LIAN C.

BASOG
ARABELLA MERIDA
EXECUTIVE CLASS III

Chapter XXXIII

ALCOHOLISM

What is ALCOHOLISM?
As defined in black laws dictionary; In medical jurisprudence. The
pathological effect (as distinguished from physiological effect) of excessive
indulgence in intoxicating liquors. It is acute when induced by excessive
potations at one time or in the course of a single debauch. An attack of
delirium tremens and alcoholic homicidal mania are examples of this form.
It is chronic when resulting from the long- continued use of spirits in less
quantity, as in the case of dipsomania.

Alcoholic beverages are primarily a mixture of water and ethyl alcohol

with small amount of other substances which impart the characteristic odors
and tastes. These substances are called "congeners" since they are
simultaneously produced during the fermentation process. The congeners
consist of organic acids and esters or even other types of alcohol. It is the
congener content that imparts the so called "odor of alcohol" among
drinkers.

Ethyl Alcohol (C 2 H 5 O H, Ethanol, grain alcohol)

Is a colorless transparent, volatile liquid with aromatic odor and with
boiling point at 78C. Like any other types of alcohol, it is formed out of the
fermentation of various carbohydrates in grains, fruits or flowers, and from
other materials subjected to and isolated by distillation.
Is commonly used as solvents, antiseptic and beverage. When
ingested, it does not require digestion before absorption. Although the word
"alcohol" refers to a large group of chemical compounds in possession of
hydroxyl radical (OH), whenever alcohol is used as part of a beverage, it
refers to ethyl alcohol.

Drunkard
Is a person who habitually takes or uses any intoxicating alcoholic
liquor and while under the influence of such, or in consequence of the effect
thereof, is either dangerous to himself and to others, or is a cause of harm or
serious annoyance to his family or his affair, or ordinary proper conduct.

Habitual Drunkard
Is one who excessively uses intoxicating drink. Habit should be actual
and confirmed, but it is not necessary that it be continuous or of daily
occurrence. It lessens individual resistance to evil thought and undermines
will power, making its victim a potential evil doer.

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Classification of Commercially Available Alcoholic Beverages
1. Wine A product of natural alcoholic fermentation with wide
variety of sugary materials including fruit juices and contains not less
than 7% but not more than 17% of alcohol by volume. In fermented
beverages the alcohol content is expressed in volume percent.
a) Red Wine
b) White Wine
c) Dry Wine
d) Sweet Wine
e) Still Wine
f) Sparkling Wine
g) Fortified Wine.
h) Chinese Medicinal
i) "Ztosi"
j) "Lambanog"
2. Distilled Liquor- Are alcoholic beverages produced from distillate of
wines, distilled from grains or starch solution or distillate from
aromatic substances. In distilled beverages the alcohol contents are
expressed in proofs. "Proof" is approximately twice the percentage of
alcohol by volume. The sole purpose of the distillation process is to
increase the concentration of alcohol in the finished product.
a) Whiskey
b) Gin
c) Rum
d) Alcoholic Cordials and Liquors
e) Vodka

3. Malt Liquors- Alcoholic beverages brewed from malt or from a

mixture of malt and malt substitute, like rye, and may contain other
cereal grains and starchy saccharine matters. A characteristic bitter
flavor is imparted by the addition of hops. The amount of alcohol
need not be stated in the label.
a) Ale
b) Beer
c) Stout
d) Porter

An alcoholic beverage shall possess the characteristic attributed to the type

of drink that is stated in the definition and standard of identification. The
preparation must be free from any ingredient injurious to health, free from
sediment of any kind, and shall be manufactured in premises built and
maintained under hygienic condition.

Causes of Drinking Alcoholic Beverages:

1. Curiosity Children prefer to experience the pleasant and unpleasant

effects rather than being told.

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2. It is being served as a symbol of friendship and sociability. Social
gathering with alcoholic beverages served becomes lively. Drinking is a part
of our culture.
3. As an escape from unpleasant realities, it suppresses inner tension,
deadens the pain of failure, frustration and anxieties.
4. Alcohol is a part of religious ceremonies.
5. As a stimulant to combat shyness, inferiorities and to suppress strong
inhibition.
6. It is a source of heat and energy. One gram of alcohol may yield calories,
by the process of oxidation. One ounce of 100 proof whiskey may yield 100
calories.

Provisions of Law Regarding Alcoholism:

1. Intoxication is an alternative circumstance to criminal liability: Art. 15,

Revised Penal Code Their concept: Alternative circumstances are those
which must be taken into consideration as aggravating or mitigating
according to the nature and effects of the crime and the other conditions
attending its commission. They are the relationship, intoxication, and the
degree of instruction and education of the offender. The intoxication of the
offender shall be taken into consideration as a mitigating circumstance when
the offender has committed a felony in a state of intoxication, if the same is
not habitual or subsequent to the plan to commit said felony; but when the
intoxication is habitual or intentional it shall be considered as an aggravating
circumstance.
1. Mitigating:
a. If intoxication is not habitual; or
b. If intoxication is not subsequent to the plan to commit the
felony.
2. Aggravating:
a. If intoxication is habitual; or
b. If intoxication is subsequent to the plan to commit the
felony.

2. Public scandal committed by a person while drunk is punishable: To be

drunk is not punishable, but if alarm and scandal happens in a public place
while at the state of intoxication, it is punishable.
Art. 155, Revised Penal Code Alarms and scandals The penalty of
arresto menor or fine not exceeding 200 pesos may be imposed upon:
4. Any person who while intoxicated or otherwise, shall
cause any disturbance or scandal in public places.

3. Contracts agreed to in a state of drunkenness are voidable- Art. 1328,

Civil Code: Contracts entered into during a lucid interval are valid.
Contracts agreed to in a state of drunkenness or during a hypnotic spell are
voidable.
4. The law penalizing manufacture of liquor without license is valid:

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If a person administers beverages to another which is injurious to the latter
without intent to kill, he is punished for his wrongful act.
Art. 264, Revised Penal Code: Administering injurious substances or
beverages:
The penalties established in the next preceding article (arresto mayor in its
maximum period to prision correccional in its minimum period) shall be
applicable in the respective cases to any person who, without intent to kill,
shall inflict upon another any serious physical injury, by knowingly
administering to him any injurious substances or beverages or by taking
advantage of his weakness of mind and credulity.
5. The state may prevent some people from drinking highly spirited
wine: The state may promulgate laws which may prevent people of lower
degree of civilization from drinking scientifically manufactured, highly
spirited liquor. The reason is to promote peace and order.

Pharmacologic Effects of Alcohol:

Ethyl alcohol depresses the central nervous system in descending order from
the cerebral cortex to the medulla oblongata. It causes depression or
temporary functional paralysis of the ganglionic cells. The more specialized
the cells are, as in the cerebral cortex, the more sensitive they are to alcohol.
A moderate dose will cause disturbance in the intellect and fine muscular
movement, but bigger doses will involve depression of the ganglion cells of
the lower brain centers in the basal ganglia and brain stem causing the
person to be stuporous and even comatose.

Effects on the Special Senses:

1. Vision With increasing amount of alcohol intake the acuity is

progressively diminished to the point where vision to obscure to a degree
comparable to wearing dark sunglasses at night. There is diminution of the
peripheral vision similar to that of a person viewing an object by means of a
binocular (tunnel vision), the amount of blood alcohol is somewhere
between 100 to 200 mg., ocular coordinator is impaired and diplopia
develops.
2. Hearing The increasing amount of alcohol intake diminishes the
ability of the individual to perceive and appreciate varying intensities of
sound. This is the very reason why in a drinking party at the start of the
drinking the conversation is in a low tone, but as the alcohol level in the
blood increases the group tends to talk louder. This also accounts for the
tendency of drivers not to perceive the sound of horns and train whistles
when intoxicated and to become more prone to vehicular accidents.
3. Touch The sense of touch is diminished with the increased amount of
alcohol intake. The blunting of touch sensation is responsible for frequent
cigarette burns on the hand of chronic alcoholics.
4. Taste There is a decrease in the sense of taste. When a person is drunk,
all food taste good.
5. Smell The perception of smell is depressed by alcohol. Malodorous
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substances may be undetected by those under the influence of alcohol.

"Proprioception" or the so-called "sixth sense" is also impaired.

Blunting of judgment is one of the first mental functions affected by alcohol.
This leads to automobile accidents, poor business decisions, gambling
losses, fights and injuries. The faculty of attention deteriorates rapidly and
this is the principal reason why individuals even with low level of alcohol
end up as traffic victims. Motor skills are also impaired progressively with
increasing amount of blood alcohol. Reaction time is prolonged. Ability to
hear is blunted and recall memory is often markedly disturbed. Moral
standard is blunted and lowered, and there is a tendency to distort reality. It
increases the desire for sex but markedly impairs the performance; a
prolonged intercourse without ejaculation is often the result.

Other Effects:

1. Dilatation of the blood vessels of the cutaneous surface.

2. Increase in the pulse rate.
3. Weaker cardiac systole which tend to cause cardiac dilatation.
4. Locally, it has direct irritation effect on the mucous membrane of the
stomach and intestine.
5. Slight depression of the liver functions as indicated by the decrease in
hepatic oxygen consumption and decrease in glycogen storage.
6. Fall of the blood pressure.

Clinical Signs and Symptoms in Relation to Blood Alcohol Level:

Blood Alcohol Clinical Signs and Symptoms

10 mg % Pleasant clearing of the head.
20 mg %, Physical feeling of well-being.
50 mg % The individual feels on top of the world and has the wisdom of
Solomon and the talkativeness of Senator Claghorn. Increased self
confidence; decreased inhibitions; diminution of attention, judgment, and
control.
100 mg % The individual is intoxicated and "under the influence". Experts
in the field believe that innocent person would be convicted of being "under
the influence" if he had a blood alcohol level of 100. Some mental
confusion, incompetency; drowsiness; emotional instability; decreased
inhibitions; loss of critical judgment; impairment of memory and
comprehension. 150 mg % At this level all individuals are intoxicated, and
deterioration in performance of acts of skill or judgment are present.
150-300 mg % Somewhere between these figures all individuals lose some
degree of muscular coordination, including the ability to walk properly and
coordinate other body movements. Disorientation; mental confusion;
dizziness; sensory disturbances; deceased sense of pain; slurred speech;
exaggerated emotional (state of grief, anger and fear).
300 mg % At this level most individuals become stuporous, incoordinated,
and may even lose sphincter control. Apathy; general inertia; decreased
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response to stimuli; impaired consciousness; sleep or stupor.
400 mg % This is the anesthetic level. Alcohol is not a good anesthetic
because there is a narrow margin between the anesthetic and the death level.
Death from alcohol per se may occur at any level above 400 mg%.
Complete unconsciousness; coma; depressed or abolished reflexes;
embarrassment of circulation and respiration; incontinence of urine and
feces.

Symptomatic Changes Following Ingestion of Alcoholic Beverages:

Although human reaction varies from person to person, the clinical signs and
symptoms following ingestion of alcohol may be divided into three stages,
namely:
1. Stage of Excitement This develops a few minutes after the initial
dose of alcoholic drink has been absorbed and has reached the central
nervous system. It is characterized by a feeling of wellbeing and slight
excitation. The actions, speech and emotion are less strained. Self-
confidence develops, as well as blunting of selfcriticism, self-
consciousness and self-control. It is the manifestation during this state
that makes the people entertain the erroneous belief that alcohol is a
stimulant rather than a depressant. Alcohol does not stimulate the
brain centers but rather "inhibits the inhibition" causing it to act freely
without constraints.
2. Stage of Incoordination or Confusion As the effects of alcohol
become more pronounced, the nervous control of the body gradually
diminishes. There is blunting of all perceptive mechanism. Muscular
coordination is lost. The irritating effects of alcohol, like nausea and
vomiting, confusion, cardiac and respiratory symptoms appear.
3. Stage of Narcosis or Coma The person passes into a deep sleep and
may only respond to strong stimuli. Pupils are dilated, breathing is
slow and stertorous, pupils are dilated and reflexes, abolished. Death
may ensue from paralysis of the cardiac or respiratory center.

Degree of Intoxication:
1. Slight Inebriation
2. Moderate Inebriation
3. Drunk
4. Very Drunk, "Dead drunk"
5. Coma

Diagnostic Points of Drunkenness:

1. Alcoholic smell of the breath or of the vomitus.
2. Dry furred tongue or with excessive salivation.
3. Irregular behavior.
4. Congestion of the conjunctivae.
5. Hesitancy or thickness of speech with impaired articulation.
6. Tremor or error of coordination and orientation.
7. Examination of the blood and the urine shows the presence of
alcohol.
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 8. History of having taken alcoholic beverages.

Physical Tests to Determine Drunkenness:

1. Romberg's test Let the subject stand straight with heels
together and with closed eyes for at least one minute. If he is
not drunk, he will not sway to the front or to the sides, but if
he is drunk the body will not be stable in the absence of any
existing disease.
2. Let the subject stand straight with one foot ahead of the other
so that the toes of one foot touch the heel of the other. This
will remove the brace to prevent side sway. If drunk, there is
more likelihood that the subject will sway sidewise and fall.
The test is repeated after the subject is free from the effect of
alcohol and make a comparison of stability.
3. Let the subject sit comfortably in a desk and get samples of
his handwriting. Compare these writings, with those taken
when he is free from the effects of alcohol.
4. Let the subject bend down and pick up a small object from
the floor. If he stumbles, then his nervous system is not stable
and that he may be drunk.
5. Let the subject walk straight forward to a comer of a room
and rapidly turn around without stopping. Tell him to walk
back. You will notice that the subject may have uncertainty
of steps, side steps, or he staggers while making the turn and
in walking.

Conditions Simulating Alcoholic .Intoxication:

1. Severe head injuries.
2. Metabolic disorders e.g. hypoglycemia, diabetes precoma, uremia,
hyperthyroidism.
3. Neurological conditions associated with dysarthria, ataxia, tremor,
drowsiness e.g., disseminated sclerosis, intracranial tumors, Parkinson's
disease, epilepsy, acute aural vertigo.
4. The effect of a drug is unlikely to be confused with the effect of alcohol
unless the drug has been taken for the first time and has produced an
unexpected reaction, or unless it has been in an unusually large dose. (Some
drugs whose effects simulate alcoholic intoxication are: insulin; the
barbiturates; most of the antihistamine group of drugs; morphine; the new
analgesics which tend to cause giddiness; certain drugs used in the treatment
of asthma e.g. remedies containing atropine; drugs used in the treatment
of involuntary movement e.g. hyoscine.)
5. Certain pre-existing psychological disorder e.g. hypomania, general
paresis.
6. Prodromata of cerebral vascular emergencies, which may show
themselves as confusional states, amnesia, or aphasia. The history may
enable the doctor to settle any doubt.
7. High fever.
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8. Exposure to carbon monoxide in sufficient concentration to give
significant anoxemia.

Factors Responsible for the Tolerance and Susceptibility to Alcohol:

1. Tolerance to Alcohol:
Two or more persons of the same age, sex, weight and environmental up-
bringing may react differently to alcohol. One may be tolerant while others
may be sensitive. Tolerance of a person to alcohol may be a result of two
different factors namely:
a. Consumption Tolerance A person who has developed tolerance may
have lesser percentage of blood alcohol as compared with another person
who is not used to it when given the same quantity at the same time. The
reason is that those habituated eliminate faster as compared with non-
habitual drinkers.
b. Constitutional Tolerance If a person habitually drinks alcoholic
beverages there develops a certain degree of adaptation by the body, thereby
increasing the body threshold to it. Later, greater quantity and percentage
will be tolerated and will lead to the diminution of its effects.
2. Susceptibility to Alcohol:
The following factors render a subject unduly susceptible to the effects of
alcohol:
a. Exposure to extreme cold; or fatigue.
b. Pre-existing post-concussional state.
c. Chronic cerebral vascular state e.g. hypertension, advanced cerebral
arteriosclerosis.
d. Cerebral depression caused by drugs, like barbiturates.
e. Neurological disorders, like disseminated sclerosis, intracranial tumor.
f. Psychological disorders.

How Alcohol Influences the Production of Trauma:

Alcohol enhances the production of trauma in the following ways:
1. Alcohol increases the irritability and decreases the sense of responsibility
of a person which, in effect, may cause him to become involved in quarrels
or accidents.
2. If a person is under the influence of alcohol, the anesthetic effect of
alcohol may obscure pain and other symptoms of injury so that serious
trauma may be overlooked.
3. Alcohol, being a depressant, renders the individual susceptible to the
effects of traumatic shock or hemorrhage.

How Alcohol Diminishes the Driving Skill:

The basic of the maxim that "Don't drive when drunk and don't
drink when driving" is that alcohol deteriorates the driving skill in
the following ways:
1. It increases the reaction time. The driver becomes sluggish in his reaction
in an impending danger.
2. It creates a false feeling of confidence.

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3. It impairs concentration, dulls judgment and degrades muscular
coordination.
4. It decreases visual and auditory acuity.

After absorption of alcohol in the alimentary tract, it reaches the

liver by way of the portal circulation. It is then eliminated from the
body through two mechanisms, namely:
1. Oxidation
2. Excretion
Causes of Death in Alcoholics:
1. Acute Alcoholic Intoxication:
a. Paralysis of the medullary center Alcohol depresses the nervous
system by affecting the cerebral cortex, basal ganglia, cerebellum, and
finally the brain stem and medulla.
b. Cardiac myopathy The heart muscles may suffer direct damage from
the high concentration of blood alcohol.
c. Ingestion of alcohol and synergistic drugs, like barbiturates and
tranquilizers may cause fatality. Potentiation of alcohol by psychotrophic
drugs has been reported to have caused death. A blood level of 0.45% or
greater is generally accepted as a fatal level, although death has occurred at a
level below 0.35%.
2. Hidden Trauma:
Alcoholics are prone to be victims of traffic accidents or other traumatic
injuries. Acute intoxication produces considerable analgesia and may
deceptively conceal physical injuries. They may suffer from subdural
hematoma, brain concussion or abdominal injuries which may be considered
symptoms of drunkenness.
3. Unexpected Aspiration of Food ("Cafe Coronary"):
Aspiration of food into the respiratory passage may cause severe asphyxia.
The sudden death in this case is characterized by the rapid onset of shortness
of breath, choking on mealtime or vomiting and the presence of food
particles on the respiratory system on post-mortem examination.
4. Poisoning by Congener or Contaminants in Alcoholic Beverages:
Alcoholic beverages may accidentally contain toxic substances which may
cause injury or death of the drinker. There is a wide variety of impurities that
may be found but the following contaminants in bootleg liquors are quite
common:
a. Methyl Alcohol (CH3OH, Methanol, Wood Alcohol) The mechanism
of methanol poisoning is its conversion to formaldehyde and formic
acid which consequently causes acidosis.
In the eye, it may cause blindness. The symptoms start as
photophobia, followed by blurred vision to permanent blindness. This
is due to the action of the poison on the ganglionic cells of the retina
with subsequent atrophy of the optic nerve. If blindness is not total,
there is considerable contraction of the field of vision and an
impairment of the color sense.
b. Isopropyl Alcohol (Rubbing Alcohol) The compound is converted
in the body to acetone and excreted as such. Acetone is excreted
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 through the lungs and produces hemorrhagic tracheobronchitis,
bronchopneumonia and hemorrhagic pulmonary edema. It also causes
lower nephron nephrosis, hemoglobinuria, fatty changes in the liver,
respiratory paralysis and death.
c. Ethylene glycol and/or Diethylene glycol Either or both are
present in industrial antifreeze mixture but may become contaminant
to the alcoholic beverages. Ethylene glycol is marked central nervous
system depressant and is oxidized in the body to toxic oxalic acid. The
oxalic acid crystals plug the excretory tubules of the kidneys causing
marked functional impairment and nephrosis. In the brain it may
cause chemical meningitis and meningoencephalitis. Diethylene
glycol is also a central nervous depressant and causes centrolobular
hydropic degeneration and necrosis of the liver as well as bilateral
cortical necrosis.
5. Diseases Associated with/or as a Complication of Alcoholism:
The most frequent effect of continuous consumption of alcohol is that the
development of fatty liver may ultimately become a condition of cirrhosis. A
cirrhotic liver may cause rupture of the esophageal varices. Alcoholism may
also cause hemorrhagic pancreatitis, bronchopneumonia and development of
other infectious diseases. An alcoholic who is suddenly withdrawn from
alcohol may suffer a state of excitement with hallucination known as
delirium tremens. It is characterized by an attack of acute insanity with
sleeplessness, marked tremors, excitement, fear and sometimes with strong
suicidal tendencies. An alcoholic may develop Korsakow's psychosis. It is a
syndrome characterized by hallucination, disorientation and multiple
neuritis, and the loss of memory for recent events. Cortical atrophy is the
main alteration grossly observed in fatal cases. Alcoholic Polyneuritis may
also develop as a complication of alcoholism. There is a combined
degeneration of the nerve fibers and myelin sheaths.

Post-mortem Findings in Death Due to Alcoholism:

Gross post-mortem findings are not characteristic. Most often the
pathological findings were associated with or have developed a complication
of alcoholism that had been observed. However, the following are some of
the most common findings:

1. Presence of "alcoholic odor" of the stomach contents. The odor emitted is

not due to alcohol but most often to that of the congener.
2. Congestion of the mucosa of the stomach.
3. Congestion of brain and its meninges.
4. Heart may be dilated and flabby and lungs congested and frothy,
otherwise normal.
5. Blood, alveolar air and urine examinations reveal the presence of
alcohol.

Pathological Drunkenness:
A condition wherein a small amount of alcohol intake may be sufficient to
make a person drunk on account of an existing pathological condition of the
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body. Brain concussion, sun-stroke, epilepsy and other conditions may
predispose a person to the effects of alcohol.

Punch Drunkenness:
This is not a condition of drunkenness. It may be observed among
professional boxers who may have developed a peculiar physical and mental
condition on account of repeated trauma on the head. The individual begins
to have lack of concentration. He may change the subject-matter of a
conversation abruptly and may ask the same question for several times. He
has a bad memory of recent events. He is not too sociable, garrulous and
boastful but rather timid and shy. His articulation may be glazed and
slurring. Romberg's sign may be positive and locomotion may be ataxic and
unsteady. Involuntary movement of a boxic nature may be present. He
simulates continuously a person who is drunk.

1. Analysis of Blood:
Analysis of the blood is probably the most widely accepted way to
determine the concentration of alcohol in the body. It is a direct method of
estimation although the subject may refuse blood extraction for such
analysis. Alcohol should not be used to sterilize the skin before withdrawal
for it might possibly give a false high reading. The blood sample must be
drawn by a physician, nurse or other competent technician under sterile
condition. On account of the great number to be tested, especially those
traffic violators, it makes the blood analysis quite impractical.
2. Analysis of the Breath:
The concentration of alcohol in the blood can be determined indirectly by
making a quantitative determination of alcohol in the respired air. The basis
of the analysis is that there is a constant ratio between the concentration of
alcohol in the blood stream and in the alveolar air.
3. Analysis of the Urine:
Urine as a specimen for alcohol determination has not gained widespread
use because of variability in the different periods of alcohol intake.
4. Analysis of Body Tissue:
This method is applicable in death cases. Examination of the brain for its
alcohol content is a reliable diagnostic procedure. Other bloody organs like
the liver, spleen, and kidney may also be examined for alcohol contents.
5. Analysis of Saliva, Perspiration and Spinal Fluid:
Although it may be done, examination of these fluids is seldom done.

Objectives of Alcohol Examination:

1. For Screening This is done to determine whether alcohol is

present in the sample. The sample may be blood, urine, saliva,
vitreous humor, stomach content or respired air (alveolar air). The
instrument and the procedures must be simple for an ordinary layman
or a police officer to perform the job. The apparatus must be portable
so that the result will be available in the shortest possible time. The
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 apparatus may be placed in a mobile laboratory for the purpose of
screening drivers of motor vehicles.
2. For Evidentiary Purpose If in the screening process the sample
had a positive result, the next procedure to be applied is the
determination of the quantity of alcohol. The report is to be submitted
in connection with such examination to be used as an evidence as to
the presence and actual amount of alcohol in the submitted specimen.
The procedure requires the use of precision instrument and should be
performed in a regular chemical laboratory.

Methods Used in Alcohol Detection:

At present there are many kinds of apparatus perfected and laboratory
procedures adopted in alcohol detection, but these different methods are
actually based on any of the following principles:
1. Chemical Method The sample is distilled and later allowed to react
with a known quantity of oxides, usually chromate, and it determines the
amount of chromate which has not reacted to alcohol. By computation the
amount of alcohol in the sample can be determined. This is the principle
involved in the use of breath alcohol determination with the use of Alco-
tester (500), Breath analyzer (900A, 1000) and Alcometer (AE-D1).
2. Enzymatic Method A known quantity of purified alcohol
dehydrogenase and its coenzyme nicotamide adenine nucleotide (NAD) is
allowed to react to the sample. Alcohol is oxidized to aldehyde the
coenzyme nicotinamide adenine dinucleotide ( N A D ) , and this can be
measured colorimetrically or spectophotometrically. The dipstick method or
quick quantification of ethanol in the body fluid is based on this principle:
"A quarter-inch cellulose pad at one end of the strip is impregnated with a
buffered solution containing yeast alcohol dehydrogenase (ADH),
nicotinamide adenine dinucleotide, pyrazole iodonitrotetrazolium
chloride (INT) and deaphorase. When the strip is dipped into saliva, urine or
serum that contains ethanol, it turns various shades of pink instantly because
of a reaction between, on the one hand, the NADH that is produced and, on
the other, diaphorase and INT. on the other. The amount of ethanol present
can be quantitated by comparison with a color chart. By this method, ethanol
concentrations in body fluids can be measured in only 60 seconds, a
considerable savings in the time over methods that require the delivery of a
sample to a laboratory plus testing time. In an emergency situation in which
the patient cannot be tested by breath analysis, this is an obvious advantage
(JAMA, Vol. 250, No. 13, Oct. 7, 1983).
3. Gas Chromatographic Method The specimen may be first purified or
injected directly to the apparatus.
4. Infrared Absorption Method Alcohol is present as a vapor in breath. It
absorbs specific wave lengths of infrared. An intoxilyzer measures alcohol
by detecting the decrease in the intensity of infrared energy as it passes
through the cell.

Societal Reaction to the Problem of Alcoholism:

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1. Promulgation of laws and regulations:
a. Manufacturing of liquor only to a certain percentage of alcohol in
beverages.
b. Restricting the time and place of drinking and the availability of
liquor to a particular age, sex and other socio-economic group.
c. Subjecting drivers at random to an alcohol screening test, and if
found positive, it is to be followed by a quantitative determination of
blood alcohol. If blood alcohol exceeds the maximum tolerable limit
prescribed, the driver can be arrested.
2. Various indoctrination methods may be employed to encourage
moderation or abstinence, like education in schools and churches.
3. An institutional-organization approach, introduces substitute form of
tension relief into the social structure. Subsequent removal of the cause of
tension and diverting attention to something else can also be looked into.
4. A variety of therapeutic approaches are taken under the concept that an
alcoholic is a patient:
a. Therapy combines medicine with psychiatry, psychology, social
case work and alcoholic anonymous.
b. Pastoral counseling are given in churches.
c. Half-way houses are built to bridge the gap between the penal
institution and the community.

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