Albia Dugger • Miami Dade College

Chapter 6 Alcohol

Alcohol is not always recognized as a drug

• Alcohol is a legal drug• Leads to belief that effects are not negative or severe• Belief that, if alcohol were bad, the government would limit

its availability

• Parents and other role models consume alcohol as part of their lifestyle

History of Alcohol Use

• Colonial Times:• Pilgrims anchored at Plymouth because their supply of

beer and spirits was becoming depleted• Attitudes of early settlers toward alcohol were positive• Two important factors: sanitation and nutrition• 1640: Dutch opened the first distillery on Staten Island• Rum trade was New England’s most profitable business• Consumption peaked during Jefferson’s presidency• 1784: Dr. Benjamin Rush described harmful effects

Temperance Movement

• Early 1800s: movement to curb the escalating rate of alcohol use and abuse

• Alcohol was seen as a major cause of crime and violence

• Temperance movement sought to modify alcohol use, not to eliminate it

• 1808: independent organizations formed temperance groups

• 1826: American Society for the Promotion of Temperance

Temperance Movement

• 1830 to 1840, annual per capita use of alcohol declined from about 7 gallons per adult to about 3 gallons

• Following the Civil War, the temperance movement became strong again

• Three influential groups in alcohol reform:• Women’s Christian Temperance Union (WCTU)• Anti-Saloon League• National Prohibition Party

1905 Saloon

1917 Ohio Dry Convention

Prohibition

• 1880 to 1889: 7 states passed prohibition laws

• 1907 to 1919: 34 states passed similar legislation

• 1920: U.S. Senate adopted the 18th Amendment (Volstead Act) which prohibited the manufacturing and sale of alcohol

• Problems:• Illegal trade of alcohol• Organized crime • Enforcement problems• Toxic adulterants in black market alcohol • Home brewing was not illegal

Current Alcohol Use

• Most people who drink today are social drinkers who are able to abstain from alcohol at will

• People who cannot abstain and develop medical and social difficulties are called problem drinkers or alcoholics

• A person can abuse alcohol and not be an alcoholic

Current Alcohol Use

• As costs increase, consumption levels decrease

• An increase in taxes on alcohol appears to reduce consumption, especially among underage drinkers

• A decline in alcohol drinking since the early 1980s has been reflected largely in less use of distilled spirits such as whiskey, vodka, gin, and rum

Per Capita Ethanol Consumption

Current Alcohol Use

• The highest rate of alcohol consumption is in the West while the lowest rate of consumption is in the South

• Abstinence is increasing for men and women

• Rates of abstinence and heavy drinking are greater in rural areas

• The proportion of heavy drinkers in their 20s has increased slightly, along with problems related to alcohol dependency

Alcohol Consumption

• Variables correlated with drinking patterns:• College students who are fraternity and sorority members

have higher alcohol consumption rates• Gay men and lesbians are more likely to drink heavily• Binge drinking is more common in households with an

annual income above $75,000• Adolescents who are victims of bullying are more likely to

drink as a coping mechanism• European adolescents living in rural areas binge drink

more than urban adolescents• People who engage in binge eating are more likely to

engage in binge drinking

Women’s Drinking Problems

• Women’s drinking patterns:• Women who are unemployed, looking for work, or

employed part-time outside the home• Women who are divorced, separated, or not married but

living with a partner• Heavy drinking after a health problem such as depression

or reproductive difficulties

College Drinking

• Student drinking patterns:• Australia: almost one-half of students drank to harmful or

hazardous levels• Germany: 80% of university students drank heavily and

20% displayed problem drinking• 37% of college students binge drink• 44% reported being drunk within the past 30 days

Binge Drinking

• Binge drinking:• Consuming five or more drinks (men) or four (women) in a

short period of time• Typically starts at an early age and increases during

adolescence• Motivations change as people age• Influenced by the perception of others’ use of alcohol

Binge drinking on college campuses

Drinking and Ethnicity

• Drinking patterns by ethnicity:• Whites begin drinking at an earlier age than Blacks and

Hispanics, and progress faster to alcohol dependence• Alcohol-related mortality is greater for Black and Hispanic

men than for White and Asian American men• Mexican Americans had more alcohol-related problems

than those of Puerto Rican or Cuban origin• Drinking patterns are affected by acculturation• Asian students resist social pressure to drink alcohol

better than Caucasians• Native Americans have the highest rates of alcohol-related

deaths of all ethnicities in the US

Alcoholic Beverages

• Ethyl alcohol• Form of alcohol that people consume

• Methyl alcohol • Wood alcohol; not fit for human consumption

• Fermentation• Process of transforming yeasts, carbon, hydrogen, and

oxygen of sugar and water into ethyl alcohol and CO2

• Distillation • Heating process that increases alcohol content

Alcoholic Beverages

• Fortified wines • Produced by adding alcohol to slightly sweetened wines

• Proof • Amount of alcohol in a beverage expressed as twice the

percentage of the alcohol content

• Alcopops • Malt, distilled alcohol-containing, or wine-containing

beverages flavored with fruit juices or other ingredients

Pharmacology of Alcohol

• Alcohol in the body is transformed by the liver into acetaldehyde, then further broken down into acetate, then water and carbon dioxide

• Alcohol leaves the body at a rate of about 3/4 ounce per hour

• One ounce of distilled spirits, a bottle of beer, and a glass of wine all have about the same amount of alcohol

Standard Drink Conversion

Pharmacology of Alcohol

• Factors that affect rate of absorption:• Food in the stomach slows absorption• Wine and beer absorbed slower than distilled spirits• Carbonation increases absorption• Strong emotions increase absorption• Males absorb alcohols slowly and break it down quickly• Women absorbs alcohol more quickly during the

premenstrual phase• Women who take birth control pills absorb alcohol more

quickly

Blood Alcohol Concentration

• Blood alcohol concentration (BAC):• Percentage of alcohol in the bloodstream• Rises when alcohol is consumed at a rate exceeding the

rate at which it is metabolized or leaves the body• As BAC increases, behavioral and subjective effects

become more pronounced• Drinking too much alcohol in a short time can be fatal

Blood Alcohol Concentration

• The definition of moderate drinking for men is no more than two alcoholic drinks per day – for women, no more than one alcoholic drink per day

• There is no standard definition of heavy drinking

• Binge drinking is consumption of five or more drinks at one sitting for men and four or more drinks for women

BAC

Effects of Alcohol at Varying BACs

Effects of Alcohol

• Alcohol accounts for 10% of all deaths in the US

• The life expectancy of an alcoholic is reduced by 15 years

• Effects are determined by frequency and quantity of drinking, not the type of alcohol consumed

• Affects every organ in the body

Effects of Alcohol on Body Systems

Alcohol and the Brain

• Five to six drinks daily adversely affects cognitive functioning

• 15% to 30% of nursing home patients are admitted because of permanent alcohol-induced brain damage

• Alcohol acts on the cerebrum, affecting judgment, reasoning, inhibitions, motor activity, and impairs the senses

• Alcohol stimulates the release of serotonin and dopamine

Alcohol and the Brain

• Prenatal exposure of the fetus to alcohol has long-term effects (fetal alcohol spectrum disorders)

• Wernicke-Korsakoff syndrome develops because alcohol impedes the body’s ability to utilize thiamine (a B vitamin)

• Alcohol use is associated with neurotic and psychotic symptoms from depressive reactions to generalized anxiety disorders and panic attacks

Alcohol and the Liver

• The liver is the main site of metabolism of alcohol

• Three main conditions associated with alcohol:• Fatty liver• Alcohol hepatitis• Cirrhosis

• Cirrhosis is irreversible, even if alcohol use stops

Alcohol and the Gastrointestinal Tract

• In moderate amounts, alcohol aids digestion by increasing gastric juice in the stomach

• Too much alcohol can irritate the stomach, leading to internal bleeding

• Heavy alcohol use is implicated in acute pancreatitis

• Alcoholics often have malnutrition because alcohol interferes with the body’s ability to utilize nutrients

Alcohol and the Cardiovascular System

• Moderate alcohol use reduces risk of heart disease, boosts good (HDL) cholesterol and helps prevent type 2 diabetes

• Effects of heavy alcohol use:• Degeneration of the heart muscle• High blood pressure• Cardiac arrhythmias• Ischemic heart disease • Strokes

Alcohol and the Immune System

• Studies show that moderate alcohol use reduces immunity

• Heavy drinkers are prone to infections such as pneumonia and peritonitis

• Alcohol interferes with white blood cells, particularly T lymphocytes, which help to resist infections

• Alcohol dependence reduces immunity to diseases such as HIV

Alcohol and Cancer

• Research links alcohol abuse with cancers of the nasopharynx, esophagus, larynx, and liver

• Risk of colon cancer is 26% higher for people who have more than two alcoholic drinks per day

• Drinking red wine has been associated with reduced risk of prostate cancer and kidney cancer

• Cancers of the lower gastrointestinal tract associated with beer consumption may be attributable to congeners

Alcohol and Women

• In the 12-to-17 age group, more females abuse alcohol or are alcohol dependent than males

• Female alcoholics are more likely to have liver damage, hypertension, anemia, and malnutrition

• Chronic heavy drinking is linked to menstrual disorders

• Of women in alcohol treatment, 70% reported some form of childhood sexual abuse

Fetal Alcohol Spectrum Disorders

• Fetal alcohol spectrum disorders (FASD):• Various effects that occur as a result of women who drink

alcohol while pregnant• Effects can be behavioral, physical, and/or mental• Leading known cause of mental retardation• Fetus is especially vulnerable during the first trimester of

pregnancy• Smaller brain at birth, head and facial anomalies, retarded

growth, central nervous system problems, and malformations of major organs, eye problems

Underage Drinking

• Underage drinking is associated with premature death, disease, injury, property damage, motor vehicle crashes, alcohol-related crime and loss of productivity

• High school students who engaged in binge drinking were six times more likely to drink and drive • 7.2% of 8th-grade students binge drink• 16.3% of 9th-grade students binge drink• 23.2% of 12th-grade students binge drink

• There is a significant relationship between drinking before age 13 and suicide attempts

Caffeinated Alcohol

• Caffeinated alcohol adversely affects visual-spatial ability and cognitive functioning

• Caffeinated alcohol enables an individual to be awake longer and drink more

• In 2010, the U.S. Food and Drug Administration banned adding caffeine to alcohol

Problem Drinking

• An alcoholic is a problem drinker, but a problem drinker is not necessarily an alcoholic

• Alcoholics are dependent on alcohol – a problem drinker has interpersonal, financial, or social problems from drinking

• The problem drinker may drink infrequently, but has problems when consuming alcohol

• A common symptom of problem drinking is blackouts, characterized by temporary memory loss

Alcoholism affects 1 in10 Americans

Alcoholism

• Alcoholism • Condition in which an individual loses control over intake

of alcohol

• Alcohol abuse • Characterized by physical, social, intellectual, emotional,

or financial problems resulting from the use of alcohol

• Alcohol dependence • Condition in which one’s body requires alcohol or else

withdrawal symptoms will occur; also marked by tolerance

Alcoholism

• Some consider alcoholism to be a disease• Disease can be used as a legal defense• Receive treatment rather than punishment

• Common elements of alcoholism• Alcoholics are unable to control their drinking• Some physical, social, or psychological consequence will

result from their drinking

Withdrawal

• Characteristics of alcohol withdrawal:• Craving for alcohol• Delirium tremens (DTs)• Extreme arousal• Auditory and visual hallucinations• Physiological symptoms• Cognitive symptoms

Causes of Alcoholism

• Genetics• 50-60% of alcoholism vulnerability has a genetic basis• Environmental factors affect the impact of genetics

• Psychosocial factors• 20% of alcoholics have a mood or anxiety disorder• Individuals are more likely to drink heavily when in a group• Expectations about alcohol are predictors of dependence• Associated with a greater number of sexual partners

• Culture• Attitudes toward alcohol affect rates of alcohol abuse

Alcohol and Society

• Automobile accidents• Leading cause of death for 15- to 20-year-olds• 57% of 16- to 20-year-olds drove a vehicle when they

thought that they were over the legal limit• 2009: 10,000 US deaths from alcohol-related motor

vehicle accidents• Ignition interlocks reduce drinking and driving

Fatalities in Crashes involving Alcohol

Effects of Alcohol on the Driver

• Alcohol-impaired drivers• Process information more slowly• Less likely to use their peripheral vision• Less able to attend to multiple sources of information• Underestimate hazards when they drive

“Driving while intoxicated”

Alcohol and Society

• Accidents and alcohol• Drinking while driving mopeds• Emergency room admissions• Fire-related fatalities• Occupational accidents• Alcohol-related boating accidents• Drowning fatalities

Alcohol and Society

• Suicide• About 7% of alcoholics commit suicide• 16% of men and 10% of women entering alcohol

treatment have contemplated suicide• 38% of people who hanged themselves had alcohol in

their system• 32% of veterans who attempted suicide were diagnosed

with alcohol abuse or disorder

Alcohol and Society

• Family violence• As alcohol use escalates, so does violence• Domestic partner violence• Dating violence• Homicides• Child abuse

Relationship between alcohol and abuse

Alcohol and Society

• Children of alcoholics• Often experience sleep difficulties, depression, loneliness,

and stomach problems• Alienated from parents, have poor communication skills,

less trust, and more emotional longing• Attention deficit hyperactivity disorder (ADHD)

• Adult children of alcoholics (ACOAs)• Feelings of failure and self-deprecation• Feel a great need to be in control

Support for ACOAs

• The family affected by alcoholism is not a normal family

• Responsibility and blame for an alcoholic family do not rest with them

• Growing up in an alcoholic household, although painful, can be a learning experience

• ACOAs have to acquire skills to form healthy relationships