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A Delightful Poison
1. HOL
A L CO
A 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. “Alcohol may be man’s worst enemy, but
the bible says love your enemy.”
- Frank Sinatra
27. Women:
10 drinks per week
2 drinks per day
Men:
15 drinks per week
3 drinks per day
http://www.camh.ca
28.
29. How much do Canadians drink?
Turn to the person next Canadian Men =
to you and tell them
your guess of the
________ standard drinks
percentage of Canadian
men and Canadian
women who drink more Canadian women =
than 14 standard drinks
in a typical week. ________ standard drinks
30.
31.
32.
33. Jolinda almost never drinks at
home with her family, but
occasionally on week ends she
gets together with a group of
female friends for dinner and
conversation. On the rare
occasions when she has more
than one or two drinks she says
that she feels drunk and dizzy.
Jolinda is known among her
social group as the one who “can’t
hold her liquor,” and is sometimes
the subject of friendly teasing
among the group.
34. Alex loves to entertain and
socialize with friends and family.
His dinner parties are legendary for
their fine food and wine, and
creating new recipes and shopping
for hard-to-find ingredients is one of
his favourite hobbies. If he were
asked to quantify his drinking, Alex
wouldn’t know where to start –
alcohol is very much a part of his
life, yet he has a successful career
and a close relationship with his
adult children, although his wife
sometimes “nags” him about his
drinking. Although he drinks a lot
on many occasions, his friends
have only rarely ever seen him
“drunk”.
38. mucous membranes esophagus
(mouth)
stomach (up to 20%)
large intestine
small intestine (up to 80%)
39. 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
40. Enzyme in the liver
transforms ethanol into a
toxic compound
A known
carcinogen,
Chemical name quickly broken
for 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
48. 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
49. Effects on the Cerebellum
CONTROL ALCOHOL
Reduction in size of brain cells and brain
mass shrinks
Sullivan et al., Neuropsychology
51. • Alcoholic
cardiomyopathy
• Arrhythmias
• Strokes
• Hypertension
Binge drinkers are
40% more likely to
suffer any kind of
stroke
NIAAA, 2011
52.
53. “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
55. Smoking + Drinking POTENTIATES cancer-
causing properties of each substance
Potentially Potentially
reduced risk of increased risk
heart disease of cancer
56.
57. 11% of all breast
cancers
ACETALDEHYDE damages genetic
material in cells, and causes cells to grow
too quickly
http://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine-
opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathw
58. 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
59. • Steatosis (fatty
liver)
• Alcoholic
hepatitis
• Fibrosis (scar
tissue)
90% of heavy drinkers will
develop fatty liver • Cirrhosis
1 in 5 will develop alcoholic – Jaundice, Type
hepatitis 2 diabetes, Liver
1 in 4 will develop cirrhosis cancer
http://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine-
opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathw
NIAAA, 2011
67. 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/control
2.
X Recurrent use in physically 8. Time spent in obtaining,
X
hazardous situations using or recovering
3.
? Persistent
social/interpersonal
?
9. Important activities given
up or reduced
problems
4. Tolerance
X
10. Continued use despite
knowing that physical or
X
5. Withdrawal psychological problems will
become worse or were
6. Larger amounts or for
? longer period than caused
intended ?
11. Craving, strong desire or
urge
www.dsm5.org
69. 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) 6-7
Cooney, Zweben & Fleming, 1995
70. 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
71. 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 men
6 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 Clinician's Guide 2007
73. Continuum of Psychosocial
Treatment Services
Highly
Minimally
Intensive
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 Substantial
Moderate Severity of Problems To Severe
CAMH
74. 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
87. • 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
90. 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
94. 1. A feature that
resonated for me
2. A question I want to
think through
3. A seed I could plant
now
95.
96.
97. 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)
