Taking a Second Look at Substance Abuse

Experts estimate that 8 million Americans are alcoholics, and another 6 million abuse alcohol, but aren't physically dependent on it.

Bootlegging and Prohibition aside, Americans have a long history with alcohol. There are many groups that explore alcoholism and its consequences. The National Institute on Alcohol Abuse and Alcoholism, Mothers Against Drunk Driving, Students Against Destructive Decisions, and Alcoholics Anonymous, are some that come to mind. Novel therapies, including acamprosate and naltrexone - pills to ease withdrawal symptoms - are being studied and tested.

Reports from the U.S. Department of Health and Human Services and the National Longitudinal Study of Adolescent Health have found that with teenagers, as far as risky behaviors go, approximately 23 percent of older adolescents are involved in regular alcohol use. Thirty percent of high school seniors smoke tobacco, 16 percent of older adolescents use marijuana, and half of older adolescents have been active sexually.

What helps to keep an adolescent on track and making decisions that are healthy? Researchers say homes where parents are authoritative but warm and consistent, and where consequences are applied when rules are broken, have a positive effect on teens. Other kinds of homes appear to foster riskier teen behavior. These include homes with autocratic parents (cold but applying rules), democratic (warm but with little or no rules), and non-involved (where contact and rules were not evident).

Dr. Mary Marden Velasquez, associate professor at The University of Texas Medical School at Houston's Department of Family Practice and Community Medicine, works with a directive approach to substance-abuse intervention called the Transtheoretical Model of Behavior Change and Motivational Interviewing. Through her teaching methods, patients learn to examine the consequences of their own faulty thinking or behavior without blame, and then are asked if they're ready to change. She recently co-authored a book on the subject, "Group Treatment for Substance Abuse: A Stages of Change Therapy Manual."

"Basically the stages of change involve precontemplation, contemplation, preparation, action, maintenance, and relapse and recycling. I teach the professional how to evaluate which stage of change a patient is in, so the professional can more efficiently counsel the patient to move toward the next stage of change. We consider relapse to be part of this process. We just ask, `And what did you learn from that? Did you learn that when you place yourself in that situation, the outcome isn't desirable?'"

Dr. Velasquez's method approaches addiction in a non-stigmatizing, respectful, and client-centered way.

"I spent some time in Greece where I was involved in setting up the stages of change approach for that country, teaching the doctors how to use intervention successfully in substance abuse programs there. Alcoholism does not carry the stigma it does here. In fact, whole families are involved in assisting their relatives, even bringing meals to the counselors and patients, while learning about the stages of change."

Dr. Velasquez, who is a co-principal investigator on a number of related grants, is currently the principal investigator for a $1 million dollar grant funded by the Centers for Disease Control and Prevention, "Project CHOICES: A Randomized Clinical Trail for Prevention of Fetal Alcohol Syndrome Among High-Risk Women."

"It's a nice window of opportunity," she says. "We can go in and look at why some of these women have come to this point in their lives and just talk to them about some of the facts of their behavior - that drinking and high-risk sexual behavior, for instance, place them in jeopardy for not only an unwanted pregnancy, but HIV, violence, and of course, substance abuse."

The 183-page report, Shoveling Up: The Impact of Substance Abuse on State Budgets, says three years ago, states spent 13 percent of their budgets on substance abuse and addiction. Of each dollar spent, 96 cents went to deal with the effects of substance abuse and addiction, and only four cents to prevent and treat it.

---

©2006 Texas Medical Center

---

E-Mail: tmcinfo@texmedctr.tmc.edu
URL: http://www.tmc.edu/tmcnews/10_01_01/page_28.html