WHAT YOU NEED TO KNOW ABOUT ALCOHOL

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Alcohol is classed as a ‘sedative hypnotic’ drug, which means it acts to depress the central nervous system at high doses. At lower doses, alcohol can act as a stimulant, inducing feelings of euphoria and talkativeness, but drinking too much alcohol at one session can lead to drowsiness, respiratory depression (where breathing becomes slow, shallow or stops entirely), coma or even death. As well as its acute and potentially lethal sedative effect at high doses, alcohol has effects on every organ in the body, and these effects depend on the blood alcohol concentration (BAC) over time. After a drink is swallowed, the alcohol is rapidly absorbed into the blood (20percent through the stomach and 80percent through the small intestine), with effects felt within 5to 10minutes after drinking. It usually peaks in the blood after 30to 90minutes, and thus is carried through all the organs of the body. Most (90percent) of the metabolism, or breaking down, of alcohol from a toxic substance to water and carbon dioxide is performed by the liver, with the rest excreted through the lungs (allowing alcohol breath tests), through the kidneys (into urine) and in sweat. The liver can break down only a certain amount of alcohol per hour, which for an average person is around one standard drink (which raises the BAC about 15to 20mg/dL the current limit for driving in New Zealand is 80mg/dL). The BAC rises, and the feeling of drunkenness occurs, when alcohol is drunk faster than the liver can break it down. The BAC level, and every individual’s reaction to alcohol, is influenced by:
•        the ability of the liver to metabolise alcohol (which varies due to genetic differences in the liver enzymes that break down alcohol)
•        the presence or absence of food in the stomach (food dilutes the alcohol and dramatically slows its absorption into the bloodstream by preventing it from passing quickly into the small intestine)
•        the concentration of alcohol in the beverage (highly concentrated beverages such as spirits are more quickly absorbed)
•        how quickly alcohol is drunk
•        body type (heavier and more muscular people have more fat and muscle to absorb the alcohol)
•        age, sex, ethnicity (e.g. women have a higher BAC after drinking the same amount of alcohol than men due to differences in metabolism and absorption – since men have on average more fluid in their body to distribute alcohol around than women do; some ethnic groups have different levels of a liver enzyme responsible for the breakdown of alcohol)
•        how frequently a person drinks alcohol (someone who drinks often can tolerate the sedating effects of alcohol more than someone who does not regularly drink)
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Alcohol is the most widely abused psychoactive drug in the United States today. Slang terms include booze, bubbly, firewater, joy juice, sauce, liquid courage, and many others. Legal for those aged 21 and over, drinking is a deeply rooted aspect of our culture. While there are many types of alcohol (an entire class of chemicals), the type that is found in drinks and medicines is known as ‘ethyl alcohol’ or ‘ethanol.’ A yeast enzyme changes the simple sugars that are found in grapes, potatoes, or corn into ethanol – the alcohol found in beer, malt liquor, wine, liquors such as vodka and whiskey, wine coolers, and liqueurs like Irish cream. Though many consider alcohol to have stimulant effects, it is actually classified as a depressant – a substance that slows the central nervous system. Other purposes for ethyl alcohol include uses as a chemical solvent, a local anesthetic, and an irritant.
When a person drinks an alcoholic beverage, it is very unlikely that he or she is actually drinking pure alcohol; pure alcohol is extremely potent and takes only a few ounces to raise a person’s blood alcohol level into the danger zone. The ethanol concentration for common types of alcoholic drinks is as follows:
•  Beer: 4-6%
•  Malt liquor: 5-8%
•  Wine: 7-15%
•  Wine coolers: 5-10%
•  Champagne: 8-14%
•  Hard liquor (Distilled spirits - vodka, rum, whiskey, etc.): 40-95%
•  Grain Alcohol: 95-97.5%
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Alcohol and the Human Body

In 2015, of the 78,529 liver disease deaths among individuals ages 12 and older, 47.0 percent involved alcohol. Among males, 49,695 liver disease deaths occurred and 49.5 percent  involved alcohol. Among females, 28,834 liver disease deaths occurred and 43.5 percent involved alcohol. Among all cirrhosis deaths in 2013, 47.9 percent were alcohol related. The proportion of alcohol-related cirrhosis was highest (76.5 percent) among deaths of persons ages 25–34,  followed by deaths of persons ages 35–44, at 70.0 percent.
In 2009, alcohol-related liver disease was the primary cause of almost 1 in 3 liver transplants in the United States. Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast.

EFFECTS OF ALCOHOL
The effects of drinking depend on a variety of factors, including, but not limited to the:
•  Amount of alcohol consumed
•  Time taken to consume it
•  Individual’s gender, weight, body size, and percentage of body fat
•  Amount of food in the stomach
•  Use of medications, including non-prescription drugs
•  Mindset of the individual at the time of consumption
•  Setting in which the drinking takes place
Also, mixing alcohol with other drugs can drastically increase the damaging effects of drinking. For example, combining alcohol with narcotics (i.e., heroin, Oxycontin®, methadone) can cause slowed breathing, heart attack, and death. For some, even the combination of alcohol and aspirin can be extremely dangerous.

Short-Term Effects
The short-term effects of drinking alcoholcan cause numerous adverse effects on the user, including:
•  Slowed reaction times and reflexes
•  Poor motor coordination
•  Blurred vision
•  Slurred speech
•  Lowered inhibitions and increase in risk behavior
•  Lowered reasoning ability, impaired judgment
•  Memory loss
•  Confusion, anxiety, restlessness
•  Slowed heart rate, reduced blood pressure
•  Slowed breathing rate
•  Heavy sweating
•  Nausea and vomiting
•  Dehydration – a leading cause of condom breakage
•  Coma
•  Death from respiratory arrest
A person who consistently uses alcohol over a period of time will develop a tolerance to the effects of drinking; that is, it takes progressively more alcohol to achieve the same effects. Over time, that person may grow dependent on alcohol, and in some cases this can lead to a vicious cycle of addiction.

Overall body effects
         Alcohol     affects        all     parts of      the    body including:
•        blood and immune system
•        bones and muscles
•        brain and nervous system
•        breasts (in women)
•        eyes
•        heart and blood pressure
•        intestines
•        kidneys and fluid balance
•        liver
•        lungs
•        mental health
•        mouth and throat
•        pancreas and digestion of sugar
•        sexual and reproductive system – men
•        sexual and reproductive system – women
•        skin and fat
•        stomach and food pipe (oesophagus).

BLOOD AND IMMUNE SYSTEM
Long-term effects of alcohol use Chronic heavy alcohol use can cause abnormalities in the blood, leading to anaemia (low haemoglobin, the component of blood that carries oxygen around the body) and low platelets (platelets help prevent bleeding).[13] Chronic heavy alcohol use also suppresses the immune system (such as affecting the white blood mouth and throat. Being drunk can cause slurred speech.

STOMACH AND FOOD PIPE
Too much alcohol can have short- and long-term effects on the oesophagus (food pipe) and the stomach.

INTESTINES
Both the small intestine and large intestine can be affected by long-term alcohol use, including cancer risk.

LIVER
Long-term alcohol use can cause damage to the liver in a variety of ways.

PANCREAS
Alcohol use, particularly when heavy, can cause acute or chronic pancreatitis (inflammation and damage to the pancreas).

KIDNEYS
Alcohol has an effect on the kidneys’ functions. Too much alcohol can affect functions of the kidney.

HEART
Alcohol use at low levels may be beneficial for the heart in some people but is harmful for everyone at high levels.

BLOOD
Alcohol is absorbed into the bloodstream and can have some long-term effect on mental health. Alcohol can be used to relax but it is also addictive and can lead to dependency.
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SEXUAL HEALTH
Alcohol use can affect judgment and increases the chance of unwanted sexual experiences. It can also affect sexual performance in men.

BREASTS
(in women) Long-term alcohol use increases the risk of breast cancer.

BONES AND MUSCLES
Alcohol immediately affects coordination and increases the likelihood of injury, while ongoing heavy alcohol use can have other health effects. Alcohol use causes many different types of injuries, including injuries from road traffic accidents, assaults and falls. This is usually because high levels of blood alcohol impair the brain’s thought processes and the coordination of muscles, causing clumsiness and difficulty walking. Common injuries seen at the emergency department include cuts, bruises, sprains and broken bones. The risk of injury in the six hours after drinking doubles with four standard drinks and increases rapidly the more alcohol is drunk on a single occasion.

EYES
Being drunk can cause blurred vision.

SKIN
Alcohol use can have direct and indirect effects on the skin.
Alcohol affects all parts of the body including:

BRAIN AND NERVOUS SYSTEM
Being drunk impairs judgment, inhibitions and concentration, and in increasing amounts leads to drowsiness and coma. The loss of memory for a period of drunkenness (alcoholic blackout) can occur in occasional as well as regular heavy drinkers, and is due to alcohol interfering with the laying down of memories.

HEART AND BLOOD PRESSURE

The evidence for the effect of alcohol on the heart is mixed. There is an opinion that light to moderate alcohol use (up to one standard drink per day for women and up to two standard drinks per day for men) can, in older age groups, reduce the risk of developing and dying from coronary artery disease (narrowing and blockage of the arteries supplying blood to the heart resulting from the build-up of fatty deposits inside the walls of the arteries (atherosclerosis), which can cause angina and heart attacks). This appears to be because small quantities of alcohol alter the lipids and clotting factors in the blood to make them protective against heart disease. However, heavy drinking (both chronic and a pattern of heavy drinking sessions) increases the risk of coronary artery disease. Heavy drinking (chronic and/or at a single session) is also associated with sudden death from heart failure, with irregular heartbeats and with chronic disease of the heart muscle (dilated cardiomyopathy). Dilated cardiomyopathy leads to heart failure, where the heart can no longer pump blood around the body effectively. Heavy chronic alcohol use is    also linked to high blood pressure, particularly in men. Blood pressure increases with drinking more than two or three drinks a day on average and restriction of alcohol lowers the blood pressure. Drinking alcohol in order to ‘protect the heart’ is not advisable, since alcohol is an addictive drug that causes
cancer, increases the risk of injury and causes damage to the fetus in pregnant women. People can find it difficult to limit their drinking to one or two standard drinks a day and heavy drinking actually increases the risk of heart disease and. People who have risk factors for or have established heart disease should focus on other factors such as cigarette smoking, high cholesterol, high blood pressure, diabetes, overweight and physical inactivity. Young and middle-aged adults, especially women, are more likely to experience harm than benefit from alcohol use due to risk from injury and, for women, increased risk from breast cancer.

INTESTINES
Long- term alcohol use can cause cancer of the large bowel/intestines and rectum. Alcohol can lead to malnutrition and diseases due to low vitamin levels, as it blocks the absorption of many important vitamins and nutrients in the gut.

KIDNEYS AND FLUID BALANCE
Alcohol is a diuretic, meaning that it causes water to be lost from the body through the kidneys (into urine), which can lead to dehydration. Alcohol can also cause the loss of important minerals and salts from the body such as magnesium, calcium, phosphate, sodium and potassium, either directly or because alcohol induces vomiting. Low levels of these elements can cause many problems ranging from irregular heartbeats to seizures.

LIVER
Chronic heavy alcohol use can damage the liver, causing alcoholic liver disease. This occurs across a spectrum from fatty liver, to acute alcoholic hepatitis, to cirrhosis. Fatty liver, where fat builds up in the liver cells, is very common in heavy drinkers and is reversible if drinking is reduced. However, a small percentage of people with fatty liver will develop alcoholic hepatitis, cirrhosis or liver cancer. Alcoholic hepatitis develops in 10to 35percent of heavy drinkers and is an acute injury to the liver which can present with symptoms of feeling unwell, tiredness, jaundice (yellow skin and whites of eyes), swollen stomach and enlarged, tender liver. Death from liver failure can occur in severe cases. Cirrhosis of the liver develops in 5to 15percent of heavy drinkers and is where the liver is permanently damaged and cells are replaced by scar tissue, so the liver can no longer function (to detoxify the body, make vital proteins, store vitamins and sugars, and make chemicals necessary for digestion). Cirrhosis can also lead to death from liver failure. Treatment for alcoholic liver disease must include stopping the drinking of alcohol. Alcohol also causes liver cancer, and treatment options are often limited if alcoholic liver disease is present or the cancer has spread widely by the time of diagnosis. This means liver cancer is often quickly fatal.

LUNGS 
Being drunk increases the risk of pneumonia (inflammation of the lungs, usually caused by infection from bacteria or viruses). This is because, at high blood concentrations, alcohol is sedating and relaxes the mouth and throat, suppresses reflexes (like the gag and cough reflexes), and reduces the ability of the lungs to clear mucus and foreign matter, so that vomit, saliva or other substances may enter the lungs and cause inflammation and infection (bronchitis or pneumonia). Chronic heavy alcohol use is also associated with higher rates of pneumonia, tuberculosis (an infectious disease that affects primarily the lungs but also any other part of the body), and acute respiratory distress syndrome (ARDS – a life-threatening condition in which the lungs fill with fluid, which occurs as a rare complication of pneumonia, trauma and severe infections). In addition to the ways in which acute alcohol use can cause pneumonia, chronic heavy alcohol use also impairs the immune system and changes the bacteria present in the mouth to those more likely to cause infections, making people more vulnerable to pneumonia.

MENTAL HEALTH
Many people use low doses of alcohol for relaxation and to relieve tension, nervousness and stress. However, in some people alcohol creates rather than reduces stress through stimulating stress hormones. Alcohol affects mood in a variety of ways, and can make people feel happy, sad or aggressive, and can also cause moods swing. However, there is a risk of becoming dependent on alcohol if it is used as a primary means to relieve stress and anxiety without addressing the underlying causes. Because it removes inhibitions and increases aggression and recklessness, alcohol is often found in the blood of people who self-harm, or attempt or complete suicide. Alcohol is addictive and can lead to dependency. This is where the body requires more alcohol to achieve the desired effect (e.g. altered mood), where use of alcohol interferes with a person’s life (causing legal, work/study, relationship or social problems), where a person continues to use alcohol despite it causing physical or mental problems, and where, if alcohol is not taken, withdrawal symptoms occur. The severity of withdrawal symptoms depends on the quantity of alcohol consumed and the length of the drinking session. Symptoms include shaking of the hands, which commonly occurs the morning after the drinking session and may be relieved by more alcohol. If alcohol is not taken, symptoms can progress to insomnia, increased heart rate, temperature and blood pressure, sweating, agitation, nausea, flushing of the face, nightmares, hallucinations (seeing, hearing or feeling things that are not present) and fits. The most serious withdrawal syndrome is ‘delirium tremens’, which develops in about 5percent of people with alcohol withdrawal (more if fits are not treated) and by definition includes the symptom of delirium (an altered and confused state of mind). This syndrome has a death rate of around 5percent. In people who drink heavily, alcohol commonly causes mood disorders, including depression, anxiety and psychosis (a mental illness defined by changes in personality, a distorted sense of reality, and delusions). If these disorders only occur during drinking sessions or withdrawal, they will usually resolve once drinking is stopped. Alcohol abuse and dependency are also common in people with pre-existing mental health conditions.

MOUTH AND THROAT
Being drunk can have various effects on speech, such as making people more friendly, talkative, unreserved, relaxed or argumentative. Increasing amounts of alcohol can cause aggressive, antisocial, angry, slurred and confused speech. Alcohol is a carcinogen, meaning that it causes cancers in humans. Regular alcohol use increases the risk of cancers of the mouth, throat and voice box. Drinking around 50g of alcohol a day (five standard drinks) increases the risk of these cancers by two to three times compared with non-drinkers, but for people who smoke, this risk is increased much more. Drinking more increases the risk of cancers, and drinking less decreases the risk of cancers.

PANCREAS AND DIGESTION OF SUGAR
Heavy alcohol use on a single occasion can lead to dangerously low blood sugar (hypoglycaemia), which can cause symptoms of shaking, sweating, dizziness,blurred vision and, if not treated, brain damage. The pancreas is a gland that secretes digestive enzymes and releases insulin, which regulates sugar levels in the blood.Chronic heavy alcohol use can cause acute pancreatitis (sudden inflammation of and damage to the pancreas that resolves over several days) and chronic pancreatitis (inflammation of the pancreas that does not heal and worsens over time). Acute pancreatitis typically causes abdominal and back pain, nausea and fever and may occur a few hours or up to two days after drinking alcohol. In 20to 30percent of people, acute pancreatitis is a severe, life-threatening condition, which requires treatment in hospital. Chronic pancreatitis typically occurs in people aged 30 to 40years and can cause abdominal pain, weight loss, diabetes, malnutrition and oily bowel motions (because the pancreas helps to digest fat and when the pancreas is damaged, fats are excreted out of the bowel instead of being absorbed into the body). The risk of acute and chronic pancreatitis increases with higher alcohol use. Moderate alcohol use is associated with a reduced risk of developing type 2diabetes, although the exact reason for this is not certain.

SEXUAL HEALTH - MEN
Being drunk increases the chances of having unsafe sex (without a condom), having sex that is later regretted or experiencing sexual assault  as alcohol impairs judgment and lowers inhibitions. These factors are also likely to increase the risk of getting a sexually transmitted infection. Chronic heavy alcohol use can lead to impotence, loss of sex drive, wasting of the testicles and reduced fertility. This is primarily because alcohol affects testosterone levels.

                                   SEXUAL HEALTH - WOMEN
Being drunk increases the chances of having unsafe sex (without a condom), having sex that is later regretted or experiencing sexual assault  as alcohol impairs judgment and lowers inhibitions. Such sexual experiences are also likely to increase the risk of getting a sexually transmitted infection  or having an unplanned pregnancy. Chronic heavy alcohol use can lead to reduced fertility and can make periods heavy or irregular or stop altogether. Consuming alcohol while pregnant may increase the risk of miscarriage, low birth weight, stillbirth and premature birth. It can also cause significant abnormalities in the unborn, developing baby (fetal alcohol spectrum disorder).

SKIN AND FAT
Acute alcohol use can lead to skin flushing and worsen the appearance of skin conditions such as rosacea (a chronic facial skin rash). Chronic heavy alcohol use, when associated with serious liver disease and liver failure, can also cause yellowing of the skin, decreased body hair and spider veins. Alcohol is a high-calorie beverage. One standard drink (100ml of wine, 30ml of spirits or 280ml of standard beer) contains 290kJ, close to half the energy of a can of fizzy drink. Alcohol is also an appetite stimulant, and people tend to eat more when consuming alcohol with their meals. However, while theoretically the potential for alcohol to increase weight is clear, and some studies find that alcohol use is associated with increased weight, others find the opposite result. Alcohol seems more likely to cause weight gain in those who drink intermittently (moderately to heavily), in those who are already overweight, in those eating a high-fat diet, and in men. For people concerned about their weight, nutritionists advise people to take into account how much energy alcohol is contributing to their diet. Chronic heavy drinkers are likely to be malnourished as alcohol has little nutritional value and replaces nutritious food in the diet.

STOMACH AND FOOD PIPE(oesophagus)
Being drunk can lead to nausea and vomiting, diarrhoea, heartburn (when acid from the stomach rises up into the food pipe, due to alcohol causing the muscle around the outlet of the stomach to relax) and acute gastritis (inflammation of the lining of the stomach, which causes stomach pain, nausea, loss of appetite and indigestion). Vomiting and diarrhoea can result in dehydration, salt imbalances and the build-up of acids in the body, especially in combination with excessive alcohol intake. Inhaling vomit can lead to bronchitis or pneumonia (infection of the lungs). Vomit can block the airway and windpipe when blood alcohol is very high and breathing and consciousness are impaired. Persistent vomiting and retching after heavy use on a single occasion can sometimes (but only rarely) rip the food pipe (a Mallory Weiss tear), which leads to vomiting of blood.
Long-term alcohol use can cause cancer of the food pipe (oesophagus) and drinking 50g of alcohol a day (five standard drinks) doubles the risk compared with a non-drinker. However, the risk is much greater in people who drink alcohol who are also deficient in a liver enzyme that metabolises alcohol (East Asian populations are commonly deficient in this enzyme). The risk is also increased in smokers. Chronic heavy alcohol use can also lead to chronic gastritis but alcohol may protect against infection from Helicobacter pylori, the bacteria that cause ulcers of the stomach. In cases of advanced liver disease due to prolonged heavy alcohol use, the veins to the stomach and oesophagus can swell and may burst, causing life-threatening bleeding

LONG-TERM EFFECTS OF ALCOHOL USE
Chronic heavy alcohol use interferes with the absorption of calcium and bone formation and can actually lead to osteoporosis. Chronic heavy use is also associated with a painful condition where bone tissue dies (osteonecrosis), gout (a type of arthritis or inflammation of the joints, often affecting the joint of the big toe), and muscle wasting and weakness.
Over time, heavy drinking can cause permanent damage to the user’s body and brain. Several factors affect the severity and extent of this damage, including the drinker’s age and gender as well as the duration and extent of abuse. The physical damage caused by sustained alcohol abuse includes:
•  Liver damage
•  Accumulation of fat in the liver
•  Cirrhosis – heavy scarring of the liverprevents blood flow; usually fatal
•  Alcoholic hepatitis – swelling of liver cells, causing blockage; sometimes fatal
•  Liver cancer
•  Heart damage
•  High blood pressure
•  Coronary disease – narrowing of the arteries, leading to heart attack or death
•  Enlarged heart
•  Irregular heartbeat, which can lead to heart attack or death
•  Decreased blood flow to the arms and legs
•  Stroke – blocked blood flow to the brain
•  Brain damage
•  Lowered cognitive abilities
•  Destruction of brain cells, producing brain deterioration and atrophy
•  Mental disorders – increased aggression, antisocial behavior, depression, anxiety
•  Damage to sense of balance, causing more accidental injuries
•  Bone damage
•  Bone growth that normally takes place in teenage years is stunted
•  Osteoporosis – severe back pain, spine deformity, increased risk of fractures
•  Pancreas damage
•  Pancreatitis – inflammation of the pancreas, causing abdominal pain, weight loss, and sometimes death
•  Cancer
•  Alcoholism increases a person’s chances of developing a variety of cancers of the
pancreas, liver, breasts, colon, rectum, mouth, pharynx, and esophagus.
•  Sexual problems
•  Reduced sperm count and mobility, as well as sperm abnormality
•  Menstrual difficulties, irregular/absent cycles, and decreased fertility
•  Early menopause
•  Birth defects
•  Drinking any alcohol during pregnancy cancause permanent, severe damage, by
putting the child at risk for Fetal Alcohol Syndrome

Alcohol-Related Problems
•  Premature aging
•  Heartburn, nausea, gastritis, and ulcers
•  Poor digestion and inflammation of the intestines
•  Malnutrition
•  Water retention
•  Weakened vision
•  Skin disorders
•  Korsakoff’s Syndrome – amnesia and delirium after long-term alcohol abuse

Symptoms of Alcohol Poisoning
•  Person is passed out and extremely difficult to wake
•  Cold, clammy, pale or bluish skin
•  Slow or irregular breathing
•  Vomiting; person vomits while passed out

Alcohol and Pregnancy
The prevalence of Fetal Alcohol Syndrome (FAS) in the United States was estimated by the Institute of Medicine in 1996 to be between 0.5 and 3.0 cases per 1,000. More recent reports from specific U.S. sites report the prevalence of FAS to be 2 to 7 cases per 1,000, and the prevalence of Fetal Alcohol Spectrum Disorders (FASD) to be as high as 20 to 50 cases per 1,000.

Health Benefits of Moderate Alcohol Consumption

Moderate alcohol use may protect against osteoporosis (thinning of the bones, which makes the bones more likely to break). Moderate alcohol consumption, according to the 2015–2020 Dietary Guidelines for Americans, is up to 1 drink per day for women and up to 2 drinks per day for men. Moderate alcohol consumption may have beneficial effects on health. These include decreased risk for heart disease and mortality due to heart disease, decreased risk of ischemic stroke (in which the arteries to the brain become narrowed or blocked, resulting in reduced blood flow), and decreased risk of diabetes. In most Western countries where chronic diseases such as coronary heart disease (CHD), cancer, stroke, and diabetes are the primary causes of death, results from large epidemiological studies consistently show that alcohol reduces mortality, especially among middle-aged and older men and women—an association that is likely due to the protective effects of moderate alcohol consumption on CHD, diabetes, and ischemic stroke. It is estimated that 26,000 deaths were averted in 2005 because of reductions in ischemic heart disease, ischemic stroke, and diabetes from the benefits attributed to moderate alcohol consumption. Expanding our understanding of the relationship between moderate alcohol consumption and potential health benefits remains a challenge, and, although there are positive effects, alcohol may not benefit everyone who drinks moderately.

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