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Substance-Related Disorders: Alcohol

Source: Doering PL, Li RM. Substance-Related Disorders: Alcohol, Nicotine, and Caffeine. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7987625. Accessed June 11, 2012.

  • Acute detoxification and withdrawal after chronic alcohol abuse a serious condition that can require hospitalization and adjunctive pharmacotherapy. Death may ensue if blood alcohol concentration (BAC) high enough.

  • Alcohol absorption begins in stomach within 5–10 minutes of ingestion.
  • Peak concentrations usually achieved 30–90 minutes after finishing last drink.
  • Alcohol metabolized by alcohol dehydrogenase to acetaldehyde, which is further metabolized to carbon dioxide and water by aldehyde dehydrogenase.
  • There is 14 g of alcohol in 12 oz of beer, 4 oz of wine, or 1.5 oz (one shot) of 80-proof whiskey. This amount increases BAC by 20–25 mg/dL (4.3–5.4 mmol/L) in healthy 70-kg man. Deaths from alcohol intoxication generally occur when BACs >500 mg/dL (87–109 mmol/L).
  • Alcohol withdrawal includes 2 main components:
  • History of cessation or reduction in heavy and prolonged alcohol use
  • Presence of two or more of symptoms of alcohol withdrawal.

  • Slightly more than half of Americans (approximately 129 million people) aged 12 or older reported being current drinkers of alcohol in a 2008 survey.
    • 23.3% (58.1 million) participated in binge drinking.
    • 6.9% reported heavy drinking.

Signs and Symptoms

  • Signs and symptoms of alcohol intoxication:
    • Slurred speech
    • Ataxia
    • Incoordination
    • Sedation
    • Nystagmus
    • Impaired judgment
    • Unconsciousness
    • Nausea
    • Vomiting
    • Respiratory depression
    • Coma
  • Signs and symptoms of alcohol withdrawal:
    • Tachycardia
    • Diaphoresis
    • Hyperthermia
    • Hallucinations
    • Delirium
    • Seizures
  • Table 1 relates effects of alcohol to BAC.

Table 1. Specific Effects of Alcohol Related to Blood Alcohol Concentration
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Table 1. Specific Effects of Alcohol Related to Blood Alcohol Concentration
BAC (%)a [mmol/L]Effect
0.02–0.03 [4–8]No loss of coordination, slight euphoria, and loss of shyness.
0.04–0.06 [9–14]Feeling of well-being, relaxation, lower inhibitions, sensation of warmth. Euphoria. Some minor impairment of reasoning and memory, lowering of caution.
0.07–0.09 [15–21]Slight impairment of balance, speech, vision, reaction time, and hearing. Euphoria. Judgment and self-control reduced; caution, reason, and memory impaired. Illegal to operate a motor vehicle in some states at this level.
0.10–0.125 [22–27]Significant impairment of motor coordination and loss of good judgment. Speech can be slurred; balance, vision, reaction time, and hearing impaired. Euphoria. Illegal to operate a motor vehicle at this level of intoxication.
0.13–0.15 [28–34]Gross motor impairment and lack of physical control. Blurred vision and major loss of balance. Euphoria reduced, and dysphoria beginning to appear.
0.16–0.20 [35–43]Dysphoria (anxiety, restlessness) predominates; nausea can appear. Drinker has appearance of “sloppy drunk.”
0.25 [54]Needs assistance in walking; total mental confusion. Dysphoria with nausea and some vomiting.
0.30 [65]Loss of consciousness.
⩾0.40 [>87]Onset of coma, possible death caused by respiratory arrest.

BAC, blood alcohol concentration.

aGrams of ethyl alcohol per 100 mL of whole blood.

Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 8th ed. New York: McGraw-Hill, 2012.

Laboratory Tests

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