Alcohol

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					Alcohol
                   History of Use
   oldest and most widely used drugs
       natural process, predates human history
       referenced in bible, Egyptian pictograms
       oldest known recipe is for beer
       always been part of American culture
   Prohibition
       1920-1933
       alcohol consumption did not decrease permanently
       crime related to alcohol increased drastically
                              Facts
                       Types of alcohol

   methyl alcohol (methanol)
          Wiper fluids, paint thinners, etc. - extremely poisonous
   isopropyl alcohol (isopropanol)
          Rubbing alcohol - poisonous
   ethyl alcohol (ethanol).
                              Facts

   Ethanol
     C(2)H(5)OH




       clear, relatively odorless liquid that is infinitely
                        mixable in water.
                                Facts

   usually produced by fermenting cereals/fruit
       yeast, water, and sugar → yeast recombines carbon,
        hydrogen, oxygen, and water to form alcohol and
        carbon dioxide
       different sources of sugar for different alcohols
            wines use fruit, fermentation goes naturally to 10-20%
             alcohol concentration
            beers uses cereals, fermentation is stopped at 3-6 %
            spirits can have between 50- nearly 100%
                          Facts

   Percent of alcohol by volume is ½ the listed
    proof
       e.g. 80 proof = 40% v/v (volume of alcohol per
        volume of solution)
   5-ounce glass of wine (12% v/v), a 12-ounce
    beer (4.9% v/v) and 1½ ounces (shot or mixed
    drink) of 80 proof spirits each contain the same
    amount of absolute (100%) ethanol
            Drug Classification
   Alcohol is not controlled by the Drug
    Enforcement Administration, therefore not
    classified, however ...
                 Extent of Use
   54.9% of adults reported drinking alcohol in the
    past month
   Americans spend over 90 billion dollars on
    alcohol each year
   overall per capita consumption has increased
    between 2000 and 2004
                    Extent of Use
                           Abuse

   Binge drinking: 5+ drinks on one occasion
       3 adult drinkers in the United States report past-
        month binge drinking
       2001: approximately 1.5 billion episodes of binge
        drinking
                     Extent of Use
                            Abuse
   Heavy drinking: 2+ drinks per day
       5.9% of adults reported heavy drinking in past 30 days
       15 mil. Americans are dependent on alcohol; 500,000
        are between the age of 9 and 12
       43% of Americans have been exposed to alcoholism
        in their families
       total cost of alcohol problems is $175.9 billion a year
        (compared to $114.2 billion for other drug problems
        and $137 billion for smoking)
                 Extent of Use
                Underage Drinking

   In 2003, 44.9% of 9th
    through 12th graders
    reported drinking alcohol
    in the past month
   28.3% of 9th through
    12th graders reported
    binge drinking during the
    past months
                    Extent of Use
                      Drunk Driving
   159 mil. adults reported driving
    under the influence of alcohol in
    2004
   In 2000, there were 85,000 deaths
    attributable to excessive/risky
    drinking
   16,694 people where killed in alcohol
    related traffic accidents in 2004
   Alcohol-related motor vehicle
    crashes kill someone every 31
    minutes and injure someone every
    two minutes
   Alcohol related crashes cost around
    $114 billion/year
               Effects of Alcohol
                     Physiological
1. Mouth: alcohol enters body
2. Stomach: some alcohol gets
into bloodstream
3. Small Intestine: alcohol enters
the bloodstream through the
walls of the small intestine
4. Heart: pumps alcohol
throughout the body
5. Brain: alcohol reaches brain
6. Liver: alcohol is oxidized by
the liver
                Effects of Alcohol
                    Physiological
   Liver: alcohol dehydrogenase breaks down
    alcohol
       Alcohol dehydrogenase oxidizes alcohol to
        acetaldehyde
       Acetaldehyde dehydrogenase oxidizes the
        acetaldehyde to acetyl CoA
       eventually alcohol is converted to carbon dioxide
        and water
   The liver can metabolize about ½ ounce of
    ethanol per hour (depending on body size, food
    intake, etc.).
          Effects of Alcohol
               Physiological
   Arthritis           Kidney Disease
   Cancer              Liver Disease
   Fetal Alcohol       Malnutrition
    Syndrome            Nervous
   Heart Disease        Disorders
   Hyperglycermia      Obesity
   Hypoglycemia        Psychological
                         Disorders
                Effects of Alcohol
                     Neurochemical
   The GABA-benzodiazepine receptor complex
       Very important inhibitory receptor type for
        mammals
       Gamma aminobutyric acid (GABA) opens up ion
        channels, lets in Cl ions
       Hyperpolarization occurs (less chance for action
        potential)
               Effects of Alcohol
                     Neurochemical
   Alcohol’s impact on GABA processing
       Alcohol binds to GABA-benzodiazepine receptor
        following consumption
       Then, once GABA also binds to the receptor, more
        Cl ions are admitted through than without the
        alcohol.
                Effects of Alcohol
                     Neurochemical
   Consequences and dependency
       Certain cognitive functions are sedated
       The brain will become dependent on alcohol for
        neural inhibition
                Effects of Alcohol
                   Neurochemical
   glutamate and the N-methyl-D-aspartic acid
    (NMDA) receptor
     glutamate action on NMDA receptors is excitatory;
      it increases the activity of brain neurons
     alcohol inhibits the NMDA receptors

     decrease in excitatory actions of glutamate
                Effects of Alcohol
                     Neurochemical
   Triggers apoptosis
       Very dangerous during synaptogenesis, and explains
        the brain damage associated with FAS
       Connected to alcohol’s NMDA antagonist and
        GABAmimetic properties
               Effects of Alcohol
                  Neurochemical
    also affects the synthesis and receptors of
    opioid peptides, which are responsible for
    euphoria and anesthesia
   Increased turnover of norepinephrine and
    dopamine
   Decreased transmission in acetylcholine systems
   Increased production of beta-endorphin in the
    hypothalamus
                 Effects of Alcohol
                  Psychological
   Alcohol dependency
       Tolerance and Withdrawal
       Alcohol use for longer periods than intended.
       Desire and/or unsuccessful efforts to cut down or
        control alcohol use
       Considerable time spent obtaining or using alcohol,
        or recovering from its effects
       Important social, work, or recreational activities
        given up because of use
       Continued use of alcohol despite knowledge of
        problems caused by or aggravated by use
               Effects of Alcohol
                    Psychological
   Short term effects: anxiety, restlessness, slowed
    heart and respiratory rates, blurred vision and
    poor motor coordination
   Long term effects: cirrhosis, cancers, cardiac
    diseases, skin diseases, gastritis and sexual
    dysfunction, irreversible neurological and
    psychological health conditions
               Effects of Alcohol
                    Psychological
   Other effects: sleep disturbance, academic
    disruption, and verbal, physical or sexual
    violence, interpersonal and environmental
    problems, such as traffic accidents, physical and
    sexual violence, property damage, family
    problems and divorces
   Nearly 40% of admissions to mental hospitals
    and 50% of arrests are alcohol-related
                           Treatments
   Active Ingredients of Effective Alcohol
    Treatment
       Early detection, including screening and brief interventions
       Comprehensive assessment and individualized treatment plan
       Care management
       Individually delivered, proven professional interventions
       Contracting with patients
       Social skills training
       Medications
       Specialized services for medical, psychiatric, employment or family
        problems
       Continuing care
       Strong bond with therapist or counselor
       Longer duration (for alcohol dependent persons)
       Participation in support groups
       Strong patient motivation
                         Treatments
   Antabuse
       blocks the oxidation of alcohol at the
        acetaldehyde stage resulting in increased
        concentration of acetaldehyde
       Accumulation of acetaldehyde produces
        unpleasant symptoms: flushing, throbbing in
        head and neck, throbbing headache,
        respiratory difficulty, nausea, copious
        vomiting, sweating, thirst, chest pain,
        hyperventilation, tachycardia, hypotension,
        marked uneasiness, weakness, vertigo,
        blurred vision, and confusion
       psychological effectiveness through
        conditioning
               Treatments

   Naltrexone
       blocks effects of alcohol by competing for opioid
        receptors in the brain
       reduces craving, helps patients remain abstinent,
        interferes with the tendency to want to drink more if
        a recovering patient slips and has a drink
       Significant reduction in drinking, well tolerated
                     Treatments

   Alcoholics Anonymous
       Patient must first “hit bottom” before anything can
        be done
       Functions as a hub for wisdom and support
       Spiritual and social as opposed to biochemical
        techniques
                Drank too much?
   Formal name for hangover:
    veisalgia
    Norwegian word for “uneasiness
    following debauchery” (kveis)
    and Greek word for “pain” (algia)
   75% of alcohol consumers have
    experienced a hangover at least
    once
   15% have one every month
   25% of college students feel
    symptoms weekly
           Symptoms of hangover
   Headache                         Nausea
   Poor sense of overall            Fatigue
    well-being                       Difficulty sleeping and
   Sensitivity to light, sound       concentrating
   Diarrhea                         Dehydration
   Loss of appetite                 Anxiety weakness
   Trembling                        Increased heart rate and
                                      blood pressure
         What causes a hangover?
 Dehydration
   Causes pituitary gland in brain to block creation of
    vasopressin
   Vasopressin increases water reabsorption in the kidneys
   Without vasopressin, kidneys send water straight to
    bladder, increasing urination
   Study: 250 mL of alcoholic beverage causes body to
    expel 800-1000 mL of water. Aftereffects help create
    hangover
                   Dehydration

   Headaches: result of dehydration. Organs need more
    water and take it from brain (blood vessels dilate)
   Frequent urination secretes salts and potassium which
    are necessary for nerve and muscle function
   Low levels can result in fatigue, nausea, headaches.
   Alcohol breaks down glycogen in the liver. Turns it into
    glucose and secretes it via urine (causes weakness)
                   Congeners
   Definition: toxic chemicals created during
    alcohol fermentation process
   Give flavor, smell and appearance to alcohol
   Greatest amounts found in red wine and dark
    liquors
   White wine, and clear liquors: less congeners,
    less frequent and less severe hangovers
   Combining alcohols mixes the various
    congeners causing very severe hangover
                Acetaldehyde
   When alcohol dehydrogenase breaks down
    alcohol in the liver, ACETALDEHYDE is
    formed
   Acetaldehyde attacked by acetaldehyde
    dehydrogenase and GLUTATHIONE is formed
   Acetaldeyhyde dehydrogenase and glutathione
    form nontoxic acetate.
   Process works well if only few drinks consumed
   BUT…
…What happens when you drink alot?
   Liver runs out of glutathione quickly
   Toxic acetaldehyde builds up in body as liver
    rushes to produce more glutathione
   Men have more acetaldehyde dehydrogenase
    and glutathione than women
             Glutamine Rebound
   Alcohol inhibits glutamine (natural body stimulant)
   When drinking stops, body tries to make up for lost
    time by producing more glutamine than it needs
   Increase in glutamine stimulates brain while person tries
    to sleep (prevents deep sleep, contributes to fatigue)
   Can also be responsible for tremors, restlessness,
    increased blood pressure and anxiety
                     And…
   Alcohol absorbed directly through stomach,
    stomach cells become irritated.
   Promotes secretion of HCl which can send the
    signal to the brain to vomit (can reduce
    hangover symptoms)
   HCl levels can lead to diarrhea and loss of
    appetite
How to prevent/remedy hangovers?
   Fried or fatty foods before drinking (stick to
    stomach longer and slow down absorption of
    alcohol)
   Eggs the morning after (energy, contain lots of
    cysteine that breaks down hangover-causing
    toxin acetaldehyde)
   Bananas the morning after (lost electrolytes,
    replenishes potassium)
                How else?

   Water: fights dehydration, and dilute
    byproducts of stomach (adding salt and sugar to
    water helps too)
   Drinking glass a water for each alcoholic
    beverage slows down drinking, giving body
    more time to break down alcohol
   Fruit juice the morning after (replenishes
    vitamins, increases energy, increases rate that
    body expels toxins)
                     Painkillers?

   Tylenol contains acetaminophen which your
    liver metabolizes and in combo with alcohol can
    cause release of a toxic metabolite
   Can cause liver damage over time
   Non-caffeinated, acetaminophen free painkillers
    are better to use (aspirin)