1. Alcohol Chapter 10

2. Alcohol Use Patterns 49% of Americans abstain from alcohol use49% of Americans abstain from alcohol use 22% are considered “light” drinkers22% are considered “light” drinkers 29% are considered “risky” drinkers29% are considered “risky” drinkers Alcohol is responsible for more than 70,000 deaths per year among AmericansAlcohol is responsible for more than 70,000 deaths per year among Americans

3. Chemistry of Alcohol Psychoactive ingredientPsychoactive ingredient DepressantDepressant Ethyl Alcohol – only alcohol that can be consumedEthyl Alcohol – only alcohol that can be consumed Beer 3-6% alcohol by volumeBeer 3-6% alcohol by volume Malt Liquors 6-8% alcohol by volumeMalt Liquors 6-8% alcohol by volume Table wines 9-14% alcohol by volumeTable wines 9-14% alcohol by volume –Fermenting Fortified wines 20% alcohol by volumeFortified wines 20% alcohol by volume –Sugar added –Extra alcohol is added Hard liquors 35-50% alcohol by volumeHard liquors 35-50% alcohol by volume –Distilling or fermented Proof ValueProof Value –Two times the percentage concentration IngestionIngestion –7calories per gram –1 drink 14-17 grams or 100-120 calories 3

4. Absorption 20% is rapidly absorbed from the stomach20% is rapidly absorbed from the stomach 75% is absorbed in the upper small intestines75% is absorbed in the upper small intestines Remain is absorbed along the GI trackRemain is absorbed along the GI track AbsorptionAbsorption –Carbonation –Food in the stomach slows the absorption –Drink of high concentration slows absorption –Eventually all the alcohol ingested will be absorbed 4

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6. Metabolism and Excretion Transported throughout the body via the bloodstream.Transported throughout the body via the bloodstream. Easily moves through most biological membranesEasily moves through most biological membranes Main site for metabolism is the Liver.Main site for metabolism is the Liver. 2-20% of ingested alcohol is not metabolized.2-20% of ingested alcohol is not metabolized. 6

7. Alcohol Intake and Blood Alcohol Concentration Blood Alcohol Concentration(BAC)Blood Alcohol Concentration(BAC) –A measure of intoxication –Body weight –Percentage of body fat –Sex Balance of alcohol absorbed and rate of metabolismBalance of alcohol absorbed and rate of metabolism Genetic factorsGenetic factors Drinking BehaviorDrinking Behavior Can not be effected byCan not be effected by –Exercise –Breathing deeply –Eating –Drinking coffee –Taking other drugs Metabolism is the same if the person is awake or asleepMetabolism is the same if the person is awake or asleep 7

8. The Immediate Effects of Alcohol At.03 -.05% = relaxation and jovialAt.03 -.05% = relaxation and jovial At.08 = DUIAt.08 = DUI At.10% = physical impairmentAt.10% = physical impairment At.20% = uncontrollable movementAt.20% = uncontrollable movement At.35% = coma and possible deathAt.35% = coma and possible death

9. Drinking and Driving In 2004In 2004 –250,000 were injured in alcohol related automobile crashes –42,000 people are killed in alcohol related accidents Dose-response functionDose-response function –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. 9

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11. Figure 10.2 Approximate blood concentration and body weight 11

13. The Effects of Chronic Use Diseases of the digestive, cardiovascular systems and some cancersDiseases of the digestive, cardiovascular systems and some cancers Digestive systemDigestive system –Liver function liver cell damage and destruction (cirrhosis)liver cell damage and destruction (cirrhosis) Cirrhosis causes drinker to lose ToleranceCirrhosis causes drinker to lose Tolerance –Pancreas inflammation Cardiovascular systemCardiovascular system moderate doses may reduce the risk of HDmoderate doses may reduce the risk of HD Higher doses elevates BP, may weaken heart muscle or cardiac myopathy.Higher doses elevates BP, may weaken heart muscle or cardiac myopathy. CancerCancer –Mouth, throat, larynx, and esophagus 5-6 total drinks5-6 total drinks –Responsible for the most common form of liver cancer Hepatitis speeds the growth of this cancerHepatitis speeds the growth of this cancer –Breast cancer Increase risk when 2-3 drinks per dayIncrease risk when 2-3 drinks per day Brain DamageBrain Damage –Cognitive impairments –Memory loss, dementia, and compromised problem-solving –Wernicke-Korsakoff syndrome MortalityMortality –Alcoholics average life expectancy is about 15 years less than non-alcoholics 13

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15. The Effects of Alcohol use During Pregnancy Effects are dose-related.Effects are dose-related. –Fetal Alcohol Syndrome (FAS) Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S.Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S. Under weight, flat nasal bridge, and long upper lip.Under weight, flat nasal bridge, and long upper lip. Small and have heart defects.Small and have heart defects. Physical and mental growth is slowed. Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS).Physical and mental growth is slowed. Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS). –ARND Alcohol-related neurodevelopment disorder. –Heavier drinking early in pregnancy. 15

16. Possible Health Benefits of Alcohol Abstainers and light to moderate drinkers live longer than heavy users.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 consumed35 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.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 16

18. Alcohol Abuse and Dependence Alcohol abuse is recurrent use that has negative consequences.Alcohol abuse is recurrent use that has negative consequences. Alcohol dependence or Alcoholism more extensive problems, tolerance and withdrawalAlcohol dependence or Alcoholism more extensive problems, tolerance and withdrawal Warning signs of alcohol abuseWarning signs of alcohol abuse –Drinking alone –Using deliberately and repeatedly –Feeling uncomfortable on certain occasions –Escalating consumption –Getting drunk regularly –Drinking in the morning or unusual times 18

19. Alcohol Abuse and Dependence Binge DrinkingBinge Drinking –The National Institute on Alcohol Abuse and Alcoholism defines: Pattern of alcohol use that brings a person’s BAC up to 0.08 or above (typically four drinks for a male or three for a women)within two hours.Pattern of alcohol use that brings a person’s BAC up to 0.08 or above (typically four drinks for a male or three for a women)within two hours. –National Survey on Drug Use and Health defines: Having five drinks in row for a man or four in a row for a women within two hours.Having five drinks in row for a man or four in a row for a women within two hours. –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 studentsReduce the rate of binge drinking to 20% among college students 19

20. Table 10-2 The Effects of Binge Drinking on College Students 20

21. Alcoholism Patterns and PrevalencePatterns and Prevalence 1.Regular daily intake of large amounts 2.Regular heavy drinking limited to weekends 3.Long periods of sobriety interspersed with binges or daily heavy drinking 4.Heavy drinking limited to periods of stress Health EffectsHealth Effects –DTs (delirium tremens) –paranoia Social and Psychological effectsSocial and Psychological effects Causes of AlcoholismCauses of Alcoholism 21

22. Treatment Programs Not one program works for everyone.Not one program works for everyone. –AA. 12-step program12-step program –Al-Anon. –Employee Assistance. –Inpatient hospital rehabilitation –Pharmacological treatments. Disulfiram (Antabuse)Disulfiram (Antabuse) –Inhibits the metabolic breakdown Naltrexone (ReVia, Depade)Naltrexone (ReVia, Depade) –Reduces the craving for alcohol and decreases its pleasant effects. Injectable Naltrexone (Vivtrol) – single monthly shotInjectable Naltrexone (Vivtrol) – single monthly shot Acamprosate (Campral)Acamprosate (Campral) –Acts on brain pathways related to alcohol abuse. 22

23. Gender and Ethnic Differences on Alcoholism Among White American men, drinking starts in the teenage years and progresses into late adulthoodAmong White American men, drinking starts in the teenage years and progresses into late adulthood Women tend to become alcoholics much later (40’s or 50’s)Women tend to become alcoholics much later (40’s or 50’s) African-Americans tend to have more health related problems with alcohol useAfrican-Americans tend to have more health related problems with alcohol use Drunk driving and cirrhosis tend to be common elements with Latino menDrunk driving and cirrhosis tend to be common elements with Latino men American Indians and Alaskans tend to abuse alcohol early in lifeAmerican Indians and Alaskans tend to abuse alcohol early in life

24. Table 10.4 Users and Abusers of Alcohol in the U.S.: 2007 24

25. Tips to Drink Responsibly Drink SlowlyDrink Slowly Space your drinksSpace your drinks Eat before and while drinkingEat before and while drinking Know your limits and your drinksKnow your limits and your drinks

26. Promote Responsible Drinking In Others Encourage responsible attitudesEncourage responsible attitudes Be a responsible hostBe a responsible host Hold the drinker responsibleHold the drinker responsible Learn about prevention programsLearn about prevention programs Take community actionTake community action 26