Alcohol Tolerance: What It Is and Why It Matters

Author: Mona Bapat, PhD, HSPP

Alcohol tolerance, which is often colloquially referred to as “holding your liquor,” tends to be viewed as a positive thing. It means that you can consume alcohol without showing signs of drunkenness, like slurred speech or behavioral changes. However, the development of alcohol tolerance can lead to further issues, such as physiological dependence and alcohol use disorder (AUD). Alongside other symptoms, it can also indicate the presence of an alcohol use disorder.

What is Alcohol Tolerance?

If you’ve developed alcohol tolerance, that means that your body has grown accustomed to the presence of alcohol, requiring you to drink greater amounts of alcohol to feel the same effects that you previously experienced with fewer drinks.

For instance, when you first started consuming alcohol, you probably only needed one or two drinks to feel drunk. But then, as you continued drinking over time, you likely noticed that you need two or three drinks to feel that way. This is also known as functional tolerance. Functional tolerance develops at different rates for different alcohol effects, such as impaired coordination and impaired concentration. Moreover, some people may develop a tolerance to the unwanted effects of alcohol while they still experience a rewarding or pleasurable feeling—this can reinforce future drinking.¹

Signs that you have developed a tolerance to alcohol include:²

You feel fewer effects of alcohol when you continue to consume the same amount.
You need to increase how much alcohol you consume to experience the same effects.

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Alcohol Tolerance and Changes in the Brain

Alcohol tolerance develops due to adaptations that occur in the brain. These neuroadaptations compensate for the physical, mental, and behavioral effects of alcohol.¹

What this means behaviorally is that you act as though you are not intoxicated, maybe even at high levels of blood alcohol concentrations (BACs).¹ BAC indicates the amount of alcohol in your blood. Legal intoxication is defined as .08% BAC.³

At this BAC, alcohol impairs brain functions, and you may experience problems such as blurred vision, slurred speech, and a slower reaction time. However, if you have a tolerance to alcohol, you may be able to see clearly, speak without difficulty, and have a normal reaction time, even at a BAC of .08.³

Those who drink chronically, in high amounts, may be able to function at a high BAC, such as .30%, which would be extremely debilitating or even potentially life-threatening for those without alcohol tolerance.^1,3

Why Is Alcohol Tolerance a Problem?

Alcohol tolerance can be problematic because it influences drinking behavior, patterns, and effects in several important ways. It can lead to further alcohol misuse, risky or dangerous situations, alcohol dependence and subsequent withdrawal symptoms, and alcohol use disorder.^1,2

Alcohol Misuse

Misusing alcohol means that your drinking may lead to interference with daily life or lead to various health problems. One way you can misuse alcohol is to binge drink. Binge drinking means having four or more drinks per occasion for women and five or more drinks per occasion for men.⁴

Another example of alcohol misuse entails consuming seven or more drinks per week for women and 14 or more drinks per week for men.⁴

Lastly, it is considered alcohol misuse if you drink while pregnant or while under the legal drinking age of 21 (in the United States).⁵

Alcohol tolerance perpetuates further alcohol misuse because tolerant individuals must drink a greater number of drinks in order to feel the desired effects. And if they don’t experience the negative effects, such as significant impairment, then this may encourage further drinking.¹

Risky Situations

Because alcohol-tolerance individuals have to drink more alcohol to feel the same effects, they are likely to drink even more per occasion.¹ This could, in turn, lead to higher and dangerous BAC levels.³

With alcohol tolerance, you appear to function normally at high BAC levels. The danger with this is that your body does not give you warning signs that you are consuming too much alcohol, such as vomiting or having trouble walking. Therefore, you may continue to drink because you think you are functioning fine. This can further raise your BAC to dangerous levels, and then you could suddenly go from appearing fine to becoming unconscious.¹

Consuming large amounts of alcohol can also decrease the effectiveness of any medications you take. It could also lead to alcohol poisoning, a potentially life-threatening consequence in which you drink a toxic amount of alcohol that the body cannot handle.¹

Moreover, if you have a high alcohol tolerance, you may decide that you’re okay to drive when your BAC is well over the legal limit since you aren’t experiencing significant impairment. This can lead to dangerous consequences.⁶

Alcohol Dependence

If you have alcohol dependence, it means that you have reached a point of needing alcohol to function. The two types of dependence are psychological and physical.

Psychological dependence means that you feel you need alcohol when experiencing negative emotions.⁷ For example, you might feel very anxious in social situations and need alcohol at a party. If alcohol is not available, you would endure the party with a great deal of discomfort or distress.

Physical or physiological dependence means that the body needs alcohol to function optimally. Along with dependence usually comes strong cravings for alcohol, continued alcohol use despite problems caused by drinking, and an inability to control alcohol consumption.⁵

Having alcohol tolerance can lead to a physical dependence because you are likely to drink more and more to get the same effects, which in turn causes your body to become used to alcohol. The risk for physical dependence goes up the more alcohol you consume, particularly if AUDs are in your family history.⁸

Alcohol Withdrawal

Alcohol withdrawal occurs when you are physically dependent on alcohol and suddenly stop drinking or significantly reduce the amount you consume. This is because your brain and body have adapted to the presence of alcohol and have compensated in several ways to function well when intoxicated. When you abruptly stop drinking, these compensations result in alcohol withdrawal symptoms, which range from uncomfortable to potentially life-threatening.

Alcohol withdrawal symptoms may include:²

Sweating
Rapid heartbeat
Hand tremors
Insomnia
Anxiety
Nausea or vomiting
Hallucinations (seeing, hearing, or feeling things that are not really there)
Agitation
Seizures

Alcohol tolerance contributes to alcohol withdrawal in the same way that it facilitates the development of dependence, since withdrawal syndrome is a manifestation of dependence.

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What Role Does Tolerance Play in an Alcohol Use Disorder?

Alcohol tolerance is both a cause and symptom of alcohol use disorder. However, it’s not the only cause and developing a tolerance does not mean that you’ve developed an alcohol addiction. Rather, once you require more and more drinks to feel intoxicated, this can lead to a cascade of consequences, such as heavy alcohol use and alcohol dependence, that increase the risk of developing alcohol use disorder. And on the other hand, you can be diagnosed with AUD without exhibiting alcohol tolerance, as long as you meet the criteria.

One of the criteria used to determine an AUD diagnosis is that of alcohol tolerance. If it’s the only symptom present, you likely don’t have an alcohol addiction, but you may still be at risk if your drinking continues and escalates. When present, along with at least one other symptom, tolerance can indicate alcohol use disorder.

A doctor can evaluate your tolerance using a series of questions related to your alcohol consumption. They might ask you how often you drink, how much you tend to drink in one session, and how frequently you’ve had five or more drinks in one sitting. Using these self-reported answers, they can assess your alcohol tolerance. Other questions they may ask when screening for alcohol use disorder include:⁹

How often, during the last year, have you found you were unable to stop drinking once you started?
How often have you failed to fulfill obligations because of drinking?
How often have you needed a drink when you wake up?
How often have you experienced cravings for a drink?
How often have you felt remorse or guilt after drinking?
How often have you been unable to remember what happened while drinking?
Have you or someone you know been injured due to your drinking?
Has a doctor or loved one expressed concern about your drinking?

How Can I Avoid Developing a Tolerance to Alcohol?

Alcohol tolerance increases the risk of various alcohol-related problems, but the good news is you can avoid it by consuming alcohol more safely. Here are some tips:¹⁰

Eat before and while you drink. This slows down the absorption of alcohol in the body.
Alternate alcoholic drinks with nonalcoholic ones like water or seltzer water.
Reduce the number of drinks you consume per occasion.
Avoid shots and drinking games, as they can increase BAC very quickly. Instead, slowly savor a good quality wine over a longer period.
Space out your drinks to no more than one standard alcoholic drink per hour, since that is what the liver can handle. Excessive drinking can lead to progressive liver damage.

A standard drink includes:

12 oz. of beer
8 oz. of malt liquor
4-5. oz of wine
1.5. oz of hard liquor

You can also take a break from alcohol consumption altogether to help lower your tolerance to where it was when you first started drinking.¹⁰

Not only can avoiding tolerance help to minimize health and safety risks, but it can also help you to experience the positive effects of alcohol, such as relaxation, that occur at safer BAC levels (0.02 to 0.06).³

If you find yourself no longer experiencing the same effects from alcohol consumption, or you find yourself consuming more to feel the same effects, you might want to get assessed by a mental health professional.

If you are concerned about your alcohol use or that of a loved one, you can call 800-948-8417 Calls are forwarded to paid advertisers 24/7 to speak with a treatment specialist.

Resources

National Institutes of Health. (2000, October). Alcohol Alert. National Institute on Alcohol Abuse and Alcoholism.
American Psychiatric Association. (2013). Substance-related and addictive disorders. In Diagnostic and Statistical Manual of Mental Disorders 5, 490-491. American Psychiatric Publishing.
National Library of Medicine. (2020, December 3). Blood Alcohol Level.
Centers for Disease Control and Prevention. (2018, February 1). Alcohol and Substance Misuse. Workplace Health Promotion.
Centers for Disease Control and Prevention. (2014, November 20). Most People Who Drink Excessively are not Alcohol Dependent. CDC Newsroom.
Amlung, M.T., Morris, D.H., & McCarthy, D.M. (2014). Effects of acute alcohol tolerance on perceptions of danger and willingness to drive after drinking. Psychopharmacology, 231, 4271-4279.
Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307-318.
Mayfield, R.D., Harris, R.A., & Schuckit, M.A. (2008). Genetic factors influencing alcohol dependence. British Journal of Pharmacology, 154, 275-287.
National Institute on Drug Abuse. (n.d.). AUDIT.
NYC Department of Health. (n.d.). Alcohol. NYC Health.