THE EFFECTS OF

VIOLENCE ON
CHILDREN AND
ADOLESCENTS.
LOS EFECTOS DE LA
VIOLENCIA EN LOS
NIÑOS Y
ADOLESCENTES

El abuso a las drogas y la adición y sus efectos en el sistema neurotransmisores

Domestic violence in heterosexual and homosexual relationships: Domestic Abuse and
Violence against Men

Jorge Yeshayahu Gonzales-Lara

 Contenido/Content
1. The effects of Domestic Violence on Children
2. The effects of Domestic Violence on Latino Children
3. Los efectos de la violencia doméstica en los niños, niñas y jóvenes
latinos en los Estados Unidos y el refugio en las padillas
4. El Maltrato infantil y el Abuso Sexual en la Comunidad Latina de los
Estados Unidos
5. Los adolescentes: alcohol y otras drogas
6. Domestic violence in heterosexual and homosexual relationships: Domestic
Abuse and Violence against Men
7. Living in Fear Domestic Abuse and Violence
8. The story of Paola a Peruvian woman as a victim of the domestic violence
9. Story of domestic violence: The penis as weapon and immigration status as
a means to humiliate and intimidate the victim by the perpetrator husband
10. Abuso doméstico y violencia contra los hombres: La violencia
doméstica en las relaciones heterosexuales u homosexuales
11. El impacto del uso de tabaco en Estados Unidos y el consumo de
tabaco en la comunidad Hispana
12. The new trends in the women consumption of drugs, alcohol and
tobacco in the Era of Globalization
13. El abuso a las drogas y la adición y sus efectos en el sistema
neurotransmisores
14. Substance abuse among teens of any kind is dangerous Alcohol,
Marijuana, Stimulants, Depressants, Opiates, Inhalants, Hallucinogens,
PCP.
15. El estigma en la adicción a las drogas, alcohol y la discriminación en
el mosaico de culturas en la comunidad latina en Estados Unidos
16. The stigma of addiction to drugs, alcohol and discrimination in the
Hispanic community
17. Biographia & References

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The effects of Domestic Violence on
Children

"Families under stress produce children under

stress. If a spouse is being abused and there are
children in the home, the children are affected by the
abuse." (Ackerman and Pickering, 1989)

Domestic violence affects all family members, especially children.

Family violence creates a home environment where children live in
constant fear. Children who witness family violence are affected in ways
similar to children who are physically abused Family violence creates a
home environment where children live in constant fear. Children who
witness domestic violence are affected similarly to children who are
abused physically, sexually and emotionally. Parents are often unable
to establish links with raising children, unable to establish nurturing
bonds and have a greater risk of abuse and neglect if they live in a
violent home.

Recently studies show that more than 3 million children witness

violence in their homes each year. Those who see and hear violence in
the home suffer physically and emotionally. Families with children living
in stress product of domestic violence and creates insecurity and live in
constant fear that children are affected that extends throughout the

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home. The abuser violates the space of a spouse physically and
emotionally. Children witnesses of domestic violence and is reflected in
their behavior as low self-esteem, violent games and develops self-
defense mechanisms that internalize.

Statistics show that over 3 million children witness violence in their

home each year. Those who see and hear violence in the home
suffer shame, guilt, self- blame, confusion about conflicting feelings
toward parents, fear of abandonment, or expressing emotions, the
unknown or personal injury, anger and depression, feelings of
helplessness and powerlessness.

Dynamics of domestic violence are unhealthy for children:

• Control of family by one dominant member.

• Abuse of a parent.

• Isolation.

• Protecting the "family secret".

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• Children react to their environment in different ways, and reactions
can vary depending on the child's gender and age.

• Children exposed to family violence are more likely to develop social,

emotional, psychological and or behavioral problems than those who are
not. Recent research indicates that children who witness domestic
violence show more anxiety, low self-esteem, depression, anger and
temperament problems than children who do not witness violence in the
home. The trauma they experience can show up in emotional,
behavioral, social and physical disturbances that effect their
development and can continue into adulthood.

Emotional effects.

• Grief for family and personal losses.

• Shame, guilt, and self-blame.

• Confusion about conflicting feelings toward parents.

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• Fear of abandonment, or expressing emotions, the unknown
or personal injury.

• Anger.

• Depression and feelings of helplessness and powerlessness.

• Embarrassment.

• Behavioral

• Acting out or withdrawing.

• Aggressive or passive.

• Refusing to go to school.

• Care taking; acting as a parent substitute.

• Lying to avoid confrontation.

• Rigid defenses.

• Excessive attention seeking.

• Bedwetting and nightmares.

• Out of control behavior.

• Reduced intellectual competency.

• Manipulation, dependency, mood swings.

Social Isolation from friends and relatives

• Stormy relationships.

• Difficulty in trusting, especially adults.

• Poor anger management and problem-solving skills.

• Excessive social involvement to avoid home.

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• Passivity with peers or bullying.

• Engaged in exploitative relationships as perpetrator or

victim.

Physical

• Somatic complaints, headaches and stomachaches.

• Nervous, anxious, short attention span.

• Tired and lethargic.

• Frequently ill.

• Poor personal hygiene.

• Regression in development.

• High risk play.

• Self abuse

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Abusers are very good at controlling and manipulating their victims.
People who have been emotionally abused or battered are depressed,
drained, scared, ashamed, and confused. They need help to get out, yet
they’ve often been isolated from their family and friends. By picking up
on the warning signs and offering support, you can help them escape
an abusive situation and begin healing.

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El Maltrato infantil y el Abuso
Sexual en la Comunidad Latina de
los Estados Unidos

La depresión, adolescentes y el abuso al alcohol y las drogas

La policía de Hialeah arrestó bajo cargos de abuso infantil a los padres

de una niña que fue encontrada deambulando sola en las calles de la
ciudad. La pequeña, de dos años y que recibió el sobrenombre de 'Baby
Bella', apareció caminando sola por la avenida 9 y la calle 74 de Hialeah,
a las 9:30 a.m. del martes. Llevaba una camiseta rosada de "Bratz" y
unos pañales. La niña se salió del apartamento y comenzó a caminar por
las calles de Hialeah, donde estuvo dando vuelta sola por dos horas.
El padre de la menor, de 31 años, y la madre de 23 años fueron
arrestados y acusados de abuso infantil y negligencia. Oficiales de la
policía de Hialeah indicaron que la pequeña tenía marcas y moretones.
El Nuevo Herald – Noticias Sur de la Florida

El maltrato infantil, el abuso sexual, la depresión en los niños y el abuso

de drogas (marijuana, cocaína, crack, estaxis, heroína) tabaco y alcohol
se han convertido en una epidemia social que amenaza la familia latina
en los Estados Unidos. La población hispana / latina es considerada de
una manera más precisa como un mosaico de culturas. Los diferentes
grupos hispanos reflejan grandes diferencias étnicas, culturales y tienen
pocas características en común. La comunidad latina cubre todos los
espectros raciales; los latinos pueden ser blancos, afroamericanos,
asiáticos o nativo americano, y su diversidad se extiende a la
nacionalidad, costumbres, ancestros, estilos de vida y nivel
socioeconómico. En la comunidad Hispana el maltrato infantil es mucha
vez ocultado con la frase “Mis padres me educaron a punta de golpes
por eso no soy delincuente o prostituta” y el maltrato físico y verbal
continua de generación en generación como parte de la
subcultura que “la letra entra con sangre.”. Este hecho se ha hecho

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cada vez más evidentes y público en el mosaico de culturas hispanas,
niños y jóvenes abusados buscan refugio en las pandillas y las drogas.
Las cifras acerca del maltrato físico de los niños son alarmantes. Se
estima que cientos de miles de niños han recibido abuso y maltrato a
manos de sus padres o parientes. Miles mueren. Los que sobreviven el
abuso, viven marcados por el trauma emocional, que perdura mucho
después de que los moretones físicos hayan desaparecido. Las
comunidades y las cortes de justicia reconocen que estas heridas
emocionales ocultas pueden ser tratadas. El reconocer y dar
tratamiento inmediato es importante para minimizar los efectos a largo
plazo causados por el abuso o maltrato físico.

Los niños que han sido abusados pueden exhibir:

✓ una pobre autoimagen
✓ reactivación del acto sexual
✓ incapacidad para depender de, confiar en, o amar a otros
✓ conducta agresiva, problemas de disciplina y, a veces,
comportamiento ilegal
✓ coraje y rabia
✓ comportamiento autodestructivo o auto abusivo, pensamientos
suicidas

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 ✓ pasividad y comportamiento retraído
✓ miedo de establecer relaciones nuevas o de comenzar actividades
nuevas
✓ ansiedad y miedos
✓ problemas en la escuela o fracaso escolar
✓ sentimientos de tristeza u otros síntomas de depresión
✓ visiones de experiencias ya vividas y pesadillas
✓ abuso de drogas o de alcohol
A menudo el daño emocional severo a los niños maltratados no se refleja
hasta la adolescencia, o aún más tarde, cuando muchos de estos niños
maltratados se convierten en padres abusivos y comienzan a maltratar
a sus propios hijos. Un adulto que fue abusado de niño tiene mucha
dificultad para establecer relaciones personales íntimas. Estas víctimas,
tanto hombres como mujeres, pueden tener problemas para establecer
relaciones cercanas, para establecer intimidad y confiar en otros al
llegar a adultos. Están expuestos a un riesgo mayor de ansiedad,
depresión, abuso de substancias, enfermedades médicas y problemas
en la escuela o en el trabajo. Sin el tratamiento adecuado el daño puede
perdurar de por vida.
La identificación y el tratamiento a tiempo son importantes para
minimizar las consecuencias del abuso a largo plazo. Profesionales de
la Salud (Psiquiatras, Psicólogos, Trabajadores Sociales (MS-
Socialworkers) consejeros especialistas en abusos de substancias no-
controladas y alcohol - CASAC- CASAC-T) de niños y adolescentes
proveen evaluación comprensiva y cuidado para los niños que han sido
abusados. Pueden ayudar a la familia a aprender nuevas formas de
darse apoyo y de comunicarse los unos con los otros. Mediante el
tratamiento, el niño maltratado comienza a recuperar su sentido de
confianza en sí mismo y en otros.
Las palizas no son el único tipo de maltrato infantil. Muchos niños son
víctimas de abandono, de abuso sexual o de abuso emocional. En todos
los tipos de abuso infantil, el niño y la familia pueden beneficiarse de
una evaluación comprensiva y del cuidado de un psiquiatra de niños y
adolescentes.
El Abuso Sexual a los Niños
Cada año se reportan miles de abuso sexual a los niños, pero el sin
número de casos que no se reporta es aún mayor, ya que los niños
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tienen miedo de decirle a alguien lo que les pasó, y el proceso legal de
verificar los informes es difícil. El problema debe de ser identificado,
debe de ponerse fin al abuso y el niño debe de recibir ayuda profesional.
El daño emocional y psicológico a largo plazo puede ser devastador.
El abuso sexual a los niños puede ocurrir en la familia, a manos de un
padre, un padrastro, hermano u otro pariente; o fuera de la casa, por
ejemplo, por un amigo, la persona que lo cuida, un vecino, un maestro,
o un desconocido. Sin embargo, cuando el abuso sexual ha ocurrido, el
niño desarrolla una variedad de pensamientos e ideas angustiantes.
No hay niño preparado psicológicamente para hacerle frente al estímulo
sexual. Aun los niños de dos o tres años que no pueden saber que la
actividad sexual es "mala", desarrollarán problemas como resultado de
su inhabilidad para hacerle frente al sobreestimulación.
El niño de cinco años o más que conoce y aprecia al que lo abusa se
siente atrapado entre el afecto o la lealtad que siente hacia esa persona
y el conocimiento de que las actividades sexuales son terriblemente
malas. Si el niño trata de romper con las relaciones sexuales, el que lo
abusa puede amenazarlo mediante la violencia o negándole su afecto.
Cuando los abusos sexuales ocurren en la familia, el niño puede tenerle
miedo a la ira, los celos o la vergüenza de otros miembros de la familia,
o quizás puede temer que la familia se desintegre si él descubre su
secreto.
El niño que es víctima de abuso sexual prolongado usualmente
desarrolla una pérdida de autoestima, tiene la sensación de que no vale
nada y adquiere una perspectiva anormal de la sexualidad. El niño
puede volverse muy retraído, perder la confianza en todos los adultos y
puede hasta llegar a considerar el suicidio.
Algunos niños que han sido abusados sexualmente tienen dificultad
para establecer relaciones con otras personas a menos que estas
relaciones tengan una base sexual. Algunos niños que han sido
abusados sexualmente se convierten en adultos que abusan de otros
niños, se dan a la prostitución, o pueden tener otros problemas serios
cuando llegan a ser adultos.
Muchas veces en el niño no hay señales físicas de abuso sexual o, si las
hay, tales como cambios en los genitales o en el ano, sólo pueden ser
reconocidas por un médico.

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El comportamiento de los niños abusados sexualmente puede
incluir:
• Interés excesivo, o el evitar todo lo de naturaleza sexual;
• Problemas con el dormir o pesadillas;
• Depresión o aislamiento de sus amigos y familia;
• Comportamiento seductor;
• Quiero decir que tienen el cuerpo sucio o dañado o tener miedo de
que haya algo malo en sus genitales;
• Negarse a ir a la escuela, delincuencia;
• Secretividad;
• Evidencia de abusos o molestias sexuales en sus dibujos, juegos o
fantasías;
• Agresividad excesiva;
• Comportamiento suicida; u otros cambios severos en su
comportamiento.
Los que abusan sexualmente de los niños pueden hacer que el niño esté
extremadamente temeroso de revelar las acciones del agresor y, sólo
cuando se ha hecho un esfuerzo para ayudarlo a sentirse seguro, puede
el niño hablar libremente. Si un niño dice que ha sido molestado
sexualmente, los padres deben hacerle sentir que lo que pasó no fue
culpa suya. Los padres deben de buscar ayuda médica y llevar al niño
para un examen físico y al psiquiatra o psicólogo para una consulta.
Estas son algunas medidas preventivas que los padres pueden
tomar:
Decirles a los niños que "si alguien trata de tocarte el cuerpo y de
hacerte cosas que te hacen sentir raro, dile que NO a la persona y ven
a contármelo enseguida."
Enseñarles a los niños que el respeto a los mayores no quiere decir que
tienen que obedecer ciegamente a los adultos y a las figuras de
autoridad, por ejemplo, no les diga "siempre tienes que hacer todo lo
que la maestra o el que te cuida te mande a hacer."
Estimular los programas profesionales del sistema escolar local
para la prevención.
Los niños que han sufrido abusos sexuales y sus familias necesitan
evaluación y tratamiento profesional. Profesionales de la Salud
(Psicólogos, Trabajadores Sociales (MS-Socialworkers) consejeros
12
especialistas en abuso de substancias no-controladas y alcohol-
CASAC- CASAC-T) pueden ayudar a los niños que han sido abusados a
recuperar su sentido de autoestima, a sobrellevar sus sentimientos de
culpabilidad sobre el abuso, y a comenzar el proceso de superación del
trauma. Estos tratamientos pueden reducir el riesgo de que el niño
desarrolle serios problemas cuando llegue a adulto.
El Nino Deprimido
No son sólo los adultos los que se deprimen. Los niños y los adolescentes
pueden sufrir también de depresión, que es una enfermedad tratable.
La depresión se define como una enfermedad cuando la condición
depresiva persiste e interfiere con la habilidad de funcionar del niño o
del adolescente.
Aproximadamente el 5 por ciento de los niños y adolescentes de la
población general padece de depresión en algún momento. Los niños
que viven con mucha tensión, que han experimentado una pérdida o
que tienen desórdenes de la atención, del aprendizaje o de la conducta
corren mayor riesgo de sufrir depresión. La depresión tiende a correr en
las familias.
El comportamiento de los niños y adolescentes deprimidos es diferente
al comportamiento de los adultos deprimidos. Los psiquiatras de niños
y adolescentes les recomiendan a los padres que estén atentos a
síntomas de depresión que puedan presentar sus niños.
Los padres deben de buscar ayuda si uno o más de los siguientes
síntomas de depresión persisten:
• Tristeza persistente, lloriqueo y llanto profuso
• Desesperanza
• Pérdida de interés en sus actividades favoritas; o inhabilidad para
disfrutar de las actividades favoritas previas
• Aburrimiento persistente y falta de energía
• Aislamiento social, comunicación pobre
• Baja autoestima y culpabilidad
• Sensibilidad extrema hacia el rechazo y el fracaso
• Aumento en la dificultad de relacionarse, coraje u hostilidad
• Dificultad en sus relaciones
• Quejas frecuentes de enfermedades físicas, tales como dolor de

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 • Ausencias frecuentes de la escuela y deterioro en los estudios
cabeza o de estómago
• Concentración pobre
• Cambios notables en los patrones de comer y de dormir
• Hablar de o tratar de escaparse de la casa
• Pensamientos o expresiones suicidas o comportamiento
autodestructivo
Un niño que jugaba a menudo con sus amigos empieza a pasarse la
mayor parte del tiempo solo y pierde interés por todo. Las cosas de las
que disfrutaba previamente ya no le dan placer al niño deprimido. Los
niños y adolescentes deprimidos dicen a veces que quisieran estar
muertos o pueden hablar del suicidio. Los adolescentes deprimidos
pueden abusar del alcohol o de otras drogas tratando de sentirse mejor.
Los niños y adolescentes que se portan mal en la casa y en la escuela
pueden estar sufriendo de depresión sin que nadie se dé cuenta de ello.
Los padres y los maestros no se dan cuenta de que la mala conducta es
un síntoma de depresión porque estos niños no siempre dan la
impresión de estar tristes. Sin embargo, si se les pregunta directamente,
los niños algunas veces admiten que están tristes o que son infelices.
El diagnóstico y tratamiento temprano de la depresión es esencial para
los niños deprimidos. Esta es una enfermedad real que requiere ayuda
profesional. Un tratamiento comprensivo a menudo incluye ambas
terapias, individual y de familia. Puede también incluir el uso de
medicamentos antidepresivos. Para ayudarles, los padres deben pedirle
a su médico de familia que los refiera a especialistas de salud mental y
pública de niños y adolescentes, quien puede diagnosticar y tratar la
depresión en niños y adolescentes.

Los Adolescentes: alcohol y otras drogas

La mayoría de los adolescentes han tenido alguna experiencia con
bebidas alcohólicas y con otras drogas. La mayoría experimenta un poco
y deja de usarlas, o las usa ocasionalmente sin tener problemas
significativos. Algunos seguirán usándolas regularmente con varios
niveles de problemas físicos, emocionales y sociales. Algunos
desarrollarán una dependencia y actuarán por años de manera
destructiva hacia sí mismos y hacia otros.

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Algunos eventualmente dejan de usar el alcohol y las otras drogas.
Como no se puede predecir quiénes desarrollarán problemas serios, se
debe considerar que todo uso es peligroso. El saber rechazar es parte de
la solución, pero el "decir no" no es suficiente.
Algunos jóvenes están en "mayor riesgo" que otros de desarrollar
problemas relacionados con el alcohol y las drogas. Encabezan la lista
aquella cuyas familias tienen ya un historial de Abuso de Substancias.
Los productos legalmente disponibles incluyen las bebidas alcohólicas
(para los mayores de 21), el tabaco (la edad legal varía), algunos
medicamentos por receta médica, inhalantes y medicinas de venta libre
para la tos, la gripe, el insomnio y para adelgazar. Las drogas ilegales
incluyen la marijuana, la cocaína/"crack", LSD, PCP, los derivados del
opio, la heroína y las "drogas diseñadas."
Aunque el uso de algunas drogas se ha mantenido constante
recientemente, el uso de otras está en aumento. En particular, el uso de
las bebidas alcohólicas, los cigarrillos y el "crack" continúan siendo
áreas de gran preocupación.
Los adolescentes que comienzan a fumar o a beber desde temprana edad
corren un grave riesgo. Estas substancias son típicamente las "drogas
del umbral" que llevan a la marijuana y de ahí a otras drogas ilícitas. La
mayor parte de estos adolescentes siguen usando las primeras drogas
que probaron en adición a las otras.
Las señales principales del abuso de drogas por los adolescentes pueden
incluir:
• Físicas: fatiga constante, quejas acerca de su salud, ojos
enrojecidos y sin brillo y una tos persistente.
• Emocionales: cambios en la personalidad, cambios rápidos de
humor, comportamiento irresponsable, poco amor propio,
depresión y una falta general de interés.
• Familia: el comenzar argumentos, desobedecer las reglas o el dejar
de comunicarse con la familia.
• Escuela: calificaciones bajas, ausencias frecuentes y problemas de
disciplina.
• Problemas Sociales: amigos nuevos a quienes no les interesan las
actividades normales de la casa y de la escuela, problemas con la

15
 ley y el cambio hacia estilos poco convencionales en el vestir y en
la música.
Algunas de estas señales de aviso pueden también ser señales
indicativas de otros problemas. Los padres pueden reconocer las señales
de problemas, pero no se espera de ellos que hagan el diagnóstico. Una
manera eficaz para los padres demostrar su preocupación y afecto por
el adolescente es discutir francamente con éste el uso y abuso de las
bebidas alcohólicas y de otras drogas. El primer paso que los padres
deben de dar es el consultar con un médico para estar seguros de que
las señales que descubren no tengan causas físicas. Esto debe de ser
acompañado o seguido por una evaluación comprensiva por un
especialista de salud mental y publica de niños y adolescentes.
Profesionales de la Salud (Psicólogos, Trabajadores Sociales (MS-
Socialworkers) consejeros en abuso de substancias no controladas y
alcohol CASAC- CASAC-T)
El niño que se orina en la cama
La mayor parte de los niños dejan de orinarse en la cama alrededor de
los tres años. Cuando un niño se sigue orinando después de los tres
años mientras duerme, enuresis nocturna, los padres se inquietan.
Los médicos enfatizan que la enuresis no es una enfermedad, sino un
síntoma bastante común. Accidentes ocasionales pueden ocurrir,
particularmente cuando el niño está enfermo.
Se presentan algunos datos que los padres deben saber acerca de la
enuresis:
• Aproximadamente el 15 por ciento de los niños mayores de los tres
años se orinan en la cama mientras duermen.
• Los niños se orinan en la cama con mayor frecuencia que las
niñas.
• La enuresis puede ser común en la familia.
• La enuresis cesa generalmente en la pubertad.
El orinarse persistentemente en la cama después de los tres o cuatro
años raramente significa que el niño tiene un problema de los riñones o
de la vejiga. Algunas veces puede estar relacionado con un desorden del
dormir. En la mayoría de los casos, es el resultado del desarrollo lento
del control de la vejiga. La enuresis también puede ser el resultado de
emociones y tensiones que requieren atención.
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La enuresis puede tener un sinnúmero de causas emocionales. Por
ejemplo, cuando un niño pequeño comienza otra vez a orinarse en la
cama después de meses o años de no hacerlo, se sospecha que estos
síntomas están causados por nuevos temores o inseguridades. Por lo
general sucede después de algún evento que lo haga sentirse inseguro:
el traslado de la familia a otro pueblo, la pérdida de un ser querido o
especialmente un nuevo bebé en la familia. A veces la enuresis vuelve a
comenzar después de un período en el que el niño ha estado seco ya que
el proceso original de aprendizaje de ir al baño fue muy intenso y le ha
causado demasiado estrés.
Los padres deben de recordar que los niños no se orinan en la cama a
propósito y que por lo general les da vergüenza cuando esto sucede. En
vez de hacer que el niño se sienta avergonzado o tímido, los padres
deben de alentarlo y demostrarle confianza de que pronto logrará dormir
la noche entera sin orinarse. El consejo del pediatra a menudo puede
ser muy útil.
En algunos casos raros, el problema de la enuresis no puede ser resuelto
ni por los padres, ni por el pediatra, ni por el médico de familia. A veces
el niño muestra síntomas de problemas emocionales, tales como la
tristeza o irritabilidad constante, un cambio en el apetito o en los
hábitos de dormir. En estos casos, los padres deben de hablar con un
psiquiatra de niños y adolescentes, quien podrá evaluar los problemas
físicos y emocionales que puedan estar causando la enuresis y quien
podrá ayudar al niño y a sus padres a resolver estos problemas.
Los niños que se niegan ir a la escuela
El asistir a la escuela usualmente es un evento agradable para los niños
pequeños. Para algunos esto conlleva miedo o pánico. Los padres tienen
motivo de preocupación cuando el niño se enferma debido a la tensión,
"finge estar enfermo" o exagera síntomas físicos para quedarse en la
casa y no ir a la escuela. A menudo, el niño de entre cinco y diez años
que se comporta de esta manera está padeciendo un temor paralizante
por tener que dejar la seguridad de la familia y de la casa. Es muy difícil
para los padres hacerle frente a este pánico infantil, pero estos temores
pueden tratarse exitosamente con ayuda de Profesionales de la Salud
(Psicólogos, Trabajadores Sociales (MS-Socialworkers) consejeros
CASAC- CASAC-T).

17
Este miedo irracional suele aparecer por vez primera en niños que
asisten a escuelas para niños de edad preescolar, a "kindergarten" o a
primer grado, siendo más frecuente en los niños que cursan el segundo
grado. El niño por lo general se queja de dolores de cabeza, de garganta
o de estómago justo antes de la hora de irse a la escuela. La
"enfermedad" se mejora cuando se le permite quedarse en la casa, pero
reaparece a la mañana siguiente antes de ir a la escuela. En algunos
casos, el niño se niega por completo a salir de la casa.
El negarse a ir a la escuela aparece generalmente después de un período
en el que el niño ha estado en la casa en compañía de su mamá, por
ejemplo, después de las vacaciones de verano, de los días de fiesta, o
después de una breve enfermedad. Puede pasar después de un evento
que le produce estrés, tal como la muerte de un familiar o de una
mascota, un cambio de escuela o una mudanza a un vecindario nuevo.
Los niños que tienen un miedo irracional de la escuela pueden sentirse
inseguros si se quedan solos en un cuarto y pueden demostrar un
comportamiento de apegamiento hacia sus padres, e inclusive se
convierten en la sombra de sus padres en la casa. Estos miedos son
comunes en niños con el Desorden de Ansiedad. Los niños tienen
dificultad para dormir, un miedo exagerado y un temor irreal hacia los
animales, monstruos, ladrones o a la oscuridad.
Los efectos potenciales a largo plazo pueden ser muy serios para un
niño con miedos persistentes si no recibe atención profesional. El niño
puede desarrollar serios problemas escolares y sociales si deja de ir a la
escuela y de ver a sus amigos por mucho tiempo.
Los padres y el niño se pueden beneficiar llevando al niño a un
psiquiatra de niños y adolescentes, quien trabajará con ellos en su
esfuerzo de hacer regresar al niño de inmediato a la escuela y a otras
actividades diarias. Como el pánico surge al dejar la casa, y no por estar
en la escuela, el niño por lo general está tranquilo una vez que está en
la escuela.
Para algunos niños se requiere un tratamiento extensivo para tratar las
causas del miedo. Los niños mayores o los adolescentes que se niegan
a ir a la escuela padecen por lo general de una enfermedad más grave y
a menudo requieren más tratamiento intensivo.

18
En cualquier caso, el miedo irracional de dejar la casa y a los padres se
puede tratar con éxito, y los padres no deben de tardar en buscar ayuda
profesional. Profesionales de la Salud (Psicólogos, Psiquiatras,
Trabajadores Sociales (MS-Socialworkers) consejeros CASAC- CASAC-
T)
Los hijos de padres alcohólicos
Se estima que más de siete millones de niños tienen padres alcohólicos.
Los especialistas de salud mental y pública de niños y adolescentes
saben que estos niños corren mayor riesgo de tener problemas
emocionales que los niños cuyos padres no son alcohólicos.
El alcoholismo es común en las familias, y los hijos de alcohólicos tienen
cuatro veces mayor probabilidad que otros niños de convertirse en
alcohólicos.
Un niño en esa familia puede tener una gran variedad de problemas:
• Culpabilidad: El niño puede creer que es la causa de que su padre
o su madre abuse de la bebida.
• Ansiedad: El niño puede estar constantemente preocupado sobre
la situación en su hogar. Puede temer que el padre alcohólico se
enferme o se hiera, y puede también temer las peleas y la violencia
entre sus padres.
• Vergüenza: Los padres pueden transmitirle al niño el mensaje de
que hay un terrible secreto en el hogar. El niño que está
avergonzado no invita sus amigos a la casa y teme pedir ayuda a
otros.
• Incapacidad de hacer amigos: Como el niño ha sido decepcionado
tantas veces por el padre que bebe, no se atreve a confiar en otros.
• Confusión: El padre alcohólico cambia de momento, va de ser
amable a ser violento sin ninguna relación con el comportamiento
del niño. Una rutina regular diaria, tan importante para el niño,
no existe en su casa porque las horas de las comidas y de acostarse
cambian constantemente.
• Ira: El niño siente ira y rabia contra el padre alcohólico porque
bebe tanto y suele estar enojado también con el padre que no es
alcohólico porque no le da apoyo o lo protege.
• Depresión: El niño se siente solo e incapaz de poder hacer algo
para cambiar la situación.

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Aunque el niño trata de mantener el alcoholismo de su papá o su mamá
en secreto, sus maestros, parientes, otros adultos o sus amigos pueden
darse cuenta de que algo está mal. Profesionales de la Salud (Psicólogos,
Psiquiatras, Trabajadores Sociales (MS-Socialworkers) consejeros
CASAC- CASAC-T) de niños y adolescentes indican que los siguientes
comportamientos pueden ser síntomas de un problema de alcohol en el
hogar:
✓ Fracaso en la escuela y ausencias frecuentes;
✓ Falta de amigos, retraimiento de los compañeros de clase;
✓ Comportamiento delincuente, como el robar y la conducta violenta;
✓ Quejas frecuentes de problemas físicos, como dolores de cabeza o
de estómago;
✓ Abuso de bebidas alcohólicas o drogas; o
✓ Agresión contra otros muchachos.
Algunos hijos de alcohólicos tratan de actuar como "padres"
responsables de la familia y entre sus amigos. Tratan de hacerle frente
al alcoholismo convirtiéndose en personas controladas, que tienen
mucho éxito en la escuela, pero que viven emocionalmente aislados de
otros niños y maestros. Sus problemas emocionales no son aparentes
hasta que llegan a ser adultos.
No importa si sus padres están en tratamiento o no, estos niños y
adolescentes pueden beneficiarse de programas educativos y grupos de
ayuda mutua organizados para los hijos de alcohólicos por Al-Anon y
Alateen. La ayuda profesional, mientras más temprano se ofrezca, mejor
es ya que es muy importante el prevenir problemas más serios para el
niño, inclusive el alcoholismo. Los profesionales en salud pública
(Psiquiatras, Social Worker, Psicólogos, consejeros CASAC- CASAC-
T) de niños y adolescentes ayudan a estos niños con sus problemas
personales y también los ayudan a entender que no son responsables
por los problemas de sus padres.
El programa de tratamiento puede incluir la terapia de grupo con
jóvenes en la misma situación, lo cual reduce el aislamiento que sienten
los hijos de alcohólicos. El psiquiatra de niños y adolescentes trabaja a
menudo con toda la familia, particularmente cuando el padre alcohólico
ha dejado de tomar, para así desarrollar formas saludables de
relacionarse entre los miembros de la familia.

20
Los niños y la violencia en la televisión
Los niños americanos ven televisión por un promedio de tres a cuatro
horas diarias. La televisión puede ser una influencia poderosa en el
desarrollo de un sistema de valores y en la formación del
comportamiento. Desgraciadamente, una gran parte de la programación
actual es violenta.
Cientos de estudios sobre los efectos de la violencia en la televisión en
los niños y los adolescentes han encontrado que los niños pueden:
• volverse "inmunes" al horror de la violencia;
• gradualmente aceptar la violencia como un modo de resolver
problemas;
• imitar la violencia que observan en la televisión;
• identificarse con ciertos caracteres, ya sean víctimas o agresores.
Los niños que se exponen excesivamente a la violencia en la televisión
tienden a ser más agresivos. Algunas veces, el mirar un sólo programa
violento puede aumentar la agresividad. Los niños que miran
espectáculos en los que la violencia es muy realista, se repite con
frecuencia, o no recibe castigo, son los que más tratarán de imitar lo
que ven. El impacto de la violencia en la televisión puede ser evidente
de inmediato en el comportamiento del niño o puede surgir años más
tarde y la gente joven puede verse afectada aun cuando la atmósfera
familiar no muestre tendencias violentas.
Esto no indica que la violencia en la televisión es la única fuente de
agresividad o de comportamiento violento, pero es un contribuyente
significativo.
Los padres pueden proteger a los niños de la violencia excesiva en
la televisión de la siguiente manera:
• prestándole atención a los programas que los niños ven en la
televisión y mirando algunos con ellos;
• estableciendo límites a la cantidad de tiempo que pueden estar
viendo televisión;
• señalándoles que, aunque el actor no se ha hecho daño ni se ha
muerto, tal violencia en la vida real resulta en dolor o en muerte;
• negándose a dejar que los niños vean programas que se sabe
contienen violencia, y cambiando el canal o apagando la televisión

21
 cuando se presenta algo ofensivo, explicándoles qué hay de malo
en el programa;
• no dando su aprobación a los episodios violentos frente a sus hijos,
enfatizando la creencia de que tal comportamiento no es la mejor
manera de resolver un problema;
• Contrarrestando la presión que ejercen sus amigos y compañeros
de clase, comunicándose con otros padres y poniéndose de
acuerdo para establecer reglas similares sobre la cantidad de
tiempo y el tipo de programa que los niños pueden mirar.
• Los padres deben de también tomar ciertas medidas para prevenir
los efectos dañinos de la televisión en temas tales como los asuntos
raciales y los estereotipos sexuales. La cantidad de tiempo que los
niños miran televisión no importa el contenido, debe de ser
moderada, ya que impide a los niños el llevar a cabo otras
actividades de mayor beneficio, tales como el leer y el jugar con
sus amigos. Si los padres tienen dificultades serias estableciendo
límites o mucha preocupación sobre cómo su niño está
reaccionando a la televisión, ellos deben de ponerse en contacto
con un psiquiatra de niños y adolescentes para que los ayude a
definir el problema.
Problemas de aprendizaje
Los padres cuyos niños tienen problemas académicos se sienten
extremadamente preocupados y desilusionados. Los psiquiatras de
niños y adolescentes saben que hay muchas causas para los fracasos
académicos y que una de las más comunes son los trastornos del
aprendizaje. Un niño con un trastorno del aprendizaje es por lo general
un niño inteligente, quien inicialmente trata de seguir las instrucciones,
de concentrarse y de tener buen comportamiento en la casa y la escuela.
Sin embargo, el niño no domina las tareas escolares y comienza a
rezagarse. Algunos de estos niños tienen dificultad en permanecer
quietos o prestar atención. Los problemas de aprendizaje afectan a no
menos de un 15% de la población escolar.
Se estima que los problemas específicos de aprendizaje son causados
por una dificultad del sistema nervioso que afecta la captación,
elaboración o comunicación de información. Algunos de estos niños son
hiperactivos y/o distraídos con un lapso de atención corto.

22
Los psiquiatras de niños y adolescentes indican, que estos niños pueden
ser ayudados, pero que, si su condición no se detecta y se trata a tiempo,
el problema puede aumentar y complicarse rápidamente. Un niño que
en la escuela elemental no aprende a sumar, al llegar a la escuela
superior, no podrá entender algebra. El niño que trata de aprender con
gran esfuerzo se frustrará progresivamente y desarrollará problemas
emocionales como una pobre autoestima, resultado de los fracasos
repetidos. Algunos niños con problemas de aprendizaje pueden
presentar también problemas de conducta, ya que prefieren lucir
"malos" en vez de "estúpidos o brutos". Los padres deben de conocer las
señales que con mayor frecuencia indican problemas de aprendizaje en
su niño.
Dificultad en atender o seguir instrucciones.
• Dificultad para recordar lo que se le acaba de decir.
• Fracasos académicos como consecuencia del poco dominio de
destrezas de la lectura, escritura y/o aritmética.
• Dificultad en distinguir entre la derecha y la izquierda, por
ejemplo, confunde 25 con 52, la "b" con la "d" o, "la" por "al" u, "o"
por "no".
• Defectos en coordinación - cuando camina, en los deportes, en
actividades manuales sencillas como sostener un lápiz, amarrarse
los zapatos o hacer un lazo.
• Pierde o se extravían sus asignaciones, sus libros, libretas y otros
materiales.
• No puede aprender los conceptos de tiempo; confunde "ayer",
"hoy", "mañana".
Muchos padres solicitan un Profesional de la Salud (Psiquiatra,
Psicólogos, Trabajadores Sociales (MS-Socialworkers) consejeros
CASAC- CASAC-T) de Niños y Adolescentes cuando su hijo presenta
problemas iguales o parecidos a los arriba mencionados.
Los profesionales de la salud de niños y adolescentes trabajarán en
colaboración con los educadores y otro personal de la escuela, para
hacer pruebas que puedan detectar la razón de la dificultad en el
aprovechamiento y la presencia de problemas específicos de
aprendizaje. Luego de entrevistar al niño y la familia, y de evaluar la
situación, el psiquiatra de niños y adolescentes hará recomendaciones
relacionadas con la ubicación escolar apropiada para el niño, la

23
necesidad de ayudas especiales, como terapia académica, ocupacional,
del habla y tomará las medidas necesarias para ayudar a que el niño
desarrolle al máximo su potencial.
En ocasiones especiales requiere el uso de medicamentos. El psiquiatra
recetará medicamentos cuando es necesario controlar su hiperactividad
y/o distraibilidad. Trabajará con el niño en el fortalecimiento de su
confianza en sí mismo, elemento esencial para el desarrollo emocional
saludable. Ayudará también a los padres y otros miembros de la familia
para enfrentarse a la realidad de vivir con un niño con problemas
específicos de aprendizaje.

The effects of Domestic Violence on

Latino Children
"Families under stress produce children under stress. If a spouse is
being abused and there are children in the home, the children are
affected by the abuse." (Ackerman and Pickering, 1989)

Domestic violence in the Latino community must be understood within

the context occurs. A legacy of multiple oppression; some dating
back to centuries, such as poverty, discrimination, racism, colonization,
classism, and homophobia. Requires that domestic violence is not seen
as a unidimensional phenomenon.
This important social problem that requires research, policy,
advocacy and services are implemented with an understanding of how
to weave the social forces that underlie domestic violence in the family
and Latino community. It is estimated that between 40 and 60% of
men who abuse women also abuse children.

Domestic violence affects all family members, especially children.

Family violence creates a home environment where children live in
constant fear. Children who witness family violence are affected in ways

24
 similar to children
who are physically
abused Family
violence creates a
home environment
where children live in
constant fear.
Children who witness
domestic violence are
affected similarly to
children who are
abused physically,
sexually and
emotionally. Parents
are often unable to
establish links with
raising children,
unable to establish
nurturing bonds and have a greater risk of abuse and neglect if they live
in a violent home.

Recently studies show that more than 3 million children witness

violence in their homes each year. Those who see and hear violence in
the home suffer physically and emotionally. Families with children living
in stress product of domestic violence and creates insecurity and live in
constant fear that children are affected that extends throughout the
home.

The abuser violates the space of a spouse physically and emotionally.

Children witnesses of domestic violence and is reflected in their behavior
as low self-esteem, violent games and develops self-defense mechanisms
that internalize.

Statistics show that over 3 million children witness violence in their

home each year. Those who see and hear violence in the home
suffer shame, guilt, self-blame, confusion about conflicting feelings

25
toward parents, fear of abandonment, or expressing emotions, the
unknown or personal injury, anger and depression, feelings of
helplessness and powerlessness. In 2010, approximately 695,000
children were victims of maltreatment. Children in the age group of birth
to 1 year had the highest rate of victimization at 20.6 per 1,000 children
of the same age group in the national population. More than one-half of
the child victims were girls 51.2% and 48.5 percent were boys; and
nearly one-half of all victims were White (44.8%), 21.9 percent were
African American, and 21.4 percent were Latino.

26
Dynamics of domestic violence are unhealthy for children:

• Control of family by one dominant member.

• Abuse of a parent.
• Isolation.
• Protecting the "family secret".
• Children react to their environment in different ways, and reactions
can vary depending on the child's gender and age.
• Children exposed to family violence are more likely to develop social,
emotional, psychological and or behavioral problems than those who are
not.
Recent research indicates that children who witness domestic violence
show more anxiety, low self-esteem, depression, anger and
temperament problems than children who do not witness violence in the
home. The trauma they experience can show up in emotional,
behavioral, social and physical disturbances that effect their
development and can continue into adulthood.

27
Emotional effects.

• Grief for family and personal losses.

• Shame, guilt, and self-blame.
• Confusion about conflicting feelings toward parents.
• Fear of abandonment, or expressing emotions, the unknown or
personal injury.
• Anger.
• Depression and feelings of helplessness and powerlessness.
• Embarrassment.
• Behavioral
• Acting out or withdrawing.
• Aggressive or passive.
• Refusing to go to school.
• Care taking; acting as a parent substitute.
• Lying to avoid confrontation.
• Rigid defenses.
• Excessive attention seeking.
• Bedwetting and nightmares.
• Out of control behavior.
• Reduced intellectual competency.

28
•

Manipulation, dependency, mood swings.

Social Isolation from friends and relatives
• Stormy relationships.
• Difficulty in trusting, especially adults.
• Poor anger management and problem-solving skills.
• Excessive social involvement to avoid home.
• Passivity with peers or bullying.
• Engaged in exploitative relationships as perpetrator or victim.
Physical
• Somatic complaints, headaches and stomachaches.
• Nervous, anxious, short attention span.
• Tired and lethargic.
• Frequently ill.
• Poor personal hygiene.
• Regression in development.
• High risk play.
• Self abuse

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Abusers are very good at controlling and manipulating their victims.
People who have been emotionally abused or battered are depressed,
drained, scared, ashamed, and confused. They need help to get out, yet
they’ve often been isolated from their family and friends. By picking up
on the warning signs and offering support, you can help them escape
an abusive situation and begin healing.

30
Los efectos de la violencia
doméstica en los niños, niñas y
jóvenes latinos en los
Estados Unidos y el refugio en las
padillas

"Las familias bajo estrés producen a los niños menores estrés. Si un

cónyuge es víctima de abuso y hay niños en el hogar, los niños se ven
afectados por el abuso." (Ackerman y Pickering, 1989).
La violencia doméstica en la comunidad latina en los Estados Unidos
debe entenderse dentro del contexto multidimensional, y se produce
dentro de un legado de opresión múltiple, algunos datan de siglos, como
la pobreza, la discriminación, el racismo, la colonización, el clasismo, y
la homofobia. La violencia doméstica no debe ser vista como un
fenómeno unidimensional, porque ella trae consigo comportamientos
aprendidos socioculturales, y estigmas sociales. Son una diversidad de
elementos que contribuyen a este comportamiento agresivo, que explica
la pasividad y sumisión de las víctimas. Este importante problema social
y de salud pública requiere que la investigación, la política, la promoción
y los servicios se implementen con una comprensión de cómo tejer las
fuerzas sociales que subyacen a la violencia doméstica en las
comunidades latinas. Se estima que entre el 40 y el 60% de los hombres
que maltratan a las mujeres también abusan de los niños y jóvenes.
La violencia doméstica afecta a todos los miembros de la familia,
especialmente los niños, niñas y jóvenes. La violencia familiar crea un
ambiente de hogar donde los niños viven en constante temor. Los niños
y jóvenes que son testigos de violencia familiar afectados de manera
similar a los niños y jóvenes que son abusados físicamente violencia
familiar crea un ambiente de hogar donde los niños y jóvenes viven en
constante temor. En el caso de los niños, niñas y jóvenes que presencian
actos de violencia doméstica son afectados de manera similar a los niños
31
o jóvenes que son abusados físicos, sexual y emocionalmente. Los
padres son a menudo incapaces de establecer vínculos con la crianza
de los niños y tienen un mayor riesgo de abuso y negligencia si viven en
un hogar violento.
Estudios recientes muestran que más de 3 millones de niños testigos de
violencia en sus hogares cada año. Aquellos que ven y oyen la violencia
en el hogar sufren física y emocionalmente. Familias con niños que
viven en el estrés producto de la violencia doméstica y crea inseguridad
y viven en constante temor de que los niños se ven afectados, y se
extiende por toda la casa.

El abusador viola el espacio de un cónyuge física y emocionalmente. Los

niños y jóvenes testigos de violencia doméstica y se refleja en su
comportamiento como baja autoestima, juegos violentos y desarrolla
mecanismos de autodefensa que internalizan este comportamiento
abusivo y violento. Las estadísticas muestran que más de 3 millones de
niños testigos de violencia en sus hogares cada año.
Aquellos que ven y oyen la violencia en el hogar sufren vergüenza, culpa,
culparse a sí mismo, la confusión de los sentimientos contradictorios
hacia los padres, miedo al abandono, o la represión de emociones,
heridas y enojo desconocido o personal, la depresión, sentimientos de
indefensión e impotencia.
En 2010, aproximadamente 695.000 niños fueron víctimas de malos
tratos. Los niños en el grupo de edad de nacimiento a 1 año tenían la
tasa más alta de la victimización en 20,6% por cada 1.000 niños del
mismo grupo de edad en la población nacional. Más de la mitad de las
víctimas eran niñas representado el 51,2% y 48,5% por ciento eran
varones, y casi la mitad de todas las víctimas eran de raza blanca
(44,8%), 21,9% por ciento eran afroamericanos, y 21,4% por ciento eran
latinos. Aparente en porcentajes (21,4%) es una representación menor
de latinos en comparación con los otros grupos étnicos, esto se debe que
en la comunidad latina muchos de los incidentes no son reportados por
miedo y/o vergüenza cultural; o que el abuso domestico ha ocurrido de
generación en generación, y es percibido como una forma de disciplina
“necesaria”. Que podría explicarse como violencia intrafamiliar
aprendida.

32
Dinámica de la violencia doméstica no son saludables para los niños
y jóvenes:

• Control de la familia por un miembro dominante.

• El abuso de un padre.
• Aislamiento.
• Proteger el "secreto de familia".
• Los niños reaccionan a su entorno de diferentes maneras, y las
reacciones pueden variar en función del sexo del niño y la edad.
• Los niños y jóvenes expuestos a violencia familiar son más
propensos a desarrollar problemas sociales, emocionales,
psicológicos o de comportamiento, y que aquellos que no lo son. La
investigación reciente indica que los niños y jóvenes que
presencian actos de violencia doméstica presentan más ansiedad,
baja autoestima, depresión ira y problemas de temperamento que
los niños que no son testigos de violencia en el hogar. El trauma
que experimentan puede aparecer en los trastornos emocionales,
conductuales, sociales y físicos que afectan a su desarrollo y puede
continuar hasta la edad adulta.

Efectos emocionales

• Dolor emocional para con la familia y las pérdidas personales.

• Vergüenza, culpa y culparse a sí mismo.
• Confusión acerca de los sentimientos contradictorios hacia los
padres.
• El miedo al abandono, o la expresión de las emociones, la lesión
desconocida o personal.
• Enojo no controlado.
• La depresión y los sentimientos de indefensión e impotencia.
• Vergüenza.
• Comportamiento erráticos (feliz- triste- depresivo).
• La actuación o la retirada.
• Cambios de comportamientos sin ninguna explicación agresivo
o pasivo.

33
 • Negarse a ir a la escuela.
• Cuidado de tomar, actuando como un padre sustituto.
• Mentir o evitar la confrontación.
• Las defensas rígidas.
• La atención excesiva buscando.
• La enuresis y pesadillas.
• Comportamiento fuera de control.
• Reducción de la competencia intelectual.
• La manipulación, la dependencia, cambios de humor y estados
de ánimo.

Aislamiento social de amigos y familiares

• Las relaciones tormentosas.

• Dificultad para confiar, especialmente en adultos.
• Deficiente control de la ira y resolución de problemas.
• El exceso de participación social para evitar su hogar.
• La pasividad con sus compañeros o intimidación.
• Participó en las relaciones de explotación como el autor o la
víctima.
• Las quejas somáticas, dolores de cabeza y de estómago.
• Nervioso, lapso de ansiedad, la falta de atención.
• ¿Está cansado y letárgico?
• Frecuentemente el mal estado de ánimo y el temor a miembros
de la familia a estar solo con ellos.
• Mala higiene personal.
• La regresión en el desarrollo.
• Juego de alto riesgo.
• La baja de autoestima personal y otros síntomas de
incompatibilidad de caracteres entre amigos y miembros de la
familia.
• Participación en pandillas como substituto de la familia o la
búsqueda de protección internalizada.
·
Los efectos de la violencia doméstica en el hogar y el refugio en las
pandillas o “Maras”
El fenómeno de las pandillas en Estados Unidos es un tema alarmante
como substituto de la familia, se ha venido observado de manera
creciente en las escuelas en zonas urbanas, muchos niños, niñas y
jóvenes buscaron refugio en las pandillas, cuando los padres convierten

34
el hogar en una constante de disputas domésticas, los efectos de la
violencia repercuten en las decisiones de los niños y jóvenes.
En el condado de Long Island niños, niñas y jóvenes víctimas del efecto
de la violencia domestica buscan refugio en La pandilla Mara
Salvatrucha; también identificada con las siglas MS-13. Esta pandilla
se originó en Los Ángeles a principio de los años 80 y luego se extendió
a través de Estados Unidos, y tiene una notable presencia en el condado
de Long Island. La mayoría de sus miembros están étnicamente
integrados por inmigrantes centroamericanos, particularmente de El
Salvador, Guatemala y Honduras.
Una reciente entrevista conducida se determinó que niños, niñas y
jóvenes entre las edades 14 a 18 años buscaron refugio en las pandillas,
resultado de la violencia doméstica en el hogar. Además se puso en
evidencia que a temprana edad eran sexualmente activos y activas en
relación con múltiples parejas, el uso de temprano de alcohol, el abuso
a las drogas y la preferencia por marihuana, cocaína, y que más de una
ocasión haber experimentado con la pastilla éxtasis[i] que es una droga
psico estimulante y el incremento del uso de cigarrillo (tabaco).[ii] Los
efectos emocionales, la falta de amor en el hogar, la inseguridad y el
miedo a la soledad.
Los abusadores son muy buenos para controlar y manipular a sus
víctimas. Las personas que han sido maltratadas emocionalmente
abusados o está deprimido, agotado, avergonzado asustado y
confundido. Ellos necesitan ayuda para salir, sin embargo, han sido a
menudo aislados de su familia y amigos. Al recoger las señales de
advertencia y ofrecer apoyo, usted puede ayudar a escapar de una
situación de abuso y comenzar la curación.
En la comunidad latina la violencia domestica fue un tema tabú por
mucho tiempo, hoy es un tema público en el cual hombres y mujeres
tienen las mismas responsabilidades de luchar contra esta epidemia
que ha enlutado muchos lugares latinos y deja miles de niños, niñas y
jóvenes con daños irreparables emocionalmente. La violencia domestica
es un crimen contra nuestras familias, nuestras hijas e hijos, nuestra
cultura y dignidad.

35
Living in Fear Domestic Abuse and
Violence
The definition of domestic abuse

Domestic violence and abuse do not discriminate

Domestic abuse' means any act or threatened act of violence that is
committed by any person against another person to whom the actor is
currently or was formerly related, or with whom the actor is living or
has lived in the same domicile, or with whom the actor is involved or
has been involved in an intimate relationship. “Domestic abuse” may
also include any act or threatened act of violence against the minor
children of either of the parties."
Domestic violence (C.R.S & 19-6-800—3), also includes any other
crime against a person or against property or any municipal ordinance
violation against a person or against property, when used as a method
of coercion, control, punishment, intimidation, or revenge directed
against a person with whom the actor is or has been involved in an
intimate relationship."
The definition of domestic abuse is further expanded in C.R.S. &
10-3-1104-8 to include "...psychological harm." The basis for domestic
abuse need not even include actual violence or abuse and today it rarely
does.
The United States Center for Disease Control has also looked at the
definition of domestic violence and concludes:
"In recent years, the term 'domestic violence' has begun to include other
forms of violence including abuse of elders, children, and siblings. The
term 'domestic violence' also tends to overlook male victims and violence
between same-sex partners. Therefore, at CDC we prefer using the more
specific term 'intimate partner violence (IPV),' defined as actual or
threatened physical or sexual violence, or psychological/emotional
abuse by a spouse, ex-spouse, boyfriend/ girlfriend, ex-boyfriend/ ex-
girlfriend, or date. Some of the common terms that are used to describe

36
intimate partner violence are domestic abuse, spouse abuse, domestic
violence, courtship violence, battering, marital rape, and date rape."
The domestic abuse and violence, intimate partner violence, or any other
terms one cares to invoke, are anything a woman and man, you have
lived with, dated, with or without sexual congress, any one-night stand,
lived in the same house with, and any friends or relations, wants it to
be. Conversely, in practice there are virtually no restrictions on a woman
using the law as "... a method of coercion, control, punishment,
intimidation, or revenge..." against a male. The Domestic Violence laws
are also reportedly abused to gain advantage by males and in gay and
lesbian relationships.
Domestic violence and abuse can happen to anyone, yet the problem is
often overlooked, excused, or denied. This is especially true when the
abuse is psychological, rather than physical. Emotional abuse is often
minimized, yet it can leave deep and lasting scars.
Living in fear
Domestic abuse, also known as spousal abuse, occurs when one person
in an intimate relationship or marriage tries to dominate and control the
other person. Domestic abuse that includes physical violence is called
domestic violence.
Domestic violence and abuse are used for one purpose and one purpose
only: to gain and maintain total control over you. An abuser doesn’t
“play fair.” Abusers use fear, guilt, shame, and intimidation to wear you
down and keep you under his or her thumb. Your abuser may also
threaten you, hurt you, or hurt those around you.
Domestic violence and abuse do not discriminate. It happens among
heterosexual couples and in same-sex partnerships. It occurs within all
age ranges, ethnic backgrounds, and economic levels. And while women
are more commonly victimized, men are also abused—especially
verbally and emotionally. The bottom line is that abusive behavior is
never acceptable, whether it’s coming from a man, a woman, a teenager,
or an older adult. You deserve to feel valued, respected, and safe.
Recognizing abuse is the first step to getting help
Domestic abuse often escalates from threats and verbal abuse to
violence. And while physical injury may be the most obvious danger, the

37
emotional and psychological consequences of domestic abuse are also
severe. Emotionally abusive relationships can destroy your self-worth,
lead to anxiety and depression, and make you feel helpless and alone.
No one should have to endure this kind of pain—and your first step to
breaking free is recognizing that your situation is abusive. Once you
acknowledge the reality of the abusive situation, then you can get the
help you need.
Signs of an abusive relationship

There are many signs of an abusive relationship. The most telling sign
is fear of your partner. If you feel like you have to walk on eggshells
around your partner—constantly watching what you say and do in order
to avoid a blow-up—chances are your relationship is unhealthy and
abusive. Other signs that you may be in an abusive relationship include
a partner who belittles you or tries to control you, and feelings of self-
loathing, helplessness, and desperation.
To determine whether your relationship is abusive, answer the
questions below. The more “yes” answers, the more likely it is that you’re
in an abusive relationship.

Physical abuse and domestic violence

When people talk about domestic violence, they are often referring to
the physical abuse of a spouse or intimate partner. Physical abuse is
the use of physical force against someone in a way that injures or
endangers that person. Physical assault or battering is a crime, whether
it occurs inside or outside of the family. The police have the power and
authority to protect you from physical attack.

Sexual abuse is a form of physical abuse

Any situation in which you are forced to participate in unwanted,

unsafe, or degrading sexual activity is sexual abuse. Forced sex, even
by a spouse or intimate partner with whom you also have consensual
38
sex, is an act of aggression and violence. Furthermore, people whose
partners abuse them physically and sexually are at a higher risk of being
seriously injured or killed.

• The incidents of physical abuse seem minor when compared to those

you have read about, seen on television or heard other women talk
about. There isn’t a “better” or “worse” form of physical abuse; you can
be severely injured as a result of being pushed, for example.
• The incidents of physical abuse have only occurred one or two times
in the relationship. Studies indicate that if your spouse/partner has
injured you once, it is likely he will continue to physically assault you.
• The physical assaults stopped when you became passive and gave up
your right to express yourself as you desire, to move about freely and
see others, and to make decisions. It is not a victory if you have to give
up your rights as a person and a partner in exchange for not being
assaulted!
• There has not been any physical violence. Many women are
emotionally and verbally assaulted. This can be as equally frightening
and is often more confusing to try to understand.
Emotional abuse
When people think of domestic abuse, they often picture battered
women who have been physically assaulted. But not all abusive
relationships involve violence. Just because you’re not battered and
bruised doesn’t mean you’re not being abused. Many men and women
suffer from emotional abuse, which is no less destructive.
Unfortunately, emotional abuse is often minimized or overlooked—even
by the person being abused.

Understanding emotional abuse

The aim of emotional abuse is to chip away at your feelings of self-worth

and independence. If you’re the victim of emotional abuse, you may feel
that there is no way out of the relationship or that without your abusive
partner you have nothing.

39
Emotional abuse includes verbal abuse such as yelling, name-calling,
blaming, and shaming. Isolation, intimidation, and controlling behavior
also fall under emotional abuse. Additionally, abusers who use
emotional or psychological abuse often throw in threats of physical
violence or other repercussions if you don’t do what they want.

You may think that physical abuse is far worse than emotional abuse,
since physical violence can send you to the hospital and leave you with
scars. But, the scars of emotional abuse are very real, and they run
deep. In fact, emotional abuse can be just as damaging as physical
abuse—sometimes even more so.

Economic or financial abuse: A subtle form of emotional abuse

An abuser’s goal is to control you, and he or she will frequently use
money to do so. Economic or financial abuse includes:
• Rigidly controlling your finances.

• Withholding money or credit cards.

• Making your account for every penny you spend.

• Withholding basic necessities (food, clothes, medications, shelter).

• Restricting you to an allowance.

• Preventing you from working or choosing your own career.

• Sabotaging your job (making you miss work, calling constantly)

• Stealing from you or taking your money.

Violent and abusive behavior is the abuser’s choice

Despite what many people believe, domestic violence and abuse is not
due to the abuser’s loss of control over his or her behavior. In fact,

40
abusive behavior and violence is a deliberate choice made by the abuser
in order to control you.

Abusers use a variety of tactics to manipulate and exert their

power:

• Dominance – Abusive individuals need to feel in charge of the

relationship. They will make decisions for you and the family, tell you
what to do, and expect you to obey without question. Your abuser may
treat you like a servant, child, or even as his or her possession.

• Humiliation – An abuser will do everything he or she can to make you

feel bad about yourself or defective in some way. After all, if you believe
you're worthless and that no one else will want you, you're less likely to
leave. Insults, name-calling, shaming, and public put-downs are all
weapons of abuse designed to erode your self-esteem and make you feel
powerless.

• Isolation – In order to increase your dependence on him or her, an

abusive partner will cut you off from the outside world. He or she may
keep you from seeing family or friends, or even prevent you from going
to work or school. You may have to ask permission to do anything, go
anywhere, or see anyone.

• Threats – Abusers commonly use threats to keep their partners from

leaving or to scare them into dropping charges. Your abuser may
threaten to hurt or kill you, your children, other family members, or
even pets. He or she may also threaten to commit suicide, file false
charges against you, or report you to child services.

• Intimidation – Your abuser may use a variety of intimidation tactics

designed to scare you into submission. Such tactics include making
threatening looks or gestures, smashing things in front of you,
destroying property, hurting your pets, or putting weapons on display.
41
The clear message is that if you don't obey, there will be violent
consequences.

• Denial and blame – Abusers are very good at making excuses for the
inexcusable. They will blame their abusive and violent behavior on a bad
childhood, a bad day, and even on the victims of their abuse. Your
abusive partner may minimize the abuse or deny that it occurred. He or
she will commonly shift the responsibility on to you: Somehow, his or
her violent and abusive behavior is your fault.

Abusers are able to control their behavior

• Abusers pick and choose whom to abuse. They don’t insult, threaten,
or assault everyone in their life who gives them grief. Usually, they save
their abuse for the people closest to them, the ones they claim to love.

• Abusers carefully choose when and where to abuse. They control

themselves until no one else is around to see their abusive behavior.
They may act like everything is fine in public but lash out instantly as
soon as you’re alone.

• Abusers are able to stop their abusive behavior when it benefits them.
Most abusers are not out of control. In fact, they’re able to immediately
stop their abusive behavior when it’s to their advantage to do so (for
example, when the police show up or their boss calls).

• Violent abusers usually direct their blows where they won’t show.
Rather than acting out in a mindless rage, many physically violent
abusers carefully aim their kicks and punches where the bruises and
marks won’t show.

The cycle of violence in domestic abuse: Domestic abuse falls into a

common pattern, or cycle of violence:
42
Abuse – Abusive partner lashes out with aggressive, belittling, or violent
behavior. The abuse is a power play designed to show you "who is boss."

• Guilt – After abusing you, your partner feels guilt, but not over what
he's done. He’s more worried about the possibility of being caught and
facing consequences for his abusive behavior.

• Normal behavior – Your abuser does everything he can to regain

control and keep you in the relationship. He may act as if nothing has
happened, or he may turn on the charm. This peaceful honeymoon
phase may give you hope that your abusive partner has really changed
this time.

• Normal behavior — The abuser does everything he can to regain

control and keep the victim in the relationship. He may act as if nothing
has happened, or he may turn on the charm. This peaceful honeymoon
phase may give the victim hope that the abuser has really changed this
time.

• Fantasy and planning – Your abuser starting to fantasize about

abusing you again. He spends a lot of time thinking about what you’ve
done wrong and how he'll make you pay. Then he plans for turning the
fantasy of abuse into reality.

• Set-up – Your abuser sets you up and puts his plan in motion, creating
a situation where he can justify abusing you.

Your abuser’s apologies and loving gestures in between the episodes of

abuse can make it difficult to leave. He may make you believe that you
are the only person who can help him, that things will be different this
time, and that he truly loves you. However, the dangers of staying are
very real.

43
The Full Cycle of Domestic Violence

A man abuses his partner. After he hits her, he experiences self-directed

guilt. He says, "I'm sorry for hurting you." What he does not say is,
"Because I might get caught." He then rationalizes his behavior by
saying that his partner is having an affair with someone. He tells her "If
you weren't such a worthless whore, I wouldn't have to hit you." He then
acts contrite, reassuring her that he will not hurt her again. He then
fantasizes and reflects on past abuse and how he will hurt her again.
He plans on telling her to go to the store to get some groceries. What he
withholds from her is that she has a certain amount of time to do the
shopping. When she is held up in traffic and is a few minutes late, he
feels completely justified in assaulting her because "you're having an
affair with the store clerk." He has just set her up.

Recognizing the warning signs of domestic violence and abuse

It's impossible to know with certainty what goes on behind closed doors,
but there are some telltale signs and symptoms of emotional abuse and
domestic violence. If you witness any warning signs of abuse in a friend,
family member, or co-worker, take them very seriously.

General warning signs of domestic abuse

People who are being abused may:

• Seem afraid or anxious to please their partner.

• Go along with everything their partner says and does.

• Check in often with their partner to report where they are and what
they’re doing.

• Receive frequent, harassing phone calls from their partner.

44
• Talk about their partner’s temper, jealousy, or possessiveness.

Warning signs of physical violence

People who are being physically abused may:

• Have frequent injuries, with the excuse of “accidents.”

• Frequently miss work, school, or social occasions, without

explanation.

• Dress in clothing designed to hide bruises or scars (e.g. wearing long

sleeves in the summer or sunglasses indoors).
Warning signs of isolation
People who are being isolated by their abuser may:

• Be restricted from seeing family and friends.

• Rarely go out in public without their partner.

• Have limited access to money, credit cards, or the car.

The psychological warning signs of abuse. People who are being

abused may:

• Have very low self-esteem, even if they used to be confident.

• Show major personality changes (e.g. an outgoing person becomes

withdrawn).

• Be depressed, anxious, or suicidal.

Speak up if you suspect domestic violence or abuse

If you suspect that someone you know is being abused, speak up! If
you’re hesitating—telling yourself that it’s none of your business, you
might be wrong, or the person might not want to talk about it—keep in

45
mind that expressing your concern will let the person know that you
care and may even save his or her life.

Do and Don’ts

• Ask if something is wrong.

• Express concern.
• Listen and validate.
• Offer help.
• Support his or her decisions.

Don’t:

• Wait for him or her to come to you.

• Judge or blame.
• Pressure him or her.
• Give advice.
• Place conditions on your support.

Talk to the person in private and let him or her know that you’re
concerned. Point out the things you’ve noticed that make you worried.
Tell the person that you’re there, whenever he or she feels ready to talk.
Reassure the person that you’ll keep whatever is said between the two
of you and let him or her know that you’ll help in any way you can.

46
My life story in the circle of
domestic violence
The complexity and strength of the intimate relationship creates many
barriers to dissolution

The domestic violence is a behavior done in the context of an adult

intimate relationship. In domestic violence cases, the abused party and
the perpetrator are intimates usually family or ex-family to each other.
The abused party is affected by domestic violence in many of the same
ways as victims of violence perpetrated by strangers, but also is affected
in unique ways since the abuser is an intimate rather than a stranger.
However, such effects of trauma are accentuated and recidivism is more
likely in domestic violence case due to the fact that the abuser, unlike
the perpetrator of stranger violence, has on-going access to the victim,
knows the victim’s daily routine, and can continue to exercise
considerable power and control over the victim’s daily life, both
physically and emotionally.

Domestic violence is a pattern of assaultive and controlling behaviors,

including physical, sexual, and psychological attacks, that one adult
intimate does to another. The domestic violence consists of a wide range
behavior, including some of the same behaviors found in strange
violence. Some acts of domestic violence are criminal: hitting, choking,
kicking, assault, touching, forcing sex with third parties, threats of
violence, harassment at work, stalking, destruction of property, attacks
against pets, etc.

The Psychological control of abused parties through intermittent use of

physical assault going along with psychological abuse: such as verbal
abuse, isolation, threats of violence, is typical used against prisoners of
war and hostages. The verbal abuse includes disparaging, degrading,
discrediting language, sometimes profane and often obscene.

These verbal attacks are fabricated with particular sensitivity to the

47
victim’s vulnerabilities. Perpetrators are able to control abused parties
by a combination of physical and psychological tactics since they are so
closely interwoven, by the perpetrator.

The complexity and strength of the intimate relationship creates many

barriers to dissolution. This is the story of Paola a Peruvian woman as
victim of domestic violence that occurred in the city of New York. During
the course of the several interviews, the following facts pertaining to her
situation emerged which indicated she was victim of domestic violence
during her marriage, the following facts pertaining to her situation was
obtained.

HISTORY OF COURTSHIP & MARRIAGE

Paola came to this country from Peru in November of 1992. Paola related
she comes from a close-knit family and that in her native country, she
worked as a journalist. She came here with savings of $3,000 and with
that money managed to rent a room the same day she arrived in the
United States.

Her first job here was as a by sitter, and later she was employed as a
waitress. She learned English by studying in the library and by getting
to tutor from the Volunteers of America. Her initial years here consisted
of working and studying English. She had just a few friends.
Paola related that she met her future husband in December of 1995 at
a dance. Her initial dates with him consisted in meeting for coffee. She
described him as being very friendly, a gentleman and very generous.
She felt they complemented each other as he was very open and
spontaneous, and she was more reserved. They saw each other
frequently over the course of the next five to six months. He then asked
her to marry him indicating that he wanted to change his life. He related
his previous relationship had failed in part due to his drinking. Paola
indicated that during their courtship she saw him intoxicated a few
times and that on several occasions he failed to come through on his
promises. He professed his love for her and made her feel happy and

48
optimistic. She indicated she accepted his marriage proposal because
she felt alone and yearned to have a real home.

HISTORY OF DOMESTIC VIOLENCE

Paola related that about six (6) months after dating, on 5/29/96, they
married in a civil ceremony. She felt very happy in the beginning of their
marriage. He professed his love for her, and she indicated that he
brought her much happiness.

She indicated though they had different interests (for example, he

enjoyed music and sports and she like literature), they enjoyed going to
the movies together and visiting friends.

Emotional abuse.

A few months after marrying, she noticed some subtle changes in his
behavior. For example, he would call her stupid or a moron. He often
did this in front of others, on a few occasions, in 1997; he jokingly said
she was not good for anything and that she did not even know how to
dance properly. In the presence of her friends, he would often treat her
poorly. He would yell or try to correct her actions in front of others. This
behavior on his part often caused her to feel very bad and disrespected.
However, in the beginning she thought that she was wrong or had acted
improperly.

She was very forgiving whenever he apologized. The constant

humiliation and demeaning continued throughout their marriage. He
would mimic her English. He refused to help her practice speaking
English and would only criticize but not help her to improve.

Paola often felt frustrated because he would not support her efforts to
study. He would also demean her appearance and tell her she was old,
old fashioned, boring and not sexy. He also proved to be inconsiderate
of others as well. On one occasion, he put the music up very loud and
when she asked him to please lower it, he began to yell at her and
refused to do so.
49
The perpetrator husband also constantly brought up her immigration
status and consistently would try to intimidate and humiliate her. He
felt she should content herself with menial jobs because she was an
immigrant and should not aspire to anything better. Economic abuse
Paola related that he suggested they bring her son to reunite with her.
In the beginning, he was okay with the child. But when things began to
deteriorate a year after marrying, he complained of being delegated to
second place. Whenever they argued, the child would get upset and cry.
The perpetrator husband would yell at the child and tell him to shut up.
Even though during their first year of marriage they had shared equal
responsibility for household expenses, he became less responsible. He
would not work consistently and if Paola would inquire as to why he
wasn’t working he would become extremely upset. As a result, Paola has
to bear the weight of the financial expenses, which caused her to feel
exploited. Paola indicated that initially she had wanted to have a child
with her husband as she yearned to have another child. But when she
noticed his change in behavior and irresponsible nature, she decided it
would not be wise to have a child by him.

Sexual abuse.

Paola also related that her husband sexually abused her throughout
their marriage and would force her to have sex with him. The last
incident of this type occurred on August 11, when she related, he came
home intoxicated and used physical force to compel her to have sex with
him.

As a result, she called the police and obtained an order of protection

against the perpetrator husband in Family Court.
As is typical of abusive personalities, the perpetrator husband would
often blame her for all the incidents. Periodically, he would ask for her
forgiveness and promise to change. However, when she would ask him
to see a psychiatrist he would refuse and tell her she was the crazy one.

50
The result of the different forms of abuse she experienced has been a
noticeable change in the perpetrator husband’s personality. For
example, she no longer feels secure about herself and believes her self-
esteem has been severely damaged. She finds it hard to trust others or
to accept positive feedback.

Physical abuse.

Paola has experienced various types of abuse by her perpetrator

husband including emotional, physical, sexual and economic abuse. It
is very clear that he used her immigration status as a means to control,
intimidate and humiliate her.

Furthermore, Paola married her perpetrator husband in good faith and

made every effort to try to maintain the relationship because she loved
her husband and wanted to keep the family unit intact. It has been a
very painful and disappointing experience for Paola to have her marriage
fail and to have suffered much abuse in the process.

The complexity and strength of the intimate relationship creates many

barriers to dissolution. Paola indicated that her perpetrators husband’s
left the home and have not returned.

EFFECTS OF DOMESTIC VIOLENCE

As is typical of domestic violence victims, the victim suffered in silence

and did not share the intimate details of the abuse the victim was
experiencing. It was especially hard for the victims to divulge the
intimate details of her sexual relationship and the victims expressed
that it was very hard for the perpetrator husband.

The sum effect of the failure of the victim marriage has left her feeling
very sad, traumatized, and in the victim’s words “a failure” and with no
desire to live.

51
The victim finds it them to trust others, especially men. The victims
often recall how the perpetrator treated them. The victims went through
a very difficult period after separating in which the abuser was
withdrawn, very sad, lacked energy, cried constantly, and unable to
sleep. The victims also were very fearful of perpetrators and continue to
be afraid of perpetrator husbands.
When we discussed the reasons, the victim remained in the relationship,
the victim identified a variety including her love for and attraction to the
perpetrator desire to have the relationship work out, and the victim hope
that she could help the perpetrator husbands. These are all common
reasons why victims of abuse remain in such situations.

The victims have experienced various types of abuse by the perpetrator

husbands including emotional, psychological sexual (forced to have sex)
and economic abuse. It is apparent that the victim’s husband used the
immigration status as a means to humiliate and intimidate the victims.
The victims did marry her husband’s in good faith and made every effort
to try to maintain the relationship because they loved their husband
and wanted the marriage to succeed.
The victims desperately wanted this marriage to work because
unintentionally supports the perpetrators minimization, denial,
externalization, and rationalization of the violent behavior.
The dynamics of using physical psychological violence to obtain power
and control over another; the experience of domestic violence victims is
understood by many experts to be akin to torture and terrorism in the
house.

My story on the domestic violence

wheel.
52
This is the story of Mary a Dominican women as a victim of domestic
violence that occurred in the city of New York. Unlike victims of stranger
violence, victims of domestic violence cannot walk away, even if the
abuser would let them. The complexity and strength of the intimate
relationship creates many barriers to dissolution.

Domestic violence is behavior done in the context of an adult intimate

relationship. In domestic violence cases, the abused party and the
perpetrator are intimates usually family or ex-family to each other. The
abused party is affected by domestic violence in many of the same ways
as victims of violence perpetrated by strangers, but also is affected in
unique ways since the abuser is an intimate rather than a stranger.

However, such effects of trauma are accentuated and recidivism is more

likely in domestic violence case due to the fact that the abuser, unlike
the perpetrator of stranger violence, has on-going access to the victim,
knows the victim’s daily routine, and can continue to exercise
considerable power and control over the victim’s daily life, both
physically and emotionally.

Unlike victims of stranger violence, victims of domestic violence cannot

walk away, even if the abuser would let them. The complexity and
strength of the intimate relationship creates many barriers to
dissolution.

This is the story of Mary a Dominican women as a victim of domestic

violence that occurred in the city of New York. During the course of the
several interviews, the following facts pertaining to her situation
emerged which indicated she is a victim of domestic violence during her
marriage.

53
HISTORY OF COURTSHIP & MARRIAGE

Mary related that around June of 1992, she first met her future
husband, Luis, at a friend’s birthday party. She indicated that they
started seeing each other on a weekly basis and after about six (6)
months or, they began living together. At that time, Luis was not steadily
employed, and she had to maintain the bulk of the household expenses.

They began to have some problems because of his unsteady

employment. She indicated that suddenly he stopped coming home
about a year or so after he had moved in. Though she tried to locate him
she was unable to do so and eventually as time passed, she tried to
forget about him. Then after about two (2) years, around 1996, Mary
indicated bumped into him at a school where she was taking classes
and he was working as a security guard. He spoke of their destiny to
meet again and how God wanted them to find each other and be
together. They began seeing each other once again.

Mary related that she was attracted to her husband because he was very
attentive and flattering. He also was very affectionate and put her on a
pedestal. From the beginning, he displayed signs of being extremely
jealous and controlling. Mary initially interpreted this as a sign of his
love and concern for her. After reuniting, about a few months later they
began living together. He subsequently asked her to marry him.

Mary related that he told her his previous relationship had failed
because his wife had been unfaithful to him. (She later found out he
had been married at least three times previously.) They lived together
for about 6 months prior to marrying on March 15, 1997 in New York.
Their families and friends were present and afterwards they had a
celebration at their home.

HISTORY OF DOMESTIC VIOLENCE

54
Mary related a pattern of psychological, emotional, sexual, economic,
and physical abuse that occurred throughout the duration of their
marriage.

Economic abuse: Mary indicated that after they reunited, they went to
live in the house she was renting in Long Island. By that time (around
1997), Mary was working as a security guard and had two (2) jobs. After
they married, he insisted that she should not work.

This was hard for Mary who was accustomed to always providing for her
family. Though she tried to reason with him, he insisted she could not
work and that a woman’s place was in the home.

As a result, she was home all day and he would call her constantly to
check up on her. If she did not answer the phone immediately, he would
question her as to why she had not responded promptly. He would give
her the money for the household expenses but would want to know how
every penny was spent.

Emotional abuse: Mary indicated that her husband always and

constantly verbally abused, cursed, and humiliated her. He often would
talk about her immigration status and try to denigrate her. Mary
indicated that her husband continued to engage in a regular pattern of
emotional and psychological abuse. He would call her names and treat
her in a demeaning manner.

He constantly would refer to her as “illegal”. She related that there were
many occasions in which he threatened her regarding her immigration
status or would try to use this to humiliate her.

Another problem they had from the beginning was that every weekend,
from Friday to Sunday, he would invite friends over to drink. Mary
related that he often humiliated her in front of his friends. Mary
indicated that she finally decided to take a part-time job because it was

55
very hard for her to be home all day and subjected to his constant calls
to check on her.

She took this job without his knowledge or consent. She was able to do
this for about two weeks until one day on July 18, 1998 she suffered an
accident running across the street from her job to meet her daughter
and rush home and was hit by a car. She was severely hurt and had to
be hospitalized for several days.

The perpetrator husband was extremely upset that she had been
working without his permission and initially refused to go visit her.
When he did visit her, he verbally abused her and accused her of having
been with another man. Mary indicated that her marriage grew worse
from that date on.

Sexual abuse: Mary indicated that after her accident in 1998 in which
she suffered numerous injuries including to her pelvis, the sexual abuse
grew worse. Because it was difficult for her to have intercourse, Mary
also related that he sexually abused her in that he would force her to
have anal sex which she was not accustomed and objected to.

On one occasion, which occurred around early 2000, she related, he

came home intoxicated and tried to force her to have sex. When she
objected, he told her he was the man of the house and that’s what he
had married her for.
Mary indicated that her husband would force her to have anal sex and
this would cause her rectal bleeding. Mary had to seek medical attention
for her condition but was too ashamed to tell the doctor who treated her
about the rectal bleeding.
Mary indicated that her husband drank alcohol excessively on the
weekends and for that reason she dreaded the onset of the weekend, as
this was when she most experienced the sexual, emotional and
psychological abuse by her husband.

56
Mary related that he would insist on having relations while intoxicated
and that he would be unable to complete the sex act. As a result, he
habitually would then put his hand inside her vagina with the pretext
that he wanted to please her sexually.

However, Mary indicated that he would cause her extreme pain,

discomfort and humiliation. If she objected, he would threaten her or
accuse her of not wanting to have relations with him because she had
another man.

Physical abuse: Mary indicated that the instances of physical abuse

occurred in the privacy of their bedroom. They occurred when Mary tried
to force her to have sexual relations or when she objected to the sexual
activity, he was trying to engage in.
On one occasion, which she said occurred around 1999, he was trying
to force her to have anal sex and she refused. He pushed her so hard
she hit her mouth across the footboard of the bed. This caused her
mouth to swell and bruise, and her teeth were jarred loose. According
to Mary the bruises she sustained bruises lasted over two (2) weeks and
she was unable to leave the house for that period.
Because Mary was so afraid and ashamed, she told everyone including
her family and dentist, that she had fallen. As a result, Mary has
permanent dental damage, which she has not been able to repair.

Mary indicated that in August of 2001 her husband left the home and
has not returned.

EFFECTS OF DOMESTIC VIOLENCEON THE VICTIM BY THE

PERPRETATOR

As is typical of domestic violence victims, they suffered in silence and

did not share the intimate details of the abuse they were experiencing.
It was especially hard for them to divulge the intimate details of their
sexual relationship and they expressed that it was very hard for them
to relate this to this social worker, counselor, and any other
professional.
57
The sum effect of the failure of their marriage has left their feeling very
sad, traumatized, and in the victim words “a failure” and with no desire
to live.

The victim finds it to trust others, especially men. Mary often recalls
how the perpetrator treated her. She went through a very difficult period
after separating in which the victim was withdrawn, very sad, lacked
energy, cried constantly, and was unable to sleep. The victim also was
very fearful of perpetrator and continues to be afraid of perpetrator.

When the victim discussed the reasons remained in the relationship,

they identified a variety including their love for and attraction to
perpetrator, the victim desire to have the relationship work out, and the
victim hope that could help him, the perpetrator. These are all common
reasons why victims of abuse remain in such situations.

The victim has experienced various types of abuse by their perpetrator

husbands including emotional, psychological sexual (penis as a weapon)
and economic abuse. It is apparent that the perpetrator husbands used
the immigration status as a means to humiliate and intimidate her. The
victim did marry their husband in good faith and made every effort to
try to maintain the relationship because they loved their husband and
wanted the marriage to succeed. They desperately wanted this marriage
to work as they have had one prior failed marriage.

The effects of the domestic violence, changes in attitude towards life, low
self-esteem and sense of failure which have resulted from the abusive
marriage.

Mary related that she has not sought help due to feelings of shame and
lack of information about resources in their community. She stands to
benefit immensely through ongoing education and support regarding
the victim options. Participation in a support group for victims of
domestic violence might also prove beneficial to lift the sense of isolation
and shame that victims of domestic violence often experience.

58
The Psychological control of abused parties through intermittent use of
physical assault going along with psychological abuse: such as verbal
abuse, isolation, threats of violence, is typical used against prisoners of
war and hostages. Perpetrators are able to control abused parties by a
combination of physical and psychological tactics since they are so
closely interwoven by the perpetrator.

The domestic violence is purposeful and instrumental behavior.

Domestic violence in heterosexual

and homosexual relationships:

59
Domestic Abuse and Violence
against Men

Awareness, perception and documentation of domestic violence differ

from country to country, and from era to era.

There are many reasons why we don't know more about domestic abuse
and violence against men. There are no absolute rules for understanding
the emotional differences between men and women. There are principles
and dynamics that allow interpretation of individual situations.
Domestic abuse and violence against men and women have some
similarities and difference. Domestic abuse can also be mental or
emotion-al. However, what will hurt a man mentally and emotionally,
can in some cases be very different from what hurts a woman. For some
men, being called a coward, impotent or a failure can have a very
different psychological impact than it would on women. Unkind and
cruel words hurt, but they can hurt in different ways and linger in
different ways.
Domestic violence, also known as domestic abuse, spousal abuse, child
abuse or intimate partner violence, can be broadly defined a pat tern of
abusive behaviors by one or both partners in an intimate relationship
such as marriage, dating, family, friends or cohabitation.

60
Domestic violence has many forms including:
• Physical aggression (hitting, kicking, biting, shoving, restraining,
throwing objects), or threats thereof; sexual abuse; emotional abuse;
controlling or domineering; intimidation; stalking; passive/covert abuse
(neglect); and economic deprivation. Domestic violence may or may not
constitute a crime, depending on local statues, se-verity and duration
of specific acts, and other variables. Alcohol consumption and mental
illness have frequently been associated with abuse.
Awareness, perception and documentation of domestic violence differ
from country to country, and from era to era. Estimates are that 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, prevent-able public
health problem affecting more than 32 million Americans, or over 10%
of the U. S. population.
Violence between spouses has long been considered a serious problem.
The United States has a lengthy history of legal precedent condemning
spousal abuse. In 1879, law scholar Nicholas St. John Green wrote,
61
"The cases in the American courts are uniform against the right of the
husband to use any [physical] chastisement, moderate or otherwise,
toward the wife, for any purpose." Green also cites the 1641 Body of
Liberties of the Massachusetts Bay colonists -— one of the first legal
documents in North American history —- as an early de jure
condemnation of violence by either spouse.
Popular emphasis has tended to be on women as the victims of domestic
violence. Many studies show that women suffer greater rates of injury
due to domestic violence, and some studies show that women suffer
higher rates of assault. Yet, other statistics show that while men tend
to inflict injury at higher rates, the majority of domes-tic violence overall
is reciprocal.
Modern attention to domestic violence began in the women's movement
of the 1970s, particularly within feminism and women's rights, as
concern about wives being beaten by their husbands gained attention.
Only since the late 1970s, and particularly in the masculine and men's
movements of the 1990s, has the problem of domestic violence against
men gained any significant attention. Estimates show that 248 of every
1,000 females and 76 of every 1,000 males are victims of physical
assault and/or rape committed by their spouses. A 1997 report says
significantly more men than women do not disclose the identity of their
attacker. A 2009 study showed that there was greater acceptance for
abuse perpetrated by females than by males.
Violence towards men is a serious social problem
Women's violence towards men is a serious social problem. While much
attention has been focused on domestic violence against women,
researchers argue that domestic violence against men is a substantial
social problem worthy of attention. However, the issue of victimization
of men by women has been contentious, due in part to studies which
report drastically different statistics regarding domestic violence.

Some studies—typically crime studies—shows that men are

substantially more likely than women to use violence. According to a
July 2000 Centers for Disease Control (CDC) report, data from the
Bureau of Justice, National Crime Victimization Survey consistently
show that women are at significantly greater risk of intimate partner

62
violence than are men. Other studies—typically family and domestic
violence studies—show that men are more likely to inflict injuries, but
also that when all acts of physical aggression or violence are considered
in aggregate; women are equally violent as men, or more violent than
men.
Recognize domestic violence in heterosexual or homosexual
relationships
Domestic violence, also known as domestic abuse, battering or intimate
partner violence occurs between people in an intimate relationship.
Domestic violence against men can take many forms, including
emotional, sexual and physical abuse. It can happen in heterosexual or
homo-sexual relationships.
It might not be easy to recognize domestic violence against men. Early
in the relationship, your partner may seem attentive, generous and
protective in ways that later turn out to be con-trolling and frightening.
Initially, the abuse may appear as isolated incidents. Your partner may
apologize and promise not to abuse you again.
In other relationships, domestic violence against men may include both
partners slapping or shoving each other when they get angry and neither
partner seeing him or her as being abused or con-trolled. But this type
of violence can still devastate a relationship, causing both physical and
emotional damage.
Experiencing domestic violence:

• Calls you names, insults you or puts you down

• Prevents you from going to work or school

• Stops you from seeing family members or friends

• Tries to control how you spend money, where you go or what you wear

• Acts jealous or possessive or constantly accuses you of being

unfaithful

• Gets angry when drinking alcohol or using drugs

63
• Threatens you with violence or a weapon

• Hits, kicks, shoves, slaps, chokes or otherwise hurts you, your

children or your pets

• Assaults you while you're sleeping, drunk or not paying attention to

make up for a difference in strength

• Forces you to have sex or engage in sexual acts against your will

• Blames you for his or her violent behavior or tells you that you deserve
it

• You may also be experiencing domes-tic violence if you're in a same-

sex relationship with a man who:

• Threatens to tell friends, family, colleagues or community members

your sexual orientation or gender identity

• Tells you that authorities won't help a homosexual, bisexual or

transgender person

• Tells you that leaving the relationship means you're admitting that
homosexual relationships are deviant

• Tells you that abuse is a normal part of homosexual relationships or

that domestic violence can't occur in homo-sexual relationships

• Justifies abuse by telling you that you're not "really" homosexual,

bisexual or transgender

• Says that men are naturally violent

• Portrays the violence as mutual and consensual

• Rationalizes the abuse as part of a sadomasochistic activity

Centers for Disease Control

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

64
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.
Strauss argues that these discrepancies between the two data sets are
due to several factors. For example, Strauss notes that crime statistics
are compiled and analyzed differently from domestic violence statistics.
Additionally, Strauss notes that most studies show that while men
inflict the greater portion of injuries, women are at least as likely as men
to shove, punch, slap or otherwise physically assault their partner, and
that such relatively minor assaults often escalate to more serious
assaults. Minor assaults perpetrated by women are also a major
problem, even when they do not result in injury, because they put
women in danger of much more severe retaliation by men. It will be
argued that in order to end 'wife beating,' it is essential for women also
to end what many regards as a "harmless" pattern of slapping, kicking,
or throwing something at a male partner. Strauss also notes that data
con-firming that women can be violent have been suppressed because
the data contradicts preconceptions that men are responsible for most
or all domestic violence.
Reasons given for non-reporting
The 2000 CDC report, based on phone inter-views with 8000 men and
8000 women, reported that 7.5% of men claim to have been raped or
assaulted by an intimate at some time in their life time (compared to
25% of women), and 0.9 per-cent of men claim to have been raped or
assaulted in the previous 12 months (compared to 1.5% of women).
A 2007-2008 online non-random, self-report survey of the experiences
and health of men who sustained partner violence in the past year. The
study showed that male victims of abuse are very hesitant to report the
violence or seek help. Reasons given for non-reporting were they:
(1) May be ashamed to come forward;

65
(2) May not be believed; and
(3) May be accused of being a batterer when they do come forward.
The 229 U.S. heterosexual men, between 18 and 59, had been physically
assaulted by their female partner within previous year and did seek
help. The researchers say their findings emphasize the need for
prevention on all levels: There are many reasons why we don't know
more about domestic abuse and violence against men. There are a
number of commonly reported interactions in which violence against
men erupts. Here is one example that illustrates a common dynamic.
Man attempt to remain unemotional
The woman is mildly distressed and upset. The man notices her distress
and then worries she may become angry. The woman attempts to
communicate and discuss her feelings. She wants to talk, feel supported
and feel less alone. She initially attributes some of her distress or
problems to him. The man begins to feel defensive, shuts down
emotionally and attempts to deal with the problems rationally. He feels
a fight is coming on. The woman feels uncared for, ignored and then
gets angry. She wants him to share the problem and he doesn't feel he
has a problem. The man will attempt to remain un-emotional and stay
in control of him.
He avoids accepting any blame for how she feels. He is also worried that
she may explode at any moment and that she will certainly do so if he
talks about his feelings. The man will start talking about her problem
as if she could feel better if she would only listen to him and stop acting
so upset. He fails to understand how she feels and tries to remain calm.
He tells her to calm down and ends up looking insensitive. She begins
to wonder if he has any feelings at all. She tells him that he thinks he's
perfect. He says he is not perfect. She calls him insensitive. He stares at
her and says nothing but looks irritated.
The woman is frustrated that he won't reveal his feelings and that he
acts like he is in control. On the other hand, the man feels out of control
and like there is no room for anybody's feelings in the conversation but
hers. Communication breaks down and the woman begins to insult the
man. When the man finally expresses his disapproval and attempts to
end the fight. The woman becomes enraged and may throw something.
The man will usually endure insults and interactions like this for weeks

66
or months. This whole pattern becomes a recurrent and all too familiar
experience. The man becomes increasingly sensitive to how the woman
acts and becomes avoidant and unsupportive. The man begins to believe
that there is nothing he can do and that it may be his entire fault. His
frustration and anger can build for months like this.
The door to violence has opened wide
This risk of violence increases when the woman insults the man in front
of their children, threatens the man's relationship with his children, or
she refuses to control her abusive behavior when the children are
present. She may call him a terrible father or an awful husband in front
of the children. Eventually he feels enraged not only because of how she
treats him, but how her be-savior is harming the children. At some point
the man may throw something, punch a wall, or slam his fist down
loudly to vent his anger and to communicate that he has reached his
limits. Up till now she has never listened to what he had to say. He
decides that maybe she will stop if she can see just how angry he has
become. Rather than recognizing that he has reached his limits,
expressing his anger physically has the opposite effect.
Man has tried to hide his anger
For a long time, the man has tried to hide his anger. Why should the
woman believe he really means it? After all, he has put up with her
abuse for a long time and done nothing. Instead of realizing that things
have gotten out of control, the woman may approach him and say some-
thing like, "What are you going to do? Hit me? Go ahead. I'll call the
police and you'll never see your children again."
Once he expressed his anger physically, the situation became
dangerous for him and for her. The door to violence has opened wide.
He should walk away. When he does walk away, she ends up angrier
than ever, will scream obscenities at him and strike him repeatedly. She
may even strike him with an object.
Domestic abuse and violence against men
There are many reasons why we don't know more about domestic abuse
and violence against men. First of all, the incidence of domestic violence
reported men appears to be so low that it is hard to get reliable
estimates. In addition, it has taken years of advocacy and support to
encourage women to report domestic violence. Virtually nothing has
67
been done to encourage, men to report abuse. The idea that men could
be victims of domestic abuse and violence is so unthinkable that many
men will not even attempt to report the situation.
The dynamic of domestic abuse and violence is also different between
men and women. The reasons, purposes and motivations are often very
different between sexes. Although the counseling and psychological
community have responded to domestic abuse and violence against
women, there has been very little investment in resources to address
and understand the issues of domestic abuse and violence against men.
In most cases, the actual physical damage inflicted by men is so much
greater than the actual physical harm inflected by women. The impact
of domestic violence is less apparent and less likely to come to the
attention of others when men are abused. For example, it is assumed
than a man with a bruise or black eye was in a fight with another man
or was injured on the job or playing contact sports. Even when men do
report domestic abuse and violence, most people are so astonished men
usually end up feeling like nobody believes them.
The Problem with Assumptions about Domestic Abuse and Violence
It is a widely held assumption that women are always the victims and
men are always the perpetrators. Between 50 and 60% of all domestic
abuse and violence is against women. There are many reasons why
people assume men are never victims and why women often ignore the
possibility. For one thing, domestic abuse and violence has been
minimized, justified and ignored for a very long time. Women are now
more organized, supportive and outspoken about the epidemic of
domestic abuse and violence against women. Very little attention has
been paid to the issue of domestic abuse and violence against men -
especially because violence against women has been so obvious and was
ignored for so long.

What Is Domestic Abuse and Violence Against Men?

There are no absolute rules for understanding the emotional differences
between men and women. There are principles and dynamics that allow
interpretation of individual situations. Domestic abuse and violence
against men and women have some similarities and difference. For men
or women, domestic violence includes pushing, slapping, hitting,

68
throwing objects, forcing or slamming a door or striking the other person
with an object, or using a weapon. Domestic abuse can also be mental
or emotional. However, what will hurt a man mentally and emotionally,
can in some cases be very different from what hurts a woman. For some
men, being called a coward, impotent or a failure can have a very
different psychological impact than it would on women. Unkind and
cruel words hurt, but they can hurt in different ways and linger in
different ways. In most cases, men are more deeply affected by emotional
abuse than physical abuse.
For example, the ability to tolerate and "brush off" a physical assault by
women in front of other men can in some cases reassure a man that he
is strong and communicate to other men that he can live up to the code
of never hitting a woman. A significant number of men are overly
sensitive to emotional and psychological abuse. In some cases,
humiliating a man emotionally in front of other men can be more
devastating than physical abuse. Some professionals have observed that
mental and emotional abuse can be an area where women are often
"brutal" than men. Men on the other hand are quicker to resort to
physical abuse and they are more capable of physical assaults that are
more brutal - even deadly.
Why Does Domestic Abuse Against Men Go Unrecognized?
Domestic violence against men goes unrecognized for the following
reasons:

• The incidence of domestic violence against men appears to be so low

that it is hard to get reliable estimates.

• It has taken years of advocacy and support to encourage women to

report domestic violence. Virtually nothing has been done to encourage
men to report abuse.

• The idea that men could be victims of domestic abuse and violence is
so un-thinkable to most people that many men will not even attempt to
report the situation.

• The counseling and psychological community have responded to

domestic abuse and violence against women. Not enough has been done
to stop abuse against women. There has been very little investment in
69
resources to address the issues of domestic abuse and violence against
men.

• In most cases, the actual physical damage inflicted by men is so much

greater than the actual physical harm inflected by women. The impact
of domestic violence is less apparent and less likely to come to the
attention of others.

• Even when men do report domestic abuse and violence, most people
are so astonished, men usually end up feeling like nobody would believe
them. It is widely assumed than a man with a bruise or black eye was
in a fight with another man or was injured on the job or while playing
contact sports. Women generally don't do those things.
The characteristics of men or women who are abusive fall into three
categories.

• Alcohol Abuse. Alcohol abuse is a major cause and trigger in domestic

violence. People, who are intoxicated have less impulse control, are
easily frustrated, have greater misunderstandings and are generally
prone to resort to violence as a solution to problems. Women who abuse
men are frequently alcoholics.

• Psychological Disorders. There are certain psychological problems,

primarily personality disorders, in which women are characteristically
abusive and violent toward men. Borderline personality disorder is a
diagnosis that is found almost exclusively with women. Approximately
1 to 2 percent of all women have a Borderline Personality disorder. At
least 50% of all domestic abuse and violence against men is associated
with woman who has a Borderline Personality disorder. The disorder is
also associated with suicidal behavior, severe mood swings, lying,
sexual problems and alcohol abuse.

• Unrealistic expectations, assumptions and conclusions. Women who

are abusive toward men usually have unrealistic expectations and make
unrealistic demands of men. These women will typically experience
repeated episodes of depression, anxiety, frustration and irritability
which they attribute to a man's behavior. In fact, their mental and
emotional state is the result of their own insecurities, emotional
problems, and trauma during childhood or even withdrawal from

70
alcohol. They blame men rather than admit their problems, take
responsibility for how they live their lives or do something about how
they make themselves miserable. They refuse to enter treatment and
may even insist the man needs treatment. Instead of helping
themselves, they blame a man for how they feel and believe that a man
should do something to make them feel better. They will often medicate
their emotions with alcohol. When men can't make them feel better,
these women become frustrated and assume that men are doing this on
purpose.
Furthermore, even when men do report domestic abuse and violence,
most people are so astonished, men usually end up feeling like nobody
believes them. Virtually nothing has been done to encourage men to
report abuse. The idea that men could be victims of domestic abuse and
violence is so unthinkable that many men will not even attempt to report
the situation.
Although the counseling and psychological community responded to
domestic abuse and violence against women, there has been little
investment in resources to address and understand the issues of
domestic abuse and violence against men.

71
Abuso doméstico y violencia contra
los hombres
La violencia doméstica en las
relaciones heterosexuales u
homosexuales

Hay muchas razones por las que no sabemos más acerca de la violencia
doméstica contra los hombres. La violencia doméstica difiere de país a
país, y de una época a otra. No hay reglas absolutas para la
comprensión de las diferencias emocionales entre hombres y mujeres.
Hay principios y las dinámicas que permiten la interpretación de las
situaciones individuales. El abuso doméstico y la violencia contra los
hombres y las mujeres tienen algunas similitudes y diferencias. El
abuso doméstico también puede ser mental o emocional. Sin embargo,
lo que va a herir a un hombre mental y emocionalmente, en algunos
casos puede ser muy diferente de lo que duele una mujer. Para algunos
hombres, ser llamado un cobarde, impotente o un fracaso puede tener
un impacto psicológico muy diferente de lo que en las mujeres. Poco
amable y las crueles palabras duelen, pero puede hacer daño de
diferentes maneras y persisten en diferentes formas.

La violencia doméstica, también conocida como maltrato conyugal,

abuso o violencia de pareja, puede definirse en términos generales como
un patrón de conductas abusivas por parte de uno o ambos socios en
una relación íntima como el matrimonio, noviazgo, familia, amigos o la
cohabitación de parejas.

La violencia doméstica tiene muchas formas:

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La agresión física (golpes, patadas, empujones, de restricción, el
lanzamiento de objetos), o amenazas, abuso sexual, abuso emocional,
la intimidación o el control dominante; acecho; pasivo, abuso,
encubierta (negligencia), y la privación económica. La violencia
doméstica puede o no puede constituir un delito, dependiendo de las
estatuas locales, la gravedad y duración de los actos específicos, y otras
variables. El consumo de alcohol y enfermedades mentales han sido
frecuentemente asociados con el abuso.

La conciencia, la percepción y la documentación de la violencia

doméstica difieren de país a país, y de una época a otra. Se estima que
sólo alrededor de un tercio de los casos de violencia doméstica son
reportados en los Estados Unidos y el Reino Unido. Según los Centros
para el Control de Enfermedades, la violencia doméstica es un grave
problema de salud pública prevenible que afecta a más de 32 millones
de estadounidenses, o más del 10% de la población de EE.UU.
La violencia entre los cónyuges ha sido considerada un problema grave.
Los Estados Unidos tienen una larga historia de precedente legal que
condena la violencia conyugal. En 1879, especialista en derecho
Nicholas St. John Green escribió: "Los casos en los tribunales
americanos son uniformes en contra del derecho del marido a usar
cualquier [físico] castigo, moderado o no, hacia la mujer, para cualquier
propósito." Verde también cita el 1641 Cuerpo de Libertades de los
colonos de la Bahía de Massachusetts
- uno de los primeros documentos legales en la historia de Norteamérica
- como principios de derecho, la condena de la violencia por cualquiera
de los cónyuges.

Énfasis Popular ha tendido a ser en las mujeres como víctimas de la

violencia doméstica. Muchos estudios muestran que las mujeres sufren
mayores tasas de lesiones debido a la violencia doméstica, y algunos
estudios muestran que las mujeres sufren mayores índices de asalto.
Sin embargo, otras estadísticas muestran que mientras los hombres
tienden a causar lesiones a tasas más altas, la mayoría de la violencia
doméstica en general es recíproca.
Moderno atención a la violencia doméstica comenzó en el movimiento
de mujeres de la década de 1970, en particular en el feminismo y los
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derechos de la mujer, como su preocupación por las esposas golpeadas
por sus maridos llamó la atención. Sólo a partir de la década de 1970,
y en particular en el masculinísimo y los movimientos de los hombres
de la década de 1990, tiene el problema de la violencia doméstica contra
los hombres ganan ninguna atención significativa.
Las estimaciones indican que 248 de cada 1.000 mujeres y 76 de cada
1.000 varones son víctimas de asalto físico y / o violación cometidos por
sus cónyuges. Un informe de 1997 dice que los hombres mucho más
que las mujeres no revelar la identidad de su atacante. Un estudio de
2009 mostró que había una mayor aceptación de los abusos
perpetrados por mujeres que por hombres.

La violencia hacia los hombres es un grave problema social

Violencia de las mujeres hacia los hombres es un grave problema social.

Aunque la atención se ha centrado en la violencia doméstica contra las
mujeres, los investigadores sostienen que la violencia doméstica contra
los hombres es un problema social importante digna de atención. Sin
embargo, la cuestión de la victimización de los hombres de las mujeres
ha sido muy discutida, debido en parte a los estudios que reportan las
estadísticas drásticamente diferentes en cuanto a la violencia
doméstica.

Algunos estudios de los estudios de la delincuencia general, muestra

que los hombres son mucho más propensos que las mujeres a usar la
violencia.

Según una de julio de 2000 Centros de Control de Enfermedades (CDC)

reportan, los datos de la Oficina de Justicia, Nacional Crimen
Victimización Survey muestran consistentemente que las mujeres
tienen un riesgo significativamente mayor de la violencia de pareja que
los hombres. Otros estudios-por lo general la familia y los estudios de
la violencia doméstica demuestran que los hombres tienen más
probabilidades de causar lesiones, pero también que cuando todos los
actos de agresión física o la violencia son considerados en conjunto, las

74
mujeres son igual de violentas que los hombres, o más violentas que los
hombres.

Reconocer la violencia doméstica en las relaciones heterosexuales

u homosexuales

La violencia doméstica, ocurre entre las personas en una relación

íntima. La violencia doméstica contra los hombres puede tomar muchas
formas, incluido el abuso emocional, sexual y física. Puede ocurrir en
las relaciones sexuales heterosexuales u homosexuales.

Tal vez no sea fácil de reconocer el viral nacional contra los hombres. A
principios de la relación, su pareja puede parecer atenta, generosa y
protectora de manera que luego resultan ser aterrador. Inicialmente, el
abuso puede aparecer como incidentes aislados. Su pareja puede pedir
disculpas y la promesa de no abusar de usted de nuevo.

En otras relaciones, la violencia doméstica contra los hombres puede

incluir bofetadas entre sí cuando están enojados y ninguno de las
parejas ya él o ella como víctima de abuso o controlar.

Pero este tipo de violencia puede todavía devastador en una relación,

causando tanto daño físico y emocional.

Formas de expresión de la violencia doméstica en las parejas

• Insultar o poner abajo a la pareja enfrente de amistades.

• Evitar que vaya a trabajar o la escuela.
• Impedir ver a sus familiares o amigos.
• Controlar cómo gasta el dinero, dónde vaya o lo que la pareja
desgaste.
Actos de celos, posesivo o constantemente acusar de infidelidad.

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Consumo de alcohol o uso de drogas, amenaza con la violencia o un
arma.
Patadas, empujones, bofetadas o perjudica a usted, sus hijos o sus
mascotas.
Agresiones durmiendo, borracho o no prestar atención a compensar la
diferencia en la fuerza a tener relaciones.
Fuerzas sexualmente o realizar actos sexuales contra su voluntad.
Amenazar con decirle a sus amigos, familiares, colegas o miembros de
la comunidad de su orientación sexual o identidad de género.
Amenazar que las autoridades no ayudarán a una persona homosexual,
bisexual o de genero.
Argumentar que el abuso es una parte normal de las relaciones
homosexuales, bisexuales o transexuales.
Argumentar que los hombres son naturalmente violentos.
Racionaliza los abusos como parte de una actividad masoquista.

Centros para el Control de Enfermedades (CDC)

En mayo de 2007, los investigadores del Centros para el Control de

Enfermedades informaron sobre las tasas de auto-reportada violencia
entre parejas utilizando datos de un estudio de 2001. En el estudio, casi
una cuarta parte de los participantes reportaron algo de violencia en
sus relaciones. La mitad de estas caras de los involucrados (“no
recíproco") y la mitad de los ataques que participan tanto las agresiones
y los ataques contra (“la violencia recíproca"). La comisión de la Mujer
informó de un solo lado los ataques más del doble de frecuencia que los
hombres (70% versus 29%). En todos los casos de violencia en la pareja,
las mujeres tenían más probabilidades de sufrir lesiones que los
hombres, pero el 25% de los hombres en las relaciones con los dos lados
las denuncias de violencia lesiones en comparación con el 20% de las
mujeres la presentación de informes de lesiones en relación con una
violencia unilateral. Las mujeres tenían más probabilidades de sufrir
lesiones en la no violencia recíproca.

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Strauss, sostiene que estas discrepancias entre los dos conjuntos de
datos se deben a varios factores. Por ejemplo, las notas de Strauss que
las estadísticas del delito son compilados y analizados de manera
diferente a las estadísticas de la violencia doméstica. Además, toma nota
de Strauss que la mayoría de los estudios muestran que mientras que
los hombres infligen la mayor parte de las lesiones, las mujeres son al
menos igual de propensas que los hombres de la verdad, golpea,
abofetea o físicamente de otra manera asalto a su pareja, y que tales
asaltos relativamente menores a menudo aumentan la más grave
asaltos. Agresiones leves cometidas por mujeres son también un
problema importante, incluso cuando no provocar lesiones, ya que
sitúan a las mujeres en peligro de represalias mucho más severas por
los hombres. Se argumentó que, en golpear a la esposa a fin determinar,
es esencial que las mujeres también para poner fin a lo que muchos
consideran un patrón de "inofensivos" de bofetadas, patadas, o tira las
cosas en una pareja masculina. Strauss también toma nota de que los
datos confirman que las mujeres pueden ser violentas han sido
suprimidas porque los datos contradicen los prejuicios que los hombres
son responsables de la mayoría o la totalidad de violencia doméstica.

Las razones dadas para no reportar los incidentes de violencia

doméstica en los hombres

El informe de 2000 de los CDC, basado en entrevistas telefónicas con

8000 hombres y 8000 mujeres, informó que el 7,5% de los hombres
afirman haber sido violadas o asaltado por un ambiente íntimo en algún
momento de su vida útil (en comparación con el 25% de mujeres) y 0,9
por ciento de los hombres afirman haber sido violados o asaltados en
los últimos 12 meses (frente al 1,5% de las mujeres).

El informe de CDC, (2007-2008) de la encuesta de las experiencias y la

salud de los hombres que sufrieron la violencia de pareja en el último
año. El estudio mostró que las víctimas masculinas de maltrato son muy
reacias a denunciar la violencia o buscar ayuda. Las razones dadas para
la no presentación de informes o reportaron el abuso domestico fueron:
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se avergüence a presentar;
no puede ser creída, y
puede ser acusado de ser un abusador cuando vienen hacia adelante.

Los hombres heterosexuales en EE.UU. 229, entre 18 y 59, había sido

asaltado físicamente por su pareja femenina en años anteriores y no
buscar ayuda. Los investigadores dicen que sus descubrimientos
destacan la necesidad de la prevención en todos los niveles:

Hay muchas razones por las que no sabemos más acerca de la violencia
doméstica y la violencia contra los hombres. Hay una serie de
interacciones de frecuencia en la que estalla la violencia contra los
hombres. He aquí un ejemplo que ilustra una dinámica común.

El esfuerzo de hombre a permanecer impasible

La mujer es ligeramente angustiada y molesta. Los anuncios de hombre

de su malestar y preocupación que puede enojarse. La mujer trata de
comunicarse y hablar de sus sentimientos. Ella quiere hablar, se
sienten apoyados y sentirse menos solo. Que inicialmente algunos de
los atributos de su angustia o problemas con él. El hombre empieza a
sentirse a la defensiva, se apaga emocional y los intentos de resolver los
problemas de manera racional. Se siente una pelea se acerca. La mujer
se siente desamparada, ignorado y luego se enfada. Ella quiere que él
para compartir el problema y que no se siente que tiene un problema.
El hombre tratará de permanecer impasible y permanecer en
control de él
Se evita la aceptación de cualquier culpa de cómo se siente. Él también
está preocupado de que puede explotar en cualquier momento y que
seguramente lo hará si habla de sus sentimientos. El hombre se empieza
a hablar de su problema como si pudiera sentir mejor si se decidiera a
escuchar a él y dejar de actuar tan molesto. Él no entiende cómo se

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siente y trata de mantener la calma. Él le dice a calmarse y termina
mirando insensible. Ella comienza a preguntarse si tiene algún
sentimiento. Ella le dice que él piensa que él es perfecto. Él dice que no
es perfecto. Ella lo llama insensible. La mira y no dice nada, pero se ve
irritada.

La mujer se siente frustrado de que no se revelan sus sentimientos y

que actúa como él está en control. Por otro lado, el hombre se siente
fuera de control y como no hay lugar para los sentimientos de nadie en
la conversación, pero la de ella. La comunicación se rompe y la mujer
empieza a insultar al hombre. Cuando el hombre finalmente expresa su
desaprobación y los intentos de poner fin a la lucha. La mujer se
enfurece y puede arrojar algo. El hombre suele sufrir los insultos y las
interacciones así por semanas o meses. Este patrón se convierte en un
conjunto de periódicos y toda la experiencia demasiado familiar. El
hombre se vuelve cada vez más sensible a cómo la mujer los actos y se
convierte en evitación y poco favorable. El hombre empieza a creer que
no hay nada que pueda hacer y que puede ser su culpa entera. Su
frustración y la ira pueden crear durante meses como este.

La puerta se ha abierto a la violencia.

Este riesgo de violencia aumenta cuando la mujer insulte al hombre

delante de sus hijos, amenaza a la relación del hombre con sus hijos, o
se niega a controlar su conducta abusiva cuando los niños están
presentes. Se le puede llamar a un padre terrible, o un
marido terrible delante de los niños. Finalmente, se siente indignado no
sólo por cómo lo trata, pero ¿cómo su comportamiento está
perjudicando a los niños. En algún punto el hombre puede tirar algo,
ponche de una pared, o golpe con el puño con fuerza para desahogar su
ira y para comunicar que ha llegado a sus límites. Hasta ahora nunca
se ha escuchado lo que tenía que decir. Él decide que tal vez ella no se
detendrá si se puede ver qué tan furioso que se ha convertido. En lugar
de reconocer que ha llegado a sus límites, expresar su enojo físicamente
tiene el efecto contrario.

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El hombre ha tratado de ocultar su enojo

Durante mucho tiempo el hombre ha tratado de ocultar su enojo. ¿Por

qué creen que la mujer que realmente quiere decir esto? Después de
todo, que ha colocado con su abuso por un largo tiempo sin hacer nada.
En vez de darse cuenta de que las cosas han salido de control, la mujer
puede acercarse a él y decir algo como, "¿Qué vas a hacer? ¿Hit me?
Adelante. Llamaré a la policía y nunca verás a tus hijos”.

Una vez que expresó su enojo físicamente, la situación se volvió

peligrosa para él y para ella. La puerta se ha abierto a la violencia de
ancho. Se debe a pie. Cuando lo hace a pie, termina más enojado que
nunca, se grita obscenidades a él y golpearle repetidamente. Incluso
puede pegarle con un objeto.

El abuso doméstico y violencia contra los hombres

Hay muchas razones por las que no sabemos más acerca de la violencia
doméstica contra los hombres. En primer lugar, la incidencia de
violencia doméstica denunciados varones parece ser tan bajo que es
difícil obtener estimaciones fiables. Además, se ha tomado años de
actividades de promoción y apoyo para alentar a las mujeres a
denunciar la violencia doméstica. Prácticamente nada se ha hecho para
alentar a los hombres a reportar el abuso. La idea de que los hombres
pueden ser víctimas de violencia doméstica es tan impensable que
muchos hombres ni siquiera se intentan denunciar la situación.

La dinámica de la violencia doméstica y la violencia también es diferente

entre hombres y mujeres. Las razones, los propósitos y motivaciones
son a menudo muy diferentes

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entre los sexos. Aunque la consejería psicológica y la comunidad han
respondido a la violencia doméstica y la violencia contra la mujer, ha
habido muy poca inversión de recursos para atender y entender los
problemas de violencia doméstica y la violencia contra los hombres. En la
mayoría de los casos, el daño físico causado por los hombres es mucho
mayor que el daño físico real modulada por las mujeres. El impacto de la
violencia doméstica es menos aparente y propenso a llegar a la atención
de los demás cuando se abusa de los hombres. Por ejemplo, se supone que
un hombre con un golpe o el ojo negro estaba en una pelea con otro
hombre o se lesionan en el trabajo o en deportes de contacto. Incluso
cuando los hombres no informar de abusos y la violencia doméstica, la
mayoría de la gente está tan asombrado por lo general los hombres
terminan sintiéndose como nadie les cree.

El problema con supuestos sobre el abuso doméstico y la violencia

Es una presunción generalizada de que las mujeres son siempre las

víctimas y los hombres son siempre los culpables. Entre el 50 y el 60% de
todos los abusos y la violencia doméstica es contra las mujeres. Hay
muchas razones por que la gente asume que los hombres nunca son
víctimas y por qué las mujeres suelen ignorar la posibilidad. Por un lado,
la violencia doméstica y la violencia han sido minimizadas, justificada e
ignorada durante mucho tiempo. Las mujeres son ahora más organizada,
solidaria y abierta acerca de la epidemia de violencia doméstica y la
violencia contra la mujer. Muy poca atención se ha prestado a la cuestión
de la violencia doméstica y violencia contra los hombres - sobre todo
porque la violencia contra las mujeres ha sido tan evidente y ha sido
ignorada durante tanto tiempo.

¿Qué es el abuso doméstico y violencia contra los hombres?

No hay reglas absolutas para la comprensión de las diferencias

emocionales entre hombres y mujeres. Hay principios y las dinámicas que
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permiten la interpretación de las situaciones individuales. El abuso
doméstico y la violencia contra los hombres y las mujeres tienen algunas
similitudes y diferencias. Para los hombres o mujeres, la violencia
doméstica incluye empujones, bofetadas, golpes, tirar objetos, obligando a
cerrar una puerta o golpear a la otra persona con un objeto, o usar un
arma.

El abuso doméstico también puede ser mental o emocional. Sin embargo,

lo que va a herir a un hombre mental y emocionalmente, en algunos casos
puede ser muy diferente de lo que duele una mujer. Para algunos hombres,
ser llamado un cobarde, impotente o un fracaso puede tener un impacto
psicológico muy diferente de lo que en las mujeres. Poco amable y las
crueles palabras duelen, pero puede hacer daño de diferentes maneras y
persisten en diferentes formas. En la mayoría de los casos, los hombres
son más profundamente afectados por el abuso emocional que el maltrato
físico. Por ejemplo, la capacidad de tolerar y "sacudir" un asalto físico de
las mujeres frente a otros hombres en algunos casos pueden tranquilizar
a un hombre que es fuerte y comunicar a otros hombres que pueden vivir
hasta el código de no golpear a una mujer.

Un número significativo de los hombres son demasiado sensibles a abuso

emocional y psicológico. En algunos casos, un hombre emocionalmente
humillante delante de otros hombres puede ser más devastadores que el
abuso físico. Algunos profesionales han observado que el abuso mental y
emocional puede ser un área donde las mujeres son a menudo "brutal"
que los hombres. Los hombres en cambio son más rápidos que recurrir al
abuso físico y son más capaces de agresiones físicas que son más brutales
- incluso mortales.

¿Por qué el abuso doméstico contra los hombres no se reconoce?

La violencia doméstica contra los hombres no se reconoce por las

siguientes razones:
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La incidencia de la violencia doméstica contra los hombres parece ser tan
bajo que es difícil obtener estimaciones fiables.
Se ha tomado años de actividades de promoción y apoyo para alentar a las
mujeres a denunciar la violencia doméstica. Prácticamente nada se ha
hecho para alentar a los hombres a reportar el abuso.
La idea de que los hombres pueden ser víctimas de violencia doméstica y
la violencia es tan impensable para la mayoría de la gente que muchos
hombres ni siquiera se intenta denunciar la situación.
El asesoramiento psicológico y de la comunidad han respondido a la
violencia doméstica y la violencia contra la mujer. No ha hecho lo
suficiente para detener el abuso contra la mujer. Ha habido muy poca
inversión de recursos para abordar las cuestiones de violencia doméstica
y la violencia contra los hombres. En la mayoría de los casos, el daño físico
causado por los hombres es mucho mayor que el daño físico real modulada
por las mujeres. El impacto de la violencia doméstica es menos aparente
y propenso a llegar a la atención de los demás.
Aun cuando los hombres no informar de abusos y la violencia doméstica,
la mayoría de la gente está tan asombrado, los hombres suelen terminar
sintiéndose como nadie les creyó. Es generalmente admitido que un
hombre con un golpe o el ojo negro estaba en una pelea con otro hombre
o se lesionan en el trabajo o mientras se practican deportes de contacto.
Las mujeres no suelen hacer esas cosas.

Muros de Silencios

Es particularmente difícil para los hombres revelar que fueron

sexualmente atacados. Nuestra sociedad nos condiciona a creer que los
hombres deben estar siempre “en control”: de sus emociones, de otras
personas y de su entorno. Se les enseña a definirse a sí mismos como
hombres por el grado al que puedan alcanzar con éxito este control. Como
consecuencia, la mayoría de los hombres no cree que será una “víctima”,
y especialmente no en el terreno sexual. Cuando esto ocurre a menudo

83
provoca un fuerte choque emocional, siendo algo tan alejado de la
experiencia normal de los hombres.

No sólo es difícil para los hombres aceptar el ser sexualmente atacados,

sino también común que vivan en silencio, ya que las reacciones de otras
personas aumentan la sensación de ser victimizados. Al igual que al
sobreviviente le resulta difícil creer lo que le ha ocurrido, también otras
personas responden con incredulidad. Si un hombre revela que fue
abusado sexualmente, a menudo se le castiga aún más cuando su
“hombría” y orientación sexual son cuestionadas

Las características de los hombres o las mujeres que son abusivos

caen en tres categorías.

Abuso de Alcohol. El abuso de alcohol es una causa importante y

desencadenar la violencia doméstica. La gente, que están intoxicadas tiene
menos control de impulsos, se frustran fácilmente, tienen más
malentendidos y son generalmente propensos a recurrir a la violencia
como solución a los problemas. Las mujeres que hombres malos tratos
son a menudo alcohólicos.

Trastornos psicológicos. Hay ciertos problemas psicológicos,

principalmente trastornos de la personalidad, en la que las mujeres se
caracterizan por ser abusivo y violento hacia los hombres. Trastorno de
personalidad limítrofe es un diagnóstico que se encuentra casi
exclusivamente con mujeres. Aproximadamente de 1 a 2 por ciento de
todas las mujeres tienen un trastorno límite de la personalidad. Al menos
el 50% del total de la violencia doméstica y la violencia contra los hombres
está relacionado con la mujer que tiene un trastorno límite de la
personalidad. El trastorno también está asociado con la conducta suicida,
cambios de humor severos, la mentira, problemas sexuales y el abuso de
alcohol.

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Las expectativas poco realistas, las hipótesis y conclusiones. Las mujeres
que son abusivas hacia los hombres suelen tener expectativas poco
realistas y hacer demandas poco realistas de los hombres. Estas mujeres
normalmente experimentan episodios repetidos de depresión, ansiedad,
frustración e irritabilidad que atribuyen a la conducta de un hombre. De
hecho, su estado mental y emocional es el resultado de sus propias
inseguridades, problemas emocionales, y el trauma durante la infancia o
incluso la retirada del alcohol. Se culpa a los hombres en lugar de admitir
sus problemas, asumir la responsabilidad de cómo viven su vida o hacer
algo sobre cómo se hacen miserable. Se niegan a entrar en tratamiento y
pueden incluso insisten en que el hombre necesita tratamiento.

En lugar de ayudarse a sí mismas, culpan a un hombre por lo que sienten

y creen que un hombre debe hacer algo para sentirse mejor. A menudo se
dedican a sus emociones con el alcohol. Cuando los hombres no pueden
hacer sentir mejor, estas mujeres se frustran y se supone que los hombres
están haciendo a propósito.

Además, incluso cuando los informes de abuso doméstico y la violencia

contra los hombres, la mayoría de la gente es incrédula de este tipo de
abuso por factores culturales; los hombres suelen terminar sintiéndose
como nadie les cree. Prácticamente nada se ha hecho para alentar a los
hombres a reportar el abuso. La idea de que los hombres pueden ser
víctimas de abuso doméstico es tan “inconcebible” que muchos hombres
ni siquiera se intentan denunciar la situación.

Aunque la consejería psicológica y la comunidad internacional

respondieron a la violencia doméstica contra la mujer, ha habido poca
inversión en recursos para atender y entender las cuestiones de violencia
doméstica contra los hombres. Este es un grave problema social y un
comportamiento aprendido reforzado por la cultura machista.

85
Bibliography and References:
Markowitz, Sara. "The Price of Alcohol, Wife Abuse, and Husband Abuse."
Southern Economic Journal. 67 no2 279-303 O 2000
Dutton, Donald G. (1994) Patriarchy and Wife Assault: The Ecological
Fallacy. Violence and Victims, 1994, 9, 2, pp. 125–140.
Tjaden and Thoennes 2000
Green, Nicholas St. John. 1879. Criminal Law Reports: Being Reports of
Cases Determined in the Federal and State Courts of the United States,
and in the Courts of England, Ireland, Canada, etc. with notes. Hurd and
Houghton.
Dutton, 1994
Strauss, 2005
Archer, 2000
Straus, Murray A.” State-to-state differences in social inequality and social
bonds in relation to assaults on wives in the United States." Journal of
Comparative Family Studies. 25 (1994): 7-24.
Deal, J. E., & Wampler, K. S. (1986). Dating violence: The primacy of
previous experience. Journal of Social and Personal Relationships, 3, 457-
471.
National Family Violence Survey, 2000,
http://www.ncjrs.gov/pdffiles1/nij/183781.pdf
Violence-Related Injuries Treated in Hospital Emergency Departments,
August 1997.
Robertson, Kirsten. Murachver, Tamar.” Attitudes and Attributions
Associated with Female and Male Partner Violence." Journal of Applied
Social Psychology v. 39 no.7 (July 2009) p. 481-512
Wallace, Harvey (2004). Family Violence: Legal, Medical, and Social
Perspectives. Allyn & Bacon

86
El impacto del uso de tabaco en
Estados Unidos y
el consumo de tabaco en la
comunidad Hispana
La adicción al uso del tabaco y el sentimiento de placer

“La nicotina activa el circuito del cerebro que regula los sentimientos de
placer. Una de las sustancias químicas clave en el cerebro implicada en el
deseo de consumir la droga es la dopamina, un neurotransmisor”.

El tabaco mata casi medio millón de personas cada ano en Estados

Unidos. Fumar hace daño a casi todos los órganos del cuerpo, causando
enfermedades y comprometiendo la salud del fumador. De acuerdo con
una reciente encuesta nacional sobre el uso de drogas y la salud (NSDUH)
alrededor de 70.3 millones de americanos mayores de 12 años informaron
haber usado tabaco por lo menos una vez. De estos, 59.9 millones, que
representa el 24.9% de la población, eran fumadores de cigarrillos, 13.7
millones de puros o cigarros, 1.8 millones de pipa, mientras que 7.2
millones usaron tabaco sin humo. Estos datos confirman que el tabaco es
una de las sustancias de más consumo y abuso en Estados Unidos. La
comunidad Hispana es afectada por esta adicción y muy poca reflexión del
uso y abuso del cigarrillo se ha tomado en cuenta para prevenir la adicción
y muertes asociadas a esta adicción que afecta a hombres, mujeres y
especialmente a jóvenes Hispanos-americanos. La falta de programas
bilingües de prevención se refleja en el alto consumo de tabaco entre los
jóvenes hispanos. El propósito es educar y prevenir a la comunidad sobre
los efectos de la Nicotina y los componentes adictivos en el cigarrillo.

87
La nicotina, es uno de los componentes en el tabaco, y es la razón principal
de su poder adictivo, aunque el humo del cigarrillo contiene muchas otras
sustancias químicas peligrosas, entre ellas el alquitrán, el monóxido de
carbono, el acetal debido y las nitrosaminas.

El tabaco es la causa principal de muertes prevenible en los Estados

Unidos. El impacto a la sociedad por el uso de tabaco en términos de costo
de morbilidad y mortalidad es asombroso. Económicamente, cada ano los
costos en cuidados de salud alcanzan a $75 mil millones directamente
mente atribuidos al consumo del tabaco.

Los efectos del tabaco en los fumadores.

Hay más de 4,000 sustancias químicas en el humo de los productos de

tabaco. De estas la nicotina, descubierta a principios del siglo XIX, es el
componente primario de refuerzo que actúa en el cerebro. Recientemente
se ha visto un aumento en la venta y consumo de productos de tabaco sin
humo, tal como el rape y el tabaco de mascar. Estos productos sin humo
también contienen nicotina, así como muchas otras sustancias químicas
toxicas.

El cigarrillo es un sistema de alta ingeniería con un diseño eficiente de

suministro de la droga. Al inhalar el humo del tabaco el fumador promedio
consume entre 1 y 2 mg de nicotina por cigarrillo. Cuando se fuma el
tabaco, la nicotina llega rápidamente a sus niveles máximos en el torrente
sanguíneo y penetra el cerebro. En un promedio de 5 minutos un fumador
típico le da unas 10 aspiradas a un cigarrillo encendido. Por lo tanto, una
persona que fuma alrededor de un paquete y medio (30 cigarrillos) al día,
le da unos 300 golpes diarios de nicotina al cerebro.

88
Inmediatamente después de estar expuesto a la nicotina, hay un estímulo
inmediato causado en parte por la acción de la droga sobre las glándulas
adrenales que resulta en una descarga de epinefrina (adrenalina). El Rush,
es decir, la sensación inicial intensa debido a la adrenalina estimula al
cuerpo y causa una descarga súbita de glucosa, así como un aumento en
la presión arterial, la respiración y la frecuencia cardiaca. La nicotina
también suprime la producción de insulina del páncreas, lo que significa
que los fumadores siempre están un poco hiperglucémicos; es decir, tienen
niveles elevados de azúcar en la sangre. El efecto calmante reportado por
los usuarios generalmente está asociado más con la disminución que con
los efectos directos de la nicotina en sí.

La Nicotina es adictiva

La nicotina es adictiva, y la mayoría de los fumadores utilizan el tabaco

regularmente es porque están adictos a la Nicotina. La adición se
caracteriza por la búsqueda y el uso compulsivo de la droga., a pesar de
las consecuencias negativas para la salud. Cada ano casi 35 millones de
fumadores tratan de romper el habito, pero menos el 6 % de ellos logran
abstenerse por más de un mes. Las investigaciones y estudios muestran
como la nicotina actúa sobre el cerebro para producir varios efectos. De
importancia primordial con relación a su naturaleza adictiva están los
hallazgos que indican que la nicotina, activa el circuito del cerebro que
regula los sentimientos de placer, también conocidos como vías
gratificación, Una de las sustancias químicas clave en el cerebro implicada
en el deseo de consumir la droga es la dopamina, que es un
neurotransmisor.

Las investigaciones han demostrado que la nicotina aumenta los niveles

de dopamina en los circuitos de gratificación. Esta reacción es similar a la
que se observa con otras drogas y se cree que es la causa de las
sensaciones placenteras que sienten muchos fumadores. Las propiedades

89
farmacocinéticas de la nicotina también aumentan el potencial para su
abuso y adicción.

Cuando se fuma un cigarrillo, hay una distribución rápida en el cerebro.,

llegando la nicotina a su nivel máximo al cerebro en 10 segundos de
inhalada. Sin embargo, los efectos agudos de la nicotina se disipan en
unos minutos juntamente con los sentimientos placenteros asociados, lo
que hace que el fumador continúe dosificándose repetidamente durante el
día para mantener efectos placenteros de la droga y evitar el síndrome de
abstinencia.

El Síndrome de Abstinencia

Entre los síntomas de abstinencia de la nicotina se encuentran la

irritabilidad, los deseos vehementes por la droga, un déficit cognitivo y de
atención; las perturbaciones en el sueño y el aumento del apetito. Estos
síntomas pueden comenzar a las pocas horas después de haber fumado el
ultimo cigarrillo, produce el deseo que la persona vuelvan a fumar.

El síndrome de la abstinencia está relacionado con los efectos

farmacológicos de la nicotina, muchos factores conductuales también
pueden afectar la severidad de los síntomas de la abstinencia. Para
algunas personas, el hecho de sentir, oler o mirar el cigarrillo, así como el
rito de obtener, manipular, encender y fumar el cigarrillo, están asociados
con los efectos placenteros de fumar y pueden empeorar los síntomas del
syndrome de abstinencia o los deseos por fumar.

90
91
The new trends in the women
consumption of drugs, alcohol and
tobacco in the Era of Globalization

Changing rapidly and consequent repercussions in new trends in the

women consumption of drugs, alcohol and tobacco in the United States.

Entering the world of globalization and the twenty-first century has

brought great changes in the 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 drugs, alcohol and tobacco
consumption and is evident, the female drugs 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, economic, 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, the
sons and daughters, young single mothers and the social pressure and
stress.

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Today, we live in a world which is changing rapidly and in continuation. A
deeper 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, music-style influence, with the
consequent repercussions in new trends in the consumption of drugs,
alcohol and tobacco.

Going through the literature, one has the impression that the theoretical
reflections on the process of female identification do not keep up with the
personal and psychopathological and sociologist aspects. Above all, this is
true in connection with the phenomena of drugs, alcohol and tobacco
addiction where the epidemiological importance of women undoubtedly
represents a part of the problem which cannot be ignored.

Indeed, when a problem of drug abuse becomes evident, the female drug,
alcohol, and tobacco consumption appears in a condition of greater
vulnerability than the male and is more seriously exposed to risks for her
health and physical integrity. An addict is a person whose life is controlled
by drugs in different of levels. This condition, which is already at a
disadvantage, is made worse by the fact that the system of the social-
health services for treatment and rehabilitation does not seem to take this
factor sufficiently into consideration by underestimating her specific needs
and therefore proposing protocols of intervention that are the same as the
males. The addicts are people in the grip of a continuing and progressive
illness whose ends are always the same: jails, institutions, and death.
Perhaps female addict that admit that have a problem with drugs, but you
don’t consider their self an addict.

All of us have preconceived ideas about what an addict is. There is nothing
shameful about being an addict once you begin to take positive action, but
in female identity is a condition of greater vulnerability than the male as

93
cultural changes such as lifestyle with the consequent repercussions than
the male.

The fact that the female drug, alcohol and tobacco 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 study of drug abuse by women, the phases of the menstrual cycle are
rarely considered. The menstrual cycle has dramatic effects on a woman’s
body, and nevertheless 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 of choice.
(Alcohol, tobacco, cocaine, heroin, others). Although people often use
drugs, high rates of anxiety and depression occur more frequently in
women of childbearing age, yet psychotropic drugs are not studied
adequately in the younger female population.[1] Changes during phases of
the menstrual cycle 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. [2] Women’s
decrements of liver function are different from men’s[3].

However, 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. [4]

94
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 drugs, alcohol and tobacco 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]

The female identity plays important role to understand of certain social

psychological aspects, 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.

The 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. The 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.

There is growing evidence according the researchers that the effects of

alcohol, tobacco and drugs abusers and addiction impact women in the
different manner of their lives: psychosocial, biological mechanisms,
behavioral responses, progression and developmental stages, sexual
abuse, victimization, pregnant women, the co-morbidity, the recruitment-
retention, and the treatment outcomes.
The psychosocial 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

95
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.
The behavioral responses studies have shown that fundamental gender
differences may exist in the reinforcing and stimulus properties of abused
drugs. On measures of stimulant-induced activity, females exhibit more
responsiveness than males; moreover, this responsiveness varies with the
estrus cycle.
The progression studies show that the developmental stages of drugs are
not identical for males and females. In the progression from legal drugs
use to illicit drugs consumption, for example, cigarettes have a relatively
larger role for females than for males, and alcohol has a relatively larger
role for males than for females; with regard to initiation into illicit drugs,
data suggest that women are more likely to begin or maintain cocaine use
in order to develop more intimate relationships, while men are more likely
to use the drug with male friends and in relation to the drug trade. The
onset of drug abuse is later for females and the paths are more complex
than for males. For females there is typically a pattern of breakdown of
individual, familial, and environmental protective factors and an increase
in childhood fears, anxieties, phobias, and failed relationships; the etiology
of female drug abuse often lies in predisposing psychiatric disorders prior
to abusing drugs.
The sexual abuse and childhood sexual abuse has been associated with
drug abuse in females in several studies. Some studies indicate that up to
70% of women in drug abuse treatment report histories of physical and
sexual abuse with victimization beginning before 11 years of age and
occurring repeatedly. A study of drug use among young women who
became pregnant before reaching 18 years of age reported that 32% had a
history of early forced sexual intercourse: rape or incest. These
adolescents, compared with non-victims, used more crack, cocaine, and
other drugs, had lower self-esteem.
The victimization in female drug abusers may have greater vulnerability to
victimization than males. For example, in a recent study of homicide in
New York City, 59% of white women and 72% of African American women

96
had been using cocaine prior to death compared with 38% of white males
and 44% of African American males. Thus, while cocaine is used by more
males than females, its use is a far greater risk factor for victimization for
women than men. It is, therefore, critical that the factors involved in the
relationship between drug abuse and dependence among females, and
physical and sexual victimization.
The pregnant women are an aspect of drug abuse by women that is of
particular concern is the use of drugs during pregnancy. Research
indicates that pregnant drug users are at increased risk for miscarriage,
ectopic pregnancy, stillbirth, low weight gain, anemia, thrombocytopenia,
hypertension and other medical problems. The National Pregnancy &
Health Survey was conducted by NIDA estimate of the number of women
who use licit and illicit drugs during pregnancy, approximately 4 million
women who deliver live-born children annually in the United States, 5.5%
or 221,000 women are projected to have used some illicit drug during
pregnancy.
The co-occurring substance abuse disorder and other psychiatric
disorders are relatively high for females. Data from a study on female crime
victims, for example, indicate that those suffering from post-traumatic
stress disorder (PTSD) were 17 times more likely to have major drug abuse
problems than non-victims. For females a high correlation appears to exist
between eating disorders and substance abuse. For example, as many as
55% of bulimic patients are reported to have drug and alcohol use
problems. Conversely, 15-40% of females with drug abuse or alcohol
problems have been reported to have eating disorder syndromes, usually
involving binge eating.
The retention, women who abuse drug and alcohol faces a variety of
barriers including barriers to treatment entry, to engagement in treatment,
and, long-term recovery. In addition, barriers to entry include a lack of
economic resources, referral networks, women-oriented services, and
conflicting child-related responsibilities. Because women have many
specific needs, a number of components of treatment have been found to
be important in attracting and retaining women in treatment. These
include the availability of female-sensitive services, non-punitive and non-
coercive treatment that incorporates supportive behavioral change
97
approaches, and treatment for a wide range of medical problems, mental
disorders, and psycho-social problems.
Finally, the treatment outcomes, a recently national study of individuals
in drug abuse treatment programs, showed that women who had at least
28 days of treatment, with at least 14 days in short-term inpatient; had
sharp reductions in their use of illicit drugs, HIV risk behavior, and illegal
activities. For instance, at intake 84 % of the women who were admitted
to long-term residential treatment programs admitted at intake using
illegal drugs every day or at least once a week. Twelve months after
treatment, only 28% continued to abuse drugs. Short-term inpatient
treatment women also showed significant reductions in illegal drug use a
year after their treatment with 86% admitting use at intake and 32%
reporting use after one year.
The 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. The group size, unanimity, cohesion, status, and prior
commitment all help to determine the level of conformity in an individual.
The 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 the 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 there
by 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.[6] 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 one-self by doing the opposite of what is
expected. This phenomenon is also known as anti-conformity and it
appears to be more common in men than in women. The differences
between man and woman have their origins in an obvious sexual
dimorphism[7]. The majority of cultures have established a differentiation

98
of social roles 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, in more advanced societies, collaborates in the perpetuation of
this dichotomy of roles.

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 effect 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,
workplace, 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 drugs and alcohol consumption, it is necessary to enter the more
social terrain where the conditions of individual identity are established.

99
In my professional sociological view, 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 has
been changed rapidly and consequent repercussions in new trends in the
consumption of drugs. Era of globalization[8] 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.

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.

I want to point two important 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

100
the Centre of their lives. In our societies, masculine values are not only
being perpetuated but 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 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.[9] In my professional opinion 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.

In the second place, other women 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 consumption of drugs and drug and alcohol
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 alcohol, tobacco and drugs, the development of
drug dependency and its consequences. The majority of the researchers,
who have studied women addicts, find significant differentiation basics
between men and women drug addiction.

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

101
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 addiction 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 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

102
not supported and that most of the time is hidden. According to the Center
for Substance Abuse Treatment -1992- (CSAT) 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. The 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 and
tobacco consumption are 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

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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 and
tobacco 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.
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. 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; appropriate services for women; and drug abuse,
drinking rituals and tobacco patterns.

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El abuso a las drogas y la adición y
sus efectos en el sistema
neurotransmisores
La carga pesada en la familia hispana en Estados Unidos

El abuso de drogas legales e ilegales y la violencia están aumentando en

la familia Hispana en los Estados Unidos, de la misma forma que sucede
en la mayoría de las culturas. La falta de recursos y las actitudes
culturales contribuyen al problema. La comunidad Hispana inmigrante
frecuentemente recibe menos atención o atención inadecuada, requiere
educación y programas de apoyo para percibir una mejoría. Esta epidemia
de drogadicción en los jóvenes y adultos de la comunidad hispana en los
Estados Unidos se viene percibiendo acentuadamente, en las escuelas, los
barrios hispanos, la violencia juvenil-pandillas, la venta y consumo de
drogas callejera, están contribuyendo a la fragmentación de la familia
latina.

Los Estados Unidos ha cambiado en los últimos 30 años y se ha convertido

en una nación con una fuerte presencia de diversidades étnicas, política y
culturalmente ha tenido grandes cambios. Pero paralelamente a ello la
plaga de drogadicción ha tocado a jóvenes y adultos como una salida a los
problemas de la vida cotidiana, el estrés, el desempleo, el miedo a la
soledad. Esta es una epidemia que toca a todas las familias y a las diversas
comunidades atravesando las fronteras y sectores sociales. La gente a
menudo no se da cuenta de lo compleja que es la drogadicción y que ésta
es una enfermedad que impacta el cerebro. Por esta razón, dejar de abusar
de las drogas no se trata simplemente de tener fuerza de voluntad. Gracias
a los avances científicos, ahora sabemos con mucha más exactitud cómo
las drogas trabajan en el cerebro y también sabemos que la drogadicción
sí se puede tratar exitosamente, ayudando así a que el toxicómano deje de
abusar de las drogas y vuelva a tener una vida productiva.

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El abuso de drogas y la adición son una carga pesada para la sociedad.

Según algunos cálculos, el costo total del abuso de sustancias en los

Estados Unidos, incluyendo costos relacionados a la salud y al crimen, así
como la pérdida de productividad, excede el medio billón de dólares
anuales. Esta cifra incluye aproximadamente $181 mil millones por drogas
ilícitas, $168 mil millones por tabaco y $185 mil millones por alcohol. A
pesar de lo abrumadoras que son estas cifras, no logran ilustrar
cabalmente el verdadero impacto del abuso de drogas y de la drogadicción
sobre la salud pública, el que incluye la desintegración de la familia, la
pérdida del empleo, el fracaso en la escuela, la violencia doméstica, el
abuso infantil y otros crímenes.
¿Qué es la adición?
La adición es una enfermedad crónica del cerebro, a menudo con recaídas,
caracterizada por la búsqueda y el uso compulsivo de drogas a pesar de
las consecuencias nocivas para el adicto y para los que le rodean. La
drogadicción se considera una enfermedad del cerebro porque el abuso de
drogas produce cambios en la estructura y en el funcionamiento del
cerebro. Si bien es cierto que en el caso de la mayoría de las personas la
decisión inicial de tomar drogas es voluntaria, con el tiempo los cambios
en el cerebro causados por el abuso repetido de las drogas pueden afectar
el autocontrol y la habilidad del usuario para tomar decisiones sensatas,
al mismo tiempo que envían impulsos intensos de usar drogas.
Debido a estos cambios en el cerebro es muy difícil para el adicto lograr
dejar de abusar de las drogas. Afortunadamente hay tratamientos que
ayudan a contrarrestar los efectos poderosamente destructores de la
adicción y a recuperar el control. Las investigaciones demuestran que para
la mayoría de los pacientes el mejor método de asegurar el éxito es una
combinación de medicamentos para tratar la adicción, cuando los hay,
con la terapia conductual. Se puede lograr una recuperación sostenida y
una vida sin abuso de drogas usando enfoques diseñados específicamente
para tratar el patrón de abuso de drogas especifico de cada paciente
juntamente con cualquier problema médico, psiquiátrico o social
concurrente.

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Al igual que muchas otras enfermedades crónicas con recaídas, como la
diabetes, el asma o las enfermedades del corazón, la drogadicción puede
tratarse exitosamente. De manera parecida a otras enfermedades crónicas,
es común que haya recaídas y que el drogadicto comience a usar drogas
nuevamente. Estas recaídas, sin embargo, no significan un fracaso. Más
bien son una señal de que se debe reinstaurar o ajustar el tratamiento o
de que es necesario un tratamiento alternativo para que la persona recobre
el control y pueda recuperarse.
¿Qué le pasa al cerebro cuando se usan drogas?
Las drogas son sustancias químicas que infiltran el sistema de
comunicación del cerebro interrumpiendo el envío, la recepción y el
procesamiento normal de información entre las células nerviosas. Hay por
lo menos dos maneras que las drogas pueden hacer esto: 1) imitando los
mensajes químicos naturales del cerebro o 2) sobre estimulando
el “circuito de gratificación” del cerebro.
Algunas drogas, como la marihuana y la heroína, tienen una estructura
similar a la de ciertos mensajeros químicos llamados neurotransmisores,
que el cerebro produce de manera natural. Debido a esta semejanza, estos
tipos de drogas pueden “engañar” a los receptores del cerebro, logrando
activar las células nerviosas para que envíen mensajes anormales.
Otras drogas
Otras drogas, como la cocaína o la metanfetamina, pueden hacer que las
células nerviosas liberen cantidades exageradas de los neurotransmisores
naturales o pueden bloquear el reciclaje normal de estas sustancias
químicas del cerebro, lo cual es necesario para cortar la señal entre las
neuronas. Esto resulta en un mensaje sumamente amplificado que a su
vez dificulta los patrones normales de comunicación.
Casi todas las drogas, directa o indirectamente, atacan al sistema de
gratificación del cerebro inundándolo con dopamina. La dopamina es un
neurotransmisor que se encuentra en las regiones del cerebro que regulan
el movimiento, las emociones, la motivación y las sensaciones placenteras.
Normalmente, este sistema responde a los comportamientos naturales
relacionados a la sobrevivencia: comer, pasar tiempo con los seres

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queridos, etc.; pero cuando es sobre estimulado por las drogas produce
sensaciones de euforia. Esta reacción inicia un patrón que “enseña” a las
personas a repetir el comportamiento de abuso de drogas.
Cuando una persona continúa abusando de las drogas, el cerebro se
adapta a estas oleadas abrumadoras de dopamina produciendo menos
dopamina o disminuyendo el número de receptores de dopamina en el
circuito de gratificación. Como resultado, el impacto de la dopamina sobre
el circuito de gratificación se ve disminuido, limitando así el placer que el
usuario es capaz de derivar no sólo de las drogas, sino que también de
cosas que anteriormente le causaban placer. Esta disminución obliga al
drogadicto a continuar abusando de drogas en un intento por lograr que
la función de la dopamina regrese a su nivel normal. Sin embargo, ahora
puede que necesite consumir una cantidad mayor de droga a fin de elevar
la función de dopamina a su nivel normal inicial. Este efecto se conoce
como tolerancia.
El abuso a largo plazo también causa cambios en otros sistemas y circuitos
químicos del cerebro. El glutamato es un neurotransmisor que influye
sobre el circuito de gratificación y la habilidad para aprender. Cuando el
abuso de drogas altera la concentración óptima del glutamato, el cerebro
intenta compensar este desequilibrio, lo que puede deteriorar la función
cognitiva. Las drogas de abuso facilitan el aprendizaje subconsciente
(condicionado), lo que hace que el usuario sienta deseos incontrolables de
usar drogas cuando ve un lugar o una persona que asocia con ellas, aun
cuando la droga en sí no está disponible. Los estudios de imágenes del
cerebro de los drogadictos muestran cambios en las áreas del cerebro
esenciales para el juicio, la toma de decisiones, el aprendizaje, la memoria
y el control del comportamiento. En conjunto, todos estos cambios pueden
hacer que el toxicómano se vuelva adicto a las drogas, es decir, que las
busque y las use compulsivamente a pesar de las consecuencias adversas
¿Por qué algunas personas se vuelven adictas a las drogas y otras no?

No hay un solo factor que determine que alguien se vuelva o no drogadicto.

El riesgo de volverse adicto se ve afectado por la constitución biológica de
la persona, el entorno social y la edad o etapa de desarrollo en que se

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encuentra. Mientras más factores de riesgo se tienen, mayor es la
probabilidad de que el abuso de drogas se convierta en adicción. Por
ejemplo:
Biológica: Los genes con los que se nace, en combinación con las
influencias del entorno, son responsables de alrededor de la mitad de la
susceptibilidad a la adicción. El sexo, la etnia y la presencia de otros
trastornos mentales también pueden influir sobre el riesgo para el abuso
de drogas y la drogadicción.
El entorno o medio ambiente: El entorno de cada persona incluye muchos
factores, desde la familia y los amigos hasta el estado socioeconómico y la
calidad de vida en general. Ciertos factores como la presión de los amigos
o colegas, el abuso físico o sexual, el estrés y el papel que juegan los
padres, pueden tener una influencia enorme sobre el curso del abuso de
drogas y la drogadicción en la vida de una persona.
Etapas de desarrollo: Los factores genéticos y ambientales interactúan con
las etapas críticas del desarrollo humano afectando la susceptibilidad a la
adicción, siendo la adolescencia una etapa en que se enfrenta un doble
reto. Si bien el consumo de drogas a cualquier edad puede llevar a la
adicción, mientras más temprano se comienza a consumir drogas, mayor
es la probabilidad de progresar al abuso más serio. Esto se debe a que las
áreas del cerebro que gobiernan la toma de decisiones, el juicio y el auto
control aún se están desarrollando durante la adolescencia, lo que hace
que los adolescentes sean especialmente proclives a comportamientos de
riesgo, lo que incluye la experimentación con las drogas de abuso.
La clave está en la prevención & educación
La adición es una enfermedad prevenible. Los resultados de las
investigaciones han demostrado que los programas de prevención que
involucran a la familia, la escuela, la comunidad y los medios de
comunicación son eficaces para reducir el abuso de drogas. Si bien hay
muchos eventos y factores culturales que afectan la tendencia de abusar
las drogas, cuando los jóvenes perciben al abuso de drogas como
perjudicial, reducen el mismo. Por lo tanto, es necesario ayudar a los
jóvenes y al público en general a comprender los riesgos del abuso de
drogas y continuar promoviendo, a través de los maestros, padres y

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profesionales de cuidados de la salud, el mensaje que la drogadicción se
puede prevenir si la persona se abstiene de comenzar a abusar de las
drogas en primera instancia.

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Substance abuse among teens of
any kind is dangerous Alcohol,
Marijuana, Stimulants,
Depressants, Opiates, Inhalants,
Hallucinogens, PCP

The primary factors that seem to affect increased or decreased drug use
among teens are perceived risk, perceived social approval, and perceived
availability. Perceived availability is often associated with overall social
approval, and so, a drug that’s readily available is considered socially
acceptable and will likely increase in use. There are differences between
drug experimentation, use, abuse, dependency and addiction.
Understanding the degree of drug ingestion by an adolescent is essential
in the intervention process.

In the mind of a young person, the “risk” of using drugs has many
dimensions. Not only do teens consider physical risk, but also emotional,
acting inappropriately, or getting depressed, social/relational, and
aspirational. Physical risks include addiction, while social risks include
disappointing friends or family, and loosing friends. Aspirational risks
include losing a job or getting in trouble with the law.
Persons of all ages can quickly or over a period of time, become victims of
their own negative behavior. Substance abuse becomes substance
dependence. Age, economics, social or ethnic group, peer pressure and
other personal and societal factors often determine a person's choice of
abused substance. It should be remembered that some of the listed signs
of abuse might signify normal behavior variability or health problems.

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Signs are not proof. Conclusions should be based on facts- not on
assumptions.
Substance abuse of any kind is dangerous. In situations where signs and
symptoms seem obvious, it is advisable to bring your observations to the
attention of an appropriate person such as school nurse or counselor-
CASAC, CASAC-T, family member, employee assistance or personnel
liaison or the primary care physician.
Behavior and Symptoms of Teen characteristics associated with substance
abuse
Abrupt changes in work or school attendance, quality of work, work
output, grades, discipline.
• Unusual flare-ups or outbreaks of temper.

• Withdrawal from responsibility.

• General changes in overall attitude.

• Deterioration of physical appearance and grooming.

• Wearing of sunglasses at inappropriate times.

• Continual wearing of long-sleeved garments particularly in hot

weather or reluctance to wear short-sleeved attire when
appropriate.

• Association with known substance abusers.

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 • Unusual borrowing of money from friends, co-workers or
parents.

• Stealing small items from employer, home or school.

Secretive behavior regarding actions and possessions; poorly concealed
attempts to avoid attention and suspicion such as frequent trips to storage
rooms, restroom, basement, etc. Different substances lend themselves to
different groups of symptoms. The most glaring symptom in all cases is a
change, sometimes a radical one, in behavior.
Various factors
There are various factors that must be considered when considering
treatment for substance abuse. Among these factors are:
Age, developmental stage, and maturity

• Values and culture

• Gender

• Co-existing mental disorders. Without the correct treatment for the co-
existing disorders, treatment for addition may not be effective because
these disorders could interfere with the patient's ability to successfully
participate in an addiction treatment program.
Family Factors: Family factors that could increase the patient's risks
should be considered: it is considered important that parents and other
family members play a large role in their family member's treatment.
• Organic syndromes may be a result of substance abuse, or independent
of substance abuse.
Signs characteristic of use of specific substances
• Alcohol

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 • Marijuana
• Stimulants
• Depressants
• Opiates
• Inhalants
• Hallucinogens
• PCP (Angel Dust)
Teenagers abuse a variety of drugs -- legal and illegal
• Alcohol
• Tobacco: Teens who smoke are three times more likely than nonsmokers
to use alcohol, eight times more likely to use marijuana, and 22 times more
likely to use cocaine. Smoking is associated with a host of other risky
behaviors, such as fighting and engaging in unprotected sex.
• Prescribed medications (such as Ritalin, Adderall, and OxyContin)
• Inhalants: Known by such street names as huffing, sniffing and winging,
the dangerous habit of getting high by inhaling the fumes of common
household products is estimated to claim the lives of more than a
thousand children each year. Many other young people, including some
first-time users, are left with serious respiratory problems and permanent
brain damage.
• Over-the-counter cough, cold, sleep, and diet medications (such as
Coricidin)
• Marijuana: About one half of the people in the United States have used
marijuana, many are currently using it, and some will require treatment
for marijuana dependence.
• Stimulants: The possible long-term effects include tolerance and
dependence, violence and aggression, malnutrition due to suppression of
appetite. Crack, a powerfully addictive stimulant, is the term used for a
smokable form of cocaine. In 1997, an estimated 1.5 million Americans,
age 12 and older, were chronic cocaine users.
• Club drugs: This term refers to drugs being used by teens and young
adults at all-night dance parties such as "raves" or "trances," dance clubs,

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and bars. MDMA (Ecstasy), GHB, Rohypnol (Rophies), ketamine,
methamphetamine, and LSD are some of the club or party drugs gaining
popularity. Because some club drugs are colorless, tasteless, and odorless,
they can be added unobtrusively to beverages by individuals who want to
intoxicate or sedate others. In recent years, there has been an increase in
reports of club drugs used to commit sexual assaults.
• Depressants: These are drugs used medicinally to relieve anxiety,
irritability, tension. There is a high potential for abuse and, combined with
alcohol, effects are heightened, and risks are multiplied.
• Heroin: Several sources indicate an increase in new, young users across
the country who are being lured by inexpensive, high-purity heroin that
can be sniffed or smoked instead of injected. Heroin has also been
appearing in more affluent communities.
• Steroids: Anabolic steroids are a group of powerful compounds closely
related to the male sex hormone testosterone. From 1998 to 1999, there
was a significant increase in anabolic steroid abuse among middle-
schoolers.
Signs of Alcohol Abuse
• Odor on the breath.
• Intoxication.
• Difficulty focusing glazed appearance of the eyes.
• Uncharacteristically passive behavior; or combative and
argumentative behavior.
• Gradual (or sudden in adolescents) deterioration in personal
appearance and hygiene.
• Gradual development of dysfunction, especially in job
performance or schoolwork.
• Absenteeism (particularly on Monday).
• Unexplained bruises and accidents.
• Irritability.

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 • Flushed skin.
• Loss of memory (blackouts).
• Availability and consumption of alcohol becomes the focus of
social or professional activities.
• Changes in peer-group associations and friendships.
• Impaired interpersonal relationships (troubled marriage,
unexplainable termination of deep relationships, and alienation
from close family members).

Signs of Marijuana Abuse

• Rapid, loud talking and bursts of laughter in early stages of
intoxication.
• Sleepy or stupor us in the later stages.
• Forgetfulness in conversation.
• Inflammation in whites of eyes; pupils unlikely to be dilated.
• Odor similar to burnt rope on clothing or breath.
• Tendency to drive slowly - below speed limit.
• Distorted sense of time passage - tendency to overestimate
time intervals.
• Use or possession of paraphernalia including roach clip, packs
of rolling papers, pipes or bongs.

Marijuana users are difficult to recognize unless they are under the
influence of the drug at the time of observation. Casual users may show
none of the general symptoms. Marijuana does have a distinct odor and
may be the same color or a bit greener than tobacco.
Signs of Stimulant Abuse
COCAINE, CRACK, CRANK, SPEED, AMPHETAMINES

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 • Dilated pupils (when large amounts are taken).
• Dry mouth and nose, bad breath, frequent lip licking.
• Excessive activity, difficulty sitting still, lack of interest in food or
sleep.
• Irritable, argumentative, nervous.
• Talkative, but conversation often lacks continuity; changes subjects
rapidly.
• Runny nose, cold or chronic sinus/nasal problems, nose bleeds.
• Use or possession of paraphernalia including small spoons, razor
blades, mirror, little bottles of white powder and plastic, glass or
metal straws
Signs of Depressant Abuse
BARBITURATES, TRANQUILIZERS
Symptoms of alcohol intoxication with no alcohol odor on breath
(remember that depressants are frequently used with alcohol).
• Lack of facial expression or animation.
• Flat affect.
• Flaccid appearance.
• Slurred speech.
There are few readily apparent symptoms. Abuse may be indicated by
activities such as frequent visits to different physicians for prescriptions
to treat "nervousness", "anxiety”, “stress", etc.
Signs of Opiate Abuse
What are opiates?
Opiates, sometimes referred to as narcotics, are a group of drugs that are
used medically to relieve pain, but also have a high potential for abuse.
Some opiates come from a resin taken from the seedpod of the Asian
poppy. This group of drugs includes opium, morphine, heroin, and

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codeine. Other opiates, such as meperidine (Demerol), are synthesized or
manufactured. Opium appears as dark brown chunks or as a powder and
is usually smoked or eaten. Heroin can be a white or brownish powder
that is usually dissolved in water and then injected. Most street
preparations of heroin are diluted, or "cut", with other substances such as
sugar or quinine. Other opiates come in a variety of forms including
capsules, tablets, syrups, solutions, and suppositories.
Which opiates are abused?
Heroin ("junk", "smack") accounts for 90 percent of the opiate abuse in the
United States. Sometimes opiates with legal medicinal uses also are
abused. They include morphine, meperidine, paregoric (which contains
opium), and cough syrups that contain codeine [or a synthetic narcotic,
such as dextromethorphan].
What are the effects of opiates?
Opiates tend to relax the user. When opiates are injected, the user feels an
immediate "rush." Other initial and unpleasant effects include
restlessness, nausea, and vomiting. The user may go "on the nod," going
back and forth from feeling alert to drowsy. With very large doses, the user
cannot be awakened, pupils become smaller, and the skin becomes cold,
moist, and bluish in color. Breathing slows down and death may occur.
Does using opiates cause dependence or addiction?
Yes. Dependence is likely, especially if a person uses a lot of the drug or
even uses it occasionally over a long period of time. When a person
becomes dependent, finding and using the drug often becomes the main
focus in life. As more and more of the drug are used over time, larger
amounts are needed to get the same effect. This is called tolerance.
What are the physical dangers?
The physical dangers depend on the specific opiate used, its source, the
dose, and the way it is used. Most of the dangers are caused by using too
much of a drug, the use of unsterile needles, contamination of the drug
itself, or combining the drug with other substances. Over time, opiate
users may develop infections of the heart lining and valves, skin abscesses,
and congested lungs. Infections from unsterile solutions, syringes, and
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needles can cause illnesses approximately 24-72 hours after they begin
and subside within 7-10 days. Sometimes symptoms such as
sleeplessness and drug craving can last for months.
What are the dangers for opiate-dependent pregnant women?
Researchers estimate that nearly half of the women who are dependent on
opiates suffer anemia, heart disease, diabetes, pneumonia, or hepatitis
during pregnancy and childbirth. They have more spontaneous abortions,
breech deliveries, caesarean sections, premature births, and stillbirths.
Infants born to these women often have withdrawal symptoms, which may
last several weeks or months. Many of these babies die.
What treatment is available for opiate addiction?
The four basic approaches to drug abuse treatment are: detoxification
(supervised withdrawal from drug dependence, either with our without
medication) in a hospital or as an outpatient, therapeutic communities
where patients live in a highly structured drug-free environment and are
encouraged to help themselves, outpatient drug-free programs which
emphasize various forms of counseling as the main treatment, and
methadone maintenance which uses methadone, a substitute for heroin,
on a daily basis to help people lead productive lives while still in treatment.
How does methadone treatment work?
Methadone, a synthetic or manufactured drug, does not produce the same
"high" as illegal drugs such as heroin, but does prevent withdrawal and
the craving to use other opiates. It often is a successful treatment for opiate
dependence because it breaks the cycle of dependency on illegal drugs
such as heroin. When patients are receiving methadone in treatment, they
are not inclined to seek and buy illegal drugs on the street, activities that
are often associated with crime. Patients in methadone maintenance
programs also receive counseling, vocational training, and education to
help them reach the ultimate goal of a drug-free normal life.
What are narcotic antagonists?
Narcotic antagonists are drugs that block the "high" and other effects of
opiates without creating physical dependence of producing a "high" of their

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own. They are extremely useful in treating opiate overdoses and may prove
useful in the treatment of opiate dependence.
Source: National Institute on Drug Abuse, 1986 Facts about...Opiates
Synopsis: The opioids include both natural opiates - that is, drugs from
the opium poppy - and opiate-related synthetic drugs, such as meperidine
and methadone.
The opiates are found in a gummy substance extracted from the seedpod
of the Asian poppy; Papaver somniferous. Opium is produced from this
substance, and codeine and morphine are derived from opium. Other
drugs, such as heroin, are processed from morphine or codeine.
Opiates have been used both medically and non-medically for centuries. A
tincture of opium called laudanum has been widely used since the 16th
century as a remedy for "nerves" or to stop coughing and diarrhea. By the
early 19th century, morphine had been extracted in a pure form suitable
for solution. With the introduction of the hypodermic needle in the mid-
19th century, injection of the solution became the common method of
administration.
Heroin (diacetylmorphine) was introduced in 1898 and was heralded as a
remedy for morphine addiction. Although heroin proved to be a more
potent painkiller (analgesic) and cough suppressant than morphine, it was
also more likely to produce dependence.
Of the 20 alkaloids contained in opium, only codeine and morphine are
still widespread clinical use today. In this century, many synthetic drugs
have been developed with essentially the same effects as the natural opium
alkaloids.
Opiate-related synthetic drugs, such as meperidine (Demerol), hydro-
condone, oxycodone, OxyContin and methadone, were first developed to
provide an analgesic that would not produce drug dependence.
Unfortunately, all opioids (including naturally occurring opiate derivatives
and synthetic opiate-related drugs), while effective as analgesics, can also
produce dependence. (Note that where a drug name is capitalized, it is a
registered trade name of the manufacturer.)

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Modern research has led, however, to the development of other families of
drugs. The narcotic antagonists (e.g. naloxone hydrochloride) - one of
these groups - are used not as painkillers but to reverse the effects of
opiate overdose.
Another group of drugs possesses both morphine-like and naloxone-like
properties (e.g. pentazocine, or Talwin) and are sometimes used for pain
relief because they are less likely to be abused and to cause addiction.
Nevertheless, abuse of pentazocine in combination with the antihistamine
tripelennamine (Pyribenzamine) was widely reported in the 1980's,
particularly in several large cities in the United States. This combination
became known on the street as "Ts and blues." The reformulation of
Talwin, however, with the narcotic antagonist nalaxone has reportedly
reduced the incidence of Ts and blues use.
Appearance
Opium appears either as dark brown chunks or in powder form and is
generally eaten or smoked. Heroin usually appears as a white or brownish
powder, which is dissolved in water for injection. Most street preparations
of heroin contain only a small percentage of the drug, as they are diluted
with sugar, quinine, or other drugs and substances. Other opiate
analgesics appear in a variety of forms, such as capsules, tablets, syrups,
clixirs, solutions, and suppositories. Street users usually inject opiate
solutions under the skin ("skin popping") or directly into a vein or muscle,
but the drug may also be "snorted" into the nose or taken orally or rectally.
Effects
The effects of any drug depend on several factors:

• the amount taken at one time

• the user's past drug experience

• the manner in which the drug is taken

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• the circumstances under which the drug is taken (the place, the user's
psychological and emotional stability, the presence of other people,
simultaneous use of alcohol or other drugs, etc.)
Short-term effects appear soon after a single dose and disappear in a few
hours or days. Opioids briefly stimulate the higher centers of the brain but
then depress activity of the central nervous system. Immediately after
injection of an opioid into a vein, the user feels a surge of pleasure or a
"rush". This gives way to a state of gratification; hunger, pain, and sexual
urges rarely intrude.

The dose required to produce this effect may at first cause restlessness,
nausea, and vomiting. With moderately high doses, however, the body feels
warm, the extremities heavy, and the mouth dry. Soon, the users go "on
the nod," an alternately wakeful and drowsy state during which the world
is forgotten.
As the dose is increased, breathing becomes gradually slower. With very
large doses, the user cannot be roused; the pupil’s contract to pinpoints;
the skin is cold, moist, and bluish; and profound respiratory depression
resulting in death may occur.

Overdose is a particular risk on the street, where the amount of a drug

contained in a "hit" cannot be accurately gauged. In a treatment setting,
the effects of a usual dose of morphine last three to four hours. Although
pain may still be felt, the reaction to it is reduced, and the patient feels
content because of the emotional detachment induced by the drug.
Long-term effects appear after repeated use over a long period. Chronic
opiate users may develop endocarditic, an infection of the heart lining and
valves as a result of unsterile injection techniques.
Drug users who share needles are also at a high risk of acquiring AIDS
(acquired immune deficiency syndrome) and HIV infection (human
immune deficiency virus) and Hepatitis C. Unsterile injection techniques

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can also cause abscesses, cellulites, liver disease, and even brain damage.
Among users with a long history of subcutaneous injection, tetanus is
common. Pulmonary complications, including various types of
pneumonia, may also result from the unhealthy lifestyle of the user, as
well as from the depressant effect of opiates on respiration.
Tolerance and Dependence
With regular use, tolerance develops too many of the desired effects of the
opioids. This means the user must use more of the drug to achieve the
same intensity of effect. Chronic users may also become psychologically
and physically dependent on opioids.
Psychological dependence exists when a drug is so central to a person's
thoughts, emotions, and activities that the need to continue its use
becomes a craving or compulsion.
With physical dependence, the body has adapted to the presence of the
drug, and withdrawal symptoms occur if use of the drug is reduced or
stopped abruptly. Some users take heroin on an occasional basis, thus
avoiding physical dependence. Withdrawal from opioids, which in regular
users may occur as early as a few hours after the last administration,
produces uneasiness, yawning, tears, diarrhea, abdominal cramps, goose
bumps, and runny nose. These symptoms are accompanied by a craving
for the drug.
Major withdrawal symptoms peak between 48 and 72 hours after the last
dose and subside after a week. Some bodily functions, however, do not
return to normal levels for as long as six months. Sudden withdrawal by
heavily dependent users who are in poor health has occasionally been
fatal. Opioid withdrawal, however, is much less dangerous to life than
alcohol and barbiturate withdrawal.
Opioids and Pregnancy
Opioid-dependent women are likely to experience complications during
pregnancy and childbirth. Among their most common medical problems
are anemia, cardiac disease, diabetes, pneumonia, and hepatitis. They
also have an abnormally high rate of spontaneous abortion, breech

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delivery, caesarian section, and premature birth. Opioid withdrawal has
also been linked to a high incidence of stillbirths.

Infants born to heroin-dependent mothers are smaller than average and

frequently show evidence of acute infection. Most exhibit withdrawal
symptoms of varying degrees and duration. The mortality rate among these
infants is higher than normal.
Who Uses Opioids
Opiates and their synthetic counterparts are used in modern medicine to
relieve acute pain suffered as a result of disease, surgery, or injury; in the
treatment of some forms of acute heart failure; and in the control of
moderate to severe coughs or diarrhea. They are not the desired treatment
for the relief of chronic pain, because their long-term and repeated use can
result in drug dependence and side effects (such as constipation and mood
swings). They are, however, of particular value in control of pain in the
later stages of terminal illness, where the possibility of dependence is not
a significant issue.
A small proportion of people for whom opioids have been medically
prescribed become dependent; they are referred to as "medical addicts."
Even use of non-prescription codeine products, if continued
inappropriately, may get out of control. Medical advice should be sought,
since withdrawal symptoms may result from abrupt cessation of use after
physical dependence has been established. Because members of the
medical and allied health professions have ready access to opioids, some
become dependent. The largest proportion of non-medical use, however,
falls into the street-use category. Currently, heroin is the most popular
opiate among street users; these users are also prone to heavy use of other
psychoactive drugs, such as cocaine, alcohol, certain sedative/hypnotics,
and tranquillizers.

During the past few years, synthetic opioids such as hydrocodone,

hydromorphone, oxycodone, and meperidine have gained prominence as
drugs of dependence. Users sometimes urge physicians to write them

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prescriptions for the opioid of preference. These opioids are also frequently
stolen from pharmacies and sold on the street. Today, illicit use of such
opioid-based medicines as Percodan, Dilaudid, and Novahistex is
common.
Opioids and the Law

The federal Narcotic Control Act regulates the possession and distribution
of all opioids. The act permits individual physicians, dentists,
pharmacists, and veterinarians, as well as hospitals, to keep supplies of
certain opioids. Members of the general public must obtain these drugs for
such authorized sources.
Although the act also permits the prescribing of methadone in the
treatment of opioid dependence, permission is given only to specially
licensed physicians, and use is governed by specific guidelines. If tried by
summary conviction, a first offence for opioid possession carries a
maximum penalty of a $1,000 fine and six months imprisonment. For
subsequent offences, the maximum penalty is a $2,000 fine and 12
months imprisonment. If tried by indictment, opioid possession carries a
maximum penalty of seven years imprisonment.
Importing, exporting, trafficking, and possession for the purposes of
trafficking are all inditable offences and carry a maximum penalty of life
imprisonment. Cultivation of opium is also an indictable offence and
carries a maximum penalty of seven years imprisonment.
It is illegal to obtain a prescription for opioids or any other "narcotic" from
health care professionals without notifying them that you have obtained a
similar prescription through another practitioner within the preceding 30
days.
Signs of Inhalant Abuse
GLUE, VAPOR PRODUCING SOLVENTS, PROPELLANTS
• Substance odor on breath and clothes.

• Runny nose.

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• Watering eyes.

• Drowsiness or unconsciousness.

• Poor muscle control.

• Prefers group activity to being alone.

• Presence of bags or rags containing dry plastic cement or other solvent

at home, in locker at school or at work.

• Discarded whipped cream, spray paint or similar chargers (users of

nitrous oxide).

• Small bottles labeled "incense" (users of butyl nitrite).

Signs of Hallucinogen Abuse

LSD, MESCALINE
• Extremely dilated pupils.

• Warm skin, excessive perspiration and body odor.

• Distorted sense of sight, hearing, touch; distorted image of self and time
perception.

• Mood and behavior changes, the extent depending on emotional state of

the user and environmental conditions.

• Unpredictable flashback episodes even long after withdrawal (although

these are rare).

Signs of PCP Abuse

ANGEL DUST
Unpredictable behavior; mood may swing from passiveness to violence for
no apparent reason.
Symptoms of intoxication.
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• Disorientation; agitation and violence if exposed to excessive sensory
stimulation.
• Fear, terror.
• Rigid muscles.
• Strange gait.
• Deadened sensory perception (may experience severe injuries while
appearing not to notice).
• Pupils may appear dilated.
• Mask like facial appearance.
• Floating pupils appear to follow a moving object.
• Comatose (unresponsive) if large amount consumed. Eyes may be open
or closed.
PCP has stimulant, depressant, hallucinogenic and analgesic effects.
Which of these will be most pronounced is unpredictable and depends on
user’s personality, psychological state and the setting at time of use?

Drug Categories for Substances Bufotenine

of Abuse Morphine LSD
Nalorphine MDA
Narcotics Opium MDEA
Oxycodone MDMA
Alfentanil Stimulants/ Propoxyphene Mescaline
Inhalants MMDA
Amphetamine
Cocaine* Depressants
Benzedrine
Codeine Benzphetamine Benzodiazepine Phencyclidine
Crack Cocaine* Chloral Hydrate Psilocybin
Butyl Nitrite Chlordiazepoxide
Fentanyl Dextroamphetamine Diazepam Cannabis
Heroin Methamphetamine Marijuana
Hydromorphone Methylphenidate Glutethimide
Ice Tetrahydrocannabinol
Phenmetrazine Meprobamate
Meperidine Methaqualone
Methadone Hallucinogens Nitrous Oxide Alcohol

127
Ethyl Alcohol Secobarbital Nandrolone
Pentobarbital Steroids
Dianabol

128
129
 El estigma en la adicción a las drogas,
alcohol y la discriminación en
el mosaico de culturas en la
comunidad latina en Estados Unidos
El estigma que sufre la comunidad latina/hispana parlante es uno de los
aspectos más humillante y el más difícil de la adicción, ya que hace más
difícil para las personas y las familias para hacer frente a sus problemas y
obtener la ayuda que necesitan.

De acuerdo con la National Health Interview Survey los adultos hispanos

son el segundo grupo étnico que más consume alcohol en Estados Unidos,
y el incremento del uso de cocaína y marijuana entre las edades 14 a 36
años.
La población hispana / latina es considerada de una manera más
precisa como un mosaico de culturas. Los diferentes grupos hispanos
reflejan grandes diferencias étnicas, culturales y tienen pocas
características en común. La comunidad latina cubre todos los espectros
raciales; los latinos pueden ser blancos, afroamericanos, asiáticos o
nativos americanos. Es más, su diversidad se extiende a nacionalidad,
costumbres, ancestros, estilos de vida y nivel socioeconómico. En la
comunidad latina existen similitudes especialmente relacionadas con
idioma (español) y religión (católica, cristiana, evangélica e inclusive de
origen judío), profundas diferencias en antecedentes y experiencias de vida
entre los diversos grupos influyen directamente sobre su salud.
Los Latinos un mosaico de Culturas.
Existen diferencias significativas en las necesidades de tratamiento de
abuso a las drogas y alcohol en la población latina / hispana. El Censo
Nacional del 2010, (El Vigesimotercer Censo de los Estados Unidos de
América) ofrece información sobre el mosaico de culturas en la
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comunidad latina /hispana parlante, 50.5 millones de personas en los
Estados Unidos se identificaron como latinos o de origen hispanos, lo que
equivale a un 16 % de la población en Estados Unidos. Los latinos
aportaron entre 2000 y 2010 representado el 56% del crecimiento de la
población total del país.

El 62.3% se identificaron como Mexicanos, 14.1% proviene de América del

Sur y Centro América, y 43.3% se identificaron como latinos e hispanos
parlantes nacidos en Estados Unidos. Un tercio de los latinos no tiene
seguro de salud y la tasa de pobreza en la comunidad Latina/Hispana
nacional alcanzó el 15.1% en 2010, y se considera que cerca de 46.2
millones de personas enfrentan carencias. El nivel de educación
académica de los latinos es notablemente inferior al de la población
general: el 23.5% de los latinos ha completado menos de nueve años de
escuela, comparado con el 6.3% de la población general, el 3% de los
blancos y el 5.4% de los negros. La mayoría de los latinos concentran
mayoritariamente en nueve estados con una larga tradición de un mosaico
de culturas: Arizona, California, Colorado, Florida, Illinois, Nuevo México,
Nueva Jersey, Nueva York y Texas.

La población latina en el estado de Nueva York creció más durante la

última década en suburbios y pueblos fuera de la gran ciudad que en los
condados urbanos como Queens, Manhattan o el Bronx. Mientras que, en
el condado de Queens, perteneciente a la ciudad de Nueva York, el total
de habitantes hispanos aumentó en 57,145 desde 2000 a 2010, condados
fuera de la ciudad como Suffolk experimento un crecimiento de casi
97,000 latinos/hispanos que representa el 65%, y el condado de Nassau,
Long Island se ha visto un significativo aumento de la comunidad
Salvadoreña.

En el estado de New York según el Censo Nacional del 2010, la

población latina alcanzo a 3.4 millones. La población latina representa
17.6% y está compuesto mayoritariamente por originarios de la Republica

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Dominicana, Puerto Rico, Cuba, Colombia, Ecuador, México, El Salvador;
Ecuador, Perú mayoritariamente residen en la ciudad de New
York, Búfalo, Rochester, Syracuse, Amherst y Albany. Queens es un
barrio tradicionalmente de inmigrantes, que representa el mosaico de
culturas y se volvió activo con la llegada de los irlandeses en el siglo XIX,
seguidos de otros grupos europeos, como los italianos, y finalmente miles
de asiáticos y latinos de diversas nacionalidades a partir de la década de
1990, mantiene su diversidad de culturas latinas.
Los Latinos y la adicción al alcohol y el abuso a las drogas.
La adicción, el abuso a las drogas y alcohol afectan a todo el mosaico
LATINO/hispano de culturas, porque a medida que la población latina en
Estados Unidos crece los centros de salud y agencias que ofrecen servicios
para las adicciones deben adaptarse a las necesidades del gran mosaico
latino hispano de culturas.
La sociedad les impone el estigma y crea un daño a los adictos y sus
familias, porque muchos de nosotros todavía creen que la adicción es un
defecto de carácter o debilidad que, probablemente, no se puede curar. La
adicción es una enfermedad crónica del cerebro con recaídas,
caracterizada por la búsqueda y el uso compulsivo de drogas, a pesar de
las consecuencias nocivas. Se considera una enfermedad del cerebro
porque las drogas cambian al cerebro: modifican su estructura y cómo
funciona. Estos cambios pueden durar largo tiempo y llevar a los
comportamientos peligrosos que se ven en las personas que abusan de las
drogas.

El estigma y los estilos de vida en la comunidad latina

El estigma contra las personas con adicciones está tan profundamente

arraigado en la sociedad que continúa incluso en la faz de la evidencia
científica de que la adicción es una enfermedad tratable y aun cuando
sabemos que las personas en nuestras familias y las diversas
comunidades que viven vidas maravillosas de recuperación a largo plazo,
porque la adicción es una enferma que afecta el cerebro.

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El estigma es la razón por la que hay tanta discriminación social y legal de
las personas con adicciones. Esto explica por qué los adictos y sus
familias, buscan esconder la enfermedad. Las agencias que tratan esta
enfermedad se convierten en agentes policiales, al reportan las recaídas
que sufre el paciente al sistema de justicia en vez de tratar de explicar las
recaídas y buscar un tratamiento más apropiado. Esta práctica crea el
estigma que el paciente es un “criminal” que no quiere la cura de la
enfermedad porque la adicción es un proceso a lo largo del tiempo que
cursa a través de diversas etapas y cuyas características cambian de
acuerdo con la severidad del problema.
Las personas con adición con frecuencia tienen uno o dos problemas
médicos asociados con la adicción, incluyendo enfermedades pulmonares
y cardiovasculares, apoplejía o ataques cerebro vasculares, diferentes
tipos de cáncer y trastornos mentales, los recientes estudios revelan que
con frecuencia se encuentra la coexistencia del abuso de drogas y los
trastornos mentales y en algunos casos, las enfermedades mentales puede
preceder a la adicción; en otros casos, el abuso de drogas puede disparar
o exacerbar los trastornos mentales, particularmente en personas con
vulnerabilidades específicas. El estigma solo oculta y distorsiona las
evidencias científicas sobre esta enfermedad.

La discriminación entre la comunidad latina.

La discriminación estigmatiza a las personas que sufren la enfermedad de

la adicción porque son excluidos de las reglas que se aplican a personas
"normales". Las compañías de seguros en muchas ocasiones se niegan
pagar por el tratamiento de alcohol o drogas, o con la carga de mayores
deducibles y copagos que para el tratamiento de cualquier otra
enfermedad. Las personas que necesitan la ayuda a menudo tienen miedo
de hablar.

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Agencias estatales y federales se sienten seguros en negar estampillas de
comida y fórmula para bebés de madres que tienen condenas de drogas
porque las madres que han consumido drogas pocos partidarios en el
sistema político y mucha cara de las personas que piensan que debe ser
"malas madres". Es evidente que este estigma está basado en criterios no
científicos sino en la percepción que el adicto o la adicta le gusta este tipo
de vida, inclusive este estigma se encuentra en los profesionales de la
salud, que se expresa en comentarios basados en prejuicios sociales
creando un estigma de la persona que necesita ayuda. En el sistema
judicial es más evidente a través de la penalización.

La adicción una enfermedad al cerebro.

La adicción es una enfermedad primaria, que afecta al cerebro, constituida

por un conjunto de signos y síntomas característicos. El origen de la
adicción es multifactorial involucrándose factores biológicos, genéticos,
psicológicos, y sociales.
Los estudios demuestran que existen cambios neuroquímicos
involucrados en las personas con desordenes adictivos y que además
existe predisposición biogenética a desarrollar esta enfermedad. La
neuroquímica de la adicción es mucho más clara ahora debido a las
investigaciones realizadas en la última década. Se atribuye el sistema
meso límbico el locus del desorden adictivo. La negación, el autoengaño y
las distorsiones del pensamiento típicas de la adicción, conforman un
sistema dilucional bien nutrido que atrapa al adicto en un círculo de
deterioro progresivo. La adicción es una enfermedad tratable y la
recuperación es posible.

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 Drogas y sus efectos sobre el Sistema Nervioso Central

Sustancias depresoras del SNC Sustancias estimulantes del SNC Alucinógenos

Alcohol Cocaína LSD

Opiáceos (heroína, morfina, etc.) Anfetaminas Psilocibina

Benzodiacepinas Nicotina Peyote

Barbitúricos Xantinas (cafeína, teína, etc.) Drogas de síntesis

Cannabis y derivados

Inhalantes

Aunque los estudios han encontrado que ayuda a los empleados a

recuperar es más rentable que la terminación, algunos empresarios creen
que despedir a un empleado con un problema con la bebida es mucho más
fácil de proporcionar rehabilitación. Una tormenta de protestas que surgen
si los empleadores trataran los trabajadores con cáncer o
enfermedades del corazón de la misma manera.

El Estigma.

Las personas que son víctimas de la estigmatización interiorizar el odio

que lleva su transformación a la vergüenza y ocultación de sus efectos.
Con demasiada frecuencia, las personas con problemas de alcohol y
drogas y sus familias comienzan a aceptar las ideas que la adicción es su
propia culpa y que tal vez sean demasiado débiles como para hacer algo al
respecto. En muchos sentidos, esconde un problema de adicción es lo
racional a lo que buscan ayuda porque puede significar perder el trabajo
y el seguro médico, o incluso la pérdida de su hijo cuando una agencia de
servicio social declara que un padre o madre no aptos, ya que tiene un
problema de alcohol o drogas.

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El estrés, la depresión y el sentirse culpable.
El estrés de ocultar a menudo causa de otros problemas médicos, como la
depresión para las personas y sus familias. Esto es especialmente cierto
cuando un adolescente tiene un problema de alcohol o drogas. El miedo a
menudo le pide a los niños y jóvenes a ocultar el problema de los padres.
Entonces, cuando los padres descubren, el estigma les hace sentirse
culpables y negligente de alguna manera. La enfermedad y la disfunción
familiar explotan. Cuando eso sucede, los padres les resultan aún más
difícil luchar por el cuidado y los recursos de su hijo necesita
urgentemente de un sistema social y médica, que culpa a la familia, la
madre, el padre, el niño o al joven que sufre esta enfermedad. El
tratamiento para la adicción consiste en una serie de intervenciones
clínicas estructuradas de tal manera que resultan útiles para promover y
apoyar la recuperación de una persona afectada por la adicción hacia una
mejor calidad de vida.

Cada persona es un ser humano diferente con distintas situaciones de

vida y distintas necesidades. La individualización del tratamiento es un
factor clave en el éxito final del tratamiento, tal como lo indican las
investigaciones recientes sobre el tema. A medida que la población de los
Estados Unidos se vuelve más diversa, centros de salud y agencias deben
crecer y adaptarse a las necesidades del gran mosaico latino/hispano de
culturas.

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The stigma of addiction to drugs,
alcohol and discrimination in the
Hispanic community

The stigma experienced by the Hispanic community is one of the most

humiliating and most difficult of addiction, and that makes it harder for
individuals and families to address their problems and get the help they
need.

According to the National Health Interview Survey, Hispanic adults are the
largest ethnic group that consumes the most alcohol in the United States.
The Hispanic / Latino population is considered more accurately as a
mosaic of cultures. The different Hispanic groups reflect great ethnic and
cultural differences and have few common characteristics. The Hispanic
community covering the entire spectrum racial Hispanics can be white,
African-Americans, Asians or Native Americans. Moreover, diversity
extends to nationality, customs, ancestry, lifestyle and socioeconomic
status. In the Hispanic community there are similarities especially related
to language (Spanish) and religion (Catholic), profound differences in
background and life experiences among the various groups directly affect
their health.
The Latino / Hispanic according to the latest census in New York reaches
2867.583, representing 15.1% and is composed mainly originating in the
Dominican Republic, Puerto Rico, Colombia, Ecuador, Mexico, El
Salvador. The Hispanic community resides mostly in New York City,
Buffalo, Rochester, Syracuse, Albany, and Amherst as well in other cities.

137
The addiction, abuse drugs and alcohol affect the entire mosaic Hispanic
cultures.

The society imposes stigma and creates damage to addicts and their
families, because many of us still believe that addiction is a character flaw
or weakness that probably cannot be cured.
Addiction is a chronic relapsing brain disease characterized by compulsive
seeking and drug use, despite harmful consequences. It is considered a
brain disease because drugs change the brain change its structure and
how it works. These changes can last a long time and lead to harmful
behaviors seen in people who abuse drugs.

The stigma against people with addictions is so deeply rooted in society

that continues even in the face of scientific evidence that addiction is a
treatable illness and even though we know that people in our families and
the diverse communities that live wonderful lives long-term recovery,
because addiction is a disease that affects the brain.

The stigma is the reason why there are so many legal and social
discrimination of people with addictions. This explains why addicts and
their families seek to hide the disease. Substances Abuse Agencies and
clinicians that deal with this disease (addiction) becomes law enforcer and
reported the patient who relapses suffered to the justice system (probation,
parole or judicial system) rather than trying to explain the relapse and
seek appropriate treatment.
This practice creates the stigma that the patient is a "criminal" that does
not cure the disease because addiction is a process over time that courses
through various stages and characteristics change according to the
severity of the problem.
People often have to add one or two medical problems associated with
addiction, including pulmonary and cardiovascular diseases, stroke, or
cerebrovascular attacks, various cancers and mental disorders, recent
studies show that often is the coexistence of Abuse drug and mental
138
disorders and in some cases, mental diseases may precede addiction; in
other cases, drug abuse may trigger or exacerbate mental disorders,
particularly in people with specific vulnerabilities. Stigma only hides and
distorts the scientific evidence about the disease.

Discrimination stigmatizes people with the disease of addiction because

they are excluded from the rules that apply to "normal" people. Insurance
companies often refuse to pay for treatment of alcohol or drugs, or
charging higher deductibles and co-payments for treatment of other
illnesses. People who need help are often afraid to speak.

State and federal agencies feel safe in denying food stamps and infant
formula to mothers who have drug convictions because mothers who have
used drugs a few supporters in the political system and a lot of faces of
people who think they must be "bad mothers ". Clearly, this stigma is
based on nonscientific criteria but on the perception that the addict or the
addict likes this kind of life, including the stigma is in the health
professionals that are expressed in commentaries based on creating social
prejudices a stigma of the person who needs help. In the judicial system
is most evident through the penalty.

Addiction is a primary disease that affects the brain, consisting of a set of

characteristic signs and symptoms. The origin of addiction is engaging
multifactorial biological, genetic, psychological, and social. Studies show
that there are neurochemical changes involved in people with addictive
disorders and also there biogenetic predisposition to develop this disease.
The neurochemistry of addiction is much clearer now because research in
the last decade. It attributes the meso limbic system, locus of addictive
disorder. Denial, deception and distortions of thought typical of addiction,
form a well-nourished delusional system trapping the addict in a circle of
deterioration. Addiction is a treatable disease and recovery is possible.

139
Although studies have found that helps employees to recover is more
profitable than the end, some employers believe that firing an employee
with a drinking problem is much easier to provide rehabilitation. A storm
of protests that arise if employers treated workers with cancer or heart
disease in the same way.

People who are victims of stigma internalize the hate that leads to
transformation of shame and concealment of its effects. Too often, people
with drug and alcohol problems and their families begin to accept the ideas
that addiction is their own fault and that may be too weak to do anything
about it. In many ways, lies a problem of addiction is rational to seeking
help because it can mean losing their jobs and health insurance, or even
the loss of his son when a social service agency declares that a parent unfit
because it has an-alcohol or drug problem.

The stress of hiding often causes other medical problems such as

depression for people and their families. This is especially true when a teen
has a drug or alcohol problem. Fear often asks children and young people
to hide the problem from parents. So when parents discover, stigma makes
them feel guilty and somehow negligent. Illness and family dysfunction
explode. When that happens, parents find it even harder to fight for the
care and resources for your child badly in need of social and medical
system that blames the family, mother, father, child or young person
suffering from this disease. Treatment for addiction is a series of
structured clinical interventions in a way that is useful to promote and
support the recovery of a person affected by addiction to a better quality
of life.

Each person is a different person with different life situations and different
needs. The individualization of treatment is a key factor in the ultimate
success of treatment, as indicated by recent research on the subject.

140
 La rueda del poder y control formas de abuso
Abuso Físico: Este abuso se expresa en agarradas
forzadas, pellizcos, empujones, bofetadas,
golpeaduras, tirones de cabello, mordidas, etc.; negar
cuidados médicos u obligar al consumo de alcohol,
drogas, marihuana, cocaína, estaxis y abuso de
medicamentos.
Abuso sexual: Este tipo de abuso consiste en utilizar
la coerción o intentar la coerción para cualquier acto
sexual sin consentimiento. La violación marital, sexo
forzado después de una golpeadura física, ataques
sobre partes sexuales del cuerpo o el trato de otros de
una forma sexualmente denigrante; forzar a la
víctima a que realice actos sexuales con otra persona,
en el Internet, o que pose para fotos en contra de su
voluntad.
Abuso económico: Este tipo de abuso muchas veces
es minimizado en algunas sociedades, por la
dependencia patriarcal y machista. El abuso
domestico busca convertir o intentar convertir a una
persona financieramente dependiente, como en el
caso de mantener el control total sobre los recursos
financieros, prohibir el acceso a dinero, prohibir la
asistencia a la escuela o centro de trabajo. El control
de los gastos, el exigir recibo o lista de los gastos para
mantener un control y crear la ansiedad que si
abandona al abusador sería imposible sobrevivir la
víctima y sus hijos.
Abuso Emocional: Destruir la estima personal de
una persona, ya sea por medio de la crítica constante,
minimizando las capacidades de la persona, el uso de
membretes- sobrenombres, deteriora la relación de la
persona con sus hijos. La crítica constante de ser una
persona inútil, dependiente crear un puente de
violencia entre al abusador y la victima que se
realimenta del abuso verbal.
En otros casos el abusador puede usar su estatus de
VIH o el suyo o su orientación sexual como un
mecanismo para abusarle. Las amenazas de revelar
su estatus o identidad sexual. Esta situación crea la
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ansiedad y depresión emocional y la víctima se
excluye de la familia y amigos.
Abuso Psicológico: Este tipo de abuso marca la
persona por parte de su vida, el daño psicológico es
muchas veces más fuerte de la golpiza porque afecta
el sistema emocional y de valores de la víctima. El
temor por intimidación, la amenaza de daño físico a
sí mismo, a la pareja o hijos, destrucción de mascotas
y propiedades, juegos mentales o forzar el
aislamiento de amigos, familia, escuela y trabajo.
La coerción sexual: Podemos incluir la esterilización
forzada es una forma de violencia contra la mujer. En
estos casos el abusador sabotea su plan de control de
la natalidad, anticonceptivo como exigiéndola tener
relaciones sexuales sin usar protección, mintiéndole
que va a eyacular fuera, escondiéndole o destruyendo
sus anticonceptivos, arrogando las pastillas
anticonceptivas al inodoro, o haciendo un hueco al
condón, prohibiéndole tener un aborto u obligándola
a tener un aborto.
La violencia doméstica es la que se produce en el
“domo”, la casa, el hogar. Y la puede ejercer y sufrir
cualquiera de los miembros del núcleo familiar, es
decir, una madre sobre sus hijos o un nieto sobre su
abuelo.
La violencia de género, en cambio, es aquella que se
produce contra la mujer “por el hecho de serlo”, tanto
dentro como fuera de casa, en el trabajo o en
cualquier otro ámbito de la vida pública. Este tipo de
violencia se fundamenta en la supuesta superioridad
de un sexo sobre otro y sus manifestaciones son muy
variadas.
La violencia sobre la mujer ha sido, a lo largo de la
historia, legitimada por casi todas las sociedades y
culturas.
 The wheel of power and control forms of abuse
Physical Abuse: This abuse is expressed in forced
seizing, pinching, pushing, slapping, hitting, pulling
hair, biting, etc. .; deny medical care or force the
consumption of alcohol, drugs, marijuana, cocaine,
stasis and drug abuse.
Sexual abuse: This type of abuse consists in using
coercion or attempting coercion for any sexual act
without consent. Marital rape, forced sex after a
physical beat, attacks on sexual parts of the body or
the treatment of others in a sexually denigrating
manner; force the victim to perform sexual acts with
another person, on the Internet, or to pose for photos
against their will.
Economic abuse: This type of abuse is often
minimized in some societies, by patriarchal and
macho dependence. Domestic abuse seeks to convert
or attempt to convert a financially dependent person,
as in the case of maintaining full control over
financial resources, prohibiting access to money,
prohibiting attendance at the school or workplace.
Control of expenses, demanding receipt or list of
expenses to maintain control and create anxiety that
if you leave the abuser it would be impossible to
survive the victim and their children.
Emotional Abuse: Destroying a person's personal
esteem, whether through constant criticism,
minimizing the person's abilities, the use of
letterheads- nicknames, deteriorates the person's
relationship with their children. The constant
criticism of being a useless, dependent person creates
a bridge of violence between the abuser and the
victim who is fed back from verbal abuse.
In other cases, the abuser may use his or her HIV
status or sexual orientation as a mechanism to abuse
142
him. The threats of revealing your sexual status or
identity. This situation creates anxiety and emotional
depression and the victim is excluded from family
and friends.
Psychological Abuse: This type of abuse marks the
person for part of his life, the psychological damage
is many times stronger than the beating because it
affects the emotional and values system of the victim.
Fear of intimidation, the threat of physical harm to
oneself, the couple or children, destruction of pets
and property, mental games or forcing the isolation
of friends, family, school and work.
Sexual coercion: We can include forced sterilization
is a form of violence against women. In these cases
the abuser sabotages his birth control plan,
contraceptive as demanding to have sex without
using protection, lying that he is going to ejaculate
outside, hiding or destroying his contraceptives,
throwing birth control pills into the toilet, or making
a hole in the condom , forbidding her to have an
abortion or forcing her to have an abortion.
Domestic violence is what occurs in the "dome", the
house, the home. And it can be exercised and suffered
by any of the members of the family nucleus, that is,
a mother over her children or a grandson over her
grandfather.
Gender-based violence, on the other hand, is one that
occurs against women “for the sake of being one,”
both inside and outside the home, at work or in any
other area of public life. This type of violence is based
on the supposed superiority of one sex over another
and its manifestations are very varied.
Violence against women has been, throughout
history, legitimized by almost all societies and
cultures.
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