The essential feature of alcohol intoxication is the presence of clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develop during, or shortly after, alcohol ingestion (Criterion B). These changes are accompanied by evidence of impaired functioning and judgment and, if intoxication is intense, can result in a life-threaten— ing coma. The symptoms must not be attributable to another medical condition (e.g., diabetic ketoacidosis), are not a reﬂection of conditions such as delirium, and are not related to intoxi- cation with other depressant drugs (e.g., benzodiazepines) (Criterion D). The levels of incoor- dination can interfere with driving abilities and performance of usual activities to the point of causing accidents. Evidence of alcohol use can be obtained by smelling alcohol on the individ- ual’s breath, eliciting a history from the individual or another observer, and, when needed, having the individual provide breath, blood, or urine samples for toxicology analyses.
Alcohol intoxication is sometimes associated with amnesia for the events that occurred during the course of the intoxication (”blackouts"). This phenomenon may be related to the presence of a high blood alcohol level and, perhaps, to the rapidity with which this level is reached. During even mild alcohol intoxication, different symptoms are likely to be observed at different time points. Evidence of mild intoxication with alcohol can be seen in most individuals after approximately two drinks (each standard drink is approximately 10—12 grams of ethanol and raises the blood alcohol concentration approximately 20 mg/ dL). Early in the drinking period, when blood alcohol levels are rising, symptoms often include talkativeness, a sensation of well-being, and a bright, expansive mood. Later, es- pecially when blood alcohol levels are falling, the individual is likely to become progres- sively more depressed, withdrawn, and cognitively impaired. At very high blood alcohol levels (e.g., 200—300 mg/dL), an individual who has not developed tolerance for alcohol is likely to fall asleep and enter a first stage of anesthesia. Higher blood alcohol levels (e.g., in excess of 300—400 mg/dL) can cause inhibition of respiration and pulse and even death in nontolerant individuals. The duration of intoxication depends on how much alcohol was consumed over what period of time. In general, the body is able to metabolize approxi- mately one drink per hour, so that the blood alcohol level generally decreases at a rate of 15—20 mg/dL per hour. Signs and symptoms of intoxication are likely to be more intense when the blood alcohol level is rising than when it is falling.
Alcohol intoxication is an important contributor to suicidal behavior. There appears to be an increased rate of suicidal behavior, as well as of completed suicide, among persons intoxicated by alcohol.
The large majority of alcohol consumers are likely to have been intoxicated to some degree at some point in their lives. For example, in 2010, 44% of 12th—grade students admitted to having been ”drunk in the past year,” with more than 70% of college students reporting the same.
Intoxication usually occurs as an episode usually developing over minutes to hours and typi— cally lasting several hours. In the United States, the average age at first intoxication is approx— imately 15 years, with the highest prevalence at approximately 18—25 years. Frequency and intensity usually decrease with further advancing age. The earlier the onset of regular intoxi— cation, the greater the likelihood the individual will go on to develop alcohol use disorder.
Temperamental. Episodes of alcohol intoxication increase with personality characteris- tics of sensation seeking and impulsivity.
Environmental. Episodes of alcohol intoxication increase with a heavy drinking envi- ronment.
The major issues parallel the cultural differences regarding the use of alcohol overall.