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PSY 320 - Chapter 9 - Alcohol

by: Elliana

PSY 320 - Chapter 9 - Alcohol PSY 320

Marketplace > University of Miami > Psychlogy > PSY 320 > PSY 320 Chapter 9 Alcohol
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Combined lecture & textbook notes on alcohol
Drugs & Behavior
Dr. Marc Gellman
Class Notes
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This 11 page Class Notes was uploaded by Elliana on Thursday February 18, 2016. The Class Notes belongs to PSY 320 at University of Miami taught by Dr. Marc Gellman in Spring 2015. Since its upload, it has received 10 views. For similar materials see Drugs & Behavior in Psychlogy at University of Miami.


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Date Created: 02/18/16
PSY 320 Drugs & Behavior Chapter 9 Alcohol History • Humans have been consuming alcohol da▯ng back to hominids (ancestors to homo sapiens) ◦ Perhaps as far back as 8000 BC • Second most widely consumed beverage ◦ According to surveys, more than half of US individuals 12 yrs + have consumed alcohol within the last 30 days • Dis▯lla▯on process discovered in Arabia around AD 800 • Introduced into Europe in about 10th century • U.S. began on a large scale at the end of 18th century Before American Revolu▯on • Ppl drank more alcohol than water ◦ Water from clean sources was rare ◦ Drunkenness viewed as misuse of posi▯ve product A▯er American Revolu▯on • Alcohol demonized & viewed as the cause of problems • First psychoac▯ve substance to become demonized in American culture ◦ Crime associated w. increasing influx of immigrants Temperance Movement • Benjamin Rush (1745 - 1813) ◦ Founding father : deve i l◦e B • Heavy drinking = health problems • Alcohol use damages morality • Alcohol addic▯on = a disease • Temperance socie▯es ◦ Ini▯ally promoted moderate consump▯on of beer/wine & abs▯nence from dis▯lled spirits ◦ Later promoted total abs▯nence ◦ Became fashionable to "take the pledge" • Grass-Roots temperance movements traveled coast to coast • States began passing prohibi▯on laws in 1851 ◦ Banning sale of alcohol • 18th Amendment (1919) banned sale of alcohol ◦ Went into effect 1920 ◦ Only lasted 13 yrs ◦ Ppl s▯ll drank illegally in speakeasies & private clubs ◦ Legally thru purchase of patent medicines containing alcohol ◦ Enforcement difficult & expensive ◦ Hospital admissions & deaths from alcohol sharply declined ◦ Alcohol dependence & related deaths remained lower than before prohibi▯on • Huge increases in racketeering & smuggling alcohol (criminal ac▯vity) • Thousands poisoned by homemade alcohol • Support for prohibi▯on dwindled 1 PSY 320 Drugs & Behavior • Prohibi▯on repealed by 21st Amendment (1933) ◦ Alcohol taxes major source of revenue ◦ Concerns that widespread disrespect for Prohibi▯on laws encouraged general sense of lawlessness ◦ Alcohol sales & consump▯on increased, returned to pre-Prohibi▯on levels a▯er WW2 ◦ Major boost to American economy Regula▯on a▯er 1933 • Laws slowly relaxed un▯l last dry state, Mississippi, became "wet" in 1966 • 1970s drinking age lowered to 18-19 in 30 states ◦ Raised back up to 21 following concerns over increased drinking rates & alcohol-related traffic accidents • Taxa▯on: ◦ Federal & state taxes, licensing fees = about half the price of an alcohol beverage ◦ When taxes increase, consump▯on slightly decreases Plant • Class of chemical: Ethyl Alcohol ◦ Body can tolerate specific amounts Manufacture Fermenta▯on Process: • Fermenta▯on - The produc▯on of alcohol from sugars through the ac▯on of yeasts ◦ Cereal grains containing starch are converted to sugar by malt before fermenta▯on begins ◦ Fruits + yeast = fermenta▯on begins • Fruits naturally contain sugar ◦ Yeast has a limited tolerance for alcohol • When alcohol concentra▯on reaches 15%, yeast dies & fermenta▯on ceases ◦ Beer - Barley malt added to cereal grains • Hops added w. yeast to give flavor ◦ Wine - From fermented grapes • One of the greatest diversi▯es in taste • May be for▯fied to bring alcohol content closer to 20% Dis▯lla▯on • Evapora▯on & condensa▯on of alcohol vapors to produce beverages w. alcohol content higher than 15% • Proof - A measure of a beverage's alcohol content ◦ 2x the percentage of alcohol by weight ◦ 90 proof whiskey is 45% alcohol • Dis▯lled Spirits - Grain neutral spirits ◦ Clear, tasteless, nearly pure alcohol (190 proof) produced by dis▯lla▯on ◦ Sold as Everclear to consumers & used in research ◦ Used in commercial products as gasoline addi▯ve, cleaner, solvent ◦ Used to make various beverages (40 - 50 proof) • Gin - Dis▯llate filtered thru juniper berries & then diluted with water • Vodka - Mixture of grain neutral spirits & water ▪ Originates from Russia/Poland ◦ Contains rela▯vely few congeners (by-products/impuri▯es) 2 PSY 320 Drugs & Behavior • Whiskey - Dis▯llate of fermented malted barley ▪ Early US dis▯ller from Bourbon County, KY gave its name ▪ Dis▯lled at a lower proof (160) so contains more congeners & flavor from grain used ▪ Usually aged at least 2 years • Liqueurs or Cordials ◦ Alcohol content 20-25% ◦ Originally made from brandy mixed w. flavorings from herbs, berries, or nuts ◦ Now typically made from flavored/diluted grain neutral spirits News • Consump▯on pa▯erns are influenced by cultural factors • Trends in US alcohol consump▯on: ◦ Similar to other drug use, alcohol use peaked in 1981 & then declined • Mirrors pa▯erns of illicit drug use ◦ Decline par▯cularly significant for dis▯lled spirits ◦ 1/3rd of Americans abstain ◦ Avg consump▯on among drinkers: ~3 drinks/day, most Americans drink far less • Half of all alcohol consumed in the US consumed by about 10% of the drinkers • Regional differences in US: ◦ Stress Index - Drinking rates higher in states where ppl experience a great deal of social stress/tension ◦ Drinking Norms - Drinking rates higher in states where ppl tend to approve of use of alcohol to relieve stress • Gender differences: ◦ Males more likely to drink than females ◦ More likely to drink larger amounts • College students: ◦ College students drink more than their nonstudent peers ◦ Many campuses have banned sale/adver▯sing of alcohol & keg par▯es ◦ Alcohol use has not changed significantly • Sight increase in binge drinking & driving a▯er drinking Binge Drinking on America's Campuses (ar▯cle) • Harvard School of Public Health College Alcohol Study (CAS) • Binge drinking: ◦ Men: 5 drinks or more in a row ◦ Women: 4 drinks or more in a row • At least once in a 2 week period • Frequent binge drinker: Binging 3 or more ▯mes in a 2 week period • Frequent binge drinkers significantly more at risk for: ◦ Educa▯onal problems ◦ Psychological problems ◦ An▯-social behaviors ◦ High-risk sex gn i v i rd & gn i kn i◦r D • 2nd hand effects: 3 PSY 320 Drugs & Behavior ◦ Automobile-related fatali▯es se i ru j n i suo i r◦ e S ◦ Vandalism ◦ Physical assaults ◦ Sexual assaults • Deaths: ◦ Acute alcohol poisonings ◦ Car accidents s gn i nw◦r D ◦ Falls ◦ Fights • The majority (56%) of students do not binge drink • Frequent binge drinkers consume 72% of all alcohol that college students drink • Frequent binge drinkers increased from 20% in 1993 to 23% in 1999 • More students drink than use cocaine, MJ, or cigare▯es combined • Strongest predictors of binge drinking: e t i W ◦ Male d l o s r y 42 r e◦ U ◦ Fraternity or sorority membership • Least likely to binge drink: ◦ African American or Asian r ed l o r o s r y ◦ 2 ◦ Married Alcohol Pharmacology • Alcohol is water & fat soluble ◦ Readily diffuses across all cell membranes • Absorp▯on ◦ Most absorbed in the small intes▯ne ◦ Some absorbed through oral ▯ssues when drinking ◦ Some absorbed in the stomach • Absorp▯on is slower if there is food or water in the stomach • Absorp▯on is faster in the presence of carbonated beverages (beer) 4 PSY 320 Drugs & Behavior Pharmacokine▯c Factors • BAC (Blood Alcohol Concentra▯on) = # of grams of alcohol in a 100-ml volume of blood (percentage) ◦ A measure of the concentra▯on of alcohol in blood • Alcohol dehydrogenase - enzyme that metabolizes alcohol • Acetaldehyde - metabolite produced from enzyma▯c conversion of alcohol w. alcohol dehydrogenase • Alcohol distributed thru body fluids & can be measured from any ▯ssue ◦ Most common method of measuring BAC from expired air (breathalyzer) • Alcohol less distributed in fa▯y ▯ssues ◦ Lean person will have a lower BAC than a fa▯er person ◦ Since fat doesn't absorb much alcohol, a fa▯er person will have less lean body mass to absorb it, hence there is a smaller "tank" to accommodate the alcohol & they get drunker Metabolism • 90% of alcohol metabolized in the liver ◦ About 2% is excreted unchanged (breath, skin, urine) • 90-95% of ingested alcohol is metabolized by the enzyme alcohol dehydrogenase ◦ Remainder excreted or metabolized by P450 • Liver metabolizes about 0.25 oz/hour ◦ If rate of intake = rate of metabolism, BAC is stable ◦ If rate of intake exceeds rate of metabolism, BAC increases • Liver responds to chronic intake of alcohol by increasing enzyme ac▯vity 5 PSY 320 Drugs & Behavior ◦ Contributes to tolerance in heavy users Mechanisms of Ac▯on • Ac▯ons of alcohol involve mul▯ple transmi▯er systems: A◦ G ◦ Glutamate d i o i po s uonegod ◦ E ◦ Dopamine n i no t o e S ◦ Endocannabinoid systems ◦ Acetylcholine neurons • CNS depressant ◦ Primarily enhances inhibitory effect of GABA @ GABA-A receptor • Depressant: cortex, hippocampus, thalamus • Reinforcing: nucleus accumbens, VTA ◦ Also blocks glutamate • Inhibits excitatory glutamate NMDA receptors ◦ Inhibits calcium channels • Reduces neurotransmi▯er release from axon terminals • Inhibi▯on of vasopressin release leads to: ▪ Increased urina▯on ▪ Impaired cogni▯on ▪ Disrupted circadian rhythm e r u s s r p doo l b de r ew o L ▪ Enhanced aggression • Chronic alcohol administra▯on: ABAG secud ◦ R A receptor levels/sensi▯vity ◦ Lowers increases in B-endorphin levels ◦ Increases # of NMDA receptors • Contributes to greater risk of seizure • Used as anesthe▯c un▯l late 19th century • Increases opioid ac▯vity in several brain regions • Mul▯ple mechanisms at work Gender Differences • Women tend to be more suscep▯ble than men to the effects of alcohol a▯er consuming the same amount ◦ Gastric alcohol dehydrogenase is less ac▯ve in women • Women generally have a smaller amount of this enzyme available to break down alcohol ◦ Women absorb a greater propor▯on of the alcohol they drink • Women tend to weigh less & have a higher propor▯on of body fat ◦ "Tank" into which alcohol added is smaller (generally) 6 PSY 320 Drugs & Behavior Effects • Vary depending on concentra▯on in the body ◦ Higher concentra▯ons: depressant effects ◦ Lower concentra▯ons: pseudo-excitatory effects • Alcohol readily passes thru blood-brain barrier • Allows neural ▯ssues to reach BALs quickly • Peak blood levels reach 30-60 min depending upon concentra▯on & what else is in the diges▯ve tract • Alcohol readily absorbed by all ▯ssues, pregnant women expose fetus to same blood level as she has • Exercise, coffee, & other strategies DO NOT speed up rate of metabolism ◦ Exercise/swea▯ng/hot showers only aggravate drunkenness thru heat & dehydra▯on Behavioral Effects • BAC determines effects es ruoc em ▯ no dnep◦e D ◦ I.E. Effects greater when BAC rises rapidly • Influenced by individual's alcohol experience 7 PSY 320 Drugs & Behavior ◦ Effects influenced by expecta▯ons • Disinhibi▯on: Weakening of behavioral control that displays as: ◦ Poor risk assessment ◦ Engagement in dangerous behavior ◦ Impulsivity (decision making w.o reflec▯ng adequately on the consequences) ◦ Reduces anxiety • A▯er consuming 1-2 drinks, users develop an urge to consume more alcohol, known as alcohol priming • Sexual behavior: ◦ Alcohol use enhances interest in sex but impairs physiological arousal xes e f asnu o t dekn◦ i L • Blackouts: ◦ Danger sign of excessive alcohol use ◦ Reversible, alcohol-induced demen▯a, stupor (dulled senses, poor cogni▯ve func▯on) anterograde amnesia (inability to form new memories) • Crime & violence: ◦ Alcohol use sta▯s▯cally related to violence ◦ Homicide ◦ Assault, family violence, sexual assault, date rape ed i c i◦ u S 8 PSY 320 Drugs & Behavior Physiological Effects • Peripheral circula▯on ◦ Dila▯on of peripheral blood vessels ◦ Drinkers lose body heat but feel warm • Fluid balance ◦ Alcohol has diure▯c effect that: • Increases urine output • Lowers blood pressure in some ppl • Hormonal effects ◦ Chronic abusers can develop a variety of hormone-related disorders Harms Acute Physiological Toxicity • Alcohol overdose (poisoning) common & dangerous • If someone drinks enough to pass out: ◦ Place the person on their side (if they're on their back they could vomit & choke) ◦ Do not leave the person alone • If someone drinks enough to vomit: gn i kn i rd po t s d l u ohs ye◦h T ◦ Vomi▯ng reflex is suppressed at BAC above 0.20 % & can quickly reach lethal levels • Inhibits sexual performance ◦ Men with high BACs unable to a▯ain or maintain erec▯ons DUI • 1/3rd of all traffic crash fatali▯es linked to alcohol use • Risk of a fatal crash is dose-related • Single-vehicle fatali▯es more likely to involve alcohol than mul▯ple-vehicle fatali▯es • Alcohol related fatali▯es: more likely to occur during dark hours & weekends • Men more likely than women to be involved in alcohol related fatal crash (men drive more) • Safe BAC for driving is below 0.05% Hangover • Drinking ~250ml of alcohol causes the body to expel 80-1,000 ml of water ◦ 4x the amount of liquid lost as gained ◦ Diure▯c effect decreases as alcohol in the bloodstream decreases ◦ A▯ereffects create a hangover • Symptoms: Upset stomach, fa▯gue, headache, thirst, depression, anxiety, & general malaise • Possible causes: Withdrawal, congeners exposure, cellular dehydra▯on, gastric irrita▯on, reduced blood sugar, accumula▯on of acetaldehyde • Moderate drinking (the night before) is the only way to avoid a hangover Fetal Alcohol Syndrome • Collec▯on of physical & behavioral abnormali▯es associated w. mother's alcohol use during pregnancy ◦ Rela▯ve to peak BAC & dura▯on of alcohol exposure ◦ Prevalence: 0.2-1.5 (80-200) per 1,000 births • Diagnos▯c criteria: ◦ Growth retarda▯on before/a▯er birth (small baby, slow growth) ◦ Pa▯ern of abnormal head & facial features 9 PSY 320 Drugs & Behavior ◦ Evidence of central nervous system abnormality • Trouble developing skills in speaking, walking, cogni▯ve func▯oning, etc. ◦ Mental retarda▯on • Drinking during pregnancy increases risk of spontaneous abor▯on • Data DO NOT prove that low levels of alcohol use during pregnancy are safe or unsafe Long Term/Chronic Effects (Organs Effected) • Brain ▯ssue loss & cogni▯ve impairment ◦ Wernicke-Korsakoff syndrome • Confusion, ataxia (impaired walking coordina▯on), abnormal eye movements ◦ Alcoholic demen▯a - global decline of intellect • Heart disease: ◦ Cardiomyopathy, cell ischemia, heart a▯ack, hypertension, stroke ◦ Alcohol's beneficial effects on HDL may reduce heart a▯ack risk among moderate drinkers (1 or 2 drinks every day or every other day), therefore considered cardioprotec▯ve • Liver disease: hepa▯▯s, fa▯y liver, cirrhosis ◦ Cirrhosis - death of liver cells, accumula▯on of collagen, decreased blood flow, inability to func▯on properly, infec▯ons, cancers • Cancer ◦ Mouth, tongue, pharynx, larynx, esophagus, stomach, liver, lung, pancreas, colon, rectum • Suppression of immune system, suscep▯bility to infec▯ons • Chronic alcohol intake increases ac▯vity of metabolic enzymes ◦ Slows metabolism of other drugs while body is concentra▯ng on alcohol intake ◦ High enzyme ac▯vity remains for 4-8 weeks a▯er cessa▯on of drinking • During this ▯me other drugs are metabolized more rapidly • Impotence in men, tes▯cular atrophy • Impaired reproduc▯ve func▯oning in women Alcoholism, Problem Drinking & Binge Drinking • Alcoholism - Chronic & o▯en progressive disease that includes problems controlling your drinking, being preoccupied w. alcohol, con▯nuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms ◦ If you have alcoholism: You can't consistently predict how much you'll drink, how long you'll drink, or what consequences will occur from drinking ◦ It's possible to have a problem with alcohol even when it has not progressed to the point of alcoholism • Problem drinking - You drink too much at ▯mes, causing repeated problems in life, even without complete dependence on alcohol • Binge drinking - A pa▯ern of drinking where a male consumes 5 or more drinks in a row, or a female drinks at least 4 or more drinks in a row ◦ Can lead to same health risks & social problems associated w. alcoholism ◦ Binge drinking in young adults or teenagers may lead to faster development of alcoholism • Michigan Alcohol Screening Test (MAST) ◦ One of the most widely used measures for assessing alcohol abuse 10 PSY 320 Drugs & Behavior ◦ 25-item ques▯onnaire to rapidly screen for life▯me alcohol-related problems & alcoholism Dependent Behaviors • Alcoholics Anonymous view ◦ Dependence as a progressive disease characterized by loss of control over drinking ◦ Only treatment is abs▯nence ◦ Disease model: alcohol dependence is the primary disease & not the result of another underlying cause • DSM ◦ Defines substance abuse & dependence & includes alcohol as psychoac▯ve substances ◦ Alcohol abuse - Maladap▯ve pa▯ern indicated by con▯nued use despite knowledge of having persistent problems caused by alcohol ◦ Alcohol dependence - Involves more serious psychosocial characteris▯cs & includes physiological factors of tolerance & withdrawal among the possible symptoms • Cogni▯ve & gene▯c factors are poten▯al underlying causes of dependence Dependence: Withdrawal Syndrome • Abs▯nence syndrome more medically severe & deadly than opioid withdrawal • Abs▯nence syndrome occurs in stages: ◦ Stage 1 - Tremors, rapid heartbeat, hypertension, heavy swea▯ng, loss of appe▯te, insomnia ◦ Stage 2 - Hallucina▯ons (auditory, visual, or tac▯le) ◦ Stage 3 - Delusions, disorienta▯on, delirium ◦ Stage 4 - Seizures • Mortality of cases may be as high as 1 in 7 • Detoxifica▯on should be carried out in an inpa▯ent medical se▯ng ◦ Seda▯ve given in stages 1 or 2 to prevent stages 3 or 4 ◦ Some symptoms can last up to several weeks Treatmen t • Alcoholics Anonymous ◦ Voluntary, worldwide fellowship who meet together to a▯ain/maintain sobriety ◦ Only requirement for membership is a desire to stop drinking ◦ Program of total abs▯nence ◦ Sobriety maintained thru sharing experience & 12-step recovery from alcoholism 11


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