Alcohol

1
Alcohol
2
Alcohol Consumption Statistics

• Percent of Americans who consume alcohol
• 60 (CDC)
• Across globe, consumption varies dramatically
• Greenfacts.org chart

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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)

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Alcohol Consumption

• Uganda
• Regulations to Reduce Alcoholism (YouTube)
• Advertisement Uganda waragi (YouTube)

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Burden of Disease Attributable to Alcohol

• Mild intoxication
• More severe alcoholism, liver cancer, esophageal
  cancer, cirrhosis, homicide, motor vehicle
  accidents
• Incidence across the world (WHO via reuters.com)

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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

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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
• When fermenting solution reaches 15 alcohol,
  yeast is killed
• So, 15 alcohol is highest natural alcohol
  content
• Video How Stuff Works Fermentation

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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 animals (YouTube)
• Hard Liquor distillation
• 40-50 alcohol solution

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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)

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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

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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

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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)

13
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

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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

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Alcoholism

• Among the most common psychiatric disorders
• Symptoms recurrent intoxication, mood swings,
  anxiety, hallucinations, GI distress, unsteady
  gait, erectile dysfunction, blackouts

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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

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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

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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

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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

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Pharmacology for Alcoholism

• Acamprosate
• Used extensively in Europe
• FDA approved in 2004
• Improves abstinence rates

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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

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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

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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

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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

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Alcoholism Resources

• Washington Recovery Line
• 866-789-1511
• 206-461-3219 (TTY)
• Teen Link
• 866-TEENLINK
• Alcohol/Drug Help Line
• 206-722-3700
• 800-562-1240 (WA)