By David Joel Miller.
Not all tolerance is created equal
What is tolerance?
Tolerance, as it applies to medications and drugs, is having less and less of a reaction to a drug the more it is used or having to use increasing amounts of the drug to get the same result. Tolerance, in the sense in which I am using the term here, is the way in which repeated exposures to something produce less and less of a reaction. People get used to things and so does your physical body.
When it comes to substances, whether they are legal, prescribed or street drugs, tolerance is that characteristic of the body to learn to resist things. The body develops an “immunity” or reacts less and less strongly the more times it experiences something.
Over time the drug addict uses more and more of their particular drug of choice. The person taking prescribed medications may also develop a tolerance resulting in needing a larger dose to achieve the same result or eventually they may need to be switched to a different drug.
Tolerance used to be one of the two symptoms that were used to define addiction. Withdrawal was the other one. Because tolerance and withdrawal are characteristics of many substances, not just drugs of abuse, we have had to look at other symptoms to define a problematic use of substances. We now call that problematic use a “substance use disorder.”
What is selective tolerance?
Selective tolerance is those times when someone develops a tolerance to one effect of the drug but not another. The body “selects” one action to develop tolerance to and not another.
A simple example of selective tolerance.
Coffee contains caffeine, a stimulant drug. Many people drink it first thing in the morning to help them wake up and get going. It is also common to find that consuming a caffeinated beverage to late in the evening results in not being able to sleep well that night. It is recommended that you not consume caffeine in the afternoon or evening so that you will get a full night’s sleep.
Have you ever known someone who could drink a lot of coffee or caffeinated soda just before bedtime and still sleep like a rock? Most of us have. That person has “built up a tolerance” to caffeine’s sleep interfering characteristic.
That same person will have some caffeine, probably a lot of it, the next morning and report that the caffeine helps them wake up and get going.
How can this be? Did they develop a tolerance to caffeine or not?
It appears that they have developed a tolerance to one action of the caffeine but not the other. That is the thing we call selective tolerance.
It is quite possible that psychological factors play a role here, but there are lots of other times when someone develops a tolerance to one of a drug’s effects and not another.
There have been some divided opinions on whether drinking coffee is good or bad. My belief is that for most people, most of the time, coffee has more positive than negatives. The choices it up to you.
Could you develop selective tolerance to the effects of alcohol?
The research says that many people do just that. This may be why we see very inconsistent results in research on some of alcohol’s effects. I am not being an apologist for alcohol by saying this, just trying to get the story right. Despite the problems, alcohol causes our society another round of prohibition is unlikely.
My view is that those countries that have a total ban on alcohol often have high levels of problems with another drug. Many countries with a total ban on alcohol have a worse problem than the U. S. does when it comes to Heroin. The solution, such as it is, seems to be better educated on the effects of drugs on the mind and the body. Hence this blog.
Heavy alcohol drinkers develop tolerance to alcohol’s motor coordination effects.
Those who drink a lot find ways to hide the fact that they are under the influence. More concentration on walking straight may keep the drunk out of jail. Research shows that many heavy drinkers do develop a tolerance to the motor coordination effects.
Heavy drinkers do not develop a tolerance to the bad decision-making effects
One key result of alcohol’s effects on the brain is disinhibiting the drinker. Under the influence, people say and do things that they would not do when sober. One study reported that they found no tolerance developing to alcohol’s disinhibiting effects in heavy drinkers (Miller, M., et al, 2012, no relation to me I know of.)
This study also notes that recent drinking patterns are predictive of tolerance. You do not need to be an alcoholic, a chronic drinker or even a heavy lifetime user of alcohol to show a tolerance to some of its effects.
So we conclude that people do develop selective tolerance to the effects of alcohol and probably most other drugs. Drinking a lot of alcohol is still not a good idea. While your liver may develop tolerance with repeated doses of alcohol, it can also develop Fatty liver, alcoholic hepatitis, and cirrhosis.
Use all medications and drugs with caution and be aware that while you may be developing some tolerance, getting used to using this drug, there are probably other effects the drug is having on your body and your mind that you are unaware of.
Staying connected with David Joel Miller
Two David Joel Miller Books are available now!
You can recover. Your cruising along the road of life and then wham, something knocks you in the ditch. If you have gone through a divorce, break up, or lost a job your life may have gotten off track. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.
Casino Robbery is a novel that explores the world of a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page or my Facebook author’s page, David Joel Miller. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.