Alcohol

When talking about alcohol, the term usually refers to ethanol (ethyl alcohol). Ethanol is a chemical compound produced through the fermentation process. [1] Alcoholic beverages are divided into mild (e.g., beers, ciders, and wines) and strong ones (e.g., liquors, whiskies, and cognacs). [2]

Legal status: In Finland, alcoholic beverages may contain a maximum of 80% alcohol by volume. Persons aged 18 or over may purchase and possess mild alcoholic beverages (up to 22%), while those aged 20 or over may purchase and possess strong alcoholic beverages (more than 22%). Alcoholic beverages must not be possessed unless they have been legally produced or imported. Pure alcohol (over 80%) may not be manufactured, imported, sold, used, or possessed without a license from Valvira. [3]

How does it work?

Alcohol affects the nervous system by influencing neurotransmitters called GABA and glutamate. The effect is primarily a depressant on the central nervous system. [4] [5] Most ethanol is absorbed from the upper part of the small intestine. This means that alcohol has a slower onset and weaker effects when consumed with food. [5] Blood alcohol levels peak approximately 60 minutes after drinking. [1] [5] [6]

Alcohol’s effects depend on various factors including gender, body weight, age, and hormonal influences. Some individuals are genetically more sensitive to alcohol than others. [7] [8]

At low doses, when blood alcohol concentration is below 0.5 per mille, alcohol typically has stimulating effects, including relaxation, reduced anxiety, increased sociability, and talkativeness. [1] [6] As the blood alcohol level rises, the depressant effects on brain activity become more pronounced.

At higher doses, approaching or exceeding 1–2 per mille, alcohol can cause dramatic mood swings, slurred speech, loss of balance, and impaired judgment. Memory blackouts are also common. [1] [6] Blood alcohol levels of 3–5 per mille are potentially life-threatening unless significant tolerance has developed. [1] [9]

Intoxication is considered the most harmful effect of alcohol. It significantly increases the risk of accidents and other adverse consequences. [10]

Key risks

Acute risks: In large doses, alcohol can cause coma, respiratory depression, and death. [6] A high level of intoxication is already a sign of poisoning. The condition is considered severe if the intoxicated person does not respond to sound or pain. [8]

Motor clumsiness and impaired brain function caused by alcohol intoxication pose a traffic hazard. [7] Driving a car requires precisely the cognitive skills that alcohol impairs: attention, reaction time, decision-making, and impulse control. [11] [12] Alcohol also increases the risk of accidents outside of traffic. [12] In cold weather, there is a higher risk of hypothermia, as intoxicated individuals may mistakenly feel warm. This is due to alcohol’s vasodilatory effects. [7]

Although alcohol itself does not cause aggression, it increases it in certain individuals. This is likely due to alcohol’s impact on judgment and behavioral regulation. [7] Alcohol is commonly a contributing factor in domestic violence cases. [13]

Risks of polydrug use: Alcohol interacts with many medications. The most critical are other central nervous system depressants like benzodiazepines, opioids, and gabapentinoids (e.g., Lyrica), which enhance alcohol’s effects and vice versa. [5] [6] [14] [15] Combining alcohol with other depressants like GHB (gamma) or GBL (lakka) increases the risk of poisoning. [16] Additionally, it is advisable to avoid alcohol use with any psychiatric medications.

Risks of heavy use: The risks of heavy and prolonged alcohol use are well known. Alcohol can damage almost every organ in the body, with the liver and brain being the most affected. [6] [17]

Over 90% of alcohol metabolism occurs in the liver. [6] Over time, this strain can lead to various liver diseases such as alcoholic hepatitis or cirrhosis. [1] [6] [17] [18] In heavy users, brain volume decreases as alcohol reduces dendrites and cell size in neurons. [17]

Alcohol use is particularly risky in adolescence: heavy drinking during brain development can impair working memory, attention, spatial perception, and executive functioning. [17] [19]

Long-term use also harms the digestive system, pancreas, and heart, and increases blood pressure. [1] [6] [18] Alcohol raises the risk for at least seven types of cancer—particularly in the digestive tract and breast cancer in women. [20] Even moderate consumption can increase cancer risk. [21] Alcohol also negatively affects sexuality, hormone function, and the immune system. [1] [6]

Adverse mental health effects include anxiety, restlessness, irritability, mood swings, sadness, phobias, lack of motivation, reduced pleasure, mental fatigue, and problems with memory and concentration. [22] Heavy drinking in men is associated with an increased risk of depression, while findings for women are more inconsistent. [23]

Around half of heavy drinkers experience memory issues and difficulty learning new information. Full dementia-like symptoms occur in about 10% of them. [24]

Stopping heavy drinking after several weeks can trigger delirium tremens. In some cases, intoxication delirium can even develop during a drinking episode. Delirium tends to recur with smaller alcohol amounts and, if repeated, may evolve into schizophrenia.

Another form of alcohol-induced psychosis is alcoholic hallucinosis, characterized mainly by auditory hallucinations without confusion. This state begins either during alcohol use or within 1–2 weeks of cessation and typically resolves within a month. Memory disorders caused by alcohol and vitamin B1 deficiency can also resemble psychosis. [25]

Dependence: One of the long-term harms associated with alcohol use is the development of dependence. [1] Genetic factors increase the risk of developing alcohol dependence. [26]

Psychological dependence manifests as a compulsive urge to drink. Physical dependence becomes evident after prolonged use, with withdrawal symptoms appearing when use is stopped. [27]

Physical withdrawal symptoms can include tremors, palpitations, insomnia, and anxiety. Without treatment, these symptoms can escalate and lead to delirium tremens. Alcoholic delirium may involve hallucinations and psychotic behavior. [1] [6]

With repeated use, tolerance to alcohol’s effects develops. This means that a greater amount of alcohol is required to achieve the same effect. Tolerance can triple in just a few weeks. [6] [28] This increases the risk of health problems.

People dependent on alcohol often also have mental health disorders, most commonly mood and anxiety disorders. The risk of depression is higher in heavy drinkers than in moderate users. Those with depression are advised to avoid alcohol, as they tend to experience more severe alcohol-related problems. [23]

Use during pregnancy: Alcohol use during pregnancy affects all of the fetus’s organs and, among other things, destroys fetal brain cells. [29]

The developmental disorders caused by alcohol exposure are collectively referred to as FASD (Fetal Alcohol Spectrum Disorders). The most severe form is Fetal Alcohol Syndrome (FAS), which includes both physical anomalies and cognitive impairments.

Other diagnoses include partial FAS (PFS), ARBD (Alcohol-Related Birth Defect) for congenital anomalies, and ARND (Alcohol-Related Neurobehavioral Disorder) for central nervous system damage. [29] [30] Alcohol should not be consumed at all during pregnancy. [13] [29]

How can risks be reduced?

Substance use always carries risks. No completely safe level of alcohol consumption has been identified. [31]

However, risks can be reduced by consuming alcohol in moderation and infrequently.

For healthy working-age men, the risk of alcohol-related harm is low when drinking 0–2 units per day; for women, the safe range is 0–1 units per day.

Risk becomes moderate at 14 units per week for men and 7 for women. High-risk levels are reached at 23–24 units per week for men and 12–16 units for women. [20]

You can assess your alcohol consumption using self-assessment tools like drinking behavior tests.

The risk of accidents increases significantly with heavy binge drinking. [20] Drinking rapidly also increases the chance of overdose and alcohol poisoning. [8]

If someone who has consumed alcohol becomes unconscious or passes out, they should be placed in the recovery position to reduce the risk of choking on vomit and ensure that their airway stays clear.

If the person responds to voice or touch, there is no immediate need to go to the hospital.

If the intoxicated person does not respond at all, emergency medical attention is needed. [32]

When treated in time, alcohol poisoning is usually not fatal. [8]