Brief description regarding the Impact of alcoholism on health and the strategies to prevent and control growing burden of alcoholism.

1. PRESENTER: DR BUSHRA JABEEN
SENIOR RESIDENT
DEPT OF COMMUNITY MEDICINE
KIMS, HUBLI

2. CONTENTS
• ALCOHOL –INTRODUCTION
• KEY FACTS – HARMFUL USE OF ALCOHOL
• TYPES OF ALCOHOL – STANDARD DRINKING
• METABOLISM OF ALCOHOL
• USES OF ALCOHOL
• CONSEQUENCES OF ALCOHOL CONSUMPTION
• STRATEGIES TO MINIMIZE ALCOHOL PROBLEMS
• PREVENTION AND CONTROL
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3. ALCOHOL
• By pharmacological definition, alcohol is a drug and may be classified as a sedative,
tranquillizer, hypnotic or anaesthetic, depending upon the quantity consumed.
Of all the drugs, alcohol is the only drug whose self-induced intoxication is socially
acceptable.
• It is not a "stimulant" as long believed, but a primary and continuous depressant
• Alcohol produces psychic dependence of varying degrees from mild to strong, and the
physical dependence develops slowly
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4. KEY FACTS (21/09/2018) HARMFUL USE OF ALCOHOL
 Worldwide, 3 million deaths/ year result from harmful use of alcohol (5.3 % of all deaths).
 Causal factor in more than 200 disease and injury conditions.
 5.1 % of the global burden of disease and injury, as measured in Disability-adjusted Life Years
 In the age group 20–39 years approximately 13.5 % of the total deaths are alcohol-attributable.
 Harmful use of alcohol  mental and behavioral disorders, NCDs, injuries.
 The latest causal relationships between harmful drinking and incidence of infectious diseases
such as tuberculosis as well as the course of HIV/AIDS.
 Significant social and economic losses to individuals and society at large.
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5. TREND AND PATTERN OF DRINKING
• Sale of alcohol has been growing steadily at 6%
and is estimated to grow at the rate of 8% per
year.
• About 80% of alcohol consumption is in the form
of hard liquor or distilled spirits.
• Branded liquor accounts for about 40% of alcohol
consumption
• People drink at an earlier age than previously.
• The annual loss due to alcohol was estimated to
be Rs.70,000 to 80,000 million.
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6. INDIA - AN ATTRACTIVE BUSINESS
PROPOSITION FOR THE LIQUOR INDUSTRY
• Large population
• Increased alcohol use due to:
• Changing social norms,
• Urbanization,
• Increased availability,
• High intensity mass marketing and
• Relaxation of overseas trade rules
• The major source of revenue are the taxes generated from alcohol production and its sale.
• Alcohol was the first or second major drug of abuse in all except one state.
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Beer, Whisky, Rum, Gin, Arrack, etc.
The alcoholic content of these beverages varies widely from 5 to 6 per cent in beers to 40 to 45 per
cent in whisky, rum, gin and brandy.

9. METABOLISM OF ALCOHOL
Stomach and small intestine
2-3 minutes
Blood – max concentration
reached in one hour after
consumption
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Every person processes alcohol at a constant rate of about
one standard drink per hour.
Factors that can influence how long an individual feels the
effects of alcohol:
 Age,
 Gender,
 Body composition
 Overall health

10. FACTORS INFLUENCING METABOLISM OF ALCOHOL
• Age : the older a person is, the longer alcohol stays in the liver.
• Sex: alcohol is metabolized differently by woman’s system and stay longer than it is in men.
• Food: peak BAC could be as much as 3 times higher in someone with an empty stomach than in
someone who has consumed food before drinking.
• Body size: a person’s body size and composition are also factors that can impact how fast alcohol is
processed. Individuals with more body fat generally have higher BAC.
• Medications: some medications slow the process of gastric emptying causing the higher BAC levels
and intoxication. Ex: anti-anxiety medications, cough and cold medicines, diabetes medications.
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11. BLOOD ALCOHOL CONCENTRATION (BAC)
• The percentage of alcohol in a person’s bloodstream
• Expressed as a percentage of ethanol present in the blood in units of mass of alcohol per volume.
• For most, one ounce of alcohol will produce a 0.015% blood alcohol concentration.
• Someone with a 0.015% BAC will have little to no alcohol in their bloodstream after 10 hours have
passed.
• Some BAC interpretations :-
• 0.05% to 0.055% = negative effects increase.
Feelings of calm, happiness, and relaxation turn into depression, irritability, and disorientation.
• 0.08% to 0.09% = sense of balance is off and motor skills are impaired.
People may vomit, the body cannot metabolize the alcohol fast enough.
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The more you drink alcohol, the longer it stays in the system.

12. HOW LONG DOES IT STAY IN BODY?
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Blood: Up to 12 hours.
Urine: Up 3 to 5 days via the Ethyl
Glucuronide (ETG) test or 10 to 12
hours via the traditional method.
Hair: Up to 90 days

13. USES OF ALCOHOL
Non-
beverage
uses
• Fuel
• Solvent
Beverage-
related uses
• Medicine,
• Religious
sacrament,
• Foodstuff,
• Thirst-
quencher
Other uses
• Anodyne
• Anesthetic
• For Mood
alteration
• Social
celebration
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Perfume Solvent
Antiseptics
Fuel
Drinks

14. DETERMINANTS OF ALCOHOL CONSUMPTION
DIMENSIONS OF DRINKING
• Individual and the societal factors
• Environmental factors
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There is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the
person is to develop alcohol-related problems
 The total volume of alcohol consumed, and
 The pattern of drinking.

15. ALCOHOL CONSUMPTION AND HEALTH OUTCOMES :
CONCEPTUAL CAUSAL MODEL
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16. ASPECTS TO BE EMPHASIZED ON THE CLIENTELE
1. “Moderate” alcohol intake may be associated with lower HDL - cholesterol levels and lower
IHD mortality
2. Continued alcohol intake, even in mild to moderate quantities, is associated with a number
of diseases.
3. It is difficult to maintain “moderation” - many of those who are initially moderate may
become heavy drinkers gradually.
4. There are various other more healthy methods (as brisk, regular physical exercise) rather
than drinking, to increase the HDL levels.
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Current concept :

18. CONSEQUENCES OF ALCOHOL ABUSE
•Crime
•Murder
•Prostitution
•Neglect of families
•Malnutrition
•Disease
•Unemployment
•Indebtedness
•Child delinquency
•Road accidents
•Loss of friends and self-esteem.
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19. CONSEQUENCES OF ALCOHOL ABUSE
Short-term
• Slurred speech
• Vision impairment
• Lack of coordination
• Extreme shifts in mood
• Memory lapses
• Slowed breathing
Long-term
• Cardiovascular diseases
• Liver disease
• Respiratory infections
• Cancer
• Nerve damage
• Ulcers
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Drinking by adults serves as a role model for the young.
Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications.

20. WHAT ALCOHOL DOES TO YOUR BODY AND BRAIN
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21. ISSUES OF CONCERN
•Pay-day drinking
•Violence including domestic violence
•Poverty
•high risk sexual behavior  sexually transmitted diseases including HIV/AIDS.
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22. POSITIVE EFFECTS CONTROVERSIAL OBSERVATIONS
Drinking (RED WINE) at moderate levels
Inhibiting the build-up of plaque in arteries
&
Diminishing the likelihood of blood clots
Cardiovascular disease
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23. STRATEGIES
TO
MINIMIZE
ALCOHOL
PROBLEM
Education and persuasion
Deterrence
Providing and encouraging alternative activities
Insulating user from harm
Regulating the availability and conditions of use
Social and religious movements and community action
Treatment and other help
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24. PREVENTION & CONTROL
•The identification of risk factors is essential for prevention.
•As drinking patterns vary considerably, the prevention of alcoholism is not easy.
•A widespread public education and discussion, and investigation of public
attitudes may result in measurable improvement.
•The above strategy should be combined with social welfare and health services.
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25. FOCUS OF PREVENTIVE STRATEGY
Two levels
The national
Or
Large community level
At the individual
Or
family level.
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26. STEPS AT
THE NATIONAL / LARGE COMMUNITY LEVEL
The approach would include a combination of three strategies
Information, Education and Communication
(IEC) steps
Statutory (legal or regulative) steps
Fiscal steps
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27. INFORMATION, EDUCATION & COMMUNICATION
STEPS
Developing a nation wide educational strategy and program :
• A comprehensive policy and programme should be developed and be involved in the departments of advertising and audio –
visual media and those concerned with information and broadcasting, not only on governmental but also private channels.
Counter - advertising (counter - marketing) campaigns :
• Taking the help of prominent public personalities as cine stars and sports - persons may be of further help.
School and youth based IEC programs :
• Educational programs be developed, targeting adolescents in the schools as well as at other youth forum as youth festivals,
sports functions, etc.
Quitlines / helplines :
• Developing telephonic helplines are helpful to provide total assistance to the alcoholic who desires to quit, maintain a state of
cessation as well as for persons who want education and assistance for not initiating alcohol use habit.
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28. LEGISLATIVE AND REGULATORY MEASURES
To make availability of alcohol difficult to consumers
To ensure that users of alcohol do not harm the other members of their family / community.
Provisions :
• Printing of statutory warnings on the packets of alcoholic products.
• Prohibition of use of these substances in public places, offices, common rooms, etc.
• Prohibition of sale of these substances to vulnerable groups.
• Ban on advertisements on promotion of alcoholic products.
• Promulgation of “dry state” order by certain state wherein consumption of alcohol is totally banned,
except for those having permit to drink.
• Testing of motor vehicle drivers for breath test and alcohol level in blood.
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29. FISCAL MEASURES
•Increasing the prices of alcoholic products
Public health policy makers should suggest to the governments to consider an
increase on excise on raw material and increased taxation on finished product.
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As regards alcohol, we do not have well formulated legislative regulations as we have
for tobacco, but the effort of the Government has been, in recent years, to develop a
comprehensive policy as well as legislation to reduce alcohol intake among
communities.

30. STEPS AT
THE FAMILY AND INDIVIDUAL LEVEL
Objectives:
Educating, motivating and supporting the individuals and families for
1. Not initiating the alcohol habit and,
2. To give up the habit.
The steps documented to be beneficial are:
Educating and motivating the family members.
Enrolling “peer groups”, in motivating and playing role model for the community.
Developing support groups as “alcoholics anonymous” groups and informing the community members about
their location, ways to contact them and the help that they can provide.
Pharmaceutical measures as disulfuram for alcohol cessation. These measures should be used under medical supervision.
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31. PUBLIC POLICIES TO
REDUCE THE HARMFUL USE OF ALCOHOL.
Regulating the marketing of alcoholic beverages (in particular to younger people);
Regulating and restricting the availability of alcohol;
Enacting appropriate drink-driving policies;
Reducing demand through taxation and pricing mechanisms;
Raising awareness of public health problems caused by harmful use of alcohol
Ensuring support for effective alcohol policies;
Providing accessible and affordable treatment for people with alcohol-use disorders;
Implementing screening and brief intervention programmes for hazardous and harmful drinking in health
services.
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32. REFERENCES
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stay-system/
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