Velasquez / Ingersoll / Sobell Women and Drinking: Preventing Alcohol-Exposed Pregnancies

2016
ISBN: 978-1-61334-401-9
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 84 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

An essential resource for anyone providing help or services to women at risk for alcohol-exposed pregnancies.

Drinking during pregnancy can cause a range of disabilities that have lifelong effects yet are 100% preventable. A variety of brief motivational behavioral interventions developed for nonpregnant women of childbearing age can effectively prevent alcohol-exposed pregnancies (AEP).

This book outlines clinical definitions and the history of Fetal Alcohol Spectrum Disorders (FASD), epidemiology and effects across the lifespan, evidence-based prevention practices such as CHOICES and CHOICES-like interventions, and opportunities for dissemination.

Based on decades of scientific research and clinical refinement, this volume is packed with helpful illustrative case vignettes, therapist–patient dialogues, sample forms, and handouts. The information and resources presented will help a wide variety of practitioners in diverse settings, ranging from high-risk settings such as mental health and substance abuse treatment centers to primary care clinics and universities, deliver interventions targeting behavior change.

Zielgruppe

For clinical psychologists, psychiatrists, psychotherapists and counselors, as well as students

Autoren/Hrsg.

Velasquez, Mary M.

Velasquez, Mary Marden

Ingersoll, Karen

Ingersoll, Karen S.

Sobell, Mark B.

Carter Sobell, Linda

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Epidemiologie, Medizinische Statistik
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

1 [1]Description Although the harmful effects of drinking alcohol during pregnancy have been observed for centuries, only in the past few decades has the relationship between prenatal alcohol use and birth defects been demonstrated (Randall, 2001). The concept of fetal alcohol spectrum disorders (FASDs) is relatively new, yet there have been differing opinions about how to label this continuum of disorders. In this chapter, the history of FASD and diagnostic issues are discussed. In addition, the magnitude of the problem and its consequences for individuals, families, and society is presented. Although the book’s focus is on the prevention of alcohol-exposed pregnancies (AEPs), this chapter will help practitioners better understand the concept of FASD, the individuals affected, and the types of preventive services available for such individuals. 1.1 What Are Fetal Alcohol Spectrum Disorders? FASD describes a range of effects in children related to maternal drinking during pregnancy The term fetal alcohol spectrum disorders is not a clinical diagnosis; rather, it is an umbrella term that has been used to describe a range of effects in children whose mothers have consumed alcohol when pregnant (Riley, Infante, & Warren, 2011). This includes a range of physical, mental, behavioral, and/or learning disabilities related to alcohol exposure during gestation. The lifelong implications of FASD can include deficits in intellectual processes (e.g., problem solving, attention, learning, memory, visuospatial abilities, motor functioning, social skills). Often those diagnosed with FASD experience a number of mental health issues and have overall poor life functioning and negative outcomes (O’Connor & Paley, 2009; Streissguth et al., 2004). Fetal alcohol syndrome (FAS) is a condition that falls at the extreme end of the FASD continuum, and is associated with the most severe impairments in functioning. 1.2 How Is FASD recognized? Because our understanding of the effects of maternal drinking during pregnancy is evolving, the development of diagnostic criteria to identify FASD is relatively new. A diagnostic schema recognizing the physical effects (e.g., abnormal facial features, growth problems, central nervous system problems), which can be more directly observed and are characteristic of FAS, was first issued by the Institute of Medicine (IOM; Stratton, Howe & Battaglia, 1996). [2]While the current International Classification of Diseases (ICD-D; World Health Organization, 2011) recognizes FAS, it does not recognize FASD, which contains a wider range of significant neurodevelopmental and mental health symptoms often associated with prenatal alcohol exposure (Bertrand & Dang, 2012). FAS is a condition that falls at the extreme end of the FASD continuum, and it is associated with the most severe impairments in functioning Clinical Pearl FASD Is a SPECTRUM of Disorders Conventional understandings of the impact of drinking during pregnancy were based on conceptualizations of fetal alcohol syndrome (FAS), a condition that is often easily detected by hallmark facial abnormalities. Although FAS is the most severe diagnosis under the fetal alcohol spectrum disorder (FASD) umbrella, multiple and varied disabilities and symptoms can arise from prenatal exposure to alcohol, and we urge practitioners to avoid the conventional view based on FAS and recognize that FASD refers to a broad spectrum of disorders from mild to severe. To do otherwise will only perpetuate problems in screening and diagnosis. We encourage practitioners to develop a thorough understanding of the effects of AEP, and to modify their practices accordingly. For instance, many of the symptoms falling under the central nervous system dysfunction cluster (e.g., hyperactivity, impulsivity, attention deficits, learning and intellectual disabilities) are not accompanied by facial abnormalities, and cannot be physically measured like growth deficiencies. To provide needed services to the children and families affected by FASD, practitioners need to recognize the more subtle signs of FASD. 1.3 The History of FASD Concerns about the dangers of drinking during pregnancy have a long history, dating back to the medical literature in the 1700s The physical effects of drinking during pregnancy were noted dating back as far as the 1700s when the Royal College of Physicians of London reported that babies born to mothers who drank heavily during pregnancy were “weak, feeble, and distempered” (Royal College of Physicians of London, 1726, p. 253). A related concern was depicted in a 1751 lithograph, Gin Lane, which English artist William Hogarth produced during London’s so-called gin epidemic. Hogarth’s print, which includes an image of a drunken woman letting a child fall from her arms, is a social commentary about the rampant use of highly distilled alcohol at the time, especially among women. When Hogarth published his print, fetal and infant death rates were higher than in previous years, even though it was a period of good wages, plentiful food, and relative freedom from the epidemic diseases that typically accounted for high infant mortality (Warren & Bast, 1988). Reports of alcohol’s negative effects on children continued throughout the 18th and 19th centuries. The earliest description of what is meant by the term fetal alcohol syndrome came from Dr. William Sullivan, a deputy medical officer at a prison in England. Sullivan observed that pregnant women prisoners who were heavy drinkers not only had higher rates of miscarriages but also that the babies who survived often displayed distinctive patterns of birth defects (Sullivan, 1899). Dr. Sullivan also reported that mortality and stillborn rates for children born to alcoholic mothers were more than twice those of [3]nonalcoholic mothers, and the more a woman drank during pregnancy, the greater the likelihood of fetal problems. During the anti-alcohol period of the 1920s and the onset of Prohibition in the United States, interest in FAS declined (Randall, 2001; Warren & Bast, 1988). Forty years later, in the early 1960s, interest in FAS gained some momentum with the publication of a few scientific articles. However, during this same period, many researchers tried to refute the idea that alcohol could be detrimental to an unborn baby (Warren & Bast, 1988). Scientific interest in the effects of alcohol on birth outcomes and child development gained momentum in 1967 when a family physician, Alexandre LeMache, published a report in the French Academy of Medicine about his 37 years of work with more than 1,200 children born to alcoholic mothers (Warren & Bast, 1988). His observations included neurological and behavioral problems, mental retardation, genital malformations, facial anomalies, and a high infant death rate. Unfortunately, LeMache’s report had a limited impact as it did not present diagnostic criteria that could have facilitated the identification of fetal alcohol effects (Hoyme et al., 2005). A subsequent French publication by Lemoine and his colleagues described anomalies in the children of parents with serious alcohol problems (Lemoine, Harousseau, Borteyni, & Menuet, 1968). This article also failed to receive much attention, perhaps because it was in French and because the journal had limited circulation. Several years later, a team of US researchers at the University of Washington, which included pediatric dysmorphologists and psychologists, reported patterns similar to those described by Lemoine. Jones and Smith (1973) were the first to use the term fetal alcohol syndrome (FAS), describing it as “a diagnosis for two” In 1973, a landmark study published in The Lancet described a small group of children all born to mothers who drank heavily during pregnancy (Jones, Smith, Ulleland, & Streissguth, 1973). All of the children had similar facial characteristics, growth deficiencies, and central nervous system dysfunction. In another publication that same year, Jones and Smith (1973) were the first to use the term fetal alcohol syndrome (FAS), describing it as “a diagnosis for two” (i.e., the child and the mother). Following this, there was a flurry of research studies, mostly epidemiological in nature. From the 1970s on, epidemiological and case studies confirmed Jones and Smith’s findings that maternal prenatal alcohol exposure can cause a pattern of permanent deficits in unborn children. By 1990, FAS had been documented in studies published in over 20 different languages (Abel, 1990). With sponsorship from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the first international meeting on FAS was held in Seattle, Washington, in 1980. During the 1980s and 1990s, professionals and practitioners became increasingly aware of the problems caused by AEPs. As it became clear that a range of developmental problems were associated with maternal alcohol consumption, and that children with distinctive FAS facial features represented only the severe end of this spectrum, it was also clear that concern about maternal drinking during pregnancies should not be limited to those women who drink heavily (Calhoun, 2011). Shortly before his death, Smith made a plea for the field to recognize a wider spectrum of damage caused by prenatal drinking which he termed fetal alcohol effects (Smith, 1981). This term, which was later used to describe intellectual disabilities and behavioral problems resulting from an AEP, has today fallen out of favor. In 1981, the [4]US Surgeon General’s Office first recommended warnings against alcohol use during pregnancy (Office of the Surgeon...