1. The Responsible Use of Alcohol
Chapter 10

2. 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

3. 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 ~ calories

4. 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)

5. 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

6. 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

7. 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.

8. 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

9. 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.

10. 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

11. 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]

12. 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

13. 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%

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

15. 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 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

16. 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

17. 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

18. 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