Drinking alcohol is so common that people may not question how even one beer, cocktail, or glass of wine could impact their health. Alcohol is a part of cultural traditions all around the world…and it’s also a drug that chemically alters the body. People of all ages need to understand these effects.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has information on how alcohol impacts your health. It also has resources to help those looking to change their drinking habits.

What does alcohol do to your body?

Just one or two alcoholic drinks can impair your balance, coordination, impulse control, memory, and decision-making. This increases your risk of injuries. Too much alcohol can also shut down parts of your brain that are essential for keeping you alive. Over the long term, alcohol can increase your risk of more than 200 different diseases, including in the liver and pancreas, and certain cancers.

The alcohol you consume resides mostly in the body’s water. Because women tend to have less water in their bodies than men, if a woman and a man of the same weight drank the same amount of alcohol, the woman’s blood alcohol concentration (BAC) would likely be higher. This could help explain why women are more likely to have negative effects from alcohol.

NIAAA Director George F. Koob, Ph.D., said that as of May 2023, the institute is not aware of specific health guidelines on alcohol consumption for transgender or gender-nonconforming individuals.

How much alcohol is safe to drink?

No amount of alcohol is "safe" or beneficial for your health. In fact, alcohol’s harmful effects (such as risk of developing certain cancers) start at fewer than one drink per day. Some people should not drink at all, including:

• People under the legal drinking age of 21
• People with certain medical conditions
• People who are pregnant or who may become pregnant

Drinking alcohol during pregnancy can lead to symptoms of fetal alcohol spectrum disorders (FASD). FASD can cause a range of neurodevelopmental and physical effects in the child after birth.

Mixing alcohol and medicines can be harmful. If you are on any medications, talk to your health care provider about how alcohol may affect them.

What is moderate alcohol use?

According to Dietary Guidelines for Americans, moderate alcohol use is consuming two drinks or less in a day for men and one drink or less a day for women. But what is a standard drink?

What is binge drinking?

Binge drinking is drinking enough alcohol to raise one's BAC to 0.08% or above. Women typically reach this level after about four drinks and men after about five drinks in two hours. Binge drinking—and heavy drinking—is a type of alcohol misuse (a spectrum of risky alcohol-related behaviors).

What is alcohol use disorder?

Alcohol use disorder (AUD) is a chronic brain disorder that makes it difficult to control alcohol use, even when it’s causing problems. AUD can be mild, moderate, or severe.

Alcohol misuse at an early age increases the risk of developing AUD. Genetics or a family history of alcohol misuse increases that risk as well. Childhood trauma, mental health issues, and stress can also lead people to begin drinking or drink more than usual.

But there is good news! No matter how severe the problem may seem, evidence-based treatment can help people with AUD recover.

Where can someone find treatment for AUD?

While there is no one-size-fits-all method for recovering from AUD, there are lots of effective treatment options. Some examples include behavioral treatments, support groups, and FDA-approved medications. NIAAA can help people find information and resources about AUD and treatments that might work best for them.

Many people are surprised to learn what counts as a drink. The amount of liquid in your glass, can, or bottle does not necessarily match up to how much alcohol is actually in your drink. Different types of beer, wine, or malt liquor can have very different amounts of alcohol content. For example, many light beers have almost as much alcohol as regular beer – about 85% as much. Here’s another way to put it:

• Regular beer: 5% alcohol content
• Some light beers: 4.2% alcohol content

That’s why it’s important to know how much alcohol your drink contains. In the United States, one "standard" drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in:

• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol
• 1.5 ounces of distilled spirits, which is about 40% alcohol

How do you know how much alcohol is in your drink?

Even though they come in different sizes, the drinks below are each examples of one standard drink:

Each beverage portrayed above represents one standard drink (or one alcoholic drink equivalent), defined in the United States as any beverage containing 0.6 fl oz or 14 grams of pure alcohol. The percentage of pure alcohol, expressed here as alcohol by volume (alc/vol), varies within and across beverage types. Although the standard drink amounts are helpful for following health guidelines, they may not reflect customary serving sizes.

Alcohol interferes with the brain’s communication pathways and can affect the way the brain looks and works. Alcohol makes it harder for the brain areas controlling balance, memory, speech, and judgment to do their jobs, resulting in a higher likelihood of injuries and other negative outcomes. Long-term heavy drinking causes alterations in the neurons, such as reductions in their size. Below are a few key topics related to alcohol and the brain.

The Adolescent Brain

Adolescent brains are more vulnerable to the negative effects of alcohol than adult brains. Misuse of alcohol during adolescence can alter brain development, potentially resulting in long-lasting changes in brain structure and function.

Alcohol-Induced Blackouts

Alcohol misuse can cause alcohol-induced blackouts. Blackouts are gaps in a person’s memory of events that occurred while they were intoxicated. These gaps happen when a person drinks enough alcohol that it temporarily blocks the transfer of memories from short-term to long-term storage—known as memory consolidation—in a brain area called the hippocampus.

Alcohol Overdose

Continuing to drink despite clear signs of significant impairments can result in 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.

Alcohol Use Disorder

As individuals continue to drink alcohol over time, progressive changes can occur in the structure and function of their brains. These changes can compromise brain function and drive the transition from controlled, occasional use to chronic misuse, which can be difficult to control and lead to alcohol use disorder (AUD). Individuals with moderate to severe AUD may enter a cycle of alcohol addiction. The extent of the brain’s ability to return to normal following long-term sobriety is not fully understood, but a growing number of studies indicate that at least some AUD-induced brain changes—and the changes in thinking, feeling, and behaving that accompany them—can improve and possibly reverse with months of abstinence from drinking.

Prenatal Alcohol Exposure

Prenatal alcohol exposure can cause brain damage, leading to a range of developmental, cognitive, and behavioral problems, which can appear at any time during childhood. Alcohol can disrupt fetal development at any stage during a pregnancy—including at the earliest stages and before a woman knows she is pregnant.

Drinking too much – on a single occasion or over time – can take a serious toll on your health. Here’s how alcohol can affect your body:

Brain:
Alcohol interferes with the brain’s communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.

Heart:
Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including:

• Cardiomyopathy – Stretching and drooping of heart muscle
• Arrhythmias – Irregular heart beat
• Stroke
• High blood pressure

Liver:
Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver inflammations including:

• Steatosis, or fatty liver
• Alcoholic hepatitis
• Fibrosis
• Cirrhosis

Pancreas:
Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation in the pancreas that causes its swelling and pain (which may spread) and impairs its ability to make enzymes and hormones for proper digestion.

Cancer:
According to the National Cancer Institute: "There is a strong scientific consensus that alcohol drinking can cause several types of cancer. In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.

"The evidence indicates that the more alcohol a person drinks–particularly the more alcohol a person drinks regularly over time–the higher his or her risk of developing an alcohol-associated cancer. Even those who have no more than one drink per day and people who binge drink (those who consume 4 or more drinks for women and 5 or more drinks for men in one sitting) have a modestly increased risk of some cancers. Based on data from 2009, an estimated 3.5% of cancer deaths in the United States (about 19,500 deaths were alcohol related."

Clear patterns have emerged between alcohol consumption and increased risks of certain types of cancer:

• Head and neck cancer, including oral cavity, pharynx, and larynx cancers.

• Esophageal cancer, particularly esophageal squamous cell carcinoma. In addition, people who inherit a deficiency in an enzyme that metabolizes alcohol have been found to have substantially increased risks of esophageal squamous cell carcinoma if they consume alcohol.

• Liver cancer.

• Breast cancer: Studies have consistently found an increased risk of breast cancer in women with increasing alcohol intake. Women who consume about 1 drink per day have a 5 to 9 percent higher chance of developing breast cancer than women who do not drink at all.

• Colorectal cancer.

Immune System:
Drinking too much can weaken your immune system, making your body a much easier target for disease. Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single occasion slows your body’s ability to ward off infections – even up to 24 hours after getting drunk.

Alcohol is part of our culture—it helps us celebrate and socialize, and it enhances our religious ceremonies. But drinking too much—on a single occasion or over time—can have serious consequences for our health. Most Americans recognize that drinking too much can lead to accidents and dependence. But that’s only part of the story. In addition to these serious problems, alcohol abuse can damage organs, weaken the immune system, and contribute to cancers. Plus, much like smoking, alcohol affects different people differently. Genes, environment, and even diet can play a role in whether you develop an alcohol-related disease. On the flip side, some people actually may benefit from drinking alcohol in small quantities. Sound complicated? It sure can be. To stay healthy, and to decide what role alcohol should play in your life, you need accurate, up-to-date information.

A little goes a long way: know the amounts

Knowing how much alcohol constitutes a “standard” drink can help you determine how much you are drinking and understand the risks. One standard drink contains about 0.6 fluid ounces or 14 grams of pure alcohol. In more familiar terms, the following amounts constitute one standard drink:

• 12 fluid ounces of beer (about 5% alcohol)
• 8 to 9 fluid ounces of malt liquor (about 7% alcohol)
• 5 fluid ounces of table wine (about 12% alcohol)
• 1.5 fluid ounces of 80-proof distilled spirits (40% alcohol)

Research demonstrates “low-risk” drinking levels for men are no more than 4 drinks on any single day AND no more than 14 drinks per week. For women, “low-risk” drinking levels are no more than three drinks on any single day AND no more than seven drinks per week. To stay low-risk, you must keep within both the single-day and weekly limits.

Even within these limits, you can have problems if you drink too quickly, have health conditions, or are over age 65. Older adults should have no more than three drinks on any day and no more than seven drinks per week.

Based on your health and how alcohol affects you, you may need to drink less or not at all. People who should abstain from alcohol completely include those who:

• Plan to drive a vehicle or operate machinery
• Are pregnant or trying to become pregnant
• Take medications that interact with alcohol
• Have a medical condition that alcohol can aggravate

You’re chatting with friends at a party and a waitress comes around with glasses of champagne. You drink one, then another, maybe even a few more. Before you realize it, you are laughing more loudly than usual and swaying as you walk. By the end of the evening, you are too slow to move out of the way of a waiter with a dessert tray and have trouble speaking clearly. The next morning, you wake up feeling dizzy and your head hurts. You may have a hard time remembering everything you did the night before.

These reactions illustrate how quickly and dramatically alcohol affects the brain. The brain is an intricate maze of connections that keeps our physical and psychological processes running smoothly. Disruption of any of these connections can affect how the brain works. Alcohol also can have longer-lasting consequences for the brain—changing the way it looks and works and resulting in a range of problems.

Most people do not realize how extensively alcohol can affect the brain. But recognizing these potential consequences will help you make better decisions about what amount of alcohol is appropriate for you.

WHAT HAPPENS INSIDE THE BRAIN?

The brain’s structure is complex. It includes multiple systems that interact to support all of your body’s functions—from thinking to breathing and moving.

These multiple brain systems communicate with each other through about a trillion tiny nerve cells called neurons. Neurons in the brain translate information into electrical and chemical signals the brain can understand. They also send messages from the brain to the rest of the body.

Chemicals called neurotransmitters carry messages between the neurons. Neurotransmitters can be very powerful. Depending on the type and the amount of neurotransmitter, these chemicals can either intensify or minimize your body’s responses, your feelings, and your mood. The brain works to balance the neurotransmitters that speed things up with the ones that slow things down to keep your body operating at the right pace.

Alcohol can slow the pace of communication between neurotransmitters in the brain.

DISCOVERING THE BRAIN CHANGES

There still is much we do not understand about how the brain works and how alcohol affects it. Researchers are constantly discovering more about how alcohol interrupts communication pathways in the brain and changes brain structure, and the resulting effects on behavior and functioning. A variety of research methods broaden our understanding in different ways:

• BRAIN IMAGING– Various imaging tools, including structural magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and positron emission tomography (PET), are used to create pictures of the brain. MRI and DTI create images of brain structure, or what the brain looks like. fMRI looks at brain function, or what the brain is doing. It can detect changes in brain activity. PET scans look at changes in neurotransmitter function. All of these imaging techniques are useful to track changes in the alcoholic brain. For example, they can show how an alcoholic brain changes immediately after drinking stops, and again after a long period of sobriety, to check for possible relapses.
• PSYCHOLOGICAL TESTS – Researchers also use psychological tests to evaluate how alcohol-related brain changes affect mental functioning. These tests demonstrate how alcohol affects emotions and personality, as well as how it compromises learning and memory skills.
• ANIMAL STUDIES – Testing the effect of alcohol on animals’ brains helps researchers better understand how alcohol injures the human brain, and how abstinence can reverse this damage.

DEFINING THE BRAIN CHANGES

Using brain imaging and psychological tests, researchers have identified the regions of the brain most vulnerable to alcohol’s effects. These include:

• CEREBELLUM – This area controls motor coordination. Damage to the cerebellum results in a loss of balance and stumbling, and also may affect cognitive functions such as memory and emotional response.
• LIMBIC SYSTEM – This complex brain system monitors a variety of tasks including memory and emotion. Damage to this area impairs each of these functions.
• CEREBRAL CORTEX – Our abilities to think, plan, behave intelligently, and interact socially stem from this brain region. In addition, this area connects the brain to the rest of the nervous system. Changes and damage to this area impair the ability to solve problems, remember, and learn.

ALCOHOL SHRINKS AND DISTURBS BRAIN TISSUE

Heavy alcohol consumption—even on a single occasion—can throw the delicate balance of neurotransmitters off course. Alcohol can cause your neurotransmitters to relay information too slowly, so you feel extremely drowsy. Alcohol-related disruptions to the neurotransmitter balance also can trigger mood and behavioral changes, including depression, agitation, memory loss, and even seizures.

Long-term, heavy drinking causes alterations in the neurons, such as reductions in the size of brain cells. As a result of these and other changes, brain mass shrinks and the brain’s inner cavity grows bigger. These changes may affect a wide range of abilities, including motor coordination; temperature regulation; sleep; mood; and various cognitive functions, including learning and memory.

One neurotransmitter particularly susceptible to even small amounts of alcohol is called glutamate. Among other things, glutamate affects memory. Researchers believe that alcohol interferes with glutamate action, and this may be what causes some people to temporarily “black out,” or forget much of what happened during a night of heavy drinking.

Alcohol also causes an increased release of serotonin, another neurotransmitter, which helps regulate emotional expression, and endorphins, which are natural substances that may spark feelings of relaxation and euphoria as intoxication sets in. Researchers now understand that the brain tries to compensate for these disruptions. Neurotransmitters adapt to create balance in the brain despite the presence of alcohol. But making these adaptations can have negative results, including building alcohol tolerance, developing alcohol dependence, and experiencing alcohol withdrawal symptoms.

WHAT FACTORS MAKE A DIFFERENCE?

Different people react differently to alcohol. That is because a variety of factors can influence your brain’s response to alcohol. These factors include:

• HOW MUCH AND HOW OFTEN YOU DRINK – The more you drink, the more vulnerable your brain is.
• YOUR GENETIC BACKGROUND AND FAMILY HISTORY OF ALCOHOLISM – Certain ethnic populations can have stronger reactions to alcohol, and children of alcoholics are more likely to become alcoholics themselves.
• YOUR PHYSICAL HEALTH – If you have liver or nutrition problems, the effects of alcohol will take longer to wear off.

ARE BRAIN PROBLEMS REVERSIBLE?

Abstaining from alcohol over several months to a year may allow structural brain changes to partially correct. Abstinence also can help reverse negative effects on thinking skills, including problem-solving, memory, and attention.

OTHER ALCOHOL-RELATED BRAIN CONDITIONS

LIVER DAMAGE THAT AFFECTS THE BRAIN

Not only does alcoholic liver disease affect liver function itself, it also damages the brain. The liver breaks down alcohol—and the toxins it releases. During this process, alcohol’s byproducts damage liver cells. These damaged liver cells no longer function as well as they should and allow too much of these toxic substances, ammonia and manganese in particular, to travel to the brain. These substances proceed to damage brain cells, causing a serious and potentially fatal brain disorder known as hepatic encephalopathy.

Hepatic encephalopathy causes a range of problems, from less severe to fatal. These problems can include:

• Sleep disturbances
• Mood and personality changes
• Anxiety
• Depression
• Shortened attention span
• Coordination problems, including asterixis, which results in hand shaking or flapping
• Coma
• Death

Doctors can help treat hepatic encephalopathy with compounds that lower blood ammonia concentrations and with devices that help remove harmful toxins from the blood. In some cases, people suffering from hepatic encephalopathy require a liver transplant, which generally helps improve brain function.

FETAL ALCOHOL SPECTRUM DISORDERS

Alcohol can affect the brain at any stage of development—even before birth. Fetal alcohol spectrum disorders are the full range of physical, learning, and behavioral problems, and other birth defects that result from prenatal alcohol exposure. The most serious of these disorders, fetal alcohol syndrome (FAS), is characterized by abnormal facial features and is usually associated with severe reductions in brain function and overall growth. FAS is the leading preventable birth defect associated with mental and behavioral impairment in the United States today. The brains of children with FAS are smaller than normal and contain fewer cells, including neurons. These deficiencies result in life-long learning and behavioral problems. Current research is investigating whether the brain function of children and adults with FAS can be improved with complex rehabilitative training, dietary supplements, or medications.

Americans know how prevalent heart disease is—about 1 in 12 of us suffer from it. What we don’t always recognize are the connections heart disease shares with alcohol. On the one hand, researchers have known for centuries that excessive alcohol consumption can damage the heart. Drinking a lot over a long period of time or drinking too much on a single occasion can put your heart—and your life—at risk. On the other hand, researchers now understand that drinking moderate amounts of alcohol can protect the hearts of some people from the risks of coronary artery disease.

Deciding how much, if any, alcohol is right for you can be complicated. To make the best decision for yourself, you need to know the facts and then consult your physician.

KNOW THE FUNCTION:

Your cardiovascular system consists of your heart, blood vessels, and blood. This system works constantly—every second of your life—delivering oxygen and nutrients to your cells, and carrying away carbon dioxide and other unnecessary material.

Your heart drives this process. It is a muscle that contracts and relaxes over and over again, moving the blood along the necessary path. Your heart beats about 100,000 times each day, pumping the equivalent of 2,000 gallons of blood throughout your body.

The two sides, or chambers, of the heart receive blood and pump it back into the body. The right ventricle of the heart pumps blood into the lungs to exchange carbon dioxide from the cells for oxygen. The heart relaxes to allow this blood back into its left chamber. It then pumps the oxygen-rich blood to tissues and organs. Blood passing through the kidneys allows the body to get rid of waste products. Electrical signals keep the heart pumping continuously and at the appropriate rate to propel this routine.

KNOW THE RISKS:

ALCOHOLIC CARDIOMYOPATHY

Long-term heavy drinking weakens the heart muscle, causing a condition called alcoholic cardiomyopathy. A weakened heart droops and stretches and cannot contract effectively. As a result, it cannot pump enough blood to sufficiently nourish the organs. In some cases, this blood flow shortage causes severe damage to organs and tissues. Symptoms of cardiomyopathy include shortness of breath and other breathing difficulties, fatigue, swollen legs and feet, and irregular heartbeat. It can even lead to heart failure.

ARRHYTHMIAS

Both binge drinking and long-term drinking can affect how quickly a heart beats.The heart depends on an internal pacemaker system to keep it pumping consistently and at the right speed. Alcohol disturbs this pacemaker system and causes the heart to beat too rapidly, or irregularly. These heart rate abnormalities are called arrhythmias. Two types of alcohol induced arrhythmias are:

• ATRIAL FIBRILLATION – In this form of arrhythmia, the heart’s upper, or atrial, chambers shudder weakly but do not contract. Blood can collect and even clot in these upper chambers. If a blood clot travels from the heart to the brain, a stroke can occur; if it travels to other organs such as the lungs, an embolism, or blood vessel blockage, occurs.
• VENTRICULAR TACHYCARDIA – This form of arrhythmia occurs in the heart’s lower, or ventricular, chambers. Electrical signals travel throughout the heart’s muscles, triggering contractions that keep blood flowing at the right pace. Alcohol-induced damage to heart muscle cells can cause these electrical impulses to circle through the ventricle too many times, causing too many contractions. The heart beats too quickly, and so does not fill up with enough blood between each beat. As a result, the rest of the body does not get enough blood. Ventricular tachycardia causes dizziness, lightheadedness, unconsciousness, cardiac arrest, and even sudden death. Drinking to excess on a particular occasion, especially when you generally don’t drink, can trigger either of these irregularities. In these cases, the problem is nicknamed “holiday heart syndrome,” because people who don’t usually drink may consume too much alcohol at parties during the holiday season. Over the long-term, chronic drinking changes the course of electrical impulses that drive the heart’s beating, which creates arrhythmia.

STROKES

A stroke occurs when blood cannot reach the brain. In about 80 percent of strokes, a blood clot prevents blood flow to the brain. These are called ischemic strokes. Sometimes, blood accumulates in the brain, or in the spaces surrounding it. This causes hemorrhagic strokes.

Both binge drinking and long-term heavy drinking can lead to strokes even in people without coronary heart disease. Recent studies show that people who binge drink are about 56 percent more likely than people who never binge drink to suffer an ischemic stroke over 10 years. Binge drinkers also are about 39 percent more likely to suffer any type of stroke than people who never binge drink.

In addition, alcohol exacerbates the problems that often lead to strokes, including hypertension, arrhythmias, and cardiomyopathy.

4. HYPERTENSION

Chronic alcohol use, as well as binge drinking, can cause high blood pressure, or hypertension. Your blood pressure is a measurement of the pressure your heart creates as it beats, and the pressure inside your veins and arteries. Healthy blood vessels stretch like elastic as the heart pumps blood through them. Hypertension develops when the blood vessels stiffen, making them less flexible. Heavy alcohol consumption triggers the release of certain stress hormones that in turn constrict blood vessels.This elevates blood pressure. In addition, alcohol may affect the function of the muscles within the blood vessels, causing them to constrict and elevate blood pressure.

KNOW THE BENEFITS:

Research shows that healthy people who drink moderate amounts of alcohol may have a lower risk of developing coronary heart disease than nondrinkers. Moderate drinking is usually defined as no more than two drinks in a given day for men and one drink per day for women who are not pregnant or trying to conceive.

A variety of factors, including diet, genetics, high blood pressure, and age, can cause fat to build up in your arteries, resulting in coronary heart disease. An excess of fat narrows the coronary arteries, which are the blood vessels that supply blood directly to the heart. Clogged arteries reduce blood supply to the heart muscle, and make it easier for blood clots to form. Blood clots can lead to both heart attacks and strokes.

According to recent studies, drinking moderately can protect your heart from these conditions. Moderate drinking helps inhibit and reduce the build-up of fat in the arteries. It can raise the levels of HDL—or “good” cholesterol—in the blood, which wards off heart disease. It can help guard against heart attack and stroke by preventing blood clots from forming and by dissolving blood clots that do develop. Drinking moderately also may help keep blood pressure levels in check.

These benefits may not apply to people with existing medical conditions, or who regularly take certain medications. In addition, researchers discourage people from beginning to drink just for the health benefits. Rather, you can use this research to help you spark a conversation with your medical professional about the best path for you.

KNOW THE FACTS:

Liver disease is one of the leading causes of illness and death in the United States. More than 2 million Americans suffer from liver disease caused by alcohol. In general, liver disease strikes people who drink heavily over many years.

While many of us recognize that excessive alcohol consumption can lead to liver disease, we might not know why. Understanding the connections between alcohol and the liver can help you make smarter decisions about drinking and take better control of your health.

KNOW THE FUNCTION:

Your liver works hard to keep your body productive and healthy. It stores energy and nutrients. It generates proteins and enzymes your body uses to function and ward off disease. It also rids your body of substances that can be dangerous—including alcohol.

The liver breaks down most of the alcohol a person consumes. But the process of breaking alcohol down generates toxins even more harmful than alcohol itself. These by-products damage liver cells, promote inflammation, and weaken the body’s natural defenses. Eventually, these problems can disrupt the body’s metabolism and impair the function of other organs.

Because the liver plays such a vital role in alcohol detoxification, it is especially vulnerable to damage from excessive alcohol.

KNOW THE CONSEQUENCES:

Heavy drinking—even for just a few days at a time—can cause fat to build up in the liver. This condition, called steatosis, or fatty liver, is the earliest stage of alcoholic liver disease and the most common alcohol-induced liver disorder. The excessive fat makes it more difficult for the liver to operate and leaves it open to developing dangerous inflammations, like alcoholic hepatitis.

For some, alcoholic hepatitis does not present obvious symptoms. For others, though, alcoholic hepatitis can cause fever, nausea, appetite loss, abdominal pain, and even mental confusion. As it increases in severity, alcoholic hepatitis dangerously enlarges the liver, and causes jaundice, excessive bleeding, and clotting difficulties.

Another liver condition associated with heavy drinking is fibrosis, which causes scar tissue to build up in the liver. Alcohol alters the chemicals in the liver needed to break down and remove this scar tissue. As a result, liver function suffers.

If you continue to drink, this excessive scar tissue builds up and creates a condition called cirrhosis, which is a slow deterioration of the liver. Cirrhosis prevents the liver from performing critical functions, including managing infections, removing harmful substances from the blood, and absorbing nutrients.

A variety of complications, including jaundice, insulin resistance and type 2 diabetes, and even liver cancer, can result as cirrhosis weakens liver function.

Risk factors ranging from genetics and gender, to alcohol accessibility, social customs around drinking, and even diet can affect a person’s individual susceptibility to alcoholic liver disease. Statistics show that about one in five heavy drinkers will develop alcoholic hepatitis, while one in four will develop cirrhosis.

KNOW THERE’S A BRIGHT SIDE:

The good news is that a variety of lifestyle changes can help treat alcoholic liver disease. The most critical lifestyle change is abstinence from alcohol. Quitting drinking will help prevent further injury to your liver. Cigarette smoking, obesity, and poor nutrition all contribute to alcoholic liver disease. It is important to stop smoking and improve your eating habits to keep liver disease in check. But when conditions like cirrhosis become severe, a liver transplant may be the primary treatment option.

KNOW THE FACTS:

Each year, acute pancreatitis sends more than 200,000 Americans to the hospital. Many of those who suffer from pancreatic problems are also heavy drinkers. Habitual and excessive drinking damages the pancreas, and commonly causes pancreatitis. Learning more about the links between alcohol and pancreatic problems can help you make better decisions to protect your health.

KNOW THE FUNCTION:

The pancreas plays an important role in food digestion and its conversion into fuel to power your body. It sends enzymes into the small intestine to digest carbohydrates, proteins, and fat. It also secretes insulin and glucagon, hormones that regulate the process of utilizing glucose, the body’s main source of energy. Insulin and glucagon control glucose levels, which helps all cells use the energy glucose provides. Insulin also ensures that extra glucose gets stored away as either glycogen or fat.

When you drink, alcohol damages pancreatic cells and influences metabolic processes involving insulin. This process leaves the pancreas open to dangerous inflammations.

KNOW THE RISKS:

A pancreas unaffected by alcohol sends enzymes out to the small intestine to metabolize food. Alcohol jumbles this process. It causes the pancreas to secrete its digestive juices internally, rather than sending the enzymes to the small intestine. These enzymes, as well as acetaldehyde—a substance produced from metabolizing, or breaking down the alcohol—are harmful to the pancreas. If you consume alcohol excessively over a long time, this continued process can cause inflammation, as well as swelling of tissues and blood vessels.

This inflammation is called pancreatitis, and it prevents the pancreas from working properly. Pancreatitis occurs as a sudden attack, called acute pancreatitis. As excessive drinking continues, the inflammation can become constant. This condition is known as chronic pancreatitis.

Pancreatitis is also a risk factor for the development of pancreatic cancer.

A heavy drinker may not be able to detect the build-up of pancreatic damage until the problems set off an attack.

An acute pancreatic attack causes symptoms including:

• Abdominal pain, which may radiate up the back
• Nausea and vomiting
• Fever
• Rapid heart rate
• Diarrhea
• Sweating

Chronic pancreatitis causes these symptoms as well as severe abdominal pain, significant reduction in pancreatic function and digestion, and blood sugar problems. Chronic pancreatitis can slowly destroy the pancreas and lead to diabetes or even death.

While a single drinking binge will not automatically lead to pancreatitis, the risk of developing the disease increases as excessive drinking continues over time.

These risks apply to all heavy drinkers, but only about 5 percent of people with alcohol dependence develop pancreatitis. Some people are more susceptible to the disease than others, but researchers have not yet identified exactly what environmental and genetic factors play the biggest role.

TREATMENT HELPS — BUT DOES NOT CURE

Abstinence from alcohol can slow the progression of pancreatitis and reduce its painful symptoms.A low-fat diet also may help. It is also critical to guard against infections and to get supportive treatment. Treatment options, including enzyme-replacement therapy or insulin, can improve pancreatic function. In some cases, surgery is necessary to relieve pain, clear blockages, and reduce attacks.

The effects of alcoholic pancreatitis can be managed, but not easily reversed.

Germs and bacteria surround us everywhere. Luckily, our immune system is designed to protect our bodies from the scores of foreign substances that can make us sick. Drinking too much alcohol weakens the immune system, making your body a much easier target for disease. Understanding the effect alcohol can have on your immune system can inform the decisions you make about drinking alcohol.

KNOW THE FACTS:

Your immune system is often compared to an army. This army defends your body from infection and disease. Your skin and the mucous that lines your respiratory and gastrointestinal tracts help block bacteria from entering or staying in your body. If foreign substances somehow make it through these barriers, your immune system kicks into gear with two defensive systems: innate and adaptive.

The innate system exists in your body before you are exposed to foreign substances like bacteria, viruses, fungi, or parasites. These substances, which are called antigens, can invade your body and make you sick. The components of the innate system include:

• WHITE BLOOD CELLS – White blood cells form your first line of defense against infection. They surround and swallow foreign bodies quickly.
• NATURAL KILLER (NK) CELLS – Natural Killers are special white blood cells that detect and destroy cells infected with cancer or viruses.
• CYTOKINES – White blood cells send out these chemical messengers directly to an infected site. Cytokines trigger inflammatory responses, like dilating blood vessels and increasing blood flow to the affected area. They also call on more white blood cells to swarm an infected area.

The adaptive system kicks in after you are exposed to an infection for the first time. The next time you encounter the same infection, your adaptive system fights it off even faster and more efficiently than the first time. The components of the adaptive system include:

• T-LYMPHOCYTE CELLS – T-cells reinforce the work of white blood cells by targeting individual foreign substances.T-cells can identify and destroy a vast array of bacteria and viruses. They can also kill infected cells and secrete cytokines.
• B-LYMPHOCYTE CELLS – B-cells produce antibodies that fight off harmful substances by sticking to them and making them stand out to other immune cells.
• ANTIBODIES – After B-cells encounter antigens, they produce antibodies. These are proteins that target specific antigens and then remember how to combat the antigen.

KNOW THE RISKS:

Alcohol suppresses both the innate and the adaptive immune systems. Chronic alcohol use reduces the ability of white blood cells to effectively engulf and swallow harmful bacteria. Excessive drinking also disrupts the production of cytokines, causing your body to either produce too much or not enough of these chemical messengers. An abundance of cytokines can damage your tissues, whereas a lack of cytokines leaves you open to infection.

Chronic alcohol use also suppresses the development of T-cells and may impair the ability of NK cells to attack tumor cells. This reduced function makes you more vulnerable to bacteria and viruses, and less capable of destroying cancerous cells.

With a compromised immune system, chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. There is also data linking alcohol’s damage to the immune system with an increased susceptibility to contracting HIV infection. HIV develops faster in chronic drinkers who already have the virus.

Drinking a lot on a single occasion also can compromise your immune system. Drinking to intoxication can slow your body’s ability to produce cytokines that ward off infections by causing inflammations. Without these inflammatory responses, your body’s ability to defend itself against bacteria is significantly reduced. A recent study shows that slower inflammatory cytokine production can reduce your ability to fight off infections for up to 24 hours after getting drunk.

STILL LOOKING FOR THE BRIGHT SIDE

At this point, scientists do not know whether abstinence, reduced drinking, or other measures will help reverse the effects of alcohol on the immune system. Nevertheless, it is important to keep in mind that avoiding drinking helps minimize the burden on your immune system, particularly if you are fighting a viral or bacterial infection.

What Is 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. Research shows that fewer drinks in the same time frame result in the same BAC in youth: only three drinks for girls and three to five drinks for boys, depending on their age and size.

How Common Is Binge Drinking?

According to the 2022 National Survey on Drug Use and Health (NSDUH), about 61 million, or 21.7%, of people in the United States ages 12 and older reported binge drinking during the past month. Although binge drinking is a concern among all age groups, there are important trends in the following groups.

• Preteens and Teens: Rates of binge drinking among young people have been steadily decreasing in the last decade. Still, according to 2022 data from the Monitoring the Future survey, 2.2% of 8th graders, 5.9% of 10th graders, and 12.6% of 12th graders reported binge drinking in the past 2 weeks.
• Young Adults: Rates of binge drinking among people ages 18 to 25 have been decreasing in the past decade, but remain high (29.5% in 2022). According to the 2022 NSDUH, of full-time college students ages 18 to 22, 49.0% drank alcohol and 28.9% engaged in binge drinking in the past month.
• Older Adults: About 9.7% of adults ages 65 and older reported binge drinking in the past month. Binge drinking among this age group is of particular concern because many older adults use medications that can interact with alcohol, have health conditions that can be exacerbated by alcohol, and may be more susceptible to alcohol-related falls and other accidental injuries.
• Women: Studies show that among U.S. women who drink, approximately 1 in 4 have engaged in binge drinking in the last month, averaging about three binge episodes per month and five drinks per binge episode.These trends are concerning because women are at increased risk for health problems related to alcohol misuse.

What Are the Consequences and Health Effects of Binge Drinking?

Although drinking any amount of alcohol can carry certain risks, crossing the binge threshold increases the risk of acute harm, such as blackouts and overdoses. Binge drinking also increases the likelihood of unsafe sexual behavior and the risk of sexually transmitted infections and unintentional pregnancy. These risks are greater at higher peak levels of consumption. Because of the impairments it produces, binge drinking also increases the likelihood of a host of potentially deadly consequences, including falls, burns, drownings, and car crashes.

Alcohol affects virtually all tissues in the body. Data suggest that even one episode of binge drinking can compromise function of the immune system and lead to acute pancreatitis (inflammation of the pancreas) in individuals with underlying pancreatic damage. Over time, alcohol misuse, including repeated episodes of binge drinking, contributes to liver and other chronic diseases as well as increases the risk of several types of cancer, including head and neck, esophageal, liver, breast, and colorectal cancers.

Binge drinking can be deadly. Approximately 140,000 deaths resulted from alcohol misuse annually in the United States between 2015 and 2019, and almost half of those were associated with binge drinking. Binge drinking is also costly. Researchers estimated that binge drinking accounted for 77% of the $249 billion (i.e., $191.1 billion) economic cost of alcohol misuse in 2010.

How Does Binge Drinking Affect Adolescents?

Brain development, once thought to taper off at the end of childhood, enters a unique phase during the adolescent years. Research indicates that repeated episodes of binge drinking during the teen years can alter the trajectory of adolescent brain development and cause lingering deficits in social, attention, memory, and other cognitive functions.

What Is “High-Intensity” Drinking?

High-intensity drinking is defined as alcohol intake at levels twice or more the gender-specific threshold for binge drinking. This dangerous drinking pattern means 8 or more drinks for women and 10 or more drinks for men on one occasion. Research suggests that high-intensity drinking peaks around age 21 and is most common among young adults attending college.

This pattern of drinking is of particular concern because it is associated with an even greater risk of severe health and safety consequences. More research is needed to identify interventions that can be used to discourage this pattern of use.

For many people, a night of drinking can lead to a painful morning after and the dreaded effects of a hangover. What does science tell us about this phenomenon? What causes the typical symptoms of a hangover? And the question perhaps as old as hangovers themselves—are there any real remedies?

What Is a Hangover?

A hangover refers to a set of symptoms that occur as a consequence of excessive alcohol use. Typical symptoms include fatigue, weakness, thirst, headache, muscle aches, nausea, stomach pain, vertigo, sensitivity to light and sound, anxiety, irritability, sweating, and increased blood pressure. A hangover can vary from person to person.

Other Substances That Contribute to Hangover Symptoms

Alcohol is the main culprit in a hangover, but other components of alcoholic beverages might contribute to hangover symptoms or make a hangover worse.

• Congeners are compounds, other than ethyl alcohol, that are produced during fermentation. These substances contribute to the taste and smell of alcoholic beverages. Darker spirits, such as bourbon, which tend to have higher levels of congeners than clear spirits, could worsen hangover symptoms for some people.
• Sulfites are compounds that are added to wine as preservatives. People who have a sensitivity to sulfites may experience a headache after drinking wine.

What Causes Hangover Symptoms?

A number of factors can contribute to hangovers:

• Mild dehydration: Alcohol suppresses the release of vasopressin, a hormone produced by the brain that sends signals to the kidneys causing them to retain fluid. As a result, alcohol increases urination and excess loss of fluids. The mild dehydration that results likely contributes to hangover symptoms such as thirst, fatigue, and a headache.
• Disrupted sleep: People may fall asleep faster after drinking alcohol, but their sleep is fragmented, and they tend to wake up earlier. This contributes to fatigue, as well as lost productivity.
• Gastrointestinal irritation: Alcohol directly irritates the lining of the stomach and increases acid release. This can lead to nausea and stomach discomfort.
• Inflammation: Alcohol increases inflammation in the body. Inflammation contributes to the malaise that people feel when they are sick, so it may play a role in hangover symptoms as well.
• Acetaldehyde exposure: Alcohol metabolism, primarily by the liver, creates the compound acetaldehyde, a toxic, short-lived byproduct, which contributes to inflammation in the liver, pancreas, brain, gastrointestinal tract, and other organs.
• Mini-withdrawal: While drinking, individuals may feel calmer, more relaxed, and even euphoric, but the brain quickly adjusts to those positive effects as it tries to maintain balance. As a result, when the buzz wears off, people can feel more restless and anxious than before they drank.

Because individuals are so different, it is difficult to predict how many drinks will cause a hangover. Any time pe ople drink to intoxication, there is a chance they could have a hangover the next day.

When Does a Hangover Peak and How Long Does It Last?

Hangover symptoms peak when the blood alcohol concentration in the body returns to about zero. The symptoms can last 24 hours or longer.

Are Hangovers Dangerous or Just Painful?

Hangovers can be both painful and dangerous. During a hangover, a person’s attention, decision-making, and muscle coordination can all be impaired. Also, the ability to perform important tasks, such as driving, operating machinery, or caring for others can be negatively affected.

Common Myths About Hangovers

Myth: Certain actions, such as drinking coffee or taking a shower, can prevent or cure a hangover.

Fact: The only way to completely avoid a hangover is to not drink alcohol at all or to keep alcohol intake to a minimum. There is no cure for a hangover other than time.

Myth: The order of drinks will affect a hangover—as captured in the expression, “beer before liquor, never sicker.”

Fact: In general, the more alcohol a person drinks, the worse the hangover will be. This is true regardless of whether a person drinks beer, wine, distilled spirits, or a combination of these.

Myth: Having an alcoholic drink in the morning after a night of drinking will help avoid a hangover—a practice known colloquially as “a hair of the dog that bit you.”

Fact: While this might temporarily minimize some symptoms, it could contribute to and prolong the malaise and other symptoms of the hangover.

Are There Any Remedies for a Hangover?

Although many remedies for alleviating hangovers are mentioned on the web and in social media, none have been scientifically proven to be effective. There is no magic potion for beating hangovers—and only time can help. A person must wait for the body to finish clearing the toxic byproducts of alcohol metabolism, to rehydrate, to heal irritated tissue, and to restore immune and brain activity to normal. There is no way to speed up the brain’s recovery from alcohol use—drinking coffee, taking a shower, or having an alcoholic beverage the next morning will not cure a hangover.

Some people take over-the-counter pain relievers (often acetaminophen) before going to bed to minimize hangovers. It is important to recognize that the combination of alcohol and acetaminophen can be toxic to the liver. Like alcohol, certain over-the-counter pain relievers, including aspirin and ibuprofen, can increase acid release and irritate the lining of the stomach. Proceed with caution when using these medications before or after consuming alcohol.

To help ease their hangover symptoms, some people turn to electrolyte-rich sports drinks or other products, or even intravenous (IV) treatments, in an effort to treat electrolyte imbalance caused by increased urination and fluid loss as a result of drinking. Research has not found a correlation between the extent of electrolyte disruptions and the severity of hangovers, or the impact of added electrolytes on hangover severity. In most people, the body will quickly restore electrolyte balance once the effects of alcohol subside.

Ultimately, the only surefire remedy for a hangover is to avoid getting one by not drinking excessively.

Drinking to the point of a blackout has gained pop culture notoriety in recent years. Blackouts are typically associated with consuming excessive amounts of alcohol that can lead to impaired memory of events that transpired while intoxicated, and a drastically increased risk of injuries and other harms. They can occur in anyone who drinks alcohol, no matter their age or level of experience with drinking. In this factsheet, we will take a sober look at this common but deeply concerning consequence of alcohol misuse.

What Are Blackouts?

Alcohol-related blackouts are gaps in a person’s memory for events that occurred while they were intoxicated. These gaps happen when a person drinks enough alcohol to temporarily block the transfer of memories from short-term to long-term storage—known as memory consolidation—in a brain area called the hippocampus.

Types of Blackouts

There are two types of blackouts; they are defined by the severity of the memory impairment. The most common type is called a “fragmentary blackout” and is characterized by spotty memories for events, with “islands” of memories separated by missing periods of time in between. This type is sometimes referred to as a grayout or a brownout.

Complete amnesia, often spanning hours, is known as an “en bloc” blackout. With this severe form of blackout, memories of events do not form and typically cannot be recovered. It is as if the events simply never occurred.

When Do Blackouts Occur?

Blackouts tend to begin at blood alcohol concentrations (BACs) of about 0.16 percent (nearly twice the legal driving limit) and higher. At these BACs, most cognitive abilities (e.g., impulse control, attention, judgment, and decision-making) are significantly impaired. The level of impairment that occurs at such high BACs makes the intoxication level associated with blackouts especially dangerous.

Blackouts can occur at much lower BACs in people who drink and take sleep and anti-anxiety medications.

Research indicates that blackouts are more likely to occur when alcohol enters the bloodstream quickly, causing the BAC to rise rapidly. This could happen if someone drinks on an empty stomach or consumes excessive amounts of alcohol in a short amount of time. Because females, on average, weigh less than males and, pound for pound, have less water in their bodies, they tend to reach higher peak BAC levels than males with each drink and do so more quickly. This helps explain why being female appears to be a risk factor for having blackouts.

Because blackouts tend to occur at high BACs, they commonly stem from binge drinking, defined as a pattern of drinking that increases a person’s BAC to 0.08 percent or higher. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. In fact, many people who have blackouts do so after engaging in a behavior known as high-intensity drinking, which is defined as drinking at levels that are at least twice as high as the binge-drinking thresholds for women and men.

Blackouts vs. Passing Out

A blackout is not the same as “passing out,” which means either falling asleep or losing consciousness from excessive alcohol consumption.

During a blackout, a person is still awake but their brain is not creating new memories. Depending on how much the person drank, it is possible to transition from having a blackout to passing out.

Are Blackouts a Sign of an Alcohol-Related Problem?

Research among college students and other young adults has shown that the frequency of blackouts predicts other alcohol-related consequences (such as missing work or school, having a lower grade point average [GPA], being injured, ending up in the emergency room, getting arrested, or experiencing other negative outcomes). Questions about blackouts during routine medical visits could serve as an important simple screen for the risk of alcohol-related harms.

Blackouts are not necessarily a sign of alcohol use disorder, but experiencing even one is a reason for concern and should prompt people to consider their relationship with alcohol and talk to their healthcare provider about their drinking.

Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism. Considered a brain disorder, AUD can be mild, moderate, or severe. Lasting changes in the brain caused by alcohol misuse perpetuate AUD and make individuals vulnerable to relapse. The good news is that no matter how severe the problem may seem, evidence-based treatment with behavioral therapies, mutual-support groups, and/or medications can help people with AUD achieve and maintain recovery. According to the 2022 National Survey on Drug Use and Health, 28.8 million adults ages 18 and older (11.2% in this age group) had AUD in 2021. Among youth, an estimated 753,000 adolescents ages 12 to 17 (2.9% of this age group) had AUD during this time frame.

What Increases the Risk for Alcohol Use Disorder?

A person’s risk for developing AUD depends in part on how much, how often, and how quickly they consume alcohol. Alcohol misuse, which includes binge drinking and heavy alcohol use, over time increases the risk of AUD. Other factors also increase the risk of AUD, such as:

• Drinking at an early age. A recent national survey found that among people ages 26 and older, those who began drinking before age 15 were more than three times as likely to report having AUD in the past year as those who waited until age 21 or later to begin drinking. The risk for females in this group is higher than that of males.
• Genetics and family history of alcohol problems. Genetics play a role, with hereditability accounting for approximately 60%; however, like other chronic health conditions, AUD risk is influenced by the interplay between a person’s genes and their environment. Parents’ drinking patterns may also influence the likelihood that a child will one day develop AUD.
• Mental health conditions and a history of trauma. A wide range of psychiatric conditions—including depression, post-traumatic stress disorder, and attention deficit hyperactivity disorder—are comorbid with AUD and are associated with an increased risk of AUD. People with a history of childhood trauma are also vulnerable to AUD.

What Are the Symptoms of Alcohol Use Disorder?

Health care professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to assess whether a person has AUD and to determine the severity, if the disorder is present. Severity is based on the number of criteria a person meets based on their symptoms—mild (2–3 criteria), moderate (4–5 criteria), or severe (6 or more criteria).

A health care provider might ask the following questions to assess a person’s symptoms.

In the past year, have you:

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of time drinking, being sick from drinking, or getting over other aftereffects?
• Wanted a drink so badly you couldn’t think of anything else?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Given up or cut back on activities you found important, interesting, or pleasurable so you could drink?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or unsafe sexual behavior)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had an alcohol-related memory blackout?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, dysphoria (feeling uneasy or unhappy), malaise (general sense of being unwell), feeling low, or a seizure? Or sensed things that were not there?

Any of these symptoms may be cause for concern. The more symptoms, the more urgent the need for change.

What Are the Types of Treatment for Alcohol Use Disorder?

Several evidence-based treatment approaches are available for AUD. One size does not fit all and a treatment approach that may work for one person may not work for another. Treatment can be outpatient and/or inpatient and be provided by specialty programs, therapists, and health care providers.

Medications

Three medications are currently approved by the U.S. Food and Drug Administration to help people stop or reduce their drinking and prevent a return to drinking: naltrexone (oral and long-acting injectable), acamprosate, and disulfiram. All these medications are nonaddictive, and they may be used alone or combined with behavioral treatments or mutual-support groups.

Behavioral Treatments

Behavioral treatments—also known as alcohol counseling, or talk therapy, and provided by licensed therapists—are aimed at changing drinking behavior. Examples of behavioral treatments are brief interventions and reinforcement approaches, treatments that build motivation and teach skills for coping and preventing a return to drinking, and mindfulness-based therapies.

Mutual-Support Groups

Mutual-support groups provide peer support for stopping or reducing drinking. Group meetings are available in most communities at low or no cost, and at convenient times and locations—including an increasing presence online. This means they can be especially helpful to individuals at risk for relapse to drinking. Combined with medications and behavioral treatment provided by health care professionals, mutual-support groups can offer a valuable added layer of support.

Please note: People with severe AUD may need medical help to avoid alcohol withdrawal if they decide to stop drinking. Alcohol withdrawal is a potentially life-threatening process that can occur when someone who has been drinking heavily for a prolonged period of time suddenly stops drinking. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing.

Can People With Alcohol Use Disorder Recover?

Many people with AUD do recover, but setbacks are common among people in treatment. Seeking professional help early can prevent a return to drinking. Behavioral therapies can help people develop skills to avoid and overcome triggers, such as stress, that might lead to drinking. Medications also can help deter drinking during times when individuals may be at greater risk of a return to drinking (e.g., divorce, death of a family member).

What Are Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to the wide range of physical, behavioral, and cognitive impairments that occur due to alcohol exposure before birth (also known as prenatal alcohol exposure). These impairments may appear at any time during childhood and last a lifetime. An estimated 1% to 5% of U.S. first graders have FASD, according to a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-supported study published in the Journal of the American Medical Association.

What Causes Fetal Alcohol Spectrum Disorders and How Are They Prevented?

Alcohol exposure during pregnancy can result in FASD by interfering with development of the baby’s brain and other critical organs and physiological functions. This can lead to deficits after birth and beyond. Alcohol can disrupt development at any stage, even before a woman knows that she is pregnant.

Research shows that binge drinking and heavy drinking during pregnancy put a developing baby at the greatest risk for severe problems. However, even lesser amounts can cause harm. In fact, there is no known safe amount of alcohol consumption during pregnancy.

What Are the Types of Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to a range of physical, cognitive, and behavioral abnormalities caused by prenatal alcohol exposure. Depending on the features identified, the disorders categorized as FASD include:

• Fetal alcohol syndrome
• Partial fetal alcohol syndrome
• Alcohol-related neurodevelopmental disorder
• Alcohol-related birth defects
• Neurobehavioral disorder associated with prenatal alcohol exposure

Prenatal alcohol exposure and central nervous system (CNS) involvement are factors common to the disorders encompassing FASD. Evidence of CNS involvement can be structural (e.g., small brain size, alterations in specific brain regions) or functional (e.g., cognitive and behavioral deficits, motor and coordination problems). For fetal alcohol syndrome—which is also characterized by growth deficiencies, distinct facial features, and other physical factors in addition to CNS involvement—confirmation of prenatal alcohol exposure is not required.

If an individual was not exposed to alcohol before birth, they will not get FASD. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or are thinking about getting pregnant should not drink alcohol at all.

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental disorders in the United States. Women who need help to stop drinking alcohol can talk to their health care provider about treatment options. There are a variety of treatments available for pregnant women, including behavioral treatment and mutual-support groups.

How Common Is Alcohol Use During Pregnancy in the United States?

A study that analyzed 2015–2018 data from the National Survey on Drug Use and Health reports that:

• About 1 in 10 (9.8%) pregnant women report current alcohol use.
• About 1 in 22 (4.5%) pregnant women report binge drinking.
• Alcohol use is highest among women who are in the first trimester of pregnancy, with about 1 in 5 (19.6%) reporting current alcohol use and 1 in 10 (10.5%) reporting binge drinking.
• About 40% of pregnant women who report current drinking also report current use of one or more other substances—most commonly tobacco and marijuana.

What Are the Symptoms of Fetal Alcohol Spectrum Disorders?

Individuals with FASD experience day-to-day challenges, which may include cognitive and behavioral impairments as well as secondary disabilities including medical, educational, mental health, and social challenges, throughout their life. They are also subject to stigmatization for their disorder. People with FASD may have difficulty in the following areas:

• Learning and memory
• Understanding and following directions
• Switching attention between tasks
• Controlling emotions and impulsivity
• Communicating and developing social skills
• Experiencing depression and anxiety
• Performing daily life skills, including feeding, bathing, counting money, telling time, and minding personal safety

How Are Fetal Alcohol Spectrum Disorders Diagnosed?

Early identification of FASD is critical for the well-being of individuals affected by prenatal alcohol exposure and their families. Early identification can maximize help in the treatment of FASD and in building supportive networks with other individuals and families impacted by FASD. Unfortunately, FASD is often undiagnosed or misdiagnosed. This may be due, in part, to a lack of information about prenatal alcohol exposure or difficulty in distinguishing FASD from other developmental disorders that might have similar cognitive or behavioral symptoms.

The American Academy of Pediatrics (AAP) stresses the importance of universal screening for prenatal alcohol exposure for all children. A diagnosis of FASD can include evidence of CNS problems (see “What Are the Types of FASD?” box), physical abnormalities (e.g., growth deficits, specific facial anomalies), health concerns, and documented prenatal alcohol exposure. The AAP recommends initial assessment and diagnosis by the child’s pediatrician. Referrals for additional evaluation and treatment can be made to other clinicians and health care professionals or, when available, to a specialized multidisciplinary team for a comprehensive evaluation and care.

What Are the Interventions or Treatments for Fetal Alcohol Spectrum Disorders?

There are various approaches that may help reduce the symptoms of FASD and lessen the impact on affected individuals and their families. These include education and behavioral interventions for individuals with FASD and their caretakers as well as medications, social support, case management, and other services for children and adults with FASD. New interventions are currently being developed and evaluated. These treatments include:

• Prenatal nutritional supplements for pregnant women and postnatal supplements for their children
• Learning and behavioral interventions aimed at improving cognition, daily life skills, and impulsive behavior
• School-based approaches focused on specialized teaching strategies and computer-based games
• Mobile health apps and other interventions that support families and caregivers to assist them in caring for children with FASD

Wernicke-Korsakoff (WK) syndrome is a serious brain condition that is usually, but not exclusively, associated with chronic alcohol misuse and severe alcohol use disorder (AUD). The prevalence of WK syndrome across populations is not well established, and researchers estimate that it may remain undiagnosed in approximately 80 percent of patients.

What Causes WK Syndrome?

WK syndrome involves two different brain disorders that often occur together: Wernicke’s disease and Korsakoff’s psychosis. They result from brain damage associated with AUD, combined with vitamin B1 (thiamine) deficiency. In people with severe AUD, poor nutrition decreases the ability of the gut to absorb thiamine from food and, therefore, increases the chance of developing WK syndrome. Without treatment, WK syndrome can be disabling, produce permanent memory loss, and be life-threatening.

What Are the Symptoms?

In WK syndrome, damage occurs in a variety of brain regions, most notably the thalamus, hippocampus, hypothalamus, and cerebellum. These areas contribute to a wide range of functions such as vision, movement, language, sleep, memory, and motivation.

Symptoms of Wernicke’s disease include:

• Confusion
• Lack of energy, hypothermia, low blood pressure, or coma
• Lack of muscle coordination that can affect posture and balance and can lead to tremors (i.e., involuntary movements in one or more parts of the body)
• Vision problems such as abnormal eye movements (e.g., back and forth movements called nystagmus), double vision, misaligned or crossed eyes, and eyelid drooping

Although some symptoms of Wernicke’s disease such as muscle and vision problems are reversible with prompt thiamine treatment, other symptoms may respond more slowly or may not be completely reversible. Without prompt treatment, Wernicke’s disease can progress to Korsakoff’s psychosis, which is not reversible.

Symptoms of Korsakoff’s psychosis include those listed above, as well as:

• Potentially severe, irreversible memory impairments, including problems forming new memories (called anterograde amnesia) and recalling memories
• Making up inaccurate stories about events (i.e., confabulation) or remembering events incorrectly
• Experiencing hallucinations (i.e., seeing or hearing things that are not really there)
• Repetitious speech and actions
• Problems with decision making as well as planning, organizing, and completing tasks
• Lack of motivation and emotional apathy

How Is WK Syndrome Diagnosed?

WK syndrome is clinically diagnosed based on a patient’s history and the presence of the above-mentioned symptoms. When clinicians identify possible cases of WK syndrome, they may be able to confirm the diagnosis through magnetic resonance imaging (MRI) scans of the brain. It is noteworthy that WK syndrome may result from other conditions that involved malnutrition and B1 deficiency, such as cancer, AIDS, excessive vomiting (often associated with pregnancy), anorexia nervosa, hemodialysis, and gastrointestinal or bariatric surgery. However, these cases are far less prevalent than cases associated with severe AUD.

How Is WK Syndrome Treated?

If you are concerned about someone with WK syndrome, talk to your primary care physician or a specialist—such as an internist, psychiatrist, addiction psychiatrist, addiction medicine physician, or neurologist.

Early symptoms of Wernicke's disease can be reversed if detected and treated promptly and completely; therefore, Wernicke’s disease should be considered a medical emergency. Doctors treat Wernicke’s disease with intravenous administration of vitamin B1 and glucose. Treatment may also consist of addressing co-occurring symptoms in the short term.

Without adequate treatment, Wernicke’s disease can progress into Korsakoff’s psychosis. In Korsakoff’s psychosis, severe memory loss and other damage could become permanent. Treatments for Korsakoff’s psychosis include intravenous vitamin B1 replacement therapy and oral supplements for several weeks, as well as proper nutrition, hydration, and other medications to manage specific symptoms. Aside from B1 therapy in the short term, there is no one optimal treatment—treatment often varies depending on symptoms, severity, and other co-occurring deficits such as psychosis or other major psychiatric disorders. Memory rehabilitation therapies—similar to those provided for various forms of dementia—can be effective in lessening the symptoms, but severe cases often require residential care.

Caution: Alcohol Withdrawal

Abstaining from alcohol use is critical to prevent and reduce additional brain damage at all stages of WK syndrome. Please note that when someone who has been drinking heavily for a prolonged period of time suddenly stops drinking, the body can go into a painful or even potentially life-threatening process of withdrawal. Individuals should seek medical help to plan a safe recovery.

6 a day: An average of 6 people die of alcohol poisoning each day in the US.

3 in 4: 76% of alcohol poisoning deaths are among adults ages 35 to 64.

76%: About 76% of those who die from alcohol poisoning are men.

On average, 6 people died every day from alcohol poisoning in the US from 2010 to 2012. Alcohol poisoning is caused by drinking large quantities of alcohol in a short period of time. Very high levels of alcohol in the body can shutdown critical areas of the brain that control breathing, heart rate, and body temperature, resulting in death. Alcohol poisoning deaths affect people of all ages but are most common among middle-aged adults and men.

States and communities can take steps to reduce alcohol poisoning deaths by preventing binge drinking, including:

• Partnering with police, community groups, health departments, and doctors, nurses, and other health care providers to reduce binge drinking and related harms.
• Tracking the role of alcohol in injuries and deaths.
• Supporting proven programs and policies that decrease binge drinking. States with stronger alcohol policies have less binge drinking.

Problem

There are 2,200 alcohol poisoning deaths in the US each year.

Alcohol poisoning deaths:

• Most people who die are 35-64 years old.
• Most people who die are men.
• Most alcohol poisoning deaths are among non- Hispanic whites. Although a smaller share of the US population, American Indians/Alaska Natives have the most alcohol poisoning deaths per million people of any of the races.
• Alaska has the most alcohol poisoning deaths per million people, while Alabama has the least.
• Alcohol dependence (alcoholism) was identified as a factor in 30% of alcohol poisoning deaths.

Binge drinking can lead to death from alcohol poisoning.

• Binge drinking (4 or more drinks for women or 5 or more drinks for men in a short period of time) typically leads to a blood alcohol concentration (BAC) that exceeds 0.08 g/dL, the legal limit for driving in all states.
• US adults who binge drink consume an average of about 8 drinks per binge, which can result in even higher levels of alcohol in the body.
• The more you drink the greater your risk of death.

What Can Be Done

The US government is

• Supporting proven programs and policies to reduce binge drinking.
• Helping states and communities measure binge drinking and related harms, including alcohol poisoning.
• Expanding access through the Affordable Care Act to new health insurance plans to cover alcohol screening and brief counseling.

States and communities can

• Support proven programs and policies that decrease binge drinking. States with stronger alcohol policies have less binge drinking.
• Partner with police, community groups, health departments, and doctors, nurses, and other health care providers to reduce binge drinking and related harms.
• Track the role of alcohol in injuries and deaths.

Doctors, nurses, and other providers can

• Screen all adult patients for binge drinking and counsel those who binge drink to drink less.
• Recognize that most people who drink too much are not alcohol dependent (alcoholics) but may still need counseling.
• Support proven programs and policies to prevent binge drinking.

Everyone can

• Avoid binge drinking. If you choose to drink alcohol, follow the dietary guidelines.
• Avoid drinks with unknown alcohol content or mixing alcohol with energy drinks. Caffeine can mask alcohol's effects and cause people to drink more than they intend.
• Get help for anyone experiencing lifethreatening signs of alcohol poisoning.
• Talk to your doctor, nurse, or other health care provider if you think you may have a drinking problem, or call the national Treatment Referral Routing Service (1-800-662-HELP).

2010 Dietary Guidelines for Americans:

• Don't start drinking or increase the amount you drink on the basis of potential health benefits. If you choose to drink, do so in moderation – up to 1 drink a day for women or up to 2 drinks a day for men.
• Don't drink at all if you are under age 21, pregnant or may be pregnant, have health problems that could be made worse by drinking, or are engaging in activities for which alcohol is dangerous (e.g., driving).

KNOW THE RISKS:

Genetics, environment, and lifestyle habits can all heighten your risk of getting cancer. We can’t do anything to change our genes, and we often can’t do much to change our environment. But lifestyle habits are a different story.

Drinking too much alcohol is one lifestyle habit that can increase your risk of developing certain cancers. This does not mean that anyone who drinks too much will develop cancer. But numerous studies do show the more you drink, the more you increase your chances of developing certain types of cancer.

For example, a group of Italy-based scientists reviewed more than 200 studies examining alcohol’s impact on cancer risk. The collective results of these studies clearly demonstrate that the more you drink, the higher your risk for developing a variety of cancers. The National Cancer Institute identifies alcohol as a risk factor for the following types of cancer:

• Mouth
• Esophagus
• Pharynx
• Larynx
• Liver
• Breast

At least 7 out of 10 people with mouth cancer drink heavily. Drinking five or more drinks per day can also increase your risk of developing other types of cancers, including colon or rectal cancer. In fact, summary estimates from the recent World Cancer Research Fund report indicate that women who drink five standard alcohol drinks each day have about 1.2 times the risk of developing colon or rectal cancer than women who do not drink at all.

People who drink are also more likely to smoke, and the combination increases the risk significantly. Smoking alone is a known risk factor for some cancers. But smoking and drinking together intensifies the cancer-causing properties of each substance. The overall effect poses an even greater risk.

The risk of throat and mouth cancers is especially high because alcohol and tobacco both come in direct contact with those areas. Overall, people who drink and smoke are 15 times more likely to develop cancers of the mouth and throat than nondrinkers and nonsmokers. In addition, recent studies estimate that alcohol and tobacco together are responsible for:

• 80 percent of throat and mouth cancer in men
• 65 percent of throat and mouth cancer in women
• 80 percent of esophageal squamous cell carcinoma, a type of esophagus cancer
• 25 to 30 percent of all liver cancers

WOMEN AND CANCER

One recent, groundbreaking study followed the drinking habits of 1.2 million middle-aged women over 7 years. The study found that alcohol increases women’s chances of developing cancers of the breast, mouth, throat, rectum, liver, and esophagus. The researchers link alcohol to about 13 percent of these cancer cases.

In addition, the study concluded that cancer risk increases no matter how little or what kind of alcohol a woman drinks. Even one drink a day can raise risk, and it continues to rise with each additional drink. While men did not participate in this study, the researchers believe this risk is likely similar for men.

This study also attributes about 11 percent of all breast cancer cases to alcohol. That means that of the 250,000 breast cancer cases diagnosed in the United States in 2008, about 27,000 may stem from alcohol.

KNOW THE REASONS:

Scientists are still trying to figure out exactly how and why alcohol can promote cancer. There are a variety of possible explanations.

One explanation is that alcohol itself is not the primary trigger for cancer. We know that metabolizing, or breaking down, alcohol results in harmful toxins in the body. One of these toxins is called acetylaldehyde. Acetylaldehyde damages the genetic material in cells—and renders the cells incapable of repairing the damage. It also causes cells to grow too quickly, which makes conditions ripe for genetic changes and mistakes. Cancer can develop more easily in cells with damaged genetic material.

In addition, recent animal studies have shown that as cells try to break down alcohol, they cause the body to produce additional amounts of a protein called vascular endothelial growth factor (VEGF). VEGF promotes the growth of blood vessels and organ tissue. But, the flip side of having too much VEGF is that it allows blood vessels to grow in cancer cells that would die on their own. This allows the cancer cells to develop into tumors.

We also know that alcohol can damage the liver, causing cirrhosis. Cirrhosis results when too much scar tissue builds up within the liver and leaves it unable to perform its vital functions. One of the many complications that can result from cirrhosis is liver cancer.

Hormones may be the link between alcohol and breast cancer. Alcohol can increase the amounts of some hormones in the body, including estrogen. An excess of estrogen may lead to breast cancer.

Finally, genetics may play a role in preventing some heavy drinkers from developing cancer. A European research team examined 9,000 people with similar lifestyle habits to determine why some of them developed mouth and throat cancers, and some did not. Of the participants who were heavy drinkers, those who did not develop cancers had a particular genetic alteration that enabled them to break down alcohol about 100 times faster than in those without it. The study suggested that this gene is the reason why some people are less likely to develop cancer in response to heavy drinking.

KNOW THERE’S A BRIGHT SIDE:

Fortunately, studies show that you can reduce your risk for cancer by drinking less. A recent Canadian report analyzed studies from 1966 through 2006 and concluded that risk reduction is possible, specifically for head and neck cancers. The study found that as people abstained from drinking, their risk for developing cancer plunged. After 20 years of abstinence, former drinkers had the same risk for head and neck cancers as people who never drank.

38 Million: At least 38 million adults in the US drink too much.

1 in 6: Only 1 in 6 adults talk with their doctor, nurse, or other health professional about their drinking.

25%: Alcohol screening and brief counseling can reduce the amount consumed on an occasion by 25% in those who drink too much.

At least 38 million adults drink too much and most are not alcoholics. Drinking too much includes binge drinking, high weekly use, and any alcohol use by pregnant women or those under age 21. It causes about 88,000 deaths in the US each year, and costs the economy about $224 billion. Alcohol screening and brief counseling can reduce drinking on an occasion by 25% in people who drink too much, but only 1 in 6 people has ever talked with their doctor or other health professional about alcohol use. Talking with a patient about their drinking is the first step of screening and brief counseling, which involves:

• Using a set of questions to screen all patients for how much and how often they drink.
• Counseling patients about the health dangers of drinking too much, including women who are (or might be) pregnant.
• Referring only those few patients who need specialized treatment for alcohol dependence.

Doctors and other health professionals can use alcohol screening and brief counseling to help people who are drinking too much to drink less. The Affordable Care Act requires new health insurance plans to cover this service without a co-payment.

Problem

Doctors, nurses, and other health professionals should screen all adult patients and counsel those who drink too much.

Most adults have not talked with a doctor, nurse, or other health professional about how much they drink.

• Drinking too much is dangerous and can lead to heart disease, breast cancer, sexually transmitted diseases, unintended pregnancy, fetal alcohol spectrum disorders, sudden infant death syndrome, motor-vehicle crashes, and violence.
• Public health experts recommend alcohol screening and counseling should happen more often than it does. Yet, people report a doctor, nurse, or other health professional has rarely talked with them about alcohol, the important first step for addressing problems with drinking too much:
  • Only 1 in 6 adults have discussed their drinking.
  • Few binge drinkers (1 in 4) have talked about alcohol use. Binge drinking is defined as men drinking 5 or more alcoholic drinks or women drinking 4 or more, in about 2-3 hours.
  • Even among adults who binge drink 10 times or more a month, only 1 in 3 have discussed drinking.
  • Only 17% of pregnant women have talked about drinking.
  • Most states had less than 1 in 4 adults who discussed their drinking. Washington, D.C. had the highest percentage with 25%.

  Alcohol screening and brief counseling has been proven to work.

  • It can reduce how much alcohol a person drinks on an occasion by 25%.
  • It improves health and saves money just as blood pressure screening, flu vaccines, and cholesterol or breast cancer screening.
  • It is recommended for all adults, including pregnant women.

What Can Be Done

Federal government is

• Studying how to best achieve alcohol screening and counseling at federally qualified health centers.
• Requiring states with expanded Medicaid to cover a set of preventive services, including alcohol screening and counseling, through the Affordable Care Act.
• Adopting clinical guidelines to carry out alcohol screening and counseling.
• Teaching providers about billing and insurance coverage for alcohol screening and counseling services.

Health professional organizations can

• Tell doctors, nurses, and other health professionals how well screening and brief counseling works.
• Teach all health professionals how to do alcohol screening and counseling.
• Provide e-tools for doctors, nurses and other health professionals to deliver these services to patients.

States and Communities can

• Encourage health care plans and provider organizations to start screening and counseling.
• Monitor how many adults are receiving these services in communities.
• Consider alternative ways to deliver these services in state and community programs, using computers, smartphones, and other electronic devices.
• Help conduct community activities that reduce drinking too much.

Doctors, nurses, health plans, and insurers can

• Screen all adult patients for alcohol use as part of their usual services. Use current guidelines to do this effectively. Counsel, refer, and track those patients who need more help.
• Advise women not to drink at all if there is any chance they could be pregnant.
• Recruit and train nurses, social workers and health educators in a practice to screen and counsel all patients.
• Through insurers and employers, provide insurance coverage for alcohol screening and counseling.

Why is being able to "hold your liquor" a concern?

For some people who drink, it takes quite a few drinks to “get a buzz” or feel relaxed, and they may be less likely to show signs of intoxication compared to others. This is sometimes called being able to “hold your liquor” or “drink someone under the table.” Often these individuals are unaware that their body’s lower response to the intoxicating effects of alcohol isn’t protection from alcohol problems but instead is a reason for caution.

These individuals tend to drink more, socialize with people who drink a lot, and develop a tolerance to alcohol (i.e., it takes more and more alcohol to feel or act intoxicated). As a result, they have an increased risk for developing alcohol use disorder (AUD). Someone who misuses alcohol, especially over the long-term, can experience permanent liver, heart, or brain damage. And all people who drink, regardless of the amount, need to be aware that critical decision-making abilities and driving-related skills are already diminished long before a person shows physical signs of intoxication.

Why do women face higher risks for alcohol-related consequences?

A growing body of evidence indicates that women who drink are at increased susceptibility to short- and long-term alcohol-related consequences, including liver disease, cardiovascular disease, neurotoxicity, and alcohol-related memory blackouts, compared to men. One reason for this is that alcohol resides predominantly in body water, and pound for pound, women have less water in their bodies than men. This means that after a woman and a man of the same weight drink the same amount of alcohol, the woman’s BAC will tend to be higher, putting her at greater risk for harm.

Other biological differences may contribute as well. While alcohol misuse by anyone presents a serious public health concern, women face alcohol-related problems sooner and at lower drinking levels than men. Women who drink are also at greater risk for developing breast cancer than women who do not consume alcohol.

What medications interact harmfully with alcohol?

Some medicines that you might never have suspected can react with alcohol, including many that can be purchased "over the counter" without a prescription. Even some herbal remedies don't mix well with alcohol. Protect yourself by avoiding alcohol if you are taking a medication and don't know its effect, or talk to your pharmacist or other health care professional.

Can I do anything to protect my liver from the effects of too much alcohol?

There is no scientific evidence that anything will prevent liver damage from too much alcohol. Liver damage from alcohol misuse happens in stages. Some relatively mild damage may happen after a single binge drinking episode, but this reverses itself if the heavy alcohol use stops. If heavy drinking continues, however, liver damage can progress to several more advanced stages, including cirrhosis, and reversal of liver damage becomes much more difficult, if not impossible. In advanced stages, the only treatment is liver transplant. The best way to avoid damaging your liver is by not misusing alcohol, if you choose to drink. If you already have liver damage, stopping drinking could prevent progression to more serious liver disease. Even the standard recommended dose of acetaminophen can increase the risk of liver damage, particularly among people who drink heavily.

I am considering cutting down or quitting drinking. How do I begin?

The first step, of course, is to decide whether cutting down or quitting is best for you. See these considerations and discuss different options with a healthcare professional, a friend, or someone else you trust.

Thinking about cutting back? Here are some tips to try, small changes that can make a big difference. Choose two or three to try in the next week or two. It may help to have reminders to reinforce your decision to make a change, such as automated smartphone alerts that you send yourself.

Thinking about quitting? One size doesn’t fit all, and it’s important to find options that appeal to you. Start by visiting the support for quitting page.

Changing unhealthy behavior such as smoking, overeating, or drinking too much can take a lot of effort, and you may not succeed with the first try. Setbacks are common, but you learn more each time. Each try brings you closer to your goal. Whatever course you choose, give it a fair trial.

I’ve decided to cut back on my drinking and I may even quit. How can I get people to stop pressuring me to drink?

Anyone who is cutting back or quitting drinking is likely to be offered a drink at times when it’s unwanted. Rethinking Drinking has a activity or “mini-guide” to help you build resistance skills and stay in control. You’ll learn how to recognize the types of pressure to drink, avoid pressure, and cope with situations you can’t avoid.

As an example, here’s one tip: Have a polite, convincing "no, thanks" ready. The faster you can say no to drink offers, the less likely you are to give in. If you hesitate, it allows you time to think of excuses to go along. See the module for more insights and suggestions, including a worksheet where you can script your ‘no’ to practice for a situation in which the pressure persists.

If you worry about how others will react or view you if you make a change, challenge these thoughts by remembering that it's your life and your choice, and that your decision should be respected.

What treatments are available for someone with an alcohol problem?

People commonly think of 12-step programs or 28-day inpatient rehabilitation as the only options for treating alcohol problems. Other choices are available, however. It’s a good idea to start by talking with a healthcare provider to put together an individualized treatment plan.