Begin with tolerance and dependence. An alcoholic tolerance is the ability to consume
larger than expected amounts of alcohol with reduced effects – you may not look or even

feel particularly intoxicated, but by objective standards, you are. Dependence refers to the
symptoms of withdrawal. Those usually start small – anxiety, mild irritability, occasional nausea
or loss of appetite, interrupted sleep. These can progress over time to include more severe
distress – disruption of the nervous system that results in insomnia, tremors, night sweats,
significant nausea and vomiting, and panic attacks. Delirium tremens (DTs) refers to a very
severe syndrome that usually develops after drinking ceases and can include hallucination and
left untreated, may be life-threatening.

Alcohol, in the form of heavy and binge drinking, is a contributor to somewhere in the
neighborhood of 80,000 deaths annually in the US. Many of those stem from alcohol’s role in
liver, heart, and respiratory disease.


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