BAC Physiology

Blood & Breath Alcohol Physiology

Blood-alcohol analysis is simply the attempt to measure the percentage by weight of alcohol within the DUI suspect's blood at the time of testing. This is done directly when dealing with a blood sample, or indirectly by analyzing the percentage in a breath sample and applying conversion ratios to estimate the percentage in the blood; these conversion ratios used in DUI cases are inaccurate in that they simply represent statistical averages.

A Brief Overview of Alcohol

The ingestible alcohol is known as ethyl alcohol, or ethanol. Its chemical abbreviation is ETOH. The "ET" stands for "ethyl" and the "OH" represents the single oxygen atom and one of the hydrogen atoms, bonded together in what chemists refer to as the "hydroxy radical". Ethanol is the variety of alcohol that has two carbon atoms. Two of ethanol's best known analogs are methyl alcohol (or methanol), commonly called "wood alcohol", and isopropyl alcohol (or isopropanol), also known as "rubbing alcohol".

Ethanol is what interests us, because it is the kind of alcohol that features prominently in impaired driving. Ethanol is beverage alcohol, the active ingredient in beer, wine, whiskey, liquors, etc. Ethanol production starts with fermentation. That is a kind of decomposition in which the sugars in fruit, grains and other organic materials combine with yeast to product the chemical we call ethanol. This can occur naturally, as yeast spores in the air come into contact with decomposing fruit and grains. However, most of the ethanol in the world didn't ferment naturally, but was produced under human supervision.

When an alcoholic beverage is produced by fermentation, the maximum ethanol content that can be reached is about 14 percent. At that concentration, the yeast dies, so the fermentation stops. Obtaining a higher ethanol content requires a process called distillation. This involves heating the beverage until the ethanol "boils off", then collecting the ethanol vapor. It is possible to do this because ethanol boils at a lower temperature than does water.

Distilled spirits is the name we give to high-ethanol-concentration beverages produced by distillation. These include rum, whiskey, gin, vodka, etc. The ethanol concentration of distilled spirits usually is expressed in terms of proof, which is a number corresponding to twice the ethanol percentage. For example, an 80-proof beverage has an ethanol concentration of 40 percent.

Over the millennia during which people have used and abused ethanol, some standard-size servings of the different beverages have evolved. Beer, for example, is normally dispensed in 12-ounce servings. Since beer has an ethanol concentration of about four percent, the typical bottle or can of beer contains a little less than one-half ounce of pure ethanol. A standard glass of wine has about four ounces of liquid. Wine is about 12 percent alcohol, so the glass of wine also has a bit less than one-half ounce of ethanol in it. Whiskey and other distilled spirits are dispensed by the "shot glass", usually containing about one and one-quarter ounce of fluid. At a typical concentration of 40 percent ethanol (80-proof), the standard shot of whiskey has approximately one-half ounce of ethanol. Therefore, as far as their alcoholic contents are concerned, a can of beer, a glass of wine and a shot of whiskey are all the same.

Alcohol's Properties

Alcohol is a general term denoting a family of organic chemicals with common properties. Members of this family include ethanol, methanol, isopropanol, and others. This introduction discusses the physical, chemical, and physiological aspects of the most commonly ingested of these - ethanol.

Alcohol (ethanol) is a clear, volatile liquid that burns (oxidizes) easily. It has a slight, characteristic odor and is very soluble in water. Alcohol is an organic compound composed of carbon, oxygen, and hydrogen; its chemical formula is C2H5OH.

Alcohol is a central nervous system depressant and it is the central nervous system which is the bodily system that is most severely affected by alcohol (see chart below). The degree to which the central nervous system function is impaired is directly proportional to the concentration of alcohol in the blood.

When ingested, alcohol passes from the stomach into the small intestine, where it is rapidly absorbed into the blood and distributed throughout the body. Because it is distributed so quickly and thoroughly the alcohol can affect the central nervous system even in small concentrations. In low concentrations, alcohol reduces inhibitions. As blood alcohol concentration increases, a person's response to stimuli decreases markedly, speech becomes slurred, and he or she becomes unsteady and has trouble walking. With very high concentrations - greater than 0.35 grams/100 milliliters of blood (equivalent to 0.35 grams/210 liters of breath) - a person can become comatose and die. The American Medical Association has defined the blood alcohol concentration level of impairment for all people to be 0.04 grams/100 milliliters of blood (equivalent to .04 grams/210 liters of breath). The following is a generally accepted guide to the effects of alcohol.

Stages of Alcohol Intoxication

Physiological Processes

Ethanol is a central nervous system depressant. It doesn't affect a person until it gets into their central nervous system, i.e., the brain, brain stem and spinal cord. Ethanol gets to the brain by getting into the blood. In order to get into the blood, it has to get into the body.

There are actually a number of different ways in which ethanol can get into the body. It can be inhaled. Ethanol fumes, when taken into the lungs, will pass into the bloodstream and a positive blood alcohol concentration (BAC) will develop.

Ethanol could also be injected, directly into a vein; it would then flow with the blood back to the heart, where it would be pumped first to the lungs and then to the brain. And, it could be inserted, as an enema, and pass quickly from the large intestine into the blood. But none of these methods are of any practical significance, because alcohol is almost always introduced into the body orally, i.e., by drinking.

Absorption

Once the ethanol gets into the stomach, it has to move into the blood. The process by which this happens is known as absorption. One very important fact that pertains to alcohol absorption is that it doesn't have to be digested in order to move from the stomach to the blood. Another very important fact is that alcohol can pass directly through the walls of the stomach. These two facts, taken together, mean that – under the right circumstances – absorption of alcohol can be accomplished fairly quickly. The ideal circumstance for rapid absorption is to drink on an empty stomach.

When the alcohol enters the empty stomach, about 20 percent of it will make its way directly through the stomach walls. The remaining 80 percent will pass through the base of the stomach and enter the small intestine, from which it is readily absorbed into the blood. Because the body doesn't need to digest the alcohol before admitting it into the bloodstream, the small intestine will be open to the alcohol as soon as it hits the stomach.

But what if there is food in the stomach? Suppose the person has had something to eat shortly before drinking, or eats food while drinking; will that affect the absorption of alcohol?

Yes it will. Food has to be at least partially digested in the stomach before it can pass to the small intestine. When the brain senses that food is in the stomach, it commands a muscle at the base of the stomach to constrict, and cut off the passage to the small intestine. The muscle is called the pylorus, or pyloric valve. As long as it remains constricted, little or nothing will move out of the stomach and into the small intestine. If alcohol is in the stomach along with the food, the alcohol will also remain trapped behind the pylorus. Some of the alcohol trapped in the stomach will begin to break down chemically before it ever gets into the blood. In time, as the digestive process continues, the pylorus will begin to relax, and some of the alcohol and food will pass through. But the overall effect will be to slow the absorption significantly. Because the alcohol only slowly gets into the blood, and because the body will continue to process and eliminate the alcohol that does manage to get in there, the drinker's BAC will not climb as high as it would have if he or she had drunk on an empty stomach.

Distribution

Once the alcohol moves from the stomach into the blood, it will be distributed throughout the body by the blood. Alcohol has an affinity for water. The blood will carry the alcohol to the various tissues and organs of the body, and will deposit the alcohol in them in proportion to their water contents. Brain tissue has a fairly high water content, so the brain receives a substantial share of the distributed alcohol. Muscle tissue also has a reasonably high water content, but fat tissue contains very little water. Thus, very little alcohol will be deposited in the drinker's body fat. This is one factor that differentiates alcohol from certain other drugs, notably PCP and THC, which are very soluble in fat.

The affinity of alcohol for water, and its lack of affinity for fat, helps explain an important difference in the way alcohol affects women and men. Pound for pound, the typical female's body contains a good deal less water than does the typical man's. This is because women have additional adipose (fatty) tissue, designed in part to protect a child in the womb. A Swedish pioneer in alcohol research, E.M.P. Widmark, determined that the typical male body is about 68 percent water, the typical female only about 55 percent. Thus, when a woman drinks, she has less fluid – pound for pound – in which to distribute the alcohol.

If a woman and a man who weighed exactly the same drank exactly the same amount of alcohol under the same circumstances, her BAC would climb higher than his. When we couple this to the fact that the average woman is smaller than the average man, it becomes apparent that a given amount of alcohol will cause a higher BAC in a woman than it usually will in a man.

Elimination

As soon as the alcohol enters the blood stream, the body starts trying to get rid of it. Some of the alcohol will be directly expelled from the body chemically unchanged. For example, some alcohol will leave the body in the breath, in the urine, in sweat, in tears, etc. However, only a small portion (about 2 - 10 percent) of the ingested alcohol will be directly eliminated.

Most of the alcohol a person drinks is eliminated by metabolism. Metabolism is a process of chemical change. In this case, alcohol reacts with oxygen in the body and changes, through a series of intermediate steps, into carbon dioxide and water, both of which are directly expelled from the body.

Most of the metabolism of alcohol in the body takes place in the liver. An enzyme known as alcohol dehydrogenase acts to speed up the reaction of alcohol with oxygen. The speed of the reaction varies somewhat from person to person, and even from time to time for any given person. On the average, however, a person's blood alcohol concentration – after reaching peak value – will drop by about 0.015 per hour. For example, if the person reaches a maximum BAC of 0.15, it will take about 10 hours for the person to eliminate all of the alcohol.

For the average-sized male, a BAC of 0.015 is equivalent to about two-thirds of the alcohol content of a standard drink (i.e., about two-thirds of a can of beer, or glass of wine or shot of whiskey). For the average-sized female, that same BAC would be reached on just one-half of a standard drink. So the typical male will eliminate about two-thirds of a drink per hour, while the typical female will burn up about one-half of a drink in that hour.

We can control the rate at which alcohol enters our bloodstream; for example, we can gulp down our drinks, or slowly sip them. We can drink on an empty stomach, or we can take the precaution of eating before drinking. We can choose to drink a lot, or a little. But once the alcohol gets into the blood, there is nothing we can do to affect how quickly it leaves. Coffee won't accelerate the rate at which our livers burn alcohol. Neither will exercise, or deep breathing, or a cold shower. We simply have to wait for the process of metabolism to move along at its own speed.

Body Weight and Body Type

In general, the less you weigh the more you will be affected by a given amount of alcohol. As detailed above, alcohol has a high affinity for water. Basically one's blood alcohol concentration is a function of the total amount of alcohol in one's system divided by total body water. So for two individuals with similar body compositions and different weights, the larger individual will achieve lower alcohol concentrations than the smaller one if ingesting the same amount of alcohol.

However, for people of the same weight, a well-muscled individual will be less affected than someone with a higher percentage of fat since fatty tissue does not contain very much water and will not absorb very much alcohol.

Rate of Consumption

Blood alcohol concentration depends on the amount of alcohol consumed and the rate at which the user's body metabolizes alcohol. Because the body metabolizes alcohol at a fairly constant rate (somewhat more quickly at higher and lower alcohol concentrations), ingesting alcohol at a rate higher than the rate of elimination results in a cumulative effect and an increasing blood alcohol concentration.

Alcohol Content

It's not how many drinks that you have, but how much alcohol that you consume. As you can see from the chart below some drinks are more potent than others.

Alcohol Content of Some Typical Drinks

Mixed drinks are based on typical drink recipes using 80 proof liquor. 
The amount of alcohol in actual mixed drinks may vary.

Alcohol Content (in Percent) of Selected Beverages

The concentration of the drinks that one ingests can have a slight effect on the peak alcohol concentration due to the differences in absorption rate of different concentrations of alcohol. Alcohol is most rapidly absorbed when the concentration of the drink is between 10% and 30%. Below 10% the concentration gradient in the gastrointestinal tract is low and slows absorption and the added volumes of liquid involved slow gastric emptying. On the other hand concentrations higher than 30% tend to irritate the mucous membranes of the gastrointestinal tract and the pyloric sphincter, causing increased secretion of mucous and delayed gastric emptying.

Food

Food consumed along with alcohol results in a lower, delayed blood alcohol concentration peak (the point of greatest intoxication). There are two major factors involved in this phenomenon.

First, because alcohol is absorbed most efficiently in the small intestine, the ingestion of food can slow down the absorption of alcohol into one's system. The pyloric valve at the bottom of the stomach will close in order to hold food in the stomach for digestion and thus keep the alcohol from reaching the small intestine. While alcohol will be absorbed from the stomach it is a slower and less efficient transition.

Second and equally important is the fact that alcohol elimination rates are inversely proportional to alcohol concentration in the blood. Therefore the suppressed levels of alcohol due to food ingestion cause the body to eliminate the alcohol that is absorbed at a faster rate.

The type of food ingested (carbohydrate, fat, protein) has not been shown to have a measurable influence on this affect but the larger the meal and closer in time between eating and drinking, the greater the diminution of peak alcohol concentration. Studies have shown reductions in peak alcohol concentration (as opposed to those of a fasting individual under otherwise similar circumstances) of 9% to 23%.

Medication

If you are taking any medication, it could increase the effects of alcohol. You should always consult your physician or the medical information that accompanies the medication when drinking alcohol in conjunction with any medication.

Fatigue

Fatigue causes many of the same symptoms that are caused by alcohol intoxication. These and other symptoms will be amplified if alcohol intoxication is concurrent with fatigue.

Tolerance

Tolerance is the diminution of the effectiveness of a drug after a period of prolonged or heavy use of that drug or a related drug (cross-tolerance). There are at least two types of tolerance at work with alcohol. The first is metabolic tolerance in which the alcohol is metabolized at a higher rate (up to two times as quickly) in chronic users. Because of the higher metabolic rate for alcohol lower peak blood alcohol concentrations are achieved by chronic alcohol users than the average drinker when the same amount of alcohol is ingested. The second is functional tolerance in which there is an actual change in the organ or system's sensitivity to the drug. Studies have shown that chronic alcohol users can have twice the tolerance for alcohol as an average person. It is important to note however that even in light of these tolerance factors, it has been shown conclusively that even in heavy alcohol users functional impairment is clearly measurable at the blood alcohol concentration levels that are currently used for traffic law enforcement and safety sensitive job performance.

Gender Differences

As outlined above in the section on Body Weight and Body Type different body types coincide with different body water percentages. In general, but by no means in all cases, women tend to have a higher percentage of body fat and thus a lower percentage of body water. Therefore, in general, if a man and a woman of the same weight ingest the same amount of alcohol the woman will tend to achieve a higher alcohol concentration. This, of course, would not be true if the woman was very fit and the man was somewhat obese, but on average, this is the case. Furthermore, total body water tends to decrease with age, so an older person will also be more affected by the same amount of alcohol. According to the table below the differences in alcohol concentration due to average body composition differences based on gender would be between 16% and 10% depending on age.

Average Total Body Water 
as a function of Sex and Age

Another gender based difference is in the elimination of alcohol. Although not explained, studies appear to show that women eliminate alcohol from their bodies at a rate 10% greater than that of men.