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January 2008

January 31, 2008

UK LOSES MUCH-NEEDED WOMEN-ONLY ADDICTION-TREATMENT CENTRE

Pierpoint’s Female Focus forced to shut down 29 January.

Pierpointfemale_focus

“To my knowledge, we provided the only gender-specific service dedicated to women trying to recover from addiction, including detox,” sighed director John Grady, who runs Pierpoint treatment services including its Female Focus unit.

“Not only am I terribly sad at having been forced to make such a difficult decision, which impacts on so many lives, but I feel frustrated and angry that such a course of action should have been remotely necessary in these times of chronic drug and alcohol misuse nationally. I feel particularly badly let down by commissioners of Tier 4 services for failing to purchase services that they themselves proclaimed were required, and for the apparent lack of interest and support shown by all regions of the National Treatment Agency, as well as by the NTA itself.”

Female Focus comprised a dedicated 8-bed Inpatient detoxification unit allied to an 8-bed residential rehabilitation centre specifically for women (including pregnant women) with drug and/or alcohol problems (these were in addition to 9 male-sepcific detox beds at Pierpoint). When it opened last August, Grady contacted all 149 Drug/Alcohol Action Team commissioners and nine NTA regional managers throughout the country to alert them to this cost-effective service – costs ranged from under £600 to £1,200 per week:  less than some B&Bs!

All Pierpoint’s centres are CSCI-registered, with excellent Inspection reports. It is signed up for the EATA gold-standard accreditation of its treatment programme, and has been accredited Investors in People since 2003.

However, the DAAT commissioners did not refer women as patients to the service.

”I then wrote to NTA treatment delivery manager Colin Bradbury, outlining our unsustainable position because of low occupancy levels, and seeking guidance on how to avert the closure of this very valuable resource,” Grady said. “I explained that it would be a tragic loss to the substance-misuse field if we hadto close, on account of being unable to keep 17 medically-monitored detox beds reasonably- well occupied at a sustainable level. I added that it was an even more horrendous prospect when you consider that our two CSCI-registered gender-specific detox units were not only competitively-priced, but delivering some of the best outcomes in the country at over 92% success rates.”

He wrote: “In view of the fact that the NTA has published on its website the Statements of Needs & Priorities for all its regions, which unequivocally state that MORE medically-monitored detox provision as well as specialist Women’s services are required, perhaps you could inform me which commissioners, DAATs and other purchasing agencies contributed to this belief that this is what is needed. We feel certain that these services ARE needed, but it concerns us greatly that, having provided them, they are not being sufficiently utilised by purchasers, who now risk losing them. “

It is hard to imagine, given the size of the drug and alcohol problem in the UK, that there are not enough people in need of such a service.  So does the problem lie with the statutory commissioners (purchasers) of these services?  Grady reports no responses from commissioners, bar one admirable exception.

“At the very least, I had hoped that there would have been some show of interest or concern. But sadly,not a word.  Interestingly, the day after we closed, I received an email from Colin Bradbury – a classic case of too little too late.”

Grady said, positively, that he fully agrees with the NTA on its recommendations to commissioners to engage with providers on 'block contracts'. The obvious benefit to providers is contracts provide a guaranteed income stream, rather than the current uncertainties surrounding spot-purchases. There are also financial benefits for the purchasers through possible discounts. “If we could engage in sufficient block contracts to secure adequate funding for Pierpoint House, I would be prepared to consider re-opening Female Focus, but I really do need some form of guarantee of revenue before contemplating such a move again,”Grade concluded reasonably.

January 26, 2008

TREATMENT-CENTRE LEAGUE TABLES

Action plan by ‘healthcare watchdog’ will start 4 February

“They are not league tables,” insists Peter Burkinshaw (pictured above with Marilyn Major of the National Treatment Agency for Substance Misuse), when discussing joint reviews by the Healthcare Commission and the NTA of alcohol- and drug-treatment providers, in order to identify and promote improvements where needed. The results are not due until autumn – but already providers are describing them as league tables.

“If I came top, I’d be boasting about it,” said the chief executive of one treatment centre, as others nodded in agreement.

The assessments cover only treatment providers contracted by the statutory sector. But when the results and points system on which each is scored are made public late this year, providers which have been omitted can score their own organisations for comparison.  If a low score, they can improve their services – if a high one, it is a strong selling point to attract potential patients, in both the private and public sectors.

ASSESSMENT STAGE

Drug/alcohol Action Team partnership and provider leads have four weeks, from Monday 3 to Friday 28 March 2008,  to complete online web-based forms. These forms might take only 15 minutes – but it will require more time for the partnerships and providers to compile an evidence portfolio to support their data submission.

Data will then be checked – if there are consistent errors, for example, perhaps a question was misunderstood. This will be followed by ‘spot checking’ where the inspectors will visit some treatment centres. Then provisional assessment results will be released.

WHO, WHAT DATA, WHEN...

Before that, local drug partnerships will nominate Tier 2 and 3 service providers (click here for explanation of Tiers)  for diversity and Tier 4 service providers – namely inpatient and residential rehabilitation – for their Tier 4 offering. Partnerships and nominated providers (those under contract) will get an individual code and links to web-based questionnaires. The nominations should be submitted between Monday 4 to Friday 15 February.

The release of anonymised results is scheduled for September 2008 latest.

Ratification: October 2008 latest.

Plan improvement: September-December 2008.

RELATED INFORMATION:

Healthcare Commission service review home page

December 2006 report  

January 25, 2008

WOMEN'S DRINK DEATHS DOUBLE - AND MEN'S ARE DOUBLE AGAIN

Office for National Statistics shows 2,990 women and 5,768 men died last year from alcohol abuse.

Criticism continues for ministers who extended licensing hours despite evidence warning of its damaging consequences (including from Addiction Today journal), and enabling of the UK's binge-drinking culture. But Alcohol Alliance campaigners state that cheap supermarket alcohol is at least to blame. As reported by Alcohol Concern CEO Srabani Sen in January 2008 Addiction Today journal, alcohol is now cheaper than bottled water and well within the price range of children's pocket money.

Men are still drinking more than women, with the gap closing. But, while most women's deaths are those aged 35-54, most men's are from age 55 onward - which coincides with retirement age. This backs earlier ONS research showing that top executives drink more than anyone else.

A disproportionate percentage of women die from alcohol complications such as liver failure and hepatitis. "Women seem to be more susceptible to the damaging physical effects of alcohol," commented Dr Ian Gilmore, president of the Royal College of Physicians. "My colleagues and I are seeing more young women with serious liver damage than ever before in our clinics."

Professor Roger Williams, director of the Institute of Hepatology at University College London, added that "Women are equal with men in many respects - but there is a big difference in their tolerance levels. They are dying at a much earlier age."

It is vital that the government invests more in alcohol treatment to help problem drinkers - and the families they affect.

January 24, 2008

DRUG OFFENCES SOAR 21% IN A YEAR

Home Office figures show that drug offences leapt by over 60% since Labour relaxed the law on cannabis possession in 2004. Drug crime rocketed by 21% last year alone. And there were 55,700 drug offences in July-September last year – police counted 34,600 drug offences in July-September 2004, the time of the reclassification. 55,000 drug offences were recorded Aril-June 2007, up 48,300 in the same period in 2006.

Critics (including Addiction Today) reiterated that the sharp rise proves former Home secretary David Blunkett made a serious blunder by downgrading cannabis from a Class B to C drug – meaning most users are no longer arrested. At the time of the reclassification, police counted 34,600 drug offences between July and September.

Prime minister Gordon Brown is currently weighing up whether to restore cannabis to Class B. Senior police officers, magistrates and medical experts support this move, but ministers await the latest report from the Advisory Council on the Misuse of Drugs in the next few weeks. But, worringly, Brown did not reverse, as initially announced, decisions for more casinos and 24-hour licensing.

In some areas, the number of mental disorders blamed on cannabis use has multiplied 10 times. This is a growing problem as potent skunk varieties become more popular, accounting for 75% of all drugs seized.  For research on the medical harms caused by cannabis, click here.   

London loses out under new funding formula

Comment by the London Drug & Alcohol Network

London boroughs are adversely affected by a new formula for allocating the pooled treatment budget based on numbers on treatment. London's overall budget for 2008/2009 drops £2million to £86million - and indicative figures suggest this could reduce progressively to £76.3million in 2010. Find out about local area allocations and providers concerns about the new formula at www.ldan.org.uk

NTA UPDATE ON COMPETENCE

Targets will be scrapped

As the new National Drug Strategy is being developed, the National Treatment Agency for Substance Misuse, in partnership with other central government stakeholders, has reviewed its approach to workforce issues.

“We will not be setting new targets when the current ones end in April 2008,” stated the NTA. “But it remains our ambition that all drug treatment-sector staff and managers have a recognised competency assessed or professional qualification appropriate to their role and are pursuing relevant continuous development.

“Over the past few years, the workforce has expanded to increase capacity and access to treatment - which thousands of clients now benefit from. But an unintended consequence was that, in some areas, workforce issues were detached from joint-commissioning commissioning (purchasing) activity. This needs to change. After all, if a partnership identifies problems such as low retention or difficulty in engaging certain groups (for example crack users), the solution is likely to lie in the workforce.

The NTA wants commissioners and services to build a workforce which is “fully competent and able to demonstrate its competence in line with the joint NTA/Home Office Workforce Development Plan. The needs assessment and treatment planning guidance 08/09 encourages partnerships to consider workforce implications. The NTA is also combining workforce monitoring with the upcoming Unit Costing exercise, so commissioners and providers factor workforce into their thinking when making decisions on allocating resources.

NTA lead: treatment delivery manager Colin Bradbury on 020-7261 8835.       

January 20, 2008

INPUT TO NIDA ADDICTION RESEARCH PLAN

Deadline 6 February 2008

For the past three decades, NIDA – the National Institute on Drug Abuse – has led the way in supporting research to prevent and treat drug abuse and addiction and mitigate the impact of their consequences, including the spread of HIV/AIDS and other infectious diseases. Given recent revolutionary advances in drug abuse research, NIDA recently underwent a strategic planning process. The result is NIDA's Draft Strategic Plan.

It outlines four major goal areas: prevention, treatment, HIV/Aids, and cross-cutting priorities, each with strategic objectives to guide NIDA's research agenda in the future.

The public is invited to review this draft plan and provide comments via email to stratplan@nida.nih.gov or mail to:

National Institute on Drug Abuse
Attn: Draft Strategic Plan

6001 Exectutive Blvd

Suite 5213, MSC 9561

Bethessa, MD 200892-9561, USA

January 17, 2008

RECOVERY MAPS: GUIDE CLIENTS...

... on their life path by drawing relapse and recovery 'maps'

Encouraging clients to draw ‘maps’ of their recovery can elicit information from the unconscious right side of their brains – Martin Weegmann steers us through

This article originally appeared in Addiction Today, March 2004.  It was prioritised on the list of archive articles to be uploaded to this website due to demand from drug and alcohol workers who regularly use it.

When I first came into the substance-misuse field, I read Marlatt and Gordon’s voluminous Relapse Prevention. Hoping to find the key to unlock addiction, I went away with more questions than answers... but at least with better questions.

When the fog of theory and research settled, what stood out most readily in my memory of the book was its use of metaphors – for example, the idea of relapse as a journey with signposts, roundabouts, turn-offs, crossroads and other choices. The book also used the image of ‘urge surfing’ to counter cravings and a visual of a map to illustrate the story of a gambler’s relapse. If these were the aspects which stood out for me, with all my psychological training, then perhaps such images might help patients.

Images can ‘stick’ and this could encourage thinking on the artistic and more unconscious ‘right’ side of the brain rather than the unemotional, rational ‘left’ side. Some art-therapy colleagues have used a version of this technique.

RELAPSE-RISK MAPS

Over the years, I have often used the technique of relapse maps in both individual and group therapy. Clearly, this fits with the relapse-prevention approach but is also compatible with other approaches: they can facilitate motivational work, psychodynamic exploration and solution-based therapy.

At the end of the day, such maps are simply a way of encouraging dialogue and entering into the client’s world: “doing a home visit without the visit”.

This need not be a one-off, since the therapist can return to and modify the map over time and invite discussion around “where next?” or “what are the sources of greatest risk?”. It can also be used in later abstinence, in which case I might call it a recovery map rather than merely a risk map.

HOW TO INTRODUCE MAPS TO CLIENTS?

Start by describing the principle to your client – that drawing a map gives us a bird’s-eye view of the client’s immediate relevant circumstances. From looking at it together, we can achieve a better sense of where the person lives, who they usually see, where are the dealers/fellow users, their sources of drugs or alcohol, and places of help and support.

I tend to take the lead the first time round, as clients can be inhibited if they think they must draw something. I ask for feelings associated with places – for instance, “describe your feelings about home in a few words”. I ask them to guide me as much as I guide them – “what else is important for you to put in the picture?”. If the picture lacks perspective – for example, it is depicted only in terms or risk or only in terms of recovery – I might redress the balance and ask clients to add the other side of the coin. I also ask them to put in the therapist or the clinic, with their feelings attached.

Finally, I ask them to give a title for the map, starting with their own name. “Indy’s lost in space” or “Sarah’s Routine” are shown in the two illustrations below. I encourage them, when they are at home, to draw their own version of the map and add other features as they think of them.

Recovery_map1

A world of using:

This map was by a heroin user – and it surprised him. Seeing what he was doing had a powerful effect, highlighting his immersion in drugs, and the users and dealers he could access. Indy added places like university and work which offered better prospects but were a real struggle to reach. Drawing the map helped him to face his minimisation and denial. Five years on, Indy’s map changed dramatically for the better.

Recovery_map2

Dry but not free?

Sarah’s map was completed after a year of sobriety. She had some fulfilling activities but the map brought home a sense of isolation. While she had ‘routine’, she did not feel close to others and could easily sit at home with her worries. Home life was a retreat from life, but therapy was a strong support. She recognised that more life or psychological development was important, but it frightened her – hence the routine.

CONCLUSION

Relapse-risk and recovery maps are a useful resource for clinicians. Borrowed initially from the relapse-prevention tradition, I have found these techniques useful at different ‘stages’ of recovery and within different modalities of treatment. They invite reflection on a person’s situation as it is and on that person’s next step in the journey. The travelling is, as always, as important – if not more so – than the destination.

Martin Weegmann is a clinical psychologist, group analyst and author of books such as The Pschodynamics of Addiction and Group psychotherapy & Addiction.  He worked for many years at the Gatehouse Drug Treatment Centre at St Bernard’s Hospital, Middlesex.

January 16, 2008

Self-help contact details

Many of these resources are free or by donation - do check.

Please feel free to send updates you come across.

Addictions Anonymous
020-7584 7383

Adult children of alcoholics
PO Box 1576, London SW3 1AZ
www.adultchildren.org

Al-aNOn...
for families and friends of problem drinkers – including after they quit
...and Alateen
for people aged 12-20 affected by someone else’s drinking.
Information & helpline for both:
020-7403 0888, 10am-10pm.
www.al-anonuk.org.uk

Alcoholics Anonymous
UK helpline: 0845-7697 555
Enquiries: 01904-644026
www.alcoholics-anonymous.org.uk

Bullying*
& National Bullying helpline:
0845-2255787
www.bullyonline.org

CITA*
(Council for Information on
Tranquillisers & Antidepressants)

Helpline, Mon-Fri, 10am-1pm: 
0151-932 0102   0151-474 9626
www.citawithdrawal.org.uk

CHRISTIANS IN RECOVERY
www.christians-in-recovery.org

Cocaine Anonymous
for cocaine/crack and other substances
helpline: 0800-612 0225
www.cauk.org.uk

Coda
(Co-Dependents Anonymous)
www.codependents.org

Cosa
for recovery from sexual codependency – meets Fridays
07986-697987
www.cosa-recovery.org

Cruse Bereavement Care*
0870-167 1677
www.cruse.org.uk

Debtors Anonymous
for problem debting, compulsive spending, under-earning & other money/work issues
www.debtorsanonymous.org

depression Alliance*
Self-help groups, workshops & conferences.
020 -7633 0557
www.depressionalliance.org

Depressives Anonymous *
0870-7744 320

DrinkLine*
0800-917 8282

Eating disorders association*
Youth helpline: 0845-634 7650
Adult helpline: 0845-634 1414
www.edauk.com

Emotions Anonymous 
www.emotionsanonymous.org

Families Anonymous
for relatives & friends of people with drug problems
0845-1200 660
020-7498 4680

www.famanon.org.uk

FOOD ADDICTS IN RECOVERY ANONYMOUS
for anyone suffering from food obsession, overeating, undereating or bulimia.
01903-520369
www.foodaddicts.org

frank*
government-funded information
0800-776 600
www.talktofrank.com

Gamblers Anonymous
for gambling problems
Gam-Anon
for relatives of those with gambling problems
For information on both:

020-7384 3040
www.gamblersanonymous.org.uk

HEROIN Anonymous
www.heroin-anonymous.org

Heroin Helpline*
020-7749 4053 (office hours)

HIV Anonymous
www.hivanonymous.com

Marijuana Anonymous
for those who wish to stop using marijuana
07940-503438
www.marijuana-anonymous.org

muslim youth helpline*
confidential counselling service for young muslims in need; numerous languages spoken
080-8808 2008
www.myh.org.uk

Nacoa*
(National Association for Children of Alcoholics)
0800-358 3456
www.nacoa.org.uk

Narcotics Anonymous
for drug problems
0845-373 3366
020-7824 8924.

www.na.org  

Net*
internet addiction in all forms
001-814-451 2405
www.netaddiction.com 

Nhs direct*
0845-4647; 24 hours/7 days a week
www.nhsdirect.com

Nicotine Anonymous
020-7976 0076.
www.nicotine-anonymous.co.uk

OBSESSIVE EATERS Anonymous
www.obsessiveeatersanonymous.org

ocd action*
information & support for people with obsessive compulsive disorder
020-7253 5272
www.ocd-uk.org

pan fellowship
any dependency/codependency with emphasis on steps 4&10
7pm Fridays at Methodist Hall,
Fulham Broadway, London

Samaritans*
for anyone feeling low, depressed or suicidal 
Helpline 24/7: 08457-909090 <

S-Anon
for families and friends of sex addicts
07000-725463
www.sanon.org

Sex Addicts Anonymous
London callback answer phone:
07000-725463
www.sauk.org

Sexaholics Anonymous
for those who want to stop their self-destructive sexual thinking and behaviour
020-8946 2436

Sex & Love Addicts Anonymous
(The Augustine Fellowship)
07951-815087
www.slaauk.com

STOPPING OVERSHOPPING*
www.stoppingovershopping.com

SPEAR*
Supporting people who self-harm
www.projectspear.com

SURVIVORS OF INCEST ANONYMOUS
www.siawso.org

TALKING ABOUT CANNABIS*
Supports families of cannabis users
www.talkingaboutcannabis.org

uk self-help*
website containing hundreds of listings
www.ukselfhelp.info

violence initiative*
offering violent people a chance to change
Meetings, one-to-one sessions, conflict resolution training:

020-8365 8220
www.tviccv.org

Workaholics Anonymous 
Celia 01993-878220
or George 020-7498 5927
www.workaholics-anonymous.org

* Resources other than 12-step

NICE ALCOHOL GUIDELINES

Chair and Clinical Adviser - Alcohol Disorders

The adverts for a Chair and Clinical Adviser for the Alcohol Disorders guideline are currently on the NICE website. The closing date for applications is 18 January 2008. Just click through on Chair or Clinical Adviser .

January 15, 2008

The ACoA FACT FINDER

The UK's largest-ever survey into the extent and traits of children of alcoholics previewed its findings at Addiction Today's conference. It has even more impact than mental illness, concludes Professor Martin Callingham.

This article was first published in Addiction Today November 1999.

23,378 people across the UK were selected at random and interviewed in 1998, in their own homes, to investigate the extent and characteristics of adults who grew up in a home with alcoholic parents. Many of the people recruited from this to take further part in the survey did not have contact with the substance-abuse or mental-health professions - which makes this survey almost unique in terms of the nature and 'representativeness' of those from whom the data was then collected.

                                Responders         Agreed     %

Total                       23,378                   9,789        41.8%

Alcohol                    1,464                      953         65.0

Mental health         1,019                      707        69.3

Trauma                   2,401                   1,548         64.4

No problem          19,454                   7,387         37.3

People were asked tree questions: "Did you grow up in a home in which either or both of your parents drank too much?", "Did you grow up in a home in which either or both of your parents suffered from a mental-health problem such as schizophrenia?" and "Did you grow up in a home in which severe trauma occurred involving disablement, death or loss of long-term contact with another member of your family?".

To maximise accuracy, the self-completed questionnaires were numbered so that, when returned, they could be weighted by demographics to represent the original 'universe' across the population and country. That said, the responses might be conservative, because denial that there is a problem is a possible symptom of growing up in an alcoholic family. Indeed, a few people who originally replied that there was no problem later rang in to the survey team saying that the opposite was true.

OBJECTIVE

The survey aimed to quantify four areas for future action:

·         How extensive is the problem compared to other recognised problems?

·         How severe is the problem in comparison with other problems?

·         What are the characteristics of the problem?

·         Does it impact differently depending on the child’s circumstances?

SO WHAT DID WE FIND OUT?

It must be stressed that these are very preliminary results as not all the questionnaires have been returned yet. But those received do reflect the demographics.

PREVALENCE

The first finding is that, in the UK, over 16% of people grew up in a home which had a severe trauma involving death, disablement, long-term separation, mental illness, or at least one of their parents drinking too much. 3.5% of people grew up in homes wit more than one of these.

There is some reporting variation by demographics. They are a bit more prevalent among women, social grade E, and less prevalent among the old. And alcoholic parents are reported more often the lower the social grade.

Second, some 6.2% of adults claim that they grew up in a family where one or both of the aprents drank too much. This is greater than the number who grew up in a home where one or both of the parents suffered from severe mental illness: 4.3%. This indicates that this situation is more prevalent.

And the likelihood of a person being prepared to help in the survey rose from 38% of people who had not grown up in such homes to over 80% of people who did grow up in homes where all three were present. This obviously suggests a wish on the part of these people to 'talk' about their childhood situation.

SEVERITY OF THE PROBLEM

Most people who had been in a home with one of these problems had tried to hide this from people outside. The proportion varied a little across the groups, with 70% of homes where a parent drank too much trying to hide it, and 75% of homes with severe mental illness and 55% of homes with trauma trying to do so.

There were some differences in the characteristics of the three samples. Children of alcoholic parents drank more than the control group (remember, the control group reports no problems), though not excessively. They were more likely to be unemployed or not looking for work than the control. They were more likely to be divorced. And they were more likely to have a job in which they 'played out' a role.

To this extent, they had similariaties to the group which grew up in a household with severe mental ilness. They, too, were appreciably more likely to be divorced, unemployed and playing out a role in their jobs than the control group. They had a slightly different age profile, being a little ounger and more concentrated in the 34-45 age range than the control.

The hig divorce rates in both the alcoholic and mental-illness groups meant that the natural father was often not living in the house and his absence was increasingl likely as the child got older. But this was offset against the greater likelihood of the mother remarrying and there being a stepfather.

CHARACTERISTICS OF THE PROBLEM

The family environment between the control group and the 'alcoholic' group was described in dramatically different ways. But there was much similarity between the households of the alcohol group and the mental-illness group.

This is the first evidence in the survey that the intensity of the phenomenon of growing up in a household in which at least one of the parents drank too much is of a similar magnitude to that of growing up in a houseold where one of the parents suffered from severe mental illness.

The control groups were very much less likely to describe their household in terms of shortage of money, arguments, violence, stress, worry and the embarrassment of taking friends home. They were much more likely to describe it int terms of good times, happiness, fun, affection, pride, helping one another and of friends being welcome.

25% of people from homes in which there was a mental illness said that the problem had affected them "ver badly". 30% of people who grew up in alcoholic homes also said this, but only about 10% said that this was now true. About 40% of the two test groups said that the mother had been "very badly" affected at the time.

The relationship which the respondents in the survey had with their parents was much better for the control group where most said - on almost every aspect they were asked about - that their parents were doiing it "just right", neither "too much" nor "too little", though the father generall got a slightly lower rating. In comparison to this, only a minority of parents were judged to do this in the two test groups.

Mothers and fathers got similar ratings from children from mental-illness homes. Fathers were rated lower than mothers in alcoholic homes, where the father was nore likely to be doing the drinking.

CHARACTERISTICS OF CHILDREN OF ALCOHOLICS COMPARED TO OTHER PEOPLE

The respondents in the survey were asked to tick a series of words which described themselves when they were a child and now. Some of these words are positive characteristics and some (more) negative.

As we have a sample of adults who did not grow up in an alcoholic family as well as those who did, we can compare the self-perception of these people as children and as adults. To what extent did they see themselves as having a personality as children which was different from the control group - and has time healed the wounds?

The answers showed that the personality was much more problematic in the case of children from alcoholic homes. And, surprisingly, the also showed that the impact of growing up in an alcoholic home was significantly worse than in a home where one or both parents had a mental-health problem.

On a number of dimensions, age brought some relief to the respondents' distress. But mostly they continue to carry the mark of being from an alcoholic home.

We found that, on a few positive fronts, children of alcoholics describe themselves more positively than the control but mostly they came off worse. And on many negative things the describe themselves as worse. Only in three aspects did it seem that the experience had a positive side, and that was that these adults were more likely to see themselves as "achieving, charming and successful". But the are less likely to identify positive characteristics such as being responsible, confident, happy, secure, satisfied, accommodating and dependable.

Improvements had been made since childhood on the happy, secure and satisfied aspects, where again time seems to have helped.

Children of alcoholics are also more likely to see themselves as having numerous negative traits: lack of feeling, depression, irrationality, agressiveness, nervousness, jitters, indecision and "being different to other people". Time has slightly improved some of these negative self-images.

Children of alcoholics are also more likely to see themselves as lonely or stressed. Both of these were worse when they were children, as was being frightened, which was a major emotion as a child but is about the same as the control group in adultood.

There are some dramatic differences in reported behaviour between the two test groups and the control. These are behavioural concerns which could lead them to need/seek professional help - and purchasers of substance-misuse treatment services should note tat this data consolidates the view that addressing these will also form an effective prevention service for the next generation.

Many more people in the test groups than in the control group claim that the have considered suicide, had eating disorders, had a drug addition and had been in trouble with the police, especially as a child, as well as having above-average alcoholic and mental-health problems themselves.

The experience and background of the two test groups leads them to worry more than the control group that their children might in the future drink too much or suffer mental-health problems.

Time has not managed to improve these negative self images.

SUMMARY

Although these are preliminary results, it is clear that more adults grew up in an 'alcoolic' home in which at least one of the aprents drank too much than grew up in a home with mental illness. So it is clear that this is a more extensive problem.

Furthermore, and perhaps more importantly, the characteristics of these two groups, in comparison with the control group are very similar. They show considerable stress in childhood and clear indications of the way in which their childhood had affected their personality and behaviour as adults - and the problems experienced by children of alcoholics are more severe and more widespread than those experienced by children of parents with a mental disorder.

Professor Martin Callingham has spent over 20 years in the research field and is on the Council of Esomar, which represents the international research community. He is one of the few Fellows of the Market Research Society and is a visiting professor at Birkbeck College.

He presented the preliminary findings of this £60,000 research, commissioned by the National Association for Children of Alcoholics, at Addiction Today's Solutions For The Millennium conference in October 1999.

On

January 14, 2008

NIDA INFOFACTS: MARIJUANA

The science of drug abuse and addiction

Research overview from the National Institute of Drug Abuse and Addiction; current as at 2 January 2008

EFFECTS ON THE BRAIN

Scientists have learned a great deal about how THC (delta-9-tetrahydrocannabinol) acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to organs throughout the body, including the brain.

In the brain, THC connects to specific sites called cannabinoid receptors on nerve cells and influences the activity of those cells. Some brain areas have many cannabinoid receptors; others have few or none. Many cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thought, concentration, sensory and time perception, and coordinated movement4.

The short-term effects of marijuana can include problems with memory and learning; distorted perception; difficulty in thinking and problem solving; loss of coordination; and increased heart rate. Research findings for long-term marijuana abuse indicate changes in the brain similar to those after long-term abuse of other major drugs. For example, cannabinoid (THC or synthetic forms of THC) withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system5 and changes in the activity of nerve cells containing dopamine6. Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.

EFFECTS ON THE HEART

One study has indicated that an abuser's risk of heart attack more than quadruples in the first hour after smoking marijuana7. The researchers suggest that such an effect might occur from marijuana's effects on blood pressure and heart rate and reduced oxygen-carrying capacity of blood.

EFFECTS ON THE LUNGS

A study of 450 people found that those who smoke marijuana often but do not smoke tobacco have more health problems and miss more days of work than nonsmokers8. Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

Even infrequent abuse can cause burning and stinging of the mouth and throat, often accompanied by a heavy cough. Someone who smokes marijuana regularly can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, a heightened risk of lung infections, and a greater tendency to obstructed airways9. Smoking marijuana possibly increases the likelihood of developing cancer of the head or neck. A study comparing 173 cancer patients and 176 healthy individuals produced evidence that marijuana smoking doubled or tripled the risk of these cancers10.

Marijuana abuse also has the potential to promote cancer of the lungs and other parts of the respiratory tract because it contains irritants and carcinogens9,11. In fact, marijuana smoke contains 50-70% more carcinogenic hydrocarbons than tobacco smoke12. It also induces high levels of an enzyme that converts certain hydrocarbons into their carcinogenic form—levels that can accelerate the changes that ultimately produce malignant cells13. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which increases the lungs' exposure to carcinogenic smoke. These facts suggest that, puff for puff, smoking marijuana may be more harmful to the lungs than smoking tobacco.

OTHER HEALTH EFFECTS