Panhandling: Don't alcoholics have a greater tolerance for alcohol?

[Spiff]

Good job on getting a handle on a difficult topic, Gfactor:

http://www.straightdope.com/mailbag/mbegprofit.html
But I’m curious about the comments by public health researcher Louise Stark that you included in your piece:

Stark notes that the alcoholic panhandler drinks until drunk, and often passes out. For long-term alcoholics, that doesn’t take much liquor.

Emphasis mine.

Don’t alcoholics develop a greater tolerance for alcohol as their disease progresses, thereby requiring more, not less, alcohol to get drunk/pass out?

[Kalhoun]

@Spiff

Good job on getting a handle on a difficult topic, Gfactor:

http://www.straightdope.com/mailbag/mbegprofit.html
But I’m curious about the comments by public health researcher Louise Stark that you included in your piece:Emphasis mine.

Don’t alcoholics develop a greater tolerance for alcohol as their disease progresses, thereby requiring more, not less, alcohol to get drunk/pass out?

Maybe QtheM will be in here to clarify for us. He knows a lot about this subject. Paging Dr. Q! Paging Dr. Q!

[Gfactor]

I suspect it has something to do with the ability of a damaged liver to metabolize alcohol, but I’m not really sure. I also note that tolerance for alcohol is only an implied part of a multi-faceted diagnostic criteria for alcohol:

@JAMA definition

“Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic.”

http://en.wikipedia.org/wiki/Alcoholism#Diagnosis

@DSMIV

That definition is: maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae.

*Id. *

Beyond that, I have to defer to Ms. Stark’s observations as evidence that the phenomenon exists, and to those with more knowledge of alcohol dependence for an explanation of the phenomenon.

[Gfactor]

Full DSM-IV:

Criteria for Substance Dependence
(cautionary statement)

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

**(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the substance **

(2) Withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present) 
**Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)** 

(Emphasis added.)

So tolerance is part of the DSM-IV criteria, but not required for a diagnosis.

[SiXSwordS]

@Spiff

Don’t alcoholics develop a greater tolerance for alcohol as their disease progresses, thereby requiring more, not less, alcohol to get drunk/pass out?

One point I can make is that alcoholism is a chronic disease that develops over years and years. A person who is able to function well enough to work and raise a family might have a tolerence for alcohol far beyond what anyone in their life would ever guess at. But, by the time a person is begging for money to get alcohol, assuming they are unable to hold a regular job or maintain social contacts, the disease is beyond the definitions you’re likely to find in a magazine article or a ten question, inset questionnaire.

Those in the late stages of chronic alcoholism might not eat until they are nearly starving to make getting drunk easier. They might drink as soon as they wake up after passing out. They are suffering, in a way, from a different disease than they were when they first started drinking.

So, yes, alcoholics-- and non-alcoholics, BTW-- develop greater tolerence. But late stage alcoholism is not the same as drinking too much.

[Kalhoun]

My husband once had a BAC of 4.0 and was fighting the paramedics to let him go home. Generally, that high a BAC level will kill many/most people.

[Kalhoun]

@Kalhoun

My husband once had a BAC of 4.0 and was fighting the paramedics to let him go home. Generally, that high a BAC level will kill many/most people.

Make that .04 - OR whatever the .XX is supposed to be. You know what I mean.

[Chronos]

.04% is a typical value for “a bit buzzed”. .08% is the prima facie “intoxicated” level in most states, for purposes of drunk driving laws and the like. .40% would kill most folks, but is conceivable, so that’s probably what you meant. 4.0% would mean that he had beer in his veins instead of blood.

[Spiff]

Interesting responses so far. Thanks.

It’s clearly more complicated than I thought, and may indeed vary from alcoholic to alcoholic so much that one cannot make a generalization one way or the other.

In my state, a BAC of 0.08 is the DUI level, so perhaps the figure **Kalhoun ** is looking for is 0.4.

[sleestak]

Recovering alky here*.

When you start drinking your tolerance goes up. If you keep drinking heavily you end up killing your liver (cirrhosis?). The liver filters out a ton of the alcohol. When your liver starts getting really damaged it cannot filter out the alcohol as well as a healthy liver. So, when the liver damage starts getting serious it takes less alcohol for a person to get drunk because more alcohol is making it past the liver.

Thankfully I got sober before my liver got too bad. According to my doctor it is still pretty healthy, there is a little damage but not a huge amount. I drank roughly an 18 pack to two cases of beer a day at my peak. When I stopped drinking my tolerance was on the down slope. I was drinking a little less than an 18 pack a day and still getting blasted drunk.

Slee

*I am in no way a medical expert. The above may be incorrect, but I don’t think it is. This info comes from talking to my doctor and a bunch of recovering alkies.

[Kalhoun]

@Chronos

.04% is a typical value for “a bit buzzed”. .08% is the prima facie “intoxicated” level in most states, for purposes of drunk driving laws and the like. .40% would kill most folks, but is conceivable, so that’s probably what you meant. 4.0% would mean that he had beer in his veins instead of blood.

.40 is the correct number. Thanks for the help on that!

[Qadgop_the_Mercotan]

On vacation, so won’t say much other than for multi-factorial reasons, after heavy alcohol use for many years, one may see the tolerance for alcohol go waaay down in chronic alcoholics. This may include both high blood alcohol levels from small amounts of alcohol, and also extreme impairment with relatively low blood levels.

[badpyxis]

I’m glad the staffer mentioned successful panhandlers, as opposed to “bums”. There was a non-threatening Afro-American gentleman working the area of Yale Station (Yale shopping district) in New Haven. I graduated in 1975 from the law school and probably gave him my “spare change” as I left town for the last time. I didn’t return until 1995 for a reunion and to my surprise he was still working his area. I offered him $20 for his story and we sat down in a restaurant. He claims to work 6 days a week, 8-10 hours a day, and (1995) made about $35K a year. He wasn’t a drinker (that was obvious) and not scary to the students so he was tolerated. He treated it like a job, which it was. (If he’d worked a job that assiduously he could have earned far far more, in my estimation, but that was his profession–panhandler.)

[Gfactor]

@Qadgop the Mercotan

On vacation, so won’t say much other than for multi-factorial reasons, after heavy alcohol use for many years, one may see the tolerance for alcohol go waaay down in chronic alcoholics. This may include both high blood alcohol levels from small amounts of alcohol, and also extreme impairment with relatively low blood levels.

Thanks Qadgop.

[SiXSwordS]

@Qadgop the Mercotan

<snip>This may include both high blood alcohol levels from small amounts of alcohol, and also extreme impairment with relatively low blood levels.

I had always assumed (There’s that damn word again!) that decreasing tolerence was due to decreasing liver function; that makes some sense with high BAL from small amounts of alcohol. Increased impairment with low BAL sounds like some type of brain damage. Maybe a general decrease in abilities before impairment?

[Una_Persson]

@Chronos

.04% is a typical value for “a bit buzzed”. .08% is the prima facie “intoxicated” level in most states, for purposes of drunk driving laws and the like. .40% would kill most folks, but is conceivable, so that’s probably what you meant. 4.0% would mean that he had beer in his veins instead of blood.

My sister had a BAC of about 0.4 after her drunk driving accident. She was fighting the paramedics as well.

[Tim_T-Bonham.net]

It’s not uncommon for alcoholic panhandlers to start drinking again as soon as they wake up. When their body has not completely processed the alcohol from the drinks they had the previous day.

If you haven’t yet ‘sobered up’ from yesterday, then it indeed “may not take much liquor” to get you drunk again today.

[Moirai]

sleestak and QtM said it better than I can, but it boils down to yes, some alcoholics require less alcohol to achieve the same effects in the late stages, not more.

It’s frigging scary (I speak from experience) when you have your formula down to a science and then your body changes the rules. For me, I never knew if tonight I would go into a blackout after only two drinks, or if I could drink all night and never get that trashed. It varied.