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The two-carbon alcohol ethanol (CH3CH2OH), or beverage alcohol, is one of the most versatile drugs known to man, with multiple direct effects on a diverse range of neurochemical systems. Produced in nature, rewarding in its effects, and easy to manufacture, it has been taken by humans since the beginning of recorded history, is consumed by a large majority of people in the Western world, and is likely to contribute to more morbidity, mortality, and public health costs than all of the illicit drugs combined. Yet most pharmacologists, pharmacists, and healthcare providers receive only minimal education about ethanol and the mechanisms through which it contributes to such diverse pathology.


This chapter presents an overview of the effects of ethanol on various physiological systems, then focuses on the mechanisms of ethanol's effects in the central nervous system (CNS) as the basis for understanding the rewards, disease processes, and treatments for ethanol-related conditions. First, it is worthwhile to recount the history of the human use of alcoholic beverages.


Human Consumption of Ethanol: A Brief History. The use of alcoholic beverages has been documented since at least 10,000 BC (Hanson, 1995). By about 3000 BC, the Greeks, Romans, and inhabitants of Babylon continued to incorporate ethanol into religious festivals, while also using these beverages for pleasure, to facilitate socialization, as a source of nutrition, and as part of medicinal practices. The role of ethanol in society continued through biblical times, with beverage alcohol incorporated into most religions, and occupying a central role in daily life. Over the last 2000 years, alcoholic beverages have been identified in most cultures, including pre-Columbian America in ~200 AD, and the Islamic world in the 700s.

Whiskey was invented in ~1400 in Ireland and rapidly increased in popularity; champagne was developed in France in 1670. In 1690, the English government enacted a law encouraging the consumption of distilled spirits, and the production of gin subsequently increased from about 0.5 million gallons in 1685 to 5 million by 1727 and 18 million gallons by the early 1800s.

The dangers of heavy consumption of beverage alcohol have been recognized by almost all cultures, with most stressing the importance of moderation. Despite these warnings, problems with ethanol are as ancient as the pattern of use of this beverage itself, and were noted early on in India, Greece, and Rome. The increase in use of ethanol in the 1800s, along with industrialization and need for a more dependable work force, contributed to the development of more widespread organized efforts to discourage drunkenness. The subsequent temperance movements set the stage for the prohibition against drinking instituted in the U.S. in 1920. In 1933, the long tradition of the use of alcohol, as well as the large minority of the population who favored the availability of alcoholic beverages, resulted in the repeal of the constitutional amendment enacting prohibition.

Beverage alcohol has widespread use in today's society, ...

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