View source for Alcohol intoxication

{{Short description|Behavioural and physical changes due to the consumption of alcohol}}
{{Redirect|Drunk}}
{{Redirect|Buzzed|the TV episode|Buzzed (Entourage)}}
{{Use dmy dates|date=September 2024}}
{{Infobox medical condition (new)
| name = Alcohol intoxication
| synonyms =  Inebriation, drunkenness, ethanol intoxication, internal damage by alcohol<ref name=Gar2007/><ref name="Gup2016">{{cite book |last=Gupta |first=P. K. |url=https://books.google.com/books?id=u3mLCwAAQBAJ&pg=PA226 |title=Fundamentals of Toxicology: Essential Concepts and Applications |date=2016 |publisher=Academic Press |isbn=978-0-12-805403-1|quote=Alcohol poisoning presents in two forms, acute and chronic. However, these are most often referred to as alcohol intoxication and alcohol addiction respectively.}}</ref>
| image = Michelangelo drunken Noah.jpg
| caption = ''The Drunkenness of Noah'' by [[Michelangelo]], 1509
| field = [[Toxicology]], [[psychiatry]]
| symptoms = '''Mild''': Mild [[sedation]], decreased coordination<ref name=Mer2018/><br />'''Moderate''': [[Dysarthria|Slurred speech]], trouble walking, vomiting<ref name=Mer2018/><br />'''Severe''': [[Hypoventilation|Decreased effort to breathe]], coma<ref name=Mer2018/>
| complications = [[Seizures]], [[aspiration pneumonia]], injuries, [[hypoglycemia|low blood sugar]]<ref name=Mer2018/><ref name=NHS2018/>
| onset = Over minutes to hours (depends on how much one drinks)<ref name=DSM5/>
| duration = Several hours<ref name=DSM5/>
| types = 
| causes = [[alcohol (drug)|Alcohol]] ([[ethanol]])<ref name=Jun2014/>
| risks = Social environment, [[impulsivity]], [[anxiety]], alcoholism<ref name=DSM5/><ref name="Mayo2019">{{cite web |title=Alcohol use disorder – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243 |access-date=26 November 2019 |website=Mayo Clinic}}</ref>
| diagnosis = Typically based on history of events and [[physical examination]]<ref name=Jun2014/>
| differential = [[Hepatic encephalopathy]], [[Wernicke encephalopathy]], [[methanol toxicity]], [[meningitis]], [[traumatic brain injury]]<ref name=Jun2014/>
| prevention = 
| treatment = [[Supportive care]]<ref name=Jun2014/>
| medication = 
| prognosis = 
| frequency = Very common
| deaths = {{circa}} 2,200 per year (U.S.)<ref name=Kan2015/>
}}
<!-- Definition and symptoms -->

'''Alcohol intoxication''', commonly described in higher doses as '''drunkenness''' or '''inebriation''',<ref>{{cite web |title=Meaning of inebriation in English |url=https://dictionary.cambridge.org/dictionary/english/inebriation |archive-url=https://archive.today/20210624152658/https://dictionary.cambridge.org/dictionary/english/inebriation |archive-date=24 June 2021 |access-date=24 June 2021 |website=dictionary.cambridge.org [[Cambridge University Press]]}}</ref> and known in [[overdose]] as '''alcohol poisoning''',<ref name="Gar2007">{{cite book |last1=Garfunkel |first1=Lynn C. |url=https://books.google.com/books?id=pwajBQAAQBAJ&pg=PA13 |title=Pediatric Clinical Advisor E-Book: Instant Diagnosis and Treatment |last2=Kaczorowski |first2=Jeffrey |last3=Christy |first3=Cynthia |date=2007 |publisher=Elsevier Health Sciences |isbn=9780323070584 |page=13}}</ref> is the behavior and physical effects caused by recent consumption of [[Alcohol (drug)|alcohol]].<ref name="Jun2014">{{cite book |last1=Jung |first1=YC |title=Alcohol and the Nervous System |last2=Namkoong |first2=K |chapter=Alcohol |date=2014 |series=Handbook of Clinical Neurology |isbn=9780444626196 |volume=125 |pages=115–21 |doi=10.1016/B978-0-444-62619-6.00007-0 |pmid=25307571}}</ref><ref name=":0">{{cite web |title=Acute intoxication |url=https://www.who.int/substance_abuse/terminology/acute_intox/en/ |url-status=dead |archive-url=https://web.archive.org/web/20040704055527/http://www.who.int/substance_abuse/terminology/acute_intox/en/ |archive-date=4 July 2004 |access-date=24 May 2018 |publisher=World Health Organization}}</ref> The technical term ''intoxication'' in common speech may suggest that a large amount of alcohol has been consumed, leading to accompanying physical symptoms and deleterious health effects. Mild intoxication is mostly referred to by slang terms such as ''tipsy'' or ''buzzed''. In addition to the [[toxicity]] of [[ethanol]], the main [[Psychoactive drug|psychoactive]] component of alcoholic beverages, other physiological symptoms may arise from the activity of [[acetaldehyde]], a [[metabolite]] of alcohol.<ref>{{cite journal|last=Zakhari|first=Samir|year=2006|title=Overview: how is alcohol metabolized by the body?|journal=Alcohol Research & Health|volume=29|issue=4|pages=245–254|issn=1535-7414|pmc=6527027|pmid=17718403}}</ref> These effects may not arise until hours after ingestion and may contribute to a condition colloquially known as a [[hangover]]. 

Symptoms of [[Substance intoxication|intoxication]] at lower doses may include mild [[sedation]] and poor coordination.<ref name=Mer2018/> At higher doses, there may be slurred speech, [[Ataxia#Exogenous substances (metabolic ataxia)|trouble walking]], impaired vision, mood swings and vomiting.<ref name=Mer2018/> Extreme doses may result in a [[Hypoventilation|respiratory depression]], coma, or death.<ref name="Mer2018">{{cite web |title=Alcohol Toxicity and Withdrawal |url=https://www.merckmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/alcohol-toxicity-and-withdrawal |access-date=24 May 2018 |website=Merck Manuals Professional Edition}}</ref> Complications may include [[seizures]], [[aspiration pneumonia]], [[hypoglycemia|low blood sugar]], and injuries or self-harm such as [[suicide]].<ref name=Mer2018/><ref name=NHS2018/> Alcohol intoxication can lead to [[alcohol-related crime]], with perpetrators more likely to be intoxicated than victims.<ref name=":1">{{Citation |last=Sung |first=Hung-En |title=Alcohol and Crime |year=2016 |encyclopedia=The Blackwell Encyclopedia of Sociology |pages=1–2 |entry=Alcohol and Crime |publisher=Wiley|doi=10.1002/9781405165518.wbeosa039.pub2 |isbn=978-1-4051-6551-8}}</ref>

<!-- Cause and diagnosis -->
Alcohol intoxication typically begins after two or more [[alcoholic drink]]s.<ref name=DSM5/> Alcohol has the potential for abuse.  Risk factors include a social situation where heavy drinking is common and a person having an impulsive personality.<ref name=DSM5/> Diagnosis is usually based on the history of events and physical examination.<ref name=Jun2014/> Verification of events by witnesses may be useful.<ref name=Jun2014/> Legally, alcohol intoxication is often defined as a [[blood alcohol concentration]] (BAC) of greater than 5.4–17.4&nbsp;mmol/L (25–80&nbsp;mg/dL or 0.025–0.080%).<ref>{{cite journal |date=22 April 2018 |title=Ethanol Level: Reference Range, Interpretation, Collection and Panels |url=https://emedicine.medscape.com/article/2090019-overview?pa=tZlaRqU6qrJZktQC5WWvdZUn3AyA7274pd4Hf2zSCvNL1t86c9tryKJmi8Xcaw5t8SIvl8zjYv73GUyW5rsbWA%3D%3D |access-date=24 May 2018 |website=Medscape}}</ref><ref name=":2">{{cite journal |last1=Canfield |first1=DV |last2=Dubowski |first2=KM |last3=Cowan |first3=M |last4=Harding |first4=PM |date=January 2014 |title=Alcohol Limits and Public Safety. |journal=Forensic Science Review |volume=26 |issue=1 |pages=9–22 |pmid=26226968}}</ref> This can be measured by blood or [[breathalyzer|breath testing]].<ref name="DSM5">{{Citation |title=Diagnostic and Statistical Manual of Mental Disorders (5th ed.) |url=https://archive.org/details/diagnosticstatis0005unse/page/497 |pages=[https://archive.org/details/diagnosticstatis0005unse/page/497 497–499] |year=2013 |place=Arlington |publisher=American Psychiatric Publishing |isbn=978-0890425558}}</ref> Alcohol is broken down in the human body at a rate of about 3.3&nbsp;mmol/L (15&nbsp;mg/dL) per hour,<ref name=Jun2014/> depending on an individual's [[metabolic rate]] ([[metabolism]]).<ref name=":3">{{cite web |title=Alcohol Alert |url=https://pubs.niaaa.nih.gov/publications/AA72/AA72.htm |access-date=24 June 2021 |website=pubs.niaaa.nih.gov |archive-date=28 February 2021 |archive-url=https://web.archive.org/web/20210228215303/https://pubs.niaaa.nih.gov/publications/AA72/AA72.htm |url-status=dead }}</ref> The [[DSM-5]] defines alcohol intoxication as at least one of the following symptoms that developed during or close after alcohol ingestion: slurred speech, incoordination, unsteady walking/movement, nystagmus (uncontrolled eye movement), attention or memory impairment, or near unconsciousness or coma.<ref name=":4">{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2013-05-22 |publisher=American Psychiatric Association |isbn=978-0-89042-555-8 |edition=5th|doi=10.1176/appi.books.9780890425596}}</ref>

<!-- Treatment -->
Management of alcohol intoxication involves supportive care.<ref name=Jun2014/> Typically, this includes putting the person in the recovery position, keeping the person warm, and making sure breathing is sufficient.<ref name="NHS2018">{{cite web |date=17 October 2017 |title=Alcohol poisoning |url=https://www.nhs.uk/conditions/alcohol-poisoning/ |access-date=24 May 2018 |website=nhs.uk}}</ref> [[Gastric lavage]] and [[activated charcoal]] have not been found to be useful.<ref name=Jun2014/> Repeated assessments may be required to rule out other potential causes of a person's symptoms.<ref name=Jun2014/>

<!-- Culture -->
Acute intoxication has been documented throughout history, and alcohol remains one of the world's most widespread [[recreational drug]]s.<ref name=":5">{{cite book |last1=Belenko |first1=Steven |url=https://books.google.com/books?id=w3pZDwAAQBAJ&pg=PT21 |title=Drugs, Crime, and Justice |last2=Spohn |first2=Cassia |date=2014 |publisher=SAGE Publications |isbn=9781483355429 |page=PT21}}</ref><ref>{{cite book |last=Martin |first=Scott C. |url=https://books.google.com/books?id=R9i5BgAAQBAJ&pg=PT1382 |title=The SAGE Encyclopedia of Alcohol: Social, Cultural, and Historical Perspectives |date=2014 |publisher=SAGE Publications |isbn=9781483374383 |page=PT1382}}</ref> Some religions, such as Islam, consider alcohol intoxication to be a sin.<ref name=DSM5/><ref>{{cite book |last=Kolig |first=Erich |url=https://books.google.com/books?id=c3iEBiWQOBwC&pg=PA101 |title=Conservative Islam: A Cultural Anthropology |date=2012 |publisher=Lexington Books |isbn=9780739174258 |page=101}}</ref>

==Symptoms==
{{See also|Short-term effects of alcohol consumption}}

* [[Vomiting]]<ref name=":0" />
* [[Bradypnea|Slow breathing]] (fewer than eight breaths per minute)<ref name=":1" />
* [[Seizure|Seizures]]<ref name=":2" />
* [[pallor|Blue, grey or pale skin]]<ref name=":3" />
* [[Hypothermia]] (Low body temperature)<ref name=":4" />
* [[Lethargy]] (Trouble staying conscious)<ref name=":5" />

[[File:The wine is a mocker 1663-1664 Jan Steen.jpg|thumb|upright=1.4|''Wine is a Mocker'' by [[Jan Steen]] {{circa}} 1663]]
Alcohol intoxication leads to negative health effects due to the recent drinking of large amount of [[ethanol]] (alcohol).<ref name=Jun2014/><ref>{{cite web |last=Latham |first=Katherine |date=2022-12-11 |title='Alcohol affects every organ': hangovers and how to survive them |url=https://www.theguardian.com/society/2022/dec/11/alcohol-affects-every-organ-hangovers-and-how-to-survive-them |access-date=2023-01-05 |website=The Guardian}}</ref> When severe it may become a [[medical emergency]]. Some effects of alcohol intoxication, such as euphoria and lowered [[social inhibition]], are central to alcohol's desirability.<ref>{{cite book |last=Dudley |first=Robert |title=The drunken monkey: why we drink and abuse alcohol |date=May 2014 |isbn=978-0-520-95817-3 |location=Berkeley |oclc=869457130}}</ref>

As drinking increases, people become sleepy or fall into a [[stupor]]. At very high [[blood alcohol concentration]]s, for example, above 0.3%, the respiratory system becomes depressed and the person may stop breathing.<ref>{{cite web |title=Students > Alcohol Effects |url=http://www.alcohol.vt.edu/Students/alcoholEffects/index.htm |website=Virginia Tech |date=5 May 2007|archive-url=https://web.archive.org/web/20070505032342/http://www.alcohol.vt.edu/Students/alcoholEffects/index.htm |archive-date=5 May 2007 }}</ref> Comatose patients may aspirate their vomit (resulting in vomitus in the lungs, which may cause "drowning" and later [[pneumonia]] if survived). CNS depression and impaired motor coordination, along with poor judgment, increase the likelihood of accidental injury occurring. It is estimated that about one-third of alcohol-related deaths are due to accidents, and another 14% are from intentional injury.<ref>The World Health Organization (2007) Alcohol and Injury in Emergency Departments</ref>

In addition to respiratory failure and accidents caused by its effects on the central nervous system, alcohol causes significant metabolic derangements. [[Hypoglycaemia]] occurs due to ethanol's inhibition of [[gluconeogenesis]], especially in children, and may cause [[lactic acidosis]], [[ketoacidosis]], and [[acute kidney injury]]. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.

==Pathophysiology==
[[File:(Five stages of inebriation, ca.1863-1868) - photographer Charles Percy Pickering (9610229733) (2).jpg|thumb|Stage three of the five stages of inebriation, {{circa}} 1863–1868, by [[Charles Percy Pickering]]]]
{{Main|Pharmacology of ethanol}}
Alcohol is [[metabolized]] by a normal [[liver]] at the rate of about 8 grams of pure [[ethanol]] per hour. 8 grams or {{convert|10|mL|usfloz|abbr=on}} is one British [[Unit of alcohol|standard unit]]. An "abnormal" liver with conditions such as [[hepatitis]], [[cirrhosis]], [[gall bladder]] disease, and [[Liver cancer|cancer]] is likely to result in a slower rate of metabolism.<ref>{{cite web |date=26 June 2018 |title=How long does alcohol stay in your blood? |url=https://www.nhs.uk/chq/Pages/853.aspx |publisher=NHS Choices}}</ref>

==Diagnosis==
{{See also|Blood alcohol content}}

Alcohol intoxication is described as a [[mental disorder|mental]] and [[Abnormal behaviour|behavioural]] [[Disorder (medicine)|disorder]] by the [[International Classification of Diseases]]. ([[ICD-10]]).<ref>Drs; {{cite web |last1=Sartorius |first1=Norman |author-link=Norman Sartorius |last2=Henderson |first2=A.S. |last3=Strotzka |first3=H. |last4=Lipowski |first4=Z. |last5=Yu-cun |first5=Shen |last6=You-xin |first6=Xu |last7=Strömgren |first7=E. |last8=Glatzel |first8=J. |last9=Kühne |first9=G.-E. |title=The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines |url=https://www.who.int/classifications/icd/en/bluebook.pdf |archive-url=https://web.archive.org/web/20041017011412/http://www.who.int/classifications/icd/en/bluebook.pdf |archive-date=17 October 2004 |url-status=live |access-date=23 June 2021 |publisher= [[World Health Organization]] |page=65 |last10=Misès |first10=R. |last11=Soldatos |first11=C.R. |last12=Pull |first12=C.B. |last13=Giel |first13=R. |last14=Jegede |first14=R. |last15=Malt |first15=U. |last16=Nadzharov |first16=R.A. |last17=Smulevitch |first17=A.B. |last18=Hagberg |first18=B. |last19=Perris |first19=C. |last20=Scharfetter |first20=C. |last21=Clare |first21=A. |last22=Cooper |first22=J.E. |last23=Corbett |first23=J.A. |last24=Griffith Edwards |first24=J. |last25=Gelder |first25=M. |last26=Goldberg |first26=D. |last27=Gossop |first27=M. |last28=Graham |first28=P. |last29=Kendell |first29=R.E. |last30=Marks |first30=I. |last31=Russell |first31=G. |last32=Rutter |first32=M. |last33=Shepherd |first33=M. |last34=West |first34=D.J. |last35=Wing |first35=J. |last36=Wing |first36=L. |last37=Neki |first37=J.S. |last38=Benson |first38=F. |last39=Cantwell |first39=D. |last40=Guze |first40=S. |last41=Helzer |first41=J. |last42=Holzman |first42=P. |last43=Kleinman |first43=A. |last44=Kupfer |first44=D.J. |last45=Mezzich |first45=J. |last46=Spitzer |first46=R. |last47=Lokar |first47=J. |agency=bluebook.doc}}</ref> Definitive [[Medical diagnosis|diagnosis]] relies on a blood test for alcohol, usually performed as part of a [[toxicology]] screen. [[Law enforcement officer]]s in the United States and other countries often use [[breathalyzer]] units and [[field sobriety test]]s as more convenient and rapid alternatives to blood tests.<ref>{{cite web |title=Random breath testing – Data by country |url=http://apps.who.int/gho/data/view.main.54620 |access-date=25 June 2018 |publisher=World Health Organization}}</ref> There are also various models of breathalyzer units that are available for consumer use. Because these may have varying reliability and may produce different results than the tests used for law-enforcement purposes, the results from such devices should be conservatively interpreted.

Many informal intoxication tests exist, which, in general, are unreliable and not recommended as deterrents to excessive intoxication or as indicators of the safety of activities such as motor vehicle driving, heavy equipment operation, machine tool use, etc.

For determining whether someone is intoxicated by alcohol by some means other than a blood-alcohol test, it is necessary to rule out other conditions such as [[hypoglycemia]], stroke, usage of other intoxicants, mental health issues, and so on. It is best if their behavior has been observed while the subject is sober to establish a baseline. Several well-known criteria can be used to establish a probable diagnosis. For a physician in the acute-treatment setting, acute alcohol intoxication can mimic other acute neurological disorders or is frequently combined with other [[recreational drug]]s that complicate diagnosis and treatment.

==Management==
Acute alcohol poisoning (an [[overdose]] of the drug) is a [[medical emergency]] due to the risk of death from [[respiratory depression]] or [[aspiration pneumonia|aspiration of vomit]] if vomiting occurs while the person is unresponsive. Emergency treatment strives to stabilize and maintain an open airway and sufficient breathing while waiting for the alcohol to metabolize. This can be done by removal of any vomit or, if the person is unconscious or has impaired [[Pharyngeal reflex|gag reflex]], intubation of the trachea.<ref>{{cite journal |last1=Devi |first1=G. |last2=Castro |first2=V. J. |last3=Huitink |first3=J. |last4=Buitelaar |first4=D. |last5=Kosten |first5=T. |last6=O'Connor |first6=P. |year=2003 |title=Management of Drug and Alcohol Withdrawal |journal=NEJM |volume=349 |issue=4 |pages=405–407 |doi=10.1056/NEJM200307243490420 |pmid=12878752}}</ref>

Other measures may include
* Administer the vitamin [[thiamine]] to prevent [[Wernicke–Korsakoff syndrome]], which can cause a [[seizure]] (more usually a treatment for chronic alcoholism, but in the acute context usually co-administered to ensure maximal benefit).
* [[Hemodialysis]] if the blood concentration is very high at >130 &nbsp;mmol/L (>600&nbsp;mg/dL)<ref>{{cite journal |last1=Adinoff |first1=B. |last2=Bone |first2=G. H. |last3=Linnoila |first3=M. |date=May 1988 |title=Acute ethanol poisoning and the ethanol withdrawal syndrome |journal=Medical Toxicology |volume=3 |issue=3 |pages=172–196 |doi=10.1007/BF03259881 |pmid=3041244 |s2cid=35315540}}</ref>
* Provide oxygen therapy as needed via nasal cannula or non-rebreather mask.
* Administration of intravenous fluids in cases involving [[hypoglycemia]] and [[electrolyte imbalance]].<ref>{{cite journal |last1=Piccioni |first1=A. |last2=Tarli |first2=C. |last3=Cardone |first3=S. |last4=Brigida |first4=M. |last5=D'Addio |first5=S. |last6=Covino |first6=M. |last7=Zanza |first7=C. |last8=Merra |first8=G. |last9=Ojetti |first9=V. |last10=Gasbarrini |first10=A. |last11=Addolorato |first11=G. |last12=Franceschi |first12=F. |date=2020-09-24 |title=Role of first aid in the management of acute alcohol intoxication: a narrative review |journal=European Review for Medical and Pharmacological Sciences |volume=24 |issue=17 |pages=9121–9128 |doi=10.26355/eurrev_202009_22859 |issn=2284-0729 |pmid=32965003 |s2cid=221862046 |quote="In case of severe intoxication (blood alcohol concentration >1 g/L), it is necessary to prevent and to treat the potentially lethal metabolic effects of alcohol libation (in particular in adolescents) and to accelerate alcohol elimination from blood. It is necessary to support with intravenous fluids, treat hypoglycemia, hypotension, hypothermia and electrolyte imbalance, administer complex B and C vitamins, and support ventilation when necessary. To accelerate the elimination of ethanol from blood (assisting a faster recovery of the patient), two possible strategies can be applied: to perform a gastric lavage within two hours after drinking a considerable amount of alcohol or to administer metadoxine (pyridoxol L-2-pyrrolidone-5-carboxylate) that may be capable of decreasing ethanol blood levels by accelerating the urinary elimination of ethanol and acetaldehyde. Hypoglycemia is fasting-related and develops more frequently in young people (because of a lower reserve of liver glycogen); it is necessary to administer intravenous 5% glucose solution or, if possible, to invite the patient to eat fructose-rich foods and complex carbohydrates. Other metabolic effects could be electrolyte imbalance such as hypokalemia, hypomagnesaemia, hypocalcemia which must be appropriately and individually treated and replaced."}}</ref>
* While the medication [[metadoxine]] may speed the breakdown of alcohol, use in alcohol intoxication requires further study as of 2017.<ref name=Jun2014/><ref name=Goh2017/> It is approved in a number of countries in Europe, as well as India and Brazil.<ref name="Goh2017">{{cite journal |last1=Goh |first1=ET |last2=Morgan |first2=MY |date=April 2017 |title=Review article: pharmacotherapy for alcohol dependence – the why, the what and the wherefore. |url=http://discovery.ucl.ac.uk/1542523/3/Morgan_MYM%20accepted%20for%20deposit%20Pharmacotherapy%20for%20Alcohol%20Dependence%20Jan%202017%20for%20APT.pdf |archive-url=https://web.archive.org/web/20180719014723/http://discovery.ucl.ac.uk/1542523/3/Morgan_MYM%20accepted%20for%20deposit%20Pharmacotherapy%20for%20Alcohol%20Dependence%20Jan%202017%20for%20APT.pdf |archive-date=19 July 2018 |url-status=live |journal=Alimentary Pharmacology & Therapeutics |volume=45 |issue=7 |pages=865–882 |doi=10.1111/apt.13965 |pmid=28220511 |doi-access=free |s2cid=5431337}}</ref>
Additional medication may be indicated for treatment of [[nausea]], [[tremor]], and [[anxiety]].

==Clinical findings==
===Hospital admissions===
Alcohol intoxication was found to be prevalent in clinical populations within the United States involving people treated for<ref name="Von2008">{{cite journal |last1=Vonghia |first1=L |last2=Leggio |first2=L |last3=Ferrulli |first3=A |last4=Bertini |first4=M |last5=Gasbarrini |first5=G |last6=Addolorato |first6=G |last7=Alcoholism Treatment Study |first7=Group. |date=December 2008 |title=Acute alcohol intoxication. |journal=European Journal of Internal Medicine |volume=19 |issue=8 |pages=561–7 |doi=10.1016/j.ejim.2007.06.033 |pmid=19046719}}</ref> trauma<ref>{{cite journal |last1=Almli |first1=Lynn M. |last2=Lori |first2=Adriana |last3=Meyers |first3=Jacquelyn L. |last4=Shin |first4=Jaemin |last5=Fani |first5=Negar |last6=Maihofer |first6=Adam X. |last7=Nievergelt |first7=Caroline M. |last8=Smith |first8=Alicia K. |last9=Mercer |first9=Kristina B. |last10=Kerley |first10=Kimberly |last11=Leveille |first11=Jennifer M. |last12=Feng |first12=Hao |last13=Abu-Amara |first13=Duna |last14=Flory |first14=Janine D. |last15=Yehuda |first15=Rachel |date=September 2018 |title=Problematic alcohol use associates with sodium channel and clathrin linker 1 (SCLT1) in trauma-exposed populations |journal=Addiction Biology |volume=23 |issue=5 |pages=1145–1159 |doi=10.1111/adb.12569 |issn=1369-1600 |pmc=6584945 |pmid=29082582}}</ref> and in the age group of people aged within their 18th–24th years (in a study of a group for the years 1999–2004).<ref>{{cite journal |last1=White |first1=Aaron M. |last2=Hingson |first2=Ralph W. |last3=Pan |first3=I.-Jen |last4=Yi |first4=Hsiao-Ye |date=September 2011 |title=Hospitalizations for alcohol and drug overdoses in young adults ages 18–24 in the United States, 1999–2008: results from the Nationwide Inpatient Sample |journal=Journal of Studies on Alcohol and Drugs |volume=72 |issue=5 |pages=774–786 |doi=10.15288/jsad.2011.72.774 |issn=1938-4114 |pmc=3357438 |pmid=21906505}}</ref> In the United States during the years 2010–2012, acute intoxication was found to be the direct cause of an average of 2,221 deaths, in the sample group of those aged within their 15th year or older.<ref name="Kan2015">{{cite journal |last1=Kanny |first1=D |last2=Brewer |first2=RD |last3=Mesnick |first3=JB |last4=Paulozzi |first4=LJ |last5=Naimi |first5=TS |last6=Lu |first6=H |date=9 January 2015 |title=Vital signs: alcohol poisoning deaths – United States, 2010–2012. |journal=[[Morbidity and Mortality Weekly Report]] |volume=63 |issue=53 |pages=1238–42 |pmc=4646044 |pmid=25577989}}</ref> The same mortality route is thought to cause indirectly more than 30,000 deaths per year.<ref name=DSM5/>

===Prognosis===
[[File:An alcoholic man with delirium Wellcome L0060780 (level correction).jpg|thumb|right|Acute confusional state caused by [[Alcohol withdrawal syndrome|alcohol withdrawal]], otherwise known as ''[[delirium tremens]]'']]

A normal liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient's overall physical condition. An abnormal liver will take longer but still succeeds, provided the alcohol does not cause [[liver failure]].<ref>{{cite journal |last=Morgan |first=TR |year=2003 |title=Management of alcoholic hepatitis |journal=Drug and Therapeutics Bulletin |volume=41 |issue=2 |pages=49–52 |doi=10.1136/dtb.2003.41749 |pmc=3099359 |pmid=21960817}}</ref>

People who have drunk heavily for several days or weeks may have [[Alcohol withdrawal syndrome|withdrawal]] symptoms after the acute intoxication has subsided.<ref>{{cite journal |last1=DeBellis |first1=R. |last2=Smith |first2=B. S. |last3=Choi |first3=S. |last4=Malloy|first4= M. |year=2005 |title=Management of Delirium Tremens |journal=J Intensive Care Med |volume=20 |issue=3 |pages=164–173 |doi=10.1177/0885066605275353 |pmid=15888905 |s2cid=31848749}}</ref>

A person consuming a dangerous amount of alcohol persistently can develop memory blackouts and idiosyncratic intoxication or pathological drunkenness symptoms.<ref>Gelder, M., Mayou, R. and Geddes, J. 2005. ''Psychiatry''. 3rd ed. New York: Oxford. pp. 186.</ref> [[Long-term effects of alcohol|Long-term persistent consumption of excessive amounts of alcohol]] can cause liver damage and have other deleterious health effects.

==Society and culture==
{{See also|List of deaths through alcohol|}}
[[File:An intoxicated man drinking beer; advertising Blauwe Week Wellcome L0048989.jpg|thumb|left|A 1936 anti-drinking poster by [[Aart van Dobbenburgh]]]]

Alcohol intoxication is a [[Risk factor (epidemiology)|risk factor]] in some cases of [[catastrophic injury]], in particular for unsupervised [[recreation]]al activity. A study in the [[Provinces and territories of Canada|province]] of [[Ontario]] based on [[Epidemiology|epidemiological]] data from 1986, 1989, 1992, and 1995 states that 79.2% of the 2,154 catastrophic injuries recorded for the study were preventable, of which 346 (17%) involved alcohol consumption.<ref name="Tator">{{cite book |title=Catastrophic Injuries in Sports and Recreation: Causes and Prevention: A Canadian Study |publisher=[[University of Toronto Press]] |year=2008 |isbn=9780802089670 |editor-last=Tator |editor-first=Charles H. |edition=2}}</ref> The activities most commonly associated with alcohol-related catastrophic injury were [[snowmobiling]] (124), fishing (41), [[Underwater diving|diving]] (40), [[boating]] (31) and [[canoeing]] (7), swimming (31), riding an [[all-terrain vehicle]] (24), and cycling (23).<ref name="Tator" /> These events are often associated with unsupervised young males, often inexperienced in the activity, and may result in [[drowning]].<ref name="Tator" /> Alcohol use is also associated with unsafe sex.

===Legal issues===
[[File:Drunk driving simulator, Montreal by CAA of Quebec.jpg|thumb|A drunk-driving simulator in [[Montreal]]]]

Laws on drunkenness vary. In the United States, it is a criminal offense for a person to be [[Driving under the influence|drunk while driving a motorized vehicle]], except in [[Alcohol laws of Wisconsin|Wisconsin]], where it is only a [[Civil infraction|fine]] for the first offense.<ref>{{cite web |title=Wisconsin Legislature: Chapter 346 |url=http://docs.legis.wisconsin.gov/statutes/statutes/346 |website=wisconsin.gov}}</ref> It is also a criminal offense to fly an aircraft or (in some [[U.S. state|American states]]) to assemble or operate an [[amusement park]] ride while drunk.<ref>{{cite web |title=Texas Penal Code § 49.065 |url=http://law.onecle.com/texas/penal/49.065.00.html |url-status=dead |archive-url=https://web.archive.org/web/20110926124717/http://law.onecle.com/texas/penal/49.065.00.html |archive-date=26 September 2011}}</ref> Similar laws also exist in the United Kingdom and most other countries.

In some jurisdictions, it is also an offense to serve alcohol to an already-intoxicated person,<ref>{{cite web |title=Camden Council: Booze license suspended after selling alcohol to drunk customers |url=http://www.camden.gov.uk/ccm/content/press/2007/february/booze-license-suspended-after-selling-alcohol-to-drunk-customers.en |url-status=dead |archive-url=https://web.archive.org/web/20090111052754/http://www.camden.gov.uk/ccm/content/press/2007/february/booze-license-suspended-after-selling-alcohol-to-drunk-customers.en |archive-date=11 January 2009 |access-date=8 January 2009 |website=camden.gov.uk}}</ref> and, often, alcohol can only be sold by persons qualified to serve responsibly through [[alcohol server training]].

The [[Blood alcohol content#Limits by country (BAC: Blood Alcohol Content)|blood alcohol content]] (BAC) for legal operation of a vehicle is typically measured as a percentage of a unit volume of blood. This percentage ranges from 0.00% in Romania and the United Arab Emirates; to 0.05% in Australia, South Africa, Germany, Scotland, and New Zealand (0.00% for underage individuals); to 0.08% in [[England and Wales]], the United States and Canada.<ref>{{cite web |title=Drinking and Driving |url=http://www.icap.org/PolicyIssues/DrinkingandDriving/BACTable/tabid/199/Default.aspx |url-status=dead |archive-url=https://web.archive.org/web/20080702135901/http://www.icap.org/PolicyIssues/DrinkingandDriving/BACTable/tabid/199/Default.aspx |archive-date=2 July 2008 |website=icap.org}}</ref>

The United States [[Federal Aviation Administration]] prohibits [[Aircrew|crew members]] from performing their duties within eight hours of consuming an alcoholic beverage, while under the influence of alcohol, or with a BAC greater than 0.04%.<ref>{{cite web |title=Federal Aviation Regulation Sec. 1.1 – General definitions. |url=http://www.risingup.com/fars/info/part1-1-FAR.shtml |website=risingup.com}}</ref><ref>{{cite web |title=FAR Part 91 Sec. 91.17 effective as of 07/21/2006 |url=http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgFAR.nsf/0/28757d8ae4d7d671862571960066be86%21OpenDocument%26Click%3D |website=faa.gov |access-date=3 July 2008 |archive-date=27 February 2021 |archive-url=https://web.archive.org/web/20210227005600/https://rgl.faa.gov/Regulatory_and_Guidance_Library/rgFAR.nsf/0/28757d8ae4d7d671862571960066be86%21OpenDocument%26Click%3D |url-status=dead }}</ref>

In the United States, the United Kingdom, and Australia, [[public intoxication]] is a crime (also known as "being drunk and disorderly" or "being drunk and incapable").<ref>{{cite news |date=10 August 1872 |title=Licensing Act 1872 |volume=1872 |work=Acts of the United Kingdom Parliament |url=http://www.statutelaw.gov.uk/content.aspx?activeTextDocId=1052305 |url-status=dead |access-date=8 May 2010 |archive-url=https://archive.today/20120805165526/http://www.statutelaw.gov.uk/content.aspx?activeTextDocId=1052305 |archive-date=5 August 2012}}</ref>

In some countries, there are special facilities, sometimes known as "[[drunk tanks]]", for the temporary detention of persons found to be drunk.

===Religious views===
Some religious groups permit the consumption of alcohol; some permit consumption but prohibit intoxication; others prohibit any amount of alcohol consumption altogether.
==== Christianity ====
[[File:Drunkenness_of_Noah_belliniFXD.jpg|thumb|''[[Drunkenness of Noah]]'' by [[Giovanni Bellini]]]]
[[File:Hendrick Goltzius - Lot and his Daughters - WGA9730.jpg|thumb|''[[Lot and his daughters]]'' by [[Hendrick Goltzius]]]]
Most [[Christian denomination|denominations]] of Christianity, such as [[Catholic Church|Catholicism]], [[Orthodoxy]] and [[Lutheranism]], use wine as a part of the [[Eucharist]] (Holy Communion) and permit its consumption, but consider it sinful to become intoxicated.<ref>{{cite book|chapter=[[s:Sermons from the Latins/Sermon 57|Sermon 57: The Vice of Drunkenness.]] |title=Sermons from the Latins|year=1902|publisher= Benziger Brothers|first=Robert|last=Bellarmine|author-link=Robert Bellarmine}}</ref>

[[Romans 13#The day is at hand (verses 11–14)|Romans 13:13–14]],<ref>{{cite web |title=Bible Gateway passage: Romans 13:13-14 – New International Version |url=https://www.biblegateway.com/passage/?search=Romans%2013%3A13-14&version=NIV |website=Bible Gateway}}</ref> [[1 Corinthians 6]]:9–11, [[Galatians 5]]:19–21<ref>{{cite web |title=Bible Gateway passage: Galatians 5:19-21 – New International Version |url=https://www.biblegateway.com/passage/?search=Galatians%205%3A19-21&version=NIV |website=Bible Gateway}}</ref> and [[Ephesians 5#Verse 18|Ephesians 5:18]]<ref>{{cite web |title=Bible Gateway passage: Ephesians 5:18 – New International Version |url=https://www.biblegateway.com/passage/?search=Ephesians%205%3A18&version=NIV |website=Bible Gateway}}</ref> are among a number of other Bible passages that speak against intoxication.

Some [[Protestantism|Protestant Christian]] denominations prohibit the consumption of alcohol<ref>{{cite web |date=June 2006 |title=On Alcohol Use in America |url=http://www.sbc.net/resolutions/amResolution.asp?ID=1156 |url-status=dead |archive-url=https://web.archive.org/web/20131105012154/http://www.sbc.net/resolutions/amResolution.asp?ID=1156 |archive-date=5 November 2013 |access-date=7 June 2013 |website=SBC Resolutions |publisher=[[Southern Baptist Convention]]}}</ref> based upon biblical passages that condemn drunkenness,<ref name="biblical" /> but others allow a [[moderationism|moderate]] rate of consumption.<ref>{{cite web |title=Frequently Asked Questions: Alcohol |url=http://www.lcms.org/Document.fdoc?src=lcm&id=576 |access-date=7 June 2013 |website=LCMS Views – Contemporary Issues |publisher=[[Lutheran Church–Missouri Synod]] |page=3}}</ref>

In the [[the Church of Jesus Christ of Latter-day Saints|Church of Jesus Christ of Latter-day Saints]], alcohol consumption is forbidden,<ref>{{cite web |title=Doctrine and Covenants 89 |url=https://www.churchofjesuschrist.org/study/scriptures/dc-testament/dc/89?lang=eng |website=churchofjesuschrist.org}}</ref> and [[teetotalism]] has become a distinguishing feature of its members. [[Jehovah's Witnesses]] allow moderate alcohol consumption among its members.

==== Islam ====
In the [[Quran]],<ref>{{cite web |title=Qur'an: 4:43 |url=http://www.usc.edu/schools/college/crcc/engagement/resources/texts/muslim/quran/004.qmt.html#004.043 |url-status=dead |archive-url=https://web.archive.org/web/20101204153931/http://www.usc.edu/schools/college/crcc/engagement/resources/texts/muslim/quran/004.qmt.html#004.043 |archive-date=4 December 2010 |access-date=4 December 2010 |publisher=Usc.edu}}</ref><ref>{{cite web |title=Qur'an: 2:19 |url=http://www.usc.edu/schools/college/crcc/engagement/resources/texts/muslim/quran/002.qmt.html#002.219 |url-status=dead |archive-url=https://web.archive.org/web/20101204153812/http://www.usc.edu/schools/college/crcc/engagement/resources/texts/muslim/quran/002.qmt.html#002.219 |archive-date=4 December 2010 |access-date=4 December 2010 |publisher=Usc.edu}}</ref><ref>{{cite web |title=Cmje |url=http://www.usc.edu/schools/college/crcc/engagement/resources/texts/muslim/quran/005.qmt.html#005.090 |url-status=dead |archive-url=https://web.archive.org/web/20101204173049/http://www.usc.edu/schools/college/crcc/engagement/resources/texts/muslim/quran/005.qmt.html#005.090 |archive-date=4 December 2010 |access-date=4 December 2010 |website=usc.edu}}</ref> there is a prohibition on the consumption of grape-based alcoholic beverages, and intoxication is considered an abomination in the [[hadith]] of [[Muhammad]]. The [[Madhhab|schools of thought]] of [[Fiqh|Islamic jurisprudence]] have interpreted this as a strict prohibition of the consumption of all types of alcohol and declared it to be ''[[haram]]'' ({{Literal translation|forbidden [in [[Islam]]]}}), although other uses may be permitted.<ref>{{cite book |last=Yilmaz |first=Ihsan |title=Muslim Laws, Politics And Society in Modern Nation States: Dynamic Legal Pluralisms in England, Turkey And Pakistan |publisher=[[Ashgate Publishing]] |year=2004 |isbn=978-0-7546-4389-0 |page=158 |chapter=Post-Modern Muslim Legality and its Consequences |chapter-url=https://books.google.com/books?id=4OrGYg31fi0C&q=Madhhab+alcohol&pg=PA158 |orig-date=2005-01-31}}</ref>

==== Buddhism ====
[[File:Guo Xu album dated 1503 (3).jpg|thumb|Drunken [[Xian (Taoism)|Immortal]] supported and escorted by a demon, by Guo Xu, [[Ming dynasty]] China.]]
In [[Buddhism]], in general, the consumption of intoxicants is discouraged for both monastics and lay followers. Many Buddhists observe a basic code of ethics known as the [[five precepts]], of which the fifth precept is an undertaking to refrain from the consumption of intoxicating substances<ref>{{cite book |last=Gwynne |first=Paul |title=World Religions in Practice: A Comparative Introduction |date=2017 |publisher=[[John Wiley & Sons]] |isbn=978-1-118-97227-4 |chapter=The Buddhist Pancasila |chapter-url=https://books.google.com/books?id=o08nDwAAQBAJ}}</ref> (except [[Alcohols (medicine)|for medical reasons]]).<ref>{{cite book |last=Gombrich |first=Richard F. |url=https://books.google.com/books?id=V3Z-dHpBsBsC |title=Buddhist Precept and Practice: Traditional Buddhism in the Rural Highlands of Ceylon |date=1995 |publisher=[[Kegan Paul, Trench and Company]] |isbn=978-0-7103-0444-5 |page=298 |author-link=Richard Gombrich}}</ref> In the [[Bodhisattva vow|''bodhisattva'' vows]] of the ''[[Brahmajāla Sūtra|Brahmajala Sutra]]'', observed by [[Mahayana|Mahayana Buddhist]] communities, distribution of intoxicants is likewise discouraged, as well as consumption.<ref>{{cite encyclopedia |title=Buddhism, Alcohol, and Tea in Medieval China |encyclopedia=Of Tripod and Palate: Food, Politics, and Religion in Traditional China |publisher=[[Springer Nature]] |url=https://books.google.com/books?id=XWPHAAAAQBAJ |last=Benn |first=James A. |year=2005 |editor-last=Sterckx |editor-first=R. |page=226 |isbn=978-1-4039-7927-8}}</ref>

==== Hinduism ====
In the [[Gaudiya Vaishnavism]] branch of [[Hinduism]], one of the four regulative principles forbids the taking of intoxicants, including alcohol.

==== Judaism ====
[[File:The Phillip Medhurst Picture Torah 104. Lot and his daughters. Genesis cap 19 vv 31-32. Drevet.jpg|thumb|Drunken [[Lot (biblical person)|Lot]] and his daughters, from an illustrated Torah]]

In the Bible, the [[Book of Proverbs]] contains several chapters related to the negative effects of drunkenness and warns to stay away from [[Alcoholic drink|intoxicating beverages]]. The [[Book of Genesis]] refers to the use of wine by [[Lot's daughters]] to rape him. The story of [[Samson]] in the [[Book of Judges]] tells of a monk from the [[tribe of Dan|Israelite tribe of Dan]] who, as a [[Nazirite]], is prohibited from cutting his hair and drinking wine.<ref name="biblical">{{cite web |title=Matthew 1|url=https://netbible.org/|access-date=31 December 2022|website=netbible.org}}</ref> [[Proverbs 31#The words of Lemuel (31:1–9)|Proverbs 31:4]] warns against kings and other rulers drinking wine and similar alcoholic beverages, Proverbs 31:6–7 promotes giving such beverages to the perishing and wine to those whose lives are bitter as a coping mechanism against the likes of poverty and other troubles.<ref>{{cite web |title=Proverbs 31: 4–7 NASB—It is not for kings, O Lemuel, It is |url=http://www.biblegateway.com/passage/?search=Proverbs+31%3A+4-7&version=NASB |website=Bible Gateway}}</ref>

In Judaism, in accordance with the biblical stance against drinking,<ref name="biblical" /> drinking wine is restricted for priests.<ref>The Talmudic decree set a schedule according to which the priests would take turns staying sober. The practice of becoming a 'biblical' monk, is discussed in a full tractate of the [[Mishna]] and Talmud. The Talmud tells of a family 'the sons of Reichab' who never drank wine, although it is not clear if this is considered good or bad.</ref> The biblical command to sanctify the [[Sabbath]] and other holidays has been interpreted as having three ceremonial meals with wine or [[grape juice]], known as ''[[Kiddush]]''.<ref>{{cite web |date=21 August 2016 |title=תעלומת הקידוש השלישי {{pipe}} רותי פויכטונגר |url=https://musaf-shabbat.com/2016/08/21/%25d7%25aa%25d7%25a2%25d7%259c%25d7%2595%25d7%259e%25d7%25aa-%25d7%2594%25d7%25a7%25d7%2599%25d7%2593%25d7%2595%25d7%25a9-%25d7%2594%25d7%25a9%25d7%259c%25d7%2599%25d7%25a9%25d7%2599-%25d7%25a8%25d7%2595%25d7%25aa%25d7%2599-%25d7%25a4%25d7%2595%25d7%2599%25d7%259b%25d7%2598%25d7%2595%25d7%25a0%25d7%2592/ |access-date=31 December 2022 |website=מוסף "שבת" – לתורה, הגות ספרות ואמנות |language=he-IL |archive-date=6 February 2023 |archive-url=https://web.archive.org/web/20230206160541/https://musaf-shabbat.com/2016/08/21/%D7%AA%D7%A2%D7%9C%D7%95%D7%9E%D7%AA-%D7%94%D7%A7%D7%99%D7%93%D7%95%D7%A9-%D7%94%D7%A9%D7%9C%D7%99%D7%A9%D7%99-%D7%A8%D7%95%D7%AA%D7%99-%D7%A4%D7%95%D7%99%D7%9B%D7%98%D7%95%D7%A0%D7%92/ |url-status=dead }}</ref><ref>The [[Pharisees]], avoiding the [[Zadokites]]' temple-based rituals, had installed many ceremonies which in a way change or contradict the literal meaning of the biblical protocol. These include the ceremony of lighting candles that stay lit during the Sabbath day, eating hot food from a fire lit previously, starting the Sabbath rituals on the night before, and drinking wine with the [[Sabbath]] meal. See [http://www.verednoam.com/articles/NoamQimronSabbathLaws.pdf Qimron Sabbath Laws] {{Webarchive|url=https://web.archive.org/web/20210308005232/http://www.verednoam.com/articles/NoamQimronSabbathLaws.pdf |date=8 March 2021 }} Vered Noam, Department of Hebrew Culture Studies, [[Tel Aviv University]] ([http://www.brill.com/dead-sea-discoveries Dead Sea Discoveries] {{Webarchive|url=https://web.archive.org/web/20170131190805/http://www.brill.com/dead-sea-discoveries |date=31 January 2017 }}, Brill Institute)</ref> A number of [[Jewish views on marriage|Jewish marriage ceremonies]] end with the bride and groom drinking a shared cup of wine after reciting [[Sheva Brachot|seven blessings]]; this occurs after a fasting day in some [[Ashkenazi Jews|Ashkenazi]] traditions. It has been customary and in many cases even mandated to drink moderately so as to stay [[Sobriety|sober]], and only after the prayers are over.<ref>{{Cite web |first=Menachem |last=Posner |url=http://www.chabad.org/library/article_cdo/aid/581082/jewish/What-is-Judaisms-take-on-alcohol-consumption.htm |title=What is Judaism's take on alcohol consumption? |work=Chabad.org}}</ref>

During the [[Passover Seder|Seder]] on [[Passover]], there is an obligation to drink four ceremonial cups of wine while reciting the [[Haggadah]]. It has been assumed to be the source of the wine-drinking ritual at communion in some Christian groups.<ref>{{cite web|date=15 November 2022|title=Was Jesus' Last Supper a Seder?|url=https://www.biblicalarchaeology.org/daily/people-cultures-in-the-bible/jesus-historical-jesus/was-jesus-last-supper-a-seder/|access-date=31 December 2022|website=Biblical Archaeology Society}}</ref> During [[Purim]], there is an obligation to become intoxicated; however, as with many other decrees, this has been avoided in many communities by allowing sleep during the day as a replacement.<ref>The [[Babylonian Talmud]] says in Megillah 7b that "[[Rava (amora)|Rava]] said: A person is obligated to become intoxicated on [[Purim]] until he is unaware of the difference between 'Cursed be [[Haman (Bible)|Haman]]' and 'Blessed be [[Mordechai]].'" This is taken to mean that on the Jewish festival of Purim, one is commanded to drink alcohol to the point of intoxication. See [[Yanki Tauber]]: [http://www.chabad.org/global/popup/default_cdo/aid/2814/jewish/The-Purim-Drunk.htm Are Jews actually supposed to get drunk on Purim?] Chabad.org (referring to the Talmudic tractate Megillah (7b)).</ref>

During the [[Prohibition in the United States|U.S. Prohibition era]] in the 1920s, a [[rabbi]] from the [[Reform Judaism]] movement proposed using grape juice for the ritual instead of wine. Although refuted at first, the practice became widely accepted by [[Orthodox Judaism|orthodox Jews]] as well.<ref>{{Cite web |url=http://www.torahlab.org/doitright/using_grape_juice_for_kiddush/ |title=Using grape juice for Kiddush |archive-url=https://web.archive.org/web/20210116114745/http://www.torahlab.org/doitright/using_grape_juice_for_kiddush/ |archive-date=16 January 2021 |work=Torahlab website}}</ref>

==Other animals==
In the film ''[[Animals Are Beautiful People]]'', an entire section was dedicated to showing many different animals, including monkeys, elephants, hogs, giraffes, and ostriches, eating over-ripe [[Sclerocarya birrea|marula]] tree fruit, causing them to sway and lose their footing in a manner similar to human drunkenness.<ref>{{cite web|title=- YouTube|url=https://www.youtube.com/watch?v=c-nSBPuRbsg|access-date=31 December 2022|via=YouTube}}</ref> Birds may become intoxicated with fermented berries, and some die colliding with hard objects when flying under the influence.<ref>{{cite news |last=Katz |first=Brigit |date=4 October 2018 |title=Birds Are Acting Erratically in Minnesota. Blame It on the Alcohol |work=[[Smithsonian (magazine)|Smithsonian]] |url=https://www.smithsonianmag.com/smart-news/birds-are-acting-erratically-minnesota-blame-it-alcohol-180970468/ |access-date=5 October 2018}}</ref><ref>{{cite journal |last=Kinde |first=Hailu |display-authors=et al |date=July 2012 |title=Strong circumstantial evidence for ethanol toxicosis in Cedar Waxwings (Bombycilla cedrorum) |journal=Journal of Ornithology |volume=153 |issue=3 |pages=995–998 |doi=10.1007/s10336-012-0858-7 |bibcode=2012JOrni.153..995K |s2cid=15546534}}</ref>

In elephant warfare, practiced by the Greeks during the [[Maccabean revolt]] and by [[Hannibal]] during the [[Punic wars]], it has been recorded that the elephants would be given wine before the attack, and only then would they charge forward after being agitated by their driver.<ref>{{cite web |last=Lundin |first=Elizabeth |date=21 December 2021 |title=Hannibal's Superweapon: The War Elephant |url=https://historythings.com/hannibals-superweapon-the-war-elephant/ |access-date=31 December 2022 |website=History Things}}</ref>

It is a regular practice to give small amounts of beer to race horses in Ireland. Ruminant farm animals have natural fermentation occurring in their stomach, and adding small quantities of alcoholic beverages to their water is generally harmless and will not cause them to become drunk.

Alcoholic beverages are extremely harmful to dogs,<ref>{{cite web|url=https://www.akc.org/expert-advice/vets-corner/is-alcohol-dangerous-for-dogs/|title=How Harmful Is Alcohol To Dogs? What To Do if Your Dog Drinks Alcohol|first1=Dr Jerry|last1=Klein|date=24 September 2019 |website=akc.org}}</ref> and often for reasons of additives such as [[xylitol]], an artificial sweetener in some mixers. Dogs can absorb ethyl alcohol in dangerous amounts through their skin as well as through drinking the liquid or consuming it in foods. Even fermenting bread dough can be dangerous to dogs.<ref>{{cite journal |last1=Means |first1=Charlotte |title=Bread dough toxicosis in dogs |journal=Journal of Veterinary Emergency and Critical Care |date=28 February 2003 |volume=13 |pages=39–41 |doi=10.1046/j.1435-6935.2003.00068.x |url=https://onlinelibrary.wiley.com/doi/10.1046/j.1435-6935.2003.00068.x |access-date=19 April 2024|url-access=subscription }}</ref> In 1999, one of the royal footmen for Britain's Queen [[Elizabeth II]] was demoted from [[Buckingham Palace]] due to his "party trick" of [[Mickey Finn (drugs)|spiking the meals and drinks]] of the [[Royal corgis|Queen's pet corgi dogs]] with alcohol which in turn would lead the dogs to run around drunk.<ref>{{cite news|url=http://nl.newsbank.com/nl-search/we/Archives?p_product=LA&p_theme=la&p_action=search&p_maxdocs=200&p_topdoc=1&p_text_direct-0=0EF80EB2A69CA15E&p_field_direct-0=document_id&p_perpage=10&p_sort=YMD_date:D&s_trackval=GooglePM|title=News Lite|newspaper=[[Daily News of Los Angeles]] |date=23 July 1999|access-date=19 October 2022}}</ref>

==See also==
{{Portal|Beer|Drink|Medicine}}

* ''[[A Night of Serious Drinking]]''
* [[Alcohol and sex]]
* [[Alcohol enema]]
* [[Alcohol flush reaction]]
* [[Disulfiram-alcohol reaction]]
* [[Driving under the influence]]
* ''[[In vino veritas]]''
* [[Long-term effects of alcohol consumption]]
* [[Non-alcoholic drink#Low-alcoholic drink|Low alcoholic drinks]]
* [[Short-term effects of alcohol consumption]]

==References==
{{Reflist}}

==Bibliography==
{{refbegin}}
* Bales, Robert F. "Attitudes toward Drinking in the Irish Culture". In: Pittman, David J. and Snyder, Charles R. (Eds.) ''Society, Culture and Drinking Patterns''. New York: Wiley, 1962, pp.&nbsp;157–187.
* Gentry, Kenneth L. Jr., ''God Gave Wine: What the Bible Says about Alcohol''. Lincoln, Calif.: Oakdown, 2001.
* Rorabaugh, W.J. "The Alcoholic Republic," Chapter 2 & 5, [[Oxford University Press]].
* Sigmund, Paul. ''St. Thomas Aquinas on Politics and Ethics''. W.W. Norton & Company, Inc, 1988, p.&nbsp;77.
* Walton, Stuart. ''Out of It. A Cultural History of Intoxication''. [[Penguin Books]], 2002. {{ISBN|0-14-027977-6}}.
* Slingerland, Edward. ''[[Drunk (book)|Drunk: How We Sipped, Danced, and Stumbled Our Way to Civilization]]''. [[Little, Brown Spark]], 2021.
{{refend}}

==External links==
{{EB1911 poster|Drunkenness}}
* [https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose Alcohol overdose]: [[NIAAA]]
* [http://www.nhs.uk/conditions/alcohol-poisoning/Pages/Introduction.aspx Alcohol poisoning]: NHS Choices

{{Medical resources
| DiseasesDB     = 
| ICD11          = {{ICD11|6C40}}, {{ICD11|NE61}}
| ICD10          = {{ICD10|F10}}, {{ICD10|T51}}
| ICD9           = {{ICD9|305.0}}, {{ICD9|980}}
| ICDO           = 
| OMIM           = 
| MedlinePlus    = 002644
| eMedicineSubj  = 
| eMedicineTopic = 
| MeshID         = D000435
}}
{{Alcohol and health}}
{{Psychoactive substance use}}
{{Authority control}}

[[Category:Alcohol abuse]]
[[Category:Drinking culture]]
[[Category:Health effects of alcohol|Intox]]
[[Category:Substance intoxication]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Disorders due to use of alcohol]]