Alcohol

Alcohol Support Services

• Washington Recovery Line: 1-866-789-1511

• Teen Link: 866-TEENLINK (866-833-6546)

• Crisis Clinic: 206-461-3222/1-866-427-4747

• Alcoholics Anonymous: 206-587-2838

• Alanon & Alateen: 206-625-0000

• Adult Children of Alcoholics: 425-213-3919/ 1-800-562-1240

• Substance Abuse & Mental Health Services Administration Facility Locator

Alcohol Consumption Statistics, U.S.

• % of adult Americans consuming alcohol regularly (1 per month)

• 51% (CDC, 2012)

• Percent of adult infrequent drinkers

• 13% (CDC, 2012)

• Binge drinking, 4/month, 8 drinks (CDC, 2012)

• 1 in 6 adults• 2.28 gallons/person (NIAAA, 2011)

Alcohol Consumption Statistics, World

• Percent of population, 15+ years who consumes alcohol

• 38% (WHO, 2014)

• (found conflicting information on amount consumed/person)

• 3.3 million deaths (WHO, 2014)

• Across globe, consumption varies dramatically (WHO, 2011, via fasdprevention)

– Greenfacts.org: chart (via 2004 WHO statistics)

Alcohol Consumption

• Type of alcohol also impacts consumption variation across world

• Top 20 countries with highest beverage-specific adult per capita consumption (Green Facts.org, via WHO 2004 statistics)

• Global Status Report on Alcohol and Health (WHO, 2014)

Burden of Disease Attributable to Alcohol

• Mild: intoxication• More severe:

alcoholism, liver cancer, esophageal cancer, cirrhosis, homicide, motor vehicle accidents

• WHO: 5.1% of global burden

• Incidence across the world (WHO via reuters.com)

Direct Alcohol Impact on Kids

• Alcohol Cost Calculator for Kids

• Population estimates for individuals aged 12-20 years

Source: Ensuring Solutions to Alcohol Problems, with data from National Survey on Drug Use and Health

Alcohol Formation

• Alcohol available for thousands of years• Created from natural fermentation process

– Yeast consumes a form of sugar/grain/fruit

– Products are alcohol and carbon dioxide

– Different sugars yield different alcohol forms

– Yeast is killed when fermenting solution accumulates enough alcohol to kill yeast

– Alcohol percentage depends on the yeast (& on manufacturer), 5-20%

– Video: Short animation of concept (Vimeo)

– Video: How Stuff Works: Fermentation

Alcohol Forms

• Beer and Ale: fermented cereal grains and malt– 3-8% alcohol content

• Wine: fermented grapes and other fruits– 9-15% alcohol content– Marula fruit – impact on animals in Africa

(YouTube)

• Hard Liquor: distillation– 40-50% alcohol solution

Distillation

• Used to separate alcohol from water

• Alcohol has lower boiling point than water– Alcohol evaporates into tube

– Cold water cools alcohol

– Alcohol collects in flask

• Animation (TutorVista, via YouTube)

• Animation #2 (no narration, 20to9.com via YouTube)

• Cognac distillation (cognac.fr)

Distilled Spirits

• Whiskey– Corn, rye, barley

• Rum– Molasses, sugar cane

• Brandy– Fruit juice/wine

• Gin– Rye/other grains– Addition of berries

• Tequila– Agave plant

• Vodka– Potatoes, rye, corn

Alcohol “Proof”

• Story of “proof”– Alcohol and water solution– Added to gun powder– If gun powder could ignite/pop, it was “proof”

solution contained ~50% alcohol

• Today, “proof” refers to alcohol content– The proof equals double the alcohol percentage– 40% alcohol = 80 proof

Alcohol Absorption

• Alcohol absorbed throughout GI tract– Some from stomach– Most from small intestine

• When food or other liquid present, absorption takes longer

• Carbonation speeds up absorption

• The path of alcohol in the body (SCRAM-x)

• Alcohol and the Brain (YouTube via TuneInNotOut; 2:52-5:42)

Alcohol Metabolism

• Metabolism = breakdown• Liver breaks down most of

alcohol• Alcohol broken down into

acetaldehyde– Acetic acid

• Carbon dioxide & water

• Metabolism = ~one drink/hour

• Caffeine, exercise, water do not change process

• Men metabolize faster

Alcohol Metabolism

• Gender differences– Females metabolize

alcohol slower than males

– Males have more muscle, so more water

– Alcohol dissolves in water

• Alcohol metabolism news feature (YouTube, 0:41-4:47)

Blood Alcohol Concentration (BAC)

• The amount of alcohol present in 100 ml of blood– .05 = .05 grams of alcohol per 100 ml of blood– .05 does not equal 5%, but .05%

• Intoximeters Drinking Wheel

• Stages of Alcohol Intoxication

Alcohol: Acute Effects

• Alcohol effects on brain (Vimeo, Sam Scopelliti)

• Results: similar to those in stages of intoxication, previous slide

Alcohol: Chronic EffectsImage below created by Mikael Haggstrom and is in the public domain

Alcoholism

• Among the most common psychiatric disorders

• Symptoms: recurrent intoxication, mood swings, anxiety, hallucinations, GI distress, unsteady gait, erectile dysfunction, blackouts

World Alcohol Dependence

• Difficult to accurately determine– Different ways of collecting data– Interpretation of dependence– Age cut-off for assessment varies across

countries– Data collected at different times– Alcohol dependence over lifetime vs last year

Source: WHO Global Status Report 2004

World Alcohol DependencePercent of Adult Population

• USA: 7.7% (male = 10.8%; female = 4.8%)• Poland: 12.2% (23.3%/4.1%)• Ethiopia: 1.0% (1.9%/0.1%)• Belgium: 7.0% (9.5%/3.6%)• Peru: 10.6% (17.8%/4.3%)• Singapore: 0.6% (1.1%/0.2%)• Japan: 4.1% (8.4%/0.7%)

Source: WHO Global Status Report 2004

Pharmacology for Alcoholism

• Variety of pharmacotherapies

• Antabuse has been used for decades– Blocks conversion of

acetaldehyde– When Antabuse taker

consumes alcohol, he/she becomes very ill

– No action on craving– Can be used as

supplemental treatment to other medications

Pharmacology for Alcoholism

• Naltrexone (ReVia)– Prevents relapse of drinking– Reduces craving– Thought to block opioid

system, involved with alcohol craving

– Side effects include nausea, anxiety, liver problems

– Video: YouTube

• Vivitrol-injectable version– Video: YouTube

• FDA approved

Pharmacology for Alcoholism

• Acamprosate– Used extensively in

Europe

– FDA approved in 2004

– Improves abstinence rates

Pharmacology for Alcoholism

• Acamprosate– Mechanism is not fully understood

• May target specific neurotransmitter systems (GABA & glutamate)

• Reduces PAWS (post acute withdrawal syndrome)– Anxiety– Mood swings– Fatigue– Sleep problems

Source: Substance Abuse and Mental Health Services Administration

Pharmacology for Alcoholism

• Ondansetron (Zofran)– Has been used to treat

nausea in chemotherapy patients

– Reduces alcohol consumption

– Improves abstinence among early-onset alcoholism

– Works with serotonin in brain to reduce craving

– YouTube video– Not yet FDA approved

Pharmacology for Alcoholism

• Nalmefene– Has been used for epilepsy– Blocks pleasure associated

with drinking– Can prevent relapse– Blocks more opioid

receptors than naltrexone– Used to reduce drinking

behavior (Naltrexone - maintain abstinence)

– Injectable, not yet FDA approved

Pharmacology for Alcoholism

• Topimirate (Topamax)– Has been used for epilepsy,

mood disorders– Reduces cravings– Works on dopamine

receptors– Reduces heavy drinking;

2008 study showed reduction in blood pressure, BMI, blood cholesterol

– Increased risk for cleft lip/palate among pregnant women using Topamax