ALCOHOLIC WOMEN IN TREATMENT: THE QUESTION OF STIGMA AND AGE

Both alcoholic women in treatment and a matched group of non-alcoholicwomen feel that social attitudes are more negative towards femaleintoxication and problem drinking than towards male intoxicationand their drinking problems. Alcoholic women report significantlymore negative attitudes, both social and personal, than do thenon-alcoholic control women. The older group of alcoholic women are consistently harsherthan the younger in their judgments, both of social attitudesand in expression of their own opinions. The less negative attitudeof younger women alcoholics may reflect more liberal attitudesof younger persons but there is a curious juxtaposition in thatyounger alcoholic women report more family and social rejectionthan do older alcoholic women. There is dissonance in youngeralcoholic women's report of less negative attitudes and moreexperienced rejection and stigmatization. Perhaps more rejectingsocial attitudes towards younger alcoholic women are relatedto their greater likelihood of public rather than private drinking. When the total sample (438 women, alcoholic and non-alcoholic)is compared in terms of posi tive family history versus negativefamily history, those with positive histories are more likelyto agree with disapproving statements about women's problemdrinking. Significantly more women with positive histories believethat social attitudes are more disapproving of women alcoholicsthen men, and they believe, to a significantly greater extentthan those without such histories, that the effects of maternalalcoholism are worse than those of paternal alcoholism.     

RELIGIOUS OBSERVANCE, ATTITUDES TOWARDS DRINKING, AND KNOWLEDGE ABOUT DRINKING, AMONGST UNIVERSITY STUDENTS

University student members and non-members of the ChristianUnion were asked about their attitudes towards social drinkingand lowards alcoholism using adaptations of previously publishedquestionnaires. Certain aspects of their knowledge about alcoholand its use were also tested using a newly designed questionnaire.As predicted, Christian Union membership was much less oftenassociated with frequent drinking and much more often associatedwith abstinence. Also as predicted, members were significantlymore negative about alcoholism and alcoholics, and particularlyabout social drinking. An analysis of individual questionnaireitems suggested a moralistic view of excessive drinking amongstChristian Union members. The latter were just significantlyless knowledgeable about alcohol and its use, but there werea large number of incorrect answers amongst subjects in bothgroups, indicating scope for alcohol education even amongstuniversity students.     

Perceived intensity and pleasantness of sucrose taste in male alcoholics

AIMS: The aim of the present study was to evaluate a possible relationship between taste responses to sweet solutions and alcoholic status. METHODS: The rated intensity and pleasantness of sucrose taste was compared in male alcoholics (n = 45) and non-alcoholic controls (n = 33). RESULTS: The rated intensity, but not pleasantness, of water taste (0% sucrose) was higher in the alcoholics. The two groups did not differ with respect to the rated intensity or pleasantness of sucrose solutions (1-30%). The proportion of sweet-likers, i.e. subjects rating 30% sucrose as most pleasant, was similar in both groups (the controls: 57.6%, the alcoholics: 62.2%). A subgroup of alcoholics with a paternal history of alcoholism (n = 22) rated the highest sucrose concentration as more pleasant compared to alcoholics without alcoholic fathers. The proportion of sweet-likers among the alcoholics with a paternal history of alcoholism (77.3%) was significantly higher than that found in the alcoholics without a familial history of alcoholism (47.8%). CONCLUSIONS: The present results suggest the following: (i) alcohol dependence is not associated with any major alterations in taste responses to sucrose solutions, (ii) sweet liking is a phenotypic marker of male alcoholics with a paternal history of alcoholism.     

Clinical nurses' attitudes toward the use of alcohol and alcoholism

This psychometric study used the Seaman Mannello's scale of "nurse's attitudes toward alcohol and alcoholism". Authors applied an instrument to a population of 196 nurses from a general hospital with the aim to measure nurses'attitudes toward alcohol and drinking. Data showed that nurses consider alcoholic drinks clearly prejudicial (54.4%), that moderately drinking is not innofensive (57.1%) and drinking is wrong (47.4%), demonstrating that it is difficult to accept drinking as a person right. 29.8% of the sample considered alcoholic drinks able to change healthy people into "disturbed and demented" ones. Authors concluded that the nurse is an essential professional in the treatment and rehabilitation of alcoholics. Nurses attitudes can influence the relationship with the patient and, consequently, favor the treatment.     

Drinking style of parents of alcoholic and control probands

One aspect of the familial component of alcoholism is the use of alcohol among the parents of affected individuals. Both the individual and concordant drinking styles of the parents of 291 inpatient alcoholic probands and 71 non-alcoholic control subjects were measured using family history methods. Social drinking was almost twice as prevalent among fathers of controls compared to fathers of alcoholics. Problem drinking was more than twice as prevalent among the fathers of alcoholics compared to fathers of controls. The abstinence rate for fathers of both groups was similar. Mothers' drinking styles were similar to the fathers' pattern for both groups. Concordance of drinking style in the parental pair was examined. Similarity in drinking style for the parents of control probands was greatest for social drinking. For parents of alcoholic probands high concordance was also found by problem drinking. Overall a great similarity in drinking style was found for the parents of control probands compared to the parents of alcoholic probands.     

A descriptive study of trauma, alcohol, and alcoholism in young adults

Young adults, 18–20 years of age, admitted to a trauma center via the emergency department, were studied to determine if they had been drinking prior to their injury event. The prevalence of self-reported chronic alcohol problems was examined using the short Michigan Alcohol Screening Test (SMAST). Of the 319 subjects, 131 (41%) tested positive for alcohol, including about onehalf of those with intentional injuries and 38% with unintentional injuries. Approximately 22% had blood alcohol concentrations of 100 mg/dL or more, indicating they were legally intoxicated at the time of their injury. Of study subjects who completed the SMAST, 49% attained scores suggesting potential or probable alcoholism, and 20% had already sought some type of treatment, despite their young age. Health-care practices and policies related to these findings include routine screening of trauma patients for alcohol abuse and integration of chemical dependency intervention services with trauma care.     

Knowledge about and attitudes towards drinking among university students in Spain

A total of 545 Spanish university students from the University of Valladolid, were surveyed in 1985 about their alcohol use, knowledge of the effects of alcohol, and attitudes towards social drinking and towards alcoholism and alcoholics. The knowledge regarding alcohol (mean scores 7.7 +/- 0.1, ranging 1-15) was associated with academic aspects: it was higher among medicine and nursing students and increased according to the length of stay at university. The attitudes both towards social drinking (mean scores 0.6 +/- 0.1, ranging -9 to 9) and towards alcoholism and the alcoholics (mean scores 3.0 +/- 0.1, ranging -6 to 9), were related to alcohol consumption: those students self-reported as "heavy" and "moderate" drinkers, and those with alcohol intake over 40 g/day, had a more favourable attitude. The results suggest a need for education on alcohol.     

Bulimia nervosa with and without alcoholism: A comparative study in Japan

To characterize females with bulimia nervosa and alcoholism, this study compared the social and family backgrounds, as well as the clinical symptoms of alcoholics with bulimia and patients with bulimia only. The subjects were 22 Japanese female patients with both bulimia nervosa and alcoholism; the comparison group comprised 22 age-matched female patients with bulimia nervosa but without alcoholism. Patients with both bulimia and alcoholism had more borderline personality disorders and pathological symptoms such as stealing, suicide attempts, and liver injuries than the nonalcoholic comparison group. The subjects' average body weight was significantly less than that of the comparison group. Whereas the clinical characteristics of females with bulimia and alcoholism differ in many respects from those with bulimia only, it is suggested that alcoholic bulimia patients form a distinct clinical subgroup among patients with bulimia nervosa. © 1994 by John Wiley & Sons, Inc.     

Event-related potentials in women at risk for alcoholism

Event-related potentials (ERPs) elicited during information processing tasks are useful for assessing brain function. Abstinent male alcoholics exhibit deficits in ERPs. The present study found that female alcoholics with early onset alcoholism (18.3 ± 1.3 years) showed significant deficits in P300 amplitude relative to both high-risk and low-risk controls. Two interpretations of these findings are possible. P300 amplitude reduction among the alcoholic women might be a neuropathological consequence of excessive drinking. Alternatively, lower amplitude of the P300 wave may be a marker for alcoholism risk segregating within high-risk families and associated with development of alcoholism. The later interpretation is favored based on the unlikely possibility that the nonalcoholic high-risk women would later convert to alcoholic status due to their age (mean age of 35.6 ± 1.6 years).     

Children of alcoholics: helping a vulnerable group

There are 28 million children of alcoholics in the United States--1 of every 8 Americans. They are more likely than others to suffer from alcoholism and a wide range of physical, emotional, and mental health problems. It is probable that an inherited predisposition for the disease of alcoholism exists. Most children of alcoholics do not become alcoholic, but they are at increased risk for many other health problems. Records of the use of services provided by health maintenance organizations and of health insurance claims show that children of alcoholics use more medical and hospital services than other children. Children of alcoholics are more likely to have problems in school and to abuse alcohol and other drugs. Their mental and physical health problems persist into adulthood. Clinical findings show that life in an alcoholic family is often characterized by pain, guilt, fear, tension, and insecurity. Children do not know that alcoholism is a disease which they cannot cause, control, or cure. Because alcoholism is a family secret, children rarely seek help, even as adults. Because the children of alcoholics are in many medical and social service systems, greater awareness and understanding by health and human service professionals can lead to identification and help for this vulnerable group. It is critical for family physicians, obstetricians, pediatricians, nurses, social workers, hospital staff, and others to incorporate questions about family alcoholism in routine screening procedures for youth and adults. Recommendations and useful materials are discussed.     

Assortative Mating Among Adult Children of Alcoholics and Alcoholics*

Relations between parental alcoholism, self‐alcoholism, and partner‐alcoholism were examined in a nonclinical, non–self‐identified sample of 128 married and engaged young couples. Couples were recruited to participate in a longitudinal study of close relationships. They were assessed using three alcoholism questionnaires that included reports of parent‐, partner‐, and self‐alcohol use. Participants were predominantly White and well educated. Cross‐sectional analyses indicated that alcoholics tend to marry other alcoholics and that male adult children of alcoholics (ACOA) are more likely to be alcoholic than their female counterparts. The relation between parental alcoholism and partner's alcoholism was affected by self‐alcoholism in male participants. There was a significant relation between ACOA status and marriage to alcoholics for women that was not affected by their own alcoholism.     

Attitudes of clinical nurses toward personal characteristics of alcoholics patients

The purpose of this exploratory study was to discover nurses' attitudes towards the perceptions of personal characteristics of alcoholics. Nurses' attitudes were measuared using the Seaman-Manello Scale, the sample consisted of 171 nurses who work in a university general hospital located in the State of S?o Paulo, Brazil. The results evidenced that more than half of the sample (52.4%) had a professional experience with alcoholics. Nurses see the alcoholic patients as unhappy, lonely, sensitive people, who doubt their own value and have serious emotional problems. It is concluded that nurses' attitudes toward personal characteristics of alcoholic patients tend to be positive and suggests greater attention to professional training in recognition and approach of the alcoholic in general hospitals.     

PROSPECTIVE PATIENTS' REACTIONS TO ALCOHOLISM CLINIC REFERRAL

Thirty-seven patients were interviewed at home before theirinitial appointment at an alcoholism clinic to discover theirreactions to referral, attitudes to attending and expectationsof what would happen. Referral for the majority was not initiatedby the patients themselves but usually by the general practitioner,sometimes at the request of the patient's spouse. Most felta sense of relief on receiving an appointment to attend. Althoughembarrassment about the prospects of attending was commonplace,those who informed all their family and friends of the referralwere more likely to attend. Few informed their employer of theappointment. Few had any knowledge of what would happen at theclinic but most expected to be told to stop drinking. Most informantswere very optimistic about their prospects of recovery. Informationcollected during the interviews raises questions about the referralprocess and how patients may be better prepared for attendanceat an alcoholism clinic. The referral agent should deal withany misconceptions and misgivings that patients may have aboutpsychiatric referral and treatment. They should attempt to motivatepatients to regard referral as a positive step towards eventualrecovery from a drinking problem. The evidence to date suggeststhat patients who are more carefully prepared for referral andconsultation have a more positive attitude towards it.     

Eight-year outcome of problem drinking among medical inpatients.

Male medical inpatients rated alcoholic on the Michigan Alcoholism Screening Test in 1982 were compared with non-alcoholic controls admitted to medical wards in the same year. By 1990 the alcoholic subjects had moderated their drinking, although peak consumption at follow-up was twice that of controls. A similar number of health and social disabilities occurred during the follow-up period among alcoholics and controls. Untraced and dead alcoholics had scored highly on MAST and the Severity of Alcohol Dependence Questionnaire in 1982.     

Profile of the Alcoholic Jew

One factor contributing to low rates of alcoholism among Jewsis the understanding that this in not a Jewish problem. Recognitionand treatment of the disease, when it does occur, is delayedwhen the Jewish community and/or professionals deny its existence.Sixteen recovered alcoholic Jews described their family background,exposure to alcohol, attitudes about drinking and drunkenness,history of alcoholism and recovery. They drank primarily torelieve stress and psychic discomfort; social drinking was minimal.Shame was increased because they interpreted their behaviouras non-Jewish. Treatment was impaired because of the lack ofculturally congruent facilities. No differences in attitudewere detected between Orthodox, Conservative, Reform and secularJews.     

PROSTAGLANDIN SYNTHESIS AND RESPONSE TO ALCOHOLISM TREATMENT

Serum prostaglandin F2 (PGF2) was assayed in 27 alcoholic patientsand in 18 control subjects. No significant difference was observedin mean basal PGF2 titers of patients and controls. However,patients who completed four months of alcoholism treatment hada mean titer that was significantly higher than that of treatmentdropouts. Patients who maintained continuous abstinence for2 years following treatment had a mean titer that was significantlyhigher than that of patients who returned to pre-treatment drinkinglevels     

Alcoholism in patients with sexual disorders

The authors screened for alcoholism 145 consecutive patients who presented with sexual dysfunction or disorders. Using the Michigan Alcoholic Screening Test (MAST), 29% of the patients scored in the probable alcoholic range. Probable alcoholics were more likely to present without a partner and claimed higher sex drive than nonalcoholic patients. Probable alcoholic males reported less joy and vigor than probable alcoholic females, while the reverse held for the nonalcoholic groups. Blind to the MAST results, the staff made six alcohol-related diagnoses and referred one patient for alcohol treatment. The authors discussed the importance of training faculty and resident staff in the relationship of alcohol abuse associated with psychosexual dysfunctions.     

Contrasting binge and continuous alcoholic drinkers using demographic and drinking history variables

While it is quite common for researchers and clinicians to categorize alcoholics as binge or continuous drinkers, relatively little is known about the characteristics of these two potentially distinct clinical populations. In the present study, binge and continuous alcoholics were evaluated on a number of demographic and drinking history variables. Binge drinkers were found to be significantly more likely than continuous drinkers to have been treated for liver problems and more likely to have reported parental alcoholism. They also tended to describe a greater number of alcohol-related arrests and hospitalizations. Six of the variables taken together yielded a discriminative function that was only moderately successful in classifying these drinkers. The potential clinical importance of objectively identifying binge versus continuous drinkers is discussed.     

The specificity of disrupted processes in families of adult children of alcoholics

Children of alcoholics (COAs) have been characterized as an at-risk population in part, because of the dysfunctional family environments that disrupt psychosocial development among offspring exposed to parental alcoholism. This study examined the specificity of problematic family environments to children of alcoholics vs children exposed to other significant family stressors that included parental death, unemployment, separation, divorce, or major illness. University students completed self-report measures of family stressors, family relationship problems, family communication quality, family conflict, and relationship with parents. Based on a family stressor checklist, 20 students exposed only to parental alcoholism and no other family stressors were compared to several other groups exposed to specific family stressors, and to 50 control subjects who had reported no family stressors. Results showed that students from families where a parent is or was an alcoholic, and where there were no other family stressors, recall disturbed family relations no more commonly than students specifically exposed to other family stressors such as parental divorce, death, or major illness, and no more commonly than those who reported no family stressors. Further analyses suggest that the disruption of COAs' family environments may be explained by their increased likelihood of experiencing additional family stressors that can have a disruptive effect, such as parental separation, divorce and unemployment.     

The cost of depression-complicated alcoholism: Health-Care utilization and treatment effectiveness

Clinical and epidemiologic evidence suggests that alcoholism complicated by concurrent or a lifetime history of depression is slower to remit and more prone to relapse than uncomplicated alcoholism. Consequently, alcoholics with a history of depressive illness, on average, are likely to use more health care and to have higher treatment costs than those without depression complications. This article contrasts evidence of the suitability of three models for predicting the impact of depression on an alcoholic’s health-care use: a null model (assuming no differences) a cumulative-effect model (arguing for a linear increase associated with comorbid depression), and a synergistic model (wherein alcoholism complicated with depression is qualitatively as well as quantitatively different than uncomplicated alcoholism). To test these models, health-care costs and utilization of 491 “pure” alcoholics (those with no history of depression diagnosis) and 199 depression-complicated alcoholics, who received alcohol treatment while enrolled in a self-insured health-care program of a major U.S. manufacturing company, were compared. Results are discussed in terms of the implications for cost containment and the likelihood of relapse among the depression-complicated alcoholism group.