# Alcohol consumption

Drinking alcohol at a party

Alcohol consumption is the drinking of alcoholic beverages , commonly known as alcohol , for pleasure or intoxication purposes , whereby the euphoric effect of alcohol is exploited. This can also be a traditional part of social customs and traditions. In almost all regions of the world, alcohol consumption is associated with rituals or ceremonies. Alcohol consumption often serves, at least if it is not a question of alcohol abuse , to consolidate or establish social contacts in the area of ​​family, friends and neighborhood celebrations as well as other festive occasions or is part of custom .

Alcohol consumption causes increased blood alcohol levels . Heavy alcohol consumption leads to a condition known as drunkenness . Excessive consumption can lead to alcohol poisoning and even death. The minimum age from which alcohol can be purchased and consumed is regulated by law in most countries.

Due to the cytotoxic and neurotoxic effects of the substance, alcohol consumption is generally considered to be harmful to health, the more so, the greater the amount consumed. Even consciously careful consumption can cause considerable damage, including cancer , liver cirrhosis or brain damage. Ethanol in beverages is classified as a carcinogen by the International Agency for Research on Cancer . Regular alcohol consumption can be addictive . According to a study by the World Health Organization , more than 3.3 million people died in 2012 as a result of alcohol consumption.

Legal consequences are possible in road, ship or air traffic due to driving under the influence of psychoactive substances if a vehicle is driven despite alcohol consumption. The consumption of foods with a low alcohol content, such as sweets , fruit juices or kefir , is generally not included in the term alcohol consumption.

## history

Alcoholic beverages such as B. Beers , and later also wines , were made with the help of wild yeast in prehistoric times . Most of these drinks had a significantly lower alcohol content than they do today, as the wild yeasts stop converting sugar into alcohol above a certain alcohol concentration, because otherwise they would poison themselves. Already the oldest known writings of mankind deal with alcohol consumption. The Epic of Gilgamesh describes how the prehistoric man Enkidu had to drink seven mugs of beer in the transition from wilderness to civilization, which put him in euphoria and at the same time turned him into a man. Around the year 1720 BC, the Codex Hammurapi laid down the oldest traditional beer dispensing order. Already at this time alcohol was drunk because of its intoxicating effect. An Egyptian text about the behavior of young men says:

“You leave the books and go from pub to pub; the enjoyment of beer every evening, the smell of beer drives people away from you. "

Alcohol, for example in the form of beer , was sacrificed to the gods by the Egyptians and used as a grave supplement. In ancient times , alcohol consumption became an essential moment in Roman and Greek culture. Both cultures gave him his own deity, Bacchus in Roman and Dionysus in Greek , the gods of wine and intoxication. The same goes for the Teutons : They saw mead , one of the earliest alcoholic beverages, as a gift from the gods.

Presumably in the area of ​​today's Turkey around 1000 AD, the distillation of wine for the production of high-proof brandy was developed. Only Paracelsus used spirit vin, alcool vini vini or alcohol in today's narrower sense as a term for "spirit" or "essence of wine". In East Asia, wines were made from lychee and plums as well as sake , a warm rice wine, whose production process is similar to that of beer.

Oat beer , called Cervisa or Cerevisia , was consumed every day in monasteries in the Middle Ages. It was drunk throughout the day, especially at nine o'clock as Cerevisia nonalis in memory of Christ's thirst in the ninth hour of the crucifixion, as well as during Lent , as this was not considered breaking the fast. The maximum daily consumption was a limit of around five liters per monk. In a cellar arrangement dating from 1648, Ernst the Pious restricted the consumption of countess and aristocratic women to four liters of beer and in the evening to three liters of beer for serving.

In the middle of the 18th century, with the discovery of the New World, the arable area of ​​the Kingdom of England increased many times over. As a result, this led to falling grain prices and the associated impoverishment of the lower class. The overproduction of grain was partly used to produce gin , which found buyers in the poor areas of the mother country. At times, a calorie of gin cost less than a calorie of bread. As a result, the increased alcohol consumption developed into the gin crisis , which the government at the time was only able to end through a series of laws such as high taxes on gin, making it difficult to trade and issuing licenses for traders. The first writings dealing with alcohol addiction and its secondary diseases can be found from this period. Against this background, alcohol consumption was also understood for the first time as a cause of social problems and undesirable developments.

While alcohol consumption fell again in the mid-19th century, industrialization began again in a time when cheaper alcohol was accessible to impoverished sections of the population. Industrial production and the massive marketing of alcoholic beverages, which began especially after the Second World War , led to a large oversupply. Women and young people became new target groups for promoting demand and sales. Alcohol-related damage is now one of the diseases of civilization .

### Recent decline in alcohol consumption

From the 1980s to the 2010s, alcohol consumption in Germany fell significantly.

Consumption of pure alcohol per inhabitant aged 15 and over in liters
1970 1980 1990 2000 2010 2012 2014 2016
14.4 15.1 13.4 12.0 10.7 11.0 10.6 10.6
Source: DHS : Alcohol

### Declining alcohol consumption among children and adolescents

This downward trend is also very pronounced among young people aged 16 to 25. In the 1970s, well over half of the under 18-year-olds drank alcohol regularly (i.e. at least once a week), today this is not even a quarter. Among adult young people up to 25 years of age, the number fell from two thirds to below a third. This is even more evident in children and adolescents under the age of 16, here only 3% drink alcohol regularly, previously it was 10–15%.

Distribution of regular alcohol consumption by age group (in percent)
1973 1976 1979 1982 1986 1989 1993 1997 2001 2004 2005 2007 2008 2010 2011 2012 2014 2015 2016
12 to 15 year olds - - 12.7 10.5 15.2 7.8 6.3 6.8 8.7 10.4 8.0 9.8 6.4 5.8 5.6 4.3 4.7 2.6 3.2
16 and 17 year olds 59.4 56.8 50.6 39.1 44.6 42.1 39.2 28.3 36.3 43.7 39.5 42.8 36.0 25.9 30.8 31.9 26.2 24.1 22.6
18 to 25 year olds 67.1 70.0 65.9 58.6 55.0 54.2 50.7 44.9 39.8 43.6 40.5 - 37.1 34.5 39.8 38.4 35.5 33.6 30.7
Source: BZgA : Alcohol Survey 2016, Table 13

As a result, the BZgA's study “The Alcohol Consumption of Adolescents and Young Adults in Germany” comes to the conclusion that “more and more 12 to 15 year-olds are giving up alcohol. In addition, the riskier forms of alcohol consumption in this age group are also on the decline. [...] Since 2011, young people aged 16 and 17 have been giving up alcohol more and more often. "

## Social and cultural aspects

Alcohol consumption takes place as alcohol enjoyment for rest and relaxation, to suppress unpleasant memories or to increase well-being. In this role, alcohol consumption was also widely recognized in literature, for example by Friedrich Schiller :

"Drink it up, the Labe's drink,
and forget the great pain!
Balm for the torn heart,
Bacchus' gift is wonderful . "

- Schiller : The Victory Festival , 1804

Alcohol consumption has always been part of festive activities such as the ancient Saturnalia and the Bacchanalia , the Cologne Carnival , the Carnival in Rio or Mardi Gras in New Orleans , private celebrations or anniversaries. The type of alcoholic drink consumed is often shaped by the occasion, although there are great cultural differences. In Europe, champagne is often associated with a special celebration, wine is drunk with food and beer is seen as a suitable drink for informal, relaxation-oriented occasions.

Alcohol consumption often occurs in groups of socially equal people or among people of the same age. It serves to establish social contacts, for example the ritualized transition from drinking to speaking under the influence of alcohol in the form of brotherhood drinking . This is based on the assumption that "drinking together [...] can connect and commit".

## Average consumption

Worldwide per capita alcohol consumption in 2005 by people over the age of 15, in liters of pure alcohol

Alcohol consumption is legal in most states. Alcohol is the most widely used psychoactive substance in the world. The consumption of alcoholic beverages is usually calculated from production and sales statistics and expressed as per capita consumption for a population . In 2005, the equivalent of 6.3 liters of pure ethanol per capita of alcoholic beverages was consumed worldwide for all persons aged 15 and over .

In European countries, the corresponding values ​​have been in the range of an average of 12.5 liters of pure alcohol per inhabitant per year for years. The national average values per capita and year determined by the WHO from data from 2008 to 2010 are 11.8 liters for Germany , 10.3 liters for Austria and 10.7 liters for Switzerland .

These values ​​are well above the limit values ​​applicable in Germany for low-risk consumption, which are 7.8 liters for men and 3.9 liters for women.

Data from representative surveys in which alcohol consumption is asked allow a more individual approach . The GEDA 2010 study reports alcohol consumption that is hazardous to health in just under a third of men and a good fifth of women in Germany. In the 1998 Federal Health Survey, just under a third of men and a sixth of women reported alcohol consumption that was hazardous to health. From an international perspective, the alcohol consumption of men and women is converging, the gender discrepancy in consumption and the associated harms are decreasing.

## Classification of alcohol consumption

The classification of alcohol consumption is based, among other things, on the average amount consumed. The spectrum ranges from primary abstinence , i.e. no or very little alcohol consumption, through low-risk alcohol consumption and harmful alcohol consumption in connection with a significant health risk to chronic consumption and alcohol dependence .

The allocation of the quantities of alcohol consumed to the various classes of alcohol consumption differs from country to country. The recommendations of the professional societies in different countries vary considerably with regard to low-risk consumption. In the United States , the definition of moderate consumption includes almost three times the amount of alcohol defined in Finland .

According to Seitz and colleagues, alcohol consumption, which could still be regarded as low-risk, was set at a maximum of 12 grams per day for women and 24 grams of pure alcohol per day for men, with no alcohol being consumed on two days a week . The British Medical Association (BMA) sets the threshold for risky consumption at 20 g for women and 30 g for men.

Consumption per day according to the

World health organization

Women Men Women Men
Beer (5%) Wine (12%) Beer (5%) Wine (12%)
low risk consumption 20 g 30 g 0.5 l 0.2 l 0.75 l 0.3 l
risky consumption > 20 g > 40 g > 0.5 l > 0.2 l > 1.0 l > 0.4 l
dangerous consumption > 40 g > 60 g > 1.0 l > 0.4 l > 1.5 l > 0.6 l
highly dangerous consumption > 80 g > 120 g > 2.0 l > 0.8 l > 3.0 l > 1.25 l

According to the ICD-10 classification system of the WHO, alcohol consumption with a lifestyle problem is coded with the number Z72.1 if there is no disease-related disorder. If there is already damage from alcohol consumption, it should be coded with F10.1. In the case of alcohol dependence in the sense of an addiction, F10.2 is coded.

## physiology

Consuming 0.3 l of beer or 0.2 l of wine has a disinhibiting effect and can lead to an increase in talkativeness. Consumption of 0.7 to 1 l of beer or 0.5 l of wine leads to a blood alcohol level of 0.5 to 1 ‰ and a "sweat" with disinhibition and overestimation of oneself with a decrease in the ability to react. After consuming about 1.7 to 3 liters of beer or 1 to 1.5 liters of wine, you are clearly drunk, ataxia begins , with impaired visual performance, with sometimes aggressive behavior and lack of insight.

An alcohol level of 2 to 3 ‰ leads to drunkenness, intoxication, severe ataxia, thinking and orientation disorders and later sometimes amnesia . Even higher concentrations lead to severe intoxication, drowsiness or loss of consciousness, aspiration of vomit and hypothermia. People who are not used to large amounts of alcohol on a regular basis can die from respiratory paralysis . A blood alcohol of 6 to 8 ‰ is usually fatal, even for severe alcoholics. These figures are average values ​​and can vary widely. The achievable blood alcohol concentration depends on the amount of drink consumed, body mass and gender as well as on factors such as stature and age as well as the filling level of the stomach.

### Alcohol intake

Digestive system of man
Depiction of a "cat" on an ashtray, 19th century

The proportion of ethanol in alcoholic beverages is absorbed throughout the digestive tract . This begins to a small extent in the oral mucosa . The ethanol absorbed there passes directly into the blood and is thus distributed over the entire body including the brain . About 20% is absorbed in the stomach; the rest in the small intestine . The alcohol absorbed in the stomach and intestines first reaches the liver with the blood , where it is partially broken down. Ethanol intake is increased by factors that increase blood flow, such as heat in Irish coffee , grog , sugar in liquor, and carbon dioxide in sparkling wine . In contrast, fat slows down absorption. This does not lead to a lower absorption of the alcohol overall, but only to a time extension.

### Alcohol breakdown

Around two to ten percent of the alcohol ingested is released unchanged through urine , sweat and breath . Partial breakdown takes place in the stomach; a sigma alcohol dehydrogenase found there shows an activity approximately 200 times higher than the isoenzymes localized in the liver . The proportion of total ethanol degradation in the stomach is around five percent.

In the liver, the main part of the alcohol is first broken down into acetaldehyde ( ethanal ) by the enzymes alcohol dehydrogenase (ADH) and catalase and the microsomal ethanol-oxidizing system (MEOS system) . The further degradation takes place oxidatively by aldehyde dehydrogenase 2 to acetic acid .

Acetic acid is breathed into carbon dioxide via the citric acid cycle and the respiratory chain in all cells of the body while generating energy . With high, regular consumption, the liver can adjust its breakdown activity to a small extent. With a higher ethanol intake of around 50 g per day or with chronic drinkers, the alcohol is also broken down via the MEOS system. Ethanol in the microsomes of the liver cells is also oxidized to acetaldehyde by cytochrome P450 (CYP2E1) with consumption of oxygen. This effect, paired with a desensitization of the autonomic nervous system , leads to a higher alcohol resistance with chronic alcohol consumption. This desensitization through habituation can go so far that drinkers with two or more alcohols show no behavioral problems.

Frequency of inactive
aldehyde dehydrogenase (ALDH-2 *) in
different ethnic populations
population inactive
ALDH-2 *
Mongols (China) 30%
Zhuang (China) 25%
Han (China) 45%
Indonesian 39%
Japanese 44%
South Koreans 27%
Vietnamese 53%
Egyptians, Germans ,
Israelis, Kenyans,
Liberians, Sudanese,
Hungarians, Turks
0%

The intermediate product acetaldehyde is partly responsible for the so-called " hangover " symptoms such as headache, nausea and vomiting. The breakdown of acetyldehyde is inhibited by sugar , so the hangover is particularly intense with sweet alcoholic drinks, especially liqueurs, punch bowls and some types of sparkling wine.

The breakdown rate, expressed in g ethanol / (hx kg body weight ) by the alcohol dehydrogenase, is constant within certain limits. For men it is about 0.1 g of ethanol per hour and kg body weight, for women it is about 0.085 g of ethanol per hour and kg of body weight. The measured degradation rates for men were between 0.088 and 0.146 g / h and kg body weight. The alcohol in a 0.5 l bottle of beer with 16 g of ethanol is then broken down in one to two hours.

${\ displaystyle 0 {,} 1 \, {\ frac {\ mathrm {g}} {\ mathrm {h} \ cdot \ mathrm {kg}}} \ cdot 80 \, \ mathrm {kg} = 8 \, { \ frac {\ mathrm {g}} {\ mathrm {h}}}}$
${\ displaystyle {\ frac {16 \, \ mathrm {g} \ cdot \ mathrm {h}} {8 \, \ mathrm {g}}} = 2 \, \ mathrm {h}}$

### Blood and breath alcohol

An objective measure of the alcoholic influence is the alcohol concentration in the venous blood circulation and in the air we breathe, whereby only limited statements can be made about the physiological impairment, as these depend heavily on individual influences, in particular habituation to alcohol.

The level of the blood alcohol concentration (BAC) or the breath alcohol concentration (AAC) is associated with a statistical probability with the risk of failure symptoms or accidents compared to the fasting state, which are the basis of the legal alcohol limits.

The Widmark formula (according to Erik Widmark ) or the Watson method are used to calculate the theoretically maximum achievable BAK . The unit of measure used is the mass ratio of milligrams of alcohol per gram of blood (mg / g), better known as the alcohol value. The calculation of the blood alcohol concentration according to Watson is carried out for men using the following formula:

BAK = 0.8 / (2.447 - 0.09516 × age in years + 0.1074 × height in cm + 0.3362 × weight in kg) × consumed alcohol in g

The breath alcohol concentration (AAC) arises from the fact that in the alveoli there is a transfer of the alcohol from the arterial blood circulation into the inhaled air, whereby alcohol is given off when exhaling. The unit of measurement is the amount of alcohol in milligrams per liter of breath (mg / l). A direct conversion from AAK to BAK is not possible exactly because the ratio changes over time. For this reason, there are two separate limit values ​​in the Federal Republic of Germany that are legally equated and are based on the average ratio of 1: 2000 of grams of alcohol per liter of blood to milligrams per liter of breath. Thus 0.5 g / kg blood alcohol concentration corresponds to 0.25 mg / l breath alcohol concentration. Comprehensive basic research on the measurement of breath alcohol concentration was carried out in 1981 at what was then the Institute for Social Medicine and Epidemiology of the Federal Health Office.

According to German case law, an AAK value cannot be converted into a BAK value with a constant conversion factor. According to current scientific studies, the fluctuation range of the conversion quotients is between 0.740 and 3.290.

### Immediate physiological effect

Depending on the situation, alcohol consumption causes anesthesia, stimulation or a change in mood. It leads to an expansion of the peripheral blood vessels in particular. This results in a feeling of warmth when consuming alcoholic beverages. The natural regulation of the heat balance is disabled at low temperatures. At the same time, alcohol has a numbing effect, so that threatening cold is no longer perceived. Therefore, frostbite or death from cold can be the result of winter alcohol consumption. So that alcohol keeps you warm is wrong and must be considered an urban legend . However, the vasodilator effects of alcohol can be used in hypothermic conditions after the patient has been moved to a warm room. The body can absorb heat more quickly through the consumption of alcohol and the resulting widened vessels.

The combination of alcohol with medication and other drugs is problematic . There are many interactions here that can lead to premature and more intense impairment than with pure alcohol consumption. The cytochrome P450 2E1 formed during the breakdown of alcohol can impair the effectiveness of drugs through their breakdown. Many of the “ drug deaths ” died from mixed consumption with alcohol; In Austria, for example, in the 2011 addiction report, 92% of deaths were caused by the use of drugs in connection with alcohol and / or medication.

### toxicology

Ethanol is classified as neither poisonous nor harmful to health, but pathologists classify it as one of the "obligatory hepatotoxic substances", ie one of the liver toxins. A "direct toxic effect of alcohol on erythropoiesis", the formation of red blood cells, is considered to be certain. Pediatricians call it a "teratogenic noxa", ie a poison that damages the fetus, and pharmacologists and toxicologists speak of "acute poisoning" above a certain threshold dose and of "chronic poisoning" in alcoholism. The consumption of dilute solutions of ethanol in water shows physiological effects even at concentrations of a few percent by volume. Ingestion leads to typical acute intoxication symptoms such as dizziness , nausea , disorientation, talkativeness and increased aggressiveness - from about 0.5–1  per thousand alcohol concentration in the blood . The lethal dose (LD) is around 3.0 to 4.0 per thousand for inexperienced drinkers. However, values ​​above 7 per thousand have already been measured. The LD 50 for the rat is 7060 mg / kg for oral administration. In acute ethanol poisoning, the alcohol still in the stomach can be partially removed by inducing vomiting or by gastric lavage .

Regular consumption of alcohol, which can lead to addiction ( alcoholism ), damages all of the body's cells . In particular, the nervous system and brain as well as the liver suffer . The vitamin B 1 metabolism is damaged by long-term alcohol consumption and can trigger polyneuropathy . Epilepsy , alcohol psychosis , social isolation and early death can result. The Wernicke encephalopathy is found in about 15% of the deceased alcoholics and, together with the Korsakoff syndrome , the Wernicke-Korsakoff syndrome . The damage to the central nervous system in delirium tremens is known . This nerve phenomenon occurs when the body is withdrawn from alcohol. In Germany, over 40,000 people die each year as a result of alcohol abuse.

#### Effects on the nervous system and brain

The acute effects of ethanol are mainly based on a disruption of nerve cells and the central nervous system . The influence is very likely based on the storage of ethanol in membrane proteins , which disrupts their function. Various ion channels are particularly sensitive to ethanol . It stimulates the GABA receptors in the brain and nervous system and inhibits the NMDA receptors . This generally leads to an inhibition of the transmission of stimuli in the central nervous system and at the same time to an increase in sensitivity and subsequently, depending on the dose, to disinhibition as well as to influencing the sense of balance , vision (narrowed field of vision, tunnel vision ) and muscle control up to aggressive behavior . Larger amounts have an acutely numbing effect and can lead to memory gaps. Furthermore, ethanol could possibly trigger the programmed cell death of developing brain cells via a complex chain of effects. This begins with the effect on GABA and NMDA receptors, which by dissolving the mitochondrial membrane could cause the release of cytochrome c and the activation of various caspases . Among other things, these peptidases cause the destruction of the cell nucleus and the DNA and thus the death of the cell.

Depending on the amount absorbed and thus the concentration in the blood, ethanol increases the permeability of the blood-brain barrier . Chronic alcohol consumption has been shown to damage the blood-brain barrier, which could be a major factor in the development of various neurodegenerative diseases. Attempts have been made to prove this through neuropathological examinations of alcohol addicts and animal experiments, but results from animal experiments cannot be transferred one-to-one to humans.

In a study with about 2800 people who were at least 55 years old, the data of the people were initially recorded between 1987 and 1989. From 1993 to 1995, brain damage was determined in around 1900 of the test subjects using magnetic resonance imaging . At the time of data acquisition, the subjects were divided into five different groups depending on their alcohol consumption. It showed that even with little regular alcohol consumption, the brain tissue shrank . In contrast, there was no demonstrable connection between the amount of alcohol consumed and the number of brain or heart attacks .

Heavy alcohol consumption leads to a condition known as drunkenness. It is characterized by physical changes and, for example, psychologically by increased emotionality and by a changed awareness of consciousness and a reduction in mental performance. New studies show that this leads to a reduction in the activity of the brain region that is required for recognizing dangers. Most often, excessive alcohol consumption leads to nausea and vomiting. Only the part of the alcohol that has not yet entered the bloodstream is excreted.

If larger amounts are consumed, acute alcohol intoxication sets in , which can lead to a coma or direct death. The rapid consumption of high-proof spirits is particularly dangerous, as the nausea threshold occurs more slowly than a life-threatening rise in blood alcohol levels. Quickly drinking a whole bottle of schnapps - it contains 150–200 ml of ethanol - can lead to a fatal collapse due to the paralysis of the brain stem center. Furthermore, there is a risk of additional poisoning if the luxury food is contaminated with large amounts of by-products such as B. methanol , which can be enriched in the distillation on which the spirits are based .

#### Deficiency symptoms

Regular alcohol consumption can lead to deficiency symptoms of various vitamins , body electrolytes and trace elements. In patients with alcoholic liver disease, the fat-soluble vitamins retinol (vitamin A) , cholecalciferol (vitamin D) and tocopherol (vitamin E) were significantly reduced in the liver, blood and the whole organism. Retinol is metabolized to a greater extent in the presence of ethanol, with some carcinogens being formed. The vitamin D deficiency manifests itself in an increased incidence of fractures and osteoporosis in alcoholics. In the case of the E vitamins, which consist of different isomers of tocopherol, ethanol induces a shift in the proportion from the α to the much less effective γ isomer and thus symptoms of deficiency. All water-soluble vitamins are reduced in alcoholism, with thiamine (vitamin B 1 ) , pyridoxine (vitamin B 6 ) and folic acid being mainly affected. Alcohol intake reduces the absorption of vitamin B 1 in the small intestine and disrupts the activation of thiamine by inhibiting its phosphorylation . This can lead to heart failure , especially if diuretics are taken at the same time . Ethanol blocks the formation of pyridoxal-5-phosphate from vitamin B 6 , which is destroyed in the organism by the ethanal produced from alcohol. Folic acid is also absorbed less; a deficiency in turn results in a lower absorption of thiamine in the intestine. The folic acid deficiency results in alcoholics among the strongest acute symptoms such as hematopoietic disorders ( macrocytic anemia ) , neurological disorders (forgetfulness and insomnia) and Fötusmissbildungen in pregnant women. Heavy alcohol consumption can also cause a deficiency of important electrolytes and trace elements, mainly zinc , magnesium and selenium . A lack of zinc causes an increase in the toxicity of the ethanol, since the enzyme alcohol dehydrogenase , which breaks down ethanol in the body, is dependent on zinc.

#### Alcohol Consumption During Pregnancy

Baby with facial features typical of the fetal alcohol syndrome: small eyes, smooth philtrum ("fold" between nose and mouth), narrow upper lip

Alcohol consumption by the mother during pregnancy , even in small amounts, can lead to so-called fetal alcohol syndrome (FAS) . This is often characterized by an impairment of the child's mental development and physical malformations such as heart defects . Every year around 10,000 alcohol-impaired children are born in Germany, 4000 of them with full fetal alcohol syndrome.

The most common prenatal health problems include those in children of alcohol-dependent mothers. Even a relatively small amount of alcohol can have serious consequences for the child during pregnancy. According to a study by the Berlin Charité , 58 percent of all pregnant women occasionally consume alcoholic beverages. Other studies put the proportion of women who consume alcohol during pregnancy at 20%.

Alcohol consumption during pregnancy is not a criminal offense in Germany.

#### Effects on the gut and the human microbiome

Ethyl alcohol has antibacterial properties and, in higher concentrations, has a bactericidal effect . However, this usually has no effect on alcohol consumption, as ethanol dissolved in water only has bactericidal properties from an alcohol content of 70%. This is used with disinfectants . Most alcoholic beverages, however, have an alcohol content between around 5 and 40%. Nevertheless, acute disorders of the gastrointestinal tract function occur when it is consumed , which is usually expressed in the form of diarrhea . Chronic alcohol consumption can lead to or contribute to dysbiosis (bacterial overgrowth of the small intestine). However, this cannot be adequately explained by ethanol itself.

The degradation product of ethanol, acetaldehyde (ethanal), could be responsible for this . It has a mutagenic effect on human cells because it easily binds with DNA . Due to this property, the death of bacterial cells can be induced through the formation of so-called DNA adducts (complex formations).

This effect is harmful if useful bacterial cells are affected, but can also be useful in individual cases if pathogenic agents are detected. Heavy alcohol consumption and simultaneous consumption of foods poisoned with Salmonella reduces the risk of Salmonella food poisoning.

High alcohol consumption in a short period of time, especially the consumption of high-proof spirits, can lead, among other things, to an acute inflammation of the intestinal mucosa . The gastric mucosa can also become acutely inflamed, as can the oral mucosa . After the acute consumption is stopped, the inflammation usually heals within the next 24 hours. Depending on the extent of the inflammation and especially in immunocompromised people (e.g. with systemic use of glucocorticoids ), the healing process can be considerably delayed in some cases.

Research in Cell Host & Microbe shows that long-term alcohol consumption may not only cause direct toxic damage to the liver. As the intestinal mucosa is damaged chronically , the penetration of pathogens into the liver is favored. In another study, a team led by Bernd Schnabl from the San Diego School of Medicine was able to show that regular alcohol consumption reduces the formation of so-called REG3 proteins in the intestine. These are natural antibiotics that are produced by intestinal residents and serve to protect against pathogenic agents. A decrease in the production of REG3 proteins also results in a change in the microbiome. Researchers were also able to show that in animal experiments, mice lacking the gene for the production of REG3 proteins developed inflammatory fatty liver ( steatohepatitis ), a precursor of liver cirrhosis , more quickly when they consumed alcohol .

#### Alcohol abuse is the cause of death

Alcohol consumption can create strong psychological and physical dependence . In Germany, up to 1.3 million people are considered to be dependent on alcohol ; a total of around 9.5 million people consume alcohol in harmful amounts.

According to the Federal Statistical Office , more than 16,000 people in Germany died from alcohol abuse in 2005; this corresponds to two percent of all deaths.

The most common alcohol-related cause of death is alcoholic cirrhosis of the liver . In 2010, 8291 of 15,031 alcohol-related deaths could be attributed to it. Acute pancreatitis (inflammation of the pancreas) is a disease that is triggered not only by gallstones but also by alcohol consumption . In the mild form, the mortality rate is below 1%, in the severe form, however - depending on the complications - it can rise to over 50%.

According to the federal government (2015), 74,000 people die in Germany every year from the direct and indirect consequences of their alcohol abuse. At the same time, an annual per capita consumption of ten liters of pure alcohol per person (population 14 years and over) is assumed, which corresponds to one death per 9,533 liters of pure alcohol consumed.

An international study by the World Health Organization ( WHO) from 2011 shows a worldwide average death rate from alcohol abuse of 3.1% for 2004, of which 6.6% were men and 1.1% women. According to the WHO report, 11.5 men and 3.6 women of 100,000 inhabitants in Germany died from alcohol-related road accidents in 2005. A meta-analysis published in The Lancet in 2018 states that alcohol consumption is responsible for 2.2 percent of all deaths in women and 6.8 percent of all deaths in men worldwide.

#### Cancer risk

In addition to partly incurable diseases such as liver cirrhosis and nerve diseases, excessive consumption of alcohol can cause many types of cancer (such as stomach and esophageal cancer).

The International Agency for Research on Cancer ( IARC , "International Agency for Research on Cancer") has the consumption of alcoholic beverages made in February 2007 by an international working group re-evaluate the consequences and for the following reasons lump sum "of ethanol in alcoholic beverages" as carcinogenic to humans (Group 1) classified: The occurrence of malignant tumors of the oral cavity, pharynx, larynx, esophagus, liver, female breast and colorectum is causally related to the consumption of alcoholic beverages, as numerous studies show. Compared to the earlier evaluation in 1988, the IARC working group considered it to be certain that ethanol and not other components or contaminants are responsible for the carcinogenicity of alcoholic beverages. The risk of cancer generally increases with the amount of alcohol consumed. A connection with the type of alcohol consumed (beer, wine or spirits) could not be established. In 2016, a meta-study showed that there is strong evidence that alcohol consumption is causally responsible for throat, esophagus, liver, colon, rectal, breast and larynx cancer and that alcohol consumption can be assumed to account for 5.8 in 2012 % of all cancer deaths worldwide was responsible.

The World Cancer Research Fund and the American Institute for Cancer Research recommend limiting daily alcohol consumption to one drink for women and two drinks for men (10–15 g of ethanol per drink; about 10 g is in 30 ml of schnapps, 330 ml of beer or contain 100 ml of wine). The reference variable is the day because occasional consumption (e.g. seven drinks on the weekend and none on weekdays) is more harmful to health than evenly distributed consumption of the same amount (e.g. one drink every day). When breast cancer is no threshold could be set; the Nurses' Health Study showed that even a low consumption of 5–15 grams of alcohol per day significantly increases the risk of illness.

The carcinogenic effect is caused by the ethanal , to which ethanol is broken down in the liver. The ethanal is converted to crotonaldehyde by polyamines , which in turn destroys the DNA .

#### Dependency

Various physiological effects of alcohol consumption - such as mood-enhancing, stimulating, and anti-anxiety effects - can create addiction or alcohol addiction . These effects are mainly based on the increased production of dopamine and endorphins . Once there is a dependency, it is favored by the strong withdrawal symptoms .

### Other effects and harm

Comparison of the harm potential of common psychotropic substances and alcohol in Great Britain (based on David Nutt, 2010).

Chronic consumption of alcohol increases the serum level of the toxic amino acid homocysteine . This has been linked to alcohol-associated brain atrophy , alcohol withdrawal attacks, and alcohol-associated cognitive decline.

Alcohol consumption affects sexuality and fertility. Ethanol increases the level of estrogen in the woman's blood, which in amounts of 0.5–1% can lead to fertility disorders. In men, the same amount of ethanol (two glasses of wine or a bottle of beer) reduces the amount of sperm and the proportion of normal sperm by up to 34%. This is justified by the reduction in testosterone production in men caused by ethanol . Ingestion of larger amounts can lead to testicular atrophy . Alcohol consumption leads to disinhibition, especially in men to an increase in libido . At the same time, from around 0.4 ‰, erectile function decreases to complete erectile dysfunction .

According to a study carried out in 2010 to re-evaluate various psychotropic substances , alcohol is the fourth most harmful drug among intoxicants after crack , heroin and methamphetamine , measured in terms of addiction potential and health-damaging effects. Measured in terms of harm to others and thus also in the overall assessment, alcohol is rated as the most harmful substance. The results of the study were published in the journal The Lancet .

### Postulated positive effects with low alcohol consumption

Poster from the Federal Office for Health Education in Cologne

It is undisputed that the health effects of alcohol consumption are negative when done in large quantities and on a regular basis. Some studies have shown evidence of a cardioprotective (heart-protecting) effect with moderate alcohol consumption. This results in a J-shaped curve, which shows a positive effect with low consumption. In a large number of studies, the increase in (vascular protecting) HDL cholesterol due to alcohol consumption has been proven. With higher amounts, the negative health effects predominate. These studies are controversial, especially as it is pointed out that if these results can be confirmed, it is only a singular effect in relation to a specific group of diseases that is offset by the many negative consequences of the disease.

According to information from the weekly newspaper Die Zeit, some of the studies that found evidence of singular health-promoting effects were funded by the alcohol-producing industry. A work funded by the Alcohol Task Force of the International Life Sciences Institute Foundation, whose members are Moët & Chandon , Allied Domecq , Brasseries Kronenbourg , Heineken and Diageo , attributed alcohol consumption to a protective effect against diabetes mellitus in 2005 . In Germany, some studies were commissioned by the German Wine Academy (DWA), which is financed by the wine producers. 160,000 euros were spent on domestic press work alone. The French Sopexa spent 800,000 euros on German media. In 2011, it became known that the University of Connecticut's Cardiovascular Research Laboratory falsified data from around two dozen studies claiming positive effects of consuming red wine. A number of meta-studies and articles in specialist journals had referred to this data.

In many cases, the supposedly positive effect is not compared to the greatly increased health risk from other diseases in the media. As an example, the significantly increased risk of cancer with low regular consumption should be mentioned here. When looking at health effects, no significant difference between individual types of beverage could be found in the studies. Alcohol consumption is therefore not recommended in any guideline; because there is no risk-free alcohol consumption.

In August 2018, the results of a large global study of alcohol consumption were published in the medical journal The Lancet . An extensive collective of authors led by Emmanuela Gakidou ( University of Washington in Seattle ) examined the effects of alcohol consumption around the world. The study evaluated 694 data sources on individual and population-related alcohol consumption and 592 prospective and retrospective studies on the risk of alcohol consumption and came to the conclusion that there is no such thing as “safe” consumption. Regular alcohol consumption - even in small quantities - has always been associated with negative effects in terms of the risk of death or the risk of developing a serious illness ( DALY ). In the 15–49 age group, alcohol consumption was responsible for nearly 10% of all deaths worldwide. The authors concluded: Our results show that the safest level of drinking is none (Our results show that the safest alcohol consumption behavior is complete abstinence).

### Weight gain

While light to moderate alcohol consumption is generally not associated with weight gain, heavy alcohol consumption (> 30 g alcohol per day) contributes to weight gain and obesity . On the other hand, laboratory tests have shown that alcohol is a nutrient that is efficiently used by the body, so its calories are important. This contradiction has been termed a "puzzle" and in many ways paradoxical. There is no evidence that the effect on obesity depends on the type of drink. Alcohol consumption can lead to increased fat deposits in the abdominal area, especially in men. The widespread view that beer in particular leads to this (“beer belly”) or that the effect does not occur with wine is not correct. It seems more likely that this perception can be explained by other aspects of the lifestyle of beer drinkers. It is unclear whether alcohol leads to increased food intake despite a lack of hunger. However, alcohol can lead to increased appetite perception.

## Legal restrictions on alcohol use

### restrictions

Reservoir glass with naturally colored absinthe and absinthe spoon

There are various options available to the legislature to control total alcohol consumption. These include legal restrictions on availability, for example by reducing shop and bar opening times or the number of businesses that are allowed to sell alcohol. Total alcohol consumption can also be influenced by levying fees, issuing licenses or examinations for the issuing of permits for the sale of alcohol, introducing a legal minimum age and increasing alcohol tax. Furthermore, the state can restrict advertising for alcohol consumption, although there is currently no uniform legal regulation of alcohol advertising in Europe. In most countries, however, there are measures that regulate the content and forms of advertising as well as restrictions on placement in the various media.

The German catering law stipulates in § 6 Catering Act that the cheapest drink - based on the extrapolated price for a liter - must be a non-alcoholic one.

On May 1, 2018, Scotland introduced a legal minimum price based on the amount of pure alcohol for alcoholic beverages such as whiskey and wine .

### Prohibitions

In some countries, especially Islamic ones , alcohol consumption is prohibited by law. Drinks like absinthe are or were, until recently, banned in many European countries because of their allegedly increased risk potential. During the American prohibition period from 1920 to 1933, the sale of alcohol in the United States was prohibited by law. This led to the massive emergence of illegal pubs ( speakeasies ) and the flourishing of organized crime . Due to community autonomy, there are still counties in the USA where the sale, promotion, and public consumption of alcohol are prohibited. These communities are known as Dry Counties.

### Protection of minors

In order to limit the consumption of alcohol by adolescents, in Germany, according to the Youth Protection Act, alcoholic beverages may not be given to people under the age of 16 and drinks that contain spirits in more than minor amounts may not be given to consumers until they are 18 years of age ( Section 9 Para . 1 JuSchG). The public consumption of alcoholic beverages not containing brandy is permitted from the age of 14 when accompanied by a legal guardian, there are no other restrictions. In Switzerland , in the absence of a uniform youth protection law, the relevant provisions can be found in the Federal Food Ordinance and the federal law on distilled water . The Food Ordinance prohibits the distribution and sale of alcoholic beverages to young people under the age of 16. Furthermore, the federal law on distilled water prohibits the delivery and sale of “distilled water” (def. “Distilled water”: spirits, as well as beer and wine with more than 15% by volume, and natural wine with more than 18% by volume. -%) to minors under 18 years of age. These provisions apply uniformly to the whole of Switzerland, with the exception of the Canton of Ticino , where the sale and serving of alcoholic beverages to minors under the age of 18 has been prohibited since 1989. In Austria , the protection of minors according to the youth protection laws there is a matter of the federal state and is relatively complex, as the age limit for young people and the percentage limit between high-percentage, distilled alcohol and low- percentage alcoholic beverages depend on the federal state or are sometimes not defined at all. The following table shows the provisions specifically; the year data apply "from the completed year of life":

State (
s)
Ban on consumption before
reaching the
age limit
Alcohol
allowed
from
Vol%
limit
Burned
alcohol is
allowed
Q
Vienna ,
Lower Austria ,
Burgenland
in generally accessible
places and at public
events
16 no 16
Styria Yes 16 14% by volume 18th
Carinthia Yes 16 n. def. 18th
Upper Austria Yes 16 n. def. 18th
Salzburg Yes 16 n. def. 18th
Tyrol , Vorarlberg in the public 16 n. def. 18th ,
Tyrol:

Other countries - for example most of the states of the USA - stipulate that the minimum age for public and private consumption of alcohol is 21 years of age.

## Alcohol crime

Alcohol consumption has a significant impact on crime. In addition to resistance to state violence, violent crimes are predominantly committed under the influence of alcohol. Alcohol consumption is often a causal factor, especially in men.

According to police crime statistics , the following were under the influence of alcohol:

Offense Percentage of suspects
Resistance to state power 63.3
Violent crime (total) 31.3
homicide 47.4
Assault with fatal outcome 41.4
rape 36.6
dangerous and serious bodily harm 33.9
murder 29.1
Sex murder 46.7
Robbery , blackmail and predatory attack on motorists 23.4
Lock screw 67.9
Shop window break-in 30.7
Property damage 29.6
willful arson 29.1
sexual coercion 28.0

The airline Ryanair is demanding that the serving of alcohol at British airports be restricted in order to reduce the number of incidents of disruptive passengers, which rose in 2016/2017.

## literature

Commons : Alcohol  - Collection of pictures, videos and audio files
Wiktionary: alcohol consumption  - explanations of meanings, word origins, synonyms, translations
Wikinews: Alcohol  - on the news
Wikiquote: Alcohol  - Quotes

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