1. Chapter 8 Alcohol and Tobacco © 2012 McGraw-Hill Companies. All Rights Reserved.

2. 2 2 The Nature of Alcohol Psychoactive ingredient Ethanol Beer 3-6% alcohol by volume Ales and malt liquors 6-8% alcohol by volume Table wines 9-14% alcohol by volume Fermenting Fortified wines 20% alcohol by volume Sugar and extra alcohol is added Hard liquors 35-50% (or more) alcohol by volume Distilling or fermenting Proof Value Two times the percentage concentration Ingestion 7 calories per gram 1 drink contains 14-17 grams, or 100-120 calories 2

3. 3 © 2012 McGraw-Hill Companies. All Rights Reserved.3 Absorption 20% is rapidly absorbed from the stomach into the bloodstream 75% is absorbed in the upper part of the small intestines Remaining is absorbed along the GI track Affected by many factors Carbonation Artificial sweeteners Food in the stomach Alcohol concentration Eventually all the alcohol ingested will be absorbed 3

4. 4 © 2012 McGraw-Hill Companies. All Rights Reserved.4 Metabolism and Excretion Easily moves through most biological membranes Transported throughout the body via the bloodstream Main site for metabolism is the liver 2-10% of ingested alcohol is not metabolized Non-metabolized alcohol excreted by lungs, kidneys, and sweat glands 4

5. 5 © 2012 McGraw-Hill Companies. All Rights Reserved.5 Alcohol Intake and Blood Alcohol Concentration Blood Alcohol Concentration (BAC) The amount of alcohol in a person’s blood, expressed as the percentage of alcohol measured in a deciliter of blood Affected by Body weight Percentage of body fat Sex Balance of alcohol absorption and rate of metabolism Drinking behavior Cannot be influenced by Exercise Breathing deeply Eating Drinking coffee Taking other drugs Metabolism is the same if the person is awake or asleep 5

6. 6 © 2012 McGraw-Hill Companies. All Rights Reserved.6 Figure 8.1 Approximate blood concentration and body weight

7. 7 © 2012 McGraw-Hill Companies. All Rights Reserved.7 The Immediate Effects of Alcohol on Health Dependent on the individual, circumstances, amount of alcohol consumed BAC of.03% -.05% - first effects felt Light-headedness, relaxation, release of inhibitions, mild euphoria Higher BAC – negative effects Impaired coordination, speech, intelligence Alcohol hangover Alcohol poisoning Using alcohol with other drugs Alcohol-related injuries and violence Alcohol and aggression Alcohol and sexual decision making 7

8. 8 © 2012 McGraw-Hill Companies. All Rights Reserved.8 Drinking and Driving In 2008 17.5% of adult American males and 9.6% of females drove under the influence of alcohol at least once Dose-response function Driving with a BAC of 0.14% is more than 40 times more likely to be involved in a crash When greater than 0.14%, the risk of fatal crash is estimated to be 380 times higher 8

9. 9 © 2012 McGraw-Hill Companies. All Rights Reserved.99 Figure 8.2 The dose-response relationship between BAC and automobile crashes

10. 10 © 2012 McGraw-Hill Companies. All Rights Reserved.10 The Effects of Chronic Use Digestive system Alters liver function “Fatty Liver,” fat accumulation occurs within a few days of heavy drinking Alcoholic hepatitis Liver cell damage and destruction (cirrhosis) Pancreas inflammation, pancreatitis Cardiovascular system Moderate doses may reduce the risk of heart disease Higher doses elevates BP, upping risk for stroke and heart attack, and may weaken heart muscle (cardiac myopathy) Cancer Mouth, throat, larynx, liver, breast, and esophagus Brain Damage Brain shrinkage, reduced blood flow, slowed metabolic rates Cognitive impairments: Memory loss, dementia, and compromised problem-solving Mortality Alcoholics average life expectancy is about 15 years less than nonalcoholics 10

11. 11 © 2012 McGraw-Hill Companies. All Rights Reserved.11 Figure 8.3 The immediate and long-term effects of alcohol abuse

12. 12 © 2012 McGraw-Hill Companies. All Rights Reserved.12 The Effects of Alcohol Use During Pregnancy Effects depend on dose and stage of pregnancy Fetal Alcohol Spectrum Disorder (FASD) Fetal Alcohol Syndrome (FAS) Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S. Deformities and slowed physical and mental growth Permanent, incurable Alcohol-related neurodevelopment disorder (ARND) Occurs in 3 times as many babies as FAS Normal appearance Learning and behavioral disorders 12

13. 13 © 2012 McGraw-Hill Companies. All Rights Reserved.13 Possible Health Benefits of Alcohol On average, light to moderate drinkers live longer than both abstainers and heavy users For those age 35 and younger, odds of dying increase in proportion to the amount consumed, even for light drinkers Moderate drinking = one drink or less per day for women and one to two drinks per day for men May lower risk of coronary heart disease Raises blood levels of HDL (“good” cholesterol) May lower risk of diabetes, arterial blockages, and Alzheimer’s 13

14. 14 © 2012 McGraw-Hill Companies. All Rights Reserved.14 Alcohol Abuse and Dependence Alcohol abuse is recurrent use that has negative consequences Alcohol dependence or alcoholism, includes more extensive problems, tolerance and withdrawal Warning signs of alcohol dependence Drinking alone Using deliberately and repeatedly as coping mechanism Feeling uncomfortable on occasions when not drinking Escalating consumption Drinking heavily in risky situations Getting drunk regularly Drinking in the morning or unusual times 14

15. 15 © 2012 McGraw-Hill Companies. All Rights Reserved.15 Binge Drinking The National Institute on Alcohol Abuse and Alcoholism defines as: Pattern of alcohol use that brings a person’s BAC up to 0.08 or above (typically four drinks for a man or three for a woman) within two hours National Survey on Drug Use and Health defines: Having five or more drinks within about 2 hours, at least once in 30 days About 75% of the alcohol consumption by adults in the U.S. meets the definition of binge drinking 15

16. 16 © 2012 McGraw-Hill Companies. All Rights Reserved.16 Alcoholism Patterns and Prevalence 1. Regular daily intake of large amounts 2. Regular heavy drinking limited to weekends 3. Long periods of sobriety interspersed with binges of daily heavy drinking lasting for weeks or months 4. Heavy drinking limited to periods of stress Health Effects Tolerance Withdrawal Hallucinations DTs (delirium tremens) Memory gaps Social and Psychological Effects Causes of Alcoholism 16

17. 17 © 2012 McGraw-Hill Companies. All Rights Reserved.17 Treatment Programs No one program works for everyone AA 12-step program Al-Anon Employee assistance programs Inpatient hospital rehabilitation Pharmacological treatments Disulfiram (Antabuse) Inhibits the metabolic breakdown Naltrexone Reduces the craving for alcohol and decreases its pleasant effects Injectable naltrexone Single monthly shot Acamprosate (Campral) Acts on brain pathways related to alcohol abuse 17

18. 18 © 2012 McGraw-Hill Companies. All Rights Reserved.18 Gender and Ethnic Differences Men Women African Americans Latinos Asian Americans American Indians and Alaska Natives Helping Someone with an Alcohol Problem 18

19. 19 © 2012 McGraw-Hill Companies. All Rights Reserved.19 Who Uses Tobacco & Why? 71 million Americans currently smoke 23% of men and 18% of women smoked in 2008 Nicotine addiction Nicotine: powerful psychoactive drug The most physically addictive of all psychoactive drugs Reaches the brain via the bloodstream in seconds Loss of control Tolerance and withdrawal

20. 20 © 2012 McGraw-Hill Companies. All Rights Reserved.20 Social & Psychological Factors Established habits or cues trigger urge to smoke Why start in the first place? Nearly 90% of all adult smokers started before age 18 Average age for starting smokers and smokeless tobacco users 15 years of age Rationalizing the dangers

21. 21 © 2012 McGraw-Hill Companies. All Rights Reserved.21 Health Hazards Tobacco adversely affects nearly every part of the body, including: Brain Stomach Mouth Reproductive organs Contains hundreds of damaging chemical substances Unfiltered cigarettes = 5 billion particles per cubic MM 50,000 times more than smoggy urban air Condensed particles in the cigarette produce a sticky, brown mass called cigarette tar

22. 22 © 2012 McGraw-Hill Companies. All Rights Reserved.22 Carcinogens and Poisons At least 43 chemicals in cigarette smoke are linked to development of cancer Carcinogens - d irectly cause cancer Benzo(a)pyrene Urethane Cocarcinogens - combine with other chemicals to cause cancer Formaldehyde Poisonous substances Arsenic Hydrogen cyanide Carbon monoxide Concentrations 400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells Additives Nearly 600 chemicals Sidestream smoke

23. 23 © 2012 McGraw-Hill Companies. All Rights Reserved.23 “Reduced Harm” Cigarettes As of June 2010, federal law prohibited the use of terms such as “light” and “mild” or “low” on packaging Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more Inhale up to 8 times as much tar and nicotine as printed on the label Less likely to quit

24. 24 © 2012 McGraw-Hill Companies. All Rights Reserved.24 Menthol Cigarettes 70% of African Americans smoke menthol cigarettes African Americans absorb more nicotine and metabolize it slower than other groups Anesthetizing effect of menthol, means smokers inhale more deeply and hold smoke longer in the lungs

25. 25 © 2012 McGraw-Hill Companies. All Rights Reserved.25 The Immediate Effects of Smoking Acts on the brain either by exciting or tranquilizing the nervous system Inhibits formation of urine Constricts blood vessels Accelerates heart rate Elevates blood pressure Depresses hunger contractions Dulls taste buds

26. 26 © 2012 McGraw-Hill Companies. All Rights Reserved.26 The Long-Term Effects of Smoking Cardiovascular Disease Coronary heart disease (CHD) Atherosclerosis – plaque build up Myocardial infarction Stroke Aortic aneurysm Pulmonary heart disease Lung cancer and other cancers Chronic obstructive pulmonary disease Emphysema Chronic bronchitis

27. 27 © 2012 McGraw-Hill Companies. All Rights Reserved.27 Additional Health, Cosmetic, and Economic Concerns Ulcers and heartburn Reproductive health problems Dental diseases Diminished physical senses Injuries and accidents Cosmetic concerns Economic costs

28. 28 © 2012 McGraw-Hill Companies. All Rights Reserved.28 Cumulative Effects Males who smoke before 15 yrs. old and continue to smoke are half as likely to live to 75 versus those who did not smoke Smokers spend one-third more time away from their jobs because of illness than nonsmokers Both men and women show a greater rate of acute and chronic diseases

29. 29 © 2012 McGraw-Hill Companies. All Rights Reserved.29 Other Forms of Tobacco Use Spit (smokeless) tobacco More than 8.1 million adults 9% of all high school students Cigar and pipes Popularity highest among white males ages 18-44 with higher-than-average income and education Women smoking cigars in record numbers Clove cigarettes and bidis Twice the tar, nicotine, and carbon monoxide

30. 30 © 2012 McGraw-Hill Companies. All Rights Reserved.30 The Effects of Smoking on the Nonsmoker Environmental Tobacco smoke (ETS) EPA designated ETS as a Class A carcinogen Surgeon General has concluded that there is no safe level of exposure to ETS

31. 31 © 2012 McGraw-Hill Companies. All Rights Reserved.31 Environmental Tobacco Smoke Mainstream smoke Smoke exhaled by smokers Sidestream smoke Smoke from the burning end of a cigarette, cigar, or pipe 85% of smoke in a room comes from sidestream smoke Twice the tar and nicotine, and three times the benzo(a)pyrene, carbon monoxide, and ammonia Cigar smoke contains up to 30 times more carbon dioxide

32. 32 © 2012 McGraw-Hill Companies. All Rights Reserved.32 ETS Effects Develop cough, headaches, nasal discomfort, eye irritation, breathlessness, and sinus problems Allergies will be exacerbated Causes 4,000 deaths due to lung cancer Contributes to about 46,000 heart disease deaths each year Nonsmokers can be affected by effects of ETS hours after they leave a smoky environment Carbon monoxide lingers in bloodstream 5 hours later

33. 33 © 2012 McGraw-Hill Companies. All Rights Reserved.33 Infants, Children, and ETS Children exposed to ETS are more likely to have SIDs Low-birth weight Bronchitis, pneumonia, and asthma Reduced lung function Middle-ear infections Lung cancer, emphysema, and chronic bronchitis later in life

34. 34 © 2012 McGraw-Hill Companies. All Rights Reserved.34 Smoking and Pregnancy Doubles risk of miscarriage Increases risk of ectopic pregnancy, premature birth, low birth weight, infant death, behavioral problems, and long term impairments in growth and intellectual development

35. 35 © 2012 McGraw-Hill Companies. All Rights Reserved. 35 What Can Be Done? Action at many levels Local level State level Federal level FDA, EPA International level WHO Individual action

36. 36 © 2012 McGraw-Hill Companies. All Rights Reserved.36 How A Tobacco User Can Quit Benefits of quitting Options for quitting “Cold-turkey” Tapering Changes to routines Over-the-counter prescription products Support from family and friends Smoking cessation programs Free telephone quitlines 1-800-QUITNOW

37. Chapter 8 Alcohol and Tobacco © 2012 McGraw-Hill Companies. All Rights Reserved.