Excessive alcohol consumption is an age-old human problem, and costs society an enormous amount of money every year. The first critique this learner would like to expand on is treatment. Treatments consist of different attempts to control the availability of alcohol. Since alcoholism is a disease, then individuals should seek medical treatment. Alcohol alone was the primary substance of abuse for almost 21.5% of all treatment admissions in the United States in 2005 (Inaba and Cohen, 2007). The average age of those with alcohol only as their problem was 39 compared with 35 who were admitted for alcohol and a secondary drug problem (Inaba and Cohen, 2007). The formation of Alcohol Anonymous (AA) in 1935 can now be seen as an important milestone in treatment (Ray and Ksir, 1999). This group supports abstinence as their goal. Everyone agrees that AA has been helpful for many people and, because it has reached more individuals than any other approach, has undoubtedly helped more people than any other method (Ray and Ksir, 1999). However, AA was developed by and for people who have made a decision to stop drinking and who want to affiliate with others who have made that same decision, and it may not be the best approach for individuals who are forced to attend meetings by court order or jail. Alcohol use disorders (AUDs) are prevalent, and rates of drinking and AUDs are increasing (U.S. Department of Human Services, 2001). In all age groups, the prevalence of AUDs is higher among men than women, but the rates for women are considerable, with 4%–9.8% of younger women (below 44 years of age) meeting criteria for diagnosis. Psychological and medical correlates of AUDs differ for women and men. In treatment samples, as many as 65% of women with AUDs meet lifetime criteria for another psychiatric disorder (Mann, Hintz, and Jung, 2004).
Women with AUDs also have higher rates of medical problems (Smith and Wisner, 2000) and an accelerated rate of development of alcohol-related morbidity and mortality. Furthermore, cognitive and somatic deficits develop more rapidly in heavy-drinking women than their male counterparts (Diehl et al., 2007). Death rates among women with AUDs are estimated to be 50%–100% higher than those of men with AUDs (Smith and Weisner, 2000). Despite the greater negative consequences of drinking, women are less likely during their lifetime to seek treatment for an AUD (23% of men with alcohol dependence vs. 15.1% of women (Dawson. 1996). Outcome research on treatments for AUDs reflects the lower prevalence of women in treatment. A recent review of treatment outcome studies found that women constituted only 15.7% of study samples in published studies (Swearingen, Moyer, and Finney, 2002). In general, the low numbers of women in alcohol treatment outcome studies have made it difficult to draw firm conclusions about effective treatments for women, and few studies have examined sex-segregated treatment. In one of the only randomized clinical trials evaluating sex-segregated versus mixed sex treatment for women with AUDs, outcomes were more positive for the women-only treatment approach (Dahlgren and Willander, 1989; Haver, Dahlgren, and Willander, 2001).
Intimate relationships may play a more significant role in women’s than men’s reasons for drinking and for relapse. Women with AUDs are more likely than men to drink in response to negative emotions or conflicts with others, and they are less likely to drink in response to pleasant emotions or positive social situations (Annis and Graham, 1995). After treatment, women are more likely to relapse with either a romantic partner (Connors, Maisto, and Zywiak, 1998) or a friend; men are more likely to relapse when alone (Rubin, Stout, and Longabaugh, 1996).
Secondly, social effects of alcohol cause many problems. The college years have traditionally been associated with alcohol use, and in 1994 the proportion of “drinkers” was indeed about 10 percent higher among 18- to 22 year old college students than among the general population of that age (e.g., about 70 percent of college students reported drinking in that past month, compared with about 61 percent of all 18-25 year olds in the NIDA household survey) (Ray and Ksir, 1999). Drinking alcohol can have profound effects on human social behavior, some of which constitute major problems for our society. The National Commission on the Causes and Prevention of Violence (1970), for example, found that “no other psychoactive substance is associated with violent crimes, suicide, and automobile accidents more than alcohol” (p. 641). Intoxicated offenders commit as much as 60% of the murders in the United States and comparably high proportions of other violent crimes such as rape, robbery, assault, domestic violence, and child abuse (Pernanen, 1976). Yet the positive effects of drinking are also well known; alcohol is used regularly to encourage friendly social interaction, self-disclosure, affection, and so on. It is surprising then, that despite the prevalence and importance of these effects, so little is known about how they occur.
Recently, progress has been made in research that shows that mere expectations about how alcohol makes us behave can mediate social drinking effects. That is, “drunkenness” can result from the self-fulfillment of drinking expectancies, or from the use of alcohol as an “excuse” for inappropriate or antisocial behavior. Drinking expectancies, independent of actual alcohol consumption, have been shown to increase binge drinking (Marlatt, Demming, and Reid, 1973), aggression (Lang, Goeckner, Adsso, and Marlatt, 1975).), and time spent viewing sexual photographic slides (Lang, Searles, Lauerman, and Adesso, 1980). Recently, progress has been made in research that shows that mere expectations about how alcohol makes us behave can mediate social drinking effects. That is, “drunkenness” can result from the self-fulfillment of drinking expectancies, or from the use of alcohol as an “excuse” for inappropriate or antisocial behavior. The idea is that alcohol releases people from their inhibition, largely because the inhibitions represent concerns about what might happen, whereas the intoxicated individual focuses on the immediate irritant or the person who needs help right now. Alcohol should generally weaken response inhibition. Once a response is instigated, its inhibition requires further information processing: Negative consequences of the response must be conceptualized, standards of conduct must be accessed and evaluated in relation to the response, and potentially inhibiting cues (again, both external and internal) must be perceived and their inhibitory significance understood (McCrady and Epstei, 2009). Alcohol’s damage to perception, however, makes it harder for one to notice peripheral inhibiting cues. Attention was focused in the early 1980s on the large number of traffic fatalities involving alcohol. It is difficult to estimate exactly how many of those fatalities are alcohol related, but we can obtain some relevant information because some states mandate that the coroner measure blood alcohol in all fatally accidents.
Single vehicle fatalities are more likely to involve alcohol than multiple vehicle fatalities in which the fatally injured person was driving the striking vehicle (Ray and Ksir, 1999). Another social effect is crime and violence. Pernanem (1976) used these facts to explain alcohol’s well-known relation to violent behavior. He argued that interacting parties who are impaired by alcohol are less likely to see justifications for the other’s behavior, are thus more likely to interpret the behavior as arbitrary and provocative, and then, having less access to inhibiting cues and behavioral standards, are more likely to react extremely (Steele and Southwick, 1985). These are all effects that cause the interaction to escalate toward physical violence. He further noted that depending on the response that is situationally instigated, alcohol’s impairment of information processing can increase back-slapping friendliness as well as belligerence (Steele and Southwick, 1985). Alcohol should make a social response more extreme when, if one were sober, the response here would be under strong inhibitory conflict—that is, pressured by strong and more or less equal instigating and inhibiting stimuli. Alcohol’s damage to inhibition allows instigatory pressures more influence on the response, making it more extreme (Steele and Southwick, 1985). For example, by blocking thoughts of negative consequences, alcohol makes it easier for our delinquent to throw the brick. In contrast, alcohol’s damage to inhibition should have little effect on response extremeness under weak inhibitory conflict. Alcohol use and homicides are well known to police and the judicial systems. Based on several studies of police and court records, the proportion of murderers who had been drinking before the crime range from 36 percent in Baltimore to 70 percent in Sweden (Ray and Ksir, 1999). Homicides are more likely to occur in situations in which drinking also occurs, but that also leaves the question as whether alcohol plays a causal role in homicides.
Treatment and social effects have been associated with alcohol from the beginning of time. Those clients who have jobs, stable family relationships, minimal psychopathology, no history of past treatment failures and minimal involvement with other drugs tend to do better than those with no jobs, no meaningful relationships, and so on. Although many alcoholics relapse after treatment, not all do, and treatment programs are statistically effective. Alcohol use and alcohol-related problems vary widely among different cultures and in different regions of the United States. Alcohol use is associated with thousands of traffic fatalities and has been correlated with homicide, assault, family violence, and suicide.
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