ALCOHOL ABUSE

1. Alcohol abuse and
Intoxication
Dr.VIVEK BENJAMIN

2. 9,000 year History of alcohol
• We began drinking it long before we even knew how to write.
• It's one of the most universally available, widely used and commonly
abused chemical substances in human history.
• We’ve been using basic chemistry to make the stuff for thousands of
years.

3. 9,000 year History of alcohol
• our primate ancestors first enjoyed its benefits millions of years ago.
• fruit falls to the forest floor and begins to decompose it produces a
substance with a strong smell called ethanol.
• Ethanol also helps apes with digestion and allows them to fight off
microbes that would otherwise make them sick.
• This process of apes seeking out rotting fruit began to really ramp up
10 million years ago.

4. 9,000 year History of alcohol
• That’s when a mutation of the ADH4 gene in African apes allowed
them to suddenly begin digesting ethanol 40 times faster than before.
• Ethanol is the least toxic type of alcohol and the only one used in
beverages. As a chemical substance, ethanol is incredibly versatile.
• Detectable indicator of food spoilage, a life-saving disinfectant, a
beverage prized by the masses and perfected by connoisseurs.
• But it’s also powerfully addictive.

5. Made In China !
• The earliest traceable instance of deliberate fermentation
occurred 9,000 years ago when the Chinese were making a
kind of wine from rice, honey, and fruit.
• In 5,400 B.C. we see the first evidence of wine production at
Hajji Firuz in the Zagros Mountains of Iran.
• Alcohol appears in Europe for the first time in Scotland 6,500
years ago.
• Barley beer was first produced in Godin Tepe, Iran, an
ancient Sumerian fortress that would later become a major
stop along the legendary Silk Road trade route.
SAKE

6. Alcohol and Agriculture
• For decades, anthropologists have debated
whether the production of beer and other
alcoholic drinks was actually the primary
reason for the Neolithic — or agricultural
revolution.
• we transitioned from being wandering
nomads to living a fixed, agriculture-based
lifestyle.
• And just about every plant containing some
starch or sugar has been fermented for our
enjoyment.

7. Alcohol,is it all bad ?
• In ancient societies beer was a dietary staple—
like an enriched liquid bread that provided
calories and essential vitamins, while delivering
hydration in a more sterile way than water even
could.
• first large-scale brewing and winemaking
operations that emerged in Mesopotamia and
Egypt 5,000 years ago.
• It’s no coincidence that the construction of over
100 enormous pyramids,the greatest structures
in ancient history were built right alongside the
creation of the first large-scale production
breweries.
• introduction of the most efficient method for
delivering nutrients to our bodies

11. Effects on body
• GABA agonist when it binds to GABA receptor it makes the response
stronger
• Activates Opioid receptors induces release of ENDORPINS. It binds to
receptors on dopaminergic neurons in nucleus accumbens to
release dopamine and serotonin.
• Blocks Glutamate activity.

12. Why Addiction
• Nucleus Accumbens and Amygdala,
produces pleasant and rewarding
feelings like Euphoria.
• MORE LIKELY TO DRINK AGAIN

13. Effects on cerebral cortex
• Acts on Cerebral cortex , the thought
processing centre of brain, slows down
everything. Making it more difficult to
think and speak clearly.
• Ethanol slows Behavioural inhibition
centers , Pre frontal cortex making people
More relaxed and less self-conscious

14. Effects on cerebellum
• Cerebellum is responsible for movement & balance, Ethanol causes
individuals to lose coordination .
• Making it hard to walk and drive

15. Effects on medulla
• Affects Autonomic functions like
Breathing
Consciousness
Body temperature
Ethanol increases sleepiness, slows breathing , lowers body
temperature.

16. Effects on liver

25. Alcohol and
pancreatitis

26. Alcohol Abuse And Cardiomyopathy
• The muscle in the heart can thicken, stiffen, thin out, or fill up with
substances foreign to the heart that the body produces.
• As a result, the heart muscle’s ability to pump blood is reduced.
• which can lead to arrhythmias , volume overload , and heart failure .

27. THIAMINE AND ALCOHOL

28. THIAMINE AND ALCOHOL

29. THIAMINE AND ALCOHOL

30. THIAMINE AND ALCOHOL

31. Blood alcohol content
• BAC is % Ethanol in a given volume of blood
Affected by:
 The amount of Ethanol consumed
 A persons blood volume
Situational factors:
a) how much they’ve had to eat and drink ?
b) how well the body is prepared for alcohol ?

32. BAC
• BAC OF 0.0 % to 0.05 %
Feel relaxed and happy
May have slurred speech
May have difficulty with coordination and balance

33. BAC
• BAC of 0.06% to 0.15%
More impairment in
Speech
Memory
Attention
Coordination
• People may exhibit more aggression and violence
• Illegal to drive over BAC OF 0.08%

34. BAC
• BAC of 0.16% to 0.30%
ALCOHOL POISONING,
1. Blackouts (AMNESIA)
2. Vomiting
3. Loss of consciousness
• BAC above 0.31% - Severely supress Breathing & leads to death.

35. Alcohol tolerance
• Theory 1
 GABA ,GLUTAMATE , DOPAMINE AND SEROTONIN receptors become
less sensitive.
• Theory 2
Down – Regulation of receptors.

36. Alcohol withdrawl
• A Person consumes alcohol everyday at 6pm for a long
period of time,
It decreases Heart rate, Blood pressure , wakefulness.
• One fine new years eve that person decides to quit alcohol.
But the brain pre-emptively increases function since it
knows that once alcohol is taken everything will decrease.
Person can feel awful and may need Alcohol to just feel
normal

41. Diagnostic and Statistical
Manual of Mental Disorders
(DSM–5)

42. Treatment
• The most effective treatment is a combination of individual and group
therapy
• Cognitive – behavioural therapy
Help an individual learn about withdrawal
Discuss thoughts , feeling & behaviors that lead to alcohol use
Create a plan to navigate triggers.

43. Peer support program
• Use group discussions to help individuals commit to ending alcohol
use.
• Hold one another accountable

44. Naltrexone
• Mu-Opioid Receptor antagonist
• Bolcks euphoric effects of alcohol
• Blocks feelings of intoxication,helps reduce heavy drinking.

45. Acamprosate
• Administered immediately following acute withdrawal
• Re-establishes some GABA and Glutamate pathways.

46. Disulfuram
• Inhibits the enzyme Acetaldehyde dehydrogenase, leads to buildup of
ACETALDEHYDE.
• Causes Hangover immediately after consumption of alcohol.

47. Treatment
• The treatment of acute alcohol intoxication is based on the severity of
respiratory and CNS depression.
• Acute alcohol intoxication can be a medical emergency.
• Patients who are comatose and who exhibit evidence of respiratory
depression should be intubated to protect the airway and to provide
ventilatory assistance.
• The stomach may be lavaged, but care must be taken to prevent
pulmonary aspiration of the return flow.
• Ethanol can be removed from blood by hemodialysis.

48. • Acute alcohol intoxication is not always associated with coma, and careful
observation is the primary treatment.
• Usual care involves observing the patient in the emergency room form 4–6
hours while the patient metabolizes the ingested ethanol.
• BALs will be reduced at a rate of ∼15 mg/dL/hr.
• During this period, some individuals may display extremely violent
behavior.
• Sedatives and antipsychotic agents have been employed to quiet such
patients, but great care must be taken when using sedatives to treat these
patients because of possible synergistic CNS depressant effects.

49. Methanol
• Country Liquor (Arrack, Hooch, Bootleg)
• Paint Thinner
• Anti freeze in Automobiles
• Laboratory chemical
• Food contaminants

52. Treatment of Methanol Poisoning
• Maintenance of Airway, Breathing, Circulation.
• I.V., Sodium Bicarbonate for acidosis.
• Ethanol i.v., - a competitive inhibitor of Alcohol Dehydrogenase.
• 4- Methyl Pyrazole – a competitive inhibitor of Alcohol
Dehydrogenase.
• Folate to metabolize and eliminate Formic acid.
• Hemodialysis.