Do you know what single product is involved in more than 200 disease and injury conditions, and is responsible 3 million deaths around the world each year?

The answer is alcohol.

April is Alcohol Awareness Month. By sharing some facts and figures about the dangers of drinking, our goal isn’t to be teetotalers, or even to make you teetotalers. But we do want you to know the risks. After all, alcohol is so ingrained in our wine-o-clock, rose-all-day culture that it’s easy to overlook the impact it can have on an individual and on a family.

With that said, here are nine things that everybody who drinks should know about what’s in their glass.

1. Alcohol has a frequent presence in the emergency room. People who are drinking —especially younger people — are more likely to injure themselves in road traffic crashes, in violent situations and by suicide. In fact, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly 20% of emergency department visits (that’s one in five) involve alcohol; alcohol is also a contributing factor in 22% of overdose deaths involving prescription opioids.
2. Alcohol can kill. In fact, it’s number four on the list of preventable deaths in the United States, following tobacco, poor diet and physical inactivity and illegal drugs. Alcohol is involved in more than 140,000 deaths per year, according to NIAAA.
3. Alcohol serving sizes in bars and restaurants may differ from what’s considered “standard.” The NIAAA considers the following sizes when it comes to “standard” drinks:

• • 12 ounces of regular beer
  • 5 ounces of wine
  • 1.5 ounces of distilled spirits
  • 8 to 9 ounces of malt liquor

If you’ve been out on the town lately, though, you probably know those portions seem a bit outdated. It’s not uncommon for cocktails to have three or more ounces of alcohol; many bars offer 9-ounce and 10-ounce wine-pour options; and a pint of beer — which many cans now hold— is 16 ounces, not 12; plus, different beers have varying amounts of alcohol. So, be aware of that when you order that a single drink may actually be closer to two servings. Oh, and it’s a myth that beer and wine are safer or “healthier” than liquor. Alcohol is alcohol. 

4. Alcohol is a depressant. Many enjoy a cocktail or glass of wine because it makes them feel relaxed, and seems to relieve stress. That’s because alcohol, in the early stages of tippling, triggers the brain to release more dopamine, according to Northwestern Medicine, bringing about feelings of euphoria. Drink more and that euphoria becomes excitement. But keep going and it can get messy: drinkers can experience feelings of confusion, and then stupor, which can lead to the possibility of coma and death in cases of alcohol poisoning, as the alcohol blocks communication pathways and impacts brain function. People who drink in excess may also be prone to mental health conditions, such as depression and anxiety.
5. The damage caused by drinking can be reversed. According to Northwestern Medicine, if a person stops drinking, they may see improvements in their health — or even a reversal of damage — within a year.
6. Alcohol is harmful to your health, and can even increase your risk of cancer. You’ve probably heard about the potential for alcohol to damage the liver; it can also contribute to high blood pressure, heart disease, stroke, liver disease and digestive problems, according to the Centers for Disease Control and Prevention (CDC). It can also make people more vulnerable to certain types of cancer, including breast, mouth, throat, esophagus, voice box, liver, colon and rectum. That’s because alcohol contains ethanol, which is a carcinogen, according to the American Cancer Society, which goes on to say: “Because cancer risk increases with the amount of ethanol consumed, all alcoholic beverages pose a risk. However, public awareness of this risk is lower than for other carcinogens.” 
7. Alcohol use also contributes to unintended pregnancies, poor pregnancy outcomes and sexually transmitted infections (STIs). According to the CDC, people who binge drink (that’s more than four drinks in one sitting for women and more than five for men) are more likely to also engage in unprotected sex and have multiple partners. That increases the risk of pregnancy as well as STIs, such as HIV, hepatitis B, HPV and other diseases. And those who drink during pregnancy also face a number of risks, according to the CDC, including fetal alcohol spectrum disorders, miscarriage, premature birth, stillbirth and sudden infant death syndrome. 
8. Alcohol impacts developing brains. It’s safe to say that alcohol isn’t great for your brain at any age. But it may be especially damaging for young brains, affecting brain development, memory, executive functioning, verbal learning and more, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Further, SAMHSA adds that alcohol can be deadly for young people, and plays a role in the deaths, annually, of more than 3,500  people under the age of 21, shortening their lives by about 60 years and leaving a devastating void for friends and family.
9. There are a number of signs and symptoms that could indicate a problem. Alcohol use disorder is a real condition, and it’s something you might have if you struggle to control your drinking, or if drinking occupies your thoughts frequently and may threaten your health. The Mayo Clinic lists these signs and symptoms of alcohol as a few possible indicators of use disorder (see the full list here):

• • You struggle to limit the amount of alcohol you drink.
  • You spend a lot of time drinking, getting alcohol or recovering from drinking alcohol.
  • You fail to fulfill major obligations at work, school or home because of drinking.
  • You continue to drink alcohol despite the problems it causes, whether they’re related to physical, social, work or relationship issues.
  • You either experience withdrawal symptoms when you stop drinking (nausea, sweating and shaking) or you drink because of these symptoms.

If you choose to drink, be responsible about it. Alcohol has a deep and respected history in religious ceremonies and even in medicine. However, too much can be harmful. The Dietary Guidelines for Americans states that moderate alcohol consumption is two drinks or fewer per day for men and one or fewer for women.

And remember, if you’re struggling with your relationship with alcohol, help is available. Talk to your primary care provider for advice, or make an appointment with a mental health provider who focuses on addiction. For immediate support, the Substance Abuse and Mental Health Services Administration has a helpline for individuals and family members: 1-800-662-HELP (4357).