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Alcohol intoxication, also known as alcohol poisoning, commonly described as drunkenness or inebriation, is the negative behavior and physical effects caused by a recent consumption of alcohol. In addition to the
toxicity Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subs ...
of
ethanol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...
, the main psychoactive component of alcoholic beverages, other physiological symptoms may arise from the activity of
acetaldehyde Acetaldehyde (IUPAC systematic name ethanal) is an organic chemical compound with the formula CH3 CHO, sometimes abbreviated by chemists as MeCHO (Me = methyl). It is a colorless liquid or gas, boiling near room temperature. It is one of the ...
, a
metabolite In biochemistry, a metabolite is an intermediate or end product of metabolism. The term is usually used for small molecules. Metabolites have various functions, including fuel, structure, signaling, stimulatory and inhibitory effects on enzymes, ...
of alcohol. These effects may not arise until hours after ingestion and may contribute to the condition colloquially known as a hangover. Symptoms of
intoxication Intoxication — or poisoning, especially by an alcoholic or narcotic substance — may refer to: * Substance intoxication: ** Alcohol intoxication ** LSD intoxication ** Toxidrome ** Tobacco intoxication ** Cannabis intoxication ** Cocaine in ...
at lower doses may include mild
sedation Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...
and poor coordination. At higher doses, there may be slurred speech, trouble walking, and
vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenter ...
. Extreme doses may result in a
respiratory depression Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (''hypo'' meaning "below") to perform needed respiratory gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapni ...
,
coma A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...
, or
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
. Complications may include
seizures An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with lo ...
, aspiration pneumonia, injuries including
suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
, and low blood sugar. Alcohol intoxication can lead to
alcohol-related crime Alcohol-related crime refers to criminal activities that involve alcohol use as well as violations of regulations covering the sale or use of alcohol; in other words, activities violating the alcohol laws. Underage drinking and drunk driving ar ...
with perpetrators more likely to be intoxicated than victims. Alcohol intoxication typically begins after two or more
alcoholic drink An alcoholic beverage (also called an alcoholic drink, adult beverage, or a drink) is a drink that contains ethanol, a type of alcohol that acts as a drug and is produced by fermentation of grains, fruits, or other sources of sugar. The c ...
s. 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 witnesses may be useful. Legally, alcohol intoxication is often defined as a
blood alcohol concentration Blood alcohol content (BAC), also called blood alcohol concentration or blood alcohol level, is a measurement of alcohol intoxication used for legal or medical purposes; it is expressed as mass of alcohol per volume or mass of blood. For example ...
(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 broken down in the human body at a rate of about 3.3 mmol/L (15 mg/dL) per hour, depending on an individual's
metabolic rate Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
(
metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run ...
). Management of alcohol intoxication involves supportive care. Typically this includes putting the person in the recovery position, keeping the person warm, and making sure breathing is sufficient.
Gastric lavage Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. Since its first recorded use in early 19th century, it has become one of the most routine means of eliminating p ...
and
activated charcoal "Activated" is a song by English singer Cher Lloyd. It was released on 22 July 2016 through Vixen Records. The song was made available to stream exclusively on ''Rolling Stone'' a day before to release (on 21 July 2016). Background In an inter ...
have not been found to be useful. Repeated assessments may be required to rule out other potential causes of a person's symptoms. 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.


Symptoms

Alcohol intoxication leads to negative health effects due to the recent drinking of
ethanol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...
(alcohol). When severe it may become a
medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...
. Some effects of alcohol intoxication, such as euphoria and lowered social inhibition, are central to alcohol's desirability.


Pathophysiology

Alcohol is
metabolized Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
by a normal
liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...
at the rate of about 8 grams of pure
ethanol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...
per hour. 8 grams or is one British standard unit. An "abnormal" liver with conditions such as
hepatitis Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes ( jaundice), poor appetite, vomiting, tiredness, abdominal ...
,
cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue rep ...
, gall bladder disease, and
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
is likely to result in a slower rate of metabolism.
Ethanol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...
is metabolised to
acetaldehyde Acetaldehyde (IUPAC systematic name ethanal) is an organic chemical compound with the formula CH3 CHO, sometimes abbreviated by chemists as MeCHO (Me = methyl). It is a colorless liquid or gas, boiling near room temperature. It is one of the ...
by alcohol dehydrogenase (ADH), which is found in many tissues, including the gastric mucosa. Acetaldehyde is metabolised to acetate by acetaldehyde dehydrogenase (ALDH), which is found predominantly in liver mitochondria. Acetate is used by the muscle cells to produce acetyl-CoA using the enzyme acetyl-CoA synthetase, and the acetyl-CoA is then used in the
citric acid cycle The citric acid cycle (CAC)—also known as the Krebs cycle or the TCA cycle (tricarboxylic acid cycle)—is a series of chemical reactions to release stored energy through the oxidation of acetyl-CoA derived from carbohydrates, fats, and prot ...
. As drinking increases, people become sleepy, or fall into a stupor. After a very high level of consumption, the respiratory system becomes depressed and the person will stop breathing. Comatose patients may aspirate their vomit (resulting in vomitus in the lungs, which may cause "drowning" and later
pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...
if survived). CNS depression and impaired motor co-ordination along with poor judgment increases the likelihood of accidental injury occurring. It is estimated that about one-third of alcohol-related deaths are due to accidents and another 14% are from intentional injury. In addition to respiratory failure and accidents caused by effects on the central nervous system, alcohol causes significant metabolic derangements.
Hypoglycaemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose bel ...
occurs due to ethanol's inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis,
ketoacidosis Ketoacidosis is a metabolic state caused by uncontrolled production of ketone bodies that cause a metabolic acidosis. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes ...
, and acute kidney injury. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.


Mechanism

In the past, alcohol was believed to be a non-specific pharmacological agent affecting many
neurotransmitter A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell. Neu ...
systems in the brain. However, molecular pharmacology studies have shown that alcohol has only a few primary targets. In some systems, these effects are facilitatory and in others inhibitory. Among the neurotransmitter systems with enhanced functions are: GABAA, 5-HT3 receptor agonism (responsible for GABAergic ( GABAA receptor PAM), glycinergic, and cholinergic effects), nicotinic acetylcholine receptors. Among those that are inhibited are: NMDA, dihydropyridine-sensitive L-type Ca2+ channels and G-protein-activated inwardly rectifying K+ channels. Alcohol is also converted into phosphatidylethanol (a lipid metabolite) by phospholipase D2, and this metabolite has been shown to directly bind to and regulate
ion channel Ion channels are pore-forming membrane proteins that allow ions to pass through the channel pore. Their functions include establishing a resting membrane potential, shaping action potentials and other electrical signals by gating the flow of ...
s. The result of these direct effects is a wave of further indirect effects involving a variety of other
neurotransmitter A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell. Neu ...
and
neuropeptide Neuropeptides are chemical messengers made up of small chains of amino acids that are synthesized and released by neurons. Neuropeptides typically bind to G protein-coupled receptors (GPCRs) to modulate neural activity and other tissues like t ...
systems, leading finally to the behavioural or symptomatic effects of alcohol intoxication. The order in which different types of alcoholic beverages are consumed ("Grape or grain but never the twain" and "Beer before wine and you'll feel fine; wine before beer and you'll feel queer") does not have any effect.


GABAA receptors

Many of the effects of activating GABAA receptors have the same effects as that of ethanol consumption. Some of these effects include anxiolytic,
anticonvulsant Anticonvulsants (also known as antiepileptic drugs or recently as antiseizure drugs) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of ...
,
sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but ...
, and
hypnotic Hypnotic (from Greek ''Hypnos'', sleep), or soporific drugs, commonly known as sleeping pills, are a class of (and umbrella term for) psychoactive drugs whose primary function is to induce sleep (or surgical anesthesiaWhen used in anesthesia ...
effects, cognitive impairment, and motor incoordination. This correlation between activating GABAA receptors and the effects of ethanol consumption has led to the study of ethanol and its effects on GABAA receptors. It has been shown that ethanol does in fact exhibit positive allosteric binding properties to GABAA receptors. However, its effects are limited to pentamers containing the δ-subunit rather than the γ-subunit. GABAA receptors containing the δ-subunit have been shown to be located exterior to the synapse and are involved with tonic inhibition rather than its γ-subunit counterpart, which is involved in phasic inhibition. The δ-subunit has been shown to be able to form the allosteric binding site which makes GABAA receptors containing the δ-subunit more sensitive to ethanol concentrations, even to moderate social ethanol consumption levels (30mM). While it has been shown by Santhakumar et al. that GABAA receptors containing the δ-subunit are sensitive to ethanol modulation, depending on subunit combinations receptors could be more or less sensitive to ethanol. It has been shown that GABAA receptors that contain both δ and β3-subunits display increased sensitivity to ethanol. One such receptor that exhibits ethanol insensitivity is α3-β6-δ GABAA. It has also been shown that subunit combination is not the only thing that contributes to ethanol sensitivity. Location of GABAA receptors within the synapse may also contribute to ethanol sensitivity.


Diagnosis

Alcohol intoxication is described as a mental and behavioural disorder by the International Classification of Diseases. (
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...
). Definitive
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
relies on a blood test for alcohol, usually performed as part of a
toxicology Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating e ...
screen.
Law enforcement officer A law enforcement officer (LEO), or peace officer in North American English, is a public-sector employee whose duties primarily involve the enforcement of laws. The phrase can include campaign disclosure specialists, local police officers, pr ...
s in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
and other countries often use
breathalyzer A breathalyzer or breathalyser (a portmanteau of ''breath'' and ''analyzer/analyser'') is a device for estimating blood alcohol content (BAC), or to detect viruses or diseases from a breath sample. The name is a genericized trademark of the Br ...
units and field sobriety tests as more convenient and rapid alternatives to blood tests. There are also various models of breathalyzer units that are available for consumer use. Because these may have varying reliability and may produce different results than the tests used for law-enforcement purposes, the results from such devices should be conservatively interpreted. Many informal intoxication tests exist, which, in general, are unreliable and not recommended as deterrents to excessive intoxication or as indicators of the safety of activities such as motor vehicle driving, heavy equipment operation, machine tool use, etc. For determining whether someone is intoxicated by alcohol by some means other than a blood-alcohol test, it is necessary to rule out other conditions such as
hypoglycemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose bel ...
,
stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...
, usage of other intoxicants, mental health issues, and so on. It is best if their behavior has been observed while the subject is sober to establish a baseline. Several well-known criteria can be used to establish a probable diagnosis. For a physician in the acute-treatment setting, acute alcohol intoxication can mimic other acute neurological disorders, or is frequently combined with other recreational drugs that complicate diagnosis and treatment.


Management

Acute alcohol poisoning is a
medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...
due to the risk of death from
respiratory depression Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (''hypo'' meaning "below") to perform needed respiratory gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapni ...
or aspiration of vomit if
vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenter ...
occurs while the person is unresponsive. Emergency treatment strives to stabilize and maintain an open airway and sufficient breathing, while waiting for the alcohol to metabolize. This can be done by removal of any vomit or, if the person is unconscious or has impaired gag reflex, intubation of the trachea. Other measures may include * Treat low blood sugar, with intravenous sugar solutions as ethanol induced low blood sugar unresponsive to glucagon. * Administer the vitamin thiamine to prevent
Wernicke–Korsakoff syndrome Wernicke–Korsakoff syndrome (WKS) is the combined presence of Wernicke encephalopathy (WE) and Korsakoff syndrome. Due to the close relationship between these two disorders, people with either are usually diagnosed with WKS as a single syndrom ...
, which can cause a
seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with lo ...
(more usually a treatment for chronic alcoholism, but in the acute context usually co-administered to ensure maximal benefit). * Hemodialysis if the blood concentration is very high at >130  mmol/L (>600 mg/dL) * Provide oxygen therapy as needed via nasal cannula or non-rebreather mask. * While the medication
metadoxine Metadoxine, also known as pyridoxine-pyrrolidone carboxylate, is a drug used to treat chronic and acute alcohol intoxication. Metadoxine accelerates alcohol clearance from the blood. Metadoxine is an ion pair salt of pyridoxine and pyrrolidone ...
may speed the breakdown of alcohol, use in alcohol intoxication requires further study as of 2017. It is approved in a number of countries in Europe, as well as India and Brazil. Additional medication may be indicated for treatment of
nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ...
, tremor, and
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
.


Clinical findings


Hospital admissions

Alcohol intoxication was found to be prevalent in clinical populations within the United States involving people treated for trauma and in the age group of people aged within their 18th - 24th years (in a study of a group for the years 1999 - 2004). In the United States during the years 2010 - 2012, acute intoxication was found to be the direct cause of an average of 2,221 deaths, in the sample group of those aged within their 15th year or older. The same mortality route is thought to cause indirectly more than 30,000 deaths per year.


Prognosis

A normal liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient's overall physical condition. An abnormal liver will take longer but still succeeds, provided the alcohol does not cause liver failure. People having drunk heavily for several days or weeks may have withdrawal symptoms after the acute intoxication has subsided. A person consuming a dangerous amount of alcohol persistently can develop memory blackouts and idiosyncratic intoxication or pathological drunkenness symptoms. Long-term persistent consumption of excessive amounts of alcohol can cause liver damage and have other deleterious health effects.


Society and culture

Alcohol intoxication is a
risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often u ...
in some cases of catastrophic injury, in particular for unsupervised
recreation Recreation is an activity of leisure, leisure being discretionary time. The "need to do something for recreation" is an essential element of human biology and psychology. Recreational activities are often done for enjoyment, amusement, or plea ...
al activity. A study in the
province A province is almost always an administrative division within a country or state. The term derives from the ancient Roman ''provincia'', which was the major territorial and administrative unit of the Roman Empire's territorial possessions out ...
of
Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
based on
epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evid ...
data from 1986, 1989, 1992, and 1995 states that 79.2% of the 2,154 catastrophic injuries recorded for the study were preventable, of which 346 (17%) involved alcohol consumption. The activities most commonly associated with alcohol-related catastrophic injury were
snowmobiling A snowmobile, also known as a Ski-Doo, snowmachine, sled, motor sled, motor sledge, skimobile, or snow scooter, is a motorized vehicle designed for winter travel and recreation on snow. It is designed to be operated on snow and ice and does not ...
(124),
fishing Fishing is the activity of trying to catch fish. Fish are often caught as wildlife from the natural environment, but may also be caught from fish stocking, stocked bodies of water such as fish pond, ponds, canals, park wetlands and reservoirs. ...
(41), diving (40), boating (31) and
canoeing Canoeing is an activity which involves paddling a canoe with a single-bladed paddle. Common meanings of the term are limited to when the canoeing is the central purpose of the activity. Broader meanings include when it is combined with other act ...
(7), swimming (31), riding an
all-terrain vehicle An all-terrain vehicle (ATV), also known as a light utility vehicle (LUV), a quad bike, or simply a quad, as defined by the American National Standards Institute (ANSI); is a vehicle that travels on low-pressure tires, with a seat that is stra ...
(24), and
cycling Cycling, also, when on a two-wheeled bicycle, called bicycling or biking, is the use of cycles for transport, recreation, exercise or sport. People engaged in cycling are referred to as "cyclists", "bicyclists", or "bikers". Apart from ...
(23). These events are often associated with unsupervised young males, often inexperienced in the activity, and many result in drowning. Alcohol use is also associated with unsafe sex.


Legal issues

Laws on drunkenness vary. In the United States, it is a criminal offense for a person to be drunk while driving a motorized vehicle, except in
Wisconsin Wisconsin () is a state in the upper Midwestern United States. Wisconsin is the 25th-largest state by total area and the 20th-most populous. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake M ...
, where it is only a fine for the first offense. It is also a criminal offense to fly an aircraft or (in some American states) to assemble or operate an
amusement park An amusement park is a park that features various attractions, such as rides and games, as well as other events for entertainment purposes. A theme park is a type of amusement park that bases its structures and attractions around a central ...
ride while drunk. Similar laws also exist in the United Kingdom and most other countries. In some countries, it is also an offense to serve alcohol to an already-intoxicated person, and, often, alcohol can be sold only by persons qualified to serve responsibly through
alcohol server training Alcohol server training is a form of occupational education typically provided to servers, sellers and consumers of alcohol to prevent intoxication, drunk driving and underage drinking. This training is sometimes regulated and mandated by state a ...
. The blood alcohol content (BAC) for legal operation of a vehicle is typically measured as a percentage of a unit volume of blood. This percentage ranges from 0.00% in Romania and the United Arab Emirates; to 0.05% in Australia, South Africa, Germany, Scotland and New Zealand (0.00% for underage individuals); to 0.08% in
England and Wales England and Wales () is one of the three legal jurisdictions of the United Kingdom. It covers the constituent countries England and Wales and was formed by the Laws in Wales Acts 1535 and 1542. The substantive law of the jurisdiction is En ...
, the United States and Canada. The United States
Federal Aviation Administration The Federal Aviation Administration (FAA) is the largest transportation agency of the U.S. government and regulates all aspects of civil aviation in the country as well as over surrounding international waters. Its powers include air traffic ...
prohibits
crew members Crewman is a generic term for a crew member serving in the operation of an aircraft, naval vessel, or train. The term may also refer to individuals serving in a military capacity on weapon system platforms, such as those operating a tank. In so ...
from performing their duties within eight hours of consuming an alcoholic beverage, while under the influence of alcohol, or with a BAC greater than 0.04%. In the United States, the United Kingdom, and Australia,
public intoxication Public intoxication, also known as "drunk and disorderly" and "drunk in public", is a summary offense in some countries rated to public cases or displays of drunkenness. Public intoxication laws vary widely by jurisdiction, but usually require an ...
is a crime (also known as "being drunk and disorderly" or "being drunk and incapable"). In some countries, there are special facilities, sometimes known as "
drunk tanks A drunk tank is a prison cell, jail cell or separate facility accommodating people who are drunkenness, intoxicated, especially with alcohol (drug), alcohol. Some such facilities are mobile, and may be spoken of as "booze buses". Traditionally, ...
", for the temporary detention of persons found to be drunk.


Religious views


Christianity

Some religious groups permit the consumption of alcohol; some permit consumption but prohibit intoxication; others prohibit any amount of alcohol consumption altogether. Many denominations of
Christianity Christianity is an Abrahamic monotheistic religion based on the life and teachings of Jesus of Nazareth. It is the world's largest and most widespread religion with roughly 2.38 billion followers representing one-third of the global popula ...
, such as
Catholicism The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
,
Orthodoxy Orthodoxy (from Greek: ) is adherence to correct or accepted creeds, especially in religion. Orthodoxy within Christianity refers to acceptance of the doctrines defined by various creeds and ecumenical councils in Antiquity, but different Church ...
and
Lutheranism Lutheranism is one of the largest branches of Protestantism, identifying primarily with the theology of Martin Luther, the 16th-century German monk and Protestant Reformers, reformer whose efforts to reform the theology and practice of the Cathol ...
, use
wine Wine is an alcoholic drink typically made from Fermentation in winemaking, fermented grapes. Yeast in winemaking, Yeast consumes the sugar in the grapes and converts it to ethanol and carbon dioxide, releasing heat in the process. Different ...
as a part of the
Eucharist The Eucharist (; from Greek , , ), also known as Holy Communion and the Lord's Supper, is a Christian rite that is considered a sacrament in most churches, and as an ordinance in others. According to the New Testament, the rite was institu ...
and permit its consumption, but consider it sinful to become intoxicated. In the
Bible The Bible (from Koine Greek , , 'the books') is a collection of religious texts or scriptures that are held to be sacred in Christianity Christianity is an Abrahamic monotheistic religion based on the life and teachings of Jesus ...
, the Book of Proverbs contains several chapters related to the negative effects of drunkenness and warn to stay away from intoxicating beverages. The
Book of Leviticus The book of Leviticus (, from grc, Λευιτικόν, ; he, וַיִּקְרָא, , "And He called") is the third book of the Torah (the Pentateuch) and of the Old Testament, also known as the Third Book of Moses. Scholars generally agree ...
tells the story of Nadab and Abihu, the eldest sons of
Aaron According to Abrahamic religions, Aaron ''′aharon'', ar, هارون, Hārūn, Greek (Septuagint): Ἀαρών; often called Aaron the priest ()., group="note" ( or ; ''’Ahărōn'') was a prophet, a high priest, and the elder brother of ...
, who were killed for serving in the
Temple in Jerusalem The Temple in Jerusalem, or alternatively the Holy Temple (; , ), refers to the two now-destroyed religious structures that served as the central places of worship for Israelites and Jews on the modern-day Temple Mount in the Old City of Jeru ...
after drinking wine, presumably while intoxicated. It continues to discuss monasticism, in which drinking wine is prohibited. The story of Samson in the
Book of Judges The Book of Judges (, ') is the seventh book of the Hebrew Bible and the Christian Old Testament. In the narrative of the Hebrew Bible, it covers the time between the conquest described in the Book of Joshua and the establishment of a kingdo ...
tells of a
monk A monk (, from el, μοναχός, ''monachos'', "single, solitary" via Latin ) is a person who practices religious asceticism by monastic living, either alone or with any number of other monks. A monk may be a person who decides to dedic ...
from the Israelite tribe of Dan who is prohibited from cutting his hair and drinking wine.Biblical examples referencing intoxication: , , Romans 13:13–14, 1 Corinthians 6:9–11, Galatians 5:19–21 and Ephesians 5:18 are among a number of other Bible passages that speak against intoxication. While Proverbs 31:4 warns against kings and other rulers drinking wine and similar alcoholic beverages, Proverbs 31:6–7 promotes giving such beverages to the perishing and wine to those whose lives are bitter as a coping mechanism against the likes of poverty and other troubles. Some
Protestant Christian Protestantism is a branch of Christianity that follows the theological tenets of the Protestant Reformation, a movement that began seeking to reform the Catholic Church from within in the 16th century against what its followers perceived to ...
denominations prohibit the consumption of alcohol based upon biblical passages that condemn drunkenness, but others allow a moderate rate of consumption. In the
Church of Jesus Christ of Latter-day Saints The Church of Jesus Christ of Latter-day Saints, informally known as the LDS Church or Mormon Church, is a nontrinitarian Christian church that considers itself to be the restoration of the original church founded by Jesus Christ. The ...
, alcohol consumption is forbidden, and teetotalism has become a distinguishing feature of its members.
Jehovah's Witnesses Jehovah's Witnesses is a millenarian restorationist Christian denomination with nontrinitarian beliefs distinct from mainstream Christianity. The group reports a worldwide membership of approximately 8.7 million adherents involved in ...
allow moderate alcohol consumption among its members.


Islam

In the
Quran The Quran (, ; Standard Arabic: , Quranic Arabic: , , 'the recitation'), also romanized Qur'an or Koran, is the central religious text of Islam, believed by Muslims to be a revelation from God. It is organized in 114 chapters (pl.: , ...
, there is a prohibition on the consumption of
grape A grape is a fruit, botanically a berry, of the deciduous woody vines of the flowering plant genus '' Vitis''. Grapes are a non- climacteric type of fruit, generally occurring in clusters. The cultivation of grapes began perhaps 8,000 years a ...
-based alcoholic beverages, and intoxication is considered an abomination in the
hadith Ḥadīth ( or ; ar, حديث, , , , , , , literally "talk" or "discourse") or Athar ( ar, أثر, , literally "remnant"/"effect") refers to what the majority of Muslims believe to be a record of the words, actions, and the silent approva ...
of
Muhammad Muhammad ( ar, مُحَمَّد;  570 – 8 June 632 CE) was an Arab religious, social, and political leader and the founder of Islam. According to Islamic doctrine, he was a prophet divinely inspired to preach and confirm the mon ...
. The schools of thought of
Islamic jurisprudence ''Fiqh'' (; ar, فقه ) is Islamic jurisprudence. Muhammad-> Companions-> Followers-> Fiqh. The commands and prohibitions chosen by God were revealed through the agency of the Prophet in both the Quran and the Sunnah (words, deeds, and ex ...
have interpreted this as a strict prohibition of the consumption of all types of alcohol and declared it to be '' haram'' (), although other uses may be permitted.


Buddhism

In
Buddhism Buddhism ( , ), also known as Buddha Dharma and Dharmavinaya (), is an Indian religion or philosophical tradition based on teachings attributed to the Buddha. It originated in northern India as a -movement in the 5th century BCE, and ...
, in general, the consumption of intoxicants is discouraged for both monastics and lay followers. Many Buddhists observe a basic code of ethics known as the
five precepts The Five precepts ( sa, pañcaśīla, italic=yes; pi, pañcasīla, italic=yes) or five rules of training ( sa, pañcaśikṣapada, italic=yes; pi, pañcasikkhapada, italic=yes) is the most important system of morality for Buddhist lay peo ...
, of which the fifth precept is an undertaking to refrain from the consumption of intoxicating substances (except for medical reasons). In the ''bodhisattva'' vows of the '' Brahmajala Sutra'', observed by
Mahayana Buddhist ''Mahāyāna'' (; "Great Vehicle") is a term for a broad group of Buddhist traditions, texts, philosophies, and practices. Mahāyāna Buddhism developed in India (c. 1st century BCE onwards) and is considered one of the three main existing bran ...
communities, distribution of intoxicants is likewise discouraged, as well as consumption.


Hinduism

In the
Gaudiya Vaishnavism Gaudiya Vaishnavism (), also known as Chaitanya Vaishnavism, is a Vaishnava Hindu religious movement inspired by Chaitanya Mahaprabhu (1486–1534) in India. "Gaudiya" refers to the Gaura or Gauḍa region of Bengal, with Vaishnavism meani ...
branch of
Hinduism Hinduism () is an Indian religion or '' dharma'', a religious and universal order or way of life by which followers abide. As a religion, it is the world's third-largest, with over 1.2–1.35 billion followers, or 15–16% of the global p ...
, one of the four regulative principles forbids the taking of intoxicants, including alcohol.


Judaism

In
Judaism Judaism ( he, ''Yahăḏūṯ'') is an Abrahamic, monotheistic, and ethnic religion comprising the collective religious, cultural, and legal tradition and civilization of the Jewish people. It has its roots as an organized religion in th ...
, in accordance with the biblical stance against drinking, wine drinking is not permitted for priests and monks. The biblical command to sanctify the Sabbath and other holidays has been interpreted as having three ceremonial meals with wine or
grape juice Grape juice is obtained from crushing and blending grapes into a liquid. In the wine industry, grape juice that contains 7–23 percent of pulp, skins, stems and seeds is often referred to as '' must''. The sugars in grape juice allow it to ...
, known as '' Kiddush''. A number of Jewish marriage ceremonies end with the bride and groom drinking a shared cup of wine after reciting seven blessings; this occurs after a fasting day in some
Ashkenazi Ashkenazi Jews ( ; he, יְהוּדֵי אַשְׁכְּנַז, translit=Yehudei Ashkenaz, ; yi, אַשכּנזישע ייִדן, Ashkenazishe Yidn), also known as Ashkenazic Jews or ''Ashkenazim'',, Ashkenazi Hebrew pronunciation: , singu ...
traditions. It has been customary and in many cases even mandated to drink moderately so as to stay sober, and only after the prayers are over. During the Seder on
Passover Passover, also called Pesach (; ), is a major Jewish holiday that celebrates the Biblical story of the Israelites escape from slavery in Egypt, which occurs on the 15th day of the Hebrew month of Nisan, the first month of Aviv, or spring. ...
, there is an obligation to drink four ceremonial cups of wine while reciting the Haggadah. It has been assumed as the source for the wine-drinking ritual at the communion in some Christian groups. During
Purim Purim (; , ; see Name below) is a Jewish holiday which commemorates the saving of the Jewish people from Haman, an official of the Achaemenid Empire who was planning to have all of Persia's Jewish subjects killed, as recounted in the Book ...
, there is an obligation to become intoxicated; however, as with many other decrees, this has been avoided in many communities by allowing sleep during the day as a replacement. During the U.S. Prohibition era in the 1920s, a
rabbi A rabbi () is a spiritual leader or religious teacher in Judaism. One becomes a rabbi by being ordained by another rabbi – known as '' semikha'' – following a course of study of Jewish history and texts such as the Talmud. The basic form o ...
from the
Reform Judaism Reform Judaism, also known as Liberal Judaism or Progressive Judaism, is a major Jewish denomination that emphasizes the evolving nature of Judaism, the superiority of its ethical aspects to its ceremonial ones, and belief in a continuous sear ...
movement proposed using grape juice for the ritual instead of wine. Although refuted at first, the practice became widely accepted by
orthodox Jews Orthodox Judaism is the collective term for the traditionalist and theologically conservative branches of contemporary Judaism. Jewish theology, Theologically, it is chiefly defined by regarding the Torah, both Torah, Written and Oral Torah, Or ...
as well.


Other animals

In the movie '' Animals are Beautiful People'', an entire section was dedicated to showing many different animals including monkeys, elephants, hogs, giraffes, and ostriches, eating over-ripe marula tree fruit causing them to sway and lose their footing in a manner similar to human drunkenness. Birds may become intoxicated with fermented berries and some die colliding with hard objects when flying under the influence. In elephant warfare, practiced by the Greeks during the
Maccabean revolt The Maccabean Revolt ( he, מרד החשמונאים) was a Jewish rebellion led by the Maccabees against the Seleucid Empire and against Hellenistic influence on Jewish life. The main phase of the revolt lasted from 167–160 BCE and ende ...
and by
Hannibal Hannibal (; xpu, 𐤇𐤍𐤁𐤏𐤋, ''Ḥannibaʿl''; 247 – between 183 and 181 BC) was a Carthaginian general and statesman who commanded the forces of Carthage in their battle against the Roman Republic during the Second Pu ...
during the Punic wars, it has been recorded that the elephants would be given wine before the attack, and only then would they charge forward after being agitated by their driver. It is a regular practice to give small amounts of beer to race horses in
Ireland Ireland ( ; ga, Éire ; Ulster-Scots: ) is an island in the North Atlantic Ocean, in north-western Europe. It is separated from Great Britain to its east by the North Channel, the Irish Sea, and St George's Channel. Ireland is the s ...
. Ruminant farm animals have natural fermentation occurring in their stomach, and adding alcoholic beverages in small amounts to their drink will generally do them no harm, and will not cause them to become drunk. Alcoholic beverages are extremely harmful to dogs, and often for reasons of additives such as xylitol, an artificial sweetener in some mixers. Dogs can absorb ethyl alcohol in dangerous amounts through their skin as well as through drinking the liquid or consuming it in foods. Even fermenting bread dough can be dangerous to dogs. In 1999, one of the royal footmen for Britain's Queen
Elizabeth II Elizabeth II (Elizabeth Alexandra Mary; 21 April 1926 – 8 September 2022) was Queen of the United Kingdom and other Commonwealth realms from 6 February 1952 until her death in 2022. She was queen regnant of 32 sovereign states durin ...
was demoted from Buckingham Palace due to his "party trick" of spiking the meals and drinks of the Queen's pet corgi dogs with alcohol which in turn would lead the dogs to run around drunk.


See also

* ''
A Night of Serious Drinking ''A Night of Serious Drinking'' (french: La Grande Beuverie) is an allegorical novel, published 1938, by the French surrealist writer René Daumal. It has a plot based on the narrator imbibing alcohol copiously. Plot summary An unnamed narrator ...
'' *
Alcohol and sex Alcohol and sex deals with the effects of the consumption of alcohol on sexual behavior. The effects of alcohol are balanced between its suppressive effects on sexual physiology, which will decrease sexual activity, and its suppression of psycholo ...
* Alcohol enema * Alcohol flush reaction * Driving under the influence * ''
In vino veritas ''In vino veritas'', also written as ''in uino ueritas'', 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. The phrase is sometim ...
'' * Long-term effects of alcohol consumption *
Short-term effects of alcohol consumption The short-term effects of alcohol (more specifically ethanol) consumption range from a decrease in anxiety and motor skills and euphoria at lower doses to intoxication (drunkenness), to stupor, unconsciousness, anterograde amnesia (memory "blac ...
* Low alcoholic drinks


References


Bibliography

* Bales, Robert F. "Attitudes toward Drinking in the Irish Culture". In: Pittman, David J. and Snyder, Charles R. (Eds.) ''Society, Culture and Drinking Patterns''. New York: Wiley, 1962, pp. 157–187. * Gentry, Kenneth L., Jr., ''God Gave Wine: What the Bible Says about Alcohol''. Lincoln, Calif.: Oakdown, 2001. * Rorabaugh, W.J. "The Alcoholic Republic," Chapter 2 & 5,
Oxford University Press Oxford University Press (OUP) is the university press of the University of Oxford. It is the largest university press in the world, and its printing history dates back to the 1480s. Having been officially granted the legal right to print book ...
. * Sigmund, Paul. ''St. Thomas Aquinas On Politics and Ethics''. W.W. Norton & Company, Inc, 1988, p. 77. * Walton, Stuart. ''Out of It. A Cultural History of Intoxication''.
Penguin Books Penguin Books is a British publishing, publishing house. It was co-founded in 1935 by Allen Lane with his brothers Richard and John, as a line of the publishers The Bodley Head, only becoming a separate company the following year.Alcohol overdose
NIAAA
Alcohol poisoning
NHS Choices {{DEFAULTSORT:Alcohol Intoxication Intox Drinking culture Intox Alcohol abuse Substance intoxication Wikipedia medicine articles ready to translate