雙語達人:女性爲何也會酗酒(2)

As she approached her 50th birthday, Joanna, a Pennsylvania information-technology specialist, grew tired of hiding her 1.5-liter empties from her husband. Joanna (who asked that her name be changed to protect her privacy) began attending meetings of Alcoholics Anonymous at the suggestion of her psychiatrist. In the U.S., the 12-step abstinence- and faith-based program is embraced by the nation's courts, much of the medical establishment, insurance companies and popular culture as a one-size-fits-all approach to harmful drinking.

快過50歲生日時，賓夕法尼亞州信息技術專家喬安娜(Joanna，她要求隱瞞真實姓名以保護隱私)厭倦了向丈夫隱瞞自己1.5升的空酒瓶。喬安娜開始在心理醫生的建議下參加“嗜酒者互誡協會”(Alcoholics Anonymou，簡稱A.A.)聚會。在美國，這個12步戒酒及建立信心的項目受到了國家法院、大部分醫療機構、保險公司及流行文化的歡迎，其被視爲是應對酗酒問題的通用方法。

A.A. was founded in 1935 by two men who believed that alcohol dependence could be tamed by regular attendance at group meetings with other recovering alcoholics. Its doctrine calls for members to tame their egos, abstain from all drinking and acknowledge they are in the grip of a force they can combat only with help from a 'higher power.''

A.A.於1935年由兩位男士創立，他們認爲對酒的依賴可以通過定期參加與其他正在恢復的酗酒者的聚會而得到抑制。其宗旨是號召成員控制自我意識，完全放棄飲酒，並承認他們正被一種力量所控制，只有在一種“更高力量”的幫助下才能與之抗衡。

It doesn't take an advanced degree in gender studies to realize that this approach─which has worked well for millions of people─may not be perfect for women whose biggest problem is not an excess of ego but a lack of it. Women are twice as likely to suffer from depression and anxiety as men─and are far more likely to medicate those conditions with alcohol.

不需要在性別研究領域取得多高的學歷就能意識到，雖然數百萬人已經通過這種方法得到很好的效果，但對那些其最大的問題是自我意識太強而非缺乏自我意識的女性來說，這種方法並不完全適用。女性得抑鬱症和焦慮症的機率是男性的兩倍，而且用酒精來治療這些症狀的可能性也大得多。

Many women who drink heavily are also the victims of sexual abuse and have had eating disorders. The idea of being powerless can underscore a woman's sense of vulnerability, researchers say. 'Women need to feel powerful, not like victims of something beyond their control,' says Dr. Barnes. 'It gives women power to feel they themselves can change.'

許多酗酒的女性同時也是性虐待的受害者，並患有進食障礙。研究人員說，無力感會加強女性的脆弱感。巴恩斯說：“女性需要感到有力量，而不受制於超出自己控制的東西。酒精賦予女性力量，讓她們覺得自己能夠改變。”

Scientists are continuing to explore the biochemical differences in the way that alcohol affects men and women. Studies show that after drinking, men report feeling more powerful, often overstating their capabilities and accomplishments, while women say that it makes them feel more affectionate, sexy and feminine.

科學家們正繼續探索酒精對男性和女性在生物化學上的不同影響。研究表明，在飲酒後，男性表示感覺到更有力量，通常會誇大自己的能力和成就，而女性則表示飲酒後她們覺得自己更感性、性感和有女人味。

In Europe, Hong Kong and elsewhere in the industrialized world, clinicians treat alcohol-use disorders with a variety of techniques developed in the nearly eight decades since the founding of A.A. (Researchers favor the term 'alcohol-use disorder,' which encompasses a range of severity, over 'alcoholism.') Many combine different behavioral therapies with medications such as naltrexone and topiramate, which help block cravings. Both drugs have proved to be effective in helping patients abstain or moderate. Studies around the world have found that for those who are not severely alcohol-dependent, controlled drinking is possible. Advocates of the 12-step program reject these findings and continue to maintain that abstinence is the only remedy.

從A.A.創立後的近八十年以來，歐洲、香港及其他發達國家的臨牀醫生運用各種不同的方法治療酒精使用障礙。（研究人員覺得用“酒精使用障礙”比“酗酒”要好，前者可涵蓋各種程度飲酒。）很多醫生將不同的行爲療法與納曲酮(naltrexone)和託口酯(topiramate)等抑制酒癮的藥物相結合。這兩種藥物均被證明能夠有效幫助病人戒掉或節制酒癮。世界各地的研究發現，對酒精依賴不是很嚴重的人來說，控制性飲酒是有可能的。12步戒酒項目的倡導者對這些研究結果表示排斥，繼續堅持認爲戒酒是唯一的治療方法。

For Joanna, wine was a nightly antidote for her pressure-filled job. It also provided a respite from a decade of depression after her parents' deaths.

對喬安娜來說，葡萄酒是晚上從壓力重重的工作中解放的良藥，它也能對自己自父母去世後已患十年的抑鬱症起到緩解作用。

Joanna tried some coed and women's A.A. meetings, but she never felt comfortable exposing herself to strangers. Her concerns were not unfounded: A.A. members talk about the tendency of old-timers to take sexual advantage of fragile newcomers, an act known as the 'Thirteenth Step.' Questioned about the sexual abuse of young women by one of its own trustees, the A.A. board's Subcommittee on Vulnerable Members responded in 2009 that it could not do anything to oversee tens of thousands of meetings each day. The public-information officer at A.A.'s central office in New York had no comment.
喬安娜嘗試過一些不限性別的A.A.聚會，也參加過女性A.A.聚會，但她總不適應把自己暴露在一羣陌生人面前。她的顧慮並不是沒有根據：A.A.成員提到有些老成員愛佔脆弱的新成員的便宜，這種行爲被稱爲“第13步”。2009年，A.A.董事會弱勢成員小組委員會(Subcommittee on Vulnerable Members)一位受託人對年輕女性實施性虐待，當被問及此事時，委員會迴應說沒辦法做到每天都監管數千場的聚會。A.A.紐約中央辦公室的公共信息官員表示無可奉告。
A.A.'s membership surveys reveal that 12% of members are ordered to attend by the courts. Though most have been charged with drunken driving, some are sex offenders and other felons with violent backgrounds. In Hawaii in 2010, a veteran with a history of violence, ordered by authorities to attend meetings after a stay in a psychiatric hospital, killed a woman he met in A.A. and her 13-year-old daughter before shooting himself.
A.A.的會員問卷調查顯示，12%的成員是被法院要求參加互助會的。雖然大多數人都被指控爲醉酒駕駛，但有些是性侵犯及其他有暴力背景的重罪犯。2010年，一名有暴力史的老兵在精神病院待了一段時間後被政府要求參加互助會，他殺害了一名在A.A.認識的女性及其13歲的女兒，然後自殺。
A.A. views the thousands of meetings that take place each day as the work of autonomous groups, responsible for supervising themselves. A group based on anonymity, board members argued, could not do anything to screen members without undercutting its basic principles.
A.A.把每天舉行的數千場互助會看作是匿名組織的工作，認爲這些組織有自我監督的責任。董事會成員表示，一個匿名建立的組織無法拋棄自己的基本原則去篩選成員。
Joanna searched for new options and found the website of Dr. Barnes and her practice partner Ed Wilson. The two offer five days of intensive personal counseling. The idea is to examine what triggers a woman's drinking and to help her decide how she might design a healthier life. 'Most of our female clients slip into harmful drinking in their 40s and 50s, masking the discomfort of fluctuating hormones, the adjustment to an empty nest, the death of parents and other role losses,' Dr. Wilson says.
喬安娜開始尋找其他辦法，她發現了巴恩斯的網站和她的合夥人艾德•維爾森(Ed Wilson)。二人爲喬安娜提供了五天的集中個人諮詢。巴恩斯的理念是找到引起女性飲酒的根源，幫助她決定如何規劃一個更健康的生活。維爾森說：“大多數的女性客戶都是在40多歲或50多歲開始酗酒，藉此隱藏由於荷爾蒙波動、適應空巢生活、父母的過世及其他角色喪失帶來的不適。”
For many such women, the problem is learning how to moderate their drinking rather than stopping completely. Decades of research show that it is possible, Dr. Wilson says, and it has been his practice's experience. Clients visit a family doctor who conducts a physical exam and prescribes naltrexone. Once clients return home, they may follow up with the psychologists by phone for several months.
對許多這樣的女性來說，問題在於學習如何節制飲酒，而不是完全戒掉。維爾森說，數十年的研究顯示這是有可能的，而且也是他執業多年的經驗。客戶可以去看家庭醫生，醫生進行體檢，然後開一些納曲酮。客戶回到家以後，她們可以在隨後的幾個月裏與心理醫生保持電話聯繫。
To Joanna, the treatment, which costs $8,750, offered brevity, privacy and encouraging results. Dr. Wilson said that his practice's 240 clients reported a 70% success rate after six years, having achieved their desired goal of moderation or abstention.
喬安娜的治療花費8,750美元（約合人民幣53,637元），對她來說，這種治療過程簡單、隱私有保證，而且效果令人欣慰。維爾森說，診所的240名客戶經過六年的時間達到70%的成功率，都達到了她們預期的節制或戒酒的目標。
Joanna, who decided it would be easiest to quit booze altogether, hasn't indulged in nearly four years. She credits her therapy and three months of naltrexone, which in some small studies has been shown to reduce alcohol euphoria most effectively in women, as well as meditation, for her success. 'It's liberating,' she says. 'I remember what I read at night now.'
喬安娜認爲徹底戒酒應該是最容易的，她已經有將近四年沒有酗酒了。她將自己的成功歸功於自己的理療和三個月服用納曲酮，還有冥想。一些小型研究已經表明納曲酮對減少女性飲酒的快感最有療效。她說：“我解脫了。現在我能記得晚上看得什麼書。”
Mark Willenbring, a psychiatrist in St. Paul, Minn., and a former director of treatment research at the National Institute of Alcohol Abuse and Alcoholism, believes that the new drugs, along with others in development, will lift the stigma of alcohol-use disorders, much as Prozac changed views of depression.
明尼蘇達州聖保羅(St. Paul)心理醫師、曾任美國國家酗酒與酒精中毒研究所治療研究主任的馬克•維綸布林(Mark Willenbring)認爲，新藥物及其他正在研發的藥物會抹去酒精使用障礙的污點，就像氟西汀(Prozac)改變了人們對抑鬱症的看法一樣。
Notwithstanding the well-publicized trips of celebrities to rehab, fewer than 10% of the estimated 20 million Americans with harmful drinking habits ever receive specialized treatment. That could change, Dr. Willenbring argues, if primary-care doctors were trained to administer antirelapse drugs and counseling to those on the less troubled end of the spectrum.
儘管媒體時常曝光明星進入康復中心，但在大約2,000萬有有害飲酒習慣的美國人中，只有不到10%的人接受過特殊治療。維綸布林認爲，如果初級保健醫生們能學習如何開抗復發藥物併爲較輕患者提供諮詢，那麼這種情況是可以改變的。
That would be good news for the many women who have crossed beyond a controlled sipping point but are unable to spend a month in rehab and uncomfortable with the notion of powerlessness.
對那些已經越過可控飲酒標準但不能在康復中心待一個月、而且對無力狀態感到不舒服的女性來說，這或許是個好消息。