1. Chapter 8: Drinking Alcohol Responsibly and Ending Tobacco Use
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2. Learning Outcomes
Explain the physiological and behavioral effects of alcohol, including absorption, metabolism, and blood alcohol concentration
Identify short-term and long-term health risks associated with alcohol consumption
Describe alcohol use patterns of college students, practical strategies for drinking responsibly, and ways to cope with campus and societal pressures to drink.
Describe alcohol use disorder, its risk factors, causes, and costs to society, and discuss options for treatment.
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3. Learning Outcomes (cont.)
Discuss the rate of tobacco use in the United States in general and among college students in particular, and explain the social and political issues involved in tobacco use and prevention.
Identify different types of tobacco products, the chemicals they contain, and explain their effects on the body.
Describe the health risks and physical impact associated with using tobacco products, as well as with environmental tobacco smoke.
Describe methods and benefits of smoking cessation.
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4. Alcohol: An Overview
Very low levels of alcohol, particularly red wine, may lower some health risks in older adults.
Half of all Americans consume alcoholic beverages regularly; about 21 percent abstain.
Men typically drink more regularly and drink more than women.
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5. The Chemistry and Potency of Alcohol
Ethyl alcohol or ethanol: the intoxicating substance in all alcoholic beverages
Fermentation process: Yeast organisms break down sugar.
Distillation: Alcohol vapors are released from the mash at high temperatures.
Proof: Measure of the percent alcohol
80 proof whiskey = 40 percent alcohol
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6. What Is a Standard Drink?
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7. Absorption and Metabolism
About 20 percent of absorption occurs in the stomach.
About 80 percent of absorption occurs in the small intestine.
Factors that influence absorption
Concentration and drink type
Amount consumed
Food in your stomach
Metabolism
Mood
Weight and/or body mass index
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8. Absorption and Metabolism (cont.)
Alcohol contains 7 calories per gram.
The breakdown of alcohol is fairly constant at about 0.5 ounce per hour (about one standard drink.)
Unmetabolized alcohol circulates in the bloodstream until enough time passes for the body to break it down.
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9. Blood Alcohol Concentration (BAC)
Ratio of alcohol to total blood volume
The legal limit for BAC is 0.08 percent in all states.
Both breath analysis (breathalyzer tests) and urinalysis are used to determine whether an individual is legally intoxicated, but blood tests are more accurate and are required in many states.
Learned behavioral tolerance—even though BAC may be quite high, the individual has learned to modify his behavior to appear sober.
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10. The Psychological and Physical Effects of Alcohol
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11. Blood Alcohol Concentration (BAC) (cont.)
A drinker's BAC depends on
Weight and body fat
The water content in the body tissues
The concentration of alcohol in the beverage consumed.
Alcohol concentration is higher in people with more body fat; women generally have more body fat than men.
Women have half as much alcohol dehydrogenase as men.
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12. Approximate Blood Alcohol Concentration (BAC) and the Physiological and Behavioral Effects
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13. Alcohol and Your Health
Short-term effects:
Alcohol depresses central nervous system (CNS) functions.
Vital functions become noticeably affected, and in extreme cases, coma and death can result.
Alcohol is a diuretic, but water is pulled out of the cerebrospinal fluid, resulting in "morning-after" headaches.
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14. Effects of Alcohol on the Body and Health
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15. Alcohol and Your Health (cont.)
Short-term effects (cont.)
Alcohol irritates the gastrointestinal system.
Brief drinking sprees of high amounts increase risk for irregular heartbeat or total loss of heart rhythm.
Hangovers kick in for more than half of drinkers when BAC reaches But, 20–25 percent of those who drink enough to reach that level do not experience them.
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16. Alcohol and Your Health (cont.)
Alcohol is involved in approximately 70 percent of fatal injuries during activities such as boating and swimming.
Heavy drinking is associated with dating violence
One drink can add 100 calories to your daily intake; adding 150 calories per day more than you need can result in weight gain of 12 pounds a year.
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17. Alcohol Poisoning Acute alcohol intoxication can be fatal.
The amount of alcohol that causes unconsciousness is dangerously close to a fatal dose.
BAC continues to rise even after a drinker is unconscious.
Signs include inability to be roused; weak, rapid pulse; cool, pale, or bluish skin.
Call immediately.
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18. Drinking and Driving
Surveys indicate that 23 percent of college students have driven after drinking.
Alcohol impaired drivers are involved in about 1 in 3 crash deaths, and nearly 10,000 deaths annually.
This represents one alcohol-related fatality every 51 minutes.
The likelihood of a driver being involved in a fatal crash rises significantly with a BAC of 0.05 percent and even more rapidly after 0.08 percent.
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19. Percentage of Fatally Injured Drivers with BACs Greater Than 0
Percentage of Fatally Injured Drivers with BACs Greater Than 0.08%, by Driver Age, 1982–2013
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20. Long-Term Effects of Alcohol
Effects on the nervous system
Cardiovascular effects
Liver disease
Cancer
Other effects
Chronic inflammation of the pancreas
Blocked absorption of calcium
Reduced ability of the body to fight bacteria and viruses.
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21. Comparison of a Healthy Liver with a Cirrhotic Liver
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22. Alcohol Use In College
Approximately 67 percent of students report having consumed an alcoholic beverage in the past 30 days.
Of college students, 39 percent engage in binge drinking. Binge drinking for men is consuming 5 or more drinks in about 2 hours; for women, consuming 4 or more.
Alcohol use among college students disrupts sleep, decreases alertness, and may affect academic performance.
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23. College Students' Patterns of Alcohol Use in the Past 30 Days
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24. High-Risk Drinking and College Students
Alcohol exacerbates risk for suicide, automobile crashes, and falls.
Many college and university students' customs and celebrations encourage certain dangerous practices and patterns of alcohol use.
Advertising and promotions from the alcoholic beverage industry heavily target university campuses.
Beer and other drink specials enable students to consume large amounts of alcohol cheaply.
College students are vulnerable to peer influence.
Administrators often deny that a problem exists.
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25. Prevalence of Negative Consequences of Drinking among College Students, Past Year
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26. Efforts to Reduce Student Drinking
Brief Alcohol Screening and Intervention for College Students (BASICS) has been effective for heavy-drinking students with already existing or risk for problems related to alcohol.
E-interventions (electronically based alcohol education interventions) are interventions using text messages, s, and podcasts. E-interventions and Web interventions like Alcohol e-Check Up to Go (e-Chug) have shown promise in reducing alcohol problems in first-year students.
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27. Abuse and Dependence
Alcohol use becomes alcohol abuse when it interferes with work, school, or social and family relationships, or when it entails law violations, including DUI.
Alcoholism or alcohol dependence occurs when alcohol use is so severe that stopping alcohol results in withdrawal symptoms.
Identifying an alcoholic
Craving, loss of control, tolerance, psychological dependence, and withdrawal symptoms must be present to qualify a drinker as an addict.
About 15 percent of people in the United States are problem drinkers.
One study shows that 25 percent of college students meet the criteria for alcohol abuse or dependence in the past year.
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28. The Causes of Alcohol Abuse and Alcoholism
Biological and family factors
Higher rates of alcoholism occur among children of alcoholics.
Scientists have not identified an alcoholism gene.
Social and cultural factors
Family attitudes
People raised in cultures in which alcohol is part of religious or ceremonial activities are less prone to dependence than people raised where purchase is controlled and alcohol use is regarded as a rite of passage.
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29. Women and Alcoholism
Women become alcoholic at later ages and after fewer years of heavy drinking than do male drinkers.
Women get addicted faster.
Women have greater risks for cirrhosis; excessive memory loss and shrinkage of the brain; heart disease; and cancers of the mouth, throat, esophagus, liver, and colon.
Risk factors include being unmarried but living with a partner; being in 20s or 30s, with a husband or partner who drinks heavily; family history; pressure to drink; depression and stress.
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30. Alcohol and Prescription Drug Abuse
Alcohol and prescription drugs taken together can cause
Alcohol poisoning
Unconsciousness
Respiratory depression
Death
Opioids, stimulants, sedatives, and sleeping aids are most often combined with alcohol.
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31. Costs to Society
Alcohol-related societal costs are estimated to be over $223.5 billion when health insurance, criminal justice costs, treatment costs, and lost productivity are factored in.
Alcoholism is directly or indirectly responsible for over 25 percent of the nation's medical expenses and lost earnings.
Underage drinking costs $62 billion annually.
Costs include violence, drunk driving, high-risk sex, property crime, and addiction treatment.
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32. Treating Alcoholism
Alcoholics who decide to quit will experience detoxification and may experience the following withdrawal symptoms:
Hyperexcitability
Confusion
Agitation
Sleep disorders
Convulsions
Hand tremors
Depression
Headache
Seizure
Possible delirium tremors (DTs)
Treatment programs include private facilities and therapy.
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33. Relapse
Up to 70 percent of alcoholics relapse (resume drinking) within 1 year of treatment.
Treatment requires more than drinking cessation.
There must be a guard against relapse.
Situations that could result in relapse, such as becoming angry, frustrated, being around drinkers, being pressured to drink, must be identified.
Joining a support group helps.
Maintain stability by avoiding major life changes.
Effective recovery programs help addicts create self-esteem and resume personal growth.
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34. Tobacco Use in the United States
Nearly 500,000 Americans die annually of tobacco-related diseases.
Another 16 million suffer tobacco-induced health disorders.
Tobacco causes about 20 diseases, and about half of all regular smokers die of smoking-related diseases.
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35. Tobacco and Social Issues
Advertising
$24 million is spent daily on advertising and promotion.
Ninety percent of adults who smoke started by age 21, and half became regular smokers by age 18.
Financial costs to society
Tobacco use causes more than $289 to $333 billion in annual health-related economic issues.
For each smoker, the cost is about $18.20 per pack of cigarettes sold.
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36. Percentage of Population That Smokes (Age 18 and Older) among Select Groups in the United States
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37. College Students and Tobacco Use
Heavy tobacco marketing and advertising is aimed at students, but smoking among college students is declining.
Why do college students smoke?
To relax or reduce stress
To fit in/social pressure
Because of addiction
Social smoking
Many students identify themselves as social smokers: those that smoke only around other smokers.
This can lead to dependence and all the same health risks as smoking regularly.
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38. Tobacco Use and Prevention Policies
It has been over 40 years since the government recognized the hazards of tobacco use.
In 1998, the tobacco industry reached a Master's Settlement Agreement with 40 states.
The Family Smoking Prevention and Tobacco Control Act (2009) forbids advertising geared to children, forbids nicotine reduction, and bans sweetened cigarettes.
Smokeless tobacco ads must have a warning that fills 20 percent of the advertising space.
Cigarette packages were required to have bigger, stronger warnings, but lawsuits by tobacco companies prevented their implementation in 2012.
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39. Trends in Prevalence of Cigarette Smoking in the Past Month among College Students
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40. Tobacco and Its Effects
Nicotine
Highly addictive, psychoactive substance
CNS stimulant
Tar and carbon monoxide
Tar is the carcinogenic particulate matter.
Nicotine paralyzes cilia, which become unable to clear out tar.
Carbon monoxide is a deadly gas that reduces the oxygen-carrying capacity of red blood cells.
Tobacco addiction
Nicotine poisoning
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41. Lung Damage from Chemicals in Tobacco Smoke
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42. Tobacco Products Cigarettes
Filtered cigarettes may deliver more hazardous gases.
Switching to low-tar or low-nicotine is self-defeating because the smoker may smoke more.
Clove cigarettes contain 60 percent tobacco.
Cigars
Contain 23 poisons and 43 carcinogens.
Bidis
Produce three times more carbon monoxide and nicotine and five times more tar than do cigarettes.
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43. Tobacco Products (cont.)
Pipes and Hookahs
Water pipes may cut down on throat irritation.
The main ingredient in hookahs is tobacco.
A hookah does not filter out harmful chemicals found in tobacco smoke.
Smokeless tobacco
Chewing tobacco
Dipping rapidly releases nicotine into the bloodstream.
Snuff
Can be inhaled, chewed, or placed against the gums.
Smokeless tobacco is just as addicting as cigarette smoking.
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44. Health Hazards of Tobacco Products
Cancer
Lung cancer is the leading cause of cancer death.
Of lung cancers, about 90 percent are caused by smoking tobacco.
It can take 10–30 years to develop, and most cases are not diagnosed until the cancer has spread. Five-year survival rate is only 17 percent.
Smoking just one cigar a day can double the risk of several cancers.
Chewing tobacco is responsible for the majority of new oral cancers, which can begin as leukoplakia.
Warning signs include lumps in the jaw or neck, color changes or lumps inside the lips, white smooth or scaly patches in the mouth or neck, lips or tongue; a red spot or sore on the lips, gums, or inside the mouth that does not heal in 2 weeks.
Other tobacco-induced cancers include pancreatic, kidney, bladder, lip, tongue, esophagus, and larynx
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45. Effects of Smoking on the Body and Health
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46. Health Hazards of Tobacco Products (cont.)
Cardiovascular disease
Over a third of all tobacco-related deaths occur from heart disease.
Environmental tobacco smoke (ETS) can have a 20 to 25 percent increase in plaque buildup
Smokers are two to four times as likely to suffer strokes as nonsmokers.
Daily cigar smoking, especially for people who inhale, also increases the risk of heart disease
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47. Health Hazards of Tobacco Products (cont.)
Respiratory disorders
Chronic bronchitis
Emphysema
Sexual dysfunction and fertility problems
Males are more likely to suffer impotence than are nonsmokers.
Women are likely to suffer infertility, problems with pregnancy, and problems for the child after birth.
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48. Health Hazards of Tobacco Products (cont.)
Unique risks for women
Smokers are 25 times more likely to die from lung cancer than are nonsmokers.
Higher rates of osteoporosis, depression, and thyroid-related diseases.
Increased risk for blood clots, especially in smoking women who take birth control pills.
Heavier menstrual bleeding, longer duration of cramps, less predictable length of menstrual cycle.
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49. Health Hazards of Tobacco Products (cont.)
Other health effects
Gum disease, macular degeneration, premature skin wrinkling, staining of the teeth, yellowing of fingernails, and bad breath.
Nicotine speeds up the process by which the body uses and eliminates drugs, making medication less effective.
Smoking significantly increases the risk for Alzheimer's disease.
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50. Environmental Tobacco Smoke (ETS)
Mainstream: smoke drawn through tobacco while inhaling.
Sidestream: smoke from the burning end of a cigarette or smoke exhaled by a smoker
Contains twice as much tar and nicotine, 5 times more carbon monoxide, and 50 times more ammonia than mainstream smoke.
Causes more deaths a year than any other environmental pollutant.
Every year, ETS is estimated to be responsible for 3,400 lung cancer deaths, 46,000 coronary and heart disease deaths, and higher risk of SIDs deaths in newborns.
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51. Quitting Smoking Breaking the nicotine addiction
Seventy percent attempt to quit each year.
Only between 4 and 7 percent succeed.
Options include going "cold turkey," gradual reduction, short-term programs based on behavior modification and a system of rewards, and treatment centers.
Combining several approaches has the most promise.
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52. Coping Strategies for Common Smoking Withdrawal Problems
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53. Quitting (cont.)
Symptoms of withdrawal include irritability, restlessness, nausea, vomiting, and intense craving for tobacco.
Nicotine replacement products
Nicotine chewing gum
Nicotine patches
Nasal spray
Nicotine inhaler
Smoking cessation medications
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54. Quitting Smoking (cont.)
Benefits of quitting
Many tissues will repair themselves, according to the American Cancer Society.
Circulation and the senses of taste and smell improve within weeks.
Risk of heart attack falls by half after only 1 year without smoking.
Can save about $2912 per year.
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55. When Smokers Quit
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