Academic journal article Alcohol Research

Gender Differences in Moderate Drinking Effects

Academic journal article Alcohol Research

Gender Differences in Moderate Drinking Effects

Article excerpt

Research has confirmed the observation that women become more impaired than men after drinking similar quantities of alcohol. In addition, women appear to be more susceptible than men to alcohol's long-term health effects (e.g., alcoholic liver disease). The prevalence of chronic alcohol-related problems is significantly lower among women, however, perhaps in part because only 2 percent of American women are heavy drinkers,(1) compared with 9 percent of men (Substance Abuse and Mental Health Services Administration 1998). Studies report adverse effects in men and women at even moderate drinking levels.(2) Among those effects are disturbances of sensory information processing, short-term memory, reaction time, and eye-hand coordination. These deficits can impair the ability to drive a motor vehicle and may persist to the following day, impeding one's performance at work. The potential influence of gender on the acute effects of alcohol is therefore of importance for the large number of women who are social drinkers.

This article reviews research on the differential effects of moderate drinking on men and women and the mechanisms that may underlie these differences. These mechanisms fall into two categories: (1) gender differences in the physiological processing and elimination of alcohol (i.e., alcohol pharmacokinetics) and (2) differential sensitivity of the nervous system to alcohol's effects. Finally, the article evaluates data on the influence of the menstrual cycle and female reproductive hormones on the pharmacokinetics and nervous system effects of alcohol.

OVERVIEW OF ALCOHOL PHARMACOKINETICS

Blood alcohol concentration (BAC) is determined by the rate of alcohol absorption from the gastrointestinal (GI) tract into the bloodstream, the volume of distribution in the body, and the rate of elimination. Absorption and distribution determine the proportion of an ingested drug or other chemical substance that reaches the organs (alcohol bioavailability), where it may subsequently exert its effects. Alcohol is eliminated from the body largely by a metabolic process called oxidation, which occurs mostly in the liver. Some oxidation of alcohol also occurs during the absorption phase, thereby affecting the bioavailability of alcohol.

Absorption and Distribution

Alcohol consumed by mouth is rapidly absorbed into the bloodstream from the stomach and small intestine. The rate of absorption of alcohol depends on several factors, including the amount and concentration of alcohol ingested and the quantity and composition of food in the stomach. Alcohol absorbed from the small intestine flows through the portal vein directly to the liver, where a portion of the alcohol is metabolized. The process by which a substance is metabolized before entering the general circulation is called first-pass metabolism (FPM).

Many toxic substances undergo hepatic FPM. In the first step of hepatic FPM of alcohol, an oxidative enzyme called alcohol dehydrogenase (ADH) converts alcohol into acetaldehyde.(3) Hepatic FPM is most significant with low to moderate alcohol doses of about 0.4 grams per kilogram of body weight (g/kg), which is equivalent to about two standard drinks(4) for a person weighing 70 kg (approximately 150 pounds). The extent of FPM in the liver depends on the rate of absorption of alcohol from the GI tract. If absorption is fast, the quantity of alcohol reaching the liver can exceed the metabolic capacity of available ADH. This allows a greater proportion of alcohol to escape FPM and reach the general circulation, resulting in a higher peak BAC. Conversely, slow absorption leads to a higher FPM and a lower peak BAC. For example, the presence of food in the stomach leads to slower alcohol absorption, hence more efficient FPM and a lower peak BAC. The time from last drink to peak BAC usually ranges from 30 to 90 minutes (Hardman and Limbird 1995).

Some FPM may occur in the GI tract (mostly in the stomach) as well as in the liver (Yin et al. …

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