By Shanna Whan 10/10/17
Three years ago I had hit my personal rock bottom, and was at a point where I was ready to take my own life. And yet here I stand, today, blessed to be three years into a life fully-recovered, healthy, and completely free from any desire to even touch alcohol. There are countless women who think there is no hope left…It wasn't like falling off a cliff and having a tragic accident. It wasn't sudden. This thing took hold of my life when I was 18, and manifested over a period of more than twenty years. It began as a series of traumatic events and abusive relationships that happened when I was an extremely naïve young country girl.
Importance: Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD.
Objective: To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally.
Data Sources: MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions.
Study Selection: Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included.
Data Extraction and Synthesis: Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated.
Main Outcomes and Measures: Prevalence of FASD.
Results: A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population).
Conclusions and Relevance: Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.
Trivialization of cannabis consumption goes hand in hand with a growing exposure of children and the number of cannabis poisoning cases is steadily increasing. As clinical presentation can be different from what is currently seen in adults, added to the fact that it is not always suspected, diagnosis of cannabis intoxication in children is often delayed or missed. A 16-month-old girl was admitted to the pediatric emergency unit for an important drowsiness combined to moderate fever. After elimination of infectious causes, a toxic origin was considered and biological analyses led to the diagnosis of involuntary acute cannabis intoxication. In conclusion, cannabis intoxication in child has uncommon presentations compared to that seen in adults. In this context, biological analyses have a great importance for a rapid diagnosis and also for the understanding intoxication circumstance. This is of paramount importance because it may lead to consider child protection measures.
Tensions Rise Over Proposed Drug Testing for Welfare Recipients
WITH ice addiction declared a public health crisis, the Government’s proposed drug-testing trial of welfare recipients couldn’t come at a better time.
Methamphetamine-related deaths have doubled in Australia in just six years, according to new findings by the National Drug and Alcohol Research Centre.
Back in May, Prime Minister Malcolm Turnbull defended the controversial trial by saying: “If you love somebody who is addicted to drugs, don’t you want to get them off drugs?”
Naturally, but the fact is that addicts won’t seek treatment or be motivated to change unless they see a reason to do so.
Controversy: Alcohol, drugs and family violence
Alcohol and other drugs (AOD) is an interesting topic to analyse, because the relationship between AOD and family violence is extremely controversial. I argued in my paper that much of the controversy boils down to whether it’s acceptable to say that AOD causes violence. I interviewed several of the nine expert witnesses from the Commission’s AOD topic, and one of them explained to me that the way people treat AOD and causation is a ‘boundary marker’. This meant that if you’re not really careful to say that alcohol doesn’t cause violence, you lose your credibility with certain types of audiences, such as the family violence service sector and others who specialise in gender-based violence. Why is that, I wondered?
Growing up on opposite sides of the fence
Firstly, my participants said that the AOD sector and the family violence sector have grown up on “opposite sides of the fence”. One (an AOD practitioner) reflected that “we’re all carrying baggage from our history”:
So the drug and alcohol sector’s baggage is that we sprung up out of a group of disenfranchised people who’d had histories of their own addiction, who’d come through the other end, who had picked people up off the streets who were like them, and it was advocating for them and fighting with them against the world.
The ‘medical’ model of addiction as disease or disorder favoured by the AOD sector can also be seen as allowing men to shift responsibility for violence. To complicate things, AOD workers see more families where violence of varying degrees occurs between all family members, and in particular, said one of my participants, “they see more violence and abuse from women than you would within the [family violence] sector”.
On the other hand, the family violence sector works with women and children experiencing relatively uni-directional violence, often from the same men that the AOD sector is supporting. Their history is trying to get the public and the government to realise that family violence is a serious problem, and getting men to take accountability for their violence. These different histories present problems of both language and understanding.
Community attitudes to intoxication and responsibility
Then there’s the problem of community attitudes to alcohol and violence. None of the experts at the Commission said that intoxication could excuse violence, but community surveys show that a significant minority of people in Australia do believe that if you’re drunk, you’re not as responsible for your actions as when you’re sober. There’s this idea that people get drunk, lose control, and then ‘snap’ and become violent.
This is the exact opposite of the women’s movement’s power and control analysis of violence, where men are seen to use violence instrumentally and deliberately, in a way that is connected to the unequal distribution of power between men and women on a societal level. Researchers from this tradition argue that the problem is not due to reactive anger. Thus, attributing causality to drug and alcohol addiction can imply a lack of control on the part of abusers. It also moves the analysis from structural factors that we are all responsible for, to individual factors that are under the domain of personal responsibility.
What does it mean to say that something ‘causes’ something else?
Finally, different research traditions use the word ‘cause’ in different ways, leading to clashes and misunderstanding between public health/epidemiology researchers and domestic/family violence researchers. In his witness statement to the Commission, addiction researcher A/Prof Peter Miller argued that it is logical to refer to alcohol as a cause, based on epidemiological and public health arguments that if you take something away (i.e. alcohol) and the problem (i.e. violence) is diminished or disappears, that thing can be termed a cause of the problem (p.5). One of my interview participants made a similar argument:
The Royal Commission’s treatment of AOD and family violence
The Commissioners were determined to incorporate factors other than gender into their investigation of the Victorian family violence service system. According to Commissioner Neave (interviewed and identified with permission), their terms of reference required them to look beyond men’s violence towards women, and they very much treated those ToR as ‘ground rules’. They wanted to operate innovatively and “explore things that added to our knowledge, rather than repeating what had been said in so many other reports”.
For these reasons, coupled with submissions and community consultations that repeatedly referenced the role of AOD, the Commission decided to focus some of its attention on this issue – despite push-back from the family violence sector, who were concerned that this would dilute the message about gender. The Commission argued that a focus on alcohol consumption did not excuse violent behaviour: rather, “more extensive engagement with all of the risk factors that contribute to family violence is required to appropriately respond to violence, to support victims, and to hold perpetrators to account” (RCFV Report, vol. III, p. 300).