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Alcohol is a depressant.
While there are many kinds of alcohol, the alcohol that people drink is ethyl alcohol. It is made from a mixture of yeast and water, fermented with grains, vegetables or fruits. The fermentation process changes the natural sugars into alcohol. Beer and whisky are made from grains, wine and brandy from grapes, vodka from potatoes, cider from apples, and rum from sugar, to name just a few of the most popular alcoholic drinks.
Alcohol concentration varies considerably with the type of drink. In Australia, beer contains 0.9-6% alcohol, wine 12-14%, fortifed wines such as sherry and port around 18-20%, and spirits such as scotch, rum, bourbon and vodka 40-50%.
People have been drinking alcohol for thousands of years, as part of various religious ceremonies, as a painkiller, and for socialisation and fun. It is the most commonly used and socially acceptable recreational drug in Australia.
How alcohol is used
Alcohol is usually drunk in social situations for its relaxing effects, which tend to reduce people's inhibitions.
How common is alcohol use?
The 2019 National Drug Strategy Household Survey found that alcohol is the most widely used recreational drug in Australia, with over 85% of Australians aged 14 years and over having drunk alcohol one or more times in their lives.
In comparison to 2016 and earlier years, more Australians are taking action to reduce their drinking—52% undertook an action in 2019, up from 48% in 2016.
Alcohol is absorbed rapidly into the bloodstream and affects the brain within about five minutes (absorption may be slower if the person has recently eaten).
Alcohol depresses the central nervous system, slowing down heart rate, breathing and other body functions. Other short-term effects may include:
- reduced inhibitions
- a sense of relaxation
- loss of alertness and coordination, and slower reaction times
- impaired memory and judgement
- nausea, shakiness and vomiting
- blurred or double vision
- disturbed sleep patterns
- disturbed sexual functioning (such as difficulty in maintaining an erection).
As consumption continues these effects are increased, which increases the risks involved in driving, using machinery or making decisions affecting safety. The effects gradually wear off as the alcohol is broken down by the gut and liver. It takes about an hour for the body to break down the alcohol in one standard drink, although there is considerable variation between individuals. It takes longer if there is damage to the liver.
Heavy use of alcohol over a lifetime increases the risks of:
- some oral, throat and breast cancers
- liver cirrhosis
- brain damage and dementia
- some forms of heart disease and stroke.
There is increasing evidence that drinking at low risk levels does not reduce the risk of heart disease; heavy drinking is always risky.
In terms of death and disability, alcohol is a major cause of preventable harm in Australia. For example, in 2019 3.7% of all deaths in NSW were attributable to alcohol. Excessive alcohol consumption is the leading contributor to the burden of illness and deaths in Australia for people aged up to 44 years and the third overall contributor to total burden of disease and illness for all ages, behind tobacco and high body mass. (Health Stats NSW).
Variation in effects
Because of the way alcohol is stored and processed by the body, people with a lower proportion of body fat and a higher proportion of body fluids, and larger people, are generally less affected than others by the same amount of alcohol. This means that some members of the following groups may be more vulnerable to the effects of alcohol:
- women, who are generally smaller than men and usually have a higher proportion of body fat
- older people, who tend to have lower levels of body fluids
- young people.
A person's general state of health, and whether they have recently eaten, also has an effect.
On the day following a drinking session a person may experience nausea, headache, fatigue and general unwellness with varying degrees of severity. Hangovers may be produced by the immune system. Alcohol is a diuretic; that is, it causes increased fuid loss. The fluids must be replaced by non- alcoholic drinks if dehydration is to be avoided.
Some alcoholic drinks, including brandy, bourbon and red wine, contain substances called congeners, which can also cause symptoms associated with hangover.
Smoking, drinking on an empty stomach, drinking quickly, and poor quality sleep may add to the severity of a hangover.
Using alcohol with other drugs
Because alcohol depresses brain activity it should not be used with other drugs or medications that have similar effects on the brain, particularly benzodiazepines and heroin. Drinking alcohol while using these drugs can cause bodily functions to slow to the point where death occurs. Many heroin overdoses are associated with heavy alcohol use.
A person taking a prescription medication should always find out about the possible effects of drinking alcohol at the same time by reading the information that comes with it, and discussing the matter with their doctor or pharmacist.
Heavy or regular alcohol use can lead to dependence.
When a heavy drinker suddenly stops or reduces their drinking they are likely to experience withdrawal symptoms—which makes stopping more difficult. Withdrawal symptoms can be quite mild or quite severe, ranging from insomnia and shakiness to severe seizures and delirium tremens—often called the DTs—where the person is not in touch with reality (delirium) and needs urgent medical treatment.
Most people do not suffer delirium tremens, but there can be significant risks in withdrawing from alcohol, and people undergoing withdrawal should be medically monitored.
Most people who are going through withdrawal are treated in an outpatient setting. Sometimes medications such as benzodiazepines are prescribed to help reduce the severity of symptoms.
If drinking continues for an extended period, bodily functions can decrease to such an extent that the person loses consciousness (blacks out), which can lead to death by suffocation if the person vomits while unconscious.In rare cases, a person's physical functioning may decrease to the point where they stop breathing. This is called alcohol poisoning.
Advice from a doctor or other health professional can be effective, especially with people who have milder alcohol problems, while there are several online or internet-based treatment options now available.
For those with more serious problems, other forms of treatment may be required. This may involve withdrawal under medical supervision, followed by psychological or medical treatments to help prevent the person going back to their risky behaviour.
Psychological treatments such as motivational interviewing, cognitive behavioural therapy and contingency management have been found to be effective in treating alcohol disorders. More recent research has found that naltrexone, acamprosate and/or disulfram in conjunction with psychological treatment can improve recovery.