Obstetricians Often Overlook Alcohol Consumption In Pregnancy, says the Australian And New Zealand Journal Of Obstetrics And Gynaecology

One in every two pregnant Australian woman still consume alcohol during pregnancy, according to a study in the Australian and New Zealand Journal of Obstetrics and Gynaecology. The responsibility of providing accurate information about the harmful effects of alcohol and its lifelong effects on the child falls on obstetricians and other health professionals.

And yet, almost half of the obstetricians interviewed said they did not routinely ask about alcohol consumption in pregnancy.

An editorial by Professor Elizabeth Elliot from the University of Sydney titled “Alcohol and Pregnancy: the Pivotal Role of the Obstetrician”, discusses the state of awareness about the adverse effects of alcohol consumption during pregnancy and the obstetricians’ participation in educating against maternal drinking.

Only 16% of the obstetricians routinely provided information about the consequences of alcohol in pregnancy, while only 5% gave advice which were consistent with the latest guidelines of The National Health and Medical Research Council of Australia (NHMRC) – which states that, for pregnant women, ‘no drinking is the safest option’.

Professor Elliot says, “Failure to provide information about the dangers of alcohol consumption in the antenatal consultation represents a lost opportunity. Accurate recording of antenatal alcohol exposure will help identify children who require pediatric assessment, since the effects of alcohol may not be obvious at birth.”

“More importantly, identifying the women who are unable to stop drinking provides an important opening for the management of problem drinking and prevention of exposure to alcohol in future pregnancies,” added Professor Elliot.

Alcohol consumption during pregnancy has been associated with increased risks of miscarriage, stillbirth, intrauterine growth restriction, pre-term birth and low birth-weight. However, the best known adverse effect of alcohol exposure on the fetus is the fetal alcohol syndrome (FAS) – which is associated with a wide range of birth defects and ongoing educational, behavioral and psychological problems.

This paper is published in the June 2008 issue of Australian and New Zealand Journal of Obstetrics and Gynaecology (Vol. 48, Issue 3, 2008).

See also;

1. Facial features of fetal alcohol syndrome
2. Alcohol and Pregnancy
3. Alcohol Free Pregnancies
4. Alcohol intervention may help.
5. Brief-TSF can assist patients cease alcohol consumption.

Multiple psychiatric disorder risk for families with alcohol dependence

First-degree relatives of people dependent on alcohol are not only at increased risk of becoming addicted to alcohol and other drugs such as cocaine, but also of developing psychiatric disorders such as depression and panic disorder, study findings indicate.

Noting that alcohol dependence tends to aggregate within families, John Nurnberger (Indiana University School of Medicine, Indianapolis, USA) and colleagues analyzed data from the family collection of the Collaborative Study on the Genetics of Alcoholism to assess whether other psychiatric disorders may be also be more common in families with a history of alcoholism.

Data were available for 8296 relatives of people with alcohol dependence and 1654 individuals with no family history of alcoholism.

The rate of DSM-IV alcohol dependence was 28.8% for relatives of people with the condition, compared with 14.4% for controls.

Overall, relatives of alcoholics were twice as likely to become addicted to alcohol as people without a family history of alcohol dependence.

Relatives of alcohol-dependent individuals were also at an increased risk of becoming addicted to other drugs, including cocaine, marijuana, opiates, sedatives, and stimulants. The greatest risk was for cocaine dependence, with relatives of individuals with alcoholism more than three times as likely as those without a family history of alcoholism to become dependant on the drug.

Moreover, relatives of alcoholics had a higher risk of depression, panic disorder, post-traumatic stress disorder, and antisocial personality disorder than controls.

“The aggregation of antisocial personality disorder, drug dependence, anxiety disorders, and mood disorders, suggests common mechanisms for these disorders and alcohol dependence within some families,” Nurnberger et al write in the Archives of General Psychiatry.

This represents a “shared specific genetic vulnerability,” they say, which puts people at risk of a number of psychiatric disorders if they have a family history of alcohol dependence.

Research Source: Arch Gen Psychiatry 2004; 61: 1246-1256

Alcoholism is a multigenerational disease as evidenced by this report.

Abstract; To test the hypothesis of a sex-linked factor influencing the occurrence of alcoholism and alcohol abuse, alcoholism or abuse rates were compared for 136 sons of the sons vs 134 sons of the daughters of 75 alcoholics. No substantial difference between the groups of grandsons was found in frequency of officially registered alcoholism or alcohol abuse, or both, which suggests no sex-linked factor is involved. The total sample was also used to calculate the risk of such registration for the grandson; the rate of registration by the grandsons’ fifth decade of life was 43%, approximately three times that of the general male population, and even higher than the equivalent rate in brothers of alcoholics. This result is incompatible with an assumption of a recessive gene being involved in the occurrence of alcoholism, though it fits with the assumption of a dominant gene.

L. Kaij and J. Dock. Grandsons of alcoholics. A test of sex-linked transmission of alcohol abuse. Arch Gen Psychiatry. Vol. 32 No. 11, November 1975.

What are the social and economic effects of gambling addiction?

In 1998 the National Gambling Impact Study Commission funded a study to determine the overall cost to society posed by problem and pathological gamblers in the United States.

The results showed that approximately $5 billion was lost annually, with an additional $40 billion in lifetime costs for productivity reductions, social services and creditor losses. Studies have concluded that two out of three pathological gamblers commit illegal acts in order to pay gambling-related debts. This places a hardship on our legal systems, prison systems and public assistance programs.

The following consequences of problem gambling all result in economic costs for states, communities and individuals:

• Job loss, unemployment
• Debt, bankruptcy
• Embezzlement, fraud, check forgery
• Eviction, forced home sales
• Crime, arrest, incarceration
• Poor physical and mental health, suicide
• Alcohol and drug abuse

The families of problem gamblers also suffer greatly from physical and psychological abuse; harassment and threats from bill collectors and creditors; increased stress stemming from neglect and divorce; and the extra financial burden placed on them to repay debts.

Sadly, children are negatively affected by gambling addiction in several ways.

• Physical and emotional abandonment is a very real phenomenon.
• “Casino kids” are left in cars or on the periphery of the gambling action while their parents gamble, or may spend hours with babysitters, thus missing the nurturing they need.
• Children of pathological gamblers are typically abused verbally, mentally and physically by the gambler, and often even more so by the co-dependent spouse.
• Finally, these children are much more likely to develop gambling addiction than their peers.

Excerpted from research: Effects of Problem Gambling. California Council on Problem Gambling (Anaheim, CA); 2006.

Beyond Codependency: And Getting Better All the Time

By Melody Beattie

Review By Neal J. Pollock (VA USA)

While I have not read Melody Beattie’s other works, I thought this a very valuable book in and of itself. It sheds much light on the topic and helped me to become sensitized to the obvious signs of codependency in people. By doing this, it enabled me to avoid situations where I could become codependent in a relationship.

I think that, as in the Diagnostic and Statistical Manual, there are levels of psychological situations and/or problems. Thus, there may be people inherently inclined towards codependency, but there may also be people who are thrust into it due to the demands of others. The latter may find this book incredibly helpful in avoiding such relationships and in helping their dependent person seek real help vs. codependency from another person. There are also a number of great quotes by the author in this book. A few are:

p. 70: “It’s hard to feel compassion for someone while that person is using or victimizing us.”

p. 71: “If everything looks black, we’ve probably got our eyes shut.”

p. 164: “Who we’re in a relationship with says as much about us as it does about them.” Earnie Tucker (quoted by Melody Beattie)

Codependency is not something to make light of, it’s as much (if not more) the codependent’s problem as the dependent’s. As Caroline Casey humorously noted in “Making the Gods Work for You” (Harmony Books NY 1998), on page 72:
“What do codependents see when they die? Someone else’s life flashes before their eyes.”

This is literally a life-changing book for codependents.

Reviewer: A reader

Once Melody Beattie’s Codependent No More has been “digested”, Beyond Codependency helps to move the recovering codependent past the hurt and on to the business of literally changing behaviors and making a better life. I absolutely recommend this book above any others to recovering codependents.

The National Institute on Alcohol Abuse and Alcoholism has established through years of clinical research the effectiveness of the following interventions to treat alcohol problems.

Professional delivery of these interventions follows established protocols that have been published in manual form.

Cognitive behavioral therapy (CBT) primarily targets alcohol dependent individuals. It assumes that alcoholism is learned problematic behavior that begins and continues with the patient’s distorted belief that alcohol helps him or her cope with stress.

CBT therapists usually try to change how a patient thinks about alcohol, and to assist a patient in identifying stressful situations and alternative ways of coping with these situations. CBT allows patients to establish the goals of treatment. These can range from controlled drinking to abstinence.

Motivational enhancement therapy (MET) targets all problem drinkers, including alcohol dependent individuals.

It is based on principles of motivational psychology and focuses on increasing a patient’s internal motivation to change his or her drinking behavior.

MET doesn’t try to guide the patient through recovery step-by-step. Instead, it uses objective feedback and empathic listening techniques to influence positive change.

MET is a less intensive intervention, requiring only four sessions to complete.

Twelve-step facilitation therapy (TSF) primarily targets alcohol dependent individuals. It is grounded in the concept of alcoholism as spiritual and medical disease.

Patients are encouraged to accept an alcoholic identity and to become involved in support group activities (going to Alcoholics Anonymous meetings, getting a sponsor and working the 12 steps of AA). Abstinence is the goal of TSF.

Behavioral marital therapy (BMT) and other couples and family therapies primarily target alcohol-dependent individuals.

They recognize that spouses, significant others and family members of patients being treated for alcoholism can play a critical role in recovery.

These therapies seek to enhance communication between couples and among family members to improve the functioning of relationships.

This leads to longer retention in treatment for patients, longer periods of abstinence among patients, and less anxiety and enabling behavior among nonalcoholic spouses, significant others and family members.

Research Sources: Project MATCH Research Group. 1997; National Institute on Alcohol Abuse and Alcoholism. 2003. List of Alcohol Interventions for Substance Abuse and Mental Health Services

From; www.ensuringsolutions.org

Brief-TSF follows the principles of full TSF and is designed for non-specialist healthcare workers as an earlier intervention.

Research Summary; Women and men appear to have different genetic and environmental risk factors for alcoholism, Reuters reported Jan. 24/2006.

A quartet of new family studies on alcoholism show, for example, that while both sexes are more likely to develop alcoholism if they have a history of aggressive behavior in childhood, women who experienced severe physical punishment in childhood were also at elevated risk, while men were not.

“Clearly, there are some common antecedents (to alcoholism), such as conduct disorder or symptoms, but there are also predictors unique to each gender,” said researcher Aruna Gogineni of the Johns Hopkins University School of Medicine. “These are the kinds of findings that call out for many more studies on women in order to determine how the mechanisms of alcoholic parental risk may differ in men and women.”

Researchers affirmed that children of alcoholics were generally more likely to have alcohol problems themselves, but said that genetic makeup may be more important for men, while environmental factors may have more of an impact on women. For example, one study comparing children of biological and adopted parents with alcoholism found that male children of alcoholics related by blood were more likely to be alcoholics themselves.

The research appears in the February 2006 issue of the journal Alcoholism: Clinical & Experimental Research.

From; Join Together Online

See also;

• 12-Step Treatment More Effective than Alternative
• Twelve Step Facilitation
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to BriefTSF by e-Mail

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions : Counseling for Recovery and Prevention Using Psychology and Religion by Howard Clinebell Read more about this title…

Impact of parental history of substance use disorders on the clinical course of anxiety disorders.

Abstract; Background Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions.

Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare.

The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years.

Methods; Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history.

Results; Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education.

History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders.

Conclusions; These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders.

Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients’ level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Research; Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Maria E. Pagano, Richard Rende, Benjamin F. Rodriguez, Eric L. Hargraves, Amanda T. Moskowitz, & Martin B. Keller. Substance Abuse Treatment, Prevention, and Policy 2007, 2:13

Substance abuse among the elderly: A growing problem

In her early years, Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic.

Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. His children, long ago burned out from trying to persuade him to get help, have come to believe that you really can’t "teach an old dog new tricks."

These two composite situations illustrate what has been called one of the fastest growing health problems in this country–substance abuse among the elderly. More people are living longer and more of them are abusing drugs and alcohol in their later years.

Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.

As demographics change, attitudes about and use of alcohol and drugs change as well. "In January 2006, the leading edge of the baby-boom generation (those born during the population swell of 1946-1964) will turn 60," said Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden’s Butler Center for Research. "These individuals have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to ‘cure’ things. We expect to see an increase in drug and alcohol use; and more use means more problems."

Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. "There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better," he said.

According to Blow and other experts, when people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol–which is water-soluble–affects them more quickly and to a greater degree. Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol.

As a whole, more older men have substance abuse problems than do older women, but women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences.

Unfortunately, health care providers often overlook substance abuse among older adults because they don’t know what to look for or they mistakenly assume that older adults cannot be successfully treated. Loved ones, too, may excuse an older relative’s substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get "written out of the will," said Blow.

Yet Blow said there is "good evidence" that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. "Older adults can recognize all kinds of benefit from treatment," stressed Blow. "There are often direct health benefits, improved cognition, more independent living, more and better social connectedness, and new hobbies. The benefits are enormous."

The U.S. Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/) offers a wide range of information and resources to help identify, treat, and prevent substance abuse among older adults.

The pamphlet " How to Talk to an Older Person Who Has a Problem With Alcohol or Medications" is available on the Hazelden Web site.

Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80