Alcohol Flashcards
1
Q
what does the term alcohol refer to and how is it formed?
A
- refers to ethanol or ethyl alcohol
- formed as a result of the conversion of sugars into cellular energy
2
Q
Fermentation - natural and commercial process
A
- a naturally occurring process that happens in anything that has sugar in it or starch that converts to sugar
- alcohol-containing liquids and fruits have been around for a long time bc this process happens accidentally
- 1 molecule of glucose is acted upon by yeast in the absence of oxygen and the presence of heat produces cellular energy and 2 molecules of ethanol, 2 molecules of CO2 and water
- commercial process: fermentation is tightly regulated by special yeast and controlled temperatures
3
Q
what was the first identified piece of evidence that led archaeologists to believe that people were purposely fermenting beverages to consume?
A
- beer jugs dated back to 10,000BC
4
Q
what was the first intentionally produced alcoholic beverage?
A
- Mead (fermented honey)
5
Q
in ancient civilizations what was the norm, excessive drinking or drinking in moderation?
A
- drinking in moderation
6
Q
What alcoholic drink was the drink of choice by ancient Greeks and what roles did this drink assume?
A
- Wine
- assumed roles in nutrition, medication, ritual and pleasure-giving
7
Q
Cult of Dionysus
A
- devoted to heavy drinking bc they thought it would bring them closer to the gods
8
Q
Plato & Aristotle
A
- commented on the dangers and undesirable aspects of excessive drinking
9
Q
Alcohol and Romans
A
- may have been the world’s first wine connoisseurs
- several indications that excessive drinking was not uncommon and in some cases, it was rewarded (ie. soldiers were promoted on the basis of being able to consume a lot of alcohol)
10
Q
Seneca (4BC-65AD)
A
- distinguished between moderate alcohol use and excessive alcohol use, characterizing excessive as a “loss of control”
11
Q
Ulpian (170-228AD)
A
- noted the addictive nature of alcohol
- suggested that a disease process might be involved and that chronic users should be treated as if physically ill
12
Q
What is the highest naturally occurring percent of alcohol - why is this so?
A
- 14%
- around this % the yeast are killed bc of the alcohol and this causes the development of alcohol to stop
13
Q
Distillation
A
- process to obtain a higher % of alcohol
- systematically used around 700-800AD
- takes an already fermented beverage and boils it (since alcohol has a lower boiling point than water) the steam produced in the boilong process has a higher alcohol content than water
- steam is condensed by cooling and the condensed liquid has a higher % of alcohol (this process can be repeated multiple times)
14
Q
Europe prior to 1500s
Europe during 1500s
Role of the Government
A
Prior: consumption was mostly wine and beer
During: consumption increased due to increased prosperity, declining influence of the Catholic church, improved transportation and stronger distilled spirits (stronger and cheaper)
- Government added additional taxation on these products so they wanted consumption to increase
15
Q
Price elasticity of alcohol - what is it and what does it mean
A
-0.5 which means that for each 1% increase in price there is 0.5% decrease in consumption
16
Q
England and Alcohol
A
- increased consumption due to GIN which was imported by the Dutch
- called it “Madam Geneva”
17
Q
Gin Epidemic
A
- London from 1720-1750
- legislative attempts to cub the gin consumption but this caused “gin riots”
- birth rates were declining
- workers not going to work
- houses were getting turned over to sell gin
18
Q
Benjamin Rush - why is he important
A
- when Europeans colonized North America they brought along their heavy drinking habits which started too rub off on the inhabitants of North America - most opposition was due to distilled spirits
- Rush supported the idea that alcoholism was a disease and that the only cure was abstinence
- he published a treatise which contained an inbriometer (device that measures the response of an organism to the effects of alcohol) showing the effects of different types of drinking
19
Q
Temperance movements
A
- early 1800s
- in response to the heavy drinking in the US and Canada
- established first in the US: American Society for the Promotion of Temperance
- established in Canada (Nova Scotia and Montreal) after
- initially the temperance movement was to advocate for moderation on the consumption of nondistilled beverages but then the US changed their name to a union and this brought along new goals: total abstinence
- prohibition in Canada 1875
20
Q
Women’s Christian Temperance Union (WCTU)
A
- one of the best-known temperance groups that formed in the US then Canada (1873)
- women were very involved bc their husbands were the primary $$ makers so if they were an alcoholic they were unable to attend work and have bad outcomes for the families
21
Q
Carrie Nation
A
- leading figure in the fight against alcohol in the US
- carried a bible
22
Q
Prohibition in Canada - provincial prohibition
A
- from March 1918 to December 1919
- largely the result of concerns about WWI (wasn’t super about the temperance aspect)
- before national prohibition was enacted the provinces had the power to enact a provincial level prohibition
- each province went through a period of prohibition
23
Q
Speakeasies
A
- places where illegal alcohol was sold and it was estimated that there were more of these places than actual taverns before prohibition
24
Q
Noble Experiment
A
- the period of prohibition in the US was referred to as this
25
What is a standard drink defined as? What are the different sizes of drinks? And how much alcohol doe it contain?
- a standard drink is defined as 1 can of beer (5%), 5oz or 150mL of wine (12%), or 1.5ounces or 45mL of distilled spirits (40%)
- contains 13.5g (13,500mg) of alcohol
26
What is the first and second most widely used psychoactive substances in the world
1. caffeine
| 2. alcohol
27
What is the worldwide average consumption of standard drinks? What are the top countries? Where does Canada place in this ranking? What regions abstain from alcohol,?
- the worldwide average is 350 standard drinks
- Eastern European and European countries top the list of consumption per capita among people aged 15+ at 1,100 standard drinks per year
- Canada ranks 45th in per capita consumption at 450 standard drinks per year
- estimated that 45% of the worlds pop (35%M and 55%F) abstain from alcohol - greatest abstinence rates are from Eastern Mediterranean and SE Asian regions
28
What is the average age for both Canadians and US kids to start drinking? How many Canadians have drank and what % of this drinking is hazardous?
- the age in Canada and the US to start the regular consumption of alcohol is 16
- 80% of Canadians drank in the past year and of this 20 % engaged in hazardous behaviour
29
AUDIT (Alcohol Use Disorders Identification Test) what is it and what % of highschoolers identify with heavy drinking
- screener that measures hazardous/harmful drinking indicated by a score of 8 or more out of 40
- based on 2017 AUDIT a score of 8+ was about 20% for grades 7-12 but 35% of grade 12
30
AUDIT score breakdown - what is considered hazardous drinking and what score is considered to indicate alcohol dependence for both males and females?
- a score of 8+ is likely associated with harmful or hazardous drinking
- a score of 13 or more in females and 15 or more is associated with alcohol dependency
31
what % of expenditures are alcohol-related? what % of deaths are alcohol-related? What % of all traffic fatalities involved an intoxicated individual with a BAC of .10+?
1. 15%
2. 10%
3. 40%
32
What % of deaths result from accidental falls and fire involve alcohol? How many years earlier do alcoholics die than the general public? What is the risk of suicide for alcoholics compared to the general public?
1. 50%
2. 15yrs
3. 30x greater
33
What is the thirs most important risk factor in the Burden of Disease metric?
Alcohol use
34
How much alcohol is actually consumed by the drinking public?
- very small proportion
- 80% of all alcohol consumed is consumed by 30% of the people who can actually drink
- 50% of all alcohol consumed is consumed by only 10% of people who actualluy drink
35
What is meant by the analogy "women's drinking is said to be telescoped"?
- women seek treatment after shorter drinking histories than men (ie. the end point is brought closer)
36
What is the % of people who conform to the sterotypical picture of an alcoholic?
- less than 5%
37
What are the main ways to ingest alcohol?
1. Orally (most common)
| 2. inhaling
38
Inhaling alcohol - AWOL
- Alcohol Without Liquid
- produces the effects faster bc it reaches the brain faster and is not metabolized by the liver
- this could be very dangerous bc the protective measure the body has is to pass out before you can ingest a lethal amount
39
Orally consuming alcohol
- 20% is absorbed by the stomach
- 80% is absorbed by the small intestine
- when alcohol is in the stomach it is subjected to metabolism by alcohol dehydrogenase (15%)
40
What are the factors influence absoprtion from the gastrointestinal tract? (7)
1. The greater the concentration of alcohol the more rapid the absorption is - distilled spirits are faster absorbed than beer (up to 25% by volume)
2. other chemicals in alcoholic beverages slow absorption - vodka & gin are faster absorbed than coloured spirits like whiskey or rum
3. food in stomach slow absorption and can reduce peak BAC by as much as 50% - delyaed gastric emptying which allows alcohol dehydrogenase to metabolize the alcohol longer and less alcohol actually enters the bloodstream per unit of time
4. alcohol in carbonated beverages is more rapidly abosorbed - carbination speeds up the gastric emptying
5. the more rapidly the beverage is ingested the higher the peak BAC - if it's consumed slowly the liver has time to metaboloze but if its consumed at a constant or fast rate the liver cannot keep up producing a higher brain level
6. leaner people will have a lower BAC for a given amount of alcohol than a person with more body fat - lean body mass is made up with abt 70% water wheras body fat is made up with 10-40% water so less alcohol can be widely distributed
7. women have less alcohol dehydrogenase in their stomach than men - less of the alcohol is broken down in the woman so more is able to enter the bloodstream of a woman
41
How is alcohol metabolized? how much is excreted by the lungs and sweat?
- metabolozed by the liver and is broken down into acetaldehyde by alcohol dehydrogenase. Then broken down into acetic acid and ultimately CO2 and water by acetaldhyde dehydrogenase
- 5% is exreted by sweat
- in high doses up to 15% is excreted by the lungs which gives "sour" breath to chronic alcoholics or during binge drinking
42
How do you measure the amount of alcohol ingested? What is the legal impaired BAC in Ontario?
- blood alcohol concentration (BAC) or bloof alcohol level (BAL)
- it shows the amt of alcohol in the blood as a function of time since ingestion
- BAC is a bell-shaped curve that has a peak then declines
- expressed as a percentage of alcohol in the blood
- legally impaired limit in Ontario is .05 or higher
43
what happens once alcohol is absorbed from the GI tract?
- readily distributed since it diffuses across the capillaries and blood-brain barrier
- 90% of blood alcohol crosses the blood-brain barrier
44
What are some effects of alcohol according to BAC level?
- 0.25: Blackouts (conscious but don't remember what you're doing)
- 0.35: Coma is possible; a level of surgical anesthesia
- 0.45+: Possible death (LD50)
45
Alcohol Effects: Behavioural Ataxia and Loss of Motor Coordination - what are the tests that are used to measure this?
- most often seen in people who stumble and fall
Coordination test:
- Finger-to-Finger test: a piece of cardboard is placed in one hand and the marking device is in the other - the goal is to bring both fingers together and the area of resulting dots is measured. The total area increases as the BAC increases
Behavioural Ataxia test:
- Tilting Plane test: uses a flat surface that starts off horizontally and the angle slowly increases. the degree to which the animal slides off the plane is measured. intoxicated animals will slide off at a shallower angle.
- Rotarod test: uses a horizontal bar that rotates along an axis. Undrugged rats can remain on the rod while drugged rats cannot in a dose-dependent manner.
- Moving-Belt Test: similar to the "walk the straight line" sobriety test. The animal must walk on a treadmill where the objective is to stay on the treadmill and not fall off into the electrified grid.
46
Stabiliometer
- quantifies body sway
- a study was done by Pascolo that showed a clear effect of alcohol and body sway
- these effects were exacerbated by stimuli designed to stimulate bars and disco lights
47
Alcohol Effects: Body Temperature and Vasodilation
- alcohol lowers core body temperature by increasing the peripheral vasodilation leading to heat loss (causes the skin to feel warm and red)
- exacerbates the effects of cold
- chronic drinkers have broken the blood vessels in the upper cheeks that give them the "jolly red nose"
48
Alcohol Effects: Impaired Judgement (especially related to driving)
- approx. 50% of all fatal highway crashes involving 2 or more cars is related to alcohol
- approx. 65% of all fatal single-car crashes are related to alcohol
- approx. 36% of all adult pedestrian accidents are alcohol-related
- approx. 4 ppl are killed in vehicle crashes involving alcohol in Canada daily
49
Risk of driving impaired stats and factors that impair driving
- probability of an accident is 4x greater when BAC is .04-.08
- 7x higher when BAC reaches 0.10-.14
- 25x higher when BAC is .15 +
- factors that impact the increased risk to accidents: reduced attention to stimuli in the peripheral visual field, slowed reaction times and impairs judgement about driving ability
50
Alcohol Effects: Impairments on Cognitive Tasks
- interferes with: inspection time, the capacity to divide attention among demands, the capacity to sustain attention, capacity to ignore irrelevant stimuli and info processing
- the more complex the task is the LOWER the dose of alcohol necessary to produce impairment
51
Alcohol Effects: Sexual Behaviour (men and women)
- in men, it's shown that BAC <0.025 increases sexual responsiveness
- BAC > 0.05 sexual responsiveness is decreased
- BAC > 0.10 temporary impotency may occur
- in women, their physiological sexual responsiveness is decreased but subjective sexual arousal/pleasure may be increased
52
Expectancy and drugs
- the effects a person expects from a drug can influence how they behave when given the drug
- can measure this using the balanced placebo design
53
Balanced Placebo design
- involves 2x2 factoriral in which 1 factor the participants are told about the substance they're receiving (placebo or drug) and the other factor is the real nature of the substance (drug or placebo)
54
Balanced Placebo design and sexula beliefs
- used to examine the belief that alcohol has been consumed affects arousal in men and women
- men who thought they were drinking alcohol (placebo or not) had great penile response, spent more time watching erotic pictures and reported greater sexual arousal than those who reported not drinkng alcohol REGARDLESS of whether they consumed it or not
- expectancy has less of an effect on women
55
Alcohol Effects: Violence & Crime
- strong 2 way relationship between alcohol and many forms of violence
- people who often commit violent acts are usuually under the influence and the victims of the violent acts are under the influence too
- estimated that the majority of homicides, a little over half sexual and male domestic assaults, some female domestic assaults and a small number of sexual abuse cases were committed by someone who was intoxicated
- justice officals are the largest source of referals for alcoholism (50%) to communiity based programs
- expectancy plays a role here too: males who thought they consumed alcohol behaved in a more aggressive manner than individuals who beleived they had consumed a drink that doesnt have alcohol (regardless if it did/didnt)
56
disinhibition theory and the study to support it
- suggests that alcohol lowers inhibitions that notmally keep aggressive behaviour in check
- the effect that alcohol has on seritonin has been found to account to more aggressive behaviour (it lowers seritonin levels and results in more violent and impulsive acts)
- study was done where the intoxicated or unintoxicated person got to deliver a shock to someone else and it was found that those who thought they consumed alcohol chose to deliver longer and more intense electrical shocks than those who thought they didnt consume alcohol
57
Alcohol Effects: Blackouts
- a period of amnesia without the loss on consciousness (no memory of what they did)
- quite often engage in risky behaviour
- 2 type:
1. En bloc blackouts: inability to recall any memories from the intoxicated period even when prompted
2. Fragmentary blackouts: certian events from the intoxicated period may be recalled with some cueing
- Fragmentary blackouts are far more common than en bloc blackouts
- black outs occur around a BAC of 0.25
- research suggests that the capacity to transcibe memory proteins from genetic material is impaired at a BAC of 0.25
58
Alcohol Effects: Hangovers
- characteristic set of symptoms that occur anywhere from 4 to 12 hours after the cessation of drinking
- considered to be a form of acute withdrawl
- symptoms include: pounding headache, nausea, vomitting, body aches, sensitivity to light, extreme thirst etc.
- no remedy has been shown to improve a hangover other than time, a placebo or the only other thing to make a hang over feel better is more alcohol
59
what are some factors that might contribute to a hnagover? (2)
1. Congeners: trace amounts of nonethyl alcohol, oils and other organic matter that are byproducts of fermentation
- more common in coloured spirits (ie. rum) thna non colour spirits (ie. vodka)
2. Acetaldehyde or low blood sugar levels
60
Alcohol Effects: Acute and Chronic Effects on the Liver, Brain and other Organs
- any amount of drinking will cause acute fatty liver syndrome (natural response to stress and reduces after) this happens bc of an accumulation of triglycerides in the liver during the metabolism of alcohol
- continued drinking causes alcoholic hepatitis which is the actual destruction of liver cells and is accompanied by jaundice, loss of appetite, nausea and fever
- Cirrhosis is the degeneration of liver cells thickening of surrounding tissue. This causes rstricted hepatic blood flow and the liver is unable to metabolize toxins. Symptoms include fatigue, loss of weight, low resistance to infection, internal bleeding, disorientation and stupor
61
Cirrhosis facts
- not the invetiable consequence of chronic consumption of alcohol
- found in only 10% of alcoholics
- 75% of all deaths attritubed to alcoholism is due to cirrhosis
- even with equal drinking women tend to develop cirrhosis more than men (potentially be due to the fact that more women are anemic than men - less capacitiy to carry oxygen on red blood cells in blood - alcohol increases the liver's demand for oxygen which if not met results in cell death)
62
What are the cognitive results from the exposure to chronic alcohol use?
- Alcoholic dementia: impairements to learning, memory and other cognitive functioning. It's estimated that up to 75% of detoxified alcoholics show evidence of some form of dementia
- Korsakoff's Psychosis: thought to be an end stage of cognitive-impairements related to alcoholism and is associated with actual brain damage. Symptoms include lack of insight, confusion, apathy, anterograde (inability to create new memories) and retrograde amnesia (inability to recall past events), and confabulation(invention of past history)
- imagin has provided evidence that there's brain atrophy in human alcoholics
63
Alcohol Effects: Feminization in Chronic Alcoholics
- occurs in men due to the simultaneous decrease of testosterone and increase in estrogen
- the testes are involved in some alcohol metabolism so chronic use of the testes for this reason means they cant do their normal function and produce testosterone
- in acute drinking can lead to reduced testosterone levels and sperm count for about 6hrs following ingestion
- Symptoms: breast enlargement, testicular atrophy and loss of facial hair
64
Alcohol Effects: Lethal Effect
- can cause death due to respiratory depression
- LD 50 of alcohol in humans is 0.45 - this is hard to achieve under regular circumstances bc you would prbably pass out first
- possible to achieve a high BAC by consuming a lot of alcohol in a short period of time
- there is no antidote for alcohol
- 750mL of distilled spirits contains 17 standard drinks
65
Fetal Alcohol Syndrome (FAS) history
- Greek and Roman mythology a bridal couple was forbidden to drink wine on there wedding night in order that defective offspring might not be conceived
- Plato suggested that night time drinking should be barred to any man or woman who is was intending to create children
- Aristotle is credited with noting an association between maternal alcohol consumption and fetal deficits
66
Alcohol Effects: Fetal Alcohol Syndrome (FAS)
- Teratology: broadly defined as the study of birth defects
- 2 publications that showed this:
1. 1968 French investigators reported finding 127 offspring of alcoholic mothers with facial abnormalities, growth deficiencies and psychomotor disturbances
2. 1973 Jones and Smith described a pattern of craniofacial, limb and cardiovascular defects, mental deficiencies, prenatal growth deficiencies and developmental delays
67
FAS: Dysmorphic features or craniofacial features
- primary physical identifying features
- facial deformities are caused by drinking in the first trimester and the level of severity is directly associated with the amount of alcohol the mother consumes
- short eye slips, narrow upper lip, small chin, budging head etc.
68
FAS: fetal growth deficiencies
- birth weight, birth length and head circumference are all significantly reduced
- 2 standard deviations below the mean of nonaffected children
- drinking during the last trimester is detrimental to weight and length
- little to no postnatal recovery
- typically smaller in both height, weight and chronological age
- not due to prenatal deficiencies
69
FAS: behavioural abnormalities and developmental delays
- children who are born to mothers who use alcohol during the last part of pregnancy are born with withdrawal symptoms like tremors (although this is not a normal part of FAS it can indicate it)
- they show developmental delays in sitting, crawling, walking and speech production
- hyperactivity is also very common
- evidence to support that learning and memory impairments produced by prenatal alcohol exposure
- impairments are likely to be found in tasks requiring the inhibiting of responses and is likely to be caused by in utero alcohol exposure
70
FAS: mental deficiencies and CNS abnormalities
- 85% score 2 standard deviations below the average IQ
- lower-level cognitive function is present throughout the life of the individual
- adverse effects can be attributed to drinking alcohol during the first trimester but this is worrisome bc some may not even know they are pregnant
71
FAS rates, how much is too much to consume?
- rate of adverse fetal effects induced by maternal consumption is around 10 cases per 1000 live births
- the general consensus is that the risk for FAS increases once the daily consumption of alcohol reaches about 6 standard drinks
- Testa, however, thinks that risk could happen with potentially as little as 2 standard drinks a day
- binge drinking may be particularly relevant to FAS since the peak BAC (as compared to the number of drinks) may be the most important variable
- about 20% of pregnant women drink alcohol
- about 4% of pregnant women binge drink or drink heavily
72
GABA receptor
- GABA unit involves a GABA receptor and several other sites where most sedative-hypnotics may bind
- when GABA occupies its receptor the ion channels open to allow chloride channels into the neuron making it more difficult for an action potential to be generated
- inhibitory NT (alcohol enhances this)
73
GABA receptor and alcohol
- when GABA occupies its receptor and alcohol occupies the satellite (at the same time) the ion channels remain open longer than usual allowing more chloride ions to enter this makes it difficult to propagate an action potential
74
NMDA glutamate receptor and alcohol
- dampens the excitatory neurotransmission mediated by NMDA glutamate receptors by reducing the responsiveness of these receptors to glutamate
- chronic use of alcohol can cause an upregulation of the glutamate receptor and when the consumption of alcohol is terminated the upregulation of this receptor produces the signs of a withdrawal
75
VTA-NA reward pathway
- alcohol increases the release of endorphins which act to reduce the GABA transmission in the VTA
- GABA activity usually controls the release od dopamine in the nucleus accumbens and frontal cortext and thus alcohol results in the increase release of dopamine (this is the basis for the reinforcing effects)
76
what are the 3 different types of tolerance?
1. Meatbolic or dispositional tolerance:
- the capacity of the liver to metabolizes alcohol increases somewhat with repeated administration of the drug
- means less of the drug enters the bloodstream and less enters the brain
2. Acute/within session tolerance or Mellanby effect:
- bell shaped blood alcohol curve is acheived twice during a single administration of the drug (ascending and descending)
- suggested to result from acutely recruited adaptive responses to alcohol and its also suggested that these acute adaptations could result in chronic tolerance
3. Chonic/functional tolerance:
- reflected by relatively long lasting adaptive changes in the CNS and is shown by a shift.to the right on teh dose-response curve
- this tolerance has been shown in almost all the effects of alcohol such as motor ataxia, hyporthermia, sedative, anxiolytic and anticonvulsant
- processes involved in development of this tolerance: development of tolerance, occurance of subclinical withdrawal syndrome in treated adults, risk for relapse, and use of specific treatment to reduce the risk of relapse
77
why is studying tolerance of interest for a scientist?
1. medical standpoint it may present problems in achoeving effective medication since as tolerance develops some desried medical effect of a drug the dose must be increased to reproduce the desired effect
2. tolerance is usually accompanied by physical dependence with resultant withdrawal symptoms - these symptoms are usually opposite of the drug effects and these are the symptoms that motivate the person to keep taking the drug
78
What did Shepard Siegal suggest about tolerance? what were the proposed results if this was true?
- Pavlovian conditioning of drug opposite CRs may play a role in tolerance
Situational Specificity of Drug Tolerance:
- the display of tolernace should depend on the presence of the CS
- tolerance is always greater when the drug is given in the context of the usual CS predrug cues thus tolerance does display situaltional specificity
Placebo CR test:
- all groups are given a placebo
- made to expect that the drug is being presented bc of the prdrug cues but the drug is not actually given
- results show that the usual CS predrug cues elicit the drug opposite CR predicted by the Pavlovian conditioning model of tolerance
Extinction
- process by which tolerance is lost
- in order to get rid of a CR need to present the CS and not follow it up with the UCS
(tolerance should be lost by repeatedly presenting the usual CS prodrug cues not followed by the drug)
- animals that have undergone extinction show a greater loss in tolerance than those who have undergone a drug free period
79
The Role of Pavlovian conditioning in chronic tolerance to alcohol: study
- study of male social drinkers
- one group was given alcohol in a distinct environment and the others were given tonic at home
- half of the experimental group was told the were getting alcohol but the didnt receive it
- the results found that those who were expecting alcohol in the distinct environment having not received it did better on tasks than they would've done having having never had alcohol in the study
80
How might drug opposite CRs be involved in withdrawal and relapse?
- physical dependence is benchmarked by the occurrence of withdrawal symptoms upon cessation of drug administration
- once a patient has been detoxified they can enter a treatment program they insulate the person from all the usual drug cues and situations
- once the person is released they go back to their old living situation and are tempted by the environment around them and start to experience withdrawal symptoms again known as subclinical withdrawal - they know to alleviate these is to take the drug again so the relapse
81
Delirium tremens (the DT's)
```
- used to characterize alcohol withdrawal
Symptoms:
- start as soon as BAC starts to fall
- lasts 7-14 days
- excessive neuronal excitation
- severe tremors
disorientation, confusion, vivid hallucinations
- convulsions (abt 10%)
- sometimes death
```
82
Subclinical withdrawal symptoms
- not as severe as to require medical attention but they make the patient uncomfortable and scared
- they can experience these feelings up to weeks, months or years after detoxification
(cues associated with drug use are capable of eliciting a conditioned response)
83
subclinical withdrawal symptoms and cravings
- if cravings and subclinical withdrawal symptoms are related to a conditioned drug compensatory response then it would be expected that cravings would be especially pronounced in the context of drug-related cues
- ask the addicts if their environment elicits a craving (addicts state that cravings intensify when they are in the presence of drinking cues where they have previously drunk)
- treated addicts experience withdrawal-like symptoms when they are shown pictures of drug-related stimuli or put in the context of drug-related stimuli
- studies show that exposing alcoholics to cues reduces the capacity of the cues to elicit withdrawal-like symptoms, cravings and the desire to drink and the consumption of alcohol
84
What makes someone susceptible to alcoholism? Freud, and others
- Freud: suggested that excessive drinking represent attempts to repress unconscious homosexual instincts
- others: suggested it was due to an inability to give or accept love
- genetic susceptibility to alcoholism
85
Genetics of alcoholism
- involves selective breeding in animals
- where males & females showing high levels of the behaviour interest are inbred and animals showing a low level of behaviour of interest inbred
- able to produce rats with all sorts of selective traits like a strong preference for alcohol or no preference
- alcoholics have a sweet tooth and in a study, 75% of them chose the sweetest solution while only 16% of non-alcoholics chose that option
86
What studies show strong evidence for a genetic basis for many alcohol effects?
1. Houchi: found that knockout mice for CB1 cannabinoid receptor exhibit reduced reinforcement from alcohol
2. Crabbe, Stark & Hen: found that knockout mice lacking specific serotonin receptors drank less alcohol and were less affected by alcohol
3. Hall & Risenger: reported that knockout mice missing mu opiate receptors showed less evidence of alcohol reinforcement
87
Does alcoholism run-in families?
- traditionally use family, twin and adoption studies
- if the case here is true than children who are born to alcoholic parents should be more likely to develop the disorder - research states that offspring of alcoholics (1 or both biological parents) are more likely to be alcoholics than the offspring of non-alcoholic parents
- sons of alcoholics are estimated to be 50% compared to the 10% of the general pop
- the estimated rate for daughters is 10% compared to the 5% in the general pop
- living in families with alcoholics would have also provided an environment where offsprings would learn drinking behaviours from parents
88
Is the concordance rate for alcoholism higher in identical twins?
- can be estimated by heritability (ie. how much of the variability of the character is due to genetics) and is typically calculated as twice the difference between the correlation in MZ and DZ twins
- found that the concordance rate for alcoholism is estimated 60% in MZ and 25% in DZ so the heritability of 70%
89
how do adopted away offspring of alcoholic parents fare?
- there's still an increased risk for adopted offspring even though they don't live with the biological family
- this shows that remaining in the family where alcohol is present doesn't increase the risk for alcoholism suggesting that its a genetic factor and not an environmental one
90
What are the 2 types of alcoholism?
1. Type 1: Nonfamilial alcoholism - equally a consequence of environment and gentics
- occurs in both males and females
- onset after the age of 25
- often associated with other comorbid psychiatric factors like depression and anxiety
2. Type 2: Familial alcoholism - largely inherited
- primarily in males
- charcterized by positive family hisotry, onset before the age of 25 and follows the severe course
- often associated with antisocial perosnality disorder and impulsiveness
- Jellinek's "gamma" alcoholic
91
Trait markers between FH+ and FH- (4)
1. BAC curve: no reliable differences in the shape or temporal characteristics of the BAC in FH+ and FH-
2. Acetaldehyde: FH+ have higher blood acetaldehyde level following the ingestion of alcohol compared to FH-
- consistent wit the fact that FH+ show a higher "flushing" reaction to alcohol than FH-
3. P300: associated with the "oddball" effect
- FH+ show a faster P300 revovery time than FH-
4. Bahvioural and subjective effects: FH+ seem to be less affected by alcohol (either measured with behavioural or subjective tests)
- FH+ people display less body sway following injestion of alcohol
- FH+ is less subjective intoxication
- FH+ shows greater stress dampening effect of alcohol than FH-
92
Stress dampening
- alcohol reduces a stress response like increased heart rate
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Treatment of alcohol use disorder: the facts
- 8% of Americans aged 12+ need treatment for alcohol problems
- of that 8%, only 15% of them actually seek the care they need
- women tend to reach out for treatment less than men do probably bc of the stigma attached to women and alcoholism compared to men
- don't seek help bc: denial of a problem, not ready to stop drinking, cost of treatment, belief of ineffective treatment and stigma
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Comorbidity and alcoholism
- 40% of alcoholics are suffering from another psychiatric disorder:
- major depression (6x more likely to have a mood disorder)
- anxiety disorders (5x more likely)
- antisocial disorder (14% of alcoholics)
- other drug dependance (40% of alcoholics)
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problem with comorbidity and alcoholism
- don't know which one to treat first or if you should treat them all together or one before the other
- limitations are not the appropriate staff to treat psychiatric conditions and many mental health centres are hesitant to treat people who are still addicted
- 2/3 were either improved or abstinent following treatment
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Pharmacological Treatment: Antabuse, Naltrexone and Acamprosate
- not enough to use on their own
- psychological and pharmalogical work best together
Antabuse:
- leads to an accumulation of acetaldehyde
- when patients take this and then consume alcohol they feel physical sick and its a form of aversion therapy
- not sufficient on its own to fix alcoholism
- most effective in high funcitoning and highly motivated ppl
Naltrexone:
- opiate antagonist
- works to block the opiate receptor and thus endorphins release by alcohol
- alcohol cannot hinder the GABA receptor and thus no dopamine is released
- works to reduce the rewarding effects of alcohol making it less appealing
- reduces cravings and relapse
Acamprosate:
- structural analogue of the excitatory neurotransmitter taurine and acts in the glutaminergic system
- diminishes the neuronal exciteabiloty of glutamate receptors that have become up regulated due to chronic alcohol intake
- reduces intensity of withdrawal and craving
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what was the long dominant view of alcoholism?
- chronic disease
- they can never really be cured and the reapperance if symptoms of the disease in patients in remission is inevitable unless they refrain from all drinking
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Jellinek's " The Disease Concept of Alcoholism" (1960)
- first to systematically outline this dominat view
- identified several types of drinkers
- Gamma drinker he identified to be the true alcoholic (individual with the diease)
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Gamma drinker criteria and what conclusions did it lead to (2)
1. alcoholism is progressive and irreversible diseases and if someone with the diease continues to drink they will suffer physical and mental effects
2. someone with this dease suffers from "loss of control" meaning that if they have an drink they cannot control how much they will drink
- lead to the conclusion that the only viable treatment goal is total abstinence
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Controlled drinking and why is this desirable? (4)
- goal that reduced and controlled drinking is possible
1. many drinkers avoid treatment bc they beleive that all treatmenst are about total abstinence and although they know they have a problem they arent ready to fully stop
2. 80% of North Americans drink and the person who doesnt drink is socially shunned
3. abstinence is confused with cure - dlects the attention away from the fact that abstinence is not alway accompanied by imporvements in most of their lives
4. self-fufilling prophecy "one drink away from being a drunk"
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what hypothesis is controlled drinking based on?
- based on the fact that drinking is a learned behaviour ahped by reinforcementsas such drinking problems may be shaped and controlled into less problematic by changing the reinforcements
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Controlled drinking: Berg study
- regardless of the actually alcohol content the participants who believed they were receiving alcohol consumed greater amounts, greater rated intoxication, greater anxietyy and appearance of phsyiological chnages invloving subclinical withdrawal syndrome copared to telling the participants they consumed a nonalcoholic beverage
- this shows that one of the core reasons for advocating for abstinence may not be a physiological response that unmodifiable, but rather a psychological expectancy that can be modifiable
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Controlled drinking: Mark and Linda Sobell
- program was regulated drinking with punishment
- used gamma alcoholics
- they had a bar set up in the facility where patients could go and learn how to control their drinking
- shocks were given if the patient ordered a straight drink, took gulps or large sips, had drinks in intervals less than 20mins apart or ordered more than 3 drinks in total
- also given counselling and coping strategies and were trained on how to identify high risk situations and were given exposure to these cues but weren't allowed to drink
- patients in the controlled group were told that total abstinence is the goal
- results: patients that received the controlled drinking program had fared better off than patients who received the total abstinence program (5 years after)
- produces a more harm-reduction approach to drug use as it might be desirable to have no drinking for individuals where that otion isnt viable this one is (ie. reducing the risk to drinkers)
