Alcohol

Generalities
Also called ethyl alcohol (ETOH) or ethanol
Is a psychoactive drug
Similar to sedative-hypnotics
Used primarily for recreational use and not medical
use (although it is useful in medicine)
The second most widely used psychoactive substance
in the world (second to caffeine)

Pharmocokinetics
Mainly water soluble (Katzung, 1992, p. 320) (this
contradicts your Julien book) but also fat soluble
Easily diffuses through membranes
Rapid and complete GI absorption
Most absorbed in upper GI tract

Pharmocokinetics
20% of typical dose passes directly from the stomach
into the blood
80% is absorbed from upper GI tract
If consumed on full stomach, gastric emptying is
delayed and rate of absorption is slowed
Absorption from the intestine is largely unaffected by
the presence of food

Pharmocokinetics
Blood-brain barrier freely permeable to alcohol
90% of consumed ETOH crosses the blood-brain
barrier immediately
Equilibrium of alcohol in blood and brain is rapid
Crosses the placental-barrier and the fetus blood-brain
barrier with ease
Fetal alcohol syndrome results

Pharmocokinetics
95% of ETOH consumed is metabolized by the
enzyme alcohol dehydrogenase
5% is excreted unchanged through the lungs (bad
breath)
Alcohol dehydrogenase in the liver converts about
85% of the non-respiratory eliminated ETOH
Alcohol dehydrogenase in the stomach converts about
15% of the non-respiratory eliminated ETOH

Pharmocokinetics
Alcohol dehydrogenase found in liver, stomach, testes,
and brain
Fraction in brain and testes probably not significant
Gastric alcohol dehydrogenase metabolizes a
significant amount of the ETOH as it crosses the
stomach wall into the bloodstream (called first pass
metabolism)
Women have less (or almost none) gastric alcohol
dehydrogenase than men

Pharmocokinetics
It may be because of the female deficiency of gastric
alcohol dehydrogenase that women suffer enhanced
vulnerability to both intoxication and earlier onset of
brain and liver damage than men
Once absorbed, ETOH metabolism in the liver occurs
where ETOH is converted to acetaldehyde and then
into acetic acid.
ETOH has no nutritional value except to supply
calories

Pharmocokinetics
Alcohol dehydrogenase
C2H5OH

C3CHO

Ethanol

Acetaldehyde

Acetyl CoA
Aldehyde dehydrogenase

Pharmocokinetics
A second alcohol degrading enzyme is called the
microsomal ethanol oxidizing system
This system probably only participates in
metabolizing ETOH after high amounts of ETOH are
present in the blood

Pharmocokinetics
Approximately 10 ml of ETOH is metabolized per
hour regardless of blood ETOH concentration
Because of the fixed metabolic rate, it will take about
the same amount of time to metabolize one can of
beer, one four oz. glass of wine, or one oz. of whiskey
Otherwise stated, consumption of any of the above
once per hour should keep the individual at a constant
level of intoxication

Pharmocokinetics
Drinking coffee after intoxication will make for a
stimulated drunk
Eating food after intoxication will make a full drunk
Taking a shower after intoxication will make a cold
and wet drunk
You are going to stay drunk until the slow metabolic
conversion of ETOH takes place - attempts to increase
the rate of this process have not worked well

Pharmocokinetics
Disulfiram (Anabuse) is commonly used to treat
alcoholics
Disulfiram inhibits aldehyde dehydrogenase, the
enzyme responsible for converting acetaldehyde into
acetic acid
Increased levels of acetaldehyde occur causing
headache, drowsiness, hangover, vomiting, nausea and
much more
Will happen even with use of cough syrup, mouth
wash, perfume, cologne, etc.

Pharmocokinetics
Disulfiram is not a cure for alcoholism
Cant drink ETOH until 3-4 days after taking
disulfiram

Pharmacodynamics
Some research suggests that ETOH enhances GABA
receptor activity
Alcohol binds to a different site on the GABAA
receptor than benzodiazepines or barbiturates
ETOH inhibits acetylcholine (a neurotransmitter) in
the CNS

Pharmacological Effects
ETOH causes reversible depression of the CNS
Respiration becomes depressed
ETOH is an anticonvulsant but not used for this effect
After suddenly stopping chronic ETOH use, rebound
convulsions commonly occur
Convulsions peak 8-12 hrs. after the last drink

Pharmacological Effects
ETOH effects are additive with other drugs
Benzodiazepine and marijuana are commonly used
along with ETOH
Use of either of these, including marijuana, add to the
impairment of motor and intellectual skills as well as
the persons state of alertness

Pharmacological Effects
ETOH plus sedatives may be supraadditive
This will depress cardiovascular and respiratory
functions
Death

Pharmacological Effects
ETOH affects the circulation and the heart
Causes vessels to dilate and body temperature to drop
- doesnt work to drink ETOH to stay warm
Cardiomyopathy
Encephalopathy
Hypetension

Pharmacological Effects
Diuretic action by increasing the excretion of fluids as
a result of decreasing the secretion of antidiuretic
hormone
ETOH does not appear to hurt the structure of the
kidney
Is not an aphrodisiac
Interferes with sexual performance
Inhibits pituitary release of oxytocin

Pharmacological Effects
Depresses immune function
Increased rates of cancers
Moderate consumption research suggests decrease in
risk for coronary artery disease
French paradox

Psychological Effects
Disinhibition - occurs at low doses and is not
predictable
In one setting a person may become relaxed and
sedated and in another setting they may become
euphoric
Mental expectations play a large role
This is less important as the dose increases

Pharmacological Effects
Low doses even cause less coordination
Memory, insight, and concentration are progressively
dulled
Disinhibition plays a strong role in violence, rape,
murder, AIDS transmission, & others
Over 50% of motor vehicle accidents are ETOH
related

Pharmacological Effects
Over 10% of our society are personally afflicted with
another persons alcohol use (drunk driving, assault,
etc)
The liver usually uses fatty acids for energy
ETOH is a rich energy source for the liver and,
therefore, the liver gets energy from ETOH and stores
the fatty acids for later resulting in a fatty liver
ETOH use is a common cause of nutritional and trace
element deficiencies in adults

Tolerance
Metabolic tolerance - the liver increases the amount of
alcohol dehydrogenase
Organic tolerance - the neurons in the brain adapt to
the amount of drug present and seem less drunk than
those who have not developed organic tolerance
Cognitive tolerance - environmental situations can
counter the effects of ETOH

Tolerance
When physical tolerance develops, abrupt cessation
can cause a period of hyperexcitability that may lead
to convulsions and death
Organic tolerance - the neurons in the brain adapt to
the amount of drug present and seem less drunk than
those who have not developed organic tolerance

Side Effects and Toxicity

Acutely, a reversible drug induced brain syndrome
occurs
This leads to a clouded sensorium and:
Disorientation
Impaired insight and judgment (STDs!)
Amnesia (blackouts)
Possibly death

Side Effects and Toxicity

Liver damage is a serious physiological consequence
of long-term ETOH consumption
75 of all deaths attributed to ETOHism are from
cirrhosis of the liver
ETOH is an immunosuppresant

GI Consequences
Liver and GI tract
injury
Cirrhosi
s
Fatty
liver
Gastritis and pancreatitis
Vitamin transport deficiencies
Nutritional deficiencies

Cardiovascular Consequences
Arrhythmias even following social
drinking
Hypertensio
n
Strok
e
Cardiomyopath
y

Cancers
ETOH ingestion is a risk factor for cancer
ETOH is not, however, a carcinogen
Cancers increase - mouth, throat, larynx, and liver
Synergistic with tobacco
Head and neck CAs are 10 to 15 times in those who
smoke and drink than in those who abstain from both
Throat cancer risk is 44 times greater in those who
smoke and drink than in those who abstain from both

Teratogenic Effects
ETOH is a teratogen
Fetal Alcohol Syndrome (FAS) occurs to offspring of
mothers having high blood alcohol levels
FAS consists of physical and behavioral
abnormalities
Is a dose related phenomenon

Teratogenic Effects
Fetal Alcohol Syndrome
CNS - mental retardation, low intelligence,
microcephaly, behavioral problems such as
hyperactivity
Retarted body growth rate
Facial abnormalities - short palpebral fissures, short
nose, wide set eyes, and small cheekbones
Other - congenital heart disease, malformed eyes and
ears

Teratogenic Effects
Fetal Alcohol Syndrome
Either ETOH or acetaldehyde may inhibit cell
division and proliferation early in pregnancy
Facial development occurs between weeks 4 and 6
Brain development is later
2.6 million infants born in the US each year with
significant intrauterine ETOH exposure

Teratogenic Effects
Fetal Alcohol Syndrome
Incidence may be 1 in 300
Fetal alcohol effects may occur in 1 in 100
This would make ETOH the third leading cause of
birth defects behind Downs Syndrome and Spina
Bifida
FAS is the only one of these that is completely
preventable

Teratogenic Effects
Fetal Alcohol Syndrome
ETOH is the most frequent cause of teratogeninduced mental deficiency know in the Western
World
One to two drinks per day can substantially increase
the risk of growth-retarded infant
One drink is not considered safe
FAS occurs in 1 in 3 alcoholic mothers

Teratogenic Effects
Fetal Alcohol Syndrome
20% of pregnant women continue to consume ETOH
The highest rates of ETOH consumption during
pregnancy are in women who smoke
Cigarette smoking increases the risk of fetal injury
More than 25% of pregnant who are moderate to
heavy drinkers report that their infants fathers are
also heavy drinkers

An AIDS-Risk
Appraisal of SDA
Youth Based Upon
the Use of Alcohol

Scope of the Problem

20% diagnosed during the ages of 20-29 years

Latency period = 10-12 years

Those who develop AIDS in their 20s

probably contracted the HIV while in
their teens
Sexual intercourse, the PRIMARY AIDS risk
behavior in adolescence, is a behavior
commonly practiced among youth

Scope of the Problem

An estimated 100,000 US adolescents are
HIV Positive

The Question

How many SDA youth are infected with

the virus that causes AIDS (HIV)?

Importance to Health Ed.

No AIDS cure or vaccine is available

Health education remains the primary

method of reducing HIV transmission

Ethics Review
Institutional Review Board of LLU required
reporting by union conference only
Active parental consent
Non random sampling
Limited external validity
Passive student consent

Collection of Parental Consent

Consent letters boxed and sent to all 93
four-year schools in NAD
13,368 letters
Eight schools did not forward letters to
parents (representing 912 students)
12,456 letters mailed to parents

Parents consented for 2,834 students to

participate (21.20%)

Questionnaire Administration
2,834

questionnaires mailed to 85 schools

1,765 quesionnaires were collected

1,069 subjects lost due to nonadministration at school level
16 schools did not administer
questionnaires

Demographics
Gender
Female
Male

56.4%
43.6%

Median age

17 years

Demographics
SDA
Year in school
Freshman
Sophomore
Junior
Senior

93.3%
24.1%
24.0%
27.9%
24.0%

Parental Use of Substances

Substance use by parents (as reported by
respondents)
Alcohol

25.7%

Tobacco

10.7%

Marijuana

4.5%

Parents & Students: Alcohol

Substance Used
by Student

Parental Alcohol Use

No

Yes

Alcohol
Tobacco
Marijuana
Cocaine
Hard Drug
Injectable

38.1%
25.3%
11.7%
2.2%
5.0%
0.5%

75.2%
48.0%
28.7%
7.4%
15.6%
1.3%

Overall

42.3%

79.2%

Sexual Intercourse
Ever had sexual intercourse:
Total sample
15.3%
Females
14.6%
Males
16.2%
SDA students
14.6%
Non-SDA students
37.1%

Public Schools

53.0%

Age at First Intercourse

Total

sample (median)

15.0 years

Females (mean)

15.0

Males (mean)

14.5

Public

Schools

14.5

Parents, Alcohol & Sex

Alcohol Use

Sexual Intercourse

Parent

Student

NO
no
yes

NO
no
no

no
YES
yes

yes
YES
yes

4.0%
4.0%
6.3%
26.7%
33.3%
33.3%

Homosexual Experience
Students who reported having had a
sexual experience with someone of
the same sex
Population
79 (4.6%)
Females
41 (4.2%)
Males
38 (5.0%)
Public Schools = 5%

Intention to Have Sex

Students Alcohol Use
Question: How likely is it that you will have
sexual intercourse before marriage?
a

Unlikely

a Alcohol No
b Alcohol Yes

b
3

Likely

Intention to Have Sex

Parents Alcohol Use
Question: How likely is it that you will have
sexual intercourse before marriage?
a

Unlikely

a Alcohol No
b Alcohol Yes

b
3

Likely

Intention to Use Drugs

Students Alcohol Use
Question: How likely is it that you will have use
drugs during the next six months?
a

Unlikely

a Alcohol No
b Alcohol Yes

b
2

Likely

Intention to Use Drugs

Parents Alcohol Use
Question: How likely is it that you will have use
drugs during the next six months?
a

Unlikely

a Alcohol No
b Alcohol Yes

b
2

Likely

Attitude Toward Pre-Marital Sex

Students Alcohol Use
Question: When you think of having sex before
marriage, how pos. or neg. does it make you feel?
a

Negative

a Alcohol No
b Alcohol Yes

b
4

Positive

Attitude Toward Pre-Marital Sex

Parents Alcohol Use
Question: When you think of having sex before
marriage, how pos. or neg. does it make you feel?
a

Negative

a Alcohol No
b Alcohol Yes

b
3

Positive

Attitude toward Drugs

Students Alcohol Use
Question: When you think about using drugs
during the next six months how positive or
negative does it make you feel?
a

Negative

a Alcohol No
b Alcohol Yes

b
2

Positive

Attitude toward Drugs

Parents Alcohol Use
Question: When you think about using drugs
during the next six months how positive or
negative does it make you feel?
a

Negative

a Alcohol No
b Alcohol Yes

b
2

Positive

Social Pressure - Sex

Students Alcohol Use
Question: Most people who are important to me
think I should have sex before marriage?
a

Disagree

a Alcohol No
b Alcohol Yes

b
2

Agree

Social Pressure - Sex

Parents Alcohol Use
Question: Most people who are important to me
think I should have sex before marriage?
a

Disagree

a Alcohol No
b Alcohol Yes

b
2

Agree

Social Pressure - Drugs

Students Alcohol Use
Question: Most people who are important to me
think I should use drugs during the next six
months?
a

Disagree

a Alcohol No
b Alcohol Yes

b
2

Agree

Social Pressure - Drugs

Parents Alcohol Use
Question: Most people who are important to me
think I should use drugs during the next six
months?
a b

Disagree

a Alcohol No
b Alcohol Yes

Agree

Best Predictor of Intention to

Have Premarital Sex
Behavioral Beliefs
& Outcome
Evaluations

Attitude

Normative Beliefs
& Motivation to
Comply

Subjective
Norm

Control Beliefs &

Perceived
Facilitation

Perceived
Control

Intention

Behavior

Resource
Resources
Measured
Best
(Predicting
Resources
Best Predicting
Predicting
Perceived
Control
Control)
Control
Encouragement from teachers
Spiritual strength
Support from female friends
Support from male friends
Self-esteem

Outcomes
Best
of Sex Before
of
Marriage
Best Predictors
Predictors
of Attitude
Attitude
(Predicting
Toward
Attitudes)
Sex
Toward
Sex
Acceptance by fellow students
Increased popularity
Improved relationship with sexual partner
Improved status at school
Ruined reputation
Decreased self-esteem

NIDA Research Findings - 1996

Protective Factors - Drug Use
Family Factors
Parental Supervision
Childs Attachment to Parent
Parents Attachment to Child
Parents Involvement in Childs Activities

NIDA Research Findings - 1996

Protective Factors - Drug Use
Educational Factors
Commitment to School
Parents Values About College
Parents Expectations for Child to Attend College
Attachment to Teachers

NIDA Research Findings - 1996

Protective Factors - Drug Use
Other Resources
Childs Self-esteem
Childs Involvement in Prosocial Activities
Child is Close to an Adult Outside the Family
Childs Involvement in Religious Activities

Conclusions
Differences exist in behaviors according
gender
respondents history of sexual and/or
substance use behaviors
parents use of substances

Implications for Schools

Teacher hiring practices

In schools where teachers teach multiple

subjects
Consider hiring health teachers to teach history
rather than history teachers to teach health
Teachers need continuing education in formal health
education

Recommendations
Remember that abstinence is NOT a singular
message as often attempted in public schools
Remember that abstinence is a part of the
complete biblical message and only in this
context
Understandable, useful, and practical

Predictions
If we do not do research on points of
intervention (identification of determinants
of behavior) our children will face a future
where consideration will be given to opening
family planning clinics in SDA schools!!!
This problem will not go away!!!
Many will continue to ignore it!!!

 Abstinence only programs will not work

Condom distribution will not work
Distribution of birth control devices or
medications will not work
Aggressive, multifaceted programs integrating
TEACHERS, students, community and
churches along with practical and attractive
biblical philosophy and principal will work

Essential Program Components

Skills
Norms
Consistent

adult supervision
Keep kids busy
Now add present research findings:
Encouragement

from teachers
Spiritual strength

Future Research

Research is needed which

measures at perceptions
vs. reality regarding
AIDS risk behaviors.

Alcoholism
In the late 50s the American Medical Association
recognized the syndrome of alcoholism
Alcoholism is a primary, chronic disease with genetic,
psychosocial, and environmental factors influencing
its development and manifestations. It is often
progressive and fatal. It is characterized by impaired
control over drinking, preoccupation with the drug
alcohol, use of alcohol despite adverse consequences,
and distortions in thinking, most notably denial. Each
of these symptoms may be continuous or periodic.

Alcoholism
Adverse consequences involvement include
impairments in such areas as physical health,
psychological functioning, interpersonal functioning,
interpersonal functioning, occupational functional, as
well as legal, financial and spiritual problems
Denial - this is a range of psychological maneuvers
that decrease awareness of the fact that alcohol use is
the cause of a persons problems rather than a solution
to those problems
Denial - Is an integral part of the disease and is nearly
always a major obstacle to recovery

Alcoholism
Over 160,000,000Americans are old enough to drink
Over 112,000,000 Americans drink
14,000,000 have a drinking problem
7,000,000 are alcoholics

Alcoholism
If cigarette smoking is excluded, alcoholism is
by far the most serious drug problem in the US
and other countries. Measured in terms of
accidents, lost productivity, crime, death, or
damaged health, the combined social costs of
problem drinking in the US are estimated to
now exceed dollars annually. The cost of
broken homes, wasted lives, loss to society, and
human misery is beyond calculation.

Alcoholism
Long term alcoholism may lead to malnutrition and
chronic physiological degeneration
May cause a bloated look, flabby muscles, fine
tremors, decreased physical capacity, and increased
susceptibility to infections
Staying well nourished does not necessarily protect
the brain, liver or GI tract from damage from ETOH

Alcoholism
When does a state of physical dependence start?
Well, since the body metabolizes about 10 ml. of
ETOH per hour, a level higher than that would result
in ETOH accumulation
There is a fair correlation between drinking habits,
maximum blood concentrations, and intensity of
withdrawal syndrome

Alcoholism
Low level of dependence produces:
Altered sleep patterns
Nausea
Anxiety
Wakefulness
Mild tremors (last a day or so)

Alcoholism
At Higher level of dependence an alcohol withdrawal
syndrome is seen:
Vomiting
Cramps
Nightmares
Transient hallucinations

Alcoholism
If the hallucinations persist, this is then called:
Alcoholic hallucinosis

Alcoholism
This late stage is called
Alcoholic withdrawal delirium, or,
delirium tremens
After recovery, the following may persist for months:

Depression
Sleep deficits
Cognitive deficits
Other alterations in brain function

Alcoholism
Some think is that alcoholism is a primary disorder
(not secondary or as a result of some other condition)
A good deal of evidence now indicates that many, if
not most, alcoholics do not have primary alcoholism.
Their alcoholism is associated with other
psychopathology, including addiction to other drugs.

Alcoholism
30 to 50% have underlying depression
33% have a coexisting anxiety disorder (social
phobias in men; agoraphobia in women)
Many have antisocial personalities
Some are schizophrenic
Around one-third are addicted to other drugs
Dual diagnosis must always be considered

Drugs used in Treating Alcoholism

Eliminating alcohol would be an obvious goal in
treating alcoholism
Chloral hydrate and barbiturates used to be used in
treating alcohol withdrawal syndrome
Benzodiazepines are now used

Drugs used in Treating Alcoholism

The short duration of alcohol and its narrow range of
safety make it a very dangerous drug
When ETOH is stopped, it is metabolized within hours
A withdrawal syndrome occurs within hours

Drugs used in Treating Alcoholism

Question: Why substitute the addictive drug of
alcohol with another addictive drug
The answer is that because withdrawal from ETOH is
so fast and so dangerous, this period must be one
where the individual must be protected from the
potentially lethal effects of delirium tremens, or
alcohol withdrawal delirium

Drugs used in Treating Alcoholism

Using a long acting drug at low levels with careful
supervision has been found to be useful
The patient is then allowed to withdraw gradually
The longest lasting and safest drugs are the best
These would be benzodiazepines, especially
chlordiazepoxide (Librium) or diazepam (Valium)

Drugs used in Treating Alcoholism

Disulfiram can be used but not until all alcohol is
cleared from the body
If taken daily, disulfiram results in total abstinence in
the vast majority of patients
Haloperidol (haldol) or other antipsychotic agents can
be used to treat hallucinations
Haloperidol should not be used if seizures occur as
this drug lowers the threshold for seizure activity

Drugs used in Treating Alcoholism

Also, regarding haloperidol which is a pnenothiazine,
there is some concern that this class of drugs may
increase the liver damage caused by alcohol
Some have tried condition-avoidance techniques in
treating alcoholism
This is done by giving an emetic (drug that provokes
vomiting) along with an alcoholic drink, the patient
then vomits - the patient learns that when they drink
they vomit - this is associated with displeasure - this is
supposed to condition them not to drink

Drugs used in Treating Alcoholism

The emetic drugs that have been used for this are
apomorphine or Ipecac
Some are looking at administering apomorphine to see
if it reduces the craving for alcohol
Many alcoholics suffer from depression as a
coexisting condition - this must be treated when
withdrawing
Tricyclic antidepressants are commonly used but their
usefulness has not been established

Tehnici folosite n tratarea

alcoolismului
Treatmentul alcoolismului este o combinaie de factori
medicali, psihologici, psihosociali i spirituali care
interacioneaz ntr-un cadru semi-organizat, ajutnd
pacientul s devin statornic i mulumit ca abstinent.
Un astfel de tratament se poate aplica doar dup
rezolvarea simptomelor sindromului de abstinen i
abinerea pentru o perioad de la consumul de alcool.

Techniques in Treating Alcoholism

Heavy chronic ETOH consumption induces an impairment
of memory and cognitive function. At the same time, a
great deal of learning is required to maintain abstinent and
even more to achieve stable moderate drinking.
Accordingly, it is not surprising that one of the best
predictors of treatment outcome is the degree of cognitive
impairment patients present upon entry into therapy; the
greater the impairment the less likely the success of
therapy. Accordingly, an initial period of abstinence is
therapeutically desirable, whatever the treatment goals

Techniques in Treating Alcoholism

Following withdrawal and a period of abstinence,
treatment has two goals:
Sobriety
Amelioration of psychiatric conditions associated
with alcoholism
The therapist can, thus, evaluate the individual sober
and to diagnose and treat coexisting psychiatric
disorders
This allows the individual time to learn that they can
cope with life without alcohol

Techniques in Treating Alcoholism

No definitive therapies for alcoholism or preventing
relapse of drinking after an initial period of sobriety
exist
Alcoholics anonymous, aversion therapy,
psychotherapy, cognitive-behavioral therapy, and
group therapy will continue to be used
Detoxification isnt difficult, preventing relapse is

Techniques in Treating Alcoholism

Each patient is different and suffer a unique spectrum
of impairments
One person may drink without much physical
impairment to their physical or vocational health - for
example, a teacher with a strong family support who is
well nourished
An alcoholics physical health may improve while their
family or social life may worsen

Techniques in Treating Alcoholism

Sobriety may be a reasonable expectation for a person
whose impairment in life is minimal
But, less drinking with modest improvements in health
may be all that can be reasonably expected for a more
severely impaired alcoholic
The goal of therapy would be at best aimed at total
abstinence, however, you may find that this is not a
reasonable goal for each person