Dr. MJ Bazos MD, Patient Handout
Alcohol: Q & A

  1. What is "sloe gin"?
While gin is a clear alcoholic spirit made from the fermentation of juniper berries, sloe gin is a cordial or liqueur flavored with sloe -- a small, sour, blackish fruit of the blackthorn shrub.
  1. We often hear that alcohol is an anesthetic. Is this true?
An anesthetic in pharmacological terms is a drug that reduces pain. Loosely, alcohol reduces emotional pain by making people feel good (for a brief time). Technically, alcohol has characteristics of both local and general anesthetics. When applied directly to nerve cells in the laboratory, alcohol reduces nerve transmission, and therefore can reduce pain. This use occurs in medicine when alcohol is injected around nerves to calm severe pain. In the Civil War, alcohol was given orally to wounded soldiers on the battlefield to reduce severe pain during bullet removal and other operations. It is not as effective as today's improved anesthetics, however.
  1. Can alcohol cure a cold?
This is a piece of erroneous folklore borne of the observation that sick people feel better when they drink. There is an old saying "When you have a cold, hang your hat on the bedpost, climb into bed, drink until two hats appear, and then your cold will be cured" (anonymous). In actuality, nothing cures a cold, but alcohol does appear in some liquid cold remedies, mainly as a solvent for analgesic and antihistamine ingredients. Of course, the alcohol has its own beneficial effect of sedation.
  1. What is "brew"?
This is another one of the many words in the English language that relates to alcohol (is it any wonder why alcohol is such a big part of American culture?). "Brew" is a colloquial name for "beer". "Brew" also relates to the making of beer or other concoctions by steeping, boiling, and fermenting ingredients such as malts and hops. "Brewage" is a fermented liquor brewed from malt.
  1. Does the beverage industry provide much money for researching the effects of their product?
No, very little. Around 95% of the (rather minimal) research on alcohol and the problems it produces is funded by the federal government (National Institute on Alcohol Abuse and Alcoholism) in this nation.
  1. Alcohol, in moderation, can save lives.
One or two drinks per day is protective against atherosclerotic heart disease, some cancers, and (perhaps) some other diseases. Why don't we use it more for such conditions?
Alcohol, like many other chemicals, is a poison. Used in excess, it can stop your breathing, it can rot your liver, and it can cause the fatal disease of "addiction". Why, then, is it legal to sell and use?
  1. Does alcohol cause you to feel "sexy"?
Certainly! Shakespeare once wrote, "drink increases the desire, but takes away the performance". Anyone who has drunk alcohol has experienced this effect, but few people realize that it is strongly based on dose and a person's physiology and environment. Everyone responds differently to alcohol. One person may respond by feeling increased sexual desire, and be able to "perform" very well. Another person may feel "high", but would never think of having sex while drunk. In general, however, the relaxation produced by alcohol (ranging from mild to extreme), is the reason for Shakespeare's observation.
  1. Does alcohol make you more "creative"?
Of course! But how much of this "creativity" is "perception" and how much of it is real? No one knows. There are a lot of "alcoholic" Pulitzer-prize winning authors. Is their success due to alcohol, or is it due to intelligence, or is it due to being able to work longer hours without fatigue, because of alcohol? We need more research like this on alcohol's effects!
  1. Does alcohol make you "stronger"?
Yes! But everyone knows that alcohol makes you attempt things that you wouldn't do when you were sober. So, you might not hesitate to do some things (lift a heavy object, fight someone) when you have imbibed, which you might not have done before. But the research behind alcohol making you "stronger" is non-existent. Probably it would show that alcohol does not increase muscle strength. We need more research like this on alcohol's effects!
Recent numbers from The University of Michigan's "Monitoring the Future" project indicates that the following teenagers had used alcohol during the previous year: 43% of eighth-graders, 65% of tenth-graders, and 73% of twelfth-graders. Those who had "been drunk" in the past 30 days, according to this report, were 8% of eighth-graders, 24% of tenth-graders, and 32% of twelfth-graders.
10. What effect does alcohol have on the lungs?
Unlike another highly "addictive" drug (nicotine) alcohol has no major effect on the lungs. And nicotine itself probably does not have a major effect on the lungs; rather, the cigarette, with its tars, carbon monoxide, and other ingredients play the largest role in increasing the risk for lung cancer with smokers. Interestingly, about 70-90% of heavy drinkers also smoke.
11. There are several reasons why alcohol helps people to have "fun".
First, it "disconnects" the frontal brain areas, so that people feel less inhibited about doing things. Second, it activates the pleasure pathway of the brain so that people actually feel good when they drink. Finally, it provides "euphoria", or a sense of well-being. Of course, all of these effects are similar, but exactly how alcohol affects the brain to produce these actions is still under investigation.
12. If you suffer "withdrawal" from alcohol, even a hangover, aren't you an alcoholic?
Absolutely not! Many people who drink too much alcohol (even one time!) suffer from hangover, and they are not alcoholic. Even people who drink very much, very often, and who suffer severe withdrawal symptoms, may not be alcoholic! "Alcoholism" is now scientifically defined as an "alcohol dependence" disease. Withdrawal is only one of several criteria that help diagnose alcohol dependence, so withdrawal from alcohol alone is not the same as "alcoholism".
Unfortunately, the word "alcoholic" means different things to many people. To the public, this word is usually pejorative, meaning someone who drinks too much, too often, and only cares about drinking. Many people drink "alcoholic-ly", but usually only during brief periods. For example, college students often drink "alcoholic-ly", but are simply having a good time. The more scientific term for "alcoholic" is "alcohol dependent", which relates to pathological drinking in people who have a brain disease.
13. What are other names for someone who drinks a lot?
According to several dictionaries: drunkard, inebriate, sot, soak, bibber, bibbler, barfly, dipsomaniac, rummy, guzzler, swiller, soaker, sponge, boozer, boozehound, lush, souse, wino, alchy, juicehead, juicer, hooch hound, gin hound, swillbelly, swillpot, stew, stewbum, elbow-bender. All of these terms are now felt to be derogatory, for many peopleee (but not all) who drink a lot are known to have a chronic medical illness.
14. Why are so many Native Americans alcoholic?
They may not be. We see more drinking among Native Americans, but this doesn't mean they're alcoholic. Remember that "alcoholism" is a broad, overused term that (to some people) means the same as problem drinking. But the better term for alcoholic today is "alcohol dependent", and new research is indicating that some American tribes have a low rate of alcohol dependence, while other tribes have a higher rate of alcohol dependence. But to broadly state that all Native Americans have a high rate of alcohol dependence is probably wrong.
15. Why do some people who drink a lot become addicted to alcohol, and others who drink a lot do not?
The easy answer is that some people have "what it takes" to become addicted (newer term: dependent). Some people have a vulnerability for the disease (some of which is genetic), while others will never develop the disease. Scientists are trying to understand exactly why this happens.
16. What is ondansetron?
Ondansetron (Zofran) is a drug that is used for the treatment of nausea and vomiting. It has also been shown, in several studies, to reduce the "craving" in alcohol-dependent patients who have a more severe, genetically-driven form of the disease. If future research continues to confirm such results, the drug may be approved for the treatment of alcohol dependence, joining other drugs such as naltrexone as an aid to helping people who are trying to stop drinking.
17. What is nalmefene?
Nalmefene (Revex) is an opioid antagonist that is on the market for the treatment of known or suspected opioid (for example, heroin) overdose. It is presently being investigated in human clinical studies for the treatment of alcohol craving. It has a similar effect as its more well-known chemical cousins, naloxone (Narcan) and naltrexone (ReVia).
18. Is liquor in any quantity good for you?
Whereas good scientific studies have shown that wine (in moderation, 1-2 glasses per day) has health benefits, there are inconclusive studies about liquor (spirits, such as vodka or scotch) having such benefits. However, some studies indicate that alcohol, not wine alone, can be beneficial with modest consumption. Some physicians prescribe a glass of wine, beer, or warm sherry to aid sleep at bedtime in the elderly. And it makes sense that small amounts of alcohol can be useful as a relaxant and sleep-aid.
19. Can someone become "addicted" to Nyquil, which has 10% alcohol as an ingredient?
Although the alcohol is added as a mild sedative, there is very little chance of a person becoming dependent on therapeutic doses ("when used as directed"). First, the quantity of alcohol is not sufficient to produce dependence. Second, we know that alcohol does not cause dependence, unless the person has the "vulnerability" for the disease (formerly known as "alcoholism").
20. Why do different states have different provinces limits for driving while intoxicated (DWI)?
As most people know, the DWI limit varies from 0.08 to 0.10% among the states. There is clear evidence that most people are unable to safely drive a car at either level, but some states are more conservative than others. In actuality, there is strong scientific evidence that 0.05% (about 2-3 drinks per hour) is related to driving impairment, but the commercial alcohol lobby in the United States has so far been able to place profit over human safety in the eyes of state legislatures and Congress. The American Medical Association and Mothers Against Drunk Driving support an 0.05% DWI level, and this is the level allowed in most European nations.
21. Alcohol is flammable, which means that it will burn if set on fire.
This quality is used in the production of canned fuels, which contain a jelly-like substance containing wood alcohol (methyl alcohol). This is not "drinking alcohol" (ethanol) and the canned fuels are sometimes carelessly used by people to produce intoxication. Methyl alcohol, however, is very toxic and can cause blindness.
22. What causes a "hangover"?
The term hangover refers to the residual feeling of drug effects the day after using the drug. In the case of alcohol, the hangover is a "mini-withdrawal" from the massive depressant effects of the drug on body symptoms. This withdrawal is a state of hyperexcitability caused by the body's systems trying to get back to normal. Thus, the heavy drinker experiences headache, upset stomach, early morning awakening, rapid heart rate, and other signs of nervous system excitation.
23. We often hear about "alcoholics" drinking a quart of spirits a day. How is this possible?
Many drugs produce tolerance (resistance to the drug's effects) by one of two major ways. Either the liver enzymes increase their activity to break down the drug, or the tissue (in this case, the brain) somehow becomes less sensitive to the drug's effects. Both of these types of tolerance are at work when a person drinks large amounts of alcohol - leading to the eventual consumption of quantities that would kill a social drinker.
24. Can alcohol increase anxiety?
Apparently yes, in small doses alcohol produces "disinhibition" of specific brain areas, leading to heightened arousal in brain areas involved in mood. Thus, in an already-anxious person, small non-sedating doses can increase anxiety. In higher doses, the well-known anti-anxiety effects of alcohol kick in.
25. What effect does alcohol have on the esophagus?
The esophagus, the tube running from the mouth to the stomach, is sometimes heavily affected by chronic drinking, leading to "esophrygeal varices". These are inflamed veins bulging into the esophagus that will bleed with the continued passage of alcohol and food. It is critical that the person stop drinking for proper treatment. (May 20, 2002)
26. What does alcohol do to the prostate?
Apparently, very little. Recent studies have shown that even heavy drinking does not increase the risk of prostate cancer. There is also apparently no relationship between drinking and benign prostate hypertrophy (BPH, enlarged prostate).
27. What does alcohol do to the pancreas?
The pancreas is the main producer of insulin in the body. Problems with the pancreas lead to Type 1 diabetes. While large doses of alcohol do not cause diabetes, there is a problem with the pancreas that develops with some problem drinkers. The problem is chronic pancreatitis, a very painful condition that is difficult to treat.
28. Is alcoholism a "will power" problem?
No, although people look at the willingness to use alcohol, especially to the point of intoxication many times a week, a "will power" problem. However, the simple excess use of alcohol is not alcohol dependence (the new term for "alcoholism"). People are alcohol dependent when they exhibit consistent clinical signs of inability to control their drinking, along with significant life problems. Such signs must meet certain diagnostic criteria established by the American Psychiatric Association. An alcohol-dependent person does not have a will power problem any more than someone who has high blood pressure of unknown cause.
29. Is alcoholism a "sin"?
Of course not. Old-time thinking is still present in this nation, but research has now shown that alcohol dependence (the new term for "alcoholism") is a brain disease much like epilepsy or schizophrenia. In other words, there is a pathology of the brain that causes a person to be unable to stop drinking. And just because a person has a disease does not mean that we are going to absolve them of the responsibility associated with what they do while under the influence of alcohol. But, they need treatment. (Intentional alcohol abuse, which is not a disease, could be called a "sin" by people who believe that alcohol is evil. However, such believers are now in the minority of the U.S. population.)
30. What percentage of the public is "alcoholic"?
It is generally believed that 2/3 of the nation's population drink alcohol (others are abstainers, recovered alcoholics, infants, etc.). Of those who drink, one in 10 will become alcohol-dependent. This works out to about 5% of the population, or about 14 million people.
31. Does drinking liquor in carbonated beverages increase the absorption of alcohol?
Some old (and limited) research indicates that spirits mixed with tonics, colas, and other carbonated beverages do become absorbed faster through the stomach lining. The practical value of this, however, is unknown. No one knows exactly how the phenomenon occurs (if it does), and it is probably not noticeable when people are drinking mixed drinks, since most of the alcohol absorption occurs in the upper intestine. Thus a "controlled" study to measure the difference between straight spirits and carbonation-enhanced spirits would be only an academic exercise.
32. What is "moonshine"?
Many people are too young to remember whiskey made "in the light of the moon" during prohibition in the United States, which lasted from 1920-1933. When the law prohibited alcohol from being manufactured and sold, many people learned how to make their own ethanol, usually by fermenting grain and mash, and producing what must have been a rather "raw" form of whiskey. This "moonshine" was used domestically and also sold on the "black market". Some say this illustrates the willingness of people to break the law to obtain alcohol, and (along with the crime associated with obtaining and selling alcohol) was one of the reasons that prohibition was repealed.
32. Is alcohol hydrophilic or lipophilic?
The root "philic" relates to "attraction", and "hydro" and "lipo" relate to water and fat, respectively. So is alcohol more attracted to water or fat in the body? Actually, alcohol has an attraction to both, but more so to water than fat. Thus alcohol concentrates readily in any body tissue with high amounts of water (blood, blood in the brain, urine, sweat, heart, etc.). While alcohol readily concentrates in fat in the body, it leaves it very quickly as blood alcohol concentrations drop, so that there is no long-term storage of alcohol in the body.
33. When alcohol and water are mixed, which one forms the upper layer?
Of course, neither one does, since alcohol and water mix perfectly. This is seen in all alcoholic beverages, where alcohol is always diluted with water. There is no 100% (200 proof) alcohol. All alcohol has a certain amount of water mixed with it. "Everclear" is about 99% alcohol, but still not 100%.
34. Isn't alcohol craving the same as alcoholism?
No, craving is a drug quality that makes a person want to drink more alcohol. This can occur in either volitional alcohol misuse or pathological alcohol dependence ("alcoholism"). Alcohol dependence ("alcoholism") involves a compulsive "need" for the drug so that the person cannot stop without treatment or 12-step programs.
35. What is alcohol's effect on the kidney?
Actually the kidney is probably the organ that is least damaged by (even large) doses of alcohol. People tend to think the kidney is affected because urination increases when people drink alcohol. But increased urination is due to alcohol's effect on blocking the pituitary's anti-diuretic hormone.
36. Once a person's brain cells are damaged by alcohol, can the brain repair itself if the person becomes abstinent?
Brain scan studies suggest that brain anatomy begins to return to normal within six months of abstinence. However, cognitive function does not always return when the brain scans appear normal. More studies are being carried out to identify what parts of the brain are repaired first.
37. What is the amount of alcohol consumption that kills brain cells?
It depends on the person. We know that decades of heavy drinking (as in alcohol abuse or dependence) can destroy brain cells (particularly in the memory part of the brain, the hippocampus). We also know that social drinking (several drinks a day) does not appear to injure brain cells. Just like any other pathology of the body, the susceptibility to damage is probably governed by many factors, such as genetic vulnerability.
38. Does everyone who is dependent on alcohol ("alcoholic") have a history of alcohol abuse?
Anecdotal (not scientific) evidence indicates that some people become alcohol dependent very early (there are 8 year old alcoholics), and sometimes with their very first drink. If this is true, then scientists must find out why and how some people become dependent ("addicted") with first exposure to the drug. The answer will probably be found in genetics studies.
39. Does alcohol abuse lead to alcohol dependence ("alcoholism")?
Although it appears that many people progress from social drinking to alcohol abuse (misuse) to alcohol dependence, obviously not everyone who drinks heavily becomes an alcoholic. Evidence is beginning to emerge that abuse and dependence are two separate conditions. For example, a recent study of alcohol abusers and dependent drinkers found, in a long-term follow-up study, that only about 3% of abusers had become dependent after 5 years.
40. What is the lethal dose of alcohol in a woman?
For both men and women, the lethal blood alcohol concentration (BAC) is approximately 0.4%. The qualified answer is approximately 10-14 beers or glasses of wine in a short period of time. While women metabolize alcohol more slowly than men (mainly because less alcohol is broken down by a stomach enzyme called gastric alcohol dehydrogenase), and while women have a higher fat/muscle ratio than men, the exact effect of these factors on a woman's BAC is not known. It is known that a woman will have a greater BAC than a man after a certain number of drinks (estimated at 20-30% higher), but more research is needed to identify the most important contributors to this difference, and other factors in women that affect BAC. This is a complex issue.
41. What is the lethal dose of alcohol in a man?
The lethal blood alcohol concentration (BAC) is approximately 0.4%. To achieve this, a man would have to drink approximately 16-18 beverage units in about an hour. (A beverage unit is one beer, 5 oz of wine, or one drink containing about a half-ounce of 40% spirits. All of these have roughly the same amount of alcohol.) Thus, roughly one and a half pints of distilled spirits drunk in rapid fashion would probably produce a lethal BAC in an "average" 150-pound man. Factors that will change this include food in the stomach, drinking history, genetic sensitivity differences to alcohol's actions, and fat/muscle ratio of the person.
42. Is alcohol found only in social beverages (beer, wine, spirits)?
No, alcohol (ethanol) is also used as a solvent for pharmaceutical preparations. Thus liquid over-the counter and prescription products (such as cough medicines, cold remedies, and vitamin preparations) contain significant concentrations of alcohol. However, unless one drinks a whole bottle of such a product, there will be insignificant effects of alcohol (for example, a tablespoonful of Geritol or Nyquil will not cause intoxication). The amount of alcohol, not the concentration, is what produces the greater pharmacological effect. Caution, is needed, however, when mixing such products with other medicines, such as disulfiram (Antabuse) and some antibiotics.
43. Do people drink more on holidays?
Alcohol is considered a social drink, and holidays are a time of planned parties. Thus alcohol drinking can be expected to increase during holidays, particularly around major holidays. The danger of this increased alcohol drinking is not an increase in the number of alcoholics, but rather problems that come with alcohol abuse: drunk driving, hangovers, and (in some people) aggressiveness, mental depression, and stomach upset. These are usually self-limiting problems that disappear after the holidays. However, parties should include non-alcoholic beverage choices.
44. Is the fetal alcohol syndrome (FAS) a 100% preventable birth defect?
It depends upon your point of view. FAS can occur in any woman who drinks heavily during pregnancy, but it does not appear in every woman who drinks heavily (it is not possible to predict which women are likely to have an FAS baby). And while some women who drink heavily are alcohol dependent, most are not. Thus it is certainly preventable in heavily drinking women who abuse alcohol (they will usually stop drinking during pregnancy), but an alcohol dependent woman will need treatment in order to stop drinking. Treatment is not effective overnight, thus her baby will likely have a high risk for FAS.
45. Women are more likely to have health problems compared to men who drink the same amount of alcohol per day.
These include liver damage, pancreatic dysfunction, and high blood pressure. This may be the result of how a woman's body handles alcohol; for example, one drink produces a higher blood alcohol level in women than in men. On the other hand, women are less likely than men to become alcohol dependent. The reason for this is unknown.
46. Alcohol dependence runs in families.
While this suggests a genetic cause, many things run in families that are not genetic (for example, speaking Spanish). However, twin and adoption studies performed over the past two decades clearly indicate a genetic susceptibility for alcohol dependence in families. Alcohol dependence is not a genetic disease (which suggests destiny); rather, the tendency to become alcoholic is inherited. Thus alcoholism can skip generations, or affect only certain individuals in an alcoholic family.
47. A specific type of alcohol dependence appears to occur mostly in men.
The so-called Type II alcoholism is also known as early onset alcoholism. It is a more severe form than the so-called Type I, which occurs in both men and women. Furthermore, there is a larger genetic component to the cause of Type II alcoholism, compared to Type I alcohol dependence.
48. How does increasing the price of alcoholic beverages affect alcohol consumption?
Keeping in mind that there are two alcohol problems in the world, willful abuse and pathological dependence ("alcoholism"), increasing the difficulty in obtaining alcohol has been shown to reduce alcohol abuse but not alcohol dependence. People who really don't need to drink will cut back on alcohol consumption (or give it up altogether), whereas people with the disease will use alcohol any way they can get it.
49. Does drinking alcohol at high altitude make a person more drunk than at sea level?
This is an old belief, but there is no significant research on this topic in humans. In animals, changing the oxygenated hyperbaric pressure on animals does affect alcohol-induced intoxication, but these studies were not designed to answer practical questions such as the altitude question in humans. With limited research funds for alcohol studies, this is not likely to be studied in the near future.
50. Social use of alcohol is generally defined as use in social settings where no harm occurs to the user or others.
Alcohol abuse occurs when alcohol is used in situations or amounts in which the user or others might be harmed (for example, while driving). Alcohol causes abuse, through its pharmacological actions on the brain. Alcohol does not cause alcohol dependence ("alcoholism") - it is merely one drug through which a brain chemistry problem is manifested.
51. Alcohol shares with some other chemicals the distinction of being the oldest addicting drugs in the history of the world.
Although no one knows for sure, alcohol may be older than marijuana and opium. There are records of Egyptian use of alcohol, and certainly the "lore" of alcohol's use as an intoxicant is as old as recorded history. This has led some to suggest that man's exposure to alcohol over the ages caused a brain susceptibility to alcohol dependence. This is not likely.
52. Alcohol dependence is now considered a brain disease.
Why do people have trouble believing that? Since alcoholics are traditionally "treated" in Alcoholics Anonymous, there is a misperception that alcoholics can help themselves, and that alcoholism is a "did-it-to-yourself" problem. However, A.A. is actually a very structured way to help problem drinkers deal with their problem. When they get better, it is probably because they have learned to adjust the abnormal brain chemistry that is causing their disease.
53. What is the evidence that alcoholism is a disease?
In 1954 (and again in 1965), the American Medical Association asserted that alcoholism is a disease. (A disease is an illness with a causative agent, and the victim has no/little control over its onset.) Also, if one compares alcoholism with other accepted medical diseases, it nicely fits the criteria: it has an onset of symptoms, it is involved with a pathological process (in this case in the brain), there are ways to diagnose it, and there are accepted medical treatments. Sadly, science has already recognized these characteristics but they are not yet understood by everyone.
54. What are the main effects of alcohol on the stomach?
Alcohol is traditionally known as a "stomachic", which means that social drinking can increase the appetite for food. It has also long been believed that alcohol can increase digestion, but this may be due to its relaxing effect, when a person has a couple of drinks before or during a meal. In higher "doses", alcohol causes gastritis (inflammation of the stomach lining), which is one of the reasons for heartburn and nausea the day after binge drinking. Continual heavy drinking can lead to stomach ulceration.
55. How does alcohol interact with "club drugs"?
This is a difficult question, and the only answer is "very unpredictably". There are six main club drugs: methamphetamine, rohypnol, ketamine, GHB, ecstasy, and LSD. There are no established rules or observations for the interaction of alcohol with GHB, ecstasy, or LSD. Alcohol and methamphetamine will either increase or decrease each other's actions, depending upon the dose of each and the timing of taking one with the other. The actions of alcohol and rohypnol and alcohol and ketamine will be additive, given that they are all depressant drugs. Beyond this, little is known about their interactions. The best advice is that they are dangerous when mixed, especially with higher doses of either one with another.
56. What does calling alcohol a "solvent" mean?
A solvent is an agent that solubilizes (causes something to go into solution) some solids or liquids. Additionally, solvents will mix with some substances and not others. Thus, alcohol mixes easily with body fat so that it can penetrate almost all organs of the body. However, it mixes most easily with water, so that alcohol concentrations are highest in the blood (which is >90%water) after drinking. Alcohol is also used as a solvent in pharmaceuticals, which is why some products contain relatively high concentrations of alcohol (e.g., Nyquil, Geritol liquid, cough medicines, etc.).
57. Does alcohol taste good?
Because it's an organic solvent, it tends to have an unpleasant taste to most first-time users. Drunk straight as "absolute" alcohol (ethanol) it really "burns" on the way down, even for heavy-duty drinkers. However, humans have learned how to make alcoholic beverages through fermentation, which produces lower concentrations of alcohol, plus a generally pleasant taste. In beer, for example, it is hard to taste the alcohol. In brandy, the taste of alcohol is apparent, but in some sweetened drinks the alcohol taste is almost entirely masked.
58. Why not just punish alcoholics?
That'll teach them! Science has clearly shown that punishment is not the answer to alcohol dependence. Punishment does tend to reduce alcohol drinking (as in multiple DWIs), but only in those who still have control over their drinking (alcohol abusers). Those with the disease of alcoholism need empathy and treatment, for they have a brain disease that makes them unable to stop drinking without professional help or 12-step program success.
The problem with alcohol dependence ("alcoholism") is not in the beer bottle, it's not in the wine glass, it's not in the margarita pitcher - it's in the brain chemistry of the individual. Science is telling us that the drug is only the agent through which the disease is expressed.
59. How does alcohol cause behavioral and cognitive intoxication?
Psychologists would say that alcohol causes a "disinhibition" (inability to control) of certain brain structures, such as the front part of the brain. Pharmacologists and neurobiologists might point to alcohol's effects on multiple neurotransmitters in the brain, perhaps at the "receptor sites" for these chemicals in the areas between nerve cells, called "synapses." In any case, such theories are in harmony with each other and do not indicate disagreement among scientists about alcohol's effects. In truth, we still have much to learn about the answer to this question, and all types of research are important.
60. Alcohol causes shrinkage of brain tissue in people after long-term use of large amounts of alcohol, according to new brain-imaging studies.
The shrinkage is due to the loss of brain cells, and the research is mixed with respect to recovery from this loss of brain cells. When people stop drinking, the shrinkage reverses itself, but it is still not clear whether this reversal parallels improved cognition or whether the damage is permanent. More research is needed!
61. Did you know that oral contraceptives (birth control pills) slow down the rate at which alcohol is removed from the body?
A woman who is on the pill, then, can expect to feel intoxicated or sedated for a longer time than a woman who is not taking the pill. While some women may strongly feel this effect, others may not feel any difference while on the pill.
62. There is no evidence that alcohol produces any detrimental effects on the body or organ toxicity in single doses of 1-3 drinks per day.
(A drink is defined as a standard beverage unit: one beer, one 5-ounce glass of wine, or one cocktail.)
63. Some people assume that alcohol has major detrimental or causative effects on all systems of the body, when consumed in high doses.
However, there is still a lot of work to be done. Here are some systems/diseases where alcohol still needs to be studied to see if there is a major detrimental or causative effect: immune system, AIDS progression, breast cancer, throat/oral cancer, prostate cancer, sex hormone function, kidney function, gall bladder function, arthritis, and many more! Support alcohol research funding!
64. About 90% of ingested alcohol is eliminated by liver breakdown (to a chemical called acetaldehyde).
Small amounts of alcohol itself are lost from the body through sweat, urine, and expired air. It is not possible to measure acetaldehyde in the blood or urine as an indicator of alcohol in the body, but it is possible to measure alcohol in sweat (sweat patches), urine (urinalysis), and air (breath analysis). The most accurate measure of blood alcohol content is through blood samples. The next most accurate is through breath analysis. Urinalysis is not very accurate, and sweat measurements are not accurate at all, giving only an indication that someone has used alcohol in the past several days.
65. Alcohol is the most toxic, but least potent, of all drugs.
This means that it has toxic effects on almost every organ of the body (the kidney being an exception, for some unknown reason). However, its potency is low because it has toxic effects only in large doses (grams, as compared to most other drugs that work in milligram doses). In lower doses, however, it affects individual cells in some organs (brain, heart) through an as-yet-unknown way.
66. One of the biggest problems with alcohol dependence is a lack of recognition of alcohol problems and intervention in patients by physicians.
Alcohol dependence is neglected in the education of U.S. physicians, and other health professionals, as well. But when physicians, who have great opportunities to affect patients' drinking habits (or refer to treatment if necessary), are not trained about the effects of alcohol, then public health suffers. It has been clearly documented that for every dollar spent on treatment of alcohol dependence, seven health care dollars are saved.
67. One of the most widely used screening tests for problem drinking is the CAGE:
- Have you ever felt the need to Cut down on your drinking? - Have you ever felt Annoyed by someone criticizing your drinking? - Have you ever felt Guilty about your drinking? - Have you ever felt the need for an Eye opener (a drink at the beginning of the day)? "Yes" answers to two or more of these questions suggests problem drinking and that more assessment of the individual is needed by a qualified professional.
68. Some people say that alcohol is a stimulant. Some people say that alcohol is a depressant. Some people say that alcohol is a poison. Some people say that alcohol is a disinfectant. Some people say that alcohol reduces anxiety. Some people say that alcohol is an antidepressant.
Actually, alcohol produces all of those effects, but for relatively brief periods of time, and not very efficiently. The effects depend very much upon the dose and upon when alcohol is used. There are other, more specific drugs that do all of those things better, compared to alcohol. Thus, alcohol is not recommended for producing any of the above effects.
69. Some people say that alcohol is a food. Some people say alcohol is a drug. Some people say that alcohol is a poison. Some people say that alcohol is a pharmaceutical solvent. Why can't it be all of those?
(Actually, it is. There is nothing that says that a chemical can't have several uses.)
70. Alcoholism is not a "too much, too often disease". It is an "I can't stop without help disease".
This means that one should not try to diagnose alcoholism by looking at a person's drinking behavior (although drinking a lot may be a red flag that someone is alcohol dependent). Some people who drink very little are alcoholic, while others who drink a lot are not alcoholic.
71. Blood alcohol tests are generally quite accurate.
Some conditions that can affect the accuracy of a blood sample (usually minimally) are putrefaction (fermentation of body tissues after death), dilution of blood by emergency survival methods (such as intravenous fluids), and extreme blood loss while alcohol absorption and metabolism are still continuing.
72. What happens at certain blood alcohol levels?
At 0.1% (the legal drinking-and-driving limit in most states) a person's ability to drive a car is significantly impaired; that is, there is a loss of judgment and some perception and muscle movement problems. At .2%, most people are "grossly intoxicated"; that is, they slur their speech and have difficulty walking. At .3%, most people will be on the verge of unconsciousness or be comatose. At .4%, death is possible. Of course, there is such variability between people that these are only "textbook" guidelines. Some people are very sensitive to alcohol's effects, while others are more tolerant to its effects.
72. What does "blood alcohol level" mean?
This is the amount of alcohol in a person's blood, measured in "grams percent". The legal drinking-and-driving limit in most states is 0.1 (.08 in many states), which means 0.1 grams of alcohol per 100 milliliters of blood. Sometimes it will be stated as 100 milligrams percent (mg%) or 100 milligrams per 100 milliliters of blood. Finally, the same amount can be designated as 100 milligrams per deciliter (mg/dl), which is 100 milliliters of blood.
73. What is the best remedy for a hangover?
Obviously, don't drink so much in the first place. But if you do have a great time at a party, then prevention of another type is in order. To overcome the dehydration and electrolyte imbalance, some people prefer a couple of large glasses of an electrolyte sports drink, or at least water and fruit juice. Also, taking acetaminophen (Tylenol) or another headache remedy (depending on the sensitivity of the stomach) will help ward off the headache. For stomach upset, a couple of antacid tablets will help a lot. Early morning awakening with your heart pounding? NOT more alcohol or a sedative tranquilizer! Just try to relax and wait for the symptoms to disappear.
74. Why does alcohol cause hangovers in some people but not other people?
Scientists don't really know, but we speculate that alcohol has a more "toxic" effect in some people. This "toxicity" is experienced as a small withdrawal syndrome in which certain body systems have been depressed by high amounts of alcohol. When the alcohol wears off, certain signs of excessive activity occur as the body tries to "normalize" its systems. Thus we see increased gastric acid (stomach upset), early morning awakening (a type of insomnia), plus other symptoms such as headache, dehydration, and electrolyte imbalance, which make people feel sick.
75. Alcohol has a mild antioxidant activity in "moderate doses" (1-3 drinks a day).
This antioxidant activity tends to overcome the detrimental effects of free oxygen radicals in body tissues. These radicals might increase the risks for cancer, heart disease, and other age-related diseases. Thus drinking a couple of drinks a day has been said to reduce the risk of these diseases, particularly atherosclerotic heart disease. The other mechanism of this protection might involve alcohol-induced changes in good/bad cholesterol ratios in the blood.
76. The major negative effects of long-term alcohol consumption are fatty liver, cirrhosis (in susceptible persons), gastritis, short-term memory loss, Wernicke-Korsakoff syndrome (in susceptible persons), clinical depression, mild hypertension, pancreatitis (in susceptible persons), and cardiomyopathy (heart muscle degeneration). Very heavy drinkers will often have esophagyl varices (dilated veins in the esophagus), brain disease (loss of cognitive function, confusion, amnesia), and signs of liver disease.
77. One of the drugs that is being studied as a possible relapse prevention medication for treating alcohol dependence is acamprosate.
This drug is being used in Europe to reduce craving and relapse in alcoholics, and it is currently in clinical trials in the U.S. This drug might work through the NMDA or glutamate systems in the brain to reduce craving and relapse in people who have undergone treatment for alcoholism and who wish to remain abstinent. Further studies will examine its earlier claims of effectiveness and low toxicity.
78. All drugs affecting the brain have a common general mechanism of action. That is, they all affect nerve cells (neurons) in some way. Some brain-affecting drugs reduce nerve cell function, while others increase nerve cell function. But it isn't that simple. When a person falls asleep, some parts of the brain continue to function and are refreshed by the reduced activity of the body. In a similar manner, some brain areas are "disinhibited" when a depressant drug such as alcohol is working. The result is an energized feeling.
79. Motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) are two research-based treatment strategies for people with alcohol problems.
It is not completely known whether these work better for alcohol abusing individuals or for alcohol dependent patients. A component of successful outcome with these therapies, as with other therapies, is the expertise and empathy of the counselor administering the treatment.
80. Alcohol has established beneficial effects on cardiac health.
The apparent positive effects from 1-3 drinks per day focus on the reduction of atherosclerosis in coronary and other arteries. This is protective for thrombotic heart disease. On the other hand, clinicians believe that alcohol also breaks down heart muscle (cardiomyopathy) in higher doses, and in sensitive people. Such information can be useful in heavy drinkers who have a family history of heart disease. Advising them to cut back to 1-3 drinks per day can be beneficial to their health.
81. Alcohol and other drugs often don't mix.
Particular drugs that interact with alcohol include anti-anxiety medications (e.g., Valium, Xanax), anti-coagulants (blood thinners such as warfarin, or Coumadin), antidepressants (e.g., Elavil), some antihistamines (e.g., Benadryl, which produces drowsiness of its own), and anti-seizure medications (e.g., Dilantin).
82. Ethyl alcohol (ethanol) is grain alcohol, the main ingredient in alcoholic beverages.
Methyl alcohol (methanol) is wood alcohol, a poison, used in some manufacturing processes. Isopropanol (isopropyl alcohol) is rubbing alcohol, used for disinfecting skin and medical instruments. All of these are simple molecules with a COH portion that distinguishes them from other organic compounds. Isn't it amazing how such simple organic molecules can significantly affect our lives?
83. Unlike other drugs, alcohol has no single receptor site for its action in the brain.
In reality, alcohol affects several receptors that exist for other brain chemicals to act upon. Thus alcohol is an interloper, working on whatever receptor sites it happens to connect with. Since alcohol is such a simple molecule, it activates (stimulates or blocks) a number of receptors, although in a somewhat unspecific fashion, since the receptors are usually designed for specific attachment by other drugs. Thus, it is not unexpected that alcohol has many central nervous system effects, which we collectively call "intoxication".
84. The problem with including both willful alcohol abuse and pathological alcohol dependence under the general term of "alcoholism" is that:
- this diffuses the powerful scientific evidence that alcohol dependence is a medical disease. Medical diseases require treatment. This means there must be adequate insurance to cover the newer research-based treatments for alcohol dependence. The scientific evidence that alcohol dependence is a brain disease requires more research to find exact causes and better treatments, including gene-based treatments. Thus, most research today utilizes the term alcohol dependence as synonymous with "alcoholism". Alcohol abuse is not "alcoholism."
85. Alcohol (ethanol) is made from fermentation of various plant products.
For example, corn mash fermentation produces bourbon; potatoes produce vodka; hops and malt, wheat and other grains are used in beer production; rice for the Japanese wine sake; malted barley for scotch whiskey; grapes for the different wines; sugar cane for rum; grains and juniper berries for gin; and many fruits for sweet liqueurs.
86. There is great tradition with mixed drinks in America:
"Boiler-maker" (whisky with a beer chaser), "bloody Mary" (vodka and tomato juice), "screwdriver" (vodka and orange juice), "cocktail" (almost anything with spirits), "one for the road" (a dangerous drink order), "nightcap" (last drink of the evening), and many more. Like any other alcoholic drinks, these are fine when only one or two are consumed. But too many Long Island Iced Teas (multiple spirits) made with EverClear (absolute alcohol) can be fatal!
87. The idea that alcohol causes nerve cells to "melt" is an old theory:
- that was once used to help scientists understand how alcohol depresses nerve cell function. "Melting" referred to the action of alcohol on disorganization of the protein and fat molecules of the nerve membrane, causing the ionic pores to be disrupted. This disruption reduced nerve cell firing. Now we know that alcohol only passively affects the nerve membrane, mainly at high doses.
88. There is no credible research evidence for the following statements about alcohol use:
89. Provincial legislatures have set a certain blood alcohol concentration (BAC) limit:
Above which a person is legally intoxicated and should not drive a motor vehicle. Many states have adopted a new lower BAC of 0.08%, compared to the previous level of 0.1%. Research studies are available to suggest significant impairment even at 0.05%, which is the recommended level adopted the American Medical Association. People can reach the 0.08% limit by simply drinking 3-4 drinks within approximately an hour. This is quite variable, however, between genders and depending on food in the stomach, prior drinking history, and genetic make-up.
90. Ethyl alcohol (ethanol, beverage alcohol) has many uses:
In addition to its reputation as one of the most abused drugs. It is an ingredient in some rubbing alcohols (some brands use isopropyl alcohol instead), it has been used historically for reducing pain when used in field block anesthesia in trigeminal neuralgia (Tic douloureaux), it is a solvent in pharmaceutical preparations (e.g., liquid cold remedies), and it probably reduces atherosclerosis when drunk in moderation.
91. Alcohol is partially metabolized (broken down) in the stomach by an enzyme called gastric alcohol dehydrogenase (GADH).
This is basically the same enzyme that metabolizes alcohol in the liver, but there is a lower concentration in the stomach lining. The levels of GADH are higher in men than women, so that when women drink, less alcohol is broken down in the stomach. Thus more alcohol passes into the upper intestine, the primary site of absorption. This is one of the reasons that blood alcohol levels are higher in women than in men after the same number of drinks.
92. How are genes related to alcohol dependence?
Genes form proteins in the brain. In the brain's neurotransmitter systems, proteins and enzymes (specialized proteins) are involved in the manufacture, release, and metabolism of chemicals that allow brain cells to communicate with one another. When such communication is disrupted between nerve cells in the "pleasure pathway", dependence on alcohol (impaired control over drinking) can occur. This disruption is probably caused by abnormal gene regulation of protein function.
93. Is alcohol dependence a genetic disease?
Yes, with qualifications. Genetics studies performed over the past 20-25 years have clearly shown that the tendency to become alcohol dependent ("alcoholic") is inherited. In other words, genetic vulnerability coupled with unknown environmental factors is the cause of most types of alcohol dependence. Science has yet to fully understand the transmission of genetic vulnerability, and the specific environmental factors that trigger the disease.
94. What are the differences among alcoholic beverages?
Beer, wine, and spirits contain different quantities of ethanol by weight or volume. Beer contains roughly 4-6% ethanol; wine, 10-13%; and spirits, 20-50%, with the majority being around 40% (80 proof). Some beverages are "lite" (beers and wines containing lower concentrations of ethanol), while some are "light" (in color) - white wine, vodka, gin, tequila. There is some evidence that these produce less hangover than darker beverages - red wine, bourbon, scotch. There is no evidence that people become addicted to spirits more readily than to beer or wine. Spirits, however, are more likely to produce death in overdose situations.
95. What are the similarities among alcoholic beverages?
Of course, beer, wine, and spirits all contain ethyl alcohol (ethanol) as a product of fermentation in the manufacturing process. Beer (and sometimes wine) has natural carbonation, which may alter the absorption rate of ethanol. In general, one beer, one 5-ounce glass of wine, and 1.5 ounces of spirits contain similar amounts of alcohol (thus these are called "beverage units"). The ethanol in all alcoholic beverages is "handled" by the body identically - metabolism, effects on organs, etc. People can become dependent ("addicted to alcohol") on any alcoholic beverage.
96. Are there different types of tolerance?
There are many words to describe three basic types of tolerance.ó Functional tolerance, caused by nerve cell adaptation to alcohol, is also called cellular or tissue tolerance.ó Dispositional tolerance is seen when the liver's breakdown enzymes increase in activity in response to alcohol. This is also called metabolic tolerance. Another type of tolerance is called learned tolerance, in which some people seem to "sober up" in special situations.
97. What is tolerance?
Tolerance is the adaptation of the body to the effects of alcohol (or another drug). This means that a person must drink more and more alcohol to produce the same effects as the first time they drank. Not everyone becomes tolerant to alcohol, but when it occurs it can be significant. For example, some heavy drinkers consume over a quart of spirits per day.
98. What is the addiction potential of alcohol?
Statistics tell us that about 5-6% of the U.S. population is dependent on alcohol. This is roughly 15-18 million people. Another way of looking at this is that one of every 10 people who drink in the U.S. develop dependence on alcohol. About 1/3 of the population does not drink ("population" includes children, old folks, and abstainers).
99. What are THIQs?
The technical name for these is "tetrahydroisoquinolines". According to a 1970s theory, THIQs are formed in the brains of alcoholics when they drink. THIQs have opioid-like pharmacological qualities, and presumably alcoholics became addicted to THIQs formed in their brains, rather than to alcohol itself. The theory generated many years of research, during which methods to measure tiny quantities of THIQs in humans were developed. However, scientists have had a difficult time finding THIQs consistently in alcoholics compared to non-alcoholic people. Thus, this theory has fallen out of favor among most scientists.
100. Can alcohol kill people?
Alcohol is a very dangerous drug, in two important ways. First, people can overdose on alcohol and die either by suffocating on their vomit while drunk or sleeping, or because alcohol can shut down the brain areas that control breathing. Anyone who has a blood alcohol level of 0.35% or above is in danger of overdose (about 14-18 drinks in a rather brief period of time). Second, chronic heavy drinkers can die during withdrawal from (especially) high blood alcohol levels. (Death is usually due to seizures when the body experiences hyperexcitability during declining blood alcohol levels.)
101. Is everyone who drinks too much, too often, an alcoholic?
No, because the latest diagnostic criteria for alcohol dependence ("alcoholism"), as listed in the Diagnostic and Statistical Manual, Edition IV, Text Revision (DSM-IV-TR, 2000) do not include amount consumed or duration of alcohol consumption as diagnostic criteria. The main difference between alcoholism (pathological alcohol dependence) and willful alcohol abuse is whether a person can stop when critical life events (e.g., loss of a job or a spouse) occur. If (s)he cannot, then by definition there is "impaired control" over alcohol use, the main diagnostic criterion of alcohol dependence.
102. Does alcohol kill brain cells?
Yes, but only when large quantities are drunk over a period of many years. Thus, alcohol abusers and alcohol dependent individuals (collectively called "problem drinkers") often suffer from Korsakoff Syndrome, amnesia, confusion, and dementia. This effect is due to alcohol toxicity on the hippocampus, or "memory" portion of the brain. Social drinking, however, does not kill brain cells.
103. Why does alcohol stimulate some people and make other people sleepy?
Observation tells us that women generally become sedated with a few drinks, whereas men become "happy". Obviously this is an overgeneralization. Alcohol affects people in different ways. This is probably due to differences in metabolism (break-down of the drug), rate of drinking, brain cell sensitivity, and other unknown factors.
104. Is alcohol a depressant or a stimulant?
Pharmacologically, alcohol depresses nerve cells in the brain and body. However, the brain is so complex that when depression occurs somewhere in the brain, stimulation occurs to compensate for the imbalance. Thus, low doses of alcohol cause people to feel "high", while higher doses cause sedation and sleepiness (and in high doses, unconsciousness).
105. What is "disinhibition"?
This is a phenomenon produced by alcohol causing nervous system depression. The cortex ("thinking" portion of the brain) is depressed by low doses of alcohol. One function of the cortex is to maintain control over the rest of the brain. When alcohol depresses the cortex, the rest of the brain speeds up. Thus, the person feels more likely to take chances, there is loss of control over judgment, and the pleasure pathway is engaged, leading to a euphoric "high".
106. Alcohol is classified as a central nervous system (brain and spinal cord) depressant. How, then, can alcohol cause someone to feel "high" or euphoric?
Scientists are not sure, but the simple explanation is that alcohol causes "dis-inhibition" of parts of the brain that are normally held in check in people who are not intoxicated. In other words, alcohol causes a reduction in the inhibitory parts of the brain, thereby causing them to relax their influence on parts of the brain that can exhibit stimulation. We feel "high" when our cerebral cortex is more dis-inhibited, so we infer that alcohol has a major effect on depressing the cerebral cortex.
107. Impairment of driving is due to many effects of alcohol:
- reduced judgment, increased reaction time, a euphoric "high" that makes the person feel they can drive safely when in fact their ability is reduced, increased risk-taking, reduced ability to focus on roadway markers and other traffic, and (when the effects are wearing off) marked drowsiness that can lead to decreased attention and perhaps periods of "nodding off".
108. In 1990, all states in the nation had an 0.1% blood alcohol concentration (BAC)
- legal limit for driving while intoxicated (DWI). In the late 1990's a number of states lowered their DWI legal limit to 0.08%. This can be reached in most people by the continuous drinking of 3-4 standard drinks (defined as a beer, a glass of wine, a mixed drink), with women requiring less alcohol to reach the level than men. Research studies show significant driving impairment with BACs as low as 0.05%, which has been recommended by organizations such as the American Medical Association. Europe has stricter standards, ranging from 0% BAC (Norway) to 0.05% (England). Many European countries and some states/cities in the U.S. allow alcohol check-points, particularly during holidays, to catch drivers who have BACs that are too high.
109. Why is the absorption of alcohol slowed down when a person has food in the stomach?
It is logical to think that food reduces the availability of alcohol to the stomach lining for absorption. However, since alcohol is absorbed more quickly from the upper intestine than from the stomach, it is more likely that food reduces the movement of alcohol from the stomach to the intestine. Alcohol does indeed reduce the rate of gastric emptying, therefore food delays the movement of alcohol to the intestine, and absorption is slowed down.
110. Unlike other drugs, alcohol has no specific receptor to activate in the brain.
For example, cocaine's receptor is called the dopamine transporter. Heroin's receptor is called the opioid receptor(s), and the receptor for marijuana is called the cannabinoid receptor. Scientists used to think that alcohol "melted" (not a scientific term) the nerve membrane in a reversible way, but today scientists are inclined to believe that alcohol has affinity for certain receptors for other chemicals in the brain. For example, alcohol is known to affect the GABA receptor, the NMDA receptor, and probably others to produce its myriad of behavioral and toxicological effects.
111. Proper terminology is critical when discussing alcohol problems.
"Alcohol use" is any use of alcohol. "Alcohol abuse" is intentional overuse of alcohol in cases of celebration, treatment of depression or anxiety, or in binge drinking (is it the alcohol that's being abused?). In Europe, "alcohol misuse" is more common than "alcohol abuse", and is slightly more accurate in that it is the person who is improperly using alcohol. Finally, "alcohol dependence" is the new term for alcohol addiction or "alcoholism", in which the person cannot stop drinking in spite of adverse consequences.
112. Alcohol unfavorably interacts with many other drugs:
- benzodiazepines (such as Xanax, Valium, Librium), antidepressants (such as Prozac, Zoloft), insulin, anticoagulants, antihistamines, some antibiotics, and many others. In fact, many prescription drugs carry the label "Do not drink alcohol while taking this medication". In general, alcohol can increase the effects of drugs that make people drowsy, can alter the metabolism (break-down) of drugs, or reduce the effectiveness of drugs.

113. Alcohol is the drug used most often by high school seniors.
Even though such students cannot legally buy alcohol, over 90% of them have tried alcohol and almost one-third of them report that they have had more than 5 drinks at one time (binge drinking) in the past two weeks. With college students, over 40% report recent heavy drinking. On one college campus, an informal survey indicated over 90% of first-year students had drunk to intoxication in the previous month.
114. "Blackouts", contrary to public knowledge, are not diagnostic of alcohol dependence (alcoholism).
Blackouts are memory lapses caused by (usually) heavy drinking, where the individual does not pass out, but appears to act relatively normal during drinking. However, the next day, events that occurred during portions of the drinking period cannot be remembered. Blackouts probably occur because the function of the hippocampus, the part of the brain that registers memory, is depressed by alcohol. Whether the memories never get "registered", or whether they become registered but cannot be retrieved, has not been determined.
115. One of the briefest intervention tests that can be used by physicians to discover whether a person has drinking problems is the CAGE questionnaire:
Have you ever felt the need to Cut down on your drinking? Have you ever felt Annoyed by someone criticizing your drinking? Have you ever felt Guilty about your drinking? Have you ever felt the need for an Eye opener (a drink at the beginning of the day)? "Yes" answers to two or more of these suggest the possibility of alcohol dependence, although the answers should be discussed with a treatment specialist.
116. Alcohol dependence ("alcoholism") is probably several diseases, each with a different cause.
For example, some scientists talk about Type I and Type II alcoholics. Others have studied the differences between Types A & B alcoholism. It is also possible that brain chemistry differences could be involved in several types of alcoholism, leading to alcohol dependence associated with dopamine abnormalities in the brain's pleasure pathway, or serotonin abnormalities, endorphin abnormalities, etc.
117. Geneticists estimate that about 60% of the causes of alcohol dependence are due to genes that lead to increased "vulnerability" to alcoholism.
These genes probably affect some physiological component of the brain that is associated with the production of "impaired control," the hallmark of alcohol dependence.
118. What is glutamate?
Glutamate is an excitatory amino acid that is part of the transmitter systems that might be affected to produce alcohol's "intoxication". It is found throughout the brain, and may either be inhibited or enhanced by different doses of alcohol.
119. What is GABA?
GABA, or gamma-amino butyric acid, is one of the major message-carrying chemicals called neurotransmitters in the brain. It is significantly affected by alcohol, causing various signs of "intoxication". Since GABA's action is to reduce the transmission of impulses between cells, it is called an "inhibitory" neurotransmitter. Thus alcohol either increases or decreases GABA function to produce the combination of inhibitory (e.g., impaired judgment) and excitatory (e.g. exhilaration) effects of alcohol on the major areas of the brain.
120. Alcohol's effects on neurotransmitters (chemical transmission molecules) in the brain are not limited to one or just a few chemicals.
While scientists agree that the alcohol molecule does not "activate" a single receptor in the brain, alcohol appears to work by affecting the receptors of several neurotransmitters. Among these are gamma-amino butyric acid (GABA), glutamate, n-methyl-d-aspartate (NMDA), endorphins, dopamine, serotonin, and acetylcholine. The myriad of effects on all these chemical systems probably explains the many effects of alcohol on the body.
121. Alcohol is a very poor drug for reducing a person's anxiety or depression.
These mental symptoms are caused by an inappropriate response to life events, and in many cases the causes are unknown. People drinking alcohol to reduce such symptoms often find that anxiety and depression are actually made worse by alcohol. Therefore the best treatment for these symptoms is medication prescribed by a doctor. In some cases, the symptoms go away after a period of time, or with the help of a therapist.
122. Two drugs are available to help alcoholics sustain behaviorally-produced abstinence.
Naltrexone (available in 35 countries) was approved by the American FDA in 1994 to help alcoholics who want to stop drinking but have trouble with relapse ("slips", inability to stop completely). It seems to work somehow on the endorphin system of the brain. Acamprosate is available in 37 countries and is in clinical studies in the United States. It helps alcoholics sustain abstinence, perhaps through an effect on the glutamate system of the brain. Both drugs are a significant improvement over Antabuse, a 50-year-old drug that works on the liver.
123. Binge or continual long-term drinking often causes withdrawal when a person stops drinking.
Because alcohol is a depressant in the body, high doses reduce cell activity. When alcohol is removed from the cells, they recover in a way that produces a change in sensitivity toward stimulation. However, this attempt by the body to produce "normalcy" often leads to over-stimulation ("hyperactivity"), which is known as withdrawal. Thus, binge drinking leads to "hangover" (headache, increased stomach acidity, early morning awakening, etc.). Long-term heavy drinking leads to the "shakes", delirium (hallucinations), and sometimes, seizures. Thus alcohol abusers or alcohol-dependent individuals must be detoxified ("detoxed") to reduce the discomfort and possible deaths produced by withdrawal. Interestingly, some people are immune to hangovers or severe withdrawal, for unknown reasons.
124. What is the most accurate way to measure the amount of alcohol drunk by an individual?
The body gets rid of alcohol in several ways: in the breath, urine, sweat, and by metabolism (breakdown) in the liver. Therefore people have tried to measure alcohol in the breath, urine, and sweat. The least accurate method is measurement of sweat alcohol, the next least accurate is measurement in urine, and the most accurate of the three is breath alcohol. However, the most accurate and sensitive measure of all is alcohol measured directly in the blood (or serum, which is the part of the blood without blood cells).
125. What is ALDH, as it refers to alcohol metabolism?
After alcohol is broken down in the body to acetaldehyde by alcohol dehydrogenase and other enzymes, acetaldehyde is broken down broken down to acetate, carbon dioxide, and water by another liver enzyme, aldehyde dehydrogenase (ALDH). ALDH is the enzyme that is blocked by disulfiram (Antabuse), a drug used to deter drinking. Blockade of ALDH results in higher acetaldehyde levels when people drink, which makes them sick and is a deterrent to drinking in some people.
126. What is ADH, as it refers to alcohol metabolism?
Most of the metabolism (breakdown) of alcohol is performed by the enzyme alcohol dehydrogenase (ADH), which is found mostly in the liver. Approximately 90-95% of all alcohol removal from the body is done by ADH. ADH is also found in other tissues, most notably the stomach lining, where it breaks down some of the alcohol that reaches the stomach.
127. "Problem drinking" is defined as any consumption of alcohol that results in significant risk of physical damage, psychological problems, accidents, legal problems, or other social problems.
"Problem" drinking includes two DSM-IV related diagnoses: willful alcohol abuse and pathological alcohol dependence. Alcohol abuse is a significant social problem, leading to major economic impact associated with drunk driving, medical costs, job- and family-related problems, etc. Alcohol dependence is the disease of "alcoholism", which also devastates lives and is a major burden on the legal, social, and medical systems of our society.
128. "Moderate use" of alcohol:
Has been defined by the Department of Agriculture (and other sources) as 1-2 drinks per day - one drink for women, two drinks for men. The interest in "moderate" drinking is underscored by the research showing beneficial effects of moderate drinking on cardiovascular function, and perhaps on the prevention of Type II diabetes and occlusive (clot-related) strokes. Moderate drinkers are clearly at reduced risk for atherosclerotic heart disease, compared to alcohol abstainers and heavy drinkers. However, the mechanism of this protective effect is incompletely known.
129. "Social use" of alcohol:
Consists of an occasional drink or two in the company of friends: a glass of champagne at a wedding, a cold beer after a softball game, or a glass of fine wine with a meal. Contrary to popular belief, social drinking does not kill brain cells, nor does it adversely affect any major body organ. Two-thirds of the U.S. population drinks alcohol, but the number of social drinkers has not accurately been measured, mainly because of the existence of several definitions of "social" drinking.
130. People often wonder how alcohol can be a legal, socially-accepted drug, while other drugs are illegal to possess, sell, or use.
Alcohol's use is historical, and to prohibit its sale and use would break a great deal of cultural, religious, and social traditions. Alcohol Prohibition, which occurred in the U.S. from 1920 to 1933, was generally considered a failure, for it spawned bootleg manufacturing operations and increased trafficking in illegal alcohol sales. Interestingly, the rate of alcohol use, abuse, and liver cirrhosis in the U.S. declined greatly during this period, but the number of alcoholics remained about the same.
131. Beverage alcohol (ethanol, ethyl alcohol, grain alcohol) is only one of several alcohols used by humans.
Two others should not be consumed: methanol (methyl alcohol, wood alcohol) is often used in antifreezes for vehicles and is highly toxic (can cause blindness, primarily); and isopropanol (isopropyl alcohol), which is best known for its use as a disinfectant in rubbing alcohols. Ethanol is also used in rubbing alcohols, but it is adulterated with methanol or another ingredient to prevent people from drinking these products.
132. Fetal alcohol syndrome (FAS):
Is a major cause of birth defects around the world. In the U.S., conservative estimates are that each day about 3-4 children are born with FAS. FAS is the only permanent fetal syndrome caused by addicting drugs. This means that women who are dependent on alcohol and who cannot stop drinking during pregnancy have a great chance of permanently damaging their baby. The signs of FAS are complex, but include physical malformations, brain damage (mild to severe), and a probable shortened life span.
133. Beverage alcohol has major toxic effects on the following organs, with heavy drinking over many years: liver, heart, brain, gastrointestinal tract (stomach and intestines), and pancreas.
These effects are, in order: fatty liver and cirrhosis, cardiomyopathy (breakdown of heart muscle), brain shrinkage and cell death (particularly memory areas), ulceration, and inflammation of the pancreas.
134. There are two major alcohol problems in the world, based upon new diagnostic criteria.
The first is alcohol abuse, which is intentional alcohol overuse or misuse such as seen on college campuses, or in other cases with poor judgment about drinking too much, too often. The main characteristic of alcohol abuse is that people will moderate or stop their drinking when they decide that the adverse consequences are worse than the desirable effects of drinking. The second problem is pathological alcohol dependence, the disease of "alcoholism". This is a brain-chemistry disease characterized by the inability to consistently stop drinking, even under adverse consequences.
135. Alcohol (ethanol) is one of the most organ-toxic (liver, brain, heart, gastrointestinal tract) drugs of all.
It is also one of the least-potent (requires large quantities) of all drugs. This means that low doses are relatively non-toxic to organs yet still effective in producing euphoric effects, since the effects of low doses are seen first on mood and judgment.
136. Beverage alcohol contains ethyl alcohol (ethanol)
- a simple molecule consisting of two carbon atoms, 6 hydrogen atoms, and one oxygen atom. Because it is so small, it penetrates readily into every tissue of the body. In spite of its easy penetration, it does have specific effects on certain organs and parts of organs. For example, it acts more on some nerve cell parts than others. This may due to the higher sensitivity of these parts to ethanol, for unknown reasons.
137. How alcohol produces "intoxicating" effects on the brain is not entirely known.
Three specific brain components, called neurotransmitter receptors, are being studied by scientists around the world. These receptors are the n-methyl-d-aspartate (NMDA) receptor, the gamma aminobutyric acid (GABA) receptor, and the nicotine (nicotinic) receptor. Blockade or enhancement of these neurotransmitter receptor systems may hold the answer to how alcohol produces its pharmacological actions.
138 Food significantly affects the absorption of alcohol from the stomach.
Alcohol is absorbed much more rapidly from an empty stomach than from a full one. Food in the stomach slows absorption and also reduces gastric emptying time into the upper part of the intestine (duodenum), which is where alcohol is absorbed most rapidly. When alcohol stays in the stomach longer, it is also more vulnerable to being broken down by gastric alcohol dehydrogenase (GADH).
139. There are several alcohols used in products that people use on a daily basis:
- ethanol (ethyl alcohol, grain alcohol) is the one used in alcoholic beverages. Another, methanol (methyl alcohol, wood alcohol) is sometimes used in antifreezes and canned burning fuels. Isopropyl alcohol (isopropanol) is used as rubbing alcohol for disinfecting skin and instruments (although ethanol is also used for this purpose, check the label on the bottle). Glycerin is also technically an alcohol (glycerol), and is used in pharmaceutical preparations. The most toxic of these alcohols is methanol, which can cause blindness when ingested.
140. In low doses (1-2 drinks, but it varies among individuals), alcohol produces: relaxation, reduced inhibitions, impaired concentration, slowed reflexes, reduced reaction time, and reduced coordination.
These effects are magnified as the number of drinks increases, until there is serious impairment, which can affect driving skills. This is because alcohol is primarily a depressant of the central nervous system.
141. Women metabolize (break down) alcohol more slowly than men because there is a smaller amount of alcohol metabolizing enzyme (alcohol dehydrogenase) in the stomach in women.
Because less enzyme is present, more alcohol passes through the stomach to the duodenum, the main alcohol-absorbing portion of the gut. This effect, combined with a different fat/lean body makeup between men and women, leads to higher blood alcohol levels (BACs) in women than men after identical alcoholic drinks.
142. One "beverage unit"
(BU; beer, wine, or spirits) drunk by a 150-pound man within roughly 20 minutes will produce a blood-alcohol concentration (BAC) of .025%, which is approximately one-third the drunk driving limit of .08% in Texas, or approximately one-fourth that in states which have a .1% BAC drunk driving limit. Keep in mind, however, that about one BU is lost per hour by being broken down in the liver.

143. One standard "beverage unit" of alcohol
- consists of one 5-ounce glass of wine, one 12-ounce beer, or one cocktail containing 1.5 ounce of 80 proof spirits. All of these contain roughly the same amount of ethanol.
144. The estimated incidence of alcohol dependent people ("alcoholics")
- in the United States is 5-6% of the population, or roughly 15-18 million individuals.
145. The main metabolizing (break-down) enzyme for alcohol is known as alcohol dehydrogenase (ADH).
This produces a compound called acetaldehyde, which is in turn broken down by aldehyde dehydrogenase. Alcohol dehydrogenase is primarily found in the liver but also occurs in the stomach, and (in low concentrations) other organs of the body.
146. Beverage alcohol (ethanol, ethyl alcohol)
- is a simple compound consisting of carbon, hydrogen, and oxygen. These form a two-carbon chain which is metabolized (broken down) in the body by the liver into carbon dioxide and water.