Reverse alcohol tolerance: what is it and how does it occur?

A phenomenon that is related to advanced stages of degradation due to alcohol consumption.

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 diverse moments of celebration or leisure.

For this reason, its use among the population is widespread to the point that almost all adults have tried it at least once in their lives, and a not inconsiderable percentage consumes it frequently.

As in the case of other substances with depressant properties, alcohol can generate symptoms typical of addictive processes, including the appearance of tolerance and withdrawal syndrome.

In this article we will review these last two concepts, which are essential to define the behavior associated with substance dependence, and will delve into the phenomenon of reverse tolerance to alcohol.

Basic aspects of substance addiction

Prior to addressing the phenomenon of reverse tolerance to alcohol, which will be the core of this article, it is important to know the basic elements that constitute addiction. the basic elements that constitute the addiction to any substance: tolerance and withdrawal syndrome.. The presence of both in an individual is the clinical criterion from which abuse (understood as the use of the substance in contexts where it produces serious harm) exceeds the limits of dependence.

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 in it. Through the mediation of specific receptors available to the brain, and the alteration in the levels of certain neurotransmitters (GABA and glutamate in the case of alcohol), an adaptive process involving both physiology and morphology is generated.

Strictly speaking, tolerance describes the need for increasing consumption of a particular substance in order to obtain the same effects as those achieved during the initial that were achieved at the initial intakes; that is, a marked reduction in the effect of the substance (at multiple levels) that precipitates an increase in dosage. This phenomenon is one of those that ultimately erodes the personal lives of those suffering from an addictive disorder, as it entails profound economic and social losses. In addition, it provides clues as to what is reverse alcohol tolerance.

Withdrawal syndrome

Withdrawal syndrome is a phenomenon that usually occurs together with tolerance, and describes a severe feeling of discomfort when the person does not have access to the substance with which he/she has a dependence relationship.

In general terms, withdrawal triggers the opposite effects to those observed during intoxication.. For example, if a drug depresses the central nervous system (as is the case with alcohol), in this phase the person will feel irritable or agitated.

The case of alcohol presents a peculiarity regarding the withdrawal syndrome: the possibility of the onset of delirium tremens. Symptoms usually occur between the second and third day (48 to 72 hours) after the last consumption; and include altered consciousness, hallucinations, delirium, sensation of fear, tremor, restlessness, irritability and hypersthesia in the different sensory modalities (photophobia or light hypersensitivity, perceptive sharpening of sounds and touch, etc.).

3. Addictive behavior

Addictive behavior is understood as all the behavioral changes that take place in the context of dependence, which are attributable to it.The addictive behavior is understood as all the behavioral changes that take place in the context of dependence, that are attributable to it and that end up deteriorating the quality of social relationships and even the ability to achieve or maintain an active working life. This phenomenon is due to a series of alterations in the brain reward system, which are common to the mechanism of action of multiple substances.

To properly understand addictive behavior, we must understand the function of this system, which is made up of a set of structures (the ventral tegmental nucleus and the area accumbens) that also project to the prefrontal cortex. What we observe after the acute consumption of the drug is an abrupt increase in the level of dopamine (pleasure neurotransmitter). (pleasure neurotransmitter) in this region, higher than that produced as a consequence of natural reinforcers.

As a result of this intense feeling of pleasure, the person will seek to use the substance in order to experience it again, progressively abandoning those things in life that previously generated joy or enjoyment. Abandonment may include personal relationships as well as hobbies.The daily life is reduced to a compulsive search for alcohol and the associated sensations (which involves investing large amounts of time in its acquisition and consumption).

4. Craving

As a direct consequence of the loss of motivation with respect to natural reinforcers, the person experiences in parallel a pressing craving that increases proportionally when faced with stimuli that are associated with it. For example, he will feel the need to drink when he goes to the establishment where he has been drinking for many years, since he is exposed to people and environmental cues with which he has forged a close association with drinking.

On the other hand, multiple studies suggest that deprivation of social incentives is a key element in the evolution of drinking from sporadic use to full-blown addiction. The lack of solid support or environments in which marginality and isolation predominate contribute to the formation of addictive disorders, so the design of therapeutic programs that incorporate the reinforcement of this component is absolutely necessary.

What is reverse alcohol tolerance

Having reviewed the elementary principles of addiction, we can delve into a more comprehensive understanding of the phenomenon of reverse alcohol tolerance, also known as alcohol sensitization.

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

However, after many years of consumption over which an addiction may have developed, many people develop a reverse tolerance to alcohol. In this case the effect of the substance on the brain occurs even at very small doses, characteristic signs and symptoms of drunkenness occur with reduced consumption.. This effect is diametrically opposed to that observed in general tolerance.

Although conventional tolerance and reverse tolerance may appear to be two antagonistic phenomena, they are in fact closely related. In people who consume alcohol, it is most common for a common chemical tolerance to emerge first.. As time goes by and continued use of this drug is maintained, there would be a specific damage on the renal function that would reduce ethyl metabolism and increase its levels in the blood.

Fortunately, the effect of reverse tolerance extends only to the initial symptoms of ethyl alcohol intoxication (behavioral disinhibition (behavioral disinhibition and euphoria), but does not precipitate an earlier onset of the dyspnea (respiratory distress) and coma that characterize the more advanced stages.

Behaviors conducive to the development of alcohol dependence

The feeling of euphoria that accompanies alcohol consumption (in low doses) is deceptive, and can lead some people to use this drug as a self-medication strategy for anxious or depressive disorders. Scientific evidence indicates that this produces the opposite effect, facilitating a series of alterations on emotions and behavior (as well as on the brain's neurochemistry) that accentuate the problem for which the person decided to start drinking..

On the other hand, binge drinking, popularly known as binge drinking (in which more than 100 grams are consumed in a very short period of time), is also a risk behavior for the development of addictive behaviors, even if no other substances are consumed during the course of the week.

Nor is it advisable at all to drink alcohol to reduce the hangover of the previous day, or to combine it with other substances. Simultaneous use of alcohol and cocaine, to cite a common example, produces cocaine ethylene. The result of this chemical reaction increases the toxicity of both drugs separately, and has been consistently linked to episodes of interpersonal violence.

Alcohol is a widely used drug, especially because it is a socially accepted substance and even integrated into traditions and festivals. It is most common for its consumption to begin in recreational and leisure contexts, in the company of other people, but the evolution towards addiction implies that it is progressively reserved for solitary spaces. Information about its effects is key to preventing addictive disorders in the population.

Bibliographical references:

• Tran, S. and Gerlai, R. (2017). Zebrafish Models of Alcohol Addiction. Addictive Substances and Neurological Diseases, 3(2), 59-66.
• Becker, H. (2008). Alcohol Dependence, Withdrawal and Relapse. Alcohol Research and Health, 31(4), 348-361.