Concept of alcoholism as a public health perspective

ppt on alcoholism . drug abuse

1. ALC O HOLISM Presented by : Pradip kushwaha MPH 8 th Batch, PU 2024

2. What is Alcohol? Alcohol is a toxic and psychoactive substance with dependence producing properties. The alcohol is a drug, toxic and addictive in nature. The alcohol in drink is called ethanol (ethyl alcohol). It is made when yeast ferments the sugar in grains, fruits and vegetables. For examples- wine is made from sugar in grapes and vodka is made from sugar in potatoes.

3. Nepal Liquor Act of 2031, liquor is defined as any alcoholic substance that's made from grains, fruits, or other starch substances that are fermented through a biochemical process or other method. This includes wine, beer, whisky, rum, gin, brandy, vodka, sherry, champagne, cider, and more. 

4. Type of Drink Alcohol By Volume (ABV) Beer 4-8 % Unfortified Wine 12-16% Fortified Wine 16-25% Whiskey 36-50% Tequila 50-51% Bourbon 40% Fine Liqueurs 15% Gin 36-50% Vodka 40-95% Rum 36-50% https://home.binwise.com/blog/abv-meaning Alcohol concentration in different brand

5. How much alcohol is safe to drink? It’s never completely safe drinking is never free of risk. The less you drink, the lower your risk of harm from alcohol.

6. Standard Drink One standard drink : In US (NIAAA):- 14 gm (17.7ml) of pure alcohol(ethanol) . In Australia/Russia :- 10gm (12.7ml) ,, In UK : 8 gm (10ml ) ,, Different country define in different way.

7. One Standard Drink A/c to National institute on Alcohol abuse and Alcoholism (NIAAA), US define one standard drink as follow:- 14 gm (17.7ml ) of pure alcohol (ethanol) which is found in 12 fluid ounces (355ml) of regular beer which is usually about 5% alcohol 5 fl. ounces (148ml) of wine, which is typically about 12% alcohol 1.5 fl. ounces (44.36 ml ) of distilled sprit which is about 40% alcohol

8. Drinking level : NIAAA US, define drinking level in three category: 1. Moderation drink: For Men : Legal drinking age can choose not to drink or drink in moderation by limiting 2 drink or less in a day. For Female : 1 drink or less in a day. 2. Binge drinking: NIAAA US defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08% or 0.08 gm per deciliter or high.

9. For a typical adult this pattern corresponds to 5 or more drinks for male and 4 or more drinks for female in about 2 hours. Substances abuse and mental health services admintration (SAMHSA) define binge drinking as a 5 or more drinks (Male) and 4 or more drinks (Female) on same occasion.(i.e. on the same time or couple of hours of each other) at least on 1 day in past months. 3. Heavy alcohol use : NIAAA define as : For Men : 5 drinks or more on any day or 15 drinks or more per week. For women : 4 or more drink on any day or 8 drinks or more per week.

10. How much alcohol is safe to drink? l is safe to drink? How much alcohol is hhow safe to drink? When a person with BAC levels between 0.10% and 0.20% does not show obvious signs of intoxication, it typically means they’ve developed a tolerance for alcohol. Pregnant women : do not drink any alcohol at any amount. Binge drinks and heavy drinks increase high risk of individual’s alcoholism.

11. Alcoholism : The term  alcoholism  was first used by Swedish physician  Magnus Huss  in an 1852 publication to describe the systemic adverse effects of alcohol. The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence". Some scholars suggested that  DSM-5  merges alcohol abuse and alcohol dependence into a single new entry, named "alcohol-use disorder.   Diagnostic and Statistical Manual of Mental Disorders - DSM

12. Definition : Alcoholism also known as alcohol use disorder (AUD), is a chronic disorder characterized by an inability to control or limit alcohol consumption despite its negative consequences on individuals' health, relationship responsibilities. Symptomps of Alcoholism : Loss of control : inability to control or stop alcohol once they start. Craving and urges : intense(strong) desire or impulses to drink alcohol frequently common. Withdrawal syndrome : when alcohol use is reduced or stop withdrawal symptoms develops such as nausea, vomiting, sweating, shaking hand or body.

13. 4. Neglecting responsibilities: alcohol can lead to neglecting major obligations at work ,school or home due to repeated alcohol use. 5. Risk taking behaviour : alcohol is consumed whare is not safe such as while driving, swimming. 6. Excess time spent on drinking: giving more time in alcohol consumption. 7. Alcohol intoxication : high blood alcohol levels can lead o behavior problems, memory lapses(blackouts) and even coma or death.

14. Burden of alcoholism: Global : The harmful use of alcohol is a causal factor in more than 200 diseases and injury conditions. Worldwide, 3 million deaths every year result from harmful use of alcohol. This is about 5.3% of all deaths. Alcohol consumption causes death and disability relatively early in life. In people aged 20–39 years, approximately 13.5% of total deaths are attributable to alcohol. (Source: https://www.who.int/news-room/fact-sheets/detail/alcohol )

15. National : Alcohol consumption patterns among adults (15-69 years) : 72.2% of adults (56% men & 86.5% women) were lifetime abstainers. 23.9% of adults (38.6% of men, 10.8% of women) were current drinkers (consumed alcohol in the past 12 months). This was equivalent to 4.8 million adults (3.7 million men and 1.1 million women) in 2019. Almost 1 in 8 men (11.7%) drink daily or almost daily.

16. Heavy episodic drinking : 6.8% of adults (12.4% of men, 1.7% of women) engaged in heavy episodic drinking (consumed 6 standard drinks or 60g of pure alcohol or more drinks on any single occasion in the past 30 days). This was equivalent to 1.1 million adults in Nepal in 2019. More than one-fourth (28.4%) of current drinkers (32.2% men, 16.2% women) engaged in heavy episodic drinking. (source: Nepal step survey 2019)

17. More than two-third (64.8 percent) of the drug users had used alcohol at least once in their lifetime. Almost every four out of five (88.4 percent) of those who ever used alcohol had consumed an alcoholic drink before the age of 20 years. Among the ever alcohol users, 71.4 percent had initiated use between the age of 15-19 years. Source: Nepal drug user survey 2076

18. Risk factors the development of alcoholism is influenced by a combination of genetic, psychological, social, and environmental factors. Here are some of the key risk factors as follow: Genetic Factors Family History : Individuals with a family history of alcoholism are more likely to develop the disorder due to inherited genetic predispositions. Genetic Variations : Certain genetic variations can affect how alcohol is metabolized and how it impacts the brain, increasing the risk of alcoholism.

19. Psychological Factors Mental Health Disorders : Conditions such as depression, anxiety, bipolar disorder, and schizophrenia can increase the likelihood of alcohol use disorder. Personality Traits : Traits such as high impulsivity, low self-esteem, and a tendency toward risk-taking behaviors are associated with a higher risk of developing alcoholism. Stress and Coping Mechanisms : Individuals who use alcohol to cope with stress, trauma, or emotional pain are at a higher risk of developing alcoholism.

20. Social and Environmental Factors: Peer Pressure and Social Norms : Social environments that normalize heavy drinking, peer pressure, and the influence of friends or family members who drink heavily can contribute to the development of alcoholism. Early Onset of Drinking : Starting to drink at a young age increases the risk of developing alcohol use disorder later in life. Cultural and Societal Influences : Societal attitudes towards drinking, availability of alcohol, and cultural practices involving alcohol can impact drinking behaviors. Such as Newar, Tamang , Gurung ethnicity.

21. Biological Factors Gender : Men are more likely to develop alcoholism than women, although women are more susceptible to the physical consequences of alcohol use. Age : Younger adults, particularly those in their late teens and twenties, are at higher risk of developing problematic drinking behaviors.

22. Environmental Stressors: Trauma and Abuse : Experiencing trauma or abuse, whether physical, emotional, or sexual, is a significant risk factor for developing alcoholism. Chronic Stress : Ongoing stress from sources such as work, relationships, or financial difficulties can lead to increased alcohol consumption as a coping mechanism. Easy Availability of Alcohol : Easy access to alcohol, whether through legal means or within one's social environment, can increase the likelihood of excessive drinking.

23. Short-Term Health Effects Impaired Judgment and Coordination : Alcohol impairs cognitive functions, leading to poor judgment, slowed reflexes, and coordination problems. increases the risk of accidents and injuries. Alcohol Poisoning : Consuming large amounts of alcohol in a short period can lead to alcohol poisoning, a potentially fatal condition characterized by confusion, vomiting, seizures, slow or irregular breathing. Accidents and Injuries : Increased risk of falls, drownings, car accidents, and other injuries due to impaired motor skills and decision-making. Violence and Risky Behaviors : Higher likelihood of engaging in violent behaviors, risky sexual activities, and other dangerous behaviors.

24. Long-Term Health Effects Liver Disease : Chronic alcohol use can lead to liver diseases such as fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Cardiovascular Problems : Increased risk of high blood pressure, cardiomyopathy (weakened heart muscle), arrhythmias (irregular heartbeat), and stroke. Gastrointestinal Issues : Alcoholism can cause gastritis, ulcers, pancreatitis, and damage to the esophagus and stomach lining. Neurological Damage : Long-term alcohol use can result in brain damage, cognitive impairments, Wernicke-Korsakoff syndrome (a severe memory disorder), and peripheral neuropathy (nerve damage).

25. 5. Mental Health Disorders: Higher risk of developing mental health issues such as depression, anxiety, and an increased risk of suicide. 6. immune System Suppression: Alcohol weakens the immune system, making the body more susceptible to infections and illnesses. 7. Cancer : Increased risk of several types of cancer, including mouth, throat, esophagus, liver, breast, and colorectal cancer. 8 .Reproductive Health Issues: In men, chronic alcohol use can lead to erectile dysfunction and reduced fertility. In women, menstrual irregularities and an increased risk of miscarriage, stillbirth, and premature delivery.

26. 9. Fetal Alcohol Spectrum Disorders (FASD) : Pregnant women who consume alcohol risk causing severe developmental issues in their babies, including physical abnormalities, cognitive deficits, and behavioral problems. 10. Family and Relationship Problems : not good relationships with family members, friends, and colleagues due to behavior changes and neglect of responsibilities.

27. SAFER Strategy WHO S- Strengthen restrictions on alcohol availability A- Advance and enforce drink driving counter measures F- Facilitate access to screening, brief interventions and treatment E- Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion R- Raise prices on alcohol through excise taxes and pricing policies

28. Drugs abuse Drugs are chemicals substances that affect both body and mind funtions when enter in body. Prolong use of drugs may leads to physical and psychological dependences. Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Drugs abuse :W hen people use drugs too much(over dose) or in harmful ways for nonmedical purpose or for pleasures, even though it causes problems in their social life, mental health, and physical well-being.

29. Indian Narcotics define drug abuse as: "Drug abuse is the habitual use of drugs not needed for therapeutic purposes, solely to alter one's mood, affect, or state of consciousness, or to affect a body function unnecessarily.“ Psychoactive drugs are substances that, when taken in or administered into one's system, affect mental processes, e.g. perception, consciousness, cognition or mood and emotions. Psychoactive drugs belong to a broader category of psychoactive substances that include also alcohol and nicotine. 

30. Global scenario :

31. Nepal

32. With average annual growth 5.06% from 2069 to 2076, current survey show that total no. of drugs users are 1,30,424 in Nepal. Among them, 1,21,692 (93.3 percent) male and 8,732 (6.7 percent) female) .among users 76.2 % are below age of 30 yrs. (source: Nepal drug user survey 2076)

33. Drugs dependency: Drug dependency is a state where the body has adapted to a drug, requiring more of dose to achieve a certain effect (tolerance) and experiencing withdrawal symptoms if the drug is discontinued. Dependency is physical but addiction is neurological. Tolerance: The need to take larger doses of a drug to achieve the same effect. Withdrawal: Physical and mental symptoms that occur after reducing or stopping drug use. Drugs addiction : Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. It is neurological.

34. Substances used as drugs abuse depressants: (down CNS) i ) alcohol ii) benzodiazepam : diazepam, alprazolam, lorazepam. iii) barbiturate iv) marijuana/cannabis 2. Stimulants : (Speed up CNS) :cocaine , pethidine, heroine, nicotine, caffeine. 3.hallucinogens:(auditory and visual alter) Lysergic acid diethylamide (LSD)

35. Causes Peer pressure Curiosity Mental stress Feeling happy Family problems Depression Academic problems Mode of drug intake Smoking Injecting Snifffing swallowing

36. पेट भित्र निलेको अवस्थामा कोकिन २किलो ६५४ ग्राम

37. Mode of Interventions 1. Health Education & public awareness: School programme : implement education programme in school on dangerous /effects of Drugs abuse or Alcoholism. Public campaign : use media ( tv,radio,social media, posture etc ) campaign to raise awarness about risk association with Drugs abuse or Alcoholism. Family level : Parental education : parental monitoring of their children's activities and peer group. Family bond : promotes activities that strength family relationship and emotional bond. Communication skills : effective communication strategies to deal about drug abuse & it’s consequences.

38. 2. Health promotion: Stress coping skills : develop coping stress mechanism to deal with stress without using drug abuse or alcohol. Psychosocial skill develop : develop social skill to resist peer pressure & social influence to adopt unhealthy behaviour , creative thinking, effective communication skills, interpersonal relationship, coping stress & emotion. Promote healthy behaviour development .

39. 3. Policy and Regulation: Restrict easy access to drugs and alcohol . Banned advertisement, sponsorship and promotion of drugs /alcohol. Banned uses of alcohol and drug at public place. Increase tax and penalty for drug abuse. Restrict sales and distribution of drugs . 4. Community organization : community organization to collaborate to prevent drug abuse. Campaign of free drug abuse or alcohol consumption through organized community effort. Mobilization of youth club for prevention of drug abuse.

40. 5. infrastructure (physical: )……………….. 6. Managerial : ……………..