Lesson 7: Drunkards, Alcoholics, and Problem Drinkers Attention
Part four in the greatest drunks series, highlighting the great W.C. Fields, no stranger to a stiff drink on and off camera. This red-nosed comedic genius was a master juggler, expert at billiards, and a seasoned drinker - he said he never drank water, and he never met a booze he didn't like! Fields died in 1946, from an alcohol-related stomach hemorrhage. Click HERE to view this directly on YouTube Learning Outcomes Upon completion of this lesson's material, students will be able
Teaching Read Chapter 9 in Nutt and Nestor Alcohol as the product of fermentation of grain and grapes was probably discovered accidentally and then done intentionally. In ancient times there were few ways of preserving food and fermentation to an alcoholic beverage was one. Also, probably unbeknownst to ancient peoples, the fermented beverage did not support bacteria and therefore was safe to drink. Human alcohol use can be traced at least as far back as the Stone Age (10,000BCE) History of alcoholic beverages Biblical Times The Bible mentions drunkenness and counsels moderation. In the Pentateuch, one of the blessings of the Promised Land (Israel) is wine (Deuteronomy 7.12,13). But the book of Proverbs counsels that strong drink is for the desperate and leads to life problems It is not for kings, O Lemuel, Proverbs 31:4-7New King James Version (NKJV) Jesus is seen as sharing wine with his disciples and may even have been accused of being a drunkard because he drank which apparently didn't match the stereotype for holy men (Luke 7.33,34). The overall judgment though seems to be that excessive drinking is a sin because it leads to out-of-control behavior. American History Heavy drinking was a fact of life in late 18th Century America. In 1790, United States government figures showed that annual per-capita alcohol consumption for everybody over fifteen amounted to thirty-four gallons of beer and cider, five gallons of distilled spirits, and one gallon of wine. However, in the late 19th and early 20th Centuries Progressives sought to improve the health and moral character of the country and eventually attained an Amendment to the Constitution banning alcohol. This was poorly enforced and widely ignored and was eventually repealed in 1933. U.S. alcohol consumption through the years since repeal National Institute on Alcohol Abuse and Alcoholism International Alcohol consumption differs from nation to nation. Some countries drink regularly with meals (France, Italy) and even children drink, but they don't seem to have high AUD rates perhaps because they have learned how to drink moderately and frown on drunkenness. Other countries see binge drinking as a social grace (Russia, Ireland). In the U.S., drinking is routinely portrayed as part of the good life and only occasionally portrayed as causing problems. Religion Islam and various sects within other religions require complete abstinence. Women are more susceptible to the effects of alcohol because they have more adipose tissue than men and consequently get alcohol into the bloodstream more quickly because fat cells do not absorb alcohol (in men some alcohol is stored in muscle tissue before entering the bloodstream). Also women may lack alcohol dehydrogenase in the gut and consequently get more alcohol into the bloodstream. It has been observed that with heavy drinking, AUD may progress more quickly for women than for men. Benefits of Alcohol Use Recent confusing research about health benefits of wine and beer. It is confusing because for the most part it follows a post hoc experimental design (where people are asked about their alcohol use and then compared on conditions such as heart disease) which does not allow inferences as to cause. It is also confusing because different studies come up with different results. The only thing we can say confidently about "healthy" drinking is "DON'T" Summy of Research on Healthy Drinking When Alcohol Consumption becomes Physically Risky Alcohol works on the GABA/Glutamate relaxation/arousal mechanism of the body initially resulting in sedation but when it wears off causing hyperarousal (hangover, withdrawal). It is the classic case of first drinking to feel good and then drinking not to feel bad. With continuous heavy drinking anyone can develop tolerance and withdrawal but it may only be people who have the right (or wrong) genes who progress in severity. It does seem though that with any substance, only a minority of users wind up with problems. Here is some information on genetics and SUDs Harm Reduction Harm reduction approaches have largely been associated with researchers such as Stanton Peele who see heavy drinking as learned behavior and suggest that new temperate habits can be learned. Adherents of the medical model generally counsel abstinence. But this is one of those arguments (like nature vs nurture) that is unnecessary and the better answer is "both" harm reduction and abstinence depending on the person we are helping. If they can drink temperately we can work with them on that and if they can't, we will make progress towards learning that abstinence is the answer. One risk of an harm reduction approach is that really bad things (like an OUI) may happen while we are trying it. One risk of an abstinence only approach is that the client may get discouraged and give up completely. Treatment Options In Patient Detox where there is tolerance and signs of withdrawal. Alcohol like benzodiazepines and barbiturates can have a life-threatening withdrawal syndrome including grand mal seizures. All heavy drinkers should be referred for medical evaluation prior to attempting alcohol cessation. With medication (such as Librium) alcohol dependent people can be safely detoxed. Outpatient Outpatient (weekly or more frequently for 8 to 12 weeks) and Intensive Outpatient (usualy 4 hours/day 4 days a week for 4 weeks) including individual, group and family treatment are what most insurances cover. These include cognitive behavioral therapy and relapse prevention. The focus is learning how to live without the substance. MHRT/Cs can work with recovering clients to reinforce what they are learning in treatment (for example how to cope with stress without drinking, how to deal with cravings by staying away from situations that provoke them, etc.) Medications
Protocol #43 Medication Assisted Treatment from the Substance Abuse and Mental Health Services Assessment Lesson 7 Quiz
Lesson 7 Discussion Describe your own spirituality and what choices it leads you to make about use of substances. Reflect on what you have just written and list at least one potential problem with your approach. Remember, you mist post TWICE in EVERY discussion board. Your first post should address the topic of the discussion (like the one above) and your second post must be a reply to ANOTHER students' post...your reply should be MORE than just a "I agree!" or "Very cool!" It should be "substantive" by expanding on the students post, asking a questions, adding your own thoughts to what they have said, etc.
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