Extensive research supports the popular observation that "smokers drink and drinkers smoke." Moreover, the heaviest alcohol consumers are also the heaviest consumers of tobacco. Concurrent use of these drugs poses a significant public health threat. A survey of persons treated for alcoholism and other drug addictions revealed that 222 of 845 subjects had died over a 12-year period; one-third of these deaths were attributed to alcohol-related causes, and one-half were related to smoking (1). This Alcohol Alert explores the association between alcohol and tobacco use, possible mechanisms of their combined health effects, and some implications for alcoholism treatment.
The Co-Occurrence of Alcoholism and Smoking
Between 80 and 95 percent of alcoholics smoke cigarettes (2), a rate that is three times higher than among the population as a whole. Approximately 70 percent of alcoholics are heavy smokers (i.e., smoke more than one pack of cigarettes per day), compared with 10 percent of the general population (3). Drinking influences smoking more than smoking influences drinking. Nevertheless, smokers are 1.32 times as likely to consume alcohol as are nonsmokers (4).
Most adult users of alcohol or tobacco first tried these drugs during their early teens (5). Among smoking alcoholics, the initiation of regular cigarette smoking typically precedes the onset of alcoholism by many years, although data are inconsistent (6). Adolescents who begin smoking are 3 times more likely to begin using alcohol (7), and smokers are 10 times more likely to develop alcoholism than are nonsmokers (6).
13 Nisan 2010 Salı
Alcohol and the Family
The number of American adults who abuse alcohol or are alcohol dependent is about 17.6 million, or about 8.46% of the adult population (Grant, et al., 2004). Not only is this a primary health concern in itself, but it is additionally of concern because alcohol involvement has significant implications for child well-being and development. Approximately one out of every four U.S. children under the age of 18 years is exposed to the effects of alcohol abuse or dependence in a family member (Grant, 2000).
The field of alcohol treatment began to systematically apply family theories during the mid- to late- 1960s and early 1970s (Zweben & Pearlman, 1983). At that time, family studies began to address the "functions" that alcohol serves in family dynamics, and began to apply a family systems perspective to the understanding of alcohol problems (Berenson, 1976). Another concern involves determining the possible family influences on how individuals develop problems with alcohol-there is consensus that children of alcoholic parents are at a greater risk for developing alcoholism (and other mental or behavioral health problems) than are others, but there is not complete consensus as to the specific mechanisms by which this increased risk is operationalized (Begun & Zweben, 1990). Problems with alcohol (and other substances) have been associated with a number of different family factors, including parental substance use, substance use of siblings, family values and attitudes about substance use, family dynamics and relational patterns, and interaction effects with biological/genetic factors (Waldron & Slesnick, 1998). Family approaches to alcohol treatment have received some research attention, as well (Waldron & Slesnick, 1998).
Critical to a contemporary understanding of alcohol and the family is appreciation for the many diverse forms that families take, and the many different cultural definitions of "family" that apply in the U.S. Early research adopted nuclear family types of definitions involving individuals living together and related to one another through "blood" or legal bonds (e.g., marriage, adoption). Culturally competent social work practice, on the other hand, extends the definition of family membership to include a much wider range of individuals who are linked through various types of formal and informal kinship ties (McGoldrick, Giordano, & Pearce, 1996). American family forms include nuclear, single parent mother, single parent father, ex- and step relations, grandparent/aunt/uncle as parent, foster families, and others. There are tremendous ethnic and cultural differences in family roles, family interdependence and informal support systems, and values about how families interrelate (Fisher & Harrison, 2000).
Family Systems
The family can be conceptualized as a dynamic system that changes over time as membership changes, individuals change and develop, relationships change, and the family's context changes. A family system is interpretable only when its many multiple components are understood-the multiple components include the individual family members, the relationships between them, the family's relationships with its ecological context, the family's history (multigenerational and experience of events), and the host of internal and external forces for developmental change. There are several concepts that are key to a systems perspective on families (Begun, 1996 provides a review):
Family systems are sometimes described by therapists as being very difficult to redirect and resistant to change-once systems have achieved a level of stability or homeostasis, they apply concerted efforts to maintain their hard-earned balance. In fact, warnings have been offered about intervening to change an individual's alcohol abuse without adequately responding to the potentially destabilizing effect of an individual's recovery on the family system-the individual's drinking may represent a family system's homeostatic solution to otherwise distressed relationships (Steinglass, Davis, & Berenson, 1977; Orford, 1975).
The field of alcohol treatment began to systematically apply family theories during the mid- to late- 1960s and early 1970s (Zweben & Pearlman, 1983). At that time, family studies began to address the "functions" that alcohol serves in family dynamics, and began to apply a family systems perspective to the understanding of alcohol problems (Berenson, 1976). Another concern involves determining the possible family influences on how individuals develop problems with alcohol-there is consensus that children of alcoholic parents are at a greater risk for developing alcoholism (and other mental or behavioral health problems) than are others, but there is not complete consensus as to the specific mechanisms by which this increased risk is operationalized (Begun & Zweben, 1990). Problems with alcohol (and other substances) have been associated with a number of different family factors, including parental substance use, substance use of siblings, family values and attitudes about substance use, family dynamics and relational patterns, and interaction effects with biological/genetic factors (Waldron & Slesnick, 1998). Family approaches to alcohol treatment have received some research attention, as well (Waldron & Slesnick, 1998).
Critical to a contemporary understanding of alcohol and the family is appreciation for the many diverse forms that families take, and the many different cultural definitions of "family" that apply in the U.S. Early research adopted nuclear family types of definitions involving individuals living together and related to one another through "blood" or legal bonds (e.g., marriage, adoption). Culturally competent social work practice, on the other hand, extends the definition of family membership to include a much wider range of individuals who are linked through various types of formal and informal kinship ties (McGoldrick, Giordano, & Pearce, 1996). American family forms include nuclear, single parent mother, single parent father, ex- and step relations, grandparent/aunt/uncle as parent, foster families, and others. There are tremendous ethnic and cultural differences in family roles, family interdependence and informal support systems, and values about how families interrelate (Fisher & Harrison, 2000).
Family Systems
The family can be conceptualized as a dynamic system that changes over time as membership changes, individuals change and develop, relationships change, and the family's context changes. A family system is interpretable only when its many multiple components are understood-the multiple components include the individual family members, the relationships between them, the family's relationships with its ecological context, the family's history (multigenerational and experience of events), and the host of internal and external forces for developmental change. There are several concepts that are key to a systems perspective on families (Begun, 1996 provides a review):
- The family as a system is more than the sum of its parts. Family systems are composed of interdependent members whose interactions, dynamics, rules, boundaries, and patterns each contribute to family behavior. Individual family members affect the system as a whole, and the system affects individual members-there is a considerable degree of "circularity of influence" involved (Minuchin, 1974).
- Changes in any part of the system affect the entire system. When there are developmental or other changes in an individual family member, changes in the interaction patterns between individuals, new family members are added, or family members leave, the changes reverberate throughout the system.
- Subsystems are embedded throughout the larger family system. Some of the most common subsystems are the couple subsystem, parent-child subsystem, and sibling subsystem; family systems might also include grandparent-grandchild, step-parent and child, half-siblings, ex-partners and other extended family subsystems. Family subsystems do not operate independently of the whole system. Their character and nature are shaped by the overall culture of the family system. Family behavior may be enacted through subsystems rather than the system as a whole. Interactions at the level of the subsystem may impact other family members and subsystems, as well-both directly and indirectly.
- Families exist within a larger social environment context. Families are nested in, are shaped by, and interact with other social systems that affect and are affected by family system processes. Thus, the family system is subject to events that occur within the neighborhood, community, health care, school, workplace, service delivery, societal, economic, historical, and cultural systems. Social workers often rely on eco-maps in order to diagram and assess the nature of a family's complex interactions with its environmental context (Hartman, 1978).
- Families are multigenerational. Family systems are influenced by their histories, as well as by an awareness of their futures. Families may have four or more generations that are currently relevant at one time, and family members are affected by inherited qualities across generations, as well. Social workers often utilize genograms to map the intergenerational and family history influences on family systems (Hartman, 1978).
Family systems are sometimes described by therapists as being very difficult to redirect and resistant to change-once systems have achieved a level of stability or homeostasis, they apply concerted efforts to maintain their hard-earned balance. In fact, warnings have been offered about intervening to change an individual's alcohol abuse without adequately responding to the potentially destabilizing effect of an individual's recovery on the family system-the individual's drinking may represent a family system's homeostatic solution to otherwise distressed relationships (Steinglass, Davis, & Berenson, 1977; Orford, 1975).
Aging and Alcohol Abuse
Anyone at any age can have a drinking problem. Great Uncle George may have always been a heavy drinker--his family may find that as he gets older the problem gets worse. Grandma Betty may have been a teetotaler all her life, just taking a drink "to help her get to sleep" after her husband died--now she needs a couple of drinks to get through the day. These are common stories. Drinking problems in older people are often neglected by families, doctors, and the public.
Physical Effects of Alcohol
Alcohol slows down brain activity. Because alcohol affects alertness, judgment, coordination, and reaction time--drinking increases the risk of falls and accidents. Some research has shown that it takes less alcohol to affect older people than younger ones. Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach. Alcohol’s effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack. It also can cause forgetfulness and confusion, which can seem like Alzheimer’s disease
How to Recognize a Drinking Problem
Not everyone who drinks regularly has a drinking problem. You might want to get help if you:
Physical Effects of Alcohol
Alcohol slows down brain activity. Because alcohol affects alertness, judgment, coordination, and reaction time--drinking increases the risk of falls and accidents. Some research has shown that it takes less alcohol to affect older people than younger ones. Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach. Alcohol’s effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack. It also can cause forgetfulness and confusion, which can seem like Alzheimer’s disease
How to Recognize a Drinking Problem
Not everyone who drinks regularly has a drinking problem. You might want to get help if you:
- Drink to calm your nerves, forget your worries, or reduce depression
- Lose interest in food
- Gulp your drinks down fast
- Lie to try to hide your drinking habits
- Drink alone more often
- Hurt yourself, or someone else, while drinking
- Were drunk more than three or four times last year
- Need more alcohol to get "high"
- Feel irritable, resentful, or unreasonable when you are not drinking
- Have medical, social, or financial problems caused by drinking
Lunesta
| Description: | Lunesta (eszopiclone) is a nonbenzodiazepine hypnotic agent that is a pyrrolopyrazine derivative of the cyclopyrrolone class. |
| Indications: | Lunesta is indicated for the treatment of insomnia. In controlled outpatient and sleep laboratory studies, Lunesta administered at bedtime decreased sleep latency and improved sleep maintenance. |
Klonopin
| Description: | Klonopin (clonazepam) is a benzodiazepin. |
| Indications: | Klonopin is useful in the treatment of the Lennox-Gastaut syndrome, akinetic, and myoclonic seizures. In patients with absence seizures (petit mal), Klonopin may be useful after failing other traditional medication trials. Although not officially approved for treatment of mood disorders, it is sometimes used as a mood stabilizer. |
Geodon
| Description: | Geodon is available as Geodon Capsules (ziprasidone hydrochloride) for oral administration and as Geodon for Injection (ziprasidone mesylate) for intramuscular injection. Ziprasidone is a psychotropic agent that is chemically unrelated to phenothiazine or butyrophenone antipsychotic agents. |
| Indications: | Geodon (ziprasidone) is indicated for the treatment of schizophrenia. Geodon (ziprasidone) is indicated for the treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. A mixed episode is characterized by the criteria for a manic episode in conjunction with those for a major depressive episode (depressed mood, loss of interest or pleasure in nearly all activities). |
Eldepryl
| Description: | Eldepryl (selegiline hydrochloride) is a levorotatory acetylenic derivative of phenethylamine. It is commonly referred to in the clinical and pharmacological literature as l-deprenyl. |
| Indications: | Eldepryl is indicated as an adjunct in the management of Parkinsonian patients being treated with levodopa/carbidopa who exhibit deterioration in the quality of their response to this therapy. There is no evidence from controlled studies that selegiline has any beneficial effect in the absence of concurrent levodopa therapy. |
Depakote
| Description: | A stable co-ordination compound comprised of sodium valproate and valproic acid. |
| Indications: | Depakote is indicated for the treatment of manic episodes associated with bipolar disorder. Revised April 2009 |
Kaydol:
Yorumlar (Atom)