Chapter 9

1. Chapter 9 Chronic Alcohol Abuse and Alcoholism

2. Alcohol Abuse andAlcohol Dependence According to health professionals, alcohol abuse is defined in terms of persistent physical, social, or occupational problems that have become associated with alcohol use recurring use of alcohol in physically hazardous situations

3. Alcohol Abuse andAlcohol Dependence Alcohol dependence is defined in terms of uncontrolled alcohol intake, unsuccessful efforts to reduce alcohol use, life problems, and alcohol tolerance and withdrawal. According to criteria set by the American Psychiatric Association, an estimated 8.5 percent of U.S. adults can be classified either as alcohol abusers or as alcohol dependent.

4. Alcoholism: Stereotypes, Definitions, and Criteria The National Institutes of Health defines alcoholism as “a physical addiction to alcohol in which people continue to drink even though the drinking causes physical, mental and social problems, including problems with job responsibilities and relationships”

5. Alcoholism: Stereotypes, Definitions, and Criteria Alcoholism is a multidimensional condition that is typically defined in terms of four major criteria: preoccupation with drinking emotional problems vocational, social, and family problems physical problems Not all criteria have to be met, however, for alcoholism to be diagnosed.

6. Patterns of ChronicAlcohol Abuse Alcoholics can be found in every age, gender, racial, ethnic, and religious group and in all socioeconomic and geographic categories. Men outnumber women in the incidence of alcoholism by about six to one, although women are more vulnerable to alcohol-related organ damage. The elderly tend to be an underreported group with respect to alcoholism.

7. Patterns of ChronicAlcohol Abuse A systems approach to alcoholism examines the complex interacting relationships among individuals, family, friends, and community. The concept of codependency, which originated in Alcoholics Anonymous, has helped shed light on the specific effects of alcoholism on spouses and other family members. What is “codependency?” (there is even a “Codependents Anonymous” organization!)

8. Patterns of ChronicAlcohol Abuse Nonetheless, men outnumber women in the incidence of alcoholism by about six to one, although women are more vulnerable to alcohol-related organ damage. The elderly tend to be an underreported group with respect to alcoholism.

9. Patterns of ChronicAlcohol Abuse The children of alcoholics (COAs) carry an increased risk of becoming alcoholic as a result of a vulnerability toward alcoholism for both genetic and environmental reasons Even so, a male with at least one alcoholic parent has only a 20-25% chance of becoming and alcoholic himself

10. The Genetics of Alcoholism Studies of adoptions and twins have provided information about the relative influence of genetics and environment on the development of alcoholism. Type 1 alcoholic male or female, late onset Type 2 alcoholic male, begins in adolescence The Type 2 alcoholism appears to have a greater genetic component in the inheritance pattern.

11. Figure 9.2

12. Table 9.1

13. Type 1 alcoholics can be either male or female, while Type 2 alcoholics are principally __________. A. females B. people over twenty-five only C. people living in urban environments D. males E. bisexual

14. Physiological Effects of Chronic Alcohol Abuse Excessive, chronic alcohol use increases the risk of liver disease cardiovascular disease cancer pancreatitis Type II diabetes neurological disorders most severely, Korsakoff’s syndrome

15. Physiological Effects of Chronic Alcohol Abuse A particular concern is the development of fetal alcohol syndrome (FAS) in the offspring of alcoholic mothers. 10–15% of pregnant women in the U.S. report having recently drunk alcohol, and up to 30% drink alcohol at some point during pregnancy There is no amount of alcohol that is known to be safe Total abstinence during pregnancy is ideal, and FAS is 100% preventable.

16. Fetal Alcohol Syndrome Facial features are a good diagnostic for underlying brain damage. The greater the facial abnormalities, the greater the underlying damage. The exact degree and nature of deficits depends on timing, length and severity of exposure, in addition to individual differences in fetal sensitivity to alcohol. upturned nose flat face small head

17. Fetal Alcohol Syndrome Shorter-than-average height Low body weight Poor coordination Small head size Hyperactive behavior Difficulty paying attention Poor memory Difficulty in school (especially with math) Learning disabilities Speech and language delays Intellectual disability or low IQ Poor reasoning and judgment skills Sleep and sucking problems as a baby Vision or hearing problems Problems with the heart, kidney, or bones

18. Fetal Alcohol Syndrome Anatomical Changes in the Brain reduction in gross brain size especially frontal and parietal lobes agenesis of the corpus callosum abnormal cerebellar development reduced size of the caudate nucleus Functionally lower cerebral blood flow reduced glucose utilization reduced caudate and frontal lobe activation on spatial memory tasks

19. Fetal alcohol syndrome A. is not a concern unless the mother is an alcoholic B. is unavoidable because it results from abnormal metabolic activity of the fetus C. can be avoided by drinking only beer and wine during pregnancy D. can be a product of changes in sperm of an alcoholic father E. can only be avoided with certainty if the mother abstains from alcohol completely

20. The Concept of Alcoholism as a Disease The majority position with respect to alcoholism is that it should be considered a disease and that alcoholics should be treated rather than punished. In 1956, the American Medical Association adopted the disease model of alcoholism. Calling alcoholism a disease was a bonanza that quickly poured many billions of dollars into the pockets of physicians, hospitals and pharmaceutical companies and continues to do so.

21. The Concept of Alcoholism as a Disease 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) and the American Society of Addiction Medicine (ASAM) published this definition for alcoholism: “Alcoholism is a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic.”

22. The Concept of Alcoholism as a Disease Alcoholism does not fit the classic definitions of a disease in that it is in part defined by attitudes of the afflicted toward the drinking problem itself, e.g. denial, or consequences of the drinking problem, an alcoholic will “continue to drink even though the drinking causes physical, mental and social problems, including problems with job responsibilities and relationships”

23. The Concept of Alcoholism as a Disease It is the only disease that is generally diagnosed by the sufferer rather than by a health professional Recent surveys of primary care physicians indicate that the medical profession is frequently ill prepared to diagnose alcoholism or supervise effective treatment.

24. The Concept of Alcoholism as a Disease Naming it as a disease may also give the illusion of explanation, “I can’t control my drinking because I am an alcoholic” (but, alcoholism is defined by that same drinking) That’s like saying “I’m hypertensive because I have high blood pressure”.

25. The Concept of Alcoholism as a Disease The disease concept makes certain assumptions and has far-reaching implications for understanding, treatment and legal treatment of alcoholics. Heavy problem drinkers show a single distinctive pattern of ever greater alcohol use leading to ever greater bodily, mental, and social deterioration. The condition, once it appears, persists involuntarily: the craving is irresistible and the drinking is uncontrollable once it has begun.

26. The Concept of Alcoholism as a Disease Medical expertise is needed to understand and relieve the condition (“cure the disease”) or at least ameliorate its symptoms. If alcoholism is a disease, then alcoholics are no more responsible legally or morally for their drinking and its consequences than epileptics are responsible for the consequences of their movements during seizures, or someone with a brain tumor, diagnosed as schizophrenic, etc.

27. The Concept of Alcoholism as a Disease The disease model also diverts attention away from the social and cultural contributions to the problem

28. Are you an alcoholic? 1. Do you lose time from work due to drinking? 2. Is drinking making your home life unhappy? 3. Do you drink because you are shy with other people?4. Is your drinking affecting your reputation? 5. Have you ever felt remorse after drinking?6. Have you ever got into financial difficulties as a result of drinking?7. Do you turn to lower companions and an inferior environment when drinking?8. Does your drinking make you careless of your family’s welfare?9. Has your ambition decreased since drinking?10. Do you crave a drink at a definite time?11. Do you want a drink the next morning?12. Does drinking cause you to have difficulty in sleeping?13. Has your efficiency decreased since drinking?14. Is drinking jeopardizing your job or business?15. Do you drink to escape from worries or trouble? 16. Do you drink alone?17. Have you ever had a complete loss of memory as a result of drinking?18. Has your physician ever treated you for drinking?19. Do you drink to build up your self-confidence?20. Have you ever been to a hospital or institution because of drinking?

29. Approaches to Treatment for Alcoholism Approaches include behaviorally and psychologically based treatments (e.g., cognitive behavioral therapy, contingency management) and spiritually based treatments (e.g., Alcoholics Anonymous). It is curious to note that although AA embraces the disease concept of alcoholism, it embraces a spiritual rather than a scientific or medical approach to its treatment.

30. Table 9.2

31. Alcoholics Anonymous is based upon the idea of ______. • A. absolute devotion to its ideals • B. absolute abstinence • C. absolute commitment toward responsible drinking • D. absolute allegiance to one’s country • E. having a place to drink where identities will not be revealed

32. Approaches to Treatment for Alcoholism Other self-help programs, such as Moderation Management (MM) and SMART Recovery, have been devised to appeal to those who cannot accept a spiritual approach or the total abstinence required in the AA program

33. Approaches to Treatment for Alcoholism Moderation Management (MM) Non-profit, supported by voluntary donations Alcoholism is a learned behavior, not a disease For those concerned about drinking habits but not dependent or are in early-stage dependency Controlled drinking, not total abstinence Self-Management and Recovery Training (SMART) Non-profit organization, recognized by NIDA A Cognitive/Behavioral Therapy approach Self-empowering and teaches self-reliance Total abstinence, controlled drinking up to the individual

34. Chronic Alcohol Abuse and Alcoholism in the Workplace Many corporations and other large organizations have instituted Employee Assistance Programs (EAPs), and unions have instituted Member Assistance Programs (MAPs), to help workers with problems of alcohol abuse or other forms of drug abuse. e.g. Counseling and Wellness Center for UF students

35. Physiological Effects of Chronic Alcohol Abuse Physical effects of alcoholism include tolerance and withdrawal, liver disease, cardiovascular disease, cancer, and neurological disorders such as Wernicke-Korsakoff syndrome. A particular concern is the development of fetal alcohol syndrome (FAS) in the offspring of alcoholic mothers.