Drunk Driving (DUI/DWI)

Physiology of Alcohol

A Brief Overview of Alcohol

Alcohol is the most abused drug in the United States.

"Alcohol" is the name given to a family of closely related and naturally-occurring chemicals. Each of the chemicals that is called an "alcohol" is made up of molecules that contain a single oxygen atom and varying numbers of hydrogen and carbon atoms. The simplest alcohol has only one carbon atom and four hydrogen atoms. The next alcohol has two carbons and six hydrogens. The third alcohol has three carbons and eight hydrogens. The next one in the "chain" has one more carbon and two more hydrogen atoms than the one before. That is how the alcohols differ from one another.

Alcohols are molecularly very similar and produce similar effects. They produce intoxicating effects when ingested into the human body. Only one of them is meant for human consumption. However, when ingested in substantial quantities it can cause death.

The ingestible alcohol is known as ethyl alcohol, or ethanol. Its chemical abbreviation is ETOH. The "ET" stands for "ethyl" and the "OH" represents the single oxygen atom and one of the hydrogen atoms, bonded together in what chemists refer to as the "hydroxy radical". Ethanol is the variety of alcohol that has two carbon atoms. Two of ethanol's best known analogs are methyl alcohol (or methanol), commonly called "wood alcohol", and isopropyl alcohol (or isopropanol), also known as "rubbing alcohol".

Ethanol is what interests us, because it is the kind of alcohol that features prominently in impaired driving. Ethanol is beverage alcohol, the active ingredient. in beer, wine, whiskey, liquors, etc. Ethanol production starts with fermentation. That is a kind of decomposition in which the sugars in fruit, grains and other organic materials combine with yeast to product the chemical we call ethanol. This can occur naturally, as yeast spores in the air come into contact with decomposing fruit and grains. However, most of the ethanol in the world didn't ferment naturally, but was produced under human supervision.

When an alcoholic beverage is produced by fermentation, the maximum ethanol content that can be reached is about 14%. At that concentration, the yeast dies, so the fermentation stops. Obtaining a higher ethanol content requires a process called distillation. This involves heating the beverage until the ethanol "boils off", then collecting the ethanol vapor. It is possible to do this because ethanol boils at a lower temperature than does water.

Distilled spirits is the name we give to high-ethanol-concentration beverages produced by distillation. These include rum, whiskey, gin, vodka, etc. The ethanol concentration of distilled spirits usually is expressed in terms of proof, which is a number corresponding to twice the ethanol percentage. For example, an SO-proof beverage has an ethanol concentration of 40 percent.

Over the millennia during which people have used and abused ethanol, some standard-size servings of the different beverages have evolved. Beer, for example, is normally dispensed in 12-ounce.servings. Since beer has an ethanol concentration of about four percent, the typical bottle or can of beer contains a little less than one-half ounce of pure ethanol. A standard glass of wine has about four ounces of liquid. Wine is about 12 percent alcohol, so the glass of wine also has a bit less than one-half ounce of ethanol in it. Whiskey and other distilled spirits are dispensed by the "shot glass", usually containing about one and one-quarter ounce of fluid. At a typical concentration of forty percent ethanol (80-proof), the standard shot of whiskey has approximately one-half ounce of ethanol. Therefore, as far as their alcoholic contents are concerned, a can of beer, a glass of wine and a shot of whiskey are all the same.

Physiologic Processes

Ethanol is a Central Nervous System Depressant. It doesn't affect a person until it gets into their central nervous system, i.e., the brain, brain stem and spinal cord. Ethanol gets to the brain by getting into the blood. In order to get into the blood, it has to get into the body.

There are actually a number of different ways in which ethanol can get into the body. It can be inhaled. Ethanol fumes, when taken into the lungs, will pass into the bloodstream and a positive blood alcohol concentration (BAC) will develop_

However, prolonged breathing of fairly concentrated fumes would be required to produce a significantly high BAC. Ethanol could also be injected, directly into a vein; it would then flow with the blood back to the heart, where it would be pumped first to the lungs and then to the brain. And, it could be inserted, as an enema, and pass quickly from the large intestine into the blood. But none of these methods are of any practical significance, because alcohol is almost always introduced into the body orally, i.e., by drinking.

Absorption

Once the ethanol gets into the stomach, it has to move into the blood. The process by which this happens is known as absorption. One very important fact that pertains to alcohol absorption is that it doesn't have to be digested in order to move from the stomach to the blood. Another very important fact is that alcohol can pass directly through the walls of the stomach. These two facts, taken together, mean that—under the right circumstances—absorption of alcohol can he accomplished fairly quickly. The ideal circumstance for rapid absorption is to drink on an empty stomach.

When the alcohol enters the empty stomach, about 20 percent of it will make its way directly through the stomach walls. The remaining 80 percent will pass through the base of the stomach and enter the small intestine, from which it is readily absorbed into the blood. Because the body doesn't need to digest the alcohol before admitting it into the bloodstream, the small intestine will be open to the alcohol as soon as it hits the stomach.

But what if there is food in the stomach? Suppose the person has had something to eat shortly before drinking, or eats food while drinking; will that affect the absorption of alcohol?

Yes it will. Food has to be at least partially digested in the stomach before it can pass to the small intestine. When the brain senses that food is in the stomach, it commands a muscle at the base of the stomach to constrict, and cut off the passage to the small intestine. The muscle is called the pylorus, or pyloric valve. As long as it remains constricted, little or nothing will move out of the stomach and into the small intestine. If alcohol is in the stomach along with the food, the alcohol will also remain trapped behind the pylorus. Some of the alcohol trapped in the stomach will begin to break down chemically before it ever gets into the blood. In time, as the digestive process continues, the pylorus will begin to relax, and some of the alcohol and food will pass through. But the overall effect will be to slow the absorption significantly. Because the alcohol only slowly gets into the blood, and because the body will continue to process and eliminate the alcohol that does manage to get in there, the drinker's BAC will not climb as high as it would have if he or she had drunk on an empty stomach.

Distribution

Once the alcohol moves from the stomach into the blood, it will be distributed throughout the body by the blood. Alcohol has an affinity for water. The blood will carry the alcohol to the various tissues and organs of the body, and will deposit the alcohol in them in proportion to their water contents. Brain tissue has a fairly high water content, so the brain receives a substantial share of the distributed alcohol. Muscle tissue also has a reasonably high water content, but fat tissue contains very little water. Thus, very little alcohol will be deposited in the drinker's body fat. This is one factor that differentiates alcohol from certain other drugs, notably PCP and THC, which are very soluble in fat.

The affinity of alcohol for water, and its lack of affinity for fat, helps explain an important difference in the way alcohol affects women and men. Pound for pound, the typical female's body contains a good deal less water than does the typical man's. This is because women have additional adipose (fatty) tissue, designed in part to protect a child in the womb. A Swedish pioneer in alcohol research, E.M.P. Widmark, determined that the typical male body is about 68% water, the typical female only about 55%. Thus, when a woman drinks, she has less fluid—pound for pound—in which to distribute the alcohol.

If a woman and a man who weighed exactly the same drank exactly the same amount of alcohol under the same circumstances, her BAC would climb higher than his. When we couple this to the fact that the average woman is smaller than the average man, it becomes apparent that a given amount of alcohol will cause a higher BAC in a woman than it usually will in a man.

Elimination

As soon as the alcohol enters the blood stream, the body starts trying to get rid of it. Some of the alcohol will be directly expelled from the body chemically unchanged. For example, some alcohol will leave the body in the breath, in the urine, in sweat, in tears, etc. However, only a small portion (about 2-10%) of the ingested alcohol will be directly eliminated.

Most of the alcohol a person drinks is eliminated by metabolism. Metabolism is a process of chemical change. In this case, alcohol reacts with oxygen in the body and changes, through a series of intermediate steps, into carbon dioxide and water, both of which are directly expelled from the body.

Most of the metabolism of alcohol in the body takes place in the liver. An enzyme known as alcohol dehydrogenase acts to speed up the reaction of alcohol with oxygen. The speed of the reaction varies somewhat from person to person, and even from time to time for any given person. On the average, however, a person's blood alcohol concentration—after reaching peak value—will drop by about 0.015 per hour. For example, if the person reaches a maximum BAC of 0.15, it will take about ten hours for the person to eliminate all of the alcohol.

For the average-sized male, a BAC of 0.015 is equivalent to about two-thirds of the alcohol content of a standard drink (i.e., about two-thirds of a can of beer, or glass of wine or shot of whiskey). For the average-sized female, that same BAC would be reached on just one-half of a standard drink. So the typical male will eliminate about two-thirds of a drink per hour, while the typical female will burn up about one-half of a drink in that hour.

We can control the rate at which alcohol enters our bloodstream; For example, we can gulp down our drinks, or slowly sip them. We can drink on an empty stomach, or we can take the precaution of eating before drinking. We can choose to drink a lot, or a little. But once the alcohol gets into the blood, there is nothing we can do to affect how quickly it leaves. Coffee won't accelerate the rate at which our livers burn alcohol. Neither will exercise, or deep breathing, or a cold shower. We simply have to wait for the process of metabolism to move along at its own speed.

Dose-Response Relationships

People sometimes ask, "how 'high' is 'drunk'?" What is the "legal limit" for "drunk driving"? How much can a person drink before becoming "impaired"?

There is no simple answer to these or similar questions, except to say that any amount of alcohol will affect a person's ability to drive to some degree. It is true that the laws of nearly all States establish a BAC limit at which it is explicitly unlawful to operate a vehicle. In most cases, that "limit" is either 0.08 or 0.10 BAC. But every State also makes it unlawful to drive when "under the influence" of alcohol, and the law admits the possibility that a particular person may be under the influence at much lower BACs.

How much alcohol does someone have to drink to reach these kinds of BACs? Obviously, as we've already seen, it depends on how much time the person spends drinking, on whether the person is a man or a woman, on how large the person is, on whether the drinking takes place on an empty stomach, and on certain other factors. But let's take as an example a 175-pound man. If he drinks two beers, or two shots of whiskey, in quick succession on an empty stomach, his BAC will climb to slightly above 0.04. Two more beers will boost him above 0.08. One more will push him over 0.10. In one respect, then, it doesn't take very much alcohol to impair someone: "a couple of beers" can do it.

But in another respect, when we contrast alcohol with virtually any other drug, we find that impairment by alcohol requires a vastly larger dose than does impairment by the others. Consider exactly what a BAC of 0.08 means. Blood alcohol concentration is expressed in terms of the "number of grams of alcohol in every 100 milliliters of blood". When we find that a person has a BAC of 0.08, that means that there is one-eighth (0.08) of a gram of alcohol in any given 100 milliliter sample of blood. One-eighth of a gram is equal to one hundred milligrams (a milligram is one-thousandth of a gram). So, at a BAC of 0.08, the person has 100 milligrams of alcohol in every 100 milliliters of blood, or exactly one milligram per milliliter. If a person has a BAC of 0.08 it means there are 0.08 grams of pure ethanol in every 100 milliliter ("percent") of his/her blood.

Note: The term BAC is used in the manual. However, it should be understood to refer to either Blood Alcohol Concentration (BAC) or Breath Alcohol Concentration (BrAC) depending on the legal requirements of the jurisdiction.

Source: NHTSA.