Alcohol Toxicity

Behavioral Toxicity

Different patterns of drinking predominate in society and can be categorized as social drinking, binge drinking, and heavy drinking according to the National Institute on Alcohol Abuse and Alcoholism (Table 6.7). Binge drinking remains a major problem among college students. Although there has been a 16% decrease in college binge drinking in the U.S. over the past 20 years, absolute numbers remain high, with 36% of college students reporting binge drinking in the 2 weeks prior to the survey (five or more drinks in a row) as outlined by the 2012 Monitoring the Future national survey results. Such binge drinking is associated with serious consequences, ranging from serious injury to death. The health and psychosocial consequences range from motor vehicle accidents, legal problems, blackouts, and missing classes to date rape, other types of violence, and unwanted or unprotected sex, with resulting problems such as sexually transmitted diseases. Binge drinking between the ages of 10 and 21 is more likely to progress to alcohol abuse or dependence, with earlier excessive drinking increasing the probability of later problems (Table 6.8; see What is Addiction?).

Figure 6.5 Comparison of effects of 0.33, 0.44, and 0.66 g/kg ethanol on (A) blood alcohol levels, (B) self-estimated subjective intoxication, and (C) observed degree of intoxication. Alcohol was taken in the form of whisky on an empty stomach, and the time allowed for drinking was 10–15 min. Means (data points) within parentheses include one zero and thus may be too high. These data show what is called “within-session tolerance” or “acute tolerance.” The degree of intoxication parallels the ascending limb of the function that relates intoxication and blood alcohol levels, but the degree of intoxication does not parallel the descending limb of the function that relates intoxication and blood alcohol levels. Blood alcohol levels remain high long after the intoxication disappears. [Modified with permission from Ekman G, Frankenhaeuser M, Goldberg L, Hagdahl R, Myrsten AL. Subjective and objective effects of alcohol as functions of dosage and time. Psychopharmacologia, 1964, (6), 399–409.]

Figure 6.6 Performance on the “finger-finger” test (in which subjects must touch the tip of the left index finger to the tip of the right index finger at arm’s length) as a function of blood alcohol concentration in abstainers, light drinkers, and heavy drinkers. The non-overlapping lines were described as evidence of tolerance to the motor-incoordinating effects of alcohol. These data show dose-dependent chronic tolerance to a motor measure of intoxication in humans. For the heavy drinkers, it takes over twice the blood alcohol level to produce the same amount of impairment as observed in abstainers. [Taken with permission from Goldberg L. Quantitative studies on alcohol tolerance in man. Acta Physiologica Scandinavica Supplementum, 1943, (5), 1–128.]

Alcohol can also be extremely toxic when high doses are consumed acutely or chronically or when ingested during pregnancy. Overdoses occur under situations of binge drinking or simply by accident, fostered by ignorance of its potential toxicity. Numerous examples can be given of young people who overdose at parties, especially when engaging in challenges or games that involve drinking excessively (see Box 6.4). In 2009, nearly 32% (over 650,000) of all drug-related emergency room visits involved alcohol. The US Drug Abuse Warning Network reported that nearly 200,000 of these alcohol-related emergency room visits were made by people under the age of 21. Others have estimated that over 1,400 students aged 18–24 and enrolled in 2- to 4-year colleges died due to alcohol-related unintentional injuries. Of the 8 million college students in the US, 25% drove under the influence of alcohol, and remarkably, 37% rode with a drinking driver. Alcohol misuse-related damage is not limited to deaths and emergency room visits; it also extends to a wide range of individual and social consequences (Table 6.8). Half a million college students were unintentionally injured under the influence of alcohol, and an additional 100,000 were assaulted by another student who had been drinking.

TABLE 6.7

Alcohol Use Definitions

Term

Definition

Current use

At least one drink in the past 30 days (includes binge and heavy use).

Binge use

Five or more drinks on the same occasion at least once in the past 30 days. A pattern of drinking that brings blood alcohol concentration to 0.08 gm% or above. For the typical adult, this pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), in about two hours.

Heavy use

Five or more drinks on the same occasion on at least five different days in the past 30 days.

Drink

A 12 ounce can or bottle of beer or wine cooler, a 5 ounce glass of wine, or 1.5 ounces of 80 proof (40% alcohol) distilled spirits.

Source: Substance Abuse and Mental Health Services Administration. Results from the 2002 National Survey on Drug Use and Health: National Findings (Office of Applied Statistics, NHSDA Series H-22, DHHS publication no. SMA 03–3836). Rockville MD, 2003; National Institute on Alcohol Abuse and Alcoholism. State of the Science Report on the Effects of Moderate Drinking. National Institute on Alcohol Abuse and Alcoholism, Bethesda, 2004.

Alcohol also facilitates sexual desire and sexual behavior by lessening a person’s inhibitions, but alcohol at higher doses also impairs sexual performance. In males, taking small amounts of alcohol acutely has been associated with an increase in self-reported sexual arousal and a slight increase or decrease in sexual response measured by penile vasocongestion. However, higher doses of alcohol lead to substantial reductions in sexual arousal, measured by both self-report and penile vasocongestion, and an impaired ability to ejaculate. Similar results for acute alcohol administration in females have been reported. Although many women reported that low-dose alcohol increases sexual pleasure, sexual arousal and the ability to achieve orgasm dose-dependently decreased with increases in blood alcohol levels. All of these effects reverse when the alcohol is cleared from the body.

TABLE 6.8

Potential Negative Consequences of College Student Drinking

Damage to self

academic impairment
blackouts
personal injury or death
short-term and long-term physical illness
unintended and unprotected sexual activity
suicide
sexual coercion/rape victimization
impaired driving
legal repercussions
impaired athletic performance

Damage to other people

property damage and vandalism
fights and interpersonal violence
sexual violence
hate-related incidents
noise disturbances

Institutional costs

property damage
student attrition
loss of perceived academic rigor
poor town relations
added time demands and emotional strain on staff
legal costs

From: Perkins HW. Surveying the damage: a review of research on consequences of alcohol misuse in college populations. Journal of Studies on Alcohol Supplement, 2002, (14), 91–100.

Chronic alcohol use and alcoholism in males is associated with a higher frequency of sexual dysfunction. Individuals with alcoholism in outpatient treatment reported a three-fold higher prevalence of serious erectile dysfunction compared with individuals without alcoholism. Chronic alcohol use is associated with low testosterone and sperm count, smaller testes, feminization, and gynecomastia (increase in the size of the mammary glands in the breast). Some of these effects can persist even with prolonged abstinence but ultimately are reversible. Alcoholism in women is associated with numerous sexual dysfunctions, including low sexual desire, lack of orgasm, contractions of the vagina that interfere with intercourse, and painful intercourse. They also said that alcohol relieved their sexual problems by relieving sexual inhibitions. Expectations of disinhibiting sexuality may serve as a motivation for drinking. Women with alcoholism also reported more guilt surrounding sexual behavior and sexuality than women without alcoholism. Thus, sexual dysfunction may be both the cause and result of high alcohol use in women.

Heavy alcohol consumption in women is also associated with menstrual dysfunction, including anovulation (a menstrual cycle occurs without ovulation), recurrent amenorrhea (the absence of a menstrual period), early menopause, and a higher incidence of spontaneous abortions. All of these effects may be related to hormonal changes in females that are caused by acute and chronic alcohol intake. Acute alcohol intoxication increased estradiol levels in both pre- and post-menopausal women. These alcohol-induced increases in estradiol and testosterone levels may be related to a decrease in the body’s ability to catabolize steroids.

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