Addictive Disorders in Arctic Climates

Theory, Research, and Practice at the Novosibirsk Institute

Bernard Segal

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317837855
• Edition: 1
• Topic: Medicina
• Subtopic: Farmacología

Discover fresh perspectives on alcoholism treatment and research with this enlightening new book describing the work of researchers at the Novosibirsk Medical Institute, USSR. By using specific examples of their studies in Siberia, the reserachers offer an innovative approach to the treatment of addictive disorders in general. Instead of focusing on the drinking behavior itself, the treatment focuses on the relation of the problem to the interaction of economic, social, and psychological factors. To address the question of whether alcoholics should all be treated in the same way, or if alcholism treatment should be more individualized in approach, chapters are devoted to the differences between alcoholism in women, adolescents, and alchoholics who are afflicted with "rapid development of alcholism syndrome." The research examples in Addictive Disorders in Arctic Climates benefits professionals involved in the treatment of alcholism by introducing new perspectives and broadening contemporary research.

Addictive Behavior in Women: A Theoretical Perspective

C. P. Korolenko, MD
T. A. Donskih, MD

C. P. Korolenko and T. A. Donskih are affiliated with the Novosibirsk Medical Institute.

Theoretical Perspective

The analysis of events which take place in a society, such as deviant behavior (behavior that is considered to border on or depart from socially acceptable ethics and morals), leads to observations and conclusions about the event, which then tends to bring about an increase in the behavior studied. These increased deviations are discovered in various fields of contemporary life and have diverse manifestations. Belonging in this category, for example, are such behaviors as stealing, violent crimes, aggressive behavior among certain groups of people, such as fanatics, black marketers and corrupters, gambling, and the misuse of various substances for the purpose of achieving an altered state of consciousness. The variety of these deviant behaviors leads to a situation in which such disorders come under the care of different medical specialists and different disciplines, which include medicine, education, police, social workers, etc. The necessity for such a diverse effort is brought about by the specific features of the different disorders. However outwardly different these deviations may appear, they nevertheless have some specific common characteristics. Discovery of these common characteristics may be significant for prevention and treatment of these problems.

Essential to establishing a common understanding of these different behavioral manifestations is the derivation of a term that unites them. The term deviance has recently been cited by researchers, especially in sociological literature. In a sociological context, the investigation of deviant behavior reflects the nature of social problems and the level of tension in a society.

One form of deviant behavior is addictive behavior. Addictive behavior may be defined as a desire to escape from reality by means of changing one’s mental state, usually achieved by using substances with narcotic effects, including alcohol. Such an alteration of consciousness, however, is not limited to using drugs. Prolonged listening to rhythmically accentuated music, for example, or psychological exercises (meditation, yoga), can also induce an altered state of consciousness to help an individual escape from reality. Other forms of addictive behavior involve gambling or eating, either of which is qualitatively and quantitatively different from drug use or self-induced psychological change. As such, alcoholism and other forms of drug abuse both represent different forms of the overall problem of addictive behavior, which itself is a representation of the much broader problem of deviant behavior.

Alcohol and drugs are not new to societies in most parts of the world. The current history in the USSR, however, is marked by a new dimension of addictive behavior–the widespread use of alcohol as well as many different kinds of mind-altering substances by large segments of society. A similar situation has also been described with respect to drug use in the United States (Segal, 1988).

The use of the term addictive behavior is very operative. It may reveal the peculiarities of the development of alcoholism, narcotic addiction, and forms of drug addiction, each of which has been considered to be a separate entity by specialists in addiction studies. When each of these problems are treated separately (i.e., a narrow approach), rather than as different manifestations of an addictive disorder, there is a strong risk of making not only a tactical error but also a strategic error, either of which, over time, can be costly. The narrow view contributes to create a public and professional attitude that calls for “the eradication of evil,” (i.e., attacks against drinking). These attacks are based on an over-simplified explanation of alcoholism, which relies on an eclectic combination of formal logic, pseudo-emotional fervor, and an appeal to common sense.

This is especially dangerous when such programs are created as a result of group pressure from people who are fanatically convinced that all forms of addiction are unrelated phenomena and are responsive to some rather simple form of treatment.

A recent and very illustrative example of such a situation was the attempt to solve the alcohol problem in the USSR with the help of predominantly prohibition-like measures affecting the production and sale of alcohol. It was possible to predict that there would be some negative consequences of such action based on the experience of attempts at prohibition in other countries during the 20th century, such as Iceland, Norway, the United States (1920-1932), Russia and the USSR (1914-1925), and Poland (1981 to 1983). Some of the negative consequences that were recorded in these countries were an increase in home-brewing, black market profiteering, the appearance of organized criminality associated with illegal production and sale of alcohol, and an increase in intoxication through various types of substances which change one’s mental state. Although these results varied in each country, the nature of their variation was strongly dependent on local social and cultural factors. For example, in the United States, the development of organized criminal gangs such as the mafia was an important by product of Prohibition. In Russia and the USSR, production of home-brewed brandy increased. In Poland production of home distilled alcohols, black marketing, decrease in sugar supplies, and an increase in intoxication through the use of other drugs and various toxic substances were noted.

Korolenko and Timofeeva (1986) attempted to report that prohibition-like efforts would not be totally effective but, unfortunately, their opinions were not in conformance with popular opinion, and were not taken into consideration. More recently, however, recognition has been paid to the realization that the attempt to limit alcohol has not been successful in eliminating alcohol-related problems. Additionally, there is an increasing awareness that addictive behavior has many different manifestations, and that these behaviors differ from what has been traditionally defined as classical addiction.

The concept of classical addiction is nevertheless repeatedly quoted in Soviet psychiatric textbooks. But the clinical picture regarding narcotic addiction has changed so dramatically in the USSR that today’s cases no longer match the classical description. Thus the description of the classical narcotic addict is no longer relevant. In other words, psychiatric thinking has failed to keep up with changes in the field.

It must be stressed that there is a need to move from the old position of classical addiction to the more modern concept of addictive disorders. The concept of addictive disorders is currently utilized in our clinic in Novosibirsk, and is part of our theoretical scheme that explains the development of addiction from its inception. Within the context of this framework, for example, narcotic addiction is seen as beginning as a primary desire to take narcotic substances with the aim of inducing a change of one’s mental state largely out of curiosity, or as a search for new and exciting sensations. In the case of classical narcotic addictions, the development of the process begins differently – narcotics are first taken as a result of a doctor’s prescription to treat pain, but repeated use results in the development of psychological and physical dependence. This process has been referred to as pharmacologically-based addiction.

Contemporarily, this approach does not account for all the different forms of drug dependence that occur. Even when opiates are used, they are used primarily to change one’s mood, to experience unusual sensations, to achieve psychological relaxation, and to induce a dream-like state. In addition to using drugs that have an analgesic effect to cause a change in consciousness, many other substances can be used such as various organic solvents or chemically modified drugs. When the substance of choice is unavailable the user seeks to substitute other drugs, but such changes only take place in the absence of strong physical dependency to the basic drug. Many substances do not induce physical dependence at all, but may contribute to severe organic disorders or brain damage with such clinical symptoms as memory loss, impoverishment of thinking, and a decrease in intellectual abilities.

We pay special attention to these peculiarities because effective preventive measures can not be based only on prohibition. Prohibition, when it is carried to an extreme to where it even bans over-the-counter medicines containing alcohol, is unduly restrictive for people who have no alcohol problems and who show little risk for development of alcohol dependence. People with addictive behavior are less affected from such limitations because they strive to find substitutes or turn to alternative drugs. A severe anti-addictive or prohibitive public policy is usually associated with a failure to understand the integral nature of the problem, which represents a complex interaction of many different factors. It must also be noted that the prohibition-like reaction to alcohol problems was not accidental. It resulted from an integration of attitudes about alcohol that prevailed in other fields such as sociology, economics, culture and education.

The discussion that follows applies some of the thinking expressed above to the study of addictive behavior in women. The results of the research presented is derived from an ongoing series of studies involving the principle authors and other clinical practitioners involved with the problem of addictive disorders in the Novosibirsk Medical Institute.

Women and Alcohol: The Relationship between Theory and Clinical Observations

In the last decade more and more women have become involved in addictive behaviors. Their misuse of alcohol has become one of the most widespread problems in the USSR. The number of women drinking has doubled over the last ten years. In the 1970s in the USSR the number of women who drank was estimated to be approximately 5 percent¹ of the alcohol abusing population. It is now estimated to be about 10 percent.

An analysis of the characteristics of women alcoholics by us showed that among those who drank alcoholically, a large number first showed some form of deviant behavior that proceeded the development of alcohol dependence. This finding was most consistent among youth and young adult women who, before their drinking problems started, showed social problems, consistently violated ethical and cultural norms, and who had numerous sexual relations with casual partners. Many of these women who gravitated towards criminal behavior did not have very strong attachment to their parents, relatives and friends. Their actions were based on a strong need to achieve immediate gratification without taking any consequences into consideration, even though intellectual ability was generally high. Once drinking started, the effects of drinking brought about a change in their motivation to drink. They now drank out of a desire to maintain a sense of stimulation, to alter impressions of reality, and to alter consciousness. As a whole, these women did not experience a deep emotional trauma in their lives or express feelings of shame and repentance. When confronted with their problems they always promised to improve, to “begin a new life,” but they maintained their old ways. They are, however, able to make a positive impression, and even evoke sympathy and trust from people unacquainted with them.

One of the features of these alcoholic women consisted of an inability to endure loneliness, they do not like to be alone even for short periods of time. If they must be at home with parents or relatives for some reason, they listen to loud rhythmic music or talk over the telephone with their friends, who show the same behavior. They usually tend not to drink alone, but among others. They seek to obtain the alcohol’s kef [dreamy condition] effect, and in some cases other substances are used in combination with alcohol or independently.

The character and the frequency of drinking and other drug use are connected with the characteristics of the group in which social relationships take place. Many women who act out are generally associated with other members of a group who also show antisocial tendencies. The types of social interaction and behavior are different for various groups, and there are variations of group dynamics. The forms of addictive behavior also vary. These women present a high risk for development of alcohol and drug dependency, sexually transmitted diseases, and are apt to commit criminal offenses.

Thus it can be clearly seen that there is an integral relationship between alcoholism, addictive behavior, and deviant behavior, and that treatment and prevention must proceed on a multidimensional level. For example, even if the drinking behavior is stopped, other problems remain, such as having to respond to periodic use of other drugs. In all these cases addictive behavior only changes its form of expression. A positive outcome can be obtained only through the elimination of the motives contributing to the deviant behavior, and not by only treating some form of an addictive disorder.

In context of learning more about the problem of women and alcohol, we investigated 160 women and teenage girls who ranged in age from 15 to 60 years old, all manifesting some form of deviant and addictive disorder. The sample group consisted of 20 school-girls, 35 college students, and a combination of 45 women who held skilled, unskilled and professional jobs, and 60 women who were unemployed. Extremely detailed psychiatric histories were obtained about their childhood and upbringing, and extensive psychological testing was also conducted (e.g., MMPI, Rorschach). Based on the results of this evaluation it was possible to identify some specific types of childhood rearing patterns that were found to be related to their deviant and addictive disorders. Six types of childhood experiences were derived.

Clinical Subgroups Based on Childhood Experiences

1. The first clinical subgroup, representing 33 percent of the cases, were all found to have clearly identifiable unfavorable childhood conditions. This was expressed by their having described a lack of parental attention, warmth, and emotional attachment. Many women (13%) came from single-parent homes, having been reared only by their mothers. Others came from a home situation involving a mother and stepfather, characterized by frequent quarrels, rows, and constant conflict between the girls and their stepfathers. From time to time these situations lead to serious fights which resulted in the girls running away. The parents were not interested in how their daughters succeeded at school and did not know how confused and troubled the girls were. The children felt lonely. They were often unsupervised by their parents. In many cases only bear necessities of food and clothing were provided – no emotional support was given. The girls did not have a positive image of their parents, and an emotional attachment to the home was absent. They did not like to return to their home, or to stay at home for long periods of time.

2. The second group (18% of the women) was composed of women who were brought up in an environment in which the families expressed antisocial attitudes. Of these women, 68% came from single-parent homes, with only the mother present. The mother’s antisocial attitudes were expressed by frequent alcohol misuse, a lack of interest in meeting parental responsibilities, and sexual promiscuity. There was little parental emphasis on spiritual and intellectual development because they themselves showed little interest in these matters. The situation at home was one of child neglect, unsanitary conditions and, in many cases, the home represented nothing more than some type of night shelter to the child. The girls were constant witnesses to drinking-bouts, bawdy talk, fights, and to explicit sexual behavior by their mothers or fathers with casual sexual partners. In families without fathers, the father was usually in prison for thievery or hooliganism.

3. The third group (9% of the cases) was represented by women whose childhood was experienced in orphanages or boarding-schools. In all cases the children reared in orphanages were raised under extremely strict conditions. The staff and teachers did not establish any emotional relations with the children, which seemed to have instilled an avoidance in establishing close personal ties with people in general. These girls only anticipated trouble, humiliation and punishment from the staff. One significant factor was that it was practically impossible for the girls to be alone –there was always a steady presence of other children. The collective group of children created microgroups, each of which chose their own leaders and arranged their own rules, and any violations resulted in an immediate penalty. Great importance was attached to physical strength, to the ability to achieve something by deceiving adults, and by a display of independence. Their sexual interests began early. The girls who rose to leadership positions within the groups were seen as authority figures by the others, and they symbolized maturity and independence. In keeping with their roles, the leaders acted in an off-hand manner, smoked, flirted with boys, and drank alcohol, showing an unusual ability to consume large amounts but not to get drunk.

Each group’s behavior reflected the personality of its leader. For example, if a leader was prone to juvenile delinquency the members of the group soon followed. The same pattern was observed with respect to the leader’s drinking or use of other drugs.

4. The fourth group (21% of the cases) represented women who came from well-established upward mobile families who were striving to move ahead socially and economically. The girls were expected to be well dressed, their parents bought them fashionable clothes, and they were expected to conform to parental expectations. Significant attention was paid to the demonstration of an outward appearance of prosperity. The tendency to raise the prestige of the family was strongly accentuated. The parents were very conformist, desiring to meet accepted standards of behavior in their circle, and they sought to make a good impression on acquaintances. The child was regarded as one of the attributes of social well-being, to be demonstrated in society as a symbol of success.

In contrast to the public side, the family’s private side reflected narrow and conservative attitudes. People were valued only on the basis of their fina...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• Preface
• Introduction
• A Review of the Problem of Alcoholism in Siberia
• Clinical-Psychological Approaches to Alcoholism: Multiple Versions of Alcohol Dependence
• Social-Psychological Aspects of Drinking by Youth and Young Adults
• Addictive Behavior in Women: A Theoretical Perspective
• The “Rapid Course of Development” of Early Alcoholism in Young People
• REVIEWS Soviet and American Perspectives on Addiction: A Brief Critique