I. The Basics

The Definition of Moderate Alcohol Use

Moderate use of alcohol is not generally considered dangerous and may have some health benefits. “Moderate Drinking” is defined by the U.S. Department of Agriculture (USDA) as no more than one drink per day for women, and no more than two drinks per day for men. A “drink” is defined by the USDA as:

  • 12 fluid ounces of regular beer
  • 5 fluid ounces of wine
  • 1.5 fluid ounces of 80-proof distilled spirits

Some people in should avoid alcohol altogether:

  • Those who are pregnant or trying to become pregnant
  • Those who have been diagnosed with alcoholism or alcohol abuse
  • Those who have a family history of alcoholism
  • Those who have liver or pancreatic disease
  • Those who have a weak heart or have experienced heart failure
  • Those who take prescription or over-the-counter medications that can interact with alcohol
  • Those who have had a hemorrhagic stroke (when a blood vessel in your brain leaks or ruptures)

Key Facts About Alcohol Abuse

While moderate use of alcohol can be beneficial for some, alcohol abuse:

  • Leads to Medical Problems: Chronic alcohol abuse over a period of several years can result in a number of medical problems, especially liver cirrhosis. In 2015, there were over 36,000 deaths from liver disease related to chronic alcohol abuse.
  • Results in Traffic Fatalities: Impaired drivers were involved in 31% of all traffic fatalities in 2014.
  • Is a “Gateway Drug” for Teens: A 2016 study concludes that alcohol use among teens leads them to the consumption of other illegal and potentially dangerous drugs.
  • Costs the U.S. $249 Billion: According to a 2016 study published by the CDC, excessive alcohol usage in the U.S. in 2010 had a total economic impact of $249 billion – that equates to a cost of $807 for every person in the country.

II. Statistics on Alcohol Use

Note: The terms “binge drinking,” “heavy alcohol use,” and “AUD” will be used below. The NIAAA defines binge drinking as about four drinks for women at a time, and five drinks for men. SAMHSA defines heavy alcohol use as binge drinking five or more times in the past month. AUD refers to an Alcohol Use Disorder, commonly known as alcoholism. See the section below titled “Defining Alcohol Use Disorder” for more information. </span

Alcohol Use Among Adults

The 2015 National Survey on Drug Use and Health (NSDUH) reports that:

  • 70.1% of adults said they drank alcohol in the past year
  • 56.0% reported that they drank in the past month.
  • 26.9% of respondents 18 or older admitted they had engaged in binge drinking in the past month
  • 7% reported they engaged in heavy alcohol use in the past month
  • 6% have an Alcohol Use Disorder (AUD)

Alcohol Use Among Youth

Data from the 2015 NSDUH suggests that:

  • Close to 5.1 million people (13.4%) aged 12-20 binge drink at least once a month
  • About 1.3 million respondents (3.3%) aged 12–20 admitted to heavy alcohol use in the past month

Alcohol Use Among College Students

The 2015 NSDUH reports that:

  • 20% of college students ages 18-22 meet the criteria for Alcohol Use Disorder (AUD)
  • 38% of college students ages 18-22 reported binge drinking in the last month
  • 12.5% of college students ages 18-22 admitted to heavy alcohol use in the past month

The consequences of alcohol abuse among college students are severe:

  • At least 1,825 college students between 18 and 24 die each year from alcohol-related unintentional injuries, notably including motor-vehicle crashes
  • At least 696,000 students between 18 and 24 are assaulted by another student who has been drinking every year
  • At least 97,000 students between 18 and 24 report experiencing alcohol-related sexual assault or date rape every year

Alcohol Use Among Pregnant Women

A 2009 study conducted by the University of New Mexico estimates that the prevalence of Fetal Alcohol Syndrome ranges from 2 to 7 cases per 1,000 pregnancies, and the rate of Fetal Alcohol Spectrum Disorders (FASD) ranges from 20 to 50 cases per 1,000.

III. Alcohol Addiction (Alcoholism)

Becoming Addicted to Alcohol

Much like other drugs, alcohol addiction is caused by a combination of the brain’s capability of rerouting it’s reward pathways, and the brain’s ability to develop tolerances.

Drinking alcohol floods the brain with opioid peptides and dopamine, causing euphoria

When someone drinks alcohol, a sense of euphoria (or “buzz”) sets in. The feelings of pleasure associated with drinking alcohol naturally teach the brain to desire more alcohol, reinforcing what the brain’s reward center thinks is a positive activity.

Alcohol inhibits a person’s ability to make decisions

The part of the brain that control decision making is inhibited by the use of alcohol, so people who drink find it harder and harder to quit drinking, even though they may know that it’s not a good choice, and it will lead to negative consequences later (such as a hangover). Since the brain’s reward center is creating a desire to drink and drinking inhibits the ability to make wise decisions, a couple of drinks can quickly turn into a binge-drinking session.

The brain develops a tolerance to alcohol, which often leads to dependence

When a person drinks frequently and heavily, a natural tolerance is often built up, so a greater amount of alcohol is required to obtain the same sense of euphoria. Eventually, the body becomes chemically dependent on alcohol, meaning that many people need to drink just to feel “normal.”

Dependence on alcohol often results in a continuing cycle of addiction

The more alcohol a person uses, the more they require to feel the same sense of pleasure, and the more dependent the body gets on the substance. This cycle of dependency is referred to as an Alcohol Use Disorder (AUD).

Diagnosing Alcohol Use Disorders

The DSM-5 (the most recent version of the Diagnostic and Statistical Manual of Mental Disorders) documents 11 criteria that are used to determine whether someone has an AUD and the severity of the disorder. If an individual meets any two of the criteria during a 12-month period, that person can be diagnosed with an AUD. The criteria below are taken directly from the NIAAA’s website. In the last 12 months, have you:

  • Had times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects?
  • Experienced craving — a strong need, or urge, to drink?
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

The severity of an AUD is officially diagnosed based on the number of questions you answered “yes” to:

  • Mild: If 2-3 of the criteria described you
  • Moderate: If 4-5 of the criteria described you
  • Severe: If 6 or more of the criteria described you

Professional assessments are necessary for a concrete diagnosis

Based on the criteria above, if you have any reason to be concerned about your alcohol-use behavior, contact an addiction specialist to schedule a professional assessment. For more on assessments and how to get help for alcohol addiction, read our guide to Alcohol Rehab.

IV. Alcohol Effects and Dangers

Alcohol is a toxic compound that causes inebriation. While the initial effects are often pleasant, there are many serious consequences that range from overdosing (which can result in death) to long-term medical complications such as liver failure.

Dangers of Alcohol Use

Alcohol poisoning can result in death

The CDC estimates that there are 2,200 deaths from alcohol poisoning every year – on average, six people die everyday from drinking too much alcohol. Alcohol poisoning happens when a person’s bloodstream is so flooded with alcohol that the portions of the brain that control life-supporting functions like breathing and heart rate start to shut down. Critical symptoms of alcohol poisoning include:

  • Mental confusion
  • Vomiting
  • Slow Breathing (less than eight breaths per minute)
  • Irregular breathing (10 seconds or more between breaths)
  • Low body temperature (hypothermia), pale or bluish skin color
  • Seizures
  • Passing out, unconsciousness, can’t be awakened

If you suspect that someone has alcohol poisoning, the Mayo Clinic recommends the following steps:

  • Call 911: Even if the victim doesn’t exhibit all the symptoms above, call for help from your local emergency services immediately.
  • Provide Critical Information: Be prepared to provide as much information as possible about how much the patient drank and when.
  • Don’t Leave Someone Who Is Unconscious Unattended: The person’s gag reflex may be impaired which mean they could choke and die from their own vomit.
  • Prevent Choking: Help a person who is vomiting by sitting them up if they are able, or turning their head to the side if they must lay down.
  • Keep Victims Awake: Do your best to keep him or her awake to prevent unconsciousness.

Impairment from binge drinking can result in injury or death

While the impairment of motor control is a serious side-effect of drinking, the real danger is the impairment of your decision-making ability. Not only are your balance, reflexes, and concentration impaired, you also may not realize the extent of your inebriation and make bad decisions, such as choosing to operate a motor vehicle. The combination of these two factors means that drinking heavily results in a higher chance of:

  • Injuries from motor vehicle crashes, falls, drownings, and burns
  • Involvement in violence, such as homicide, suicide, sexual assault, and domestic violence
  • Dangerous sexual behaviors, such as unprotected sex or sex with multiple partners, which can lead to unintended pregnancy or sexually transmitted diseases (STDs)

Alcohol abuse leads to a variety of serious medical problems

Alcohol abuse has both short- and long-term negative consequences on your health. The “hangover” you typically have the next day after binging on alcohol relates to both dehydration and depletion of key vitamins and minerals from your system. Binge drinking puts a notable stress on your liver, pancreas and other organs. According to the CDC and the NIAAA, health-related consequences of heavy drinking and long-term alcohol abuse include:

  • Suppressed immune function for up to 24 hours after a heavy drinking episode
  • High blood pressure, heart disease, stroke, liver disease, and stomach and digestive problems
  • Cancer of the breast, mouth, throat, esophagus, liver, and colon
  • Anemia related to a low red blood cell count
  • A variety of learning and memory problems, in particular, early dementia and poor academic performance (chronic alcohol abuse can actually cause shrinkage of some areas of the brain)
  • A range of mental health problems, including depression and anxiety
  • Social problems, especially low productivity, family and personal problems, and unemployment

Combining Alcohol with Drugs and Medicines

Alcohol is especially dangerous when combined with illicit drugs, prescription medications, or even common medicines – even when they aren’t taken simultaneously. As long as alcohol is still in your blood stream it can still interact with other substances.

Alcohol stays in your system for up to 24 hours

Alcohol stays in your bloodstream until it is broken down by the liver. Since the symptoms of intoxication generally peak 40 to 60 minutes after you drink, alcohol may still be in your system after you quit feeling “drunk.”

How much alcohol is consumed determines how long alcohol will remain in your system. The higher your blood alcohol levels, the longer it will take for alcohol to be completely removed from your system. Alcohol can stay in your system anywhere from 2 to 24 hours, with blood alcohol levels decreasing gradually during that timeframe.

Taking alcohol and medicine together can result in unintended side-effects

While many medicines have warning labels that instruct users not to mix them with alcohol, it’s always best to consult your doctor or a pharmacist before mixing alcohol with medicines. For a full list of common ingredients that interact with alcohol, read the NIAAA’s publication on the topic. Additionally, there are special factors to take into account:

  • Medicines may have several different ingredients that interact with alcohol
  • Women are more sensitive to the effects of alcohol interacting with medicine than men
  • Older people’s bodies break down alcohol more slowly, and they are more likely to take medications that interact with alcohol

Using alcohol and prescription or illicit drugs together can have fatal results

Whether you are unaware of the interactions between alcohol and prescriptions drugs you are taking, you are attempting to get a “better high,” or you are a victim of someone attempting to commit a crime (such as sexual assault or robbery), the consequences of combining drugs and alcohol include potentially fatal overdoses, and other medical problems.

  • Depressants Have a Synergistic Effect: When taking substances like Xanax of Valium with alcohol, dangerous levels of intoxication can happen unexpectedly and more quickly than if each substance was taken independently. Side effects that rapidly occur include dizziness, memory loss, and even death.
  • Stimulants Conceal Alcohol’s Effects: Stimulants counteract the symptoms of alcohol intoxication, but the alcohol content in the bloodstream remains unchanged. This means that people using alcohol with substances like Adderall, methamphetamine, or cocaine aren’t aware of their level of intoxication and can quickly experience alcohol poisoning without the usual symptoms that warn the user to quit drinking.
  • Opioids Enhance Alcohol Sedative Effects: Much like depressants, opioids enhance the sedative effects of alcohol. Using substances like heroin or anything with hydrocodone (Vicodin, Percocet) in conjunction with alcohol can have serious consequences such as slowed breathing, unconsciousness, or death.

Withdrawal from Alcohol

Alcohol withdrawal is not a danger for most people

Withdrawal is what happens when a person’s body becomes dependent on a substance, and that substance is suddenly removed. For most people, withdrawal symptoms are only moderate or mild and disappear within 2-7 days of the last drink, not requiring medical attention. However, the symptoms are still unpleasant and can be complicated by other addictions or medical problems. According to the U.S. National Library of Medicine, common symptoms include:

  • Anxiety or nervousness
  • Depression
  • Fatigue
  • Irritability
  • Jumpiness or shakiness
  • Mood swings
  • Nightmares
  • Not thinking clearly

Additionally, less common symptoms that sometimes occur are:

  • Sweating, clammy skin
  • Enlarged (dilated) pupils
  • Headaches
  • Insomnia (sleeping difficulty)
  • Loss of appetite
  • Nausea and vomiting
  • Pallor
  • Rapid heart rate
  • Tremor of the hands or other body parts

Delirium tremens is not common, but it is potentially fatal

A serious form of alcohol withdrawal, delirium tremens (DT) occurs in 5-10% of cases involving alcohol withdrawal and have fatal results in 15% of untreated cases, 1% of treated cases, and 20% of treated cases when patients have other medical complications. According to the U.S. National Library of Medicine, DT involves “sudden and severe mental or nervous system changes” and is most common for those who have previously experienced alcohol withdrawal. Other factors impacting the prevalence of DT include the amount of alcohol regularly consumed, whether the person has used alcohol heavily for more than 10 years, and whether the person has a head injury, infection, or illness when they stop drinking. The U.S. National Library of Medicine states that the common symptoms of DT include:

  • Delirium, which is sudden severe confusion
  • Body tremors
  • Changes in mental function
  • Agitation, irritability
  • Deep sleep that lasts for a day or longer
  • Excitement or fear
  • Hallucinations (seeing or feeling things that are not really there)
  • Bursts of energy
  • Quick mood changes
  • Restlessness, excitement
  • Sensitivity to light, sound, touch
  • Stupor, sleepiness, fatigue
  • Seizures

Additionally, the typical symptoms of alcohol withdrawal (as listed above) may also occur with DT cases.

Those at risk of DT shouldn’t attempt to detox from alcohol on their own

If you have a history of alcohol withdrawal, or you have been drinking heavily for a long period of time, you should contact your doctor or another medical professional before attempting to detox from alcohol. It’s especially important for those with a history of medical problems to be carefully monitored during the detox process.

For more information on treatment options and detox, read our guide on alcohol rehab

Alcohol’s Withdrawal Symptoms
Common Withdrawal Symptoms
  • Fatigue
  • Jumpiness
  • Shakiness
  • Depression
  • Anxiety
  • Nervousness
  • Irritability
  • Mood swings
  • Nightmares
  • Not thinking clearly
Less-Common Withdrawal Symptoms
  • Sweating, clammy skin
  • Enlarged (dilated) pupils
  • Headaches
  • Insomnia
  • Loss of appetite
  • Nausea and vomiting
  • Pallor
  • Rapid heart rate
  • Tremor of the hands or other body parts
Delirium Tremens (DT) Symptoms
  • Body tremors
  • Deep sleep that lasts for a day or longer
  • Bursts of energy
  • Sensitivity to light, sound, touch
  • Stupor, sleepiness, fatigue
  • Seizures
  • Delirium (sudden severe confusion)
  • Changes in mental function
  • Agitation, irritability
  • Excitement or fear
  • Hallucinations
  • Quick mood changes
  • Restlessness, excitement

Effects on Pregnant Women and the Fetus

Alcohol is particularly harmful to a growing human fetus, so pregnant women should avoid all alcohol consumption. The CDC emphasizes that no amount of alcohol use is “safe” during any point of the pregnancy – alcohol can even harm a baby before the mother knows she is pregnant. That’s why the CDC recommends that women who are sexually active and don’t use effective birth control shouldn’t drink.

Any alcohol in the mother’s blood is passed directly to the growing baby through the umbilical cord. Consuming alcohol during pregnancy notably increases the odds of miscarriage, stillbirth, and other permanent physical, behavioral, and intellectual disabilities. These congenital disabilities are generally described as fetal alcohol spectrum disorders (FASDs).

According to the U.S. National Library of Medicine, babies with FASD suffer problems that last a lifetime, including:

  • Learning and remembering
  • Understanding and following directions
  • Controlling emotions
  • Communicating and socializing
  • Daily life skills, such as feeding and bathing

V. Current Research About Alcohol Addiction

Current Research

A Japanese asthma medication may reduce cravings for alcohol

An anti-inflammatory drug named Ibudilast, originally marketed in Japan to treat asthma, has shown great promise in reducing patients’ desire for alcohol. In a recent clinical trial, UCLA researchers found that Ibudilast could help people overcome alcohol addiction. The results showed that craving for alcohol was significantly lower among the trial participants when they were taking the medication.

Controversial Research

Moderate alcohol consumption may lead to brain damage

Moderate drinking has been long thought to have health benefits, but a 2017 study published in the BMJ found that moderate drinkers (about one glass of wine an evening) were three times as likely suffer adverse brain outcomes including hippocampal atrophy – a form of brain damage that is associated with memory-loss conditions like Alzheimer’s and dementia.

Medication-based treatment models may be more effective than traditional methods

A growing body of research suggests current addictive drug and alcohol treatment models are of limited value, and that specialized medication-based treatments may be more effective. Dr. Domenic Ciraulo, Psychiatrist-in-Chief at the Boston Medical Center, is a major proponent of these new treatment methods. Ciraulo argues that adding long-term drug therapy to alcohol treatment offers a number of important benefits compared to traditional 12-step based programs that don’t include medication.

VI. How to Get Help for Alcohol Addiction

Alcoholism is a treatable disease, and even the most severe cases of alcohol addiction can be successfully treated. You can learn more about alcohol rehab programs and how to find a treatment facility near you in our guide to alcohol rehab.

Additionally, if you or a loved one are struggling with mental health issues in addition to substance addiction, read our guide to dual-diagnosis rehabs.