I got alcohol poisoning as a teenager. I would tell you about it, but frankly I don’t remember it. I have recollections of laughing and foul-tasting gin. Next, I woke up in a hospital room with all sorts of tubes and monitors attached to me.
Most cases of alcohol poisoning are brought on by binge drinking. Binge drinking is episodic drinking, during which large amounts of alcohol are consumed in a short period of time.
Austin excels at this. Our binge drinking rates outrank every other Texas city.
In 2015, the 78701 zip code was named the best neighborhood to find a bar…in the country. 78701 had the highest number of bars per capita in the entire country; roughly one bar for every 67 people. In 2017, Austin was named the 5th most drunken city in the US, beating New Orleans and Las Vegas.
So, we know how to drink, but why don’t we understand how to moderate? This is of course a problem across the nation, with alcohol ranking 3rd for preventable deaths.
What is moderate drinking?
Moderate drinking, (low-risk drinking) provides parameters for safer drinking. For men, this equates to 3-4 drinks per day, no more than 14 per week. For women, no more than 3 drinks per day, no more than 7-8 per week. But, before you fill up your Solo cup or your Yeti tumbler, let’s define “drink”. Drinks are standardized by beverage unit, or BU.
· Beer: 12 ounces (oz), at approximately 5% alcohol by volume (ABV)
· Malt liquor: 8 oz, at approximately 7% ABV
· Wine: 5 oz, at approximately 12% ABV
· Distilled spirits: 1.5 oz, at approximately 40% ABV
Alcohol effects on the brain and body
Morphine has been referred to as a “chemical scalpel”, having a very precise effect on one neurotransmitter system. Alcohol is more like a pharmacological hand grenade. Alcohol affects more organ systems than any other drug, including our brain, liver, heart, stomach and digestive tract and the pancreas.
When we drink, alcohol passes through our digestive tract and is absorbed into the blood stream through the intestines. Then, it passes through the liver before reaching your brain. However, the first drink skips the intestine. Therefore, the first drink tends to hit us the fastest, especially if we have not eaten.
Alcohol is a depressant. It depresses our cortex, where we do our thinking. Thus, when we drink, we are more likely to take chances and use poor judgment. Our pleasure pathway is engaged, leading to the euphoric high of alcohol. Loss of inhibitions is one of the beginning stages of intoxication.
Other depressant effects include slurred speech, unsteady movement, and delayed reaction times.
The body and how it breaks down alcohol
92-98% of the alcohol we consume is metabolized and the remainder is lost through sweat and urine. It takes most people about an hour to metabolize a drink. When we drink faster, the additional alcohol accumulates in the blood and body tissues, resulting in higher blood alcohol concentrations and more intoxication.
Alcohol dehydrogenase (ADH) breaks down some of the alcohol in our stomach and liver before it is absorbed in our blood. Women have less of this enzyme than men. If a male and female of the same weight consume the same amount, under the same circumstances, the woman (on average) will have a higher BAC (blood alcohol content). ADH declines with age, so the elderly are more likely to become intoxicated on smaller doses of alcohol.
Other considerations for how quickly or slowly alcohol is metabolized include, how much food has been consumed, other licit or illicit drugs in the system, amount of sleep, etc.
Alcohol overdose (or poisoning) occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions shut down. This includes our breathing, heart rate and temperature control.
A lethal half dose (LD50) is defined as the dose in which half of the test subjects die. For alcohol, the LD50 is a BAC of 0.45. Inexperienced drinkers are most likely to suffer alcohol poisoning. (I will attest to this.)
Taking other central nervous system depressants while drinking increases the risk of alcohol poisoning and decreases the amount of alcohol needed to reach a dangerous level. These may include benzodiazepines, opioids, and sleep medications.
Alcohol irritates the stomach, causing people to vomit. In some cases, this can prevent alcohol poisoning. However, our gag reflex may be suppressed since alcohol is a central nervous system depressant. This may prevent vomiting or cause a person to choke on their vomit. Further, vomiting does nothing to excrete the surplus alcohol from the blood stream or small intestine.
Signs and symptoms of an alcohol overdose
· Passing out (unconsciousness) and cannot be awakened
· Slow breathing (less than eight breaths a minute)
· Irregular breathing (a gap of more than 10 seconds between breaths)
· Slow heart rate
· Skin that is clammy, blue-tinged or pale
· Low body temperature (hypothermia)
What to do if you suspect someone has alcohol poisoning
People will respond differently during alcohol poisoning. Someone does not have to show all those signs to need emergency help.
· Call 911.
· If the person is conscious and you are not sure what to do, you can call 800.222.1222 to be connected to poison control. They can help determine if the person should be taken to the hospital.
· Never leave an unconscious person alone and never assume they will “sleep it off”
· Help someone who is vomiting—sit them up or ensure their head is turned to the side if they are lying down.
Concerns of alcohol poisoning should always be taken seriously.
Changing your drinking
Though legal, alcohol is a psychoactive drug. Therefore, it has dangers and risks just like any drug. If you want to reduce harm when drinking, practice moderation, or abstain, Substance Use Therapy is here to support you.
Anderson, K. (2010). How to Change Your Drinking. HAMS Harm Reduction Network.
Denning, P., & Little, J. (2017). Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. The Guilford Press.
Erickson, C. (2007). The Science of Addiction: From Neurobiology to Treatment. W.W. Norton & Company.
Kuhn, C., Swartzwelder, S., & Wilson, W. (2019). Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy. W.W. Norton & Company.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.