Chapter 11 Chapter 11 Alcohol, Tobacco and Caffeine Unacknowledged Addictions Alcohol

Alcohol a Dangerous Drug? Cocaine, heroin, marijuana, LSD, PCP….and others!Cocaine, heroin, marijuana, LSD, PCP….and others! Alcohol isn’t considered because it is socially exceptedAlcohol isn’t considered because it is socially excepted Canadians consumed 7.1 litersCanadians consumed 7.1 liters comparable to US, Australia, and less than European countriescomparable to US, Australia, and less than European countries

Alcohol a Dangerous Drug? Can have some positive health benefitsCan have some positive health benefits moderate use can be enjoyablemoderate use can be enjoyable However! Many tragedies associated with abuse……..However! Many tragedies associated with abuse……..

Alcohol and University Students Most popular drug on University campuses %Most popular drug on University campuses % In Ontario - 1/3 had more than 15 drinks per week!In Ontario - 1/3 had more than 15 drinks per week! Live in residenceLive in residence lower gradeslower grades 17 and 22 years of age17 and 22 years of age

Alcohol and University Students Be aware of drinking campus culture and tradition reduces tension celebrations social lubricant drinking games and binge drinking

Drinking Alcohol and the Risks!!!!!! Exacerbates risks of suicide, automobile crashes and fallsExacerbates risks of suicide, automobile crashes and falls peers / university traditions encourage dangerous practicespeers / university traditions encourage dangerous practices participate in dangerous behaviours……..participate in dangerous behaviours……..

Physiological and Behavioural Effects of Alcohol ethyl alcohol or ethanolethyl alcohol or ethanol Fermentation - a process to produce ethanol - 14% alcoholFermentation - a process to produce ethanol - 14% alcohol Distillation - increases alcohol contentDistillation - increases alcohol content Proof - % of alcoholProof - % of alcohol Proof – gunpowder proof / 50% alcohol > 80 proof = 40% alcoholProof – gunpowder proof / 50% alcohol > 80 proof = 40% alcohol

Behavioural Effects NOTE: individual variation in alcohol toleranceNOTE: individual variation in alcohol tolerance alcohol is a depressant - acts on CNS by decreasing its activityalcohol is a depressant - acts on CNS by decreasing its activity depression is progressive/continuousdepression is progressive/continuous

Behaviours………... Alcohol has different effects on: sight: visual acuitysight: visual acuity hearinghearing speakingspeaking smell-tastesmell-taste pain receptionpain reception motor skillsmotor skills

Blood Alcohol Concentration (BAC): ratio of alcohol to total blood volume at 0.02 % (2 parts of alcohol for every 10,000 parts of blood) = relaxed good mood at 0.05 % = impaired - relaxation increases / some motor impairment / talkative at 0.08 % = impaired - euphoria / more motor impairment

Blood Alcohol Concentration at 0.10 % = intoxicated - depression / further loss of motor skills / loss of judgement / drowsiness larger individuals lower BAC - greater blood volume alcohol invades muscle tissue to a greater extent than fatty tissue

Learned Behavioural Tolerance Ability to modify behaviour to appear soberAbility to modify behaviour to appear sober Acquired physiological and psychological toleranceAcquired physiological and psychological tolerance No skills or functions enhanced by drinking alcoholNo skills or functions enhanced by drinking alcohol

Women and Alcohol Women have less alcohol hydrogenaseWomen have less alcohol hydrogenase greater sensitivity to the negative effects of alcoholgreater sensitivity to the negative effects of alcohol higher BAC (30%) for same body weight and alcohol consumed as a manhigher BAC (30%) for same body weight and alcohol consumed as a man

Breathalyzer and Other Tests... Breathalyzer determine BAC via exhaled breath Urinalysis Urinalysis - concentration of unmetabolized alcohol in urine both used to determine level of intoxication Blood tests Blood tests are most accurate

The Morning After…... NEXT DAY Congeners - forms of alcohol that metabolize more slowly - produce toxic by-productsCongeners - forms of alcohol that metabolize more slowly - produce toxic by-products dehydration – fluids are in the muscles and cerebral tissues hangover – mitochondrial dehydration in CNS (loss of cerebrospinal fluid) = headaches gastrointestinal irritation = discomfort

….. The night before rest / solid food / pain relievers (12 hours to recover) alcohol is a drug, therefore tolerance and withdrawal occur

Long Term Effects Nervous System: reduction in brain size and weight / left side = language written & spoken, mathematical skill and logic reduced intellectual ability binge drinking = most damage

Cardiovascular Disease: effect on heart minimal (small amounts of alchol) may decrease cholesterol levels increases blood pressure heart rate cardiac output

Hypertension and Stroke: moderate alcoholmoderate alcohol consumption (red wine) = increased HDL = increased HDL reduce hypertension reduce hypertension Alcohol consumption (large quantity) causes: hypertension hypertension strokestroke negative effects / out-weight goodnegative effects / out-weight good (moderate to heavy drinkers)(moderate to heavy drinkers)

Liver Disease: cirrhosis = liver cells die / top ten causes of deathscirrhosis = liver cells die / top ten causes of deaths effects fat storage and transport in the liver / cells stop functioningeffects fat storage and transport in the liver / cells stop functioning fibroses = damaged area develops scar tissue / cells function ineffectivelyfibroses = damaged area develops scar tissue / cells function ineffectively alcoholic hepatitis = inflammation of the liver / can lead to cirrhosisalcoholic hepatitis = inflammation of the liver / can lead to cirrhosis

Cancer esophagus, stomach, mouth, tongue and liver breast cancer – women between 34 & 59 / 3 to 9 drinks/wk / 30% males – 12% increase for 1 drink per day & 123% for 2 drinks per day facilitates absorption of carcinogenic substances into sensitive tissues, i.e. tobacco alcohol-induced immunologic suppression synergistic effect with tobacco alcohol-induced outcomes, such as malnutrition, anemia

Other Effects causes indigestion and heart burn damages mucous membranes = stomach and intestinal irritation, absorption and chronic diarrhea

Alcohol and Pregnancy Excessive Drinking during Pregnancy / Rate of Developmental Disabilities alcohol passes directly into the infant's blood stream BAC much greater than mother FAS - leading cause of development delays in Canada / North America during 1 st trimester - organ development last trimester - CNS development

Foetal Alcohol Syndrome (FAS) Physical and Foetal Behaviour Difficulties: sleeping / hyperactive learning disabilities dyslexic greater incidence of : congenital heart disease spina bifida hip dislocation skeletal development

Foetal Alcohol Effects (FSE) - Infants Exposed to Prenatal Alcohol No FAS - symptoms effects 3/1000 children low birth weight irritability possible permanent mental impairment

Alcoholism – Alcohol Abuse Interferes with work, school or social and family relationships violation / law i.e., drunk driving approx. 2 in 10 Canadians / drinking problem resulting in physical health problems, financial, relationships 50% of Canadians – problems with others people who drink loud, insulting, humiliation, argumentative, violent

Social impact of alcohol: motor vehicle accidents Pedestrian accidents Occupational accidents Home and recreational accidents Homicide Rape Marital problems Family violence/abuse Suicide

Overall – family patterns important Genetic link not found to date however - alcoholism 4 to 5 times greater in alcoholic homes Two Types Types of Alcoholics have been identified

Type 1: Had at least One Parent Who was an Alcoholic drinking at home was normal and encourageddrinking at home was normal and encouraged avoids novelty/harmful situationsavoids novelty/harmful situations concerned about the thoughts and feeling of othersconcerned about the thoughts and feeling of others

Type 2: males only / biological sons of alcoholic fathers experiences both violence and drug abuse don't seek social approval / lack inhibition One alcoholic Parent = 52% chance of developing a problem Two alcoholic Parents = 71% chance of developing a problem

Social and Cultural Factors and Alcoholism : part of traditions and cultural interactions may predispose people more than genetic potential Medication – temporally escape! Stress – disappointment – unfulfilled expectations – relationships – depression

Effects on the Family: Children have no idea of what normal family life is like!!!! (dysfunctional) Victims of violence, abuse, neglect or incest low self-esteem and depression Adopt one of the following roles Family Hero – too good to be true

Effects on the Family: Children have no idea of what normal family life is like!!!! Scapegoat - Draws attention through poor behaviours Lost Child – passive and withdrawn in upsetting situations Mascot – comic relief

Recovery #1 Assume Responsibility for Actions Intervention – planned confrontation ( Family and trained therapist) Treatment Programs: Symptoms: + delirium tremens (DT’s) Long-term addicts – medical treatment – detoxification ( 7 to 21 days) physiological addiction psychological treatment starts ( 3 to 6 weeks) may require more time / repeated intervention!

Family Therapy, Individual Therapy, and Group Therapy determine underlying reasons for problem develop coping mechanisms Other types of treatment Drug – Disulfiram (Antabuse) – causes extremely unpleasant side effects when coupled with alcohol

Alcoholic’s Anonymous (AA) private, nonprofit, self-help organization founded in 1935 group support – over 1 million members world wide lifetime problem AA ( Al-non) has other groups to help spouses, partners, children and friends Alateen – help teens deal with alcoholic parents Relapse Success varies from Individual to Individual some recover other never recover others partially recover approx. 60% relapse pattern has to be broken – promote self-esteem and personal growth

Relapse Success varies from Individual to Individual some recover other never recover others partially recover approx. 60% relapse pattern has to be broken – promote self- esteem and personal growth