health
Mesh4114
alcohol_pdf.pptAlcohol:
A Behavioral Perspective
Chapter 8
How Serious Is
Alcohol Consumption?
- Approximately 51% (129 million) of Americans are past month alcohol drinkers (also referred to as current drinkers).
- Approximately 23% (58.1 million) of Americans binge drink and 6.9% (17.3 million) reported heavy drinking.
© AbleStock
How Serious Is Alcohol Consumption? (continued)
- Alcohol use (age 12 or older):
- 56.2% of whites
- 47.5% of persons reporting two or more races
- 43.3% of American Indians or Alaska Natives
- 43.2% of Hispanics
- 41.9% of blacks
- 37% of Asians
How Serious Is Alcohol Consumption? (continued)
- Estimated spending for yearly healthcare services for alcohol problems and medical consequences of alcohol: $18.8 billion.
- Alcohol is officially linked to at least half of all highway fatalities.
- To date, alcohol has been tried by 38.9% of 8th graders, 58.3% of 10th graders, 78.9% of 12th graders, and 83.5% of college students.
- An estimated yearly $82 billion was lost in potential productivity due to alcohol and other drug use.
Alcohol and Marijuana Use and the Very Young
- Use of alcohol to the point of inebriation: 18% of 8th graders, 37% of 10th graders, and 55% of 12 graders.
- Self-reported drunkenness 30 days prior to being surveyed: 5% of 8th, 14%, of 10th, and 30% of 12th graders.
- On a daily basis for 8th, 10th, and 12th graders, marijuana usage now exceeds alcohol usage.
- 45% of all 12th graders reported some marijuana use in their lifetime (34% reported past year and 20% reported past month).
History of Alcohol (Ethanol) in America
- 1830—peak drinking period
- Prohibition period
- Alcohol has coincided with historical events:
- Colonial America
- Triangle trade (New England Yankees traded rum for slaves in Africa, then slaves for molasses in West Indies, and then back to New England to make rum)
- Colonial taverns were key “institutions” promoting alcohol consumption
History of Alcohol in America (continued)
- Temperance movement (1830–1850)
- Prohibition era (1920–1933)
- Ratification of the 18th Amendment (1919) to the U.S. Constitution (outlawing alcohol use)
- Alcohol was outlawed (January 1920)
- Speakeasies and bootlegging grew
- Patent medicines flourished
- In 1933, the 21st Amendment repealed Prohibition
Major Problems Encountered During Prohibition Period
Alcohol use began to diminish for the first 2 or 3 years after Prohibition was in effect. However, after 3 years of steady decline, the use of distilled liquors rose every year afterward.
Enforcement against alcohol use was overthrown by corruption in law enforcement.
Many early European immigrants populating American cities during Prohibition came from cultures that viewed drinking as normal and customary, resulting in their refusal to give up alcohol consumption.
Defining Alcoholism
- There is no agreement regarding at what specific point someone is an alcoholic.
- Alcoholism is a state of physical and psychological addiction to a psychoactive substance known as ethanol.
- Most definitions include chronic behavioral disorders, repeated drinking to the point of loss of control, health disorders, and difficulty functioning socially and economically.
Defining Alcoholism:
First Definition
World Health Organization (WHO) definition:
- “Alcohol dependence syndrome
is characterized by a state, psychic
and usually also physical, resulting
from drinking alcohol. This state is
characterized by behavioral and
other responses that include a compulsion to take alcohol on a continuous or periodic basis to experience its psychic effects and sometimes to avoid the discomfort of its absence; tolerance may or may not be present” (NIAAA, 1980).
© Corbis
Defining Alcoholism:
Second Definition
- “Alcoholism is a chronic behavioral disorder manifested by repeated drinking of alcoholic beverages in excess of the dietary and social uses of the community, and to an extent that interferes with the drinker’s health or his social or economic functioning” (Keller, 1958).
Defining Alcoholism:
Third Definition
- “Alcoholism is a chronic, primary,
hereditary disease that progresses
from an early, physiological
susceptibility into an addiction
characterized by tolerance changes,
physiological dependence, and loss
of control over drinking.
Psychological symptoms are
secondary to the physiological
disease and not relevant to its onset’’
(Gold, 1991).
© Pixtal/age fotostock
Major Known Components of Alcoholism
- Craving: A compulsion to drink alcohol even during inappropriate times (e.g., while driving, working, at a formal event)
- Very impaired or loss of control: Inability to limit drinking once begun
- Physical dependence: Withdrawal symptoms when attempting to abstain (e.g., nausea, sweating, anxiety)
- Tolerance: Need to increase usage to achieve the effect, the “buzz” from alcohol
Types of Alcoholics by Jellinek
- Alpha alcoholics: Mostly a psychological dependence
- Beta alcoholics: Mostly socially dependent on alcohol
- Gamma alcoholics: Most severe; suffers from emotional and psychological impairment
- Delta alcoholics: Constantly losing control over the amount of alcohol consumed
- Epsilon alcoholics: Constantly binge drinking and at times days at a time
- Zeta alcoholics: Moderate drinker who becomes abusive and violent
Types of Alcoholics by Moss et al.
- Young Adult (31.5% of U.S. alcoholics): Young adult drinkers without major problems regarding their drinking
- Young Antisocial (21% of U.S. alcoholics): Mid-20s, had earlier onset of regular drinking and alcohol problems, and come from heavy alcohol use families
- Functional (19.5% of U.S. alcoholics): Middle-aged, well-educated, with stable jobs and families
- Intermediate Familial (19% of U.S. alcoholics): Middle-aged, with 50% from families with multigenerational alcoholism
- Chronic Severe (9% of U.S. alcoholics): Mostly middle-aged, high rates of antisocial personality disorder and criminality
Culture and Alcohol:
Important Terms
- Drunken comportment: Behavior exhibited while under the direct influence of alcohol determined by the norms and expectations of a particular culture.
- Disinhibitor: A psychoactive chemical that depresses thought and judgment functions in the cerebral cortex, which has the effect of allowing relatively unrestrained behavior (as in alcohol inebriation).
- Pseudointoxication: Acting inebriated even before the quantity consumed produces its effects
Culture and Alcohol (continued)
- Some psychologists contend that both set and setting can often overshadow the pharmacological effects of most drugs, including alcohol.
- Set: An individual’s expectation of what a drug will do to his/her personality
- Setting: The physical and social environment where most drugs, including alcohol, are consumed
Culture and Alcohol (continued)
- Culture provides how alcohol use is perceived (e.g., violation of norms, “normal” to drink, sexy, sophisticated, mature).
- Cultural rules state how much one can drink and where one can drink.
- Cultures provide ceremonial
meaning to alcohol use. - Drinking rates among Jews
- Drinking rates among Irish
- Culture provides a model of alcoholism.
- Culture provides attitudes and stereo-
types regarding drinking behavior.
© www.imagesource.com/Jupiterimages
Alcohol Abuse Among College and University Students
CORE Institute (2006) research results:
- Approximately 72% of college students consumed alcohol and 42% to 55% engaged in binge drinking within 30 days when survey was given.
- College students consume an average of 5.4 alcoholic drinks per week.
- Of all the drugs reported, alcohol was the most heavily abused on college campuses, followed by tobacco (44%) and marijuana (31%).
Alcohol Abuse Among College and University Students (continued)
Other studies found that …
- The main reason given for binge drinking was “to get drunk.”
- Males binge drink more than females.
- For binge drinkers, the impact on impaired academic performance is just as great for women drinkers.
- Being white, involved in athletics, or a resident of a fraternity or sorority made it more likely that a student would be a binge drinker.
Alcohol Abuse Among College and University Students
(continued)
- On U.S. campuses, alcohol is a factor in 40% of all academic problems and 28% of all dropouts.
- Seventy-five percent of male students and 55% of female students involved in acquaintance rape had been drinking or using drugs.
- The transition into college is associated
with a doubling of the percentages of
those who drink for both males
and females.
- For heavier drinkers, grades suffered
for both male and female students.
© AbleStock
Women and Alcohol
- Women possess greater sensitivity to alcohol, have a greater likelihood of addiction, and develop alcohol-related health problems sooner than men (e.g., stomach cancer, cirrhosis of the liver).
- More women in alcohol treatment come from sexually abusive homes (70%) in comparison to men (12%).
Women and Alcohol (continued)
- Three major reasons why women are more sensitive to the effects of alcohol:
Body size (men generally larger than women)
Women absorb alcohol sooner—women possess more body fat and body fat does not dilute alcohol
Women possess less of a metabolizing enzyme—this enzyme gets rid of (processes out) alcohol
Women and Alcohol (continued)
- Alcohol consumption patterns of women:
- Women 21 to 34 years of age were least likely to report alcohol-related problems if they had stable marriages and were working full time.
- Women tend to marry men whose drinking habits match their own.
- Between 35 to 49 years of age, the heaviest drinkers were divorced or separated women without children.
- Between 50 to 64 years of age, the heaviest drinkers were women whose husbands/partners drank heavily.
- Women 65 and older comprised less than 10% of drinkers with drinking problems.
Alcohol Consumption in the United States
- Alcohol consumption has dropped sharply since 1981.
- What explains the steady decline in alcohol consumption during the past twenty years?
- Demographics
- Conservatism
- Decrease in social acceptability
- Increased awareness of risks
- Increased concerns for health
U.S. Alcohol Consumption
Per capita ethanol consumption by beverage type
Source: NIAAA Surveillance Report No. 73
© 2008 McGraw-Hill Higher Education. All rights reserved.
*
Figure 9.1 from text
*
Alcohol Use in 2003
- Any Use: 50% (119 million)
- Binge Use: 23% (54 million)
- Heavy Use: 7% (16 million)
- No significant changes from 2002 to 2003
*
Current, Binge, and Heavy Alcohol Use, by Age: 2003
Fig
3.1
Age in Years
12-13
14-15
16-17
18-20
21-25
26-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Percent Using in Past Month
4.5
17.0
31.8
51.5
67.8
61.7
59.2
59.5
58.6
57.7
54.0
52.9
46.2
34.4
Current Use
Heavy Alcohol Use
Binge Use
*
Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2002 and 2003
Percent Using in Past Month
Total 12-20
Males 12-20
Females 12-20
6.2
6.1
8.1
4.2
7.9
4.3
28.8
29.0
29.6
28.0
29.9
28.1
Current Use
Heavy Alcohol Use
Binge Use
Alcohol Use / College
- Where do young people drink?
- http://www.oas.samhsa.gov/2k8/location/underage.htm
- From 2002 to 2005, an average of 5.2 million young adults aged 18 to 20 were enrolled full time in college each year. This represents 41.3 percent of young adults in this age range. Full-time college students included an average of 2.8 million women aged 18 to 20 (46.0 percent of women in this age group) and 2.4 million men aged 18 to 20 years (36.9 percent of men in this age group) each year. Over half of full-time college students aged 18 to 20 (58.2 percent) lived in the same household with a parent, grandparent, or parent-in-law, while 41.8 percent lived independently of a parental relative
*
Heavy Alcohol Use, by College Attendance and Age: 2003
Fig
3.4
Enrolled Full Time in College
Not Enrolled Full Time in College
Graduated from College
Some College or Less
Aged 18 to 22
Aged 26 or Older
Percent Using in Past Month
Rethinking Drinking
*
Driving Under the Influence of Alcohol among Persons Aged 12 or Older: 2002 and 2003
Percent Driving Under the
Influence of Alcohol in Past Year
, = Significant change 2002 to 2003
*
Driving Under the Influence of Alcohol, by Age: 2003
Fig
3.6
Percent Driving Under the Influence in Past Year
Age in Years
16-17
18-20
21-25
26-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
DUII 2008
- http://oas.samhsa.gov/spotlight/Spotlight014DUIPatients.pdf
- 1.5 million DUI arrests
- A person died every 38 minutes in alcohol involved car crash
- Increases referrals to treatment
Driving Under the Influence
Alcohol-related and nonalcohol-related traffic crash fatalities for the United States
© 2008 McGraw-Hill Higher Education. All rights reserved.
*
Figure 9.4 from text
Driving Under the Influence
- Men are more likely than women to be involved in an alcohol-related fatal crash
- Anyone who drinks and drives is a potential threat, not just problem drinkers
- Current efforts
- Keep repeat offenders off the road
- Publicize the dangers of drinking and driving
- Target younger drinkers for special prevention efforts
*
Image source: S. Solum/PhotoLink/Getty Image (Image Ch09_23DWIEnforcement)
Alcohol / Drug Patterns USA
Additional Facts Regarding Alcohol Use/Abuse
- Drinking and driving: On most
weekend nights throughout the
United States, 70% of all fatal
single-vehicle crashes involve a
driver who is legally intoxicated. - Income/wealth: Less affluent
people drink less than more affluent individuals. - The average “alcoholic”: The largest percentage of alcoholics are secret or disguised drinkers who look very much like common working people.
- On average: Most people who consume alcohol do not become problem drinkers.
© Marcin Balcerzak/ShutterStock, Inc.
Alcohol and the Family
- Co-dependency (or co-alcoholism): A relationship pattern in which addicted or nonaddicted family members identify with the alcohol addict and deny the existence of alcohol consumption as a problem.
- Enabling: Denial or making
up of excuses for the excessive
drinking of an alcohol addict to
whom someone is close.
© Jones and Bartlett Publishers/Photographed by Kimberly Potvin and Christine McKeen
Alcohol and the Family (continued)
- Children of alcoholics (COAs) 2–4 times more likely to become alcoholics themselves.
- Adult children of alcoholics (ACOAs) 2–4 times more likely to develop alcoholism.
- Approximately, 9.7 million children age 17 or younger are living in households with one or more adults classified as having an alcohol abuse or dependence problem.
- Seventy percent of these children were biological, foster, adopted, or stepchildren.
- As a result, 6.8 million children, or about 15% of children aged 17 or younger, meet the formal definition of children of alcoholics.
- COAs and ACOAs are more likely to marry into families where alcoholism is prevalent.
- Twenty-five percent of American children are exposed to an alcoholic before the age of 18.
Helping the Family Recover
- Psychodrama: A family therapy in which significant inter- and intra-personal issues are enacted in a focused setting using dramatic techniques.
- Genogram: A family therapy technique that records information about behavior and relationships on a type of family tree to elucidate persistent patterns of dysfunctional behavior.
- Role-playing: A therapeutic technique in which group members play assigned parts to elicit emotional actors.
Helping the Family Recover (continued)
- Post-traumatic stress disorder: A psychiatric syndrome in which an individual who has been exposed to a traumatic event or situation experiences psychological stress that may manifest itself in a wide range of symptoms, including re-experiencing the trauma, numbing of general responsiveness, and hyper-arousal.
Recovery from Alcoholism
- Treatment of alcoholism
- Denial as a psychological defense
- Easy to relapse without radical shift in lifestyle
- Alcohol rehabilitation and medical ramifications
- More emotionally fragile than other addicts
- Relapsing syndrome
Withdrawal
- Relapsing syndrome: Returning to the use of alcohol after quitting.
- Acute alcohol withdrawal syndrome: Symptoms that occur when an alcohol addicted individual does not maintain his/her usual blood alcohol level.
- Delirium tremens: The most severe, even life-threatening, form of alcohol withdrawal, involving hallucinations, deliriums, and fever.
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
200220032002200320022003
17.6
13.4
4.4
6.5
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
14.2
13.6
0.0
5.0
10.0
15.0
20022003
9.7
20.1
28.7
23.8
19.1
17.5
17.0
14.2
11.9
9.6
4.1
3.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
