Alcohol

Are You Addicted to Alcohol?

Reference: AddictionsAndRecovery.org

The terms alcohol addiction, alcoholism, and alcohol dependence all mean the same thing. No one term is more serious than the other.

Are you addicted to alcohol? Take the self-test questionnaire.

Drinking Statistics

  • Approximately 60% of drinkers drink less than 4 drinks on the days when they drink.
  • 20% of drinkers drink 5 or more less than 10% of the time.
  • 9% of drinkers drink 5 or more at least half the time. (1)

The Consequences of Alcohol Abuse

The four most common medical consequences of alcohol abuse are:

  • High blood pressure
  • Liver damage
  • Red blood cell damage
  • Depression

There is a simple blood test that can check for liver damage. Your doctor can check for liver damage by testing three liver enzymes (AST, ALT, GGT). These enzymes normally occur inside your liver cells. When your liver is damaged, the enzymes are released into your blood stream and show up on a blood test. Therefore the higher the enzyme count the greater the liver damage. The most accurate of these test for alcohol liver damage is GGT.

Even if you have liver damage, your liver can repair itself. Your liver is designed to filter toxins from your blood, therefore it’s designed to take care of itself. All you have to do is stop drinking and it will gradually go back to normal.

Repeated liver damage can cause cirrhosis. Your liver is a remarkable organ, but it can only repair itself so many times. If you continue to damage it with alcohol abuse, after a while your liver won’t be able to repair itself and it will turn into scar tissue. Cirrhosis is just the medical term that means part of your liver has turned into scar tissue.

But there’s good news. Cirrhosis is not a progressive disease. If you stop drinking, any cirrhosis you have will not get worse as long as you don’t have advanced cirrhosis. There’s even more good news. Your liver is a big organ and you have more liver than you need. People can lose 30% of their liver in a car accident and still lead normal lives. So if you have less than 30% cirrhosis and you stop drinking, you can lead a normal life. Your doctor can do an ultrasound to see if you have cirrhosis, and estimate what percent cirrhosis you may have.

Alcohol abuse can damage your red blood cells. When your red blood cells are damaged by alcohol they swell up and increase in volume. Your doctor can do a simple blood test to check for that. It’s called MCV (mean corpuscular volume). If your red blood cells are enlarged, they’re usually repairable since they get recycled by your body every 3-4 months. Stop drinking and they’ll quickly return to normal.

Depression is one of the most common, serious consequences of alcohol abuse. One study looked at 2,945 alcoholics. 15% were depressed before they began abusing alcohol. 26% were depressed while they were using alcohol, and 15% remained depressed once they had stopped drinking for an extended period. In other words alcohol abuse almost doubles the risk of depression.(2)

The post-acute withdrawal syndrome for alcoholism. Look at the post-acute withdrawal page to learn about those symptoms and how to deal with them.

Some less common but serious consequences of alcohol abuse are:

  • Cardiac arrhythmias
  • Impaired immune system
  • Decreased bone density
  • Peripheral nerve damage
  • Gastrointestinal bleeding
  • Heart attacks and cardiomyopathy
  • Strokes

The broader consequences of addiction. Look at the disease of addiction page to learn more about the broader consequences of addiction.

Moderate Alcohol Use

If you’re not sure if you’re addicted to alcohol, try the following test. Keep an honest journal of how much you drink every day for 6 months, and see if you can stick to moderate drinking. It’s important that you do it for at least 6 months, because it’s easy to moderate your drinking for a short time.

If there are days when you drink more than a moderate amount, make note of the circumstances and identify your triggers. Then review your journal in 6 months. If you’re happy with your use – great. But if you’re not happy, or if you couldn’t stick to moderate drinking, then that should tell you something.

Ultimately alcoholics decide to quit drinking, because they realize it’s easier to not drink, than it is to control their drinking.

What is moderate alcohol use? The US Department of Health and Human Services, and the World Health Organization have created guidelines for moderate drinking.

  • The US guidelines suggest no more than 1 drink per day for women and no more than 2 drinks per day for men. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits.
  • The WHO guidelines suggest no more than 2 drinks per day, and no more than 5 drinking days per week. They recommend 2 non-drinking days. Of course, you can’t stockpile your drinks, and have them all at the end of the week.

How Much is A Drink?

The Definition of A Drink

A drink is 14g of pure alcohol according to the US Department of Health and Human Services. The World Health Organization defines a drink as 10g of pure alcohol.

Each milliliter of pure alcohol weighs 0.79 grams. Therefore, you can calculate the alcohol content of a drink with the following formula:

  • 1 can of beer (330 ml, 12 oz) at 5% (strength) x 0.79 (conversion factor) = 13 grams of alcohol
  • 1 glass of wine (140 ml, 5 oz) at 12% x 0.79 = 13.3 grams of alcohol
  • 1 shot of liquor (40 ml, 1.5 oz) at 40% x 0.79 = 12.6 grams of alcohol

Note that a 750ml bottle of wine contains 5 drinks. Therefore 2 drinks a day is less than half a bottle of wine a day.

Metabolizing Alcohol

Reference: drinkfox.com

How long does alcohol stay in your system?

People may say they can sober up quickly, but their physiology tells a different story. Alcohol is one of the most predictable chemical reactions in the human body, and virtually everyone breaks alcohol down at almost precisely the same rate.

Alcohol is metabolized (broken down) by the body at a rate of 0.016% per hour.1 It doesn’t matter if you are 6’4” or 4’6” or if you drank red wine or moonshine. Once your blood alcohol concentration (BAC) reaches a certain level-no matter how it got to that level-your body needs time to break the alcohol down and remove it from your system.

The main way that alcohol is broken down in the body is through an enzyme called alcohol dehydrogenase. Alcohol dehydrogenase takes a molecule of ethanol (the alcohol you drink) and breaks it apart. The funny thing about this enzyme is that you cannot make it work any faster, no matter how much alcohol you give it to break down.2

Alcohol dehydrogenase is like a one-lane tunnel; no matter how many cars (alcohol molecules) are waiting to get through the tunnel (enzyme), only one can go through at a time. The more you drink, the more molecules are waiting to “get through” the enzyme.

On the bright side, this precise metabolism makes it fairly easy to determine how long it will take for you BAC to reach zero. Take a BAC of 0.16, for example, a BAC that is twice the legal limit (BAC 0.08) in some countries. Since your body (and every body) metabolizes alcohol at 0.016% per hour, it will take 10 hours for a person with a BAC or 0.016 to reach a BAC of 0.00.

In fact, you can determine BAC for each hour that you spend metabolizing alcohol. Let’s continue using the same example. Assume a person has a BAC of 0.16 at two in the morning. She stopped drinking and is simply sobering up (letting her enzymes break down alcohol). Even without measuring each hour, you already know her BAC for the next 10 hours.

Time BAC
2:00 0.16
3:00 0.144
4:00 0.128
5:00 0.112
6:00 0.096
7:00 0.08
8:00 0.064
9:00 0.048
10:00 0.032
11:00 0.016
12:00 0.000

Therefore, if the person with a BAC of 0.16 leaves the pub at two in the morning, her BAC will reach zero at noon the next day. At any time before seven in the morning, she will be above the legal limit.

There is no practical way to lower your BAC any faster than your enzymes will work. Once your BAC reaches a certain level, all you can do is wait for your liver to do its job.

People who eat before they drink metabolize alcohol slightly faster than people who drink on an empty stomach.4 In other words, the rate of alcohol metabolism is faster on a full stomach than an empty stomach. Scientists believe this may be due to increased blood flow to the liverand increased activity of liver enzymes. Having food in the stomach (intestines, really) induces more enzyme activity in the liver than in the fasting state. Using the previous analogy, the tunnel gets wider and allows more cars to go pass (The activity of alcohol dehydrogenase is increased temporarily).4

However, eating a meal is really not something you can do after your BAC is at a certain level. Moreover, the speed of alcohol metabolism only increases a small amount on a full stomach. This means you still need to wait a specific amount of time for your liver enzymes to break down the alcohol in your system.

Food and alcohol absorption

The effect of food and alcohol absorption is complicated. If you drink on a full stomach, the rate at which the alcohol and food moves from the stomach to the intestines slows down. Since alcohol is mainly absorbed from the intestines, this slows down absorption. This means BAC levels rise more slowly. This is especially true if the meal is especially fatty.

On the other hand, eating a meal increases blood flow to the stomach, intestines, and liver. This increased blood flow actually speeds up absorption. But, as mentioned previously, this blood flow also increases enzyme activity in the liver, which speeds up alcohol metabolism slightly.

The bottom line: Food affects the absorption and metabolism in a variety of ways, but they mostly cancel each other out.

BAC and feeling drunk

Alcohol intoxication (or feeling drunk) roughly correlates with BAC.6 Obviously, the higher your BAC, the more drunk you will feel. In people who do not abuse alcohol, the effects of alcohol are predictable (shown in the table). In heavy or problem drinkers, these effects may not occur until the BAC is much higher.7

BAC between 0.01 and 0.10 Mild euphoria, mild problems with coordination and attention
BAC between 0.10 and 0.20 Impaired judgment, slurred speech, and trouble walking
BAC between 0.20 and 0.30 Lack of coordination,confusion, nausea and vomiting
BAC above 0.30 Stupor, loss of consciousness, coma, death

References

    1. Wilkinson PK, Sedman AJ, Sakmar E, Kay DR, Wagner JG. pharmacokinetics of ethanol after oral administration in the fasting state. Journal of pharmacokinetics and biopharmaceutics. 1977;5(3):207-224.
    2. Matsumoto H, Fukui Y. pharmacokinetics of ethanol: a review of the methodology. Addict Biol. Jan 2002;7(1):5-14. doi:10.1080/135562101200100553
    3. Cederbaum AI. Alcohol Metabolism. Clinics in liver disease. 2012;16(4):667-685. doi:10.1016/j.cld.2012.08.002
    4. Ramchandani VA, Kwo PY, Li TK. Effect of food and food composition on alcohol elimination rates in healthy men and women. J Clin Pharmacol. Dec 2001;41(12):1345-1350.
    5. Baraona E, Abittan CS, Dohmen K, et al. Gender differences in pharmacokinetics of alcohol. Alcohol Clin Exp Res. Apr 2001;25(4):502-507.
    6. Marx J, Walls R, Hockberger R. Rosen’s Emergency Medicine-Concepts and Clinical Practice. Elsevier Health Sciences; 2013.
    7. Sullivan JB, Jr., Hauptman M, Bronstein AC. Lack of observable intoxication in humans with high plasma alcohol concentrations. J Forensic Sci. Nov 1987;32(6):1660-1665.

 

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