Talk:Alcohol intoxication

Psychiatry

Is "alcohol intoxication" psychiatry? IMO no. Alcoholism definitely is but not really acute intoxication.

Acute intoxication is toxicology. Psychiatry is not interested in getting involved until they are sober. This is the reality is most of the world. Doc James (talk · contribs · email) 07:04, 7 January 2018 (UTC)

Plenty of folks on behavioral health units are on withdrawl protocols. 69.255.127.93 (talk) 05:57, 20 October 2019 (UTC)

Is drinking alcohol the same as alcohol poisoning?

Somebody went through and conflated "alcohol intoxication" with "alcohol poisoning". That's not at all supported by the current sources and is 100% incorrect from a medical perspective. It's simply wrong. One's an acute medical emergency and the other's not. It seems somebody just folded the separate section into the main lede for organizational purposes. That's... not really helpful.

Does anybody want to take a stab at fixing this? It currently borders on inaccurate medical advice. J. Harrington Inchworm III (talk) 22:32, 2 March 2019 (UTC)

I agree with you @J. Harrington Inchworm III: I'm trying to edit the page accordingly but it seems to be contentious. FrankP (talk) 00:52, 20 December 2019 (UTC)

User:J. Harrington Inchworm III This source says they are synonyms https://books.google.ca/books?id=pwajBQAAQBAJ&pg=PA13#v=onepage&q&f=false

Which sources say they are not? Doc James (talk · contribs · email) 03:23, 3 March 2019 (UTC)

"This source says they are synonyms" -- No, that's a misreading of the source. Under the heading "Synonyms" are several entries -- the items in each line are synonyms of each other, e.g Alcohol poisoning (primary term) = Acute pathological intoxication (term in parentheses). But the inclusion of pathological is important there, because that is distinct from the items on the first line, where Inebriation = Acute alcohol intoxication, i.e. just being drunk. FrankP (talk) 22:57, 17 December 2019 (UTC)

I've removed this now, as not in source cited, and also WP:PN FrankP (talk) 19:03, 19 December 2019 (UTC)

@Doc James: Are you serious? I see you have immediately reverted my change. I have restrained myself from reverting you back for now. Is it your actual position that "alcohol poisoning" is verifiably synonymous with "inebriation"? Please discuss this a bit further. Thank you. FrankP (talk) 00:35, 20 December 2019 (UTC)

User:FrankP if you read the source[1] it lists under synonyms "alcohol poisoning" being the same as "acute pathologic intoxication"

I've seen the source. I have to disagree with you. Yes it equates "alcohol poisoning" with "acute pathologic intoxication". What it does not do is equate "alcohol poisoning" with "inebriation" or "drunkenness". Let's use WP:COMMON here. If you say being inebriated is the same as suffering alcohol poisoning then you rob the latter term of any significance. This source does not support your position. FrankP (talk) 01:04, 20 December 2019 (UTC)

This source also links the two.[2] Doc James (talk · contribs · email) 00:55, 20 December 2019 (UTC)

Another "bullet-point" list, from which it is hard to draw conclusions about what exactly is stated to be the same as what else. FrankP (talk) 01:11, 20 December 2019 (UTC)

"Alcohol poisoning presents in two forms, acute and chronic. However, these are most often referred to as alcohol intoxication and alcohol addiction respectively."[3] Doc James (talk · contribs · email) 01:05, 20 December 2019 (UTC)

Thank you, this does seem to be a much clearer expression, in a source, of the viewpoint you are presenting. Do you not see, however, that such a viewpoint is likely to be regarded as unusual by most speakers of English who have previously heard the term "alcohol poisoning"? Is it the case that if I drink a pint or two of beer that I have suffered a case of alcohol poisoning? FrankP (talk) 01:11, 20 December 2019 (UTC)

You would not really be intoxicated at a pint or two I do not imagine. I get parents / friends who bring in intoxicated youth and they often refer to it as alcohol poisoning. People do not generally present to the ER saying they are intoxicated but rather that they have alcohol poisoning. I think people use different terminology in different settings. Doc James (talk · contribs · email) 01:18, 20 December 2019 (UTC)

Yes, people use different terms, agreed. But what we should be looking for here is rather beyond what "some guy said in ER" -- shouldn't we be using the terminology that is current within relevant secondary literature? I appreciate that you've found a source (Gupta: Toxicology) which seems to use the term in the way you are suggesting, I just feel still it is counter-intuitive and would benefit from a bit of a step back so we can ask "is this really a consensus view"? An extra thought -- there might be some confirmation bias going on. The vast majority of people who become inebriated/intoxicated/drunk do not end up in ER. So that's a pretty bad sample to take. I've made a request for further input from Wikipedia:WikiProject Medicine FrankP (talk) 01:27, 20 December 2019 (UTC)

Sure sounds good... Doc James (talk · contribs · email) 06:38, 20 December 2019 (UTC)

(Here from WT:MED talk) For what it's worth, ICD has separate codes for intoxication and poisoning – F10.0 and T59 respectively in ICD-10, and 6C40.3 and NE61 respectively in ICD-11. I can only speak from a UK clinical coding aspect; but I'd be comfortable using both codes if both intoxication and poisoning were mentioned by the clinician (and have in the past). (I am not watching this page, so please ping me if you want my attention.) Little pob (talk) 13:40, 24 December 2019 (UTC)

I had a look at a few textbooks. The general theme seems to be that there's a spectrum that runs like this:

• alcohol intoxication ("got drunk")
• alcohol poisoning (serious medical problems; "pale or bluish skin, vomiting, nausea, confusion, unconciousness or cannot be roused, seizures, low body temperature, and slow or irregular breathing" per ISBN 9781444345315 page 185; in occasional drinkers, this appears to correlate with the symptoms given on page 238 for 150 to 300 mg/dL [which is double to quadruple the legal driving limits in the US)
• alcohol-induced coma
• death

My overall impression is that the line drawn between "intoxication" and "poisoning" is when you might die without treatment. However, ISBN 9781444345315 (page 53) says that different countries use the terms in different ways (and also notes some of the differences between the DSM and ICD definitions). Therefore, I think we're going to have to pick a way to use those terms in this article, explicitly say what we picked, and use them consistently throughout the article. There is no single correct answer. WhatamIdoing (talk) 05:17, 25 December 2019 (UTC)

Two more points:

• I thought this was a good summary of where to draw the line: "Most commonly, severe depression of the central nervous system coupled with respiratory depression is associated with alcohol poisoning. This is also a final common pathway to alcohol poisoning-related coma and death. In acute alcohol poisoning, the narrow spectrum of moderate to severe intoxication leading to poisoning and coma should be taken into strong consideration."
• The section heading is misleading, in what seems to be a POV-revealing way. There's a difference between "drinking alcohol" and "being intoxicated". Healthy adults can drink some alcohol without becoming intoxicated. WhatamIdoing (talk) 15:53, 25 December 2019 (UTC)

I wrote the section heading. It derives directly from the opening sentence of the article: "Alcohol intoxication, also known as drunkenness or alcohol poisoning, is the negative behavior and physical effects due to the recent drinking of ethanol (alcohol)". This sentence does not add any of the qualification concerning degrees of intoxication which are evident in the discussion so far. It seems to say quite simply (and misleadingly) that drinking alcohol = alcohol intoxication = drunkenness = alcohol poisoning. My point is that it should be more nuanced, and I think the comments here reflect that idea, that there is a spectrum with poisoning at the far end. FrankP (talk) 18:43, 3 January 2020 (UTC)

Short answer: Ethanol is not a poison but one can poison oneself with it in several ways.

Much longer answer: One usually associates the concept of a poison with a risk of death or disease. Let us exemplify this with a different substance as an introduction to the terminology as follows. We all have a certain amount of mercury in our bodies, and mercury is certainly poisonous in large enough quantities. Chronic mercury poisoning is debilitating; Erethism, also known as erethism mercurialis, mad hatter disease, or mad hatter syndrome, is a neurological disorder which affects the whole central nervous system, as well as a symptom complex, derived from mercury poisoning. Now to call mercury a poison is only slightly semantically challenged. However, it is more exactly a hazardous substance, and generally poisonous in the context of inhaled metallic vapor or ingested as the chloride, which latter is extremely toxic.

When chronic ethanol intoxication is debilitating, it is a disease. I leave it to the semanticists to define the difference between psychosocial debilitating chronic ethanol intoxication and alcoholism, but do leave a clues; As with any psychiatric condition, it is up to an external observer, and not the afflicted who therein may lack insight, to ascertain what degree of debilitation qualifies a person as an alcoholic. However, objectively organic disease resulting from chronic ethanol intoxication in some cases includes: (1) retrograde amnesia (Korsakoff's syndrome) via thiamine deficiency. (2) alcoholic cirrhosis of the liver.

Ethanol is toxic in large quantities, i.e., its toxicity is called low. Moreover, a certain concentration of naturally occurring ethanol blood level is called endogenous-normal physiologic (and sometimes is higher than normally physiological; endogenous pathophysiological).

Finally, as it naturally produced in the body, ethanol is not a poison per se. However, it is poisonous with acute or chronic (ingestion or inhalation) in large enough quantities as it can cause disease and death, and is typically toxic at lower levels than it would be thought poisonous. For example, see the 50% lethal dose (LD50) and 50% lethal concentration literature for ethanol.

From Ethyl Alcohol - Fisher Scientific

LD50/LC50: CAS# 64-17-5:

    Draize test, rabbit, eye: 500 mg Severe;
    Draize test, rabbit, eye: 500 mg/24H Mild;
    Draize test, rabbit, skin: 20 mg/24H Moderate;
    Inhalation, mouse: LC50 = 39 gm/m3/4H;
    Inhalation, rat: LC50 = 20000 ppm/10H;
    Oral, mouse: LD50 = 3450 mg/kg;
    Oral, rabbit: LD50 = 6300 mg/kg;
    Oral, rat: LD50 = 7060 mg/kg;
    Oral, rat: LD50 = 9000 mg/kg;

CarlWesolowski (talk) 01:38, 5 January 2020 (UTC)

Alcoholism

Fits better as a risk factor of alcohol intoxication than a complication per this source.

"Alcohol use disorder - Symptoms and causes". Mayo Clinic. Retrieved 26 November 2019.

Unless you have another source?

Basically alcohol intoxication is a complication of alcoholism does not mean that alcoholism is viewed as a complication of intoxication. Doc James (talk · contribs · email) 15:32, 29 November 2019 (UTC)

Death by alcohol

I watched this video -- https://www.youtube.com/watch?v=2gn-QZ_e06k -- and it said that since alcohol relaxes parts of the brain, if you drink a huge amount of alcohol it can relax it so much that the medulla shuts down, killing the drinker. This death due to vital functions not happening anymore/vital organs not working should be written about in the article, probably with a better source. Notice, that this death by ethanol is not caused by choking on vomit. --User123o987name (talk) 05:28, 2 December 2019 (UTC)

RfC: Is it possible for alcohol intoxication to lead to alcoholism?

I have been involved in an edit war with @Doc James: over the question of whether alcoholism should be included as a complication of alcohol intoxication. My position is that our own article on Alcoholism provides sufficient language to justify the notion that alcohol intoxication leads to alcoholism: subsection Alcoholism#Warning_signs states that "warning signs of alcoholism include... frequent intoxication," and subsection Alcoholism#Definition states that "the drinking will increase as more intoxication is required." The other editor insists that listing alcoholism as a risk factor is sufficient, despite the fact that language published by Wikipedia makes clear that additional alcohol intoxication is just as much of a complication—in other words, my position is that alcohol intoxication is BOTH a risk factor for, AND complication of, alcoholism. I'm saying that we should, at the least, classify it as both. Rowsdower45 (talk) 05:12, 10 December 2019 (UTC)

Do you have a reference?

Current we list "alcohol intoxication" as a complication of alcoholism.

Does a single episode of intoxication lead to alcoholism? No.

Thus I would not see it as a complication. Doc James (talk · contribs · email) 19:16, 10 December 2019 (UTC)

I side withUser:Doc James on this. Unfortunately, I'm also an expert on alcoholism, as I'm in the 12 step fellowship and have been sober 30+ years. I was an alcoholic before I had my first drink, that is , I had the personality and the addictive mentality first.

Additionally this diff is troubling as it appears as if you're looking to introduce Original research into the article. We do have to say what the source says. Necromonger...We keep what we kill 14:26, 11 December 2019 (UTC)

Congratulations on your sobriety.

I'm not sure that a scientific understanding of alcoholism supports the idea that someone can be an alcoholic even if the person never drinks any alcohol, since a distinction is usually drawn between someone being at risk for developing alcoholism and having already developed the disorder. WhatamIdoing (talk) 05:50, 25 December 2019 (UTC)

That's a tough one. I don't see sources describing it as a "complication," per se. I think this is just a case of trying to fit a square peg into a round hole. The template doesn't have a field of what I would say is the relationship between alcohol intoxication and alcoholism. I don't think it should go into "complications". AlexEng^(TALK) 22:14, 19 December 2019 (UTC)

No This claim should not be included within the article unless you have valid sources. It's a bit of a stretch to say intoxication leads to alcoholism. If anything its the other way around.HAL333 22:55, 19 December 2019 (UTC)

No. Not a complication. Alcohol intoxication is separate and apart from alcoholism and isn't caused by it nor vice versa. -SusanLesch (talk) 21:03, 22 December 2019 (UTC)

no per all editors aboveOzzie10aaaa (talk) 23:21, 22 December 2019 (UTC)

no a complication implies that alcoholism is an expected possible result of intoxication. That is a gross oversimplification of a complex problem. — Preceding unsigned comment added by Nightenbelle (talk • contribs)

It depends almost entirely on whether you're discussing acute intoxication or chronic intoxication. If acute, then no. If chronic, then yes. The duration matters w.r.t. the answer because of how this induction occurs. I'm assuming this discussion strictly pertains to acute intoxication based upon the replies though. Seppi333 (Insert 2¢) 05:26, 29 December 2019 (UTC)

alcohol intoxication is BOTH a risk factor for, AND complication of, alcoholism. You're not wrong, and that's true for any addictive drug; you obviously can't become addicted to something to which you aren't exposed. But, dosage and timing are both relevant when you're talking about addiction risk. Chronic low-dose exposure to an addictive agent doesn't create an addiction risk, nor does an isolated high-dose exposure to one in spite of the reward-priming effects it might have. In contrast, even relatively infrequent high-dose exposure to an addictive substance creates a significant risk because ΔFosB persists in the human brain for months, increases in its expression are potentiated by positive feedback loops through c-Fos and H3K9me2, and increases in its expression progressively increase drug-seeking behavior to the point of compulsion. Hence why duration/frequency of exposure matters.

Anyway, there is a very obvious solution to this dispute: just state that regular or chronic intoxication entails a high addiction risk while acute intoxication does not (provided it's an isolated event). There are plenty of sources out there to cite a statement like this since it's true for literally any drug. E.g., this one if it wasn't obvious. Seppi333 (Insert 2¢) 06:57, 29 December 2019 (UTC)

If you will allow a comment. The above question is futile in the sense that the arguments are alike to the "Which came first; the chicken or the egg?" question. That question actually has an answer, but one would not recognize it from the type of arguments used to debate it. In the chicken/egg case, in point of fact, they co-evolved so there never was a first chicken egg. At some point in the past there were proto-chickens laying proto-chicken eggs, which gradually turned into chickens and chicken eggs, or, to put it another way, at some point in the past, and although we can only do this as a thought experiment, proto-chicken mating with modern rooster would be sterile, which probably occurred at a different past epoch than infertility of mating proto-rooster with modern chicken. What is the point here? One cannot perform a substance dependency test using a proto-alcoholic who has never ever consumed alcohol, without taking that first drink (or first inhalation). It is an important step to maintaining sobriety for someone to say, "I am an alcoholic," and to pointedly omit saying "but I am on the wagon." What this implies is that alcoholism means different things to different people, such that for some there is a need to differentiate between current and past substance dependence, and for others there is a need to not distinguish between them. In point of fact, one cannot travel down that road without alcohol having been consumed at some point in time and like the chicken and egg problem, one cannot have a history of chronic substance abuse without both the substance and the abuser, and one needs both the substance and someone to abuse it to have substance abuse, whenever that occurred.CarlWesolowski (talk) 04:08, 7 January 2020 (UTC)

Reflist

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