Low to moderate doses of alcohol produce a slight, brief increase in heartbeat and blood pressure. Large doses can reduce the pumping power of the heart, producing irregular electrocardiograms (EKGs), which are recordings of the electrical activity of the heart. Blood vessels within muscles constrict, but those at the surface expand, causing rapid heat loss from the skin. This causes the flushing or reddening of the skin that often accompanies alcohol intake. Large doses of alcohol decrease body temperature and may cause numbness of the skin, legs, and arms, creating a false feeling of warmth. Figure 3.2 illustrates the path alcohol takes through the body after it is consumed.
Alcohol affects the endocrine system (a group of glands that produce hormones) in several ways. One effect is increased urination. Urination increases not only because of fluid intake, but also because alcohol stops the release of an antidiuretic hormone—ADH, or vasopressin—from the pituitary gland. This hormone controls how much water the kidneys reabsorb from the urine as it is being produced, and how much water the kidneys excrete. Therefore, heavy alcohol intake can result in both dehydration and an imbalance in electrolytes, which are chemicals dissolved in body fluids that conduct electrical currents. Both of these conditions are serious health hazards.
Alcohol also inhibits the release of the hormone oxytocin from the pituitary gland. Oxytocin normally stimulates contractions of the uterus during childbirth. Because alcohol inhibits uterine contractions, it was used in the past to control premature labor.
Alcohol is sometimes believed to be an aphrodisiac (sexual stimulant). While low to moderate amounts of alcohol can reduce fear and decrease sexual inhibitions, larger doses tend to impair sexual performance. Alcoholics sometimes report difficulties in their sex lives.
Intoxication
The speed of alcohol absorption affects the rate at which one becomes intoxicated. Intoxication occurs when alcohol is absorbed into the blood faster than the liver can oxidize it (or break it down into water, carbon dioxide, and energy). In a 160-pound man, alcohol is metabolized (absorbed and processed by the body) at a rate of about one drink every two hours. The absorption of alcohol is influenced by several factors:
- Body weight—Heavier people are less affected than lighter people by the same amount of alcohol because there is more blood and water in their systems to dilute the alcohol intake. In addition, the greater the body muscle weight, the lower the blood alcohol concentration (BAC) for a given amount of alcohol.
- Speed of drinking—The faster alcohol is drunk, the faster the BAC level rises.
- Presence of food in the stomach—Eating while drinking slows down the absorption of alcohol by increasing the amount of time it takes the alcohol to
TABLE 3.5
Trends in the twelve-month prevalence of alcohol abuse, by age, sex, and race/ethnicity: percent population, 1991-92 and 2001-02
SOURCE: "Trends in the 12-Month Prevalence of DSM-IV Alcohol Abuse by Age, Sex, and Race-Ethnicity: United States, 1991-1992 (NLAES) and 2001-2002 (NESARC)," in National Institute on Alcohol Abuse and Alcoholism Databases Quick Facts, http://www.niaaa.nih.gov/databases/abusedep3.htm (accessed March 12, 2005)
get from the stomach to the small intestine. Only a small amount of alcohol is absorbed through the stomach wall.Male Female Total Sociodemographic characteristic NLAES*(1991-1992) NESARC*(2001-2002) NLAES(1991-1992) NESARC(2001-2002) NLAES(1991-1992) NESARC(2001-2002) Total Total 4.67 6.93 1.51 2.55 3.03 4.65 18-29 9.26 9.35 3.83 4.57 6.54 6.95 30-44 4.58 8.69 1.50 3.31 3.02 5.95 45-64 2.38 5.50 0.38 1.70 1.35 3.54 65+ 0.55 2.36 0.04 0.38 0.25 1.21 White Total 5.09 7.45 1.71 2.92 3.33 5.10 18-29 10.75 10.19 4.83 5.56 7.83 7.86 30-44 5.16 10.10 1.68 4.13 3.41 7.09 45-64 2.55 5.97 0.44 2.02 1.47 3.96 65+ 0.52 2.38 0.04 0.36 0.24 1.21 Black Total 2.38 5.71 0.73 1.41 1.46 3.29 18-29 3.83 6.92 1.27 2.10 2.44 4.28 30-44 2.54 7.04 1.00 1.51 1.70 3.95 45-64 1.19 4.48 0.02 1.25 0.54 2.66 65+ 0.00 1.79 0.00 0.12 0.00 0.78 Native American Total 12.80 7.47 4.31 4.18 8.14 5.75 18-29 27.88 15.25 8.19 6.68 17.59 10.35 30-44 2.64 7.67 3.73 6.52 3.22 7.07 45-64 0.00 4.85 0.00 0.00 0.00 2.57 65+ 0.00 3.59 0.00 4.12 0.00 3.91 Asian Total 1.65 3.20 0.47 1.13 1.08 2.13 18-29 3.30 4.77 0.74 3.89 2.02 4.35 30-44 1.67 4.22 0.21 0.23 0.93 2.18 45-64 0.00 1.13 0.66 0.20 0.30 0.61 65+ 0.00 0.00 0.00 0.00 0.00 0.00 Hispanic/Latino Total 4.15 6.21 0.87 1.65 2.52 3.97 18-29 5.85 9.08 1.56 3.04 3.71 6.28 30-44 3.30 4.88 0.86 1.46 2.15 3.23 45-64 3.08 4.35 0.13 0.63 1.60 2.43 65+ 2.90 3.69 0.00 0.00 1.16 1.56 *Data are from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) and 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). - Drinking history and body chemistry—The longer a person has been drinking, the greater his or her tolerance (i.e., the more alcohol it takes him or her to get drunk). An individual's physiological functioning or "body chemistry" may also affect his or her reactions to alcohol. Women are more easily affected by alcohol regardless of weight because women metabolize alcohol differently than men. In general, women have less body water than men of similar body weight, so that equivalent amounts of alcohol result in higher concentrations of alcohol in the blood of women than men. However, women appear to eliminate alcohol from the blood faster than men.
As a person's BAC rises, there are somewhat predictable responses in behavior.
- At a BAC of about 0.05% (0.05 grams of alcohol per 100 milliliters of blood), thought processes, judgment, and restraint are more lax. The person may feel more at ease socially. Also, reaction time to visual or auditory stimuli slows down as the BAC rises.
- At 0.10%, voluntary motor actions become noticeably clumsy. (Note: it is illegal to drive with a BAC of 0.08% or higher.)
TABLE 3.6
Trends in the twelve-month prevalence of alcohol dependence, by age, sex, and race/ethnicity: percent population, 1991-92 and
2001-02
| Male | Female | Total | ||||
| Sociodemographic characteristic | NLAES | NESARC* | NLAES | NESARC | NLAES | NESARC |
| (1991-1992) | (2001-2002) | (1991-1992) | (2001-2002) | (1991-1992) | (2001-2002) | |
| Total | ||||||
| Total | 6.33 | 5.42 | 2.58 | 2.32 | 4.38 | 3.81 |
| 18-29 | 12.81 | 13.00 | 6.01 | 5.52 | 9.40 | 9.24 |
| 30-44 | 6.07 | 4.98 | 2.47 | 2.61 | 4.25 | 3.77 |
| 45-64 | 3.19 | 2.67 | 1.12 | 1.15 | 2.12 | 1.89 |
| 65+ | 0.63 | 0.39 | 0.23 | 0.13 | 0.39 | 0.24 |
| White | ||||||
| Total | 6.16 | 5.41 | 2.67 | 2.37 | 4.35 | 3.83 |
| 18-29 | 13.59 | 15.10 | 7.28 | 6.38 | 10.48 | 10.71 |
| 30-44 | 6.12 | 5.13 | 2.43 | 2.84 | 4.27 | 3.98 |
| 45-64 | 2.80 | 2.56 | 1.03 | 1.15 | 1.89 | 1.84 |
| 65+ | 0.57 | 0.32 | 0.24 | 0.08 | 0.38 | 0.18 |
| Black | ||||||
| Total | 5.86 | 5.09 | 2.21 | 2.39 | 3.84 | 3.57 |
| 18-29 | 8.54 | 8.75 | 2.14 | 3.79 | 5.07 | 6.03 |
| 30-44 | 6.13 | 4.40 | 3.26 | 2.53 | 4.57 | 3.36 |
| 45-64 | 4.05 | 3.98 | 1.95 | 1.74 | 2.89 | 2.72 |
| 65+ | 0.83 | 1.10 | 0.00 | 0.71 | 0.32 | 0.87 |
| Native American | ||||||
| Total | 11.00 | 8.38 | 7.38 | 4.49 | 9.01 | 6.35 |
| 18-29 | 13.34 | 15.96 | 14.67 | 8.73 | 14.03 | 11.83 |
| 30-44 | 8.85 | 10.94 | 2.15 | 5.77 | 5.32 | 8.27 |
| 45-64 | 4.61 | 5.11 | 4.73 | 2.53 | 4.68 | 3.90 |
| 65+ | 25.39 | 0.00 | 0.00 | 0.00 | 9.75 | 0.00 |
| Asian | ||||||
| Total | 3.06 | 3.56 | 1.41 | 1.34 | 2.26 | 2.41 |
| 18-29 | 4.09 | 10.22 | 3.77 | 4.27 | 3.93 | 7.39 |
| 30-44 | 3.02 | 0.28 | 0.00 | 0.59 | 1.50 | 0.44 |
| 45-64 | 2.90 | 1.42 | 0.73 | 0.15 | 1.90 | 0.72 |
| 65+ | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
| Hispanic/Latino | ||||||
| Total | 9.40 | 5.90 | 2.15 | 1.94 | 5.78 | 3.95 |
| 18-29 | 15.44 | 9.58 | 2.97 | 3.85 | 9.21 | 6.92 |
| 30-44 | 6.56 | 5.33 | 2.70 | 1.65 | 4.74 | 3.55 |
| 45-64 | 6.70 | 2.06 | 0.63 | 0.46 | 3.65 | 1.23 |
| 65+ | 0.00 | 0.85 | 0.62 | 0.00 | 0.37 | 0.36 |
| *Data are from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) and 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). | ||||||
- At 0.20%, the entire motor area of the brain becomes significantly depressed. The person staggers, may want to lie down, may be easily angered, or may shout or weep.
- At 0.30%, the person generally acts confused or may be in a stupor.
- At 0.40%, the person usually falls into a coma.
- At 0.50% or more, the medulla is severely depressed, and death generally occurs within a couple of hours, usually from respiratory failure. The medulla is the portion of the brainstem that regulates many involuntary processes, such as breathing.
There have been some cases of delayed death from circulatory failure as long as sixteen hours after the last known ingestion of alcohol. Without immediate medical attention, a person whose BAC reaches 0.50% will almost certainly die. Death may even occur at a BAC of 0.40% if the alcohol is "chugged," or consumed quickly and in a large amount, causing the BAC to rise rapidly.
Sobering Up
Time is the only way to rid the body of alcohol. The more slowly a person drinks, the more time the body has to process the alcohol, so that less alcohol accumulates in
TABLE 3.7
Estimated economic costs of alcohol abuse, 1992 and 1998
| Economic cost | 1992a($ millions) | 1998a(Projected) ($ millions) |
| Health care expenditures | ||
| Alcohol use disorders: treatment, prevention, and support | 5,573 | 7,466 |
| Medical consequences of alcohol consumption | 13,247 | 18,872 |
| Total | 18,820 | 26,338 |
| Productivity impacts | ||
| Lost productivity due to alcohol-related illness | 69,209 | 87,622 |
| Lost future earnings due to premature deathsb | 31,327 | 36,499 |
| Lost productivity due to alcohol-related crimes | 6,461 | 10,085 |
| Total | 106,997 | 134,206 |
| Other impacts on society | ||
| Motor vehicle crashes | 13,619 | 15,744 |
| Crime | 6,312 | 6,328 |
| Fire destruction | 1,590 | 1,537 |
| Social welfare administration | 683 | 484 |
| Total | 22,204 | 24,093 |
| Total costs | 148,021 | 184,636 |
| aThe authors estimated the economic costs of alcohol abuse for 1992 and projected those estimates forward to 1998, adjusting for inflation, population growth, and other fatcors. Detailed tables can be found in http://www.niaaa.nih.gov/publications/economic-2000/ | ||
| bPresent discounted value of future earnings calculated using a 6-percent discount rate. | ||
the bloodstream. According to the National Clearing-house for Alcohol and Drug Information, five drinks consumed in quick succession by a 180-pound man will produce a BAC of 0.11. In a 140-pound man, this intake will produce a BAC of 0.13. And in a 120-pound woman, it will produce a BAC of 0.19. The body takes nearly seven hours to metabolize this blood concentration of alcohol. Under normal conditions, five drinks consumed with an hour or so between each drink will produce a BAC of only 0.02, depending on the gender and weight of the person. It will likely produce a BAC higher than 0.02 in women and persons weighing less than 180 pounds.
Hangovers
Hangovers cause a great deal of misery as well as absenteeism and loss of productivity at work or school. A person with a hangover experiences two or more physical symptoms after drinking and fully metabolizing alcohol. The major symptoms of a hangover are listed in Table 3.8, but the causes of these symptoms are not well known. Results from one study (Jeff Wiese et al., "Effect of Opunitia ficus indica on Symptoms of the Alcohol Hangover," Archives of Internal Medicine, vol. 164, June 28, 2004) support the idea that the symptoms of a hangover are largely due to an inflammatory response of the body to impurities in alcohol and by-products of alcohol metabolism. Fluctuations in body hormones and dehydration intensify hangover symptoms.
There is no scientific evidence to support popular hangover cures such as black coffee, raw egg, chili pepper, steak sauce, "alkalizers," and vitamins. To treat a hangover, health care practitioners usually prescribe bed rest as well as eating food and drinking nonalcoholic fluids.
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