mini med delightful poison pub

ALCOHOL

A Delightful Poison?

Director, TEACH Project, Centre for Addiction and Mental HealthDirector, Collaborative Program in Addiction Studies, University of Toronto

Assistant Professor (Status Only) Factor‐Inwentash Faculty of Social Work, U of T

Marilyn Herie PhD, RSW

“Alcohol may be man’s worst enemy, but the bible says love your enemy.”

- Frank Sinatra

"He was a wise man who invented beer." -Plato

1. A feature that resonated for me

2. A question I want to think through

3. A seed I could plant now

Learning Objectives

At the end of this session, you will be able to:1.

Identify the physical effects of alcohol

2.

Define low‐risk drinking and reflect on where your own and others’

drinking fits into Canadian drinking

norms3.

Explain why women and older adults are at higher

risk for alcohol‐related problems4.

Use simple screening tools to detect who might be

at risk for alcohol problems5.

Access credible and evidence‐based online

resources, self‐help and treatment programs.

Addiction: A binary construct?

Addiction: A continuum of severity

No Alcohol Problems

Severe Alcohol Problems

Psychoactive Drug Classes

1) Depressants

2) Opiates/Opioids

3) Stimulants

4) Hallucinogens

5) Psychiatric Medications

Depressants

Opiates/Opioids

methamphetimine.co.uk

Stimulants

Hallucinogens

psychology.wikia.com

Psychiatric Medications

www.camh.ca

What is standard?

http://www2.ku.edu

= 14 grams or .6 oz of pure alcohol

http://wcu.edu

http://www.camh.ca

Women:10 drinks per week

2 drinks per day

Men:15 drinks per week

3 drinks per day

How much do Canadians drink?How much do Canadians drink?

Canadian Men =

________ standard drinks

Canadian women =

________ standard drinks

Turn to the person next to you and tell them

your guess of the percentage of Canadian

men

and Canadian women

who drink more

than 14 standard drinks in a typical week.

Jolinda almost never drinks at home with her family, but occasionally on week ends she gets together with a group of female friends for dinner and conversation. On the rare occasions when she has more than one or two drinks she says that she feels drunk and dizzy. Jolinda is known among her social group as the one who “can’t hold her liquor,” and is sometimes the subject of friendly teasing among the group.

Alex loves to entertain and socialize with friends and family. His dinner parties are legendary for their fine food and wine, and creating new recipes and shopping for hard-to-find ingredients is one of his favourite hobbies. If he were asked to quantify his drinking, Alex wouldn’t know where to start – alcohol is very much a part of his life, yet he has a successful career and a close relationship with his adult children, although his wife sometimes “nags” him about his drinking. Although he drinks a lot on many occasions, his friends have only rarely ever seen him “drunk”.

•Tolerance•Cross‐tolerance•Potentiation

XPOTENTIATION

Absorption and Metabolism

mucous membranes (mouth)

large intestine

esophagus

stomach (up to 20%)

small intestine (up to 80%)

Alcohol is metabolized in the body mainly by the liver. The brain, pancreas, and stomach also metabolize alcohol.

pancreasliver

stomach

esophagus

brain

http://pubs.niaaa.nih.gov/publications/AA72/AA72.htm

http://pubs.niaaa.nih.gov/publications/AA72/AA72.htm

Further broken down to carbon dioxide and water

Other enzymes:cytochrome P450 2E1 (CYP2E1)

catalase

Chemical name for alcohol

Enzyme in the liver transforms ethanol into a toxic compound

A known carcinogen, quickly broken down…

…by another enzyme into…

http://caaneo.ca/about/blog/?page_id=30

.0554

http://caaneo.ca/about/blog/?page_id=30

.0875

Physical Effects of Alcohol

http://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine- opiates-marijuana/section-ii-introduction-to-reward-system/2-reward-pathw

Effects on the Brain

• Limbic system:

complex monitoring system including memory and emotion

• Cerebellum:

motor coordination, also emotion and memory

• Cerebral Cortex:

think, plan, behave intelligently and social interaction –

damage

can impair problem‐solving, memory and learning

Sullivan et al., Neuropsychology

CONTROL ALCOHOL

Effects on the Cerebellum

Reduction in size of brain cells and brain mass shrinks

What are the heart risks of chronic

heavy or binge

drinking?

• Alcoholic cardiomyopathy

• Arrhythmias• Strokes• Hypertension

NIAAA, 2011

Binge drinkers are 40% more likely to suffer any kind of stroke

“There is now little doubt that moderate alcohol consumption is

associated with reduced coronary heart disease risk in both men and women.”

Herie and Skinner, 2010

Moderate drinking can…

• Reduce/inhibit build up of fat in arteries and raise HDL (“good”) cholesterol

• Prevent clotting – guards against stroke and heart attack

• Keep blood pressure in check

Potentially reduced risk of heart disease

Potentially increased risk

of cancer

Smoking + Drinking POTENTIATES cancer- causing properties of each substance


11% of all breast cancers

ACETALDEHYDE damages genetic material in cells, and causes cells to grow too quickly


What are the risks to the

liver of chronic alcohol use?


• Steatosis

(fatty liver)

• Alcoholic hepatitis

• Fibrosis (scar tissue)

• Cirrhosis– Jaundice, Type

2 diabetes, Liver cancer

NIAAA, 2011

90% of heavy drinkers will develop fatty liver

1 in 5 will develop alcoholic hepatitis

1 in 4 will develop cirrhosis

What are the pancreatic

risks of chronic heavy or

binge drinking?


• Acute pancreatitis

• Chronic pancreatitis

–Pancreatic cancer

– Type 2 diabetes

NIAAA, 2011

Approx 5% of heavy drinkers will develop pancreatitis

Alcohol’s Effects on the Immune System

Alcohol suppresses the immune system

Chronic use impairs white blood cell functioning

Impairment up to 24 hours after binge drinking

How can I tell who is at risk?

DSM 5: Proposed Revisions

“Given the empirical evidence, the DSM‐5 Substance Use Disorders

Workgroup

recommends combining abuse and dependence into a single disorder of graded

clinical severity, with two criteria required to make a diagnosis.”

www.dsm5.org

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of

the following within a 12 month period:

1.

Failure to fulfill major obligations at school, work

or home2.

Recurrent use in physically

hazardous situations3.

Persistent

social/interpersonal problems

4.

Tolerance5.

Withdrawal

6.

Larger amounts or for longer period than

intended

7.

Persistent desire or unsuccessful efforts to cut

down/control8.

Time spent in obtaining,

using or recovering9.

Important activities given

up or reduced10.

Continued use despite

knowing that physical or psychological problems will

become worse or were caused

11.

Craving, strong desire or urge

www.dsm5.org

X?

X

X

X

X

?

?

?

X

Three Suggested Screening Tools

1.

Quantity/Frequency2.

CAGE

3.

Single Item

1. Quantity/Frequency Questions

• How many days per week did you drink over the last month?

• On a day when you drink, how many drinks do you have?

• How many times during the last month did you drink more than 5 drinks? (binge

drinking)

Cooney, Zweben & Fleming, 1995

30

4-5

6-7

2. CAGE QUESTIONS1.

Have you ever felt the need to Cut down

on your drinking?

2. Have you ever been Annoyed at criticism

of your drinking?

3. Have you ever felt Guilty about your

drinking?

4. Have you ever had a morning Eye

opener?2 or more “yes” answers is clinically significant.

Mayfield et al., 1974

NO

YES

NO

NO

3. Single Item• A one‐item questionnaire developed for

brief screening in primary care settings. • Ask client:How many times in the past year have you had ___ or more drinks in a day?__ = 5 for men__ = 4 for women

Scoring:

an answer of more than 1 identifies unhealthy alcohol use

National Institute on Alcohol Abuse and Alcoholism (NIAAA): Helping Patients Who Drink Too Much: A Clinician's Guide 2007

6 x 12 = 72

Psychosocial Treatment Resources

ContinuumofPsychosocial TreatmentServices

Pre

vent

ion

Custodial C

are

Levels of Treatment IntensityMinimallyIntensive

HighlyIntensive

Mild toModerate

SubstantialTo Severe

FacilitateRecoverywithout

Treatment

Brief Community

Interventions (e.g.., self-help manuals,physician’s advice)

Short-termOutpatient

Self-ChangeOriented

InterventionsShort-termOutpatientTherapist-Directed

Interventions

ResidentialHospital-Based

Day Treatment

ResidentialSocialModel

ExtendedOutpatient

Interventions

Long-termResidential

Severity of ProblemsCAMH

Client‐Treatment Matching• Lack of strong evidence by which to match clients to specific

treatments• Does not mean that clients all require the same types of services• A variety of flexible and individualized services are required• Guidelines for selecting services are needed

Lo Lo Hi

Lo-Hi Lo-Hi Mod-Hi

Mod-Hi Mod-Hi Mod

Mod-Hi LoMod-Hi

Brief Outpatient

ProblemMultiplicity

Social Support& Stability

Drug UseSeverity

Outpatient

Day Treatment

Residential

Skinner & Martin, 1995

www.connexontario.ca

www.camh.ca

McLaughlin Information Centre

CAMH now has 'centralized access' with one doorway (a front door) to ALL services

1‐800‐463‐6273

or 416‐595‐6111

Call if you would like:• General addiction and mental illness information • Information on how to obtain assessments for

mental health and addictions

What if the person refuses to seek help?

www.alcoholhelpcenter.net

Case Example

• Alex, 52 years old• Drinks 7 days per week• Approximately 40 drinks per week


How does your drinking compare with other Canadian men in your age group?

Within the last twelve (12) months: • You reported drinking on approximately

100.0% of days

in the last year.

• You reported that you drank a total of

? # of drinks

in the last year.


Within the last twelve (12) months: • You reported drinking on approximately

100.0% of days

in the last year.

• You reported that you drank a total of 2080 drinks

in the last year.


This also means that:

• You spent approximately

? $ in the last year, depending on where you drank (at

home, in a bar, etc.).


This also means that: • You spent approximately $10,400

in the last

year, depending on where you drank (at home, in a bar, etc.).


• You consumed (on average) 500 calories

from alcohol on days that you drink. Based on the

total amount of drinking you had enough alcohol to add roughly 59 pounds

or 27

kilograms to your weight in the last year. Note:

One drink has about 100 calories and

3,500 calories roughly equals 1 extra pound of weight.

• You also reported that within the past year, the greatest number of drinks you had on one

occasion was 12 drinks. www.alcoholhelpcenter.net

You reported that you weigh 160 lbs. This means that:

• If your liver is healthy, burning one drink takes you 2 hours. Burning four drinks takes you about 8 hours.

If you had ten drinks, it will take about 19

hours until there is no alcohol in your system.


• In the last year you spent about

? hours under the influence of alcohol

(based on your typical drinking

during one week).


• In the last year you spent about 4,004

hours under the influence of alcohol

(based on your

typical drinking during one week).


Hmm…

1. A feature that resonated for me

2. A question I want to think through

3. A seed I could plant now

Playlist

• La Traviata, Giusseppe

Verdi: The "Drinking Song”• Eric Burdon and War – Spill the Wine• UB 40 – Red Red

Wine

• Frank Sinatra – The Lady is a Tramp• Jimmy Buffett –

Margaritaville

• Garth Brooks – Friends in Low Places • Amy Winehouse

–

Rehab

• Frank Sinatra – One for My Baby (One for The Road)

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