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After reading this essay you will learn about Alcoholism:- 1. Meaning of Alcoholism 2. Classification of Alcoholism 3. Consequence 4. Causes 5. Current Methods to Treatment Alcoholism 6. Psychosocial Measures.
Contents:
- Meaning of Alcoholism
- Classification of Alcoholism
- Consequence of Alcoholism
- Causes of Alcoholism
- Current Methods to Treatment Alcoholism
- Psychosocial Measures of Alcoholism
Essay # 1. Meaning of Alcoholism:
The problem of alcoholism has posed a serious threat to modern civilization for the very fact that around the world and particularly in the west very swiftly teenagers are turning alcoholics. It is stated that out of every 20 persons in the U.S.A., at least one is an alcoholic.
In India, a study sponsored by the Dep’t of Social Welfare, Govt., of India, in 6 states, Bombay, Delhi, Hyderabad, Madras, Varanasi and Jaipur on a sample of 35,000 showed that the most commonly abused drugs were alcohol, tobacco and pain killers.
In the revised edition of DSM III-R there is no specific diagnostic category called “Alcoholism”. Alcoholism is classified under the general term of “Psychoactive substance use disorder” and the specific syndrome that relate to alcoholism.
Alcohol is the major Psychotic drug used worldwide. Only in the U.S. there are estimated more than 13 million people who are diagnosed as alcoholics. DSM III-R reports that according to the community study approximately 13 per cent of the adults had alcohol abuse or dependence at some point of their life.
Following heart disease and cancer alcoholism is the third largest health problem in the U.S. today. As estimated by DSM III-R about 35 per cent of the American adults abstain, 55 per cent drink less than three alcoholic drinks a week and only 11 per cent drink an average of one ounce or more alcohol a day.
Drinking pattern also vary with age and sex. It is thus obvious that a small percentage of the population consume 20% of the total and 30% of the drinkers consume 80 per cent and 10 per cent of the drinkers consume 50 per cent.
Alcoholism is linked with many social evils including automobile and train accidents, murder, rape, physical assault, molestation, industrial accidents and also homicide and suicide. It disrupts social and familial life.
Cancer and heart diseases occur due to heavy drinking. It is also responsible for lowered efficiency and absenteeism among industrial workers. It is considered as the third major cause of death in U.S.A. The average life span of an alcoholic is 12 years less than of a normal person.
The W.H.O. (1969) has defined alcoholics as excessive drinkers whose dependence on alcohol has attained such a degree that they show noticeable mental disturbance or an interference with their mental and bodily health, their interpersonal relations and their smooth social and economic functioning, or who show the prodromal (beginning) signs of such developments.
Alcohol is a depressant drug which affects the central nervous system immediately. It no doubt produces some stimulation and reduces tension and brings relaxation. But when larger amounts are consumed, sensory motor coordination, balance, vision, speech, thought processes and perceptions are affected.
Essay # 2. Classification of Alcoholism:
i. The Alpha Alcoholics:
It is the beginning stage. The alpha alcoholic depends upon alcohol to reduce or relieve emotional tension or physical pain. It does not lose control after the use of the drug. But when he finds that use of alcohol is more important than communicating with others, his interpersonal relationship deteriorates.
ii. The Beta Alcoholics:
In addition to interpersonal difficulties physical problems arise by the excessive use of alcohol like cirrhosis of liver and ulcers, heart troubles. But in this type there is no physical or psychological dependence.
iii. The Gamma Alcoholics:
The gamma drinkers lose control of their drinking and exhibit significant signs of physical, psychological and social deterioration. The physiological dependence in the gamma drinkers is such that when they stop drinking physiological withdrawal symptoms are found.
iv. The Delta Alcoholics:
The delta alcoholic is the most severe type among the four. The drinkers drink right from the morning continuously without any break and cannot abstain from drinking for any period of time. He neglects his food and becomes weak. He is never found to be sober. When the drinking is cleared, it leads to severe physiological withdrawal symptoms.
Essay # 3. Consequences of Alcoholism:
A Japanese proverb says “First the man takes the drink, then the drink takes the man.” The physiological, social, psychological familial and occupational disturbances arise due to the adverse consequences of alcoholism.
Physiological damages include damage of the liver, endocrine glands, heart failure and hypertension etc. The physical effects are so adverse that according to Talbolt (1974) withdrawal from alcohol may lead to death in certain cases. It is also psychologically unpleasant. Hallucinations occur.
There is physical pain. Vision and speech are affected. The nervous system may not automatically continue functioning, breathing may stop and convulsions may occur. When this stage is somehow passed, the person gets back his normal life to some extent and many of the symptoms may disappear. But alcoholic toxicity is still present and needs medical care.
Delirium tremens are the most important psychological symptoms associated with withdrawal of alcohol. These tremens occur in people who are over 30 years age and drinking consistently at-least for 4 years. It is caused by a suaden drop in the intake of alcohol. The symptoms of delirium tremens are restlessness, sleeplessness, night mares, hallucinations, and delusions of terrifying nature.
After the delirium Korsakeff’s psychoses may also occur; with the symptoms of amnesia, disorientation in time and place, distortion of memory or pseudo memory. Due to pseudo memory, the person talks about things that never happened to him and this occurs in women alcoholics more frequently.
Alcohol being a central nervous system depressant like the other anaesthetics, when 0.05 per cent alcohol is found in the blood, thought, judgment and restraints are loosened and sometimes disrupted. Voluntary motor actions by and large become visibly clumsy at a concentration of 0.10 per cent.
When the level of alcohol in blood reaches 0.20 per cent, the function of the entire motor area of the brain is significantly depressed and the parts of the brain controlling emotional behaviour is likely to be affected. At 30 per cent a person is usually confused and may become stuporaous.
At 40 to 50 per cent the alcoholic is in coma and at more higher levels, centres of the brain controlling breaching and rate of heart beat are affected leading to possibility of death. Alcohol also decreases REM sleep and causes insomnia.
Alcoholic paramecia also may occur in some who are predisposed to faulty adjustment and suspicion. Abuse of alcohol may also lead to all sorts of maladaptive characters like jealousy, hatred, fault finding and the adjustive capacity of the person becomes weak day by day.
Essay # 4. Causes of Alcoholism:
It is said that alcohol tends to induce a pleasant feeling tone, brings relaxation, reduces tension and provides physical and mental stimulation to work. Pointing out the physiological effects of wine, a Roman poet wrote, “It discloses secrets, ratifies and confirms our hopes, thrusts the coward forth the battle, ceases the anxious mind from its burden and instructs in arts.”
However, the alcoholic has strong craving for alcohol and this makes him unfit for any job in the sense that his attention is centred around alcohol only.
Why a person becomes alcoholic while others not?
It has several causes.
i. Biological Factors:
Some believe that alcoholism or the tendency for alcohol may be inherited. Findings of the studies by Erickson (1968), Rodgers (1966) and Schlesinger (1966) show certain evidences of the presence of certain genetic components in the occurrence of alcoholism.
Winokur (1970) found that alcoholism does tend to run in families. In a study of 259 hospitalized alcoholics he found that more than 40 per cent had a parent who was an alcoholic. Goodwin (1973, 1974) on the basis of their findings viewed that “it was being born to an alcoholic biologic parent rather than being raised by one that increases the risk of the son becoming an alcoholic.”
It is said that children of alcoholics become alcoholics about 4 times more often than children of non-alcoholics even when they are not brought up by their own parents. In a 30 year longitudinal Swedish study of adopted male children who subsequently become alcoholics, it was found that about 25 per cent had biological fathers who were also alcoholics.
Another Swedish study revealed that monozygotic twins had about twice the coincidence rate of alcoholism as dizygotic twins of the same sex. Studies also indicate a higher craving for alcoholism among dizygotic twins than among non-twin siblings.
Irwin (1968) reported that more than 50 per cent of the alcoholics had an alcoholic parent. On the other hand, Roe, Burks and Mittleman’s (1945)’s findings doubt the genetic hypotheses. Studies of Rose, Burks have supported the above study.
There are majority of cases where children of alcoholic parents do not become alcoholics. Thus Coleman (1981) says, “whether the familial incidence results from shared genes or a shared alcoholic environment is a matter of some controversy.”
The exact role of genetic factors in the causation of alcoholism is therefore not known. It is viewed that constitutional predisposition to alcoholism can be acquired as well as inherited. However, the genetic factors may play their role in predisposing causes.
ii. Psychological and Personality Factors:
Besides the physiological dependence alcohol also produces a strong psychological dependency as well because of the following factors:
(a) Psychological vulnerability:
It refers to a type of personality which makes one vulnerable or predisposed to alcohol under conditions of stress. Instead of using some other defence to adjust with or overcome the stress, these people turn to alcohol.
Personality studies of alcoholics show that they are emotionally immature, they need a lot of praise, appreciation and attention from others and they are very much hurt and disturbed by failures and frustrations.
They feel very in-secured and inferior and have low frustration tolerance. Winokur (1970), Pralt (1972) and Mcclelland (1972) have stated that many young men take to heavy drinking to prove their masculinity and to achieve feelings of adequacy and competency.
According to the findings of James (1968, 1971), Wood uff (1973), antisocial personality and depression may also have some links with heavy drinking.
In-spite of these findings it is not yet established which specific characters are responsible in the development of alcoholism. Nobody can deny that there are also many persons with identical personality characteristics and yet they have not become alcoholics.
However, the role of personality maladjustment in the causation of alcoholism cannot be denied. Since excessive drinking impairs the total life adjustment of an individual, the question arises as to what needs alcohol fulfils that the individual so much depends upon it?
According to the psychological theories alcohol takes the person away from the burdens, responsibilities, heart aches, sorrows and distresses, worries and anxieties of modern life. Alcohol is a vehicle to escape from conflicts, business worries and inferiority complexes.
It gives courage to the coward, confidence to the timid, pleasure to the unhappy and success to failure that is what those who take alcoholics say. In brief, alcohol permits a flight from the disappointments and frustrations of reality. These explanations nevertheless speak only a part of the story.
(b) Stress, tension reduction and reinforcement:
Innumerable observations of the personal lives of alcoholics and quite a number of investigations point out that an alcoholic is dissatisfied with life and has very less frustration and stress tolerance capacity. They probably take it to be away from reality, a reality without hope and meaning for them.
This view has been particularly put forth by the American Medical Association Committee on Alcoholism and Drug Dependency (1969). According to Schafer, alcoholism is a conditioned response to anxiety. When the person finds that each time he takes alcohol it reduces his anxiety, stress and gives him relaxation, he is further reinforced to take it more and more until he becomes alcoholic.
Other experts on the subject reject this view and opine that alcoholism is only a learned maladaptive response which is reinforced and maintained by tension reduction.
Bandura (1969) stated that delayed consequences are very harmful and destructive for the person; yet people are more influenced and controlled by the immediate effect. The immediate reinforcement encourages them to take to drinking more and more.
(c) Marital crisis and other familial problems:
Marital problems pose many crisis for the individual. It not only hurts him, but brings in self devaluation. Divorce, separation, untimely death of children or spouse add to the extra marital relationship of one of the partners, constant quarrel and conflict between husband and wife, poverty and disease may lead to habitual drinking.
Alcohol problems are also correlated with a history of school difficulty, High School dropouts and persons with records of antisocial activity and delinquency appear to be at particularly high risk for alcoholism. Cirhosis data suggest that persons in certain occupation are more likely to develop alcoholism.
Alcoholism is estimated to be associated with at-least 50 per cent of traffic accidents, 50 per cent homicides, 25 per cent of suicides and large number of deaths in a year from alcoholic related diseases.
Persons with a harsh superego turn to alcohol as a means of reducing their unconscious stress. Some alcoholics are fixated at the oral stage of development and relieve frustration by taking substances in mouth. The alcoholic personality is described as shy, isolated, impatient, irritable, anxious, hypersensitive and sexually repressed.
iii. Sociocultural Factors:
The role of sociocultural factors in alcoholism and alcohol abuse has been emphasised by many investigators, particularly in certain societies and cultures, drinking has been considered as a social act. This sociocultural trend encourages many to drink in clubs, parties and in many other social get together.
According to Pliner and Capped (1974) liquor has come to play an almost ritualistic role in prompting gaiety and pleasant social interaction. Different cultures pose different degree of stress for the person. Horton (1943) noted that greater the insecurity level and stress in a culture, greater is the need for taking alcohol to the level of becoming an alcoholic.
Bales (1946) in a quite useful study pointed out 3 cultural factors that play a part in determining the incidence of alcoholism in a given society:
(a) The degree of stress and inner tension produced by that culture.
(b) The attitude towards drinking fostered by that culture.
(c) The degree to which the culture provides the substitute means of satisfaction and other ways of copying with tension and anxiety. To add to this, the effects of rapid social change and social disintegration in a particular culture, with which people are not able to cope, lead to further stress and anxiety.
Eskimos for instance, in many places of rural Alaska, (Time, 1974) are taking to heavy drinking mainly due to the rapid social change in their traditional values and way of life.
In comparison to other countries of the world, alcoholism is said to be a major problem in the United States and Soviet Union. An overall analysis of the various explanations of alcoholism reveals that it is not caused by a single factor. It is an outcome of multiple variables influencing simultaneously. Many more factors of alcoholism are still unknown and future research can only highlight these factors.
Treatment:
Alcoholism is a highly complex disorder involving multifarious causes. Thus, the appropriate approach to the treatment of alcoholism seems to be multidisciplinary. Alcoholism requires flexibility and individualisation of treatment procedures. Hospitalisation and institutionalisation of alcoholics are being treated in community clinics.
When the impairment because of alcoholism becomes severe the patient needs constant care. The risk is 35 per cent of alcoholic pregnant woman having a defective child. Excessive consumption of alcohol also causes her more imbalances leading to the risk of abnormalities.
Treatment can be most successful in patients who voluntarily come to a psychiatrist for treatment because they feel that they need help to give up alcoholism. This conscious feeling that alcohol is undesirable for them is to be aroused by someone since this realisation has a tremendous impact.
Physical punishment is an old type of treatment which does not work. In many plants, however, alcoholic employees are threatened by employers with immediate discharge from job which leads to permanent cure in some cases. Vigilance during the first week of the month may also reduce alcoholism to some extent.
Essay # 5. Current Methods to Treatment Alcoholism:
i. Biological Measure:
Medical measures in detoxification include, elimination of the harmful alcoholic substances from the individuals body, treatment of withdrawal symptoms. A drug called chlordiazepoxide has helped a lot in the treatment of withdrawal symptoms like motor excitement, nausea, vomiting, delirium, tremors and convulsions.
It also alleviates tension and anxiety. After detoxification psychological measures like family counselling, employment facilities including other social readjustments are provided.
ii. Aversion Therapy:
The patient is given to drink at regular intervals mixed with emetic drugs; which have extremely uncomfortable effects. Antabuse may also be administered to prevent the return of drinking immediately. It is presumed that since each such drink makes him ill, he will become sufficiently conditioned to stop taking to alcohol.
By means of electric shock aversive conditioning, technique can be applied with success. But unless his emotional problems are solved he may again take to drinking in-spite of the uncomfortable feeling it provides and he will again continue to drink.
Davidson (1974) has viewed on the basis of extensive comparison of available studies that despite a number of positive results there was insufficient data to assess the long range effectiveness of aversion therapy on alcoholism.
iii. Brain Surgery:
Fritz, Roder and his associates (1974) from Gottingen University in Germany have opined “our research have revealed that dependence on drugs or alcohol assumes that proportions of a natural urge after a certain period and the sexual drive or urge to eat, is controlled by a certain brain centre. Neutralizing this centre which is more than 50 cubic millimetre in volume, will cure the patient for all time.”
However, to use brain surgery for the treatment of alcoholism is a controversial matter in view of its dangerous procedure.
It involves:
(a) Group therapy,
(b) Socio-therapy,
(c) Alcoholics Anonymous.
i. Group Therapy:
The alcoholic must realise that he has a problem which needs his cooperation for its solution. This very recognition of the problem and its undesirable devastating consequences will have the way to therapy. After this through group discussion in the midst of family members and through family therapy treatment may proceed. Here each family member is given a responsibility for cooperating in treatment.
Behaviour therapy:
Through behaviour therapy the alcoholic is taught other ways and methods to reduce anxiety. By the help of relaxation training, assertiveness training, self controlled skills and new strategies to master the environment, efforts are made to reduce anxiety and tension of the alcoholic.
A number of operant conditioning techniques are also used which condition alcoholics to modify their drinking behaviour or abstain from drinking completely. The reinforces in these techniques used are monitory reward, an opportunity to live in an enriched, in-patient environment and access to pleasurable social interaction.
ii. Socio Therapy:
The therapist helps the patient to work out a solution that will give him the satisfaction he is lacking. His aversive life situations are to be alleviated. The therapist must help the patient to reopen the happy chapter of his family life once more having a congenial and cordial relationship with family members, relations and friends.
He should be helped to develop effective methods of adjustment. He should not be allowed in any way to live in high risk environments.
Thus, the aim of socio-therapy is to deal adequately with the hostility, negative attitude of the family, friends and society towards the alcoholic. Keeping this in mind currently community reinforcement approach has developed the main aim of which is to help the problem drinkers to achieve more satisfactory adjustment in personal, professional and social life.
iii. Alcoholics Anonymous:
It is a practical approach to the treatment of alcoholism which has been quite effective. It is mostly a psychotherapeutic programme in which person to person and group relationships are encouraged, spiritual development is the central point of its approach to treatment.
Discussions on the problem are made. It provides for its members an atmosphere of mutual understanding, acceptance and sympathetic fellow feeling. The alcoholics are encouraged to solve their problems without the feelings of isolation and shame.
The alcoholics anonymous technique lifts the burden of personal responsibility from the alcoholic by helping him to realise that “alcoholism like many other problems is bigger than he.
” Regarding the effectiveness of Alcoholic Anonymous Coleman (1981) states “By mutual help and reassurance through participation in a group composed of others, who have shared similar experiences, many an alcoholic acquires insight into his problems, new sense of purpose, greater ego strength and more effective coping techniques.”
Among patients who really want to be cured and whose drinking has been of recent origin, this approach to alcoholism has met with considerable success. Not only treatment, prevention of alcoholism is particularly important in India, keeping in view the widespread misery, wastage, illness and loss of life it causes.
Social consciousness through propaganda campaigns, posters, audio visual aids and education is aroused among people regarding the adverse effects of alcohol. The rural illiterate masses and the weaker sections of the society who have particularly become victims to alcohol should be given special attention.