Alcohol can be considered to be the oldest substance synthesized by humans since the first human brewery dates to about 3700 BC in Egypt.  Grape wine has been used since 400-300 BC.

Twice as much beer is produced in the U.S than distilled spirits; 15 times more beer than wine. Approximately $              per year is spent in the U.S. on beer, wine and liquor.

Alcohol is our nation's biggest drug problem as evidenced by the following facts:

* Alcohol accounts for over               accidental injuries per year.

* Alcohol plays a major role in        % of the U.S. highway fatalities (recently this totaled          lives in one year).

*       % of admissions to mental hospitals each year are due to alcohol.

* More than _____% of all arrests (over              ) per year are due to alcohol.

* The suicide rate among alcoholics is         times greater than among the general population.

* Alcoholism ranks as the      __ leading health problem in the U.S.  behind         _______ and                      .

* Alcohol causes approximately                defective births per year.

* Nearly      % of all adolescents drink; over _____% of 7th graders and _____% of 12th graders drink; the average age of initiation is                    .

* Approximately       % of all women and      __% of all men drink some form of alcoholic beverages; there are over              alcoholic women in the U.S.

* Between       __% of all drowning victims were found to have been drinking.

* Between           % of all fire fatalities are associated with the use of alcohol.

* Alcoholism is not confined to "skid row"-only       __% of all alcoholics are in this population.

* The life expectancy of drinkers is estimated to be shorter by          years than that of the general public and the mortality rate for alcoholics is                      than expected.

WHO DRINKS THE MOST?

* Males drink significantly        than females; male "heavy drinkers" outnumber their female counterparts in all age groups.

The 1985 University of Michigan National Drug Survey indicates that college students are more likely than their age peers not in college to report occasions of heavy drinking (five or more drinks at least once in the 2 weeks prior to the survey. Some       % of male college students and _____% of females reported such drinking bouts.

*  Younger adults drink        than older adults.

* High school seniors from the South and West apparently consume        alcohol than do those from the North-east and North Central regions.

* In a 1982 sample of high school seniors approximately ______% were found to have consumed five or more drinks on at least one occasion prior to the survey.

* Fortunately, women reduce alcohol consumption substantially when they become pregnant; a 1980 survey in-dicated that the percentage of mothers who were moderate to heavy drinkers declined from 12% before pregnancy to 2% during pregnancy-Fetal Alcohol Syndrome will be discussed later.

* Black and Hispanic mothers drink         before and during pregnancy than do white mothers.

* Women with less education and from families with lower incomes drink         than women with more educa-tion and higher family incomes.

* A 1979 study of adults showed the following distribution of drinkers:

 Abstainers (1 drink/year or never)                   %
 Light drinkers (1 drink/year-3 drinks/week)          %
 Moderate drinkers (4-13 drinks/week)                 %
 Heavy drinkers (2 or more drinks/day)            ____%

WHAT IS A DRINK?

A drink is considered to be                 beer,             glass of wine or                     of distilled spirits.

Each of the above contain approximately           ounce of ethyl alcohol.

WHAT IS ALCOHOL?

Ethyl alcohol (or ethanol or alcohol) is a clear, colorless liquid having a bitter taste.  The color, taste, aroma, and most of the "hangover" comes from ingredients added to alcohol rather than from the ethyl alcohol it-self.

The proof strength of an alcoholic beverage is          the percent strength by volume.  In other words, an 86 proof liquor is      % alcohol.

Other alcohols should not be confused with ethyl alcohol.  For example, wood alcohol is                   which can be very toxic to the                and can lead to               .  Death from ingestion from as little as      ml (approximately 1 fluid ounce) has been reported but the usual fatal dose is 100-250 ml).  Rubbing alcohol is _____________ ; ____ ml (approximately 3.5 fluid ounces) can be fatal.

Ethyl alcohol has industrial properties.  The ethyl alcohol which is used in alcoholic beverages is heavily taxed.  To prevent some of the industrial alcohol from being used in beverages to avoid paying taxes, chemicals are added to industrial alcohol which make it unfit for human consumption (acetone, wood alcohol, phenol, iodine, menthol, etc.).  Therefore,                alcohol should never be consumed since it is virtually impossible for the lay person to remove the denaturants.

Intoxication

There are two general types of intoxication:

a) The most commonly encountered type results from                                 &nbs p;       .  The signs most evident are                                      ;                (lack of muscle coordination during walking).  These signs are easily observed.

b) The second type of intoxication is usually associated with the use of                    ,                     , and                     __________________.  Cerebral signs are not as evident but the loss of perception and cognition are very evi-dent.  Intoxication from opiates is somewhat between these two types.

THE PHARMACOLOGY OF ALCOHOL

A. Effects on the Central Nervous System

Contrary to what many individuals perceive, ethyl alcohol is a central nervous system (CNS)               , not a             .  At lower blood levels the brain is released from inhibitory controls.  The resulting "                " is thus confused with "stimulation".  The drinker may think he or she is a better driver, speaker, lover, etc., but this is not the case.

The highest centers of the brain are affected first:                                 &n bsp;                                    .

As the blood alcohol level (BAL) rises lower brain function is affected:                                                       .

Unquestionably, alcohol consumption can produce a state of euphoria but this state is      predictable in all individuals. As BALs             the pain threshold may increase.

Large quantities of alcohol cause a                         of motor control leading to a reduction in reflex or reac-tion times.  Driving skills can be severely impaired.

There is an excellent correlation of BAL, the extent of CNS depression and behavior.

SEE TABLES

BAL is measured in percentages. a 0.10% BAL indicates that there are         mg of ethanol in each       ml of blood.  The              the person, the greater the body fluids and thus the               the concentration of alcohol in blood.  Since women have               body fluids than men, a woman who weighs the same as a man and has had the same number of drinks will have a                BAL.

In moderate drinkers the maximum amount of ethanol that can be metabolized is between  _____________ ounces per hour.  In other words, metabolism generally lowers BAL        % per hour.  When intake exceeds metabolism, BALs increase.

Individuals                    in regard to their ability to handle alcohol.  Some individuals drive with BALs at levels which should induce comas while others may exhibit signs of intoxication at BALs of 0.05% or less.

The                   appears to be the most sensitive to the effects of alcohol.  Memory loss occurs frequently in episodes of heavy drinking and symptoms associated with aging appear in heavy drinkers.

B. Effects on the Cardiovascular System

At low doses                  effects on the heart and vascular system are observed.  However,          drinking could lead to more serious problems.  Cardiac muscle cells can be damaged upon chronic use and the pumping functions of the ventricles can be impaired leading to an enlarged heart.  Additionally,                      -irregular heart beats- may result from heavy drinking which may be felt by the drinker in the form of palpitations.

A recent study (Journal of Substance Abuse Treatment, Vol. 3, pp. 121--129, 1986) concludes that there is little question that ethanol can induce an                  in blood pressure in certain individuals. Some investigators have noted a continual increase of blood pressure with increasing alcohol ingestion while other have observed a threshold-like effect at         or more drinks/day.  In addition to recommending additional studies regarding the relationship of alcohol to hypertension, coronary disease and cardiac dysrhythmias this study suggests that for those individuals who are neither alcoholic nor hypertensive it would be wise to limit consumption to 3 drinks per day.

C. Effects on the Gastro-Intestinal (GI) Tract

Alcohol has an                    effect on the GI tract due to the direct effects of ethanol on the stomach lining as well as the ability of ethanol to stimulate the secretion of acid and pepsin.  Consequently, individuals suffering from peptic ulcers should        alcohol.  The other ingredients in distilled spirits (              ) which impart color. taste, etc., to alcohol can produce gastritis which is often associated with hangover.  Alcohol can produce the same effect.

In acute alcohol intoxication                                   can result particularly in individuals suffering from GI disorders or in those individuals sensitive to the GI irritation associated with aspirin consumption.
 

D. Effects on the Liver

Recall that the liver is an organ intimately involved in the metabolism of drugs and medicines.  It is actively involved in the metabolism of ethanol:

ethanol  =====>  acetaldehyde  =====> acetic acid (acetate)

The liver is also an organ which is extensively damaged by alcohol.  Long-tern ingestion of alcohol            the digestive functions of the liver; thus, the alcoholic, who is perhaps already in a malnutrition state characteris-tic of chronic consumers, becomes weak, loses appetite, loses weight, etc.  Cirrhosis (the 7th leading cause of death in the U.S.) occurs in about      % of alcoholics and involves replacement of normal liver cells with fibrous connective tissue also known as scar tissue.  Women who are heavy drinkers appear to be at greater risk than men in developing cirrhosis.

Once liver function is impaired by heavy alcohol consumption, the metabolism of other drugs and foods by liver microsomal enzymes is impaired.

E. Effects of Kidneys

Alcohol possesses diuretic properties, i.e., it stimulates the production of urine.

F. Effects on Sexual Function and Activities

Ethanol is a "               ".  Because of its ability to remove inhibitions, facilitation of personal communications often results.  Thus, alcohol has been mistakenly referred to as as aphrodisiac.  In fact, the reverse may be true since too much alcohol abolishes sexual function.  Although libido may be increased in acute alcohol consump-tion it is decreased, along with performance, in chronic consumption.

G. Alcohol and Cancer

Certain types of cancer are more prevalent in individuals who are heavy alcohol consumers than normal individuals.  Examples are cancer of                           ,                            , and                      .  There may be a relationship between the consumption of beer and cancer of the                                         .  Also, cancer of the _________________________ and                              may be correlated with heavy alcohol use.
 

H. Special Problems

The use of alcohol should be especially avoided in the following cases:
a) Pregnancy

As mentioned earlier, almost all drugs have the ability to cross the placental barrier.  Alcohol readily crosses this barrier.  Thus, when the mother gets "drunk" the fetus does as well.  The problem, however, is that while the mother can metabolize ethanol fetal blood alcohol levels remain high (it takes twice as long to clear blood alcohol in the fetus than the mother) because during the early stages of development the fetus lacks liver enzymes necessary to metabolize ethanol.The use of alcohol by women during pregnancy can result in __________________________________, a birth defect characterized by mental retardation, growth deficiency and facial abnormalities.

Fetal alcohol syndrome may affect            of every 1,000 births in the U.S.  It is the third leading birth defect resulting in mental retardation.  The sad fact is that it is completely preventable.  While heavy drinkers are obviously at greater risk, a pregnant woman should avoid the consumption of any alcohol.

b) Epilepsy

Epileptics should avoid the consumption of alcohol even though alcohol, being a CNS depressant, is actu-ally an anticonvulsant.

c) Interactions With Other Drugs

Alcohol synergizes the depressant effects of other drugs and concomitant use should be avoided. Barbitu-rates, antihistamines, minor and major tranquilizers and narcotics should be especially avoided.

As mentioned earlier, aspirin and alcohol can combine to cause severe stomach irritation.

Of the 100 most frequently prescribed drugs approximately                      contain at least one ingredient which can interact adversely with alcohol.

I. Tolerance

The inexperienced drinker achieves a much                        response to a given amount of alcohol than an experienced one.
 
The withdrawal syndrome can be pronounced.  Within 12-72 hours of cessation an alcoholic experiences shaking or tremors, profuse sweating, nausea, anxiety, diarrhea, hallucinations and disorientation.  In severe cases                                        &nb sp;       (DTs), a potentially lethal condition, can result, seizures and cardiovascular collapse and hyperthermia can occur.

J. Drinking and Driving

A recent survey by the Jackson Clarion-Ledger indicates that 94% of drunk Mississippians at the wheel are men and nearly 1/3 has had his license previously suspended for DUI convictions.  On the average, a Mississippi drunken driver is:

                (61% of the time)
Is about          years of age
Has a BAL of _____%
Is arrested between 9 pm and midnight on a                Resides in a              county
Is a         -offender

K. Treatment of Alcoholism

It is estimated that there are             million alcoholics in the U.S.  The three general steps in the treatment of alcoholism are:
1. Managing acute episodes to save life and overcome the immediate effects;
2. Correcting the chronic health problems associated with alcoholism;
3. Changing long-term behavior to prevent destructive drinking habits.

                               has been tried as chemical treatment of alcoholism.  It blocks the metabolism of ethanol at the step at which                  in converted to acetate.  The increased levels of                  which result sensitizes the body to subsequent doses of alcohol.  Thus if an individual takes Antabuse® then consumes alcohol a violent reaction consisting of nausea, vomiting, flushing of face, headaches, dizziness, drop in blood pressure occurs.