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What resources are available for women whose spouses are alcoholic and abusive?

Spousal abuse as well as child abuse is highly correlated with alcoholism. Domestic violence occurs in all cultures, races and ethnicities, religious, and socioeconomic groups. Many clinicians and researchers believe that violence is a learned behavior, role modeled by the parents and perpetuated in the next generation. A child raised in a home with physical abuse is much more likely to be abusive as an adult or to tolerate an abusive spouse. Women are more likely to be the victims than men and when attacked by men, their injuries are more severe. Men, however, can also be victims of spousal abuse, but are less likely to report abuse or to seek help. Another alarming fact is that 50% of men who assaulted their wives also abused their children. Seventy-five percent of spousal abuse reports stated that the offender had been drinking. A study of spousal abuse by male U.S. army soldiers found that domestic violence was more prevalent in families where the soldier drank heavily. A large percentage of women who abuse alcohol or drugs are reported to have been abused either physically or sexually as children. The result of early childhood abuse is poor and inadequate coping skills and severe psychological problems such as chronic anxiety, depression, or PTSD.

There is no one explanation as to why women stay with their abusers. Usually these relationships start out loving and down the road the first incidence of violence occurs, leaving the woman stunned and the man apologetic; however, the cycle frequently is repeated, and the spouse is ashamed, begins to blame himself or herself, and feels trapped. There are some things you can do if you find yourself in a cycle of violence. Plan ahead when you may or may not need an escape route. Pack a bag and hide it from your spouse. Include in the bag a change of clothes, a set of car and house keys, bank account numbers, birth certificates, insurance policies and numbers, marriage license, valuable jewelry, important telephone numbers, and money. Try to contact resources ahead of time. Seek support from 12-step programs for wives of alcoholics. Get support from multiple sources, Al-Anon, Crises Centers, the clergy, and other community organizations. This will empower you to do what is best for you and your children.

What are my rights to refuse treatment?

Treatment for alcoholism and drug abuse is most often done in the community, except for detoxification from a substance, which usually takes place in a hospital. Hospitalizations occur when either the patient's life is threatened during the withdrawal period or because of some other threat to safety, such as threatening violence, as in child abuse or spouse abuse. Unlike most hospitalizations where the issues of safety trump autonomy (the right to self determination), the right to refuse treatment is sacrosanct in all of health care.

Treatment for alcoholism and drug abuse is most often done in the community, except for detoxification from a substance, which usually takes place in a hospital.

In general, patients have the right to refuse medical or psychiatric treatment, short of emergency hospitalizations for reasons of safety.

Informed Consent

When a patient agrees to treatment, he or she must be able to sign a form regarding informed consent that states that he or she understands the proposed treatment plan and the reasons for it. The process of obtaining informed consent includes the following:

• Assessment of the patient's capacity to make medical decisions

• The absence of coercion

• The patient who has been fully informed of the diagnosis, prognosis, risks, and benefits of the treatment and who has been informed of alternative treatments as well as the risks versus benefits of no treatment

The health care provider should test the patient's understanding of the explanation in order to be certain that he or she clearly understands it. All relevant factors, including what was disclosed, the patient's competency, and the agreement to treatment, plus the actual consent form, should be stored in the patient's medical record. Exceptions to informed consent do exist, however.

• Emergencies, such as alcohol withdrawal syndrome or impending DTs

• Court-ordered evaluations

• Therapeutic privilege waiver

• A patient who is unconscious and in need of lifesaving treatment

• A patient who is incompetent

• Child abuse proceedings

Therapeutic privilege occurs when the physician withholds information from the patient because he or she believes that informing the patient will cause more harm than good. Occasionally, patients waive the right to know. It is a good idea for the health care provider to enlist the aid of a family member to make decisions when the patient refuses to participate in his or her health care decisions. Consent is implied when he or she actively participates in the treatment; for example, the patient offers his or her arm to have blood drawn (Albrecht & Herrick, 2006). When refusing medication or treatment, it is important that the patient understands the potential consequences.

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