2.  False. Moderate drinking is not more than one drink per day for women and no more than two drinks per day for men. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 2

3.  C. Most other adults drink lightly and occasionally; a small number of heavy drinkers, about 7% of adults, consume more than half of all the alcohol in the United States. Overall, college students drink more alcohol and are more likely to binge drink than young adults who are not in college, but nonstudents are more likely to be dependent on alcohol. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 3

4.  True. Women usually have a higher percentage of body fat than men and a less active form of a stomach enzyme that breaks down alcohol. Both factors cause them to become intoxicated more quickly and to a greater degree. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 4

5.  True. Consuming a number of drinks over a period of several hours is likely to cause intoxication, followed by a hangover; chugging the same amount in an hour or less can be lethal. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 5

6.  False. Once alcohol has been absorbed by the body, nothing speeds its metabolism. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 6

7.  False. The figure is more than 97,000 students each year, a half million students report having unsafe sex while drunk or having sex when they are too intoxicated to know whether they have consented. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 7

8.  55% adult Americans (age 18 and older) currently drink  14% are former drinkers  31% are lifetime abstainers  Of those who drink: › 79% are light drinkers › 14% are moderate drinkers › 7% are heavy drinkers › 3.5% are dependent on alcohol › 4.3% classified as alcohol abusers  Social, economic and medical costs of alcohol abuse are estimated at over $180 billion per year  Between 20 and 40 percent of all hospital beds are occupied by people being treated for medical, psychiatric, and traumatic complications of alcohol use.  Alcohol is responsible for about 85,000 deaths per year  Alcohol is the third leading actual cause of death among Americans  Alcohol is the leading cause of death among people aged 15- 24.  Alcohol is the number one drug of abuse. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 8

9.  How does alcohol affect people?  Does it affect some people differently than others?  Can some people handle alcohol? ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 9

10.  Within minutes after alcohol is consumed it enters the bloodstream and nerve cells are numbed.  Nerve messages are slowed to all parts of the body.  Alcohol acts as a relaxant when one or two drinks are taken.  When larger amounts of alcohol are consumed, the nerve centers in the brain that govern judgment, memory, speech, reaction time, coordination, muscular control, and brain activity are impaired.  The depressive effects of alcohol intensify as the concentration of alcohol in the blood increases. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 10

11.  20% is rapidly absorbed from the stomach into the bloodstream  75% is absorbed in the upper small intestines  Remaining is absorbed along the gastro-intestinal track into the bloodstream  Rate of Absorption › Carbonation increases rate of absorption › Artificial sweeteners in drink mixers increase rate of absorption › Food in the stomach slows the absorption › Drink of high concentration slows absorption › Eventually all the alcohol ingested will be absorbed ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 11

12.  Easily moves through most biological membranes  Main site for metabolism is the liver though small amount is metabolized in the stomach.  2-20% of ingested alcohol is not metabolized but is excreted unchanged by the lungs, kidneys, and sweat glands. › Excreted alcohol causes the breath to smell › The basis for breath and urine analysis  The body can metabolize about ½ ounce of alcohol per hour for an average-sized person. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 12

13.  Blood Alcohol Concentration (BAC) is the ratio of alcohol in a person’s blood to the person’s total amount of blood. BAC is expressed as a percent.  BAC is a measure of intoxication and can be measured through: › Urine › Breath › Blood samples ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 13

14.  BAC is determined by:  Amount of time of metabolism  Body weight  Percentage of body fat  higher body fat = higher BAC than more muscular person of the same weight because fat has fewer blood vessels  Gender  because of less active stomach enzyme in women, women are generally smaller and contain more body fat and hormonal fluctuations during certain times of menstrual cycle  Race  Age ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 14

15.  Less alcohol consumed than can metabolize in an hour = BAC remains low › This is how people can consume large amounts over a long period of time without becoming noticeably drunk however consider long-term hazards  More alcohol consumed than can metabolize in an hour = BAC steadily increases › Person will get more and more drunk  Time is essential to BAC › Several drinks over several hours results in intoxication and hangover › Several drinks in an hour could be lethal ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 15

16.  Exercise  Breathing deeply  Eating  Drinking coffee  Taking other drugs  Sleep ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 16

17.  Dependant on the individual.  Alcohol is a Central Nervous System depressant  At any given BAC, the effects are more pronounced when the BAC is rapidly increasing than slowly increasing, steady or decreasing  Low Concentrations.03% -.05%. › Relaxed, jovial, light-headedness, mild euphoria  Higher Concentrations 0.1% -0.2%. › Angry, sedated, sleepy, interference with motor coordination, verbal performance and intellectual functions ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 17

18. BAC %Common Behavioral EffectsHours Required to Metabolize Alcohol 0.00 – 0.05 Slight change in feelings, usually relaxation and euphoria. Decreased alertness. 2-3 0.05 – 0.10 Emotional instability, with exaggerated feelings and behavior. Reduced social inhibitions. Impairment of reaction time and fine motor coordination. Increasingly impaired during driving. Legally drunk at 0.08%. 3-6 0.10 – 0.15 Unsteadiness in standing and walking. Loss of peripheral vision. Driving is extremely dangerous. 6-10 0.15 – 0.30 Staggering gait. Slurred speech. Pain and other sensory perceptions greatly impaired. 10-24 More than 0.30 Stupor or unconsciousness. Anesthesia. Death possible at 0.35% and above. Can result from rapid or binge drinking with few earlier effects. More than 24 ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 18

19.  Proof Value = The concentration of alcohol in a beverage › Two times the percentage concentration › 100 proof beverage = 50% alcohol › 2 ounces of 100 proof whiskey contains 1 oz. of pure alcohol  1 drink is equal to: › 1 12 oz. beer › 5 oz. table wine › Cocktail containing 1.5 oz. 80 proof liquor › Each contains the same amount of alcohol = 0.5 – 0.6 ounces ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 19

20.  Ingestion › 7 calories per gram › 1 drink = 14-17 grams or 100-120 calories › Most alcoholic beverages also contain some carbohydrate  1 beer = 150 calories  1 light beer = 100 calories  “Light” refers to calories and not amount of alcohol  5 oz. red table wine = 100 calories  5 oz. white table wine = 96 calories  6 oz. margarita = 314 calories  6 oz. cosmopolitan = 143 calories  6 oz. rum and coke = 180 calories ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 20

21.  In 2004 › 250,000 were injured in alcohol related automobile crashes – average of 1 person injured every 2 minutes › 42,000 people are killed in alcohol related accidents - =40% which is down from 50% in 1990  Increased public education and stiffer drunk driving laws are largely responsible ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 21

22.  Dose-response function › Relationship between the amount of alcohol or drug consumed and the type and intensity of the resulting effect  Higher doses are associated with a much greater probability of auto crashes  Driving with a BAC of 0.14% is more than 40 times more likely to be involved in a crash.  Greater than 0.14% the risk of fatal crash is estimated to be 380 times higher  Younger drivers result in significant impairment with BACs as low as 0.02% ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 22

23.  Driving Under the Influence (DUI) › In Maryland = BAC 0.04% to 0.07%  Driving While Intoxicated (DWI) › All states and Washington DC = BAC 0.08% and above  Zero-Tolerance Laws › In some states – drivers under age 21 who have consumed any alcohol may have their licenses suspended  Penalties include fines, loss of license, confiscation of vehicle, jail time, public scrutiny ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 23

24. ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 24

25. ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 25 BAC and Body weight

26.  Alcohol-related injuries and violence › 1.6 million emergency room visits in 2004 › Linked to more than 75,000 American deaths in 2001 › A 2006 study showed that more than 3000 minors die each year as a result of alcohol abuse › Alcohol use contributes to over 50% of all murders, assaults, and rapes. Alcohol is frequently found in the bloodstream of perpetrators and victims. › The majority of people who attempt suicide have been drinking, about half of all successful suicides are alcoholics. › Alcohol use triples the chances of fatal injuries during leisure activities such as swimming and boating. › More than half of all fatal falls and serious burns happen to people who have been drinking. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 26

27.  Alcohol poisoning can result from Binge Drinking  Binge Drinking is drinking 5 or more drinks in a row › Drinking large amounts of alcohol over a short period of time can rapidly increase BAC into the lethal range  Alcohol Poisoning happens as a result of drinking more alcohol than the body can process. › Alcohol poisoning can be caused in situations with inexperienced drinkers, drinking games, competitions, young drinkers ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 27

28.  Binge drinkers can be… › College students, high school students, middle school students  4.4 million teens under 21 are classified as binge drinkers  Students who binge drink are twice as likely to die from accidental injuries as non-bingers ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 28

29.  Alcohol alone or in combination with other drugs is responsible for more toxic Overdose deaths than any other drug  Death is caused by Central Nervous System and respiratory depression or by inhaling fluid or vomit into the lungs  The amount of alcohol it takes to make a person unconscious is dangerously close to a fatal dose. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 29

30.  Heavy drinking can result in severe Central Nervous System depression resulting in sleep, general anesthesia, coma and death.  Death from alcohol overdose occurs due to respiratory failure because of effects on the breathing center in the brain. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 30

31.  Don’t leave your friend alone!  Call 911 for medical assistance immediately.  Place your friend on his/her side to reduce risk of choking on vomit.  Wait with your friend until help arrives. Explain what you know to EMS about how much alcohol your friend has ingested. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 31

32.  Alcohol and Sexual Decision Making › Frequent binge drinkers are 5 times more likely to engage in unplanned sexual activity and 5.5 times more likely to have unprotected sex than non-binge drinkers › Heavy drinkers are more likely to have multiple sex partners and to engage in other forms of high-risk sexual behavior › Rates of STDs and unwanted pregnancies are higher among people who drink moderately or excessively › Women who binge drink are at increased risk for rape and other forms of nonconsensual sex. › Laws state a person who is very drunk or passed out cannot consent to sex. If you have sex with a person who is drunk or unconscious, you are committing sexual assault. › Ohio high school football players Ohio high school football players ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 32

33.  Alcohol abuse is recurrent use that has negative consequences.  Alcohol dependence or Alcoholism has more extensive problems, tolerance and withdrawal  Alcoholism is a progressive disease  The consequences get increasingly worse in the absence of treatment. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 33

34.  Drinking alone  Using deliberately and repeatedly  Feeling uncomfortable on certain occasions  Escalating consumption  Getting drunk regularly  Drinking in the morning or unusual times  Preoccupation with getting a supply  Changes in behavior  Changes in peer groups ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 34

35.  Not one program works for everyone. › AA – Alcoholics Anonymous  12-step program › Al-Anon – program for friends and family members › Al-Ateen – program for young people ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 35

36.  Using Alcohol with other drugs › Increases effects with both drugs potentially leading to coma, respiratory depression, and death  Barbiturates, valium-like drugs, narcotics (codeine) and OTC antihistamines (Benadryl) › 3 or more drinks per day cause OTC pain relievers like aspirin, ibuprofen, or acetaminophen to increase risk of stomach bleeding or liver damage › Antibiotics and diabetes medications can also interact dangerously › When cocaine and alcohol are used together, a toxic substance called cocaethylene is formed; responsible for more than half of cocaine-related deaths ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 36

37.  Diseases of the digestive, cardiovascular systems and some cancers  Digestive system › Liver function  “Fatty liver” – fat deposits in the liver  Alcoholic Hepatitis – inflammation of the liver  Cirrhosis - liver cell damage and destruction  Cirrhosis causes drinker to lose Tolerance › Pancreas inflammation  Cardiovascular system  moderate doses may reduce the risk of HD  Higher doses elevates BP, may weaken heart muscle or cardiac myopathy.  Cancer – Alcoholics 10 times higher cancer rate  Brain Damage – men 100 or women 80 or more drinks per month experience impairment of memory, processing speed, attention, balance  Mortality – Alcoholics life expectancy 15 years less ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 37

38. ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 38

39.  Effects are dose-related. › FAS Fetal Alcohol Syndrome  Occurs in 1 or 2 out of every 1000 live births in the U.S.  Under weight, flat nasal bridge, and long upper lip.  Small and have heart defects.  Physical and mental growth is slow.Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS). › ARND Alcohol-related neurodevelopment disorder. › Heavier drinking early in pregnancy. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 39

41.  Abstainers and light to moderate drinkers live longer than heavy users.  35 years old and younger, your odds of dying increase in proportion to the amount consumed  Moderate drinking = one drink per day for women and two drinks per day for men. › May lower coronary heart disease. › Raising blood levels of HDL. › May lower risks of; diabetes, arterial blockages, Alzheimer’s ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 41

42.  Binge Drinking › Having five drinks in a row for a man or four in a row for a women. › Frequent binge drinking in college were three to seven times more likely than non-binge drinkers to engage in unplanned or unprotected sex › Healthy People 2010  Reduce the rate of binge drinking to 20% among college students ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 42

43. ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 43 Alcohol consumption by college students Only one in five college students is a frequent binge drinker but binge drinkers account for nearly three-fourths of all the alcohol consumed by college students each year.

44.  Patterns and Prevalence › Regular daily intake of large amounts › Regular heavy drinking limited to weekends › Long periods of sobriety interspersed with binges or daily heavy drinking › Heavy drinking limited to periods of stress  Health Effects › DTs (delirium tremens) › paranoia  Social and Psychological effects  Causes of Alcoholism ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 44

45.  Men › White American men › “Other men”  Women  African Americans  Latinos  Asian Americans  American Indians and Alaska Natives ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 45

46. Past Year Prevalence (Percentage) Alcohol AbuseAlcohol Dependence Gender Men6.14.6 Women2.62.4 Ethnicity White4.63.5 African American2.93.4 American Indians and Alaska Natives4.410.4 Native Hawaiians and Pacific Islanders1.9n/a Asian Americans2.71.0 Latinos4.53.6 Total Population4.33.5 ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 46

47.  Examine your attitudes about alcohol use.  Examine your drinking behavior.  Drink Moderately and responsibly  Drink slowly  Space your drinks  Eat before and while drinking  Know your limits and your drinks ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 47

48.  Encourage responsible attitudes  Be a responsible host  Hold the drinker responsible  Learn about prevention programs  Take community action ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 48

49.  Depressant  Psychoactive ingredient  Ethyl Alcohol – only alcohol that can be consumed  Beer 3-6% alcohol by volume  Malt Liquors 6-8% alcohol by volume  Table wines 9-14% alcohol by volume  Fermenting juices of grapes and other fruits  Fortified wines 20% alcohol by volume  Sugar and alcohol added such as sherry, port, Madiera  Hard liquors 35-50% alcohol by volume  Distilling or fermented grains such as gin, whiskey, brandy, rum, tequila, vodka, and liqueurs ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 49

50.  Disturbs sleep patterns making sleep more light, punctuated with awakenings, and unrefreshing  Alcohol hangover › Headache, shakiness, nausea, diarrhea, fatigue, impaired mental functioning › Result of alcohol breakdown, dehydration and hormonal effects › Absenteeism and poor job performance  EEG studies show slowing of brain waves for up to 16 hours after BAC drops to zero. ChapterTen ©2008 McGraw-Hill Companies. All Rights Reserved. 50

51. ChapterTen©2008 McGraw-Hill Companies. All Rights Reserved. 51