Alcohol
Alcohol Support Services
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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/ 1-800562-1240
• Substance Abuse & Mental Health Services
Administration Facility Locator
Alcohol Consumption Statistics,
U.S.
• % of adult Americans
consuming alcohol regularly
(1 per month)
• 56% (CDC, 2013)
• Percent of adult infrequent
drinkers
• 13% (CDC, 2012)
• State info, women (CDC, 2013)
• 2.34 gallons/person (NIAAA, 2013)
• 88,000 deaths (CDC, 2006-10)
Alcohol Consumption Statistics,
World
• Percent of population, 15+
years who consumes alcohol
• 38% (WHO, 2014)
• 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
– Beer (Euromonitor, via Paste Magazine,
2014)
– Wine (The Economist, 2012)
– Variation across countries
(WHO, page 32; sex differences, page 39)
• Country profiles (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
Legal Drinking Age: Procon.org
U.S. Legal Drinking Age:
Changing?
• After Prohibition era, most drinking ages were 21
– A few were set at 18
– A few states had different ages or beer/wine/liquor
• When Constitutional amendment passed in 1970s to
allow voting age of 18, drinking ages generally lowered
• In 1984-86, states changed drinking age to 21
– Federal government threatened to withhold 10% of highway
funding otherwise
• In 2012, US Supreme Court decided feds could not force
states to comply (pay) under threat of losing federal
funding match – leaving drinking age change vulnerable
Alcohol Formation
• Alcohol available for thousands of years
• Created from natural fermentation process
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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
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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
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 Dependence
Percent 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)
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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