Alcohol Absorption Dominated by Small Intestine Diffusion

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Alcohol is absorbed from all parts of the gastrointestinal tract largely by simple diffusion into the blood. However the small intestine is by far the most efficient region of the gastrointestinal tract for alcohol absorption because of its very large surface area. In a fasting individual, it is generally agreed that 10% to 20% of a dose of alcohol is absorbed from the stomach (the volume of alcohol affects the absorption) and 75% to 80% is absorbed from the small intestine. Because of this peak blood alcohol concentrations are achieved in fasting people within 0.

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5 to 2.

0 hours, (average 0. 75 - 1. 35 hours depending upon dose and time of last meal) while non-fasting people exhibit peak alcohol concentrations within 1. 0, and in extreme cases up to as much as 4. 0 hours (average 1. 06 - 2. 12 hours). Because it is distributed so quickly and thoroughly the alcohol can affect the central nervous system even in small concentrations. In low concentrations, alcohol reduces inhibitions. As blood alcohol concentration increases, a person's response to stimuli decreases markedly, speech becomes slurred, and he or she becomes unsteady and has trouble walking.

With very high concentrations - greater than 0. 35 grams/100 milliliters of blood (equivalent to 0. 35 grams/210 liters of breath ) - a person can become comatose and die. The American Medical Association has defined the blood alcohol concentration level of impairment for all people to be 0. 04 grams/100 milliliters of blood (equivalent to . 04 grams/210 liters of breath). The following is a generally accepted guide to the effects of alcohol.

Distribution Alcohol has a high affinity for water and is therefore found in body tissues and fluids inasmuch as they contain water.

Absorbed alcohol is rapidly carried throughout the body in the blood and once absorption of alcohol is complete an equilibrium occurs such that blood at all points in the system contains approximately the same concentration of alcohol. Elimination The liver is responsible for the elimination - through metabolism - of 95% of ingested alcohol from the body. The remainder of the alcohol is eliminated through excretion of alcohol in breath, urine, sweat, feces, milk and saliva.

The body uses several different metabolic pathways in its oxidation of alcohol to acetaldehyde to acetic acid to carbon dioxide and water. Healthy people metabolize alcohol at a fairly consistent rate. As a rule of thumb, a person will eliminate one average drink or . 5 oz (15 ml) of alcohol per hour. Several factors influence this rate. The rate of elimination tends to be higher when the blood alcohol concentration in the body is very high. Also chronic alcoholics may (depending on liver health) metabolize alcohol at a significantly higher rate than the average.

Finally, the body's ability to metabolize alcohol quickly tend to diminish with age. Body Weight and Body Type In general, the less you weigh the more you will be affected by a given amount of alcohol. As detailed above, alcohol has a high affinity for water. Basically one's blood alcohol concentration is a function of the total amount of alcohol in one's system divided by total body water. So for two individuals with similar body compositions and different weights, the larger individual will achieve lower alcohol concentrations than the smaller one if ingesting the same amount of alcohol.

However, for people of the same weight, a well muscled individual will be less affected than someone with a higher percentage of fat since fatty tissue does not contain very much water and will not absorb very much alcohol. Rate Of Consumption Blood alcohol concentration depends on the amount of alcohol consumed and the rate at which the user's body metabolizes alcohol. Because the body metabolizes alcohol at a fairly constant rate (somewhat more quickly at higher and lower alcohol concentrations), ingesting alcohol at a rate higher than the rate of elimination results in a cumulative effect and an increasing blood alcohol concentration.

Alcohol Content It's not how many drinks that you have, but how much alcohol that you consume. The concentration of the drinks that one ingest can have a slight effect on the peak alcohol concentration due to the differences in absorption rate of different concentrations of alcohol. Alcohol is most rapidly absorbed when the concentration of the drink is between 10% and 30%. Below 10% the concentration gradient in the gastrointestinal tract is low and slows absorption and the added volumes of liquid involved slow gastric emptying.

On the other hand concentrations higher than 30% tend to irritate the mucous membranes of the gastrointestinal tract and the pyloric sphincter, causing increased secretion of mucous and delayed gastric emptying. Food Food taken along with alcohol results in a lower, delayed blood alcohol concentration peak (the point of greatest intoxication). There are two major factors involved in this phenomenon. First, because alcohol is absorbed most efficiently in the small intestine, the ingestion of food can slow down the absorption of alcohol into one's system.

The pyloric valve at the bottom of the stomach will close in order to hold food in the stomach for digestion and thus keep the alcohol from reaching the small intestine. While alcohol will be absorbed from the stomach it is a slower and less efficient transition. Second and equally important is the fact that alcohol elimination rates are inversely proportional to alcohol concentration in the blood. Therefore the suppressed levels of alcohol due to food ingestion cause the body to eliminate the alcohol that is absorbed at a faster rate.

The type of food ingested (carbohydrate, fat, protein) has not been shown to have a measurable influence on this affect but the larger the meal and closer in time between eating and drinking, the greater the diminution of peak alcohol concentration. Studies have shown reductions in peak alcohol concentration (as opposed to those of a fasting individual under otherwise similar circumstances) of 9% to 23%. Medication If you are taking any medication, it could increase the effects of alcohol.

You should always consult your physician or the medical information that accompanies the medication when drinking alcohol in conjunction with any medication. Fatigue Fatigue causes many of the same symptoms that are caused by alcohol intoxication. These and other symptoms will be amplified if alcohol intoxication is concurrent with fatigue. Tolerance Tolerance is the diminution of the effectiveness of a drug after a period of prolonged or heavy use of that drug or a related drug (cross-tolerance).

There are at least two types of tolerance at work with alcohol. The first is metabolic tolerance in which the alcohol is metabolized at a higher rate (up to two times as quickly) in chronic users. Because of the higher metabolic rate for alcohol lower peak blood alcohol concentrations are achieved by chronic alcohol users than the average drinker when the same amount of alcohol is ingested. The second is functional tolerance in which there is an actual change in the organ or system's sensitivity to the drug.

Studies have shown that chronic alcohol users can have twice the tolerance for alcohol as an average person. It is important to note however that even in light of these tolerance factors, it has been shown conclusively that even in heavy alcohol users functional impairment is clearly measurable at the blood alcohol concentration levels that are currently used for traffic law enforcement and safety sensitive job performance. Gender Differences As outlined above in the section on Body Weight and Body Type different body types coincide with different body water percentages.

In general, but by no means in all cases, women tend to have a higher percentage of body fat and thus a lower percentage of body water. Therefore, in general, if a man and a woman of the same weight ingest the same amount of alcohol the woman will tend to achieve a higher alcohol concentration. This, of course, would not be true if the woman was very fit and the man was somewhat obese, but on average, this is the case. Furthermore, total body water tends to decrease with age, so an older person will also be more affected by the same amount of alcohol.

According to the table below the differences in alcohol concentration due to average body composition differences based on gender would be between 16% and 10% depending on age. ________________________________________ Average Total Body Water as a function of Sex and Age AgeMaleFemale 18 to 4061%52% over 6051%46% ________________________________________ Another gender based difference is in the elimination of alcohol. Although not explained, studies appear to show that women eliminate alcohol from their bodies at a rate 10% greater than that of men.

Alcoholism and alcohol abuse Alcoholism (alcohol dependence) and alcohol abuse are two different forms of problem drinking. •Alcoholism is when you have signs of physical addiction to alcohol and continues to drink, despite problems with physical health, mental health, and social, family, or job responsibilities. Alcohol may control your life and relationships. •Alcohol abuse is when your drinking leads to problems, but not physical addiction. Causes, incidence, and risk factors There is no known cause of alcohol abuse or alcoholism.

Research suggests that certain genes may increase the risk of alcoholism, but which genes and how they work are not known. How much you drink can influence your chances of becoming dependent. Those at risk for developing alcoholism include: •Men who have 15 or more drinks a week •Women who have 12 or more drinks a week •Anyone who has five or more drinks per occasion at least once a week One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor. You have an increased risk for alcohol abuse and dependence if you have a parent with alcoholism.

You may also be more likely to abuse alcohol or become dependent if you: •Are a young adult under peer pressure •Have depression, bipolar disorder, anxiety disorders, or schizophrenia •Have easy access to alcohol •Have low self-esteem •Have problems with relationships •Live a stressful lifestyle •Live in a culture alcohol use is more common and accepted Alcohol abuse is rising. Around 1 out of 6 people in the world have a drinking problem. Symptoms People who have alcoholism or alcohol abuse often: •Continue to drink, even when health, work, or family are being harmed •Drink alone.

•Become violent when drinking •Become hostile when asked about drinking •Are not able to control drinking -- being unable to stop or reduce alcohol intake •Make excuses to drink •Miss work or school, or have a decrease in performance because of drinking •Stop taking part in activities because of alcohol •Need to use alcohol on most days to get through the day •Neglect to eat or eat poorly •Do not care about or ignore how they dress or whether they are clean •Try to hide alcohol use •Shake in the morning or after periods when they have not a drink

Symptoms of alcohol dependence include: •Memory lapses after heavy drinking •Needing more and more alcohol to feel "drunk" •Alcohol withdrawal symptoms when you haven't had a drink for a while •Alcohol-related illnesses such as alcoholic liver disease Signs and tests The health care provider will perform a physical exam and ask questions about your medical and family history, including use of alcohol. The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence: •Do you ever drive when you have been drinking?

•Do you have to drink more than before to get drunk or feel the desired effect? •Have you felt that you should cut down on your drinking? •Have you ever had any blackouts after drinking? •Have you ever missed work or lost a job because of drinking? •Is someone in your family worried about your drinking? Tests that may be done include: •Blood alcohol level (this can tell whether someone has recently been drinking alcohol, but it does not necessarily confirm alcoholism) •Complete blood count (CBC) •Liver function tests.

•Magnesium blood test Medical Illness Associated With Chronic Alcohol Abuse DisorderIllness MetabolicAlcoholic ketoacidosis, alcoholic hypoglycemia, water and salt disorders NeurologicChronic problems with thinking such as Wernicke's encephalopathy and Korsakoff's psychosis, alcoholic cerebellar degeneration, and central pontine myelinolysis leading to problems walking and other motor activities, acute and chronic dementia, alcoholic peripheral neuropathy MuscularAcute and chronic alcoholic muscle weakness.

GastrointestinalFatty liver, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis, poor pancreatic function, gastroesophageal reflux, esophageal carcinoma, erosive gastritis, chronic diarrhea, malabsorption, esophageal varices leading to bleeding into the GI tract Metabolic-endocrineHigh cholesterol, high levels of uric acid, low testosterone levels, impotence, testicular atrophy, gynecomastia, irregular menstrual periods, reversible Cushing's syndrome BloodAnemia due to poor production of blood cells or slow intestinal bleeding, poor white cell production, destruction of platelets, blood too thin to clot properly.

CardiacDecreased cardiac function, arrhythmias, dilated cardiomyopathy, high blood pressure PulmonaryIncreased incidence of pneumonia, increased incidence of tuberculosis OtherIncreased incidence of severe intestinal infections, fetal alcohol syndrome, vitamin deficiency syndromes, trauma, sexual dysfunction, insomnia Social Problems Associated With Alcohol Abuse Accidental death and injury50% of fatal car crashes 25-fold increased risk of falls or drowning 50% of fire-related burns or deaths 20% to 30% of trauma seen in emergency rooms.

CrimeFrequently involved in violent crime SuicideInvolved in up to 35% of suicides Economic cost$148 billion annually (estimated); 15% for health care and treatment OtherAssociated with increased rates of spouse or child abuse and increased spread of sexually transmitted diseases Treatment Completely stopping the use of alcohol is the ideal goal of treatment. This is called abstinence. A strong social network and family support are important in achieving this. Completely stopping and avoiding alcohol is difficult for many people with alcoholism.

There will be times when it is difficult. You should aim to avoid drinking for as long as possible. Some people who abuse alcohol may be able to simply reduce the amount they drink. This is called drinking in moderation. If this method does not work, you should try to quit drinking completely. DECIDING TO QUIT Many people with alcohol problems do not recognize when their drinking gets out of hand. The ideal approach to treatment is to help the person realize how much their alcohol use is harming their life and those around them.

Studies find that more people with alcohol problems opt for treatment when their family members or employers are honest with them about their concerns, and try to help them see that drinking is preventing them from reaching their goals. Withdrawal from alcohol is best done in a controlled, supervised setting. Complications from withdrawal can be life threatening. For more information, see: Alcohol withdrawal Your health care provider should order blood and urine tests to check for health problems that are common in people who abuse alcohol. LONG-TERM SUPPORT

Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer: •Counseling and therapy to discuss alcoholism and its effects and how to control your thoughts and behaviors •Mental health support •Medical care You may be treated in a special recovery center (inpatient), or you may attend a program while you live at home (outpatient). Medications are sometimes prescribed to prevent you from drinking again. •Acamprosate is a drug that has been shown to lower relapse rates in those who are alcohol dependent.

•Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug. •Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injectable form. You cannot take these medications if you are pregnant or have certain medical conditions. The medications are often used with long-term treatment with counseling or support groups. Depression or other mood or anxiety disorders may be noticed after you stop drinking. These should be promptly treated. It is important that the patient has a living situation that supports their need to avoid alcohol.

Some programs offer housing options for people with alcoholism or alcohol abuse. Support Groups Support groups are available to help people who are dealing with alcoholism. ALCOHOLICS ANONYMOUS (AA) Alcoholics Anonymous (AA) is a self-help group of recovering alcoholics that offers emotional support and specific steps for people recovering from alcohol dependence. The program is commonly called a "12-step" approach. There are local chapters throughout the United States. AA offers help 24 hours a day and teaches that it is possible to participate in social functions without drinking.

AL-ANON Family members of a person with an alcohol abuse problem often need counseling. Al-Anon is a support group for partners and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of people with alcoholism. OTHER SUPPORT GROUPS Several other support groups are available. •SMART recovery teaches you have to change your thoughts and behaviors to help people with alcoholism recover. •LifeRing recovery and SOS are two nonreligious programs that offer support for people with alcohol abuse.

•Women for Sobriety is a self-help group just for women. Moderation Management is a program for those who want to reduce how much they drink. It recommends abstinence for people who cannot do this. Expectations (prognosis) How well a person with alcoholism or alcohol abuse does depends on whether or not they can stop drinking. Alcoholism is a major social, economic, and public health problem. Problem drinking can affect every part of a person's life. If you have an alcohol problem, abstinence can help improve your mental and physical health and possibly, your relationships.

Treatment programs can help you quit. However, drinking again after treatment is common. It is important to have a good support system. Complications Alcoholism and alcohol abuse can increase your risk of many health problems, including: •Bleeding in the digestive tract •Brain cell damage •Brain disorder called Wernicke-Korsakoff syndrome •Cancer of the esophagus, liver, colon, and other areas •Changes in the menstrual cycle (period) •Delirium tremens (DT's) •Dementia and memory loss •Depression and suicide •Erectile dysfunction •Heart damage •High blood pressure.

•Inflammation of the pancreas (pancreatitis) •Liver disease, including cirrhosis •Nerve damage •Poor nutrition •Sleeping problems (insomnia) Alcohol use also increases your risk for sexually transmitted infections (STIs) and violence. Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. Prevention The National Institute on Alcohol Abuse and Alcoholism recommends: •Women should not drink more than 1 drink per day •Men should not drink more than 2 drinks per day One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1? ounces of liquor.