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Chapter 11Chapter 11

Alcohol, Tobacco and CaffeineUnacknowledged Addictions

Alcohol

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Alcohol a Dangerous Drug?

Cocaine, heroin, marijuana,Cocaine, heroin, marijuana,LSD, PCP.and others!LSD, PCP.and others!Alcohol isnt consideredAlcohol isnt consideredbecause it is sociallybecause it is sociallyexceptedexceptedCanadians consumed 7.1Canadians consumed 7.1litersliterscomparable to US,comparable to US,Australia, and less thanAustralia, and less thanEuropean countriesEuropean countries

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Alcohol a Dangerous Drug?

Can have someCan have somepositive healthpositive health

benefitsbenefitsmoderate use can bemoderate use can beenjoyableenjoyableHowever! ManyHowever! Manytragedies associatedtragedies associatedwith abuse..with abuse..

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Alcohol and University StudentsMost popular drugMost popular drugon Universityon University

campusescampuses - - 94.5%94.5%In OntarioIn Ontario - - 1/3 had1/3 hadmore than 15 drinksmore than 15 drinksper week!per week!Live in residenceLive in residencelower gradeslower grades17 and 22 years of 17 and 22 years of

ageage

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Alcohol and University Students Be aware of drinking campus culture and

tradition reduces tension celebrations social lubricant drinking games and

binge drinking

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Drinking Alcohol and theRisks!!!!!!

Exacerbates risks of Exacerbates risks of suicide, automobilesuicide, automobile

crashes and fallscrashes and falls peers / university peers / university

traditions encouragetraditions encouragedangerous practicesdangerous practices

participate in dangerous participate in dangerous behaviours.. behaviours..

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P hysiological and BehaviouralEffects of Alcohol

ethyl alcohol or ethanolethyl alcohol or ethanolFermentationFermentation - - a process toa process toproduce ethanolproduce ethanol - - 14%14%alcoholalcoholDistillationDistillation - - increasesincreasesalcohol contentalcohol contentProof Proof - - % of alcohol% of alcoholProof Proof gunpowder proof /gunpowder proof /50% alcohol > 80 proof =50% alcohol > 80 proof =

40% alcohol40% alcohol

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Behavioural Effects

N OTE: individualN OTE: individualvariation in alcoholvariation in alcoholtolerancetolerancealcohol is a depressantalcohol is a depressant - -

acts on C N S by decreasingacts on C N S by decreasingits activityits activitydepression isdepression isprogressive/continuousprogressive/continuous

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Behaviours...

Behaviours...

Alcohol has differentAlcohol has differenteffects on:effects on:

sight: visual acuitysight: visual acuityhearinghearingspeakingspeakingsmellsmell--tastetastepain receptionpain receptionmotor skillsmotor skills

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B lood Alcohol Concentration ( B AC):ratio of alcohol to total blood volume

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

at 0.05 % = impaired -relaxation increases / some

motor impairment /talkative

at 0.08 % = impaired -euphoria / more motorimpairment

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Blood Alcohol Concentration

Blood Alcohol Concentration

at 0.10 % = intoxicated -depression / further loss of

motor skills / loss of judgement / drowsiness

larger individuals lowerB AC - greater bloodvolume

alcohol invades muscletissue to a greater extent

than fatty tissue

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Learned B ehavioural ToleranceLearned B ehavioural Tolerance

Ability to modifyAbility to modifybehaviour to appearbehaviour to appear

sobersoberAcquiredAcquiredphysiological andphysiological andpsychologicalpsychologicaltolerancetoleranceN o skills or functionsN o skills or functionsenhanced byenhanced bydrinking alcoholdrinking alcohol

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Breathalyzer and Other Tests...

B reathalyzerB reathalyzer determine BAC via exhaled

breath

UrinalysisUrinalysis - concentration of unmetabolized alcohol inurine

both used to determine levelof intoxication

B lood testsB lood tests are most accurate

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The Morning After...N EXT DAYN EXT DAY

CongenersCongeners - - forms of alcohol thatforms of alcohol thatmetabolize more slowlymetabolize more slowly - - produceproduce

toxic bytoxic by- -productsproductsdehydration fluids are in themuscles and cerebral tissueshangover mitochondrialdehydration in C N S (loss of cerebrospinal fluid) = headachesgastrointestinal irritation =

discomfort

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.. The night before

rest / solid food / painrelievers (12 hours to

recover)alcohol is a drug,therefore toleranceand withdrawaloccur

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L ong Term Effects

N ervous System:N ervous System:reduction in brain sizeand weight / left side =

language written &spoken, mathematicalskill and logicreduced intellectual

abilitybinge drinking = mostdamage

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Cardiovascular Disease:

effect on heart minimal(small amounts of

alchol) may decreasecholesterol levelsincreases blood pressureheart ratecardiac output

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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

strokestrokenegative effects / outnegative effects / out- -weightweightgoodgood

(moderate to heavy drinkers)(moderate to heavy drinkers)

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Liver Disease:

cirrhosis = liver cells die / top tencirrhosis = liver cells die / top tencauses of deathscauses of deathseffects fat storage and transporteffects fat storage and transport

in the liver / cells stop functioningin the liver / cells stop functioningfibroses = damaged area developsfibroses = damaged area developsscar tissue / cells functionscar tissue / cells functionineffectivelyineffectively

alcoholic hepatitis = inflammationalcoholic hepatitis = inflammationof the liver / can lead to cirrhosisof the liver / can lead to cirrhosis

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Canceresophagus, stomach, mouth, tongue

and liverbreast cancer women between 34 &59 / 3 to 9 drinks/wk / 30%males 12% increase for 1 drink per

day & 123% for 2 drinks per dayfacilitates absorption of carcinogenicsubstances into sensitive tissues, i.e.tobacco

alcohol-induced immunologicsuppressionsynergistic effect with tobacco

alcohol-induced outcomes, such asmalnutrition, anemia

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Other Effects

causes indigestionand heart burn

damages mucousmembranes =stomach andintestinal irritation,absorption andchronic diarrhea

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Alcohol and PregnancyExcessive Drinking during Pregnancy / Rate of

Developmental Disabilitiesalcohol passes directly into the infant's blood stream

B AC much greater than mother

FAS - leading cause of development delays in Canada /N orth America

during 1st

trimester - organdevelopmentlast trimester - C N S development

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Foetal Alcohol Syndrome (FAS)Physical and Foetal B ehaviour Difficulties:

sleeping / hyperactive

learning disabilities

dyslexicgreater incidence of :

congenital heart disease

spina bifidahip dislocation

skeletal development

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Foetal Alcohol Effects (FSE) -

Infants Exposed to Prenatal AlcoholN o FAS - symptoms

effects 3/1000children

low birth weight

irritability

possible permanentmental impairment

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Alcoholism Alcohol Abuse

Interferes with work, school or socialand family relationships

violation / law i.e., drunk driving

approx. 2 in 10 Canadians / drinkingproblem resulting in physical healthproblems, financial, relationships

50% of Canadians problems withothers people who drink

loud, insulting, humiliation,

argumentative, violent

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Social impact of alcohol:motor vehicle accidents

Pedestrian accidents

Occupational accidents

Home and recreational accidents

Homicide

Rape

Marital problems

Family violence/abuse

Suicide

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Overall family patternsimportant

Genetic link notfound to date

however - alcoholism4 to 5 times greaterin alcoholic homes

Two Types Types of Alcoholics have beenidentified

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Type 1: Had at least OneParent W ho was an Alcoholic

drinking at home wasdrinking at home wasnormal and encouragednormal and encouraged

avoids novelty/harmfulavoids novelty/harmfulsituationssituations

concerned about theconcerned about thethoughts and feeling of thoughts and feeling of othersothers

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Type 2:males only / biological sons of alcoholic

fathersexperiences both violence anddrug abuse

don't seek social approval /lack inhibition

One alcoholic Parent = 52%

chance of developing a problemTwo alcoholic Parents = 71%chance of developing a problem

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Social and Cultural Factors andAlcoholism

:Social and Cultural Factors andAlcoholism:

part of traditions and culturalinteractions

may predispose people more thangenetic potential

Medication temporally escape!Stress disappointment unfulfilled expectations relationships depression

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

life is like!!!!

(dysfunctional)

Victims of violence, abuse, neglect orincest

low self-esteem and depression

Adopt one of the following roles

Family Hero too good to be true

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

family life is like!!!!Sc apegoat - Drawsattention through

poor behavioursL ost Child passiveand withdrawn inupsetting situations

M as c ot comic relief

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Recovery#1 Assume Responsibility for Actions

InterventionIntervention planned confrontationplanned confrontation( Family and trained therapist)

Treatment Programs:Symptoms: + delirium tremens (DTs)

Long-term addicts medical treatment detoxification ( 7 to 21 days) physiologicaladdiction

psychological treatment starts ( 3 to 6 weeks)

may require more time / repeated intervention!

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Family Therapy, Individual Therapy,and Group Therapy

determine underlyingreasons for problem

develop coping mechanismsOther types of treatment

Drug Disulfiram

(Antabuse) causesextremely unpleasant sideeffects when coupled withalcohol

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Alcoholics Anonymous (AA)

private, nonprofit, self-helporganization founded in 1935

group support over 1 million

members world widelifetime problem

AA ( Al-non) has other groups to

help spouses, partners, childrenand friends

Alateen help teens deal withalcoholic parents

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RelapseSuccess varies fromIndividual toIndividual

some recover other

never recover otherspartially recover

approx. 60% relapse

pattern has to bebroken promote self-esteem and personalgrowth