High Alcohol Tolerance: Is it Possible To Treat It?

Last Updated: April 2, 2021

Reviewed by Michael Espelin APRN

Alcohol tolerance (AT) is the key element that explains why one individual can consume large quantities of drinks with fewer negative effects while another individual feels overwhelming intoxication with small amounts of alcohol. The effects of drinking may vary from one person to the other, and the history of alcohol use plays a significant role in AT. High tolerance for alcohol is usually seen in people who drink regularly. In some cases, certain individuals are born with high alcohol tolerance, while others develop theirs through years of ardent drinking. Physicians can use a person’s tolerance level to identify individuals who may be at critical risk of health problems related to excessive use of alcohol. What is alcohol tolerance, and how does it work? Is there an impending health problem for people who have naturally high alcohol tolerance, and is there a way to decrease tolerance levels? Also, how related is AT with genetics?

How does Alcohol Tolerance Work?

This term refers to the capacity of the body to tolerate or support large amounts of alcohol. Due to chronic and excessive consumption by alcoholics, their bodies need more ethanol to produce the same effects that a new or non-frequent drinker would feel on taking standard units of alcoholic beverages. An individual who drinks regularly may find that it takes longer for them to achieve desired effects whenever they drink. This usually leads to drinking more than last time to achieve the same effect. The capacity to drink more and more is a serial development of high alcohol tolerance, which some people may perceive to be a good thing, but it is not. AT may not show signs of physical intoxication, but its development typically paves the way for serious health issues.

The deception of AT is that it may not interfere with one’s behavior or conduct. The individual may find themselves feeling no sign of intoxication; this may lead to dependency and alcohol addiction. As tolerance increases, the brain’s chemistry equally changes, transforming into pathological cravings for the effects of alcohol. Other changes may include the risk of developing withdrawal symptoms.

Man with a glass has drunk a lot of alcohol.

Tolerance to alcohol is caused by changes in the functions and contact of neurotransmitters in the brain. The general effectiveness of synaptic transmission is affected in the brain, which can cause further damages that bring about withdrawal symptoms and other physical and mental problems.

Can You Build Up a Tolerance to Alcohol?

Absolutely, you can. It develops over time, meaning that a dedicated drinker may need consistently higher volumes of alcohol to achieve the same physical effects over the weeks and months of drinking. The adaptation to the effects of drinking is what leads to high tolerance for alcohol.  Reports have shown that different individuals have varying degrees of tolerance. The reason is yet uncertain; however, there are several types of tolerance with their own mechanisms.

Alcohol Tolerance Causes

AT’s primary cause is excessive and frequent consumption of alcohol, and tolerance occurs less often with people who only drink occasionally.

However, body type, gender, ethnicity, and metabolism are also factors that contribute to the development of tolerance. Men use alcohol a lot more than women do, while women are more likely to get intoxicated faster than men due to body size and their slower metabolism. Generally, larger people can hold as much alcohol as smaller people but with a milder intoxicating effect.

There are Different Theories on the Causes of Alcohol Tolerance:

Neurotransmitters

The effects of drinking on the brain may alter the functions of neurotransmitters. The transmission of nerve impulses characterizes the unique communication system of the brain. The neurological effects of alcohol alter this communication. When nerves are unable to receive signals, the brain cannot share the consequences of intoxication with the body.

Enzymes

Ingested ethanol is metabolized by an enzyme, “alcohol dehydrogenase,” to a metabolite called acetaldehyde. The acetaldehyde is metabolized by an enzyme ‘aldehyde dehydrogenase’ to the final product. Some people, by nature, lack the enzyme aldehyde dehydrogenase, which leads to an excess of acetaldehyde in the blood. The toxin causes low alcohol tolerance in individuals. Low alcohol tolerance is common in Asians.

Metabolism

Like every other drug or compound, ethanol is metabolized by the liver and stomach, and the metabolism of ethanol in individuals varies. Not everyone digests alcohol in the same way. This variation is due to levels of a metabolic enzyme called alcohol dehydrogenase (ADH) in the body. It converts alcohol into acetaldehyde (a very toxic intermediate product) and later converts it into water and carbon dioxide. This enzyme is our strong defense against the highly toxic effects of non-metabolized alcohol on the nervous and cardiac systems.

Depressed man drinking the third glass.

Some people have slower variants of these enzymes, which has been linked to tolerance and dependence. Usually, one standard drink is metabolized in one hour, but people who have little or no ADH have no simple way of metabolizing the alcohol. Thus they develop effects and build tolerance faster than people who do have ADH.

Body Types

Muscular individuals have a bit more tolerance for alcohol than those who have lesser muscle mass and therefore require more alcohol to reach the same level because ethanol is distributed in the periphery, where many tissues are located, before going into the brain and producing the desired sensations.

Gender

Studies have found that women get drunk faster and feel stronger effects than men. This is because they have smaller bodies and a higher proportion of fat than men, so their bodies need fewer drinks to induce insobriety. They also have lower levels of the ADH enzyme. Thus the alcohol remains in their bodies longer.

However, women are more exposed to health risks associated with alcoholism. Most gender difference reports conclude that women get intoxicated faster than men based on weight and other factors.

Ethnicity

For people of various ethnicities, genetic differences mean differences in AT levels. The majority of Asians don’t have ADH and thus cannot metabolize alcohol. Some enzymes are present that can metabolize the substance, but at a prolonged rate, and they cannot compensate for the ADH deficiency. Thus Asians tend to get drunk a lot faster than Americans or Europeans. The difference is so dramatic that if an Asian person with ADH deficiency consumes the average amount consumed by people in the West, they might develop an alcohol flush reaction. This response causes red blotches to appear on the skin or face and back, and sometimes the whole body due to the accumulation of acetaldehyde that cannot be metabolized. Almost 36% of Asians experience this reaction.

Reverse Alcohol Tolerance and Other Tolerance Types

Over time, tolerance for alcohol compels some people to use higher and higher amounts, resulting in a further inclination towards alcoholism. Eventually, such high quantities damage the liver, impeding its ability to produce the enzymes needed to break down alcohol. This phenomenon is known as reverse alcohol tolerance, and it can lead to alcoholics becoming drunk on tiny quantities of alcohol. Reverse alcohol tolerance is a critical state for the liver and can lead to other health complications.

Some Other Types Of Tolerance Include the Following:

Learned Tolerance

Some writers, poets, artists, or people with different talents feel the need for booze to get them in the mood to be creative, which can result in chronic alcoholism. Humans may develop a tolerance for alcohol while practicing a task and drinking at the same time.

Girl painting and drinking wine.

Acute Tolerance

Unlike other forms of alcohol tolerance that develop over time and after numerous drinking sessions, the individual may develop tolerance in a single drinking session. It develops very fast and may also cause the user to indulge more in drinking bouts.

Environment-Induced Tolerance

People who go to clubs or pubs regularly become so used to the environment where they develop AT while they are in that environment. In this case, tolerance for alcohol is accelerated if an ardent drinker engages in several alcohol sessions in the same environment or, in some cases, accompanied by the same signals. The environment triggers this kind of AT, and the effects of alcohol may significantly differ if the individual received alcohol in a different venue or room.

Tolerance Due To Past Exposure

Children of alcoholics have a high risk of developing tolerance because of exposure to alcohol from a young age. Several studies have shown that sons of alcoholics were less impaired during drinking bouts compared to sons of non-alcoholics.

Functional Tolerance

Functional alcohol tolerance is exhibited in both humans and animals. It is a stage where the brain functions are pushed or stimulated to adapt to the frequent chemical disruptions in order to create a stable state. A chronic drinker may show no sign of intoxication even with high BAC that may have been fatal or incapacitating to an average drinker. The chronic drinker may be compelled to even increase their alcohol intake due to the lack of physical impact. This kind of tolerance develops at different rates for alcohol effects. For this reason, a person who has sound mental functions and can have coordinated conversations may show impairment when it comes to activities that involve eye-hand coordination such as driving. At this point, driving may be a death sentence even without the awareness of the drinker.

 

Metabolic Tolerance

The rapid elimination of alcohol from the system due to the presence of certain liver enzymes is called metabolic tolerance. The enzyme reduces the time in which alcohol effects are felt; this means that alcohol intoxication is greatly reduced in the individual. Some individuals have increased levels of this enzyme, while some do not.

Is a High Tolerance for Alcohol Genetic?

Genetic differences do account for some differences in alcohol tolerance, which in some cases fall along ethnic lines. As described above, most Asians don’t have the alcohol metabolic enzyme alcohol dehydrogenase (ADH), which means they tend to get drunk faster than Americans or Europeans.

Alcohol Tolerance Dangers

Is alcohol tolerance dangerous? Yes, it is.

Here Are Some of the Risks Associated With Increased Tolerance to Ethanol:

  • May cause damage to organs in the body
  • It may increase the toxicity of pharmaceuticals or controlled drugs
  • It may increase alcohol consumption in heavy drinkers
  • Tolerance may contribute to levels of alcohol dependency
  • If may affect the ability of the individual to carry out their task effectively
  • It may lead to a decrease in the effectiveness of medications
  • It increases the risk of alcoholism

Reducing Alcohol Tolerance

To reduce alcohol tolerance, a person needs to reduce the amount of booze one drinks. Refraining from drinking will lower the body’s AT level. As a result of lowering the tolerance, one will feel the effects of alcohol after consuming smaller quantities than before. This method is used to prevent the development of alcohol dependence and alcohol abuse.

Person refuses to drink alcohol.

This process is simple to understand but hard to follow, yet it works miracles in reducing alcohol tolerance. Refrain for a few days, and the body will automatically lower the level at which alcohol produces its effects. After this time, people who couldn’t previously get drunk after 5-6 drinks feel alcoholic effects after one drink. This is done to reduce AT and prevent alcohol abuse. 

Here is a Guide on How to Lower a Tolerance for Alcohol in a Safe Way:

  • Identify goals: Make a firm choice to either cut down on alcohol consumption or quit completely.
  • Evaluate: understanding one’s present level of alcohol needs compared to the goal they want to achieve helps create mental milestones, especially while monitoring other possible side effects such as withdrawal symptoms.
  • Weigh best options: if one is not experiencing withdrawal symptoms to alcohol on reduction, then there is no dependency. Therefore it is safe and possible to completely stop using alcohol.
  • Abstain: try abstinence from drinking for a while. One may begin with complete abstinence for 30 days to eliminate the substance from the system.
  • Reevaluate: re-check your goals and priorities to solidify your decision to remain sober and then abstain or drink moderately. One could also seek help on how to proceed from this phase.

How Long Does it Take to Reduce AT?

Well, it depends because the time required to change tolerance level varies from person to person. Decreasing the number of drinks per week may work for almost everyone; for others, a month without a drink works just fine to reduce someone’s tolerance. The first month is the hardest, but gradually decreasing the number of drinks per week can help bring down the tolerance level without suffering from withdrawals. Seeking professional help can ease the process greatly.

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Page Sources

  1. National Institute on Alcohol Abuse and Alcoholism. Alcohol and Tolerance - Alcohol Alert No. 28-1995, https://pubs.niaaa.nih.gov/publications/aa28.htm
  2. NHS. Genes 'affect alcohol tolerance', https://www.nhs.uk/news/genetics-and-stem-cells/genes-affect-alcohol-tolerance/
  3. NIH – Mechanisms of Alcohol Tolerance (R21/R33 Clinical Trial Not Allowed), https://news.med.virginia.edu/deansoffice/2018/02/nih-mechanisms-of-alcohol-tolerance-r21r33-clinical-trial-not-allowed/
  4. Tabakoff, B., Cornell, N., & Hoffman, P. L. (1986). Alcohol tolerance. Annals of emergency medicine, 15(9), 1005-1012.https://pubs.niaaa.nih.gov/publications/aa28.htm
  5. Elvig, S. K., McGinn, M. A., Smith, C., Arends, M. A., Koob, G. F., & Vendruscolo, L. F. (2021). Tolerance to alcohol: A critical yet understudied factor in alcohol addiction. Pharmacology Biochemistry and Behavior, 173155.https://wellness.huhs.harvard.edu/understanding-alcohol-tolerance
  6. Beaini, A. (2013). Centers for Collaborative Research in Fragile X (U01): RFA-HD-13-004. Journal of Investigative Medicine, 61(1), 50. https://news.med.virginia.edu/deansoffice/2018/02/nih-mechanisms-of-alcohol-tolerance-r21r33-clinical-trial-not-allowed/
  7. University Of Toledo. https://www.utoledo.edu/studentaffairs/counseling/selfhelp/substanceuse/tolerance.html
  8. Jenna Birch. Why some people have a higher alcohol tolerance than others. Aug 28,2020. https://www.huffpost.com/entry/alcohol-tolerance-reasons_l_5d2e098be4b0a873f642acde
  9. Morozova, T. V., Mackay, T. F., & Anholt, R. R. (2014). Genetics and genomics of alcohol sensitivity. Molecular Genetics and Genomics, 289(3), 253-269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037586/
  10. Alcohol Use in the United States - National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
  11. What are the Effects of Alcohol - Australian Government Department of Health. https://www.health.gov.au/health-topics/alcohol/about-alcohol/what-are-the-effects-of-alcohol
  12. Are Women More Vulnerable to Alcohol Effects? - National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/aa46.htm

Published on: March 9th, 2018

Updated on: April 2nd, 2021

About Author

Juliette Siegfried, MPH

Juliette has been working in the health communications field since 1991, when she began working at the National Cancer Institute of the National Institutes of Health in Bethesda, Maryland. Her initial campaigns focused on smoking cessation and cancer prevention. Juliette later moved to the corporate side of health communications, including working at Kaiser Permanente, where she designed interactive computer-based training for health education.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.