Alcohol on Purim: The Neuroscience of Intoxication
As the holiday of Purim approaches, the Jewish people are preparing once again, per our legislated custom, to commemorate the thwarting of Haman’s plan to annihilate us. Traditionally, we celebrate this miracle of survival via a seudah, or festive banquet charged with copious cuisine, joyous song, and, for many, consumption of alcohol. The source of the latter practice is taken from the Talmudic tractate Megillah (7b): “A person is obligated to drink on Purim until he does not know the difference between ‘cursed be Haman’ and ‘blessed be Mordechai.’” While the precise nature regarding the logistical implementation of this excerpt is highly debated among Rabbanim, many, nevertheless, have retained the custom to consume alcohol on Purim.
Regardless of one's personal decision to drink, alcohol remains one of the most hazardous drugs worldwide, contributing to the death of 3.3 million people annually. According to the World Health Organization, chronic alcohol consumption is the cause of nearly 200 diseases and injury conditions in individuals, including a direct connection with infections such as tuberculosis and HIV/AIDS. Symptoms of acute alcohol poisoning include severe confusion, lapses in and out of consciousness, vomiting while unconscious, seizures, and respiratory depression. Emergency treatment of acute alcohol poisoning includes the aggressive maintenance of a patent (clear) airway and supplemental oxygen administration. As a volunteer EMT, this is a treatment for which I am all too familiar. In order to understand the cause of many of these symptoms, the science will need to be discussed.
An alcoholic molecule is scientifically defined as any organic compound with at least a single hydroxyl group (-OH) attached, with differing types of alcohols characterized by the location of such a group. Therefore, while many consider solely the drinkable variety of alcohol, several other types exist as well. Methyl alcohol, propyl alcohol, butyl alcohol, and glycerol are all common alcohols, each contributing differing effects on the body. Ethyl alcohol, better known as ethanol, is the drinkable type. The terms ethanol and alcohol are essentially synonymous, and will therefore be used interchangeably for our purposes. When ethanol is ingested, the molecule bypasses the stomach and is absorbed directly through the small intestine; after entering the bloodstream, the ethanol readily crosses the blood brain barrier.
The brain is the command center of the body. Whether the task consists of moving a limb, reading this article, or solving complex mathematical equations, the brain is in charge. At 3.3 lbs, the human brain contributes to roughly 2% of an individual's body weight and is one of the most complex biological entities known to mankind. Therefore, while the neuroscience is about to get relatively heavy, it is important and I urge you to bear with me! The brain consists of four lobes: the frontal, temporal, parietal, and occipital lobes, each responsible for various functions. Furthermore, the brain contains on the magnitude of 86 billion nerve cells, or neurons. Neurons display dendrites, tree-like structures with branches that protrude from the cell membrane, in order to “catch” messages from neighboring neurons (comparable to a net catching fish). When a neuron desires to communicate it uses a complex electrochemical system to “launch” molecules, termed neurotransmitters, to a neighboring neuron and its associated dendrite. Common neurotransmitters include serotonin, dopamine, and norepinephrine, which are known for their mood regulating, rewarding, and attention modulating effects, respectively. For the context of this writing the neurotransmitters GABA and glutamate are also important, which are inhibitory and excitatory, respectively. If a person, for example, enjoys a delectable hamantaschen, neurons in the reward area of the brain will fire dopamine to its neighbor, which will, in turn, create a cascade of the neurotransmitter, causing the individual to feel pleasure. While the neurobiology is far more nuanced and complicated than I have explained here, this description will provide sufficient knowledge for this article.
When alcohol crosses into the brain it begins to cause a multitude of effects, mainly through the modulation of various neurotransmitters. At moderate doses serotonin is activated, partially explaining the tranquil, calming nature of alcohol. Furthermore, alcohol ingestion is correlated with dopamine activation, accounting for the addictive qualities of the drug. However, when assessing the lethal qualities of alcohol, two neurotransmitters dominate: GABA and glutamate. Recall that GABA is an inhibitory neurotransmitter; if it is activated, the person’s neuronal activity will be suppressed. Contrastingly, glutamate is excitatory; if it is activated, neuronal activity will be turned up. Alcohol activates GABA, yet it inhibits glutamate. Between these mechanisms, a synergistic neuronal inhibition ensues. Brain activity is reduced to the point of unconsciousness. If an individual vomits when in this state, it may result in aspiration, in which the fluids travel down the trachea into the lungs -- obviously concerning.
Underage drinking has become a culturally accepted norm on Purim (and on Simchat Torah too). While the legal drinking age in the United States is 21, many experts believe the human brain continues to develop, in a general sense, until age 25. Alcohol has long been theorized to disrupt brain development in the growing adolescent brain. One of the brain’s four lobes, the frontal lobe, is often attributed to executive functioning, holding responsibility for long-term planning and decision making. From deciding on a college, a career, or even to experimenting with a drug, the frontal lobe is behind these choices. Backed by scientific research on mice, alcohol is theorized to damage the frontal lobe and hippocampus in the growing adolescent brain, thereby contributing to substandard motivation and memory, decisive abilities, and general self control into adulthood. Notably, these damages can persist even past the legal drinking age of 21. Most college students fall into this age gap and are therefore risking permanent frontal lobe and hippocampal damage when ingesting alcohol. While these findings are preliminary, and additional scientific research is required, this should, nonetheless, be taken seriously.
Should a person choose to drink on Purim, or in general for that matter, there are certain methods of “damage control” that can be deployed before acute intoxication. Of the simplest measures includes consumption of a substantial meal high in fatty acids, carbohydrates, and protein prior to initiating alcohol ingestion, ensuring a delayed delivery of the drug into the body. Furthermore, proper hydration, alternating with non-alcoholic drinks, and pre-planning transportation could reduce the risk of injury. A quick tip for a person who may be unconscious and vomiting involves placing the incapacitated individual in the left lateral recumbent position (lying him down on the left side), helping to prevent vomit from entering the lungs.
Societal norms dictate alcohol consumption to be relatively safe. However, upon rigorous scientific analysis, this is clearly not the case. After an extensive study of 20 common drugs of abuse including heroin, crack cocaine, and crystal meth, neuropharmacologist David Nutt, MD found alcohol to be “the most harmful drug to society and fourth most harmful drug to users”. While the danger is widely applicable, underage drinkers, and perhaps those slightly older, possess a greater risk for both acute and chronic damages.
While Purim for many is an enjoyable holiday filled with family and friends, an inherent risk may threaten the integrity of the celebration. Come March 12th YU students, in addition to the larger Jewish community, should allocate attention to the potential detrimental effects of alcohol. Ultimately, however, through careful planning, intelligent decisions, and implementing general awareness, Purim will be infused with simcha and joy for all those who participate.