1. Alcohol and Tobacco Chapter 8

2. ©2008 McGraw-Hill Companies. All Rights Reserved.2 Chemistry of Alcohol Psychoactive ingredient Depressant Ethyl Alcohol – only alcohol that can be consumed Beer 3-6% alcohol by volume Malt Liquors 6-8% alcohol by volume Table wines 9-14% alcohol by volume  Fermenting Fortified wines 20% alcohol by volume  Sugar added Hard liquors 35-50% alcohol by volume  Distilling or fermented Proof Value Two times the percentage concentration Ingestion 7 calories per gram 1 drink 14-17 grams or 100-120 calories

3. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.3 Absorption 20% is rapidly absorbed from the stomach 75% is absorbed in the upper small intestines Remain is absorbed along the GI track Absorption Carbonation Food in the stomach slows the absorption Drink of high concentration slows absorption Eventually all the alcohol ingested will be absorbed

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5. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.5 Metabolism and Excretion Transported throughout the body via the bloodstream. Easily moves through most biological membranes Main site for metabolism is the Liver. 2-20% of ingested alcohol is not metabolized.

6. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.6 Alcohol Intake and Blood Alcohol Concentration A measure of intoxication Body weight Percentage of body fat Difference between women & men Balance of alcohol absorbed and rate of metabolism Genetic factors Drinking Behavior Can not be effected by Exercise Breathing deeply Eating Drinking coffee Taking other drugs Metabolism is the same if the person is awake or asleep

7. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.7 The Immediate Effects of Alcohol on Health Dependant on the individual. Low Concentrations.03% -.05%. Higher Concentrations 0.1% -0.2%. Concentration of.35%. Alcohol hangover Alcohol poisoning Using Alcohol with other drugs Alcohol-related injuries and violence Alcohol and sexual decision making

8. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.8 Drinking and Driving In 2004 250,000 were injured in alcohol related automobile crashes 42,000 people are killed in alcohol related accidents Dose-response function Driving with a BAC of 0.14% is more than 40 times more likely to be involved in a crash. Greater than 0.14% the risk of fatal crash is estimated to be 380 times higher

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11. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.11 The Effects of Chronic Use Diseases of the digestive, cardiovascular systems and some cancers Digestive system Liver function liver cell damage and destruction (cirrhosis) Cirrhosis causes drinker to lose Tolerance Pancreas inflammation Cardiovascular system moderate doses may reduce the risk of HD Higher doses elevates BP, may weaken heart muscle or cardiac myopathy. Cancer Brain Damage Mortality

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13. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.13 The Effects of Alcohol use During Pregnancy Effects are dose-related. FAS Fetal Alcohol Syndrome Occurs in 1 or 2 out of every 1000 live births in the U.S. Under weight, flat nasal bridge, and long upper lip. Small and have heart defects. Physical and mental growth is slow.Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS). ARND Alcohol-related neurodevelopment disorder. Heavier drinking early in pregnancy.

14. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.14 Possible Health Benefits of Alcohol Abstainers and light to moderate drinkers live longer than heavy users. 35 years old and younger, your odds of dying increase in proportion to the amount consumed Moderate drinking = one drink per day for women and two drinks per day for men. May lower coronary heart disease. Raising blood levels of HDL. May lower risks of; diabetes, arterial blockages, Alzheimer’s

15. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.15 Alcohol Abuse and Dependence Alcohol abuse is recurrent use that has negative consequences. Alcohol dependence or Alcoholism more extensive problems, tolerance and withdrawal Warning signs of alcohol abuse Drinking alone Using deliberately and repeatedly Feeling uncomfortable on certain occasions Escalating consumption Getting drunk regularly Drinking in the morning or unusual times

16. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.16 Alcohol Abuse and Dependence Binge Drinking Having five drinks in row for a man or four in a row for a women. Frequent binge drinking in college were three to seven times more likely than non-binge drinkers to engage in unplanned or unprotected sex Healthy People 2010 Reduce the rate of binge drinking to 20% among college students

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18. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.18 Alcoholism Patterns and Prevalence Regular daily intake of large amounts Regular heavy drinking limited to weekends Long periods of sobriety interspersed with binges or daily heavy drinking Heavy drinking limited to periods of stress Health Effects DTs (delirium tremens) paranoia Social and Psychological effects Causes of Alcoholism

19. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.19 Treatment Programs Not one program works for everyone. AA. 12-step program Al-Anon. Employee Assistance. Inpatient hospital rehabilitation Pharmacological treatments. Disulfiram (Antabuse) Naltrexone Acamprosate (Campral)

20. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.20 Gender and Ethnic Differences Men White American men “Other men” Women African Americans Latinos Asian Americans American Indians and Alaska Natives

21. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.21 Promote Responsible Drinking In Others Encourage responsible attitudes Be a responsible host Hold the drinker responsible Learn about prevention programs Take community action

22. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.22 Why People use Tobacco 70 Million Americans, nearly 4 million adolescents  Nicotine Addiction  Powerful psychoactive drug  Reaches Brain via bloodstream in seconds  Most physically addictive of the psychoactive drugs.  Loss of control  Tolerance and Withdrawal

23. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.23 Why Start in the First Place? Between 2001-2005 high school use has declined. 28.5% to 23% Children and teenagers make-up 90% of all new smokers in this country. Estimated 4000 children and adolescents (12-17) start smoking. Average age 13 for smoking 10 for spit tobacco

24. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.24 Listening to Advertising 2003, Tobacco spends nearly $15 billion per year. Most heavily advertised brands Marlboro Camel Newport 90% of teens prefer the top three most advertised brands. Joe Camel is more familiar than Mickey Mouse. More than 90% of 6-year-olds recognized the character

25. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.25 Who Uses Tobacco? Characteristics which could increase the potential for use. A parent or sibling uses tobacco Peers use tobacco Child comes from blue-collar family Child comes from low-income home Single parent. Performs poorly in school Child drops out of school Has positive attitudes towards tobacco

26. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.26 Health Hazards Contains hundreds of damaging chemical substances Unfiltered cigarettes = 5 billion particles per cubic MM 50,000 times more than polluted urban air Condensed particles in the cigarette produce the tar

27. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.27 Health Hazards (cont) Carcinogens and Poisons 43 chemicals are linked to cancer (Carcinogen) Benzo(a)pyrene Urethane Cocarcinogens Combine with other chemicals to cause cancer Poisonous substances Arsenic Hydorgen cyanide Carbon monoxide 400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells Additives Nearly 600 chemicals

28. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.28 Health Hazards (cont) Cardiovascular Disease Coronary Heart Disease (CHD) Atherosclerosis Angina pectoris Myocardial infarction Stroke Aortic aneurysm Pulmonary heart disease Lung and other cancers Chronic Obstructive Lung Disease Emphysema Chronic Bronchitis Other Respiratory Damage

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31. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.31 Additional Health, Cosmetic, and Economic Concerns Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns Economic costs

32. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.32 Cumulative Effects Males before 15 yrs. old are half as likely to live to 75 versus those who did not smoke Females with similar habits reduce life expectancy by more than 10 years Female smokers spend 17% more sick days in bed than nonsmokers Both men and women show a greater rate of acute and chronic diseases

33. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.33 Other Forms of Tobacco Spit (Smokeless) Tobacco More than 6.5 million adults Cigar and Pipes Cigar smoking has increased by 50% since 1993 Clover cigarettes and Bidis Twice the tar, nicotine, and carbon monoxide

34. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.34 The Effects of Smoking on the Nonsmoker Environmental Tobacco smoke (ETS)  EPA - 1993 – Class A Carcinogen  Department of Health and Human Services’ National Toxicology Program - 2000 - “known human carcinogen”

35. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.35 Environmental Tobacco Smoke Second hand smoke Mainstream smoke  Sidestream smoke  Twice the tar and nicotine  Three times the benzo(a)pyrene  Three times the ammonia  85% of smoke in a room is second hand  Smoke from a cigar can be even more dangerous  30 times more carbon monoxide

36. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.36 ETS Effects Develop cough, headaches, nasal discomfort, eye irritation, breathlessness and sinus problems Allergies will be exacerbated 24-50% increase in lung cancer risk Causes 3,000 deaths due to lung cancer Contributes to about 35,000 overall deaths Contributes to increased Asthma attacks

37. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.37 Infants, Children, and ETS More likely to develop Bronchitis, pneumonia,& respiratory infections More complications from asthma Increased chance of SIDS Low-birth weight Bronchitis Chemicals from smoking show up in breast milk Children inhale three times more pollutants per unit of body weight than adults.

38. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.38 Avoiding ETS Speak up tactfully Display reminders Don’t allow smoking in your home or room Open a window Sit in the nonsmoking section Fight for a smoke-free environment Discuss quitting strategies

39. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.39 Smoking and Pregnancy Estimated 4600 infant deaths in the U.S. Miscarriage, premature birth, low birth weight, long term impairments in growth and intellectual development Possible higher risks of getting cancer 11% of pregnant women smoke 14% of female smokers quit while pregnant

40. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.40 Cost of Tobacco Use to Society Health care costs exceed $75 billion per year. Lost productivity from sickness, disability, and premature death makes it closer to $157 Billion per year. 1998 Master Settlement Agreement (MSA) Tobacco companies have to pay $206 billion over 25 years

41. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.41 What Can Be Done? Local laws State and Federal laws International Action Private sector Individual Action

42. Chapter 8©2008 McGraw-Hill Companies. All Rights Reserved.42 Quitting Since 1964 - 50% of all adults who have smoked have quit. Benefits of quitting Options for quitting Smoking cessation programs Smoking cessation products Chantix (Varinicline) Zyban (Bupropion) Nicotine replacement products Patches, gums, lozenges, nasal sprays, and inhalers

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44. Alcohol and Tobacco Chapter 8