Alcohol

What Kind of Drug Is It?

Alcohol is an ancient drug. Beer and wine jugs well over 5,000 years old have been excavated from archaeological sites in southwest Asia and northern Africa. Prehistoric peoples are thought to have produced the first alcoholic beverages by accident. This occurred when mixtures of water, a bit of fungus, and wild berries left alone in the sun turned into alcohol through a process known as fermentation.

Alcohol acts as a depressant. A depressant is a substance that slows down the activity of an organism or one of its parts. At the same time, drinking alcohol also lowers one's inhibitions. When this happens, someone might act more recklessly than he or she would normally.

Overview

Through the ages, alcohol has been used as an all-purpose drug: a painkiller, an antiseptic, a disinfectant, a teething aid for babies, a sedative, a battlefield medicine, and a drowner of sorrows. It is also associated with celebrations: offering a toast to a newly married couple is a common tradition.

During the Middle Ages (c. 500–c. 1500), alcohol became something of a status symbol among Europe's upper classes. Wine production became very important to the economies of Italy and France throughout the Renaissance period, which spanned the fourteenth through the early seventeenth centuries. Meanwhile, in the New World, the first distillery opened in 1640 in what would later become the state of New York. In the 1700s, home brewing processes were replaced largely by the commercial manufacture of beer and wine in Europe.

Official Drug Name: Ethyl alcohol, ethanol, grain alcohol

Also Known As: Booze, hooch, moonshine, sauce, spirits (for alcohol in general); brew, suds (for beer); vino (for wine)

Drug Classifications: Not classified, depressant

Laws banning the sale of alcoholic beverages date back to the fourteenth century, when Germany banned the sale of alcohol on Sundays and other religious holidays. Even earlier, Switzerland instituted laws requiring drinking establishments to close at certain times to combat public drunkenness. The United States has seen historical increases and decreases in alcohol use as well. High periods of alcohol consumption coincided with periods of war: during the American Civil War (1861–1865), World War I (1914–1918), and

World War II (1939–1945), drinking increased among Americans. These peaks in alcohol usage were interrupted by so-called "dry" periods in U.S. history—times when the consumption of alcohol dropped to very low levels throughout the nation.

The Era of Prohibition in the United States

The longest span of dry years in the United States occurred during prohibition, which lasted from 1920 to 1933. At that time,

many Americans viewed alcohol as a destructive force in society. Crime, poverty, gambling, prostitution, and declining family values were blamed on alcohol consumption. A ban on the manufacture and sale of all alcoholic beverages in the United States began on January 16, 1920, with the passage of the Eighteenth Amendment to the Constitution. However, Prohibition did not stop all drinking in the United States. Some people produced alcohol in illegal stills, especial in rural areas. The brew created in these stills was often referred to as Moonshine. The liquor was then sold on the black market. Otherpeople brewed alcoholic beverages at home, hoping to not get caught.

During Prohibition, some people even went to other countries, such as Canada, to buy alcohol and smuggle it back into the United States. Smugglers used all sorts of methods to hide the illegal drink. They hid it under false floors in trucks, under their clothing, and even in vials placed within walking sticks or canes. Prohibition proved to be highly unpopular. Thirteen years after it had begun, Prohibition ended and alcohol was once again deemed a legal substance in the United States.

Alcohol consumption rose considerably in the early and middle 1980s, when many states lowered the drinking age to eighteen. Because of the increase in the number of teen deaths tied to drinking and driving, the legal drinking age was raised to twenty-one throughout the nation in 1987. The rate of alcohol consumption dipped in the 1990s, but alcohol remains the most commonly used legal drug. Consumption of alcohol by young people is very high.

Much could be written on the topic of alcohol as an addictive substance. The following entry attempts to provide as much relevant information as possible for the scope and intended audience of this encyclopedia.

What Is It Made Of?

The chemical composition for ethanol or ethyl alcohol, otherwise known as alcohol, is C₂H₅OH. That means it is composed of two atoms of carbon, one atom of oxygen, and six atoms of hydrogen. Ethanol is a colorless liquid that is highly flammable. Aside from being an ingredient in alcoholic beverages, it is used in fuels, solvents, disinfectants, and preservatives.

Pure alcohol is too strong to drink by itself. It must be diluted with water and other substances to create alcoholic beverages. Ethyl alcohol is the only alcohol considered safe to drink. Other alcohols such as methanol (also called wood alcohol) and isopropyl alcohol (pronounced EYE-so-PROPE-uhl; also called rubbing alcohol) are not used in beverages. They are highly toxic (poisonous) to the body. Methanol, in particular, can cause blindness and even death if swallowed.

No Nutritional Value

Alcohol contains what are called "empty calories." Beer, wine, wine coolers, and liquor have no nutritional value, but they still cause weight gain. Drinking alcohol is bad for the skin as well as the waistline. It increases the number and severity of acne breakouts. It is also known for causing bad breath among users.

Types of Alcoholic Beverages

Wines and beers are produced by fermenting fruits, vegetables, and grains. Fermentation occurs when sugar in berries or grains is combined with yeast, which is a fungus. A fungus is a sort of recycler that dissolves nutrients and changes them. A chemical reaction takes place as yeast cells eat up the sugars in food. Those sugars are changed into carbon dioxide and alcohol. Wine is formed when the combination of sugar, yeast, and berries reaches an alcohol concentration point between 9 and 15 percent. Similarly, when sugar, yeast, and grains such as barley are combined and reach an alcohol concentration of 3 to 6 percent, beer is made and fermentation stops.

Hard liquor is produced by a process called distillation, which adds an extra step to the fermentation process. In distillation, liquids that have already been fermented are boiled to remove the alcohol. At the boiling point, the alcohol separates from the fermented liquid to create a vapor. The vapor is captured and then held separately in a cooling tube until it turns back into a liquid. The resulting alcohol, now removed from the original fermented liquid, becomes hard liquor when mixed with water.

Alcohol makes up 50 percent of distilled liquors such as whiskey, rum, vodka, scotch, and gin. The percentage of alcohol in hard liquor is used to determine the "proof" number printed on every bottle. Proof is determined by doubling the percentage of pure alcohol in a liquor and then dropping the percentage sign. For instance, whiskey that is 50 percent alcohol is said to be 100 proof.

Liqueurs (pronounced lick-OARZ) are distilled from grain and mixed with fruit, herbs, spices, and sugary syrups. They are extremely sweet and very high in alcohol content. They are intended to be drunk in very small quantities, usually as an "after dinner" drink. Popular liqueurs include Cointreau (pronounced KWANNtroh), Tia Maria, and Drambuie (pronounced dram-BOO-ee).

Hard Liquors

The difference between hard liquors lies in the grains or vegetables that are used to make them. Rye, corn, and barley are used to make whiskey. Vodka is distilled from potatoes, rye, or wheat. Scotch is derived from malted barley. Gin is a combination of distilled spirits (alcohol) flavored with juniper berries. Rum is made from molasses.

Adding carbonated drinks to hard liquor—mixing rum with cola or whiskey with ginger ale, for instance—produces a drink that seems stronger than liquor mixed with plain water. Carbonation speeds up the absorption of alcohol into the bloodstream.

Sweet and powerful drinks like brandy and port are made from distilled wine, which increases the alcohol content of 12 percent to two to three times that amount. "The original idea of distillers," wrote Andrew Weil and Winifred Rosen in From Chocolate to Morphine, "was to concentrate wine to a smaller volume to make it easier to ship it in barrels overseas. At the end of the voyage the brandy was to be diluted with water back to an alcohol content of 12 percent. What happened… was that when people got their hands on what was in the barrels, no one waited to add water. Suddenly a new and powerful form of alcohol flooded the world."

How Is It Taken?

Alcohol is swallowed, usually in a liquid form. It is also swallowed in gel form in semisolid "Jell-O shots." These Jell-O shots are medicine-cup-sized mixtures of gelatin and hard liquor, such as vodka, which are chilled before serving. The high sugar content in the gelatin hides the taste of the alcohol, making Jell-O shots particularly dangerous. Fruit punch spiked with hard liquor can have the same powerful effect. Users could accidentally consume far more alcohol than they intended in a short period of time.

According to Ron Weathermon and David W. Crabb in Alcohol Research & Health, a standard drink is defined as one 12-ounce can of beer or bottle of wine cooler, one 5-ounce glass of wine, or 1.5 ounces of distilled liquor. Each of these drinks contains the equivalent of 1 ounce of pure alcohol.

Are There Any Medical Reasons for Taking This Substance?

"Alcohol actually blocks some of the messages trying to get to the brain," according to the TeensHealth Web site. That is the primary reason it has been used for thousands of years to suppress pain, treat injuries and infections, and prepare people for surgery. In the past, alcohol has been used as an anesthetic, a sedative, and even a treatment for a lung disease called typhus.

The facts about youth & alcohol

Alcohol use is widespread among today's teenagers

• Nearly 70% of 8th graders perceive alcoholic beverages as "fairly easy" or "very easy" to get.
• By the time they complete high school nearly 80% of teenagers have consumed alcohol, 30% report having been drunk in the past month, and 29% report having 5 or more drinks in a row in the past two weeks.

Alcohol use increases substantially from middle to high school

• Approximately 20% of 8th graders report having recently (within the past 30 days) consumed alcohol compared to 35% of 10th graders and almost 50% of 12th graders.
• A little over 20% of 8th graders report having been drunk at least once in their life compared to almost 45% of 10th graders and 60% of 12th graders.

The consequences of underage drinking

• A person who begins drinking as a young teen is four times more likely to develop alcohol dependence than someone who waits until adulthood to use alcohol.
• During adolescence significant changes occur in the body, including the formation of new networks in the brain. Alcohol use during this time may affect brain development.
• Motor vehicle crashes are the leading cause of death among youth ages 15 to 20, and the rate of fatal crashes among alcohol-involved drivers between 16 and 20 years old is more than twice the rate for alcohol-involved drivers 21 and older. Alcohol use also is linked with youthful deaths by drowning, suicide, and homicide.
• Alcohol use is associated with many adolescent risk behaviors, including other drug use and delinquency, weapon carrying and fighting, and perpetrating or being the victim of date rape.

source: "The Facts About Youth & Alcohol," National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD [Online] http://www.niaaa.nih.gov/publications/PSA/factsheet. pdf#search='the%20facts%20about%20youth%20&%20alcohol' [accessed May 24, 2005]

Research in the 1990s showed that moderate amounts of alcohol could help reduce the risk of heart attacks. Abuse of alcohol, however, has been connected to heart disease. "Between the extremes of heavy and light drinking lies a 'gray area' that is not completely understood," explained Cynthia Kuhn and her coauthors in their book Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy. "Moreover, this gray area appears to be rather small. That is, while an average of one-half to one drink per day may be healthy for your heart, it is perfectly clear that an average of two drinks per day significantly increases your risk of dying from heart disease or cancer." As of 2005, there were no known therapeutic uses for alcohol.

Usage Trends

"Next to tobacco and caffeine, alcohol is the world's most popular drug," wrote Paul M. Gahlinger in Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse. Peer pressure, depression, and a need to fit in are all factors leading to alcohol use by teens.

Alcoholism Defined

There is a difference between alcohol abuse and alcoholism. In 1956, the American Medical Association defined alcoholism as a disease. Alcoholism is described as a loss of control over drinking—a preoccupation with drinking despite negative consequences to one's physical, mental, and emotional makeup as well as one's work and family life. Problem drinkers might start out by abusing alcohol occasionally without being addicted to it. However, Kuhn pointed out that "continued exposure to alcohol changes the brain in ways that produce dependence." Therefore, anyone who drinks heavily over a long period of time "will become physically dependent on the drug."

According to the National Council on Alcoholism and Drug Dependence (NCADD), about 18 million Americans have alcohol problems. Excessive drinkers are generally defined as: 1) men who consume more than two drinks per day, every day, or more than three drinks at a time; and 2) women who consume more than one drink per day, every day, or more than three drinks at a time. Women used to make up one-third of the problem drinking population, but they are quickly catching up to men in terms of abuse. In general, if a woman and a man consume the same amount of alcohol, the woman will become more intoxicated in a shorter period of time. And because of their physical makeup, women are more likely than men to damage their hearts, livers, and brains due to drinking. An increased risk of breast cancer has also been linked to drinking.

Problem drinkers can be rich or poor, young or old, male or female. They come from all racial and ethnic backgrounds. Although anyone can become an alcoholic, a child with an alcoholic parent runs a greater risk of developing the disease of alcoholism than a child of non-alcoholic parents.

Young People and Alcohol

New York Times contributor Howard Markel wrote, "Because the brains of teenagers are still developing, many experts believe they are at greater risk for becoming addicted." According to the National Institutes of Health (NIH), young people who begin drinking before the age of thirteen are four times more likely to develop an addiction to alcohol than people who begin drinking at age twenty-one.

The results of the 2004 Monitoring the Future (MTF) study were released to the public on December 21, 2004. Conducted by the University of Michigan (U of M), the MTF was sponsored by research grants from the National Institute on Drug Abuse (NIDA). Since 1991, U of M has tracked patterns of alcohol and drug use, as well as attitudes toward alcohol and drugs, among students in the eighth, tenth, and twelfth grades. (Prior to that, from 1975 to 1990, the MTF survey was limited to twelfth graders.)

The 2004 MTF survey results indicate that alcohol use among students in the eighth and tenth grades has fallen each year since 2001. Researchers noted, however, that "drinking and drunkenness did not continue to decline" among twelfth graders in 2004. According to MTF charts for 2003 to 2004, about three in every ten high school seniors reported "being drunk in the past 30 days." The ease with which seniors said they would be able to get the drug held steady, with more than 94 percent of the twelfth graders surveyed saying it would be "fairly easy" or "very easy" to obtain alcohol. Only 26 percent of twelfth graders disapproved of kids their age "trying one or two drinks of an alcoholic beverage." Beer and fruit-flavored alcoholic beverages, such as wine coolers, seemed to be a favorite among middle school and high school drinkers.

The 2004 Monitoring the Future survey also showed that:

• 44 percent of eighth-grade students, 64 percent of tenth-grade students, and 77 percent of twelfth-grade students admit to having tried alcohol.
• 20 percent of eighth-grade students, 42 percent of tenth-grade students, and 60 percent of twelfth-grade students report having been drunk from alcohol use at least once.

Binge Drinking

In the late 1990s, "binge drinking" became an accepted term for a night of heavy drinking or simply for heavy alcohol consumption at one sitting. The NCADD claimed that in 1999 "44 percent of college students reported binge drinking (five or more drinks in a row for males or four or more drinks in a row for females)" at some point in their college years. This does not make them frequent binge drinkers; it means that they have engaged in binge drinking at least once. As of 2002, about one in four students could be classified as a frequent binge drinker. To make matters worse, "59 percent of frequent binge drinkers report driving after drinking," noted Dr. Henry Wechsler, director of the Harvard School of Public Health's College Alcohol Study, in his book Dying to Drink: Confronting Binge Drinking on College Campuses, written with Bernice Wuethrich.

Alcohol and the Entertainment Industry

Nels Ericson, a writer for the U.S. Office of Juvenile Justice and Delinquency Prevention, pointed out that alcohol is a standard prop in more than 90 percent of America's most popular movie rentals. Television is another media source that bombards youth with pro-drinking messages. The National Council on Alcoholism and Drug Dependence (NCADD) reported that "the typical American young person will see 100,000 beer commercials before he or she turns 18."

The New York Times reported in 2002 that a link may exist between movie-viewing habits and alcohol usage among teens. A Dartmouth College survey based on information from more than 4,500 fifth through eighth graders in the eastern United States revealed that "teenagers whose parents place no restrictions on their viewing R-rated movies appear much more likely to use tobacco or alcohol." Most of the students interviewed were fourteen years old or younger. By law, moviegoers are supposed to be seventeen or older to view an R-rated film at a theater. Nearly half of the students who saw R-rated films on a regular basis admitted they had tried alcohol, versus only 4 percent of the students who were not allowed to view R-rated films.

Research conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that some 1,400 college students die each school year in alcohol-related incidents. Another 100,000 became victims of sexual assault after drinking too much.

Effects on the Body

Even though alcohol is considered "one of the most widely accepted recreational drugs," noted Gahlinger, its overall impact on public health "is far worse than all illegal drugs combined." Prolonged use of alcohol can have serious negative effects on the body. Long-term alcohol use can result in memory loss. Alcohol can suppress the immune system, making people more susceptible to infections. Heavy drinking can increase the user's risk of nutritional deficiencies, ulcers, high blood pressure, heart disease, stroke, certain cancers, and liver disease.

Paying the Price

In addition to the high one gets when drinking alcohol, the substance produces a variety of other potentially embarrassing, not to mention uncomfortable, effects. Read on to learn more.

• The human body has all sorts of natural protective mechanisms. Vomiting is one of them. Nausea and stomach cramps are two ways that the brain alerts the body to the presence of poisons—like alcohol—in the system. The stomach rids itself of the poison by vomiting. People who have too much alcohol in their systems often end up clutching a toilet bowl and heaving up every bit of food and drink in their stomachs. And those are the lucky ones. Vomiting in a toilet is preferable to vomiting somewhere else, and sometimes people under the influence of alcohol just cannot reach a toilet in time. Accidental urination can occur under the influence of alcohol as well, compounding the embarrassment.
• Alcohol makes the blood vessels inside the brain expand. Drinking to the point of intoxication (drunkenness) often results in an uncomfortable set of physical effects known as a "hangover." Contrary to popular belief, drinking coffee, eating high-sugar foods, or taking a cold shower will not relieve hangover symptoms. The pounding headache, upset stomach, and trembling feelings that often follow a night of heavy drinking will not subside until the brain's blood vessels return to their normal size. In short, nothing but time will get rid of a hangover.

The NIAAA reported that "alcohol-induced liver disease is a major cause of illness and death in the United States." The liver is the organ that breaks down alcohol in the body. It removes alcohol from the blood, leaving water, carbon dioxide gas, and energy as by-products. The carbon dioxide gas leaves the body through the lungs, and the water is eliminated in urine. Depending on the size, gender, and general health of the drinker, it can take the liver between one and two hours to process a glass of wine, a single beer, a shot of hard liquor, or one mixed drink.

If large quantities of alcohol are present in the body, the liver has to work overtime to break it down and eliminate it from the body. Until the liver has a chance to filter all of the toxins, or highly poisonous substances, out of a drinker's blood, the remaining alcohol will simply stay in the bloodstream and recirculate. "There are limits on the number and amounts of toxic substances a liver can handle without harm to it," explained Laurence Pringle in Drinking: A Risky Business. Heavy drinking can lead to cirrhosis of the liver, a deadly disease common among alcoholics. "In cirrhosis," continued Pringle, "cells of the liver are actually being killed by alcohol.… Continued heavy drinking may cause the liver to fail entirely."

Down the Hatch, and Then What?

After alcohol is swallowed, it passes first into the stomach and then into the small intestine. Most of the alcohol is absorbed into the

bloodstream through the small intestine and carried to the brain through the blood. Alcohol has profound effects on the brain's ability to function effectively. Even though alcohol is a depressant, low doses of it can cause the release of certain brain chemicals that produce a sense of euphoria. This "high" is misleading because it makes alcohol seem like a stimulant.

First and foremost, alcohol causes a loss of inhibition in those who drink it. "Judgment is the first function of the brain to be affected," wrote Gail Gleason Milgram of the Rutgers University Center of Alcohol Studies in an online article. "The ability to think and make decisions becomes impaired." People with lowered inhibitions tend to take more chances and engage in riskier behavior than they would if they had not been drinking. A self-conscious individual who has had a drink or two may become more confident. A shy person may become more talkative. People who have had too much to drink often engage in unsafe sex and are at a much greater risk for contracting sexually transmitted diseases, including HIV (the human immunodeficiency virus), which can lead to AIDS (acquired immunodeficiency syndrome).

The most obvious physical effects of alcohol consumption are slowed reflexes, a lack of coordination, difficulty walking "a straight line," and slurred speech. As more alcohol is consumed, drinkers experience dizziness, nausea, dehydration, and an inability to reason. Having a large number of drinks in rapid succession puts many drinkers to sleep. Those who remain awake and continue drinking increase their likelihood of passing out, which can be very dangerous. Intoxicated people who throw up while unconscious risk choking on their vomit. This can be—and often is—fatal, because vomit easily blocks the drinker's airway, making breathing impossible.

"Chronic, repeated drinking damages and sometimes kills the cells in specific brain areas," noted Kuhn. "And it turns out that it might not take a very long history of heavy drinking to kill cells in certain areas of the brain" involved in memory formation and problem solving.

Effects May Vary

The physical effects of alcohol on the body depend on several different factors. Both the amount of food present in the stomach when drinking and the amount of time that elapses between drinks influence a person's physical response to alcohol. "Peak blood alcohol concentration [BAC] could be as much as three times greater in someone with an empty stomach than in someone who has just eaten," wrote Kuhn. Five drinks consumed in one hour will have drastically different effects on the drinker than five drinks consumed with food over five hours.

The gender, size, and mental outlook of the drinker also affect the body's response to alcohol. "Alcohol does not dissolve in fat tissues," explained Weathermon and Crabb. Because women have a larger proportion of body fat than men, they tend to feel the effects of alcohol after drinking smaller doses than men do. A smaller person will become intoxicated sooner than a larger person because the larger person has more blood and body fluids mixing with the alcohol he or she consumes. A person's reaction to alcohol also varies according to the circumstances under which it is consumed. "The same amount of wine that makes someone pleasantly high at a party may make a depressed person in a lonely room even more depressed," commented Weil.

Drinking and Driving

"Alcohol abuse kills some 75,000 Americans each year and shortens the lives of these people by an average of thirty years," noted MSNBC.com in the fall of 2004. The statistics, which were provided by the Centers for Disease Control and Prevention (CDC), indicate that about 35,000 of these people died from diseases connected with heavy drinking. The other 40,000 were killed in alcohol-related car crashes and other accidents, including falls, fires, and drownings. Young people under twenty-one years of age accounted for about 4,500 of alcohol-related deaths.

The rate of fatal motor-vehicle crashes in alcohol-involved drivers age sixteen to twenty is more than twice the rate for alcohol-involved drivers over the age of twenty-one. The probable reason for this statistic, according to an NIAAA "Alcohol Alert" from 2003, is that younger drivers have less experience behind the wheel. Adding alcohol to the mix is a recipe for disaster. In addition, Newsweek reported in 2005 that, according to the NIH, "the area of the brain that inhibits risky behavior isn't fully developed" in humans until they reach the age of twenty-five.

Alcohol and Pregnancy

Alcohol and pregnancy do not mix. Alcohol use can interfere with a woman's ability to become pregnant. It can also lower a man's sperm count and reduce his sexual drive.

There is no safe level of alcohol consumption for a woman at any time during a pregnancy. Every bottle of alcohol bears a warning label that reads: "According to the Surgeon General, women should

not drink alcoholic beverages during pregnancy because of the risk of birth defects." If a pregnant woman drinks alcohol, so does her baby. If she becomes drunk, so does her baby.

Drinking alcohol during pregnancy can cause miscarriages, stillbirths, and serious birth defects. Alcohol "disrupts [the] formation of nerve cells in a baby's brain," wrote Margaret O. Hyde and John F. Setaro in Drugs 101: An Overview for Teens.fetal alcohol syndrome (as) can occur when a woman drinks while she is pregnant. It is one of the leading causes of birth defects in children and the most preventable cause of mental retardation. FAS babies have low birth weights, small heads, slowed mental and physical growth rates, and certain facial and skeletal abnormalities. It is a hard condition to diagnose because its symptoms can mimic those of other disorders. Babies born with FETAL ALCOHOL EFFECTS (ae) are less severely impaired than FAS babies. FAE babies do not have distinctive facial and skeletal abnormalities, nor do they suffer the same level of brain damage as FAS babies, but they can have physical and behavioral problems such as poor coordination, learning disabilities, and attention deficit disorders.

Reactions with Other Drugs or Substances

Alcohol should not be consumed with any over-the-counter or prescription medications because harmful interactions can occur. Sometimes, the effect of a medicine is increased by alcohol. In other cases, a medication may not be able to break down properly in the presence of alcohol. Drinking alcohol with antihistamines, for instance, will increase the drowsiness that can occur with cold-type medicines. Alcohol can cause liver damage when taken in combination with acetaminophen (best known by the brand name Tylenol).

Alcohol has additional negative effects when taken with other drugs. For example, when taken with aspirin, alcohol can irritate the stomach lining and cause gastrointestinal bleeding. Alcohol combined with antidepressants affects the user's coordination and reaction time, making the operation of motor vehicles and other machinery extremely risky. Alcohol taken with barbiturates ("downers" such as Nembutal, Seconal, Amytal, and Tuinal) can increase depression.

Mixing alcohol with tranquilizers, muscle relaxants, sleeping aids, and other medicines can cause serious side effects, especially in elderly people. Alcohol consumed with illegal drugs such as marijuana, cocaine, heroin, or amphetamines can be deadly.

Alcohol-Related Vehicle Crashes

According to the U.S. Department of Transportation's National Highway Traffic Safety Administration (www.nhtsa.dot.gov):

• 17,013 people in the United States died in alcohol-related motor-vehicle crashes in 2003
• Alcohol-related crashes on America's roads injure someone every two minutes
• Alcohol-related crashes in the United States cost roughly 51 billion dollars each year.

Treatment for Habitual Users

There is no cure for alcoholism, but the advancement of the disease can be stopped if the user quits drinking. The Hazelden Foundation's "Alcohol Screening" Web page states that "for one in thirteen American adults, alcohol abuse or alcohol dependence (alcoholism) causes substantial harm to their health and disruption in their lives." In "Substance Abuse: The Nation's Number One Health Problem," Nels Ericson noted that "only a quarter of individuals who abuse alcohol and illicit drugs get treatment.… Treatment for alco holism is successful for 40 to 70 percent of patients."

There are several types of treatment options available for alcoholics. Most incorporate at least some of the principles that make up the twelve-step program used by Alcoholics Anonymous (AA). AA offers a popular and effective approach to rehabilitation. It helps the user gain an understanding of alcoholism as a disease. The first AA group was formed in Akron, Ohio, in 1935, by Bill Wilson and Dr. Bob Smith. According to the AA Web site, there were more than 100,000 groups and over 2 million members in 150 countries as of 2005.

Inpatient programs, which are often found in hospital settings, usually begin with a period of detoxification, followed by extensive counseling and, if necessary, a drug program to discourage the drinker from relapsing. (Certain medications are designed to make an alcoholic feel very sick when combined with alcohol.) Detoxification, or detox, addresses the physical aspect of "drying out" the drinker. Withdrawal symptoms can be intense and frightening to the recovering alcoholic. At their worst, symptoms can include hallucinations, tremors (uncontrollable shaking), and seizures.

Detox is usually followed up with individual and/or family counseling and involvement in a twelve-step program such as the one offered by AA. Psychiatric hospitals address both the problem of alcohol abuse and the emotional issues that accompany it. Treatment includes individual, group, and/or family counseling, drugs to treat psychiatric illnesses, and the additional support of a twelve-step program.

Another type of inpatient program is the 28-day rehabilitation facility. This type of treatment program offers detoxification from alcohol as well as: 1) support from substance abuse counselors; 2) education on the disease concept of alcoholism; and 3) individual, group, and family therapy. In addition, it uses support group meetings both on and offsite. Residential programs are yet another alternative. In residential programs, patients stay at a home for recovering alcoholics. At these "sober houses," as they are called, several alcoholics work together to stay alcohol-free. They receive counseling, job assistance, and group support.

Consequences

People have been known to do things under the influence of alcohol that they would never consider doing when sober. Drinking too much can leave users with little or no recollection of what they did or said while drunk. NCADD statistics show that alcohol is

involved in one out of every four emergency room admissions, one out of every three suicides, and one out of every two homicides and incidents of domestic violence. "A report from the British Medical Association," stated Emma Haughton in Drug Abuse? (1997), estimated that up to 70 percent of all murders in the United Kingdom were somehow "associated with alcohol abuse."

People who drink heavily develop a tolerance to alcohol. As the disease of alcoholism progresses, an alcoholic will need to drink more and more to get the desired result that lower doses of alcohol had once produced. Tolerance actually changes the alcoholic's brain impulses and the chemical makeup of cell membranes.

Alcoholics typically go through several stages, changing their patterns of use to patterns of abuse. They may begin using alcohol as an occasional stress reliever. They promise themselves and others that their drinking is just a "temporary thing." But over several years it becomes a habit. Their families struggle to hide the drinkers' growing problems with alcohol. As the disease progresses, drinkers usually experience mood changes, problems with friends and family, and trouble on the job. In the final stage, alcoholics begin to suffer physical decline as a result of drinking and may develop illnesses like liver disease or heart failure.

The personal consequences of alcoholism reach far beyond the alcoholic. An alcoholic's drinking affects many people, especially the members of his or her family. Children of alcoholics sometimes continue the cycle of alcoholic behavior when they reach adulthood. Alateen is an international organization for teens who are relatives or friends of a problem drinker. Support groups like Alateen help young people break the cycle of addiction and lead healthy lives.

The Law

It is against the law to consume alcohol in the United States until the age of twenty-one, but, according to the TeensHealth Web site, nearly 80 percent of teens have done it. Underage drinking can lead to arrest. In the United Kingdom, it is illegal for anyone under the age of eighteen to buy alcohol, whether in a supermarket or a pub. It is also illegal to supply someone under the age of eighteen with alcohol.

For years, the legal blood alcohol concentration for adult drivers ranged from 0.08 percent to 0.1 percent throughout the United States. A stricter national standard of 0.08 was adopted by most states in the first few years of the twenty-first century. The BAC limit for drivers under twenty-one was set at 0.02 in every state. Penalties for driving while intoxicated vary from state to state and can include fines, jail sentences, probation, driver's license suspension, mandatory community service, or participation in an alcohol education program.

The National Center for Injury Prevention and Control (NCIPC), a division of the Centers for Disease Control and Prevention, released a summary of impaired-driving statistics in December of 2004. The latest information available for that report came from the records of the National Highway Traffic Safety Administration (NHTSA) for 2002 and 2003. According to the data, about 1.5 million people were arrested for driving under the influence (DUI) in 2002. More than 100 million other drunk drivers were on the roads but were not caught. Alcohol consumption was a factor in two out of every five traffic-related deaths in 2003. In addition, about 25 percent of all drivers under the age of twenty who were killed in motor vehicle crashes that year had a bloodalcohol level of 0.08 or higher.

Drunk on Mouthwash

Listerine mouthwash is 26.9 percent alcohol. In January of 2005, a Michigan woman was arrested for drunk driving after drinking three glasses of Listerine. Her blood alcohol concentration (BAC) was more than three times Michigan's legal limit of 0.08 percent.

Alcoholic beverage control laws (ABC laws) were developed in the United States to prevent the illegal sale of alcohol. ABC laws are enforced by federal, state, and local law enforcement agencies. Each state regulates where alcohol can be sold and where it can be consumed. Restaurants, convenience stores, grocery stores, and bars selling alcohol must have special licensing. A person must be twenty-one years old to purchase and consume alcohol. Buying alcohol for an underage drinker is illegal, even if the buyer is over twenty-one. Warning labels are required on all alcoholic beverages sold in the United States. These labels alert consumers to the possible dangers of alcohol use when pregnant, driving an automobile, or operating machinery.

For More Information

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