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Alcohol and society

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The 2010 ISCD study "Drug Harms in the UK: a multi-criteria decision analysis" found that alcohol scored highest overall and in Economic cost, Injury, Family adversities, Environmental damage, and Community harm.

Alcohol and society are closely intertwined, as it is widely consumed and legally permitted in most countries around the globe, despite its potential to lead to various issues.[1] According to a 2024 World Health Organization (WHO) report, these harmful consequences of alcohol use result in 2.6 million deaths annually, accounting for 4.7% of all global deaths.[2]

Evolving alcohol norms

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Alcohol education

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Main article: Alcohol education

Alcohol education is the planned provision of information and skills relevant to living in a world where alcohol is commonly misused.[3] WHO Global Status Report on Alcohol and Health, highlights the fact that alcohol will be a larger problem in later years, with estimates suggesting it will be the leading cause of disability and death.[4]

Denormalization

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In October 2024, the WHO Regional Office for Europe launched the "Redefine alcohol" campaign to address alcohol-related health risks, as alcohol causes nearly 1 in 11 deaths in the region. The campaign aims to raise awareness about alcohol's link to over 200 diseases, including several cancers, and to encourage healthier choices by sharing research and personal stories. It also calls for stricter regulation of alcohol to reduce its societal harm. This initiative is part of the WHO/EU Evidence into Action Alcohol Project, which seeks to reduce alcohol-related harm across Europe.[5]

Intermittent sobriety

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Intermittent sobriety refers to planned periods of abstinence from alcohol, often as part of awareness campaigns or personal health initiatives.[6][7]

Notable examples include:

  • Dry January: An annual campaign encouraging people to abstain from alcohol for the month of January.
  • Dry July: A similar initiative held in July, often with a fundraising component for cancer-related charities.
  • Ocsober: An October-based challenge to abstain from alcohol.

Sober curious

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See also: Brief intervention
Global per capita alcohol consumption has shown a downward trajectory since the 20th century, suggesting a shift towards prioritizing health and well-being.

Sober curious is a cultural movement and lifestyle of consuming no or limited alcohol that started in the late 2010s.[citation needed] It differs from traditional abstinence in that it is not founded on asceticism, religious condemnation of alcohol or previous alcohol abuse, but motivated by a curiosity of a sober lifestyle. Markets have reacted by offering a wider selection of non-alcoholic beverages.[8]

Sober curiosity is often defined as having the option to question or change one's drinking habits, for mental or physical health reasons.[9] It may be practised in many ways, ranging from complete abstinence to more thought about when and how much is consumed.[10]

Since the onset of the COVID-19 pandemic, more people in Europe have reduced their alcohol consumption.[11]

Usage

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Consumption recommendations

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Share of over-fifteen-year-old population who have not drunk alcohol in the past year (interactive version); in most countries, it exceeds a third.
Main article: Alcohol consumption recommendations

The recommended maximum intake (or safe limits) of alcohol varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The WHO published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health".[12]

According to the U.S. Department of Agriculture, based on NHANES 2013–2014 surveys, women in the US ages 20 and up consume on average 6.8 grams/day and men consume on average 15.5 grams/day.[13] A March 2023 review found light-moderate daily drinking not significantly associated with increased mortality rate, but higher intake raises risk, with women affected at lower levels than men.[14] However, according to a 2024 systematic review and meta-analysis, even at 20 g/day (1 large beer), the risk of developing an alcohol use disorder (AUD) is nearly 3 times higher than non-drinkers, and the risk of dying from an AUD is about 2 times higher than non-drinkers.[15]

Drinking culture

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See also: Drinking culture and List of countries by alcohol consumption per capita
Great British Beer Festival, London

Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. Many students attending colleges, universities, and other higher education institutions consume alcoholic beverages. However, there are often restrictions on alcohol sale and use, for instance a minimum age for drinking and laws against public drinking and drinking and driving.[16] A 2024 meta-analysis found that alcohol consumption increased on average each year, with the most significant rise occurring between the ages of 12 and 13. Drinking peaked around 22 years old, then began to decline at 24.[17]

Alcohol holds considerable societal and cultural significance, playing a role in social interactions across much of the world. Drinking establishments, such as bars and nightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Alcohol is related to various societal problems, including drunk driving, accidental injuries, sexual assaults, domestic abuse, and violent crime.[18] Alcohol remains illegal for sale and consumption in a number of countries, mainly in the Middle East.

Research on the societal benefits of alcohol is rare, but a 2017 study suggested there it was beneficial.[19] Alcohol is often used as a social lubricant; it increases occurrences of Duchenne smiling, talking, and social bonding, even when participants are unaware of their alcohol consumption or lack thereof.[20] In a study of the UK, regular drinking was correlated with happiness, feeling that life was worthwhile, and life satisfaction. According to a causal path analysis the cause was vice versa; alcohol consumption was not the cause, but rather that the life satisfaction resulted in greater happiness and an inclination to visit pubs and develop a regular drinking venue. City centre bars were distinguished by their focus on maximizing alcohol sales. Community pubs had less variation in visible group sizes and longer, more focused conversations than those in city centre bars. Drinking regularly at a community pub led to higher trust in others and better networking with the local community, compared to non-drinkers and city centre bar drinkers.[19]

Global initiatives

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United Nations Sustainable Development Goal 3 is part of "The Alcohol Policy Playbook"

United Nations Sustainable Development Goal 3 is part of "The Alcohol Policy Playbook," which is a resource for reaching the goals of the WHO European Framework for Action on Alcohol (2022–2025) and the WHO Global Alcohol Action Plan (2022–2030).[21]

The Global Information System on Alcohol and Health (GISAH) is a tool developed by the WHO to collect and analyze data on alcohol consumption, related health issues, and policy responses in countries.[22]

The WHO's SAFER initiative aims to reduce alcohol-related harm through a comprehensive set of strategies. The components of the initiative are as follows:[23]

  • Strengthen restrictions on alcohol availability
  • Advance and enforce drink driving countermeasures
  • Facilitate access to screening, brief interventions, and treatment
  • Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion
  • Raise prices on alcohol through excise taxes and pricing policies

Psychosocial factors

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Research has shown that various psychosocial factors can influence alcohol consumption patterns throughout an individual's life.

A 2024 study from UT Southwestern Medical Center indicates that higher IQ during high school is linked to a greater likelihood of moderate or heavy drinking in midlife, with each one-point increase in IQ correlating to a 1.6% higher probability of such drinking. The study also found that this relationship is influenced by psychosocial factors, particularly income and career stress, highlighting the need for further research in diverse populations.[24][25]

Religion

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Main article: Religion and alcohol
A chaplain pouring sacramental wine from a cruet into a chalice

The relationship between religion and alcohol exhibits variations across cultures, geographical areas, and religious denominations. Some religions emphasize moderation and responsible use as a means of honoring the divine gift of life, while others impose outright bans on alcohol as a means of honoring the divine gift of life. Moreover, within the same religious tradition, there are many adherents that may interpret and practice their faith's teachings on alcohol in diverse ways. Hence, a wide range of factors, such as religious affiliation, levels of religiosity, cultural traditions, family influences, and peer networks, collectively influence the dynamics of this relationship.

The levels of alcohol use in spiritual context can be broken down into:

  • Prohibition: Some religions, including Islam[26] prohibit alcohol consumption.
  • Symbolic use: In some Christian denominations, the sacramental wine is alcoholic, however, only a sip is taken, and it does not raise the blood alcohol content, and other denominations are using nonalcoholic wine. See also Libation.
  • Discourage consumption: Hinduism does not have a central authority which is followed by all Hindus, though religious texts generally discourage the use or consumption of alcohol.
  • Inebriating spiritual use: See the spiritual section.

Secularity

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In some cultures, including those with religious traditions, consuming alcohol in moderation to celebrate joyful occasions is accepted in a non-religious, secular context.

During the Jewish holiday of Purim, Jews are obligated to drink (especially Kosher wine) until their judgmental abilities become impaired according to the Book of Esther.[27][28][29] However, Purim has more of a national than a religious character.

Misconceptions

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While the terms "drug" and "medicine" are sometimes used interchangeably, "drug" can have a negative connotation, often associated with illegal substances like cocaine or heroin.[30]

The term narcotic usually refers to opiates or opioids, which are called narcotic analgesics. In common parlance and legal usage, it is often used imprecisely to mean illicit drugs, irrespective of their pharmacology.[31] However, in countries with alcohol prohibition, it is classified and treated as a narcotic. Also, research acknowledges that alcohol can have similar effects to narcotics in head and/or trunk trauma situations.[32] In addition to these findings, recent research indicates that among chronic pain patients on long-term opioid therapy, alcohol consumption is connected to heightened opioid cravings.[33]

The normalization of alcohol consumption,[34] along with past misconceptions about its health benefits, also promoted by the industry,[35] further reinforces the mistaken idea that it is not a "drug". Even within the realm of scientific inquiry, the common phrase "drugs and alcohol" persists, implying that alcohol is somehow separate from other drugs.

Criticism of the alcohol industry may note that the industry argues that "alcohol is not a drug".[36][37] Also, some religious organizations, such as the Catholic Church, requires alcoholic sacramental wine in the Eucharist and do not explicitly categorize alcohol as a "drug" in the same manner as illicit substances.[38][39] This practice has been a longstanding tradition within the Church, reflecting its historical, theological significance, and normalization of alcohol use within its rituals. However, the term "Alcohol and Other Drugs", a term frequently used by public health authorities, emphasizes this inclusion by grouping alcohol with other substances that alter mood and behavior.

Paradoxically, despite being legal, alcohol, scientifically classified as a drug, has demonstrably been linked to greater social harm than most illegal drugs.[40][41] This contradicts the perception some hold of alcohol being a harmless substance.

Law

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Alcohol packaging warning messages

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Main article: Alcohol packaging warning messages
Intervention alcohol warning labels (actual size 5.0 cm × 3.2 cm each). The label intervention included three rotating labels: (a) a cancer warning, (b) national drinking guidelines, and (c) standard drink information (four separate labels were developed for wine, spirits, coolers, and beer; wine example shown above)

Alcohol packaging warning messages (alcohol warning labels, AWLs[42]) are warning messages that appear on the packaging of alcoholic drinks concerning their health effects.

A WHO report, published in 2017, stated:[43]

Alcohol product labelling could be considered as a component of a comprehensive public health strategy to reduce alcohol-related harm. Adding health labels to alcohol containers is an important first step in raising awareness and has a longer-term utility in helping to establish a social understanding of the harmful use of alcohol.

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Main articles: Alcohol law, Prohibition, and Legal drinking age
Sobriety checkpoint in Stralsund, Germany

Alcohol consumption is fully legal and available in most countries of the world.[1] Home made alcoholic beverages with low alcohol content like wine, and beer is also legal in most countries, but distilling moonshine outside of a registered distillery remains illegal in most of them.

Some majority-Muslim countries, such as Saudi Arabia, Kuwait, Pakistan, Iran and Libya prohibit the production, sale, and consumption of alcoholic beverages because they are forbidden by Islam.[44][45][46] Laws banning alcohol consumption are found in some Indian states as well as some Native American reservations in the U.S.[1]

In addition, there are regulations on alcohol sales and use in many countries throughout the world.[1] For instance, the majority of countries have a minimum legal drinking age to purchase or consume alcoholic beverages, although there are often exceptions such as underage consumption of small amounts of alcohol with parental supervision. Also, some countries have bans on public intoxication.[1] Drinking while driving or intoxicated driving is frequently outlawed and it may be illegal to have an open container of alcohol or liquor bottle in an automobile, bus or aircraft.[1]

In Iran, consumption of alcohol (one glass) is punished by 80 lashes, but repeated offences may lead to death penalty, although rarely exercised. In 2012, two men were sentenced to death after a third offense in Khorasan.[47][48]

Minimum pricing policies

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The "R" in WHO's SAFER initiative stands for "Raise prices on alcohol through excise taxes and pricing policies," emphasizing the importance of economic measures to mitigate alcohol-related harm.[23]

The Alcohol (Minimum Pricing) (Scotland) Act 2012 is an Act of the Scottish Parliament, which introduces a statutory minimum price for alcohol, initially 50p per unit, as an element in the programme to counter alcohol problems.

The Liquor Act 2019 is an act enacted and signed into legislation by the Northern Territory Legislative Assembly in 2019, which introduces a statutory minimum price for alcohol inorder to counter alcohol problems.

The Public Health (Minimum Price for Alcohol) (Wales) Act 2018 (anaw 5) is an Act of the National Assembly for Wales, which introduces a statutory minimum price for alcohol, initially 50p per unit, as an element in the programme to counter alcohol problems.

Austria, Switzerland and Germany determine that a barkeeper has to offer one or more non-alcoholic beverages at a cheaper price than any alcoholic drink. Before the so-called Apfelsaft-Paragraph (applejuice clause) was established in Germany in 2002 beer was often the cheapest beverage available.

Criticism of the alcohol industry

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Main article: Criticism of the alcohol industry
An Absolut LGBT marketing flyer in Portland, Oregon. The LGBT+ community has historically suffered from higher levels of substance abuse than non-LGBT+ individuals.

A 2019 survey conducted by the American Institute for Cancer Research (AICR) showed that only 45% of Americans were aware of the associated risk of cancer due to alcohol consumption, up from 39% in 2017.[49] The AICR believes that alcohol advertising about the healthy cardiovascular benefits of modest alcohol overshadow messages about the increased cancer risks.[49]

The alcohol industry has tried to market its products to appeal to impressionable youth and young adults.[50]

Drinking alcoholic beverages increase the risk for breast cancer. Several studies indicate that the use of marketing by the alcohol industry to associate their products with breast cancer awareness campaigns, known as pinkwashing, is misleading and potentially harmful.[51][52][53][54]

The alcohol industries have marketed products directly to the LGBT+ community. In 2010, of the sampled parades that listed sponsors, 61% of the prides were sponsored by the alcohol industry.[55] A study found that alcohol consumption within LGBTQ+ communities presents a challenge for health promotion efforts. The positive association with alcohol within these communities makes it harder to reduce alcohol-related health issues.[56]

Standard drink

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Main article: Standard drink

A standard drink is a measure of alcohol consumption representing a fixed amount of pure ethanol, used in relation to recommendations about alcohol consumption and its relative risks to health. The size of a standard drink varies from 8g to 20g across countries, but 10g alcohol (12.7 millilitres) is used in the WHO Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example,[57] and has been adopted by more countries than any other amount.[58]

Social issues

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Table from the 2010 DrugScience study ranking various drugs (legal and illegal) based on statements by drug-harm experts. This study rated alcohol the most harmful drug overall, and the only drug more harmful to others than to the users themselves.[40]
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational substances. Alcohol was ranked 2nd in social harm, 6th in dependence, and 11th in physical harm.[41]
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Main article: Alcohol-related crime

Alcohol use is stereotypically associated with crime,[59] both violent and non-violent.[18] Some crimes are uniquely tied to alcohol, such as public intoxication or underage drinking, while others are simply more likely to occur together with alcohol consumption. Crime perpetrators are much more likely to be intoxicated than crime victims. Many alcohol laws have been passed to criminalize various alcohol-related activities.[59][60] Underage drinking and drunk driving are the most prevalent alcohol-specific offenses in the United States[59] and a major problem in many countries worldwide.[61][62][63] About one-third of arrests in the United States involve alcohol misuse,[18] and arrests for alcohol-related crimes constitute a high proportion of all arrests made by police in the U.S. and elsewhere.[64] In general, programs aimed at reducing society's consumption of alcohol, including education in schools, are seen as an effective long-term solution. Strategies aiming to reduce alcohol consumption among adult offenders have various estimates of effectiveness.[65] Policing alcohol-related street disorder and enforcing compliance checks of alcohol-dispensing businesses has proven successful in reducing public perception of and fear of criminal activities.[59]

In the early 2000s, the monetary cost of alcohol-related crime in the United States alone has been estimated at over $205 billion, twice the economic cost of all other drug-related crimes.[66] In a similar period in the United Kingdom, the cost of crime and its antisocial effects was estimated at £7.3 billion.[65] Another estimate for the UK for yearly cost of alcohol-related crime suggested double that estimate, at between £8 and 13 billion.[67] Risky patterns of drinking are particularly problematic in and around Russia, Mexico and some parts of Africa.[68] Alcohol is more commonly associated with both violent and non-violent crime than are drugs like marijuana.[18]

Passive drinking, like passive smoking, refers to the damage done to others as a result of drinking alcoholic beverages. These include the unborn fetus and children of parents who drink excessively, drunk drivers, accidents, domestic violence and alcohol-related sexual assaults[69]

Public-order crimes

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See also: Passive drinking

Public-order crimes caused by drinking include drunk driving, domestic violence, and alcohol-related sexual assaults.

Automobile accidents
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Main articles: Drunk driving and Driving under influence
An Estonian billboard warning against drunk driving

A 2002 study found 41% of people fatally injured in traffic accidents were in alcohol-related crashes.[70] Misuse of alcohol is associated with more than 40% of deaths that occur in automobile accidents every year.[18] The risk of a fatal car accident increases exponentially with the level of alcohol in the driver's blood.[71]

Most countries have passed laws prohibiting driving a motor vehicle while impaired by alcohol. In the U.S., these crimes are generally referred to as driving under the influence (DUI), although there are many naming variations among jurisdictions, such as driving while intoxicated (DWI).[72] With alcohol consumption, a drunk driver's level of intoxication is typically determined by a measurement of blood alcohol content or BAC; but this can also be expressed as a breath test measurement, often referred to as a BrAC. A BAC or BrAC measurement in excess of the specific threshold level, such as 0.08% in the U.S.,[73] defines the criminal offense with no need to prove impairment.[74] In some jurisdictions, there is an aggravated category of the offense at a higher BAC level, such as 0.12%, 0.15% or 0.25%. In many jurisdictions, police officers can conduct field tests of suspects to look for signs of intoxication.

Negligence
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Shards of broken beer bottles

Negligence in alcohol consumption can have a ripple effect on environmentally responsible behavior. Examples:

  • Consuming alcoholic beverages, which increases urine production and reduces social inhibitions, can lead to public urination. Public urination is illegal in most areas.
  • Improper disposal of alcohol bottles is a common problem. Many are not recycled or left behind in public spaces. Discarded alcoholic beverage containers, especially broken glass shards that are difficult to remove, does not only create an eyesore but may also cause flat tires for cyclists, injure wildlife or kids.
  • Alcohol consumption can contribute to nighttime noise pollution, especially through loud music played by intoxicated individuals. This disrupts sleep and relaxation for nearby residents, impacting health and productivity. Municipal noise ordinances often establish quiet hours and penalties for violations.
  • People under the influence may forget to extinguish outdoor fireplaces, which may create a fire hazard since unchecked fires can escalate into wildfires.
  • Drunk cyclists can only be charged if they ride dangerously, cause a crash, or behave disruptively.[75] However, cycling under the influence increases the risk of severe injury, hospital resource use, and even death, according to a study highlighting the importance of safe cycling practices.[76]
Public drunkenness
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Main articles: Public intoxication and Drunk walking
A man in Saint Petersburg, resting on the ground on a summer night, shows signs of intoxication.

Public drunkenness or intoxication is a common problem in many jurisdictions. Public intoxication laws vary widely by jurisdiction, but include public nuisance laws, open-container laws, and prohibitions on drinking alcohol in public or certain areas. The offenders are often lower class individuals and this crime has a very high recidivism rate, with numerous instances of repeated instances of the arrest, jail, release without treatment cycle. The high number of arrests for public drunkenness often reflects rearrests of the same offenders.[64]

Sexual assaults
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Main articles: Alcohol and sex and Beer goggles

Rape is any sexual activity that occurs without the freely given consent of one of the parties involved. This includes alcohol-facilitated sexual assault which is considered rape in most if not all jurisdictions,[77] or non-consensual condom removal which is criminalized in some countries (see the map below).

A 2008 study found that rapists typically consumed relatively high amounts of alcohol and infrequently used condoms during assaults, which was linked to a significant increase in STI transmission.[78] This also increase the risk of pregnancy from rape for female victims. Some people turn to drugs or alcohol to cope with emotional trauma after a rape; use of these during pregnancy can harm the fetus.[79]

Alcohol-facilitated sexual assault
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Most sexual assaults occur when the victim has consumed alcohol, rather than "spiked" drinks.[80]
See also: Campus sexual assault

One of the most common date rape drugs is alcohol,[81][82][83] administered either surreptitiously[84] or consumed voluntarily,[81] rendering the victim unable to make informed decisions or give consent. The perpetrator then facilitates sexual assault or rape, a crime known as alcohol- or drug-facilitated sexual assault (DFSA).[85][77][86] However, sex with an unconscious victim is considered rape in most if not all jurisdictions, and some assailants have committed "rapes of convenience" whereby they have assaulted a victim after he or she had become unconscious from drinking too much.[87] The risk of individuals either experiencing or perpetrating sexual violence and risky sexual behavior increases with alcohol abuse,[88] and by the consumption of caffeinated alcoholic drinks.[89][90]

Non-consensual condom removal
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  Court decision declaring stealthing as rape or sexual assault
  Law prohibiting stealthing

Non-consensual condom removal, or "stealthing",[91] is the practice of a person removing a condom during sexual intercourse without consent, when their sex partner has only consented to condom-protected sex.[92][93] Purposefully damaging a condom before or during intercourse may also be referred to as stealthing,[94] regardless of who damaged the condom.

Consuming alcohol can be risky in sexual situations. It can impair judgment and make it difficult for both people to give or receive informed sexual consent. However, a history of sexual aggression and alcohol intoxication are factors associated with an increased risk of men employing non-consensual condom removal and engaging in sexually aggressive behavior with female partners.[95][96]

Wartime sexual violence
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The use of alcohol is a documented factor in wartime sexual violence.

For example, rape during the liberation of Serbia was committed by Soviet Red Army soldiers against women during their advance to Berlin in late 1944 and early 1945 during World War II. Serbian journalist Vuk Perišić said about the rapes: "The rapes were extremely brutal, under the influence of alcohol and usually by a group of soldiers. The Soviet soldiers did not pay attention to the fact that Serbia was their ally, and there is no doubt that the Soviet high command tacitly approved the rape."[97]

While there was not a codified international law specifically prohibiting rape during World War II, customary international law principles already existed that condemned violence against civilians. These principles formed the basis for the development of more explicit laws after the war,[98] including the Nuremberg Principles established in 1950.

Violent crime
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Main article: Violent crime
Photo of an empty bottle of Buckfast Tonic Wine
In certain parts of Scotland, the caffeinated alcoholic drink Buckfast Tonic Wine (originally made by monks at Buckfast Abbey) is associated with drinkers who are prone to committing anti-social behaviour when drunk.[99]

The WHO has noted that out of social problems created by the harmful use of alcohol, "crime and violence related to alcohol consumption" are likely the most significant issue.[68] In the United States, 15% of robberies, 63% of intimate partner violence incidents, 37% of sexual assaults, 45–46% of physical assaults and 40–45% of homicides (murders) involved use of alcohol.[100][66] A 1983 study for the United States found that 54% of violent crime perpetrators, arrested in that country, had been consuming alcohol before their offenses.[64] In 2002, it was estimated that 1 million violent crimes in the U.S. were related to alcohol use.[18] More than 43% of violent encounters with police involve alcohol.[18] Alcohol is implicated in more than two-thirds of cases of intimate partner violence.[18] Studies also suggest there may be links between alcohol abuse and child abuse.[59] In the United Kingdom, in 2015/2016, 39% of those involved in violent crimes were under alcohol influence.[101] A significant portion, 40%, of homicide victims tested positive for alcohol in the US.[102] International studies are similar, with an estimate that 63% of violent crimes worldwide involves the use of alcohol.[66]

The relation between alcohol and violence is not yet fully understood, as its impact on different individuals varies.[citation needed] Studies and theories of alcohol abuse suggest, among others, that use of alcohol likely reduces the offender's perception and awareness of consequences of their actions.[83][59][64][103] Heavy drinking is associated with vulnerability to injury, marital discord, and domestic violence.[18] Moderate drinkers are more frequently engaged in intimate violence than are light drinkers and abstainers, however generally it is heavy and/or binge drinkers who are involved in the most chronic and serious forms of aggression. Research found that factors that increase the likelihood of alcohol-related violence include difficult temperament, hyperactivity, hostile beliefs, history of family violence, poor school performance, delinquent peers, criminogenic beliefs about alcohol's effects, impulsivity, and antisocial personality disorder. The odds, frequency, and severity of physical attacks are all positively correlated with alcohol use. In turn, violence decreases after behavioral marital alcoholism treatment.[59]

Methanol laced alcohol

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Main articles: List of methanol poisoning incidents and Alcohol congener analysis
Russian poster warning people about the dangers of drinking methanol.

Outbreaks of methanol poisoning have occurred when methanol is used to lace moonshine (bootleg liquor).[104] This is commonly done to bulk up the original product to gain profit.

India has a thriving moonshine industry, and methanol-tainted batches have killed over 2,000 people in the last 3 decades.

Methanol is a toxic alcohol. If as little as 10 mL (about 1/4th of a US standard shot size (44 mL)) of pure methanol is ingested, for example, it can break down into formic acid, which can cause permanent blindness by destruction of the optic nerve, and 30 mL is potentially fatal,[105] although the median lethal dose is typically 100 mL (3.4 fl oz) (i.e. 1–2 mL/kg body weight of pure methanol[106]). Reference dose for methanol is 2.0 mg/kg/day.[107] Toxic effects take hours to start, and effective antidotes can often prevent permanent damage.[105]

Distinguishing between safe, drinkable ethanol and toxic methanol is extremely challenging through sight, or touch alone, especially when drunk, which dramatically impairs sensory perception and judgment. It is crucial to emphasize that suspected methanol should never be tasted due to its high toxicity; even small amounts can lead to severe health consequences or death. Also, a flame color testing may not be reliable. Both ethanol and methanol are primary alcohols, meaning they have a hydroxyl group (-OH) attached to a terminal carbon atom in their molecular structure. This structural similarity contributes to their comparable physical characteristics and underscores the difficulty in differentiating them through casual observation or sensory perception alone. A proper chemical analysis should be performed by a qualified chemist to accurately distinguish between the two substances.

Alternative routes of administration

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Alternative methods of alcohol administration like alcohol enema, alcohol inhalation, vodka eyeballing, or using alcohol powder (which can be added to water to make an alcoholic beverage, or inhaled with a nebulizer), all carry significant health risks.

Binge drinking

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Main article: Binge drinking
Binge drinking can prompt police action for public intoxication and disturbing the peace.

Binge drinking is a style of drinking that is popular in several countries worldwide, and overlaps somewhat with social drinking since it is often done in groups. The degree of intoxication however, varies between and within various cultures that engage in this practice. A binge on alcohol can occur over hours, last up to several days, or in the event of extended abuse, even weeks. Due to the long term effects of alcohol abuse, binge drinking is considered to be a major public health issue.[108]

Binge drinking is more common in males, during adolescence and young adulthood. Heavy regular binge drinking is associated with adverse effects on neurologic, cardiac, gastrointestinal, hematologic, immune, and musculoskeletal organ systems as well as increasing the risk of alcohol induced psychiatric disorders.[109][110] A US-based review of the literature found that up to one-third of adolescents binge-drink, with 6% reaching the threshold of having an alcohol-related substance use disorder.[111] Approximately one in 25 women binge-drinks during pregnancy, which can lead to fetal alcohol syndrome and fetal alcohol spectrum disorders.[112] Binge drinking during adolescence is associated with traffic accidents and other types of accidents, violent behavior as well as suicide. The more often a child or adolescent binge drinks and the younger they are the more likely that they will develop an alcohol use disorder including alcoholism. A large number of adolescents who binge-drink also consume other psychotropic substances.[113]

Drinking games

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Neknominate have resulted in several deaths due to alcohol poisoning.[114][115]

Drinking games are popular social activities, particularly among young adults and college students, but they come with significant health risks. These games often encourage rapid alcohol consumption, often leading to binge drinking, which can result in severe consequences such as alcohol poisoning:

  • Beer pong. Some writers have mentioned beer pong as contributing to "out of control" college drinking.[116][117][118]
  • Power hour. Players may have difficulty completing the specified number of drinks as the rate of consumption can raise their blood alcohol content to high levels.[119][120]
  • Keg stand is another drinking game known for its extreme consumption style.[116]
  • Neknominate. The original rules of the game require the participants to film themselves drinking a pint of an alcoholic beverage. Five people are believed to have died as a result of playing the game, including a Cardiff man thought to have downed a pint of vodka,[114] and a London hostel worker who reportedly mixed an entire bottle of white wine with a quarter bottle of whisky, a small bottle of vodka and a can of lager.[115] In the latter case, the victim's nominator was interviewed by police, but it was ruled an accidental death without coercion.[121]

Emotional issues

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In emotional self-regulation, some people turn to drugs such as alcohol. Drug use, an example of response modulation, can be used to alter emotion-associated physiological responses. For example, alcohol can produce sedative and anxiolytic effects.[122] A 2013 study found that immature defense mechanisms are linked to placing a higher value on junk food, alcohol, and television.[123]

There is a two-way street between loneliness and drinking. People who drink more than once a week tend to feel lonelier, according to a study on Japanese workers during the COVID-19 pandemic.[124] On the other hand, feelings of loneliness can also lead people to drink more, as shown in a separate study.[125] Loneliness is a major risk factor for depression and alcoholism.[126]

Hurtful communication

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Alcohol may cause hurtful communication.

Drunk dialing

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Main article: Drunk dialing

Drunk dialing refers to an intoxicated person making phone calls that they would not likely make if sober, often a lonely individual calling former or current love interests.

A 2021 study, that examined the relationship between drunk texting and emotional dysregulation, found a positive correlation. The findings suggest that interventions targeting emotional regulation skills may be beneficial.[127]

In vino veritas

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Main article: In vino veritas

In vino veritas is a Latin phrase that means 'in wine, there is truth', suggesting a person under the influence of alcohol is more likely to speak their hidden thoughts and desires.

Parental supervision of alcohol consumption for minors

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See also: Alcoholism in adolescence and Alcoholism in family systems
Not to be confused with Straw purchase.

Some parents are willing to provide alcohol for their children if they drink it in a controlled environment. Furnishing alcohol to one's own children is permitted in 31 states, while it's illegal to do so for other people's children in all fifty states.[128] However, despite research indicating negative consequences, many parents mistakenly believe that providing alcohol to their underage children will protect them from drinking-related harm. This misconception persists even though studies have shown a connection between parental alcohol supply and unfavorable outcomes related to alcohol consumption among minors.[129] Parental provision of alcohol during childhood may raise the risk of risky drinking in adolescence. However, methodological limitations hinder causal conclusions. To clarify this relationship, more robust longitudinal studies are needed that differentiate between sips and full drinks, accurately measure confounding factors, and apply multivariable adjustments.[130]

Parental attitudes that are less restrictive regarding children's alcohol consumption are linked to an earlier onset of alcohol use, increased frequency of use, and higher instances of drunkenness among children. Additionally, when children perceive their parents as having more lenient attitudes towards alcohol, they are more likely to engage in drinking themselves.[131] Adolescents permitted to drink by their parents were more likely to quickly move from their first drink to binge drinking (5 or more drinks at once) and heavy drinking (3 or more times in the past year). These findings contradict the belief that parental approval of underage drinking protects against alcohol misuse, highlighting the risks associated with adolescent heavy drinking.[132]

Parents may face significant legal consequences in various countries and jurisdictions if they knowingly allow their children to drink alcohol without supervision. This liability arises from a perceived failure to protect the child from the risks associated with alcohol consumption, which could lead to investigations by child protective services.

Risky sexual behavior

[edit]
Main article: Alcohol and sex

Some studies have made a connection between hookup culture and substance use.[133] Most students said that their hookups occurred after drinking alcohol.[133][134][135] Frietas stated that in her study, the relationships between drinking and the party scene and between alcohol and hookup culture were "impossible to miss".[136]: 41 

Studies suggest that the degree of alcoholic intoxication in young people directly correlates with the level of risky behavior,[137] such as engaging in multiple sex partners.[138]

In 2018, the first study of its kind, found that alcohol and caffeinated energy drinks is linked with casual, risky sex among college-age adults.[90]

Sexually transmitted infections and unintended pregnancy

[edit]
For alcohol-related environments linked to sexually transmitted infections in the LGBTQ culture, see Circuit party and gay bar.
A 0-0-1-3 media campaign poster specifically highlighting that responsible alcohol use may prevent risky sexual behavior that often results in unplanned pregnancy

Alcohol intoxication is associated with an increased risk that people will become involved in risky sexual behaviors, such as unprotected sex.[139] Both men,[140] and women,[141] reported higher intentions to avoid using a condom when they were intoxicated by alcohol.

Coitus interruptus, also known as withdrawal, pulling out or the pull-out method, is a method of birth control during penetrative sexual intercourse, whereby the penis is withdrawn from a vagina or anus prior to ejaculation so that the ejaculate (semen) may be directed away in an effort to avoid insemination.[142][143] Coitus interruptus carries a risk of sexually transmitted infections (STIs) and unintended pregnancy. This risk is especially high during alcohol intoxication because lowered sexual inhibition can make it difficult to withdraw in time.

Women with unintended pregnancies are more likely to smoke tobacco,[144] drink alcohol during pregnancy,[145][146] and binge drink during pregnancy,[144] which results in poorer health outcomes.[145] (See also: fetal alcohol spectrum disorder)

The relationship between drinking alcohol and how HIV develops and progresses in people has been the subject of prior research investigations.[147][148][149][150][151] To date, HIV has been recognized as an alcohol-attributable STI in the WHO’s most recent comparative risk assessment or related exercises.[152]

Societal damage

[edit]

Alcohol causes a plethora of detrimental effects in society.[18] A 2023 systematic review estimated the societal costs of alcohol use to be around 2.6% of the GDP.[153] Many emergency room visits involve alcohol use.[18] Alcohol availability and consumption rates and alcohol rates are positively associated with nuisance, loitering, panhandling, and disorderly conduct in public space.[59]

A 2011 study challenged the perception of heroin as the more dangerous substance. The research suggests, when considering the wider social, physical, and financial costs, alcohol may be more harmful.[154]

Individuals who engage with or share alcohol-related content on social networking services tend to exhibit higher levels of alcohol use and related issues.[155]

College

[edit]
Main article: Alcohol use among college students
A house party used to draw huge crowds of college-aged people celebrating an alcohol-aided rite of Spring.

Many students attending colleges, universities, and other higher education institutions consume alcoholic beverages. The laws and social culture around this practice vary by country and institution type, and within an institution, some students may drink heavily whereas others may not drink at all. In the United States, drinking tends to be particularly associated with fraternities.

List of hazing deaths in the United States highlights a troubling trend, as there has been at least one university hazing death each year from 1969 to 2021.[156] Over 200 university hazing deaths have occurred since 1838, with 40 deaths between 2007 and 2017 alone.[157] Alcohol poisoning is the biggest cause of death.[157]

Alcohol abuse among college students refers to unhealthy alcohol drinking behaviors by college and university students. While the legal drinking age varies by country, the high number of underage students that consume alcohol has presented many problems and consequences for universities. The causes of alcohol abuse tend to be peer pressure, fraternity or sorority involvement, and stress. College students who abuse alcohol can suffer from health concerns, poor academic performance or legal consequences. Prevention and treatment include campus counseling, stronger enforcement of underage drinking or changing the campus culture.

Recent research indicates that the abundance of alcohol retailers and the availability of inexpensive alcoholic beverages are linked to heavy alcohol consumption among college students.[158]

Homelessness

[edit]
A man lies on the street next to his belongings after having been drinking.

Conditions such as alcoholism and mental illness are often associated with homelessness.[159] For people in Russia, especially the youth, alcohol, and substance use is a major cause and reason for becoming and continuing to be homeless.[160] Also, street children from areas with limited resources have reported a high lifetime prevalence of substance use. The most commonly used substances are inhalants, followed by tobacco, alcohol, and marijuana.[161]

[edit]

Overwork is linked to an increased risk of unhealthy alcohol consumption.[162] Also, unemployment can heighten the risk of alcohol consumption and smoking.[163] As many as 15% of employees show problematic alcohol-related behaviors in the workplace, such as drinking before going to work or even drinking on the job.[18]

Occupational risks
[edit]
A United States Forces Korea poster, warning soldiers not to engage in prostitution or purchase a "bar fine", here referred to as a "night off"

A bargirl is a woman who is paid to entertain patrons in a bar or nightclub. A bar fine is a payment made by a customer to the operators of a bar or nightclub in East and Southeast Asia, allowing her to leave work early, typically to accompany a customer outside for sexual services.[164] Female sex workers in low- and middle-income countries have high rates of harmful alcohol use, which is associated with increased risk of risky sexual behavior.[165] Screening carried out in the 1990s in Malawi, an African country, indicated that about 80 per cent of bargirls carried the HIV virus. Research carried out at the time indicated that economic necessity was a major consideration in engaging and persisting in sex work.[166]

A 2022 study found that bartenders experience high levels of hazardous alcohol and drug use, particularly among those working over 40 hours a week, with males and individuals aged 26–40 exhibiting the most problematic consumption, underscoring the need for targeted preventative interventions and further investigation into the underlying risk factors.[167]

Poverty

[edit]
A man on the street of Moscow asks for money for alcoholic drinks.

Alcohol consumption can contribute to secondary poverty (where people fall back into poverty after escaping it). The Bureau of Labor Statistics found that "the average American consumer dedicates 1 percent of all their spending to alcohol".[168]

Unsustainable tourism

[edit]

Some popular tourist destinations, are cracking down on the impacts of tourism from excessive drinking. In an effort to promote a more sustainable tourism industry, these locations are implementing new regulations to curb binge drinking. This includes Llucmajor, Palma, Calvia (Magaluf) in Majorca and Sant Antoni in Ibiza, where late-night sales of alcohol will be banned. This comes after years of issues with rowdy tourists and the negative impacts it has on local residents.[169]

Suicide

[edit]
The Drunkard's Progress: from the first glass to the grave, shows how a single drink starts an arc that ends in suicide.

Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide,[170] with alcoholism present in between 15% and 61% of cases.[171] Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide.[172] About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide.[172] Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past.[171] In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.[173]

Surrogate alcohol

[edit]

In December 2016, 78 people died from drinking surrogate alcohol in the Russian city of Irkutsk.[174]

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