Chapter 9 Alcohol


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Chapter 9 Alcohol

  1. 1. Alcohol Chapter 9
  2. 2. Alcoholic Beverages <ul><li>“Alcohol” refers to many substances – for example, isopropyl alcohol (rubbing alcohol) and methyl alcohol (wood alcohol), but ethanol is the alcohol we drink </li></ul><ul><li>Three classes of alcoholic beverage: beer, wine, hard liquor (distilled spirits) </li></ul><ul><li>All are made through fermentation , which begins when sugar is dissolved in water and exposed to air and thus creates yeasts. </li></ul><ul><li>Fermented beverages do not have an alcohol content higher than 15% </li></ul>
  3. 3. <ul><li>Beverages produced from fermentation depends on what sugar-containing substance is used, i.e., grapes for wine, grains for beer </li></ul><ul><li>Hard liquor requires further processing called distillation, which was created to increase the ethanol content of fermented beverages. </li></ul><ul><li>Distillation – the process by which the heating of a fermented mixture increases its alcohol content </li></ul><ul><li>Proof – The proportion of alcohol in a beverage, by volume. Proof typically is used in reference to distilled spirits and equals twice the percentage of alcohol </li></ul>
  4. 4. History of Alcohol Use <ul><li>First beers produced in Egypt 5000 to 6000 B.C. was thought to have been made like baking bread where a barley dough was soaked in water until fermentation produced an acid beer called boozah” </li></ul><ul><li>Earliest reference to distilled spirits appeared in China in 1000 B.C. </li></ul><ul><li>No record in Western Europe until about 800 A.D. </li></ul><ul><li>Alcohol has been a double-edged sword, playing a role in many important social occasions such as births, religious ceremonies, marriages, and funerals but , on the other hand, always causing a problem for some and the society for which he or she lived </li></ul>
  5. 5. <ul><li>In Colonial America drinking was pervasive </li></ul><ul><li>Tavern was the center of town politics, business, trade, and pleasure </li></ul><ul><li>Drinking showed no distinction among time, place, or person </li></ul><ul><li>Attitudes toward alcohol consumption were positive and in 1790, adult citizens drank 6 gallons of pure alcohol per capita annually, rising to 7 gallons in 1830 </li></ul><ul><li>Averages to five alcoholic beverage drinks a day for each adult </li></ul>
  6. 6. <ul><li>Dr. Benjamin Rush, a pillar of the Temperance Movement, spoke out against alcohol in his treatise of 1785 titled “Inquiring into the effects of distilled spirits on the human body and mind” </li></ul><ul><li>This document was the basis of the idea that alcoholism is a disease </li></ul><ul><li>As America expanded westward, the tavern was replaced by the saloon but was not the center of civilized interchange as before </li></ul><ul><li>Behavior associated with the saloon led to the rebirth of the Temperance movement </li></ul>
  7. 7. <ul><li>Captains of industry of the late 19 th and early 20 th centuries such as John D. Rockefeller, Andrew Carnegie, and Henry Ford supported the Temperance Movement believing that abstinent employees would be better employees </li></ul><ul><li>The antialcohol drive led to the passage of the Volstead Act and Prohibition, and though repealed in 1933, many laws have been passed since illustrating America’s ambivalence about the use of alcohol </li></ul><ul><li>The general trend has been toward limiting alcohol’s use through changes in social attitudes and tighter government controls </li></ul>
  8. 8. Consumption of Alcohol and Heavy Drinking in the U. S. <ul><li>Per Capita Consumption is one statistic used to indicate how much the “average” person in the U.S. drinks </li></ul><ul><li>Quantity of alcohol in gallons is divided by population number to yield per capita alcohol consumption in gallons </li></ul><ul><li>Per capita consumption showed a constant increase after Prohibition into the 1940s with another increase from 1960 through the 1970s. The 1980s marked the beginning of a decline which was slightly reversed in 1990, declined again, and then rose slightly to 2.2 gallons from 1995 to 2003. </li></ul>
  9. 9. <ul><li>2.2 gallons of pure alcohol equals about 563 12-ounce cans or bottles of regular domestic beer </li></ul><ul><li>The decrease in the 1980s to the mid-1990s was due to a reduction in the use of hard liquor reaching it’s lowest point since 1939 in 1995 </li></ul><ul><li>From 1995 to 2003 there were slight increases in the consumption of wine and hard liquor with beer staying about the same </li></ul><ul><li>“Heavy drinking” is defined as drinking associated with negative consequences: accidents, job and family problems, symptoms of dependence </li></ul><ul><li>Most important is the amount of alcohol consumed on one drinking occasion </li></ul>
  10. 10. <ul><li>The data shows the average U.S. drinker consumes a considerable amount of alcohol in a year </li></ul><ul><li>In 2004, more than 7% of the national sample reported heavy drinking in the last month </li></ul><ul><li>Men reported a rate of heavy drinking 3x higher than women </li></ul><ul><li>More than 15% of 18-25 year olds reported heavy drinking compared to the overall rate of 6.9% , with rates of 21.2% for men compared to only 8.8% for women </li></ul><ul><li>Whites reported a higher rate ( 19.4%) than did either Blacks ( 5.9%) or Hispanics ( 9.0%) </li></ul>
  11. 11. Consumption of Alcohol and Heavy Drinking Among College Students <ul><li>Drinking is such a large part of campus life at most colleges that many believe there is a “culture of alcohol” or pro-alcohol consumption traditions / customs passed on from one generation of students to the next </li></ul><ul><li>Students tend to be “binge drinkers” - consuming at least 5 (for men) or 4 (for women) drinks on at least one occasion in the last two weeks </li></ul><ul><li>Students who drink the most are first year students, Whites, members of fraternities and sororities, and athletes </li></ul>
  12. 12. <ul><li>Students who drink the least attend religious schools, commuter schools, and historically Black colleges and universities </li></ul><ul><li>Percentage of students classified as abstainers increased in 2001, as did the number of students asking others to reduce their alcohol use, and the number of students supporting policies such as prohibiting kegs, banning alcohol advertisements, and offering alcohol-free residences </li></ul>
  13. 13. CONTEMPORARY ISSUE BOX 9.2 “Drinking Games and Alcohol Advertising” <ul><li>Drinking games such as beer pong are popular among college students yet promote heavy drinking </li></ul><ul><li>This raises the question as to what role beer manufacturers should play in promoting drinking games through advertisement </li></ul><ul><li>Beer manufacturers argue their marketing is not illegal, it targets people over 21 only, and they always promote “responsible drinking” </li></ul><ul><li>Should the beer manufacturers be able to promote drinking games and should the alcohol beverage industry be as restricted as the tobacco industry?????? </li></ul>
  14. 14. Pharmacology of Alcohol <ul><li>Alcohol is a CNS depressant </li></ul><ul><li>Pinpointing a site of action or a single mechanism of alcohol effects is difficult because the drug effects cell membranes, all neurochemical systems, and all endocrine systems </li></ul><ul><li>Because it provides calories, alcohol is classified as a food </li></ul><ul><li>Factors influencing absorption are those that alter the rate of alcohol’s passage from the stomach to the intestines </li></ul><ul><li>These include eating, milk is especially effective in slowing absorption, and the rate at which the alcohol is consumed </li></ul>
  15. 15. Absorption <ul><li>Drinks with a higher concentration of alcohol and carbonated beverages are absorbed more quickly </li></ul><ul><li>A reflexive action of the body that prevents the drinking of large quantities of alcohol involves the pylorus, a muscular valve between the stomach and intestines that shuts when a large amount of alcohol has been ingested </li></ul><ul><li>Pylorospasm – The shutting of the pylorus valve that occurs in some people when they drink very large quantities of alcohol </li></ul><ul><li>This is an important safeguard since only 10 to 20% of the alcohol in the stomach is absorbed </li></ul>
  16. 16. Distribution <ul><li>Blood is about 70% water and thus gets a high concentration of alcohol </li></ul><ul><li>Concentration of alcohol in the brain approximates that in the blood because of the brain’s large blood supply and because alcohol freely passes the blood brain barrier </li></ul><ul><li>The blood alcohol concentration (BAC) is the amount of alcohol in the bloodstream </li></ul><ul><li>BAC is approximated by an equation that includes alcohol dose and time. Other factors that influence BAC are % of body fat, gender, and rate of alcohol metabolism </li></ul>
  17. 17. <ul><li>Alcohol’s LD 50 is a BAC of .45% - .50% </li></ul><ul><li>The average adult would reach alcohol’s LD 50 after drinking about 25 standard drinks in an hour or so </li></ul><ul><li>Standard Drink – The alcohol equivalent in a drink of beer, wine, or distilled spirits. A standard drink equals .5 ounces of alcohol – about the alcohol content in 12 ounces of beer, 4 ounces of table wine, or 1 ounce of 90-100 proof whiskey </li></ul><ul><li>More than 90% of the alcohol absorbed is metabolized by the liver at a constant rate of about .35 ounces of alcohol an hour, and little can be done to quicken the pace </li></ul>
  18. 18. <ul><li>Disulfiram (Antabuse) – A drug that interferes with the metabolism of alcohol so that a person soon feels very ill if he or she drinks while on a regimen of disulfiram. </li></ul><ul><li>Used as part of a treatment program for alcohol dependence </li></ul><ul><li>It takes two or three days after a person stops taking disulfiram before a drink can be taken safely, so a person must make decision to stop taking the drug for that length of time if he or she wants to drink </li></ul><ul><li>Most effective by helping those who want to avoid drinking by helping them resist a momentary impulse or giving in to social pressures </li></ul>
  19. 19. Tolerance and Dependence <ul><li>Alcohol use results in dispositional tolerance, an increase in the rate of metabolizing the drug, and therefore the drinker must consume greater quantities of alcohol in order to maintain a certain BAC </li></ul><ul><li>Acute and protracted functional tolerance also develop and have a greater influence on how alcohol effects a person </li></ul><ul><li>There is both cross-tolerance and cross-dependence between alcohol and other CNS depressant drugs </li></ul><ul><li>Benzodiazepine drugs such as Valium and Librium have been used to manage withdrawal from alcohol </li></ul>
  20. 20. Physical Dependence <ul><li>Symptoms of physical dependence can be severe and may be classified into three phases, though not all people experience all three phases of symptoms (See Table 9.3 for Symptoms of the Alcohol Withdrawal Syndrome) </li></ul><ul><li>Phase 2 symptoms appear least frequently </li></ul><ul><li>Before its management by use of drugs, alcohol withdrawal often ended in death </li></ul><ul><li>Social Detoxification – Treatment of alcohol withdrawal without the use of medicine </li></ul><ul><li>Orientation to Time – Awareness of temporal specification, such as time of day, day of the week, or year. Orientation to time is one of the functions assessed in a psychiatric mental status exam </li></ul>
  21. 21. Therapeutic Uses <ul><li>Alcohol is an ingredient in several legitimate medical products such as cough syrups </li></ul><ul><li>It is an ingredient in mouth washes and shaving lotions </li></ul><ul><li>Because it cools when it evaporates, ethanol sponges are used to treat fevers </li></ul><ul><li>Part of liniments </li></ul><ul><li>Dehydrated alcohol may be injected to relieve chronic pain </li></ul><ul><li>Recommended in moderate amounts to convalescent or elderly patients to be taken before meals to stimulate appetite and digestion </li></ul>
  22. 22. Acute Effects of Alcohol <ul><li>Intoxication – A transient state of physical and psychological disruption caused by the presence of a toxic substance, such as alcohol, in the CNS. </li></ul><ul><li>How humans experience intoxication and behave under the influence of alcohol is influenced by psychological and situational factors as well as alcohol dose and tolerance to the drug </li></ul><ul><li>Alcohol’s acute action is evident in a wide variety of physiological, sensorimotor, and behavioral effects </li></ul><ul><li>In general, as the BAC increases, acute effects increase in number and intensity </li></ul>
  23. 23. Physiological Effects <ul><li>By inhibiting the secretion of the antidiuretic hormone, alcohol causes increased urination </li></ul><ul><li>Reduces the amount of fat in the body that is oxidized </li></ul><ul><li>Is a peripheral dilator and thus causes the skin to feel warm and turn red </li></ul><ul><li>Increases gastric secretion and stimulates the appetite, which is the basis for the cocktail hour </li></ul><ul><li>Disrupts sleep patterns, such as suppressing REM sleep </li></ul><ul><li>REM sleep – Acronym for “rapid eye movements” which are associated with dream activity and are one stage in a cycle of sleep </li></ul>
  24. 24. <ul><li>Impairs memory, with greatest impact on short-term memory. When high BACs are reached rapidly, a blackout may occur </li></ul><ul><li>Blackout – Failure to recall events that occurred while drinking even through there is no loss of consciousness. Thought to result from a failure in the transfer of information in short-term memory to long-term memory. “Grayouts” may also occur where the person can partially recall events while drinking </li></ul><ul><li>Short-term Memory – Memory for recent events; thought to differ from long-term memory in several important ways </li></ul>
  25. 25. <ul><li>Long-term Memory – Memory for remote events. According to one theory of memory, information enters long-term memory through short-term memory </li></ul><ul><li>Hangover – Thought of as a minor withdrawal syndrome which begins about 4-12 hours after the peak BAC is reached </li></ul><ul><li>Alcohol interacts synergistically with other CNS depressants and thus is a common cause of both intended and unintended suicides. Mixing alcohol and the barbiturates is especially dangerous </li></ul><ul><li>Mixing alcohol and benzodiazepines and alcohol and marijuana can cause serious decrements in driving skills </li></ul>
  26. 26. Alcohol and Driving Ability <ul><li>Sensorimotor skills constitute a major part of driving ability </li></ul><ul><li>Vision decreases in acuity </li></ul><ul><li>Reaction time begins to slow significantly at a BAC of .10% </li></ul><ul><li>Alcohol strongly affects body sway, thus the reason for the “walk a straight line” test by police </li></ul><ul><li>Psychomotor skills begin to be impaired as low as BACs of .03% </li></ul><ul><li>Motor vehicle crashes are the most common nonnatural cause of death in the U.S. and the leading cause of death overall of people aged 1-24. </li></ul>
  27. 27. <ul><li>Alcohol appears to be a major contributor in both fatal and nonfatal automobile accidents </li></ul><ul><li>Gender and age combine with alcohol to influence risk of involvement in an accident. For example, young drivers are disproportionately more likely to be involved in alcohol-related accidents with young men (18-34 years old) most likely to be intoxicated, driving, and in traffic accidents </li></ul><ul><li>The higher risk for young people is thought to be due to their relative inexperience in both drinking and driving </li></ul>
  28. 28. Psychological Effects <ul><li>Alcohol combines with other factors to change emotion and mood </li></ul><ul><li>Situational and cognitive variables (expectancies and attitudes) influence effects, as does the person’s mood state before he or she started to drink </li></ul><ul><li>Drinkers report different feelings depending on whether the BAC is rising or falling </li></ul><ul><li>Effects on thinking and perception are less influenced by nondrug factors and more by the BAC </li></ul><ul><li>Drinkers report feelings ranging from elation, relaxation, and self-confidence to feeling depressed, hostile, and withdrawn </li></ul>
  29. 29. Alcohol, Aggression, and Sex <ul><li>Alcohol is consistently associated with violence </li></ul><ul><li>The co-occurrence of alcohol use and violent crime is especially prevalent among men 18-30 years old who have a high rate of both heavy drinking and criminal activity </li></ul><ul><li>Alcohol has been estimated to be involved in 25%-50% of spouse abuse incidents </li></ul><ul><li>Suicide is one of the three leading causes of death among men 15-34 years old and one of the 10 leading causes of death among all persons 34-54 </li></ul><ul><li>Studies have shown that 35% of suicide victims had been drinking when they took their lives </li></ul>
  30. 30. <ul><li>Despite the consistent co-occurrence of drinking and violent behavior, alcohol does not itself cause aggression. Aggression is a complex social behavior affected by the characteristics of the aggressor and situational factors, only one of which is alcohol consumption </li></ul><ul><li>Alcohol’s effects on sexual behavior are similarly complex </li></ul><ul><li>Studies of alcohol expectancies suggest that the drinking public (both men and women) generally believe alcohol enhances sexual experience </li></ul><ul><li>Pharmacologically, alcohol impairs sexual performance, particularly when BACs reach .05% and higher </li></ul>
  31. 31. CONTEMPORARY ISSUE BOX 9.5 “Accuracy of Self-Reports of Alcohol Consumption” <ul><li>How accurate are self-reports of alcohol consumption and what factors play a role? </li></ul><ul><li>Limitations of human memory </li></ul><ul><li>How much alcohol is actually in your drink? – bartender variability </li></ul><ul><li>Perceptual illusions, i.e., bartenders pouring more alcohol in taller glasses </li></ul><ul><li>Knowing such limitations, scientists attempt to look to converging evidence and replication of studies to be confident in their results. </li></ul>
  32. 32. Effects of Chronic Heavy Drinking <ul><li>Some chronic effects are caused directly by alcohol’s toxicity to the body, yet others are indirectly related to long-term abusive drinking </li></ul><ul><li>Wernicke’s disease – Involves impaired cognitive functioning caused by nutritional deficiencies that tend to occur in people who are dependent on alcohol. Characterized by confusion, loss of memory, staggering gait, and an inability to focus the eye </li></ul><ul><li>In the absence of permanent brain damage, Wernicke’s disease is reversible by giving the patient Vitamin B 1 </li></ul>
  33. 33. <ul><li>Two prominent body systems that alcohol harms are the brain and the liver </li></ul><ul><li>Korsakoff’s syndrome – Associated with damage to brain structure and most affects memory, with short-term memory and learning most affected. Because of these dysfunctions, there often is considerable confusion and confabulation </li></ul><ul><li>Confabulation – A fabrication of events, when asked questions concerning them, because of an inability to recall </li></ul><ul><li>Three liver disorders that are attributable to drinking are fatty liver, alcohol hepatitis, and cirrhosis </li></ul>
  34. 34. <ul><li>Fatty liver is characterized by fat accumulating in the liver and is reversible with abstinence from alcohol </li></ul><ul><li>Alcohol hepatitis is more serious and involves the inflammation and death of liver cells. This condition is reversible with abstinence and medical treatment but can cause death if severe enough and not treated </li></ul><ul><li>The most serious and life- threatening is cirrhosis, a chronic inflammatory disease of the liver involving cell death and the formation of scar tissue. It is not reversible and often results in death </li></ul><ul><li>Alcohol dependence is the leading cause of cirrhosis, which is the eighth leading cause of death by disease in the United States </li></ul>
  35. 35. <ul><li>Both men and women suffer impaired sexual and reproductive functioning as a result of chronic, heavy drinking </li></ul><ul><li>A mother’s drinking during pregnancy may result in fetal alcohol syndrome (FAS) in the newborn child </li></ul><ul><li>FAS falls into the class of alcohol teratology </li></ul><ul><li>Teratology – In biology, the study of monsters, or distortions in growth </li></ul><ul><li>FAS consists of gross physical deformities that are identifiable at birth and is associated with continued physical problems as well as subaverage intellectual functioning later in childhood </li></ul>
  36. 36. Moderate Drinking and Health <ul><li>“Moderate” is defined as one to three drinks a day and “Health” most often has been measured by risk of cardiovascular disease and mortality </li></ul><ul><li>Most experts have concluded, and there is good research support for the hypothesis that moderate drinking is associated with lower risk of coronary disease </li></ul><ul><li>The French paradox lends support to the moderate drinking-health hypothesis in that there is a co-occurrence of a diet high in saturated fat and a low incidence of coronary heart disease with consumption of relatively high amounts of wine </li></ul>
  37. 37. The Development of Alcohol Abuse and Dependence <ul><li>Until recently researchers and clinicians sought a single-factor explanation of what causes alcohol problems </li></ul><ul><li>Biological approaches hold that a physiological or structural anomaly causes the individual to become alcohol-dependent. Examples included metabolic, glandular, body chemistry, allergic reactions and the most popular genetic predisposition theories which have some research support from family, twin, and adoption studies </li></ul>
  38. 38. <ul><li>The argument for a biological predisposition to alcohol dependence continues to gain strength as a 2004 study suggests genetic factors may account for up to one half of the variance in the etiology of alcohol dependence. </li></ul><ul><li>The most prevalent position among treatment providers is that alcohol dependence is a physical disease and the disease model is a biological model </li></ul><ul><li>Sociological models focus on cross-cultural differences in drinking patterns and demographic factors </li></ul>
  39. 39. <ul><li>Psychological explanations have centered on the “alcoholic personality” or a psychological trait or set of traits that predispose someone to become alcohol-dependent. Some research has revealed that the personality dimensions of neuroticism-emotionality, extraversion-sociability, and impulsivity-disinhibition predispose one to alcohol dependence </li></ul><ul><li>The “Biopsychosocial” model suggests that single-cause theories are inadequate and argues that a combination of factors cause alcohol dependence </li></ul>
  40. 40. I’m outa here !!