Chapter 11Chapter 11 Alcohol, Tobacco and CaffeineUnacknowledged Addictions

Alcohol

Alcohol a Dangerous Drug?• Cocaine, heroin, marijuana, Cocaine, heroin, marijuana,

LSD, PCP….and others!LSD, PCP….and others!• Alcohol isn’t considered Alcohol isn’t considered

because it is socially because it is socially exceptedexcepted

• Canadians consumed 7.1 Canadians consumed 7.1 litersliters

• comparable to US, comparable to US, Australia, and less than Australia, and less than European countriesEuropean countries

Alcohol a Dangerous Drug?

• Can have some Can have some positive health positive health benefitsbenefits

• moderate use can be moderate use can be enjoyableenjoyable

• However! Many However! Many tragedies associated tragedies associated with abuse……..with abuse……..

Alcohol and University Students

• Most popular drug on Most popular drug on University campuses - University campuses - 94.5%94.5%

• In Ontario - 1/3 had In Ontario - 1/3 had more than 15 drinks more than 15 drinks per week!per week!

• Live in residenceLive in residence• lower gradeslower grades• 17 and 22 years of age 17 and 22 years of age

Alcohol and University Students

• Be aware of drinking• campus culture and

tradition• reduces tension • celebrations• social lubricant• drinking games and

binge drinking

Drinking Alcohol and the Risks!!!!!!

• Exacerbates risks of Exacerbates risks of suicide, automobile suicide, automobile crashes and fallscrashes and falls

• peers / university peers / university traditions encourage traditions encourage dangerous practicesdangerous practices

• participate in dangerous participate in dangerous behaviours……..behaviours……..

Physiological and Behavioural Effects of Alcohol

• ethyl alcohol or ethanolethyl alcohol or ethanol• Fermentation - a process to Fermentation - a process to

produce ethanol - 14% produce ethanol - 14% alcoholalcohol

• Distillation - increases Distillation - increases alcohol contentalcohol content

• Proof - % of alcoholProof - % of alcohol• Proof – gunpowder proof / Proof – gunpowder proof /

50% alcohol > 80 proof = 50% alcohol > 80 proof = 40% alcohol40% alcohol

Behavioural Effects

• NOTE: individual variation NOTE: individual variation in alcohol tolerancein alcohol tolerance

• alcohol is a depressant - alcohol is a depressant - acts on CNS by decreasing acts on CNS by decreasing its activityits activity

• depression is depression is progressive/continuousprogressive/continuous

Behaviours………...Behaviours………...

Alcohol has different Alcohol has different effects on:effects on:• sight: visual acuitysight: visual acuity• hearinghearing• speakingspeaking• smell-tastesmell-taste• pain receptionpain reception• motor skillsmotor skills

Blood Alcohol Concentration (BAC):ratio of alcohol to total blood volume

• at 0.02 % (2 parts of alcohol for every 10,000 parts of blood) = relaxed good mood

• at 0.05 % = impaired - relaxation increases / some motor impairment / talkative

• at 0.08 % = impaired - euphoria / more motor impairment

Blood Alcohol ConcentrationBlood Alcohol Concentration

• at 0.10 % = intoxicated - depression / further loss of motor skills / loss of judgement / drowsiness

• larger individuals lower BAC - greater blood volume

• alcohol invades muscle tissue to a greater extent than fatty tissue

Learned Behavioural ToleranceLearned Behavioural Tolerance

• Ability to modify Ability to modify behaviour to appear behaviour to appear sobersober

• Acquired physiological Acquired physiological and psychological and psychological tolerancetolerance

• No skills or functions No skills or functions enhanced by drinking enhanced by drinking alcoholalcohol

Women and Alcohol

• Women have less Women have less alcohol hydrogenasealcohol hydrogenase

• greater sensitivity to greater sensitivity to the negative effects of the negative effects of alcoholalcohol

• higher BAC (30%) higher BAC (30%) for same body weight for same body weight and alcohol and alcohol consumed as a manconsumed as a man

Breathalyzer and Other Tests...

BreathalyzerBreathalyzer• determine BAC via exhaled

breath

Urinalysis Urinalysis - concentration of unmetabolized alcohol in urine

• both used to determine level of intoxication

Blood testsBlood tests are most accurate

The Morning After…...NEXT DAYNEXT DAY• Congeners - forms of alcohol that Congeners - forms of alcohol that

metabolize more slowly - produce metabolize more slowly - produce toxic by-productstoxic by-products

• dehydration – fluids are in the muscles and cerebral tissues

• hangover – mitochondrial dehydration in CNS (loss of cerebrospinal fluid) = headaches

• gastrointestinal irritation = discomfort

….. The night before

• rest / solid food / pain relievers (12 hours to recover)

• alcohol is a drug, therefore tolerance and withdrawal occur

Long Term Effects

Nervous System:Nervous System: • reduction in brain size

and weight / left side = language written & spoken, mathematical skill and logic

• reduced intellectual ability

• binge drinking = most damage

Cardiovascular Disease:

• effect on heart minimal (small amounts of alchol) may decrease cholesterol levels

• increases blood pressure• heart rate • cardiac output

Hypertension and Stroke:• moderate alcoholmoderate alcoholconsumption (red wine)consumption (red wine) = increased HDL= increased HDL• reduce hypertensionreduce hypertensionAlcohol consumption (largeAlcohol consumption (largequantity) causes:quantity) causes:• hypertensionhypertension• strokestroke• negative effects / out-weight good negative effects / out-weight good • (moderate to heavy drinkers)(moderate to heavy drinkers)

Liver Disease:• cirrhosis = liver cells die / top ten cirrhosis = liver cells die / top ten

causes of deathscauses of deaths• effects fat storage and transport effects fat storage and transport

in the liver / cells stop functioningin the liver / cells stop functioning• fibroses = damaged area develops fibroses = damaged area develops

scar tissue / cells function scar tissue / cells function ineffectivelyineffectively

• alcoholic hepatitis = inflammation alcoholic hepatitis = inflammation of the liver / can lead to cirrhosisof the liver / can lead to cirrhosis

Cancer• esophagus, stomach, mouth, tongue and

liver• breast cancer – women between 34 & 59 /

3 to 9 drinks/wk / 30%• males – 12% increase for 1 drink per day

& 123% for 2 drinks per day• facilitates absorption of carcinogenic

substances into sensitive tissues, i.e. tobacco

• alcohol-induced immunologic suppression• synergistic effect with tobacco• alcohol-induced outcomes, such as

malnutrition, anemia

Other Effects

• causes indigestion and heart burn

• damages mucous membranes = stomach and intestinal irritation, absorption and chronic diarrhea

Alcohol and PregnancyExcessive Drinking during Pregnancy / Rate of

Developmental Disabilities

alcohol passes directly into the infant's blood stream • BAC much greater than mother• FAS - leading cause of

development delays in Canada / North America

• during 1st trimester - organ development

• last trimester - CNS development

Foetal Alcohol Syndrome (FAS)Physical and Foetal Behaviour Difficulties:

• sleeping / hyperactive• learning disabilities• dyslexic• greater incidence of :• congenital heart disease• spina bifida• hip dislocation• skeletal development

Foetal Alcohol Effects (FSE) - Infants Exposed to Prenatal Alcohol

• No FAS - symptoms• effects 3/1000

children• low birth weight• irritability• possible permanent

mental impairment

Alcoholism – Alcohol Abuse• Interferes with work, school or social and

family relationships• violation / law i.e., drunk driving • approx. 2 in 10 Canadians / drinking

problem resulting in physical health problems, financial, relationships

• 50% of Canadians – problems with others people who drink

• loud, insulting, humiliation, argumentative, violent

Social impact of alcohol:• motor vehicle accidents• Pedestrian accidents• Occupational accidents• Home and recreational accidents• Homicide• Rape• Marital problems• Family violence/abuse• Suicide

Overall – family patterns important

• Genetic link not found to date

• however - alcoholism 4 to 5 times greater in alcoholic homes

• Two Types Types of Alcoholics have been identified

Type 1: Had at least One Parent Who was an Alcoholic

• drinking at home was drinking at home was normal and encouragednormal and encouraged

• avoids novelty/harmful avoids novelty/harmful situationssituations

• concerned about the concerned about the thoughts and feeling of thoughts and feeling of othersothers

Type 2: males only / biological sons of alcoholic

fathers• experiences both violence and

drug abuse• don't seek social approval /

lack inhibition• One alcoholic Parent = 52%

chance of developing a problem• Two alcoholic Parents = 71%

chance of developing a problem

Social and Cultural Factors and Alcoholism:

• Social and Cultural Factors and Alcoholism:

• part of traditions and cultural interactions

• may predispose people more than genetic potential

• Medication – temporally escape!• Stress – disappointment –

unfulfilled expectations – relationships – depression

Effects on the Family:Children have no idea of what normal family

life is like!!!!

• (dysfunctional) • Victims of violence, abuse, neglect or

incest• low self-esteem and depression• Adopt one of the following roles• Family Hero – too good to be true

Effects on the Family:Children have no idea of what normal

family life is like!!!!• Scapegoat - Draws

attention through poor behaviours

• Lost Child – passive and withdrawn in upsetting situations

• Mascot – comic relief

Recovery#1 Assume Responsibility for Actions

Intervention – planned confrontationIntervention – planned confrontation

• ( Family and trained therapist)

Treatment Programs:

• Symptoms: + delirium tremens (DT’s)• Long-term addicts – medical treatment –

detoxification ( 7 to 21 days) physiological addiction

• psychological treatment starts ( 3 to 6 weeks)• may require more time / repeated intervention!

Family Therapy, Individual Therapy, and Group Therapy

• determine underlying reasons for problem

• develop coping mechanisms• Other types of treatment• Drug – Disulfiram

(Antabuse) – causes extremely unpleasant side effects when coupled with alcohol

Alcoholic’s Anonymous (AA)• private, nonprofit, self-help organization founded in 1935• group support – over 1 million members world wide• lifetime problem• AA ( Al-non) has other groups to help spouses, partners,

children and friends• Alateen – help teens deal with alcoholic parents

• Relapse• Success varies from Individual to Individual• some recover other never recover others partially recover• approx. 60% relapse• pattern has to be broken – promote self-esteem and personal

growth

Relapse• Success varies from

Individual to Individual

• some recover other never recover others partially recover

• approx. 60% relapse• pattern has to be

broken – promote self-esteem and personal growth