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Alcohol
- 1. Dopamine is responsible for A. Mood B. Pleasure/reward C. Alertness D. Pain control M ood Pleasure/rew ard Alertness Pain control 0% 0%0%0% Response
- 2. Your body’s natural pain killers are A. Inhibitory neurotransmitters B. Dopamine C. Opiates D. Endorphins Inhibitory neurotransm itters Dopam ine Opiates Endorphins 0% 0%0%0% Response
- 3. The neurotransmitter responsible for mood is: A. Dopamine B. GABA C. Serotonin D. Glutamate Dopam ine GABA Serotonin Glutam ate 0% 0%0%0% Response
- 4. This neurotransmitter is the major excitatory neurotransmitter A. Glutamate B. GABA C. Endorphins D. Dopamine Glutam ate GABA Endorphins Dopam ine 0% 0%0%0% Response
- 5. This neurotransmitter is excitatory and is implicated in the fight or flight response A. GABA B. Glutamate C. Serotonin D. Norepinephrine GABA Glutam ate Serotonin Norepinephrine 0% 0%0%0% Response
- 6. This neurotransmitter is implicated in muscle movement A. Norepinephrine B. Anandamide C. Serotonin D. Acetylcholine Norepinephrine Anandam ide Serotonin Acetylcholine 0% 0%0%0% Response
- 7. The body’s own cannabinoid is A. Dopamine B. Acetylcholine C. Anandamide D. THC Dopam ine Acetylcholine Anandam ide THC 0% 0%0%0% Response
- 8. Alcohol Goldberg Chapter 6 SOC 204 Drugs & Society
- 9. Is someone close to you an alcoholic? A. Yes, more than one person B. Yes, one person C. No Yes,m ore than one person Yes,one person No 60% 16% 24%
- 10. Alcohol • Fermentation • Distillation • Proof
- 11. Pharmacology • Absorption • Distribution • Metabolism • Mechanism of Action • BLOOD ALCOHOL CONTENT
- 12. Alcohol is metabolized in your liver A. True B. False True False 0% 100%
- 13. You can increase your rate of metabolizing alcohol by exercise or by taking caffeine A. True B. False True False 96% 4%
- 14. Alcohol’s Effects • Alcohol acts on the cerebrum affecting ▫ Judgment ▫ Reasoning ▫ Inhibitions ▫ Motor activity ▫ Impairs the senses • Mouse Party
- 15. BAC (%) Behavioral Effects •0.05 Lowered alertness, release of inhibitions, impaired judgment •0.10 Slower reaction times, impaired motor function, less caution •0.15 Large, consistent increases in reaction time •0.20 Marked depression in sensory and motor capability, intoxication •0.25 Severe motor disturbance, staggering, great impairment •0.30 Stuporous but conscious—no comprehension of what’s going on •0.35 Surgical anesthesia; about LD1, minimal level causing death •0.40 About LD50
- 16. Alcohol primarily impacts this part of the brain: A. Limbic system B. Cerebellum C. Cerebral cortex D. Basal ganglia Lim bicsystem Cerebellum Cerebralcortex Basalganglia 0% 0% 88% 13%
- 17. Alcohol sedates by increasing glutamate’s action – an agonist response. A. True B. False True False 63% 38%
- 18. Alcoholism • Alcoholism ▫ Condition in which an individual loses control over intake of alcohol • Substance Use Disorder ▫ Physical, social, intellectual, emotional, or financial problems resulting from the use of alcohol ▫ Withdrawal symptoms ▫ Tolerance ▫ Blackouts
- 19. Alcoholism • Some consider alcoholism to be a disease ▫ Compared to heart disease or diabetes ▫ 1956 American Medical Association declared it a disease ▫ Disease can be used as a legal defense ▫ Receive treatment rather than punishment
- 20. Do you agree alcoholism is a disease? A. Yes B. No C. I’m not sure Yes No I’m notsure 75% 8% 17%
- 21. I know that for the discussion Thursday, I have to interview two people A. Yep. On it. B. Noooo C. What discussion? Yep. On it. Noooo W hatdiscussion? 46% 25% 29%
- 22. Alcoholism • Genetics ▫ 50-60% of alcoholism vulnerability has a genetic basis ▫ Environmental factors affect the impact of genetics
- 23. Alcohol and Genetics • Alcoholism is among the most inherited mental illnesses • Specific genes contribute to: (i) excessive consumption, (ii) diminished negative feedback, (iii) enhanced sense of pleasure, and (iv) diminished hangovers • However, environment is as important as genetics
- 24. Alcoholism • Psychosocial factors ▫ 20% of alcoholics have a mood or anxiety disorder ▫ Individuals are more likely to drink heavily when in a group ▫ Expectations about alcohol are predictors of dependence ▫ Associated with a greater number of sexual partners
- 25. Alcoholism • Culture ▫ Attitudes toward alcohol affect rates of alcohol abuse
- 26. Culture and Alcohol (continued) • Some psychologists contend that both set and setting can often overshadow the pharmacological effects of most drugs, including alcohol. ▫ Set: An individual’s expectation of what a drug will do to his/her personality ▫ Setting: The physical and social environment where most drugs, including alcohol, are consumed
- 27. Culture and Alcohol • Culture provides how alcohol use is perceived (e.g., violation of norms, “normal” to drink, sexy, sophisticated, mature). • Cultural rules state how much one can drink and where one can drink. • Cultures provide ceremonial meaning to alcohol use. ▫ Drinking rates among Jews ▫ Drinking rates among Irish • Culture provides a model of alcoholism. • Culture provides attitudes and stereo- types regarding drinking behavior.
- 28. Distinctions Between “Wet” and “Dry Cultures “Wet” Cultures - In these cultures alcohol is integrated into daily life and activities (e.g., alcohol consumed with meals). In these cultures, abstinence rates are low and wine is largely the beverage of preference. European countries bordering the Mediterranean have traditionally exemplified wet cultures. “Dry” Cultures – Alcohol consumption is not as common during everyday activities. Abstinence is more common, however, when drinking occurs, it is more likely to result in intoxication. Scandinavian countries, the U.S., and Canada are examples of counties that are dry.
- 29. Alcohol Withdrawal • Characteristics of alcohol withdrawal: ▫ Craving for alcohol ▫ Delirium tremens (DTs) ▫ Extreme arousal ▫ Auditory and visual hallucinations ▫ Physiological symptoms ▫ Cognitive symptoms
- 30. Impacts of Alcohol Individual Family Society
- 31. Family Effects • Children of alcoholics ▫ Often experience sleep difficulties, depression, loneliness, and stomach problems ▫ Alienated from parents, have poor communication skills, less trust, and more emotional longing ▫ Attention deficit hyperactivity disorder (ADHD) • Adult children of alcoholics (ACOAs) ▫ Feelings of failure and self-deprecation ▫ Feel a great need to be in control
- 32. Addict • Behaviors ▫ Use of chemicals ▫ Abusive ▫ Controlling ▫ Withdrawal of love, attention, affection ▫ Blaming ▫ Anger ▫ Self- righteousness Underlying feeling: SHAME
- 33. Co-Dependent • Behaviors ▫ Rescuing ▫ Excusing ▫ Denial ▫ Helplessness ▫ Martyr Underlying feeling: ANGER
- 34. Hero • Behaviors ▫ The “Good Kid” ▫ High achiever ▫ Successful ▫ Overly responsible ▫ Intellectual Underlying feeling: INADEQUACY
- 35. Scapegoat • Behaviors ▫ Acting out ▫ Defiant ▫ Peer-oriented ▫ Sullen, angry ▫ Irresponsible ▫ Chemical use ▫ Law breaking, truancy Underlying feeling: HURT
- 36. Lost Child • Behaviors ▫ Withdrawn ▫ Loner ▫ Day dreamer ▫ Unnoticed Underlying Feeling: LONELINESS
- 37. Mascot • Behaviors ▫ Attention-getting ▫ Humor ▫ Clowning ▫ Super cute ▫ Overly active ▫ Silly Underlying Feeling: FEAR
- 38. I know that for Friday’s discussion, I need to interview two people. A. Got it B. I do now! Gotit Ido now ! 0%0%
- 39. Which do you most identify with? A. Addict B. Co-dependent C. Hero D. Scapegoat E. Lost Child F. Mascot AddictCo-dependent Hero Scapegoat LostChild M ascot 4% 8% 13% 25% 4% 46%
- 40. COSTS • Hero ▫ Compulsive drive, pressure, suicide • Scapegoat ▫ Addiction, criminal behavior, drop out • Lost Child ▫ Isolation, abuse victim, eating disorders • Mascot ▫ Immaturity, distant relationships, manipulation
- 41. Exam……do you want: A. Friday B. Monday Friday M onday 57% 43%
- 42. Correlations with Violence As alcohol use escalates, so does violence ▫ Domestic partner violence 66% ▫ Sexual Assault 37% ▫ Homicides 40% ▫ Child abuse 70% http://www.ph.ucla.edu/sciprc/pdf/ALCOHOL_AND_VIOLENCE.pdf
- 43. Suicide ▫ About 7% of alcoholics commit suicide ▫ 16% of men and 10% of women entering alcohol treatment have contemplated suicide ▫ 38% of people who hanged themselves had alcohol in their system ▫ 32% of veterans who attempted suicide were diagnosed with alcohol abuse or disorder
- 44. Accidents and Alcohol ▫ Drinking while driving Emergency room admissions ▫ Fire-related fatalities ▫ Alcohol-related boating accidents ▫ Drowning fatalities YouTube
- 46. Prohibition • Temperance Movement – view of alcohol • Prohibition • States 1851 • Federal 1919 • Repealed in 1933 • Since 1933, states regulate alcohol • Federal taxation
- 47. Total estimated U.S. per capita ethanol consumption in gallons per year by state, 2007 Source: Data from NIAAA © 2011 McGraw-Hill Higher Education. All rights reserved.
- 48. Who drinks and why • Cultural Differences • Trends in US • Regional Differences • Gender Differences • Drinking Among College Students
- 49. Alcohol Abuse Among College and University Students CORE Institute (2008) research results: • Approximately 72% of college students consumed alcohol and 42% to 55% engaged in binge drinking within 30 days when survey was given. • College students consume an average of 5.4 alcoholic drinks per week. • Of all the drugs reported, alcohol was the most heavily abused on college campuses, followed by tobacco (44%) and marijuana (31%).
- 50. Alcohol Abuse Among College and University Students (continued) Other studies found that … • The main reason given for binge drinking was “to get drunk.” • Males binge drink more than females. • For binge drinkers, the impact on impaired academic performance is just as great for women drinkers. • Being white, involved in athletics, or a resident of a fraternity or sorority made it more likely that a student would be a binge drinker.
- 51. Alcohol Abuse Among College and University Students • On U.S. campuses, alcohol is a factor in 40% of all academic problems and 28% of all dropouts. • Seventy-five percent of male students and 55% of female students involved in acquaintance rape had been drinking or using drugs. • The transition into college is associated with a doubling of the percentages of those who drink for both males and females. • For heavier drinkers, grades suffered for both male and female students.
- 52. Women and Alcohol • Women possess greater sensitivity to alcohol, have a greater likelihood of addiction, and develop alcohol-related health problems sooner than men (e.g., stomach cancer, cirrhosis of the liver). • More women in alcohol treatment come from sexually abusive homes (70%) in comparison to men (12%).
- 53. Women and Alcohol (continued) • Three major reasons why women are more sensitive to the effects of alcohol: 1. Body size (men generally larger than women) 2. Women absorb alcohol sooner—women possess more body fat and body fat does not dilute alcohol 3. Women possess less of a metabolizing enzyme that gets rid of (processes out) alcohol
- 54. Women and Alcohol (continued) • Alcohol consumption patterns of women: ▫ Women 21 to 34 years of age were least likely to report alcohol-related problems if they had stable marriages and were working full time. ▫ Women tend to marry men whose drinking habits match their own. ▫ Between 35 to 49 years of age, the heaviest drinkers were divorced or separated women without children. ▫ Between 50 to 64 years of age, the heaviest drinkers were women whose husbands/partners drank heavily. ▫ Women 65 and older comprised less than 10% of drinkers with drinking problems.
- 55. Alcohol Consumption in the United States • Alcohol consumption has dropped sharply since 1981. • What explains the steady decline in alcohol consumption during the past twenty years? ▫ Demographics ▫ Conservatism ▫ Decrease in social acceptability ▫ Increased awareness of risks ▫ Increased concerns for health
- 56. Additional Facts Regarding Alcohol Use/Abuse • Drinking and driving: On most weekend nights throughout the United States, 70% of all fatal single- vehicle crashes involve a driver who is legally intoxicated. • Income/wealth: Less affluent people drink less than more affluent individuals. • The average “alcoholic”: The largest percentage of alcoholics are secret or disguised drinkers who look very much like common working people. • On average: Most people who consume alcohol do not become problem drinkers.
- 57. Most college students reduce their binge drinking after graduating from college. A.True B.False True False 24% 76%
- 58. The younger one is when drinking alcohol for the first time, the more likely one will become a problem drinker. A.True B.False True False 64% 36%
- 59. How’s your group doing? A. We rock. B. Working on it. C. We need help. D. Group? What group? W erock. W orkingon it. W eneed help. Group? W hatgroup? 43% 10% 0% 48%
- 60. Underage Drinking • Underage drinking is associated with premature death, disease, injury, property damage, motor vehicle crashes, alcohol-related crime and loss of productivity • There is a significant relationship between drinking before age 13 and suicide attempts
- 61. Underage Drinking • High school students who engaged in binge drinking were six times more likely to drink and drive ▫ 7.2% of 8th-grade students binge drink ▫ 16.3% of 9th-grade students binge drink ▫ 23.2% of 12th-grade students binge drink
- 62. Moderate alcohol drinkers have lower rates of cardiovascular disease than abstainers. A.True B.False True False 43% 57%
- 63. Physiological Toxicity • Overdose • Hangover
- 64. When someone passes out from alcohol use: A. Put them on their back B. Put them to bed and let them sleep it off C. Put them on their side Putthem on theirback Putthem to bed and let...Putthem on theirside 0% 100% 0%
- 66. There is a safe level of alcohol to consume while pregnant A. True B. False True False 73% 27%
- 68. Physiological Toxicity - Brain • Wernicke-Korsakoff syndrome develops because alcohol impedes the body’s ability to utilize thiamine (a B vitamin) • Alcohol use is associated with psychological symptoms: depression, anxiety
- 69. Physiological Toxicity - Liver • Three main conditions associated with alcohol: ▫ Fatty liver ▫ Alcohol hepatitis ▫ Cirrhosis • Cirrhosis is irreversible, even if alcohol use stops
- 70. Physiological Toxicity – Digestive System • In moderate amounts, alcohol aids digestion by increasing gastric juice in the stomach • Too much alcohol can irritate the stomach, leading to internal bleeding • Heavy alcohol use is implicated in acute pancreatitis • Alcoholics often have malnutrition because alcohol interferes with the body’s ability to utilize nutrients
- 71. Physiological Toxicity – Circulatory System • Moderate alcohol use reduces risk of heart disease, boosts good (HDL) cholesterol and helps prevent type 2 diabetes • Effects of heavy alcohol use: ▫ Degeneration of the heart muscle ▫ High blood pressure ▫ Cardiac arrhythmias ▫ Ischemic heart disease ▫ Strokes
- 72. Physiological Toxicity – Immune System • Studies show that moderate alcohol use reduces immunity • Alcohol interferes with white blood cells, particularly T lymphocytes, which help to resist infections
Editor's Notes
- Fermentation = the production of alcohol from sugars through the action of yeasts Forms the basis of all alcoholic beverages Fruits + yeast = fermentation will begin Fruits naturally contain sugar Cereal grains contain starch, which must be converted to sugar by malt before fermentation can begin Yeast has a limited tolerance for alcohol When the concentration reaches a certain percentage (15% is possible, but standard for wine is about 12%) the yeast dies and fermentation ceases. Distillation = evaporation and condensing of alcohol vapors to produce beverages with alcohol content higher than 15 percent Perhaps first used in Arabia around AD 800 Introduced into Europe in about the 10th century In U.S., began on a large scale at the end of the 18th century Grain neutral spirits—clear, tasteless, nearly pure alcohol (190 proof) produced by distillation May be sold as Everclear or used in research Ethanol is used in commercial products as a gasoline additive, cleaner, solvent Used to make various beverages Gin: distillate filtered through juniper berries and then diluted with water Vodka: mixture of grain neutral spirits and water Contains relatively few congeners Whiskey = distillate of fermented malted barley Early U.S. distiller from Bourbon County, KY, gave beverage its name Distilled at a lower proof (160) and so contains more congeners and some flavor from the grain used Rye whiskey, corn whiskey (bourbon), blended whiskey Usually aged for at least two years Liqueurs or cordials Alcohol content 20 to 25 percent Originally made from brandy mixed with flavorings from herbs, berries, or nuts Now typically made from flavored, diluted grain neutral spirits Proof = alcohol content of a distilled beverage; twice the percentage of alcohol by weight 90-proof whiskey is 45 percent alcohol Beer Made by adding barley malt to other cereal grains Hops are added with yeast to give beer its distinctive flavor Lager—uses a type of yeast that settles to the bottom of the mash to ferment Most common type in United States Ale—uses a top-fermentation yeast, warmer fermentation temperature, more malt and hops Light beer—fermented longer at a cooler temperature More sugar is converted to alcohol, then water added Result is a beverage with similar alcohol content but less sugar (and fewer calories) than regular beer Most beer sold in the United States is mass-produced by the two largest brewers Imported beers and microbreweries are growing in popularity WINE Made from fermented grapes Produced by both small and large wineries Most wines contain about 12% alcohol Factors in quality include selection and cultivation of grapevines, good weather, timing of harvest, and careful monitoring of fermentation and aging Generics vs. varietals Determined by type of grapes and flavor Red vs. white Sweet vs. dry Sparkling wines Fortified wines Alcohol content near 20 percent
- Absorption Some absorbed in the stomach, most in the small intestine Absorption is slower if there is food or water in the stomach Absorption is faster in the presence of carbonated beverages Factors that affect rate of absorption: Food in the stomach slows absorption Wine and beer absorbed slower than distilled spirits Carbonation increases absorption Strong emotions increase absorption Males absorb alcohols slowly and break it down quickly Women absorbs alcohol more quickly during the premenstrual phase Women who take birth control pills absorb alcohol more quickly Distribution Blood alcohol concentration (BAC) is a measure of the concentration of alcohol in blood, expressed as a percentage in terms of grams per 100 ml Alcohol is distributed throughout body fluids Alcohol is less distributed in fatty tissues, so a lean person will have a lower BAC than a fatter person of the same weight Metabolism: Liver metabolizes about 0.25 ounces of alcohol per hour If rate of intake = rate of metabolism, BAC is stable If rate of intake exceeds rate of metabolism, BAC climbs Standard drink has about 0.5 ounces of pure alcohol 12 ounces of beer 4 ounces of wine 1 ounce of 100-proof spirits Women tend to be more susceptible than men to the effects of alcohol after consuming the same amount Alcohol dehydrogenase (a stomach enzyme) is more active in men Women absorb a greater proportion of the alcohol they drink Women tend to weigh less and have a higher proportion of body fat “Tank” into which alcohol is added is smaller About 2 percent of alcohol is excreted unchanged About 90 percent is metabolized in the liver Exercise, coffee, and other strategies do not speed up the rate of metabolism Liver responds to chronic intake of alcohol by increasing enzyme activity Contributes to tolerance among heavy users Can result in cross-tolerance to other depressants MECHANISM OF ACTION Central nervous system depressant Used as anesthetic until the late 19th century Alcohol has many effects on the brain and the mechanisms are difficult to pin down Similar to barbiturates and benzodiazepines, it enhances the inhibitory effect of GABA at the GABA-A receptor At high doses, it blocks the effects of the excitatory transmitter glutamate It affects dopamine, serotonin, and acetylcholine neurons Alcohol in the body is transformed by the liver into acetaldehyde, then further broken down into acetate, then water and carbon dioxide Alcohol leaves the body at a rate of about 3/4 ounce per hour One ounce of distilled spirits, a bottle of beer, and a glass of wine all have about the same amount of alcohol Blood alcohol concentration (BAC): Percentage of alcohol in the bloodstream Rises when alcohol is consumed at a rate exceeding the rate at which it is metabolized or leaves the body As BAC increases, behavioral and subjective effects become more pronounced Drinking too much alcohol in a short time can be fatal
- 15% to 30% of nursing home patients are admitted because of permanent alcohol-induced brain damage Five to six drinks daily adversely affects cognitive functioning Time out from day-to-day expectations Driving under the influence Sexual behavior Blackouts Blood alcohol concentration determines effects At low effective blood levels: complex and abstract behaviors disrupted At higher blood levels: simpler behaviors also affected Mood changes can include euphoria, reduced anxieties, and reduced inhibitions Effects are greater when BAC is rising A higher BAC is needed to impair a chronic heavy drinker Expectations (placebo effects) explain many of the effects on social behavior Alcohol use serves as a social signal for a time-out from responsibilities, work, and seriousness Intoxicated individuals focus on the here and now, with little care for future consequences (alcohol myopia) DRIVING UNDER INFLUENCE Less than 40 percent of all traffic crash fatalities are linked to alcohol use Risk of a fatal crash is dose-related Single-vehicle fatalities are more likely to involve alcohol than are multiple-vehicle fatalities Alcohol-related fatalities are more likely to occur during dark hours and on weekends Men are more likely than women to be involved in an alcohol-related fatal crash Anyone who drinks and drives (not just problem drinkers) is a potential threat Current efforts Keep repeat offenders off the road Publicize the dangers of drinking and driving Target younger drinkers for special prevention efforts Sexual behavior Alcohol use enhances interest in sex but impairs physiological arousal Linked to unsafe sex Blackouts A danger sign of excessive alcohol use Crime and violence—alcohol use is statistically related to violence Homicide Assault, including family violence, sexual assault, and date rape Suicide Peripheral circulation: Dilation of peripheral blood vessels means that drinkers lose body heat but feel warm Fluid balance: Alcohol has a diuretic effect that can lower blood pressure in some people Hormonal effects: Chronic abusers of alcohol can develop a variety of hormone-related disorders Crime and violence Physiological Effects
- An alcoholic is a problem drinker, but a problem drinker is not necessarily an alcoholic Alcoholics are dependent on alcohol – a problem drinker has interpersonal, financial, or social problems from drinking The problem drinker may drink infrequently, but has problems when consuming alcohol A common symptom of problem drinking is blackouts, characterized by temporary memory loss Common elements of alcoholism Alcoholics are unable to control their drinking Some physical, social, or psychological consequence will result from their drinking
- Genetics is not destiny
- The family affected by alcoholism is not a normal family Responsibility and blame for an alcoholic family do not rest with them Growing up in an alcoholic household, although painful, can be a learning experience ACOAs have to acquire skills to form healthy relationships
- Guilt, self-hatred, helplessness, despair
- Hurt, exhaustion, fearful, anxious, betrayed
- Internalized messages I will take care of everyone I’m okay if I do well I’m responsible for everything I must look good at all costs Underlying feeling: INADEQUACY Payoff: Honor/worth
- PAYOFF: REMOVE FOCUS FROM REAL PROBLEM, TARGET FOR PAIN Internalized messages I’ll show you I don’t need anyone I don’t care I won’t feel You can’t hurt me
- PAYOFF: RELIEF OF RESPONSIBILITY Internalized Messages I don’t matter I am invisible I have no self I am worthless
- PAYOFF: FUN, DISTRACTION Internalized Messages I laugh instead of cry If they laugh, they like me I can fix it I’m not worth taking seriously I will stay little
- According to the Violent Death Reporting System, in 2004 73% of suicides also tested positive for at least one substance (alcohol, cocaine, heroin or marijuana). http://www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-F1EC-3F66462866FCB4E6
- Leading cause of death 15-20 years is motor vehicle crashes Highest rate of drunk driving fatalities is 21-24. in pedestrian fatalities, 48% involved alcohol. Moped drivers is higher than that of automobile or motorcycle drivers, mortality rate is higher 38% of women and 48 % of men admitted to ERs tested positive for drugs, alcohol the most prevalent In fire fatalities, victims were more likely to have high BAC than survivors 20% of boating fatalities are from alcohol related accidents 40% of drownings (Canada)
- HISTORY Alcoholic beverages have been consumed for thousands of years, at least as far back as 6400 BC (beer and berry wine) Grape wine has existed for over 2,000 years Mead may date back to the Paleolithic Age, around 8000 BC Beer was consumed by Native Americans at the time of Columbus’s landing Before American Revolution People drank more alcohol than water Drunkenness was viewed as misuse of positive product After American Revolution Alcohol itself viewed as the cause of serious problems, an active agent of evil Alcohol was first psychoactive substance to become demonized in American culture Benjamin Rush (1745-1813) Heavy drinking = health problems Alcohol use damages morality Alcohol addiction = a disease Temperance societies Initially promoted abstinence from distilled spirits and moderate consumption of beer and wine Later promoted total abstinence Became fashionable to “take the pledge” (see right) States began passing prohibition laws in 1851 By 1917, 64 percent of Americans lived in “dry” territory Laws reflected issues of class, ethnicity, religion, immigration, and politics People still drank illegally in speakeasies and private clubs and legally through purchase of patent medicines Federal prohibition 18th Amendment to the U.S. Constitution, banning the sale of alcohol, was ratified in January 1919 National prohibition went into effect in January 1920 People continued to buy and sell alcohol illegally, and enforcement was challenging and expensive Organized crime became more organized and profitable Alcohol dependence and alcohol-related deaths declined REPEALED Concerns that widespread disrespect for Prohibition laws encouraged a general sense of lawlessness Taxation: Alcohol taxes had been a major source of revenue Repealed by the 21st Amendment Ratified in 1933 Alcohol per capita sales and consumption increased slowly until after World War II, when they returned to pre-Prohibition levels Regulation after 1933 Some states remained dry after national prohibition ended, but most allowed at least beer sales Laws were slowly relaxed until the last dry state, Mississippi, became wet in 1966 Drinking ages were lowered in some states but raised again to 21 following concerns over increased drinking rates and alcohol-related traffic accidents Taxation Federal and state taxes and licensing fees = about half the price of an alcoholic beverage When taxes go up, consumption goes down, but not dramatically Colonial Times: Pilgrims anchored at Plymouth because their supply of beer and spirits was becoming depleted Attitudes of early settlers toward alcohol were positive Two important factors: sanitation and nutrition 1640: Dutch opened the first distillery on Staten Island Rum trade was New England’s most profitable business Consumption peaked during Jefferson’s presidency 1784: Dr. Benjamin Rush described harmful effects Early 1800s: movement to curb the escalating rate of alcohol use and abuse Alcohol was seen as a major cause of crime and violence Temperance movement sought to modify alcohol use, not to eliminate it 1808: independent organizations formed temperance groups 1826: American Society for the Promotion of Temperance 1830 to 1840, annual per capita use of alcohol declined from about 7 gallons per adult to about 3 gallons Following the Civil War, the temperance movement became strong again Three influential groups in alcohol reform: Women’s Christian Temperance Union (WCTU) Anti-Saloon League National Prohibition Party 1880 to 1889: 7 states passed prohibition laws 1907 to 1919: 34 states passed similar legislation 1920: U.S. Senate adopted the 18th Amendment (Volstead Act) which prohibited the manufacturing and sale of alcohol Problems: Illegal trade of alcohol Organized crime Enforcement problems Toxic adulterants in black market alcohol Home brewing was not illegal
- Regional differences in the United States Stress index: Drinking rates higher in states where people experience a great deal of social stress and tension Drinking norms: Drinking rates higher in states where people tend to approve of the use of alcohol to relieve stress Gender differences: Males more likely to drink than females, and more likely to drink more Women’s drinking patterns: Women who are unemployed, looking for work, or employed part-time outside the home Women who are divorced, separated, or not married but living with a partner Heavy drinking after a health problem such as depression or reproductive difficulties Drinking among college students College students drink more than their nonstudent peers Many campuses have banned sale and advertising of alcohol, and many fraternities have banned keg parties Alcohol use and drinking behavior hasn’t changed significantly in response Today’s college students are less likely to drink and drive compared to students in the early 1980s Student drinking patterns: Australia: almost one-half of students drank to harmful or hazardous levels Germany: 80% of university students drank heavily and 20% displayed problem drinking 37% of college students binge drink 44% reported being drunk within the past 30 days Binge drinking: Consuming five or more drinks (men) or four (women) in a short period of time Typically starts at an early age and increases during adolescence Motivations change as people age Influenced by the perception of others’ use of alcohol The highest rate of alcohol consumption is in the West while the lowest rate of consumption is in the South Abstinence is increasing for men and women Rates of abstinence and heavy drinking are greater in rural areas The proportion of heavy drinkers in their 20s has increased slightly, along with problems related to alcohol dependency Variables correlated with drinking patterns: College students who are fraternity and sorority members have higher alcohol consumption rates Gay men and lesbians are more likely to drink heavily Binge drinking is more common in households with an annual income above $75,000 Adolescents who are victims of bullying are more likely to drink as a coping mechanism European adolescents living in rural areas binge drink more than urban adolescents People who engage in binge eating are more likely to engage in binge drinking Drinking patterns by ethnicity: Whites begin drinking at an earlier age than Blacks and Hispanics, and progress faster to alcohol dependence Alcohol-related mortality is greater for Black and Hispanic men than for White and Asian American men Mexican Americans had more alcohol-related problems than those of Puerto Rican or Cuban origin Drinking patterns are affected by acculturation Asian students resist social pressure to drink alcohol better than Caucasians Native Americans have the highest rates of alcohol-related deaths of all ethnicities in the US
- Cultural influences on drinking—ethnic and social factors Trends in U.S. alcohol consumption Use peaked in 1981, followed by a decline, mirroring patterns of illicit drug use Decline particularly significant for distilled spirits About one-third of Americans abstain Average consumption among drinkers = about 3 drinks per day—but most drink far less Half of all alcohol consumed in the United States is consumed by about 10 percent of the drinkers Regional differences in the United States Stress index: Drinking rates higher in states where people experience a great deal of social stress and tension Drinking norms: Drinking rates higher in states where people tend to approve of the use of alcohol to relieve stress Most people who drink today are social drinkers who are able to abstain from alcohol at will People who cannot abstain and develop medical and social difficulties are called problem drinkers or alcoholics A person can abuse alcohol and not be an alcoholic Alcohol is a legal drug Leads to belief that effects are not negative or severe Belief that, if alcohol were bad, the government would limit its availability Parents and other role models consume alcohol as part of their lifestyle As costs increase, consumption levels decrease An increase in taxes on alcohol appears to reduce consumption, especially among underage drinkers A decline in alcohol drinking since the early 1980s has been reflected largely in less use of distilled spirits such as whiskey, vodka, gin, and rum
- The definition of moderate drinking for men is no more than two alcoholic drinks per day – for women, no more than one alcoholic drink per day There is no standard definition of heavy drinking Binge drinking is consumption of five or more drinks at one sitting for men and four or more drinks for women
- Alcohol overdose (poisoning) is common and dangerous If someone drinks enough to pass out Place her or him on side and monitor breathing or take to ER immediately Do not leave the person alone If someone drinks enough to vomit He or she should stop drinking Vomiting reflex indicates a rapidly rising BAC but is suppressed at BACs above 0.20 percent HANGOVER Symptoms: upset stomach, fatigue, headache, thirst, depression, anxiety, and general malaise Possible causes: alcohol withdrawal, exposure to congeners, cellular dehydration, gastric irritation, reduced blood sugar, and/or the accumulation of acetaldehyde Moderate drinking is the only way to avoid a hangover LONG TERM RISKS Brain tissue loss and intellectual impairment Liver disease: hepatitis, fatty liver, cirrhosis (see right) Heart disease: cardiomyopathy, heart attack, hypertension, stroke Alcohol’s effects on HDL may reduce heart attack risk among moderate drinkers Cancer Impaired immunity
- FAS = a collection of physical and behavioral abnormalities caused by the presence of alcohol during fetal development Diagnostic criteria Growth retardation before and/or after birth Pattern of abnormal features of the face and head Evidence of central nervous system abnormality Fetal alcohol spectrum disorders (FASD): Various effects that occur as a result of women who drink alcohol while pregnant Effects can be behavioral, physical, and/or mental Leading known cause of mental retardation Fetus is especially vulnerable during the first trimester of pregnancy Smaller brain at birth, head and facial anomalies, retarded growth, central nervous system problems, and malformations of major organs, eye problems
- Alcohol use is associated with neurotic and psychotic symptoms from depressive reactions to generalized anxiety disorders and panic attacks Wernicke-Korsakoff syndrome is a brain disorder due to thiamine (vitamin B1) deficiency. Causes Wernicke encephalopathy and Korsakoff syndrome are different conditions. Both are due to brain damage caused by a lack of vitamin B1. Lack of vitamin B1 is common in people with alcoholism. It is also common in persons whose bodies do not absorb food properly (malabsorption), as sometimes occurs with a chronic illness or after obesity (bariatric) surgery. Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke symptoms go away. Wernicke encephalopathy causes brain damage in lower parts of the brain called the thalamus and hypothalamus. Korsakoff psychosis results from permanent damage to areas of the brain involved with memory. Symptoms Symptoms of Wernicke encephalopathy include: Confusion and loss of mental activity that can progress to coma and death Loss of muscle coordination (ataxia) that can cause leg tremor Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping Alcohol withdrawal Symptoms of Korsakoff syndrome: Inability to form new memories Loss of memory, can be severe Making up stories (confabulation) Seeing or hearing things that are not really there (hallucinations) Exams and Tests Examination of the nervous/muscular system may show damage to many nerve systems: Abnormal eye movement Decreased or abnormal reflexes Fast pulse (heart rate) Low blood pressure Low body temperature Muscle weakness and atrophy (loss of tissue mass) Problems with walk (gait) and coordination The person may appear poorly nourished. The following tests are used to check a person's nutrition level: Serum albumin (relates to person's general nutrition) Serum vitamin B1 levels Transketolase activity in red blood cells (reduced in people with thiamine deficiency) Liver enzymes may be high in people with a history of long-term alcohol abuse. Other conditions that may cause vitamin B1 deficiency include: AIDS Cancers that have spread throughout the body Extreme nausea and vomiting during pregnancy (hyperemesis gravidarum) Heart failure (when treated with long-term diuretic therapy) Long periods of intravenous (IV) therapy without receiving thiamine supplements Long-term dialysis Very high thyroid hormone levels (thyrotoxicosis) A brain MRI may show changes in the tissue of the brain. But if Wernicke-Korsakoff syndrome is suspected, treatment should start immediately. Usually a brain MRI exam is not needed. Treatment The goals of treatment are to control symptoms and to prevent the disorder from getting worse. Some people may need to stay in the hospital early in the condition to help control symptoms. Monitoring and special care may be needed if the person is: Comatose Lethargic Unconscious Vitamin B1 may be given by injection into a vein or a muscle, or by mouth. It may improve symptoms of: Confusion or delirium Difficulties with vision and eye movement Lack of muscle coordination Vitamin B1 usually does not improve loss of memory and intellect that occur with Korsakoff psychosis. Stopping alcohol use can prevent more loss of brain function and damage to nerves. Eating a well-balanced, nourishing diet can help, but it is not a substitute for stopping alcohol use. Outlook (Prognosis) Without treatment, Wernicke-Korsakoff syndrome gets steadily worse, and can be life-threatening. With treatment, it is possible to control symptoms (such as uncoordinated movement and vision difficulties). This disorder can also be slowed or stopped. Some symptoms, especially the loss of memory and thinking skills, may be permanent. Other disorders related to alcohol use may also occur. http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm
- The liver is the main site of metabolism of alcohol
- Heavy drinkers are prone to infections such as pneumonia and peritonitis Alcohol dependence reduces immunity to diseases such as HIV
- Research links alcohol abuse with cancers of the nasopharynx, esophagus, larynx, and liver Risk of colon cancer is 26% higher for people who have more than two alcoholic drinks per day Drinking red wine has been associated with reduced risk of prostate cancer and kidney cancer Cancers of the lower gastrointestinal tract associated with beer consumption may be attributable to congeners