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Received Jan 4, 1999; accepted Jan 5, 1999.

James G. Emshoff and Ann W. Price
From the Department of Psychology, Georgia State University, Atlanta, Georgia.

Objective. This article was designed to give pediatricians a basic knowledge of the needs of children who live in families with alcoholism. It briefly presents issues involved in the identification and screening of such individuals and provides primary attention to a variety of preventive and treatment strategies that have been used with school children of alcoholics (COAs), along with evidence of their effectiveness.

Methodology. A literature search including both published and unpublished descriptions and evaluations of interventions with COAs.

Results. The scope and nature of the problems of growing up in an alcoholic home are presented. The risk and protective factors associated with this population have been used as a foundation for preventive and treatment interventions. The most common modality of prevention and intervention programs is the short-term small group format. Programs for COAs should include the basic components of information, problem- and emotion-focused coping skills, and social and emotional support. Physicians are in a unique position to identify and provide basic services and referrals for COAs. School settings are the most common intervention sites, but family and broad-based community programs also have shown promise in alcohol and other drug prevention.

Conclusions. Several COA interventions have demonstrated positive results with respect to a variety of measures including knowledge of program content, social support, coping skills, and emotional functioning. Rigorous studies are needed to understand better the complex ways children deal with parental alcoholism. A need remains for empirically sound evaluations and for the delineation of research findings. Key words: children of alcoholics, familial alcoholism, substance abuse, prevention, treatment.

SOURCE:PEDIATRICS Vol. 103 No. 5 Supplement May 1999, pp. 1112-1121

]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry090715-230448 Webmaster Thu, 16 Jul 2009 04:04:48 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081103-142527 In an interview with Parade magazine, Kidman, 41, spoke candidly about Urban's struggle with addiction, his stint in rehab and the birth of their daughter Sunday Rose.
"We were thrown into his alcohol problem three months into the marriage, and that was big," she told Parade. "We became the closest we would become because we had to bear our souls. We did ten years of marriage in three months."
Still, the actress and ex-wife of Tom Cruise said the marriage has granted her emotional fulfillment and blessed her with a newborn daughter, of whom she is fiercely protective.
Kidman said she experienced "whatever that primal thing is, the need and desire to keep her very protected," and vowed that she would not expose her to public scrutiny at least until she grew up.
"For now, I'm still keeping her in a bubble," she said.
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081103-142527 Webmaster Mon, 03 Nov 2008 20:25:27 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081102-160929 Sports agent Leigh Steinberg, the inspiration for the title character in "Jerry Maguire," was arrested in Newport Beach for public intoxication, police confirmed today. Steinberg, 59, was taken into custody about 7:45 p.m. Oct. 22 in the 400 block of E. Pacific Coast Highway, said Newport Beach Police Sgt. Evan Sailor. Steinberg, who has acknowledged a struggle with alcohol dependence, was released on his own recognizance after being given a Dec. 8 court date. It was not immediately clear if charges had been filed.
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081102-160929 Webmaster Sun, 02 Nov 2008 22:09:29 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081101-082235
"Pediatricians, with their commitment to child health, frequent interactions with parents, and close relationships with both children and families, have a unique opportunity to screen parents for alcohol use and refer them for further assessment and treatment," says Celeste Wilson, MD, researcher and pediatrician in the CeASAR program at Children's and lead author of the study.

In the multi-center study, 879 parents from three pediatric primary care clinic sites---rural, urban and suburban---were surveyed using anonymous questionnaires. The questionnaire included two brief alcohol screening tests and questions designed to assess parents' preferences for who should perform the alcohol screening, acceptance of the screening, and preferred interventions if the screening was positive.

Nearly 90% of all parents responding to this anonymous survey reported being open to being asked about their alcohol use at their child's pediatric appointment. Surprisingly, over 75% of parents with a positive alcohol screen also indicated acceptance of being screened for alcohol problems during the pediatric office visit. The top three preferred screening methods for parents, including those found to have alcohol problems, were direct conversation with the pediatrician, computer-based questionnaire, and paper-pencil questionnaire. The researchers believe that the endorsement of the pediatrician over screening conducted by other medical staff (e.g., nurse, medical assistant) results from an intangible, yet distinct, quality of the parent-pediatrician relationship.

While the parents' openness to alcohol screening at pediatric appointments was encouraging, the researchers are quick to point out some of the findings are cause for concern. Of the 879 parent participants, one out of every nine (11.5%) were found to have a positive alcohol screen; an alarmingly high number when considering recruitment for study participation was on a volunteer-only basis.

"It is possible that those parents who declined participation in the study were the ones with the most severe alcohol problems," says Wilson who is also an Instructor in Pediatrics at Harvard Medical School. "However, if this is true, our results represent an underestimate of the actual problem."

According to research, children of alcoholics are at increased risk for behavioral, cognitive and mental health problems. They are more likely to witness domestic violence, and have a greater chance of becoming victims of all forms of child maltreatment including neglect, physical abuse, and sexual abuse. Furthermore, children of alcoholics are 3 to 4 times more likely to have their own alcohol problems later in life.

"Given the negative consequences of growing up with an alcoholic parent, it is critical, for the future health and well being of the child, to identify and provide a pathway to assessment and treatment for the parent with an unhealthy pattern of alcohol consumption," adds Wilson.

Dr. Wilson and her colleagues suggest that to optimally treat patients, pediatricians must acknowledge the potential adverse effects of parental alcohol use on the child and embrace the concept that alcohol use should be addressed with parents during the clinic visit. When considering possible implementation strategies, they believe that an alcohol screening tool could be incorporated into a preexisting health survey and completed by the parent prior to their child's clinic appointment.

The study was supported by a grant from the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program. Dr. Wilson was supported by a faculty fellowship grant from The Center of Excellence in Minority Health and Health Disparities at Harvard Medical School.

]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081101-082235 Webmaster Sat, 01 Nov 2008 13:22:35 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081031-211939
Andrew Durnford and Tommy Perkins co-led a team of researchers from the University of Birmingham who investigated the effects of the Licensing Act 2003 on Emergency Department admissions to an inner city hospital. Durnford said, "Interestingly, since 24-hour drinking, significantly more alcohol-related attendances were observed in the early hours of the morning and a significantly smaller proportion in the earlier evening. This trend was seen for weekdays and weekends".

He added, "Our findings suggest that although the Act has not affected the number of alcohol-related attendances at the Emergency Department or the day of presentation; it is associated with a shift in the time of attendances into the early hours of the morning. This may reflect a change in drinking patterns".

The research suggests that 24-hour drinking has not reduced the burden of alcohol attendances to emergency departments and has simply shifted the problem later into the night. According to the authors, "For the NHS, this suggests 24-hour drinking has not lessened the workload. Furthermore, this shift to increased attendances in the early hours will have implications for night-time service provision in the NHS and the Police".

The Licensing Act 2003 allowed longer and more flexible opening hours for pubs, clubs and other licensed premises. Durnford and his colleagues investigated the alcohol-related attendances to the Emergency Department over a week in January 2005 (before the Act was implemented) and during the same week in January 2006 (after licensing hours were changed). In the period between the Act's implementation and the start of the study, 37% of licensed premises in Birmingham had successfully applied to extend their opening hours. However, the authors do point out that "Some venues may not have changed their opening hours immediately and attitudes towards alcohol may take more time to adapt to the new environment".

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Article adapted by Medical News Today from original press release.
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081031-211939 Webmaster Sat, 01 Nov 2008 02:19:39 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081031-171811
A new study at the University at Buffalo's Research Institute on Addictions (RIA) will investigate these anger emotions and how they might be addressed in outpatient alcoholism treatment. In this study, researchers will develop a treatment specifically focused on anger management for use with individuals with drinking problems and will then examine the effects of the new treatment protocol in a pilot clinical trial.

The study is funded by a $1.8 million grant from the National Institute of Alcohol Abuse and Alcoholism and will run through 2013.

"We have seen that alcoholics score higher on various measures of anger emotions than non-alcoholics," explained Kimberly S. Walitzer, Ph.D., lead investigator on the study. "Furthermore, anger emotions can play a role in relapse to drinking following a period of abstinence from alcohol use. If we can help individuals to manage anger emotions differently, we should be able to help them cope in different ways other than drinking."

Walitzer is a senior research scientist and deputy director of RIA, as well as research associate professor in the Department of Psychology in the UB College of Arts and Sciences.

Walitzer's research team includes two senior research scientists at RIA. Paul R. Stasiewicz, Ph.D. is director of RIA's Clinical Research Center and research associate professor in UB's Department of Psychiatry in the School of Medicine and Biomedical Sciences. Gerard J. Connors, Ph.D. is RIA's director, professor in the Department of Psychology and research professor in the Department of Psychiatry in the School of Medicine and Biomedical Sciences.

The Research Institute on Addictions has been a national leader in the study of addictions since 1970 and a research center of the University at Buffalo since 1999.
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081031-171811 Webmaster Fri, 31 Oct 2008 22:18:11 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081028-131008
In a three-year study, funded with £360,000 from the Medical Research Council, Dr Lee Hogarth in the University's School of Psychology will study the impact that an abnormal frontal cortex can have in people's risk of becoming dependant upon drugs such as tobacco, alcohol, cannabis or heroin.

Dr Hogarth said: "Evidence suggests that a large percentage of the population try drugs but only a small proportion of experimental users - roughly about 15 per cent - will make the transition to full-blown addiction.

"Our study will move us a step closer to understanding why some people can use drugs recreationally without becoming hooked, while others will go on to develop clinical dependence."

The research will focus on the frontal cortex, the area of the brain which is involved in decision-making and which allows us to weigh up short term gain with potential long term negative consequences. The researchers believe that some people may have a biological predisposition to becoming addicted because this portion of their brain is malfunctioning, preventing them from appreciating risks adequately, leading them to make poor choices in relation to drug abuse.

Young people may be particularly affected by this as the frontal cortex is not yet fully developed, which may explain many risk-taking behaviours in adolescents.

The research will compare students who report social versus daily smoking, and adult smokers who are dependant on nicotine versus those who are not. These four groups will allow researchers to trace the transition to dependence across the lifetime of drug use.

In the experiments, volunteers will first learn to earn cigarettes before this behaviour is punished with an unpleasant noise. The question is whether nicotine dependence is associated with a persistence in cigarette seeking despite the negative consequence of this behaviour, which is the clinical hallmark of addiction.

In addition, researchers will use MRI technology to measure abnormal brain activity in participants who persist in drug seeking, despite this behaviour being punished.

Dr Hogarth commented: "The risk of becoming addicted is due to a failure to offset the anticipated pleasure from drug use with knowledge of the long term negative consequences. The frontal cortex carries signals for anticipated pleasure and pain, so we expect to see an abnormality in the integration of these signals in dependent addicts who persist in punished drug seeking behaviour.

"There is currently a debate as to whether addicts are responsible for their addictive behaviour, which has implications for the funding of their healthcare and treatment. If our hypothesis proves correct, we would argue that addicts are intentionally choosing to take drugs, rather than being controlled, like robots, by urges beyond their control. However, this does not mean that addicts are morally culpable for their choices, because they cannot help being vulnerable to a distortion of the neural system that computes their choices.

"If we identify those who possess this vulnerability, perhaps more can be done to prevent them from making the transition to pathological addiction."

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Article adapted by Medical News Today from original press release.
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]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081028-131008 Webmaster Tue, 28 Oct 2008 18:10:08 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081023-130929 A new report released today by HHS' Agency for Healthcare Research and Quality found evidence that people treated for depression in primary care clinics that provide coordinated services for mental and physical health do better and have fewer symptoms than patients who are treated at sites that just provide health services. However, the report's authors could not identify the mechanism by which this improvement occurred; nor could they determine whether any level of traditional beliefs about integrating mental and physical health services, or simply systematic practice, produced the benefit.

The report, which was co-funded by HHS' Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Office of Women's Health, and Office of Minority Health, also found that patients treated in specialty mental health centers appear to benefit when the facilities offer general medical care, but the number of studies was too limited to draw firm conclusions.

The report by the AHRQ-supported University of Minnesota Evidence-based Research Center in Minneapolis, did not find sufficient evidence to draw conclusions about the impact of integrating mental health and physical medicine services on patients with anxiety disorders, alcohol use disorders, or other mental or behavioral health problems.

The authors, who were led by Mary Butler, Ph.D., found that there are financial barriers to combining mental health and physical health services including a lack of reimbursement for consultations and communication activities between providers, telephone conversations with patients, and other care management functions, such as payment to care coordinators. Other barriers include staff resistance to change and lack of strong leadership committed to integration

Experts have called for integration because persons with mental health problems often do not receive treatment for their physical disorders. Also, primary care physicians may be in a good position to recognize underlying mental problems in patients who come to them regularly for treatment of chronic illnesses. In addition, patients with mental disorders are more likely to see a primary care physician during the year than a mental health specialist. Combined treatment also may reduce overall health care costs because mental disorders can worsen disability associated with chronic illnesses,

-- Integration of Mental Health/Substance Abuse and Primary Care.
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081023-130929 Webmaster Thu, 23 Oct 2008 18:09:29 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081018-130836 Children are exposed to nearly seven times more alcohol advertising if they attend a school where at least one-fifth of the students are Hispanic, a new University of Florida and University of Texas study shows.

In a study of 63 elementary schools in Chicago, researchers found there were 29 alcohol ads on average in the two-block radius surrounding schools with larger Hispanic populations compared with an average of four ads around schools where less than one-fifth of students were Hispanic. In all, the researchers counted 771 alcohol ads around the 27 schools with more Hispanic students and only 160 ads around the 36 schools with fewer Hispanic students, the researchers recently reported online in the journal Ethnicity & Health.

"This is a concern because we know from past research that exposure to ads is associated with alcohol use and intentions to use alcohol," said Kelli Komro, Ph.D., an associate professor of epidemiology in the UF College of Medicine and Institute for Child Health Policy and the study's principal investigator. "We also know from previous research that Hispanic children are at increased risk for alcohol use at young ages."

The ads around these schools were also more likely to contain cartoon images and animals, which other studies have shown can influence children, Komro said. Some of the ads, which ranged from billboards to signs around stores and bus stops, also seemed to attempt to tie into Hispanic culture by featuring Spanish words and the colors from the Mexican flag. About 70 percent of Chicago's Hispanic residents are Mexican, the study states.

The schools the researchers studied were all located within the city limits of Chicago and most housed kindergarten through eighth-grade classes. Most of the students in these schools were from racial minorities - about half the children were African-American, while about 25 percent were Hispanic - and came from low socioeconomic backgrounds.

One key difference was that schools with more Hispanic students tended to have fewer African-American students and vice versa.

Overall, students were about seven times more likely to see advertising if they attended a school with at least a 20 percent Hispanic student body.

There are more than 45 million Hispanic people living in the United States, about 10 million more than there were in 2000, according to the Pew Hispanic Center. A report the center released this month shows that the bulk of the population boom stems from more Hispanic children being born here rather than immigration. About 20 percent of public school students across the country are Hispanic, the report shows.

"According to previous studies, Hispanic youth are at higher risk for alcohol use than either white or African-American youth," said Keryn Pasch, Ph.D., an assistant professor of kinesiology and health education at the University of Texas and the study's lead author. "Exposure to alcohol advertising has been shown to increase alcohol use and intention to use alcohol, and marketers are aggressively capitalizing on the rapidly growing Hispanic population, targeting their marketing efforts at this group. Given these facts, I think it's critical to determine if alcohol advertising around schools is related to the ethnicity of the students and, if it is, to take steps to reduce the exposure of high-risk groups to this negative influence."

To combat the problem, communities could band together to demand to have fewer alcohol ads around schools. This occurred in several African-American communities in Chicago where organizers were able to successfully lobby for fewer alcohol ads, Komro said. Also, ordinances that limit advertising around schools could be strengthened to further shield children from alcohol advertising, Komro said.

"Policies could be expanded to a wider range around the schools, especially given what we know about how effective ads are, both alcohol and tobacco ads, in influencing children's behavior," Komro said.

University of Florida Health Science Center - the most comprehensive academic health center in the Southeast - is dedicated to high-quality programs of education, research, patient care and public service. The Health Science Center encompasses the colleges of Dentistry, Public Health and Health Professions, Medicine, Nursing, Pharmacy and Veterinary Medicine, as well as the Veterinary Medical Teaching Hospital and an academic campus in Jacksonville offering graduate education programs in dentistry, medicine, nursing and pharmacy. Patient care activities, under the banner UF&Shands, are provided through teaching hospitals and a network of clinics in Gainesville and Jacksonville. The Health Science Center also has a statewide presence through satellite medical, dental and nursing clinics staffed by UF health professionals; and affiliations with community-based health-care facilities stretching from Hialeah and Miami to the Florida Panhandle.

University of Florida Health Science Center
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081018-130836 Webmaster Sat, 18 Oct 2008 18:08:36 GMT http://www.interventionorangecounty.com/blog/index.php?entry=entry081014-130658
Children and adolescents who abuse alcohol or are sexually active are more likely to take methamphetamines (MA), also known as 'meth' or 'speed'. Research published in the open access journal BMC Pediatrics reveals the risk factors associated with MA use, in both low-risk children (those who don't take drugs) and high-risk children (those who have taken other drugs or who have ever attended juvenile detention centers).

MA is a stimulant, usually smoked, snorted or injected. It produces sensations of euphoria, lowered inhibitions, feelings of invincibility, increased wakefulness, heightened sexual experiences, and hyperactivity resulting from increased energy for extended periods of time. According to the lead author of this study, Terry P. Klassen of the University of Alberta, Canada, "MA is produced, or 'cooked', quickly, reasonably simply, and cheaply by using legal and readily available ingredients with recipes that can be found on the internet".

Because of the low cost, ready availability and legal status of the drug, long-term use can be a serious problem. In order to assess the risk factors that are associated with people using MA, Klassen and his team carried out an analysis of twelve different medical studies, combining their results to get a bigger picture of the MA problem. They said, "Within the low-risk group, there were some clear patterns of risk factors associated with MA use. A history of engaging in behaviors such as sexual activity, alcohol consumption and smoking was significantly associated with MA use among low-risk youth. Engaging in these kinds of behaviors may be a gateway for MA use or vice versa. A homosexual or bisexual lifestyle is also a risk factor."

Amongst high-risk youth, the risk factors the authors identified were, "growing up in an unstable family environment (e.g., family history of crime, alcohol use and drug use) and having received treatment for psychiatric conditions. Among high-risk youth, being female was also a risk factor".
]]> http://www.interventionorangecounty.com/blog/index.php?entry=entry081014-130658 Webmaster Tue, 14 Oct 2008 18:06:58 GMT