How are average-sized and above-average-sized people sometimes able to develop huge tolerances to alcohol and not immediately die?

Question

I’m sure we’ve all heard and read endless anecdotes about the guy who got pulled over and blew a .46, or someone that can drink entire bottle of vodka. Or Ric Flair, for example, who told a story in a documentary about a time when he drank a six-pack of beer before arriving at an airport, drank 10 double tequila, cranberry and sodas before the flight at the airport bar, had eight bloody Mary’s on the flight, and drank another six-pack of beer upon landing. Like, how does that not kill someone?

In: 876

Answer 1

There are basically two mechanisms of alcohol tolerance. The first is that your body (specifically your liver) gets better at clearing alcohol from the bloodstream. This means that if you drink the same amount, it doesn’t raise your blood alcohol content (BAC) as much. The second mechanism is that the places where alcohol has an effect in the body become less sensitive to it. Your body “recalibrates”, as it were, to the presence of alcohol. This means that, even if you have the same BAC as someone else, you won’t feel the effects as much. The flipside of this is that you won’t feel good if you have a BAC of 0. Because your body (and esp. your brain) has recalibrated to having alcohol around all the time, having no alcohol means you don’t function well.

People who drink a lot of alcohol will “train” both of these mechanisms. So an alcoholic who chugs a fifth of scotch will (A) not raise their BAC as much as a healthy person and (B) not feel the effects of the BAC they run up as much as a healthy person would.

The “breakdown tolerance” mechanism can eventually fail as people rack up so much liver damage that their liver just gives out.

The “systemic tolerance” (I’m making these terms up btw) mechanism is very important to be aware of when trying to get rid of alcohol addiction, because it get can to the point where an alcoholic **needs** to consume some amount of alcohol, or they might actually develop seizures and even die. Their brain chemistry is so adapted to constantly having alcohol, that without it the chemical balance gets totally screwed up. People with severe alcohol addiction therefore need to be weaned off alcohol gradually, and not quit drinking all at once. This is best done under expert medical supervision, of course.