Chapter 9: Drinking Alcohol Responsibly and Ending Tobacco Use – Study Notes

Alcohol: An Overview

General Patterns and Health Implications

Alcohol is widely consumed in the United States, with varying patterns among different demographic groups. Understanding its effects and responsible use is essential for personal health.

• Low levels of alcohol, especially red wine, may lower certain health risks in older adults.

• Prevalence: 85.6% of Americans have tried alcohol; just over half drink regularly, and about 20% abstain.

• Gender differences: Men typically drink more regularly and in greater quantities than women.

The Chemistry and Potency of Alcohol

Key Terms and Processes

Alcoholic beverages contain ethyl alcohol (ethanol), an addictive drug produced by fermentation. The potency and effects of alcohol depend on its chemical composition and concentration.

• Fermentation: Yeast breaks down plant sugars to yield ethanol.

• Distillation: Alcohol vapors are condensed and mixed with water to produce hard liquor.

• Proof: Indicates alcohol content; proof is double the percentage of alcohol (e.g., 80 proof = 40% alcohol).

Standard Drink Equivalents

Standard Drink Equivalent (& % alcohol)	Approximate Number of Standard Drinks in:
Beer = 12 oz (≈5% alcohol)	12 oz = 1; 16 oz = 1.3; 22 oz = 2
Malt liquor = 8.5 oz (≈7% alcohol)	12 oz = 1.5; 16 oz = 2; 22 oz = 2.5; 40 oz = 4.5
Table wine = 5 oz (≈12% alcohol)	750 mL (25-oz) bottle = 5
80 proof spirits (gin, vodka, etc.) = 1.5 oz (≈40% alcohol)	Mixed drink = 1 or more; Pint (16 oz) = 11; Fifth (25 oz) = 17; 1.75L (59 oz) = 39

Absorption and Metabolism of Alcohol

Physiological Processes

Alcohol absorption and metabolism are influenced by several factors, affecting its impact on the body.

• About 20% of alcohol absorption occurs in the stomach; 80% in the small intestine.

• Influencing factors: Concentration and type of drink, amount consumed, food in stomach, metabolism, mood, weight/body mass index.

• Alcohol provides 7 calories per gram.

• Breakdown rate: About 0.5 ounce per hour (≈1 standard drink).

• Unmetabolized alcohol circulates in the bloodstream until metabolized.

Blood Alcohol Concentration (BAC)

Definition and Measurement

BAC is the ratio of alcohol to total blood volume and is used to determine intoxication levels.

• Legal limit for BAC: 0.08% in all states.

• Measurement methods: Breathalyzer, urinalysis, and blood tests (most accurate).

• Learned behavioral tolerance: Individuals may appear sober despite high BAC due to behavioral adaptation.

Factors Affecting BAC

• Weight and body fat

• Water content in body tissues

• Alcohol concentration in beverage

• Women generally have more body fat and half as much alcohol dehydrogenase as men, leading to higher BACs.

Psychological and Physical Effects by BAC Level

BAC	Psychological and Physical Effects
<0.01%	Negligible
0.01–0.04%	Slight muscle relaxation, mild euphoria, increased sociability
0.05–0.07%	Lowered alertness, impaired judgment, exaggerated behavior
0.08–0.14%	Slowed reaction time, poor muscle coordination, short-term memory loss
0.15–0.24%	Blurred vision, lack of motor skills, sedation, difficulty standing/walking
0.25–0.34%	Impaired consciousness, disorientation, possible death
0.35% and up	Unconsciousness, coma, death

Alcohol and Your Health

Short-Term Effects

• Depresses central nervous system (CNS) functions.

• Vital functions affected; extreme cases may result in coma or death.

• Diuretic effect leads to dehydration and “morning-after” headaches.

• Irritates gastrointestinal system.

• High amounts increase risk for irregular heartbeat.

• Congeners: Toxic forms of alcohol that contribute to hangovers.

• Associated with fatal injuries, dating violence, and increased vulnerability to sexual assault (especially in women).

Alcohol Poisoning

• Acute alcohol intoxication can be fatal.

• Unconsciousness may occur at doses close to fatal levels.

• BAC continues to rise after unconsciousness.

• Signs: Inability to be roused, weak/rapid pulse, cool/pale/blue skin.

• Immediate medical attention (call 9-1-1) is required.

Drinking and Driving

• Alcohol-impaired drivers are involved in about 28% of traffic deaths (≈10,500 deaths/year).

• Risk remains substantial despite preventative measures.

• Fatal crash rates have decreased over the past 20 years for all age groups.

Long-Term Effects of Alcohol

Chronic Health Impacts

• Nervous system damage

• Weight gain

• Cardiovascular effects

• Liver disease (e.g., cirrhosis)

• Cancer (various types)

• Other effects: Chronic pancreatitis, blocked calcium absorption, reduced immune function

Comparison of Healthy and Cirrhotic Liver

Healthy Liver	Cirrhotic Liver
Normal, smooth texture	Irregular, nodular, scarred appearance

Alcohol and Pregnancy

Risks and Fetal Alcohol Syndrome (FAS)

Alcohol is a teratogenic substance, meaning it can cause birth defects. Fetal Alcohol Syndrome (FAS) is a severe consequence of prenatal alcohol exposure.

• One in five children exposed to alcohol in utero.

• FAS symptoms: Mental retardation, small head, tremors, impulsive behaviors, reduced attention span, facial/limb/heart/brain abnormalities.

• FAS is the third most common birth defect in the U.S.

Alcohol Use in College

Patterns and Consequences

• 53% of students consumed alcohol in the past 30 days.

• 33% engage in binge drinking (5+ drinks for men, 4+ for women in 2 hours).

• Alcohol use disrupts sleep, decreases alertness, and may impair academic performance.

Negative Consequences of Drinking

• Increased risk for suicide, automobile crashes, and falls.

• Peer influence and advertising contribute to high-risk drinking behaviors.

• Common negative outcomes: Forgetting actions, regretted behaviors, unprotected sex, physical injury.

Efforts to Reduce Student Drinking

• BASICS: Brief Alcohol Screening and Intervention for College Students is effective for high-risk students.

• E-interventions: Use of digital tools (texts, emails, podcasts) and web programs (e.g., e-Chug) to reduce alcohol problems.

Abuse and Dependence

Definitions and Identification

• Alcohol abuse: Interferes with work, school, relationships, or involves legal violations.

• Alcoholism (dependence): Severe use resulting in withdrawal symptoms when stopping.

• Identifying an alcoholic: Craving, loss of control, tolerance, psychological dependence, withdrawal symptoms.

• 15% of Americans are problem drinkers; functional alcoholics may maintain jobs and families.

Causes of Alcohol Use Disorder

• Biological/family factors: Higher rates among children of alcoholics; no single gene identified.

• Social/cultural factors: Family attitudes and cultural context influence risk.

Alcohol Use Disorder in Women

• Women become alcoholic at later ages and after fewer years of heavy drinking.

• Women get addicted faster and have greater risks for cirrhosis, memory loss, heart disease, and certain cancers.

• Risk factors: Unmarried but living with a partner, partner who drinks heavily, family history, depression, stress.

Additional info:

• Further details on treatment, relapse prevention, and societal costs are covered in the full chapter.