Chapter 9: Alcohol

protracted functional tolerance

-As with dispositional tolerance, the development of protracted tolerance requires an individual to drink greater amounts of alcohol to achieve an effect once achieved with less alcohol. -Because protracted functional tolerance far outpaces dispositional tolerance, the person becomes more susceptible to serious health and other conse- quences of heavy alcohol consumption. ex./ For example, a person may drink large quan- tities of alcohol to achieve a mood change that was once reached with much less alcohol.

disulfiram

A drug that interferes with the metabolism of alcohol so that people soon feel very ill if they drink while on a regimen of disulfiram. The drug may be used as part of a treatment program for alcohol dependence.

confabulation

A fabrication of events, when asked questions con- cerning them, because of an inability to recall.

Wernicke-Korsakoff Syndrome

A severe CNS disorder results from the combination of extreme nutritional deficiency, specifically vitamin B1 or thiamine, and chronic heavy drinking. Basically, the syndrome comprises two disease -Wernicke's disease is characterized by confusion, loss of memory, staggering gait, and an inability to focus the eye. In the absence of permanent brain damage, Wernicke's disease is reversible by giving the patient vitamin B -Korsakoff's syndrome may have a nutritional component but is primarily due to alcohol. It is associated with damage to brain structure and most affects memory. The impairments in short-term memory and learning are serious.

Cirrhosis of the liver

Cirrhosis is a chronic inflammatory disease of the liver involving cell death and the formation of scar tissue. -Alcohol hepatitis may or may not precede it. Death results from cirrhosis because the liver fails to metabolize various toxins, such as ammonia, and these toxins accumulate in the body

pylorospasm

The shutting of the pylorus valve that occurs in some people when they drink very large quantities of alcohol - The pylorus, which is the muscular valve that separates the stomach from the intestines, shuts when a large amount of alcohol has been ingested. -. This mechanism is a natural defense against an individual becoming a very heavy drinker.

Traditional Approaches to Etiology

Theories frequently outpaced data available to evaluate them and can be classified as biological, psychological, or sociological. - Earlier single-factor biological approaches, which have not received experimental support, have included hypotheses that the source of the structural deficit is metabolic, glandular, due to body chemistry, or due to an allergic condition. The most prevalent position among U.S. treatment providers is that alcohol use disorder is a physical disease - recent research has revealed that the personality dimensions of neuroticism-emotionality, extraversion-sociability, and impulsivity-disinhibition predispose people to alcohol dependence

Binge drinking

"Binge drinking" in this context means consuming at least five (for men) or four (for women) drinks on at least one occasion -Calling heavier drinking episodes "binge drinking" is in some ways unfortunate, because people who are acquainted with treatment settings tend to associate that term with extended periods (days or weeks) of very heavy alcohol consumption. - Heavy drinking among undergraduates attracts national attention because it is associated with accidental death, injury, assault, unwanted and unprotected sex, drunk driving, vandalism, suicide, and academic problems

Fetal Alcohol Syndrome

- A characteristic set of symptoms that appear in some newborns of mothers who drink during pregnancy has become known as the fetal alcohol syndrome (FAS). - FAS involves gross physical deformities that were first identified in eight very young children who had severely alcohol-dependent mothers who drank during pregnancy. ^ small eyes and small eye openings, drooping eyelids, underdeveloped mid face, skin folds across the inner corners of the eyes, underdevelopment of the depression above the upper lip, and a small head circumference. - Furthermore, abnormal creases in the palm were reported, along with abnormalities in the joints. Some of the children had cardiac defects, benign tumors consisting of dilated blood vessels, and minor ear abnormalities - A 10-year follow-up of these children showed low-normal to severely retarded intellectual functioning, physical deformities similar to those origi- nally reported, and the development of additional physical problem - Because FAS can be detected only after a child is born, postpar- tum environmental and other factors cloud an interpretation of what part prenatal alcohol exposure played in the resulting FAS. It is sometimes even difficult to deter- mine whether alcohol was the only prenatal substance that may have resulted in FAS.

Moderate Drinking and Health

- A number of studies have suggested that the moderate drinkers turn out to be the healthiest, followed by the abstainers, and dead last are the heavy drinkers (Sayed & French, 2016). "Health" most often has been measured by risk of cardiovascular disease and mortality.

Alcohol and sex

- Rather, social and psychological factors seem to be important determinants of sexual response in men at low BACs and often work to increase libido. However, the pharmacology of alcohol begins to dominate at BACs greater than 0.05%, which causes a decrease in arousal and sexual compete - Unlike men, however, women continue to perceive increased sexual arousal and sexual plea- sure even as the physiological indexes of their response and arousal are declining. -. Despite their perceived increased sexual arousal when they drink, whether women act on such perception depends on characteristics of the drinking setting and what the drinker has learned is acceptable sexual behavior in that setting. Therefore, again, a theory about the acute effects of alcohol on women's sexual behavior should incorporate social and psycho- logical factors as well as the pharmacology of alcohol

Alcohol and aggression

- Violent crimes include murder or attempted murder, manslaughter, rape or sexual assault, robbery, assault, and others such as kidnapping, purse snatching, hit-and-run driving, and child abuse. - prevalent among men 18 to 30 years old, who have a relatively high rate of both heavy drinking and criminal activity. Another problem of national concern is physical abuse of spouses (predominantly husbands abusing wives -National statistics show associations between alcohol and violence toward others and also violence toward oneself. -. Alcohol has also been identified as a major problem in the behavior of members of fraternities on college campuses. The misconduct and violence against property and people that some fra- ternities are known for seem to be highly correlated with the occurrence of popular frat functions such as beer bashes. -This theory holds that alcohol releases behavior normally inhibited by society, such as aggression and sex, as a result of its depressant action on the brain. Essentially the theory suggests that whatever anxieties we have about the social consequences of behavior such as aggression vanish as a result of alcohol's pharmacological action. Thus, people who have been drinking should be more aggressive than people who have not. - Rather, alcohol combines with situational factors, such as social pressure and threat of retaliation (Adesso, 1985; Graham et al., 1998), as well as personal factors, such as how angry a person is characteristically

Sensorimotor Effects

- Vision decreases in acuity, and taste and smell are not so sensitive. Pain sensitivity decreases when the BAC is in the 0.08% to 0.10% range. - The sensitivity of body sway to alcohol is the reason for the "walk a straight line" test that police use to decide whether a suspect is drunk. Alcohol's influence on body sway is due to its effects on balance controls in the inner ear. -Alcohol impairs psychomotor skills. In tasks designed to measure these skills, par- ticipants are asked to make controlled muscular movements to adjust or position a machine or some mechanism on an experimental apparatus in response to changes in the speed or direction of a moving object - there is clear abnormality in gross motor functions like standing and walking. At these levels, alco- hol has impaired the brain centers responsible for motor activity and balance to such a degree that the neural messages are not being sent to the muscles.

"Biopsychosocial" Approaches to Etiology

- a minority of children of parents with alcohol use disorder develop the disorder themselves. - Demographic factors are correlated with drinking problems, but the factors themselves are often associated with biological and psychological variables, too. It seems that single-factor researchers design their studies so that one type of factor— say, psychological—is emphasized and other types are underplayed or not represented at all.

Distribution

-After absorption, the blood distributes alcohol to all of the body's tissues. Because alcohol is easily dissolved in water, the proportion of water in a tissue determines the concentration of alcohol in it. -Blood is about 70% water and therefore gets a high concentration of alcohol. -Muscle and bone contain smaller percentages of water and have correspondingly smaller percentages of alcohol. -Alcohol affects primarily the CNS, especially the brain. The concentration of alcohol in the brain approximates that in the blood because of the brain e alcohol freely passes through the blood-brain barrier.

Therapeutic use

-Because alcohol is an excellent solvent, small amounts are combined with other ingredients in cough syrups and other products taken orally. -Furthermore, alcohol is an ingredient in mouthwashes and shaving lotions. If the individuals like them, alcoholic beverages may be recommended in moderate amounts to convalescent or elderly patients to be taken before meals to stimulate appetite and digestion. -Alcohol is also included in compounds created to treat skin problems. Because alcohol cools when it evaporates, ethanol sponges are used to treat fevers. In addition, alcohol is part of mixtures that serve as liniments -Finally, dehydrated alcohol may be injected close to nerves or sympathetic ganglia to relieve chronic pain that may occur, for example, in patients with inoperable cancer

Slowing absorption

-Drinkers can considerably slow absorption by eating while drinking, because the presence of food in the stomach retards absorption. -Milk is especially effective for slowing alcohol absorption. -Another factor is the rate at which an alcoholic beverage is consumed; faster drinking means faster absorption.

Hangover

-Hangovers begin to appear about 4 to 12 hours after reaching the peak BAC and generally are not considered a pleasant alcohol effect. -Symptoms may include headache, dizziness, nausea, vomiting, increased heart rate, fatigue, and thirst -Although people usually do not think of hangovers as a serious negative consequence of over- indulging in drinking alcohol beyond not feeling well temporarily, the cumulative effect of hangovers for a society are considerable.

Alcohol and Brain Functioning

-The average individual with more severe alcohol use disorder who has been studied, when abstinent from alcohol or other psychoactive drugs, performs more poorly than nonalcoholic control groups on tests of abstracting, problem solving, memory, learning, and perceptual-motor speed. - Other characteristics of the drinkers also influence their vulnerability to alcohol's effects on brain function. A major one is the individual's drinking history. -Fortunately, with long-term abstinence from alcohol, most alcohol-related neuropsychological impairment once evidenced can be virtually reversed, with only mild deficits left compared with control subjects. -.The reversibility of cognitive deficits may be due to several factors, including increased cerebral blood flow, better nutrition, the reorganization of brain-cell networks, and some recovery of brain atrophy

Psychological Effects

-The influences of nondrug factors, particularly situational and cognitive variables (e.g., expectancies and attitudes), are perhaps most powerful in this domain. -The person's mood state before starting to drink also is an important factor. -At lower BACs, drinkers report feeling elated and friendly when the BAC is rising, but when it is falling, common feelings are anger and fatigue. Other reports when the BAC is rising have been expansiveness, joviality, relaxation, and self-confidence.

Metabolism and Excretion

-The small percentage of alcohol that is not metabolized is excreted in pure form through the kidneys and the lungs. When alcohol is metabolized in the liver, it is broken down to acetaldehyde by the enzyme alcohol dehydrogenase. -. Acetaldehyde eventually is broken down to carbon dioxide and water. At this point, there is a release of energy, or calories (Julien, 1996). The carbon dioxide is excreted from the body through air exchange in the lungs, and the water is excreted in urine.

Consumption of Alcohol and Heavy Drinking among College Students

-The typical college undergraduate is in the young adult age range. -Therefore, according to the national survey data, you would expect a majority of college students to drink alcohol, and a large proportion of these students to have days when they drink heavily. -That prediction has been confirmed in a series of major surveys of U.S. colleges and universities. - The students who drink the most are first-year students, whites, members of fraternities and sororities, and athletes

Physical dependence

-Tremulousness (shakes), profuse perspiration, weakness, alcohol and other drug seeking. Also may include agitation, headache, anorexia, nausea and vomiting, abdominal cramps, high heart rate, and exaggerated and rapid reflexes. -Visual and auditory hallucinations may follow in increased intensity. Hallucinations may also occur when individuals are severely intoxicated (called acute alcoholic hallucinosis). -Grand mal seizures, ranging from one seizure to continuous severe seizure activity with little or no interruption. -Severe agitation, often appearance of confusion and disorientation; almost continual activity; very high body temperature and abnormally rapid heartbeat; terrifying hallucinations, may be visual, auditory, or tactile. The latter is most often felt as bugs or little animals crawling on the skin. -Hallucinations are accompanied by delusions, with a high potential for violent behavior without medical management. Deaths during DTs occur due to high fever, cardiovascular collapse, or traumatic injury. -Exhaustion and severe dehydration

BAC

. Factors besides dose of alcohol determine the peak BAC that is reached. - Total body mass is a major factor because alcohol is distributed in both muscle and fat. As a result, heavier people will have a lower BAC than lighter ones after drinking the same amount of alcohol. -Another factor is how much of a person's body consists of fat and muscle. -Alcohol is soluble in fat but is even more soluble in water. Everything being equal, a drink will result in a lower BAC for a leaner person than for a drinker who has a higher percentage of body fat. -This is the reason a woman tends to reach higher BACs from drinking a given amount of alcohol than does a man of the same body weight. -Women tend to have a higher percentage of body fat than men do. Also, one study suggests that women have less of the enzyme alcohol dehydrogenase in their stomachs, which prevents them from metabolizing as much alcohol in their stomachs. -More alcohol enters a woman's bloodstream and eventually the brain and other organs - This finding suggests that, for a man and a woman of equal weight, the same amount of alcohol affects the woman more (this is one reason "binge drinking" is defined as five drinks for men and as four drinks for women).

Effects of Chronic, Heavy Drinking on Body Systems

1. Central Nervous Liver Specific and general impairment in cognitive functioning 2. Liver Minor reversible (with abstinence) damage to irreversible, sometimes fatal damage 4. Cardiovascular Increased mortality from coronary heart disease and increased risk for cardiovascular diseases in general; alcohol-induced wasting of the heart muscle (alcohol cardiomyopathy) 5. Endocrine Effects on the secretion of hormones in different hormone hierarchies, or "axes"—for example, the hypothalamic-pituitary-adrenal axis and the hypothalamic-pituitary-gonadal axis 6. Immune Increased susceptibility to several infectious diseases 5. Gastrointestinal Cause of gastritis and increased risk of pancreatitis 6. Multiple Increased risk of contracting the following cancers: oral cavity, tongue, pharynx, larynx, esophagus, stomach, liver, lung, pancreas, colon, rectum

intoxication

A transient state of physical and psychological disrup- tion caused by the presence of a toxic substance, such as alcohol, in the CNS

REM sleep

Acronym for "rapid eye movements," which are associated with dream activity and are one stage in a cycle of sleep.

Alcohol Hepatitis

Alcohol hepatitis is more serious and involves the inflammation and death of liver cells. Often, jaundice occurs because of the accumulation of bile. This condition is reversible with abstinence and medical treatment but can cause death if it is severe enough and not treated. Liver hepatitis can be caused by means other than heavy drinking.

Physiological effects

Alcohol inhibits the secretion of the antidiuretic hormone, which causes increased urination. The effect happens when the BAC is rising but not when it is falling. -Alcohol also reduces the amount of body fat that is oxidized. This acute effect of alcohol accumulates to result in long-term increased body fat and weight gain when alcohol is used in addition to normal food intake -Such weight gain is com- monly called a "beer belly." Alcohol is a peripheral dilator and causes the skin to feel warm and turn red. -Alcohol's dilating effect on peripheral blood vessels causes some loss of body heat, however, and such action was thought to ultimately decrease protection against the cold. -Nausea and vomiting may occur at BACs greater than 0.15%. -Another physiological effect of alcohol when taken in high doses and when the BAC increases rapidly is a release of corticosteroids, part of the body's general reaction to stress.

Sits of action

Alcohol is a drug that depresses the central nervous system (CNS). -Alcohol may exert its effects by dissolving in lipid membranes, which disturbs the normal chemi- cal actions that occur there (Rall, 1990b). -That is, alcohol alters the cell membranes' anatomy by entering their internal structure. -The result is reduced efficiency of conduction of neural impulses along axons, which reduces the action potential amplitude that reaches the synapse. -As a consequence, neurotransmitter release and transmission of impulses across the synapse are inhibited.

Alcoholic beverages

Alcohol virtually always is drunk in one of the three major classes of alcoholic beverages: beer, wine, and hard liquor (also called distilled spirits)

Alcohol and behavior

Among alcohol's effects, those involving interpersonal behavior are of great social interest. -As the word implies, interpersonal means "between people." The interpersonal behaviors of sex and aggression in combination with alcohol have garnered the greatest interest and concern

Alcohol and the Liver

As the major metabolic site of alcohol, the liver is highly vulnerable to alcohol's toxic effects. The damage that alcohol can cause to the liver occurs in three ways: fatty liver, alcohol hepatitis, and cirrhosis.

orientation to time

Awareness of temporal specification, such as time of day, day of the week, or year. Orientation to time is one of the functions assessed in a psychiatric mental status exam.

Alcohol and reproductive functioning

Both men and women suffer impaired reproductive functioning as a result of chronic heavy drinking. -In men, such drinking affects the male sex hormones, reflexive responses of the nervous system relating to sexual performance, and sperm production. -First, men often experience gynecomastia (formation of breasts in men), which is a result of alcohol altering the balance of the female sex hormone (estrogen) and the male sex hormone (testosterone). -The shift in balance is due to damage to the liver from alcohol and resorption of estrogens into the blood. -A second result of changing the balance in the sex hormones is a loss in sexual desire. Along with a loss in desire is a drop in sexual performance, manifested as ejaculatory incompetence and impotence. - The scientific information available suggests that alcohol dependence in women is associated with dysfunction of the ovaries, disruption of the luteal phase of fertilization, and amenorrhea

monoamine oxidase (MAO) inhibitor

Drugs used to treat depressions that inhibit the activity of the enzyme monoamine oxidase, which degrades the neurotrans- mitters of norepinephrine and serotonin -Higher doses also are associated with the induction of sleep, stupor, and in extremely high doses, coma. In the overdose range of consumption, cardiovascular depression can occur. Earlier, we noted that a dose of alcohol could be lethal

Blackout

Failure to recall events that occurred while drinking even though there is no loss of consciousness.

Fatty Liver

Fatty liver is characterized by fat accumulating in the liver and is the earliest, most benign effect of alcohol on the liver. This condition is reversible with abstinence from alcohol, and there is no evidence that it is a precursor of cirrhosis.

neuropsychological test

Formal ways of measuring behavioral functions that may be impaired by brain lesions.

teratology

In biology, the study of monsters, or distortions in growth.

Consumption of Alcohol and heavy drinking

In the national survey, "heavy" drinking was defined as 5/4 drinks on an occasion at least 5 days in the past 30 days for men and women, respectively. -The data are highly consistent with earlier surveys and reveal that current heavy drinking is by no means a rarity in the American population aged 12 and older. -A total of 6.5% of the national sample reported heavy drinking in the last month in 2015. However, major differences are hidden in that total percentage. Men reported a rate of heavy drinking over twice as high as women reported.

short-term memory

Memory for recent events; thought to differ from long-term memory in several important way

Long term memory

Memory for remote events. According to one theory of memory, information enters long-term memory through short-term memory.

Absorption

Nevertheless, most of the alcohol that is consumed must pass from the stomach to the small intestine for rapid absorption to occur. -This is by far the most common way humans absorb alcohol. If alcohol is vaporized, however, it can be absorbed through the lungs and subcutaneous sites -The major factors influencing absorption are those that alter the rate of alcohol's passage from the stomach to the intestines - Drinks that have a higher concentration of alcohol, such as scotch drunk "neat" (no ice, no mix such as soda or water), are absorbed more quickly than those with a lower concentration, such as a scotch and water.

Tolerance

Regular use of alcohol results in some dispositional tolerance (see Chapter 5 for a detailed discussion of tolerance). -Therefore, a drinker must consume greater quanti- ties of alcohol to maintain a certain BAC. -Dispositional tolerance can be reversed with a period of abstinence from alcohol. - Functional tolerance has a greater practical influence than does dispositional tolerance in altering how alcohol affects a person with repeated use. -Tolerance to alcohol may be both acute and protracted. Because of acute tolerance, some effects of alcohol at a given BAC tend to be greater when the BAC curve is rising than on the descending limb of the curve.

standard drink

The alcohol equivalent in a drink of beer, wine, or distilled spirits. A standard drink equals 0.5 ounce of alcohol—about the alcohol content in 12 ounces of beer, 4 ounces of table wine, or 1 ounce of 90- to 100-proof whiskey. - The blood alcohol concentration (BAC), as the name implies, is the amount of alcohol in the bloodstream. It is expressed as a percentage of weight of alcohol per 100 units of blood volume

The french paradox

The moderate drinking-health hypothesis relates to a research finding that has been called the French paradox, or the co-occurrence of a diet high in saturated fats and a low incidence of coronary heart disease

Distillation

The process by which the heating of a fermented mixture increases its alcohol content. -Then sugar is dissolved in water and exposed to air, which is called yeasts. In this environment, yeasts multiply rapidly by eating the sugar, which is then converted to ethanol and carbon dioxide by the yeasts' metabolic processes. -The carbon dioxide bubbles to the top of the mixture, leaving ethanol.

Proof

The proportion of alcohol in a beverage, by volume. Proof typically is used in reference to distilled spirits and equals twice the percentage of alcohol

social detoxification

Treatment of alcohol withdrawal without the use of medicine.

Alcohol and Driving ability

Young men (18 to 34 years old) seem to be the group most likely to be intoxicated, driving, and in traffic accidents -This coincides with the consistent finding in surveys that young men are the ones most likely to drink heavily (say, five or more drinks) on an occasion.

Acute effects of alcohol

the acute and chronic effects of alcohol consumption. We first go over alcohol's many acute physiological, sensory-motor (sensorimotor), and psychological effects. -special societal concern related to alcohol's acute effects, including aggression, sexual behavior, and driving.