Australian Broadcasting Commission, Online, AM, 11 January 2007, journalist Anne Barker

TONY EASTLEY: It’s proven that women who drink in pregnancy risk causing life-long health problems for their unborn children.

What isn’t so well known is that there’s growing evidence that foetal alcohol disorders, as they’re known, are a major cause of crime.

A Canadian lawyer is in Darwin this week talking to judges and barristers about the impact of foetal alcohol.

Anne Barker reports.

ANNE BARKER: It’s common knowledge that women who drink when they’re pregnant can cause permanent and serious brain damage to the unborn child.

But only now is a growing body of research revealing the scale of foetal alcohol disorders in the western world.

One man who has witnessed the consequences of alcohol induced delinquency over 20 years is Canadian barrister David Boulding.

DAVID BOULDING: Alcohol acts like nail polish remover on your nails. It dissolves brain cells. And when the brain cells are not there, the brain is missing brain function.

So you get kids who are impulsive, suggestive, no abstract thinking, memory problems, learning problems, attention problems.

ANNE BARKER: David Boulding believes one to two per cent of the population has some form of life-long disability caused even before they were born. And contrary to popular belief, he says they’re more likely to come from an affluent background.

DAVID BOULDING: Rich, white stockbrokers have wives who drink while they are pregnant.

The University of California just did a huge multi-year study and they found out that women that drink the most while they are pregnant are white, with four years of university education, earning 400 per cent above the poverty line.

ANNE BARKER: Wealthy or not, youngsters with foetal alcohol disorders, whether it’s learning problems or memory loss appear to account for a staggering proportion of delinquents.

In the only study of its kind in one Canadian province, one quarter of young offenders were found to have some form of permanent foetal alcohol syndrome.

David Boulding says there’s a clear connection to crime.

DAVID BOULDING: They really are missing that little voice. That superior, frontal lobe conscience part of the brain that knows right and wrong.

But also they are alone. They don’t have friends, they’ll do anything to please people. They will confess to murder, they’ll hold the gun, they’ll drive the get away car.

ANNE BARKER: David Boulding is in the Northern Territory this week as a guest of the Aboriginal justice agency NAAJA, which represents Indigenous offenders in court.

One NAAJA lawyer Stewart O’Connell says despite the clear impact of alcohol on crime in the NT, the prevalence of foetal alcohol syndrome is virtually unknown.

STEWART O’CONNELL: We are locking Aboriginal people up in jail at a greater rate than ever before. The sentences are getting longer, and it’s not working.

And we have to ask the question – why is it not working? And one of the reasons may be because of things such as foetal alcohol syndrome.

ANNE BARKER: And David Boulding says while nothing can ever reverse foetal alcohol disorders, a recognition of the problem would lead to more effective solutions than jail.

He says it’s already working in Canada.

DAVID BOULDING: Every probation officer, every judge, every lawyer has got stories where somebody took and interest in somebody and made sure, okay he’s not going to hang out with those guys any more, he’s not going to go there any more. I’m going to get him some kind of job maybe, even if it’s volunteer work, he’s going to have new friends.

And guess what? The crime stops.

TONY EASTLEY: Canadian barrister David Boulding talking to Anne Barker in Darwin.

Link to story: http://www.abc.net.au/cgi-bin/common/printfriendly.pl?http://www.abc.net.au/am/content/2007/s2136186.htm

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

Domestic violence

Intimate partner violence against women is prevalent and is associated with poor health outcomes.

Understanding indicators of exposure to intimate partner violence can assist health care professionals to identify and respond to abused women. This study was undertaken to determine the strength of association between selected evidence-based risk indicators and exposure to intimate partner violence.

In this cross-sectional study of 768 women aged 18-64 years who presented to 2 emergency departments in Ontario, Canada, participants answered questions about risk indicators and completed the Composite Abuse Scale to determine their exposure to intimate partner violence in the past year.

Results: Intimate partner violence was significantly associated with

• being separated,
• in a common-law relationship or
• single
• depression
• somatic symptoms
• having a male partner who was employed less than part time, or
• having a partner with an alcohol or
• drug problem

Each unit increase in the number of indicators corresponded to a four-fold increase in the risk of intimate partner violence; women with 3 or more indicators had a greater than 50% probability of a positive score on the Composite Abuse Scale.

Intimate partner violence was not associated with pregnancy status.

Specific characteristics of male partners, relationships and women’s mental health are significantly related to exposure to intimate partner violence in the past year. Identification of these indicators has implications for the clinical care of women who present to health care settings. (Source: Open Medicine

The Process of Reconnecting: Recovery from the Perspective of Addicted Women

This study examined women’s experiences with addiction to drugs and/or alcohol and their process of recovery. The techniques of in-depth interviews and participant observations were employed to elicit the perspectives of the women. The study consisted of 12 participants, 6 who were currently involved in a 90-day community-based drug and alcohol treatment program and 6 who had more than five years of recovery.

Grounded theory method guided data collection and analysis. The women in this study described experiences of connectedness and disconnectedness throughout their lives, their addiction, and their recovery. The researcher constructed a substantive theory and model to explain this process of connectedness and disconnectedness.

The findings support that making connections and establishing healthy relationships play a significant role for women in achieving sobriety and maintaining recovery.

Research; The Process of Reconnecting: Recovery from the Perspective of Addicted Women. Carolynn Masters & Dorothy S. Carlson. Journal of Addictions Nursing, Volume 17, Issue 4 December 2006 , pages 205 – 210

Postural sway among abstinent alcoholics can be improved up to a point

Excessive sway during quiet standing is a common and significant consequence of chronic alcoholism, even after prolonged sobriety, and can lead to fall-related injury and even death.

A new study of residual postural instability in alcohol-abstinent men and women shows that alcoholics improve with prolonged sobriety, but the improvement may not fully erase the problem of instability.

Results will be published in the March 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Caricatures depict acutely intoxicated individuals with a stumbling, weaving, wobbly gait,” said Edith V. Sullivan, professor in the department of psychiatry and behavioural sciences at Stanford University School of Medicine and corresponding author for the study. “With sobriety, gait and balance become stable. However, even with prolonged sobriety, people with long-term chronic alcohol dependence can have difficulty in standing upright. Their balance can be marked by sway that exceeds what most of us experience while standing still in one place, especially with feet together and hands down by one’s side, that is, without use of natural stabilizing factors.”

Sullivan said that quantifying the sway can be accomplished by using a force plate to record the sway path in fractions of an inch over fractions of seconds during quiet standing. This provides “sway path tracking” as well as measurement of body tremor, which are micro-movements often reflective of central nervous system damage that can be found both in Parkinson’s disease and alcoholism.

Researchers used a “force platform” to measure postural sway – with and without stabilizing conditions from touch, vision and stance – in 34 alcoholic men, 15 alcoholic women, 22 control men, and 29 control women. They then analyzed “biomechanical control mechanisms” that indicate skeletomuscular control over balance, which – under normal circumstances – means the muscles, joints, and skeletal structure are working synergistically, in a give-and-take manner.

“Results show the sway paths of alcoholics are longer and cover a wider area than those of controls for a given time,” said Sullivan. “However, it is important to note that the standing stability of sober alcoholics can be improved by using stabilizing factors. These factors can include simple aids like turning a light on in a dark room, touching a banister while walking down a flight of stairs, or walking or standing with feet apart rather than with ankles close together.”

Sullivan added that the disproportionately greater sway in the anterior-posterior (front-to-back) direction than the medial-lateral (side-to-side) direction that they found is associated with chronic alcoholism as well as pathology of the anterior superior vermis of the cerebellum.

“This part of the brain is often disturbed in alcoholism, and lesions there, whether or not a result of alcoholism, can cause impairment in gait and balance,” she said. “It is interesting to note that while alcoholic men and women can quell their imbalance with stabilizing factors, alcoholic women do not necessarily improve to control levels.” Until more is known about improving this deficit, Sullivan suggested that people who are at risk utilized simple strategies to stabilize balance and to avert falls.

Al-Anon offers new life

AA’s 12-Step Recovery Program

Alcohol and Anxiety

Alcohol Problems Database

Alcoholic Defence Mechanisms

Alcoholics Anonymous and Nursing

An Introduction to Medication for Alcohol Dependence

Anti-craving Drugs

Binge Drinking & Brain Damage

Brain Damage & Cirrhosis

Brief-TSF Description

Brief-TSF Learning Objectives

Characteristics of Children of Alcoholic

Controlled drinking?

Counselling and the 12 Steps of AA

Counsellor Characteristics

Craving Reduction

Depression & 12-Step Programs

Effects of Gambling Addiction

Elderly Substance Abuse

Families, Mental Health & Alcohol abuse

Female Victims of Child Abuse

Five Alcoholism Subtypes

Free Training Alcoholism Anti-craving Medications

Gender Matching Hypothesis in Alcohol Treatment

Healing through Social and Spiritual Affiliation

How Alcoholics Anonymous is changing

How do alcoholics get to AA?

Humility and Surrender

Nutritional Therapy in Alcoholic Liver Disease

Painkiller abuse

Phases of Recovery from Alcoholism

Readiness to Change Profiles

Recovery through the Twelve Steps

Research Evidence for TSF

Risky Partners and Domestic Violence

Slogans for everyday life in AA

Spiritual Assessment

Spirituality in Alcoholism Recovery

Stages of an Eating Disorder

Strategies for Dealing With Denial

Symptoms of alcoholism

The 12-Steps Promote Acceptance of Addiction

The Personality Traits of Alcoholics

Treating Alcoholism as a Chronic Disease

TSF Description

Twelve step programs

What about partners of alcoholics?

Women and the Twelve Steps of AA

World view change in Adult Children of Alcoholics

• Subscribe to Twelve Step Facilitation by e-Mail

Alcoholism Is Not Just A Mans Disease Anymore

A new examination of data on similarly aged groups, compared across decades, has found substantial increases in drinking and alcohol dependence among women.

Increases were particularly notable among white and Hispanic women beginning with those born in the United States after World War II.

Cross-sectional studies, which collect information at a single point in time, generally find that young Americans report having more lifetime alcohol problems than older Americans, despite having had less time to develop these problems.  But these studies are hampered by the fact that people of different ages may remember or report problems to different degrees.  A new examination of data, collected on similarly aged groups one decade apart, has found substantial increases in drinking and alcohol dependence among women “ particularly white and Hispanic women“ beginning with those born in the United States after World War II.

Results are published in the May issue of Alcoholism: Clinical & Experimental Research.

“By looking at two different cross-sectional surveys that asked the same questions in the same manner, but were conducted 10 years apart, we were able to compare, for example, 30 – 40 year olds in 2001 with 30 – 40 year olds in 1991, explained Richard A. Grucza, an epidemiologist at Washington University School of Medicine and the studys corresponding author.  Essentially, this allowed us to correct for the effects of age on reporting.  When we did this, we found that the tendency for young people to have higher levels of lifetime alcohol dependence clearly remained for women, although it disappeared for men.

Furthermore, added Shelly F. Greenfield, associate clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital, prevalence surveys are inclusive.  “Epidemiologic surveys document the prevalence of an illness such as alcohol dependence in the entire population rather than just one segment of the population, such as those seeking treatment,” she said.  “This allows us to track trends in illnesses – including whether certain people are more vulnerable for a particular disease, at what age they manifest symptoms, and how quickly the illness progresses.”

For this study, researchers examined two large, national surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES), conducted in 1991 and 1992; and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), conducted in 2001 and 2002.  They compared lifetime prevalence rates from the same age groups and demographics, while simultaneously controlling for age-related factors.

“We found that for women born after World War II, there are lower levels of abstaining from alcohol, and higher levels of alcohol dependence, even when looking only at women who drank,” said Grucza.  “However, we didn’t see any significant tendency for more recently born men to have lower levels of abstention, or higher levels of alcohol dependence.”  He added that these results shed more light on a “closing gender-gap in alcoholism,” showing that it is probably due to higher levels of problems among women, while men have been more or less steady in their levels of dependence.

Greenfield concurred.  “This is an excellent study that adds important information to the accumulating evidence that the gender gap between women and men in the prevalence of alcohol dependence is narrowing,” she said.  “One possible explanation is that between 1934 and 1964, the social acceptability of women’s drinking increased.  As it was more socially acceptable for women to drink, a greater number of them became drinkers.  Because women have a heightened vulnerability to the effects of alcohol – that is, greater blood alcohol levels at similar ‘doses’ of alcohol – we may therefore see a concomitant rise in alcohol dependence among those who ever drank.”

Grucza drew an analogy between women’s drinking habits and culture and immigration.  “Clearly there were many changes in the cultural environment for women born in the 40s, 50s and 60s compared to women born earlier,” he said.  “Women entered the work force, were more likely to go to college, were less hampered by gender stereotypes, and had more purchasing power.  They were freer to engage in a range of behaviors that were culturally or practically off-limits, and these behaviors probably would have included excessive drinking and alcohol problems.”

He noted that U.S. immigrants from cultures with conservative values vis-à-vis drinking tend to adhere to their own cultural norms, while their children are likely to adopt U.S. norms, which are comparatively lax regarding alcohol.

“We can think of U.S. culture as having been traditionally dominated by white men,” added Grucza.  “As women have ‘immigrated’ into this culture, they have become ‘acculturated’ with regard to alcohol use.  But Black women – who still have the lowest rates of drinking among the demographic groups we looked at – have a second barrier between them and the dominant U.S. culture, namely, their race, that may be keeping them from adopting the standards of the dominant culture with respect to alcohol use.”

Greenfield suggested that specially designed prevention programs that target female drinkers might help to lower drinking rates, and also delay the age of drinking initiation, which could help prevent later alcohol problems.  “It would also be helpful to educate women about the gender differences in metabolism of alcohol, and the associated heightened female vulnerability to alcohol’s adverse health consequences at lower doses than men,” she said.

Grucza agreed that interventions for women need further investigation.  “Whenever we see change in a disorder in the population, there is an opportunity to take a closer look at which risk factors for the disorder might be changing at the same time,” he said.  “The classic example of this would be the rise in lung cancer in the late 20th century, a time in which sales of commercially produced cigarettes also skyrocketed.  In this case, we obviously wouldn’t want to change the progress made by women over the last 50 – 60 years, but we can look at specific changes in their drinking behavior and start to speculate about what interventions might work.”

Richard A. Grucza, Kathleen K. Bucholz, John P. Rice, Laura J. Bierut. (May 2008). Secular trends in the lifetime prevalence of alcohol dependence in the United States: a re-evaluation.  Alcoholism: Clinical and Experimental Research (ACER). 32(5): 763–770.

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF ASSESSMENT
• Subscribe to Twelve Step Facilitation by e-Mail

Counseling The Alcoholic Woman by Joseph F. Perez Read more about this title…

Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative

This paper examines how women “work” the twelve steps of Alcoholics Anonymous (AA) from a gendered perspective.

Feminist critics of AA have

• challenged the language of AA’s Twelve Steps,
• the spiritual nature of the steps, and
• the male-dominated culture of the Twelve-Step program.

This paper offers insight into how women in AA approach, interpret, and utilize the Twelve Steps to recover from alcoholism.

Through survey and narrative data, findings suggests

• that women working AA’s Twelve Steps become empowered and
• change for the better in spite of the male-dominated culture and language of the Twelve Steps and
• regardless of the difficulty they may have encountered in completing these steps.

In particular, the first three steps-the “surrender steps”-

• encourage women to let go of their alcoholic obsession and
• begin a spiritual path of recovery.

Steps Four through Nine require

• women to “clean house” and
• get rid of old self-destructive ways so that they may develop a new and stronger sense of self.

Finally, on completing Steps Ten through Twelve, women

• experience a spiritual awakening and
• then, in turn, “pass on” what they have learned from the Twelve Steps to other women in the program.

Woven throughout these women’s experiences is

• an acknowledgment of gender and
• the role it plays in how they work the Twelve Steps.

In the end, these women express a sense of personal empowerment that is particular to a gender-specific orientation to the Twelve Steps of AA.

Research; Jolene M. Sanders, Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative. Alcoholism Treatment Quarterly, Volume: 24 Issue: 3, 2006.

New Findings on Asian Alcohol-Protection Gene

Only certain East Asian populations have a high prevalence of a gene that protects against alcohol over-consumption, and researchers speculate that some event must have occurred over the past few thousand years to make this genetic protection advantageous, Reuters reported.

Yale University researchers said that unknown environmental factors are the likely cause for the prevalence of the ADH1B*47His gene variant among some Asian populations, but not others. The gene causes rapid metabolism of alcohol into acetaldehyde, a chemical that produces hangovers, flushing, nausea and other unpleasant symptoms that make even moderate drinking a poor experience.

Researchers found that the gene variant was very prevalent in East Asia, fairly common in West Asia and North Africa, and rare in other parts of the world. In Asia, the gene was most common among speakers of the Hmong and Altaic languages. Within these groups, environmental factors apparently made survival more likely among individuals with the gene than those who lacked the variant.

However, researchers doubt that protection against alcoholism was the key to survival, noting that consumption of highly concentrated forms of alcohol is a relatively recent phenomenon. One possibility is that the gene protected these populations from toxins in their traditional foods that was not present in the diets of other populations.

The study was published in the journal PLoS One.

See also;

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

Counseling the Culturally Diverse: Theory and Practice by Derald Wing Sue, David Sue Read more about this title…

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

Abstract (provisional)

Background Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs.

In few cases do we know the full picture of how abstinence is achieved in Taiwan.

We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results.

This research explores the process of recovery from the viewpoint of the alcohol-dependent.

Methods Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004.

The data were analyzed using content analysis.

Participants were 32 adults (men and women) , purposefully selected from Alcoholics Anonymous group and a psychiatric hospital in North Taiwan.

Results We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery.

We have identified three stages of change in the struggle against alcoholism:

1. the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing;
2. the Turning Point, in which a Personal Nadir is reached, and
3. the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups.

We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle.

Conclusion This study provides important points of reference for alcohol and drug service workers and community healthcare professionals, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence Mei-Yu Yeh, Hui-Lian Che and Shu-Mei Wu BMC Psychiatry 2009, 9:76doi:10.1186/1471-244X-9-76.

Click file below to download full report.