The Responsible Use of Alcohol

1. The Responsible Use of Alcohol Chapter 10

2. Alcoholic Beverages • Alcohol is the most popular psychoactive drug in the Western world • Categorized as a depressant • Ethyl alcohol – only alcohol that can be consumed • Beer 3-6% alcohol by volume • Ales and malt liquors 6-8% alcohol by volume • Table wines 9-14% alcohol by volume • Fermenting • Fortified wines 20% alcohol by volume • Sugar added • Extra alcohol is added • Hard liquors 35-50% alcohol by volume (or stronger) • Distilling brewed or fermented grains or other plant products • Proof value • Two times the alcohol percentage concentration

3. Standard Drinks and Calories • One drink = standard drink • One drink typically contains 0.6 ounces of alcohol • Caloric content • 7 calories per gram • One drink (14-17 grams) has about 100-120 calories • Also contains carbohydrates • One beer about 150 calories • “Light” in light beer refers to calories (about 100) • 5-ounce glass of red wine has 100 calories • 5-ounce glass of white wine has 96 calories • 3-ounce margarita has 157 calories • 6-ounce Cosmopolitan has 143 calories • 6-ounce rum and Coke has 180 calories

4. Table 10.1 Serving Sizes Versus Standard Drinks of Common Alcoholic Beverages

5. Absorption • 20% is rapidly absorbed from the stomach • 75% is absorbed in the upper small intestines • Any remaining is absorbed along the GI track • Absorption is affected by what is in the drink • Carbonation increases the rate of absorption • Artificial sweeteners (in drink mixers) increase the absorption • Food in the stomach slows the absorption • Drink of high concentration slows absorption • Eventually all the alcohol ingested will be absorbed

6. Metabolism and Excretion • Transported throughout the body via the bloodstream • Easily moves through most biological membranes • Main site for metabolism is the liver • About 2-10% of ingested alcohol is not metabolized

7. Alcohol Intake andBlood Alcohol Concentration (BAC) • Blood alcohol concentration (BAC) • The amount of alcohol in a person’s blood; a measure of intoxication • Body weight • Percentage of body fat • Sex • Balance of alcohol absorbed and rate of metabolism • Genetic factors • Drinking behavior • Can not be influenced by: • Exercise • Breathing deeply • Eating • Drinking coffee • Taking other drugs • Metabolism is the same if the person is awake or asleep

8. Figure 10.2 Approximate Blood Alcohol Concentration and Body Weight

9. The Immediate Effectsof Alcohol on Health • Depends on the individual • Low concentrations 0.03%-0.05% • Higher Concentrations 0.1%-0.2% • Concentration of .35% and higher can be fatal • Alcohol hangover • Alcohol poisoning • Using alcohol with other drugs

10. Alcohol and Impaired Judgment • Alcohol-related injuries and violence • Homicide • Suicide • Automobile crashes • Hostility • Alcohol and aggression • Antisocial personality disorder • Leads to arrest • Impairs home life • Alcohol and sexual decision making • More likely to engage in unsafe sex

11. Drinking and Driving • In 2008, • 275,000 people were injured in alcohol related automobile crashes • 11,773 people were killed in alcohol related accidents • Dose-response function • Driving with a BAC of 0.14% is over 40 times more likely to be involved in a crash • Greater than 0.14%, the risk of fatal crash is estimated to be 380 times higher

12. Figure 10.3 The Dose-Response Relationship Between BAC and Automobile Crashes

13. The Effects of Chronic Use • Diseases of the digestive, cardiovascular systems, and some cancers • Digestive system • Liver function • Liver cell damage and destruction (cirrhosis) • Cirrhosis causes drinker to lose tolerance • Pancreas inflammation • Cardiovascular system • Moderate doses may reduce the risk of heart disease • Higher doses elevates blood pressure, may weaken heart muscle or cardiac myopathy • Cancer • Mouth, throat, larynx, and esophagus • 5-6 total drinks daily • Responsible for the most common form of liver cancer • Hepatitis speeds the growth of this cancer • Breast cancer • Increase risk with 2-3 drinks per day • Brain damage • Cognitive impairments and brain shrinkage • Memory loss, dementia, and compromised problem-solving • Mortality • Alcoholics’ average life expectancy is about 15 years less than non-alcoholics

14. Figure 10.4 The Immediate and Long-Term Effects of Alcohol Abuse

15. The Effects of AlcoholUse During Pregnancy • Effects are dose-related • Fetal alcohol syndrome (FAS) • Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S. • Alcohol-related neurodevelopment disorder (ARND) • Negative effects on the baby’s brain development

16. Possible Health Benefits of Alcohol • Abstainers and light to moderate drinkers live longer than do heavy drinkers • 35 years old and younger, your odds of dying increase in proportion to the amount consumed • Moderate drinking = one drink per day for women and two drinks per day for men • May lower coronary heart disease • Raises blood levels of HDL, reduces blood clots • May lower risks of diabetes, arterial blockages, Alzheimer’s

17. Alcohol Abuse and Dependence • Statistics on American alcohol usage • 60% ages 18 or older routinely drink alcohol • 15% are former drinkers • 25% are lifetime abstainers • 7% are classified as heavy alcohol users

18. Abuse Versus Dependence • Alcohol abuse is recurrent use that has negative consequences • Alcohol dependence (alcoholism) involves more extensive problems, tolerance, and withdrawal • Warning signs of alcohol abuse • Drinking alone or secretively • Using deliberately and repeatedly • Self-medicating • Feeling uncomfortable on certain occasions when no alcohol • Escalating consumption • Consuming alcohol heavily in risky situations (before driving) • Getting drunk regularly • Drinking in the morning or at unusual times

19. Binge Drinking • The National Institute on Alcohol Abuse and Alcoholism defines: • Pattern of alcohol use that brings a person’s BAC up to 0.08 or above (typically four drinks for a male or three for a woman) within two hours • National Survey on Drug Use and Health defines: • Having five drinks in a row for a man or four in a row for a woman within two hours • About 75% of the alcohol consumed by adults in the U.S. meets the definition of binge drinking

20. Table 10.2 The Effects of Binge Drinking on College Students

21. Alcoholism • Patterns and prevalence • Regular daily intake of large amounts • Regular heavy drinking limited to weekends • Long periods of sobriety interspersed with binges or daily heavy drinking lasting for weeks or months • Heavy drinking limited to periods of stress • Health Effects • Delirium tremens (the DTs) • Blackouts and other memory problems • Social and psychological effects • Causes of alcoholism

22. Treatment Programs • Different programs work for different people • Alcoholics Anonymous (AA) • 12-step program • Al-Anon, Rationale Recovery, Women for Sobriety • Employee assistance and school-based programs • Inpatient hospital rehabilitation • Pharmacological treatments. • Disulfiram (Antabuse) • Inhibits the metabolic breakdown; feel ill • Naltrexone (ReVia, Depade) • Reduces the craving for alcohol and decreases its pleasant effects • Injectable naltrexone (Vivtrol) – single monthly shot • Acamprosate (Campral) • Acts on brain pathways related to alcohol abuse

23. Gender and Ethnic Differences • Men • White American men • Non-white men • Women • African Americans • Latinos • Asian Americans • American Indians and Alaska Natives • Helping someone with an alcohol problem

24. Table 10.3 Users and Abusers of Alcohol in the U.S.: 2008

25. Drinking Behavior and Responsibility • Examine your drinking behavior • CAGE screening test • Drink moderately and responsibly • Drink slowly • Space your drinks • Eat before and while drinking • Know your limits and your drinks

26. Promote Responsible Drinking in Others • Encourage responsible attitudes • Be a responsible host • Hold the drinker responsible • Take community action

27. Develop ResponsibleDrinking Habits • Keep a record of your behavior in a health journal • Analyze your record • Set goals • Devise a plan • Monitor your progress • Reward yourself

28. The Responsible Use of Alcohol Chapter 10