Uppers, Downers, All Arounders, 8th Edition – Instructors’ Manual Chapter 5-1 Chapter 5 – ALCOHOL Chapter Overview Alcohol is the oldest and most widely used psychoactive drug in the world. Throughout history, societies’ attitudes towards the use of beer, wine, and distilled liquors has wavered between prohibition, temperance, and free use. Presently it is legal in most countries except Islamic ones. This chapter surveys the chemistry of alcohol (the third major downer in addition to opioids and sedative- hypnotics), its pharmacology (including effects on the brain’s neurotransmitters), and physiological/psychological effects. It also reviews the classification of alcohol containing beverages. The absorption and distribution of alcohol via the circulatory system can vary among every drinker and especially between men and women. Metabolism on the other hand eliminates the alcohol at a fairly fixed rate. Blood alcohol concentration (BAC) is correlated to the severity of alcohol effects. The desired effects of alcohol include relaxation, lowering of inhibitions, and a certain high. The effects are very dose dependent. For heavier drinkers and long-term drinkers, alcohol causes more problems than any other psychoactive drug in terms of health effects, legal liabilities, domestic/social violence, and crime. Some of the side effects include decreased alertness, exaggerated emotions, slurred speech, inability to walk, heart problems, cirrhosis of the liver, neurological damage, and drunk-driving arrests. Between 15% and 25% of emergency room patients test positive for alcohol while up to 40% of industrial fatalities involve alcohol. Binge drinking has increased at colleges. Many students bring their high school drinking patterns to college and overdo it in their first year. By their senior year most of the students learn how to control their drinking. Polydrug abuse involving alcohol, mental health related problems, correlation to violent behaviors, impairment of driving, and impact of developing fetuses during pregnancy are some of many problems associated with alcohol abuse. Despite student drinking problems of lowered grades, binge drinking, “second-hand” drinking (exposure of non-drinkers to violence, unwanted sexual advances and vandalism), a movement known as the Amethyst Initiative advocates for the lowering the legal drinking age in the U.S. Drinking patterns vary depending on the culture of the individual. As the members of each community assimilate into American culture, their drinking patterns change. The road to alcoholism can vary depending on family history, childhood abuse, peer pressure, and the availability of alcohol. Brief Chapter Outline OVERVIEW I. INTRODUCTION (5.1) II. HISTORY (also see Chapter 1) (5.2-5.5) A. THE LEGAL DRUG (5.3-5.5) ALCOHOLIC BEVERAGES III. THE CHEMISTRY OF ALCOHOL (5.5) IV. TYPES OF ALCOHOLIC BEVERAGES (5.5-5.8) A. BEER (5.5-5.6) B. WINE (5.6) C. DISTILLED SPIRITS (liquor) (5.6-5.7) D. OTHER ALCOHOLIC BEVERAGES (5.7-5.8) ABSORPTION, DISTRIBUTION, AND METABOLISM V. ABSORPTION AND DISTRIBUTION (5.8-5.9) VI. METABOLISM (5.9-5.10) 1. Blood Alcohol Concentration (BAC) DESIRED EFFECTS, SIDE EFFECTS, AND HEALTH CONSEQUENCES VII. LEVELS OF USE (5.11-5.12) • ABSTENTION (5.11) • EXPERIMENTATION (5.11) • SOCIAL/RECREATIONAL USE (5.11) • HABITUATION (5.11) • ABUSE (5.11) • ADDICTION (5.11) VIII. LOW-TO-MODERATE-DOSE EPISODES (5.12-5.14) A. LOW-TO-MODERATE-DOSE USE: PHYSICAL EFFECTS (5.12-5.13) B. LOW-TO-MODERATE-DOSE USE: PSYCHOLOGICAL EFFECTS (5.13-5.14) C. NEUROTRANSMITTERS AFFECTED BY ALCOHOL (5.14) D. LOW-TO-MODERATE-DOSE USE: SEXUAL EFFECTS (5.14) IX. HIGH-DOSE EPISODES (5.14-5.17) A. HIGH-DOSE USE: PHYSICAL EFFECTS (5.14-5.15) B. HIGH-DOSE USE: MENTAL AND EMOTIONAL EFFECTS (5.15) C. HIGH-DOSE USE: ALCOHOL POISONING (OVERDOSE) (5.15-5.16) D. HIGH-DOSE USE: BLACKOUTS (5.16) E. HIGH-DOSE USE: HANGOVER (5.16) F. HIGH-DOSE USE: SOBERING UP (5.17) X. CHRONIC HIGH-DOSE USE (5.17-5.21) A. DIGESTIVE SYSTEM AND LIVER DISEASE (5.17) B. OTHER DIGESTIVE ORGANS (5.18) C. CARDIOVASCULAR DISEASE (5.18-5.19) D. NERVOUS SYSTEM (5.19-5.20) E. SEXUAL DESIRE AND THE REPRODUCTIVE SYSTEM (5.20) F. CANCER (5.20) G. SYSTEMIC PROBLEMS (5.21-5.22) H. CHRONIC HIGH-DOSE USE: MENTAL/EMOTIONAL EFFECTS (5.21) ADDICTION (alcohol dependence or alcoholism) XI. CLASSIFICATION (5.21-5.23) A. EARLY CLASSIFICATIONS (5.21-5.22) B. E. M. JELLINEK (5.22) C. MODERN CLASSIFICATIONS (5.22) D. THE DISEASE CONCEPT OF ALCOHOLISM (5.23) XII. HEREDITY, ENVIRONMENT, AND PSYCHOACTIVE DRUGS (5.23-5.24) A. HEREDITY (5.23-5.24) B. ENVIRONMENT (5.24) C. PSYCHOACTIVE DRUGS AND BEHAVIORS (5.24) XIII. TOLERANCE, TISSUE DEPENDENCE AND WITHDRAWAL (5.24-5.26) A. TOLERANCE (5.24-5.25) B. WITHDRAWAL (5.25-5.26) XIV. DIRECTIONS IN RESEARCH (5.26-5.27) OTHER PROBLEMS WITH ALCOHOL XV. POLYDRUG ABUSE (5.27) XVI. ALCOHOL AND MENTAL PROBLEMS (5.27-5.28) XVII. ALCOHOL AND PREGNANCY (5.28-5.31) A. MATERNAL DRINKING (5.28-5.29) B. FETAL ALCOHOL SPECTRUM DISORDERS (FASD) (5.29-5.31) C. PATERNAL DRINKING (5.31) XVIII. AGGRESSION AND VIOLENCE (5.31-5.33) XIX. DRIVING UNDER THE INFLUENCE (5.33-5.35) XX. INJURIES AND SUICIDE (5.35) EPIDEMIOLOGY Uppers, Downers, All Arounders, 8th Edition – Instructors’ Manual Chapter 5.5 XXI. PATTERNS OF ALCOHOL CONSUMPTION (5.35-5.37) XXII. POPULATION SUBGROUPS A. MEN AND WOMEN (5.37) B. ADOLESCENTS (5.37-5.38) C. COLLEGE STUDENTS AND LEARNING (5.39-5.40) D. OLDER AMERICANS (5.40-5.41) E. U.S. MILITARY (5.41) F. THE HOMELESS (5.41-5.42) XXIII. ETHNIC POPULATIONS (5.42-5.45) A. AFRICAN AMERICANS (5.42-5.43) B. HISPANICS (5.43) C. ASIAN AND PACIFIC ISLANDERS (APIS) (5.43-5.44) D. AMERICAN INDIANS AND ALASKAN NATIVES (5.44) XXIV. CONCLUSIONS Uppers, Downers, All Arounders, 8th Edition – Instructors’ Manual Chapter 5.6 Extended Outline OVERVIEW I. INTRODUCTION (5.1) Worldwide: • People in most countries, except Islamic countries, drink alcohol (2 billion drinkers); • China’s and India’s alcohol consumption has doubled in recent years. • Russian men consume the equivalent of six to seven bottles of vodka per capita per year. Unfortunately: • More than 2 million people died due to alcohol and 76 million have an alcohol consumption disorder. • About 10% of all diseases and injuries are alcohol-abuse related. In the United States: • Last month about 135 million Americans had at least 1 drink; 17 million of this group are considered heavy drinkers; Unfortunately: • From 25% to 30% of hospital admissions are due to complications from alcohol; and • about half of the murder victims and half of the murderers were drinking alcohol at the time of the crime; half of all rapes involved alcohol. II. HISTORY (also see Chapter 1) (5.2-5.5) Alcohol is the oldest known and, at present, the most widely-used psychoactive drug in the world. Thirsty farmers discovered that grapes as well as the starch in potatoes, rice, corn, fruit, and grains could be fermented into alcohol (beer or wine). The first civilized settlements were created to ensure a regular supply of grain for food and beer, grapes for wine, and poppies for opium. People were drawn to alcohol more for the mental/emotional effects, but eventually the value of alcohol as an antiseptic and medicine was discovered, as well as a dozen other uses. A. THE LEGAL DRUG (5.3-5.5) Uppers, Downers, All Arounders, 8th Edition – Instructors’ Manual Chapter 5.7 Alcohol has been used as a reward, as a food (grain-rich beer), as a cure-all, as a sacrament, as a water substitute, as a social lubricant, as a tranquilizer, and as a source of taxes. • Almost every country has periods in its history when alcohol use was restricted or banned. Those prohibitions were usually rescinded, though they still exist in Islamic countries today. • The Gin Epidemic in England in the 1700s illustrated that poverty, unrestricted use, and industrial despair coupled with the higher concentration of distilled alcohol resulted in abuse and, for many, addiction. As a result, taxes were increased and severe restrictions limited its manufacture. • In colonial America, alcohol was a part of everyday life. The founding fathers realized that the cultivation, manufacture, sale, and taxation of whiskey and rum could finance the American Revolution (and the slave trade). • Official prohibition of alcohol by the U.S. government started in 1920, but widespread flouting of the Prohibition amendment and pressure by those who wanted to drink (and those who wanted the excise taxes) led to the repeal of Prohibition 13 years later. ALCOHOLIC BEVERAGES III. THE CHEMISTRY OF ALCOHOL (5.5) There are hundreds of different alcohols including • ethyl alcohol (ethanol, or grain alcohol) is the least toxic and is found in all alcoholic beverages; • methyl alcohol (methanol or wood alcohol), is a toxic industrial solvent; • isopropyl alcohol (propanol or rubbing alcohol) used in shaving lotion, shellac, antiseptic, etc; • butyl alcohol, used in many industrial processes. Other components produced during fermentation, known as congeners, contribute to the distinctive tastes, aromas, and colors of the various alcoholic beverages. When airborne yeast feeds on the sugars in the mishmash of fruit, grains or vegetables, resulting fermentation process results in ethyl alcohol and carbon dioxide. IV. TYPES OF ALCOHOLIC BEVERAGES (5.5-5.8) • Beer is produced from fermented grain. • Wine is produced from fermented fruit. Uppers, Downers, All Arounders, 8th Edition – Instructors’ Manual Chapter 5.8 • Distilled spirits with different concentrations of alcohol are made from fermented grains, tubers (e.g., potatoes), vegetables, and other plants. They can also be distilled from wine or other fermented beverages.