"Det var jag som var den där vuxna och han var ett barn" : En kvalitativ studie om hur det är att vara ett vuxet barn till en alkoholist

Syftet med vårt lärdomsprov är att undersöka hur uppväxten i en alkoholistfamilj har påverkat det vuxna barnet. Vi undersöker även vilka konsekvenser det vuxna barnet fått av uppväxten, vilket förhållningssätt det vuxna barnet har till alkohol och hur relationen mellan det vuxna barnet och den missbrukande föräldern ser ut. I teoridelen definieras alkoholismen; vad är alkoholism, vem kan bli alkoholist och vad är skillnaden mellan en alkoholist och en storkonsument. Vidare fastställs missbrukets effekt på familjen, samt barnens roller i en alkoholistfamilj. Även typiska karaktärsdrag och konsekvenser i vuxenlivet tas upp. I undersökningen har vi använt oss av kvalitativ undersökning. Vi har intervjuat fyra personer som har en pappa som är alkoholist. I resultatet framkommer både likheter och olikheter mellan vuxna barn till alkoholister, men den gemensamma nämnaren är konsekvenser i vuxenlivet för alla barn som levt med en alkoholiserad förälder.The aim of our thesis is to investigate how growing up with an alcoholic parent has affected the adult child. We also examine the impact on the adult child as a result of growing up in a family where one parent is or was an alcoholic, what kind of attitude the adult child has to alcohol and how the relationship between the adult child and the alcoholic parent has been affected. In our theoretical part, we define alcoholism; what is alcoholism, who can become an alcoholic and what is the difference between an alcoholic and a big consumer. Further down we establish the impact on the family and the children's roles in the family. We also cover the typical characteristics and consequences in adult life. In the survey, we used a qualitative research. We have interviewed four people who have a father who is an alcoholic. The result shows both similarities and differences between adult children of alcoholics, but the common denominator is that all children of alcoholics are affected in adulthood

Förebyggande arbete bland gravida mödrar med riskbruk av alkohol

Examensarbetet är framställt inom projektet familjehuset vars syfte är att utveckla familjehusverksamheten genom mångprofessionellt och resursförstärkande arbete. Detta arbete fokuserar sig på riskbruk av alkohol bland gravida mödrar för att förebygga risker under graviditeten och framtida konsekvenser hos fostret. Inom projektet finns en beställning av reflektionskort. Korten inom detta arbete tar upp frågor kring alkohol och graviditet för att få gravida mödrar att reflektera kring de risker det finns och för att förebygga alkoholkonsumtion under en graviditet. Reflektionskorten skall alltid användas i samarbete med en professionell som har kunskap inom ämnet, detta för att kunna motivera modern. Ämnet är aktuellt eftersom allt fler kvinnor i fertil ålder konsumerar rikligt med alkohol och alkoholism anses vara en folksjukdom i dagens samhälle. Med fokus på fostret och på barnen så är det påvisat att allt fler barnfamiljer omfattas av barnskyddets öppenvård. Syftet är att få gravida mödrar att reflektera kring ämnet med hjälp av korten. Korten är baserade på den teoretiska delen vars litteratur är tillförlitlig.Tämä opinnäytetyö on osa hankekokonaisuutta Familjehuset, jonka tarkoituksena on jatkaa perhetalotoiminnan kehittämistä voimavarojen vahvistamisen ja moniammatillisen työn kautta. Opinnäytetyö keskittyy odottavien äitien alkoholin riskikäyttöön, tavoitteen ollessa että ammattilaiset voivat ehkäistä odotusajan riskejä, jos äiti juo alkoholia raskauden aikana, sekä ehkäistä sikiöön kohdistuvat, äidin alkoholin käytöstä johtuvat seuraukset. Hanke on tehnyt tilauksen reflektointikorteista, ja tämän opinnäytetyön lopputuotteena on kortit jotka keskittyvät raskaudenaikaisen alkoholinkäytön vaaroihin, tarkoituksena saada äidit pohtimaan omaa alkoholinkäyttöä ja siihen liittyviä riskejä, jotta alkoholinkäyttö raskauden aikana saataisiin ehkäistyä. Kortteja tulee aina käyttää äidin motivoimiseen yhdessä ammattilaisen kanssa, jolla on tietoja aiheesta. Aihe on ajankohtainen koska hedelmällisessä iässä olevat naiset juovat yhä enemmän alkoholia, ja koska alkoholismi nähdään nykyään kansantautina. Tarkoituksena on saada raskaana olevat äidit pohtimaan aihetta korttien avulla. Kortit pohjautuvat opinnäytetyön teoreettiseen osioon, jossa käsitellään alkoholin aiheuttamia seurauksia raskauden aikana.The thesis is produced within a project called Familjehuset which is aimed to develop family house operations by multi-professional and resource-enhancing work. This work focuses on risky alcohol consumption among pregnant mothers to prevent risks in pregnancy and future consequences for the fetus. The project has ordered a set of reflection cards. The cards in this thesis raise questions about alcohol and pregnancy to pregnant mothers in order to make them reflect on the risks that are involved and to prevent alcohol consumption during pregnancy. The reflection cards should always be used in cooperation with a professional who has knowledge of the subject, in order to motivate the mother. The subject is relevant as more and more women of childbearing age consume copious amounts of alcohol and alcoholism is considered a public health problem in today's society. Focusing on the fetus and the children, it is shown that an increasing number of families are subjects to child welfare interventions. The aim is to get pregnant mothers to reflect upon the subject with the help of the cards. The cards are based on the theoretical part which literature is reliable

"Det var jag som var den där vuxna och han var ett barn" : En kvalitativ studie om hur det är att vara ett vuxet barn till en alkoholist

Syftet med vårt lärdomsprov är att undersöka hur uppväxten i en alkoholistfamilj har påverkat det vuxna barnet. Vi undersöker även vilka konsekvenser det vuxna barnet fått av uppväxten, vilket förhållningssätt det vuxna barnet har till alkohol och hur relationen mellan det vuxna barnet och den missbrukande föräldern ser ut. I teoridelen definieras alkoholismen; vad är alkoholism, vem kan bli alkoholist och vad är skillnaden mellan en alkoholist och en storkonsument. Vidare fastställs missbrukets effekt på familjen, samt barnens roller i en alkoholistfamilj. Även typiska karaktärsdrag och konsekvenser i vuxenlivet tas upp. I undersökningen har vi använt oss av kvalitativ undersökning. Vi har intervjuat fyra personer som har en pappa som är alkoholist. I resultatet framkommer både likheter och olikheter mellan vuxna barn till alkoholister, men den gemensamma nämnaren är konsekvenser i vuxenlivet för alla barn som levt med en alkoholiserad förälder.The aim of our thesis is to investigate how growing up with an alcoholic parent has affected the adult child. We also examine the impact on the adult child as a result of growing up in a family where one parent is or was an alcoholic, what kind of attitude the adult child has to alcohol and how the relationship between the adult child and the alcoholic parent has been affected. In our theoretical part, we define alcoholism; what is alcoholism, who can become an alcoholic and what is the difference between an alcoholic and a big consumer. Further down we establish the impact on the family and the children's roles in the family. We also cover the typical characteristics and consequences in adult life. In the survey, we used a qualitative research. We have interviewed four people who have a father who is an alcoholic. The result shows both similarities and differences between adult children of alcoholics, but the common denominator is that all children of alcoholics are affected in adulthood

Hazardous alcohol use and alcohol use disorders in women : characteristics and vulnerability factors

The overall aim of this thesis was to study vulnerability factors associated with hazardous alcohol consumption during pregnancy and alcohol use disorders among Swedish women. Different risk-factors and characteristics were studied, and examined for their ability to discriminate or identify different subtypes (type I/late onset and type II/early onset) of alcohol dependence ( alcoholism ). In study I, an RCT at ANC in Stockholm (control, n = 156, intervention, n =147) we examined the ability of Swedish antenatal care to identify alcohol-related risk pregnancies, and the utility of some tools that could improve its performance (AUDIT, TLFB and biomarkers). In study II, a pilot cohort (n = 139) was screened for alcohol use disorders, and assessed for psychopathology, personality traits, and alcohol use during the first trimester. Subjects reporting consumption exceeding a conservative threshold for harmful use were offered a diagnostic psychiatric interview. The main findings of the pilot study were replicated using a large sample of women in the third trimester (n = 715). In study III and IV, a case-control study, detailed assessment was obtained from 200 treatment-seeking alcohol dependent women and 189 healthy population controls. All women were assessed for alcohol-related behaviors, sexual abuse history, psychiatric problems, and personality traits. Cases and controls were genotyped for markers in the CRHR1, MAOA and OPRM1 genes. In study V, female twins from the Swedish Twin Registry (n =13 501) answered questions to establish lifetime alcohol use disorders, and subjects with alcoholism were classified for subtype. Heritability estimates were obtained, and environmental factors associated with alcoholism and its subtypes were studied. Sixteen percent of pregnant women drank at levels that could be defined as riskconsumption . Significantly more of these were identified by intensified screening compared to regular antenatal screening procedures (p = 0.0001), while biomarkers were of little use. Only a minority of women with hazardous alcohol consumption during pregnancy fulfilled alcohol dependence criteria. Psychiatric distress in those with risk-consumption did not differ from those with low or no consumption during pregnancy, but subjects with continued alcohol use scored higher on novelty seeking. Among women with alcohol dependence, early onset/type II alcoholism is a valid construct. We found that alcohol dependent women classified as type II had more severe alcohol problems and significantly higher rates of illicit drug use. Family history of alcoholism was also considerably more common among type II than subjects than those classified as type I. Both alcoholism subtypes scored higher than normal on anxiety and impulsivity traits, but type II subjects scored markedly higher than either of the other groups on aggression (p = 0.00004). Despite a higher density of family history among type II subjects in the clinical cohort, our twin study did not support a difference in heritability between early onset/type II and late onset/type I alcoholism. Both genetic and environmental factors play an important role for susceptibility to alcoholism in women, in particular the early onset subtype. Childhood trauma is a category of environmental factors that plays a major role. The effect of emotional neglect and physical trauma was accounted for by familial background factors, which can be both genetic and environmental. In addition, childhood sexual abuse was an independent individual risk factor for alcohol dependence. Effects of sexual abuse were in part mediated trough psychiatric problems. Overall, treatment-seeking alcohol dependent women with a history of abuse have distinct features as compared to other alcohol dependent women

Essays on Societal Cost of Alcohol and Related Issues - A Health Economic Analysis

The consumption of alcoholic beverages has wide effects, for example, causes premature mortality, prevents certain heart diseases, increases crime rates, and affects quality of life. The main problems with alcohol consumption from an economic point of view are lack of information for consumers when making consumption decisions, externalities, and the addictive nature. It is expected that this results in non-optimal consumption levels, causing higher costs than benefits. Studying the effects of alcohol consumption is thus important in order to increase information and to allow interventions and regulations to be implemented targeting market failures, with the overall purpose of improving societal and individual welfare. The aim of this thesis is to study the effect of alcohol consumption on society, calculating the societal cost of consumption, and investigating possible improvements with regard to the estimation methods, data materials, and methodological assumptions. The focus of the latter is on issues related to labour market outcomes. Four research papers are included, together covering the aim. Paper I conservatively estimates the societal cost of alcohol consumption in Sweden, including health and quality of life effects. The costs add up to a net cost of SEK 20.3 billion (0.9% of GDP) in 2002. To this should a partial estimate of reduced quality of life be added, totalling 122,000 QALYs. Sensitivity analyses indicate a sensitivity range of 50% of the net cost. However, even the lowest plausible estimate shows net societal cost of alcohol consumption. Paper II investigates the effect of low alcohol consumption on health, measured as medical care costs and prevalence of alcohol-attributable diseases. It is found that low alcohol consumption increases medical care costs and episodes, with the exception for individuals above 80 years of age. Thus, the protective effect of low alcohol consumption for some diseases can not fully counter the detrimental effect from those diseases where low alcohol consumption increases the risk. Based on the epidemiological literature, low alcohol consumption should therefore not be considered to improve health. Paper III studies a methodological issue in connection to the wage equation; whether failure to account for individuals’ drinking histories causes heterogeneity within commonly pooled consumption groups, potentially causing bias in econometric estimations. By applying a multinomial logit model, it is found that pooled drinking groups (current abstainers and light drinkers) are heterogeneous, and that this might implicate estimation bias due to confounding and misclassification. This study thus argues that it is imperative to account for drinking history when studying the effect of alcohol consumption. Paper IV analyses the effect of women’s alcohol consumption on the likelihood of being long-term absent from work. Drinking history and selection effects are controlled for by applying a Heckman model. Women who are not a long-term light drinker is associated with an increase in the probability of long-term sickness-related absence, except for the insignificant effect of being a current light but former heavy drinker. The strongest effect is found for former drinkers (18%) followed by former abstainers (15%). Surprisingly are both being a long-term abstainer and a long-term heavy drinker associated with an increase of around 10%. Several simulation models were estimated, for example investigating the potential societal gain in productivity if all women were long-term light drinkers. It is found that the effect of alcohol consumption on long-term sickness-related absence is rather small on an individual level, although the added societal effect is substantial. It is shown in this thesis that alcohol consumption has a large societal impact. The societal cost was estimated in Paper I and Paper II – IV have supplied new information, with focus on the possible wage effect of alcohol consumption, in order to improve future estimations. Paper II rejects, based on the epidemiological literature, the possibility that the positive wage effect of low alcohol consumption is mediated through a protective health effect. According to Paper III, drinking history should be controlled for although this can not explain the commonly found inversed U-shaped relationship between alcohol and wages. Paper IV in turn suggests sickness-related absence as a mediator, potentially explaining (parts of) the alcohol – wage effect. Finally, the thesis has shown that the results of cost estimations are sensitive to what type of data is being used. Compared to a society without alcohol, the current Swedish consumption increases long-term sickness-related absence when using epidemiological data (Paper I), and decreases absence when using microdata and econometric methods (Paper IV)

Blödning efter isolerad implantation av biologisk aortaklaff : en retrospektiv studie

Aortaklaffstenos är den vanligaste indikationen för implantation av biologisk aortaklaff. Enligt vårdrekommendationer har patienterna antikoagulativ behandling med warfarin i tre månader efter operationen. Målet med studien är att kartlägga blödningar hos patienter med biologisk aortaklaffprotes, samt undersöka riskfaktorer för blödning i denna patientgrupp. Undersökningen gjordes på material som retrospektivt samlats in ur patientjournaler från universitetssjukhus i Finland och är en del i CARE-AVR-projektet. I materialet ingick 721 patienter och det förekom totalt 98 blödningsincidenter under uppföljningstiden, av dessa var 56 stora blödningar. I studien framkommer att behandlad hypertension innan aortaklaffimplantationen tredubblar risken för stor blödning. Permanent warfarinbehandling vid 3 månader efter operationen ökar risken för blödning. Kön, ålder vid operationen, diabetesbehandling och hjärtsvikt inverkar inte på blödningsrisken. En modifierad HAS-BLED klassifikation lämpar sig inte som verktyg vid bedömning av blödningsrisken hos patienter med biologisk AVR

Påverkar ruset ekonomin? En empirisk studie av alkoholkonsumtionens inverkan på ekonomisk tillväxt

Syftet med denna uppsats är att undersöka om det föreligger ett samband mellan alkoholkonsumtion och ekonomisk tillväxt, samt att utröna hur detta potentiella samband ser ut för olika kvantiteter av alkoholintag. Sambandet mellan alkoholkonsumtion och makroekonomiska utfall är ett relativt outforskat område, vilket lämnar sambandet mellan alkoholkonsumtion och tillväxt nästintill outforskat. Den teoretiska utgångspunkten är att alkoholkonsumtion påverkar arbetskraftens produktivitet, humankapital, befolkningstillväxt samt offentliga utgifter. Envar av dessa faktorer är tillika sådana som enligt den tillämpade tillväxtmodellen samt empiriska undersökningar påverkar den ekonomiska tillväxttakten i ett land. Den empiriska undersökningen är gjord med paneldata för 38 länder och sträcker sig över tidsperioden 1960-2010. Med hjälp av minsta kvadrat-metoden (OLS) har skattningar på effekter av alkoholkonsumtion på ekonomisk tillväxt tagits fram för både alkoholkonsumtion generellt, samt för olika nivåer av konsumtion. Resultaten visar att alkoholkonsumtion har en signifikant positiv påverkan på ekonomisk tillväxt men att det positiva sambandet är svagare för högre konsumtionsnivåer