"In reviewing the results there is a striking discrepancy in guidelines for low-risk consumption, ranging from 10 g per day (Bosnia and Herzegovina²⁷, Croatia*, India²⁸, Portugal*, Slovenia²⁹ and Sweden³⁰) to 56 g per day (Chile²³). It is also notable that countries disagree as to whether low-risk drinking has the same definition for men and women. Differences in how countries define low-risk consumption in general and for different population groups may stem from reliance upon diverse data sources regarding alcohol-related harm. For example, public health officials and scientists in different countries may rely upon studies performed in different populations (e.g. in the general population versus in clinical samples), in different populations (e.g. in samples of men versus women, young people versus older adults) and in different social contexts (e.g. in cultures where drinking by women is or is not stigmatized more than drinking by men). That said, given the wide disparity in definitions of low-risk drinking around the world, it seems unlikely that everyone is correct. Indeed, one cannot even rule out the possibility that all 37 countries examined are in some sense wrong, in so far as there is no robust evidence that the general population changes its level of alcohol consumption in response to governments defining standard drinks and publishing low-risk drinking guidelines. Comparing the potential health impact of different nations' guidelines would be a worthy activity for international research teams."

"Among the 139.7 million current alcohol users aged 12 or older in 2019, 65.8 million people (47.1 percent) were past month binge drinkers (Figure 6). Among past month binge drinkers, 16.0 million people (24.4 percent of current binge drinkers and 11.5 percent of current alcohol users) were past month heavy drinkers.²¹

"Any Alcohol Use
"Among people aged 12 or older in 2019, 50.8 percent (or 139.7 million people) drank alcohol in the past month (Figure 7 and 2019 DT 7.3). This percentage in 2019 was similar to the percentages in 2002 to 2004 and in 2015 to 2018, but it was lower than the percentages in most years from 2005 through 2014."

"In this randomized clinical trial of psilocybin-assisted psychotherapy treatment for AUD [Alcohol Use Disorder], psilocybin treatment was associated with improved drinking outcomes during 32 weeks of double-blind observation. PHDD [Percentage of Heavy Drinking Days] among participants treated with psilocybin was 41% of that observed in the diphenhydramine-treated group. Exploratory analyses confirmed a between-group effect across a range of secondary drinking measures. Although this was, to our knowledge, the first controlled trial of psilocybin for AUD, these findings are consistent with a meta-analysis³⁹ of trials conducted in the 1960s evaluating LSD as a treatment for AUD.

"Adverse events associated with psilocybin administration were mostly mild and self-limiting, consistent with other recent trials evaluating the effects of psilocybin in various conditions.^1-8 However, it must be emphasized that these safety findings cannot be generalized to other contexts. The study implemented measures to ensure safety, including careful medical and psychiatric screening, therapy and monitoring provided by 2 well-trained therapists including a licensed psychiatrist, and the availability of medications to treat acute psychiatric reactions."

"Among people aged 12 or older, the percentage who were past month heavy alcohol users declined from 6.5 percent (or 17.3 million people) in 2015 to 5.8 percent (or 16.0 million people) in 2019 (Figure 9 and 2019 DT 7.3). However, these estimates in 2019 were similar to those in 2016 to 2018.

"Aged 12 to 17
"Among adolescents aged 12 to 17, past month heavy alcohol use increased from 0.5 percent (or 131,000 adolescents) in 2018 to 0.8 percent (or 208,000 adolescents) in 2019 (Figure 9 and 2019 DT 7.6). However, these estimates in 2019 were similar to those in 2015 to 2017. Thus, continued monitoring of trends in heavy alcohol use among adolescents is important to help reduce harmful consequences related to underage drinking problems in the United States.

"Aged 18 to 25
"Among young adults aged 18 to 25, the percentage who were past month heavy alcohol users declined from 10.9 percent (or 3.8 million people) in 2015 to 8.4 percent (or 2.8 million people) in 2019 (Figure 9 and 2019 DT 7.12). These estimates in 2019 were lower than those in 2015 to 2017, but they were similar to those in 2018.

"Aged 26 or Older
"Among adults aged 26 or older, the percentage who were past month heavy alcohol users remained stable between 2015 and 2019 (Figure 9 and 2019 DT 7.15). In 2019, 6.0 percent of adults aged 26 or older (or 13.0 million people) were heavy alcohol users in the past month."

Note: According to SAMHSA:
"In addition to asking about any alcohol use, NSDUH collected information on past month binge alcohol use and heavy alcohol use. Binge drinking for males was defined as drinking five or more drinks¹⁸ on the same occasion on at least 1 day in the past 30 days, which has remained unchanged from the threshold prior to 2015. Since 2015, binge alcohol use for females has been defined as drinking four or more drinks on the same occasion on at least 1 day in the past 30 days.¹⁹ This definition of binge alcohol use is consistent with federal definitions.²⁰ Heavy alcohol use was defined as binge drinking on 5 or more days in the past 30 days based on the thresholds described previously for males and females.

"Among the 139.7 million current alcohol users aged 12 or older in 2019, 65.8 million people (47.1 percent) were past month binge drinkers (Figure 6). Among past month binge drinkers, 16.0 million people (24.4 percent of current binge drinkers and 11.5 percent of current alcohol users) were past month heavy drinkers.²¹"

"In addition to asking about any alcohol use, NSDUH collected information on past month binge alcohol use and heavy alcohol use. Binge drinking for males was defined as drinking five or more drinks¹⁸ on the same occasion on at least 1 day in the past 30 days, which has remained unchanged from the threshold prior to 2015. Since 2015, binge alcohol use for females has been defined as drinking four or more drinks on the same occasion on at least 1 day in the past 30 days.¹⁹ This definition of binge alcohol use is consistent with federal definitions.²⁰ Heavy alcohol use was defined as binge drinking on 5 or more days in the past 30 days based on the thresholds described previously for males and females.

"Among the 139.7 million current alcohol users aged 12 or older in 2019, 65.8 million people (47.1 percent) were past month binge drinkers (Figure 6). Among past month binge drinkers, 16.0 million people (24.4 percent of current binge drinkers and 11.5 percent of current alcohol users) were past month heavy drinkers.²¹"

"In 2014, alcohols, including ethanol and isopropyl alcohol, were involved in 15% of all drug overdose deaths and 17% of the drug overdose deaths that mentioned involvement of at least one specific drug. Table E shows the frequency of alcohol involvement among drug overdose deaths involving specific drugs.

"• Alcohol involvement was mentioned in 12%–22% of the drug overdose deaths involving fentanyl, heroin, hydrocodone, morphine, oxycodone, alprazolam, diazepam, or cocaine.

"• Alcohol involvement was mentioned in less than 10% of the drug overdose deaths involving methadone and methamphetamine."

"Of 6774 total OODs [Opioid Overdose Deaths] (5033 males and 1741 females; 5233 aged <55 years and 1541 aged ≥55 years), alcohol was involved in 2073 OODs (30.6%). Decedent demographic characteristics are presented in Table 1. The model failed to identify any significant trend over time prior to the COVID-19 stay-at-home order nor any significant immediate changes in prevalence level or changes in trends after the implementation or withdrawal of the stay-at-home order (Table 2). The models that incorporated sex, race, ethnicity, and age revealed differences in alcohol involvement in the years prior to the order. The prevalence of alcohol use in OODs was higher for men than women (prevalence ratio [PR] for women, 0.51; 95% CI, 0.40-0.66), for non-Hispanic Black and Hispanic decedents than White decedents (non-Hispanic Black decedents: PR, 1.71; 95% CI, 1.39-2.09; Hispanic decedents: PR, 1.59; 95% CI, 1.22-2.07), and for decedents aged 55 years or older than decedents younger than 55 years (aged ≥55 years: PR, 1.38; 95% CI, 1.13-1.68). There were no significant changes by subgroup associated with COVID-19 policy changes."

"Substance use was common among U.S. high school students during 2019 and varied by substance, year, and demographic groups (Table 1). Among current substance use measures, the highest prevalence estimates were for alcohol (29.2%) and marijuana use (21.7%). Current binge drinking was reported by 13.7% of high school students, and 7.2% reported current prescription opioid misuse. Among lifetime use measures, marijuana use was reported by 36.8% of high school students, followed by misuse of prescription opioids (14.3%) and use of synthetic marijuana (7.3%), cocaine (3.9%), methamphetamine (2.1%), or heroin (1.8%). Lifetime injection drug use was reported by 1.6% of high school students.

"Trend data were available for eight of the 11 substance use measures included in the analyses. Among these measures, current alcohol use, lifetime cocaine, lifetime methamphetamine, lifetime heroin, and lifetime injection drug use decreased during 2009–2019. Lifetime use of synthetic marijuana decreased during 2015–2019. The prevalence of lifetime marijuana use increased during 2009–2013 (36.8%–40.7%) and then decreased during 2013–2019 (40.7%–36.8%). No statistically significant changes from 2017 to 2019 were observed for any of the substance use behaviors.

"Compared with females, males had a significantly higher prevalence of lifetime use of cocaine (4.9% versus 2.7%), methamphetamine (2.7% versus 1.5%), heroin (2.3% versus 1.0%), and injection drug use (2.1% versus 1.1%) (Table 2). Compared with males, females had a significantly higher prevalence of current alcohol use (31.9% versus 26.4%), binge drinking (14.6% versus 12.7%), current prescription opioid misuse (8.3% versus 6.1%), and lifetime prescription opioid misuse (16.1% versus 12.4%). Among racial/ethnic groups, notable differences in prevalence estimates were identified for current use of alcohol, binge drinking, current prescription opioid misuse, and lifetime use of cocaine, methamphetamine, heroin, injection drug use, and synthetic marijuana. However, no clear pattern emerged. For example, the prevalence of current prescription opioid misuse was significantly lower among white students (5.5%) compared with black (8.7%) or Hispanic students (9.8%). Conversely, the prevalence of current alcohol use was lower among black students (16.8%) compared with white (34.2%) or Hispanic students (28.4%).

"Approximately half of the substance use behaviors varied substantially by grade, with consistently higher prevalence among 11th- and 12th-grade students compared with 9th- and 10th-grade students for current marijuana use, current alcohol use and binge drinking, lifetime marijuana use, lifetime cocaine use, lifetime methamphetamine use, and lifetime synthetic marijuana. Prevalence of all but one of the substance use behaviors (i.e., binge drinking) varied considerably by sexual identity. Students who identified as lesbian, gay, or bisexual had a higher prevalence of all substance use behaviors, except binge drinking, compared with students who identified as heterosexual. Similarly, students who identified as not sure of their sexual identity also had higher prevalence of approximately half of the substance use behaviors compared with heterosexual students, including current prescription opioid misuse, lifetime cocaine use, lifetime methamphetamine use, lifetime heroin use, lifetime injection drug use, and lifetime prescription opioid misuse. However, students who identified as not sure of their sexual identity had lower prevalence of certain substance use behaviors compared with students identifying as lesbian, gay, or bisexual, including current marijuana use, current alcohol use, and lifetime marijuana use."

"Among residents of a COVID-19 isolation hotel shelter for people experiencing homelessness, we found that an emergency, provisional safe supply program (i.e., prescribing pharmaceutical-grade medications and beverage-grade alcohol) was associated with low rates of adverse events and high rates of successful completion of the 14-day isolation period. No shelter residents experienced an overdose during their stay. We identified medication dosage ranges that generally fell within those recommended in “risk mitigation” prescribing guidelines, which were urgently produced in response to evolving risks of COVID-19."

"In 2015, 138.3 million Americans aged 12 or older reported current use of alcohol, 66.7 million reported binge alcohol use in the past month, and 17.3 million reported heavy alcohol use in the past month (Figure 21). Thus, nearly half of current alcohol users reported binge alcohol use (48.2 percent), and about 1 in 8 current alcohol users reported heavy alcohol use (12.5 percent). Among binge alcohol users, about 1 in 4 (26.0 percent) were heavy users.

"Current Alcohol Use
"The estimate of 138.3 million current alcohol users aged 12 or older in 2015 (Figure 21) corresponds to alcohol use in the past month by slightly more than half (51.7 percent) of people aged 12 or older (Figure 22). The 2015 estimate of past month alcohol use was similar to the estimate in 2005 to 2013, but it was lower than the 2014 estimate."

"Social anxiety disorder (SAD) and alcohol use disorders (AUDs) are frequently comorbid (see Morris, Stewart, and Ham (2005), for a review). Approximately 13% of adults with past-year SAD met criteria for a comorbid AUD, and of adults with lifetime SAD, 48.2% met criteria for an AUD (Grant et al., 2005). This relationship appears to be due to a greater likelihood of having comorbid alcohol dependence (characterized by tolerance, withdrawal, or compulsive alcohol consumption (APA, 2000); OR = 2.26 to 2.7) rather than alcohol abuse (characterized by a pattern of negative consequences that result from alcohol use (APA, 2000); OR = 1.2 to 1.23; Buckner, Timpano, Zvolensky, Sachs-Ericsson, & Schmidt, 2008; Grant et al., 2005). Both retrospective and longitudinal studies have shown that when SAD and AUD co-occur, SAD typically precedes the onset of the AUD (Buckner, Schmidt, et al., 2008; Buckner, Timpano, et al., 2008; Buckner & Turner, 2009; Falk, Yi, & Hilton, 2008).

"Consistent with studies of adults, Kushner and Sher (1993) found that 43% of college freshmen with SAD met diagnostic criteria for an AUD while only 26% of college freshman without SAD met criteria for an AUD. Overall, however, research on the relationship between social anxiety and alcohol use among college students has revealed very mixed findings (see Morris et al. (2005), for a review). Some laboratory studies have demonstrated that socially anxious participants drink more in anticipation of both interaction (Higgins & Marlatt, 1975) and speech tasks (Kidorf & Lang, 1999), whereas others (e.g., Holroyd, 1978) have found that socially anxious students drink significantly less alcohol than non-socially anxious peers during informal laboratory-based “get togethers.” Survey studies of college students have either failed to find a relationship between social anxiety and alcohol consumption, or have found an inverse relationship between social anxiety and alcohol consumption (e.g., Buckner, Schmidt, & Eggleston, 2006; Gilles, Turk, & Fresco, 2006; Ham & Hope, 2006; Lewis et al., 2008). One possible reason for the lack of a positive relationship between social anxiety and alcohol use is that socially anxious students may avoid social situations and only use alcohol to cope with anxiety in social situations when they cannot be avoided (Norberg, Norton, & Olivier, 2009; Stewart, Morris, Mellings, & Komar, 2006).

"Despite the fact that many studies have found a negative relationship, or no relationship at all, between social anxiety and alcohol use, A.R. Schry, S.W. White / Addictive Behaviors 38 (2013) 2690–2706 2691many studies have found that social anxiety is positively associated with ARPs (e.g., Buckner, Ecker, & Proctor, 2011; Buckner & Heimberg, 2010; Buckner et al., 2006; Gilles et al., 2006; Norberg et al., 2009). A significant relationship between social anxiety and ARPs may be particularly important, because AUDs are defined by problems resulting from the use of alcohol rather than simply the quantity and frequency of use (Buckner et al., 2006). However, not all studies have found a significant relationship between social anxiety and ARPs (e.g., Ham, Zamboanga, Bacon, & Garcia, 2009; LaBrie, Pedersen, Neighbors, & Hummer, 2008)."

"• Worldwide in 2016, more than half (57%, or 3.1 billion people) of the global population aged 15 years and over had abstained from drinking alcohol in the previous 12 months. Some 2.3 billion people are current drinkers. Alcohol is consumed by more than half of the population in only three WHO regions – the Americas, Europe and Western Pacific.

"• In the African, Americas, Eastern Mediterranean and European regions, the percentage of drinkers has declined since 2000. However, it increased in the Western Pacific Region from 51.5% in 2000 to 53.8% today and has remained stable in the South-East Asia Region.

"• Total alcohol per capita consumption in the world’s population over 15 years of age rose from 5.5 litres of pure alcohol in 2005 to 6.4 litres in 2010 and was still at the level of 6.4 litres in 2016. The highest levels of per capita alcohol consumption are observed in countries of the WHO European Region.

"• Whereas in the WHO African Region, the Region of the Americas and the Eastern Mediterranean Region alcohol per capita consumption remained rather stable, in the European Region it decreased from 12.3 litres in 2005 to 9.8 litres in 2016. The increase in per capita alcohol consumption is observed in the WHO Western Pacific and South-East Asia regions.

"• Current drinkers consume on average 32.8 grams of pure alcohol per day, and this is some 20% higher (40.0 g/day) in the African Region and about 20% lower (26.3 g/day in the South-East Asia Region. Drinkers increased their alcohol consumption since 2000 in almost all regions except the WHO European Region.

"• One quarter (25.5%) of all alcohol consumed worldwide is in the form of unrecorded alcohol – i.e. alcohol that is not accounted for in official statistics on alcohol taxation or sales as it is usually produced, distributed and sold outside the formal channels under governmental control."

"Alcohol and marijuana are the two most commonly used substances by teenagers to get high, and a question that is often asked is to what extent does change in one lead to a change in the other. If the substances co-vary negatively (an increase in one is accompanied by a decrease in the other) they are said to be substitutes; if they co-vary positively, they are said to be complements.

"Interestingly, the answer may differ by historical era. Before 2007 patterns of use for the two substances suggested they acted as complements. When marijuana use increased in the late 1970s, so too did alcohol use. Between 1979 and 1992 marijuana use declined and a parallel decline took place in annual, monthly, and daily alcohol use, as well as in binge drinking among 12th graders. As marijuana use increased again in the 1990s, alcohol use again increased with it, although not as sharply. In sum, before 2007 there was little evidence from MTF to support what we have termed “the displacement hypothesis,” which asserts that an increase in marijuana use will lead to a decline in alcohol use, or vice versa.8

"However, since 2007 a new trend has emerged that would be consistent with the “displacement” hypothesis. From 2007 through 2019 alcohol use declined markedly, reaching historic lows in the life of the study. Meanwhile, for most of this time period marijuana use has stayed steady or increased for all age groups. For the first time trends in alcohol and marijuana use are substantially diverging, suggesting that the historical relationship between these two drugs may have changed."

"The data are quite consistent with the view that Prohibition at the state level inhibited alcohol consumption, and an attempt to explain correlated residuals by including omitted variables revealed that enforcement of Prohibitionist legislation had a significant inhibiting effect as well. Moreover, both hypotheses about the effects of alcohol and Prohibition are supported by the analysis. Despite the fact that alcohol consumption is a positive correlate of homicide (as expected), Prohibition and its enforcement increased the homicide rate."

"Lifetime alcohol users aged 21 or older had a significantly higher rate of past year illicit drug use (13.7 percent) compared with lifetime nondrinkers (2.7 percent). In addition, lifetime alcohol users had significantly higher rates of past year use across all illicit drug categories, with the exception of inhalants (Table 1). Nonmedical use of pain relievers was the illicit drug used most often by lifetime nondrinkers, whereas lifetime alcohol users reported using marijuana most frequently."

"• As was the case in prior years, the level of alcohol use was associated with illicit drug use in 2013. Among the 16.5 million heavy drinkers aged 12 or older, 33.7 percent were current illicit drug users. Persons who were not current alcohol users were less likely to have used illicit drugs in the past month (4.3 percent) than those who reported current use of alcohol but no binge or heavy use (7.3 percent), binge use but no heavy use (18.5 percent), or heavy use of alcohol (33.7 percent).

"• Alcohol consumption levels also were associated with tobacco use in 2013. Among heavy alcohol users aged 12 or older, 53.1 percent smoked cigarettes in the past month compared with 16.2 percent of non-binge current drinkers and 15.5 percent of persons who did not drink alcohol in the past month. Smokeless tobacco use and cigar use also were more prevalent among heavy drinkers (12.1 and 15.4 percent, respectively) than among non-binge drinkers (2.0 and 3.9 percent) and persons who were not current alcohol users (2.0 and 1.8 percent)."

"Excessive alcohol use* accounted for an estimated average of 80,000 deaths and 2.3 million years of potential life lost (YPLL) in the United States each year during 2001–2005, and an estimated $223.5 billion in economic costs in 2006. Binge drinking accounted for more than half of those deaths, two thirds of the YPLL, and three quarters of the economic costs."

* Excessive alcohol use includes binge drinking (defined by CDC as consuming four or more drinks per occasion for women or five or more drinks per occasion for men), heavy drinking (defined as consuming more than one drink per day on average for women or more than two drinks per day on average for men), any alcohol consumption by pregnant women, and any alcohol consumption by youths aged less than 21 years.

"Combined data from 2002 to 2006 indicated that an annual average of 9.4 percent of persons aged 12 to 20 (3.5 million persons in that age range) met the diagnostic criteria for an alcohol use disorder (dependence or abuse) in the past year."

"Withdrawal: A continuum of symptoms and signs of CNS (including autonomic) hyperactivity may accompany cessation of alcohol intake.
"A mild withdrawal syndrome includes tremor, weakness, headache, sweating, hyperreflexia, and GI symptoms. Symptoms usually begin within about 6 h of cessation. Some patients have generalized tonic-clonic seizures (called alcoholic epilepsy, or rum fits) but usually not > 2 in short succession.
"Alcoholic hallucinosis (hallucinations without other impairment of consciousness) follows abrupt cessation from prolonged, excessive alcohol use, usually within 12 to 24 h. Hallucinations are typically visual. Symptoms may also include auditory illusions and hallucinations that frequently are accusatory and threatening; patients are usually apprehensive and may be terrified by the hallucinations and by vivid, frightening dreams. The syndrome may resemble schizophrenia, although thought is usually not disordered and the history is not typical of schizophrenia. Symptoms do not resemble the delirious state of an acute organic brain syndrome as much as does delirium tremens (DT) or other pathologic reactions associated with withdrawal. Consciousness remains clear, and the signs of autonomic lability that occur in DT are usually absent. When hallucinosis occurs, it usually precedes DT and is transient.
"DT usually begins 48 to 72 h after alcohol withdrawal; anxiety attacks, increasing confusion, poor sleep (with frightening dreams or nocturnal illusions), profuse sweating, and severe depression also occur. Fleeting hallucinations that arouse restlessness, fear, and even terror are common. Typical of the initial delirious, confused, and disoriented state is a return to a habitual activity; eg, patients frequently imagine that they are back at work and attempt to do some related activity. Autonomic lability, evidenced by diaphoresis and increased pulse rate and temperature, accompanies the delirium and progresses with it. Mild delirium is usually accompanied by marked diaphoresis, a pulse rate of 100 to 120 beats/min, and a temperature of 37.2 to 37.8° C. Marked delirium, with gross disorientation and cognitive disruption, is accompanied by significant restlessness, a pulse of > 120 beats/min, and a temperature of > 37.8° C; risk of death is high.
"During DT, patients are suggestible to many sensory stimuli, particularly to objects seen in dim light. Vestibular disturbances may cause them to believe that the floor is moving, the walls are falling, or the room is rotating. As the delirium progresses, resting tremor of the hand develops, sometimes extending to the head and trunk. Ataxia is marked; care must be taken to prevent self-injury. Symptoms vary among patients but are usually the same for a particular patient with each recurrence."

"In sum, these findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes. To be sure, medical marijuana laws were not found to have a crime exacerbating effect on any of the seven crime types. On the contrary, our findings indicated that MML precedes a reduction in homicide and assault. While it is important to remain cautious when interpreting these findings as evidence that MML reduces crime, these results do fall in line with recent evidence [29] and they conform to the longstanding notion that marijuana legalization may lead to a reduction in alcohol use due to individuals substituting marijuana for alcohol [see generally 29, 30]. Given the relationship between alcohol and violent crime [31], it may turn out that substituting marijuana for alcohol leads to minor reductions in violent crimes that can be detected at the state level. That said, it also remains possible that these associations are statistical artifacts (recall that only the homicide effect holds up when a Bonferroni correction is made)."

"Alcohol is neurotoxic to brain development, leading to structural hippocampal changes in adolescence,¹⁶ and to reduced brain volume in middle age.¹⁷ Alcohol is a dependence-producing drug, similar to other substances under international control, through its reinforcing properties and neuro-adaptation in the brain.¹⁸ It is an immunosuppressant, increasing the risk of communicable diseases,¹⁹ including tuberculosis.²⁰ Alcoholic beverages are classified as carcinogenic by the International Agency for Research on Cancer, increasing the risk of cancers of the oral cavity and pharynx, oesophagus, stomach, colon, rectum, and breast in a linear dose-response relation,²¹ with acetaldehyde as a potential pathway.²² Alcohol has a biform relation with coronary heart disease. In low and apparently regular doses (as little as 10 g every other day), alcohol is cardioprotective,²³ although doubt remains about the effect of confounders.²⁴ At high doses, especially when consumed irregularly, it is cardiotoxic.²⁵

"The present study sought to test the validity of a commercially available uEtG test to detect past day drinking, past day binge drinking, past 3-day drinking, and past 3-day binge drinking in a sample of heavy drinkers. We found that while uEtG was reasonably able to detect past day alcohol use and past day binge drinking, detection of drinking and binge drinking in the past 3 days was poor. These findings were consistent with a recent study examining the utility of uEtG testing among women of childbearing age, which found poor sensitivity to detect light-to-moderate drinking beyond a 12-hour window (Graham et al., 2017). These preliminary results call into question the validity of commercially available urine EtG tests at the manufacturer recommended detection cutoffs as means of validating alcohol abstinence and binge drinking in clinical research. It is important to consider the sensitivity of detection window as the current uEtG was commercially sold to detect alcohol use in the past 80 h, yet was only accurate for detecting past 24 h’ alcohol use. As false positives are common with uEtG tests (Costantino et al., 2006; Wurst et al., 2015), researchers should be aware of the limitations of urinary EtG using the manufacturer recommended detection threshold of 500 ng/ml and should not rely on commercial uEtG alone as verification of past alcohol use, particularly when using conservative detection thresholds. Breath alcohol concentrations (BrAC) should be used in conjunction with physiological biomarkers and self-report in order to accurately capture recent alcohol intake."

"Alcohol has a range of psychomotor and cognitive effects that increase accident risk on reaction times, cognitive processing, coordination, vigilance, vision and hearing, even at low blood alcohol levels. For these reasons alcohol consumption is normally closely regulated in relation to the operation of transport systems and other safety sensitive environments and activities.

"Adverse effects on vision have been found at blood alcohol concentrations of 30mg ethanol per 100ml blood, and the psychomotor skills required for driving have been found to show impairment from 40mg/100ml (in the UK the legal blood alcohol limit for drivers is 80mg/100ml). Raised risk of accident can also remain for some time after drinking, as skills and faculties do not necessarily return to normal immediately even once all alcohol has left the body. Drink-driving vehicles in general is a dangerous activity, as the number of alcohol-related serious injuries and deaths on Great Britain’s roads demonstrates. Since 2010, 4% – 5% of all reported road traffic accidents involved at least one driver over the drink drive limit have accounted for around. Between 13% – 16% of all deaths on GB roads over the same period did so too.¹

"Impairment of faculties can also have a dangerous effect on the control of aircraft. In a study of airline pilots who had to perform routine tasks in a simulator under three alcohol test conditions, it was found that:

"• before the ingestion of any alcohol, 10% of them could not perform all the operations correctly;

"• after reaching a blood alcohol concentration of 100mg/dl, 89% could not perform all the operations correctly;

"• and 14 hours later, after all the alcohol had left their systems, 68% still could not perform all the operations correctly.²"

"In each year, AID was most common among men, people who binge drink and people who did not always use a seatbelt (tables 1–3). Men accounted for an overwhelming percentage of AID episodes (80% in 2014, 70% in 2016 and 80% in 2018; data not shown). Similarly, people who engaged in recent binge drinking accounted for 85%, 80% and 86% of all AID episodes in 2014, 2016 and 2018, respectively (data not shown). Those who reported more binge drinking reported more AID episodes. For example, in 2014, the 4% of adults who reported binge drinking at least four times per month accounted for 58% of AID episodes. This was true in 2016 and 2018 where 4% and 5% of those who reported binge drinking at least four times a month accounted for 55% and 65% of AID episodes in each respective year. People who reported not always wearing a seatbelt had an annual AID rate four times higher in 2014 and 2016 and six times higher in 2018 than those who always wore a seatbelt.

"Reported AID varied by other characteristics as well. Regardless of gender and year, AID rates were highest among people aged 21–34 years and then decreased with age. Married adults, particularly married male adults, tended to have lower AID rates compared with those who were coupled, previously married or never married. There were no significant differences in AID rates by race/ethnicity, education level or household income no matter the year or gender. Among those engaging in AID, 60% reported seeing a doctor for a routine check-up within the past year (data not shown). Another 16% had a check-up between 1 and 2 years prior (data not shown). Among respondents who reported recent binge drinking, 62% reported a routine check-up within the past year (data not shown). Finally, among those reporting recent AID and recent binge drinking, 57% had a check-up within the past year (data not shown)."

"As with cannabis, alcohol use increased variability in lane position and headway (Casswell, 1979; Ramaekers et al., 2000; Smiley et al., 1981; Stein et al., 1983) but caused faster speeds (Casswell, 1977; Krueger & Vollrath, 2000; Peck et al., 1986; Smiley et al., 1987; Stein et al., 1983). Some studies also showed that alcohol use alone and in combination with cannabis affected visual search behavior (Lamers & Ramaekers, 2001; Moskowitz, Ziedman, & Sharma, 1976). Alcohol consumption combined with cannabis use also worsened driver performance relative to use of either substance alone. Lane position and headway variability were more exaggerated (Attwood et al., 1981; Ramaekers et al., 2000; Robbe, 1998) and speeds were faster (Peck et al., 1986).
"Both simulator and road studies showed that relative to alcohol use alone, participants who used cannabis alone or in combination with alcohol were more aware of their intoxication. Robbe (1998) found that participants who consumed 100 g/kg of cannabis rated their performance worse and the amount of effort required greater compared to those who consumed alcohol (0.05 BAC). Ramaekers et al. (2000) showed that cannabis use alone and in combination with alcohol consumption increased self-ratings of intoxication and decreased self-ratings of performance. Lamers and Ramaekers (2001) found that cannabis use alone (100 g/kg) and in combination with alcohol consumption resulted in lower ratings of alertness, greater perceptions of effort, and worse ratings of performance."

"The first discussion of a relationship between alcohol consumption and motor vehicle collisions to be published in an American scientific journal appeared as an editorial in the Quarterly Journal of Inebriation (1904). The editor had received a communication about 25 fatal crashes of automobile wagons in which 23 occupants died and 14 suffered injuries. Nineteen of the drivers had used alcohol within an hour of the crash. The author of the communication commented that driving automobile wagons was a more dangerous activity for drinkers than driving locomotives. Drinking by on-duty railroad employees had been prohibited since 1843 (Borkenstein, 1985)."

"By all estimates, the Eighteenth Amendment was a costly blunder. Between 1920 and 1930, the federal government spent an average of twenty-one million dollars enforcing the Volstead Act.¹² [the National Prohibition Act - enabling legislation for the 18th Amendment] During the same period, the United States lost an estimated $1.25 billion in potential tax revenues annually.¹³ In spite of the resources consumed by Alcohol Prohibition, it affected only one segment of the nation. National Prohibition cut in half the consumption of spirits by the poor and working classes, but the “consumption of alcoholic beverages by the business, professional and salaried class [was] fully as great . . . as it was prior to prohibition.”¹⁴ While National Prohibition kept the poor dry, it made local organized crime groups wealthy enough to extend their control over entire cities.¹⁵ This success further reflected mainstream America’s implicit rejection of temperance morality. As Al Capone himself so pointedly remarked:"

"I make my money by supplying a public demand. If I break the law, my customers, who number hundreds of the best people in Chicago, are as guilty as I am. The only difference between us is that I sell and they buy. Everybody calls me a racketeer. I call myself a business man. When I sell liquor, it’s bootlegging. When my patrons serve it on a silver tray on Lake Shore Drive, it’s hospitality."

"The presence of alcohol in almost all of the polydrug-use repertoires and among all of the different populations addressed is one of the key findings of this ‘Selected issue’. Alcohol is almost always the first drug with strong psychoactive and mind-altering effects used by young people, and its widespread availability makes it the ever-present drug in substance combinations among young adults, particularly in recreational settings."

"Thirty-day prevalence of alcohol use is also negatively associated with SES [Socio-Economic Status] in 8th grade, but that association declines in upper grades and showing little difference by 12th grade. The prevalence of getting drunk in the prior 30 days is also negatively associated with SES in 8th grade, but becomes positively correlated with SES by 12th grade."

"In 2006, more than one third (35.8 percent) of persons aged 12 to 20 who used alcohol in the past month also had used an illicit drug in the past month, and 16.0 percent of underage drinkers used an illicit drug within 2 hours of using alcohol on their last occasion of alcohol use.

"Marijuana was the illicit drug most used by underage drinkers, with nearly one third (30.0 percent) having used marijuana in the past month, and 15.0 percent having used marijuana within 2 hours of their last alcohol use."

"• In 2012, 75.9 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol prevention messages in the past year from sources outside of school, such as from posters or pamphlets, on the radio, or on television. This rate in 2012 was similar to the 75.1 percent reported in 2011, but was lower than the 83.2 percent reported in 2002 (Figure 6.6). In 2012, the prevalence of past month use of illicit drugs among those who reported having such exposure (9.4 percent) was not significantly different from the prevalence among those who reported having no such exposure (10.0 percent).

"• In 2012, 75.0 percent of youths aged 12 to 17 enrolled in school in the past year reported having seen or heard drug or alcohol prevention messages at school, which was similar to the 74.6 percent reported in 2011, but was lower than the 78.8 percent reported in 2002 (Figure 6.6). In 2012, the prevalence of past month use of illicit drugs or marijuana was lower among those who reported having such exposure in school (8.9 and 6.7 percent for illicit drugs and marijuana, respectively) than among youths who were enrolled in school but reported having no such exposure (12.3 and 9.7 percent)."