Alcohol Use

Physiological Properties of Alcohol

Alcohol is rapidly absorbed from the gastrointestinal tract, enters the bloodstream, and is distributed in the body water compartment. Most alcohol is metabolized to acetaldehyde by alcohol dehydrogenase in the liver. However, chronic heavy drinking may induce added metabolic capacity by the microsomal ethanol-oxidizing system, an enzyme sited predominantly within hepatocyte microsomes that degrades a number of drugs. Acetaldehyde, 100 times more toxic than alcohol, is rapidly metabolized by acetaldehyde dehydrogenase to water and carbon dioxide in most people, but it may accumulate in those who have inherited a less efficient form of acetaldehyde dehydrogenase, giving rise to a dysphoric ‘flushing syndrome’ most prevalent in Asians and often associated with abstention and light drinking patterns.

In general, alcohol has a biphasic effect on mood. As it is absorbed from the gastrointestinal tract, rising blood alcohol levels (BALs) are usually associated with elevated mood. In contrast, as alcohol is metabolized and BALs fall, people are more likely to feel dysphoric and, in some cases, drink more, seeking to regain initial feelings of well-being. Within these broad parameters, there is substantial individual variability in response to alcohol. Studies of subjective response to alcohol indicate that nonalcoholic sons of alcoholics are less affected by a given alcohol dose than nonalcoholic sons of nonalcoholics. Paradoxically, innate tolerance (experiencing fewer effects during initial drinking) appears to be a risk factor for developing alcohol dependence.

Monitoring Alcohol Use

Per capita alcohol consumption, based on alcohol sales and census data, is a standard ecological measure of alcohol use. It provides both cross-jurisdictional (across states and nations) and cross-time-series data for epidemiologic studies of alcohol's impact on rates of morbidity and mortality. Efforts to improve statespecific estimates in the United States include adjusting for abstention rates and taking into consideration the ethanol content of specific beverage types and their market shares in each state.

National surveys dating from the early 1940s provide individual-level data on alcohol use to complement ecological data, and the number, size, and sophistication of alcohol surveys have increased dramatically in recent decades. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) was established in 1973 to lead national efforts to reduce alcohol-related problems. The Alcohol Research Group, an NIAAA Alcohol Research Center, has conducted periodic National Alcohol Surveys since 1964 at approximately 5-year intervals with standardized measures since 1979. Special Alcohol Supplements have been administered in conjunction with several National Health Information Surveys, and the National Health and Nutrition Examination Surveys also include questions on alcohol use. Similarly, questions on alcohol use are asked in the annual National Household Survey on Drug Abuse, sponsored by the National Institute on Drug Abuse. The largest U.S. alcohol surveys today are those conducted by NIAAA's intramural program—the National Longitudinal Alcohol Epidemiologic Survey and the National Epidemiologic Survey of Alcohol-Related Conditions.

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