How Does Alcohol Metabolize in Our Bodies, and When Do the Effects Wear Off?

There are a few ways to think about how our bodies metabolize alcohol — a process in which enzymes break down the alcohol so it can be excreted from the body. First, there are the technical definitions of blood alcohol level (BAC) and legal intoxication. Second, there is one’s personal experience of feeling tipsy or drunk, and how long it takes for those effects to wear off. And finally, there is the breakdown and removal of alcohol from the body, which lasts well beyond the feelings of intoxication. 

Here, we’ll explain the different ways we can think about how alcohol is metabolized in our bodies and the factors that affect that metabolism.

How long does alcohol last in your body?

Let’s start with the legal definition. Intoxication is defined as a BAC of 0.1% or higher. Most states consider 0.08% to be the upper limit for legal driving purposes.

But not everyone feels the same way when they have a BAC of 0.08%, which is why some people say they “feel okay to drive.” Everyone experiences alcohol a little differently. For most people, it takes about 15 to 45 minutes to start to feel the effects of alcohol, and about an hour for these effects to wear off. 

Alcohol remains in your body for much longer than the amount of time we feel intoxicated. It stays in the bloodstream for about 6 hours; in the breath (the “breathalyzer” test) for 12 to 24  hours; and can be found in the urine for up to 72 hours.

Why do people metabolize alcohol differently?

Alcohol is rapidly absorbed into the bloodstream through the stomach, and then 90% of it is broken down in the liver by chemicals called enzymes. The remaining 10% of alcohol is removed (without digestion) through the breath, sweat, and urine.

Every person’s liver produces different types of enzymes. This is mostly because of genetic differences. But the amount of enzymes in the liver can also differ, depending on the health of your liver and if you drink regularly. The more you drink, the more enzymes you are likely to produce, and thus you will metabolize alcohol faster. But if your liver becomes damaged over time from alcohol, then your liver starts to lose its ability to make those enzymes. 

Other factors that affect alcohol metabolism

Genetics and alcohol use are not the only determinants of how your body breaks down alcohol. Other factors that play a role include: 

• Sex: On average, women process alcohol about 20% slower than men. This is because women have lower total body water content than men. In other words, alcohol tends to be more concentrated in women. The end result is that it takes fewer drinks to achieve the same blood alcohol level as men.

• Weight: Some people think that the larger the person, the more they can drink. This isn’t exactly true. Body fat cannot absorb alcohol, which instead stays in the blood, muscle, and non-fatty areas of the body. So, alcohol absorption depends on lean body mass more than actual weight. In addition, for those people with a higher percentage of body fat, there is a risk for fatty liver disease, which can cause a decrease in the available enzymes to process alcohol. 

• Food: Your last meal and the amount of food in your stomach can affect alcohol absorption. It doesn’t change the steps of alcohol metabolism, but it slows the process down. This is why some people say they feel the effects of alcohol sooner, and stronger, when they drink on an empty stomach. 

• Age: As we age, our tolerance for alcohol generally decreases. This is because we lose lean body mass as well as liver enzymes. In addition, older adults are more likely to take medications that can react poorly with alcohol. 

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Medications that can affect alcohol metabolism 

Medications can significantly impact the way you metabolize alcohol. This happens for a number of reasons. First, some medications compete for attention from your liver enzymes. This means those enzymes are not available to help with alcohol breakdown when you drink. Second, some medications can be toxic to the liver in higher doses. So, if your liver has been affected or injured by alcohol intake, those medications can harm you at lower doses than expected.

According to the National Institute on Alcohol Abuse and Alcoholism, the most common medications to avoid if you plan to drink alcohol include:

• Aspirin and ibuprofen: These may increase the risk of bleeding, particularly in the stomach.

• Acetaminophen (Tylenol): This medication can cause liver damage if combined with alcohol.

• Cough medicine: Many cough syrups already contain alcohol and can magnify the  effects of alcohol.

• Cold and allergy medicines: These tend to cause excess drowsiness when combined with alcohol. 

• Prescription pain medication, anxiety and depression medications, and sleep aids: These may cause dangerous levels of drowsiness.

What are the signs of alcohol poisoning?  

In large amounts, alcohol can cause severe sickness — and even death  — by shutting down key areas in the brain that control the heart, lungs, and body temperature. Since it may take 15 to 45 minutes for alcohol to take effect, you may not realize immediately that an overdose has occurred. 

If you see any of these signs or symptoms in a person who has been drinking heavily, you should seek emergency assistance:

• Seizures

• Lethargy or inability to wake up

• Severe confusion

• Slow or irregular breathing

• Slow or weak pulse

• Cold body temperature

• Bluish or pale skin

Why trust our experts?

Written by:

Valerie Anne Jones, MD

Val Jones, MD, is a physician who is certified by the American Board of Physical Medicine and Rehabilitation (ABPMR).

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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