Female alcoholics. V. Morbidity

Data from the public health insurance societies regarding 66 female alcoholics, hospitalized for the first time for alcoholism at the Department of Alcohol Diseases, Karolinska Hospital, Stockholm, were studied, and the developmental pattern of morbidity was compared with that of 68 male alcoholics fulfilling the same criteria. The observation period was 15 years. The progress of the alcoholism was not reflected in data from the social insurance societies up to the time of the first clinical treatment. However, the morbidity increased in both sexes after the treatment period, with higher disability, severity, and frequency rates, a large number of persons with disability pensions and increasing social stigmatization. The proportion of women granted disability pensions increased to significantly higher values than that of men, and that of women in the general population. The women had significantly fewer registrations in social registers than the men during the whole period. Women and older patients had higher disability rates, more sick-days due to "mental diseases" and a higher severity rate before admission. All differences were equalized in the last part of the study.     

Female alcoholics

The aim of this study has been to describe the different ways in which 100 alcoholics of each sex sought treatment, with special reference to the females. In addition, some psychiatric and social characteristics of the two groups of patients are presented. A significantly higher number of the females were admitted as a result of an acute complication: unconsciousness, suicide attempt, confusion, neurological disorders, etc., while the males generally sought treatment under less dramatic circumstances. As the patients selected were early cases, most had not been treated before, but in those with previous in-patient psychiatric treatment a diagnosis without an alcohol connection was significantly more common among the women. Drug abuse was considerably more frequent among the female as compared with the male alcoholics, and the specific lonely drinking pattern was also more common among the women. A striking difference between the sexes appeared with respect to partner: more than one-half of the married women had alcoholic husbands. The corresponding figure for the married men amounted to about 10 %.     

Sexual jealousy in alcoholics

A hundred patients referred to an alcoholism service were assessed in terms of sexual jealousy by interview and with a Sexual Jealousy Questionnaire. The overall incidence of sexual jealousy was 35% in men and 31% in women as judged by the interview. Twenty-seven per cent of the men and 15% of the women had morbid jealousy. There was no relationship between sexual jealousy, as measured by the questionnaire, and sexual dysfunction. However, in the men there were inverse relationships between the scores for sexual jealousy and measures of sexual satisfaction and marital stability, and in the women sexual jealousy scores correlated negatively with duration of the marriage and positively with severity of alcohol dependence.     

Female alcoholics. IV. Admission problems and patterns

In an age-matched sample of male and female inpatient alcoholics (n = 518) of the same ethnic background, subjects under 35 years of age described significantly more problem areas than older age groups. Elderly subjects over 55 were the least articulate group. The first-ever addiction treatment subjects reported the lowest mean number of years of problem drinking, the lowest mean Michigan Alcoholic Screening Test scores and the lowest mean daily alcohol intakes. They also displayed greater current social stability than the 2 readmission treatment categories. The general determinants of admission to this addiction unit centered around the experience of crises, social instability and psychological complaints. The most important specific determinants for the individual subject were the propensity to fight when drunk, followed by a positive parental history of excess alcohol intake. Criminal and occupational factors were infrequently encountered in female subjects, but widowhood was common in the older ones.     

Parental alcohol use and brain volumes in early- and late-onset alcoholics.

BACKGROUND: Studies have shown that alcoholics have smaller brain volumes than non-alcoholic cohorts, but an effect of family history (FH) of heavy drinking on brain volume has not been demonstrated. We examined the relationship between an FH of heavy drinking and both brain shrinkage as measured by the ratio of brain volumes to intracranial volume (ICV) as well as maximal brain growth as measured by ICV in early-onset and late-onset alcoholics. METHODS: With T1-weighted resonance imaging, we measured ICV, brain volume, and white and gray matter volume in adult treatment-seeking late-onset and early-onset alcoholics with either a positive or a negative FH of heavy alcohol use, and in healthy control subjects. We also calculated brain shrinkage using a ratio of soft tissue volumes to ICV. RESULTS: The FH positive alcoholic patients had significantly smaller ICVs than FH negative patients, suggesting smaller premorbid brain growth. Brain shrinkage did not correlate with FH. Late-onset alcoholics showed a greater difference in ICV between FH positive and FH negative patients than early-onset alcoholics. Late-onset FH positive patients also had significantly lower IQ scores than late-onset FH negative patients, and IQ scores were correlated with ICV. CONCLUSIONS: These data provide evidence that parental alcohol use might increase risk for alcoholism in offspring in part by a genetic and/or environmental effect that might be related to reduced brain growth.     

Religion and Spirituality as a Resource in Marital and Family Therapy

ABSTRACT

Today's therapists are faced with a myriad of challenges in their quest to provide the best and most appropriate care for each of their clients. In our training, for the most part, religion and spirituality are left out of the equation. Knowing that many individuals are searching for some type of meaning in their lives and that religion and spirituality are important issues to a large number of people, it follows that to become a truly effective therapist one needs to become more knowledgeable and comfortable in dealing with religious and spiritual issues. This article explores various aspects of religion and spirituality as a part of marital and family therapy including definitions, attitudes and beliefs, ethical issues, culture, and training.     

Ataxia and cerebellar atrophy in chronic alcoholics

Summary Forty-five alcoholics were examined clinically and by CT scanning in order to evaluate the relationship between ataxia, cerebellar atrophy and peripheral neuropathy. A significant relationship was found between ataxia and cerebellar atrophy as well as between ataxia and peripheral neuropathy.     

Epileptic seizures and cerebral atrophy in alcoholics

Summary Computed tomography was carried out in two groups of chronic alcoholics diagnosed according to the research diagnostic criteria, one with and the other without epileptic seizures. The sizes of the ventricles and the extracerebral spaces were compared with those of a control group, in order to examine the possible role of cerebral atrophy in precipitating epileptic fits in chronic alcoholics. Although a severe degree of atrophy was demonstrated in both groups, no difference was found between alcoholics with and without seizures. However, by correlating the sizes of different spaces, a more generalized atrophy was found in alcoholics with seizures. Thus, cerebral atrophy in a more generalized form may play a yet undefined role in precipitating epileptic attacks.

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Zusammenfassung Zwei Gruppen von chronischen Alkoholikern, eine Gruppe mit und eine Gruppe ohne epileptische Anfälle, wurden computertomographisch untersucht und im Hinblick auf die Größe der äußeren und inneren Liquorräume verglichen. Ausgangspunkt war die Frage, ob eine Hirnatrophie einen wesentlichen Faktor für die Auslösung von epileptischen Anfällen darstellt. Die Diagnose Alkoholismus wurde entsprechend den Research Diagnostic Criteria gestellt. Wir fanden eine sehr ausgeprägte Hirnatrophie in beiden Gruppen von Alkoholikern. In der Gruppe mit Anfällen bestand eine strengere Korrelation zwischen den verschiedenen Liquorräumen, d. h., ein Hinweis auf eine mehr generalisierte Hirnatrophie. Eine mitverursachende Rolle dieser Form der Atrophie für das Auftreten von epileptischen Anfällen ist wahrscheinlich.

     

Female alcoholics: IV. The relationship between family violence and outcome 3-10 years after treatment

In a long-term follow-up study of 44 female alcoholics, the women's childhood history of family violence was found to be related to violence in partner relationship as an adult and to outcome of treatment. The number of violent relations experienced during childhood was significantly related to a repetitive pattern of violent partnerships after treatment, which added to a poor outcome. The small number of selected women studied limits the generalization of data. However, treatment intervention in violent partner relationships of female alcoholics probably would benefit long-term outcome.     

Mortality in alcoholics related to clinical state at first admission. A study of 537 deaths

The Department of Psychiatry, University Hospital, Lund, is in possession of systematic clinical ratings from 1949 to 1969 based on a multi-dimensional diagnostic schedule. All 1312 first-admitted patients (120 women) from the county who were rated as "chronic alcohol intoxication" were followed up until 31 December, 1980. Of 537 deaths, 495 were male compared with an expected number of 198 in the general population standardized for age and sex (2.5 X), and 42 were female compared with eight expected (5.1 X). The frequency of liver cirrhosis as primary cause of death compared with that of the general mortality was 4.3 times more in men and 60 times more in women. Those who died from liver cirrhosis and alcohol-induced neoplasms were at first admission more often married and had a more continuous drinking pattern than the remaining alcoholics.     

Heart rate variability of chronic alcoholics in withdrawal and abstinence

Measurement of heart rate variability was performed in 106 healthy volunteers and 31 alcoholics. The mean momentary arrhythmia (MMA) of normal individuals showed an exponential decrease with increasing age. Cardiac autonomic neuropathy was found in 5 of 31 alcoholics. In agreement with the concept of hyperexcitability the withdrawing alcoholics had a significant increase in heart rate and decrease in MMA compared to later measurements. The result suggests that the diagnosis of autonomic alcoholic neuropathy may be reliable only after at least a one week period of abstinence from alcohol.     

Hypothalamic-pituitary-adrenal system adaptation to detoxification in alcohol-dependent patients is affected by family history of alcoholism.

BACKGROUND: Alcohol withdrawal profoundly affects the hypothalamic-pituitary-adrenocortical (HPA) system. We investigated whether a family history of alcoholism modulates HPA response to pharmacologic intervention during detoxification in alcohol-dependent patients. METHODS: Sixteen family history negative (FH-N) and 19 family history positive (FH-P) alcohol-dependent patients were admitted for withdrawal. All 35 patients were investigated 1 week after remission of withdrawal symptoms; 17 patients were also tested during acute withdrawal. Dexamethasone 1.5 mg was given orally at 11 PM, followed by 100 microg corticotropin-releasing hormone (hCRH) administered intravenously at 3 PM the following day. Plasma adrenocorticotropic hormone (ACTH) and cortisol concentrations were determined at 0, 30, 45, 60, and 75 min after CRH. RESULTS: During withdrawal, cortisol but not ACTH secretion was increased in patients compared with 19 control subjects matched for age and gender. After withdrawal, cortisol was normal in FH-P but still increased in FH-N patients versus control subjects, and ACTH was marginally decreased in FH-P patients only. Both hormones were increased in FH-N versus FH-P patients. CONCLUSIONS: Recovery from alcohol withdrawal-induced impairment of HPA system regulation occurs earlier in FH-P than FH-N patients, indicating that the efficacy of central neuroadaptation to this ethanol-related stimulus may be related to genetic factors.     

Female alcoholics. I. Psycho-social outcome six years after treatment

In a long-term follow-up study of 44 young female alcoholics, 57% were abstainers, light, or moderate drinkers with good social functioning. The women's vocational functioning had improved compared with the situation at intake. Nevertheless, many needed public financial support, and 62% reported mental disturbances relevant to their present functioning. Anxiety disorders with phobias, depression and psycho-somatic complaints were most frequently reported. A few women suffered from a post-traumatic stress syndrome following a relationship with a violent partner. The symptom picture of the abstainers and heavy drinkers was much the same when measured by the SCL-90, whereas the light and moderate drinkers had fewer symptoms and lower symptom intensity. The article discusses the complicated relationship between life situation, mental disorders, and personality disorders, in women alcoholics. All these aspects must be dealt with to allow a more effective treatment of female alcoholics.     

Integrating Sex Therapy Strategies and Techniques into Marital Therapy

Abstract

Marital therapy is a growing field, while sex therapy is stagnating, and even shrinking. However, this does not mean sexual problems have lessened in frequency or severity.

Traditionally, sexuality has not been a focus in marital therapy training, research, or practice. The Plissit model provides a format for marital therapies to integrate sexual interventions into their therapeutic repertoire. Sex therapists can provide workshops and consultations emphasizing permission giving, sexual information, and specific cognitive and behavioral suggestions. The supervision format helps the marital therapist assess interest in and ability to integrate sexual interventions into the therapeutic repertoire, as well as explore personal issues or values that might subvert therapeutic effectiveness.     

Peripheral neuropathy, cerebral atrophy, and intellectual impairment in chronic alcoholics

Peripheral neuropathy, cerebral atrophy, and intellectual impairment was investigated in 46 males with alcoholic nervous system damage. An overall correlation was found between peripheral neuropathy and cerebral atrophy and between several of the individual neurophysiological and neuroradiological variables examined. There was also a correlation between cerebral atrophy and intellectual impairment. The findings support the view that alcohol in itself is toxic to central and peripheral nervous tissues, although a dose-response dependence could not be established.     

Behavior of alcoholics and spouses in a simulation game situation.

The interaction of alcoholics and their spouses in a simulation game was systematically observed and compared to the behavior of nonalcoholic couples. Overall, 28 couples played a mixed-motive bargaining game, the "tax game," which is a modification of Kelly's "game of nines." Alcohol couples as a group did not manifest a distinct game "style." They were less uniform in this respect than "normal" couples and a mixed group of "psychiatrically disturbed" couples. Subgroup trends without the alcoholic sample were suggested and discussed. Extreme behavior, rigidity, and lack of communication were common features in the game behavior of alcoholic couples that did not appear to relate to a particular game style, but did distinguish the game play of alcoholic couples from that of nonalcoholic couples.     

Acceptance,attrition, and outcome in an outpatient treatment programme for alcoholics

Summary Acceptance, attrition and outcome of the same outpatient treatment programme for alcoholics was studied first in a non-randomized and later in a randomized study. There was a lower (15%) rate of acceptance and a higher (19%) rate of attrition in the randomized study. Among treatment completers drinking outcome during the third year after commencement of treatment did not differ between the non-randomized and the randomized study. It is concluded that the characteristics of subjects accepting a randomly assigned study should always be clearly presented. The absence of a patient-therapist matching in a randomized design could negatively effect attrition and probably also acceptance of treatment, while it seems to be less influential on outcome in those completing therapy.     

Children of alcoholics in Spain: from risk to pathology

OBJECTIVE: To identify the possible risk factors and negative outcomes associated with parental alcoholism. A secondary aim was to determine the influence of the family density of alcoholism on children of alcoholics' (COAs) psychological functioning. METHOD: A multisite epidemiological study was conducted in 8 Spanish cities, recruiting a total sample of 371 COAs (whose parents were in contact with alcohol treatment centers and accepted to participate in this study) and 147 controls (from schools in the same localities as COAs). Both groups were 6-17 years old and received a comprehensive evaluation of mental disorders (no symptoms, subclinical symptoms or clinical diagnosis for each disorder; according to DSM-IV criteria); alcohol and other substance use (none, occasional, regular and risky consumption); school achievement (low, middle and high) and other academic performance indicators (WISC-R Information and Arithmetic subtests, school support activities and failed subjects and courses). Lastly, several cognitive functions were measured by the WISC-R Similarities, Block Design and Digit Symbol subtests, the Toulouse-Piéron test and the Stroop test. Logistic regression methods were used to compare both groups and a linear regression model was used to determine the influence of the family density of alcoholism. The following confounding variables were controlled for: age, gender, socio-economic status and family cohesion. RESULTS: Children of alcoholics' were twice as likely as controls to present subclinical symptoms and four times more likely than controls to have a definite diagnosis of any mental disorder. More specifically, COAs had a significantly higher risk than controls of attention deficit disorder/hyperactivity, depression, phobias, enuresis and tics. COAs also tended to have more symptoms of generalized anxiety disorder. COAs had worse results on all the cognitive tests used and their risk of low school achievement was nine times higher than that of controls. Family density of alcoholism was significantly related to several psychiatric disorders and to low academic and cognitive performance in these children. CONCLUSION: Children of alcoholics' whose parents are in contact with treatment centers in Spain constitute a target group for selective prevention, as they have a higher risk of different negative outcomes, which mainly include attention disorders and other cognitive deficits, depression and anxiety.