FACTS ABOUT...Alcohol DRUG CLASS: Sedative/Hypnotic Synopsis: Alcohol is often not thought of as a drug - largely because its use is common for both religious and social purposes in most parts of the world. It is a drug, however, and compulsive drinking in excess has become one of modern society's most serious problems. Beverage alcohol (scientifically known as ethyl alcohol, or ethanol) is produced by fermenting or distilling various fruits, vegetables, or grains. Ethyl alcohol itself is a clear, colorless liquid. Alcoholic beverages get their distinctive colors from the diluents, additives, and by-products of fermentation. In Ontario, beer is fermented to contain about 5% alcohol by volume (or 3.5% in light beer). Most wine is fermented to have between 10% and 14% alcohol content; however, such fortified wines as sherry, port, and vermouth contain between 14% and 20%. Distilled spirits (whisky, vodka, rum, gin) are first fermented, then distilled to raise the alcohol content. In Canada, the concentration of alcohol in spirits is 40% by volume. Some liqueurs may be stronger. The effects of drinking do not depend on the type of alcoholic beverage - but rather on the amount of alcohol consumed on a specific occasion. The following table outlines the alcohol content of various beverages. The right-hand column shows the amount of alcohol consumed in each drink. Beverage % alcohol Size of Grams of by volume drink alcohol ml oz Beer (bottle) 5 341 12 13.4 Beer (can) 5 355 12.5 14.0 Light beer (bottle) 3.5 341 12 9.4 Light beer (can) 3.5 355 12.5 9.8 Wine 12 142 5 13.4 12 170 6 16.1 Fortified wine 20 56.8 2 8.9 Spirits 40 28.4 1 8.9 40 35.5 1.25 11.2 40 42.6 1.5 13.4 How Alcohol Works Alcohol- is rapidly absorbed into the bloodstream from the small intestine, and less rapidly from the stomach and colon. In proportion to its concentration in the bloodstream, alcohol decreases activity in parts of the brain and spinal cord. The drinker's blood alcohol concentration depends on: * the amount consumed in a given time * the drinker's size, sex, body build, and metabolism * the type and amount of food in the stomach. Once the alcohol has passed into the blood, however, no food or beverage can retard or interfere with its effects. Fruit sugar, however, in some cases can shorten the duration of alcohol's effect by speeding up its elimination from the blood. In the average adult, the rate of metabolism is about 8.5 g of alcohol per hour (i.e. about two-thirds of a regular beer or about 30 mL of spirits an hour). This rate can vary dramatically among individuals, however, depending on such diverse factors as usual amount of drinking, physique, sex, liver size, and genetic factors. Effects The effects of any drug depend on several factors: * the amount taken at one time * the user's past drug experience * the manner in which the drug is taken * the circumstances under which the drug is taken (the place, the user's psychological and emotional stability, the presence of other people, the concurrent use of other drugs, etc.). It is the amount of alcohol in the blood that causes the effects. In the following table, the left-hand column lists the number of milligrams of alcohol in each decilitre of blood - that is, the blood alcohol concentration, or BAC. (For example, an average person may get a blood alcohol concentration of 50 mg/dL after two drinks consumed quickly.) The right-hand column describes the usual effects of these amounts on normal people - those who haven't developed a tolerance to alcohol. BAC (ma/dL) Effect _________________________________________________________________ 50 Mild intoxication Feeling of warmth, skin flushed; impaired judgment; decreased inhibitions 100 Obvious intoxication in most people Increased impairment of judgment, inhibition, attention, and control; Some impairment of muscular performance; slowing of reflexes 150 Obvious intoxication in all normal people Staggering gait and other muscular incoordination; slurred speech; double vision; memory and comprehension loss 250 Extreme intoxication or stupor Reduced response to stimuli; inability to stand; vomiting; incontinence; sleepiness 350 Coma Unconsciousness; little response to stimuli; incontinence; low body temperature; poor respiration; fall in blood pressure; clammy skin 500 Death likely _________________________________________________________________ Drinking heavily over a short period of time usually results in a "hangover" - headache, nausea, shakiness, and sometimes vomiting, beginning from 8 to 12 hours later. A hangover is due partly to poisoning by alcohol and other components of the drink, and partly to the body's reaction to withdrawal from alcohol. Although there are dozens of home remedies suggested for hangovers, there is currently no known effective cure. Combining alcohol with other drugs can make the effects of these other drugs much stronger and more dangerous. Many accidental deaths have occurred after people have used alcohol combined with other drugs. Cannabis, tranquillizers, barbiturates and other sleeping pills, or antihistamines (in cold, cough, and allergy remedies) should not be taken with alcohol. Even a small amount of alcohol with any of these drugs can seriously impair a person's ability to drive a car, for example. Long-term effects of alcohol appear after repeated use over a period of many months or years. The negative physical and psychological effects of chronic abuse are numerous; some are potentially life-threatening. Some of these harmful consequences are primary - that is, they result directly from prolonged exposure to alcohol's toxic effects (such as heart and liver disease or inflammation of the stomach). Others are secondary; indirectly related to chronic alcohol abuse, they include loss of appetite, vitamin deficiencies, infections, and sexual impotence or menstrual irregularities. The risk of serious disease increases with the amount of alcohol consumed. Early death rates are much higher for heavy drinkers than for light drinkers or abstainers, particularly from heart and liver disease, pneumonia, some types of cancer, acute alcohol poisoning, accident, homicide, and suicide. No precise limits of safe drinking can be recommended. According to 1988 figures from Statistics Canada, 2,828 deaths were directly attributable to alcohol in that year. There were, however, an estimated 13,870 more deaths - five times as many - indirectly caused by alcohol. Tolerance and Dependence People who drink on a regular basis become tolerant to many of the unpleasant effects of alcohol, and thus are able to drink more before suffering these effects. Yet even with increased consumption, many such drinkers don't appear intoxicated. Because they continue to work and socialize reasonably well, their deteriorating physical condition may go unrecognized by others until severe damage develops - or until they are hospitalized for other reasons and suddenly experience alcohol withdrawal symptoms. Psychological dependence on alcohol may occur with regular use of even relatively moderate daily amounts. It may also occur in people who consume alcohol only under certain conditions, such as before and during social occasions. This form of dependence refers to a craving for alcohol's psychological effects, although not necessarily in amounts that produce serious intoxication. For psychologically dependent drinkers, the lack of alcohol tends to make them anxious and, in some cases, panicky. Physical dependence occurs in consistently heavy drinkers. Since their bodies have adapted to the presence of alcohol, they suffer withdrawal symptoms if they suddenly stop drinking. Withdrawal symptoms range from jumpiness, sleeplessness, sweating, and poor appetite, to tremors (the "shakes"), convulsions. hallucinations. and sometimes death. Alcohol and Pregnancy Pregnant women who drink risk having babies with fetal alcohol effects (known as fetal alcohol syndrome or FAS). The most serious of these effects include mental retardation, growth deficiency, head and facial deformities, joint and limb abnormalities, and heart defects. While it is known that the risk of bearing an FAS-afflicted child increases with the amount of alcohol consumed, a safe level of consumption has not been determined. Who Uses Alcohol In a 1990 nation-wide Gallup poll, 79% of adults reported they had at some point drunk alcohol. A 1989 survey of adults in Ontario found that 83% reported ever having used alcohol, with 55% saying they have five drinks or more at a single sitting and 10% reporting daily drinking. Among young people between 12 and 19 years, a 1985 national survey recorded 73% using alcohol at least once in the past year. Of Ontario students in grades 7, 9, 11, and 13 polled in 1989, 66% admitted to alcohol use, with more than 80% of the grade 11 and 13 students saying they drank. More than one in five of all those who drank said they did so more than once a week. Since the legal drinking age in Ontario is 19, it appears that alcohol has a high degree of social acceptance, whether legal or not. Total alcohol consumption in Canada during 1988/89 reached 202.9 million litres. This corresponds to an average annual consumption of 9.9 L of alcohol for each Canadian over the age of 15 - that is to say, about 11 drinks per week or a little under two drinks a day. Beer, making up 52% of the total volume, was the most popular drink, with spirits in second place at 31 %, and wine a distant third at 17%. In recent years, Canadians have spent about $9.6 billion a year for alcohol in retail stores and another estimated $2.6 billion for alcohol consumed in taverns and restaurants. There is a direct relationship between the overall level of consumption within a population and the number of alcohol- dependent people. A nation with a low per capita consumption rate has a lower number of heavy users, whereas one with widespread use and high per capita consumption has a proportionately higher rate of alcohol-related diseases and deaths. Most researchers agree that one in 20 drinkers in North America has an alcohol dependency problem. Alcohol and the Law Alcohol legislation is a joint responsibility of the federal and provincial governments, and many laws regulate its manufacture, distribution, advertising, possession, and consumption. In Ontario, marketing and consumption of alcohol is primarily governed by the provincial Liquor Licence Act. It is an offence for anyone under 19 years to possess, consume, or purchase alcohol. It is also illegal to sell or supply alcohol to anyone known to be or appearing to be (unless that person has proof otherwise) under the age of 19. It is not illegal, though, for parents or guardians to give an under-age child a drink at home. Provisions similar to Ontario's apply in most other Canadian provinces and in the Yukon and Northwest Territories, as well as in many states in the United States. The act also makes it illegal to sell or supply alcohol to a person who appears to be intoxicated. As well, anyone who sells or supplies alcohol to others - whether these are patrons of a tavern or restaurant or guests in a private home - may be held civilly liable if intoxicated patrons or guests injure themselves or others. The federal criminal law sets out a range of drinking and driving offences. It is illegal, for example, to operate a motor vehicle, boat, or aircraft while impaired by any amount of alcohol or other drugs. The manner in which one drives, slurred speech or physical incoordination, and the smell of alcohol may all be used as evidence of a person's impairment. It is also a criminal offence to drive with a blood alcohol concentration (BAC) above .08% (which means with more than 80 mg of alcohol in each 100 mL of blood in one's bloodstream) The Criminal Code sets out complex provisions authorizing police to demand breath samples or, in limited circumstances, blood samples, from suspected drinking drivers. Those refusing to comply can be convicted unless they have a reasonable excuse. The Ontario Highway Traffic Act gives police broad powers to stop drivers to determine if they have been drinking and to issue a 12-hour licence suspension if their BAC is above .05% (i.e. higher than 50 mg of alcohol per 100 mL of blood). Drinking and driving is by far the largest criminal cause of death and injury in Canada. In 1988, there were 121,307 Canadians charged with federal drinking and driving offences: 110,773 for impaired operation of a motor vehicle; 1,194 for impaired operation causing bodily harm; and 158 for causing death. Another 8,786 people were charged for failure or refusal to provide a breath sample for testing. In all, 19,808 Canadians were jailed for drinking and driving offences in 1988/89. For more information, contact your nearest ARF office (consult your local telephone directory), or call Drug and Alcohol Information Line, Ontario Toll-free 1-800-lNFO-ARF (1-800-463-6273), Metro Toronto 595-6111 9.00 am 9.00 pm except holidays A public information service of the Addiction Research Foundation 33 Russell Street, Toronto, Canada M5S 2S1 Copyright (c) 1971 Revised January 1991 Alcoholism and Drug Addiction Research Foundation, Toronto Canada