Today we'll be talking about alcohol and drugs, and their role in violence, which is an important public health issue. But before we get started, let's talk a little bit about what alcohol is. Who uses it, and what happens when people drink alcohol. Especially when they binge drink or drink a lot of alcohol. And then we'll move on to talk about how and why alcohol facilitates involvement in violence. And which forms of violence seems to be most impacted by alcohol use. So what is alcohol? We talk a lot about alcohol in general but just to make sure we are all on the same page. Let's provide a little context. The alcohol that people drink at home or in bars or at parties is called ethyl alcohol. Or ethanol and it is created by fermentation. What people usually do not know, is that all alcohol is made with the same fermentation process. So from the cheapest beer to the most expensive wine, it is basically the same process. What differs in colors or taste or potency and flavor. Come from the different fruits or vegetables that I used in the process as well as any additives. So intentionally fermented beverages have been around for a long time, even back to the stone age, some 10,000 years BC. But since then alcohol use in this various forms have been noted across ancient cultures such as Babylon, China, Egypt, in Greece, India, Persia. And, it's often referenced in religious and celebratory context. Now, alcohol use has evolved to it's many modern forms that we see in most societies, today. However, the most intriguing part of the historical context of alcohol is the warnings associated with excessive alcohol use. That dates back thousands of years. As such, it's no surprise that alcohol use, especially heavy use, has been found to be problematic across cultures. Across countries and over time and that it's well-known to facilitate violence. So what about alcohol and the health burden in the US? Based on findings from a recent study, we have a better sense of the costs of excessive drinking in the US. Based on 2006 data, it was found that excessive drinking caused. Costs the United States $223 billion that year. And these costs largely results from losses in workplace productivity, healthcare expenses, criminal justice expenses. As well as motor vehicle crash costs for impaired driving. It is also estimated that almost 3/4 of these costs were due to binge drinking specifically. So what is binge drinking? Well binge drinking is the most common pattern of excessive alcohol use in the US. And binge drinking is typically defined as drinking five or more drinks for men. And four or more drinks for women. In one occasion. And there are very important patterns of binge drinking in the United States. The Centers for Disease Control and Prevention summarize many data sources of the epidemiology of alcohol use in the U.S.. Here are some facts. More than half of the alcohol consumed by adults in the US is in the form of binge drinks. Binge drinking also various across the United States. One in six US adults binge drinks about four times a month, consuming about eight drinks per binge. And then prevalence of binge drinking among men is twice the prevalence among women. And while binge drinking is more common among young adults, aged 18 to 34 years. Binge drinkers aged 65 years and older report binge drinking more often. An average of five to six times a month. About 90% of the alcohol consumed by youth, under the age of 21, in the U.S., is in for form of binge drinks. Making underage drinking a substantial problem. So, what happens when people drink, especially when they binge drink? Well, there are many important consequences of drinking too much alcohol. That are outlined by the National Institute on Alcohol Abuse and Alcoholism. When alcohol enters the blood stream, as soon as the person takes their first sip of alcohol. Immediate effects can actually appear within 10 minutes. So if a person continues to drink, there will be an increase in their blood alcohol concentration. And the higher the concentration, the more impaired the person will become. So effects can include reduced inhibitions, slurred speech, motor impairment, confusion, memory problems. Concentration problems, coma, breathing problems, and even death. So because of the impact of alcohol. In particular because of the reduced inhibition, the confusion, and concentration problems. Excessive alcohol use is often associated with different forms of violence. So, let's transition to talk a little bit about alcohol and crime, or the link between alcohol and crime. Which has not really received the same level of attention as say driving while under the influence of alcohol. However there are lots of studies that show that alcohol is often involved in both perpetrators and victims of violence. So we have substantial amount of research by the US department of justice for example that shows several important factors. So for example, 5.3 million adult, or 36% of those under correctional supervision at the time were drinking at the time of their conviction offense. And the majority of criminal offenders were under the influence of alcohol alone when they committed their crimes. And another fact is for the 40% of convicted murderers that are being held in their jail or state prison. Alcohol use was a factor in that homicide. About three million violent crimes occur each year which victims perceive the offender to have been drinking. And such crimes include rape, sexual assault, robbery, aggravated and simple assault. According to the national crime victimization survey. In 2007 there were 5.2 million violent victimizations of residents aged twelve and over in the United States. And victims of violence were asked to describe whether they perceived the offender to be drinking or using drugs. About 26% of the victims of violence reported. Reported that the offender was using drugs or alcohol. And based on victim's report, alcohol by the offender was a factor in 37% of rapes and sexual assaults. 15% of robberies. 27% of aggravated assaults. And 25% of simple assaults. In fact, alcohol is more likely to be a factor in violence where the attacker and the victim know each other. In fact, two-thirds of victims who were attacked by an intimate, including a current or former spouse. Boyfriend or girlfriend, reported that alcohol had been involved. 70% of alcohol-related incidents of violence occur in the home. The reason why we focus mostly on the link between alcohol and violence. Rather than drugs and violence, is because it seems that alcohol has a specific substance. It's just much more strongly and more easily linked to violence. Also, among violent crimes, the offender is far more likely to have been drinking alcohol than being under the influence of other drugs. With the exception of robberies where other drugs are used. Because there's so many different drugs. And because they have different psychopharmacoligcal properties. It's very difficult to generalize their effect on the human body, and its link to violence. Also, from the violence prevention perspective. We're less interested in drug defined offenses. Or those that merely are linked to a lifestyle that involve illicit drug use, and other deviant behaviors. Instead, we are specifically interested in drug related violent. Crimes that are committed because of this psychopharmacological effect on the person involved. One of the reasons that use of drugs contributes to violence is the impact some drugs have on the brain. And the National Institute on Drug Abuse has made this area of research a key priority. As an example, the repeated use of addictive drugs eventually changes how the brain functions. Resulting brain changes which can accompany the transition from voluntary to compulsive drug use. Effect the brain's natural inhibition and reward centers. Causing the addicted person to use drugs, in spite of the adverse health, social, and legal consequences. In the 2004 survey of inmates in state and federal correction facilities, 32% of state prisoners. And 26% of federal prisoners said that they had committed their offense while under the influence of drugs. Among federal prisoners 32% of drug offenders, and 24% of violent offenders were the most likely to report drug use at the time of their crimes. So as you can see, there are many data points to examine when we want to understand the role of alcohol and drugs and violence. And as Public Health Researchers, we can approach this complicated issue using data from the general population. We can examine it from a medical and health perspective. If as an example we can look at people who's a treatment from their injuries from violence. Or we can look at data among arrested or retained for having committed a violent crime. All these approaches are needed so that we get a better sense of how common it is for alcohol or drugs to be involve in violence. And also to better understand how to prevent alcohol or drug related violence. We also need this information to determine who maybe at increase risk for either perpetration or victimization of these forms of violence. So clearly balance prevention is an important public health priority. And as we have just outlined, alcohol and drugs are an important factor in violence and really needs more attention.
