Frequently Asked Questions

Alcohol Use

Alcohol and Public Health

Underage Drinking

Frequently Asked Questions

What is Alcohol?

Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. Alcohol is produced by the fermentation of yeast, sugars, and starches.

How does alcohol affect a person?

Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes; however, the liver can only metabolize a small amount of alcohol at a time, leaving the excess alcohol to circulate throughout the body. The intensity of the effect of alcohol on the body is directly related to the amount consumed.

Why do some people react differently to alcohol than others?

Individual reactions to alcohol vary, and are influenced by many factors; such as:

• Age.
• Gender.
• Race or ethnicity.
• Physical condition (weight, fitness level, etc).
• Amount of food consumed before drinking.
• How quickly the alcohol was consumed.
• Use of drugs or prescription medicines.
• Family history of alcohol problems.

What is a standard drink in the United States?

A standard drink is equal to 13.7 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in

• 12-ounces of beer.
• 8-ounces of malt liquor.
• 5-ounces of wine.
• 1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

Is beer or wine safer to drink than liquor?

No. One 12-ounce beer has about the same amount of alcohol as one 5-ounce glass of wine, or 1.5-ounce shot of liquor. It is the amount of alcohol consumed that affects a person most, not the type of alcoholic drink.

What are caffeinated alcoholic beverages (CABs)?

Caffeinated alcoholic beverages (CABs) are premixed beverages that combine alcohol, caffeine, and other stimulants. They may be malt- or distilled spirits-based and usually have higher alcohol content than beer (e.g., 5%–12% on average for CABs compared to 4%–5% for beer). The caffeine content in these beverages is usually not reported.

What does moderate drinking mean?

There is no one definition of moderate drinking, but generally the term is used to describe a lower-risk pattern of drinking. According to the Dietary Guidelines for Americans,¹ drinking in moderation is defined as having no more than 1 drink per day for women and no more than 2 drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days.

Is it safe to drink alcohol and drive?

No. Alcohol use slows reaction time and impairs judgment and coordination, which are all skills needed to drive a car safely.² The more alcohol consumed, the greater the impairment.

What does it mean to be above the legal limit for drinking?

The legal limit for drinking is the alcohol level above which an individual is subject to legal penalties (e.g., arrest or loss of a driver's license).

• Legal limits are measured using either a blood alcohol test or a breathalyzer.
• Legal limits are typically defined by state law, and may vary based on individual characteristics, such as age and occupation.

All states in the United States have adopted 0.08% (80 mg/dL) as the legal limit for operating a motor vehicle for drivers aged 21 years or older. However, drivers younger than 21 are not allowed to operate a motor vehicle with any level of alcohol in their system.

Note: Legal limits do not define a level below which it is safe to operate a vehicle or engage in some other activity. Impairment due to alcohol use begins to occur at levels well below the legal limit.

How do I know if it’s okay to drink?

The current Dietary Guidelines for Americans1 recommend that if you choose to drink alcoholic beverages, do not exceed 1 drink per day for women or 2 drinks per day for men. According to the guidelines, people who should not drink alcoholic beverages at all include the following:

• Children and adolescents.
• Individuals of any age who cannot limit their drinking to low level.
• Women who may become pregnant or who are pregnant.
• Individuals who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination.
• Individuals taking prescription or over-the-counter medications that can interact with alcohol.
• Individuals with certain medical conditions.
• Persons recovering from alcoholism.

What do you mean by heavy drinking?

For men, heavy drinking is typically defined as consuming an average of more than 2 drinks per day. For women, heavy drinking is typically defined as consuming an average of more than 1 drink per day.

What is binge drinking?

According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or more. This pattern of drinking usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.³

What is the difference between alcoholism and alcohol abuse?

Alcohol abuse⁴ is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. Manifestations of alcohol abuse include the following:

• Failure to fulfill major responsibilities at work, school, or home.
• Drinking in dangerous situations, such as drinking while driving or operating machinery.
• Legal problems related to alcohol, such as being arrested for drinking while driving or for physically hurting someone while drunk.
• Continued drinking despite ongoing relationship problems that are caused or worsened by drinking.
• Long-term alcohol abuse can turn into alcohol dependence.

Dependency on alcohol, also known as alcohol addiction and alcoholism4, is a chronic disease. The signs and symptoms of alcohol dependence include—

• A strong craving for alcohol.
• Continued use despite repeated physical, psychological, or interpersonal problems.
• The inability to limit drinking.

What does it mean to get drunk?

“Getting drunk” or intoxicated is the result of consuming excessive amounts of alcohol. Binge drinking typically results in acute intoxication.

Alcohol intoxication can be harmful for a variety of reasons, including—

• Impaired brain function resulting in poor judgment, reduced reaction time, loss of balance and motor skills, or slurred speech.
• Dilation of blood vessels causing a feeling of warmth but resulting in rapid loss of body heat.
• Increased risk of certain cancers, stroke, and liver diseases (e.g., cirrhosis), particularly when excessive amounts of alcohol are consumed over extended periods of time.
• Damage to a developing fetus if consumed by pregnant women.⁵
• Increased risk of motor-vehicle traffic crashes, violence, and other injuries.

Coma and death can occur if alcohol is consumed rapidly and in large amounts.

How do I know if I have a drinking problem?

Drinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a drinking problem, consult your personal health care provider.

What can I do if I or someone I know has a drinking problem?

Consult your personal health care provider if you feel you or someone you know has a drinking problem. Other resources include the National Drug and Alcohol Treatment Referral Routing Service available at 1-800-662-HELP. This service can provide you with information about treatment programs in your local community and allow you to speak with someone about alcohol problems.⁶

What health problems are associated with excessive alcohol use?

Excessive drinking both in the form of heavy drinking or binge drinking, is associated with numerous health problems, including—

• Chronic diseases such as liver cirrhosis (damage to liver cells); pancreatitis (inflammation of the pancreas); various cancers, including liver, mouth, throat, larynx (the voice box), and esophagus; high blood pressure; and psychological disorders.
• Unintentional injuries, such as motor-vehicle traffic crashes, falls, drowning, burns and firearm injuries.
• Violence, such as child maltreatment, homicide, and suicide.
• Harm to a developing fetus if a woman drinks while pregnant, such as fetal alcohol spectrum disorders.
• Sudden infant death syndrome (SIDS).
• Alcohol abuse or dependence.

I’m young. Is drinking bad for my health?

Yes.^{7, 8} Studies have shown that alcohol use by youth and young adults increases the risk of both fatal and nonfatal injuries.^{9, 10, 11} Research has also shown that youth who use alcohol before age 15 are five times more likely to become alcohol dependent than adults who begin drinking at age 21.¹² Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.^{13, 14, 15}

Is it okay to drink when pregnant?

No. There is no safe level of alcohol use during pregnancy. Women who are pregnant or plan on becoming pregnant should refrain from drinking alcohol.¹⁶ Several conditions, including Fetal Alcohol Spectrum Disorders have been linked to alcohol use during pregnancy. Women of child bearing age should also avoid binge drinking to reduce the risk of unintended pregnancy and potential exposure of a developing fetus to alcohol.

References

1. United States Department of Agriculture and United States Department of Health and Human Services. In: Dietary Guidelines for Americans. Chapter 9 – Alcoholic Beverages. Washington, DC: US Government Printing Office; 2005, p. 43–46. Available at the U.S. Government Health Web Site Accessed March 28, 2008.

2. National Highway Traffic Safety Administration. Accessed March 28, 2008.

3. National Institute of Alcohol Abuse and Alcoholism. NIAAA council approves definition of binge drinking [PDF–1.6Mb] NIAAA Newsletter 2004;3:3.

4. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), published by the American Psychiatric Association, Washington D.C., 1994.

5. Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorders. Available at the CDC Website. Accessed March 31, 2008.

6. Substance Abuse and Mental Health Services Administration. Available at SAMHSA. Accessed March 28, 2008.

7. Bonnie RJ and O’Connell ME, editors. National Research Council and Institute of Medicine, Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2004.

8. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. Rockville, MD: U.S. Department of Health and Human Services; 2007. Available at the Surgeon General's Web Site. Accessed March 28, 2008.

9. Hingson RW, Heeren T, Jamanka A, Howland J. Age of onset and unintentional injury involvement after drinking. JAMA 2000;284(12):1527–1533.

10. Hingson RW, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001. Annu Rev Public Health 2005;26:259–79.

11.Levy DT, Mallonee S, Miller TR, Smith GS, Spicer RS, Romano EO, Fisher DA. Alcohol involvement in burn, submersion, spinal cord, and brain injuries. Medical Science Monitor 2004;10(1):CR17–24.

12. Office of Applied Studies. The NSDUH Report: Alcohol Dependence or Abuse and Age at First Use. Rockville, MD: Substance Abuse and Mental Health Services Administration, October 2004. Available at SAMHSA. Accessed March 31, 2008.

13. Substance Abuse and Mental Health Services Administration. A Comprehensive Plan for Preventing and Reducing Underage Drinking. Washington, DC: 2006. Available at Stop Alcohol Abuse [PDF–513KB]. Accessed March 28, 2008.

14. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC. Available at theCDC Web Site. Accessed March 28, 2008.

15. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85.

16. Department of Health and Human Services. U.S. Surgeon General Releases Advisory on Alcohol Use in Pregnancy; urges women who are pregnant or who may become pregnant to abstain from alcohol. Released Monday, February 21, 2005. Available at the Surgeon General's Web Site. Accessed April 1, 2010.

CDC Alcohol and Public Health Frequently asked Questions

• Alcohol Use

(Data are for the U.S.)

Prevalence

• Percent of adults who were current regular drinkers (at least 12 drinks in the past year): 52%
• Percent of adults who were current infrequent drinkers (1-11 drinks in the past year): 13%

Source: Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009, table 27

Mortality

• Number of alcoholic liver disease deaths: 14,406
• Number of alcohol-induced deaths, excluding accidents and homicides: 23,199

Source: Deaths: Final Data for 2007, tables 12, 23

Source: Centers for Disease Control and Prevention

• Alcohol and Public Health

• Alcohol use is very common in our society. Drinking alcohol has immediate effects that can increase the risk of many harmful health conditions.
• Excessive alcohol use, either in the form of heavy drinking (drinking more than two drinks per day on average for men or more than one drink per day on average for women), or binge drinking (drinking 5 or more drinks during a single occasion for men or 4 or more drinks during a single occasion for women), can lead to increased risk of health problems such as liver disease or unintentional injuries.
• According to the Behavioral Risk Factor Surveillance System (BRFSS) survey, more than half of the adult U.S. population drank alcohol in the past 30 days. Approximately 5% of the total population drank heavily, while 15% of the population binge drank.
• According to the Alcohol-Related Disease Impact (ARDI) tool, from 2001–2005, there were approximately 79,000 deaths annually attributable to excessive alcohol use. In fact, excessive alcohol use is the 3rd leading lifestyle-related cause of death for people in the United States each year.
• Alcohol use poses additional problems for underage drinkers.

Centers for Disease Control and Prevention

• Underage Drinking

From the CDC Alcohol and Public Health.

Alcohol use by persons under age 21 years is a major public health problem.¹ Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs. Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.² More than 90% of this alcohol is consumed in the form of binge drinks.² On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.³ In 2008, there were approximately 190,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.⁴

Drinking Levels among Youth

The 2009 Youth Risk Behavior Survey⁵ found that among high school students, during the past 30 days

• 42% drank some amount of alcohol.
• 24% binge drank.
• 10% drove after drinking alcohol.
• 28% rode with a driver who had been drinking alcohol.

Other national surveys indicate

• In 2008 the National Survey on Drug Use and Health reported that 28% of youth aged 12 to 20 years drink alcohol and 19% reported binge drinking.⁶
• In 2009, the Monitoring the Future Survey reported that 37% of 8th graders and 72% of 12th graders had tried alcohol, and 15% of 8th graders and 44% of 12th graders drank during the past month.⁷

Consequences of Underage Drinking

Youth who drink alcohol^1,3,8 are more likely to experience

• School problems, such as higher absence and poor or failing grades.
• Social problems, such as fighting and lack of participation in youth activities.
• Legal problems, such as arrest for driving or physically hurting someone while drunk.
• Physical problems, such as hangovers or illnesses.
• Unwanted, unplanned, and unprotected sexual activity.
• Disruption of normal growth and sexual development.
• Physical and sexual assault.
• Higher risk for suicide and homicide.
• Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
• Memory problems.
• Abuse of other drugs.
• Changes in brain development that may have life-long effects.
• Death from alcohol poisoning.

In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.⁸

Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.^9,10

Prevention of Underage Drinking

Reducing underage drinking will require community-based efforts to monitor the activities of youth and decrease youth access to alcohol. Recent publications by the Surgeon General¹ and the Institute of Medicine³ outlined many prevention strategies that will require actions on the national, state, and local levels, such as enforcement of minimum legal drinking age laws, national media campaigns targeting youth and adults, increasing alcohol excise taxes, reducing youth exposure to alcohol advertising, and development of comprehensive community-based programs. These efforts will require continued research and evaluation to determine their success and to improve their effectiveness.

From the CDC Alcohol and Public Health.

References:

1.U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. Rockville, MD: U.S. Department of Health and Human Services; 2007. Available at Surgeon General's Web Site. Accessed March 28, 2008.

2.Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and Prevention Policy. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, 2005. Available at http://www.udetc.org/documents/Drinking_in_America.pdf [PDF–1.08MB]. Accessed March 28, 2008.

3.Bonnie RJ and O’Connell ME, editors. National Research Council and Institute of Medicine, Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2004.

4.Drug Abuse Warning Network, 2008: Selected Tables of National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Office of Applied Studies, SAMHSA, 2009. Available at https://dawninfo.samhsa.gov/data/default.asp?met=All. Accessed March 25,2010.

5.Eaton DK, Kann L, Kinchen SA, et al. Youth Risk Behavior Surveillance—United States, 2009. CDC Morb Mort Surveil Summ 2010;59(SS-5):1–148. Available athttp://www.cdc.gov/mmwr/PDF/ss/ss5905.pdf [PDF–3.5MB]. Accessed June 3, 2010.

6.Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD. Available at SAMHSA [PDF–1.46MB] . Accessed March 25, 2010.

7.Johnston, L D, O'Malley P M, Bachman, J G, & Schulenberg J E (December 14, 2009). "Teen Marijuana Use Tilts Up, While Some Drugs Decline in Use." University of Michigan News Service: Ann Arbor, MI. [Online]. Available at Monitoring the Future. Accessed March 25, 2010.

8.Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85.

9.Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Pediatrics 2006;160:739–746.

10.Office of Applied Studies. The NSDUH Report: Alcohol Dependence or Abuse and Age at First Use. Rockville, MD: Substance Abuse and Mental Health Services Administration, October 2004. Available at SAMHSA. Accessed March 31, 2008.

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