The Responsible Use of Alcohol Chapter 10

The Nature of Alcohol Ethyl Alcohol (Ethanol, EtOH) Is the only alcohol that can be consumed Is the psychoactive ingredient in alcoholic beverages There are varying amounts of alcohol in various alcoholic beverages: Beer: 3-6% alcohol by volume Malt Liquors (not lower than 5%): 6-8% alcohol by volume Table wines: 9-14% alcohol by volume Fortified wines: 20% alcohol by volume Sugar and extra alcohol is added Hard liquors: 35-50% (or more) alcohol by volume

The Nature of Alcohol The concentration of alcohol in a beverage is indicated by its proof value Proof Value Two times the percentage concentration So if the alcohol percentage is 40% then it is 80 proof Caloric Content of alcohol 7 calories per gram 1 drink contains ~100-120 calories

Alcohol Absorption 20% of alcohol is rapidly absorbed in the stomach;75% is absorbed in the small intestines Once alcohol is in the bloodstream it produces sensations of intoxication The rate at which alcohol is absorbed is affected by many factors: Carbonation: increases absorption rate Food in the stomach: slows rate Increased alcohol concentration: slows rate (irritates mucous membranes)

alcohol Metabolism Alcohol is transported through the body in the bloodstream Main site for metabolism is the liver (digests about 1 drink/hour) 2-10% of ingested alcohol is not metabolized by the liver but is excreted unchanged through skin, lungs, etc. Although the rate of alcohol absorption can be slowed the metabolic rate cannot be influenced by exercise, breathing deeply, eating, drinking coffee, or taking other drugs

Alcohol Intake and Blood Alcohol Concentration (BAC) Blood Alcohol Concentration (BAC) is the amount of alcohol in a persons blood BAC is affected by the amount of alcohol consumed in a given amount of time and by individual factors which are: Body Weight: smaller people develop higher BAC; smaller people have less body tissue into which alcohol can be distributed. Percentage of body fat: higher % body fat = higher BAC (alcohol stays in bloodstream, and not in fat) Gender: women metabolize less alcohol in stomach, more unmetabolized alcohol is released into bloodstream and women tend to have higher % body fat Drinking behavior : chronic drinkers metabolize alcohol faster, so lower BAC Drinking behavior: the faster you drink, the faster BAC rises

Metabolism and Excretion of alcohol Alcohol is eliminated from the body by excretion and metabolism (most is metabolized). You cannot change the rate at which alcohol is metabolized. The rate of alcohol metabolism is constant, while the rate of absorption can vary. Once BAC reaches a certain level, the only way to lower it is to wait for liver enzymes to do their job. Heavy drinkers metabolize alcohol faster than light or non-drinkers.

The Immediate Effects of Alcohol Alcohol depresses the CNS and its effects vary with BAC The effects vary b/c different body systems are affected to different degrees at different BACs At low concentrations (0.03%-0.05% ): effects of alcohol are light-headedness, relaxation, release of inhibitions At higher concentrations (0.1% -0.2%): motor coordination, verbal performance and intellectual functions impaired At 0.2% most drinkers are completely unable to function (physically or psychologically A BAC of 0.35% or higher can be fatal

The Immediate Effects of Alcohol Other effects include: Alcohol hangover- caused by a combination of toxic products of alcohol breakdown, dehydration and hormonal effects. Alcohol poisoning –rapid rise in BAC; loss of consciousness and possible death from CNS and respiratory depression or by inhaling fluid or vomit into the lungs. Using alcohol with other Drugs- Alcohol-drug combinations are a leading cause of drug-related deaths. Alcohol-related injuries and violence -the combination of impaired judgement, weakened sensory perception, reduced inhibitions, impaired motor coordination and increased aggressiveness and hostility can be dangerous.

The Effects of Chronic Use of alcohol Digestive system Chronic alcohol use alters liver function Cirrhosis -Liver cell damage and death Cirrhosis causes drinker to lose their capacity to tolerate alcohol Acute Pancreatitis- inflammation of pancreas that can be caused by heavy alcohol use

The Effects of Chronic Use of alcohol Cardiovascular system Higher doses elevates BP, and may weaken heart muscle (cardiac myopathy) Cancer Mouth, throat, larynx, liver, breast, and esophagus Brain Damage Death of brain cells leading to brain disorders like memory loss, dementia, delirium tremens and compromised problem-solving Mortality Average life expectancy for alcoholics is about 10 years less than non-alcoholics Wernicke–Korsakoff syndrome (also called wet brain, Korsakoff's psychosis, alcoholic encephalopathy, Wernicke's disease, and encephalopathy - alcoholic)[1] is a manifestation of thiamine (vitamin B1) deficiency, or beriberi. This is usually secondary to alcohol abuse. It mainly causes vision changes, ataxia and impaired memory.[2]

Alcohol Abuse and Dependence Alcohol abuse is recurrent use that has negative consequences Alcohol dependence or alcoholism includes more extensive problems like tolerance and withdrawal Warning signs of alcohol abuse Drinking alone Using deliberately and repeatedly Feeling uncomfortable on occasions when not drinking Escalating consumption Getting drunk regularly Drinking in the morning or unusual times

Drinking and Driving In 2015, 10,265 people were killed in alcohol impaired crashes Dose-response function Is the relationship between the amount of alcohol or drug consumed and the type and intensity of the resulting effect. Driving with a BAC of 0.14% makes you more than 40 times more likely to be involved in a crash than with a BAC =0.0%

The dose-response relationship between BAC and automobile crashes Figure 10.3 The dose-response relationship between BAC and automobile crashes.

The Effects of Alcohol Use During Pregnancy Effects are dose-related Fetal alcohol spectrum disorders (FASD)are a group of birth defects that can happen when a pregnant woman drinks alcohol. Fetal alcohol syndrome (FAS) is the most severe type of the disorder. Symptoms can range from mild to severe. Full-blown FAS occurs in up to 10-15 out of every 10,000 live births in the U.S. Characteristics include small head, abnormal facial structures, heart defects, and other physical abnormalities Slowed physical and mental growth, with many mentally impaired

Possible Health Benefits of Alcohol Moderate drinking = one drink per day for women and two drinks per day for men Moderate drinking raises blood levels of HDLs, so may reduce the risk of developing and dying from heart disease Moderate use may reduce risk of ischemic stroke Moderate doses may lower risk of diabetes, arterial blockages, and Alzheimer’s On average, light to moderate drinkers live longer than both abstainers and heavy users

Drinking Behavior and Responsibility Examine your drinking behavior CAGE screening test: Feel the need to CUT down, ANNOYED by criticism, feel GUILTY about drinking, use alcohol as an EYE-OPENER Drink moderately and responsibly Drink slowly Space your drinks Eat before and while drinking Know your limits and your drinks

Treatment Programs No one program works for everyone Alcoholics Anonymous (AA) 12-step program Employee assistance programs Inpatient hospital rehabilitation Pharmacological treatments Antabuse Inhibits the metabolic breakdown Naltrexone Reduces the craving for alcohol and decreases its pleasant effects