Key PointsAlcohol metabolism occurs mainly via hepatic oxidation and is governed by the catalytic properties • of the alcohol-metabolizing enzymes, alcohol dehydrogenase (ADH), and aldehyde dehydrogenase (ALDH2). Genetic polymorphisms in • ADH1B and ALDH2 , and ethnic differences in the prevalence of these polymorphisms, result in increased variation in alcohol metabolism among individuals. Polymorphisms in • ADH1B result in variants that code for isozymes that tend to show a faster rate of alcohol metabolism, while the ALDH2*2 polymorphism results in a "de fi cient" form of ALDH2 that causes an accumulation of acetaldehyde and its associated physiological effects.• ADH and ALDH polymorphisms are also associated with a protective effect on the development of alcoholism. The allele frequencies of ADH1B*2 , ADH1B*3 , and ALDH2*2 are signi fi cantly lower in individuals diagnosed with alcohol dependence compared to controls. Further evaluation of the factors, both genetic and environmental, regulating the rates of alcohol • and acetaldehyde metabolism, will help improve our understanding of the metabolic basis and consequences of alcohol's effects, including the risk and consequences of alcohol-related organ damage, developmental problems, as well as alcohol dependence.