If it came in pill form, it would be called a tranquilizer. It would be available by prescription only. The prescription bottle would bear warning labels: "Causes drowsiness--do not take this drug while operating machinery." "Do not use this drug if you are pregnant." Since it effects every system in the body, it would be inadvisable to consume if you have any health concerns, especially diabetes, liver, or heart disease. You would be given only a small supply at a time. You would be cautioned to watch for potentially serious side effects, and advised to discontinue its use if you experienced any. Your dosage would be carefully monitored, and you would be watched for signs of abuse or addiction.

Instead, this drug, a central nervous system (CNS) depressant, is freely available, self-administered, and widely abused, regardless of potentially deadly short and long-term effects. It is addictive. It carries no warning labels, and its manufacturers spend millions yearly to promote its use.

What is it?

Alcohol...C₂H₅OH, ethanol, booze,
liquid courage, social lubricant...

rev12/96

What are the effects of alcohol?

The effects of alcohol are related to dose, rate of intake, body size and percentage of body fluid, expectations, social environment, physical conditions (disease or more common hormonal cycles or sleepiness can be factors), enzyme differences, concentration of alcohol in a drink and whether carbonated mixes were used.

Most individuals can tolerate one standard drink per hour with no significant impairment.

Calculation of Estimated Blood Alcohol Level (BAL)

Body Weight: Calculations are for people with a normal body for their height, free of drugs or other affecting medication and neither unusually thin nor obese.

Drink Equivalents
1 DRINK = 1.25 oz rum, rye, scotch, brandy, gin, vodka, etc.

= 1 12-oz bottle of domestic beer

= 3.5 oz fortified wine

= 5.5 oz unfortified/table wine

**Drink Equivalents**
1 DRINK =	1.25 oz rum, rye, scotch, brandy, gin, vodka, etc.
=	1 12-oz bottle of domestic beer
=	3.5 oz fortified wine
=	5.5 oz unfortified/table wine

Using the chart: Find the appropriate figure using the proper chart (male or female), body weight and number of drinks consumed. Then subtract the time factor (see Time Factor Table below) from the figure on the chart to obtain the approximate BAL. For example, for a 125-lb. woman who has had 4 drinks in two hours, take the figure .162 (from the chart for males) and subtract .030 (from the Time Factor Table) to obtain a BAL of .132%.

Time Factor Table
Hours since first drink 1 2 3 4 5 6

Subtract from BAL .015 .030 .045 .060 .075 .090

Time Factor Table
Hours since first drink	1	2	3	4	5	6
Subtract from BAL	.015	.030	.045	.060	.075	.090

MALES
Number of drinks
Body Weight 1 2 3 4 5 6 7 8 9 10

100 .043 .087 .130 .174 .217 .261 .304 .348 .391 .435

125 .034 .069 .103 .139 .173 .209 .242 .278 .312 .346

150 .029 .058 .087 .116 .145 .174 .203 .232 .261 .290

175 .025 .050 .075 .100 .125 .150 .175 .200 .225 .250

200 .022 .043 .065 .087 .108 .130 .152 .174 .195 .217

225 .019 .039 .058 .078 .097 .117 .136 .156 .175 .195

250 .017 .035 .052 .070 .087 .105 .122 .139 .156 .173

MALES
Number of drinks
Body Weight	1	2	3	4	5	6	7	8	9	10
100	.043	.087	.130	.174	.217	.261	.304	.348	.391	.435
125	.034	.069	.103	.139	.173	.209	.242	.278	.312	.346
150	.029	.058	.087	.116	.145	.174	.203	.232	.261	.290
175	.025	.050	.075	.100	.125	.150	.175	.200	.225	.250
200	.022	.043	.065	.087	.108	.130	.152	.174	.195	.217
225	.019	.039	.058	.078	.097	.117	.136	.156	.175	.195
250	.017	.035	.052	.070	.087	.105	.122	.139	.156	.173

FEMALES
Number of Drinks
Body Weight 1 2 3 4 5 6 7 8 9 10

100 .050 .101 .152 .203 .253 .304 .355 .406 .456 .507

125 .040 .080 .120 .162 .202 .244 .282 .324 .364 .404

150 .034 .068 .101 .135 .169 .203 .237 .271 .304 .338

175 .029 .058 .087 .117 .146 .175 .204 .233 .262 .292

200 .026 .050 .076 .101 .126 .152 .177 .203 .227 .253

225 .022 .045 .068 .091 .113 .136 .159 .182 .204 .227

250 .020 .041 .061 .082 .101 .122 .142 .162 .182 .202

FEMALES
Number of Drinks
Body Weight	1	2	3	4	5	6	7	8	9	10
100	.050	.101	.152	.203	.253	.304	.355	.406	.456	.507
125	.040	.080	.120	.162	.202	.244	.282	.324	.364	.404
150	.034	.068	.101	.135	.169	.203	.237	.271	.304	.338
175	.029	.058	.087	.117	.146	.175	.204	.233	.262	.292
200	.026	.050	.076	.101	.126	.152	.177	.203	.227	.253
225	.022	.045	.068	.091	.113	.136	.159	.182	.204	.227
250	.020	.041	.061	.082	.101	.122	.142	.162	.182	.202

Alcohol first affects the most complex area (the frontal lobe) of the brain. This area controls higher functions of the brain such as judgment and social inhibitions (survival skills for group functioning). These complex functions are more sensitive to alcohol than the brain stem functions of respiration or heart rate. Therefore judgment and self control are the first abilities to be suppressed by alcohol. The following chart illustrates the effects of varying blood alcohol level (BAL).

Blood Alcohol Level Alcohol's Effects on Thinking, Feeling, and Behavior

.02-.04 Few obvious effects; slight intensification of existing moods; some impairment of judgment or memory.

.05-.06 Feeling of warmth, relaxation, mild sedation, exaggeration of emotion and behavior; slight increase in reaction time, impaired judgment about continued drinking; visual and hearing acuity reduced; slight speech impairment; minor disturbance of balance.

.07-.09 More noticeable speech impairment and disturbance of balance; impaired coordination; feeling of elation or depression; definite impairment of judgment and memory; major increase in reaction time; may not recognize impairment. Legally intoxicated at .08 BAL.

.10-.13 Noticeable disturbance of balance; uncoordinated behavior; major increase in reaction time; increased impairment of judgement and memory.

.14-.17 Major impairment of all physical and mental functions; difficulty in standing, talking; distorted perception and judgment; cannot recognize impairment.

20-.25 Confused or dazed; major body movements cannot be made without assistance.

.30-.35 Minimal perception and comprehension; general suspension of cognitive abilities.

.40 Unconscious/coma.

.41+ Deep coma/death.

Blood Alcohol Level	Alcohol's Effects on Thinking, Feeling, and Behavior
.02-.04	Few obvious effects; slight intensification of existing moods; some impairment of judgment or memory.
.05-.06	Feeling of warmth, relaxation, mild sedation, exaggeration of emotion and behavior; slight increase in reaction time, impaired judgment about continued drinking; visual and hearing acuity reduced; slight speech impairment; minor disturbance of balance.
.07-.09	More noticeable speech impairment and disturbance of balance; impaired coordination; feeling of elation or depression; definite impairment of judgment and memory; major increase in reaction time; may not recognize impairment. Legally intoxicated at .08 BAL.
.10-.13	Noticeable disturbance of balance; uncoordinated behavior; major increase in reaction time; increased impairment of judgement and memory.
.14-.17	Major impairment of all physical and mental functions; difficulty in standing, talking; distorted perception and judgment; cannot recognize impairment.

20-.25	Confused or dazed; major body movements cannot be made without assistance.
.30-.35	Minimal perception and comprehension; general suspension of cognitive abilities.
.40	Unconscious/coma.
.41+	Deep coma/death.

Tolerance may play a part in the effects of alcohol and the above functions; however, tolerance is an indication of the body's adjustment to regular drinking and is a warning sign of alcohol abuse.

EFFECTS OF SHORT-TERM ALCOHOL ABUSE

Specific body functions and body parts can be influenced directly or indirectly by alcohol. Short-term effects include:

Sensation and Perception

decreases in both visual and hearing acuity
altered sensitivity to odors and taste
reduced sensitivity to pain
altered sense of time: time appears to pass more rapidly
underestimation of speed of moving objects

Emotions

decreased fear/anxiety
increased risk-taking behaviors
increased likelihood of aggressive humor
reduced inhibitions

Sleep

sleep disturbance and tiredness upon awakening

Body Organs

increased urinary output due to the diuretic effect of alcohol on the pituitary hormones
temporary increase in heart rate and blood pressure; with higher dosages, decreased heart rate
dilated peripheral blood vessels in arms and legs. This blood vessel expansion leads to loss of body heat, while producing a feeling of added warmth. Hyperthermia can occur in cool water as well as cool air. (Starting at 50^oF)
constricted arteries supplying the heart, decreasing the supply of oxygen to the cells which may contribute to arrhythmia

Motor Skills

impaired performance, although individual susceptibility varies at Blood Alcohol Level (BAL) of 10% or below
decreased balance
interference with coordination, as in tracing a moving object
slowed reaction time

Hangover

temporary, acute physical and psychological distress following excessive consumption. Nausea, abdominal pain, fatigue, headache, and anxiety are reminders of disrupted body functions that could not be felt while intoxicated. A hangover is the body's reaction to excessive drinking.

Sexuality

small doses may facilitate sexual activity by overcoming inhibitions. But while alcohol may provoke desire, even moderate amounts spoil the capacity to perform and respond.
decreased levels of testosterone have been measured in young males after as few as 4-12 ounce beers.

Effects of Alcohol on Sexuality
Women Men Women & Men

Small Dose Increased enjoyment of foreplay; feelings of warmth; increased quality of orgasm Increased arousal; control of premature ejaculation lost Release of inhibitions; increased aggression; increased desire

Moderate Dose Fewer or no orgasms; decreased quality of orgasms Increased time needed for erection to form; difficulty maintaining erection; uncertain orgasm; decreased penile rigidity Longer foreplay

Large Dose No orgasms; lethargy; no lubrication Erectile impotence, ejaculatory impotence; thoughtlessness; unpleasant or painful ejaculation; aggressiveness

Alcoholism Loss of menstruation; frigidity; infertility Loss of sexual satisfaction; erectile impotence; decreased testosterone; infertility; breast development; decreased body hair; shriveled testicles Loss of sex drive

**Effects of Alcohol on Sexuality**
	Women	Men	Women & Men
Small Dose	Increased enjoyment of foreplay; feelings of warmth; increased quality of orgasm	Increased arousal; control of premature ejaculation lost	Release of inhibitions; increased aggression; increased desire
Moderate Dose	Fewer or no orgasms; decreased quality of orgasms	Increased time needed for erection to form; difficulty maintaining erection; uncertain orgasm; decreased penile rigidity	Longer foreplay
Large Dose	No orgasms; lethargy; no lubrication	Erectile impotence, ejaculatory impotence; thoughtlessness; unpleasant or painful ejaculation; aggressiveness
Alcoholism	Loss of menstruation; frigidity; infertility	Loss of sexual satisfaction; erectile impotence; decreased testosterone; infertility; breast development; decreased body hair; shriveled testicles	Loss of sex drive

Synergism

Perhaps the most dangerous alcohol/drug interaction is related to synergism, in which the combined effect of two drugs taken together is greater than the sum of the effects of the two drugs alone. Mix alcohol, a CNS depressant, with another CNS depressant, and the pharmacologic effect on the body is multiplied or exaggerated. Sometimes the result is drowsiness and difficulty in walking, talking, driving, and thinking. Breathing and heart rate can be depressed to dangerous levels. Some combinations of alcohol with barbiturates, tranquilizers, and prescription painkillers can be fatal.

DOUBLE TROUBLE: MIXING DRINKS WITH OTHER DRUGS

Drug interaction is the phenomenon that occurs when one or more drugs present in the body alter the actions or effects of another drug present in the body at the same time. Some of the interactions may be minor and some disastrous. The consequence of the interaction is the important thing to remember.

Alcohol is primarily a central nervous system depressant. When combined with other drugs with similar depression action on the central nervous system, an additive or synergistic effect occurs. This is the most important type of interaction between alcohol and other drugs.

Selected Alcohol-Drug Interactions
Drugs Interacting with Alcohol Mechanism Effect Significance

Acetaminophen (Tylenol, Anacin-3, Panadol, etc. Metabolism of drug > or < with chronic use of alcohol > risk of liver impairment Moderate

Antidiabetic agents Interfaces with glycogen production in the liver; enhances the effect of diabetic medicines Increased low blood sugar Moderate

Antihistamines (Benadryl, Actifed, & most over-the-counter cold medicines contain antihistamines) Enhances the effect of antihistamines > sedation Minor to moderate

Antimicrobials

Isoniazid (INH) Metabolism of drug enhanced with use of alcohol < INH effect Moderate

Flagyl, griseofulvin, chloramphenicol < metabolism of alcohol Hypotension, flushing, vomiting Minor

Aspirin and salicylates > effect of medicine damage to gastric mucosa Moderate

Narcotic analgesics; Demerol, percodan, tylox, codeine, Tylenol #3, codeine cough syrups > effect of medicine > depression of central nervous system MAJOR

Non-steroidal anti-inflammatory drugs: Ibuprofen, Motrin, Advil, etc. > effect of medicine Damage to gastric mucosa Minor

Sedative-hypnotics: barbiturates, benzodiazepines, others Metabolism of drug enhanced with acute alcohol intoxication > depression of central nervous system MAJOR

Tranquilizers > effect of medicine Impaired coordination and > depression of central nervous system Minor

Selected Alcohol-Drug Interactions
Drugs Interacting with Alcohol	Mechanism	Effect	Significance
Acetaminophen (Tylenol, Anacin-3, Panadol, etc.	Metabolism of drug > or < with chronic use of alcohol	> risk of liver impairment	Moderate
Antidiabetic agents	Interfaces with glycogen production in the liver; enhances the effect of diabetic medicines	Increased low blood sugar	Moderate
Antihistamines (Benadryl, Actifed, & most over-the-counter cold medicines contain antihistamines)	Enhances the effect of antihistamines	> sedation	Minor to moderate
Antimicrobials
Isoniazid (INH)	Metabolism of drug enhanced with use of alcohol	< INH effect	Moderate
Flagyl, griseofulvin, chloramphenicol	< metabolism of alcohol	Hypotension, flushing, vomiting	Minor
Aspirin and salicylates	> effect of medicine	damage to gastric mucosa	Moderate
Narcotic analgesics; Demerol, percodan, tylox, codeine, Tylenol #3, codeine cough syrups	> effect of medicine	> depression of central nervous system	MAJOR
Non-steroidal anti-inflammatory drugs: Ibuprofen, Motrin, Advil, etc.	> effect of medicine	Damage to gastric mucosa	Minor
Sedative-hypnotics: barbiturates, benzodiazepines, others	Metabolism of drug enhanced with acute alcohol intoxication	> depression of central nervous system	MAJOR
Tranquilizers	> effect of medicine	Impaired coordination and > depression of central nervous system	Minor

EFFECTS OF LONG-TERM ALCOHOL ABUSE

Prolonged, heavy consumption of alcoholic beverages can result in one or more serious, often life threatening consequences.

infectious diseases
nutritional deficiency
cancer
liver disorders & diseases
muscle disease
hypoglycemia
nervous system diseases
mental disorders
endocrine system disorders
cardiovascular diseases
gastrointestinal system disorders
alcohol/drug interactions and diseases
deprivation of rapid eye movements (REM) or dreaming sleep, results in anxiety, chronic tiredness, and impaired concentration
alcohol use may aggravate migraine sufferers' tendency to vascular headaches

What are blackouts?

Blackouts are lapses in memory during intoxication; they are not a loss of consciousness. Whether lasting a few minutes or hours, blackouts are unpredictable but usually happen when the blood alcohol level is high. A blackout usually occurs after ingestion of large amounts of alcohol and for most social drinkers, it is a learning experience. Continued drinking patterns that produce blackouts indicate a high risk for alcohol problems.

HANGOVERS

Hangover Theories

The hangover is a mild manifestation of alcohol withdrawal. In the earlier stages, it is the all too familiar "hangover headache." This is more likely related to vascular changes and has nothing to do with the brain. The brain itself has no pain receptors. So, any headache pain must be from the nerves surrounding the lining, skin, vessels, or muscles. Although the alcohol has been eliminated, the body's chemical balance has been upset, digestive organs have been abused, and an overpowering fatigue is felt. There is a lack of consensus among researchers on the causes of hangovers. The explanations most frequently cited are described below.

What are the causes of a hangover?

Central Nervous System (CNS) Rebound
Alcohol has a depressant effect on the CNS. With abstinence, this depressant effect is removed and there is a "rebound" of sensitivity to stimuli. An area of the CNS particularly affected is the reticular activating system which oversees the general arousal level and CNS activity.

Congeners
The congeners or chemicals added to color, flavor, preserve, or stabilize alcoholic beverages may cause headaches.

Dehydration
Alcohol suppresses the hormone regulating the amount of urine produced, therefore, too little of the hormone is released and the kidneys form excessive urine. The kidneys' capacity to reabsorb water is diminished and water is excreted from the body. Therefore, intoxication causes the body to lose water (including vitamins and minerals). This produces the sensation of thirst of "cotton mouth."

Depleted Body Blood Sugar/Glucose
Alcohol depletes the body of its blood sugar causing a hypoglycemic state. In this state there is a reduced concentration of blood sugar. The brain is deprived of its proper nourishment. Symptoms include hunger, weakness, nervousness, sweating, headache, and tremor.

Deprivation of Brain Oxygen
The brain is the organ most sensitive to alcohol. It also receives less oxygen when alcohol is present, which adds to the feeling of fatigue the following morning.

Stomach Irritant/Digestion Rebound
Alcohol is an irritant which produces the flow of gastric juices in the stomach lining, causing nausea and vomiting. The next morning, a "rebound effect" is produced as the stomach works extra hard to neutralize the gastric acid. This may cause an upset stomach.

Sleep Disturbance
Alcohol alters the neurochemical balance within the brain. Although some people fall asleep faster with a drink, alcohol depresses REM (Rapid Eye Movement or dreaming) sleep and causes more sleep disturbance later at night. REM sleep is an important component of a healthy sleep cycle. Even if people think they sleep well, the loss of REM sleep makes people want to sleep longer in the morning and would then feel tired during the day. Deprivation of REM sleep is what causes people to feel tired.

Vascular Changes
Alcohol is a vasodilator. It increases blood flow to the extremities. One reason for morning chills may be a rebound effect. As the blood vessels constrict, there is a reduced blood flow to the extremities, and therefore less warmth. These vascular changes have also been related to the hangover headaches. Migraine sufferers should avoid alcohol because use ma aggravate their tendency to vascular headaches.

Are there any cures for a hangover?

The simple cause is too much alcohol. The only prevention is to avoid drinking too much, too fast. There is no cure for a hangover. Once excessive drinking has taken place, only time will cure a hangover--none of the many popular home remedies have been shown to be cures.

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