Alcohol Use Misuse Abuse and Dependence

ALCOHOL (ETOH) An Arabic Word Meaning – “Something Subtle”

Alcohol History Probably the world’s oldest anodyne Made from the fermentation of carbohydrates Distillation increased ETOH content Meade existed by 8000 BCE Fermented in every culture on earth at some point in time

Alcohol Prevalence in US 90% Ever drank 60% Current drinkers >40% Temporary problems 10-20% Abuse 3-10% Dependence

YEARLY COSTS IN US $300 Billion Overall $71 Billion Direct Costs 22,000 Deaths + 2,000,000 Injuries 4,600,000 Damaged Vehicles 15% - 25% Healthcare Budget 90% of Liver Disease 72% of Pancreatitis 41% of Seizure Disorders 13% Breast Cancers 5

Alcohol – Public Health Model Agent Factors Host Factors Environment Factors

Agent Factors CNS Depressant Potentiates GABA, Dopamine, Endorphins Produces stimulation, sedation, motor incoordination Withdrawal potential Toxic to body/brain tissues Direct Effects –GI/Liver –Heart –Brain

Host Factors Genetic Susceptibility Males > Females Age – College years Personality/Psychopathology

Environmental Factors Models Access Policy Peers Media Social Norms

DSM-IV Abuse 1. Failure to fulfill major role obligations 2. Use in hazardous situations 3. Legal Problems 4. Use despite problems 11

DSM-IV Dependence 1. Tolerance 2. Withdrawal 3. Larger amounts/longer period than intended 4. Inability to, or persistent desire to, cut down or control 5. A great deal of time spent obtaining, using, or recovering 6. Important activities given up or reduced 7. Use despite problems caused or exacerbated by use 12

Why People Get in Trouble Various models to explain –Disease Model – Alcohol Dependence Syndrome –Tension Reduction –Social Learning –Genetics

Negative Health Effects Exacerbates ulcers Can cause cancer (head, neck, oral GI) Liver disease –Fatty Liver –Fibrosis –Cirrhosis CVD Accidents & Violence

Health Benefits Protective against CVD – Increases HDL Stress inoculation???? Bone mineral density Men 3 or less/day Women 2 or less/day Never more than 5

Ultimately There is – –Use – Most people who drink –Misuse – College and/or drinking to cope –Abuse – Continued misuse –Dependence – Small percent BIG TROUBLE

Be Careful If Family history Depression Anxiety ADHD If you can hold you liquor

Please Don’t Drink and drive Drink while pregnant Drink more than 4 drinks/day