1. . © 2009 McGraw-Hill Higher Education. All rights reserved. 1 Chapter Eleven Alcohol: Responsible Approaches to Drinking

2. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 2 Patterns of Alcohol Use More than 60% of American adults drink, at least occasionally. One-third of the adult U.S. population are non-drinkers (abstainers). Of the two-thirds who do consume alcohol, 10% are heavy drinkers. Moderate drinkers are men who drink no more than two drinks per day or women who drink no more than one drink per day. Light drinkers drink less than moderate drinkers.

3. © 2009 McGraw-Hill Higher Education. All rights reserved. 3 Drinking Patterns Across the Lifespan Alcohol consumption is highest between 18 and 25 for Whites and between 26 and 30 for Hispanics and African Americans. People are most likely to drink as adolescents and during early adulthood. Older adults drink significantly less than younger adults do. Women drink less than men and start drinking later in life. It takes less time for women to develop a drinking problem compared to men.

4. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 4 What Is “One Drink”?

5. © 2009 McGraw-Hill Higher Education. All rights reserved. 5 Ethnic Differences in Alcohol Use Alcohol use is higher among Whites than African Americans. Hispanic men have higher percentages of alcohol use than other ethnic groups, but Hispanic women are more likely to abstain than are African American and White women. Among Native Americans, alcoholism is recognized as the number one health concern. Asian Americans have lower consumption rates than white Americans, possibly due to genetic biological reactions towards alcohol.

6. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 6 What causes drinking problems? Genetic and Biological Factors Psychosocial Factors –Family history of alcoholism –Family dysfunction in general High levels of stress and negative emotions Depression –Childhood traumas –Compensatory drinking (coping mechanism) –External motivations (project certain image) –Developmental staging Socio-cultural/Environmental Factors –Cultural attitudes –Economic factors –Laws –Stresses

7. © 2009 McGraw-Hill Higher Education. All rights reserved. 7 Binge Drinking Consumption of 5 or more drinks in a row for a man or 4 or more drinks in a row for a woman The Harvard School of Public Health College Alcohol Study determined than 83% of college students drank alcohol – About half were binge drinkers –First year college women binged more than other women –One in five were frequent binge drinkers Students at historically Black colleges and universities have lower rates of binge drinking.

8. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 8 Some Consequences of College Drinking Binge drinking can have serious physical, academic, social, and legal consequences. –Death –Injury –Assault –Sexual assault –Unsafe sex –Academic problems –Health problems/suicide attempts –Drunk driving –Vandalism –Property damage –Police involvement –Alcohol abuse and dependence See Who’s at Risk? College Students and Binge Drinking

9. © 2009 McGraw-Hill Higher Education. All rights reserved. 9 Why Do College Students Binge Drink? Students may use drinking for a variety of reasons: –to ease social inhibitions –to fit in with peers –imitate role models –reduce stress –sooth negative emotions –or cope with academic pressure –mistaken belief of increased sexual arousal and performance

10. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 10 Addressing the Problem of College Drinking Screening interviews to identify high-risk students Enforcing college alcohol policies Punishing students who violate policies or break the law Mandating treatment for substance-related offenses Educating students to resist peer pressure Helping students cope with stress and time management issues Targeting prevention messages to high-risk events

11. © 2009 McGraw-Hill Higher Education. All rights reserved. 11 Effects of Alcohol on the Body Alcohol is a small molecule that is digested and quickly absorbed into the bloodstream via the stomach and small intestine. Once it reaches the brain, alcohol alters brain chemistry and neurotransmitter functions. Alcohol is a central nervous system depressant, which impairs movement and thinking. As alcohol concentrations increase, more functions are depressed, and greater impairment occurs.

12. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 12 Factors Affecting Alcohol Absorption Food in the stomach Gender Age Drug interaction Cigarette smoke Mood and physical condition Alcohol concentration Carbonation Tolerance

13. © 2009 McGraw-Hill Higher Education. All rights reserved. 13 Alcohol Metabolism A small amount of alcohol is broken down by the stomach however 90% is metabolized by the liver. Between 2-10% is not metabolized at all but is excreted unchanged through the skin, urine, or breath The liver allows conversion of alcohol to acetaldehyde by an enzyme alcohol dehydrogenase (ADH) and is converted into acetic acid. Acetic acid is eventually broken down into carbon dioxide and water.

14. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 14 Blood Alcohol Concentration Blood Alcohol Concentration (BAC): the amount of alcohol in grams in 100 milliliters of blood, expressed as a percentage 100 mgs of alcohol in 100 milliliters of blood is equivalent to a BAC of.10% Breath analyzers are valid based upon alcohol concentrations in the breath that correspond well to levels of alcohol in the brain. The amount of body water and body fat a person has influences the BAC levels in the body.

15. © 2009 McGraw-Hill Higher Education. All rights reserved. 15 Gender Differences in Alcohol Absorption and Metabolism Women are generally more susceptible to the effects of alcohol and have a higher BAC than men do based on the following: Generally smaller than men Higher body fat percentage ADH differences These differences create further health consequences such as: Liver Disease Heart Disease Brain Damage © Digital Vision/Punchstock

16. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 16 Possible Short-Term Results of Alcohol Consumption Acute alcohol intoxication is a life-threatening blood alcohol concentration which can produce collapse of vital body functions. Vomiting may be activated if a BAC reaches.12% or higher in a rapid method (binge drinking). A blackout is a period of time during which a drinker is conscious but has partial or complete amnesia for events. Hangovers are a result of a common reaction to alcohol toxicity characterized by headache, stomach upset, thirst, and fatigue. See Stages of Acute Alcoholic Influence/Intoxication, Table 11.2

17. © 2009 McGraw-Hill Higher Education. All rights reserved. 17 Long-Term Effects of Alcohol Use Heart Disease –Cardiomyopathy (disease of the heart muscle) –Abnormal heart rhythm Stroke Liver Disease –Fatty liver (liver swells with fat globules) –Alcoholic hepatitis (inflammation of the liver) –Cirrhosis (scarring of the liver) Cancer Brain Damage Malnutrition

18. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 18 Social Problems Associated with Alcohol Use Reduces inhibitions which may lead to high- risk sexual activity and a lowered likelihood of practicing safe sex Violence, including rape, sexual assault, and domestic violence Risk of injury Drunk driving Alcoholism Suicide risk

19. © 2009 McGraw-Hill Higher Education. All rights reserved. 19 Health Benefits of Alcohol The Dietary Guidelines for Americans notes that the lowest rates of death occur among people who consume one to two drinks a day. –Moderate consumption may increase high-density lipoproteins (HDL, the “good cholesterol”) –Anti-clotting effect on the blood –Reduces stress Binge drinking does not serve as a protective factor and can increase the risk for heart disease In younger adults, alcohol appears to have fewer, if any health benefits and is associated with more deaths and injuries and accidents. ©Stockbyte/Punchstock

20. © 2009 McGraw-Hill Higher Education. All rights reserved. 20 Health Benefits for Men light drinkers enjoyed a 28 % reduction in heart attacks, by-pass, angioplasties, cardiac deaths (compared to non-drinkers) 1991 Health Professionals Study moderated drinkers 48% reduction in risk 51,529 = N Men that drink on 3 or 4 days each week are 34% less likely to develop heart attacks than men who drink just once a week; If anything, liquor had a slight advantage over other beverages Drinking was associated with higher levels of HDL

21. © 2009 McGraw-Hill Higher Education. All rights reserved. 21 Physicians health study: cardiac patients: low doses of alcohol best; 2 – 4 drinks a week reduced recurrent heart attack by 28% men who consume little or no alcohol early in adult life derive cardiac protection if they begin modest drinking later on 1 – 7 drinks per week, 20% less likely to have strokes than non-drinkers Australia: 10-19 gm EtOH per day (one drink) had a 16% lower death rate than abstainers 3 drinks/day had the same mortality as non-drinkers 5 drinks/day 1.33 times higher than non-drinkers

22. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 22 Alcohol Misuse Problem drinking: Pattern of alcohol use that impairs the drinker’s life, causing difficulties for the drinker and for others. Alcohol abuse: Pattern of alcohol abuse that leads to distress or impairment, increases the risk of health and/or social problems, and continues despite awareness of effects. Alcohol dependence: Disorder characterized by a strong craving for alcohol, development of tolerance for alcohol, and withdrawal symptoms Alcoholism: Primary chronic disease characterized by excessive, compulsive drinking Withdrawal: A state of acute physical and psychological discomfort when alcohol consumption stops abruptly

23. © 2009 McGraw-Hill Higher Education. All rights reserved. 23 Treatment Options Brief Interventions Primary care physician Inpatient Treatment Residential facilities – Detoxification – Medications – Counseling Outpatient Treatment Counseling Self-help Approaches Support groups (AA, Al-Anon, Alateen, Adult Children of Alcoholics)

24. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2009 McGraw-Hill Higher Education. All rights reserved. 24 Relapse Prevention The first two years after treatment are usually the hardest. Difficulty of recovery is thought to be due to changes the alcohol as produced in the brain. Craving can continue for years, even during sleep. Relapse prevention includes social skills training: –Stress management –Assertiveness –Communication skills –Self-control –Family and marital therapy

25. © 2009 McGraw-Hill Higher Education. All rights reserved. 25 Developing A Behavior Change Plan Following a behavior change plan can assist you with reducing alcohol consumption. Record Behavior Patterns Analyze Your Drinking Diary Establish Goals Implement Your Plan Evaluate Your Results

26. . © 2009 McGraw-Hill Higher Education. All rights reserved. 26 Chapter Eleven Alcohol: Responsible Approaches to Drinking