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ALCOHOLISM.
Term Paper ID:26505
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Essay Subject:
Causes, stereotypes, treatment options, recovery process, 12-step programs, prevention, intervention, research.... More...
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10 Pages / 2250 Words
15 sources, 20 Citations,
APA Format
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Paper Abstract:
Causes, stereotypes, treatment options, recovery process, 12-step programs, prevention, intervention, research.
Paper Introduction:
Alcoholism: A Survey
Introduction
Anyone who reads the newspaper, watches television or the movies, or is aware of popular culture, can recognize that drugs are considered a serious problem, leading to crime, ruined lives, and early death. It is not as obvious that alcoholism remains a problem directly affecting about 14 million people in this country and indirectly affecting a sizeable minority of the population (Knapp, 1999).
Alcoholism is the equal opportunity problem that can baffle family friends, doctors, and the psychiatric establishment. It affects the rich and famous, as well as the poor (Baugh, 1999). It can kill children of the powerful, even when the experts are all exerting their efforts to help someone recover (McGovern,
Text of the Paper:
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Many of the more visible substance abusers, however, begin theirrecovery process in holding cells, hospitals, and recovery centers. These contributed toboth a low level of response to alcohol at age 2 years and a higher riskof alcoholism by age 35 years. The author discussed many of the variablesthat could be included in measures of risk, including numerous family andsocial environment factors. The authors concluded that the interventions were certainly beneficialin terms of improving the children's functioning, including coping skills,emotional processing, and social support. McGovern, G. In addition, there is potentialvalue in studying the cellular mechanisms of alcohol, with particularattention to adenelyl cyclase and other similar systems. (1996). They are factors thatinvolve more than one gene, or involve incomplete express, and may combinewith environmental factors to increase prevalence. The American Journal ofNursing, 96(9), 15. As aconsequence, the idea of treating it like a disease, and curing it withdrugs, is rejected by many who feel that it should require hard work on thepart of the alcoholic. Journal of Studies on Alcohol, 6 (2), 252-26 . Schuckit (1999) noted that there are additional factors that need tobe researched more fully. Alcohol withdrawal? Alcoholism is the equal opportunity problem that can baffle familyfriends, doctors, and the psychiatric establishment. The American Journal of Nursing, 98(8), 2 -21. Yet, they are beingincreasingly utilized, particularly among young people at-risk forincreasing their substance abuse, and unable to succeed in traditionalprograms. Gorman, M. Randall, C.L., Roberts, J.S., Del Boca, F.K., Carroll, K.M. Beneath the glitter. They noted that alcohol problems are not really higher among ethnicminorities than among European-Americans, but that stereotypes continue toaffect our perceptions. They also provided the childrenwith good information about alcoholism itself. (1996). Perhaps the best thedrugs can do is to reduce that craving, which might allow the individual todo the hard work of building a more satisfying life. Schuckit (1999) noted, however, that the wide range of geneticfactors associated with alcoholism risk means that there probably willnever be one single, definitive treatment for every person. Krach, P. (1998). Swift, R.M. Alcoholism: A Survey Introduction Anyone who reads the newspaper, watches television or the movies, oris aware of popular culture, can recognize that drugs are considered aserious problem, leading to crime, ruined lives, and early death. Pediatrics, 1 3(5), 1128-1144. Anotherfactor may be stress, which is an environmental factor that is not easilyaltered. For many of the more subtle alcoholics, doctors and nurses mayprovide an important service by learning more about the signs whichindicate possible alcohol abuse in their patients. Family,friends, and health care professionals cannot necessarily convince theindividual that alcohol treatment is desirable. In fact,estimates are that 3 million people over the age of 65 abuse alcohol. (1999). One of the problems of alcohol abuse inthe elderly is that it is often confused with problems of aging, or withmedication effects. The intention in the following pages isto provide a brief summary of current thinking on the causes and treatmentsfor alcoholism. Fine-tuning predictive instruments is a firststep. Thus, nurses in oncology wereparticularly prone to binge drinking, along with nurses in administration.On the other hand, emergency nurses were more likely to use cocaine(Trinkoff and Storr, 1998). And Storr, C.L. In one study specifically designed to inform pediatricians aboutprograms for children of alcoholics, Emshoff and Price (1999) reviewed theliterature dealing with those programs for information about their utility. Pediatrics, 1 3(5), 1112-1121. (1999).Telescoping of landmark events associated with drinking: A gendercomparison. They reach thefinal stages of alcoholism at an earlier age and they may drink for a muchshorter period of time before drinking alcoholically (Randall, et al.,1999) They have different symptoms than male drinkers and experiencegreater difficulties in recovering from alcohol abuse unless provided withsupportive services. (1999). For example, avariation of ALDH2 provides some protection to Asians and Jewish people,because it leads to adverse reactions to even low doses of alcohol. The glass half empty. Prevention and interventionstrategies with children of alcoholics. Such things as sweats, chanting, dancing, and religious ceremoniesmay be utilized in working with any individual or group (Group for theAdvancement of Psychiatry, 1996). (1998). Alcoholism & Drug Abuse Week, 11(2), 5. Baugh, L. The NewEngland Journal of Medicine, 34 (19), 1482-149 . Since not enough is yetknown about alcoholism to be able to predict who will drink alcoholically,this is risky in itself. One of the stereotypes that hurts a significant group of people is thestereotype of alcoholism as primarily a young person's disease. On theother hand, low response levels, which are associated with alcoholism, seemto be connected to the LL allele of the serontonin transporter gene and thegamma-aminobutryric acid sub A(alpha)6 receptor gene. 6,19:2. Treatment possibilities The standard treatment of choice for most alcoholics at this point intime has been a drying-out process, followed by complete abstinence fromalcohol use and attendance at 12-step recovery meetings. This means that pediatricians and elementary school teachers areimportant to the process of treating substance abuse, along with moretraditional groups. These different treatments might include what are currently beingcalled "harm reduction" strategies. Defying denial: Clues to detecting alcoholabuse. In a recent review article, MarcSchuckit (1999) examined some of the genetic influences which lead to threeor four-fold higher prevalence of the disorder in first-degree relatives ofalcoholics or eight-fold higher prevalence in identical twins ofalcoholics. Instead, there are a number of issuesthat are considered as being elements of the problem. The causes of alcoholism There is generally no one thing that experts point to and declare thatit is the sole cause of alcoholics. (1999). For example, he noted that while study of lparticular polymorphism related to an opioid receptor gene was negative,there is still the possibility of some connection. de Miranda, J. Still, providing educational services forchildren, in general, could be helpful, and providing services to childrenof alcoholics might be even more beneficial. They start from the premise that alcoholism is a chronicproblem that has many different causal factors, including genetic,psychosocial, and environmental factors. In contradistinction to traditionalabstinence-based models, harm reduction strategies acknowledge that someindividuals may not succeed in completely ceasing substance abuse. Ultimately, prevention and early intervention are the best forms oftreatment. And Price, A.W. Outcome measures of interventions in the studyof children of substance-abusing parents. Nursing, 28(2), 25. These associations have included genetic, physiological, cultural, andeconomic factors. (1997). For example,in her exploration of racial and ethnic considerations, the Committee onCultural Psychiatry (Group, 1996) looked at urban migration as part of theproblem for African-Americans, and acculturation as an issue for Hispanics. NY: Plume Books. Theymay be much more physically impacted and much more violently opposed tolimiting their alcohol consumption. Ryan, L.A. There are not only ethnic, racial, and age associations, but genderassociations with substance abuse. Emshoff, J.G. Thus, both the patients and cost-conscious hospitaladministrators were served. Essentially,culturally appropriate treatments attempt to find values, principles,activities, and supports within the individual's own culture in order tocreate treatment models that are more effective. Would these children drink alcoholically evenwithout the early intervention? Even more suspect to some hard-line AA supporters are drug therapieswhich are designed to support positive treatment outcomes in some alcohol-dependent individuals. What is not really knownyet is the benefit of such early intervention programs in the long-term.Do these programs actually prevent children from drinking alcoholicallywhen they become adults? Another innovation in substance abuse treatment which has met withsomewhat less resistance is culturally appropriate treatment. After that, outcomes measures need to be refined. Thus, further researchon the opioid receptor genes is desirable. Drug therapy for alcohol dependence. Given this, they work with theindividual patient to provide support for positive outcomes, even if thepatient must be dependent upon certain drugs, or even if the individualcontinues to drink (Swift, 1999). Linda Ryan (1997)noted that the development of one such protocol, relying of valium andvitamin therapy for managing withdrawal, led to both a reduction inwithdrawal symptoms and an increase of referrals to aftercare programs.There was also a decrease in the need for protective safety devices andprivate duty sitters. Prevention While the preceding pages have focused on treating substance abusersafter alcohol has already become a problem, another form of treatment isprevention and early intervention strategies. The combinationof the two would lead to a more reliable intervention process in whichchildren truly at-risk for alcoholism could more readily be identified,even when their parents were not visibly substance abusers. There arefew magic bullets, she indicated, and nothing in the drugs themselves thatwill help people deal with the difficult feelings of loneliness andisolation that reinforce the craving for alcohol. Another age-associated issue contributing to alcohol abuse is the tendency of olderpeople to drink more frequently than younger people, probably because ofmore free time and fewer responsibilities interfering with their drinking(Krach, 1998). Thus, providing them with programs that lead to betterfunctioning is likely to have a positive impact on their future. There seems to be an interplay between a complexity offactors in the creation of an individual who drinks alcoholically. Kumpfer (1999) noted that unless as much attention is actually givento developing good measures of outcomes of prevention interventions,outcomes will not be optimal. Thosebehaviors which were precursors to substance abuse would triggerintervention efforts, which would use program models more firmlyestablished by the research as effective. Whileinformation cannot alter the genetic factors that cause people to have apredisposition to alcoholism, that information and other facts can helppeople make better decisions about their drinking behavior, including thesafety of drinking at all. Thus, individuals are steered toward behaviors that wouldput them less at risk of dying, while still not weaning them from alcohol.These methods are not well-accepted by the federal government at this time,nor by old-line professionals (deMiranda, 1999). (1999). While more men than women arealcoholics, women tend to become alcoholics more easily. Thus, there is the tendency to prefer 12-stepprograms, and another tendency to abhor the idea of treating alcoholismwith antiaddiction drugs. (1996). The first problem, however, is identifying people who are substanceabusers and convincing them that a problem exists that needs to beaddressed. Even when those symptoms and diseases are identified, however, theindividual may still deny that there is a problem. (1999). Mostof those do not receive treatment. Because of their situation, they maybe faced with an involuntary withdrawal from alcohol, creating bothpsychological and physical problems. This protocol works. Alcoholism in theUnited States: Racial and ethnic considerations. It can kill children of thepowerful, even when the experts are all exerting their efforts to helpsomeone recover (McGovern, 1996). It isnot as obvious that alcoholism remains a problem directly affecting about14 million people in this country and indirectly affecting a sizeableminority of the population (Knapp, 1999). Crigger, N. Starting recovery. In addition, a low amplitude positive-polarity brain wave, and a certain type of dopamine receptor gene have beenassociated with greater prevalence of alcoholism. Trinkoff, A.M. For example, theCommittee on Cultural Psychiatry described working with Native Americanrituals in order to support Native Americans recovering from substanceabuse. Sports Illustrated, 9 (18),86-96. Myth and facts -- about alcohol abuse in theelderly. References Group for the Advancement of Psychiatry. Knapp (1999) discussed some of the criticisms of this kind oftreatment, noting that alcoholism -- although labeled a disease -- actuallycontinues to be considered a moral failing by much of the population. (1999). In order to obtain optimum results,standardized treatment protocols need to be developed. In this case, family andfriends may need support and service themselves (Gorman, 1996). (1999). American Journal of Public Health, 88(4),581-585. Although thisdoes not directly address the genetic issues, it does lead to healing formany people. Emshoff and Price (1999) noted that research has shown that 13% to 25%of children of alcoholics are likely to become alcoholic themselves.Although the wide variation in estimates show how difficult it is to comeup with reliable numbers, there still seems to be an increased risk forthis population. Some of these arecontroversial, too, because they depend upon identifying children, orindividuals, who are at-risk for alcohol abuse. Knapp, C. For example, there arephysical symptoms, associated diseases, and specific laboratory testresults that can lead the health care provider to think about a problemwith alcohol abuse (Crigger, 1998). R.N.,6 (8), 17-2 . Unless there is some as yet unidentifiedgenetic factor influencing nurses' choice of specialty, clearly stressplays a role in triggering the kind of drinking that can lead to out-of-control substance abuse and a diagnosis of alcoholism. These, too, can be refined,but at present treatment efforts leave too many people still substanceabusers, and still at risk of death and numerous diseases. There are racial and ethnic associations with alcoholism that maydepend upon genetics, but may also result from other factors. (1998). Washington, D.C.:American Psychiatric Press, Inc. Substance abusers may continue to deny they have aproblem, or a serious problem, even if they are hospitalized and even ifthey are unable to stop drinking for even a short period of time. Substance use among nurses:Differences between specialties. Knapp (1999) also noted, however, that even with these antiaddictiondrugs, recovering from alcoholism is likely to remain hard work. Terry. The next step after withdrawal for most patients is a treatment centerof recovery program, most of which rely on abstinence models and 12-stepprograms. New York Times Magazine,May 9, p. Schuckit, M.A. It affects the richand famous, as well as the poor (Baugh, 1999). For example, in a study that looked specifically at nurses,substance abuse rates were quite high, and the type of substance abuseseemed to be associated with specialties. However, until more is known about the pathways to substanceabuse, and about the interventions that are likely to work with children at-risk for alcoholism, treatment is likely to consist of the kinds of effortsthat were described in the preceding pages. Despite federal resistance, harm reductionstrategies take hold. Withdrawal from alcohol abuse can bedifficult, and some people become quite sick with delirium tremens andother withdrawal symptoms. Genetics is one of those elements. Harmreduction strategies are designed to limit the harm to the individual andthe community. Alcoholism is frequently overlooked, even though itmay be an even more significant problem for older people, because olderpeople seem to need less alcohol than younger people. While the 12-step programs focus on abstinence fromall drugs, drug therapy programs aim at improving the quality of life ofalcohol abusers. New findings in the genetics of alcoholism.JAMA, 281(2 ), 1875-1876. Schuckit indicated that genetic influences are differentfrom, and separate from, a genetic predisposition. Certainly denial is anissue in other kinds of health care situations, but it is a major issuewith substance abuse. Kumpfer, K.L. For example, an individual carrying a predispositionthrough the dopamine system might require one treatment, while anothercarrying greater risk through opioid receptors might require a differenttreatment. Thus, heindicated, both prevention and treatment methods will require a variety ofinterventions.
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