Alcohol:

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• Chapter 9
• Alcohol
• Social Beverage/Social Drug

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THREE BASIC CATEGORIES OF ALCOHOLIC BEVERAGES

• Beer --- approximately 4.5 percent alcohol
• Wine --- approximately 12-14 percent alcohol
• Distilled spirits (liquor) --- approximately 40
  to 50 percent alcohol

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METHODS OF PRODUCING ALCOHOLIC BEVERAGES

• Fermentation --- the process of making wine,
  converting natural sugars into ethyl alcohol by
  the action of yeasts
• Brewing --- the process of making beer from
  barley grain
• Distillation --- the process of making liquor, by
  boiling a fermented liquid then cooling it, to
  produce a higher alcohol content

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SOURCES OF DISTILLED SPIRITS

• Brandy --- grapes, cherries, other fruits
• Rum --- sugar cane or molasses
• Scotch --- corn and barley malt
• Bourbon --- corn
• Gin --- many grains, flavored with juniper
• Vodka --- pure alcohol diluted with water
• Tequila --- juice of the maguey plant

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HIGHLIGHTS IN THE HISTORY OF ALCOHOL

• 3700 B.C --- Egypt First official brewery
• 1700 B.C. --- Babylonia First reference to wine
• Middle Ages --- Salerno, Italy First documented
  distillation of alcohol (as brandy)
• 1750 --- Gin epidemic in English cities
• 1830 --- Alcohol consumption peaks in U.S.
• 1920 --- National Prohibition of alcohol begins
  in U.S.

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ALCOHOLIC BEVERAGES AND ALCOHOL EQUIVALENCIES

• 1 five-ounce glass of wine
• 5 x 0.12 0.60 oz alcohol
• 1 twelve-ounce beer
• 12 x 0.045 0.54 oz alcohol
• 1 1.5-ounce shot of 80-proof liquor
• 1.5 x 0.40 0.60 oz alcohol
• 1 twelve-ounce bottle of wine cooler
• 12 x 0.05 0.60 oz alcohol

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STANDARD ALCOHOLIC DRINKS

• 1 five-ounce glass of wine
• 1 twelve-ounce can of beer
• 1 1.5-ounce shot of liquor
• 1 twelve-ounce bottle of wine cooler
• ALL OF THE ABOVE CONTAIN ROUGHLY EQUIVALENT
  AMOUNTS OF ALCOHOL

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WHAT IS A STANDARD DRINK?
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WHAT IS A STANDARD DRINK?
Kaskutas and Graves (2000) found that African
American women commonly poured themselves
drinks that contained up to six times the
amount defined as a standard serving (12g
alcohol). Banwell (1999) reported that the
average serving for a glass of wine in Melbourne
bars was 180mL, not 100mL as defined both in
surveys and by health promoters in Australia. 4
British pints of beer (16g ethanol each), 5 US
bottles of beer (1214g ethanol each), and 6
Australian middies of regular beer (10g ethanol
each) contain approximately the same quantity of
ethanol (60g).
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WHAT IS NORMAL DRINKING?
WHO (2000) threshold for consumption with medium
risk of acute adverse outcomes gt 60 g of alcohol
per day for men and gt 40 g of alcohol per day for
women. In the US, one standard drink e.g., 12
ounces of beer, 5 ounces of wine, or 1.5 ounces
of distilled spirits contains approximately 12
grams of alcohol.) Consumption with high risk
of adverse consequences gt 100 g of alcohol per
day for men and gt 60 g of alcohol per day for
women.
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DISPARITY OF ALCOHOL CONSUMPTION IN THE U.S.

• Imagine 10 people and 10 bottles of beer
• Three people drink nothing (non-drinkers)
• Five people split two bottles
• One person drinks two bottles
• One person drinks six bottles
• 20 of the U.S. population drinks 80 of the
  total alcohol consumed.

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VISUALIZING THE DISPARITY IN ALCOHOL CONSUMPTION
IN THE UNITED STATES
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TWO DEFINITIONS OF BINGE DRINKING

• Five drinks or more in a row for men
• Four drinks or more in a row for women
• An extended bout of drinking or other substance
  use (often lasting at least two days) in which
  the person neglects other activities in order to
  engage in this behavior

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BINGE DRINKING

• Global (2000) Canadian men and Swedish women had
  the highest percentages of drinkers who had
  engaged in heavy episodic drinking in the last 12
  months.
• Israeli men and women had the lowest percentages
  of heavy episodic drinking.
• Scandivnavia (2001) Danish men and women had the
  highest annual frequencies of consuming six or
  more drinks on one occasion, Norwegian men and
  Finnish women had the lowest frequencies.

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BINGE DRINKING

• EU (2002) people in the United Kingdom had the
  highest annual frequency of heavy drinking
  (drinking a bottle of wine or the equivalent on
  one occasion), and people in France had the
  lowest.
• EU vs US (2002) the number of days per month on
  which five or more drinks were consumed was
  almost twice as high in Germany as in the United
  States.

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BINGE DRINKING

• The lowest percentages of student binge
  drinkersapproximately 10 of all drinkers
  Lithuania, Greece, Slovak Republic, Portugal, and
  Romania.
• The highest percentages of binge drinkers -
  Poland, Ireland, the United Kingdom, and many
  northern countries (percentages of students
  bingeing at least three times per month ranged
  between 20 and 40).
• Bingeing, however, showed no significant
  association with the percentage of drinkers in a
  given country.

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OXIDATIVE BREAKDOWN AND ELIMINATION OF ALCOHOL

• Alcohol is broken down to acetaldehyde, via
  alcohol dehydrogenase
• Acetaldehyde breaks down to acetic acid, via
  acetaldehyde dehydrogenase
• Further oxidation results in oxygen, carbon
  dioxide, and calories of energy.

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Dark Side of Alcohol

• According to the National Institute on Alcohol
  Abuse and Alcoholism
• 14 million Americans meet standard criteria for
  alcohol abuse or alcoholism
• Alcohol plays a role in 1 in 4 cases of violent
  crime
• More than 16,000 people die each year in
  automobile accidents in which alcohol was
  involved
• Alcohol abuse costs more than 180 billion
  dollars a year

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Dark Side of Alcohol

• Heavy drinking can cause
• inflammation of the liver (alcoholic hepatitis)
• scarring of the liver (cirrhosis)
• increase blood pressure
• damage heart muscle (cardiomyopathy)
• linked with several cancers, particularly those
  of the mouth, throat, esophagus, colon, and
  breast

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ACUTE PHYSIOLOGICAL EFFECTS OF ALCOHOL

• LD50/ED50 ratio is approximately six.
• Increased heat loss in cold weather
• Swollen fingers and limbs
• Dehydration
• Increased likelihood of cardiac arrhythmia
• Reduction in REM sleep
• Risk of toxicity to fetus during pregnancy
• Adverse interactions with other drugs

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MAJOR ACUTE PHYSIOLOGICAL EFFECTS OF ALCOHOL

• Toxic reactions
• Heat loss and the Saint Bernard myth
• Diuretic effects
• Sleep effects
• Effects on pregnancy
• Drug-alcohol interactions
• Hangovers

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EMERGENCY SIGNS OF ACUTE ALCOHOL INTOXICATION

• Stupor or unconsciousness
• Cool or damp skin
• Weak, rapid pulse (more than 100 bpm)
• Shallow and irregular breathing
• Pale or bluish skin

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CALCULATING BLOOD-ALCOHOL CONCENTRATION LEVELS
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ACUTE BEHAVIORAL EFFECTS OF ALCOHOL

• Blackouts
• Impaired driving skills, eye-hand coordination
• Increased tendency toward violence and aggression

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TECHNOLOGICAL ASSISTANCE IN REDUCING DRUNK DRIVING
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DWI BLOOD-ALCOHOL CONCENTRATIONS IN VARIOUS
COUNTRIES
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HEALTH BENEFITS OF ALCOHOL CONSUMPTION

• Increases HDL cholesterol, reducing risk of heart
  disease
• Reduces risk of diabetes mellitus
• Reduces risk of stroke
• Reduces risk of dementia
• NOTE Benefits are associated with moderate
  levels of alcohol consumption only.

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HEALTH BENEFITS OF ALCOHOL CONSUMPTION

• American Heart Association, 1996, Thomas A.
  Pearson, MD, PhD
• The lowest mortality occurs in those who consume
  one or two drinks per day. In teetotalers or
  occasional drinkers, the rates are higher than in
  those consuming one or two drinks per day. In
  persons who consume three or more drinks per day,
  total mortality climbs rapidly with increasing
  numbers of drinks per day.

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HEALTH BENEFITS OF ALCOHOL CONSUMPTION

• More than 100 prospective studies show an inverse
  association between moderate drinking and risk of
  heart attack, ischemic stroke, peripheral
  vascular disease, sudden cardiac death, and death
  from all cardiovascular causes. The effect is
  fairly consistent, and corresponds to a 25-40
  reduction in risk.
• The connection also applies to those at high risk
  for cardiovascular disease - people with type 2
  diabetes and those with high blood pressure,
  angina (chest pain), a prior heart attack, or
  other forms of cardiovascular disease.

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HEALTH BENEFITS OF ALCOHOL CONSUMPTION

• Part of a national 1985 health interview survey
  showed that moderate drinkers were more likely
  than non-drinkers or heavy drinkers to be at a
  healthy weight, to get 7-8 hours of sleep a
  night, and to exercise regularly.

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GUIDELINES FOR RESPONSIBLE DRINKING

• Know how much you are drinking
• Choose beer or wine over liquor
• Drink slowly
• Dont cluster your drinking
• Eat something substantial before drinking
• Never drink alone
• Never drive a car after having had a drink