fanfic: this character has had several bottles of hard liquor and they’re just slurring their speech slightly and for some reason are not in the hospital with alcohol poisoning

me: ….you’ve literally never had a drink in your life have you

very good point.

Alcohol For the Non-Drinking Fanfic Writer, a primer by me

There’s a shit ton of variability in response to alcohol depending on body mass, history of drinking (your liver can upregulate the CYP450 enzyme responsible for metabolizing alcohol but only to a certain point; chronic alcoholics hit a point where their livers are so trashed they lose this and go back to getting drunk off small amounts of alcohol), and ethnicity (people of East Asian descent are more likely to lack a critical enzyme for breaking down one of the metabolic steps in the degradation of ethanol and are stuck in the shittiest part of it, with flushing and nausea), and other factors.

But if I had to guesstimate for writing:

1 drink (a tall glass of beer, a can of beer, or a shot of hard alcohol in a cocktail or alone): are you a burly dude? you may or may not feel it. are you a tiny lady? you will probably notice it.

2 drinks: burly dude may or may not be noticing it. tiny lady like me: this is a sweet spot where you’re talkative but not drunk. (Note: people don’t go from zero to “so drunk you remember nothing/are profoundly disinhibited.” There’s a lot of ground to cover in between.)

3 drinks: burly dude probably feeling it, tiny lady getting drunk.

4 drinks: burly dude still feeling it, tiny lady ready to FUCKING FIGHT YOU

5 drinks: burly dude, slow down, buddy, you gonna polish off that six-pack by yourself? That’s going to hurt in the morning. Tiny lady: oh my GOD stop. Go to bed.

This is where we draw the cut-off for a “binge,” if you were wondering. More than this and you’re officially binge-drinking, where your odds of serious harm go up sharply. From alcohol, but also from the bad decision dinosaur that plagues you when you binge-drink.

a fifth of anything by yourself: Sir. Sir, can you hear me? Sir, I need you to open your eyes. Squeeze my fingers. Sir, you’re in the emergency room.

Splitting a bottle of wine between two adults: generally like three drinks each, you’ll feel it but you’ll survive. (A bottle of wine between three adults: usually not quiiiiiite enough.)

An entire bottle of wine by yourself: oh, so you enjoy suffering?

Other Fun Medical Alcohol Facts: high-proof alcohol like vodka will temporarily paralyze your pyloric sphincter, so the alcohol can’t get into your gut for about twenty minutes. Then, when it DOES get into your small intestine, enjoy getting uncomfortably drunk too fast.

Alcohol is a zero-order metabolizer: that means that nothing on Earth can sober you up except time*, and the time it takes is linear, directly related to how much you drank. Most of us can clear about a drink an hour, so if you’re drinking slowly you can stay roughly sober all day. Most of us don’t drink that slowly. Hangovers are made awful by a metabolic intermediate (literal acid in your blood!!!! it’s so shitty!!!!!!!) that makes you nauseated and feel super gross, and not every drinking episode will lead to a hangover, and severity of hangover varies greatly by person and amount drunk.

So please never write someone having coffee to “sober up.“ Now they’re drunk AND they can’t sleep. Bad combo. Sucks for driving. Splashing cold water on your face? No. Amphetamines? Good Lord what’s wrong with you. Look, the room’s gonna spin, you fucked up your endolymph in your semicircular canals, deal with it. You can partially override that with proprioceptive feedback–keeping one foot on the floor to get tactile input–but it’s just gonna suck for a while.

The variability in capacity is real; my aunt-in-law, who is roughly my size, can drink me under the table easily. She’s a high-powered business executive who has martinis with lunch. I tried to keep up with her once and had to call in sick. So you don’t HAVE to write a character having a “normal” alcohol tolerance, but don’t get into “yep, definitely alcohol poisoning” territory, please.

This has been Please Don’t Show Up In My Emergency Room, I Hate Getting Barfed On by your local friendly medical trainee.

*this is technically not true, but no substance you can get your hands on will do it. hmu if you want to hear the story of the EtOH receptor antagonist and why it never went to market, what with all the dying.

what’s the EtOH receptor antagonist???

okay whew. here we go. there has been a LOT more interest in this than I was expecting (I was expecting none, to be clear), and it has been approx. 8 billion years since I was in undergrad, which is the last time I can reasonably claim to have been CURRENT on Neuro research. (I did my master’s at an institution that does not have what one might call a robust Neuro department and mainly did Stats.) So if a real live Neuro person comes on here and contradicts me, you should probably believe them.

BUT. Here is the story, as I recall it:

Alcohol, or, as we fancy-schmancy-pantsy medical types like to call it to distinguish it from the bajillion other alcohols out there (”alcohol” describes a general type of molecule in chemistry, not the good ol’-fashioned Get You Drunk molecule) ethanol, abbreviated EtOH, is what’s generally called a “sedative-hypnotic.” What that means is that it doesn’t work on opioid receptors, it doesn’t work on cannabinoid receptors. It does stuff to your GABA receptors–GABA being the major inhibitory neurotransmitter–and it also binds to other stuff. We still don’t have its actions in the brain fully mapped. But we know, and we’ve known for a while, that it does stuff to GABA receptors.

A major pharmaceutical company developed an honest-to-God antagonist. If you’re not a pharm person, you may be going, “a what now?” First point: damn near everything your brain does is determined by neurotransmitters and the receptors that love them. Neurotransmitters interact with their receptors in a variety of ways, with a HUGE variety of end results. Humans love jamming other chemicals that are not neurotransmitters into their receptors. Why do opioids work? Because they mimic NTs we make ourselves. Why does cannabis get us high? Because it mimics endogenous (”originating inside”, self-made) NTs. Manmade molecules that alter us are hijacking built-in systems. Don’t even get me started on how fucking bananas cool it is that neurons can adapt to neurotransmitter levels, and in a super awesome sci-fi-like variety of ways. Take a Neuro class! Take five! Take seventeen! Most fun I ever had was in a Neuro lab.

So what’s an antagonist? It’s something that, one way or another, makes it so the NT can’t do its thing at the receptor.

The line of thinking went, if we can keep ethanol from doing its thing at the GABA receptor, we can make people sober again. They can drink and then take a pill and be sober. Wouldn’t that be AMAZING? Wouldn’t that be lucrative? These are questions that drug companies think about a LOT.

So they made the chemical! Its name is
Ro15-4513. You can Google it and get a WAY less interesting description of what went down. But how my professor explained it to us is like this:

It works. It’s an ethanol antagonist at the GABA receptor. You take it and it blows the ethanol off the receptor and you’re sober. And… because humans are awful, you get drunk again. You take another pill. You’re sober again. The time that pill is active is less than the time it takes your body to metabolize ethanol, so you’ve still got all that ethanol swishing around in your system waiting to murder you via aspirating your own vomit the hot second it wears off, but by God, you’re sober.

Except, as mentioned, the GABA receptor is not the only place where ethanol does stuff. One of the effects it has, since it’s such a teeny tiny molecule, is fucking with the lipid bilayer that forms the bulk of your cell membrane. If you’re a Neuro person, you’re getting cold chills right about now, because the only reason neurotransmission works is the properties of the lipid bilayer. You have to be able to transmit electricity down the axon of the neuron to generate an action potential. The lipid bilayer is what allows you to do that.

The pill does nothing for that. So if you take enough of the pill, and keep drinking, there comes a point where you’ve fucked the lipid bilayer beyond repair. You can’t transmit messages. Your brain doesn’t remember how to tell your body to do things like breathe, or not have seizures. And you die!

So, in summary, we have a pill that could make you a responsible designated driver, but actually fucking kills you because people have no self-control.

Moral of the story: Neuroscience Is Super Fun!!!!! It was my gateway drug into medicine. I would never have gone to medical school if it weren’t for my Behavioral Neuroscience professors.

today on: humanity’s hubris has led to so many things being bad when they were designed to be good

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