People use alcohol to feel pleasure, decrease anxiety, decrease inhibitions, and
to relax. In the later stage of alcohol dependence, alcohol may
be consumed to decrease uncomfortable withdrawal symptoms.

An intoxicated person will show certain signs and symptoms depending on
the level of alcohol in their blood, which is measured as a percentage of
alcohol present in the individual’s bloodstream.

Signs and Symptoms by Blood Alcohol Concentrations (BAC):

.02 - .09 Loss of muscular coordination
.10 -.19 Neurological and mental impairment, prolonged reaction time, 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.

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
.30.

Withdrawal

Alcohol is a depressant that affects all parts of the body. Alcohol withdrawal can start at 6-60 hours after the last drink. Signs and symptoms include tremors, nausea, decreased appetite, anxiety, weakness, insomnia, inattention, flushed face, redness of eyes and increase in reflexes.

Persistent mild withdrawal is characterized by an individual 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 remains sober.

The treatment of withdrawal may require the use of medication. However, the individual must always be evaluated for other illnesses or injuries first. Treatment of withdrawal only helps the body to repair
itself, but for recovery, the person needs to continue with substance abuse treatment.

Withdrawal may be complicated by illusions, hallucinations and seizures. Illusions are misinterpretations of the surroundings are reported by about 25% of patients who report for treatment of the withdrawal. Hallucinations are less common and are described as feeling something, smelling something or seeing something. In all cases, the perception is not real. The individual who presents with these symptoms has otherwise a clear mental status and is upset by the illusion or hallucination.

Seizures, or “rum fits,” as they were called in the past, tend to be a part severe withdrawal; An individual may complain of heightened light sensitivity during the period when he is most vulnerable to a seizure occurrence. Thirty percent of those who have withdrawal seizures go onto delirium tremens (DTs). Complicated withdrawal can be accompanied by delirium tremens if are other symptoms present including: tremors, restlessness, agitation and increased reflexes, increased heart rate and blood
pressure, profuse sweating, 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. DT’s should always be treated as an emergency and in an in-patient setting.
The mortality of untreated DT’s is 10 -15%. If treated, the mortality is 1 – 2%

What is a Hangover?

Alcohol Hangover, or Veisalgia, is derived from the Norwegian and the Greek words “uneasiness” and “pain”.

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
problems.

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
coma.

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.