Remember the characteristics of depressants:
General CNS Depressants
n
Dose-dependent
depression
n
Additive or
hyperadditive interaction with other depressants
n
Cross-tolerance
and cross-dependence
n
Hyperexcitability rebound
n
Low doses
may appear “stimulating” because of depression of inhibitions
n
Withdrawal
can be dangerous
Dose-Dependent Depression
n
Depending
on dose, you may experience
•
calming, relief
from anxiety
•
disinhibition, intoxication
•
sedation
•
sleep
•
general anesthesia
•
coma
•
death
Alcohols
n
beverage alcohol =
ethanol or ethyl alcohol
n
rubbing alcohol =
isopropyl alcohol (also antiseptics, aftershave, window washer fluid)
n
methanol or methyl
alcohol - common industrial/chemical form of alcohol (antifreeze, Sterno, solvents, duplicating fluid)
n
All are
toxic but latter 2 extremely so.
Ethanol
n
Produced by
the action of yeast on a sugary mixture (“fermentation”)
n
Also can
come from starches by stimulating their conversion to sugar
n
Fermentation
yields a max of a 15% alcoholic beverage
n
Distillation
must be used to produce stronger spirits
n
“Proof” = 2
x %
Major Kinds of Alcoholic Beverages and
Their Alcohol Content
Alcohol
n
Small fat
& water soluble molecules easily get into all tissues; no digestion
necessary
n
About 20%
absorbed from stomach, 80% from intestines
n
Stomach
contents, alcohol concentration, carbonation, gender, drug interactions (e.g.
aspirin, antiulcer) all affect absorption
n
Other
factors influencing intoxication: Speed of consumption, individual sensitivity,
expectancy
n
We are
terrible judges of our impairment.
Actions on the Brain
n
Produces
depressant actions by enhancing the effects of GABA
Also decreases effects of excitatory transmitter glutamate.
n
This leads
to the release of 5HT, DA & endorphin, producing rewarding/mood elevating
effects
Typical Effects on the Body
n
Dilation of
blood vessels in skin leading a warm flush (but drop in body temp)
n
Decreased Antidiuretic Hormone leading to increased urination
n
Increased HDLs and lowered LDLs except in
smokers
n
Gastric
irritation
n
Potentiation of
depressant drugs
Typical Effects on Behavior
n
dose-dependent depression
of sensory, motor, cognitive and behavioral
inhibition systems
n
depressed appetite
& sexual function*
n impaired memory, attention, insight and judgment
n
suppression of REM
sleep
Loss of Judgement
and Control
n
Alcohol is
involved in
•
50% of
police arrests
•
50-60 % of
murders
•
40% males
committing sexual assault
•
60-70%
males committing domestic abuse
•
60% of
child molestation & abuse
•
35% of
suicides
Impairment of Driving
n
impairs attention,
judgement, reaction time, alertness, coordination
n
41% of
traffics fatalities involve someone legally intoxicated (60% of teen
fatalities)
n
Even a BAC
of .02-.04à 40% increase in accidents
n
.05-.09
BAC- 4x greater risk than sober
n
.10-.14 BAC- 6-7 x greater
risk
n
>.15 BAC - 25x greater risk
·Expectancy Effects
(balanced placebo design)
·Expectancy Effects
·
In separate
studies, males who expected to receive
alcohol showed:
·
if you expect
to get drunk you act drunker
·
more subjective
arousal & sexual disinhibition whether or not
they got alcohol
·
more aggressive
behavior whether or not they actually received alcohol
Metabolism
n alcohol dehydrogenase converts alcohol into acetaldehyde
n
acetaldehyde dehydrogenase breaks
down acetaldehyde into acetic acid
n
acetic acid is
oxidized into oxygen, carbon dioxide, and calories
n
~1 standard
drink per hour metabolized
Tolerance and Dependence
n
regular use leads
to all types of tolerance
n
adaptation (increased
activity) by the CNS to compensate for the regular presence of depressant
n
withdrawal is
characterized by hyperexcitability
Alcohol Withdrawal
n
Without the
depressant you are overstimulated:
•
tremors (“the
shakes”)
•
agitation, anxiety
(“the jitters”)
•
insomnia - if you
do sleep, vivid nightmares
•
sweating, nausea,
vomiting
•
increased HR &
BP
•
grand mal
seizures in about 10%
Alcohol Withdrawal- the “DT’s”
Delirium tremens
n
Disorientation,
agitation, confusion
hallucinations as well as nightmares
more extreme bodily stimulation (sweating, fever, risk of heart failure as well
as seizures)
Toxic Effects of Alcohol Abuse
n
Liver
damage (fatty liver, hepatitis, cirrhosis)
n
Gastritis, pancreatitis
n
CNS &
peripheral nerve damage
n
Increased
risk of mouth, stomach, intestine, breast, voicebox,
liver cancers (potentiated by smoking)
n
Increased
disease due to immune suppression
n
Increased
mortality due to accidents
Alcohol Poisoning
n
Symptoms:
•
Stuporous or
unconscious; can’t be roused
•
Cool or
damp skin; pale or bluish skin
•
Shallow
slow or irregular breathing <8/min
•
Vomiting
while unconscious
•
Weak rapid
pulse
n
Can be fatal or cause brain damage –
call 911
n
30,000 college
students/yr treated for alc. overdose – untreated,
many die
Fetal Alcohol Syndrome (FAS)
n
caused by
prenatal exposure to alcohol
n
may be subtle
or severe depending on degree & timing of exposure
n
3rd most
common cause of retardation & birth defects (and the most preventable)
n
babies born to
alcoholic mothers are at most risk but symptoms have been seen with as little
as 2 drinks twice a week
Symptoms:
n
Reduced
growth (75% of FAS babies are less than 5 lbs).
This low birth weight is associated with increased infant mortality.
n
Physical
deformities (small head, distinctive facial features, hand abnormalities)
n
CNS
abnormalities causing mental retardation, poor motor skills, a variety of
learning/behavioral disabilities)
n
Developmental
& behavioral problems even in the absence of physical symptoms
n
Partial
symptoms= FAE or ARND
Riddle
n
The Germans
call it “the wailing of cats” (Katzenjammer), the
Italians “out of tune” (stonato), the French “woody
mouth” (gueule de boise),
the Norwegians “workmen in my head” (jeg har tommermen), and the Swedes
“pain in the roots of my hair” (hont i haret). What is it?
Why Do We Experience Hangovers?
n
Mini-withdrawal
from alcohol (rebound hyperexcitability)
n
Toxic
reaction to congeners
n
Toxic
reaction to alcohol & its byproduct acetaldehyde
n
Fatigue,
dehydration, hypoglycemia, loss of vitamins , etc. due
to partying and abnormal sleep following drinking
n
RO 15-4513
the sober-up drug that never made it to market
Congeners:
n
other alcohols,
oils, and organic substances formed during the production of an alcoholic
beverage
n
Congeners
give these beverages their distinctive color, odor and taste
Dual Diagnosis
n
30-50% of
alcoholics meet the criteria for major depression
n
~33% have a
co-existing anxiety disorder
n
~38% meet
criteria for impulse control problem
n
~36% have
another drug dependency
n
~14% have
antisocial personalities
n
~3% are
schizophrenic
Pharmacological Aids to Treatment
n
Use of
other depressants (benzodiazepines; anticonvulsants) during assisted withdrawal
n
Less
commonly, antipsychotics for DTs
n
Anti-relapse:
Antabuse (disulfiram); Zofran (ondansetron)
n
Anti-craving:
Revia (naltrexone), Revex (nalmefene); Campral (acomprosate, approved
7/04)
n
BuSpar (buspirone) – anti-anxiety
n
SSRI or tricyclic antidepressants
Many Modes of Treatment
n
Inpatient vs outpatient
n
Support
groups
•
Alcoholics
Anonymous (faith based – 12 step program)
•
Women for
Sobriety
•
Secular
Organizations for Sobriety (not faith based)
•
Rational
Recovery – based on cognitive-behavioral therapy
n
Half-way
houses
n
Multiple
psychotherapeutic approaches
Self-help Approach
n
Alcoholics
Anonymous
•
Prototype
self-help group, model for others
•
12 Steps
faith-based program Steps
•
Self-examination
& sharing of experiences
•
Abstinence
is a must
•
Sponsorship
by a successful member
•
Building
alcohol-free social relationships
n
Women for
Sobriety – similar in orientation to AA but with special attention to the needs
women face when trying to reach and maintain sobriety
The “Big Book” of AA
Controlled Drinking (non-abstinent)
Strategies
n
Behavioral Self-Control
Training – teaching self-monitoring, goal setting, rate control, drink refusal,
identification of triggers, behavioral contracting, relapse prevention
n
Moderation
Oriented Cue Exposure- extinguishing responses to cues that elicit craving and
drinking
n
Guided
Self-Change – cog-behav motivational intervention
teaching recognition of personal strengths
Rational Recovery
•
Departure
from credo of AA; based on Albert Ellis’s Rational Emotive Therapy and a
humanistic orientation (we are capable of making the choice to be sober)
•
Focuses on
recognizing irrational thoughts and bad personal decisions (not faith based)
•
Does not
accept alcoholism is a disease or that the alcoholic is “powerless”
•
Recovery is
not lifelong- simply involves learning skills to control your thoughts and
behaviors
•
Has moved
away from group format