A call for the review of the regulation of the supply of alcohol to people while gambling.

Effect of Alcohol on motor skills and judgment/perception

Visual functions

• Even small doses of alcohol may cause longer eye fixation time, tunnel vision and defective attention switching.
• The response time of both eye movement and accommodation may be lengthened and there is a significant reduction in tolerance to glare from light.

i.e. Because of these effects, the high speed decision making requirement in the environment of a casino (for instance), would put someone under the influence of alcohol at a disadvantage.

Information processing

• Even with low blood alcohol concentrations, when more than one form of information input is presenting itself at one time the rate of processing is depressed significantly.
• Alcohol impairs impulse conduction and transmission in the central and peripheral nervous systems; rapid information analyses and processing is delayed and this in turn delays prompt and appropriate decision making.

i.e. A gambler who is  under the influence of alcohol would be at a disadvantage.

Judgment

• Behaviour, judgment, self-control and depth of thought are affected with associated impairment of reaction times, accuracy of response speed judgment, and performance awareness.

i.e. A gambler who is  under the influence of alcohol would be at a disadvantage.

Restraint and impulse

• Alcohol disturbs the balance between restraint and impulse, frequently resulting in impulsive behaviour.

i.e. A gambler who is  under the influence of alcohol would be at a disadvantage.

Muscular response

• Alcohol produces a tendency to exceed boundaries and to take much longer to correct such mistakes; furthermore, even with low blood alcohol concentration levels, gamblers tend to make too little or too many movements in placing bets. High alcohol concentrations in the blood also increase the time required to place bets and reduces the degree of restraint in the size of the bets placed

i.e. A gambler who is  under the influence of alcohol would be at a disadvantage.

1. Correlation between blood alcohol concentration & clinical features

The legal Blood Alcohol Content for South Africa is 0,05%

i. 0,00 – 0,05%

Most persons show no signs of abnormality at this level while some may already show signs of euphoria with a loss of the normal balance between inhibitions and impulses. Reaction time at the level of 0,05g% is already twice as slow as normal. Impairment of coordination is already evident at a level of 0,04g%.

ii. 0,05 – 0,10g%

There is further loss of inhibitions, impairment of the ability to be self critical, over-confidence, a decrease in ability to concentrate and clouding of judgment. Most people have impaired muscular coordination at levels of 0,08g%. At 0,10g%, the reaction time is four times slower than normal.

iii. 0,10 – 0,15g%

There is further impairment of the ability to be self-critical, as well as emotional instability, memory lapses, and signs of ataxia, apraxia and agraphia. Reaction times are further delayed. Orientation with regard to time and place may be impaired.

iv. 0,15 – 0,25g%

Clinical features include ataxia, apraxia and agraphia, markedly decreased muscular coordination, a loss of orientation, emotional instability, impairment of balance and equilibrium, apathy and dullness with emotional outbursts, impairment of the normal response to painful stimuli, impairment of memory and possible memory loss.

v. 0,25 – 0,35g%

The above-mentioned abnormalities are more pronounced.

Complete muscular incoordination is evident, together with apathy, loss of memory and complete loss of sense of orientation to time and place. Stupor is possible.

i. 0,35g% and higher concentrations

Stupor is followed by coma, generalised anaesthesia and paralysis, depression of the vital centres controlling respiration and the cardiovascular system and body temperature, deep coma and death.

2. Diagnosis/levels of intoxication

i. Sober

The individual is not, or is only minimally under the influence of alcohol and shows no signs of intoxication on examination.

ii. Slightly intoxicated

The individual has a flushed face, dilated pupils and is euphoric with a loss of inhibitions.

iii. Moderately intoxicated

The individual will, in addition to the above, display delayed pupillary reaction, in coordination of fine movements, Rhombergism, thick speech and a tendency to stumble when turning.

iv. Strongly under the influence

The individual will now also have dilated pupils with very slow reaction, nystagmus, incoordination of movements, and a stumbling gait with exaggerated reactions when required to perform unexpected movements.

v. Very strongly under the influence

In addition to all the above-mentioned features, the face may be either flushed or pale, the pupils may be pinpoint or dilated, the person may be apathetic and show intellectual clouding and disorientation. Pronounced incoordination and pronounced Rhombergism are evident and vomiting may occur.

3. The Absorption of Alcohol in the Body

The absorption of alcohol in the mouth and oesophagus is minimal because of the rapid passage of the alcohol through these structures; approximately 20% of ingested alcohol is absorbed in the stomach and the rest is absorbed in the small intestine. Depending on the volume of alcohol ingested, a small quantity may reach the colon and be absorbed there.

There are a variety of factors which affect the rate at which alcohol is absorbed, and consequently, the rapidity with which the blood alcohol concentration rises:

• If the mucous membrane of the stomach or small intestine is covered by mucus or food, absorption is delayed as the surface area of contact between the alcohol and the mucous membrane has been decreased.
• If the blood supply to the mucous membrane is increased as a result of congestion, inflammation or the ingestion of warm liquids, absorption will be increased.
• The rate of absorption of alcohol depends on the concentration gradient between the alcohol in the stomach and small intestine and the alcohol in the blood of the capillaries in the stomach and intestinal wall; the smaller the gradient, the slower the absorption.
• Absorption of alcohol in the small intestine may be decreased if gastric motility is reduced by medicines such as sympathomimetics, very high alcohol concentrations or in cases of nausea and shock.
• Gastric motility and associated alcohol absorption is increased by the intake of large volumes of food and liquids.
• Gastric motility is increased in persons with gastritis and peptic ulceration.
• The presence of irritating substances in the stomach may cause pyloric sphincter contraction and a delay in gastric emptying, thereby delaying alcohol absorption.
• Psychological factors may unpredictably affect pyloric sphincter function and consequent alcohol absorption in the small intestine.
• Certain surgical procedures such as gastrectomy or gastro-jejunostomy will accelerate the passage of gastric contents into the small intestine with more rapid absorption of alcohol.
• The higher the alcohol content of a beverage, the slower the absorption rate because of secretion of excessive mucus, pyloric sphincter spasm and suppression of gastric motility.
• Large volumes of beverage make contact with a large surface area of mucous membrane and also increase gastric motility with resultant faster absorption of alcohol.
• The presence of carbohydrates in beer delays alcohol absorption.
• Alcohol absorption is accelerated where beverages contain gas such as carbon dioxide.
• Warm beverages are absorbed faster than cold ones with faster alcohol absorption.
• Foodstuffs which are fatty in nature or which have a high protein or carbohydrate content delay alcohol absorption by reducing contact between the alcohol and the mucous membranes.
• Fatty foods also delay gastric emptying with associated retardation of alcohol absorption in the small intestine.
• Parasympathetic agents such as carbachol, pilocarpine, atropine and belladona increase gastric motility and relaxation of the pyloric sphincter, thereby increasing alcohol absorption in the small intestine.
• Ingestion of levulose, nicotine and caffeine delay alcohol absorption.

4. Using alcohol when driving, operating machinery & gambling

According to SAB Miller Operating Machinery Factsheet from www.talkingalcohol.com , alcohol affects your vision, judgement, concentration, coordination and reaction time. That’s why you shouldn’t operate dangerous machinery or tools if you’ve been drinking. Things can and do go wrong. You need to be alert and in control to make sure that you’re not putting yourself or others at risk.

1. Hazardous machinery and tools include:

• Wood processing machinery
• Cutting tools
• Electrical equipment
• Heating or burning tools (such as blow torches)
• Ladders (anything that means you’re working at heights)
• Motorized machinery
• Machinery with guards
• Machinery with exposed moving parts

2. Drinking and driving

Drinking and driving is not only irresponsible and dangerous: it’s also illegal. Criminal penalties for driving under the influence range from fines and licensing sanctions to jail sentences. Why? Because alcohol affects your vision, judgment, concentration, coordination and reaction time.

3. Drinking and gambling

• Consuming alcohol and gambling is also not only irresponsible but it is also dangerous for the same reasons as it is dangerous to operate machinery or drive.
• Whilst government cannot control whether someone drinks and drives or drinks and operates machinery, it can regulate drinking and gambling in/at licensed gambling operator establishments..

4. Conclusion

It is a reasonable conclusion that practice of combining drinking and gambling is questionable and following aspects should be given due consideration.

1. Should alcohol be served in gambling establishments?
2. Should people under the influence of alcohol be allowed to gamble at licensed gambling operator establishments?
3. Should alcohol be allowed into gambling establishments such as, but not limited to casinos, totes etc.?

Bibliography

• International Center for Alcohol Policies (ICAP)
• Arrive Alive
• SAB Miller www.talkingalcohol.com
• The Medical Research Council – Professor Charles Parry.