WELCOME TO THE SCIENCE OF ALCOHOL AND ALCOHOLISM.

WELCOME TO WELCOME TO THE SCIENCE OF ALCOHOL THE SCIENCE OF ALCOHOL

AND ALCOHOLISMAND ALCOHOLISM

Element- A substance which cannot be decomposed into simpler substances by chemical reactions. Some important biological elements:

Oxygen (O) Carbon (C) Phosphorus (P) Calcium (Ca) Potassium (K) Iron (Fe)

Hydrogen (H) Nitrogen (N) Sulfur (S) Sodium (Na) Magnesium

(Mg)

CHEMICAL ISOMERSBOTH CHEMICALS ARE H6C2O, BUT THEY ARE NOT THE SAME

CHEMICAL!

Types of Alcohol

Isopropyl (“rubbing alcohol”) Methyl (“wood alcohol”) (CH3OH) Ethyl (beverage

alcohol/ethylene/ethanol) H5 C2OH

ALCOHOL EQUIVALENTSALCOHOL EQUIVALENTS

12 Oz. Beer @ 6% alcohol =12 Oz. Beer @ 6% alcohol =

4 oz wine @ 12% alcohol =4 oz wine @ 12% alcohol =

1.25 oz spirits @ 80 proof (40%) 1.25 oz spirits @ 80 proof (40%) alcohol =alcohol =

1 oz spirits @ 100 proof (50%) alcohol1 oz spirits @ 100 proof (50%) alcohol

Absorption of alcoholAbsorption of alcohol

small amounts of alcohol small amounts of alcohol absorbed by the mouth absorbed by the mouth

most alcohol enters most alcohol enters bloodstream from stomach, bloodstream from stomach, small intestine and colonsmall intestine and colon

rate of absorption dependent rate of absorption dependent on gastric emptying timeon gastric emptying time

Absorption of alcoholAbsorption of alcohol

absorption delayed by presence of food in the small intestine

Metabolism of alcoholMetabolism of alcohol

occurs primarily in the liveroccurs primarily in the liver

Proportionate to body weightProportionate to body weight

A small amount of alcohol is detoxified A small amount of alcohol is detoxified by the microsomal enzyme oxidation by the microsomal enzyme oxidation systemsystem


On average, occurs at rate of 1 ounce of On average, occurs at rate of 1 ounce of pure alcohol per three hourspure alcohol per three hours

(1.78 oz of 80 proof alcohol/hour)(1.78 oz of 80 proof alcohol/hour)

Metabolism of alcoholMetabolism of alcoholAlcohol Alcohol

alcohol dehydrogenase (ADH)alcohol dehydrogenase (ADH)

Acetaldehyde-Acetaldehyde-

acetaldehyde dehydrogenase (ALD-H)acetaldehyde dehydrogenase (ALD-H)

Acetic acid (acetate) Acetic acid (acetate)

CO2 & H20CO2 & H20


In heavy alcohol drinkers, liver enzymes In heavy alcohol drinkers, liver enzymes will show an increase, especially:will show an increase, especially:

SGOT (serum oxaloacetic tranaminase) SGOT (serum oxaloacetic tranaminase)

SGPT (serum glutamic pyruvic SGPT (serum glutamic pyruvic tranaminase)tranaminase)

Variations in alcohol Variations in alcohol metabolismmetabolism

50% of persons of Japanese ancestry 50% of persons of Japanese ancestry have a variant form of ALDH which is have a variant form of ALDH which is less able to metabolize alcohol. Also less able to metabolize alcohol. Also present in some persons of Chinese present in some persons of Chinese ancestry.ancestry.

Levels of acetaldehyde may be 10X Levels of acetaldehyde may be 10X higher than in persons with normal higher than in persons with normal ALDHALDH

Variations in alcohol Variations in alcohol metabolismmetabolism

Excess acetaldehyde produces “alcohol Excess acetaldehyde produces “alcohol flush reaction”flush reaction”

Alcohol Flush ReactionAlcohol Flush Reaction

facial flushingfacial flushing

vasodilationvasodilation

tachycardiatachycardia

headacheheadache


nauseanausea

vomitingvomiting

edema (fluid build-up/”water weight”)edema (fluid build-up/”water weight”)

hypotensionhypotension


Same reaction occurs when individuals Same reaction occurs when individuals on Antabuse drink on Antabuse drink

Presence of ALDH variant seems to Presence of ALDH variant seems to lessen tendency to drink alcohollessen tendency to drink alcohol

The ALDH variant is rare in Japanese The ALDH variant is rare in Japanese alcoholics with liver diseasealcoholics with liver disease

Blood alcohol level (BAL)/Blood alcohol Blood alcohol level (BAL)/Blood alcohol concentration (BAC) & Behaviorconcentration (BAC) & Behavior

BALBAL BehaviorBehavior

0.05%0.05% Relaxation, decreased Relaxation, decreased inhibitions & alertness, inhibitions & alertness,

possible personality possible personality changechange

0.080.08 Legal level in Illinois for DUILegal level in Illinois for DUI



0.100.10 Slowed reaction time, impaired Slowed reaction time, impaired judgment, personality changesjudgment, personality changes

0.150.15 Large, consistent in reaction Large, consistent in reaction time, increasing intoxication, time, increasing intoxication, mood/personality changesmood/personality changes



0.200.20 Significant impairment of Significant impairment of sensory and motor sensory and motor

functions, functions, marked intoxicationmarked intoxication

0.250.25 Severe motor and sensory Severe motor and sensory disturbance, staggering disturbance, staggering

gait, gait, marked intoxicationmarked intoxication



.30.30 Semi-stupor, marked decrease Semi-stupor, marked decrease in in awareness and breathing rate, awareness and breathing rate,

blackoutsblackouts

.35.35 Surgical anesthesia, level of Surgical anesthesia, level of LDLD11, , minimal level normally minimal level normally required required to cause deathto cause death



0.400.40 LDLD5050

On average, fifty percent of drinkers On average, fifty percent of drinkers with a blood alcohol level of 0.40 will die with a blood alcohol level of 0.40 will die of alcohol poisoning. of alcohol poisoning.

““HE IS……”HE IS……”

WHAT ABOUT “SHE”?WHAT ABOUT “SHE”?

SEX DIFFERENCES AND SEX DIFFERENCES AND ALCOHOL INTOXICATIONALCOHOL INTOXICATION

IN GENERAL, AT THE SAME IN GENERAL, AT THE SAME LEVEL OF ALCOHOL LEVEL OF ALCOHOL COSUMPTION, WOMEN COSUMPTION, WOMEN ACHIEVE A HIGHER BAC THAN ACHIEVE A HIGHER BAC THAN MENMEN


Women’s body weight is usually less than Women’s body weight is usually less than men’smen’s

Women tend to have less water in their Women tend to have less water in their bodies and a higher percent of body fat, bodies and a higher percent of body fat, so there is less tissue in which alcohol can so there is less tissue in which alcohol can dissolvedissolve

Women tend to metabolize alcohol less Women tend to metabolize alcohol less efficiently than men.efficiently than men.


Food in the stomach tends to slow the Food in the stomach tends to slow the absorption of alcoholabsorption of alcohol

Men tend to drink and snack, thus Men tend to drink and snack, thus increasing the amount of food in the increasing the amount of food in the stomachstomach

Women tend to diet more than men, and Women tend to diet more than men, and may not very much prior to drinkingmay not very much prior to drinking

PHYSIOLOGICAL EFFECTS OF PHYSIOLOGICAL EFFECTS OF ACUTE ALCOHOL CONSUMPTIONACUTE ALCOHOL CONSUMPTION

Dilation of the peripheral blood vessels = Dilation of the peripheral blood vessels = flushing, increased warmth of skin, flushing, increased warmth of skin, possibly sweating. possibly sweating.

Small doses produce slight in Small doses produce slight in respiration. Large doses (>.39) can respiration. Large doses (>.39) can produce respiratory arrest.produce respiratory arrest.

GASTROINTESTINAL (G.I.) GASTROINTESTINAL (G.I.) SYSTEM: THE G.I. TRACTSYSTEM: THE G.I. TRACT

mouth esophagus stomach small intestine large intestine (colon) rectum anus

GATROINTESTINAL (G.I.) SYSTEM GATROINTESTINAL (G.I.) SYSTEM : ACCESSORY ORGANS: ACCESSORY ORGANS

salivary glandssalivary glands

pancreaspancreas

liver liver

gallbladdergallbladder

EFFECT OF ALCOHOL ON THE EFFECT OF ALCOHOL ON THE

GASTROINTESTINAL SYSTEMGASTROINTESTINAL SYSTEM

Responsible for:Responsible for: ingestion, digestion, absorption of foodingestion, digestion, absorption of food

ingestion, absorption, and breakdown of ingestion, absorption, and breakdown of some drugssome drugs

the elimination of solid wastes. the elimination of solid wastes.

EFFECT OF ALCOHOL ON EFFECT OF ALCOHOL ON

THE GASTROINTESTINAL SYSTEMTHE GASTROINTESTINAL SYSTEM

EsophagitisEsophagitis

Peptic Ulcer DiseasePeptic Ulcer Disease Hemorrhagic Hemorrhagic

pancreatitispancreatitis Uric acid elevation--- Uric acid elevation---

GoutGout HyperglycemiaHyperglycemia Alcoholic hepatitisAlcoholic hepatitis

GastritisGastritis

PancreatitisPancreatitis Pancreatic insufficiencyPancreatic insufficiency HypoglycemiaHypoglycemia Alcoholic fatty liver Alcoholic fatty liver

(hepatosis)(hepatosis) CirrhosisCirrhosis

GastritisGastritis

Presence of alcohol in the stomach initiates Presence of alcohol in the stomach initiates release of gastric juicesrelease of gastric juices

If no food is present, the stomach can If no food is present, the stomach can become irritatedbecome irritated

Peptic Ulcer DiseasePeptic Ulcer Disease

Alcohol does not cause ulcers, but Alcohol does not cause ulcers, but if one is already present, both if one is already present, both alcohol and unabsorbed gastric alcohol and unabsorbed gastric juices can make it worsejuices can make it worse

If stomach lining is ulcerated If stomach lining is ulcerated enough, bleeding can occurenough, bleeding can occur

PancreatitisPancreatitis

Pancreas secretes digestive Pancreas secretes digestive enzymes into the small intestine enzymes into the small intestine via the pancreatic duct.via the pancreatic duct.

Alcohol can block the duct by Alcohol can block the duct by inflaming the small intestineinflaming the small intestine

Digestive enzymes “stuck” in Digestive enzymes “stuck” in pancreas; begin to irritate and pancreas; begin to irritate and digest itdigest it

PancreasPancreas

Pancreatitis

Most common symptom pancreatitis is pain. May come on suddenly or build gradually. Pain usually centered in the upper middle or

upper left part of the abdomen. May feel as if it radiates through to the back. Often begins or worsens after eating. Typically lasts a few days, unless drinking

continues Pain worsen when person lies flat

on his/her back May be relieved when the person curls up

into a ball.

Pancreatitis

Other symptoms:Nausea, w/ or w/o vomtingFever, chills, or both Abdomen swollen and tender to the touch Tachycardia (May indicate internal

bleeding) In very severe cases, dehydration and low

blood pressure, fatigue, faintness, lethargy, irritability, confusion or difficulty concentrating, headache.

If blood pressure too much, circulatory shock

Hemorrhagic Pancreatitis

Pancreatic enzymes eat through Pancreatic enzymes eat through wall of pancreas, causing bleeding wall of pancreas, causing bleeding in the abdominal cavity in the abdominal cavity

Pancreatic insufficiency

Pancreas is sufficiently damaged that Pancreas is sufficiently damaged that it stops producing digestive enzymesit stops producing digestive enzymes

Islands of langerhans are on bottom Islands of langerhans are on bottom surface of pancreas. They secrete surface of pancreas. They secrete insulininsulin

Production and secretion of insulin Production and secretion of insulin may slow or stop.may slow or stop.

Tx=Supplemental enzymes and Tx=Supplemental enzymes and insulins insulins

ALCOHOL AND LIVER DISEASEALCOHOL AND LIVER DISEASE

Alcohol-induced liver disease (ALD) is a Alcohol-induced liver disease (ALD) is a major cause of illness and death in the major cause of illness and death in the United States. United States.

Alcoholic fatty liver (hepatosis), the most Alcoholic fatty liver (hepatosis), the most common form of ALD, is reversible with common form of ALD, is reversible with abstinence.abstinence.

HEPATOSIS

At least nine out of ten chronic At least nine out of ten chronic alcoholics will develop alcoholic alcoholics will develop alcoholic fatty liver. fatty liver.

Placques of fat invade the normal Placques of fat invade the normal structure of the liver to cause this structure of the liver to cause this condition. condition.

The disease usually has no obvious The disease usually has no obvious symptoms. It is detected by symptoms. It is detected by physical exam and blood laboratory physical exam and blood laboratory studies. studies.

HEPATOSIS

If a person stops drinking, fatty liver will disappear on its own in 4 to 6 weeks without formalized medical treatment.

If drinking continues, fatty liver may progress to hepatitis.

ALCOHOL AND LIVER ALCOHOL AND LIVER DISEASEDISEASE

More serious ALD includes

- alcoholic hepatitis, characterized by persistent

inflammation of the liver

- cirrhosis, characterized by progressive scarring of

liver tissue.

ALCOHOLIC HEPATITISALCOHOLIC HEPATITIS

Hepatitis" is a general word that refers to swelling or inflammation of the liver.

Alcoholic hepatitis is caused by the toxic effects of alcohol on the liver after long-term use.

Alcoholic hepatitis usually occurs after fatty liver but may appear without any previous liver dysfunction.

ALCOHOLIC HEPATITISALCOHOLIC HEPATITIS Ten to thirty percent of all

alcoholics will develop hepatitis if they continue to abuse alcohol.

A person with alcoholic hepatitis feels generally ill.

Common symptoms:- loss of appetite and weight,- low grade fever- abdominal pain- nausea and vomiting

ALCOHOLIC HEPATITISALCOHOLIC HEPATITIS

Common symptoms:

- enlarged, tender liver

- abnormal laboratory tests of liver function

Treatment of alcoholic hepatitis involves abstinence from alcohol and provision of adequate nutrition.

CIRRHOSISCIRRHOSIS

Five to ten percent of all alcoholics develop cirrhosis of the liver

It usually develops after a long history of excessive alcohol intake.

The disease may follow alcoholic hepatitis or may occur without any previous symptoms

ALCOHOL AND LIVER ALCOHOL AND LIVER DISEASEDISEASE

CONSEQUENCES OF LIVER DISEASE

inability to synthesize protein

inability to manufacture clotting factors

inability to eliminate estrogen

lessened ability to store vitamins

diminished tolerance

CIRCULATORY SYSTEMCIRCULATORY SYSTEM

Transports nutrients and removes wastes from all tissues of the body– heart

– blood

– blood vessels (capillaries, veins, arteries)

COMPOSITION OF BLOODCOMPOSITION OF BLOOD

Platelets

White blood cells (WBC)

Red blood cells (RBC)

EFFECT OF ALCOHOL ON THE EFFECT OF ALCOHOL ON THE CIRCULATORY SYSTEMCIRCULATORY SYSTEM

Small amounts of etoh (~ 1 alcohol equivalent/day) seem to be good for the circulatory system

Alcohol affects the entire circulatory system as well as the heart.

Alcohol can produce:

– High blood pressure

– An enlarged, weakened heart

– Irregular heartbeat

EFFECT OF ALCOHOL ON THE EFFECT OF ALCOHOL ON THE CIRCULATORY SYSTEMCIRCULATORY SYSTEM

Alcohol can produce:

– Capillaries surrounding the conjunctiva of the eye to become enlarged

– Due to peripheral blood vessel dilation, skin appears flushed, and "whiskey nose" may develop

– Depression of bone marrow function

EFFECT OF ALCOHOL ON THE EFFECT OF ALCOHOL ON THE

CIRCULATORY SYSTEMCIRCULATORY SYSTEM

Poor diet = blood problems- anemias

- decreased WBC Count- “Weak” WBCs

- decreased platelets

Alcoholic cardiomyopathy

- palpitations

- labored breathing

EFFECT OF ALCOHOL ON THE EFFECT OF ALCOHOL ON THE RESPIRATORY SYSTEMRESPIRATORY SYSTEM

Paralysis of cilia Fluid accumulates in the nose,

pharynx, larynx, and vocal chords ("whiskey voice"/hoarseness)

Lung/esophageal cancer

EFFECT OF ALCOHOL ON EFFECT OF ALCOHOL ON THE ENDOCRINE SYSTEMTHE ENDOCRINE SYSTEM

decreased testosterone levels

increased estrogen levels

EFFECT OF ALCOHOLISM ON THE EFFECT OF ALCOHOLISM ON THE NERVOUS SYSTEMNERVOUS SYSTEM

Compared to non-alcoholics, the brains of alcoholics:

– contain fewer nerve cells, fewer connections among cells, less white and grey matter, and larger ventricles.

This “cerebral atrophy” is associated with impairment of intellect.

The underlying mechanism of brain damage appears to be a direct toxic action of alcohol on nerve cells

EFFECT OF ALCOHOLISM ON EFFECT OF ALCOHOLISM ON THE NERVOUS SYSTEMTHE NERVOUS SYSTEMWernicke Korsakoff Syndrome

Results from thiamin deficiency Disorientation Confusion Apathy Inattentivenss Nystagmus Gaze paralysis Retrobulbar neuropathy - transient blindness/spots in visual

field

EFFECT OF ALCOHOLISM ON EFFECT OF ALCOHOLISM ON THE NERVOUS SYSTEMTHE NERVOUS SYSTEM

Wernicke Korsakoff Syndrome Ataxia Korsakoff: Severe memory problems

(retrograde and antegrade) Confabulation


Alcoholic Cerebellar Degeneration– Wide-based gait– Leg incoordination– Inability to walk heel-to-toe– Develops over several weeks, may be

relatively mild for some time, suddenly worsens after binge drinking or an unrelated illness.


Alcoholic Peripheral Neuropathy– Due to nutritional deficiencies,

especially B1– Degeneration of cells in PNS– Numbness– Tingling/burning sensation in

hands/feet

– Muscle weakness

– Depressed reflexes

INDIRECT EFFECTS OF ALCOHOLISM INDIRECT EFFECTS OF ALCOHOLISM ON THE NERVOUS SYSTEMON THE NERVOUS SYSTEM

By damaging the liver, alcohol impairs the deactivation of many toxins found in the normal diet.

Toxic compounds (e.g., ammonia) otherwise deactivated by the liver are released into the bloodstream.

When they reach the brain, high concentrations of ammonia & other chemicals cause gradual psychological changes and mental confusion.

INDIRECT EFFECTS OF ALCOHOLISM INDIRECT EFFECTS OF ALCOHOLISM ON THE NERVOUS SYSTEMON THE NERVOUS SYSTEM

If condition continues:– Lack of coordination– Incontinence– Tremors

– Nystagmus

ALCOHOL AND CANCER ALCOHOL AND CANCER

MechanismsMechanisms

-- irritation of cellsirritation of cells

-- liver damageliver damage

-- nutritional deficienciesnutritional deficiencies

-- carcinogenic congenerscarcinogenic congeners

-- interaction with tobacco (effect on interaction with tobacco (effect on lungs and inhibition of salivation)lungs and inhibition of salivation)

ALCOHOL AND CANCERALCOHOL AND CANCER

Types of CancerTypes of Cancer

-- head/neckhead/neck

-- esophagusesophagus

-- lunglung

-- liverliver

-- breastbreast

ALCOHOL AND ALCOHOL AND BREAST CANCERBREAST CANCER

Intake of 2-5 drinks/day is associated Intake of 2-5 drinks/day is associated with increased risk of breast cancerwith increased risk of breast cancer

After 5 drinks/day, risk did not increase After 5 drinks/day, risk did not increase significantlysignificantly

““Among women who consume alcohol Among women who consume alcohol regularly, reducing alcohol consumption regularly, reducing alcohol consumption is a potential means to reduce breast is a potential means to reduce breast cancer risk. “cancer risk. “

Source: Smith-Warner, et. al. (1998)Source: Smith-Warner, et. al. (1998)

BEER, BEEF AND CANCERBEER, BEEF AND CANCER

Some evidence exists that moderate Some evidence exists that moderate

intake of beer may neutralize some of the intake of beer may neutralize some of the

carcinogens (hetereocyclic amines/HAs) carcinogens (hetereocyclic amines/HAs)

that form when meat is cooked. that form when meat is cooked.

ALCOHOL AND ALCOHOL AND PREGNANCYPREGNANCY

Women who consume two or more Women who consume two or more drinks per week while pregnant have a drinks per week while pregnant have a higher risk of spontaneous abortion.higher risk of spontaneous abortion.

Most spontaneous abortions occur during Most spontaneous abortions occur during the second trimester. the second trimester.

Source: Harlap & Shiono (1980) Source: Harlap & Shiono (1980)


Drinking while pregnant increases the Drinking while pregnant increases the risk of stillbirth.risk of stillbirth.

Stillbirths can occur after heavy drinking Stillbirths can occur after heavy drinking in the last trimester. in the last trimester.


Drinking alcohol during the last Drinking alcohol during the last trimester of pregnancy lessens the trimester of pregnancy lessens the amount of oxygen delivered to the amount of oxygen delivered to the developing child. This leads to fetal developing child. This leads to fetal death (stillbirth fetus).death (stillbirth fetus).

Source: Herfindal, et. al., 1988Source: Herfindal, et. al., 1988


Alcohol decreases the amount of blood Alcohol decreases the amount of blood flow to the fetus from the mother, thus flow to the fetus from the mother, thus cutting down on nutrient and oxygen cutting down on nutrient and oxygen transfer. transfer.

It also inhibits cell division and interferes It also inhibits cell division and interferes with replication of RNA.with replication of RNA.

FETAL ALCOHOL SYNDROME FETAL ALCOHOL SYNDROME & FETAL ALCOHOL EFFECT& FETAL ALCOHOL EFFECT

Prenatal alcohol exposure is one of the leading known causes of mental retardation in the Western World

Prenatal and/or postnatal growth retardation (weight and/or length below the 10th percentile);


Lessened ability in many body functionsLessened ability in many body functions Poor coordination or clumsinessPoor coordination or clumsiness Low muscle toneLow muscle tone Irritability,Irritability, Jitteriness, Jitteriness, HyperactivityHyperactivity


Central nervous system involvement, Central nervous system involvement, including:including:

-- neurological abnormalities neurological abnormalities

-- developmental delaysdevelopmental delays

-- behavioral dysfunction behavioral dysfunction

-- intellectual impairment intellectual impairment

-- skull or brain malformations skull or brain malformations


A characteristic face with A characteristic face with

-- short palpebral fissures (eye short palpebral fissures (eye openings)openings)

-- a thin upper lipa thin upper lip

-- an elongated, flattened midface and an elongated, flattened midface and philtrumphiltrum

Typical Physical Features of Fetal Alcohol Syndrome

FAS:Upper Lip Features

Variations in Epicanthal Folds

STAGES OF ALCOHOL WITHDRAWAL: Stage 1:

Anxiety Agitation Hypertension Eating Disturbances (e.g., anorexia) Hallucinations Quality of contact (awareness of

examiner and people around him/her) Paroxysmal Sweats Tachycardia Hyperreflexia

STAGES OF ALCOHOL WITHDRAWAL: Stage 1:

Seizures/Convulsions Sleep Disturbances (e.g., insomnia/poor

quality of sleep) Sensorium clouded (disorientation) Hyperthermia/Hyperpyrexia Tremor ("the shakes")

STAGES OF ALCOHOL WITHDRAWAL:Stage 2

All of the signs of stage 1, but increased severity

Begins within 48 hours of last drink Distinguishing feature is appearance of

hallucinationsAuditory, but may be visualUsually non threateningPatient/client usually has insight into

their benign nature

STAGES OF ALCOHOL WITHDRAWAL:Stage 3: Delirium Tremens ("DT's")

An acute, reversible organic psychosis Usually begins after ~72 hours after the

last drink Duration: two to six days All signs and symptoms listed in Stage 1,

but greatly increased severity Hallucinations: may now include olfactory

and/or tactile manifestationsHallucinations may be fusedPatient/client lacks insight into benign

nature of hallucinations


Disorientation (person, place, time) Misidentification common Emotional Lability Anxious, fearful Depressed, apathetic Angry Euphoric Agitation often becomes more

pronounced after sunset


(CAUTION: DARKENED ROOMS MAY TRIGGER THIS REACTION DURING DAYTIME HOURS)

USE OF MEDICATION TO TREAT WITHDRAWAL

Administration of thiamin (100 mg/day) to avoid Wernicke Korsakoff syndrome

Many patients/clients will need little or no additional medication during withdrawal

Medication of withdrawal should not begin while the patient is at 0.15 BAL or above

USE OF MEDICATION TO TREAT WITHDRAWAL:

Pharmaceutical Agents Alcohol is cross-reactive and cross

tolerant with most commonly used, non-neuroleptic sedatives (tranquilizers and hypnotics). These include:All of the benzodiazepines (Ativan, Xanax,

Valium, etc.)All barbiturates (phenobarbital,

secobarbital/Seconal, etc.)Most non barbiturate hypnotics (Dalmane,

Placidyl, Doriden)

USE OF MEDICATION TO TREAT WITHDRAWAL:

Pharmaceutical Agents Long acting benzodiazepines

(chlordiazepoxide/Librium) are drug of choice

Depends on patient characteristics:Liver diseaseNausea and vomitingKnown potential for seizuresPregnancyAdvanced age

The Genetics of AlcoholismThe Genetics of Alcoholism

Rates of alcoholism among the relatives Rates of alcoholism among the relatives

of alcoholics are significantly higher than of alcoholics are significantly higher than

among the relatives of non-alcoholics, among the relatives of non-alcoholics,

with children of alcoholics showing a 3-with children of alcoholics showing a 3-

4X greater risk of developing the 4X greater risk of developing the

disorder.disorder.

Genetic Influences Operate in:Genetic Influences Operate in:

Choice to DrinkChoice to Drink

Level of ResponseLevel of Response

ReinforcementReinforcement

ConsequencesConsequences DependenceDependence

Wernicke - KorsakoffWernicke - Korsakoff

CirrhosisCirrhosis

PancreatitisPancreatitis Withdrawal seizuresWithdrawal seizures

Alcohol MetabolismAlcohol Metabolism

Disinhibition / Disinhibition / ImpulsivityImpulsivity

Independent Independent Psychiatric DisordersPsychiatric Disorders


The evaluation of family, twin and The evaluation of family, twin and

adoption studies all indicate that genetics adoption studies all indicate that genetics

plays an important part in the plays an important part in the

development of some forms of alcoholismdevelopment of some forms of alcoholism


Cloninger and his associates have Cloninger and his associates have identified two types of alcoholism based identified two types of alcoholism based on:on:

– the biological parents’ pattern of alcohol the biological parents’ pattern of alcohol abuse abuse

– the degree to which postnatal environmental the degree to which postnatal environmental factors affect the inheritance of a factors affect the inheritance of a susceptibility to alcoholismsusceptibility to alcoholism

Cloninger’s Typology:Cloninger’s Typology:Milieu-Limited (Type 1)Milieu-Limited (Type 1)

predominates among female alcoholics predominates among female alcoholics and their male relativesand their male relatives

characterized by:characterized by:

– loss of control over drinking after the age of loss of control over drinking after the age of 2525

– pronounced environmental reactivity to pronounced environmental reactivity to drinking drinking

Cloninger’s Typology:Cloninger’s Typology:Milieu-Limited (Type 1)Milieu-Limited (Type 1)

– minimal criminalityminimal criminality

– ““passive-aggressive” traits passive-aggressive” traits

– high degrees of harm avoidance, reward high degrees of harm avoidance, reward dependence; dependence;

– low levels of novelty-seekinglow levels of novelty-seeking

Cloninger’s Typology:Cloninger’s Typology:Male-Limited (Type 2)Male-Limited (Type 2)

predominates among male alcoholics and predominates among male alcoholics and their male relativestheir male relatives

less dependency on environmental factors less dependency on environmental factors more associated criminalitymore associated criminality personality traits are the opposite of the personality traits are the opposite of the

milieu-limited alcoholicmilieu-limited alcoholic

Date post:	17-Dec-2015
Category:	Documents
Upload:	wesley-wood
View:	216 times
Download:	0 times

WELCOME TO THE SCIENCE OF ALCOHOL AND ALCOHOLISM.

Documents