Substance Abuse, Part I Alcohol AbuseAlcoholism: Definitions

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Substance Abuse, Part IAlcohol Abuse/Alcoholism
Definitions

• BCE 548
• Meeting 10
• March 24, 2003

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Alcohol

• There are several different types of alcohol.
• Ethyl Alcohol (ethanol, grain alcohol)
  C2H5OHAlcoholic Beverages
• Methyl Alcohol (Wood Alcohol, Methanol, Carbinol)
  CH3O3
• Isopropyl Alcohol (Rubbing Alcohol) (CH3)2CHOH
• Denatured Alcohol Ethyl Alcohol with certain
  additives extremely poisonous
• Many others

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Alcohol and Metabolism

• Alcohol is not digested normally
• Small amount passes to blood directly through
  stomach lining remainder is absorbed through the
  small intestine.
• Removed through oxidation (combination of alcohol
  with oxygen) where it is converted to water and
  carbon dioxide and removed from the body.
• Primary site of oxidation is the liver (rate of
  one ounce of 100 proof alcohol per hour).

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Specifics of Alcohol Metabolism

• Ethanol gt mostly to liver gt Alcohol Dehydrogenase
• Alcohol Dehydrogenase gt Acetaldehyde (highly
  toxic)
• Acetaldehyde gt Acetaldehyde Dehydrogenase
• Acetaldehyde Dehydrogenase gtAcetic Acid
• Acetic Acid gt Small Amount of Acetate, Carbon
  Dioxide, Water
• Carbon Dioxide and Water absorbed or excreted
  Acetate becomes ketones in the body cells, stored
  as energy, burned, or passed.

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Effects on Body Organs

• Liver Disease Alcohol gets VIP treatment is
  metabolized before other substances, esp. fats.
• Fat deposits in liver (acute fatty liver)
• Eventually leads to swelling of liver (alcoholic
  hepatitis)
• Death of liver cells begins, but can be
  reversible (fibrosis, replacement of dead liver
  cells with connective tissue)
• Final stage of liver disease Cirrhosis,
  irreversible destruction of liver tissue.

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Other Physical Effects of Alcohol Abuse

• Gouty Arthritis
• Nervous system disorders (neuropathy dementia)
• Cancer Risk (liver, pancreas, rectum, breast,
  mouth, pharynx, larynx and esophagus).
• Heart disease (heavy drinkers) increased blood
  pressure, higher lipid levels.
• Malnutrition Difficulty with absorbing or
  retaining various minerals, vitamins, and
  nutrients.
• Brain Damage (Korsakoffs Psychosis)

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Effect of Alcohol on the Brain

• Central Nervous System Depressant (classified as
  a sedative-hypnotic) essentially, it numbs the
  brain.
• First effects are in the higher centers of
  functioning (toward the front and top of the
  brain) moving backward and downward as alcohol
  builds up in the system (get drunker)
• 1) Frontal Lobe Inhibitions, talkativeness,
  caution, reason, sociability, intelligence.
• 2) Temporal/Parietal Lobe Fine motor skills,
  reaction time, shaking, slurred speech, impaired
  hearing.
• 3) Occipital Lobe Vision, judging distance.
• 4) Cerebellum Coordination and balance
• 5) Brain Stem Vital functions

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How Much to What Effect?

• Varies according to body size gender age
  tolerance.
• Blood alcohol content ()
• 0.01-0.05 (Subclinical) No observable
  disturbances.
• 0.03-0.12 (Euphoria) Relaxed inhibitions,
  increased self-confidence, sociability, feeling
  high
• 0.09-0.25 (Excitement) Emotional instability,
  loss of critical judgment, visual deficits,
  impaired balance and coordination, drowsiness.
• 0.18-0.30 (Confusion) Disorientation,
  exaggerated emotions, increased pain threshold,
  slurred speech, apathy, lethargy, greater loss of
  coordination/problems with vision.
• 0.25-0.40 (Stupor) Unresponsive to stimuli, near
  total loss of motor activity, inability to
  stand/walk sleep/stupor.
• 0.35-0.50 (Coma) Unconscious decreased body
  temperature, problems with respiration/circulation
  incontinence possible death.
• 0.45 (Death) Death from respiratory collapse.

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Alcohol Use/Misuse Abuse/Dependence
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Alcohol Use/Misuse

• Alcohol is a legal drug.
• At least half the population uses alcohol on a
  somewhat regular basis more imbibe on a social
  basis during special occasions.
• Use of alcohol on an occasional basis, even to
  the point of impairment in certain circumstances,
  is not necessarily a clinical concern.
• Misuse of alcohol The use of alcohol in a
  situation that can lead to hazard to ones self
  or others (100,000 deaths per year linked to
  alcohol use, untold cases of disability).

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Alcohol Abuse

• Maladaptive patterns of use, leading to one or
  more of the following in a 12-month period
• Failure to fulfill major work, school, or home
  obligations.
• Recurrent misuse of alcohol (drunk driving,
  machine operation when drinking).
• Repeated arrests (DUI, Disorderly Conduct)
• Continued use of alcohol despite strains on
  social or interpersonal relationships.

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Alcohol Dependency

• Symptoms
• Tolerance The need to increase intake to achieve
  desired effect.
• Physical Withdrawal Symptoms Discomfort, shakes,
  sweating, nausea, anxiety upon cessation of use
  sometimes having an eye-opener hair of the
  dog.
• Extended use of alcohol or drinking more than was
  planned.
• Unsuccessful desire/effort to control drinking
• Preference for activities including alcohol to
  the detriment of other activities or
  responsibilities
• Continued use of alcohol despite knowledge of
  problems.

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Lexicon of Other Alcohol-Related Terms

• Bender An extended period of intoxication,
  lasting for days, weeks or months.
• Binge Drinking Extreme, excessive use of alcohol
  over a short period.
• Blackout Inability to remember what happened for
  periods of time during intoxication.
• Brownout Inability to remember some, but not
  all, details of what happened during
  intoxication.
• Delirium Tremens (DTs) Severe physical
  withdrawal symptoms can be fatal.
• Eye-Opener A drink taken to relieve withdrawal
  symptoms.
• Pathological Intoxication Violent behavior when
  exposed to even a relatively small amount of
  alcohol.

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Alcoholism
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Alcoholism Defined

• A primary, chronic disease that is often
  progressive and can be fatal. The illness is
  characterized by continuous or periodic impaired
  control over drinking, preoccupation with the
  drug, use of alcohol despite adverse
  consequences, and distortions in thinking,
  including denial or the actual consequences
• American Society of Addition Medicine
• National Council on Alcoholism and Drug Dependence

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Prevalence of Alcholism

• As many as 7 of the population are problem
  drinkers (abusers)
• About ¾ of these are alcoholic.
• Men more prevalent (41) may be due to lack of
  visibility, other causes.

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Stages of Alcoholism

• Jellineck (1952) Four Stages
• Prealcoholic Social drinking with occasional
  heavy drinking to relieve stress.
• Prodromal Loss of memory of events during
  intoxication (blackouts) guilt preoccupation
  with next drink. Alcohol becomes a drug rather
  than a beverage.
• Crucial Alcohol use becomes apparent to others,
  begins to interfere with social/vocational
  adjustment. May neglect personal care,
  nutrition. First bender. May consume alcohol
  even when nauseous. May have severe withdrawal
  symptoms (Delirium Tremens)
• Chronic Person lives to drink. Body must have
  alcohol to functionmay drink hair tonic,
  mouthwash if liquor not available. Self-esteem
  is lost. Personal care severely neglected.
  Eventually stops caring about anything other than
  alcohol.

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Stages of Alcoholism-Another View

• Early Stage
• Alcohol is a coping device to relieve tension
  and escape problems. The alcoholic drinks more
  and more to achieve the same effect and has
  trouble stopping. The alcoholic promises to quit
  but never does.
• Middle Stage
• The drinker cannot get through the day without
  alcohol and has the "shakes." The alcoholic
  manipulates others, lies about drinking and
  drinks in secret or hides alcohol. It is harder
  to get the same effects as tolerance increases.
  Physical and psychological problems begin and
  the alcoholic denies the problem.
• Late Stage
• The alcoholic lives to drink and avoids and
  distrusts others. Ambition and the power to cope
  with life is lost. The drinker is absent from
  work. Severe physical and psychological effects
  begin. If drinking stops, there are severe
  withdrawal reactions.
• - National Institute on Alcohol Abuse and
  Alcoholism

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Etiology of Alcoholism

• No single cause.
• Genetics Son of alcoholic father four times more
  likely to develop alcoholism than child of
  nonalcoholic father (twin studies).
• Women also more likely to develop alcoholism with
  alcoholic parents.
• Similarities in brain-wave patterns of children
  of alcoholics to alcoholic parent.
• Culture/Socialization Some cultures show more
  prevalence for alcoholism than others some have
  extremely low incidence of alcoholism.

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Physiology and Metabolism The THIQ Hypothesis

• Tetrahyroisoquinolone (THIQ for short) is a
  chemical that is a by-product of the metabolism
  of heroin and other opiates. Created in the
  brain, it acts as a neurotransmitter, causing
  physical cravings for more of the substance.
• It never leaves once deposited only detectable
  through brain biopsy.
• Texas pathologist (Virginia Davis) examining
  brains of those who donated their bodies to
  science noticed significant amounts of THIQ in
  the brain on autopsy (1950s).
• Theory is that some persons have a defective
  metabolism of alcoholthe brain creates THIQ as a
  byproduct. These individuals develop alcoholism.
• Theory is not universally acceptedwould explain
  a number of things (genetic influences, why some
  people become addicted to alcohol, why alcoholism
  is treatable but not curable).
• See http//home.usit.net/rfhale/thiq.htm for
  more information

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Assessing Alcoholism Clinical Signs

• Red flags for ASSESSMENT
• Sensitivity to light
• Flushed face
• Unsteady gait
• Odor of alcohol
• Tearfulness
• Irritability
• Agitation
• Angry outbursts
• Difficulty concentrating
• Improper hygiene or self care

• Red flags for SUSPISCION
• Preoccupation with death
• Thoughts of suicide
• Self-destructive behavior
• Hostility
• Problems with authority
• Isolation
• Depressed Demeanor
• Withdrawn Affect

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Alcoholism Tests

• See http//home.usit.net/rfhale/testpage.htm
• Approaching Alcoholism with client you suspect of
  having a drinking problemThe CAGE method
• Ask the following questions
• Have you ever tried to Cut down on your drinking?
• Do you get Annoyed when people talk about your
  drinking?
• Do you feel Guilty about your drinking?
• Have you ever had an Eye-Opener