ALCOHOL AND TOBACCO

Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

ALCOHOL

Alcohol is a drug. It is classed as a depressant, meaning

that it slows down vital functions—resulting in slurred
speech, unsteady movement, disturbed perceptions and an
inability to react quickly. As for how it affects the mind, it
is best understood as a drug that reduces a person’s ability
to think rationally and distorts his or her judgment.

Although classified as a depressant, the amount of alcohol

consumed determines the type of effect. Most people drink for the stimulant effect, such as a
beer or glass of wine taken to “loosen up.” But if a person consumes more than the body can
handle, they then experience alcohol’s depressant effect. They start to feel “stupid” or lose
coordination and control.

Alcohol overdose causes even more severe depressant effects (inability to feel pain, toxicity
where the body vomits the poison, and finally unconsciousness or, worse, coma or death from
severe toxic overdose). These reactions depend on how much is consumed and how quickly.
There are different kinds of alcohol. Ethyl alcohol (ethanol), the only alcohol used in beverages,
is produced by the fermentation of grains and fruits. Fermenting is a chemical process whereby
yeast acts upon certain ingredients in the food, creating alcohol.

Alcohol Content

Fermented drinks, such as beer and wine, contain from 2% alcohol to 20% alcohol. Distilled
drinks, or liquor, contain from 40% to 50% or more alcohol. The usual alcohol content for each
is:
• Beer 2–6% alcohol
• Cider 4–8% alcohol
• Wine 8–20% alcohol
• Tequila 40% alcohol
• Rum 40% or more alcohol
• Brandy 40% or more alcohol
• Gin 40–47% alcohol
• Whiskey 40–50% alcohol
• Vodka 40–50% alcohol
• Liqueurs 15–60% alcohol

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

Overview of Alcohol Consumption

People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people – and
throughout history, we’ve struggled to understand and manage alcohol’s power. Why does
alcohol cause us to act and feel differently? How much is too much? Why do some people
become addicted while others do not?

Alcohol’s effects vary from person to person, depending on a variety of factors, including:
• How much you drink
• How often you drink
• Your age
• Your health status
• Your family history

While drinking alcohol is itself not necessarily a problem – drinking too much can cause a range
of consequences, and increase your risk for a variety of problems.

Consequences of drinking too much

Alcohol enters your bloodstream as soon as you take your

first sip. Alcohol’s immediate effects can appear within
about 10 minutes. As you drink, you increase your blood
alcohol concentration (BAC) level, which is the amount of
alcohol present in your bloodstream. The higher your
BAC, the more impaired you become by alcohol’s effects.
• Death
These effects can include:
• Reduced inhibitions Other risks of drinking can include:
• Slurred speech • Car crashes and other accidents
• Motor impairment • Risky behavior
• Confusion • Violent behavior
• Memory problems • Suicide and homicide
• Concentration problems
• Coma
• Breathing problems

In addition, long-term alcohol use disorder may result in Wernicke-Korsakoff syndrome, a brain
disorder due to thiamine (vitamin B1) deficiency. Lack of vitamin B1 is common in people with
alcohol use disorder.
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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

Alcohol's Effects on the Body

Brain: Alcohol interferes with the brain’s communication pathways, and can affect the way the
brain looks and works. These disruptions can change mood and behavior, and make it harder to
think clearly and move with coordination.

Heart: Drinking a lot over a long time or too much on a single occasion can damage the heart,
causing problems including:
• Cardiomyopathy – Stretching and drooping of heart muscle
• Arrhythmias – Irregular heart beat
• Stroke
• High blood pressure

Liver: Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver
inflammations including:
• Steatosis, or fatty liver
• Alcoholic hepatitis
• Fibrosis
• Cirrhosis

Pancreas: Alcohol causes the pancreas to produce toxic substances that can eventually lead to
pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that
prevents proper digestion.

Cancer: Based on extensive reviews of research studies, there is a strong scientific consensus of
an association between alcohol drinking and several types of cancer. In its Report on
Carcinogens, the National Toxicology Program of the US Department of Health and Human
Services lists consumption of alcoholic beverages as a known human carcinogen. The research
evidence indicates that the more alcohol a person drinks—particularly the more alcohol a person
drinks regularly over time—the higher his or her risk of developing an alcohol-associated cancer.
Based on data from 2009, an estimated 3.5 percent of all cancer deaths in the United States
(about 19,500 deaths) were alcohol related (see https://www.cancer.gov/about-cancer/causes-
prevention/risk/alcohol/alcohol-fact-sheet).

Immune System: Drinking too much can weaken your immune system, making your body a
much easier target for disease. Chronic drinkers are more liable to contract diseases like
pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single
occasion slows your body’s ability to ward off infections – even up to 24 hours after getting
drunk. (Source: National Institute on Alcohol Abuse and Alcoholism https://www.niaaa.nih.gov)

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

Short Term Effects of Alcohol

The short-term effects of alcohol (more specifically ethanol) consumption – due to drinking beer,
wine, distilled spirits or other alcoholic beverages – range from a decrease in anxiety and motor
skills and euphoria at lower doses to intoxication (drunkenness), stupor, unconsciousness,
anterograde amnesia (memory "blackouts"), and central nervous system depression at higher
doses. Cell membranes are highly permeable to alcohol, so once alcohol is in the bloodstream, it
can diffuse into nearly every cell in the body.

The concentration of alcohol in blood is measured via blood alcohol content (BAC). The amount
and circumstances of consumption play a large role in determining the extent of intoxication; for
example, eating a heavy meal before alcohol consumption causes alcohol to absorb more slowly.
[1] The amount of alcohol consumed largely determines the extent of hangovers, although
hydration also plays a role. After excessive drinking, stupor and unconsciousness both can occur.
Extreme levels of consumption can cause alcohol poisoning and death; in fact, a concentration in
the blood stream of 0.36% will kill half of those affected. [2][3][4] Alcohol may also cause death
indirectly, by asphyxiation from vomiting. Alcohol can greatly exacerbate sleep problems.
During abstinence, residual disruptions in sleep regularity and sleep patterns are the greatest
predictors of relapse.

Results of the 2010 ISCD

study ranking the levels of
damage caused by drugs, in
the opinion of drug-harm
experts. When harm to self
and others is summed,
alcohol was the most harmful
of all drugs considered,
scoring 72%.

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

Repeated Use of Alcohol Can Cause Long-term Changes in the Brain

When a person drinks alcohol repeatedly, it takes more drinks to become intoxicated. This means
that the person has developed tolerance to alcohol. Tolerance is a consequence of two changes
in the body. With repeated use of alcohol, the targets (receptors) for alcohol adapt by decreasing
their number. Now, it’s harder for alcohol to produce its effects.

Second, liver cells respond by making more enzymes to metabolize alcohol. The increased
metabolism means there is less alcohol in the body. In both of these situations, the person will
drink more alcohol to try and achieve the original effect. These cellular adaptations and the
development of tolerance are key to the progression to addiction.

Researchers have shown that repeated episodes of binging and drinking to intoxication
substantially increases the risk of alcohol addiction. Once the person is addicted to alcohol,
he/she no longer has control over drinking. The loss of control and craving that ensues when the
alcohol isn’t available are due to changes that take place in the brain.

One serious change that can result from repeated drinking is shrinkage of the brain. The
shrinkage is probably due to a loss of neurons (grey matter) and glial cells (white matter), the
other major type of cell in the brain. The shrinkage happens especially in areas of the brain that
are important in learning and memory, such as the cerebral cortex and the hippocampus.

Figure 2.6 Brain scans (magnetic resonance imaging or MRI) show a smaller hippocampus (in the red circles) in a
person with adolescent alcohol-use disorder (right) compared to a healthy person of the same age (left). (Adapted
from M.D. De Bellis, with permission). Learn how an MRI is obtained.

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

The brain adapts to the repeated use of alcohol by decreasing the neurotransmitter receptors with
which alcohol interacts. This adaptation can explain the development of alcohol tolerance, which
can progress to addiction.

Signs of Ethanol Intoxication

Intoxication describes a state of altered physical and mental processes that are produced by
substances such as alcohol. The symptoms include physical, behavioral, and mental changes,
based on where the alcohol acts in the brain. Some signs of intoxication are listed here:

• Excitability or “disinhibition”—Initially, some people get excitable when they drink

alcohol and the normal brakes on inappropriate behavior are “released”. The person talks
loudly, laughs inappropriately, and touches inappropriately, etc., “Obnoxious” behavior.
• Loss of judgment—One of the earliest signs of intoxication; loss of judgment may be
why some people decide it’s OK to drive after drinking alcohol or why people who do
drive misjudge traffic conditions, leading to accidents.
• Cognitive impairment—another early sign of intoxication is that the person has trouble
thinking clearly. A danger of this symptom is that it lasts well after someone stops
drinking, again a basis for misjudgment during a task such as driving.
• Unsteady gait—Incoordination can lead to imbalance while walking and to other
problems that require fine motor control.
• Nausea & vomiting—The alcohol irritates the stomach producing nausea, and eventually
vomiting. Vomiting is the body’s protective mechanism to get rid of the alcohol from the
stomach before the blood alcohol concentration gets high enough to cause death.
• Loss of memory—drinking episodes, especially binging, lead to a loss of memory of
specific events or even entire events during a drinking period (blackout). A blackout
does not mean the person “passed out”.
• Sedation—Alcohol can make one feel sleepy, just like a sleeping pill.
• Loss of consciousness—The body protects itself by “passing out” as alcohol reaches
high levels in the brain. While passing out doesn’t necessarily lead to death, if the levels
of alcohol are high enough in the brain, cardiovascular and respiratory centers in the
brain shut down, producing death.
Figure 2.1 Symptoms of alcohol intoxication occur as one drinks
more alcohol and more alcohol reaches the brain.
Impaired thinking and poor judgment are among the first
effects to emerge after drinking alcohol.

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

TOBACCO

Tobacco is the common name of several plants in

the Nicotiana genus the Solanaceae (nightshade and) family, and
the general term for any product prepared from the cured leaves of
the tobacco plant. More than 70 species of tobacco are known, but
the chief commercial crop is N. tabacum. The more potent
variant N. rustica is also used around the world.

It is a plant grown for its leaves, which are dried and fermented
before being put in tobacco products. Tobacco contains nicotine,
an ingredient that can lead to addiction, which is why so many
people who use tobacco find it difficult to quit. There are also
many other potentially harmful chemicals found in tobacco or
created by burning it such as tar, carbon monoxide, acetaldehyde,
and nitrosamines, also can cause serious harm to the body.
Tobacco products come in many forms. People can smoke, chew, sniff them, or inhale their
vapors.

Smoked tobacco products.

1. Cigarettes: These are labeled as regular, light, or menthol, but no evidence exists that
“lite” or menthol cigarettes are safer than regular cigarettes.
2. Cigars and pipes: Some small cigars are hollowed out to make room for marijuana,
known as "blunts," often done to hide the fact that they are smoking marijuana. Either
way, they are inhaling toxic chemicals.
3. Bidis and kreteks (clove cigarettes): Bidis are small, thin, hand-rolled cigarettes.
Kreteks—sometimes referred to as clove cigarettes—contain about 60-80% tobacco and
20-40% ground cloves.
4. Hookahs or water pipes: Hookah tobacco comes in many flavors, and the pipe is typically
passed around in groups. A recent study found that a typical hookah session delivers
approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times
the carbon monoxide as smoking a cigarette.

Smokeless tobacco products. The tobacco is not burned with these products:
1. Chewing tobacco. It is typically placed between the cheek and gums.
2. Snuff: Ground tobacco that can be sniffed if dried or placed between the cheek and gums.
3. Dip: Moist snuff that is used like chewing tobacco.
4. Snus: A small pouch of moist snuff.
5. Dissolvable products: These include lozenges, orbs, sticks, and strip.

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

Vaping/electronic cigarettes (also called e-cigarettes, electronic nicotine delivery systems,

vaping devices, e-cigs, or JUULing). Vaping products are battery-operated devices that deliver
nicotine and flavorings without burning tobacco. In most products, puffing activates the battery-
powered heating device, which vaporizes the liquid in the cartridge. The resulting vapor is then
inhaled (called “vaping”).

The smoke from combustible tobacco products contains more than 7,000 chemicals. Nicotine is
the primary reinforcing component of tobacco; it drives tobacco addiction. Hundreds of
compounds are added to tobacco to enhance its flavor and the absorption of nicotine.

What is nicotine?

Nicotine is a stimulant drug that speeds up the messages travelling between the brain and body. It
is the main psychoactive ingredient in tobacco products.

Tar and carbon monoxide (a toxic gas) are also released when tobacco is burned, such as when
it’s smoked. Nicotine constitutes 0.3 to 5 percent of the tobacco plant by dry weight, with
biosynthesis taking place in the roots, and accumulates in the leaves. It is a potent neurotoxin and
is included in many insecticides.

Electronic cigarettes (also known as E cigarettes) do not contain dried tobacco leaves, but they
may still contain nicotine. Nicotine stimulates the adrenal glands to release the hormone
epinephrine (adrenaline) and increases the levels of a chemical messenger in the brain
called dopamine. Pleasure caused by nicotine’s interaction with the brain’s reward system
motivates some people to use nicotine again and again, despite possible risks to their health and
well-being.

Nicotine is poisonous and, though uncommon, overdose is possible. Nicotine contained in

tobacco is highly addictive. Although it’s addictive, most of the severe health effects of tobacco
use also come from other chemicals, those which sprayed during Planting up to Curing.

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ALCOHOL AND TOBACCO
Legal/Forensic Medicine
Submitted by: Gigi M. Gonzales, Ariel Liaod, and Zyrene Cabaldo,

Tobacco smoking can lead to lung cancer, chronic bronchitis, and emphysema. It increases the
risk of heart disease, which can lead to stroke or heart attack. Smoking has also been linked to
other cancers, leukemia, cataracts, Type 2 Diabetes, and pneumonia. All of these risks apply to
use of any smoked product, including hookah tobacco. Smokeless tobacco increases the risk of
cancer, especially mouth cancers.

For many who use tobacco, long-term brain changes brought on by continued nicotine exposure
result in addiction. When a person tries to quit, he or she may have withdrawal symptoms,
including:
▪ irritability
▪ problems paying attention
▪ trouble sleeping
▪ increased appetite
▪ powerful cravings for tobacco

Tobacco can also be deadly for non-smokers. Second-hand smoke exposure has also been
implicated in adverse health outcomes, causing 1.2 million deaths annually. Nearly half of all
children breathe air polluted by tobacco smoke and 65 000 children die each year due to illnesses
related to second-hand smoke. Smoking while pregnant can lead to several life-long health
conditions for babies.

Heated tobacco products (HTPs) contain tobacco and expose users to toxic emissions, many of
which cause cancer and are harmful to health. Electronic nicotine delivery systems (ENDS) and
electronic non-nicotine delivery systems (ENNDS), commonly known as e-cigarettes, do not
contain tobacco and may or may not contain nicotine, but are harmful to health and undoubtedly
unsafe.

OTHER REFERENCES:

1. https://www.drugabuse.gov
2. https://www.who.int/news-room/fact-sheets/detail/tobacco
3. https://en.wikipedia.org/wiki/Tobacco
4. https://adf.org.au/drug-facts/nicotine/
5. https://sites.duke.edu/apep/module-2-the-abcs-of-intoxication
6. https://www.drugfreeworld.org
7. https://discoveryplace.info/six-classifications-of-drugs/
8. https://en.wikipedia.org/wiki/Tobacco
9. https://www.who.int/health-topics/tobacco#tab=tab_3

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