A quantitative theory of acute tolerance to alcohol

A critical review of front-loading: A maladaptive drinking pattern driven by alcohol's rewarding effects

Front-loading is a drinking pattern in which alcohol intake is skewed toward the onset of reward access. This phenomenon has been reported across several different alcohol self-administration protocols in a wide variety of species, including humans. The hypothesis of the current review is that front-loading emerges in response to the rewarding effects of alcohol and can be used to measure the motivation to consume alcohol. Alternative or additional hypotheses that we consider and contrast with the main hypothesis are that: (1) front-loading is directed at overcoming behavioral and/or metabolic tolerance and (2) front-loading is driven by negative reinforcement. Evidence for each of these explanations is reviewed. We also consider how front-loading has been evaluated statistically in previous research and make recommendations for defining this intake pattern in future studies. Because front-loading may predict long-term maladaptive alcohol drinking patterns leading to the development of alcohol use disorder (AUD), several future directions are proposed to elucidate the relationship between front-loading and AUD.

Acute rewarding and disinhibiting effects of alcohol as indicators of drinking habits

RATIONALE

Laboratory studies have reliably shown that heightened sensitivity to the rewarding effects of alcohol is associated with heavier drinking patterns. More recently, there has been research to suggest that heightened sensitivity to the disinhibiting effects of alcohol might also contribute to drinking habits. Most research on the acute effects of alcohol has focused on drinking magnitudes averaged across participants with little attention paid to how individual differences influence alcohol abuse potential. In large part, this is due to limited sample sizes in previous laboratory studies.

OBJECTIVES

This study overcomes previous limitations by testing the degree to which individual differences in acute sensitivity and tolerance to the rewarding and disinhibiting effects of alcohol relate to drinking behavior in a large sample size.

METHODS

Data from six laboratory studies were aggregated to comprise a sample of 181 adults. Participants' level of "liking" (the effects of alcohol) and disinhibition were assessed following 0.65 g/kg alcohol once during the ascending limb of the blood alcohol concentration (BAC) curve and again at the same BAC during the descending limb of the curve. The measures were also assessed following placebo.

RESULTS

Alcohol increased ratings of liking and behavioral disinhibition. Heavier drinking was associated with heightened sensitivity to liking on the ascending limb. Additionally, those who showed reduced acute tolerance to both disinhibition and liking were also heavier drinkers.

CONCLUSIONS

These data suggest that individual variability in liking the effects of alcohol and persistent disinhibition are key indicators of drinking habits.

Association between overall rate of change in rising breath alcohol concentration and the magnitude of acute tolerance of subjective intoxication via the Mellanby method

OBJECTIVE

The magnitude of acute tolerance is a strong predictor of the development of longer-term chronic tolerance and plays a decisive role in risky decisions (e.g., driving after drinking). Therefore, it is important to identify factors that increase the magnitude of this adaptive process. This study explored whether acute tolerance magnitude varied as a function of the overall rate of increase in breath alcohol concentration (BrAC).

METHODS

Twenty-nine young adult social drinkers (M age = 22.55, SD = 3.10; 62.1% women) consumed a moderate dose of alcohol (men: 0.86 g/kg, women: 0.75 g/kg) in a controlled laboratory setting. Subjective intoxication was assessed at matched BrACs (~0.060 g/dl) on each limb of the BrAC curve.

RESULTS

Hierarchical regression results indicated that faster overall increases in BrAC on the ascending limb were associated with greater acute tolerance for subjective intoxication ratings (p < .01, R²  = .29).

CONCLUSIONS

These results present some of the first evidence that faster increases in BrAC may be associated with greater acute tolerance, as indicated by greater reduction in subjective intoxication across the limbs of the BrAC curve. This greater reduction may, in turn, promote heavier drinking and/or engagement in behaviors for which one is unfit (e.g., driving after drinking).

Application of an alcohol clamp paradigm to examine inhibitory control, subjective responses, and acute tolerance in late adolescence

Individual differences in acute alcohol effects on cognitive control and subjective responses--and acute tolerance to these effects--are implicated in the risk for heavy drinking and alcohol-related harms. Few studies have examined these effects in drinkers under age 21. Additionally, studies of acute tolerance typically involve bolus oral alcohol administration, such that estimates of tolerance are confounded with blood alcohol concentration (BAC) limb. The current study examined cognitive control and subjective responses in young heavy drinkers (n = 88; M = 19.8 years old, SD = 0.8) during a single-session alcohol clamp protocol. Participants completed an intravenous alcohol session comprising an ascending limb (0 to 80 mg% in 20 min) and a BAC plateau (80 mg% for 80 min). Serial assessments included a cued go/no-go task and measures of stimulation, sedation, and craving. Relevant individual difference factors (attention-deficit hyperactivity disorder [ADHD] symptoms and sensation seeking) were examined as moderators. Multilevel modeling demonstrated that response inhibition worsened following initial rise in BAC and showed increasing impairment during the BAC plateau. ADHD symptoms and sensation seeking moderated this effect. Significant within-person associations between stimulation and craving were evident on the ascending limb only. Participants with higher ADHD symptoms reported steeper increases in stimulation during the ascending limb. These findings provide initial information about subjective and behavioral responses during pseudoconstant BAC, and potential moderators of these outcomes, in late adolescence. Additional studies with placebo-controlled designs are necessary to confirm these findings.

Reduced acute recovery from alcohol impairment in adults with ADHD

RATIONALE

Prior research has found that adults with attention-deficit/hyperactivity disorder (ADHD) show increased sensitivity to the impairing effects of alcohol (Weafer et al., Exp Clin Psychopharmacol 17: 113-121, 2009). However, these studies have focused exclusively on the ascending limb of the blood alcohol concentration (BAC) curve, and it is unclear whether these adults continue to show increased sensitivity during the later phase of the dose as BAC is declining.

OBJECTIVE

This study tested the hypothesis that those with ADHD would display increased response to alcohol during the ascending limb of the BAC curve and less recovery from the impairing effects during the descending limb.

METHODS

Adult social drinkers with ADHD and control adults completed measures of motor coordination, reaction time (RT), and subjective intoxication twice following 0.64 g/kg alcohol and placebo. The measures were administered during the ascending limb of the BAC curve and again during the descending limb.

RESULTS

During the ascending limb, alcohol reduced motor coordination, slowed RT, and increased self-reports of subjective intoxication. Those with ADHD displayed greater impairment of motor coordination compared with controls. During the descending limb, controls reported diminished subjective intoxication and showed recovery from the impairing effects of alcohol on both their motor coordination and their RT. Those with ADHD showed reduced subjective intoxication and faster RT during this time, but they did not recover motor control.

CONCLUSIONS

The protracted time course of motor impairment in adults with ADHD despite reductions in subjective intoxication may contribute to poor decision making and diminished behavioral control in this group.

Alcohol exposure rate control through physiologically based pharmacokinetic modeling

BACKGROUND

The instantaneous rate of change of alcohol exposure (slope) may contribute to changes in measures of brain function following administration of alcohol that are usually attributed to breath alcohol concentration (BrAC) acting alone. To test this proposition, a 2-session experiment was designed in which carefully prescribed, constant-slope trajectories of BrAC intersected at the same exposure level and time since the exposure began. This paper presents the methods and limitations of the experimental design.

METHODS

Individualized intravenous infusion rate profiles of 6% ethanol (EtOH) that achieved the constant-slope trajectories for an individual were precomputed using a physiologically based pharmacokinetic model. Adjusting the parameters of the model allowed each infusion profile to account for the subject's EtOH distribution and elimination kinetics. Sessions were conducted in randomized order and made no use of feedback of BrAC measurements obtained during the session to modify the precalculated infusion profiles. In one session, an individual's time course of exposure, BrAC(t), was prescribed to rise at a constant rate of 6.0 mg% per minute until it reached 68 mg% and then descend at -1.0 mg% per minute; in the other, to rise at a rate of 3.0 mg% per minute. The 2 exposure trajectories were designed to intersect at a BrAC (t = 20 minutes) = 60 mg% at an experimental time of 20 minutes.

RESULTS

Intersection points for 54 of 61 subjects were within prescribed deviations (range of ± 3 mg% and ± 4 minutes from the nominal intersection point).

CONCLUSIONS

Results confirmed the feasibility of applying the novel methods for achieving the intended time courses of the BrAC, with technical problems limiting success to 90% of the individuals tested.

Different chronic ethanol exposure regimens in adolescent and adult male rats: effects on tolerance to ethanol-induced motor impairment

Findings are mixed regarding the expression of tolerance after repeated ethanol exposure, perhaps in part due to dose/frequency variations in exposure regimens. The present study compared age-related differences in tolerance development following 10 days of 1g/kg twice daily, 2g/kg once daily, or intermittent 4g/kg ethanol exposure regimens. To measure expression of chronic tolerance and acute tolerance, ethanol-induced motor impairment was assessed on day 12, with functionally equivalent ethanol doses administered across age (2g/kg - adolescents; 1.5g/kg - adults). Subsequent challenge doses resulted in lower brain ethanol concentrations in both age groups as a function of the chronic ethanol regimens. Expected age-related differences emerged in acute tolerance expression in non-manipulated animals, with adolescents, but not adults showing acute tolerance. Regimens sufficient to induce alterations in ethanol metabolism did not result in chronic functional tolerance at either age, although chronic injections were sufficient to induce acute tolerance in adults.

Age differences in the expression of acute and chronic tolerance to ethanol in male and female rats

BACKGROUND

Ontogenetic differences in response to ethanol (EtOH) challenge have been observed under a variety of circumstances, including varying reports of developmental differences in the expression of tolerance to EtOH. The purpose of the present experiment was to further explore potential differences in acute (AT) and chronic (CT) tolerance expression between adolescent and adult, male and female Sprague-Dawley rats, using the social interaction test.

METHODS

AT and CT to the social suppressing effects of a moderate dose of EtOH was assessed in adolescent and adult rats following intraperitoneal injections of 2.0 g/kg EtOH or saline daily for 10 days. At test, adults and adolescents were challenged with 1.0 or 1.25 g/kg EtOH, respectively, with AT and CT assessed at 5 and 25 minutes postinjection using ratios of impairment to brain ethanol concentrations (BrECs) at each time period (CT) and within-session declines in impairment relative to BrECs (AT).

RESULTS

In adolescents, 10 days of EtOH pre-exposure resulted in evidence of CT at 25 minutes postinjection, perhaps associated with an enhanced expression of AT. Among adults, signs of CT were seen at 5 minutes postinjection in adults, and may reflect neuroadaptations unassociated with AT, as with evidence of tolerance emerging only in adult control animals repeatedly exposed to saline injection prior to EtOH challenge on test day. Sex differences in tolerance expression were not observed at either age.

CONCLUSIONS

Our results show ontogenetic differences between adolescents and adults in the short- and long-term neuroadaptations that they express in response to repeated perturbations with EtOH. Together these findings add age of exposure and time of testing within the intoxication period as critical variables to be considered when exploring the complex relationship between AT and CT.

Effect of the selective NMDA NR2B antagonist, ifenprodil, on acute tolerance to ethanol-induced motor impairment in adolescent and adult rats

BACKGROUND

Adolescent rats have been observed to be less sensitive than adults to a number of acute ethanol effects, including ethanol-induced motor impairment. These adolescent insensitivities may be related in part to the more rapid emergence of within session (acute) tolerance in adolescents than adults. Adolescent-related alterations in neural systems that serve as ethanol target sites, including changes in NMDA receptor subunit expression, may influence the responsiveness of adolescents to acute ethanol effects. This study explored the role of NMDA NR2B receptors in the development of acute tolerance to ethanol-induced motor impairment in male adolescent [postnatal day (P)28-30] and adult (P68-70) Sprague-Dawley rats.

METHODS

Motor-impairing effects of ethanol on the stationary inclined plane and blood ethanol concentrations (BECs) were examined following challenge at each age with a functionally equivalent ethanol dose (adolescents: 2.25 g/kg; adults: 1.5 g/kg). Data were collected at two postinjection intervals (10 or 60 minutes) to compare rate of recovery from ethanol intoxication with BEC declines using the Radlow approach (Radlow, 1994) and changes in motor impairment/BEC ratios over time for assessing acute tolerance.

RESULTS

Both vehicle-treated adolescent and adult animals showed similar acute tolerance development to the motor-impairing effects of ethanol at these functionally equivalent doses on the stationary inclined plane, as indexed by an increasing time-dependent dissociation between BECs and ethanol-induced motor impairment, with motor impairment declining faster than BECs, as well as by significant declines in motor impairment/BEC ratios over time. Acute tolerance development was reliably blocked by administration of the NR2B antagonist, ifenprodil, (5.0 mg/kg), in adult rats, whereas adolescents were affected by a higher dose (10.0 mg/kg).

CONCLUSIONS

These data support the suggestion that alterations in NMDA receptor systems occurring during adolescence may contribute to reduced sensitivity to ethanol by enhancing the expression of acute tolerance development in adolescents relative to adults.

What neurobiology cannot tell us about addiction

Molecular neurobiological studies have yielded enormous amounts of valuable information about neuronal response mechanisms and their adaptive changes. However, in relation to addiction this information is of limited value because almost every cell function appears to be involved. Thus it tells us only that neurons adapt to 'addictive drugs' as they do to all sorts of other functional disturbances. This information may be of limited help in the development of potential auxiliary agents for treatment of addiction. However, a reductionist approach which attempts to analyse addiction at ever finer levels of structure and function, is inherently incapable of explaining what causes these mechanisms to be brought into play in some cases and not in others, or by self-administration of a drug but not by passive exposure. There is abundant evidence that psychological, social, economic and specific situational factors play important roles in initiating addiction, in addition to genetic and other biological factors. Therefore, if we hope to be able to make predictions at any but a statistical level, or to develop effective means of prevention, it is necessary to devise appropriate integrative approaches to the study of addiction, rather than pursue an ever-finer reductive approach which leads steadily farther away from the complex interaction of drug, user, environment and specific situations that characterizes the problem in humans.

BK channel subunit composition modulates molecular tolerance to ethanol

BACKGROUND

The large conductance calcium-activated potassium channel (also called BK channel or Slo channels) is a well-studied target of alcohol action, and plays an important role in behavioral tolerance.

METHODS

Using patch clamp electrophysiology, we examined human BK channels expressed in HEK293 cells to test whether tolerance to ethanol occurs in excised patches and whether it is influenced by subunit composition. Three combinations were examined: hSlo, hSlo + beta(1), and hSlo + beta(4).

RESULTS

The 2 components of BK alcohol adaptation (Component 1: rapid tolerance to acute potentiation, and Component 2: a more slowly developing decrease in current density) were observed, and varied according to subunit combination. Using a 2-exposure protocol, Component 1 tolerance was evident in 2 of the 3 combinations, because it was more pronounced for hSlo and hSlo + beta(4).

CONCLUSIONS

Thus, rapid tolerance in human BK occurs in cell-free membrane patches, independent of cytosolic second messengers, nucleotides or changes in free calcium. Alcohol pretreatment for 24 hours altered subsequent short-term plasticity of hSlo + beta(4) channels, suggesting a relationship between classes of tolerance. Finally, Component 2 reduction in current density showed a striking dependency on channel composition. Twenty-four hour exposure to 25 mM ethanol resulted in a down-regulation of BK current in hSlo and hSlo + beta(4) channels, but not in hSlo + beta(1) channels. The fact that hSlo + beta(1) channels show less sensitivity to acute challenge, in conjunction with less Component 1 and Component 2 tolerance, suggests subunit composition is an important factor for these elements of alcohol response.

Acute tolerance to rate-decreasing effects of single doses of ethanol

Acute tolerance occurs when behavioral impairment is greater at a given blood ethanol concentration (BAC) on the ascending versus descending limb of the BAC-time curve following administration of a single dose of ethanol, however studies utilizing learned behaviors have not been widely reported. We assessed acute tolerance to single doses of ethanol in five Lewis rats responding under a fixed-ratio (FR8) schedule of food presentation. Response rates for food during 1-min components (ending 2, 4, 11, 18, 33, and 57 min after ethanol administration) were determined, and BAC was measured immediately after each component using a rat breathalyzer. Ethanol (0.4, 0.6, 0.8, and 1.2 g/kg, i.p.) produced dose-related decreases in responding for food that tended to recover over time for all but the highest dose tested. Similarly, dose-related increases in BAC were also observed. Using either an analysis that expressed impairment per unit BAC on the ascending limb versus the descending limb (by assessing the area under the curve (AUC) for behavior and BAC on each limb), the slope of the function that relates the behavioral effect to BAC (each expressed as percent maximum effect), or a variant of the Mellanby method (hysteresis), acute tolerance was observed following a dose of 0.4 g/kg ethanol. Though behavior appeared to recover on the descending limb following higher doses (especially 0.6 and 0.8 g/kg), acute tolerance to these doses was not present.

The clinical significance of variations in ethanol toxicokinetics

INTRODUCTION

Many variables affect the interpretation of an isolated ethanol level in an acutely intoxicated patient. This review demonstrates the significant variability in metabolism and elimination of ethanol, how it can differ between individuals, and the clinical importance of these variables.

DISCUSSION

Isolated ethanol values in a clinical scenario are only a snapshot of a dynamic process. The individual pharmacokinetic differences of people make it extremely difficult to estimate ethanol elimination rates or calculate previous ethanol concentrations at the time of an accident because of medical-legal reasons. Not only are the techniques used in measuring ethanol concentrations in bodily fluids (blood, serum, breath, and urine) not equivalent, but also the units used to report ethanol concentrations are often misinterpreted. Acute and chronic tolerance and social adaptive changes make interpreting this isolated ethanol level extremely difficult. The purpose of this review is to enable the clinician to appropriately interpret ethanol concentrations.

CONCLUSION

The clinical evaluation of a patient's inebriation is always more reliable than an isolated ethanol level for determining disposition. Only an estimation of a current serum ethanol level can be made if the blood draw was performed hours earlier. This review is clinically important because it shows the clinically significant variability in metabolism and elimination of ethanol and how it can differ between individuals. It will also describe different ways to measure ethanol concentrations and how to compare them. Finally, the interpretation of isolated ethanol levels will be discussed.

Short-term selection for acute ethanol tolerance and sensitization from an F2 population derived from the high and low alcohol-sensitive selectively bred rat lines

Previous studies have identified quantitative trait loci (QTL) in the inbred high and low alcohol-sensitive rat (IHAS1 and ILAS1) strains. The original development of the strains involved selection for ethanol sensitivity based on duration of the loss of the righting reflex (LORR) after a standard dose of ethanol. This paper confirms some of these QTL using a short-term selection procedure based on the difference between the blood ethanol level at LORR and regain of the righting response. An F(2) population of rats was developed by a reciprocal cross of IHAS1 and ILAS1 rats. Selection for five generations was carried out using delta-blood ethanol concentration (dBEC) as the selection trait, where dBEC=BECLR (BEC at loss of righting reflex)-BECRR (BEC at regain of righting reflex). The lines were labeled tolerant (TOL) or sensitive (SENS). Approximately one-third of the offspring for each generation in each line were genotyped using DNA markers that had been previously found to be linked to QTL on chromosomes 1, 2, 5, 12, and 13. By the fifth generation of selection, the lines showed a very large difference in dBEC, BECRR, and duration of LORR; BECLR showed little segregation during the selection, and latency to lose the righting reflex showed none. IHAS allele frequency increased in the SENS line for markers on chromosomes 1, 5, 12, and 13 while ILAS allele frequency increased in the TOL line. These results were in good agreement with the two previous QTL studies. On chromosome 2, the selection resulted in an accumulation of ILAS alleles in both lines. This study provides independent confirmation of the location of QTL on chromosomes 1, 5, 12, and 13 for ethanol sensitivity. It also suggests that genetic differences in duration of LORR are mediated primarily by the dBEC phenotype.

Effects of SR141716 and WIN 55,212-2 on tolerance to ethanol in rats using the acute and rapid procedures

RATIONALE

Our previous findings have shown rapid cross-tolerance between ethanol and Delta(9)-tetrahydrocannabinol and that intraperitoneal (i.p.) injection of cannabinoid receptor type 1 (CB1R) antagonist SR141716 (SR) does not interfere with tolerance to either of these drugs in mice.

OBJECTIVES

This study investigates the effects of SR, alone or in combination with the CB receptor agonist WIN 55,212-2 (WIN), on the development of acute and rapid tolerance to the incoordinating effect of ethanol in rats.

MATERIALS AND METHODS

Male Wistar rats received SR, through i.p. (0.5-2.0 mg/kg) or intracerebroventricular (i.c.v.) injections (0.5-4.0 microg), alone or together with WIN (1.0 microg, i.c.v.), in combination with ethanol (2.7 g/kg, i.p.). Another group received WIN (1.0 microg, i.c.v.) in combination with ethanol (2.3 g/kg), and the rats were tested for motor coordination. Rapid tolerance was assessed 24 h later by administering ethanol to all animals and retesting them under the same dose regimen. Acute tolerance was evaluated for 75 min after ethanol (3.0 g/kg, i.p.) in animals treated with SR or WIN (i.c.v.).

RESULTS

The reduced motor impairment on day 2 (i.e., rapid tolerance) was blocked by SR (i.p. and i.c.v.). WIN (1.0 microg, i.c.v.) facilitated rapid tolerance and also prevented the blockade of rapid tolerance by SR (1.0 microg, i.c.v.). In the acute tolerance procedure, SR did not affect the motor incoordination induced by ethanol.

CONCLUSIONS

The results suggest that the endocannabinoid system may contribute to the development of rapid tolerance to ethanol.

How gene–stress–behavior interactions can promote adolescent alcohol use: The roles of predrinking allostatic load and childhood behavior disorders

A variety of environmental and genetic factors modulating the risk for alcoholism have been described, which predominantly act by interacting with each other. For example, the family, peers and society determine the level of exposure to stress and alcohol, while genes modulate how sensitive an individual responds to both. The resulting behaviors feed back to the social environment, modulating and in the worst case increasing further stress exposure. We here review neurobiological evidence how such a process of mutual interaction can involve and affect drinking. In at-risk adolescents it may have been in force for many years before they have their first alcoholic drink, increasing their risk for addiction by generating allostatic load. As an example, psychiatric disorders involving attention deficit, hyperactivity, or disruptive behaviors first evolve during childhood and are influenced by all the above factors. They are also strongly associated with harmful adolescent drinking and later alcohol use disorders. One important implication of this concept is that issues such as family adversity, adolescent psychiatric disorders, or adolescent drinking might not only be associated with, but causally related to, the risk for later addiction. They are targets for preventive interventions, which should start as early as possible in subjects at-risk.

Acute functional tolerance to ethanol mediated by protein kinase Cepsilon

A low level of response to ethanol is associated with increased risk of alcoholism. A major determinant of the level of response is the capacity to develop acute functional tolerance (AFT) to ethanol during a single drinking session. Mice lacking protein kinase C epsilon (PKCepsilon) show increased signs of ethanol intoxication and reduced ethanol self-administration. Here, we report that AFT to the motor-impairing effects of ethanol is reduced in PKCepsilon (-/-) mice when compared with wild-type littermates. In wild-type mice, in vivo ethanol exposure produced AFT that was accompanied by increased phosphorylation of PKCepsilon and resistance of GABA(A) receptors to ethanol. In contrast, in PKCepsilon (-/-) mice, GABA(A) receptor sensitivity to ethanol was unaltered by acute in vivo ethanol exposure. Both PKCepsilon (-/-) and PKCepsilon (+/+) mice developed robust chronic tolerance to ethanol, but the presence of chronic tolerance did not change ethanol preference drinking. These findings suggest that ethanol activates a PKCepsilon signaling pathway that contributes to GABA(A) receptor resistance to ethanol and to AFT. AFT can be genetically dissociated from chronic tolerance, which is not regulated by PKCepsilon and does not alter PKCepsilon modulation of ethanol preference.

Ontogeny of acute tolerance to ethanol-induced social inhibition in Sprague-Dawley rats

BACKGROUND

Adolescent rats are less sensitive than adults to a number of acute effects of ethanol, including ethanol-induced social inhibition. Adolescent insensitivity to the suppressing effects of ethanol on social interactions could be related in part to age differences in compensatory responses, including acute tolerance, that serve to counteract these inhibitory effects of ethanol. The present study explored ontogenetic development of acute tolerance within 30 minutes after administration of a relatively low ethanol dose, using ethanol-induced social impairment as the target response measure.

METHODS

Overall social activity was examined following challenge with 1 g/kg ethanol (intraperitoneally) at 2 postinjection intervals (5 or 30 minutes) in early [postnatal day (P) 28], mid (P35), or late (P42) adolescent or adult (P70) group-housed male and female Sprague-Dawley rats (Experiment 1). Blood and brain ethanol concentrations (BECs and BrECs) were assessed in separate groups of animals 5 or 30 minutes after ethanol administration (Experiment 2). Expression of acute tolerance was examined by assessing the relationship between BrECs and the degree of social impairment in individual animals at P28, P35, P42, and P70 during early recovery period (up to 30 minutes) following acute ethanol challenge (Experiment 3).

RESULTS

Effects of ethanol on overall social activity were age-dependent and time-dependent. Whereas all age groups showed equivalent ethanol-induced social inhibition 5 minutes after injection, testing at 30 minutes revealed marked age differences. Social inhibition was still pronounced at this time in adults, but was diminished in an age-related manner at younger ages (Experiment 1). In contrast to the ontogenetic differences in rates of decline in social impairment across time, decreases in brain and blood ethanol levels over time were similar across age (Experiment 2). Only P28 and P35 adolescents showed acute tolerance to ethanol-induced social inhibition, as indexed by an increasing time-dependent dissociation between BrECs and ethanol-induced social impairment, with social impairment declining faster than BrECs (Experiment 3).

CONCLUSIONS

This is the first study to document enhanced acute tolerance in adolescent rats relative to adult animals at nonhypnotic doses of ethanol. The greater expression of acute tolerance in young animals may reflect an enhanced predisposition of their nervous systems to respond rapidly to even modest doses of ethanol with compensatory adaptations. A greater propensity of early adolescents to develop acute tolerance may contribute to their resistance to adverse effects of ethanol, thereby permitting heavy drinking at this age and placing early adolescents at higher risk for extensive alcohol use.

The UChA and UChB rat lines: metabolic and genetic differences influencing ethanol intake

Ethanol non-drinker (UChA) and drinker (UChB) rat lines derived from an original Wistar colony have been selectively bred at the University of Chile for over 70 generations. Two main differences between these lines are clear. (1) Drinker rats display a markedly faster acute tolerance than non-drinker rats. In F2 UChA x UChB rats (in which all genes are 'shuffled'), a high acute tolerance of the offspring predicts higher drinking than a low acute tolerance. It is further shown that high-drinker animals 'learn' to drink, starting from consumption levels that are one half of the maximum consumptions reached after 1 month of unrestricted access to 10% ethanol and water. It is likely that acquired tolerance is at the basis of the increases in ethanol consumption over time. (2) Non-drinker rats carry a previously unreported allele of aldehyde dehydrogenase-2 (Aldh2) that encodes an enzyme with a low affinity for Nicotinamide-adenine-dinuclectide (NAD+) (Aldh2(2)), while drinker rats present two Aldh2 alleles (Aldh2(1) and Aldh2(3)) with four- to fivefold higher affinities for NAD+. Further, the ALDH2 encoded by Aldh2(1) also shows a 33% higher Vmax than those encoded by Aldh2(2) and Aldh2(3). Maximal voluntary ethanol intakes are the following: UChA Aldh2(2)/Aldh2(2) = 0.3-0.6 g/kg/day; UChB Aldh2(3)/Aldh2(3) = 4.5-5.0 g/kg/day; UChB Aldh2(1)/Aldh2(1) = 7.0-7.5 g/kg/day. In F2 offspring of UChA x UChB, the Aldh2(2)/Aldh2(2) genotype predicts a 40-60% of the alcohol consumption. Studies also show that the low alcohol consumption phenotype of Aldh2(2)/Aldh2(2) animals depends on the existence of a maternally derived low-activity mitochondrial reduced form of nicotinamide-adenine-dinucleotide (NADH)-ubiquinone complex I. The latter does not influence ethanol consumption of animals exhibiting an ALDH2 with a higher affinity for NAD+. An illuminating finding is the existence of an 'acetaldehyde burst' in animals with a low capacity to oxidize acetaldehyde, being fivefold higher in UChA than in UChB animals. We propose that such a burst results from a great generation of acetaldehyde by alcohol dehydrogenase in pre-steady-state conditions that is not met by the high rate of acetaldehyde oxidation in mitochondria. The acetaldehyde burst is seen despite the lack of differences between UChA and UChB rats in acetaldehyde levels or rates of alcohol metabolism in steady state. Inferences are drawn as to how these studies might explain the protection against alcoholism seen in humans that carry the high-activity alcohol dehydrogenase but metabolize ethanol at about normal rates.

Rapid ethanol tolerance mediated by adaptations in acute tolerance in inbred mouse strains

It has been postulated that decreased acute sensitivity to ethanol is an important genetically-mediated risk factor for the development of alcoholism. Previous work in mice and rats has indicated that ethanol sensitivity can be reduced in a genotype-dependent manner by a single dose of ethanol 24 h prior to testing, so-called 'rapid' tolerance. The current studies were undertaken to determine if the observed rapid tolerance was mediated by alterations in initial sensitivity or acute functional tolerance (AFT), the two primary components of acute sensitivity. Separate groups of C57BL/6, DBA/2, ILS, and ISS inbred mouse strains were administered a single pretreatment dose of saline or ethanol (5 g/kg). The original and modified versions of the loss of righting reflex test, ethanol-induced hypothermia, and ataxia on a stationary dowel rod were tested 24 h later. Dependent on the test and strain, varying degrees of rapid tolerance were observed; a pronounced sensitization was detected in one case. There was a concomitant increase in the rate and/or magnitude of AFT with little change in initial sensitivity suggesting that rapid tolerance was mediated primarily by alterations in AFT. This conclusion may have implications for the contribution of acute sensitivity to human alcoholism.

The Effects of NMDA and GABAA Pharmacological Manipulations on Acute and Rapid Tolerance to Ethanol During Ontogeny

BACKGROUND

Sensitivity to several ethanol effects increases during ontogeny, perhaps in part because of a notable decline in acute tolerance. In contrast, rapid tolerance to ethanol-induced sedation emerges slowly during ontogeny. This study tested the hypothesis that ontogenetic differences in glutamate and/or gamma-aminobutyric acid systems influence tolerance expression.

METHODS

Sprague-Dawley rats at postnatal day (P)26 or P70 received (+)MK-801, muscimol, or saline before ethanol (3.5 or 4.5 g/kg) or saline on day 1 and ethanol only on day 2. Loss of and time to regain the righting reflex and blood alcohol levels at recovery were recorded. The presence of acute tolerance was indicated as a positive slope of the linear regression of blood alcohol levels at recovery versus ethanol dose. Rapid tolerance was estimated on day 2 by comparing animals given ethanol only on day 2 with those given ethanol on both days.

RESULTS

Acute tolerance on day 1 only was observed at P26; this was disrupted by (+)MK-801 but not muscimol. Evidence for acute tolerance also emerged in adults on day 2. Whereas both drugs increased ethanol sedation at both ages, they did not facilitate ontogenetic expression of rapid tolerance: rapid tolerance was not evident at P26 regardless of pretreatment when indexed in terms of recovery time.

CONCLUSIONS

These data provide further evidence for an ontogenetic dissociation in the expression of acute and rapid tolerance to ethanol-induced sedation. Pharmacological attenuation of the expression of acute tolerance was sufficient but not necessary to delay recovery of righting after ethanol. The greater propensity of young animals to develop acute tolerance, seemingly modulated in part by NMDA receptors, may contribute to their relative resistance to ethanol, although other factors, including pharmacokinetic factors, also contribute to their more rapid recovery from ethanol sedation.

Tolerance and withdrawal in goldfish exposed to ethanol

Acute ethanol exposure decreases regulated body temperature. Tolerance and dependence develop with continued exposure. Removal of ethanol following chronic exposure produces withdrawal. There is little information on the time course for the development of tolerance and disagreement about the presence of a rebound effect on body temperature during withdrawal. For tolerance, we monitored the selected temperature [T(sel)] of goldfish [Carassius auratus] for 8 h while they were exposed to one of three doses of ethanol. During the period from 90 to 150 min post-exposure, T(sel) was: control: 24.1+/-0.07 degrees C; 0.4% ethanol: 21.9+/-0.09 degrees C; 0.8% ethanol: 21.3+/-0.05 degrees C; 1.1% ethanol: 18.4+/-0.10 degrees C. The difference between control and experimental T(sel) decreased by the following amounts for the final 1.5 h in the gradient: 0.4% ethanol: 2.60+/-0.12 degrees C; 0.8% ethanol: 1.58+/-0.09 degrees C; 1.1% ethanol: 4.08+/-0.12 degrees C. At all 3 doses, tolerance proceeded in a stepwise manner rather than continuously. Temperature regulation during withdrawal was evaluated by maintaining the goldfish in 0.8% ethanol for three days and subsequently monitoring T(sel) in an ethanol-free temperature gradient for 36 h. During withdrawal there was no evidence for an effect on T(sel); experimental and control values were nearly identical.

Characterization of acute functional tolerance to the hypnotic effects of ethanol in mice

BACKGROUND

Acute functional tolerance (AFT) to ethanol-induced hypnosis is one of the main factors that affect the duration of ethanol-induced loss of righting reflex (LRR: "sleep time"). Investigators who use duration of LRR as a measure of ethanol-induced sedation should consider the potential magnitude and time course of this neuroadaptation when interpreting their results. However, AFT to the hypnotic effects of ethanol has not been well characterized. The present study explored this form of AFT using a novel method of monitoring LRR in mice.

METHODS

Genetically heterogeneous mice were used to study effects of dose and time on the development of AFT. Mice were treated with different dose regimens and tested for LRR after hypnotic doses using a cylindrical restrainer. Measures of initial sensitivity and AFT to ethanol-induced hypnosis were calculated and analyzed. Inbred strains of mice were then characterized for AFT magnitude after a single ethanol dose.

RESULTS

Results showed that (a) AFT developed in a dose-dependent fashion but attained an apparent maximum value; (b) AFT to ethanol-induced hypnosis could develop partially after a small, subhypnotic dose; (c) AFT developed very rapidly and approached its maximum for a given dose by the 10th min after injection of ethanol; and (d) AFT has a strong genetic component.

CONCLUSION

Although specific for AFT to the hypnotic effects of ethanol, the present findings expand general knowledge about acute tolerance and should also be useful for investigators who use loss of righting reflex as a measure of ethanol sensitivity.

Inhibition by ethanol of NMDA-induced responses and acute tolerance to the inhibition in rat sympathetic preganglionic neurons in vitro and in vivo

N-methyl-d-aspartate (NMDA) receptors have been demonstrated to be a pivotal target for ethanol action. The present study examined the actions of acute ethanol exposure on NMDA-induced responses and the acute tolerance to ethanol actions in rat sympathetic preganglionic neurons (SPNs) in vitro and in vivo. NMDA (50 microM) applied every 5 min induced reproducible membrane depolarizations of SPNs in neonatal spinal cord slice preparations. Ethanol (50 - 100 mM) applied by superfusion for 15 min caused a sustained decrease in NMDA-induced depolarizations in a dose-dependent and reversible manner. When the superfusion time of ethanol (100 mm) was increased to 50 min, NMDA-induced depolarizations were attenuated initially but a gradual recovery was seen in approximately 40% of SPNs tested. Repeated injections of NMDA (2 nM) intrathecally at 30 min interval caused reproducible increases in mean arterial pressure (MAP) in urethane-anesthetized rats. Intravenous injections of ethanol (0.16 or 0.32 g, 1 ml) inhibited NMDA-induced pressor effects in a blood concentration-dependent manner. The inhibition by ethanol of NMDA-induced pressor effects was reduced over time during continuous infusion of ethanol or on the second injection 3.5 h after prior injection of a higher dose of ethanol. Ethanol, at concentrations significantly inhibited NMDA-induced responses, had no significant effects on alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid-induced responses. The study demonstrated the selective inhibition by ethanol of NMDA-induced responses and the development of acute tolerance to the inhibitory effects in SPNs both in vitro and in vivo. These effects may play important roles in the ethanol regulation of cardiovascular function.

Current state of knowledge about the mechanisms of alcohol tolerance

Far from being a simple homeostatic response to the presence of ethanol in the brain, tolerance is now recognized as a complex process which can develop within various time frames (acute, rapid, chronic) and in which the drug interacts with various environmental and cognitive factors, including associative and operant learning. A major question is whether the acute form is an innate adaptive response, which is converted into the rapid and chronic forms by the action of these external influences. So far, all behavioral and neuropharmacological manipulations that alter chronic tolerance also modify rapid and acute tolerance in similar ways. These include lesions of serotonergic forebrain projections, blockade of NMDA-type glutamate receptors and calcium "L" channels, central or peripheral injection of vasopressin and blockade of vasopressin V1 receptors. Cytochemical and immunofluorescence studies, combined with use of retrograde tracers, indicate the existence of a septohippocampal circuit which may mediate the interactions of these diverse elements in the production and maintenance of tolerance. There is limited evidence that development of tolerance leads to increased consumption of ethanol in experimental animals, but the clinical significance of these findings remains to be proven.

The cyclic AMP/protein kinase A signal transduction pathway modulates tolerance to sedative and hypothermic effects of ethanol

BACKGROUND

An expanding body of literature indicates the important role of the cAMP/PKA signaling pathway in establishing initial sensitivity to alcohol as well as being involved in certain forms of tolerance to ethanol. The use of mice with heterozygous inactivation of the Gnas gene encoding Gsalpha allowed us to explore the relationship between tolerance to ethanol and cAMP/PKA signaling.

METHODS

Mice with the targeted disruption of one Gsalpha allele were compared with wild-type littermates in their initial sensitivity to ethanol-induced sedation and hypothermia and then monitored for the development of tolerance during two subsequent bouts of intoxication. Components of the cAMP/PKA signaling pathway were analyzed in ethanol-naïve mice and again following the development of tolerance to ethanol to better understand the contribution of this signaling pathway to the acquisition of tolerance.

RESULTS

During the initial exposure to ethanol, mice with the targeted disruption of one Gsalpha allele (Gnas) were more sensitive to the sedative effects of ethanol compared with wild-type littermates. Wild-type mice developed within-session tolerance to ethanol-induced hypothermia whereas Gnas mice did not. Following the subsequent ethanol treatments, wild-type mice developed between-session tolerance to the sedative effects of ethanol to a greater degree than mice with heterozygous inactivation of the Gnas gene. The development of tolerance to the sedative effects of ethanol was accompanied by increased expression of phospho-CREB in the cerebellum, hippocampus, and frontal cortex. No changes in phospho-CREB expression were detected in these brain regions in mice with heterozygous inactivation of the Gnas gene.

CONCLUSION

The results show that cAMP/PKA signal transduction modulates sensitivity to sedative and hypothermic effects of ethanol. This signal transduction system also influences the acquisition of within-session and between-session tolerance. The mechanism through which cAMP/PKA signaling modulates the development of tolerance remains to be elucidated but may involve changes in phospho-CREB expression.

Effect of a dose of ethanol on acute tolerance and ethanol consumption in alcohol drinker(UChB) and non-drinker (UChA) rats

Acute tolerance that develops within minutes of ethanol exposure appears to influence the apparent acute behavioral sensitivity of laboratory animals to ethanol actions. The existence of a correlation between voluntary ethanol consumption and the speed of acquiring acute tolerance has been proposed. In the present paper we investigated the effect of an acute dose of ethanol on tolerance development and on ethanol voluntary consumption in our two selected bred strains, UChA (low ethanol drinker) and UChB (high ethanol drinker) rats. Acute tolerance developed to motor impairment induced by a dose of ethanol of 2.3 g/kg. administered intraperitoneally was evaluated by the tilting plane test. Voluntary ethanol consumption was compared in rats receiving the ethanol dose, to rats receiving a saline intraperitoneal (i.p.) injection. The results show that UChB rats receiving an intoxicating dose of ethanol develop more tolerance and they significantly increased their ethanol consumption compared to the same line that received a saline injection, while no change in acute tolerance and voluntary ethanol consumption were obtained in UChA rats. In conclusion, a possible mechanism by which UChB rats drink high amounts of ethanol appears to be the development of tolerance to the pharmacological effects of ethanol.

Effect of NMDA antagonists, an NMDA agonist, and serotonin depletion on acute tolerance to ethanol

The effect of N-methyl-D-aspartate (NMDA) antagonists [dizocilpine, (+)MK-801, and ketamine], an NMDA agonist (D-cycloserine) and of brain serotonin (5-HT) depletion with p-chlorophenylalanine (p-CPA) on acute tolerance to ethanol was examined, using the tolerance model proposed by Radlow [Psychopharmacology 114 (1994) 1-8] and Martin and Moss [Alcohol Clin Exp Res 17 (1993) 211-216]. This model is based on the concept of a linear increase of acute tolerance with time; the rate of acute tolerance development is the slope of the output function that relates blood alcohol concentrations (BACs) and intoxication. Pretreatment with NMDA antagonists inhibited the development of acute tolerance to ethanol, whereas pretreatment with D-cycloserine enhanced it. Depletion of 5-HT by p-CPA also blocked acute tolerance to ethanol. These results on acute tolerance are similar to those previously found on rapid and chronic tolerance to ethanol.

Rapid tolerance to Delta(9)-tetrahydrocannabinol and cross-tolerance between ethanol and Delta(9)-tetrahydrocannabinol in mice

Motor incoordination in the rota-rod test was used to assess the development of rapid tolerance to Delta(9)-tetrahydrocannabinol and rapid cross-tolerance between ethanol and Delta(9)-tetrahydrocannabinol in mice. Further, the influence of the cannabinoid receptor antagonist SR 141716A (N-(piperidin-1-yl)-5-(4-chlorophenyl)-4-methyl-1H-pyrazole-3-carboxyamide) on the motor impairment induced by both drugs was examined. Mice were injected on day 1 with equipotent doses of Delta(9)-tetrahydrocannabinol (28 mg/kg, i.p.) and ethanol (2.25 g/kg, i.p.) and tested at 30, 60 and 90 min after the injections. On day 2, control groups received ethanol or Delta(9)-tetrahydrocannabinol, some groups received the same treatment as the day before, while the remaining groups switched the treatment. All groups were tested to evaluate tolerance. The development of rapid tolerance to Delta(9)-tetrahydrocannabinol was observed and pretreatment with ethanol resulted in rapid cross-tolerance to Delta(9)-tetrahydrocannabinol. SR 141716A (2 mg/kg, i.p.) failed to block the development of rapid tolerance to both drugs, ethanol and Delta(9)-tetrahydrocannabinol. These results suggest that Delta(9)-tetrahydrocannabinol, similarly to ethanol, can induce rapid tolerance to motor incoordination in mice. They also support the use of the 2-day protocol as an effective procedure to reduce the length of drug exposure necessary to induce tolerance.

Effect of naltrexone on acute tolerance to ethanol in UChB rats

The effect of naltrexone (a non-selective opioid receptor antagonist) on both alcohol consumption in a voluntary selection situation and acute tolerance to the motor impairment effect of ethanol was examined in female high alcohol-drinking (UChB) rats using the tilting plane test. In experiment 1, the effect of naltrexone on alcohol consumption was studied in UChB rats which were given a daily 1-h period access to a 10% (v/v) ethanol solution with food and water always available. Naltrexone in doses of 5 or 10 mg/kg intaperitoneal (i.p.) caused dose-dependent reduction in voluntary alcohol intake by 45% and 66%, respectively, without altering daily water intake. In experiment 2, the effect of naltrexone (5 mg/kg i.p.) on acute tolerance to motor impairment effect of a dose of 2.3 g ethanol/kg i.p. was examined. A comparison of control (C) and naltrexone (Nal) UChB groups indicated that naltrexone slowed the recovery of the motor activity and reduce acute tolerance development at comparable ethanol levels in cerebral blood. These results suggest a contribution of the opioid system to acute tolerance to ethanol.

Research on tolerance: what can we learn from history?

The concept of tolerance to ethanol has evolved gradually over the past two centuries, and all of the basic clinical features, as they are now understood, have been clearly recognized for nearly 100 years. The basic mechanisms involved in central nervous system tolerance, however, have been elucidated only in the past 20 to 30 years. Little progress was made as long as tolerance was viewed as a purely cellular or physiological adaptation to alcohol, and researchers used overly simple paradigms based on mere exposure to the drug. With the recognition that learning, both operant and associative, can play a major role in the development of tolerance to alcohol and cross-tolerance to other drugs, a radical change in research approaches became possible. Most of the neural mechanisms related to learning and memory are now known to be involved in the development and retention of tolerance, and the simplistic models used in earlier research must now be abandoned. Nevertheless, a review of the history of past research points to a number of important lessons for future work, including the following: (1) many of the present concepts were enunciated by astute observers many decades ago, and research was hindered because this older literature was forgotten; (2) for many decades progress was slow because of a narrow focus on specific techniques, questions, and hypotheses that overlooked important research in related disciplines; (3) the course of research is often irregular, and past questions may have to be revisited with new approaches--but these are more likely to be fruitful if based on knowledge of past history; and (4) excellent researchers often obtain apparently contradictory findings, but the disagreements may hold the key to deeper understanding of the phenomena, and should not be brushed over by ignoring the minority findings and interpretations. As in all scientific research, the most important requirement for major progress is the formulation of good questions or hypotheses: the results yielded by the best available techniques can be only as good as the questions they are meant to answer.

Differential effects of ethanol in adolescent and adult rats

Alcohol use in children and adolescents is widespread. However, very little is known about the effects of alcohol exposure during this period of postnatal development. The goal of the present study was to compare the relative sensitivity to the sedative effects of alcohol in periadolescent and adult rats. After treatment with either 4 or 5 g/kg ethanol, both 20- and 30-day-old rats regained their righting reflex significantly earlier than 60-day old rats. In 30-day-old rats, serum ethanol concentrations (SECs) were significantly greater at the time of the recovery of the righting reflex than 60-day-old rats. Developmental differences in the effects of ethanol on locomotor activity were also observed. In 60-day-old rats, 2.5 g/kg ethanol generally decreased locomotor activity. Ethanol did not significantly alter locomotor activity in 20- and 30-day-old rats. Finally there were significant developmental differences in the pharmacokinetics of ethanol with a significant delay in the time to peak SECs in 60-day-old rats relative to 20- and 30-day-old rats. These findings indicate that peri-adolescent rats are less sensitive to the sedative effects of ethanol as they recovered their righting reflex earlier and at significantly higher SECs than adult rats.

The biological, social and clinical bases of drug addiction: commentary and debate

This article summarizes the main discussions at a meeting on the biological, social and clinical bases of drug addiction focused on contemporary topics in drug dependence. Four main domains are surveyed, reflecting the structure of the meeting: psychological and pharmacological factors; neurobiological substrates; risk factors (including a consideration of vulnerability from an environmental and genetic perspective); and clinical treatment. Among the topics discussed were tolerance, sensitization, withdrawal, craving and relapse; mechanisms of reinforcing actions of drugs at the behavioural, cognitive and neural levels; the role of subjective factors in drug dependence; approaches to the behavioural and molecular genetics of drug dependence; the use of functional neuroimaging; pharmaceutical and psychosocial strategies for treatment; epidemiological and sociological aspects of drug dependence. The survey takes into account the considerable disagreements and controversies arising from the discussions, but also reaches a degree of consensus in certain areas.

Loss of tolerance to morphine after a change in route of administration: control of within-session tolerance by interoceptive conditioned stimuli

Tolerance to morphine analgesia (tail-immersion test) was examined after manipulation of two aspects of a tolerance test: 1) the route of drug administration and 2) the time interval between the test dosing and the tolerance test. The intravenous (IV) and intraperitoneal (IP) routes were used, together with a novel test for tolerance in which the test morphine was infused IV just 2 min before measuring the opiate effect. The first experiment validated this test as an assay for tolerance by examining the log dose-response (LDR) curve changes produced by daily IP injection with 0, 20 or 200 mg/kg morphine; the IV test confirmed the expected parallel shift to the right and flattening of the LDR curve. In the second experiment, all rats of two groups were injected once daily for 3 weeks with 20 mg/kg morphine and with saline except that one group received the morphine IV (and saline IP), the other morphine IP (saline IV). The results indicated route-specific tolerance. On a test using 20 mg/kg given IV morphine, tolerance was significantly greater in rats treated with IV morphine than in those treated IP. However, a larger effect on tolerance was produced by a pretest application of 5 mg/kg morphine 30 min before the actual tolerance test. This manipulation was designed to "prime" short-term, adaptive processes hypothesized to occur within a normal tolerance test session as morphine is taking effect. The tolerance on the test increased (equivalent to 2 to 3 fold shift in the LDR curve) when the pretest morphine was given with the same route as the chronic morphine, regardless of treatment group. It was concluded that opiate tolerance may be modulated by conditioned stimuli produced by morphine acting through different routes. These interoceptive cues appear to modulate rapidly acquired and short-lived adaptive processes taking place within a given test session.

Brain alcohol detectability increase with repeated administration in humans: a proton spectroscopy study

Proton MRS was used to detect brain alcohol after repeated alcohol exposure in human subjects. MRS detectability measurements were made after administration of an alcoholic drink (0.6 g/kg alcohol) and after an identical drink administrated 6 h later. Between-drink differences in the methyl proton triplet resonance of ethyl alcohol were assessed at statistically equivalent and near-peak blood alcohol concentrations (reflecting brain alcohol concentrations) and statistically equivalent internal standard N-acetyl resonance areas after Drinks 1 and 2, respectively. Brain alcohol detectability was not altered in TE 30-ms spectra but was increased in all five subjects after Drink 2 by an average of 70% in TE 270-ms spectra (p < 0.01). This was accompanied by significant between-drink differences in subjective ratings of alcohol's effects, suggestive of induction of acute alcohol tolerance. These findings suggest increased brain alcohol detectability in TE 270-ms spectra after repeated alcohol exposure that may reflect acute alcohol tolerance.