Alcohol, probably the oldest drug known, has been used at least since the earliest societies for which records exist. Of the numerous types of alcohol, ethyl alcohol is the type consumed in drinking. In its pure form it is a clear substance with little odor. People drink alcohol in three main kinds of beverages: BEERS, which are made from grain through brewing and fermentation and contain from 3% to 8% alcohol; WINES, which are fermented from fruits such as grapes and contain from 8% to 12% alcohol naturally, and up to 21% when fortified by adding alcohol; and distilled beverages (spirits) such as WHISKEY, GIN, and VODKA, which on the average contain from 40% to 50% alcohol. Drinkers may become addicted to any of these beverages. Physical Effects of Alcohol The effects of alcohol on the human body depend on the amount of alcohol in the blood (blood-alcohol concentration). This varies with the rate of consumption and with the rate at which the drinker’s physical system absorbs and metabolizes alcohol. The higher the alcohol content of the beverage consumed, the more alcohol will enter the bloodstream. The amount and type of food in the stomach also affect the absorption rate. Drinking when the stomach is filled is less intoxicating than when it is empty; the foods in the stomach, which contain fat and protein, delay alcohol absorption. Body weight is also a factor; the heavier the person, the slower the absorption of alcohol. After alcohol passes through the stomach, it is rapidly absorbed through the walls of the intestines into the bloodstream and carried to the various organ systems of the body, where it is metabolized. Although small amounts of alcohol are processed by the kidneys and secreted in the urine, and other small amounts are processed through the lungs and exhaled in the breath, most of the alcohol is metabolized by the liver. As the alcohol is metabolized, it gives off heat. The body metabolizes alcohol at about the rate of three-fourths of an ounce to one ounce of whiskey an hour. Technically it is possible to drink at the same rate as the alcohol is being oxidized out of the body. Most people, however, drink faster than this, and so the concentration of alcohol in the bloodstream keeps rising. Alcohol begins to impair the brain’s ability to function when the blood-alcohol concentration (BAC) reaches 0.05%, that is, 0.05 grams of alcohol per 100 cubic centimeters of blood. Most state traffic laws in the United States presume that a driver with a BAC of 0.10% is intoxicated. With a concentration of 0.20% (a level obtained from drinking about 10 ounces of whiskey), a person has difficulty controlling the emotions and may cry or laugh extensively. The person will experience a great deal of difficulty in attempting to walk and will want to lie down. When the blood-alcohol content reaches about 0.30%, which can be attained when a person rapidly drinks about a pint of whiskey, the drinker will have trouble comprehending and may become unconscious. At levels from 0.35% to 0.50%, the brain centers that control breathing and heart action are affected; concentrations above 0.50% may cause death, although a person generally becomes unconscious before absorbing a lethal dosage. Moderate or temperate use of alcohol is not harmful, but excessive or heavy drinking is associated with alcoholism and numerous other health problems. The effects of excessive drinking on major organ systems of the human body are cumulative and become evident after heavy, continuous drinking or after intermittent drinking over a period of time that may range from 5 to 30 years. The parts of the body most affected by heavy drinking are the digestive and nervous systems. Digestive-system disorders that may be related to heavy drinking include cancer of the mouth, throat, and esophagus; gastritis; ulcers; cirrhosis of the liver; and inflammation of the pancreas. Disorders of the nervous system can include neuritis, lapse of memory (blackouts), hallucinations, and extreme tremor as found in delirium tremens. Delirium tremens ("the DTs") may occur when a person stops drinking after a period of heavy, continuous imbibing. Permanent damage to the brain and central nervous system may also result, including Korsakoff psychosis and Wernicke’s disease. Recent evidence indicates that pregnant women who drink heavily may give birth to infants with the FETAL ALCOHOL SYNDROME, which is characterized by face and body abnormalities and, in some cases, impaired intellectual facilities. Additionally, the combination of alcohol and drugs, such as commonly used sleeping pills, tranquilizers, antibiotics, and aspirin, can be fatal, even when both are taken in nonlethal doses. Drinking Patterns Many studies have been made of attitudes toward drinking in different societies. Every culture has its own general ethos or sense of decorum about the use and role of alcoholic beverages within its social structure. In some cultures drinking is either forbidden or frowned upon. The Koran contains prohibitions against drinking, and Muslims are forbidden to sell or serve alcoholic beverages. Hindus take a negative view of the use of alcohol; this is reflected in the constitution of India, which requires every state to work toward the prohibition of alcohol except for medicinal purposes. Abstinence from alcohol has also been the goal of temperance movements in Europe and the United States. Some Christian religious groups strongly urge abstinence, including the Christian Scientists, Mormons, Seventh-Day Adventists, Pentecostalists, and some Baptists and Methodists. In some ambivalent cultures, such as the United States and Ireland, the values of those who believe in abstinence conflict with the values of those who regard moderate drinking as a way of being hospitable and sociable. This accounts for the plethora of laws and regulations that restrict the buying of alcoholic beverages. Some psychologists say that this ambivalence in the culture makes it harder for some people to develop a stable attitude toward drinking. Some cultures have a permissive attitude toward drinking, including those of Spain, Portugal, Italy, Japan, and Israel. The proportion of Jews and Italians who use alcohol is high, but the rates of alcoholism among them are lower than in Irish and Scandinavian groups. Some cultures may be said to look too favorably upon drinking, as do the French. In France the heavy consumption of alcohol has been related to the fact that many people are engaged in viticulture and in the production and distribution of alcoholic beverages. Various surveys indicate that subgroups within a society or culture do not all have the same attitudes toward alcoholic beverages or the same drinking patterns. Drinking behavior differs significantly among groups of different age, sex, social class, racial status, ethnic background, occupational status, religious affiliation, and regional location. David J. Pittman Bibliography: Austin, G.A., Alcohol in Western Society from Antiquity to 1800 (1985); Barrows, Susanna, and Roam, Robin, eds., Drinking: Behavior and Belief in Modern History (1990); Birnbaum, Isabel, and Parker, Elizabeth, Alcohol and Human Memory (1977); Goldstein, Dora B., Pharmacology of Alcohol (1983); Lender, Mark E., and Martin, James K., Drinking in America: A History (1982); Luks, Alan, and Barbato, Joseph, You Are What You Drink (1989); Mendelson, Jack H., and Mello, Nancy K., Alcohol: Use and Abuse in America (1985); Plotkin, R.A., Intervention Handbook: The Legal Aspects of Serving Alcohol (1988); Royal College of Psychiatrists, Alcohol: Our Favorite Drug (1986); Solomon, Joel, and Keeley, Kim, Alcohol and Drug Abuse: Similarities and Differences (1982); West, James R., Alcohol and Brain Development (1986).