Alcohol and Tobacco

1. Alcohol and Tobacco Chapter 8

2. Chemistry of Alcohol • Psychoactive ingredient • Depressant • Ethyl Alcohol – only alcohol that can be consumed • Beer 3-6% alcohol by volume • Malt Liquors 6-8% alcohol by volume • Table wines 9-14% alcohol by volume • Fermenting • Fortified wines 20% alcohol by volume • Sugar added • Hard liquors 35-50% alcohol by volume • Distilling or fermented • Proof Value • Two times the percentage concentration • Ingestion • 7 calories per gram • 1 drink 14-17 grams or 100-120 calories ©2008 McGraw-Hill Companies. All Rights Reserved.

3. Absorption • 20% is rapidly absorbed from the stomach • 75% is absorbed in the upper small intestines • Remain is absorbed along the GI track • Absorption • Carbonation • Food in the stomach slows the absorption • Drink of high concentration slows absorption • Eventually all the alcohol ingested will be absorbed ©2008 McGraw-Hill Companies. All Rights Reserved.

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5. Metabolism and Excretion • Transported throughout the body via the bloodstream. • Easily moves through most biological membranes • Main site for metabolism is the Liver. • 2-20% of ingested alcohol is not metabolized. ©2008 McGraw-Hill Companies. All Rights Reserved.

6. Alcohol Intake and Blood Alcohol Concentration • A measure of intoxication • Body weight • Percentage of body fat • Difference between women & men • Balance of alcohol absorbed and rate of metabolism • Genetic factors • Drinking Behavior • Can not be effected by • Exercise • Breathing deeply • Eating • Drinking coffee • Taking other drugs • Metabolism is the same if the person is awake or asleep ©2008 McGraw-Hill Companies. All Rights Reserved.

7. The Immediate Effects of Alcohol on Health • Dependant on the individual. • Low Concentrations .03% -.05%. • Higher Concentrations 0.1% -0.2%. • Concentration of .35%. • Alcohol hangover • Alcohol poisoning • Using Alcohol with other drugs • Alcohol-related injuries and violence • Alcohol and sexual decision making ©2008 McGraw-Hill Companies. All Rights Reserved.

8. Drinking and Driving • In 2004 • 250,000 were injured in alcohol related automobile crashes • 42,000 people are killed in alcohol related accidents • Dose-response function • Driving with a BAC of 0.14% is more than 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 ©2008 McGraw-Hill Companies. All Rights Reserved.

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11. 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 HD • Higher doses elevates BP, may weaken heart muscle or cardiac myopathy. • Cancer • Brain Damage • Mortality ©2008 McGraw-Hill Companies. All Rights Reserved.

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13. The Effects of Alcohol use During Pregnancy • Effects are dose-related. • FAS Fetal Alcohol Syndrome • Occurs in 1 or 2 out of every 1000 live births in the U.S. • Under weight, flat nasal bridge, and long upper lip. • Small and have heart defects. • Physical and mental growth is slow.Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS). • ARND Alcohol-related neurodevelopment disorder. • Heavier drinking early in pregnancy. ©2008 McGraw-Hill Companies. All Rights Reserved.

14. Possible Health Benefits of Alcohol • Abstainers and light to moderate drinkers live longer than heavy users. • 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. • Raising blood levels of HDL. • May lower risks of; diabetes, arterial blockages, Alzheimer’s ©2008 McGraw-Hill Companies. All Rights Reserved.

15. Alcohol Abuse and Dependence • Alcohol abuse is recurrent use that has negative consequences. • Alcohol dependence or Alcoholism more extensive problems, tolerance and withdrawal • Warning signs of alcohol abuse • Drinking alone • Using deliberately and repeatedly • Feeling uncomfortable on certain occasions • Escalating consumption • Getting drunk regularly • Drinking in the morning or unusual times ©2008 McGraw-Hill Companies. All Rights Reserved.

16. Alcohol Abuse and Dependence • Binge Drinking • Having five drinks in row for a man or four in a row for a women. • Frequent binge drinking in college were three to seven times more likely than non-binge drinkers to engage in unplanned or unprotected sex • Healthy People 2010 • Reduce the rate of binge drinking to 20% among college students ©2008 McGraw-Hill Companies. All Rights Reserved.

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18. 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 • Heavy drinking limited to periods of stress • Health Effects • DTs (delirium tremens) • paranoia • Social and Psychological effects • Causes of Alcoholism ©2008 McGraw-Hill Companies. All Rights Reserved.

19. Treatment Programs • Not one program works for everyone. • AA. • 12-step program • Al-Anon. • Employee Assistance. • Inpatient hospital rehabilitation • Pharmacological treatments. • Disulfiram (Antabuse) • Naltrexone • Acamprosate (Campral) ©2008 McGraw-Hill Companies. All Rights Reserved.

20. Gender and Ethnic Differences • Men • White American men • “Other men” • Women • African Americans • Latinos • Asian Americans • American Indians and Alaska Natives ©2008 McGraw-Hill Companies. All Rights Reserved.

21. Promote Responsible Drinking In Others • Encourage responsible attitudes • Be a responsible host • Hold the drinker responsible • Learn about prevention programs • Take community action ©2008 McGraw-Hill Companies. All Rights Reserved.

22. Why People use Tobacco • 70 Million Americans, nearly 4 million adolescents • Nicotine Addiction • Powerful psychoactive drug • Reaches Brain via bloodstream in seconds • Most physically addictive of the psychoactive drugs. • Loss of control • Tolerance and Withdrawal ©2008 McGraw-Hill Companies. All Rights Reserved.

23. Why Start in the First Place? • Between 2001-2005 high school use has declined. • 28.5% to 23% • Children and teenagers make-up 90% of all new smokers in this country. • Estimated 4000 children and adolescents (12-17) start smoking. • Average age • 13 for smoking • 10 for spit tobacco ©2008 McGraw-Hill Companies. All Rights Reserved.

24. Listening to Advertising • 2003, Tobacco spends nearly $15 billion per year. • Most heavily advertised brands • Marlboro • Camel • Newport • 90% of teens prefer the top three most advertised brands. • Joe Camel is more familiar than Mickey Mouse. • More than 90% of 6-year-olds recognized the character ©2008 McGraw-Hill Companies. All Rights Reserved.

25. Who Uses Tobacco? • Characteristics which could increase the potential for use. • A parent or sibling uses tobacco • Peers use tobacco • Child comes from blue-collar family • Child comes from low-income home • Single parent. • Performs poorly in school • Child drops out of school • Has positive attitudes towards tobacco ©2008 McGraw-Hill Companies. All Rights Reserved.

26. Health Hazards • Contains hundreds of damaging chemical substances • Unfiltered cigarettes = 5 billion particles per cubic MM • 50,000 times more than polluted urban air • Condensed particles in the cigarette produce the tar ©2008 McGraw-Hill Companies. All Rights Reserved.

27. Health Hazards (cont) Carcinogens and Poisons • 43 chemicals are linked to cancer (Carcinogen) • Benzo(a)pyrene • Urethane • Cocarcinogens • Combine with other chemicals to cause cancer • Poisonous substances • Arsenic • Hydorgen cyanide • Carbon monoxide • 400 times greater than is considered safe in industrial workplaces • Displaces oxygen in red blood cells • Additives • Nearly 600 chemicals ©2008 McGraw-Hill Companies. All Rights Reserved.

28. Health Hazards (cont) • Cardiovascular Disease • Coronary Heart Disease (CHD) • Atherosclerosis • Angina pectoris • Myocardial infarction • Stroke • Aortic aneurysm • Pulmonary heart disease • Lung and other cancers • Chronic Obstructive Lung Disease • Emphysema • Chronic Bronchitis • Other Respiratory Damage ©2008 McGraw-Hill Companies. All Rights Reserved.

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31. Additional Health, Cosmetic, and Economic Concerns • Ulcers • Impotence • Reproductive health problems • Dental diseases • Diminished physical senses • Injuries • Cosmetic concerns • Economic costs ©2008 McGraw-Hill Companies. All Rights Reserved.

32. Cumulative Effects • Males before 15 yrs. old are half as likely to live to 75 versus those who did not smoke • Females with similar habits reduce life expectancy by more than 10 years • Female smokers spend 17% more sick days in bed than nonsmokers • Both men and women show a greater rate of acute and chronic diseases ©2008 McGraw-Hill Companies. All Rights Reserved.

33. Other Forms of Tobacco • Spit (Smokeless) Tobacco • More than 6.5 million adults • Cigar and Pipes • Cigar smoking has increased by 50% since 1993 • Clover cigarettes and Bidis • Twice the tar, nicotine, and carbon monoxide ©2008 McGraw-Hill Companies. All Rights Reserved.

34. The Effects of Smoking on the Nonsmoker • Environmental Tobacco smoke (ETS) • EPA - 1993 – Class A Carcinogen • Department of Health and Human Services’ National Toxicology Program - 2000 - “known human carcinogen” ©2008 McGraw-Hill Companies. All Rights Reserved.

35. Environmental Tobacco Smoke • Second hand smoke • Mainstream smoke • Sidestream smoke • Twice the tar and nicotine • Three times the benzo(a)pyrene • Three times the ammonia • 85% of smoke in a room is second hand • Smoke from a cigar can be even more dangerous • 30 times more carbon monoxide ©2008 McGraw-Hill Companies. All Rights Reserved.

36. ETS Effects • Develop cough, headaches, nasal discomfort, eye irritation, breathlessness and sinus problems • Allergies will be exacerbated • 24-50% increase in lung cancer risk • Causes 3,000 deaths due to lung cancer • Contributes to about 35,000 overall deaths • Contributes to increased Asthma attacks ©2008 McGraw-Hill Companies. All Rights Reserved.

37. Infants, Children, and ETS • More likely to develop • Bronchitis, pneumonia,& respiratory infections • More complications from asthma • Increased chance of SIDS • Low-birth weight • Bronchitis • Chemicals from smoking show up in breast milk • Children inhale three times more pollutants per unit of body weight than adults. ©2008 McGraw-Hill Companies. All Rights Reserved.

38. Avoiding ETS • Speak up tactfully • Display reminders • Don’t allow smoking in your home or room • Open a window • Sit in the nonsmoking section • Fight for a smoke-free environment • Discuss quitting strategies ©2008 McGraw-Hill Companies. All Rights Reserved.

39. Smoking and Pregnancy • Estimated 4600 infant deaths in the U.S. • Miscarriage, premature birth, low birth weight, long term impairments in growth and intellectual development • Possible higher risks of getting cancer • 11% of pregnant women smoke • 14% of female smokers quit while pregnant ©2008 McGraw-Hill Companies. All Rights Reserved.

40. Cost of Tobacco Use to Society • Health care costs exceed $75 billion per year. • Lost productivity from sickness, disability, and premature death makes it closer to $157 Billion per year. • 1998 Master Settlement Agreement (MSA) • Tobacco companies have to pay $206 billion over 25 years ©2008 McGraw-Hill Companies. All Rights Reserved.

41. What Can Be Done? • Local laws • State and Federal laws • International Action • Private sector • Individual Action ©2008 McGraw-Hill Companies. All Rights Reserved.

42. Quitting • Since 1964 - 50% of all adults who have smoked have quit. • Benefits of quitting • Options for quitting • Smoking cessation programs • Smoking cessation products • Chantix (Varinicline) • Zyban (Bupropion) • Nicotine replacement products • Patches, gums, lozenges, nasal sprays, and inhalers ©2008 McGraw-Hill Companies. All Rights Reserved.

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44. Alcohol and Tobacco Chapter 8