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(酒量浅 The health impacts of alcohol Reference : effects/default.htm ; ALCOHOL CONCERN Factsheet 8 : Health impacts of alcohol (Edited, rewritten and much modified by KP HO for teaching purpose at cccmkc June, 2003) , A recent WHO report (2-WHO, 2002) identifies alcohol as the third highest risk to health in developed countries. Affluence in many countries generates a severe non-infectious disease, alcoholism, that should have been preventable. The metabolism of ethanol in the body When a person drinks ethyl alcohol (drinking alcohol, or ethanol, CHOH), it is 25 absorbed into the bloodstream. The alcohol is then absorbed by the small intestines and rapidly distributed to the entire body through the bloodstream. As the blood passes through the LIVER, the body removes it by oxidation. A small percent (less than 10%) is removed from the body in urine, breath and sweat. Fill in equations in the spaces provided. , Enzymes in the liver 肝臟 metabolize it to acetaldehyde, a poisonous substance. The enzyme Acetaldehyde dehydrogenase then converts acetaldehyde to acetic acid, a chemical product that the body can use as a source of energy People who can't metabolize acetaldehyde to acetic acid are less likely to drink, and have very low tolerance. (酒量淺, 唔飲得) The level of acetaldehyde dehydrogenase in a person is a phenotypic expression of genetic characteristic, and studies show that it has racial and sexual variation. However, as a general rule, each unit (8 g) of alcohol takes at least one hour to Liver cells can only be catabolised. break down 8 g of pure ethanol per hour. Not much ! And it varies with individuals. One unit is equivalent to 8 g or 10 ml of pure alcohol. {A single measure, 25 ml, of spirits 烈酒 (40%) is thus one unit. } The UK's official guidelines for responsible drinking state that for men who regularly drink 4 or more units per day, there is an increasing risk to their health. However, obeying a daily benchmark of not more than 3 - 4 units per day poses insignificant health risks. The figures for women are less tolerant. The accumulation of acetaldehyde produces the effects of alcohol intoxication (直接引起酒醉的化學物質是 acetaldehyde) flushing of the face, increased heart rate (i.e. cardiac frequency) nausea, headache, abdominal pains, difficulty in breathing, impaired co-ordination of movements; errors in judgment about movements, distance, and time; impaired learning and memory; and sedation. The neuro-chemical effects of alcohol Once in the bloodstream, the acetaldehyde can also cross the blood brain barrier (BBB), a barrier that protects the brain from many harmful chemicals, and attack the neuronal cells, which provide the power source for information processing in the body. The acetaldehyde alters the function of the brain by changing communication within and between the neurons by either reducing or increasing the activity of neurotransmitters. Neurotransmitters are chemicals that provide a means for neurons to communicate with one another. They are released by one neuron and received by another to pass messages between the brain and other parts of the body. Neurotransmitters work as systems; examples include GABA, glutamate, and adenosine (see below for more detail). Some systems increase neurotransmitter activity (excitatory signals), and others decrease activity (inhibitory signals). Intoxication and other effects of alcohol are caused by disruptions of the balance of excitatory and inhibitory neurotransmitter systems. The specific neurotransmitters affected by alcohol and their effects are listed in the table below. ...... The Short Term Health Effects of drinking alcohol Ethanol is the form of alcohol found in most alcoholic beverages. It is absorbed directly into the bloodstream from the stomach and small intestine. Typically, a drink will reach the bloodstream within 15 minutes and blood concentration will peak in 30 minutes or so. However, this is just an average. Several factors will affect this rate: the alcohol content of the drink, whether or not there is food in the stomach, and a person's weight, size, sex, age, race, and heredity. Ethanol is a central nervous system (CNS) depressant. It slows the responses of the brain and nervous system, impairing cognitive (認知), perceptual (感知) and motor (肌肉調協) performance for several hours, especially during the first 2 or 3 hours after drinks are consumed. The degree of impairment (請查 字典 ) is directly related to the blood alcohol concentration. Ethanol, even in low concentrations, also affects brain regions that control behavior, resulting in the disruption of inhibitions. As the concentration increases, symptoms of intoxication occur, followed by stupor or coma if levels become high enough. Intoxication Indicators 酒醉指標 : Slurred speech Impairment in attention (= can not concentrate) loss of memory Poor muscular co-ordination Unsteady Gait Coma (or stupor) A person is considered drunk (or intoxicated) when he or she suffers from behavioral or psychological changes such as inappropriate sexual or aggressive behavior, mood swings, impaired judgment, impaired social or occupational functioning that develop during or shortly after alcohol consumption. The best way to tell if someone is intoxicated is through the amount of alcohol in his or her blood. The Blood - Alcohol Concentration (BAC) is expressed in percentage. Here 's an example: the BAC of 0.05% means that about five parts alcohol to 10,000 parts of other blood components. Most people reach this limit after one or two drinks. The amount of alcohol consumed recently can be estimated by measuring its level in exhaled air, a standard procedure that is carried out by the police during their routine screening of " dangerous drivers ". The drinker may experience a " hangover ". Dehydration occurs because alcohol is a diuretic 利尿劑 (i.e. it stimulates urination). Alcohol also stimulates the production of insulin, which in turn reduces blood glucose level. Low blood glucose produces feelings of drowsiness, weakness, trembling, faintness and hunger. Alcoholism or the misuse of alcohol The Long Term Health Effects of drinking alcohol Long-term heavy drinkers put themselves at risk for developing several health problems. Long-term heavy drinking affects almost every system in the body including the nervous, digestive, cardio-vascular, musculo-skeletal, and endocrine systems. Perhaps the most well-known disease related to heavy consumption of alcohol is cirrhosis of the liver in which liver cells gradually die off and are replaced by permanent non-functioning scar tissue. The liver soon becomes less able to cleanse the blood and regulate its composition. Heavy drinking has also been associated with the following problems : Liver Disease (酒精害肝) In general, people react differently to alcohol based on multiple factors including sex, race, and weight. The liver metabolizes alcohol after consumption reducing its toxic effects and its ability to do so is based on the factors stated above. However, in incidences of high alcohol consumption seen in alcoholics, damage to the liver occurs. Alcoholic liver disease begins with fatty liver, then can progress to alcoholic hepatitis and then to cirrhosis. The risk for progressing through these stages is dependent on the amount and regularity of alcohol intake. Past studies have also suggested that more women develop liver disease than men because of their body's reaction to alcohol; women have higher blood alcohol concentrations because of their relatively more body fat and less water content. Fatty Liver (脂肪肝) With any major alcohol consumption, even over a few days, a condition develops that is highlighted by the liver cells being swollen with fat globules and water. Other causes of fatty liver, besides alcohol, include obesity, drugs, and diabetes. In the case of alcohol, the condition is reversible when drinking is stopped. Alcoholic Hepatitis (肝炎) Hepaitis is the inflammation of the liver. Just because an individual develops fattly liver, doesn't necessarily mean that alcoholic hepatitis will develop. With the onset of the disease, it usually lasts for one to two weeks but can last longer and eventually lead to cirrhosis or more permanent damage. Diagnosis of alcoholic hepatitis is usually done by liver biopsy with help from blood tests. Symptoms: loss of appetite ; nausea and vomiting ; abdominal pain and tenderness ; fever ; jaundice Alcoholic Cirrhosis (肝硬化) With permanent damage to the liver, blood flow into the liver is reduced and normal functioning is impaired. Cirrhosis consists of permanent damage to the liver in which normal liver structures (hepatocytes) are replaced and changed to scar tissue. Despite having multiple causes, excessive alcohol intake is the most common. Because scar tissue is fairly permanent, treatment of the disease often focuses on preventing the progression of the disease and treating complications that may be present. In alcoholic cirrhosis, treatment consists of abstinence (戒酒) from alcohol and wholesome diet (食營養豐富餐). It is also known that some drinkers are more susceptible to cirrhosis and women are at higher risk than men. The disease has no cure. Liver transplant is possible when conditions are available.Those who continue to drink will develop complete liver failure and a small percentage will go on to develop liver cancer - another fatal disease. Signs/Symptoms: loss of appetite ; nausea and vomiting ; weight loss ; liver enlargement ;jaundice ;itching increased sensitivity to drugs Complications : pathological changes in the liver affect other body parts....... Cancer-especially cancer of the liver, esophagus, throat, and larynx (voice-box) People who BOTH smoke and drink run a much greater risk of developing cancer. , Malnutrition Alcohol contains calories and no other nutritional benefits. Alcoholic suffer from the loss of appetite and vomiting. Reproductive and Sexual Dysfunction : impotence & fertility As alcohol intake contributes to risk-taking behaviour (膽壯豪放誤事), it increases the chance of contracting STD (sexually transmitted diseases), such as HIV, gonorrhoea and syphilis. Research suggests that alcohol increases desire but decreases physiological stimulation in both sexes. In men, there can be temporary impotence, shrinking of the testes, reduction in penis size, reduced sperm formation, loss of pubic and body hair...... In women, ovulation fails and there are general menstrual problems, the shrinking of the breasts and sexual organs, and body fat is being redistributed into a male figure. Digestive Problems (The stomach, oesophagus and pancreas are affected. Inflammation of the stomach, gastritis, may be acute or chronic. Excessive alcohol consumption can cause reflux 胃液倒流 , a process whereby digestive juices from the stomach are forced up the oesophagus and damage its unprotected lining.) , Problems associated with the heart and circulatory system , Damage to heart and cardiovascular system { HOWEVER, 然而 there is evidence that light to moderate intake of alcohol - one unit a day - the risk of cardiovascular reduces disease (e.g. heart attack) in older adults (i.e. men over 40 and women past the menopause), but the health risks multiply with heavy use} , High blood pressure (= hypertension) As a result, heavy drinkers are more susceptible to heart diseases and strokes. , Problems associated with the bones, muscles and skin , Osteoporosis 骨質疏鬆症 (Heavy drinking contributes to osteoporosis. The bones are thinner and liable to collapse; there are signs of muscle degeneration; the "alcohol-dependents" show skin abnormalities......) , Problems associated with the brain and nervous system , Brain damage (neurological disorder) Other than alcohol's short-term effect as a CNS depressant (e.g. slurred speech, loss of self-control), problem drinkers may suffer from various types of brain damage, brain scans can show brain tissue loss and mental tests may reveal specific abnormalities in the performance of intellectual tasks (e.g. poor abstract reasoning, inability to solve visual-spatial problems.), a condition called alcoholic dementia. Specific brain area damage may impair the co-ordination of body movements and cause unsteadiness when walking is observed. , Vitamin Deficiencies (e.g. thiamine, i.e. vitamin B) 1 Among frequent drinkers (long-term alcoholics), poor diet control (= malnutrition) and frequent vomiting deplete their vitamin stores. 不用記以 下學名A brain disorder thus caused is Wernicke's encephalopathy. Some symptoms are : confusion about time or space, drowsiness, double vision, abnormal eye movemnt. If Wernicke's encephalopathy is left untreated, Korsakoff's psychosis can develop. It is shown by a profound memory loss, affecting both the ability to recall events and to form new memories..... , Mental health problems Disorders of the immune system With weakened body defence, drinkers are prone to contract various diseases. , Abnormal foetal development in pregnant women Alcohol can pass across the placenta and is taken up by the developing foetus who is especially sensitive during the early stages of development when the complex organs and nervous system are being formed. The newborn babies have lower birth weight, those that are born from heavy drinkers show growth deficiencies, central nervous system defects, lowered IQ and facial malformations. ,, Sudden death Final remarks , Excessive drinking of alcohol has been shown to trigger off short-term health hazards and induce progressive organ damage and diseases, some of which are irreversible. , Alcoholics may have other forms of undesirable behaviours, so it is difficult to state exactly how the death and disease rate are caused by alcohol drinking. , " Cirrhosis takes TIME to develop, alcohol damage to the liver builds up over many years until the liver starts to malfunction or fail......" (The Chief Medical Officer's report 2001, U.K.) , The COST of treating the chronic and acute effects of alcohol misuse is heavy : think of the money spent on hospital services and the increased accidents and injuries associated with alcohol indulgence which promotes risk-taking behaviour. , Alcohol is NOT an essential nutrient. In fact, it is regarded as a poisonous substance that is being constantly broken down by our normal liver enzymes. However, it has been established as a social drink in many civilisations because of its stimulatory and inhibition-removal effect on the human body. When drinking alcohol is desired, one must do so in moderation. Excessive intake poses long-term health hazards. Furthermore, alcoholism is not inborn, it is an acquired social behaviour, one can always makes wise choices. Appendix (to enhance awareness !) Chapter: 374 Title: ROAD TRAFFIC ORDINANCE Gazette Number: 50 of 1999 Section: 39B Heading: Screening breath tests Version Date: 01/10/1999 Source : (Font format has been done by the present editor) (1) A police officer in uniform may require a person to provide a specimen of breath for a screening breath test where the police officer has reasonable cause to suspect- (a) that the person driving or attempting to drive or in charge of a motor vehicle on a road has alcohol in his body or has committed a traffic offence while the vehicle was in motion; or (b) that the person has been driving or attempting to drive or been in charge of a motor vehicle on a road with alcohol in his body and that the person still has alcohol in his body; or (c) that the person has been driving or attempting to drive or been in charge of a motor vehicle on a road and has committed a traffic offence while the vehicle was in motion. (2) If an accident occurs owing to the presence of a motor vehicle on any road, a police officer in uniform may require a person, whom the police officer has reasonable cause to suspect was driving or attempting to drive or in charge of the vehicle at the time of the accident, to provide a specimen of breath for a screening breath test. (3) A police officer in uniform may require a person to provide a specimen at or near the place where the requirement is made under subsection (1). 現場測試 (4) A police officer in uniform may require a person to provide a specimen under subsection (2) either at or near the place where the requirement is made or at a breath test centre, a police station or a hospital specified by the police officer. (Amended 50 of 1999 s. 3) (5) A police officer shall warn a person at the time of requiring a specimen for a screening breath test under this section that a failure to provide it may render him liable to prosecution. (6) A person who, without reasonable excuse, fails to provide a specimen of breath when required under this section commits an offence and is liable- (a) on conviction on indictment to a fine at level 4 and to imprisonment for 3 years; and (b) on summary conviction on a first offence to a fine at level 3 and to imprisonment for 6 months and on a second or subsequent conviction or on a conviction subsequent to a conviction under section 39, 39A or 39C to a fine at level 4 and to imprisonment for 12 months. (7) The court or magistrate convicting a person of an offence under this section shall disqualify him from driving for a period of not less than 2 years for a second or subsequent conviction or for a conviction subsequent to a conviction under section 39, 39A or 39C unless for special reasons the court or magistrate orders that he be disqualified for a shorter period or that he not be disqualified. (8) The court or magistrate may deal with the offence as a first offence when a period of 5 years has elapsed since the person's last conviction under this section or section 39, 39A or 39C. (9) A police officer in uniform may arrest a person without warrant if- (a) AS A RESULT OF A SCREENING BREATH TEST he has reasonable cause to suspect that the proportion of alcohol in that person's breath exceeds the prescribed limit; or (b) the person has failed to provide a specimen of breath for a screening breath test when required to do so under this section. (10) A person fails to provide a specimen for a screening breath test unless the specimen- (a) is sufficient to enable the test to be carried out; and (b) is provided in a way to enable the objective of the test to be satisfactorily achieved. (Added 39 of 1995 s. 7) ................................................................................................................................................ Chapter: 374 Title: ROAD TRAFFIC ORDINANCE Gazette Number: 50 of 1999 Section: 39D Heading: Choice of specimens of breath Version Date: 01/10/1999 (1) The court or magistrate shall use the statement referred to in section 39C(3)(a) relating to the specimen with the lower proportion of alcohol out of the 2 specimens of breath a person provides under section 39C and shall disregard the other. (2) If the specimen of breath with the lower proportion of alcohol contains no more than 37 micrograms of alcohol in 100 millilitres of breath, a person who has provided the specimens of breath under section 39C may ask that the specimens of breath be replaced by a specimen of blood or urine and the police officer shall decide whether it should be a specimen of blood or urine. (Amended 50 of 1999 s. 5) (3) The specimen under subsection (2) shall be a specimen of urine if a medical practitioner is of the opinion that for medical reasons a specimen of blood cannot or should not be taken. (4) If the person then provides a specimen under subsection (2) within a reasonable time after the breath analysis, the statement referred to in section 39C(3)(a) of neither specimen of breath shall be used. (Added 39 of 1995 s. 7) ................................................................................................................................................ 喜好思路清晰,細致,慎密的同學,請考慮進修法律,彰顯社會公義。 ................................................................................................................................................ Chapter: 374 Title: ROAD TRAFFIC ORDINANCE Gazette Number: 50 of 1999 Section: 39C Heading: Provision of specimens for analysis Version Date: 01/10/1999 (1) A police officer may require a person whose screening breath test indicates that the proportion of alcohol in that person's breath is likely to exceed the prescribed limit or who fails to provide a specimen for the screening breath test with reasonable excuse- (a) to provide 2 specimens of breath for analysis by means of an approved breath analysing instrument; or (b) to provide a specimen of blood or urine for a laboratory test. (2) The police officer shall decide that the person is to provide a specimen of blood or urine if- (a) the police officer has reasonable cause to believe that for medical reasons a specimen of breath cannot be provided or should not be required; or (b) at the time the requirement is made, an approved breath analysing instrument is not available at the breath test centre, the police station or the hospital where the requirement is made or it is for any other reason not practicable to use an approved breath analysing instrument. (Amended 50 of 1999 s. 4) (3) Evidence of the proportion of alcohol in a specimen of breath, blood or urine may be given by the production of a document which purports to be either- (a) a statement automatically produced by the approved breath analysing instrument by which the proportion of alcohol in a specimen of breath was measured and a certificate signed by an approved operator (which may but need not be contained in the same document as the statement) certifying that the statement relates to a specimen provided by the accused at the date and time shown in the statement and that the approved breath analysing instrument was operated correctly and properly when the specimen of breath was being taken; or (b) a certificate under section 25 of the Evidence Ordinance (Cap 8) as to the proportion of alcohol found in a specimen of blood or urine identified in the certificate. (4) Evidence that a specimen of blood was taken from the accused with his consent by a medical practitioner, a registered nurse or an enrolled nurse may be given by the production of a document certifying that fact and purporting to be signed by the medical practitioner, the registered nurse or the enrolled nurse, as the case may be. (Amended 50 of 1999 s. 4) (5) Evidence that a specimen of urine was taken from the accused by a police officer or a medical practitioner may be given by the production of a document certifying that fact and purporting to be signed by a police officer or a medical practitioner, as the case may be. (6) A requirement under this section to provide a specimen of breath can only be made at a breath test centre, a police station or a hospital. (Amended 50 of 1999 s. 4) (7) A requirement under this section to provide a specimen of blood can only be made at a breath test centre, a police station or a hospital. (Amended 50 of 1999 s. 4) (8) A requirement under this section to provide a specimen of urine can only be made at a breath test centre, a police station or a hospital and the police officer making the requirement shall decide whether the specimen of urine is to be provided at a breath test centre, a police station or a hospital. (Amended 50 of 1999 s. 4) (9) The police officer requiring the provision of a specimen other than a specimen of breath under this section shall decide whether a specimen is to be of blood or of urine, but if a medical practitioner is of the opinion that for medical reasons a specimen of blood cannot or should not be taken the specimen shall be a specimen of urine. (10) If the police officer requires a person to provide a specimen of blood, the specimen of blood shall be taken by a medical practitioner, registered nurse or enrolled nurse specified by the police officer. (Amended 50 of 1999 s. 4) (11) Without limiting the effect of the provisions of this section, a specimen of blood shall not be taken from a person unless he consents to its being taken and it is so taken. (Amended 50 of 1999 s. 4) (12) Evidence of the proportion of alcohol in a specimen of breath, blood or urine provided by the accused shall be evidence that the proportion of alcohol in the accused's breath, blood or urine at the time of the alleged offence was not less than that in the specimen. (13) Where, at the time a specimen of blood or urine was provided by the accused, he asked to be provided with such a specimen, evidence of the proportion of alcohol found in the specimen is not admissible on behalf of the prosecution unless- (a) the specimen in which the alcohol was found is one of 2 parts into which the specimen provided by the accused was divided at the time it was provided; and (b) the other part was supplied to the accused. (14) The person shall provide the specimen of urine within one hour of being required to provide it and after the provision of a previous specimen of urine. (15) A person who, without reasonable excuse, fails to provide a specimen when required to do so under this section commits an offence and is liable- (a) on conviction on indictment to a fine at level 4 and to imprisonment for 3 years; and (b) on summary conviction on a first offence to a fine at level 3 and to imprisonment for 6 months and on a second or subsequent conviction or on a conviction subsequent to a conviction under section 39, 39A or 39B to a fine at level 4 and to imprisonment for 12 months. (16) The court or magistrate convicting a person of an offence under this section shall disqualify him from driving for a period of not less than 2 years for a second or subsequent conviction or for a conviction subsequent to a conviction under section 39, 39A or 39B unless for special reasons the court or magistrate orders that he be disqualified for a shorter period or that he not be disqualified. (17) The court or magistrate may deal with the offence as a first offence when a period of 5 years has elapsed since the person's last conviction under this section or section 39, 39A or 39B. (18) A police officer shall warn a person at the time of requiring a specimen under this section that a failure to provide it may render him liable to prosecution. (19) A person fails to provide a specimen of breath, blood or urine for analysis or laboratory test unless the specimen- (a) is sufficient to enable the analysis or laboratory test to be carried out; and (b) is provided in a way to enable the objective of the analysis or laboratory test to be satisfactorily achieved. (20) The Commissioner of Police may by notice in the Gazette designate a place or vehicle to be a breath test centre. (Added 50 of 1999 s. 4) (21) For the avoidance of doubt, a notice under subsection (20) is not subsidiary legislation. (Added 50 of 1999 s. 4) (22) For the purposes of this section, "registered nurse" (註冊護士) and "enrolled nurse" (登記護士) have the respective meanings assigned to them by section 2 of the Nurses Registration Ordinance (Cap 164). (Added 50 of 1999 s. 4) (Added 39 of 1995 s. 7) How to search for the laws of Hong Kong ? Bilingual Laws Information System