1. Alcohol An Arabic Word Meaning “Something of spirit” ( or demon)
ETHYL ALCOHOL (ETOH)
Alcohol
An Arabic Word Meaning
“Something of spirit”
( or demon)
Alcohol falls into a category of drugs known as sedative hypnotics. Other well known drugs in this class include tranquilizers like Librium, valium and Xanax.

2. Alcohol Made from the fermentation of carbohydrates by yeast
Yeast are unicellular fungi
Fermented in every culture on earth at some point in time
Animals (monkeys and birds) consume fermented fruit
Fermentation of ethanol comes from any material that contains sugar. Sugars mostly from cane, sugar beets, molasses and fruits may be converted to ethanol directly.
The overall process of fermentation is to convert glucose sugar (C6H12O6) to alcohol (CH3CH2OH) and carbon dioxide gas (CO2). The reactions within the yeast to make this happen are very complex but the overall process is as follows:
C6H12O6    ====>   2(CH3CH2OH)      +        2(CO2)    Sugar      ====>       Alcohol             +   Carbon dioxide gas (Glucose)               (Ethyl alcohol)

3. Alcohol History Probably the world’s oldest anodyne ( pain reliever)
Beers & wines since about 6400 BC
Berries, apples and honey
Early use for spiritual ceremonies
First brewery in Egypt 3700 BC
Only natural fermentation around 800 BC
Process of distillation in Arabia- the “Alembic Still” Jabir Ibn Hayyan, 721–815
The discovery of late Stone Age beer jugs has established the fact that purposely fermented beverages existed at least as early as c. 10,000 BC. It has been suggested that beer may have preceded bread as a staple.
Brewing dates from the beginning of civilization in ancient Egypt and alcoholic beverages were very important at that time. Symbolic of this is the fact that while many gods were local or familial, Osiris was worshiped throughout the entire country. The Egyptians believed that this important god invented beer, a beverage that was considered a necessity of life; it was brewed in the home "on an everyday basis."[2]
Both beer and wine were deified and offered to gods. Cellars and wine presses even had a god whose hieroglyph was a winepress. The ancient Egyptians made at least 17 types of beer and at least 24 varieties of wine. Alcoholic beverages were used for pleasure, nutrition, medicine, ritual, remuneration and funerary purposes. The latter involved storing the beverages in tombs of the deceased for their use in the after-life.[2]
Numerous accounts of the period stressed the importance of moderation, and these norms were both secular and religious. While Egyptians did not generally appear to define drunkenness as a problem, they warned against taverns (which were often houses of prostitution) and excessive drinking. After reviewing extensive evidence regarding the widespread but generally moderate use of alcoholic beverages, the nutritional biochemist and historian William J. Darby makes a most important observation: all these accounts are warped by the fact that moderate users "were overshadowed by their more boisterous counterparts who added 'color' to history." Thus, the intemperate use of alcohol throughout history receives a disproportionate amount of attention. Those who abuse alcohol cause problems, draw attention to themselves, are highly visible and cause legislation to be enacted. The vast majority of drinkers, who neither experience nor cause difficulties, are not noteworthy. Consequently, observers and writers largely ignore moderation.[2]
Among Greeks, the Macedonians viewed intemperance as a sign of masculinity and were well known for their drunkenness. Their king, Alexander the Great ( BC), whose mother adhered to the Dionysian cult, developed a reputation for inebriety.[2]
Pure distilled alcohol was first produced by Muslim chemists in the Islamic world during the 8th and 9th centuries. The development of the still with cooled collector—necessary for the efficient distillation of spirits without freezing—was an invention of Muslim alchemists during this time. In particular, Geber (Jabir Ibn Hayyan, 721–815) invented the alembic still; he observed that heated wine from this still released a flammable vapor, which he described as "of little use, but of great importance to science". Not much later, al-Razi (864–930) described the distillation of alcohol and its use in medicine.[7]
In Europe However, the production and distribution of spirits spread slowly. Spirit drinking was still largely for medicinal purposes throughout most of the sixteenth century. It has been said of distilled alcohol that "the sixteenth century created it; the seventeenth century consolidated it; the eighteenth popularized it."[2]
The original grain spirit, whisky and its specific origins are unknown but the distillation of whisky has been performed in Scotland and Ireland for centuries. The first confirmed written record of whisky comes from 1405 in Ireland, the production of whisky from malted barley is first mentioned in Scotland in an entry on the 1494, although both countries could have distilled grain alcohol before this date.
Distilled spirit was generally flavored with juniper berries. The resulting beverage was known as jenever, the Dutch word for "juniper." The French changed the name to genievre, which the English changed to "geneva" and then modified to "gin." Originally used for medicinal purposes, the use of gin as a social drink did not grow rapidly at first. However, in 1690, England passed "An Act for the Encouraging of the Distillation of Brandy and Spirits from Corn" and within four years the annual production of distilled spirits, most of which was gin, reached nearly one million gallons.[2]. It should be noted that "corn" in British English means "grain" in general, while in American English "corn" refers principally to maize.
The dawn of the eighteenth century saw the British Parliament pass legislation designed to encourage the use of grain for distilling spirits. In 1685, consumption of gin had been slightly over one-half million gallons but by 1714 it stood at two million gallons. In 1727, official (declared and taxed) production reached five million gallons; six years later the London area alone produced eleven million gallons of gin. The English government actively promoted gin production to utilize surplus grain and to raise revenue. Encouraged by public policy, very cheap spirits flooded the market at a time when there was little stigma attached to drunkenness and when the growing urban poor in London sought relief from the newfound insecurities and harsh realities of urban life. Thus developed the so-called Gin Epidemic.[2]
While the negative effects of that phenomenon may have been exaggerated, Parliament passed legislation in 1736 to discourage consumption by prohibiting the sale of gin in quantities of less than two gallons and raising the tax on it dramatically. However, the peak in consumption was reached seven years later, when the nation of six and one-half million people drank over 18 million gallons of gin. And most was consumed by the small minority of the population then living in London and other cities; people in the countryside largely consumed beer, ale and cider.[2]
While drunkenness was still an accepted part of life in the eighteenth century, the nineteenth century would bring a change in attitudes as a result of increasing industrialization and the need for a reliable and punctual work force. Self-discipline was needed in place of self-expression, and task orientation had to replace relaxed conviviality. Drunkenness would come to be defined as a threat to industrial efficiency and growth.[2]
Problems commonly associated with industrialization and rapid urbanization were also attributed to alcohol. Thus, problems such as urban crime, poverty and high infant mortality rates were blamed on alcohol, although "it is likely that gross overcrowding and unemployment had much to do with these problems." Over time, more and more personal, social and religious/moral problems would be blamed on alcohol. And not only would it be enough to prevent drunkenness; any consumption of alcohol would come to be seen as unacceptable. Groups that began by promoting the moderate use of alcohol instead of its abuse- would ultimately form temperance movements and press for the complete and total prohibition of the production and distribution of beverage alcohol. Unfortunately, this would not eliminate social problems but would compound the situation by creating additional problems wherever it was implemented.[2]
Alcoholic beverages played an important role in Colonial America from the very beginning. The Puritans brought more beer than water on the Mayflower as they departed for the New World. While this may seem strange for Puritans viewed from the modern context, it should be understood that drinking wine and beer at that time was safer than water - which was usually taken from sources used to dispose of sewerage and garbage. Their experience showed them that it was safer to drink alcohol than the typically polluted water in Europe. Alcohol was also an effective analgesic, provided energy necessary for hard work, and generally enhanced the quality of life.
Alcohol was viewed positively while its abuse was condemned. Increase Mather (d. 1723) expressed the common view in a sermon against drunkenness: "Drink is in itself a good creature of God, and to be received with thankfulness, but the abuse of drink is from Satan; the wine is from God, but the drunkard is from the Devil."

4. Alcohol History in Europe
1500s - high alcohol consumption problems (reign of Henry VIII)
first laws against drunkenness passed in England
Gin discovered in 1650 by Dutch physician
From corn mash poured over juniper berries
1700s - gin epidemic - led to decline in British population
tried to regulate use - led to riots
Coffee & Tea & Methodist movement led to decline in alcohol use

5. Alcohol History- in the U.S.
Brought from Europe by settlers
Production was encouraged
Drinking was condoned to point of drunkenness
6 gallons/yr per capita
Consumption escalated in the Frontier regions
Aggressive and exploitive men.
Per capita consumption 7 gallons/yr.

6. “Saloons” in the “Wild West”

7. Used as anesthetic in Civil War Temperance Movement rise
The Industrial period is cited as the force of change in attitudes about drunkeness. Dr. Benjamin Rush was one especially influential voice in the anti alcohol attitudes that described the Temperence movement. The “temperance movement" existed alongside various womens’ rights movements, and often the same activists were active in both. This movement culminated in the U.S. in the legal Prohibition of alcohol.

8. The Volstead Act 18th Amendment (1920)
Illegal to produce alcoholic beverages
Yet Increased number of drinking establishments
Increased strength of organized crime
Effectiveness is debatable
was very unpopular

9. State
February 1913, Congress adopted the Webb-Kenyon Law, which prohibited shipments of liquor from wet states into dry states if such shipments were in violation of the dry state law. This did not prohibit all shipments into dry states, since some dry states allowed importation (Merz 1930, p. 14). In February 1917, Congress passed the Reed bone-dry amendment, which forbade interstate shipment of liquor into states that prohibited manufacture and sale, even if the state allowed importation. (Merz 1930, p. 20). In August 1917, Congress adopted the Food Control Law, which forbade the manufacture of distilled spirits from any form of foodstuff and closed the distilleries (Merz 1930, pp , 40-41). In September 1918, it closed the breweries as well (Merz 1930, p. 41). Also in September 1918, Congress approved wartime prohibition, although this did not take effect until July 1, 1919 (Merz 1930, p. 41). Wartime prohibition contained the first general restriction on sale, providing that after June 30, 1919, no liquor could be sold for beverage purposes except for export (Schmeckebier 1929, pp. 4-5). prohibition laws were becoming increasingly widespread during the period

10. 21st repealed 18th in 1933 – Happy Days are Here Again

11. 4/23/2017
ALCOHOL TODAY
The worlds largest drug business: > $ 60 billion dollars/year in USA
8 million junior high and high schoolers drink every week
Undergraduates in US spend $4.2 billion on booze: more than they spend on textbooks!

12. 4/23/2017 90 85 95 00 05

13. Prevalence- context
Past-month adolescent alcohol, cigarette, and marijuana use by grade according to the 2007 Monitoring the Future Survey.

14. Consumption may start even earlier
Percent of adults who were current regular drinkers (at least 12 drinks in the past year): 50%
Percent of adults who were current infrequent drinkers (1-11 drinks in the past year): 14%

15. Alcohol Prevalence in US
90% Ever drank
65% Current drinkers (70% men and 60% women )
>40% Temporary problems
10-20% Abuse
5-15% (One in twelve will develop alcoholism or alcohol abuse disorder ) Dependence (Lifetime)

16. Alcohol-Pharmacology
4/23/2017
Alcohol-Pharmacology
Ethyl alcohol or ethanol
(not methyl alcohol)
Methanol is a common laboratory solvent.
Methyl Alcohol ( wood alcohol) can act as a slight irritant to the mucous membranes. Toxic effects exerted upon nervous system, particularly the optic nerve. Once absorbed into the body, it is very slowly eliminated. Symptoms of overexposure may include headache, drowsiness, nausea, vomiting, blurred vision, blindness, coma, and death. A person may get better but then worse again up to 30 hours later.

17. Alcohol: Forms Beer- typically made from grains
Naturally Fermented (max 14%)
Any organic substance that has sugar content can be fermented
Beer- typically made from grains
Wine- typically made from grapes, but can also be made from fruits of all types
Mead- honey…one of the earliest brews
In brewing, alcoholic fermentation is the conversion of sugar into carbon dioxide gas (CO2) and ethyl alcohol. This process is carried out by yeast enzymes. This is in fact a complex series of conversions that bring about the conversion of sugar to CO2 and alcohol. Yeast is a member of the plant family and in brewing we use the sugar fungi form of yeast. These cell gain energy from the break down of the sugar. The by-product, CO2, bubbles through the liquid and dissipates into the air. The other by-product alcohol, remains in the liquid which is great for us but not for the yeast, as the yeast dies when the alcohol exceeds its tolerance level. 
Brewer's yeast tolerate up to about 5% alcohol. Beyond this alcohol level the yeast cannot continue fermentation. Wine yeast on the other hand tolerates up to about 12% alcohol. The level of alcohol tolerance by yeast varies from 5% to about 21% depending on yeast strain. The fermentation process has other limits such as temperature. Greater than 27C kills the yeast less and than 15C results in yeast activity which is too slow. The amount of sugar in the solution can be too much and this can prevent fermentation. Some recipes suggest adding the sugar in parts throughout fermentation rather that all at the beginning. This is especially true if the brew is aimed at producing a high level of alcohol. Some yeast strains have evolved to handle higher sugar levels. Yeast such as Tokay and Sauterne. The normal, home brewing, fermentation is in two parts.

18. Distilled Alcohol Heat to evaporate water content
-Spirits/Liquor
Heat to evaporate water content
Cooling to condense the ethanol
Much higher alcohol concentrations
Distilled (up to 95%)
Bourbon (40-50%)-corn, rye
Whiskey (40-50%)-distilled beers
Gin (40%)any distillate flavored w/juniper berries
Vodka (40%)-potato
Tequila (40%)-
Everclear (95%)
Proof ( 80 proof = 40% alcohol content)
British Army used “proof” as a measure of concentration
Poor alcohol on gunpowder and tried to light it
This is a diagram of a moonshine still, an ethanol still works in much the same way. In essence you heat up the “mash” (fermented corn, sugar, whatever) and that begins producing alcohol vapor(it boils the alcohol out of the mash), the vapor is captured and cooled and forced to condense into liquid alcohol.
Everclear Grain Alcohol is a neutral grain spirit, which means it is low in the impurities that are by-products of fermentation related to most types of alcohol. Since those impurities (called congeners) are supposed to be what causes hangovers, a lot of people are under the misconception that you won?t get a hangover if you drink Everclear. This is not necessarily so. Everclear doesn?t have much of a taste, so people will tend to drink too much, or mix it?s already high proof alcohol with other types of alcohol.

19. Route/Absorption Oral is by far the route of choice
Rapidly absorbed, primarily from small intestine
20% stomach, 80% small intestine
Peak blood alcohol concentration (BAC) depends on:
Amount and alcohol concentration of beverage
Rate of drinking
Food consumption and composition
Gastric emptying and gastric metabolism
Hepatic (liver) first pass
Gender
Alcohol Pharmacokinetics: Absorption
After oral absorption, alcohol is absorbed almost completely from the duodenum. It is rapidly absorbed by diffusion. The rate of absorption is extremely variable depends on several factors:
- volume, type and alcohol concentration of the beverage - less concentrated solutions are absorbed more slowly, however very concentrated solutions can inhibited gastric emptying. Also carbonation can increase the absorption of alcohol
- rate of drinking - the faster you drink, the faster the absorption
- food - food has a major effect on alcohol absorption. The amount, timing and type of food all have an effect. For example, high-fat foods can significantly delay the absorption of alcohol. The effect of food on alcohol is primarily due to the delay in gastric emptying seen after meal consumption.
- gastric metabolism, as well as hepatic first-pass metabolism can significantly decrease the bioavailability of alcohol and thus the amount of alcohol getting into the systemic circulation.

20. Of course there are always those who only learn from “hindsight!!”
In 2004 a woman in Texas was accused of causing the death of her husband by giving him an “sherry enema” that caused his death. The charges against her were dropped. The man died from shooting sherry up his behind. According to his wife's testimony, he was in the habit of getting drunk this way since a medical condition did not allow him to drink booze the normal way. When he died, his blood alcohol level was .47. In Texas, .08 percent is legally drunk. The term extreme alcoholic does come to mind when thinking about this case. Other terms and comments come to mind too.

21. Metabolism Metabolism 90-98% metabolized in liver
Alcohol Acetaldehyde Acetate
A constant 0.015% per hr metabolized
Accumulation of acetaldehyde associated with headache, gastritis, nausea, dizziness (hangover)
Alcohol
dehydrogenase
Aldehyde
dehydrogenase
Alcohol Pharmacokinetics: Metabolism
Metabolism of alcohol occurs primarily in the liver, in a 2-step process. In the first step, alcohol is oxidized to acetaldehyde by the enzyme alcohol dehydrogenase or ADH. This enzyme saturates at fairly low blood alcohol concentrations (it has a low Km and follows Michaelis-Menten kinetics). Thus at moderate blood alcohol levels seen after social drinking, it follows apparent zero-order kinetics - this means that the rate of metabolism is at the maximal capacity and has a constant rate of approximately 7-10 grams per hour (equivalent to 1-drink per hour). However, the rate is extremely variable between individuals and even within individuals from day-to-day.

22. Computing BAC 1 Standard drink = Blood Alcohol Content 1 beer (12 oz)
4/23/2017
Computing BAC
1 Standard drink =
1 beer (12 oz)
4 oz wine
1 oz 100 proof liquor
Blood Alcohol Content
Blood Alcohol Content (a.k.a. blood alcohol level; BAL), represent the percent of alcohol in your blood (in mg /100 ml of blood). A BAC of .10 means that .1% of your bloodstream is composed of alcohol. One standard drink increases BAC by 0.025% on average.
Some factors that affect BAC:
How many standard drinks you drink
Remember different drinks have different strengths either because of differences in proofs of hard liquor or because some drinks contain more than one shot
Food eaten along with drinking alcohol will result in a lower, delayed BAC because the alcohol enters the bloodstream at a lower rate
Alcohol is attracted to areas of the body with a lot of water. Fat contains very little water, and allows more alcohol to enter the blood stream.
Therefore, a person with lower percent of body fat will generally have lower BACs than people with a higher percent of body fat
Women tend to have a higher percentage of fat and lower percentage of body water. Therefore, if a man and a woman of the same weight ingest the same amount of alcohol the women will tend to have a higher BAC.
Muscle contains a good amount of water. People who are more muscular tend to achieve lower BACs
Drinking when you are tired can lead to a higher BAC because your liver does not function as well when you are tired.
When you’ve been sick or are currently sick, you will be dehydrated. Dehydration has a number of effects that cause greater intoxication. Dehydration can also be a factor in how bad a hangover may be.
Most people can eliminate (metabolize) an average of one standard drink per hour.
Only time can lower your BAC. Coffee, cold showers, and runs around the block will just leave you alert, wet, and out of breath.

23. Computing BAC Alcohol metabolization 1 drink every 2 hrs
4/23/2017
Computing BAC
Alcohol metabolization
1 drink every 2 hrs
.01% every 40 min
BAC=NSD X (.025%) - NHD X (.015%)
0.08% BAC = legal intoxication
Blood alcohol content (BAC) or blood alcohol concentration is the concentration of alcohol in blood. It is usually measured as mass per volume. For example, a BAC of 0.02% means 0.2‰ (permille) or 0.02 grams of alcohol per 100 grams of individual's blood, or 0.2 grams of alcohol per 1000 grams of blood.
0.025% reflects the average/estimated increase in BAC associated with one standard drink

24. Pharmacokinetics: Gender Differences
in absorption
Differences in gastric ADH activity
in volume of distribution
Differences in body composition and total body water (TBW)
in metabolism
Differences in liver volume, ADH activity?
And other factors…
Gender Differences in pharmacokinetics
As mentioned before, there are gender difference in alcohol pharmacokinetics. There are gender differences in gastric ADH activity resulting in differences in absorption and bioavailability. Differences in distribution of alcohol arise from gender differences in body composition and total body water. Differences in metabolism result in women having higher alcohol elimination rates per kg body weight or lean body mass possibly related to the higher liver volumes per unit lean body mass seen in women, or due to gender differences in alcohol dehydrogenase activity.
The effect of the menstrual cycle on alcohol pharmacokinetics has been studied and overall there does not appear to be any effect, although the response to alcohol may be different in women during the different phases of the cycle.
Also, studies on the effect of oral contraceptives on alcohol pharmacokinetics are conflicting - with some studies showing an effect and some not.

25. Pharmacodynamics: CNS Effects
Alcohol is a CNS depressant
Apparent stimulatory effects result from depression of inhibitory control mechanisms in the brain
Characteristic response: Increased IQ and good looks.
JUST KIDDING!
euphoria, impaired thought processes, decreased mechanical efficiency, sedation
Alcohol Pharmacodynamics
Alcohol is a central nervous system depressant. Its apparent stimulatory effects result from depression of inhibitory control mechanisms in the brain. Characteristic responses to alcohol include euphoria, impaired thought processes and decreased mechanical efficiency.

26. Concentration-Effect Relationship
BAC [%]
Effects
Mood elevation. Slight muscle relaxation.
Relaxation and warmth. Increased reaction time. Decreased fine muscle coordination.
Impaired balance, speech, vision, hearing, muscle coordination. Euphoria.
Gross impairment of physical and mental control.
Severely intoxicated. Very little control of mind or body.
Unconscious. Deep coma. Death from respiratory depression
Alcohol Pharmacology: Concentration-Response relationships
This slide shows the characteristic effects of alcohol at progressively increasing blood alcohol levels. Its important to note that this correlation is based on the acute use of alcohol by a socially-drinking, non-abusing individual. At low BACs corresponding to 1-2 drinks ( %), there is mood elevation and slight muscle relaxation. As BACs increase, there is increased relation, warmth, and increases in reaction time. At around the legal limit of intoxication, there is impairment of balance, speech, vision, hearing and muscle coordination, accompanied by feelings of euphoria. At higher BACs, there is progressive intoxication, impairment and loss of physical and mental control, until levels of where the individual is in a deep coma and at risk of death from respiratory depression. It is important to re-emphasize that this is the scenario in non-abusing individuals. Once chronic use and abuse occurs and tolerance develop, the threshold concentrations at which these effects occur are elevated.
Common myths about sobering up include drinking black coffee, taking a cold bath or shower, sleeping it off, or walking it off. But these are just myths, and they don't work. The only thing that reverses the effects of alcohol is time-something you may not have if you are suffering from alcohol poisoning. And many different factors affect the level of intoxication of an individual, so it's difficult to gauge exactly how much is too much. (link to BAC information)
What Happens to Your Body When You Get Alcohol Poisoning?
Alcohol depresses nerves that control involuntary actions such as breathing and the gag reflex (which prevents choking). A fatal dose of alcohol will eventually stop these functions.
It is common for someone who drank excessive alcohol to vomit since alcohol is an irritant to the stomach. There is then the danger of choking on vomit, which could cause death by asphyxiation in a person who is not conscious because of intoxication.
You should also know that a person's blood alcohol concentration (BAC) can continue to rise even while he or she is passed out. Even after a person stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. It is dangerous to assume the person will be fine by sleeping it off.

27. Alcohol as a Reinforcer
Reinforcer: a substance whose pharmacological effects drive the user to continue to use it
Positive reinforcing effects:
Gain pleasure
Altered consciousness
Conform to behavior of peers
Negative reinforcing effects:
Relief of stress and negative emotions
Relief of withdrawal symptoms
Alcohol as a Reinforcer
It seems self-evident, but nevertheless is worth stating that alcohol would not be a drug of abuse except for its action on the brain. It is important to discuss the mechanism of action of alcohol and why alcohol is so addictive and why its effects are so reinforcing.
A reinforcer in this context can be defined as a substance whose pharmacological effects are rewarding so that it drives the user to continue to use it - in other words, the effect reinforces the use of the drug. In most cases the reward is positive - such as the pleasurable, euphoric effects of drugs, or the altered consciousness following the drug, or to conform to the behavior of peers. If the pharmacological effect reverses an aversive state, it is called negative reinforcement - such as the relief of stress and negative emotions or the relief of withdrawal.

28. Alcohol as a Reinforcer: Neural Systems
Animals will self-administer alcohol & show increased DA levels in the mesolimbic system (Vta- nucleus accumbens)
Animals will bar-press for intra-cranial injections of alcohol into the VTA (ventral tegmental area)
Alcohol activates neurons of the VTA-accumbens (and VTA-frontal cortex)…. leads to release of DA
Alcohol and a reinforcer: Neural Systems
There has been considerable research into understanding the neural circuits involved in reinforcement. This is the dopamine (DA) system. The DA system originates in the ventral tegmental area (VTA) and connects to the nucleus accumbens, prefrontal cortex as well as hippocampus. This is the mesocorticolimbic system.
Activation of the VTA results in the release of DA in the nucleus accumbens and limbic system and the prefrontal cortex. This is associated with rewarding/reinforcing effects, not only for alcohol but for almost all abused drugs.
Although beta-endorphin activity in the brain has
been associated with the basic reward mechanisms of a
variety of drugs (Finn in press; Gianoulakis et al. 1996), it is
unclear whether blood levels of beta-endorphin levels are
associated with brain reward mechanisms.
Repeatedly engaging in self-intoxication is a learned phenomenon, and evidence suggests that humans and animals undergo an acquisition phase of varying length as they “learn to drink alcohol” (Samson and Grant 1990). Additional studies (for a review, see Grant and Bennett 2003) found that simple access to alcohol solutions generally is not sufficient to produce sustained self-administration of intoxicating quantities of ethanol in monkeys. In fact, most monkeys show an aversion to high concentrations (greater than 8 percent volume for volume [v/v]) of ethanol; however, some monkeys readily consume intoxicating quantities of less concentrated ethanol solutions (i.e., 5 percent v/v). Additional studies (Macenski and Meisch 1992) found that monkeys can acquire ethanol self-administration even if no specific induction procedure or alcohol with added flavorants is used. In these animals, however, the average intake is relatively low (i.e., 0.2 to 1.0 g/kg per 3-hour session, which corresponds to less than one to four drinks every 3 hours).
To produce elevated and consistent ethanol consumption, researchers commonly use specific initiation procedures (see Grant and Bennet 2003; Katner et al. 2004, 2007; Weed et al. 2008). The most common methods used to induce oral ethanol consumption in monkeys have been to deprive the animals of food, to flavor the alcohol solution with a preferred taste (e.g., fruit juice), or to use a scheduleinduction procedure (Katner at al. 2007; Grant and Bennett 2003). With such induction procedures, ethanol intakes increase to over 1.0 g/kg/hour or the equivalent of four drinks per hour in rhesus monkeys (Macenski and Meisch 1992; Rodefer et al. 1999; Vivian et al. 2001; Williams et al. 1998) and in baboons (Weerts et al. 2006) during limited access (less than 4 hours/day).
Studies have not directly determined the efficacy of different induction procedures for establishing excessive or heavy-drinking outcomes. Still, there appears to be a consensus that once oral self-administration of ethanol has been established, “...the subsequent pattern and amount of drug intake appears to be independent of the acquisition procedure” (Meisch 2001, p. 119). Direct studies of the efficacy of induction procedures as well as examination of self-administration under the same access conditions following different induction procedures are needed and could be uniquely informative for assessing the risk of progression to heavy drinking in humans based on how alcohol use was initiated.

29. Negative Effects of Alcohol In general, people do things when under the influence that they would not do normally.
On college campuses a high percentage of injuries, property damage, unwanted pregnancies, and health problems are related to high-risk decisions about the use of alcohol and other drugs. Problem chemical use in college also negatively affects people's relationships and academic performance.
More than 100,000 U.S. deaths are caused by excessive alcohol consumption each year. Direct and indirect causes of death include drunk driving, cirrhosis of the liver, falls, cancer, and stroke.1
At least once a year, the guidelines for low risk drinking are exceeded by an estimated 74% of male drinkers and 72% of female drinkers aged 21 and older.2
65% of youth surveyed said that they got the alcohol they drink from family and friends.7
Nearly 14 million Americans meet diagnostic criteria for alcohol use disorders.5
Youth who drink alcohol are 50 times more likely to use cocaine than those who never drink alcohol.3
Among current adult drinkers, more than half say they have a blood relative who is or was an alcoholic or problem drinker.1
Across people of all ages, males are four times as likely as females to be heavy drinkers.1
More than 18% of Americans experience alcohol abuse or alcohol dependence at some time in their lives.6
Traffic crashes are the greatest single cause of death for persons aged 6–33. About 45% of these fatalities are in alcohol-related crashes.4
Underage drinking costs the United States more than $58 billion every year — enough to buy every public school student a state-of-the-art computer.2
Alcohol is the most commonly used drug among young people.1
Problem drinkers average four times as many days in the hospital as nondrinkers — mostly because of drinking-related injuries.1
Alcohol kills 6½ times more youth than all other illicit drugs combined.2
Concerning the past 30 days, 50% of high school seniors report drinking, with 32% report being drunk at least once.2
Sources      1  Substance Abuse: The Nation’s Number One Health Problem, Feb      2  Mothers Against Drunk Driving      3  National Center on Addiction and Substance Abuse      4  National Highway Traffic Safety Administration      5  Alcohol Health & Research World      6  National Institute on Alcohol Abuse and Alcoholism Analysis      7  The Century Council
Here's are some highlights of the U.S. Justice Department, B. of Justice statistics April 1998 report on Alcohol and Crime:
About 3 million violent crimes occur each year in which victims perceive the offender to have been drinking at the time of the offense. Among those victims who provided information about the offender's use of alcohol, about 35 percent of the victimizations involved an offender who had been drinking. About two-thirds of the alcohol-involved crimes were characterized as simple assaults.
Two-thirds of victims who suffered violence by an intimate (a current or former spouse, boyfriend, or girlfriend) reported that alcohol had been a factor. Among spouse victims, 3 out of 4 incidents were reported to have involved an offender who had been drinking. By contrast, an estimated 31 percent of stranger victimizations where the victim could determine the absence or presence of alcohol were perceived to be alcohol-related.
In 1996, local law enforcement agencies nationwide made an estimated 1,467,300 arrests for driving under the influence (DUI). Arrests for DUI peaked in 1983 when there were 1.9 million arrests. Compared to 1983, the per capita rate of arrest for DUI in 1996 was 34 percent lower.
Declines in DUI arrest rates have occurred for every age group. Of particular note is the decrease in DUI arrest rates for those under the age of 21 compared to their rates of DUI arrest in the early 1980's when States had not adopted a uniform drinking age. In 1980 persons between 16 and 20 years old accounted for 10 percent of licensed drivers but 15 percent of DUI arrestees. In 1996, this age group accounted for 7 percent of drivers and 8 percent of DUI arrestees.
In 1996 there were 17,126 alcohol-related traffic fatalities accounting for 40.9 percent of all traffic fatalities during the year. This is a 29 percent reduction from the more than 24,000 fatalities recorded 10 years earlier when alcohol was involved in 52 percent of the fatalities.
An estimated 32 percent of fatal accidents involved an intoxicated driver or pedestrian (the majority are drivers, however) with a blood alcohol concentration, or BAC, of at least 0.10 grams of alcohol per deciliter of blood, the most commonly used definition of intoxication.
Over the last decade rates of intoxication in fatal accidents have declined across every age group. In 1986, there was about 1 driver involved in a fatal accident in which he/she was intoxicated for every 10,500 drivers; in 1996, the rate translates into about 1 intoxicated driver in a fatal accident for every 17,200 licensed drivers.
Among the 5.3 million convicted offenders under the jurisdiction of corrections agencies in 1996, nearly 2 million, or about 36 percent, were estimated to have been drinking at the time of the offense. The vast majority, about 1.5 million, of these alcohol-involved offenders were sentenced to supervision in the community: 1.3 million on probation and more than 200,000 on parole.
There was some variation in the percentage of offenders who had been using alcohol at the time of the offense across different correctional statuses: 40 percent of both jail inmates and probationers, 32 percent of State prisoners, and 29 percent of parolees.
Alcohol use at the time of the offense was commonly found among those convicted of public-order crimes, a type of offense most highly represented among those on probation and in jail. Among violent offenders, 41 percent of probationers, 41 percent of those in local jails, 38 percent of those in State prisons, and 20 percent of those in Federal prisons were estimated to have been drinking when they committed the crime.
An analysis dependence among trauma center patients found that the prevalence of alcoholism was substantially higher among vehicular crash victims and other trauma patients than among the equivalent general population group. More than half of trauma patients with a positive BAC at the time of the trauma were diagnosed as alcoholics, and nearly 1 in 7 patients who were not drinking at the time of the trauma were diagnosed as alcohol-dependent.

30. Alcohol related Emotional/ Social Problems

31. Alcohol Effects on Driving
4/23/2017
Traffic crashes are the greatest single cause of death for persons aged 6–33. About 45% of these fatalities are in alcohol-related crashes.4
Driving: 50% of all highway fatalities

32. Movements such as Mothers against Drunk Driving may have had significant impact on DUI.
Since 1980 (the year Mothers Against Drunk Driving was founded), alcohol-related traffic fatalities have decreased nearly 50 percent, from over 30,000 to under 15,500 .

33. Binge Drinking
Number of Days in the Past 30 in Which Drinkers Consumed 5 or More Drinks, by Age and Gender.
Source: SAMHSA data from 2005 NSDUH

34. Binge Drinking
The NSDUH data also indicate that adolescents drink less often than adults but drink more than adults per drinking occasion (see figure 4). When young people drink, they consume on average about five drinks, which constitutes binge drinking (typically defined as consuming five or more drinks per occasion for men and four or more per occasion for women). Certain youth-oriented settings that attract adolescents, such as teen parties, college, and military service, are associated with high rates of drinking, especially binge drinking behavior (Bray et al. 2006; National Institute on Alcohol Abuse and Alcoholism [NIAAA] 2002). In fact, underage drinking accounts for a substantial portion of all alcohol consumed in the United States and, therefore, of consumer expenditures for alcohol. The estimated short-term cash value to the alcohol industry of underage drinking was $22.5 billion in 2001(Foster et al. 2006).
Various nationally representative surveys confirm that alcohol is the drug of choice among American adolescents of all ages. Data from the Monitoring the Future Survey indicate that more 8th-, 10th-, and 12th-grade youth drink alcohol than smoke cigarettes or use marijuana (see figure 5) (Johnston et al. 2006). The percentages for males are even more dramatic: 50.7 percent of 12th-grade males reported having consumed alcohol in the past month.
Alcohol dependence, as defined by the criteria of the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV), typically emerges during late adolescence or early in the young-adult years. As shown in figure 6, past-year prevalence of DSM–IV alcohol dependence dramatically increases between ages 12 and 20 and peaks between ages 18 and 20. Moreover, children and youth whose alcohol use begins earlier (typically in childhood or early adolescence) are much more likely to develop alcohol dependence (see figure 7).
Figure 2 Past-month alcohol use (any, binge, heavy) by age.

35. Binge Drinking- Fun Fun Fun!
4/23/2017
Binge Drinking- Fun Fun Fun!
Memory: blackouts
Hangover
Overdose

36. Hangover! Fatigue , Thirst Headaches and muscle aches
Hangover symptoms typically begin when your blood alcohol drops significantly and is at or near zero. They're usually in full effect the morning after a night of heavy drinking.
Fatigue , Thirst  
Headaches and muscle aches
Nausea, vomiting or stomach pain
Poor or decreased sleep
Sensitivity to light and sound
Dizziness or a sense of the room spinning
Rapid heartbeat , Bloodshot eyes
Shakiness , Decreased ability to concentrate
Mood disturbances, such as depression, anxiety and irritability

37. BLACKOUTS
Alcohol interferes with the ability to form new long–term memories,
As the amount of alcohol consumed increases, so does the magnitude of the memory impairments. Large amounts of alcohol, particularly if consumed rapidly, can produce partial (i.e., fragmentary) or complete (i.e., en bloc) blackouts, which are periods of memory loss for events that transpired while a person was drinking.
Blackouts are much more common among social drinkers—including college drinkers—than was previously assumed, and have been found to encompass events ranging from conversations to intercourse.

38. Alcohol Toxicity Confusion or stupor, as if in a daze
Vomiting that persists
Seizures
Slow breathing (less than eight breaths a minute)
Irregular breathing
Blue-tinged skin or pale skin
Low body temperature (hypothermia)
Unconsciousness — "passing out"

39. 4/23/2017

40. 4/23/2017

41. Negative Effects of Alcohol- Aggression
4/23/2017
Negative Effects of Alcohol- Aggression
>50% assaults and homicides are alcohol related
At least one-half of all violent crimes involve alcohol consumption by the perpetrator, the victim, or both (Collins and Messerschmidt 1993).

42. Alcohol and Aggression
4/23/2017
Alcohol and Aggression
Shuntich & Taylor study of alcohol and aggression in the laboratory
Alcohol increased intense and potentially injurious shock delivery
40 male undergraduates over 21 yrs of age were provoked following their ingestion of either 1.5 oz (.045 l) or .5 oz (.015 l) of 100 proof bourbon or vodka per 40 lbs (18 kg) of body weight. The expression of physical aggression was related to the quantity of alcohol ingested. The high dose of alcohol appeared to instigate and the low dose to inhibit aggressive responding. This effect was most pronounced in the vodka conditions. Interpersonal judgments were also influenced by the type and dose of alcohol consumed. (19 ref) (PsycINFO Database Record (c) 2009 APA, all rights reserved)

43. Alcohol and Sexual Behavior
4/23/2017
Alcohol and Sexual Behavior
Lechery, sir, it doth provoke, and...
It doth unprovoke!… It provokes the desire, but takes away the performance. Macbeth
Alcohol's Role in Sexual Assault Sexual assault 1 of adolescent and adult women has been called a silent epidemic, because it occurs at high rates yet is rarely reported to the authorities (Koss 1988). Several reasons contribute to the underreporting of sexual assault cases. Many victims do not tell others about the assault, because they fear that they will not be believed or will be derogated, which, according to research findings, is a valid concern (Abbey et al. 1996b). Other victims may not realize that they have actually experienced legally defined rape or sexual assault, because the incident does not fit the prototypic scenario of "stranger rape." For example, in a study by Abbey and colleagues (1996b), a woman wrote, "For years I believed it was my fault for being too drunk. I never called it 'rape' until much more recently, even though I repeatedly told him 'no'."
PREVALENCE The Prevalence of Sexual Assault and Alcohol-Involved Sexual Assault The prevalence of sexual assault, both involving and not involving alcohol use, cannot be accurately determined, because it is usually unreported. Estimates of sexual assault prevalence have been based on a variety of sources, including police reports, national random samples of crime victims, interviews with incarcerated rapists, interviews with victims who seek hospital treatment, general population surveys of women, and surveys of male and female college students (Crowell and Burgess 1996). In such studies, the estimates' adequacy varies with the sources of information used. Most researchers agree that the most reliable estimates derive from studies using multi-item scales-that is, measures containing several questions describing behaviors which constitute sexual assault in simple, nonlegal language (Koss 1988). Based on such measures, conservative estimates suggest that at least 25 percent of American women have been sexually assaulted in adolescence or adulthood and that 18 percent have been raped. Furthermore, at least 20 percent of American men report having perpetrated sexual assault and 5 percent report having committed rape (Crowell and Burgess 1996; Spitzberg 1999; Tjaden and Thoennes 2000). Due to their accessibility, college student surveys tend to employ the most thorough measures of sexual assault by including the largest number of behaviorally specific questions. These studies suggest that approximately 50 percent of college women have been sexually assaulted, and 27 percent have experienced rape or attempted rape; in contrast, 25 percent of college men have committed sexual assault, and 8 percent have committed rape or attempted rape (Crowell and Burgess 1996; Koss 1988; Spitzberg 1999). At least one-half of all violent crimes involve alcohol consumption by the perpetrator, the victim, or both (Collins and Messerschmidt 1993). Sexual assault fits this pattern. Thus, across the disparate populations studied, researchers consistently have found that approximately one-half of all sexual assaults are committed by men who have been drinking alcohol. Depending on the sample studied and the measures used, the estimates for alcohol use among perpetrators have ranged from 34 to 74 percent (Abbey et al. 1994; Crowell and Burgess 1996). Similarly, approximately one-half of all sexual assault victims report that they were drinking alcohol at the time of the assault, with estimates ranging from 30 to 79 percent (Abbey et al. 1994; Crowell and Burgess 1996). It is important to emphasize, however, that although a woman's alcohol consumption may place her at increased risk of sexual assault, she is in no way responsible for the assault. The perpetrators are legally and morally responsible for their behavior. Finally, alcohol consumption by perpetrators and victims tends to co-occur--that is, when one of them is drinking, the other one is generally drinking as well (Abbey et al. 1998; Harrington and Leitenberg 1994). Rarely is only the victim drinking alcohol. This finding is not surprising, because in social situations (e.g., in bars or at parties), drinking tends to be a shared activity. However, this finding complicates researchers' efforts to disentangle the unique effects of alcohol consumption on the perpetrators' versus the victims' behavior.

44. nonetheless a common agent in Sexual Assault
Approximately one-half of all sexual assaults are committed by men who have been drinking alcohol (the estimates for alcohol use among perpetrators have ranged from 34 to 74 percent).
Similarly, approximately one-half of all sexual assault victims report that they were drinking alcohol at the time of the assault(Abbey et al. 1994; Crowell and Burgess 1996).

45. Adverse ALCOHOL EFFECTS
Alcohol and Sleep
Many college students may think that moderate drinking has no negative effects on learning and health. As little as one drink, however, can impair a person’s ability to get a good night’s sleep, which can lead to more significant problems.
Normal sleep is characterized as having four (4) different stages plus an additional type of sleep called REM or rapid eye movement sleep. The four stages are generally characterized by having different types of electrical activity as measured by an electroencephalogram (EEG). Stages 1 and 2 have more rapid electrical activity, yet still slower than that seen during waking. Slow wave sleep (SWS) is most characteristic of stages 3 and 4 which are the stages of deep sleep. REM sleep, however, is characterized by having more rapid brain waves somewhat similar to those seen while one is awake. Dreaming occurs during REM, so it is interesting that the brain wave pattern during REM looks somewhat like that during wakefulness.
Most people find that a drink or two before bed helps them fall asleep faster. This may be true. However, as alcohol is metabolized during the night, sleep becomes progressively lighter and more disturbed. The extent to which cognitive and physical performance is impaired by sleep deprivation is directly related to the degree to which a person is intoxicated at the time he or she falls asleep. Generally, the more an individual is intoxicated, the more sleep is disrupted. What kind of changes in sleep can be expected?
Total sleep time increases during the first half of the night; it decreases, however, during the second half of the night
Wakefulness after sleep onset decreases during the first half of the night; it increases, however, during the second half of the night
Rapid Eye Movement (REM) decreases during the first half of the night; REM rebound occurs in later portions of the night (possible side-effect = nightmares), following alcohol metabolism. Greater levels of intoxication may fully suppress REM sleep and prevent rebound until the following night, because of the set metabolism rate of alcohol (approximately one drink per hour).
Delta sleep decreases
Disturbances of sleep lead to fatigue and sleepiness during the day. The more one drinks, the faster the person will fall asleep, but the likelihood of sleep disturbances increases. Alcohol consumed up to 6 hours before bedtime can affect sleep patterns, increasing the longevity of disturbances alcohol causes in the body’s sleep cycles.
The average adult sleeps for 8 hrs a night, though different people may need more or less sleep. People who do not get enough sleep are more susceptible to:
depression disorders
learning impairment
irritability
poor concentration
coordination/performance impairment
decreased cognitive abilities
memory deficits
impaired social and occupational function
medical conditions such as heart disease
Lack of sleep and alcohol consumption are common occurrences in a college student’s life. Many college students are significantly sleep-deprived. The adverse effects of alcohol on sleep magnify this effect. Both of these practices can have negative effects on cognitive abilities, especially when paired together.
From a psychological perspective, it is not uncommon to experience feeling unrested and unrefreshed, groggy and fatigued, and more irritable than usual. Cognitive dampening is also quite common; this is typically experienced as not feeling as “sharp” or “quick” as one usually does. Finally, mental stamina (e.g., the ability to sustain focus and concentration for periods of time) is diminished as well.
Physiologically, sleep deprivation results in the suppression of normal levels of prolactin, cortisol, and growth hormone. Oxygen consumption also decreases at maximum workload; in other words, physical endurance performance may be substantially impaired as a result of temporary impairment to the aerobic pathways.
©Academic Skills Center, Dartmouth College 2001 BASICS – A Harm Reduction Approach

46. Adverse Effects of Chronic Drinking
4/23/2017
Adverse Effects of Chronic Drinking
Cirrhosis of the liver
Wernicke-Korsakoff syndrome
Fetal Alcohol syndrome
Alcoholism
Cirrhosis is characterized by abnormal structure and function of the liver due to injury, inflammation and repair. Scar tissue forms in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), virus, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases),
The liver performs many critical functions, such as metabolism of toxic substances that can be harmful to the body. The liver also has an important role in regulating the supply to the body of glucose (sugar) and lipids (fat) that the body uses as fuel.
Wernicke's encephalopathy is caused by damaging changes in the brain, usually due to a lack of vitamin B1 (thiamine), common in people with alcoholism. Heavy alcohol use affects the breakdown of thiamine in the body. Even if someone who drinks alcohol heavily follows a well-balanced diet, most of the thiamine is not absorbed.
Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke's symptoms go away. Korsakoff psychosis involves damage to areas of the brain involved with memory and leads to deficits in forming new memories , loss of coordination (ataxia), Unsteady, uncoordinated walking , Making up stories (confabulation)
Seeing or hearing things that aren't really there (hallucinations), Vision changes and Abnormal eye movements; Double vision, Eyelid drooping
One of the most severe effects of drinking during pregnancy is fetal alcohol syndrome (FAS). FAS is associated with Mental retardation , Birth defects , Abnormal facial features , Growth problems , Problems with the central nervous system
Trouble remembering and/or learning , Vision or hearing problems.
OTHER POTENTIAL ADVERSE CONSEQUENCES OF ALCOHOL CONSUMPTION-
Exacerbates ulcers
Can cause cancer (head, neck, oral, GI)
Liver disease
Fatty Liver
Fibrosis
Cirrhosis
CVD
Accidents & Violence
Approximately 18.8 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a depressive disorder.
These figures translate to 12.4 million women and 6.4 million men in the U.S.
Depressive disorders may be appearing earlier in life in people born in recent decades compared to the past. Depressive disorders often co-occur with anxiety disorders and substance abuse.
Depression and alcohol problems often go together, but the evidence suggests that in men alcohol use preceded the depression, whereas in women the depression precedes the alcohol use. {American Journal of Epidemiology, "Study Links Depression and Alcohol Problems," Washington Post Health, Dec. 16, 1997}
Up to 40 per cent of people who drink heavily have symptoms that resemble a depressive illness. About 5 to 10 per cent of people with a depressive illness also have symptoms of an alcohol problem.

47. Copyright Alcohol Medical Scholars Program
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% of Breast Cancers
Closer to Home – Consequences in College Students
Death: 1,700 college students between the ages of 18 and 24 die each year from alcohol-related unintentional injuries, including motor vehicle crashes .
Injury: 599,000 students between the ages of 18 and 24 are unintentionally injured under the influence of alcohol.
Academic Problems: About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall.
Health Problems/Suicide Attempts: More than 150,000 students develop an alcohol-related health problem and between 1.2 and 1.5 percent of students indicate that they tried to commit suicide within the past year due to drinking or drug use.
Drunk Driving: 2.1 million students between the ages of 18 and 24 drove under the influence of alcohol last year. Vandalism: About 11 percent of college student drinkers report that they have damaged property while under the influence of alcohol .
Assault: More than 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
Sexual Abuse: More than 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape.
Unsafe Sex: 400,000 students between the ages of 18 and 24 had unprotected sex and more than 100,000 students between the ages of 18 and 24 report having been too intoxicated to know if they consented to having sex.
Copyright Alcohol Medical Scholars Program 47

48. Health Benefits?
Moderate Drinking (Men 3 or less/day, Women 2 or less/day, Never more than 5)
Stress inoculation?
Bone mineral density
The evidence for a direct stress-reducing effect of alcohol remains somewhat controversial, however studies of the relationship between alcohol and stress suggest that drinking can reduce stress in certain people and under certain circumstances. Studies conducted over the past two decades have identified several factors that render certain people particularly susceptible to alcohol's SRD effects. For example, a family history of alcoholism may increase a person's likelihood of experiencing those effects. However, some of those studies require further replication and clarification of the mechanisms underlying this enhanced susceptibility. In addition to FHP individuals, alcohol may be effective in reducing stress in people who have difficulty controlling their behavior, are highly self-conscious, or have difficulty organizing new information while sober. Future studies are needed to confirm those relationships.
People who enjoy a glass or two of wine or beer every day could be helping to keep their bones strong, new research published in the American Journal of Clinical Nutrition suggests.
However, drinking more -- and choosing hard liquor instead of wine or beer -- may actually weaken bones, Dr. Katherine Tucker of Tufts University in Boston and her colleagues found.

49. Alcohol and CVD
The strongest medical evidence exists for the link between moderate drinking and a reduced risk of heart disease. Dr. Kenneth Mukamal examining the roles of drinking patterns and heart disease found, after 12 year of follow-up, that older men who consumed alcohol between three and seven days a week had fewer heart attacks than men who drank once a week.

50. Alcohol and CVD
Benefits of alcohol are thought to be mediated by actions on blood flow to the heart and to the brain.
alcohol‘ increases the good cholesterol (HDL cholesterol).
alcohol may lower heart attack risk by acting as a blood thinner.
A lower risk of diabetes has been seen in women and men. It may actually lower insulin levels altogether and may prevent diabetes through that mechanism.
There is also evidence that moderate drinking may prevent silent strokes or other subtle types of brain injury
Increased risk of CVD among people who drink to excess even occasionally.

51. Alcohol Benefits- Dementia?
Studies from both the U.S. and Europe have suggested that older adults who were drinking moderately may have a lower risk of dementia.

52. Tolerance: Definitions
Dispositional
Behavioral
Functional
Cross Tolerance: Tolerance to one drug leads to tolerance to other drugs in a class
Benzos
Barbs
General Anesthesia
GHB
Alcohol: Tolerance (definition)
Tolerance can be defined as the phenomenon of decreased effect with prolonged exposure to a drug. When the tolerance occurs within the time course of a single exposure to the drug it is called acute tolerance, while chronic tolerance occurs over repeated uses of the drug.
Tolerance can be metabolic (or pharmacokinetic) - due to induction of enzymes - for example, barbiturates. Tolerance can also be pharmacodynamic - due to physiological adaptation of the body to the presence of the drug
Tolerance and Cross-Tolerance
Tolerance is defined as a reduction in the response to a drug after repeated exposure to the drug. Development of tolerance to alcohol and other drugs is thought to be an important factor in the escalation of drug intake and the development of drug dependence. Both in humans and in animal models, repeated use of alcohol or nicotine results in tolerance to a variety of the drugs’ pharmacological effects (Perkins 2002; Suwaki et al. 2001).
The development of tolerance resulting from chronic exposure to one drug also can confer cross-tolerance to one or more other drugs.

53. Withdrawal
Tremors, sweating, anxiety, perspiration, headache, nausea, vomiting
As withdrawal continues, one can have grand mal seizures
DTs (Delirium Tremens) – Severe agitation, hallucinations, high fever, delirium
The most likely of all drug withdrawals to be fatal

54. Dependence DSM-IV Disorder
It is the model for all other substance dependence

55. Prevalence of alcohol dependence by Age
Prevalence of past-year DSM–IV alcohol dependence in the United States.
Source: 18+ years: 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, 12–17 years: National Survey on Drug Use and Health, 2003.

57. Alcohol Timeline
BCE
Viticulture, the selective cultivation of grape vines for making wine, is believed to originate in the mountains between the Black and Caspian seas (modern Armenia).
c BCE
Beer making flourishes in Sumerian/Mesopotamian civilization (modern day Iraq) with recipes for over twenty varieties of beer recorded on clay tablets.
BCE
Wine production and trade become an important part of Meditaranean commerce and culture. Ships carry large quantities between cities.
2200 BCE
Cuneiform tablet recommends beer as a tonic for lactating women.
BCE
Beer is unrefined and usually drunk through straw because it had large quantities of grain and mash in it.
c BCE
Beer is produced in quantity in northern Syria.
1500 B.C.
Wine is produced commercially in the Levant and Aegean.

58. BCE
Extensive, large scale vineyards laid out in Assyria (modern Iraq) produced over 10,000 skins of wine for the new capitol at Nimrud by Assurbanipal II.
c. 800 BCE
Distillation of barley and rice beer is practiced in India.
c. 50 BCE
Dionysius of Halicarnassus writes "the Gauls (french) have no knowledge of wine.. but used a foul-smelling liquour made of barley rotted in water (beer)."
c. 500
Wine making reaches Tang China along the Silk Road.
768
First specific reference to the use of hops in beer from the Abbey St. Denis in France by King Pepin le Bref.
1100
Alcohol distillation is documented by the medical school at Salerno, Italy. The product of the distillation is named 'spirits' in reference to it being the extracted spirit of the wine.
Middle Ages
Distillation of grain alcohol in Europe follows the earlier distillation of wine.

59. 1516
German Beer Purity Law ("Rheinheitsgebot") makes it illegal to make beer with anything but barley, hops, and pure water.
Early 1500's
Benedictine, a cognac-based alcohol with added herbs, is developed at the monastery in Fecamp, Normandy.
England. Excessive use of distilled spirits first becomes apparent.
Viticulture spread through Peru, Chile and Argentina.
1500's
The term 'alcohol' is now used specifically to refer to distilled spirits rather than its previous general meaning of any product of the process of vaporizing and condensing.
England. Thomas Nash describes widespread inebriety in Elizabethan England; drunkenness is mentioned for the first time as a crime, and preventive statutes multiply.
17th Century
Use of hashish, alcohol, and opium spreads among the population of occupied Constantinople

60.
England. During the reign of James I, numerous writers describe widespread drunkenness from beer and wine among all classes. Alcohol use is tied to every endeavor and phase of life, a condition that continues well into the eighteenth century.
1606
England. Parliament passes "The Act to Repress the Odious and Loathsome Sin of Drunkenness".
17th century
America. Massachusetts laws attempt to control widespread drunkenness, particularly from home-brews, and to supervise taverns. At the same time each town is ordered to establish a man to sell wines and "strong water" so that the public will not suffer from lack of proper accommodations (1637); inns are required to provide beer for entertainment (1649).
1643
Britain imposes an excise tax on distilled spirits. Along with a tax of alcohol came the development of the moonshine trade.
America. New England colonies attempt to establish a precise definition of drunkenness that includes the time spent drinking, amount, and behavior. Massachusetts laws against home-brews are reaffirmed (1654); a law forbidding the payment of wages in the form of alcohol results in a labor strike (1672). Increase Mather writes Wo to Drunkards (1673).

61.
England. Gin is developed in Holland (c. 1650) by distilling grain with the juniper berry. gin can be produced cheaply and plentifully, and the gin industry grows rapidly in England after it is introduced by British soldiers fighting in the Low Countries.
America. The office of tithingman is established in Massachusetts to report on liquor violations in homes (1675). Cotton Mather blames growing irreligiosity on excess tippling (1694).
England. New laws encourage the distillation and sale of spirits for revenues and support of the landed aristocracy (1690). The production of distilled liquors, mostly gin, increases dramatically; so does use, particularly among the poor. Excessive consumption of beer and wine is still prevalent among the middle and upper classes.
Late 1600's
Western France develops a reputation as the producer of fine quality cognac.
1700
Scotland and Ireland develop reputations for their quality whiskies.
1770s
Viticulture brought to Alta California. Within a century, it became one of the great wine-producing regions of the world.

62. 1791
The Act of 1791 (popularly called the "Whiskey Tax") enacted a tax on both publicly and privately distilled whiskey.
1793
The 'Whiskey Rebellio' of Pennslyvania, during which government troops were used to make arrests of a handful of distillery leaders who were refusing to pay taxes on their products.
1802
The 'Whiskey Tax' was repealed by Thomas Jefferson who called it 'infernal,' and 'hostile to the genius of a free people'.
A new alcohol tax is temporarily imposed in the United States to help pay for the War of 1812.
Early 19th Century
Development of the continuous still makes the process of alcohol distillation cheaper and easier to control.
1860
1,138 legal alcohol distilleries were operating in the United States producing 88 million gallons of liquor per year.

63. 1862
Abraham Lincoln imposed a new tax on liquor (the Act of July 1) to help pay the bills from the Civil War. This act also created the office of internal revenue. The alcohol tax began at 20 cents per gallon in 1862 and had risen to $2.00 per gallon just over two years later.
1906
Pure Food and Drug Act is passed, regulating the labelling of products containing Alcohol, Opiates, Cocaine, and Cannabis, among others. The law went into effect Jan 1, 1907
Dec 1917
The 18th Amendment to the Constitution (prohibition amendment) is adopted by the required majority of both houses of Congress.
Jan 16, 1919
The 18th Amendment to the Constitution (prohibition amendment) is ratified by the 36th state, meeting the 3/4 requirement. It goes into effect one year later.
Oct 1919
The Volstead Act is passed by Congress over President Wilson's veto. This clarifies and broadens the base of the 18th Amendment, and defines methods of enforcement. It specifies that production and sales of alcoholic beverages is illegal except for medical or religious purposes. Consuption and/or possession of alcohol was legal only in ones own home with legally acquired alcohol. Went into effect Feb 1, 1920.

64. Jan 16, 1920
The 18th Amendment (prohibition amendment) takes effect, prohibiting the manufacture, sale, transportation, import, and export of intoxicating liquors for beverage purposes.
The illicit alcohol trade booms in the United States.
Mar 22, 1933
The Volstead Act is modified, legalizing beverages containing not more than 3.2 percent alcohol. Roosevelt proposed this change to Congress nine days after his inauguration.
Dec 5, 1933
The prohibition of alcohol is repealed with the passage of the 21st Amendment, effective immediately.
Once the Eighteenth Amendment was repealed, the excise tax on alcohol began to climb again. In 1934 the tax was $2.00 per gallon, in 1940 it was $3.00, $4.00 in 1941, $6.00 in 1942, $9.00 in 1944, and $10.50 in At this point a moonshiner could produce and sell a gallon of alcohol for half the amount of the tax alone.
Oct 14, 1978
US President Jimmy Carter signs bill legalizing home brewing of beer for the first time since Prohibition.