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Alcoholism in Adolescence
Significance of the health issue of alcoholism
Everything is good in moderation, and, indeed, studies show that low-levels of alcohol consumption (such as 1-2 drinks per day (Sellman et al., 2009) may prove beneficial to drinkers. Chronic alcohol abuse (i.e. consistent and persistent consumption of alcohol) has an undoubted negative long-term impact. It is ironic that whilst low drinking can consequent in decreased risks of osteoporosis, cardiovascular condition, stroke, rheumatoid arthritis, and diabetes, high levels of alcoholism aggravate and bring on the onset of these conditions, oftentimes also resulting in mortality.
High levels of alcoholism show significant positive association to conditions that include the following: cancer, alcoholic liver disease, malabsorption, chronic pancreatic, and cardiovascular disease aside from long-term damage to both the central nervous system and the peripheral nervous system (Caan & Belleroche, 2002). Risks extend to vulnerability to injuries, fetal damage, hypertension, coronary heart disease, ischemic stroke, liver disease, and certain forms of cancer such as cancer of the digestive system, ovaries, breast, and liver. Most notoriously, alcoholism shrivels the liver called in medical terms, cirrhosis (Cargiulo, 2007). And these are the physical risks alone. Psychiatric disorders that are linked to alcoholism include brain damage, neurological deficits (e.g. impairments of balance, memory, executive functions, gait, emotions, reasoning, judgment and decision making and so forth), suicide, personality disorders, schizophrenia, manic disorder, phobia, hypomania, dysthymia, mania, and depression (ibid.).
The above range of mental and physical conditions that result from alcoholism are just a few of the negative results. Their addiction to alcoholism has been consistently and reliably documented as a result of long-term, consistent studies on wide samples of people. Research has been both quantitative and qualitative consisting of both longitudinal and cross-sectional investigation and of both genders as well as a diversity of ethnicities and ages. Of all populations, adolescents seem to be the most vulnerable.
Significance of health issue to adolescents
Even though chronic alcoholism has a negative impact on all drinkers, adolescents are particularly vulnerable to its ravages due to their developing brain.
Unfortunately, alcohol is the drug of choice of adolescents and even if taken moderately initially, chronic abuse can soon become a habit. The Adolescent Substance Abuse Knowledge Base (ASAKB) uses its investigations to assume that America has as much as four million alcoholics under age 18. This is three years below the legal age for drinking:
Many children are already experimenting with alcohol in the fifth grade… According to the Centers for Disease Control, 40% of ninth-graders report that they tried alcohol before the age of 13 and had used alcohol within the past month (http://www.adolescent-substance-abuse.com/myths-alcohol.html).
Unfortunately, drinking started at this young age, has a greater impact on cognitive faculties than obsessive drinking when adult, besides which the early habit of drinking is far more likely to develop into entrenched addiction later on. .
Study after study shows the impact that peer pressure can have in influencing adolescents to drink. And teens are particularly vulnerable to peer pressure.
Consistent research also indicates that college students who have drunk little or negligible alcohol before college are intimidated in doing so in college, often exceeding their non-college colleagues in the amount and consistency of their drinking (e.g. O'Malley & Johnston, 2002).
Alcohol advertising is another medium that often induces adolescents to drink particularly with images indicating alcohol to be cool, hip and prestigious.
One asset of this particular population
The asset of this population is that they may find it easier to adopt positive habits and to retrench negative habits than that of an older age. Adolescents, when motivated, have a zest and energy unequalled by younger and older ages with the consequent possibility of achieving the seemingly impossible.
In fact, in the late 1990s one group of researchers decided to deliberately adopt this approach to dealing with problems of addiction in adolescents (Philantrho Media). Instead of seeing them as problematic and particularly immune to trouble, the researchers decided to view adolescents, instead, as a population that had to be nurtured, managed, and leveraged, particularly since they were on the cusp of a promising future. Seeing them as talented and with the ability to break habits that few others possessed helped adolescents perceive their age as an asset to overcoming their addiction. Seeing themselves as the leaders of the future provided them with the confidence and ability to reverse their addiction. Helpers, using this asset, can help them too.
One challenge of this particular population
The challenge, however is that adolescents are particularly vulnerable to peer pressure and peer pressure is a hefty impulse in causing them to drink. We see this from the significant positive association of college with drinking, peer pressure often indicated to be the cause.
For example, in Wood et al.'s (2000) study of college students (n-399) that were heavy drinkers, structural equation modelling indicated that active social influence greatly instigated alcohol use and alcoholism. The researchers concluded that their study provided strong evidence that college drinking is associated with social factors. Likewise, Capone et al. (2007) had also demonstrated that Greek sororities seem to encourage higher levels of alcohol use particularly amongst males, although many of these students who joined the fraternities were already heavy drinkers prior to matriculation. The authors had solicited self-reports from 338 undergraduates prior to their enrollment and, again, in their freshmen and sophomore years. Latent growth curve modeling showed that the effects of gender, membership in sororities, and drinking tendencies during the first 2 years of college were facilitated by socialization or by processes of reciprocal influence. Apparantly, socialization has a tremendous impact on drinking.
In 2002, O'Malley and Johnston analyzed five different sources of data related to drinking amongst college students and noted that alcohol use persists in being very high amongst college students. In fact, college students who have drunk little or negligible alcohol before college go on to exceed their non-college colleagues in the amount and consistency of their drinking induced, the researchers noted, due to peer pressure.
The evidence, in short, seems to be clear-cut and consistent that an association exists between social influence and college drinking. The greater the peer pressure to drink (reinforced by partying, sororities, membership in associations and so forth), the more likely it is that certain students will indulge in alcoholism and adolescents are particularly prone to social influence.
General approach take to this and rationale for choice.
I will take a disease management approach to this issue drawing on intervention that has proved to be most effective with impeding and encouraging adolescents to break the habit of alcoholism.
Daley (1993) suggests that an effective counseling program for addiction consists of the following:
1. Achieving and retaining cessation of drugs. For challenging clients, aiming to reduce the existent level of their drug usage.
2. Stabilizing acute symptoms
3. Working with client on interpersonal and interpersonal problems so that client would not need to rely on drugs for relief.
4. Monitoring and attempting to control relapse in its initial stages.
Any intervention program should be constructed around those 4 principles.
As to the models used -- for all counseling has to involve one or more specific models - in a meta-analysis on psychotherapeutic interventions most effective for adolescents, Williams et al. (2000) found that the most effective interventions consisted of a community reinforcement approach, behavioral contracting, social skills training, and motivational enhancement. Family therapy appears to be particularly helpful, as well as the counseling-client relationship.
The counselor's qualities should consist of the following: empathy, non-judgmentalness, excellent interpersonal skills, and a certain level of intelligence. This is where understanding and respect of a person's particular culture is important, and although it usually is the case that clients are best matched up to counselors from similar cultures, the counselor's dynamic may be a more important characteristic in promoting a positive effect (Williams, Chang, & ACARGA, 2000). This positive effect is all the more important in addiction that is often linked to emotional sources.
Addiction-involved counseling typically goes through the four phases of (i) Engagement and Stabilization (where drug-stabilization occurs and patients are induced to continue their counseling sessions); (ii) Early recovery: (where client acquires skills that include coping with cravings; coping with drug-related environmental factors; recognizing and dealing with psychiatric symptoms; identifying problems to work on in recovery, and brainstorming goals for a healthy life); (iii) Middle Recovery: (A continuation of the last stage, client learns to deal with irrational emotions and beliefs as well as acquiring social communication techniques, and developing a social support system); and (iv) Late recovery or the maintenance phase (or recovery): A review of the previous phases as well as counselor addressing external topics that may emerge ( (Sales, 2006).
Occassioanlly, addiction counseling works best in a family therapy format where the entire family is involved, but in all cases social support is a necessary perequisite, particularly since as Kohut long ago obsaerved: "the addict & #8230; craves the drug because the drug seems to him to be capable of curing the…[continue]
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