Alcohol Withdrawal 499
Diagnostic Markers
Intoxication is usually established by observing an individual’s behavior and smelling alcohol
on the breath. The degree of into xication increases with an individual’s blood or breath alcohol
level and with the ingestion of other substanc es, especially those with sedating effects.
Functional Consequences of Alcohol Intoxication
Alcohol intoxication contributes to the more than 30,000 alcohol-related drinking deaths in
the United States each year. In addition, intoxication with this drug contributes to huge
costs associated with drunk driving, lost time from school or work, as well as interpersonal
arguments and physical fights.
Differential Diagnosis
Other medical conditions. Several medical (e.g., diabetic acidosis) and neurological condi-
tions (e.g., cerebellar ataxia, multiple sclerosis) can temporarily resemble alcohol intoxication. 
Sedative, hypnotic, or anxiolytic intoxication. Intoxication with se dative, hypnotic, or
anxiolytic drugs or with other sedating subs tances (e.g., antihistam ines, anticholinergic
drugs) can be mistaken for alcohol intoxicati on. The differential requires observing alco-
hol on the breath, measuring blood or breath alcohol levels , ordering a medical workup,
and gathering a good history. The signs and symptoms of sedative-hypnotic intoxication
are very similar to those observed with alco hol and include similar problematic behavioral
or psychological changes. These changes are accompanied by evidence of impaired func-
tioning and judgment—which, if intense, can result in a life-threat ening coma—and levels
of incoordination that can interfere with driving abilities and with performing usual
activities. However, there is no smell as there is with alcohol, but there is likely to be evi-