Interventions for Alcohol Dependency in Children and Young People - Research Proposal Example

Interventions for Alcohol Dependency in Children and Young People Introduction Alcohol dependency (or alcohol-use disorders) is one of the most important public health topics in the UK. Current statistics suggest that it affects over 4% of the UK population aged between16 and 25, making it a common disorder. Alcohol dependency can be extremely harmful to those of any age, but is particularly damaging both physically and psychologically to young people aged 10-17. Additionally, in this age group, there are a number of psychosocial aspects of their habit to consider, as well as the possibility of abuse (Horsfall et al, 2009). There are also a number of therapy options, such as family therapy, which may be more appropriate for this age group than for others. These factors mean that interventions for alcohol dependency in children and young people have to vary slightly from standard interventions. As a public health topic, alcohol dependency in this age group is important as it can help to normalize certain behaviours (Lembke, 2011), which may further the problem. Alcohol itself is one of the biggest burdens on the NHS, as it can lead to problems with the cardiovascular and digestive systems (Lembke, 2011), as well as causing dementia and related psychiatric problems. The purpose of this research is to explore which interventions for alcohol dependency in the 10-17 age bracket are most appropriate, and should inform policy guidelines on the matter. To do this, a critical review of the literature on the topic will be conducted. In this review, primary research on alcohol dependency in young people will be explored to show some of the most important issues that this age group has with alcohol dependency. This will highlight the important areas upon which to focus when considering interventions, and suggest areas that may be missing from current knowledge. Additionally, current policy guidelines in the UK will be analysed to ascertain whether they are appropriate when considered in light of the literature review. Aim The main aim of the research is to highlight the most appropriate interventions for children and young people suffering from alcohol dependence. Objectives The objectives for the research are: To critically assess the current literature on alcohol dependency in children and young people To uncover and explore the areas which need to be improved upon when considering this topic To produce guidelines to inform an improved policy with respect to alcohol dependency in the 10-17 group Search Strategy To find the most appropriate literature for this review, a strict search strategy was used as outlined below. Search Terms 1. “Alcohol Dependence” AND “Children” OR “Young People” 2. “Interventions” “Alcohol Dependence” “Public Health” AND “Children” OR “Young People” 3. “UK Policy” OR “UK Guidelines” AND “Alcohol Dependence” AND “Children OR “Young People” Databases Used The databases used for the searches were Academic Search Complete, PubMED and Google Scholar. Results The number of hits that each of the search terms listed above is given below, with the database that returned the most results being used. 1. 14391 2. 13839 3. 4122 Inclusions and Exclusions Literature published before 2002 was excluded from the literature review as it was deemed to be irrelevant and potentially out of date, particularly the information on guidelines. Literature that was included was judged to be the most relevant amongst the search results at that time when informing the research objectives. Manual Information Included in the literature review is the NICE Pathways information set (NICE, 2011). Literature Review Alcohol dependency in children and young people is on the rise in the UK (NICE, 2011), and therefore has the potential to become a serious public health issue. Bonomo et al (2004) researched the relationship between alcohol dependency in those aged 14 to 15 and their later drinking habits and addictions at 20 to 21, and how this was a predictor of cigarette smoking, depression and other drug use. The study showed strong links between alcohol use at a young age and later dependence (as well as to other negative behaviours) and stresses the importance of early intervention to reduce the negative long-term conditions of excessive alcohol usage. The results suggest that programs that target young people may help to reduce incidences of alcohol dependence later in life, which may reduce the public health burden further. As a quantitative study, this study has the benefit of having less subjective interaction with the patients which may induce bias (Wood & Ross-Kerr, 2010). Additionally, the study was done on over 2000 patients, which suggests the results may be generalizable. However, there is a clear bias in that the criterion for inclusion in the study was DSM-IV alcohol dependence, which is not always the most accurate measure statistically, as alcohol problems tend to remain hidden, particularly in children who have been mistreated (Shin et al, 2009). Additionally, unlike a qualitative study, it is unclear about the psychological aspects of the study that may need to be taken into account for policy guidance. Chung & Martin (2005) uncovered some interesting elements of how the DSM-IV diagnostic criteria relates to teenage views on drinking and alcohol. This research is interesting, as it highlights some of the reasons that teenagers may be susceptible to alcohol dependence and how the typical psychological criteria may not necessarily be applicable to this age group. For example, the research highlights that the DSM-IV holds one of the criteria for diagnosis as drinking more or longer than intended, which does not apply to many teenagers who drink simply for intoxication effects. This may lead to measurement errors when using standard diagnosis mechanisms within the 10-17 group. As a qualitative study, the research highlights a lot of the issues around teenage drinking and the links with alcohol dependency, particularly the attitudes towards alcohol that some young people have. Qualitative research such as this is useful for determining attitudes. However, this combined with the semi-structured interview format may lead to some interpreter bias (Punch, 2005) from the researchers. Qualitative research also has limitation on sample sizes (as is seen in this study of fifty individuals) which means that care must be taken when making generalizations (Punch, 2005). Despite these limitations, this research suggests that policy and research may need to focus on young people’s attitudes towards alcohol. Many studies have explored the causes of alcohol dependence and attempted to link these to questions of how some individuals develop this disorder as young as 10. Sartor et al (2008) examined 3546 female twins to help clarify the proportion of genetic and environmental influence. The research builds upon earlier research on male twins (Scherrer et al, 2008), and confirms a genetic component which evidently cannot be targeted with public health initiatives. Milne et al (2009) designed a prospective longitudinal cohort study of 981 individuals to explore the environmental effects of family history. This study showed that environmental exposure to alcohol may increase susceptibility to alcohol dependence, although it does not appear to decrease age at onset. The large, quantitative nature of the study makes it less prone to bias, but it must be noted that the study took place in New Zealand and thus care must be taken when using this to explore UK policy (Punch, 2005). Additionally, Milne et al (2009) focused on four psychiatric disorders, which may have confounded the results slightly. Also interesting to consider is the research by Harden (2010) which explores how religiosity affects young people and alcohol dependence. Although the results are merely correlative, there is strong evidence of a link between religious family environments and reduced incidence of alcohol dependence in young people. This suggests that specific elements of this environment may be influencing attitudes towards alcohol and thus incidence of dependence (Sartor et al, 2008). Enoch (2011) also found a correlation between early-life stress and alcohol dependence in children in a review of the literature. By reviewing the literature, a more general overview of the subject can be gained and aspects of bias are removed, suggesting that this result has a high validity (Punch, 2005). Taking this into account, it can be assumed that policy needs to focus on home environment and family attitudes when considering alcohol-dependence issues in children and young people, and research further into specific protective or aggravating elements of certain environments. The National Institute for Health and Clinical Excellence (NICE) pathways on alcohol dependence also offer some guidance on alcohol dependence in young people. The guidelines do specify the need for special care when discussing alcohol dependence in children aged 10-15 (NICE, 2011), as this may require extra sensitivity. Additionally, the NICE guideline do stress that familial involvement may be appropriate when necessary, as this has been shown to be more effective in many kinds of therapy in children with psychiatric conditions (Goldenberg et al, 2012). However, the guidelines for prevention and screening have overlooked the need to alter the DSM-IV diagnostic criteria to fit with this age group and their attitudes, as Chung & Martin (2005) suggest. The NICE guidelines also focus on abstinence as the primary goal of treatment for alcohol dependence in children and young people, as with any age group (NICE, 2012). Whilst this has been shown to be the most effective way of controlling alcohol dependence (Lawrence et al, 2009), there are several things that need to be taken into account. Firstly, there is acute alcohol withdrawal, which is an issue in any age group (NICE, 2011). Secondly, attitudes towards alcohol and binge-drinking in this age group are different to that of adults (Chung & Martin, 2005), and this needs to be acknowledged when considering how to approach life-long abstinence as an option to the dependent young person. As the research by Harden (2010), Enoch (2011) and Milne et al (2009) suggests, there may also be a necessity to deal with environmental and psychological issues with the child before aiming for total abstinence. In this case, abstinence will need full co-operation from parents or legal guardians, as alcohol will need to be removed from the home to prevent relapse (Lawrence et al, 2009), amongst other supportive measures. Finally, there are the complications of alcohol dependence to consider. Firstly, a child or young adult with this condition is statistically more likely to suffer from problems with this or drug addiction in later life (Bonomo et al, 2004), which means that this is long-term project. Alcohol dependence is also often co-morbid with other conditions, such as depression and anxiety (Kranzler & Rosenthal, 2010), which means that any policy (as the NICE guidelines do) needs to incorporate provisions for these mental health issues. Additionally, alcohol dependence can cause brain damage in any individual, although young people may be more at risk, which suggests that provisions for care and long-term goal achievement need to be worked into policy and planning. Young people may also need advice on sexual health issues that have arisen due to alcohol dependence, as alcohol and sexual promiscuity are correlated (Kranzler & Rosenthal, 2010). This suggests that advice and provisions for these events will also need to be worked into an effective public health plan for children and young people with alcohol dependence. Conclusion Evidently, there are a lot of things to consider when considering alcohol dependence in young people. Firstly, there are the environmental effects which cause dependence, which are varied, and require further research to ascertain specifics. Additionally, there are risk-factors, such as genetics and early alcohol dependence, which need to be worked into policy. Finally, there are complications which need to be taken into account, such as the increased likelihood of depression, anxiety and sexual health problems. There are gaps in the research, particularly regarding young people who suffered from alcohol dependence in their formative years and how they responded, and continue to respond to, treatment options and advice. It is also evident that there are a number of things to consider with this disorder which apply generally to alcohol dependence and specifically to children and young people, which highlights the need for this research. References Bonomo, Y.A., Bowes, G., Coffey, C., Carlin, J.B., Patton, G.C., 2004. Teenage drinking and the onset of alcohol dependence: a cohort study over seven years. Addiction 99, 1520–1528. Chung, T., Martin, C.S., 2005. What were they thinking?: Adolescents’ interpretations of DSM-IV alcohol dependence symptom queries and implications for diagnostic validity. Drug and Alcohol Dependence 80, 191–200. Enoch, M.-A., 2011. The role of early life stress as a predictor for alcohol and drug dependence. Psychopharmacology 214, 17–31. Goldenberg, H., Goldenberg, I., Goldenberg, S.M., 2012. Family therapy: An overview. Brooks/Cole Publishing Company. Harden, K.P., 2010. Does religious involvement protect against early drinking? A behavior genetic approach. Journal of Child Psychology and Psychiatry 51, 763–771. Horsfall, J., Cleary, M., Hunt, G.E., Walter, G., 2009. Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): A review of empirical evidence. Harvard review of psychiatry 17, 24–34. Kranzler, H.R., Rosenthal, R.N., 2010. Dual Diagnosis: Alcoholism and Co-Morbid Psychiatric Disorders. The American journal on addictions 12, s26–s40. Lawrence, A.J., Luty, J., Bogdan, N.A., Sahakian, B.J., Clark, L., 2009. Impulsivity and response inhibition in alcohol dependence and problem gambling. Psychopharmacology 207, 163–172. Lembke, A., Humphreys, K., Moos, R., 2011. Diagnosis, Development, and Treatment of Substance Use Disorders among Adolescents and Young Adults. Handbook of Developmental Psychiatry 365. Milne, B.J., Caspi, A., Harrington, H.L., Poulton, R., Rutter, M., Moffitt, T.E., 2009. Predictive value of family history on severity of illness: the case for depression, anxiety, alcohol dependence, and drug dependence. Archives of general psychiatry 66, 738. National Institute for Health and Clinical Excellence, 2011. Alcohol Dependence Disorders. PH24. London: National Institute for Health and Clinical Excellence. Punch, K.F., 2005. 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