CHAPTER 2 REVIEW OF RELATED LITERATURE
2.1 Review of Related Literature
This chapter presents a review of the literature that is relevant to this study on the lived experiences of mothers with family members with alcoholism. The chapter contains major sections that are relevant to the study in which they will serve as theoretical frameworks for analyzing results of research interviews with research participants.
2.1.1 Alcohol and Alcoholism
Alcohol can be found in drinks, preservatives, antiseptics or in some medications. Alcohol is an organic substance that is formed when a hydroxyl group is substituted for a hydrogen atom in a hydrocarbon (MedicineNet.com, 2018). Alcoholic drinks have been classified as a depressant, slowing down a person’s functions which otherwise that person could have been more vivacious and energetic, and eliciting slow responses as well as uneasy reactions. Generally, alcohol affects a person’s mental faculties and the ability to think reasonably. Rarely do we find positive effects of drinking alcohol especially when alcohol consumption exceeds the body’s capacity to handle. Aside from being classified as a depressant, its effects are largely dependent on the amount being consumed by the individual. When consumed excessively, alcohol is no respecter to its victims; men, women, teenagers, including the elderly. Alcohol puts them at risk to serious health problems like cirrhosis (Rehm, Taylor, ; Mohapatra, et al., 2010), hypertension, heart ailments (Rehm, Sempos, ; Trevisan, 2003) and nerve damage. Alcohol is the world’s third largest risk factor for chronic disease (Rehm, et al., 2009).
The term “alcoholism” is commonly used to refer to habitual and unrestrained intake of alcohol usually placing the health, social status and personal relationships of the drinker at risk. Those who suffer from alcoholism are called ‘alcoholics’. The World Health Organization frowned on the use of the term “alcoholism” and instead, preferred to have it called as” alcohol dependence syndrome”. Since 1979, agencies worldwide have used the terms, “alcoholic” and “alcoholism” to refer to a condition where a person indulges himself in uncontrolled drinking, Other terms included “alcohol abuse” and “alcohol addiction”. Regardless of the term used to describe the condition, it seemed to be difficult to remove the social stigma of alcoholism making these alcohol dependents avoid neither diagnosis nor treatment for fear of social rejection (Schomerus, et al., 2011).
There are certain characteristics or conditions that could describe alcoholism; a craving or compulsion to drink without control; physical dependence, signs of withdrawal like heavy sweating, nausea, etc. and tolerance to increased amounts of alcohol consumption. Alcohol misuse is common to alcoholics; such abusive act can be considered harmful, hazardous, especially if the person develops dependency towards it.
The World Health Organization has estimated that there are 140 million people worldwide who suffer from alcohol dependency. In the United States, alcohol abuse ranks third from among the leading causes of preventable death and has even surpassed the expense for cancer in 2005 at approximately US$220 billion, with the expense for cancer was only US$196 billion. (Adewale & Ifudu, 2014). Alcohol is pointed out as the cause of 200 disease and injury conditions, while worldwide; 3.3 million deaths are accounted every year due to alcohol or 5.9% in proportion to the aggregate number of deaths. Further, alcohol accounts for 5.1% of the world’s burden of disease and injury, measure in disability and adjustment life years. Alcohol abuse is no respecter when it comes to death and disability at a young age (20-39 years old) as it is estimated to account for 25% of the total deaths recorded (World Health Organization, 2018). Further, alcohol dependence has been pointed out as a mental disorder that is most prevalent and the most severe (Schomerus, et al., 2011).
The World Health Organization estimates that 76.3 million people worldwide suffer from alcohol use disorders (WHO, 2004). About 4% of all deaths and 5% of all disability-adjusted life-years lost can be attributed to alcohol and alcohol abuse(Rehm et al., 2009). Negative consequences of alcohol dependence are not restricted to physical health alone: alcoholism also has profound negative effects on one’s social behavior, social interactions and social environment (Klingemann, 2001).
The stigma of alcoholism may hinder the seeking of professional and lay help due to the fear of being labelled as an alcoholic and as a consequence the patient may lose his status and undergo social discrimination or social exclusion (Room, 2005). Similarly, it may also create structural discrimination against alcoholic persons when it comes to its treatment which insurance companies would not cover. However, research on psychiatric attitude does not give that much attention than other substance abuse disorders (Schomerus et al., 2010).
In a research by Shivani, Goldsmith, & Anthenelli (2002), the authos noted that there can be difficulty in assessing psychiatric disorders with persons with alcoholism. This is becaise psychiatric syndromes can be associated with alcoholism thus, alcoholism can either cmplicate or mimic psychiatric syndromes that are present in mental health surroundings.thereby affecting accuracy of the diagnosis. It was also noted in the study that there can be instances when psychiatric disorders and alcoholism occur together and patients become more likely to have difficulty in sustaining abstinence, attempting suicide and utilizing mental health services. A comprehensive and exhaustive evaluation of psychiatric syptoms is thus necessary among alcoholic patients to lessen the severity of these symptoms.
Alcohol addiction is manifested in many signs and symptoms like depression, anxiety, psychosis, and antisocial behavior, either when intoxicated and during withdrawal. They could last for few weeks right after abstinence (Shivani, Goldsmith, & Anthenelli, 2002). Other symptoms of alcohol addiction are uncontrollable behaviors, neglect of duties and important activities, relationships issues, changes or deterioration in hygiene and appearance, tolerance to the substance, fatigue, loss of appetite, headaches, irritability, insomnia and depression (NCADD, 2016).
According to Anton (2008) “alcohol abuse is a pattern of drinking resulting to harm to a person’s health, interpersonal relationships, or ability to work”. Generally, alcoholism is a substance abuse disorder (SUD) which is a combination of the elements of a mental disease and physical illness, the symptom appearing early on prior to any physical health complications. Uncontrollable behaviors including uncontrolled drinking of alcohol; a determined desire to drink continued drinking and recurrent drunkenness or withdrawal symptoms appearing instead of fulfilling normal obligations are all behavioral or mental symptoms that are inevitably accompanied by physical complications as a result of the addiction to alcohol. Long-term heavy drinking results to many ailments like cirrhosis of the liver, hypertension, cancers, brain deterioration and other severe health outcomes accompanied by behavioral symptoms. The treatment of alcoholism is more focused on the mind more than the physical system of the patient. Many theories on the biological, psychological and social facets of the alcoholic can explain the underlying reasons for alcohol abuse.
2.1.2 Theories on Alcoholism
• Disease Theory
This theory focuses on the resemblances and differences between those with the “disease” (addiction) from those without. The theory defines the addiction as an uncontrollable and irreversible brain disease (Horvath, Misra, Epner, & Cooper, 2014). The theory while concerned with the pathological changes in the brain, also focus on the cravings and urges of the alcoholic. The theory describes the addiction which is progressive and becomes a lifetime illness of loss of control. It also claims an inherited tendency of the illness (West & Brown, 2013); a combination of the genes and the environment that could lead up to the addiction. Those with a family history of alcoholism are at a higher risk because of defective genes. Treatment is immediately required as chances of recovery is quite remote and even if treatment is received the individual has higher chances of relapses. Abstinence and peer support is the recommended method for recovery, with hope and motivation.
• Biological Theory
This theory takes into consideration a number of factors as reasons for the addiction. They include genetics, brain chemistry, structure and functions of the brain with the premise that each individual is physiologically and genetically unique to the extent that individual enjoy in a variety of things and some more than others do, up to the extent of being unable to resist as their brains have already altered functions (Horvath, Misra, Epner, & Cooper, 2014).
The biological theory also includes the physical component of addiction to alcohol together with withdrawal symptoms occurring physically such as changes in the body temperature, chills, delusions, depression, fever, increased pulse rate, paranoia, panic disorder, sweating, tremors, sneezing, , spontaneous orgasms, tachycardia which are considered as physical indicators to addiction (Sremac, 2010) As the alcohol addiction commences via incentive-based mechanisms, continued use of alcohol leads to tolerance and avoidance of abstinence. This also includes the mesolimbic dopamine system, which has a key role in sending pleasure sensations to the brain. This mesolimbic system is also the central part of the brain which stimulates addiction and consumption of alcohol. Physical treatment may initially consist of detoxification followed by abstinence.
• The Social Learning Theory
This theory suggests the role of society in influencing an individual’s decisions and choices (Akers, 2011). Close bonds with family, teachers, colleagues and peers are known to have the least tendency to develop negative behaviors such as alcohol abuse. The presence of stressors or problematic backgrounds could also influence the individual’s decisions towards alcohol abuse or if the individual comes from an environment of alcohol dependent fathers and mothers (Sremac, 2010) providing a vicarious experience to the individual. What the individual observes may make the individual more prone to try the habit. On the other hand, negative consequences may also be observed and thus may make the individual withdraw or stay away from the habit.
2.1.3 Medical Interventions
• Community Reinforcement Approach (CRA)
Community Reinforcement Approach (CRA) deliberates on the presence of drug-related reinforcers and the absence of non-drug alternatives as the cause of the addiction. As a form of treatment it utilizes counselling to offset the effects of reinforcers present and as part of the social environment that can go against drug-use reinforcers and eliminates or reduces conditioned or social enforcers. CRA endeavors to establish a strong reinforcing environment to the individual, within his family, work and recreational contexts. Coping skills are subsequently learned through communication and training. CRA reduces substance use with treatment sessions that are to be complied by patients and likely to achieve positive outcomes.
• Contingency Management (CM)
Contingency Management (CM) views the addictive behavior as a product of both conditioned and unconditioned reinforcement that are related to substance use and the lack of non-drug alternative reinforcers; making it difficult to alter any undesirable behaviors that can be modified by punishment or any other powerful reinforces that are contingent upon these behaviors like abstinence and compliance to medical treatment. The use of CM necessitates strong, competing reinforce, selection and objective verification of the appropriate behavior (Stitzer & Petry, 2006); i.e. drug abstinence. Reinforced medication can also be used like offers of shelter, vouchers, access to employment (Higgins et al., 2008). CM treatment can either be outpatient or a part of a comprehensive treatment program (Dutra, Stathopoulou, Basden, Leyro, & Power, 2008; Stitzer & Petry, 2006).
2.2 Synthesis of Related Studies
The foregoing literature has tackled concepts on alcoholism, alcoholic behaviors, theories on alcoholic behaviors and their potential treatment, as well as alternative treatments that can be employed. These concepts are useful to familiarize readers on information that is relevant to the research topic. Further, they can serve as a guide to the researcher in analyzing phenomenological data obtained from research respondents.
Primarily the literature review presented has provided an ample background on alcohol and alcoholism; the substance, its components and how it is medically classified. The effects of drinking excessively were also enumerated at the beginning of the chapter. Alcoholism and the conditions that describe alcoholism, such as a compulsion and uncontrolled drinking of alcohol, dependence were also enumerated in Chapter 2.
To emphasize on the adverse impact of alcohol, statistics were presented based on WHO reports as well as from studies made on alcohol effects such as the one conducted by Rehm, et al (209)) and Klingerman (2001). Other descriptions on alcohol abuse were also made in addition for its underlying reasons. Finally Chapter 2 highlighted on three theories of alcoholism followed by medical interventions that have been tested and remains plausible up to the present. These interventions are Community Reinforcement Approach (CRA) and Contingency Management or CM.