First….Why Study Alcohol?

1. First….Why Study Alcohol?

2. Societal ambivalence re: alcohol You have asked me how I feel about whisky. All right, here is just how I stand on this question: If, when you say whisky, you mean the devil's brew, the poison scourge, the bloody monster that defiles innocence, yea, literally takes the bread from the mouths of little children; if you mean the evil drink that topples the Christian man and woman from the pinnacles of righteous, gracious living into the bottomless pit of degradation and despair, shame and helplessness and hopelessness, then certainly I am against it with all of my power.

3. But, if when you say whisky, you mean the oil of conversation, the philosophic wine, the stuff that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips and the warm glow of contentment in their eyes; if you mean the drink that enables a man to magnify his joy, and his happiness, and to forget, if only for a little while, life's great tragedies and heartbreaks and sorrows, if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirm, to build highways, hospitals, and schools, then certainly I am in favor of it.

4. But, if when you say whisky, you mean the oil of conversation, the philosophic wine, the stuff that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips and the warm glow of contentment in their eyes; if you mean the drink that enables a man to magnify his joy, and his happiness, and to forget, if only for a little while, life's great tragedies and heartbreaks and sorrows, if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirm, to build highways, hospitals, and schools, then certainly I am in favor of it.

5. This is my stand. I will not retreat from it; I will not compromise.

6. Alcohol: Good or Bad? • On the good side • Economic: a good that can generate both commerce and tax revenue • Provides a stimulus and enhancement to social interaction • Can have salutary effects on mood • Can have significant health benefits

7. Alcohol: Good or Bad? • On the bad side • Total cost to society is huge • YPLL/DALY • Medical care costs • Lost productivity • Strong associations with crime and a host of social problems • Interference with normal development

8. Alcohol Studies as a Window on Science and Society “to know syphilis in all its manifestations and relations, and all things clinical will be added unto you."Sir William Osler

9. The Saintof Hopkins

10. What does it mean “to know alcohol”? Alcohol Versus Syphilis? • Like syphilis, alcohol can affect almost all bodily systems • Brain, digestive, cardiovascular, genitourinary • Both syphilis and alcohol represented major public health problems • Syphilis was almost eradicated 50 years ago, and currently much less of a problem than alcohol • Both alcohol and syphilis associated with moral weakness and sin…stigmatized

11. But to know alcohol also means to know something about… • Genetics • Molecular genetics, genetic epidemiology • Pharmacology • Physiology • Teratology/ontogeny/morphology • Unintentional and intentional injury • Addiction • Psychopathology • Personality • Social influence processes • Cognitive Processes • Psychological and social development

12. But to know alcohol also means to know something about… • Advertising • Social policy • Public safety/law enforcement • Economics • Religion • History

13. You could put together an entire undergraduate curriculum on alcohol studies... • And produce well rounded graduates

14. The original symposia • The Greek symposium was a male aristocratic activity, a tightly choreographed social gathering where men drank together, conversed, and enjoyed themselves in a convivial atmosphere. Bedecked in garlands, participants reclined–one or two to a couch–in a room designed to hold seven to fifteen couches with cushions and low tables. Many such rooms have been identified archaeologically in domestic settings, although the best representation is perhaps the painted Tomb of the Diver at Paestum.

15. Scene from a Symposium Fresco from the Tomb of the Diver. 475 BCE. Paestum Museum, Italy.

16. The symposium was a “wet” environment By the late sixth century B.C., there was an established repertoire of symposium vessels that included wine coolers, jugs, various drinking cups, and mixing vessels, many of which were decorated with scenes of drinking parties or of Dionysos and his followers. Water was mixed with wine in a large central krater to a strength determined by the symposiarch (master of ceremonies). The mixture, usually three or four parts water to one part wine, was served by slave boys who filled pitchers from the krater and poured the drink into each participant's cup.

17. Not Like Our “Symposium”

18. Symposium - wineboy

19. Symposia…cont’d The men conversed, often about specific topics, as in Plato's Symposium, and some recited poetry or played music. Jokes, gossip, and games of skill and balance enlivened the evening, as did professional musicians, dancers, and courtesans. The well-conducted symposium was a center for the transmission of traditional values, as well as an event that provided liberation from everyday restraints within a carefully regulated environment.

20. Gin…18th Century Crack- but beer is OK to Hogarth

21. Inspiring… Degas

22. Picasso

23. Manet Toulouse-Lautrec

24. Gin Lane University

25. Alcohol Constructs and Measurements

26. Domains of Alcohol Involvement • Abstention vs. Drinking • Frequency of Consumption • Quantity of Consumption • Quantity-Frequency (Volume) • Volume Variability • Frequency of heavy use • Frequency of heavy episodic drinking, binge drinking, or drunkenness • “Max drinks” • “Hazardous” use

27. Domains of Alcohol Involvement(continued) • Alcohol-related problems (consequences, disabilities) • Alcohol dependence syndrome • Alcohol use disorders • Alcohol abuse • Alcohol dependence

28. DSM-IV Abuse Criteria • Failure to fulfill major role obligations • Recurrent use in physically hazardous situations • Recurrent alcohol-related legal problems • Continued drinking despite social/interpersonal problems that are caused/exacerbated by alcohol • Criteria for alcohol dependence not met

29. DSM-IV Dependence Criteria • Tolerance • Withdrawal • Using in larger amounts/over a longer time period than intended • Persistent desire to cut down/control • Great deal of time spent obtaining/using/recovering • Important activities given up/reduced • Continued drinking despite physical/psychological problems that are caused/exacerbated by alcohol

30. Problems with the AUD Definitions • Polythetic criteria • Diagnostic orphans • Diagnostic imposters • Abuse and dependence don’t behave well psychometrically • Continuum or categories

31. Assessing Alcohol Consumption • Questionnaire-based approaches • Assessing alcohol daily (or more frequently) • Time-line follow-back • Diary methods • Daily report • EMA • Event sampling • Time sampling • Transdermal ethanol sensors

32. Name/ID#: Date: TIMELINE FOLLOWBACK CALENDAR: 2010 1 Standard Drink is Equal to One 12 oz can/bottle of beer 1 mixed or straight drink with 1 ½ oz hard liquor One 5 oz glass of regular (12%) wine 1 ½ oz of hard liquor (e.g. rum, vodka, whiskey) Complete the Following Start Date (Day 1): End Date (yesterday): MO DY YR MO DY YR

33. Typical Questions • Frequency: Drinking days/year. • How often did you have a drink containing alcohol, that is beer, wine or liquor? • Quantity: Drinks per Drinking Day • About how many drinks would you have on average on a typical day when you drank? • Volume: (Drinking days/year X Drinks per drinking day)/days in a year = Drinks per day

34. Graduated QF Think of all kinds of alcoholic beverages combined, that is, any combination of cans of beer, glasses of wine, or drinks containing liquor of any kind. During the past 12 months, Start with largest amount drunk;what is the largest number ask frequency of consumingof drinks on a single day? successively lower amounts per day. •Was it 24 or more drinks on • Daily or nearly every day a single day? • 3 or 4 times a week • 12 to 23 drinks on a single day? • Once or twice a week • 8-11? • 2 or 3 times a month • 5-7? •  Once a month • 3-4? • 1-3 times in the past year • 1-2? • Twice in the past year • No drinks • Once in the past year • Never

35. Drinking Pattern Questionnaire 1. On Fridays during a typical month, how often did you drink - every Friday, three Fridays, two Fridays, one Friday, or hardly ever on Fridays? 2. How many drinks would you usually have on a Friday? 3. Repeat for Saturday, Sunday, and weekdays. 4. Were there days when you had more than your usual in the past 12 months? 5. If yes, what did you typically drink and how often.? 6. Proportion of time you drank with a meal, while snacking, or without eating anything. 7. Did you ever drink enough to get drunk or very high, that is, your speech was slurred or you were unsteady on your feet? 8. If yes, how often did you drink enough to get drunk or very high?

36. “Recommended Questions”: 3 item set During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one. During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol? During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

37. “Recommended Questions”: 4 item set During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one. During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol? During the last 12 months, what is the largest number of drinks containing alcohol that you drank within a 24-hour period? During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

40. Epidemiology of Use and Abstention Percent

41. Total per capita ethanol consumption, United States, 1997

42. Reductions in Problems During Prohibition Source: Moore & Gerstein, 1981

43. Total per capita ethanol consumption, United States, 1997

44. Total Beer Spirits Wine

45. Relative Price of Alcoholic Beverages, 1970-1997 Relative Price, 1970 $ Sources: Mosher, 1997; Mosher & Cowan, 1985; Bureau of Labor Statistics, 1996

46. Total Per Capita Consumption of Ethanol by State, United States, 1997

47. Total Per Capita Consumption of Ethanol among Current Drinkers by State, United States, 1997

48. Concentration of U.S. Alcohol Consumption Greenfield TK & Rogers JD. J Stud Alcohol 60:78 (1999)

49. Epidemiology of Heavy Use Heavy Use Women: > 1 drink / day Men: > 2 drinks / day Percent

50. Total and alcohol-related traffic fatality rates per 100 million vehicle miles traveled (VMT), United States, 1977-97