Reverse tolerance to alcohol: what it is and how it is produced

Alcohol is a substance included in the category of central nervous system depressants. Its consumption is widely accepted in society and is part of very different times of celebration or leisure.

For this reason, its use in the general population is spreading to the point that almost all adults have tried it at least once in their life, and a significant percentage consume it frequently.

As in the case of other substances with depressive properties, alcohol can generate symptoms typical of addictive processes, in particular the development of tolerance and a withdrawal syndrome.

In this article, we’ll review these last two concepts, which are key to defining behavior associated with substance dependence, and delve deeper into the phenomenon of reverse tolerance to alcohol.

    Basic aspects of drug addiction

    Before tackling the phenomenon of reverse tolerance to alcohol, which will be at the heart of this article, it is important to know the basic elements that make up dependence on any substance: tolerance and withdrawal syndrome. The presence of both in an individual is the clinical criterion by which abuse (understood as the use of the substance in contexts where it causes serious harm) exceeds the limits of addiction.

    1. Tolerance

    Tolerance is the result of changes that occur in the central nervous system as a result of the introduction of a substance that is not naturally found there. Through the mediation of specific receptors available in the brain, and the alteration of the levels of certain neurotransmitters (GABA and glutamate in the case of alcohol), an adaptation process is generated which involves both physiology and morphology.

    In strict terms, tolerance describes the need to increase the consumption of a particular substance to achieve the same effects which were affected in the initial prey; that is, a noticeable reduction in the effect of the substance (at several levels) which precipitates the increase in dose. This phenomenon ends up eroding the personal lives of those who suffer from an addictive disorder, because it causes very deep economic and social losses. Plus, it gives us clues about what reverse alcohol tolerance is.

    2. Withdrawal syndrome

    Withdrawal syndrome is a phenomenon that usually occurs alongside tolerance and describes a feeling of severe discomfort when the person does not have access to the substance with which they have an addictive relationship.

    In general, abstinence triggers the opposite effects to those observed during intoxication. For example, if a drug depresses the central nervous system (as with alcohol), at this point the person will feel irritable or restless.

    The case of alcohol presents a particularity in terms of withdrawal syndrome: the possibility of the appearance of delirium tremens. Symptoms usually appear between the second and third day (48 to 72 hours) after the last drink; and include altered consciousness, hallucinations, delusions, feelings of fear, shaking, restlessness, irritability and hypersthesis in different sensory modalities (photophobia or hypersensitivity to light, perceptual sharpness of sounds and touch, etc.).

    3. Addictive behavior

    It is understood by addictive behavior all behavior changes that take place in the context of addiction, Which are attributable to it and end up deteriorating the quality of social relations and even the ability to achieve or maintain an active professional life. This phenomenon is due to a number of alterations in the brain reward system, which are common to the mechanism of action of several substances.

    To fully understand addictive behavior, it is necessary to understand the function of the said system, which is made up of a set of structures (the ventral tegmental nucleus and the accumbens zone) which also project towards the prefrontal cortex. What we observe after acute drug use is a sharp rise in dopamine level (Pleasure neurotransmitter) in this region, higher than that which occurs as a result of natural activators.

    As a result of this intense feeling of pleasure, the person will seek to use the substance to experience it again, gradually letting go of things in life that previously generated joy or pleasure. Abandonment can include both personal relationships and hobbies, Reduce daily life to a compulsive search for alcohol and associated sensations (which implies investing a lot of time in its acquisition and consumption).

    4. Desire or desire

    Direct consequence of the loss of motivation vis-à-vis natural activators, the person experiences in parallel an urgent desire for consumption which increases proportionally in the face of the stimuli associated with it. For example, you will feel the urge to drink when you visit the establishment where you have been drinking for many years, as you are exposed to people and environmental keys with whom you have developed a close relationship with drinking.

    On the other hand, several studies suggest that deprivation of social incentives is a key element for consumption to evolve from sporadic use to addiction itself. The lack of strong supports or environments in which marginality and isolation predominate contribute to the formation of addictive disorders, so the design of therapeutic programs incorporating the reinforcement of this component is absolutely necessary.

      What is reverse tolerance to alcohol

      Having reviewed the basic principles of addiction, we can gain a deeper understanding of the phenomenon of reverse alcohol tolerance, also known as alcohol awareness.

      As noted, chronic alcohol consumption increases tolerance to alcohol, as well as other chemicals that have a depressant effect on the central nervous system (cross tolerance). This would be the case with benzodiazepines, which should under no circumstances be combined with alcohol, as they considerably increase the risk of overdose (coma and ultimately death). It is for this reason that people tend to drink more and more over time.

      However, after many years of addiction, many people develop a reverse tolerance to alcohol. In this case, the effect of the substance on the brain takes place even at very small doses, showing signs and symptoms characteristic of poisoning with reduced consumption. This effect is diametrically opposed to that observed in general tolerance.

      Although conventional tolerance and reverse tolerance may seem like two opposing phenomena, they actually have a close relationship. In people who drink alcohol, it is more common for a common chemical tolerance to start in the first place.. As time passes and the continued use of this drug is maintained, there will be concrete damage to kidney function which will reduce the metabolism of alcohol and increase its levels in the blood.

      Fortunately, the effect of reverse tolerance extends only to the first symptoms of alcohol poisoning (Behavioral disinhibition and euphoria), but does not precipitate the early onset of dyspnea (respiratory strain) and coma which characterize the most advanced stages.

      Behaviors that promote the development of alcohol dependence

      The euphoric feeling that accompanies drinking (low dose) alcohol is misleading and may lead some people to use this medicine as a self-medication strategy for anxiety or depressive disorders. Scientific evidence indicates that this has the opposite effect, facilitating a number of changes in emotions and behavior (as well as brain neurochemistry) that they accentuate the problem for which the person decided to start drinking.

      On the other hand, consumption in frenzy, popularly known as botellón (in which they manage to ingest more than 100 grams in a very short time), is also a risk behavior for the development of addictive behaviors, even if no other substance is not consumed during the week.

      It is also not recommended to drink alcohol to reduce the hangover from the night before, or to combine it with other substances. The simultaneous use of alcohol and cocaine, to cite a common example, produces ethylene cocaine. The result of this chemical reaction increases the toxicity of the two drugs separately, and has been consistently associated with episodes of interpersonal violence.

      Alcohol is a widely used drug, not least because it is a socially accepted substance and even integrated into traditions and festivals. The most common is that the onset of its use occurs in recreational and leisure contexts, in the company of other people, but the evolution towards dependence implies that it is gradually reserved for spaces of solitude. Information on its effects is essential to prevent addictive disorders in the population.

      Bibliographical references:

      • Tran, S. and Gerlai, R. (2017). Alcohol addiction zebrafish models. Addictive substances and neurological diseases, 3 (2), 59-66.
      • Becker, H. (2008). Alcohol dependence, withdrawal and relapse. Alcohol and Health Research, 31 (4), 348-361.

      Leave a Comment