PATIENT CHARACTERISTICS: FAMILY THERAPY GROUPS

The essential thrust of this book is to deal with clinical events and techniques for those cases actually involved in family therapy. While Chapter 5 discusses recruitment principles that also apply to the Family Movie cases and to treatment "refusers,- and Chapter 17 presents outcomes for all four treatment conditions, the major concern is with family therapy. Thus attention will be given here to the 46 cases (21 and 25, respectively) in the combined Paid and Unpaid Family Therapy groups (although two Unpaid cases never did, in fact, attend a family therapy session). This gives a more accurate picture of the patient population with which the treatment principles have been developed. Demographics for the other groups are, of course, quite similar, and are presented elsewhere:-

Of the 46 family therapy patients, 48% were Black and 52% White. Among the Whites, 40% were of Italian, and 25% of Irish extraction. The mean age at intake was 24.7 years and ranged from age 20 to age 34. Some 24% were married and another 11% had been previously married but were unmarried at intake. All had been away from home in military service for at least a brief period in their lives; 32% had served in Vietnam and 5% had been dishonorably discharged from the military for drug use. Of the 46 patients, 61% still lived with their parent(s). Most had completed high school or an equivalency examination, 4% were in school or a training program, and 41%. were employed at intake. The average length of time during which they had used opiates was 6.7 years, while 94% had been previously treated for drug abuse (i.e., they were "repeaters- ). The socioeconomic composition of this (urban) group, as defined by Hollingshead and Redlich's

Two-Factor Index of Social Position,69 was Class III, 8%; Class IV, 66%; Class V, 26%.

Aside from their somewhat worse prognosis (mentioned above and in Appendix C), the major differences between this group and the overall DDTC patient population are probably that this group (1) was slightly younger; (2) had a slightly higher ratio of Whites to Blacks; (3 ) included fewer patients who had ever been married; and (4) included a

somewhat lower percentage of patients in a school or training pro-gram (4% vs. 18% ).

Alcohol Abuse

Drug Class: Sedative hypnotic

Individual Drugs: beer (3 to 7 percent or less alcohol); wine (8 to 14 per­cent alcohol); "fortified" wine (17 to 22 percent alcohol); spirits, liquor, whiskey (40 percent or more alcohol)

Common Terms: liquor, whiskey, booze, hooch, wine, beer, ale, porter

 When people drinking alcohol, they feel pleasure and relaxation during the first half hour or so, often becoming talkative and socially out­ going. But these feelings are usually replaced by sedation (drowsiness) as the alcohol is eliminated from the body, so drinkers may become quiet and withdrawn later. This pattern often motivates them to drink more to keep the initial pleasant buzz going.

Overdose and Other Bad Effects: Under most circumstances, the chances of life-threatening overdose are low. However, people get into trouble when they drink a lot of alcohol very quickly—such as in a drinking game, on a dare, or when they can't taste the alcohol (as in punch or Jell-O shots). Drinking on an empty stomach is particularly risky. If a person becomes unconscious, is impossible to arouse, or seems to have trouble breathing, it is a medical emergency and immediate attention is necessary. Some very drunk people vomit, block their airway, suffocate, and die. Call for emergency medical assistance.

When drunk people pass out, their bodies continue to absorb the alco­hol they just drank. The amount of alcohol in their blood can then reach dangerous levels and they can die in their sleep. Keep checking someone who has gone to sleep drunk. Do not leave him alone.

"Binge drinking" is particularly dangerous because it is during binges that most fatal overdoses occur.

Unique Risks for Adolescents: Young people may respond quite differ­ently from adults to alcohol. Although the research is still developing, it looks like alcohol may impair learning more in adolescents but be less potent at making them sleepy. The newest studies indicate that adoles­cents may be at greater risk than adults for long-lasting effects of alcohol on the brain—even down to the cellular level.

Dangerous Combinations with Other Drugs: It is dangerous to combine alcohol with anything else that makes you sleepy. This includes other sed­ative drugs, such as opiates (e.g., heroin, morphine, or oxycodone), barbi­turates (e.g., phenobarbital), Quaaludes (methaqualone), Valium-like drugs (benzodiazepines), sleep medications like Ambien, and even the antihistamines found in some cold medicines.

All sedative drugs share at least some of alcohol's effects and each increases the other's effects. Drugs can become deadly when combined. Even doses of drugs that do not cause unconsciousness or breathing prob­lems alone can powerfully impair physical activities such as sports, driv­ing a car, and operating machinery when taken together.

Finally, non-narcotic pain relievers such as aspirin, acetaminophen (the pain reliever in Tylenol), and ibuprofen (the pain reliever in Motrin) can each have bad side effects if taken with alcohol. Aspirin and ibuprofen can both be highly irritating to the stomach when taken with alcohol, and under some circumstances the combination of extremely high amounts of acetaminophen with alcohol can damage the liver.

The use of chemicals to alter thinking and feeling is as old as humanity itself, and alcohol was probably one of the first substances used. Even the

·                                 earliest historical writings make note of alcohol drinking, and breweries can be traced back some 6,000 years to ancient Egypt and Babylonia. In the Middle Ages, Arab technology introduced distillation—a way to increase the alcohol content in beverages—to Europe. In those times alco­hol was believed to remedy practically any disease. In fact, the Gaelic term whiskey is best translated as "water of life."

These days, beverage alcohol is clearly the drug of choice for much of Western culture, and we need only to look closely at much of the advertis­ing in this country to see that it is still sold as a magic elixir of sorts. ANC use

alcohol abuse to celebrate successes, to mourn failures and losses, and to celebrate

holidays of cultural and religious significance. Implicit in these uses are the

hope and promise that alcohol will amplify the good times and help us through the bad ones.

Nowhere is the alcohol advertising more targeted, or the peer pressure to drink more powerful, than on adolescents and young adults—particu­larly young men. And the advertising works. We know that people's choices about the alcoholic beverages they drink are powerfully influ­enced by advertising. While young people do most of the drinking in American society, they are also the ones who need their brains to be func‑

tioning at their highest levels because of the intellectual demands of edu­cation and career preparation.

For most people alcohol is not a terribly dangerous drug—but it is a powerful drug and must be treated accordingly. No one would take a powerful antibiotic or heart medication without the advice of a physician. But alcohol is available to virtually anyone who wants to have it, without a prescription. The vast majority of people in the United States face the decision of whether to use alcohol, and how much to use, during their high school or college years. The responsibility for making these decisions

falls on each individual. This chapter will provide the latest information about alcohol and its effects.

Scott Swartzwelder