Uppers, Downers and All Arounders Downers: Alcohol.

Uppers, Downers andAll Arounders

Downers:

Alcohol

Alcohol Overview• Most people drink alcohol except in Islamic

countries• In U.S. 48% had at least one drink last month• 25-30% of hospital admissions was due to

direct and indirect medical complications from alcohol

• ½ of American adults had a family member who is an alcoholic

• Worldwide 2 million people died as a result of alcohol– 10% of diseases and injuries were a direct result

of alcohol

Alcohol Overview• Alcohol is the oldest known and most

widely used psychoactive drug in the world

• Historians believe that alcohol was found accidentally

• Historians believe that first civilized settlements were created to ensure regular supply wine, grain & opium

• First evidence of use is recipe for beer dated to 8000 B.C.

Alcohol Overview

• Historically alcohol has been used for:– Food (beer) for peasants– Solvent for opium– Sacrament for religious ceremonies– Water substitute– Social– Tranquilizer– Source of taxes

Alcohol Overview

• All countries have had periods of restriction for alcohol consumption– England: 1700’s unrestricted sale of gin led to

abuse and addiction– America: 1920-1933 Prohibition period

• Repealed because of major source or revenue and tax

– 1930 American Alcoholics Anonymous founded in

Alcohol Beverages• Hundreds of different alcohols

– Ethyl (beverage)– Methyl (wood alcohol)– Isopropyl – Butyl – Any alcohol with 2% grain is considered a

beverage alcohol

• Alcohol occurs naturally as a result of airborne yeast feeding on sugars in honey, fruits, berries, vegetables and grains called “fermentation” that produces alcohol and carbon dioxide

Alcohol Beverages• Beer: Drink of common people in early times

– Ale– Stout– Porter– Malt liquor– Larger– Bock beer– Beer is brewed or fermented by roasting barley and

cereal grains then combining the result with water, grain, hops and yeast

– Alcohol content:• Larger beers: 4-5%• Ales: 5-6%• Malt liquor: 6-9%

Alcohol Beverages

• Wine was the drink of priest and nobles in early times– Fermented from berries and other fruit and

starchy grains like rice– 8-14% alcohol– More than 14% alcohol content are fortified

with pure alcohol or brandy added after fermentation

Alcohol Beverages• Distilled Spirits discovered by Arabs in A.D. 800• Result of boiling wine or other alcoholic

beverages and collecting the condensation• Brandy is distilled from wine• Rum distilled from sugar cane or molasses• Vodka from potatoes• Whisky and gin from grains• Distilled beverages have high alcohol content

than wine or beer• Alcoholism exploded as a result of distilled

spirits

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Alcohol ContentAlcohol Content

WineWinered, white, rosered, white, rose 12%12%wine coolerswine coolers 6%6%

BeerBeerlager, dark alelager, dark ale 6%6%light beerlight beer 4%4%

Hard LiquorsHard Liquorswhiskey, Scotch, vodka, whiskey, Scotch, vodka, 4040--43%43%rum, gin, cognac,rum, gin, cognac, etcetc..amarettoamaretto, , kahluakahlua, , etcetc.. 28%28%

(Note: 100% alcohol = 200 proof)(Note: 100% alcohol = 200 proof)

Absorption & Distribution

• Absorption into bloodstream:– Takes place along various sites along the

gastrointestinal tract:• Stomach, small intestines and colon

• Men and women process alcohol differently even with the same body weight– In men 10-20% of alcohol absorbed by stomach– In women most alcohol is absorb in the walls of

the small intestine at a rate of 30%– Women feel the effects of alcohol faster and

more intensely.

Absorption & Distribution

• Absorption: Women– Women have higher blood alcohol content

than men due to – Lower % of body water than men – Less alcohol dehydrogenase enzyme in

stomach to break down alcohol so less alcohol is metabolized before entering bloodstream

– Changes in gonadal hormones levels during menstruation affect the rate of alcohol metabolism

– Death rates are 50-100% higher than men

Absorption

• Factors that speed-up absorption:– Increasing the amount drunk or drinking rate– Drinking on a empty stomach– Using high alcohol concentrations up to a

maximum of 95% with Everclear– Drinking carbonated drinks like champagne,

sparkling wines, soft drinks, and tonic mixers– Warming the alcohol

• Factors that slow Absorption– Eating before or while drinking (meat, cheese

& fatty foods)– Diluting drinks with ice, water or fruit juice

Metabolism & Alcohol Concentration

• Alcohol treated as toxin or poison so elimination begins as soon as it is ingested

• 2-10% eliminated without being metabolized• 90-98% neutralized through metabolism by

liver• Excreted by kidneys and lungs• Alcohol high in calories, but no real food

value causing high malnutrition • Alcoholics get have their energy from empty

calories

Metabolism & Alcohol Concentration

• Blood Alcohol concentration (BAC)– 1 oz. of pure alcohol eliminated every 3 hours– Person’s biochemical makeup due to heredity

can have strong effect on metabolism and elimination

– Actual reaction and level of impairment depends on:

• Drinking history• Tolerance• Mood• And other factors

– Most states consider .08 or 1.0 of BAC Drunk

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Level of Impairment Level of Impairment vsvs. Blood Alcohol Concentration. Blood Alcohol Concentration

.00 Blood Alcohol Concentration.00 Blood Alcohol ConcentrationLowered inhibitions, feelings of relaxationLowered inhibitions, feelings of relaxation

Some loss of muscular coordinationSome loss of muscular coordinationDecreased alertnessDecreased alertness

Reduced social inhibitionsReduced social inhibitionsImpaired ability to driveImpaired ability to drive

Slowed reaction timeSlowed reaction timeClumsiness, exaggerated emotionsClumsiness, exaggerated emotions

Unsteadiness standing or walkingUnsteadiness standing or walkingArgumentative & often hostile behaviorArgumentative & often hostile behaviorSlurred speechSlurred speech

Severe intoxicationSevere intoxicationInability to walk without helpInability to walk without help

Confused speechConfused speechIncapacitated, loss of feelingIncapacitated, loss of feeling

Difficult to rouseDifficult to rouseLifeLife--threatening unconsciousnessthreatening unconsciousness

ComaComaDeath from lung & heart failureDeath from lung & heart failure

.50 Blood Alcohol Concentration.50 Blood Alcohol Concentration

Levels of Use

• Low-to-moderate: 1 drink for women & 2 drinks for women daily– Generally does not have negative consequences– Generally not safe for pregnant women, people who

have physical or mental impairments– Use includes:– Relaxation– Relax muscles– Stimulate appetite– Reduce incidents of heart attack & stroke– Alcohol interferes with REM sleep & dreaming

essential to feeling fully rested

Levels of Use

• High-doses (heavy drinking)– 5 or more drinks at one sitting for males and 4 or

more for females at least 5xs per month

• Depresses nervous system• Possibly leading to cardiac failure or death• .40 is threshold for alcohol poisoning that can

fatally.• .20 can result in severe depressed

respiration and vomiting while semiconscious– Vomit can be aspirated or swallowed blocking air

passages to lungs resulting in asphyxiation and death

Levels of Use

• Blackouts: Person appears to be acting normally and is awake and conscious but afterwards cannot recall anything.– Early signs of alcoholism– Different from passing out (drinker has partial recollection)

• Hangovers– May be severe many hours after– Effects include:– Headache– Nausea– Vomiting– Thirst– Dizziness– Dry mouth– Inability to concentrate– General depressed feeling

Levels of Use

• Mental and emotional effects– Depresses and slows functions to Cental and

peripheral NS– Moves from initial relaxation to lowered

inhibitions– Mental confusion– Mood swings– Loss of judgment– Emotional turbulance– BAC of .10 slurred speech– Chronic alcoholism results in daily fatigue– Nightmares, bed wetting and heavy snoring

Levels of Use

• Liver Disease– 10-35% of chronic alcoholics develop alcoholic

hepatitis• Causes inflammation of the liver• Areas of fibrosis• Necrosis (cell death)• Damaged membranes

– 10-20% cirrhosis of the liver• Occurs when alcohol causes scarring• Most advanced form of liver disease• Leading cause of death among alcoholics• 10,000-24,000 die each year• France and Germany have a rate of 2-3 times more than

U.S.

High Use of Alcohol

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Cirrhotic Liver

High Use of Alcohol

• Liver Disease– Fatty Liver: accumulation of fatty acids in the

liver• Occurs after a few days of heavy drinking• Abstention eliminates much of accumulated fat

• Liver diseases decrease the ability of the liver to metabolize alcohol thus allowing alcohol to travel to other organs in original toxic form

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Fatty Liver

High Use of Alcohol

• Digestive system– Moderate to high use stimulate production of stomach

acid and delay emptying time of the stomach causing acid stomach and diarrhea

– Gastritis (stomach inflammation) common– Inflammation and irritation of esophagus, small

intestine and pancreas– Linked to ulcers, stomach hemorrage and

gastrointestinal bleeding– Can cause hypoglycemia in drinkers that get little

nutrition (too little sugar)– Hyperglycemia in people who have sufficient nutrition

(too much sugar)

High Use of Alcohol

• Cardiovascular disease– Related to heart disease, including

• Hypertension, cardiac arrhythmias• Damages striated heart muscles• Cardiomyopathy, (enlarged, flabby and insufficient

heart)• Increases risk of stroke

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9Normal Heart Normal Heart Alcoholic’s HeartAlcoholic’s Heart

High Use of Alcohol

• Central Nervous System (CNS)– Causes direct damage to nerve cells– Alcohol-induced malnutrition can injure brain

& disrupt brain chemistry– Brain atrophy (loss of brain tissue)

documented in50-100% of alcoholics in autopsy

– Dementia– Wernicke’s encephalopathy and Kosakoff’s

psychosis (serious brain damage caused by chronic alcoholism and thiamin deficiency)

– m

High Use of Alcohol

• Reproductive System

• In females– Decreases sexual desire and intensity of orgasm– Raises chances of infertility and spontaneous

abortion

• In men– Impairs gonadal function causing decrease in

testosterone levels– 8% are impotent– Only half recover sexual function after abstinence

High Use of Alcohol

• Cancer:– Association between breast cancer and heavy drinking

– Risk of mouth, throat, larynx & esphageal cancer are 6 times greater and 38% for those who smoke and drink

• Systemic Problems– Leeches minerals from body cause greater risk of

fracture

– Unbalances electrolytes by chronic use

– Reddish skin completion

– Respiratory infections

– Turberculosis

– Pnenomonia

– Weaken immune system

Addiction to Alcohol

• 10-12% of 140 million Americans develop addiction to alcohol

• 2-3 times greater for men• 20% consume 80% of alcohol • E.M. Jellineck classification of alcoholics:

– Primary: immediate liking of alcohol, progressing to alcoholism

– Steady endogenous: alcohol is secondary to psychiatric disease

– Intermittent: periodic binge drinking– Stammtisch: alcoholism precipitated by outside and

social causes

Addiction to Alcohol

• Modern classifications– Type I

• Later onset • Effects men and women• Requires genetic and environment predisposition• Can be moderate to severe• Takes years of drinking to trigger it

– Type II “Male Limited”• Affects sons of alcoholics• Moderately severe• Primarily genetic• Mildly influenced by environmental factors

Addiction to Alcohol

• Modern classifications– Type A

• Later-onset of alcoholism• Less family history• Less severe dependence

– Type B• More severe alcoholism with earlier onset• More impulsive behavior and conduct disorders• More co-occurring disorders• More severe dependence

Addiction to Alcohol

• Disease Concept– Primary disease with genetic, psychosocial and

environment factors influencing development and manisfestation

– Progressive– Fatal– Impaired control– Preoccupation– Use of alcohol despite negative consequences– Distortions in thinking– Most notably denial of problem drinking– Can be periodic or continuous

Addiction to Alcohol

• Heredity:– Strong genetic influences shown in family, twin, and

adoption studies– Several genes have an influence on one’s

susceptibility to alcoholism– Strong genetic susceptibility to blackouts– Hereditary link to physical consequences to cirrhosis

and alcoholic psychosis

• Environmental factors– Child abuse– Poor nutrition– Alcohol/drug abusing friends and relations– Extreme stress

Addiction to Alcohol

• Exposure to brain initiates process of adaptation or change in brain function

• Tolerance– Body changes as alcohol is metabolizes– Heavy drinking causes liver to be less able to

metabolize alcohol (reverse tolerance)– Brain cells and neurons become more resistant

to effects by increasing receptor sites– Drinkers learn how to “handle their liquor” and

modify their behavior

Addiction to Alcohol

• Withdrawal– Minor symptoms

• 85% will have minor symptoms• Rapid pulse• Sweating• Increased body temperature• Hand tremors• Anxiety• Depression

Addiction to Alcohol

• Withdrawal– Major Symptoms

• Tachycardia• Transient visual, tactile or audio hallucinations &

delusions• Psychomotor agitation• Grand-mal seizures• Delirium tremens (DTs) requiring hospitalization• Kindling: repeated bouts of drinking causing

severe withdrawal that causes seizures

Alcohol and Pregnancy• Leading cause of mental retardation in

children• 12.4% drank alcohol during several months of

pregnancy• 3.9% had binge pattern• 0.7% heavy drinkers• 5.5%• Study of infants with FAS found that 89% were

using alcohol and at least two other drugs• 49% were using just two drugs, usually

cocaine and alcohol

Alcohol and Pregnancy

• Fetal Alcohol Syndrome – Retarded growth before and after birth– Facial abnormalities, including shortened eye

openings, thin upper lip, flattened midface, missing groove in upper lip.

– Occasional problems with heart and limbs– Delayed intellectual development – Neurological problems– Behavioral problems– Visual problems– Hearing loss– Balance or gait problems

Alcohol and Pregnancy

• Critical period during pregnancy for alcohol effects on brain development is weeks 3 – 8 at onset of embryogenesis

• 7 standard drinks per week was threshold for pregnant women

Aggression & Violence

• ¼ 11.1 million victims of violent crime report that the offender had been drinking alcohol

• 34-37% of sexual assaults predators• 30-79% of victims drinking• Encourages release of pent-up anger,

hatred and desires forbidden by society• Any type of violence can cause permanent

biochemical changes in victim that makes them susceptible to drug abuse and other emotional problems

Driving Under the Influence• 40% of fatalities in 2001• 1 in 4 drinker gets behind wheel after 2 hours of

drinking• Of those convicted of DUI

– 61% drank beer– 2% drank wine– 18% drank liquor– 20% drank combination

• 15-25% emergency room patients• 16 x’s likely to die in falls• 10 x’s likely like to become burn victims• 31% boating accidents