Some Observations on the Neurological Effects of Alcohol Intoxication and Withdrawal

The abuse of alcohol gives rise to a wide variety of neurological disorders. However, the mechanism by which alcohol produces its effect is quite different in each of them. One group of symptoms is due to the toxic effects of alcohol-per.. se;. anatb r; io t1ie withdrawal of the drug after a period of prolonged inebriation; and still others, to the effects of ^maTnulrhion or -derangement of liver function. The failure to appreciate these fundamental distinctions among the alcoholic neurological disorders has led to a great deal of confusion and contradictory statements about .them in medical writings. In particular, there has been a failure to distinguish clearly between effects of alcohol intoxication and the effects of withdrawal of alcohol following a period of chronic intoxication. Why delirium tremens and related disorders were ever confused with the effects of alcohol intoxication is difficult to understand. A moment's reflection indicates the basic differences between these syndromes. It is obvious that the symptoms of toxicity, consisting of slurred speech, uninhibited behavior, staggering gait, stupor, and coma are in themselves distinctive and different from the symptom complex of tremor, hallucinations, fits, and delirium. The former group of symptoms is associated with an elevated blood alcohol level, whereas the latter become evident only when the blood alcohol level is reduced. Finally, the toxic symptoms increase in severity as more alcohol is consumed (the drowsy patient becomes stuporous, for example whereas tremor, _hallucinosis, and similar ymptoms e r a suppressed by the administration of alcohol. The manifestations of acute alcohol intoxication are so commonplace that they hardly require elaboration. These manifestations and the mechanisms by which they are produced do not differ essentially from those of many other sedative-hypnotic drugs and anesthetic agents. For these reasons little more is said of them here, and the remainder of this discussion is concerned with the alcohol withdrawal syndrome.