Monday, September 6
 Editor's note: This is the sixth of an eight-part series of articles examining the effects of commonly abused substances on athletic performance and overall health. Dr. Gary Wadler, a New York University School of Medicine professor and lead author of the book "Drugs and the Athlete", has also won the International Olympic Committee President's Prize for his work in the area of performance-enhancing drugs in competitive sports. He joined us to address the issue of alcohol use and sports performance.

What is alcohol?

Alcohol, a very simple molecule is probably the most widely used drug in the world. It is distributed to all the organs and fluids of the body, but it is in the brain that alcohol exerts most of its effects. Like other general anesthetics, alcohol is a central nervous system depressant. In general, its effects are proportional to its concentration in the blood.

How does the body handle alcohol?

Alcohol is rapidly absorbed from the gastrointestinal tract into the bloodstream and from there it is distributed throughout the other bodily fluids and tissues. Alcohol is principally metabolized by the liver into acetaldehyde, with the remainder being excreted in the urine. On average, it takes the liver about an hour to break down one unit of alcohol -- the amount typically found in 12 ounces of beer, 4 ounces of wine or one ounce of 50 proof hard liquor. "Blood alcohol levels decline at a fixed rate irrespective of the amount consumed," says Wadler. "The more consumed, the longer it takes to be metabolized. Additionally, blood levels are greatly, and inversely, influenced by body weight. The thinner you are, the greater the alcohol blood level for any given amount of alcohol consumed." Because of these factors, blood levels may remain elevated for many hours after the last drink."

What is the prevalence of alcohol use?

The most widely abused drug in the world, alcohol remains the No. 1 substance abused by teenagers and by all athletes, from junior high school through the professional ranks. It has been conservatively estimated that the average American college student drinks more than 34 gallons of alcohol yearly, predominantly beer. Alcohol is the most commonly used drug by college athletes, with about 80 percent having reported use in the past 12 months, down somewhat from 88 percent in previous years. In 1993, 40 percent of the 5,905 traffic fatalities of people between 15 and 20 years of age were alcohol-related.

What effect does alcohol have on performance?

Alcohol is generally not considered to be a performance-enhancing substance, and it has numerous deleterious effects associated with its use. According to Wadler, "Its effects depend upon a number of factors, including how much and how fast one drinks, the individual's size and how much food is in the stomach." The effects of alcohol are directly related to the concentration (percentage) of alcohol in the blood; however, the effects vary among individuals and even in the same individual at different times. Additionally, an acute tolerance may develop whereby increasing amounts are necessary to produce the same effect.

The detrimental effects of alcohol on performance are extremely well documented and include impairment of the following:

  • Balance and steadiness

  • Reaction time

  • Fine and complex motor skills

  • Information processing

  • Boisterousness, unsteadiness, slurred speech

  • Nausea, vomiting, marked unsteadiness, drowsiness

"Additionally, alcohol may impair temperature regulation during prolonged exercise in the cold, and in the heat, its diuretic effect may lead to dehydration," says Wadler. "Poorly appreciated is the fact that athletes who socially consume excessive alcohol the evening after a practice or a game may subsequently have an impairment of athletic skills for as long as 14 hours." Hangovers, the residual or "day-after" effect of alcoholic consumption, can result in symptoms of headaches, nausea, diarrhea, fatigue, dehydration, and body aches that can diminish athletic performance.

What are the long term adverse effects of alcohol?

The chronic abuse of alcohol may cause numerous adverse health effects which include:

  • Chronic alteration of brain and nerve function

  • Weakening of heart muscle

  • Testicular shrinkage and male breast enlargement

  • Impotency

  • Elevated triglycerides

  • Fat deposits in the liver

  • Cirrhosis and liver failure

  • Blood-clotting abnormalities

  • Pancreatitis

  • Vitamin deficiencies

  • Chronic skin alterations

  • Death

How is the degree of alcohol use categorized?

The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association divides alcohol use disorders into "Alcohol Dependence" and "Alcohol Abuse." Alcohol dependence is indicated by evidence of tolerance and/or symptoms of withdrawal such as delirium tremens (DTs) or alcohol withdrawal seizures upon cessation of drinking. Alcohol abuse is characterized by recurrent performance problems at school or on the job that result either from the after-effects of drinking alcohol or from actual intoxication. In addition, patients with alcohol abuse disorders may use alcohol in dangerous circumstances -- e.g., while driving - and may miss work or school, neglect child care, or household responsibilities because of alcohol use.