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Alcohol - Clinical and Cultural Context Clinical and...

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Unformatted text preview: Clinical and Cultural Context Clinical and Cultural Context of Alcohol Dr Bergen­Cico Sociological Biological Psychological One Standard Drink: One Standard Drink: 12 ounces beer or wine cooler one 5­ounce glass of wine 1.5 ounces of 80­proof distilled spirits 8.5 ounces of malt liquor beverage (Zima, Hard Lemonade) What is proof: “Proof” is a measurement of the alcohol content in a beverage. 18th century test of alcohol content if alcohol ignited that was “proof” of sufficient alcohol content. Alcohol Content Alcohol Wine red, white, rose wine coolers Beer lager, dark ale light beer 12% 6% 6% 4% Hard Liquors whiskey, Scotch, vodka, whiskey, rum, gin, cognac, etc. amaretto, kahlua, etc. (Note: 100% alcohol = 200 proof) 40-43% 40-43% 28% What do you want and what do What do you want and what do you get from alcohol? Euphoria: Psychological feeling of well being, extreme happiness. Dysphoria: Opposite of euphoria; e.g. depression, anger, nausea, dizziness Alcohol’s Biphasic Effect Euphoria ­ Up Feeling Scale + Point of Diminishing Returns Cultural Myth About Alcohol 0 __ Dysphoria ­ Down After Tolerance Develops Time Effects of Alcohol Moderate Use • Disinhibition, sedation, mood swings • Blood vessel dilation, heat loss • CNS depression (heart, pulse, respiration) • Digestive irritation Heavy, Long-Term Use • Erratic behavior, blackouts • Nerve, liver, heart damage • Mental confusion, delirium • Impotence, fetal damage • Severe CNS depression, possibly death Blood Alcohol Concentration Blood Alcohol Concentration As a Function of Drinks Consumed and Time Taken to Consume Male 185 lbs. Hours 0 1 0.020 No. of 2 0.040 drinks 3 0.060 4 0.080 5 0.100 6 0.120 7 0.140 8 0.160 9 0.180 10 0.200 11 0.220 12 0.240 1 0.004 0.024 0.044 0.064 0.084 0.104 0.124 0.144 0.164 0.184 0.204 0.224 2 0.000 0.008 0.028 0.048 0.068 0.088 0.108 0.128 0.148 0.168 0.188 0.208 3 0.000 0.000 0.012 0.032 0.052 0.072 0.092 0.112 0.132 0.152 0.172 0.192 4 0.000 0.000 0.000 0.016 0.036 0.056 0.076 0.096 0.116 0.136 0.156 0.176 5 0.000 0.000 0.000 0.000 0.020 0.400 0.060 0.080 0.100 0.120 0.140 0.160 6 0.000 0.000 0.000 0.000 0.004 0.024 0.044 0.064 0.084 0.104 0.124 0.144 7 0.000 0.000 0.000 0.000 0.000 0.008 0.028 0.048 0.068 0.088 0.108 0.128 8 0.000 0.000 0.000 0.000 0.000 0.000 0.012 0.032 0.052 0.072 0.092 0.112 9 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.016 0.036 0.056 0.076 0.096 10 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 0.040 0.060 0.080 Level of Impairment vs. Blood Alcohol Concentration .00 Blood Alcohol Concentration Lowered inhibitions, feelings of relaxation Some loss of muscular coordination Decreased alertness Reduced social inhibitions Impaired ability to drive Slowed reaction time Clumsiness, exaggerated emotions Unsteadiness standing or walking Argumentative & often hostile behavior Slurred speech Severe intoxication Inability to walk without help Confused speech Incapacitated, loss of feeling Difficult to rouse Life-threatening unconsciousness Coma Death from lung & heart failure .50 Blood Alcohol Concentration 21 21 Alcohol & Muscle Function Alcohol & Muscle Function Diminishes Protein Synthesis ↓ muscle growth and development (HGH) ↓ HGH by ~ 70% ↓ recovery Disrupts H2O balance in muscles ↓ contraction Causes dehydration ↓ recovery Dehydration ↓ muscle performance by ~ 60% Alcohol & Nutrition Alcohol & Nutrition Reduces glucose – energy stored in muscle ~150 empty calories/ drink Body treats as fat & stores as fatty acids Inhibits absorption of Thiamin­ B1, B12, Folic Acid, Zinc Alcohol & Performance Alcohol & Performance ↓brain’s ability to store new info, ↓ new memories,↓ learning Hangover takes several hours to readapt to working in teams 5+ drinks affect brain and body for 3 days Sat ­ Tuesday 2 nights of 5+ drinks impact for 5 days Fri & Sat ­ Thursday College students drink more than College students drink more than their non­college peers Percent who consumed 5 or more drinks on a single occasion at least once in the previous 2 weeks 40% of college students (18­24) 35% same­age non­college peers (18­24) 31% among high school seniors Source Monitoring the Future Survey 2000 Alcohol Use in the United States Alcohol Use in the United States Compared to Level of Education Average Number of Drinks Per Week Listed by Grade Average Listed Grade Average A B C D or F or Drinks Per Week Males Female Overall Female Overall 5.4 7.4 9.2 14.6 2.3 3.4 4.1 5.2 3.3 5.0 6.6 10.1 10.1 College Core Study, Southern Illinois University at Carbondale College Alcohol Use Among College Students Drinking by college students results in: Drinking by college students results in: 1,400 student deaths 500,000 injuries 70,000 cases of sexual assaults/date rapes each year 8 million college students in the United States more than 2 million drove under the influence of alcohol over 3 million rode with a driver who had been drinking Source: National Institute on Alcohol Abuse and Alcoholism Task Force on College Drinking (2002) Alcohol: Social and Health Effects Alcohol: Total U. S. Drinking Deaths, 130,000 Drinking is involved in 40% of fatal car crashes 50% of all murders 20-36% of suicides 50% of sexual assaults/rapes 25-30% of admissions to hospitals World Health Organization Definition of World Health Organization Definition of Hazardous Alcohol Use In contrast to harmful use, hazardous use refers to patterns of use that are of public health significance despite the absence of any current disorder in the individual user (WHO, 1994, p. 41) Physical, mental health and social consequences Long-term physiological harm- dependence, malignancies, high blood pressure and stroke, coronary heart disease, (Edwards et al., 1994). Short-term and long term social consequences of drinking such as trauma have been quantified with some correlate of drinking (BAC/blood alcohol levels) Social consequence risk assessment is more difficult than it is for physiological harm, as social consequences are heavily influenced by external factors such as culture or drinking/drug use context. Governmental, quasi-governmental and professional bodies, use population rather than individual data (e.g. mortality, liver cirrhosis Rates of drinking/drug problems for populations vary considerably between different cultures –particularly for drinking problems that depend on culturally predicated expectancies of what is deemed acceptable drinking behavior. Social and physiological benefits and harms must be balanced against each other and consider the variability that exists within any given population. Worldwide Per Capita Alcohol Use vs. Incidence of Chronic Liver Disease Incidence Alcohol in Liters Alcohol of Pure Ethanol of Russia 14.5 liters Russia France 13.7 France Germany 13.8 Germany Italy 9.6 Italy United States 8.9 United Israel 1.8 Israel Cirrhosis Rate per 100,000 per N/A N/A 12.1 12.1 15.4 15.4 13.9 13.9 7.7 4.9 Thresholds for Hazardous Drinking Calculations of risk based on the individual-level relationship with a particular indicator of harm. Quantity/frequency and time period of consumption key to level of intoxication and risk Drinking context and other activities that accompany the drinking behavior (e.g. drinking and driving), cultural context [Psycho-Social] Gender Gender Individual traits such as gender, age, weight, overall health, predisposing factors, medication/other drugs [Bio-Psycho] Physiological difference in affect determinants for hazardous drinking between men and women Women - smaller size and body mass, less water, higher percentage of body fat content, lower levels of enzymes to metabolize alcohol Facial Features of Children with Fetal Alcohol Syndrome (FAS) Most official government-issued guidelines on drinking and pregnancy consider any drinking at all to be hazardous FAS Infant Brain FAS Normal Infant Brain Age Age Cardioprotective effects of moderate alcohol consumption noted for older men, post-menopausal women, Risk of acute social harm is greater for the young and inexperienced drinker than the risk for chronic health-related harm. Culture surrounding alcohol consumption, views as to whether and to what extent drinking among young people is appropriate. The age at which the risk diminishes is very much dependent on the prevailing cultural views of the country and legal drinking age . (ICAP, 1998). Predisposing Risks Predisposing Risks Genetic differences in race and ethnicity play a significant role in an individual's susceptibility to alcohol related harm (Cherpitel, 1999). Genetic basis familial alcoholism regarded as a major contributor to an individual's risk for harm from alcohol consumption (Beirut et al., 1998; Cougizou et al., 1999; Edenberg et al., 1998; McGue, 1999). Family history of alcoholism or certain types of cancer, depression, or stress Personal history of depression, suicidal ideation Clinical Diagnosis Clinical Diagnosis DSM­IV: The Diagnostic and Statistical Manual of Mental Disorders (DSM­IV­TR), published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States. (DSM V, due in 2011) ICD­10 The International Statistical Classification of Diseases and Related Health Problems (ICD) international alternative to DSM­ IV Alcoholism is a disease: Alcoholism is a disease: But what is a disease? A condition that results in medically significant symptoms, bodily dysfunction A disorder with recognizable signs usually a known cause In the context of addiction, some people reject the fact that addiction is a disease The word disease may imply to some that addiction can be treated with medication alone. Proper addiction treatment requires psychosocial care as well. Alcohol/Substance Abuse: Alcohol/Substance Abuse: Excessive use of a substance in a way it was not meant to be used or not as prescribed. (DSMIV and ICD10 diagnoses) Alcohol/Substance Abuse are a stigmatizing labels because it negates the fact that substance use disorders are a medical condition; it blames the illness solely on the individual with the illness, ignoring environmental and genetic factors, as well as the drugs’ abilities to change brain chemistry; it absolves those selling and promoting addictive substances of any wrong doing; it feeds into the stigma experienced not only by individuals with substance use disorders, by also by family members and the treatment/recovery field. Alcohol dependence (alcoholism) is a disease. Alcohol dependence (alcoholism) is a disease. Alcohol dependence alters parts of the brain from its normal healthy state The craving that an alcohol­dependent person feels for alcohol can be as strong as the need for food or water. An alcohol­dependent person will continue to drink despite serious family, health, or legal problems. Alcohol Dependence: Alcohol Dependence: Alcohol Dependence, also known as "alcoholism," is a disease that includes four symptoms: Craving: A strong need, or compulsion, to drink. Loss of control: The inability to limit one's drinking on any given occasion. Physical dependence: Withdrawal symptoms, nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking. Tolerance: The need to drink greater amounts of alcohol in order to achieve same level of intoxication or desired effect Alcoholism has little to do with willpower. Alcoholics are in the grip of a powerful "craving," or uncontrollable need, for alcohol that overrides their ability to stop drinking. Alcohol Withdrawal: Alcohol Withdrawal: Alcohol Withdrawal occurs in adults and adolescents It occurs when a person who uses alcohol excessively suddenly stops the alcohol use. The withdrawal usually occurs within 5­10 hours after the decrease in alcohol intake, but it may occur up to 7­10 days later. Excessive alcohol use is generally considered the equivalent of 4 beers (or 4 shots of "hard" alcohol) per day for one week or habitual use of alcohol that disrupts a person's life and routines. Hangover is physiological withdrawal Alcohol Withdrawal continued… Alcohol Withdrawal continued… The likelihood of developing alcohol withdrawal symptoms increases as the number and frequency of drinks increase. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems Enabling: As it applies to the disease of addiction, can be defined as doing for someone, in an attempt to help, those things they could or should be doing for themselves, thus actually making it easier for them to continue in the progression of the disease. Covering for someone, supplying them… Stages Of Change Action Maintenance Preparation Termination Precontemplation Contemplation Relapse: A relapse occurs when a person is affected again by a condition that affected them in the past. This could be a medical condition such as depression, bipolar disorder, cancer or an addiction to a drug. A recurrence of symptoms after a period of remission. Remission: A period of time in which the signs and symptoms of the addiction have disappeared. Risk for Alcohol Dependency Risk for Alcohol Dependency Research shows that the risk for developing alcoholism runs in families. Genetics partially explain this pattern, but lifestyle is also a factor. Friends, the amount of stress in life, and how readily available alcohol is also are factors that may increase risk for alcoholism. Risk is not destiny. Normal Heart Normal Alcoholic’s Heart ...
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