Alcohol A delightful poison pubPresentation Transcript
HOL A L COA Delightful Poison? Marilyn Herie PhD, RSW Director, TEACH Project, Centre for Addiction and Mental Health Director, Collaborative Program in Addiction Studies, University of Toronto Assistant Professor (Status Only) Factor‐Inwentash Faculty of Social Work, U of T
“Alcohol may be man’s worst enemy, butthe bible says love your enemy.” - Frank Sinatra
"He was a wise man who invented beer." -Plato
1. A feature that resonated for me2. A question I want to think through3. A seed I could plant now
Learning ObjectivesAt the end of this session, you will be able to:1. Identify the physical effects of alcohol2. Define low‐risk drinking and reflect on where your own and others’ drinking fits into Canadian drinking norms3. Explain why women and older adults are at higher risk for alcohol‐related problems4. Use simple screening tools to detect who might be at risk for alcohol problems5. Access credible and evidence‐based online resources, self‐help and treatment programs.
Addiction: A binary construct?
Addiction: A continuum of severityNo Alcohol Severe AlcoholProblems Problems
Psychoactive Drug Classes1) Depressants2) Opiates/Opioids3) Stimulants4) Hallucinogens5) Psychiatric Medications
What is standard?
= 14 grams or .6 oz of pure alcoholhttp://www2.ku.edu
Women: 10 drinks per week 2 drinks per day Men: 15 drinks per week 3 drinks per dayhttp://www.camh.ca
How much do Canadians drink?Turn to the person next Canadian Men = to you and tell them your guess of the ________ standard drinkspercentage of Canadian men and Canadian women who drink more Canadian women = than 14 standard drinks in a typical week. ________ standard drinks
Jolinda almost never drinks athome with her family, butoccasionally on week ends shegets together with a group offemale friends for dinner andconversation. On the rareoccasions when she has morethan one or two drinks she saysthat she feels drunk and dizzy.Jolinda is known among hersocial group as the one who “can’thold her liquor,” and is sometimesthe subject of friendly teasingamong the group.
Alex loves to entertain andsocialize with friends and family.His dinner parties are legendary fortheir fine food and wine, andcreating new recipes and shoppingfor hard-to-find ingredients is one ofhis favourite hobbies. If he wereasked to quantify his drinking, Alexwouldn’t know where to start –alcohol is very much a part of hislife, yet he has a successful careerand a close relationship with hisadult children, although his wifesometimes “nags” him about hisdrinking. Although he drinks a loton many occasions, his friendshave only rarely ever seen him“drunk”.
Absorption and Metabolism
mucous membranes esophagus (mouth) stomach (up to 20%) large intestine small intestine (up to 80%)
brain esophagus liver pancreas stomach Alcohol is metabolized in the body mainly by the liver. The brain, pancreas, and stomach also metabolize alcohol.http://pubs.niaaa.nih.gov/publications/AA72/AA72.htm
Enzyme in the liver transforms ethanol into a toxic compound A known carcinogen,Chemical name quickly brokenfor alcohol down… Further broken down to carbon dioxide and water …by another enzyme into… Other enzymes: cytochrome P450 2E1 (CYP2E1) catalase http://pubs.niaaa.nih.gov/publications/AA72/AA72.htm
Effects on the Brain• Limbic system: complex monitoring system including memory and emotion• Cerebellum: motor coordination, also emotion and memory• Cerebral Cortex: think, plan, behave intelligently and social interaction – damage can impair problem‐solving, memory and learning
Effects on the Cerebellum CONTROL ALCOHOL Reduction in size of brain cells and brain mass shrinksSullivan et al., Neuropsychology
What are the heart risks of chronic heavy or binge drinking?
• Alcoholic cardiomyopathy • Arrhythmias • Strokes • Hypertension Binge drinkers are 40% more likely to suffer any kind of strokeNIAAA, 2011
“There is now little doubt that moderate alcohol consumption is associated with reduced coronary heart disease risk in both men and women.”Herie and Skinner, 2010
Moderate drinking can…• Reduce/inhibit build up of fat in arteries and raise HDL (“good”) cholesterol• Prevent clotting – guards against stroke and heart attack• Keep blood pressure in check
Smoking + Drinking POTENTIATES cancer- causing properties of each substancePotentially Potentiallyreduced risk of increased riskheart disease of cancer
11% of all breast cancers ACETALDEHYDE damages genetic material in cells, and causes cells to grow too quicklyhttp://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine- opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathw
What are the risks to the liver of chronic alcohol use?http://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine- opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathw
• Steatosis (fatty liver) • Alcoholic hepatitis • Fibrosis (scar tissue)90% of heavy drinkers willdevelop fatty liver • Cirrhosis1 in 5 will develop alcoholic – Jaundice, Type hepatitis 2 diabetes, Liver 1 in 4 will develop cirrhosis cancerhttp://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine- opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathwNIAAA, 2011
What are the pancreatic risks of chronic heavy or binge drinking?
• Acute pancreatitis • Chronic pancreatitis – Pancreatic cancer – Type 2 diabetes Approx 5% of heavy drinkers will develop pancreatitishttp://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine- opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathwNIAAA, 2011
Alcohol’s Effects on the Immune System
Alcohol suppresses the immune systemChronic use impairs white blood cell functioningImpairment up to 24 hours after binge drinking
How can I tell who is at risk?
DSM 5: Proposed Revisions “Given the empirical evidence, the DSM‐5 Substance Use Disorders Workgroup recommends combining abuse and dependence into a single disorder of graded clinical severity, with two criteria required to make a diagnosis.”www.dsm5.org
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of the following within a 12 month period:1.X Failure to fulfill major 7. X Persistent desire or obligations at school, work unsuccessful efforts to cut or home down/control2.X Recurrent use in physically 8. Time spent in obtaining, X hazardous situations using or recovering3.? Persistent social/interpersonal ? 9. Important activities given up or reduced problems4. Tolerance X 10. Continued use despite knowing that physical or X5. Withdrawal psychological problems will become worse or were 6. Larger amounts or for ? longer period than caused intended ? 11. Craving, strong desire or urgewww.dsm5.org
Three Suggested Screening Tools1. Quantity/Frequency2. CAGE3. Single Item
1. Quantity/Frequency Questions • How many days per week did you drink over the last month? 30 • On a day when you drink, how many drinks do you have? 4-5 • How many times during the last month did you drink more than 5 drinks? (binge drinking) 6-7Cooney, Zweben & Fleming, 1995
2. CAGE QUESTIONS 1. Have you ever felt the need to Cut down on your drinking? NO 2. Have you ever been Annoyed at criticism of your drinking? YES 3. Have you ever felt Guilty about your drinking? NO 4. Have you ever had a morning Eye opener? NO 2 or more “yes” answers is clinically significant.Mayfield et al., 1974
3. Single Item • A one‐item questionnaire developed for brief screening in primary care settings. • Ask client: How many times in the past year have you had ___ or more drinks in a day? __ = 5 for men6 x 12 = 72 __ = 4 for women Scoring: an answer of more than 1 identifies unhealthy alcohol use National Institute on Alcohol Abuse and Alcoholism (NIAAA): Helping Patients Who Drink Too Much: A Clinicians Guide 2007
Psychosocial Treatment Resources
Continuum of Psychosocial Treatment Services HighlyMinimallyIntensive Levels of Treatment Intensity Intensive Custodial Care Prevention Facilitate Extended Residential Long-term Short-term Recovery Outpatient Social Residential Outpatient without Interventions Model Self-Change Treatment Oriented Interventions Day Treatment Residential Brief Short-term Hospital-Based Community Outpatient Interventions (e.g.., Therapist- self-help manuals, Directed physician’s advice) Interventions Mild to SubstantialModerate Severity of Problems To Severe CAMH
Client‐Treatment Matching• Lack of strong evidence by which to match clients to specific treatments• Does not mean that clients all require the same types of services• A variety of flexible and individualized services are required• Guidelines for selecting services are needed Drug Use Problem Social Support Severity Multiplicity & Stability Lo Lo Hi Brief Outpatient Lo-Hi Lo-Hi Mod-Hi Outpatient Day Treatment Mod-Hi Mod-Hi Mod Residential Mod-Hi Mod-Hi Lo Skinner & Martin, 1995
McLaughlin Information CentreCAMH now has centralized access with one doorway (a front door) to ALL services 1‐800‐463‐6273 or 416‐595‐6111Call if you would like:• General addiction and mental illness information • Information on how to obtain assessments for mental health and addictions
What if the person refuses to seek help?
Case Example• Alex, 52 years old• Drinks 7 days per week• Approximately 40 drinks per week
How does your drinking compare with other Canadian men in your age group?www.alcoholhelpcenter.net
Within the last twelve (12) months: • You reported drinking on approximately 100.0% of days in the last year. • You reported that you drank a total of ? # of drinks in the last year. www.alcoholhelpcenter.net
Within the last twelve (12) months: • You reported drinking on approximately 100.0% of days in the last year. • You reported that you drank a total of 2080 drinks in the last year. www.alcoholhelpcenter.net
This also means that: • You spent approximately ? $ in the last year, depending on where you drank (at home, in a bar, etc.). www.alcoholhelpcenter.net
This also means that: • You spent approximately $10,400 in the last year, depending on where you drank (at home, in a bar, etc.). www.alcoholhelpcenter.net
• You consumed (on average) 500 calories from alcohol on days that you drink. Based on the total amount of drinking you had enough alcohol to add roughly 59 pounds or 27 kilograms to your weight in the last year. Note: One drink has about 100 calories and 3,500 calories roughly equals 1 extra pound of weight. • You also reported that within the past year, the greatest number of drinks you had on one occasion was 12 drinks. www.alcoholhelpcenter.net
You reported that you weigh 160 lbs. This means that: • If your liver is healthy, burning one drink takes you 2 hours. Burning four drinks takes you about 8 hours. If you had ten drinks, it will take about 19 hours until there is no alcohol in your system. www.alcoholhelpcenter.net
?• In the last year you spent about hours under the influence of alcohol (based on your typical drinking during one week).www.alcoholhelpcenter.net
• In the last year you spent about 4,004 hours under the influence of alcohol (based on your typical drinking during one week).www.alcoholhelpcenter.net
1. A feature that resonated for me2. A question I want to think through3. A seed I could plant now
Playlist• La Traviata, Giusseppe Verdi: The "Drinking Song”• Eric Burdon and War – Spill the Wine• UB 40 – Red Red Wine • Frank Sinatra – The Lady is a Tramp• Jimmy Buffett – Margaritaville• Garth Brooks – Friends in Low Places • Amy Winehouse – Rehab• Frank Sinatra – One for My Baby (One for The Road)