This article is about ethanol as a psychoactive or recreational substance. For the class of chemical compounds, see
Alcohol (chemistry). For types and characteristics of alcoholic beverages from a cultural perspective, see
Alcoholic beverage. For the substance in general, see
Ethanol.
Constant-rate elimination at typical concentrations:[7][8][6] • Range: 10–34 mg/dL/hour • Mean (men): 15 mg/dL/hour • Mean (women): 18 mg/dL/hr At very high concentrations (t1/2): 4.0–4.5 hours[5][4]
Alcohol, sometimes referred to by the chemical name ethanol, is a
depressant drug found in
fermentedbeverages such as beer, wine, and distilled
spirit[11] -- in particular,
rectified spirit.[12] Ethanol is colloquially refereed to as "alcohol" because it is the most prevalent alcohol in alcoholic beverages, but technically all
alcoholic beverages contain several types of psychoactive alcohols,
that are categorized as
primary,
secondary, or
tertiary; Primary alcohols are
oxidized to
aldehydes, secondary alcohols undergo oxidation to form
ketones, while tertiary alcohols are generally resistant to oxidation;[13] Ethanol is a primary alcohol that has unpleasant actions in the body, many of which are mediated by its toxic
metaboliteacetaldehyde.[14] Less prevalent alcohols found in alcoholic beverages, are secondary, and tertiary alcohols. For example, the tertiary alcohol
2M2B which is up to 50 times more potent than ethanol and found in trace quantities in alcoholic beverages, has been synthesized and used as a
designer drug. Alcoholic beverages are sometimes
laced with toxic alcohols, such as
methanol (the simplest alcohol) and
isopropyl alcohol.[11] A mild, brief exposure to isopropyl alcohol (which is only moderately more toxic than ethanol) is unlikely to cause any serious harm, but many
methanol poisoning incidents have occurred through history, since methanol is lethal even in small quantities, as little as 10–15 milliliters (2–3 teaspoons). Ethanol is used to
treat methanol and ethylene glycol toxicity.
Consuming alcohol prior to visiting female sex workers is a common practice among some men.[32] Also, sex workers often resort to using drugs and alcohol to cope with stress. However, female
sex workers in low- and middle-income countries have high rates of harmful alcohol use, which is associated with increased risk of
risky sexual behavior.[33]
Alcohol has a long association of military use, and has been called "
liquid courage" for its role in preparing troops for battle,
anaesthetize injured soldiers, and celebrate military
victories. It has also served as a coping mechanism for the intense stress of war and a means of decompression from combat to everyday life. However, this reliance on alcohol can have negative consequences for physical and mental health.[34] Military and veteran populations face significant challenges in addressing the co-occurrence of
PTSD and
alcohol use disorder.[35]
For risk of using alcohol in diabetics, see
§ Diabetes.
The use of alcohol as a
staple food source is considered inconvenient due to the fact that it increases the
blood alcohol content (BAC). However, alcohol is a significant source of
food energy for individuals with alcoholism and those who engage in binge drinking; For example, individuals with
drunkorexia, engage in the combination of self-imposed malnutrition and binge drinking to avoid
weight gain from alcohol, to save money for purchasing alcohol,[36] and to facilitate alcohol intoxication.[37]
The
USDA uses a figure of 6.93
kilocalories (29.0 kJ) per gram of alcohol (5.47 kcal or 22.9 kJ per
ml) for calculating food energy.[38] For
distilled spirits, a standard serving in the United States is 44 ml (1.5 US fl oz), which at 40% ethanol (80
proof), would be 14 grams and 98 calories.
Alcohol can have
analgesic (pain-relieving) effects, which is why some people with
chronic pain turn to alcohol to self-medicate and try to alleviate their physical discomfort.[46]
People with
social anxiety disorder commonly
self-medicate with alcohol to overcome their highly set inhibitions.[47] However, self-medicating excessively for prolonged periods of time with alcohol often makes the symptoms of anxiety or depression worse. This is believed to occur as a result of the changes in brain chemistry from long-term use.[48][49][50] A 2023
systematic review highlights the non-addictive use of alcohol for managing
developmental issues, personality traits, and
psychiatric symptoms, emphasizing the need for informed, harm-controlled approaches to alcohol consumption within a personalized health policy framework.[51]
"
Hair of the dog", short for "hair of the dog that bit you", is a
colloquial expression in the English language predominantly used to refer to alcohol that is consumed as a
hangover remedy (with the aim of lessening the effects of a
hangover). Many other languages have their own phrase to describe the same concept. The idea may have some basis in science in the difference between
ethanol and
methanol metabolism. Instead of alcohol,
rehydration before going to bed or during hangover may relieve
dehydration-associated symptoms such as thirst, dizziness, dry mouth, and headache.[53][54][55][56][57][58]
In the US, alcohol is subject to the FDA drug labeling
Pregnancy CategoryX (Contraindicated in pregnancy).
Ethanol is classified as a
teratogen[18][19][medical citation needed]—a substance known to cause birth defects; According to the U.S.
Centers for Disease Control and Prevention (CDC), alcohol consumption by women who are not using birth control increases the risk of fetal alcohol syndrome. The CDC currently recommends complete abstinence from alcoholic beverages for women of child-bearing age who are pregnant, trying to become pregnant, or are sexually active and not using birth control.[64]
Minnesota, North Dakota, Oklahoma, South Dakota, and Wisconsin have laws that allow the state to involuntarily commit pregnant women to treatment if they abuse alcohol during pregnancy.[65]
Alcohol is a common cause of
substance-induced psychosis or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions.[69] Research has shown that
excessive alcohol use causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women.[70][71] While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent.[69] Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as
schizophrenia.[72]
An
inability to process or exhibit emotions in a proper manner has been shown to exist in people who consume excessive amounts of alcohol and those who were exposed to alcohol while fetuses (FAexp).[73]
The amount of ethanol in the body is typically quantified by
blood alcohol content (BAC); weight of ethanol per unit volume of blood. Small doses of ethanol, in general, are
stimulant-like[74] and produce euphoria and relaxation; people experiencing these symptoms tend to become talkative and less inhibited, and may exhibit poor judgement. At higher dosages (BAC > 1 gram/liter), ethanol acts as a
central nervous system (CNS)
depressant,[74] producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death. Ethanol is commonly consumed as a recreational substance, especially while socializing, due to its psychoactive effects.
Central nervous system impairment
Alcohol causes generalized CNS depression, is a
positive allosteric GABAA modulator and is associated and related with
cognitive, memory,
motor, and
sensory impairment. It slows and impairs
cognition and reaction time and the cognitive skills, impairs judgement, interferes with motor function resulting in motor incoordination, loss of balance, confusion, sedation, numbness and slurred speech, impairs memory formation, and causes sensory impairment. At high concentrations, it can induce
amnesia,
analgesia,
spins,
stupor, and
unconsciousness as result of high levels of ethanol in blood.
Alcohol can cause
nausea and
vomiting in sufficiently high amounts (varying by person).
Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption stimulates acidic secretions normally intended to digest protein molecules. Consequently, the excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer that prevents the stomach from, essentially, digesting itself. However, in patients who have a
peptic ulcer disease (PUD), this mucosal layer is broken down. PUD is commonly associated with the bacteria Helicobacter pylori, which secretes a toxin that weakens the mucosal wall, allowing acid and protein enzymes to penetrate the weakened barrier. Because alcohol stimulates the stomach to secrete acid, a person with PUD should avoid drinking alcohol on an empty stomach. Drinking alcohol causes more acid release, which further damages the already-weakened stomach wall.[75] Complications of this disease could include a burning pain in the abdomen, bloating and in severe cases, the presence of dark black stools indicate internal bleeding.[76] A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.[76]
Ingestion of alcohol can initiate systemic pro-inflammatory changes through two intestinal routes: (1) altering intestinal microbiota composition (dysbiosis), which increases
lipopolysaccharide (LPS) release, and (2) degrading
intestinal mucosal barrier integrity – thus allowing LPS to enter the circulatory system. The major portion of the blood supply to the
liver is provided by the portal vein. Therefore, while the liver is continuously fed nutrients from the intestine, it is also exposed to any bacteria and/or bacterial derivatives that breach the intestinal mucosal barrier. Consequently, LPS levels increase in the portal vein, liver and systemic circulation after alcohol intake. Immune cells in the liver respond to LPS with the production of
reactive oxygen species, leukotrienes, chemokines and cytokines. These factors promote tissue inflammation and contribute to organ pathology.[77]
Holiday heart syndrome, also known as alcohol-induced atrial arrhythmias, is a
syndrome defined by an
irregular heartbeat and
palpitations[78] associated with high levels of
ethanol consumption.[79][80] Holiday heart syndrome was discovered in 1978 when
Philip Ettinger discovered the connection between arrhythmia and alcohol consumption.[81] It received its common name as it is associated with the
binge drinking common during the holidays.[82] It is unclear how common this syndrome is. 5-10% of cases of
atrial fibrillation may be related to this condition, but it could be as high 63%.[83]
Positional alcohol nystagmus (PAN) is
nystagmus (visible jerkiness in
eye movement) produced when the head is placed in a sideways position. PAN occurs when the
specific gravity of the membrane space of the
semicircular canals in the ear differs from the specific gravity of the fluid in the canals because of the presence of alcohol.[84]
Ethanol-containing beverages can cause alcohol flush reactions, exacerbations of
rhinitis and, more seriously and commonly,
bronchoconstriction in patients with a history of
asthma, and in some cases,
urticarial skin eruptions, and systemic
dermatitis. Such reactions can occur within 1–60 minutes of ethanol ingestion, and may be caused by:[87]
genetic abnormalities in the metabolism of ethanol, which can cause the ethanol metabolite,
acetaldehyde, to accumulate in tissues and trigger the release of
histamine, or
true
allergy reactions to
allergens occurring naturally in, or contaminating, alcoholic beverages (particularly wine and beer), and
Prolonged heavy consumption of alcohol can cause significant permanent damage to the
brain and other organs, resulting in dysfunction or death. The
impact of alcohol on aging is multifaceted. The relationship between
alcohol consumption and body weight is the subject of inconclusive studies.
Alcoholic lung disease is
disease of the lungs caused by excessive alcohol. However, the term 'alcoholic lung disease' is not a generally accepted medical diagnosis.
Alcoholism or its medical diagnosis alcohol use disorder refers to alcohol addiction, alcohol dependence,
dipsomania, and/or alcohol abuse. It is a major problem and many health problems as well as death can result from excessive alcohol use.[88][66] Alcohol dependence is linked to a
lifespan that is reduced by about 12 years relative to the average person.[88] In 2004, it was estimated that 4% of deaths worldwide were attributable to alcohol use.[66] Deaths from alcohol are split about evenly between acute causes (e.g., overdose, accidents) and chronic conditions.[66] The leading chronic alcohol-related condition associated with death is
alcoholic liver disease.[66] Alcohol dependence is also associated with
cognitive impairment and
organic brain damage.[88] Some researchers have found that even one alcoholic drink a day increases an individual's risk of health problems by 0.4%.[89]
Two or more consecutive alcohol-free days a week have been recommended to improve health and break dependence.[90][91]
Dry drunk is an expression coined by the founder of Alcoholics Anonymous [92] that describes an
alcoholic who no longer drinks but otherwise maintains the same behavior patterns of an alcoholic.[93]
Delirium tremens is a condition that requires people with a long history of heavy drinking to undertake an
alcohol detoxification regimen.
Alcohol is one of the more dangerous drugs to withdraw from.[99] Drugs which help to re-stabilize the glutamate system such as
N-acetylcysteine have been proposed for the treatment of addiction to
cocaine,
nicotine, and alcohol.[100]
Alcoholic ketoacidosis (AKA) is a specific
group of symptoms and metabolic state related to alcohol use.[101] Symptoms often include abdominal pain, vomiting, agitation, a fast respiratory rate, and a specific "fruity" smell.[102] Consciousness is generally normal.[103] Complications may include sudden death.[103]
Alcohol-related dementia (ARD) is a form of
dementia caused by long-term, excessive consumption of alcohol, resulting in
neurological damage and impaired cognitive function.[104]
Alcoholic cardiomyopathy (ACM) is a disease in which the long-term consumption of alcohol leads to
heart failure.[105] ACM is a type of
dilated cardiomyopathy. The heart is unable to pump blood efficiently, leading to heart failure. It can affect other parts of the body if the heart failure is severe. It is most common in males between the ages of 35 and 50.
Austrian syndrome, also known as Osler's triad, is a medical condition that was named after
Robert Austrian in 1957. The presentation of the condition consists of
pneumonia,
endocarditis, and
meningitis, all caused by Streptococcus pneumoniae. It is associated with
alcoholism due to
hyposplenism (reduced
splenic functioning) and can be seen in males between the ages of 40 and 60 years old.[106] Robert Austrian was not the first one to describe the condition, but Richard Heschl (around 1860s) or William Osler were not able to link the signs to the bacteria because microbiology was not yet developed.
The leading cause of Osler's triad (Austrian syndrome) is Streptococcus pneumoniae, which is usually associated with heavy alcohol use.
The
International Agency for Research on Cancer lists ethanol in alcoholic beverages as a Group 1 carcinogen in humans and argues that "There is sufficient evidence and research showing the carcinogenicity of acetaldehyde (the major metabolite of ethanol) which is excreted by the liver enzyme when one drinks alcohol."[15]
A 2001 meta-analysis did not find a clear safe level of alcohol consumption where there is no increased risk of cancer.[24] In 2020, alcohol was estimated to cause 750,000 cases of cancer worldwide, particularly
esophagus,
liver, and
breast cancer.[109]
Research has looked into the effects of alcohol on the amount of
cortisol that is produced in the human body. Continuous consumption of alcohol over an extended period of time has been shown to raise cortisol levels in the body. Cortisol is released during periods of high stress, and can result in the temporary shut down of other physical processes, causing physical damage to the body.
Consuming more than 30 grams of pure alcohol per day over an extended period can significantly increase the risk of developing alcoholic liver disease.[110] During the metabolism of alcohol via the respective dehydrogenases,
nicotinamide adenine dinucleotide (NAD) is converted into reduced NAD. Normally, NAD is used to metabolize fats in the liver, and as such alcohol competes with these fats for the use of NAD. Prolonged exposure to alcohol means that fats accumulate in the liver, leading to the term 'fatty liver'. Continued consumption (such as in alcohol use disorder) then leads to cell death in the hepatocytes as the fat stores reduce the function of the cell to the point of death. These cells are then replaced with scar tissue, leading to the condition called
cirrhosis.
Specific population
Pregnant women: Babies exposed to alcohol, benzodiazepines, barbiturates, and some antidepressants (SSRIs) during pregnancy may experience
neonatal withdrawal.[111]
Other effects
Frequent drinking of alcoholic beverages is a major contributing factor in cases of elevated blood levels of
triglycerides.[112]
Social issues
Alcohol causes a plethora of detrimental effects in society.[88] Many
emergency room visits involve alcohol use.[88] As many as 15% of employees show problematic alcohol-related behaviors in the workplace, such as drinking before going to work or even drinking on the job.[88]
Individuals who engage with or share alcohol-related content on
social networking services tend to exhibit higher levels of alcohol use and related issues.[114] Alcohol availability and consumption rates and alcohol rates are positively associated with
nuisance,
loitering,
panhandling, and
disorderly conduct in
public space.[115] Recent research indicates that the abundance of alcohol retailers and the availability of inexpensive alcoholic beverages are linked to heavy alcohol consumption among college students.[116] Also, joblessness can heighten the risk of alcohol consumption and smoking.[117]
Alcohol use is stereotypically associated with crime,[115] both
violent and non-violent.[88] Some crimes are uniquely tied to alcohol, such as
public intoxication or
underage drinking, while others are simply more likely to occur together with alcohol consumption. Crime perpetrators are much more likely to be intoxicated than crime victims. Many
alcohol laws have been passed to criminalize various alcohol-related activities.[115][118] Underage drinking and
drunk driving are the most prevalent alcohol‐specific offenses in the United States[115] and a major problem in many countries worldwide.[119][120][121] About one-third of
arrests in the United States involve alcohol misuse,[88] and arrests for alcohol-related crimes constitute a high proportion of all arrests made by police in the U.S. and elsewhere.[122] In general, programs aimed at reducing society's consumption of alcohol, including education in schools, are seen as an effective long-term solution. Strategies aiming to reduce alcohol consumption among adult offenders have various estimates of effectiveness.[123] Policing alcohol‐related street disorder and enforcing compliance checks of alcohol‐dispensing businesses has proven successful in reducing public perception of and fear of criminal activities.[115]
In the early 2000s, the monetary cost of alcohol-related crime in the United States alone has been estimated at over $205 billion, twice the economic cost of all other
drug-related crimes.[124] In a similar period in the United Kingdom, the cost of crime and its antisocial effects was estimated at £7.3 billion.[123] Another estimate for the UK for yearly cost of alcohol-related crime suggested double that estimate, at between £8 and 13 billion.[125] Risky patterns of drinking are particularly problematic in and around Russia, Mexico and some parts of Africa.[126] Alcohol is more commonly associated with both violent and non-violent crime than are drugs like
marijuana.[88]
A 2002 study found 41% of people fatally injured in traffic accidents were in alcohol-related crashes.[128] Misuse of alcohol is associated with more than 40% of deaths that occur in automobile accidents every year.[88] The risk of a fatal
car accident increases exponentially with the level of alcohol in the driver's blood.[129]
Most countries have passed laws prohibiting driving a
motor vehicle while impaired by alcohol. In the U.S., these crimes are generally referred to as
driving under the influence (DUI), although there are many naming variations among jurisdictions, such as driving while intoxicated (DWI).[130] With alcohol consumption, a
drunk driver's level of intoxication is typically determined by a measurement of
blood alcohol content or BAC; but this can also be expressed as a breath test measurement, often referred to as a BrAC. A BAC or BrAC measurement in excess of the specific threshold level, such as 0.08% in the U.S.,[131] defines the
criminal offense with no need to prove impairment.[132] In some jurisdictions, there is an aggravated category of the offense at a higher BAC level, such as 0.12%, 0.15% or 0.25%. In many jurisdictions, police officers can conduct field tests of suspects to look for signs of intoxication.
Outbreaks of
methanol poisoning have occurred when methanol is used to
lacemoonshine (bootleg liquor).[133] This is commonly done to bulk up the original product to gain profit. Because of its similarities in both appearance and odor to
ethanol (the alcohol in beverages), it is difficult to differentiate between the two.
Methanol is a toxic alcohol. If as little as 10 mL of pure methanol is ingested, for example, it can break down into
formic acid, which can cause permanent
blindness by destruction of the
optic nerve, and 30 mL is potentially fatal,[134] although the median lethal dose is typically 100 mL (3.4 fl oz) (i.e. 1–2 mL/kg body weight of pure methanol[135]).
Reference dose for methanol is 2.0 mg/kg/day.[136] Toxic effects take hours to start, and effective antidotes can often prevent permanent damage.[134]
Public drunkenness or intoxication is a common problem in many jurisdictions. Public intoxication laws vary widely by jurisdiction, but include public nuisance laws,
open-container laws, and prohibitions on
drinking alcohol in public or certain areas. The offenders are often lower class individuals and this crime has a very high
recidivism rate, with numerous instances of repeated instances of the arrest, jail, release without treatment cycle. The high number of arrests for public drunkenness often reflects rearrests of the same offenders.[122]
A person may take a drug, such as alcohol, to reduce their level of
sexual inhibition, but it is associated with an increased risk in
risky sexual behaviors.
One of the most common
date rape drugs is alcohol,[143][144][145] administered either surreptitiously[146] or consumed voluntarily,[143] rendering the victim unable to make informed decisions or give consent. The perpetrator then facilitates
sexual assault or
rape, a crime known as
drug-facilitated sexual assault (DFSA).[147][148] However, sex with an unconscious victim is considered rape in most if not all jurisdictions, and some assailants have committed "rapes of convenience" whereby they have assaulted a victim after he or she had become unconscious from drinking too much.[149] The risk of individuals either experiencing or perpetrating
sexual violence and
risky sexual behavior increases with
alcohol abuse,[150] and by the consumption of
caffeinated alcoholic drinks.[151][152]
The
World Health Organization has noted that out of
social problems created by the harmful use of alcohol, "crime and violence related to alcohol consumption" are likely the most significant issue.[126] In the United States, 15% of robberies, 63% of intimate partner violence incidents, 37% of sexual assaults, 45–46% of physical
assaults and 40–45% of homicides (
murders) involved use of alcohol.[154][124] A 1983 study for the United States found that 54% of violent crime perpetrators, arrested in that country, had been consuming alcohol before their offenses.[122] In 2002, it was estimated that 1 million violent crimes in the U.S. were related to alcohol use.[88] More than 43% of violent encounters with police involve alcohol.[88] Alcohol is implicated in more than two-thirds of cases of
intimate partner violence.[88] Studies also suggest there may be links between alcohol abuse and
child abuse.[115] In the United Kingdom, in 2015/2016, 39% of those involved in violent crimes were under alcohol influence.[155] International studies are similar, with an estimate that 63% of violent crimes worldwide involves the use of alcohol.[124]
The relation between
alcohol and violence is not yet fully understood, as its impact on different individuals varies.[citation needed] Studies and theories of
alcohol abuse suggest, among others, that use of alcohol likely reduces the offender's perception and awareness of consequences of their actions.[145][115][122][156]Heavy drinking is associated with vulnerability to
injury,
marital discord, and
domestic violence.[88] Moderate drinkers are more frequently engaged in intimate violence than are light drinkers and abstainers, however generally it is heavy and/or binge drinkers who are involved in the most chronic and serious forms of aggression. Research found that factors that increase the likelihood of alcohol‐related violence include difficult temperament, hyperactivity, hostile beliefs, history of family violence, poor school performance, delinquent peers, criminogenic beliefs about alcohol's effects, impulsivity, and antisocial personality disorder. The odds, frequency, and severity of physical attacks are all positively correlated with alcohol use. In turn, violence decreases after behavioral marital alcoholism treatment.[115]
Binge drinking is a style of drinking that is popular in several countries worldwide, and overlaps somewhat with
social drinking since it is often done in groups. The degree of intoxication however, varies between and within various cultures that engage in this practice. A binge on alcohol can occur over hours, last up to several days, or in the event of extended abuse, even weeks. Due to the
long term effects of alcohol abuse, binge drinking is considered to be a major
public health issue.[23]
Binge drinking is more common in males, during adolescence and young adulthood. Heavy regular binge drinking is associated with adverse effects on
neurologic,
cardiac,
gastrointestinal,
hematologic,
immune, and
musculoskeletal organ systems as well as increasing the risk of alcohol induced
psychiatric disorders.[157][158] A US-based review of the literature found that up to one-third of adolescents binge-drink, with 6% reaching the threshold of having an alcohol-related
substance use disorder.[159] Approximately one in 25 women binge-drinks during pregnancy, which can lead to
fetal alcohol syndrome and
fetal alcohol spectrum disorders.[160] Binge drinking during adolescence is associated with traffic accidents and other types of accidents, violent behavior as well as suicide. The more often a child or adolescent binge drinks and the younger they are the more likely that they will develop an alcohol use disorder including
alcoholism. A large number of adolescents who binge-drink also consume other psychotropic substances.[161]
Environment
Alcoholic beverage containers, particularly broken glass bottles, are a common source of litter that is difficult to clean up, which may puncture bicycle tires, hurt wild life animals, etc. Alcoholic bottles are often discarded improperly, not
recycled, or left in public spaces, which have negative impacts on the environment. Alcohol may negatively impact decision making in taking environmental responsibility.
A 2021 study, that examined the relationship between drunk texting and
emotional dysregulation, found a positive correlation. The findings suggest that interventions targeting
emotional regulation skills may be beneficial.[162]
In vino veritas is a
Latin phrase that means 'in wine, there is truth', suggesting a person under the influence of alcohol is more likely to speak their hidden thoughts and desires.
Suicide
Most people are under the influence of
sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by
suicide,[163] with alcoholism present in between 15% and 61% of cases.[164] Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide.[165] About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide.[165] Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past.[164] In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.[166]
Symptoms of ethanol
overdose may include nausea, vomiting, CNS depression, coma,
acute respiratory failure, or death. Levels of even less than 0.1% can cause intoxication, with unconsciousness often occurring at 0.3–0.4%.[167] Death from ethanol consumption is possible when blood alcohol levels reach 0.4%. A blood level of 0.5% or more is commonly fatal. The oral
median lethal dose (LD50) of ethanol in rats is 5,628 mg/kg. Directly translated to human beings, this would mean that if a person who weighs 70 kg (150 lb) drank a 500 mL (17 US fl oz) glass of pure ethanol, they would theoretically have a 50% risk of dying. The highest blood alcohol level ever recorded, in which the subject survived, is 1.41%.[168]
Alcohol consumption can be especially dangerous for those with pre-existing liver damage from
hepatitis B or
C. Even relatively low amounts of alcohol can be life-threatening in these cases,[22] so a strict adherence to abstinence is highly recommended.[169]
This
dose dumping effect is an unintended rapid release of large amounts of a given drug, when administered through a
modified-release dosage while co-ingesting ethanol.[171] This is considered a pharmaceutical disadvantage due to the high risk of causing drug-induced toxicity by increasing the absorption and serum concentration above the
therapeutic window of the drug. The best way to prevent this interaction is by avoiding the co-ingestion of both substances or using specific controlled-release formulations that are resistant to AIDD.
Alcohol combined with
cannabis (not to be confused with
tincture of cannabis which contains minute quantities of alcohol) — known as cross-fading and may easily cause
spins in people who are drunk and smoke potent cannabis; Ethanol increases plasma
tetrahydrocannabinol levels, which suggests that ethanol may increase the absorption of tetrahydrocannabinol.[172]
TOMSO is a lesser-known psychedelic drug and a
substituted amphetamine. TOMSO is inactive on its own; it is activated with the consumption of alcohol.
Disulfiram inhibits the enzyme
acetaldehyde dehydrogenase, which in turn results in buildup of acetaldehyde, a toxic metabolite of ethanol with unpleasant effects. The medication or drug is commonly used to treat alcohol use disorder, and results in immediate hangover-like symptoms upon consumption of alcohol, this effect is widely known as
disulfiram effect.
Metronidazole
Metronidazole is an antibacterial agent that kills bacteria by damaging cellular DNA and hence cellular function.[173] Metronidazole is usually given to people who have diarrhea caused by Clostridium difficile bacteria. Patients who are taking metronidazole are sometimes advised to avoid alcohol, even after 1 hour following the last dose. Although older data suggested a possible disulfiram-like effect of metronidazole, newer data has challenged this and suggests it does not actually have this effect.
Ethanol interacts with
cocainein vivo to produce
cocaethylene, another psychoactive substance which may be substantially more
cardiotoxic than either cocaine or alcohol by themselves.[176][177]
Ethylphenidate formation appears to be more common when large quantities of methylphenidate and alcohol are consumed at the same time, such as in non-medical use or
overdose scenarios.[178] However, only a small percent of the consumed methylphenidate is converted to ethylphenidate.[179]
A
nicotini is any
alcoholic drink which includes
nicotine as an ingredient. Its name is modeled after the word "
martini" in the fashion of such drinks as the
appletini. Tobacco and nicotine increase alcohol craving.[180]
The rate-limiting steps for the elimination of ethanol are in common with certain other substances. As a result, the blood alcohol concentration can be used to modify the rate of metabolism of toxic alcohols, such as
methanol and ethylene glycol. Methanol itself is not highly toxic, but its metabolites
formaldehyde and
formic acid are; therefore, to reduce the rate of production and concentration of these harmful metabolites, ethanol can be ingested.[181] Ethylene glycol poisoning can be treated in the same way.
Excessive use of alcohol is also known to affect the metabolism of warfarin and can elevate the INR, and thus increase the risk of bleeding.[182] The U.S.
Food and Drug Administration (FDA) product insert on warfarin states that alcohol should be avoided.[183] The
Cleveland Clinic suggests that when taking warfarin one should not drink more than "one beer, 6 oz of wine, or one shot of alcohol per day".[184]
Levels of liver enzymes in the bloodstream should be frequently checked in daily alcohol drinkers, pregnant women, IV drug users, people over 35, and those who have chronic liver disease, severe kidney dysfunction, peripheral neuropathy, or HIV infection since they are more likely to develop hepatitis from INH.[185][186]
The principal
mechanism of action for ethanol has proven elusive and remains not fully understood.[27][187] Identifying
molecular targets for ethanol has proven unusually difficult, in large part due to its unique biochemical properties.[187] Specifically, ethanol is a very low
molecular weight compound and is of exceptionally low
potency in its actions, causing effects only at very high (
millimolarmM) concentrations.[187][188] For these reasons, unlike with most drugs, it has not yet been possible to employ traditional biochemical techniques to directly assess the binding of ethanol to
receptors or
ion channels.[187][188] Instead, researchers have had to rely on functional studies to elucidate the actions of ethanol.[187] Moreover, although it has been established that ethanol modulates ion channels to mediate its effects,[29] ion channels are complex proteins, and their interactions and functions are complicated by diverse
subunit compositions and regulation by conserved cellular signals (e.g. signaling lipids).[27][187]
In 2007, it was discovered that ethanol potentiates
extrasynapticδ subunit-containing GABAA receptors at behaviorally relevant (as low as 3 mM) concentrations.[27][187][193] This is in contrast to previous functional assays of ethanol on
γ subunit-containing GABAA receptors, which it enhances only at far higher concentrations (> 100 mM) that are in excess of recreational concentrations (up to 50 mM).[27][187][194]Ro15-4513, a close
analogue of the benzodiazepine antagonist
flumazenil (Ro15-1788), has been found to bind to the same site as ethanol and to competitively displace it in a saturable manner.[187][193] In addition, Ro15-4513 blocked the enhancement of δ subunit-containing GABAA receptor currents by ethanol in vitro.[187] In accordance, the drug has been found to reverse many of the behavioral effects of low-to-moderate doses of ethanol in rodents, including its effects on anxiety, memory, motor behavior, and self-administration.[187][193] Taken together, these findings suggest a binding site for ethanol on subpopulations of the GABAA receptor with specific subunit compositions via which it interacts with and potentiates the receptor.[27][187][193][195]
A 2019 study showed the accumulation of an unnatural lipid
phosphatidylethanol (PEth) competes with
PIP2 agonist sites on
lipid-gated ion channels.[196] This presents a novel indirect mechanism and suggests that a metabolite, not the ethanol itself, can affect the primary targets of ethanol intoxication. Many of the primary targets of ethanol are known to bind PIP2 including GABAA receptors,[197] but the role of PEth will need to be investigated for each of the primary targets.
Rewarding and reinforcing actions
The reinforcing effects of alcohol consumption are mediated by acetaldehyde generated by
catalase and other oxidizing enzymes such as
cytochrome P-4502E1 in the brain.[200] Although acetaldehyde has been associated with some of the adverse and toxic effects of ethanol, it appears to play a central role in the activation of the
mesolimbic dopamine system.[201]
With chronic alcohol intake, consumption of ethanol similarly induces CREB phosphorylation through the D1 receptor pathway, but it also alters NMDA receptor function through phosphorylation mechanisms;[202][203] an adaptive
downregulation of the D1 receptor pathway and CREB function occurs as well.[202][203] Chronic consumption is also associated with an effect on CREB phosphorylation and function via postsynaptic NMDA receptor signaling cascades through a
MAPK/ERK pathway and
CAMK-mediated pathway.[203] These modifications to CREB function in the mesolimbic pathway
induce expression (i.e., increase gene expression) of ΔFosB in the
NAcc,[203] where ΔFosB is the "master control protein" that, when overexpressed in the NAcc, is
necessary and sufficient for the development and maintenance of an addictive state (i.e., its overexpression in the nucleus accumbens produces and then directly modulates compulsive alcohol consumption).[203][205][206][207]
Central nervous system depression, anxiety suppression, stress suppression, sedation, nausea, possible vomiting. Impaired motor, memory, cognition and sensory function.
>140
30
>0.14%
Decreased blood flow to brain, slurred speech, double or blurry vision.
300
65
0.3%
Stupefaction, confusion, numbness, dizziness, loss of consciousness.
400
87
0.4%
Ethylic intoxication, drunkenness, inebriation, alcohol poisoning or possible death.
500
109
>0.55%
Unconsciousness, coma and death.
Recreational concentrations of ethanol are typically in the range of 1 to 50 mM.[194][27] Very low concentrations of 1 to 2 mM ethanol produce zero or undetectable effects except in alcohol-naive individuals.[194] Slightly higher levels of 5 to 10 mM, which are associated with light social drinking, produce measurable effects including changes in visual acuity, decreased anxiety, and modest behavioral disinhibition.[194] Further higher levels of 15 to 20 mM result in a degree of sedation and motor incoordination that is contraindicated with the operation of motor vehicles.[194] In jurisdictions in the U.S., maximum blood alcohol levels for legal driving are about 17 to 22 mM.[209][210] In the upper range of recreational ethanol concentrations of 20 to 50 mM, depression of the central nervous system is more marked, with effects including complete drunkenness, profound sedation, amnesia, emesis, hypnosis, and eventually unconsciousness.[194][209] Levels of ethanol above 50 mM are not typically experienced by normal individuals and hence are not usually physiologically relevant; however, such levels – ranging from 50 to 100 mM – may be experienced by alcoholics with high tolerance to ethanol.[194] Concentrations above this range, specifically in the range of 100 to 200 mM, would cause death in all people except alcoholics.[194]
List of known actions in the central nervous system
Ethanol has been reported to possess the following actions in functional assays at varying concentrations:[188]
Some of the actions of ethanol on ligand-gated ion channels, specifically the nicotinic acetylcholine receptors and the glycine receptor, are
dose-dependent, with potentiation or inhibition occurring dependent on ethanol concentration.[188] This seems to be because the effects of ethanol on these channels are a summation of positive and negative allosteric modulatory actions.[188]
Pharmacokinetics
Absorption
Ethanol can be
administeredorally, by
inhalation,
rectally, or by
injection (e.g.,
intravenous),[6][215] though it is typically ingested simply via oral administration.[4] The oral
bioavailability of ethanol is around 80% or more.[4][5] In fasting volunteers, blood levels of ethanol increase proportionally with the dose of ethanol administered.[215] Blood alcohol concentrations may be estimated by dividing the amount of ethanol ingested by the
body weight of the individual and correcting for water dilution.[6]
Onset
Peak circulating levels of ethanol are usually reached within a range of 30 to 90 minutes of ingestion, with an average of 45 to 60 minutes.[6][4] People who have fasted overnight have been found to reach peak ethanol concentrations more rapidly, at within 30 minutes of ingestion.[6]
The onset varies depends on the type of alcoholic drink:[216]
Also, carbonated alcoholic drinks seem to have a shorter onset compare to flat drinks in the same volume. One theory is that carbon dioxide in the bubbles somehow speeds the flow of alcohol into the intestines.[217]
Food in the
gastrointestinal system and hence
gastric emptying is the most important factor that influences the absorption of orally ingested ethanol.[6][215] The absorption of ethanol is much more rapid on an empty stomach than with a full one.[6] The delay in ethanol absorption caused by food is similar regardless of whether food is consumed just before, at the same time, or just after ingestion of ethanol.[6] The type of food, whether
fat,
carbohydrates, or
protein, also is of little importance.[215] Not only does food slow the absorption of ethanol, but it also reduces the bioavailability of ethanol, resulting in lower circulating concentrations.[6]
Approximately 90% of the
metabolism of ethanol occurs in the liver.[6][8] This occurs predominantly via the
enzymealcohol dehydrogenase, which transforms ethanol into its
metabolite acetaldehyde (ethanal).[6][8] Acetaldehyde is subsequently metabolized by the enzyme
aldehyde dehydrogenase into
acetate (ethanoate), which in turn is broken down into
carbon dioxide and
water.[6] Acetate also combines with
coenzyme A to form
acetyl-CoA, and hence may participate in
metabolic pathways.[4] Alcohol dehydrogenase and aldehyde dehydrogenase are present at their highest concentrations in the liver, but are widely expressed throughout the body, and alcohol dehydrogenase may also be present in the
stomach and
small intestine.[4] Aside from alcohol dehydrogenase, the
microsomal ethanol-oxidizing system (MEOS), specifically mediated by the
cytochrome P450 enzyme
CYP2E1, is the other major route of ethanol metabolism.[6][8] CYP2E1 is
inducible by ethanol, so while alcohol dehydrogenase handles acute or low concentrations of ethanol, MEOS is predominant with higher concentrations or with repeated/chronic use.[6][8] A small amount of ethanol undergoes
conjugation to form
ethyl glucuronide and
ethyl sulfate.[4] There may also be another
metabolic pathway that metabolizes as much as 25 to 35% of ethanol at typical concentrations.[5]
At even low physiological concentrations, ethanol completely saturates alcohol dehydrogenase.[6] This is because ethanol has high affinity for the enzyme and very high concentrations of ethanol occur when it is used as a recreational substance.[6] For this reason, the metabolism of ethanol follows
zero-order kinetics at typical physiological concentrations.[8] That is, ethanol does not have an
elimination half-life (i.e., is not metabolized at an exponential rate), and instead, is eliminated from the circulation at a constant rate.[8][7] The mean elimination rates for ethanol are 15 mg/dL per hour for men and 18 mg/dL per hour for women, with a range of 10 to 34 mg/dL per hour.[8][6] At very high concentrations, such as in overdose, it has been found that the rate of elimination of ethanol is increased.[5] In addition, ethanol metabolism follows
first-order kinetics at very high concentrations, with an elimination half-life of about 4 or 4.5 hours (which implies a clearance rate of approximately 6 L/hour/70 kg).[5][4] This seems to be because other processes, such as the MEOS/CYP2E1, also become involved in the metabolism of ethanol at higher concentrations.[4] However, the MEOS/CYP2E1 alone does not appear sufficient to fully explain the increase in ethanol metabolism rate.[5]
Some individuals have less effective forms of one or both of the metabolizing enzymes of ethanol, and can experience more marked symptoms from ethanol consumption than others.[218] However, those having acquired
alcohol tolerance have a greater quantity of these enzymes, and metabolize ethanol more rapidly.[218]
Elimination
Ethanol is mainly
eliminated from the body via metabolism into carbon dioxide and water.[6] Around 5 to 10% of ethanol that is ingested is eliminated unchanged in
urine,
breath, and
sweat.[4] Transdermal alcohol that diffuses through the skin as insensible perspiration or is exuded as sweat (sensible perspiration) can be detected using wearable sensor technology[219] such as SCRAM ankle bracelet[220] or the more discreet ION Wearable.[221] Ethanol or its metabolites may be detectable in urine for up to 96 hours (3–5 days) after ingestion.[4]
Ethanol is also known chemically as alcohol, ethyl alcohol, or drinking alcohol. It is a simple
alcohol with a
molecular formula of C2H6O and a
molecular weight of 46.0684 g/mol. The molecular formula of ethanol may also be written as CH3−CH2−OH or as C2H5−OH. The latter can also be thought of as an
ethyl group linked to a
hydroxyl (alcohol) group and can be abbreviated as EtOH. Ethanol is a
volatile,
flammable,
colorlessliquid with a slight characteristic
odor. Aside from its use as a psychoactive and recreational substance, ethanol is also commonly used as an
antiseptic and
disinfectant, a chemical and medicinal
solvent, and a
fuel.
Homebrewing is the
brewing of
beer or other alcoholic beverages on a small scale for personal, non-commercial purposes. Supplies, such as kits and fermentation tanks, can be purchased locally at specialty stores or online. Beer was brewed domestically for thousands of years before its commercial production, although its legality has varied according to local regulation. Homebrewing is closely related to the hobby of home distillation, the production of
alcoholic spirits for personal consumption; however home distillation is generally
more tightly regulated.
Although
methanol is not produced in toxic amounts by fermentation of sugars from grain starches,[222] it is a major occurrence in
fruit spirits.[223] However, in modern times, reducing methanol with the absorption of a
molecular sieve is a practical method for production.[224]
Ethanol has a variety of
analogues, many of which have similar actions and effects.
Methanol (methyl alcohol) and
isopropyl alcohol (also called
rubbing alcohol) are toxic alcohols, and thus unsafe for human consumption.[11] Methanol is the most toxic alcohol; the toxicity of isopropyl alcohol lies between that of ethanol and methanol, and is about twice that of ethanol.[225] In general, higher alcohols are less toxic.[225]n-Butanol is reported to produce similar effects to those of ethanol and relatively low toxicity (one-sixth of that of ethanol in one rat study).[226][227] However, its
vapors can produce
eye irritation and inhalation can cause
pulmonary edema.[225]Acetone (propanone) is a
ketone rather than an alcohol, and is reported to produce similar toxic effects; it can be extremely damaging to the
cornea.[225]
Ethchlorvynol is not compatible with intravenous injection like ethanol—serious injury (including the loss of limbs due to vascular injury) or death can occur when it is used in this manner.[229]
The recommended maximum intake (or safe limits) of alcohol varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The
World Health Organization published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health".[20]
According to a 2024
systematic review and
meta-analysis, even at 20 g/day (1 large beer), the risk of developing an alcohol use disorder (AUD) is nearly 3 times higher than non-drinkers, and the risk of dying from an AUD is about 2 times higher than non-drinkers.[230]
Ethanol is typically consumed as a recreational substance by mouth in the form of
alcoholic beverages such as
beer,
wine, and
spirits. It is commonly used in social settings due to its capacity to enhance sociability.
Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. Many students attending colleges, universities, and other higher education institutions
consume alcoholic beverages. However, there are often restrictions on alcohol sale and use, for instance a
minimum age for drinking and laws against public drinking and drinking and driving.[231] Alcohol has considerable societal and cultural significance and has important social roles in much of the world.
Drinking establishments, such as bars and
nightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Alcohol is related to various
societal problems, including
drunk driving, accidental
injuries,
sexual assaults,
domestic abuse, and
violent crime.[88] Alcohol remains illegal for sale and consumption in
a number of countries, mainly in the
Middle East.
According to the U.S. Department of Agriculture, based on
NHANES 2013–2014 surveys, women in the US ages 20 and up consume on average 6.8 grams/day and men consume on average 15.5 grams/day.[232]
Research on the societal benefits of alcohol is rare, but a 2017 study suggested there it was beneficial.[233] Alcohol is often used as a
social lubricant; it increases occurrences of
Duchenne smiling, talking, and
social bonding, even when participants are unaware of their alcohol consumption or lack thereof.[234] In a study of the UK, regular drinking was correlated with happiness, feeling that life was worthwhile, and life satisfaction. According to a causal
path analysis the cause was vice versa; alcohol consumption was not the cause, but rather that the
life satisfaction resulted in greater happiness and an inclination to visit pubs and develop a regular drinking venue. City centre bars were distinguished by their focus on maximizing alcohol sales. Community pubs had less variation in visible group sizes and longer, more focused conversations than those in city centre bars. Drinking regularly at a community pub led to higher trust in others and better networking with the
local community, compared to non-drinkers and city centre bar drinkers.[233]
The relationship between
alcohol and religion exhibits variations across cultures, geographical areas, and religious denominations. Some religions emphasize moderation and responsible use as a means of honoring the divine gift of life, while others impose outright bans on alcohol as a means of honoring the divine gift of life. Moreover, within the same religious tradition, there are many adherents that may interpret and practice their faith's teachings on alcohol in diverse ways. Hence, a wide range of factors, such as religious affiliation, levels of religiosity, cultural traditions, family influences, and peer networks, collectively influence the dynamics of this relationship.
The levels of alcohol use in spiritual context can be broken down into:
Symbolic use: In some
Christian denominations, the
sacramental wine is alcoholic, however, only a sip is taken, and it does not raise the
blood alcohol content, and other denominations are using nonalcoholic wine. See also
Libation.
Discourage consumption:
Hinduism does not have a central authority which is followed by all Hindus, though religious texts generally discourage the use or consumption of alcohol.
Recreational use:
Recreational drug use of alcohol in moderation to celebrate joy, is allowed in some religions.
Christian views on alcohol are varied. For example, in the mid-19th century, some
Protestant Christians moved from a position of allowing moderate use of alcohol (sometimes called moderationism) to either deciding that not imbibing was wisest in the present circumstances (abstentionism) or prohibiting all ordinary consumption of alcohol because it was believed to be a sin (prohibitionism).[236]
During the Jewish holiday of
Purim, Jews are obligated to drink (especially
Kosher wine) until their judgmental abilities become impaired according to the
Book of Esther.[237][238][239] However, Purim has more of a national than a religious character.
Alcohol consumption is fully legal and available in most countries of the world.[240] Home made alcoholic beverages with low alcohol content like wine, and beer is also legal in most countries, but distilling
moonshine outside of a registered distillery remains illegal in most of them.
In addition, there are regulations on alcohol sales and use in many countries throughout the world.[240] For instance, the majority of countries have a minimum
legal drinking age to purchase or consume alcoholic beverages, although there are often exceptions such as underage consumption of small amounts of alcohol with parental supervision. Also, some countries have bans on public intoxication.[240] Drinking while driving or intoxicated driving is frequently outlawed and it may be illegal to have an open container of alcohol or liquor bottle in an
automobile, bus or
aircraft.[240]
In Iran, consumption of alcohol (one glass) is punished by 80 lashes, but repeated offences may lead to death penalty, although rarely exercised. In 2012, two men were sentenced to death after a third offense in Khorasan.[244][245]
Alcohol product labelling could be considered as a component of a comprehensive
public health strategy to reduce alcohol-related harm. Adding health labels to alcohol containers is an important first step in raising awareness and has a longer-term utility in helping to establish a social understanding of the harmful use of alcohol.
A 2019 survey conducted by the
American Institute for Cancer Research (AICR) showed that only 45% of Americans were aware of the associated risk of cancer due to alcohol consumption, up from 39% in 2017.[248] The AICR believes that alcohol-related advertisements about the healthy
cardiovascular benefits of modest alcohol overshadow messages about the increased cancer risks.[248]
Drinking alcoholic beverages increase the risk for
breast cancer. Several studies indicate that the use of
marketing by the alcohol industry to associate their products with breast cancer awareness campaigns, known as
pinkwashing, is misleading and potentially harmful.[249][250][251][252]
The alcohol industries have marketed products directly to the LGBT+ community. In 2010, of the sampled parades that listed sponsors, 61% of the prides were sponsored by the alcohol industry.[253]
A
standard drink is a measure of alcohol consumption representing a fixed amount of pure ethanol, used in relation to recommendations about alcohol consumption and its relative risks to health. The size of a standard drink varies from 8g to 20g across countries, but 10g alcohol (12.7 millilitres) is used in the
World Health Organization (WHO)
Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example,[254] and has been adopted by more countries than any other amount.[255]
Sober curiosity is often defined as having the option to question or change one's drinking habits, for mental or physical health reasons.[258] It may be practised in many ways, ranging from complete abstinence to more thought about when and how much is consumed.[259]
Since the onset of the
COVID-19 pandemic, more people in Europe have reduced their alcohol consumption.[260]
The popular story dates the etymology of the term Dutch courage to English soldiers fighting in the
Anglo-Dutch Wars[261] (1652–1674) and perhaps as early as the
Thirty Years' War (1618–1648). One version states that
jenever (or Dutch gin) was used by English soldiers for its calming effects before battle, and for its purported warming properties on the body in cold weather. Another version has it that English soldiers noted the bravery-inducing effects of jenever on Dutch soldiers.[262][263]
The
Andrew Johnson alcoholism debate is the dispute, originally conducted amongst the general public, and now typically a question for historians, about whether or not
Andrew Johnson, the 17th president of the United States (1865–1869), drank to excess.
The
Bratt System was a system that was used in
Sweden (1919–1955) and similarly in
Finland (1944–1970) to control alcohol consumption, by
rationing of liquor. Every citizen allowed to consume alcohol was given a booklet called a motbok (viinakortti in Finland), in which a stamp was added each time a purchase was made at
Systembolaget (in Sweden) and
Alko (in Finland).[265] A similar system also existed in
Estonia between July 1, 1920 to December 31, 1925.[266] The stamps were based on the amount of alcohol bought. When a certain amount of alcohol had been bought, the owner of the booklet had to wait until next month to buy more.
The
rum ration (also called the tot) was a daily amount of
rum given to sailors on
Royal Navy ships. It was
abolished in 1970 after concerns that the intake of strong alcohol would lead to unsteady hands when working machinery.
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