Alcohol is absorbed through the stomach into the bloodstream. Within minutes, it is distributed throughout the body in the muscles, organs and brain, and peaks over the next 45 to 90 minutes. During that time, the body will metabolize alcohol by breaking it down in the liver with an enzyme called alcohol dehydrogenase. From there, its byproducts can be excreted from the body. This finite rate of removal may vary to some degree from person to person, but as the alcohol is broken down into acetaldehyde and other byproducts, the effects of the alcohol diminish. If the amount of alcohol ingested is greater than can be removed from the body, blood alcohol levels increase along with its effects. For some, these effects may initially be pleasant due to relaxation and reduced inhibitions. But as alcohol levels continue to rise, other functional changes in the brain produce lowered concentration, slurred speech, lessened reflexes and response time as well as poor judgement, coordination and concentration.
Blood alcohol levels can be measured by lab testing. The legal definition of DUI intoxication in Arizona is a blood alcohol concentration of 0.08 percent or more. Personal diversity allows for some people to be more influenced by the effects of alcohol, others less. But ability to perform is not an indication of intoxication, as “it is unlawful for any person who is under the influence of intoxicating liquor or any drugs to drive or be in actual physical control of any vehicle” per ADOT definition.
So how much drinking is too much? There are individuals who may deem themselves as “responsible drinkers”. This means assigning a designated driver, limiting the amount of drinks consumed at an event, not allowing personal compromise from alcohol intake, and not allowing alcohol to control life or relationships. The National Institute on Alcohol Abuse and Alcoholism defines moderate alcohol consumption as up to one drink per day for women and up to 2 drinks per day for men.
Binge drinking is defined at 4 drinks for women and 5 drinks for men on the same occasion over about 2 hours. Binge drinkers are at a high risk of experiencing personal injuries and are 14 more times more likely to drive impaired. They are also more likely to experience sexual compromises, including unintended pregnancy and STDs. And with large quantities consumed in a short time, alcohol poisoning can be a real and fatal consequence.
“Alcohol use disorder” is a medical diagnosis of chronic compulsive alcohol use, loss of control over intake and a negative emotional state when not under the influence. This problem can be seen with people who continue to drink on a daily basis despite the negative impacts of physical or social problems. This pattern of repeated abuse is also associated with chronic disease development. Heart associated diseases include arrhythmias (irregular heartbeats), cardiomyopathy (weakening of the heart muscle), stroke and high blood pressure. Liver diseases include hepatitis, fatty liver and cirrhosis. Alcoholic pancreatitis is an extremely painful inflammation of the pancreas. There is increased risk of cancer of the mouth, esophagus, throat, liver and breast. Alcoholic dementia is the deterioration of memory and destruction of the brain from chronic alcohol exposure.
As April is Alcohol Awareness month, this article is to encourage you reflect upon your drinking habits. Not everyone who abuses alcohol is an alcoholic. In fact, only about one out of ten are. Most individuals at risk from their habits are unaware or in denial. Most alcohol abuse is brought forward by spouse, family or friends. The AUDIT-C is an alcohol screen that can help identify hazardous drinkers or those who have an active disorder. It can be found online at https://www.integration.samhsa.gov/images/res/tool_auditc.pdf. A very quick screening test is the CAGE test: Have you ever felt you should Cut down on your drinking: Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)? An answer of “yes” to two or more is clinically significant. If you think you may have a problem with your drinking, please talk to your Primary Care Provider.
Bradford Croft, DO
East Flagstaff Family Medicine