chapter 8 alcohol and tobacco © 2012 mcgraw-hill companies. all rights reserved

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Chapter 8

Alcohol and TobaccoAlcohol and Tobacco

© 2012 McGraw-Hill Companies. All Rights Reserved.

2© 2012 McGraw-Hill Companies. All Rights Reserved. 2

The Nature of Alcohol Psychoactive ingredient

Ethanol Beer 3-6% alcohol by volume Ales and malt liquors 6-8% alcohol by volume Table wines 9-14% alcohol by volume

Fermenting Fortified wines 20% alcohol by volume

Sugar and extra alcohol is added Hard liquors 35-50% (or more) alcohol by volume

Distilling or fermentingProof Value

Two times the percentage concentrationIngestion

7 calories per gram1 drink contains 14-17 grams, or 100-120 calories

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Absorption20% is rapidly absorbed from the stomach into

the bloodstream75% is absorbed in the upper part of the small

intestinesRemaining is absorbed along the GI trackAffected by many factors

CarbonationArtificial sweetenersFood in the stomachAlcohol concentrationEventually all the alcohol ingested will be absorbed

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Metabolism and ExcretionEasily moves through most biological

membranesTransported throughout the body via the

bloodstreamMain site for metabolism is the liver2-10% of ingested alcohol is not metabolizedNon-metabolized alcohol excreted by lungs,

kidneys, and sweat glands

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Alcohol Intake and Blood Alcohol ConcentrationBlood Alcohol Concentration (BAC)

The amount of alcohol in a person’s blood, expressed as the percentage of alcohol measured in a deciliter of blood

Affected by Body weight Percentage of body fat Sex Balance of alcohol absorption and rate of metabolism Drinking behavior

Cannot be influenced by Exercise Breathing deeply Eating Drinking coffee Taking other drugs

Metabolism is the same if the person is awake or asleep5


Figure 8.1 Approximate blood concentration and body weight


The Immediate Effects of Alcohol on HealthDependent on the individual, circumstances, amount of

alcohol consumedBAC of .03% -.05% - first effects felt

Light-headedness, relaxation, release of inhibitions, mild euphoria

Higher BAC – negative effects Impaired coordination, speech, intelligence

Alcohol hangoverAlcohol poisoningUsing alcohol with other drugsAlcohol-related injuries and violenceAlcohol and aggressionAlcohol and sexual decision making

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Drinking and DrivingIn 2008

17.5% of adult American males and 9.6% of females drove under the influence of alcohol at least once

Dose-response functionDriving with a BAC of 0.14% is more than 40 times more likely to be involved in a crashWhen greater than 0.14%, the risk of fatal crash is estimated to be 380 times higher

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Figure 8.2 The dose-response relationship between BAC and automobile crashes


The Effects of Chronic Use

Digestive system Alters liver function

“Fatty Liver,” fat accumulation occurs within a few days of heavy drinking

Alcoholic hepatitis Liver cell damage and destruction (cirrhosis)

Pancreas inflammation, pancreatitisCardiovascular system

Moderate doses may reduce the risk of heart disease Higher doses elevates BP, upping risk for stroke and heart

attack, and may weaken heart muscle (cardiac myopathy)Cancer

Mouth, throat, larynx, liver, breast, and esophagusBrain Damage

Brain shrinkage, reduced blood flow, slowed metabolic rates Cognitive impairments: Memory loss, dementia, and compromised problem-solving

Mortality Alcoholics average life expectancy is about 15 years less than

nonalcoholics10


Figure 8.3 The immediate and long-term effects of alcohol abuse


The Effects of Alcohol Use During Pregnancy

Effects depend on dose and stage of pregnancyFetal Alcohol Spectrum Disorder (FASD)

Fetal Alcohol Syndrome (FAS) Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S. Deformities and slowed physical and mental growth Permanent, incurable

Alcohol-related neurodevelopment disorder (ARND) Occurs in 3 times as many babies as FAS Normal appearance Learning and behavioral disorders

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Possible Health Benefits of Alcohol

On average, light to moderate drinkers live longer than both abstainers and heavy users

For those age 35 and younger, odds of dying increase in proportion to the amount consumed, even for light drinkers

Moderate drinking = one drink or less per day for women and one to two drinks per day for menMay lower risk of coronary heart diseaseRaises blood levels of HDL (“good” cholesterol)May lower risk of diabetes, arterial blockages, and

Alzheimer’s13


Alcohol Abuse and DependenceAlcohol abuse is recurrent use that has negative

consequencesAlcohol dependence or alcoholism, includes more

extensive problems, tolerance and withdrawalWarning signs of alcohol dependence

Drinking aloneUsing deliberately and repeatedly as coping mechanismFeeling uncomfortable on occasions when not drinkingEscalating consumptionDrinking heavily in risky situationsGetting drunk regularlyDrinking in the morning or unusual times

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Binge DrinkingThe National Institute on Alcohol Abuse

and Alcoholism defines as:Pattern of alcohol use that brings a person’s

BAC up to 0.08 or above (typically four drinks for a man or three for a woman) within two hours

National Survey on Drug Use and Health defines:Having five or more drinks within about 2

hours, at least once in 30 daysAbout 75% of the alcohol consumption

by adults in the U.S. meets the definition of binge drinking

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AlcoholismPatterns and Prevalence

1. Regular daily intake of large amounts2. Regular heavy drinking limited to weekends3. Long periods of sobriety interspersed with binges

of daily heavy drinking lasting for weeks or months4. Heavy drinking limited to periods of stress

Health Effects Tolerance Withdrawal

Hallucinations DTs (delirium tremens) Memory gaps

Social and Psychological EffectsCauses of Alcoholism

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Treatment ProgramsNo one program works for everyone

AA 12-step program

Al-AnonEmployee assistance programsInpatient hospital rehabilitationPharmacological treatments

Disulfiram (Antabuse) Inhibits the metabolic breakdown

Naltrexone Reduces the craving for alcohol and decreases its pleasant

effects Injectable naltrexone

Single monthly shot Acamprosate (Campral)

Acts on brain pathways related to alcohol abuse

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Gender and Ethnic DifferencesMenWomenAfrican AmericansLatinosAsian AmericansAmerican Indians and Alaska Natives

Helping Someone with an Alcohol Problem

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Who Uses Tobacco & Why? 71 million Americans currently smoke 23% of men and 18% of women smoked in

2008 Nicotine addiction

Nicotine: powerful psychoactive drug The most physically addictive of all psychoactive

drugs Reaches the brain via the bloodstream in seconds

Loss of control Tolerance and withdrawal


Social & Psychological Factors Established habits or cues trigger urge to

smoke Why start in the first place? Nearly 90% of all adult smokers started before

age 18 Average age for starting smokers and smokeless

tobacco users 15 years of age

Rationalizing the dangers


Health Hazards Tobacco adversely affects nearly every part of the

body, including: Brain Stomach Mouth Reproductive organs

Contains hundreds of damaging chemical substances Unfiltered cigarettes = 5 billion particles per cubic

MM 50,000 times more than smoggy urban air

Condensed particles in the cigarette produce a sticky, brown mass called cigarette tar


Carcinogens and PoisonsAt least 43 chemicals in cigarette smoke are linked to development of cancer Carcinogens - directly cause cancer

Benzo(a)pyrene Urethane

Cocarcinogens - combine with other chemicals to cause cancer

FormaldehydePoisonous substances

Arsenic Hydrogen cyanide

Carbon monoxide Concentrations 400 times greater than is considered safe in

industrial workplaces Displaces oxygen in red blood cells

Additives Nearly 600 chemicals Sidestream smoke


“Reduced Harm” Cigarettes As of June 2010, federal law prohibited the

use of terms such as “light” and “mild” or “low” on packaging

Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more Inhale up to 8 times as much tar and nicotine as printed on the label Less likely to quit


Menthol Cigarettes 70% of African Americans smoke menthol

cigarettes African Americans absorb more nicotine and

metabolize it slower than other groups Anesthetizing effect of menthol, means

smokers inhale more deeply and hold smoke longer in the lungs


The Immediate Effects of Smoking Acts on the brain either by exciting or

tranquilizing the nervous system Inhibits formation of urine Constricts blood vessels Accelerates heart rate Elevates blood pressure Depresses hunger contractions Dulls taste buds


The Long-Term Effects of Smoking Cardiovascular Disease

Coronary heart disease (CHD) Atherosclerosis – plaque build up Myocardial infarction Stroke Aortic aneurysm Pulmonary heart disease

Lung cancer and other cancers Chronic obstructive pulmonary disease

Emphysema Chronic bronchitis


Additional Health, Cosmetic, and Economic Concerns Ulcers and heartburn Reproductive health problems Dental diseases Diminished physical senses Injuries and accidents Cosmetic concerns Economic costs


Cumulative Effects Males who smoke before 15 yrs. old and

continue to smoke are half as likely to live to 75 versus those who did not smoke

Smokers spend one-third more time away from their jobs because of illness than nonsmokers

Both men and women show a greater rate of acute and chronic diseases


Other Forms of Tobacco Use Spit (smokeless) tobacco

More than 8.1 million adults 9% of all high school students

Cigar and pipes Popularity highest among white males ages

18-44 with higher-than-average income and education

Women smoking cigars in record numbers Clove cigarettes and bidis

Twice the tar, nicotine, and carbon monoxide


The Effects of Smoking on the Nonsmoker Environmental Tobacco smoke (ETS)

EPA designated ETS as a Class A carcinogen Surgeon General has concluded that there is

no safe level of exposure to ETS


Environmental Tobacco Smoke Mainstream smoke

Smoke exhaled by smokers Sidestream smoke

Smoke from the burning end of a cigarette, cigar, or pipe

85% of smoke in a room comes from sidestream smoke Twice the tar and nicotine, and three times the

benzo(a)pyrene, carbon monoxide, and ammonia Cigar smoke contains up to 30 times more carbon

dioxide


ETS Effects Develop cough, headaches, nasal discomfort, eye

irritation, breathlessness, and sinus problems Allergies will be exacerbated Causes 4,000 deaths due to lung cancer Contributes to about 46,000 heart disease deaths

each year Nonsmokers can be affected by effects of ETS hours

after they leave a smoky environment Carbon monoxide lingers in bloodstream 5 hours later


Infants, Children, and ETS Children exposed to ETS are more likely

to have SIDs Low-birth weight Bronchitis, pneumonia, and asthma Reduced lung function Middle-ear infections Lung cancer, emphysema, and chronic

bronchitis later in life


Smoking and Pregnancy Doubles risk of miscarriage Increases risk of ectopic pregnancy,

premature birth, low birth weight, infant death, behavioral problems, and long term impairments in growth and intellectual development


How A Tobacco User Can Quit Benefits of quitting Options for quitting

“Cold-turkey” Tapering Changes to routines Over-the-counter prescription products Support from family and friends Smoking cessation programs Free telephone quitlines

1-800-QUITNOW

chapter 8 alcohol and tobacco © 2012 mcgraw-hill companies. all rights reserved

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