Lecture 19 Alcohol Use 1 Lecture 19 1. What is Alcohol? 2. History of Alcohol Consumption 3. Patterns of Alcohol Use 4. Short-Term Effects of Alcohol Use 5. Long-Term Effects of Alcohol Use 6. Alcohol Misuse, Abuse, and Dependence 2 1
What is Alcohol? 3 What is Alcohol? The alcohol found in alcoholic beverages Ethyl Alcohol (Ethanol) drinking pure alcohol can be deadly just a few ounces of pure alcohol raises the blood alcohol level into the danger zone. 2
Ethyl Alcohol (Ethanol) What is Alcohol? Beer = 4 to 6 percent (average of about 4.5 percent) Wine = 7 to 15 percent (average of about 11 percent) Champagne = 8 to 14 percent (average of about 12 percent) Distilled Spirits (e.g. rum, gin, vodka, whiskey) = 40 to 70 percent. What is Alcohol? Fermentation Process (e.g. Beer, Wine) Yeast organisms break down sugar Produce alcohol and CO 2 3
What is Alcohol? Distillation (e.g. Bourbon, Vodka) done in a Still Alcohol vapors are released from the mash at high temperatures What is Alcohol? Proof Measure of the percent alcohol by volume twice the percentage of alcohol by volume 50% alcohol = 100 proof (USA standard) A historical concept not used today 4
A Brief History of Alcohol Consumption 9 Alcohol: Our Most Primitive Intoxicant Sumerians invented the art of beer brewing prior to 4200 B.C. Ancient Egypt The first civilization to perfect the art of brewing beer, made from barley Beer was enjoyed by both adults and children, was the staple drink of both poor and wealthy Egyptians Evidence that as a staple foodstuff, ancient Egyptian beer was not particularly intoxicating. 5
Alcohol: Our Most Primitive Intoxicant China 7000 BC - the production of a prehistoric mixed fermented beverage of rice, honey and fruit (Neolithic villages) 2000 BC- unique cereal beverages (Shang and Western Zhou Dynasties) Greece and Rome The historical record contains many references to wine, which figured prominently in ancient Greek and Roman religious ceremonies and celebrations Warnings About Alcohol Use Through the Ages 460-320 BC- Grecian Scholars issued advisories on drunkenness and moderate drinking Plato No use under age 18, between 18-30 use in moderation, no restrictions for use by those older than 40 Aristotle and Hippocrates were both critical of drunkenness 11 th Century AD - Simeon Seth, a physician in the Byzantine Court, wrote that drinking wine to excess caused inflammation of the liver, a condition he treated with pomegranate syrup 6
Patterns of Alcohol Use 13 Who Drinks? Patterns of Alcohol Use About 65% of American adults drink at least occasionally 35% of the adult U.S. population are abstainers Of the two-thirds who do consume alcohol, 28% are at-risk drinkers Low-risk drinkers are men who drink no more than 14 drinks per week or women who drink no more than 7 drinks per week NIAAA National Epidemiological Survey on Alcohol and Related Conditions (NESARC) (2001-2002). 14 7
Drinking Pattern Across the Lifespan Number of Days in Past 30 Drank 5 or More Drinks 4.5 4 3.5 Males Females Days 3 2.5 2 1.5 1 0.5 0 12 13 14 15 16 17 18 19 20 21 22-23 24-25 26-29 30-34 35-49 50-64 65+ Age U.S. Substance Abuse and Mental Health Services Administration, 2003 National Survey on Drug Use and Health (NSDUH) 16 8
Patterns of Alcohol Use Moderate Drinking: up to 2 drinks/day for men up to 1 drink/day for women One drink is defined by the NIAAA as 0.5 ounce of alcohol (USDA/HHS Dietary Guidelines, 2005) NIAAA National Epidemiological Survey on Alcohol and Related Conditions (NESARC) (2001-2002). One Drink 18 9
Blood Alcohol Concentration (BAC): the amount of alcohol in grams in 100 milliliters of blood, expressed as a percentage 19 Patterns of Alcohol Use Nearly 3 in 10 U.S. adults engage in these high-risk drinking patterns 1 Men: Women: more than 14 drinks in a typical week more than 4 drinks on any day more than 7 drinks in a typical week more than 3 drinks on any day 1 Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003 10
21 Patterns of Alcohol Use Binge Drinking - The National Advisory Council on Alcohol Abuse and Alcoholism (NACAAA) has recommended the following definition A binge is a pattern of drinking - brings blood alcohol concentration (BAC) to 0.08 gm% or above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male) or 4 or more drinks (female) in about 2 hours. 11
Short-term Effects of Alcohol on the Body 23 Effects of Alcohol on the Body Alcohol is a central nervous system depressant that impairs thinking, balance, and motor function 24 12
Effects of Alcohol on the Body Once it reaches the brain, alcohol alters brain chemistry and neurotransmitter functions 25 Effects of Alcohol on the Body As alcohol concentrations increase, more functions are depressed, and greater impairment occurs 26 13
At what BAC will your reaction time be slowed?.02 At what BAC will blackouts, memory loss and vomiting occur?.20 What is the legal BAC Level if you are 21 or older? 21 AND OLDER:.08 ZERO TOLERANCE = Any detectable amount of alcohol if you are under 21. 28 14
Blood Alcohol Concentration Over Time 29 Effects of Alcohol on the Body Acute Alcohol Intoxication - a life-threatening blood alcohol concentration which can produce collapse of vital body functions Blackout - 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, dehydration 30 15
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 Less body water than men Metabolize alcohol less efficiently. Women have half as much alcohol dehydrogenase enzyme that breaks down alcohol in the stomach 31 Long-term Effects of Alcohol on the Body 32 16
Benefits of Alcohol Consumption Associated with the substances known as flavonoids (anitioxidants) ONLY found in red wine and beer. White alcoholic drinks, like vodka and cider, contain the least concentration of flavonoids. 33 Benefits of Alcohol Consumption Alcohol can have protective benefits for the heart but only if you drink within the daily limit (moderation) Prevents Artery Damage. Alcohol appears to increase the level of good cholesterol (HDL) in the blood. Alcohol can help prevent the formation of blood clots which can close off the arteries, causing a heart attack. 34 17
Physiological and Behavioral Effects of Alcohol Long-term effects of alcohol abuse Effects on the Nervous System Cardiovascular Effects Liver disease Cirrhosis Alcoholic hepatitis Cancer Chronic inflammation of pancreas Impairs ability to recognize and fight bacteria and viruses Relative Risk of an Alcohol-Related Health Condition as a Function of Daily Alcohol Intake 30 25 Relative Risk 20 15 50 g/day 100 g/day 10 5 0 Oral cavity and pharynx Esophagus Breast Essential hypertension Coronary heart disease Ischemic stroke Hemorrhagic stroke Liver cirrhosis Chronic pancreatitis Condition Adapted from Corrao et al. (2004), Preventive Medicine, 38:613 619 18
Alcoholic Cardiomyopathy Heavy drinking weakens the heart muscle, which means the heart can t pump blood as efficiently. Can cause premature death, usually through heart failure. 37 Medical Problems Associated with Alcohol Use Heart Disease and Stroke Coronary heart disease Drinking excessive alcohol increase the risk of getting high blood pressure. one of the most important risk factors for having a heart attack or a stroke. 38 19
Medical Problems Associated with Alcohol Use Liver Diseases Fatty Liver - liver swells with fat globules Alcoholic fatty liver disease may be reversible with abstinence of alcohol. 39 Medical Problems Associated with Alcohol Use Liver Diseases Alcoholic Hepatitis - Alcoholic hepatitis is characterized by fat deposition in liver cells, inflammation and mild scarring of the liver. 40 20
Medical Problems Associated with Alcohol Use Liver disease Cirrhosis - scarring of the liver 41 Medical Problems Associated with Alcohol Use Alcohol is associated with several types of cancer, particularly cancers of the head and neck, cancers of the digestive tract, and breast cancer 42 21
Medical Problems Associated with Alcohol Use Heavy alcohol consumption directly damages brain cells. The more alcohol one consumes, the more of the brain s white matter is lost. This leads to cognitive failure as individual s age. The more you drink, the earlier it begins to show. Medical Problems Associated with Alcohol Use Long-term heavy drinkers are at risk for weight loss and malnutrition Drunkorexia - a slang, non-medical term, Drunkorexia refers to someone who restricts food calories to make room for alcoholic drink calories. Others may purge their food and alcoholic drink to avoid the calories. 44 22
Risks Alcohol and Pregnancy Alcohol can harm fetal development Even a single exposure can cause damage Fetal Alcohol Syndrome (FAS) Mental retardation, small head, tremors, and abnormalities of face, limbs, heart, and brain FAS is the 3rd most common birth defect in the United States Alcohol and Pregnancy FAS behaviors include Impaired learning Poor memory Impulsive behaviors Reduced attention span Poor problem solving 23
Facts Drinking and Driving 39% of all traffic fatalities are alcohol related In 2005, 16,885 alcohol related fatalities (ARTFs) One ARTF every 30 minutes At BAC 0.10, ten times more likely to be in an accident Current limit for BAC in all 50 states: 0.08% Alcohol Misuse, Abuse, and Dependence 48 24
Alcohol Misuse, Abuse, and Dependence 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 use 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 49 Alcohol Abuse and Alcoholism Alcoholism = alcohol dependency (addition) Tolerance Psychological dependence Withdrawal 25
Alcohol Abuse and Alcoholism Identifying a problem drinker Abuse interferes with Work School Social/family relationships Recovery The High Functional Alcoholic The family s role Intervention planned confrontation Express concern Treatment programs Psychologist and psychiatrists specializing in treatment Alcoholics Anonymous (AA) Private treatment centers Family, individual and group therapy 26
Recovery Relapse 60% rate of relapse in first 3 months Many say they are recovering their whole life To be effective, must work on self esteem and personal growth 27