Alcohol and health
Alcohol (also known as ethanol) has a number of effects on health. Short-term effects of alcohol consumption include intoxication and dehydration. Long-term effects of alcohol consumption include changes in the metabolism of the liver and brain and alcoholism. Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. Alcohol stimulates insulin production, which speeds up glucose metabolism and can result in low blood sugar, causing irritability and possibly death for diabetics.[medical citation needed] Even light and moderate alcohol consumption increases cancer risk in individuals. A 2014 World Health Organization report found that harmful alcohol consumption caused about 3.3 million deaths annually worldwide. Negative efforts are related to the amount consumed with no safe lower limit seen. Some nations have introduced alcohol packaging warning messages that inform consumers about alcohol and cancer, as well as foetal alcohol syndrome.
The median lethal dose of alcohol in test animals is a blood alcohol content of 0.45%. This is about six times the level of ordinary intoxication (0.08%), but vomiting or unconsciousness may occur much sooner in people who have a low tolerance for alcohol. The high tolerance of chronic heavy drinkers may allow some of them to remain conscious at levels above 0.40%, although serious health hazards are incurred at this level.
Alcohol also limits the production of vasopressin (ADH) from the hypothalamus and the secretion of this hormone from the posterior pituitary gland. This is what causes severe dehydration when alcohol is consumed in large amounts. It also causes a high concentration of water in the urine and vomit and the intense thirst that goes along with a hangover.
Stress, hangovers, and the oral contraceptive pill may increase the desire for alcohol because these things will lower the level of testosterone and alcohol will acutely elevate it. Tobacco has the same effect of increasing the craving for alcohol.
The short-term effects of alcohol consumption range from a decrease in anxiety and motor skills at lower doses to unconsciousness, anterograde amnesia, and central nervous system depression at higher doses. Cell membranes are highly permeable to alcohol, so once alcohol is in the bloodstream it can diffuse into nearly every cell in the body.
The concentration of alcohol in blood is measured via blood alcohol content (BAC). The amount and circumstances of consumption play a large part in determining the extent of intoxication; for example, eating a heavy meal before alcohol consumption causes alcohol to absorb more slowly. Hydration also plays a role, especially in determining the extent of hangovers. After excessive drinking, unconsciousness can occur and extreme levels of consumption can lead to alcohol poisoning and death (a concentration in the blood stream of 0.40% will kill half of those affected[medical citation needed]). Alcohol may also cause death indirectly, by asphyxiation from vomit.
According to the World Health Organization's 2018 Global Status Report on Alcohol and Health, there are more than 3 million people who die from the harmful effects of alcohol each year, which amounts to more than 5% of the burden of disease world-wide. The US National Institutes of Health similarly estimates that 3.3 million deaths (5.9% of all deaths) were believed to be due to alcohol each year.
A systematic analysis of data from the Global Burden of Disease Study, which was an observational study, found that long term consumption of any amount of alcohol is associated with an increased of risk of death in all people, and that even moderate consumption appears to be risky. Similar to prior analyses, it found an apparent benefit for older women in reducing the risks of death from ischemic heart disease and from diabetes, but unlike prior studies it found those risks cancelled by an apparent increased risk of death from breast cancer and other causes. A 2016 systematic review and meta-analysis found that moderate ethanol consumption brought no mortality benefit compared with lifetime abstention from ethanol consumption. Risk is greater in younger people due to binge drinking which may result in violence or accidents.
Long-term heavy use of alcohol damages nearly every organ and system in the body. Risks include alcoholism, malnutrition, chronic pancreatitis, alcoholic liver disease and cancer. In addition, damage to the central nervous system and peripheral nervous system can occur from chronic alcohol abuse.
The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol.
Medical organizations strongly discourage drinking alcohol during pregnancy. Alcohol passes easily from the mother's bloodstream through the placenta and into the bloodstream of the fetus, which interferes with brain and organ development. Alcohol can affect the fetus at any stage during pregnancy, but the level of risk depends on the amount and frequency of alcohol consumed. Regular heavy drinking and binge drinking (four or more drinks on any one occasion) pose the greatest risk for harm, but lesser amounts can cause problems as well. There is no known safe amount or safe time to drink during pregnancy, and the U.S. CDC recommends complete abstinence for women who are pregnant, trying to become pregnant, or are sexually active and not using birth control.
Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASDs). The most severe form of FASD is fetal alcohol syndrome (FAS). Problems associated with FASD include facial anomalies, low birth weight, stunted growth, small head size, delayed or uncoordinated motor skills, hearing or vision problems, learning disabilities, behavior problems, and inappropriate social skills compared to same-age peers. Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and develop substance use disorders themselves.
In 2010, a systematic review reported that moderate consumption of alcohol does not cause harm to people with cardiovascular disease. However, the authors did not encourage people to start drinking alcohol in hope of benefit. The position of the American Heart Association is that people who are currently nondrinkers should not start drinking alcohol.
The UK National Health Service states that "an occasional drink is unlikely to harm" a breastfed baby, and recommends consumption of "no more than one or two units of alcohol once or twice a week" for breastfeeding mothers (where a pint of beer or 50 ml drink of a spirit such as whisky corresponds to about two units of alcohol). The NHS also recommends to wait for a couple of hours before breastfeeding or express the milk into a bottle before drinking. Researchers have shown that intoxicated breastfeeding reduces the average milk expression but poses no immediate threat to the child as the amount of transferred alcohol is insignificant.
Alcohol education is the practice of disseminating information about the effects of alcohol on health, as well as society and the family unit. It was introduced into the public schools by temperance organizations such as the Woman's Christian Temperance Union in the late 19th century. Initially, alcohol education focused on how the consumption of alcoholic beverages affected society, as well as the family unit. In the 1930s, this came to also incorporate education pertaining to alcohol's effects on health. Organizations such as the National Institute on Alcohol Abuse and Alcoholism in the United States were founded to promulgate alcohol education alongside those of the temperance movement, such as the American Council on Alcohol Problems.
Alcohol expectations are beliefs and attitudes that people have about the effects they will experience when drinking alcoholic beverages. They are just largely beliefs about alcohol's effects on a person’s behaviors, abilities, and emotions. Some people believe that if alcohol expectations can be changed, then alcohol abuse might be reduced. Men tend to become more aggressive in laboratory studies in which they are drinking only tonic water but believe that it contains alcohol. They also become less aggressive when they believe they are drinking only tonic water, but are actually drinking tonic water that contains alcohol.
The phenomenon of alcohol expectations recognizes that intoxication has real physiological consequences that alter a drinker's perception of space and time, reduce psychomotor skills, and disrupt equilibrium. The manner and degree to which alcohol expectations interact with the physiological short-term effects of alcohol, resulting in specific behaviors, is unclear.
A single study found that if a society believes that intoxication leads to sexual behavior, rowdy behavior, or aggression, then people tend to act that way when intoxicated. But if a society believes that intoxication leads to relaxation and tranquil behavior, then it usually leads to those outcomes. Alcohol expectations vary within a society, so these outcomes are not certain.
People tend to conform to social expectations, and some societies expect that drinking alcohol will cause disinhibition. However, in societies in which the people do not expect that alcohol will disinhibit, intoxication seldom leads to disinhibition and bad behavior.
Alcohol expectations can operate in the absence of actual consumption of alcohol. Research in the United States over a period of decades has shown that men tend to become more sexually aroused when they think they have been drinking alcohol—even when they have not been drinking it. Women report feeling more sexually aroused when they falsely believe the beverages they have been drinking contained alcohol (although one measure of their physiological arousal shows that they became less aroused).
Drug treatment programsEdit
Most addiction treatment programs encourage people with drinking problems to see themselves as having a chronic, relapsing disease that requires a lifetime of attendance at 12-step meetings to keep in check. However, some people do not develop lifelong problems.
Alcohol abuse prevention programsEdit
Recommended maximum intakeEdit
Binge drinking is becoming a major problem in the UK. Advice on weekly consumption is avoided in United Kingdom.
Since 1995 the UK government has advised that regular consumption of three to four units (one unit equates to 10 mL of pure ethanol) a day for men and or two to three units for women, would not pose significant health risks. However, consistently drinking more than four units a day (for men) and three units (women), is not advisable.
Previously (from 1992 until 1995), the advice was that men should drink no more than 21 units per week, and women no more than 14. (The difference between the sexes was due to the typically lower weight and water-to-body-mass ratio of women.) This was changed because a government study showed that many people were in effect "saving up" their units and using them at the end of the week, a phenomenon referred to as binge drinking. The Times reported in October 2007 that these limits had been "plucked out of the air" and had no scientific basis.
Sobriety is the condition of not having any measurable levels, or effects from mood-altering drugs. According to WHO "Lexicon of alcohol and drug terms..." sobriety is continued abstinence from psychoactive drug use. Sobriety is also considered to be the natural state of a human being given at a birth. In a treatment setting, sobriety is the achieved goal of independence from consuming or craving mind-altering substances. As such, sustained abstinence is a prerequisite for sobriety. Early in abstinence, residual effects of mind-altering substances can preclude sobriety. These effects are labeled "PAWS", or "post acute withdrawal syndrome". Someone who abstains, but has a latent desire to resume use, is not considered truly sober. An abstainer may be subconsciously motivated to resume drug use, but for a variety of reasons, abstains (e.g. such as a medical or legal concern precluding use). Sobriety has more specific meanings within specific contexts, such as the culture of Alcoholics Anonymous, other 12 step programs, law enforcement, and some schools of psychology. In some cases, sobriety implies achieving "life balance".
Injury and deathsEdit
Injury is defined as physical damage or harm that is done or sustained. The potential of injuring oneself or others can be increased after consuming alcohol due to the certain short term effects related to the substance such as lack of coordination, blurred vision, and slower reflexes to name a few. Due to these effects the most common injuries include head, fall, and vehicle-related injuries. A study was conducted of patients admitted to the Ulster Hospital in Northern Ireland with fall related injuries. They found that 113 of those patients admitted to that hospital during that had consumed alcohol recently and that the injury severity was higher for those that had consumed alcohol compared to those that had not. Another study showed that 21% of patients admitted to the Emergency Department of the Bristol Royal Infirmary had either direct or indirect alcohol related injuries. If these figures are extrapolated it shows that the estimated number of patients with alcohol related injuries are over 7,000 during the year at this emergency department alone.
In the United States alcohol resulted in about 88,000 deaths in 2010. The World Health Organization calculated that more than 3 million people, mostly men, died as a result of harmful use of alcohol in 2016. This was about 13.5 % of the total deaths of people between 20 and 39. More than 5% of the global disease burden was caused by the harmful use of alcohol.
Alcohol flush and respiratory reactionsEdit
Alcohol flush reaction is a condition in which an individual's face or body experiences flushes or blotches as a result of an accumulation of acetaldehyde, a metabolic byproduct of the catabolic metabolism of alcohol. It is best known as a condition that is experienced by people of Asian descent. According to the analysis by HapMap Project, the rs671 allele of the ALDH2 gene responsible for the flush reaction is rare among Europeans and Africans, and it is very rare among Mexican-Americans. 30% to 50% of people of Chinese and Japanese ancestry have at least one ALDH*2 allele. The rs671 form of ALDH2, which accounts for most incidents of alcohol flush reaction worldwide, is native to East Asia and most common in southeastern China. It most likely originated among Han Chinese in central China, and it appears to have been positively selected in the past. Another analysis correlates the rise and spread of rice cultivation in Southern China with the spread of the allele. The reasons for this positive selection aren't known, but it's been hypothesized that elevated concentrations of acetaldehyde may have conferred protection against certain parasitic infections, such as Entamoeba histolytica. The same SNP allele of ALDH2, also termed glu487lys, and the abnormal accumulation of acetaldehyde following the drinking of alcohol, is associated with the alcohol-induced respiratory reactions of rhinitis and asthma that occur in Eastern Asian populations.
American Indian alcoholismEdit
The examples and perspective in this section may not represent a worldwide view of the subject. (September 2016) (Learn how and when to remove this template message)
While little detailed genetic research has been done, it has been shown that alcoholism tends to run in families with possible involvement of differences in alcohol metabolism and the genotype of alcohol-metabolizing enzymes.
Genetics and amount of consumptionEdit
Having a particular genetic variant (A-allele of ADH1B rs1229984) is associated with non-drinking and lower alcohol consumption. This variant is also associated with favorable cardiovascular profile and a reduced risk of coronary heart disease compared to those without the genetic variant, but it is unknown whether this may be caused by differences in alcohol consumption or by additional confounding effects of the genetic variant itself.
Historically, according to the British Medical Journal, "men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes". However, analysis of data collected over a century from multiple countries suggests that the gender gap in alcohol consumption is narrowing, and that young women (born after 1981) are consuming alcohol more than their male counterparts. Such findings have implications for the way in which alcohol-use prevention and intervention programs are designed and implemented.
Based on combined data from SAMHSA's 2004-2005 National Surveys on Drug Use & Health, the rate of past year alcohol dependence or abuse among people aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%). Over time the difference between males and females has narrowed. According to a 2016 systematic review, for those born at the end of the 20th century men were 1.2 times as likely to drink to problematic levels, and 1.3 times as likely to develop health problems from drinking.
Several biological factors make women more vulnerable to the effects of alcohol than men.
- Body fat. Women tend to weigh less than men, and—pound for pound—a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, alcohol remains at higher concentrations for longer periods of time in a woman’s body, exposing her brain and other organs to more alcohol.
- Enzymes. Women have lower levels of two enzymes—alcohol dehydrogenase and aldehyde dehydrogenase—that metabolize (break down) alcohol in the stomach and liver. As a result, women absorb more alcohol into their bloodstreams than men.
- Hormones. Changes in hormone levels during the menstrual cycle may also affect how a woman metabolizes alcohol.
Females demonstrated a higher average rate of elimination (mean, 0.017; range, 0.014–0.021 g/210 L) than males (mean, 0.015; range, 0.013–0.017 g/210 L). Female subjects on average had a higher percentage of body fat (mean, 26.0; range, 16.7–36.8%) than males (mean, 18.0; range, 10.2–25.3%).
The link between alcohol consumption, depression, and gender was examined by the Centre for Addiction and Mental Health (Canada). The study found that women taking antidepressants consumed more alcohol than women who did not experience depression as well as men taking antidepressants. The researchers, Dr. Kathryn Graham and a PhD Student Agnes Massak analyzed the responses to a survey by 14,063 Canadian residents aged 18–76 years. The survey included measures of quantity, frequency of drinking, depression and antidepressants use, over the period of a year. The researchers used data from the GENACIS Canada survey, part of an international collaboration to investigate the influence of cultural variation on gender differences in alcohol use and related problems. The purpose of the study was to examine whether, like in other studies already conducted on male depression and alcohol consumption, depressed women also consumed less alcohol when taking anti-depressants. According to the study, both men and women experiencing depression (but not on anti-depressants) drank more than non-depressed counterparts. Men taking antidepressants consumed significantly less alcohol than depressed men who did not use antidepressants. Non-depressed men consumed 436 drinks per year, compared to 579 drinks for depressed men not using antidepressants, and 414 drinks for depressed men who used antidepressants. Alcohol consumption remained higher whether the depressed women were taking anti-depressants or not. 179 drinks per year for non-depressed women, 235 drinks for depressed women not using antidepressants, and 264 drinks for depressed women who used antidepressants. The lead researcher argued that the study "suggests that the use of antidepressants is associated with lower alcohol consumption among men suffering from depression. But this does not appear to be true for women."
- "Alcohol and diabetes: Drinking safely – Mayo Clinic".
- Cheryl Platzman Weinstock (8 November 2017). "Alcohol Consumption Increases Risk of Breast and Other Cancers, Doctors Say". Scientific American. Retrieved 13 November 2018.
The ASCO statement, published in the Journal of Clinical Oncology, cautions that while the greatest risks are seen with heavy long-term use, even low alcohol consumption (defined as less than one drink per day) or moderate consumption (up to two drinks per day for men, and one drink per day for women because they absorb and metabolize it differently) can increase cancer risk. Among women, light drinkers have a four percent increased risk of breast cancer, while moderate drinkers have a 23 percent increased risk of the disease.
- Noelle K. LoConte, Abenaa M. Brewster, Judith S. Kaur, Janette K. Merrill, and Anthony J. Alberg (7 November 2017). "Alcohol and Cancer: A Statement of the American Society of Clinical Oncology". Journal of Clinical Oncology. 36 (1).
Clearly, the greatest cancer risks are concentrated in the heavy and moderate drinker categories. Nevertheless, some cancer risk persists even at low levels of consumption. A meta-analysis that focused solely on cancer risks associated with drinking one drink or fewer per day observed that this level of alcohol consumption was still associated with some elevated risk for squamous cell carcinoma of the esophagus (sRR, 1.30; 95% CI, 1.09 to 1.56), oropharyngeal cancer (sRR, 1.17; 95% CI, 1.06 to 1.29), and breast cancer (sRR, 1.05; 95% CI, 1.02 to 1.08), but no discernable associations were seen for cancers of the colorectum, larynx, and liver.CS1 maint: Multiple names: authors list (link)
- "Global status report on alcohol and health" (PDF). World Health Organization. 2014. pp. vii. Retrieved 23 November 2015.
- Griswold, MG; Fullman, N; Hawley, C; Arian, N; Zimsen, SM; et al. (August 2018). "Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. 392 (10152): 1015–1035. doi:10.1016/S0140-6736(18)31310-2. PMC 6148333. PMID 30146330.
- "Cancer warning labels to be included on alcohol in Ireland, minister confirms". Belfasttelegraph.co.uk. Belfast Telegraph. 26 September 2018.
- Meyer, Jerold S. and Linda F. Quenzer. Psychopharmacology: Drugs, the Brain, and Behavior. Sinauer Associates, Inc.: Sunderland, Massachusetts. 2005. Page 228.
- helsinki.fi – Effect of alcohol on hormones in women, Helsinki 2001
- helsinki.fi – Clinical studies on dependence and drug effects Archived 21 February 2013 at the Wayback Machine, ESBRA 2009
- Horowitz M, Maddox A, Bochner M, et al. (1989). "Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption". Am. J. Physiol. 257 (2 Pt 1): G291–6298. doi:10.1152/ajpgi.1989.257.2.G291. PMID 2764113.
- "Carleton College: Wellness Center: Blood Alcohol Concentration (BAC)". Archived from the original on 14 September 2009. Retrieved 29 August 2015.
- Feige B, Scaal S, Hornyak M, Gann H, Riemann D (2007). "Sleep electroencephalographic spectral power after withdrawal from alcohol in alcohol-dependent patients". Alcohol. Clin. Exp. Res. 31 (1): 19–27. doi:10.1111/j.1530-0277.2006.00260.x. PMID 17207097.
- "WHO | Global status report on alcohol and health 2018".
- "Alcohol Facts and Statistics". Retrieved 9 May 2015.
- "Appendix 9. Alcohol - 2015-2020 Dietary Guidelines - health.gov". U.S. Department of Health and Human Services.
- "New alcohol advice issued". NHS. 8 January 2016.
- GBD 2016 Alcohol Collaborators (August 2018). "Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016". Lancet. 392 (10152): 1015–1035. doi:10.1016/S0140-6736(18)31310-2. PMC 6148333. PMID 30146330.
- Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T (2016). "Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality". J Stud Alcohol Drugs. 77 (2): 185–198. doi:10.15288/jsad.2016.77.185. PMC 4803651. PMID 26997174.
- O'Keefe, JH; Bhatti, SK; Bajwa, A; DiNicolantonio, JJ; Lavie, CJ (2014). "Alcohol and cardiovascular health: the dose makes the poison...or the remedy". Mayo Clinic Proceedings. 89 (3): 382–393. doi:10.1016/j.mayocp.2013.11.005. PMID 24582196.
- Caan, Woody; Belleroche, Jackie de, eds. (11 April 2002). Drink, Drugs and Dependence: From Science to Clinical Practice (1st ed.). Routledge. pp. 19–20. ISBN 978-0-415-27891-1.
- Müller D, Koch RD, von Specht H, Völker W, Münch EM (March 1985). "Neurophysiologic findings in chronic alcohol abuse". Psychiatr Neurol Med Psychol (Leipz) (in German). 37 (3): 129–32. PMID 2988001.
- Testino G (2008). "Alcoholic diseases in hepato-gastroenterology: a point of view". Hepatogastroenterology. 55 (82–83): 371–377. PMID 18613369.
- Guerri, C.; Pascual, M.A. (2010)."Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence". Alcohol 44 (1) 15–26. doi:10.1016/j.alcohol.2009.10.003. PMID 20113871
- Vice Admiral Richard H. Carmona (2005). "A 2005 Message to Women from the U.S. Surgeon General" (PDF). Retrieved 12 June 2015.
- Committee to Study Fetal Alcohol Syndrome, Division of Biobehavioral Sciences and Mental Disorders, Institute of Medicine (1995). Fetal alcohol syndrome : diagnosis, epidemiology, prevention, and treatment. Washington, D.C.: National Academy Press. doi:10.17226/4991. ISBN 978-0-309-05292-4.CS1 maint: Uses authors parameter (link)
- "Australian Government National Health and Medical Research Council". Archived from the original on 5 November 2012. Retrieved 4 November 2012.
- Nathanson, Vivienne; Nicky Jayesinghe; George Roycroft (27 October 2007). "Is it all right for women to drink small amounts of alcohol in pregnancy? No". BMJ. 335 (7625): 857. doi:10.1136/bmj.39356.489340.AD. PMC 2043444. PMID 17962287.
- "Fetal Alcohol Exposure". April 2015. Retrieved 10 June 2015.
- "Facts about FASDs". 16 April 2015. Retrieved 10 June 2015.
- "More than 3 million US women at risk for alcohol-exposed pregnancy". Centers for Disease Control and Prevention. 2 February 2016. Retrieved 3 March 2016.
'drinking any alcohol at any stage of pregnancy can cause a range of disabilities for their child,' said Coleen Boyle, Ph.D., director of CDC's National Center on Birth Defects and Developmental Disabilities.
- Coriale; et al. (2013). "Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment". Rivista di Psichiatria. 48 (5): 359–69. doi:10.1708/1356.15062. PMID 24326748.
- Chudley; et al. (2005), "Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis", CMAJ, 172 (5 Suppl): S1–S21, doi:10.1503/cmaj.1040302, PMC 557121, PMID 15738468, retrieved 16 April 2016
- Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G (2010). "Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis". J. Am. Coll. Cardiol. 55 (13): 1339–1347. doi:10.1016/j.jacc.2010.01.006. PMID 20338495.
- "Alcohol and Heart Health". American Heart Association. 15 August 2014.
- Choices, N. H. S. (1 May 2017). "Breastfeeding and drinking alcohol – Pregnancy and baby guide – NHS Choices".
- Haastrup, MB; Pottegård, A; Damkier, P (2014). "Alcohol and Breastfeeding". Basic & Clinical Pharmacology & Toxicology. 114 (2): 168–173. doi:10.1111/bcpt.12149. PMID 24118767.
even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol
- Moore, Mark Harrison; Gerstein, Dean R. (1981). Alcohol and Public Policy. National Academies. p. 90–93.
- Martin, Scott C. (2014). The SAGE Encyclopedia of Alcohol: Social, Cultural, and Historical Perspectives. SAGE Publications. ISBN 9781483374383.
- Grattan, Karen E.; Vogel-Sprott, M. (2001). "Maintaining Intentional Control of Behavior Under Alcohol". Alcoholism: Clinical and Experimental Research. 25 (2): 192–7. doi:10.1111/j.1530-0277.2001.tb02198.x. PMID 11236832.
- MacAndrew, C. and Edgerton. Drunken Comportment: A Social Explanation. Chicago: Aldine, 1969.
- Marlatt GA, Rosenow (1981). "The think-drink effect". Psychology Today. 15: 60–93.
- Nutt, D; King, LA; Saulsbury, W; Blakemore, C (24 March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet. 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831.
- "Sensible Drinking". Aim-digest.com. Archived from the original on 19 November 2010. Retrieved 5 February 2013.
- "Alcohol misuse : Department of Health". Dh.gov.uk. Retrieved 5 February 2013.
- "Alcohol and health: how alcohol can affect your long and short term health". Drinkaware.co.uk. Retrieved 5 February 2013.
- Drink limits ‘useless’, The Times, 20 October 2007
- "Lexicon and drug terms". Who.int. 9 December 2010. Retrieved 5 February 2013.
- MD Basharin K.G. (2010). "Scientific grounding for sobriety: Western experience" (PDF). Retrieved 5 February 2013.
- Twelve Steps and Twelve Traditions (PDF). Alcoholics Anonymous World Services. April 1953. ISBN 978-0-916856-01-4. Retrieved 31 December 2018. (Electronic .PDF version, September 2005).
- "Drinkwise Australia". DrinkWise Australia.
- Johnson J, McGovern S (2003). "Alcohol related falls: an interesting pattern of injuries". Emergency Medicine Journal. 21 (2): 185–188. doi:10.1136/emj.2003.006130. PMC 1726307.
- Hoskins R, Benger J (2013). "What is the burden of alcohol-related injuries in an inner city emergency department?". Alcoholism: Clinical and Experimental Research. 33 (9): 1532–1538. doi:10.1111/j.1530-0277.2009.00981.x. PMC 2757258. PMID 19485974.
- "Alcohol-attributable deaths and years of potential life lost — 11 states, 2006–2010". www.cdc.gov.
- "Alcohol". World health Organization. 21 September 2018. Retrieved 5 November 2018.
- "Rs671". SNPmedia.
- Hui Li; et al. (2009). "Refined Geographic Distribution of the Oriental ALDH2*504Lys (nee 487Lys) Variant". Ann Hum Genet. 73 (Pt 3): 335–345. doi:10.1111/j.1469-1809.2009.00517.x. PMC 2846302. PMID 19456322.
- Yi Peng; Hong Shi; Xue-bin Qi; Chun-jie Xiao; Hua Zhong; Run-lin Z Ma; Bing Su (2010). "The ADH1B Arg47His polymorphism in East Asian populations and expansion of rice domestication in history". BMC Evolutionary Biology. 10 (1): 15. doi:10.1186/1471-2148-10-15. PMC 2823730. PMID 20089146.
- Oota H, Pakstis AJ, Bonne-Tamir B, Goldman D, Grigorenko E, Kajuna SL, et al. (2004). "The evolution and population genetics of the ALDH2 locus: random genetic drift, selection, and low levels of recombination". Ann. Hum. Genet. 68 (Pt 2): 93–109. PMID 15008789.
- Adams, KE; Rans, TS (2013). "Adverse reactions to alcohol and alcoholic beverages". Annals of Allergy, Asthma & Immunology. 111 (6): 439–445. doi:10.1016/j.anai.2013.09.016. PMID 24267355.
- Holmes, Michael V.; et al. (2014). "Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data". BMJ. 349: g4164. doi:10.1136/bmj.g4164. PMC 4091648. PMID 25011450.
- "Women catching up with men in alcohol consumption and its associated harms" (PDF). BMJ Open (Press release). 25 October 2016.
- Slade T, Chapman C, Swift W, Keyes K, Tonks Z, Teesson M (2016). "Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression" (PDF). BMJ Open. 6 (10): e011827. doi:10.1136/bmjopen-2016-011827. PMC 5093369. PMID 27797998.
- "Gender differences in alcohol use and alcohol dependence or abuse: 2004 or 2005." The NSDUH Report. Accessed 22 June 2012.
- "Women & Alcohol: The Hidden Risks of Drinking". Helpguide.org. Archived from the original on 3 January 2013. Retrieved 5 February 2013.
- Cowan, JM Jr; Weathermon, A; McCutcheon, JR; Oliver, RD (September 1996). "Determination of volume of distribution for ethanol in male and female subjects". J Anal Toxicol. 20 (5): 287–90. doi:10.1093/jat/20.5.287. PMID 8872236.
- Graham, Katherine and Massak, Agnes. "Alcohol consumption and the use of antidepressants." UK PubMed Central (2007). 20 June 2012.