Disturbing Trends in Alcohol and Drug Abuse 2014-15
Notes
I.
Municipal Court Concerns
a. Alcohol Offenses
i. Chapter 106 ABC
1. Minor in Possession
2. Minor in Consumption
3. DUI
ii. Public Intoxication
b. Alcohol Related Offenses
c. What Can We Do?
II.
Disturbing Trends
a. Mixing Drugs with Alcohol
i. Mixing alcohol and medicines can be harmful.
Alcohol, like some medicines, can make you
sleepy, drowsy, or lightheaded. Drinking alcohol
while taking medicines can intensify these
effects. You may have trouble concentrating or
performing mechanical skills. Small amounts of
alcohol can make it dangerous to drive, and
when you mix alcohol with certain medicines
you put yourself at even greater risk. Combining
alcohol with some medicines can lead to falls and
serious injuries, especially among older people.
1. Some medications—including many
popular painkillers and cough, cold, and
allergy remedies—contain more than one
ingredient that can react with alcohol.
Read the label on the medication bottle to
find out exactly what ingredients a
medicine contains. Ask your pharmacist if
you have any questions about how
1
TMCEC Regional Judges Seminar - Mark Goodner
Disturbing Trends in Alcohol and Drug Abuse 2014-15
Notes
alcohol might interact with a drug you are
taking.
2. Some medicines contain alcohol. Certain
medicines contain up to 10 percent
alcohol. Cough syrup and laxatives may
have some of the highest alcohol
concentrations.
3. Older people are at particularly high risk
for harmful alcohol–medication
interactions. Aging slows the body’s
ability to break down alcohol, so alcohol
remains in a person’s system longer.
Older people also are more likely to take a
medication that interacts with alcohol—
in fact, they often need to take more than
one of these medications.
4. Mixing alcohol and medicines puts you at
risk for dangerous reactions. Protect
yourself by avoiding alcohol if you are
taking a medication and don’t know its
effect. To learn more about a medicine
and whether it will interact with alcohol,
talk to your pharmacist or other health
care provider.
ii. E-cigs and Vaportinis
1. Alcohol is inhaled rather than swallowed.
2. Selling points (from the website)
a. smooth and flavorful
b. absorbed directly into the
bloodstream
2
TMCEC Regional Judges Seminar - Mark Goodner
Disturbing Trends in Alcohol and Drug Abuse 2014-15
Notes
c. does not go through the digestive
tract
i. no calories, no carbs, no
impurities
ii. the effects of consuming
alcohol are immediately
felt, making it easier to
responsibly imbibe
d. Vaportinis give more control,
shortly after exhaling all of the
effects of the alcohol consumed are
felt. In contrast, it takes 20 to 30
minutes to feel the full effects of
spirits that are swallowed.
e. The Vaportini is legal to sell in all
states for any establishment with a
ìConsumption on Premiseî license.
The alcohol consumed through a
Vaportini will be detected by a
blood alcohol test.
3. Dangers
a. The recommended amount of
spirits is 1 ounce. One inhales
through the straw and holds their
breathe for a moment and then
exhales.
b. Unlike drinking alcohol, where the
liquid is metabolized through
one’s liver, inhaling alcoholic
vapors sends ethanol straight to
3
TMCEC Regional Judges Seminar - Mark Goodner
Disturbing Trends in Alcohol and Drug Abuse 2014-15
Notes
the lungs, the blood stream and
ultimately, the brain.
c. Leads to rapid intoxication
d. Particularly risky for kids because
they may not know when to stop
inhaling.
e. “When people drink, the normal
sensation when they get more and
more drunk is to vomit. It's your
body's way of expelling alcohol is
to vomit," he wrote. "However
your brain can't expel alcohol, so
it's extremely dangerous."
iii. Pharming Parties
1. Get-togethers where prescription drugs
are exchanged and randomly ingested, in
order to become intoxicated.
a. Fact or Fiction?
iv. Alcohol Energy Drinks
1. Caffeinated alcoholic beverages are
premixed beverages that contain not only
alcohol but also include caffeine and other
stimulants.
2. As much caffeine as a large cup of coffee,
along with additives like guarana and
ginseng that can speed up the central
nervous system.
3. High alcohol content, sometimes as high
as 12% as compared with 5% for a typical
can of beer.
4
TMCEC Regional Judges Seminar - Mark Goodner
Disturbing Trends in Alcohol and Drug Abuse 2014-15
Notes
4. Wide-awake drunkenness, where caffeine
masks the feeling of drunkenness but
does not decrease actual alcohol-related
impairment. As a result, you feel less
drunk than you really are, which can lead
to consumption of even more alcohol or
engaging in risky activities like drunk
driving.
5. In 2010 the Food and Drug
Administration warned companies that
the caffeine added to some of their
alcoholic beverages makes the products
unsafe.
6. Double The Risk: Wake Forest University
School of Medicine researchers found that
students who mixed alcohol and energy
drinks had double the risk of being hurt
or injured, requiring medical attention,
driving with an intoxicated driver, being
taken advantage of sexually, or taking
advantage of another sexually.
b. They Put it WHERE?
i. Alcohol Enemas
1. Introducing alcohol into the rectum and
colon via the anus. This method of alcohol
consumption is dangerous because it
leads to faster intoxication since the
alcohol is absorbed directly into the
bloodstream and neutralizes the body's
ability to reject the toxin by vomiting.
5
TMCEC Regional Judges Seminar - Mark Goodner
Disturbing Trends in Alcohol and Drug Abuse 2014-15
Notes
ii. Tampons
1. Vodka-soaked tampons inserted vaginally
to get drunk faster and without having
booze on your breath. It's known as
"slimming."
2. Snopes.com concluded it was false, but a
November 2011 report by KPHO Phoenix
included interviews with a police officer
and doctor who said they had witnessed
cases of it.
iii. Eyeballing
1. Those who do it claim that it induces
feelings of drunkenness at break-neck
speeds, providing an instant high.
c. Substances Not Intended for Ingestion
i. Hairspray
ii. Mouthwash
iii. Antifreeze
III.
Resources
a. www.niaaa.nih.gov
b. http://www.madd.org/
c. http://www.drugabuse.gov/
6
TMCEC Regional Judges Seminar - Mark Goodner
Alcohol Facts and Statistics
Alcohol Use in the United States:
»» Prevalence of Drinking: In 2012, 87.6 percent
of people ages 18 or older reported that they
drank alcohol at some point in their lifetime;
71 percent reported that they drank in the past
year; 56.3 percent reported that they drank in
the past month.1
»» Prevalence of Binge Drinking and Heavy
Drinking: In 2012, 24.6 percent of people ages
18 or older reported that they engaged in binge
drinking in the past month; 7.1 percent reported
that they engaged in heavy drinking in the past month.2
Alcohol Use Disorders (AUDs) in the United States:
»» Adults (ages 18+): Approximately 17 million adults ages 18 and older (7.2 percent of this
age group) had an AUD in 2012. This includes 11.2 million men (9.9 percent of men in this
age group) and 5.7 million women (4.6 percent of women in this age group).3
• About 1.4 million adults received treatment for an AUD at a specialized facility in 2012
(8.4 percent of adults in need). This included 416,000 women (7.3 percent of women in
need) and 1.0 million men (8.9 percent of men in need).4
»» Youth (ages 12–17): In 2012, an estimated 855,000 adolescents ages 12–17 (3.4 percent of
this age group) had an AUD. This number includes 444,000 females (3.6 percent) and 411,000
males (3.2 percent).5 • An estimated 76,000 adolescents received treatment for an AUD at a specialized facility
in 2012 (8.9 percent of adolescents in need). This included 28,000 females (6.3 percent of
adolescent females in need) and 48,000 males (11.7 percent of adolescent males in need).6
Alcohol-Related Deaths:
»» Nearly 88,0007 people (approximately 62,000 men and 26,000 women8) die from alcoholrelated causes annually, making it the third leading preventable cause of death in the United
States.7
»» In 2012, alcohol-impaired-driving fatalities accounted for 10,322 deaths (31 percent of overall
driving fatalities).9
NIH . . . Turning Discovery Into Health®
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov • 301.443.3860
Economic Burden:
»» In 2006, alcohol misuse problems cost the
United States $223.5 billion.10 »» Almost three-quarters of the total cost of
alcohol misuse is related to binge drinking.10
Global Burden:
»» In 2012, 3.3 million deaths, or 5.9 percent
of all global deaths (7.6 percent for men
and 4 percent for women), were attributable
to alcohol consumption.11
»» Alcohol contributes to over 200 diseases
and injury-related health conditions, most
notably alcohol dependence, liver cirrhosis,
cancers, and injuries.12 In 2012, alcohol
accounted for 5.1 percent of disability
adjusted life years (DALYs) worldwide.11
»» Globally, alcohol misuse is the fifth leading
risk factor for premature death and disability;
among people between the ages of 15 and
49, it is the first.13
Family Consequences:
»» More than 10 percent of U.S. children
live with a parent with alcohol problems,
according to a 2012 study.14
Underage Drinking:
»» Prevalence of Underage Alcohol Use:
• Prevalence of Drinking: 2 out of 5
15-year-olds report that they have had
at least 1 drink in their lives.15 In 2012,
about 9.3 million people ages 12–20
(24.3 percent of this age group) reported
drinking alcohol in the past month
(24.7 percent of males and 24 percent
of females).16
• Prevalence of Binge Drinking:
Approximately 5.9 million people
(about 15 percent) ages 12–20 were
binge drinkers (16.5 percent of males
and 14 percent of females).16
Definitions
Alcohol Use Disorder (AUD): AUDs are medical
conditions that doctors diagnose when a patient’s
drinking causes distress or harm. The fourth edition
of the Diagnostic and Statistical Manual (DSM–IV),
published by the American Psychiatric Association,
described two distinct disorders—alcohol abuse
and alcohol dependence—with specific criteria
for each. The fifth edition, DSM–5, integrates the
two DSM–IV disorders, alcohol abuse and alcohol
dependence, into a single disorder called alcohol
use disorder, or AUD, with mild, moderate, and
severe subclassifications.
Binge Drinking:
»»NIAAA defines binge drinking as a pattern of
drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically
occurs after 4 drinks for women and 5 drinks for
men—in about 2 hours.33
»»The Substance Abuse and Mental Health
Services Administration (SAMHSA), which
conducts the annual National Survey on Drug
Use and Health (NSDUH), defines binge
drinking as drinking 5 or more alcoholic drinks
on the same occasion on at least 1 day in the
past 30 days.34
Heavy Drinking: SAMHSA defines heavy drinking
as drinking 5 or more drinks on the same occasion
on each of 5 or more days in the past 30 days.
NIAAA’s Definition of Drinking at Low Risk for
Developing an AUD: For women, low-risk drinking
is defined as no more than 3 drinks on any single
day and no more than 7 drinks per week. For men,
it is defined as no more than 4 drinks on any single
day and no more than 14 drinks per week. NIAAA
research shows that only about 2 in 100 people who
drink within these limits have an AUD.
Substance Use Treatment at a Specialty Facility:
Treatment received at a hospital (inpatient only),
rehabilitation facility (inpatient or outpatient),
or mental health center to reduce alcohol use,
or to address medical problems associated with
alcohol use.
Alcohol-Impaired-Driving Fatality: A fatality
in a crash involving a driver or motorcycle rider
(operator) with a BAC of 0.08 g/dL or greater.
Disability Adjusted Life Years (DALYs): A measure
of years of life lost or lived in less than full health.
Underage Drinking: Alcohol use by anyone
under the age of 21. In the United States, the legal
drinking age is 21.
NIH . . . Turning Discovery Into Health®
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov • 301.443.3860
• Prevalence of Heavy Drinking: Approximately 1.7 million people (about 4.3 percent)
ages 12–20 were heavy drinkers (5.2 percent of males and 3.4 percent of females).16
»» Consequences of Underage Alcohol Use:
• Research indicates that alcohol use during the teenage years could interfere with normal
adolescent brain development and increase the risk of developing an AUD. In addition,
underage drinking contributes to a range of acute consequences, including injuries, sexual
assaults, and even deaths.17
Alcohol and College Students:
»» Prevalence of Alcohol Use:
• Prevalence of Drinking: In 2012, 60.3 percent of college students ages 18–22 drank
alcohol in the past month compared with 51.9 percent of same-age peers not in college.18
• Prevalence of Binge Drinking: 40.1 percent of college students ages 18–22 engaged
in binge drinking (5 or more drinks on an occasion) in the past month compared with 35
percent of same-age peers not in college.19
• Prevalence of Heavy Drinking: 14.4 percent of college students ages 18–22 engaged in
heavy drinking (5 or more drinks on an occasion on 5 or more occasions per month) in the
past month compared with 10.7 percent of same-age peers not in college.20
»» Consequences—Researchers estimate that each year:
• 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional
injuries, including motor-vehicle crashes.21
• 696,000 students between the ages of 18 and 24 are assaulted by another student who has
been drinking.21
• 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual
assault or date rape.21
• Roughly 20 percent of college students meet the criteria for an AUD.22
• About 1 in 4 college students report academic consequences from drinking, including
missing class, falling behind in class, doing poorly on exams or papers, and receiving lower
grades overall.23
Alcohol and Pregnancy:
»» The prevalence of Fetal Alcohol Syndrome (FAS) in the United States was estimated by the
Institute of Medicine in 1996 to be between 0.5 and 3.0 cases per 1,000.24
»» More recent reports from specific U.S. sites found the prevalence of FAS to be 2 to 7 cases
per 1,000,24 and the prevalence of Fetal Alcohol Spectrum Disorders (FASD) to be as high
as 20 to 50 cases per 1,000.25
Alcohol and the Human Body:
»» Among all cirrhosis deaths in 2009, 48.2 percent were alcohol related. The proportion of
alcohol-related cirrhosis was highest (70.6 percent) among decedents ages 35–44.26
NIH . . . Turning Discovery Into Health®
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov • 301.443.3860
»» In 2009, alcohol-related liver disease was the primary cause of almost 1 in 3 liver transplants
in the United States.27
»» Alcohol has been identified as a risk factor for the following types of cancer: mouth, esophagus,
pharynx, larynx, liver, and breast.28
Health Benefits of Moderate Alcohol Consumption:
»» Moderate alcohol consumption, according to the Dietary Guidelines for Americans, is up to
1 drink per day for women and up to 2 drinks per day for men.29
»» Moderate alcohol consumption may have beneficial effects on health. These include decreased
risk for heart disease and mortality due to heart disease, decreased risk of ischemic stroke
(in which the arteries to the brain become narrowed or blocked, resulting in reduced blood
flow), and decreased risk of diabetes.30
»» In most Western countries where chronic diseases such as coronary heart disease (CHD),
cancer, stroke, and diabetes are the primary causes of death, results from large epidemiological
studies consistently show that alcohol reduces mortality, especially among middle-aged and
older men and women—an association which is likely due to the protective effects of moderate
alcohol consumption on CHD, diabetes, and ischemic stroke.31
»» It is estimated that 26,000 deaths were averted in 2005 because of reductions in heart
disease, stroke, and diabetes from the benefits attributed to moderate alcohol consumption.32
»» Expanding our understanding of the relationship between moderate alcohol consumption and
potential health benefits remains a challenge, and although there are positive effects, alcohol
may not benefit everyone who drinks moderately.
For more information, please visit: www.niaaa.nih.gov
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs43to84-2012.htm#Tab2.71B
2
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs43to84-2012.htm#Tab2.46B
3
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.8A
4
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.32A
5
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.5A
6
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect5peTabs1to56-2012.htm#Tab5.29A
7
Centers for Disease Control and Prevention. Alcohol use and health. Available at: http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
8
Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Available at: http://apps.nccd.cdc.gov/DACH_ARDI/
Default/Report.aspx?T=AAM&P=f6d7eda7-036e-4553-9968-9b17ffad620e&R=d7a9b303-48e9-4440-bf47-070a4827e1fd&M=AD96A9C1-285A-44D2-B76DBA2AE037FC56&F=&D=
9
National Highway Traffic Safety Administration. 2012 Motor vehicle crashes: Overview. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811856.pdf
10
Centers for Disease Control and Prevention. Excessive drinking costs U.S. $223.5 Billion. Available at: http://www.cdc.gov/features/alcoholconsumption/
11
World Health Organization. Global status report on alcohol and health, p. XIV. 2014 ed. Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/
msb_gsr_2014_1.pdf?ua=1
12
World Health Organization. Global status report on alcohol and health, p. XIII. 2014 ed. Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/
msb_gsr_2014_1.pdf?ua=1
13
Lim, S.S.; Vos, T.; Flaxman, A.D.; et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions,
1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260, 2012. PMID:23245609 http://www.sciencedirect.com/
science/article/pii/S0140673612617668
14
Substance Abuse and Mental Health Services Administration (SAMHSA). Data spotlight: Over 7 million children live with a parent with alcohol problems. 2012. Available at:
http://www.samhsa.gov/data/spotlight/Spot061ChildrenOfAlcoholics2012.pdf
15
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs1to42-2012.htm#Tab2.15B
1
NIH . . . Turning Discovery Into Health®
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov • 301.443.3860
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2012 National Survey on Drug Use and Health: Summary of national findings.
NSDUH Series H-46., HHS Publication No. (SMA) 13–4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Available at: http://www.
samhsa.gov/data/NSDUH/2012SummNatFindDetTables/index.aspx?from=carousel&position=1&date=09052013.
17
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert, No. 67 “Underage Drinking,” 2006. Available at: http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm
18
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs55to107-2012.htm#Tab6.88B
19
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs55to107-2012.htm#Tab6.89B
20
Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at: http://www.samhsa.gov/
data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs55to107-2012.htm#Tab6.90B
21
Hingson, R.W.; Zha, W.; and Weitzman, E.R. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18–24, 1998-2005.
Journal of Studies on Alcohol and Drugs (Suppl. 16):12–20, 2009. PMID:19538908 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701090/
22
Blanco, C.; Okuda, M.; Wright, C. et al. Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol
and Related Conditions. Archives of General Psychiatry 65(12):1429–1437, 2008. PMID: 19047530 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734947/
23
Wechsler, H.; Dowdall, G.W.; Maenner, G.; et al. Changes in binge drinking and related problems among American college students between 1993 and 1997: Results
of the Harvard School of Public Health College Alcohol Study. Journal of American College Health 47(2):57–68, 1998. PMID: 9782661 http://www.tandfonline.com/doi/
pdf/10.1080/07448489809595621
24
Stratton, K., Howe, C., Battaglia, F., eds. 1996 Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: Institute of Medicine National
Academy Press, 1996.
25
May, P.A.; Gossage, J.P.; Kalberg, W.O.; et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school
studies. Developmental Disabilities Research Reviews 15(3):176–192, 2009. PMID:19731384 http://onlinelibrary.wiley.com/doi/10.1002/ddrr.68/pdf
26
Yoon, Y.H., and Yi, H.Y. Surveillance Report #93: Liver Cirrhosis Mortality in the United States, 1970–2009. Bethesda, MD: NIAAA, 2012. Available at: http://pubs.niaaa.nih.
gov/publications/Surveillance93/Cirr09.htm
27
Singal, A.K.; Guturu, P.; and Hmoud, B.; et al. Evolving frequency and outcomes of liver transplantation based on etiology of liver disease. Transplantation 95(5):755–760,
2012. PMID:23370710 (Please note: The “almost 1 in 3” figure aggregates the total number of transplants necessitated by alcoholic cirrhosis, alcoholic liver disease plus
hepatitis C virus infection, and 40 percent of transplants necessitated by hepatocellular carcinoma.)
28
National Cancer Institute. Cancer Trends Progress Report, 2009–2010 Update. Available at: http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=
91&coid=906&mid
29
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, p. 31. Available at:
http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf
30
U.S. Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, pp. 355, 359. Available at:
http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/2010DGACReport-camera-ready-Jan11-11.pdf
31
U.S. Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, pp. 355–356. Available at:
http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/2010DGACReport-camera-ready-Jan11-11.pdf
32
Danaei, G.; Ding, E.L.; Mozaffarian, D.; et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk
factors. PLoS Medicine 6(4):1–23, 2009. PMID: 19399161
33
National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIAAA Council Approves Definition of Binge Drinking. NIAAA Newsletter Number 3, Winter 2004.
Available at: http://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf
34
Substance Abuse and Mental Health Services Administration (SAMHSA). Binge Drinking: Terminology and Patterns of Use. Available at: http://captus.samhsa.gov/
access-resources/binge-drinking-terminology-and-patterns-use
16
NIH . . . Turning Discovery Into Health®
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov • 301.443.3860
July 2014
Harmful
Interactions
mixing alcohol
with medicines
ct.
. effe r
SS his ca
NE t a
SI nsify ting
OW nte era .
DR y i op ery
se ma en hin
au L wh ac
y c HO RE s m
Ma LCO CA rou
A E ge
US r dan
o
Harmful
interactions
You’ve probably seen this warning on medicines you’ve taken.
The danger is real. Mixing alcohol with certain medications can
cause nausea and vomiting, headaches, drowsiness, fainting, or
loss of coordination. It also can put you at risk for internal
bleeding, heart problems, and difficulties in breathing. In addition
to these dangers, alcohol can make a medication less effective
or even useless, or it may make the medication harmful or
toxic to your body.
Some medicines that you might
never have suspected can react with
alcohol, including many medications
which can be purchased “over-thecounter”—that is, without a prescription.
Even some herbal remedies can
have harmful effects when combined
with alcohol.
This pamphlet lists medications
that can cause harm when taken with
alcohol and describes the effects that
can result. The list gives the brand
name by which each medicine is
commonly known (for example,
Benadryl ® ) and its generic name or
active ingredient (in Benadryl ® , this
is diphenhydramine). The list
presented here does not include all
the medicines that may interact
harmfully with alcohol. Most important, the list does not include all
the ingredients in every medication.
1
Medications typically are safe and
effective when used appropriately.
Your pharmacist or other health care
provider can help you determine
which medications interact harmfully
with alcohol.
D I D YO U K N OW …
Mixing alcohol and medicines can
be harmful. Alcohol, like some medicines, can make you sleepy, drowsy,
or lightheaded. Drinking alcohol
while taking medicines can intensify
these effects. You may have trouble
concentrating or performing mechanical skills. Small amounts of
alcohol can make it dangerous to
drive, and when you mix alcohol with
certain medicines you put yourself at
even greater risk. Combining alcohol
with some medicines can lead to falls
and serious injuries, especially among
older people.
MEDICINES MAY HAVE
MANY INGREDIENTS
Some medications—including many
popular painkillers and cough, cold,
and allergy remedies—contain more
than one ingredient that can react
with alcohol. Read the label on the
medication bottle to find out exactly
what ingredients a medicine contains.
Ask your pharmacist if you have any
questions about how alcohol might
interact with a drug you are taking.
2
SOME MEDICINES
CONTAIN ALCOHOL
Certain medicines contain up to 10
percent alcohol. Cough syrup and
laxatives may have some of the highest alcohol concentrations.
ALCOHOL AFFECTS
WOMEN DIFFERENTLY
Women, in general, have a higher
risk for problems than men. When a
woman drinks, the alcohol in her
bloodstream typically reaches a higher
level than a man’s even if both are
drinking the same amount. This is
because women’s bodies generally
have less water than men’s bodies. Because alcohol mixes with body water,
a given amount of alcohol is more
concentrated in a woman’s body than
in a man’s. As a result, women are
more susceptible to alcohol-related
damage to organs such as the liver.
OLDER PEOPLE FACE
GREATER RISK
TIMING IS IMPORTANT
Older people are at particularly
high risk for harmful alcohol–
medication interactions. Aging slows
the body’s ability to break down
alcohol, so alcohol remains in a
person’s system longer. Older people
also are more likely to take a
medication that interacts with
alcohol—in fact, they often need
to take more than one of these
medications.
Alcohol and medicines can interact
harmfully even if they are not taken
at the same time.
REMEMBER...
Mixing alcohol and medicines puts
you at risk for dangerous reactions.
Protect yourself by avoiding alcohol if
you are taking a medication and don’t
know its effect. To learn more about
a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.
Commonly Used Medicines (Both Prescription and Over-the-Counter)
That Interact With Alcohol
Symptoms/
Disorders
Medication
(Brand name)
Medication
(Generic name)
Allergies/
colds/flu
• Alavert®
• Atarax®
• Benadryl®
• Clarinex®
• Claritin®,
Claritin-D®
• Dimetapp®
Cold & Allergy
• Sudafed®
Sinus & Allergy
• Triaminic®
Cold & Allergy
• Tylenol®
Allergy Sinus
• Tylenol®
Cold & Flu
• Zyrtec®
Loratadine
Hydroxyzine
Diphenhydramine
Desloratadine
Loratadine
Angina
• Isordil®
(chest pain),
coronary
heart disease
Some possible
reactions with alcohol
Drowsiness,
dizziness;
increased risk
for overdose
Brompheniramine
Chlorpheniramine
Chlorpheniramine
Chlorpheniramine
Chlorpheniramine
Cetirizine
Isosorbide
Nitroglycerin
Rapid heartbeat,
sudden changes
in blood pressure,
dizziness, fainting
3
Commonly Used Medicines (Both Prescription and
Symptoms/
Disorders
Anxiety
and
epilepsy
Medication
(Brand name)
• Ativan®
• BuSpar®
• Klonopin®
• Librium®
• Paxil®
• Valium®
• Xanax®
Medication
(Generic name)
Some possible
reactions with alcohol
Lorazepam
Buspirone
Clonazepam
Chlordiazepoxide
Paroxetine
Diazepam
Alprazolam
Drowsiness, dizziness;
increased risk for
overdose; slowed or
difficulty breathing;
impaired motor control;
unusual behavior;
memory problems
• Herbal preparations
(Kava Kava)
4
Liver damage,
drowsiness
Arthritis
• Celebrex®
• Naprosyn®
• Voltaren®
Celecoxib
Naproxen
Diclofenac
Ulcers, stomach
bleeding, liver
damage
Attention and
concentration
(Attention
deficit/
hyperactivity
disorder)
• Adderall ®
Amphetamine/
dextro-amphetamine
Methylphenidate
Dizziness, drowsiness,
impaired concentration
(methylphenidate,
dexmethylphenidate);
possible increased risk
for heart problems
(amphetamine, dextroamphetamine, lisdexamfetamine); liver
damage (atomoxetine)
• Concerta ®,
Ritalin ®
• Dexedrine ®
• Focalin ®
• Strattera ®
• Vyvanse ®
Dextroamphetamine
Dexmethylphenidate
Atomoxetine
Lisdexamfetamine
Warfarin
Occasional drinking
may lead to internal
bleeding; heavier
drinking also may
cause bleeding or
may have the opposite
effect, resulting in
possible blood clots,
strokes, or heart attacks
Blood clots
• Coumadin®
Cough
Dextromethorpan
Drowsiness, dizziness;
• Delsym®,
increased risk
Robitussin Cough®
Guaifenesin + codeine for overdose
• Robitussin A–C®
Over-the-Counter) That Interact With Alcohol
Symptoms/
Disorders
Depression
Diabetes
Enlarged
prostate
Medication
(Brand name)
Medication
(Generic name)
• Abilify®
Aripriprazone
• Anafranil®
Clomipramine
Citalopram
• Celexa®
• Clozaril®
Clozapine
Duloxetine
• Cymbalta®
• Desyrel®
Trazodone
Venlafaxine
• Effexor®
Amitriptyline
• Elavil®
• Geodon®
Ziprasidone
Paliperidone
• Invega®
®
• Lexapro
Escitalopram
Fluvoxamine
• Luvox®
Phenelzine
• Nardil®
Desipramine
• Norpramin®
®
• Parnate
Tranylcypromine
• Paxil®
Paroxetine
• Pristiq®
Desevenlafaxine
• Prozac®
Fluoxetine
• Remeron®
Mirtazapine
Risperidone
• Risperdal®
Quetiapine
• Seroquel®
• Serzone®
Nefazodone
• Symbyax®
Fluoxetine/Olanzapine
• Wellbutrin®
Bupropion
Sertraline
• Zoloft®
Olanzapine
• Zyprexa
• Herbal preparations
(St. John’s Wort)
• Diabinese®
• Glucotrol®
• Glucophage®
• Glynase®,
DiaBeta®,
Micronase®
• Orinase®
• Tolinase®
Chlorpropamide
Glipizide
Metformin
Glyburide
• Cardura®
• Flomax®
• Hytrin®
• Minipress®
Doxazosin
Tamsulosin
Terazosin
Prazosin
Tolbutamide
Tolazamide
Some possible
reactions with alcohol
Drowsiness, dizziness;
increased risk for overdose;
increased feelings of
depression or hopelessness
(all medications); impaired
motor control (quetiapine,
mirtazapine); increased
alcohol effect (bupropion);
liver damage (duloxetine)
Monoamine oxidase
inhibitors (MAOIs),
such as tranylcypromine
and phenelzine, when
combined with alcohol,
may result in serious heartrelated side effects. Risk for
dangerously high blood
pressure is increased when
MAOIs are mixed with
tyramine, a byproduct
found in beer and red wine
Abnormally low blood sugar
levels, flushing reaction
(nausea, vomiting,
headache, rapid heartbeat,
sudden changes in blood
pressure); symptoms of
nausea and weakness may
occur (metformin)
Dizziness, light
headedness, fainting
5
Commonly Used Medicines (Both Prescription and
Symptoms/
Disorders
Medication
(Brand name)
Some possible
reactions with alcohol
Heartburn, • Axid®
indigestion, • Reglan®
sour stomach • Tagamet®
• Zantac®
Nizatidine
Metoclopramide
Cimetidine
Ranitidine
Rapid heartbeat; increased
alcohol effect; sudden
changes in blood pressure
(metoclopramide)
High blood
pressure
• Accupril®
• Calan®
• Capozide®
• Cardura®
• Catapres®
• Cozaar®
• Hytrin®
• Lopressor® HCT
• Lotensin®
• Minipress®
• Norvasc®
• Prinivil®,
Zestril®
• Vaseretic®
Quinapril
Verapamil
Hydrochlorothiazide
Doxazosin
Clonidine
Losartan
Terazosin
Hydrochlorothiazide
Benzapril
Prazosin
Amlodipine mesylate
Lisinopril
Dizziness, fainting,
drowsiness; heart
problems such as changes
in the heart’s regular
heartbeat (arrhythmia)
• Advicor®
• Altocor®
• Crestor®
• Lipitor®
• Mevacor®
• Niaspan®
• Pravachol®
• Pravigard™
Liver damage (all
medications); increased
flushing and itching
(niacin), increased
stomach bleeding
(pravastatin + aspirin)
• Zocor®
Lovastatin + Niacin
Lovastatin
Rosuvastatin
Atorvastatin
Lovastatin
Niacin
Pravastatin
Pravastatin +
Aspirin
Ezetimibe +
Simvastatin
Simvastatin
• Acrodantin®
• Flagyl®
• Grisactin®
• Nizoral®
• Nydrazid®
• Seromycin®
• Tindamax®
• Zithromax®
Nitrofurantoin
Metronidazole
Griseofulvin
Ketoconazole
Isoniazid
Cycloserine
Tinidazole
Azithromycin
Fast heartbeat, sudden
changes in blood
pressure; stomach pain,
upset stomach, vomiting,
headache, or flushing or
redness of the face; liver
damage (isoniazid,
ketoconazole)
High
cholesterol
• Vytorin™
Infections
6
Medication
(Generic name)
Enalapril
Over-the-Counter) That Interact With Alcohol
Symptoms/
Disorders
Mood
stabilizers
Medication
(Brand name)
• Depakene®,
Depakote®
• Eskalith®,
Eskalith®CR,
Lithobid
Medication
(Generic name)
Valproic acid
Lithium
Some possible
reactions with alcohol
Drowsiness, dizziness;
tremors; increased risk for
side effects, such as restlessness, impaired motor
control; loss of appetite;
stomach upset; irregular
bowel movement; joint or
muscle pain; depression;
liver damage (valproic acid)
Muscle pain • Flexeril®
• Soma®
Cyclobenzaprine
Carisoprodol
Drowsiness, dizziness;
increased risk of seizures;
increased risk for overdose;
slowed or difficulty
breathing; impaired motor
control; unusual behavior;
memory problems
Nausea,
motion
sickness
Meclizine
Dimenhydrinate
Promethazine
Drowsiness, dizziness;
increased risk for overdose
Pain
• Advil®
(such as
• Aleve®
muscle ache, • Excedrin®
minor arthritis
pain), fever, • Motrin®
inflammation • Tylenol®
Ibuprofen
Naproxen
Aspirin,
Acetaminophen
Ibuprofen
Acetaminophen
Stomach upset, bleeding
and ulcers; liver damage
(acetaminophen); rapid
heartbeat
Seizures
Phenytoin
Gabapentin
Drowsiness, dizziness;
increased risk of seizures
(levetiracetam, phenytoin);
unusual behavior and
changes in mental health
(such as thoughts of
suicide) (topiramate)
• Antivert®
• Dramamine®
• Phenergan®
• Dilantin®
• Horizant®,
Neurontin®
• Keppra®
• Klonopin®
• Lamictal®
• Lyrica®
• Tegretol®
• Topamax®
• Trileptal®
Levetiracetam
Clonazepam
Phenobarbital
Lamotrigine
Pregabalin
Carbamazepine
Topiramate
Oxcarbazepine
Barbiturates
7
Commonly Used Medicines (Both Prescription and Over-the-Counter)
That Interact With Alcohol
Symptoms/
Disorders
8
Medication
(Brand name)
Medication
(Generic name)
Some possible
reactions with alcohol
Drowsiness, dizziness;
Propoxyphene
increased risk for overdose;
Merepidine
Butalbital + codeine slowed or difficulty
breathing; impaired motor
control; unusual behavior;
Oxycodone
memory problems
Hydrocodone
Severe pain
from injury,
postsurgical
care, oral
surgery,
migraines
• Darvocet–N®
• Demerol®
• Fiorinal®
with codeine
• Percocet®
• Vicodin®
Sleep
problems
Zolpidem
• Ambien®
Eszopiclone
• Lunesta™
Estazolam
• Prosom™
®
Temazepam
• Restoril
Diphenhydramine
• Sominex®
Doxylamine
• Unisom®
• Herbal
preparations
(chamomile,
valerian, lavender)
Drowsiness, sleepiness,
dizziness; slowed or
difficulty breathing; impaired
motor control; unusual
behavior; memory problems
Increased drowsiness
Additional
resources
MedlinePlus
A service of the U.S. National Library
of Medicine and the National Institutes
of Health.
http://www.nlm.nih.gov/medlineplus/
druginformation.html
Provides information on prescription and
over-the-counter medications.
National Institute on Alcohol Abuse
and Alcoholism
http://www.niaaa.nih.gov
Phone number: 301–443–3860
Makes available free informational
materials on alcohol use, alcohol abuse,
and alcoholism.
U.S. Food and Drug Administration
Center for Drug Evaluation and Research
http://www.fda.gov/cder
Phone numbers:
• Main FDA for general inquiries:
1–888–INFO–FDA (1–888–463–6332)
• Drug Information: 301–827–4570
• To submit a report about Adverse
Drug Reaction: Medwatch:
1–800–FDA–1088
Provides information on prescription
and over-the-counter medications,
consumer drug information, and reports
and publications.
9
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
NIH . . . Turning Discovery Into Health
NIH Publication No. 13–5329
Published 2003
Revised 2014