In order to earn full credit you need to answer each of the questions correctly and fully with substance making at least 1 reference in addition to the unit material, text, or other academic source, and meet the length requirement of 200-350 words minimum for your total response to questions. If two questions, the word count should be divided almost equally (no less than 200 words combined). Your responses should be clearly written and consist of original ideas rather than a recap of what others contribute. Avoid “great post”. If you agree, support your agreement in your own words. Do not repeat the questions!

Reminder: Review Weekly Discussion Participation and Grading Form & APA Style-Format. You may use subheadings and respond in a narrative format (paragraphs).

Discussion Question 1

Relationship between alcohol use and suicide: Here are two apparently contradictory statements: (1) Approximately 10% of persons with a substance use disorder eventually commit suicide, and (2) 40-60% of individuals who take their lives were intoxicated at the time of their deaths. Closer inspection will reveal part of the reason for this apparent discrepancy, however.

The first statement addressed the fact that approximately 10% of all persons with a substance use disorder will eventually (and regrettably) commit suicide. This includes persons with an opioid use disorder, persons with a CNS stimulant use disorder, etc. Many cases of substance-related suicides are impulsive acts, possibly induced (or at least exacerbated) by the effects of the chemicals. As will be discussed later in this text, the CNS stimulants are famous for inducing a deep state of depression in the abuser at times, and such depressive states might reach suicidal proportions. Other drugs of abuse might also induce depressive states that could reach suicidal proportions.

However, many of those persons who decide upon ending their lives will use alcohol to help them build up the courage to do so. Thus, 40-60% of those persons who end their lives are found to have alcohol in their systems at the time of the autopsy. While the subject of suicide makes many people uncomfortable, avoidance of an open and honest discussion of the topic only contributes both to the stigma associated with a person’s suicide, and makes those people who are contemplating such an act reluctant to seek assistance in avoiding death.[i]

Question 1: According to the literature, discuss other ways that substance use and suicide might be intertwined. (PLEASE FOLLOW DIRECTIONS FOR DISCUSSION LISTED ABOVE)

Discussion Question 2

Nonalcoholic liver disease: As stated in your text, excessive alcohol consumption is a major cause of liver disease in this country. However, there are other conditions that can induce liver disease, many of which appear very similar to alcohol-induced liver damage. Viral hepatitis is one such disorder. Another is Nonalcoholic Steatohepatitis (NASH). NASH is usually “silent,” which is to say that it does not induce obvious physical symptoms, although blood tests for liver disease might reveal abnormal level of liver enzymes. Nonalcoholic fatty liver disease might induce nonspecific symptoms such as fatigue, pain in the upper right abdomen, and weight loss, but for many persons with this disorder it is only discovered when a physician orders routine blood tests as part of a general physical examination.

NASH is not automatically progressive, but can halt at an intermediate stage, go into remission, or progress to the point where scar tissue forms on the liver and cirrhosis of the liver develops. If the cirrhosis continues to progress, the individual will eventually suffer so much liver damage that he or she enters the stage of end-stage liver disease. As is seen with alcohol-induced liver disease, persons with nonalcoholic liver disease are at risk for premature death, although the death rate from nonalcoholic liver disease is lower than that seen in alcohol-related liver disease (Angulo, 2010; Soderberg, Stal, Askling, Glaumann, et. al., 2010). Treatment for NASH includes avoidance of alcohol, weight loss, and exercise, as well as control of possible concurrent medical problems such as diabetes, hypertension, and elevated cholesterol levels.

When NASH reaches the stage where it induces liver cirrhosis, it begins to follow a similar course to that seen in alcohol-induced liver cirrhosis. Radiological examination of the liver might reveal signs of fat deposits on the liver, but the definitive diagnosis is achieved through a biopsy of liver tissue. To obtain a sample of liver tissue a needle is inserted into the chest cavity and a small sample of liver cells is aspirated for microscopic examination. If the liver is severely damaged, it might become necessary for a liver transplant to be performed to save the patient’s life.

Another cause of non-alcoholic liver disease are the changes in the liver induced by diabetes, infectious disease, or exposure to toxins such as extreme levels of acetaminophen or allergic reactions to compounds such as disulfiram. Only a physician can determine whether a given patient has alcohol-induced, or nonalcoholic liver disease.

Question 2: Are there other diseases you can think of that have similar stigmas? Is there a scientific basis for these beliefs? If not, how do you think people develop them? (PLEASE FOLLOW DIRECTIONS FOR DISCUSSION LISTED ABOVE)