Alcohol and health

Alcohol (also known as ethanol) has a number of effects on health. Short-term effects of alcohol consumption include intoxication and dehydration. Long-term effects of alcohol consumption include changes in the metabolism of the liver and brain and alcoholism. Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. Alcohol stimulates insulin production, which speeds up glucose metabolism and can result in low blood sugar, causing irritability and possibly death for diabetics.[1] Even light and moderate alcohol consumption increases cancer risk in individuals.[2][3] A 2014 World Health Organization report found that harmful alcohol consumption caused about 3.3 million deaths annually worldwide.[4] Negative efforts are related to the amount consumed with no safe lower limit seen.[5] Some nations have introduced alcohol packaging warning messages that inform consumers about alcohol and cancer, as well as foetal alcohol syndrome.[6]

The median lethal dose of alcohol in test animals is a blood alcohol content of 0.45%. This is about six times the level of ordinary intoxication (0.08%), but vomiting or unconsciousness may occur much sooner in people who have a low tolerance for alcohol.[7] The high tolerance of chronic heavy drinkers may allow some of them to remain conscious at levels above 0.40%, although serious health hazards are incurred at this level.

Alcohol also limits the production of vasopressin (ADH) from the hypothalamus and the secretion of this hormone from the posterior pituitary gland. This is what causes severe dehydration when alcohol is consumed in large amounts. It also causes a high concentration of water in the urine and vomit and the intense thirst that goes along with a hangover.

Stress, hangovers, and the oral contraceptive pill may increase the desire for alcohol because these things will lower the level of testosterone and alcohol will acutely elevate it.[8] Tobacco has the same effect of increasing the craving for alcohol.[9]

Alcohol and health

Short-term effects

The short-term effects of alcohol consumption range from a decrease in anxiety and motor skills at lower doses to unconsciousness, anterograde amnesia, and central nervous system depression at higher doses. Cell membranes are highly permeable to alcohol, so once alcohol is in the bloodstream it can diffuse into nearly every cell in the body.

The concentration of alcohol in blood is measured via blood alcohol content (BAC). The amount and circumstances of consumption play a large part in determining the extent of intoxication; for example, eating a heavy meal before alcohol consumption causes alcohol to absorb more slowly.[10] Hydration also plays a role, especially in determining the extent of hangovers. After excessive drinking, unconsciousness can occur and extreme levels of consumption can lead to alcohol poisoning and death (a concentration in the blood stream of 0.40% will kill half of those affected[11]). Alcohol may also cause death indirectly, by asphyxiation from vomit.

Alcohol can greatly exacerbate sleep problems. During abstinence, residual disruptions in sleep regularity and sleep patterns are the greatest predictors of relapse.[12]

Long-term effects

Possible long-term effects of ethanol

According to the World Health Organization's 2018 Global Status Report on Alcohol and Health, there are more than 3 million people who die from the harmful effects of alcohol each year, which amounts to more than 5% of the burden of disease world-wide.[13] The US National Institutes of Health similarly estimates that 3.3 million deaths (5.9% of all deaths) were believed to be due to alcohol each year.[14]

Guidelines in the US and the UK advise that if people choose to drink, they should drink moderately.[15][16]

Even light and moderate alcohol consumption increases cancer risk in individuals, especially with respect to squamous cell carcinoma of the esophagus, oropharyngeal cancer, and breast cancer.[2][3]

A systematic analysis of data from the Global Burden of Disease Study, which was an observational study, found that long term consumption of any amount of alcohol is associated with an increased of risk of death in all people, and that even moderate consumption appears to be risky. Similar to prior analyses, it found an apparent benefit for older women in reducing the risks of death from ischemic heart disease and from diabetes, but unlike prior studies it found those risks cancelled by an apparent increased risk of death from breast cancer and other causes.[17] A 2016 systematic review and meta-analysis found that moderate ethanol consumption brought no mortality benefit compared with lifetime abstention from ethanol consumption.[18] Risk is greater in younger people due to binge drinking which may result in violence or accidents.[19]

Long-term heavy use of alcohol damages nearly every organ and system in the body.[20] Risks include alcoholism, malnutrition, chronic pancreatitis, alcoholic liver disease and cancer. In addition, damage to the central nervous system and peripheral nervous system can occur from chronic alcohol abuse.[21][22]

The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol.[23]

Pregnancy

Medical organizations strongly discourage drinking alcohol during pregnancy.[24][25][26] Alcohol passes easily from the mother's bloodstream through the placenta and into the bloodstream of the fetus,[27] which interferes with brain and organ development.[28] Alcohol can affect the fetus at any stage during pregnancy, but the level of risk depends on the amount and frequency of alcohol consumed.[28] Regular heavy drinking and binge drinking (four or more drinks on any one occasion) pose the greatest risk for harm, but lesser amounts can cause problems as well.[28] There is no known safe amount or safe time to drink during pregnancy, and the U.S. CDC recommends complete abstinence for women who are pregnant, trying to become pregnant, or are sexually active and not using birth control.[29][30]

Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASDs). The most severe form of FASD is fetal alcohol syndrome (FAS).[29] Problems associated with FASD include facial anomalies, low birth weight, stunted growth, small head size, delayed or uncoordinated motor skills, hearing or vision problems, learning disabilities, behavior problems, and inappropriate social skills compared to same-age peers.[31][32] Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and develop substance use disorders themselves.[31]

Breastfeeding

The National Health Service states that "an occasional drink is unlikely to harm" a breastfed baby, and recommends consumption of "no more than one or two units of alcohol once or twice a week" for breastfeeding mothers (where a pint of beer or 50 ml drink of a spirit such as whisky corresponds to about two units of alcohol).[33] The NHS also recommends to wait for a couple of hours before breastfeeding or express the milk into a bottle before drinking.[33] Researchers have shown that intoxicated breastfeeding reduces the average milk expression but poses no immediate threat to the child as the amount of transferred alcohol is insignificant.[34]

Alcohol education

Alcohol education is the practice of disseminating information about the effects of alcohol on health, as well as society and the family unit.[35] It was introduced into the public schools by temperance organizations such as the Woman's Christian Temperance Union in the late 19th century.[35] Initially, alcohol education focused on how the consumption of alcoholic beverages affected society, as well as the family unit.[35] In the 1930s, this came to also incorporate education pertaining to alcohol's effects on health.[35] Organizations such as the National Institute on Alcohol Abuse and Alcoholism in the United States were founded to promulgate alcohol education alongside those of the temperance movement, such as the American Council on Alcohol Problems.[35][36]

Alcohol expectations

Alcohol expectations are beliefs and attitudes that people have about the effects they will experience when drinking alcoholic beverages. They are just largely beliefs about alcohol's effects on a person’s behaviors, abilities, and emotions. Some people believe that if alcohol expectations can be changed, then alcohol abuse might be reduced. Men tend to become more aggressive in laboratory studies in which they are drinking only tonic water but believe that it contains alcohol. They also become less aggressive when they believe they are drinking only tonic water, but are actually drinking tonic water that contains alcohol.[37]

The phenomenon of alcohol expectations recognizes that intoxication has real physiological consequences that alter a drinker's perception of space and time, reduce psychomotor skills, and disrupt equilibrium.[38] The manner and degree to which alcohol expectations interact with the physiological short-term effects of alcohol, resulting in specific behaviors, is unclear.

A single study found that if a society believes that intoxication leads to sexual behavior, rowdy behavior, or aggression, then people tend to act that way when intoxicated. But if a society believes that intoxication leads to relaxation and tranquil behavior, then it usually leads to those outcomes. Alcohol expectations vary within a society, so these outcomes are not certain.[39]

People tend to conform to social expectations, and some societies expect that drinking alcohol will cause disinhibition. However, in societies in which the people do not expect that alcohol will disinhibit, intoxication seldom leads to disinhibition and bad behavior.[38]

Alcohol expectations can operate in the absence of actual consumption of alcohol. Research in the United States over a period of decades has shown that men tend to become more sexually aroused when they think they have been drinking alcohol—even when they have not been drinking it. Women report feeling more sexually aroused when they falsely believe the beverages they have been drinking contained alcohol (although one measure of their physiological arousal shows that they became less aroused).

Drug treatment programs

Most addiction treatment programs encourage people with drinking problems to see themselves as having a chronic, relapsing disease that requires a lifetime of attendance at 12-step meetings to keep in check. However, some people do not develop lifelong problems.[40]

Alcohol abuse

Rational harm assessment of drugs radar plot
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Alcohol was ranked 6th in dependence, 11th in physical harm, and 2nd in social harm.[41]

Alcohol abuse prevention programs

The Army at Fort Drum has taken the "0-0-1-3" and exchanged it for the new "0-1-2-3" described in the Prime-For-Life Program, which highlights the ill effects of alcohol abuse as more than just an individual’s "driving while intoxicated." The Prime-For-Life program identifies alcohol abuse to be a health and impairment problem, leading to adverse legal as well as health outcomes associated with misuse.

The 0-1-2-3 now represents low-risk guidelines:

  • 0 – Zero drinks for those driving a vehicle.
  • 1 – One drink per hour
  • 2 – No more than two drinking sessions per week
  • 3 – Not to exceed three drinks on any one day

Recommended maximum intake

Binge drinking is becoming a major problem in the UK. Advice on weekly consumption is avoided in United Kingdom.[42]

Since 1995 the UK government has advised that regular consumption of three to four units (one unit equates to 10 mL of pure ethanol) a day for men and or two to three units for women, would not pose significant health risks. However, consistently drinking more than four units a day (for men) and three units (women), is not advisable.[43]

Previously (from 1992 until 1995), the advice was that men should drink no more than 21 units per week, and women no more than 14.[44] (The difference between the sexes was due to the typically lower weight and water-to-body-mass ratio of women.) This was changed because a government study showed that many people were in effect "saving up" their units and using them at the end of the week, a phenomenon referred to as binge drinking. The Times reported in October 2007 that these limits had been "plucked out of the air" and had no scientific basis.[45]

Sobriety

Breathalyzer test 0013
A midshipman is subjected to a random breathalyzer test to determine sobriety.

Sobriety is the condition of not having any measurable levels, or effects from mood-altering drugs. According to WHO "Lexicon of alcohol and drug terms..." sobriety is continued abstinence from psychoactive drug use.[46] Sobriety is also considered to be the natural state of a human being given at a birth. In a treatment setting, sobriety is the achieved goal of independence from consuming or craving mind-altering substances. As such, sustained abstinence is a prerequisite for sobriety. Early in abstinence, residual effects of mind-altering substances can preclude sobriety. These effects are labeled "PAWS", or "post acute withdrawal syndrome". Someone who abstains, but has a latent desire to resume use, is not considered truly sober. An abstainer may be subconsciously motivated to resume drug use, but for a variety of reasons, abstains (e.g. such as a medical or legal concern precluding use).[47] Sobriety has more specific meanings within specific contexts, such as the culture of Alcoholics Anonymous, other 12 step programs, law enforcement, and some schools of psychology. In some cases, sobriety implies achieving "life balance".[48]

Injury and deaths

Injury is defined as damage or harm that is done or sustained.[49] The potential of injuring oneself or others can be increased after consuming alcohol due to the certain short term effects related to the substance such as lack of coordination, blurred vision, and slower reflexes to name a few.[50] Due to these effects the most common injuries include head, fall, and vehicle related injuries. These include a range of soft tissue damage and fractures. A study was conducted between 1 November 2001 and 30 June 2002 of patients admitted to the Ulster Hospital in Northern Ireland with fall related injuries. They found that 113 of those patients admitted to that hospital during that had consumed alcohol recently and that the injury severity was higher for those that had consumed alcohol compared to those that hadn't.[51] Another study showed that 21% of patients admitted to the Emergency Department of the Bristol Royal Infirmary had either direct or indirect alcohol related injuries. If these figures are extrapolated it shows that the estimated number of patients with alcohol related injuries are over 7000 during the year at this ED alone.[52]

In the United States alcohol resulted in about 88,000 deaths in 2010.[53] The World Health Organization calculated that more than 3 million people, mostly men, died as a result of harmful use of alcohol in 2016. This was about 13.5 % of the total deaths of people between 20 and 39. More than 5% of the global disease burden was caused by the harmful use of alcohol.[54]

Genetic differences

Alcohol flush and respiratory reactions

Alcohol flush reaction is a condition in which an individual's face or body experiences flushes or blotches as a result of an accumulation of acetaldehyde, a metabolic byproduct of the catabolic metabolism of alcohol. It is best known as a condition that is experienced by people of Asian descent. According to the analysis by HapMap Project, the rs671 allele of the ALDH2 gene responsible for the flush reaction is rare among Europeans and Africans, and it is very rare among Mexican-Americans. 30% to 50% of people of Chinese and Japanese ancestry have at least one ALDH*2 allele.[55] The rs671 form of ALDH2, which accounts for most incidents of alcohol flush reaction worldwide, is native to East Asia and most common in southeastern China. It most likely originated among Han Chinese in central China,[56] and it appears to have been positively selected in the past. Another analysis correlates the rise and spread of rice cultivation in Southern China with the spread of the allele.[57] The reasons for this positive selection aren't known, but it's been hypothesized that elevated concentrations of acetaldehyde may have conferred protection against certain parasitic infections, such as Entamoeba histolytica.[58]

The same SNP allele of ALDH2, also termed glu487lys, and the abnormal accumulation of acetaldehyde following the drinking of alcohol, is associated with the alcohol-induced respiratory reactions of rhinitis and asthma that occur in Eastern Asian populations.[59]

Metabolism of alcohol (ethanol) to acetaldehyde (ethanal) and then acetic acid (ethanoic acid)

American Indian alcoholism

While little detailed genetic research has been done, it has been shown that alcoholism tends to run in families with possible involvement of differences in alcohol metabolism and the genotype of alcohol-metabolizing enzymes.

Genetics and amount of consumption

Having a particular genetic variant (A-allele of ADH1B rs1229984) is associated with non-drinking and lower alcohol consumption. This variant is also associated with favorable cardiovascular profile and a reduced risk of coronary heart disease compared to those without the genetic variant, but it is unknown whether this may be caused by differences in alcohol consumption or by additional confounding effects of the genetic variant itself.[60]

Gender differences

Historically, according to the British Medical Journal, "men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes".[61] However, analysis of data collected over a century from multiple countries suggests that the gender gap in alcohol consumption is narrowing, and that young women (born after 1981) are consuming alcohol more than their male counterparts. Such findings have implications for the way in which alcohol-use prevention and intervention programs are designed and implemented.[62]

Alcoholism

Based on combined data from SAMHSA's 2004-2005 National Surveys on Drug Use & Health, the rate of past year alcohol dependence or abuse among people aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%).[63] Over time the difference between males and females has narrowed. According to a 2016 systematic review, for those born at the end of the 20th century men were 1.2 times as likely to drink to problematic levels, and 1.3 times as likely to develop health problems from drinking.[62]

Sensitivity

Several biological factors make women more vulnerable to the effects of alcohol than men.[64]

  • Body fat. Women tend to weigh less than men, and—pound for pound—a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, alcohol remains at higher concentrations for longer periods of time in a woman’s body, exposing her brain and other organs to more alcohol.
  • Enzymes. Women have lower levels of two enzymes—alcohol dehydrogenase and aldehyde dehydrogenase—that metabolize (break down) alcohol in the stomach and liver. As a result, women absorb more alcohol into their bloodstreams than men.
  • Hormones. Changes in hormone levels during the menstrual cycle may also affect how a woman metabolizes alcohol.

Metabolism

Females demonstrated a higher average rate of elimination (mean, 0.017; range, 0.014–0.021 g/210 L) than males (mean, 0.015; range, 0.013–0.017 g/210 L). Female subjects on average had a higher percentage of body fat (mean, 26.0; range, 16.7–36.8%) than males (mean, 18.0; range, 10.2–25.3%).[65]

Depression

The link between alcohol consumption, depression, and gender was examined by the Centre for Addiction and Mental Health (Canada). The study found that women taking antidepressants consumed more alcohol than women who did not experience depression as well as men taking antidepressants. The researchers, Dr. Kathryn Graham and a PhD Student Agnes Massak analyzed the responses to a survey by 14,063 Canadian residents aged 18–76 years. The survey included measures of quantity, frequency of drinking, depression and antidepressants use, over the period of a year. The researchers used data from the GENACIS Canada survey, part of an international collaboration to investigate the influence of cultural variation on gender differences in alcohol use and related problems. The purpose of the study was to examine whether, like in other studies already conducted on male depression and alcohol consumption, depressed women also consumed less alcohol when taking anti-depressants.[66] According to the study, both men and women experiencing depression (but not on anti-depressants) drank more than non-depressed counterparts. Men taking antidepressants consumed significantly less alcohol than depressed men who did not use antidepressants. Non-depressed men consumed 436 drinks per year, compared to 579 drinks for depressed men not using antidepressants, and 414 drinks for depressed men who used antidepressants. Alcohol consumption remained higher whether the depressed women were taking anti-depressants or not. 179 drinks per year for non-depressed women, 235 drinks for depressed women not using antidepressants, and 264 drinks for depressed women who used antidepressants. The lead researcher argued that the study "suggests that the use of antidepressants is associated with lower alcohol consumption among men suffering from depression. But this does not appear to be true for women."[67]

See also

  • Portal-puzzle.svg Alcohol and health portal

References

  1. ^ "Alcohol and diabetes: Drinking safely – Mayo Clinic".
  2. ^ a b Cheryl Platzman Weinstock (8 November 2017). "Alcohol Consumption Increases Risk of Breast and Other Cancers, Doctors Say". Scientific American. Retrieved 13 November 2018. The ASCO statement, published in the Journal of Clinical Oncology, cautions that while the greatest risks are seen with heavy long-term use, even low alcohol consumption (defined as less than one drink per day) or moderate consumption (up to two drinks per day for men, and one drink per day for women because they absorb and metabolize it differently) can increase cancer risk. Among women, light drinkers have a four percent increased risk of breast cancer, while moderate drinkers have a 23 percent increased risk of the disease.
  3. ^ a b Noelle K. LoConte, Abenaa M. Brewster, Judith S. Kaur, Janette K. Merrill, and Anthony J. Alberg (7 November 2017). "Alcohol and Cancer: A Statement of the American Society of Clinical Oncology". Journal of Clinical Oncology. 36 (1). Clearly, the greatest cancer risks are concentrated in the heavy and moderate drinker categories. Nevertheless, some cancer risk persists even at low levels of consumption. A meta-analysis that focused solely on cancer risks associated with drinking one drink or fewer per day observed that this level of alcohol consumption was still associated with some elevated risk for squamous cell carcinoma of the esophagus (sRR, 1.30; 95% CI, 1.09 to 1.56), oropharyngeal cancer (sRR, 1.17; 95% CI, 1.06 to 1.29), and breast cancer (sRR, 1.05; 95% CI, 1.02 to 1.08), but no discernable associations were seen for cancers of the colorectum, larynx, and liver.CS1 maint: Multiple names: authors list (link)
  4. ^ "Global status report on alcohol and health" (PDF). World Health Organization. 2014. pp. vii. Retrieved 23 November 2015.
  5. ^ Griswold, Max G.; Fullman, Nancy; Hawley, Caitlin; Arian, Nicholas; Zimsen, Stephanie R M.; Tymeson, Hayley D.; Venkateswaran, Vidhya; Tapp, Austin Douglas; Forouzanfar, Mohammad H.; Salama, Joseph S.; Abate, Kalkidan Hassen; Abate, Degu; Abay, Solomon M.; Abbafati, Cristiana; Abdulkader, Rizwan Suliankatchi; Abebe, Zegeye; Aboyans, Victor; Abrar, Mohammed Mehdi; Acharya, Pawan; Adetokunboh, Olatunji O.; Adhikari, Tara Ballav; Adsuar, Jose C.; Afarideh, Mohsen; Agardh, Emilie Elisabet; Agarwal, Gina; Aghayan, Sargis Aghasi; Agrawal, Sutapa; Ahmed, Muktar Beshir; Akibu, Mohammed; et al. (August 2018). "Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. 392 (10152): 1015–1035. doi:10.1016/S0140-6736(18)31310-2. PMID 30146330.
  6. ^ "Cancer warning labels to be included on alcohol in Ireland, minister confirms". Belfasttelegraph.co.uk. Belfast Telegraph. 26 September 2018.
  7. ^ Meyer, Jerold S. and Linda F. Quenzer. Psychopharmacology: Drugs, the Brain, and Behavior. Sinauer Associates, Inc.: Sunderland, Massachusetts. 2005. Page 228.
  8. ^ helsinki.fi – Effect of alcohol on hormones in women, Helsinki 2001
  9. ^ helsinki.fi – Clinical studies on dependence and drug effects Archived 21 February 2013 at the Wayback Machine, ESBRA 2009
  10. ^ Horowitz M, Maddox A, Bochner M, et al. (August 1989). "Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption". Am. J. Physiol. 257 (2 Pt 1): G291–8. doi:10.1152/ajpgi.1989.257.2.G291. PMID 2764113. Archived from the original on 2012-07-01.
  11. ^ "Carleton College: Wellness Center: Blood Alcohol Concentration (BAC)". Archived from the original on 14 September 2009. Retrieved 29 August 2015.
  12. ^ Feige B, Scaal S, Hornyak M, Gann H, Riemann D (January 2007). "Sleep electroencephalographic spectral power after withdrawal from alcohol in alcohol-dependent patients". Alcohol. Clin. Exp. Res. 31 (1): 19–27. doi:10.1111/j.1530-0277.2006.00260.x. PMID 17207097.
  13. ^ "WHO | Global status report on alcohol and health 2018".
  14. ^ "Alcohol Facts and Statistics". Retrieved 9 May 2015.
  15. ^ "Appendix 9. Alcohol - 2015-2020 Dietary Guidelines - health.gov". U.S. Department of Health and Human Services.
  16. ^ "New alcohol advice issued". NHS. 8 January 2016.
  17. ^ GBD 2016 Alcohol Collaborators (August 2018). "Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016". Lancet. 392 (10152): 1015–1035. doi:10.1016/S0140-6736(18)31310-2. PMC 6148333. PMID 30146330.
  18. ^ Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T (March 2016). "Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality". J Stud Alcohol Drugs. 77 (2): 185–98. PMC 4803651. PMID 26997174.
  19. ^ O'Keefe, JH; Bhatti, SK; Bajwa, A; DiNicolantonio, JJ; Lavie, CJ (March 2014). "Alcohol and cardiovascular health: the dose makes the poison...or the remedy". Mayo Clinic Proceedings. 89 (3): 382–93. doi:10.1016/j.mayocp.2013.11.005. PMID 24582196.
  20. ^ Caan, Woody; Belleroche, Jackie de, eds. (11 April 2002). Drink, Drugs and Dependence: From Science to Clinical Practice (1st ed.). Routledge. pp. 19–20. ISBN 978-0-415-27891-1.
  21. ^ Müller D, Koch RD, von Specht H, Völker W, Münch EM (March 1985). "Neurophysiologic findings in chronic alcohol abuse". Psychiatr Neurol Med Psychol (Leipz) (in German). 37 (3): 129–32. PMID 2988001.
  22. ^ Testino G (2008). "Alcoholic diseases in hepato-gastroenterology: a point of view". Hepatogastroenterology. 55 (82–83): 371–7. PMID 18613369.
  23. ^ Guerri, C.; Pascual, M.A. (2010)."Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence". Alcohol 44 (1) 15–26. doi:10.1016/j.alcohol.2009.10.003. PMID 20113871
  24. ^ Vice Admiral Richard H. Carmona (2005). "A 2005 Message to Women from the U.S. Surgeon General" (PDF). Retrieved 12 June 2015.
  25. ^ Committee to Study Fetal Alcohol Syndrome, Division of Biobehavioral Sciences and Mental Disorders, Institute of Medicine (1995). Fetal alcohol syndrome : diagnosis, epidemiology, prevention, and treatment. Washington, D.C.: National Academy Press. ISBN 978-0-309-05292-4.CS1 maint: Uses authors parameter (link)
  26. ^ "Australian Government National Health and Medical Research Council". Retrieved 4 November 2012.
  27. ^ Nathanson, Vivienne; Nicky Jayesinghe; George Roycroft (27 Oct 2007). "Is it all right for women to drink small amounts of alcohol in pregnancy? No". BMJ. 335 (7625): 857. doi:10.1136/bmj.39356.489340.AD. PMC 2043444. PMID 17962287.
  28. ^ a b c "Fetal Alcohol Exposure". April 2015. Retrieved 10 June 2015.
  29. ^ a b "Facts about FASDs". 16 April 2015. Retrieved 10 June 2015.
  30. ^ "More than 3 million US women at risk for alcohol-exposed pregnancy". Centers for Disease Control and Prevention. 2016-02-02. Retrieved 3 March 2016. 'drinking any alcohol at any stage of pregnancy can cause a range of disabilities for their child,' said Coleen Boyle, Ph.D., director of CDC's National Center on Birth Defects and Developmental Disabilities.
  31. ^ a b Coriale; et al. (2013). "Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment". Rivista di Psichiatria. 48 (5): 359–69. doi:10.1708/1356.15062. PMID 24326748.
  32. ^ Chudley; et al. (2005), "Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis", CMAJ, 172 (5 Suppl): S1–S21, doi:10.1503/cmaj.1040302, PMC 557121, PMID 15738468, retrieved 16 April 2016
  33. ^ a b Choices, N. H. S. (1 May 2017). "Breastfeeding and drinking alcohol – Pregnancy and baby guide – NHS Choices".
  34. ^ Haastrup, Maija Bruun; Pottegård, Anton; Damkier, Per (February 2014). "Alcohol and Breastfeeding". Basic & Clinical Pharmacology & Toxicology. 114 (2): 168–173. doi:10.1111/bcpt.12149. PMID 24118767. even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol
  35. ^ a b c d e Moore, Mark Harrison; Gerstein, Dean R. (1981). Alcohol and Public Policy. National Academies. p. 90–93.
  36. ^ Martin, Scott C. (2014). The SAGE Encyclopedia of Alcohol: Social, Cultural, and Historical Perspectives. SAGE Publications. ISBN 9781483374383.
  37. ^ Grattan, Karen E.; Vogel-Sprott, M. (2001). "Maintaining Intentional Control of Behavior Under Alcohol". Alcoholism: Clinical and Experimental Research. 25 (2): 192–7. doi:10.1111/j.1530-0277.2001.tb02198.x. PMID 11236832.
  38. ^ a b MacAndrew, C. and Edgerton. Drunken Comportment: A Social Explanation. Chicago: Aldine, 1969.
  39. ^ Marlatt GA, Rosenow (1981). "The think-drink effect". Psychology Today. 15: 60–93.
  40. ^ Szalavitz, Maia (14 May 2012). "DSM-5 Could Categorize 40% of College Students as Alcoholics". Time. Retrieved 31 January 2015.
  41. ^ Nutt, D; King, LA; Saulsbury, W; Blakemore, C (24 March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet. 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831.
  42. ^ "Sensible Drinking". Aim-digest.com. Archived from the original on 19 November 2010. Retrieved 2013-02-05.
  43. ^ "Alcohol misuse : Department of Health". Dh.gov.uk. Retrieved 2013-02-05.
  44. ^ "Alcohol and health: how alcohol can affect your long and short term health". Drinkaware.co.uk. Retrieved 2013-02-05.
  45. ^ Drink limits ‘useless’, The Times, 20 October 2007
  46. ^ "Lexicon and drug terms". Who.int. 2010-12-09. Retrieved 2013-02-05.
  47. ^ MD Basharin K.G. (2010). "Scientific grounding for sobriety: Western experience" (PDF). Retrieved 2013-02-05.
  48. ^ Twelve Steps and Twelve Traditions (PDF). Alcoholics Anonymous World Services. April 1953. ISBN 978-0-916856-01-4. Retrieved 31 December 2018. (Electronic .PDF version, September 2005).
  49. ^ "Dictionary.com".
  50. ^ "Drinkwise Australia". DrinkWise Australia.
  51. ^ McGovern & Johnston (26 July 2003). "Alcohol related falls: an interesting pattern of injuries". Emergency Medicine Journal. 21 (2): 185–188. doi:10.1136/emj.2003.006130.
  52. ^ Rebecca Hoskins; Jonathan Benger (2013). "What is the burden of alcohol-related injuries in an inner city emergency department?". Alcoholism: Clinical and Experimental Research. 33 (9): 1532–1538. doi:10.1111/j.1530-0277.2009.00981.x. PMC 2757258. PMID 19485974.
  53. ^ "Alcohol-Attributable Deaths and Years of Potential Life Lost — 11 States, 2006–2010". www.cdc.gov.
  54. ^ "Alcohol". World health Organization. 21 September 2018. Retrieved 5 November 2018.
  55. ^ "Rs671".
  56. ^ Hui Li; et al. (2009). "Refined Geographic Distribution of the Oriental ALDH2*504Lys (nee 487Lys) Variant". Ann Hum Genet. 73 (Pt 3): 335–45. doi:10.1111/j.1469-1809.2009.00517.x. PMC 2846302. PMID 19456322.
  57. ^ Yi Peng; Hong Shi; Xue-bin Qi; Chun-jie Xiao; Hua Zhong; Run-lin Z Ma; Bing Su (2010). "The ADH1B Arg47His polymorphism in East Asian populations and expansion of rice domestication in history". BMC Evolutionary Biology. 10 (1): 15. doi:10.1186/1471-2148-10-15. PMC 2823730. PMID 20089146.
  58. ^ Oota; et al. (2004). "The evolution and population genetics of the ALDH2 locus: random genetic drift, selection, and low levels of recombination". Annals of Human Genetics. 68 (2): 93–109. doi:10.1046/j.1529-8817.2003.00060.x.
  59. ^ Adams, Karla E.; Rans, Tonya S. (December 2013). "Adverse reactions to alcohol and alcoholic beverages". Annals of Allergy, Asthma & Immunology. 111 (6): 439–445. doi:10.1016/j.anai.2013.09.016. PMID 24267355.
  60. ^ Holmes, Michael V.; et al. (2014). "Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data". BMJ. 349: g4164. doi:10.1136/bmj.g4164. PMC 4091648. PMID 25011450.
  61. ^ "Women catching up with men in alcohol consumption and its associated harms" (PDF). BMJ Open (Press release). 25 October 2016.
  62. ^ a b Slade, Tim; Chapman, Cath; Swift, Wendy; Keyes, Katherine; Tonks, Zoe; Teesson, Maree (24 October 2016). "Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression" (PDF). BMJ Open. 6 (10): e011827. doi:10.1136/bmjopen-2016-011827. PMC 5093369. PMID 27797998.
  63. ^ "Gender differences in alcohol use and alcohol dependence or abuse: 2004 or 2005." The NSDUH Report. Accessed 22 June 2012.
  64. ^ "Women & Alcohol: The Hidden Risks of Drinking". Helpguide.org. Archived from the original on 3 January 2013. Retrieved 2013-02-05.
  65. ^ Cowan, JM Jr; Weathermon, A; McCutcheon, JR; Oliver, RD (Sep 1996). "Determination of volume of distribution for ethanol in male and female subjects". J Anal Toxicol. 20 (5): 287–90. doi:10.1093/jat/20.5.287. PMID 8872236.
  66. ^ "Antidepressants Help Men, But Not Women, Decrease Alcohol Consumption." Science Daily. 27 February 2007.
  67. ^ Graham, Katherine and Massak, Agnes. "Alcohol consumption and the use of antidepressants." UK PubMed Central (2007). 20 June 2012.

External links

Alcohol and weight

The relationship between alcohol and weight is the subject of inconclusive studies. Findings of these studies range from increase in body weight to a small decrease among women who begin consuming alcohol. Some of these studies are conducted with a large number of subjects; one involved nearly 80,000 and another 140,000 subjects.

Findings are inconclusive because alcohol itself contains 7 calories per gram, but research suggests that alcohol energy is not efficiently used. Alcohol also appears to increase metabolic rate significantly, thus causing more calories to be burned rather than stored in the body as fat (Klesges et al., 1994). Other research has found consumption of sugar to decrease as consumption of alcohol increases.According to Dr. Kent Bunting, the research results do not necessarily mean that people who wish to lose weight should continue to consume alcohol because consumption is known to have an enhancing effect on appetite. Due to these discrepancies in findings, the relationship between alcohol and weight remains unresolved and requires further research.

Biological and environmental factors are thought to contribute to alcoholism and obesity. The physiologic commonalities between excessive eating and excessive alcohol drinking shed light on intervention strategies, such as pharmaceutical compounds that may help those who suffer from both.

Some of the brain signaling proteins that mediate excessive eating and weight gain also mediate uncontrolled alcohol consumption. Some physiological substrates that underlie food intake and alcohol intake have been identified. Melanocortins, a group of signaling proteins, are found to be involved in both excessive food intake and alcohol intake.Alcohol may contribute to obesity. A study found frequent, light drinkers (three to seven drinking days per week, one drink per drinking day) had lower BMIs than infrequent, but heavier drinkers. Although calories in liquids containing ethanol may fail to trigger the physiologic mechanism that produces the feeling of fullness in the short term, long-term, frequent drinkers may compensate for energy derived from ethanol by eating less.

Alcohol dehydrogenase

Alcohol dehydrogenases (ADH) (EC 1.1.1.1) are a group of dehydrogenase enzymes that occur in many organisms and facilitate the interconversion between alcohols and aldehydes or ketones with the reduction of nicotinamide adenine dinucleotide (NAD+) to NADH. In humans and many other animals, they serve to break down alcohols that otherwise are toxic, and they also participate in generation of useful aldehyde, ketone, or alcohol groups during biosynthesis of various metabolites. In yeast, plants, and many bacteria, some alcohol dehydrogenases catalyze the opposite reaction as part of fermentation to ensure a constant supply of NAD+.

Alcohol industry

The alcohol industry, also known as Big Alcohol, is the commercial industry involved in the manufacturing, distribution, and sale of alcoholic beverages. The industry has been criticised in the 1990s for deflecting attention away from the problems associated with alcohol use. The alcohol industry has also been criticised for being unhelpful in reducing the harm of alcohol.The World Bank works with and invests in alcohol industry projects when positive effects with regard to public health concerns and social policy are demonstrated. Alcohol industry sponsored education to reduce the harm of alcohol actually results in an increase in the harm of alcohol. As a result, it has been recommended that the alcohol industry does not become involved in alcohol policy or educational programs.In the UK the New Labour government took the view that working with the alcohol industry to reduce harm was the most effective strategy. However, alcohol-related harm and alcohol abuse increased. The alcohol industry has been accused of exaggerating the health benefits of alcohol which is regarded as a potentially dangerous recreational drug with potentially serious adverse effects on health.Since ethanol was classified as Class I carcinogen and there is no safe dose of alcohol; the alcohol industry is considered one of main contributor to formation of

civilization or lifestyle diseases. The alcohol industry has tried to actively mislead the public about the risk of cancer due to alcohol consumption, in addition to campaigning to remove laws that require alcoholic beverages to have cancer warning labels.

Alcohol intolerance

Alcohol intolerance (or acute alcohol sensitivity) is due to a genetic polymorphism of the enzyme alcohol dehydrogenase, the enzyme that metabolises ingested alcohol. This polymorphism is most often reported in Asian patients. It can also be an effect or side effect associated with certain drugs such as disulfiram, metronidazole, or nilutamide. Stuffy nose and skin flushing are the most common symptoms upon the ingestion of alcohol. It may also be characterized as intolerance causing hangover symptoms similar to the "disulfiram-like reaction" of aldehyde dehydrogenase deficiency or chronic fatigue syndrome.

If people are intolerant, some nearly non-alcoholic beverages may be a problem, similar to alcohol-containing medications, vinegar, inhalation of alcohol or the vapour of alcohol-containing cleaning agents.

Drinking alcohol first or afterwards together with Calcium cyanamide, an inorganic compound used as a fertilizer, can cause permanent or long lasting intolerance (nitrolime disease), contributing together with other substances to the accumulation of harmful Acetaldehyde by inhibiting the enzyme acetaldehyde dehydrogenase.

Alcohol intoxication

Alcohol intoxication, also known as drunkenness or alcohol poisoning, is the negative behavior and physical effects due to the recent drinking of ethanol (alcohol). Symptoms at lower doses may include mild sedation and poor coordination. At higher doses, there may be slurred speech, trouble walking, and vomiting. Extreme doses may result in a decreased effort to breathe (respiratory depression), coma, or death. Complications may include seizures, aspiration pneumonia, injuries including suicide, and low blood sugar.Alcohol intoxication typically begins after two or more alcoholic drinks. Risk factors include a social situation where heavy drinking is common and a person having an impulsive personality. Diagnosis is usually based on the history of events and physical examination. Verification of events by the people a person was with may be useful. Legally, alcohol intoxication is often defined as a blood alcohol concentration (BAC) of greater than 5.4-17.4 mmol/L (25–80 mg/dL or 0.025-0.080%). This can be measured by blood or breath testing. Alcohol is then broken down at a rate of about 3.3 mmol/L (15 mg/dL) per hour.Management of alcohol intoxication involves supportive care. Typically this includes putting the person in the recovery position, keeping them warm, and making sure they are breathing sufficiently. Gastric lavage and activated charcoal have not been found to be useful. Repeated assessments may be required to rule out other potential causes of a person's symptoms.Alcohol intoxication is very common, especially in the Western world. Most people who drink alcohol have at some time been intoxicated. In the United States acute intoxication directly results in about 2,200 deaths per year, and indirectly more than 30,000 deaths per year. Acute intoxication has been documented throughout history and alcohol remains one of the world's most widespread recreational drugs. Some religions consider alcohol intoxication to be a sin.

Dipsomania

Dipsomania is a historical term describing a medical condition involving an uncontrollable craving for alcohol. In the 19th century, the term dipsomania was used to refer to a variety of alcohol-related problems, most of which are known today as alcoholism. Dipsomania is occasionally still used to describe a particular condition of periodic, compulsive bouts of alcohol intake. The idea of dipsomania is important for its historical role in promoting a disease theory of chronic drunkenness. The word comes from Greek dipso (Greek: "δίψα"= thirst) and mania.

It is still mentioned in the WHO ICD-10 classification as an alternative description for Alcohol Dependence Syndrome, episodic use F10.26

Dry January

Dry January is a public health campaign urging people to abstain from alcohol for the month of January, particularly practised in the United Kingdom. It is generally accepted where the New Year starts mid-week the Dry January commences the following Monday, allowing for a debaucherous start to the year before abstinence.

The campaign, as a formal entity, appears to be relatively recent, being described as having "sprung up in recent years" even in 2014. However, the Finnish government had launched a campaign called "Sober January" in 1942 as part of its war effort. The term "Dry January" was registered as a trademark by the charity Alcohol Concern in mid-2014; the first ever Dry January campaign by Alcohol Concern occurred in January 2013. In the leadup to the January 2015 campaign, for the first time Alcohol Concern partnered with Public Health England.In January 2014, according to Alcohol Concern, which initiated the campaign, over 17,000 Britons stopped drinking for that month. While there is controversy as to the efficacy and benefits of the practice, a 2014 survey by the University of Sussex found that six months following January 2014, out of 900 surveyed participants in the custom, 72% had "kept harmful drinking episodes down" and 4% were still not drinking.

Fetal alcohol spectrum disorder

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Problems may include an abnormal appearance, short height, low body weight, small head size, poor coordination, low intelligence, behavior problems, and problems with hearing or seeing. Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and have trouble with alcohol or other drugs. The most severe form of the condition is known as fetal alcohol syndrome (FAS). Other types include partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). Some accept only FAS as a diagnosis, seeing the evidence as inconclusive with respect to other types.Fetal alcohol spectrum disorders are caused by drinking alcohol during pregnancy. Surveys from the United States have found about 10% of pregnant women have drank alcohol in the last month, and 20% to 30% drank at some point during the pregnancy. About 4.7% of North American women who are pregnant are alcoholics. The risk of problems depends on the amount consumed and the frequency of consumption as well as when during pregnancy the alcohol is consumed. Other risk factors include an older mother, smoking, and poor diet. There is no known safe amount or safe time to drink during pregnancy. While drinking small amounts of alcohol does not cause abnormalities in the face, it may cause behavioral issues. Alcohol crosses the blood brain barrier and both directly and indirectly affects a developing baby. Diagnosis is based on signs and symptoms in the person.Fetal alcohol spectrum disorders are preventable by avoiding alcohol. For this reason, medical authorities recommend no alcohol during pregnancy or while trying to become pregnant. While the condition is permanent, treatment can improve outcomes. Interventions may include parent-child interaction therapy, efforts to modify child behavior, and possibly medications.FASD is estimated to affect between 2% and 5% of people in the United States and Western Europe. FAS is believed to occur in between 0.2 and 9 per 1000 live births in the United States. In South Africa, some populations have rates as high as 9%. The negative effects of alcohol during pregnancy have been described since ancient times. The lifetime cost per child with FAS was $2,000,000 in 2002 in the US. The term fetal alcohol syndrome was first used in 1973.

Gin Craze

The Gin Craze was a period in the first half of the 18th century when the consumption of gin increased rapidly in Great Britain, especially in London. Daniel Defoe commented: "the Distillers have found out a way to hit the palate of the Poor, by their new fashion'd compound Waters called Geneva, so that the common People seem not to value the French-brandy as usual, and even not to desire it". Many people overconsumed and the city had an epidemic of extreme drunkenness; this provoked moral outrage and a legislative backlash that some compare to the modern drug wars.

Parliament passed five major Acts, in 1729, 1736, 1743, 1747 and 1751, designed to control the consumption of gin. Though many similar drinks were available and alcohol consumption was considerable at all levels of society, gin caused the greatest public concern. Although it is commonly thought gin or Jenever was the singular drink, "gin" was a blanket statement for all grain-based alcohols at the time.

Health in Japan

The level of health in Japan is due to a number of factors including cultural habits, isolation, and a universal health care system. John Creighton Campbell, a professor at the University of Michigan and Tokyo University, told the New York Times in 2009 that Japanese people are the healthiest group on the planet. Japanese visit a doctor nearly 14 times a year, more than four times as often as Americans. Life expectancy in 2013 was 83.3 years - among the highest on the planet. A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. Japan had the highest level of expected human capital among the 20 largest countries: 24.1 health, education, and learning-adjusted expected years lived between age 20 and 64 years.

List of countries by beer consumption per capita

This is a list of countries ordered by annual per capita consumption of beer. Information not provided for some countries is not given in the available sources.

Macrocytosis

Macrocytosis is the enlargement of red blood cells with near-constant hemoglobin concentration, and is defined by a mean corpuscular volume (MCV) of greater than 100 femtolitres (the precise criterion varies between laboratories). The enlarged erythrocytes are called macrocytes or megalocytes (both words have roots meaning "big cell").

Michel Craplet

Michel Craplet is French psychiatrist, an expert in alcohol-related problems, their treatment and prevention. He is senior medical advisor of French Association Nationale de Prévention en Alcoologie et Addictologie (ANPAA).

Michel Craplet has been Chairman of European Alcohol Policy Alliance (Eurocare) since its creation in 1990, served as advisor to WHO's mission in Moldavia, and member of the expert group “Alcohol and Health” of the European Union.

Paddington alcohol test

The Paddington alcohol test (PAT) was first published in the Journal of Accident and Emergency Medicine in 1996. It was designed to identify alcohol-related problems amongst those attending accident and emergency departments. It concords well with the Alcohol Use Disorders Identification Test (AUDIT) questionnaire but is administered in a fifth of the time.When 40–70% of the patients in an accident and emergency department (AED) are there because of alcohol-related issues, it is useful for the staff of the AED to determine which of them are hazardous drinkers so that they can treat the underlying cause and offer brief advice which may reduce the health impact of alcohol for that patient. In accident and emergency departments it is also important to triage incoming patients as quickly as possible, to reduce staff size and cost. In one study, it took an average of 73 seconds to administer the AUDIT questionnaire but only 20 seconds for the PAT.The working version of the PAT is reviewed at St Mary's Hospital based on feedback from frontline doctors in the emergency department (A&E) (see below). There is also a modified version in use for an English multi-site programme research (Screening and Intervention Programme for Sensible Drinking, SIPS).The latest version of the PAT is available on the UK Department of Health website, the Alcohol Learning Centre.

Passive drinking

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 assaultsOn 2 February 2010 Eurocare, the European Alcohol Policy Alliance, organised a seminar on “The Social Cost of Alcohol : Passive drinking”. On 21 May 2010 the World Health Organization reached a consensus at the World Health Assembly on a resolution to confront the harmful use of alcohol.

Recommended maximum intake of alcoholic beverages

There is no global consensus on recommended maximum intake (or safe limits) of the drug alcohol (also known formally as ethanol). The guidelines provided by health agencies of governments are varied and are shown below. These recommendations concerning maximum intake are distinct from any legal restrictions (e.g. driving after consuming alcohol) that may apply in those countries. The American Heart Association recommends that those who do not already consume alcoholic beverages should not start doing so because of the negative long-term effects of alcohol consumption.

Rick Parfitt

Richard John Parfitt, OBE (12 October 1948 – 24 December 2016) was an English musician, best known as a singer, songwriter and rhythm guitarist with rock band Status Quo.

Parfitt began his career in the early 1960s, playing in pubs and holiday camps. He joined Status Quo in 1967 when they were looking for an additional singer. He wrote songs for the band and remained with them for 49 years. He occasionally guested with other bands, and recorded an unreleased solo album in 1985. In 2016, Parfitt temporarily retired from touring with the band due to ill health, and died in December of that year. His only solo album, Over and Out, was released posthumously in 2018.

Sobriety

Sobriety is the condition of not having any measurable levels or effects from alcohol. Sobriety is also considered to be the natural state of a human being given at a birth. A person in a state of sobriety is considered sober. In a treatment setting, sobriety is the achieved goal of independence from consuming alcohol. As such, sustained abstinence is a prerequisite for sobriety. Early in abstinence, residual effects of alcohol consumption can preclude sobriety. These effects are labeled "PAWS," or "post acute withdrawal syndrome." Someone who abstains, but has a latent desire to resume use, is not considered truly sober. An abstainer may be subconsciously motivated to resume alcohol consumption, but for a variety of reasons, abstains (e.g. a medical or legal concern precluding use). Sobriety has more specific meanings within specific contexts, such as the culture of many substance use recovery programs, law enforcement, and some schools of psychology. In some cases, sobriety implies achieving "life balance."

Spirits Europe

spiritsEUROPE represents producers of spirits drinks at the EU level.

This page is based on a Wikipedia article written by authors (here).
Text is available under the CC BY-SA 3.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.