HOL                              A   L COA Delightful Poison?                          Marilyn Herie PhD, RSW           Di...
“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 lo...
Addiction: A binary construct?
Addiction: A continuum of severityNo Alcohol              Severe AlcoholProblems                     Problems
Psychoactive Drug Classes1)   Depressants2)   Opiates/Opioids3)   Stimulants4)   Hallucinogens5)   Psychiatric Medications
Depressants
Opiates/Opioids
Stimulants    methamphetimine.co.uk
Hallucinogens                psychology.wikia.com
Psychiatric Medications
www.camh.ca
What is standard?
= 14 grams or .6 oz of pure alcoholhttp://www2.ku.edu
http://wcu.edu
Women:                     10 drinks per week                     2 drinks per day                     Men:               ...
How much do Canadians drink?Turn to the person next    Canadian Men = to you and tell them your guess of the              ...
Jolinda almost never drinks athome with her family, butoccasionally on week ends shegets together with a group offemale fr...
Alex loves to entertain andsocialize with friends and family.His dinner parties are legendary fortheir fine food and wine,...
•Tolerance•Cross‐tolerance•Potentiation
POTENTIATION         X
Absorption and Metabolism
mucous membranes    esophagus          (mouth)                          stomach (up to 20%) large intestine               ...
brain                                           esophagus                      liver                  pancreas            ...
Enzyme in the liver            transforms ethanol into a            toxic compound                                  A know...
.0554http://caaneo.ca/about/blog/?page_id=30
.0875http://caaneo.ca/about/blog/?page_id=30
Physical Effects of Alcohol
http://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine-    opiates-marijuana/section-ii-introduction...
Effects on the Brain• Limbic system: complex monitoring system   including memory and emotion• Cerebellum: motor coordinat...
Effects on the Cerebellum                       CONTROL     ALCOHOL       Reduction in size of brain cells and brain      ...
What are the heart risks of chronic heavy or binge drinking?
• Alcoholic                 cardiomyopathy              • Arrhythmias              • Strokes              • Hypertension  ...
“There is now little doubt that       moderate alcohol consumption is       associated with reduced coronary       heart d...
Moderate drinking can…• Reduce/inhibit build up of fat in arteries and   raise HDL (“good”) cholesterol• Prevent clotting ...
Smoking + Drinking POTENTIATES cancer-      causing properties of each substancePotentially                           Pote...
11% of all breast                                                            cancers            ACETALDEHYDE damages genet...
What are the                                                risks to the                                                li...
• Steatosis (fatty                                               liver)                                            • Alcoh...
What are the pancreatic risks of chronic heavy or binge drinking?
• Acute                                               pancreatitis                                            • Chronic   ...
Alcohol’s Effects on the Immune              System
Alcohol suppresses the immune systemChronic use impairs white blood cell functioningImpairment up to 24 hours after binge ...
How can I tell who is at risk?
DSM 5: Proposed Revisions  “Given the empirical evidence, the DSM‐5   Substance Use Disorders Workgroup    recommends comb...
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or mor...
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 ...
2. CAGE QUESTIONS  1.    Have you ever felt the need to Cut down         on your drinking? NO  2. Have you ever been Annoy...
3. Single Item     • A one‐item questionnaire developed for        brief screening in primary care settings.       • Ask c...
Psychosocial Treatment Resources
Continuum	of	Psychosocial	                                Treatment	Services	                                             ...
Client‐Treatment Matching• Lack of strong evidence by which to match clients to specific   treatments• Does not mean that ...
www.connexontario.ca
www.camh.ca
McLaughlin Information CentreCAMH now has centralized access with one doorway           (a front door) to ALL services    ...
What if the person refuses to seek help?
www.alcoholhelpcenter.net
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 repo...
Within the last twelve (12) months: • You reported drinking on approximately   100.0% of days in the last year. • You repo...
This also means that: • You spent approximately   ? $ in the last   year, depending on where you drank (at   home, in a ba...
This also means that: • You spent approximately $10,400 in the last   year, depending on where you drank (at   home, in a ...
• You consumed (on average) 500 calories from   alcohol on days that you drink. Based on the   total amount of drinking yo...
www.alcoholhelpcenter.net
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....
?• In the last year you spent about  hours under the   influence of alcohol (based on your typical drinking   during one w...
• In the last year you spent about 4,004 hours   under the influence of alcohol (based on your   typical drinking during o...
Hmm…
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 W...
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
Alcohol A delightful poison pub
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Alcohol A delightful poison pub

  1. 1. 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
  2. 2. “Alcohol may be man’s worst enemy, butthe bible says love your enemy.” - Frank Sinatra
  3. 3. "He was a wise man who invented beer." -Plato
  4. 4. 1. A feature that resonated for me2. A question I want to think through3. A seed I could plant now
  5. 5. 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.
  6. 6. Addiction: A binary construct?
  7. 7. Addiction: A continuum of severityNo Alcohol Severe AlcoholProblems Problems
  8. 8. Psychoactive Drug Classes1) Depressants2) Opiates/Opioids3) Stimulants4) Hallucinogens5) Psychiatric Medications
  9. 9. Depressants
  10. 10. Opiates/Opioids
  11. 11. Stimulants methamphetimine.co.uk
  12. 12. Hallucinogens psychology.wikia.com
  13. 13. Psychiatric Medications
  14. 14. www.camh.ca
  15. 15. What is standard?
  16. 16. = 14 grams or .6 oz of pure alcoholhttp://www2.ku.edu
  17. 17. http://wcu.edu
  18. 18. Women: 10 drinks per week 2 drinks per day Men: 15 drinks per week 3 drinks per dayhttp://www.camh.ca
  19. 19. 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
  20. 20. 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.
  21. 21. 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”.
  22. 22. •Tolerance•Cross‐tolerance•Potentiation
  23. 23. POTENTIATION X
  24. 24. Absorption and Metabolism
  25. 25. mucous membranes esophagus (mouth) stomach (up to 20%) large intestine small intestine (up to 80%)
  26. 26. 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
  27. 27. 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
  28. 28. .0554http://caaneo.ca/about/blog/?page_id=30
  29. 29. .0875http://caaneo.ca/about/blog/?page_id=30
  30. 30. Physical Effects of Alcohol
  31. 31. http://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine- opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathw
  32. 32. 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
  33. 33. Effects on the Cerebellum CONTROL ALCOHOL Reduction in size of brain cells and brain mass shrinksSullivan et al., Neuropsychology
  34. 34. What are the heart risks of chronic heavy or binge drinking?
  35. 35. • Alcoholic  cardiomyopathy • Arrhythmias • Strokes • Hypertension Binge drinkers are 40% more likely to suffer any kind of strokeNIAAA, 2011
  36. 36. “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
  37. 37. 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
  38. 38. Smoking + Drinking POTENTIATES cancer- causing properties of each substancePotentially Potentiallyreduced risk of increased riskheart disease of cancer
  39. 39. 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
  40. 40. 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
  41. 41. • 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
  42. 42. What are the pancreatic risks of chronic heavy or binge drinking?
  43. 43. • 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
  44. 44. Alcohol’s Effects on the Immune  System
  45. 45. Alcohol suppresses the immune systemChronic use impairs white blood cell functioningImpairment up to 24 hours after binge drinking
  46. 46. How can I tell who is at risk?
  47. 47. 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
  48. 48. 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
  49. 49. Three Suggested Screening Tools1. Quantity/Frequency2. CAGE3. Single Item
  50. 50. 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
  51. 51. 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
  52. 52. 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
  53. 53. Psychosocial Treatment Resources
  54. 54. 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
  55. 55. 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
  56. 56. www.connexontario.ca
  57. 57. www.camh.ca
  58. 58. 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
  59. 59. What if the person refuses to seek help?
  60. 60. www.alcoholhelpcenter.net
  61. 61. Case Example• Alex, 52 years old• Drinks 7 days per week• Approximately 40 drinks per week
  62. 62. How does your drinking compare with other Canadian men in your age group?www.alcoholhelpcenter.net
  63. 63. 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
  64. 64. 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
  65. 65. 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
  66. 66. 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
  67. 67. • 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
  68. 68. www.alcoholhelpcenter.net
  69. 69. www.alcoholhelpcenter.net
  70. 70. 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
  71. 71. ?• In the last year you spent about  hours under the  influence of alcohol (based on your typical drinking  during one week).www.alcoholhelpcenter.net
  72. 72. • 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
  73. 73. Hmm…
  74. 74. 1. A feature that resonated for me2. A question I want to think through3. A seed I could plant now
  75. 75. 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) 

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