Alcohol

1
Alcohol
2
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

3
FactsTypes of alcohol

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

4
Facts

• Ethanol
• C(2)H(5)OH

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

5
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

6
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

7
Drug Classification

• Alcohol is not controlled by the Drug Enforcement
  Administration, therefore not classified, however
  ...

8
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

9
Extent of UseAbuse

• 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

10
Extent of UseAbuse

• 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)

11
Extent of UseUnderage 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

12
Extent of UseDrunk 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

13
Effects of AlcoholPhysiological
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
14
Effects of AlcoholPhysiological

• 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.). 

15
Effects of AlcoholPhysiological

• Kidney Disease
• Liver Disease
• Malnutrition
• Nervous Disorders
• Obesity
• Psychological Disorders

• Arthritis
• Cancer
• Fetal Alcohol Syndrome
• Heart Disease
• Hyperglycermia
• Hypoglycemia

16
Effects of AlcoholNeurochemical

• 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)

17
Effects of AlcoholNeurochemical

• Alcohols 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.

18
Effects of AlcoholNeurochemical

• Consequences and dependency
• Certain cognitive functions are sedated
• The brain will become dependent on alcohol for
  neural inhibition

19
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

20
Effects of AlcoholNeurochemical

• Triggers apoptosis
• Very dangerous during synaptogenesis, and
  explains the brain damage associated with FAS
• Connected to alcohols NMDA antagonist and
  GABAmimetic properties

21
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

22
Effects of AlcoholPsychological

• 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

23
Effects of AlcoholPsychological

• 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

24
Effects of AlcoholPsychological

• 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

25
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

26
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

27
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

28
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

29
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

30
Symptoms of hangover

• Headache
• Poor sense of overall well-being
• Sensitivity to light, sound
• Diarrhea
• Loss of appetite
• Trembling

• Nausea
• Fatigue
• Difficulty sleeping and concentrating
• Dehydration
• Anxiety weakness
• Increased heart rate and blood pressure

31
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

32
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)

33
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

34
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

35
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

36
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

37
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

38
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)

39
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)

40
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)