The rest of us can often only marvel at those who can knock back multiple rounds without batting an eyelid - no slurred speech, stumbling steps, or obliterated late-night fast food orders. Nor are they heard groaning about hangovers the next morning. While this enviable capacity to "hold one's liquor" could come across as a useful social aptitude, it often unveils a concerning reality, experts say.

Dr. Daniel Schatz, MD, the medical director of addiction services at NYC Health + Hospitals describes high alcohol tolerance as the ability of one person to consume more alcohol without feeling its effects compared to another who may feel intoxicated on a smaller quantity. But countering commonly held beliefs, this differential is not exclusively about being adept at drinking. Your genetics, body composition, and behaviors all have a starring role to play, and not all forms of tolerance share the same virtues.

A noticeable part of alcohol tolerance is innately determined by genetics, influencing how your body metabolizes alcohol. "Genetic factors contribute to the ability to metabolize alcohol, the receptors impacted by alcohol, and numerous neurotransmitters responsible for communication within the body" explains Schatz. And the predisposition for alcohol use disorder (AUD) might be an inherited trait, possibly up to a 50% chance.

Further, your physical constitution plays an integral part. Gouri Pimputkar, DO, FACOOG, DipABLM, clinical lead for gynecology and lifestyle medicine at Allara Health claims that, "Body water content greatly influences how alcohol is processed. Alcohol won't mix with fat, but with body water. Hence, a larger individual with more water in the body can dilute the alcohol more."

Sexual differences also play a part in how alcohol is processed. Women generally have a lower water content than men and produce less of the enzyme required to break down alcohol. Hormonal fluctuations throughout a menstrual cycle can further affect alcohol absorption rates.

However, while genetics and bodily constitution set the stage, it is often our behavior that influences major changes in tolerance. And herein lies the darker underbelly.

Regular high consumption or high frequency of alcohol can result in your body working harder to process alcohol, with metabolic effects and neuroadaptation, explains Schatz. Allows Pimputkar, "Alcohol is cleared from the bloodstream faster in people with metabolic tolerance compared to those without. And arguably more significant is functional or neurological tolerance, where the brain adjusts itself over time to fend off the sedating effects of alcohol, making you feel less drunk."

Frequent drinkers can also unconsciously mask the signs of intoxication, making them appear less inebriated than they actually are. This adjustment to regular alcohol consumption then casts 'handling your liquor' not as a boon, but as a sign of your body adapting to constant exposure.

Contrary to popular belief, how you feel doesn't always mirror what's happening within you. Schatz emphasizes that one could feel entirely sober while still experiencing high blood alcohol concentration (BAC) levels, especially with developed tolerance.

Ignoring rising alcohol tolerance is dangerous. It is often the first red flag of alcohol misuse. Warning signs include needing more alcohol to feel effects, or experiencing symptoms like anxiety or poor sleep, explains Pimputkar.

Aging also affects tolerance levels. Schatz points out that what one could tolerate in their 40s might be too much for their 70s due to shifts in body composition and slowed metabolism.

Chronic heavy drinking can lead to worrying health consequences, including liver disease, cardiovascular complications, cognitive decline, and sleep disorders. Schatz underscores that "approximately 5.4% of all U.S. cancer cases are linked to alcohol". Pimputkar reminds us that alcohol, a recognized carcinogen with no established safe limit, can affect your liver, heart, brain, and immune system. Therefore, seeming to 'hold one's liquor' well might be a sign of concern than a testament to strength.