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Disturbing Trends in and Drug Abuse 2014-15 Notes I. Municipal Court Concerns a. Alcohol Offenses i. Chapter 106 ABC 1. Minor in Possession 2. Minor in Consumption 3. DUI ii. Public Intoxication b. Alcohol Related Offenses c. What Can We Do? II. Disturbing Trends a. Mixing Drugs with Alcohol i. Mixing alcohol and can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people. 1. Some medications—including many popular painkillers and cough, cold, and remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a contains. Ask your pharmacist if you have any questions about how 1 TMCEC Regional Judges Seminar - Mark Goodner

Disturbing Trends in Alcohol and Drug Abuse 2014-15 Notes alcohol might interact with a drug you are taking. 2. Some medicines contain alcohol. Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations. 3. Older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol— in fact, they often need to take more than one of these medications. 4. Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider. ii. E-cigs and Vaportinis 1. Alcohol is inhaled rather than swallowed. 2. Selling points (from the website) a. smooth and flavorful b. absorbed directly into the bloodstream 2 TMCEC Regional Judges Seminar - Mark Goodner

Disturbing Trends in Alcohol and Drug Abuse 2014-15 Notes c. does not go through the digestive tract i. no calories, no carbs, no impurities ii. the effects of consuming alcohol are immediately felt, making it easier to responsibly imbibe d. Vaportinis give more control, shortly after exhaling all of the effects of the alcohol consumed are felt. In contrast, it takes 20 to 30 minutes to feel the full effects of spirits that are swallowed. e. The Vaportini is legal to sell in all states for any establishment with a ìConsumption on Premiseî license. The alcohol consumed through a Vaportini will be detected by a alcohol test. 3. Dangers a. The recommended amount of spirits is 1 ounce. One inhales through the straw and holds their breathe for a moment and then exhales. b. Unlike drinking alcohol, where the liquid is metabolized through one’s , inhaling alcoholic vapors sends straight to 3 TMCEC Regional Judges Seminar - Mark Goodner

Disturbing Trends in Alcohol and Drug Abuse 2014-15 Notes the lungs, the blood stream and ultimately, the brain. c. Leads to rapid intoxication d. Particularly risky for kids because they may not know when to stop inhaling. e. “When people drink, the normal sensation when they get more and more drunk is to vomit. It's your body's way of expelling alcohol is to vomit," he wrote. "However your brain can't expel alcohol, so it's extremely dangerous." iii. Pharming Parties 1. Get-togethers where prescription drugs are exchanged and randomly ingested, in order to become intoxicated. a. Fact or Fiction? iv. Alcohol Energy Drinks 1. Caffeinated alcoholic beverages are premixed beverages that contain not only alcohol but also include and other stimulants. 2. As much caffeine as a large cup of coffee, along with additives like guarana and ginseng that can speed up the central nervous system. 3. High alcohol content, sometimes as high as 12% as compared with 5% for a typical can of beer. 4 TMCEC Regional Judges Seminar - Mark Goodner

Disturbing Trends in Alcohol and Drug Abuse 2014-15 Notes 4. Wide-awake drunkenness, where caffeine masks the feeling of drunkenness but does not decrease actual alcohol-related impairment. As a result, you feel less drunk than you really are, which can lead to consumption of even more alcohol or engaging in risky activities like drunk driving. 5. In 2010 the Food and Drug Administration warned companies that the caffeine added to some of their alcoholic beverages makes the products unsafe. 6. Double The Risk: Wake Forest University School of Medicine researchers found that students who mixed alcohol and energy drinks had double the risk of being hurt or injured, requiring medical attention, driving with an intoxicated driver, being taken advantage of sexually, or taking advantage of another sexually. b. They Put it WHERE? i. Alcohol Enemas 1. Introducing alcohol into the rectum and colon via the anus. This method of alcohol consumption is dangerous because it leads to faster intoxication since the alcohol is absorbed directly into the bloodstream and neutralizes the body's ability to reject the toxin by . 5 TMCEC Regional Judges Seminar - Mark Goodner

Disturbing Trends in Alcohol and Drug Abuse 2014-15 Notes ii. Tampons 1. Vodka-soaked tampons inserted vaginally to get drunk faster and without having booze on your breath. It's known as "slimming." 2. Snopes.com concluded it was false, but a November 2011 report by KPHO Phoenix included interviews with a police officer and doctor who said they had witnessed cases of it. iii. Eyeballing 1. Those who do it claim that it induces feelings of drunkenness at break-neck speeds, providing an instant high. c. Substances Not Intended for Ingestion i. Hairspray ii. Mouthwash iii. Antifreeze III. Resources a. www.niaaa.nih.gov b. http://www.madd.org/ c. http://www.drugabuse.gov/

6 TMCEC Regional Judges Seminar - Mark Goodner

Alcohol Facts and Statistics

Alcohol Use in the United States: »» Prevalence of Drinking: In 2012, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 71 percent reported that they drank in the past year; 56.3 percent reported that they drank in the past month.1 »» Prevalence of Binge Drinking and Heavy Drinking: In 2012, 24.6 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 7.1 percent reported that they engaged in heavy drinking in the past month.2

Alcohol Use Disorders (AUDs) in the United States: »» Adults (ages 18+): Approximately 17 million adults ages 18 and older (7.2 percent of this age group) had an AUD in 2012. This includes 11.2 million men (9.9 percent of men in this age group) and 5.7 million women (4.6 percent of women in this age group).3 • About 1.4 million adults received treatment for an AUD at a specialized facility in 2012 (8.4 percent of adults in need). This included 416,000 women (7.3 percent of women in need) and 1.0 million men (8.9 percent of men in need).4 »» Youth (ages 12–17): In 2012, an estimated 855,000 adolescents ages 12–17 (3.4 percent of this age group) had an AUD. This number includes 444,000 females (3.6 percent) and 411,000 males (3.2 percent).5 • An estimated 76,000 adolescents received treatment for an AUD at a specialized facility in 2012 (8.9 percent of adolescents in need). This included 28,000 females (6.3 percent of adolescent females in need) and 48,000 males (11.7 percent of adolescent males in need).6

Alcohol-Related Deaths: »» Nearly 88,0007 people (approximately 62,000 men and 26,000 women8) die from alcohol- related causes annually, making it the third leading preventable cause of death in the United States.7 »» In 2012, alcohol-impaired-driving fatalities accounted for 10,322 deaths (31 percent of overall driving fatalities).9

NIH . . . Turning Discovery Into Health® National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov • 301.443.3860 Economic Burden: Definitions In 2006, alcohol misuse problems cost the »» Alcohol Use Disorder (AUD): AUDs are medical 10 United States $223.5 billion. conditions that doctors diagnose when a patient’s drinking causes distress or harm. The fourth edition »» Almost three-quarters of the total cost of of the Diagnostic and Statistical Manual (DSM–IV), alcohol misuse is related to binge drinking.10 published by the American Psychiatric Association, described two distinct disorders—alcohol abuse Global Burden: and alcohol dependence—with specific criteria for each. The fifth edition, DSM–5, integrates the »» In 2012, 3.3 million deaths, or 5.9 percent two DSM–IV disorders, alcohol abuse and alcohol of all global deaths (7.6 percent for men dependence, into a single disorder called alcohol and 4 percent for women), were attributable use disorder, or AUD, with mild, moderate, and to alcohol consumption.11 severe subclassifications. Binge Drinking: »» Alcohol contributes to over 200 diseases »»NIAAA defines binge drinking as a pattern of and injury-related health conditions, most drinking that brings blood alcohol concen- notably alcohol dependence, liver cirrhosis, tration (BAC) levels to 0.08 g/dL. This typically 12 occurs after 4 drinks for women and 5 drinks for cancers, and injuries. In 2012, alcohol men—in about 2 hours.33 accounted for 5.1 percent of disability »»The Substance Abuse and Mental Health adjusted life years (DALYs) worldwide.11 Services Administration (SAMHSA), which conducts the annual National Survey on Drug »» Globally, alcohol misuse is the fifth leading Use and Health (NSDUH), defines binge risk factor for premature death and disability; drinking as drinking 5 or more alcoholic drinks among people between the ages of 15 and on the same occasion on at least 1 day in the past 30 days.34 49, it is the first.13 Heavy Drinking: SAMHSA defines heavy drinking Family Consequences: as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days. »» More than 10 percent of U.S. children NIAAA’s Definition of Drinking at Low Risk for live with a parent with alcohol problems, Developing an AUD: For women, low-risk drinking according to a 2012 study.14 is defined as no more than 3 drinks on any single day and no more than 7 drinks per week. For men, Underage Drinking: it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA »» Prevalence of Underage Alcohol Use: research shows that only about 2 in 100 people who drink within these limits have an AUD. • Prevalence of Drinking: 2 out of 5 Substance Use Treatment at a Specialty Facility: 15-year-olds report that they have had Treatment received at a hospital (inpatient only), at least 1 drink in their lives.15 In 2012, rehabilitation facility (inpatient or outpatient), about 9.3 million people ages 12–20 or mental health center to reduce alcohol use, (24.3 percent of this age group) reported or to address medical problems associated with alcohol use. drinking alcohol in the past month Alcohol-Impaired-Driving Fatality: A fatality (24.7 percent of males and 24 percent in a crash involving a driver or motorcycle rider of females).16 (operator) with a BAC of 0.08 g/dL or greater. • Prevalence of Binge Drinking: Disability Adjusted Life Years (DALYs): A measure of years of life lost or lived in less than full health. Approximately 5.9 million people Underage Drinking: Alcohol use by anyone (about 15 percent) ages 12–20 were under the age of 21. In the United States, the legal binge drinkers (16.5 percent of males drinking age is 21. and 14 percent of females).16

NIH . . . Turning Discovery Into Health® National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov • 301.443.3860 • Prevalence of Heavy Drinking: Approximately 1.7 million people (about 4.3 percent) ages 12–20 were heavy drinkers (5.2 percent of males and 3.4 percent of females).16 »» Consequences of Underage Alcohol Use: • Research indicates that alcohol use during the teenage years could interfere with normal adolescent brain development and increase the risk of developing an AUD. In addition, underage drinking contributes to a range of acute consequences, including injuries, sexual assaults, and even deaths.17

Alcohol and College Students: »» Prevalence of Alcohol Use: • Prevalence of Drinking: In 2012, 60.3 percent of college students ages 18–22 drank alcohol in the past month compared with 51.9 percent of same-age peers not in college.18 • Prevalence of Binge Drinking: 40.1 percent of college students ages 18–22 engaged in binge drinking (5 or more drinks on an occasion) in the past month compared with 35 percent of same-age peers not in college.19 • Prevalence of Heavy Drinking: 14.4 percent of college students ages 18–22 engaged in heavy drinking (5 or more drinks on an occasion on 5 or more occasions per month) in the past month compared with 10.7 percent of same-age peers not in college.20 »» Consequences—Researchers estimate that each year: • 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor-vehicle crashes.21 • 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.21 • 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or date rape.21 • Roughly 20 percent of college students meet the criteria for an AUD.22 • About 1 in 4 college students report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.23

Alcohol and : »» The prevalence of Fetal Alcohol Syndrome (FAS) in the United States was estimated by the Institute of Medicine in 1996 to be between 0.5 and 3.0 cases per 1,000.24 »» More recent reports from specific U.S. sites found the prevalence of ASF to be 2 to 7 cases per 1,000,24 and the prevalence of Fetal Alcohol Spectrum Disorders (FASD) to be as high as 20 to 50 cases per 1,000.25

Alcohol and the Human Body: »» Among all cirrhosis deaths in 2009, 48.2 percent were alcohol related. The proportion of alcohol-related cirrhosis was highest (70.6 percent) among decedents ages 35–44.26

NIH . . . Turning Discovery Into Health® National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov • 301.443.3860 »» In 2009, alcohol-related was the primary cause of almost 1 in 3 liver transplants in the United States.27 »» Alcohol has been identified as a risk factor for the following types of cancer: mouth, esophagus, pharynx, larynx, liver, and breast.28

Health Benefits of Moderate Alcohol Consumption: »» Moderate alcohol consumption, according to the Dietary Guidelines for Americans, is up to 1 drink per day for women and up to 2 drinks per day for men.29 »» Moderate alcohol consumption may have beneficial effects on health. These include decreased risk for heart disease and mortality due to heart disease, decreased risk of ischemic (in which the arteries to the brain become narrowed or blocked, resulting in reduced blood flow), and decreased risk of diabetes.30 »» In most Western countries where chronic diseases such as coronary heart disease (CHD), cancer, stroke, and diabetes are the primary causes of death, results from large epidemiological studies consistently show that alcohol reduces mortality, especially among middle-aged and older men and women—an association which is likely due to the protective effects of moderate alcohol consumption on CHD, diabetes, and ischemic stroke.31 »» It is estimated that 26,000 deaths were averted in 2005 because of reductions in heart disease, stroke, and diabetes from the benefits attributed to moderate alcohol consumption.32 »» Expanding our understanding of the relationship between moderate alcohol consumption and potential health benefits remains a challenge, and although there are positive effects, alcohol may not benefit everyone who drinks moderately.

For more information, please visit: www.niaaa.nih.gov

1  Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs43to84-2012.htm#Tab2.71B 2 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs43to84-2012.htm#Tab2.46B 3 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.8A 4 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.32A 5 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.5A 6 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.29A 7 Centers for Disease Control and Prevention. Alcohol use and health. Available at: http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm 8 Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Available at: http://apps.nccd.cdc.gov/DACH_ARDI/ Default/Report.aspx?T=AAM&P=f6d7eda7-036e-4553-9968-9b17ffad620e&R=d7a9b303-48e9-4440-bf47-070a4827e1fd&M=AD96A9C1-285A-44D2-B76D- BA2AE037FC56&F=&D= 9 National Highway Traffic Safety Administration. 2012 Motor vehicle crashes: Overview. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811856.pdf 10 Centers for Disease Control and Prevention. Excessive drinking costs U.S. $223.5 Billion. Available at: http://www.cdc.gov/features/alcoholconsumption/ 11 World Health Organization. Global status report on alcohol and health, p. XIV. 2014 ed. Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/ msb_gsr_2014_1.pdf?ua=1 12 World Health Organization. Global status report on alcohol and health, p. XIII. 2014 ed. Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/ msb_gsr_2014_1.pdf?ua=1 13 Lim, S.S.; Vos, T.; Flaxman, A.D.; et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260, 2012. PMID:23245609 http://www.sciencedirect.com/ science/article/pii/S0140673612617668 14 Substance Abuse and Mental Health Services Administration (SAMHSA). Data spotlight: Over 7 million children live with a parent with alcohol problems. 2012. Available at: http://www.samhsa.gov/data/spotlight/Spot061ChildrenOfAlcoholics2012.pdf 15 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs1to42-2012.htm#Tab2.15B

NIH . . . Turning Discovery Into Health® National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov • 301.443.3860 16 Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2012 National Survey on Drug Use and Health: Summary of national findings. NSDUH Series H-46., HHS Publication No. (SMA) 13–4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Available at: http://www. samhsa.gov/data/NSDUH/2012SummNatFindDetTables/index.aspx?from=carousel&position=1&date=09052013. 17 National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert, No. 67 “Underage Drinking,” 2006. Available at: http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm 18 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs55to107-2012.htm#Tab6.88B 19 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs55to107-2012.htm#Tab6.89B 20 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/ data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs55to107-2012.htm#Tab6.90B 21 Hingson, R.W.; Zha, W.; and Weitzman, E.R. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18–24, 1998-2005. Journal of Studies on Alcohol and Drugs (Suppl. 16):12–20, 2009. PMID:19538908 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701090/ 22 Blanco, C.; Okuda, M.; Wright, C. et al. Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry 65(12):1429–1437, 2008. PMID: 19047530 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734947/ 23 Wechsler, H.; Dowdall, G.W.; Maenner, G.; et al. Changes in binge drinking and related problems among American college students between 1993 and 1997: Results of the Harvard School of Public Health College Alcohol Study. Journal of American College Health 47(2):57–68, 1998. PMID: 9782661 http://www.tandfonline.com/doi/ pdf/10.1080/07448489809595621 24 Stratton, K., Howe, C., Battaglia, F., eds. 1996 Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: Institute of Medicine National Academy Press, 1996. 25 May, P.A.; Gossage, J.P.; Kalberg, W.O.; et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Developmental Disabilities Research Reviews 15(3):176–192, 2009. PMID:19731384 http://onlinelibrary.wiley.com/doi/10.1002/ddrr.68/pdf 26 Yoon, Y.H., and Yi, H.Y. Surveillance Report #93: Liver Cirrhosis Mortality in the United States, 1970–2009. Bethesda, MD: NIAAA, 2012. Available at: http://pubs.niaaa.nih. gov/publications/Surveillance93/Cirr09.htm 27 Singal, A.K.; Guturu, P.; and Hmoud, B.; et al. Evolving frequency and outcomes of liver transplantation based on etiology of liver disease. Transplantation 95(5):755–760, 2012. PMID:23370710 (Please note: The “almost 1 in 3” figure aggregates the total number of transplants necessitated by alcoholic cirrhosis, alcoholic liver disease plus C virus infection, and 40 percent of transplants necessitated by hepatocellular carcinoma.) 28 National Cancer Institute. Cancer Trends Progress Report, 2009–2010 Update. Available at: http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid= 91&coid=906&mid 29 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, p. 31. Available at: http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf 30 U.S. Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, pp. 355, 359. Available at: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/2010DGACReport-camera-ready-Jan11-11.pdf 31 U.S. Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, pp. 355–356. Available at: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/2010DGACReport-camera-ready-Jan11-11.pdf 32 Danaei, G.; Ding, E.L.; Mozaffarian, D.; et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Medicine 6(4):1–23, 2009. PMID: 19399161 33 National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIAAA Council Approves Definition of Binge Drinking. NIAAA Newsletter Number 3, Winter 2004. Available at: http://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf 34 Substance Abuse and Mental Health Services Administration (SAMHSA). Binge Drinking: Terminology and Patterns of Use. Available at: http://captus.samhsa.gov/ access-resources/binge-drinking-terminology-and-patterns-use

NIH . . . Turning Discovery Into Health® National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov • 301.443.3860 July 2014 Harmful Interactions

mixing alcohol with medicines May cause DROWSINESS. ALCOHOL USE CARE or dangerous machinery.

may intensify this effect. when operating a car Harmful interactions

You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause and vomiting, , drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might can result. The list gives the brand never have suspected can react with name by which each medicine is alcohol, including many medications commonly known (for example, which can be purchased “over-the- Benadryl®) and its generic name or counter”—that is, without a prescription. active ingredient (in Benadryl®, this Even some herbal remedies can is ). The list have harmful effects when combined presented here does not include all with alcohol. the medicines that may interact This pamphlet lists medications harmfully with alcohol. Most im- that can cause harm when taken with portant, the list does not include all alcohol and describes the effects that the ingredients in every medication.

1 Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

DID YOU KNOW…

Mixing alcohol and medicines can be harmful. Alcohol, like some medi- cines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify SOME MEDICINES these effects. You may have trouble CONTAIN ALCOHOL concentrating or performing me- Certain medicines contain up to 10 chanical skills. Small amounts of percent alcohol. Cough syrup and alcohol can make it dangerous to laxatives may have some of the high- drive, and when you mix alcohol with est alcohol concentrations. certain medicines you put yourself at even greater risk. Combining alcohol ALCOHOL AFFECTS with some medicines can lead to falls WOMEN DIFFERENTLY and serious injuries, especially among Women, in general, have a higher older people. risk for problems than men. When a MEDICINES MAY HAVE woman drinks, the alcohol in her MANY INGREDIENTS bloodstream typically reaches a higher level than a man’s even if both are Some medications—including many drinking the same amount. This is popular painkillers and cough, cold, and allergy remedies—contain more because women’s bodies generally than one ingredient that can react have less water than men’s bodies. Be- with alcohol. Read the label on the cause alcohol mixes with body water, medication bottle to find out exactly a given amount of alcohol is more what ingredients a medicine contains. concentrated in a woman’s body than Ask your pharmacist if you have any in a man’s. As a result, women are questions about how alcohol might more susceptible to alcohol-related interact with a drug you are taking. damage to organs such as the liver.

2 OLDER PEOPLE FACE TIMING IS IMPORTANT GREATER RISK Alcohol and medicines can interact Older people are at particularly harmfully even if they are not taken high risk for harmful alcohol– at the same time. medication interactions. Aging slows the body’s ability to break down REMEMBER... alcohol, so alcohol remains in a Mixing alcohol and medicines puts person’s system longer. Older people you at risk for dangerous reactions. also are more likely to take a Protect yourself by avoiding alcohol if medication that interacts with you are taking a medication and don’t alcohol—in fact, they often need know its effect. To learn more about to take more than one of these a medicine and whether it will inter- medications. act with alcohol, talk to your phar- macist or other health care provider. Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol / • Alavert® Drowsiness, colds/flu • Atarax® ; • Benadryl® Diphenhydramine increased risk • Clarinex® for overdose • Claritin®, Loratadine Claritin-D® • Dimetapp® Cold & Allergy • Sudafed® Chlorpheniramine Sinus & Allergy • Triaminic® Chlorpheniramine Cold & Allergy • Tylenol® Chlorpheniramine Allergy Sinus • Tylenol® Chlorpheniramine Cold & Flu • Zyrtec®

Angina • Isordil® Isosorbide Rapid heartbeat, (chest ), Nitroglycerin sudden changes coronary in blood pressure, heart disease dizziness, fainting

3 Commonly Used Medicines (Both Prescription and Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol Anxiety • Ativan® Drowsiness, dizziness; and • BuSpar® Buspirone increased risk for epilepsy • Klonopin® overdose; slowed or • Librium® difficulty breathing; • Paxil® impaired motor control; • Valium® unusual behavior; • Xanax® memory problems • Herbal preparations Liver damage, ( Kava) drowsiness

Arthritis • Celebrex® Ulcers, stomach • Naprosyn® Naproxen bleeding, liver • Voltaren® Diclofenac damage

Attention and • Adderall® / Dizziness, drowsiness, concentration dextro-amphetamine impaired concentration (Attention • Concerta®, (methylphenidate, deficit/ Ritalin® dexmethylphenidate); hyperactivity • Dexedrine® Dextroamphetamine possible increased risk disorder) • Focalin® Dexmethylphenidate for heart problems • Strattera® (amphetamine, dex- • Vyvanse® Lisdexamfetamine troamphetamine, lis- dexamfetamine); liver damage (atomoxetine) Blood clots • Coumadin® Warfarin Occasional drinking may lead to internal bleeding; heavier drinking also may cause bleeding or may have the opposite effect, resulting in possible blood clots, , or heart attacks Cough • Delsym®, Dextromethorpan Drowsiness, dizziness; Robitussin Cough® increased risk • Robitussin A–C® + for overdose

4 Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol

Depression • Abilify® Aripriprazone Drowsiness, dizziness; • Anafranil® increased risk for overdose; • Celexa® Citalopram increased feelings of • Clozaril® depression or hopelessness • Cymbalta® Duloxetine (all medications); impaired • Desyrel® motor control (, • Effexor® Venlafaxine ); increased • Elavil® alcohol effect (bupropion); • Geodon® liver damage (duloxetine) • Invega® • Lexapro® Escitalopram Monoamine oxidase • Luvox® Fluvoxamine inhibitors (MAOIs), • Nardil® Phenelzine such as tranylcypromine • Norpramin® and phenelzine, when • Parnate® Tranylcypromine combined with alcohol, • Paxil® Paroxetine may result in serious heart- • Pristiq® Desevenlafaxine related side effects. Risk for • Prozac® dangerously high blood • Remeron® Mirtazapine pressure is increased when • Risperdal® MAOIs are mixed with • Seroquel® Quetiapine tyramine, a byproduct • Serzone® found in beer and red wine • Symbyax® Fluoxetine/ • Wellbutrin® Bupropion • Zoloft® Sertraline • Zyprexa Olanzapine • Herbal preparations (St. John’s Wort)

Diabetes • Diabinese® Abnormally low blood sugar • Glucotrol® levels, reaction • Glucophage® (nausea, vomiting, • Glynase®, Glyburide , rapid heartbeat, DiaBeta®, sudden changes in blood Micronase® pressure); symptoms of • Orinase® nausea and weakness may • Tolinase® occur (metformin) Enlarged • Cardura® Doxazosin Dizziness, light prostate • Flomax® Tamsulosin headedness, fainting • Hytrin® Terazosin • Minipress® Prazosin 5 Commonly Used Medicines (Both Prescription and Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol Heartburn, • Axid® Rapid heartbeat; increased indigestion, • Reglan® alcohol effect; sudden sour stomach • Tagamet® changes in blood pressure • Zantac® (metoclopramide)

High blood • Accupril® Dizziness, fainting, pressure • Calan® drowsiness; heart • Capozide® problems such as changes • Cardura® Doxazosin in the heart’s regular • Catapres® Clonidine heartbeat (arrhythmia) • Cozaar® • Hytrin® Terazosin • Lopressor® HCT Hydrochlorothiazide • Lotensin® Benzapril • Minipress® Prazosin • Norvasc® mesylate • Prinivil®, Zestril® • Vaseretic®

High • Advicor® + Liver damage (all • Altocor® Lovastatin medications); increased • Crestor® Rosuvastatin flushing and itching • Lipitor® Atorvastatin (niacin), increased • Mevacor® Lovastatin stomach bleeding • Niaspan® Niacin (pravastatin + ) • Pravachol® Pravastatin • Pravigard™ Pravastatin + Aspirin • Vytorin™ Ezetimibe + • Zocor® Simvastatin

Infections • Acrodantin® Nitrofurantoin Fast heartbeat, sudden • Flagyl® Metronidazole changes in blood • Grisactin® pressure; stomach pain, • Nizoral® upset stomach, vomiting, • Nydrazid® Isoniazid headache, or flushing or • Seromycin® redness of the face; liver • Tindamax® Tinidazole damage (isoniazid, • Zithromax® Azithromycin ketoconazole) 6 Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol Mood • Depakene®, Valproic acid Drowsiness, dizziness; stabilizers Depakote® tremors; increased risk for • Eskalith®, Lithium side effects, such as rest- Eskalith®CR, lessness, impaired motor Lithobid control; loss of appetite; stomach upset; irregular bowel movement; joint or muscle pain; depression; liver damage (valproic acid)

Muscle pain • Flexeril® Drowsiness, dizziness; • Soma® increased risk of seizures; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems

Nausea, • Antivert® Drowsiness, dizziness; motion • Dramamine® increased risk for overdose sickness • Phenergan®

Pain • Advil® Stomach upset, bleeding (such as • Aleve® Naproxen and ulcers; liver damage muscle ache, • Excedrin® Aspirin, (acetaminophen); rapid minor arthritis Acetaminophen heartbeat pain), fever, • Motrin® Ibuprofen inflammation • Tylenol® Acetaminophen

Seizures • Dilantin® Drowsiness, dizziness; • Horizant®, increased risk of seizures Neurontin® (, phenytoin); • Keppra® Levetiracetam unusual behavior and • Klonopin® Clonazepam changes in mental health (such as thoughts of suicide) () • Lamictal® • Lyrica® • Tegretol® • Topamax® Topiramate • Trileptal® 7 Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol

Severe pain • Darvocet–N® Propoxyphene Drowsiness, dizziness; from injury, • Demerol® Merepidine increased risk for overdose; postsurgical • Fiorinal® + codeine slowed or difficulty care, oral with codeine breathing; impaired motor surgery, • Percocet® Oxycodone control; unusual behavior; • Vicodin® Hydrocodone memory problems

Sleep • Ambien® Drowsiness, sleepiness, problems • Lunesta™ dizziness; slowed or • Prosom™ difficulty breathing; impaired • Restoril® motor control; unusual • Sominex® Diphenhydramine behavior; memory problems • Unisom® • Herbal Increased drowsiness preparations (chamomile, , lavender)

8 Additional resources

MedlinePlus U.S. Food and Drug Administration A service of the U.S. National Library Center for Drug Evaluation and Research of Medicine and the National Institutes http://www.fda.gov/cder of Health. http://www.nlm.nih.gov/medlineplus/ Phone numbers: druginformation.html • Main FDA for general inquiries: 1–888–INFO–FDA (1–888–463–6332) Provides information on prescription and • Drug Information: 301–827–4570 over-the-counter medications. • To submit a report about Adverse Drug Reaction: Medwatch: National Institute on Alcohol Abuse 1–800–FDA–1088 and Alcoholism http://www.niaaa.nih.gov Provides information on prescription Phone number: 301–443–3860 and over-the-counter medications, consumer drug information, and reports Makes available free informational and publications. materials on alcohol use, alcohol abuse, and alcoholism.

9 NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM NIH . . . Turning Discovery Into Health

NIH Publication No. 13–5329 Published 2003 Revised 2014