Lecture Outline
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Alcohol: An Overview
- Alcohol is the most popular drug used on college campuses.
- It is estimated that 84% of college students use
alcohol.
- Culture and tradition influence alcohol use on
campuses.
- Binge drinking
is defined as five drinks in one episode for men and four drinks
in one episode for women. The purpose of binge drinking is to become
intoxicated. Binge drinkers are more likely to have problems on
campus. (See Table 8.1)
- There are several reasons why college students
are at particularly high risk for alcoholism and alcohol related
problems.
- Alcohol use among Americans has been declining steadily
since the 1970s. Use in 1998 represented a per capita decline in consumption
of 2.19 gallon of pure alcohol per person.
Physiological and Behavioral Effects of Alcohol
- The intoxicating substance found in beer, wine and
liquor is ethyl alcohol or ethanol.
- It is produced in a process called fermentation.
- Hard liquors go through another process called
distillation.
- The "
proof " of an alcoholic
beverage is twice the percentage alcohol content.
- Percentage of alcohol varies per beverage.
- Behavioral effects vary with the individual and the
setting.
- Blood Alcohol Concentration
( BAC ) is the ratio of alcohol to total blood volume (see
Table 8.2)
- It is used to measure the physiological and
behavioral effects of alcohol.
- Learned behavioral tolerance is having a high
BAC, but appearing sober.
- About 20 percent of alcohol is absorbed through the
lining of the stomach. The other 80 percent is absorbed through the
small intestine.
- Several factors influence the speed
of absorption:
- The alcohol concentration of your drink and
the amount you consume.
- The amount of food in your stomach. Food slows
the absorption process.
- Carbonation in the beverage causes the opening
from the stomach to the small intestine to relax, emptying its
contents more rapidly.
- Your mood. Powerful moods like stress and tension
cause the stomach to dump its contents more rapidly.
- Alcohol is metabolized in the liver where it is
converted by alcohol dehydrogenase to acetaldehyde, which is a toxic
chemical that can cause nausea and vomiting as well as liver damage.
- Alcohol contains 7 calories per gram.
- A drinker's BAC depends on weight and body fat,
the water content in body tissues, the concentration of alcohol
in the beverage consumed, the rate of consumption, and the volume
of alcohol consumed.
- Alcohol poisoning
occurs when one drinks large amounts of alcohol in a short amount
of time and can result in death due to respiratory depression or
aspiration.
- Women appear to have about half the alcohol dehydrogenase
as men, meaning females have the central nervous system effects
longer than males.
- Breathalyzer, urinalysis, and blood tests are used
to determine BAC.
- In some states, refusal to take the test will result
in the immediate revocation of the person's driver's license.
- Immediate Effects.
- The most dramatic effects occur within the Central
Nervous System (CNS).
- The CNS depression can cause vital function depression
and even death.
Alcohol is a diuretic.
- Dehydration can occur due to loss of water
from cerebrospinal fluid.
- This dehydration occurs at the cellular level,
so that the cells cannot function normally. This causes several
symptoms such as the morning-after headaches.
- A hangover can occur for many reasons.
- Symptoms of hangover include headache, upset
stomach, anxiety, depression, and thirst.
- Congeners are forms of alcohol that are metabolized
more slowly than ethanol and are more toxic.
- Time is the only cure for a hangover. It takes
12 hours, sometimes longer.
- Drug interactions are common with alcohol (see
Table 8.3)
- Long-term effects have recently been the subject of
research.
- Nervous System effects are directly related to
amount of alcohol consumed and include:
- Shrinkage in brain size and weight.
- Loss of some degree of intellectual ability
.
- Damage to left brain may affect written and
spoken language skills, logic, and mathematical skills.
- Moderate alcohol use (no more than 2 drinks a day)
is associated with a reduced risk of coronary artery disease.
- There is an increase in HDL.
- Alcohol has an antithrombotic effect, decreasing
the clotting factors associated with atherosclerosis.
- One of the most common liver diseases related to
alcohol abuse is cirrhosis of the liver,
which is among the top ten leading cause of death in the US
- Fatty liver is the first stage of liver damage
from heavy drinking.
- Fibrosis, liver cells replaced by scar tissue,
is a further stage of deterioration.
- Alcoholic hepatitis
is a serious condition from prolonged alcohol use. This can
be fatal in itself or lead to cirrhosis.
- Many different cancers are associated with heavy
alcohol use, particularly cancers of
the esophagus, stomach, mouth, tongue, and liver.
- One compelling report demonstrated that drinkers
of 3 or more drinks per day were at greater risk for breast cancer
.
- Alcohol abuse can cause gastric irritation, inflammation
of the pancreas, decreased enzyme production, and block the absorption
of nutrients, in particular calcium.
- Evidence also shows that alcohol can decrease the
effectiveness of the immune system.
- Fetal alcohol syndrome
(FAS) is associated with alcohol consumption during pregnancy.
- FAS is the third most common birth defect and the
second leading cause of mental retardation in the US It is the most
common preventable cause of mental impairments in the western world.
- If alcohol is consumed during first trimester,
it affects organ development, if consumed during third trimester,
it affects brain development.
- Symptoms include mental retardation, small
head, tremors, and abnormalities of the face, limbs, heart and
brain.
- Fetal alcohol effects
(FAE) are seen in children with history of prenatal alcohol exposure
but who do not have all the physical and behavioral symptoms of
FAS.
- The signs of FAE in newborns are low birth
weight and irritability.
- There may also be permanent mental impairment.
- Alcohol can be passed to a baby through breast
milk. It is recommended to abstain from alcohol or to wait at least
4 hours to nurse after drinking.
- The leading cause of death for all age groups from
5-45 is traffic accidents, 40% of which are alcohol-related.
- Fatalities decreased among 15-20 years olds due
to zero tolerance laws.
- Many states have lowered the legal blood alcohol
level to 0.08 percent due to research that suggests that this level
shows significant impairment.
- MADD and
SADD are organizations
to promote awareness of this problem.
- There is a direct relationship between the blood
alcohol of the driver and the likelihood of an auto accident. A
person with a BAC level of 0.10 percent is about 10 times more likely
to be in a car accident that a non drinker.
- In 2000, 53% of fatally injured drivers had blood
alcohol levels over 0.10 percent.
Alcohol Abuse and Alcoholism
- Alcoholism effects
all SES levels, professions, geographic locations, religions, and races.
- Alcoholics tend to have a number of behaviors in
common.
- There are many theories on the causes of alcoholism.
- Biological and family factors are influences in
alcoholism.
- Type 1 alcoholics
are drinkers who had one parent who was a problem drinker and
grew up in an environment that encouraged heavy drinking.
- Type 2 alcoholics
are males who are the biological sons of alcoholics.
- Social and cultural influences have an effect on
alcohol use.
- Family history may play a role.
- Factors such as urbanization may have an effect
on alcohol use.
- Alcoholism affects the family as well as the individual.
- The code in dysfunctional families is "don't
talk, don't trust, don't feel."
- Children in dysfunctional families generally assume
one of these roles:
- The family hero.
- The Scapegoat.
- The lost child.
- The Mascot.
- The cost of alcoholism to society is tremendous.
- Crimes, medical expenses, accidents, and alcoholic
treatment all contribute to the cost.
- According to the National
Institute on Alcohol Abuse and Alcoholism, in 1998 alcohol related
costs to society were at least $184.6 billion.
- Emotional costs are not tangible, but still have
an effect on society .
- New studies show that there may be as many female alcoholics
as male alcoholics.
- There appears to be several differences between
male and female alcoholics.
Recovery
- Family members of an alcoholic usually take action
before the alcoholic does.
- Treatment programs vary .
- Private treatment facilities provide medical assistance
for withdrawal symptoms.
- Delirium tremens
occur in a small percentage of alcoholics.
- Other symptoms vary from person to person.
- Detoxification
refers to the process by which addicts end their dependence
on the drug.
- Family therapy, individual therapy, and group therapy
are all used for alcoholic treatment.
- Antabuse is a
form of aversion therapy for alcoholic recovery .
- Alcoholics
Anonymous teaches people that recovery is a lifelong process.
- It is based on a "higher power."
- The road to recovery is taken one step at a time.
- Al-Anon is
an auxiliary group for those affected by an alcoholic.
- Alateen is
an auxiliary group to help adolescents who live with an alcoholic
parent.
- Women
for Sobriety is designed to meet the specific needs of female
alcoholics.
- Secular Organizations for Sobriety is a recovery
group without a spiritual emphasis.
- Relapse occurs within the first three months in 60%
of alcoholics.
- A comprehensive, long-term plan can help decrease
chance of relapse.
- Many alcoholics refer to themselves as constantly
in recovery.
Our Smoking Society
- More than 430,000 Americans die each year of tobacco-related
diseases and 10 million will suffer from diseases caused by tobacco.
Tobacco is the probable cause of 25 diseases. One in every 5 deaths
in the US is smoking related.
- The proportion of teen smokers has increased in
the past few years. By 1999, almost 34.8 percent were currently
smoking.
- Every day another 6,000 teens under the age of
18 smoke their first cigarette.
- Tobacco and social issues.
- Advertising by tobacco companies have been geared
toward young people and women.
- The financial costs of tobacco to society are high.
- Health care costs, productivity costs, and other
smoking related costs add to total financial costs of about $100
billion a year.
- Smoking among college students has increased 32% between
1991 and 1999.
Tobacco and Its Effects
- There are many health effects of tobacco.
- Nicotine
is the major psychoactive substance in tobacco.
- Smoking is the most common form of tobacco use
and delivers nicotine and about 4,000 other chemical substances
to the user and anyone who breathes in the environmental tobacco
smoke (see Table 8.4).
- Tar is the
thick, brownish sludge from particulate matter that condenses in
the lungs. It contains cancer-causing agents such as benzopyrene
and irritants such as phenol.
- Nicotine and hydrogen cyanide impair the action
of cilia cells in the lungs, making it nearly impossible for the
lungs to clear and contributing to "smokers cough."
- Many other gasses and chemicals are found in tobacco;
one of the most dangerous is carbon monoxide.
- Carbon monoxide is present at levels about
800 times higher than considered safe by the Environmental Protection
Agency.
- This can cause oxygen deprivation in many body
tissues.
- Tobacco comes in several forms.
- Cigarettes, cigars, and pipes are used for burning
and inhaling tobacco.
- Clove cigarettes are about 60% tobacco, and are
higher in tar, nicotine, and carbon monoxide than regular cigarettes.
They also contain eugenol, which allows deeper inhalation, thereby
increasing risk.
- Cigar sales have increased dramatically in the
last few years. Smoking even one a day increases risk for cancers,
heart disease, and Chronic Obstructive Pulmonary Disease (COPD).
- Bidis are small hand-rolled, flavored cigarettes,
made in India or Southeast Asia. They look similar to a marijuana
cigarette, and are far more toxic than cigarettes.
- About 5 million adults use smokeless tobacco. Chewing
tobacco and snuff are two forms of smokeless tobacco.
- Chewing tobacco contains tobacco leaves treated
with molasses and other flavorings.
- It is placed in mouth and chewed or sucked
to release the nicotine.
- Dipping is a similar method where the tobacco
is placed between the lower lip and teeth to stimulate the
flow of saliva and release the nicotine.
- Snuff is placed inside the cheek or inhaled.
- There are many risks associated with smokeless
tobacco.
- It is just as addictive as smoking tobacco.
- Leukoplakia, a white leathery patch inside
the mouth, is a precursor to oral cancer .
- It is estimated that 75 percent of oral
cancer cases result from tobacco use.
- Warning signs include lumps in the jaw
or neck, color changes or lumps inside the lips, white,
smooth, or scaly patches in the mouth or on the neck, lips,
or tongue, a red spot or sore that does not heal, and difficulty
speaking or swallowing.
- Smokeless tobacco impairs the sense of
taste and can cause tooth decay and gum disease.
- Users suffer the same withdrawal as do
smokers.
- Nicotine is a powerful CNS stimulant.
- Nicotine causes many physiological reactions.
- It produces an aroused state.
- It stimulates production of adrenaline.
- It causes an increase in heart rate and blood
pressure
- It decreases the stomach contractions that signal
hunger, and decreases sensation in the taste buds, reducing hunger.
- Many smokers eat less and weigh about 7 pounds
less than nonsmokers.
- Nicotine poisoning can occur for a beginning smoker
until tolerance develops.
- Symptoms include dizziness, lightheadedness, rapid,
erratic pulse, clammy skin, nausea, vomiting and diarrhea.
- Tolerance to nicotine occurs rapidly, after just
a few cigarettes.
- Addiction to nicotine also occurs rapidly.
Health Hazards of Smoking
- It is estimated that 30% of all cancers and more than
85% of lung cancers are caused by tobacco.
- Lung cancer is the leading cause of cancer death
in the US.
- Lung cancer takes from 10 to 30 years to develop,
has a five year survival rate of 13 percent and risk depends on:
- Number of cigarettes smoked per day.
- When you started smoking.
- How deeply you inhale.
- Occupational or domestic exposure to other
irritants, such as asbestos or radon.
- Other cancers associated with tobacco include pancreatic
cancer, and cancers of the lip, tongue, salivary glands, esophagus,
kidney, bladder, and larynx.
- Half of all tobacco-related deaths occur from some
form of cardiovascular disease.
- Smoking ages the arteries by about 10 years.
- Smoking decreases HDL levels.
- Platelet adhesiveness increases the risk of blood
clots.
- Oxygen deprivation weakens tissues of the heart.
- Risk goes down by 50% after one year of quitting
and drops to normal after 15 years.
- Smokers are twice as likely as nonsmokers to suffer
a stroke.
- Women who take birth control pills and smoke cigarettes
increase their risk of heart attack by 20 times that of nonsmokers.
This combination can also increase risk of blood clots, peripheral vascular
disease and stroke.
- There are several respiratory problems associated with
smoking.
- Chronic bronchitis is caused by inflamed lungs
producing excess mucous.
- Emphysema is a chronic condition where alveoli
are destroyed and oxygen intake
- Eighty-percent of all emphysema cases are due
to smoking.
- Gum disease is three times more common in smokers than
in nonsmokers.
- Women who smoke have a greater risk for cervical cancer
than do nonsmokers.
- Women who smoke during pregnancy increase risk of miscarriage,
low birth weight, infant mortality and developmental problems.
- SIDS occurs more frequently in babies whose mothers
smoked during pregnancy.
- A recent study suggests that smoking during pregnancy
predisposes the brain in females to nicotine addiction.
Environmental Tobacco Smoke (ETS)
- Environmental tobacco smoke is
divided into two categories:
- Mainstream smoke
refers to the smoke drawn through tobacco while inhaling.
- Sidestream smoke
(secondhand smoke) refers to smoke from the burning end of a cigarette
or to smoke exhaled by the smoker.
- Involuntary smokers, also called passive smokers, breathe
less smoke than smokers but are still exposed to dangerous chemicals.
Secondhand smoke has higher levels of unhealthy chemicals than the smoke
the smoker inhales. Sidestream smoke has two times the tar as mainstream.
- Involuntary smokers have increased risk of several
diseases.
- Lung cancer and heart disease risk increases with
exposure to sidestream smoke.
- Sidestream smoke increases risk of bronchitis and
pneumonia.
- Children under the age of five are at greatest
health risks from sidestream smoke.
- Children exposed to sidestream smoke have a
greater risk of other illnesses such as asthma, chest colds,
and decrease in pulmonary performance.
- They miss 33 percent more school days.
- Several anti-smoking groups have emerged to reduce
the hazards associated with passive smoking.
- Forty-six states have sued the tobacco industry and
in 1998 a settlement was reached where the tobacco industry will pay
in excess of $200 billion as well as fund additional anti-smoking measures.
Quitting
- Quitting smoking is very difficult.
- Smokers must break the physical addiction to nicotine.
- One-third of all smokers try to quit each year,
but 90% fail.
- Symptoms of nicotine withdrawal include irritability,
restlessness, nausea, vomiting, and intense cravings for tobacco.
- Nicotine replacement products are one way to help smokers
break the addiction.
- Nicotine replacement gum has been used to ease
withdrawal symptoms.
- The nicotine patch helps relieve the smoker's physical
craving for nicotine.
- The nicotine patch helps relieve the smoker's physical
craving for nicotine.
- The FDA recently approved a nicotine nasal spray
to help in quitting. It requires a prescription.
- A nicotine inhaler is now on the market, but requires
a prescription.
- There are several other ways that are used to help
smokers quit the habit.
- A version therapy techniques attempt to reduce
smoking by pairing the act of smoking with some sort of noxious
stimulus.
- Operant strategies involves pairing the act of
smoking with an external stimulus such as a sounding buzzer to help
condition the smoker into quitting when the stimulus is removed.
- Self-control strategies view smoking as a learned
habit associated with specific situations.
- There are many benefits of quitting smoking (see Figure
8.2).
- The body begins to repair itself within hours of
quitting.
- Carbon monoxide and oxygen levels return to
normal.
- Within days, mucous which is clogging airways is
broken up and eliminated.
- Within ten smoke-free years, an ex-smoker can expect
to live out his or her normal lifespan
- Risks for several cancers, and several types of
heart disease drop considerably as well.
Caffeine
- Caffeine is the most popular and widely consumed drug
in the US.
- Caffeine is a drug derived from the chemical family
called xanthines.
- Xanthines are mild CNS stimulants.
- Levels of caffeine vary in beverages.
- Chronic caffeine use and its attendant behaviors is
called caffeinism.
- Withdrawal from caffeine if you are addicted will
cause a severe headache.
- Caffeinism meets the requirements for addiction.
- No strong evidence exists to suggest that moderate
caffeine use (about 5 cups of coffee) produces harmful effects in healthy,
nonpregnant people.
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