The Responsible Use of Alcohol

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 ~100-120 calories

4. Alcohol Absorption • 20% of alcohol is rapidly absorbed in the stomach;75% is absorbed in the small intestines • Remaining is absorbed along the rest of the GI tract • 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) • 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

5. Metabolism and Excretion of alcohol • Alcohol is transported throughout the body via the bloodstream • Alcohol easily moves through most biological membranes • 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.

6. Metabolism and Excretion of alcohol • Alcohol is eliminated from the body from excretion and metabolism (most is metabolized) • There is no way to change the rate at which alcohol is metabolized. • The rate of alcohol metabolism is constant, while the rate of absorption can vary • Once your BAC reaches a certain level, the only thing you can do to lower it is to wait for your liver enzymes to do their job. • Heavy drinkers metabolize alcohol faster than light or non-drinkers but the rate of alcohol metabolism drops substantially in advance liver disease.

7. 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) • Sex: women metabolize less alcohol in stomach, more unmetabolized alcohol is released into bloodstream and women tend to have higher % body fat • Genetic factors: chronic drinkers metabolize alcohol faster, so lower BAC • Drinking behavior: the faster you drink, the faster BAC rises

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 -drinking large amounts of alcohol in a short period of time can rapidly raise the BAC to lethal levels; death from alcohol poisoning may be caused either by 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. Life threatening overdoses occur at much lower doses when heroin and other narcotics are combined with alcohol. • Alcohol-related injuries and violence -the combination of impaired judgement, weakened sensory perception, reduced inhibitions, impaired motor coordination and increased aggressiveness and hostility that characterizes alcohol intoxication 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, thiamine deficiency (can lead to Wernicke-Korsakoff syndrome), delirium tremens and compromised problem-solving • Mortality • Average life expectancy for alcoholics is about 10 years less than non-alcoholics

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

15. The Effects of Alcohol Use During Pregnancy • Effects are dose-related • Fetalalcohol spectrum disorders (FASD)are a group of birth defects that can happen when a pregnant woman drinks alcohol. Fetalalcoholsyndrome (FAS) is the most severe type of the disorder. • FAS and other spectrum disorders affect children differently. • 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

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