Student Drinking Behavior at PSU Paper

Lesson 8: Consequences of Alcohol Abuse and Alcoholism

Overview and Objectives

Overview

In this lesson, we will discuss the consequences of problem drinking, including the physical and social consequences of alcohol abuse, binge drinking, and alcoholism. We will discuss how expectations can affect the behavioral outcomes of alcohol use.

Objectives

At the end of this lesson students will be able to:

Explain the concept of blood alcohol concentration; what it measures and what it means. Understand the term expectancy effect and explain how it can alter the behavioral outcomes of alcohol use. Explain what is meant by binge drinking and alcoholism Describe the long term physical effects of heavy alcohol use and the diseases related to long term problem drinking. Explain the potential role of alcohol in sexual assault. State how alcohol abuse reportedly affects students here at Penn State. Give examples of the common responses at a variety of BACs Describe the physical and cognitive/behavioral symptoms of Fetal Alcohol Syndrome. List what PA law considers first-degree felonies in terms of alcohol and sexual assault. List what you can do to reduce the risk of sexual assault in social situations. Introduction

A variety of St. Patty's Day t-shirts are shown in a storefront window in downtown State College.In 2007, students used Facebook to organize an alternative, coordinated drinking day to replace St. Patrick’s Day, which fell during Penn State’s spring break that year. Since then, St. Patrick’s Day has fallen after spring break was over, but the students have continued to organize the annual drinking event.

Over the past several years, arrests, damages, emergency response calls and hospital visits have all steadily and dramatically increased. In 2010 alone the Borough of State College reported that:

They had spent $6100 in extra costs for law enforcement for a single 24 hour period--nearly $2000 more than the $4500 extra spent on law enforcement for the same event the year before. They had made 160 arrests in a single night (up from the 79 arrests made on State Patty’s Day in 2009). State College residents have reported countless incidents of multiple cars driving the wrong way on a one way street; groups of intoxicated, loud young people wandering into busy streets; multiple strangers urinating and vomiting in their yards and flower beds; having their families awakened by yelling, screaming, and chanting throughout the night. Other local residents reported encountering extremely long waits for services in the local hospital as a result of the flood of alcohol related injuries and illnesses.

Local groups and businesses decided to cancel or postpone other events, citing fear on the part of their members to be downtown that evening. The problem escalated to the point where the Tavern Owners Association unanimously agreed to not open early, serve drink specials, or encourage the event in any other way. A couple of down town bars simply did not open that (weekend) night, citing concerns over potential harm and liability as their reason for closing up shop for what would be a busy night on any other weekend. Other down town businesses have refused to sell merchandise related to the event, including the t shirts and beads many students purchase and wear for the occasion, forgoing the potential profits in an attempt to discourage the event and reduce the damage and cost to the town.

This student-organized “event” and the binge drinking associated with it has created enormous costs financially, socially, and culturally in what is normally a safe and quiet town. Hard feelings and animosity over the event have created a sharp divide between town residents and the student population. The costs of this single night of extreme alcohol use fall heavily on both the town and the university, despite the fact that the majority of people in the town and on campus are drinking relatively little, if any, alcohol themselves that night. The damages from alcohol abuse and alcoholism have a much larger social and financial impact than just the drinkers themselves.

Frequency of Alcohol Abuse on College Campuses

Research sponsored by the National Institute of Alcoholism and Alcohol Abuse (NIAAA) estimates that approximately 700,000 college students suffer assaults as a result of alcohol use. This amounts to roughly 4% of college students in the US. The authors of this study have been criticized for their data collection techniques, and critics argue that errors in data collection have lead to an inflation of the reported numbers.

Data collected from a Penn State University survey, however, confirms what NIAAA has been reporting at colleges nationwide:

A bar graph titled: How PSU Students Suffer as a result of other Students’ Alcohol Abuse. See text alternative for more information.

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Because the consequences of alcohol use, particularly heavy alcohol use, impact many more people than those who are drinking or those who live with the person who is drinking, a recent study published in The Lancet (a peer-reviewed medical journal) ranked alcohol as the most dangerous drug.

A set of images of damage: a newspaper kiosk has door torn off (lying on the ground) and Taco Bell has a hole in the door which is covered with cardboard and blue tape

Blood Alcohol Concentration

Blood alcohol concentration (BAC) is an index of how much alcohol is in your bloodstream and is measured by calculating the grams of alcohol per ml of blood. Most drinks contain 10-14 g of alcohol per drink (remember this is the average standard drink—12 oz. beer, 4 oz, wine, etc.).

You can use a BAC calculator to get a rough estimate of your BAC based on what you have been drinking, over what time frame, your body weight, and your sex. The following link will direct you to a BAC calculator that will give you a rough estimate of your BAC for your sex, weight, and number of drinks.

http://www.dot.wisconsin.gov/safety/motorist/drunkdriving/calculator.htm

Please remember that this is an estimate, and that a number of factors may influence your exact BAC at any given time, including what you’ve had to eat, your experience with alcohol, and the types of drinks you have been drinking.

The chart below illustrates the common responses at a variety of BACs:

Common Effects by Blood Alcohol Concentration (BAC) for Men and Women BAC Common Effect Approximate # drinks/#hours, women Approximate # drinks/ #hours, men 0.05 Loss of inhibitions, judgment 2 drinks/1 hour 3 drinks/1 hour 0.10 Noticeably slowed reaction time, impaired motor function 4 drinks/2 hours, over legal limit for DUI 5 drinks/2 hours 0.15 Severe reaction time impairment, noticeably reduced coordination 6 drinks/3 hours 8 drinks/3 hours 0.20 Noticeably reduced sensory function (blurred vision, diminished hearing, some impairment in feeling) 7 drinks/3 hours 12 drinks/4 hours 0.25 Prone to falls, difficulty standing 9 drinks/4 hours 15 drinks/5 hours 0.30 Conscious, but little awareness or comprehension of surroundings 10 drinks/4 hours 18 drinks/6 hours 0.35 Sensory impairment at level of surgical anesthesia, minimum lethal dose 12 drinks/4 hours 20 drinks/6 hours NOTE: Drinks per hour is approximate and based on an average body size for a 140 lb woman and a 180 lb man. Smaller body size, food eaten before or during drinking, and blood volume will all impact BAC. Number of drinks assumes a “regular” drink (12 oz beer, 4 oz. wine) NOT any drink. Many drinks commonly served in bars as mixed drinks may contain enough alcohol to qualify as 2-3 drinks, so as few as 6 drinks like this in 4 hours may actually be closer to 12-18 drinks in the same time.

Expectancy Effect

The behavioral effects of alcohol are particularly sensitive to something called the expectancy effect. Expectancy effect is the idea that our experience with a drug will likely be very close to what we believe the effects of that drug to be. In other words, people will display the types of behaviors they believe will be consistent with alcohol use when they are drinking.

Several studies have demonstrated the Expectancy Effect with alcohol consumption. This effect is so strong that it can induce behaviors that drinkers believe are consistent with alcohol use, even when there is no alcohol present in their drink.

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It’s important to note that expectancy effect can induce the behaviors and symptoms of intoxication, but cannot override them. Those in group B will still display some of the characteristics of having drunk alcohol because of the effects of alcohol on the brain. The expectancy effect can induce someone to believe they feel effects, but cannot override the pharmacologic effects of the alcohol itself.

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Alcohol Abuse and Alcoholism

As we have discussed in previous lessons, abuse of a drug is use that:

Violates medical or social norms Continues despite the harm its use causes (physical, social, occupational/academic, etc.) Alcohol is one of the most widely used drugs in the world, and more than 50% of American adults (over the age of 18) consume some alcohol at least occasionally. The majority of American adults who drink, drink in moderation. That is, most adults are drinking fewer than 7 drinks per week on average and fewer than 4 drinks at one time when they do drink. A small percentage of drinkers, however, consume much more alcohol than most adults. This heavy drinking is referred to as binge drinking.

Binge Drinking

Binge drinking is defined as 4 or more drinks at one time for adult men or 3 or more drinks at one time for adult women. Binge drinkers make up less than ¼ of the population and tend to be younger drinkers (under the age of 25), but consume roughly ¾ of the alcohol consumed in the US.

Incidentally, for all the encouragement of the alcohol industry (primarily the larger beer producers) for adults to “drink responsibly,” binge drinkers make up the largest proportion of their sales. If binge drinkers were to cut their consumption by half, the total amount of alcohol consumed in the US could drop by nearly 40%.

Alcoholism

Alcoholism is addiction to alcohol. Addiction implies both the physical dependence on alcohol as well as the psychological need and craving for the effects of alcohol. The National Institutes of Health estimate that approximately 4% of Americans are addicted to alcohol.

Long Term Effects of Alcohol Abuse and Addiction

Long term heavy alcohol use can result in a number of health consequences, including damage to the brain, liver, and cardiovascular system. Although there are some benefits to regular alcohol consumption in light to moderate amounts, regular consumption at higher levels (more

than 2 drinks per day), or heavy consumption even sporadically (binge drinking), can damage vital organ systems and cause long term or even permanent health problems. We will look specifically at long term damage caused to the brain, liver, and cardiovascular system by heavy alcohol consumption.

Brain Damage and Alcohol Use

Long term heavy alcohol use can result in a loss of brain tissue that may be irreversible. Damage to the brain can lead to the loss of cognitive and hormonal functioning, depending on the areas in which the damage occurs. Loss of brain tissue in the frontal lobe can result in a loss of problem solving abilities, while damage to the tissue in the hippocampus may result in impaired short term memory functioning. Heavy alcohol use can also lead to damage in the hypothalamus, which can lead to endocrine disorders and disrupted reproductive and sexual functioning, particularly in men.

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome is a nutritional deficiency resulting in the body’s inability to absorb thiamine. Thiamine deficiency often accompanies long-term alcoholism and can cause damage to the thalamus, hypothalamus and hippocampus. Wernicke-Korsakoff syndrome also can occur as the result of eating disorders, chemotherapy, or other conditions which may cause malnutrition. In the US, however, the most common cause of Wernicke-Korsakoff Syndrome is alcoholism.

Wernicke-Korsakoff Syndrome presents itself in two phases.

The first phase, Wernicke’s encephalopathy, is a condition in which thiamine deficiency causes loss of brain tissue in the thalamus and hypothalamus. The effects of this loss of brain tissue include confusion, tremors, loss of muscle coordination, and unusual and uncontrollable eye movements. The second phase, Korsakoff syndrome, is a condition in which damage to the hippocampus deteriorates memory functioning and prevents the formation of new memories. Very early on in the disease, treatment with high levels of thiamine supplements may help to alleviate the symptoms associated with Wernicke’s encephalopathy, but only if the alcoholic stops drinking altogether. As the disease progresses and symptoms of Korsakoff’s syndrome begin to appear, the conditions seem to be irreversible. Progression of the disease can be slowed this point with abstinence and thiamine treatment, but damage already done to the brain does not seem to be reversed by this stage.

Liver Damage and Alcohol Abuse/Addiction

Because the liver is the organ primarily responsible for the metabolism of alcohol and its byproducts, long term heavy alcohol use eventually causes wear and tear on the liver that can result in disease conditions.

Fatty Liver

This is a condition that can result from heavy alcohol use, such as binge drinking, even though the user may not be addicted to alcohol.

Fatty liver develops when fat deposits are stored in the liver tissue itself. By itself, fatty liver is not usually a serious condition and is nearly always reversible with changes in diet, exercise, and reduction of alcohol consumption.

Long-term fatty liver and the continuation of the causes of fatty liver (high calorie/high fat diet, low physical activity, heavy alcohol use) can lead to chronic inflammation of the liver and damage to the liver cells.

Alcoholic Hepatitis

This is a condition of long term inflammation of the liver that leads to cell death and reduced liver functioning. Alcoholic hepatitis results primarily from the long term build up of acetaldehyde which damages the liver cells. The decreased functioning of the liver can cause jaundice, fatigue, loss of appetite, nausea and vomiting, and fever.

Cirrhosis

Cirrhosis is the most serious of the liver conditions caused by heavy alcohol use. Cirrhosis occurs when healthy, functioning liver cells die off and are replaced not by new liver cells but by fibrous, non-functioning tissue.

Cirrhosis can result from the progression of damage from other alcohol-related liver disorders. For example, over time the inflammation and cell damage caused by hepatitis can lead to the scarring of the liver and development of fibrous tissue in cirrhosis. As more functional cells die and are replaced with fibrous cells, the function of the liver diminishes.

If left unchecked, this condition is potentially fatal. Damage from cirrhosis is irreversible.

Cardiovascular Effects of Alcohol Use

Negative Effects of Heavy Alcohol Use

Long term heavy alcohol use can have negative consequences for the cardiovascular system. Specifically, chronic heavy drinking can cause the heart muscle to begin to deteriorate and become less efficient. This deterioration is referred to as cardiomyopathy.

Heavy alcohol use can also result in arrhythmia, or irregular heart beat. While these arrhythmias are usually more common among chronic heavy drinkers and during withdrawal, some minor arrhythmia can occur after a single bout of heavy drinking.

Long term heavy alcohol use also is associated with hypertension (high blood pressure), most likely because alcohol interferes with the normal control mechanisms in the brain that control such biochemicals as norepinephrine and epinephrine. If levels of these hormones are not controlled effectively, they can trigger increases in blood pressure.

Positive Effects of Alcohol Use

Regular light to moderate drinking, on the other hand, can have some possible protective effects on the cardiovascular system. A number of studies have shown an association between regular light to moderate alcohol consumption (1-2 drinks per day, on average) and a decreased risk of cardiovascular disease. This association seems to be related to increases in high density lipoproteins (HDLs) and possibly with lowered clotting activity that may occur with regular alcohol consumption. These effects seem to occur regardless of the type of alcohol consumed, although they may be more pronounced with the consumption of red wine. This may be because red wine also contains higher levels of antioxidants that also appear to lower the risk of cardiovascular disease.

It is important to note that the spacing of the 1-2 drinks per day average is important. Consumption of small amounts of alcohol on a regular basis seems to be associated with these positive cardiovascular effects. Sporadic consumption of large amounts of alcohol is not. For example, someone who has 2 drinks, four days out of the week averages slightly over 1 drink per day. Someone who typically drinks 6 drinks on a Friday night averages slightly less than 1 drink per day. The former is an example of light to moderate alcohol consumption that may result in protective cardiovascular effects. The latter is an example of periodic heavy drinking, or binge drinking, that is associated with the negative effects of alcohol on the cardiovascular and other bodily systems.

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Fetal Alcohol Syndrome

Child with Fetal Alcohol Syndrome. The child has skin folds at the corner of the eye, low nasal bridge, short nose, indistinct philtrum (grove between nose and upper lip), small head circumference, small eye opening, small midface, thin upper lip.Fetal Alcohol Syndrome (FAS) is a condition that affects approximately 1 in every 1000 live births and is related to the consumption of alcohol during pregnancy. FAS refers to a cluster of individual symptoms that vary in severity depending on the amount of exposure and the time frame of exposure during fetal development.

Physical Symptoms

The physical symptoms of FAS include short stature for developmental age and a set of distinctive facial characteristics:

Small eyes (in width, appear widely spaced) Thin upper lip Shallow or non-existant philtrum (grove between nose and upper lip, the facial feature that forms the “cupid’s bow” shape of the upper lip). Appearance of a short nose or low nasal bridge.

Although many children may have one of these facial characteristics, several need to be present to indicate potential FAS. Facial characteristics are more likely to be influenced by alcohol consumption during the first trimester (when much of the facial structures develop in utero).

Cognitive and Behavioral Symptoms

Children born with FAS may show the following cognitive and behavioral symptoms

Learning disabilities Motor coordination problems Hyperactivity Trouble sleeping Mental retardation/low IQ Developmental delays in language Developmental deficits in reasoning ability, logic, and judgment These characteristics will vary in amount and severity, depending on how much alcohol exposure occurred and when, in fetal development, it occurred. It is not known how much alcohol exposure presents a risk for fetal development and again, this may vary depending on the timing of the exposure. For example, different areas of the brain develop during different gestational time periods, so exposure during any one period may interfere with brain development of a particular region. This may lead to problems associated with that area of the brain (visual processing, hearing, reasoning ability, etc.). Less alcohol consumption may be needed for risks during critical developmental windows, particularly during the first trimester of development. Higher order brain functions associated with the prefrontal cortex, though, occur during the final trimester and so alcohol exposure during the last stages of pregnancy increases the risk of cognitive deficits associated with logic, reasoning, impulse control, and problem solving. All alcohol exposure increases the risk of developing one or more of the problems associated with FAS, so most obstetricians recommend that women abstain completely from alcohol consumption throughout their entire pregnancy.

Alcohol and Sexual Assault

Sexual assault and rape are among the most under-reported violent crimes, making prevalence rates difficult to estimate accurately. Most studies aiming to investigate sexual assault, and most crime statistics collected on sexual assault, estimate that 50-75% of all sexual assaults involve the use of alcohol by either the perpetrator, the victim, or most commonly, both. Estimates on college campuses run as high as 90% of all acquaintance rapes involving the use of alcohol. At Penn State, reports estimate that 70% of rapes and sexual assaults involve the use of alcohol by one or both parties.

There are a number of reasons why drinking seems to be so commonly associated with sexual assaults:

Reason 1: Alcohol is commonly used in social occasions, either in groups or one-on-one activities like dinner dates. This is particularly true in college populations. It is probably often the case that a social event which precedes a sexual assault involves drinking, whether or not the alcohol was a factor in the assault itself.

Reason 2: Alcohol can mask the taste of drugs meant to prevent resistance—that is, date rape drugs such as Rohypnol, GHB, and ketamine. These drugs are all potent sedatives in their own right and mixed with the sedative effects of alcohol can cause nearly immediate effects that can incapacitate a victim and make him or her unable to resist (or even be aware of what is happening).

Reason 3: Alcohol inhibits decision making and impulse control, as well as awareness of one’s surroundings. While alcohol will not make someone do something they would not do, it can inhibit the controls in the parts of the brain responsible for higher order thought that ordinarily causes us to reconsider some behaviors that occur to us (this inhibition of impulse control and decision making is probably responsible for the overwhelming number of people who have called an ex-girlfriend or boyfriend at 3:00 am). This inhibition of decision making makes the victim more vulnerable to assault by increasing the likelihood of being in a risky situation.

Note that the use of alcohol does NOT make the victim responsible for their attack, but it does mean that he or she may not have been as aware of danger cues as they may have been if they were not drinking. He or she may be less likely, for example, to register aggressive behaviors as controlling or intrusive. They may be less likely to notice that they have been systematically steered away from the group and isolated until they realize that they are completely alone with the other person.

Reason 4: Alcohol slows reaction times and inhibits physical coordination. This makes it extraordinarily difficult for the victim to put up an effective resistance to unwanted advances. He or she may have a much harder time extricating themselves from unwanted physical contact or preventing someone from unfastening or removing their clothing. It may be much more difficult to find and reach an exit or effectively fight back, especially against a larger assailant.

Alcohol, Sexual Assault, and PA Law

The last two reasons mentioned on the previous page most likely explain alcohol’s use historically as a date rape drug. Plying someone with alcohol to lower their resistance and cloud judgment has been so commonly used as a means of ensuring sexual activity that it is still a part of our popular culture. Many movies and tv shows still make reference to getting someone drunk in order to “have your way with them” and any number of t shirts, buttons, and bar signs extol patrons to “drink until he’s (or she’s) cute.”

Alcohol is so often used as a means of lowering someone’s resistance that it also is part of the Pennsylvania penal code. The following are first degree felonies under PA Law:

Supplying or encouraging the use of alcohol to lower someone’s resistance to sex. Sex with someone who is unconscious (and therefore unable to consent) or conscious but unaware of surroundings or unable to resist (also unable to fully consent). Whether or not the victim of a sexual assault or rape has been drinking, what happens to that person is never their fault. Additionally, use of alcohol by the perpetrator does not excuse or explain their behavior. We hold people legally accountable for any criminal behaviors they engage in, including sexual assault, even if they are intoxicated (i.e., burglary, vandalism, DUI).

Reducing the Risk of Sexual Assault

Below is a list of suggestions to help avoid being vulnerable to sexual assault. This is no way means that not doing any of these things makes being attacked the fault of the victim, nor does it imply that doing these things will prevent a sexual assault from happening. These suggestions may help reduce the risk by avoiding certain situations and behaviors that may make someone more vulnerable to being selected as a target.

Stick together! Look out for your friends and roommates. Have a signal to let each other know if you are unsure of or uncomfortable with a person or situation. Trust your instincts. If something feels wrong or uncomfortable, there’s probably a good reason. If something or someone weirds you out, leave. Never drink anything you didn’t get yourself, and avoid drinks you can’t identify or aren’t familiar with. If you aren’t familiar with the taste or appearance of that drink, it’s easier to add something (including more alcohol) that you won’t detect. Try to stick with “prepackaged” drinks—cans of soda, bottles of beer or malt beverages, wine coolers, etc. These are harder to tamper with Never leave your drink unattended—give it to a friend you trust while you dance, use the bathroom, etc. If no one else is available, leave your drink in front of the bartender and be sure he/she knows you are leaving it there. Stay aware of your surroundings—avoid being out when you’re too tired or too intoxicated. A designated sober person who agrees to keep tabs on what’s going on is a good idea, even if no one is driving. Avoid people who stand too close, are too aggressive, or “overly helpful.” It’s better to be rude to someone who insists on helping you after you’ve turned them down than risk assault. Someone who insists on “helping” you even after you’ve politely and firmly turned them down may not really be interested in being helpful. When you can’t avoid or find yourself in an uncomfortable situation, call a friend and keep the line open until you get to where you are safe. If something does happen, someone else will hear it and be able to reach help. Avoid being caught up in a conversation that distracts you from your surroundings, instead, make sure the person on the other end knows where you are and what’s happening. Be assertive and, when necessary, be loud. Better to be rude than a victim. If all else fails… Passive resistance: talk. Do your best to make yourself seem human to your attacker. Talk about your family, his family, anything that might make him think of you as a person or feel guilty or ashamed of what he’s doing. Active resistance: fight back—hard. This person means to hurt you, don’t be afraid to hurt them to get away. Use whatever you have available as a weapon—keys, pencil, sticks. If you decide to fight, commit to fighting back. A half-hearted attempt may only serve to escalate the violence. Submit—Do what you have to do to keep yourself from being injured further or killed. Submission is NOT consent. Check Yourself Activity 3

Conclusion

The majority of adults who drink do so in ways that are neither unhealthy not dangerous to themselves or others. Alcohol abuse and binge drinking are often associated with behaviors that create physical and social problems not only for the drinker but for others around them. Long term heavy alcohol use can lead to a number of health consequences, including damage to the

brain, liver, and cardiovascular system. Even a single episode of alcohol abuse or binge drinking during pregnancy can create permanent and catastrophic consequences. Because alcohol impairs judgment, awareness, and physical coordination, it is often a factor in sexual assaults.