ALCOHOL

Where does it come from?

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History of Use?

• beer dates back to at least the Egyptians 5000-6000 BC, probably further

• wines date back a few thousand years

• distilled spirits “younger”; in China about 1000 BC but in Arabia/Europe around 800 AD

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Prevalence of Use

• Almost everyone will have at least sipped alcohol in the course of their lifetime; 1 in 4 lifetime abstainers

• Consumption per person actually highest in the mid-1800s• Since 1935 consumption has generally increased, peaking

in the early 80s• In 2001, per capita alcohol ingestion was about 2.2 gallons

• http://www.health.gov/dietaryguidelines/dga2005/report/HTML/D8_Ethanol.htm#top

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Standard Drink Chart

SPIRITS Standard Drinks• 1oz. (86-100 proof) 1• 8 oz. (1/2 pint) 8• 16 oz. (pint) 16• “Fifth” (4/5 quart) 26• 32 oz. (quart) 32• 1/2 gallon (2 quarts) 64• 1 liter (1 quart ) 32• 750 ml (3/4 liter) 24

BEER Standard Drinks• 12 oz (5% alc by vol.) 1• 16 oz. (pint) 1.33• 32 oz. (quart) 2.67

WINE• 4 oz. (12% alc by vol.) 1• 12 oz. (bottle) 3

REINFORCED WINE OR CORDIAL• 2.5 oz. 1

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Prevalence of Use

• From my first visit to a major brewery, I learned a lot: – 250, 000 cases of beer are shipped out of

Anheiser Busch in St. Louis daily, to just the midwestern states

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NHSDA Data

2004

• Lifetime 82.4%

• Past Year 65.1

• Past Month (current) 50.3

• Past Month Binge 22.8%

• Heavy Usage 6.6

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Prevalence of Use by Age

• Rates of current use were at least 60% for most age groups in the 21-44 age range

• curvilinear effect

• Find the usage rate for your specific age bracket at: (Fig. 3.1)

http://www.oas.samhsa.gov/nhsda.htm

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Prevalence of Use by Race/Ethnicity

• Whites continue to have highest rate of use

• Heavy use among groups about the same??– Si o no?

• See figure 3.3 from NSDUH

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Prevalence of Use by Gender

• As you might guess, current (past month) alcohol use is more prevalent among males :

(56.9% vs. 44% - 2004 data)

• Men were much more likely to be binge and be “heavy” drinkers

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Prevalence of Use by Education

• In contrast to drug abuse patterns, the more education a person has, the more likely they reported current drinking

• 66% of college grads vs. 39% of those having less than high school education

• Heavy drinking more common among those without high school education (6.8 vs 3.7)

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Figure 3.4 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2006

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College binge drinking

Harvard Study:

• 43% binged in prior 2 weeks (48% men; 39% women)

• about 65% of the members of frats/sor. Binged

• Reasons for drinking1993 1997

• “get drunk” 39% 52%

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Alcohol’s Pharmacology

• It is a CNS depressant

• Peak concentrations are reached between 30-90 minutes after drinking is stopped

• Alcohol is distributed to all tissues in the body and passes to the brain easily

• LD 50 is 25 drinks in 1 hour; BAC of .45 - .55 (BAC is expressed as a ratio of milligrams or weight of alcohol per 100 milliliters - about 3 ounces of blood)

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Relationship Between Blood Alcohol and Alcohol Intake

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most of the consumed alcohol metabolized in liver

broken down to acetaldehyde (by ADH - alcohol dehydrogenase and then to acetic acid by aldehyde dehy.)

carbon dioxide and water

excreted by lungs excreted in urine

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Addiction and Withdrawal Indicators

• Is it Addictive? How do we know?

– Tolerance (cellular & metabolic) develops

– Withdrawal symptoms occur• BAC can still be above .00 for withdrawal sx to begin

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Withdrawal Indicators• Stoppage (or reduction in) etoh use that has been

heavy and prolonged• Symptoms developing within hours to a few days

may include: (need at least 2 for DSM criteria)

– autonomic hyperactivity (sweating or pulse rate > than 100)

– increased hand tremor

– insomnia

– nausea or vomiting

– transient visual, tactile, or auditory hallucinations or illusions

– psychomotor agitation

– anxiety

– grand mal seizures

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CONSEQUENCES

What are some positive and negative effects?

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Short-term Effects

• Physiological– urination, increased gastric secretion stimulating

appetite at low or moderate doses– disruption of sleep; suppresses REM throughout

night at high doses– hangover (although no alcohol in body, driving

ability may still be impaired)– body sway– may experience a decrease in pain sensitivity, and

in vision-taste senses

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Short-term Effects cont.

• Psychological– mood enhancer at lower doses– mood state prior to drinking critical– emotional lability and aggression by some at higher

doses

• Social/familial Interference– but may facilitate emotional expression and be the

only time that this happens; drinking subcultures

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Short-term Effects cont.

• Cognitive– memory impairment– reaction time slows

• Other– Drunk driving– Suicide– Sexual assualt , esp. acquaintance rape– High risk sex

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Drinking and Driving

• The many skills involved in driving are not all impaired at the same BAC– Ability to divide attention between 2 or more

sources of visual stimuli impaired at .02– Impairments occur consistently at .05 or more:

• eye movements• glare resistance• depth perception

• reaction time• information processing• some steering tasks

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Drinking and Driving

• Drivers with BACs of .15 or greater have about 380 times the risk of being in a single-vehicle fatal crash versus those not drinking at all

• MV crashes leading cause of death among youth 15-20

• E.g. In 1994 about 7,800 16-20 year-olds were drivers in fatal crashes; 23% of these had positive BACs

– Inexperience in driving, in drinking, and in combining the two activities is often fatal

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Long-term Consequences:

• 60% of males & 30% of females have had at least one negative alcohol-related incident

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Long-term Consequences cont.

• Physical:– fatty liver, alcohol hepatitis, and cirrhosis– increased risk of CAD and various types of

cancers– increased susceptibility to illness; lower immune

system functioning– GI problems such as pancreatitis– FAS: small eyes, droopy eyelids, small head, low

intellectual functioning; associated with low SES

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(a) Normal Liver (b) Cirrhotic LiverFigure 11-4

11-6

a.

b.

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Long-term Consequences cont.

• Cognitive:– impairs memory, problem-solving, learning and

reaction time– neuropsychological damage can be reversed with

prolonged abstinence– Wernicke-Korsakoff Syndrome

• unable to learn new material due to failure to transfer

• confabulation

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Long-term Consequences cont.

• Social and family consequences:– Sometimes its helpful to look not only at what has

directly happened due to long-term alcohol abuse, but what the drinker and family missed out on

• Psychological consequences:

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College binge drinking

Harvard Study:

• 43% binged in prior 2 weeks (48% men; 39% women)

• about 65% of the members of frats/sor. Binged

• Reasons for drinking1993 1997

• “get drunk” 39% 52%

• Now

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Alcohol’s effects onaggressive behavior

• Associated with:– domestic violence– child abuse– murder– common assaults– suicide (in one study of 3,400, 35% had been

drinking)

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THEORIES:

• Alcohol as a Direct Cause of Aggression– alcohol as a disinhibitor of those brain functions

that normally prevent aggression– alcohol “paralyzes the brakes, does not step on the

gas”

• Indirect Cause– alcohol causes physical, emotional and cognitive

changes that make aggression more likely• e.g. Cognitive: perceive risk where there is none

• e.g. Physical: increases arousal levels

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THEORIES cont.• Motives for Drinking

– people drink for some main reason, maybe to reduce anxiety or increase their feeling of power

• EX. men drink to feel stronger

• Predispositional - Situational Factors– certain types of people are predisposed to act

aggressively…and drinking situations give them an outlet to do so

– those who expect alcohol to increase aggression act aggressively…“blame the bottle”

– drinking situations may be seen as culturally agreed on time-outs

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Alcohol and Aggression

Most likely, aggression results from a complex interplay between

alcohol expectancy,

alcohol dose,

personal factors

and

situational factors