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C H A P T E R 1 3
Using Alcohol and Other Drugs
Lecture Outline
I. Alcohol Consumption—Yesterday and Today
Alcohol has a long history, having been consumed by nearly every known civilization. The
problems and benefits of drinking alcoholic beverages continue today.
A. A Brief History of Alcohol Consumption
In colonial America, drinking was much more common than it is today (see Figure 13.1),
partially because water and milk were not always purified. Early Puritans objected to
drunkenness, not drinking. Prohibition sentiment emerged during the mid-1800s, and alcohol
consumption in the United States dropped sharply after 1830. In 1920, the 18th Amendment
to the United States constitution outlawed the sale of alcoholic beverages and greatly lowered
per capita consumption. When this amendment was repealed in 1934, consumption rose
sharply.
B. The Prevalence of Alcohol Consumption Today
About two thirds of the adults in the United States are classified as current drinkers, about
10% engage in binge drinking, and 5% are heavy drinkers. Worldwide, about half of adults
drink alcohol.
II. The Effects of Alcohol
Two enzymes, alcohol dehydrogenase and aldelyde dehydrogenase, metabolize alcohol into
acetic acid and water. This metabolic process increases lactic acid (which may bring on anxiety
A. Hazards of Alcohol
Alcohol produces a variety of hazards, both direct and indirect.
1. Direct Effects
Direct hazards are all those harmful effects of alcohol itself, exclusive of any
psychological, social, or economic consequences. With long-term, heavy drinkers, fat
accumulates in the liver, which may eventually lead to cirrhosis, nonfunctional scar tissue
on the liver. Cirrhosis is a major cause of deaths among alcoholics. Prolonged heavy
drinking can also cause neurological damage, and Korsakoff syndrome is often found
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among such drinkers who suffer severe memory loss and cognitive dysfunction. However,
light to moderate consumption does not ordinarily lead to cognitive impairment but seems
2. Indirect Hazards
Indirect hazards of alcohol include poor coordination, judgment, attention, and
possibly increased aggression. Alcohol is involved in as many as 32% of deaths from
motor vehicle crashes around the world and plays a role in homicide, suicide, assault, and
rape. Aggression is not an inevitable consequence of alcohol, but some people show such
a reaction. Drinking alcohol also increases the tendency to make risky decisions, which
may affect safety in many ways.
B. Benefits of Alcohol
Many studies have reported a J-shaped relationship between alcohol consumption and
health, with nondrinkers and heavy drinkers at increased risk, and light to moderate drinkers
having the best prospects for good health. These benefits do not apply to young people but
appear in middle-aged and older adults.
1. Reduced Cardiovascular Mortality
Most of the benefits of alcohol come from reduced heart disease, but drinking also
2. Other Benefits of Alcohol
Compared with nondrinkers, people who consume alcohol moderately have lower
rates of Type 2 diabetes, ulcers, and gallstones. In addition, they may have better cognitive
functioning and they are sick less often. Nevertheless, the benefits of drinking remain
controversial.
III. Why Do People Drink?
A. The Disease Model
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During the past 50 years, the medical profession has advocated a disease model of
alcoholism. The first person to conceptualize alcoholism as a disease was E. M. Jellinek, who
identified specific varieties of drinking patterns. More recently, Jellinek’s classification
system has been replaced by the alcohol dependency syndrome.
1. The Alcohol Dependency Syndrome
2. Evaluation of the Disease Model
Disease models offer a reasonable explanation for why some people drink too much,
B. Cognitive-Physiological Theories
Several alternatives to the disease model emphasize the combination of physiological and
cognitive changes that occur with alcohol use.
1. The Tension Reduction Hypothesis
2. Alcohol Myopia
The alcohol myopia model hypothesizes that use of alcohol creates effects on social
behaviors that produce a kind of shortsightedness in which alcohol blocks out insightful
cognitive processing and alters thoughts related to the self, stress, and social anxiety. The
effects include self-inflation, drunken relief from worry, and drunken excess—manifested
by increased aggression, friendliness, sexiness, and many other exaggerated behaviors.
C. The Social Learning Model
The social learning model suggests that drinking behavior is acquired in the same manner
IV. Changing Problem Drinking
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An increasing number of people in the United States are seeking treatment for problem
drinking. Men outnumber women 2 to 1. The most common programs include self-help and
outpatient programs, but inpatient treatment is another option.
A. Change without Therapy
Many people quit drinking without entering a treatment program. The term spontaneous
remission applies to disease cures without treatment, but for those who do not consider
problem drinking a disease, this term is not adequate. The term unassisted change may be
more accurate, but it, too, may be misleading because it suggests that problem drinkers have
no help from friends or family with their attempts to quit.
B. Treatments Oriented toward Abstinence
All treatment programs have abstinence as their immediate goal, although some
(especially in England and Canada) include controlled drinking as an ultimate goal—at least
for some patients.
1. Alcoholics Anonymous
2. Psychotherapy
Many psychotherapy approaches have been used to treat drinking problems, including
3. Chemical Treatments
Some alcohol treatment programs include disulfiram (Antabuse) or other drugs that
interact with alcohol to produce unpleasant effects, such as dizziness, sweating, headache,
and vomiting. This process is called aversion therapy, which forms an association
between drinking and unpleasant consequences. The problem with adherence and the
unpleasantness of this approach led to its decline. Another chemical treatment uses the
drug naltrexone, which decreases the reward value of drinking and acamprosate, which
decreases craving for alcohol. These last two drugs show more promise than disulfiram for
treating drinking problems.
C. Controlled Drinking
Can former problem drinkers learn to control their drinking? In spite of evidence that
some ex-drinkers can become controlled drinkers, this question remains controversial. Since
the 1960s, controlled drinkers have been found in programs aimed at abstinence, as well as
those designed to allow for controlled drinking.
In programs with control as a goal, research shows that many former drinkers can learn to
control their level of consumption. However, most U.S. treatment centers establish abstinence
as the aim of therapy and do not accept the notion of controlled drinking as an official goal of
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treatment, but controlled drinking is a more common goal in the United Kingdom and
Australia.
D. The Problem of Relapse
V. Other Drugs
Illicit drugs have created many serious social problems in the United States, but despite some
popular media coverage, the health consequences of illegal drugs are relatively minor.
A. Health Effects
Potential health hazards are not limited to illicit drugs—legal drugs can also pose a risk.
The FDA classifies drugs into five categories that vary according to an evaluation of the
dangers of the drug, ranging from those that are available over the counter (Schedule V) to
those that have a high abuse potential and are not legal to possess under any circumstances
(Schedule I).
1. Sedatives
Sedatives induce relaxation by lowering the activity of the brain and even slowing
metabolic rate. The sedative category includes tranquilizers and alcohol, which have
2. Stimulants
Stimulant drugs produce alertness, reduce feelings of fatigue, elevate mood, and
decrease appetite. The most frequently abused stimulants are the amphetamines, drugs
often used to help people stay awake or to decrease appetite. Amphetamines can have
many unpleasant side effects, including increased blood pressure, hallucinations, and
paranoid delusions.
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which produces a feeling of peace and well being, but this massive release depletes the
brain’s supply of serotonin, which produces short-term and possibly long-term problems.
3. Marijuana
4. Anabolic Steroids
Anabolic steroids are used to increase muscle bulk or to improve one’s appearance.
Steroids decrease body fat and increase muscle mass, which makes them attractive to
athletes. Their dangers include upsetting the body’s chemical balance, producing toxicity,
shutting off the body’s own production of steroids, and decreasing levels of HDL.
Tolerance or dependence properties are controversial, but their behavioral effects include
aggression, mood swings, and confusion.
B. Drug Misuse and Abuse
All psychoactive drugs, including those used primarily for medical purposes, are
C. Treatment for Drug Abuse
Treatment for illegal drug abuse is similar to the treatment for alcohol abuse. The
immediate goal for both is abstinence, but the detoxification phase of inpatient treatment is
usually shorter for drug abusers. After detoxification, patients typically receive therapy
oriented toward self-exploration. As with alcohol treatments, programs for drug abuse suffer
from high relapse rates.
D. Preventing and Controlling Drug Use
Efforts to control drug use have taken several forms. Programs similar to smoking
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Exploring Health on the Web
A great deal of information about alcohol and other drugs is available on the Internet, both from
government agencies and from a variety of organizations. A number of the sites devoted to
safety-related information also mention alcohol because of its relation to unintentional and
intentional injuries.
The National Institute on Drug Abuse (NIDA) maintains a website with many options,
including sections for researchers and health professionals, parents and teachers, and students.
Each of these sections has several options, offering a variety of information. In addition, this
website allows access to recent publications and links to related websites.
http://www.rational.org/
This website is sponsored by Rational Recovery, a group that believes that AA is not the
route to recovery. This website provides an interesting way to learn about this alternative
approach.
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A website focused on college drinking and controlling drinking on college campuses. The
website has links to alcohol policies of colleges, as well as facts and research concerning college
drinking.
Suggested Activities
Personal Health Profile — Personal Drinking Patterns
The majority of college students drink alcohol—some abuse it, some will become
abusers, but most will learn to drink responsibly. As part of the Personal Health Profile, your
students should examine their patterns of drinking (or nondrinking), and predict the health
consequences of their alcohol consumption (or abstention). For college-aged people, the health
consequences of smoking are in the future. But with alcohol, the consequences can be immediate
and swift because unintentional injuries and death are more likely when people are drinking.
Debate: Do the Health Benefits of Alcohol Outweigh the Risks?
Alcohol consumption is a major risk for both unintentional and intentional injury, but
drinking also has health benefits. This conflict is the issue of current debate, and you can lead
your students to debate this controversial topic. The issue is whether or not drinking carries
adequate health benefits to lead to its recommendation; do the risks outweigh the benefits. Keep
the debate focused on the issue of health benefits and risks related to alcohol consumption.
Assessing Drug Prevention Programs
Most of your students have experienced drug prevention programs as participants; these
programs are a common part of contemporary education. Arrange a class discussion centered on
students’ experiences and feelings about drug prevention programs (not about drug use or abuse).
Make sure your students are familiar with research on the topic of effective prevention programs
and those that are not so effective. How do these results compare with your students’ experiences
and beliefs? Have them prepare a list of recommendations to school systems for the types of drug
prevention programs they would recommend.
Observing Alcoholics Anonymous
Some meetings of Alcoholics Anonymous (AA) are open only to people who have
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Drinking Patterns of College Students
Assign your students the task of determining drinking patterns of college students on
their campus. The goal of this research is to obtain a representative sample of students who
attend your school, survey them about their drinking habits, analyze the data, and draw
A Social Norms Approach to Reducing Binge Drinking
Many colleges across the United States have tried to implement a social norms-based
intervention to reduce binge drinking. This approach posts messages to students (via the web,
mailings, or posters) that remind students of the low drinking norms among students at that
school. The aim of such interventions is to change student’s perception about the prevalence of
binge drinking.
Campus Policy on Drinking and Drug Use
Many campuses have adopted policies that make campuses drug-free zones. Is your
campus among them? Have your students research the history of this policy, including the
impetus for its formulation. Who decided that the campus should be drug-free? Were students
involved in formulating the policy? What changes occurred as a result of this policy?
Is alcohol included in your school’s drug policy? Discuss how your students feel about
restricting the use of alcohol, which is legal for anyone over age 21.
How Cool is The Cool Spot?
The National Institute on Alcohol Abuse and Alcoholism maintains a website called The
Cool Spot (http://www.thecoolspot.gov/), which offers information to teenagers about underage
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Understanding and Treating Problem Drinking
Have students talk about the biological, social, and psychological factors that may lead to
problem drinking. How do these factors relate to theories mentioned in this chapter? How would
a person’s conceptualization of problem drinking (e.g., a mainly biological viewpoint) possibly
impact his or her treatment choice? What other factors may influence how an individual chooses
treatment?
(From Chapter 4) Health-Related Persuasion
Most college students were not born yet in the 1980s and missed the ubiquitous “Just Say No”
campaign. The following three links are from TV commercials or shows during the 80s that tried
to convince children and teens to “Just Say No” to drugs.
Have students attempt to identify psychological constructs (e.g., self-efficacy, subjective norms,
attitudes) in these commercials. You may want to ask students how they would design more
effective health communications—possibly by targeting different psychological constructs.
Relevant Citations:
o Paglia, A., & Room, R. (1999). Preventing substance use problems among youth:
A literature review and recommendations. The Journal of Primary Prevention,
20(1), 3-50.
▪ This article summarizes the many different approaches possible to
preventing drug abuse.
o Trost, M. R., Langan, E. J., & Kellar‐Guenther, Y. (1999). Not everyone listens
when you “just say no”: Drug resistance in relational context. Journal of Applied
Research 120-138.
▪ This article makes an important point that possibly students will bring up
themselves after watching the PSA—it is much easier to “Just Say No” to
strangers rather than close friends. How could planning (part of the HAPA
model) or implementation intentions help teens be more willing to say no
to friends?
Video Recommendations
From the Media Education Foundation:
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Deadly Persuasion: The Advertising of Alcohol & Tobacco (2003) is a program by Jean
Kilbourne, who specializes in critical analysis of advertising and its impact on behavior and
lives.
From Films for the Humanities & Sciences:
Alcohol (2009) explores the history, some of the myths, attitudes, health impact, and the
prevalence of alcohol use in the United States.
Altered States: A History of Drug Use in America (1993) presents the history of legal and illegal
drug use from the time of the early European settlers to modern times. Putting drug use in
historical perspective can alert your students to the prevalence of drug use over centuries while
contrasting current attitudes and laws with previous beliefs and approaches to controlling drug
use.
Drinking: Are You in Control? (2000) examines the contention that people with drinking
problems are powerless to control their drinking and comes to different conclusions than the AA,
12-step treatment approach.
Steroids (1999) is a video that examines the history of steroid use, interviewing people who have
used or observed the effects of steroids.
Treating Stimulant Addiction: The CBT Approach (2006) features cognitive behavioral therapy,
an underused approach to treating substance use problems.
Videos from the Web:
Multiple Choice Questions
Using Alcohol and Other Drugs
1. What was the effect of the introduction of distilled alcoholic beverages into 18th century
England?
a. All social classes dramatically increased consumption of the new alcoholic
beverages.
b. Consumption of distilled spirits rapidly decreased among the lower classes
because of cost.
c. Widespread consumption and drunkenness increased among the richest social
class.
d. Intoxication increased dramatically among the lower and working classes.
2. A history of social attitudes toward drunkenness reveals that
a. drunkenness has always been acceptable in wine-drinking countries.
b. drunkenness and drinking have been equally condemned.
c. drunkenness has generally been acceptable in beer-drinking countries.
d. drunkenness has always been unacceptable except for special occasions.
3. Alcohol consumption in the United States reached its peak during
a. the early 1800s.
b. the Civil War.
c. Prohibition.
d. World War II.
4. Per capita alcohol consumption decreased dramatically after 1830 in the United States
because of
a. strict enforcement of import quotas on foreign wines and spirits.
b. the high cost of distilled beverages, which related to periodic grain shortages.
c. the passage of the 18th Amendment.
d. the spread of the temperance movement.
5. What was the effect of the passage of the 18th Amendment to the United States
constitution on alcohol consumption?
a. Illegal alcohol consumption increased among the rich who could afford the cost.
b. Consumption increased initially but decreased steadily afterwards.
c. Consumption decreased dramatically from previous levels.
d. There was no effect.
6. Since 1980, the per capita consumption of alcohol in the United States has
a. increased dramatically.
b. increased slightly.
c. remained about the same.
d. declined.
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7. With regard to the consumption of alcohol in the United States, it is most accurate to say
that about
a. 90% of adults drink; about one fourth abuse alcohol.
b. 75% of adults drink; about one tenth abuse alcohol.
c. 66% of adults drink; about 10% binge drink.
d. 90% of adults drink; about 5% abuse alcohol.
8. In the United States, people of this ethnic background have the highest rate of drinking.
a. European Americans
b. Hispanic Americans
c. African Americans
d. Asian Americans
9. In the United States, people of this ethnic background have the highest rate of binge
drinking and heavy drinking.
a. European Americans
b. Hispanic Americans
c. African Americans
d. Native Americans
10. _______ is the most widely consumed drug in the United States.
a. Marijuana
b. Alcohol
c. Cocaine
d. Ecstasy
11. During the mid-1800s in the United States, the attitude toward alcohol was one of
____________.
a. temperance, or moderate use of alcohol
b. prohibition, or abstinence from alcohol
c. toleration, as long as people did not get drunk
d. celebration; people drank in large amounts.
12. The ___________ outlawed the manufacture or sale of alcohol and the _____ ended
Prohibition.
a. 18th Amendment; 19th Amendment
b. 18th Amendment; 21st Amendment
c. 21st Amendment; 22nd Amendment
d. 21st Amendment; 24 Amendment
13. ______ of adults in the US are classified as current drinkers.
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a. 33%
b. 50%
c. 66%
d. 10%
14. In the United States, _____ of people are classified as regular drinkers, ____ as binge
drinkers, and____ as heavy drinkers.
a. 50%, 20%, 10%
b. 50%, 10%, 5%
c. 66%, 15%, 10%
d. 66%, 10%, 1%
15. ________ drinking is having 5 or more drinks on the same occasion at least once per
month.
a. Binge
b. Moderate
c. Heavy
d. Regular
16. ________ drinking is having 14 or more drinks per week for men or having 7 or more
drinks per week for women.
a. Binge
b. Moderate
c. Heavy
d. Regular
17. Which ethnic group has the lowest rates of heavy and binge drinking?
a. European Americans
b. Asian Americans
c. Hispanic Americans
d. Native Americans
18. In the age group of 18-24 year olds, ______ are binge drinkers.
a. 10%
b. 25%
c. 33%
d. 40%
19. Binge drinking can lead to all of the following EXCEPT
a. intoxication.
b. poor judgment.
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c. impaired coordination.
d. long-term cognitive deficits.
20. In the age group of 12-17 year olds, ______ are current drinkers.
a. 10%
b. 20%
c. 33%
d. 40%
21. _______ is the most widely used drug among high school students.
a. Alcohol
b. Marijuana
c. Cocaine
d. Ecstasy
22. The highest rate of binge drinking in the United States is among
a. young adolescents.
b. the elderly.
c. women.
d. young adults, 18 to 25 years of age.
23. After the legal age for buying alcohol was raised to 21, consumption among adolescents
ages 12 to 17
a. dropped dramatically.
b. dropped slightly.
c. remained about the same.
d. rose dramatically.
24. In general,
a. high school dropouts have the highest rate of alcohol consumption.
b. people with a high school education have the highest rate of alcohol consumption.
c. college graduates have the highest rate of alcohol consumption.
d. no relationship exists between educational level and consumption of alcohol.
25. In general, ____ are less likely to binge or drink heavily, whereas ____ are more likely to
be heavy and problem drinkers
a. college graduates . . . high school dropouts
b. high school dropouts . . . college graduates.
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c. college graduates . . . high school graduates
d. men . . . women
26. If not consumed, alcohol turns to vinegar. If it is consumed, it
a. also turns to vinegar.
b. turns to ethanol.
c. is digested by the stomach and passed through the excretory system.
d. turns mostly to sugar.
27. Alcohol dehydrogenase and aldehyde dehydrogenase are
a. enzymes involved in the metabolism of alcohol.
b. toxic byproducts of excessive alcohol consumption.
c. found in fermented but not distilled alcoholic beverages.
d. biological markers that differentiate alcoholics from nonalcoholics.
28. Carla, a 120-pound woman, and her twin brother Carlos, a 200-pound man, decided to
celebrate their 21st birthday by equally dividing a six-pack of beer, although neither had
consumed much alcohol before this time. You would guess that
a. Carla will be more affected by the beer than Carlos.
b. Carlos will be more affected by the beer than Carla.
c. the twins will be equally affected by the beer.
d. neither will be affected by the beer, because beer does not contain enough alcohol
to bring about intoxication.
29. Tolerance refers to
a. the ability to tolerate large doses of drugs without impairment of psychological or
physical abilities.
b. a strong psychological desire and craving for a drug.
c. the property of a drug that requires increasingly higher levels to get the same
effect.
d. the property of a drug that requires changes in the body’s physical functioning,
making the drug necessary for normal functioning.
30. When a drug becomes incorporated into the functioning of the body’s cells and thus
becomes necessary for “normal” functioning, ________ has occurred.
Using Alcohol and Other Drugs
a. dependence
b. tolerance
c. withdrawal
d. death
31. The combination of physiological dependence and withdrawal symptoms is usually
referred to as
a. addiction.
b. tolerance.
c. psychological dependence.
d. psychological addiction.
32. Which of the following is a “direct hazard” of alcohol consumption?
a. an association between consumption and aggression
b. increased consumption leads to increased accidents
c. alcohol’s effect on coordination and cognitive functions
d. an association between increased consumption and progressive liver damage
33. Erick drinks about seven or eight drinks a day. Besides the risk of accidents, Erick’s
greatest INCREASED risk is that of
a. heart disease.
b. oral cancer.
c. lung cancer.
d. cirrhosis of the liver.
34. Korsakoff syndrome is sometimes found among long-term, heavy users of alcohol and is
characterized by
a. nonfunctional scar tissue on the liver.
b. confusion, disorientation, and memory impairment.
c. high blood pressure and rapid, irregular heartbeat.
d. excessive trembling, sweating, anxiety, and hallucinations.
35. Heavy consumption of alcohol may affect pregnancy by
a. decreasing fertility.
b. increasing fertility.
c. increasing the risk of fetal alcohol syndrome.
d. both a and c.
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36. A woman who is a light to moderate drinker during pregnancy
a. is most likely to have a child who suffers from fetal alcohol syndrome.
b. is likely to have a child with facial abnormalities but no other symptoms of fetal
alcohol syndrome.
c. has an increased risk of miscarriage.
d. is likely to have a child who has a heavier than average birth weight.
37. Which of the following is an indirect effect of alcohol consumption?
a. the relationship between drinking and cirrhosis of the liver
b. the relationship between drinking and motor vehicle crashes
c. an increased risk of fetal alcohol syndrome in pregnant women
d. a decrease in thiamin absorption
38. Along with cirrhosis of the liver, alcohol’s principal threat to health is its likelihood of
causing
a. lung cancer.
b. unintentional injuries.
c. heart disease.
d. chronic obstructive pulmonary disease.
39. Research indicates that alcohol
a. increases aggression in some people.
b. increases concentration.
c. causes lung cancer.
d. decreases high-density lipoprotein.
40. Research on the relationship between alcohol and homicide indicates that
a. the killer is likely to have been drinking.
b. the victim is likely to have been drinking.
c. both the victim and the killer are likely to have been drinking.
d. consumption of alcohol causes homicides.
41. College-aged men who have been drinking
a. tend to lose interest in women.
b. tend to drive motor vehicles more cautiously.
c. report that they can concentrate better on schoolwork.
d. are more likely than sober men to be willing to have unprotected sex.