Many Americans drink alcohol at least occasionally. The Dietary Guidelines for Americans say that adults of legal drinking age should either not drink or drink in moderation. Drinking less is better for your health than drinking more. Also, there are some people who should not drink at all.

If you are going to drink, it's important to know how alcohol affects you and how much is too much.

How does alcohol affect the body?

Alcohol is a central nervous system depressant. This means that it is a drug that slows down brain activity. It can change your mood, behavior, and self-control. It can cause problems with memory and thinking clearly. Alcohol can also affect your coordination and physical control.

Alcohol also has effects on the other organs in your body. For example, it can raise your blood pressure and heart rate. If you drink too much at once, it could make you throw up.

Why are the effects of alcohol different from person to person?

Alcohol's effects vary from person to person, depending on a variety of factors, including:

• How much you drink
• How often you drink
• Your age
• Your sex
• Your genetics
• Your overall health
• Whether or not you have a family history of alcohol problems

What is moderate drinking?

• For most women, moderate drinking is no more than 1 standard drink a day
• For most men, moderate drinking is no more than 2 standard drinks a day

Even though moderate drinking may be safe for many people, there are still risks. Moderate drinking can raise the risk of death from certain cancers and heart diseases.

What is a standard drink?

In the United States, a standard drink is one that contains about 14 grams of pure alcohol, which is found in:

• 12 ounces of regular beer (5% alcohol content)
• 5 ounces of wine (12% alcohol content)
• 1.5 ounces or a "shot" of distilled spirits or liquor (40% alcohol content)

Who should not drink alcohol?

Some people should not drink alcohol at all, including those who:

• Are in recovery from an alcohol use disorder (AUD)
• Are are unable to control the amount they drink
• Are under age 21
• Are pregnant or trying to become pregnant
• Are taking medicines that can interact with alcohol
• Have medical conditions that get can worse if you drink alcohol
• Are planning on driving
• Will be operating machinery or doing activities that require skill, coordination, and alertness

If you have questions about whether it is safe for you to drink, talk with your health care provider.

What is excessive drinking?

Excessive drinking includes binge drinking and heavy alcohol use:

• Binge drinking is drinking so much at once that your blood alcohol concentration (BAC) level is 0.08% or more:
  • For men, this usually happens after having 5 or more drinks within a few hours.
  • For women, it is usually after about 4 or more drinks within a few hours.
• Heavy alcohol use means:
  • For men, having more than 5 drinks on any day or more than 15 drinks per week.
  • For women, having more than 4 drinks on any day or more than 8 drinks per week.

Binge drinking raises your risk of injuries, car crashes, and alcohol overdose. It also puts you at risk of becoming violent or being the victim of violence.

Heavy alcohol use over a long period of time may cause health problems such as:

• Alcohol use disorder (AUD)
• Liver diseases, including cirrhosis and fatty liver disease
• Heart diseases
• Increased risk for certain cancers
• Increased risk of injuries

Heavy alcohol use can also cause problems at home, at work, and with friends. But treatment can help.

Drinking in Moderation:

According to the "Dietary Guidelines for Americans 2020-2025,” U.S. Department of Health and Human Services and U.S. Department of Agriculture, adults of legal drinking age can choose not to drink or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more.

Binge Drinking:

• NIAAA defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent - or 0.08 grams of alcohol per deciliter - or higher. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.
• The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month.

Heavy Alcohol Use:

• NIAAA defines heavy drinking as follows:
  • For men, consuming more than 4 drinks on any day or more than 14 drinks per week
  • For women, consuming more than 3 drinks on any day or more than 7 drinks per week
• SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.

Patterns of Drinking Associated with Alcohol Use Disorder:

Binge drinking and heavy alcohol use can increase an individual's risk of alcohol use disorder.

Certain people should avoid alcohol completely, including those who:

• Plan to drive or operate machinery, or participate in activities that require skill, coordination, and alertness
• Take certain over-the-counter or prescription medications
• Have certain medical conditions
• Are recovering from alcohol use disorder or are unable to control the amount that they drink
• Are younger than age 21
• Are pregnant or may become pregnant

• Alcohol consumption is associated with a variety of short- and long-term health risks, including motor vehicle crashes, violence, sexual risk behaviors, high blood pressure, and various cancers (e.g., breast cancer).
• The risk of these harms increases with the amount of alcohol you drink. For some conditions, like some cancers, the risk increases even at very low levels of alcohol consumption (less than 1 drink).
• To reduce the risk of alcohol-related harms, the 2020-2025 Dietary Guidelines for Americans recommends that adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed. The Guidelines also do not recommend that individuals who do not drink alcohol start drinking for any reason and that if adults of legal drinking age choose to drink alcoholic beverages, drinking less is better for health than drinking more.
• Two in three adult drinkers report drinking above moderate levels at least once a month.

People Who Shouldn’t Drink At All

The Guidelines note that some people should not drink alcohol at all, such as:

• If they are pregnant or might be pregnant.
• If they are younger than age 21.
• If they have certain medical conditions or are taking certain medications that can interact with alcohol.
• If they are recovering from an alcohol use disorder or if they are unable to control the amount they drink.

The Guidelines also note that not drinking alcohol also is the safest option for women who are lactating. Generally, moderate consumption of alcoholic beverages by a woman who is lactating (up to 1 standard drink in a day) is not known to be harmful to the infant, especially if the woman waits at least 2 hours after a single drink before nursing or expressing breast milk. Women considering consuming alcohol during lactation should talk to their healthcare provider. Learn more about breastfeeding and alcohol use.

Science around Moderate Alcohol Consumption

• The Guidelines note, “Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day).”
• Although past studies have indicated that moderate alcohol consumption has protective health benefits (e.g., reducing risk of heart disease), recent studies show this may not be true. While some studies have found improved health outcomes among moderate drinkers, it’s impossible to conclude whether these improved outcomes are due to moderate alcohol consumption or other differences in behaviors or genetics between people who drink moderately and people who don’t.
• Most U.S. adults who drink don’t drink every day. That’s why it’s important to focus on the amount people drink on the days that they drink. Even if women consume an average of 1 drink per day or men consume an average of 2 drinks per day, binge drinking increases the risk of experiencing alcohol-related harm in the short-term and in the future.
• Drinking at levels above the moderate drinking guidelines significantly increases the risk of short-term harms, such as injuries, as well as the risk of long-term chronic health problems, such as some types of cancer.

Some people who drink alcohol experience an unpleasant phenomenon called the alcohol flush reaction. The primary feature of the alcohol flush reaction is a red face—or flush—but it can also be accompanied by hives, nausea, low blood pressure, the worsening of asthma, or an episode of migraine. Of particular significance, the alcohol flush reaction is linked to a higher risk of certain types of cancer.

What causes alcohol flush reaction?

The alcohol flush reaction is a type of alcohol intolerance—not an “alcohol allergy”—and is a condition predominantly due to inherited variations in genes of certain enzymes, causing people to metabolize alcohol less efficiently.

During alcohol metabolism, the enzyme alcohol dehydrogenase (ADH) converts alcohol to acetaldehyde, a toxic molecule. The resulting acetaldehyde is metabolized to nontoxic molecules by another enzyme called aldehyde dehydrogenase (ALDH). If acetaldehyde is not metabolized efficiently, it can cause release of histamine and thereby trigger flushing and other unpleasant symptoms.

Variations in the alcohol dehydrogenase gene, ADH1B, and the aldehyde dehydrogenase gene, ALDH2, are well-known variations that lead to higher acetaldehyde levels due to altered alcohol metabolism and are more common among people of East Asian ancestry. People of other races and ethnicities, however, can also carry these variations.

People who take certain medications that alter alcohol metabolism can also experience the alcohol flush reaction. Such medications include those used to treat diabetes, high cholesterol, and infections. In addition, disulfiram, a medication used to treat alcohol use disorder, alters alcohol metabolism so that acetaldehyde builds up when a person drinks alcohol. This causes unpleasant symptoms such as flushing and nausea. The desire to avoid those unpleasant effects can encourage some people to refrain from drinking.

What health problems are associated with the alcohol flush reaction?

People who experience the alcohol flush reaction and who drink alcohol are at higher risk for cancer, including esophageal and breast cancer. The reason for this increased risk is that acetaldehyde is itself carcinogenic.

Can the alcohol flush reaction be prevented?

For individuals carrying gene variations that impair alcohol metabolism, the best way to prevent alcohol flush reaction is to avoid drinking or to limit alcohol intake. Some information found on the Internet suggests taking antihistamines and certain over-the-counter medications to reduce or hinder alcohol flushing, but these medications do not block the damaging effects of acetaldehyde. In fact, hindering alcohol flushing elevates the risk of cancer by enabling higher levels of alcohol consumption and thus higher acetaldehyde production.

Alcohol and Medication Interactions in General

Many over-the-counter and prescription medications can have adverse health consequences when mixed with alcohol. These medications include many popular painkillers such as acetaminophen (Tylenol); sedative drugs such as diazepam (Valium); and cough, cold, and allergy remedies. People taking medications should read the label and package inserts for possible interactions with alcohol or other drugs, especially if they have multiple drinks on an occasion. People who consume alcohol should ask their doctor or pharmacist about interactions with alcohol and the medications they are taking.

Drinking heavily puts people at risk for many adverse health consequences, including alcohol use disorder, liver damage, and various cancers. But some people appear to be at greater risk than others for developing these problems. Why do some people drink more than others? And why do some people who drink develop problems, whereas others do not?

Research shows that alcohol misuse and alcohol-related problems are influenced by individual variations in alcohol metabolism, or the way in which alcohol is broken down and eliminated by the body. Alcohol metabolism is controlled by genetic factors, such as variations in the enzymes that break down alcohol, and environmental factors, such as the amount of alcohol an individual consumes and his or her overall nutrition. Differences in alcohol metabolism may put some people at greater risk for alcohol problems, whereas others may be at least somewhat protected from alcohol’s harmful effects.

The Chemical Breakdown of Alcohol

Alcohol is metabolized by several processes or pathways. The most common of these pathways involves two enzymes—alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). These enzymes help break apart the alcohol molecule, making it possible to eliminate it from the body. First, ADH metabolizes alcohol to acetaldehyde, a highly toxic substance and known carcinogen. Then, acetaldehyde is further metabolized down to another, less active byproduct called acetate, which then is broken down into water and carbon dioxide for easy elimination.

Other enzymes

The enzymes cytochrome P450 2E1 (CYP2E1) and catalase also break down alcohol to acetaldehyde. However, CYP2E1 only is active after a person has consumed large amounts of alcohol, and catalase metabolizes only a small fraction of alcohol in the body. Small amounts of alcohol also are removed by interacting with fatty acids to form compounds called fatty acid ethyl esters (FAEEs). These compounds have been shown to contribute to damage to the liver and pancreas.

The Chemical Breakdown of Alcohol

Most of the ethanol in the body is broken down in the liver by an enzyme called alcohol dehydrogenase (ADH), which transforms ethanol into a toxic compound called acetaldehyde (CH3CHO), a known carcinogen. However, acetaldehyde is generally short-lived; it is quickly broken down to a less toxic compound called acetate (CH3COO-) by another enzyme called aldehyde dehydrogenase (ALDH). Acetate then is broken down to carbon dioxide and water, mainly in tissues other than the liver.

Acetaldehyde: A toxic byproduct

Much of the research on alcohol metabolism has focused on an intermediate byproduct that occurs early in the breakdown process—acetaldehyde. Although acetaldehyde is short-lived, usually existing in the body only for a brief time before it is further broken down into acetate, it has the potential to cause significant damage. This is particularly evident in the liver, where the bulk of alcohol metabolism takes place. Some alcohol metabolism also occurs in other tissues, including the pancreas and the brain, causing damage to cells and tissues. Additionally, small amounts of alcohol are metabolized to acetaldehyde in the gastrointestinal tract, exposing these tissues to acetaldehyde’s damaging effects.

In addition to acetaldehyde’s toxic effects, some researchers believe that it may be responsible for some of the behavioral and physiological effects previously attributed to alcohol. For example, when acetaldehyde is administered to lab animals, it leads to incoordination, memory impairment, and sleepiness, effects often associated with alcohol.

On the other hand, other researchers report that acetaldehyde concentrations in the brain are not high enough to produce these effects. This is because the brain has a unique barrier of cells (the blood–brain barrier) that help to protect it from toxic products circulating in the bloodstream. It is possible, however, that acetaldehyde may be produced in the brain itself when alcohol is metabolized by the enzymes catalaseand CYP2E1.

Dangers of Mixing Alcohol and Caffeine

• The 2015–2020 Dietary Guidelines for Americans cautions against mixing alcohol with caffeine.
• When alcohol is mixed with caffeine, the caffeine can mask the depressant effects of alcohol, making drinkers feel more alert than they would otherwise. As a result, they may drink more alcohol and become more impaired than they realize, increasing the risk of alcohol-attributable harms.
• Caffeine has no effect on the metabolism of alcohol by the liver and thus does not reduce breath or blood alcohol concentrations (it does not “sober you up”) or reduce impairment due to alcohol consumption.

Dangers of Mixing Alcohol and Energy Drinks

• Energy drinks typically contain caffeine, plant-based stimulants, simple sugars, and other additives.
• Mixing alcohol with energy drinks is a popular practice, especially among young people in the United States. In 2015, 13.0% of students in grades 8, 10, and 12 and 33.5% of young adults aged 19 to 28 reported consuming alcohol mixed with energy drinks at least once in the past year.
• In a study among Michigan high school students, those who binge drank were more than twice as likely to mix alcohol with energy drinks as non-binge drinkers (49.0% vs. 18.2%). Liquor was the usual type of alcohol consumed by students who reported mixing alcohol and energy drinks (52.7%).
• Drinkers aged 15 to 23 who mix alcohol with energy drinks are 4 times more likely to binge drink at high intensity (i.e., consume 6 or more drinks per binge episode) than drinkers who do not mix alcohol with energy drinks.
• Drinkers who mix alcohol with energy drinks are more likely than drinkers who do not mix alcohol with energy drinks to report unwanted or unprotected sex, driving drunk or riding with a driver who was intoxicated, or sustaining alcohol-related injuries.

Caffeinated Alcoholic Beverages

• Caffeinated Alcoholic Beverages (CABs) were premixed beverages popular in the 2000s that combined alcohol, caffeine, and other stimulants. They were malt or distilled spirits-based beverages and they usually had a higher alcohol content than beer (e.g., 12% alcohol by volume compared to 4% to 5% for beer).
• CABs were heavily marketed in youth-friendly media (e.g., social media) and with youth-oriented graphics and messaging that connected the consumption of these beverages with extreme sports or other risk-taking behaviors.
• In November 2010, the US Food and Drug Administration (FDA) told the manufacturers of seven CABs that their drinks could no longer stay on the market in their current form, stating that “FDA does not find support for the claim that the addition of caffeine to these alcoholic beverages is ‘generally recognized as safe,’ which is the legal standard.”
• Producers of CABs responded by removing caffeine and other stimulants from their products. However, some producers continued to sell these products without caffeine.

Public Health Impact of Excessive Alcohol Use

• Excessive alcohol use is responsible for about 93,000 deaths in the United States each yearand $249 billion in economic costs in 2010.
• Binge drinking (consuming 4 or more drinks per occasion for women or 5 or more drinks per occasion for men) is responsible for almost half of these deaths and three quarters of economic costs.
• Binge drinking is also associated with many health and social problems, including alcohol-impaired driving, interpersonal violence, risky sexual activity, and unintended pregnancy.
• Most people younger than age 21 who drink report binge drinking, usually on multiple occasions.

Prevention Strategies

• The Community Preventive Services Task Force recommends effective population-based strategies for preventing excessive alcohol consumption and related harms, including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host (dram shop) liability for service to underage or intoxicated customers.
• States and communities have also developed educational strategies to alert consumers to the risks of mixing alcohol with energy drinks. At least one community enacted an ordinance requiring retailers to post warning signs informing consumers of the risks of mixing alcohol and energy drinks.
• Monitoring and reducing youth exposure to alcohol advertising through“no-buy” lists could also help reduce underage drinking.No-buy lists identify television programming that advertisers can avoid to improve compliance with the alcohol industry’s self-regulated alcohol marketing guidelines.

Polysubstance use is when two or more substances are used together or within a short time period, either intentionally or unintentionally. Polysubstance use involving alcohol includes drinking and using other substances such as marijuana, opioids, heroin or other illicit drugs, or medications not as prescribed. Whether intentional or not, using alcohol and other substances is unsafe because the effects may be stronger and more unpredictable than one drug alone, and even deadly.

Polysubstance use involving alcohol can increase the chance of health risks including:

• Overdose.
• Injury.
• Violence.
• Risky sexual behavior.
• Chronic disease.
• Alcohol or other substance use disorders.

Alcohol can increase overdose risk.

Using alcohol and certain other substances, including other depressants like opioids or benzodiazepines, together or within a couple of hours of drinking can result in:

• Difficulty or stopping breathing.
• Damage to the brain, heart, and other organs.
• Death.

Drinking alcohol with medications can also cause health problems or death. Always check with your healthcare provider before drinking while taking prescription medicine.

How common are overdoses involving alcohol in the United States?

• About 1 in 5 emergency department visits associated with the misuse of prescription medicines also involved alcohol in 2016.
• About 1 in 7 opioid-related deaths involved drinking alcohol within a few hours of using an opioid in 2017. The proportion of opioid overdose deaths involving alcohol varied by state, ranging from 7% to 29%.
• Opioid overdose deaths where alcohol contributed to the death increased 41% from 2019 to 2020.

What factors are associated with higher rates of polysubstance use involving alcohol?

• Being male, younger in age, non-Hispanic Black, or having a lower household income.
• Individual-level binge drinking. People who binge drink are four times more likely to use other substances than people who do not drink.
• Frequent binge drinking. Other substance use increases as the frequency of binge drinking increases.
• State-level binge drinking. States with higher binge drinking rates also have higher rates of opioid overdose deaths involving alcohol.

Harms involving the use of alcohol and other substances can be prevented.

You can:

• Avoid using alcohol when using other substances.
• Choose not to drink or limit alcohol use. If you are an adult of legal drinking age and choose to drink alcohol, adhere to the Dietary Guidelines for Americans on moderate alcohol use (up to one drink in a day for women and up to 2 drinks in a day for men).
• Talk with your healthcare provider about your drinking and discuss the medications that you are taking to prevent adverse reactions with prescribed medicines.
• Take a quick assessment to check your drinking.
• Support effective community strategies to prevent excessive alcohol use, such as increasing alcohol taxes, regulating the number of places that sell alcohol in your community, or others recommended by the Community Preventive Services Task Force.

States and communities can:

• Use comprehensive and effective approaches to reduce the availability and affordability of alcohol such as by regulating the density of alcohol outlets through zoning and licensing, increasing alcohol taxes, or other strategies recommended by the Community Preventive Services Task Force. These strategies can be used with other strategies to reduce overdoses, such as strengthening prescription drug monitoring programs.
• Enforce existing laws and regulations about alcohol sales and service.
• Develop and strengthen community coalitions that build partnerships between schools, faith-based organizations, law enforcement, healthcare providers, public health agencies, and local, tribal, and state leaders to reduce alcohol and other substance use and its impacts.
• Routinely monitor and report the prevalence, frequency, and intensity of binge drinking (whether people binge drink, how often they do so, and the number of drinks they consume) and other substance use.
• Routinely assess alcohol in toxicology testing in acute care settings and among decedents.

People have used alcohol to relieve pain since ancient times. Laboratory studies confirm that alcohol does indeed reduce pain in humans and in animals. Moreover, recent research suggests that as many as 28 percent of people experiencing chronic pain turn to alcohol to alleviate their suffering. Despite this, using alcohol to alleviate pain places people at risk for a number of harmful health consequences.

What Are the Risks?

Mixing alcohol and pain medicines can be harmful

• Mixing alcohol and acetaminophen can cause acute liver failure

• Mixing alcohol and aspirin increases risk for gastric bleeding

• Alcohol increases analgesic, reinforcing, and sedative effects of opiates, elevating risk for combined misuse of alcohol and opiates as well as overdose.

If you’re taking medications to manage your pain, talk to your doctor or pharmacist about any reactions that may result from mixing them with alcohol.

Analgesic doses of alcohol exceed levels recommended in the Dietary Guidelines for Americans, 2020-2025

• According to the Dietary Guidelines for Americans, 2020–2025, if alcohol is consumed, intake should be limited to 1 drink or less in a day for women and 2 drinks or less in a day for men. The greatest pain-reducing effects occur when alcohol is consumed at doses exceeding these guidelines.

• Tolerance develops to alcohol’s analgesic effects so that it takes more alcohol to produce the same effects. Increasing alcohol use to stay ahead of tolerance can lead to other problems, including the development of alcohol dependence.

Chronic alcohol drinking makes pain worse

• Withdrawal from chronic alcohol use often increases pain sensitivity which could motivate some people to continue drinking or even increase their drinking to reverse withdrawal-related increases in pain.

• Over time, alcohol misuse generates a painful small fiber peripheral neuropathy, the most common neurologic complication associated with alcohol use disorder.

If you use alcohol to relieve your pain, it is important to learn about possible adverse health effects.

You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.

This pamphlet lists medications that can cause harm when taken with alcohol and describes the effects that can result. The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication.

Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Did You Know…

Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.

Medicines may have many ingredients

Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking.

Some medicines contain alcohol

Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.

Alcohol affects women differently

Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.

Older people face greater risk

Older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.

Timing is important

Alcohol and medicines can interact harmfully even if they are not taken at the same time.

Remember...

Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.

Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol

What health problems are associated with excessive alcohol use?

Excessive drinking both in the form of heavy drinking or binge drinking, is associated with numerous health problems, including

• Chronic diseases such as liver cirrhosis (damage to liver cells); pancreatitis (inflammation of the pancreas); various cancers, including liver, mouth, throat, larynx (the voice box), and esophagus; high blood pressure; and psychological disorders.
• Unintentional injuries, such as motor-vehicle traffic crashes, falls, drowning, burns, and firearm injuries.
• Violence, such as child maltreatment, homicide, and suicide.
• Harm to a developing fetus if a woman drinks while pregnant, such as fetal alcohol spectrum disorders.
• Sudden infant death syndrome (SIDS).
• Alcohol use disorders.

Can alcohol use cause cancer?

There is a strong scientific evidence that drinking alcohol increases the risk for cancer, including cancers of the mouth and throat, liver, breast (in women) and colon and rectum, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day). The evidence indicates that the more alcohol a person drinks, the higher his or her risk of developing an alcohol-associated cancer. The risk varies by many factors, such as the quantity of alcohol consumed and type of cancer. The Dietary Guidelines for Americans recommends that adults who choose to drink do so in moderation – 1 drink or less on a day for women or 2 drinks or less on a day for men. However, emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.

How do I know if it’s okay to drink?

According to the 2020–2025 Dietary Guidelines for Americans some people should not drink alcoholic beverages at all, including:

• If they are pregnant or might be pregnant.
• If they are under the legal age for drinking.
• If they have certain medical conditions or are taking certain medications that can interact with alcohol.
• If they are recovering from an alcohol use disorder or if they are unable to control the amount they drink.

To reduce the risk of alcohol-related harms, the Guidelines recommend that adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed. The Guidelines also do not recommend that individuals who do not drink alcohol start drinking for any reason and that if adults of legal drinking age choose to drink alcoholic beverages, drinking less is better for health than drinking more. By following the Dietary Guidelines, you can reduce the risk of harm to yourself or others.

I am young. Is drinking bad for my health?

Yes. Studies have shown that alcohol use by adolescents and young adults increases the risk of both fatal and nonfatal injuries. Research has also shown that people who use alcohol before age 15 are six times more likely to become alcohol dependent than adults who begin drinking at age 21. Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.

Is it okay to drink when pregnant?

No. There is no known safe level of alcohol use during pregnancy. Women who are pregnant or plan on becoming pregnant should refrain from drinking alcohol. Several conditions, including fetal alcohol spectrum disorders, have been linked to alcohol use during pregnancy. Women of childbearing age should also avoid binge drinking to reduce the risk of unintended pregnancy and potential exposure of a developing fetus to alcohol.

Is it okay to drink when breastfeeding?

Not drinking alcohol is the safest option for breastfeeding mothers. Generally, moderate consumption of alcoholic beverages by a woman who is lactating (up to 1 standard drink in a day) is not known to be harmful to the infant, especially if the woman waits at least 2 hours after a single drink before nursing or expressing breast milk. Women considering consuming alcohol during lactation should talk to their healthcare provider.

Celebrating at parties, cheering a favorite sports team, and enjoying get-togethers after work are common ways to relax or be with friends. For some people, these occasions may also include drinking—even binge or extreme binge drinking (also known as high-intensity drinking). And when that happens, the results can be deadly.

Drinking too much and too quickly can lead to significant impairments in motor coordination, decision-making, impulse control, and other functions, increasing the risk of harm. Continuing to drink despite clear signs of significant impairments can result in an alcohol overdose.

What Is an Alcohol Overdose?

An alcohol overdose occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions—such as breathing, heart rate, and temperature control—begin to shut down. Symptoms of alcohol overdose include mental confusion, difficulty remaining conscious, vomiting, seizure, trouble breathing, slow heart rate, clammy skin, dulled responses such as no gag reflex (which prevents choking), and extremely low body temperature. Alcohol overdose can lead to permanent brain damage or death.

What tips the balance from drinking that produces impairment to drinking that puts one’s life in jeopardy varies among individuals. Age, sensitivity to alcohol (tolerance), gender, speed of drinking, medications you are taking, and amount of food eaten can all be factors.

Alcohol use and taking opioids or sedative-hypnotics, such as sleep and anti-anxiety medications, can increase your risk of an overdose. Examples of these medications include sleep aids such as zolpidem (Ambien) and eszopiclone (Lunesta), and benzodiazepines such as diazepam (Valium) and alprazolam (Xanax). Even drinking alcohol while taking over-the-counter antihistamines can be dangerous. Using alcohol with opioid pain relievers such as oxycodone and morphine or illicit opioids such as heroin is also a very dangerous combination. Like alcohol, these drugs suppress areas in the brain that control vital functions such as breathing. Ingesting alcohol and other drugs together intensifies their individual effects and could produce an overdose with even moderate amounts of alcohol.

Who May Be at Risk?

Anyone who consumes too much alcohol too quickly may be in danger of an alcohol overdose. This is especially true of individuals who engage in binge drinking, defined as a pattern of drinking that brings blood alcohol concentration (BAC) to .08 percent or higher,* typically occurring after a woman consumes 4 drinks or a man consumes 5 drinks in about 2 hours; as well as extreme binge drinking (also known as high-intensity drinking), defined as drinking two or more times the binge-drinking thresholds for women and men.

Teenagers and young adults who drink may be at particular risk for alcohol overdose. Research shows that teens and college-age young adults often engage in binge drinking and extreme binge drinking (or high-intensity drinking). Drinking such large quantities of alcohol can overwhelm the body’s ability to break down and clear alcohol from the bloodstream. This leads to rapid increases in BAC and significantly impairs brain and other bodily functions.

*A blood alcohol concentration (BAC) of .08 percent corresponds to .08 grams per deciliter, or .08 grams per 100 milliliters.

As BAC Increases—So Do the Risks

As blood alcohol concentration (BAC) increases, so does the effect of alcohol—as well as the risk of harm. Even small increases in BAC can decrease motor coordination, make a person feel sick, and cloud judgment. This can increase an individual’s risk of being injured from falls or car crashes, experiencing acts of violence, and engaging in unprotected or unintended sex. When BAC reaches high levels, amnesia (blackouts), loss of consciousness (passing out), and death can occur.

BAC can continue to rise even when a person stops drinking or is unconscious. Alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body.

It is dangerous to assume that an unconscious person will be fine by sleeping it off. One potential danger of alcohol overdose is choking on one’s own vomit. Alcohol at very high levels can hinder signals in the brain that control automatic responses such as the gag reflex. With no gag reflex, a person who drinks to the point of passing out is in danger of choking on his or her vomit and dying from a lack of oxygen (i.e., asphyxiation). Even if the person survives, an alcohol overdose like this can lead to long-lasting brain damage.

Critical Signs and Symptoms of an Alcohol Overdose

• Mental confusion, stupor
• Difficulty remaining conscious, or inability to wake up
• Vomiting
• Seizures
• Slow breathing (fewer than 8 breaths per minute)
• Irregular breathing (10 seconds or more between breaths)
• Slow heart rate
• Clammy skin
• Dulled responses, such as no gag reflex (which prevents choking)
• Extremely low body temperature, bluish skin color, or paleness

Know the Danger Signs and Act Quickly

Know the danger signals and, if you suspect that someone has an alcohol overdose, call 911 for help immediately. Do not wait for the person to have all the symptoms, and be aware that a person who has passed out can die. Don’t play doctor—cold showers, hot coffee, and walking do not reverse the effects of alcohol overdose and could actually make things worse.

While waiting for medical help to arrive:

• Be prepared to provide information to the responders, including the type and amount of alcohol the person drank; other drugs he or she took, if known; and any health information that you know about the person, such as medications currently taking, allergies to medications, and any existing health conditions.

• Do not leave an intoxicated person alone, as he or she is at risk of getting injured from falling or choking. Keep the person on the ground in a sitting or partially upright position rather than in a chair.

• Help a person who is vomiting. Have him or her lean forward to prevent choking. If a person is unconscious or lying down, roll him or her onto one side with an ear toward the ground to prevent choking.

Alcohol misuse: Drinking in a manner, situation, amount, or frequency that could cause harm to the person who drinks or to those around them. For individuals younger than the U.S. Minimum Legal Drinking Age of 21, or for pregnant females, any alcohol use constitutes alcohol misuse.

Alcohol use disorder (AUD): AUD is a chronic, relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM-5, integrates the two DSM-IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications.

Alcohol-impaired driving fatality: A fatality in a crash involving a driver or motorcycle rider (operator) with a blood alcohol concentration (BAC) of 0.08 g/dL or more (a BAC of 0.08% corresponds to 0.08 grams of alcohol per deciliter, or 0.08 grams per 100 milliliters).

Binge drinking:

• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08%—or 0.08 grams of alcohol per deciliter—or more. This typically happens if a woman has four or more drinks, or a man has five or more drinks, within about 2 hours.
• The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as consuming five or more beverages containing alcohol for males or four or more beverages containing alcohol for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days, regardless of frequency in the past year.
• The Monitoring the Future (MTF) survey defines binge drinking as having five or more drinks in a row in the past 2 weeks.

Disability-adjusted life years: A measure of years of life lost or lived in less than full health.

Heavy alcohol use (or heavy drinking):

• NIAAA defines heavy alcohol use as follows:
  • For men, consuming five or more drinks on any day or 15 or more per week
  • For women, consuming four or more drinks on any day or 8 or more per week
• SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past 30 days.

High-intensity drinking:

• Consumption of two or more times the gender-specific thresholds for binge drinking, which means 10 or more standard drinks (or alcoholic drink equivalents) for males and eight or more for females. High-intensity drinking is consistent with drinking at binge levels II and III. The levels correspond to one to two times (I), two to three times (II), and three or more times (III) the standard gender-specific binge thresholds.
• The MTF survey defines high-intensity drinking among adolescents as consuming 10 or more (8th, 10th, and 12th grade) or 15 or more (12th grade only) drinks in a row in the past 2 weeks.

Medication assisted treatment (MAT) for AUD: The 2022 NSDUH defines MAT as medication prescribed by a doctor or other health professional to help cut back or stop the use of alcohol. Medications shown to survey respondents as examples included acamprosate, disulfiram, naltrexone pills, and injectable naltrexone.

Patterns of drinking associated with AUD: Binge drinking and heavy alcohol use can increase an individual’s risk of AUD. According to the 2020–2025 Dietary Guidelines for Americans, adults of legal drinking age can choose not to drink or to limit intake to two drinks or less in a day for men and one drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. Some individuals should avoid alcohol completely.

Substance use treatment: The 2022 NSDUH defines substance use treatment as treatment for drug or alcohol use through inpatient treatment/counseling, outpatient treatment/counseling, MAT, telehealth treatment, or treatment received in a prison, jail, or juvenile detention center.

Underage drinking: Alcohol use by anyone under the age of 21. The U.S. Minimum Legal Drinking Age is 21.