Effects of Drugs and Alcohol

Click here for an on-line BAC Calculator – Courtesy of Intoximeters Inc.

I. OVERVIEW

A. Absorption
Alcohol is primarily absorbed through the stomach and the small intestines. It is considered a food because it has calories, but does not need to be digested and proceeds directly into the body through the digestive system. After ingestion it is carried through the blood stream and crosses the blood–brain barrier, at which time impairment begins. A greater amount of ingestion causes greater impairment to the brain, which, in turn, causes a person to have a greater degree of difficulty in functioning.

B. Metabolism/Elimination
The majority of alcohol in the body is eliminated by the liver. Ninety percent is eliminated through the body, while ten percent is eliminated (unchanged) through sweat and urine. Before the liver can process alcohol, a threshold amount is needed and can occur at the rate of one 12 oz. can of beer, one 5 oz. glass of wine, or 1 1/2 oz. shot of whiskey per hour.

C. Brief Overview
Alcohol is a central nervous system depressant.
Alcohol is among the most abused drugs in our society.
Alcohol can be as potent as many other illegal drugs.
Alcohol can cause severe damage to a developing fetus.
People often do not realize that they are becoming dependent on alcohol.
D. Short-term Effects

Reduces sensitivity to pain.
Affects vision in the following ways: narrows the visual field, reduces resistance to glare, interferes with the ability to differentiate intensities of light, and lessens sensitivity to colors.
E. Long-term Effects

Damage to vital organs; including liver, heart and pancreas.

Linked to several medical conditions; including gastro intestinal problems, malnutrition, high blood pressure, and lower resistance to disease. Also linked to several types of cancer; including esophagus, stomach, liver, pancreas and colon.
F. Special Hazards Involving the Driving Task
Specific elements to the hazards of alcohol use and driving are listed in a separate section of the curriculum. However, alcohol impairs one’s ability to drive or operate machinery safely.

G. Effects with Other Drugs

Alcohol produces a synergistic effect when taken with other central nervous system depressants. These include: sedative hypnotics, barbiturates, minor tranquilizers, narcotics, codeine, methadone, and some analgesics.

Alcohol can be additive in nature when taken with antipsychotic medications, antihistamines, solvents or motion sickness preparations. When used on a daily basis, in conjunction with aspirin, it may cause gastro intestinal bleeding. Also, when used with acetaminophen, an increase in liver damage could occur.

II. BLOOD ALCOHOL CONCENTRATIONS

Alcohol begins to affect individuals prior to reaching the legally intoxicated Blood Alcohol Concentration level of .08%. If a 150 lb. person consumes one drink equal to twelve ounces of beer (5 percent alcohol), five ounces of wine (12 percent alcohol) or one-and-a-half ounces of hard liquor (40 percent alcohol), all would contain about the same amount of alcohol and would raise the person’s Blood Alcohol Concentration about .02%. It takes the liver approximately one hour to oxidize or metabolize one drink.
A. Factors Influencing Blood Alcohol Concentrations

Weight
Gender
Food in Stomach
Duration of Administration
Dosage
B. Tests for Intoxication

Blood Analysis
The methodology of blood analysis measures the amount or percentage of alcohol per 1,000 drops of blood.
Breath Analysis
Measures the blood alcohol content of air in the lungs.
Urinalysis
Detects marijuana, cocaine, PCP, and heroin; and gives the presence of the drug. It does not provide the level of impairment, since legal levels of impairment have not been established.

I. DRUG ABSORPTION/METABOLISM/ELIMINATION

A. Method of Administration
Drugs are administered to or enter the human body in a number of ways, including injection, inhalation, and ingestion. The method of administration impacts on how the drug affects the person. For example: injection takes the drug directly into the blood stream, providing more immediate effects; while ingestion requires the drug to pass through the digestive system, delaying the effects.

B. Factors Affecting Absorption/Metabolism
Factors that affect absorption/metabolism include physical, emotional and drug-related factors.

Physical Factors
Physical factors that affect the absorption or metabolism of a drug include:

a. Person’s weight and age – The amount of physical mass a drug must travel through will have an outcome on the drug’s total effect on the body. Also, the aging process affects the manner in which the drug exerts its effects on the body.

b. Individual biomedical/chemical make-up – Each individual tolerates substances differently. For example: a person’s physical condition as well as hypersensitivity (allergies) or hyposensitivity (need for larger doses to gain the desired effect) will influence the total effect of the drug on the individual.

c. Rate of metabolism – Each drug metabolizes or processes within the body at a different rate. The drug remains active in the body until metabolism occurs. For example: certain medications require dosages to be taken every four, twelve or twenty-four hours, depending on the duration and rate at which the drug is metabolized.

d. Food – Food in the body slows absorption of the drug into the body by not allowing it to pass directly through the digestive process without first being processed by the digestive system. A slower process occurs, since the body is digesting food in addition to the substance or drug utilized by the person.

Emotional Factors
The emotional factors that may influence drug absorption and metabolism within the body are:

a. Emotional state – A person’s specific emotional state or degree of psychological comfort or discomfort will influence how a drug may affect the individual. For example: if a person began using alcohol and was extremely angry or upset, the alcohol could intensify this anger or psychological discomfort. On the other hand, if alcohol was being used as part of a celebration, the psychological state of pleasure could be enhanced by the use of the drug.

b. Anticipation/Expectancy – The degree to which a person believes that a given drug will affect them, may have an effect on their emotional state. If a person truly believes that by using a substance, they will experience a given effect, then their expectations may cause a psychological change in the manner in which the drug affects them.

Drug-Related Factors
The drug-related factors that influence the way drugs are absorbed and metabolized within the body are:

a. Tolerance – Tolerance refers to the amount of a given substance necessary to receive its desired effect.

b. Presence or use of other drugs – The presence or use of other drugs such as prescription, over-the-counter, nicotine, and caffeine also influence the rate of absorption and metabolism of drugs in the body.

c. Method of administration – A drug injected directly into the blood stream will affect an individual at a greater rate, since it will be directly absorbed through the blood stream and presented to various organs. If a drug is snorted or inhaled, the effects may be enhanced, due to the fact that the sinus cavity is located in close proximity to the brain. On the other hand, if a drug is ingested, the effects may be slower due to the fact that they must pass through the digestive system.

d. Physical dependence (addiction) – If a person is physically addicted to a drug, then more of a given substance may be necessary and the effects on the body will differ from those seen in a non-dependent individual.
C. Elimination
Drugs are eliminated from the body primarily through the liver. The liver and kidneys act as a body’s filter to filter out and excrete drugs from the body. The liver metabolizes ninety percent of alcohol in the body, while ten percent is excreted through the lungs and sweat. Also, the liver metabolizes drugs in a fairly consistent manner. For example: alcohol is removed at the rate of one 12 oz. can of beer, one 5 oz. glass of wine, or 1 1/2 oz. shot of whiskey per hour.

II. SPECIFIC EFFECTS ON THE CENTRAL NERVOUS SYSTEM

Drugs affect the various areas of the brain and change normal brain activity. It is important to know what specific functions are located in each of the major brain areas, to better understand the effects of drugs and alcohol on behavior and functioning.

A. Hypothalamus
The hypothalamus regulates homeostasis, the body’s system for keeping itself balanced. This includes: sleep and wake cycles, hunger, thirst, sexual behavior, blood pressure, and temperature. Also, the hypothalamus determines what parts of the body are affected by analgesics and regulates hormonal impulses and emotions.
B. Medulla
The medulla is responsible for head balance, movement, and assisting the hypothalamus in regulating automatic body functions.

C. Cerebral Cortex
The cerebral cortex contains half of the nervous system’s cells, which regulates the speed and vomiting reflexes. It is also responsible for language, abstract thinking, personality, and interpretation of emotion and sensory information, including judgment.

D. Cerebellum
The cerebellum is responsible for coordination of muscles, maintenance of balance, and specific memory and learning system functions that are not to one part of the brain.

III. DRUG CATEGORIES

A. Marijuana
Absorption
Marijuana may be inhaled or ingested.

Metabolism/Elimination
THC (Delta-9-tetrahydrocannabinol) is highly fat-soluble and may take up to three months to be fully eliminated from the body by the liver and kidneys. One joint affects the body for a period of two to four hours.

Brief Overview
Marijuana is the most frequently used illicit drug in America and has been linked to harming a developing fetus. It has the same or similar effects as depressants, stimulants, and hallucinogens. Marijuana cigarettes yield almost four times as much tar as tobacco, creating a higher risk of lung damage.

Short-term Effects
a. Increases in heart rate, body temperature, and appetite.
b. Drowsiness.
c. Dryness of the mouth and throat.
d. Reddening of the eyes and reduction in ocular pressure.

Long-term Effects
a. Can cause the following medical conditions: respiratory problems, lung damage, and cancer.
b. Memory and concentration impairments.
c. Possible motivational syndrome.

Special Hazards Involving the Driving Task
Marijuana has been linked to the impairment of the ability to drive a vehicle. Concentration is affected and there is difficulty in perceiving time and distance, which can lead to the following: bad judgment, impaired reaction time, poor speed control, an inability to accurately read signs, drowsiness, and distraction.

Effects with Other Drugs
When marijuana is combined with alcohol it creates greater impairment in areas such as reaction time and coordination. When combined with sedatives and opiates, it can cause an increase in anxiety and even hallucinations, along with an increase in heart rate and blood pressure when used with amphetamines. On the other hand, effects are somewhat unpredictable when marijuana is combined with stimulants, such as nicotine, caffeine, amphetamines, and cocaine.

B. Cocaine

Absorption
Cocaine enters the body in one of three ways: injection, smoking, or snorting.

Metabolism/Elimination
Cocaine is a strong stimulant to the central nervous system. Its effects can last anywhere from 20 minutes to several hours, depending on the content, purity, administration, and dosage of the drug.

Brief Overview
a. Cocaine users become dependent on the drug.
b. Crack is a form of the drug that is highly addictive.
c. Exposure to the drug can harm a developing fetus.
d. It produces short-lived senses of euphoria, the length depends on how the drug was administered.

Short-term Effects
a. May cause extreme anxiety and restlessness.
b. May experience the following medical conditions: twitches, tremors, spasms, coordination problems, chest pain, nausea, seizures, respiratory arrest, and cardiac arrest.

Long-term Effects
a. May cause extreme alertness, watchfulness, impaired judgment, impulsiveness, and compulsively repeated acts.
b. May cause stuffiness, runny nose, tissue deterioration inside the nose, and perforation of the nasal septum.
Special Hazards Involving the Driving Task
a. Cocaine may successfully mask fatigue, however, high dosages impair judgment and interfere with the ability of the driver to concentrate.
b. Coordination and vision are impaired.
c. There is an increase in impulsive behaviors with tendencies to take more risks and create confusion within the user.

Effects with Other Drugs
a. Additive effects are noted when cocaine is combined with over-the-counter products, such as diet pills or antihistamines.
b. Cocaine taken with psychotropic drugs, especially antidepressants, can be extremely detrimental.
c. A person who has extremely high blood pressure and uses cocaine may suffer from a stroke or heart attack.
d. Some users combine cocaine with alcohol and sedatives to cushion the “crash” or feeling of depression and agitation that sometimes occurs as the effects of cocaine wear off.
e. A person using cocaine maintains the illusion of being alert and stimulated, although physical reactions are impaired.
f. Further research indicates that additive and antagonistic effects can be produced when cocaine is mixed with alcohol.
g. If cocaine is used in high doses, as in the case of overdose, alcohol will probably have an additive effect on the symptoms that eventually contribute to death.
h. When cocaine is injected in combination with heroin, sometimes called “speedballing,” there is an increased risk of toxicity, overdose, and death.

C. Sedative Hypnotics (Barbiturates, Benzodiazepines)

Absorption
Sedative Hypnotics are absorbed through ingestion.

Metabolism/Elimination
Sedative Hypnotics are eliminated by the liver and excreted in urine. Their effect can last anywhere from two to ten hours.

Brief Overview
a. Antianxiety tranquilizers are among the most commonly prescribed drugs in the world.
b. Driving under the influence of tranquilizers is dangerous.
c. A person can become dependent on tranquilizers and depressant drugs, which make them feel calmer, more relaxed, and drowsy.

Short-term Effects
a. Short-term effects can occur with low to moderate use.
b. May experience moderate relief of anxiety and a sense of well-being.
c. There may be temporary memory impairment, confusion, and impaired thinking.
d. A person could be in a stupor, and have altered perception and slurred speech.

Long-term Effects
a. May include over-sedation, decreased motivation, apathy, and lack of interest in surroundings.
b. A person may experience headaches, dizziness, sleep disorders, anxiety, depression, and tremors.
c. There may be an increase in appetite and impairment of thinking, memory, and judgment.

Special Hazards Involving the Driving Task
a. The use of tranquilizers produces drowsiness, incoordination, altered perceptions, memory impairment, poor control of speech, and slower reaction time.
b. Effects on driving include: poor tracking, difficulty in maintaining lane position, and neglecting roadside instructions.
c. When combined with alcohol, the effects may be more hazardous.

Effects with Other Drugs
a. Some people in methadone treatment programs use benzodiazepines to enhance the effects of methadone.
b. When tranquilizers are combined with alcohol or other central nervous system depressants, synergistic effects may be produced, which may be fatal.
c. Alcohol increases the absorption of benzodiazepines, slows their break down in the liver and can cause cardio vascular and respiratory depression.
d. People who take stimulants sometimes take tranquilizers to off set agitation and sleepiness.

D. Opiates (Morphine, Heroin, Codeine, Opium)

Absorption
Opiates are normally absorbed though injection.

Metabolism/Elimination

Opiates are metabolized by the liver and may have a lengthy metabolism due to excessive half-lives of the drugs.

Brief Overview
a. Opiates can cause sedation and euphoria.
b. They are often used to relieve pain, suppress coughs, and control physical conditions such as diarrhea.
c. Respiratory depression and death can occur from overdoses of opiates.
d. Opiates may impair a person’s ability to drive.
e. A person can become physically and psychologically addicted to opiates.

Short-term Effects
a. Include drowsiness, dizziness, mental confusion, constriction of pupils, and euphoria.
b. Some opiate drugs, such as Codeine, Demerol, and Darvon, also have stimulating effects.
c. Stimulating effects include: central nervous system excitation, increased blood, elevated blood pressure, increased heart rate, tremors, and seizures.

Long-term Effects
a. May include impaired vision, pulmonary complications, and menstrual irregularity.
b. A person may experience nightmares, hallucinations, and mood swings.

Special Hazards Involving the Driving Task
a. Opiates can cause drowsiness, mental confusion, and visual impairment even at lower, moderate doses.
b. A driver may have difficulty keeping the vehicle in the correct lane and may make errors in judgment.

Effects with Other Drugs
a. Alcohol greatly increases the present effects of opiates and can lead to respiratory arrest.
b. A person injecting heroin mixed with cocaine or methamphetamines, known as “speedballing,” produces a stimulant effect.
c. The listed drug combinations increase the risk of toxicity, overdose, and death.

E. Amphetamines

Absorption
Amphetamines are absorbed by the body in one of three ways: snorting, swallowing, or injection.

Metabolism/Elimination
Amphetamines are eliminated through the liver.

Brief Overview
a. Amphetamines have a strong central nervous system stimulant which can increase alertness and induce a sense of well-being.
b. If used while driving, amphetamines are dangerous.
c. The use of amphetamines reduces a person’s resistance to disease.

Short-term Effects
a. A person may experience a loss of appetite, increased alertness, and a feeling of well-being.
b. A person’s physical condition may be altered by an increase in breathing and heart rate, elevation in blood pressure, and dilation of pupils.

Long-term Effects
a. Anxiety and agitation.
b. Sleeplessness.
c. Higher blood pressure and irregular heart beat.
d. Increased susceptibility to disease.

Special Hazards Involving the Driving Task
The use of amphetamines can interfere with concentration, impair vision, and increase the driver’s tendencies to take risks.

Effects with Other Drugs
a. Amphetamines should never be taken with a class of antidepressants known as MAO inhibitors, because of potential hypertensive crisis.
b. Amphetamine users sometimes use marijuana and depressant drugs in order to avoid the adverse side effects of the “crash,” therefore creating multiple drug dependencies.

F. Poly-drug Use
(Poly-drug use is where the use of more than one substance normally causes one of three reactions: additive, synergistic, or antagonistic.

Additive Effects
Additive effects occur when drug combinations produce an effect that is like simple addition, such as the equation: 1 + 1 = 2.

Synergistic Effects
Synergistic effects occur when drug combinations produce an effect that is greater than the sum of the effects of the two drugs, such as the equation: 1 + 1 = 3.

Antagonistic Effects
Antagonistic effects occur when a drug combination produces an effect that is less than the sum of the effects of the drugs acting alone, such as the equation: 1 + 1 = 1 or 1 + 1 = 0.

I. IMPACT OF DRUG USE ON DRIVING

A. Necessary Driving Skills
Several skills necessary for driving include: vision, reaction time, judgment, hearing, and simultaneous task processing/accomplishment.

Driving skills can be divided into cognitive skills, such as information processing, and psycho motor skills.

B. Drug Impact on Driving Skills

Impairment is related to alcohol, in terms of its concentration in the blood stream.

The brain’s control of eye movements is highly vulnerable to alcohol. It only takes low to moderate blood alcohol concentrations (.03 to .05%) to interfere with voluntary eye movements and impair the eyes’ ability to rapidly track a moving target.

Steering an automobile is adversely affected by alcohol, as alcohol affects eye-to-hand reaction times, which are superimposed upon the visual effects. Significant impairment and deterioration of steering ability begin at approximately .03 to .04% Blood Alcohol Concentrations and continue to deteriorate as Blood Alcohol Concentration rises.

Almost every aspect of the brain’s information-processing ability is impaired by alcohol. Alcohol-impaired drivers require more time to read street signs or respond to traffic signals than unimpaired drivers. Research on the effects of alcohol on the performance of automobile and aircraft operators shows a narrowing of the attention field beginning at .04% blood alcohol concentration.

C. Dividing Attention Among Component Skills

Most sensitive aspect of the driving performance.

Component skills involve maintaining the vehicle in the proper lane and direction (tracking task), while monitoring the environment for vital safety information, i.e. other vehicles, traffic signs, and pedestrians.

Alcohol-impaired drivers who are required to divide their attention between two tasks tend to favor just one task. Often times the favored task is concentrating on steering while becoming less vigilant with respect to other safety information.

Numerous studies indicate that divided attention deficits occur as low as .02% Blood Alcohol Concentration.

Four conclusions can be drawn from results of epidemiologic and experimental studies.
a. The degree of impairment depends on the complexity of the task involved as well as the Blood Alcohol Concentration.
b. The magnitude of alcohol-induced impairment rises as the Blood Alcohol level increases and dissipates as the alcohol is eliminated from the body.
c. At a given time and Blood Alcohol Concentration, some skills are more impaired than others.
d. There is no evidence of an absolute BAC threshold below which there is no impairment of any kind. Therefore, certain skills important to the driving task are impaired at .01 to .02% blood alcohol level the lowest levels that can be reliably measured by the commonly used devices.

II. THE DUI ARREST AS A WARNING SIGN

A. The Court Reporting Network (CRN)
CRN is the Pennsylvania Alcohol Highway Safety Program’s Court Reporting Network.
Helps provide a coordinated and integrated systems approach to the alcohol highway safety problem and resultant driving under the influence counter-measures in the Commonwealth of Pennsylvania.
Purpose of CRN is to provide a computer-assisted information system that links the county DUI programs into a comprehensive statewide network and assists local coordinators in planning, implementing, and monitoring their programs.

(See CRN Flow Chart)
B. Three Problem Levels of Alcohol Users – CRN divides alcohol users into one of three problem levels.

Level I – Non-problem, Social Drinker
a. Client has not been identified as having a problem with alcohol, based on all available criteria.
b. Individual will receive a recommendation for Alcohol Highway Safety School.

Level II – Presumptive Problem Drinker
a. Client appears to be experiencing some degree of life problems due to alcohol.
b. Individual will often receive a recommendation for Alcohol Highway Safety School and outpatient counseling.

Level III – Highly Presumptive Problem Drinker
a. Client has been identified as experiencing serious life problems due to their abuse of alcohol, based on available criteria.
b. Individual will often receive a recommendation for Alcohol Highway Safety School and outpatient treatment.

CRN data indicates that 80% of all arrests for driving under the influence of alcohol place the individual in either Level II or Level III; hence, the DUI arrest may be part of a more total inclusive alcohol problem.

The DUI Educational Program should serve as a mechanism by which the person can evaluate his or her problem and hope to identify the need for further counseling.

III. THEORIES ABOUT ADDICTION/DEPENDENCE

A. Definition of Addiction
Physiological and/or psychological dependence on a drug. The overpowering physical or emotional urge to repeatedly do something that is uncontrollable by the individual and is accompanied by a tolerance for the drug, with withdrawal symptoms if the drug is stopped.
B. Causes of Addiction – There are many different approaches to looking at addiction.

Disease concept refers to alcohol and chemical dependency as a disease.

Genetics have been shown to play a predisposition factor. Essentially, in families where chemical dependency appears to be prevalent and multi-generational, some members may be more susceptible to becoming chemically dependent.

Environmental factors and what people are exposed to within their environment play a critical role in addiction.

Cultural influences and the belief systems which evolve around the use and abuse of drugs are factors which contribute to addiction.
C. Stages Of Addiction - Addiction develops in a predictable series of stages.

Early Stage Addiction
a. Characterized by an increase in tolerance and dependence.
b. People who are becoming addicted can use larger and larger quantities without becoming intoxicated or suffering harmful consequences.
c. As the body cells change to tolerate larger quantities of the chemical, even larger quantities are needed to achieve the same effect.
d. Difficult to distinguish addictive use from heavy non-addictive use because there are few outward symptoms.
e. Alcohol or drugs are used so frequently that the person comes to depend on them.
f. Use begins to seem normal; life without use begins to seem abnormal.

Middle Stage Addiction
a. Marked by a progressive loss of control.
b. It takes more alcohol or drugs to get high.
c. Increased quantities damage the liver, alter brain chemistry, and eventually, tolerance begins to decrease.
d. The drug is used to relieve the pain created by not using.
e. Physical, psychological, and social problems develop.

Chronic Stage Addiction
a. Marked by physical, psychological, behavioral, social, and spiritual deterioration.
b. All systems of the body can be affected.
c. Mood swings are common as the person uses the drug to feel better, but cannot maintain the good feelings.
d. There is less and less control over behavior.
e. Relationships are damaged.
f. The person loses touch with a higher power and with a sense of purpose and meaning in life.
g. Life is consumed with the need to use.
D. Addiction Terminology

Tolerance - Physical tolerance is the body’s ability to adapt to the usual effects of a drug so that an increased dosage is needed to achieve the same effect as before. Tolerance begins to occur in the early stage of addiction.

Cross-Tolerance - Among certain related drugs (narcotics), tolerance built up to the effects of one drug will carry over to another drug.

Enabling Behavior – In the area of chemical abuse, behaviors of one person which encourage another’s chemical abuse are known as enabling behaviors. These behaviors may be conscious or unconscious, intentional or unintentional. An example would be someone who downplays or denies the problems a friend is having with drugs.

Withdrawal – This is the result of discontinuing the intake of a drug after developing physical dependence. With alcohol this may cause such reactions as mild disorientation, hallucinations, shaking, and convulsions.

IV. PATTERNS OF ALCOHOL USE

A. Alcohol Abuse
Refers to patterns of problem drinking that have resulted in detrimental effects on both social and health problems.

Alcohol can have negative effects on the social well-being and physical health of the problem drinker.
B. Alcohol Dependence

Often referred to as Alcoholism.

Refers to a disease characterized by compulsive alcohol-seeking behavior that leads to the inability to control drinking.
C. Differences between Abuse and Dependence

Alcohol dependency and alcohol abusers experience many of the same harmful effects of drinking.

Critical difference is the physical dependence displayed by alcoholics and their lack of ability to regulate their consumption of alcohol.

Alcoholics will continue to drink in spite of severe negative consequences of their drinking.
D. Warning Signs of Problem Drinking

Frequently drinking to state of intoxication.
Using alcohol to seek relief from problems and cope with stress.
Engaging in antisocial behavior during and after drinking.
Going to work intoxicated or decline in job performance.
Experiencing family or economic problems.
Driving a car under the influence of alcohol.
Sustaining injuries as a result of intoxication.
Seeking out places where alcohol is available and avoiding places where it is not.

V. ALCOHOLISM

A. Definition of Alcoholism
The National Council on Alcoholism and Drug Dependence (1990) defines alcoholism as:

ALCOHOLISM is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking–most notably denial.
1) Terms in the Definition of Alcohol Dependency

a. Primary
i. Refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it.
ii. Suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.

b. Disease
i. Means an involuntary disability.
ii. Represents the sum of the abnormal phenomena displayed by a group of individuals.
iii. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.

c. Often Progressive and Fatal
i. Means the disease persists over time and that physical, emotional and social changes are often cumulative and may progress as drinking continues.
ii. Causes premature death through overdose, organic complications involving the brain, liver, heart, and many other organs.
iii. Contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

d. Impaired Control
Means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.

e. Preoccupation
i. Refers to excessive focused attention given to the drug alcohol, its effects, and/or its use.
ii. The relative value thus assigned to alcohol by an individual often leads to a diversion of energies away from important life concerns.

f. Adverse Consequences
i. Refers to alcohol-related problems or impairments.
ii. Physical health problems, i.e. alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders.
iii. Psychological functioning problems, i.e. impairments in cognition, changes in mood and behavior.
iv. Interpersonal functioning problems, i.e. marital problems, child abuse and impaired social relationships.
v. Occupational functioning problems, i.e. scholastic or job problems.
vi. Legal, financial, or spiritual problems.

g. Denial
Refers to a defense mechanism reducing the significance of events, but more broadly includes a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual’s problems rather than a solution. It becomes an integral part of the disease and a major obstacle to recovery. Examples of denial:

i. “I only drink on weekends.” (minimizing)
ii. “You’d drink too if you had my job.” (blaming)
iii. “Everyone drinks and drives.” (generalizing)

h. Progression of the Disease
An addiction develops and can be classified into the following three distinct stages:

i. Early Stage – Early problems are not observed or clearly linked to addiction.
ii. Middle Stage – problems are identified or observed but not yet associated with the use of alcohol.
iii. Late or Chronic Stage – the disease makes it difficult, if not impossible,to think or observe in a rational manner.

B. Symptoms Of Addiction
The behavioral symptoms of alcoholism, discussed previously, which manifest themselves within the three (3) stages of addiction will not be present for every individual at the same time period. The following is an overview of the symptoms within each major stage of addiction.

The Disease Concept Chart

The disease concept chart, on the following page, indicates the progressive nature of the chemical dependency through the early, middle, and late/chronic stages of addiction.

Recovery
a. Refers to a continuous lifelong process.
b. Critical to know where to find resources to help in the identification and treatment of abusive use of alcohol and/or other drugs.

Symptoms of Alcohol Dependency

The following symptoms mark the three stages of alcoholism, but not all are seen in every individual. These stages are intended only as guidelines, since every individual may experience some or all of these symptoms at different times in their alcoholism.
a. Early Stage
i. Sneaking drinks.
ii. Gulping drinks.
iii. Preoccupation with drinking.
iv. Personality changes when drinking.
v. Drinking to the point of drunkenness.
vi. Guilt feelings about drinking.
vii. Missing responsibilities of work and school due to hangovers.
viii. Seeking companions who are heavy drinkers.
ix. Blackouts.
x. Increased tolerance to alcohol.
xi. Changing forms of alcohol (i.e. vodka to beer).
xii. Spouse complaining of drinking.
xiii. Losing interest in activities not directly associated with drinking.
b. Middle Stage
i. Drinking more than intended (loss of control).
ii. Protecting the supply of alcohol.
iii. Drinking to relieve anger, tension, insomnia, fatigue depression, social discomfort.
iv. Increased incidence of infections and colds.
v. Benders.
vi. Morning drinking.
vii. Drinking despite strong social reasons not to, such as marital and family disruptions, arrests for drunk driving, etc.
viii. Repeated attempts at abstinence.
ix. Paranoid attitude.
x. Projection, resentments, and denial become more severe.

c. Late Stage
i. Alcoholic hepatitis.
ii. Cirrhosis (enlargement of the liver).
iii. Lowering of personal standards.
iv. Tremors when sober.
v. Lowering of tolerance to alcohol.
vi. Blatant and indiscriminate use of alcohol.
vii. Choice of work situations which facilitate drinking.
viii. Brain damage.
ix. Alcoholic seizures.
x. Delirium tremens.
xi. Alcoholic hallucinations.
xii. Fears of “going crazy”.
xiii. Depression, isolation, and suicidal preoccupation.

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