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Thesis (PhD (Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: There is a paucity of research documenting women’s undisclosed drinking. This study explored the discursive accounts of women’s alcohol dependence, treatment history and barriers in accessing alcohol dependence treatment. The goals of this dissertation were to explore women’s alcohol dependence history; explore women’s treatment history (or lack thereof); identify barriers and nature of barriers that limit women’s access to alcohol dependence treatment; identify the reasons for women not accessing treatment, and to interpret women’s experiences of treatment per se. A Human Scientific Approach was adopted to examine and interpret how women’s drinking is socially constructed. A social constructionist approach was utilised to access and construct meaning from the discourses emanating from the women’s narratives of their experience with alcohol and their attempts at rehabilitation. Ten women were interviewed using the life story (narrative) interview method. The findings illustrate two major discourses namely, secret drinking and inaccessibility of appropriate treatment facilities for women alcohol dependents. This means that participants feel forced to conceal their drinking and to drink secretively because of the stigma associated with women drinking heavily. The stigma they experience translates into barriers (mostly internal barriers) to seeking institutionalised treatment. This makes it easier for them to seek alternative treatment such as an anonymous fellowship, like Alcoholics Anonymous. Other discourses signify the importance of problem identification and treatment readiness. This means that if the alcohol dependent woman realises what the real problem is causing her to use alcohol as an escape or as a coping strategy, she will be more willing to address the underlying problem. Recommendations are made focusing on micro and macro-level intervention strategies such as access to treatment, public health campaigns and policies to improve the quality of life of women recovering from alcohol dependence. / AFRIKAANSE OPSOMMING: Daar is min inligting beskikbaar oor die dokumentering van vroue wat in-die-geheim alkohol gebruik. Hierdie studie het die diskursiewe weergawe van vroue se alkoholgebruik, behandelingsgeskiedenis en hindernisse tot die behandeling van alkohol-misbruik verken. Die doelstellings van hierdie verhandeling is om die volgende te verken: Vroue se afhanklikheidsgeskiedenis; vroue se rehabiliteringsgeskiedenis (of die gebrek daaraan); die identifisering van hindernisse en die aard van die probleme wat vroue se toegang tot die behandeling van alkohol-misbruik beperk; die identifisering van redes waarom vroue rehabilitering weier; en die interpretasie van vroue se belewings van behandeling per se. ‘n Humanisties-wetenskaplike benadering is gebruik om die sosiale konstruksie van vroue se drinkgewoontes te ondersoek en te interpreteer. Die verstaan van en die skep van betekenis van die diskoerse van die vroue, en die temas wat na vore gekom het vanuit hul vertellings/narratiewe van hul alkohol-ervarings en hul pogings tot rehabilitering, is binne die raamwerk van die sosiaal-konstruksionistiese uitgangspunt aangepak. Onderhoude is met tien vroue gevoer en die narratiewe metode is gebruik. Die bevindings toon twee hoofdiskoerse naamlik, drinkery in-die-geheim en die ontoeganklikheid van gepaste behandelingsfasiliteite vir vroue met afhanklikheidsprobleme. Dit beteken dat vroue ondervind dat hulle gedwing word om in-die-geheim te drink, as gevolg van die stigmatisering van vroue en oormatige alkohol-gebruik. Hierdie stigmatisering kan herlei word tot hindernisse (meestal interne hindernisse) te make met ge-institutionaliseerde behandeling. Om die rede is dit makliker vir vroue om alternatiewe behandeling soos anonieme gemeenskappe, byvoorbeeld Alkoholiste Anoniem te oorweeg. Ander diskoerse beklemtoon die identifisering van probleme en die instemming tot rehabilitering. Dit beteken dat wanneer die alkoholis die werklike probleem vir alkohol-gebruik verstaan as ‘n ontsnapping of as ‘n hanteringsstrategie, sy meer gewillig sal wees om die onderliggende probleem aan te spreek. Aanbevelings is gemaak met die fokus op mikro- en makrointervensiestrategieë, soos die toegang tot rehabilitering, openbare gesondheidsveldtogte en beleide ten einde die leef-kwaliteit van vroue in die herstelproses van alkoholafhanklikheid te verbeter.

The aims of the thesis were to examine i) whether the endogenous opioid system (EOS) is lateralized in human brain areas involved in processing of emotions and pain; ii) whether EOS responses to unilateral brain injury depend on side of lesion, and iii) whether in human alcoholics, this system is involved in molecular adaptations in brain areas relevant for cognitive control of addictive behavior and habit formation. The main findings were that (1) opioid peptides but not opioid receptors and classic neurotransmitters are markedly lateralized in the anterior cingulate cortex involved in processing of  positive and negative emotions and affective component of pain. The region-specific lateralization of neuronal networks expressing opioid peptides may underlie in part lateralization of higher functions in the human brain including emotions and pain. (2) Analysis of the effects of traumatic brain injury (TBI) demonstrated predominant alteration of dynorphin levels in the hippocampus ipsilateral to the injury, while injury to the right hemisphere affected dynorphin levels in the striatum and frontal cortex to a greater extent than that to the left hemisphere. Thus, trauma reveals a lateralization in the mechanisms mediating the response of dynorphin expressing neuronal networks in the brain. These networks may differentially mediate effects of left or right brain injury on lateralized brain functions. (3) In human alcoholics, the enkephalin and dynorphin systems were found to be downregulated in the caudate nucleus and / or putamen that may underlie in part changes in goal directed behavior and formation of a compulsive habit in alcoholics. In contrast to downregulation in these areas, PDYN mRNA and dynorphins in dorsolateral prefrontal cortex, k-opioid receptor mRNA in orbitofrontal cortex, and dynorphins in hippocampus were upregulated in alcoholics. Activation of the k-opioid receptor by upregulated dynorphins may underlie in part neurocognitive dysfunctions relevant for addiction and disrupted inhibitory control. We conclude that the EOS exhibits region-specific lateralization in human brain and brain-area specific lateralized response after unilateral TBI in mice; and that the EOS is involved in adaptive processes associated with specific aspects of alcohol dependence.

Family, twin and adoption studies consistently suggest that genetic factors strongly influence the risk for alcohol dependence (AD). Although the literature supports the role of genetics in AD, identification of specific genes contributing to the etiology of AD has proven difficult. These difficulties are due in part to the complex set of risk factors contributing to the development of AD. These risk factors include comorbidities with other clinical diagnoses and behavioral phenotypes (e.g., major depression), physiological differences that contribute to the differences between people in their level of response to ethanol (e.g., initial sensitivity) and finally the large number of biological pathways targeted by and involved in the processing of ethanol. These complexities have probably contributed to the limited success of linkage and candidate gene association studies in finding genes underlying AD. The powerful and unbiased genome-wide association study (GWAS) offers promise in the study of complex diseases. However, due to the complexities of known risk factors, GWAS data has yet to provide consistent, replicable results. In light of these difficulties, this dissertation has five specific aims which attempt to investigate genetic risk loci for AD and related phenotypes through improved methods for candidate gene selection, analysis of a pooled genome-wide association study, genome-wide analyses of initial sensitivity and maximum alcohol consumption in a twenty-four hour period and finally, creation of a multivariate AD/internalizing phenotype.

Bakgrund: Alkoholberoende är ett stort problem i det svenska samhället och har under 2000-talet vuxit sig större. Problemet påverkar barnen som lever med alkoholberoende föräldrar. Föräldrarna är viktiga för barnets utveckling. En otrygg uppväxt påverkar barnets fysiska och psykiska hälsa och livsvärld. Sjuksköterskan har en viktig roll i att upptäcka och erbjuda dessa barn och familjer hjälp. Syfte: Att beskriva barns upplevelser av att växa upp med alkoholberoende föräldrar. Metod: Uppsatsen är en kvalitativ narrativ litteraturstudie grundad på självbiografier skrivna av författare som har växt upp med alkoholberoende föräldrar. Resultat: Barn till alkoholberoende föräldrar upplever att de får ta den vuxna rollen i familjen. De känner sig annorlunda och ett utanförskap bland andra barn och vuxna. Deras livssituation är otrygg och ofta präglad av våld, trots det vågar de inte berätta för någon. Barnen drabbas av både fysisk och psykisk ohälsa och de känner en avsaknad av bekräftelse från den vuxna omgivningen. De upplever att sjukvården inte ser eller hjälper dem, de blundar för barnets situation. Slutsats: Sjuksköterskor behöver mer kunskap och verktyg för att förstå och kunna hjälpa dessa barn. Genom kunskap kan sjuksköterskan uppmärksamma barnen i tid och erbjuda barnet hjälp och stöd / Background: Alcohol dependency is a large problem in Swedish society that in the 2000s has grown larger. The problem affects the children living with alcohol dependent parents. Parents are important for child development. An insecure childhood affects the child's physical and mental health and life world. Nurses are important for detecting and offer these children and families help. Purpose: To describe children's experiences of growing up with alcohol dependent parents Method: A qualitative narrative literature based study on autobiographies written by authors who have grown up with alcohol dependent parents. Results: Children of alcohol dependent parents feel that they have to take the adult role in the family. They feel different and alienated from other children and adults. Their living conditions are precarious and often marked by violence, even so they dare not tell anyone. The children suffer both physical and mental illness and they feel a lack of confirmation from the adult environment. They felt that health care didn’t see or help them; they closed their eyes to the child's situation. Conclusion: Nurses need more knowledge and tools to understand and be able to help these children. Through knowledge nurses can notice the children in time and offer them help and support.

The main goal of this essay is to show that lifestyle has an influence on alcohol addiction and its process, but most importantly on maintaining abstinence after a treatment. From various research, which where made, is clear, that most of relapses are directly related to lifestyle of addicts (or at least to its parts such as health, social situation, economic status, hobbies etc.). That is why it is important to work on a lifestyle change during a treatment so that the addicts are in balance during the abstinence and are not exposed to risky situations which they do not know how to react to and deal with them. There is Relapse Prevention to learn these pocedures and it should be applied also during the treatment and after. Part of my essay is qualitative research, which should reflect previously mentioned phenomenons among ten respondents of detoxification centre, who experienced relapses before. I tried to prove that lifestyle and its disorders influence and increase the potential of relapse after completed treatment and it is necessary to change it during abstinence.

O consumo abusivo do álcool e suas conseqüências vêm aumentando significativamente, constituindo sério problema para a saúde pública. Esses problemas representam alto custo social e comprometem diversas áreas da saúde. O presente estudo é do tipo descritivo e tem como objetivo identificar o apoio social para dependentes do álcool e analisar suas relações. A amostra foi composta por 50 usuários, cadastrados, e em atendimento no Centro de Atenção Psicossocial -Álcool e Drogas - CAPS ad.II, de Ribeirão Preto, com diagnóstico de síndrome de dependência do álcool. Para a coleta de dados foi utilizado questionário estruturado com perguntas fechadas, dividido em três partes: as informações sociodemográficas, o teste de identificação do uso do álcool (Audit) e o instrumento de apoio social Medical Outcomes Study (MOS). Resultados: 43(86%) do sexo masculi no, 26(46%) solteiros, 26(52%) adultos, faixa etária entre 30 e 49 anos, com baixo nível de escolaridade 31(62%), pois tinham o ensino fundamental completo ou incompleto, e 21(42%) estavam desempregados. Com relação ao uso do álcool, 44(88%) apresentaram níveis de provável dependência, ou dependência, do álcool, e 31(62%) iniciaram o uso do álcool na adolescência, entre 12 e 18 anos. Referente ao apoio social (apoio material, apoio afetivo mais interação social positiva, apoio emocional mais apoio de informação) de um modo geral, observou-se que os usuários apresentaram apoio social baixo, quando comparados os tipos de apoio, encontrou-se associação entre apoio afetivo e interação social positiva e a faixa etária, principalmente na idade de 50 anos, pois a chance de não terem apoio é 15 vezes maior quando comparado aos mais jovens. Os achados do presente estudo apontam para o desenvolvimento de programas direcionados a fortalecer o apoio social durante e após o tratamento do uso abusivo o álcool. / Binge drinking and its consequences have been increasing significantly, thus becoming a serious health problem. Such problems represent a high social cost and they adversely affect several health sectors.The present descriptive study aims to identify social support among alcohol dependent individuals and evaluate their association. The sample consisted of fifty alcohol users who signed up for treatment at the Center for Psychosocial Attention- Alcohol and Drugs (CAPS ad.II) in Ribeirão Preto, diagnosed with Alcohol Dependence Syndrome. For data collection, a questionnaire, divided into three parts, containing closed ended questions on social demographic information, the Alcohol Use Identification Test (Audit), and the Social Support Instrument Medical Outcomes Study (MOS) was used.RESULTS: 43 (86%) of the subjects were male, 26 (52%) were single, 26 (52%) were adults between thirty and forty nine years old with low educational level (they had not completed elementary school), and 21 (42%) were unemployed. As for alcohol use, 44 (88%) of the subjects presented level of probable dependence or alcohol dependence and 31 62%) started using alcohol between the age of twelve or eighteen. As regards social support, (material support, affective support plus positive social interaction, emotional support plus information support) subjects were found to count on low social support. When types of support were compared, an association between affective support and positive social interaction and age group emerged, mainly around the age of 50, for this age group is one fifteenth times as likely to count on social support when compared with younger subjects. These findings present indicators for the development of programs aiming to strengthen social support during and after binge drinking treatment.

O consumo abusivo do álcool e suas conseqüências vêm aumentando significativamente, constituindo sério problema para a saúde pública. Esses problemas representam alto custo social e comprometem diversas áreas da saúde. O presente estudo é do tipo descritivo e tem como objetivo identificar o apoio social para dependentes do álcool e analisar suas relações. A amostra foi composta por 50 usuários, cadastrados, e em atendimento no Centro de Atenção Psicossocial -Álcool e Drogas - CAPS ad.II, de Ribeirão Preto, com diagnóstico de síndrome de dependência do álcool. Para a coleta de dados foi utilizado questionário estruturado com perguntas fechadas, dividido em três partes: as informações sociodemográficas, o teste de identificação do uso do álcool (Audit) e o instrumento de apoio social Medical Outcomes Study (MOS). Resultados: 43(86%) do sexo masculi no, 26(46%) solteiros, 26(52%) adultos, faixa etária entre 30 e 49 anos, com baixo nível de escolaridade 31(62%), pois tinham o ensino fundamental completo ou incompleto, e 21(42%) estavam desempregados. Com relação ao uso do álcool, 44(88%) apresentaram níveis de provável dependência, ou dependência, do álcool, e 31(62%) iniciaram o uso do álcool na adolescência, entre 12 e 18 anos. Referente ao apoio social (apoio material, apoio afetivo mais interação social positiva, apoio emocional mais apoio de informação) de um modo geral, observou-se que os usuários apresentaram apoio social baixo, quando comparados os tipos de apoio, encontrou-se associação entre apoio afetivo e interação social positiva e a faixa etária, principalmente na idade de 50 anos, pois a chance de não terem apoio é 15 vezes maior quando comparado aos mais jovens. Os achados do presente estudo apontam para o desenvolvimento de programas direcionados a fortalecer o apoio social durante e após o tratamento do uso abusivo o álcool. / Binge drinking and its consequences have been increasing significantly, thus becoming a serious health problem. Such problems represent a high social cost and they adversely affect several health sectors.The present descriptive study aims to identify social support among alcohol dependent individuals and evaluate their association. The sample consisted of fifty alcohol users who signed up for treatment at the Center for Psychosocial Attention- Alcohol and Drugs (CAPS ad.II) in Ribeirão Preto, diagnosed with Alcohol Dependence Syndrome. For data collection, a questionnaire, divided into three parts, containing closed ended questions on social demographic information, the Alcohol Use Identification Test (Audit), and the Social Support Instrument Medical Outcomes Study (MOS) was used.RESULTS: 43 (86%) of the subjects were male, 26 (52%) were single, 26 (52%) were adults between thirty and forty nine years old with low educational level (they had not completed elementary school), and 21 (42%) were unemployed. As for alcohol use, 44 (88%) of the subjects presented level of probable dependence or alcohol dependence and 31 62%) started using alcohol between the age of twelve or eighteen. As regards social support, (material support, affective support plus positive social interaction, emotional support plus information support) subjects were found to count on low social support. When types of support were compared, an association between affective support and positive social interaction and age group emerged, mainly around the age of 50, for this age group is one fifteenth times as likely to count on social support when compared with younger subjects. These findings present indicators for the development of programs aiming to strengthen social support during and after binge drinking treatment.