Chapter 6: Depressants: Alcohol

By the end of this chapter, you should be able to:

• Examine the dominant beliefs and attitudes in our society with regard to chemical use. (LO1)
• Define the characteristics of the major classes of drugs. (LO2)
• Identify and summarize the addiction process and the characteristics thereof. (LO3)

Overview

This chapter will discuss alcohol and its relationship with addiction, other health issues, and epidemiology. Alcohol is a substance that has been in use (in some form or fashion) for many thousands of years across the world. Fermented beverages resembling alcohol, we consume by early Egyptians, Chinese, and India as far back as 7000 BC (Drug Free World, 2022). Many cultures had gods and goddesses that were worshiped through drink, usually to excess. Early civilizations and cultures in South and Central America also had their own varieties of fermented beverages, often made from sugary produce like corn, grape, or apples (Drug Free World, 2022; Setiz & Neuman, 2021). European and North American populations have more recent, even challenging history with alcohol, including periods of temperance and prohibition (Drug Free World, 2022). It seems that no matter where an individual is located, alcohol is a prevalent part of the culture. To learn more about a the history of alcohol from this short video by Rod Phillips (2020).

Alcohol

Alcohol is has one major psychoactive component and that is ethyl alcohol (or ethanol). It is created through the fermentation of glucose found in alcoholic beverages like beer, wine, and liquors. This substance, like other drugs, affects the central nervous system and its electronic functioning (Jurado-Barba, 2020). It generally affects mood and cognitive function, but other times with excessive use, it will also impair self-control, speech, bodily control and function (APA, 2022; Inaba, 2011; NIAAA, 2022; Wang, 2020). Additionally, despite the negative affects experienced by the user, the individual will continue to consume because of this loss of self-control (Stock, 2017). The amount of pure alcohol varies from one type of beverage to another. Review this resource provided by the Australian Government (2022) that covers a Standard Drinks Guide; Drink Calculators may also be interesting resources to explore. Please note that some drinks in a bar contain two or more shots of alcohol.

• Drink Calculator
• Drink Calculator Quiz Game

Select this link to a Blood Alcohol Chart that shares what levels are in relation to sex and body weight: BAC Chart

Alcohol Processing

Alcohol is processed by two main enzymes. These enzymes break down the alcohol molecule into manageable pieces, that are easier for the body to eliminate (NIAAA, 2022). The rate at which alcohol is broken down depends greatly on the weight, gender, age, and additional individual characteristics. As with other substances, once the psychoactive component of alcohol crosses the blood-brain barrier, the effects are felt by the user. Women typically feel the affects of alcohol much quicker than males (Inaba, 2011). Review the usage levels below, expand with the double pointed arrow in the lower right corner for full screen.

Alcohol Addiction

Alcoholism also known as alcohol dependence, is a chronic disease that has severe, significant behavioral, psychological, and pscyhosocial consequences. Addiction of this substance can include cravings, tolerance, dependence and withdrawal when it is no longer consumed (APA, 2022; Inaba, 2011). Research has suggested that there are many genetic predictors for alcohol abuse and other addictions, in addition to environmental factors. Pre-disposition for alcohol usage creates a vicious, repetitive cycle of use, withdrawal, and craving (Heilig, 2021) as covered in previous chapters. An estimated 15 million people ages 12 and up have not only used alcohol but abuse it, just in the United States (SAMHSA, 2022). The National Institute on Alcohol Abuse and Alcoholism reports the following statistics for alcohol use in United States (2022):

• Prevalence of Drinking:
  • 85.6% of people aged 18 years and older report that they have tried alcohol.
  • 69.5% of these people reported drinking in the last year.
  • 54.9% of these people reported that they drank in the last month.
• Binge Drinking and Heavy Alcohol Consumption:
  • 25.8% of people reported that they engaged in binge drinking in the past month.
  • 6.3% of people reported that they engaged in heavy alcohol usages in the past month
• Other Extreme situations
  • Aggression and violence are are often triggered when under the influence of alcohol.
  • Millions of drivers each year are arrested for using alcohol while driving, killing others while intoxicated, and being distracted in other ways while also intoxicated.
  • Other fatal situations like suicide, boating and industrial accidents are prevalent among alcohol users as well. Billions of dollars are spent each year due to all of these consequences of alcohol usage (Grace, 2021; Heilig, 2019; Grace, 2021; Stock 2017).

More Problems

Influences

Alcohol is usually paired with other substances or issues, rarely working alone. It is a complex situation and the individual needs proper attention and care for all of the disorders. Potential other influences include, but are not limited to:

• The majority of alcohol users report marijuana and cigarettes used with alcohol.
• It is also popular to combine alcohol with methamphetamine or cocaine to create a “speedball” to combat depression symptoms (Inaba, 2011).
• Alcohol is also prevalent in individuals with mental disorders like depression and anxiety. Alcoholism can be hidden by the mental disorders (NIAAA, 2022).
• Social influences also cause many alcohol-related experiences (Bodnar, 2021), both positive and negative.

Pregnancy

Women who consume alcohol while pregnant are more likely to experience miscarriage, stillbirth, premature birth, SIDS, and FASD. For more information regarding alcohol and pregnancy, review the information regarding Fetal Alcohol Exposure provided by NIAA (2022).

Epidemiology

Every country has different rules, regulations, or cultural expectations regarding the use (and abuse) of alcohol. Each subgroup, like age, sex, and vocation, also has its own rules and expectations.

Cultural and Ethnic Implications

Select each of the hot spots on the map below to learn a bit more about the cultural and ethical differences between cultures around the world.

Gender Implications

Earlier in this chapter it is mentioned that women are affected by alcohol consumption more quickly than men. In addition to this, women are more likely to die of alcoholism than men (Inaba, 2011). Learn more by watching this video.

References:

Addicted to Happy (2021, November 16). Where does your drinking fall on the alcohol use spectrum? [Video]. YouTube. https://www.youtube.com/watch?v=2OKXmaLoFdE

American Psychological Association (2022). Alcohol use disorder. APA Dictionary. https://dictionary.apa.org/alcohol-use-disorder

American Psychological Association (2022).Ethanol. APA Dictionary. https://dictionary.apa.org/ethanol

Australian Government (2020). Standard drinks guide. About Alcohol. https://www.health.gov.au/health-topics/alcohol/about-alcohol/standard-drinks-guide

Bodnar, V., Nagy, K, Cziboly, A., & Bardos, G. (2021). Alcohol and placebo: The role of expectations and social influence. International Journal of Mental Health and Addiction, 19, https://link.springer.com/article/10.1007/s11469-020-00321-0

Dandelion Medical Animation (2021, December 25). Digestion of alcohol is not like other food [Video]. YouTube. https://www.youtube.com/watch?v=9Oslu11jnmM

Foundation for a Drug-Free World (2022). Alcohol: A short history. A Foundation for a Drug-Free World. https://www.drugfreeworld.org/drugfacts/alcohol/a-short-history.html

Grace, S., Rossetti, M.G., Allen, N. et al. (2021). Sex differences in the neuroanatomy of alcohol dependence: hippocampus and amygdala subregions in a sample of 966 people from the ENIGMA Addiction Working Group. Translational Psychiatry 11, 156 . https://doi.org/10.1038/s41398-021-01204-1

Grossman, E., Benjamin-Neelon, S., & Sonnenschein, S. (2020). Alcohol consumption during the COVID-19 pandemic: A cross-sectional survey of US adults. International Journal of Environmental Research and Public Health, 17(24). https://doi.org/10.3390/ijerph17249189

Harker, N., Londani, M., Morojele, N., Williams, P., Parry, C. (2020). Characteristics and predictors of heavy episodic drinking (HED) among people aged 16-25: The international alcohol control study (IAC), Tshwane, South Africa. International Journal of Environmental Research and Public Health, 17(10). https://doi.org/10.3390/ijerph17103537

Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L, & Vandershuren, L. (2021). Addiction as a brain disease revised: Why it still matters, and the need for consilience. Neuropsychopharmacology, 46, https://www.nature.com/articles/s41386-020-00950-y

Heilig, M., Augier, E., Pfarr, S. et al. (2019). Developing neuroscience-based treatments for alcohol addiction: A matter of choice?. Translational Psychiatry, 9, 255 (2019). https://doi.org/10.1038/s41398-019-0591-6

Hernandez-Vasquez, A., Chacon-Torrico, H., Vargas-Fernandez, R., Grenda, L., Bendezu-Quispe, G. (2022). Gender differences in the factors associated with alcohol binge drinking: A population-based analysis in a Latin American country. International Journal of Environmental Research and Public Health, 19(9). https://www.mdpi.com/1660-4601/19/9/4931/htm

Inaba, D. (2011). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs. CNS Productions.

Jurado-Barba R, Sion A, Martínez-Maldonado A, Domínguez-Centeno I, Prieto-Montalvo J, Navarrete F, García-Gutierrez MS, Manzanares J and Rubio G (2020). Neuropsychophysiological Measures of Alcohol Dependence: Can We Use EEG in the Clinical Assessment? Front. Psychiatry 11:676. doi: 10.3389/fpsyt.2020.00676

Miller, E., Olver, I., Wilson, C., Lunnay, B., Meyer, S., Foley, K., Thomas, J., Toson, B., & Ward, P. (2021). COVID-19, alcohol consumption and stockpiling practices in midlife women: Repeat surveys during lockdown in Australia and the United Kingdom. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2021.642950

National Institute on Alcohol Abuse and Alcoholism (2022). Alcohol topics A to Z. NIAAA. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics-a-to-z

Philips, R. (2020, January 2020). A brief history of alcohol [Video]. YouTube. https://www.youtube.com/watch?v=y5XEwTDlriE

Rossow, I., Bartak, M., Bloomfield, K., Braddick, F., Bye, E., Kilian, C., Lopez-Pelayo, H., Makela, P., Moan, I., Moskalewicz, J., Petruszelka, B., Rogalewics, V., & Manthey, J. (2021). Changes in alcohol consumption during the COVID-19 pandemic are dependent on initial consumption level: Findings from eight European countries. International Journal of Environmental Research and Public Health, 18(19). https://doi.org/10.3390/ijerph181910547

Substance Abuse and Mental Health Services Administration (2022). Alcohol, tobacco, and other drugs. US Department of Health and Human Services. https://www.samhsa.gov/find-help/atod

Seitz, H. & Neuman, M. (2021). The history of alcoholic liver disease: From an unrecognized disease to one of the most frequent diseases in hepatology. Journal of Clinical Medicine, 10(4). https://www.mdpi.com/2077-0383/10/4/858/htm

Stock, A. (2017). Braking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.00884

Theron, M., Swart, R., Londani, M., Parry, C., Williams, P., & Harker, N. (2021). Did COVID-19-related alcohol sales restrictions reduce alcohol consumption? Findings from a national online survey in South Africa. International Journal of Environmental Research and Public Health, 19(4). https://doi.org/10.3390/ijerph19042422

Wang, S., Chen, Y., Chen, S., Lee, C., & Cheng, C. (2020). Alcohol addiction, gut microbota, and alcoholism treatment: A review. International Journal of Molecular Sciences, 21(17). https://www.mdpi.com/1422-0067/21/17/6413