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    Alcohol and Tolerance

    National Institute on Alcohol Abuse and Alcoholism No. 28 PH 356 April 1995

    Alcohol consumption interferes with many bodily functions and affects behavior. However, after chronic alcohol consumption, the drinker often develops tolerance to at least some of alcohol's effects. Tolerance means that after continued drinking, consumption of a constant amount of alcohol produces a lesser effect or increasing amounts of alcohol are necessary to produce the same effect (1). Despite this uncomplicated definition, scientists distinguish between several types of tolerance that are produced by different mechanisms.

    Tolerance to alcohol's effects influences drinking behavior and drinking consequences in several ways. This describes how tolerance may encourage alcohol consumption, contributing to alcohol dependence and organ damage; affect the performance of tasks, such as driving, while under the influence of alcohol; contribute to the ineffectiveness or toxicity of other drugs and medications; and may contribute to the risk for alcoholism.

    Humans and animals develop tolerance when their brain functions adapt to compensate for the disruption caused by alcohol in both their behavior and their bodily functions. This adaptation is called functional tolerance (2). Chronic heavy drinkers display functional tolerance when they show few obvious signs of intoxication even at high blood alcohol concentrations (BAC's), which in others would be incapacitating or even fatal (3). Because the drinker does not experience significant behavioral impairment as a result of drinking, tolerance may facilitate the consumption of increasing amounts of alcohol. This can result in physical dependence and alcohol-related organ damage.

    However, functional tolerance does not develop at the same rate for all alcohol effects (4-6). Consequently, a person may be able to perform some tasks after consuming alcohol while being impaired in performing others. In one study, young men developed tolerance more quickly when conducting a task requiring mental functions, such as taking a test, than when conducting a task requiring eye-hand coordination (4), such as driving a car. Development of tolerance to different alcohol effects at different rates also can influence how much a person drinks. Rapid development of tolerance to unpleasant, but not to pleasurable, alcohol effects could promote increased alcohol consumption (7).

    Different types of functional tolerance and the factors influencing their development are described below. During repeated exposure to low levels of alcohol, environmental cues and processes related to memory and learning can facilitate tolerance development; during exposure to high levels of alcohol, tolerance may develop independently of environmental influences.

    . Although tolerance to most alcohol effects develops over time and over several drinking sessions, it also has been observed within a single drinking session. This phenomenon is called acute tolerance (2). It means that alcohol-induced impairment is greater when measured soon after beginning alcohol consumption than when measured later in the drinking session, even if the BAC is the same at both times (8-10).

    Acute tolerance does not develop to all effects of alcohol but does develop to the feeling of intoxication experienced after alcohol consumption (4). This may prompt the drinker to consume more alcohol, which in turn can impair performance or bodily functions that do not develop acute tolerance.

    The development of tolerance to alcohol's eff ects over several drinking sessions is accelerated if alcohol is always administered in the same environment or is accompanied by the same cues. This effect has been called environment-dependent tolerance. Rats that regularly received alcohol in one room and a placebo in a different room demonstrated tolerance to the sedative and temperature-lowering effects of alcohol only in the alcohol-specific environment (11). Similar results were found when an alcohol-induced increase in heart rate was studied in humans (12). When the study subjects always received alcohol in the same room, their heart rate increased to a lesser extent after drinking in that room than in a new environment.

    Environment-dependent tolerance develops even in "social" drinkers in response to alcohol-associated cues. In a study analyzing alcohol's effects on the performance of an eye-hand coordination task, a group of men classified as social drinkers received alcohol either in an office or in a room resembling a bar. Most subjects performed the task better (i.e., were more tolerant) when drinking in the barlike environment (13). This suggests that for many people, a bar contains cues that are associated with alcohol consumption and promote environment-dependent tolerance.

    The development of tolerance also can be accelerated by practicing a task while under the influence of alcohol. This phenomenon is called behaviorally augmented (i.e., learned) tolerance. It first was observed in rats that were trained to navigate a maze while under the influence of alcohol (14). One group of rats received alcohol before their training sessions; the other group received the same amount of alcohol after their training sessions. Rats that practiced the task while under the influence of alcohol developed tolerance more quickly than rats practicing without prior alcohol administration.

    Source : pubs.niaaa.nih.gov

    Four reasons why your tolerance for alcohol can change

    Tolerance happens when the brain adapts to the effects of alcohol – eventually causing us to need more to achieve the same effects.

    Four reasons why your tolerance for alcohol can change

    Published: April 28, 2021 12.21pm BST

    Sally Adams, University of Bath

    Drinking as much as you used to could lead to greater intoxication. View Apart/ Shutterstock

    As pubs and bars reopen across England, many are excited about the opportunity to enjoy a drink with friends and family. While some evidence suggests alcohol consumption increased during lockdown, other reports suggest that over one in three adults drank less – or stopped altogether.

    But though we may be excited to get back to the pub, our tolerance may be lower than it was pre-lockdown.

    Regularly drinking a certain amount of alcohol (for example, having four pints every Friday evening after work) can lead to increased tolerance. This is where the brain adapts to the effects of alcohol (such as relaxation and improved mood), and over time more alcohol is needed to achieve the same effects.

    In this scenario you may need to drink five pints to get the same initial “buzz” you got from four pints. Tolerance is a hallmark feature of addiction. But it can also develop with regular and continued alcohol use in social drinkers.

    Following a period of reduced alcohol use or abstinence, alcohol tolerance can decrease to levels before regular use. This means that your brain and body are “out of practice” in terms of processing and responding to alcohol. Alcohol tolerance can be explained via several mechanisms – but here are four ways that tolerance may develop and change.

    1. Functional tolerance

    As we drink over the course of an evening the amount of alcohol in our bloodstream increases, leading to slower reaction times, lowered inhibitions and impaired judgement. Large amounts of alcohol cause slurred speech, lack of coordination and blurred vision.

    People who regularly drink any amount of alcohol can become tolerant to these impairments and show few signs of intoxication – even when there are large amounts of alcohol in their bloodstream. If these drinkers stop or reduce their alcohol consumption, this tolerance could be lost.

    But if they start drinking at their previous levels again, alcohol-related impairments in cognition and behaviour could return – but after having smaller amounts of alcohol. These changes in tolerance reflect the brain’s desensitisation (increased tolerance) and resensitisation (reduced tolerance) to alcohol at the cellular level.

    2. Environmental-dependent tolerance

    Tolerance can develop much more quickly if alcohol is always consumed in the same environment – for example, if you only drank at home during lockdown. This is a sub-type of functional tolerance.

    This is because familiar “cues” – such as your home setting – are repeatedly paired with alcohol’s effects. This leads to a conditioned compensatory response. This response counters alcohol’s impairing effects, and we may not feel as “intoxicated” as a result.

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    If you’re used to drinking at home, drinking in the pub could lead to feeling more intoxicated. Jelena Zelen/ Shutterstock

    But when we drink in a new environment – such as going to the pub for the first time in six months – the compensatory response is not activated, making us more prone to experiencing alcohol’s effects. So even if you’ve still been consuming large amounts of alcohol at home during lockdown, you may find you feel alcohol’s effects to a greater degree when drinking the same amount as normal in a pub or bar.

    3. Learned tolerance

    Developing tolerance can be sped up if we repeatedly perform the same task or activity under the influence of alcohol.

    Studies of rats have shown that animals trained to navigate a maze while intoxicated actually performed better and were more [tolerant to the effects of the alcohol] than those who didn’t receive alcohol during training.

    In humans, this type of tolerance can be shown in the performance of well-practiced games played under the influence of alcohol. For example, an person who typically plays darts sober would likely experience impairment in performance if intoxicated. But if a person regularly drinks while playing darts, they may experience no alcohol-related impairment because of their learned tolerance.

    If you regularly played darts or pool at the pub prior to lockdown, a loss of learned tolerance could mean that you don’t play as well as you used to when you have a game after a few drinks.

    4. Metabolic tolerance

    While the other three types of tolerance focus on alcohol’s effects on the brain, metabolic tolerance refers instead to the rapid elimination of alcohol from the body following prolonged or heavy alcohol consumption.

    Repeated alcohol use causes the liver to become more “efficient” at eliminating alcohol from the body. This results in a reduction of alcohol in the bloodstream, alongside its intoxicating effects. Similar to functional tolerance, as metabolic tolerance develops, a greater amount of alcohol is needed to experience the same effects as you experienced initially.

    So drinking lower amounts of alcohol during lockdown could mean that your liver is less effective at “clearing” alcohol from the body. As a result, you’ll feel the intoxicating effects even from lower amounts of alcohol. Equally, increased alcohol consumption during lockdown could lead to increased metabolic tolerance, where a greater amount of alcohol is needed to feel intoxicated.

    Source : theconversation.com

    Alcohol Tolerance May Lead to Damaging Effects

    Developing a tolerance to the effects of alcohol can influence drinking behavior and create negative consequences in many different ways.

    ADDICTION ALCOHOL USE

    The Negative Effects of Alcohol Tolerance

    The Negative Effects of Alcohol Tolerance Early Tolerance of Alcohol's Effects Can Signal Future Problems

    By Buddy T Updated on September 14, 2020

    Medically reviewed by John C. Umhau, MD, MPH, CPE

    Thomas Barwick/Getty Images

    You can drink enough alcohol for a period of time that you can develop a tolerance to some of its effects. If you drink long enough, you may find that drinking the same amount you usually drink does not produce the same effect.

    In other words, if you have developed alcohol tolerance you have to drink increasingly greater amounts of alcohol to feel the same effects you used to feel with fewer drinks.

    You may think that not having alcohol interfere with your behavior and ability to function like it used to do is a positive occurrence, however, the development of tolerance to alcohol can actually signal pending problems.

    Tolerance to the effects of alcohol can influence drinking behavior and consequences in many ways.

    Alcohol Tolerance Can:

    Encourage greater alcohol consumption

    Contribute to alcohol dependence

    Cause organ damage

    Affect the performance of tasks

    Contribute to the ineffectiveness of medications

    Increase the toxicity of other drugs

    Contribute to the risk of alcoholism

    There are several ways that tolerance to alcohol develops:

    Functional Tolerance

    Functional tolerance is when the brain functions of drinkers adapt to compensate for the disruption that alcohol causes in their behavior and their bodily functions.

    Have you ever known someone who could consume large amounts of alcohol and not display any obvious signs of intoxication? That is because that person has developed a functional tolerance to alcohol.

    When someone has had enough to drink that they should be exhibiting some signs of behavioral impairment and they do not, their tolerance to alcohol is allowing them to drink increasing amounts of alcohol.

    Functional Tolerance Can Result in Dependence

    The problem is that a higher level of consumption can result in developing a physical dependence on alcohol and developing alcohol-related organ damage.

    Research has found, however, that functional tolerance can develop at the same rate for all of the effects of alcohol. For example, someone may quickly develop a functional tolerance for mental functions, such as solving puzzles, but not for tasks requiring eye-hand coordination, such as driving a vehicle.

    Alcohol Abuse vs. Dependence

    Different Types of Functional Tolerance

    Sometimes drinkers will quickly develop a tolerance to the unpleasant effects of intoxication, such as becoming nauseous or dizzy, while not developing a tolerance to the pleasurable effects. This can cause increased alcohol consumption.

    There are different types of functional tolerance to alcohol which are produced by different factors and influences.

    Acute Tolerance

    When a drinker develops a tolerance to the effects of alcohol during a single drinking session, it is called acute tolerance. The drinker may appear to be more intoxicated in the early stages of the drinking session than near the end.

    But, acute tolerance typically develops into the "feeling" of intoxication, but not to all of the effects of alcohol. Consequently, the person may be prompted to drink more, which can impair those bodily functions that do not develop acute tolerance.

    Environment-Dependent Tolerance

    Research has found that alcohol tolerance can be accelerated if drinking over a series of drinking sessions always take place in the same environment or accompanied by the same cues.

    Studies have found that when drinkers consumed their alcohol in the same room all the time their heart rate increased to a lesser extent than when they drank in a new environment.

    Cues Associated With Drinking

    Another study found that "social drinkers" who were given an eye-hand coordination task, performed better if they consumed their alcohol in a bar-like environment, rather than an office environment.

    The researchers concluded that the subjects were more alcohol tolerant in the bar environment because it contained cues associated with drinking. This is called environment-dependent tolerance.

    The Dangers of Drinking and Driving

    Learned Tolerance

    Alcohol tolerance can also be accelerated by practicing a task while under the influence of alcohol. Even if the subjects only mentally rehearsed the task after drinking alcohol, they developed the same level of tolerance as those who actually physically practiced the task while drinking.

    This is called behaviorally augmented tolerance or learned tolerance.

    Rewards Can Affect Tolerance

    Learned tolerance can also be accelerated by the expectation of a reward. One study found that subjects who knew they would receive money for the successful performance of a task while under the influence developed tolerance more quickly than when they did not expect a reward.

    How Does This Apply to Real-Life Situations?

    Repeatedly driving the same route home while intoxicated could cause the driver to develop a tolerance for the task and reduce alcohol-induced impairment. However, that tolerance for that specific task is not transferable to a new task.

    Source : www.verywellmind.com

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