Alcohols

• beverage alcohol = ethanol or ethyl alcohol

• rubbing alcohol = isopropyl alcohol

• methanol or methyl alcohol - common industrial/chemical form of alcohol

• All are toxic but some are more toxic!

Alcohol

• Small fat and water soluble molecules that easily get into all tissues

• No digestion necessary

• About 20% absorbed from stomach, 80% from intestines

• Stomach contents affect absorption

Alcohol

• Produced by the action of yeast on a sugary mixture (“fermentation”)

• Also can come from starches by stimulating their conversion to sugar

• Fermentation yields a max of a 15% alcoholic beverage

• Distillation must be used to produce stronger spirits

Factors Affecting Intoxication

• Concentration and quantity of beverage

• Speed of consumption

• Stomach contents

• Carbonation

• Individual physiology & sensitivity

• Expectancy

• Drug interactions

• We are terrible judges of our impairment.

Actions on the Brain

• Facilitates the action of GABA

• Blocks receptors for glutamate

• Indirectly augments 5HT (mood) & DA (reward system)

• At high doses alters neuron’s cell membrane, depressing nerve impulses

Typical Effects on the Body

• Dilation of blood vessels in skin leading a warm flush (but drop in body temp)

• Decreased Antidiuretic Hormone leading to increased urination

• Increased HDLs and lowered LDLs except in smokers

• Gastric irritation

• Potentiation of depressant drugs

Typical Effects on Behavior

• dose-dependent depression of sensory, motor, cognitive and behavioral inhibition systems

• depressed appetite & sexual function

• impaired memory, attention, insight and judgment

• suppression of REM sleep

·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

Congeners:

• other alcohols, oils, and organic substances formed during the production of an alcoholic beverage

• Congeners give these beverages their distinctive color, odor and taste

• Congeners are 1 of the factors influencing hangover

Metabolism

• alcohol dehydrogenase converts alcohol into acetaldehyde

• aldehyde dehydrogenase breaks down acetaldehyde into acetic acid

• acetic acid is oxidized into oxygen, carbon dioxide, and calories

• ~1 average drink per hour metabolized

Riddle

• 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 “pian in the roots of my hair” (hont I haret). What is it?

Why Do We Experience Hangovers?

• Mini-withdrawal from alcohol (rebound hyperexcitability)

• Toxic reaction to congeners

• Toxic reaction to alcohol & its byproduct acetaldehyde

• Fatigue, dehydration, hypoglycemia, loss of vitamins , etc. due to partying

Tolerance and Dependence

• regular use leads to all types of tolerance

• adaptation (increased activity) by the CNS to compensate for the regular presence of depressant

• withdrawal is characterized by hyperexcitability

Toxic Effects

• Liver damage (fatty liver, hepatitis, cirrhosis)

• Gastritis, pancreatitis

• CNS & peripheral nerve damage

• Increased risk of mouth, stomach, intestine, breast, voicebox, liver cancers (potentiated by smoking)

• Increased disease due to immune suppression

• Increased mortality due to accidents

Loss of Judgement and Control

• 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

• impairs attention, judgement, reaction time, alertness, coordination

• 41% of traffics fatalities involve someone legally intoxicated (60% of teens)

• .05-.09 BAL - 4x greater risk than sober

• .10-.14 BAL- 6-7x greater risk

• >.15 - 25x the risk

Fetal Alcohol Syndrome (FAS)

• caused by prenatal exposure to alcohol

• may be subtle or severe depending on degree & timing of exposure

• 3rd most common cause of retardation & birth defects (and the most preventable)

• babies born to alcoholic mothers are at most risk but symptoms have been seen with as little as 2 drinks twice a week

Symptoms:

• Reduced growth (75% of FAS babies are less than 5 lbs). This low birth weight is associated with increased infant mortality.

• Physical deformities (small head, distinctive facial features, hand abnormalities)

• CNS abnormalities causing mental retardation, poor motor skills, a variety of learning/behavioral disabilities)

• Developmental & behavioral problems even in the absence of physical symptoms

• Partial symptoms= FAE or ARND

Alcohol Withdrawal

• 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

• Disorientation, agitation, confusion
hallucinations as well as nightmares
more extreme bodily stimulation (sweating, fever, risk of heart failure as well as seizures)

Pharmacological Aids to Treatment

• Use of other depressants (benzodiazepines; anticonvulsants) during assisted withdrawal

• Less commonly, antipsychotics for DTs

• Anti-relapse: Antabuse (disulfiram)

• Anti-craving: Revia (naltrexone), Revex (nalmefene); acomprosate

• BuSpar (buspirone) – anti-anxiety

• SSRI antidepressants

Dual Diagnosis

• 30-50% of alcoholics meet the criteria for major depression

• ~33% have a co-existing anxiety disorder

• ~38% meet criteria for impulse control problem

• ~36% have another drug dependency

• ~14% have antisocial personalities

• ~3% are schizophrenic

Many Modes of Treatment

• Inpatient vs outpatient

• Support groups

– Alcoholics Anonymous

– Women for Sobriety

– Secular Organizations for Sobriety

– Rational Recovery

• Half-way houses

• Multiple psychotherapeutic approaches

Self-help Approach

• 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

• 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

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

– Internet course: www.rational.org/recovery

Currently a large federally funded controlled comparison of pharmacological and/or behavioral treatments of alcohol abuse going on.