Changing rapidly and consequent repercussions in new trends in the women consumption of drugs (página 2)

The fact that the female drug addicts are a clear minority in respect to the males, with a rate of less than in The United States, leads to the situation that together with the needs for assistance on the one hand, and the whole of the evolutionary potentiality are often conformed by an interpretation of the situation which takes on a prevalently male connotation.

The Menstrual cycle on drug abuse

Sidney H. Schnoll, M.D., Ph.D., and Michael F. Weaver, M.D in the study of drug use by women, the phases of the menstrual cycle are rarely taken into account. The menstrual cycle[2]has dramatic effects on a woman"s body, yet drugs are rarely given with consideration of this fact. Because the hormonal fluctuation encountered during the menstrual cycle may affect the outcome of studies with a particular drug, the desired positive effect might not result. Studies that test new drugs with women usually are conducted with postmenopausal women. Although elderly people often use drugs, high rates of anxiety and depression occur more frequently in women of child bearing age, yet psychotropic drugs are not studied adequately in the younger female population.[3]

Gastrointestinal transit time changes during phases of the menstrual cycle and also can affect how drugs are absorbed into the body. The time sustained-release drugs spend in certain parts of the gastrointestinal tract is critical for absorption. Time changes also can be critical to maintaining therapeutic blood levels in women during various menstrual cycle phases. Medical professionals also know that older women metabolize benzodiazepines much faster than older men (Greenblatt et al. 1980; Ochs et al. 1981). Women"s decrements of liver function are different from men"s (Dawkins and Potter 1991). However, this is true only of microsomal oxidation and not of glucuronidation, which is important for the longer-acting benzodiazepines that are metabolized to active metabolites. Some shorter-acting benzodiazepines like oxazepam and lorazepam are directly metabolized to excretable forms; glucuronidation is the process responsible. There is no evidence that benzodiazepine metabolism is altered during the menstrual cycle. Antipsychotics cause tardive dyskinesia and extrapyramidal effects more frequently in women than in men (Halbreich et al. 1984); care must be taken in prescribing these drugs for women.[4]

Because the drug abuse treatment system was largely developed at a time when most patients were men, there is concern that this system is not sufficiently responsive to women"s economic, social, and emotional issues (Kumpfer 1991; Wallen 1990, pp. 103-109).

Entering the world of globalization and the twenty-first century has brought great changes in female identity, which can contribute significantly to the understanding of certain psychological, emotional, and social in a world of globalization not only at personal evolution, but also on the social implications. One problem is drug abuse and is evident, the female drug addiction. The women are in a condition of greater vulnerability than men and are more heavily exposed to risks to their health and physical appearances are the phases of the menstrual cycle, this is one aspect in this essay, regarding the other social, psycho and pathological aspects.

The system of social-health services in the United States for treatment and rehabilitation does not seem to take this into account sufficiently for underestimating their specific needs and therefore propose that intervention protocols are the same as men has not been do take into account aspects of female identity, which has to do with the behavior and psycho-social vision of the world of women, influenced by media advertising, beauty contests, the presentation of women often as a visual object and the real world of the woman responsible towards society and the sons and daughters, young single mothers and the social pressure and stress.

In the most general form, and according to Llopis, Castillo and Rebullida in a study of 2003, the association between psycho-pathological addictive disorder and traits in women often have a relationship with a history of sexual abuse, rape and abuse. Another aspect that is particularly relevant in a drug and alcohol dependence in women is undoubtedly the fact that one or more parents have had, earlier this dependency. As for the personal, familial, social and labor faced by women who suffer from a disorder of alcohol or drug dependency of a greater number of suicide attempts in case of men.[5]

Women often experience drug abuse and addiction quite differently than men

The female identity play important role to understand of certain social psychological aspects[6]not only at a personal evolutional level but also regarding the social implications, and changing rapidly and consequent repercussions in new trends in the consumption of drugs.

Social influence refers to the way people affect the thoughts, feelings, and behaviors of others. Like the study of attitudes, it is a traditional, core topic in social psychology. In fact, research on social influence overlaps considerably with research on attitudes and persuasion. Social influence is also closely related to the study of group dynamics, as most of the principles of influence are strongest when they take place in social groups.

Conformity is the most common and pervasive form of social influence. It is generally defined as the tendency to act or think like other members of a group. Group size, unanimity, cohesion, status, and prior commitment all help to determine the level of conformity in an individual. Conformity is usually viewed as a negative tendency in American culture, but a certain amount of conformity is not only necessary and normal, but probably essential for a community to function.

The two major motives in conformity are normative influence, the tendency to conform in order to gain social acceptance, and avoid social rejection or conflict, as in peer pressure; and informational influence, which is based on the desire to obtain useful information through conformity, and thereby achieve a correct or appropriate result. Minority influence is the degree to which a smaller faction within the group influences the group during decision making. This refers to a minority position on some issue, not an ethnic minority. Their influence is primarily informational and depends on consistent adherence to a position, degree of defection from the majority, and the status and self-confidence of the minority members. Reactance is a tendency to assert oneself by doing the opposite of what is expected. This phenomenon is also known as anti-conformity[7]and it appears to be more common in men than in women.

The differences between man and woman

The differences between man and woman have their origins in an obvious sexual dimorphism[8]The majority of cultures have established a differentiation of social role between the sexes which considers them not only distinctive but often antagonistic. Biological differences such as pregnancy in women or the greater physical strength of men have determined the assignation of traditionally dichotomized roles: one characteristic of men and the other characteristic of woman, as much on the educational plane as on that of the family, employment and even in interpersonal relationships of power. In spite of the fact that some separation on the basis of biological differences has been made obsolete by technological changes, the social system, even in more advanced societies, collaborates in the perpetuation of this dichotomy of roles.

Women in the socio-cultural circumstances

In current socio-cultural circumstances, the gender variable constitutes a key reference when analyzing and understanding the significance and the effect of certain external common differences between men and women in so far as social attitudes and repercussions on the quality of life are concerned. The attitude towards a situation has been considered as a relative predictor of human behavior and an underlying one in psychological processes and social behaviors.

Attitudes towards social aspects in respect of the relationship of equality between women and men have a special and determinant affect on the objective and subjective dimensions of the quality of life and, in an overall concept of the term, health included. The ability to develop an influential and autonomous role is a process which must not only be developed in the first years of infancy and adolescence but one which must be continued in the different stages of adult life.

The experiences of participation in the family, school, work place, etc. are key factors in understanding the potential, limitations and obstacles affecting the participation of women in the social system. The assumption of an active social role is not produced in isolated subjects but in individuals linked to the everyday context of interaction between communities.

Therefore, in order to understand the differential effect between men and women in drug use, it is necessary to enter the more social terrain where the conditions of individual identity are established. The perspective of gender permits analysis of the relationships of power and influence in the configuration of the identity of women. The traditional model of the family is based on a hierarchal relationship of power and activities. The male is allocated the role of authority and the women that of the subordinate, roles segmented by the hierarchy of the social groups with different status. This aspect have been change rapidly and consequent repercussions in new trends in the consumption of drugs. The globalization[9]have made big changes in the women behavior, also the new technology, information through internet and information have made a new impact in their daily activities.

Women in the social hierarchy

In addition, the activities allocated to men and women also occupy a position in the social hierarchy, the masculine activities being of greater social value and the feminine ones the most devalued. These activities, those labeled as female, are the most fundamental in social reproduction (care of family members and domestic tasks), without which no social group would survive, and their good administration determines the quality of life. Thus, women are relegated to a subordinate social space but they are allocated tasks which are fundamental but which, paradoxically, are devalued.

Added to this model of power relationships between men and women is the constant dialectic game of transgression and use of these roles to their own advantage, by men as much as women but more so the women in order to confront their subordinate position. This game explains why new forms of domination of the masculine spaces are constantly being generated to maintain their position of power and, at the same time, the transgression of the feminine spaces.

This is important for two aspects that concern this subject. In the first place, the activity of caring for others, the devotion to the family as part of the feminine identity, is a double-edged weapon, it makes the female more dependent on these others, on the males, in particular, but also gives them greater strength and power, given that the development of everyday life and the affective sphere of their families depends on them.

There are many women who feel themselves identified with the role of career, and make it the centre of their lives. Secondly, in our societies, masculine values are not only being perpetuated but they are being reinforced giving more value to the activities and spaces which have traditionally been masculine much as the employment/professional one, and maintaining the traditional feminine activities in a devalued position (Rivera 1998) although these, at the same time, are encroaching more and more on the employment space. Some women attempt to integrate themselves in the space with most prestige – the professional one – and distance themselves from the domestic and care space, but others do not achieve it and remain in the most devalued space. In the case of younger women, who are the ones most affected by the social change, some take on the traditional role positively and continue to seek refuge in the invisible power and the potential their position gives them.

Others, on the contrary, experience a fragmentation of their identity. They are not integrated in the traditional role or part of the prestigious space. In each of these positions, women are vulnerable and protect themselves in different ways and this comes to mean that they face up to the use of drugs and drug addiction with different personal and social recourses, both in respect of other women as in respect of the men in their group.

Deriving from the interaction of all these factors will be the greater or lesser ability to face fundamental daily life situations which also include the relationship of women and drugs, the development of drug dependency and its consequences. The majority of the researchers who have studied women addicts, Rosenbaum (1981, Hser et al. 1987, Thom 1995, Nelson-Zlupko et al, Ettorre 1996, Estebanez and Cifuentes 1997, etc.) find significant differentiation basics between men and women drug addicts.

Women develop an addiction much faster

Women take lower quantities of drugs but develop an addiction much faster, take more tranquillizers and sedatives, receive a greater measure of psychiatric attention and are found to be less involved than men in judicial proceedings. They present lower educational levels, have few financial resources and are more concerned than their partners about day-to-day survival. A drug addiction in women involves higher risks and has serious repercussions on their children. In addition, throughout their lives, women also suffer frequent episodes of sexual and physical abuse.

Women drug addicts have different motivations both for initiation and for continuing use and their main motivation for giving up drugs is the care and custody of their children. Finally, women present specific therapeutically necessities which, when not properly approached, become obstacles in access to treatment.

The phenomena of drug addiction and the epidemiology[10]factors affecting the health and illness of women populations, and the drug addiction in women involves higher risks and has serious repercussions on their children serves. The foundation and logic of interventions made in the interest of public health and preventive medicine an important factor of prevention. The importance of women undoubtedly represents a part of the problem which cannot be ignored. The fact that the female drug addicts are a clear minority in respect to the males, in the United States, leads to the situation that together with the needs for assistance on the one hand, and the whole of the evolutionary potentiality are often conformed by an interpretation of the situation which takes on a prevalently male connotation. Indeed, when a problem of drug abuse becomes evident, the female drug addict appears in a condition of greater vulnerability than the male and is more seriously exposed to risks for her health and physical integrity and understanding, of the subject of female identity can undoubtedly contribute significantly towards the understanding of certain psychological aspects, not only at a personal evolutional level but also regarding the social implications since they are the ones most affected by these cultural changes such as life-style with the consequent repercussions in new trends in the consumption of drugs.

Excessive consumption of drug, alcohol and tobacco, the use and abuse of other drugs – especially drugs prescribed minor tranquilizers and sedatives – is a widespread practice among women. This is a reality that is not supported and that most of the time is hidden. According to the Center for Substance Abuse Treatment -1992- (CSAT)[11] in the United States 921.000 young women and teenagers more than 50,000 abused alcohols, 4.4 million women over age 12 had used an illicit drug and 1.3 million used psychotherapeutic drugs for non-medical reasons. These numbers have increased year after year, is a reality. Studies show that addiction to the woman goes on to pose a health concern. Tobacco use, alcohol and other drugs, not only adversely affects health, but in the case of pregnant women affects the whole process of reproduction, from fertilization, pregnancy and childbirth, breastfeeding and development the child. The National Association for Prenatal Addiction Research and Education in the United States has estimated that each year 375,000 children are born to mothers who abuse drugs.

In 1999 a study of Substance Abuse by the Mental Health Services Administration. A National Household Survey on Drug Abuse -1998, estimates that 77.6% of women age 12 and older reported ever using alcohol, while 60% reported past year (1997) use and 45.1% reported using alcohol in the past month. 82.5% of white women reported ever using alcohol, while 65% reported past year use and 49.7% reported using alcohol in the past month. 67.9% of black women reported ever using alcohol, while 45.1% reported past year use and 32.3% reported using alcohol in the past month. 60.8% of Hispanic women reported ever using alcohol, while 48.4% reported past year use and 33.6% reported using alcohol in the past month. Among current female drinkers, 7.16% of whites, 10.22% of blacks, 22.16% of American Indians/Alaska Native, and 9.03% of Hispanics reported alcohol dependence. Men and women reported different levels of alcohol involvement. 58.7% of men age 12 and older reported past month alcohol use compared to 45.1% of women, while 23.2% of men age 12 and older reported binge drinking in the past month compared to 8.6% of women.

Women absorb and metabolize alcohol differently than men. Alcohol consumption is associated with a linear increase in breast cancer incidence in women over the range of consumption reported by most women. A pooled analysis of several studies found breast cancer risk was significantly elevated by 9% for each 10-gram per day increase in alcohol intake for intakes up to 60 grams per day. Although the mean lifetime dose of alcohol in female alcoholics is only 60% of that in male alcoholics, one study noted that cardiomyopathy (a degenerative disease of the heart muscle) and myopathy (a degenerative disease of skeletal muscle) was as common in female alcoholics as in males. The study concluded that women are more susceptible than men to the toxic effects of alcohol on the heart muscle. Brain shrinkage in men and women was found to be similar despite significantly shorter periods of alcohol exposure or drinking histories in women.[12]

Women with chronic pancreatitis have shorter drinking histories than that of men. Women with alcoholic hepatitis and cirrhosis were found to have consumed less alcohol per body weight per day than men. These findings indicate that women are more vulnerable to alcoholic liver disease than men.[13] Although alcohol problems are more common in male trauma patients, women with alcohol problems are just as severely impaired, have at least as many adverse consequences of alcohol use, and have more evidence of alcohol-related physical and psychological harm.

Using cultural analysis as a perspective for gaining gendered information may allow for identifying new patterns within specific cultural and subgroup contexts. It may contribute new information to the following treatment research areas: gender-appropriate measurement issues; service integration; gender-appropriate services for women; and drug abuse, drinking rituals and patterns.

Brentwood, New York November 18, 2009.

Jorge Yeshayahu Gonzales-Lara, MA

Sociologist, University of Inca Garcilaso de la Vega, Perú

Latin American Studies & International Migration, Hunter College, U.S.

Graduate from Federal Academy as Federal immigration Officer, Glenco, Georgia. U.S.

Accepted into Diploma Program Alcoholism & Substance Abuse Counselor

Outreach Training Institute, Brentwood, New York 2009.

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Paolo Stocco, Juan José Llopis Llacer, Laura DeFazio, Amador Calafat, Fernando Mendes. WOMEN DRUG ABUSE IN EUROPE: GENDER IDENTITY. IREFREA & European Commission. I.S.B.N.: 84-607-0775-XD. Legal: V-2391-2000. IREFREA ESPAÑA. Rambla, 15, 2º, 3ª E. 07003 Palma de Mallorca (ESPAÑA). Print: MARTIN IMPRESORES, S.L. • Pintor Jover, 1 • 46013 Valencia.

Fernández, Alonso. Los Secretos del Alcoholismo. 1998. Madrid Ediciones Libertarias.

Sidney H. Schnoll, M.D., Ph.D., and Michael F. Weaver, M.D. Pharmacology: Gender-Specific Considerations in the Use of Psychoactive Medications. Division of Substance Abuse Medicine.

Source: National Institute on Drug Abuse.

Kathleen R. Merikangas, Ph.D., and Denise E. Stevens, Ph.D. Substance Abuse Among Women: Familial Factors and Comorbidity. Department of Epidemiology.

Wikipedia, the free encyclopedia. Sexual dimorphism.

Wikipedia, the free encyclopedia. Globalization and various aspects which affect the world in several different ways.

Wikipedia, the free encyclopedia. Epidemiology.

Jeremy Kendal, Luc-Alain Giraldeau, and Kevin Laland. The evolution of social learning rules: Payoff-biased and frequency-dependent biased transmission Department of Anthropology, University of Durham, Dawson Building, South Road, Durham DH1 3LE, UK. 2008.

Valerie DeMarinis, Christina Scheffel-Birath, and Helen Hansagi. Cultural Analysis as a Perspective for Gender. Informed Alcohol Treatment Research in a Swedish Context. Published by Oxford University Press. 2008.

The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT).

Substance Abuse and Mental Health Services Administration. (1999). National Household Survey on Drug Abuse: Population Estimates 1998. DHHS Publication No. (SMA) 99-3327. Rockville, MD: U.S. Department of Health and Human Services.

National Institute of Alcohol Abuse and Alcoholism. (1998). Drinking in the United States: Main findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey. NIH Publication No. 99-35198. Bethesda, MD: U.S. Department of Health and Human Services.

Substance Abuse and Mental Health Services Administration. (1999). Summary of Findings from the 1998 National Household Survey on Drug Abuse. DHHS Publication No. (SMA) 99-3328. Rockville, MD: U.S. Department of Health and Human Services.

National Institute on Alcohol Abuse and Alcoholism. (1999). Are women more vulnerable to alcohol effects? Alcohol Alert No. 46. Rockville, MD: U.S. Department of Health and Human Services.

Smith-Warner, S. A., Spiegelman, D., Yaun, S., van den Brandt., P. A., Folsom, A. R., Goldbohn, R. A., Graham, S., Holmberg, L., Howe, G. R., Marshall, J. R., Miller, A. B., Potter, J. D., Speizer, F. E., Willett, W. C., Wolk, A., & Hunter, D. J. (1998). Alcohol and breast cancer in women: A pooled analysis of cohort studies. Journal of the American Medical Association, 279(7):535-540.

Urbano-Marquez, Estruch, R., Fernandez-Sola, J. Nicolas, J. M., Pare, J. C., & Rubin, E. (1995). The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. Journal of the American Medical Association, 274(2): 149-154.

Mann, K., Batra, A., Gunthner, A., & Schroth, G. (1992). Do women develop alcoholic brain damage more readily than men? Alcohol Clin Exp Res, 16(6):1052-6.

Mezey, E., Kolman, C. J., Diehl, A. M., Mitchell, M. C., & Herlong, H. F. (1988). Alcohol and dietary intake in the development of chronic pancreatitus and liver disease in alcoholism. American Journal of Clinical Nutrition, 48(1):148-51.

Autor:

Jorge Yeshayahu Gonzales-Lara

[1] When we think about male and female identity we tend to assume that these individual identities are absolute and that there is a male identity and that there is a female identity. In addition to this, we also tend to imagine that everyone around us regards male and female identity in the same way. Not only that, but we are inclined to believe that male and female identity are so absolute in their nature that they can be defined in detail, rather like a national costume or a recipe. Because of this, an impression exists that when we talk to another male or a female as the case may be, that their impression of the male identity and the female identity is identical and therefore can be agreed upon by all. In fact, nothing could be further from the truth.

[2] The menstrual cycle is a cycle of physiological changes that occurs in fertile females. Overt menstruation (where there is blood flow from the uterus through the vagina) occurs primarily in humans and close evolutionary relatives such as chimpanzees. Females of other species of placental mammal undergo estrous cycles, in which the endometrium is completely reabsorbed by the animal (covert menstruation) at the end of its reproductive cycle. This article focuses on the human menstrual cycle. The menstrual cycle, under the control of the endocrine system, is necessary for reproduction. It may be divided into three distinct phases: menstruation, the follicular phase and the luteal phase. Ovulation defines the transition from the follicular phase to the luteal phase. The length of each phase varies from woman to woman and cycle to cycle, though the average menstrual cycle is 28 days. Hormonal contraception interferes with the normal hormonal changes with the aim of preventing reproduction.

[3] Sidney H. Schnoll, M.D., Ph.D., and Michael F. Weaver, M.D. Pharmacology: Gender-Specific Considerations in the Use of Psychoactive Medications. Division of Substance Abuse Medicine. Pages. 224. 225

[4] Sidney H. Schnoll, M.D., Ph.D., and Michael F. Weaver, M.D. Pharmacology: Gender-Specific Considerations in the Use of Psychoactive Medications. Division of Substance Abuse Medicine, Page 225.

[5] Fernández, Alonso. Los Secretos del Alcoholismo. 1998. Madrid Ediciones Libertarias. Page. 201.

[6] Social psychology is the scientific study of how people's thoughts, feelings, and behaviors are influenced by the actual, imagined, or implied presence of others. By this definition, scientific refers to the empirical method of investigation. The terms thoughts, feelings, and behaviors include all of the psychological variables that are measurable in a human being. The statement that others may be imagined or implied suggests that we are prone to social influence even when no other people are present, such as when watching television, or following internalized cultural norms.

[7] The present a gene-culture co evolutionary analysis of a small selection of such rules (unbiased social learning, payoff-biased social learning and frequency-dependent biased social learning, including conformism and anti-conformism) in a population of asocial learners where the environment is subject to a constant probability of change to a novel state. We define conditions under which each rule evolves to a genetically polymorphic equilibrium. We find that payoff-biased social learning may evolve under high levels of environmental variation if the fitness benefit associated with the acquired behavior is either high or low but not of intermediate value. In contrast, both conformist and anti-conformist biases can become fixed when environment variation is low, whereupon the mean fitness in the population is higher than for a population of asocial learners. Our examination of the population dynamics reveals stable limit cycles under conformist and anti-conformist biases and some highly complex dynamics including chaos. Anti-conformists can out-compete conformists when conditions favor a low equilibrium frequency of the learned behavior. We conclude that evolution, punctuated by the repeated successful invasion of different social learning rules, should continuously favor a reduction in the equilibrium frequency of asocial learning, and propose that, among competing social learning rules, the dominant rule will be the one that can persist with the lowest frequency of asocial learning. 2009 Elsevier Ltd All rights reserved. The evolution of social learning rules: Payoff-biased and frequency-dependent biased transmission. Jeremy Kendal, Luc-Alain Giraldeau, and Kevin Laland. Department of Anthropology, University of Durham, Dawson Building, South Road, Durham DH1 3LE, UK. 2008. (Abstract.) page. 1

[8] Dimorphism: Types of dimorphism (having two body types) include: Sexual dimorphism, differences in the physiology of a species based only on sex non-sexual dimorphism, two clearly distinct physiologies present in a species not based on sex.

[9] Globalization describes an ongoing process by which regional economies, societies, and cultures have become integrated through a globe-spanning network of communication and execution. The term is sometimes used to refer specifically to economic globalization: the integration of national economies into the international economy through trade, foreign direct investment, capital flows, migration, and the spread of technology. However, globalization is usually recognized as being driven by a combination of economic, technological, socio-cultural, political, and biological factors. The term can also refer to the transnational circulation of ideas, languages, or popular culture. Globalization has various aspects which affect the world in several different ways such as: Informational – increase in information flows between geographically remote locations. Arguably this is a technological change with the advent of fibre optic communications, satellites, and increased availability of telephone and Internet. Cultural – growth of cross-cultural contacts; advent of new categories of consciousness and identities which embodies cultural diffusion, the desire to increase one's standard of living and enjoy foreign products and ideas, adopt new technology and practices, and participate in a "world culture". Some bemoan the resulting consumerism and loss of languages. Also: Transformation of culture. Spreading of multiculturalism, and better individual access to cultural diversity (e.g. through the export of Hollywood and, to a lesser extent, Bollywood movies). Some consider such "imported" culture a danger, since it may supplant the local culture, causing reduction in diversity or even assimilation. Others consider multiculturalism to promote peace and understanding between peoples.

[10] Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges from outbreak investigation to study design, data collection and analysis including the development of statistical models to test hypotheses and the documentation of results for submission to peer-reviewed journals. Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic. Epidemiologists rely on a number of other scientific disciplines, such as biology (to better understand disease processes), Geographic Information Science (to store data and map disease patterns) and social science disciplines (to better understand proximate and distal risk factors). Epidemiology is concerned with the incidence of disease in populations and does not address the question of the cause of an individual€™s disease. This question, sometimes referred to as specific causation, is beyond the domain of the science of epidemiology. Epidemiology has its limits at the point where an inference is made that the relationship between an agent and a disease is causal (general causation) and where the magnitude of excess risk attributed to the agent has been determined; that is, epidemiology addresses whether an agent can cause a disease, not whether an agent did cause a specific plaintiff€™s disease.

[11] The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT). The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency of the United States federal government. It is charged with improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. SAMHSA is a branch of the Health and Human Services Department, and its director (administrator) reports directly to the Health and Human Services Secretary. SAMHSA's headquarters building is located in Rockville, Maryland.

[12] Substance Abuse and Mental Health Services Administration. (1999). National Household Survey on Drug Abuse: Population Estimates 1998. DHHS Publication No. (SMA) 99-3327. Rockville, MD: U.S. Department of Health and Human Services.

[13] Smith-Warner, S. A., Spiegelman, D., Yaun, S., van den Brandt., P. A., Folsom, A. R., Goldbohn, R. A., Graham, S., Holmberg, L., Howe, G. R., Marshall, J. R., Miller, A. B., Potter, J. D., Speizer, F. E., Willett, W. C., Wolk, A., & Hunter, D. J. (1998). Alcohol and breast cancer in women: A pooled analysis of cohort studies. Journal of the American Medical Association, 279(7):535-540