8 酒, 煙, 以及咖啡因: 未被公認的成癮性

Alcohol 飲酒的概況 70% 的美國人會規律地喝含有酒精性飲料 10% 的人為飲酒過量者 飲酒與大專生 84% 的大專生會購買含有酒精性的飲料 1/3 的大專生為飲酒過量者 每年有12 million undergrads 喝掉4 billion 的罐裝啤酒 每人大致花上$446購買含有酒精性的飲料

表 8.1

Alcohol 狂飲的定義與大專生 男性連續喝 5 杯 女性連喝四杯 美國每年估計有50名學生死於酒精中毒

Alcohol College Student’s Patterns of Alcohol Use, 2001 19 percent 戒酒者 Why might college students be vulnerable to alcohol abuse?

Alcohol Trends in Consumption Alcohol use is declining Per capita consumption in 1977 was 2.64 gallons of pure alcohol Per capital consumption in 1998 was 2.19 gallons of pure alcohol Reasons may include attention to weight and health What, if any, trends in consumption have you noticed?

Alcohol 酒的化學成分 (使人酒醉的成分) 乙基酒精(ethyl alcohol)或乙醇(ethanol) 其製造過程稱為發酵 (fermentation process) - Produces beer or wine 蒸餾 (distillation) – 而後蒸氣凝且與水結合而製成最後的產物 強度標準 (proof) – 測量飲料中酒精的百分比

Alcohol 吸收與新成代謝 大約20%喝入的酒是經由胃內襯擴散進入血液中 幾近80%的液體是經由上1/3的小腸吸收 身體吸收酒的速度受許多因素影響: 喝入酒之酒精濃度 喝入的酒量 胃中食物的量 幽門經巒 (Pylorospasm) 飲酒者的情緒

表 8.2

Alcohol 飲酒的毒害 酒精中毒死亡 Two ways this happens 1) 中樞神經系統及呼吸受到抑制或 1) 中樞神經系統及呼吸受到抑制或 2) 吸入嘔吐物或流入肺部

Alcohol 女性與飲酒 Body fat more than lean tissue Alcohol does not diffuse rapidly in body fat 女性只有一半的酒精去經酶 (enzyme) 體內酒量測定器及尿液分析 兩者皆是測量 Blood Alcohol Concentration

Physiological and Behavioral Effects of Alcohol 立即的影響 降低在突觸接合的神經傳導以及衝動的頻率 脫水 水分從腦脊隨液流失 酒精會刺激腸胃系統 宿醉 (Hangovers) 酒精同類物 (Congeners) – 比乙醇代謝僈且更毒 酒精與藥物的交互作用 (p-8-9) What are some symptoms experienced by someone with a hangover?

Physiological and Behavioral Effects of Alcohol 長期的影響 神經系統的影響 Nervous system 心臟血管的影響 Cardiovascular system 肝臟疾病 Liver disease 肝硬化 Cirrhosis 酒精性肝癌 Alcoholic hepatitis 癌 Cancer 對胃腸造成的影響 Irritant to gastrointestinal system 慢性胰臟癌 Chronic inflammation of pancreas

Physiological and Behavioral Effects of Alcohol 酒精與懷孕 影響中樞神經 (腦部) 精神障礙 胎兒酒精症候群 Fetal Alcohol Syndrome (FAS) 每1000名新生兒就有一至二位

Physiological and Behavioral Effects of Alcohol Alcohol and Pregnancy (continued) FAS behaviors include: Difficulty in structuring time 學習障礙 Impaired learning 記憶不好 Poor memory 不正常的行為 Impulsive behaviors Troubled behaviors 胎兒酒精影響 Fetal Alcohol Effects (less severe)

Physiological and Behavioral Effects of Alcohol 飲酒與開車 40% 的交通事故與酒精有關 大專學生喝酒且開車 酒精濃度的標準 0.08, some 0.10 At BAC 0.10, ten times more likely to be in an accident

Alcohol Abuse and Alcoholism Identifying a Problem Drinker Abuse interferes with: Work Life Family Addiction defined by: Tolerance Psychological dependence Withdrawal

酒精中毒的原因 Causes 生理及家庭因素 第一類酗酒者 第二類酗酒者 社會及文化的因素

Alcohol Abuse and Alcoholism 酒精中毒對家庭的影響 1 in 4 children live in an alcoholic situation 影響正常家庭的功能 小孩的角色: 家庭英雄 Family hero 代罪羔羊 Scapegoat 迷失的小孩 Lost child 小丑 Mascot Do you know someone who fits the description of these roles?

Alcohol Abuse and Alcoholism 社會成本 交通事故 健康保險 Health insurance 犯罪成本 Criminal justice 治療的花費 Treatment costs 失去生產力 Lost productivity 飲酒方面的相關花費大約 $184.6 億

Alcohol Abuse and Alcoholism 女人與酒精中毒 更多女性喝酒 女性酗酒者幾乎和男性一樣多 危險因素有: 家族歷史 同儕的壓力 沮喪 壓力

Alcohol Abuse and Alcoholism What are some risk factors among college women? Despite the growing problem only 14% receive treatment Why do you think the percentage is so low?

復原 Recovery 家庭的角色 介入 Express love and concern 治療計劃 私立治療機構 家庭治療、個體治療及團體治療 其他類型的治療 復發

Recovery Treatment Programs (continued) Community mental health facilities Support groups (AA or Women for Sobriety) 復發 Relapse 在治療頭三個月復發的機率是60% Many say they are recovering their whole life

我們吸煙的社會 事實 吸煙再美國統計的死因是單一最容易預防的 每年有43萬美國人死與香菸有關的疾病 這數字是所有因非法藥物死亡總合的50倍 青少年吸煙的百分比 = 34.8% 廣告 Advertising 一天花費 $18 million per day 族群以 18-24 year olds are a target

Annual Deaths Attributable to Smoking in the United States Figure 8.1

Our Smoking Society Financial Costs to Society $150 billion in annual health related economic losses $75.5 billion in medical expenditures College Students Are Smoking More Estimated 60% have tried tobacco products Does tobacco appear to be a big problem on your campus? What efforts are made to decrease smoking?

Table 8.4

Tobacco and Its Effects 吸煙及其影響 丁香菸 雪茄 無菸香菸 香菸過濾器

Tobacco and Its Effects 尼古丁對生理的影響 刺激中樞神經 刺激腎上腺素 增加腎上腺素的生產 增加心跳率 增加循環系統(呼吸系統)的速度 血管挾窄

Tobacco and Its Effects 香菸對健康的危害 癌症 Cancers 肺癌 (85-90%) associated with smoking 胰臟癌 唇癌 舌癌 唾腺癌 食道癌

Tobacco and Its Effects Health Hazards of Smoking (continued) 心臟血管疾病 Cardiovascular Disease Smokers have 70% higher death rate 中風 Smokers are 2 times more likely to suffer

吸煙對肺臟的影響 Figure 8. 1

Health Hazards of Smoking 呼吸系統障礙 Chronic bronchitis Emphysema 性生活 Males are 2 times more likely to suffer impotence 其他對健康的影響 Gum disease More likely to need medications Metabolism of drugs is affected

Environmental Tobacco Smoke (ETS) Risks from ETS Mainstream Sidestream – more carcinogens ETS is responsible for deaths Sidestream smoke causes more deaths a year than any other environmental pollutant Children exposed Have you seen any anti-smoking public service announcements you thought were powerful?

Environmental Tobacco Smoke (ETS) 香菸及政策 (p-8-33) 警告吸煙有害 40 years ago 46 週請求陪賞有關治療吸煙者的健康照顧費用 有些州有菸稅 嚴格管控香煙販賣

Quitting 阻斷尼古丁成癮性 1/3 attempt to quit a year 90% fail Many programs exist to help with quitting Nicotine withdrawal is experienced 尼古丁取代物

Quitting Other Means of Breaking the Habit Aversion therapy Operant strategies Self-control 戒煙的好處 According to the American Cancer Society many tissues will repair themselves (p8-35)

當吸煙者戒煙 Figure 8.3

Caffeine Facts 從黃鹼(xanthines)的化學族群中所獲得的藥物 輕微的刺激中樞神經系統 加快心跳 增加耗氧量 增加尿流量 刺激清醒度

Caffeine 影響 非本意的肌肉收縮 增加心肌收縮 暈眩 反胃 消化不良

Table 8.5

Caffeine Caffeine Addiction Drink more when coming down Caffeinism – jitters, muscle twitch Withdrawing may produce headaches No long-term damage is seen with moderate use in non-pregnant women Have you noticed any of the signs of caffeine addiction in yourself or friends?