Alcoholism

Dr R B Sah

SPH & CM

What is alcohol?

• Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor.

• Alcohol is produced by the fermentation of yeast, sugars, and starches.

How does alcohol affect a person?

• Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes; however, the liver can only metabolize a small amount of alcohol at a time, leaving the excess alcohol to circulate throughout the body.

• The intensity of the effect of alcohol on the body is directly related to the amount consumed.

Why do some people react differently to alcohol than others?

• Individual reactions to alcohol vary, and are influenced by many factors; such as:

1. Age.

2. Gender.

3. Race or ethnicity.

4. Physical condition (weight, fitness level, etc).

5. Amount of food consumed before drinking.

6. How quickly the alcohol was consumed.

7. Use of drugs or prescription medicines.

8. Family history of alcohol problems.

What is the difference between alcoholism and alcohol abuse?

• Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work.

• Manifestations of alcohol abuse include the following:1. Failure to fulfill major responsibilities at work, school, or

home. 2. Drinking in dangerous situations, such as drinking while

driving or operating machinery. 3. Legal problems related to alcohol, such as being arrested

for drinking while driving or for physically hurting someone while drunk.

4. Continued drinking despite ongoing relationship problems that are caused or worsened by drinking.

5. Long-term alcohol abuse can turn into alcohol dependence.

• Dependency on alcohol, also known as alcohol addiction and alcoholism, is a chronic disease.

• The signs and symptoms of alcohol dependence include:

1. A strong craving for alcohol.

2. Continued use despite repeated physical, psychological, or interpersonal problems.

3. The inability to limit drinking.

What does it mean to get drunk?

• “Getting drunk” or intoxicated is the result of consuming excessive amounts of alcohol.

• Binge drinking typically results in acute intoxication.

• Alcohol intoxication can be harmful for a variety of reasons, including:

1. Impaired brain function resulting in poor judgment, reduced reaction time, loss of balance and motor skills, or slurred speech.

2. Dilation of blood vessels causing a feeling of warmth but resulting in rapid loss of body heat.

3. Increased risk of certain cancers, stroke, and liver diseases (e.g., cirrhosis),

4. Damage to a developing fetus if consumed by pregnant women.

5. Increased risk of motor-vehicle traffic crashes, violence, and other injuries.

•  Coma and death can occur if alcohol is consumed rapidly and in large amounts.

Introduction

• There are approximately 79,000 deaths attributable to excessive alcohol use each year in the US.

• This makes excessive alcohol use the 3rd leading lifestyle-related cause of death for the nation.

• In the single year 2005, there were more than 1.6 million hospitalizations and more than 4 million emergency room visits for alcohol-related conditions.

The Standard Measure of Alcohol

• In the US, a standard drink is any drink that contains 0.6 ounces (13.7 grams or 1.2 tablespoons) of pure alcohol.

• Generally, this amount of pure alcohol is found in

1. 12-ounces of regular beer or wine cooler.

2. 8-ounces of malt liquor.

3. 5-ounces of wine.

4. 1.5-ounces of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

Definitions of Patterns of Drinking Alcohol

Binge drinking

a. For women, 4 or more drinks during a single occasion.

b. For men, 5 or more drinks during a single occasion.

Heavy drinking

a. For women, more than 1 drink per day on average.

b. For men, more than 2 drinks per day on average

• Excessive drinking includes heavy drinking, binge drinking or both.

• Most people who binge drink are not alcoholics or alcohol dependent.

• According to the Dietary Guidelines for Americans, if you drink alcoholic beverages, do so in moderation, which is defined as no more than 1 drink per day for women and no more than 2 drinks per day for men.

• However, there are some persons who should not drink any alcohol, including those who are:

1. Pregnant or trying to become pregnant. 2. Taking prescription or over-the-counter medications that

may cause harmful reactions when mixed with alcohol. 3. Younger than age 21. 4. Recovering from alcoholism or are unable to control the

amount they drink.

What Causes Alcoholism?

• Alcoholism is caused by a combination of genetic, environmental, biological, and psychological factors.

• Alcoholism often runs in families. This is partially due to genetic factors.

• Although genetics is involved in many cases of alcoholism, children of alcoholic parents do not necessarily become alcoholic.

• In addition, people with no family history of the disease can develop alcoholism.

• Environmental factors also may affect drinking and the development of alcohol abuse and alcoholism.

• They include:

1. Influence of family and friends;

2. Cultural attitudes and practices;

3. Ease of obtaining alcohol; and

4. Stress

• Depression and anxiety disorders also increase people’s risk of developing alcohol problems.

• People may use alcohol to help deal with symptoms of these disorders.

• However, in some people depression and anxiety can be caused by the alcohol dependence and go away after they withdraw from alcohol.

A. Immediate Health Risks

• Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions.

• These immediate effects are most often the result of binge drinking and include the following:

1. Unintentional injuries, including traffic injuries, falls, drownings, burns, and unintentional firearm injuries. 

2. Violence, including intimate partner violence and child maltreatment.

3. Risky sexual behaviors, including unprotected sex, sex with multiple partners, and increased risk of sexual assault. These behaviors can result in unintended pregnancy or sexually transmitted diseases. 

4. Miscarriage and stillbirth among pregnant women, and a combination of physical and mental birth defects among children that last throughout life. 

5. Alcohol poisoning, a medical emergency that results from high blood alcohol levels that suppress the central nervous system and can cause loss of consciousness, low blood pressure and body temperature, coma, respiratory depression, or death.

Long-Term Health Risks

• Over time, excessive alcohol use can lead to development of chronic diseases, neurological impairments and social problems.

• These include but are not limited to:

1. Neurological problems, including dementia, stroke and neuropathy.

2. Cardiovascular problems, including myocardial infarction, cardiomyopathy, atrial fibrillation and hypertension.

3. Psychiatric problems, including depression, anxiety, and suicide.

4. Social problems, including unemployment, lost productivity, and family problems.

5. Cancer of the mouth, throat, esophagus, liver, colon, and breast.

6. Liver diseases, including:

a. Alcoholic hepatitis.

b. Cirrhosis,

c. Other gastrointestinal problems, including pancreatitis

and gastritis.

Social Problems

• Alcohol use can make mild social problems worse by causing people to be more irritable and likely to argue and by affecting judgment and control of behavior.

• Misuse of alcohol can lead to a number of moderate and serious social problems including:

1. Losing friends;

2. Losing jobs;

3. Child abuse and domestic violence;

4. Separation of family members; and

5. Divorce.

Work or School Problems

• Misuse of alcohol may cause performance at work or school to suffer in ways such as:

1. Arriving late;

2. Making more mistakes;

3. Leaving assignments incomplete;

4. Problems with bosses and co-workers;

5. Getting poor grades or evaluations;

6. Flunking out of school; and

7. Losing jobs.

Financial Problems

• Misuse of alcohol may make current money problems worse and cause new ones, including:

1. Having less money for necessary expenses like food and clothing;

2. Neglecting to pay bills; and • Creating additional expenses, such as extra medical

costs, fines, or car repairs.

Reasons for increased alcohol consumption

• Five variables, from the individual’s upbringing and their present situation can influence drinking behavior, both normal and uncontrolled:

• Family drinking• Family structure• Personality variables• Spouse’s drinking behaviour• Drinking environment

• However poverty, unemployment and sense of helplessness may also predispose to the over-use of alcohol.

Alcohol and Women

• Fewer women than men drink.• It is estimated that of the 15.1 million alcohol-abusing or

alcohol-dependent individuals in the United States, approximately 4.6 million (nearly one-third) are women.

• On the whole, women who drink consume less alcohol and have fewer alcohol-related problems and dependence symptoms than men,

• yet among the heaviest drinkers, women equal or surpass men in the number of problems that result from their drinking.

• Drinking behavior differs with the age, life role, and marital status of women.

• women who have multiple roles (e.g., married women who work outside the home) may have lower rates of alcohol problems

• In fact, role deprivation (e.g., loss of role as wife, mother, or worker) may increase a woman's risk for abusing alcohol.

• Women who have never married or who are divorced or separated are more likely to drink heavily and experience alcohol-related problems than women who are married or widowed.

Greater Physiological Impairment

• Women often experience greater physiological impairment earlier in their drinking careers, despite having consumed less alcohol than men.

• Three possible mechanisms may explain this response:

• First, Because of their smaller quantity of body water, women achieve higher concentrations of alcohol in their

blood. • Second, diminished activity of alcohol dehydrogenase (the

primary enzyme involved in the metabolism of alcohol) in the stomach

• Third, fluctuations in gonadal hormone levels during the menstrual cycle may affect the rate of alcohol metabolism, making a woman more susceptible to elevated blood alcohol concentrations at different points in the cycle.

• Female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics.

• Further, a greater percentage of female alcoholics die from suicides, alcohol-related accidents, circulatory disorders, and cirrhosis of the liver.

Heightened Vulnerability

• Alcoholic women may be more susceptible to liver damage because of the diminished activity of gastric alcohol dehydrogenase in first-pass metabolism

• increased risk for breast cancer, when a woman consumes 1 ounce or more of absolute alcohol daily.

• Menstrual disorders (e.g., painful menstruation, heavy flow, premenstrual discomfort, and irregular or absent cycles) have been associated with chronic heavy drinking.

• These disorders can have adverse effects on fertility.

• Further, continued drinking may lead to early menopause.

THANK YOU