drugs and society and human behavior Ch 9

Abstinence syndrome

alcohol withdrawal syndrome that develops when a heavy drinker stops drinking is medially more severe and more likely to cause death than withdrawal from opioids

Delirium tremens

alcohol withdrawal syndrome that includes hallucinations and tremors (old name for stage 1-3)

Detoxification

an early treatment stage in which the body eliminates the alcohol or other substance• Medical treatment is usually sought in stage 1 or 2, and rapid intervention with a sedative drug will prevent stage 3 or 4 from occurring

Liqueurs, or cordials,

are similar to fortified wines •Highly flavored and contain 20 to 25 percent alcohol

Cardiomyopathy

damaged heart muscle; associated with higher rate for heart disease

Stage 3 Detoxification

delusions, disorientation, delirium, sometimes intermittent and usually followed by amnesia

Driving Under the Influence Alcohol-related fatalities are a greater proportion of the fatalities occurring

during dark hours and on the weekends

Driving Under the Influence 90 percent of the intoxicated drivers involved in fatal crashes

have never been convicted of driving under the influence in the past

Korsakoff's psychosis

inability to remember recent events or learn new information; irreversible

Alcoholic hepatitis

inflammation and impairment of liver function

Cirrhosis

irreversible, frequently deadly liver disorder associated with heavy alcohol use

Alcohol-related fatty liver

liver uses alcohol as fuel instead of lipids, and instead stores the lipids in its cells

• Alcohol use is associated with cancers of the

mouth, tongue, pharynx, larynx, esophagus, stomach, liver, lung, pancreas, colon, and rectum • Interaction with cigarette smoking increases the incidence of cancers of the oral cavity, pharynx, and larynx

Varietal wine

named after a variety of grape; by law, at least 51% of grapes used must be named grape; e.g. Chardonnay, Merlot, Zinfandel

Stage 1 Detoxification

tremors, excessively rapid heartbeat, hypertension, heavy sweating, loss of appetite, insomnia; can happen within hours of quitting alcohol

Generic wine

usually have names taken from European land areas where the original wines were produced; e.g. Chablis, Burgundy, Rhine; blended wines, using whichever grapes are available

Protracted withdrawal syndrome

withdrawal symptoms that can last for weeks: irregular blood pressure, uneven breathing, panic attacks, anxiety, depression; can trigger alcohol cravings

Standard drink has about 0.5 ounce of absolute alcohol and is equivalent to:

• 12 ounces of beer at about 4 percent alcohol • 4 ounces of wine at 12 percent alcohol • 1 ounce of 100-proof spirits or 1.25 ounces of 80-proof spirits

Proof

• A measure of the alcohol content of a distilled beverage • The percentage of alcohol by volume is one-half of the proof number • Example: 90-proof whiskey is 45 percent alcohol

Physiological Effects Fluid balance

• Alcohol has a diuretic effects • Increases urine flow • Lowers blood pressure in some individuals

18th Amendment was repealed by the 21st Amendment in 1933 Outcomes of the repeal

• Alcohol per capita sales and consumption increased • Alcohol consumption returned to pre-Prohibition levels after World War II

Alcohol Consumption Differences in per-capita sales reflect differences in the degree of urbanization and some regional cultural differences

• Alcohol sales are higher in population centers • Examples: District of Columbia and Las Vegas and Reno in Nevada

18th Amendment was repealed by the 21st Amendment in 1933 Reasons for the repeal

• Alcohol taxes had been a major source of revenue • Concerns that widespread disrespect for the Prohibition law encouraged a general sense of lawlessness

Trends in the United States alcohol consumption

• Alcohol use rose through most of the 1970s and peaked in 1981 • Use of illicit drugs also reached a peak about the same time • Declined between the years 1981 and 1995

Most wines contain about xx percent alcohol

12 percent alcohol

prohibition

13 states passed prohibition laws between 1851 and 1855 •By 1917, 64 percent of the American population lived in dry territory •People drank illegally in speakeasies and other private clubs, and they drank legally from a variety of the many patent medicines that were freely available

Driving Under the Influence

By 2004, the percentage had declined to less than 40 percent from the peak of almost 60 percent in 1982

Distilled Spirits

Contain 95 percent pure ethyl alcohol, that is 190 proof

Fetal Alcohol Syndrome (FAS)

Facial and developmental abnormalities associated with the mother's alcohol use during pregnancy Related to peak B A C and to duration of alcohol exposure Prevalent in about 2 of 1,000 births

behavioral effects of alcohol

Mood changes can include: • euphoria • reduced anxieties • reduced inhibitions

How alcohol affects the Immune System

Observed increase in the frequency of various infectious diseases, including tuberculosis, pneumonia, yellow fever, cholera, and hepatitis

Outcomes of Prohibition

Organized crime became more organized and profitable •Alcohol dependence and alcohol-related deaths declined

Withdrawal Syndrome

Physical dependence associated with prolonged heavy use of alcohol is revealed when alcohol intake is stopped • Abstinence syndrome is medically more severe and more deadly than withdrawal from opioid drugs • If untreated, mortality can be as high as 1 in 7

Beer

Production process • Made by adding barley malt to other cereal grains • Hops are added with yeast to give beer its distinctive, pungent flavor Two giants, Anheuser-Busch and MillerCoors, dominate the market for beers in the United States • Imported beers and microbreweries are growing in popularity

Red versus white

Sweet versus dry Sparkling wines Fortified wines • Have alcohol content near 20 percent

• If someone drinks enough to vomit, the individual should stop drinking

Vomiting reflex is triggered by rapidly rising B A C, usually above 0.12 percent, and is inhibited when B A C reaches above 0.20 and can quickly reach lethal levels if one continues to drink

Wernicke-Korsakoff syndrome

chronic mental impairment produced by heavy alcohol use over a long period of time; associated with thiamine deficiency; confusion, ataxia, abnormal eye movements (can be reversed)

Alcoholic dementia

global decline of intellect; difficulty swallowing, impaired problem solving, difficulty manipulating objects, and abnormal electrocefelograms

Stage 2 Detoxification

hallucinations: auditory, visual, tactile, or combination of; begins a day or two after quitting alcohol

Alcoholics Anonymous

has over 1.5 members in over 100 countries; believe that alcohol dependence is a progressive disease characterized by a loss of control over drinking and that diseases can never be cured

Stage 4 Detoxification

seizure activity happens at this stage

Effects depend on the B A C, which is also called blood alcohol level

• At low blood alcohol levels, complex, abstract, and poorly learned behaviors are disrupted • As blood alcohol levels increase, better learned and simpler behaviors are also affected

• American consumption per person per year

• Beer: 27 gallons of beer per person per year, which translates to more than 1 gallon of alcohol per person • 0.75 gallons of alcohol in the form of spirits • 0.33 gallons of alcohol in the form of wine

Distribution

• Blood alcohol concentration or B A C • measure of the concentration of alcohol in blood, which is expressed as a percentage in terms of grams per 100 m l • Alcohol is distributed throughout the body fluids including blood but does not distribute much into fatty tissues • Thus, a 180-pound lean person will have a lower B A C than a 180-pound fat person who drinks the same amount of alcohol

Fermentation

• Certain yeasts act on sugar in the presence of water, and this chemical action is fermentation • Forms the basis of all alcoholic beverages Raw materials • Fruits • Addition of the appropriate yeast to a mixture of crushed grapes and water will begin the fermentation process because of the sugar content in fruits • Cereal grains: require malt to convert starch into sugar Yeast has a limited tolerance for alcohol • When the concentration reaches 15 percent, the yeast dies and fermentation ceases

Physiological Effects Hormonal effects

• Chronic alcohol abusers can develop a variety of hormone-related disorders • Examples: Testicular atrophy and impotence in men and impaired reproductive functioning in women

Drinking among college students

• College students drink more among others in the same age group • Many campuses have banned the sale or advertising of alcohol • Many fraternities have banned keg parties • There is some evidence that this is helping • Fewer students are binge drinking • Fewer students are driving after drinking

Physiological Effects Peripheral circulation

• Dilation of peripheral blood vessels • Increases heat loss from the body but makes the drinker feel warm

Taxation

• Federal and state taxes and licensing fees amount to about half the cost of an alcoholic beverage • The Congress initiated a significant tax increase in 1991, which resulted in fairly modest declines in purchases

Fetal Alcohol Syndrome Diagnostic criteria, with at least one present

• Growth retardation before and slash or after birth • Pattern of abnormal features of the face and head or evidence of retarded formation of the midfacial area • Evidence of C N S abnormality or other evidence of abnormal neurobehavioral development

Light beer

• Has fewer calories, lighter taste, and less alcohol • Mash is fermented at a cooler temperature for a longer time • This converts more of the sugars to alcohol • Then water is added to adjust the alcohol content

Alcohol overdose is relatively common and dangerous Two pieces of advice

• If someone drinks enough to pass out: • Do not leave the person alone to sleep it off • Place the person on his or her side and monitor the person's breathing or take the person to the E R immediately

Metabolism

• Liver metabolizes about 0.25 to 0.30 ounces of ethanol per hour • A person's B A C is stable if the rate of intake equals rate of metabolism • If rate of intake exceeds rate of metabolism, B A C increases

Wine Production

• Made from fermented grapes • A large volume of wine is produced in mechanized, sterilized wine factories • Many small wineries operate alongside the industry giants

Alcohol Consumption Gender differences

• Males are more likely to drink than females • Males are more likely than females to report binge drinking within the past 30 days

Pharmacology Absorption

• Most absorption happens in the small intestine • Some alcohol is absorbed in the stomach • Slower if there is food or water in the stomach • Faster in the presence of carbonated beverages

Lager

• Most common type of beer sold in the United States • Uses a type of yeast that settles to the bottom of the mash to ferment • Requires cool temperature and slower fermentation

Alcohol Consumption in the USRegional differences in the United States

• One-third of the adult population label themselves as abstainers • Half the alcohol is consumed by 10 percent of the drinkers

Distillation

• Process in which a solution containing alcohol is heated, and the vapors are collected and condensed into liquid form again • Said to be discovered in Arabia around A D 800 • Introduced in Europe around the tenth century

Factors that add to the quality of wines

• Selection and cultivation of grapevines • Good weather • Timing of the harvest • Careful monitoring of fermentation and aging

Regulation after 1933

• Some states remained dry after national Prohibition • Most states allowed beer sales • Mississippi was the last dry state • Allowed alcohol purchase and consumption in 1966 • In 1970s, 30 states lowered drinking age to 18 or 19 • It was raised again to 21 following concerns over young people dying in alcohol-related traffic accidents

Driving Under the Influence Risk of a fatal crash is dose-related

• There is a sharp increase in fatalities as B A C increases over 0.10 Men are more likely than women to be involved in an alcohol-related traffic fatality

Ale

• Uses a top-fermenting yeast and slightly warmer temperatures • Shorter fermentation time results in more of the flavor of the malt being retained in the final product

Fetal alcohol spectrum disorder, or F A S D

• individual developmental abnormalities associated with the mother's alcohol use during pregnancy • Prevalence is about 80 to a few hundred per 1,000 births Drinking during pregnancy increases the risk of spontaneous abortion

After the American Revolution

•Alcohol was the first psychoactive substance to become demonized in American culture

Grain neutral spirits

•Clear liquid that is tasteless •Sold as Everclear to consumers and can be used in medicine or research •Used to make various beverages •Gin: distillate filtered through juniper berries and then diluted with water •Vodka: mixture of grain neutral spirits and water Contain relatively few congeners •Congeners may include alcohols other than ethanol and oils contained in alcoholic beverages

Whiskey

•Distilled at a lower proof, not more than 160 •Distillate contains more congeners and some flavor from the grain •Whiskey accumulates congeners during aging, at least for the first five years

About 90 percent of alcohol is metabolized in the liver About 2 percent of alcohol is excreted unchanged:

•In the breath •Through the skin •In the urine

The temperance movement

•Initially promoted abstinence from distilled spirits only •Later promoted total abstinence •Became fashionable to "take the pledge" in the early 1800s

At the time of America's revolution

•Most people drank more alcohol compared with water •Early Puritan ministers referred to alcoholic drink as the Good Creature of God •They denounced drunkenness as a sinful misuse of the Good Creature

Types of whiskey

•Straight rye whiskey •Bourbon whiskey •Blended whiskey

Federal prohibition

•The 18th Amendment banned the sale of alcohol •People still drank illegally •Enforcement was challenging and expensive

alcohol Primary metabolic system

•The enzyme alcohol dehydrogenase converts alcohol to acetaldehyde •Acetaldehyde is then converted rapidly by aldehyde dehydrogenase to acetic acid •The major factor determining the rate of alcohol metabolism is the activity of the enzyme alcohol dehydrogenase

Benjamin Rush

•Wrote a pamphlet titled "An Inquiry into the Effects of Ardent Spirits on the Mind and Body" •Noticed a relationship between heavy drinking and jaundice, "madness," and epilepsy •Believed that hard liquor damaged drinkers' morality •Referred to alcohol addiction as a disease