An Invitation to Health - Cengage...An Invitation to Health: Build Your Future, 15th Edition Dianne...

An Invitation to Health:

Build Your Future

D I A N N E H A L E S

1 5 t H E D I t I o N

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An Invitation to Health: Build Your Future, 15th EditionDianne Hales

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13

After studying the material in this chapter, you should be able to

• Identify reasonsAmeri-canschoosetodrinkorabstainfromdrinking.

• Describe theimpactofalcoholmisuseamongcollegestudents.

• Define astandarddrinkandbingedrinking.

• Identify factorsthataffectanindividual’sBACandresponsetoalcohol.

• Describe thesymptomsofalcoholpoisoningandstepstakentoassistsomeonewithit.

• Define alcoholabuse,dependence,andalcoholism.

• List theeffectsofalcoholonthebody.

• Evaluate yourdrink-inghabitsandidentifybehaviorsyoucanmodifytoreduceyourrisk.

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Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

425

Visit www.cengagebrain.com to access course materials for this text, including the Behavior Change Planner, interactive quizzes, tutorials, and more. See the preface on page xv for details.B

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By the time Ryan reached 12 drinks, he was slur-ring his words. As he kept chugging drinks, his face looked flushed; he started sweating heav-ily. When Ryan lurched to his feet, he swayed unsteadily for a few moments and then col-lapsed. At first everyone laughed. Then two of his buddies tried to revive him. They couldn’t.

“He’s not breathing!” one of them shouted. Someone called 911, and paramedics rushed Ryan to the nearest hospital. His blood-alcohol concentration was several times above the legal limit. Despite intensive efforts by the medical team, nothing helped. Ryan’s twenty-first birth-day was his last.

As Ryan’s tragic death shows, alcohol, when not used responsibly, can take an enormous toll. Alcohol and tobacco are the most widely used mind-altering substances in the world. Each dangerous in itself, drinking and smoking tend to go together. The more individuals smoke and drink, the less likely they are to eat a nutritious diet and follow a healthy lifestyle.

Even if you never drink to excess, you live with the consequences of others’ drinking. That’s why it’s important for everyone to know about

the very real dangers of alcohol abuse. This chapter provides information that can help you understand, avoid, and change behaviors that could destroy your health, happiness, and life.

Drinking in AmericaAlcohol is the most widely used drug in the world. No medical conditions, other than heart disease, cause more disability and premature death than alcohol-related problems. No men-tal or medical disorders touch the lives of more families. No other form of disability costs indi-viduals, employers, and the government more for treatment, injuries, reduced worker pro-ductivity, and property damage. The costs in emotional pain and in lost and shattered lives because of irresponsible drinking are beyond measure.

Many Americans drink alcohol; most do not misuse or abuse it. According to the most recent statistics available from the National Institute

It was just another Friday night at the frat house.

The drinking started early and usually didn’t

stop until dawn. One of the brothers, a popular

easy-going guy named Ryan—not usually much

of a drinker—was celebrating a big birthday: his

twenty-first. Egged on by the hooting crowd,

Ryan bolted down one drink after another, after

another, after another.

Alcohol

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426 Section IV Making Healthy Choices

Themedianageof firstalcoholuseis15.Drink-ingtypicallyincreasesinthelateteens,peaksintheearly20s,anddecreasesaspeopleage.Themedianageof onsetforalcohol-usedisordersis19to20.

Why People Don’t DrinkMore Americans are choosing not to drink,and alcohol consumption is at its lowest levelindecades.Aboutaquarterof adults—31per-centof womenand18percentof men—reportdrinkingnoalcoholinthelastyear.

With fewer people drinking alcohol, nonalco-holicbeverageshavegrowninpopularity.Theyappeal to drivers, boaters, individuals withhealthproblemsthatcouldworsenwithalcohol,thosewhoareolderandcan’ttoleratealcohol,anyonetakingmedicinesthatinteractwithalco-hol (including antibiotics, antidepressants, andmuscle relaxers), and everyone interested inlimitingalcoholintake.Underfederallaw,thesedrinks can contain some alcohol but a muchsmalleramountthanregularbeerorwine.Non-alcoholicbeersandwinesonthemarketalsoarelowerincaloriesthanalcoholicvarieties.

Certain people should not drink at all. Theseinclude:

• Anyoneyoungerthanage21.Underagedrinking(discussedlaterinthischapter)posesmanymedical,behavioral,andlegaldangers.

• Anyonewhoplanstodrive,operatemotor-izedequipment,orengageinotheractivitiesthatrequirealertnessandskill(includingsportsandrecreationalactivities).

• Womenwhoarepregnantortryingtobecomepregnant.

• Individualstakingcertainover-the-counterorprescriptionmedications.(SeeConsumerAlert,p.445.)

• Peoplewithmedicalconditionsthatcanbemadeworsebydrinking.

• Recoveringalcoholics.

onAlcoholAbuseandAlcoholism,52percentof adultsoverage18arecurrentregulardrink-ers; 13percentare infrequentdrinkers; 6per-centareformerregulardrinkers;9percentareformerinfrequentdrinkers;and20percentarelifetimeabstainers.1

White men and women are morelikely to drink than other adults.Seventy percent of white men say

they drink, compared to 57 percent of blackmen,55percentof Asianmen,and58percentof American Indian or Alaska Native men.Among women, 59 percent of white womendrink,comparedwith40percentforblacks,32percentforAsians,and45percentforAmericanIndianorAlaskaNatives.2

Thecurrentalcohol-userate forblacksage18andolderissignificantlylowerthanthenationaladult average (44 percent versus 55 percent).Blacks also have a lower rate of binge drink-ingthanotherAmericans(22percentversus26percent).3

Nearlythree-quartersof Americanswithgrad-uatedegreesdrink,comparedto44percentof those with less than a high school education.Richerpeoplealsodrinkmorethanpoorones.Amongfamilieswithincomesbelowthepovertylevel,45percentdrink,comparedwith73per-centof thosewithincomesfourormoretimesgreater.4

Some people feel they

can be more relaxed

when they have a

drink. However, alco-

hol lowers inhibitions

and can lead to behav-

ior that one or both

people regret later.

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427Chapter 13 Alcohol

• Depression. Womenaremorelikelythanmentobedepressedpriortodrinkingandtosufferfrombothdepressionandadrinkingproblematthesametime.

• Inherited susceptibility. Inbothwomenandmen,geneticsaccountsfor50to60per-centof aperson’svulnerabilitytoaseriousdrinkingproblem.

Drinking on Campus

Young adults are the most frequentusersof alcoholintheUnitedStates,and college students consumemore

alcoholmoreoftenandmoredangerouslythannonstudents the same age. (See How Do YouCompare?) Many health experts consider theuseandabuseof alcoholastheprimaryhealthconcernforcollegestudents.

Aboutone in three students increases alcoholuse and encounters more related problemsthroughout the college years; a third do notchangepreviouspatterns;andathirddecreasedrinking.5 But alcohol can affect every aspectof a student’s life. Nearly 160,000 freshmendrop out of college after their first year foralcohol- or drug-related reasons, accordingto the CORE Institute, which surveys drink-ing practices on campuses. College drinkingis responsible for an estimated 1,700 annualalcohol-relateddeaths, 599,000 injuries,morethan696,000physicalattacks,andmore than97,000sexualassaults.6

Inthepreliminaryfindingsof anongoingstudyof binge drinking and college students, alco-holsignificantlyloweredGPAsinthefirstyearof college. The undergraduates who bingedshowed significantly higher levels of bothdepression and anxiety; those who drank butdidnotbingedemonstratedthegreatestimpul-sivity;andthosewhobingedwithinthe30daysprior to testingmade significantlymoreerrorsonatestof spatialworkingmemory.7

Althoughthepercentageof studentswhodrinkhasn’t changed much over the years, drinkingon campus has. At many schools, students’social lives revolvearoundparties, games,and

Why People DrinkThemostcommonreasonpeopledrinkalcoholistorelax.Becauseitdepressesthecentralnervoussystem,alcoholcanmakepeoplefeellesstense.Somepsychologiststheorizethatmenengageinconfirmatory drinking;thatis,theydrinktoreinforcetheimageof masculinityassociatedwithalcoholconsumption.Bothgendersmayengageincom-pensatory drinking,consumingalcoholtoheightentheirsenseof masculinityorfemininity.

Here are some other reasons why men andwomendrink:

• Social ease.Whenpeopleusealcohol,theymayseembolder,wittier,sexier.Atthesametime,theybecomemorerelaxedandseemtoenjoyeachother’scompanymore.Becausealcohollowersinhibitions,somepeopleseeitasapreludetoseduction.

• Role models.Athletes,someof thebiggestcelebritiesinourcountry,havealonghistoryof appearingincommercialsforalcohol.Manyadvertisementsfeatureglamorousmenandwomenholdingorsippingalcoholicbeverages.

• Advertising.Brewersandbeerdistributorsspendmultimillionsof dollarseveryyearpromotingthemessage:If youwanttohavefun,haveadrink.Youngpeoplemaybeespeciallyresponsivetosuchsalespitches.

• Relationship issues.Single,separated,ordivorcedmenandwomendrinkmoreandmoreoftenthanmarriedones.

Individuals with drinking problems often turntoalcoholforotherreasons,including:

• Psychological factors. Bothmenandwomenmaydrinktocompensateforfeel-ingsof inadequacy.Yetwomenwhotendtoruminateormulloverbadfeelingsmayfindthatalcoholincreasesthistendencyandmakesthemfeelmoredistressed.

• Self-medication. Moresothanmen,somewomenfeelit’spermissibletousealcoholasif itwereamedicine.Aslongasthey’retakingitforareason,itseemsacceptabletothem.

• Childhood traumas. Femalealcoholicsoftenreportthattheywerephysicallyorsexu-allyabusedaschildrenorsufferedgreatdis-tressbecauseof povertyoraparent’sdeath.





eight or more for a female. In a recent study,about 16 percent of students—twice as manymenaswomen—engagedinthislevelof drink-ingongamedays.10

Morecollegewomendrink,andtheydrinkmorethaninthepast.Collegewomenwhodrinkareatmuchgreaterriskof unwantedsexualactiv-ity.Inonestudymorethanoneinfivereportedsometypeof sexualassault.

College men drink more, moreoften, and more intensely thanwomen. Caucasians drink more

than African or Asian Americans. Fraternityand sorority members, athletes, and vigorousexercisers also use more alcohol more oftenthanotherstudents.Thestudentswhodrinktheleast are those attending two-year institutions,religious schools, commuter schools, and his-toricallyblackcollegesanduniversities.

Why Students Don’t DrinkAccording to the National College HealthAssessment,21percentof studentsreportneverusing alcohol. Students who don’t drink give

bar crawls. More students drink simply to getdrunkanddrinkmoreperdrinkingepisode.

Overall, studentsdrinkmoreheavilyonweek-ends than weekdays and at the beginning of eachsemesterorquarterthanduringfinalexamperiods.ThehighestdrinkingdaysincludeHal-loween,NewYear’sEve,andSt.Patrick’sDay.8

Inarecentstudythatfollowedundergraduatesfor70days,studentsdrankthemostonweek-ends,withFridaysandSaturdaysaccountingfor60percentof alldrinksconsumedandThurs-daysoranadditional17percent.Theoddsof drinking heavily, drinking enough to stumblearound,anddrinkingenoughtopassoutwerealsogreateronweekenddays.Maleundergrad-uates, those who started drinking at an earlyage,membersof theGreek system,and thosemotivatedbyadesiretosocializeandhavefunweremore likely todrinkonweekdaysaswellasweekends.9

Alcoholconsumptionespeciallysoarson“gamedays,” when a significant number of studentsengage in “extreme ritualistic alcohol con-sumption,”which isdefinedas consuming tenormoredrinksonthesamedayforamaleand

How Do You Compare?

StuDent Drinking

Percent (%)

Alcohol Consumption Actual Use Perceived Use

Male Female Total Male Female Total

Never used 21.5 20.4 20.9 4.2 2.9 3.5

Used, but not in the last 30 days 12.2 14.8 13.9 2.4 1.8 2.0

Used 1–9 days 47.1 51.6 49.7 39.2 32.7 35.0

Used 10–29 17.3 12.6 14.3 40.7 46.7 44.4

Used all 30 days 1.9 0.6 1.1 13.4 15.9 15.1

Any use within the last 30 days 66.3 64.8 65.2 93.3 95.3 94.4

How Do You Compare?As the figures above show, most undergraduates overestimate the number of students who drink—and drink frequently—and underestimate the number who don’t drink often at all. How do

your perceptions and actual behavior compare? What role does alcohol play in your life? Describe its impact on you, your choices, and your behavior in your online journal.

Source: American College Health Association, American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2010 (Linthicum, MD: American College Health Association, 2010).





howmuchandhowoftentheirclassmatesdrink.

• Party schools.CollegesanduniversitiesintheNortheast,thosewithastrongGreeksystem,andthosewhereathleticspredomi-natehavehigherdrinkingratesthanothers.Studentswhodrankheavilybeforecollegearemorelikelytojoinafraternityorsorority,andtheenvironmentinmanyGreekorgani-zationsfosterscontinueddrinking.Studentswhoneverjoinorwhodropoutof afra-ternityorsororityreportlessriskydrinkingbehavior.

• Living arrangements.Drinkingratesarehighestamongstudentslivinginfraternityandsororityhouses,followedbythoseinon-campushousing(dormitories,residencehalls)andoff-campusapartmentsorhouses.Studentslivingathomewiththeirfamiliesdrinktheleast.

• Celebrations.Atwenty-firstbirthdayposesacommonandseriousrisk.Inastudyof some2,500collegedrinkers,fourinfivereporteddrinkingtocelebratetheirtwenty-firstbirthdays,12percent(menandwomen)reportedhaving21drinks,andabouthalf drankmorethantheyeverhadbefore.14Tail-gatingparties,biggamerallies,Halloweenbonfires,andothereventsfueledby“fun”alsobecomeoccasionsfordrinking.ThemostnotoriouscelebratorydrinkingoccursduringSpringBreak.

• Participation in sports.Collegeathletesdrinkmoreoftenandmoreheavilythannon-athletes.Theymaybeatgreaterriskbecausemanyareyoungerthan21,belongtoGreekorganizations,havelowerGPAs,orspendmoretimesocializingthanotherstudents.Individualsportsalsomatter.Malehockeyandfemalesoccerplayersdrinkthemost;malebasketballplayersandcross-countryortrackathletesof bothsexes,theleast.Femaleathletesmaydrinkmorethanothercollegewomenbecausetheyarefollowingthemaleathleticmodelof takingthelead,notjustonthefield,butalsoatthepartyorbar.

• Coping.Studentsturntoalcoholtocopewitheverydayproblemsandpersonalissues.Thosewithsymptomsof depressionwholackskillstocopewithdailyproblems,par-ticularlymales,aremorelikelytodrinkthanothers.Studentswhofeelangry,hostile,

various reasons for their choice, including nothavingaccesstoalcohol,parentalorpeerpres-sure, being underage, costs, religious reasons,andnotlikingthetaste.11

African American students aremorelikelythanwhiteundergradu-ates toabstainandtoreportnever

havinghadanalcoholicdrinkornothavingadrink inthepast30days.Theyalsodrink lessfrequentlyandconsumefewerdrinksperocca-sionthanwhites.

Spiritual and religious values also influencedrinkingoncampus.Inarecentstudy,studentsatareligiouscollegewerefourtimeslesslikelyto be moderate or heavy drinkers comparedwiththoseatapublicuniversity.Studentswiththeleasttendencytowardreligiousbeliefswere27timesmorelikelytobeheavydrinkersthanthosewithgreaterreligiosity.12

Character virtues also correlate with drink-ing choices. Temperance, which psychologistsdefineasacombinationof forgiveness,humility,prudence,andself-regulation,isassociatedwithsexualabstinence,lessriskydrinking,andfewernegative consequences from drinking. Othercharacter traits, including wisdom and cour-age,donotseemlinkedtoaparticulardrinkingpattern.13

Why Students DrinkUndergraduateshavealwaysturnedtoalcoholfor the same reasons. Away from home, oftenfor the first time, many are excited by andapprehensive about their newfound indepen-dence. When new pressures seem overwhelm-ing,whentheyfeelawkwardorinsecure,whentheyjustwanttoletlooseandhaveagoodtime,theyreachforadrink.

The following list summarizes the most com-moninfluencesonstudentdrinking.

• Social norms.Comparedwithotherfac-tors,suchasrace,gender,yearinschool,andfraternity/sororitymembership,socialnorms(discussedinChapter1)havethestrongestassociationwithhowmuchcollegestudentsdrink.Students’perceptionsof howmuchtheirpeers,particularlythoseclosesttothem,drinkhavemoreinfluenceontheirowndrinkingthandoparentsorresidentadvisors.Yet,studentsgenerallyoverestimate





binge For a man, having five or more alcoholic drinks at a single sitting; for a woman, having four drinks or more at a single sitting.

Alcohol ExpectancyAccordingtoexpectancytheory,anindividual’sbelief, rational or not, that a certain behaviororexperiencewillhaveaparticulareffect,posi-tiveornegative,increasestheprobabilityof thiseffect.Asmanystudieshaveshown,expectancyinfluenceshowmuchandhowoften individu-alsdrink.Collegewomengenerallyexpectposi-tive social experiences when drinking alcohol;young adult men expect sexual arousal andmoreaggressivebehavior.16

Manycollegestudentsdrinkbecausetheybelieve“liquid courage” will make them feel better—more at ease, less stressed, more sociable, lessself-conscious.17Thebehaviorsmostcommonlyreported by students when they drink reflecttheseexpectations:flirting,dancing,tellingjokes,andlaughingharderormorefrequently.

Defensive DrinkingInthemostrecentACHAsurvey,thevastmajor-ityof students—97percent—reportedusingatleast one behavioral strategy to control theirdrinkingandpreventalcohol-relatedproblems.Themostpopular strategieswere stayingwiththesamegroupof friendsthroughoutanevent,choosingadesignateddriver,eatingbeforeand/orwhiledrinking, stickingwithonlyone formof alcohol, and deciding in advance not toexceedasetnumberof drinks.18Themorethatstudentsrelyonprotectivebehavioralstrategies,the less alcohol they consume and the feweralcohol-relatedproblemstheyencounter.19 (Foradditionalstrategies,seeHealthonaBudget.)

High-Risk Drinking on CampusThe most common types of student high-riskdrinkingarebingedrinking,predrinking,under-agedrinking,bingedrinkingcombinedwithdis-orderedeating,andconsumptionof caffeinatedalcoholicbeverages.

Binge Drinking AccordingtotheNationalInstitute of Alcohol Abuse and Alcoholism,a binge is a pattern of drinking alcohol thatbrings blood alcohol concentration (BAC)(discussed later in this chapter) to 0.08 gram-percentorabove.Foratypicaladultman,this

nervous,guilty,orashamedaremorelikelytodrinkintheirdormroomsandapart-mentsthanthosewhoreportpositivemoods.Studentswhoscorehighinsocialanxietyreportheavierdrinking,evenafterabasicinterventiondesignedtoreducealcoholconsumption.15

• Parental approval. Studentswhobelievethattheirparentsapproveof drinkingaremorelikelytodrinkandtoreportadrinking-relatedproblem.Thisrelationshipisevenstrongerinyoungerstudentsandthosewhoperceivethattheirmothersapproveof drinking.

• First-year transition.Somestudentswhodranklessinhighschoolthanclassmateswhoweren’theadedforcollegestartdrink-ing,anddrinkingheavily,incollege—oftenduringtheirfirstsixweeksoncampusandpeakingduringschoolbreaks.Alcoholcon-sumptiondeclinesoverthecourseof anundergraduateeducation,butasubstantialnumberof studentscontinuetodrinkheavilythroughtheirthirdyear.

Health on a Budget

Drink Less, Save MoreYet another good reason to con-

trol how much you drink is eco-

nomic. The less spending money

that college students have, the

less they drink—and the less likely

they are to get drunk and to suf-

fer alcohol-related negative con-

sequences. Here are some simple

ways to spend less on alcohol:

• Pace yourself. Start with a soft

drink and have a nonalcoholic

drink every second or third

drink.

• Stay busy. You will drink less if

you play pool or dance rather

than just sitting and drinking.

• Try low-alcohol alternatives,

such as light beers and low- or

no-alcohol wines.

• Have alcohol-free days. Don’t

drink at all at least two days a

week.

• Drink slowly. Take sips and not

gulps. Put your glass down

between sips.

• Avoid salty snacks. Salty foods

like chips or nuts make you

thirsty so you drink more.

• Have one drink at a time. Don’t

let people top up your drinks.

It makes it harder to keep track

of how much alcohol you’re

consuming.





unprotectedsexualactivity,orgetintroublewithcampuspolice.

Why Students Binge-Drink Youngpeoplewho came from, socialized within, or wereexposed to “wet” environments—settings inwhich alcohol is cheap and accessible anddrinkingisprevalent—aremorelikelytoengageinbingedrinking.Studentswhoreportdrinkingatleastonceamonthduringtheirfinalyearof highschoolareoverthreetimesmorelikelytobinge-drinkincollegethanthosewhodranklessfrequentlyinhighschool.

Thefactorsthatmostinfluencestudentstobinge-drinkare:

• Low price for alcohol.Beer,whichischeapandeasytoobtain,isthebeverageof choiceamongbingedrinkers.

• Easy access to alcohol.Inonestudy,thedensityof alcoholoutlets(suchasbars)nearcampusaffectedthedrinkingof students.

• Attending a schoolorlivinginaresidencewithmanybingedrinkers.

patterncorrespondstoconsumingfiveormoredrinksinabouttwohours;forawoman,fourormoredrinks.

Inarecentstudy,bingedrinkersconsumedanaverageof eightdrinksduringtheirmostrecentdrinking episode.Men consumedmoredrinksthanwomen,andthosebetweenages18and34drankmorethanolderbingedrinkers.20

Colleges vary widely in their binge-drinkingrates—from1percenttomorethan70percent.The federalgovernmenthassetagoalof cut-tingthecurrentbinge-drinkingrateof 40per-cent among college students in half as a goalforHealthy People 2010–2020.Howdoyouthinkyourcampuscompared?

Who Binge-Drinks in College? Anestimatedfourintencollegestu-dentsdrinkatbingelevelsorgreater.

They consume 91 percent of all alcohol thatundergraduates report drinking. (See Table13.1.)Hundredsof studieshavecreatedapor-traitof whotheyareandhowtheydifferfromothers.Herearesomeof theircharacteristics.

• Morelikelytobemalethanfemale,althoughoneinthreewomen—upfromoneinfour—reportsbingedrinking.

• Morelikelytobewhitethananyothereth-nicorracialgroup(leastlikelytobeAfricanAmericanwomen).21

• Morelikelytobeunderage24thanolder.

• Morelikelytobeenrolledinfour-yearcollegesthantwo-yearones.

• Morelikelytoliveinstateswithfeweralco-holcontrolpolicies.

• Morelikelytobeinvolvedinathleticsandsocializefrequently.

• Morelikelytobeinafraternityorsorority.

• Morelikelytobedissatisfiedwiththeirbodies,notexercise,eatpoorly,andgoonunhealthydiets.

• Morelikelytoputthemselvesorothersatriskbydrivingafterdrinking.

• Muchmorelikelytomissclassesorfallbehindinschoolwork.

• Morelikelytoabuseothersubstances,includingnicotine,marijuana,cocaine,andLSD.

• Muchmorelikelytoengageinvandalism,beinjuredorhurt,engageinunplannedor

Table 13.1 Binge Drinking on Campus

Reported number of drinks consumed the last time students “partied” or

socialized (only students reporting one or more drinks were included):

Percent (%)

Number of Drinks Male Female Total

4 or fewer 30.1 45.6 39.8

5 7.3 8.9 8.3

6 6.9 6.2 6.4

7 or more 28.6 12.0 18.0

Reported number of times college students consumed five or more drinks in a

sitting within the last two weeks:

Percent (%)

Male Female Total

N/A don’t drink 22.3 21.7 22.0

None 34.2 48.0 42.9

1–2 times 25.7 21.6 23.0

3–5 times 13.6 7.3 9.6

6 or more times 4.2 1.4 2.5






thefirsttimeverysoonaftertheyarriveoncam-pus.Bingesbecomelesscommonintheirsub-sequentyearsatschoolandalmostalwaysendwitheducation.Reallife,oneeducatornotes,is“astrongdisincentive”tothistypeof drinking.

Drinking Games Two-thirds of collegestudentsengageindrinkinggamesthatinvolvebinge drinking.22 All share a common theme:becomingintoxicatedinashortperiodof time.Menaremorelikelytoparticipatethanwomenand to consume larger amounts of alcohol.23Players, who don’t monitor or regulate howmuch they’re drinking, are at risk of extremeintoxication.Drinkinggameshavebeen impli-cated in alcohol-related injuries and deathsfromalcoholpoisoning.

Predrinking/Pregaming Drinking be-foregoingouthasbecomeincreasinglycommononcollegecampuses,wherepredrinking(alsocalledpregaming,preloading,orfront-loading)is announcedandcelebrated in textmessages,e-mails, blogs, YouTube videos, and Facebookentries.

Ina recent studyat tenPennsylvaniacolleges,almosttwothirds—64percent—of undergrad-uates reported pregaming and consumed anaverageof 4.9drinksduringtheirlastpre-eventdrinking episode. Social norms and assump-tionsaboutothers’drinkingpatternsinfluencedthis drinking pattern. Undergraduates whoestimated that the average student pregamedthreeormoretimesinthelasttwoweeksweremorelikelytodrinkbeforeaneventandtodrinkheavily.24

Predrinkers consistently report much higheralcohol consumption during the evening andmore negative consequences, such as gettingintoafight,beingarrested,orbeingreferredtoa university’s mandatory alcohol interventionprogram.

Why Is Predrinking Popular? Collegestudents predrink for a variety of reasons,including:

• Economic.Manysaytheywanttoavoidpayingforexpensivedrinksatabar,althoughmostendupdrinkingjustasmuchif notmorethantheydowhentheydon’tdrinkbeforehand.25(Forbetterwaystosavemoneyonbooze,seeHealthonaBudgetonp.430.)

• Beliefthatclosefriendswerelikelytobinge.

• Drinking games—suchasbeerpongordrinkingwheneveracertainphraseismen-tionedinasongoronaTVprogram—canresultinhighlevelsof intoxicationinashortperiodof time.

• Parents who drankordidnotdisapproveof theirchildrendrinking.

• Recreational drinkingbeforeage16.

Someeducatorsviewbingeingasaproductof thecollegeenvironment.Morestudentsbinge-drinkat thebeginningof the school yearandthen cut back as the semester progresses andacademic demands increase. Binge drinkingalsopeaks followingexamtimes,duringhomefootball weekends, and during Spring Break.Manynewstudentsengageinbingedrinkingfor

Young people in “wet”

environments where

alcohol is cheap and

accessible are more

likely to engage in

binge drinking.

Sea

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/Get

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predrinking Consuming alcoholic beverages, usually with friends, before going out to bars or parties; also called pre-gaming, pre-loading, or front-loading.





causing property damage, getting into troublewith police, and being hurt or injured. Thedrinking behavior of underage students alsodependsontheirlivingarrangements.Thoseincontrolledsettings,suchastheirparents’homeorasubstance-freedorm,arelesslikelytobinge-drink.Studentslivinginfraternitiesorsororitiesaremostlikelytobinge-drink,regardlessof age.

Binge Drinking and Disordered Eating Thecombinationof tworiskybehaviors—disor-deredeatingandheavydrinking—posesspecialdangerstostudents.AsdiscussedinChapter7,disorderedeatingcanrangefromexcessivecon-cern about weight to binge eating to extremeweight-control methods, such as purging. Insome studies, as many as 60 percent of col-legewomenreportedbingeeatingandpurging,while9percentof collegemenreportedsomeform of disordered eating. In a recent report,63 percent of female students and 83 percentof malesengagedinbingedrinking;48percentalso reported binge eating.26 In women, thecombination of these behaviors increases therisk of many negative consequences, includ-ing blackouts, unintended sexual activity, andforcedsexualintercourse.

• Intoxication.Agrowingnumberof stu-dentsseemtowanttogetdrunkasquicklyaspossible.

• Socializing. Predrinkinggivesstudentsachancetochatwiththeirfriends,whichoftenisn’tpossibleinnoisy,crowdedclubsorbars.

• Anxiety reduction.Bydrinkingbeforemeetingstrangers,studentssaytheyfeellessshyorself-conscious.

• Group bonding.Youngmenmayusepredrinkingaswhatoneresearchercalls“acollectiveritualof confidencebuildingtopreparethemselvesforsubsequentinterac-tionswiththeoppositesex.”

The Perils of Predrinking Whenstudentsgettogethertodrinkbeforeagameoranightout, they usually consume large quantities of alcohol quite rapidly. In part that’s becausethey’redrinkinginplaceswithoutrestraintsonhowmuchtheycandrink.Variousstudieshaveshownthatstudentsdrinkmoreandhavehigherblood-alcohol concentrations on days whentheypredrink.Theyalsoareatgreaterriskof blackouts,passingout,hangovers, andalcoholpoisoning.

Inadditiontodrinkingmorealcohol,predrink-ersaremore likely touseotherdrugs, suchasmarijuana and cocaine. The combined effectsof thesesubstancesfurtherincreasetheriskof injury,violence,orvictimization.

Underage Drinking on Campus Eachyear,approximately5,000youngpeopleundertheageof 21dieasaresultof underagedrink-ing.Thisfigureincludesabout1,900deathsfrommotorvehiclecrashes,1,600asaresultof homi-cides,300fromsuicide,aswellashundredsfromother injuries such as falls, burns, and drown-ings.Studentsunderage21drinklessoftenthanolder students, but tend todrinkmoreheavilyandtoexperiencemorenegativealcohol-relatedconsequences. More underage students reportdrinking“togetdrunk”anddrinkingatbingelevelswhentheyconsumedalcohol.

Underage college students are most likely todrink if they can easily obtain cheap alcohol,especially beer. They tend to drink in privatesettings, such as dorms and fraternity parties,and to experience such drinking-related con-sequences as doing something they regretted,forgetting where they were or what they did,

Your Strategies for Prevention

How to Manage Predrinking and Drinking without Getting DrunkHere are some strategies students

frequently use:

• Eat before and/or during drinking.

• Keep track of how many drinks you’re

having.

• Avoid drinking games.

• Decide in advance how many drinks

to have.

• Alternate alcoholic and nonalcoholic

beverages.

• Limit yourself to no more than one drink

an hour.

• Have a friend let you know when you’ve

had enough.

• Choose not to drink.





have banned some brands, but young peoplecontinuetocombineenergydrinkssuchasRedBullwithvodkaorotherformsof alcohol.Thecaffeine in these drinks may mask the depres-sant effects of alcohol, but it has no effect onthemetabolismof alcoholbytheliverandthusdoesnot reducebreathalcohol concentrationsorreducealcohol-relatedrisks.

Drinkers who consume alcohol mixed withenergy drinks are three times more likely toreach thebreathalcohol levelsassociatedwithbingedrinkingthanarethosewhodonotreportmixing alcohol with energy drinks. They alsoare about twice as likely as other drinkers toreportbeingtakenadvantageof sexually,takingadvantage of someone else sexually, and driv-ingorgettingintoacarwithadriverundertheinfluenceof alcohol.27

Why Students Stop DrinkingOnly1percentof studentsages18to24receivetreatment foralcoholordrugabuse.Nonethe-less,asmanyas22percentof alcohol-abusingcollege students “spontaneously” reduce theirdrinking as they progress through college.Unlikeolderadults,whooftenhitbottombeforethey change their drinking behaviors, manycollege students go through a gradual processof reduced drinking. Researchers refer to thisbehavioral change as early cessation, naturalreduction, natural recovery, or spontaneousrecovery.

As with other behavioral changes, individualsmustbereadytochangetheirdrinkingpatterns.In a recent study, students who binged fre-quently,whoexperiencedmorealcohol-relatedinterpersonalandacademicproblems,whodidnotalsousemarijuana,andwholivedinaresi-dencehallwherebingedrinkingwasthenormshowedagreaterreadinesstochange.28

Whydostudentssaytheystopheavydrinking?Onecommonresponse:“Itwasjustgettingold.”Somedescribemorespecificreasonswhyalco-hol lost its appeal, including vomiting, urinat-inginhallways,beingphysicallyfondled,sexualassault,violence,accidents,injuries,unprotectedintercourse,andemergencyroomvisits.Vicari-ousexperiences,suchasaroommate’sarrestfordrivingundertheinfluenceorasororitysister’sdaterape,haveapowerfulimpact.

Somestudentsrestrictcaloriesfromfoodpriorto planned drinking—some to avoid weightgain; others, to enhance the effects of alco-hol.Thepopularmediahavecreatedtheterm“drunkorexia” to describe this risky behavior,butitisnotanofficialpsychiatricterm.

Inarecentstudyatasoutheasternuniversity,14percent of male and female students reportedrestrictingcaloriespriortoplanneddrinking—6percenttoavoidweightgainand10percenttoenhance alcohol’s effects. The students whoengagedinbingedrinkingfrequentlyweremostlikelytocutbackoncaloriesbeforedrinking.

Caffeinated Alcoholic Beverages Caf-feinated alcoholic beverages (CABs) are pre-mixedbeveragesthatcombinealcohol,caffeine,and other stimulants. Often malt- or distilled-spirits-based,theyusuallyhaveahigheralcoholcontent(5to12percent)thanbeer(4to5per-cent). Because CABs may have higher alcoholcontent than beer, some states have classifiedCABs as liquor, thereby limiting the locationswherethesebeveragescanbesold.

Like energy drinks (discussed in Chapter 5),CABs—sometimes dubbed “blackout in acan”—have surged in popularity among teensandyoungadults.TheFDAandlocalauthorities

Four Loko is among

the energy drinks

combining caffeine

and alcohol that

have been banned

at certain colleges.

Joe

Rae

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Get

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ages





of coupleswho reportedviolentbehavior saidthey had used alcohol before or during theepisode.31Inastudyof collegestudents,heavydrinkingwasassociatedwithdatingviolencebymen in their freshman year. Among women,heavy drinking in their sophomore year pre-dicteddatingviolenceintheirjunioryear.32

Alcohol-Related Problems on CampusAsmanyas10to30percentof collegestudentsexperience some negative consequences of drinking.

IntheNationalCollegeHealthAssessment,35percent of students who drank did somethingtheylaterregretted;31percentforgotwhotheywerewithorwhattheydid.Menweremorelikelythanwomen to injure themselves, haveunpro-tectedsex,get involved ina fight,orphysicallyinjureanotherperson.Womenweremorelikelytohavesomeoneuseforceorthreatof forcetohavesexwith them. (SeeTable13.2.)Studentswhodrinkheavilyalsoaremuchmorelikelytoabuseprescriptiondrugs(seeChapter12).

Consequences of Drinking Amongtheotherproblemslinkedtodrinkingare:

• Atypical behavior.Undertheinfluenceof alcohol,studentsbehaveinwaystheynormallywouldn’t.Maleheavydrinkersaremorepronetobehaveinwaysthatarecon-sidered“antisocial,”orcontrarytothestan-dardsof oursociety,suchasforcingortryingtoforceunwantedsexualcontact,drivingdrunk,exposingthemselves,orhavingsexwithastranger.

• Academic problems.Themorethatstudentsdrink,themorelikelytheyaretofallbehindinschoolwork,missclasses,havelowerGPAs,andfacesuspensions.Ingen-eral,studentswithanAaveragehavethreetofourdrinksperweek,whilestudentswithDorFaveragesdrinkalmosttendrinksaweek.(SeeFigure13.1.)

• Risky sexual behavior.Aboutoneinfivecollegestudentsreportsengaginginunplannedsexualactivity,includinghavingsexwithsomeonetheyjustmetandhavingunprotectedsex.29

• Sexual assault.Inarecentsurvey,almost20percentof undergraduatewomenreportedsometypeof completedsexualassaultsinceenteringcollege.Mostoccurredafterwomenvoluntarilyconsumedalcohol;afewaftertheywereunknowinglygivenadrugintheirdrinks.30

Alcohol increases the risk of violence amongcouples,especiallyviolencebothtoandbythefemalepartner.Inarecentanalysis,30percent

Table 13.2 Consequences of Drinking

College students who drank alcohol reported the following consequences

occurring in the last 12 months as a result of their own drinking:*

Percent (%)

Male Female Total

Did something you later regretted 35.0 34.5 34.7

Forgot where you were or what you did 33.3 30.0 31.2

Got in trouble with the police 5.9 3.0 4.1

Had sex with someone without giving your

consent

2.0 2.4 2.3

Had sex with someone without getting her

or his consent

0.9 0.3 0.6

Had unprotected sex 19.2 16.1 17.3

Physically injured yourself 18.2 15.5 16.6

Physically injured another person 4.5 1.8 2.9

Seriously considered suicide 1.9 1.6 1.7

Reported one or more of the above 53.5 49.8 51.1

*Students responding “N/A, don’t drink” were excluded from this analysis.


F D C B A

2.5

5

7.5

10

12.5

Grade

Drin

ks p

er w

eek

Figure 13.1 Alcohol and Academic Success

Source: Core Institute and SIU’s Core Institute and SDSU’s eCHECKUP TO GO, http://core.siuc.edu and http://www.echeckuptogo.com.





Although most drunk drivers are men, moreyoung women than ever before are drivingdrunkandgettingintofatalcaraccidents.Moreyoung women than men involved in deadlycrasheshadhighblood-alcohollevels,accordingtoa recentanalysisof data fromtheNationalHighwayTrafficSafetyAdministration.35

Of the 5,000 alcohol-related deaths among18-to24-year-olds,80percentwerecausedbyalcohol-related traffic accidents. A young per-son dies in an alcohol-related traffic crash anaverageof onceeverythreehours.36Sincestatesbegansetting the legaldrinkingageat21, theNationalHighwaySafetyBoardestimates thatover26,000liveshavebeensaved.37

Safetygroupsalsoattributethedeclineinalco-hol-related deaths to enforcement tools likesobrietycheckpointsandtothestates’adoptionof a uniform drunken-driving standard of aBACof 0.08percent.

Inthelasttwodecades,familiesof thevictimsof drunkdrivershaveorganizedtochangethewaythe nation treats its drunk drivers. Because of theeffortsof MADD(MothersAgainstDrunkDriving), SADD (Students Against Destruc-tiveDecisions),andother lobbyinggroups,cit-ies, counties, and states are cracking down ondriverswhodrink.Sincecourtshaveheldestab-lishmentsthatservealcoholliablefortheconse-quencesof allowingdrunkcustomers todrive,manybarsandrestaurantshavejoinedthecam-paignagainstdrunkdriving.

Topreventdrunk-drivingdisasters,takethefol-lowingsteps:

• Whengoingoutinagroup,alwaysdesignateonepersonwhowon’tdrinkatalltoserveasthedriver.

• Nevergetbehindthewheelif you’vehadmorethantwodrinkswithintwohours,espe-ciallyif youhaven’teaten.

• Neverletintoxicatedfriendsdrivehome.Callataxi,drivethemyourself,orarrangeforthemtospendthenightinasafeplace.

“Secondhand” Drinking Problems Heavyalcoholusecanendangerbothdrinkersand others. Secondhand problems caused byother’salcoholuse include lossof sleep, inter-ruption of studies, assaults, vandalism, andunwanted sexual advances. Students living on

• Unintentional injury. Morethan30per-centof collegedrinkershavebeenhurtorinjuredasaresultof drinking.Theyalsoaremorelikelytocauseinjurytoothers,tohaveacaraccident,tosufferburns,andtosuf-ferafallseriousenoughtorequiremedicalattention.

• Consequences beyond college.Alcohol-relatedconvictions,includingcarryingafalseI.D.ordrivingundertheinfluenceof alcohol,remainonanindividual’scriminalrecordandcouldaffectastudent’sgraduateschoolandprofessionalopportunities.

• Illness and death. Manystudentssuffershort-termhealthconsequencesof drinking,suchasheadachesandhangovers.Heavyalcoholuseincollegestudentsisassociatedwithimmunologicalproblemsanddigestiveandupperrespiratorydisorders.Evenmod-eratedrinkingcancontributetoinfertilityinwomen.Longer-termconsequencesof heavydrinkingincludeliverdisease,stroke,heartdisease,andcertaintypesof cancer.About300,000of today’scollegestudentswilleven-tuallydiefromalcohol-relatedcauses,includ-ingdrunk-drivingaccidents,cirrhosisof theliver,variouscancers,andheartdisease.

Drinking and Driving Drunkdriving is the most frequently com-mittedcrimeintheUnitedStates.In

the ACHA survey, 27 percent of studentsreporteddrivingafterhavinghadanyalcohol;3percent drove after five or more drinks. In arecent study, traditional-age undergraduatestypically increased how often and how muchthey drank from ages 18 to 21 and thendecreased the amount they drank on any oneoccasionfromages21to23.Drivingafterdrink-ingincreasedacrossthisentireagerange,withthebiggestjumpbetweenages21and23.33

Alcoholimpairsdriving-relatedskillsregardlessof the ageof thedriveror the timeof day itis consumed. However, younger drinkers anddrivers are at greatest risk.Underagedrinkersaremore likely todrive afterdrinking, to ridewithintoxicateddrivers,andtobeinjuredafterdrinking—at least inpartbecause theybelievethat people can drive safely and legally afterdrinking.34





• “E-interventions.”Electronicallybasedinterventionsincludingtextmessages,e-mails,andpodcastshavebecomeincreas-inglypopular.Web-basedinterventions,suchasTheAlcohole-CheckUpToGo(e-Chug),haveshownpromiseinreducingalcohol-relatedproblemsamongfirst-yearstudents.

• Alcohol policies. Universityalcoholpoli-ciesincludecampusalcoholbans,noalcoholatuniversity-sponsoredevents,prohibitionof beerkegs,limitsonthemaximumnumberof drinksservedperstudent,anddrysoror-ityandfraternityinitiationactivities.Studiessuggestthatstudentswhoattendschoolsthatbanalcoholarelesslikelytoengageinheavybingedrinking,morelikelytoabstainfromusingalcohol,andlesslikelytoexperiencethesecondhandeffectsof drinking.

Some college presidents and administratorshave recommended lowering the minimumlegaldrinkingageto18toreducebingedrink-ingbyunderagestudents.Criticspointoutthatthis approach might just shift the problem tohighschoolsandmighthaveaminimalimpacton risky drinking on campus.40 (See Health intheHeadlines:CampusDrinking.)

campuseswithhighratesof bingedrinkingaretwoormoretimesaslikelytoexperiencethesesecondhandeffectsasthoselivingoncampuseswithlowrates.Inonestudy,nearlythree-quar-ters of campus rapeshappenedwhen the vic-timsweresointoxicatedthattheywereunabletoconsentorrefuse.

How Schools Are Sobering UpThe National Institute on Alcohol Abuse andAlcoholismhasstudiedinterventionsthateffec-tivelydealwithcollegedrinkingproblems.Pro-grams that address alcohol-related attitudesandbehaviors,use surveydata tocounter stu-dents’ misconceptions about their fellow stu-dents’drinkingpractices,andincreasestudents’motivationtochangetheirdrinkinghabitshaveprovedeffective.38

• Social norms. Thisapproach,whichcommunicatesactualfactsaboutdrinkingbehaviortodispelmyths,issimple,cost-efficient,andeffective.Itspositivemessageisthatmoststudentsonvirtuallyeverycampusbelieveinandpracticesafety,responsibility,andmoderation,ratherthanexcessdrinking.

• Motivational enhancement.Thisnon-judgmental,supportiveapproachtopersonalchangealsohasprovedbeneficial.Inbrief interventions,speciallytrainedcounselorshelpbuildstudents’self-efficacy,inthiscase,theirbelief intheirabilitytochangetheirdrinkingbehavior.

• Challenging alcohol expectancy.Asalreadynoted,studentswhoexpectalco-holtoaffecttheminspecificways(suchasbeingmoreateasesociallyormoresexuallyaroused)aremorelikelytoexperiencesucheffects.Challengingthevalidityof suchexpectationshasprovenparticularlyeffectiveasagroupinterventionformalestudents,butlesssoforwomen.39

• Freshman education. Sincefirst-yearstu-dentsareatparticularriskforalcohol-relatedproblems,someschoolsfocusonincomingfreshmenwithinterventionsthatincludeself-surveys,groupdiscussionsaboutnormaldrinkingbehavior,andpracticalstrategiesforhigh-risksituations.

You can share in the

fun and toast a happy

occasion with nonal-

coholic or alcoholic

beverages.

© J

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berg

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Health in the Headlines

Campus DrinkingMany schools are confronting the serious issues related to student drinking by setting up programs and changing their policies. To learn more about these approaches, access the Addiction portal of Global Health Watch (found under Health and Wellness), click on “alcoholism” and scan the latest news about student drinking and college alcohol policies. How does your school com-pare—both in terms of alcohol-related problems and in campus initiatives to prevent dangerous drinking? If you use alcohol, how have drinking programs and policies affected your alco-hol consumption? Record your observations in your online journal.





All of these drinks contain close to the sameamount of alcohol—that is, if the number of ounces in each drink is multiplied by the per-centage of alcohol, each drink contains theequivalent of approximately ½ ounce of 100percentethylalcohol.

Drinksatcollegepartiesvarygreatlyintheiralcoholiccontent.Itmaybeimpossible for students to monitor

their alcohol intake simply by counting thenumberof drinkstheyhave.Inonestudy,whenaskedtopouraliquidintocupsof varioussizesto reflect what they perceived to be one beer,oneshot,ortheamountof liquorinonemixeddrink, undergraduates overpoured beer by 25percent,shotsby26percent,andmixeddrinksby80percent.

Thewordsbottleandglassalsocanbedeceiving.Drinkinga16-ouncebottleof maltliquor,whichis6.4percentalcohol,isnotthesameasdrink-inga12-ounceglassof lightbeer (3.2percentalcohol):Themalt liquor contains1ounceof alcoholandistheequivalentof twodrinks.Twobottles of high-alcohol wines (such as Cisco),packagedtoresemblemuchlesspowerfulwinecoolers,canleadtoalcoholpoisoning,especiallyinthosewhoweighlessthan150pounds.

With distilled spirits (such as bourbon, scotch,vodka,gin,andrum),alcoholcontentisexpressedin termsof proof, anumber that is twice thepercentageof alcohol:100-proof bourbonis50percentalcohol;80-proof ginis40percentalco-hol. Many mixed drinks are equivalent to oneandahalf ortwostandarddrinks;forinstance,seethemargaritainFigure13.2.

Understanding AlcoholPure alcohol is a colorless liquid obtainedthroughthefermentationof aliquidcontainingsugar.Ethyl alcohol,orethanol, isthetypeof alcoholinalcoholicbeverages.Anothertype—methyl, or wood, alcohol—is a poison thatshould never be drunk. Any liquid containing0.5to80percentethylalcoholbyvolumeisanalcoholic beverage. However, different drinkscontaindifferentamountsof alcohol.

Thetypesof alcoholconsumedvaryaroundtheworld. Beer accounts for most of the alcoholconsumedintheUnitedStates.Peopleinsouth-ernEuropeancountriessuchasFrance,Spain,Italy,andPortugalpreferwine.

Do you know what a “drink” is? Most stu-dents—particularlyfreshmen,sophomores,andwomen—don’t.41Inoneexperimentundergrad-uatesdefineda“drink”asoneserving,regard-lessof howbig itwasorhowmuchalcohol itcontained. In fact, one standard drink can beanyof thefollowing:

• One bottle or can(12ounces)of beer,whichis5percentalcohol.

• One glass(4or5ounces)of tablewine,suchasburgundy,whichis12percentalcohol.

• One small glass(2½ounces)of fortifiedwine,whichis20percentalcohol.

• One shot(1ounce)of distilledspirits(suchaswhiskey,vodka,orrum),whichis50per-centalcohol.

Margarita:

11/2 oz. tequila (80 proof) � 1.5 oz. � 40 percent alcohol � 0.6 oz. alcohol

3/4 oz. triple sec (60 proof) � 0.75 oz. � 30 percent alcohol � 0.23 oz. alcohol

Splash of sour mix 0.83 oz. alcohol � 11/2 drinks

Dash of lime juice

Salt for the rim

Malt liquor:16 oz. � 6.4 percent alcohol � 1 oz. alcohol � 2 drinks

MALTLIQUOR

Figure 13.2 How Many Standard Drinks Are You Drinking?

ethyl alcohol The intoxicating agent in alcoholic beverages; also called ethanol.

proof The alcoholic strength of a distilled spirit, expressed as twice the percentage of alcohol present.





blood-alcohol concentration (BAC) The amount of alcohol in the blood, expressed as a percentage.

absorption The passage of substances into or across membranes or tissues.

nonalcoholicsubstancesthatslowtherateof absorption(passageof thealcoholintoyourbodytissues).If thedrinkcontainswater,juice,ormilk,therateof absorptionwillbeslowed.However,carbondioxide—whetherinchampagne,gingerale,oracola—whisksalcoholintoyourbloodstream.Also,thealcoholinwarmdrinks—suchasahotrumtoddyorwarmedsake—movesintoyourbloodstreammorequicklythanthealcoholinchilledwineorscotchontherocks.

• Your size.If you’realargeperson(whetherduetofatortomuscle),you’llgetdrunkmoreslowlythansomeonesmallerwho’sdrinkingthesameamountof alcoholatthesamerate.Heavierindividualshavealargerwatervolume,whichdilutesthealcoholtheydrink.

• Your gender.Womenhavelowerquanti-tiesof astomachenzymethatneutralizesalcohol,soonedrinkforawomanhastheimpactthattwodrinkshaveforaman.Hor-monelevelsalsoaffecttheimpactof alcohol.Womenaremoresensitivetoalcoholjustbeforemenstruation,andbirthcontrolpillsandotherformsof estrogencanintensifyalcohol’simpact.

• Your age.Thesameamountof alcoholproduceshigherBACsinolderdrinkers,whohavelowervolumesof bodywatertodilutethealcoholthanyoungerdrinkersdo.Peopleover50maybecomeimpairedafteronlyoneortwodrinks.

• Your race.Manymembersof certainethnicgroups,includingAsiansandNativeAmericans,

areunabletobreakdownalcoholasquicklyasCaucasians.ThiscanresultinhigherBACs,aswellasuncomfortablereactions,suchasflushingandnausea,whentheydrink.

• Other drugs. Somecommonmedica-tions—includingaspirin,acetaminophen(Tylenol),andulcermedications—cancauseblood-alcohollevelstoincreasemorerapidly.Individualstakingthesedrugscanbeoverthelegallimitforblood-alcoholconcentra-tionafteraslittleasasingledrink.

• Family history of alcoholism. Somechildrenof alcoholicsdon’tdevelopanyof theusualbehavioralsymptomsthatindicate

Blood-Alcohol ConcentrationThe amount of alcohol in your blood at anygiven time is your blood-alcohol concen-tration (BAC).It isexpressedintermsof thepercentageof alcoholinthebloodandisoftenmeasuredfrombreathorurinesamples.

Law enforcement officers use BAC to deter-minewhetheradriveris legallydrunk.Allthestates have followed the recommendation of the federal Department of Transportation toset 0.08 percent—the BAC that a 150-poundman would have after consuming about threemixeddrinkswithinanhour—asthethresholdatwhichapersoncanbecitedfordrunkdriving(Figure13.3).

Using a formula for blood-alcohol concentra-tiondevelopedbyhighwaytransportationoffi-cials, researchers calculate that when collegestudentsdrink,theirtypicalBACis0.079,dan-gerouslyclosetothelegallimit.

ABACof 0.05percentindicatesapproximately5 parts alcohol to 10,000 parts other bloodcomponents.Mostpeoplereachthis levelafterconsuming one or two drinks and experienceall the positive sensations of drinking—relax-ation, euphoria, and well-being—without feel-ing intoxicated. If they continue to drink pastthe 0.05 percent BAC level, they start feelingworse rather thanbetter,gradually losingcon-trolof speech,balance,andemotions.AtaBACof 0.2percent,theymaypassout.AtaBACof 0.3percent,theycouldlapseintoacoma;at0.4percent,theycoulddie.

Many factors affect an individual’s BAC andresponsetoalcohol,includingthefollowing:

• How much and how quickly you drink.Themorealcoholyouputintoyourbody,thehigheryourBAC.If youchugdrinkafterdrink,yourliver,whichmetabolizesabout½ounceof alcoholanhour,won’tbeabletokeepup—andyourBACwillsoar.

• What you’re drinking.Thestrongerthedrink,thefasterandharderthealcoholhits.Straightshotsof liquorandcocktailssuchasmartiniswillgetalcoholintoyourbloodstreamfasterthanbeerortablewine.Beerandwinenotonlycontainlowercon-centrationsof alcohol,buttheyalsocontain





Body weight in pounds

100

0 .00 .00 .00 .00 .00 .00 .00 .00 Only safe driving limit

1 .04 .03 .03 .02 .02 .02 .02 .02 Impairment begins

2 .08 .06 .05 .05 .04 .04 .03 .03Driving skillssignificantly affected

Possible criminalpenalties

3 .11 .09 .08 .07 .06 .06 .05 .05

4 .15 .12 .11 .09 .08 .08 .07 .06

5 .19 .16 .13 .12 .11 .09 .09 .08

6 .23 .19 .16 .14 .13 .11 .10 .09

7 .26 .22 .19 .16 .15 .13 .12 .11

8 .30 .25 .21 .19 .17 .15 .14 .13 Legally intoxicated

Subtract 0.01 percent for each 40 minutes of drinking.One drink is 1.25 oz. of 80 proof liquor, 12 oz. of beer, or 5 oz. of table wine.

9 .34 .28 .24 .21 .19 .17 .15 .14 Criminal penalties

10 .38 .31 .27 .23 .21 .19 .17 .16

120 140 160 180 200 220 240

Men

Drinks

Approximate blood alcohol percentage


90

0

.01–.06 BAC .06–.10 BAC .11–.20 BAC .21–.29 BAC .30–.39 BAC .40+ BAC

.00 .00 .00 .00 .00 .00 .00 .00 .00 Only safe driving limit


2 .10 .09 .08 .07 .06 .05 .05 .04 Driving skillssignificantly affected


3 .15 .14 .11 .10 .09 .08 .07 .06

4 .20 .18 .15 .13 .11 .10 .09 .08

5 .25 .23 .19 .16 .14 .13 .11 .10

6 .30 .27 .23 .19 .17 .15 .14 .12

7 .35 .32 .27 .23 .20 .18 .16 .14

8 .40 .36 .30 .26 .23 .20 .18 .17Legally intoxicated


9 .45 .41 .34 .29 .26 .23 .20 .19Criminal penalties

10 .51 .45 .38 .32 .28 .25 .23 .21

.02

.04

.06

.08

.09

.11

.13

.15

.17

.19

100 120 140 160 180 200 220 240

Women

Drinks


Relaxation, sense of well-being, loss of inhibition, lowered alertness

Some impact on thought, judgment, coordination,concentration

Emotional swings, anger, sadness, boisterous

Impaired reaction time, gross motor control, staggering, slurred speech

Stupor, impaired sensations

Severe motor impairment, memory blackouts

Not responsive, slowed heart rate, breathing, risk of death

Not responsive, death

Blunted feelings, disinhibition, extroversion, reduced sexual pleasure

Impaired reflexes, reasoning, depth perception, distance acuity, peripheral vision, glare recovery


100





3 .11 .09 .08 .07 .06 .06 .05 .05

4 .15 .12 .11 .09 .08 .08 .07 .06

5 .19 .16 .13 .12 .11 .09 .09 .08

6 .23 .19 .16 .14 .13 .11 .10 .09

7 .26 .22 .19 .16 .15 .13 .12 .11




10 .38 .31 .27 .23 .21 .19 .17 .16

120 140 160 180 200 220 240

Men

Drinks



90

0






3 .15 .14 .11 .10 .09 .08 .07 .06

4 .20 .18 .15 .13 .11 .10 .09 .08

5 .25 .23 .19 .16 .14 .13 .11 .10

6 .30 .27 .23 .19 .17 .15 .14 .12

7 .35 .32 .27 .23 .20 .18 .16 .14




10 .51 .45 .38 .32 .28 .25 .23 .21

.02

.04

.06

.08

.09

.11

.13

.15

.17

.19

100 120 140 160 180 200 220 240

Women

Drinks













100





3 .11 .09 .08 .07 .06 .06 .05 .05

4 .15 .12 .11 .09 .08 .08 .07 .06

5 .19 .16 .13 .12 .11 .09 .09 .08

6 .23 .19 .16 .14 .13 .11 .10 .09

7 .26 .22 .19 .16 .15 .13 .12 .11




10 .38 .31 .27 .23 .21 .19 .17 .16

120 140 160 180 200 220 240

Men

Drinks



90

0






3 .15 .14 .11 .10 .09 .08 .07 .06

4 .20 .18 .15 .13 .11 .10 .09 .08

5 .25 .23 .19 .16 .14 .13 .11 .10

6 .30 .27 .23 .19 .17 .15 .14 .12

7 .35 .32 .27 .23 .20 .18 .16 .14




10 .51 .45 .38 .32 .28 .25 .23 .21

.02

.04

.06

.08

.09

.11

.13

.15

.17

.19

100 120 140 160 180 200 220 240

Women

Drinks












Figure 13.3 Alcohol Impairment ChartSource: Adapted from data supplied by the Pennsylvania Liquor Control Board.





likely to put on excessive weight over time.42However,evenoccasionalbingesof fourtofivedrinksadaycanundoalcohol’spositiveeffects.

Thebenefitsof alcoholalsoarerelatedtoage.Belowage40drinkingatalllevelsisassociatedwithanincreasedriskordeath.Amongpeopleolderthan50or60,moderatedrinkershavethelowestriskof death.43

Usingamathematicalmodel,researchershavedeterminedthatalcohol-relatedproblemsoccurateverydrinkinglevel,includingjusttwodrinks,but increase fivefold at three drinks and moregradually thereafter.44 Individuals who drinkheavilyhaveahighermortalityratethanthosewhohavetwoorfewerdrinksaday.However,the boundary between moderate and heavydrinking isn’t thesameforeveryone.Forsomepeople, theupper limitof safety iszero:Oncetheystart,theycan’tstop.

IntoxicationIf you drink too much, the immediate conse-quence is that you get drunk—or, more pre-cisely, intoxicated. Alcohol intoxication, whichcanrangefrommildinebriationtolossof con-sciousness,ischaracterizedbyatleastoneof thefollowingsigns: slurredspeech,poorcoordina-tion, unsteady gait, abnormal eye movements,impairedattentionormemory,stupor,orcoma.

Medicalrisksof intoxicationincludefalls,hypo-thermiaincoldclimates,andincreasedriskof infectionsbecauseof suppressedimmunefunc-tion.Timeandaprotectiveenvironmentaretherecommended treatments for alcohol intoxica-tion.Alsofollowtheseguidelines:

• Continuallymonitortheintoxicatedperson.

• If thepersonis“out,”checkbreathing,wak-ingthepersonoftentobesureheorsheisnotunconscious.

• Donotforcethepersontowalkormovearound.

• Donotallowthepersontodriveacarorrideabicycle.

• Donotgivethepersonfood,liquid(includ-ingcoffee),medicines,ordrugstosoberthepersonup.

• Donotgivethepersonacoldshower;theshockof thecoldcouldcauseunconsciousness.

someoneisdrinkingtoomuch.It’snotknownwhetherthisbehaviorisgeneticallycausedorisaresultof growingupwithanalcoholic.

• Eating.Foodslowstheabsorptionof alco-holbydilutingit,bycoveringsomeof themembranesthroughwhichalcoholwouldbeabsorbed,andbyprolongingthetimethestomachtakestoempty.

• Expectations.Invariousexperiments,volunteerswhobelievedtheyweregivenalcoholicbeveragesbutwereactuallygivennonalcoholicdrinksactedasif theywereguzzlingtherealthingandbecamemoretalkative,relaxed,andsexuallystimulated.

• Physical tolerance. If youdrinkregularly,yourbrainbecomesaccustomedtoacertainlevelof alcohol.Youmaybeabletolookandbehaveinaseeminglynormalfashion,eventhoughyoudrinkasmuchaswouldnormallyintoxicatesomeoneyoursize.However,yourdrivingabilityandjudgmentwillstillbeimpaired.

Once you develop tolerance, you may drinkmoretogetthedesiredeffectsfromalcohol.Insomepeople,thiscanleadtoabuseandalcohol-ism. On the other hand, after years of drink-ing, some people become exquisitely sensitiveto alcohol. Such reverse tolerance means thattheycanbecomeintoxicatedafterdrinkingonlyasmallamountof alcohol.

Moderate Alcohol UseMany people describe themselves as “light” or“moderate”drinkers.However,thesearenotsci-entificterms.Itismoreprecisetothinkintermsof the amount of alcohol that seems safe formostpeople.Thefederalgovernment’sDietaryGuidelinesforAmericansrecommendnomorethanonedrinkaday forwomenandnomorethantwodrinksaday formen.TheAmericanHeart Association (AHA) advises that alcoholaccountfornomorethan15percentof thetotalcaloriesconsumedbyanindividualeveryday,uptoanabsolutemaximumof 1.75ouncesof alco-hol a day—the equivalent of three beers, twomixeddrinks,orthreeandahalf glassesof wine.

Moderatealcoholusehasbeenlinkedwithsomepositivehealthbenefits,includinglowerrisksof heartdisease.Inaddition,middle-agedwomenwhoreport light tomoderatedrinkingare less





how much alcohol the victim drank. Promptactionmaysavealife.Here’swhattodo:

• If thepersonisbreathinglessthantwelvetimesperminuteorstopsbreathingforperi-odsof tensecondsormore,call 911.

• If thepersonisasleepandyouareunabletowakehimorherup,call 911.

• Lookattheperson’sskin.If itiscold,clammy,pale,bluishincolor,call 911.

• Staywithapersonwhoisvomiting.Trytokeephimorhersittingup.If thepersonmustliedown,keephimonhissidewithheadturnedtotheside.Watchforchoking;if thepersonbeginstochoke,call 911.

The Impact of Alcohol on the BodyUnlike foodordrugs intablet form,alcohol isdirectly and quickly absorbed into the blood-stream through the stomach walls and upperintestine.Thealcoholinatypicaldrinkreachesthebloodstream in15minutesand rises to itspeak concentration in about an hour. Thebloodstream carries the alcohol to the liver,heart,andbrain(Figure13.4).

Most of the alcohol you drink can leave yourbodyonlyaftermetabolismbytheliver,whichconvertsabout95percentof thealcoholtocar-bondioxideandwater.Theother5percent isexcretedunchanged,mainlythroughurination,respiration,andperspiration.

Alcoholisadiuretic,adrugthatspeedsuptheeliminationof fluidfromthebody,sodrinkwaterwhenyoudrinkalcohol tomaintainyour fluidbalance.Andalcohollowersbodytemperature,soyoushouldneverdrinktogetorstaywarm.

Digestive SystemAlcohol reaches the stomach first, where it ispartiallybrokendown.Theremainingalcoholis absorbed easily through the stomach tissueinto the bloodstream. In the stomach, alcoholtriggersthesecretionof acids,whichirritatethestomachlining.Excessivedrinkingatonesitting

Alcohol PoisoningBecause federal law requires colleges to pub-lish all student deaths, the stories of younglives ended by alcohol poisoning have gainednational attention. Yet many students remainunaware that alcohol, in large enough doses,cananddoeskill.

Alcohol depresses nerves that control invol-untary actions, such as breathing and the gagreflex(whichpreventschoking).Afataldoseof alcoholwilleventuallysuppressthesefunctions.Because alcohol irritates the stomach, peoplewhodrinkanexcessiveamountoftenvomit.If intoxicationhasledtoalossof consciousness,adrinkerisindangerof chokingonvomit,whichcancausedeathbyasphyxiation.Blood-alcoholconcentrationcanriseevenafteradrinkerhaspassedoutbecausealcoholinthestomachandintestinecontinuestoenterthebloodstreamandcirculatethroughoutthebody.

Thesignsof alcoholpoisoninginclude:

• Mentalconfusion,stupor,coma,orpersoncannotberoused.

• Vomiting.

• Seizures.

• Slowbreathing(fewerthaneightbreathsperminute).

• Irregularbreathing(tensecondsormorebetweenbreaths).

• Hypothermia(lowbodytemperature),bluishskincolor,paleness.

Alcohol poisoning is a medical emergencyrequiringimmediatetreatment.Blackcoffee,acold shower, or letting a person “sleep it off ”does not help. Without medical treatment,breathing slows, becomes irregular, or stops.The heart beats irregularly. Body temperaturefalls,whichcancausecardiacarrest.Bloodsugarplummets,whichcanleadtoseizures.Vomitingcreatesseveredehydration,whichcancausesei-zures,permanentbraindamage,ordeath.Evenif thevictimlives,analcoholoverdosecanresultinirreversiblebraindamage.

Rapid binge drinking is especially dangerousbecausethevictimcaningestafataldosebeforebecoming unconscious. If you suspect alcoholpoisoning,call911forhelp.Don’ttrytoguessthelevelof drunkenness.Tellemergencymedi-caltechniciansthesymptomsand,if youknow,





standarddrinkcontains12to15gramsof alco-hol,thealcoholinasingledrinkaddsabout100calories to your daily intake. A glass of winecontainsasmanycaloriesassomecandybars;you would have to walk a mile to burn themoff. In addition to being a calorie-dense food,alcoholstimulatestheappetitesoyou’relikelytoeatmore.Obesityplusdailydrinkingbooststherisksof liverdiseaseinmenandwomen.45

Cardiorespiratory SystemAlcoholgetsmixedreviewsregardingitseffectsonthecardiorespiratorysystem.

According to the American HeartAssociation, college students whodrink excessively may double their

levelsof C-reactiveprotein(CRP),abiologicalmarker for inflammation associated with ahigher chance of cardiorespiratory problems.Although the long-term impact is unknown,researcherscautionthathighCRPlevelscouldpredict futureriskof heartdisease.46However,several studies have shown that people who

may result in nausea; chronic drinking mayresultinpepticulcers(breaksinthestomachlin-ing)andbleedingfromthestomachlining.

The alcohol in the bloodstream eventuallyreaches the liver. The liver, which bears themajor responsibility of fat metabolism in thebody,convertsthisexcessalcoholtofat.Afterafewweeksof fourorfivedrinksaday,livercellsstarttoaccumulatefat.Alcoholalsostimulateslivercellstoattractwhitebloodcells,whichnor-mallytravelthroughoutthebloodstreamengulf-ing harmful substances and wastes. If whitebloodcellsbegintoinvadebodytissue,suchasthe liver, they can cause irreversible damage.More than 2 million Americans have alcohol-relatedliverdiseases,suchasalcoholichepatitisandcirrhosisof theliver.

Weight and WaistsAt 7 calories per gram, alcohol has nearly asmanycalories as fat (9 caloriespergram)andsignificantly more than carbohydrates or pro-tein (whichhave4caloriespergram).Sincea

Brain • Damages and eventually destroys brain cells • Impairs memory • Dulls senses • Impairs physical coordination

Breast cancer in women

Stomach and intestines• Causes bleeding and inflammation• May trigger cancer

Pancreas• Increases risk of cancer

Immune system • Lowers resistance to diseases

Heart • Weakens heart muscle • May raise blood pressure • Causes irregular heartbeat

Liver • Damages and eventually destroys liver cells • Displaces important nutrients, which can cause malnutrition Reproductive system

• In men, hormone levels may be altered; impotence may occur • In women, menstrual cycles become irregular; pregnant women have an increased risk of bearing children with birth defects

Figure 13.4 The Effects of Alcohol Abuse on the BodyAlcohol has a major effect on the brain, damaging brain cells, impairing judgment and perceptions, and often leading to

accidents and altercations. Alcohol also damages the digestive system, especially the liver.





• Dulled smell and taste.Alcoholitself maycausesomevitamindeficiencies,andthepooreatinghabitsof heavydrinkersresultinfurthernutritionproblems.

• Diminished sensation.Onafreezingwinternight,youmaywalkoutsidewithoutacoatandnotfeelthecold.

• Altered sense of space.Youmaynotreal-ize,forinstance,thatyouhavebeeninoneplaceforseveralhours.

• Impaired motor skills.Writing,typ-ing,driving,andotherabilitiesinvolvingyourmusclesareimpaired.Thisiswhylawenforcementofficerssometimesasksus-pecteddrunkdriverstotouchtheirnosewithafingerortowalkastraightline.Drinkinglargeamountsof alcoholimpairsreactiontime,speed,accuracy,andconsistency,aswellasjudgment.

• Impaired sexual performance.Whiledrinkingmayincreaseyourinterestinsex,itmayalsoimpairsexualresponse,especiallyaman’sabilitytoachieveormaintainanerec-tion.AsShakespearewrote,“Itprovokesthedesire,butittakesawaytheperformance.”

Moderate and heavy drinkers show signs of impaired intelligence, slowed-down reflexes,and difficulty remembering. Because alcoholisacentralnervoussystemdepressant,itslowsdowntheactivityof theneurons in thebrain,graduallydullingtheresponsesof thebrainandnervoussystem.Oneortwodrinksactasatran-quilizerorrelaxant.Additionaldrinksresultinaprogressive reduction incentralnervous sys-temactivity,leadingtosleep,generalanesthesia,coma,andevendeath.

Heavy alcohol use may pose special dangersto the brains of drinkers at both ends of theagespectrum.Adolescentswhodrinkregularlyshow impairments in their neurological andcognitivefunctioning.Elderlypeoplewhodrinkheavilyappeartohavemorebrainshrinkage,oratrophy,thanthosewhodrinklightlyornotatall.Ingeneral,moderatedrinkershavehealthierbrainsandalowerriskof dementiathanthosewhodon’tdrinkandthosewhodrinktoexcess.

drinkmoderateamountsof alcoholhavelowermortalityratesafteraheartattack,aswellasalowerriskof heartattackcomparedtoabstain-ersandheavydrinkers.

Somecardiologistscontendthatthebenefitsof moderatedrinkingmaybeoverstated,especiallybecause of alcohol’s contribution to the epi-demicof obesityaroundtheworld.Consump-tionof twoormoredrinksperdaymayincreaseaperson’sriskof pancreaticcancerbyabout22percent.Heavierdrinkingtriggersthereleaseof harmfuloxygenmolecules called free radicals,which can increase the risk of heart disease,stroke, and cirrhosis of the liver. Alcohol usecan weaken the heart muscle directly, causinga disorder called cardiomyopathy. The com-bineduseof alcoholandotherdrugs,includingtobaccoandcocaine,greatlyincreasesthelikeli-hoodof damagetotheheart.

CancerOverall past and current drinking may con-tributetoabout10percentof allcancercasesinmenand3percentinwomen.Alcoholcon-sumptionhasbeenmorespecificallyimplicatedasacauseof cancersof theoral cavity,phar-ynx,larynx,esophagus,liver,colon-rectum,andfemalebreast.Theriskincreasesabovetherec-ommendedupperlimitof twodrinksadayformenandonedrinkforwomen.47

Brain and BehaviorAtfirstwhenyoudrink,youfeelup.Inlowdos-ages,alcoholaffectstheregionsof thebrainthatinhibitorcontrolbehavior,soyoufeellooserandactinwaysyoumightnototherwise.However,you also experience losses of concentration,memory,judgment,andfinemotorcontrol;andyouhavemoodswingsandemotionaloutbursts.

Moderateamountsof alcoholcanhavedisturb-ingeffectsonperceptionandjudgment,includ-ingthefollowing:

• Impaired perceptions.You’relessabletoadjustyoureyestobrightlightsbecauseglarebothersyoumore.Althoughyoucanstillhearsounds,youcan’tdistinguishbetweenthemorjudgetheirdirectionwell.





Immune SystemChronicalcoholusecaninhibittheproductionof bothwhitebloodcells,whichfightoff infec-tions,andredbloodcells,whichcarryoxygentoall theorgansandtissuesof thebody.Alcoholmayincreasetheriskof infectionwithhumanimmunodeficiency virus (HIV) by altering thejudgment of users so that they more readilyengageinactivitiessuchasunsafesexthatputthemindanger.If youdrinkwhenyouhaveacoldortheflu,alcoholinterfereswiththebody’sabilitytorecover.Italsoincreasesthechanceof bacterialpneumoniainflusufferers.

Increased Risk of DyingAlcoholkills.Alcoholisresponsiblefor100,000deathseachyearandisthethirdleadingcauseof

Interaction with Other DrugsAlcohol can interact with other drugs—pre-scriptionandnonprescription,legalandillegal.Of the 100 most frequently prescribed drugs,morethanhalf containat leastoneingredientthat interacts adversely with alcohol. Becausealcoholandotherpsychoactivedrugsmayworkonthesameareasof thebrain,theircombina-tion can produce an effect much greater thanthatexpectedof eitherdrugbyitself.Forexam-ple, the livercombinesalcoholandcocaine toproduce cocaethylene, which intensifies thedrug’seffectsandmayincreasetheriskof sud-den death. Alcohol is particularly dangerouswhen combined with other depressants andantianxietymedications.(SeeConsumerAlert.)

ConsumerAlert

Alcohol and Drug Interactions

Drug Possible Effects of Interaction

Allergy, cold, flu medicines (Allegra, Benadryl, Claritin,

Dimetapp, Sudafed, Tylenol Cold & Flu)

Drowsiness, dizziness, increased risk for overdose.

Analgesics (painkillers)

Narcotic (Codeine, Demerol, Percodan, Vicodin)

Nonnarcotic (aspirin, acetaminophen, ibuprofen)

Increase in central nervous system depression, possibly leading to

respiratory failure and death.

Irritation of stomach resulting in bleeding and increased susceptibility

to liver damage.

Antabuse (disulfiram: an aid to quit drinking) Nausea, vomiting, headache, high blood pressure, and erratic heartbeat.

Antianxiety drugs (Valium, Librium, Ativan, Xanax) Increase in central nervous system depression; decreased alertness and

impaired judgment.

Antidepressants (Prozac, Zoloft, Celexa, Lexapro, Paxil,

Wellbutrin, Luvox, and others)

Increase in central nervous system depression; certain antidepressants

in combination with red wine could cause a sudden increase in blood

pressure.

Antihistamines (Actifed, Dimetapp, and other cold

medications)

Increase in drowsiness; decrease in ability to drive.

Antibiotics Nausea, vomiting, headache; some medications rendered less effective.

Central nervous system stimulants (caffeine, Dexedrine,

Ritalin)

Stimulant effects of these drugs may reverse depressant effect of

alcohol but do not decrease its intoxicating effects.

Cocaine Intensification of cocaine’s effects; increased risk of sudden death.

Sedatives (Dalmane, Nembutal, Quaalude) Increase in central nervous system depression, possibly leading to

coma, respiratory failure, and death.





drinkers were at higher risk of dying of anycausethanothermen.

Alcohol, Gender, and RaceExperts in alcohol treatment are increasinglyrecognizingracialandethnicdifferencesinriskfactorsfordrinkingproblems,patternsof drink-ing,andmosteffectivetypesof treatment.

GenderIn general, men drink more frequently, con-sumealargerquantityof alcoholperdrinkingoccasion,andreportmoreproblemsrelatedtodrinking.Morethanhalf of womendrink:Theydrinkalonemoreoften,binge less, havemoreregular drinking patterns, and drink smallerquantitiesthanmen.

The bodies of men and women respond toalcohol indifferentways.Because theyhaveafar smallerquantityof aprotectiveenzyme inthe stomach to break down alcohol before it’sabsorbed intothebloodstream,womenabsorbabout30percentmorealcoholintotheirblood-streamthanmen—seeTable13.3.Thealcoholtravelsthroughthebloodtothebrain,sowomenbecome intoxicated much more quickly. Andbecausethere’smorealcoholinthebloodstreamtobreakdown,thelivermayalsobeadverselyaffected.Inalcoholicwomen,thestomachseemstocompletelystopdigestingalcohol,whichmayexplainwhyfemalealcoholicsaremorelikelytosufferliverdamagethanmen.

Anestimated15percentof womendrinkalco-hol while pregnant, most having one drink orless per day. Even light consumption of alco-hol can lead to fetal alcohol effects (FAE):lowbirthweight, irritability asnewborns, andpermanent mental impairment. A few drink-ingbingesof fourormoredrinksadayduringpregnancymaysignificantlyincreasetheriskof childhoodmentalhealthandlearningproblems.

The babies of women who consume three ormore ounces of alcohol (the equivalent of sixor seven cocktails) are at risk of more severeproblems. One of every 750 newborns has acluster of physical and mental defects called

deathaftertobaccoandimproperdietandlackof exercise. The leading alcohol-related causeof deathisinjury.Alcoholplaysaroleinalmosthalf of alltrafficfatalities,half of allhomicides,andaquarterof allsuicides.Thesecondlead-ingcauseof alcohol-relateddeaths is cirrhosisof theliver,achronicdiseasethatcausesexten-sivescarringandirreversibledamage.Inaddi-tion, as many as half of patients admitted tohospitalsand15percentof thosemakingofficevisitsseekorneedmedicalcarebecauseof thedirectorindirecteffectsof alcohol.

Youngdrinkers—teensandthoseintheirearly20s—areathighestriskof dyingfrominjuries,mostly car accidents. Older drinkers over age50facethegreatestdangerof prematuredeathfromcirrhosisof the liver,hepatitis,andotheralcohol-linkedillnesses.

Moststudiesof therelationshipbetweenalcoholconsumption and death from all causes showthat moderate drinkers—those who consumeapproximately seven drinks per week—have alowerriskof deaththanabstainers,whileheavydrinkers have a higher risk than either group.Inoneten-yearstudy,never-drinkersshowednoelevatedriskof dying,whileconsistentheavier

Table 13.3 How Alcohol Discriminates

Women Men

Ability to Dilute

Alcohol

Average total body water:

52%

Average total body water:

61%

Ability to

Metabolize

Alcohol

Women have a smaller

quantity of dehydrogenase,

an enzyme that breaks

down alcohol.

Men have a larger quantity

of dehydrogenase, which

allows them to break down

the alcohol they take in

more quickly.

Hormonal

Factors, Part 1

Premenstrual hormonal

changes cause intoxication

to set in faster during the

days right after a woman

gets her period.

Their susceptibility to get-

ting drunk does not fluctu-

ate dramatically at certain

times of the month.

Hormonal

Factors, Part 2

Alcohol increases estrogen

levels. Birth control pills or

other medicines with estro-

gen increase intoxication.

Alcohol also increases

estrogen levels in men.

Chronic alcoholism has

been associated with loss of

body hair and muscle mass,

development of swollen

breasts and shrunken tes-

ticles, and impotence.

Source: www.factsontap.org/factsontap/risky/discrimination.htm.

fetal alcohol effects (FAE) Milder forms of FAS, including low birth weight, irritability as newborns, and permanent mental impairment as a result of the mother’s alcohol consumption during pregnancy.





fetal alcohol syndrome (FAS) A cluster of physical and mental defects in the newborn, including low birth weight, smaller-than-normal head circumference, intrauter-ine growth retardation, and permanent mental impair-ment caused by the mother’s alcohol consumption during pregnancy.

therequestof triballeaders,theU.S.Congressin1832prohibitedtheuseof alcoholbyNativeAmericans.Manyreservationsstillbanalcoholuse, so Native Americans who want to drinkmayhavetotravellongdistancestoobtainalco-hol,whichmaycontributetothehighdeathratefrom hypothermia and pedestrian and motor-vehicle accidents among Native Americans.(Injuriesaretheleadingcauseof deathamongthisgroup.)

Certainly,notallNativeAmericansdrink,andnotallwhodrinkdosotoexcess.However,theyhave three times the general population’s rateof alcohol-related injury and illness. Cirrhosisof theliveristhefourthleadingcauseof deathamongthisculturalgroup.WhilemanyNativeAmerican women don’t drink, those who dohave high rates of alcohol-related problems,which affect both them and their children.Their rateof cirrhosisof the liver is36 timesthatof whitewomen.Insometribes,10.5outof every1,000newbornshavefetalalcoholsyn-drome,comparedwith1to3outof 1,000inthegeneralpopulation.

Asian American Community AsianAmericans tend to drink very little or not atall, in part because of an inborn physiologi-cal reaction toalcohol thatcauses facial flush-ing, rapid heart rate, lowered blood pressure,nausea,vomiting,andothersymptoms.Averyhighpercentageof womenof allAsianAmeri-can nationalities abstain completely. Some

fetal alcohol syndrome (FAS): small head,abnormal facial features, jitters, poor muscletone, sleep disorders, sluggish motor develop-ment, failure to thrive, short stature, delayedspeech,mentalretardation,andhyperactivity.

Alcohol interferes with male sexual functionandfertility throughdirecteffectsontestoster-oneandthetesticles.Inhalf of alcoholicmen,increased levels of female hormones lead tobreast enlargement anda femininepubichairpattern. Damage to the nerves in the penisby heavy drinking can lead to impotence. Inwomenwhodrinkheavily,adropinfemalehor-moneproductionmaycausemenstrual irregu-larityandinfertility.

RaceAfrican American Commu-nity Overall, African Americansconsume less alcohol per person

thanwhites,yettwiceasmanyblacksdieof cir-rhosisof thelivereachyear.Insomecities,therateof cirrhosisistentimeshigheramongAfri-can American than white men. Alcohol alsocontributes to high rates of hypertension,esophageal cancer, and homicide among Afri-canAmericanmen.

Hispanic Community The various His-panicculturestendtodiscourageanydrinkingby women but encourage heavy drinking bymenaspartof machismo,orfeelingsof man-hood.Hispanicmenhavehigherratesof alco-holuseandabusethanthegeneralpopulationand suffer a high rate of cirrhosis. Moreover,American-bornHispanicmendrinkmorethanthoseborninothercountries.

Few Hispanics with severe alcohol problemsenter treatment, partly because of a lack of information, language barriers, and poorcommunity-based services. Hispanic familiesgenerally try to resolve problems themselves,andtheirculturalvaluesdiscouragethesharingof intimate personal stories, which character-izes Alcoholics Anonymous and other supportgroups.Churchesoftenprovidethemosteffec-tiveformsof help.

Native American Community Euro-pean settlers introduced alcohol to NativeAmericans.Becauseof thesocietalandphysicalproblems resulting from excessive drinking, at

Liquor advertisers

use billboards like

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Bill

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consumelargerandlargeramounts toachieveintoxication.If theyabruptlystopdrinking,theysufferwithdrawal, a stateof acutephysical andpsychological discomfort. A diagnosis of alco-hol dependence is based on three or more of the following symptoms occurring during any12-monthperiod:

• Tolerance,asdefinedbyeitheraneedformarkedlyincreasedamountsof alcoholtoachieveintoxicationordesiredeffect,oramarkedlydiminishedeffectwithcontinueddrinkingof thesameamountof alcoholasinthepast.

• Withdrawal,includingatleasttwoof thefollowingsymptoms:sweating,rapidpulse,orothersignsof autonomichyperactivity;increasedhandtremor;insomnia;nauseaorvomiting;temporaryhallucinationsorillu-sions;physicalagitationorrestlessness;anxi-ety;orgrandmalseizures.

• Drinkingtoavoidorrelievethesymptomsof withdrawal.

• Consuminglargeramountsof alcohol,ordrinkingoveralongerperiodthanwasintended.

• Persistentdesireorunsuccessfuleffortstocutdownorcontroldrinking.

• Agreatdealof timespentinactivitiesneces-sarytoobtainalcohol,drinkit,orrecoverfromitseffects.

• Importantsocial,occupational,orrecre-ationalactivitiesgivenuporreducedbecauseof alcoholuse.

• Continuedalcoholusedespiteknowledgethatalcoholislikelytocauseorexacerbateapersistentorrecurringphysicalorpsycho-logicalproblem.

About a third of college studentsmeetthediagnosticcriteriaforalco-holabuse,while6percentqualifyfor

a diagnosis of alcohol dependence.48 Althoughmanystudentsreducetheiralcoholconsumptionafter college, others continue to drink heavilyandfaceincreasedriskof alcohol-usedisordersandalcohol-relatedproblemsandmedicalrisks.(SeeSelf Survey:DoYouHaveaDrinkingProb-lem?toassessyourdrinkingstatus.)

Alcoholism,asdefinedbytheNationalCoun-cil on Alcoholism and Drug Dependence and

sociologists have expressed concern, how-ever, that as Asian Americans become moreassimilatedintoAmericanculture,they’lldrinkmore—andpossibly sufferveryadverse effectsfromalcohol.

Alcohol ProblemsBythesimplestdefinition,problemdrinking istheuseof alcohol inanyway thatcreatesdif-ficulties,potentialdifficulties,orhealthrisksforan individual. Like alcoholics, problem drink-ersareindividualswhoselivesareinsomewayimpairedbytheirdrinking.Theonlydifferenceisoneof degree.Alcoholbecomesaproblem,andapersonbecomesanalcoholic,when thedrinker can’t “take it or leave it.” He or shespends more and more time anticipating thenext drink, planning when and where to getit,buyingandhidingalcohol,andcoveringupsecret drinking. As many as one in six adultsintheUnitedStatesmayhaveaproblemwithdrinking.

Alcohol abuseinvolvescontinueduseof alco-hol despite awareness of social, occupational,psychological, or physical problems relatedto drinking, or drinking in dangerous ways orsituations(beforedriving,forinstance).Adiag-nosisof alcoholabuseisbasedononeormoreof thefollowingoccurringatanytimeduringa12-monthperiod:

• Afailuretofulfillmajorroleobligationsatwork,school,orhome(suchasmissingworkorschool).

• Theuseof alcoholinsituationsinwhichitisphysicallyhazardous(suchasbeforedriving).

• Alcohol-relatedlegalproblems(suchasdrunk-drivingarrests).

• Continuedalcoholusedespitepersistentorrecurringsocialorinterpersonalproblemscausedorexacerbatedbyalcohol(suchasfightingwhiledrunk).

Alcohol dependenceisaseparatedisorderinwhich individualsdevelopa strongcraving foralcohol because it produces pleasurable feel-ingsorrelievesstressoranxiety.Overtimetheyexperience physiological changes that lead totoleranceof itseffects;thismeansthattheymust

A normal liver (top)

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alcohol abuse Continued use of alcohol despite awareness of social, occupational, psycho-logical, or physical problems related to its use, or use of alcohol in dangerous ways or situations, such as before driving.

alcohol dependence Develop-ment of a strong craving for alcohol due to the pleasurable feelings or relief of stress or anxiety produced by drinking.

alcoholism A chronic, progres-sive, potentially fatal disease characterized by impaired control of drinking; a preoccu-pation with alcohol; continued use of alcohol despite adverse consequences; and distorted thinking, most notably denial.





in the body, including the brain, the digestivetract,theheart,muscles,blood,andhormones(look back atFigure13.4, page443). In addi-tion,becausealcoholinteractswithmanydrugs,itcanincreasetheriskof potentiallylethalover-dosesandharmfulinteractions.Asummaryof themajorrisksandcomplicationsfollows:

• Liver disease. Chronicheavydrinkingcanleadtoalcoholichepatitis(inflammationanddestructionof livercells)andinthe15percentof peoplewhocontinuedrinkingbeyondthisstage,cirrhosis(irreversiblescar-ringanddestructionof livercells).Thelivereventuallymayfailcompletely,resultingincomaanddeath.

• Cardiorespiratory disease. Heavydrink-ingcanweakentheheartmuscle(causingcardiacmyopathy),elevatebloodpressure,andincreasetheriskof stroke.

• Cancer.Heavyalcoholusemaycontributetocancerof theliver,stomach,andcolon,aswellasmalignantmelanoma,adeadlyformof skincancer.

• Brain damage. Long-termheavydrink-ersmaysuffermemorylossandbeunable

theAmericanSocietyof Addiction,isaprimary,chronicdisease inwhichgenetic,psychosocial,andenvironmentalfactorsinfluenceitsdevelop-ment and manifestations. The disease is oftenprogressiveandfatal.Itscharacteristicsincludeaninabilitytocontroldrinking;apreoccupationwithalcohol; continueduseof alcoholdespiteadverse consequences; and distorted thinking,mostnotablydenial.Likeotherdiseases, alco-holismisnotsimplyamatterof insufficientwill-powerbutacomplexproblemthatcausesmanysymptoms, can have serious consequences, yetcanimprovewithtreatment.

Causes of Alcohol Dependence and AbuseAlthough the exact cause of alcohol depen-denceandabuseisnotknown,certainfactors—includingbiochemicalimbalancesinthebrain,heredity, cultural acceptability, and stress—allseemtoplayarole.Theyincludethefollowing:

• Genetics. Scientistshavenotyetidenti-fiedconclusivelyaspecificgenethatputspeopleatriskforalcoholism.However,epi-demiologicalstudieshaveshownevidenceof heredity’srole.Studiesof twinssuggestthatheredityaccountsfortwo-thirdsof theriskof becomingalcoholicinbothmenandwomen.

• Stress and traumatic experiences.Manypeoplestartdrinkingheavilyasawayof copingwithpsychologicalproblems.

• Parental alcoholism. Accordingtoresearchers,alcoholismisfourtofivetimesmorecommonamongthechildrenof alco-holics,whomaybeinfluencedbythebehav-iortheyseeintheirparents.

• Drug abuse. Alcoholismisalsoassoci-atedwiththeabuseof otherpsychoactivedrugs,includingmarijuana,cocaine,heroin,amphetamines,andvariousantianxietymedications.

Medical Complications of Alcohol Abuse and DependenceAs previously discussed, excessive alcohol useadversely affects virtually every organ system

Daytime drinking and

drinking alone can

be signs of a serious

problem, even though

the drinker may other-

wise appear to be

in control.

Fuse

/Jup

iterim

ages





Alcoholism TreatmentsAn estimated 8 million adults in the UnitedStateshavealcoholdependence.Onlyaminor-ity ever undergo treatment for alcohol-relatedproblems. Until recent years, the only optionsforprofessionalalcoholtreatmentwere,asoneexpertputsit,“intensive,extensive,andexpen-sive,” suchasresidentialprogramsathospitalsorspecializedtreatmentcenters.Todayindivid-ualswhosedrinkingcouldbehazardoustotheirhealthmaychoosefromavarietyof approaches,including medication, behavioral therapy, orboth. Treatment that works well for one per-sonmaynotworkforanother.Asresearchintotheoutcomesof alcoholtreatmentshasgrown,moreattemptshavebeenmadetomatchindi-viduals to approaches tailored to their needsand more likely to help them overcome theiralcoholproblems.49

Menandwomenwhohaveseriouslyremainedsober for more than a decade credit a varietyof approaches, including Alcoholics Anony-mous(AA),individualpsychotherapy,andothergroups, such as Women for Sobriety. There isno one sure path to sobriety—a wide varietyof treatmentsmayofferhelpandhopetothosewith alcohol-related problems. Genetics maypredictthesuccessof specifictherapiesinhelp-ingindividualsovercomealcoholdependence.50

DetoxificationThefirstphaseof treatmentforalcoholdepen-dence focusesondetoxification, thegradualwithdrawal of alcohol from the body. For 90to95percent of alcoholics,withdrawal symp-tomsaremildtomoderate.Theyincludesweat-ing;rapidpulse;elevatedbloodpressure;handtremor; insomnia;nauseaorvomiting;malaiseorweakness;anxiety;depressedmoodorirrita-bility;headache;andtemporaryhallucinationsorillusions.Withdrawalcanbelife-threateningwhenaccompaniedbymedicalproblems,suchasgrandmalseizures,pneumonia,liverfailure,orgastrointestinalbleeding.Thestandardtreat-mentisasafersedative,suchasValiumorAti-van,withagradualreductioninthedose.

tothinkabstractly,recallnamesof com-monobjects,andfollowsimpleinstructions.ChronicbraindamageresultingfromalcoholconsumptionissecondonlytoAlzheimer’sdiseaseasacauseof cognitivedeteriorationinadults.

• Vitamin deficiencies. Alcoholismisasso-ciatedwithvitamindeficiencies,especiallyof thiamin(B1).Lackof thiaminmayresultinWernicke-Korsakoff syndrome,whichischaracterizedbydisorientation,memoryfailure,hallucinations,andjerkyeyemove-ments,andcanbedisablingenoughtorequirelifelongcustodialcare.

• Digestive problems.Alcoholtriggersthesecretionof acidsinthestomachthatirri-tatethemucousliningandcausegastritis.Chronicdrinkingmayresultinpepticulcers(breaksinthestomachlining)andbleedingfromthestomachlining.

Your Strategies for Prevention

How to Recognize the Warning Signs of Alcoholism

• Experiencing the following symptoms

after drinking: frequent headaches,

nausea, stomach pain, heartburn, gas,

fatigue, weakness, muscle cramps,

irregular or rapid heartbeats.

• Needing a drink in the morning to start

the day.

• Denying any problem with alcohol.

• Doing things while drinking that are

regretted afterward.

• Experiencing dramatic mood swings,

from anger to laughter to anxiety.

• Having sleep problems.

• Experiencing depression and paranoia.

• Forgetting what happened during a

drinking episode.

• Changing brands or going on the wagon

to control drinking.

• Having five or more drinks a day.

detoxification The supervised removal of a poisonous or harmful substance (such as a drug) from the body; a therapy for alcoholics in which they are denied alcohol in a controlled environment.





delirium tremens (DTs) The delusions, hallucinations, and agitated behavior following withdrawal from long-term chronic alcohol abuse.

facilitywere thecornerstoneof early recoverytreatment.Accordingtooutcomestudies,inpa-tienttreatmentwaseffective,withasmanyas70percentof “graduates”remainingabstinentorstable,nonproblemdrinkersforfiveyearsafter.However, because of cost pressures from theinsuranceindustry,thelengthof stayhasbeenreduced,and there’sbeen increasingemphasisonoutpatientcare.

Outpatient TreatmentOutpatient treatmentmay involve group ther-apy, individual supportive therapy, marital orfamily therapy, regular attendance at Alcohol-icsAnonymous(AA)oranothersupportgroup,brief interventions, and relapse prevention.According to outcome studies, intensive out-patient treatment at a day hospital (with indi-viduals returning home every evening) are aseffective as inpatient care. Outpatient therapycontinuesforatleastayear,butmanyindividu-als continue to participate in outpatient pro-gramsfortherestof theirlives.

Brief Interventions These methods in-cludeindividualcounseling,grouptherapy,andtraining in specific skills—such as assertive-ness—allpackedintoasix-toeight-weekperiod.Offeredatagrowingnumberof centers,brief interventionsmaybemosthelpful forproblemdrinkers who are not physically dependent onalcohol.Theyhaveprovedeffectiveinreducingalcoholconsumptionuptooneyearcomparedwithnointerventionorstandardcare.However,at ten years, there is no difference in alcoholconsumptionamongthosewhohadabrief in-terventionandthosewhodidnot.Thisindicatestheneedforfollow-upadviceandcounseling.

According to a recent review, Internet-basedinterventions can be more effective than sim-plyprovidingprintedmaterialsinhelpingsomealcoholicsdrinka little less.52However, follow-upwithacounselorhasprovenmoreeffectiveinreducingweeklydrinkingfrequencyandalcoholconsumption.53

Moderation Training Highly controver-sial, this approach uses cognitive-behavioraltechniques, such as keeping a diary to chartdrinking patterns and learning “consumptionmanagement”techniques,suchasneverhavingmorethanonedrinkanhour.

Alcoholwithdrawaldelirium,commonlyknownasdelirium tremens,orDTs, ismostcom-moninchronicheavydrinkerswhoalsosufferfrom a physical illness, fatigue, depression, ormalnutrition. Delirium tremens are character-izedbyagitatedbehavior,delusions,rapidheartrate, sweating, vivid hallucinations, tremblinghands,andfever.Thesymptomsusuallyappearover several days after heavy drinking stops.Individuals frequently report terrifying visualhallucinations, such as seeing insects all overtheirbodies.Withtreatment,mostcasessubsideafter several days, although delirium tremenshasbeenknown to last as longas fouror fiveweeks. In some cases, complications such asinfectionsorheartarrhythmiasprovefatal.

Medical TreatmentsAntianxietyandantidepressivedrugsaresome-times used in early treatment for alcoholism,especially for those with underlying mentaldisorders. Four drugs—disulfiram, naltrexone,acamprosate,andtopiramate—areapprovedtoreducethepersistentcravingforalcohol.Vita-min supplements, especially thiamin and folicacid,canhelpovercomesomeof thenutritionaldeficiencieslinkedwithalcoholism.51

Thedrugdisulfiram(Antabuse),giventodeterdrinking, causes individuals to become nause-atedandacutelyillwhentheyconsumealcohol.Antabuseinterruptstheremovalof acetaldehyebytheliver,sothistoxicsubstanceaccumulatesand causes nausea or vomiting. If individualstakingAntabusedrinkatallorconsumefoodswithalcoholiccontent,theybecomeextremelyill.Theymustavoidfoodscookedormarinatedinwineandcoughsyruppreparationscontain-ingalcohol.Someindividualshavereactionstothealcoholinafter-shavelotion.Alargeamountof alcoholcanmakethemdangerouslyill;fatali-tieshaveoccurred.Sideeffectsareusuallymildand includedrowsiness,badbreath, skin rash,and temporary impotence. Because Antabusedoes not reduce cravings for alcohol, psycho-therapyandsupportgroupsremainanecessarypartof treatment.

Inpatient or Residential TreatmentIn the past, 28-day treatment programs in amedicalorpsychiatrichospitalora residential





foundthatfewerthan1in30peopleremaininAAafteroneyear,althoughthismaybebecausemany are coerced to make their initial visits.However,continuedAAattendanceismodestlyassociatedwithabstinenceandimprovedsocialfunctioning. According to the “helper theoryprinciple,”whenpeoplewitha conditionhelpothers with a similar problem, they also helpthemselves.Thisprinciple,fundamentaltoAA,maycontributetotheircontinuingsobriety.54

Spirituality is another key and controver-sialcomponentof AA,with11of its12 stepsexplicitly referring to the importance of Godorahigherpower forrecovery.Yetbothspiri-tuallyorientedandatheisticindividualsbenefitequallyfromAAprograms.Inaten-yearstudy,individuals involved with AA reported signifi-cantly larger gains in religious practices, suchas prayer, compared with those without suchexposure. Individuals who maintain consistentAAmembershipreportedthegreatestincreasesin“Godconsciousness”andreligiouspractices.

Harm Reduction Therapy This contro-versialapproachaimstohelpsubstanceabusersreducethenegativeimpactof alcoholordrugsontheirlives.Itsfundamentalprinciplesincludethefollowing:

• Whileabsoluteabstinencemaybepreferableformanyormostsubstanceabusers,veryfewachieveit.Eventhesefewwilltaketimetoreachthispointandmayrelapseperiodically.

• Thefieldof medicineacceptsandpracticesothertypesof treatmentsthatpreservehealthandwell-beingevenwhenpeoplefailtocomplywithallrecommendedbehaviors.

• Therapistscannotmakejudgmentsforcli-ents,eventhoughtheyshouldpresentaccu-rateinformationandmayevenexpresstheirownbeliefs.

• Therearemanyshadesof improvementineverykindof therapy.If acertainlevelof improvementisallapersoniscapableof reaching,thatpersonshouldbeencouraged.

Alternatives to AA Secular Organiza-tions for Sobriety (SOS) was founded in 1986asanalternativeforpeoplewhocouldn’tacceptthe spirituality of AA. Like AA, SOS holdsconfidentialmeetings,celebratessobrietyanni-versaries,andviewsrecoveryasaone-day-at-a-timeprocess.

Treatmentprogramsinothercountries,suchasGreat Britain and Canada, have long offeredmoderationtraining forproblemdrinkerswhoconsume too much alcohol. However, mostexperts agree that the best—and perhapsonly—hope for recovery for chronic alcohol-icswhoarephysicallydependentonalcohol iscompleteabstinence.

12-Step Self-Help Programs Thebest-known and most commonly used self-helpprogram for alcohol problems is AlcoholicsAnonymous (AA), which was founded morethan60yearsagoandwhichhasgrownintoaninternationalorganization that includes2mil-lion members and 185,000 groups worldwide.Acknowledgingthepowerof alcohol,AAofferssupportfromothersstrugglingwiththesameill-ness,fromasponsoravailableatanytimeof thedayornight,andfromfellowshipmeetingsthatareheldeverydayof theyear.Becauseanonym-ityisakeypartof AA,ithasbeendifficultforresearcherstostudyitssuccess,butitisgenerallybelievedtobeahighlyeffectivemeansof over-comingalcoholismandmaintainingabstinence.Its12steps,whichemphasizehonesty,sobriety,andacknowledgmentof a“higherpower,”havebecomethemodelforself-helpgroupsforotheraddictivebehaviors, includingdrugabuse (dis-cussedinChapter12)andcompulsiveeating.

Theaverageageof entryintoAAis30;about60percentof themembersaremen.Membersencompassawide rangeof ages,occupations,nationalities,andsocioeconomicclasses.Peoplegenerally attend 12-step meetings every daywhentheyfirstbeginrecovery;mostprogramsrecommend90meetingsin90days.Manypeo-pletaperoff tooneortwomeetingsaweekastheirrecoveryprogresses.Nooneknowsexactlyhow12-stepprogramshelppeoplebreakoutof addictions. Some individuals stop their drink-ing, or other destructive behavior, simply onthebasis of the information theyget atmeet-ings.Othersbondtothegroupanduseitasasocialsupportandrefugewhiletheyexploreandreleasetheirinnerfeelings—aprocesssimilartowhathappensinpsychotherapy.

Many individuals recovering from substanceabuse—as many as one in ten Americans, bysomeestimates—willattenda12-stepmeetingintheirlifetime.Formanywithalcohol-relatedproblems, AA is the first and only treatmenttheyreceive.DoesAAwork?Somestudieshave





relapse prevention An alcohol recovery treatment method that focuses on social skills training to develop ways of preventing or minimizing a relapse.

niques as a way of coping with cravings andhigh-riskrelapsesituations.

Alcoholism’s Impact on RelationshipsAlcoholism shatters families and createsunhealthy patterns of communicating andrelating.Separationanddivorceratesarehighamongalcoholics.

Havingaheavydrinker—afriend,familymem-ber,orcolleague—inyourlifecanputyourownhealthandwell-beingatrisk.Inarecentstudy,thoselinkedwithaheavydrinkerreportedmoresymptoms such as chronic pain, anxiety, anddepression.56

Growing Up with an Alcoholic ParentAnestimated28millionchildrenintheUnitedStates (or one of every four) are living in ahousehold with an alcoholic adult. Parentalalcoholismincreasesthelikelihoodof childhoodADHD, conduct disorder, and anxiety disor-ders.Theexperienceoften leadsyoungsters toplaycertainroles:Theadjusteror“lostchild”does whatever the parent says. The respon-sible child, or “family hero,” typically takesovermanyhouseholdtasksandresponsibilities.Theacting-outchild,or“scapegoat,”showshisorher anger early in lifeby causingproblemsat home or in school and taking on the roleof troublemaker. The “mascot” disrupts tensesituations by focusing attention on himself orherself,oftenbyclowning.Regardlessof whichrolestheyassume,thechildrenof alcoholicsareprone to learning disabilities, eating disorders,andaddictivebehavior.

Numerousstudieshavelinkedparentaldrinkingtochildabuseandneglect.Childrenof womenwho are problem drinkers have twice the riskof serious injury as children of mothers whodon’tdrink.Childrenwithtwoparentswhoareproblem drinkers are at even higher risk. Asteenagers,childrenof alcoholicsaremorelikelyto report early sexual intercourse and face agreaterriskof adolescentpregnancy.

RationalRecovery,whichalsoemphasizesano-nymity and total abstinence, focuses on theself rather than spirituality.Membersuse rea-son insteadof prayerand learn tocontrol theimpulsetodrinkbylearninghowtocontroltheemotionsthatleadthemtodrink.

RecoveryRecoveryfromalcoholismisalifelongprocessof personalgrowthandhealing.Thefirsttwoyearsarethemostdifficult,andrelapsesareextremelycommon.Bysomeestimates,morethan90per-cent of those recovering from substance usewillusealcoholordrugsinanyone12-monthperiodaftertreatment.However,approximately70percentof thosewhoget formal treatmentstopdrinkingforprolongedperiods.Evenwith-outtreatment,30percentof alcoholicsareableto stop drinking for long periods. Those mostlikelytoremainsoberaftertreatmenthavethemosttolosebycontinuingtodrink:theytendtobeemployed,married,andupper-middleclass.Recoveringalcoholicswhohelpotheralcoholicsstaysoberarebetterabletomaintaintheirownsobriety.

Mostrecoveringalcoholicsexperienceurgestodrink, especially during early recovery whentheyarelikelytofeelconsiderablestress.Theseurges are a natural consequence of years of drinkinganddiminishwithtime.Moodswingsare common during recovery, and individualstypicallydescribethemselvesasalternatelyfeel-ingrelievedorelatedandthendiscouragedortearful.Suchdisconcertingupsanddownsalsodecreaseover time.Patience—learningto take“onedayatatime”—iscrucial.55

Increasingly, treatment programs focus onrelapse prevention,whichincludesthedevel-opmentof copingstrategiesandlearningtech-niques that make it easier to live with alcoholcravingsandrehearsalof variouswaysof saying“no”tooffersof adrink.Accordingtooutcomesresearch, social skills training—a combinationof stress management therapy, assertivenessand communication skills training, behavioralself-control training, and behavioral maritaltherapy—hasprovedeffectiveindecreasingthedurationandseverityof relapsesafteroneyearin a group of alcoholics. A new approach torelapse behavior, “Mindfulness-Based-RelapsePrevention” teaches clients meditation tech-





children are alike or necessarily suffer from psy-chological problems or face an increased risk of substance abuse themselves.

Because the impact of alcoholism can be so enduring, support groups—such as Adult Chil-dren of Alcoholics, Children of Alcoholics, and Adult Children of Dysfunctional Fami-lies—have spread throughout the country in the last decade. These organizations provide adult children of alcoholics a mutually supportive group setting in which to discuss their childhood experiences with alcoholic parents and the emo-tional consequences they carry into adult life. Through such groups or other forms of therapy, individuals may learn to move beyond anger and blame, see the part they themselves play in their current state of unhappiness, and create a future that is healthier and happier than their past. (See Health in Action.)

Adult Children of AlcoholicsGrowing up with an alcoholic parent can have a long-lasting effect. Adult children of alcohol-ics are at risk for many problems. Some try to fill the emptiness inside with alcohol, drugs, or addictive habits. Others find themselves caught up in destructive relationships that repeat the patterns of their childhood. They are likely to have difficulty solving problems, identify-ing and expressing their feelings, trusting oth-ers, and being intimate. In addition to their own increased risk of addictive behavior, they are likely to marry individuals with some form of addiction and keep on playing out the roles of their childhood. They may feel inadequate, not know how to set limits or recognize normal behavior, be perfectionistic, and want to control all aspects of their lives. However, not all adult

Health in Action

If Someone Close to You Drinks Too Much

• Trytoremaincalm,unemo-tional,andfactuallyhonestinspeakingaboutthedrinker’sbehavior. Include the drinker in family life.

• Discussthesituationwithsomeoneyoutrust:amemberoftheclergy,socialworker,friend,orsomeonewhohasexperiencedalcoholismdirectly.

• Nevercoverupormakeexcusesforthedrinker,orshieldhimorherfromtheconsequencesofdrinking.Assuming the drinker’s responsibilities undermines his or her dignity and sense of importance.

• Refusetoridewiththedrinkerifheorsheisdrivingwhileintoxicated.

• Encouragenewinterestsandparticipateinleisure-timeactivitiesthatthedrinkerenjoys.

• Trytoacceptsetbacksandrelapsescalmly.

In addition to focusing on your friend or family member, take time to sort through your own feelings about the situation. Record your observations and concerns in your online journal.

27007_ch13_ptg01_lores_424-459.indd 454 10/7/11 11:58 AM




Take Charge of Alcohol

If youusealcohol,developadefensivedrinkingprogram.Checkthestepsthatyouhavetakenorwilltakeinthefuturetostayincontrolof youralcoholintake.

____Findingalternativeways tosoothestress.Dailysessionsof meditationhaveproveneffectiveinhelpinghigh-riskstudentdrinkersrelax.

____Setting a limit on how many drinks you’re going to haveaheadof time—andstickingtoit.

____Whenyou’remixingadrink,measuringthealcohol.

____Alternatingnonalcoholicandalcoholicdrinks.

____Drinkingslowly;notguzzling.

____Eatingbeforeandwhiledrinking.

____Avoidingtasksthatrequireskilledreactionsduringorafterdrinking.

____Not encouraging or reinforcing others’ irresponsiblebehavior.

____Checking out community resources. Are there chaptersof AAandAl-Anononcampus?FindoutmoreabouttheBACCHUS(BoostAlcoholConsciousnessConcerningtheHealthof UniversityStudents)network,includingprogramsinyourarea.Dothesegroupsoffervolunteeropportunitiesthatinterestyou?

____Talkingtoyourdormmates,fraternitybrothers,sororitysis-ters,orroommatesaboutstepsyoucould takecollectively,suchasrestrictingdrinkinginroomsorsettingupa“SeizetheKeys”policytopreventdrunkdriving.

Build Your

Future

Do You Have a Drinking Problem?

This self-assessment, the Michigan Alcoholism Screening Test (MAST), is widely used to identify potential problems. This test screens for the major psychological, sociological, and physiological consequences of alcoholism.

Answer Yes or No to the following questions, and add up the points shown in the right column for your answers.

Yes No Points

1. Do you enjoy a drink now and then? ________ ________ (0 for either)

2. Do you think that you’re a normal drinker? (By normal, we mean that you drink less than or as much as most other people.) ________ ________ (2 for no)

3. Have you ever awakened the morning after some drinking the night before and found that you couldn’t remember part of the evening? ________ ________ (2 for yes)

4. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking? ________ ________ (1 for yes)

5. Can you stop drinking without a struggle after one or two drinks? ________ ________ (2 for no)

6. Do you ever feel guilty about your drinking? ________ ________ (1 for yes)

7. Do friends or relatives think that you’re a normal drinker? ________ ________ (2 for no)

8. Do you ever try to limit your drinking to certain times of the day or to certain places? ________ ________ (0 for either)

9. Have you ever attended a meeting of Alcoholics Anonymous? ________ ________ (2 for yes)

10. Have you ever gotten into physical fights when drinking? ________ ________ (1 for yes)

11. Has your drinking ever created problems for you and your wife, husband, a parent, or other relative? ________ ________ (2 for yes)

Self Survey





12. Have your wife, husband, or other family members ever gone to anyone for help about your drinking? ________ ________ (2 for yes)

13. Have you ever lost friends because of your drinking? ________ ________ (2 for yes)

14. Have you ever gotten into trouble at work or school because of your drinking? ________ ________ (2 for yes)

15. Have you ever lost a job because of your drinking? ________ ________ (2 for yes)

16. Have you ever neglected your obligations, your family, or your work for two or more days in a row because of drinking? ________ ________ (2 for yes)

17. Do you drink before noon fairly often? ________ ________ (1 for yes)

18. Have you ever been told you have liver trouble? Cirrhosis? ________ ________ (2 for yes)

19. After heavy drinking, have you ever had delirium tremens (DTs) or severe shaking, or heard voices or seen things that weren’t actually there? ________ ________ (2 for yes*)

20. Have you ever gone to anyone for help about your drinking? ________ ________ (5 for yes)

21. Have you ever been in a hospital because of your drinking? ________ ________ (5 for yes)

22. Have you ever been a patient in a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was part of the problem that resulted in hospitalization? ________ ________ (2 for yes)

23. Have you ever been seen at a psychiatric or mental health clinic or gone to any doctor, social worker, or clergyman for help with any emotional problem where drinking was part of the problem? ________ ________ (2 for yes)

24. Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? ________ ________ (2 for yes)

25. Have you ever been arrested, or taken into custody, even for a few hours, because of drunken behavior? ________ ________ (2 for yes)

(If Yes, how many times?) ________**

*Five points for delirium tremens **Two points for each arrest

Scoring

In general, five or more points places you in an alcoholic category; four points suggests alcoholism; three or fewer points indicates that you’re not an alcoholic.





Making Change Happen

Your Alcohol AuditWe have no objection to drinking. What does concern

us is drinking without thinking. When you drink without

thinking, you give up control and turn your life over to

alcohol. And when you lose control, you lose. You can end

up a hapless spectator or a victim of consequences you

never intended. A third of students report doing some-

thing they later regretted as a result of their drinking.

“Your Alcohol Audit” in Labs for IPC can help you avoid

this experience—ever or again. If just thinking about drink-

ing makes you uneasy, definitely read the following and

do this lab. The feeling is a red flag you shouldn’t ignore.

Get RealIn this section, you analyze your drinking by

answering 12 questions, including the follow-

ing three:

• When did you last have a drink? How many drinks did

you have? Why did you choose to drink?

• How often do you drink? When do you drink? Where?

• Have you ever failed to do what was expected of you

because of drinking? How often?

On a scale of 1 (no reason for concern) to 10 (I have a

drinking problem), you rate your concern about the role

of alcohol in your life.

Get ReadyIn this stage, you research alcoholism in your

family, going back to your grandparents. If

drinking problems run in your family, you

need to think about drinking even more care-

fully than other students. You also list what you see as

the advantages of drinking (such as feeling less socially

anxious) and then its negative consequences (such as

headaches, hangovers, or blowing a test because you

were too wasted to study).

Get GoingIn this stage you set a drinking quota and

write in your IPC Journal:

“My limit is ____ drink(s) whenever I drink.”

You keep to this limit through a variety of strategies,

including the following:

• When “No” Isn’t Enough

Being with people who are drinking doesn’t mean you

have to drink as much as they do. Here are some effective

ways to get your message across. Rehearse the following

two examples before you go out:

“Just have one beer.” “I have a bet with someone (no

need to say it’s you) to see how

long I can go without drinking.”

OR

“I can’t stop at one, and I’m not

going there tonight.”

“Why aren’t you “I’ve got practice/work/a job

drinking?” interview/whatever first thing

tomorrow.”

Lock It InResponsible drinking requires attention.

Among other steps, you continue your alco-

hol audit for the rest of the term by using this

format:

Day of Number Type of Place Week of Drinks Drinks Consumed

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Check how the amounts recorded compare with the goal

you set at the beginning of the “Get Going” section.





6. Which of the following statements about alcoholism treatment is true?a. Inpatient treatment has been shown to be more

effective than outpatient treatment.b. Alcoholism can be cured by detoxifying or ridding

the body of all traces of alcohol.c. Antabuse is a medication given to alcoholics with

underlying mental disorders.d. A combination of medical, behavioral, and self-

help approaches may be necessary to treat alcohol abuse and dependence.

7. Which of the following statements about drinking on college campuses is true?a. The federal government has a goal to reduce the

binge-drinking rate among college students to 20 percent.

b. The number of women who binge-drink has decreased.

c. Because of peer pressure, students in fraternities and sororities tend to drink less than students in dormitories.

d. Students who attend two-year institutions tend to binge-drink when alcohol is available.

8. Responsible drinking includes which of the following behaviors?a. Avoid eating while drinking because eating speeds

up absorption of alcohol.b. Limit alcohol intake to no more than four drinks in

an hour.c. Take aspirin while drinking to lower your risk of a

heart attack.d. Socialize with individuals who limit their alcohol

intake.

9. Which of these is a standard drink?a. a margaritab. a 12-oz regular beerc. a double martinid. a 16-oz can of malt liquor

10. An individual’s response to alcohol depends on all of the following excepta. the rate at which the drink is absorbed into the

body’s tissues.b. the blood-alcohol concentration.c. socioeconomic status.d. gender and race.

Answers to these questions can be found on page 672.

Review Questions 1. Which of the following statements about the effects

of alcohol on the body systems is true?a. In most individuals, alcohol sharpens the responses

of the brain and nervous system, enhancing sensa-tion and perception.

b. Moderate drinking may have a positive effect on the cardiorespiratory system.

c. French researchers have found that drinking red wine with meals may have a positive effect on the digestive system.

d. The leading alcohol-related cause of death is liver damage.

2. Racial and ethnic patterns related to alcohol use include which of the following?a. Asian American women tend to have higher rates

of alcoholism than Asian American men.b. Alcohol-related deaths are highest as a percentage

of population among Native Americans.c. White Americans tend to have higher rates of cir-

rhosis of the liver than African Americans or Native Americans.

d. The Hispanic culture discourages men from drink-ing because heavy drinking indicates a lack of machismo.

3. Alcoholisma. is considered a chronic disease with genetic, psy-

chosocial, and environment components.b. is characterized by a persistent lack of willpower.c. may be classified as either Type A, which affects

people who are high-strung, or Type B, which affects people who are more mild mannered.

d. is easily controlled by avoiding exposure to social situations where drinking is common.

4. Which of the following statements about alcohol abuse and dependence is false?a. Alcohol dependence involves a persistent craving

for and an increased tolerance to alcohol.b. An individual may have a genetic predisposition for

developing alcoholism.c. Alcoholics often abuse other psychoactive drugs.d. Alcohol abuse and alcohol dependence are differ-

ent names for the same problem.

5. Health risks of alcoholism include all of the following excepta. hypertension. c. peptic ulcers.b. lung cancer. d. hepatitis.

Making This Chapter Work for You





absorption 439

alcohol abuse 448

alcohol dependence 448

alcoholism 448

binge 430

blood-alcohol concentration (BAC) 439

delirium tremens (DTs) 451

detoxification 450

ethyl alcohol 438

fetal alcohol effects (FAE) 446

fetal alcohol syndrome (FAS) 447

predrinking 432

proof 438

relapse prevention 453

Key TermsThe terms listed are used on the page indicated. Definitions of the terms are in the Glossary at the end of the book.

Was the experience not particularly enjoyable, boring, or difficult in some way? Have you ever been intoxi-cated? How do you behave when you are drunk? Do you find the experience enjoyable? What do the people around you think of your actions when you are drunk?

3. What effects has alcohol use had in your life? Try mak-ing a list of the positive and negative effects your own alcohol use has had. Be specific. If you continue to drink at your current rate, what positive and negative effects do you think it will have on your future? What effects have other people’s drinking had on your life? List fam-ily members and friends who drink regularly and how their drinking has affected you.

• Use the CengageNOW product to develop a Personal-ized Learning Plan targeting resources that address areas you should study.

• Coach you through identifying target goals for behav-ioral change and creating and monitoring your personal change plan throughout the semester using the Behavior Change Planner available in the CengageNOW resource.

information about the consequences of alcohol abuse and alcoholism.

www.al-anon.alateen.org This site provides information and referrals to local Al-Anon and Alateen groups. It also includes a self-quiz to determine if you are affected by someone who has an alcohol problem.

www.nacoa.org This association provides information about and for children of alcoholics. The website contains numerous links to relevant support groups.

Critical Thinking 1. Driving home from a friend’s twenty-first birthday

party, 18-year-old Rick has had too much to drink. As he crosses the dividing line on the two-lane road, the driver of an oncoming car—a young mother with two young children in the backseat—swerves to avoid an accident. She hits a concrete wall and dies instantly, but her children survive. Rick has no record of drunk driving. Should he go to prison? Is he guilty of man-slaughter? How would you feel if you were the victim’s husband? If you were Rick’s friend?

2. Have you ever been around people who have been intoxicated when you have been sober? What did you think of their behavior? Were they fun to be around?

Media MenuVisit www.cengagebrain.com to access course materials and companion resources for this text that will:

• Help you evaluate your knowledge of the material.

• Allow you to prepare for exams with interactive quizzing.

Internet Connectionswww.factsontap.org This excellent site is geared to college students. Sections include Alcohol & Student Life, Alcohol & Sex, Alcohol & Your Body.

www.collegedrinkingprevention.gov This website, sponsored by the National Institute of Alcohol Abuse and Alcoholism, focuses on the college alcohol culture with information for students, parents, college health administrators, and more. The site also features information about alcohol abuse prevention, college alcohol policies, research topics, and factual




672

Making This Chapter Work for You

Chapter 13

1. b; 2. b; 3. a; 4. d; 5. b; 6. d; 7. a; 8. d; 9. b; 10. c

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