Alcohol is a depressant that affects all parts of the body. People use
alcohol to feel pleasure, decrease anxiety and sexual inhibitions, and
often to relax. (In the later stage of alcohol dependence, alcohol may
be ingested to decrease uncomfortable withdrawal symptoms.) An
intoxicated person will show certain signs and symptoms depending on
the level of alcohol in their blood (measured as a percentage of
alcohol present in the individual’s bloodstream). For example, a
person with a blood alcohol level greater than .15, who shows no signs
or symptoms of intoxication, is usually alcohol-dependent, as is
someone who can actually drink enough to reach levels greater than
Signs and Symptoms by Blood Alcohol Concentrations (BAC):
- .02 – .09: Loss of muscular coordination
- .10 -.19: Neurological impairment, impaired gait, prolonged reaction time, mental impairment and lack of coordination.
- .20 – .29: Nausea, vomiting, worsening gait and impairment
- .30 – .39: Decrease in body temperature, difficulty speaking, amnesia, stupor
- .40 >: Coma
Alcohol is broken down in the stomach and by the liver at a rate of
1/3 of an ounce per hour. One beer will raise the blood alcohol level
.015. Therefore, 3 beers consumed in one hour will result in a blood
alcohol level of about .045. The alcohol level drops by .015 per hour.
Signs and Symptom of Withdrawal
Alcohol withdrawal can start at 6-60 hours after the last drink.
Signs and symptoms of withdrawal include tremors, nausea, decreased
appetite, anxiety, weakness, insomnia, inattention, flushed face,
redness of eyes and increase in reflexes.
The treatment of withdrawal requires support and the occasional use of
medication. The patient must always be evaluated for other illnesses
or injuries. Treatment of withdrawal only helps the body to repair
itself, but for recovery, the patient must enter into continuing
Withdrawal may be complicated by illusions, hallucinations and
seizures. Illusions are misinterpretations of the surroundings and
effect up to 25% of withdrawal patients. For example, the patient may
think he/she sees wavy lines at the corners of walls. Hallucinations
are less common and are described as tactile (feeling something),
olfactory (smelling something) or visual (seeing something). In all
cases, the perception is not real. The patient has a clear mental
status and is upset by the illusion or hallucination.
Seizures, or “rum fits,” as they were called in the past, are usually
singular; only 25% are multiple. The patient may complain of
heightened light sensitivity during the period when he/she is most
vulnerable to a seizure occurrence. Thirty percent (30%) of patients
that have withdrawal seizures go onto delirium tremens (DTs).
Complicated withdrawal can be accompanied by delirium tremens if there
is motor hyperactivity (tremors, restlessness, agitation and increased
reflexes), autonomic hyperactivity (increased heart rate and blood
pressure, profuse sweating and dilated pupils), profound confusion,
disorientation, hallucinations and paranoid delusions. The risk of
delirium tremens is increased if the patient has a blood alcohol level
greater than .30 or withdrawal seizures. The mortality of untreated
DT’s is 10 -15%. If treated, the mortality is 1 – 2%. DT’s should
always be treated as an emergency and in an intensive care-like
Persistent mild withdrawal is characterized by a patient complaining
of sleep disturbances, a mild tremor, anxiety and depression. This can
last for weeks or months after the last drink. It will get better if
the person stays sober.
What is a Hangover?
Possible medical causes of hangover include: dehydration, inflammation
caused by the release of cytokines from white blood cells, build up of
acetaldehyde, decreased glucose and the hyper-excitable state of the
brain the day after drinking. This state happens because alcohol
suppresses brain activity and then there is a rebound – hyperactivity.
The symptoms of a hangover include:
- headaches (66%)
- poor sense of well-being (60%)
- poor appetite (21%), tremors (20%)
- fatigue (20%) and nausea (9%)
- increased heart rate
- impairment of thinking and visual-spatial relationships
- lightheadedness and dizziness upon arising
Hangovers have a significant economic impact. There is an increased
risk for injury and poor job performance from decreased visual-spatial
skills, decreased dexterity, decreased management skills and decreased
task completion. It has been reported that 29% of all college students
have lost school time awaiting hangover recovery.
Medical Consequences of Alcohol Abuse
Nervous system: Too much alcohol can cause insomnia, night terrors and
frequent awakening. Long-term alcohol abuse can lead to chronic
organic brain syndrome (fatigue, anxiety, depression, memory loss and
confusion), cerebellar degeneration (loss of tissue in the part of the
brain that controls fine movements); optic neuropathy (damage to the
optic nerve that can cause loss of vision, blurred vision and loss of
color vision); strokes from increased blood pressure and increased
blood clotting and blackouts (short-term memory loss).
Lungs: Because it suppresses the cough reflex, stomach contents can be
aspirated into the lungs. White blood cells function poorly; pneumonia
and TB can occur. The use of cigarettes can compound respiratory
Heart: Since long-term alcohol abuse can cause arrhythmia (irregular
heartbeat), it can lead to more serious heart problems. Longer-term
consumption may result in alcohol cardiomyopathy or heart failure.
Cocaine and alcohol used together can increase blood pressure.
Liver: One-fifth of alcoholics develop significant liver disease, most
commonly seen as a “fatty liver.” Liver enzymes must be measured to
determine diagnosis. Alcohol hepatitis is a more serious inflammation
of the liver and causes nausea, vomiting, anorexia, abdominal pain on
the upper right side and intermittent fever and jaundice and can lead
to cirrhosis (scarring and fibrosis of the liver). Symptoms include
all those previously noted, as well as gynecomasta (enlarged breasts),
testicular atrophy, ascites (fluid on abdomen), poor clotting,
esophageal varices (dilated veins in the esophagus), confusion and
Stomach: Alcohol can affect the esophagus by increasing acid
production in the stomach and causing heartburn and reflux. If very
severe, the esophagus can rupture and contents of the stomach may go
into the chest cavity. Alcohol can cause erosive gastritis and ulcers.
Forty percent of all pancreatitis (inflammation of the pancreas) is
caused by alcohol. It can cause abdominal pain, nausea, vomiting and
diarrhea. Lack of pancreatic enzymes leads to non-absorbed fat and
sugar in the small intestines which causes diarrhea and malnutrition.
Skeleton: Alcohol can decrease potassium and phosphate levels,
inhibit the use of carbohydrates by the muscle and cause alcohol
myopathy (discomfort in the extremities, muscular pain, muscle
tenderness, muscle edema and swelling). Alcohol can also affect the
calcium metabolism in the bones, causing osteoporosis.
Skin: Consequences of alcohol use include premature aging, severe
itching, palmar erythema (red palms) and spider angiomata (dilated
blood vessels on the chest).
Other medical effects include: breast enlargement in men at the
end-stage of liver disease, testicle atrophy (small testicles),
peripheral neuropathy (numbness and tingling in hands and feet),
depressed bone marrow and impotence.
source of information:
Principles of Addiction Medicine (2nd edition); American Society of
OASAS Addiction Medicine website: http://www.oasas.state.ny.us/
National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/
National Institute on Drug Abuse: http://www.nida.nih.gov/