Loosening the Grip: a handbook of Alcohol Information 9th

Chapter 3 Alcohol and the Body

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Chapter 3 Alcohol and the Body

Abramson S, SinghAK. Treatment of the alcohol intoxications: Ethylene glycol, methanol and isopropanol (review). Current Opinion in Nephrology and Hypertension 9(6): 695–701, 2000. (32 refs.)

Anderson P, Baumberg B. Alcohol in Europe. A Public Health Perspective. London: Institute of Alcohol Studies, June 2006. (chapter refs.)
This report commissioned by the European Commission addresses the social, health, and economic burden associated with alcohol use in Europe. The European Union is the heaviest drinking region of the world, although the current 11 litres of pure ethanol consumed annually is substantially less the 15 litres of the mid-1970s. Alcohol is estimated to generate social costs related to health, welfare, employment and criminal justice system, costs estimated to be 125 billion Euros per year. In addition it promotes social inequalities throughout the European Union with a negative impact on social cohesion. While must has been done to reduce this, the report identifies areas in which further efforts are warranted. The report is organized into 10 chapters. Chapter 1 provides an introduction and outlines the methods used and key terminology and the structure of the report. Chapter 2 provides a brief history of alcohol use in Europe. Chapter 3 describes the economic impact of alcohol, with attention to global and European production and trade. It also considers smuggling and lost taxes, annual expenditures, and social costs. Chapter 4 deals with drinking patterns in Europe, drinking context, estimates of drinking frequency, and differences in drinking patterns related to gender and social class. Chapter 5 describes the impact of alcohol use on individuals - on social well-being, health status, injury and disease rates - while also considering determinants of risk factors. Chapter 6 will address health from the societal perspective, summarizing the numbers of those with different alcohol-related conditions, as well as societal parameters of harm, i.e. crime, violence, and impact on the family. The relationship of harm to population levels of consumption is reviews. Chapter 7 deals with alcohol policy, namely what does and does not work. Detailed attention is directed to drinking and driving, policies that support education, promote harm reduction, and promote advice and treatment. Chapter 8 deals with global and European factors that impinge of alcohol policy, with attention to General Agreement of Tariffs and Trade (GATT), tax policy, monopolies and advertising. Chapter 9 summarizes current alcohol policy in Member Sates, and compares countries over time and in relation to other geographical areas. Chapter 10 summarizes major points and makes recommendations of actions to promote the health of citizens. The recommendations fall into nine areas, ranging from drinking and driving to reducing harm in drinking establishments, to tax measures advertising. Data is summarized in multiple tables and charts. (Copyright 2006, Project Cork.
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Bullers S, Ennis M. Effects of blood-alcohol concentration (BAC) feedback on BAC estimates over time. Journal of Alcohol and Drug Education 50(2): 66–87, 2006. (24 refs.)

This study examines the effects of self-tested blood alcohol concentration (BAC) feedback, from personal hand-held breathalyzers, on the accuracy of BAC estimation. Using an e-mail prompted web-based questionnaire, 19 participants were asked to report both BAC estimates and subsequently measured BAC levels over the course of 27 days. Results from the 14 subjects who reported drinking during that time period suggest that BAC estimation improves over the first four drinking events, only when controlling for amount of alcohol consumed. BAC estimate accuracy was found to decrease as number of drinks and measured BAC increased. Participants were more likely to over-estimate their BAC's than to under-estimate them but this trend was much more pronounced for light drinkers than for heavy drinkers. There were no additional effects of heavy/ light drinker status on estimate accuracy, beyond the effects of BAC at time of measured event. (Copyright 2006, American Alcohol and Drug Information Foundation)

Chamberlain E, Solomon R. The case for a 0.05% criminal law blood alcohol concentration limit for driving (review). Injury Prevention 8(Supplement 3): 1–17, 2002. (109 refs.)

This article provides a comprehensive review of factors that would support adoption of a 0.05% BAC for driving. Section I reviews the effects of low doses of alcohol. It covers vision, vigilance, psychomotor skills, information processing, divided attention skills. Both laboratory and field studies indicate that these important driving related skills are adversely affected by relatively small amounts of alcohol. Section II deals with the risk of accidents at varying blood alcohol levels. It notes the earliest studies, beginning with the landmark "Grand Rapids Study" in 1964, that showed the risk of accidents increased proportionate to increases in BAC. More recent studies provide further support, e.g. that the risk of a fatal crash is 9 times greater for those with a BAC in the 0.05 range to 0.9 range, among males age 25 and over. Section III considers the impact of lowering the BAC for driving. It looks at data from Canada, and also the impact in the United States in the reduction from 0.10% to 0.08%, and also international experiences with BAC limits of 0.05% or lower. Special situations are also reviewed such as lower limits for young and beginning drivers. Also reviewed is the general impact on highway safety, measures beyond fatal accidents. The author also presents the relevant evidence to examine some of the frequent arguments used to counter a lowering of the legal BAC for driving, such as "it would interfere with social drinking," or that "it would not deter 'hard core' drinkers," or "it would cost too much to enforce," or "it would over-burden the courts." The author concludes that there is more than sufficient evidence to support a lowering of legal BAC, whether one considers the pharmacological effects of alcohol, or reviews the impact where such changes have been made. (Copyright 2002, BMJ Publishing Group)

Cherpitel CJ, Ye Y, Bond J, Rehm J, Poznyak V, Macdonald S., et al. Multi-level analysis of alcohol-related injury among emergency department patients: A cross-national study. Addiction 100(12): 1840–1850, 2005. (27 refs.)

Aim: The aim of this analysis was to examine the average rate and variation of alcohol-related injury across emergency department (ED) studies, the effect of usual drinking on likelihood of alcohol-related injury, whether cross-study variation in rate of alcohol-related injury can be explained by between-study difference in usual consumption and whether social-cultural contextual variables help explain cross-study variations, after between-study difference in usual consumption has been controlled. Design: Data were merged from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries, together representing 28 studies in 16 countries, and include 8423 (drinking) injury patients who arrived in the ED within 6 hours after injury. Alcohol-related injury was based, separately, on a positive blood alcohol concentration (BAC) and self-reported drinking within 6 hours prior to injury. A multi-level design and hierarchical generalized linear models were used for analysis in which patients were nested within studies. Findings: Overall prevalence of alcohol-related injury was 24% and 29% for positive BAC and self-report, respectively. At the patient level, log-transformed alcohol consumption in the last 12 months was a significant predictor of alcohol-related injury. At the study level significant variation in rates of alcohol-related injury was observed; studies with higher overall average consumption reported a higher rate of alcohol-related injury. When volume was controlled, societies with higher detrimental drinking pattern and higher legal level for intoxication while driving were more likely to have an increased rate of alcohol-related injury. Conclusion: Alcohol-related injury varies across EDs and countries. While it is associated with an individual's usual alcohol consumption, it is also affected by a number of societal drinking characteristics including the aggregate volume of consumption, overall drinking pattern and legislative policies to control drinking and related harms. (Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs)

Chikritzhs TN, Jonas HA, Stockwell TR, Heale PF, Dietze PM. Mortality and life-years lost due to alcohol: A comparison of acute and chronic causes. Medical Journal of Australia 174(6): 281–284, 2001. (15 refs.)

Objectives: (i) To estimate the numbers of deaths and person-years of life lost (PYLL) due to high-risk alcohol consumption in Australia during 1997, using current estimates of consumption. (ii) To compare the number of deaths and PYLL due to acute conditions associated with bouts of intoxication and chronic conditions associated with long- term misuse of alcohol. Methods: All Australian deaths during 1997 related to conditions considered to be partially or wholly caused by high-risk alcohol consumption were extracted from the Australian Bureau of Statistics Mortality Datafile and adjusted by alcohol aetiologic fractions calculated for Australia in 1997. A life-table method was used to estimate the PYLL for deaths from alcohol-caused conditions. Main outcome measures: Numbers of all deaths and PYLL due to chronic and acute alcohol-related conditions. Results: Of the 3290 estimated alcohol-caused deaths in 1997, chronic conditions (eg, alcoholic liver cirrhosis and alcohol dependence) accounted for 42%, acute conditions (eg, alcohol-related road injuries and assaults) for 28% and mixed (chronic and acute) for 30%. Of the 62914 estimated potential life years lost, acute conditions were responsible for 46%, chronic for 33% and mixed for 21%. The average number of years of life lost through deaths from acute conditions was more than twice that from chronic conditions, because the former mostly involved younger people. Conclusions: in view of the societal burdens imposed by premature deaths, more effective public health strategies are needed to reduce the harm associated with occasional high-risk drinking las well as sustained high-risk drinking), especially among young people. (Copyright 2001, Australasian Medical Publishing Co., Ltd.)

Correa CL, Oga S. Effects of the menstrual cycle of white women on ethanol toxicokinetics. Journal of Studies on Alcohol 65(2): 227–231, 2004. (19 refs.)

Objective: The aim of this study was to investigate the existing variations of the kinetics of ethanol in white women during the menstrual and luteal phases to further current understanding of the role of the menstrual cycle in gender differences in ethanol's adverse effects. Method: In a within-subjects design, 10 female white volunteers were administered a moderate dose of ethanol (0.3 g/kg) in the morning after an overnight fast. On each test day, blood samples were collected before ethanol administration so that hormonal (estrogen, progesterone, luteinizing hormone and follicle stimulating hormone) and biochemical (hepatic and renal functions) analyses could be performed. Blood samples were also drawn from each volunteer to determine BAC and to examine toxicokinetic differences between the two phases using classical and Widmark's measures. Results: The analysis of time-to-peak BAC in the two menstrual phases shows that there was no significant statistical difference when each phase was evaluated and in the interaction of the phase with time. The estimated toxicokinetic parameters did not show significant differences when the two phases were compared. Conclusions: Despite careful experimental design, which considered present debate and discussion in the literature, no significant differences between the two phases studied (menstrual and luteal) were observed. (Copyright 2004, Alcohol Research Documentation)

Eaton DL. Scientific judgment and toxic torts: A primer in toxicology for judges and lawyers. Journal of Law and Policy 12:5–42, 2003. (50 refs.)

This article provides a primer on a range of scientific matters related to toxicology, ranging from chemical agents to alcohol. It covers adverse effects, with attention to dose, route of administration, duration of use and frequency of use. (Copyright 2003, Journal of Law and Policy, Inc.)

Editor. Health risks and benefits of alcohol consumption. Alcohol Research & Health 24(1): 5–11, 2000. (93 refs.)

Alcohol consumption has consequences for the health and well-being of those who drink and, by extension, the lives of those around them. The research reviewed here represents a wide spectrum of approaches to understanding the risks and benefits of alcohol consumption. These research findings can help shape the efforts of communities to reduce the negative consequences of alcohol consumption, assist health practitioners in advising consumers, and help individuals make informed decisions about drinking. Public Domain

Editor. Papers on absorption, distribution, and elimination of alcohol in non-alcoholics. Alcoholism: Clinical and Experimental Research 24(4): 244–257, 2000.

Flilmore MT, Blackburn J. Compensating for alcohol-induced impairment: Alcohol expectancies and behavioral disinhibition. Journal of Studies on Alcohol 63(2): 237–246, 2002. (31 refs.)
Objective: Studies have shown that expectations of alcohol-induced impairment can produce adaptive responses to alcohol that serve to reduce the degree of behavioral impairment displayed. The present research examined how an expectancy-induced adaptive response could reduce the impairing effects of alcohol on response activation, while at the same time increase its impairing effect on response inhibition. Method: Social drinkers (N = 48) practiced a stop-signal choice reaction time (RT) task that measured their speed of responding and their ability to inhibit responses to stop signals. Subjects then received 0,65 g kg of alcohol, a placebo beverage, or no beverage. Prior to performing the task again, one-half of the sample was given information to expect that alcohol would slow (i.e., impair) their RT. The others received no expectancy treatment. Results: Subjects led to expect slowed RT displayed faster RTs but fewer inhibitions under alcohol, compared with those who received no such expectancy. The same pattern of results as observed under the placebo condition. In the "no beverage" condition, the expectancy treatment had no significant effect on subjects' RT or inhibitions, Conclusions: The findings demonstrate that an alcohol expectancy can reduce impairment of one aspect of performance under the drug while increasing it, impairing effect on another. The study contributes to a growing body of research that highlights the importance of understanding interactions between the expected and pharmacological effects of alcohol. Copyright 2002, Alcohol Research Documentation, Inc.

Gibbons B. Alcohol: The legal drug. National Geographic 181(Feb): 2–35, 1992.

Graham AW, Schultz TK. Principles of Addiction Medicine, 3rd ed. Chevy Chase, MD: American Society of Addiction Medicine, 2003
A reference work on all aspects or alcohol and drug use and associated problems and their treatment..

Gutjahr E, Gmel G, Rehm J. Relation between average alcohol consumption and disease: An overview (review). European Addiction Research 7(3): 117–127, 2001. (161 refs.)

Objective: To conduct an overview of alcohol-related health consequences and to estimate relative risk for chronic consequences and attributable fractions for acute consequences. Methods: Identification of alcohol-related consequences was performed by means of reviewing and evaluating large-scale epidemiological studies and reviews on alcohol and health, including epidemiological contributions to major social cost studies. Relative risks and alcohol-attributable fractions were drawn from the international literature and risk estimates were updated, whenever possible, by means of meta-analytical techniques. Results: More than 60 health consequences were identified for which a causal link between alcohol consumption and outcome can be assumed. Conclusions: Future research on alcohol-related health consequences should focus on standardization of exposure measures and take into consideration both average volume of consumption and patterns of drinking. Copyright 2001, S. Karger Publishers

Kerr WC, Greenfield TK, Midanik LT. How many drinks does it take you to feel drunk? Trends and predictors for subjective drunkenness. Addiction 101(10): 1428–1437, 2006. (31 refs.)

Aims: To describe and model the sources of the variation and trends in the meaning of subjective drunkenness. Design: Trend analyses of three cross-sectional surveys. Setting: US general population. Participants: Those who report being drunk in the past year among those in the 1979, 1995 and 2000 National Alcohol Surveys. Measurements Number of drinks reported to feel drunk (dependent variable), past-year alcohol consumption measures, beverage preference, state drunk driving blood alcohol concentration (BAC) limit and demographics. Findings: The mean reported number of drinks to feel drunk declined significantly between each survey and was significantly lower for women. Considerable variation was also found within surveys and was explained partially by available variables. Volume of alcohol and heavy drinking occasions were associated positively with the number of drinks to feel drunk. Higher educational attainment was associated negatively as was being a wine drinker, of older age, of African American ethnicity and of becoming drunk more frequently than once per month. Living in a state with a per se BAC limit of 0.08% was associated negatively in models for men. Conclusions: A substantial shift downward in the meaning of drunkenness occurred in the US between 1979 and 2000. This may be explained partly by the increase in educational attainment, the ageing of the population, the decline in per capita alcohol consumption and changes in alcohol policy towards lower BAC limits for drunk driving along with greater penalties, enforcement and awareness. (Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs)

Lowinson JH, Ruiz P, Millman RB, Langred JG. Substance Abuse: A Comprehensive Textbook, 4th ed. Baltimore, MD: Williams and Wilkins, 2005.

This volume is a reference work on all aspects of alcohol and other drug use.

Meister K, Whelan E, Kava R. The health effects of moderate alcohol intake in humans: An epidemiologic review. Critical Reviews in Clinical Laboratory Sciences 37(3): 261–296, 2000. (193 refs.)

A large body of scientific evidence associates the moderate intake of alcohol with reduced mortality among middle-aged and older people in industrialized societies. This association is due largely to a reduced risk of death from coronary hart disease, which appears to outweigh any possible adverse effects of moderate drinking. The regular consumption of small amounts of alcohol is more healthful than the sporadic consumption of larger amounts. No beneficial effect of moderate drinking on mortality has been demonstrated in young adults (premenopausal women and men who have not reached their forties). It is theoretically possible that moderate drinking in young adulthood might reduce the risk of later heart disease; however, this has not been clearly demonstrated. For some individuals (e.g., those who cannot keep their drinking moderate, pregnant women, and those who are taking medications that may interact adversely with alcoholic beverages), the risks of alcohol consumption, even in moderation, outweigh any potential benefits. Because even small amounts of alcohol can impair judgement and coordination, no one should drink alcoholic beverages, even in moderation, before driving a motor vehicle or performing other activities that involve attention and skill. Copyright 2000, CRC Press, Inc

Moskowitz H, Burns M. Effects of alcohol on driving performance. Alcohol Health and ResearchWorld 14(1): 12–14, 1990. (24 refs.)

Alcohol impairs driving. That fact, established by epidemiological data together with many controlled studies of alcohol and driving skills, is well known and generally accepted. What is less well understood is that impairment of the most important skills can occur at a very low blood alcohol concentration (BAC). The skills involved in driving a motor vehicle include psychomotor skills, vision, perception, tracking (steering), information processing, and attention. Data from laboratory experiments indicate that all of these functions are impaired by alcohol, although they differ in the extent of their impairment at any given BAC. This article discusses recent research on the effects of alcohol on those brain functions involved in driving a motor vehicle. Public Domain.

Parlesak A, Billinger MHU, Bode C, Bode C. Gastric alcohol dehydrogenase activity in man: Influence of gender, age, alcohol consumption and smoking in a Caucasian population. Alcohol and Alcoholism 37(4): 388–393, 2002. (32 refs.)

Gastric alcohol dehydrogenase (ADH) activity was studied in a Caucasian population, with a focus on the effects of gender, age, alcohol consumption and smoking. The research sample included 111 Caucasian subjects, ranging in age from 20 to 80 years, 51 of whom were female. ADH activity was studied in endoscopic gastric biopsy specimens. The following results of the study were seen: (1) highest ADH activity at ethanol concentrations between 150 and 500 mM; (2) higher mean ADH activity in antral specimens than in those from the gastric corpus; (3) decreasing ADH activity with increasing age in males; (4) higher values for ADH activity in females aged 41-60 years than in those aged 20-40 years; (5) association of larger amounts of alcohol with reduced ADH activity in men aged 20-40 years; and (6) decrease in gastric ADH activity with H sub 2-receptor antagonist treatment. It is concluded that ADH activity in the human gastric mucosa is negatively associated with consumption of larger amounts of alcohol. Gastric ADH activity in young men is distinctly higher than that in young women, but the relationship is reversed in middle-aged subjects. Copyright 2002, Medical Council on Alcoholism. Used with permission

Sher L. Alcohol consumption and suicide. QJM: Monthly Journal of the Association of Physicians 99(1): 57–61, 2006. (47 refs.)

About 90% of people in Western countries use alcohol at some time in their lives, and 40% experience temporary or permanent alcohol-related impairment in some area of life as a result of drinking. Multiple sociocultural and environmental factors influence suicide rates, and thus studies conducted in one nation are not always applicable to other nations. Impulsivity and aggression are strongly implicated in suicidal behaviour. Constructs related to aggression and impulsivity confer additional risk for suicidal behaviour in people with alcohol dependence. Lower serotonin activity is tied to increased aggression/impulsivity, which in turn may enhance the probability of suicidal behaviour. Acute alcohol use is associated with suicide. Suicide completers have high rates of positive blood alcohol. Intoxicated people are more likely to attempt suicide using more lethal methods. Alcohol may be important in suicides among individuals with no previous psychiatric history. Alcohol dependence is an important risk factor for suicidal behaviour. Mood disorder is a more powerful risk factor for suicide among problem drinkers as age increases. All individuals with alcohol use disorders should be assessed for suicide, especially at the end of a binge or in the very early phase of withdrawal. Middle-age and older men with alcohol dependence and mood disorders are at particularly high risk. (Copyright 2006, Association of Physicians of Great Britain and Ireland)

Standridge JB, Zylstra RG, Adams SM. Alcohol consumption: An overview of benefits and risk (review). Southern Medical Journal 97(7): 664–672, 2004. (73 refs.)

Published health benefits of regular light-to-moderate alcohol consumption include lower myocardial infarction rates, reduced heart failure rates, reduced risk of ischemic stroke, lower risk for dementia, decreased risk of diabetes and reduced risk of osteoporosis. Numerous complimentary biochemical changes have been identified that explain the beneficial effects of moderate alcohol consumption. Heavy alcohol consumption, however, can negatively affect neurologic, cardiac, gastrointestinal, hematologic, immune, psychiatric and musculoskeletal organ systems. Binge drinking is a significant problem even among moderate drinkers and is associated with particularly high social and economic costs. A cautious approach should be emphasized for those individuals who drink even small amounts of alcohol. Physicians can apply the research evidence describing the known risks and benefits of alcohol consumption when counseling their patients regarding alcohol consumption. (Copyright 2004, Southern Medical Association)

White AM. What happened? Alcohol, memory blackouts, and the brain. Alcohol Research&Health 27(2): 186–196, 2003. (80 refs.)

Alcohol primarily interferes with the ability to form new long-term memories, leaving intact previously established longp-term memories and the ability to keep new information active in memory for brief periods. As the amount of alcohol consumed increases, so does the magnitude of the memory impairments. Large amounts of alcohol, particularly if consumed rapidly, can produce partial (i.e., fragmentary) or complete (i.e., en bloc) blackouts, which are periods of memory loss for events that transpired while a person was drinking. Blackouts are much more common among social drinkers -- including college drinkers -- than was previously assumed, and have been found to encompass events ranging from conversations to intercourse. Mechanisms underlying alcohol-induced memory impairments include disruption of activity in the hippocampus, a brain region that plays a central role in the formation of new auotbiographical memories. (Public Domain)

Whitfield JB. Acute reactions to alcohol (review). Addiction Biology 2(4): 377–386, 1997. (70 refs.)

When the experience of alcohol is unpleasant or there are adverse reactions to small amounts, alcohol consumption is likely to be low and alcohol dependence rare. This is shown by many studies of Asian subjects who experience the alcohol flush reaction (AFR) due to inherited aldehyde dehydrogenase (ALDH) deficiency. Alcohol reactions are less common and on average less severe in non-Asian subjects, but they do occur and can affect alcohol consumption. Information about alcohol reactions and their consequences in Europeans is reviewed , and such reactions are compared with those caused by mitochondrial ALDH deficiency in Asians. Copyright 1997, Carfax, Ltd.

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