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Substance-Related Disorders: Alcohol

SOURCE

Source: Doering PL, Li RM. Substance-related disorders II: alcohol, nicotine, and caffeine. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146064353. Accessed April 13, 2017.

DEFINITION

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

PATHOPHYSIOLOGY

  • Alcohol absorption begins in the stomach within 5–10 min of ingestion.

  • Peak concentrations usually achieved 30–90 min 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, 5 oz of nonfortified 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 a 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.

EPIDEMIOLOGY

  • Approximately half of Americans (approximately 136.9 million people) aged 12 or older reported being current drinkers of alcohol according to a 2013 survey (NSDUH).

    • 22.9% participated in binge drinking.

    • 6.3% (16.5 million) reported heavy drinking.

CLINICAL PRESENTATION

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.aSpecific 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 ...

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