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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
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
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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.
This is an electronic version of the print textbook. Due to electronic rights restrictions,some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. Forvaluable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest.
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ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher.
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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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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
lend
Imag
es/J
upite
rimag
es
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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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.
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.
© iS
tock
phot
o.co
m/C
hris
Sch
mid
t
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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.
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.
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428 Section IV Making Healthy Choices
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).
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429Chapter 13 Alcohol
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
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430 Section IV Making Healthy Choices
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.
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431Chapter 13 Alcohol
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
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).
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432 Section IV Making Healthy Choices
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
n M
urph
y/S
tone
/Get
ty Im
ages
predrinking Consuming alcoholic beverages, usually with friends, before going out to bars or parties; also called pre-gaming, pre-loading, or front-loading.
27007_ch13_ptg01_lores_424-459.indd 432 10/6/11 1:43 PM
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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.
433Chapter 13 Alcohol
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.
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434 Section IV Making Healthy Choices
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
dle/
Get
ty Im
ages
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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.
435Chapter 13 Alcohol
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.
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).
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.
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436 Section IV Making Healthy Choices
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
27007_ch13_ptg01_lores_424-459.indd 436 10/6/11 1:43 PM
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437Chapter 13 Alcohol
• “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
eff G
reen
berg
/Ala
my
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.
27007_ch13_ptg01_lores_424-459.indd 437 10/6/11 1:43 PM
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438 Section IV Making Healthy Choices
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.
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439Chapter 13 Alcohol
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
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440 Section IV Making Healthy Choices
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
Body weight in pounds
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
1 .05 .05 .04 .03 .03 .03 .02 .02 Impairment begins
2 .10 .09 .08 .07 .06 .05 .05 .04 Driving skillssignificantly affected
Possible criminalpenalties
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
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 .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
Approximate blood alcohol percentage
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
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
Body weight in pounds
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
1 .05 .05 .04 .03 .03 .03 .02 .02 Impairment begins
2 .10 .09 .08 .07 .06 .05 .05 .04 Driving skillssignificantly affected
Possible criminalpenalties
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
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 .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
Approximate blood alcohol percentage
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
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
Body weight in pounds
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
1 .05 .05 .04 .03 .03 .03 .02 .02 Impairment begins
2 .10 .09 .08 .07 .06 .05 .05 .04 Driving skillssignificantly affected
Possible criminalpenalties
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
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 .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
Approximate blood alcohol percentage
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
Figure 13.3 Alcohol Impairment ChartSource: Adapted from data supplied by the Pennsylvania Liquor Control Board.
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441Chapter 13 Alcohol
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
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442 Section IV Making Healthy Choices
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,
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443Chapter 13 Alcohol
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.
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444 Section IV Making Healthy Choices
• 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.
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445Chapter 13 Alcohol
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.
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446 Section IV Making Healthy Choices
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.
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447Chapter 13 Alcohol
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
this to promote their
products to Hispanic
Americans.©
Bill
Aro
n/P
hoto
Edi
t
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448 Section IV Making Healthy Choices
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)
compared to one with
cirrhosis.
© P
eter
Arn
old,
Inc.
/Ala
my
Mar
tin M
. Rot
ker/
Pho
to
Res
earc
hers
, Inc
.
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.
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449Chapter 13 Alcohol
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
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450 Section IV Making Healthy Choices
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.
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451Chapter 13 Alcohol
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
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452 Section IV Making Healthy Choices
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
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453Chapter 13 Alcohol
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-
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454 Section IV Making Healthy Choices
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.
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455Chapter 13 Alcohol
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
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456 Section IV Making Healthy Choices
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.
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457Chapter 13 Alcohol
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.
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458 Section IV Making Healthy Choices
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
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459Chapter 13 Alcohol
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
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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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This page contains qustions for this chapter only
688 References
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