1. Uppers, Downers and All Arounders
Alcohol

2. Alcohol Overview Most people drink alcohol except in Islamic countries
In U.S. 48% had at least one drink last month
25-30% of hospital admissions was due to direct and indirect medical complications from alcohol
½ of American adults had a family member who is an alcoholic
Worldwide 2 million people died as a result of alcohol
10% of diseases and injuries were a direct result of alcohol

3. Alcohol Overview
Alcohol is the oldest known and most widely used psychoactive drug in the world
Historians believe that alcohol was found accidentally
Historians believe that first civilized settlements were created to ensure regular supply wine, grain & opium
First evidence of use is recipe for beer dated to 8000 B.C.

4. Alcohol Overview Historically alcohol has been used for:
Food (beer) for peasants
Solvent for opium
Sacrament for religious ceremonies
Water substitute
Social
Tranquilizer
Source of taxes

5. Alcohol Overview
All countries have had periods of restriction for alcohol consumption
England: 1700’s unrestricted sale of gin led to abuse and addiction
America: Prohibition period
Repealed because of major source or revenue and tax
1930 American Alcoholics Anonymous founded in

6. Alcohol Beverages Hundreds of different alcohols
Ethyl (beverage)
Methyl (wood alcohol)
Isopropyl
Butyl
Any alcohol with 2% grain is considered a beverage alcohol
Alcohol occurs naturally as a result of airborne yeast feeding on sugars in honey, fruits, berries, vegetables and grains called “fermentation” that produces alcohol and carbon dioxide

7. Alcohol Beverages Beer: Drink of common people in early times Ale
Stout
Porter
Malt liquor
Larger
Bock beer
Beer is brewed or fermented by roasting barley and cereal grains then combining the result with water, grain, hops and yeast
Alcohol content:
Larger beers: 4-5%
Ales: 5-6%
Malt liquor: 6-9%

8. Alcohol Beverages
Wine was the drink of priest and nobles in early times
Fermented from berries and other fruit and starchy grains like rice
8-14% alcohol
More than 14% alcohol content are fortified with pure alcohol or brandy added after fermentation

9. Alcohol Beverages Distilled Spirits discovered by Arabs in A.D. 800
Result of boiling wine or other alcoholic beverages and collecting the condensation
Brandy is distilled from wine
Rum distilled from sugar cane or molasses
Vodka from potatoes
Whisky and gin from grains
Distilled beverages have high alcohol content than wine or beer
Alcoholism exploded as a result of distilled spirits

11. Absorption & Distribution
Absorption into bloodstream:
Takes place along various sites along the gastrointestinal tract:
Stomach, small intestines and colon
Men and women process alcohol differently even with the same body weight
In men 10-20% of alcohol absorbed by stomach
In women most alcohol is absorb in the walls of the small intestine at a rate of 30%
Women feel the effects of alcohol faster and more intensely.

12. Absorption & Distribution
Absorption: Women
Women have higher blood alcohol content than men due to
Lower % of body water than men
Less alcohol dehydrogenase enzyme in stomach to break down alcohol so less alcohol is metabolized before entering bloodstream
Changes in gonadal hormones levels during menstruation affect the rate of alcohol metabolism
Death rates are % higher than men

13. Absorption Factors that speed-up absorption:
Increasing the amount drunk or drinking rate
Drinking on a empty stomach
Using high alcohol concentrations up to a maximum of 95% with Everclear
Drinking carbonated drinks like champagne, sparkling wines, soft drinks, and tonic mixers
Warming the alcohol
Factors that slow Absorption
Eating before or while drinking (meat, cheese & fatty foods)
Diluting drinks with ice, water or fruit juice

14. Metabolism & Alcohol Concentration
Alcohol treated as toxin or poison so elimination begins as soon as it is ingested
2-10% eliminated without being metabolized
90-98% neutralized through metabolism by liver
Excreted by kidneys and lungs
Alcohol high in calories, but no real food value causing high malnutrition
Alcoholics get have their energy from empty calories

15. Metabolism & Alcohol Concentration
Blood Alcohol concentration (BAC)
1 oz. of pure alcohol eliminated every 3 hours
Person’s biochemical makeup due to heredity can have strong effect on metabolism and elimination
Actual reaction and level of impairment depends on:
Drinking history
Tolerance
Mood
And other factors
Most states consider .08 or 1.0 of BAC Drunk

17. Levels of Use
Low-to-moderate: 1 drink for women & 2 drinks for women daily
Generally does not have negative consequences
Generally not safe for pregnant women, people who have physical or mental impairments
Use includes:
Relaxation
Relax muscles
Stimulate appetite
Reduce incidents of heart attack & stroke
Alcohol interferes with REM sleep & dreaming essential to feeling fully rested

18. Levels of Use High-doses (heavy drinking) Depresses nervous system
5 or more drinks at one sitting for males and 4 or more for females at least 5xs per month
Depresses nervous system
Possibly leading to cardiac failure or death
.40 is threshold for alcohol poisoning that can fatally.
.20 can result in severe depressed respiration and vomiting while semiconscious
Vomit can be aspirated or swallowed blocking air passages to lungs resulting in asphyxiation and death

19. Levels of Use
Blackouts: Person appears to be acting normally and is awake and conscious but afterwards cannot recall anything.
Early signs of alcoholism
Different from passing out (drinker has partial recollection)
Hangovers
May be severe many hours after
Effects include:
Headache
Nausea
Vomiting
Thirst
Dizziness
Dry mouth
Inability to concentrate
General depressed feeling

20. Levels of Use Mental and emotional effects
Depresses and slows functions to Cental and peripheral NS
Moves from initial relaxation to lowered inhibitions
Mental confusion
Mood swings
Loss of judgment
Emotional turbulance
BAC of .10 slurred speech
Chronic alcoholism results in daily fatigue
Nightmares, bed wetting and heavy snoring

21. Levels of Use Liver Disease
10-35% of chronic alcoholics develop alcoholic hepatitis
Causes inflammation of the liver
Areas of fibrosis
Necrosis (cell death)
Damaged membranes
10-20% cirrhosis of the liver
Occurs when alcohol causes scarring
Most advanced form of liver disease
Leading cause of death among alcoholics
10,000-24,000 die each year
France and Germany have a rate of 2-3 times more than U.S.

22. High Use of Alcohol

23. High Use of Alcohol Liver Disease
Fatty Liver: accumulation of fatty acids in the liver
Occurs after a few days of heavy drinking
Abstention eliminates much of accumulated fat
Liver diseases decrease the ability of the liver to metabolize alcohol thus allowing alcohol to travel to other organs in original toxic form

25. High Use of Alcohol Digestive system
Moderate to high use stimulate production of stomach acid and delay emptying time of the stomach causing acid stomach and diarrhea
Gastritis (stomach inflammation) common
Inflammation and irritation of esophagus, small intestine and pancreas
Linked to ulcers, stomach hemorrage and gastrointestinal bleeding
Can cause hypoglycemia in drinkers that get little nutrition (too little sugar)
Hyperglycemia in people who have sufficient nutrition (too much sugar)

26. High Use of Alcohol Cardiovascular disease
Related to heart disease, including
Hypertension, cardiac arrhythmias
Damages striated heart muscles
Cardiomyopathy, (enlarged, flabby and insufficient heart)
Increases risk of stroke

28. High Use of Alcohol Central Nervous System (CNS)
Causes direct damage to nerve cells
Alcohol-induced malnutrition can injure brain & disrupt brain chemistry
Brain atrophy (loss of brain tissue) documented in50-100% of alcoholics in autopsy
Dementia
Wernicke’s encephalopathy and Kosakoff’s psychosis (serious brain damage caused by chronic alcoholism and thiamin deficiency) m

29. High Use of Alcohol Reproductive System In females In men
Decreases sexual desire and intensity of orgasm
Raises chances of infertility and spontaneous abortion
In men
Impairs gonadal function causing decrease in testosterone levels
8% are impotent
Only half recover sexual function after abstinence

30. High Use of Alcohol Cancer: Systemic Problems
Association between breast cancer and heavy drinking
Risk of mouth, throat, larynx & esphageal cancer are 6 times greater and 38% for those who smoke and drink
Systemic Problems
Leeches minerals from body cause greater risk of fracture
Unbalances electrolytes by chronic use
Reddish skin completion
Respiratory infections
Turberculosis
Pnenomonia
Weaken immune system

31. Addiction to Alcohol
10-12% of 140 million Americans develop addiction to alcohol
2-3 times greater for men
20% consume 80% of alcohol
E.M. Jellineck classification of alcoholics:
Primary: immediate liking of alcohol, progressing to alcoholism
Steady endogenous: alcohol is secondary to psychiatric disease
Intermittent: periodic binge drinking
Stammtisch: alcoholism precipitated by outside and social causes

32. Addiction to Alcohol Modern classifications Type I
Later onset
Effects men and women
Requires genetic and environment predisposition
Can be moderate to severe
Takes years of drinking to trigger it
Type II “Male Limited”
Affects sons of alcoholics
Moderately severe
Primarily genetic
Mildly influenced by environmental factors

33. Addiction to Alcohol Modern classifications Type A Type B
Later-onset of alcoholism
Less family history
Less severe dependence
Type B
More severe alcoholism with earlier onset
More impulsive behavior and conduct disorders
More co-occurring disorders
More severe dependence

34. Addiction to Alcohol Disease Concept
Primary disease with genetic, psychosocial and environment factors influencing development and manisfestation
Progressive
Fatal
Impaired control
Preoccupation
Use of alcohol despite negative consequences
Distortions in thinking
Most notably denial of problem drinking
Can be periodic or continuous

35. Addiction to Alcohol Heredity: Environmental factors
Strong genetic influences shown in family, twin, and adoption studies
Several genes have an influence on one’s susceptibility to alcoholism
Strong genetic susceptibility to blackouts
Hereditary link to physical consequences to cirrhosis and alcoholic psychosis
Environmental factors
Child abuse
Poor nutrition
Alcohol/drug abusing friends and relations
Extreme stress

36. Addiction to Alcohol
Exposure to brain initiates process of adaptation or change in brain function
Tolerance
Body changes as alcohol is metabolizes
Heavy drinking causes liver to be less able to metabolize alcohol (reverse tolerance)
Brain cells and neurons become more resistant to effects by increasing receptor sites
Drinkers learn how to “handle their liquor” and modify their behavior

37. Addiction to Alcohol Withdrawal Minor symptoms
85% will have minor symptoms
Rapid pulse
Sweating
Increased body temperature
Hand tremors
Anxiety
Depression

38. Addiction to Alcohol Withdrawal Major Symptoms Tachycardia
Transient visual, tactile or audio hallucinations & delusions
Psychomotor agitation
Grand-mal seizures
Delirium tremens (DTs) requiring hospitalization
Kindling: repeated bouts of drinking causing severe withdrawal that causes seizures

39. Alcohol and Pregnancy Leading cause of mental retardation in children
12.4% drank alcohol during several months of pregnancy
3.9% had binge pattern
0.7% heavy drinkers
5.5%
Study of infants with FAS found that 89% were using alcohol and at least two other drugs
49% were using just two drugs, usually cocaine and alcohol

40. Alcohol and Pregnancy Fetal Alcohol Syndrome
Retarded growth before and after birth
Facial abnormalities, including shortened eye openings, thin upper lip, flattened midface, missing groove in upper lip.
Occasional problems with heart and limbs
Delayed intellectual development
Neurological problems
Behavioral problems
Visual problems
Hearing loss
Balance or gait problems

41. Alcohol and Pregnancy
Critical period during pregnancy for alcohol effects on brain development is weeks 3 – 8 at onset of embryogenesis
7 standard drinks per week was threshold for pregnant women

42. Aggression & Violence
¼ 11.1 million victims of violent crime report that the offender had been drinking alcohol
34-37% of sexual assaults predators
30-79% of victims drinking
Encourages release of pent-up anger, hatred and desires forbidden by society
Any type of violence can cause permanent biochemical changes in victim that makes them susceptible to drug abuse and other emotional problems

43. Driving Under the Influence
40% of fatalities in 2001
1 in 4 drinker gets behind wheel after 2 hours of drinking
Of those convicted of DUI
61% drank beer
2% drank wine
18% drank liquor
20% drank combination
15-25% emergency room patients
16 x’s likely to die in falls
10 x’s likely like to become burn victims
31% boating accidents