Are you struggling with problems related to your alcohol use or even an alcohol addiction? Maybe you tried quitting on your own, but it just didn’t seem to work. You may go a few days or weeks without using. But, before you know it, an unexpected setback causes you to retreat to your old habits.

Or maybe you’re worried about a loved one. Has their alcohol use negatively affected your family? Do they say they don’t have a problem or make excuses for their behavior, but you can see how it is slowly destroying their life?

Alcohol is a powerful, addictive substance. Even worse, it is readily available in just about any grocery, convenience, or corner store. This makes something as simple as driving down the street a trigger for using alcohol.

Substance Overview: Alcohol

Legality

allowed for over 21s1

Cost

cheap2

Annual deaths

93,000

Side effects

liver disease, stroke, infertility, breast cancer, anxiety, brain damage

Also known as

Drink, sauce, booze, moonshine, hooch

What is Alcohol?

Alcohol (ethyl alcohol or ethanol) is a legal intoxicating substance that is widely consumed in various forms like beer, wine, and hard liquor. It is produced when yeast ferments sugars and starches in different foods, such as when the sugar in grapes is fermented to make wine. The fermented product can also be distilled to make various spirits like rum, brandy, gin, tequila, vodka, and whiskey.

The history of voluntary alcohol use dates back several thousand years. Human interest in alcohol has not waned in modern times. Drinking alcohol is an inherent part of socializing and celebrations in many cultures around the world.

Alcohol is technically classified as a depressant, 3 because it depresses (slows down) the Central Nervous System, including brain functioning and neural activity. While the initial effects during a drinking event may be stimulating (e.g., “loosening up”, reducing social inhibitions), later effects during a drinking event, especially a heavy one, may be more sedating (e.g., slowed thinking and reaction times, feeling sleepy). Drinking alcoholic beverages in limited quantities is largely considered safe. But the fact that alcohol is a socially acceptable intoxicant makes it particularly dangerous. Many people start drinking socially with controlled consumption of alcohol but progress over time to problematic drinking patterns and/or addiction, which may be referred to by experts as an “alcohol use disorder”.

What is Alcohol Use Disorder?

Alcohol use disorder is a chronic disorder that can affect people of all ages, genders, and ethnicities, from all walks of life. The most severe form of alcohol use disorder, referred to as “addiction” may involve physical dependence on alcohol, mental dependence on alcohol, and/or drinking to the point that alcohol consumption becomes compulsive.

Alcohol use disorders can lead to a variety of health problems. Individuals struggling with alcohol addiction may not be able to function normally without alcohol. Drinking can impact their personal life, relationships, school/work performance, and finances. Some people with alcohol use disorder perform illegal activities under the influence of alcohol and get into trouble with the law.

It is important to note that alcoholism is a disease, a complex disease. Alcohol makes people feel good and produces a “high” by increasing the production of endorphins, which are the brain’s natural pleasure and reward chemicals. Alcohol also affects important brain functions like decision making and impulse control. Continued excessive alcohol use can lead to changes in brain chemistry such that the person is unable to control their drinking. Heavy drinkers can develop a physical dependence on alcohol, leading to intense cravings and withdrawal symptoms when alcohol consumption is substantially reduced or stopped. 4

Warning Signs and Symptoms of An Alcohol Use Disorder

People who are addicted to alcohol may be in denial and unable accept they have a problem. In this case, it can fall on family members and friends to spot the warning signs of problematic alcohol use and/or addiction and get help. Listed below are the symptoms of alcohol use disorder. 5

  • The person is drinking more or longer than intended.
  • There is an inability to stop drinking despite the desire to quit.
  • The person is spending a lot of time either drinking or recovering from the effects of alcohol.
  • The person wants alcohol so badly that it’s all they can think about (cravings, urges to drink). 
  • Drinking is interfering with major obligations at work, school, or home.
  • The person continues to use alcohol despite having persistent or recurrent impacts on interpersonal relationships caused or worsened by the effects of alcohol.
  • The person has given up or reduced important social, occupational, or recreational activities because of alcohol use.
  • The person continues to use alcohol in situations in which it is physically hazardous (g., driving under the influence).
  • The person continues to drink despite negative health or psychological consequences.
  • Tolerance, which can show up as either:
    • Needing to drink much more than before to achieve intoxication or desired effect; or
      • Finding that the same number of drinks has much less effect than it once did.
    • Withdrawal, which can show up as either:
      • When the effects of alcohol are wearing off, having symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, a seizure, or sensing things that were not really there
    • Using alcohol (or a closely related substance, such as a benzodiazepine) in order to relieve or avoid withdrawal symptoms.

If a person has 2-3 of the above symptoms within the past 12 months, their alcohol use disorder is considered “mild”; 4-5 symptoms is “moderate”; and 6 or more symptoms is considered a “severe” alcohol use disorder.

Drinking Levels: How Much Alcohol Is Safe to Drink?

Drinking alcohol within limits is believed to be relatively safe, but it can quickly escalate to dangerous alcohol use and/or addiction. To drink responsibly, it’s important to be aware of what constitutes a standard drink, how much alcohol is in your drink, and how many drinks are too many.

The amount of liquid in your glass, can, or bottle does not tell you how much alcohol you’re consuming. Different alcoholic beverages have varying alcohol content, which is roughly as follows:6

  • Light beers: 4.2% alcohol
  • Regular beers: 5% alcohol
  • Malt liquors: 7% alcohol
  • Wine: 12% alcohol
  • Distilled spirits: 40% alcohol

In the United States, one standard alcoholic drink is roughly 14 grams of pure alcohol. In other words, if you drink a 1.5 fl. oz shot of whiskey, a 5 fl. oz glass of wine, or a 12 fl. oz bottle of regular beer, it counts as one drink. On the other hand, a 12 oz craft beer with a higher level of alcohol (e.g., 9%) may be equal to two standard drinks. Similarly, drinks like martinis or margaritas often have more than just one “shot” of liquor, and therefore count as more than one standard drink.

How many standard drinks can you safely consume on a daily or weekly basis without developing alcohol addiction? The U.S. Department of Health and Human Services says up to 2 drinks a day for men and 1 drink a day for women is considered moderate drinking.

According to the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration, heavy alcohol consumption is 5 or more drinks for men and 4 or more drinks for women on any given day.

Heavy episodic drinking, sometimes called “binge drinking” is drinking a large amount of alcohol in a short time. It is defined as drinking such that blood alcohol concentration (BAC) reaches a level of 0.08 g/dL. This usually happens after men consume 5 drinks and women consume 4 drinks over about 2 hours. Binge drinking on more than 4 days per month qualifies as heavy alcohol use.7 Heavy and binge drinking put a person at risk of developing alcohol addiction and alcohol use disorder.

Alcohol Use Disorders in the United States

Alcohol use disorders are a public health crisis in the United States and have been a problem for a long time. They affect people across age, gender, race, and socioeconomic status. The stereotypical picture of an alcoholic as a derelict homeless person who drinks to escape reality is not entirely true. An college student or high-functioning business executive who drinks to cope with stress are just as likely to have an alcohol use disorder.

The estimated cost of excessive alcohol use in the United States is nearly $250 billion per year. A large percentage of this is due to binge drinking. Most of these costs are on account of lost productivity at work, healthcare problems caused by excessive drinking, criminal justice and law enforcement expenses, and costs related to accidents and injuries caused by excessive alcohol use.

But there is more than just an economic burden from alcohol use in the US. The following paragraphs demonstrate the true scope of the consequences of heavy alcohol use and/or addiction.

Statistics on Alcohol Use and Addiction

Alcohol consumption levels and patterns in the United States offer a deep insight into the problem of alcohol addiction. Here are some interesting statistics on alcohol use and its consequences in the US.8 9

  • More than 86% of American adults have drank alcohol at some point in their lifetime.
  • Roughly 1 in 4 adults in the US reports binge drinking within the past month.
  • More than 14 million adults (age 18+) in the United States have alcohol use disorder. Roughly 400,000 adolescents (ages 12-17) have alcohol use disorder.
  • Less than 8% of people with alcohol addiction received treatment within the past year.
  • More than 10% of children in the United States live with a parent with alcohol problems.
  • According to the World Health Organization, alcohol contributes to more than 200 diseases and health conditions.
  • Alcohol is the third leading cause of preventable deaths in the USA. An estimated 93,000 people die from alcohol-related causes every year.

Why Do People Drink?

It is obvious from the previous section that heavy alcohol use and addiction can have dangerous, even fatal consequences. Despite the dangers of drinking, why do people continue to drink heavily? The motivation to consume alcohol can come from various factors, just a few of which are listed below.

  • Past experiences: A person’s prior experience with alcohol shapes the current expectations they have about alcohol and the value they place on drinking. For example, memories of a fun time with friends that involved alcohol use leads to beliefs that drinking produces a good time, which can in turn serve as a motivation to drink
  • Personality factors: Certain personality charac­teristics, such as sensation seeking or impulsivity have been linked to heavier drinking.
  • Life circumstances and coping: Some people drink alcohol as an escape from difficult life circumstances or to cope with stress and unpleasant emotions. This can be anything from a divorce to the death of a loved one, trauma, or loneliness.
  • Social norms: What is seen as common and/or acceptable in a community affect a person’s drinking. For instance, students tend to drink more on college campuses that have a strong drinking culture.
  • Environmental factors: A variety of outside factors influence a person’s motivation to drink. For example, heavy taxation on alcoholic beverages can make it less attractive for a person to drink. Evidence has shown that a 10% increase in taxes can lead to a 7% reduction in alcohol consumption.

It is often a combination of psychological and social factors that leads to the transition from occasional social alcohol consumption to problematic alcohol use and addiction.

How Long Does It Take to Develop An Alcohol Use Disorder?

Social drinking is largely considered harmless. Most people believe that as long as they drink responsibly, alcohol can’t do any harm. But what many people don’t realize is that an alcohol use disorder can develop relatively quickly. What starts as social alcohol consumption can rapidly transition into problematic alcohol use and/or addiction.

There is no specific timeline that can predict how long it will take for a person to develop an alcohol use disorder. It’s like asking how long it will take to drive from LA to San Francisco. It would depend on traffic, how fast the person drives, and how many times they stop along the way.

Similarly, the time it takes to develop an alcohol use disorder varies from person to person. You can reduce your risk by avoiding binge drinking, which is associated with a higher risk of developing alcohol addiction. Also, certain people are inherently at an increased risk of developing alcoholism and should be careful about using even small amounts of alcohol.

Causes and Risk Factors for Alcoholism

Many factors affect why some people never have any problems with alcohol while others spend years battling an alcohol use disorder. Different people have different reactions to alcohol, depending on age, gender, race, body weight, and several other factors. Also, some risk factors increase a person’s chance of developing an addiction to alcohol:

  • Alcohol use disorders run in families. People with family members who have struggled with alcohol use disorder are more likely to have similar problems.10
  • Drinking at a young age may predispose a person to develop alcohol use disorders later in life.
  • Men are more likely than women to develop alcohol use disorders, but women are more likely to suffer alcohol-related health complications. 11

Deaths from Alcohol

Every year around 93,000 deaths in the United States are caused by alcohol, with men accounting for 70% of this figure. 12

Top causes of death include:

• Alcoholic liver disease (18,000)

• Motor-vehicle traffic crashes (7,000)

• Non-alcoholic poisoning (12,000)

• Suicide (10,000)

• Homicide (5,000)

• Liver cirrhosis (10,000)

Health Effects of Alcohol

Alcohol has a negative effect on health, both in the short and long term. In the short term your decision making and reactions are impaired, making you more likely to crash your car, get into a fight or fall on the street. In the long term it increases the risk of cancer, stroke and other issues.

Short-term effects

• Increased risk of unplanned pregnancy and STDs

• Injuries and fatalities from falls, vehicle collisions and other types of accidents

• Exposure to violence, including homicide and sexual assaults

• Alcohol poisoning deaths in the case of very high blood alcohol levels

• Difficulty sleeping

Binge drinking is associated with increased risk of unintended pregnancy. 13 14 Binge drinkers are also more likely to engage in unplanned sex, which increases the risk of contracting HIV and other sexually transmitted diseases.

Binge drinkers experience increased risk of assault, getting into fights, and suffering physical injuries, making them more exposed to health complications in general.  Alcohol has been demonstrated to be a factor in fatal non-traffic accidents, such as homicides, accidental injuries and suicide. 15

Alcohol may increase the risk of stillbirths and miscarriages in pregnant women. Drinking during pregnancy can lead to fetal alcohol spectrum disorders (FASDs). These is no specific medical test used in diagnosing FASDs, and so doctors will look for a combination of distinctive facial features, below-average height and/or weight and central nervous system issues in deciding whether it may be present. Physical and mental issues for the child will vary in severity, and could include coordination issues, learning difficulties, attention difficulties, speech and language problems, vision and hearing impairment, poor sleeping as a child, and issues with the heart, bones and kidneys.16

Alcohol is also a contributing factor to road accidents, which is why most legislators around the world have introduced some forms of restriction on driving while under the influence. One study 17 in New Zealand found that young people who drink and drive had a 2.6 higher rates of active traffic accidents than those who did not.

Alcohol poisoning is a major cause of death in the United States. 18 Covering the 2010-2012 period, 2,221 annual deaths were attributed to alcohol poisoning, which is around 9 deaths per million. There are wide differences in alcohol poisoning numbers between states, with Alaska reporting nearly 10 times more than Alabama. Adjusting for age, the highest death rates was found in American Indians and Alaska Natives.  Men are overwhelmingly more likely to die from alcohol poisoning than women.

Long-term effects

• Liver damage

• Pancreatitis

• High blood pressure

• Weakening of the immune system

• Pneumonia

• Sepsis

• Chronic inflammation

• Stroke

• Heart failure

• Infertility

• Cancer

• Anxiety

• Brain damage

Heavy drinking weakens the immune system. 19 It leads to increased likelihood of pneumonia, sepsis and other immune-related issues. It also slows down tissue repair, and makes you more likely to experience complications from surgery.

There is an association between alcohol and chronic inflammation. 20 Alcohol causes LPS (lipopolysaccharide) translocation across the gut, and in fact people with alcohol-related liver disease have higher levels of circulating LPS. The body is able to detoxify LPS using complex multi-organ interactions, with the liver in particular playing an important role. Drinking makes the body much less able to do this job.

Alcoholic liver disease can develop in heavy drinkers. The liver is the place where ethanol is metabolized, and therefore it is no surprise it is exposed to the highest levels of tissue damage in those with alcohol use disorders. Excessive drinking causes lesions on the liver, which can include inflammation, an accumulation of fat, scar tissue development and remodeling of tissue. Beyond quitting drinking and liver transplants, there are few options available for treating the condition. 21

Alcohol is associated with increased risk for a broad range of cancers, including breast, liver, esophageal, pancreatic, colon and others. In the case of breast cancer, for example, there are more than 100 studies that have demonstrated a link between alcohol consumption and the disease. While we know alcohol plays a multifactorial role in developing cancers, the precise mechanisms are yet to be fully understood. 22

Pancreatitis occurs when the pancreas becomes inflamed. The pancreas plays an important role in the metabolism of alcohol, and a result can experience complications in those with alcohol issues. Alcoholic pancreatitis develops to a greater extent in heavier drinkers, however it is important to note that some heavy drinkers go without any identifiable symptoms of the condition. 23

Alcohol has been associated with increased blood pressure, which itself is associated with a wide range of health conditions. Researchers have proposed a number of possible methods by which this could happen, including alcohol causing imbalances in the central nervous system.  It has been established that alcohol has a larger effect on systolic versus diastolic blood pressure. 24

Alcohol consumption is associated with increased risk of stroke. One meta-analysis found that those who consume more than 60g of alcohol per day were more likely to experience a stroke, while on the contrary those with more moderate drinking patterns experienced reduced risk against both total and ischemic stroke.25

People with alcohol use disorders are exposed to the risk of developing asymptomatic alcoholic cardiomyopathy (ACM), following which it is common to see the signs and symptoms of heart failure emerging. Unless the patient responds with completely eliminating alcohol consumption, they will experience an almost 50% mortality rate within four years. 26

Chronic alcohol consumption is also linked to heart rhythm problems (heart arrhythmias), which encompasses the heart beating too fast, too slow or irregularly. Studies in particular point towards tachycardias (resting heart rate greater than 100 bpm) being a concern for heavy drinkers. There is also some evidence that heavy drinking increases the risk of sudden death by fatal arrhythmia. 27

Alcohol consumption is associated with brain damage. Studies have demonstrated that people with alcohol use disorders have smaller brain volume than those without alcohol use disorders, which is most severe in the frontal cortex. In fact, there is evidence to suggest that the neurodegeneration caused by excessive alcohol consumption can make you more impulsive and less able to resist the temptations presented by addiction.28

Alcohol use disorders and anxiety commonly present alongside each other. The question of how the two are linked is not yet fully understood, however a number of pathways have been proposed. It could be that the alcohol consumption causes anxiety, that those suffering from anxiety are drawn to alcohol in order to self-medicate or that a third unknown factor leads to the presentation of both. More research is required to understand the precise reasons behind the comorbidity.29 One specific anxiety disorder that has been linked to alcohol use disorders is posttraumatic stress disorder (PTSD).30

Alcohol is associated with fertility problems in both males and females. Men suffer from worsening semen quality as consumption of alcohol increases. In a study examining 100 males with alcohol use disorders, only 12% presented with normal semen parameters. Of the heavier drinkers in the group (those consuming 80g per day), none had normal semen parameters, which suggests a dose-response relationship. Women that take more than two drinks per day experience higher risk of infertility issues, and the effect is even more pronounced in older women. 31

Alcohol and Pregnancy

Pregnant women or women who are planning a pregnancy soon should avoid drinking alcohol. There is no safe drinking limit during pregnancy. Several medical conditions, such as fetal alcohol syndrome (FAS), have been directly linked to alcohol use during pregnancy. FAS is a condition in which babies exposed to alcohol during the mother’s pregnancy suffer growth problems and irreversible brain damage. Moderate alcohol consumption (1 drink per day) is not known to be harmful while breastfeeding (especially if waiting 2 hours after the 1 drink), but avoiding alcohol is the safest option for new mothers.

Women of childbearing age should refrain from behaviors such as binge drinking because it puts them at risk of unintended pregnancy due to risky sexual behaviors under the influence of alcohol.

Alcohol Poisoning or Overdose

Alcohol poisoning is a serious, sometimes fatal, consequence of heavy drinking. When a person consumes a large amount of alcohol quickly, alcohol and its metabolites (breakdown products) accumulate in the blood faster than the liver can get rid of them.32 This leads to major adverse effects on vital functions such as the gag reflex, breathing, heart rate, and body temperature. Alcohol poisoning is a medical emergency capable of causing coma and death. Symptoms of alcohol poisoning include:

  • Confusion
  • Seizures
  • Slow breathing
  • Vomiting
  • Bluish tinge to the skin
  • Reduced body temperature
  • Unconsciousness

If you suspect someone has suffered alcohol poisoning, call 911. Don’t leave the person unattended until help arrives. Try to keep them sitting up and awake to reduce risk of choking on vomit.

Alcohol Withdrawal Syndrome

When a person who is a heavy drinker abruptly stops drinking, either intentionally or unintentionally, they can suffer several symptoms which are collectively called alcohol withdrawal syndrome. Severe alcohol withdrawal syndrome frequently requires a hospital stay with intensive care to manage medical complications like seizures. The symptoms of alcohol withdrawal can start 1 to 3 days after the last drink and may include:33

  • Fast breathing and fast heart rate
  • High blood pressure
  • Dilated pupils
  • Elevated body temperature
  • Sweating
  • Nausea, vomiting, diarrhea
  • Tremors (shaking hands)
  • Seizures
  • Agitation, irritability, disorientation
  • Anxiety
  • Insomnia
  • Delusions, hallucinations, paranoia
  • Combativeness

The most severe form of alcohol withdrawal is called delirium tremens (DTs). Symptoms of DTs may include confusion, agitation, disorientation, hallucinations, sweating, fever, high blood pressure, and fast heart rate.

Because of the risk of severe alcohol withdrawal and delirium tremens, people who have a long history of heavy alcohol use and alcohol addiction should not attempt to quit cold turkey at home. Treatment at an alcohol rehab center and medically-supervised withdrawal are necessary to help alcoholics safely stop drinking.

Treatment Options for Alcoholism

Recovery from alcoholism is a lifelong commitment. There is no magic pill that can make the problem disappear overnight. Alcohol addiction treatment is a complex and challenging medical specialty. The good news is that help is available at centers staffed by clinical teams with extensive experience in helping people get sober or drink more moderately. Depending on a person’s specific symptoms and preferences, components of treatment for alcohol use disorders may include:

  • Detox (medically-supervised withdrawal from alcohol).
  • Medication management to reduce cravings and treat symptoms.
  • Inpatient or outpatient rehab with behavioral therapies for long-term recovery.
  • Alcoholics Anonymous and/or other support groups.
  • Sober communities to transition to daily life without alcohol.
  • Dual diagnosis addiction treatment for co-occurring mental health issues.

Worldwide, alcohol claims 3 million lives each year and is responsible for 13% of deaths in young adults. If you or someone you love is struggling with alcohol addiction, get help before it’s too late.

Alcoholism Hotlines

An alcohol hotline for addiction is a quick, easy way to get answers. Even if you are just seeking information for yourself or a loved one, these hotlines provide valuable information and resources to empower your choices.

Calling an Alcohol Help Phone Number

Many people are reluctant to call an alcohol help hotline. They may be embarrassed or even a little bit scared. After all, it takes courage to finally change.

By calling an alcohol helpline, you have an easy, noncommittal way to connect with knowledgeable professionals who understand the problems of those struggling with alcohol addiction. They won’t judge you or make you feel bad. Instead, they help you start a support network necessary for overcoming addiction.

Some people hesitate to call an alcohol hotline because they aren’t sure what to say. Even if you are just seeking advice, the person on the other end of the line can help guide the conversation. Here are some subjects typically covered during a call:

  • Questions about alcohol use and alcohol use disorders
  • Signs and symptoms you need to know
  • Advice on talking to your loved one about their issues
  • Types of treatment available
  • How to easily get access to the most appropriate treatment

Don’t wait until disaster strikes. An alcohol addiction hotline is your lifeline to finally stepping up to your struggles with addiction.

When to Call an Alcohol Hotline for Addiction?

Some people wait until disaster strikes. When alcohol use gets so out of control it destroys their career, family life, and causes health problems. While an alcohol helpline can be helpful in these situations, you shouldn’t wait this long to call. After all, isn’t it better to take care of a problem before it gets out of control?

Early interventions are just as, if not more, effective than waiting until someone hits “rock bottom”. An alcohol hotline can help you find the most appropriate treatment options based on your struggles or a loved one’s struggles.

Last updated: September 4, 2020

About the author

Dr. Jennifer Merrill
Dr. Jennifer Merrill

Dr. Jennifer Merrill is an Associate Professor in the Department of Behavioral and Social Sciences at Brown University. She received her PhD in 2012 from the University at Buffalo, and is a licensed clinical psychologist in Rhode Island (Credential ID: PS01479).

Dr. Merrill has published over 70 peer-reviewed articles in journals such as Psychology of Addictive Behaviors, Addictive Behaviors and Journal of Studies on Alcohol and Drugs. Her published work includes 'Drinking over the lifespan: Focus on college ages' and 'Event-level correlates of drinking events characterized by alcohol-induced blackouts'.

Medical Reviewer

Dr. Abe Malkin
Dr. Abe Malkin

Dr. Abe Malkin is the founder and medical director of Concierge MD LA, a provider of high-end medical care in Los Angeles. He graduated with a combined MD/MBA under a joint program from Tufts University School of Medicine and The Heller School for Social Policy and Management at Brandeis University.

Dr. Malkin is the medical director of Grace Recovery and 1 Method Center, and is a contracted physician for Avalon Malibu. He is also the founder and medical director of Elite Home Detox, a personalized addiction and recovery service. He completed his 3-year family residency for Kaiser Permanente in 2016, and is board certified in the state of California (license number: A 133110).

References

  1. Alcohol Policy. National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/alcohol-health/alcohol-policy. Published 2020. Accessed June 10, 2020.
  2. Olson S, Gerstein D. Alcohol In America. Washington, D.C.: National Academy Press; 1985.
  3. National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Alcohol. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20360/
  4. Becker HC. Alcohol dependence, withdrawal, and relapse. Alcohol Res Health. 2008;31(4):348-361.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  6. National Institute on Alcohol Abuse and Alcoholism. What is a Standard Drink? No date. Available online. https://www.niaaa.nih.gov/what-standard-drink
  7. National Institute on Alcohol Abuse and Alcoholism. Drinking Levels Defined. No date. Available online. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
  8. World Health Organization. United States of America. Alcohol Consumption: Levels and Patterns. No date. Available online. https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/usa.pdf?ua=1
  9. National Institute on Alcohol Abuse and Alcoholism. Alcohol Facts and Statistics. No date. Available online. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
  10. Edenberg HJ, Foroud T. Genetics and alcoholism. Nat Rev Gastroenterol Hepatol. 2013;10(8):487-494. doi:10.1038/nrgastro.2013.86
  11. Ceylan-Isik AF, McBride SM, Ren J. Sex difference in alcoholism: who is at a greater risk for development of alcoholic complication?. Life Sci. 2010;87(5-6):133-138. doi:10.1016/j.lfs.2010.06.002
  12. Report – Alcohol-Attributable Deaths, US, By Sex, Excessive Use. Nccd.cdc.gov. https://nccd.cdc.gov/DPH_ARDI/Default/Default.aspx. Published 2020. Accessed August 13, 2020.
  13. Naimi TS, Lipscomb LE, Brewer RD, Gilbert BC. Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children. Pediatrics. 2003;111(5 Pt 2):1136‐1141.
  14. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college. A national survey of students at 140 campuses. JAMA. 1994;272(21):1672‐1677.
  15. Smith GS, Branas CC, Miller TR. Fatal nontraffic injuries involving alcohol: A metaanalysis. Ann Emerg Med. 1999;33(6):659‐668.
  16. Wilhoit LF, Scott DA, Simecka BA. Fetal Alcohol Spectrum Disorders: Characteristics, Complications, and Treatment. Community Ment Health J. 2017;53(6):711‐718. doi:10.1007/s10597-017-0104-0
  17. Horwood LJ, Fergusson DM. Drink driving and traffic accidents in young people. Accid Anal Prev. 2000;32(6):805‐814. doi:10.1016/s0001-4575(00)00005-1
  18. 5. Kanny D, Brewer, MD R, B. Mesnick, MPH J, Paulozzi, MD L, Naimi, MD T, MS H. Vital Signs: Alcohol Poisoning Deaths — United States, 2010–2012. Cdc.gov. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6353a2.htm?s_cid=mm6353a2_w. Published 2015. Accessed June 11, 2020.
  19. Sarkar D, Jung MK, Wang HJ. Alcohol and the Immune System. Alcohol Res. 2015;37(2):153‐155.
  20. Wang HJ, Zakhari S, Jung MK. Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development. World J Gastroenterol. 2010;16(11):1304‐1313. doi:10.3748/wjg.v16.i11.1304.
  21. Osna NA, Donohue TM Jr, Kharbanda KK. Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res. 2017;38(2):147-161.
  22. Ratna A, Mandrekar P. Alcohol and Cancer: Mechanisms and Therapies. Biomolecules. 2017;7(3):61. Published 2017 Aug 14. doi:10.3390/biom7030061
  23. Apte MV, Pirola RC, Wilson JS. Mechanisms of alcoholic pancreatitis. J Gastroenterol Hepatol. 2010;25(12):1816-1826. doi:10.1111/j.1440-1746.2010.06445.x
  24. Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: Mechanism and prevention. World J Cardiol. 2014;6(5):245-252. doi:10.4330/wjc.v6.i5.245
  25. Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis [published correction appears in JAMA. 2003 Jun 4;289(21):2798. Lewis, Brian L [corrected to Lewis, Brian]]. JAMA. 2003;289(5):579-588. doi:10.1001/jama.289.5.579
  26. Laonigro I, Correale M, Di Biase M, Altomare E. Alcohol abuse and heart failure. Eur J Heart Fail. 2009;11(5):453-462. doi:10.1093/eurjhf/hfp037
  27. Kupari M, Koskinen P. Alcohol, cardiac arrhythmias and sudden death. Novartis Found Symp. 1998;216:68-85. doi:10.1002/9780470515549.ch6
  28. Crews FT, Vetreno RP. Neuroimmune basis of alcoholic brain damage. Int Rev Neurobiol. 2014;118:315-357. doi:10.1016/B978-0-12-801284-0.00010-5
  29. Smith JP, Randall CL. Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Res. 2012;34(4):414-431.
  30. Neupane SP, Bramness JG, Lien L. Comorbid post-traumatic stress disorder in alcohol use disorder: relationships to demography, drinking and neuroimmune profile. BMC Psychiatry. 2017;17(1):312. Published 2017 Aug 29. doi:10.1186/s12888-017-1479-8
  31. Gude D. Alcohol and fertility. J Hum Reprod Sci. 2012;5(2):226-228. doi:10.4103/0974-1208.101030
  32. Jung YC, Namkoong K. Alcohol: intoxication and poisoning – diagnosis and treatment. Handb Clin Neurol. 2014;125:115-121. doi:10.1016/B978-0-444-62619-6.00007-0
  33. Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben‐Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A.and Ludolph, A. C. (2017), Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135: 4– 16. doi: 1111/ane.12671