tag:theconversation.com,2011:/africa/topics/alcohol-addiction-22751/articlesAlcohol addiction – The Conversation2023-04-27T20:17:20Ztag:theconversation.com,2011:article/2041132023-04-27T20:17:20Z2023-04-27T20:17:20ZStudy reveals at least 11% of child maltreatment in NZ could be due to heavy drinking by caregivers<figure><img src="https://images.theconversation.com/files/522902/original/file-20230426-14-isrm2t.jpg?ixlib=rb-1.1.0&rect=160%2C103%2C3673%2C2052&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>More than one in ten children who are maltreated suffer because of the second-hand effects of alcohol, according to our recently published <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.16111">research</a>. </p>
<p>This is the first national cohort study in Aotearoa New Zealand focused on child maltreatment among children under 18 and alcohol use by adults caring for them. We estimate at least 11% of maltreatment could be due to hazardous or severe drinking among carers. </p>
<p>This is also the first study globally to examine all five domains of child maltreatment – physical abuse, neglect or abandonment, emotional or psychological abuse, sexual abuse and exposure to family violence – using data from child protection, hospitals and police linked to hazardous or severe alcohol consumption among parents. </p>
<p>Our findings show children exposed to this level of drinking among their caregivers have a 65% increased risk of maltreatment. But current alcohol policy does not reflect this. We argue it could play an important role in the prevention of harm to children. </p>
<h2>Alcohol and the risk of child maltreatment</h2>
<p>Carers who drink may be less vigilant, or cause conflict or violence. It is important to reduce this harm, given children are largely unable to remove themselves from the harmful environment. </p>
<p>We analysed data from 58,359 children aged 0–17 and their parents, from 2000 to 2017. Parents with hazardous or severe alcohol use were identified from hospitalisations or their use of mental health and addiction services, including community services.</p>
<p>Across all five domains of child maltreatment, 14% of children experienced at least one maltreatment event. This percentage was as high as 34% for emotional abuse. The next most common types were neglect and exposure to family violence in the household, both around 20%. </p>
<p>Hazardous or severe alcohol consumption among parents increased the risk of child maltreatment by 65%. </p>
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Read more:
<a href="https://theconversation.com/major-study-reveals-two-thirds-of-people-who-suffer-childhood-maltreatment-suffer-more-than-one-kind-202033">Major study reveals two-thirds of people who suffer childhood maltreatment suffer more than one kind</a>
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<h2>The burden of alcohol on child maltreatment</h2>
<p>We also analysed data from one year – 2017. We found between 11.4% and 14.6% of child maltreatment could be due to hazardous or severe consumption among parents. This impact of alcohol on maltreatment is similar to traffic crash deaths caused by others drinking (13%), highlighting the size of the problem. </p>
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<img alt="A drunk adult with a child holding a teddy." src="https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Children born into a family with existing problems, including heavy drinking, face a higher risk of maltreatment.</span>
<span class="attribution"><span class="source">Shutterstock/M-Production</span></span>
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<p>Hazardous alcohol exposure is involved in child maltreatment as part of a cluster of precipitating factors. This often reflects other types of adversities families experience. </p>
<p>In our study, the risk of child maltreatment was greater for children born into a family with already existing adversities, such as heavy use of other drugs, mental health issues or the mother’s age at childbirth. </p>
<p>If a family had a history of hazardous drinking, this accrued more risk for maltreatment than if the family developed alcohol problems as the child was growing up. Children from families with low education status had almost five times the risk of maltreatment, relative to families with high education status. </p>
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Read more:
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<p>We argue alcohol policy has a place in preventing child maltreatment related to alcohol. It is critical children receive more attention in the alcohol policy debate. </p>
<p>We know from <a href="https://global.oup.com/academic/product/Alcohol-no-ordinary-commodity-9780192844484">previous research</a> that increasing tax on alcohol, banning or reducing alcohol marketing and reducing the availability of alcohol will work to reduce heavy drinking among adults. This can, by default, protect children from the second-hand effects of alcohol. </p>
<p>These policies are cost-effective in reducing harm from alcohol and do not further burden child protection services. </p>
<h2>Lack of health regulations for alcohol</h2>
<p>There are challenges implementing effective alcohol policy. We still don’t have any internationally binding health regulations in place for alcohol. Alcohol remains the sole major addictive substance without such oversight. </p>
<p>The structure and practices of the alcohol industry, as with other industries producing and marketing unhealthy products, also play a crucial role in this challenge. </p>
<p>The primary source of contention between the alcohol industry and the public health community stems from the industry’s reliance on heavy consumption for sales and profits. This conflict of interest is a powerful motivator for industry interference in both <a href="https://global.oup.com/academic/product/Alcohol-no-ordinary-commodity-9780192844484">effective policy development and implementation</a>.</p>
<p>Nevertheless, children have rights to be protected from maltreatment (Article 19 of the <a href="https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/monitoring/uncroc/">UN Convention on the Rights of the Child</a>). Good public policy can reduce some of the burden of alcohol on child maltreatment, and also lessen prenatal exposure to alcohol and fetal alcohol spectrum disorder.</p><img src="https://counter.theconversation.com/content/204113/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taisia Huckle receives funding from The Health Research Council of New Zealand. </span></em></p><p class="fine-print"><em><span>Jose S. Romeo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Heavy use of alcohol by caregivers places children at increased risk of serious harm. This burden of alcohol-related maltreatment is similar to traffic deaths caused by others drinking.Taisia Huckle, Associate Professor in alcohol policy, Massey UniversityJose S. Romeo, Senior Research Officer and Statistician, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1841382022-08-19T02:39:01Z2022-08-19T02:39:01ZFrom tough love to interventions, what works when a loved one is struggling with addiction?<figure><img src="https://images.theconversation.com/files/480017/original/file-20220819-11-7h2x9m.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3822%2C2542&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Mishal ibrahim/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>There’s some pretty bad advice out there for families impacted by alcohol and other drug use. Some of it not only doesn’t work but could actually make things worse.</p>
<p>Most people who use alcohol or other drugs <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">never develop a problem</a> with it, and most people who develop problems <a href="https://www.racgp.org.au/afp/2012/august/the-recovery-paradigm">recover</a>. If you discover someone in your family is using drugs, don’t panic or jump to conclusions. Getting angry or upset may mean they just hide their drug use.</p>
<p>So what can you do and what should you avoid if you discover a family member has an alcohol or other drug problem?</p>
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Read more:
<a href="https://theconversation.com/does-alcoholics-anonymous-actually-work-179665">Does Alcoholics Anonymous actually work?</a>
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<h2>‘Tough love’</h2>
<p>“Tough love” is treating someone harshly with the intention of reducing unwanted behaviour. For example, refusing to pick them up from a party if they are drunk, locking them out of the house if they don’t go to rehab, or refusing money for food if they are still using.</p>
<p>The problem is tough love doesn’t work for most people and, worse, it can cause more harm than good.</p>
<p>Sometimes it’s a well-intentioned attempt to set boundaries or protect against perceived “manipulation”. But it is often used out of frustration, anger or desperation, or driven by stigma about alcohol or drug use.</p>
<p>The problem is it is humiliating and demeaning, and can lead to feelings of guilt and shame. It can increase stress and sends the message the family’s love is conditional, which can result in more drug use, not less.</p>
<p>It is sometimes a misguided strategy to help someone to hit “rock bottom” so recovery can begin. But the idea someone needs to hit rock bottom before they will change <a href="https://theconversation.com/alcohol-problems-arent-for-life-and-aa-isnt-the-only-option-8-things-film-and-tv-get-wrong-about-drug-and-alcohol-treatment-180946">is a myth</a>.</p>
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<a href="https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Holding hands" src="https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/480019/original/file-20220819-18-mgps0e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">It’s not true people must ‘hit rock bottom’ in order to change.</span>
<span class="attribution"><span class="source">Priscilla du preez/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>We know from behavioural psychology that punishment and harsh treatment <a href="https://www.psychologytoday.com/us/blog/feeling-our-way/201401/punishment-doesnt-work">do not lead to long-term change</a>. Motivation to change comes when the benefits of giving up outweigh the benefits of using alcohol or other drugs.</p>
<p>A great piece of advice comes from one of our colleagues who is a carer of someone with a drug problem and also provides support for other families: do what you would do if drugs were not involved. If your child was struggling with another health issue, like a depression or anxiety, would you withhold money, lock them out of the house or refuse to speak to them if they didn’t want to seek help?</p>
<h2>‘Enabling’</h2>
<p>Families are sometimes accused of “enabling” drug use if they don’t use the tough love approach. Enabling is behaviour that is seen to protect someone from the consequences of their alcohol and other drug use.</p>
<p>The problem is it’s impossible to know what is helpful and what is enabling until the outcome is known.</p>
<p>Families may draw criticism if they take action that is helpful for them, but that outsiders see as enabling. You might remember the criticism levelled at the <a href="https://www.perthnow.com.au/news/wa/ben-cousins-father-bryan-feared-his-sons-life-would-be-lost-to-drugs-ng-1392de75b91e84ab68b8e340073cfa08">father of footballer</a> Ben Cousins when he revealed that he went with his son to buy drugs because he was so worried he would die.</p>
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Read more:
<a href="https://theconversation.com/alcohol-problems-arent-for-life-and-aa-isnt-the-only-option-8-things-film-and-tv-get-wrong-about-drug-and-alcohol-treatment-180946">Alcohol problems aren't for life, and AA isn't the only option. 8 things film and TV get wrong about drug and alcohol treatment</a>
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<p>When families are criticised for their attempts to help, it <a href="https://www.tandfonline.com/doi/abs/10.3109/16066359809026059">increases stress</a> in the family and can make the situation worse. </p>
<p>Enabling is merely a cliche that doesn’t help families work out what is helpful and unhelpful for them.</p>
<h2>Staging an ‘intervention’</h2>
<p>The “intervention” is a familiar scene in movies and on TV: concerned family and friends ambush their family member to get them to change.</p>
<p>There is some <a href="https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/johnson-intervention">therapeutic basis</a> to this idea. It was originally designed as a caring conversation within the family, coached by a professional facilitator.</p>
<p>There is some evidence that it increases the likelihood of someone <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001665">going to treatment</a>, but reduces the likelihood they will stay there and increases likelihood of relapse.</p>
<p>When families stage their own intervention, the likely outcome is shame and embarrassment, and relationships can be damaged.</p>
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Read more:
<a href="https://theconversation.com/is-there-really-such-a-thing-as-an-addictive-personality-184137">Is there really such a thing as an 'addictive personality'?</a>
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<h2>Think about desired outcomes</h2>
<p>Families tend to intervene for two main reasons: to help the person using alcohol or other drugs to change their behaviour, or to improve wellbeing for the broader family.</p>
<p>Working out which of these is the priority can help the family get on the same page about the best approach.</p>
<p>It can be helpful to think about harm reduction. All or nothing goals, like complete abstinence, may not be achievable in the short term. So focusing on reducing behaviours that are harmful to the individual or the family might be more feasible. What can the family live with, even if it is not a perfect solution?</p>
<h2>Agree on acceptable boundaries</h2>
<p>When family members disagree about the best approach it can cause additional conflict and stress in the family. Setting realistic boundaries everyone agrees on and that are easy to maintain means they are more likely to be adhered to.</p>
<p>A good start is to think about boundaries that focus on positive action (like providing food) rather than only thinking about boundaries that focus on negative actions (refusing to provide money) or that only come into play when something goes wrong.</p>
<p>Boundaries that aim to reduce the family’s stress are also helpful, no matter how small. For example, putting the phone on “do not disturb” after a certain time so they can get some sleep.</p>
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<span class="caption">When deciding how to intervene in a loved one’s dependence issues, think about the desired outcome.</span>
<span class="attribution"><span class="source">Priscilla du preez/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Improving communication</h2>
<p>Families with alcohol or other drug problems do better when general communication in the family improves. </p>
<p>Focusing on <a href="https://www.jstor.org/stable/pdf/40005342.pdf?refreqid=excelsior%3A721ef9819d0ac7e3cd96755a41459fe7&ab_segments=&origin=&acceptTC=1">reducing conflict and improving communication</a> has benefits for both the family and the person using alcohol or other drugs.</p>
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Read more:
<a href="https://theconversation.com/viewpoints-is-addiction-a-disease-63113">Viewpoints: is addiction a disease?</a>
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<h2>Look after yourself</h2>
<p>Discovering drug use in the family can be a confusing and upsetting time. It may also come with additional unexpected worries, like care of grandchildren. As a result, families can experience poorer physical and mental health. </p>
<p>Family members need to look after themselves to be in a good position to provide support for the person using alcohol or other drugs and the rest of the family. It’s important to get enough sleep, eat well, and exercise regularly.</p>
<p>Consider the supports the whole family might need. Being around supportive family and friends can be helpful. Support groups provide help from others going through a similar situation. Families might also need professional support from a family therapist to figure out what is and is not working in their current approach and what they might do differently.</p>
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<p><em>If you are worried about your own or someone else’s alcohol or other drug use, contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice. Family support is available from a number of organisations including <a href="https://apod.org.au">APOD Family Support</a>, <a href="https://www.fds.org.au">Family Drug Support</a> and <a href="https://www.sharc.org.au/sharc-programs/family-drug-gambling-help/">Family Drug Help</a> in Australia, and <a href="https://fds.org.nz">Family Drug Support</a> in Aotearoa New Zealand</em></p><img src="https://counter.theconversation.com/content/184138/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Paula Ross works as as consultant in the alcohol and other drug sector and as a psychologist in private practice.
</span></em></p>There’s a lot of bad advice out there for families struggling with the alcohol or other drug dependence of a loved one. Here’s what works, and what doesn’t.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityPaula Ross, Sessional psychology lecturer, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1581212021-04-07T12:29:38Z2021-04-07T12:29:38ZMisunderstanding addiction breeds despair and suffering – and, for alleged Atlanta shooter, violence<figure><img src="https://images.theconversation.com/files/393262/original/file-20210402-15-hrcyx0.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C4031%2C2661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A makeshift memorial to the victims of the Atlanta spa shooting shows both grief and outrage.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/MassageParlorShooting/bd69e0bbb92d45cb83dc1f050b912276/photo">AP Photo/Candice Choi</a></span></figcaption></figure><p>When a man claiming to suffer from the disease of sex addiction found that “<a href="https://hopequestgroup.org/treatment-programs/trek/">comprehensive and fully integrated treatment</a>” at a Christian recovery center could not cure him, he decided to try another approach: <a href="https://www.gpb.org/news/2021/03/17/police-suspect-charged-in-massage-parlor-deaths-planned-kill-more">eliminating the women</a> he believed were a “temptation” aggravating his problem.</p>
<p>That’s the <a href="https://www.nytimes.com/2021/03/18/us/robert-aaron-long-atlanta-spa-shooting.html">best understanding so far</a> of what drove Robert Aaron Long to <a href="https://www.cbsnews.com/live-updates/atlanta-shootings-robert-long-murder-8-counts/">allegedly murder eight women</a>, including six of Asian descent, in Atlanta, Georgia on March 16, 2021.</p>
<p>To me as a <a href="https://people.clas.ufl.edu/ttravis/">cultural historian of addiction and recovery</a>, his story highlights the two most common ways Americans think about and deal with compulsive behaviors. We like to consider them the results of temptation or treat them as diseases. </p>
<p>Although these two approaches are often treated as opposites, both stem from the most prominent effort to fight compulsion in U.S. history: the grassroots movement to ban alcohol, which led to <a href="https://www.history.com/topics/roaring-twenties/prohibition">national Prohibition from 1920 to 1933</a>.</p>
<p>The disease concept of addiction arose in the aftermath of Prohibition, in part as a way to explain why the national alcohol ban didn’t actually get rid of alcohol or its abuse. Far from being a biomedical truth, it is <a href="https://psychcongress.com/article/disease-concept-addiction-revisited">just a way of framing compulsive drinking</a>. The story of the alleged Atlanta shooter shows how well the disease concept succeeded as a public relations tool – and also how limited it is as a means of explaining human behavior.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woodcut illustration of a group of women outside a bar, where two men lean against the doorway" src="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women were prominent leaders and members of the temperance movement, and used various tactics, including singing hymns outside bars.</span>
<span class="attribution"><a class="source" href="https://picryl.com/media/the-ohio-whiskey-war-the-ladies-of-logan-singing-hymns-in-front-of-barrooms">Frank Leslie's illustrated newspaper, 1874, via Picryl</a></span>
</figcaption>
</figure>
<h2>A brief history of Prohibition</h2>
<p>Beginning in the early 19th century, a broad cross-section of Americans – <a href="https://prohibition.themobmuseum.org/the-history/the-road-to-prohibition/the-temperance-movement">often led by women</a> – looked at poverty, domestic violence, labor unrest and other social problems and connected them with drinking alcohol. </p>
<p>So-called “temperance” activists worked for years to limit alcohol consumption in the U.S. by promoting moderation and voluntary abstinence. “Prohibitionists,” by contrast, pushed to restrict the times and places liquor could be sold. Interrupted only briefly by the Civil War, both groups used moral suasion and political lobbying to <a href="https://www.ncbi.nlm.nih.gov/books/NBK216414/">shift the culture and the laws around alcohol</a>.</p>
<p>Their tactics worked. Fraternal organizations promoted abstinence as a sound business principle; saloons were closed by prayer vigils; and many states enacted local provisions that allowed counties and municipalities to vote in bans or restrictions on liquor sales. </p>
<p>But by the early 20th century, “the liquor traffic” – the network of manufacturers and distributors, and the politicians who benefited from their kickbacks – seemed unstoppable. Around the nation, even in “dry” counties, “<a href="https://www.gotrum.com/the-rum-university/rum-in-history/american-Rum-27-Demon-Rum/">demon rum</a>” flowed freely. </p>
<p>When men – problem drinkers were then, as now, <a href="https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm">disproportionately male</a> – fell victim to its seductions, they abandoned their roles at home and in the workplace. This bad behavior threatened the social order.</p>
<p>In 1913, the <a href="http://www.westervillelibrary.org/AntiSaloon">Anti-Saloon League</a>, which had previously championed the local option as a way to gradually reform the nation, had had enough. It was clear they could not shame or regulate the liquor traffic into limiting its hold on men’s lives. That left only one alternative, which had first been proposed two decades before by Archbishop John Ireland of St. Paul, Minnesota: “<a href="https://www.newspapers.com/clip/4540146/evening-gazette/">there is nothing now to be done but to wipe it out completely</a>.”</p>
<p>It took just six years for Congress to pass the 18th Amendment and for the states to ratify it, banning the production, transport and sale of intoxicating liquors. In January 1920, America was officially cleansed of “<a href="https://www.davidanthembookseller.com/pages/books/00926/hon-richmond-p-hobson/the-great-destroyer-alcohol-devours-the-products-of-civilization">the great destroyer</a>.” </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Men pour bottles into a storm drain" src="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During Prohibition, alcohol was illegal but common, and when it was found by authorities, it was destroyed.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2001706109/">Library of Congress</a></span>
</figcaption>
</figure>
<h2>A new understanding?</h2>
<p>Even most Prohibition advocates quickly realized that alcohol could not really be wiped out of American life. </p>
<p>The nation also learned that the cost of trying was itself sky high. Illegal and bootleg spirits were more expensive – and often toxic. Instead of turning men into hardworking teetotalers, <a href="https://www.history.com/news/prohibition-organized-crime-al-capone">Prohibition encouraged new kinds of social deviance</a>, such as organized crime.</p>
<p>When Prohibition was repealed in 1933, the liquor industry and its political patrons established and funded what historians call the “<a href="https://academic.oup.com/alcalc/article/35/1/10/142396#1129078">modern alcoholism movement</a>.” This was a group of activist scientists, public relations experts and reformed drinkers looking to promote a <a href="http://www.roizen.com/ron/postrepeal.htm">responsible solutions to the problems of alcohol</a> – while also keeping the booze flowing. </p>
<p>This movement acknowledged that some people were problem drinkers, but argued that neither the industry nor alcohol itself was to blame. Instead, during the 1940s and 1950s, movement members recast drunkenness as a personal and, significantly, a medical issue. They called it “<a href="https://doi.org/10.1111/add.14400">the disease of alcoholism</a>.”</p>
<p>This new disease was <a href="https://silkworth.net/alcoholics-anonymous/alcoholism-as-a-manifestation-of-allergy/">like an allergy</a>. It was mysterious; it was not clear why some people developed a compulsion to drink. More important, it was rare: Most people could drink socially without ill effect. Those who could not deserved help, not scorn. </p>
<p>This medicalized approach claimed that with understanding and fellowship – such as that provided by Alcoholics Anonymous – disease sufferers could remain cheerfully abstinent. The scientific community would work to <a href="https://www.theatlantic.com/health/archive/2012/02/mrs-marty-mann-and-the-early-medicalization-of-alcoholism/252286/">unlock the secrets of the disease of alcoholism</a>, just as it had with tuberculosis and polio. In the meantime, the undiseased could enjoy the three-martini lunches and suburban cocktail parties that symbolized the postwar American good life.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sits with a drink glass in one hand and the other hand over his face" src="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not everyone was able to drink without problems.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/alcohol-addiction-royalty-free-image/962083312">D-Keine/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Diseases spread</h2>
<p>Billions of research dollars later, there is <a href="https://dx.doi.org/10.1111%2Facer.14246">no clear consensus</a> that the compulsive use of alcohol – or any other drug – is the effect or the cause of any <a href="https://doi.org/10.1901/jeab.2011.95-263">physiological or genetic abnormality, or whether it is just bad decision-making</a>.</p>
<p>But reframing problem drinking as a disease had helped everyone move on from the disastrous experiment of Prohibition. Alcoholics got sympathy, research scientists won government grants and the liquor industry made plenty of money marketing alcohol to Americans without the disease.</p>
<p>The disease concept was so useful to so many people that in the late 20th century, it migrated out of the alcohol and drug world. Overindulgence in anything – including work, exercise and sex – became known as “<a href="https://dx.doi.org/10.3109%2F00952990.2010.491884">behavioral addiction</a>.” </p>
<p>Near-total lack of evidence that <a href="https://doi.org/10.1016/j.euroneuro.2015.08.013">such compulsive behavior has physiological roots</a> has not stopped Americans from seeing it as disease. </p>
<p>The alleged Atlanta shooter fell into this trap. He was a man whose appetite for sex was <a href="https://www.nytimes.com/2021/03/18/us/robert-aaron-long-atlanta-spa-shooting.html">larger than he thought it should be</a>. His Christian community called that a sin. When he couldn’t pray his desires away, he appears to have borrowed a concept from the secular world and <a href="https://theconversation.com/sex-addiction-isnt-a-justification-for-killing-or-really-an-addiction-it-reflects-a-persons-own-moral-misgivings-about-sex-157543">decided to treat it as a disease</a>. </p>
<p>When that modern approach didn’t work, he took a step back in time, reverting to the old Prohibitionist tactic of eliminating what he believed to be the source of his problems. </p>
<p>The Anti-Saloon League used pressure tactics to change legislation. Robert Aaron Long got a gun and ended women’s lives.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/158121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trysh Travis has received funding from the National Endowment for the Humanities for research on the history of Alcoholics Anonymous and its offshoots.</span></em></p>The story of the alleged Atlanta shooter highlights the two most common ways Americans think about compulsive behaviors – considering them the results of temptation and treating them as diseases.Trysh Travis, Associate Professor of Women's Studies, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1484312020-11-04T23:23:47Z2020-11-04T23:23:47ZHow a simple brain training program could help you stay away from alcohol<figure><img src="https://images.theconversation.com/files/367152/original/file-20201103-19-dmmq9a.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129606/">one in five</a> Australians will develop an alcohol use disorder, such as dependence, during their lifetime.</p>
<p>Reports suggest <a href="https://www.theguardian.com/australia-news/2020/aug/09/one-in-12-australians-drinking-alcohol-every-day-during-coronavirus-outbreak-survey-finds">some people</a> have been drinking more during the COVID pandemic, potentially putting themselves at greater risk of becoming dependent.</p>
<p>While some people will seek treatment for problem drinking, more than half of patients who go through inpatient withdrawal treatment, or detox, relapse <a href="https://pubmed.ncbi.nlm.nih.gov/27488392/">within two weeks</a> of discharge.</p>
<p>My team and I have found a new form of brain training can have <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772631">positive results</a> for people going through detox.</p>
<h2>The conscious brain versus the subconscious brain</h2>
<p>When we want to change a behaviour like alcohol use, we might use our conscious brain to think about the benefits quitting will bring, such as improved sleep and being sharper in the mornings. We might reflect on the downsides if we continue to drink, like the unwanted calories, the cost, and the risk of harm to our physical or mental health. </p>
<p>But despite these conscious thought processes, we still may find ourselves reaching into the fridge for a beer, or pouring a glass of wine, as though on “autopilot”. This is because our subconscious brain is in action, driving the desire to drink alcohol. </p>
<p>Over time, when we drink frequently, alcohol cues such as places, sights, smells and social situations that remind us of drinking subconsciously capture our attention and drive impulses to drink. This tendency is called <a href="https://journals.sagepub.com/doi/abs/10.1177/2167702612466547">cognitive bias</a>.</p>
<p>In Australia, we’re continually bombarded with alcohol cues, whether from bottle shops, pubs, or advertising. Recent research found we’re targeted by an alcohol advertisement as often as <a href="https://fare.org.au/wp-content/uploads/2020-05-08-CCWA-FARE-An-alcohol-ad-every-35-seconds-A-snapshot-final.pdf">every 35 seconds</a> on social media. </p>
<p>But by reducing cognitive bias towards alcohol cues, we can increase the likelihood our behaviour will be driven by our conscious rather than our subconscious brain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-brain-training-work-that-depends-on-your-purpose-36947">Does brain training work? That depends on your purpose</a>
</strong>
</em>
</p>
<hr>
<h2>Training our subconscious brain</h2>
<p>A relatively new form of brain training that directly targets cognitive biases <a href="https://pubmed.ncbi.nlm.nih.gov/31998146/">is showing promising results</a> in treating alcohol use disorders. </p>
<p>Cognitive bias modification is a computerised brain-training program that trains people to repeatedly “avoid” alcohol-related cues, and to “approach” neutral or positive ones.</p>
<p>Using a joystick, the user repeatedly pushes away pictures of alcohol, and pulls healthier alternatives, such as bottled water, towards them. By practising this over and over again, the avoidance of alcohol cues becomes automatic, thereby disabling the autopilot response to these cues.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/altvRX0OooY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>European researchers <a href="https://psycnet.apa.org/record/2018-61344-005">have shown</a> that when added to a residential rehabilitation program, cognitive bias modification <a href="https://journals.sagepub.com/doi/10.1177/0956797611400615">reduced rates</a> of relapse to drinking <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00871/full#B27">by 8-13%</a> 12 months after treatment.</p>
<p>Cognitive bias modification is delivered in several residential rehabilitation facilities in Germany, where <a href="https://pubmed.ncbi.nlm.nih.gov/28178695/">it’s recommended</a> in treatment guidelines.</p>
<p>It’s not yet available in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-are-drinking-more-during-the-pandemic-and-its-probably-got-a-lot-to-do-with-their-mental-health-139295">Women are drinking more during the pandemic, and it's probably got a lot to do with their mental health</a>
</strong>
</em>
</p>
<hr>
<h2>What we did</h2>
<p>Our study, published today in <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772631">JAMA Psychiatry</a>, was a randomised control trial with 300 patients from four alcohol withdrawal units in Melbourne.</p>
<p>Roughly half were allocated to the intervention group, to receive one 15-minute session of cognitive bias modification a day for four consecutive days during their week-long detox treatment. The other half were allocated to a control group and received a pretend version of the training.</p>
<p>Before the treatment, participants generally had an automatic tendency to approach alcohol cues with the joystick. But we found the cognitive bias modification generally shifted this to an automatic tendency to avoid them.</p>
<p>Most importantly, cognitive bias modification increased rates of abstinence by 17% at two weeks after discharge. Some 63.8% of the brain-training group reported no alcohol use, compared with 46.8% of the control group. </p>
<figure class="align-center ">
<img alt="A woman looks at a bottle of wine in a store." src="https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/367153/original/file-20201103-23-1ma6uni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A bottle of wine for tonight? Often our subconscious brain will win the battle.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The main limitation of our study was that alcohol use after treatment was self-reported. The vast geographical catchment of the withdrawal units meant we had to do follow-up interviews over the phone, so we couldn’t use tools like breathalysers or blood tests to verify abstinence.</p>
<p>Nonetheless, we feel confident cognitive bias modification can optimise outcomes for patients receiving treatment for alcohol addiction. The training is simple, safe, easy to implement and cost-effective, and we believe it should be routinely offered as part of inpatient withdrawal treatment in Australia.</p>
<h2>Now we’re trialling an app version</h2>
<p>Inpatient treatment services are geared towards people with moderate to severe alcohol use disorders. But these people represent only a fraction of those who want to reduce or stop drinking. </p>
<p>Recognising this, we’ve developed a smartphone version of cognitive bias modification called SWiPE. It enables users to personalise their training by selecting the alcohol beverages or brands they wish to avoid. </p>
<p>At the same time, the app aims to strengthen motivation for quitting or reducing alcohol use by training users to repeatedly swipe towards meaningful, goal-related images they select from their photo libraries (for example, of family, friends, hobbies, travel, and so on). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-taking-a-break-from-alcohol-heres-how-to-cut-back-or-quit-130952">Thinking about taking a break from alcohol? Here's how to cut back or quit</a>
</strong>
</em>
</p>
<hr>
<p>We’re currently running a <a href="https://pubmed.ncbi.nlm.nih.gov/32795989/">trial</a> to test whether SWiPE effectively reduces alcohol consumption and craving. Early results, not yet peer-reviewed or published, are encouraging.</p>
<p>In today’s culture where we make instantaneous decisions with the swipe of a finger, if it proves to be effective, this app could be adapted to weaken the subconscious drivers of other unhealthy habits we wish to break, such as smoking and the overconsumption of unhealthy foods.</p><img src="https://counter.theconversation.com/content/148431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Manning receives funding from the National Health and Medical Research Council, National Centre for Clinical Research on Emerging Drugs, VicHealth, Victorian Department of Health and Human Services and the Australian Rechabite Foundation. She is affiliated with Turning Point, Eastern Health and a board member of the Victorian Alcohol and Drug Association.
Victoria Manning would like to acknowledge the contribution of her co-authors.</span></em></p>If you’re struggling to cut back on the booze, your subconscious brain may be over-riding your conscious brain. A new form of brain training targets our subconscious tendencies towards alcohol.Victoria Manning, Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1442362020-08-11T13:23:13Z2020-08-11T13:23:13ZAlcohol addiction: could the brain’s immune system be the key to understanding and treating alcoholism?<figure><img src="https://images.theconversation.com/files/352256/original/file-20200811-19-1cqb7w7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even moderate alcohol consumption changes the brain's structure.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alcoholism-alcohol-addiction-people-concept-male-1130260130">Syda Productions/ Shutterstock</a></span></figcaption></figure><p>Alcohol abuse is a serious problem worldwide. In <a href="https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2020">England alone</a>, over 350,000 alcohol-related hospital admissions – and over 5,000 alcohol-related deaths – were reported in 2018. Long-term alcohol abuse can have many <a href="https://www.nhs.uk/conditions/alcohol-misuse/risks/">harmful effects</a> on our body. But one of the organs most affected by alcohol is the brain. Even moderate consumption changes <a href="https://www.bmj.com/content/357/bmj.j2353.full">brain structure</a> and leads to cognitive issues, such as declines in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875727/">memory and problem-solving</a>. </p>
<p>Alcohol use is habit forming and can eventually lead to alcoholism. And though there are many treatments available for alcoholism, research shows these interventions often fail – with <a href="https://emedicine.medscape.com/article/285913-followup">less than 20%</a> of patients remaining alcohol free after intervention. Like every addiction, alcoholism is a disease and not a choice, so finding the root cause of it will make treatment easier.</p>
<p>Although <a href="https://www.drinkaware.co.uk/facts/health-effects-of-alcohol/mental-health/alcohol-dependence#whatcausesalcoholdependence">genetics and the environment</a> you live in are known to play a role in developing alcoholism, these factors don’t tell us how dependence occurs. </p>
<p>However, past research has found hints that the brain’s immune system cells (known as microglia) may be involved in addiction, including to <a href="https://www.nature.com/articles/s41467-019-14173-3">cocaine</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0028390820302252">tobacco</a>). One study even found that <a href="https://academic.oup.com/alcalc/article/37/5/421/182524">alcohol exposure and withdrawal</a> in rats increased microglia numbers in the brain, before any other signs of alcohol-induced decline. </p>
<p>Another two recent studies have investigated brain changes seen in people and animals with alcohol dependence. Each of these studies found a common culprit: inflamed <a href="https://theconversation.com/microglia-the-brains-immune-cells-protect-against-diseases-but-they-can-also-cause-them-139232">microglia</a>.</p>
<p>Microglia are the brain’s resident immune system cells. Their main role is to guard and maintain balance in the brain. When microglia detect a threat, they respond by becoming inflamed and attacking. Normally, they return to normal after the threat is gone, but sometimes when inflammation becomes uncontrollable – such as with Alzeimer’s disease – it can lead to brain degeneration.</p>
<h2>Microglia and addiction</h2>
<p>One <a href="https://www.sciencedirect.com/science/article/abs/pii/S0006322320315985">recent study</a> used mice to study the effect of alcohol dependence on the brain. </p>
<p>In the brains of male mice that had alcohol dependency, research found there were more microglia cells in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562704/">medial prefrontal cortex</a>, a region associated with pain, decision making, and memory processes. Similar results have also previously been found in <a href="https://www.sciencedirect.com/science/article/abs/pii/S0014488607004220">humans</a>. </p>
<p>They then examined what effects microglia depletion had on alcohol dependent mice by looking at their alcohol seeking behaviour, and anxious behaviour during alcohol withdrawal. The researchers found both factors were lowered when the microglia cells were reduced in the brain.</p>
<p>They also saw gene changes with microglia depletion. Genes involved in inflammation and immune responses were expressed less after depletion. The expression of genes involved in alcohol consumption, and alcohol dependence also changed when microglia had decreased. They also found that microglia depletion weakens brain circuits involved in the development of dependence and relapse behaviour in rodents.</p>
<p>A <a href="https://advances.sciencemag.org/content/6/26/eaba0154">second study</a> looking at both rodent and human brains also showed microglia is involved in alcohol dependence. </p>
<p>The researchers of this study used brain imaging, microglia depletion, and studies of post mortem brains, to examine changes that occur in alcohol dependence. For the brain imaging part, they used a variation of <a href="https://www.nhs.uk/conditions/mri-scan/">MRI scans</a>, called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2041910/">DTI-MRI</a> in humans and rats, focusing on a measure called mean diffusivity. </p>
<figure class="align-center ">
<img alt="A microglia cell." src="https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352258/original/file-20200811-18-1facmxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microglia are involved in alcohol dependence.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/microglia-cell-plays-important-role-pathogenesis-1421648234">Juan Gaertner/ Shutterstock</a></span>
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<p>As DTI-MRI is based on the diffusion of water in tissues, mean diffusivity essentially shows the amount of diffusion of water molecules in tissues, with more dense and structurally-intact tissues having lower mean diffusivity. Mean diffusivity has previously been shown to change in the brain in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0041441">inflammatory and degenerative conditions</a> (including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487800/">Alzheimer’s Disease</a> and even <a href="https://www.karger.com/Article/Fulltext/442605">psychosis</a>). The researchers therefore chose to look at mean diffusivity as neuroinflammation is also <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/acer.12367">involved in alcoholism</a>. The researchers wanted to examine whether changes in mean diffusivity would be found between alcoholics and non-alcoholics, which hasn’t been done before. </p>
<p>Indeed their findings showed that mean diffusivity is overall higher in the brain of alcohol dependent rats and humans. They also found additional changes in how certain neurotransmitters – including dopamine, which is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120286/">involved in alcohol dependence</a> – move and are distributed in the brain.</p>
<p>The researchers went on to examine the microglia in the brains of rats with alcohol dependence, and rats with previous dependence who had abstained from alcohol for a week. They found a decreased amount of microglia in specific brain regions of dependent rats (including the hippocampus, which is involved in memory, and the nucleus accumbens, which is involved in the reward system). The microglia in the brains of alcohol dependent rats were also in their inflamed form. </p>
<p>Although this study showed a decrease in microglia numbers – whereas the previous study saw an increase – this might be because the researchers looked at different brain regions and used different research methods and animal models. However, both studies give hints towards how microglia functions during alcohol consumption and dependence, may differ in different brain regions.</p>
<p>The researchers also found that depleting microglia from the brain, or inducing microglia’s inflammatory response, led to similar results to each other, as both increased the mean diffusivity. Changes in microglia’s form when inflamed were also similar to the ones they observed in dependent rats. They concluded that the changes in the brain areas they studied could be explained by an inflammatory reaction of microglia caused by alcohol.</p>
<p>One limitation of both studies’ findings is that they used both only male rodents and male humans. However, both studies exhibit how alcoholism is a complex disease that produces clear changes in the brain. </p>
<p>Examining how exactly microglia is involved, and being able to interfere with their responses, could lead to better understanding and detection of addiction to alcohol, and give a good stepping stone for future targeted interventions.</p><img src="https://counter.theconversation.com/content/144236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eleftheria Kodosaki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The brain’s immune system cells (called microglia) have already been shown to be involved in addiction to other substances.Eleftheria Kodosaki, Academic associate in Biomedical Sciences, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1376982020-05-08T02:48:10Z2020-05-08T02:48:10ZAlcohol can make coronavirus worse – so why was it treated as essential in New Zealand’s lockdown?<figure><img src="https://images.theconversation.com/files/333258/original/file-20200506-49569-1wh0q1l.jpg?ixlib=rb-1.1.0&rect=103%2C230%2C5200%2C2751&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>New Zealand has won <a href="https://www.nytimes.com/2020/04/30/opinion/coronavirus-leadership.html">international praise</a> for its <a href="https://covidtracker.bsg.ox.ac.uk/">strict</a> lockdown conditions and public health response to COVID-19, but there’s one glaring blindspot. </p>
<p>Last month, the World Health Organisation released a new <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/437608/Alcohol-and-COVID-19-what-you-need-to-know.pdf?ua=1">factsheet on alcohol and COVID-19</a>, warning that heavy alcohol consumption increases the risk of respiratory failure, one of the most severe complications of COVID-19.</p>
<p>Yet alcohol was sold as an essential item, along with food, during New Zealand’s level 4 lockdown, even though <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12665">almost half of all alcohol in New Zealand</a> is drunk in heavy and binge drinking sessions.</p>
<p>While this isn’t a simple health issue to address – and <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12330612">lockdown might not</a> have been the time to do it – it is an issue we can’t ignore. Alcohol is a risk factor not just for COVID-19 but many other conditions, including cancer.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-its-tempting-to-drink-your-worries-away-but-there-are-healthier-ways-to-manage-stress-and-keep-your-drinking-in-check-134669">Coronavirus: it's tempting to drink your worries away but there are healthier ways to manage stress and keep your drinking in check</a>
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<h2>The World Health Organisation on alcohol and COVID-19</h2>
<p>The World Health Organisation’s comprehensive <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/437608/Alcohol-and-COVID-19-what-you-need-to-know.pdf?ua=1">factsheet</a> stresses that alcohol weakens the immune system and heavy drinking increases the risk of acute respiratory distress syndrome, which leads to widespread inflammation in the lungs.</p>
<p>This link between heavy alcohol consumption and respiratory disease is not well known, despite a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29288645">systematic review</a>, published in 2018, which concluded there is comprehensive evidence for it. </p>
<p>It is missing from the burgeoning research effort to quantify other COVID-19 risk factors <a href="http://www.tobaccoinduceddiseases.org/COVID-19-and-smoking-A-systematic-review-of-the-evidence,119324,0,2.html">such as smoking</a>. </p>
<p>This <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30008-5/fulltext">global health blindspot</a> is reminiscent of the lack of awareness of alcohol as a cause of cancer, even though the WHO’s <a href="https://www.iarc.fr/">International Agency for Research on Cancer</a> stated in 2011 that alcohol is a <a href="https://publications.iarc.fr/122">class one carcinogen</a> – meaning it’s a known cause of cancer.</p>
<p>Despite this, alcohol supply was an essential service during New Zealand’s lockdown. This raised concerns, but they focused largely on the increased risk of intimate partner violence and likely <a href="https://www.healthcoalition.org.nz/wp-content/uploads/2020/04/HCA-open-letter.pdf">impact on families</a> in stressful lockdown situations. Potential effects on drinkers, such as an increased risk of dependence, were also discussed – but not the health risks from heavy drinking specifically associated with COVID-19.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-coronavirus-is-putting-our-relationship-with-alcohol-to-the-test-135460">How the coronavirus is putting our relationship with alcohol to the test</a>
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<h2>Access to alcohol during lockdown</h2>
<p>So why did the New Zealand government decide access to alcohol was essential during the lockdown? Given wine and beer are sold in supermarkets in New Zealand and supermarkets were selected to operate as essential businesses, it was unlikely wine and beer sales would be restricted – although some countries such as <a href="https://www.ctvnews.ca/health/coronavirus/thailand-bans-sale-of-alcoholic-drinks-in-war-on-covid-19-1.4891515">Thailand have banned alcohol sales</a>. </p>
<p>The question for New Zealand then became one of access to spirits and ready-to-drink premixed alcohol beverages. These have never been sold in supermarkets, but the decision was complicated by the fact there are some geographical areas, known as Licensing Trusts, where alcohol is not sold in supermarkets but only through local bottle shops. </p>
<p>One option would have been to allow only beer and wine sales from Licencing Trust outlets to create a level playing field with supermarkets elsewhere, but the government chose not to do this. As a consequence, people travelled outside of their area to buy spirits.</p>
<p>The government then allowed online sales of alcohol, initially restricted to existing online-only alcohol businesses but then extended to other premises, provided they consulted with their local council authorities. This increased potential availability from about 250 online-only businesses to around 1,000 physical bottle shops. And social media were used to promote online sales.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-we-keep-family-violence-perpetrators-in-view-during-the-covid-19-lockdown-135942">How do we keep family violence perpetrators ‘in view’ during the COVID-19 lockdown?</a>
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<h2>Alcohol as an ordinary commodity</h2>
<p>One element of the government’s decision to treat alcohol supply as an essential service will have been concern for business interests. A second may have been concern for heavy drinkers and the possibility of withdrawal symptoms if they could not access alcohol. The latter is questionable given ongoing beer and wine sales and the availability of addiction support services online. </p>
<p>A third element was undoubtedly a framing of alcohol as an “ordinary commodity”. But this is not how alcohol is consumed in New Zealand. Almost half is consumed as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12665">heavy and binge drinking</a> (defined as eight or more cans of premixed alcoholic drinks for men, and six or more cans for women). </p>
<p>For heavy drinkers, premixed drinks are a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12495">source of cheap alcohol</a>, and there is every reason to expect much of the spirits and premixed drinks ordered online during this current period of restricted access will be consumed in this way.</p>
<p>Heavy drinking contributes to several diseases that likely exacerbate the effects of COVID-19. The government’s decisions projected the idea of alcohol supply as an essential business, and it appeared to favour commercial interests over public health. </p>
<p>This approach has influenced New Zealand’s policy response for many decades, before the present government took office. Evidence-based recommendations made by the <a href="https://www.lawcom.govt.nz/sites/default/files/projectAvailableFormats/NZLC%20R114.pdf">New Zealand Law Commission</a> in 2010 and supported by <a href="https://www.mentalhealth.inquiry.govt.nz/inquiry-report/">subsequent inquiries</a> have not been implemented, despite more than 800 deaths that can be attributed to alcohol and NZ$7.8 billion in costs each year. </p>
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<strong>
Read more:
<a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">Interactive body map: what really gives you cancer?</a>
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<p>Going forward into a post-pandemic world, we should learn from the government’s science-based response to the threat of coronavirus to inform our response to persistent and ongoing harms from the marketing and over-supply of cheap alcohol.</p><img src="https://counter.theconversation.com/content/137698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally Casswell receives funding from the Health Research Council of New Zealand. She s affiliated with the Global Alcohol Policy Alliance and is director of a WHO Collaborating Centre.
</span></em></p>Despite World Health Organisation warnings that heavy alcohol consumption increases the risk of severe complications of COVID-19, alcohol was sold as an essential item during New Zealand’s lockdown.Sally Casswell, Professor of public health policy, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1273132019-11-21T19:42:19Z2019-11-21T19:42:19ZBrain activity predicts which mice will become compulsive drinkers<figure><img src="https://images.theconversation.com/files/302787/original/file-20191120-515-1yve1an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Can the activity in brain circuits predict who is vulnerable to excessive drinking?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/brain-glass-alcohol-drink-alcoholism-concept-600714989">AlexLMX/Shutterstock.com</a></span></figcaption></figure><p>Some individuals consume alcohol their entire adult life without developing an alcohol use disorder. Others, however, quickly transition to compulsive and problematic drinking. Can we determine what makes some people vulnerable to addiction?</p>
<p>Alcohol drinking is the <a href="https://doi.org/10.1001/jama.291.10.1238">third leading cause of preventable death</a> in the United States, and is responsible for millions of deaths per year worldwide. If the reasons why some people are susceptible to alcohol use disorder were known, it might be possible to more effectively treat this devastating disease, or even intervene before serious problems emerge. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=612&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=612&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=612&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=769&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=769&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=769&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">How much drinking is excessive?</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/alcohol/onlinemedia/infographics/excessive-alcohol-use.html">CDC</a></span>
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<p>I have <a href="https://scholar.google.com/citations?hl=en&user=JJ14QfUAAAAJ">spent my career</a> as a neuroscientist and pharmacologist trying to understand how drugs and alcohol act on the brain, and what makes a brain more or less susceptible to substance use disorders. <a href="https://sicilianolab.com">My laboratory</a> at the <a href="https://medschool.vanderbilt.edu/vcar/">Vanderbilt Center for Addiction Research</a> develops approaches for studying addictive behaviors in rats and mice. Using <a href="https://sicilianolab.com/research/techniques">electrochemical and optical approaches</a> to measure brain activity, our goal is to determine how patterns of activity in brain cells give rise to these behaviors – and how we may use this information to treat or prevent substance use disorders. </p>
<p>In a report published in the <a href="https://science.sciencemag.org/lookup/doi/10.1126/science.aay1186">Nov. 22 issue of the journal Science</a>, <a href="https://www.salk.edu/scientist/kay-tye/">Kay Tye of the Salk Institute</a> and I set out to understand how binge drinking alters the brain and how this can lead to compulsive behaviors in some drinkers. </p>
<h2>Testing for compulsive drinking</h2>
<p>To study this, we designed an experiment in which mice were scored for their propensity to drink alcohol. We measured compulsive drinking by determining how much they drank when we mixed the alcohol with a bitter tasting substance that mice normally avoid. </p>
<p>After assessing levels of compulsive drinking in each mouse, mice were allowed to binge drink for several weeks, during which they consumed large amounts of alcohol daily. Then compulsive drinking was measured again. This allowed for tracking the development of excessive and compulsive drinking behaviors across time and experience.</p>
<p>Initially, all of the mice in our experiment had very similar drinking behaviors. However, even though the mice were all genetically identical, after binge drinking there was wide variability that enabled us to divide the mice into three distinct groups. After binge drinking, some mice drank large amounts, and continued to drink even when the alcohol was made bitter. We classified these mice as “compulsive drinkers.” The next group was designated as “high drinkers.” These mice drank large amounts of alcohol, but quickly stopped when the alcohol was bitter. “Low drinkers” had the lowest levels of alcohol consumption under both conditions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=233&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=233&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=233&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=293&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=293&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=293&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">What is considered a single serving of a drink?</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/alcohol/onlinemedia/infographics/excessive-alcohol-use.html">CDC</a></span>
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</figure>
<h2>Brain circuit activity predicts compulsive drinking</h2>
<p>We wanted to understand how a group of neurons connecting two brain regions, called the medial prefrontal cortex and the dorsal periaqueductal gray area, contribute to compulsive drinking behaviors. The prefrontal cortex is involved in decision making; the dorsal periaqueductal gray area processes painful and aversive events.</p>
<p>We reasoned that the communication between these two regions might be critical in determining how subjects make decisions when negative outcomes (like bitter taste) are paired with drinking. Using an approach called <a href="https://static1.squarespace.com/static/5d27c543eea0d500016ccf1d/t/5d6ebf3ea2517200013d331c/1567539009396/leveraging-calcium-imaging-to-illuminate-circuit-dysfunction-in-addiction.pdf">calcium imaging</a>, we were able to observe the activity of these neurons while the mice drank.</p>
<p>The initial hypothesis was that binge drinking would disrupt the ability of this neural circuit to respond appropriately to events in the environment. However, we were surprised to discover early on in these experiments that each of the three groups of mice had very distinct brain activity patterns the first time the mice drank alcohol, even though the behavior of these three groups of mice was the same at this point in time. </p>
<p>Mice that progressed to become compulsive showed less brain activity in this pathway during early exposure to alcohol. Those that showed little interest in alcohol and were easily put off by the bitter taste showed increased activity in these same neurons during drinking.</p>
<p>By examining the neural response to alcohol prior to the binge drinking, we could predict which mice would eventually become compulsive drinkers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cells in the medial prefrontal cortex are labeled in blue. The medial prefrontal cortex neurons that connect and send messages to the dorsal periaqueductal gray area are labeled in green.</span>
<span class="attribution"><span class="source">Cody Siciliano</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Altering drinking behaviors</h2>
<p>In a separate experiment, we used a technique called optogenetics, where light-sensitive proteins are introduced to the mouse’s brain cells so that their activity can be controlled with pulses of light, to manipulate the activity of this population of neurons.</p>
<p>By artificially reproducing the brain activity patterns we observed in the compulsive mice, we were able to cause compulsive drinking behaviors even in mice that had never had a binge drinking experience. Conversely, by driving excitatory activity in these neurons during alcohol drinking, just like we observed in the low drinking animals, we were able to decrease drinking. </p>
<p>It seems as if this medial prefrontal cortex-dorsal periaqueductal gray circuit acts like a gate for compulsive drinking. When there is increased activity in these brain cells during alcohol drinking, a mouse is less likely to drink again in the future. When there is decreased activity during drinking, the mice are prone to drink again, even if that means suffering a negative consequence. What causes these differences in activity in individual mice is still unclear.</p>
<p>Although much more research is required before these findings can be applied to humans, we believe this study provides critical insights into the neurobiological mechanisms that predispose some users to alcohol use disorders. </p>
<p>Understanding the neural mechanisms controlling the behavioral processes that ultimately lead to substance use disorder is the critical first step to developing treatments to reduce excessive alcohol drinking. Importantly, these findings suggest that may we may be able to identify at risk individuals, based on neural activity patterns, and intervene before an alcohol use disorder fully develops. </p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/127313/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cody A. Siciliano receives funding from the National Institutes of Health, and the Brain and Behavior Research Foundation. </span></em></p>One in six US adults binge drinks, consuming about seven drinks per binge. A new study can predict which mice are hardwired to binge drink. Is it possible to do the same for humans?Cody A. Siciliano, Assistant Professor of Pharmacology, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1179002019-08-08T20:06:06Z2019-08-08T20:06:06ZOne in 10 Aussie kids care for someone with a disability or drug dependence – they need help at school<figure><img src="https://images.theconversation.com/files/287288/original/file-20190808-144873-9kytxy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thousands of children and young people provide substantial unpaid care to a family member with a disability, chronic or mental illness, dependence on alcohol or other drugs, or frailty due to old age. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/NcWNzEAD7Fs">Jesús Rodríguez/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Children who care for a family member with a disability, mental illness or dependence on alcohol or other drugs are less likely to complete, or do well in, secondary school compared with young people without caring responsibilities.</p>
<p>Our study, published in the journal <a href="https://link.springer.com/article/10.1007/s12187-019-09647-1">Child Indicators Research</a>, compared the levels of school engagement among children who identified as carers with children who didn’t shoulder such responsibilities. </p>
<p>We measured levels of school engagement by asking how often children felt positive emotions, such as being happy and safe, towards school.</p>
<p>In a national school-based survey of 5,220 Australian children aged 8-14, more than 450 respondents (9% of the sample) indicated they were looking after a family member with a disability or another serious health issue. </p>
<p>More than half of these young carers had responsibilities for a family member with a mental illness or dependence on alcohol or other drugs. </p>
<p>Overall, we found children who cared for a person with a mental illness or one using alcohol or other drugs had significantly lower engagement at school than children without caring responsibilities. </p>
<p>Studies show children who are more engaged at school are <a href="https://deepblue.lib.umich.edu/bitstream/handle/2027.42/91225/j.1467-8624.2012.01745.x.pdf?%5Blink%20text%5D(https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0%7E2016%7EMain%20Features%7EYoung%20Carers%7E143)%20sequence=1&isAllowed=y">more likely to stay in school</a> longer, with better outcomes for employment and earnings. </p>
<p>The challenges facing young carers will continue without improved support in schools and broader policy and community services, as well as personalised intervention programs.</p>
<h2>Who are young carers?</h2>
<p>Young carers are children and young people who provide substantial unpaid care to a family member with a disability, chronic or mental illness, dependence on alcohol or other drugs, or frailty due to old age. </p>
<p>The people <a href="https://www.sprc.unsw.edu.au/media/SPRCFile/1_Young_Carers_Report_Final_2011.pdf">they care for include</a> parents, siblings, grandparents, extended family or friends. Most young people take care of a parent or sibling. </p>
<p>About <a href="https://www.dss.gov.au/our-responsibilities/disability-and-carers/publications-articles/young-carers-research-project-final-report?HTML">5-10%</a> of <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0%7E2016%7EMain%20Features%7EYoung%20Carers%7E143">Australian young people</a> aged under 26 (that’s between about 150,000 and 300,000) are carers. There is <a href="https://aifs.gov.au/publications/young-carers">some suggestion</a> the figure could be even higher.</p>
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<strong>
Read more:
<a href="https://theconversation.com/heres-how-much-it-would-cost-the-government-to-pay-everyone-who-takes-care-of-family-with-mental-illness-74760">Here's how much it would cost the government to pay everyone who takes care of family with mental illness</a>
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<p>They help their family members with a range of activities beyond those typical of a person that age. </p>
<p>This includes helping with personal care such as showering and going to the toilet, administering medication, liaising with doctors and services, overseeing household administration and finances or providing emotional support.</p>
<p>Previous research has shown young carers’ responsibilities negatively affect their educational outcomes. For instance, young carers are more than one <a href="https://aifs.gov.au/publications/young-carers">year behind</a> their peers in literacy and numeracy. </p>
<p>They are also <a href="https://www.sprc.unsw.edu.au/media/SPRCFile/1_Young_Carers_Report_Final_2011.pdf">less likely</a> to complete secondary school and <a href="http://australianchildwellbeing.com.au/sites/default/files/uploads/ACWP_Final_Report_2016_Full.pdf">aspire to university</a> after leaving school.</p>
<h2>Why are young carers less engaged in school?</h2>
<p>We compared the levels of young carers’ school engagement with those of their peers without care responsibilities. </p>
<p>We measured emotional engagement in school by asking young people whether they felt happy and safe at school, and whether they enjoyed going to school and learning. We also measured their behavioural engagement by asking about how often they did homework. </p>
<p>Young carers of a person with a mental illness or drug or alcohol dependence were significantly less likely than young people who were not carers to report feeling happy and safe at school and enjoying school. They were also significantly less likely to do homework daily compared with students who weren’t carers.</p>
<p>Our results showed little difference in the school engagement of young people who took care of a person with a physical or intellectual disability compared with young people who were not carers. But <a href="https://www.tandfonline.com/doi/pdf/10.1080/13676261.2012.710743?needAccess=true">previous research</a> suggests this group of young carers also faces considerable challenges at school.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287318/original/file-20190808-144843-1l3qj2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many young people who care for a family member with mental illness or drug addiction keep it a secret.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Past research shows the responsibilities of a young person caring for someone with a mental illness or alcohol or drug dependence are <a href="https://professionals.carers.org/sites/default/files/media/mycare-report-final-5492.pdf">often unpredictable</a>. They manage crises, as well as monitoring the person’s well-being and medication use, which may heighten young carers’ levels of worry while at school. </p>
<p>Research also suggests many young carers of a person with a mental illness or drug or alcohol dependence keep their <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1475-3588.2007.00477.x">caring responsibilities a secret</a> from their peers and school professionals. This is often to protect themselves and their families from bullying and for fear of intervention by child protection services. </p>
<p>The strain of concealment is likely to affect the carers’ own mental health and create a barrier to them <a href="https://bmjopen.bmj.com/content/bmjopen/7/1/e013946.full.pdf">seeking support</a>. This may, in turn, affect the quality of their school experience.</p>
<p>We also found poor engagement in school of young carers of a person with a mental illness or using alcohol or other drugs was amplified by other indicators of marginalisation. These included whether the young carer themselves had a disability, was from a lower socioeconomic background or identified as Indigenous. </p>
<p>This suggests even stronger barriers to school engagement among young carers who experience multiple forms of marginalisation.</p>
<h2>How can we help young carers?</h2>
<p>Carer organisations and governments provide resources to schools, such as <a href="https://www.youngcarersnsw.org.au/wp-content/uploads/2014/03/YC-School-Booklet-Primary.pdf">teacher toolkits</a>, that raise awareness about young carers’ needs among staff and students and support their continued education. </p>
<p>The federal government has also announced <a href="https://www.dss.gov.au/sites/default/files/documents/04_2019/pbs-fact-sheet-carer-support-serviceslfexzjs.pdf">new packages</a> – available from later in 2019 – to support carers with education and employment. But only about 5,000 packages will be provided and only a small share of these will be earmarked for young carers. </p>
<p>Likewise, a <a href="https://www.paulfletcher.com.au/media-releases/joint-media-release-morrison-government-supporting-australias-young-carers">Young Carer Bursary</a> of A$3,000 was introduced in 2014 to support young carers to attend school – but only 1,000 of these are available in 2019.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/looking-after-loved-ones-with-mental-illness-puts-carers-at-risk-themselves-they-need-more-support-116349">Looking after loved ones with mental illness puts carers at risk themselves. They need more support</a>
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<p>While current policies may be making a positive difference for some carers, the results in this study show there are more young carers than support services available for them. </p>
<p>More needs to be done for the large number of young carers who are not as engaged in school as their peers. This includes high-quality, affordable and accessible services for their family members requiring care. </p>
<p>A personalised approach that includes the entire family and greater awareness and understanding among teachers and students of mental illness and drug or alcohol use could help make the school environment more welcoming for young carers.</p><img src="https://counter.theconversation.com/content/117900/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Myra Hamilton receives funding from the Australian Research Council and periodically from state and federal government departments in portfolios that provide services for carers. She is an academic member of the Carers NSW Carer Respite Alliance. </span></em></p><p class="fine-print"><em><span>Gerry Redmond receives funding from the Australian Research Council. </span></em></p>A study has found children between the ages of 8 and 14 who take care of a family member with a drug addiction or mental illness aren’t very happy at, and don’t feel all that safe, at school.Myra Hamilton, Senior Research Fellow in Social Policy, UNSW SydneyGerry Redmond, Professor, College of Business, Government & Law, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/654132016-11-17T18:54:05Z2016-11-17T18:54:05ZDrug rehab and group therapy: do they work?<figure><img src="https://images.theconversation.com/files/145521/original/image-20161111-25055-1xhksln.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Therapeutic group work is a consistent feature of traditional rehab treatments.</span> <span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=n3ze1M3kxBk">Horrible Bosses 2 - "Group Therapy" Clip [HD]/YouTube screenshot</a></span></figcaption></figure><p>Rehab is the short name for residential rehabilitation, the best known treatment for drug and alcohol problems. It involves living with a group of people with the shared goal of changing drinking or drug habits. </p>
<p>There are <a href="http://www.newsday.com/entertainment/celebrities/celebrities-who-have-been-to-rehab-1.4077079#5">regular media reports</a> of celebrities being sent to rehab by the courts, or choosing to “check themselves in”. Rehab is even the subject of television shows such as <a href="http://www.tv.com/shows/celebrity-rehab-with-dr-drew/">Celebrity Rehab with Dr. Drew</a>, that aired from 2008 and 2012 in the United States; and <a href="http://www.tv.com/shows/intervention/">Intervention</a>. </p>
<p>But rehab is more than a celebrity phenomenon. Thousands of Australians go to residential drug and alcohol rehab programs every year.</p>
<h2>Group therapy</h2>
<p>Rehab emerged out of <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-923X.1959.tb01701.x/full">developments in social psychology</a> and psychiatry in the 1940s. At that time, large institutions based around practices of punishment and isolation, were being dismantled in favour of rehabilitation.</p>
<p>In his 1948 novel <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778813/">Walden Two</a>, behaviourist B.F. Skinner described a utopian communal lifestyle that included developing self-control through positive and negative reinforcement instead of punishment. Residents of Walden learned to work together for the good of the group. </p>
<p>Later <a href="http://hum.sagepub.com/content/1/1/5.extract">research</a> on <a href="http://infed.org/mobi/kurt-lewin-groups-experiential-learning-and-action-research/#groupdynamics">group processes</a> and dynamics promoted the therapeutic benefits of living and participating in groups and contributing to shared goals. During the 1950s and 1960s, therapy in general was about giving people a good experience of <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9299.1959.tb01545.x/abstract">membership in a group</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=696&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=696&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=696&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=874&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=874&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145515/original/image-20161111-25070-lh0i2y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=874&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Historically, drug and alcohol addiction was seen as a vice that needed punishment.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Alcoholism#/media/File:William_Hogarth_-_Gin_Lane.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Drug and alcohol therapy was no different. Alcoholics Anonymous (AA) – a mutual aid group - began in the United States offering group support in a shared struggle against alcohol dependence. AA, that <a href="http://www.aa.org.au/members/history.php">started in Australia</a> in the 1950s, has been one of the most influential approaches to drug and alcohol treatment around the world. </p>
<p>Today <a href="https://ndarc.med.unsw.edu.au/blog/why-addiction-isnt-disease-instead-result-deep-learning">many rehabs</a> follow AA philosophy, using the 12 steps as the basis for their treatment programs. Some operate as therapeutic communities - a model consistent with Walden Two and starting at the same time. </p>
<p>In the therapeutic community drug and alcohol treatment and personal growth comes from adhering to the group rules and participating in daily activities that <a href="http://www.atca.com.au/wp-content/uploads/2012/07/Therapeutic-Community-Model-of-Treatment.pdf">support the community.</a> </p>
<p>There are <a href="http://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/">strong</a> critics of AA as a rehab approach. They see it as a one-size-fits-all program that blames lack of success on those who don’t follow <a href="https://ndarc.med.unsw.edu.au/blog/why-addiction-isnt-disease-instead-result-deep-learning">the rules</a>.</p>
<p>Research on outcomes of AA is not permitted under <a href="http://www.aa.org.au/new-to-aa/what-is-aa.php">the rules of the fellowship</a>, so its success rate is unknown. The effectiveness of the 12 step approach or any other therapy method delivered in groups has <a href="https://www.ncbi.nlm.nih.gov/pubmed/15764469">very limited research</a>. One study comparing the outcomes of a therapy delivered to individuals and to groups found the reduction in drinking and drug use was about the same, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/20025373">group therapy was cheaper to run</a>. </p>
<p>Some <a href="http://www.newbeginningsdrugrehab.org/non-12-step-drug-rehab/">rehabs</a> take a different approach to the 12 step model. They rely on individualised treatment plans that help the patient work through their substance abuse problems, as caused by mental distress, trauma or dysfunctional relationships.</p>
<h2>How do rehabs work?</h2>
<p>Regardless of the philosophy, all rehab programs operate in similar ways. The main feature is an extended period of abstinence from drinking and drug use. </p>
<p>In her popular 2006 song <em>Rehab</em>, Amy Winehouse said she didn’t have 70 days or ten weeks to stay in rehab. Treatment guidelines suggest <a href="http://www.health.nsw.gov.au/mentalhealth/programs/da/Publications/drug-a-guidelines.pdf">about that length is required</a> to have a significant experience of life without intoxication. </p>
<p>Eight to ten weeks is the most common length of programs in Australia. Although they vary from four <a href="http://www.nada.org.au/media/62549/nada_sector_mapping_web.pdf">weeks to 12 months</a>.</p>
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<figcaption><span class="caption">Amy Winehouse said she didn’t have 70 days or ten weeks to stay in rehab.</span></figcaption>
</figure>
<p>Other consistent features of rehabs are educational and therapeutic group work, individual counselling, and <a href="http://www.nta.nhs.uk/options.aspx">structured daily routines</a> that typically include cooking, cleaning and exercise. However, there is little evidence for a positive effect of any of these activities on drug or alcohol dependence. </p>
<p>Investigating residential drug and alcohol treatment programs, <a href="http://www.tandfonline.com/doi/abs/10.1080/1556035X.2011.570557">researcher Rowdy Yates</a> said: </p>
<blockquote>
<p><em>Very little is known about how it [rehab] works or who it works best for. It is […] therefore, not entirely surprising that many treatment plan decisions are, in practice, based more upon individual beliefs and assumptions than upon any scientific evidence.</em></p>
</blockquote>
<p>Instead, success in rehab is usually measured by how many finish treatment. Private facilities post completion rates on their websites – <a href="http://www.thecabinchiangmai.com/our-success-rates/">some as high</a> as 96%. </p>
<p>One <a href="https://www.ncbi.nlm.nih.gov/pubmed/16854661">study from England and Wales</a> found completion rates varied widely, from 3% to 92%; the average was 48%. Higher completion rates were related to lower counsellor caseloads, fewer beds, single rooms, shorter treatment length, higher fees, and a program containing individual counselling and free time with only moderate demands for domestic duties.</p>
<h2>How much they cost</h2>
<p>Private rehabs are most likely to cost a lot. In Victoria, <a href="http://www.smh.com.au/national/money-makes-all-the-difference-when-it-comes-to-tackling-ice-addiction-in-victoria-20150210-13b2ic.html">it costs A$32,000</a> for a three-month program at The Hader clinic, while a week at Innisfree will set you back A$3,500. </p>
<p>Thailand is sometimes a cheaper option. A month at <a href="http://www.traveller.com.au/healing-paradise-rehab-in-thailand-and-sydney-at-the-cabin-glgw5l">The Cabin in Chang Mai</a> will cost from A$14,000 but at <a href="http://dararehab.com/about/cost/">DARA, the cheapest option is US$4,995</a> (A$6,680). These fees will be unaffordable for many. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145519/original/image-20161111-25052-1dext59.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rehabs in Thailand are likely to be a cheaper option.</span>
<span class="attribution"><a class="source" href="http://www.thecabinchiangmai.com/">Screnshot, The Cabin Chiang Mai</a></span>
</figcaption>
</figure>
<p>Cheaper publicly funded programs are limited. There are about 800 funded beds in residential rehabilitation centres <a href="http://www.smh.com.au/national/money-makes-all-the-difference-when-it-comes-to-tackling-ice-addiction-in-victoria-20150210-13b2ic.html">in New South Wales and 200 in Victoria</a>, with <a href="http://www.news.com.au/lifestyle/health/health-problems/why-ice-addicts-are-waiting-six-months-for-help-from-the-salvation-army/news-story/3976f9d0407c50b59259ddbd15c2f709">waiting times varying</a> from three to six months. </p>
<p>At these centres, residents pay a contribution towards the cost of accommodation, meals and staff. At <a href="http://www.lyndon.org.au/wp-content/uploads/2016/07/FEES-as-at-010716.pdf">Lyndon in Orange</a> NSW, for instance, each resident pays A$240 a week, but it costs an additional A$700 per person per week to run it. Government funding covers some of the difference; donations cover the rest. </p>
<p>People often report <a href="http://www.smh.com.au/national/money-makes-all-the-difference-when-it-comes-to-tackling-ice-addiction-in-victoria-20150210-13b2ic.html">feeling desperate</a> to stop using drugs before they die or go to jail, or equally desperate to help their family member or friend get <a href="http://www.fds.org.au/newsletters/letter-to-family-and-friends">their use under control</a>. A rehab’s supervised drug and alcohol free environment offers some safety and security.</p>
<p>But trying a different treatment could be a better option than rehab. Substance dependence is usually a recurring chronic condition not easily fixed. Reports of treatment effectiveness vary according to treatment types, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24325414">types of drugs and types of people</a>.</p>
<p>However, a study from Scotland found three years after treatment of any kind, 58% of people are no longer substance dependant. So treatment <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797101/">works for about two thirds</a> of people, eventually.</p><img src="https://counter.theconversation.com/content/65413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan has received funding from the NHMRC, ARC and RIRDC for research related to drug and alcohol use. Julaine works for Lyndon, a not for profit drug and alcohol treatment, research and training organisation. </span></em></p>Thousands of Australians go to residential drug and alcohol rehab programs every year. But is there evidence rehabs, as well as the group therapy they often rely on, actually work?Julaine Allan, Senior Research Fellow, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/631132016-08-21T20:04:24Z2016-08-21T20:04:24ZViewpoints: is addiction a disease?<figure><img src="https://images.theconversation.com/files/134380/original/image-20160817-13707-163bo14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We've long heard we can't blame people for their addiction because it's a disease, but is it? </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><h2>The case against</h2>
<p><strong>Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin University</strong></p>
<p>We used to think of “addiction”, or what we now call dependence, as a moral failing. This had the result of blaming the person who was addicted – it was a matter of willpower and they just weren’t trying hard enough. So the obvious solution was shaming and scolding until they did.</p>
<p>In the mid-20th century, a new movement started: the recovery movement, led by peer organisations such as Alcoholics Anonymous. This signalled a shift towards a focus on disease. This shift was important in understanding drug use as a health issue and focusing responses towards support rather than blaming.</p>
<p>The downside to this way of thinking is that it conceptualises drug use and dependence as a problem you have no control over – it needs someone or something to “fix” it (typically a medicine). The first step in the 12-step movement demonstrates this well: “I admit that I am powerless over alcohol/drugs.” The pendulum had swung in the opposite direction.</p>
<p>But what is a disease? Traditional definitions refer to a failing or problem with cells, tissues or organs – an illness of some sort. The organ in question here is the brain. </p>
<p>Many <a href="http://scholar.google.com.au/scholar_url?url=https://www.researchgate.net/profile/Miguel_Perez-Garcia/publication/6884468_Executive_dysfunction_in_substance_dependent_individuals_during_drug_use_and_abstinence_An_examination_of_the_behavioral_cognitive_and_emotional_correlates_of_addiction/links/09e4150fee0125a130000000.pdf&hl=en&sa=X&scisig=AAGBfm22AhDVWPlZbr2cvdu96C02kE69fQ&nossl=1&oi=scholarr&ved=0ahUKEwiQ_uOw97rOAhWMkZQKHV7_A4sQgAMIHSgBMAA">studies</a> demonstrate cognitive deficits among drug users, but there is little evidence those brain deficits occurred <em>before</em> drug use. Some cognitive risk factors increase the likelihood of a drug or alcohol problem, but no-one has done a study that has measured babies’ brain structure and function, and then looked at who developed problems with drugs 15 to 20 years later to see whether there are particular brain deficits that “cause” drug dependence.</p>
<p>A broader definition of a disease would be an “abnormal” condition of some sort – which would also place mental health issues in the category of disease. We don’t usually consider mental health problems, such as depression or anxiety, as a disease, even though they have biological (including neurological) aspects to them.</p>
<p>Modern understanding of brain plasticity shows repeated behaviours form strong paths in the brain. This suggests drug problems might be more of a habit ingrained in the brain by repeated reinforcement of behaviours. Those behaviours are influenced by factors such as biology, the social and environmental situation, and upbringing. </p>
<p>There’s no evidence anyone has become addicted to a drug on the first use (they might like it a lot on first use – enough to do it over and over until they become dependent). The disease model doesn’t account very well for people who use drugs but aren’t dependent (about 90% of people who use alcohol or other drugs), or people who use drugs and have problems other than dependence (about 20% of that 90%).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If people see their addiction as a learnt behaviour, will it be easier for them to stop?</span>
<span class="attribution"><span class="source">from ww.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Addiction as a learnt behaviour (that can be unlearnt), with multiple influences, can better account for the wide range of ways people use alcohol and other drugs, and also for the path to dependence.</p>
<p>We know there are multiple factors that increase risk of a) drug use, b) drug-related problems and c) drug dependence. Some of them are probably biological, but we haven’t found a gene or biological cause.</p>
<hr>
<h2>The case for</h2>
<p><strong>Femke Buisman-Pijlman, Senior Lecturer in Addiction Studies, University of Adelaide</strong></p>
<p>Our understanding of addiction or dependence is still growing and with it we change the way we describe it. A model to explain dependence can be useful to help a user or family member understand the illogical behaviour or help the general public understand the need for a specific treatment. </p>
<p>I find the disease model useful in explaining how dependence is different from other excessive alcohol or drug use. </p>
<p>A disease can be defined as a set of symptoms caused by external or internal factors. Dependence is not like a virus or infection, but more like a chronic disease. You may have a predisposition to it, but it will not manifest itself until it is triggered. </p>
<p>Our behaviour, whether it is drug-taking, over-eating or lack of exercise, may increase the chance of developing a disease. As with a chronic disease, long-term management may be necessary to get the best outcome, but relapses may still occur. I find this model helps people understand the long-term perspective of a person who is struggling to manage dependence. </p>
<p>Only repeated use of alcohol or drugs lead to dependence, so I agree a person is not powerless in this. Although it is difficult to control the behaviour, a person needs to learn to manage it. </p>
<p>There is no easy fix, like with many diseases. Just taking away the drug will not cure the “disease”. A range of approaches is needed to help people cope with life in different ways and connect to healthy habits and people. </p>
<p>Specific medication can be useful during withdrawal to manage the physical side of dependence or to support a person in the long term to decrease the risk of relapse. The medications to support long-term relapse prevention have rates of success similar to those for other chronic health problems (low to moderate). But we have hardly any effective medications to support people to manage amphetamine and cannabis dependence in the long term. </p>
<p>Psychological support should be a vital part of the support to help people increase motivation for change and give them the tools to manage their use. As with chronic health problems, the person has an important role, but they can be supported by professionals. We know the success rate of attempts to quit smoking without any support are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2004.00540.x/full">very low</a>. Medication and social support can increase this.</p>
<p>Addiction or dependence is characterised by a large range of changes in behaviour; it is unlikely we will find one gene that is responsible for this. There are large individual differences in how we respond to drugs, whether we continue after negative effects arise and how we handle reduction in use.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The disease model is useful in explaining how dependence is different from other excessive alcohol or drug use.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/kphotographerrr/4505714773/in/photolist-7S9Y2t-9ju8xz-94Sx1A-gnnXbh-aitkxg-qu73p6-9fV5xi-gwmAC2-oNQBYF-7sZRqK-oaHWKu-27yd4y-2jsiBz-9WKkti-L1qNq-gwmN7H-fd4kgb-nbdfPZ-q27rVB-abrdvT-nHEVtP-gPy47D-pUzb-AkcbB-bvc7PH-oaK8sB-dpvkD8-bAJDSn-6HTERN-bCYuAM-8Dvf6G-6tDtwJ-6j1BHH-diqnZK-cinZEN-fPs3U5-d71ZCN-etybU-bCYuxX-eegnmy-qYrtkW-4N11am-foVw6v-5S9BtN-ieDvcK-a3se4R-edZStq-damued-A8zQK-foWNhF">Kphotographer/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Some of these changes <a href="http://www.ncbi.nlm.nih.gov/pubmed/24056025">may rely on genes</a> or psychological factors (impulsivity or coping skills), others may be dependent on our “environment” (trauma or abuse). <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02213.x/full">Twin studies</a> and cohort studies are useful in identifying biological factors and looking at cause and effect.</p>
<hr>
<p><strong>Nicole Lee</strong></p>
<p>Even people who are heavily dependent can often control their alcohol or other drug use when they need to, which suggests a disease model is not a good fit as an explanation. We all know someone who can resist drinking at a party, but if they start to drink they may get out of control. </p>
<p>I ask my clients to make an effort not to come to counselling in an intoxicated state. Most are able to stop or reduce their use in response to that, or in order to look after children, or when they need to go to work. The biological drive to use can be strong, but it can also be managed.</p>
<p>Medications to actually treat dependence are really only modestly effective for most alcohol and other drug issues. Replacement pharmacotherapy for <a href="http://www.cochrane.org/CD011117/ADDICTN_opioid-maintenance-medicines-treatment-dependence-opioid-pain-medicines">opiate dependence</a> and for nicotine dependence has the best evidence. The outcomes of pharmacotherapy for other drugs, such as <a href="http://www.cochrane.org/CD004332/ADDICTN_acamprosate-for-alcohol-dependent-patients">alcohol</a>, are fairly modest.</p>
<p>Only a relatively <a href="https://theconversation.com/you-dont-have-to-go-off-the-grid-to-get-treatment-for-drug-dependence-50075">small number</a> of people become dependent on alcohol or other drugs (between 5% and 20% depending on the drug), suggesting the alcohol or drugs themselves are not the primary cause of the problem.</p>
<p>The search for the underlying mechanism that causes some people to become dependent, and others not, has been one of the drivers of the disease explanation.</p>
<p>But the broad range of factors that both explain alcohol and other drug dependence and seem to maintain it, suggests the disease model on its own has significant limitations as an explanation. Psychological factors, such as coping skills and resilience; biological factors, such as genetics and tolerance; and social factors, such as abuse or trauma, low socio-economic status and poor community connectedness, all contribute to both the development and maintenance of alcohol and other drug problems.</p>
<p>Any single-factor theory to explain alcohol and other drug use and dependence will inevitably fall short. We would do better looking at the full range of factors that enable problems with alcohol or drug use. Dependence is a complex problem with no simple solution.</p>
<hr>
<p><strong>Femke Buisman-Pijlman</strong></p>
<p>I agree a single-factor theory is not helpful to explain addiction behaviour. Many diseases are similar in this, having a large number of risk and contributing factors. Addiction can be viewed as a treatable disease, but the person is central in managing the behaviour. </p>
<p>Continued drug use has a complex impact on our brain. Only a multi-disciplinary approach will help us fully understand what these impacts are and help us provide optimal support.</p><img src="https://counter.theconversation.com/content/63113/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant to public, private and not for profit services to support best practice treatment and policy. She has previously been awarded grants by the Australian Government, NHMRC and other public funding bodies for drug research.</span></em></p><p class="fine-print"><em><span>Femke Buisman-Pijlman is affiliated with Virginia Commonwealth University as Affiliate Graduate Faculty. She teaches the Master of Science in Addiction Studies with VCU and King's College London. Reckitt-Benckiser Pharmaceuticals offers partial merit based scholarship to students in this degree.
Femke has received funding from governments in Australia, The Netherlands and the USA to support teaching, research and travel. Her PhD project was funded in a collaboration between Utrecht University and Solvay Pharmaceuticals (now Abbott)
She works as an educational advisor for PwC and several schools.</span></em></p>Some think labelling it a disease is a helpful way to think about addiction; others think this makes the addict helpless in their fight against addiction. Two academics debate both sides of the coin.Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversityAssociate Professor Femke Buisman-Pijlman, Senior Lecturer Addiction Studies, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/506602015-11-25T04:07:15Z2015-11-25T04:07:15ZOlder Australians’ drinking on the rise and they don’t know the risks<figure><img src="https://images.theconversation.com/files/102442/original/image-20151119-19372-8vjzw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older Australians don't know how risky their alcohol habits can be. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=117247519&size=huge&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ0NzkzMTg5OCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTE3MjQ3NTE5IiwiayI6InBob3RvLzExNzI0NzUxOS9odWdlLmpwZyIsIm0iOiIxIiwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJkRXZKTFlsTENTcjFqUnMwV3pXdXFvajNwN3MiXQ%2Fshutterstock_117247519.jpg&racksite_id=ny&chosen_subscription=1&license=standard&src=8JGih0P8kFJYoGAJ2Duz0Q-1-59">from www.shutterstock.com.au</a></span></figcaption></figure><p>When we think about who experiences harm caused by alcohol, most people think about young people. However, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">Australian data</a> show the rate of risky drinking among young people has been decreasing, while risky drinking among older adults has been increasing. </p>
<p>The consumption of cannabis shows a similar trend. This is of significant concern since older adults are at elevated risk of alcohol-related harm.</p>
<h2>Why are older drinkers more at risk?</h2>
<p>The Australian government has <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">specific guidelines</a> for the general population to minimise the potential of alcohol-related harm. However, these guidelines simply recommend that older adults drink less. This is because there is a lack of specific research to indicate more precise levels for low-risk drinking among older people.</p>
<p>Older adults are at increased risk of experiencing alcohol-related harms for three main reasons.</p>
<p>First, with age, the body becomes less effective at <a href="http://nihseniorhealth.gov/alcoholuse/alcoholandaging/01.html">metabolising alcohol</a>. This means alcohol has a more potent impact on an older person compared to a younger person consuming the same amount of alcohol. In turn, this increases the likelihood of injury and falls among older people who drink.</p>
<p>Second, older adults are more likely to be taking a range of medications that can interact with alcohol and cause an adverse drug event. A <a href="http://www.biomedcentral.com/content/pdf/1471-2318-14-57.pdf">recent study</a> found that 60% of drinkers were taking at least one medication that could adversely react with alcohol. Many of these medications can severely interact with alcohol. For example, drinking alcohol while taking certain blood-thinning medications could cause increased risk of death from haemorrhaging. </p>
<p>Third, older people are likely to experience health conditions that can be <a href="http://nihseniorhealth.gov/alcoholuse/alcoholandaging/01.html">exacerbated</a> by the effects of alcohol. For example, high blood pressure and heart disease can be more difficult to treat when a person drinks alcohol. In addition, alcohol is a known carcinogen. As such, it is recommended that cancer survivors abstain from alcohol and that alcohol consumption be minimised to avoid the risk of developing various forms of cancer. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102444/original/image-20151119-19365-145n55p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Older Australians have more time and less responsibility, so they may find their drinking increases.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=160190972&size=huge&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ0NzkzMjI5OSwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTYwMTkwOTcyIiwiayI6InBob3RvLzE2MDE5MDk3Mi9odWdlLmpwZyIsIm0iOiIxIiwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJlWTM5eStlZGdsZ0hTUTNhd2s2dDAya3V4aTAiXQ%2Fshutterstock_160190972.jpg&racksite_id=ny&chosen_subscription=1&license=standard&src=8JGih0P8kFJYoGAJ2Duz0Q-1-74">from www.shutterstock.com</a></span>
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<p>While some older people who experience alcohol-related problems have been heavy drinkers for much of their life, there are others whose previously moderate drinking <a href="http://onlinelibrary.wiley.com/doi/10.1002/gps.930090409/abstract;jsessionid=495E2AA2D681DC7874E61E76BD088FCE.f02t03">escalates with age</a>. </p>
<p>Various events associated with ageing can precipitate the onset of problems associated with alcohol. Such events include loss of identity associated with retirement, more free time and less responsibility. Some older people’s drinking escalates as a result of grief associated with losing a loved one, or inability to engage in activities due to health conditions, or loneliness and isolation.</p>
<h2>The role of health-care professionals</h2>
<p>Australia’s drinking <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">guidelines</a> suggest that each older adult should seek advice from their GP about what constitutes a safe drinking limit for them that takes into account all of the risks. However, most older adults don’t know about these risks. They are therefore unlikely to seek such advice from their GP. </p>
<p>Conversely, many health-care professionals are reluctant to ask older people about their use of alcohol and other drugs. Most don’t think that the lovely old lady or gentlemen that they see might have a problem with alcohol. Even if concerned, they may feel embarrassed to ask them about their substance use. </p>
<p>Not asking about drinking patterns and levels can result in health-care professionals treating what they believe to be the symptoms of a medical problem, when in fact the symptoms are related to the use of alcohol or other drugs.</p>
<p>To support health professionals to navigate this delicate area, we have published <a href="http://www.peninsulahealth.org.au/wp-content/uploads/AODPenHealth_150915.pdf">Australia’s first guidelines for health professionals</a>. This provides the necessary skills to assess older adults’ use of alcohol and other drugs. </p>
<p>We hope health-care professionals will now be better able to identify older adults at risk of experiencing alcohol-related harm and provide appropriate advice and support. We also hope more older adults will be referred for specialist treatment to address their use of alcohol and other drugs.</p>
<h2>Treatment services</h2>
<p>Older adults are less likely to engage with traditional treatment services, such as counselling and rehabilitation. They may perceive such services to be for younger people, or lacking mobility access or an appropriate atmosphere. </p>
<p>Many other countries such as <a href="http://brainxchange.ca/Public/Files/Addictions/Older_Adults_-and_Addictions_FD.aspx">Canada</a>, the <a href="http://treatment-facilities.healthgrove.com/l/1163/Saint-Marys-Center">United States</a> and the <a href="http://www.spiegel.de/international/zeitgeist/care-home-for-aging-junkies-finds-success-in-the-netherlands-a-826075.html">Netherlands</a> have developed services specifically for older adults. However, in Australia there is currently only <a href="http://www.olderwiseraod.net">one older-adult-specific treatment</a> service. </p>
<p>The <a href="http://www.peninsulahealth.org.au/wp-content/uploads/AODPenHealth_150915.pdf">guidelines</a> we have published will assist other treatment services to implement older adult-specific services. We hope this will lead to more such age-specific treatment in Australia.</p><img src="https://counter.theconversation.com/content/50660/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Bright is affiliated with Peninsula Health's Older Wiser Lifestyles (OWL)</span></em></p><p class="fine-print"><em><span>Ann Roche is Professor and Director of the National Centre for Education and Training on Addicition (NCETA), Flinders University and receives funding from the Australian Government Department of Health and Ageing.</span></em></p>The rate of risky drinking among young people is decreasing, while risky drinking among older adults is increasing.Stephen Bright, Registered psychologist and sessional academic, Curtin UniversityAnn Roche, Professor and Director of the National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.