Alcohol
Alcohol Support Services Washington Recovery Line: 1-866-789-1511 Teen Link: 866-TEENLINK (866-833-6546) Crisis Clinic: 206-461-3222/1-866-427-4747 Alcoholics Anonymous: 206-587-2838 Alanon & Alateen: 206-625-0000 Adult Children of Alcoholics: 425-213-3919/ 1-800-562-1240 Substance Abuse & Mental Health Services Administration Facility Locator
Alcohol Consumption Statistics, % of adult Americans consuming alcohol regularly (1 per month) 56% (CDC, 2013) Percent of adult infrequent drinkers 13% (CDC, 2012) State info, women (CDC, 2013) 2.34 gallons/person (NIAAA, 2015) 30,722 deaths (CDC, 2014) U.S.
Alcohol Consumption Statistics, World Percent of population, 15+ years who consumes alcohol 38% (WHO, 2014) 3.3 million deaths (WHO, 2014) WHO: global consumption (2015) Patterns of drinking (WHO, 2010) BAC limits, countries (WHO) Across globe, consumption varies dramatically (WHO, 2011, via fasdprevention)
Alcohol Consumption Type of alcohol also impacts consumption variation across world Beer (Euromonitor, via Paste Magazine, 2014) Wine (The Economist, 2012) Variation across countries (WHO, page 32; sex differences, page 39) Country profiles (WHO, 2014)
Burden of Disease Attributable to Alcohol Mild: intoxication More severe: alcoholism, liver cancer, esophageal cancer, cirrhosis, homicide, motor vehicle accidents WHO: 5.1% of global burden
Alcohol Impact on U.S. Kids Alcohol Cost Calculator for Kids Population estimates for individuals aged 12-20 years Source: Ensuring Solutions to Alcohol Problems, with data from National Survey on Drug Use and Health
Legal Drinking Age: Procon.org
U.S. Legal Drinking Age: Changing? After Prohibition era, most drinking ages were 21 A few were set at 18 A few states had different ages or beer/wine/liquor When Constitutional amendment passed in 1970s to allow voting age of 18, drinking ages generally lowered In 1984-86, states changed drinking age to 21 Federal government threatened to withhold 10% of highway funding otherwise In 2012, US Supreme Court decided feds could not force states to comply (pay) under threat of losing federal funding match leaving drinking age change vulnerable
Alcohol Formation Alcohol available for thousands of years Created from natural fermentation process Yeast consumes a form of sugar/grain/fruit Products are alcohol and carbon dioxide Different sugars yield different alcohol forms Yeast is killed when fermenting solution accumulates enough alcohol to kill yeast Alcohol percentage depends on the yeast (& on manufacturer), 5-20% Video: Short animation of concept (Vimeo) Video: How Stuff Works: Fermentation
Alcohol Forms Beer and Ale: fermented cereal grains and malt 3-8% alcohol content Wine: fermented grapes and other fruits 9-15% alcohol content Marula fruit impact on animals in Africa (YouTube) Hard Liquor: distillation 40-50% alcohol solution
Distillation Used to separate alcohol from water Alcohol has lower boiling point than water Alcohol evaporates into tube Cold water cools alcohol Alcohol collects in flask Animation (TutorVista, via YouTube) Animation #2 (no narration, 20to9.com via YouTube) Cognac distillation (cognac.fr)
Whiskey Corn, rye, barley Rum Molasses, sugar cane Brandy Fruit juice/wine Gin Rye/other grains Addition of berries Tequila Agave plant Vodka Potatoes, rye, corn Distilled Spirits
Alcohol Proof Story of proof Alcohol and water solution Added to gun powder If gun powder could ignite/pop, it was proof solution contained ~50% alcohol Today, proof refers to alcohol content The proof equals double the alcohol percentage 40% alcohol = 80 proof
Alcohol Absorption Alcohol absorbed throughout GI tract Some from stomach Most from small intestine When food or other liquid present, absorption takes longer Carbonation speeds up absorption Alcohol and the Brain (YouTube via TuneInNotOut; 2:52-5:42)
Alcohol Metabolism Metabolism = breakdown Liver breaks down most of alcohol Alcohol broken down into acetaldehyde Acetic acid Carbon dioxide & water Metabolism = ~one drink/ hour Caffeine, exercise, water do not change process Men metabolize faster
Alcohol Metabolism Gender differences Females metabolize alcohol slower than males Males have more muscle, so more water Alcohol dissolves in water Alcohol metabolism news feature (YouTube, 0:41-4:47)
Blood Alcohol Concentration (BAC) The amount of alcohol present in 100 ml of blood.05 =.05 grams of alcohol per 100 ml of blood.05 does not equal 5%, but.05% Intoximeters Drinking Wheel Stages of Alcohol Intoxication
Alcoholism Among the most common psychiatric disorders Symptoms: recurrent intoxication, mood swings, anxiety, hallucinations, GI distress, unsteady gait, erectile dysfunction, blackouts
World Alcohol Dependence Difficult to accurately determine Different ways of collecting data Interpretation of dependence Age cut-off for assessment varies across countries Data collected at different times Alcohol dependence over lifetime vs last year Source: WHO Global Status Report 2004
World Alcohol Dependence Percent of Adult Population USA: 7.7% (male = 10.8%; female = 4.8%) Poland: 12.2% (23.3%/4.1%) Ethiopia: 1.0% (1.9%/0.1%) Belgium: 7.0% (9.5%/3.6%) Peru: 10.6% (17.8%/4.3%) Singapore: 0.6% (1.1%/0.2%) Japan: 4.1% (8.4%/0.7%) Source: WHO Global Status Report 2004
Pharmacology for Alcoholism Variety of pharmacotherapies Antabuse has been used for decades Blocks conversion of acetaldehyde When Antabuse taker consumes alcohol, he/she becomes very ill No action on craving Can be used as supplemental treatment to other medications
Pharmacology for Alcoholism Naltrexone (ReVia) Prevents relapse of drinking Reduces craving Thought to block opioid system, involved with alcohol craving Side effects include nausea, anxiety, liver problems Video: YouTube Vivitrol-injectable version Video: YouTube FDA approved
Pharmacology for Alcoholism Acamprosate Used extensively in Europe FDA approved in 2004 Improves abstinence rates
Pharmacology for Alcoholism Acamprosate Mechanism is not fully understood May target specific neurotransmitter systems (GABA & glutamate) Reduces PAWS (post acute withdrawal syndrome) Anxiety Mood swings Fatigue Sleep problems Source: Substance Abuse and Mental Health Services Administration
Pharmacology for Alcoholism Ondansetron (Zofran) Has been used to treat nausea in chemotherapy patients Reduces alcohol consumption Improves abstinence among early-onset alcoholism Works with serotonin in brain to reduce craving YouTube video Not yet FDA approved
Pharmacology for Alcoholism Nalmefene Has been used for epilepsy Blocks pleasure associated with drinking Can prevent relapse Blocks more opioid receptors than naltrexone Used to reduce drinking behavior (Naltrexone - maintain abstinence) Injectable, not yet FDA approved
Pharmacology for Alcoholism Topimirate (Topamax) Has been used for epilepsy, mood disorders Reduces cravings Works on dopamine receptors Reduces heavy drinking; 2008 study showed reduction in blood pressure, BMI, blood cholesterol Increased risk for cleft lip/ palate among pregnant women using Topamax