. © 2009 McGraw-Hill Higher Education. All rights reserved. 1 Chapter Eleven Alcohol: Responsible Approaches to Drinking.

© 2009 McGraw-Hill Higher Education. All rights reserved.

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Chapter ElevenChapter Eleven

Alcohol: Responsible Approaches to DrinkingAlcohol: Responsible

Approaches to Drinking


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Patterns of Alcohol Use

• More than 60% of American adults drink, at least occasionally.

• One-third of the adult U.S. population are non-drinkers (abstainers).

• Of the two-thirds who do consume alcohol, 10% are heavy drinkers.

• Moderate drinkers are men who drink no more than two drinks per day or women who drink no more than one drink per day.

• Light drinkers drink less than moderate drinkers.


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Drinking Patterns Across the Lifespan

• Alcohol consumption is highest between 18 and 25 for Whites and between 26 and 30 for Hispanics and African Americans.

• People are most likely to drink as adolescents and during early adulthood.

• Older adults drink significantly less than younger adults do.

• Women drink less than men and start drinking later in life.

• It takes less time for women to develop a drinking problem compared to men.


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What Is “One Drink”?


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Ethnic Differences in Alcohol Use

• Alcohol use is higher among Whites than African Americans.

• Hispanic men have higher percentages of alcohol use than other ethnic groups, but Hispanic women are more likely to abstain than are African American and White women.

• Among Native Americans, alcoholism is recognized as the number one health concern.

• Asian Americans have lower consumption rates than white Americans, possibly due to genetic biological reactions towards alcohol.


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What causes drinking problems?

• Genetic and Biological Factors

• Psychosocial Factors– Family history of alcoholism

– Family dysfunction in general• High levels of stress and negative emotions• Depression

– Childhood traumas

– Compensatory drinking (coping mechanism)

– External motivations (project certain image)

– Developmental staging

• Socio-cultural/Environmental Factors– Cultural attitudes

– Economic factors

– Laws

– Stresses


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Binge Drinking• Consumption of 5 or more drinks in a row for a man or

4 or more drinks in a row for a woman

• The Harvard School of Public Health College Alcohol Study determined than 83% of college students drank alcohol

– About half were binge drinkers

– First year college women binged more than other women

– One in five were frequent binge drinkers

• Students at historically Black colleges and universities have lower rates of binge drinking.


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Some Consequences of College Drinking

• Binge drinking can have serious physical, academic, social, and legal consequences.

– Death– Injury– Assault– Sexual assault– Unsafe sex– Academic problems– Health problems/suicide attempts– Drunk driving– Vandalism– Property damage– Police involvement– Alcohol abuse and dependence

See Who’s at Risk? College Students and Binge Drinking


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Why Do College Students Binge Drink?

• Students may use drinking for a variety of reasons:

– to ease social inhibitions– to fit in with peers– imitate role models– reduce stress– sooth negative emotions– or cope with academic pressure– mistaken belief of increased sexual arousal and

performance


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Addressing the Problem of College Drinking

• Screening interviews to identify high-risk students

• Enforcing college alcohol policies• Punishing students who violate policies or break

the law• Mandating treatment for substance-related

offenses• Educating students to resist peer pressure• Helping students cope with stress and time

management issues• Targeting prevention messages to high-risk

events


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Effects of Alcohol on the Body

• Alcohol is a small molecule that is digested and quickly absorbed into the bloodstream via the stomach and small intestine.

• Once it reaches the brain, alcohol alters brain chemistry and neurotransmitter functions.

• Alcohol is a central nervous system depressant, which impairs movement and thinking.

• As alcohol concentrations increase, more functions are depressed, and greater impairment occurs.


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Factors Affecting Alcohol Absorption

• Food in the stomach• Gender• Age• Drug interaction• Cigarette smoke• Mood and physical condition• Alcohol concentration• Carbonation• Tolerance


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Alcohol Metabolism• A small amount of alcohol is broken down by the

stomach however 90% is metabolized by the liver.

• Between 2-10% is not metabolized at all but is excreted unchanged through the skin, urine, or breath

• The liver allows conversion of alcohol to acetaldehyde by an enzyme alcohol dehydrogenase (ADH) and is converted into acetic acid.

• Acetic acid is eventually broken down into carbon dioxide and water.


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Blood Alcohol Concentration

• Blood Alcohol Concentration (BAC): the amount of alcohol in grams in 100 milliliters of blood, expressed as a percentage

• 100 mgs of alcohol in 100 milliliters of blood is equivalent to a BAC of .10%

• Breath analyzers are valid based upon alcohol concentrations in the breath that correspond well to levels of alcohol in the brain.

• The amount of body water and body fat a person has influences the BAC levels in the body.


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Gender Differences in Alcohol Absorption and Metabolism

• Women are generally more susceptible to the effects of alcohol and have a higher BAC than men do based on the following:

• Generally smaller than men• Higher body fat percentage• ADH differences

• These differences create further health consequences such as:

• Liver Disease• Heart Disease• Brain Damage

© Digital Vision/Punchstock


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Possible Short-Term Results of Alcohol Consumption

• Acute alcohol intoxication is a life-threatening blood alcohol concentration which can produce collapse of vital body functions.

• Vomiting may be activated if a BAC reaches .12% or higher in a rapid method (binge drinking).

• A blackout is a period of time during which a drinker is conscious but has partial or complete amnesia for events.

• Hangovers are a result of a common reaction to alcohol toxicity characterized by headache, stomach upset, thirst, and fatigue.

See Stages of Acute Alcoholic Influence/Intoxication, Table 11.2


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Long-Term Effects of Alcohol Use

• Heart Disease– Cardiomyopathy (disease of the heart muscle)– Abnormal heart rhythm

• Stroke• Liver Disease

– Fatty liver (liver swells with fat globules)– Alcoholic hepatitis (inflammation of the liver)– Cirrhosis (scarring of the liver)

• Cancer• Brain Damage• Malnutrition


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Social Problems Associated with Alcohol Use

• Reduces inhibitions which may lead to high-risk sexual activity and a lowered likelihood of practicing safe sex

• Violence, including rape, sexual assault, and domestic violence

• Risk of injury

• Drunk driving

• Alcoholism

• Suicide risk


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Health Benefits of Alcohol• The Dietary Guidelines for Americans notes that the lowest rates

of death occur among people who consume one to two drinks a day.

– Moderate consumption may increase high-density lipoproteins (HDL, the “good cholesterol”)

– Anti-clotting effect on the blood– Reduces stress

• Binge drinking does not serve as a protective factor and can increase the risk for heart disease

• In younger adults, alcohol appears to have fewer, if any health benefits and is associated with more deaths and injuries and accidents.

©Stockbyte/Punchstock


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light drinkers enjoyed a 28 % reduction in heart attacks, by-pass, angioplasties, cardiac deaths (compared to non-drinkers) 1991 Health Professionals Study

moderated drinkers 48% reduction in risk

51,529 = N

Men that drink on 3 or 4 days each week are 34% less likely to develop heart attacks than men who drink just once a week;

If anything, liquor had a slight advantage over other beverages

Drinking was associated with higher levels of HDL


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• Physicians health study:

• cardiac patients: low doses of alcohol best;

• 2 – 4 drinks a week reduced recurrent heart attack by 28%

• men who consume little or no alcohol early in adult life derive cardiac protection if they begin modest drinking later on

• 1 – 7 drinks per week, 20% less likely to have strokes than non-drinkers

• Australia:

• 10-19 gm EtOH per day (one drink) had a 16% lower death rate than abstainers

• 3 drinks/day had the same mortality as non-drinkers

• 5 drinks/day 1.33 times higher than non-drinkers


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Alcohol Misuse• Problem drinking: Pattern of alcohol use that impairs the

drinker’s life, causing difficulties for the drinker and for others.

• Alcohol abuse: Pattern of alcohol abuse that leads to distress or impairment, increases the risk of health and/or social problems, and continues despite awareness of effects.

• Alcohol dependence: Disorder characterized by a strong craving for alcohol, development of tolerance for alcohol, and withdrawal symptoms

• Alcoholism: Primary chronic disease characterized by excessive, compulsive drinking

• Withdrawal: A state of acute physical and psychological discomfort when alcohol consumption stops abruptly


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Treatment Options• Brief Interventions

• Primary care physician

• Inpatient Treatment•Residential facilities

– Detoxification– Medications– Counseling

• Outpatient Treatment• Counseling

• Self-help Approaches• Support groups (AA, Al-Anon, Alateen, Adult Children of Alcoholics)


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Relapse Prevention

• The first two years after treatment are usually the hardest.

• Difficulty of recovery is thought to be due to changes the alcohol as produced in the brain.

• Craving can continue for years, even during sleep.• Relapse prevention includes social skills training:

– Stress management

– Assertiveness

– Communication skills

– Self-control

– Family and marital therapy


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Developing A Behavior Change Plan

Following a behavior change plan can assist you with reducing alcohol consumption.

• Record Behavior Patterns

• Analyze Your Drinking Diary

• Establish Goals

• Implement Your Plan

• Evaluate Your Results


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Chapter ElevenChapter Eleven

Alcohol: Responsible Approaches to DrinkingAlcohol: Responsible

Approaches to Drinking

. © 2009 McGraw-Hill Higher Education. All rights reserved. 1 Chapter Eleven Alcohol: Responsible Approaches to Drinking.

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