Intoxication: The Fourth Drive

Of all human experiences the English language has more words for the state of inebriation than any other. From ankled to zombied, with expressions such as caned, ganted, glambazzled, lashed, trollied, and sloshed coming in between. Try this experiment. Make up a nonsense word then place the suffix ‘ed’ on the end and say to a friend ‘I was completely **** ed last night’. They will understand what you mean and may reply sympathetically ‘Oh dear did you end up photocopying your face on the office copier?

Could it be true that humans are hard-wired to seek mind altering substances such as caffeine, tobacco, psychedelic drugs, and alcohol?  American psychopharmacologist Dr Ronald Siegel believes so and calls this basic desire for intoxication the ‘fourth drive’ as fundamental as food, drink and sex. Dr Samuel Johnson, 18th century essayist recognised it when he described alcohol as life’s ‘second greatest pleasure‘.

Alcohol is the most readily available intoxicant but what happens physically when we have a drink?  Alcohol enters the bloodstream through the stomach lining and small intestine. If the drink is carbonated or warm (for instance mulled wine) this increases pressure in the stomach and speedily forces alcohol through the pyloric sphincter into the gut where it is absorbed. Food slows the absorption of alcohol which is why when drinking on an empty stomach it has a quicker effect.

Alcohol normally affects women more rapidly than men because they tend to have a higher proportion of body fat. Fat cannot absorb alcohol so it concentrates at higher levels in the blood. Women also have less alcohol dehydrogenase, an enzyme that breaks down alcohol before it enters the bloodstream. Hormonal changes during the menstrual cycle can also affect alcohol metabolism meaning that women become drunker quicker at certain times of the month than others.

Once absorbed the alcohol hits the brain and this is where it becomes so seductive. Ethanol is the soul of alcohol and it affects the central nervous system. In small doses creating euphoria and diminishing inhibitions, in larger quantities slurred speech, drowsiness and impaired motor function. In excessive amounts it can be fatal. The brain’s neural pathways are affected, particularly the emotional centres and those concerned with language, music making, and self-consciousness. One minute it is natter, natter natter, then Bohemian Rhapsody on the karaoke machine, then ‘I love you mate, you’re my best friend’, followed by tears into the beers, and finally a kebab.

Alcohol triggers the brain chemicals dopamine and serotonin in a reward cascade that makes us feel good, relieves anxiety, and calms frayed nerves. Opioids are also released bestowing a feeling of elation and providing temporary relief from pain. But alcohol is also a depressive and in excess and depending on a person’s mood and mental state it may have negative effects.

Alcohol is largely metabolized in the liver with the aid of enzymes called alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). They break it down into acetaldehyde, a toxin that causes hangovers, then to acetate and finally water and carbon dioxide as it is expelled from the body. It takes longer for alcohol to be metabolized than it does to absorb it so intoxication lasts for some time after a person ceases drinking.  Some people have a genetic mutation that prevents the body producing standard levels of ADH so they are unable to metabolize acetaldehyde properly and suffer when they drink. This problem is virtually non-existent in the West, but it occurs in up to 40% of people in east Asia causing unpleasant symptoms such as nausea and dizziness. In other words drinkers get an instant hangover. It’s enough to put a person off. Or maybe not. How many times have you said ‘never again’ the morning after?  According to the epigram the definition of insanity is repeating the same action and expecting a different result. So that would suggest people who have ever suffered a hangover are mad if they don’t give up drinking. But if the theory of the fourth drive is actuality then humans cannot help themselves in the pursuit of altered states of consciousness.


This blog is an abridged chapter from Jane Peyton’s book ‘Drink:  A Tippler’s Miscellany. Buy a signed copy of the book here.