ALCOHOL

OFFICIAL NAMES: Ethyl alcohol, ethanol, grain alcohol

STREET NAMES: Booze, hooch, juice, sauce, spirits

DRUG CLASSIFICATIONS: Not classified, depressant

OVERVIEW

Jugs that held beer and wine have been found dating back to 3500 b.c. It was easy enough for prehistoric peoples to make alcohol. Mixtures of water and berries left alone in the sun turned into alcohol. Alcohol had its medicinal qualities as well. It was used as a disinfectant, to stimulate the flow of milk in nursing mothers, and to remedy a variety of illnesses.

By the Middle Ages, the upper classes consumed alcohol in abundance, while the peasant population made beer at home. In Italy and France, wine became an important product in commercial markets and continued to be an integral part of the European economy throughout the Renaissance period. Home brewing was largely replaced by the commercial manufacture of beer and wine in Europe by the early eighteenth century.

The first distillery in the United States opened in New York in 1640. Mass production, international trade, and expanding commercialism facilitated an increase in alcohol use into the twentieth century and brought with it concern over alcohol abuse.

In the United States there have been historical increases and decreases in alcohol use. There were high periods of alcohol consumption during the Civil War, World War I, and World War II. Low periods occurred during Prohibition and the Depression. Alcohol consumption rose in the 1980s, when many states in the United States lowered the drinking age to 18. Because of the number of teen deaths due to drinking and driving, the legal age of drinking was raised to 21 in 1987. Coincidentally, the rate of alcohol consumption decreased in the 1990s, but alcohol remains the most commonly used legal drug, and consumption of alcohol by young people is very high.

CHEMICAL/ORGANIC COMPOSITION

The chemical composition for ethanol or ethyl alcohol, otherwise known as alcohol, is C₂H₅OH. This means it is composed of two atoms of carbon, six atoms of hydrogen, and one oxygen atom. Ethanol is colorless and highly flammable. Alcohol is too strong to drink by itself, so it is mixed with water and other substances to create alcoholic beverages. Ethyl alcohol is the only safe alcohol to drink. Other alcohols like methanol (wood alcohol; CH₃OH) and isopropyl alcohol [rubbing alcohol; (CH₃)₂CHOH] are highly toxic and poisonous to the body.

Alcohol is produced by fermenting fruits, vegetables, and grains. Fermentation occurs when sugar in berries or grains is combined with yeast. An enzyme is released that changes the sugar into carbon dioxide and alcohol. When the combination of sugar, yeast, and berries reaches an alcohol concentration point of 14%, fermentation is complete and wine is formed. Similarly, when sugar, yeast, and grains such as barley, corn, or rice are combined and reach an alcohol concentration of about 6%, beer is made and fermentation stops.

Hard liquor is produced by a process called distillation. In distillation, liquids that have been fermented are boiled and the alcohol is extracted. At the boiling point, the alcohol separates from the fermented liquid to create a vapor. The vapor is held in a cooling tube until it turns into a liquid once again. The alcohol is then mixed with water. Hard liquor is about 60% water. Whiskey, rum, vodka, scotch, and gin are distilled liquors. These alcoholic beverages contain about 50% alcohol. The percentage of alcohol in hard liquor is called "proof." Proof is double the amount of pure alcohol, which means that a 100 proof whiskey contains 50% alcohol. A 4-ounce glass of wine, a 12-ounce beer, and a 1-ounce shot glass of hard liquor all have the same amount of alcohol or alcohol content. Cordials like brandy, port, and liqueurs are made from wine and have pure alcohol added to them. Sugar is added to make them sweet, thus hiding the taste of alcohol and making these drinks seem less potent than they really are.

INGESTION METHODS

When a person drinks alcohol, it immediately travels from the stomach to the small intestine and then into the bloodstream. When alcohol enters the bloodstream, a person begins to feel its effects. Because alcohol is absorbed faster than it is metabolized, the alcohol level in a person's blood rises quickly. Drinking alcohol on an empty stomach also causes blood alcohol levels (BAL) to rise quickly. High-protein foods in the body can slow down the absorption of alcohol, whereas carbonated alcoholic beverages such as champagne, rum and coke, and whiskey and ginger ale speed up the absorption of alcohol into the bloodstream. A smaller person will begin to feel the effects of alcohol sooner than a larger person because the larger person has more blood and body fluids.

Alcohol leaves the body through a process of elimination and oxidation. The liver removes alcohol from the blood and causes the alcohol to break down into water and carbon dioxide gas. The carbon dioxide gas leaves the body through the lungs, and the water is eliminated in urine. It takes the liver about one hour to process a glass of wine, one to two hours to process hard liquor, and about two hours to process a glass of beer. 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.

Alcohol is carried to the brain through the bloodstream. Because alcohol is a depressant, it has immediate effects on the brain's ability to function effectively. Alcohol can impair judgement, affect behavior and coordination, and cause nausea, slurred speech, and dehydration. Gail Gleason Milgram, Professor and Director of Education and Training at the Center of Alcohol Studies, offers a profile of behavior that can follow a rise in blood alcohol levels (BAL) due to drinking. She explains that when a person has a BAL of0.03%, which is approximately one drink, "the drinker will feel relaxed and experience a slight feeling of exhilaration." After two drinks and a BAL of 0.06%, "the drinker will experience a feeling of warmth and relaxation" as well as a decline in coordination. After three drinks, speech can be slurred and muscle control can be affected. When a drinker has had five or six drinks, he or she can have difficulty walking and staying awake. At this point a person's BAL could reach0.30%. Milgram further explains that when the BAL reaches 0.50%, "the drinker is in a deep coma or in danger of death." Many states use a BAL of 0.1% as a measure for drunk driving.

THERAPEUTIC USE

In the past, alcohol has been used as a treatment for infection, as an anesthetic, and as a sedative. Alcohol is known as a pain suppressant and was used for hundreds of years for treating people with injuries and for those needing surgery. Alcohol was used to treat typhus as recently as the 1920s. Research in the 1990s showed that moderate amounts of alcohol could help reduce the risk of heart attacks but, conversely, alcohol abuse has been connected to heart disease. Today, there are no known therapeutic uses for alcohol.

USAGE TRENDS

According to the National Council on Alcoholism and Drug Dependence (NCADD), close to 14 million Americans use and abuse alcohol. One third are women and the rest are men. Fifty percent of adults in the United States admit to having alcoholism in their family. One out of every four children come from families where alcohol abuse is a problem.

Adult women drink less than men overall, but are more likely to damage their hearts, livers, and brains due to drinking. The death rate for women who drink large amounts of alcohol frequently is 50% to 100% higher than it is for male alcoholics. Young people who begin drinking before their teenage years are four times more likely to develop an addiction to alcohol than people who begin drinking at age 21. Data taken from The 2000 Monitoring the Future Survey indicate that:

• 22% of middle school students and close to 50% of high school students admit to having tried alcohol.
• 8% of middle school students and close to 30% of high school students report having been drunk from alcohol use.
• 14% of teens from ages 13 to 14 admitted to binge drinking as compared to 30% of high school teens.

The National Council on Alcoholism and Drug Dependence (NCADD) claims that in 1999 "44% 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)." The NCADD also reported that binge drinking among college fraternity and sorority students can be higher.

Scope and severity

Over 50% of Americans who currently drink report having a close relative who abuses alcohol; 25% are children of an alcoholic parent. Alcohol abuse can devastate families by causing separation, divorce, and domestic violence, as well child abuse and neglect. Six million children live with an alcohol-abusing parent, and this can result in problems at school such as low attendance, academic difficulties, attention deficit disorders, and behavioral problems. Each year in America, more than 100,000 people die from alcohol-related accidents (cars, falls, fires, drownings, burns), cancer, liver disease, and stroke.

Age, ethnic, and gender trends

According to the National Household Survey on Drug Abuse (NHSDA), "male and female rates of alcohol use among 12–17 year olds were similar in the 1990s for the first time." Peer pressure, incidence of teenage depression, and a need to fit in are all factors leading to alcohol use by teens. According to the U.S. Department of Health and Human Services, women drink most heavily when they are between the ages of 26 and 34. As women and men get older, there is evidence that drinking among men is greater than that of women. College-bound students are reported to drink less than those students not headed for college.

The biochemical reaction of alcohol in the body explains the differences in ethnic susceptibility to alcohol. Dr. Bert Vallee from Harvard Medical School has

determined that the enzymes involved in the metabolism of alcohol can vary from ethnic group to ethnic group, and this variation influences the way in which individual members of these groups are affected by alcohol. These enzymes appear to be genetically inherited. For example, alcoholism among Jews and Italians is low compared to the levels seen among Scandinavians, Irish, and French. The ethnic groups with the highest susceptibility to alcohol are the Native Americans and Eskimos. These two groups have difficulty oxidizing and eliminating alcohol from the body. Asian populations show a physical reaction to alcohol sooner than Americans and Europeans because of the genetic makeup in their enzyme groupings that react with alcohol.

MENTAL EFFECTS

Alcohol acts as a depressant on the brain. Blood carries alcohol to the brain, where it acts on the body's central nervous system to slow a person's mental responses. There are a variety of mental effects associated with alcohol consumption. The more immediate are: a lessening of inhibitions, mental relaxation, exaggerated emotional response to people and situations, extreme changes in behavior, and impaired judgment. Low doses of alcohol can cause the release of certain chemicals in the brain that can cause a sense of euphoria—a "high" that makes alcohol seem like a stimulant. Memory is sharpened and the ability to think creatively is strengthened, but when alcohol consumption increases, its sedative effects cause a loss of self-control and inhibition. A self-conscious individual becomes more confident; a shy person becomes more talkative. Alcohol also can cause people to become argumentative or emotionally withdrawn. Relationship problems can develop. Judgment is affected and risk-taking behaviors can result. People are known to do things under the influence of alcohol that they would never consider doing when sober. As alcohol consumption increases and levels of alcohol in the blood rise, the reflexes are slowed; memory loss and a sense of confusion can occur. Committing crimes or being the victim of a crime, domestic violence, child abuse, automobile accidents, homicide, and suicide are among the events related to the consumption of alcohol.

The effects of alcohol are related to the size of the person and the amount of alcohol in the blood, as well as to the rate of consumption. After one drink a person weighing about 150 lb (68 kg) will feel relaxed and happy. After two drinks in an hour a person will fell less inhibited. Three drinks will affect a person's muscle control. Speech can become slurred and walking may be difficult. After four drinks judgment is affected and the ability to reason becomes impaired. Five drinks will make speech patterns difficult to understand and impair vision. After six drinks a person may begin to lose consciousness and fall asleep. Ten or more drinks can cause a person to fall into a deep sleep also known as "passing out." Long-term alcohol use can result in serious neurological disorders in the brain such as confusion, coordination problems, short-term memory loss, and emotional as well as psychological problems.

PHYSIOLOGICAL EFFECTS

The physical effects of alcohol on the body depend on the person's size, weight, sex, and age. Additionally, the amount of food present in the body and the amount of alcohol consumed determine one's physical response to alcohol. The immediate physical effects of alcohol consumption are slurred speech, nausea, lack of coordination, dizziness, and dehydration. Alcohol has no nutritional value, but it can have an effect on a person's weight. It decreases one's appetite by filling the body with empty calories and convinces the body it has had enough to eat. People who abuse alcohol run the risk of becoming malnourished.

Harmful side effects

Alcohol can suppress the immune system, making people more susceptible to infections. Because alcohol reduces inhibitions and impairs judgment, those under its influence may be prone to engage in unsafe sexual activity, raising the risks of HIV infection and sexually transmitted diseases. Alcohol use can interfere with a woman's ability to become pregnant. It can 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, her baby is drinking alcohol. If she becomes drunk, her baby is drunk.

Drinking alcohol during pregnancy can cause miscarriages, stillbirths, and serious birth defects such as fetal alcohol syndrome (FAS) and fetal alcohol effect (FAE). FAS is one of the leading causes of birth defects in children and the most preventable cause of mental retardation in the United States. Over 8,000 babies are born each year with fetal alcohol syndrome. It wasn't until 1973 that FAS was defined. FAS babies have lower birthweight, slower mental and physical growth rates, and abnormal facial features such as droopy eyelids, broad noses, large nostrils, and possible cleft palates. Additionally they can have deformed sex organs, internal problems, skeletal abnormalities, brain damage, and mental retardation. FAS is hard to diagnose because the symptoms can mimic those of other birth defects. Thirty thousand babies are born each year with fetal alcohol effect. FAE babies do not have the obvious facial and/or skeletal abnormalities, nor do they have the same level of brain damage as FAS babies, but FAE babies can have physical and behavioral problems such as learning disabilities, attention deficit disorders, and hyperactivity.

Both the mother and father can be responsible for birth defects by drinking alcohol. Miscarriages can be a result of sperm damaged by alcohol. A man's sperm count can be lowered by alcohol consumption. A breast-feeding mother needs to know that any alcohol she consumes passes from her breast milk into her baby. The simplest way to prevent alcohol problems during pregnancy is not to drink while pregnant and to avoid any alcohol consumption when planning a pregnancy.

Long-term health effects

Prolonged use of alcohol can have serious negative effects on the body. It causes vitamin deficiencies. Alcohol can reduce iron levels, causing anemia, and deplete the body of niacin, causing skin damage. Internally, alcohol can cause inflammation of the stomach, liver, pancreas, and esophagus, causing ulcers, hepatitis, cirrhosis, pancreatitis, and several forms of cancer. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that "alcohol-induced liver disease is a major cause of illness and death in the United States." Long-term alcohol use is associated with high blood pressure, heart disease, stroke, and death.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

Alcohol should not be consumed while taking medications. Drinking alcohol along with antihistamines will increase the drowsiness that can occur with cold medicines. Alcohol can cause liver damage when taken in combination with acetaminophen. It has additional adverse effects when taken with other drugs. For example, when taken with aspirin alcohol can cause inflammation of the stomach and increase gastrointestinal bleeding. Alcohol combined with antidepressants slows down psychomotor performance. Alcohol taken with barbiturates (Nembutal, Seconal, Amytal, Tuinal, etc.) can increase depression. Tranquilizers that depress the central nervous system like Valium and Librium taken along with alcohol can cause high blood pressure, drowsiness, depression, and confusion in elderly people. Elderly people should avoid alcohol when taking antidepressants, muscle relaxants, sleeping aids, or cold medicines. Those people taking prescription or over-thecounter medicines should check with a physician about alcohol use.

Polysubstance use refers to combining one drug with another drug or drugs. It often involves the use of a legal drug like alcohol with an illegal drug such as marijuana, cocaine, heroin, and/or pills. Polysubstance use is common among young people. The user may get high on a stimulant like speed or cocaine and then use a depressant like alcohol to come down from the high. Alcohol is considered by many to be a gateway drug, as are nicotine and marijuana. Individuals who use one or more of these gateway drugs are believed to go on to deeper and more severe drug involvement. Jeanne Nagel in her book Polysubstance Abuse says "statistics reveal that alcoholics are 35 times more likely than nonalcoholics to use cocaine." She goes on to say that alcoholics are "17 times more likely to abuse sedatives, 13 times more likely to take opiates, 12 times more likely to ingest hallucinogens, and 11 times more likely to abuse stimulants." Furthermore, Nagel reports 90% of alcoholics smoke cigarettes, and alcohol abusers are six times more likely to abuse marijuana. When someone develops an addiction to more than one drug, the person is said to be cross-addicted.

TREATMENT AND REHABILITATION

There is no cure for alcoholism, but the progression of the disease can be arrested by total abstinence from alcohol. According to the 1998 National Household Survey on Drug Abuse, an estimated 9.7 million Americans are dependent on alcohol. This figure includes the 915,000 young people ages 12 to 17 who have a drinking problem. Public and private treatment facilities in the United States are capable of treating about 1.7 million people each year, a far cry from the number needing help.

There are several types of inpatient and outpatient treatment options available in this country. Inpatient programs are often found in hospital settings such as a hospital detox unit or a psychiatric unit. Detox is a short-term solution because it only addresses the physical aspect of drying out the drinker. It should be followed up with individual and/or family counseling and an understanding of the disease concept of alcoholism through a program like Alcoholics Anonymous. Psychiatric hospitals address both the problem of alcohol abuse and the emotional problems 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 can be found at a 28-day rehabilitation facility. This type of treatment program offers detox from alcohol as well as support from substance abuse counselors; education on the disease concept of alcoholism; and individual, group, and family therapy. In addition, it utilizes support group meetings both on and offsite.

Outpatient programs can be connected to a hospital or a public or private treatment facility. These programs are often short term and require the patient to complete a series of daily or weekly visits for a period of several months. Like inpatient treatment, outpatient programs include individual and/or group therapy, trained substance abuse counselors, education on the disease of alcoholism, and a recommendation to attend a support group.

Another type of treatment program is a residential program in which the patient stays at a home for recovering alcoholics—a sober house where several alcoholics are working to stay sober with the help of counseling, job assistance, and regular attendance at support group meetings. There are residential programs specific to men, women, and young people trying to recover from alcohol addiction. The criminal justice system currently helps offenders get alcohol abuse treatment, and many prisons offer weekly Alcoholics Anonymous meetings for prison inmates trying to stay sober. There is no definitive evidence as to what treatment works best for which patient. Due to the lack of data on the effectiveness of individual programs, it is important for treatment facilities to offer a variety of options to meet the needs of their patients.

Treatment programs based on the twelve steps of Alcoholics Anonymous and that encourage attendance at Alcoholics Anonymous meetings have been the most common approach used in the United States. The first Alcoholics Anonymous group was formed in Akron, Ohio in 1935 by Bill Wilson and Dr. Bob Smith. Today there are approximately 99,000 groups in existence across America.

PERSONAL AND SOCIAL CONSEQUENCES

Alcoholism is a chronic, progressive disease that can be fatal. An Edinburgh physician described the disease concept of alcoholism as far back as 1804, but it wasn't until 1956 that the American Medical Association defined alcoholism as a disease. In 1990, the National Council on Alcoholism and Drug Dependence along with the American Society of Addictive Medicine defined alcoholism as a chronic disease that has genetic, psychological, and environmental factors that influence it. 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. Alcoholics can be rich or poor, young or old, male or female, white or black. Anyone can become an alcoholic, but children of an alcoholic parent are four times more likely to develop the disease of alcoholism than children of non-alcoholic parents.

People who drink develop a tolerance to alcohol. Tolerance is the result of the way in which the body handles alcohol as well as alcohol's effect on the central nervous system. A non-alcoholic will have a consistent level of tolerance for alcohol, but an alcoholic's tolerance for alcohol will constantly change, requiring him or her to drink more to get the desired result that lower doses of alcohol had once produced. Tolerance changes the alcoholic's brain impulses, hormone levels, and the chemical make-up of cell membranes.

The alcoholic goes through several stages as the disease progresses. The stages of alcoholism were documented by E.M. Jellinek in 1952. The four stages are: the prealcoholic stage, the prodromal stage, the crucial stage, and the chronic or final stage.

The prealcoholic stage refers to that period of time when the individual has every intention of drinking socially but begins to use alcohol as a relief from stress and tension. This stage can last for several months to two years. During the prodromal stage the alcoholic continues to drink when others have stopped. He or she experiences blackouts—periods during which the individual continues to function (walking and talking) but has no memory of things that have been said or done. This stage can go on for four or five years.

The crucial stage is when the individual has lost control over the drinking—perhaps promising to stop, but unable to do so. The alcoholic may become defensive when confronted, looks for excuses to drink, blames others for his or her problems, and looks for relief in what is called "the geographic cure"—a new job, moving to a new location, or a change in marital status. At this stage the alcoholic's moods change from being pleasant and understanding to becoming irritable and unreasonable without warning. The alcoholic may experience job loss or the loss of family and friends. Legal problems may arise.

The final stage of alcoholism is the chronic stage. The alcoholic begins to suffer physical decline as a result of drinking, and may develop illnesses like liver disease or heart failure. There is the risk of overdose or possible suicide as the individual sees no way out of this malady.

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. Alcoholism is a family disease, and the members of an alcoholic family system develop roles that are unconsciously played out to draw attention away from the alcoholic. The spouse or partner of the alcoholic is called the enabler. The enabler's role is to protect the alcoholic from the negative consequences of drinking. The enabler works hard to control life in an alcoholic family.

Children tend to take on one of the following roles:

• The oldest child in an alcoholic family most commonly assumes the hero role. The hero brings honor and respect to the family by being a good student, an accomplished athlete, being involved in school activities, and caretaking younger children at home as a substitute parent. The hero is a perfectionist who hopes that by doing everything well the family's problem with alcohol will go away.
• The scapegoat tries to win the alcoholic's attention by engaging in negative behavior. This child often does poorly in school, can have behavioral problems or attention deficit disorders that affect learning, and emotional problems that may lead to alcohol and drug use.
• The lost child in an alcoholic family system withdraws into the isolation of his or her own world. This child has difficulty making friends, lacks the ability to develop intimate relationships, and often turns to food for comfort from the loneliness.
• The mascot is the family member who uses humor to mask pain. This child feels a responsibility to lighten the family tension by being funny and quick-witted. This behavior becomes a handicap in the development of the child's emotional maturity.

Without an understanding of the alcoholic family system, these children will often grow up and continue the cycle of alcoholic behavior. Through counseling and the help of support networks, these children can learn to break the cycle of family addiction and go on to lead healthy lives in adulthood.

Alcohol abuse in the United States costs an estimated $170 billion each year. Close to half of this figure is due to a loss in workplace productivity resulting from illness and work-related injury. Other contributing factors are alcohol-related health care expenses costing society over $26 million and automobile accidents estimated at $15 million. Fifty percent of the adults in prison are incarcerated for crimes that are alcohol related. Alcohol is involved in one-third of all suicides, one-half of all homicides, and one-third of all reported child abuse cases. Drinking can lead to physical injury. People who drink are four times more likely to be hospitalized than nondrinkers. Alcoholism can lead to family violence and physical abuse of children.

LEGAL CONSEQUENCES

In October 2000, the U.S. Congress passed a transportation spending bill that included the establishment of a national standard for drunk driving for adults at a0.08% blood alcohol level (BAL). States are required to adopt this stricter standard by 2004 or face penalties. As of 2001, more than half the states had adopted this stricter standard, while most other states have a BAL limit of 0.1% in place. Penalties for DUI (driving under the influence of alcohol) offenses vary from state to state and can include fines, jail sentences, driver license supension or revokation, driving record points, community service, mandatory participation in a drug/alcohol program, and/or probation.

In 1999, according to the FBI's Uniform Crime Reports, the number of people arrested for DUI was 1,511,300. Alcohol is a factor in close to two-thirds of the homicides and assaults committed in this country. It is known to be connected to rape in both the offender and the victim. Sixty percent of sexual offenders have committed the offense under the influence of alcohol. Studies of prison inmates show that men are more likely to be drinking at the time of the offense than female offenders.

Dram Shop laws hold bar and restaurant owners responsible for the harm that intoxicated customers cause to other people or, in some cases, to themselves. As a result, college campuses and business organizations are placing greater emphasis on providing alcohol-free organizations and activities. Some colleges have established alcohol-free fraternities, sports events have instituted seating sections where no alcohol is allowed, and many bar owners provide taxi service for patrons who are too intoxicated to drive safely.

Legal history

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 first formal temperance movement began in Germany but movements promoting drinking in moderation became popular in other countries. In the middle of the seventeenth century, England imposed high taxes on alcoholic beverages. In America, taxes on whiskey brought about resistance by the distillers resulting in the Whiskey Rebellion of 1794.

Temperance movements began to spring up in America largely supported by religious groups. By the eighteenth century the American Temperance Society promoted the concept of total abstinence from alcohol. In 1919 laws prohibiting the sale and consumption of alcohol nationwide were enacted, but these laws were repealed in 1933 by the Twenty-first Amendment to the Constitution.

Federal guidelines, regulations, and penalties

Alcoholic beverage control laws (ABC laws) were developed to prevent the illegal sale of alcohol, to control the sale of alcohol, and to collect revenue for each state selling alcoholic beverages. The laws vary from state to state and are enforced by federal, state, and local law enforcement agencies. Restaurants, convenience stores, grocery stores, and bars selling alcohol must have special licensing. The licensing differs for the type of establishment selling alcohol or alcoholic beverages. Each state regulates where alcohol can be sold and where it can be consumed. A person must be 21 years old to purchase alcohol. 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.

RESOURCES

Books

Alcoholics Anonymous. The Big Book. 3rd ed. New York: Alco holics Anonymous World Service, 1976.

Berkow, Robert, ed. The Merck Manual of Medical Information. Home ed. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Carson-Dewitt, Rosalyn, ed. Encyclopedia of Drugs, Alcohol & Addictive Behavior. 2nd ed. Vol.1-4. New York: Macmillan Ref erence USA, 2001.

Kinney, Jean, and Gwen Leaton. Loosening the Grip. 4th ed. Boston: Mosby-Year Book, Inc., 1991.

Milam, James R., and Katherine Ketcham. Under The Influence. New York: Bantam Books, 1981.

Nagle, Jeanne. Polysubstance Abuse. New York: Rosen Publish ing Group, Inc., 2000.

National Institute on Alcohol Abuse and Alcoholism. Tenth Spe cial Report to the U.S. Congress on Alcohol and Health. Bethes da, MD: NIAAA, 2000.

Schneider Institute for Health Policy at Brandeis University. Substance Abuse, The Nation's Number One Health Problem. Prince-ton, NJ: The Robert Wood Johnson Foundation, 2001.

Wegscheider, Sharon. Another Chance, Hope & Health for the Alcoholic Family. Palo Alto, CA: Science and Behavior Books, Inc., 1981.

Periodicals

Brink, Susan. "Your Brain On Alcohol." U.S. News & World Report (May 7, 2001): 50–57.

Johnston, L. D., P. M. O'Malley, and J.G. Bachman. National Survey Results on Drug Use from The Monitoring the Future Study. Rockville, Maryland: National Institute on Drug Abuse, 1975–1998.

U.S. Department of Health and Human Services (DHHS). Office of Applied Studies. National Household Survey on Drug Abuse: Main Findings (1997): 106–111.

Other

CNN.Com-Health. "Alcohol Named Europe's Youth Killer." February 20,2001. <http://www.cnn.com/2001/health/02/19/deaths.alcohol/index.html>.

National Council on Alcoholism and Drug Dependence, Inc. (NCADD). <http://www.ncadd.org>.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). <http://www.niaaa.nih.gov>.

The Cool Spot. National Institute on Alcohol Abuse and Alcoholism (NIAAA) Web Site for Kids. <http://www.thecoolspot.org>.

ONDCP Teens Page. Office of Drug Control Policy. <http://www.mediacampaign.org/kidsteens/teens.html>.

Prevline (Prevention Online). National Clearinghouse for Alcohol and Drug Information(NCADI). <http://www.health.org/>.

Organizations

Al-Anon Family Group Headquarters, 1600 Corporate Landing Parkway, Virginia Beach, VA, USA, 23454-5617, <http://www.al-anon.alateen.org>.

Alcoholics Anonymous (AA) World Services, 475 Riverside Drive, 11th Floor, New York, NY, USA, 10115, (212) 870-3400, <http://www.alcoholics-anonymous.org>.

Barbara Sullivan Smith