Magazine article Clinical Psychiatry News

Push Better Parenting in Substance Abuse Patients. (Breaking the Cycle of Violence)

Magazine article Clinical Psychiatry News

Push Better Parenting in Substance Abuse Patients. (Breaking the Cycle of Violence)

Article excerpt

AMELIA ISLAND, FLA. -- Physicians can intervene with violent, substance-abusing patients to interrupt the cycle of violence in families, Dr. Kathleen T. Brady said at the annual meeting of the American Academy of Addiction Psychiatry.

An area where physicians have been remiss is teaching alcohol and substance abuse patients to be better parents, she said. There is a strong connection between substance abuse and aggression or violence, induding some common neurobiology, and a combination of pharmacotherapy and behavioral treatments can be effective.

"Punitive parenting, poor supervision, and a genetic predisposition for abuse can lead to 'at-risk' children," said Dr. Brady of the Medical University of South Carolina in Charleston. "If you're going to break the cycle, you have to pick a place where you can intervene," which, as she suggested, may be to promote better parenting.

Violent, substance-abusing patients often have an alcoholic or abusive family of origin, as was the case with a 24-year-old, alcoholic white man, who was violent with his wife when intoxicated. His wife threatened to leave if he did not seek treatment, so he came to see Dr. Brady.

"He was very apologetic--it had happened two or three times," she said. He was recently arrested for fighting in a bar, and had lost two jobs and his driver's license. Although he was not violent with his children, his parenting was inconsistent and punitive. He also had a family history of depression and, possibly, bipolar disorder. His paternal grandfather committed suicide violently.

Upon psychiatric and neuropsychiatric evaluation, Dr. Brady noted that the patient reported feeling sad, frustrated, and irritable. He had classic deficits in executive cognitive functions associated with substance abuse and aggression, such as attention, planning, abstract reasoning, and self-monitoring. "It's hard to sometimes differentiate mood disorders in people with alcohol dependence. Over the years he was either drunk or going through withdrawal," she said. …

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