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Lecture Seven

Alcohol #2

**Experimental Drinking, Social Drinking, Culinary Drinking, Recreational Drinking, Binge Drinking, Drinking alone. What are some key differences between these behaviours? The amount of alcohol, types of drinks, the environment (where, with, who), social pressure, your intentions
**What are the 4 characteristics that help us determine is drinking is Drug Abuse? (TASR) Time, Amount, Situation, Recurrent Problems
Drug addition would involve the TASR components + ___________ use, inability to cut down, cravings. Basically dependence on it compulsive
**What does time mean in the TASR components of drug abuse? Time refers to the time to obtain the drink, the time spend drinking it, the time recovering from it.
**What component of TARS is this referring to? Kiwis do not consume a lot more than the world average (6.13). We are at 9.6. But we do exceed in areas of binge drinking, youth drinking, pregnancy drinking. Amount
**Inappropriate situations of drinking could be considered as drug abuse. Name 5 situations that would be inappropriate. At work, while driving, during pregnancy, at weddings and funerals (getting drunk), during the week with no occassion, in front of kids.
**Discuss if NZ meets the TAST components of drug abuse. ..
**Medicalization has fostered the distinction between alcoholism and drug addiction. In 1950s alcoholism was recognised as...? Then it was redefined as a ..? and now it is seen as a..... ______ ______ ______ with genetic psychological and enviro. factors. an illness, chronic, progressive disease, primary chronic disease
**Describe how tolerance develops in chronic alcoholism (pharmacokinetically, pharmacodynamically and acssociative tolerance) Tolerance develops pharmacokinetically as alcohol dehydrogenase upregulate in the liver (*biphasic), pharmacodynamically as receptors adapt to ethonals effect in two ways, and through associative tolerance where the context initiates adaptive physio mxns
**Tolerance in chronic alcoholism develops pharmacokinetically. Describe this in further detail Alcohol dehydrogenase enzymes upregulate in the liver->means that more alcohol will be metabolised.This upregulation is BIPHASIC-> means in earlier stages of consumption enzymes upregulate but u then lose tolerance as u lose enzymes so get drunk .
**Tolerance in chronic alcoholism develops pharmacodynamically as well. Describe this in further detail Receptors adapt to ethanols effect in TWO ways: overtime GABA agonist receptors are down regulated which decr. level of inhibition to counter sedative effects of alc. Simultaniously NMDA antagonist receptors upregulate which also decr. inhibition.
**Tolerance in chronic alcoholism develops via associative tolerance as well. Describe this in further detail Context initiates adaptive physio mechansims. For example with patterned drinking, if u drink at the same time & same place your body will prepare by upregulating alcohol dehydrogenase enzymes in liver or by adapting GABA, NMDA recpeptors & HR incr.
**an alcoholic may not appear intoxicated despite a high BAC (due to....) But their ___________ and _____________ processing will be impaired. Pharmacodynamic tolerance that decreases behavioural inhibition. Cognitive and locomotor processing
**Even if you do not feel drunk or inhibited, it is still important not to drive. Why? Because prior to this euphoria/behavioural disinhibition, your cognitive and locomotor processing is already impaired.
**Describe the how dependence develops when BAC level drops When BAC drops an alcoholic will experiences seizures, tremors, hallucinations, agitation, confusion, disorientation which in sum=Delirium Tremens-DTs is fatal as high risk of seizure cos of upregulation of NMDA receptors & glutamate activity (alc tox.)
**How could alcohol withdrawal induce seizures? As NMDA receptors have upregulated, when you stop drinking you have too much Glutamate activity in your synapses which contributes to neurotoxicity due to too much excitation which leads to DT (seizures)
**The health damage of chronic alcoholism is multi-faceted. List the possible health problems: Cirrhosis (loss of function in liver), Dementia (Korskoffs), GI problems (pancreatitis, gastrisis, ulcers as if liver isn't working you cant get vitamins), <--nutritional problems, muscle wasting usually in legs and major risk of cancer.
**Define Dementia Significant persistent, progressive (will only get worse) loss in cognitive capacities (not just memory).
**There is a hidden population of people with dementia. Explain 10% of dementias are alcohol-related (Korsakoffs syndrome) BUT likely > 10%. Clinicians not realise that dementia patient was an alcoholic-family don't talk about or being an alcohol is not as obvious as heroin addict.
**How is alcohol related to Dementia? *Alcohol is a neurotoxin which means it can cause neuro damage. *Alcohol interferes with vitamin absorption and utilization --> B deficiency -> neuro damage --> Wernickes Encephalophathy) Therefore alcoholism damages the brain in two ways...
**Alcohol is a neurotoxin which means it can cause neuro damage. Alcohol interferes with vitamin absorption and utilization --> B deficiency -> neuro damage) Therefore alcoholism damages the brain in two ways...? Alcohol damage + B deficiency damage --> two-fold neuro damage as you can get Korsakoffs Dementia AND Wernickes Encephalopathy (WK syndrome)
**What are the symptoms of Korsakoff's Dementia (Wernicke Korsakoff Syndrome)? *Profound antero and retrograde amnesia (so behaviour changes as you become delusional), * Confusion, confabulation and disorientation, *Ataxia (lack of voluntary control of muscle movements) and oculomotor dysfunction.
Korsakoffs Dementia's age of onset is usually....? YOUNGER (40s, 50s).
*How you treat alcoholism depends on how you define alcoholism - a choice or a disease? Alcoholic Anonymous (AA) spans treatment for both ways of thinking as you have to take rational logic of behaviour but also say you have no control. Describe this Being a behavioural choice you need to alter behaviour (use CBT-based Rehab and Rational Recovery groups to address logic of behav.). Being a medical condition you must treat it using Medical Rehab and Pharmacological approaches.
**Should alcohol be illegal, should there be an age requirement for alcohol, what should it be for purchasing for consumption? Should not be illegal cos this will create blackmarket and govt. won't be able to control alcohol use, & people won't receive knowledge about safe alcohol use. Age should be 18 as thats when we are adults. Consumption age should also be 18-not with parent
**Would raising the drinking age positively change the drinking culture? No because people will still be able to access alcohol off people older then them.
**Would increasing the price of alcohol positively change the drinking culture? Yes, but noone would vote for this
**Would reducing the number of trading hours of alcohol outlets positively change the drinking culture? No because people will just be more prepared and stock up on alcohol. And drink more earlier on so that they don't sober up as much (which could be more harmful)
**With drink driving, should the BAC of alcohol be reduced to 0.05? Yes, and I actually think that BAC limit for all ages when driving should be zero because of the large amount of car incidents due to alcohol and 1000 people killed every year because of it. That is almost 20 people are week!!
**There is huge variability in behaviour effects between individuals with BAC of 0.08. And motor impairments occur before the behavioural effects. !!!! ..
Created by: alice476