Chapter 8 in Health: The Basics - Alcohol, Tobacco, and Caffeine.

8
Alcohol, Tobacco,
and Caffeine
DAILY PLEASURES, DAILY CHALLENGES
Aren’t the majority of college students heavy drinkers?
Is there any cure for a hangover?
Is secondhand smoke a risk to my health?
Is caffeine really addictive?
OBJECTIVES
■ Discuss the alcohol use patterns of college students and overall trends
in consumption.
■ Explain the physiological and behavioral effects of alcohol, including
blood alcohol concentration, absorption, metabolism, and immediate
and long-term effects of alcohol consumption.
■ Explain the symptoms and causes of alcoholism, its cost to society,
effects on the family, and treatment options.
■ Discuss the social and political issues involved in tobacco use.
■ Discuss the health risks of smoking, spit (smokeless) tobacco, and
environmental tobacco smoke, and describe how the chemicals in
tobacco products affect the body.
ISBN: 0-558-34154-3
■ Summarize the benefits, risks, and potential health consequences
associated with caffeine use.
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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campus. There is growing research that college students’
drinking behavior is strongly influenced by the incorrect
perception of peer drinking norms. Many students misper-
Usually the word drugconjures up images of
people abusing illegal substances. We use
the term to describe dangerous chemicals
such as heroin or cocaine, without recogniz-
ceive that their peers drink more than they actually do.
ing that socially accepted substances can be
This misperception is true not only about the frequency
drugs, too—for example, alcohol, tobacco,
and amount that students drink, but also about the actual
and caffeine.
consequences students experience as a result of their
drinking. For example, at a large midwestern university,
42 percent of students reported not having had a hangover
Alcohol: An Overview
in the past 6 months. Yet the same group of surveyed
students perceived that only 3 percent of their peers had
Moderate use of alcohol can enhance celebrations and special
not had a hangover in the past month.
times. Research shows that very low levels of use may actu-
Today, many campuses are working to change mispercep-
ally decrease some health risks. However, always remember
tions of normal drinking behavior. As a result, heavy episodic
that alcohol is a chemical substance that affects your physical
alcohol consumption—“binge drinking”—has declined at
and mental behavior.
campuses across the country (Table 8.1).
An estimated 65 percent of Americans consume alcoholic
beverages regularly, though consumption patterns are unevenly
Binge Drinking
distributed throughout the drinking population. Ten percent
are heavy drinkers, and they account for half of all the alcohol
and College Students
consumed. The remaining 90 percent of the drinking popula-
There are, however, some students who indulge in binge
tion are infrequent, light, or moderate drinkers.
drinking. The stakes of binge drinking are high because
it poses high risk for alcohol-related injuries and death.
Alcohol and College Students
According to a recent study, 1,700 college students die
each year because of alcohol-related, unintentional injuries,
Alcohol is the most widely used (and abused) recreational
including car accidents. Binge drinking is the number-one
drug in our society. It is also the most popular drug on college
cause of preventable death among undergraduate college
campuses, where approximately 70 percent of students report
students in the United States today.2
having consumed alcoholic beverages in the last 30 days.1
A study by the Harvard School of Public Health found that
Almost half of all college students engage in heavy episodic
44.4 percent of students were binge drinkers, and, of those,
(binge) drinking, meaning that they consume five or more
22.8 percent were frequent bingers (people who binge drink
drinks in a row (men), or four or more in a row (women).
three times or more in a 2-week period; Table 8.2).3 Com-
Therefore, students who might go out and drink only once a
pared with nonbinge drinkers, frequent binge drinkers are
week are considered heavy drinkers if they consume a great
16 times more likely to miss class, 8 times more likely to get
deal of alcohol during that occasion. In a new trend on col-
behind in their school work, and more apt to get into trouble
lege campuses, women’s consumption of alcohol has come
with campus or local police.4 Unfortunately, recent studies
close to equaling men’s.
confirm what students have been experiencing for a long
College is a critical time to become aware of and respon-
time—binge drinkers cause problems not only for them-
sible for drinking. There is little doubt that drinking is a part
selves, but also for those around them.
of campus culture and tradition. Many students are away
Although everyone is at some risk for alcohol-related
from home, often for the first time, and are excited by their
problems, college students seem to be particularly vulnerable
newfound independence. For some students, this indepen-
for the following reasons:
dence and the rite of passage into the college culture are
symbolized by the use of alcohol. It provides the answer to
■ Alcohol exacerbates their already high risk for suicide,
one of the most commonly heard statements on any college
automobile crashes, and falls.
campus: “There is nothing to do.” Additionally, many stu-
■ Many college and university customs, norms, traditions,
dents say they drink to have fun. Having fun, which often
and mores encourage certain dangerous practices and
means drinking simply to get drunk, may really be a way of
patterns of alcohol use.
coping with stress, boredom, anxiety, or pressures created
■ University campuses are heavily targeted by advertising
by academic and social demands.
and promotions from the alcoholic beverage industry.
Aren’t the
Statistics about college students’
majority
drinking may not always reflect actual
of college
consumption. Many college and universi-
students
heavy episodic (binge) drinking Drinking for the express
ties are trying a social norms approach,
heavy
purpose of becoming intoxicated; five drinks or more on a
sending a consistent message to students
drinkers?
single occasion for men and four drinks or more for women.
about actual drinking behavior on
ISBN: 0-558-34154-3
CHAPTER 8
Alcohol, Tobacco, and Caffeine
217
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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SPOTLIGHT on your health
THE FACTS ABOUT COLLEGE STUDENTS AND DRINKING
College administrators esti- ■Over the past decade, there has been pay less for their alcohol than their
mate that alcohol is involved
a threefold increase in the number of
older classmates do. Though underage
with 29 percent of dropouts,
college women who report having been
students drink less often, they con-
38 percent of academic
drunk on ten or more occasions in the
sume more per occasion than students
failures, and 64 percent of violent
previous month.
age 21 and older who are allowed to
behaviors.
■
Areas of a college campus offering
drink legally.
Perhaps you’ve heard conflicting re-
cheap beer prices have more crime,
ports in the media about the prevalence
including trouble between students
and effects of drinking on campus. The
and police or other campus authorities,
Source: Data were compiled from the numer-
ous studies cited throughout this chapter and
statistic above is just one of many that
arguments, physical fighting, property
from M. Mohler-Kuo et al., “College Rapes
detail the scope of the problem. Consider
damage, false fire alarms, and sexual
Linked to Binge-Drinking Rates,” Journal
the following facts about students and
misconduct.
of Studies on Alcohol 65, no. 1 (2004);
alcohol consumption:
■
Alcohol is involved in more than
H. Weschler, “Watering Down the Drinks: The
two-thirds of suicides among college
Moderating Effect of College Demographics on
■
Alcohol kills more people below age 21
Alcohol Use in High Risk Groups,” American
students, 90 percent of campus rapes
than cocaine, marijuana, and heroin
Journal of Public Health 93, no. 11 (2003):
and sexual assaults, and 95 percent
combined.
1929–33; T. F. Nelson et al., “Alcohol and
of violent crime on campus.
Collegiate Sports Fans,” Addictive Behaviors 28,
■
Half a million students between ages
■
Seventy-five percent of male students
no. 1 (2003): 1–11; R. W. Hingson et al.,
15 and 24 are unintentionally injured
and 55 percent of female students
“Magnitude of Alcohol-Related Mortality and
each year while intoxicated.
Morbidity among U.S. College Students Aged
involved in acquaintance rape had been
■
Eight percent of students reported
18–24,” Journal of Studies on Alcohol 63, no. 2
drinking or using drugs at the time.
alcohol use as one of their top ten
(2002): 136–44; American College Health
■
Each year, more than 100,000 students
impediments to academic performance
Association, “American College Health
between the ages of 18 and 24 report
Association–National College Health Assess-
in the previous year.
having been too intoxicated to know
ment (ACHA–NCHA) Spring 2006 Reference
■
Of today’s first-year college students,
Group Data Report,” Journal of American Col-
whether they consented to having sex.
159,000 will drop out of school next year
lege Health 55, no. 4 (2007): 195–206; Facts
■
College students under the age of 21
for alcohol or other drug-related reasons.
on Tap, “The College Experience: Alcohol and
are more prone to binge drinking and
Student Life,” 2006, www.factsontap.org.
TABLE 8.1
Reported Change in Alcohol Use as a Result of Social Norms Campaigns
The statistics below represent a small number of institutions using social norms campaigns to reduce alcohol consumption
among college students, and their reported results.
University or College with a
Reduction in Heavy Episodic Alcohol Consumption
Social Norms Campaign
Due to Social Norms Campaign
Northern Illinois University
44% over 10 years
Hobart & William Smith Colleges
40% over 5 years
Rowan University
23% over 5 semesters
University of Missouri–Columbia
21% over 2 years
University of North Carolina
30% over 5 years
University of Arizona
29% over 3 years
Western Washington University
20% over 3 years
Florida State University
22% over 3 years
Michigan State University
26% over 3 years
ISBN: 0-558-34154-3
Source: National Social Norms Resource Center, July 17, 2006, www.socialnorms.org.
218 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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TABLE 8.2
The Frequency and Effects of Binge Drinking among College Students
College Students’ Patterns of Alcohol Use, 2001
Alcohol-Related Problems
Total
Men
Women
Nonbinge
Frequent Binge
Category
(%)
(%)
(%)
Problem Reported
Drinkers (%)
Drinkers (%)
Abstainer (past year)
19.3
20.1
18.7
Did something regrettable
18
62
Nonbinge drinker
36.3
31.3
40.4
Missed a class
9
63
Occasional
Forgot where they were or
binge drinker
21.6
23.4
20.0
what they did
10
54
Frequent
Got behind in schoolwork
10
46
binge drinker
22.8
25.2
20.9
Argued with friends
10
43
Got hurt or injured
4
27
Damaged property
2
23
Engaged in unplanned
sexual activities
8
42
Drove after drinking
19
57
Sources: H. Wechsler et al., “Trends in College Binge Drinking during a Period of Increased Prevention Efforts: Findings from Four Harvard School of
Public Health College Study Surveys: 1993–2001,” Journal of American College Health 50, no. 5 (2002): 207. Reprinted with permission of Helen
Dwight Reid Educational Foundation. Published by Heldref Publications, 1319 18th St. NW, Washington DC 20036. Copyright 2002.
■ It is more common for college students than their non-
other unwanted sexual advances, and vandalism of personal
collegiate peers to drink recklessly and to engage in
property.
drinking games and other dangerous drinking practices.
To curb binge drinking and alcohol abuse, many schools
■ College students are particularly vulnerable to peer influ-
are instituting strong policies against drinking. University
ence and have a strong need to be accepted by their peers.
presidents have formed a leadership group to help curb the
■ There is institutional denial by college administrators that
problem of alcohol abuse. Many fraternities have elected to
alcohol problems exist on their campuses.
have “dry” houses. At the same time, schools are making more
help available to students with drinking problems. Today, most
Binge drinking is especially dangerous because it often
campuses offer both individual and group counseling and are
involves drinking a lot of alcohol in a very short period of
directing more attention toward preventing alcohol abuse.
time. This type of consumption can quickly lead to extreme
Student organizations such as BACCHUS (Boost Alcohol
intoxication, involving unconsciousness, alcohol poisoning,
Consciousness Concerning the Health of University Students)
and even death. Often, drinking competitions or games and
promote responsible drinking and party hosting.
hazing rituals encourage this type of drinking. To see whether
your alcohol consumption is a problem, complete the quiz in
the Assess Yourself box on page 220.
There is also significant evidence that campus rape is
linked to binge drinking. Women from colleges with medium
DID youKNOW?
to high binge drinking rates are 1.5 times more at risk of
being raped than those from schools with a low binge drink-
ing rate. Seventy-two percent of campus rapes occur when
the victim is so intoxicated that she is unable to consent to
College students consume an estimated
or refuse sex.5 For more on rape, see Chapter 4.
430 million gallons of beer, wine, and
Binge drinking also affects students who do not partici-
liquor per year. This is enough alcohol
pate in binge drinking behavior. One study indicated that
to fill more than 650 Olympic-sized
over 696,000 students between the ages of 18 and 24 were
assaulted by another student who had been drinking.6 Other
swimming pools.
students report sleep and study disruptions, sexual abuse and
(Text continues on page 222.)
ISBN: 0-558-34154-3
CHAPTER 8
Alcohol, Tobacco, and Caffeine
219
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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ASSESS yourself
ALCOHOL ABUSE: EVALUATING YOUR RISK
Fill out this assessment online at
www.aw-bc.com/myhealthlab
or www.aw-bc.com/donatelle.
For each question, choose the answer that is correct for you.
1. How often do you have a drink containing alcohol?
Never
Monthly
2 to 4 times
2 to 3 times
4 or more
or less
a month
a week
times a week
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
1 or 2
3 or 4
5 or 6
7 to 9
10 or more
3. How often do you have 6 drinks or more on one occasion?
Never
Less than
Monthly
Weekly
Daily or almost
monthly
daily
4. How often during the last year have you found that you were not able to stop drinking once you had started?
Never
Less than
Monthly
Weekly
Daily or almost
monthly
daily
5. How often during the last year have you failed to do what was normally expected from you because of drinking?
Never
Less than
Monthly
Weekly
Daily or almost
monthly
daily
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy
drinking session?
Never
Less than
Monthly
Weekly
Daily or almost
monthly
daily
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
Never
Less than
Monthly
Weekly
Daily or almost
monthly
daily
8. How often during the last year have you been unable to remember what happened the night before because you had
been drinking?
Never
Less than
Monthly
Weekly
Daily or almost
monthly
daily
9. Have you or someone else been injured as a result of your drinking?
No
Yes, but not in
Yes, during the last year
the last year
10. Has a relative or friend or a doctor or other health worker been concerned about your drinking or suggested you cut down?
No
Yes, but not in
Yes, during the last year
the last year
Analyzing Your Answers
Each question has its own set of scores. Assign yourself the
Question 2: 0 = 1–2 drinks; 1 = 3–4 drinks; 2 = 5–6 drinks;
correct number of points as indicated below, based on your
3 = 7–9 drinks; 4 = 10 or more drinks
answers.
Questions 3–8: 0 = never; 1 = less than monthly;
Question 1: 0 = never; 1 = monthly or less; 2 = 2–4 times/
2 = monthly; 3 = weekly; 4 = daily or almost daily
month; 3 = 2–3 times/week; 4 = 4 or more times/week
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220 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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Questions 9 and 10: 0 = no; 1 = yes, but not in the last year;
Scores above 8: Your drinking patterns are putting you at
2 = yes, during the last year
high risk for illness, unsafe sexual situations, or alcohol-
related injuries, and they may even be affecting your
Scores below 6: Congratulations! You are in control of your
academic performance. Look back at how you answered
drinking behaviors and do a good job of consuming alcohol
each question, and identify some changes you can make to
responsibly and in moderation.
reduce your risk.
Scores between 6 and 8: Your alcohol consumption is
Source: K. Bush et al., “The AUDIT Alcohol Consumption Questions
possibly risky. Try to take steps to change your drinking
(Audit-C),” Archives of Internal Medicine 158, no. 16 (1998):
behavior. It might be hard when you are surrounded by
1789–95; World Health Organization, Division of Mental Health and
friends who participate in the same risky actions, but try
Prevention of Substance Abuse, “Alcohol Use Disorders Identification
Text (AUDIT),” 2006, www.who.net.
to make some positive changes for your health and safety.
MAKE it happen!
ASSESSMENT: The Assess Yourself activity gave you the
EXAMPLE: After completing the quiz in the Assess Yourself
chance to evaluate your alcohol consumption and determine
box, Mark was surprised to discover that he drank much
whether it is harmful to you and those around you. If you
more often than he had thought. In particular, he was
were surprised by some of your answers, or couldn’t be sure
surprised to realize that he was a heavy episodic drinker.
how to answer some of the questions, you may want to take
During his 3 years in college, Mark had grown used to con-
steps to change your behavior.
suming 5 or more drinks once a week, and he had never
MAKING A CHANGE: To change your behavior, you need to
seen this as a problem before he completed this question-
develop a plan. Follow these steps below and complete your
naire. He decided to address his concerns about his alcohol
Behavior Change Contract to take action.
use in several steps.
First, Mark kept a log of his alcohol consumption over
1.
Evaluate your behavior, and identify patterns and specific
2 weeks. He saw that he was drinking almost every night of
things you are doing. What can you change now? What
the week, and drinking very heavily at least once a week. Mark
can you change in the near future?
decided he wanted to reduce his drinking and set two goals:
2.
Select one pattern of behavior that you want to change.
taking a break from drinking altogether for 3 weeks and, after
3.
Fill out the Behavior Change Contract found at the front
that, drinking only 3 drinks on Friday and Saturday nights for
of your book. It should include your long-term goals for
the rest of the semester. Mark explained to his friends that he
change, your short-term goals, the rewards you’ll give
was taking a break and invited them to go with him on hikes,
yourself for reaching these goals, potential obstacles
to the movies, and to other alcohol-free environments. After
along the way, and strategies for overcoming these
successfully taking this break, Mark decided to set some
obstacles. For each goal, list the small steps and specific
goals and limits for himself on the alcohol he would consume
actions that you will take.
in the future. He went to a fraternity party on a Friday night
and drank 2 beers, his predetermined limit. He was happy
4.
Chart your progress in a journal. At the end of a
to realize when he woke up the next morning that he felt
week, consider how successful you were in following
refreshed, not hung over. When he went out for dinner with
your plan. What helped you be successful? What made
his friends Saturday night, they wanted to go barhopping
change more difficult? What will you do differently next
afterwards. He volunteered to be the designated driver, and
week?
the bar gave him free sodas for the night. The next weekend,
5.
Revise your plan as needed: Are the short-term goals
Mark found he had extra money that he hadn’t spent on beer
attainable? Are the rewards satisfying?
during the week and bought himself a new DVD.
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CHAPTER 8
Alcohol, Tobacco, and Caffeine
221
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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Light beer
Regular beer
Wine
Most cocktails
(12-oz. can)
(12-oz. bottle)
(4-oz. glass)
(mixed drinks)
Percentage
of alcohol
2.4–4.8%
3.2–5.0%
12%
40–50%
by volume
Amount
of alcohol
0.29–0.58 oz.
0.38–0.60 oz.
0.48 oz.
1.25 oz.
per serving
FIGURE 8.1 Alcoholic Beverages and Their Alcohol Equivalencies
Trends in Consumption
The Chemical Makeup
In general, alcohol consumption levels among Americans have
of Alcohol
declined steadily since the late 1970s. In 2005, the estimated
per capita consumption was the equivalent of 2.2 gallons of
The intoxicating substance found in beer, wine, liquor, and
pure alcohol per person.7 This represents a substantial decline
liqueurs is ethyl alcohol, or ethanol. It is produced during a
from 2.64 gallons reported for 1977. (This measure indicates
process called fermentation, in which yeast organisms break
the amount of alcohol that a person would obtain by drinking
down plant sugars, yielding ethanol and carbon dioxide. Fer-
approximately 50 gallons of beer, 20 gallons of wine, or more
mentation continues until the solution of plant sugars (called
than 4 gallons of distilled spirits.)
mash) reaches a concentration of 14 percent alcohol. For
This downward trend has been tied to a growing attention
beers, ales, and wines, the process ends with fermentation.
to weight, personal health, and physical activity. The alcohol
Manufacturers then add other ingredients that dilute the alco-
industry has responded by introducing beer and wines with
hol content of the beverage.
fewer calories and carbohydrates and with reduced alcohol
Hard liquor is produced through further processing called
content.
?
distillation, during which alcohol vapors are released from
the mash at high temperatures. The vapors are then con-
what do you THINK?
densed and mixed with water to make the final product.
The proof of an alcoholic drink is a measure of the per-
Why do some college students drink excessive
centage of alcohol in the beverage and therefore the strength
amounts of alcohol? ■ Are there particular
of the drink. Alcohol percentage is half of the given proof. For
traditions or norms related to when and why
example, 80 proof whiskey or scotch is 40 percent alcohol by
students drink on your campus? ■ Have you ever
volume, and 100 proof vodka is 50 percent alcohol by volume.
had your sleep or studies interrupted, or have you
Lower-proof drinks will produce fewer alcohol effects than
had to babysit a friend because he or she had
the same amount of higher-proof drinks will produce. Most
been drinking?
wines are between 12 and 15 percent alcohol, and most beers
are between 2 and 8 percent, depending on state laws and type
of beer (Figure 8.1).
ethyl alcohol (ethanol) An addictive drug produced by
Absorption and Metabolism
fermentation and found in many beverages.
Unlike the molecules found in most foods and drugs, alcohol
fermentation The process whereby yeast organisms break
molecules are sufficiently small and fat soluble to be absorbed
down plant sugars to yield ethanol.
throughout the entire gastrointestinal system. A negligible
distillation The process whereby mash is subjected to high
amount of alcohol is absorbed through the lining of the mouth.
temperatures to release alcohol vapors, which are then
Approximately 20 percent of ingested alcohol diffuses through
ISBN: 0-558-34154-3
condensed and mixed with water to make the final product.
the stomach lining into the bloodstream, and nearly 80 percent
proof A measure of the percentage of alcohol in a beverage.
passes through the lining of the upper third of the small intes-
tine. Absorption into the bloodstream is rapid and complete.
222 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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Several factors influence how quickly your body will
absorb alcohol: the alcohol concentration in your drink, the
amount of alcohol you consume, the amount of food in your
stomach, pylorospasm (spasm of the pyloric valve in the
digestive system), your metabolism, weight and body mass
index, and your mood. The higher the concentration of alco-
hol in your drink, the more rapidly it will be absorbed in your
digestive tract. As a rule, wine and beer are absorbed more
slowly than distilled beverages. Carbonated alcoholic
beverages—such as champagne and carbonated wines—are
absorbed more rapidly than those containing no sparkling
additives, or fizz. Carbonated beverages and drinks served
with mixers cause the pyloric valve—the opening from the
stomach into the small intestine—to relax, thereby emptying
the contents of the stomach more rapidly into the small intes-
Many factors influence how rapidly your body absorbs alcohol. For
tine. Because the small intestine is the site of the greatest
example, eating while drinking slows down the absorption of alcohol
absorption of alcohol, carbonated beverages increase the rate
into your bloodstream.
of absorption. In contrast, if your stomach is full, absorption
slows because the surface area exposed to alcohol is smaller.
A full stomach also retards the emptying of alcoholic bever-
Blood Alcohol Concentration
ages into the small intestine.
The more alcohol you consume, the longer absorption
Blood alcohol concentration (BAC) is the ratio of alcohol to
takes. Alcohol can irritate the digestive system, which causes
total blood volume. It is the factor used to measure the physio-
pylorospasm. When the pyloric valve is closed, nothing can
logical and behavioral effects of alcohol. Despite individual
move from the stomach to the upper third of the small intes-
differences, alcohol produces some general behavioral effects,
tine, which slows absorption. If the irritation continues, it can
depending on BAC (Table 8.3). At a BAC of 0.02 percent,
cause vomiting.
a person feels slightly relaxed and in a good mood. At 0.05,
Mood is another factor, because emotions affect how long
relaxation increases, there is some motor impairment, and a
it takes for the contents of the stomach to empty into the
willingness to talk becomes apparent. At 0.08, the person feels
intestine. Powerful moods, such as stress and tension, are
euphoric, and there is further motor impairment. At 0.10, the
likely to cause the stomach to dump its contents into the
depressant effects of alcohol become apparent, drowsiness
small intestine. That is why alcohol is absorbed much more
sets in, and motor skills are further impaired, followed by a
rapidly when people are tense than when they are relaxed.
loss of judgment. Thus, a driver may not be able to estimate
Alcohol is metabolized in the liver, where it is converted
distance or speed, and some drinkers lose their ability to make
to acetaldehyde by the enzyme alcohol dehydrogenase. It is
value-related decisions and may do things they would not do
then rapidly oxidized to acetate, converted to carbon dioxide
when sober. As BAC increases, the drinker suffers increased
and water, and eventually excreted from the body. Acetalde-
physiological and psychological effects. All these changes are
hyde is a toxic chemical that can cause immediate symptoms,
negative. Alcohol ingestion does not enhance any physical
such as nausea and vomiting, as well as long-term effects,
skills or mental functions.
such as liver damage. A very small portion of alcohol is
A drinker’s BAC depends on weight and body fat, the
excreted unchanged by the kidneys, lungs, and skin.
water content in body tissues, the concentration of alcohol in
Alcohol contains 7 calories (kcal) per gram (you will
the beverage consumed, the rate of consumption, and the vol-
learn more about calories in Chapter 9). This means that the
ume of alcohol consumed. Heavier people have larger body
average regular beer contains about 150 calories. Mixed
surfaces through which to diffuse alcohol; therefore, they
drinks may contain more if they are combined with sugary
have lower concentrations of alcohol in their blood than do
soda or fruit juice. The body uses the calories in alcohol in
thin people after drinking the same amount. Because alcohol
the same manner it uses those found in carbohydrates: for
does not diffuse as rapidly into body fat as into water, alcohol
immediate energy or for storage as fat if not immediately
concentration is higher in a person with more body fat.
needed.
Because a woman is likely to have more body fat and less
When compared to the variable breakdown rates of
water in her body tissues than a man of the same weight,
foods and other beverages, the breakdown of alcohol occurs
she will be more intoxicated than a man after drinking the
at a fairly constant rate of 0.5 ounce per hour. This amount
same amount of alcohol.
of alcohol is equivalent to 12 ounces of 5 percent beer,
5 ounces of 12 percent wine, or 1.5 ounces of 40 percent
blood alcohol concentration (BAC) The ratio of alcohol
(80 proof) liquor. Unmetabolized alcohol circulates in the
to total blood volume; the factor used to measure the
bloodstream until enough time passes for the body to break
physiological and behavioral effects of alcohol.
it down.8
ISBN: 0-558-34154-3
CHAPTER 8
Alcohol, Tobacco, and Caffeine
223
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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TABLE 8.3
Psychological and Physical Effects of Various Blood Alcohol Concentration Levels*
Number
Blood Alcohol
of Drinks†
Concentration (%)
Psychological and Physical Effects
2
0.05–0.06
Feeling of relaxation, warmth; slight decrease in reaction time and in fine-muscle coordination
3
0.08–0.09
Balance, speech, vision, and hearing slightly impaired; feelings of euphoria, increased confidence;
loss of motor coordination
3–4
0.08–0.10
Legal intoxication in most states; some have lower limits
4
0.11–0.12
Coordination and balance becoming difficult; distinct impairment of mental faculties, judgment
5
0.14–0.15
Major impairment of mental and physical control; slurred speech, blurred vision, lack of motor skills
7
0.20
Loss of motor control—must have assistance in moving about; mental confusion
10
0.30
Severe intoxication; minimal conscious control of mind and body
14
0.40
Unconsciousness, coma, death
*For each hour elapsed since the last drink, subtract 0.015 percent blood alcohol concentration, or approximately one drink.
†One drink = one beer (4% alcohol, 12 ounces), one highball (1 ounce whiskey), or one glass table wine (5 ounces).
Source: Modified from data given in Ohio State Police Driver Information Seminars and the National Clearinghouse for Alcohol and Alcoholism
Information, Rockville, MD.
Both breath analysis (Breathalyzer tests) and urinalysis are
found that injured patients with a BAC of over 0.08 percent
used to determine whether an individual is legally intoxicated,
who were treated in emergency rooms were 3.2 times more
but blood tests are more accurate measures of BAC. An in-
likely to have a violent injury than an unintentional injury.9
creasing number of states are requiring blood tests for people
Most people admitted to emergency rooms are men 21 years
suspected of driving under the influence of alcohol, but legal
or older, mostly as the result of accidents or fights where
limits of BAC while driving do vary from one state to another.
alcohol was involved.10
In some states, refusal to take the breath or urine test results in
immediate revocation of the person’s driver’s license.
Alcohol Poisoning
People can acquire physical and psychologi-
cal tolerance to the effects of alcohol through
Alcohol poisoning occurs much more frequently than people
regular use. The nervous system adapts over
realize, and all too often it can be fatal. Drinking large amounts
time, so greater amounts of alcohol are required to produce
of alcohol in a short period of time can cause the blood alcohol
the same physiological and psychological effects. Though
level to reach the lethal range quickly. Alcohol, used either
BAC may be quite high, the individual has learned to modify
alone or in combination with other drugs, is responsible for
his behavior to appear sober. This ability is called learned
more deaths due to toxic overdose than any other substance.
behavioral tolerance.
Death from alcohol poisoning can be caused by either
central nervous system (CNS) and respiratory depression or
the inhalation of vomit or fluid into the lungs. The amount
Physiological and
of alcohol it takes for a person to become unconscious is
dangerously close to the lethal dose. Signs of alcohol poison-
Behavioral Effects
ing include inability to be roused; a weak, rapid pulse; an
unusual or irregular breathing pattern; and cool (possibly
of Alcohol
damp), pale, or bluish skin. If you are with someone who has
been drinking heavily and who exhibits these conditions or
Alcohol and Injuries
if you are unsure about the person’s condition, call your local
emergency number (911 in most areas) for immediate assis-
Alcohol use plays a significant role in the types of injuries
tance. Don’t wait for the individual to become unconscious;
people experience. Thirteen percent of emergency room
by then, the risk of death increases tenfold.
visits by undergraduates are related to alcohol; of this total,
34 percent were the result of acute intoxication. A recent study
Alcohol and Sexual
Decision Making
ISBN: 0-558-34154-3
learned behavioral tolerance The ability of heavy
Alcohol has a clear influence on one’s abilities to make good
drinkers to modify behavior so that they appear to be sober
decisions about sex because it lowers inhibitions, and you
even when they have high BAC levels.
may do things you might not do when sober. Seventy percent
224 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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of college students admit to having engaged in sexual activity
primarily as a result of being under the influence of alcohol.
Students who are intoxicated are less likely to use safer
sex practices and are more likely to engage in high-risk
sexual activity. The risk of acquiring a sexually transmitted
infection or an unplanned pregnancy also increases among
students who drink more heavily compared to those who
drink moderately or not at all.
Women and Alcohol
Body fat is not the only contributor to the differences in alco-
hol’s effects on men and women. Compared to men, women
have half as much alcohol dehydrogenase, the enzyme that
breaks down alcohol in the stomach before it has a chance to
reach the bloodstream and the brain. Therefore, if a man and
a woman drink the same amount of alcohol, the woman’s
BAC will be approximately 30 percent higher than the man’s
BAC, leaving her more vulnerable to slurred speech, careless
driving, and other drinking-related impairments.
Hormonal differences can also affect a woman’s BAC. Cer-
Increasing numbers of women on college campuses are trying to
tain times in the menstrual cycle and the use of oral contracep-
keep up with their male peers when binge drinking. The results can
tives are likely to contribute to longer periods of intoxication.
be dangerous; a woman’s BAC will be higher than a man’s after the
This prolonged peak appears to be related to estrogen levels.
same number of drinks.
Immediate Effects of Alcohol
headache, muscle aches, upset stomach, anxiety, depression,
diarrhea, and thirst. Congeners, forms of alcohol that are
The most dramatic effects produced by ethanol occur within
metabolized more slowly than ethanol and are more toxic, are
the central nervous system. Alcohol depresses CNS functions,
thought to play a role in the development of a hangover. The
which decreases respiratory rate, pulse rate, and blood pres-
body metabolizes the congeners after the ethanol is gone
sure. As CNS depression deepens, vital functions become notice-
from the system, and their toxic by-products may contribute
ably affected. In extreme cases, coma and death can result.
to the hangover. Alcohol also upsets the water balance in the
Alcohol is a diuretic that causes increased urinary output.
body, which results in excess urination, dehydration, and thirst
Although this effect might be expected to lead to automatic
the next day. Increased production of hydrochloric acid can
dehydration (loss of water), the body actually retains water,
irritate the stomach lining and cause nausea. It usually takes
most of it in the muscles or in the cerebral tissues. The reason
12 hours to recover from a hangover. Bed rest, solid food, and
is that water is usually pulled out of the cerebrospinal fluid
aspirin may help relieve its discomforts, but the only cure for
(fluid within the brain and spinal cord), leading to what is
a hangover is abstaining from excessive alcohol use.
known as mitochondrial dehydration at the cellular level
within the nervous system. Mitochondria are miniature
Drug Interactions When you use any drug (and alcohol
organelles within cells that are responsible for cell respira-
is a drug), you need to be aware of its possible interactions
tion, and they rely heavily on fluid balance. When mitochon-
with other drugs (Chapter 7), whether prescription or over-
drial dehydration occurs, the mitochondria cannot carry out
the-counter (OTC). Using alcohol while taking any other drug
their normal functions. This results in symptoms that include
that causes CNS depression increases the effects of both of the
the “morning-after” headaches some drinkers suffer.
Alcohol irritates the gastrointestinal system and may cause
indigestion and heartburn if taken on an empty stomach. In
dehydration Loss of fluids from body tissues.
addition, people who engage in brief drinking sprees during
which they consume unusually high amounts of alcohol put
cerebrospinal fluid Fluid within and surrounding the brain
themselves at risk for irregular heartbeat or even total loss of
and spinal cord tissues.
heart rhythm, which can disrupt blood
hangover The physiological reaction to excessive drinking,
flow and damage the heart muscle.
Is
including symptoms such as headache, upset stomach,
there
any cure
Hangover
anxiety, depression, diarrhea, and thirst.
A hangover is often expe-
rienced the morning after a drinking
congeners Forms of alcohol that are metabolized more
for a
spree. The symptoms of a hangover are
slowly than ethanol and produce toxic by-products.
hangover?
familiar to most people who drink:
ISBN: 0-558-34154-3
CHAPTER 8
Alcohol, Tobacco, and Caffeine
225
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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