Event alcohol friend or foe of man. Alcohols are friends and enemies of mankind. Cosmetics based on alcohols and their derivatives
Spirits - friends and enemies
humanity
Goals. Repeat and summarize knowledge about the class of alcohols, their chemical properties, production and use; alcoholism prevention.
Equipment and reagents. Cards with data on the physical properties of ethanol and methanol; alcohol tinctures of herbs, iodine (pharmaceutical preparations), lotions, perfumes, colognes, deodorants, glycerin, antifreezes, solvents for varnishes and paints containing alcohols, foods for diabetics - cookies, sweets (or packaging from these products), xylitol, sorbitol (pharmaceutical preparations), chewing gum with xylitol; two glass bottles with a capacity of 200–250 ml with labels, one says “Ethyl alcohol”, the other says “Methyl alcohol. Poison ”and a skull with bones is drawn (pour ethyl alcohol into both bottles).
Preparing for the lesson
It is desirable to involve teachers of biology, history, and literature in the preparation and conduct of this lesson. They will help students find the information they need and prepare reports on various aspects of the problem of alcoholism. Such messages will make it possible to actively include in the lesson students whose cognitive interests are mainly related to humanitarian subjects - history, literature. Students who have chosen the profession of a lawyer can prepare reports based on the materials of local law enforcement agencies, analyze some articles of the Criminal Code of the Russian Federation, which talk about the features of their application to crimes committed while intoxicated. Students who decide to devote themselves to medicine can talk about the physiological effect of alcohol on the body of adults and children, about the features of the so-called "drunken injuries".
The whole lesson or its individual stages can be held in the form of a conference or role-playing game.
Sample Topics for Student Messages.
The physiological effect of alcohol on the human body.
Images of victims of alcoholism in Russian literature.
Alcohol in the personal and creative fate of Russian writers, artists.
Alcohol and crime in our area (city, village).
Chronicle of incidents: victims of the use of counterfeit alcoholic beverages, methanol, denatured alcohol, technical fluids.
Alcohol and adolescent health.
Alcohol in the history of Russia.
Attitude to alcohol in world religions.
Students who do not make detailed reports, in preparation for the lesson, select individual facts (based on the local press) of criminal incidents related to the use of alcohol, poisoning with surrogate alcoholic products and technical liquids, methyl alcohol.
DURING THE CLASSES
Cosmetics
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Let's start the lesson with repetition of the structure of alcohols- monohydric and polyhydric, nomenclature, homologous series of monohydric alcohols.
Next, we consider the material on the main methods of industrial production of ethanol.
ancient method ethanol production - fermentation of sugary substances. This is an example of an enzymatic process. The enzymes necessary for it are produced by yeast fungi. Ethanol can also be obtained from wood, since wood cellulose is identical to starch in its elemental composition. And yet, alcohol for food and medical purposes is obtained exclusively from food raw materials - grain, potatoes.
We are discussing a quote from a song by V. Vysotsky, in which there is a monologue of an alcoholic: “And if vodka was not driven from sawdust, then what would we have from five bottles?” From the point of view of a chemist, it refers to the different quality of alcohol obtained from food raw materials and from wood.
Blackboard work. Two students “receive alcohol” (write reaction equations): one from grain (alcoholic fermentation reaction), the second from sawdust (cellulose hydrolysis reaction and subsequent glucose fermentation).
Hydrolysis of cellulose proceeds in the presence of acids. The glucose obtained as a result of hydrolysis is subjected to enzymatic fermentation into alcohol. This alcohol is called hydrolytic. It is unsuitable for the manufacture of medicines and alcoholic beverages and is used only for technical purposes.
At first glance, the product of these reactions is the same - ethanol. It is important to pay attention to the reaction conditions and discuss them.
Cellulose hydrolysis proceeds under harsh conditions, while other natural compounds that make up wood are hydrolyzed. Therefore, the hydrolysis products contain many impurities (in particular, methanol), which are very difficult to remove from alcohol.
Alcoholic fermentation proceeds under fairly mild conditions and under the action of enzymes. This is an example of the selective action of enzymes. Of course, there are impurities in the fermentation products, they are called "fusel oils", these impurities are not so harmful to humans, and the fermentation product can be purified by distillation.
To obtain food alcohol, soft wheat varieties are used, because. they have a high starch content.
Now consider the use of ethyl alcohol. This stage of the lesson can be carried out in the form of a game. The class is divided into two teams, and each in turn names the scope of ethanol. The team on which the enumeration ends loses.
Having discussed the scope of ethanol, we should focus on one of the main areas of its use - the production of alcoholic beverages.
This stage of the lesson has primarily educational value and is aimed at alcoholism prevention.
TEACHER. Perhaps there is not a single class of chemical compounds that would enter the history of mankind so controversially as alcohols, and mainly thanks to one of its representatives - ethyl alcohol.
Since ancient times, viticulture and winemaking have been revered as a worthy and profitable occupation for the peasants of many countries, such as France, Italy, Greece. On the territory of the former USSR, Georgia, Moldova, Armenia, Azerbaijan were famous for winemaking. In Russia, winemaking is widespread mainly in the Krasnodar Territory. Wine is an integral element of the cultural traditions of many peoples of the world. And at the same time, the spread of alcoholism and related diseases and crimes is a serious problem for many countries. The thief of reason - this is how alcohol has been called since ancient times.
It is advisable at this stage of the lesson to briefly review such information.
The effect of alcohol on a living cell and the organism as a whole.
The effect of alcohol on the human psyche and behavior.
Features of the effect of alcohol on the body of children.
Alcoholism and crime.
This material can be presented in the form of a role-playing game - through the messages of students playing the role of a biologist (physiologist), doctors of various specialties (therapist and traumatologist, pediatrician, psychiatrist), lawyer, representative of the traffic police.
Students' reports about the role of alcohol in the fate of prominent Russian writers and artists (for example, S. Yesenin, V. Vysotsky), about the history of alcohol consumption in Russia can become especially interesting and instructive.
TEACHER. One of the most dangerous consequences of alcoholism is poisoning with technical liquids containing crude ethanol or substances of a similar taste and smell. The most common poisoning occurs with methanol, which is often mistaken for ethanol in searches of alcohol.
The student makes a report on the materials of the local criminal chronicle about the consequences of methanol poisoning.
After the student's report, we discuss the question: why is methanol most often the cause of severe poisoning? Solving the problem, we repeat the basic physical and chemical properties of alcohols. On the board is a table of physical properties that students fill in as they repeat the properties of two alcohols. On the board, they write down the equations of the chemical reactions of alcohols.
Chemical properties:
combustion in air:
C 2 H 5 OH + 3O 2 2CO 2 + 3H 2 O;
interaction with metals:
2CH 3 OH + 2Na 2CH3ONa + H 2 ;
esterification reaction:
CH 3 COOH + CH 3 OH CH 3 COOCH 3 + H 2 O;
oxidation (with preservation of C–C bonds):
CH 3 CH 2 OH + [O] CH 3 C (O) H + H 2 O.
There are two students at the blackboard. First, everyone receives a bottle with the appropriate label (it is unnecessary to remind that both bottles have ethanol, only the labels differ) and describes the external signs of methyl and ethyl alcohol, writing them on the board in a table.
Table
| Physical characteristics of alcohols | Alcohol | |
|---|---|---|
| ethanol | methanol | |
| Color | Colorless | Colorless |
| Smell | Alcoholic | Alcoholic |
| Refractive index | 1,3611 | 1,3330 |
| Relative density, g / cm 3 | 0,7936 | 0,7917 |
| t kip, °С | 64,5 | 78,39 |
| Maximum allowable concentration in the air, mg / m 3 | 1000 | 5 |
Discuss with the class what physical characteristics of the two alcohols can be used to recognize them. Ethanol can be distinguished from methanol by its boiling point, relative density, and refractive index (refractive index). But this can only be done in laboratory conditions, with the appropriate equipment, and rather complex equipment (a distillation apparatus with an accurate thermometer, a refractometer). Relative density can be determined using a hydrometer, but the densities of these alcohols are very close, so there is no guarantee of recognition accuracy.
The conclusion from this stage of the lesson, students write in notebooks: it is possible to distinguish toxic methanol from ethanol only in laboratory conditions, using special equipment. These alcohols, being nearby in the homologous series, have similar chemical and physical properties, they are very difficult to distinguish, which is why methanol poisoning occurs so often.
According to its physiological action, methanol is a neurovascular poison. Ingestion of 5–10 ml of methanol already causes poisoning, which can lead to loss of vision, and a dose of 30 ml of methanol is lethal.
A natural question arises: maybe it is worth giving up altogether. wide application methanol and replace it with ethanol? It is impossible to do this, because methanol is a raw material for the production of formaldehyde and acetic acid, a solvent for varnishes and paints. Methanol is a good alternative to gasoline as an automotive fuel. Although its calorific value is half that of gasoline, it has a high octane number (125–130). In Brazil, methyl and ethyl alcohols, obtained from cheap agricultural raw materials (threshed corn cobs), are already quite successfully competing with gasoline. Alcohols as automobile fuel are also preferable from the point of view of ecology (write the equations for the combustion reactions of gasoline C 8 H 18 and methanol CH 3 OH).
Continuing the topic of the danger of poisoning by alcohol surrogates, we discuss what other substances can cause poisoning when they are used instead of food alcohol.
Very common poisoning denatured alcohol. This is the name of the crude alcohol-raw, which contains fusel oils - butanol, methanol, pyridine bases. The peculiarity of denatured alcohol is that the impurities contained in it cannot be isolated by simple physical and chemical methods, such as distillation, freezing.
There are also frequent poisonings with liquids that are poured into a car, especially antifreeze. They most often include ethylene glycol - a dihydric alcohol.
The next stage of the lesson is devoted to the consideration polyhydric alcohols in terms of their practical application. Typically, students are familiar with the applications of dihydric and trihydric alcohols. Ethylene glycol is currently the main component of antifreezes. Glycerin is used in the pharmaceutical, perfume and food industries.
It is advisable to get acquainted with the properties and use of two other representatives of polyhydric alcohols - xylitol
CH 2 OH(CHOH) 3 CH 2 OH
and sorbitol
CH 2 OH (CHOH) 4 CH 2 OH.
Xylitol is obtained by reducing the monosaccharide xylose, which is found in hardwood, corn cobs, straw, and seed husks. Sorbitol is obtained by hydrogenation of D-glucose, but it is also found in vegetable raw materials - the fruits of plants of the Rosaceae family, mountain ash is especially rich in it.
Xylitol and sorbitol are valuable in that they have a sweet taste and serve as a sugar substitute for diabetic patients (we demonstrate pharmaceutical preparations of xylitol and sorbitol, confectionery based on them, chewing gum with xylitol). Xylitol is used in medicine and as a good choleretic agent.
You can complete the lesson with a discussion about possible measures to combat alcoholism - both at the state level and at the level of each family, each team.
Additional Information
People learned about the intoxicating properties of alcoholic beverages at least 8000 BC. - with the advent of ceramic dishes, which made it possible to make alcoholic beverages from honey, fruits, juices, wild grapes. Perhaps winemaking arose even before the beginning of cultivated agriculture. Thus, the well-known traveler N.N.
Pure alcohol began to be obtained in the 6th-7th centuries. The Arabs called it "al cogol", which means "intoxicating". The distillation of wine to obtain alcohol contributed to the spread of drunkenness. It is believed that this was the reason for the ban on the consumption of alcoholic beverages, introduced by the founder of Islam, Mohammed (570-632). This prohibition was subsequently included in the code of Muslim laws - the Koran (VII century).
According to the classification of the World Health Organization, alcohol is classified as a drug. With more or less prolonged use of alcohol, a person develops a need for it.
There is an opinion that drunkenness is supposedly an ancient tradition of the Russian people. But the Russian historian and ethnographer, an expert on the customs of the people, Professor N.I. Kostomarov (1817–1885) completely refuted this opinion. He proved that in ancient Rus' they drank very little. Only on selected holidays they brewed mead, mash or beer, the strength of which did not exceed 5-10%. Chara started up in a circle, and everyone drank a few sips from it. On weekdays, no alcoholic drinks were allowed, and drunkenness was considered the greatest shame and sin. Under Peter I, drunkards who ended up in prison were hung around their necks with a heavy cast-iron medal “3a drunkenness”.
The subsequent spread of drunkenness in Rus' is connected with the policy of the ruling classes, their desire to get as much as possible more profit to the treasury from the liquor trade.
With water, alcohol forms hydrates of various composition, depending on the ratio of alcohol and water. The ancestor of modern forty-degree vodka is considered D.I. Mendeleev, who defended his thesis entitled "On the combination of alcohol with water." He proved that it is precisely this proportion of alcohol and water that gives the largest number heat and less burns the esophagus.
The most toxic are the hydrates formed at an alcohol strength of 70–80%. With a decrease in strength, toxicity decreases several times faster than concentration. Therefore, the toxicity of alcohol in low-alcohol drinks is much less pronounced than in the same amount (in absolute terms) of strong drinks. This property of alcohol has been noticed by man for a very long time. The ancient Greeks and Romans drank dry wine with a strength of 10-12%, diluting it with water, and were sincerely indignant when they learned that "the Scythians drink wine undiluted."
Special attention should be paid to the consumption of beer and its consequences. Beer belongs to low-alcohol drinks (on average 4-5%, but there are also strong varieties - up to 9%). However, this does not mean that beer is harmless. Narcologists have the term "beer alcoholism". Abroad, on average, 21% of patients treated for alcoholism in narcological clinics drank only beer. Therefore, even drinking only beer, a person is at risk of becoming an alcoholic. In addition, beer, being the primary product of fermentation, contains many impurities that adversely affect the liver.
Domestic forensic scientists and sociologists, based on research results, believe that approximately 93–96% of crimes are committed while drunk. In the US, of the more than 5 million annual arrests, almost half are related to alcohol abuse. Approximately the same statistics among prisoners: in approximately 50% of them, the cause of antisocial acts was alcohol.
Currently, researchers express the following points of view on the relationship between alcohol and aggression:
Alcohol reduces the processes of inhibition and releases violent impulses;
alcohol disrupts the activity of neurotransmitters;
alcohol leads to dysfunction of the temporal lobe of the brain, which contributes to aggressive behavior;
alcohol exacerbates behavioral disorders in mentally abnormal individuals.
Russian legislation determines that a person who has committed a crime while intoxicated is not only not exempted from criminal liability, but, on the contrary, bears it to a much greater extent, because intoxication is an aggravating circumstance.
The article was prepared with the support of the online store "optom-tut". If you decide to purchase quality household goods, then the best solution would be to contact the online store "optom-tut". On the site, located at www.Optom-Tut.Ru, you can purchase, without leaving the monitor screen, dishwashing sponges, adhesive tape, gloves, antimoles and mousetraps at competitive prices. Online store "optom-tut" has a wide range of quality household products, constantly updated.
Barannik V.P. Merciless but irreplaceable methanol. Chemistry at school, 1999, No. 6, p. 11–13;
Titova I.M., Martynova M.A. Solving problems of drug addiction in the process of teaching chemistry. Chemistry at school, 2002, no. 5, p. 49;
Volzhskaya N.Yu. Anti-drug education in the process of teaching chemistry. Methods of teaching chemistry, 2002, no. 3, p. 66–75.
ETHYL ALCOHOL: ARE YOU FRIEND OR ENEMY?
LESSON - CONFERENCE IN 11 CLASS
Biology teacher MOU secondary school No. 72
Lesson objectives: - to study the effect of alcohol on the human body
To generalize and deepen the knowledge of schoolchildren about a healthy lifestyle
To form students' understanding of the effect on the body
human alcohol
To form in students a negative attitude towards alcoholism
as a social phenomenon
Explore different ways to deal with negative
social pressure
Expand their horizons, prepare students for the adoption
balanced, sensible decisions
Develop the ability to think logically
conclusions and generalizations, develop skills of independent
analysis and evaluation of the proposed information
Continue developing the ability to work with additional
sources of information, find a logical relationship
between facts and put knowledge into practice
Equipment: tables "Harm of alcohol", "Liver of an alcoholic", "Brain of alcohol
Golik", "Heart of an Alcoholic", "Formula of Ethyl Alcohol"
Lesson motto: "Poison that takes longer to act is no less dangerous"
"Wine destroys the soul of people and their offspring"
"Disease is easier to prevent than to cure"
DURING THE CLASSES
Teacher: Since ancient times, a large number of toxic substances and many cases of their use have been known to man. All of them differ in strength and effect on the human body. What kind chemical substances should be considered harmful, and which should be considered beneficial? In many cases, this is a difficult question. Sometimes disputes here take on such a sharp character that it is just right to weigh all the pros and cons, as in a real court session.
Among the toxic compounds, a substance stands out, which is known in medicine as a strong protoplasmic poison, which a person uses to the detriment of himself and his health. This is Ethyl Alcohol. The death rate from alcoholism exceeds the number of deaths caused by all infectious diseases combined.
Health is not only a personal matter of each person. Loss of health is a physical, moral, economic damage to society. This will be discussed at our conference.
The conference is attended by researchers, doctors, law enforcement officers, historians. You flipped through many pages of textbooks and additional literature. And today we will create a lesson together.
Leading: Today we have a difficult but noble task - to speak openly against Ethyl Alcohol. The task is very difficult, since until recently ethyl alcohol conquered countries and continents, and no, even the most terrible punishment could stop the victorious march of alcoholism. In the course of studying the problem, it turned out that there is no such organ system that would not suffer from alcohol. The question always arose before us - what kind of substance did we meet? We cannot do without a true connoisseur of ethyl alcohol. I ask you to listen to the chemist's opinion about this insidious drink.
Chemist - expert: From the side of chemistry, ethyl alcohol is the most valuable substance. It is a colorless odorous liquid with a density of 0.79 g / cm3, with a boiling point of 78.4 C, and a melting point of 114 C. The closest relatives of wine alcohol are: Methyl and Propyl Alcohols. Acids enter into an esterification reaction with it, as a result of which esters, solvents and aromatic substances are obtained. Ethanol is obtained in two ways: a little benzene is added to an aqueous solution and the resulting mixture is subjected to fractional distillation. In this case, a mixture of water, alcohol and benzene is first distilled off, then a mixture of alcohol with benzene, and finally pure alcohol. According to another method, 96% alcohol is heated with calcium oxide or calcined copper sulfate, while the main part of the water is removed, but 0.2 - 0.3% of it remains; these traces of water can be removed with metallic magnesium or calcium.
Since the time of ancient civilizations, it has been the basis of most intoxicating drinks accepted in society. In table wines, every twentieth molecule is an Ethanol molecule. He was interested in himself, who devoted a section in his dissertation. And in the 1919s, a whole science of alcohol appeared - alkology. The molecular formula of Ethyl Alcohol is CH3-CH2-OH.
Scheme 1. N O --- N
N S ---- S N
The atomic orbitals of carbon and oxygen are in a state of hybridization. In this case, the C, O, H atoms connected by a sigma bond do not lie on one straight line. The O atom in the Ethanol molecule pulls the electrons of the C and H atoms towards itself, forming charges “+” on the H atom and “-” on the O atom. This gives it the ability to form hydrogen bonds with water molecules, allowing Ethanol to mix with it in any ratio, and also causes some dissociation of its molecules. O-N connection in an alcohol molecule it is less polar than in a water molecule, therefore it exhibits slightly acidic properties and reacts with alkali metals (but not with alkalis). Ethanol enters into a substitution reaction with hydrogen halides, into an esterification reaction, dehydrogenates, oxidizes to acetaldehyde and dehydrates. Ethanol is synthesized by ethylene hydration, reduction of acetaldehyde and hydrolysis of halogen derivatives, as well as fermentation of sugars obtained from rice, potatoes, corn and other plants, such as sugar palm.
Leading: The Ministry of Health warns that the use of alcoholic beverages adversely affects our organ systems. Let's ask the doctor. Is it so?
Physician - therapist: Alcohol is a strong poison for the liver, it leads to the degeneration and death of its cells - cirrhosis. Ethyl alcohol is one of the few substances that are already absorbed in the mouth and stomach, immediately begin to act. Aromatic compounds of alcohol irritate the mucous membranes of the mouth, tongue, and pharynx. Atrophy of the surface layers of the tongue occurs, which leads to a loss of taste. It destroys digestive enzymes. Because of this, the process of digestion of food in the digestive tract is disrupted. Once in the stomach, alcohol can increase the secretion of gastric juice. A large amount of acid burns the mucous membrane and leads to its death. In this case, not only the secretory, but also the motor function of the stomach is disturbed. Getting into the interstitial fluid, Ethanol begins to take water from the cells, as the concentration of substances outside the cells increases dramatically. Edema develops. Where are the old features? Where is the beauty?
The cause of 35% of all sudden deaths is alcohol myocardial damage, which is caused by a single intake of a large amount of alcohol. Cells suffering from lack of water age 1.5 times faster. Alcohol “washes out” microelements from the working heart muscle. There are pains in the heart. Prolonged exposure to alcohol and its decay products on the muscle tissue of the heart contributes to the degeneration of its individual sections into adipose tissue. As a result, the heart enlarges by 2-3 times and turns into an “alcoholic heart” or “bull heart”.
Toxic Ethanol inhibits the work of nerve cells, and then entire areas of the cerebral cortex are turned off. Exhaustion of the cerebral hemispheres is the cause of the inertness of the processes of inhibition and excitation. It is he who drowns out the receptors in the depths of the brain when exposed to small stimuli. Under the influence of alcohol, the synthesis of many proteins, including those responsible for memory, changes. The activity of neurotransmitters is also disturbed - biologically active substances involved in the transfer of excitation from one nerve cell to another. There is a decrease in mental and mental performance.
The source of energy for a person who consumes alcohol is not glucose, as in healthy people, but ethyl alcohol. The carbohydrates you eat are converted into fat. Adipose tissue is replaced in patients with alcoholism cells of the liver and other organs. At the last stage, there is a complete mental and physical dependence on alcohol, irreversible changes occur in the body.
Advocate: Sorry, but let me disagree with you. The opinion that alcoholic beverages have a negative impact on health has always prevailed over other points of view. However, now there is a sufficient amount of scientific evidence that people who drink small amounts of alcohol have a reduced risk of developing coronary heart disease. Such people die from heart attacks 1.5 times less often than those who do not drink at all. Small doses of alcohol help the arteries get rid of cholesterol, and this prevents atherosclerosis of the vessels.
In the 1930s, before antibiotics were discovered. The surgeon and scientist took large doses of alcohol for several weeks to treat sepsis, and this may have saved his life. The topical use of alcohol as a disinfectant is well known. In medicine, a well-known method of treatment is enotherapy (wine therapy). With reduced tone, hypotension, it is useful to add 1-2 teaspoons of cognac to a glass of tea. You can drink alcoholic beverages, but in moderation. The ancient physician Paracelsus said that the measure determines whether a substance is harmful or beneficial.
Leading: Serious passions begin to boil at our conference. Or maybe this substance is really useful. What does our head of the chemical laboratory think about this?
Chemist - expert: Scientific studies have shown that friendship with Ethanol can benefit the body: a few glasses of wine a week reduce the risk of diseases of the cardiovascular system. But with too close communication with him, people develop diseases such as cirrhosis of the liver, hypertension, pancreatitis, tracheobronchitis, nephropathy ...
In the liver, ethanol is oxidized to aldehydes, and as a result, products are formed, due to which its fatty degeneration begins. From a physiological point of view, ethanol is a depressant (depresses the body) and resembles an anesthetic (pain reliever) of general action. To lovers of alcoholic beverages, ethanol seems to be an aphrodisiac. But in fact, it inhibits the activity of the cerebral cortex. Ethyl alcohol is used in industry to produce many materials and organic compounds, including butadiene rubber, medical ether, chloroethane for local anesthesia, solvents, and more. It is used as a fuel, for example, for blowtorches and lighting fixtures.
Ethyl alcohol kills bacteria living on the skin, which could get inside the body and cause serious illness. Ethyl alcohol burns well. The first chemists called ethyl alcohol the spirit of wine, that is, wine spirit. In moderation, it has a pleasant effect on a person.
Leading: For centuries, ethyl alcohol, like a faithful dog, accompanied a person, performing a variety of social functions. Now in the world they drink 25 billion. bottles per year of wine (5 bottles per person). And in Russia - 8.5 liters each. Millions of people are turned off from active life, families are breaking up and a global earthly problem of alcoholism arises. In confirmation of my words, I ask you to listen to a sociologist.
Sociologist: Alcoholism - excessive consumption of alcoholic beverages - adversely affects the health, life and working capacity of people, the welfare and morality of the whole society. Alcoholism is incompatible with a healthy lifestyle. Public production suffers from drunkenness: many enterprises and institutions suffer losses from absenteeism, injuries of workers, accidents, theft, and a decrease in labor productivity associated with alcohol consumption. For example, according to American insurance companies, alcoholics annually miss more than 36 million person-days, which is twice as much as downtime during strikes.
Due to impaired coordination of movements and weakening of attention after taking small doses of alcohol, labor productivity decreases by an average of 30%, and with a moderate degree of intoxication - by 70%. When taking 30 ml. vodka significantly increases the number of errors among typesetters, typists and operators, when taking 150 ml. vodka in diggers and masons, muscle strength is reduced by 25%.
Alcohol has a negative effect on the accuracy of shooting. After taking 50 g of alcohol by an athlete, his result is: 26 out of 100. The decline in intelligence and moral level, the loss of normal interests and the constant desire to drink lead to the fact that the drunkard simply, as they say, “loses his mind”, is capable of humiliating his loved ones, ruining own family and even crime.
In conclusion, I will quote the words of the Russian proverb “First, a person drinks wine, then wine drinks wine, and then wine drinks a person.”
Leading: The sociologist gave us a lot of facts about the threat to the society of alcohol, and he is echoed by a law enforcement officer.
Internal affairs officer: According to the operational reports of the traffic police, 60% of accidents occur due to the fault of drunk drivers.
Ethyl alcohol, which is part of alcoholic beverages, acts on the central nervous system, causing a decrease in attention, a slow reaction, drowsiness, which leads to tragic consequences. In 2008, for this reason, about 5,000 people died on the roads of the region, and throughout Russia, the number of deaths is ten times higher.
Of course, scientifically technical progress gave rise to methods to determine the presence of alcohol in the body. This is the "Indicator" device. It is worth breathing into the tube - and under the influence of the vapors of Ethyl Alcohol from the respiratory tract of a person, the color of the substance - the indicator that fills this tube - changes.
In a state of intoxication, 55% of thefts, 79% of robberies, 69% of all attacks are committed. Ethyl alcohol can also cause interstate conflicts. For example, recently on one of the borders of Russia there was an attempt to illegally smuggle tens of tons of ethyl alcohol into the country. We imagine with horror the consequences that would result from the penetration of smuggled alcohol and low-quality alcoholic products to the domestic market of the country.
Finally, fires. Almost half of them are associated with drunkenness. And this is fraught not only with huge material damage but also loss of life. From these facts we can conclude: Ethyl alcohol is a source of increased danger.
Advocate: I agree that excessive drinking of alcoholic beverages is harmful to others. But Ethanol cannot be blamed for this. Rather, the person himself is to blame for this: usually a certain amount of ethyl alcohol is constantly formed in his body. In drunkards, alcohol ceases to be produced, but the body constantly requires its presence. That is why it is so difficult to recover from alcoholism. But the man himself is to blame.
Leading: We all know very well that Ethanol poisons the unborn generation of children with its bad breath. Just think, the children have not yet been born, but have already been sacrificed to him. The son of the mighty Zeus - Hephaestus - a small ugly hunchbacked freak - the child of a drunken conception. Isn't that why, from ancient times, even in ancient Greece, a Decree was introduced prohibiting the use of wine under 21 years of age. Now between 3 and 9 children per 1000 are born with fetal alcohol symptom. As confirmation of these facts, I ask you to listen to the opinion of a scientist - genetics.
Geneticist:(video about the effects of alcohol on babies)
By the nature of my service, I have to see a human misfortune: children suffering from hereditary diseases and pathologies of development. The systematic use of narcotic substances, which include alcohol, causes damage to germ cells - sperm and eggs. The use of Ethyl Alcohol is especially dangerous for women. Research conducted by Dutch scientists showed that 3,000 examined children suffering from congenital idiocy were conceived by parents in holidays in a state of extreme intoxication. When drinking alcohol, the hereditary apparatus (chromosomal, gene) of germ cells, their viability suffer. The action of alcohol at the stage of intrauterine development leads to deformities, increased mortality of newborns.
Scientists have identified a gene for alcoholism, which manifests itself in 40% of cases. Children with this gene have unpredictable behavior, they feel the need for alcohol from early childhood. Geneticists call this phenomenon fetal alcohol syndrome. Scientists have found that 90% of mentally retarded children who attend auxiliary schools and boarding schools are children of drinking parents. I will give one example. In the attic of the shed, where moonshine was secretly driven, there were 160 chicken eggs for incubation. What was the surprise of the owners when only 78 chickens hatched from these eggs, 40 of them soon died, and 25 turned out to be freaks: the embryos were poisoned by alcohol vapors.
In drinking families, 40% of children are sick. They work hard. Behavior becomes careless. It is difficult for them to retell what they have read. In such families, children are born dead or with congenital malformations 2 times more often. individual bodies, with a variety of deformities, and their mortality in early age 3 times higher than in families of non-drinking parents.
Leading: All of this is, of course, terrible. But among people who drink alcohol, there is an opinion that drinking alcohol brings benefits to people. There is an opinion that it helps people to live. They become smarter, more relaxed, brilliant ideas come to mind. Is it so?
Physician - enotherapist: I want to tell you how Ethanol helps us doctors. It is used as an antiseptic. In this capacity, he has helped many of us. Doesn't it seem black ingratitude to you to blame Ethanol and slander him? It is used for both rubbing and compresses. The solvent in many liquid medicines is also it. The simplest of medicines is vodka with pepper. Isn't it true, she cured many of us from colds!
Finally, Ethanol is used to make anatomical preparations that help students medical universities penetrate into all the secrets of the structure of the human body. It is Ethanol, and no one else, that is the most common solvent and reagent in biochemical, clinical diagnostic and chemical - pharmaceutical laboratories. We must not forget about his children - Chloroform and Diethyl Ether. They also help us doctors. And they get them from Ethanol! Ethanol is not the enemy of man at all. It is found in the tissues of the brain, muscles, human liver. The blood normally contains 0.004% Ethanol. It is also found in natural waters, soil, plant leaves and even in milk!
As for the harmful effect on the body, it is not Ethanol that should be blamed at all, but a person! Ethyl Alcohol never even thought of acting to harm people. On the contrary, this man used Ethanol for his nefarious purposes.
Leading: The previous speech contained many interesting facts. Ethyl alcohol has firmly entered our lives. It seems to have existed and has existed forever. What does our history say about its origin?
Historian: Since time immemorial, there has been a fame about drinks that amuse the soul, healing drinks, and relaxation drinks. As we know, the ancient peoples, having switched to a settled way of life, began to engage in agriculture, mastered the art of pottery and joined in alcohol.
They noticed that it was enough to leave crushed grapes or any other fruits in a closed vessel, after a few days they could find a drink that had strange and, as it seemed to them, miraculous properties. People appeared talkative, bragging, aggressiveness. But our distant ancestors did not drink at all in order to get drunk, but in strictly defined situations related to rituals and customs. The ancient peoples of the Mediterranean more than 4 thousand years before our era were able to make wine by fermenting grape juice. In ancient Egypt, wine was used from 3-2 millennium BC. The Sumerians were famous for their grain drinks, according to the recipes of the Aztecs, the Indians obtained “octli” from agave, “pulque” and tequila from cacti. African bushmen prepared invigorating drinks from the honey of wild bees. The ancient Rus mastered the art of preparing healing surya from honey and medicinal herbs.
Fortified wines have appeared in Rus' since the reign of Prince Oleg. Vodka appeared in Rus' in the 16th century, when alchemists mastered the method of distilling alcohol-containing liquids. It was suggested that the special, healing properties of alcohol. And its solutions were first sold in pharmacies under the name "water of life" or "fire water".
The word "vodka" in the Novgorod chronicle of 1533 meant not an intoxicating drink, but a medicinal infusion.
In 1552, Tsar Ivan the Terrible arranges the first tavern in Russia, only for guardsmen. Drinking tsar's vodka is a great honor. But trouble has not yet threatened Russia. By 1905, Russia consumed 0.57 buckets of wine per year per person, in France - 4.76 buckets, in Germany - 1.87 buckets. The soldering of the people became unrestrained at the beginning of the 20th century, when a kind of drinking procedure developed in Russia, according to which not a single significant event, not a single day of rest passes without wine. Vodka and alcohol were consumed in all life situations and in large quantities, which was associated with the "breadth" of the Russian soul. As said
Drink a cup - a sorceress
Zabubenny our fellow countryman;
Life is a penny! Death is a villain
He thinks it's rubbish.
Leading: Yes, a lot of words have been said today about Ethyl Alcohol. His influence on the world of people leads to dire consequences. It has been walking alongside humanity for a long time and is applicable in many areas of life. The use of drinks containing ethanol - wine, vodka, cognac, at first glance seems harmless and pleasant, but in fact it is fraught with many dangers. Many have become victims of disasters that occurred through the fault of people whose minds were clouded by wine vapors. According to the saying “The use of alcoholic beverages brutes and brutes a person, hardens him, distracts him from bright thoughts ... and most importantly, it irresistibly stands above the human will and generally eradicates all humanity”
One has to think that on planet Earth there is a real force capable of subjugating the will of a person and destroying him physically. She is more powerful than the mind. Humanity will either have to defeat her or perish in her painful poisoned embrace.
Advocate: Let me remind you, dear host, that even Galen and Aristotle used wine as medicine. The pectin substances of wine help the body to get rid of foreign compounds (radioactive strontium). Tannins are valuable for their antibacterial action. Sugar is a source of carbohydrates for the weakened and depleted. Ethanol is an excellent solvent. He is able to mix truly immiscible substances. It is a flushing agent in optics and electronics, and a preservative in biology.
Ethanol is used as fuel in different devices– from spirit lamps to rocket engines. Balms and tinctures, perfumes and lotions are produced on its basis. Don't forget the alcohol thermometers. As for the harm of Ethanol, I repeat: Paracelsus said that the measure determines whether a substance is harmful or beneficial.
Teacher: Dear my friends! Summing up our conference, where many opinions were expressed about the benefits and harms of Ethanol, I want to add the following in unison with Paracelsus: any immoderation, intemperance causes suffering to a person, leads to illness, reduces his intelligence. Even Aristotle said that in smart people passions are consistent with reason. A good mood arises from moderation in pleasures, deficiency and excess usually pass into each other and often lead to physical and moral upheavals.
Our conversation today has come to an end. But it is important for me to know your opinion about our dispute, What each of you will take with you.
The ancients had a deity, the best suited for the symbol of the contradictions defined by our topic. This is Janus two-faced. One face - dark - is turned to the past (there is a lot of sadness), the other - bright - looks to the future. Our task today was to form our opinion on the problem of harm or benefit of Ethyl Alcohol. As in those ancient, wise times, express your opinion by voting with balls: black ball - Ethanol is the enemy; white ball - Ethanol is a friend; red ball - everything is good in moderation. (vote)
Teacher: Here we have filled our vessel with a drink that sparkles with thoughts, dreams, doubts, contradictions. A small drop of doubt is the basis for future reflections. The main assessment will be given to you by life, for how you implement your knowledge, including those that you received in today's lesson. Health is 25% dependent on heredity and medicine, and 75% depends on the lifestyle you lead.
And I would like to end the lesson with the words of the German poet and naturalist Goethe: “It is not enough to know, one must also apply. It’s not enough to want, you have to do it.” Thank you all for the lesson - cooperation.
COMPETITION QUESTIONNAIRE
2. Biology teacher MOU secondary school No. 72
3. MOU SOSH No. 72, a
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Text content of presentation slides: ALCOHOL: FRIEND OR ENEMY? The use of alcohols. The impact of alcohol on the human body. The most famous organic compounds with a hydroxyl group - OH are alcohols (alcohols). ALCOHOL (FROM ARABIC alkohol - THIN POWDER) or "LIFE WATER" (aqua vitae) - THE STRONGEST MEDICINE This is how ethyl alcohol was called in the Middle Ages. Later, the name alcohols was assigned to the entire class of alcohols. ETHANOL ETHANDIOL PROPANTRIOL -1,2,3 THE HISTORY OF ETHYL ALCOHOL IS LOST IN THE DEEP OF THE CENTURIES. People learned about the intoxicating properties of alcoholic beverages at least 8000 years before our era - with the advent of ceramic dishes, which made it possible to make alcoholic beverages from honey, fruit juices and wild grapes. A well-known traveler, N.N.Miklukho-Maclay observed the Papuans of New Guinea, who still did not know how to make fire, but who already knew how to prepare intoxicating drinks. Pure alcohol began to be obtained in the 6th-7th centuries by the Arabs and they called it "al cogl", which means "intoxicating". The first bottle of vodka was made by the Arab Ragez in 860. In Western Europe, for the first time, "a miraculous elixir that makes an old man young, tired - cheerful, yearning - cheerful" was received by the Italian monk alchemist Valentius. ETHYL ALCOHOL IS THE MOST KNOWN AND WIDELY COMMON NARCOTIC SUBSTANCE. THE 11TH CENTURY ARAB SCIENTIST ABOUL FARAZH WROTE: “WINE INFORMS EVERYONE WHO DRINKS IT FOUR QUALITIES: THE NEED FOR ALCOHOL IS NOT AMONG THE NATURAL HUMAN LIFE NEEDS (NEED FOR OXYGEN OR FOOD). ALCOHOL BY ITSELF DOES NOT HAVE INCENTIVE FORCE FOR HUMANS. BBNY appears because ྡ $ ࠀ $ C ྪ ྪ $ ྦ ྦ ྦł 䐄 j ǯǯſƿǀࠀǒǿ̿ ο ouline 7 开 ⸯ 敲獬 콬 콬 ، ﯠ 裆寓 힡 㻒 놀쒕똬 撌 軇 軇 軇 軇 軇 軇 軇 軇 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 柭橺 䤿 괧 ⍦ 죑싙 ᳶ 鹢尭 윯 ྷ 娰 ᙌꑮ ᙌꑮ ᡰ 彟 꺭 邶 넮 榨噊 儓䋽 槉 藇魲 ⱌ 헉쩖 ⿹⸼ ဒ 藄 䁼 㜅 냲컛 㛮檘 썎 썎 썎 썎 HI 吩踢 侰䅑 䈝 䪗诩 ಚ 藺裭垣杚䐰 熎 드 饲欤 끩 捐蝇誚 ꧫ 蹾 팟 ⾥綯 枖 敿 풠 综 뿚 ࢀ 蔴 쭏 蠕磲 뢻 ϩ 䘂逸 䘂逸 䘂逸 䘂逸 䘂逸 忛Ͽ倀ŋⴂ᐀ࠀ℀蔀ğ牟汥⽳爮汥偳ŋⴂ᐀ࠀ℀폥팒ༀBD-BD------------------------------ 䐄 开 敲獬 ⸯ 敲獬 櫁ッ ، ﯠ 瑠鑟僮 裆寓 㻒 놀쒕똬 撌 柭橺 軇 䤿 괧 ⍦ 죑싙 僁 ᳶ 鹢尭 윯 ྷ 娰 " 榨噊 䬋 儓䋽 槉 藇魲 헉쩖 얌 ⿹ 掄 અ 츰 䃽 붜 ྋ 匎 ꆖ 㪕㗠 쬫 墢蝉 푷 厷 ố 迆 " -! 䌀踈 긍 耏 ༉ ᄀ ⳰ ᰏ āᰏdy ā ā 牟汥 ⽳ 爮 汥汳 쇏썪 ర 惻 惯彴 왐펈 ꅛ 틗 耾閱 貶 뉤 穧 읪 銎㿸 ⟡ 턣껂 쇫 戜 럇 럇 럇 럇 럇 럇 럇 럇 럇 ⽜ ⽜ ⽜ HIL 』嵚渎 䳥渖 炤 弘號 괳뚮 ꢱ 䩩 ୖ 굋툪 三 ㆒ 尛 ⽲狧 ꬖ 㛁 贐 ɷ⛮々 镲 ˕鿶 뜯쀏 䉢 낧 軱谄 愔" 嘼 ⲛ 视 쥯 菤 ꡣ હ 柘涸 듸 辰捁佋 ꪚ ꪚ 礯 湐燥 㞿䅯 距 휐썗 ᇺ ﴡ 㾏 㾏﹗ 㚢 쁊뢼 鶀 읞 っ蝪儱逐 닽 븅 ǽ 䭐 䭐 䭐 HI ȁ-! 쯶 쯶 开 敲獬 ⸯ 敲獬䭐 ȁ ȁ-! 弣蚑 弣蚑 shiȇ 牤⽳潤 湷 浸偬 ջ̀̀ ഀ က ࣰ ࣰ ༏ ༏ ⳰ ༀ āᰏdyԁā℄∄ ሄ ḅ ἀ ἀ ἀ ἀ ἀ ἀ ἀ ἀ HI ᠄ᜄሄḄᐄ᠄∄ഄ᐀ငᴄᴄ⬄ᤄ ἀ Ḅᐄ⌄ᨄ∄ꄀ䀏␀ĀĀĀĀЀĀ۾ĀĀĀࠀĀĀꨀฏ␀܀ᤀꘀఏ퐀퀁ဃ༅Ѐ舀ࣰ܀D쌀拰缀老⨏ 蔆 ȁ ā ā 뼀 脀 脀 駿 뼀 ခ ā ā （ࠁ ᠀ 㼀 ࠀ 耀 뼀 ȁ 琀 漀匀 栀愀 瀀攀 牟 汥⽳ 爮 쇏썪 ర 惯彴 왐펈 ꅛ 틗 틗 틗 틗 틗 틗 틗 틗 틗 틗 틗 틗 틗 틗 HIP 閱 ⳅ 貶 뉤 穧 읪 썉 ⟡ 暭 턣껂 쇫 戜 戜 ⽜ 럇 』嵚渎 䳥渖 炤 괳뚮 ⺐ ꢱ 䩩 ୖ 굋 枻駦 ㌄ 쉯퓌 ꇟ 皋 玗" 畡 ꗍ 쯓 ዃ ྄ ᫈ 悤 ༠ 滨馅 ᶶ 螖䑒 馴 뺔좨 龠雘 瘸 蘌崘 딩 ⻃ 朣 ㉉ڗ 蹫 ᔏ 쵱 趿 랂 穃雨 膻 몔 ⟛ 脐 HI 㸿浿 썏꿾 䗼檽 鴤䀭 癜 㺈厐 ﴐ 涢 դ ͽ 倀 ŋ ⴂ ᐀ ࠀ℀ 蔀 ğ ⽳ 爮 汥偳 ⴂ ᐀ ࠀ℀ ꄶ ﴀ ༀ 搀獲搯睯牮 癥 䭐 䭐 䭐 䭐 䭐 䭐 䭐 HI ्̎࢝ᘥၘ,န$䐄 "REPRODUCES" CUSTOMS, FORMS, HABITS AND The prejudices associated with his consumption ྡ 4bࠀ ྪ ྪ ྦ ྦ ྦ ఒ 䐈 \ \ ǯ ǯ ၠ خ خ خ خ خ خ ‡ ɓࠀƿǿ̿ 쎀 쎀 쎀 ᕙ cā 輀 need appears because society produces a given product “reproduces” customs and forms , HABITS AND PREJUDICES ASSOCIATED WITH ITS CONSUMPTION THE REASONS FOR THE FIRST INTRODUCTION TO ALCOHOL ARE VARIOUS. THEIR CHARACTERISTIC CHANGES DEPENDING ON AGE ARE TRACED. UNTIL 11 YEARS OLD THE FIRST ACQUAINTANCE WITH ALCOHOL HAPPENS EITHER BY ACCIDENTAL OR IT IS GIVEN "FOR APPETITIS", "CURED" WITH WINE OR THE CHILD TAKES ALCOHOL OUT OF CURIOSITY. AT A OLDER AGE THE MOTIVATIONS BECOME: “HOLIDAY”, “FAMILY Celebration”, “GUESTS”, ETC. "FOR COURAGE", GET RID OF BOREDOM", "RELIEVING STRESS", "STATEMENT IN THE GROUP OF COMRADES", ETC. A LITTLE CHILD MAY DIE FROM 50-60 GVODS ADULT - AFTER A SINGLE ADMINISTRATION OF 1-1.5 L ALCOHOL IS A DEATH ENEMY OF THE GROWING GENERATION. 3 DEGREES OF DRUNKING ARE KNOWN: EUPHORIC - THE EASIEST DEGREE OF DRUNKING;2. DEGREE OF OPPRESSION OF DEPARTMENTS OF THE BRAIN; 3. THE MOST SEVERE WHEN THERE CAN BE PARALIC VEGETATIVE CENTERS. THE CAUSE OF ALCOHOLISM (DISEASE) IS DRUNKNESS, LITTLE LIFE, IMMORAL, ANTISOCIAL WAYS OF LIFE. DRINKING IS SITUATIONAL ALCOHOL USE THAT IS DETERMINED BY EXTERNAL CAUSES AND CIRCUMSTANCES. TO UNDERSTAND THE DEVELOPMENT OF ALCOHOLISM, YOU NEED TO KNOW THE INFLUENCE OF ALCOHOL ON THE NERVOUS SYSTEM. ALCOHOL FROM THE STOMACH ENTERS THE BLOOD 2 MINUTES AFTER CONSUMPTION. First of all, the cells of the large hemispheres of the brain suffer: the conditionally reflex activity of a person slows down the formation of complex movements changes the ratio of the processes of excitation and inhibition is characterized by a special pathological state of the body: an uncontrollable attraction to alcohol changes in the degree of tolerance of alcohol, alcoholism, is not a habit, but a disease. ADDITION TO ALCOHOL IS HARDER TO OVERCOME BECAUSE OF POISONING OF THE BODY (10% OF PEOPLE WHO USE ALCOHOL BECOME ALCOHOLICS). THE CHEMICAL SUBSTANCE IN THE ORGANISM IS SUBJECT TO TRANSFORMATIONS: ITS TOXICITY IS DECREASED; METABOLITES ARE RELEASED. IN THE STOMACH, A SMALL PART OF IT IS ABSORBED BY THE MUCOSA, AND THE REST IS QUICKLY DILUTED BY GASTRIC JUICE. IN THE SMALL INTESTINE, ALCOHOL IS ABSORBED INTO THE BLOOD IN UNMODIFIED FORM, THEN WITH THE BLOOD GETS INTO ALL ORGANS AND TISSUES. ALCOHOL CIRCULATES WITH THE BLOOD THROUGH THE BODY, SLOWLY DEVELOPING IN THE LIVER, PART OF THE METABOLITES IS EXHAUSTED THROUGH THE KIDNEYS AND LUNGS, A SMALL PART THROUGH THE SKIN WITH Sweat. ALCOHOL DISTURBES THE STRUCTURE OF LIVER CELLS, LEADING TO REGENERATION OF ITS TISSUES. WITH THE SYSTEMATIC USE OF ALCOHOLIC DRINKS, FAT CHANGES IN THE LIVER CELLS LEAD TO THE DEATHING OF THE LIVER TISSUE - LIVER CIRRHOSIS DEVELOPES. DAMAGE TO LIVER CELLS LEADS TO DISTURBANCE OF PROTEIN AND CARBON METABOLISM, SYNTHESIS OF VITAMINS AND ENZYMES. IN 1 HOUR, ON AVERAGE, 0.1 g of ALCOHOL PER 1 kg of HUMAN WEIGHT IS DESTROYED. ACETALDEHYDE IS THE MAIN PRODUCT OF ETHANOL DESTRUCTION. THIS SUBSTANCE IS A TOXIC COMPOUND (REACTS WITH MANY BIOLOGICALLY ACTIVE SUBSTANCES). FURTHER DECAY LEADS TO FORMATION OF ACETIC ACID (FURTHER DECIDED IN ALL CELLS OF THE ORGANISM, FORMING WATER AND CARBON DIOXIDE GAS). Alcohol decay products - poisonous! ྡ) ࠀ) m ﺙ ྪ ྪ 橺軇 䤿 괧 ⍦ 僁 ᳶ 鹢尭 윯 娰 ᙌꑮ ᡰ 彟 ㎆ 꺭 邶 榨噊 䬋 儓䋽 藇魲 ⱌ 헉쩖 얌 ⿹े ἅ١ ߂ 赤掵 ṍ 猂 猂 猂 쭖솇 HI 滭䛼 ⧝⊔꣧ 蓀 禍郂㽅 ൲ ᢵ 沢 ꥋ 뱛롅 䤤 퉦앢 셱 䍠蘯 쾊 韓灕 뫌 糦 답 髙柬 䵿箯麥 㧧䂈 㯛 ₭ ꒝ 垉 ⹀ſ ȁ ȁ-- ! 쯶 开 敲獬 ⸯ 敲獬䭐 ȁ-! ꊑ 䆖 䆖 䆖 牤⽳潤 牤⽳潤 敲 浸偬 ջ̀̀ ﰀ က ࣰꐀ✀ 눁 ༁ ᄀ 㣰 섀 ☀ ᰏ āᰏdỳāā 牟汥⽳ 爮汥 汳 쇏썪 ర 惻 惯彴 왐펈 ꅛ 틗 耾閱 ⳅ 뉤 穧 읪 銎㿸 썉 ⟡ 暭 쇫 戜 럇 』嵚渎 䳥渖 炤 弘號 ⺐ ꢱ ୖ 굋뎤 쭴 쭴 쭴 쭴 芍 펏 萅 젏 㬚 갼짋 腃皹 㹷 귒 贊 㧶 㧶 〪 钹㚾 峏 ᱏ 讽 ⱋ 䚇 ǫ ᇯ 㭮伹 ꖒ 屲 ﵐ 嵕芭 탦 ზ⹙ 쿞 㮳 䵊 윟 ્ ﾇ ﾇ ﾇ ﰱ ﰱ ﰱ ﰱ ﰱ AH ?? ✀ ༀ ༀ āᰏdy ā ā ā 牟汥 爮 汥汳 쇏썪 ర 惯彴 왐펈 ꅛ 틗 ⳅ 貶 뉤 穧 읪 銎㿸 썉 ⟡ 暭 쇫 ⽜ 럇 』渎 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 嵚 䳥渖 炤 弘號 괳뚮 ⺐ ꢱ ୖ 굋 ︊ 㛿 `홇 存 存 ԧ 뺼 ㇌ 뛕 㷧饵 愈 ꊗ 튂 ⛻ ◥ 琙 琙 泮荛 쀾 邶 萾媛 儦鄴 ⬆എ 㘥⺴ 坤 坤 坤 坤 坤 坤 坤 坤 坤 坤 AH ??? Ջ̀̀ 뜀 豈 က ࣰ⨀ 鄀 켐 ༃ ᄀ 㣰 섀 ћ ⠀ ༀ āᰏD ā ā ā 爮 汥汳 쇏썪 ర 惻 惯彴 ꅛ 틗 ⳅ 貶 뉤 穧 썉 썉 썉 銎㿸 銎㿸 銎㿸 銎㿸 銎㿸 銎㿸 銎㿸 銎㿸 AH ⟡ 暭 턣껂 쇫 戜 ⽜ 럇 』嵚渎 炤 弘號 괳뚮 ⺐ ꢱ 䩩 ୖ 굋 勛僊牙 옘 ▾ 옜 眄 ⲍ 㩅㦬 堭楬 ꥣ ﳸ ㅹ 뗣븝 뗣븝 뗣븝 뗣븝 뗣븝 滅疻デ 滅疻デ 滅疻デ ꔚ伆竽∎ὒ嚻⤰臘渌퉷逕⯋Ͽ倀ŋⴂ᐀ࠀ℀蔀ğ牟汥⽳爮汥偳ŋⴂ᐀ࠀ℀退冯筮筥殐毠 䭐 · ˼̆ ᅴ 开 ⸯ 敲獬 콬 櫁ッ ﯠ 瑠鑟僮 裆寓 힡 㻒 놀쒕똬 撌 軇 䤿 괧 ⍦ 죑싙 僁 ᳶ 윯 ྷ 娰 ᙌꑮ ᡰ 彟 ㎆ 꺭 邶 넮 䬋 儓䋽 槉 ⱌ 헉쩖 헉쩖 얌 렡 䩌 땟큤갯 踣浞 쨡 醡 쁺 踱庛 銲㬆 ྎ ྎ 럚 絔㞗 홴 返 卥 ꏗ 卽燪 卽燪 卽燪 HI - ·˹ѝ֞8ு*န$䐄Ϩ რ ^ā輀 ALL ALCOHOL DECAY PRODUCTS ARE POISONOUS! Under the influence of the systematic use of alcohol, it occurs: significant disturbances in the cerebral cortex are enhanced by atherosclerotic processes => thrombosis or stroke of blood vessels associate with the development of sclerosis (elastic tissue of their walls is replaced by a coarse connective tissue, cholesterol is laid in the walls) many blood vessels expand (in the abuse of abuse WITH ALCOHOL, THE FACE IS OFTEN RED, AND SOMETIMES BLUE - DUE TO THE PERMANENT DILATION OF THE NOSE AND BEEKS VEINS) MUSCLE FIBERS ARE PARTIALLY REPLACED BY FAT AND CONNECTIVE TISSUE REDUCED HEART CONTRACTILITY HEART RATE, dyspnea, WEAKNESS CARDIOVASCULAR DISORDERS IN ALCOHOLISM ARE SO GREAT THAT CAN BE A CAUSE OF DEATH. THE MINUTE PLEASURE THAT ALCOHOL GIVES DOES NOT EXPECT THE MASS OF TROUBLES AND GROWTH THAT IT BRINGS TO PEOPLE, THAT LONG STRING OF UNACTIONS, THOSE TERRIBLE DESTRUCTIONS THAT THE ABUSE OF IT BRINGS INTO MODERN LIFE. CANEL DEPENDS ON THE PERSON ITSELF: DOES HE CHOOSE THE WAY OF DRINKING AND THEN AND ALCOHOLISM, THAT IS DISEASE AND THE ROAD TO ANYWHERE, OR HE STRIVES FOR A HEALTHY, ACTIVE, INTERESTING LIFE.
SBEE HPE "Moscow State Medical and Dental University named after A.I. A.I. Evdokimov" of the Ministry of Health of Russia, Department of Faculty Therapy and Occupational Diseases
SBEE HPE "First Moscow State Medical University named after I.I. THEM. Sechenov" of the Ministry of Health of Russia, Department of Clinical Pharmacology and Propaedeutics of Internal Diseases
Keywords: arterial hypertension, coronary heart disease, stroke, blood pressure, alcohol
Features of alcohol consumption in Russia. Alcohol and coronary artery disease
Numerous studies of the causes of high mortality in the Russian population have confirmed the negative role of excessive alcohol consumption. Thus, in the Russian Federation, the mortality of men due to alcohol is 5 times higher than in Western Europe. However, in general, the total alcohol consumption in Russia, although exceeding the indicators of developed countries, is not enough to explain the differences in mortality rates and life expectancy. Indeed, alcohol mortality per liter of consumption in Russia significantly exceeds similar indicators in Western Europe. The main reasons are the specific structure of alcohol consumption in our country (a large proportion of strong drinks), the northern type of alcohol consumption (large doses in a short time), as well as the traditionally low level of criticality of Russian citizens to their own health.
In the structure of various causes of death in patients with alcoholism, the main place is occupied by deaths from somatic diseases - 58%, while violent death (injury, poisoning, accidental drowning) occurs in 22% of cases, deaths from mental disorders (alcoholic psychosis) - in 2 .5%, suicides - in 2.1% of cases. These data are based on an analysis of 5,122 cases of death of alcoholics according to the Narcological Service. In turn, among the somatic pathology that caused the death of patients with alcoholism, diseases of the cardiovascular system (acute myocardial infarction, acute cardiovascular insufficiency) occupy the 2nd place - 16% (figure) .
Super-high alcohol consumption in Russia is about 30% of the death rate for men and 15% for women. Super-high alcohol consumption in Russia leads to premature, potentially preventable death of about 500,000 people every year (!). In the structure of mortality of the Russian population, the first place is occupied by mortality from coronary heart disease (CHD). According to this indicator, we, unfortunately, are ahead of most countries in the world. What is the relationship between the risk of developing coronary artery disease, including leading to death, and alcohol? The fact that even moderate and especially excessive alcohol consumption increases the risk of death from coronary artery disease has been absolutely proven. So, S. Costanzo et al. conducted a meta-analysis of 8 studies, in which a total of 16,351 patients with coronary artery disease participated. An increase in the risk of death from coronary artery disease was found with the use of more than 26 g of alcohol per day. At the same time, data are widely known that the relationship between alcohol consumption and mortality from coronary artery disease has the form of a J-shaped curve, that is, people who consume a small amount of alcohol have a lower risk of death from coronary artery disease than do not drink at all, and people Those who drink moderate or excessive amounts of alcohol are at greater risk than those who do not drink. In the meta-analysis cited above, alcohol consumption at a dose of 5–26 g per day was associated with significantly lower mortality from coronary artery disease, and more than 26 g with more. However, in our opinion, the benefits of small doses of alcohol can by no means be considered proven. In this regard, we emphasize that the positive effect of small doses of alcohol on the course of coronary artery disease was obtained in works that studied the use of wine, and not strong alcoholic beverages.
In Russia, it is hard liquor that dominates in the structure of alcohol consumption. According to Rosstat data for 2011, strong drinks accounted for 54.5% of alcohol consumption, while wine accounted for only 13.2%. For comparison: in France, with approximately the same alcohol consumption per capita, mortality from coronary artery disease is much less than in our country. Perhaps this is due to the fact that 62% of the alcohol consumed in France is wine, and spirits - 20%. In this regard, Russia is most interested in the experience of the Nordic countries, the type of alcohol consumption in which until recently was close to the Russian one (the use of strong alcoholic beverages to a greater extent).
In Iceland, Finland, Norway and Sweden in the 1980s–90s. there have been dramatic changes in the structure of alcohol consumption - the consumption of strong alcoholic beverages has significantly decreased: by 1.5 liters of pure alcohol per person in Norway, by 2 liters in Iceland and Finland, and by almost 3 liters in Sweden. At the same time, total alcohol consumption did not decrease and even slightly increased, as the consumption of spirits was replaced by wine and beer. As a result, these countries have moved from the category of countries with predominant consumption of spirits to countries with predominant consumption of beer. The change in the structure of alcohol consumption, while not the only reason for the increase in life expectancy in the Nordic countries, certainly had a positive effect on reducing mortality and increasing life expectancy in these countries. It should be noted that switching from predominant consumption of hard alcoholic beverages to consumption of beer or wine does not in itself guarantee a reduction in the risk of death. Another decisive factor, no less important than the amount of alcohol consumed, is the type of alcohol consumption: Russia is characterized by the so-called northern type - large doses in a short time. In a meta-analysis conducted by V. Ba-gnardi et al., it was shown that the periodic consumption of large doses of alcohol completely eliminates the positive effects of alcohol on cardiovascular risk.
The results of another meta-analysis suggest that if a person regularly consumes small doses of alcohol, but against this background periodically (once or more times a month) consumes significant amounts of alcohol, then the risk of coronary heart disease is significantly increased in comparison with persons without a tendency to such episodic excesses.
Therefore, heavy alcohol consumption, predominant consumption of hard liquor, and a drinking pattern of "high doses in a short time" increase the risk of coronary artery disease, including death.
Alcohol and stroke
Vascular diseases of the brain, primarily strokes, rank second in the structure of mortality from diseases of the circulatory system (39%) and in the overall mortality of the population (23.4%). Stroke is the leading cause of disability in the population, a third of patients who have had it need outside help, another 20% cannot walk independently, only one in five can return to labor activity. The cost of treating one patient who has had a stroke, including inpatient treatment, medical and social rehabilitation and secondary prevention, in our country is 127 thousand rubles a year, that is, the total amount of direct costs associated with a stroke (based on 499 thousand cases per year). ), is 63.4 billion rubles. Indirect costs measured by the loss of internal gross product(GDP) of the country due to premature mortality, disability and temporary disability of the population due to stroke, in Russia amount to about 304 billion rubles a year. It has been proven that excessive alcohol consumption can lead to stroke. There is strong evidence from various studies that alcohol abuse is a major risk factor for all types of stroke.
Picture. The role of various somatic diseases
in the structure of mortality of patients with alcoholism
Most studies suggest a J-shaped relationship between alcohol use and overall risk of stroke or risk of ischemic stroke, with a protective effect in people who consume alcohol in low or moderate doses and an increased risk in people who abuse alcohol. In contrast, there is a linear relationship between alcohol consumption and the risk of hemorrhagic stroke.
NB! Reference data for identifying individuals with hazardous and unhealthy drinking patterns
The Russian equivalent of the English term "one drink" is one minimum standard dose (portion) of pure alcohol. According to the criteria of the World Health Organization (WHO), the dose (portion) is equal to 10 g of pure alcohol (or 12.7 ml of alcohol) 1 .
Description of doses (servings) by type of alcohol (in ml) (WHO criteria) 1
The ratio of doses of alcohol consumption and risks of harm to health (WHO data) 1
| Risk | Alcohol consumption per week (servings or doses per week) |
|---|---|
| High risk consumption / Unhealthy level of consumption | For women: more than 28 doses per week (more than 840 ml of 40% alcohol per week); 4 or more doses per day For men: more than 42 doses per week (more than 1260 ml of 40% alcohol per week); 6 or more doses per day |
| Average risk of consumption / Hazardous or Healthy level of consumption | Women: 14-21 doses per week (420–630 ml of 40% alcohol per week); no more than 3 doses per day For men: 22-41 doses per week (660-1230 ml of 40% alcohol per week); no more than 5 doses per day |
| Low Health Risk / Recommended Intake Level | For women: less than 14 doses per week (less than 420 ml of 40% alcohol per week); no more than 1-2 doses per day For men: less than 22 doses per week (less than 630 ml of 40% alcohol per week); no more than 3-4 doses per day |
According to WHO experts, alcohol begins to harm health when consumed:
- 22 doses/servings (or drinks) per week for men and
- 14 doses/servings (or drinks) per week for women 1, 2
A recent prospective cohort study of 43,685 men from the Health Study medical workers(Health Professionals Follow-up Study) and 71,243 women from the Nurses' Health Study showed that alcohol use has a J-shaped relationship with the risk of stroke. In women who drink alcohol in low doses, the risk of stroke was quite low, but in women who drank ≥ 30 g of alcohol per day, there was a 40% increase in the risk of stroke (hazard ratio (RR) 1.41 at 95% confidence interval (CI) 1.07–1.88 for ischemic stroke; RR 1.40 at 95% CI 0.86–2.28 for hemorrhagic stroke). In men, similar indicators were found. In a meta-analysis of 35 observational studies, it was found that drinking 60 g of alcohol per day increased the risk of stroke by 64% (RR 1.64; 95% CI 1.39–1.93), the risk of ischemic stroke by 69% ( RR 1.69; 95% CI 1.34–2.15) and more than double the risk of hemorrhagic stroke (RR 2.18; 95% CI 1.48–3.20). In summary, observational studies have shown that low to moderate alcohol consumption, especially in the form of wine, reduces the overall risk of stroke and the risk of ischemic stroke, while high alcohol consumption increases the risk of stroke. However, not enough prospective randomized clinical trials have been conducted to date to show that reducing the amount of alcohol consumed reduces the risk of stroke, and drinking in small doses is beneficial. At the same time, it is not possible to conduct such studies, since it is associated with the risk of developing alcohol dependence.
The American Guidelines for Primary Prevention of Stroke (2011) list the following: practical advice :
- For health reasons, it is recommended to reduce or completely eliminate the consumption of alcohol by people who misuse alcohol, through methods of monitoring and providing advisory support(class I, level of evidence A).
- Alcohol drinkers are allowed to drink ≤ 2 drinks per day for men and ≤ 1 drink per day for non-pregnant women (Class IIb, Level of Evidence B).
Alcohol and hypertension
The relationship between alcohol consumption, blood pressure (BP) and the prevalence of arterial hypertension (AH) is linear. Taking even a moderate amount of alcohol is accompanied by an increase in blood pressure, and during the withdrawal period in chronic alcoholism there is a high risk of developing hypertensive crises. Regular alcohol intake causes an increase in blood pressure in patients with AH who are already receiving antihypertensive therapy. While moderate consumption may be harmless (but not beneficial!), the transition from moderate to excessive consumption of alcoholic beverages is accompanied by an increase in both blood pressure and the risk of stroke.
Increased alcohol consumption in hypertensive patients leads to more rapid development of target organ damage - left ventricular myocardial hypertrophy and microalbuminuria. The pressor effect of alcohol is equally pronounced in people who use it both constantly and occasionally.
The Prevention and Treatment of Hypertension Study (PATHS) examined how reducing alcohol consumption affects blood pressure. In the group that reduced alcohol consumption by just one drink per day, BP decreased by 1.2/0.7 mm Hg by the end of the six-month period. Art. more than in control group. In an 18-week study, combining alcohol restriction to 4–5 standard drinks per day with a reduction in daily food intake resulted in a 10 mmHg reduction in systolic BP. Art. . There is evidence that complete abstinence from alcohol for 1–2 weeks is accompanied by a gradual decrease in blood pressure over 4–6 weeks.
Reducing alcohol consumption from five drinks to one standard drink per day after 18 weeks leads to a significant and stable decrease in blood pressure. Therefore, a decrease in alcohol consumption leads to a decrease in blood pressure, and this effect is dose-dependent. It is believed that a decrease in alcohol consumption by one standard dose per day (14 ml of absolute ethyl alcohol) is accompanied by a decrease in blood pressure by 1 mm Hg. Art. . However, none of the studies were specifically designed to evaluate the effect of reducing alcohol consumption on cardiovascular outcomes. The importance of limiting alcohol intake as an effective non-pharmacological treatment of hypertension is emphasized in all recommendations for hypertension.
So, in the European guidelines for the diagnosis and treatment of hypertension (2013) it is written that men with hypertension who drink alcohol should be advised to limit its intake to 20-30 g per day (ethanol), and women with hypertension - up to 10-20 g per day (level of evidence IA - the highest). Total alcohol consumption per week should not exceed 140 g for men and 80 g for women. The Russian guidelines for the diagnosis and treatment of hypertension (2010; fourth revision) also emphasize the need to reduce the consumption of alcoholic beverages to less than 30 g of alcohol per day for men and 20 g per day for women in hypertensive patients. From the foregoing, an unequivocal conclusion follows about the need to reduce alcohol consumption to the above amounts in all persons who use it excessively, and not only in patients with alcoholism. In this regard, the emergence in Europe of a new drug aimed at reducing alcohol consumption, Selincro (nalmefene), is of particular interest. As is known, acute alcohol consumption leads to the release of dopamine in the mesolimbic system of the brain, mediated by the release of beta-endorphin. Following repeated exposure to large doses of alcohol, adaptations occur in several neurotransmitter/neuropeptide systems, including the opioid receptor system, which can lead to continuous alcohol consumption. Selincro (nalmefene) is a modulator of the opiate system, is an antagonist of the mu- and delta-opiate receptors and a partial agonist of the kappa-opiate receptors. By modulating the function of the cortico-mesolimbic system, Selincro thereby reduces the reinforcing effects of alcohol, helping the patient reduce its consumption. A significant effect of the drug has been proven both in terms of reducing the number of days of alcohol abuse (eng. heavy drinking days), and in relation to the total average volume of pure alcohol consumption per day (eng. total alcohol consumption) .
APPENDIX
AUDIT test / AUDIT 1 to identify individuals with hazardous and harmful patterns of alcohol consumption
With the help of a screening test in patients, it is possible to establish the severity of alcohol abuse and dependence on it 21. How often do you drink alcoholic beverages?
Circle the number of the answer that is closest to you.
2. What is your usual dose of alcoholic beverages on the day you drink alcohol
(standard serving of alcohol or number of drinks #)?
Circle the number of the answer in the table that is closest to you.
| № | Standard dose (serving) | Description of doses (servings) by type of alcohol | ||||
|---|---|---|---|---|---|---|
| Vodka (ml), fortress 40% vol. | Fortified wine (ml), fortress 17–20% vol. | Dry wine (ml), fortress 11–13% vol. | Beer (bottle 0.5 l), fortress 5% vol. |
|||
| 0 | 1 or 2 | 30-60 | 75-150 | 100-200 | 250 ml - 1 bot. | |
| 1 | 3 or 4 | 90-120 | 225-300 | 300-400 | 1.5 bottles - 2 bottles. | |
| 2 | 5 or 6 | 150-180 | 375-450 | 500-600 | 2.5 bottles - 3 bottles. | |
| 3 | 7-9 | 210-240 | 525-600 | 700-800 | 3.5 bottles - 4 bottles. | |
| 4 | 10 or more | 300 or more | 750 and over | 1000 or more | 5 bottles and more | |
| # The Russian equivalent of the English term "one drink" is 1 minimum standard serving (dose) of pure alcohol. According to the criteria of the World Health Organization (WHO), 1 dose (portion) is equal to 10 g of pure alcohol (or 12.7 ml of alcohol). | ||||||
3. Answer each of the questions in the table by circling the answer that is closest to you.
| Question | Never | Less than 1 time per month | Monthly (1 time per month) | Weekly (1 time per week) | Daily or almost daily |
|---|---|---|---|---|---|
| How often do you drink six or more doses (servings) (or more than 180 ml of vodka, or 450 ml of wine) during one event? | 0 | 1 | 2 | 3 | 4 |
| How often during the past year have you been unable to stop drinking since you started? | 0 | 1 | 2 | 3 | 4 |
| During the past year, how often have you failed to do what you were supposed to do because of drinking alcohol? | 0 | 1 | 2 | 3 | 4 |
| How often during the past year have you needed alcohol in the morning to recover from drinking too much the night before? | 0 | 1 | 2 | 3 | 4 |
| During the past year, how often have you had feelings of guilt or remorse after drinking alcohol the previous day? | 0 | 1 | 2 | 3 | 4 |
| How often during the past year did you not remember the next morning what happened the night before because of drinking? | 0 | 1 | 2 | 3 | 4 |
4. Answer each of the questions in the table by circling the answer that is closest to you.
Calculate and write down the amount of points received _________.
Differentiated indications for brief psychological interventions depending on the results of the AUDIT 3 test
risk zone
(8–15 AUDIT points)
Step 1.
Step 3 Formulate a goal to change alcohol-related behavior, set an upper limit on alcohol consumption.
Step 4 Support the patient by pointing out possible difficulties and aiming him at the persistent achievement of his goals.
Consumption with harmful effects
(16-19 AUDIT points)
Step 1. To acquaint the patient with the results of his testing, demonstrate relevant visual information materials, listen to his opinion on this matter.
Step 2 Evaluate and formulate advice based on the patient's readiness for change. Ask the patient to rate on a scale of 1 to 10 how important it is for them to change their alcohol intake.
Step 3 The implementation of the intervention depends on what phase of the change the patient is in:
- if the patient has not yet made a decision to change alcohol consumption, the main focus should be on his arguments in order to encourage him to take the necessary actions;
- if the patient is hesitant about reducing alcohol consumption, emphasis should be placed on the benefits of such a decision, the risks associated with delaying action, and what steps should be taken first;
- if the patient is already ready to take concrete action, the counselor may be better off focusing on setting specific goals and strengthening the patient's resolve to reduce alcohol consumption.
- What is problem-free alcohol consumption
- How can you change your drinking habits?
- Good reasons to drink less
- What to do when you want to drink
- People need other people
- What to do with boredom
- How to stick to your plans
- Recommendations for those who can help
- Creating a Plan to Overcome Your Drinking Habit
- assistance to the patient in identifying provoking situations;
- recognition of failures and support in successes;
- involvement of loved ones in the process of change;
- periodically reassessing the level of risk a patient is at. In case of progress, it can be carried out once every six months or a year. If unsuccessful, referral for treatment to a specialist.
Consumption with possible dependence on alcohol
(20 or more points on AUDIT)
Step 1. The consultant, when evaluating the results of testing, should clearly show the patient:
- their alcohol consumption is outside the safe range;
- there are already specific problems associated with alcohol consumption;
- there are signs of possible dependence on alcohol.
- indicate a possible relationship between the patient's state of health and alcohol consumption;
- Discuss the risk to the patient's future health, as well as the likelihood that the patient will experience social embarrassment.
- if the patient agrees, it is advisable to provide him with relevant information and support him;
- if the patient exhibits psychological resistance, a follow-up appointment should be made and given time to think and make a decision.
Step 5 Support.
In such a situation, patients need to be reassured and provided with emotional support. They should be told that treatment for alcohol dependence is generally very effective, but that they themselves will have to put in a lot of effort.
Step 6 Follow-up contact with a consultant after treatment is essential for patients as well as for patients with somatic diseases. Alcohol dependence is a chronic disorder, and periodic contact and support can help patients avoid relapse or lessen its effects.
1 Babor T.E, Higgins-Biddle J.C., Saunders J.B. et al. Te Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care. second edition. World Health Organization Department of Mental Health and Substance Dependence.
2 The AUDIT test (AUDIT) was developed by the World Health Organization (WHO) as simple method screening ( brief assessment) to excessive alcohol consumption, and to inform recommendations and provide assistance. The first edition was published in 1989 and has since been updated.
The test is designed to identify individuals with hazardous and harmful drinking patterns, and can also help identify excessive drinking as a cause of illness. AUDIT serves to justify intervention and assistance to reduce or stop alcohol consumption in order to reduce the risk or avoid the development of adverse health outcomes.
This test is intended primarily for healthcare practitioners and researchers, but other professionals who deal with individuals with alcohol problems may also find it useful. The test is used in conjunction with the primary medical care early (short-term intervention) for the hazardous and harmful use of alcohol. 3 Babor T., Higgins-Biddle J. C. Brief Intervention for Hazardous and Harmful Drinking. A Manual for Use in Primary Care. World Health Organization, 2001. 53 p. 4 Project on Identifcation and Management of Alcohol-Related Problems: Report on Phase II - A Randomized Clinical Trial of Brief Interventions in Primary Health Care / Ed. by T.F. Babor, M. Grant. Geneva: World Health Organization, Program on Substance Abuse, 1992.
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