Treatments of Alcoholism
Treatments of Alcoholism
On any given day in the United States… 10,657 babies are born. (US Census Bureau). Twenty of these babies are born with Fetal Alcohol Syndrome. Twenty may seem as though it is not a lot, but when you compare it to the fact that this number is more than HIV positive, Muscular Dystrophy, Spina Bifida and Down Syndrome combine it creates a whole new parameter. Fetal Alcohol Syndrome is a direct result of a woman’s competed disregard for the fetus.
Fetal Alcohol Syndrome (FAS, hereinafter), is a series of both mental and physical birth defects that can include, but are not limited to, mental retardation, deficiencies in growth, central nervous system dysfunction, behavioral maladjustments, and craniofacial abnormalities.
It is common knowledge not to smoke or drink during pregnancy.
Growth abnormalities can be significant and also includes all three of the following respects of growth: weight, length and head circumference. Most of the time the baby’s growth abnormalities are so severe they need to be hospitalized because of obvious failure to survive.
A baby with craniofacial abnormalities can be recognized by their eyes in that they are small with exaggerated inner epicanthic folds. (Health Visitor Nov. 1981) The bridge of the nose is normally poorly developed. The ears are often large and simple in form. (Midwives Chronicle and Nursing notes)
At first, when the baby is delivered, the affected infant shows signs of alcohol withdrawal; with signs that are much similar to delirium tremens in adults. They are often anxious, have a weak grasp, poor hand-to-eye coordination and consistent difficulty in feeding and sucking.
People can not blame the mother’s for the most part though. It is a common ignorance among the health care providers. Most health care providers are untrained and unfamiliar with substance abuse issues among pregnant women. FAS is widely misdiagnosed and or under diagnosed. Only ten percent of medical schools require students to complete a course on the proper diagnosis of individuals with alcohol and other drug addictions.
Many women do not receive proper pre-natal care, and a study performed by a National Center for Health Statistics found that doctors appear less likely to tell a pregnant black woman to quit drinking and or smoking than they would be to a white woman. (The New York Times, January 19, 1994)
As mentioned above, a baby with FAS can suffer from many different birth abnormalities. These disabilities will indeed last a lifetime. There is no amount of alcohol found to be safe to consume during pregnancy. FAS is, however, 100% preventable when a woman abstains from alcohol.
FAS is the leading known cause of mental retardation. Approximately, one out of 750 live birth are born each year with FAS. (The Journal of American Medical Association, 1991) Thirty to 40% of the mothers who drink “heavily” throughout pregnancy have the syndrome. FAS is not limited to any one group, race, culture, or socio-economic background. Between one-third and two-thirds of children in special education have been affected by alcohol in some way. (The Journal of American Medical Association, 1991) Comparison of children and adults with FAS shows that with the approach to adolescence, the specific craniofacial features are not as noticeable as they are in infancy. Average academic functioning of these children and adults does not seem to develop beyond early school grade level. The short stature and small head (micro cephalic), seem to be permanent. The most noticeable behavioral problems were found to be with comprehension, judgment, and attention skills, causing these adults born with FAS to experience major psychological and adjustment problems for the rest of their lives.
Numerous studies with animals, of experimental alcoholism, where nutritional status has been well controlled, have shown that the damage to the developing fetus, such as low birth rate CNS ( Central Nervous System) impairment, etc. are caused by the direct consequence of the effects of alcohol. In addition, some of these studies have shown a clear continuum effect; the higher the blood alcohol of the mother, the greater the damage to the developing fetus.
Even though the direct connection between alcohol intake and birth defects is now indisputable, there are other etiological factors associated with maternal drinking that must also be considered as contributing factors in an adverse pregnancy outcome.
The most important of these secondary factors is alcohol related malnutrition, as nutritional deficiencies occur frequently with alcohol intake due to reduced appetite. Alcohol-induced zinc depletion is particularly well documented. This has shown a positive correlation with reduced zinc status and low birth weight and fetal malformations, suggesting that inadequate zinc intake could also act independently as a teratogenic agent. (Yearbook of Nutritional Medicine 1984-85)
Many studies have been performed on FAS. The University of Washington School of Medicine is the leader in scientific research of FAS. The school/students have done many controlled research study’s. A few will be discussed in the following pages. The longitudinal Study on Alcohol and Pregnancy, Neuropsychological Analyses of FAS/FAE Deficits, Parent-Child Assistance Program (P-Cap), and the FAS Follow-up Program.
The longitudinal prospective study evaluates adverse outcomes in young adults who were pre-natally exposed to known levels and patterns of alcohol. The basic hypothesis of this long-term study is that prenatal alcohol exposure exerts an enduring dose-dependent influence on offspring across a life-span.
One of the many problems of misdiagnosis, and is shown in this study is that, the birth rate of FAS children is nearly 1 per 100 births. The problem is this, alcohol-affected children and adults are often denied services when they lack the characteristic FAS face and or mental retardation as defined by a standardized IQ score of less then 69. It is essential that these diagnosis’ become more accurate so that the consequences can be understood and that the markers of clinically affected individuals be identified to support appropriate diagnosis and intervention.
The Neuropsychological Analyses of FAS/FAE deficits study proposes to quantify and link the neuroanatomic and neuropsychological abnormalities in people with brain damage caused by prenatal alcohol exposure. As of present time there is no scientific way of measuring the amount of brain damage caused by alcohol and its relation to the dysfunctional behavior of the patient. FAS is a diagnostic category which is the only means of measuring quantitative brain damage. People that suffer from FAS are often considered to be in a different group that carries the diagnosis of ARND Alcohol Related Neurodevelopment Disorders. What the researchers in this study are hoping to conclude, is by using a new analysis method it will reveal a significant means of differences in brain form between FAS groups and Control group that are not simply due to micro cephalic and that are not detectable from the clinical reading of an MRI. The researchers also believe that that a brain/behavior study will find significant correlations between brain dysmorphology and neuropsychological deficits, and that the associations will be strong enough to suggest the nature and extent of brain damage in the individual case.
Although there are many cases each day of FAS, and seems almost hopeless for the children born from ignorance, there is help. There are many programs out there one that will be mentioned is P-CAP. P-CAP is Parent-Child Assistance Program (formally known as Birth to 3). It started in 1991 in Seattle, WA. P-CAP is an intervention model developed through federal funds to enable communities to respond, through long term advocacy, to the problems of mothers who have abused drugs or alcohol during pregnancy and to the needs of the children. This program reaches out to those women who had little to no prenatal care, and are not connected to community resources.
The goals of P-CAP are simple. they are (1) to assist clients in obtaining alcohol and drug treatment, staying in recovery and resolving complex issues that might have risen during within the context of their substance abuse; (2) to assure that the children are in a safe home with these mothers and are receiving proper health care; (3) to link these mothers to community resources for the professional services and education that will help learn and maintain a healthy independent family life; (4) to demonstrate to community services that positive work is being done to further the prevention of future births of FAS.
Typical mothers that are enrolled in this program are characterized by poverty, upbringing by substance abusing parents, child abuse, abusive adult relationships, and trouble with the law to name a few. Notably, there have been no turnover among the paraprofessional staff for over five years in a field which is known for hate rates of burnouts among personnel.
I found this letter in a publication, this shows the tremendous difference between a client with limited mental abilities and a client with FAS:
June 14, 1999
To: President and Hillary Clinton,
Twenty three years ago a young woman who was pregnant was abandoned by her husband. She had no job, no money, no health insurance and no family. Alone, she turned to alcohol for comfort. Eventually, she returned to school. Got some good training and got a good job but all the good things came too late for the child she was carrying during the time she was relying on alcohol. This child was born with Fetal Alcohol Syndrome. Being a single parent, this mom was not able to take proper care of a child who never slept and was constantly ill. Eventually she was forced to place the child in an institution for the mentally retarded.
Fortunately, for the child in this story, a friend at the institution told me about the new child at the school and asked for my assistance. I had worked with hundreds of delayed children and was confident that I could help this child gain the skills necessary to live with her family again. I was naive. I had not met FAS head on before. I had had wonderful success teaching children with other forms of mental retardation to dress, eat and use the bathroom appropriately. This time it did not work the way I thought it would.
Sixteen years ago when this child came to live with us I really thought I knew the answers. I now know that FAS is different the answers are different. She has learned many good and wonderful things. She still cannot dress, eat and use the bathroom appropriately for her age. The brain damage caused by prenatal exposure to alcohol damages the brain’s ability to communicate within itself. This young woman has no appropriate sense of hot or cold. If she looks at a thermometer outdoors, she can read the temperature but cannot reason out what type of clothes she is to wear in hot weather or cold. She needs constant guidance to make it from day to day without placing herself at risk.
Despite all that some of us have learned about FAS, we still find that most teachers and school personnel do not recognize that this disability is different from other forms of mental retardation. Despite all that has been written about FAS, we find that more women are drinking while pregnant than there were in 1992. Despite all the research by the medical profession, we find that many, many doctors still cannot recognize FAS in their patients. Despite the efforts made by social workers, therapists, and schools, we are finding that approximately 40% of those in our state prisons are disabled by prenatal exposure to alcohol.
I cannot condemn the ignorance of others as I was once ignorant myself. However I cannot see a healthy outcome for our country if we continue in this mass ignorance. I am asking you to lend us your support in turning the tide of ignorance concerning this disability.
Delinda L. McCann MA
I found this quiz in a magazine, it is interesting to know what you don’t really know about FAS. Do not feel intimidated by this test. It’s purpose is to spread the knowledge of FAS. Most of the people who took and will take this test do and will not score about a 50.
1) What is the leading known cause of mental retardation in western civilization today?
a. Down Syndrome
d. Cerebral Palsy
e. Spina Bifida
2) What percentage of women of child-bearing age drink alcohol (many before they realize that they are pregnant)?
3) What percentage of persons with FAS/FAE attain independence in living and in employment?
4) Which of the following alcoholic beverages contains the greatest amount of alcohol?
a. A 12 oz. can of beer.
b. A 5oz glass of wine.
c. One shot of liquor.
d. A 12oz. wine cooler.
e. All of the above.
5) What is the most debilitating aspect of prenatal alcohol exposure?
a. Memory deficits.
b. Growth retardation
c. Lack of impulse control
d. Mental retardation with IQ below 70
e. Attention Deficit Disorder (ADD)
6) How much does it cost each year to treat infants, children and adults with FAS?
a. Almost $1,000,000.00
b. Almost $2,000,000.00
c. Almost $100,000,000.00
d. Almost $2,000,000,000.00
e. Almost nothing, as expenses are incurred by private insurance.
7) Which of the following women are at high risks for drinking during pregnancy?
a. Women with a college education.
b. Unmarried women.
c. Female students.
d. Women in households with > $50,000 annual income.
e. All of the above
Of the following secondary disabilities associated with FAS/FAE, which one is the most common?
a. Mental illness
b. Trouble in school.
c. Trouble with the law.
d. Abuse of alcohol and/or other drugs.
e. Sexuality problems.
9) Which of the following are protective factors for preventing secondary disabilities in FAS/FAE?
a. IQ below 70.
b. Early diagnosis.
c. Eligibility for disability services.
d. Stable home environment
e. All of the above.
10) In which of the following ways does alcohol affect a man’s ability to father healthy children?
a. Lowered levels of testosterone that interfere with sexual performance.
b. Reduced mobility of healthy sperm at time of infection.
c. Increased risk of inherited tendency toward alcoholism.
d. Possible adverse effects on DNA in sperm before conception.
e. All of the above.
The answers to this quiz will follow at the end of this paper.
Patterns of alcohol use are changing with the changing times of today, with more and more teenagers consuming alcohol on a regular basis. This is a growing concern as research shows that, in recent years, regular alcohol consumption has increased alarmingly among the female population; particularly among younger women and teenage girls. Due to this vast rise in alcohol consumption it is societies burden to put forth evidence and proof about the dangers of alcohol consumption among women during their child-bearing years.
In order for society to accomplish this, three things must happen:
1) Local education staff should implement the teachings of the dangers that alcohol can cause not only normal consumption but while pregnant as well.
2) Pamphlets should be regularly handed out among young women and teens, in hospital waiting rooms, family planning clinics, schools, by the parents, dealing with the adverse effects of alcohol.
3) Government officials should affix warning labels on alcohol so they can be seen clearly . They should be similar to those that are placed on cigarettes.
The most salient point that can be made about alcohol induced fetal damage is that it is 100% totally preventable, we can only hope that education of this subject, on the part of both prospective parents, will control the increasing problem. It is astonishing to know that this information has been readily available for such a long time and no one seems to worry about it. If we could effectively foster the simple fact that “mothering from conception is direct mothering”, and therefore everything that the mother consumes during pregnancy the fetus consumes as well, some of these tragedies could be more easily be avoided.
Answers to the quiz above are as follows:
Streissguth, A.P., Barr, H.M., Bookstein, F.L., Sampson, P.D., & Carmichael Olsen, H. (1999). The long-term neurocognitive consequences of prenatal alcohol: A 14-year study. Psychological Science, 10(3), 186-190.
Streissguth, A.P., Barr, H.M., & Sampson, P.D. (1990)
Moderate prenatal alcohol exposure: Effects on child IQ and learning problems at age 7 1/2 years.
Alcoholism: Clinical and Experimental Research, 14(5), 662-669.
Streissguth, A.P., Barr, H.M., &Sampson, P.D. (1989). Neurobehavioral effects of prenatal alcohol. Parts I, II, and III. Neurotoxicology & Teratology, 11(5), 461-507.
Streissguth, A.P., Barr, H.M., Sampson, P.D., & Martin, D.C. (1986).
Attention, distraction and reaction time at age 7 years and prenatal alcohol exposure. Neurobehavioral Toxicology and Teratology, 8(6), 717-725.
Streissguth, A.P., Grant, T.M., & Ernst, C.C. (1999).
Intervention with high-risk alcohol and drug abusing mothers: II. 3 year findings from the Seattle Model of Paraprofessional Advocacy. Journal of Community Psychology, 27(1), 19-38.
Grant, T.M., Ernst, C.C., & Steissguth, A.P. (1996). An intervention with high-risk mothers who abuse alcohol and drugs: The Seattle Advocacy Model. American Journal of Public Health, 86(12), 1816-1817.