008 data indicate that, in the past month, 44.3 percent of black adults used alcohol, 21.7 percent reported binge alcohol use, and 9.5 percent used an illicit drug (Figure 2).

"Rates of past month alcohol use and binge alcohol use were lower among black adults than the national averages. The rate of past month illicit drug use among black adults, however, was higher than the national average.

"Rates of past month and binge alcohol use were considerably lower among young black adults than the national average of young adults (48.6 vs. 61.1 percent and 25.3 vs. 41.6 percent, respectively) (Figure 3). Past month illicit drug use among young black adults was slightly lower than the national average (18.7 vs. 19.7 percent).

"Older black adults had a rate of past month alcohol use that was considerably lower than the national average of older adults (20.3 vs. 38.3 percent) (Figure 4). Their rates of binge alcohol use and past month illicit drug use, however, did not differ significantly from the national averages.

"Compared with the national averages, adult black females had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 1).

"Compared with the national averages, adult black males had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 2)."

(2006 - cause of death - alcohol) "In 2006, a total of 22,073 persons died of alcohol-induced causes in the United States (Tables 23 and 24). This category includes not only deaths from dependent and nondependent use of alcohol, but also accidental poisoning by alcohol. It excludes unintentional injuries, homicides, and other causes indirectly related to alcohol use as well as deaths due to fetal alcohol syndrome."

(2007 - cause of death - alcohol) "In 2007, a total of 23,199 persons died of alcohol-induced causes in the United States, 1,126 more deaths than in 2006."

(2006 - alcohol - admissions to substance abuse treatment) "Nearly half (49 percent) of alcohol-only treatment admissions report-ing daily use were referred to treatment by themselves, a family member, or a friend; over half (55 percent) of alcohol-only treatment admissions reporting less than daily use were referred to treatment by the criminal justice system."

(2006 - alcohol - rate of past year use by ethnicity) "The rate of past year alcohol use disorder among persons aged 12 to 20 was higher for American Indians or Alaska Natives (14.9 percent) than for whites (10.9 percent), blacks (4.6 percent), Hispanics (8.7 percent), and Asians (4.9 percent). One in eight Native Hawaiians or Other Pacific Islanders (12.7 percent) met the criteria for an alcohol use disorder."

(2002-2006 - alcohol - prevalence of use disorder) "Combined data from 2002 to 2006 indicated that an annual average of 9.4 percent of persons aged 12 to 20 (3.5 million persons in that age range) met the diagnostic criteria for an alcohol use disorder (dependence or abuse) in the past year."

(2000-2004 - crime - drug and alcohol offenses in schools and colleges) "Table 9 provides the reported instances in each offense record in which the offenders were suspected of using alcohol, computers, and/or drugs.²² The data show that such use was minimal in situations occurring at schools during the 5-year study period. Of the 589,534 offense records, reports of offenders suspected of using drugs totaled 32,366, while reports of alcohol use totaled 5,844."

(2002 + 2003 - alcohol - other substance use by 'lifetime' users) "Lifetime alcohol users aged 21 or older had a significantly higher rate of past year illicit drug use (13.7 percent) compared with lifetime nondrinkers (2.7 percent). In addition, lifetime alcohol users had significantly higher rates of past year use across all illicit drug categories, with the exception of inhalants (Table 1). Nonmedical use of pain relievers was the illicit drug used most often by lifetime nondrinkers, whereas lifetime alcohol users reported using marijuana most frequently."

(2002 + 2003 - alcohol - estimated 'lifetime' substance use) "In 2002 and 2003, an estimated 88.2 percent of persons aged 21 or older (175.6 million) were lifetime alcohol users, whereas an estimated 11.8 percent (23.5 million) were lifetime nondrinkers. Over half of lifetime alcohol users (52.7 percent) had used one or more illicit drugs at some time in their life, compared to 8.0 percent of lifetime nondrinkers. Among persons who had used an illicit drug in their lifetime, the average age at first illicit drug use was 19 years for lifetime alcohol users, versus 23 years for lifetime nondrinkers."

(2002 - drug usage - heavy alcohol use among military personnel) "The significant increase from 1998 to 2002 in heavy alcohol use suggests that this is an area that may need greater emphasis by the Military. Indeed, the rate of heavy alcohol use had not changed significantly since 1988 and indicates that more than one out of six military personnel in 2002 was likely to be a heavy drinker. The finding of no significant change in illicit drug use between 1998 and 2002 and the relatively low rates of use for both surveys suggest that the Military's effort to curtail illicit drug use may have reached its lower limit. The trend line resembles an asymptotic curve that shows steep declines initially with successively smaller declines until it eventually flattens out. The 1992 through 2002 data suggest that the flattening point may have been reached and that it may not be realistic to expect drug use among military personnel to go much lower."

(1998 - alcohol - youth exposure to prevention messages) In the "Drug Use Among Youths, by Exposure to Prevention Messsages" section of its 1998 National Household Survey on Drug Use, SAMHSA concluded, "youths’ exposure to prevention messages outside school, such as through the media, was fairly widespread but appeared to be unrelated to illicit drug use or being drunk on 51 or more days in the past year. Nearly 80% of youths who used illicit drugs and more than three-fourths of youths who were drunk on 51 or more days in the past year reported being exposed to prevention messages outside school."

(marijuana - cannabis, alcohol and driving) According to a literature review of the effects of alcohol on driving, "As with cannabis, alcohol use increased variability in lane position and headway (Casswell, 1979; Ramaekers et al., 2000; Smiley et al., 1981; Stein et al., 1983) but caused faster speeds (Casswell, 1977; Krueger & Vollrath, 2000; Peck et al., 1986; Smiley et al., 1987; Stein et al., 1983). Some studies also showed that alcohol use alone and in combination with cannabis affected visual search behavior (Lamers & Ramaekers, 2001; Moskowitz, Ziedman, & Sharma, 1976). Alcohol consumption combined with cannabis use also worsened driver performance relative to use of either substance alone. Lane position and headway variability were more exaggerated (Attwood et al., 1981; Ramaekers et al., 2000; Robbe, 1998) and speeds were faster (Peck et al., 1986).

"Both simulator and road studies showed that relative to alcohol use alone, participants who used cannabis alone or in combination with alcohol were more aware of their intoxication. Robbe (1998) found that participants who consumed 100 g/kg of cannabis rated their performance worse and the amount of effort required greater compared to those who consumed alcohol (0.05 BAC). Ramaekers et al. (2000) showed that cannabis use alone and in combination with alcohol consumption increased self-ratings of intoxication and decreased self-ratings of performance. Lamers and Ramaekers (2001) found that cannabis use alone (100 g/kg) and in combination with alcohol consumption resulted in lower ratings of alertness, greater perceptions of effort, and worse ratings of performance."

(marijuana - cannabis, alcohol, and driving) "When compared to alcohol, cannabis is detected far less often in accident-involved drivers. Drummer et al. (2003) cited several studies and found that alcohol was detected in 12.5% to 79% of drivers involved in accidents. With regard to crash risk, a large study conducted by Borkenstein, Crowther, Shumate, Zeil and Zylman (1964) compared BAC in approximately 6,000 accident-involved drivers and 7,600 nonaccident controls. They determined the crash risk for each BAC by comparing the number of accident-involved drivers with detected levels of alcohol at each BAC to the number of nonaccident control drivers with the same BAC. They found that crash risk increased sharply as BAC increased. More specifically, at a BAC of 0.10, drivers were approximately five times more likely to be involved in an accident.

"Similar crash risk results were obtained when data for culpable drivers were evaluated. Drummer (1995) found that drivers with detected levels of alcohol were 7.6 times more likely to be culpable. Longo et al. (2000) showed that drivers who tested positive for alcohol were 8.0 times more culpable, and alcohol consumption in combination with cannabis use produced an odds ratio of 5.4. Similar results were also noted by Swann (2000) and Drummer et al. (2003)."

(drug testing - impairment by drug) "After drinking [alcohol], the brain works inefficiently, taking longer to receive messages from the eye; processing information becomes more difficult and instructions to the muscles are delayed. Alcohol can slow down reaction time by 10 to 30 per cent. It also reduces ability to perform two or more tasks at the same time.

"Alcohol reduces the ability to see distant objects and night vision can be reduced by 25 per cent. Blurred and double vision can also occur. Ability to perceive what is happening at the roadside is weakened. Loss of peripheral vision could be crucial. Alcohol may also create a sense of overconfidence, with the result that people are prepared to take greater risks."

Alcohol - Law and Policy

(alcohol - industry involvement in alcohol policy) "Since there are substantial commercial interests involved in promotion of alcohol’s manufacture, distribution, pricing, and sale,² the alcohol industry has become increasingly involved in the policy arena to protect its commercial interests, leading to a common claim among public health professionals that the industry is influential in setting the policy agenda, shaping the perspectives of legislators on policy issues, and determining the outcome of policy debates towards self-regulation.²"

Alcohol - Research

(alcohol - research - driving) "When an alcoholic beverage is consumed, approximately 20% of the alcohol is absorbed in the stomach and 80% is absorbed in the small intestine (Freudenrich, 2001). After absorption, alcohol enters the bloodstream and dissolves in the water of the blood where it is quickly distributed to body tissues. When alcohol reaches the brain, it affects the cerebral cortex first, followed by the limbic system (hippocampus and septal area), cerebellum, hypothalamus, pituitary gland, and lastly, the medulla, or brain stem. Some of these regions are similar to those affected by cannabis, but alcohol also affects sexual arousal/function and increases urinary output. When BAC is near toxic levels, lower order brain regions are affected, which is often followed by sleepiness, lack of consciousness, coma, or death."

(alcohol - research - prohibition, alcohol consumption and homicide) "The data are quite consistent with the view that Prohibition at the state level inhibited alcohol consumption, and an attempt to explain correlated residuals by including omitted variables revealed that enforcement of Prohibitionist legislation had a significant inhibiting effect as well. Moreover, both hypotheses about the effects of alcohol and Prohibition are supported by the analysis. Despite the fact that alcohol consumption is a positive correlate of homicide (as expected), Prohibition and its enforcement increased the homicide rate."

Adolescents - Alcohol

(adolescents - alcohol) "The presence of alcohol in almost all of the polydrug-use repertoires and among all of the different populations addressed is one of the key findings of this ‘Selected issue’. Alcohol is almost always the first drug with strong psychoactive and mind-altering effects used by young people, and its widespread availability makes it the ever-present drug in substance combinations among young adults, particularly in recreational settings."

(2006 - adolescent - past month use of alcohol and other drugs) "In 2006, more than one third (35.8 percent) of persons aged 12 to 20 who used alcohol in the past month also had used an illicit drug in the past month, and 16.0 percent of underage drinkers used an illicit drug within 2 hours of using alcohol on their last occasion of alcohol use.

"Marijuana was the illicit drug most used by underage drinkers, with nearly one third (30.0 percent) having used marijuana in the past month, and 15.0 percent having used marijuana within 2 hours of their last alcohol use."

(2002-2006 - adolescents - payment for alcohol) "Among all underage current drinkers, 31.0 percent paid for the alcohol the last time they drank, including 9.3 percent who purchased the alcohol themselves and 21.6 percent who gave money to someone else to purchase it. Underage persons who paid for alcohol themselves consumed more drinks on their last drinking occasion (average of 5.9 drinks) than did those who did not pay for the alcohol themselves (average of 3.9 drinks).

More than one in four underage drinkers (25.8 percent) indicated that on their last drinking occasion they were given alcohol for free by an unrelated person aged 21 or older. One in sixteen (6.4 percent) got the alcohol from a parent or guardian, 8.3 percent got it from another family member aged 21 or older, and 3.9 percent took it from their own home."

(2002-2006 - alcohol - rates of current and binge alcohol use) "Combined data from 2002 to 2006 indicated that rates of current (past month) alcohol use were 7.0 percent for youths aged 12 to 14, 27.5 percent for youths aged 15 to 17, and 51.3 percent for 18 to 20 year olds. Binge alcohol use rates for these age groups were 3.3, 17.8, and 36.3 percent, respectively."

(2003 - adolescents - substance use and nonfatal violent victimization) "Juveniles using drugs or alcohol committed 1 in 10 of the nonfatal violent victimizations against older teens. This was 2-1/2 times higher than the percentage of victimizations against younger teens perceived to be committed by a juvenile who was using drugs or alcohol.

"Younger teens were more likely than older teens to report that their juvenile offender was not using drugs or alcohol. In about 4 in 10 victimizations against younger and older teens committed by juveniles, the victim could not ascertain whether or not the offender was using drugs or alcohol."