Around half of all adults in the United States currently consume alcohol, 20% are former drinkers, and approximately 30 to 35% have abstained from alcohol throughout their lives. Alcohol consumption is also a concern among children aged 9 to 12 and adolescents.
For most drinkers, the frequency and quantity of alcohol consumption do not impair physical or mental health or affect their ability to carry out daily activities safely. However, acute alcohol intoxication is a major factor in injuries—particularly those resulting from interpersonal violence, suicide, traffic accidents, and other alcohol use consequences.
Chronic alcohol abuse interferes with the ability to maintain relationships and hold a job. While estimates vary across studies, approximately 14% of adults meet the criteria for an alcohol use disorder (abuse or dependence) each year, highlighting serious consequences.
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In the following text we discuss distinct aspects of alcohol use consequences.
Metabolism of Alcohol in the Body
A standard alcoholic drink contains about 10–15 grams of ethanol. Alcohol is primarily absorbed into the bloodstream from the small intestine, although some is absorbed from the stomach. Because alcohol absorption is faster than its metabolism and elimination, it tends to accumulate in the blood, which has several potential consequences for users.
About 5–10% of ingested alcohol is excreted unchanged in urine, sweat, and exhaled breath. The rest is metabolized mainly in the liver, where the enzyme alcohol dehydrogenase converts ethanol to acetaldehyde. Acetaldehyde is then further oxidized to carbon dioxide and water at a rate of 5–10 ml of absolute alcohol per hour. Each milliliter of alcohol provides roughly 7 kcal. Some alcohol metabolism also occurs in the stomach lining, but women generally have lower alcohol dehydrogenase activity in the stomach compared to men. Alcohol use has distinct consequences, including both metabolic and excretion processes.
Alcohol exerts its effects through several mechanisms. It binds directly to GABA (gamma-aminobutyric acid) receptors in the central nervous system, producing sedative effects. It also directly affects the heart, liver, and thyroid tissue, all being part of alcohol use consequences.
Tolerance. The Consequence of Alcohol Use
Tolerance to alcohol develops quickly—meaning the same amount causes less intoxication over time. This tolerance results from cellular (pharmacodynamic) adaptation in the brain as well as increased activity of metabolic enzymes.
People with high alcohol tolerance can reach surprisingly high Blood Alcohol Content (BAC) levels. However, tolerance is never complete—if the dose is high enough, intoxication and impairment still occur. Even those with tolerance can die from respiratory depression caused by alcohol overdose, which is among severe alcohol use consequences.
Acute Effects of Alcohol Use
The symptoms of alcohol intoxication develop in proportion to blood alcohol concentration (BAC). The exact amount needed to cause specific symptoms depends on the person’s tolerance. However, typical effects for most people include
- 20–50 mg/dL (4.3 to 10.9 mmol/L): Feeling relaxed, mild sedation, and some loss of fine motor control
- 50–100 mg/dL (10.9–21.7 mmol/L): Impaired judgment and further loss of coordination
- 100–150 mg/dL (21.7–32.6 mmol/L): Unsteady walking, involuntary eye movements (nystagmus), slurred speech, disinhibited behavior, and memory problems
- 150–300 mg/dL (32.6–65.1 mmol/L): Likely delirium and lethargy
Vomiting is common in moderate to severe intoxication. Since this usually occurs with reduced consciousness, there’s a high risk of aspiration.
In most U.S. states, a BAC of ≥ 0.08% (≥ 80 mg/dL or 17.4 mmol/L) legally defines intoxication. This is the most widely accepted legal limit.
Toxicity and Overdose
In people who aren’t used to alcohol, a BAC of 300–400 mg/dL (65.1–86.8 mmol/L) can cause unconsciousness. Levels ≥ 400 mg/dL (86.8 mmol/L) can be fatal.
Rapid heavy drinking can lead to sudden death due to respiratory depression or heart arrhythmias. Low blood pressure and low blood sugar are also common complications. Alcohol intoxication is also associated with an increased risk of alcoholic ketoacidosis, especially during binge drinking episodes.
However, effects vary greatly. Some chronic drinkers function almost normally even at 300–400 mg/dL, while non-drinkers or occasional drinkers may be seriously impaired at much lower levels.
Physical dependence, which accompanies tolerance, is serious. A sudden alcohol withdrawal can cause life-threatening complications such as delirium tremens, which is a major alcohol use consequence.
Chronic Effects of Alcohol Use
Chronic alcohol use can cause visible physical changes, such as spider veins and signs of hormonal imbalance in men, including smooth skin, breast development, and shrunken testicles. Poor nutrition may also lead to enlarged salivary glands.
Chronic, heavy alcohol consumption commonly leads to liver disease (e.g., fatty liver, alcoholic hepatitis, cirrhosis). The amount and duration of drinking required for liver damage vary among individuals, marking the gravity of alcohol use consequences. Patients with severe liver disease often develop coagulation disorders due to impaired liver synthesis of clotting factors. This increases the risk of significant bleeding following trauma (e.g., falls or accidents) and gastrointestinal bleeding (e.g., from gastritis or esophageal varices caused by portal hypertension).
Lasting severe physical effects of long-term drinking:
- Gastritis
- Pancreatitis
- Cardiomyopathy, often accompanied by arrhythmias and high blood pressure
- Peripheral neuropathy
- Brain damage, including Wernicke’s encephalopathy, Korsakoff Syndrome, Marchiafava-Bignami disease, and alcohol-related dementia
- Certain types of cancer (e.g., liver, head and neck, esophagus), particularly when alcohol use is combined with smoking
Indirect long-term consequences include malnutrition, particularly vitamin deficiencies, which further highlight alcohol use consequences.
Consequences of suddenly stopping alcohol after long-term drinking
When alcohol use stops suddenly, withdrawal symptoms can appear. Mild symptoms begin about six hours after the last drink and include tremors, muscle weakness, headaches, sweating, and digestive issues. Some people may experience seizures, usually within 6 to 48 hours.
Alcohol hallucinosis
can occur 12–24 hours after stopping alcohol in long-term heavy drinkers. These are mostly visual or auditory hallucinations without loss of consciousness. Patients often hear threatening voices, which cause anxiety or panic. Though it may resemble schizophrenia, thinking usually remains clear, and symptoms are temporary.
Delirium tremens (DTs)
is the most severe withdrawal reaction and typically begins 48–72 hours after stopping alcohol. It involves confusion, intense fear, nightmares, sweating, and hallucinations. Patients may act out tasks from their daily lives, thinking they are at work, for example. Severe cases include high heart rate, fever, disorientation, and motor agitation and can be life-threatening.
Patients with delirium tremens are highly suggestible and prone to illusions and balance problems, which increase the risk of injury. Symptoms vary between individuals but tend to repeat similarly in future episodes.
Sakina Rehabilitation Center
The Rehabilitation Center Sakina offers a comprehensive range of services, including individual and group sessions, psychoeducation on addiction and mental health, Cognitive Behavioral Therapy (CBT), relapse prevention strategies, family support, and holistic approaches such as mindfulness and physical fitness.
The aftercare planning and support systems ensure continuity of care. Additionally, Sakina provides customized programs to meet individual needs, including dual-diagnosis support for co-occurring mental health conditions such as addiction and depression.
