The Blame Game
© 2002 Mary Horner
Historically alcoholism has always been viewed as a simple matter of 'willpower'. To some extent even in modern times we still harbor the principles of shame and blame that caused heavy drinkers to be led through town by a cord in their nose 17 centuries ago. Even today the majority view Alcoholics Anonymous as the only 'treatment' for alcoholism. While the goals of this organization are admirable, it fails entirely to address the psychoactive nature of alcohol. It also ignores the genetic and ethnic roots of alcoholism. In order to understand Fetal Alcohol Syndrome and address the root causes of this disability, we must be informed about alcoholism and view it as the illness it is, rather than the 'weakness' it historically has been labeled as. In so doing we will move from a blaming stance and stop 'shoulding' all over women who struggle with alcoholism. What needs to be developed are more treatments that are founded on medical knowledge.
I think alcoholism is like a virus that lies dormant in your body and when the right conditions occur it can flair up. If the right conditions never occur you might never know that the virus is in your system.
In other posts I have indicated the research that has found that offspring exposed to alcohol in utero have fewer dopamine receptors and also have different neuron activity. I have heard several birth moms who were alcoholics in recovery, themselves children of alcoholics, say that the very first time they drank was an epiphany for them - it made them feel whole in a way they never had before. The research backs this up because the depressed dopamine activity is finally brought into normal balance with the presence of alcohol. Further, I have my own daughter who did not have to 'train' to become a drinker. At her age I could drink exactly 1 5/8 beers - that's why my husband married me; I was a cheap drunk (just kidding but he used to tease me about my low tolerance). In any case almost from day one my daughter could drink a case of beer on her own and not appear drunk. This is not normal and I think this is an indication of the type of neuron/receptor damage that exists in her brain.
I have a friend who slurs his words so badly I can no longer understand him. He is falling down all the time and injuring himself. He does not plan to attend his daughter's graduation. Nor will he attend her wedding. You say there is no excuse for this. His disease will kill him before he will see any of these milestones in his family's life. He has ALS - Lou Gherig's disease. I had a relative who lay on the sofa day after day and ignored her children. She became verbally abusive. She had a disease. But you say this is not an excuse. She died of cancer, her disease. Another friend's mother also died on the sofa from a massive brain hemorrhage. Her disease was alcoholism.
Obviously, I believe alcoholism is a disease and I believe that it is this disease we are battling and not the women who suffer from it. I believe that until we find a way to reach these women and to treat this disease, FAS will continue to follow in its wake. Further, I believe that until we acknowledge this and stop denying, we have no hope of mounting a successful campaign. The 'will' to find solutions is handicapped as long as we continue to blame women for their alcoholism rather than viewing alcoholism as the enemy. What I find frustrating is that if we can't get the truth about alcoholism over to people on support groups such as FASlink and OlderFAS, how can we ever hope to get the knowledge out to the average person in society, in the world?
Here is the reality these women face. They often live in poverty, have poor prenatal care, poor nutrition and health, and psychiatric/mental health and drug use issues. In a 1994 study of 500 BC women in alcohol and drug treatment programs, 92% of those of childbearing age had suffered emotional abuse, 69% physical abuse, and 51% sexual abuse.
One adoptive mom's personal glimpse on birth moms: "We don't know much about our son's birth Mom but do know that she was the
5th of 6 children of an alcoholic Mom, that she was sexually abused by her stepfather and that she dropped out of 8th grade to have her first child. She has had a long history of problems with drugs and alcohol and landed in a long-lasting co-dependent, abusive situation with our kids' Dad. When I met her, not knowing about FAS, I was stumped by what seemed to me to be a very emotionally immature "attitude" about her kids. She could be very tearful one minute and joking in the next, without any comprehension of her responsibility in the situation. I am now convinced that she suffers from FAS herself and never had a chance, without outside help (that "external brain") to stop making the same mistakes over and over (7 children worth)."
This story brings reality to the issue that birth moms 'should' know better. How can anyone reading this description of a birth mom hold this poor girl responsible? It was society that failed to intervene, to support her, to care enough to discover that she too is probably dealing with brain damage. These women aren't monsters. They are victims in my mind, in need of our compassion and services.
Another adoptive mother: "I live day to day with the affects that alcohol has had on my 6 children. I do not blame their birthparents. Blaming their parents only lessen my children's self-esteem. I do not need this for my children. I work everyday to help build their self-esteem."
This type of blaming is discouraging. I have never wasted any energy blaming the bio mom. All I have to do is look at my own daughter, brain damaged by FAS, further brain damaged to be programmed for alcoholism, further brain damaged by her own alcoholism as a result of the prenatal programming, who is probably another in the cycle of bio moms, to realize that she can't help herself.
Are birth mother's intentionally careless? I doubt that there is a birth mom who knowingly sets out to harm her unborn child. The women I have met who are both alcoholics and birth moms of FAS-affected children have shared heartbreaking stories. Many are themselves children of alcoholics. They lacked the knowledge, they lacked the medical support and care, they were living in poverty and abuse. But not one ever intended to harm her child. Many of these women are now in recovery and many are active in the FAS movement, including Diane Malbin who has written two landmark books, which are amongst the most highly recommended books on FAS. The single most poignant workshop at last year's FAS conference in Vancouver was the birth moms' panel. These women were eloquent and courageous in their efforts to reach out to us and to tell their stories. I can tell you that I was so blown away by their presentation that I was unable to attend the following workshop. I admire their honesty and strength.
Many people express shock, righteous indignation and disgust that despite all that is known about FAS, women continue to drink in pregnancy. I am really troubled by this attitude. How many of us REALLY knew and understood the actual facts about FAS back when our children were conceived. How many of your mothers, sisters and friends are truly aware even now? What about your 16-year-old daughters or nieces? Would you hold these young girls responsible despite the lack of education in sex ed classes and despite the fact that most 16-year-olds are not planning on getting pregnant?
I suggest most alcoholic parents have a disease that they are suffering from, which causes them to behave in such a way that compromises the welfare of their children. But like all diseases, they need medical intervention to get well. I suggest that the brain damage to their frontal lobes caused by this disease is further impairing their ability to 'think'. I suggest that it is time we all stop blaming the messenger and find a cure for the message, which is alcoholism.
"Society cannot help those who are not willing to help themselves."
Does society help those who are not ABLE to help themselves? If a person is mentally retarded or blind or schizophrenic or diseased in some way, say HIV or cancer, does society help?
Dr. Sumner about birth moms: "As society, we are to protect and help our members, especially the bio mom who is an addict. To provide her with a companion during pregnancy would cost $50,000, and guarantee a healthy child. This is much less than raising a child with FAS." The way he puts it, we have no reason to point a finger at a bio mom. Remember when you point one finger, the others are pointed at yourself.'
Kristi Swendrzynski, FAS Instructor at University of Wisconsin-Madison: "Society's role is to identify and support women substance abusers BEFORE they become pregnant (and thus prevent FAS). We shouldn't forget that as many as 60% of U.S. pregnancies are unintended.... and it isn't always easy for an addicted woman (or even substance abusers) to end up pregnant and THEN try and stop drinking. We need to put more focus on addressing substance abuse/addiction PRE-pregnancy."
Alcoholic birth moms operate without free choice. Many of these women have lost the ability to make wise, responsible choices. I don't think women should have the right to drink while pregnant. I think the fetus has an equal right to be healthy and to be born with his genetic potential intact, which should take precedence. However, penalizing the mom who struggles with alcoholism will not bring the results we want. Moms who need help will be less likely to come forward or seek it if they fear a penalty. They will be more likely to hide their pregnancy and their addiction. We need to support these women with knowledge and compassion based on the fact that alcoholism is a brain disease.
Definitions of Alcoholism:
National Council on Alcoholism and Drug Dependency: A DISEASE with impaired CONTROL over drinking, preoccupation with alcohol, continued use despite consequences, and distorted thinking. American Society of Addiction Medicine: Primary, chronic DISEASE with genetic, psychological, and environmental factors characterized by continuous or periodic use, impaired CONTROL over drinking, preoccupation with alcohol, use despite consequences, and distortion in thinking
The American psychiatric community has formulating and published its diagnostic criteria for mental disorders in the Diagnostic and Statistical Manual of Mental Disorders. DSM-III-R described alcohol dependence as including both physiological symptoms, such as tolerance and withdrawal, and behavioral symptoms, such as impaired CONTROL over drinking. In ICD-8, alcoholism was a separate category that included episodic excessive drinking, habitual excessive drinking, and alcohol addiction that was characterized by the compulsion to drink and by withdrawal symptoms when drinking was stopped.
The U.S. government, and in particular the National Institute of Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse not only consider addiction a brain disease... but have been proactively campaigning to raise public awareness about this very issue. For example, Alan Lechner, head of NIDA, states the following "Remarkable research and technological advances in the past two decades have proved that brain disruption and damage play central roles in the consequences of drug abuse and addiction." In addition, the Institute of Medicine has adopted the term "brain disease" for several recent publications indicating that this is a disorder involving the brain and brain mechanisms.
Alcoholism is a brain disease
Here's
a site worth looking at: http://www.utexas.edu/research/asrec/unsecure/etohgenes.html
A critical question in addiction," said R. Adron Harris, director of the Waggoner Center for Alcohol and Addiction Research at the University of Texas at Austin, "is how the reprogramming of the brain leads to long-lasting, severe, life-threatening dependence. This study provides insight regarding the molecular neurocircuitry of the frontal cortex that is altered in alcoholism. A key point here is that we study the superior frontal cortex. This is also called the 'executive cortex' because it is critical for judgment and decision making, tasks that are corrupted in addiction. Just as a computer virus can change the programming of specific functions, our data show that chronic alcohol abuse can change the molecular programming and circuitry of the frontal cortex."
"Drugs can change gene expression and thereby disturb normal functions of the cell and tissue," explained Harris. "Alcohol can change gene expression in the brain and this is believed to be responsible for many of the hallmarks of addiction, such as tolerance, physical dependence, and craving as well as the consequences of chronic alcoholism, such as neurotoxicity (brain damage).
"Alcoholism is a major health problem in the US," said Harris, "yet there are few treatment options. This is due to our lack of understanding of the process of addiction. Alcoholism is a brain disease..."
"Addiction is essentially a chronic relapsing disease of the brain," said Friedbert Weiss, Associate Professor in the Department of Neuropharmacology at The Scripps Research Institute and senior author of the study.
What Role does Environment play in alcoholism?
Scientific research has clearly shown that alcoholism is a disease of the brain. While environmental factors may influence the progression of the disease and exacerbate drinking, they do NOT cause alcoholism.
I agree that environment plays a role in drinking patterns and habits. Students on campuses across North America are surrounded by drinking. Yet only a fraction will become alcoholics, even though probably all will experience more than one session of binge drinking. What is the critical factor that drives one to go over the edge into alcoholism, while most of us, after puking our guts out once or twice (?) finally manage to get the drinking under control so that it does not run our lives. According to research, some are predisposed to alcoholism because of changes in their brain reward center with regard to either dopamine receptors or the action of the dopamine neurotransmitters. Additionally, there are those whose extreme drinking has damaged these same receptors leading to addiction. Environment does play a role with some but not all alcoholics. But in order to become alcoholic if you were not predisposed you have to drink enough to alter the balance of neurotransmitters and receptor sites. Environment may lead you to cause this damage but it is still the brain that is the center and will take over and drive the alcoholism. This is why alcoholism is said to be a disease of the brain. Other organs are injured as well but the control site is the brain.
Alcoholism and dopamine:
I did a Google search under dopamine+alcohol and came up with some interesting information that served to reinforce and clarify this week's lecture.
First
some random quotes: "Addiction is essentially a chronic relapsing disease
of the brain," said Friedbert Weiss, Associate Professor in the Department
of Neuropharmacology at The Scripps Research Institute.
http://www.utexas.edu/research/asrec/unsecure/smellrelapse.html
"One of the important benefits of animal experiments is that they remove the moral question from alcoholism," said Dirk Gibson, supervisor of the addiction program at Benefis Healthcare. "They show that alcoholism is a medical illness. Therefore, people suffering from this disease should be treated with compassion and respect."
(Scientists)
have discovered that alcoholism isn't just a human weakness - it can be induced
in monkeys, rats and mice by changing the chemical levels in their brains.
And scientists now can prove that the disease is genetic.
They can breed rats that crave alcohol, are indifferent to it, or hate
it. http://www.gannett.com/go/difference/greatfalls/pages/part2/breed.html
Jessica said, "If you're mother or father is an alcoholic, you are surrounded by the behavior and therefore, are more likely to partake in the behavior yourself." I think that if your parents are alcoholics there are a number of possibilities you are overlooking that have nothing to do with the environment. This course is about FAS. If your mother is an alcoholic than it is safe to assume that you were exposed to alcohol as a fetus. This may predispose you to all kinds of brain damage that may have a significant impact on the way you handle alcohol.
What does it mean to be genetically predisposed? Here's more info from my dopamine+alcohol search:
The researchers found that the electrical activity of dopamine neurons in the brain is reduced in the offspring of pregnant rats exposed to alcohol. http://www.parentsplace.com/pregnancy/exposure/articles/0,10335,239060_114244,00.html
At
Wayne State University a study was performed in which pregnant sheep were
intubated with alcohol. It was
found that the resulting offspring had a significantly decreased number of
dopamine binding sites. This would
suggest that prenatal alcohol expose would cause persistent changes within the
dopaminergic system. http://www.macalester.edu/~psych/whathap/UBNRP/Dopamine/alcoholtobac.html
In some rats, alcohol doesn't seem to affect normal dopamine levels. But alcohol-craving rats seem to start with a dopamine deficit, then use alcohol to stimulate the chemical. Ultimately, the brain depends on alcohol for production of dopamine, making withdrawal doubly difficult. http://www.gannett.com/go/difference/greatfalls/pages/part2/breed.html
Chronic drinking has been associated with low levels of dopamine and its metabolites in humans. Dopamine D2 receptors are depleted in human alcoholics. Dopamine D2 depletion produces a blunted pleasure response that leads alcoholics to increase their intake. http://www.nih.gov/news/pr/sep2001/niaaa-13.htm
I found this last site most hopeful as the research described the use of gene therapy in rats to reduce alcohol consumption. The results suggest that increasing levels of dopamine D2 may protect against alcohol abuse in humans.
Who are the women who are having FAS babies?
Who are having babies and who are at greatest risk of giving birth to a FAS-affected infant? I believe we can divide the populace of fertile women into 4 groups:
1) Well-educated, mature, and/or responsible women who are planning a pregnancy,
2) Well-educated, mature, and/or responsible women who discover they are in the midst of an unplanned pregnancy,
3) Women of all classes, ages, and education levels who are struggling with alcoholism,
4) Young women, typically teens who are partying, binge drinking and sexually active every weekend.
All of these women may be influenced by early education, which is a must. The first two groups will go to their docs and follow medical advice for a healthy birth. But how do we reach groups 3 and 4. Often, these women don't know or admit they are pregnant until it is too late. These women don't get appropriate medical care and support. One of the recognized groups at highest risk is students. They are not planning on having babies. The rate of alcohol consumption on campuses across North America is horrendous.
There has been some success with a program in Vancouver for alcoholics in the inner city. These women are given extensive one-on-one support. Blame and shame have no place in a program that hopes to have an impact with this group. There was a presentation on this program given at the FAS conference in Vancouver earlier this year Too many keep relating FAS to alcoholics. THIS IS A MYTH! It is just this kind of thinking that allows too many pregnant women out there to think that they don't need to worry about FAS because 'THEY' are not alcoholics. There is a massive clarification and education job to be done to warn every mother-to-be to be alcohol free.
This one segment of women, the alcoholics, poses a pretty daunting challenge. But these are not the only women having FAS-affected children. In fact I don't even believe that they are in the majority. The women we can reach are the young women and the unplanned pregnancies where individuals are indiscriminately having sex and partying. If we don't care about ourselves and the risk this poses to our own health with regard the STD's and AIDs, perhaps we may be more successful (?) in getting women to think about the unborn child they may be unknowingly and unintentionally creating.
Some say that there is no excuse for ignorance. We have to deal with reality. Let's look at group #4, teens. If a teenager is binge drinking every weekend and having sex, she is not in a bar because she isn't old enough, she reads no warning labels because in the majority of countries around the world there is no labeling, she is not seeing her family doc about her sexuality and drinking because this is her secret and she has never heard about FAS in sex ed classes, then whether ignorance is an excuse or not is immaterial!!!!!!!!!
FACTS: Women at highest risk of drinking during pregnancy include women who smoke, who are single, WHO ARE IN COLLEGE OR HAVE A DEGREE, and women in households with incomes over $50,000. (Obstetrics and Gynecology Vol. 92, pp. 187-192, Aug. 1998)
Over 50% of women of childbearing age drink alcohol. (American Medical Association) And only 39% of women of childbearing age even know what FAS is. (National Institute of Health)
About 20% of women who are known to be pregnant continue to drink during their pregnancy. (Journal of American Medical Association) The incidence of drinking during pregnancy has increased substantially in the past several years, possibly due to the misleading media message that a drink a day is healthy. (Center for Disease Control and Prevention)
What I take out of this is that we can't dismiss the risk of FAS as only an alcoholic problem or only a problem for poor, uneducated women. This risk is sitting right on the campuses across North America as they are populated by young, single, college educated students who party a lot.
FAS babies beget FAS babies
Streissguth's long-term study points out another group of birth moms who definitely do not understand their own responsibility. In this study the birth moms themselves were FAS/E - 57% of them no longer had their children in their care; 40% were drinking during pregnancy; 17% had children diagnosed FAS/E and an additional 13% had children suspected of having FAS/E. Without dramatic intervention, many FAE women in particular will go on to have FAS affected children.
For those who want to blame the alcoholic, what about the FAS alcoholic who is brain damaged and they don't get it. They can't connect their actions with the risk to an unborn child. I have not yet met a FAS teen or adult who could reliably take meds on their own. This goes for birth control pills. Never did my daughter manage to take a full 21 days in a row. She shared them with friends, she gave them away, she sold them on the street as illegal drugs. Then the doc put her on Depro Provera. Remember, the doc doesn't know she is FAS (the majority of FAE kids are undiagnosed or misdiagnosed) with the result that he is honor bound to the Hippocratic oath of confidentiality. So there is no follow up and the necessary support people are kept out of the loop. She did not return at the end of 3 months for the next shot. A year later it was too late. She was 23 weeks pregnant and did not even know she was pregnant!!!!!!! Another FAS reality - the medical professionals DON"T GET IT!
We may rage silently for these poor damaged babies we are raising who did not have any choice in their exposure to alcohol and will live a lifetime scarred by this teratogen. Please think ahead 15 years when these babies have become troubled, homeless teens. Again this is not their choice. This is the hand that life dealt them. Now this teen-baby you empathize with finds herself pregnant. If she is like my daughter she does not even realize she is pregnant because she "didn't think she could get pregnant" and she is not attuned to her own body. Of course, she has been drinking. NOW YOU BLAME HER. Where is this line we cross between empathy for the FAS child and blame for the FAS teen-child-mother who drank though pregnancy? Her damaged brain does not compute cause and effect. She has no idea what the abstract concept of 'responsibility' means.
Understanding alcoholism helps us understand our kids
Understanding that alcoholism is a disease of the brain helped me understand why my daughter is the way she is. I believe that she is demonstrating the type of dopamine receptor damage that affects offsprings of alcoholics, thus making her genetically predisposed to alcoholism. Perhaps because either she has less dopamine receptors or because the electrical activity of dopamine neurons in the brain is reduced, she was born with a tolerance that allows her to drink more before she experiences the same high as her friends. Perhaps because she is dopamine deficit, she uses alcohol to stimulate the chemical.
"Alcoholics
may be divided into two distinct groups. The
first of these groups is the Noradrenergic Type in which 80% of alcoholics fit.
Drinking alcohol improves their mood.
The seratonin Type is the category that remaining 20% of alcoholics fall
into. These individuals find
alcohol an excellent antidepressant and need to drink to stay normal. Thus reducing alcohol in this group results in decrease in
brain neurotransmitter release. In
a way they drink themselves sober. http://www.macalester.edu/~psych/whathap/UBNRP/Dopamine/alcoholtobac.html
Alcohol makes our FAS kids feel better in their bodies. These are children with MAJOR sensory problems. Their bodies bother them and do not work right. Alcohol may make it easier to live in those bodies.
When you are raising a grandchild whose genetic history includes alcoholism on both sides and who has also been prenatally exposed to alcohol, it becomes even more apparent that there will be a continuous need for education, starting at a young age, as this child matures regarding the increased risk alcohol poses specifically to them. In order to break the cycle of FAS adults birthing FAS children, it must be made absolutely clear that alcohol is a toxin and in all probability something they must choose to avoid at all costs.
Is AA the only treatment for Alcoholism?
I have attended a few AL-Anon meetings and I am concerned that their rigid adherence to the 12 Step program may be detrimental to promising new treatment methods. It is my understanding that the only materials welcomed at an AA meeting are materials that have been approved by the head AA organization. It was during this time that my daughter first was referred to a drug and alcohol teen program where the youth worker recommended the book I mentioned earlier that approached treatment through the body biochemistry. I brought this book to the AL-Anon group quite excited about sharing this research, which seemed to me to make incredible sense. It was the first time I had stopped to consider the medical ramifications of alcohol abuse. However, the group was not open to outside literature and preferred to focus entirely on the 12-step program. I find this logically unsound. If there is new research that has the potential of making alcoholics lives easier and more livable, why not use it. I would like AA to open their doors, to be willing to work at several levels to assist the alcoholic, to shed the mantle of shame and blame and take a bold stand on the true nature of this disease. I wish more recovering alcoholics would come out of the closet and share their stories, not just in 12-step meetings, but publicly to raise awareness and hopefully help prevent a future alcoholic from making the same mistakes.
Promising
Research on Treatments for Alcoholism http://www.macalester.edu/~psych/whathap/UBNRP/Dopamine/alcoholtobac.html
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