Alcoholism Vision in the 20th Century - Essay Example

Alcoholism Vision in the 20th Century Description: In this paper we examine the problem of alcoholism and related to it concepts. Mr. H is a 79-year-old white widowed male was admitted to the medical service due to complaints of dizziness and weakness, with his blood pressure on entry was 220/110 mm Hg, pulse, 112 bpm, and blood glucose level, 355 mg/dL. On examination several bruises were found on his extremities. Contacting the patient's closest male friend doctors get to know that he had been consuming up to a fifth of whiskey per day since his wife died 9 months ago. Patient’s daughter could not believe her father had a problem with alcohol. (Holbert & Tueth, 2004) That’s one of the numerous pictures how people get into the trap which they are powerless to get over with. In this paper we research the alcoholism problem, behavior of alcoholics and concepts related to this problem. The vision on alcoholism changed in the 20th century. It shifted from passing harsh moral judgment to understanding the nature of disease. It can be judged it from the definitions like: “alcoholism is a disease that affects the part of the brain that controls your feelings, the way you make decisions, and the way you act” (Identifying alcoholism, 2003) Keller called alcoholism a disease because of the disablement represented in behavioural manifestations. The same concept is offered by American Psychiatric Association which argued that a mental disorder is characterized by present distress, disability, or a significantly increased risk of suffering death, pain, or an important loss of freedom. (Mann, Hermann & Heinz, 1999) In effect, deviant drinking became medicalized, or cast in the perspective of a disease model. Scientists and physicians regarded the disease of alcoholism as congenital, progressive, developmental, and, while incurable, capable of treatment. (Lectures) Since the dawn of 19th century alcohol has become a ‘social problem’ in the USA. During the colonial era drunkenness was common with per capita alcohol consumption being 4 times higher than at present. That’s why alcoholism has attracted much public attention and interest of the researches. Modern concept of alcoholism includes the psychosocial and neurobiological foundations and consequences of alcoholism. Neurobiological research explains addictive behaviour by the dispositional factor of monoaminergic dysfunction, neuroadaptation and sensitization. New treatment includes pharmacological approaches and highlight the importance of behaviour and motivational therapy and the attendance of patient groups such as Alcoholics Anonymous. (Mann, Hermann & Heinz, 1999) Alcoholics’ behavior is determined by so-called "alcoholic thinking" which is the belief that alcohol is “desirable, then necessary, and eventually an inevitable part of their existence”. Many alcoholics confessed at the meeting of Alcoholics Anonymous that it was "alcoholic thinking" that resulted in many mistakes. It was alcoholic thinking that hampered progress in the program. It was alcoholic thinking that was underlying alcoholism and supported for years the illusion of a rational dependence on alcohol. (Wiseman, 1991) Denzin offers the concept of alcoholic alibi as the way an alcoholic excuses one’s drinking and feels less ashamed of him/her self. Many alcoholics feel out of place as well as out of time. Alcoholics resort to creating specialized spaces for drinking and storing. The obsessive alcoholic is concentrated only on alcohol but realizing the hazard of being identified as a problem drinker, he/she hides drinking, deceives others, and pretends that his/her drinking is not an issue. (Lectures) An alcoholic desires a company of other drinkers who will "keep up" with the alcoholic seeking for a social rationalization for continued drinking. The act of drinking begins to replace intimacy. Alcoholic is more interested in the drink than in a woman. He/she looks for drink as some look for a sexual partner. (lectures) The excessive intake of alcohol changes the behavior of the drinker so that personality and character seem to change as well. The speech turns to be illogical and slurred, kind and thoughtful people turn into nasty and even violent under the influence of alcoholic overindulgence. In majority of cases the alcoholic behaves in socially unacceptable ways being unable to perceive these negative changes because of dull self-insight. (Wiseman, 1991) The reasons of this disease can be summarized into the following set: genetic predisposition, emotional burdens, stresses and anxiety, low-self esteem or depression and social and cultural factors. The researchers have long noticed that alcoholism runs in families and statistics shows that 60% of alcoholics have at least one alcoholic parent. Family incidence of alcoholism runs unusually high among early-onset alcoholics (40% of the estimated 8 million male alcoholics in the United States), suggesting a genetic predisposition. (A tight pair, 1992) In the recent group of studies it was suggested that there’s a gene that affects the ability of brain cells to respond to dopamine--a neurochemical active in pleasure responses. The lack of dopamine makes people use alcohol as self-medication in an attempt to boost dopamine levels. Some other researches highlight the existence of a "mean gene" that impairs the action of serotonin, a widespread neurotransmitter that normally dampens many brain stimuli, including those wrought by dopamine. (A tight pair, 1992) Along with the role of genes the influence of neurochemical responses to alcohol make the transmission of alcoholism from parent to child more alcohol-specific. Children of alcoholics are more likely to be involved “in alcohol use, more drug dependence, more depression, agoraphobia, social phobia and generalized anxiety, less behavioral control, lower self-esteem, lower scores on tests of verbal ability, and lower academic achievement than others” (Menees and Segrin, 2000) There’s a view that alcoholics share a common set of personal characteristics. Despite numerous researches there has not been found distinctive connection between alcohol dependence and specific personality traits. However some personality traits are still associated with alcohol-dependent people. Alcoholism is correlated with dependent personality traits like being ‘dependent’, ‘oral’ individuals. Having emotionally dependent behaviour alcoholics are unable to govern their own lives often exhibiting a more external locus of control. However, many studies show that alcoholics have an internal control orientation (events as being a consequence of one’s own behaviour). (Marchiori et.al, 1999) Recent studies assessing personality disorders and dimensions of temperament associated to alcohol dependence discover that sensation seeking, antisocial personality and novelty seeking are most of all connected with dependence. The research shows that patients with alcohol dependence have a higher level of sensation seeking. Neurophysiological and genetic studies try to correlate these personality features to biological parameters. (Lejoyeux, 2004) Social and cultural attitudes towards alcohol is claimed to have impact on alcohol consumption. Alcohol has been mystified in the human societies. Mythological, biblical, and folklore narratives place alcohol, and especially the creation of alcohol, in an awesome and even spiritual light. Alcohol is blessed by institutions and spiritual higher powers. (lectures) Given the widespread use of alcohol among different cultural groups around the world, it was readily apparent and frequently reported that the native production of alcoholic beverages was common. Alcoholic beverages tended to be in the context of ritual, ceremonial, and social uses. The use of alcohol was seen as another mechanism that established or maintained social and ritual relationships. (Wilcox, 1998) People in society agree that some people who drink “create problems for themselves and others to the point that friends, family, coworkers, supervisors, legal authorities, and doctors call for resolution”— or sobriety (Lectures) Alcoholics do not position themselves as such. It’s family, friends, or doctor who notice the first signs of the developing disease. So the problem of alcoholism concerns not only the alcoholics themselves but the lives of the closest people living with them resulting in social and psychological damages. The fate of the close people living with alcoholic is a separate field for research. The wives of alcoholics suffer greatly from continuing marriage relationship deterioration. Wives of alcoholics feel unsatisfied in 4 areas of marital interaction: talk or communications, mealtime, joint recreation and social activities, and sexual intimacy. They do not have a means to fulfill their role as a spouse which results in anger and sorrow from her side and hostility of a husband to his wife's unhappiness. (Wiseman, 1991) The tension is accompanying feature of the alcoholic’s family relations. Recent studies show that women who are married to alcoholics are three times more likely to abuse alcohol themselves and three times more likely to work outside the home. (Wives of Alcoholics) Alcoholism is a social problem and should be treated accordingly. The characteristic feature of alcoholism is denial which means that alcoholic abusers are not likely to seek medical treatment. The estimated ratio of untreated individuals needing treatment to treated individuals ranges from 3:1 to 13:1. (Grant, 1997) During the last decade of 20th century alcoholism treatment options and strategies were much improved. Primary health care institutions and general practitioner participation are effective in reducing alcohol consumption. The participation in treatment programs is promoted through motivational enhancement which is associated with reduced subsequent relapse rates. (Bien et al., 1993) Three alcoholism treatment options offered by Project MATCH are cognitive behavior therapy, twelve-step facilitation according to the AA program and motivational enhancement therapy which proved to be successful worldwide. (Mann, Hermann and Heinz, 1999) Other approaches for alcohol problems used are interventions and motivational interviewing, social skills training, community reinforcement, behavior contracting, relapse prevention and some aversion therapies. These treatment approaches have one feature in common – active engagement of the client in the processes of suppressing use and teaching alternative coping skills. (Heather and Stockwell, 2004) Alcoholism can be also treated with pharmaceuticals - naltrexone and acamprosate which successfully reduce the relapse risk during early abstinence. However, medical treatment does not assure from alcoholics relapse. The task is to find out what subgroups of patients may respond positively to specific medications. (Mann, Hermann and Heinz, 1999) The treatment effectiveness is determined by a number of factors such as therapist characteristics and treatment setting. The most effective approach is an empathic one when respect and support of patients is demonstrated. (Heather and Stockwell, 2004) The most wide known treatment option is the program Alcoholics Anonymous. It emphasizes the spiritual dimensions of alcoholism, though it is not a religious program and does belong to any "sect, denomination, politics, organization or institution." But this spiritual orientation contributes to the success the program enjoys. The members have to find some ‘higher power” or “God, as we understand him.” Many members consider the group dynamic as their higher power. The community takes into account the sociocultural and individual factors leading to alcohol abuse and dependence. It considers the role of society attitudes, values, and beliefs which foster dependence. (Wiseman, 1991) At the same time the spiritual aspect of the program contributes to failures in initial attempts to gain sobriety. Some members resist the necessity of a "total psychic change." Some refuse to participate in the program because of the stubborn orientation. Despite the success the organization reaches approximately 5 percent of the total population of alcohol dependent individuals in this country. (Wiseman, 1991) Alcoholism is pervasive national health problems, the human and economic costs of which are very large. However, America is spending too little on alcoholism treatment, research, and prevention. The reason is a set of attitudes toward alcoholism as a disease toward which the public has complex and ambivalent reactions. Distorted perspective on the problem leads to the ignorance of the indirect costs of a disease and thus the investment component of health expenditures. (Fein, 1984) Alcoholism being identified as a disease for over than 50 years has been reluctantly accepted as a national public health problem. Our vision of alcoholic is limited to irredeemable and morally derelict person. The studies on the problem shows that 41% of the respondents agree that one’s identification as an alcohol destroys person's reputation and treatment has to be conducted away from one's neighbourhood for privacy issues. (Fein, 1984) To summarize the finding we’d like to conclude that the problem of alcoholism is multifaceted and complex. It requires closer attention of the researchers, legislators, physicians and general public. The acceptance of alcoholism as a disease requires public intervention into private life for the good of the patient and community. More attention should be paid to public awareness of the problem. References Armstrong E. M. and E. L. Abel Fetal Alcohol Syndrome: The Origins Of A Moral Panic. University of Michigan and Wayne State University, MI, USA, 7 November 1999 Bien, T. H., W. R. Miller, and S. J. Tonigan, Brief interventions for alcohol problems: a review. Addiction 88, 1993 pp. 315–336 Wilcox D. M. Alcohollc Thinking: Language, Culture, and Belief in Alcoholics Anonymous. PRAEGER Westport, Connecticut London, 1998 Fein R. Alcohol in America: The Price We Pay. Newport Beach: CareInstitute., CA. 1984. Grant B. F. Barriers to alcoholism treatment: reasons for not seeking treatment in a general population sample. Journal of Studies on Alcohol, Vol. 58, 1997 Heather N. and T. Stockwell The Essential Handbook of Treatment and Prevention of Alcohol Problems. John Wiley & Sons Ltd, 2004. Holbert R. K., and M. J. Tueth Alcohol abuse and dependence: a clinical update on alcoholism in the older population. Geriatrics. Sept. 2004 Identifying alcoholism - House call: expert advice on health and fitness. Ebony, Oct. 2003   Lejoyeux M. Alcohol dependence, temper and personality. Med Sci (Paris). 2004 Dec; 20(12):1140-4. Mann K., D. Hermann and A. Heinz One hundred years of alcoholism: the twentieth century Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, 2 October 1999 Marchiori E, S. Loschi, P. L. Marconi, D. Mioni and L. Pavan Dependence, Locus Of Control, Parental Bonding, And Personality Disorders: A Study In Alcoholics And Controls. University of Padua, Italy, 12 January 1999. Menees M. M. and C. Segrin The Specificity Of Disrupted Processes In Families Of Adult Children Of Alcoholics. University of Arizona, 3 March 2000 A tight pair of genes? - research on causes of alcoholism. Psychology Today. May-June, 1992. Wives of Alcoholics More Likely to Drink. About site. http://alcoholism.about.com/library/weekly/aa020923a.htm retr. 29 Apr. 2006 Wiseman J. P. The Other Half: Wives of Alcoholics and Their Social-Psychological Situation. New York: Aldine de Gruyter, 1991. Read More