Addiction

Wikipedia

The term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive physical dependence or psychological dependence, such as: drug addiction, video game addiction, crime, alcoholism, compulsive overeating, problem gambling, computer addiction, pornography addiction, etc. In medical terminology, an addiction is a state in which the body relies on a substance for normal functioning and develops physical dependence, as in drug addiction. When the drug or substance on which someone is dependent is suddenly removed, it will cause withdrawal, a characteristic set of signs and symptoms. Addiction is generally associated with increased drug tolerance. In physiological terms, addiction is not necessarily associated with substance abuse since this form of addiction can result from using medication as prescribed by a doctor. However, common usage of the term addiction has spread to include psychological dependence. In this context, the term is used in drug addiction and substance abuse problems, but also refers to behaviors that are not generally recognized by the medical community as problems of addiction, such as compulsive overeating. The term addiction is also sometimes applied to compulsions that are not substance-related, such as problem gambling and computer addiction. In these kinds of common usages, the term addiction is used to describe a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences to the individual's health, mental state or social life. History of addiction models <hr></hr> The term "addiction" appeared as far back as at least 1599, when Shakespeare used it in the first scene of Henry V; however it wasn't until 1906, in reference to opium, that it began to be used regularly. There is also an isolated usage, recorded from 1779, referring to tobacco. The first use of the adjective 'addict' (with the meaning of 'delivered, devoted') was in 1529 and comes from the Latin addictus, pp. of addicere ('deliver, yield, devote,' from ad-, 'to' + dicere, 'say, declare'). Prior to the latter half of the 20th Century, addiction was primarily a pharmacological term that referred to the process of developing drug tolerance so that more of a drug was required, more frequently, for the same effect to occur. However, with the founding of Alcoholics Anonymous in 1935, the allergy concept eventually morphed into the disease-model of addiction was proposed, based on the work of Dr. William Duncan Silkworth, and began to gather support in the professional community, amongst medical and social services workers, and amongst addicts themselves. The disease-model concept led to a definition of addiction based on the continued use of alcohol or drugs despite negative consequences for the user. This latter definition is now thought of as a disease state by the medical community. Morse and Flavin summarise the disease-model definition of addiction commonly utilized by treatment centers and substance abuse counselors: Addiction is a primary, progressive, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and can sometimes be fatal. It is characterized by impaired control over use of the substance, preoccupation with the substance, use of the substance despite adverse consequences, and distortions in thinking. In the latter half of the 20th Century, the twelve-step program began to be applied to a wide range of problem behaviours, many never previously identified as addictions. For example, during this process the establishment of Overeaters Anonymous in 1960 led to the identification of an associated concept of food addiction and the establishment of Sex and Love Addicts Anonymous in 1977 led to the identification of the concept of sexual addiction. However, although these terms are widely used in the recovery movement, and by commentators on that movement, neither of them are widely accepted by members of the professional communities working in the fields of addiction. In the 21st Century, attempts have been made to model addiction using the tools of economics, for instance, by calculating the elasticity of addictive goods and determining to what extent present income and consumption has on future consumption. In general, most modern economists identify 3 models of addiction when analyzing patterns for policy research. These are: - Myopic/Naive: This model essentially stipulates that addicts are characterized by near-sighted behavior and are wholly incapable of ascertaining the potential implications of their behavior. Therefore, under this model, demand for whatever the addict is addicted to would be totally inelastic, implying that the addict is unable to even slightly reduce consumption regardless of cost. - Rational time-consistent: Under this model, the addict is assumed to be perfectly aware of future consequences of their behavior and is assumed to have fully considered all benefits and costs of their actions. Under this model, the elasticity of demand would be very high (at or nearing 1), implying that the addict will almost certainly change their behavior in response to price, since a high price may outweigh potential benefits. - Time-inconsistent (as well as imperfectly rational): Under this model, the addict is assumed to be capable of some level of analysis of the benefits and costs of their behavior, but may not be able to act on the conclusions of this analysis due to physical dependencies and/or insufficient "willpower". The essence of this model is an attempt to classify typical behavior by which most addicts wish they could quit, indicating rationality and proper benefit/cost analysis, but are still unable to. Under this model, there is a moderate level of elasticity indicating some but not perfect responsiveness to price. Definition <hr></hr> Not all doctors agree on the exact nature of addiction or dependency however the biopsychosocial model is generally accepted in scientific fields as the most comprehensive theorem for addiction. Historically, addiction has been defined with regard solely to psychoactive substances (for example alcohol, tobacco and other drugs) which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain. However, "studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder)." However, such disorders are classified by the American Psychological Association as impulse control disorders and therefore not as addictions. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, spiritual obsession (as opposed to religious devotion), cutting and shopping so these behaviors count as 'addictions' as well and cause guilt, shame, fear, hopelessness, failure, rejection, anxiety, or humiliation symptoms associated with, among other medical conditions, depression and epilepsy. Although, the above mentioned are things or tasks which, when used or performed, do not fit into the traditional view of addiction and may be better defined as an obsessive-compulsive disorder, withdrawal symptoms may occur with abatement of such behaviors. It is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. However, understanding of neural science, the brain, the nervous system, human behavior, and affective disorders has revealed "the impact of molecular biology in the mechanisms underlying developmental processes and in the pathogenesis of disease". The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been confirmed repeatedly. Modern research into addiction is generally focused on Dopaminergic pathways. There is great and sometimes heated debate around the definition of addiction with parties falling into two main camps the Disease model of addiction and the behaviorists, explanations of various models can be found in the article on Drug rehabilitation.

The term “addiction” is used in many contexts to describe an obsession, compulsion, or excessive physical dependence or psychological dependence, such as: drug addiction, video game addiction, crime, alcoholism, compulsive overeating, problem gambling, computer addiction, pornography addiction, etc. In medical terminology, an addiction is a state in which the body relies on a substance for normal functioning and develops physical dependence, as in drug addiction. When the drug or substance on which someone is dependent is suddenly removed, it will cause withdrawal, a characteristic set of signs and symptoms. Addiction is generally associated with increased drug tolerance. In physiological terms, addiction is not necessarily associated with substance abuse since this form of addiction can result from using medication as prescribed by a doctor. However, common usage of the term addiction has spread to include psychological dependence. In this context, the term is used in drug addiction and substance abuse problems, but also refers to behaviors that are not generally recognized by the medical community as problems of addiction, such as compulsive overeating. The term addiction is also sometimes applied to compulsions that are not substance-related, such as problem gambling and computer addiction. In these kinds of common usages, the term addiction is used to describe a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences to the individual’s health, mental state or social life. History of addiction models <hr></hr> The term “addiction” appeared as far back as at least 1599, when Shakespeare used it in the first scene of Henry V; however it wasn’t until 1906, in reference to opium, that it began to be used regularly. There is also an isolated usage, recorded from 1779, referring to tobacco. The first use of the adjective ‘addict’ (with the meaning of ‘delivered, devoted’) was in 1529 and comes from the Latin addictus, pp. of addicere (‘deliver, yield, devote,’ from ad-, ‘to’ + dicere, ‘say, declare’). Prior to the latter half of the 20th Century, addiction was primarily a pharmacological term that referred to the process of developing drug tolerance so that more of a drug was required, more frequently, for the same effect to occur. However, with the founding of Alcoholics Anonymous in 1935, the allergy concept eventually morphed into the disease-model of addiction was proposed, based on the work of Dr. William Duncan Silkworth, and began to gather support in the professional community, amongst medical and social services workers, and amongst addicts themselves. The disease-model concept led to a definition of addiction based on the continued use of alcohol or drugs despite negative consequences for the user. This latter definition is now thought of as a disease state by the medical community. Morse and Flavin summarise the disease-model definition of addiction commonly utilized by treatment centers and substance abuse counselors: Addiction is a primary, progressive, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and can sometimes be fatal. It is characterized by impaired control over use of the substance, preoccupation with the substance, use of the substance despite adverse consequences, and distortions in thinking. In the latter half of the 20th Century, the twelve-step program began to be applied to a wide range of problem behaviours, many never previously identified as addictions. For example, during this process the establishment of Overeaters Anonymous in 1960 led to the identification of an associated concept of food addiction and the establishment of Sex and Love Addicts Anonymous in 1977 led to the identification of the concept of sexual addiction. However, although these terms are widely used in the recovery movement, and by commentators on that movement, neither of them are widely accepted by members of the professional communities working in the fields of addiction. In the 21st Century, attempts have been made to model addiction using the tools of economics, for instance, by calculating the elasticity of addictive goods and determining to what extent present income and consumption has on future consumption. In general, most modern economists identify 3 models of addiction when analyzing patterns for policy research. These are: - Myopic/Naive: This model essentially stipulates that addicts are characterized by near-sighted behavior and are wholly incapable of ascertaining the potential implications of their behavior. Therefore, under this model, demand for whatever the addict is addicted to would be totally inelastic, implying that the addict is unable to even slightly reduce consumption regardless of cost. - Rational time-consistent: Under this model, the addict is assumed to be perfectly aware of future consequences of their behavior and is assumed to have fully considered all benefits and costs of their actions. Under this model, the elasticity of demand would be very high (at or nearing 1), implying that the addict will almost certainly change their behavior in response to price, since a high price may outweigh potential benefits. - Time-inconsistent (as well as imperfectly rational): Under this model, the addict is assumed to be capable of some level of analysis of the benefits and costs of their behavior, but may not be able to act on the conclusions of this analysis due to physical dependencies and/or insufficient “willpower”. The essence of this model is an attempt to classify typical behavior by which most addicts wish they could quit, indicating rationality and proper benefit/cost analysis, but are still unable to. Under this model, there is a moderate level of elasticity indicating some but not perfect responsiveness to price. Definition <hr></hr> Not all doctors agree on the exact nature of addiction or dependency however the biopsychosocial model is generally accepted in scientific fields as the most comprehensive theorem for addiction. Historically, addiction has been defined with regard solely to psychoactive substances (for example alcohol, tobacco and other drugs) which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain. However, “studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder).” However, such disorders are classified by the American Psychological Association as impulse control disorders and therefore not as addictions. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, spiritual obsession (as opposed to religious devotion), cutting and shopping so these behaviors count as ‘addictions’ as well and cause guilt, shame, fear, hopelessness, failure, rejection, anxiety, or humiliation symptoms associated with, among other medical conditions, depression and epilepsy. Although, the above mentioned are things or tasks which, when used or performed, do not fit into the traditional view of addiction and may be better defined as an obsessive-compulsive disorder, withdrawal symptoms may occur with abatement of such behaviors. It is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. However, understanding of neural science, the brain, the nervous system, human behavior, and affective disorders has revealed “the impact of molecular biology in the mechanisms underlying developmental processes and in the pathogenesis of disease”. The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been confirmed repeatedly. Modern research into addiction is generally focused on Dopaminergic pathways. There is great and sometimes heated debate around the definition of addiction with parties falling into two main camps the Disease model of addiction and the behaviorists, explanations of various models can be found in the article on Drug rehabilitation.

2009-03-12T18:14:39Z

http://en.wikipedia.org/wiki/Addictions

Addiction

Wikipedia

Alcoholism is a term with multiple and sometimes conflicting definitions to describe the detrimental effects of alcohol intake. In common and historic usage, alcoholism refers to any condition that results in the continued consumption of alcoholic beverages despite health problems and negative social consequences. Modern medical definitions[1] describe alcoholism as a disease and addiction which results in a persistent use of alcohol despite negative consequences. In the 19th and early 20th centuries, alcoholism, also referred to as dipsomania[2] described a preoccupation with, or compulsion toward the consumption of, alcohol and/or an impaired ability to recognize the negative effects of excessive alcohol consumption. Although not all of these definitions specify current and on-going use of alcohol as a qualifier for alcoholism, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including dependence and symptoms of withdrawal. While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. It is estimated that 9% of the general population is pre disposed to alcoholism based on genetic factors. The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, stress,[3] emotional health, genetic predisposition, age, and gender have been identified. For example, those who consume alcohol at an early age, by age 16 or younger, are at a higher risk of alcohol dependence or abuse. Also, studies indicate that the proportion of men with alcohol dependence are higher than that of the proportion of women, 7% and 2.5% respectively. Although women are more vulnerable to long-term consequences of alcoholism. In general, about 90% of adults in United States consume alcohol and more than 700,000 of them have been treated for alcoholism. [4] Definitions and terminology The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public. Medical definitions The Journal of the American Medical Association defines alcoholism as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."[5] The DSM-IV (the standard for diagnosis in psychiatry and psychology) defines alcohol abuse as repeated use despite recurrent adverse consequences.[6] It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[6] (See DSM diagnosis below.) According to the APA Dictionary of Psychology, alcoholism is the popular term for alcohol dependence.[6] Note that there is debate whether dependence in this use is physical (characterised by withdrawal), psychological (based on reinforcement), or both. Terminology Many terms are applied to a drinker's relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. The introduction of politics and religion further muddles the issue. Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse, problem use, abuse,[7] and heavy use do not have standard definitions, but suggest consumption of alcohol to the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual. Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, abuse can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition. Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into early or sustained, and partial or full. The fellowship known as Alcoholics Anonymous does not use the term "remission" because AA's basic text, which was first published in 1939, uses the terms "recover" and "recovered" to describe those who have stopped consuming alcohol by addressing their underlying problem. On page 64, the AA text says "Our liquor was but a symptom. So we had to get down to causes and conditions."[8] Etymology The term "alcoholism" was first used in 1849 by the physician Magnus Huss to describe the systematic adverse effects of alcohol.[9] In the United States, use of the word "alcoholism" was[citation needed] largely popularized by the founding and growth of Alcoholics Anonymous in 1935. AA's basic text, known as the "Big Book," describes alcoholism as an illness that involves a physical allergy[8]:p.xxviii and a mental obsession.[8]:p.23[10] Note that the definition of "allergy" used in this context is not the same as used in modern medicine.[11] A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism.[12] Jellinek's definition restricted the use of the word "alcoholism" to those showing a particular natural history. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.[13] A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele, argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term "heavy drinking" when discussing the negative effects of alcohol consumption. Epidemiology Substance use disorders are a major public health problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."[15] In the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001.[16] The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence.[17][18] Within the medical and scientific communities, there is broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."[13] Current evidence indicates that in both men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.[19] A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adult alcoholics and found that after one year some were no longer alcoholics, even though only 25.5% of the group received any treatment,[20] with the breakdown as follows: * 25% still dependent * 27.3% in partial remission (some symptoms persist) * 11.8% asymptomatic drinkers (consumption increases chances of relapse) * 35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers. In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."[21] Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage." Identification and diagnosis Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be difficult because there is no detectable physiologic difference between a person who drinks frequently and a person with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker's life compared with the subjective benefits the drinker perceives from consuming alcohol. While there are many cases where an alcoholic's life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify. Unless they have M.C. type symptoms, and in these cases are probably alcoholics, no diagnosis needed. Addiction Medicine specialists have extensive training with respect to diagnosing and treating patients with alcoholism. Screening Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use. * The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office. Two "yes" responses indicate that the respondent should be investigated further. The questionnaire asks the following questions: 1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?[22][23] The CAGE questionnaire, among others, has been extensively validated for use in identifying alcoholism. It is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE are frequently implemented for such a purpose. * The Alcohol Dependence Data Questionnaire is a more sensitive diagnostic test than the CAGE test.[24] It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. * The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,[25] driving under the influence being the most common. * The Alcohol Use Disorders Identification Test (AUDIT) is a screening questionnaire developed by the World Health Organization. This test is unique in that it has been validated in six countries and is used internationally.[26] Like the CAGE questionnaire, it uses a simple set of questions - a high score earning a deeper investigation. * The Paddington Alcohol Test (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.[27] Genetic predisposition testing Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism does not have a single cause—including genetic—but that genes do play an important role "by affecting processes in the body and brain that interact with one another and with an individual's life experiences to produce protection or susceptibility." They also report that fewer than a dozen alcoholism-related genes have been identified, but that more likely await discovery.[28] At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction.[29] Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol.[30] Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.[28] DSM diagnosis The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared with one another. According to the DSM-IV, an alcohol dependence diagnosis is: ...maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae. Urine and blood tests There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including: * Macrocytosis (enlarged MCV)1 * Elevated GGT² * Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1. * High carbohydrate deficient transferrin (CDT) However, none of these blood tests for biological markers are as sensitive as screening questionaires. Effects of long term alcohol misuse The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging to physical health. The secondary damage caused by an inability to control one's drinking manifests in many ways. Alcoholism also has significant social costs to both the alcoholic and their family and friends. Alcoholics have a very high suicide rate and studies show between 8% and 21% of alcoholics commit suicide. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5,080 times that of the general public.[31] Physical health effects It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption may include cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources. Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol related making alcohol the 2nd leading cause of dementia.[32] Mental health effects Long term misuse of alcohol can cause a wide range of mental health effects. Alcohol misuse is not only toxic to the body but also to brain function and thus psychological well being can be adversely affected by the long-term effects of alcohol misuse. Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typically these psychiatric symptoms caused by alcohol misuse initially worsen during alcohol withdrawal but with abstinence these psychiatric symptoms typically gradually improve or disappear altogether.[33] Psychosis, confusion and organic brain syndrome may be induced by chronic alcohol abuse which can lead to a misdiagnosis of major mental health disorders such as schizophrenia.[34] Panic disorder can develop as a direct result of long term alcohol misuse. Panic disorder can also worsen or occur as part of the alcohol withdrawal syndrome.[35] Chronic alcohol misuse can cause panic disorder to develop or worsen an underlying panic disorder via distortion of the neurochemical system in the brain.[36] The co-occurence of major depressive disorder and alcoholism is well documented.[37][38][39] Among those with comorbid occurances, a distinction is commonly made between depressive episodes that are secondary to the pharmacological or toxic effects of heavy alcohol use and remit with abstinence, and depressive episodes that are primary and do not remit with abstinence. Additional use of other drugs may increase the risk of depression in alcoholics.[40] Depressive episodes with an onset prior to heavy drinking or those that continue in the absence of heavy drinking are typically referred to as "independent" episodes, whereas those that appear to be etiologically related to heavy drinking are termed "substance-induced".[41][42][43] Social effects The social problems arising from alcoholism can be massive and are caused in part due to the serious pathological changes induced in the brain from prolonged alcohol misuse and partly because of the the intoxicating effects of alcohol.[32] Being drunk or hung over during work hours can result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic's children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided. Alcohol withdrawal Alcohol withdrawal differs significantly from most other drugs in that it can be directly fatal. Drugs which have a similar mechanism of action to alcohol also have a similar risk of causing death during withdrawal, including barbiturate and benzodiazepine withdrawal. For example it is extremely rare for heroin withdrawal to be fatal. When people die from heroin or cocaine withdrawal they typically have serious underlying health problems which are made worse by the strain of acute withdrawal. An alcoholic however, who has no serious health issues has a significant risk of dying from the direct effects of withdrawal if it is not properly managed. Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. Thus when alcohol is stopped, especially abruptly, the person's nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening seizures, delirium tremens and hallucinations, shakes and possible heart failure. Acute withdrawal symptoms tend to subside after 1 - 3 weeks. Less severe symptoms (e.g. insomnia and anxiety) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system makes adaptations to reverse tolerance and restore GABA function towards normal. Other neurotransmitter systems are involved, especially glutamate and NMDA. Treatments Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.[15] Texas Tech University in Lubbock, Texas, has developed a model to support college students who are in recovery from addictive disorders such as alcoholism. [44] Effectiveness When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.[45] A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed.[46] Detoxification Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to prevent alcohol withdrawal. Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox is complete, relapse is likely without further treatment. These rehabilitations (or 'rehabs') may take place in an inpatient or outpatient setting. Group therapy and psychotherapy After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service. Alcoholics Anonymous was the first group, and has more members than all other programs combined. Some of the others include LifeRing Secular Recovery, Rational Recovery, SMART Recovery, and Women For Sobriety. Rationing and moderation Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency.[47] A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was "Abstinence represents the most stable form of remission for most recovering alcoholics".[48] Medications A variety of medications may be prescribed as part of treatment for alcoholism. * Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and a related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50%.[49] * Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. Alcohol releases endorphins, hence when Naltrexone is in the body drinkers no longer get any pleasure from consuming alcohol. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. Naltrexone comes in two forms. Oral naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken one hour before drinking to be effective. For pharmacological extinction to be effect the medicine must be taken an hour before drinking for the rest of the patients life. Vivitrol is a time-release formulation that is injected in the buttocks once a month. * Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying "While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse... Campral proved superior to placebo in maintaining abstinence for a short period of time..."[50] The COMBINE study was unable to demonstrate efficacy for Acamprosate.[51] * Topiramate (brand name Topamax), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. In one study heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.[52][53] In another study, those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo.[54] Topiramate works by reducing dopamine so that drinkers no longer get any pleasure from consuming alcohol. Dual addictions Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcoholics is a benzodiazepine dependence with studies showing 10 - 20% of alcoholics having problems of dependence and/or misuse problems of benzodiazepines. Dependence on other sedative hypnotics such as zolpidem and zopiclone as well as opiates also occurs as well as illegal drugs. Benzodiazepine withdrawal can like alcohol be medically severe and include the risk of psychosis and seizures if not managed properly.[55] Benzodiazepine dependency requires careful reduction in dosage to avoid a serious benzodiazepine withdrawal syndrome and health consequences. Benzodiazepines have the problem of increasing cravings for alcohol in problem alcohol consumers. Benzodiazepines also increase the volume of alcohol consumed by problem drinkers.[56] Women and alcoholism Alcoholism has a higher prevalence among men, though in recent decades, the number of female alcoholics has increased.[57] It is important to articulate the different biological and social ways alcoholism manifests in women in order to understand barriers to treatment and effective recovery strategies. Biological differences and physiological effects Biologically, women have symptom profiles from their alcohol use that differ in important ways from men. They experience a telescoping of physiological effects from alcohol use. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs).[58] This can be attributed to many reasons, the main being that women have less body water than men. A given amount of alcohol, therefore becomes more highly concentrated in a woman's body. Besides this fact, women also become more intoxicated, which is due to different hormone release.[59] Women develop long-term complications of alcohol dependence more rapidly than do alcoholic men. Additionally, women have a higher mortality rate from alcoholism than men.[60] Examples of long term complications include brain, heart, and liver damage[61] and an increased risk for breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, irregular menses, amenorrhea, luteal phase dysfunction, and early menopause.[62] Psychological and emotional effects Psychiatric disorders are generally more prevalent among those with alcohol disorders. This is true for both men and women, however the disorders differ depending on gender. Women who have alcohol-use disorders have co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have co-occurring diagnosis of narcissistic and antisocial personality disorders, bipolar disorder, schizophrenia, impulse disorders and attention deficit/ hyperactivity disorder.[63] Women with alcoholism are also more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population.[64] This trauma can lead to higher instances of PTSD, depression, anxiety, and a greater dependence on alcohol. Societal barriers to treatment Attitudes and social stereotypes about women and alcohol can create barriers to the detection and treatment of female alcohol abusers. Such beliefs stigmatize women who drink by characterizing them as "both generally and sexually immoral" or the "fallen women." Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.[65] Women also tend to have a greater fear that the negative implications from the stigma will reflect poorly on their families. This may also keep them from seeking help.[66] Implications for treatment Research has indicated a lack of adequate training for practitioners both in problematic alcohol use in general, and in relation to women's issues.[67] The complexity of alcohol use disorders, particularly with gender-related issues, indicates that the need for practitioners' knowledge, insight and compassion is enormous.[68] Better education and awareness surrounding the gender implications of alcoholism will help care providers to adequately treat women who suffer from alcoholism. Early intervention will also increase the probability of recovery. Societal impact The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is also the pain and suffering of the individuals besides the alcoholic affected. For instance, alcohol consumption by a pregnant woman can lead to Fetal alcohol syndrome,[69] an incurable and damaging condition.[70] Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country's GDP.[71] One Australian estimate pegged alcohol's social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41 per cent.[72] A study quantified the cost to the UK of all forms of alcohol misuse as £18.5–20 billion annually (2001 figures).[73][16] Stereotypes Stereotypes of alcoholics are often found in fiction and popular culture. The 'town drunk' is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers.[74][75] In Australia, Canada, and the United States, Aboriginal people have similarly been stereotyped as alcoholics. On the other hand, studies by social psychologists Stivers and Greeley[76] attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America. In film and literature In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. The disjoined narrative of Patrick Hamilton's Hangover Square reflects the alcoholism of its central character. A famous depiction of alcoholism, and the psychology of an alcoholic, is in Malcolm Lowry's widely acclaimed novel Under the Volcano, which details the final day of the British consul Geoffrey Firmin on the Day of the Dead in 1939 Mexico and his choice to continue his extreme alcohol consumption instead of returning to the wife he loves. Films like Bad Santa, Days of Wine and Roses, My Name is Bill W., Withnail and I, Arthur, Leaving Las Vegas, Shattered Spirits and The Lost Weekend, chronicle similar stories of alcoholism. Politics and public health Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs. References 1. ^ The American Medical Association "Definitions" 2. ^ www.dictionary.com,Definition: dipsomania 3. ^ Glavas MM, Weinberg J (2006). "Stress, Alcohol Consumption, and the Hypothalamic-Pituitary-Adrenal Axis". in Yehuda S, Mostofsky DI. Nutrients, Stress, and Medical Disorders. Totowa, NJ: Humana Press. pp. 165–183. ISBN 978-1-58829-432-6. 4. ^ [hhttp://health.nytimes.com/health/guides/disease/alcoholism/risk-factors.html "Alcoholism"]. A.D.A.M. Inc. hhttp://health.nytimes.com/health/guides/disease/alcoholism/risk-factors.html. Retrieved on 2009-03-17. 5. ^ Morse RM, Flavin DK (August 1992). "The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism". JAMA : the journal of the American Medical Association 268 (8): 1012–4. doi:10.1001/jama.268.8.1012. PMID 1501306. 6. ^ a b c APA Dictionary of Psychology, 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007 7. ^ To use wrongly or improperly; misuse: abuse alcohol; The American Heritage Dictionary of the English Language, 4th ed. 8. ^ a b c Anonymous; The first 100 members of AA (1939, 2001). [www.aa.org Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism]. New York City: Alcoholics Anonymous World Services. xxxii, 575 p.. ISBN 1893007162. www.aa.org. 9. ^ "Alcoholismus chronicus, eller Chronisk alkoholssjukdom:". Stockholm und Leipzig. http://books.google.com/books?hl=en&lr=&id=wt6r2Zw8sCEC&oi=fnd&pg=PR5&ots=TTCBeEzjQ2&sig=jxuMZ5wgL48SZjvu1PcwXIdjFJw#PPP1,M1. Retrieved on 2008-02-19. 10. ^ "The Big Book Self Test:". intoaction.us. http://www.intoaction.us/SelfTest.html. Retrieved on 2008-02-19. 11. ^ Kay AB (2000). "Overview of 'allergy and allergic diseases: with a view to the future'". Br. Med. Bull. 56 (4): 843–64. doi:10.1258/0007142001903481. PMID 11359624. 12. ^ "OCTOBER 22 DEATHS". todayinsci.com. http://www.todayinsci.com/10/10_22.htm. Retrieved on 2008-02-18. 13. ^ a b http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf 14. ^ Global Status Report on Alcohol 2004 15. ^ a b Gabbard: "Treatments of Psychiatric Disorders". Published by the American Psychiatric Association: 3rd edition, 2001, ISBN 0-88048-910-3 16. ^ a b Cabinet Office Strategy Unit Alcohol misuse: How much does it cost? September 2003 17. ^ WHO European Ministerial Conference on Young People and Alcohol 18. ^ WHO to meet beverage company representatives to discuss health-related alcohol issues 19. ^ Dick DM, Bierut LJ (April 2006). "The genetics of alcohol dependence". Current psychiatry reports 8 (2): 151–7. PMID 16539893. 20. ^ National Institute on Alcohol Abuse and Alcoholism 2001-2002 Survey Finds That Many Recover From Alcoholism Press release 18 January 2005. 21. ^ Vaillant GE (2003). "A 60-year follow-up of alcoholic men". Addiction. 98: 1043–51. doi:10.1046/j.1360-0443.2003.00422.x. PMID 12873238. 22. ^ Ewing JA (October 1984). "Detecting alcoholism. The CAGE questionnaire". JAMA : the journal of the American Medical Association 252 (14): 1905–7. doi:10.1001/jama.252.14.1905. PMID 6471323. 23. ^ CAGE Questionnaire (PDF) 24. ^ Alcohol Dependence Data Questionnaire (SADD) 25. ^ Michigan Alcohol Screening Test (MAST) 26. ^ AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care 27. ^ Smith, SG; R Touquet, S Wright and N Das Gupta (September 1996). "Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)". Journal of Accident and Emergency Medicine (British Association for Accident and Emergency Medicine) 13 (5): 308–312. doi:10.1093/alcalc/agh049. PMID 8894853. http://emj.bmj.com/cgi/content/abstract/13/5/308?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&title=Paddington+Alcohol+Test&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT,HWELTR. Retrieved on 2006-11-19. 28. ^ a b Nurnberger, Jr., John I., and Bierut, Laura Jean. "Seeking the Connections: Alcoholism and our Genes." Scientific American, Apr2007, Vol. 296, Issue 4. 29. ^ New York Daily News (William Sherman) Test targets addiction gene 11 February 2006 30. ^ Berggren U, Fahlke C, Aronsson E, et al (2006). "The taqI DRD2 A1 allele is associated with alcohol-dependence although its effect size is small". Alcohol and alcoholism (Oxford, Oxfordshire) 41 (5): 479–85. doi:10.1093/alcalc/agl043. PMID 16751215. 31. ^ Kendall RE (1983). "Alcohol and suicide". Subst Alcohol Actions Misuse 4 (2-3): 121–7. PMID 6648755. 32. ^ a b Professor Georgy Bakalkin (8 July 2008). "Alcoholism-associated molecular adaptations in brain neurocognitive circuits". eurekalert.org. http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php. Retrieved on 14 February 2009. 33. ^ Wetterling T; Junghanns K (September 2000). "Psychopathology of alcoholics during withdrawal and early abstinence". Eur Psychiatry 15 (8): 483–8. doi:10.1016/S0924-9338(00)00519-8. PMID 11175926. 34. ^ Schuckit MA (November 1983). "Alcoholism and other psychiatric disorders". Hosp Community Psychiatry 34 (11): 1022–7. PMID 6642446. 35. ^ Cowley DS (January 24, 1992). "Alcohol abuse, substance abuse, and panic disorder". Am J Med 92 (1A): 41S–48S. doi:10.1016/0002-9343(92)90136-Y. PMID 1346485. 36. ^ Cosci F; Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry 68 (6): 874–80. PMID 17592911. 37. ^ Grant BF, Harford TC (October 1995). "Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey". Drug Alcohol Depend 39 (3): 197–206. PMID 8556968. http://linkinghub.elsevier.com/retrieve/pii/0376871695011604. 38. ^ Kandel DB, Huang FY, Davies M (October 2001). "Comorbidity between patterns of substance use dependence and psychiatric syndromes". Drug Alcohol Depend 64 (2): 233–41. PMID 11543993. 39. ^ Cornelius JR, Bukstein O, Salloum I, Clark D (2003). "Alcohol and psychiatric comorbidity". Recent Dev Alcohol 16: 361–74. PMID 12638646. 40. ^ Schuckit M (June 1983). "Alcoholic patients with secondary depression". Am J Psychiatry 140 (6): 711–4. PMID 6846629. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=6846629. 41. ^ Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL (July 1997). "Comparison of induced and independent major depressive disorders in 2,945 alcoholics". Am J Psychiatry 154 (7): 948–57. PMID 9210745. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=9210745. 42. ^ Schuckit MA, Tipp JE, Bucholz KK, et al (October 1997). "The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls". Addiction 92 (10): 1289–304. PMID 9489046. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=1997&volume=92&issue=10&spage=1289. 43. ^ Schuckit MA, Smith TL, Danko GP, et al (November 2007). "A comparison of factors associated with substance-induced versus independent depressions". J Stud Alcohol Drugs 68 (6): 805–12. PMID 17960298. 44. ^ Chris Volkmann (2006). From Binge to Blackout: A Mother and Son Struggle with Teen Drinking. New American Library. pp. 152. ISBN 978-0451219091. 45. ^ Smart RG (April 1976). "Spontaneous recovery in alcoholics: a review and analysis of the available research". Drug and alcohol dependence 1 (4): 277–85. doi:10.1016/0376-8716(76)90023-5. PMID 797563. 46. ^ Based on information from Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism, the February 2007 issue of Newsweek - Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "Rehab Reality Check" Newsweek, 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c 47. ^ Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ (March 2005). "Recovery from DSM-IV alcohol dependence: United States, 2001-2002". Addiction (Abingdon, England) 100 (3): 281–92. doi:10.1111/j.1360-0443.2004.00964.x. PMID 15733237. 48. ^ Dawson DA, Goldstein RB, Grant BF (December 2007). "Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up". Alcoholism, clinical and experimental research 31 (12): 2036–45. doi:10.1111/j.1530-0277.2007.00536.x. PMID 18034696. 49. ^ Krampe H, Stawicki S, Wagner T, et al (January 2006). "Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome". Alcoholism, clinical and experimental research 30 (1): 86–95. doi:10.1111/j.1530-0277.2006.00013.x. PMID 16433735. 50. ^ "FDA Approves New Drug for Treatment of Alcoholism". http://www.fda.gov/bbs/topics/answers/2004/ANS01302.html. Retrieved on 2006-04-02. " 51. ^ "Naltrexone or Specialized Alcohol Counseling an Effective Treatment for Alcohol Dependence When Delivered with Medical Management". 2006-05-02. http://www.niaaa.nih.gov/NewsEvents/NewsReleases/COMBINERelease.htm. 52. ^ Johnson BA, Ait-Daoud N, Bowden CL, et al (May 2003). "Oral topiramate for treatment of alcohol dependence: a randomised controlled trial". Lancet 361 (9370): 1677–85. doi:10.1016/S0140-6736(03)13370-3. PMID 12767733. 53. ^ Swift RM (May 2003). "Topiramate for the treatment of alcohol dependence: initiating abstinence". Lancet 361 (9370): 1666–7. doi:10.1016/S0140-6736(03)13378-8. PMID 12767727. 54. ^ Johnson BA, Rosenthal N, Capece JA, et al (October 2007). "Topiramate for treating alcohol dependence: a randomized controlled trial". JAMA : the journal of the American Medical Association 298 (14): 1641–51. doi:10.1001/jama.298.14.1641. PMID 17925516. 55. ^ Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I (2003). "Dependence on legal psychotropic drugs among alcoholics" (PDF). Alcohol Alcohol. 38 (6): 613–8. PMID 14633651. http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613. 56. ^ Poulos CX, Zack M (November 2004). "Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers". Behav Pharmacol 15 (7): 503–12. PMID 15472572. 57. ^ Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al (June 2003). "gender-specific differences in alcoholism: implications for treatment". Archives of Women's Mental Health 6: 253–268. doi:10.1007/s/00737-003-0014-8. 58. ^ Karrol Brad R. (2002). "women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 59. ^ Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al (June 2003). "gender-specific differences in alcoholism: implications for treatment". Archives of Women's Mental Health 6: 253–268. doi:10.1007/s/00737-003-0014-8. 60. ^ Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). "Alcoholism and alcohol abuse among women: report of the council on scientific affairs". Journal of women's health 7 (7): 861–870. 61. ^ Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al (June 2003). "gender-specific differences in alcoholism: implications for treatment". Archives of Women's Mental Health 6: 253–268. doi:10.1007/s/00737-003-0014-8. 62. ^ Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). "Alcoholism and alcohol abuse among women: report of the council on scientific affairs". Journal of women's health 7 (7): 861–870. 63. ^ Karrol Brad R. (2002). "women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 64. ^ Karrol Brad R. (2002). "women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 65. ^ Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). "Alcoholism and alcohol abuse among women: report of the council on scientific affairs". Journal of women's health 7 (7): 861–870. 66. ^ Karrol Brad R. (2002). "women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 67. ^ Karrol Brad R. (2002). "women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 68. ^ Karrol Brad R. (2002). "women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 69. ^ CDC. (2004). Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Can be downloaded at http://www.cdc.gov/fas/faspub.htm 70. ^ Streissguth, A. (1997). Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore: Brookes Publishing. ISBN 1-55766-283-5. 71. ^ "Global Status Report on Alcohol 2004" (PDF). World Health Organization. http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf. Retrieved on 2007-01-03. 72. ^ "Economic cost of alcohol consumption". World Health Organization Global Alcohol Database. http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2. Retrieved on 2007-01-03. 73. ^ "Q&A: The costs of alcohol". BBC. 2003-09-19. http://news.bbc.co.uk/1/hi/health/3122244.stm. 74. ^ "World/Global Alcohol/Drink Consumption 2007". http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm. 75. ^ "The World's Drunks: The Irish". http://clippednews.wordpress.com/2007/03/14/the-worlds-drunks-the-irish/. 76. ^ Stivers, Richard (2000). Hair of the dog: Irish drinking and its American stereotype. London: Continuum. ISBN 0-8264-1218-1.

Alcoholism is a term with multiple and sometimes conflicting definitions to describe the detrimental effects of alcohol intake. In common and historic usage, alcoholism refers to any condition that results in the continued consumption of alcoholic beverages despite health problems and negative social consequences. Modern medical definitions<a href="#fn1">1</a> describe alcoholism as a disease and addiction which results in a persistent use of alcohol despite negative consequences. In the 19th and early 20th centuries, alcoholism, also referred to as dipsomania<a href="#fn2">2</a> described a preoccupation with, or compulsion toward the consumption of, alcohol and/or an impaired ability to recognize the negative effects of excessive alcohol consumption. Although not all of these definitions specify current and on-going use of alcohol as a qualifier for alcoholism, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including dependence and symptoms of withdrawal. While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. It is estimated that 9% of the general population is pre disposed to alcoholism based on genetic factors. The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, stress,<a href="#fn3">3</a> emotional health, genetic predisposition, age, and gender have been identified. For example, those who consume alcohol at an early age, by age 16 or younger, are at a higher risk of alcohol dependence or abuse. Also, studies indicate that the proportion of men with alcohol dependence are higher than that of the proportion of women, 7% and 2.5% respectively. Although women are more vulnerable to long-term consequences of alcoholism. In general, about 90% of adults in United States consume alcohol and more than 700,000 of them have been treated for alcoholism. <a href="#fn4">4</a> Definitions and terminology The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public. Medical definitions The Journal of the American Medical Association defines alcoholism as “a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking.”<a href="#fn5">5</a> The DSM-IV (the standard for diagnosis in psychiatry and psychology) defines alcohol abuse as repeated use despite recurrent adverse consequences.<a href="#fn6">6</a> It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.<a href="#fn6">6</a> (See DSM diagnosis below.) According to the APA Dictionary of Psychology, alcoholism is the popular term for alcohol dependence.<a href="#fn6">6</a> Note that there is debate whether dependence in this use is physical (characterised by withdrawal), psychological (based on reinforcement), or both. Terminology Many terms are applied to a drinker’s relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. The introduction of politics and religion further muddles the issue. Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse, problem use, abuse,<a href="#fn7">7</a> and heavy use do not have standard definitions, but suggest consumption of alcohol to the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual. Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, abuse can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition. Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into early or sustained, and partial or full. The fellowship known as Alcoholics Anonymous does not use the term “remission” because AA’s basic text, which was first published in 1939, uses the terms “recover” and “recovered” to describe those who have stopped consuming alcohol by addressing their underlying problem. On page 64, the AA text says “Our liquor was but a symptom. So we had to get down to causes and conditions.”<a href="#fn8">8</a> Etymology The term “alcoholism” was first used in 1849 by the physician Magnus Huss to describe the systematic adverse effects of alcohol.<a href="#fn9">9</a> In the United States, use of the word “alcoholism” was[citation needed] largely popularized by the founding and growth of Alcoholics Anonymous in 1935. AA’s basic text, known as the “Big Book,” describes alcoholism as an illness that involves a physical allergy<a href="#fn8">8</a>:p.xxviii and a mental obsession.<a href="#fn8">8</a>:p.23<a href="#fn10">10</a> Note that the definition of “allergy” used in this context is not the same as used in modern medicine.<a href="#fn11">11</a> A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism.<a href="#fn12">12</a> Jellinek’s definition restricted the use of the word “alcoholism” to those showing a particular natural history. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.<a href="#fn13">13</a> A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele, argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term “heavy drinking” when discussing the negative effects of alcohol consumption. Epidemiology Substance use disorders are a major public health problem facing many countries. “The most common substance of abuse/dependence in patients presenting for treatment is alcohol.”<a href="#fn15">15</a> In the United Kingdom, the number of ‘dependent drinkers’ was calculated as over 2.8 million in 2001.<a href="#fn16">16</a> The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence.<a href="#fn17">17</a><a href="#fn18">18</a> Within the medical and scientific communities, there is broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that “drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity).”<a href="#fn13">13</a> Current evidence indicates that in both men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.<a href="#fn19">19</a> A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adult alcoholics and found that after one year some were no longer alcoholics, even though only 25.5% of the group received any treatment,<a href="#fn20">20</a> with the breakdown as follows: <ul> <li>25% still dependent</li> <li>27.3% in partial remission (some symptoms persist)</li> <li>11.8% asymptomatic drinkers (consumption increases chances of relapse)</li> <li>35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers.</li> </ul> In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that “return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence.”<a href="#fn21">21</a> Vaillant also noted that “return-to-controlled drinking, as reported in short-term studies, is often a mirage.” Identification and diagnosis Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be difficult because there is no detectable physiologic difference between a person who drinks frequently and a person with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker’s life compared with the subjective benefits the drinker perceives from consuming alcohol. While there are many cases where an alcoholic’s life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify. Unless they have M.C. type symptoms, and in these cases are probably alcoholics, no diagnosis needed. Addiction Medicine specialists have extensive training with respect to diagnosing and treating patients with alcoholism. Screening Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use. <ul> <li>The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor’s office.</li> </ul> Two “yes” responses indicate that the respondent should be investigated further. The questionnaire asks the following questions: 1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?<a href="#fn22">22</a><a href="#fn23">23</a> The CAGE questionnaire, among others, has been extensively validated for use in identifying alcoholism. It is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE are frequently implemented for such a purpose. <ul> <li>The Alcohol Dependence Data Questionnaire is a more sensitive diagnostic test than the CAGE test.<a href="#fn24">24</a> It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.</li> </ul> <ul> <li>The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,<a href="#fn25">25</a> driving under the influence being the most common.</li> </ul> <ul> <li>The Alcohol Use Disorders Identification Test (AUDIT) is a screening questionnaire developed by the World Health Organization. This test is unique in that it has been validated in six countries and is used internationally.<a href="#fn26">26</a> Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.</li> </ul> <ul> <li>The Paddington Alcohol Test (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.<a href="#fn27">27</a></li> </ul> Genetic predisposition testing Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism does not have a single cause—including genetic—but that genes do play an important role “by affecting processes in the body and brain that interact with one another and with an individual’s life experiences to produce protection or susceptibility.” They also report that fewer than a dozen alcoholism-related genes have been identified, but that more likely await discovery.<a href="#fn28">28</a> At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction.<a href="#fn29">29</a> Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol.<a href="#fn30">30</a> Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.<a href="#fn28">28</a> DSM diagnosis The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared with one another. According to the DSM-IV, an alcohol dependence diagnosis is: …maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae. Urine and blood tests There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including: <ul> <li>Macrocytosis (enlarged MCV)1</li> <li>Elevated GGT²</li> <li>Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1.</li> <li>High carbohydrate deficient transferrin (CDT)</li> </ul> However, none of these blood tests for biological markers are as sensitive as screening questionaires. Effects of long term alcohol misuse The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging to physical health. The secondary damage caused by an inability to control one’s drinking manifests in many ways. Alcoholism also has significant social costs to both the alcoholic and their family and friends. Alcoholics have a very high suicide rate and studies show between 8% and 21% of alcoholics commit suicide. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5,080 times that of the general public.<a href="#fn31">31</a> Physical health effects It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption may include cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources. Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol related making alcohol the 2nd leading cause of dementia.<a href="#fn32">32</a> Mental health effects Long term misuse of alcohol can cause a wide range of mental health effects. Alcohol misuse is not only toxic to the body but also to brain function and thus psychological well being can be adversely affected by the long-term effects of alcohol misuse. Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typically these psychiatric symptoms caused by alcohol misuse initially worsen during alcohol withdrawal but with abstinence these psychiatric symptoms typically gradually improve or disappear altogether.<a href="#fn33">33</a> Psychosis, confusion and organic brain syndrome may be induced by chronic alcohol abuse which can lead to a misdiagnosis of major mental health disorders such as schizophrenia.<a href="#fn34">34</a> Panic disorder can develop as a direct result of long term alcohol misuse. Panic disorder can also worsen or occur as part of the alcohol withdrawal syndrome.<a href="#fn35">35</a> Chronic alcohol misuse can cause panic disorder to develop or worsen an underlying panic disorder via distortion of the neurochemical system in the brain.<a href="#fn36">36</a> The co-occurence of major depressive disorder and alcoholism is well documented.<a href="#fn37">37</a><a href="#fn38">38</a><a href="#fn39">39</a> Among those with comorbid occurances, a distinction is commonly made between depressive episodes that are secondary to the pharmacological or toxic effects of heavy alcohol use and remit with abstinence, and depressive episodes that are primary and do not remit with abstinence. Additional use of other drugs may increase the risk of depression in alcoholics.<a href="#fn40">40</a> Depressive episodes with an onset prior to heavy drinking or those that continue in the absence of heavy drinking are typically referred to as “independent” episodes, whereas those that appear to be etiologically related to heavy drinking are termed “substance-induced”.<a href="#fn41">41</a><a href="#fn42">42</a><a href="#fn43">43</a> Social effects The social problems arising from alcoholism can be massive and are caused in part due to the serious pathological changes induced in the brain from prolonged alcohol misuse and partly because of the the intoxicating effects of alcohol.<a href="#fn32">32</a> Being drunk or hung over during work hours can result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic’s behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic’s children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided. Alcohol withdrawal Alcohol withdrawal differs significantly from most other drugs in that it can be directly fatal. Drugs which have a similar mechanism of action to alcohol also have a similar risk of causing death during withdrawal, including barbiturate and benzodiazepine withdrawal. For example it is extremely rare for heroin withdrawal to be fatal. When people die from heroin or cocaine withdrawal they typically have serious underlying health problems which are made worse by the strain of acute withdrawal. An alcoholic however, who has no serious health issues has a significant risk of dying from the direct effects of withdrawal if it is not properly managed. Alcohol’s primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. Thus when alcohol is stopped, especially abruptly, the person’s nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening seizures, delirium tremens and hallucinations, shakes and possible heart failure. Acute withdrawal symptoms tend to subside after 1 – 3 weeks. Less severe symptoms (e.g. insomnia and anxiety) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system makes adaptations to reverse tolerance and restore GABA function towards normal. Other neurotransmitter systems are involved, especially glutamate and NMDA. Treatments Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.<a href="#fn15">15</a> Texas Tech University in Lubbock, Texas, has developed a model to support college students who are in recovery from addictive disorders such as alcoholism. <a href="#fn44">44</a> Effectiveness When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.<a href="#fn45">45</a> A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed.<a href="#fn46">46</a> Detoxification Alcohol detoxification or ‘detox’ for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to prevent alcohol withdrawal. Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox is complete, relapse is likely without further treatment. These rehabilitations (or ‘rehabs’) may take place in an inpatient or outpatient setting. Group therapy and psychotherapy After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service. Alcoholics Anonymous was the first group, and has more members than all other programs combined. Some of the others include LifeRing Secular Recovery, Rational Recovery, SMART Recovery, and Women For Sobriety. Rationing and moderation Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency.<a href="#fn47">47</a> A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was “Abstinence represents the most stable form of remission for most recovering alcoholics”.<a href="#fn48">48</a> Medications A variety of medications may be prescribed as part of treatment for alcoholism. <ul> <li>Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and a related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50%.<a href="#fn49">49</a></li> </ul> <ul> <li>Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. Alcohol releases endorphins, hence when Naltrexone is in the body drinkers no longer get any pleasure from consuming alcohol. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction.</li> </ul> Naltrexone comes in two forms. Oral naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken one hour before drinking to be effective. For pharmacological extinction to be effect the medicine must be taken an hour before drinking for the rest of the patients life. Vivitrol is a time-release formulation that is injected in the buttocks once a month. <ul> <li>Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying “While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse… Campral proved superior to placebo in maintaining abstinence for a short period of time…”<a href="#fn50">50</a> The COMBINE study was unable to demonstrate efficacy for Acamprosate.<a href="#fn51">51</a></li> </ul> <ul> <li>Topiramate (brand name Topamax), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. In one study heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.<a href="#fn52">52</a><a href="#fn53">53</a> In another study, those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo.<a href="#fn54">54</a> Topiramate works by reducing dopamine so that drinkers no longer get any pleasure from consuming alcohol.</li> </ul> Dual addictions Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcoholics is a benzodiazepine dependence with studies showing 10 – 20% of alcoholics having problems of dependence and/or misuse problems of benzodiazepines. Dependence on other sedative hypnotics such as zolpidem and zopiclone as well as opiates also occurs as well as illegal drugs. Benzodiazepine withdrawal can like alcohol be medically severe and include the risk of psychosis and seizures if not managed properly.<a href="#fn55">55</a> Benzodiazepine dependency requires careful reduction in dosage to avoid a serious benzodiazepine withdrawal syndrome and health consequences. Benzodiazepines have the problem of increasing cravings for alcohol in problem alcohol consumers. Benzodiazepines also increase the volume of alcohol consumed by problem drinkers.<a href="#fn56">56</a> Women and alcoholism Alcoholism has a higher prevalence among men, though in recent decades, the number of female alcoholics has increased.<a href="#fn57">57</a> It is important to articulate the different biological and social ways alcoholism manifests in women in order to understand barriers to treatment and effective recovery strategies. Biological differences and physiological effects Biologically, women have symptom profiles from their alcohol use that differ in important ways from men. They experience a telescoping of physiological effects from alcohol use. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs).<a href="#fn58">58</a> This can be attributed to many reasons, the main being that women have less body water than men. A given amount of alcohol, therefore becomes more highly concentrated in a woman’s body. Besides this fact, women also become more intoxicated, which is due to different hormone release.<a href="#fn59">59</a> Women develop long-term complications of alcohol dependence more rapidly than do alcoholic men. Additionally, women have a higher mortality rate from alcoholism than men.<a href="#fn60">60</a> Examples of long term complications include brain, heart, and liver damage<a href="#fn61">61</a> and an increased risk for breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, irregular menses, amenorrhea, luteal phase dysfunction, and early menopause.<a href="#fn62">62</a> Psychological and emotional effects Psychiatric disorders are generally more prevalent among those with alcohol disorders. This is true for both men and women, however the disorders differ depending on gender. Women who have alcohol-use disorders have co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have co-occurring diagnosis of narcissistic and antisocial personality disorders, bipolar disorder, schizophrenia, impulse disorders and attention deficit/ hyperactivity disorder.<a href="#fn63">63</a> Women with alcoholism are also more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population.<a href="#fn64">64</a> This trauma can lead to higher instances of PTSD, depression, anxiety, and a greater dependence on alcohol. Societal barriers to treatment Attitudes and social stereotypes about women and alcohol can create barriers to the detection and treatment of female alcohol abusers. Such beliefs stigmatize women who drink by characterizing them as “both generally and sexually immoral” or the “fallen women.” Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.<a href="#fn65">65</a> Women also tend to have a greater fear that the negative implications from the stigma will reflect poorly on their families. This may also keep them from seeking help.<a href="#fn66">66</a> Implications for treatment Research has indicated a lack of adequate training for practitioners both in problematic alcohol use in general, and in relation to women’s issues.<a href="#fn67">67</a> The complexity of alcohol use disorders, particularly with gender-related issues, indicates that the need for practitioners’ knowledge, insight and compassion is enormous.<a href="#fn68">68</a> Better education and awareness surrounding the gender implications of alcoholism will help care providers to adequately treat women who suffer from alcoholism. Early intervention will also increase the probability of recovery. Societal impact The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is also the pain and suffering of the individuals besides the alcoholic affected. For instance, alcohol consumption by a pregnant woman can lead to Fetal alcohol syndrome,<a href="#fn69">69</a> an incurable and damaging condition.<a href="#fn70">70</a> Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country’s GDP.<a href="#fn71">71</a> One Australian estimate pegged alcohol’s social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol’s share was 41 per cent.<a href="#fn72">72</a> A study quantified the cost to the UK of all forms of alcohol misuse as £18.5–20 billion annually (2001 figures).<a href="#fn73">73</a><a href="#fn16">16</a> Stereotypes Stereotypes of alcoholics are often found in fiction and popular culture. The ‘town drunk’ is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers.<a href="#fn74">74</a><a href="#fn75">75</a> In Australia, Canada, and the United States, Aboriginal people have similarly been stereotyped as alcoholics. On the other hand, studies by social psychologists Stivers and Greeley<a href="#fn76">76</a> attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America. In film and literature In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. The disjoined narrative of Patrick Hamilton’s Hangover Square reflects the alcoholism of its central character. A famous depiction of alcoholism, and the psychology of an alcoholic, is in Malcolm Lowry’s widely acclaimed novel Under the Volcano, which details the final day of the British consul Geoffrey Firmin on the Day of the Dead in 1939 Mexico and his choice to continue his extreme alcohol consumption instead of returning to the wife he loves. Films like Bad Santa, Days of Wine and Roses, My Name is Bill W., Withnail and I, Arthur, Leaving Las Vegas, Shattered Spirits and The Lost Weekend, chronicle similar stories of alcoholism. Politics and public health Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs. References 1. ^ The American Medical Association “Definitions” 2. ^ <a href="http://www.dictionary.com">www.dictionary.com</a>,Definition: dipsomania 3. ^ Glavas MM, Weinberg J (2006). “Stress, Alcohol Consumption, and the Hypothalamic-Pituitary-Adrenal Axis”. in Yehuda S, Mostofsky DI. Nutrients, Stress, and Medical Disorders. Totowa, NJ: Humana Press. pp. 165–183. ISBN 978-1-58829-432-6. 4. ^ [h<a href="http://health.nytimes.com/health/guides/disease/alcoholism/risk-factors.html">http://health.nytimes.com/health/guides/disease…</a> “Alcoholism”]. A.D.A.M. Inc. h<a href="http://health.nytimes.com/health/guides/disease/alcoholism/risk-factors.html">http://health.nytimes.com/health/guides/disease…</a>. Retrieved on 2009-03-17. 5. ^ Morse RM, Flavin DK (August 1992). “The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism”. JAMA : the journal of the American Medical Association 268 (8): 1012–4. doi:10.1001/jama.268.8.1012. PMID 1501306. 6. ^ a b c APA Dictionary of Psychology, 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007 7. ^ To use wrongly or improperly; misuse: abuse alcohol; The American Heritage Dictionary of the English Language, 4th ed. 8. ^ a b c Anonymous; The first 100 members of AA (1939, 2001). [<a href="http://www.aa.org">www.aa.org</a> Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism]. New York City: Alcoholics Anonymous World Services. xxxii, 575 p.. ISBN 1893007162. <a href="http://www.aa.org">www.aa.org</a>. 9. ^ “Alcoholismus chronicus, eller Chronisk alkoholssjukdom:”. Stockholm und Leipzig. <a href="http://books.google.com/books?hl=en&lr=&id=wt6r2Zw8sCEC&oi=fnd&pg=PR5&ots=TTCBeEzjQ2&sig=jxuMZ5wgL48SZjvu1PcwXIdjFJw#PPP1">http://books.google.com/books?hl=en&lr=&id=wt6r…</a>,M1. Retrieved on 2008-02-19. 10. ^ “The Big Book Self Test:”. intoaction.us. <a href="http://www.intoaction.us/SelfTest.html">http://www.intoaction.us/SelfTest.html</a>. Retrieved on 2008-02-19. 11. ^ Kay AB (2000). “Overview of ‘allergy and allergic diseases: with a view to the future’”. Br. Med. Bull. 56 (4): 843–64. doi:10.1258/0007142001903481. PMID 11359624. 12. ^ “OCTOBER 22 DEATHS”. todayinsci.com. <a href="http://www.todayinsci.com/10/10_22.htm">http://www.todayinsci.com/10/10_22.htm</a>. Retrieved on 2008-02-18. 13. ^ a b <a href="http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf">http://www.ama-assn.org/ama1/pub/upload/mm/388/…</a> 14. ^ Global Status Report on Alcohol 2004 15. ^ a b Gabbard: “Treatments of Psychiatric Disorders”. Published by the American Psychiatric Association: 3rd edition, 2001, ISBN 0-88048-910-3 16. ^ a b Cabinet Office Strategy Unit Alcohol misuse: How much does it cost? September 2003 17. ^ WHO European Ministerial Conference on Young People and Alcohol 18. ^ WHO to meet beverage company representatives to discuss health-related alcohol issues 19. ^ Dick DM, Bierut LJ (April 2006). “The genetics of alcohol dependence”. Current psychiatry reports 8 (2): 151–7. PMID 16539893. 20. ^ National Institute on Alcohol Abuse and Alcoholism 2001-2002 Survey Finds That Many Recover From Alcoholism Press release 18 January 2005. 21. ^ Vaillant GE (2003). “A 60-year follow-up of alcoholic men”. Addiction. 98: 1043–51. doi:10.1046/j.1360-0443.2003.00422.×. PMID 12873238. 22. ^ Ewing JA (October 1984). “Detecting alcoholism. The CAGE questionnaire”. JAMA : the journal of the American Medical Association 252 (14): 1905–7. doi:10.1001/jama.252.14.1905. PMID 6471323. 23. ^ CAGE Questionnaire (PDF) 24. ^ Alcohol Dependence Data Questionnaire (SADD) 25. ^ Michigan Alcohol Screening Test (MAST) 26. ^ AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care 27. ^ Smith, SG; R Touquet, S Wright and N Das Gupta (September 1996). “Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)”. Journal of Accident and Emergency Medicine (British Association for Accident and Emergency Medicine) 13 (5): 308–312. doi:10.1093/alcalc/agh049. PMID 8894853. <a href="http://emj.bmj.com/cgi/content/abstract/13/5/308?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&title=Paddington+Alcohol+Test&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT">http://emj.bmj.com/cgi/content/abstract/13/5/30…</a>,HWELTR. Retrieved on 2006-11-19. 28. ^ a b Nurnberger, Jr., John I., and Bierut, Laura Jean. “Seeking the Connections: Alcoholism and our Genes.” Scientific American, Apr2007, Vol. 296, Issue 4. 29. ^ New York Daily News (William Sherman) Test targets addiction gene 11 February 2006 30. ^ Berggren U, Fahlke C, Aronsson E, et al (2006). “The taqI DRD2 A1 allele is associated with alcohol-dependence although its effect size is small”. Alcohol and alcoholism (Oxford, Oxfordshire) 41 (5): 479–85. doi:10.1093/alcalc/agl043. PMID 16751215. 31. ^ Kendall RE (1983). “Alcohol and suicide”. Subst Alcohol Actions Misuse 4 (2-3): 121–7. PMID 6648755. 32. ^ a b Professor Georgy Bakalkin (8 July 2008). “Alcoholism-associated molecular adaptations in brain neurocognitive circuits”. eurekalert.org. <a href="http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php">http://www.eurekalert.org/pub_releases/2008-07/…</a>. Retrieved on 14 February 2009. 33. ^ Wetterling T; Junghanns K (September 2000). “Psychopathology of alcoholics during withdrawal and early abstinence”. Eur Psychiatry 15 (8): 483–8. doi:10.1016/S0924-9338(00)00519-8. PMID 11175926. 34. ^ Schuckit MA (November 1983). “Alcoholism and other psychiatric disorders”. Hosp Community Psychiatry 34 (11): 1022–7. PMID 6642446. 35. ^ Cowley DS (January 24, 1992). “Alcohol abuse, substance abuse, and panic disorder”. Am J Med 92 (1A): 41S–48S. doi:10.1016/0002-9343(92)90136-Y. PMID 1346485. 36. ^ Cosci F; Schruers KR, Abrams K, Griez EJ (June 2007). “Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship”. J Clin Psychiatry 68 (6): 874–80. PMID 17592911. 37. ^ Grant BF, Harford TC (October 1995). “Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey”. Drug Alcohol Depend 39 (3): 197–206. PMID 8556968. <a href="http://linkinghub.elsevier.com/retrieve/pii/0376871695011604">http://linkinghub.elsevier.com/retrieve/pii/037…</a>. 38. ^ Kandel DB, Huang FY, Davies M (October 2001). “Comorbidity between patterns of substance use dependence and psychiatric syndromes”. Drug Alcohol Depend 64 (2): 233–41. PMID 11543993. 39. ^ Cornelius JR, Bukstein O, Salloum I, Clark D (2003). “Alcohol and psychiatric comorbidity”. Recent Dev Alcohol 16: 361–74. PMID 12638646. 40. ^ Schuckit M (June 1983). “Alcoholic patients with secondary depression”. Am J Psychiatry 140 (6): 711–4. PMID 6846629. <a href="http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=6846629.">http://ajp.psychiatryonline.org/cgi/pmidlookup?…</a> 41. ^ Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL (July 1997). “Comparison of induced and independent major depressive disorders in 2,945 alcoholics”. Am J Psychiatry 154 (7): 948–57. PMID 9210745. <a href="http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=9210745.">http://ajp.psychiatryonline.org/cgi/pmidlookup?…</a> 42. ^ Schuckit MA, Tipp JE, Bucholz KK, et al (October 1997). “The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls”. Addiction 92 (10): 1289–304. PMID 9489046. <a href="http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm">http://www3.interscience.wiley.com/resolve/open…</a>:pubmed&issn=0965-2140&date=1997&volume=92&issue=10&spage=1289. 43. ^ Schuckit MA, Smith TL, Danko GP, et al (November 2007). “A comparison of factors associated with substance-induced versus independent depressions”. J Stud Alcohol Drugs 68 (6): 805–12. PMID 17960298. 44. ^ Chris Volkmann (2006). From Binge to Blackout: A Mother and Son Struggle with Teen Drinking. New American Library. pp. 152. ISBN 978-0451219091. 45. ^ Smart RG (April 1976). “Spontaneous recovery in alcoholics: a review and analysis of the available research”. Drug and alcohol dependence 1 (4): 277–85. doi:10.1016/0376-8716(76)90023-5. PMID 797563. 46. ^ Based on information from Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism, the February 2007 issue of Newsweek – Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. “Rehab Reality Check” Newsweek, 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c 47. ^ Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ (March 2005). “Recovery from DSM-IV alcohol dependence: United States, 2001-2002”. Addiction (Abingdon, England) 100 (3): 281–92. doi:10.1111/j.1360-0443.2004.00964.×. PMID 15733237. 48. ^ Dawson DA, Goldstein RB, Grant BF (December 2007). “Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up”. Alcoholism, clinical and experimental research 31 (12): 2036–45. doi:10.1111/j.1530-0277.2007.00536.×. PMID 18034696. 49. ^ Krampe H, Stawicki S, Wagner T, et al (January 2006). “Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome”. Alcoholism, clinical and experimental research 30 (1): 86–95. doi:10.1111/j.1530-0277.2006.00013.×. PMID 16433735. 50. ^ “FDA Approves New Drug for Treatment of Alcoholism”. <a href="http://www.fda.gov/bbs/topics/answers/2004/ANS01302.html">http://www.fda.gov/bbs/topics/answers/2004/ANS0…</a>. Retrieved on 2006-04-02. " 51. ^ “Naltrexone or Specialized Alcohol Counseling an Effective Treatment for Alcohol Dependence When Delivered with Medical Management”. 2006-05-02. <a href="http://www.niaaa.nih.gov/NewsEvents/NewsReleases/COMBINERelease.htm">http://www.niaaa.nih.gov/NewsEvents/NewsRelease…</a>. 52. ^ Johnson BA, Ait-Daoud N, Bowden CL, et al (May 2003). “Oral topiramate for treatment of alcohol dependence: a randomised controlled trial”. Lancet 361 (9370): 1677–85. doi:10.1016/S0140-6736(03)13370-3. PMID 12767733. 53. ^ Swift RM (May 2003). “Topiramate for the treatment of alcohol dependence: initiating abstinence”. Lancet 361 (9370): 1666–7. doi:10.1016/S0140-6736(03)13378-8. PMID 12767727. 54. ^ Johnson BA, Rosenthal N, Capece JA, et al (October 2007). “Topiramate for treating alcohol dependence: a randomized controlled trial”. JAMA : the journal of the American Medical Association 298 (14): 1641–51. doi:10.1001/jama.298.14.1641. PMID 17925516. 55. ^ Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I (2003). “Dependence on legal psychotropic drugs among alcoholics” (PDF). Alcohol Alcohol. 38 (6): 613–8. PMID 14633651. <a href="http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613">http://alcalc.oxfordjournals.org/cgi/reprint/38…</a>. 56. ^ Poulos CX, Zack M (November 2004). “Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers”. Behav Pharmacol 15 (7): 503–12. PMID 15472572. 57. ^ Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al (June 2003). “gender-specific differences in alcoholism: implications for treatment”. Archives of Women’s Mental Health 6: 253–268. doi:10.1007/s/00737-003-0014-8. 58. ^ Karrol Brad R. (2002). “women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners”. Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 59. ^ Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al (June 2003). “gender-specific differences in alcoholism: implications for treatment”. Archives of Women’s Mental Health 6: 253–268. doi:10.1007/s/00737-003-0014-8. 60. ^ Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). “Alcoholism and alcohol abuse among women: report of the council on scientific affairs”. Journal of women’s health 7 (7): 861–870. 61. ^ Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al (June 2003). “gender-specific differences in alcoholism: implications for treatment”. Archives of Women’s Mental Health 6: 253–268. doi:10.1007/s/00737-003-0014-8. 62. ^ Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). “Alcoholism and alcohol abuse among women: report of the council on scientific affairs”. Journal of women’s health 7 (7): 861–870. 63. ^ Karrol Brad R. (2002). “women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners”. Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 64. ^ Karrol Brad R. (2002). “women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners”. Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 65. ^ Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). “Alcoholism and alcohol abuse among women: report of the council on scientific affairs”. Journal of women’s health 7 (7): 861–870. 66. ^ Karrol Brad R. (2002). “women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners”. Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 67. ^ Karrol Brad R. (2002). “women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners”. Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 68. ^ Karrol Brad R. (2002). “women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners”. Journal of social work 2 (3): 337–356. doi:1468-0173(200212)2:3;337-356;029430. 69. ^ CDC. (2004). Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Can be downloaded at <a href="http://www.cdc.gov/fas/faspub.htm">http://www.cdc.gov/fas/faspub.htm</a> 70. ^ Streissguth, A. (1997). Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore: Brookes Publishing. ISBN 1-55766-283-5. 71. ^ “Global Status Report on Alcohol 2004” (PDF). World Health Organization. <a href="http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf">http://www.who.int/substance_abuse/publications…</a>. Retrieved on 2007-01-03. 72. ^ “Economic cost of alcohol consumption”. World Health Organization Global Alcohol Database. <a href="http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2.">http://www.who.int/globalatlas/dataQuery/object…</a> Retrieved on 2007-01-03. 73. ^ “Q&A: The costs of alcohol”. BBC. 2003-09-19. <a href="http://news.bbc.co.uk/1/hi/health/3122244.stm">http://news.bbc.co.uk/1/hi/health/3122244.stm</a>. 74. ^ “World/Global Alcohol/Drink Consumption 2007”. <a href="http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm">http://www.finfacts.ie/Private/bestprice/alcoho…</a>. 75. ^ “The World’s Drunks: The Irish”. <a href="http://clippednews.wordpress.com/2007/03/14/the-worlds-drunks-the-irish/">http://clippednews.wordpress.com/2007/03/14/the…</a>. 76. ^ Stivers, Richard (2000). Hair of the dog: Irish drinking and its American stereotype. London: Continuum. ISBN 0-8264-1218-1.

2009-03-18T20:38:40Z

http://en.wikipedia.org/wiki/Alcoholism

Alcoholism - General Information

Tina Tessina, Ph.D.

Anger is the emotional energy within each of us that rises up when something needs to change. If you act on the need to create change, your anger can be channeled effectively; but it’s not redirected to something effective, your frustration will build, sometimes to hurricane force. Anger that is allowed to get out of control is as destructive as a hurricane, but anger that is expressed in healthy ways can “clear the air” just as a mild rainstorm does. If you express your anger clearly and cleanly, without too much drama, it will be like a cleansing rain, leaving you calm and relaxed, and the problem solved. People who have angry outbursts, whether at spouses or freeway traffic, have poor impulse control. They are often emotionally “stuck” in the early childhood temper tantrum stage (about age 2 1/2 to 3) because they never learned to manage their own anger. Whoever was supposed to help them manage their temper, such as parents or teachers, were absent, intimidated or helpless, and allowed the child to grow into a raging adult. People who are prone to violent outbursts may also have witnessed a family member who was a “rageaholic” and frequently angry or violent. People who rage don’t know how to do "emotional maintenance" and shake off stress. They also don't know how to quit when something is getting to them. Those who allow themselves to rage don't know how to tell they're on the brink, or how to stop. They often have a sense of entitlement (“I just have a bad temper”) and a lack of emotional maturity. For the people subjected to the angry outburst, it’s actually like dealing with a tantrum-throwing three year old in an adult body, which is dangerous. The difference between people who lose their temper (throw fits, throw objects, scream and yell) and those who don't is that those with self control can feel that they're getting upset, getting close to “losing it.” With enough harassment and pressure, anyone can be goaded into rage. People who usually keep control of their anger just stop or leave the situation earlier; before they are pushed so far. They respect their own anger, and deal with it effectively. As soon as they feel their emotions getting out of control, they stop what they're doing, walk away, change their thinking or attitude, write out their upset, pray, or call a friend to get calmed down. Once an angry person understands that just spewing anger about is not healthy or functional, anger management is not difficult to learn. Most habitually angry people have a feeling of entitlement (“I can’t change who I am”) that prevents them from wanting to control their anger. Once they understand that shouting, blaming, raging and being violent doesn't accomplish anything; that it ruins relationships, and makes them look weak, rather than powerful, then learning to control anger is not hard. I tell clients who see me for anger management that “He who loses it, loses,” because no matter who started it, or who’s to blame, once you lose your temper, you become the bad guy. You Have Choices To solve your anger problems, make some choices: Do you want to keep doing what you're doing, or do you want to learn self control and have a life that works? Do you want to look macho or controlling, or do you want to be successful? Do you want to be right, or be loved? In every case, learning to control your anger and act responsibly will get you more of what you want from life. If you or your partner tends to get loud and obnoxious frequently, it's a bigger problem than just struggling. Perhaps you need to swear off drinking, or get some therapy. No matter what, you must find a way to end this childish and demeaning behavior. If your partner tends to be too argumentative, use behavioral training: Treat him or her very well as long as he or she's agreeable and will discuss things calmly. If your spouse gets oppositional and controlling; try being silent. Do not respond at all. If your partner doesn't stop after a few moments, or if she or he gets louder, that may be evidence of anger management problems. Out of control yelling and bad behavior is actually a childish temper tantrum, and it is not necessary to put up with it. Leave on the spot. If you’re home, go to another room, or take a walk. If you're dining out, take a taxi, leave money for the bill if there is one, but get out of there. It doesn't matter how important the occasion is; it's ruined anyway. Once your mate realizes you're not going to put up with bad behavior, he or she will hopefully understand it is unacceptable, and change it if possible, or perhaps even get necessary therapy. The person who loses his or her temper looks like the bad guy to everyone else, no matter who started the problem, or who is really at fault. Keeping your cool is a very important social skill. It doesn't matter who's right, who started it, or whether it's fair. He (or she) who "loses it" to win an argument actually loses everything instead. To get better at controlling your anger, use the following exercise to visualize a scene where you got angry, and replay the tape several times, to get a clear picture of yourself responding in different ways. When you do this, you are actually rehearsing different reactions, and giving yourself new options. You always have choices: you can laugh, walk away, get thoughtful, be afraid, be angry or be reasonable. Exercise: Rewinding the Tape 1. Imagine a previous angry situation as if it’s occurring now. Get as clear a picture of the scene as possible, imagining what people are wearing, what the room looks like, etc. 2. Mentally play the scene as if it's a video, and see how it develops. Don't worry if it plays out according to your worst fears; just watch it as you would any video. 3. Because this scene didn’t go well originally, consider what you'd like to change about what you're doing (remember, you can't control the others in the scene, but you can get them to respond differently by giving them something different to respond to.) Rewind and replay this mental image, trying new ways to handle it until you are successful (that is, you handle the situation without losing your temper). 4. Play the tape a few more times, with this successful process and outcome, until you feel confident you can do and say what you are visualizing. 5. Play the tape again and again, visualizing your successful outcome. The more you replay it, and practice your new responses, the easier it will be to access them in the next discussion. 6. You have just reprogrammed your mind to create some new responses to tense or angry situations, and you'll find these responses are available to you when you need them. Use this technique any time you're concerned about an upcoming discussion or confrontation. Adapted with permission from: Money, Sex and Kids: Stop Squabbling About the Three Things That Can Destroy Your Marriage (Adams Media) ISBN# 978-1-59869-325-6 © Tina B.Tessina, 2008 Tina B. Tessina, Ph.D. is a licensed psychotherapist in S. California, with over 30 years' experience in counseling individuals and couples and author of thirteen books in seventeen languages, including It Ends With You: Grow Up and Out of Dysfunction (New Page); How to Be a Couple and Still Be Free (New Page); The Unofficial Guide to Dating Again (Wiley) and The Real 13th Step: Discovering Self-Confidence, Self-Reliance and Independence Beyond the Twelve Step Programs (New Page.) Her newest book, from Adams Press in 2008, is : Money, Sex and Kids: Stop Fighting About the Three Things That Can Ruin Your Marriage and Commuter Marriage. She publishes “Happiness Tips from Tina”, an e-mail newsletter, and the “Dr. Romance Blog” and has hosted "The Psyche Deli: Delectable Tidbits for the Subconscious," a weekly hour long radio show. Online, she is “Dr. Romance” with columns at Divorce360.com, CougarCandy.com, and Yahoo!Personals, as well as a Redbook Love Network expert. Dr. Tessina guests frequently on radio, and such TV shows as ,Oprah, Larry King Live and ABC News. Follow her on Twitter at Twitter.com/tinatessina, or look for her blog at http://drromance.typepad.com/dr_romance_blog/.

Anger is the emotional energy within each of us that rises up when something needs to change. If you act on the need to create change, your anger can be channeled effectively; but it’s not redirected to something effective, your frustration will build, sometimes to hurricane force. Anger that is allowed to get out of control is as destructive as a hurricane, but anger that is expressed in healthy ways can “clear the air” just as a mild rainstorm does. If you express your anger clearly and cleanly, without too much drama, it will be like a cleansing rain, leaving you calm and relaxed, and the problem solved. People who have angry outbursts, whether at spouses or freeway traffic, have poor impulse control. They are often emotionally “stuck” in the early childhood temper tantrum stage (about age 2 1/2 to 3) because they never learned to manage their own anger. Whoever was supposed to help them manage their temper, such as parents or teachers, were absent, intimidated or helpless, and allowed the child to grow into a raging adult. People who are prone to violent outbursts may also have witnessed a family member who was a “rageaholic” and frequently angry or violent. People who rage don’t know how to do “emotional maintenance” and shake off stress. They also don’t know how to quit when something is getting to them. Those who allow themselves to rage don’t know how to tell they’re on the brink, or how to stop. They often have a sense of entitlement (“I just have a bad temper”) and a lack of emotional maturity. For the people subjected to the angry outburst, it’s actually like dealing with a tantrum-throwing three year old in an adult body, which is dangerous. The difference between people who lose their temper (throw fits, throw objects, scream and yell) and those who don’t is that those with self control can feel that they’re getting upset, getting close to “losing it.” With enough harassment and pressure, anyone can be goaded into rage. People who usually keep control of their anger just stop or leave the situation earlier; before they are pushed so far. They respect their own anger, and deal with it effectively. As soon as they feel their emotions getting out of control, they stop what they’re doing, walk away, change their thinking or attitude, write out their upset, pray, or call a friend to get calmed down. Once an angry person understands that just spewing anger about is not healthy or functional, anger management is not difficult to learn. Most habitually angry people have a feeling of entitlement (“I can’t change who I am”) that prevents them from wanting to control their anger. Once they understand that shouting, blaming, raging and being violent doesn’t accomplish anything; that it ruins relationships, and makes them look weak, rather than powerful, then learning to control anger is not hard. I tell clients who see me for anger management that “He who loses it, loses,” because no matter who started it, or who’s to blame, once you lose your temper, you become the bad guy. You Have Choices To solve your anger problems, make some choices: Do you want to keep doing what you’re doing, or do you want to learn self control and have a life that works? Do you want to look macho or controlling, or do you want to be successful? Do you want to be right, or be loved? In every case, learning to control your anger and act responsibly will get you more of what you want from life. If you or your partner tends to get loud and obnoxious frequently, it’s a bigger problem than just struggling. Perhaps you need to swear off drinking, or get some therapy. No matter what, you must find a way to end this childish and demeaning behavior. If your partner tends to be too argumentative, use behavioral training: Treat him or her very well as long as he or she’s agreeable and will discuss things calmly. If your spouse gets oppositional and controlling; try being silent. Do not respond at all. If your partner doesn’t stop after a few moments, or if she or he gets louder, that may be evidence of anger management problems. Out of control yelling and bad behavior is actually a childish temper tantrum, and it is not necessary to put up with it. Leave on the spot. If you’re home, go to another room, or take a walk. If you’re dining out, take a taxi, leave money for the bill if there is one, but get out of there. It doesn’t matter how important the occasion is; it’s ruined anyway. Once your mate realizes you’re not going to put up with bad behavior, he or she will hopefully understand it is unacceptable, and change it if possible, or perhaps even get necessary therapy. The person who loses his or her temper looks like the bad guy to everyone else, no matter who started the problem, or who is really at fault. Keeping your cool is a very important social skill. It doesn’t matter who’s right, who started it, or whether it’s fair. He (or she) who “loses it” to win an argument actually loses everything instead. To get better at controlling your anger, use the following exercise to visualize a scene where you got angry, and replay the tape several times, to get a clear picture of yourself responding in different ways. When you do this, you are actually rehearsing different reactions, and giving yourself new options. You always have choices: you can laugh, walk away, get thoughtful, be afraid, be angry or be reasonable. Exercise: Rewinding the Tape 1. Imagine a previous angry situation as if it’s occurring now. Get as clear a picture of the scene as possible, imagining what people are wearing, what the room looks like, etc. 2. Mentally play the scene as if it’s a video, and see how it develops. Don’t worry if it plays out according to your worst fears; just watch it as you would any video. 3. Because this scene didn’t go well originally, consider what you’d like to change about what you’re doing (remember, you can’t control the others in the scene, but you can get them to respond differently by giving them something different to respond to.) Rewind and replay this mental image, trying new ways to handle it until you are successful (that is, you handle the situation without losing your temper). 4. Play the tape a few more times, with this successful process and outcome, until you feel confident you can do and say what you are visualizing. 5. Play the tape again and again, visualizing your successful outcome. The more you replay it, and practice your new responses, the easier it will be to access them in the next discussion. 6. You have just reprogrammed your mind to create some new responses to tense or angry situations, and you’ll find these responses are available to you when you need them. Use this technique any time you’re concerned about an upcoming discussion or confrontation. Adapted with permission from: Money, Sex and Kids: Stop Squabbling About the Three Things That Can Destroy Your Marriage (Adams Media) ISBN# 978-1-59869-325-6 © Tina B.Tessina, 2008 Tina B. Tessina, Ph.D. is a licensed psychotherapist in S. California, with over 30 years’ experience in counseling individuals and couples and author of thirteen books in seventeen languages, including It Ends With You: Grow Up and Out of Dysfunction (New Page); How to Be a Couple and Still Be Free (New Page); The Unofficial Guide to Dating Again (Wiley) and The Real 13th Step: Discovering Self-Confidence, Self-Reliance and Independence Beyond the Twelve Step Programs (New Page.) Her newest book, from Adams Press in 2008, is : Money, Sex and Kids: Stop Fighting About the Three Things That Can Ruin Your Marriage and Commuter Marriage. She publishes “Happiness Tips from Tina”, an e-mail newsletter, and the “Dr. Romance Blog” and has hosted “The Psyche Deli: Delectable Tidbits for the Subconscious,” a weekly hour long radio show. Online, she is “Dr. Romance” with columns at Divorce360.com, CougarCandy.com, and Yahoo!Personals, as well as a Redbook Love Network expert. Dr. Tessina guests frequently on radio, and such TV shows as ,Oprah, Larry King Live and ABC News. Follow her on Twitter at Twitter.com/tinatessina, or look for her blog at <a href="http://drromance.typepad.com/dr_romance_blog/">http://drromance.typepad.com/dr_romance_blog/</a>.

2009-05-19T16:22:23Z

235

http://www.tinatessina.com/anger.html

Anger: Cleansing Squall or Hurricane?

Wikipedia

Compulsive overeating, also sometimes called food addiction is characterized by an obsessive/compulsive relationship to food. Professionals address this with either a behaviour-modification model or a food-addiction model.[1] An individual suffering from compulsive overeating disorder engages in frequent episodes of uncontrolled eating, or bingeing, during which they may feel frenzied or out of control, often consuming food past the point of being comfortably full. Bingeing in this way is generally followed by feelings of guilt and depression. Unlike individuals with bulimia, compulsive overeaters do not attempt to compensate for their bingeing with purging behaviors such as fasting, laxative use or vomiting. Compulsive overeaters will typically eat when they are not hungry. Their obsession is demonstrated in that they spend excessive amounts of time and thought devoted to food, and secretly plan or fantasize about eating alone. Compulsive overeating usually leads to weight gain and obesity, but not everyone who is obese is also a compulsive overeater. In addition to binge eating, compulsive overeaters can also engage in grazing behavior, during which they return to pick at food throughout the day. This results in a large overall number of calories consumed even if the quantities eaten at any one time may be small. When a compulsive eater overeats primarily through bingeing, he or she can be said to have binge eating disorder. Where there is continuous overeating but no bingeing, then the sufferer has compulsive overeating disorder. Left untreated, compulsive overeating can lead to serious medical conditions including high cholesterol, diabetes, heart disease, hypertension, sleep apnea, and major depression. Additional long-term side effects of the condition also include kidney disease, arthritis, bone deterioration and stroke. Signs of compulsive overeating * Binge eating, or eating uncontrollably even when not physically hungry * Eating much more rapidly than normal * Eating alone due to shame and embarrassment * Feelings of guilt due to overeating * Preoccupation with body weight * Depression or mood swings * Awareness that eating patterns are abnormal * History of weight fluctuations * Withdrawal from activities because of embarrassment about weight * History of many different unsuccessful diets * Eating little in public, but maintaining a high body weight Addiction During binges compulsive overeaters consume as much as 5,000 calories and up to 60,000 calories per day, which results as an addictive "high" not unlike those experienced through drug usage, and a release from psychological stress. In bulimics, this high may be intensified by the act of purging. Researchers have speculated there is an abnormality of endorphin metabolism in the brain of binge eaters that triggers the addictive process. This is in line with other theories of addiction that attribute it not to avoidance of withdrawal symptoms, but to a primary problem in the reward centers of the brain. For the Compulsive Overeater, the ingestion of trigger foods causes release of the neurotransmitter, serotonin. This could be another sign of neurobiological factors contributing to the addictive process. Abstinence from addictive food and food eating processes causes withdrawal symptoms in those with eating disorders. There may be higher levels of depression and anxiety due to the decreased levels of serotonin in the individual.[2] There are complexities with the biology of compulsive eating that separate it from a pure substance abuse analogy. Food is a complex mixture of chemicals that can affect the body in multiple ways, which is magnified by stomach-brain communication. In some ways, it may be much more difficult for compulsive overeaters to recover than drug addicts. There is an anecdotal saying among Overeaters Anonymous members that "when you are addicted to drugs you put the tiger in the cage to recover; when you are addicted to food you put the tiger in the cage, but take it out three times a day for a walk."[2] The physical explanation of compulsive overeating may be attributed to an overeaters' increased tendency to secrete insulin at the sight and smell of food, though medical evidence supporting this is controversial.[3] Some researchers also attribute it to excessive neurological sensitivity in taste and/or smell. Recovery from compulsive overeating Compulsive overeating is treatable with counseling and therapy. Approximately 80% of sufferers who seek professional help recover completely or experience significant reduction in their symptoms. According to Dr. Gregg Jantz of The Center for Counseling and Health Resources in Edmonds, WA; less than 2% of morbidly obese clients ever recover. Many eating disorders are thought to be behavioral patterns stemming from emotional conflicts that need to be resolved in order for the sufferer to develop a healthy relationship with food. Like other eating disorders such as anorexia and bulimia, compulsive overeating is a serious problem and can result in death. However, with treatment, which should include talk therapy, medical and nutritional counseling, it can be overcome. References 1. ^ International Journal of Eating Disorders 2. ^ a b Kriz, Kerri-Lynn Murphy (May 2002). The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-Eating Disorder and Bulimia Nervosa. Virginia Polytechnic Institute and State University. http://scholar.lib.vt.edu/theses/available/etd-05092002-143548/. 3. ^ Weiner, Sydell (1998). "The Addiction of Overeating: Self-Help Groups as Treatment Models". Journal of Clinical Psychology 54: 163–167. doi:10.1002/(SICI)1097-4679(199802)54:2<163::AID-JCLP5>3.0.CO;2-T. ISSN 0021-9762.

Compulsive overeating, also sometimes called food addiction is characterized by an obsessive/compulsive relationship to food. Professionals address this with either a behaviour-modification model or a food-addiction model.<a href="#fn1">1</a> An individual suffering from compulsive overeating disorder engages in frequent episodes of uncontrolled eating, or bingeing, during which they may feel frenzied or out of control, often consuming food past the point of being comfortably full. Bingeing in this way is generally followed by feelings of guilt and depression. Unlike individuals with bulimia, compulsive overeaters do not attempt to compensate for their bingeing with purging behaviors such as fasting, laxative use or vomiting. Compulsive overeaters will typically eat when they are not hungry. Their obsession is demonstrated in that they spend excessive amounts of time and thought devoted to food, and secretly plan or fantasize about eating alone. Compulsive overeating usually leads to weight gain and obesity, but not everyone who is obese is also a compulsive overeater. In addition to binge eating, compulsive overeaters can also engage in grazing behavior, during which they return to pick at food throughout the day. This results in a large overall number of calories consumed even if the quantities eaten at any one time may be small. When a compulsive eater overeats primarily through bingeing, he or she can be said to have binge eating disorder. Where there is continuous overeating but no bingeing, then the sufferer has compulsive overeating disorder. Left untreated, compulsive overeating can lead to serious medical conditions including high cholesterol, diabetes, heart disease, hypertension, sleep apnea, and major depression. Additional long-term side effects of the condition also include kidney disease, arthritis, bone deterioration and stroke. Signs of compulsive overeating <ul> <li>Binge eating, or eating uncontrollably even when not physically hungry</li> <li>Eating much more rapidly than normal</li> <li>Eating alone due to shame and embarrassment</li> <li>Feelings of guilt due to overeating</li> <li>Preoccupation with body weight</li> <li>Depression or mood swings</li> <li>Awareness that eating patterns are abnormal</li> <li>History of weight fluctuations</li> <li>Withdrawal from activities because of embarrassment about weight</li> <li>History of many different unsuccessful diets</li> <li>Eating little in public, but maintaining a high body weight</li> </ul> Addiction During binges compulsive overeaters consume as much as 5,000 calories and up to 60,000 calories per day, which results as an addictive “high” not unlike those experienced through drug usage, and a release from psychological stress. In bulimics, this high may be intensified by the act of purging. Researchers have speculated there is an abnormality of endorphin metabolism in the brain of binge eaters that triggers the addictive process. This is in line with other theories of addiction that attribute it not to avoidance of withdrawal symptoms, but to a primary problem in the reward centers of the brain. For the Compulsive Overeater, the ingestion of trigger foods causes release of the neurotransmitter, serotonin. This could be another sign of neurobiological factors contributing to the addictive process. Abstinence from addictive food and food eating processes causes withdrawal symptoms in those with eating disorders. There may be higher levels of depression and anxiety due to the decreased levels of serotonin in the individual.<a href="#fn2">2</a> There are complexities with the biology of compulsive eating that separate it from a pure substance abuse analogy. Food is a complex mixture of chemicals that can affect the body in multiple ways, which is magnified by stomach-brain communication. In some ways, it may be much more difficult for compulsive overeaters to recover than drug addicts. There is an anecdotal saying among Overeaters Anonymous members that “when you are addicted to drugs you put the tiger in the cage to recover; when you are addicted to food you put the tiger in the cage, but take it out three times a day for a walk.”<a href="#fn2">2</a> The physical explanation of compulsive overeating may be attributed to an overeaters’ increased tendency to secrete insulin at the sight and smell of food, though medical evidence supporting this is controversial.<a href="#fn3">3</a> Some researchers also attribute it to excessive neurological sensitivity in taste and/or smell. Recovery from compulsive overeating Compulsive overeating is treatable with counseling and therapy. Approximately 80% of sufferers who seek professional help recover completely or experience significant reduction in their symptoms. According to Dr. Gregg Jantz of The Center for Counseling and Health Resources in Edmonds, WA; less than 2% of morbidly obese clients ever recover. Many eating disorders are thought to be behavioral patterns stemming from emotional conflicts that need to be resolved in order for the sufferer to develop a healthy relationship with food. Like other eating disorders such as anorexia and bulimia, compulsive overeating is a serious problem and can result in death. However, with treatment, which should include talk therapy, medical and nutritional counseling, it can be overcome. References 1. ^ International Journal of Eating Disorders 2. ^ a b Kriz, Kerri-Lynn Murphy (May 2002). The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-Eating Disorder and Bulimia Nervosa. Virginia Polytechnic Institute and State University. <a href="http://scholar.lib.vt.edu/theses/available/etd-05092002-143548/">http://scholar.lib.vt.edu/theses/available/etd-…</a>. 3. ^ Weiner, Sydell (1998). “The Addiction of Overeating: Self-Help Groups as Treatment Models”. Journal of Clinical Psychology 54: 163–167. doi:10.1002/(SICI)1097-4679(199802)54:2<163::AID-JCLP5>3.0.CO;2-T. ISSN 0021-9762.

2009-03-21T20:39:50Z

http://en.wikipedia.org/wiki/Food_addiction

Compulsive Overeating

National Institutes of Health

Throughout much of the last century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When science began to study addictive behavior in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society's responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punitive rather than preventative and therapeutic actions. Today, thanks to science, our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem. As a result of scientific research, we know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities. Despite these advances, many people today do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. This booklet aims to fill that knowledge gap by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat the disease. At the National Institute on Drug Abuse (NIDA), we believe that increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation's well-being. Nora D. Volkow, M.D. Director National Institute on Drug Abuse

Throughout much of the last century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When science began to study addictive behavior in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society’s responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punitive rather than preventative and therapeutic actions. Today, thanks to science, our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem. As a result of scientific research, we know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities. Despite these advances, many people today do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. This booklet aims to fill that knowledge gap by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat the disease. At the National Institute on Drug Abuse (NIDA), we believe that increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation’s well-being. Nora D. Volkow, M.D. Director National Institute on Drug Abuse

2009-03-18T20:01:23Z

http://www.drugabuse.gov/scienceofaddiction/

Drugs, Brains, and Behavior

Thom Rutledge

Eating disorders are, by their very nature, self-protecting. That is not to say that an eating disorder is protecting the “self” with the disorder. Instead, the eating disorder is actually working around the clock against that “self” for its own protection. An eating disorder is more like being possessed by a malevolent spirit than it is like having a nice neat clinical diagnosis. Through the years of working with clients I have come to approach eating disorders as those malevolent, possessing culprits. I have come to think of an eating disorder as an entity quite separate and distinct from the client I am treating. And using an acronym for eating disorder, I have come to refer to this trouble-making s.o.b. as Ed. An amazing blend of quick-thinking attorney, masterful hypnotist, intimidating bully, guilt-inducing parent and seductive con-artist, Ed definitely has a mind of his own. And he uses that mind to brainwash his host with lie after lie after lie. One of my therapy assignments for eating disordered clients is to practice identifying Ed’s lies and creating corresponding truths. It is not enough to know you are being lied to; you need to know, you deserve to know, and it is your responsibility to know the truth. I recommend this journal exercise highly, as does the young woman who has been kind enough to share some of her journaling here. I am grateful to her. A DAY IN THE LIE-FE OF ED ED'S LIE: You must eat the same thing and same amount everyday without variation. TRUTH: Everyday does not have to look the same. There is nothing magic about eating the exact same thing everyday. Variety is good so I do not get tired of the same foods. Also, I need different nutrients that come from different foods. LIE: You have always only eaten 1/2 cup beans per day, so if you listen to that silly nutritionist and increase to 1 cup, you will get fat. TRUTH: I probably will not get fat if I increase my bean intake from 1/2 cup to 1 cup. :) Thanks anyway. LIE: It is okay to binge today--a good thing, actually--because you can start over tomorrow. You won't regret it. TRUTH: I always regret it when I binge. Tomorrow will be so much better if I do not binge today. Today is very very important. LIE: There is no hope for you to get better and live the life you want to live. Just look at how long you have had this problem. You should just stay stuck. The recovery road is just too hard for you. Think of all the times you have fallen down. Just stay with me (Ed). Life is so much easier with me. You don't have to fight anymore. I give you everything you need. You don't need or want people. You need me. TRUTH: There is hope for me. I have dreams and goals that I want to accomplish....so many things. Recovery is hard. But I can do it. Ed gives me nothing I need. Not one thing. And everything I do not want. I need and want people, relationships. And to finally do all the things that I want to do. LIE: Bingeing is fun and good because you don't have to have any rules about what you can and cannot eat and you get to eat whatever you want to. TRUTH: Total illusion. It is not fun. It is horrible. I can eat foods I enjoy without bingeing on them. LIE: You should eat less on work days because you don't get to exercise as much. TRUTH: I should eat more on workdays because I need the energy and focus to take excellent care of my patients. LIE: You are a bad weak person it you choose to eat meat or dessert. TRUTH: I am not good or bad based on any foods that I eat. That is ridiculous. LIE: If you eat more than my (Ed's) allotment of fat per day, you will become fat. TRUTH: I need to be sure I am getting enough fat in my diet so that my body functions properly. LIE: You won't regret it this time if you binge. You will be glad you did because it just makes sense to. It is the right thing to do, really, in this situation. It will make everything better. You won't have to fight--binge or no binge- you will have rest. TRUTH: I will regret this time and every time that I binge. I will not be glad I did. It does not make sense. There is nothing sensible about it. It is never the right thing to do in any situation. It makes everything worse. It brings nothing but chaos, despair, death. And most definitely not rest. LIE: If you are hungry in the afternoon at work, you are a complete failure if you eat a snack because you should not have to eat a snack. You've had days when you were able to get by without a snack, so if some days you eat one, you are weak and you will gain weight. And any failure is grounds for bingeing. TRUTH: If I am hungry in the afternoon at work, it means my body needs food and it is okay to eat a snack. I am not weak if I eat a snack. I am strong because I did not listen to Ed. If you have an eating disorder, if a man named Ed is living rent-free between your ears, I guarantee you one thing: he is lying to you. Do whatever it takes to break free from his brainwashing. As Jenni Schaefer, author of Life Without Ed, recommends, declare your independence from Ed. - - - - - - - - - - - - - - - Thom Rutledge is a psychotherapist and author of Embracing Fear: How to Turn What Scares Us into Our Greatest Gift, and co-author (with Jenni Schaefer) of Life Without Ed: How One Woman Declared Independence from Her Eating Disorder & How You Can Too. Thom is available for telephone consultations, and he facilitates a weekend retreat, Beyond Eating Disorders, three times a year. For information: www.nutshellwisdom.com

Eating disorders are, by their very nature, self-protecting. That is not to say that an eating disorder is protecting the “self” with the disorder. Instead, the eating disorder is actually working around the clock against that “self” for its own protection. An eating disorder is more like being possessed by a malevolent spirit than it is like having a nice neat clinical diagnosis. Through the years of working with clients I have come to approach eating disorders as those malevolent, possessing culprits. I have come to think of an eating disorder as an entity quite separate and distinct from the client I am treating. And using an acronym for eating disorder, I have come to refer to this trouble-making s.o.b. as Ed. An amazing blend of quick-thinking attorney, masterful hypnotist, intimidating bully, guilt-inducing parent and seductive con-artist, Ed definitely has a mind of his own. And he uses that mind to brainwash his host with lie after lie after lie. One of my therapy assignments for eating disordered clients is to practice identifying Ed’s lies and creating corresponding truths. It is not enough to know you are being lied to; you need to know, you deserve to know, and it is your responsibility to know the truth. I recommend this journal exercise highly, as does the young woman who has been kind enough to share some of her journaling here. I am grateful to her. A DAY IN THE LIE-FE OF ED ED’S LIE: You must eat the same thing and same amount everyday without variation. TRUTH: Everyday does not have to look the same. There is nothing magic about eating the exact same thing everyday. Variety is good so I do not get tired of the same foods. Also, I need different nutrients that come from different foods. LIE: You have always only eaten 1/2 cup beans per day, so if you listen to that silly nutritionist and increase to 1 cup, you will get fat. TRUTH: I probably will not get fat if I increase my bean intake from 1/2 cup to 1 cup. :) Thanks anyway. LIE: It is okay to binge today—a good thing, actually—because you can start over tomorrow. You won’t regret it. TRUTH: I always regret it when I binge. Tomorrow will be so much better if I do not binge today. Today is very very important. LIE: There is no hope for you to get better and live the life you want to live. Just look at how long you have had this problem. You should just stay stuck. The recovery road is just too hard for you. Think of all the times you have fallen down. Just stay with me (Ed). Life is so much easier with me. You don’t have to fight anymore. I give you everything you need. You don’t need or want people. You need me. TRUTH: There is hope for me. I have dreams and goals that I want to accomplish….so many things. Recovery is hard. But I can do it. Ed gives me nothing I need. Not one thing. And everything I do not want. I need and want people, relationships. And to finally do all the things that I want to do. LIE: Bingeing is fun and good because you don’t have to have any rules about what you can and cannot eat and you get to eat whatever you want to. TRUTH: Total illusion. It is not fun. It is horrible. I can eat foods I enjoy without bingeing on them. LIE: You should eat less on work days because you don’t get to exercise as much. TRUTH: I should eat more on workdays because I need the energy and focus to take excellent care of my patients. LIE: You are a bad weak person it you choose to eat meat or dessert. TRUTH: I am not good or bad based on any foods that I eat. That is ridiculous. LIE: If you eat more than my (Ed’s) allotment of fat per day, you will become fat. TRUTH: I need to be sure I am getting enough fat in my diet so that my body functions properly. LIE: You won’t regret it this time if you binge. You will be glad you did because it just makes sense to. It is the right thing to do, really, in this situation. It will make everything better. You won’t have to fight—binge or no binge- you will have rest. TRUTH: I will regret this time and every time that I binge. I will not be glad I did. It does not make sense. There is nothing sensible about it. It is never the right thing to do in any situation. It makes everything worse. It brings nothing but chaos, despair, death. And most definitely not rest. LIE: If you are hungry in the afternoon at work, you are a complete failure if you eat a snack because you should not have to eat a snack. You’ve had days when you were able to get by without a snack, so if some days you eat one, you are weak and you will gain weight. And any failure is grounds for bingeing. TRUTH: If I am hungry in the afternoon at work, it means my body needs food and it is okay to eat a snack. I am not weak if I eat a snack. I am strong because I did not listen to Ed. If you have an eating disorder, if a man named Ed is living rent-free between your ears, I guarantee you one thing: he is lying to you. Do whatever it takes to break free from his brainwashing. As Jenni Schaefer, author of Life Without Ed, recommends, declare your independence from Ed. - – - – - – - – - – - – - – - Thom Rutledge is a psychotherapist and author of Embracing Fear: How to Turn What Scares Us into Our Greatest Gift, and co-author (with Jenni Schaefer) of Life Without Ed: How One Woman Declared Independence from Her Eating Disorder & How You Can Too. Thom is available for telephone consultations, and he facilitates a weekend retreat, Beyond Eating Disorders, three times a year. For information: <a href="http://www.nutshellwisdom.com">www.nutshellwisdom.com</a>

2009-09-02T19:16:48Z

252

Facing and Responding to Ed's Lies

Payam Ghassemlou, Ph.D.

The experience of being by yourself can feel like either painful loneliness or nourishing spiritual solitude. In loneliness, you are alone, without a deep connection to God, who is a particular God of your understanding, the Beloved, or your Higher Self. You are not like a happy child, with a deep attachment to a loving parent, who has the capacity to be alone in comfortable solitude. You feel lonely when you are alone. Think of your loneliness as a small inner child. This child within you is crying and in need of holding. You are not connected enough to your adult Self to hold your inner child with regard. The loneliness becomes overwhelming and intolerable. Our extroverted culture encourages you to get rid of this feeling of loneliness without trying to understand it, to ease it with unhealthy activities like drinking, drug use, and shopping. You might long for someone to come into your life and rescue you from the isolation that often comes with loneliness. Many people get into unhealthy relationships as a desperate way not to feel alone. When lonely, you experience yourself as empty and void of vitality. You suffer, and you might not be willing or able to transform your suffering. However, this loneliness can become the doorway to a profound experience of solitude. Everyone has the need for a reliable connection to someone, and when that connection is missing you can feel alone. When you find yourself caught in a painful experience of loneliness it's important not to judge your experience and nor compare yourself to others who seem happier. Having shame for being alone can only make it feel worse. Having compassion and empathy for life's challenging, lonely experiences is an important step toward understanding them and eventually transforming loneliness to solitude. This transformation requires asking yourself, "What does it mean to me to be alone?" How you define your experience of being by yourself can lead you to either positive or negative emotions. For example, if being alone means you are not a loveable person, then loneliness can feel like a humiliating experience. Embrace being alone as a part of life, and work on redefining it. Writing about your loneliness in a journal, while you are experiencing it in the moment, can bring consciousness to it. When you are consciously working with your painful emotions in the moment, you are better able to tolerate them. The light of consciousness eventually transforms your painful emotions. In order to transform your loneliness to solitude, you need patience, and you need support from a friend or guide who is mature and experienced in mining the gold found in solitude. There is nothing wrong with reaching out to others and asking for support when you feel alone. Hiding it from others who are willing to be supportive is not helpful. Sometimes loneliness can feel like being lost, and having a guide to help you start a journey toward solitude is important. This journey requires psychological inner work such as dream work, active imagination, and holding your lonely inner child. Dream work can help you to have a deeper relationship with yourself and open yourself up to messages from the unconscious. Through writing your dream in a dream journal and analyzing it you can have a profound experience honoring your unconscious. One of the Sufi poets who has inspired me to pay attention to my dreams is Rumi. In one of his poems on dreams, Rumi states, "Many wonders are manifest in sleep: in sleep the heart becomes a window. One that is awake and dreams beautiful dreams, he is the knower of God. Receive the dust of his eyes." Working with the power of active imagination can be a transformative experience. This technique can help you to use the power of imagination to consciously explore your inner world. Hence, you can have dialogue with the different parts of yourself including your feeling of loneliness. You can even use active imagination when you are awake to re-enter your dream and dialogue with your dream figures. Your inner child can be helped to make a secure attachment to your adult Self. Your adult self can sooth your lonely inner child. The key is consistency. On a consistent basis you need to make time and reach out to your inner child. You can meditate on the image of holding and loving the child you once were. This loving image can have a profound healing effect on your experience of loneliness. This psychological inner work can help you to grow bigger than the painful experience of loneliness. Loneliness can feel like the "dark night of the soul," and your inner work is the torch you need to journey toward home. Psychological inner work can help you enter a vast space of solitude where it is possible to meet your inner Beloved. In solitude you are alone with the Beloved. You are connected to something beyond yourself. In solitude you are part of the community of people who are consciously alone for the purpose of spiritual enlightenment. Whatever longings or painful feelings you might have, you are able to tolerate them and not act them out. In solitude you feel your suffering and work on transforming it to grace. Your adult Self feels comfortable alone, and this Self can hold the loneliness in the heart like a small baby and provide empathy for it. You have the capacity to be alone and yet feel yourself in the presence of your Beloved. In solitude you are aware of your breathing, and each breath connects you more deeply to your Self. You have the potential to be a spiritual purifier by the quality of your breath. With every breath you practice remembrance of the Beloved. Sufis refer to this practice as Zikr. From this zone, your loving thoughts, feelings, imagination, and actions can impact the universe. Just like an alchemist, you can turn something like loneliness to something more like solitude. Psychological work is the fire needed to transform the lead of painful loneliness to golden solitude. What deep and lasting contentment you can find in your life, as you enter nourishing solitude. © This article is copyrighted by Dr. Payam Ghassemlou, a psychotherapist in private practice in Los Angeles, California. Send comments to DrPayam1@aol.com. www.DrPayam.com. Dr. Payam Ghassemlou is licensed in the state of California as a Marriage and Family Therapist. As a psychotherapist, he helps people with personal growth. His education and training includes a doctorate in psychology plus advanced training in contemporary psychoanalysis, Jungian psychology, sandplay therapy, cognitive therapy, 12-step modality, and Eastern spirituality. Also, He is skilled at goal-oriented, problem focused, and time-efficient therapy. Since 1992, he has been helping individuals and couples from different walks of life and sexual orientations to live happier and more meaningful lives. www.DrPayam.com. More information about Dr. Payam is available at http://www.feelbetternetwork.com/professionals/1962

The experience of being by yourself can feel like either painful loneliness or nourishing spiritual solitude. In loneliness, you are alone, without a deep connection to God, who is a particular God of your understanding, the Beloved, or your Higher Self. You are not like a happy child, with a deep attachment to a loving parent, who has the capacity to be alone in comfortable solitude. You feel lonely when you are alone. Think of your loneliness as a small inner child. This child within you is crying and in need of holding. You are not connected enough to your adult Self to hold your inner child with regard. The loneliness becomes overwhelming and intolerable. Our extroverted culture encourages you to get rid of this feeling of loneliness without trying to understand it, to ease it with unhealthy activities like drinking, drug use, and shopping. You might long for someone to come into your life and rescue you from the isolation that often comes with loneliness. Many people get into unhealthy relationships as a desperate way not to feel alone. When lonely, you experience yourself as empty and void of vitality. You suffer, and you might not be willing or able to transform your suffering. However, this loneliness can become the doorway to a profound experience of solitude. Everyone has the need for a reliable connection to someone, and when that connection is missing you can feel alone. When you find yourself caught in a painful experience of loneliness it’s important not to judge your experience and nor compare yourself to others who seem happier. Having shame for being alone can only make it feel worse. Having compassion and empathy for life’s challenging, lonely experiences is an important step toward understanding them and eventually transforming loneliness to solitude. This transformation requires asking yourself, “What does it mean to me to be alone?” How you define your experience of being by yourself can lead you to either positive or negative emotions. For example, if being alone means you are not a loveable person, then loneliness can feel like a humiliating experience. Embrace being alone as a part of life, and work on redefining it. Writing about your loneliness in a journal, while you are experiencing it in the moment, can bring consciousness to it. When you are consciously working with your painful emotions in the moment, you are better able to tolerate them. The light of consciousness eventually transforms your painful emotions. In order to transform your loneliness to solitude, you need patience, and you need support from a friend or guide who is mature and experienced in mining the gold found in solitude. There is nothing wrong with reaching out to others and asking for support when you feel alone. Hiding it from others who are willing to be supportive is not helpful. Sometimes loneliness can feel like being lost, and having a guide to help you start a journey toward solitude is important. This journey requires psychological inner work such as dream work, active imagination, and holding your lonely inner child. Dream work can help you to have a deeper relationship with yourself and open yourself up to messages from the unconscious. Through writing your dream in a dream journal and analyzing it you can have a profound experience honoring your unconscious. One of the Sufi poets who has inspired me to pay attention to my dreams is Rumi. In one of his poems on dreams, Rumi states, “Many wonders are manifest in sleep: in sleep the heart becomes a window. One that is awake and dreams beautiful dreams, he is the knower of God. Receive the dust of his eyes.” Working with the power of active imagination can be a transformative experience. This technique can help you to use the power of imagination to consciously explore your inner world. Hence, you can have dialogue with the different parts of yourself including your feeling of loneliness. You can even use active imagination when you are awake to re-enter your dream and dialogue with your dream figures. Your inner child can be helped to make a secure attachment to your adult Self. Your adult self can sooth your lonely inner child. The key is consistency. On a consistent basis you need to make time and reach out to your inner child. You can meditate on the image of holding and loving the child you once were. This loving image can have a profound healing effect on your experience of loneliness. This psychological inner work can help you to grow bigger than the painful experience of loneliness. Loneliness can feel like the “dark night of the soul,” and your inner work is the torch you need to journey toward home. Psychological inner work can help you enter a vast space of solitude where it is possible to meet your inner Beloved. In solitude you are alone with the Beloved. You are connected to something beyond yourself. In solitude you are part of the community of people who are consciously alone for the purpose of spiritual enlightenment. Whatever longings or painful feelings you might have, you are able to tolerate them and not act them out. In solitude you feel your suffering and work on transforming it to grace. Your adult Self feels comfortable alone, and this Self can hold the loneliness in the heart like a small baby and provide empathy for it. You have the capacity to be alone and yet feel yourself in the presence of your Beloved. In solitude you are aware of your breathing, and each breath connects you more deeply to your Self. You have the potential to be a spiritual purifier by the quality of your breath. With every breath you practice remembrance of the Beloved. Sufis refer to this practice as Zikr. From this zone, your loving thoughts, feelings, imagination, and actions can impact the universe. Just like an alchemist, you can turn something like loneliness to something more like solitude. Psychological work is the fire needed to transform the lead of painful loneliness to golden solitude. What deep and lasting contentment you can find in your life, as you enter nourishing solitude. © This article is copyrighted by Dr. Payam Ghassemlou, a psychotherapist in private practice in Los Angeles, California. Send comments to <a href="mailto:DrPayam1@aol.com">DrPayam1@aol.com</a>. <a href="http://www.DrPayam.com">www.DrPayam.com</a>. Dr. Payam Ghassemlou is licensed in the state of California as a Marriage and Family Therapist. As a psychotherapist, he helps people with personal growth. His education and training includes a doctorate in psychology plus advanced training in contemporary psychoanalysis, Jungian psychology, sandplay therapy, cognitive therapy, 12-step modality, and Eastern spirituality. Also, He is skilled at goal-oriented, problem focused, and time-efficient therapy. Since 1992, he has been helping individuals and couples from different walks of life and sexual orientations to live happier and more meaningful lives. <a href="http://www.DrPayam.com">www.DrPayam.com</a>. More information about Dr. Payam is available at <a href="http://www.feelbetternetwork.com/professionals/1962">http://www.feelbetternetwork.com/professionals/…</a>

2009-09-22T22:28:15Z

266

From Loneliness to Solitude

Wikipedia

Gambling is the wagering of money or something of material value on an event with an uncertain outcome with the primary intent of winning additional money and/or material goods. Typically, the outcome of the wager is evident within a short period. The term gaming[1] in this context typically refers to instances in which the activity has been specifically permitted by law. The two words are not mutually exclusive; i.e., a “gaming” company offers (legal) “gambling” activities to the public.[2] This distinction is not universally observed in the English-speaking world, however. For instance, in the UK, the regulator of gambling activities is called the Gambling Commission (not the Gaming Commission).[3] Legal aspects Both the Catholic and Jewish traditions traditionally set aside days for gambling,[4] although religious authorities generally disapprove of gambling to some extent. Gambling can have adverse social consequences. For these social and religious reasons, most legal jurisdictions limit gambling. Some Islamic nations prohibit gambling; most other countries regulate it.[5]Many jurisdictions, local as well as national, either ban or heavily control (by licensing) gambling. Such regulation generally leads to gambling tourism and illegal gambling. In other terms gambling can be performed through materials which are given a value but isn’t real money. The involvement of governments, through regulation and taxation, has led to a close connection between many governments and gaming organizations, where legal gambling provides significant government revenue, such as in Monaco or Macau. Under US federal law, gambling is legal in the United States, and states are free to regulate or prohibit the practice. Gambling has been legal in Nevada since 1931, forming the backbone of the state's economy, and the city of Las Vegas is perhaps the best known gambling destination in the world. In 1976, gambling was legalized in Atlantic City, New Jersey, and in 1990, it was legalized in Tunica, Mississippi; both of those cities have developed extensive casino and resort areas since then. Since a favorable U.S. Supreme Court decision in 1987, many Native American tribes have built their own casinos on tribal lands as a way to provide revenue for the tribe. Because the tribes are considered sovereign nations, they are often exempt from state laws restricting gambling, and are instead regulated under federal law. Additionally, almost all states have legalized gambling in the form of a state-run lottery. Because contracts of insurance have many features in common with wagers, insurance contracts are often distinguished under law as agreements in which either party has an interest in the "bet-upon" outcome beyond the specific financial terms. E.g.: a “bet” with an insurer on whether one's house will burn down is not gambling, but rather insurance — as the homeowner has an obvious interest in the continued existence of his/her home independent of the purely financial aspects of the "bet" (i.e., the insurance policy). Nonetheless, both insurance and gambling contracts are typically considered aleatory contracts under most legal systems, though they are subject to different types of regulation. There is generally legislation requiring that the odds in gaming devices are statistically random, to prevent manufacturers from making some high-payoff results impossible. Since these high-payoffs have very low probability, a house bias can quite easily be missed unless checking the odds carefully.[6] Gambling variables There are three variables common to all forms of gambling: • How much is being wagered, the initial stake (in money or material goods). • The predictability of the event. o In mechanical or electronic gambling such as lotteries, slot machines and bingo, the results are random and unpredictable; no amount of skill or knowledge (assuming machinery is functioning as intended) can give an advantage in predictability to anyone. o However, for sports events such as horse racing and soccer matches there is some predictability to the outcome; thus a person with greater knowledge and/or skill will have an advantage over others. • The odds agreed between the two (or more) parties to the wager; where there is a house or a bookmaker, the odds are (quite legally) arranged in favor of the house. The expected value, positive or negative, is a mathematical calculation using these three variables. The amount wagered determines the scale of an individual wager (bet); the odds and the amount wagered determine the payout if successful; the predictability determines the frequency of success. Finally the frequency of success times the payout minus the amount wagered equals the "expected value" The skill of a gambler lies in understanding and maneuvering the three variables so that the "actual value" is positive over a series of wagers. Types of gambling Casino games While almost any game can be played for money, and any game typically played for money can also be played just for fun, some games are generally offered in a casino setting. Table games • 3-card poker • 4-card poker • Baccarat (punto banco) • Blackjack • Caribbean Stud Poker • Casino war • Craps • Fan-Tan • Faro • Let It Ride • Pai Gow Poker and Tiles • Poker • Pyramid Poker • Red Dog • Roulette • Sic bo • Spanish 21 • Teen Patti • Texas Hold'em Bonus Poker Electronic gaming • Pachinko • Slot machine • Video poker Other gambling • Bingo • Keno Non-casino gambling games Gambling games that take place outside of casinos include Bingo (as played in the US and UK), dead pool, lotteries, pull-tab games and scratchcards, and Mahjong. Other non-casino gambling games include: • Card games, such as Liar's poker, Bridge, Basset, Lansquenet, Piquet, Put, Teen patti • Carnival Games such as The Razzle or Hanky Pank • Coin-tossing games such as Head and Tail, Two-up* • Confidence tricks such as Three-card Monte or the Shell game • Dice-based games, such as Backgammon, Liar's dice, Passe-dix, Hazard, Threes, Pig, or Mexico *Although coin tossing isn't usually played in a casino, it has been known to be an official gambling game in some Australian casinos[7] Fixed-odds gambling Fixed-odds gambling and Parimutuel betting frequently occur at many types of sporting events, and political elections. In addition many bookmakers offer fixed odds on a number of non-sports related outcomes, for example the direction and extent of movement of various financial indices, the winner of television competitions such as Big Brother, and election results.[8] Interactive prediction markets also offer trading on these outcomes, with "shares" of results trading on an open market. Parimutuel betting One of the most widespread forms of gambling involves betting on horse or greyhound racing. Wagering may take place through parimutuel pools, or bookmakers may take bets personally. Parimutuel wagers pay off at prices determined by support in the wagering pools, while bookmakers pay off either at the odds offered at the time of accepting the bet; or at the median odds offered by track bookmakers at the time the race started. Sports betting Betting on team sports has become an important service industry in many countries. For example, millions of Britons play the football pools every week. In addition to organized sports betting, both legal and illegal, there are many side-betting games played by casual groups of spectators, such as NCAA Basketball Tournament Bracket Pools, Super Bowl Squares, Fantasy Sports Leagues with monetary entry fees and winnings, and in-person spectator games like Moundball. Arbitrage betting Arbitrage betting is a theoretically risk-free betting system in which every outcome of an event is bet upon so that a known profit will be made by the bettor upon completion of the event, regardless of the outcome. Arbitrage betting is a combination of the ancient art of arbitrage trading and gambling, which has been made possible by the large numbers of bookmakers in the marketplace, creating occasional opportunities for arbitrage. Other types of betting One can also bet with another person that a statement is true or false, or that a specified event will happen (a "back bet") or will not happen (a "lay bet") within a specified time. This occurs in particular when two people have opposing but strongly-held views on truth or events. Not only do the parties hope to gain from the bet, they place the bet also to demonstrate their certainty about the issue. Some means of determining the issue at stake must exist. Sometimes the amount bet remains nominal, demonstrating the outcome as one of principle rather than of financial importance. Betting exchanges allow consumers to both back and lay at odds of their choice. Similar in some ways to a stock exchange, a better may want to back a horse (hoping it will win) or lay a horse (hoping it will lose, effectively acting as bookmaker) Staking systems Many betting systems have been created in an attempt to "beat the bookie" but most still accept that no system can make an unprofitable bet profitable over time. Widely-used systems include: • Card counting - Many systems exist for Blackjack to keep track of the ratio of ten values to all others; when this ratio is high the player has an advantage and should increase the amount of their bets. Keeping track of cards dealt confers an advantage in other games as well. • Due-column betting – A variation on fixed profits betting in which the bettor sets a target profit and then calculates a bet size that will make this profit, adding any losses to the target. • Fixed profits – the stakes vary based on the odds to ensure the same profit from each winning selection. • Fixed stakes – a traditional system of staking the same amount on each selection. • Kelly – the optimum level to bet to maximize your future median bank level. • Martingale – A system based on staking enough each time to recover losses from previous bet(s) until one wins. • Pot odds vs. true odds - In poker, the ratio of the size of the current pot to the bet a player is considering is called "pot odds", which can be compared to the "true odds" of a player completing a winning hand from the cards remaining to be dealt to determine whether to make the bet. Other uses of the term "gambling" Many risk-return choices are sometimes referred to colloquially as "gambling." Whether this terminology is acceptable is a matter of debate, but generally the following activities are not considered gambling: • Emotional or physical risk-taking, where the risk-return ratio is not quantifiable (e.g., skydiving, campaigning for political office, asking someone for a date, etc.) • Insurance is a method of shifting risk from one party to another. Insurers use actuarial methods to calculate appropriate premiums, which could be considered similar to calculating gambling odds. However, insurers can set their premiums to obtain a long term positive expected return. • Situations where the possible return is a secondary reason for the wager/purchase (e.g. buying a raffle ticket to support a charitable cause) Investments are also usually not considered gambling, although some investments can involve significant risk. Examples of investments include stocks, bonds and real estate. Starting a business can also be considered a form of investment. Investments are generally not considered gambling when they meet the following criteria: • Economic utility • Positive expected returns (at least in the long term) • Underlying value independent of the risk being undertaken Some speculative investment activities are particularly risky, but are still usually considered separately from gambling: • Foreign currency exchange (forex) transactions • Prediction markets • Securities derivatives, such as options or futures, where the value of the derivative is dependent on the value of the underlying asset at a specific point in time (typically the derivative's associated expiration date) Psychological aspects Studies show that though many people participate in gambling as a form of recreation or even as a means to gain an income, gambling, like any behavior which involves variation in brain chemistry, can become a psychologically addictive and harmful behavior in some people. Reinforcement schedules may also make gamblers persist in gambling even after repeated losses. The Russian writer Dostoevsky (himself a problem gambler) portrays in his novella The Gambler the psychological implications of gambling and how gambling can affect gamblers. He also associates gambling and the idea of "getting rich quick", suggesting that Russians may have a particular affinity for gambling. Dostoevsky shows the effect of betting money for the chance of gaining more in 19th-century Europe. The association between Russians and gambling has fed legends of the origins of Russian roulette. References 1. ^ United Kingdom Office of Public Sector Information: Definition as Gaming 2. ^ Gambling Law US 3. ^ UK Gambling Commission 4. ^ Barlow, Rich (2007-12-02). "Gambling had role in religious history". The Boston Globe. http://www.boston.com/news/local/articles/2007/12/01/gambling_had_role_in_religious_history/. 5. ^ International Association of Gaming Regulators: Members 6. ^ Nevada State Gaming Control Board: Technical Standards (Adopted) 7. ^ Sky City - SkyCity Casino - Table Games - Two Up 8. ^ ABC.net: US election betting backs Bush

Gambling is the wagering of money or something of material value on an event with an uncertain outcome with the primary intent of winning additional money and/or material goods. Typically, the outcome of the wager is evident within a short period. The term gaming<a href="#fn1">1</a> in this context typically refers to instances in which the activity has been specifically permitted by law. The two words are not mutually exclusive; i.e., a “gaming” company offers (legal) “gambling” activities to the public.<a href="#fn2">2</a> This distinction is not universally observed in the English-speaking world, however. For instance, in the UK, the regulator of gambling activities is called the Gambling Commission (not the Gaming Commission).<a href="#fn3">3</a> Legal aspects Both the Catholic and Jewish traditions traditionally set aside days for gambling,<a href="#fn4">4</a> although religious authorities generally disapprove of gambling to some extent. Gambling can have adverse social consequences. For these social and religious reasons, most legal jurisdictions limit gambling. Some Islamic nations prohibit gambling; most other countries regulate it.<a href="#fn5">5</a>Many jurisdictions, local as well as national, either ban or heavily control (by licensing) gambling. Such regulation generally leads to gambling tourism and illegal gambling. In other terms gambling can be performed through materials which are given a value but isn’t real money. The involvement of governments, through regulation and taxation, has led to a close connection between many governments and gaming organizations, where legal gambling provides significant government revenue, such as in Monaco or Macau. Under US federal law, gambling is legal in the United States, and states are free to regulate or prohibit the practice. Gambling has been legal in Nevada since 1931, forming the backbone of the state’s economy, and the city of Las Vegas is perhaps the best known gambling destination in the world. In 1976, gambling was legalized in Atlantic City, New Jersey, and in 1990, it was legalized in Tunica, Mississippi; both of those cities have developed extensive casino and resort areas since then. Since a favorable U.S. Supreme Court decision in 1987, many Native American tribes have built their own casinos on tribal lands as a way to provide revenue for the tribe. Because the tribes are considered sovereign nations, they are often exempt from state laws restricting gambling, and are instead regulated under federal law. Additionally, almost all states have legalized gambling in the form of a state-run lottery. Because contracts of insurance have many features in common with wagers, insurance contracts are often distinguished under law as agreements in which either party has an interest in the “bet-upon” outcome beyond the specific financial terms. E.g.: a “bet” with an insurer on whether one’s house will burn down is not gambling, but rather insurance — as the homeowner has an obvious interest in the continued existence of his/her home independent of the purely financial aspects of the “bet” (i.e., the insurance policy). Nonetheless, both insurance and gambling contracts are typically considered aleatory contracts under most legal systems, though they are subject to different types of regulation. There is generally legislation requiring that the odds in gaming devices are statistically random, to prevent manufacturers from making some high-payoff results impossible. Since these high-payoffs have very low probability, a house bias can quite easily be missed unless checking the odds carefully.<a href="#fn6">6</a> Gambling variables There are three variables common to all forms of gambling: • How much is being wagered, the initial stake (in money or material goods). • The predictability of the event. o In mechanical or electronic gambling such as lotteries, slot machines and bingo, the results are random and unpredictable; no amount of skill or knowledge (assuming machinery is functioning as intended) can give an advantage in predictability to anyone. o However, for sports events such as horse racing and soccer matches there is some predictability to the outcome; thus a person with greater knowledge and/or skill will have an advantage over others. • The odds agreed between the two (or more) parties to the wager; where there is a house or a bookmaker, the odds are (quite legally) arranged in favor of the house. The expected value, positive or negative, is a mathematical calculation using these three variables. The amount wagered determines the scale of an individual wager (bet); the odds and the amount wagered determine the payout if successful; the predictability determines the frequency of success. Finally the frequency of success times the payout minus the amount wagered equals the “expected value” The skill of a gambler lies in understanding and maneuvering the three variables so that the “actual value” is positive over a series of wagers. Types of gambling Casino games While almost any game can be played for money, and any game typically played for money can also be played just for fun, some games are generally offered in a casino setting. Table games • 3-card poker • 4-card poker • Baccarat (punto banco) • Blackjack • Caribbean Stud Poker • Casino war • Craps • Fan-Tan • Faro • Let It Ride • Pai Gow Poker and Tiles • Poker • Pyramid Poker • Red Dog • Roulette • Sic bo • Spanish 21 • Teen Patti • Texas Hold’em Bonus Poker Electronic gaming • Pachinko • Slot machine • Video poker Other gambling • Bingo • Keno Non-casino gambling games Gambling games that take place outside of casinos include Bingo (as played in the US and UK), dead pool, lotteries, pull-tab games and scratchcards, and Mahjong. Other non-casino gambling games include: • Card games, such as Liar’s poker, Bridge, Basset, Lansquenet, Piquet, Put, Teen patti • Carnival Games such as The Razzle or Hanky Pank • Coin-tossing games such as Head and Tail, Two-up* • Confidence tricks such as Three-card Monte or the Shell game • Dice-based games, such as Backgammon, Liar’s dice, Passe-dix, Hazard, Threes, Pig, or Mexico *Although coin tossing isn’t usually played in a casino, it has been known to be an official gambling game in some Australian casinos<a href="#fn7">7</a> Fixed-odds gambling Fixed-odds gambling and Parimutuel betting frequently occur at many types of sporting events, and political elections. In addition many bookmakers offer fixed odds on a number of non-sports related outcomes, for example the direction and extent of movement of various financial indices, the winner of television competitions such as Big Brother, and election results.<a href="#fn8">8</a> Interactive prediction markets also offer trading on these outcomes, with “shares” of results trading on an open market. Parimutuel betting One of the most widespread forms of gambling involves betting on horse or greyhound racing. Wagering may take place through parimutuel pools, or bookmakers may take bets personally. Parimutuel wagers pay off at prices determined by support in the wagering pools, while bookmakers pay off either at the odds offered at the time of accepting the bet; or at the median odds offered by track bookmakers at the time the race started. Sports betting Betting on team sports has become an important service industry in many countries. For example, millions of Britons play the football pools every week. In addition to organized sports betting, both legal and illegal, there are many side-betting games played by casual groups of spectators, such as NCAA Basketball Tournament Bracket Pools, Super Bowl Squares, Fantasy Sports Leagues with monetary entry fees and winnings, and in-person spectator games like Moundball. Arbitrage betting Arbitrage betting is a theoretically risk-free betting system in which every outcome of an event is bet upon so that a known profit will be made by the bettor upon completion of the event, regardless of the outcome. Arbitrage betting is a combination of the ancient art of arbitrage trading and gambling, which has been made possible by the large numbers of bookmakers in the marketplace, creating occasional opportunities for arbitrage. Other types of betting One can also bet with another person that a statement is true or false, or that a specified event will happen (a “back bet”) or will not happen (a “lay bet”) within a specified time. This occurs in particular when two people have opposing but strongly-held views on truth or events. Not only do the parties hope to gain from the bet, they place the bet also to demonstrate their certainty about the issue. Some means of determining the issue at stake must exist. Sometimes the amount bet remains nominal, demonstrating the outcome as one of principle rather than of financial importance. Betting exchanges allow consumers to both back and lay at odds of their choice. Similar in some ways to a stock exchange, a better may want to back a horse (hoping it will win) or lay a horse (hoping it will lose, effectively acting as bookmaker) Staking systems Many betting systems have been created in an attempt to “beat the bookie” but most still accept that no system can make an unprofitable bet profitable over time. Widely-used systems include: • Card counting – Many systems exist for Blackjack to keep track of the ratio of ten values to all others; when this ratio is high the player has an advantage and should increase the amount of their bets. Keeping track of cards dealt confers an advantage in other games as well. • Due-column betting – A variation on fixed profits betting in which the bettor sets a target profit and then calculates a bet size that will make this profit, adding any losses to the target. • Fixed profits – the stakes vary based on the odds to ensure the same profit from each winning selection. • Fixed stakes – a traditional system of staking the same amount on each selection. • Kelly – the optimum level to bet to maximize your future median bank level. • Martingale – A system based on staking enough each time to recover losses from previous bet(s) until one wins. • Pot odds vs. true odds – In poker, the ratio of the size of the current pot to the bet a player is considering is called “pot odds”, which can be compared to the “true odds” of a player completing a winning hand from the cards remaining to be dealt to determine whether to make the bet. Other uses of the term “gambling” Many risk-return choices are sometimes referred to colloquially as “gambling.” Whether this terminology is acceptable is a matter of debate, but generally the following activities are not considered gambling: • Emotional or physical risk-taking, where the risk-return ratio is not quantifiable (e.g., skydiving, campaigning for political office, asking someone for a date, etc.) • Insurance is a method of shifting risk from one party to another. Insurers use actuarial methods to calculate appropriate premiums, which could be considered similar to calculating gambling odds. However, insurers can set their premiums to obtain a long term positive expected return. • Situations where the possible return is a secondary reason for the wager/purchase (e.g. buying a raffle ticket to support a charitable cause) Investments are also usually not considered gambling, although some investments can involve significant risk. Examples of investments include stocks, bonds and real estate. Starting a business can also be considered a form of investment. Investments are generally not considered gambling when they meet the following criteria: • Economic utility • Positive expected returns (at least in the long term) • Underlying value independent of the risk being undertaken Some speculative investment activities are particularly risky, but are still usually considered separately from gambling: • Foreign currency exchange (forex) transactions • Prediction markets • Securities derivatives, such as options or futures, where the value of the derivative is dependent on the value of the underlying asset at a specific point in time (typically the derivative’s associated expiration date) Psychological aspects Studies show that though many people participate in gambling as a form of recreation or even as a means to gain an income, gambling, like any behavior which involves variation in brain chemistry, can become a psychologically addictive and harmful behavior in some people. Reinforcement schedules may also make gamblers persist in gambling even after repeated losses. The Russian writer Dostoevsky (himself a problem gambler) portrays in his novella The Gambler the psychological implications of gambling and how gambling can affect gamblers. He also associates gambling and the idea of “getting rich quick”, suggesting that Russians may have a particular affinity for gambling. Dostoevsky shows the effect of betting money for the chance of gaining more in 19th-century Europe. The association between Russians and gambling has fed legends of the origins of Russian roulette. References 1. ^ United Kingdom Office of Public Sector Information: Definition as Gaming 2. ^ Gambling Law US 3. ^ UK Gambling Commission 4. ^ Barlow, Rich (2007-12-02). “Gambling had role in religious history”. The Boston Globe. <a href="http://www.boston.com/news/local/articles/2007/12/01/gambling_had_role_in_religious_history/">http://www.boston.com/news/local/articles/2007/…</a>. 5. ^ International Association of Gaming Regulators: Members 6. ^ Nevada State Gaming Control Board: Technical Standards (Adopted) 7. ^ Sky City – SkyCity Casino – Table Games – Two Up 8. ^ ABC.net: US election betting backs Bush

2009-03-22T00:55:31Z

http://en.wikipedia.org/wiki/Gambling

Gambling

Juliet Zuercher, RD and Dena Cabrera, Psy.D. , Remuda Ranch Programs for Eating and Anxiety Disorders

Kids today face different options for food and play than past generations. Abundant, inexpensive, tasty, unsupervised, and calorie but not nutrient-dense foods combine with sedentary entertainment choices and we end up with overweight kids. What can a parent do? Top 10 Tips for Parents Who Want Healthy Kids 1. Be a good role model. Do not follow fad diets for weight loss; eat intuitively. Choose from a variety of foods that are tasty and satisfying. Eat when hungry; stop when not hungry. 2. Promote size acceptance. All bodies are shaped differently. This is part of the natural, genetic variety of our species! Fostering an environment of size acceptance for diverse shapes promotes a child's self acceptance and well being. Body differences should be welcomed, not feared. 3. Use positive body language. Are you constantly talking about the weight you want to lose or how much better you think you would feel if you could just shed 10 more pounds? Do you comment often on others' appearance and make judgments about them based on weight? Instead of these negative expressions, talk positively about your own body and you will model a healthy self-concept to your children. 4. Allow for freedom of choice within structure. When given the opportunity, children are wonderful intuitive eaters. The young ones have not learned the social definition of good and bad foods. They eat what they like and what sounds good to them. If given options of whole grains, fruits, and vegetables, along with other foods, children will sometimes choose the grains, fruits, and vegetables (Dietary Guidelines and Food Guide Pyramid Incapacitate Consumers and Contribute to Distorted Eating Attitudes and Behaviors, Ellyn Satter, MS, RD, LCSW, BCD). So provide food options for children with reason: one snack may be an apple with peanut butter or graham crackers with milk; another may be a cereal bar or two cookies. 5. Create a positive food environment. We know that children excel both emotionally and academically in environments where they feel safety and love (Your Child's Weight, Helping without Harming, chapter 3, "Make family meals a priority", Ellyn Satter, MS, RD, LCSW, BCD). The dinner table is perhaps the best venue for providing this environment. "Time spent with families at meals is more related to the psychological and academic success of preadolescents and adolescents than time spent in school, studying, church, playing sports, or doing art activities" (Hofferth, S.L. 2001. How American children spend their time. Journal of Marriage and the Family. 63, 295-308; Council of Economic Advisers to the President [CEAC]. 2000. Teens and their parents in the 21st Century: an examination of trends in teen behavior and the role of parental involvement.). So make it a rule for the family to eat at least one meal together per day. Keep the conversation positive. The child will associate the context of the meal with positive feelings, promoting a healthy rather than a conflicted relationship with food. 6. Be aware of food allergies. Not all childhood food allergies will last a lifetime. Most will be outgrown. Provide opportunity for the child's body to develop immunity to the proteins in allergenic foods by testing those with small doses. Otherwise, a child may carry unnecessary food restrictions into adulthood and this may inadvertently contribute to disordered eating or an eating disorder. 7. Be active. Limit “screen time”: television, computer, video games, text messaging, etc. Instead, build in family times that encourage an active lifestyle. Plan family vacations that include enjoyable activities: hiking, biking, roller blading, swimming, etc. Set clear expectations for the child’s chores; do not apologize for requiring the child to contribute to the household in this way. But take enough time to invent games while doing chores so that even routine activities become associated with fun and closeness. 8. Involve the child in menu planning. Ask about and include some of the child's preferences when planning the weekly menu. Include the child in grocery shopping and meal preparation when possible. These are great teachable moments that foster empowerment around food choices rather than passivity. 9. Eat the same meal at dinner time. Resist the urge to make a special plate for the child who refuses to eat what is served. The parent decides what will be served and when; the child decides if s/he will eat, and if so, how much. This encourages the child to make good choices around food and increase variety; otherwise, the child's food selection remains limited thus limiting nutritional adequacy. 10. Eat with balance, variety and moderation. Do not require the child to finish everything on his/her plate. Provide a variety of flavors, colors, textures, and aromas in food to expand the child's food repertoire. Depending on the child's age, portion food appropriately or let the child portion on his/her own. Small, frequent meals and snacks allow the body's metabolism to work most efficiently. Remuda Ranch offers Christian inpatient and residential programs for individuals of all faiths suffering from eating or anxiety disorders. Each patient is treated by a multi-disciplinary team including a Psychiatric and a Primary Care Provider, Registered Dietitian, Masters Level therapist, Psychologist and Registered Nurse. The professional staff equips each patient with the right tools to live a healthy, productive life. For more information, call 1-800-445-1900 or visit www.remudaranch.com.

Kids today face different options for food and play than past generations. Abundant, inexpensive, tasty, unsupervised, and calorie but not nutrient-dense foods combine with sedentary entertainment choices and we end up with overweight kids. What can a parent do? Top 10 Tips for Parents Who Want Healthy Kids 1. Be a good role model. Do not follow fad diets for weight loss; eat intuitively. Choose from a variety of foods that are tasty and satisfying. Eat when hungry; stop when not hungry. 2. Promote size acceptance. All bodies are shaped differently. This is part of the natural, genetic variety of our species! Fostering an environment of size acceptance for diverse shapes promotes a child’s self acceptance and well being. Body differences should be welcomed, not feared. 3. Use positive body language. Are you constantly talking about the weight you want to lose or how much better you think you would feel if you could just shed 10 more pounds? Do you comment often on others’ appearance and make judgments about them based on weight? Instead of these negative expressions, talk positively about your own body and you will model a healthy self-concept to your children. 4. Allow for freedom of choice within structure. When given the opportunity, children are wonderful intuitive eaters. The young ones have not learned the social definition of good and bad foods. They eat what they like and what sounds good to them. If given options of whole grains, fruits, and vegetables, along with other foods, children will sometimes choose the grains, fruits, and vegetables (Dietary Guidelines and Food Guide Pyramid Incapacitate Consumers and Contribute to Distorted Eating Attitudes and Behaviors, Ellyn Satter, MS, RD, LCSW, BCD). So provide food options for children with reason: one snack may be an apple with peanut butter or graham crackers with milk; another may be a cereal bar or two cookies. 5. Create a positive food environment. We know that children excel both emotionally and academically in environments where they feel safety and love (Your Child’s Weight, Helping without Harming, chapter 3, “Make family meals a priority”, Ellyn Satter, MS, RD, LCSW, BCD). The dinner table is perhaps the best venue for providing this environment. “Time spent with families at meals is more related to the psychological and academic success of preadolescents and adolescents than time spent in school, studying, church, playing sports, or doing art activities” (Hofferth, S.L. 2001. How American children spend their time. Journal of Marriage and the Family. 63, 295-308; Council of Economic Advisers to the President [CEAC]. 2000. Teens and their parents in the 21st Century: an examination of trends in teen behavior and the role of parental involvement.). So make it a rule for the family to eat at least one meal together per day. Keep the conversation positive. The child will associate the context of the meal with positive feelings, promoting a healthy rather than a conflicted relationship with food. 6. Be aware of food allergies. Not all childhood food allergies will last a lifetime. Most will be outgrown. Provide opportunity for the child’s body to develop immunity to the proteins in allergenic foods by testing those with small doses. Otherwise, a child may carry unnecessary food restrictions into adulthood and this may inadvertently contribute to disordered eating or an eating disorder. 7. Be active. Limit “screen time”: television, computer, video games, text messaging, etc. Instead, build in family times that encourage an active lifestyle. Plan family vacations that include enjoyable activities: hiking, biking, roller blading, swimming, etc. Set clear expectations for the child’s chores; do not apologize for requiring the child to contribute to the household in this way. But take enough time to invent games while doing chores so that even routine activities become associated with fun and closeness. 8. Involve the child in menu planning. Ask about and include some of the child’s preferences when planning the weekly menu. Include the child in grocery shopping and meal preparation when possible. These are great teachable moments that foster empowerment around food choices rather than passivity. 9. Eat the same meal at dinner time. Resist the urge to make a special plate for the child who refuses to eat what is served. The parent decides what will be served and when; the child decides if s/he will eat, and if so, how much. This encourages the child to make good choices around food and increase variety; otherwise, the child’s food selection remains limited thus limiting nutritional adequacy. 10. Eat with balance, variety and moderation. Do not require the child to finish everything on his/her plate. Provide a variety of flavors, colors, textures, and aromas in food to expand the child’s food repertoire. Depending on the child’s age, portion food appropriately or let the child portion on his/her own. Small, frequent meals and snacks allow the body’s metabolism to work most efficiently. Remuda Ranch offers Christian inpatient and residential programs for individuals of all faiths suffering from eating or anxiety disorders. Each patient is treated by a multi-disciplinary team including a Psychiatric and a Primary Care Provider, Registered Dietitian, Masters Level therapist, Psychologist and Registered Nurse. The professional staff equips each patient with the right tools to live a healthy, productive life. For more information, call 1-800-445-1900 or visit <a href="http://www.remudaranch.com">www.remudaranch.com</a>.

2009-11-17T17:33:48Z

272

Healthy Eating Tips for Kids

Wikipedia

Oniomania (from Greek onios = "for sale," mania = insanity[1]) is a medical term for the compulsive desire to shop. Oniomania is the technical term for the compulsive desire to shop, more commonly referred to as compulsive shopping, compulsive buying, shopping addiction or shopaholism. First described by Bleuler in 1915, and then Kraepelin in 1924, as oneomania from the Greek oneomai, to buy, included among other pathological and reactive impulses, compulsive buying went largely ignored for nearly sixty years. Disorders Psychiatrists often call oniomania a disorder, but it has only been accepted as a disorder by the Deutsche Gesellschaft Zwangserkrankungen (German organization for obsessive-compulsive disorders), for several years[2]. In the United States, impulsive-compulsive buying behavior may be diagnosed as an Impulse-Control Disorder - Not Otherwise Specified in the DSM-IV-TR.[3] It may be under consideration for inclusion as a separate specific Impulse-Control Disorder in the next edition of the Diagnostic and Statistical Manual of Mental Disorders. Only in the past twenty years has specific and persistent inquiry into the disorder occurred. Although the study of compulsive buying is still in its infancy compared with some of its psychological siblings—alcoholism, eating disorders or drug abuse—there is more and more evidence that it poses a serious and worsening problem, one with significant emotional, social, occupational, and financial consequences. As many as 8.9 percent of the American population may be full-fledged compulsive buyers. (Ridgway, et al., 2008), and the problem is fast becoming a global one. The terms compulsive shopping, compulsive buying, and compulsive spending are often used interchangeably, but the behaviors they represent are in fact distinctly different (Nataraajan and Goff 1992). However, one may buy without shopping or certainly shop without buying. Most current researchers use the term compulsive buying and subscribe to an exceptionally specific definition proposed by McElroy and her colleagues (1994) as follows: 1. Compulsive buying is a maladaptive preoccupation with buying or shopping, or maladaptive buying or shopping impulses or behavior, as indicated by either: frequent preoccupation with buying or impulses to buy that is/are experienced as irresistible, intrusive, and/or senseless, or frequent buying items that are not needed or cannot be afforded or shopping for longer periods of time than intended. 2. The buying preoccupations, impulses, or behaviors cause marked distress, are time-consuming, significantly interfere with social or occupational functioning, or result in financial problems, and they do not occur exclusively during periods of hypomania or mania. Symptoms Similar to other compulsive behaviors, sufferers often experience the highs and lows associated with addiction. Victims often experience moods of satisfaction when they are in the process of purchasing, which seems to give their life meaning while letting them forget about their sorrows. Once leaving the environment where the purchasing occurred, the feeling of a personal reward has already gone. To compensate, the addicted person goes shopping again. Eventually a feeling of suppression will overcome the person. For example, cases have shown that the bought goods will be hidden or destroyed, because the person concerned feels ashamed of their addiction and tries to conceal it. Causes The addicted person gets into a vicious circle that consists of negative emotions like anger and stress, which lead to purchasing something. After the buying is over, the person is either regretful or depressed. In order to cope with the feelings, the addicted person resorts to another purchase. Shopaholism often begins at an early age. Children who experience parental neglect often grow up with low self-esteem because throughout much of their childhood they experienced that they were not important as a person. As a result, they used toys to compensate for their feelings of loneliness. Adults that have depended on materials for emotional support when they were much younger are more likely to become addicted to shopping because of the ongoing sentiment of deprivation they endured as children. During adulthood, the purchase instead of the toy is substituted for affection. Shopaholics are unable to deal with their everyday problems, especially those that alter their self-esteem. Most of the issues in their lives are repressed by buying something. Social conditions may also play an important role, especially in capitalist societies that are dominated by a consumerist economy where buying is an important part of daily life. Credit cards facilitate the spending of money as well as mail order via catalogues or the Internet. What differentiates oniomania from healthy shopping is the compulsive, destructive nature of the buying. This disorder is often linked to emotional deprivations in childhood, an inability to tolerate negative feelings, the need to fill an internal void, excitement seeking, excessive dependency, approval seeking, perfectionism, general impulsiveness and compulsiveness, and the need to gain control (DeSarbo and Edwards 1996, Faber et al. 1987, Benson, 2000). Compulsive buying seems to represent a search for self in people whose identity is neither firmly felt nor dependable. Most shopaholics try to counteract feelings of low self-esteem through the emotional lift and momentary euphoria provided by compulsive shopping. These shoppers, who also experience a higher than normal rate of associated disorders—depression, anxiety, substance abuse, eating disorders, and impulse-control disorders—may be using their symptom to self-medicate. Underlying (or at least intensifying) the deeply felt need of problem shoppers is our nationwide outbreak of “affluenza,” the modern American plague of materialism and overconsumption. Consequences The consequences of oniomania, which may persist long after a spree, can be devastating. They may include crushing consumer debt, theft or defalcation of money, defaulted loans, and general financial trouble. Sufferers often come into conflict with the law. The “smiled upon addiction,” as Catalano and Sonnenberg have called it (1993), is smiled upon in two senses: it is at once a source of wry humor and at the same time a behavior much inflamed by our ever present marketing machinery. As a result, compulsive shopping may be an even greater source of guilt and shame than alcoholism or drug abuse. Self help groups In the USA and Canada there are support groups for shopping-addicted people. • Debtors Anonymous • Recovery Connection for Addiction Treatment [1] • Shopping Addicts Only, Yahoo Group • Stopping Overshopping Group Telephone Coaching Program [2] References 1. ^ OMD. (2000, Mar 5). Retrieved, January 16, 2008, from http://cancerweb.ncl.ac.uk/cgi-bin/omd?oniomania 2. ^ http://www.zwaenge.de Deutsche Gesellschaft Zwangserkrankungen 3. ^ Clinical Manual of Impulse-control Disorders, Eric Hollander and Dan J. Stein. Published by American Psychiatric Pub, 2006

Oniomania (from Greek onios = “for sale,” mania = insanity<a href="#fn1">1</a>) is a medical term for the compulsive desire to shop. Oniomania is the technical term for the compulsive desire to shop, more commonly referred to as compulsive shopping, compulsive buying, shopping addiction or shopaholism. First described by Bleuler in 1915, and then Kraepelin in 1924, as oneomania from the Greek oneomai, to buy, included among other pathological and reactive impulses, compulsive buying went largely ignored for nearly sixty years. Disorders Psychiatrists often call oniomania a disorder, but it has only been accepted as a disorder by the Deutsche Gesellschaft Zwangserkrankungen (German organization for obsessive-compulsive disorders), for several years<a href="#fn2">2</a>. In the United States, impulsive-compulsive buying behavior may be diagnosed as an Impulse-Control Disorder – Not Otherwise Specified in the DSM-IV-TR.<a href="#fn3">3</a> It may be under consideration for inclusion as a separate specific Impulse-Control Disorder in the next edition of the Diagnostic and Statistical Manual of Mental Disorders. Only in the past twenty years has specific and persistent inquiry into the disorder occurred. Although the study of compulsive buying is still in its infancy compared with some of its psychological siblings—alcoholism, eating disorders or drug abuse—there is more and more evidence that it poses a serious and worsening problem, one with significant emotional, social, occupational, and financial consequences. As many as 8.9 percent of the American population may be full-fledged compulsive buyers. (Ridgway, et al., 2008), and the problem is fast becoming a global one. The terms compulsive shopping, compulsive buying, and compulsive spending are often used interchangeably, but the behaviors they represent are in fact distinctly different (Nataraajan and Goff 1992). However, one may buy without shopping or certainly shop without buying. Most current researchers use the term compulsive buying and subscribe to an exceptionally specific definition proposed by McElroy and her colleagues (1994) as follows: 1. Compulsive buying is a maladaptive preoccupation with buying or shopping, or maladaptive buying or shopping impulses or behavior, as indicated by either: frequent preoccupation with buying or impulses to buy that is/are experienced as irresistible, intrusive, and/or senseless, or frequent buying items that are not needed or cannot be afforded or shopping for longer periods of time than intended. 2. The buying preoccupations, impulses, or behaviors cause marked distress, are time-consuming, significantly interfere with social or occupational functioning, or result in financial problems, and they do not occur exclusively during periods of hypomania or mania. Symptoms Similar to other compulsive behaviors, sufferers often experience the highs and lows associated with addiction. Victims often experience moods of satisfaction when they are in the process of purchasing, which seems to give their life meaning while letting them forget about their sorrows. Once leaving the environment where the purchasing occurred, the feeling of a personal reward has already gone. To compensate, the addicted person goes shopping again. Eventually a feeling of suppression will overcome the person. For example, cases have shown that the bought goods will be hidden or destroyed, because the person concerned feels ashamed of their addiction and tries to conceal it. Causes The addicted person gets into a vicious circle that consists of negative emotions like anger and stress, which lead to purchasing something. After the buying is over, the person is either regretful or depressed. In order to cope with the feelings, the addicted person resorts to another purchase. Shopaholism often begins at an early age. Children who experience parental neglect often grow up with low self-esteem because throughout much of their childhood they experienced that they were not important as a person. As a result, they used toys to compensate for their feelings of loneliness. Adults that have depended on materials for emotional support when they were much younger are more likely to become addicted to shopping because of the ongoing sentiment of deprivation they endured as children. During adulthood, the purchase instead of the toy is substituted for affection. Shopaholics are unable to deal with their everyday problems, especially those that alter their self-esteem. Most of the issues in their lives are repressed by buying something. Social conditions may also play an important role, especially in capitalist societies that are dominated by a consumerist economy where buying is an important part of daily life. Credit cards facilitate the spending of money as well as mail order via catalogues or the Internet. What differentiates oniomania from healthy shopping is the compulsive, destructive nature of the buying. This disorder is often linked to emotional deprivations in childhood, an inability to tolerate negative feelings, the need to fill an internal void, excitement seeking, excessive dependency, approval seeking, perfectionism, general impulsiveness and compulsiveness, and the need to gain control (DeSarbo and Edwards 1996, Faber et al. 1987, Benson, 2000). Compulsive buying seems to represent a search for self in people whose identity is neither firmly felt nor dependable. Most shopaholics try to counteract feelings of low self-esteem through the emotional lift and momentary euphoria provided by compulsive shopping. These shoppers, who also experience a higher than normal rate of associated disorders—depression, anxiety, substance abuse, eating disorders, and impulse-control disorders—may be using their symptom to self-medicate. Underlying (or at least intensifying) the deeply felt need of problem shoppers is our nationwide outbreak of “affluenza,” the modern American plague of materialism and overconsumption. Consequences The consequences of oniomania, which may persist long after a spree, can be devastating. They may include crushing consumer debt, theft or defalcation of money, defaulted loans, and general financial trouble. Sufferers often come into conflict with the law. The “smiled upon addiction,” as Catalano and Sonnenberg have called it (1993), is smiled upon in two senses: it is at once a source of wry humor and at the same time a behavior much inflamed by our ever present marketing machinery. As a result, compulsive shopping may be an even greater source of guilt and shame than alcoholism or drug abuse. Self help groups In the USA and Canada there are support groups for shopping-addicted people. • Debtors Anonymous • Recovery Connection for Addiction Treatment <a href="#fn1">1</a> • Shopping Addicts Only, Yahoo Group • Stopping Overshopping Group Telephone Coaching Program <a href="#fn2">2</a> References 1. ^ OMD. (2000, Mar 5). Retrieved, January 16, 2008, from <a href="http://cancerweb.ncl.ac.uk/cgi-bin/omd?oniomania">http://cancerweb.ncl.ac.uk/cgi-bin/omd?oniomania</a> 2. ^ <a href="http://www.zwaenge.de">http://www.zwaenge.de</a> Deutsche Gesellschaft Zwangserkrankungen 3. ^ Clinical Manual of Impulse-control Disorders, Eric Hollander and Dan J. Stein. Published by American Psychiatric Pub, 2006

2009-03-22T00:13:50Z

http://en.wikipedia.org/wiki/Shopping_addiction

Oniomania - Compulsive Shopping

Wikipedia

Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance [1] and where negative physical symptoms[2] of withdrawal result from abrupt discontinuation or dosage reduction.[3] Physical dependence can develop from low-dose therapeutic use of certain medications as well as misuse of recreational drugs such as alcohol. The higher the dose used typically the worse the physical dependence and thus the worse the withdrawal syndrome. Withdrawal syndromes can last days, weeks or months or occasionally longer and will vary according to the dose, the type of drug used and the individual person.[4] From the point of view of the dependent person, "dependence is duress," argues addiction researcher Griffith Edwards.[5] Symptoms Physical dependence can manifest itself in the appearance of both physical and psychological symptoms but which are caused by physiological adaptions in the central nervous system and the brain due to chronic exposure to a substance. Some symptoms which may be experienced during withdrawal or reduction in dosage can include increased heart rate and/or blood pressure, sweating, and tremors are common signs of withdrawal. More serious symptoms such as confusion, seizures, and visual hallucinations indicate a serious emergency and the need for immediate medical care. Sedative hypnotic drugs such as alcohol, benzodiazepines, and barbiturates are the only commonly available substances that can be fatal in withdrawal due their propensity to induce withdrawal convulsions. Abrupt withdrawal from other drugs, such as opioids or psychostimulants, can exaggerate mild to moderate neurotoxic side effects due to hyperthermia and generation of free radicals[6], but life-threatening complications are very rare. Treatment Treatment for physical dependence depends upon the drug being withdrawn and often includes administration of another drug, especially for substances that can be dangerous when abruptly discontinued. Physical dependence is usually managed by a slow dose reduction over a period of weeks, months or sometimes longer depending on the drug, dose and the individual.[4] A physical dependence on alcohol is often managed with a cross tolerant drug eg long acting benzodiazepines to manage the alcohol withdrawal symptoms. Difference from addiction Physical dependence is different from psychological dependence (addiction). The latter is often characterized by a compulsive need for a drug for psychological reasons, while the former is characterized by need for the drug due to tolerance and the need to prevent withdrawal symptoms on discontinuing the use of a drug. Physical dependence however, commonly occurs with both addiction and therapeutic use of drugs. Drugs that cause physical dependence nicotine[7] opioids[8] barbiturates benzodiazepines (see benzodiazepine dependence and benzodiazepine withdrawal syndrome) nonbenzodiazepines, such as zopiclone[9] ethyl alcohol (alcoholic beverage)[10] GHB[11] methaqualone (Quaalude) caffeine[12] blood pressure medications such as beta blockers[13] [14] androgenic-anabolic steroids[15 ] [16] glucocorticoids[17] Rebound syndrome A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal.[18] These can include stimulants,[19] [20] [21 ] [22], antidepressants,[23] [24] anticonvulsants,[25] [26] [27] steroidal drugs and antiparkinsonian drugs.[28] Antipsychotics are another drug class that do not cause true physical dependency[29] but if discontinued too rapidly can cause an acute withdrawal syndrome.[30] Drugs like cocaine, marijuana, amphetamines, and hallucinogens can be associated with minimal physical dependence[31] but can still cause withdrawal or rebound symptoms. When talking about illicit drugs rebound withdrawal is, especially with stimulants, sometimes referred to as "coming down" or "crashing". Some drugs, like anticonvulsants and antidepressants, describe the drug category and not the mechanism. The individual agents and drug classes in the anticonvulsant drug category act at many different receptors and it is not possible to generalize their potential for physical dependence or incidence or severity of rebound syndrome as a group so need to be looked at individually. Anticonvulsants as a group however are known to cause tolerance to the anti-seizure effect.[32] SSRI drugs, which have an important use as antidepressants, are not considered to cause physical dependence, but it's generally accepted that they cause a discontinuation syndrome. Due to this, in Europe these drugs cannot be advertised as "non-habit forming".[citation needed] There has however been case reports of dependence with venlafaxine (Effexor).[33] References 1 physical dependence at Dorland's Medical Dictionary 2 "Definition of physical dependence - NCI Dictionary of Cancer Terms". http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=454765. Retrieved on 2008-12-21. 3 "Drug Addiction". CNN. http://www.cnn.com/HEALTH/library/DS/00183.html. 4 a b Landry MJ, Smith DE, McDuff DR, Baughman OL (1992). "Benzodiazepine dependence and withdrawal: identification and medical management". J Am Board Fam Pract 5 (2): 167–75. PMID 1575069. 5 Griffith Edwards. Alcohol: The World's Favourite Drug. 1st US ed. Thomas Dunne Books: 2002. ISBN 0-312-28387-3. P 72. 6 Sharma HS, Sjöquist PO, Ali SF (2007). "Drugs of abuse-induced hyperthermia, blood-brain barrier dysfunction and neurotoxicity: neuroprotective effects of a new antioxidant compound H-290/51". Current pharmaceutical design 13 (18): 1903–23. PMID 17584116. http://www.bentham-direct.org/pages/content.php?CPD/2007/00000013/00000018/0006B.SGM. 7 Jed E. Rose (October 2007). "Multiple brain pathways and receptors underlying tobacco addiction". Biochemical Pharmacology 74 (8): 1263-1270. http://dx.doi.org/10.1016/j.bcp.2007.07.039. 8 Trang T, Sutak M, Quirion R, Jhamandas K (May 2002). "The role of spinal neuropeptides and prostaglandins in opioid physical dependence". Br. J. Pharmacol. 136 (1): 37–48. doi:10.1038/sj.bjp.0704681. PMID 11976266. PMC: 1762111. http://dx.doi.org/10.1038/sj.bjp.0704681. 9 Sikdar S (July 1998). "Physical dependence on zopiclone. Prescribing this drug to addicts may give rise to iatrogenic drug misuse". BMJ 317 (7151): 146. PMID 9657802. PMC: 1113504. http://bmj.com/cgi/pmidlookup?view=long&pmid=9657802. 10 Kozell L, Belknap JK, Hofstetter JR, Mayeda A, Buck KJ (July 2008). "Mapping a locus for alcohol physical dependence and associated withdrawal to a 1.1 Mb interval of mouse chromosome 1 syntenic with human chromosome 1q23.2-23.3". Genes Brain Behav. 7 (5): 560–7. doi:10.1111/j.1601-183X.2008.00391.x. PMID 18363856. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1601-1848&date=2008&volume=7&issue=5&spage=560. 11 Galloway GP, Frederick SL, Staggers FE, Gonzales M, Stalcup SA, Smith DE (January 1997). "Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence". Addiction 92 (1): 89–96. PMID 9060200. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=1997&volume=92&issue=1&spage=89. 12 Griffiths RR, Evans SM, Heishman SJ, et al (December 1990). "Low-dose caffeine physical dependence in humans". J. Pharmacol. Exp. Ther. 255 (3): 1123–32. PMID 2262896. http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=2262896. 13 "MedlinePlus Medical Encyclopedia: Drug abuse and dependence". http://www.nlm.nih.gov/medlineplus/ency/article/001522.htm. Retrieved on 2008-12-21. 14 Karachalios GN, Charalabopoulos A, Papalimneou V, et al (May 2005). "Withdrawal syndrome following cessation of antihypertensive drug therapy". Int. J. Clin. Pract. 59 (5): 562–70. doi:10.1111/j.1368-5031.2005.00520.x. PMID 15857353. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1368-5031&date=2005&volume=59&issue=5&spage=562. 15 Trenton AJ, Currier GW (2005). "Behavioural manifestations of anabolic steroid use". CNS Drugs 19 (7): 571–95. PMID 15984895. 16 Hartgens F, Kuipers H (2004). "Effects of androgenic-anabolic steroids in athletes". Sports Med 34 (8): 513–54. PMID 15248788. 17 http://www.uptodate.com/patients/content/topic.do?topicKey=~jjC8pTJDFe1Wix 18 Heh CW, Sramek J, Herrera J, Costa J (July 1988). "Exacerbation of psychosis after discontinuation of carbamazepine treatment". Am J Psychiatry 145 (7): 878–9. PMID 2898213 19 Lake CR, Quirk RS (December 1984). "CNS stimulants and the look-alike drugs". Psychiatr. Clin. North Am. 7 (4): 689–701. PMID 6151645. 20 Sarampote CS, Efron LA, Robb AS, Pearl PL, Stein MA (2002). "Can stimulant rebound mimic pediatric bipolar disorder?". J Child Adolesc Psychopharmacol 12 (1): 63–7. doi:10.1089/10445460252943588. PMID 12014597. http://dx.doi.org/10.1089/10445460252943588. 21 Danke F (1975). "[Methylphenidate addiction--Reversal of effect on withdrawal]" (in German). Psychiatr Clin (Basel) 8 (4): 201–11. PMID 1208893. 22 Cohen D, Leo J, Stanton T, et al (2002). "A boy who stops taking stimulants for "ADHD": commentaries on a Pediatrics case study". Ethical Hum Sci Serv 4 (3): 189–209. PMID 15278983. 23 Kora K, Kaplan P (2008). "[Hypomania/mania induced by cessation of antidepressant drugs]" (in Turkish). Turk Psikiyatri Derg 19 (3): 329–33. PMID 18791886. http://www.turkpsikiyatri.com/ftr.aspx?id=643. 24 Tint A, Haddad PM, Anderson IM (May 2008). "The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study". J. Psychopharmacol. (Oxford) 22 (3): 330–2. doi:10.1177/0269881107087488. PMID 18515448. http://jop.sagepub.com/cgi/pmidlookup?view=long&pmid=18515448. 25 Hennessy MJ, Tighe MG, Binnie CD, Nashef L (November 2001). "Sudden withdrawal of carbamazepine increases cardiac sympathetic activity in sleep". Neurology 57 (9): 1650–4. PMID 11706106. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=11706106. 26 Tran KT, Hranicky D, Lark T, Jacob Nj (June 2005). "Gabapentin withdrawal syndrome in the presence of a taper". Bipolar Disord 7 (3): 302–4. doi:10.1111/j.1399-5618.2005.00200.x. PMID 15898970. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1398-5647&date=2005&volume=7&issue=3&spage=302. 27 Lazarova M, Petkova B, Staneva-Stoycheva D (December 1999). "Effects of the calcium antagonists verapamil and nitrendipine on carbamazepine withdrawal". Methods Find Exp Clin Pharmacol 21 (10): 669–71. PMID 10702963. http://journals.prous.com/journals/servlet/xmlxsl/pk_journals.xml_summaryn_pr?p_JournalId=6&p_RefId=795757. 28 Chichmanian RM, Gustovic P, Spreux A, Baldin B (1993). "[Risk related to withdrawal from non-psychotropic drugs]" (in French). Therapie 48 (5): 415–9. PMID 8146817. 29 Tierney, Lawrence M.; McPhee, Stephen J.; Papadakis, Maxine A. (2008). Current medical diagnosis & treatment, 2008. McGraw-Hill Medical. pp. 916. ISBN 0-07-149430-8. 30 BNF; British Medical Journal (2008). "Antipsychotic drugs". written at UK. British National Formulary. http://www.bnf.org/bnf/bnf/56/3209.htm. Retrieved on 22 december 2008. 31 "Addiction Disorders". http://www.csmc.edu/14529.html. Retrieved on 2008-12-21. 32 Wolfgang Löscher and Dieter Schmidt (August 2006). "Experimental and Clinical Evidence for Loss of Effect (Tolerance) during Prolonged Treatment with Antiepileptic Drugs". Epilepsia 47 (8): 1253 - 1284. http://dx.doi.org/10.1111/j.1528-1167.2006.00607.x. 33 Quaglio G, Schifano F, Lugoboni F (September 2008). "Venlafaxine dependence in a patient with a history of alcohol and amineptine misuse". Addiction 103 (9): 1572–4. doi:10.1111/j.1360-0443.2008.02266.x. PMID 18636997.

Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance <a href="#fn1">1</a> and where negative physical symptoms<a href="#fn2">2</a> of withdrawal result from abrupt discontinuation or dosage reduction.<a href="#fn3">3</a> Physical dependence can develop from low-dose therapeutic use of certain medications as well as misuse of recreational drugs such as alcohol. The higher the dose used typically the worse the physical dependence and thus the worse the withdrawal syndrome. Withdrawal syndromes can last days, weeks or months or occasionally longer and will vary according to the dose, the type of drug used and the individual person.<a href="#fn4">4</a> From the point of view of the dependent person, “dependence is duress,” argues addiction researcher Griffith Edwards.<a href="#fn5">5</a> Symptoms Physical dependence can manifest itself in the appearance of both physical and psychological symptoms but which are caused by physiological adaptions in the central nervous system and the brain due to chronic exposure to a substance. Some symptoms which may be experienced during withdrawal or reduction in dosage can include increased heart rate and/or blood pressure, sweating, and tremors are common signs of withdrawal. More serious symptoms such as confusion, seizures, and visual hallucinations indicate a serious emergency and the need for immediate medical care. Sedative hypnotic drugs such as alcohol, benzodiazepines, and barbiturates are the only commonly available substances that can be fatal in withdrawal due their propensity to induce withdrawal convulsions. Abrupt withdrawal from other drugs, such as opioids or psychostimulants, can exaggerate mild to moderate neurotoxic side effects due to hyperthermia and generation of free radicals<a href="#fn6">6</a>, but life-threatening complications are very rare. Treatment Treatment for physical dependence depends upon the drug being withdrawn and often includes administration of another drug, especially for substances that can be dangerous when abruptly discontinued. Physical dependence is usually managed by a slow dose reduction over a period of weeks, months or sometimes longer depending on the drug, dose and the individual.<a href="#fn4">4</a> A physical dependence on alcohol is often managed with a cross tolerant drug eg long acting benzodiazepines to manage the alcohol withdrawal symptoms. Difference from addiction Physical dependence is different from psychological dependence (addiction). The latter is often characterized by a compulsive need for a drug for psychological reasons, while the former is characterized by need for the drug due to tolerance and the need to prevent withdrawal symptoms on discontinuing the use of a drug. Physical dependence however, commonly occurs with both addiction and therapeutic use of drugs. Drugs that cause physical dependence nicotine<a href="#fn7">7</a> opioids<a href="#fn8">8</a> barbiturates benzodiazepines (see benzodiazepine dependence and benzodiazepine withdrawal syndrome) nonbenzodiazepines, such as zopiclone<a href="#fn9">9</a> ethyl alcohol (alcoholic beverage)<a href="#fn10">10</a> GHB<a href="#fn11">11</a> methaqualone (Quaalude) caffeine<a href="#fn12">12</a> blood pressure medications such as beta blockers<a href="#fn13">13</a> <a href="#fn14">14</a> androgenic-anabolic steroids[15 ] <a href="#fn16">16</a> glucocorticoids<a href="#fn17">17</a> Rebound syndrome A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal.<a href="#fn18">18</a> These can include stimulants,<a href="#fn19">19</a> <a href="#fn20">20</a> [21 ] <a href="#fn22">22</a>, antidepressants,<a href="#fn23">23</a> <a href="#fn24">24</a> anticonvulsants,<a href="#fn25">25</a> <a href="#fn26">26</a> <a href="#fn27">27</a> steroidal drugs and antiparkinsonian drugs.<a href="#fn28">28</a> Antipsychotics are another drug class that do not cause true physical dependency<a href="#fn29">29</a> but if discontinued too rapidly can cause an acute withdrawal syndrome.<a href="#fn30">30</a> Drugs like cocaine, marijuana, amphetamines, and hallucinogens can be associated with minimal physical dependence<a href="#fn31">31</a> but can still cause withdrawal or rebound symptoms. When talking about illicit drugs rebound withdrawal is, especially with stimulants, sometimes referred to as “coming down” or “crashing”. Some drugs, like anticonvulsants and antidepressants, describe the drug category and not the mechanism. The individual agents and drug classes in the anticonvulsant drug category act at many different receptors and it is not possible to generalize their potential for physical dependence or incidence or severity of rebound syndrome as a group so need to be looked at individually. Anticonvulsants as a group however are known to cause tolerance to the anti-seizure effect.<a href="#fn32">32</a> SSRI drugs, which have an important use as antidepressants, are not considered to cause physical dependence, but it’s generally accepted that they cause a discontinuation syndrome. Due to this, in Europe these drugs cannot be advertised as “non-habit forming”.[citation needed] There has however been case reports of dependence with venlafaxine (Effexor).<a href="#fn33">33</a> References 1 physical dependence at Dorland’s Medical Dictionary 2 “Definition of physical dependence – NCI Dictionary of Cancer Terms”. <a href="http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=454765.">http://www.cancer.gov/Templates/db_alpha.aspx?C…</a> Retrieved on 2008-12-21. 3 “Drug Addiction”. CNN. <a href="http://www.cnn.com/HEALTH/library/DS/00183.html">http://www.cnn.com/HEALTH/library/DS/00183.html</a>. 4 a b Landry MJ, Smith DE, McDuff DR, Baughman OL (1992). “Benzodiazepine dependence and withdrawal: identification and medical management”. J Am Board Fam Pract 5 (2): 167–75. PMID 1575069. 5 Griffith Edwards. Alcohol: The World’s Favourite Drug. 1st US ed. Thomas Dunne Books: 2002. ISBN 0-312-28387-3. P 72. 6 Sharma HS, Sjöquist PO, Ali SF (2007). “Drugs of abuse-induced hyperthermia, blood-brain barrier dysfunction and neurotoxicity: neuroprotective effects of a new antioxidant compound H-290/51”. Current pharmaceutical design 13 (18): 1903–23. PMID 17584116. <a href="http://www.bentham-direct.org/pages/content.php?CPD">http://www.bentham-direct.org/pages/content.php…</a>/2007/00000013/00000018/0006B.SGM. 7 Jed E. Rose (October 2007). “Multiple brain pathways and receptors underlying tobacco addiction”. Biochemical Pharmacology 74 (8): 1263-1270. <a href="http://dx.doi.org/10.1016/j.bcp.2007.07.039">http://dx.doi.org/10.1016/j.bcp.2007.07.039</a>. 8 Trang T, Sutak M, Quirion R, Jhamandas K (May 2002). “The role of spinal neuropeptides and prostaglandins in opioid physical dependence”. Br. J. Pharmacol. 136 (1): 37–48. doi:10.1038/sj.bjp.0704681. PMID 11976266. PMC: 1762111. <a href="http://dx.doi.org/10.1038/sj.bjp.0704681">http://dx.doi.org/10.1038/sj.bjp.0704681</a>. 9 Sikdar S (July 1998). “Physical dependence on zopiclone. Prescribing this drug to addicts may give rise to iatrogenic drug misuse”. BMJ 317 (7151): 146. PMID 9657802. PMC: 1113504. <a href="http://bmj.com/cgi/pmidlookup?view=long&pmid=9657802.">http://bmj.com/cgi/pmidlookup?view=long&pmid=96…</a> 10 Kozell L, Belknap JK, Hofstetter JR, Mayeda A, Buck KJ (July 2008). “Mapping a locus for alcohol physical dependence and associated withdrawal to a 1.1 Mb interval of mouse chromosome 1 syntenic with human chromosome 1q23.2-23.3”. Genes Brain Behav. 7 (5): 560–7. doi:10.1111/j.1601-183X.2008.00391.×. PMID 18363856. <a href="http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm">http://www3.interscience.wiley.com/resolve/open…</a>:pubmed&issn=1601-1848&date=2008&volume=7&issue=5&spage=560. 11 Galloway GP, Frederick SL, Staggers FE, Gonzales M, Stalcup SA, Smith DE (January 1997). “Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence”. Addiction 92 (1): 89–96. PMID 9060200. <a href="http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm">http://www3.interscience.wiley.com/resolve/open…</a>:pubmed&issn=0965-2140&date=1997&volume=92&issue=1&spage=89. 12 Griffiths RR, Evans SM, Heishman SJ, et al (December 1990). “Low-dose caffeine physical dependence in humans”. J. Pharmacol. Exp. Ther. 255 (3): 1123–32. PMID 2262896. <a href="http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=2262896.">http://jpet.aspetjournals.org/cgi/pmidlookup?vi…</a> 13 “MedlinePlus Medical Encyclopedia: Drug abuse and dependence”. <a href="http://www.nlm.nih.gov/medlineplus/ency/article/001522.htm">http://www.nlm.nih.gov/medlineplus/ency/article…</a>. Retrieved on 2008-12-21. 14 Karachalios GN, Charalabopoulos A, Papalimneou V, et al (May 2005). “Withdrawal syndrome following cessation of antihypertensive drug therapy”. Int. J. Clin. Pract. 59 (5): 562–70. doi:10.1111/j.1368-5031.2005.00520.×. PMID 15857353. <a href="http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm">http://www3.interscience.wiley.com/resolve/open…</a>:pubmed&issn=1368-5031&date=2005&volume=59&issue=5&spage=562. 15 Trenton AJ, Currier GW (2005). “Behavioural manifestations of anabolic steroid use”. CNS Drugs 19 (7): 571–95. PMID 15984895. 16 Hartgens F, Kuipers H (2004). “Effects of androgenic-anabolic steroids in athletes”. Sports Med 34 (8): 513–54. PMID 15248788. 17 <a href="http://www.uptodate.com/patients/content/topic.do?topicKey=">http://www.uptodate.com/patients/content/topic….</a>~jjC8pTJDFe1Wix 18 Heh CW, Sramek J, Herrera J, Costa J (July 1988). “Exacerbation of psychosis after discontinuation of carbamazepine treatment”. Am J Psychiatry 145 (7): 878–9. PMID 2898213 19 Lake CR, Quirk RS (December 1984). “CNS stimulants and the look-alike drugs”. Psychiatr. Clin. North Am. 7 (4): 689–701. PMID 6151645. 20 Sarampote CS, Efron LA, Robb AS, Pearl PL, Stein MA (2002). “Can stimulant rebound mimic pediatric bipolar disorder?”. J Child Adolesc Psychopharmacol 12 (1): 63–7. doi:10.1089/10445460252943588. PMID 12014597. <a href="http://dx.doi.org/10.1089/10445460252943588">http://dx.doi.org/10.1089/10445460252943588</a>. 21 Danke F (1975). “[Methylphenidate addiction—Reversal of effect on withdrawal]” (in German). Psychiatr Clin (Basel) 8 (4): 201–11. PMID 1208893. 22 Cohen D, Leo J, Stanton T, et al (2002). "A boy who stops taking stimulants for “ADHD”: commentaries on a Pediatrics case study". Ethical Hum Sci Serv 4 (3): 189–209. PMID 15278983. 23 Kora K, Kaplan P (2008). “[Hypomania/mania induced by cessation of antidepressant drugs]” (in Turkish). Turk Psikiyatri Derg 19 (3): 329–33. PMID 18791886. <a href="http://www.turkpsikiyatri.com/ftr.aspx?id=643.">http://www.turkpsikiyatri.com/ftr.aspx?id=643.</a> 24 Tint A, Haddad PM, Anderson IM (May 2008). “The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study”. J. Psychopharmacol. (Oxford) 22 (3): 330–2. doi:10.1177/0269881107087488. PMID 18515448. <a href="http://jop.sagepub.com/cgi/pmidlookup?view=long&pmid=18515448.">http://jop.sagepub.com/cgi/pmidlookup?view=long…</a> 25 Hennessy MJ, Tighe MG, Binnie CD, Nashef L (November 2001). “Sudden withdrawal of carbamazepine increases cardiac sympathetic activity in sleep”. Neurology 57 (9): 1650–4. PMID 11706106. <a href="http://www.neurology.org/cgi/pmidlookup?view=long&pmid=11706106.">http://www.neurology.org/cgi/pmidlookup?view=lo…</a> 26 Tran KT, Hranicky D, Lark T, Jacob Nj (June 2005). “Gabapentin withdrawal syndrome in the presence of a taper”. Bipolar Disord 7 (3): 302–4. doi:10.1111/j.1399-5618.2005.00200.×. PMID 15898970. <a href="http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm">http://www3.interscience.wiley.com/resolve/open…</a>:pubmed&issn=1398-5647&date=2005&volume=7&issue=3&spage=302. 27 Lazarova M, Petkova B, Staneva-Stoycheva D (December 1999). “Effects of the calcium antagonists verapamil and nitrendipine on carbamazepine withdrawal”. Methods Find Exp Clin Pharmacol 21 (10): 669–71. PMID 10702963. <a href="http://journals.prous.com/journals/servlet/xmlxsl/pk_journals.xml_summaryn_pr?p_JournalId=6&p_RefId=795757.">http://journals.prous.com/journals/servlet/xmlx…</a> 28 Chichmanian RM, Gustovic P, Spreux A, Baldin B (1993). “[Risk related to withdrawal from non-psychotropic drugs]” (in French). Therapie 48 (5): 415–9. PMID 8146817. 29 Tierney, Lawrence M.; McPhee, Stephen J.; Papadakis, Maxine A. (2008). Current medical diagnosis & treatment, 2008. McGraw-Hill Medical. pp. 916. ISBN 0-07-149430-8. 30 BNF; British Medical Journal (2008). “Antipsychotic drugs”. written at UK. British National Formulary. <a href="http://www.bnf.org/bnf/bnf/56/3209.htm">http://www.bnf.org/bnf/bnf/56/3209.htm</a>. Retrieved on 22 december 2008. 31 “Addiction Disorders”. <a href="http://www.csmc.edu/14529.html">http://www.csmc.edu/14529.html</a>. Retrieved on 2008-12-21. 32 Wolfgang Löscher and Dieter Schmidt (August 2006). “Experimental and Clinical Evidence for Loss of Effect (Tolerance) during Prolonged Treatment with Antiepileptic Drugs”. Epilepsia 47 (8): 1253 – 1284. <a href="http://dx.doi.org/10.1111/j.1528-1167.2006.00607.x">http://dx.doi.org/10.1111/j.1528-1167.2006.00607.x</a>. 33 Quaglio G, Schifano F, Lugoboni F (September 2008). “Venlafaxine dependence in a patient with a history of alcohol and amineptine misuse”. Addiction 103 (9): 1572–4. doi:10.1111/j.1360-0443.2008.02266.×. PMID 18636997.

2009-03-12T18:18:27Z

http://en.wikipedia.org/wiki/Physical_dependence

Physical Dependence

Wikipedia

Pornography addiction, or more broadly overuse of pornography, is excessive pornography use that interferes with daily life. There is no diagnosis of pornography addiction in the current DSM. As with sexual addiction, of which it is a proposed form, there is debate as to whether or not it is an addiction. [1][2] Diagnosis as an addiction Dispute There is dispute about whether pornography addiction exists. There is further argument as to whether or not it has harmful effects. Some sex therapists argue that it is a real addiction with serious consequences, whilst others argue it is not comparable to substance addiction and should not be classed as such.[2] Erick Janssen criticizes the application of the term addiction to pornography overuse, arguing that while it describes addiction-like behaviour, treating the users as addicts may not help.[1] Stephen Andert states that pornography is a problem for many people, and argues that it can take control of a person's life like alcohol, gambling or drugs, and "drag them kicking and screaming or voluntarily into the gutter." He argues further that the "addictive and progressive (or regressive) nature of pornography is well documented."[3] Proposed definition Pornography addiction is defined, by those who argue that it exists, as a psychological addiction to, or dependence upon, pornography, characterized by obsessive viewing, reading, and thinking about pornography and sexual themes to the detriment of other areas of one's own life. Proposed diagnosis Goodman compared the DSM criteria lists for various addictive disorders and derived these general characteristics:[4] • Recurrent failure to resist impulses to engage in a specified behavior • Increasing sense of tension immediately prior to initiating the behavior • Pleasure or relief at the time of engaging in the behavior • At least five of the following: o Frequent preoccupation with the behavior or with activity that is preparatory to the behavior o Frequent engaging in the behavior to a greater extent or over a longer period than intended o Repeated efforts to reduce, control, or stop the behavior o A great deal of time spent in activities necessary for the behavior, engaging in the behavior, or recovering from its effects o Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations o Important social, occupational, or recreational activities given up or reduced because of the behavior o Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior o Tolerance: need to increase the intensity or frequency of the behavior in order to achieve the desired effect, or diminished effect with continued behavior of the same intensity o Restlessness or irritability if unable to engage in the behavior • Some symptoms of the disturbance have persisted for at least one month, or have occurred repeatedly over a longer period of time Proposed stages of pornography addiction Some psychologists and sex therapists (for example Dr.Kimberly Young and Dr.Victor Cline) have suggested the following stages in pornography addiction,[5][6][7] 1. Discovery — The thrill or arousal associated with the material is encountered during this stage. This can happen accidentally or through curiosity. This stage usually refers to initial exposure rather than exposure over a prolonged period of time. There can be a rush because the event represents entering an area that is taboo, forbidden, or simply sensually arousing.[5] 2. Experimentation/Exploration — This stage is characterized by various cognitive distortions as the person rationalizes exploring or experimenting with the material: "it's just harmless fun" or "this isn't hurting anyone". Masturbation usually accompanies this stage, powerfully reinforcing the experience.[5][8] 3. Desensitization — As exploration and experimentation continue, desensitization takes place. In this stage, what was once shocking or atrocious is now considered normal or even mundane, thus setting the stage for escalation.[5][9] 4. Escalation — During this stage, the material becomes rougher and more explicit, and what Cline considered to be more deviant and "kinky," in order for the person to achieve the same level of arousal or rush.[5][10] 5. Performance — Frequent exposure to the material may be accompanied by the person wanting to act out sexual behaviours she or he has seen depicted in the pornography. In some cases, she or he may engage in these behaviors with her or his partner, or if married, she or he may seek a partner outside the marriage.[11] Rory C. Reid and Dan Gray note that these stages need not be sequential and not all individuals experience all stages.[5] Serial killer Ted Bundy stated that his pornography addiction went through stages. As a boy he reported seeing softcore pornography, and that he later viewed hardcore pornography and violent pornography. Ben Shapiro, in his book "Porn Generation: How Social Liberalism Is Corrupting Our Future", claimed that this played an influencing role in Bundy's crimes.[12] However, Alexander Barnes Dryer, in his review of the book for The New Republic states that it was difficult to cite just one flaw with the book, as there were so many.[13] Online pornography addiction Online pornography addiction involves pornography obtained via the Internet. Psychologists who support this concept argue that it is stronger, and more addictive, than ordinary pornography addiction because of its wide availability, explicit nature, and the privacy that online viewing offers. Some claim that "addicts" regularly spend extended periods of time searching the internet for new or increasingly hardcore pornography.[1] Use of content control and monitoring Some clinicians and support organizations recommend using voluntary content control mechanisms (also known as "Internet filters" and "censorware"), internet monitoring, or both as a tool in the treatment of purportedly excessive online pornography use.[14][15][16][17][18][19][20][21] Sex researcher Alvin Cooper and colleagues suggested several reasons for using filters as a therapeutic measure, including curbing accessibility that facilitates problematic behavior and encouraging clients to develop coping and relapse prevention strategies.[14] Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control.[18] Internet behavior researcher David Delmonico noted that, despite their limitations, filters may serve as a "frontline of protection."[15] Filters that target pornography have been included in computer operating systems such as Linux and are sold as stand-alone applications and devices. References 1. ^ a b c Downs, Martin F.; Louise Chang, MD (reviewer) (August 30, 2005). "Is Pornography Addictive? Psychologists debate whether people can have an addiction to pornography.". WebMD. http://men.webmd.com/guide/is-pornography-addictive. Retrieved on 2007-03-22. 2. ^ a b http://news.bbc.co.uk/1/hi/magazine/7371171.stm 3. ^ Andert, Stephen; Donald K. Burleson (2005). Web Stalkers. Rampant TechPress. pp. 160–161. 4. ^ Goodman, Aviel, 1990. Addiction: Definition and implications. Brit J Psychiatry 85:1403-1408 5. ^ a b c d e f Rory C. Reid; Dan Gray (2006). "Assessing a Problem: Pornography Questionnaire". Confronting Your Spouse's Pornography Problem. Silverleaf Press. pp. 167–8. ISBN 9781933317434. 6. ^ Cline, Dr.Victor B., Treatment and Healing of Sexual and Pornographic Addictions, http://www.obscenitycrimes.org/vbctreat.cfm 7. ^ Cline, Dr.Victor B., Pornography's Effects on Adults and Children, http://www.obscenitycrimes.org/clineart.cfm 8. ^ Cline, Dr.Victor (PDF). Victor Cline, Ph.D. Witness Statement, Commission on Child Online Protection. http://www.copacommission.org/meetings/hearing3/cline.test.pdf. "In the case of pedophiles; the overwhelming majority, in my clinical experience use child pornography and/or create it to stimulate and whet their sexual appetites which they masturbate to then later use as a model for their own sexual acting out with children.[...]Other related studies by D.R. Evens and B.T. Jackson support his thesis. They found that deviant masturbatory fantasy very significantly effected the habit strength of the subject’s sexual deviation". 9. ^ Cline, Dr.Victor B., Pornography's Effects on Adults and Children, http://www.obscenitycrimes.org/clineart.cfm, "The sexual activity depicted in the pornography (no matter how anti-social or deviant) became legitimized. There was an increasing sense that "everybody does it" and this gave them permission to also do it, even though the activity was possibly illegal and contrary to their previous moral beliefs and personal standards." 10. ^ Cline, Dr.Victor B., Pornography's Effects on Adults and Children, http://www.obscenitycrimes.org/clineart.cfm, "Being married or in a relationship with a willing sexual partner did not solve their problem. Their addiction and escalation were mainly due to the powerful sexual imagery in their minds, implanted there by the exposure to pornography." 11. ^ Cline, Dr.Victor B., Pornography's Effects on Adults and Children, http://www.obscenitycrimes.org/clineart.cfm, "... an increasing tendency to act out sexually the behaviors viewed in the pornography, including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex. This behavior frequently grew into a sexual addiction which they found themselves locked into and unable to change or reverse, no matter what the negative consequences were in their life." 12. ^ Shapiro, Ben (2005). Porn Generation: Porn Generation: How Social Liberalism Is Corrupting Our Future. Regnery Publishing. pp. 160. ISBN 978-0895260161. 13. ^ "Porn Identity:A review by Alexander Barnes Dryer". 30 June 2005. http://www.powells.com/review/2005_06_30.html. 14. ^ a b Cooper, Alvin; Putnam, Dana E., Planchon, Lynn A., & Boies, Sylvain C. (1999). "Online Sexual Compulsivity: Getting Tangled in the Net". Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention 6 (2): 79–104. doi:10.1080/10720169908400182. 15. ^ a b Delmonico, D.L. (1997). "Cybersex: High Tech Sex Addiction". Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention 4 (2): 159–167. doi:10.1080/10720169708400139. 16. ^ "AAMFT Consumer Update - Sexual Addiction". American Association for Marriage and Family Therapy. http://www.aamft.org/families/Consumer_Updates/Sexual%20Addiction.asp. Retrieved on 2007-06-10. 17. ^ Corley, M. Deborah, Ph.D. (Winter 2002). "Cybersex Addiction" (PDF). Paradigm: 12, 22. http://www.addictionrecov.org/paradigm/P_PR_W02/W02-composite.pdf. 18. ^ a b Layden, Mary Anne, Ph.D. (September 2005). "Cyber Sex Addiction" (PDF). Advances in Cognitive Therapy: 1–2, 4–5. http://www.google.com/url?sa=t&ct=res&cd=2&url=http%3A%2F%2Fwww.academyofct.org%2FLibrary%2FInfoManage%2FGuide.asp%3FFolderID%3D295%26SessionID%3D&ei=ng-jRtv7PImCgATwws3KDQ&usg=AFQjCNEf86dfie8vIsUfNnNv8F0VGezocA&sig2=2XfdVuPQH5l5A5B3q9A69g. 19. ^ Bissette, David C., Psy.D. (February 2004). "Choosing an Internet Filter" (PDF). http://healthymind.com/filters.pdf. Retrieved on 2007-06-10. 20. ^ "Recovery Resources". Recovery Path Counselling Services. http://www.recoverypath.ca/therapists_addicts_resources.php. Retrieved on 2007-06-10. 21. ^ " "Evangelicals Are Addicted To Porn". ChristiaNet.com. http://christiannews.christianet.com/1154951956.htm". Retrieved on 2007-06-06.

Pornography addiction, or more broadly overuse of pornography, is excessive pornography use that interferes with daily life. There is no diagnosis of pornography addiction in the current DSM. As with sexual addiction, of which it is a proposed form, there is debate as to whether or not it is an addiction. <a href="#fn1">1</a><a href="#fn2">2</a> Diagnosis as an addiction Dispute There is dispute about whether pornography addiction exists. There is further argument as to whether or not it has harmful effects. Some sex therapists argue that it is a real addiction with serious consequences, whilst others argue it is not comparable to substance addiction and should not be classed as such.<a href="#fn2">2</a> Erick Janssen criticizes the application of the term addiction to pornography overuse, arguing that while it describes addiction-like behaviour, treating the users as addicts may not help.<a href="#fn1">1</a> Stephen Andert states that pornography is a problem for many people, and argues that it can take control of a person’s life like alcohol, gambling or drugs, and “drag them kicking and screaming or voluntarily into the gutter.” He argues further that the “addictive and progressive (or regressive) nature of pornography is well documented.”<a href="#fn3">3</a> Proposed definition Pornography addiction is defined, by those who argue that it exists, as a psychological addiction to, or dependence upon, pornography, characterized by obsessive viewing, reading, and thinking about pornography and sexual themes to the detriment of other areas of one’s own life. Proposed diagnosis Goodman compared the DSM criteria lists for various addictive disorders and derived these general characteristics:<a href="#fn4">4</a> • Recurrent failure to resist impulses to engage in a specified behavior • Increasing sense of tension immediately prior to initiating the behavior • Pleasure or relief at the time of engaging in the behavior • At least five of the following: o Frequent preoccupation with the behavior or with activity that is preparatory to the behavior o Frequent engaging in the behavior to a greater extent or over a longer period than intended o Repeated efforts to reduce, control, or stop the behavior o A great deal of time spent in activities necessary for the behavior, engaging in the behavior, or recovering from its effects o Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations o Important social, occupational, or recreational activities given up or reduced because of the behavior o Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior o Tolerance: need to increase the intensity or frequency of the behavior in order to achieve the desired effect, or diminished effect with continued behavior of the same intensity o Restlessness or irritability if unable to engage in the behavior • Some symptoms of the disturbance have persisted for at least one month, or have occurred repeatedly over a longer period of time Proposed stages of pornography addiction Some psychologists and sex therapists (for example Dr.Kimberly Young and Dr.Victor Cline) have suggested the following stages in pornography addiction,<a href="#fn5">5</a><a href="#fn6">6</a><a href="#fn7">7</a> 1. Discovery — The thrill or arousal associated with the material is encountered during this stage. This can happen accidentally or through curiosity. This stage usually refers to initial exposure rather than exposure over a prolonged period of time. There can be a rush because the event represents entering an area that is taboo, forbidden, or simply sensually arousing.<a href="#fn5">5</a> 2. Experimentation/Exploration — This stage is characterized by various cognitive distortions as the person rationalizes exploring or experimenting with the material: “it’s just harmless fun” or “this isn’t hurting anyone”. Masturbation usually accompanies this stage, powerfully reinforcing the experience.<a href="#fn5">5</a><a href="#fn8">8</a> 3. Desensitization — As exploration and experimentation continue, desensitization takes place. In this stage, what was once shocking or atrocious is now considered normal or even mundane, thus setting the stage for escalation.<a href="#fn5">5</a><a href="#fn9">9</a> 4. Escalation — During this stage, the material becomes rougher and more explicit, and what Cline considered to be more deviant and “kinky,” in order for the person to achieve the same level of arousal or rush.<a href="#fn5">5</a><a href="#fn10">10</a> 5. Performance — Frequent exposure to the material may be accompanied by the person wanting to act out sexual behaviours she or he has seen depicted in the pornography. In some cases, she or he may engage in these behaviors with her or his partner, or if married, she or he may seek a partner outside the marriage.<a href="#fn11">11</a> Rory C. Reid and Dan Gray note that these stages need not be sequential and not all individuals experience all stages.<a href="#fn5">5</a> Serial killer Ted Bundy stated that his pornography addiction went through stages. As a boy he reported seeing softcore pornography, and that he later viewed hardcore pornography and violent pornography. Ben Shapiro, in his book “Porn Generation: How Social Liberalism Is Corrupting Our Future”, claimed that this played an influencing role in Bundy’s crimes.<a href="#fn12">12</a> However, Alexander Barnes Dryer, in his review of the book for The New Republic states that it was difficult to cite just one flaw with the book, as there were so many.<a href="#fn13">13</a> Online pornography addiction Online pornography addiction involves pornography obtained via the Internet. Psychologists who support this concept argue that it is stronger, and more addictive, than ordinary pornography addiction because of its wide availability, explicit nature, and the privacy that online viewing offers. Some claim that “addicts” regularly spend extended periods of time searching the internet for new or increasingly hardcore pornography.<a href="#fn1">1</a> Use of content control and monitoring Some clinicians and support organizations recommend using voluntary content control mechanisms (also known as “Internet filters” and “censorware”), internet monitoring, or both as a tool in the treatment of purportedly excessive online pornography use.<a href="#fn14">14</a><a href="#fn15">15</a><a href="#fn16">16</a><a href="#fn17">17</a><a href="#fn18">18</a><a href="#fn19">19</a><a href="#fn20">20</a><a href="#fn21">21</a> Sex researcher Alvin Cooper and colleagues suggested several reasons for using filters as a therapeutic measure, including curbing accessibility that facilitates problematic behavior and encouraging clients to develop coping and relapse prevention strategies.<a href="#fn14">14</a> Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control.<a href="#fn18">18</a> Internet behavior researcher David Delmonico noted that, despite their limitations, filters may serve as a “frontline of protection.”<a href="#fn15">15</a> Filters that target pornography have been included in computer operating systems such as Linux and are sold as stand-alone applications and devices. References 1. ^ a b c Downs, Martin F.; Louise Chang, MD (reviewer) (August 30, 2005). “Is Pornography Addictive? Psychologists debate whether people can have an addiction to pornography.”. WebMD. <a href="http://men.webmd.com/guide/is-pornography-addictive">http://men.webmd.com/guide/is-pornography-addic…</a>. Retrieved on 2007-03-22. 2. ^ a b <a href="http://news.bbc.co.uk/1/hi/magazine/7371171.stm">http://news.bbc.co.uk/1/hi/magazine/7371171.stm</a> 3. ^ Andert, Stephen; Donald K. Burleson (2005). Web Stalkers. Rampant TechPress. pp. 160–161. 4. ^ Goodman, Aviel, 1990. Addiction: Definition and implications. Brit J Psychiatry 85:1403-1408 5. ^ a b c d e f Rory C. Reid; Dan Gray (2006). “Assessing a Problem: Pornography Questionnaire”. Confronting Your Spouse’s Pornography Problem. Silverleaf Press. pp. 167–8. ISBN 9781933317434. 6. ^ Cline, Dr.Victor B., Treatment and Healing of Sexual and Pornographic Addictions, <a href="http://www.obscenitycrimes.org/vbctreat.cfm">http://www.obscenitycrimes.org/vbctreat.cfm</a> 7. ^ Cline, Dr.Victor B., Pornography’s Effects on Adults and Children, <a href="http://www.obscenitycrimes.org/clineart.cfm">http://www.obscenitycrimes.org/clineart.cfm</a> 8. ^ Cline, Dr.Victor (PDF). Victor Cline, Ph.D. Witness Statement, Commission on Child Online Protection. <a href="http://www.copacommission.org/meetings/hearing3/cline.test.pdf">http://www.copacommission.org/meetings/hearing3…</a>. “In the case of pedophiles; the overwhelming majority, in my clinical experience use child pornography and/or create it to stimulate and whet their sexual appetites which they masturbate to then later use as a model for their own sexual acting out with children.[…]Other related studies by D.R. Evens and B.T. Jackson support his thesis. They found that deviant masturbatory fantasy very significantly effected the habit strength of the subject’s sexual deviation”. 9. ^ Cline, Dr.Victor B., Pornography’s Effects on Adults and Children, <a href="http://www.obscenitycrimes.org/clineart.cfm">http://www.obscenitycrimes.org/clineart.cfm</a>, "The sexual activity depicted in the pornography (no matter how anti-social or deviant) became legitimized. There was an increasing sense that “everybody does it” and this gave them permission to also do it, even though the activity was possibly illegal and contrary to their previous moral beliefs and personal standards." 10. ^ Cline, Dr.Victor B., Pornography’s Effects on Adults and Children, <a href="http://www.obscenitycrimes.org/clineart.cfm">http://www.obscenitycrimes.org/clineart.cfm</a>, “Being married or in a relationship with a willing sexual partner did not solve their problem. Their addiction and escalation were mainly due to the powerful sexual imagery in their minds, implanted there by the exposure to pornography.” 11. ^ Cline, Dr.Victor B., Pornography’s Effects on Adults and Children, <a href="http://www.obscenitycrimes.org/clineart.cfm">http://www.obscenitycrimes.org/clineart.cfm</a>, “… an increasing tendency to act out sexually the behaviors viewed in the pornography, including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex. This behavior frequently grew into a sexual addiction which they found themselves locked into and unable to change or reverse, no matter what the negative consequences were in their life.” 12. ^ Shapiro, Ben (2005). Porn Generation: Porn Generation: How Social Liberalism Is Corrupting Our Future. Regnery Publishing. pp. 160. ISBN 978-0895260161. 13. ^ “Porn Identity:A review by Alexander Barnes Dryer”. 30 June 2005. <a href="http://www.powells.com/review/2005_06_30.html">http://www.powells.com/review/2005_06_30.html</a>. 14. ^ a b Cooper, Alvin; Putnam, Dana E., Planchon, Lynn A., & Boies, Sylvain C. (1999). “Online Sexual Compulsivity: Getting Tangled in the Net”. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention 6 (2): 79–104. doi:10.1080/10720169908400182. 15. ^ a b Delmonico, D.L. (1997). “Cybersex: High Tech Sex Addiction”. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention 4 (2): 159–167. doi:10.1080/10720169708400139. 16. ^ “AAMFT Consumer Update – Sexual Addiction”. American Association for Marriage and Family Therapy. <a href="http://www.aamft.org/families/Consumer_Updates/Sexual%20Addiction.asp">http://www.aamft.org/families/Consumer_Updates/…</a>. Retrieved on 2007-06-10. 17. ^ Corley, M. Deborah, Ph.D. (Winter 2002). “Cybersex Addiction” (PDF). Paradigm: 12, 22. <a href="http://www.addictionrecov.org/paradigm/P_PR_W02/W02-composite.pdf">http://www.addictionrecov.org/paradigm/P_PR_W02…</a>. 18. ^ a b Layden, Mary Anne, Ph.D. (September 2005). “Cyber Sex Addiction” (PDF). Advances in Cognitive Therapy: 1–2, 4–5. <a href="http://www.google.com/url?sa=t&ct=res&cd=2&url=http%3A%2F%2Fwww.academyofct.org%2FLibrary%2FInfoManage%2FGuide.asp%3FFolderID%3D295%26SessionID%3D&ei=ng-jRtv7PImCgATwws3KDQ&usg=AFQjCNEf86dfie8vIsUfNnNv8F0VGezocA&sig2=2XfdVuPQH5l5A5B3q9A69g.">http://www.google.com/url?sa=t&ct=res&cd=2&url=…</a> 19. ^ Bissette, David C., Psy.D. (February 2004). “Choosing an Internet Filter” (PDF). <a href="http://healthymind.com/filters.pdf">http://healthymind.com/filters.pdf</a>. Retrieved on 2007-06-10. 20. ^ “Recovery Resources”. Recovery Path Counselling Services. <a href="http://www.recoverypath.ca/therapists_addicts_resources.php">http://www.recoverypath.ca/therapists_addicts_r…</a>. Retrieved on 2007-06-10. 21. ^ " “Evangelicals Are Addicted To Porn”. ChristiaNet.com. <a href="http://christiannews.christianet.com/1154951956.htm">http://christiannews.christianet.com/1154951956…</a>". Retrieved on 2007-06-06.

2009-01-22T02:14:05Z

http://en.wikipedia.org/wiki/Pornography_addiction

Pornography Addiction

National Institutes of Health

Drug addiction is a complex disorder that can involve virtually every aspect of an individual's functioning in the family, at work, and in the community. Because of addiction's complexity and pervasive consequences, drug addiction treatment typically must involve many components. Some of those components focus directly on the individual's drug use. Others, like employment training, focus on restoring the addicted individual to productive membership in the family and society (see Components of Comprehensive Drug Abuse Treatment diagram). Treatment for drug abuse and addiction is delivered in many different settings, using a variety of behavioral and pharmacological approaches. In the United States, more than 11,000 specialized drug treatment facilities provide rehabilitation, counseling, behavioral therapy, medication, case management, and other types of services to persons with drug use disorders. Because drug abuse and addiction are major public health problems, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of drug addiction and its medical consequences. Drug abuse and addiction are treated in specialized treatment facilities and mental health clinics by a variety of providers, including certified drug abuse counselors, physicians, psychologists, nurses, and social workers. Treatment is delivered in outpatient, inpatient, and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting. General Categories of Treatment Programs Research studies on drug addiction treatment have typically classified treatment programs into several general types or modalities, which are described in the following text. Treatment approaches and individual programs continue to evolve, and many programs in existence today do not fit neatly into traditional drug addiction treatment classifications. Examples of specific research-based treatment components are described in the Approaches to Treatment Section.

Drug addiction is a complex disorder that can involve virtually every aspect of an individual’s functioning in the family, at work, and in the community. Because of addiction’s complexity and pervasive consequences, drug addiction treatment typically must involve many components. Some of those components focus directly on the individual’s drug use. Others, like employment training, focus on restoring the addicted individual to productive membership in the family and society (see Components of Comprehensive Drug Abuse Treatment diagram). Treatment for drug abuse and addiction is delivered in many different settings, using a variety of behavioral and pharmacological approaches. In the United States, more than 11,000 specialized drug treatment facilities provide rehabilitation, counseling, behavioral therapy, medication, case management, and other types of services to persons with drug use disorders. Because drug abuse and addiction are major public health problems, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of drug addiction and its medical consequences. Drug abuse and addiction are treated in specialized treatment facilities and mental health clinics by a variety of providers, including certified drug abuse counselors, physicians, psychologists, nurses, and social workers. Treatment is delivered in outpatient, inpatient, and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting. General Categories of Treatment Programs Research studies on drug addiction treatment have typically classified treatment programs into several general types or modalities, which are described in the following text. Treatment approaches and individual programs continue to evolve, and many programs in existence today do not fit neatly into traditional drug addiction treatment classifications. Examples of specific research-based treatment components are described in the Approaches to Treatment Section.

2009-03-18T20:14:27Z

http://www.drugabuse.gov/PODAT/PODAT7.html

Principles of Drug Addiction and Treatment

Wikipedia

Sexual addiction refers to phenomenon in which individuals report being unable to manage their sexual behavior. It has also been called "hypersexuality," "sexual dependency," and "sexual compulsivity." The existence of the condition is not universally accepted by sexologists, and there is debate about its etiology, nature, and validity. Proponents of the concept have offered varying descriptions, each according to their favored model of the putative phenomenon: Proponents of an addiction model of the phenomenon refer to it as "sexual addiction" and offer definitions based on substance addictions; proponents of lack-of-control models refer to it as "sexual compulsivity" and offer definitions based on obsessive-compulsive disorder (OCD); etc. Skeptics believe that it is a myth that the phenomenon exists as a disease or disorder at all and is instead a by-product of cultural and other influences. Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention, a journal in which proponents explore the topic, has devoted an entire issue to AIDS and sex addiction as a worldwide problem.[1] Definition Sexologists have not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon.[2][3] Some experts believe that sexual addiction is literally an addiction, directly analogous to alcohol and drug addictions. Other experts believe that sexual addiction is actually a form of obsessive compulsive disorder and refer to it as sexual compulsivity.[4] Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.[5][6] Terminology "Nymphomania" and "satyriasis" are not listed as disorders in the DSM-IV, though they remain a part of ICD-10, each listed as a subtype of "Hypersexuality."[7] The threshold for what constitutes hypersexuality is subject to debate, and critics question whether a standardized diagnostic threshold even exists. Sex drive varies widely in humans; what one person would regard as a normal sex drive might be deemed to be excessive by some and low by others. The consensus among those who consider this a disorder is that the threshold is met when the behavior causes distress or impaired social functioning. Official status The American Psychiatric Association publishes and periodically updates the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely recognized compendium of acknowledged mental disorders and their diagnostic criteria. The most recent version of that manual, DSM-IV-TR, was published in 2000 and does not recognize sexual addiction as a diagnosis.[8] Some experts have expressed that excluding sexual addiction from the DSM represents a problem.[9] The DSM does, however, include a miscellaneous diagnosis called Sexual Disorders Not Otherwise Specified, and includes as one of the examples of it: "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used." Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.[8] The World Health Organization produces the International Classification of Diseases (ICD)), which is used globally and is not limited to mental disorders. The most recent version of that document, ICD-10, includes "Excessive sexual drive" as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).[7] Symptoms and proposed diagnostic criteria An abstract on the problem of the DSM IV's exclusion of sexual compulsive behavior has been outlined by Irons and Schneider (1996).[9] Proposals based on addictions models Irons and Schneider have noted that "Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence."[9] Similarly, Lowinson and colleagues use the addiction model and define sexual addiction as a condition in which some form of sexual behaviour is employed in a pattern that is characterized at least by two key features: recurrent failure to control the behaviour and continuation of the behaviour despite harmful consequences.[10] Patrick Carnes, another proponent of the addiction model of sexual addiction, argued that most professionals in the field agree with the World Health Organization's definition of addiction.[11] Patrick Carnes, a proponent of the idea of sexual addiction, proposed using:[12] 1. Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex. 2. Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended. 3. Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors. 4. Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience. 5. Preoccupation with the behavior or preparatory activities. 6. Frequent engaging in violent sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations. 7. Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic, financial, psychological, or physical problem that is caused or exacerbated by the behavior. 8. Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk. 9. Giving up or limiting social, occupational, or recreational activities because of the behavior. 10. Resorting to distress, anxiety, restlessness, or violence if unable to engage in the behavior at times relating to SRD (Sexual Rage Disorder). Goodman proposed:[13] A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. tolerance, as defined by either of the following: 1. a need for markedly increased amount or intensity of the behavior to achieve the desired effect 2. markedly diminished effect with continued involvement in the behavior at the same level or intensity 3. withdrawal, as manifested by either of the following: 1. characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior 2. the same {or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms 4. the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended 5. there is a persistent desire or unsuccessful efforts to cut down or control the behavior 6. a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects 7. important social, occupational, or recreational activities are given up or reduced because of the behavior 8. the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior Proposals based on obsessive/compulsive models Schneider identified three indicators of sexual addiction: compulsivity, continuation despite consequences, and obsession.[14] 1. Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior.[15] 2. Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires.[16] Despite all of these consequences, they continue indulging in excessive sexual activity. 3. Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they could be thinking about are neglected. Eli Coleman proposed:[17] 1. involves recurrent and intense normophilic (nonparaphilic) sexually arousing fantasies, sexual urges, and behaviors that cause clinically significant distress in social, occupational, or other important areas of functioning; and 2. is not due simply to another medical condition, substance use disorder, or a developmental disorder Epidemiology Sexual addiction is hypothesized to be (but is not always) associated with Obsessive-compulsive disorder (OCD), Narcissistic personality disorder,[18][19] and manic-depression.[20] There are those who suffer from more than one condition simultaneously (known as a dual diagnosis or a co-occurring disorder), but traits of addiction are often confused with those of these disorders, often due to most clinicians not being adequately trained in diagnosis and characteristics of addictions, and many clinicians tending to avoid use of the diagnosis at all.[2][21][22] Specialists in obsessive-compulsive disorder (OCD) and addictions use the same terms to refer to different symptoms. In addictions, obsession is progressive and pervasive, and develops along with denial; the person usually does not see themselves as preoccupied, and simultaneously makes excuses, justifies and blames. Compulsion is present only while the addict is physically dependent on the activity for physiological stasis. Constant repetition of the activity creates a chemically dependent state. If the addict acts out when not in this state, it is seen as being spurred by the obsession only. Some addicts do have OCD as well as addiction, and the symptoms will interact.[21] Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full personality disorder even after successful addiction treatment.[18] Manifestation According to the book Synopsis of Psychiatry, sex addicts are unable to control their sexual impulses, which can involve the entire spectrum of sexual fantasy or behavior. Eventually, the need for sexual activity increases, and the person's behavior is motivated solely by the persistent desire to experience the sex act and the history usually reveals a long-standing pattern of such behavior, which the person repeatedly has tried to stop, but without success. Although a patient may have feeling of guilt and remorse after the act, these feelings do not suffice to prevent its recurrence and the patient may report that the need to act out is most severe during stressful periods or when angry, depressed, anxious, or otherwise dysphoric. Eventually, the sexual activity interferes with the person's social, vocational, or marital life, which begins to deteriorate.[23] Etiology Proponents of the concept have described sufferers as repeatedly and compulsively attempting to escape emotional or physical discomfort by using ritualized, sexualized behaviors such as masturbation, pornography, including obsessive thoughts. Some individuals try to connect with others through highly impersonal intimate behaviors: empty affairs, frequent visits to prostitutes, voyeurism, exhibitionism, frotteurism, cybersex, and the like. Neurochemical theories Earle has argued that neurochemical changes, similar to an adrenaline rush in the brain, temporarily reduce the discomfort an individual experiences with urges and cravings for sexualized behaviors that can be achieved through obsessive, highly ritualized patterns of sexual behavior.[24] Psychological distress theories Patrick Carnes (2001, p.40) argues that when children are growing up, they develop “core beliefs” through the way that their family functions and treats them. If a child is brought up in a family where his or her parents take proper care of him or her, he or she has good chances of growing up, having faith in other people and having self worth. On the other hand, if a child grows up in a family where he or she is neglected by his or her parents he or she will develop unhealthy and negative core beliefs. He or she will grow up to believe that people in the world do not care about him or her. Later on in life, the person will have trouble keeping stable relationships and will experience feelings of isolation. Generally, addicts do not perceive themselves as worthwhile human beings (Carnes, Delmonico and Griffin, 2001, p. 40). They cope with these feelings of isolation and weakness by engaging in excessive sex (Poudat, 2005, p.121). Addiction theories According to Patrick Carnes the cycle begins with the "Core Beliefs" that sex addicts hold:[25] 1. "I am basically a bad, unworthy person." 2. "No one would love me as I am." 3. "My needs are never going to be met if I have to depend on others." 4. "Sex is my most important need." These beliefs drive the addiction on its progressive and destructive course:[25] • Pain agent — First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict). A sex addict is not able to take care of the pain agent in a healthy way. • Dissociation — Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addict begins to dissociate (moves away from his or her feelings). A separation begins to take place between his or her mind and his or her emotional self. • Altered state of consciousness / a trance state / bubble of euphoric fantasized experience — Sex addict is disconnected from his or her emotions and he or she becomes pre-occupied with acting out behaviours. The reality becomes blocked out/distorted. • Preoccupation or "sexual pressure" — involves obsessing about being sexual or romantic. Fantasy becomes an obsession that serves in some way to avoid life. The addict's thoughts become focused on reaching a mood-altering high without actually acting-out sexually. He or she thinks about sex to produce a trance-like state of arousal in order to fully eliminate feelings of the current pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before moving into the next stage of the cycle. • Ritualization or "acting out." — These obsessions are intensified through the use of ritualization or acting out. A sex addict first cruises and then goes to a strip show to heighten his or her arousal until he or she is beyond the point of saying no. Ritualization helps to put distance between reality and sexual obsession. Rituals are a way to induce trance and further separate oneself from reality. Once the addict has begun his or her ritual, the chances of stopping that cycle diminish greatly. He or she is giving into the pull of the compelling sex act. • Sexual compulsivity — The next phase of the cycle is sexual compulsivity or "sex act". The tensions that the addict feels are reduced by acting on their sexual feelings. They feel better for the moment, thanks to the release that occurs. Compulsivity simply means that addicts regularly get to the point where sex becomes inevitable, no matter what the circumstances or the consequences. The compulsive act, which normally ends in orgasm, is perhaps the starkest reminder of the degradation involved in the addiction as the person realizes that he or she has become nothing more than a slave to the addiction. • Despair — Almost immediately reality sets in and the addict begins to feel ashamed. This point of the cycle is a painful place where the Addict has been many, many times. The last time the Addict was at this low point, they probably promised to never do it again. Yet once again, they act out and that leads to despair. He or she may feel he or she has betrayed spiritual beliefs, possibly a partner, and his or her own sense of integrity. At a superficial level, the addict hopes that this will be the last battle. According to Carnes, for many addicts, this dark emotion brings on depression and feelings of hopelessness. One easy way to cure feelings of despair is to start obsessing all over again. The cycle then perpetuates itself.[26] Treatment Self-help groups such as Sex Addicts Anonymous, Sexaholics Anonymous, Masturbators Anonymous and Sex and Love Addicts Anonymous are popular with proponents of the sexual addiction concept. These are large groups based on the 12-step system of Alcoholics Anonymous. There are various online support forums as well as real-life help through an out- or in-patient program or private counselor. Portrayal in popular culture Some sexual addiction proponents have commented that the concept faces many obstacles to being viewed seriously by the general public. One of these obstacles is the manner in which it is portrayed in popular media. Daily media sources sensationalize and denigrate people who are reported to be sex addicts. This portrayal typically extends into fictional television shows and movies. References 1. ^ Carnes, Patrick (2001). "Preface to 2001 Edition". Out of the Shadows. p. xii. 2. ^ a b Francoeur, R. T. (1994). Taking sides: Clashing views on controversial issues in human sexuality, p. 25. Dushkin Pub. Group. 3. ^ Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction and Compulsivity, 15, 284-310. 4. ^ Mayo Clinic Website 5. ^ Levine, M. P., & Troiden, R. R. (1988). The myth of sexual compulsivity. Journal of Sex Research, 25, 347-363. 6. ^ Giles, J. (2006). No such thing as excessive levels of sexual behavior. Archives of Sexual Behavior, 35, 641-642. 7. ^ a b International Classification of Diseases, version 2007. 8. ^ a b American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington, DC: Author. 9. ^ a b c Irons, R., & Schneider, J. P. (1996). Differential diagnosis of addictive sexual disorders using the DSM-IV. Sexual Addiction & Compulsivity, 3, 7-21. 10. ^ Lowinson, J. H., Ruiz, P., Millman, R. B., & Langrod, J. G. (2004). Substance abuse. Lippincott Williams & Wilkins. 11. ^ Carnes, P., & Adams, K. M. (2002). Clinical management of sex addiction. Psychology Press. 12. ^ Patrick Carnes; David Delmonico, Elizabeth Griffin (2001). In the Shadows of the Net. p. 31. 13. ^ (Goodman, 2001, pp. 195-196) 14. ^ (1994, p.19-44) 15. ^ (Carnes, Delmonico, & Griffin, 2001, p. 18) 16. ^ Arterburn, 1991, p.123 17. ^ Coleman, E. (2003). Compulsive sexual behavior: What to call it, how to treat it? SIECUS Report, 31(5), 12. 18. ^ a b Ulman, Richard B.; Harry Paul (2006). The Self Psychology of Addiction and Its Treatment. Psychology Press. 19. ^ Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for Addicts and Co-dependents. 1989. p. 57. 20. ^ Williams, Terrie M. (2008). Black Pain: It Just Looks Like We're Not Hurting. Simon & Schuster. p. 114. "[..]diagnosed as bipolar or manic-depressive, but his depression first started manifesting itself as sexual addiction." 21. ^ a b Hollander, Eric; Dan J. Stein (1997). Obsessive-compulsive Disorders. Informa Health Care. p. 212. 22. ^ Couples Therapy. Haworth Clinical Practice Press. 2001. p. 375. "They found that sexual narcissism is more common among men ... These characteristics are also central to the person with a sexual addiction" 23. ^ Sadock, Benjamin J.; Harold I. Kaplan, Virginia A. Sadock (2007). "21.3 Paraphilias and Sexual Disorder Not otherwise specified". Kaplan & Sadock's Synopsis of Psychiatry. Lippincott Williams & Wilkins. 24. ^ Earle, R., Crow, G. M., & Osborn, K. (1989). Lonely all the time: Recognizing, understanding, and overcoming sex addiction, for addicts and co-dependents. Simon & Schuster. 25. ^ a b Patrick Carnes, Out of the Shadows 26. ^ Patrick Carnes (2006) Facing the Shadow 27. ^ "Biography for David Duchovny". Internet Movie Database. http://www.imdb.com/name/nm0000141/bio. Retrieved on 2008-12-21.

Sexual addiction refers to phenomenon in which individuals report being unable to manage their sexual behavior. It has also been called “hypersexuality,” “sexual dependency,” and “sexual compulsivity.” The existence of the condition is not universally accepted by sexologists, and there is debate about its etiology, nature, and validity. Proponents of the concept have offered varying descriptions, each according to their favored model of the putative phenomenon: Proponents of an addiction model of the phenomenon refer to it as “sexual addiction” and offer definitions based on substance addictions; proponents of lack-of-control models refer to it as “sexual compulsivity” and offer definitions based on obsessive-compulsive disorder (OCD); etc. Skeptics believe that it is a myth that the phenomenon exists as a disease or disorder at all and is instead a by-product of cultural and other influences. Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention, a journal in which proponents explore the topic, has devoted an entire issue to AIDS and sex addiction as a worldwide problem.<a href="#fn1">1</a> Definition Sexologists have not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon.<a href="#fn2">2</a><a href="#fn3">3</a> Some experts believe that sexual addiction is literally an addiction, directly analogous to alcohol and drug addictions. Other experts believe that sexual addiction is actually a form of obsessive compulsive disorder and refer to it as sexual compulsivity.<a href="#fn4">4</a> Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.<a href="#fn5">5</a><a href="#fn6">6</a> Terminology “Nymphomania” and “satyriasis” are not listed as disorders in the DSM-IV, though they remain a part of ICD-10, each listed as a subtype of “Hypersexuality.”<a href="#fn7">7</a> The threshold for what constitutes hypersexuality is subject to debate, and critics question whether a standardized diagnostic threshold even exists. Sex drive varies widely in humans; what one person would regard as a normal sex drive might be deemed to be excessive by some and low by others. The consensus among those who consider this a disorder is that the threshold is met when the behavior causes distress or impaired social functioning. Official status The American Psychiatric Association publishes and periodically updates the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely recognized compendium of acknowledged mental disorders and their diagnostic criteria. The most recent version of that manual, DSM-IV-TR, was published in 2000 and does not recognize sexual addiction as a diagnosis.<a href="#fn8">8</a> Some experts have expressed that excluding sexual addiction from the DSM represents a problem.<a href="#fn9">9</a> The DSM does, however, include a miscellaneous diagnosis called Sexual Disorders Not Otherwise Specified, and includes as one of the examples of it: “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used.” Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.<a href="#fn8">8</a> The World Health Organization produces the International Classification of Diseases (ICD)), which is used globally and is not limited to mental disorders. The most recent version of that document, ICD-10, includes “Excessive sexual drive” as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).<a href="#fn7">7</a> Symptoms and proposed diagnostic criteria An abstract on the problem of the DSM IV’s exclusion of sexual compulsive behavior has been outlined by Irons and Schneider (1996).<a href="#fn9">9</a> Proposals based on addictions models Irons and Schneider have noted that “Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence.”<a href="#fn9">9</a> Similarly, Lowinson and colleagues use the addiction model and define sexual addiction as a condition in which some form of sexual behaviour is employed in a pattern that is characterized at least by two key features: recurrent failure to control the behaviour and continuation of the behaviour despite harmful consequences.<a href="#fn10">10</a> Patrick Carnes, another proponent of the addiction model of sexual addiction, argued that most professionals in the field agree with the World Health Organization’s definition of addiction.<a href="#fn11">11</a> Patrick Carnes, a proponent of the idea of sexual addiction, proposed using:<a href="#fn12">12</a> 1. Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex. 2. Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended. 3. Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors. 4. Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience. 5. Preoccupation with the behavior or preparatory activities. 6. Frequent engaging in violent sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations. 7. Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic, financial, psychological, or physical problem that is caused or exacerbated by the behavior. 8. Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk. 9. Giving up or limiting social, occupational, or recreational activities because of the behavior. 10. Resorting to distress, anxiety, restlessness, or violence if unable to engage in the behavior at times relating to SRD (Sexual Rage Disorder). Goodman proposed:<a href="#fn13">13</a> A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. tolerance, as defined by either of the following: 1. a need for markedly increased amount or intensity of the behavior to achieve the desired effect 2. markedly diminished effect with continued involvement in the behavior at the same level or intensity 3. withdrawal, as manifested by either of the following: 1. characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior 2. the same {or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms 4. the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended 5. there is a persistent desire or unsuccessful efforts to cut down or control the behavior 6. a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects 7. important social, occupational, or recreational activities are given up or reduced because of the behavior 8. the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior Proposals based on obsessive/compulsive models Schneider identified three indicators of sexual addiction: compulsivity, continuation despite consequences, and obsession.<a href="#fn14">14</a> 1. Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior.<a href="#fn15">15</a> 2. Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires.<a href="#fn16">16</a> Despite all of these consequences, they continue indulging in excessive sexual activity. 3. Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they could be thinking about are neglected. Eli Coleman proposed:<a href="#fn17">17</a> 1. involves recurrent and intense normophilic (nonparaphilic) sexually arousing fantasies, sexual urges, and behaviors that cause clinically significant distress in social, occupational, or other important areas of functioning; and 2. is not due simply to another medical condition, substance use disorder, or a developmental disorder Epidemiology Sexual addiction is hypothesized to be (but is not always) associated with Obsessive-compulsive disorder (OCD), Narcissistic personality disorder,<a href="#fn18">18</a><a href="#fn19">19</a> and manic-depression.<a href="#fn20">20</a> There are those who suffer from more than one condition simultaneously (known as a dual diagnosis or a co-occurring disorder), but traits of addiction are often confused with those of these disorders, often due to most clinicians not being adequately trained in diagnosis and characteristics of addictions, and many clinicians tending to avoid use of the diagnosis at all.<a href="#fn2">2</a><a href="#fn21">21</a><a href="#fn22">22</a> Specialists in obsessive-compulsive disorder (OCD) and addictions use the same terms to refer to different symptoms. In addictions, obsession is progressive and pervasive, and develops along with denial; the person usually does not see themselves as preoccupied, and simultaneously makes excuses, justifies and blames. Compulsion is present only while the addict is physically dependent on the activity for physiological stasis. Constant repetition of the activity creates a chemically dependent state. If the addict acts out when not in this state, it is seen as being spurred by the obsession only. Some addicts do have OCD as well as addiction, and the symptoms will interact.<a href="#fn21">21</a> Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full personality disorder even after successful addiction treatment.<a href="#fn18">18</a> Manifestation According to the book Synopsis of Psychiatry, sex addicts are unable to control their sexual impulses, which can involve the entire spectrum of sexual fantasy or behavior. Eventually, the need for sexual activity increases, and the person’s behavior is motivated solely by the persistent desire to experience the sex act and the history usually reveals a long-standing pattern of such behavior, which the person repeatedly has tried to stop, but without success. Although a patient may have feeling of guilt and remorse after the act, these feelings do not suffice to prevent its recurrence and the patient may report that the need to act out is most severe during stressful periods or when angry, depressed, anxious, or otherwise dysphoric. Eventually, the sexual activity interferes with the person’s social, vocational, or marital life, which begins to deteriorate.<a href="#fn23">23</a> Etiology Proponents of the concept have described sufferers as repeatedly and compulsively attempting to escape emotional or physical discomfort by using ritualized, sexualized behaviors such as masturbation, pornography, including obsessive thoughts. Some individuals try to connect with others through highly impersonal intimate behaviors: empty affairs, frequent visits to prostitutes, voyeurism, exhibitionism, frotteurism, cybersex, and the like. Neurochemical theories Earle has argued that neurochemical changes, similar to an adrenaline rush in the brain, temporarily reduce the discomfort an individual experiences with urges and cravings for sexualized behaviors that can be achieved through obsessive, highly ritualized patterns of sexual behavior.<a href="#fn24">24</a> Psychological distress theories Patrick Carnes (2001, p.40) argues that when children are growing up, they develop “core beliefs” through the way that their family functions and treats them. If a child is brought up in a family where his or her parents take proper care of him or her, he or she has good chances of growing up, having faith in other people and having self worth. On the other hand, if a child grows up in a family where he or she is neglected by his or her parents he or she will develop unhealthy and negative core beliefs. He or she will grow up to believe that people in the world do not care about him or her. Later on in life, the person will have trouble keeping stable relationships and will experience feelings of isolation. Generally, addicts do not perceive themselves as worthwhile human beings (Carnes, Delmonico and Griffin, 2001, p. 40). They cope with these feelings of isolation and weakness by engaging in excessive sex (Poudat, 2005, p.121). Addiction theories According to Patrick Carnes the cycle begins with the “Core Beliefs” that sex addicts hold:<a href="#fn25">25</a> 1. “I am basically a bad, unworthy person.” 2. “No one would love me as I am.” 3. “My needs are never going to be met if I have to depend on others.” 4. “Sex is my most important need.” These beliefs drive the addiction on its progressive and destructive course:<a href="#fn25">25</a> • Pain agent — First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict). A sex addict is not able to take care of the pain agent in a healthy way. • Dissociation — Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addict begins to dissociate (moves away from his or her feelings). A separation begins to take place between his or her mind and his or her emotional self. • Altered state of consciousness / a trance state / bubble of euphoric fantasized experience — Sex addict is disconnected from his or her emotions and he or she becomes pre-occupied with acting out behaviours. The reality becomes blocked out/distorted. • Preoccupation or “sexual pressure” — involves obsessing about being sexual or romantic. Fantasy becomes an obsession that serves in some way to avoid life. The addict’s thoughts become focused on reaching a mood-altering high without actually acting-out sexually. He or she thinks about sex to produce a trance-like state of arousal in order to fully eliminate feelings of the current pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before moving into the next stage of the cycle. • Ritualization or “acting out.” — These obsessions are intensified through the use of ritualization or acting out. A sex addict first cruises and then goes to a strip show to heighten his or her arousal until he or she is beyond the point of saying no. Ritualization helps to put distance between reality and sexual obsession. Rituals are a way to induce trance and further separate oneself from reality. Once the addict has begun his or her ritual, the chances of stopping that cycle diminish greatly. He or she is giving into the pull of the compelling sex act. • Sexual compulsivity — The next phase of the cycle is sexual compulsivity or “sex act”. The tensions that the addict feels are reduced by acting on their sexual feelings. They feel better for the moment, thanks to the release that occurs. Compulsivity simply means that addicts regularly get to the point where sex becomes inevitable, no matter what the circumstances or the consequences. The compulsive act, which normally ends in orgasm, is perhaps the starkest reminder of the degradation involved in the addiction as the person realizes that he or she has become nothing more than a slave to the addiction. • Despair — Almost immediately reality sets in and the addict begins to feel ashamed. This point of the cycle is a painful place where the Addict has been many, many times. The last time the Addict was at this low point, they probably promised to never do it again. Yet once again, they act out and that leads to despair. He or she may feel he or she has betrayed spiritual beliefs, possibly a partner, and his or her own sense of integrity. At a superficial level, the addict hopes that this will be the last battle. According to Carnes, for many addicts, this dark emotion brings on depression and feelings of hopelessness. One easy way to cure feelings of despair is to start obsessing all over again. The cycle then perpetuates itself.<a href="#fn26">26</a> Treatment Self-help groups such as Sex Addicts Anonymous, Sexaholics Anonymous, Masturbators Anonymous and Sex and Love Addicts Anonymous are popular with proponents of the sexual addiction concept. These are large groups based on the 12-step system of Alcoholics Anonymous. There are various online support forums as well as real-life help through an out- or in-patient program or private counselor. Portrayal in popular culture Some sexual addiction proponents have commented that the concept faces many obstacles to being viewed seriously by the general public. One of these obstacles is the manner in which it is portrayed in popular media. Daily media sources sensationalize and denigrate people who are reported to be sex addicts. This portrayal typically extends into fictional television shows and movies. References 1. ^ Carnes, Patrick (2001). “Preface to 2001 Edition”. Out of the Shadows. p. xii. 2. ^ a b Francoeur, R. T. (1994). Taking sides: Clashing views on controversial issues in human sexuality, p. 25. Dushkin Pub. Group. 3. ^ Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction and Compulsivity, 15, 284-310. 4. ^ Mayo Clinic Website 5. ^ Levine, M. P., & Troiden, R. R. (1988). The myth of sexual compulsivity. Journal of Sex Research, 25, 347-363. 6. ^ Giles, J. (2006). No such thing as excessive levels of sexual behavior. Archives of Sexual Behavior, 35, 641-642. 7. ^ a b International Classification of Diseases, version 2007. 8. ^ a b American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington, DC: Author. 9. ^ a b c Irons, R., & Schneider, J. P. (1996). Differential diagnosis of addictive sexual disorders using the DSM-IV. Sexual Addiction & Compulsivity, 3, 7-21. 10. ^ Lowinson, J. H., Ruiz, P., Millman, R. B., & Langrod, J. G. (2004). Substance abuse. Lippincott Williams & Wilkins. 11. ^ Carnes, P., & Adams, K. M. (2002). Clinical management of sex addiction. Psychology Press. 12. ^ Patrick Carnes; David Delmonico, Elizabeth Griffin (2001). In the Shadows of the Net. p. 31. 13. ^ (Goodman, 2001, pp. 195-196) 14. ^ (1994, p.19-44) 15. ^ (Carnes, Delmonico, & Griffin, 2001, p. 18) 16. ^ Arterburn, 1991, p.123 17. ^ Coleman, E. (2003). Compulsive sexual behavior: What to call it, how to treat it? SIECUS Report, 31(5), 12. 18. ^ a b Ulman, Richard B.; Harry Paul (2006). The Self Psychology of Addiction and Its Treatment. Psychology Press. 19. ^ Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for Addicts and Co-dependents. 1989. p. 57. 20. ^ Williams, Terrie M. (2008). Black Pain: It Just Looks Like We’re Not Hurting. Simon & Schuster. p. 114. “[..]diagnosed as bipolar or manic-depressive, but his depression first started manifesting itself as sexual addiction.” 21. ^ a b Hollander, Eric; Dan J. Stein (1997). Obsessive-compulsive Disorders. Informa Health Care. p. 212. 22. ^ Couples Therapy. Haworth Clinical Practice Press. 2001. p. 375. “They found that sexual narcissism is more common among men … These characteristics are also central to the person with a sexual addiction” 23. ^ Sadock, Benjamin J.; Harold I. Kaplan, Virginia A. Sadock (2007). “21.3 Paraphilias and Sexual Disorder Not otherwise specified”. Kaplan & Sadock’s Synopsis of Psychiatry. Lippincott Williams & Wilkins. 24. ^ Earle, R., Crow, G. M., & Osborn, K. (1989). Lonely all the time: Recognizing, understanding, and overcoming sex addiction, for addicts and co-dependents. Simon & Schuster. 25. ^ a b Patrick Carnes, Out of the Shadows 26. ^ Patrick Carnes (2006) Facing the Shadow 27. ^ “Biography for David Duchovny”. Internet Movie Database. <a href="http://www.imdb.com/name/nm0000141/bio">http://www.imdb.com/name/nm0000141/bio</a>. Retrieved on 2008-12-21.

2009-01-22T01:52:44Z

http://en.wikipedia.org/wiki/Sexual_addiction

Sexual Addiction

Wikipedia

Substance abuse is the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. The disorder is characterized by a pattern of continued pathological use of a medication, non-medically indicated drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. There are on-going debates as to the exact distinctions between substance abuse and substance dependence, but current practice standard distinguishes between the two by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Medically, physiologic dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse, but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance. Dependence involves physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society. Substance abuse is sometimes used as a synonym for drug abuse, drug addiction, and chemical dependency, but actually refers to the use of substances in a manner outside sociocultural conventions. All use of controlled drugs and all use of other drugs in a manner not dictated by convention (e.g. according to physician's orders or societal norms) is abuse according to this definition, however there is no universally accepted definition of substance abuse. The physical harm for twenty drugs was compared in an article in the Lancet, with the results shown in the diagram. Physical harm was assigned a value from 0 to 3 for acute harm, chronic harm and intravenous harm. Shown is the mean physical harm. Not shown, but also evaluated, was the social harm. History In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness. The third edition,in the 1980s, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance. In 1987 the DSM-IIIR category "psychoactive substance abuse", which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous". It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis. By 1988, the DSM-IV defines substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal". Substance abuse can be harmful to your health and may even be deadly in certain scenarios By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association ,the DSM-IV-TR, defines substance dependence as "when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed." followed by criteria for the diagnose. DSM-IV-TR defines substance abuse as: * A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household) 2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) * B. The symptoms have never met the criteria for Substance Dependence for this class of substance. The fifth edition of the DSM, planned for release in 2010, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-V discussion. Mediators & Moderators When the relationship between a predictor variable and an outcome variable have a significant relationship, which is, in turn, dependent on a third variable, the relationship is said to be mediated by the third variable. In this relationship the predictor variable influences the mediating variable in a causal manner. This mediating variable then leads to the outcome, creating the relationship between the predictor and outcome. It is only because of this mediating variable that a relationship between the predictor and outcome exists. Also, quasi-causal inferences may be drawn from mediated relationships. Numerous studies have examined factors which mediate substance abuse or dependence. In these examples, the predictor variables lead to the mediator which in turn leads to the outcome, which is always substance abuse or dependence. For example, research has found that being raised in a single-parent home can lead to increased exposure to stress and that increased exposure to stress, not being raised in a single-parent home, leads to substance abuse or dependence. When a variable indicates the conditions under which a specific effect occurs as well as displays how the direction or strength varies within a given relationship, the variable is said to moderate the relationship. Another explanation is that a moderator variable indicates that an effect only occurs under specific conditions. Unlike a relationship containing a mediator variable, the impact of the predictor variable on the outcome is dependent on the value of the moderating variable. Also unlike a relationship involving mediation, no causal inferences can be drawn from a moderated relationship; relationships can only be described as correlated. However, moderated relationships do identify interaction effects between predictor and moderator variables. Numerous studies have examined factors which moderate substance abuse or dependence. In these examples, the moderator variable impacts the level to which the strength of the relationship varies between a given predictor variable and the outcome of substance abuse or dependence. For example, there is a significant relationship between psychobehavioral risk factors, such as tolerance of deviance, rebelliousness, achievement, perceived drug risk, familism, family church attendance and other factors, and substance abuse and dependence. That relationship is moderated by familism which means that the strength of the relationship is increased or decreased based on the level of familism present in a given individual. Mediation and moderation research continues to inform the field’s knowledge and understanding of a pervasive and dangerous threat to public health, substance abuse and dependence. As the relationships between various predictor variables and the factors which influence them are more closely scrutinized, clinicians and researchers are provided with the necessary information to create more sophisticated and relevant methods of prevention and intervention. While these factors are important to the development of SUDs, there are plenty of other factors both known and unknown that influence the development of this disorder. As such, continued research is both necessary and invaluable. Additional Mediators and Moderators of Substance Abuse Mediators and Moderators Defined: Baron and Kenny (1986) define a moderator as, “a qualitative (e.g., sex, race, class) or quantitative (e.g., level of reward) variable that affects the direction and/or strength of the relation between and independent or predictor variable and a dependent or criterion variable” (p. 1174)]. Moderators may operate as protective factors, decreasing the strength of the relationship between the predictor variable and the outcome. Conversely, moderators may heighten risk levels and strengthen the effects of the predictor on the outcome. In either instance, moderators do not explain why the connection exists, but rather affect the strength and direction of the relationship between the variables. A mediator, as defined by Baron and Kenny (1986), “represents the generative mechanism through which the focal independent variable is able to influence the dependent variable of interest” (p. 1173). Unlike moderators, mediators can explain the relationship between the predictor variable and outcome. Holmbeck (1997) elaborated on Baron and Kenny’s definition by adding, “the nature of the mediated relationship is such that the independent variable influences the mediator which, in turn, influences the outcome” (p. 600). Examples of mediators and moderators in empirical research: Examples of mediators and moderators can be found in several empirical studies. For example, Pilgrim et al.’s hypothesized mediation model posited that school success and time spent with friends mediated the relationship between parental involvement and risk-taking behavior with substance use (2006). More specifically, the relationship between parental involvement and risk-taking behavior is explained via the interaction with third variables, school success and time spent with friends. In this example, increased parental involvement led to increased school success and decreased time with friends, both of which were associated with decreased drug use. Another example of mediation involved risk-taking behaviors. As risk-taking behaviors increased, school success decreased and time with friends increased, both of which were associated with increased drug use. A second example of a mediating variable is depression. In a study by Lo and Cheng (2007), depression was found to mediate the relationship between childhood maltreatment and subsequent substance abuse in adulthood. In other words, childhood physical abuse is associated with increased depression, which in turn, in associated with increased drug and alcohol use in young adulthood. More specifically, depression helps to explain how childhood abuse is related to subsequent substance abuse in young adulthood. A third example of a mediating variable is an increase of externalizing symptoms. King and Chassin (2008) conducted research examining the relationship between stressful life events and drug dependence in young adulthood. Their findings identified problematic externalizing behavior on subsequent substance dependency. In other words, stressful life events are associated with externalizing symptoms, such as aggression or hostility, which can lead to peer alienation or acceptance by socially deviant peers, which could lead to increased drug use. The relationship between stressful life events and subsequent drug dependence however exists via the presence of the mediation effects of externalizing behaviors. An example of a moderating variable is level of cognitive distortion. An individual with high levels of cognitive distortion might react adversely to potentially innocuous events, and may have increased difficulty reacting to them in an adaptive manner (Shoal & Giancola, 2005). In their study, Shoal and Giancola investigated the moderating effects of cognitive distortion on adolescent substance use. Individuals with low levels of cognitive distortion may be more apt to choose more adaptive methods of coping with social problems, thereby potentially reducing the risk of drug use. Individuals with high levels of cognitive distortions, because of their increased misperceptions and misattributions, are at increased risk for social difficulties. Individuals may be more likely to react aggressively or inappropriately, potentially alienating themselves from their peers, thereby putting them at greater risk for delinquent behaviors, including substance use and abuse. In this study, social problems are a significant risk factor for drug use when moderated by high levels of cognitive distortions. Mediators and Moderators for alcohol related use disorder The internal construct of personality has been studied as a potential moderator and mediator of the relationship between risk for development of an alcohol use disorder as defined by family history and alcohol use behaviors. In one such study done by Rogosch, Chassin, and Sher (1990), the personality characteristics of dispositional self-awareness and presumed personality risk as measured by patterns of anti-social behaviors including aggressiveness impulsivity, and poor school performance were examined as potential mediators and moderators, as defined by Baron and Kenny (1985). The study started that it explicitly aimed to examine “the role that personality characteristics may play in the link between family history risk and alcohol abuse” (1990, p. 310). Thus, they attempted to illustrate mediation; that is, personality is related to family history of alcohol use in addition to measures of alcohol use. Based on Baron and Kenney’s definition, it was also essential that they find the relationship between alcohol consumption and family history is substantially weakened or completely gone when personality characteristics of interest are considered. They also attempted to examine moderation, that is, personality characteristics affect on the strength or direction of the relationship between familial history of alcohol use and current use and/or abuse. Analysis of the data found both personality characteristics examined, presumed personality risk and self-awareness to play a moderation role. However, no meditational relationships were demonstrated based on regression analyses. The construct of Self-awareness moderated the relationship between family risk and levels of alcohol use such that; those with family history risk consumed less alcohol if they reported a higher the level of dispositional self-awareness than those who had the family risk but reported lower levels of self-awareness. The authors suggest that this might be due to highly self-aware individuals’ tendency to adherence to social norms and their knowledge of the potential consequences of increased alcohol use. The authors also found that presumed personality risk moderated the relationship between family history risk and levels of alcohol use. Specifically, individuals with elevated levels of presumed personality risk were more likely to have increased alcohol use. Thus presumed personality risk and dispositional self-awareness both acted as moderators. The authors note that their study should not be used alone in support of a lack of existence of the meditational role that personality may play on familial risk and alcohol use and/or abuse. Other studies concerning internal variables have also been done to examine the mediating roles of other psychopathology in the development of alcohol use disorders. One such study done by Bowie, Ensminger, and Robertson (2006), specifically examined young African-Americans alcohol use problems, depression, and religiosity as measured by church attendance. They study was stimulated by past research findings that religiosity was a protective factor for development of problem drinking behaviors and that levels of religiosity are greater for black than other racial groups. In addition, research found that churches act as a social resource and support in many minority communities. The authors suggest that this might matter due to greater social support availability during more difficult times and thus less likelihood to turn to alcohol and less likely to develop depression due to the particular stressor. Analysis of all data found moderating relationships between variables. The relationship between church attendance and alcohol use problems was moderated by depression. Specifically, “alcohol use problems of those who are depressed are much lower for frequent attendees compared with less frequent attendees…(in addition) frequency of church attendance is not related to alcohol problems for those who are not depressed” (2006, p. 50). The authors suggest that this may be due to the social support accessible to those who attend church and thus a decrease in likelihood to use alcohol and depression. Recently, Gradus and colleagues (2008) did further examination of depression and the potential mediating role on the relationship between sexual harassment and alcohol use problems among men and women who previously served in the United States military. The authors explain that this study hopes to further the self-medication hypothesis of the development of alcohol use problems. This theory posits that after trauma individual experience distress, which they attempt to numb by using drugs and/or alcohol. After analysis of the data, the authors found a relationship between sexual harassment and harmful alcohol use among women, but not among men. Additionally, findings supported a meditational role for current depressive symptoms on the association between sexual harassment and harmful alcohol use. The authors suggest that this provides support for the theory, suggested by others that women are more likely to use alcohol as a means for dealing with emotional distress and stress than their male counterparts. Another study examining moderating effects on alcohol consumption evaluated the external environmental variable of college attendance. Timberlake and colleagues (2007) examined the potential moderating role of college attendance on the relationship between genetic influence and alcohol consumption. The overwhelming reports and literature documenting problem drinking among college students spurred this study. The authors conducted analysis and explain that in terms of moderation, “college exposure acts as an environmental moderator, and thus, does not reflect a spurious association due to overlapping genetic influences” (p. 1028, 2007). Further, the authors explain that college exposure acts as a moderator in the genetic influence and alcohol consumption relationship due to a higher likelihood that drinking behaviors will be promoted in a college or university setting. As a replication of past research, Marshal and colleagues (2007) examined life stress as a potential mediator for the relationship between parental alcoholism and offspring pathological alcohol use. Marshal and colleagues found that life stress, as measured by self-report of stressful life event experienced, mediated the relationship between parental alcoholism and offspring pathological alcohol use. The investigators further examined the relationship among adolescents suffering from attention deficit hyperactivity disorder (ADHD). The meditational relationship held for this population and was in fact stronger for the adolescents suffering from ADHD than the control group who did not report an ADHD diagnosis. The authors suggest that the relationship may be stronger in those suffering from ADHD due to “deficiencies in individual characteristics and skills” (p. 570, 2007). Understanding the concepts of mediation and moderation are critical when examining relationships between risk factors and substance use and abuse. Risk factor and predictors of substance use and abuse do not always occur independently or without the effects of other factors. Instead, it is their interaction with other variables that often clarify the relationship between predictive factors and substance abuse.

Substance abuse is the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual’s physical and mental health, or the welfare of others. The disorder is characterized by a pattern of continued pathological use of a medication, non-medically indicated drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. There are on-going debates as to the exact distinctions between substance abuse and substance dependence, but current practice standard distinguishes between the two by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Medically, physiologic dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse, but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance. Dependence involves physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society. Substance abuse is sometimes used as a synonym for drug abuse, drug addiction, and chemical dependency, but actually refers to the use of substances in a manner outside sociocultural conventions. All use of controlled drugs and all use of other drugs in a manner not dictated by convention (e.g. according to physician’s orders or societal norms) is abuse according to this definition, however there is no universally accepted definition of substance abuse. The physical harm for twenty drugs was compared in an article in the Lancet, with the results shown in the diagram. Physical harm was assigned a value from 0 to 3 for acute harm, chronic harm and intravenous harm. Shown is the mean physical harm. Not shown, but also evaluated, was the social harm. History In the early 1950s, the first edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness. The third edition,in the 1980s, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as “problematic use with social or occupational impairment” but without withdrawal or tolerance. In 1987 the DSM-IIIR category “psychoactive substance abuse”, which includes former concepts of drug abuse is defined as “a maladaptive pattern of use indicated by…continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous”. It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis. By 1988, the DSM-IV defines substance dependence as “a syndrome involving compulsive use, with or without tolerance and withdrawal”; whereas substance abuse is “problematic use without compulsive use, significant tolerance, or withdrawal”. Substance abuse can be harmful to your health and may even be deadly in certain scenarios By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association ,the DSM-IV-TR, defines substance dependence as “when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed.” followed by criteria for the diagnose. DSM-IV-TR defines substance abuse as: <ul> <li>A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:</li> </ul> 1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household) 2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) <ul> <li>B. The symptoms have never met the criteria for Substance Dependence for this class of substance.</li> </ul> The fifth edition of the DSM, planned for release in 2010, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA’s ‘dependence’ term, as noted above, does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-V discussion. Mediators & Moderators When the relationship between a predictor variable and an outcome variable have a significant relationship, which is, in turn, dependent on a third variable, the relationship is said to be mediated by the third variable. In this relationship the predictor variable influences the mediating variable in a causal manner. This mediating variable then leads to the outcome, creating the relationship between the predictor and outcome. It is only because of this mediating variable that a relationship between the predictor and outcome exists. Also, quasi-causal inferences may be drawn from mediated relationships. Numerous studies have examined factors which mediate substance abuse or dependence. In these examples, the predictor variables lead to the mediator which in turn leads to the outcome, which is always substance abuse or dependence. For example, research has found that being raised in a single-parent home can lead to increased exposure to stress and that increased exposure to stress, not being raised in a single-parent home, leads to substance abuse or dependence. When a variable indicates the conditions under which a specific effect occurs as well as displays how the direction or strength varies within a given relationship, the variable is said to moderate the relationship. Another explanation is that a moderator variable indicates that an effect only occurs under specific conditions. Unlike a relationship containing a mediator variable, the impact of the predictor variable on the outcome is dependent on the value of the moderating variable. Also unlike a relationship involving mediation, no causal inferences can be drawn from a moderated relationship; relationships can only be described as correlated. However, moderated relationships do identify interaction effects between predictor and moderator variables. Numerous studies have examined factors which moderate substance abuse or dependence. In these examples, the moderator variable impacts the level to which the strength of the relationship varies between a given predictor variable and the outcome of substance abuse or dependence. For example, there is a significant relationship between psychobehavioral risk factors, such as tolerance of deviance, rebelliousness, achievement, perceived drug risk, familism, family church attendance and other factors, and substance abuse and dependence. That relationship is moderated by familism which means that the strength of the relationship is increased or decreased based on the level of familism present in a given individual. Mediation and moderation research continues to inform the field’s knowledge and understanding of a pervasive and dangerous threat to public health, substance abuse and dependence. As the relationships between various predictor variables and the factors which influence them are more closely scrutinized, clinicians and researchers are provided with the necessary information to create more sophisticated and relevant methods of prevention and intervention. While these factors are important to the development of SUDs, there are plenty of other factors both known and unknown that influence the development of this disorder. As such, continued research is both necessary and invaluable. Additional Mediators and Moderators of Substance Abuse Mediators and Moderators Defined: Baron and Kenny (1986) define a moderator as, “a qualitative (e.g., sex, race, class) or quantitative (e.g., level of reward) variable that affects the direction and/or strength of the relation between and independent or predictor variable and a dependent or criterion variable” (p. 1174)]. Moderators may operate as protective factors, decreasing the strength of the relationship between the predictor variable and the outcome. Conversely, moderators may heighten risk levels and strengthen the effects of the predictor on the outcome. In either instance, moderators do not explain why the connection exists, but rather affect the strength and direction of the relationship between the variables. A mediator, as defined by Baron and Kenny (1986), “represents the generative mechanism through which the focal independent variable is able to influence the dependent variable of interest” (p. 1173). Unlike moderators, mediators can explain the relationship between the predictor variable and outcome. Holmbeck (1997) elaborated on Baron and Kenny’s definition by adding, “the nature of the mediated relationship is such that the independent variable influences the mediator which, in turn, influences the outcome” (p. 600). Examples of mediators and moderators in empirical research: Examples of mediators and moderators can be found in several empirical studies. For example, Pilgrim et al.’s hypothesized mediation model posited that school success and time spent with friends mediated the relationship between parental involvement and risk-taking behavior with substance use (2006). More specifically, the relationship between parental involvement and risk-taking behavior is explained via the interaction with third variables, school success and time spent with friends. In this example, increased parental involvement led to increased school success and decreased time with friends, both of which were associated with decreased drug use. Another example of mediation involved risk-taking behaviors. As risk-taking behaviors increased, school success decreased and time with friends increased, both of which were associated with increased drug use. A second example of a mediating variable is depression. In a study by Lo and Cheng (2007), depression was found to mediate the relationship between childhood maltreatment and subsequent substance abuse in adulthood. In other words, childhood physical abuse is associated with increased depression, which in turn, in associated with increased drug and alcohol use in young adulthood. More specifically, depression helps to explain how childhood abuse is related to subsequent substance abuse in young adulthood. A third example of a mediating variable is an increase of externalizing symptoms. King and Chassin (2008) conducted research examining the relationship between stressful life events and drug dependence in young adulthood. Their findings identified problematic externalizing behavior on subsequent substance dependency. In other words, stressful life events are associated with externalizing symptoms, such as aggression or hostility, which can lead to peer alienation or acceptance by socially deviant peers, which could lead to increased drug use. The relationship between stressful life events and subsequent drug dependence however exists via the presence of the mediation effects of externalizing behaviors. An example of a moderating variable is level of cognitive distortion. An individual with high levels of cognitive distortion might react adversely to potentially innocuous events, and may have increased difficulty reacting to them in an adaptive manner (Shoal & Giancola, 2005). In their study, Shoal and Giancola investigated the moderating effects of cognitive distortion on adolescent substance use. Individuals with low levels of cognitive distortion may be more apt to choose more adaptive methods of coping with social problems, thereby potentially reducing the risk of drug use. Individuals with high levels of cognitive distortions, because of their increased misperceptions and misattributions, are at increased risk for social difficulties. Individuals may be more likely to react aggressively or inappropriately, potentially alienating themselves from their peers, thereby putting them at greater risk for delinquent behaviors, including substance use and abuse. In this study, social problems are a significant risk factor for drug use when moderated by high levels of cognitive distortions. Mediators and Moderators for alcohol related use disorder The internal construct of personality has been studied as a potential moderator and mediator of the relationship between risk for development of an alcohol use disorder as defined by family history and alcohol use behaviors. In one such study done by Rogosch, Chassin, and Sher (1990), the personality characteristics of dispositional self-awareness and presumed personality risk as measured by patterns of anti-social behaviors including aggressiveness impulsivity, and poor school performance were examined as potential mediators and moderators, as defined by Baron and Kenny (1985). The study started that it explicitly aimed to examine “the role that personality characteristics may play in the link between family history risk and alcohol abuse” (1990, p. 310). Thus, they attempted to illustrate mediation; that is, personality is related to family history of alcohol use in addition to measures of alcohol use. Based on Baron and Kenney’s definition, it was also essential that they find the relationship between alcohol consumption and family history is substantially weakened or completely gone when personality characteristics of interest are considered. They also attempted to examine moderation, that is, personality characteristics affect on the strength or direction of the relationship between familial history of alcohol use and current use and/or abuse. Analysis of the data found both personality characteristics examined, presumed personality risk and self-awareness to play a moderation role. However, no meditational relationships were demonstrated based on regression analyses. The construct of Self-awareness moderated the relationship between family risk and levels of alcohol use such that; those with family history risk consumed less alcohol if they reported a higher the level of dispositional self-awareness than those who had the family risk but reported lower levels of self-awareness. The authors suggest that this might be due to highly self-aware individuals’ tendency to adherence to social norms and their knowledge of the potential consequences of increased alcohol use. The authors also found that presumed personality risk moderated the relationship between family history risk and levels of alcohol use. Specifically, individuals with elevated levels of presumed personality risk were more likely to have increased alcohol use. Thus presumed personality risk and dispositional self-awareness both acted as moderators. The authors note that their study should not be used alone in support of a lack of existence of the meditational role that personality may play on familial risk and alcohol use and/or abuse. Other studies concerning internal variables have also been done to examine the mediating roles of other psychopathology in the development of alcohol use disorders. One such study done by Bowie, Ensminger, and Robertson (2006), specifically examined young African-Americans alcohol use problems, depression, and religiosity as measured by church attendance. They study was stimulated by past research findings that religiosity was a protective factor for development of problem drinking behaviors and that levels of religiosity are greater for black than other racial groups. In addition, research found that churches act as a social resource and support in many minority communities. The authors suggest that this might matter due to greater social support availability during more difficult times and thus less likelihood to turn to alcohol and less likely to develop depression due to the particular stressor. Analysis of all data found moderating relationships between variables. The relationship between church attendance and alcohol use problems was moderated by depression. Specifically, “alcohol use problems of those who are depressed are much lower for frequent attendees compared with less frequent attendees…(in addition) frequency of church attendance is not related to alcohol problems for those who are not depressed” (2006, p. 50). The authors suggest that this may be due to the social support accessible to those who attend church and thus a decrease in likelihood to use alcohol and depression. Recently, Gradus and colleagues (2008) did further examination of depression and the potential mediating role on the relationship between sexual harassment and alcohol use problems among men and women who previously served in the United States military. The authors explain that this study hopes to further the self-medication hypothesis of the development of alcohol use problems. This theory posits that after trauma individual experience distress, which they attempt to numb by using drugs and/or alcohol. After analysis of the data, the authors found a relationship between sexual harassment and harmful alcohol use among women, but not among men. Additionally, findings supported a meditational role for current depressive symptoms on the association between sexual harassment and harmful alcohol use. The authors suggest that this provides support for the theory, suggested by others that women are more likely to use alcohol as a means for dealing with emotional distress and stress than their male counterparts. Another study examining moderating effects on alcohol consumption evaluated the external environmental variable of college attendance. Timberlake and colleagues (2007) examined the potential moderating role of college attendance on the relationship between genetic influence and alcohol consumption. The overwhelming reports and literature documenting problem drinking among college students spurred this study. The authors conducted analysis and explain that in terms of moderation, “college exposure acts as an environmental moderator, and thus, does not reflect a spurious association due to overlapping genetic influences” (p. 1028, 2007). Further, the authors explain that college exposure acts as a moderator in the genetic influence and alcohol consumption relationship due to a higher likelihood that drinking behaviors will be promoted in a college or university setting. As a replication of past research, Marshal and colleagues (2007) examined life stress as a potential mediator for the relationship between parental alcoholism and offspring pathological alcohol use. Marshal and colleagues found that life stress, as measured by self-report of stressful life event experienced, mediated the relationship between parental alcoholism and offspring pathological alcohol use. The investigators further examined the relationship among adolescents suffering from attention deficit hyperactivity disorder (ADHD). The meditational relationship held for this population and was in fact stronger for the adolescents suffering from ADHD than the control group who did not report an ADHD diagnosis. The authors suggest that the relationship may be stronger in those suffering from ADHD due to “deficiencies in individual characteristics and skills” (p. 570, 2007). Understanding the concepts of mediation and moderation are critical when examining relationships between risk factors and substance use and abuse. Risk factor and predictors of substance use and abuse do not always occur independently or without the effects of other factors. Instead, it is their interaction with other variables that often clarify the relationship between predictive factors and substance abuse.

2009-03-18T20:22:52Z

http://en.wikipedia.org/wiki/Substance_abuse

Substance Abuse

The National Institute on Drug Abuse (NIDA)

What is the extent and impact of tobacco use? According to the 2004 National Survey on Drug Use and Health, an estimated 70.3 million Americans age 12 or older reported current use of tobacco—59.9 million (24.9 percent of the population) were current cigarette smokers, 13.7 million (5.7 percent) smoked cigars, 1.8 million (0.8 percent) smoked pipes, and 7.2 million (3.0 percent) used smokeless tobacco, confirming that tobacco is one of the most widely abused substances in the United States [1]. While these numbers are still unacceptably high, they represent a decrease of almost 50 percent since peak use in 1965 [2]. NIDA’s 2005 Monitoring the Future Survey of 8th-, 10th-, and 12th-graders, used to track drug use patterns and attitudes, has also shown a striking decrease in smoking trends among the Nation’s youth. The latest results indicate that about 9 percent of 8th-graders, 15 percent of 10th-graders, and 23 percent of 12th-graders had used cigarettes in the 30 days prior to the survey [3]. Despite cigarette use being at the lowest levels of the survey since a peak in the mid-1990s, the past few years indicate a clear slowing of this decline. And while perceived risk and disapproval of smoking had been on the rise, recent years have shown the rate of change to be dwindling. In fact, current use, perceived risk, and disapproval leveled off among 8th-graders in 2005 [3], suggesting that renewed efforts are needed to ensure that teens understand the harmful consequences of smoking. Moreover, the declining prevalence of cigarette smoking among the general U.S. population is not reflected in patients with mental illnesses. For them, it remains substantially higher, with the incidence of smoking in patients suffering from post-traumatic stress disorder, bipolar disorder, major depression, and other mental illness twofold to fourfold higher than the general population, and smoking incidence among people with schizophrenia as high as 90 percent [4,5,6]. Tobacco use is the leading preventable cause of death in the United States. The impact of tobacco use in terms of morbidity and mortality costs to society is staggering. Economically, more than $75 billion of total U.S. healthcare costs each year is attributable directly to smoking [7]. However, this cost is well below the total cost to society because it does not include burn care from smoking-related fires, perinatal care for low birth-weight infants of mothers who smoke, and medical care costs associated with disease caused by secondhand smoke. In addition to healthcare costs, the costs of lost productivity due to smoking effects are estimated at $82 billion per year, bringing a conservative estimate of the economic burden of smoking to more than $150 billion per year [7] . How does tobacco deliver its effects? There are more than 4,000 chemicals found in the smoke of tobacco products. Of these, nicotine, first identified in the early 1800s, is the primary reinforcing component of tobacco that acts on the brain. Cigarette smoking is the most popular method of using tobacco; however, there has also been a recent increase in the sale and consumption of smokeless tobacco products, such as snuff and chewing tobacco. These smokeless products also contain nicotine, as well as many toxic chemicals. The cigarette is a very efficient and highly engineered drugdelivery system. By inhaling tobacco smoke, the average smoker takes in 1 to 2 mg of nicotine per cigarette [8]. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1-1/2 packs (30 cigarettes) daily gets 300 “hits” of nicotine to the brain each day. In those who typically do not inhale the smoke—such as cigar and pipe smokers and smokeless tobacco users––nicotine is absorbed through the mucosal membranes and reaches peak blood levels and the brain more slowly. Immediately after exposure to nicotine, there is a “kick” caused in part by the drug’s stimulation of the adrenal glands and resulting discharge of epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes a sudden release of glucose, as well as an increase in blood pressure, respiration, and heart rate [9]. Nicotine also suppresses insulin output from the pancreas, which means that smokers are always slightly hyperglycemic (i.e., they have elevated blood sugar levels [10]). The calming effect of nicotine reported by many users is usually associated with a decline in withdrawal effects rather than direct effects of nicotine. Is nicotine addictive? Yes. Most smokers use tobacco regularly because they are addicted to nicotine [9]. Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year [7]. Unfortunately, only about 6 percent of people who try to quit are successful for more than a month [11]. Research has shown how nicotine acts on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse, and is thought to underlie the pleasurable sensations experienced by many smokers [9]. Nicotine’s pharmacokinetic properties also enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation [9]. However, the acute effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, which causes the smoker to continue dosing to maintain the drug’s pleasurable effects and prevent withdrawal. Nicotine withdrawal symptoms include irritability, craving, cognitive and attentional deficits, sleep disturbances, and increased appetite. These symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and may subside within a few weeks [12]. For some people, however, symptoms may persist for months. While withdrawal is related to the pharmacological effects of nicotine, many behavioral factors can also affect the severity of withdrawal symptoms. For some people, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse. While nicotine gum and patches may alleviate the pharmacological aspects of withdrawal, cravings often persist. Other forms of nicotine replacement, such as inhalers, attempt to address some of these other issues, while behavioral therapies can help smokers identify environmental triggers of withdrawal and craving so they can employ strategies to prevent or circumvent these symptoms and urges. References 1. Substance Abuse and Mental Health Services Administration. Results from the 2004 National Survey on Drug Use and Health: National Findings. DHHS Pub. No. SMA 05-4062, 2005. 2. Giovino GA, Henningfield JE, Tomar SL, Escobedo LG, Slade J. Epidemiology of tobacco use and dependence. Epidemiol Rev 17(1):48–65, 1995. 3. National Institute on Drug Abuse. Monitoring the Future, National Results on Adolescent Drug Use, Overview of Key Findings 2005. NIH Pub. No. 01-4923, 2005. 4. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness. A population-based prevalence study. JAMA 284:2606–2610, 2000. 5. Breslau N. Psychiatric comorbidity of smoking and nicotine dependence. Behav Genet 25:95–101, 1995. 6. Hughes JR, Hatsukami DK, Mitchell JE, and Dahlgren LA. Prevalence of smoking among psychiatric outpatients. American Journal of Psychiatry 143:993-997, 1986. 7. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. 8. Federal Trade Commission. "Tar," nicotine, and carbon monoxide of the smoke of 1294 varieties of domestic cigarettes for the year 1998. Federal Trade Commission, 2000. 9. Benowitz NL. Pharmacology of nicotine: addiction and therapeutics. Ann Rev Pharmacol Toxicol 36:597–613, 1996. 10. Bornemisza P, Suciu I. Effect of cigarette smoking on the blood glucose level in normals and diabetics. Med Interne 18 :353-6, 1980. 11. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. 12. Henningfield JE. Nicotine medications for smoking cessation. New Engl J Med 333:1196–1203, 1995.

What is the extent and impact of tobacco use? According to the 2004 National Survey on Drug Use and Health, an estimated 70.3 million Americans age 12 or older reported current use of tobacco—59.9 million (24.9 percent of the population) were current cigarette smokers, 13.7 million (5.7 percent) smoked cigars, 1.8 million (0.8 percent) smoked pipes, and 7.2 million (3.0 percent) used smokeless tobacco, confirming that tobacco is one of the most widely abused substances in the United States <a href="#fn1">1</a>. While these numbers are still unacceptably high, they represent a decrease of almost 50 percent since peak use in 1965 <a href="#fn2">2</a>. NIDA’s 2005 Monitoring the Future Survey of 8th-, 10th-, and 12th-graders, used to track drug use patterns and attitudes, has also shown a striking decrease in smoking trends among the Nation’s youth. The latest results indicate that about 9 percent of 8th-graders, 15 percent of 10th-graders, and 23 percent of 12th-graders had used cigarettes in the 30 days prior to the survey <a href="#fn3">3</a>. Despite cigarette use being at the lowest levels of the survey since a peak in the mid-1990s, the past few years indicate a clear slowing of this decline. And while perceived risk and disapproval of smoking had been on the rise, recent years have shown the rate of change to be dwindling. In fact, current use, perceived risk, and disapproval leveled off among 8th-graders in 2005 <a href="#fn3">3</a>, suggesting that renewed efforts are needed to ensure that teens understand the harmful consequences of smoking. Moreover, the declining prevalence of cigarette smoking among the general U.S. population is not reflected in patients with mental illnesses. For them, it remains substantially higher, with the incidence of smoking in patients suffering from post-traumatic stress disorder, bipolar disorder, major depression, and other mental illness twofold to fourfold higher than the general population, and smoking incidence among people with schizophrenia as high as 90 percent [4,5,6]. Tobacco use is the leading preventable cause of death in the United States. The impact of tobacco use in terms of morbidity and mortality costs to society is staggering. Economically, more than $75 billion of total U.S. healthcare costs each year is attributable directly to smoking <a href="#fn7">7</a>. However, this cost is well below the total cost to society because it does not include burn care from smoking-related fires, perinatal care for low birth-weight infants of mothers who smoke, and medical care costs associated with disease caused by secondhand smoke. In addition to healthcare costs, the costs of lost productivity due to smoking effects are estimated at $82 billion per year, bringing a conservative estimate of the economic burden of smoking to more than $150 billion per year <a href="#fn7">7</a> . How does tobacco deliver its effects? There are more than 4,000 chemicals found in the smoke of tobacco products. Of these, nicotine, first identified in the early 1800s, is the primary reinforcing component of tobacco that acts on the brain. Cigarette smoking is the most popular method of using tobacco; however, there has also been a recent increase in the sale and consumption of smokeless tobacco products, such as snuff and chewing tobacco. These smokeless products also contain nicotine, as well as many toxic chemicals. The cigarette is a very efficient and highly engineered drugdelivery system. By inhaling tobacco smoke, the average smoker takes in 1 to 2 mg of nicotine per cigarette <a href="#fn8">8</a>. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1-1/2 packs (30 cigarettes) daily gets 300 “hits” of nicotine to the brain each day. In those who typically do not inhale the smoke—such as cigar and pipe smokers and smokeless tobacco users––nicotine is absorbed through the mucosal membranes and reaches peak blood levels and the brain more slowly. Immediately after exposure to nicotine, there is a “kick” caused in part by the drug’s stimulation of the adrenal glands and resulting discharge of epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes a sudden release of glucose, as well as an increase in blood pressure, respiration, and heart rate <a href="#fn9">9</a>. Nicotine also suppresses insulin output from the pancreas, which means that smokers are always slightly hyperglycemic (i.e., they have elevated blood sugar levels <a href="#fn10">10</a>). The calming effect of nicotine reported by many users is usually associated with a decline in withdrawal effects rather than direct effects of nicotine. Is nicotine addictive? Yes. Most smokers use tobacco regularly because they are addicted to nicotine <a href="#fn9">9</a>. Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year <a href="#fn7">7</a>. Unfortunately, only about 6 percent of people who try to quit are successful for more than a month <a href="#fn11">11</a>. Research has shown how nicotine acts on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse, and is thought to underlie the pleasurable sensations experienced by many smokers <a href="#fn9">9</a>. Nicotine’s pharmacokinetic properties also enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation <a href="#fn9">9</a>. However, the acute effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, which causes the smoker to continue dosing to maintain the drug’s pleasurable effects and prevent withdrawal. Nicotine withdrawal symptoms include irritability, craving, cognitive and attentional deficits, sleep disturbances, and increased appetite. These symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and may subside within a few weeks <a href="#fn12">12</a>. For some people, however, symptoms may persist for months. While withdrawal is related to the pharmacological effects of nicotine, many behavioral factors can also affect the severity of withdrawal symptoms. For some people, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse. While nicotine gum and patches may alleviate the pharmacological aspects of withdrawal, cravings often persist. Other forms of nicotine replacement, such as inhalers, attempt to address some of these other issues, while behavioral therapies can help smokers identify environmental triggers of withdrawal and craving so they can employ strategies to prevent or circumvent these symptoms and urges. References 1. Substance Abuse and Mental Health Services Administration. Results from the 2004 National Survey on Drug Use and Health: National Findings. DHHS Pub. No. SMA 05-4062, 2005. 2. Giovino GA, Henningfield JE, Tomar SL, Escobedo LG, Slade J. Epidemiology of tobacco use and dependence. Epidemiol Rev 17(1):48–65, 1995. 3. National Institute on Drug Abuse. Monitoring the Future, National Results on Adolescent Drug Use, Overview of Key Findings 2005. NIH Pub. No. 01-4923, 2005. 4. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness. A population-based prevalence study. JAMA 284:2606–2610, 2000. 5. Breslau N. Psychiatric comorbidity of smoking and nicotine dependence. Behav Genet 25:95–101, 1995. 6. Hughes JR, Hatsukami DK, Mitchell JE, and Dahlgren LA. Prevalence of smoking among psychiatric outpatients. American Journal of Psychiatry 143:993-997, 1986. 7. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. 8. Federal Trade Commission. “Tar,” nicotine, and carbon monoxide of the smoke of 1294 varieties of domestic cigarettes for the year 1998. Federal Trade Commission, 2000. 9. Benowitz NL. Pharmacology of nicotine: addiction and therapeutics. Ann Rev Pharmacol Toxicol 36:597–613, 1996. 10. Bornemisza P, Suciu I. Effect of cigarette smoking on the blood glucose level in normals and diabetics. Med Interne 18 :353-6, 1980. 11. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. 12. Henningfield JE. Nicotine medications for smoking cessation. New Engl J Med 333:1196–1203, 1995.

2009-03-22T01:18:13Z

http://www.drugabuse.gov/researchreports/nicotine/nicotine5.html#12

Tobacco Addiction

Wikipedia

Agoraphobia is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to his or her home, experiencing difficulty traveling from this "safe place." Definition The word "agoraphobia" is an English adaptation of the Greek words agora (αγορά) and phobos (φόβος), and literally translates to "a fear of the marketplace." Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include wide open spaces, crowds, or traveling (even short distances). This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public.[1] Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. [2] Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack. Prevalence The one-year prevalence of agoraphobia in the United States is about 5 percent.[3] According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with panic disorder progress to develop agoraphobia.[4] Gender Differences Agoraphobia occurs about twice as commonly among women as it does in men.[5] The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviors.[6] Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia. Causes and Contributing Factors The causes of agoraphobia are currently unknown. It is linked however to the presence of other anxiety disorders, a stressful environment or substance abuse. More women than men are affected.[7] Chronic use of tranquillisers and sleeping pills such as benzodiazepines has been linked to causing agoraphobia. When benzodiazepine dependence has been treated and after a period of abstinence, agoraphobia symptoms gradually abate.[8] Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.[9] [10] Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces.[11] Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data. [12] Alternate Theories Attachment Theory Some scholars [13] [14] have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Recent empirical research has also linked attachment and spatial theories of agoraphobia [15]. Spatial Theory In the social sciences there is a perceived clinical bias [16] in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.[17]. Diagnosis Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.[18] In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used. DSM-IV-TR Diagnostic Criteria A) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion. C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).[19] Association with Panic Attacks Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. [20] Symptoms of a panic attack include palpitations, a rapid heartbeat, sweating, trembling, vomiting, dizziness, tightness in the throat and shortness of breath. Many patients report a fear of dying or of losing control of emotions and/or behavior. [20] Treatments Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications.[citation needed] Treatment options for agoraphobia and panic disorder are similar. Cognitive Behavioral Treatments Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. [21] Similarly, Systematic desensitization may also be used. Cognitive restructuring has also proved useful in treating agoraphobia. This treatment uses thought replacing with the goal of replacing one's irrational, counter-factual beliefs with more accurate and beneficial ones. Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic. Psychopharmaceutical Treatments Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia. Alternative Treatments Eye movement desensitization and reprogramming (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.[22] As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.[23] Alternative treatments of agoraphobia include hypnotherapy, acupuncture, guided imagery meditation, music therapy, yoga, religious practice and ayurvedic medicine. However, there is no evidence that any of these practices have any impact at all on agoraphobia. Additionally, many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.[24] References 1. ^ Psych Central: Agoraphobia Symptoms 2. ^ "Treatment of Panic Disorder", NIH Consens Statement 9 (2): 1–24, September 25-27, 1991, http://consensus.nih.gov/1991/1991PanicDisorder085html.htm 3. ^ Anxiety Disorders. NIH Publication No. 06-3879. 2006. http://www.nimh.nih.gov/publicat/NIMHanxiety.pdf. 4. ^ Robins, LN; Regier, DN, eds. (1991), Psychiatric Disorders in America: the Epidemiologic Catchment Area Study, New York, NY: The Free Press 5. ^ Magee, W. J., Eaton, W. W. , Wittchen, H. U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey, Archives of General Psychiatry, 53, 159–168. 6. ^ Agoraphobia Research Center. "Is agoraphobia more common in men or women?". http://www.agoraphobia.ws/whogets.htm. Retrieved on 2007-11-15. 7. ^ "Agoraphobia". http://www.mayoclinic.com/health/agoraphobia/DS00894/DSECTION=risk%2Dfactors. 8. ^ Professor C Heather Ashton (1987). "Benzodiazepine Withdrawal: Outcome in 50 Patients". British Journal of Addiction 82: 655–671. http://www.benzo.org.uk/ashbzoc.htm. 9. ^ "Relationship between balance system function and agoraphobic avoidance.". Behav Res Ther. 33 (4): 435–9. 1995 May. doi:10.1016/0005-7967(94)00060-W. PMID : 7755529. 10. ^ "Panic, agoraphobia, and vestibular dysfunction". Am J Psychiatry 153: 503–512. 1996. 11. ^ "Surface dependence: a balance control strategy in panic disorder with agoraphobia". Psychosom Med. 59 (3): 323–30. 1997 May-June. PMID : 9178344. 12. ^ "High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.". Eur Psychiatry 21 (7): 501–8. 2006 October. PMID : 17055951. 13. ^ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle. 14. ^ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation). 15. ^ J. Holmes, (2008). "Space and the secure base in agoraphobia: a qualitative survey", Area, 40, 3, 357 - 382. 16. ^ J. Davidson, (2003). Phobic Geographies 17. ^ J. Holmes, (2006). "Building Bridges and Breaking Boundaries: Modernity and Agoraphobia", Opticon1826, 1, 1, http://www.ucl.ac.uk/opticon1826/archive/issue1 18. ^ Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press. 19. ^ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DVM-IV-TR). 2000. 20. ^ a b David Satcher etal. (1999). "Chapter 4.2". Mental Health: A Report of the Surgeon General. http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html. 21. ^ Fava, G.A.; Rafanelli, C.; Grandi, S.; Cinto, S.; Ruini, C. (2001). "Long-term outcome of panic disorder with agoraphobia treated by exposure". Psychological Medicine (Cambridge University Press) 31: 891–898. doi:10.1017/S0033291701003592. 22. ^ Goldstein, Alan J.; Goldstein, Alan J., de Beurs, Edwin, Chambless, Dianne L., Wilson, Kimberly A. (2000). "EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions". Journal of Consulting & Clinical Psychology 68 (6): 947–957. doi:10.1037/0022-006X.68.6.947. 23. ^ Agoraphobia Resource Center, Agoraphobia treatments - Eye movement desensitization and reprogramming, http://www.agoraphobia.ws/treatment-emdr.htm, retrieved on 2008-04-18 24. ^ National Institute of Mental Health, How to get help for anxiety disorders, http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml, retrieved on 2008-04-18 25. ^ "Reconstructing Woody" 26. ^ [1] 27. ^ [2] 28. ^ "I do not want to receive three hundred e-mail messages per week from strangers wanting to communicate with me" Josefsson.net 29. ^ http://en.wikipedia.org/w/index.php?title=H._L._Gold&action=edit&section=4 30. ^ Biography for Daryl Hannah. Internet Movie Database. Retrieved 28 November 2007. 31. ^ Psychological Autopsy can help understand controversial deaths -- The Crime Library on truTV.com 32. ^ Olivia Hussey - People Magazine – March 16, 1992 33. ^ Olivia Hussey Biography - Internet Movie Database 34. ^ Biography for Rose McGowan. Internet Movie Database. Retrieved 15 May 2008. 35. ^ [Saturday Magazine, January 2009 issue] 36. ^ Stanisław Fita, ed., Wspomnienia o Bolesławie Prusie (Reminiscences about Bolesław Prus), Warsaw, Państwowy Instytut Wydawniczy (State Publishing Institute), 1962, p. 113. 37. ^ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.

Agoraphobia is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to his or her home, experiencing difficulty traveling from this “safe place.” Definition The word “agoraphobia” is an English adaptation of the Greek words agora (αγορά) and phobos (φόβος), and literally translates to “a fear of the marketplace.” Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include wide open spaces, crowds, or traveling (even short distances). This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public.<a href="#fn1">1</a> Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. <a href="#fn2">2</a> Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack. Prevalence The one-year prevalence of agoraphobia in the United States is about 5 percent.<a href="#fn3">3</a> According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with panic disorder progress to develop agoraphobia.<a href="#fn4">4</a> Gender Differences Agoraphobia occurs about twice as commonly among women as it does in men.<a href="#fn5">5</a> The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviors.<a href="#fn6">6</a> Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia. Causes and Contributing Factors The causes of agoraphobia are currently unknown. It is linked however to the presence of other anxiety disorders, a stressful environment or substance abuse. More women than men are affected.<a href="#fn7">7</a> Chronic use of tranquillisers and sleeping pills such as benzodiazepines has been linked to causing agoraphobia. When benzodiazepine dependence has been treated and after a period of abstinence, agoraphobia symptoms gradually abate.<a href="#fn8">8</a> Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.<a href="#fn9">9</a> <a href="#fn10">10</a> Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces.<a href="#fn11">11</a> Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data. <a href="#fn12">12</a> Alternate Theories Attachment Theory Some scholars <a href="#fn13">13</a> <a href="#fn14">14</a> have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Recent empirical research has also linked attachment and spatial theories of agoraphobia <a href="#fn15">15</a>. Spatial Theory In the social sciences there is a perceived clinical bias <a href="#fn16">16</a> in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.<a href="#fn17">17</a>. Diagnosis Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.<a href="#fn18">18</a> In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used. DSM-IV-TR Diagnostic Criteria A) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion. C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).<a href="#fn19">19</a> Association with Panic Attacks Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body’s natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. <a href="#fn20">20</a> Symptoms of a panic attack include palpitations, a rapid heartbeat, sweating, trembling, vomiting, dizziness, tightness in the throat and shortness of breath. Many patients report a fear of dying or of losing control of emotions and/or behavior. <a href="#fn20">20</a> Treatments Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications.[citation needed] Treatment options for agoraphobia and panic disorder are similar. Cognitive Behavioral Treatments Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. <a href="#fn21">21</a> Similarly, Systematic desensitization may also be used. Cognitive restructuring has also proved useful in treating agoraphobia. This treatment uses thought replacing with the goal of replacing one’s irrational, counter-factual beliefs with more accurate and beneficial ones. Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic. Psychopharmaceutical Treatments Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia. Alternative Treatments Eye movement desensitization and reprogramming (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.<a href="#fn22">22</a> As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.<a href="#fn23">23</a> Alternative treatments of agoraphobia include hypnotherapy, acupuncture, guided imagery meditation, music therapy, yoga, religious practice and ayurvedic medicine. However, there is no evidence that any of these practices have any impact at all on agoraphobia. Additionally, many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.<a href="#fn24">24</a> References 1. ^ Psych Central: Agoraphobia Symptoms 2. ^ “Treatment of Panic Disorder”, NIH Consens Statement 9 (2): 1–24, September 25-27, 1991, <a href="http://consensus.nih.gov/1991/1991PanicDisorder085html.htm">http://consensus.nih.gov/1991/1991PanicDisorder…</a> 3. ^ Anxiety Disorders. NIH Publication No. 06-3879. 2006. <a href="http://www.nimh.nih.gov/publicat/NIMHanxiety.pdf">http://www.nimh.nih.gov/publicat/NIMHanxiety.pdf</a>. 4. ^ Robins, LN; Regier, DN, eds. (1991), Psychiatric Disorders in America: the Epidemiologic Catchment Area Study, New York, NY: The Free Press 5. ^ Magee, W. J., Eaton, W. W. , Wittchen, H. U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey, Archives of General Psychiatry, 53, 159–168. 6. ^ Agoraphobia Research Center. “Is agoraphobia more common in men or women?”. <a href="http://www.agoraphobia.ws/whogets.htm">http://www.agoraphobia.ws/whogets.htm</a>. Retrieved on 2007-11-15. 7. ^ “Agoraphobia”. <a href="http://www.mayoclinic.com/health/agoraphobia/DS00894/DSECTION=risk%2Dfactors">http://www.mayoclinic.com/health/agoraphobia/DS…</a>. 8. ^ Professor C Heather Ashton (1987). “Benzodiazepine Withdrawal: Outcome in 50 Patients”. British Journal of Addiction 82: 655–671. <a href="http://www.benzo.org.uk/ashbzoc.htm">http://www.benzo.org.uk/ashbzoc.htm</a>. 9. ^ “Relationship between balance system function and agoraphobic avoidance.”. Behav Res Ther. 33 (4): 435–9. 1995 May. doi:10.1016/0005-7967(94)00060-W. PMID : 7755529. 10. ^ “Panic, agoraphobia, and vestibular dysfunction”. Am J Psychiatry 153: 503–512. 1996. 11. ^ “Surface dependence: a balance control strategy in panic disorder with agoraphobia”. Psychosom Med. 59 (3): 323–30. 1997 May-June. PMID : 9178344. 12. ^ “High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.”. Eur Psychiatry 21 (7): 501–8. 2006 October. PMID : 17055951. 13. ^ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle. 14. ^ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation). 15. ^ J. Holmes, (2008). “Space and the secure base in agoraphobia: a qualitative survey”, Area, 40, 3, 357 – 382. 16. ^ J. Davidson, (2003). Phobic Geographies 17. ^ J. Holmes, (2006). “Building Bridges and Breaking Boundaries: Modernity and Agoraphobia”, Opticon1826, 1, 1, <a href="http://www.ucl.ac.uk/opticon1826/archive/issue1">http://www.ucl.ac.uk/opticon1826/archive/issue1</a> 18. ^ Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press. 19. ^ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DVM-IV-TR). 2000. 20. ^ a b David Satcher etal. (1999). “Chapter 4.2”. Mental Health: A Report of the Surgeon General. <a href="http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html">http://www.surgeongeneral.gov/library/mentalhea…</a>. 21. ^ Fava, G.A.; Rafanelli, C.; Grandi, S.; Cinto, S.; Ruini, C. (2001). “Long-term outcome of panic disorder with agoraphobia treated by exposure”. Psychological Medicine (Cambridge University Press) 31: 891–898. doi:10.1017/S0033291701003592. 22. ^ Goldstein, Alan J.; Goldstein, Alan J., de Beurs, Edwin, Chambless, Dianne L., Wilson, Kimberly A. (2000). “EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions”. Journal of Consulting & Clinical Psychology 68 (6): 947–957. doi:10.1037/0022-006X.68.6.947. 23. ^ Agoraphobia Resource Center, Agoraphobia treatments – Eye movement desensitization and reprogramming, <a href="http://www.agoraphobia.ws/treatment-emdr.htm">http://www.agoraphobia.ws/treatment-emdr.htm</a>, retrieved on 2008-04-18 24. ^ National Institute of Mental Health, How to get help for anxiety disorders, <a href="http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml">http://www.nimh.nih.gov/health/publications/anx…</a>, retrieved on 2008-04-18 25. ^ “Reconstructing Woody” 26. ^ <a href="#fn1">1</a> 27. ^ <a href="#fn2">2</a> 28. ^ “I do not want to receive three hundred e-mail messages per week from strangers wanting to communicate with me” Josefsson.net 29. ^ <a href="http://en.wikipedia.org/w/index.php?title=H._L._Gold&action=edit&section=4">http://en.wikipedia.org/w/index.php?title=H._L….</a> 30. ^ Biography for Daryl Hannah. Internet Movie Database. Retrieved 28 November 2007. 31. ^ Psychological Autopsy can help understand controversial deaths — The Crime Library on truTV.com 32. ^ Olivia Hussey – People Magazine – March 16, 1992 33. ^ Olivia Hussey Biography – Internet Movie Database 34. ^ Biography for Rose McGowan. Internet Movie Database. Retrieved 15 May 2008. 35. ^ [Saturday Magazine, January 2009 issue] 36. ^ Stanisław Fita, ed., Wspomnienia o Bolesławie Prusie (Reminiscences about Bolesław Prus), Warsaw, Państwowy Instytut Wydawniczy (State Publishing Institute), 1962, p. 113. 37. ^ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.

2009-04-04T23:40:43Z

154

http://en.wikipedia.org/wiki/Agoraphobia

Agoraphobia

Dr. Kathy Nickerson

It can come from out of nowhere. One minute, you're shopping and looking for the perfect sweater to match your new pants. The next minute, you're breathing heavily, your heart is beating wildly, and you're very worried. Sometimes for no reason at all. If you find yourself worrying more than you'd like to to, you're not alone. In fact, research from the Anxiety Disorders Association of America shows that nearly 40 million adults suffer from anxiety every day. This makes anxiety, and related stress disorders, the most common type of mental health problems in the United States. To help you cope when anxiety attacks, try one of these 10 tips: One: Control your breathing. If you find you are breathing rapidly, breathe slowly in and out and try to focus on counting your breaths and controlling your breathing. Two: Walk it off. Take a walk around your floor, go up to the roof, or take a walk around the building. Three: Go with it. Don't attempt to fight your way out of a panic attack, this will simply make it worse. Instead, accept the feelings, and tell yourself that these feelings will pass. Eventually the panic will subside. Four: Distract yourself. Do a puzzle, try sudoku, play a game online, or write an email. Five: Use your imagination. Try to focus outside of yourself during an attack. Listen to some music or do a pleasurable task while waiting for the panic to subside. Six: Use a relaxation technique. First close your eyes and breathe slowly and deeply. Locate any areas of tension and imagine them disappearing. Then, relax each part of the body, bit by bit, from the feet upwards. Think of warmth and heaviness. After 20 minutes of doing this, take some deep breaths and stretch. Seven: Schedule worry time. Designate a small amount of time (maybe 30 minutes or less) to worrying/analysis of what's worrying you. Then, during worry time, do the following exercise: On a piece of paper, make a chart with four columns. In column 1, write down all the things you are worried about. In column 2, write down how likely that event is to happen (is it 10% likely, 25%?). In column 3, write down all the "if/thens" that come to mind when you think about what's bothering you. In column 4, write down some things you can actively do if the worst case scenario events happen or what you can do now to prevent the worst case scenarios from happening. Here's an example: Column 1: What's bothering me? I may lose my job. Column 2: How likely is this to happen? 30% because my company just had a lay off. Column 3: If this happens, what then? Then I will need to look for a new job, I don't know how long that might take, maybe I will not be able to pay the bills Column 4: If the worst case scenario happens? Then I will need to polish up my resume, get into contact with a networking group, call some old contacts, reach out to some connections, post my resume online, etc… - OR - I could be proactive and talk to my supervisor about the company's future plans, how I can be helpful; I could also connect now with some old contacts or join a networking group. Sometimes just by thinking a worrisome thought all the way through and coming up with a solution, we find we feel much better. Eight: Flip your thoughts. If you're finding yourself telling yourself some very negative things, try challenging yourself to come up with one good thing about you or the situation for every one negative thing. Nine: Reach out to friends and family. If you're finding yourself really getting upset, reach out to a friend, call someone you care about, just talk it out. Ten: Your body can handle stress. Under times of extreme stress, you might have physical symptoms that scare you. If so, call your doctor and talk over your concerns. It's likely you will hear that your symptoms are due to an over-sensitized nervous system. If so, they are temporary feelings and will go away.

It can come from out of nowhere. One minute, you’re shopping and looking for the perfect sweater to match your new pants. The next minute, you’re breathing heavily, your heart is beating wildly, and you’re very worried. Sometimes for no reason at all. If you find yourself worrying more than you’d like to to, you’re not alone. In fact, research from the Anxiety Disorders Association of America shows that nearly 40 million adults suffer from anxiety every day. This makes anxiety, and related stress disorders, the most common type of mental health problems in the United States. To help you cope when anxiety attacks, try one of these 10 tips: One: Control your breathing. If you find you are breathing rapidly, breathe slowly in and out and try to focus on counting your breaths and controlling your breathing. Two: Walk it off. Take a walk around your floor, go up to the roof, or take a walk around the building. Three: Go with it. Don’t attempt to fight your way out of a panic attack, this will simply make it worse. Instead, accept the feelings, and tell yourself that these feelings will pass. Eventually the panic will subside. Four: Distract yourself. Do a puzzle, try sudoku, play a game online, or write an email. Five: Use your imagination. Try to focus outside of yourself during an attack. Listen to some music or do a pleasurable task while waiting for the panic to subside. Six: Use a relaxation technique. First close your eyes and breathe slowly and deeply. Locate any areas of tension and imagine them disappearing. Then, relax each part of the body, bit by bit, from the feet upwards. Think of warmth and heaviness. After 20 minutes of doing this, take some deep breaths and stretch. Seven: Schedule worry time. Designate a small amount of time (maybe 30 minutes or less) to worrying/analysis of what’s worrying you. Then, during worry time, do the following exercise: On a piece of paper, make a chart with four columns. In column 1, write down all the things you are worried about. In column 2, write down how likely that event is to happen (is it 10% likely, 25%?). In column 3, write down all the “if/thens” that come to mind when you think about what’s bothering you. In column 4, write down some things you can actively do if the worst case scenario events happen or what you can do now to prevent the worst case scenarios from happening. Here’s an example: Column 1: What’s bothering me? I may lose my job. Column 2: How likely is this to happen? 30% because my company just had a lay off. Column 3: If this happens, what then? Then I will need to look for a new job, I don’t know how long that might take, maybe I will not be able to pay the bills Column 4: If the worst case scenario happens? Then I will need to polish up my resume, get into contact with a networking group, call some old contacts, reach out to some connections, post my resume online, etc… – OR – I could be proactive and talk to my supervisor about the company’s future plans, how I can be helpful; I could also connect now with some old contacts or join a networking group. Sometimes just by thinking a worrisome thought all the way through and coming up with a solution, we find we feel much better. Eight: Flip your thoughts. If you’re finding yourself telling yourself some very negative things, try challenging yourself to come up with one good thing about you or the situation for every one negative thing. Nine: Reach out to friends and family. If you’re finding yourself really getting upset, reach out to a friend, call someone you care about, just talk it out. Ten: Your body can handle stress. Under times of extreme stress, you might have physical symptoms that scare you. If so, call your doctor and talk over your concerns. It’s likely you will hear that your symptoms are due to an over-sensitized nervous system. If so, they are temporary feelings and will go away.

2009-04-14T17:48:15Z

201

http://www.drkathynickerson.com/Kathy_Nickerson_Anxiety_Attacks.pdf

Anxiety Attacks - 10 Tips To Help You Cope

Jennifer Lafferty O’Connor, PhD, Remuda Ranch

Anxiety disorders are the most common form of mental illness in both children and adults, affecting one in six individuals in America each year. Although these disorders vary distinctly in their presentation and symptoms, at their core these disorders all involve persistent, intense, and irrational anxiety, fear, or dread that interferes with daily life. Too often, anxiety disorders are misunderstood or misdiagnosed, preventing the sufferer from receiving appropriate treatment. When left untreated, anxiety disorders can quickly become incapacitating and may result in the development of additional problems including unemployment, social isolation, depression, and substance abuse. Cognitive behavioral treatment (CBT) is a form of treatment that has been proven to be effective in reducing and managing anxiety symptoms. The primary goal of CBT treatment is to free sufferers from a vicious cycle in which they have come to rely on ineffective behaviors in a futile effort to self-manage their anxiety. For example, persons with obsessive-compulsive disorder (OCD) typically rely on time consuming compulsions and avoidance behaviors to manage intrusive and distressing obsessions. OCD sufferers with contamination obsessions may spend three hours daily in washing and cleansing compulsions, confined to their homes because they avoid “contaminated” locations such as school, work, and public places. Over time, compulsive and avoidance behaviors drastically reduce the sufferer’s life quality, resulting in disability. These behaviors also strengthen the distorted and obsessive fears that drive the OCD cycle to begin with. OCD sufferers may believe that if they ever enter the perceived “contaminated” places or stop their compulsive washing, they will contract a horrible disease. Because of avoidance, their beliefs are never subjected to reality testing, but instead grow stronger. CBT interventions directly challenge both distorted thoughts and ineffective behaviors. Exposure with Response Prevention (ERP) is the primary CBT intervention used to treat most anxiety disorders, including OCD, social phobia, panic disorder, and OCD-spectrum disorders such as body dysmorphic disorder. ERP involves direct exposure to feared situations plus prevention of clients’ ineffective behaviors, such as their compulsions and avoidance behaviors. Prior to ERP, clients receive extensive psycho-education, facilitating insights into their thinking and behavior. As clients realize that their compulsive and avoidance behaviors are preventing the lives they want, they begin to desire change. Clients learn that the pathway out of this cycle is facing their fears through ERP. They learn about behavioral concepts, such as “habituation”: if they remain in distressing situations long enough, their anxiety naturally abates, making avoidance and compulsive behaviors unnecessary. Clients create “fear hierarchies”—lists of situations that trigger their anxiety. Fear hierarchies always begin with situations that provoke mild/moderate distress and proceed to those provoking severe distress. Clients gradually develop confidence in their ability to tolerate distress without using ineffective behaviors for relief. As clients face fears on their hierarchy, they learn experientially that habituation does indeed occur and that their imagined fears do not come to pass. As this happens, clients become less entrenched in fear and more willing to confront challenging situations. As clients develop confidence in their ability to manage a variety of previously distressing situations, they become free to lead lives that are guided by their personal values, goals, and priorities, rather than limited by anxiety and efforts to reduce or avoid it. Remuda Ranch offers Christian inpatient and residential programs for individuals of all faiths suffering from eating or anxiety disorders. Each patient is treated by a multi-disciplinary team including a Psychiatric and a Primary Care Provider, Registered Dietitian, Masters Level therapist, Psychologist and Registered Nurse. The professional staff equips each patient with the right tools to live a healthy, productive life. For more information, call 1-800-445-1900 or visit www.remudaranch.com.

Anxiety disorders are the most common form of mental illness in both children and adults, affecting one in six individuals in America each year. Although these disorders vary distinctly in their presentation and symptoms, at their core these disorders all involve persistent, intense, and irrational anxiety, fear, or dread that interferes with daily life. Too often, anxiety disorders are misunderstood or misdiagnosed, preventing the sufferer from receiving appropriate treatment. When left untreated, anxiety disorders can quickly become incapacitating and may result in the development of additional problems including unemployment, social isolation, depression, and substance abuse. Cognitive behavioral treatment (CBT) is a form of treatment that has been proven to be effective in reducing and managing anxiety symptoms. The primary goal of CBT treatment is to free sufferers from a vicious cycle in which they have come to rely on ineffective behaviors in a futile effort to self-manage their anxiety. For example, persons with obsessive-compulsive disorder (OCD) typically rely on time consuming compulsions and avoidance behaviors to manage intrusive and distressing obsessions. OCD sufferers with contamination obsessions may spend three hours daily in washing and cleansing compulsions, confined to their homes because they avoid “contaminated” locations such as school, work, and public places. Over time, compulsive and avoidance behaviors drastically reduce the sufferer’s life quality, resulting in disability. These behaviors also strengthen the distorted and obsessive fears that drive the OCD cycle to begin with. OCD sufferers may believe that if they ever enter the perceived “contaminated” places or stop their compulsive washing, they will contract a horrible disease. Because of avoidance, their beliefs are never subjected to reality testing, but instead grow stronger. CBT interventions directly challenge both distorted thoughts and ineffective behaviors. Exposure with Response Prevention (ERP) is the primary CBT intervention used to treat most anxiety disorders, including OCD, social phobia, panic disorder, and OCD-spectrum disorders such as body dysmorphic disorder. ERP involves direct exposure to feared situations plus prevention of clients’ ineffective behaviors, such as their compulsions and avoidance behaviors. Prior to ERP, clients receive extensive psycho-education, facilitating insights into their thinking and behavior. As clients realize that their compulsive and avoidance behaviors are preventing the lives they want, they begin to desire change. Clients learn that the pathway out of this cycle is facing their fears through ERP. They learn about behavioral concepts, such as “habituation”: if they remain in distressing situations long enough, their anxiety naturally abates, making avoidance and compulsive behaviors unnecessary. Clients create “fear hierarchies”—lists of situations that trigger their anxiety. Fear hierarchies always begin with situations that provoke mild/moderate distress and proceed to those provoking severe distress. Clients gradually develop confidence in their ability to tolerate distress without using ineffective behaviors for relief. As clients face fears on their hierarchy, they learn experientially that habituation does indeed occur and that their imagined fears do not come to pass. As this happens, clients become less entrenched in fear and more willing to confront challenging situations. As clients develop confidence in their ability to manage a variety of previously distressing situations, they become free to lead lives that are guided by their personal values, goals, and priorities, rather than limited by anxiety and efforts to reduce or avoid it. Remuda Ranch offers Christian inpatient and residential programs for individuals of all faiths suffering from eating or anxiety disorders. Each patient is treated by a multi-disciplinary team including a Psychiatric and a Primary Care Provider, Registered Dietitian, Masters Level therapist, Psychologist and Registered Nurse. The professional staff equips each patient with the right tools to live a healthy, productive life. For more information, call 1-800-445-1900 or visit <a href="http://www.remudaranch.com">www.remudaranch.com</a>.

2009-09-25T17:10:54Z

267

Anxiety Disorder Recovery: Discovering a Life Worth Living

The National Institute of Mental Health (NIMH)

What are Anxiety Disorders? Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder. Five major types of anxiety disorders are: <hr></hr> * Generalized Anxiety Disorder * Obsessive-Compulsive Disorder (OCD) * Panic Disorder * Post-Traumatic Stress Disorder (PTSD) * Social Phobia (or Social Anxiety Disorder) Treatment <hr></hr> Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives.

What are Anxiety Disorders? Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder. Five major types of anxiety disorders are: <hr></hr> <ul> <li>Generalized Anxiety Disorder</li> <li>Obsessive-Compulsive Disorder (OCD)</li> <li>Panic Disorder</li> <li>Post-Traumatic Stress Disorder (PTSD)</li> <li>Social Phobia (or Social Anxiety Disorder)</li> </ul> Treatment <hr></hr> Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives.

2009-03-12T19:13:40Z

http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Anxiety Disorders