Mom's House, Dad's House
3 Hours
AR, CA, CO, FL, HI, KY, LA, MA, MI, MO, NV, NY, OH, OR, TX
According to the Stepfamily Association of America, 60 percent of all families are breaking up, and custody and visitation issues loom large in the lives of many parents. Isolina Ricci's Mom's House, Dad's House guides separated, divorced, and remarried parents through the hassles and confusions of setting up a strong, working relationship with the ex-spouse in order to make two loving homes for the kids.
Showing posts with label Ceus. Show all posts
Showing posts with label Ceus. Show all posts
January 27, 2010
January 20, 2010
Spousal and Partner Abuse CEUs
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. Learn definition and distinguish between types of abuse
2. Become familiar with relevant facts and statistics
3. Identify spousal/partner abuse symptoms
4. Evaluate the effects of spousal/ partner abuse5. Identify same gender abuse dynamics
6. Become familiar with relevant cultural factors
7. Learn the national domestic violence applicable laws
8. Become familiar with resources and referrals
Table of Contents:
1. Definitions and Types of Abuse
2. Facts and Statistics
3. Symptoms and Effects
4. Domestic Violence and the Law
5. Evaluation, Intervention and Treatment
6. Resources and Referrals
7. References
1. Definitions and Types of Abuse
Domestic violence and emotional abuse is characterized by physically and/or psychologically dominating behaviors used by a perpetrator to control the victim. Partners may be married or unmarried; heterosexual, or homosexual; living together, separated or dating. Domestic violence occurs in all cultures; people of all races, ethnicities, religions, sexes and classes can be perpetrators of domestic violence. Domestic violence is also known as domestic abuse, spousal abuse, or intimate partner violence. Domestic violence is perpetrated by both men and women. Domestic abuse is any form of abuse that occurs between and among persons related by affection, kinship, or trust. It can occur with youth, adults or elders of all ages and walks of life. The perpetrator often will use fear and intimidation as a method of control. The perpetrator may also threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence. Domestic abuse is intentionally trying to control another person. The abuser intentionally uses verbal, nonverbal, or physical methods to gain control over the other person. Domestic abuse includes:
• Physical abuse
• Sexual abuse or sexual assault
• Verbal abuse
• Emotional Abuse
• Financial abuse
• Neglect
• Ritual abuse
• Spiritual abuse
• Criminal harassment
• Stalking, and Cyber stalking(Stark, E., A. Flitcraft, 1996. Women at Risk: Domestic Violence and Women's Health. Sage).
There are many considerations in evaluating abuse including:
• Mode: physical, psychological, sexual and/or social.
• Frequency: on/off, occasional and chronic.
• Severity: in terms of both psychological or physical harm and the need for treatment.
• Transitory or permanent injury: mild, moderate, severe and up to homicide.
An area of the domestic violence field that is often overlooked is passive abuse leading to violence. Passive abuse is covert, subtle and veiled. This includes victimization, procrastination, forgetfulness, ambiguity, neglect, spiritual and intellectual abuse.
Increased recognition of domestic violence began during the women's movement. Awareness regarding domestic violence varies among different countries. Only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or more than 10% of the U.S. population.
There is increasing awareness and advocacy for men victimized by women. In a report on violence related injuries by the US Department of justice (USDOJ August 1997) hospital emergency room visits related to domestic violence revealed that physically abused men represent just under one-sixth of the total patients admitted to hospital reporting domestic violence as the cause of their injuries. The report reveals that significantly more men than women did not disclose the identity of their attacker. This is likely due to shame, stigma, and embarrassment associated with men victimized by women.
According to a July 2000 Centers for Disease Control Report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury
compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence.
Physical Abuse
Physical abuse is characterized by aggressive behavior that may result in the victim sustaining injury. Physical abuse attacks are used by the perpetrator to control the victim. The abuse is rarely a single incident and typically forms identifiable patterns that may repeat more and more quickly, and which may become increasingly violent.
Physical abuse can include:
• assault with a weapon
• biting, pinching
• burning
• choking
• kicking, pushing, throwing or shaking
• slapping, hitting, tripping, grabbing or punching
• tying down or otherwise restraining or confining
• homicide
Sexual Abuse and Assault
Sexual abuse and assault includes any non-consensual sexual activity ranging from harassment, unwanted sexual touching, to rape. Sexual harassment is characterized by ridiculing another person to try to limit their sexuality or reproductive choices, while sexual exploitation could involve forcing someone to participate in pornographic film-making. Examples of sexual abuse include fondling of genitals, penetration, incest, rape, sodomy, indecent exposure, forced prostitution, forced production of pornographic materials (
Verbal/ Emotional/ Psychological Abuse
Abbott, Pamela and Emma Williamson, 1999.. "Women, Health and Domestic Violence". Journal of Gender Studies).
Domestic violence is not only physical and sexual violence but also psychological. Psychological violence can be defined as intense and repetitive degradation, creating isolation, and controlling the actions or behaviors of the spouse through intimidation or manipulation to the detriment of the individual. Emotional and psychological abuse sometimes involves tactics to undermine an individual's self-confidence and sense of self-worth, such as yelling, mocking, insulting, threatening, using abusive language, humiliating, harassing and degrading. It can also include deprivation of emotional care, and isolating the individual being targeted (Five Year State Master Plan for the Prevention of and Service for Domestic Violence." Utah State Department of Human Services, January 1994).
Financial/Economic Abuse
Financial abuse occurs when one individual attempts to take total or partial control of another's finances, inheritance or employment income. It may include denying access to one's own financial records and knowledge about personal investments, income or debt, or preventing a partner from engaging in activities that would lead to financial independence.
Financial or economic abuse includes:
• withholding economic resources such as money or credit cards
• stealing from or defrauding a partner of money or assets
• exploiting the partner's resources for personal gain
• withholding physical resources such as food, clothes, necessary medications, or shelter from a partner
• preventing a partner from working or choosing an occupation
Ritual Abuse
Ritual abuse is defined as a combination of severe physical, sexual, psychological and spiritual abuses used systematically and in combination with symbols, ceremonies and/or group activities that have a religious, magical or supernatural connotation. Victims are terrorized into silence by repetitive torture and abuse over time and indoctrinated into the beliefs and practices of the cult or group. Ritual abuse may also be linked to Satanism or devil worship.
Spiritual Abuse
Spiritual abuse may include:
• using the partner's religious or spiritual beliefs to manipulate them
• preventing the partner from practicing their religious or spiritual beliefs
• ridiculing the other person's religious or spiritual beliefs
• forcing the children to be reared in a faith that the partner has not agreed to
Spiritual and religious abuse is also abuse done in the name of, brought on by, or attributed to a belief system of the abuser, or abuse from a religious leader. This can include Priests, Ministers, cult members, family members, or anyone abusing in the name of a deity or perceived deity. Spiritual or religious abuse can find its way into every religion and belief system that exists. It may encompass many other forms of abuse, especially physical, sexual, emotional, psychological and financial (Warshaw, C. (1993). "Limitations of the Medical Model in the Care of Battered Women". in Bart, P., E. Moran. Violence Against Women: The Bloody Footprints. Sage).
Harassment, Stalking and Cyberstalking
Stalking is harassment of or threatening another person, especially in a manner that physically or emotionally disturbs them. Stalking of an intimate partner can occur place during the relationship, with intense monitoring of the partner's activities, or it can take place after a partner or spouse has left the relationship. The stalker may be trying to get their partner back, or they may wish to harm their partner as punishment for their departure. Regardless of the motive, the victim fears for their safety. Stalking may occur at or near the victim's home, near or in their workplace, on the way to any destination, or on the internet (cyberstalking). Stalking can be on the phone, in person, or online. Stalkers sometimes do not reveal themselves, or they may just “show up” unexpectedly. Stalking is often unpredictable and dangerous. Stalkers may utilize threatening tactics including:
• “showing up” wherever the victim is located
• repeated phone calls (often hanging up)
• following the victim
• watching the victim from a hiding place
• sending the victim unwanted packages/gifts/letters
• monitoring the victim's phone calls
• monitoring the victim’s mail or internet use
• sifting through the victim's garbage
• contacting the victim's friends, family, co-workers, or neighbors to obtain information about the victim
• damaging the victim's property
• threatening to hurt the victim or the victim’s family, friends or pets
Cyberstalking is defined as utilizing the internet with the intention to harass and/or stalk another person. Cyberstalking is deliberate and persistent in nature. It may be an additional form of harassment, or the only method the perpetrator employs. The cyber stalker’s communication may be disturbing and inappropriate. Often, the more the victim protests or responds, the more rewarding the cyberstalker experiences the stalking. The best way to respond to a cyberstalker is not to respond. Cyberstalking may graduate to physical stalking, aggression, and violence.
Battering relationships are often characterized by cyclical phases, sometimes referred to as The Cycle of Violence. A period of peace and calm is followed by escalating tension. A woman might feel as though she were walking on eggshells. Minor incidents may occur that the woman tries to minimize or deny, sometimes by taking the blame. When the tension becomes unmanageable, aggression occurs. The victim may be kicked, thrown against a wall, raped, threatened at gun or knife point, slapped, punched or subjected to any of the endless mental and physical abuses that batterers use to intimidate and control their partners.
1. Learn definition and distinguish between types of abuse
2. Become familiar with relevant facts and statistics
3. Identify spousal/partner abuse symptoms
4. Evaluate the effects of spousal/ partner abuse5. Identify same gender abuse dynamics
6. Become familiar with relevant cultural factors
7. Learn the national domestic violence applicable laws
8. Become familiar with resources and referrals
Table of Contents:
1. Definitions and Types of Abuse
2. Facts and Statistics
3. Symptoms and Effects
4. Domestic Violence and the Law
5. Evaluation, Intervention and Treatment
6. Resources and Referrals
7. References
1. Definitions and Types of Abuse
Domestic violence and emotional abuse is characterized by physically and/or psychologically dominating behaviors used by a perpetrator to control the victim. Partners may be married or unmarried; heterosexual, or homosexual; living together, separated or dating. Domestic violence occurs in all cultures; people of all races, ethnicities, religions, sexes and classes can be perpetrators of domestic violence. Domestic violence is also known as domestic abuse, spousal abuse, or intimate partner violence. Domestic violence is perpetrated by both men and women. Domestic abuse is any form of abuse that occurs between and among persons related by affection, kinship, or trust. It can occur with youth, adults or elders of all ages and walks of life. The perpetrator often will use fear and intimidation as a method of control. The perpetrator may also threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence. Domestic abuse is intentionally trying to control another person. The abuser intentionally uses verbal, nonverbal, or physical methods to gain control over the other person. Domestic abuse includes:
• Physical abuse
• Sexual abuse or sexual assault
• Verbal abuse
• Emotional Abuse
• Financial abuse
• Neglect
• Ritual abuse
• Spiritual abuse
• Criminal harassment
• Stalking, and Cyber stalking(Stark, E., A. Flitcraft, 1996. Women at Risk: Domestic Violence and Women's Health. Sage).
There are many considerations in evaluating abuse including:
• Mode: physical, psychological, sexual and/or social.
• Frequency: on/off, occasional and chronic.
• Severity: in terms of both psychological or physical harm and the need for treatment.
• Transitory or permanent injury: mild, moderate, severe and up to homicide.
An area of the domestic violence field that is often overlooked is passive abuse leading to violence. Passive abuse is covert, subtle and veiled. This includes victimization, procrastination, forgetfulness, ambiguity, neglect, spiritual and intellectual abuse.
Increased recognition of domestic violence began during the women's movement. Awareness regarding domestic violence varies among different countries. Only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or more than 10% of the U.S. population.
There is increasing awareness and advocacy for men victimized by women. In a report on violence related injuries by the US Department of justice (USDOJ August 1997) hospital emergency room visits related to domestic violence revealed that physically abused men represent just under one-sixth of the total patients admitted to hospital reporting domestic violence as the cause of their injuries. The report reveals that significantly more men than women did not disclose the identity of their attacker. This is likely due to shame, stigma, and embarrassment associated with men victimized by women.
According to a July 2000 Centers for Disease Control Report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury
compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence.
Physical Abuse
Physical abuse is characterized by aggressive behavior that may result in the victim sustaining injury. Physical abuse attacks are used by the perpetrator to control the victim. The abuse is rarely a single incident and typically forms identifiable patterns that may repeat more and more quickly, and which may become increasingly violent.
Physical abuse can include:
• assault with a weapon
• biting, pinching
• burning
• choking
• kicking, pushing, throwing or shaking
• slapping, hitting, tripping, grabbing or punching
• tying down or otherwise restraining or confining
• homicide
Sexual Abuse and Assault
Sexual abuse and assault includes any non-consensual sexual activity ranging from harassment, unwanted sexual touching, to rape. Sexual harassment is characterized by ridiculing another person to try to limit their sexuality or reproductive choices, while sexual exploitation could involve forcing someone to participate in pornographic film-making. Examples of sexual abuse include fondling of genitals, penetration, incest, rape, sodomy, indecent exposure, forced prostitution, forced production of pornographic materials (
Verbal/ Emotional/ Psychological Abuse
Abbott, Pamela and Emma Williamson, 1999.. "Women, Health and Domestic Violence". Journal of Gender Studies).
Domestic violence is not only physical and sexual violence but also psychological. Psychological violence can be defined as intense and repetitive degradation, creating isolation, and controlling the actions or behaviors of the spouse through intimidation or manipulation to the detriment of the individual. Emotional and psychological abuse sometimes involves tactics to undermine an individual's self-confidence and sense of self-worth, such as yelling, mocking, insulting, threatening, using abusive language, humiliating, harassing and degrading. It can also include deprivation of emotional care, and isolating the individual being targeted (Five Year State Master Plan for the Prevention of and Service for Domestic Violence." Utah State Department of Human Services, January 1994).
Financial/Economic Abuse
Financial abuse occurs when one individual attempts to take total or partial control of another's finances, inheritance or employment income. It may include denying access to one's own financial records and knowledge about personal investments, income or debt, or preventing a partner from engaging in activities that would lead to financial independence.
Financial or economic abuse includes:
• withholding economic resources such as money or credit cards
• stealing from or defrauding a partner of money or assets
• exploiting the partner's resources for personal gain
• withholding physical resources such as food, clothes, necessary medications, or shelter from a partner
• preventing a partner from working or choosing an occupation
Ritual Abuse
Ritual abuse is defined as a combination of severe physical, sexual, psychological and spiritual abuses used systematically and in combination with symbols, ceremonies and/or group activities that have a religious, magical or supernatural connotation. Victims are terrorized into silence by repetitive torture and abuse over time and indoctrinated into the beliefs and practices of the cult or group. Ritual abuse may also be linked to Satanism or devil worship.
Spiritual Abuse
Spiritual abuse may include:
• using the partner's religious or spiritual beliefs to manipulate them
• preventing the partner from practicing their religious or spiritual beliefs
• ridiculing the other person's religious or spiritual beliefs
• forcing the children to be reared in a faith that the partner has not agreed to
Spiritual and religious abuse is also abuse done in the name of, brought on by, or attributed to a belief system of the abuser, or abuse from a religious leader. This can include Priests, Ministers, cult members, family members, or anyone abusing in the name of a deity or perceived deity. Spiritual or religious abuse can find its way into every religion and belief system that exists. It may encompass many other forms of abuse, especially physical, sexual, emotional, psychological and financial (Warshaw, C. (1993). "Limitations of the Medical Model in the Care of Battered Women". in Bart, P., E. Moran. Violence Against Women: The Bloody Footprints. Sage).
Harassment, Stalking and Cyberstalking
Stalking is harassment of or threatening another person, especially in a manner that physically or emotionally disturbs them. Stalking of an intimate partner can occur place during the relationship, with intense monitoring of the partner's activities, or it can take place after a partner or spouse has left the relationship. The stalker may be trying to get their partner back, or they may wish to harm their partner as punishment for their departure. Regardless of the motive, the victim fears for their safety. Stalking may occur at or near the victim's home, near or in their workplace, on the way to any destination, or on the internet (cyberstalking). Stalking can be on the phone, in person, or online. Stalkers sometimes do not reveal themselves, or they may just “show up” unexpectedly. Stalking is often unpredictable and dangerous. Stalkers may utilize threatening tactics including:
• “showing up” wherever the victim is located
• repeated phone calls (often hanging up)
• following the victim
• watching the victim from a hiding place
• sending the victim unwanted packages/gifts/letters
• monitoring the victim's phone calls
• monitoring the victim’s mail or internet use
• sifting through the victim's garbage
• contacting the victim's friends, family, co-workers, or neighbors to obtain information about the victim
• damaging the victim's property
• threatening to hurt the victim or the victim’s family, friends or pets
Cyberstalking is defined as utilizing the internet with the intention to harass and/or stalk another person. Cyberstalking is deliberate and persistent in nature. It may be an additional form of harassment, or the only method the perpetrator employs. The cyber stalker’s communication may be disturbing and inappropriate. Often, the more the victim protests or responds, the more rewarding the cyberstalker experiences the stalking. The best way to respond to a cyberstalker is not to respond. Cyberstalking may graduate to physical stalking, aggression, and violence.
Battering relationships are often characterized by cyclical phases, sometimes referred to as The Cycle of Violence. A period of peace and calm is followed by escalating tension. A woman might feel as though she were walking on eggshells. Minor incidents may occur that the woman tries to minimize or deny, sometimes by taking the blame. When the tension becomes unmanageable, aggression occurs. The victim may be kicked, thrown against a wall, raped, threatened at gun or knife point, slapped, punched or subjected to any of the endless mental and physical abuses that batterers use to intimidate and control their partners.
January 19, 2010
Alchoholism and Substance Abuse Dependancy
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.
Table of Contents: 1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References
1. DEFINITIONS
Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”
2. HISTORY
Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). The problems of addiction became gradually identified. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts; many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s. The spirit of temperance led to the prohibition of alcohol by the Eighteenth Amendment to the Constitution in 1919, but Prohibition was repealed in 1933. In the 1930s most states required antidrug education in the schools, but fears that knowledge would lead to experimentation caused it to be abandoned in most places. Soon after the repeal of Prohibition, the U.S. Federal Bureau of Narcotics (now the Drug Enforcement Administration) began a campaign to portray marijuana as a powerful, addicting substance that would lead users into narcotics addiction. In the 1950s, use of marijuana increased again, along with that of amphetamines and tranquilizers. The social upheaval of the 1960s brought with it a dramatic increase in drug use and some increased social acceptance; by the early 1970s some states and localities had decriminalized marijuana and lowered drinking ages. The 1980s brought a decline in the use of most drugs, but cocaine and crack use soared. The military became involved in border patrols for the first time, and troops invaded Panama and brought its de facto leader, Manuel Noriega, to trial for drug trafficking (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). Throughout the years, the public's perception of the dangers of specific substances changed. The surgeon general's warning label on tobacco packaging gradually made people aware of the addictive nature of nicotine. By 1995, the Food and Drug Administration was considering its regulation. The recognition of fetal alcohol syndrome brought warning labels to alcohol products. The addictive nature of prescription drugs such as diazepam (Valium) became known, and caffeine came under scrutiny as well. Drug laws have tried to keep up with the changing perceptions and real dangers of substance abuse. By 1970 over 55 federal drug laws and countless state laws specified a variety of punitive measures, including life imprisonment and
even the death penalty. To clarify the situation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, or updated all previous federal laws concerned with narcotics and all other dangerous drugs. While possession was made illegal, the severest penalties were reserved for illicit distribution and manufacture of drugs. The act dealt with prevention and treatment of drug abuse as well as control of drug traffic. The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy. Its director, often referred to as the drug “czar,” is responsible for coordinating national drug control policy (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).
1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.
Table of Contents: 1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References
1. DEFINITIONS
Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”
2. HISTORY
Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). The problems of addiction became gradually identified. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts; many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s. The spirit of temperance led to the prohibition of alcohol by the Eighteenth Amendment to the Constitution in 1919, but Prohibition was repealed in 1933. In the 1930s most states required antidrug education in the schools, but fears that knowledge would lead to experimentation caused it to be abandoned in most places. Soon after the repeal of Prohibition, the U.S. Federal Bureau of Narcotics (now the Drug Enforcement Administration) began a campaign to portray marijuana as a powerful, addicting substance that would lead users into narcotics addiction. In the 1950s, use of marijuana increased again, along with that of amphetamines and tranquilizers. The social upheaval of the 1960s brought with it a dramatic increase in drug use and some increased social acceptance; by the early 1970s some states and localities had decriminalized marijuana and lowered drinking ages. The 1980s brought a decline in the use of most drugs, but cocaine and crack use soared. The military became involved in border patrols for the first time, and troops invaded Panama and brought its de facto leader, Manuel Noriega, to trial for drug trafficking (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). Throughout the years, the public's perception of the dangers of specific substances changed. The surgeon general's warning label on tobacco packaging gradually made people aware of the addictive nature of nicotine. By 1995, the Food and Drug Administration was considering its regulation. The recognition of fetal alcohol syndrome brought warning labels to alcohol products. The addictive nature of prescription drugs such as diazepam (Valium) became known, and caffeine came under scrutiny as well. Drug laws have tried to keep up with the changing perceptions and real dangers of substance abuse. By 1970 over 55 federal drug laws and countless state laws specified a variety of punitive measures, including life imprisonment and
even the death penalty. To clarify the situation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, or updated all previous federal laws concerned with narcotics and all other dangerous drugs. While possession was made illegal, the severest penalties were reserved for illicit distribution and manufacture of drugs. The act dealt with prevention and treatment of drug abuse as well as control of drug traffic. The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy. Its director, often referred to as the drug “czar,” is responsible for coordinating national drug control policy (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).
Child Abuse Assessment and Reporting
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. Assess child abuse risk factors 2. Evaluate the need for a Suspected Child Abuse Report 3. Become familiar with relevant child abuse statistics 4. Differentiate between the roles of mandated and non-mandated reporters 5. Identify the symptoms and warning signs of child abuse 6. Utilize applicable clinical assessment and treatment tools 7. Utilize applicable treatment interventions 8. Identify and have accessibility to relevant resources Table of Contents: 1. Definition 2. History and the Law 3. Types of Child Abuse 4. Statistics 5. Mandated Reporters 6. Child Abuse Symptoms 7. Clinical Assessment 8. Treatment 9. Resources 10. References 1.
Definition
Child abuse is the physical, psychological or sexual maltreatment of children. The
Centers for Disease Control and Prevention (CDC) defines child maltreatment as “any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child”. Most child abuse occurs in the home, with a lesser amount occurring in the organizations, schools or community organizations. Currently, there are four widely recognized and identifiable categories of child abuse including neglect, physical abuse, psychological/emotional abuse, and sexual abuse. Different jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge. The Mental Health Journal defines child as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm.”
2. History and the Law
Child sexual abuse is illegal in every civilized society with consequences often including severe criminal penalties, and in some jurisdictions, life imprisonment or capital punishment. A legal adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is of course not considered to be legal consent. The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC, including every member of the United Nations except the United States and Somalia. Child sexual abuse has gained increased public attention throughout the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has existed throughout history, it has only become the object of significant public attention in recent times. The first published work dedicated specifically to child sexual abuse appeared in France in 1857: Medical-Legal Studies of Sexual Assault (Etude Médico-Légale sur les Attentats aux Moeurs), by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine (Masson, 1984, pp. 15–25). Prior to the 1970’s and 1980’s, sexual abuse remained secretive and socially unspeakable. Studies on child molestation did not emerge until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws. Feminism contributed to increased awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book Trauma and Recovery, considered a classic and ground-breaking work coined the term complex post-traumatic stress disorder. "In it she defines this concept not only in terms of prolonged trauma, but in terms of what she calls "subjection to totalitarian control." Examples of this concept include:...hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation (In 1986, Congress passed the Child Abuse Victims' Rights Act, which allowed victims a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abuse perpetrators. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 2004, gives the public access to knowledge and identification of sex offenders nationwide. Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one history's largest social revolutions." According to John Jay College of Criminal Justice professor B.J. Cling, "By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism...As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma...depends on the support of a political movement.'" Herman, Judith Lewis, 1997. Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books). Increasing awareness of child sexual abuse in the United States has ignited civil lawsuits for monetary damages. Increased awareness of child sexual abuse has also encouraged more victims to step forward, whereas in the past victims were often secretive about their abuse. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, was charged with supervising the child but failed to do so with child sexual abuse resulting. In the Catholic sex abuse cases the various Roman Catholic Dioceses in the
United States have paid out approximately $1 billion settling hundreds of these lawsuits since the early 1990s. Due to the fact that lawsuits often involve demanding procedures, concern exists that children or adults who file suit will be re-victimized by defendants through the legal process. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process. A 2000 World Health Organization Geneva report, “World Report on Violence and Health (Chap 6 - Sexual Violence)” states, “Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools.” 3. Types of Child Abuse • Neglect, in which the responsible adult fails to adequately provide for various needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional (failure to provide nurturing or affection) or educational (failure to enroll a child in school). • Physical abuse is physical aggression directed at a child by an adult. It can involve striking, burning, choking or shaking a child, and the distinction between discipline and abuse is often poorly defined. The transmission of toxins to a child through their mother (such as with fetal alcohol syndrome) can also be considered physical abuse in some jurisdictions. • Child sexual abuse is any sexual act between an adult and a child, including penetration, fondling, exposure to adult sexuality and violations of privacy. • Psychological abuse, also known as emotional abuse, which can involve belittling or shaming a child, inappropriate or extreme punishment and the withholding of affection.
Physical Abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm. Forms of physical abuse include: • striking • punching • pushing, pulling • slapping • Whipping • striking with an object • locking in or out of a room or place/false imprisonment • excessive pinching • kicking • having someone fall • kneeing • strangling • head butting • drowning • sleep deprivation • exposure to cold, freezing • exposure to heat or radiation, burning • exposure to electric shock • placing in "stress positions" (tied or otherwise forced) • cutting or otherwise exposing somebody to something sharp • exposure to a dangerous animal • throwing or shooting a projectile • exposure to a toxic substance • infecting with a disease • withholding food or medication • assault • bodily harm • humiliation • torture
1. Assess child abuse risk factors 2. Evaluate the need for a Suspected Child Abuse Report 3. Become familiar with relevant child abuse statistics 4. Differentiate between the roles of mandated and non-mandated reporters 5. Identify the symptoms and warning signs of child abuse 6. Utilize applicable clinical assessment and treatment tools 7. Utilize applicable treatment interventions 8. Identify and have accessibility to relevant resources Table of Contents: 1. Definition 2. History and the Law 3. Types of Child Abuse 4. Statistics 5. Mandated Reporters 6. Child Abuse Symptoms 7. Clinical Assessment 8. Treatment 9. Resources 10. References 1.
Definition
Child abuse is the physical, psychological or sexual maltreatment of children. The
Centers for Disease Control and Prevention (CDC) defines child maltreatment as “any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child”. Most child abuse occurs in the home, with a lesser amount occurring in the organizations, schools or community organizations. Currently, there are four widely recognized and identifiable categories of child abuse including neglect, physical abuse, psychological/emotional abuse, and sexual abuse. Different jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge. The Mental Health Journal defines child as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm.”
2. History and the Law
Child sexual abuse is illegal in every civilized society with consequences often including severe criminal penalties, and in some jurisdictions, life imprisonment or capital punishment. A legal adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is of course not considered to be legal consent. The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC, including every member of the United Nations except the United States and Somalia. Child sexual abuse has gained increased public attention throughout the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has existed throughout history, it has only become the object of significant public attention in recent times. The first published work dedicated specifically to child sexual abuse appeared in France in 1857: Medical-Legal Studies of Sexual Assault (Etude Médico-Légale sur les Attentats aux Moeurs), by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine (Masson, 1984, pp. 15–25). Prior to the 1970’s and 1980’s, sexual abuse remained secretive and socially unspeakable. Studies on child molestation did not emerge until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws. Feminism contributed to increased awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book Trauma and Recovery, considered a classic and ground-breaking work coined the term complex post-traumatic stress disorder. "In it she defines this concept not only in terms of prolonged trauma, but in terms of what she calls "subjection to totalitarian control." Examples of this concept include:...hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation (In 1986, Congress passed the Child Abuse Victims' Rights Act, which allowed victims a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abuse perpetrators. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 2004, gives the public access to knowledge and identification of sex offenders nationwide. Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one history's largest social revolutions." According to John Jay College of Criminal Justice professor B.J. Cling, "By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism...As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma...depends on the support of a political movement.'" Herman, Judith Lewis, 1997. Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books). Increasing awareness of child sexual abuse in the United States has ignited civil lawsuits for monetary damages. Increased awareness of child sexual abuse has also encouraged more victims to step forward, whereas in the past victims were often secretive about their abuse. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, was charged with supervising the child but failed to do so with child sexual abuse resulting. In the Catholic sex abuse cases the various Roman Catholic Dioceses in the
United States have paid out approximately $1 billion settling hundreds of these lawsuits since the early 1990s. Due to the fact that lawsuits often involve demanding procedures, concern exists that children or adults who file suit will be re-victimized by defendants through the legal process. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process. A 2000 World Health Organization Geneva report, “World Report on Violence and Health (Chap 6 - Sexual Violence)” states, “Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools.” 3. Types of Child Abuse • Neglect, in which the responsible adult fails to adequately provide for various needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional (failure to provide nurturing or affection) or educational (failure to enroll a child in school). • Physical abuse is physical aggression directed at a child by an adult. It can involve striking, burning, choking or shaking a child, and the distinction between discipline and abuse is often poorly defined. The transmission of toxins to a child through their mother (such as with fetal alcohol syndrome) can also be considered physical abuse in some jurisdictions. • Child sexual abuse is any sexual act between an adult and a child, including penetration, fondling, exposure to adult sexuality and violations of privacy. • Psychological abuse, also known as emotional abuse, which can involve belittling or shaming a child, inappropriate or extreme punishment and the withholding of affection.
Physical Abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm. Forms of physical abuse include: • striking • punching • pushing, pulling • slapping • Whipping • striking with an object • locking in or out of a room or place/false imprisonment • excessive pinching • kicking • having someone fall • kneeing • strangling • head butting • drowning • sleep deprivation • exposure to cold, freezing • exposure to heat or radiation, burning • exposure to electric shock • placing in "stress positions" (tied or otherwise forced) • cutting or otherwise exposing somebody to something sharp • exposure to a dangerous animal • throwing or shooting a projectile • exposure to a toxic substance • infecting with a disease • withholding food or medication • assault • bodily harm • humiliation • torture
January 18, 2010
HIV and AIDS Continuing Education CEUS
HIV and AIDS Continuing Education
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material
may be transmitted or reproduced in any form, or by any means, mechanical or
electronic without written permission of Aspira Continuing Education.
1. Differentiate between HIV and AIDS
2. Identify causes
3. Learn epidemiology
4. Learn the historical framework related to the development of
HIV/AIDS
5. Become familiar with the impact HIV/AIDS on culture
6. Identify and recognize common stigmas associated with HIV/AIDS
7. Increase familiarity with the relationship between HIV/AIDS and
mental health
8. Increase familiarity with the relationship between HIV/AIDS and
substance abuse
9. Develop the ability to identify the characteristics and method of
assessment and treatment of people who live with HIV/AIDS.
Table of Contents:
1. Definitions
2. Causes
3. Epidemiology
2
4. History
5. Stigma
6. HIV/AIDS and Mental Health
7. HIV/AIDS and Substance Abuse
8. Cognitive Disorders
9. Summary
10. References
1. Definitions
Human immunodeficiency virus (HIV) is a lentivirus (a member of the
retrovirus family) that can lead to acquired immunodeficiency syndrome
(AIDS), a condition in humans in which the immune system begins to fail,
leading to life-threatening opportunistic infections. Previous names for the
virus include human T-lymphotropic virus-III (HTLV-III),
lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus
(ARV). Infection with HIV occurs by the transfer of blood, semen, vaginal
fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present
as both free virus particles and virus within infected immune cells. The four
major routes of transmission are unprotected sexual intercourse,
contaminated needles, breast milk, and transmission from an infected mother
to her baby at birth (Vertical transmission). Screening of blood products for
HIV has largely eliminated transmission through blood transfusions or
infected blood products in the developed world (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
HIV infection in humans is now pandemic. As
of January 2006, the Joint United Nations
Programme on HIV/AIDS (UNAIDS) and the
World Health Organization (WHO) estimate that
AIDS has killed more than 25 million people
since it was first recognized on December 1,
1981. It is estimated that about 0.6 percent of the
world's population is infected with HIV. In
2005 alone, AIDS claimed an estimated 2.4–3.3
million lives, of which more than 570,000 were
children. A third of these deaths are occurring in
sub-Saharan Africa, retarding economic growth
and increasing poverty. According to current
estimates, HIV is set to infect 90 million people
in Africa, resulting in a minimum estimate of 18 million orphans.
Antiretroviral treatment reduces both the mortality and the morbidity of HIV
infection, but routine access to antiretroviral medication is not available in
all countries. HIV primarily infects vital cells in the human immune system
such as helper T cells (specifically CD4+ T cells), macrophages, and
Human
immunodeficiency virus
Scanning electron micrograph
of HIV-1 (in green) budding
from cultured lymphocyte.
Multiple round bumps on cell
surface represent sites of
assembly and budding of
virions.
dendritic cells. HIV infection leads to low levels of CD4+ T cells through
three main mechanisms: firstly, direct viral killing of infected cells;
secondly, increased rates of apoptosis in infected cells; and thirdly, killing of
infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected
cells. When CD4+ T cell numbers decline below a critical level, cellmediated
immunity is lost, and the body becomes progressively more
susceptible to opportunistic infections (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Eventually most HIV-infected individuals develop AIDS (Acquired
Immunodeficiency Syndrome). These individuals mostly die from
opportunistic infections or malignancies associated with the progressive
failure of the immune system. Without treatment, about 9 out of every 10
persons with HIV will progress to AIDS after 10-15 years. Many people
deteriorate much sooner. Treatment with anti-retrovirals increases the life
expectancy of people infected with HIV. Even after HIV has progressed to
diagnosable AIDS, the average survival time with antiretroviral therapy (as
of 2005) is estimated to be more than 5 years. Without antiretroviral therapy,
death normally occurs within a year. It is hoped that current and future
treatments may allow HIV-infected individuals to achieve a life expectancy
approaching that of the general public (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Acquired immune deficiency syndrome or acquired immunodeficiency
syndrome (AIDS) is a set of symptoms and infections resulting from the
damage to the human immune system caused by the human
immunodeficiency virus (HIV). This condition progressively reduces the
effectiveness of the immune system and leaves individuals susceptible to
opportunistic infections and tumors. HIV is transmitted through direct
contact of a mucous membrane or the bloodstream with a bodily fluid
containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and
breast milk (Appay V, Sauce D (January 2008). "Immune activation and
inflammation in HIV-1 infection: causes and consequences". J. Pathol.)
This transmission can involve anal, vaginal or oral sex, blood transfusion,
contaminated hypodermic needles, exchange between mother and baby
during pregnancy, childbirth, or breastfeeding, or other exposure to one of
the above bodily fluids (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived
with the disease worldwide, and it killed an estimated 2.1 million people,
including 330,000 children. Over three-quarters of these deaths occurred in
sub-Saharan Africa, retarding economic growth and destroying human
capital. Genetic research indicates that HIV originated in west-central
Africa during the late nineteenth or early twentieth century. AIDS was first
recognized by the U.S. Centers for Disease Control and Prevention in 1981
and its cause, HIV, identified in the early 1980s (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Although treatments for AIDS and HIV can slow the course of the disease,
there is currently no vaccine or cure. Antiretroviral treatment reduces both
the mortality and the morbidity of HIV infection, but these drugs are
expensive and routine access to antiretroviral medication is not available in
all countries. Due to the difficulty in treating HIV infection, preventing
infection is a key aim in controlling the AIDS epidemic, with health
organizations promoting safe sex and needle-exchange programs in attempts
to slow the spread of the virus (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
2. Causes
AIDS is the most severe acceleration of infection with HIV. HIV is a
retrovirus that primarily infects vital organs of the human immune system
such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells.
It directly and indirectly destroys CD4+ T cells. Once HIV has killed so
many CD4+ T cells that there are fewer than 200 of these cells per microliter
(µL) of blood, cellular immunity is lost. Acute HIV infection progresses
over time to clinical latent HIV infection and then to early symptomatic HIV
infection and later to AIDS, which is identified either on the basis of the
amount of CD4+ T cells remaining in the blood, and/or the presence of
certain infections (Appay V, Sauce D, January 2008. "Immune activation
and inflammation in HIV-1 infection: causes and consequences". J. Pathol).
Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.
In the absence of antiretroviral therapy, the median time of progression from
HIV infection to AIDS is nine to ten years, and the median survival time
after developing AIDS is only 9.2 months. However, the rate of clinical
disease progression varies widely between individuals, from two weeks up
to 20 years. Many factors affect the rate of progression. These include
factors that influence the body's ability to defend against HIV such as the
infected person's general immune function. Older people have weaker
immune systems, and therefore have a greater risk of rapid disease
progression than younger people. Poor access to health care and the
existence of coexisting infections such as tuberculosis also may predispose
people to faster disease progression. The infected person's genetic
inheritance plays an important role and some people are resistant to certain
strains of HIV. An example of this is people with the homozygous CCR5-
Δ32 variation are resistant to infection with certain strains of HIV. HIV is
genetically variable and exists as different strains, which cause different
rates of clinical disease progression (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Sexual transmission
Sexual transmission occurs with the contact between sexual secretions of
one person with the rectal, genital or oral mucous membranes of another.
Unprotected receptive sexual acts are riskier than unprotected insertive
sexual acts, and the risk for transmitting HIV through unprotected anal
intercourse is greater than the risk from vaginal intercourse or oral sex.
However, oral sex is not entirely safe, as HIV can be transmitted through
both insertive and receptive oral sex. Sexual assault greatly increases the risk
of HIV transmission as protection is rarely employed and physical trauma to
the vagina occurs frequently, facilitating the transmission of HIV. Other
sexually transmitted infections (STI) increase the risk of HIV transmission
and infection, because they cause the disruption of the normal epithelial
barrier by genital ulceration and/or microulceration; and by accumulation of
pools of HIV-susceptible or HIV-infected cells (lymphocytes and
macrophages) in semen and vaginal secretions. Epidemiological studies
from sub-Saharan Africa, Europe and North America suggest that genital
ulcers, such as those caused by syphilis and/or chancroid, increase the risk of
becoming infected with HIV by about fourfold. There is also a significant
although lesser increase in risk from STIs such as gonorrhea, Chlamydial
infection and trichomoniasis, which all cause local accumulations of
lymphocytes and macrophages (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Transmission of HIV depends on the infectiousness of the index case and the
susceptibility of the uninfected partner. Infectivity seems to vary during the
course of illness and is not constant between individuals. An undetectable
plasma viral load does not necessarily indicate a low viral load in the
seminal liquid or genital secretions. However, each 10-fold increase in the
level of HIV in the blood is associated with an 81% increased rate of HIV
transmission. Women are more susceptible to HIV-1 infection due to
hormonal changes, vaginal microbial ecology and physiology, and a higher
prevalence of sexually transmitted diseases. People who have been infected
with one strain of HIV can still be infected later on in their lives by other,
more virulent strains. Infection is unlikely in a single encounter. High rates
of infection have been linked to a pattern of overlapping long-term romantic
relationships. This allows the virus to quickly spread to multiple partners
who in turn infect their partners. A pattern of serial monogamy or occasional
casual encounters is associated with lower rates of infection. HIV spreads
readily through heterosexual sex in Africa, but less so elsewhere. One
possibility being researched is that schistosomiasis, which affects up to 50
per cent of women in parts of Africa, damages the lining of the vagina
(Mastro TD, de Vincenzi I, 1996. "Probabilities of sexual HIV-1
transmission).
Exposure to blood-borne pathogens
(CDC poster from 1989 highlighting the threat of AIDS associated with drug use)
This transmission route is particularly relevant to intravenous drug users,
hemophiliacs and recipients of blood transfusions and blood products.
Sharing and reusing syringes contaminated with HIV-infected blood
represents a major risk for infection with HIV. Needle sharing is the cause
of one third of all new HIV-infections in North America, China, and Eastern
Europe. The risk of being infected with HIV from a single prick with a
needle that has been used on an HIV-infected person is thought to be about 1
in 150. Post-exposure prophylaxis with anti-HIV drugs can further reduce
this risk. This route can also affect people who give and receive tattoos and
piercings. Universal precautions are frequently not followed in both sub-
Saharan Africa and much of Asia because of both a shortage of supplies and
inadequate training. The WHO estimates that approximately 2.5% of all HIV
infections in sub-Saharan Africa are transmitted through unsafe healthcare
injections. Because of this, the United Nations General Assembly has urged
the nations of the world to implement precautions to prevent HIV
transmission by health workers. The risk of transmitting HIV to blood
transfusion recipients is extremely low in developed countries where
improved donor selection and HIV screening is performed. However,
according to the WHO, the overwhelming majority of the world's population
does not have access to safe blood and between 5% and 10% of the world's
9
9
HIV infections come from transfusion of infected blood and blood products
(Source: The World Health Organization).
Perinatal transmission
The transmission of the virus from the mother to the child can occur in utero
during the last weeks of pregnancy and at childbirth. In the absence of
treatment, the transmission rate between a mother and her child during
pregnancy, labor and delivery is 25%. However, when the mother takes
antiretroviral therapy and gives birth by caesarean section, the rate of
transmission is just 1%. The risk of infection is influenced by the viral load
of the mother at birth, with the higher the viral load, the higher the risk.
Breastfeeding also increases the risk of transmission by about 4 % (Source:
The World Health Organization).
Misconceptions
A number of misconceptions have arisen surrounding HIV/AIDS. Three of
the most common are that AIDS can spread through casual contact, that
sexual intercourse with a virgin will cure AIDS, and that HIV can infect
only homosexual men and drug users. Other misconceptions are that any act
of anal intercourse between gay men can lead to AIDS infection, and that
open discussion of homosexuality and HIV in schools will lead to increased
rates of homosexuality and AIDS (Source: The World Health
Organization).
Pathophysiology
The pathophysiology of AIDS is complex, as is the case with all syndromes.
Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes.
This weakens the immune system and allows opportunistic infections. T
lymphocytes are essential to the immune response and without them, the
body cannot fight infections or kill cancerous cells. The mechanism of CD4+
T cell depletion differs in the acute and chronic phases.
10
10
During the acute phase, HIVinduced
cell lysis and killing of
infected cells by cytotoxic T cells
accounts for CD4+ T cell
depletion, although apoptosis may
also be a factor. During the
chronic phase, the consequences
of generalized immune activation
coupled with the gradual loss of
the ability of the immune system
to generate new T cells appear to
account for the slow decline in
CD4+ T cell numbers.
Although the symptoms of
immune deficiency characteristic
of AIDS do not appear for years
after a person is infected, the bulk
of CD4+ T cell loss occurs during
the first weeks of infection,
especially in the intestinal
mucosa, which harbors the
majority of the lymphocytes
found in the body. The reason for
the preferential loss of mucosal
CD4+ T cells is that a majority of
mucosal CD4+ T cells express the
CCR5 coreceptor, whereas a
small fraction of CD4+ T cells in
the bloodstream do so.
HIV seeks out and destroys CCR5
expressing CD4+ cells during
acute infection. A vigorous
immune response eventually
controls the infection and initiates
the clinically latent phase.
However, CD4+ T cells in mucosal tissues remain depleted throughout the
infection, although enough remain to initially ward off life-threatening
infections (Source: The World Health Organization).
Estimated per act risk for acquisition
of HIV by exposure route.
Exposure Route
Estimated infections
per 10,000 exposures
to an infected source
Blood Transfusion 9,000
Childbirth 2,500
Needle-sharing injection drug use 67
Percutaneous needle stick 30
Receptive anal intercourse* 50
Insertive anal intercourse* 6.5
Receptive penile-vaginal intercourse* 10
Insertive penile-vaginal intercourse* 5
Receptive oral intercourse*§ 1
Insertive oral intercourse*§ 0.5
* assuming no condom use
§ source refers to oral intercourse
performed on a man
11
11
Continuous HIV replication results in a state of generalized immune
activation persisting throughout the chronic phase. Immune activation,
which is reflected by the increased activation state of immune cells and
release of proinflammatory cytokines, results from the activity of several
HIV gene products and the immune response to ongoing HIV replication.
Another cause is the breakdown of the immune surveillance system of the
mucosal barrier caused by the depletion of mucosal CD4+ T cells during the
acute phase of disease.
This results in the systemic exposure of the immune system to microbial
components of the gut’s normal flora, which in a healthy person is kept in
check by the mucosal immune system. The activation and proliferation of T
cells that results from immune activation provides fresh targets for HIV
infection. However, direct killing by HIV alone cannot account for the
observed depletion of CD4+ T cells since only 0.01-0.10% of CD4+ T cells
in the blood are infected. A major cause of CD4+ T cell loss appears to
result from their heightened susceptibility to apoptosis when the immune
system remains activated. Although new T cells are continuously produced
by the thymus to replace the ones lost, the regenerative capacity of the
thymus is slowly destroyed by direct infection of its thymocytes by HIV.
Eventually, the minimal number of CD4+ T cells necessary to maintain a
sufficient immune response is lost, leading to AIDS (Source: The World
Health Organization).
3. Epidemiology
Estimated prevalence of HIV among young adults (15-49) per country at the end of 2005
The AIDS pandemic can also be seen as several epidemics of separate
subtypes; the major factors in its spread are sexual transmission and vertical
12
12
transmission from mother to child at birth and through breast milk. Despite
recent, improved access to antiretroviral treatment and care in many regions
of the world, the AIDS pandemic claimed an estimated 2.1 million (range
1.9–2.4 million) lives in 2007 of which an estimated 330,000 were children
under 15 years. Globally, an estimated 33.2 million people lived with HIV in
2007, including 2.5 million children. An estimated 2.5 million (range 1.8–
4.1 million) people were newly infected in 2007, including 420,000 children
(Source: The World Health Organization).
Sub-Saharan Africa remains by far the worst affected region. In 2007 it
contained an estimated 68% of all people living with AIDS and 76% of all
AIDS deaths, with 1.7 million new infections bringing the number of people
living with HIV to 22.5 million, and with 11.4 million AIDS orphans living
in the region. Unlike other regions, most people living with HIV in sub-
Saharan Africa in 2007 (61%) were women. Adult prevalence in 2007 was
an estimated 5.0%, and AIDS continued to be the single largest cause of
mortality in this region. South Africa has the largest population of HIV
patients in the world, followed by Nigeria and India. South & South East
Asia are second worst affected; in 2007 this region contained an estimated
18% of all people living with AIDS, and an estimated 300,000 deaths from
AIDS. India has an estimated 2.5 million infections and an estimated adult
prevalence of 0.36%. Life expectancy has fallen dramatically in the worstaffected
countries; for example, in 2006 it was estimated that it had dropped
from 65 to 35 years in Botswana (Source: The World Health Organization).
Changes in life expectancy in some hard-hit African countries. Botswana
Zimbabwe Kenya South Africa Uganda
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material
may be transmitted or reproduced in any form, or by any means, mechanical or
electronic without written permission of Aspira Continuing Education.
1. Differentiate between HIV and AIDS
2. Identify causes
3. Learn epidemiology
4. Learn the historical framework related to the development of
HIV/AIDS
5. Become familiar with the impact HIV/AIDS on culture
6. Identify and recognize common stigmas associated with HIV/AIDS
7. Increase familiarity with the relationship between HIV/AIDS and
mental health
8. Increase familiarity with the relationship between HIV/AIDS and
substance abuse
9. Develop the ability to identify the characteristics and method of
assessment and treatment of people who live with HIV/AIDS.
Table of Contents:
1. Definitions
2. Causes
3. Epidemiology
2
4. History
5. Stigma
6. HIV/AIDS and Mental Health
7. HIV/AIDS and Substance Abuse
8. Cognitive Disorders
9. Summary
10. References
1. Definitions
Human immunodeficiency virus (HIV) is a lentivirus (a member of the
retrovirus family) that can lead to acquired immunodeficiency syndrome
(AIDS), a condition in humans in which the immune system begins to fail,
leading to life-threatening opportunistic infections. Previous names for the
virus include human T-lymphotropic virus-III (HTLV-III),
lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus
(ARV). Infection with HIV occurs by the transfer of blood, semen, vaginal
fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present
as both free virus particles and virus within infected immune cells. The four
major routes of transmission are unprotected sexual intercourse,
contaminated needles, breast milk, and transmission from an infected mother
to her baby at birth (Vertical transmission). Screening of blood products for
HIV has largely eliminated transmission through blood transfusions or
infected blood products in the developed world (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
HIV infection in humans is now pandemic. As
of January 2006, the Joint United Nations
Programme on HIV/AIDS (UNAIDS) and the
World Health Organization (WHO) estimate that
AIDS has killed more than 25 million people
since it was first recognized on December 1,
1981. It is estimated that about 0.6 percent of the
world's population is infected with HIV. In
2005 alone, AIDS claimed an estimated 2.4–3.3
million lives, of which more than 570,000 were
children. A third of these deaths are occurring in
sub-Saharan Africa, retarding economic growth
and increasing poverty. According to current
estimates, HIV is set to infect 90 million people
in Africa, resulting in a minimum estimate of 18 million orphans.
Antiretroviral treatment reduces both the mortality and the morbidity of HIV
infection, but routine access to antiretroviral medication is not available in
all countries. HIV primarily infects vital cells in the human immune system
such as helper T cells (specifically CD4+ T cells), macrophages, and
Human
immunodeficiency virus
Scanning electron micrograph
of HIV-1 (in green) budding
from cultured lymphocyte.
Multiple round bumps on cell
surface represent sites of
assembly and budding of
virions.
dendritic cells. HIV infection leads to low levels of CD4+ T cells through
three main mechanisms: firstly, direct viral killing of infected cells;
secondly, increased rates of apoptosis in infected cells; and thirdly, killing of
infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected
cells. When CD4+ T cell numbers decline below a critical level, cellmediated
immunity is lost, and the body becomes progressively more
susceptible to opportunistic infections (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Eventually most HIV-infected individuals develop AIDS (Acquired
Immunodeficiency Syndrome). These individuals mostly die from
opportunistic infections or malignancies associated with the progressive
failure of the immune system. Without treatment, about 9 out of every 10
persons with HIV will progress to AIDS after 10-15 years. Many people
deteriorate much sooner. Treatment with anti-retrovirals increases the life
expectancy of people infected with HIV. Even after HIV has progressed to
diagnosable AIDS, the average survival time with antiretroviral therapy (as
of 2005) is estimated to be more than 5 years. Without antiretroviral therapy,
death normally occurs within a year. It is hoped that current and future
treatments may allow HIV-infected individuals to achieve a life expectancy
approaching that of the general public (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Acquired immune deficiency syndrome or acquired immunodeficiency
syndrome (AIDS) is a set of symptoms and infections resulting from the
damage to the human immune system caused by the human
immunodeficiency virus (HIV). This condition progressively reduces the
effectiveness of the immune system and leaves individuals susceptible to
opportunistic infections and tumors. HIV is transmitted through direct
contact of a mucous membrane or the bloodstream with a bodily fluid
containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and
breast milk (Appay V, Sauce D (January 2008). "Immune activation and
inflammation in HIV-1 infection: causes and consequences". J. Pathol.)
This transmission can involve anal, vaginal or oral sex, blood transfusion,
contaminated hypodermic needles, exchange between mother and baby
during pregnancy, childbirth, or breastfeeding, or other exposure to one of
the above bodily fluids (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived
with the disease worldwide, and it killed an estimated 2.1 million people,
including 330,000 children. Over three-quarters of these deaths occurred in
sub-Saharan Africa, retarding economic growth and destroying human
capital. Genetic research indicates that HIV originated in west-central
Africa during the late nineteenth or early twentieth century. AIDS was first
recognized by the U.S. Centers for Disease Control and Prevention in 1981
and its cause, HIV, identified in the early 1980s (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Although treatments for AIDS and HIV can slow the course of the disease,
there is currently no vaccine or cure. Antiretroviral treatment reduces both
the mortality and the morbidity of HIV infection, but these drugs are
expensive and routine access to antiretroviral medication is not available in
all countries. Due to the difficulty in treating HIV infection, preventing
infection is a key aim in controlling the AIDS epidemic, with health
organizations promoting safe sex and needle-exchange programs in attempts
to slow the spread of the virus (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
2. Causes
AIDS is the most severe acceleration of infection with HIV. HIV is a
retrovirus that primarily infects vital organs of the human immune system
such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells.
It directly and indirectly destroys CD4+ T cells. Once HIV has killed so
many CD4+ T cells that there are fewer than 200 of these cells per microliter
(µL) of blood, cellular immunity is lost. Acute HIV infection progresses
over time to clinical latent HIV infection and then to early symptomatic HIV
infection and later to AIDS, which is identified either on the basis of the
amount of CD4+ T cells remaining in the blood, and/or the presence of
certain infections (Appay V, Sauce D, January 2008. "Immune activation
and inflammation in HIV-1 infection: causes and consequences". J. Pathol).
Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.
In the absence of antiretroviral therapy, the median time of progression from
HIV infection to AIDS is nine to ten years, and the median survival time
after developing AIDS is only 9.2 months. However, the rate of clinical
disease progression varies widely between individuals, from two weeks up
to 20 years. Many factors affect the rate of progression. These include
factors that influence the body's ability to defend against HIV such as the
infected person's general immune function. Older people have weaker
immune systems, and therefore have a greater risk of rapid disease
progression than younger people. Poor access to health care and the
existence of coexisting infections such as tuberculosis also may predispose
people to faster disease progression. The infected person's genetic
inheritance plays an important role and some people are resistant to certain
strains of HIV. An example of this is people with the homozygous CCR5-
Δ32 variation are resistant to infection with certain strains of HIV. HIV is
genetically variable and exists as different strains, which cause different
rates of clinical disease progression (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Sexual transmission
Sexual transmission occurs with the contact between sexual secretions of
one person with the rectal, genital or oral mucous membranes of another.
Unprotected receptive sexual acts are riskier than unprotected insertive
sexual acts, and the risk for transmitting HIV through unprotected anal
intercourse is greater than the risk from vaginal intercourse or oral sex.
However, oral sex is not entirely safe, as HIV can be transmitted through
both insertive and receptive oral sex. Sexual assault greatly increases the risk
of HIV transmission as protection is rarely employed and physical trauma to
the vagina occurs frequently, facilitating the transmission of HIV. Other
sexually transmitted infections (STI) increase the risk of HIV transmission
and infection, because they cause the disruption of the normal epithelial
barrier by genital ulceration and/or microulceration; and by accumulation of
pools of HIV-susceptible or HIV-infected cells (lymphocytes and
macrophages) in semen and vaginal secretions. Epidemiological studies
from sub-Saharan Africa, Europe and North America suggest that genital
ulcers, such as those caused by syphilis and/or chancroid, increase the risk of
becoming infected with HIV by about fourfold. There is also a significant
although lesser increase in risk from STIs such as gonorrhea, Chlamydial
infection and trichomoniasis, which all cause local accumulations of
lymphocytes and macrophages (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Transmission of HIV depends on the infectiousness of the index case and the
susceptibility of the uninfected partner. Infectivity seems to vary during the
course of illness and is not constant between individuals. An undetectable
plasma viral load does not necessarily indicate a low viral load in the
seminal liquid or genital secretions. However, each 10-fold increase in the
level of HIV in the blood is associated with an 81% increased rate of HIV
transmission. Women are more susceptible to HIV-1 infection due to
hormonal changes, vaginal microbial ecology and physiology, and a higher
prevalence of sexually transmitted diseases. People who have been infected
with one strain of HIV can still be infected later on in their lives by other,
more virulent strains. Infection is unlikely in a single encounter. High rates
of infection have been linked to a pattern of overlapping long-term romantic
relationships. This allows the virus to quickly spread to multiple partners
who in turn infect their partners. A pattern of serial monogamy or occasional
casual encounters is associated with lower rates of infection. HIV spreads
readily through heterosexual sex in Africa, but less so elsewhere. One
possibility being researched is that schistosomiasis, which affects up to 50
per cent of women in parts of Africa, damages the lining of the vagina
(Mastro TD, de Vincenzi I, 1996. "Probabilities of sexual HIV-1
transmission).
Exposure to blood-borne pathogens
(CDC poster from 1989 highlighting the threat of AIDS associated with drug use)
This transmission route is particularly relevant to intravenous drug users,
hemophiliacs and recipients of blood transfusions and blood products.
Sharing and reusing syringes contaminated with HIV-infected blood
represents a major risk for infection with HIV. Needle sharing is the cause
of one third of all new HIV-infections in North America, China, and Eastern
Europe. The risk of being infected with HIV from a single prick with a
needle that has been used on an HIV-infected person is thought to be about 1
in 150. Post-exposure prophylaxis with anti-HIV drugs can further reduce
this risk. This route can also affect people who give and receive tattoos and
piercings. Universal precautions are frequently not followed in both sub-
Saharan Africa and much of Asia because of both a shortage of supplies and
inadequate training. The WHO estimates that approximately 2.5% of all HIV
infections in sub-Saharan Africa are transmitted through unsafe healthcare
injections. Because of this, the United Nations General Assembly has urged
the nations of the world to implement precautions to prevent HIV
transmission by health workers. The risk of transmitting HIV to blood
transfusion recipients is extremely low in developed countries where
improved donor selection and HIV screening is performed. However,
according to the WHO, the overwhelming majority of the world's population
does not have access to safe blood and between 5% and 10% of the world's
9
9
HIV infections come from transfusion of infected blood and blood products
(Source: The World Health Organization).
Perinatal transmission
The transmission of the virus from the mother to the child can occur in utero
during the last weeks of pregnancy and at childbirth. In the absence of
treatment, the transmission rate between a mother and her child during
pregnancy, labor and delivery is 25%. However, when the mother takes
antiretroviral therapy and gives birth by caesarean section, the rate of
transmission is just 1%. The risk of infection is influenced by the viral load
of the mother at birth, with the higher the viral load, the higher the risk.
Breastfeeding also increases the risk of transmission by about 4 % (Source:
The World Health Organization).
Misconceptions
A number of misconceptions have arisen surrounding HIV/AIDS. Three of
the most common are that AIDS can spread through casual contact, that
sexual intercourse with a virgin will cure AIDS, and that HIV can infect
only homosexual men and drug users. Other misconceptions are that any act
of anal intercourse between gay men can lead to AIDS infection, and that
open discussion of homosexuality and HIV in schools will lead to increased
rates of homosexuality and AIDS (Source: The World Health
Organization).
Pathophysiology
The pathophysiology of AIDS is complex, as is the case with all syndromes.
Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes.
This weakens the immune system and allows opportunistic infections. T
lymphocytes are essential to the immune response and without them, the
body cannot fight infections or kill cancerous cells. The mechanism of CD4+
T cell depletion differs in the acute and chronic phases.
10
10
During the acute phase, HIVinduced
cell lysis and killing of
infected cells by cytotoxic T cells
accounts for CD4+ T cell
depletion, although apoptosis may
also be a factor. During the
chronic phase, the consequences
of generalized immune activation
coupled with the gradual loss of
the ability of the immune system
to generate new T cells appear to
account for the slow decline in
CD4+ T cell numbers.
Although the symptoms of
immune deficiency characteristic
of AIDS do not appear for years
after a person is infected, the bulk
of CD4+ T cell loss occurs during
the first weeks of infection,
especially in the intestinal
mucosa, which harbors the
majority of the lymphocytes
found in the body. The reason for
the preferential loss of mucosal
CD4+ T cells is that a majority of
mucosal CD4+ T cells express the
CCR5 coreceptor, whereas a
small fraction of CD4+ T cells in
the bloodstream do so.
HIV seeks out and destroys CCR5
expressing CD4+ cells during
acute infection. A vigorous
immune response eventually
controls the infection and initiates
the clinically latent phase.
However, CD4+ T cells in mucosal tissues remain depleted throughout the
infection, although enough remain to initially ward off life-threatening
infections (Source: The World Health Organization).
Estimated per act risk for acquisition
of HIV by exposure route.
Exposure Route
Estimated infections
per 10,000 exposures
to an infected source
Blood Transfusion 9,000
Childbirth 2,500
Needle-sharing injection drug use 67
Percutaneous needle stick 30
Receptive anal intercourse* 50
Insertive anal intercourse* 6.5
Receptive penile-vaginal intercourse* 10
Insertive penile-vaginal intercourse* 5
Receptive oral intercourse*§ 1
Insertive oral intercourse*§ 0.5
* assuming no condom use
§ source refers to oral intercourse
performed on a man
11
11
Continuous HIV replication results in a state of generalized immune
activation persisting throughout the chronic phase. Immune activation,
which is reflected by the increased activation state of immune cells and
release of proinflammatory cytokines, results from the activity of several
HIV gene products and the immune response to ongoing HIV replication.
Another cause is the breakdown of the immune surveillance system of the
mucosal barrier caused by the depletion of mucosal CD4+ T cells during the
acute phase of disease.
This results in the systemic exposure of the immune system to microbial
components of the gut’s normal flora, which in a healthy person is kept in
check by the mucosal immune system. The activation and proliferation of T
cells that results from immune activation provides fresh targets for HIV
infection. However, direct killing by HIV alone cannot account for the
observed depletion of CD4+ T cells since only 0.01-0.10% of CD4+ T cells
in the blood are infected. A major cause of CD4+ T cell loss appears to
result from their heightened susceptibility to apoptosis when the immune
system remains activated. Although new T cells are continuously produced
by the thymus to replace the ones lost, the regenerative capacity of the
thymus is slowly destroyed by direct infection of its thymocytes by HIV.
Eventually, the minimal number of CD4+ T cells necessary to maintain a
sufficient immune response is lost, leading to AIDS (Source: The World
Health Organization).
3. Epidemiology
Estimated prevalence of HIV among young adults (15-49) per country at the end of 2005
The AIDS pandemic can also be seen as several epidemics of separate
subtypes; the major factors in its spread are sexual transmission and vertical
12
12
transmission from mother to child at birth and through breast milk. Despite
recent, improved access to antiretroviral treatment and care in many regions
of the world, the AIDS pandemic claimed an estimated 2.1 million (range
1.9–2.4 million) lives in 2007 of which an estimated 330,000 were children
under 15 years. Globally, an estimated 33.2 million people lived with HIV in
2007, including 2.5 million children. An estimated 2.5 million (range 1.8–
4.1 million) people were newly infected in 2007, including 420,000 children
(Source: The World Health Organization).
Sub-Saharan Africa remains by far the worst affected region. In 2007 it
contained an estimated 68% of all people living with AIDS and 76% of all
AIDS deaths, with 1.7 million new infections bringing the number of people
living with HIV to 22.5 million, and with 11.4 million AIDS orphans living
in the region. Unlike other regions, most people living with HIV in sub-
Saharan Africa in 2007 (61%) were women. Adult prevalence in 2007 was
an estimated 5.0%, and AIDS continued to be the single largest cause of
mortality in this region. South Africa has the largest population of HIV
patients in the world, followed by Nigeria and India. South & South East
Asia are second worst affected; in 2007 this region contained an estimated
18% of all people living with AIDS, and an estimated 300,000 deaths from
AIDS. India has an estimated 2.5 million infections and an estimated adult
prevalence of 0.36%. Life expectancy has fallen dramatically in the worstaffected
countries; for example, in 2006 it was estimated that it had dropped
from 65 to 35 years in Botswana (Source: The World Health Organization).
Changes in life expectancy in some hard-hit African countries. Botswana
Zimbabwe Kenya South Africa Uganda
January 17, 2010
Substance Abuse Dependency CEU MFT LMFT
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.
Table of Contents:
1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References
1. DEFINITIONS
Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”
2. HISTORY
Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).
1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.
Table of Contents:
1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References
1. DEFINITIONS
Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”
2. HISTORY
Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).
June 17, 2009
CEUS Continuing Education for LMFT, LCSW, and LPC Licenses in many states including California
Why choose Aspira? 
Aspira's commitment to excellence means that the mental health and social work online courses we offer are the best you'll find. We offer a broad range of course subjects that are board approved for many professions including MFT, LCSW, and LPC. The process is as simple as selecting a course, completing and passing the online exam, and receiving/printing your certificate issued immediately with your payment.
"Great value in a NO-NONSENSE approach to Continuing Education Units required for
professional licensure. No fluff or filler, just the facts in a clear and
concise format...I'd gladly use them again..."
B.C., MA, LMFT, California
Aspira's commitment to excellence means that the mental health and social work online courses we offer are the best you'll find. We offer a broad range of course subjects that are board approved for many professions including MFT, LCSW, and LPC. The process is as simple as selecting a course, completing and passing the online exam, and receiving/printing your certificate issued immediately with your payment.
With Aspira, you can:
- Satisfy your CE requirements conveniently anywhere you have online access.
- Take your test and even print your completion certificate at any time.
- Take as much time as needed to complete the exam.
- Take the exam as many times necessary to receive a 70% passing score.
- Pay only after you have passed your exam.
- Earn hours for passing exams based on books you may have already read.
- Listen to selected audio courses directly from your computer or MP3 player.
Take some time to browse our courses, and become a part of the Aspira family.
"Great value in a NO-NONSENSE approach to Continuing Education Units required for
professional licensure. No fluff or filler, just the facts in a clear and
concise format...I'd gladly use them again..."
B.C., MA, LMFT, California
Save with our referral program...
Our number one form of advertising is word-of-mouth. We want to make sure that you are happy, so that you will spread the word! We also like to reward our loyal customers who tell others about our service. Visit aspirace.com to learn more about how our referral rewards program saves you money!
Subscribe to:
Posts (Atom)
