Cases reported "Alcoholism"

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1/28. Network therapy for addiction: bringing family and peer support into office practice.

    Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the internet in dissemination.
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2/28. Jesus, peyote, and the holy people: alcohol abuse and the ethos of power in Navajo healing.

    Of the three religious healing traditions that coexist within the contemporary Navajo health care system, the Native American Church (NAC) and Pentecostal christianity are more actively involved in the treatment of alcohol and substance abuse than is Traditional Navajo healing. This article examines these two more recent healing traditions as religious responses to the contemporary Navajo crisis of alcohol and substance abuse as well as to socioeconomic changes. These traditions offer new kinds of power, social networks, and personal meaning that facilitate a transformation of self, a revitalized sense of community, and a new vision of the possibilities of the future for Navajo people who suffer. Examining the ethos of power that underlies Navajo healing can complement the theoretical emphasis on harmony and beauty in anthropological research on Navajo culture and religion.
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3/28. Multiple self-damaging behaviour among alcoholic women. A prevalence study.

    Among patients being treated for specific behaviour-control problems, there exists an important subgroup of 'multi-impulsive' patients whose treatment might be facilitated if the full range of their problems were recognised and dealt with as one general issue of impulse control. In women in particular, loss of control of eating may be prevalent and easily concealed from staff, and may thwart treatment. This survey of 50 women attending an alcoholic-treatment unit explored the prevalence of behavioural-control problems other than those of alcohol. Three-quarters of the women also had other behavioural problems. Over half the sample had thought of taking an overdose and just under half had actually taken one; about a quarter had cut themselves deliberately; half described impulsive physical violence; half acknowledged a period of 'promiscuity'; and at least 16% had had a clinically diagnosable eating disorder. More research is needed but we believe that all self-damaging behaviour should be addressed simultaneously to prevent 'revolving door' relapses as emotional distress is transferred from one behaviour to another.
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4/28. All in the family: resources and referrals for alcoholism.

    PURPOSE: To emphasize the family as the unit of treatment when one member has alcoholism, discuss the impact of alcoholism on families, and identify resources and referrals available for primary care nurse practitioners (NPs) to assist the patient and family in improving recovery outcomes and family function. DATA SOURCES: Extensive review of current research, literature, and internet-based resources, supplemented and illustrated with a case study. CONCLUSIONS: Alcohol dependency flourishes within the social context of the family system and is one of the leading causes of family dysfunction. Understanding the impact that alcoholism has on the family system and being familiar with resources and referrals are critical facets of the overall management of treatment for the patient and family. IMPLICATIONS FOR PRACTICE: patients often seek health care in a primary care clinic for treatment of medical problems related to alcohol use or abuse, and the primary care NP is frequently the initial point of contact. It is imperative that the family be recognized as the unit of treatment and be included in the treatment plan. As the first line of defense, primary care NPs play a critical role in making appropriate referrals for management of family alcoholism. Helping families make changes leads to improved functioning and recovery outcomes for patients with alcoholism as well as to improved family function.
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5/28. Increased deep sleep in a medication-free, detoxified female offender with schizophrenia, alcoholism and a history of attempted homicide: case report.

    BACKGROUND: Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Both schizophrenia and alcoholism are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep, the physiologically significant, refreshing part of the sleep. Antisocial behaviour with severe aggression, on the contrary, has been reported to associate with increased deep sleep reflecting either specific brain pathology or a delay in the normal development of sleep patterns. The authors are not aware of previous sleep studies in patients with both schizophrenia and antisocial personality disorder. CASE PRESENTATION: The aim of the present case-study was to characterize the sleep architecture of a violent, medication-free and detoxified female offender with schizophrenia, alcoholism and features of antisocial personality disorder using polysomnography. The controls consisted of three healthy, age-matched women with no history of physical violence. The offender's sleep architecture was otherwise very typical for patients with schizophrenia and/or alcoholism, but an extremely high amount of deep sleep was observed in her sleep recording. CONCLUSIONS: The finding strengthens the view that severe aggression is related to an abnormal sleep pattern with increased deep sleep. The authors were able to observe this phenomenon in an antisocially behaving, violent female offender with schizophrenia and alcohol dependence, the latter disorders previously reported to be associated with low levels of slow wave sleep. New studies are, however, needed to confirm and explain this preliminary finding.
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6/28. The psychiatric diagnosis of alcoholism: critique and proposed reformulation.

    A taxonomy of alcohol problem involvement is proposed which encompasses categorical and dimensional approaches to classification. It is argued that contemporary nosology such as that described in DSM or ICD cannot, in principle, yield discrete categories containing homogeneous membership. Nor does current classification and diagnosis yield sufficient specific information necessary for effective treatment. These limitations are not resolvable by additional empirical research; rather, as discussed herein, a new conceptual framework and focus are required. The proposed new taxonomy comprises the first step in developing a comprehensive and clinically useful method for characterizing the alcohol consuming population.
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7/28. Warm turkey: other routes to abstinence.

    The requirement of immediate and abrupt quitting ("cold turkey") can be an obstacle to the acceptance and accomplishment of abstinence as a long-term outcome. Three alternative "warm turkey" routes to abstinence are discussed: (a) sobriety sampling, (b) tapering down, and (c) trial moderation. Clinical research evidence and case examples are provided in support of these alternative approaches.
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8/28. alcoholism recovery in lesbian women: a theory in development.

    Utilizing the modified practice-theory strategy for theory building, a provisional theoretical model was developed to describe alcoholism recovery in lesbian women. Assumptions are acknowledged, key concepts are identified, and propositions are formulated for the purpose of generating nursing knowledge about a significant health problem in this aggregate of women. The theory's implications for nursing research, practice, and further theory development are discussed.
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9/28. Alcohol use and abuse secondary to anxiety.

    The relationship between alcohol use and anxiety is complex. From a clinical standpoint, it is clear that psychiatrists caring for anxious patients must be aware of the possibility of secondary alcohol abuse. For the most part, anxiety disorders are highly treatable conditions, whereas alcoholism is less successfully treated. With this in mind, it is important for the clinician to accurately diagnose anxiety disorders in their patients. Failure to do so may lead a high percentage of patients to the major complication of substance abuse, which itself may be very difficult to treat. Further research to understand the relationship between anxiety and alcohol use is warranted. Future studies should focus on discovering which anxious patients are likely to abuse alcohol. Studies screening patients for the presence of alcoholic traits, such as antisocial behavior or a family history of alcoholism, may help identify anxiety disorder patients who are likely to go on to become alcohol abusers. Researchers interested in the treatment of substance abusers should become acutely interested in the recognition and treatment of anxiety disorder in their patients. Identifying patients with anxiety disorders would be a first step in individualizing treatment for a given alcoholic patient.
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10/28. Men, blue collar work and drinking: alcohol use in an industrial subculture.

    We present the findings of research designed to identify the social and environmental precursors of heavy drinking in a population of white assembly-line workers. Using a primarily qualitative approach, we examine alcohol use in relation to the sociocultural characteristics of individuals' community and workplace environments and their early-life socialization experiences. The sample consists of 30 men--15 heavy drinkers and 15 moderate drinkers--who were drawn from the workforce of a large durable goods manufacturing plant that closed in 1982. Workers' accounts of their own and coworkers' drinking suggest that a heavy drinking subculture existed in the workplace. Within this culture, drinking was a normal part of work life, and served to improve social relationships, reduce boredom and dissatisfaction, and to express solidarity in defiance of management rules and working conditions. Membership in this subculture, we believe, was most important for those men who had no interests or social involvements outside the workplace. We compare the characteristics of workers who chose to join this subculture (the heavy drinkers), with those who did not (moderate drinkers). Factors that predicted involvement in the heavy drinking subculture were: a sociocultural background where heavy male drinking was normative, lack of extra-work social resources, and leisure activities restricted to coworkers and work-related contexts. Conversely, moderate drinkers tended to come from moderate drinking backgrounds, and had considerable community and social group involvements that included family and peer networks to the virtual exclusion of coworkers.
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