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Saturday, April 25, 2020

Disease theory of alcoholism

From Wikipedia, the free encyclopedia
 
Alcohol dependence
1904 Claim of Alcoholism Being Disease4.jpg
A 1904 advertisement labeling alcoholism a "disease"
SpecialtyPsychiatry

The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function.

The largest association of physicians - the American Medical Association (AMA) declared that alcoholism was an illness in 1956. In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

Theory

Alcoholism is a chronic problem. However, if managed properly, damage to the brain can be stopped and to some extent reversed.  In addition to problem drinking, the disease is characterized by symptoms including an impaired control over alcohol, compulsive thoughts about alcohol, and distorted thinking. Alcoholism can also lead indirectly, through excess consumption, to physical dependence on alcohol, and diseases such as cirrhosis of the liver.

The risk of developing alcoholism depends on many factors, such as environment. Those with a family history of alcoholism are more likely to develop it themselves (Enoch & Goldman, 2001); however, many individuals have developed alcoholism without a family history of the disease. Since the consumption of alcohol is necessary to develop alcoholism, the availability of and attitudes towards alcohol in an individual's environment affect their likelihood of developing the disease. Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40-50% for environmental influences.

In a review in 2001, McLellan et al. compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. They found that genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders, providing evidence that drug (including alcohol) dependence is a chronic medical illness.

Genetics and environment

According to the theory, genes play a strong role in the development of alcoholism. 

Twin studies, adoption studies, and artificial selection studies have shown that a person's genes can predispose them to developing alcoholism. Evidence from twin studies show that concordance rates for alcoholism are higher for monozygotic twins than dizygotic twins—76% for monozygotic twins and 61% for dizygotic twins. However, female twin studies demonstrate that females have much lower concordance rates than males. Reasons for gender differences may be due to environmental factors, such as negative public attitudes towards female drinkers. Twin studies suggest that males are more likely to have a genetic predisposition for alcoholism. However, this does not suggest that a male who does have a genetic predisposition will become an alcoholic. Sometimes the individual may never encounter an environmental trigger that leads to alcoholism.

Adoption studies also suggest a strong genetic tendency towards alcoholism. Studies on children separated from their biological parents demonstrates that sons of alcoholic biological fathers were more likely to become alcoholic, even though they have been separated and raised by non alcoholic parents. Female show similar results, but to a lesser degree.

In artificial selection studies, specific strains of rats were bred to prefer alcohol. These rats preferred drinking alcohol over other liquids, resulting in a tolerance for alcohol and exhibited a physical dependency on alcohol. Rats that were not bred for this preference did not have these traits. Upon analyzing the brains of these two strains of rats, it was discovered that there were differences in chemical composition of certain areas of the brain. This study suggests that certain brain mechanisms are more genetically prone to alcoholism.

The convergent evidence from these studies present a strong case for the genetic basis of alcoholism.

History

Historians debate who has primacy in arguing that habitual drinking carried the characteristics of a disease. Some note that Scottish physician Thomas Trotter was the first to characterize excessive drinking as a disease, or medical condition.

Others point to American physician Benjamin Rush (1745–1813), a signatory to the United States Declaration of Independence — who understood drunkenness to be what we would now call a "loss of control" — as possibly the first to use the term "addiction" in this sort of meaning.
My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.
— Levine, H.G., The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America
Rush argued that "habitual drunkenness should be regarded not as a bad habit but as a disease", describing it as "a palsy of the will". Rush expounded his views in a book published in 1808. His views are described by Valverde and by Levine:

Swedish physician Magnus Huss coined the term "alcoholism" in his book Alcoholismus chronicus (1849). Some argue he was the first to systematically describe the physical characteristics of habitual drinking and claim that it was a disease. However, this came decades after Rush and Trotter wrote their works, and some historians argue that the idea that habitual drinking was a diseased state emerged earlier.

Given this controversy, the best one can say is that the idea that habitual alcohol drinking was a disease had become more acceptable by the middle of the nineteenth century, although many writers still argued it was a vice, a sin, and not the purview of medicine but of religion.

Between 1980 and 1991, medical organizations, including the AMA, worked together to establish policies regarding their positions on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, formed through consensus of the federation of state and specialty medical societies within their House of Delegates, state, in part:
"The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice."
In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

Controlled drinking

The disease theory is often interpreted as implying that problem drinkers are incapable of returning to 'normal' problem free drinking, and therefore that treatment should focus on total abstinence. Some critics have used evidence of controlled drinking in formerly dependent drinkers to dispute the disease theory of alcoholism.

The first major empirical challenge to this interpretation of the disease theory followed a 1962 study by Dr. D. L. Davies. Davies' follow-up of 93 problem drinkers found that 7 of them were able to return to "controlled drinking" (less than 7 drinks per day for at least 7 years). Davies concluded that "the accepted view that no alcohol addict can ever again drink normally should be modified, although all patients should be advised to aim at total abstinence"; After the Davies study, several other researchers reported cases of problem drinkers returning to controlled drinking.

In 1976, a major study commonly referred to as the RAND report, published evidence of problem drinkers learning to consume alcohol in moderation. The publication of the study renewed controversy over how people suffering a disease which reputedly leads to uncontrollable drinking could manage to drink controllably. Subsequent studies also reported evidence of return to controlled drinking. Similarly, according to a 2002 National Institute on Alcohol Abuse and Alcoholism (NIAAA) study, about one of every six (18%) of alcohol dependent adults in the U.S. whose dependence began over one year previously had become "low-risk drinkers" (less than 14 drinks per week and 5 drinks per day for men, or less than 7 per week and 4 per day for women). This modern longitudinal study surveyed more than 43,000 individuals representative of the U.S. adult population, rather than focusing solely on those seeking or receiving treatment for alcohol dependence. "Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence."

However, many researchers have debated the results of the smaller studies. A 1994 followup of the original 7 cases studied by Davies suggested that he "had been substantially misled, and the paradox exists that a widely influential paper which did much to stimulate new thinking was based on faulty data." The most recent study, a long-term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage." 

The second RAND study, in 1980, found that alcohol dependence represents a factor of central importance in the process of relapse. Among people with low dependence levels at admission, the risk of relapse appears relatively low for those who later drank without problems. But the greater the initial level of dependence, the higher the likelihood of relapse for nonproblem drinkers. The second RAND study findings have been strengthened by subsequent research by Dawson et al. in 2005 which found that severity was associated positively with the likelihood of abstinent recovery and associated negatively with the likelihood of non-abstinent recovery or controlled drinking. Other factors such as a significant period of abstinence or changes in life circumstances were also identified as strong influences for success in a book on Controlled Drinking published in 1981.

Managed drinking

As part of a harm reduction strategy, provision of small amounts of alcoholic beverages to homeless alcoholics at homeless shelters in Toronto and Ottawa reduced government costs and improved health outcomes.

Legal considerations

In 1988, the US Supreme Court upheld a regulation whereby the Veterans' Administration was able to avoid paying benefits by presuming that primary alcoholism is always the result of the veteran's "own willful misconduct." The majority opinion written by Justice Byron R. White echoed the District of Columbia Circuit's finding that there exists "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility". He also wrote: "Indeed, even among many who consider alcoholism a "disease" to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary." However, the majority opinion stated in conclusion that "this litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control. It is not our role to resolve this medical issue on which the authorities remain sharply divided." The dissenting opinion noted that "despite much comment in the popular press, these cases are not concerned with whether alcoholism, simplistically, is or is not a "disease.""

The American Bar Association "affirms the principle that dependence on alcohol or other drugs is a disease."

Current acceptance

Alcoholism is a disease with a known pathology and an established biomolecular signal transduction pathway which culminates in ΔFosB overexpression within the D1-type medium spiny neurons of the nucleus accumbens; when this overexpression occurs, ΔFosB induces the addictive state.

In 2004, the World Health Organization published a detailed report on alcohol and other psychoactive substances entitled "Neuroscience of psychoactive substance use and dependence". It stated that this was the "first attempt by WHO to provide a comprehensive overview of the biological factors related to substance use and dependence by summarizing the vast amount of knowledge gained in the last 20-30 years. The report highlights the current state of knowledge of the mechanisms of action of different types of psychoactive substances, and explains how the use of these substances can lead to the development of dependence syndrome." The report states that "dependence has not previously been recognized as a disorder of the brain, in the same way that psychiatric and mental illnesses were not previously viewed as being a result of a disorder of the brain. However, with recent advances in neuroscience, it is clear that dependence is as much a disorder of the brain as any other neurological or psychiatric illness." 

The American Society of Addiction Medicine and the American Medical Association both maintain extensive policy regarding alcoholism. The American Psychiatric Association recognizes the existence of "alcoholism" as the equivalent of alcohol dependence. The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease.

In the US, the National Institutes of Health has a specific institute, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), concerned with the support and conduct of biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. It funds approximately 90 percent of all such research in the United States. The official NIAAA position is that "alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle."

Certain medications including opioid antagonists such as naltrexone have been shown to be effective in the treatment of alcoholism.

Criticism

Some physicians, scientists and others have rejected the disease theory of alcoholism on logical, empirical and other grounds. Indeed, some addiction experts such as Stanton Peele are outspoken in their rejection of the disease model, and other prominent alcohol researchers such as Nick Heather have authored books intending to disprove the disease model.

Some critics of the disease model argue alcoholism still involves choice, not total loss of control, and stripping alcohol abusers of their choice, by applying the disease concept, is a threat to the health of the individual; the disease concept gives the substance abuser an excuse. A disease cannot be cured by force of will; therefore, adding the medical label transfers the responsibility from the abuser to caregivers. Inevitably the abusers become unwilling victims, and just as inevitably they take on that role. They argue that the disease theory of alcoholism exists only to benefit the professionals' and governmental agencies responsible for providing recovery services, and the disease model has not offered a solution for those attempting to stop abusive alcohol and drug use.

These critics hold that by removing some of the stigma and personal responsibility the disease concept actually increases alcoholism and drug abuse and thus the need for treatment. This is somewhat supported by a study which found that a greater belief in the disease theory of alcoholism and higher commitment to total abstinence to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use). However, the authors noted that "the direction of causality cannot be determined from these data. It is possible that belief in alcoholism as a loss-of-control disease predisposes clients to relapse, or that repeated relapses reinforce clients' beliefs in the disease model." 

One study found that only 25 percent of physicians believed that alcoholism is a disease. The majority believed alcoholism to be a social or psychological problem instead of a disease.

A survey of physicians at an annual conference of the International Doctors in Alcoholics Anonymous reported that 80 percent believe that alcoholism is merely bad behavior instead of a disease.

Thomas R. Hobbs says that "Based on my experiences working in the addiction field for the past 10 years, I believe many, if not most, health care professionals still view alcohol addiction as a willpower or conduct problem and are resistant to look at it as a disease."

Lynn Appleton says that "Despite all public pronouncements about alcoholism as a disease, medical practice rejects treating it as such. Not only does alcoholism not follow the model of a 'disease,' it is not amenable to standard medical treatment." She says that "Medical doctors' rejection of the disease theory of alcoholism has a strong basis in the biomedical model underpinning most of their training" and that "medical research on alcoholism does not support the disease model."

"Many doctors have been loath to prescribe drugs to treat alcoholism, sometimes because of the belief that alcoholism is a moral disorder rather than a disease," according to Dr. Bankole Johnson, Chairman of the Department of Psychiatry at the University of Virginia. Dr Johnson's own pioneering work has made important contributions to the understanding of alcoholism as a disease.

Frequency and quantity of alcohol use are not related to the presence of the condition; that is, people can drink a great deal without necessarily being alcoholic, and alcoholics may drink minimally or infrequently.

Alcoholics Anonymous

From Wikipedia, the free encyclopedia
 
Alcoholics Anonymous
Alcoholics Anonymous, Book Cover, 4th Edition.jpg
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book and is written by AA members.
TypeMutual-help addiction recovery twelve-step program
Websitewww.aa.org

Alcoholics Anonymous (AA) is an international mutual aid fellowship with the stated purpose of enabling its members to "stay sober and help other alcoholics achieve sobriety." AA is nonprofessional, self-supporting, and apolitical. Its only membership requirement is a desire to stop drinking. The AA program of recovery is set forth in the Twelve Steps.

AA was founded in 1935 in Akron, Ohio when one alcoholic, Bill Wilson, talked to another alcoholic, Bob Smith, about the nature of alcoholism and a possible solution. With the help of other early members, the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism was written in 1939. Its title became the name of the organization and is now usually referred to as "The Big Book". AA's initial Twelve Traditions were introduced in 1946 to help the fellowship be stable and unified while disengaged from "outside issues" and influences.

The Traditions recommend that members remain anonymous in public media, altruistically help other alcoholics, and that AA groups avoid official affiliations with other organizations. They also advise against dogma and coercive hierarchies. Subsequent fellowships such as Narcotics Anonymous have adapted the Twelve Steps and the Twelve Traditions to their respective primary purposes.

AA membership has since spread internationally "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements. Close to two million people worldwide are estimated to be members of AA as of 2016.

History

Sobriety token or "chip", given for specified lengths of sobriety, on the back is the Serenity Prayer. Here green is for six months of sobriety; purple is for nine months.
 
AA sprang from The Oxford Group, a non-denominational movement modeled after first-century Christianity. Some members founded the Group to help in maintaining sobriety. "Grouper" Ebby Thacher was Wilson's former drinking buddy who approached Wilson saying that he had "got religion", was sober, and that Wilson could do the same if he set aside objections to religion and instead formed a personal idea of God, "another power" or "higher power".

Feeling a "kinship of common suffering" and, though drunk, Wilson attended his first Group gathering. Within days, Wilson admitted himself to the Charles B. Towns Hospital after drinking four beers on the way—the last alcohol he ever drank. Under the care of William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna. At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself. Following his hospital discharge, Wilson joined the Oxford Group and recruited other alcoholics to the Group. Wilson's early efforts to help others become sober were ineffective, prompting Silkworth to suggest that Wilson place less stress on religion and more on "the science" of treating alcoholism. Wilson's first success came during a business trip to Akron, Ohio, where he was introduced to Robert Smith, a surgeon and Oxford Group member who was unable to stay sober. After thirty days of working with Wilson, Smith drank his last drink on 10 June 1935, the date marked by AA for its anniversaries.

The first female member Florence Rankin joined AA in March 1937, and the first non-Protestant member, a Roman Catholic, joined in 1939. The first Black AA group was established in 1945 in Washington DC by Jim S., an African-American physician from Virginia.

During the 2020 global coronavirus pandemic, many AA meetings moved to online meetings using platforms such as Zoom, Google Hangouts, and conference calls. Some members expressed concerns about anonymity and security and steps were taken, including having "digital bouncers at some online meetings.

The Big Book, the Twelve Steps and the Twelve Traditions

To share their method, Wilson and other members wrote the initially-titled book, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism, from which AA drew its name. Informally known as "The Big Book" (with its first 164 pages virtually unchanged since the 1939 edition), it suggests a twelve-step program in which members admit that they are powerless over alcohol and need help from a "higher power". They seek guidance and strength through prayer and meditation from God or a Higher Power of their own understanding; take a moral inventory with care to include resentments; list and become ready to remove character defects; list and make amends to those harmed; continue to take a moral inventory, pray, meditate, and try to help other alcoholics recover. The second half of the book, "Personal Stories" (subject to additions, removal and retitling in subsequent editions), is made of AA members' redemptive autobiographical sketches.

In 1941, interviews on American radio and favorable articles in US magazines, including a piece by Jack Alexander in The Saturday Evening Post, led to increased book sales and membership. By 1946, as the growing fellowship quarreled over structure, purpose, and authority, as well as finances and publicity, Wilson began to form and promote what became known as AA's "Twelve Traditions," which are guidelines for an altruistic, unaffiliated, non-coercive, and non-hierarchical structure that limited AA's purpose to only helping alcoholics on a non-professional level while shunning publicity. Eventually, he gained formal adoption and inclusion of the Twelve Traditions in all future editions of the Big Book. At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference, as AA grew to millions of members internationally.

Organization and finances

A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense", and Bill Wilson, borrowing the phrase from anarchist theorist Peter Kropotkin, called it a "benign anarchy". In Ireland, Shane Butler said that AA "looks like it couldn't survive as there's no leadership or top-level telling local cumanns what to do, but it has worked and proved itself extremely robust". Butler explained that "AA's 'inverted pyramid' style of governance has helped it to avoid many of the pitfalls that political and religious institutions have encountered since it was established here in 1946."

In 2018, AA counted 2,087,840 members and 120,300 AA groups worldwide. The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.

A member who accepts a service position or an organizing role is a "trusted servant" with terms rotating and limited, typically lasting three months to two years and determined by group vote and the nature of the position. Each group is a self-governing entity with AA World Services acting only in an advisory capacity. AA is served entirely by alcoholics, except for seven "nonalcoholic friends of the fellowship" of the 21-member AA Board of Trustees.

AA groups are self-supporting, relying on voluntary donations from members to cover expenses. The AA General Service Office (GSO) limits contributions to US$3,000 a year. Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.

Like individual groups, the GSO is self-supporting. AA receives proceeds from books and literature that constitute more than 50% of the income for its General Service Office. In keeping with AA's Seventh Tradition, the Central Office is fully self-supporting through the sale of literature and related products, and through the voluntary donations of AA members and groups. It does not accept donations from people or organizations outside of AA. 

In keeping with AA's Eighth Tradition, the Central Office employs special workers who are compensated financially for their services, but their services do not include traditional "12th Step" work of working with alcoholics in need. All 12th Step calls that come to the Central Office are handed to sober AA members who have volunteered to handle these calls. It also maintains service centers, which coordinate activities such as printing literature, responding to public inquiries, and organizing conferences. Other International General Service Offices (Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.

Program

AA's program extends beyond abstaining from alcohol. Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism" through "an entire psychic change," or spiritual awakening. A spiritual awakening is meant to be achieved by taking the Twelve Steps, and sobriety is furthered by volunteering for AA and regular AA meeting attendance or contact with AA members. Members are encouraged to find an experienced fellow alcoholic, called a sponsor, to help them understand and follow the AA program. The sponsor should preferably have experience of all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person. Following the helper therapy principle, sponsors in AA may benefit from their relationship with their charges, as "helping behaviors" correlate with increased abstinence and lower probabilities of binge drinking.

AA's program is an inheritor of Counter-Enlightenment philosophy. AA shares the view that acceptance of one's inherent limitations is critical to finding one's proper place among other humans and God. Such ideas are described as "Counter-Enlightenment" because they are contrary to the Enlightenment's ideal that humans have the capacity to make their lives and societies a heaven on earth using their own power and reason. After evaluating AA's literature and observing AA meetings for sixteen months, sociologists David R. Rudy and Arthur L. Greil found that for an AA member to remain sober a high level of commitment is necessary. This commitment is facilitated by a change in the member's worldview. To help members stay sober AA must, they argue, provide an all-encompassing worldview while creating and sustaining an atmosphere of transcendence in the organization. To be all-encompassing AA's ideology places an emphasis on tolerance rather than on a narrow religious worldview that could make the organization unpalatable to potential members and thereby limit its effectiveness. AA's emphasis on the spiritual nature of its program, however, is necessary to institutionalize a feeling of transcendence. A tension results from the risk that the necessity of transcendence, if taken too literally, would compromise AA's efforts to maintain a broad appeal. As this tension is an integral part of AA, Rudy and Greil argue that AA is best described as a quasi-religious organization.

Meetings

AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics". They are usually informal and often feature discussions with voluntary donations collected during meetings. (AA's 7th tradition encourages groups to be self-supporting, declining outside contributions). Local AA directories list weekly meetings. Those listed as "closed" are available to those with a self-professed "desire to stop drinking," which cannot be challenged by another member on any grounds. "Open" meetings are available to anyone (nonalcoholics can attend as observers). At speaker meetings (also known as gratitude meetings), one or more members who typically come in from a neighboring town's meeting tell their stories. At Big Book meetings, the group in attendance will take turns reading a passage from the AA Big Book and then discuss how they relate to it after. At twelve step meetings, the group will typically break out into subgroups depending on where they are in their program and start working on the twelve steps outlined in the program. In addition to those three most common types of meetings, there are also other kinds of discussion meetings which tend to allocate the most time for general discussion.

Building for Spanish-speaking AA group in Westlake neighborhood, Los Angeles

AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation, or culture. Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish. While AA has pamphlets that suggest meeting formats, groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole". Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".

Confidentiality

US courts have not extended the status of privileged communication, such as that enjoyed by clergy and lawyers, to AA related communications between members.

Spirituality

A study found an association between an increase in attendance to AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use. The research also found that AA was effective at helping agnostics and atheists become sober. The authors concluded that though spirituality was an important mechanism of behavioral change for some alcoholics, it was not the only effective mechanism. Since the mid-1970s, a number of 'agnostic' or 'no-prayer' AA groups have begun across the U.S., Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo use of opening or closing prayers. There are online resources listing AA meetings for atheists and agnostics.

Disease concept of alcoholism

More informally than not AA's membership has helped popularize the disease concept of alcoholism which had appeared in the eighteenth century. Though AA usually avoids the term "disease", 1973 conference-approved literature said "we had the disease of alcoholism." Regardless of official positions, since AA's inception, most members have believed alcoholism to be a disease.

AA's Big Book calls alcoholism "an illness which only a spiritual experience will conquer." Ernest Kurtz says this is "The closest the book Alcoholics Anonymous comes to a definition of alcoholism." Somewhat divergently in his introduction to The Big Book, non-member and early benefactor William Silkworth said those unable to moderate their drinking suffer from an allergy. In presenting the doctor's postulate AA said "The doctor's theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account." AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us." Wilson explained in 1960 why AA had refrained from using the term "disease":
We AAs have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Hence, we have always called it an illness or a malady—a far safer term for us to use.
Since then medical and scientific communities have generally concluded that alcoholism is an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild). The ten criteria are: alcoholism is a Primary Illness not caused by other illnesses nor by personality or character defects; second, an addiction gene is part of its etiology; third, alcoholism has predictable symptoms; fourth, it is progressive, becoming more severe even after long periods of abstinence; fifth, it is chronic and incurable; sixth, alcoholic drinking or other drug use persists in spite of negative consequences and efforts to quit; seventh, brain chemistry and neural functions change so alcohol is perceived as necessary for survival; eighth, it produces physical dependence and life-threatening withdrawal; ninth, it is a terminal illness; tenth, alcoholism can be treated and can be kept in remission.

Canadian and United States demographics

AA's New York General Service Office regularly surveys AA members in North America. Its 2014 survey of over 6,000 members in Canada and the United States concluded that, in North America, AA members who responded to the survey were 62% male and 38% female.

Average member sobriety is slightly under 10 years with 36% sober more than ten years, 13% sober from five to ten years, 24% sober from one to five years, and 27% sober less than one year. Before coming to AA, 63% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 59% received outside treatment or counseling. Of those members, 84% said that outside help played an important part in their recovery.

The same survey showed that AA received 32% of its membership from other members, another 32% from treatment facilities, 30% were self-motivated to attend AA, 12% of its membership from court–ordered attendance, and only 1% of AA members decided to join based on information obtained from the Internet. People taking the survey were allowed to select multiple answers for what motivated them to join AA.

Effectiveness

Studies of AA's efficacy have produced inconsistent results. While some studies have suggested an association between AA attendance and increased abstinence or other positive outcomes, other studies have not.

The Surgeon General of the United States 2016 Report on Alcohol, Drugs, and Health states "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions."

Relationship with institutions

Hospitals

Many AA meetings take place in treatment facilities. Carrying the message of AA into hospitals was how the co-founders of AA first remained sober. They discovered great value in working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did. Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics". Bill Wilson visited Towns Hospital in New York City in an attempt to help the alcoholics who were patients there in 1934. At St. Thomas Hospital in Akron, Ohio, Smith worked with still more alcoholics. In 1939, a New York mental institution, Rockland State Hospital, was one of the first institutions to allow AA hospital groups. Service to corrections and treatment facilities used to be combined until the General Service Conference, in 1977, voted to dissolve its Institutions Committee and form two separate committees, one for treatment facilities, and one for correctional facilities.

Prisons

In the United States and Canada, AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods of approaching correctional-facility officials with the intent of developing an in-prison AA program. In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic. Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.

United States court rulings

United States courts have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed a religion, it was ruled that it contained enough religious components (variously described in Griffin v. Coughlin below as, inter alia, "religion", "religious activity", "religious exercise") to make coerced attendance at AA meetings a violation of the Establishment Clause of the First Amendment of the constitution. In 2007, the Ninth Circuit of the U.S. Court of Appeals stated that a parolee who was ordered to attend AA had standing to sue his parole office.

American treatment industry

In 1939, High Watch Recovery Center in Kent, Connecticut was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12-step-based treatment center in the world still operating today.

In 1949, the Hazelden treatment center was founded and staffed by AA members, and since then many alcoholic rehabilitation clinics have incorporated AA's precepts into their treatment programs. 32% of AA's membership was introduced to it through a treatment facility.

United Kingdom treatment industry

A cross-sectional survey of substance-misuse treatment providers in the West Midlands found fewer than 10% integrated twelve-step methods in their practice and only a third felt their consumers were suited for Alcoholics Anonymous or Narcotics Anonymous membership. Less than half were likely to recommend self-help groups to their clients. Providers with nursing qualifications were more likely to make such referrals than those without them. A statistically significant correlation was found between providers' self-reported level of spirituality and their likelihood of recommending AA or NA.

Criticism

Thirteenth-stepping

"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates. A study in the Journal of Addiction Nursing sampled 55 women in AA and found that 35% of these women had experienced a "pass" and 29% had felt seduced at least once in AA settings. This has also happened with new male members who received guidance from older female AA members, in pursuit of sexual company. The authors suggest that both men and women need to be prepared for this behavior or find male-only or female-only groups. However, women report feeling safe in AA, women-only meetings are a very prevalent part of AA culture, and AA has become more welcoming for women. AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.

Moderation or abstinence

Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics. Along with Nancy Shute, Peele has advocated that besides AA, other options should be readily available to those problem drinkers who are able to manage their drinking with the right treatment. The Big Book says "moderate drinkers" and "a certain type of hard drinker" are able to stop or moderate their drinking. The Big Book suggests no program for these drinkers, but instead seeks to help drinkers without "power of choice in drink."

Cultural identity

One review of AA warned of detrimental iatrogenic effects of twelve-step philosophy and concluded that AA uses many methods that are also used by cults. A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial. Another study found that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. A survey of group members, however, found they had a bicultural identity and saw AA's program as a complement to their other national, ethnic, and religious cultures.

Literature

Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine. Two books are used primarily: Alcoholics Anonymous (the "Big Book") and Twelve Steps and Twelve Traditions, the latter explaining AA's fundamental principles in depth. The full text of each of these two books is available on the AA website at no charge.

AA in film

Films about Alcoholics Anonymous

Films where primary plot line includes AA

AA in television

Chuck Lorre's Mom (2013–), follows dysfunctional daughter/mother duo Christy and Bonnie Plunkett, who are estranged for years while simultaneously struggling with addiction. They attempt to pull their lives and relationships together by trying to stay sober and visiting Alcoholics Anonymous. The show also explores themes of alcoholism, drug addiction and relapse

In Hill Street Blues, Captain Furillo (Daniel J. Travanti) is a regular member of AA and is shown several times in AA meetings. 

In Grey's Anatomy, AA plays a large role in the storylines of multiple characters. In season 6, Dr. Richard Webber (James Pickens Jr.) begins struggling with alcoholism and it is revealed that he has a history of alcohol addiction. AA and maintaining sobriety become an important part of Dr. Webber's life through out the rest of the series. Alcoholism, but more so drug addiction, is also heavily featured in the spin-off series Private Practice. In season 4, it is revealed that both Dr. Charlotte King (KaDee Strickland) and Dr. Amelia Shepherd (Caterina Scorsone) have a history of problem drinking and narcotics addiction. This becomes main theme in season 5 when Amelia relapses and begins using again following her friend's suicide. The season follows her relapse and recovery. When Amelia joins Grey's in season 11, overcoming addiction remains an important part of her story line. Both series commonly discuss AA meetings, sponsors, and the "serenity prayer".

In Aaron Sorkin's political drama, The West Wing, the character Leo McGarry is an admitted alcoholic and drug addict. He is reluctant to attend regular AA meetings, feeling the high-profile nature of his position as Chief of Staff of the White House would encourage a media frenzy. The vice president (Tim Matheson) invites him to a "weekly poker game", which turns out to be a secret AA meeting known only to those invited.

Glass ceiling

From Wikipedia, the free encyclopedia
A chart illustrating the differences in earnings between men and women of the same educational level (USA 2006)
 
A glass ceiling is a metaphor used to represent an invisible barrier that keeps a given demographic (typically applied to minorities) from rising beyond a certain level in a hierarchy.

The metaphor was first coined by feminists in reference to barriers in the careers of high-achieving women. In the US, the concept is sometimes extended to refer to obstacles hindering the advancement of minority women, as well as minority men. Minority women often find the most difficulty in "breaking the glass ceiling" because they lie at the intersection of two historically marginalized groups: women and people of color. East Asian and East Asian American news outlets have coined the term "bamboo ceiling" to refer to the obstacles that all East Asian Americans face in advancing their careers. Similarly, a set of invisible obstacles posed against refugees' efforts to workforce integration is coined "canvas ceiling". 

Within the same concepts of the other terms surrounding the workplace, there are similar terms for restrictions and barriers concerning women and their roles within organizations and how they coincide with their maternal duties. These "Invisible Barriers" function as metaphors to describe the extra circumstances that women undergo, usually when trying to advance within areas of their careers and often while trying to advance within their lives outside their work spaces.

"A glass ceiling" represents a barrier that prohibits women from advancing toward the top of a hierarchical corporation. 

Women in the workforce are faced with "the glass ceiling." Those women are prevented from receiving promotion, especially to the executive rankings, within their corporation. Within the last twenty years, the women who are becoming more involved and pertinent in industries and organizations have rarely been in the executive ranks. Women in most corporations encompass below five percent of board of directors and corporate officer positions.

Definition

The United States Federal Glass Ceiling Commission defines the glass ceiling as "the unseen, yet unbreachable barrier that keeps minorities and women from rising to the upper rungs of the corporate ladder, regardless of their qualifications or achievements."

David Cotter and colleagues defined four distinctive characteristics that must be met to conclude that a glass ceiling exists. A glass ceiling inequality represents:
  1. "A gender or racial difference that is not explained by other job-relevant characteristics of the employee."
  2. "A gender or racial difference that is greater at higher levels of an outcome than at lower levels of an outcome."
  3. "A gender or racial inequality in the chances of advancement into higher levels, not merely the proportions of each gender or race currently at those higher levels."
  4. "A gender or racial inequality that increases over the course of a career."
Cotter and his colleagues found that glass ceilings are correlated strongly with gender. Both white and minority women face a glass ceiling in the course of their careers. In contrast, the researchers did not find evidence of a glass ceiling for African-American men.

The glass ceiling metaphor has often been used to describe invisible barriers ("glass") through which women can see elite positions but cannot reach them ("ceiling"). These barriers prevent large numbers of women and ethnic minorities from obtaining and securing the most powerful, prestigious and highest-grossing jobs in the workforce. Moreover, this effect prevents women from filling high-ranking positions and puts them at a disadvantage as potential candidates for advancement.

History

In 1839, French feminist and author George Sand used a similar phrase, une voûte de cristal impénétrable, in a passage of Gabriel, a never-performed play: "I was a woman; for suddenly my wings collapsed, ether closed in around my head like an impenetrable crystal vault, and I fell...." [emphasis added]. The statement, a description of the heroine's dream of soaring with wings, has been interpreted as a feminine Icarus tale of a woman who attempts to ascend above her accepted role.

The first person said to use the term Glass ceiling was Marilyn Loden during a 1978 speech. At the same time, according to the April 3, 2015, Wall Street Journal, completely independent of Loden, the term glass ceiling was coined in the spring of 1978 by Marianne Schriber and Katherine Lawrence at Hewlett-Packard. The ceiling was defined as discriminatory promotion patterns where the written promotional policy is non-discriminatory, but in practice denies promotion to qualified females. Lawrence presented this at the annual Conference of the Women's Institute for Freedom of the Press at meeting the National Press.

The term was later used in March 1984 by Gay Bryant. She was the former editor of Working Woman magazine and was changing jobs to be the editor of Family Circle. In an Adweek article written by Nora Frenkel, Bryant was reported as saying, "Women have reached a certain point—I call it the glass ceiling. They're in the top of middle management and they're stopping and getting stuck. There isn't enough room for all those women at the top. Some are going into business for themselves. Others are going out and raising families." Also in 1984, Bryant used the term in a chapter of the book The Working Woman Report: Succeeding in Business in the 1980s. In the same book, Basia Hellwig used the term in another chapter.

In a widely cited article in the Wall Street Journal in March 1986 the term was used in the article's title: "The Glass Ceiling: Why Women Can't Seem to Break The Invisible Barrier That Blocks Them From the Top Jobs". The article was written by Carol Hymowitz and Timothy D. Schellhardt. Hymowitz and Schellhardt introduced glass ceiling was "not something that could be found in any corporate manual or even discussed at a business meeting; it was originally introduced as an invisible, covert, and unspoken phenomenon that existed to keep executive level leadership positions in the hands of Caucasian males."

As the term "Glass Ceiling" got more issued within society, public responded with differing ideas and opinions. Some argued that glass ceiling is a myth rather than a reality because women chose to stay home and showed less dedication to advance into executive suite. As a result of continuing public debate, the US Labor Department's chief, Lynn Morley Martin, reported the results of a research project called "The Glass Ceiling Initiative" formed to investigate the low numbers of women and minorities in executive positions. This report defined the new term as "those artificial barriers based on attitudinal or organizational bias that prevent qualified individuals from advancing upward in their organization into management-level positions."

In 1991, as a part of Title II of the Civil Right Act of 1991, Congress created the Glass Ceiling Commission. This 21 member Presidential Commission was chaired by Secretary of Labor Robert Reich, and was created to study the "barriers to the advancement of minorities and women within corporate hierarchies (the problem known as the glass ceiling), to issue a report on its findings and conclusions, and to make recommendations on ways to dis- mantle the glass ceiling." The commission conducted extensive research including, surveys, public hearings and interviews, and released their findings in a report in 1995. The report, "Good for Business", offered "tangible guidelines and solutions on how these barriers can be overcome and eliminated". The goal of the commission was to provide recommendations on how to shatter the glass ceiling, specifically in the world of business. The report issued 12 recommendations on how to improve the workplace by increasing diversity in the organization and reducing discrimination through policy.

Number of women CEOs from the Fortune Lists has been increasing from 2012–2014, but ironically women's labor force participation rate decreased from 52.4% to 49.6% between 1995 and 2015 globally. However, it is evident that some countries like Australia has increased the labor force participation of women over 27% since 1978. Furthermore, only 19.2% of S&P 500 Board Seats were held by women in 2014, of whom 80.2% were considered white.

Gender pay gap

The gender pay gap is the difference between male and female earnings. In 2008 the OECD suggested that the median earnings of female full-time workers were 17% lower than the earnings of their male counterparts and that "30% of the variation in gender wage gaps across OECD countries can be explained by discriminatory practices in the labour market." The European Commission suggested that women's hourly earnings were 17.5% lower on average in the 27 EU Member States in 2008. A paper by political activist website "nationalpartnership.org" suggests that as of April 2017, women in the United States were on average paid "80 cents for every dollar paid to men, amounting to an annual gender wage gap of $10,470". It may help from a research perspective to note that there are many disagreeing viewpoints on this issue, and the research cited here is presented in favor of the side that asserts society's view on minorities is the cause of the pay gap. Moreover, "based on the human capital theory, not only the general gender-specific pay differentials, but also the different proportions of women and men in certain occupations and fields of work and thus the gender-specific labor market segregation is explained with the so-called self selection". In economics, there are various essential theories that describe the illegitimate part of the gender pay gap. Gary S. Becker's theory of "tastes of discrimination" indicates that there are some personal prejudices which concern cooperation with a certain group of people.

Glass escalator

In addition to the glass ceiling, which already is stopping women from climbing higher in success in the workplace, a parallel phenomenon called the "glass escalator" can be seen to occur. As more men join fields that were previously dominated by women, such as nursing and teaching, men are promoted and given more opportunities compared to women, as if men were taking escalators and women were taking the stairs. The chart from Carolyn K. Broner shows an example of the glass escalator in favor of men for female-dominant occupations in schools. While women have historically dominated the teaching profession, men tend to take higher positions in school systems such as deans or principals.

Men benefit financially from their gender status in historically female field, often "reaping the benefits of their token status to reach higher levels in female-dominated work."

A 2008 study published in Social Problems found that sex segregation in nursing did not follow the "glass escalator" pattern of disproportional vertical distribution; rather, men and women gravitated towards different areas within the field, with male nurses tending to specialize in areas of work perceived as "masculine". The article noted that "men encounter powerful social pressures that direct them away from entering female-dominated occupations (Jacobs 1989, 1993)". Since female-dominated occupations are usually characterized with more feminine activities, men who enter these jobs can be perceived socially as "effeminate, homosexual, or sexual predators".

Sticky floor

In the literature on gender discrimination, the concept of "sticky floors" complements the concept of a glass ceiling. Sticky floors can be described as the pattern that women are, compared to men, less likely to start to climb the job ladder. Thereby, this phenomenon is related to gender differentials at the bottom of the wage distribution. Building on the seminal study by Booth and co-authors in European Economic Review, during the last decade economists have attempted to identify sticky floors in the labour market. They found empirical evidence for the existence of sticky floors in countries such as Australia, Belgium, Italy, Thailand and the United States.

The frozen middle

Similar to the sticky floor, the frozen middle describes the phenomenon of women's progress up the corporate ladder slowing, if not halting, in the ranks of middle management. Originally the term referred to the resistance corporate upper management faced from middle management when issuing directives. Due to a lack of ability or lack of drive in the ranks of middle management these directives do not come into fruition and as a result the company's bottom line suffers.The term was popularized by a Harvard Business Review article titled "Middle Management Excellence". Due to the growing proportion of women to men in the workforce, however, the term "frozen middle" has become more commonly ascribed to the aforementioned slowing of the careers of women in middle management. The 1996 study "A Study of the Career Development and Aspirations of Women in Middle Management" posits that social structures and networks within businesses that favor "good old boys" and norms of masculinity exist based on the experiences of women surveyed. According to the study, women who did not exhibit stereotypical masculine traits, (e.g. aggressiveness, thick skin, lack of emotional expression) and interpersonal communication tendencies are at an inherent disadvantage compared to their male peers. As the ratio of men to women increases in the upper levels of management, women's access to female mentors who could advise them on ways to navigate office politics is limited, further inhibiting upward mobility within a corporation or firm. Furthermore, the frozen middle affects female professionals in western and eastern countries such as the United States and Malaysia, respectively, as well as women in a variety of fields ranging from the aforementioned corporations to STEM fields.

Glass Ceiling Index

In 2017, the Economist updated their glass-ceiling index. It combines data on higher education, labour-force participation, pay, child-care costs, maternity and paternity rights, business-school applications and representation in senior jobs. The countries where inequality was the lowest were, in order of most equality, Iceland, Sweden, Norway, Finland, and Poland.

Gender stereotypes

Gallup Poll: Men are more Aggressive, Women are more Emotional 
 
In a 1993 report released through the U.S. Army Research Institute for the Behavioral and Social Sciences, researchers noted that women have the same educational opportunities as their male counterparts, the Glass Ceiling persist due to systematic barriers, low representation and mobility, and stereotypes. Feminine stereotypes attributed to women is one widely recognized reason as to why female employees are systematically inhibited from receiving advantageous opportunities in their career field. A majority of Americans perceive women to be more emotional and men to be more aggressive than their opposite sex. Gender stereotypes influence how leaders are chosen by employers and how workers of different sex are treated. Glass ceilings can be observed in the typical American supermarket in which women are assigned to be cashiers due to the belief that women are better than their male co-workers at emotional management with customers. Journeyman clerks whom are mostly assigned cashier shifts experience a low quality of work and significantly less promotions. A class action lawsuit was filed against Lucky Stores for the unjust assignment of tasks to employees of different race and sex. Moreover, one of the stereotypes towards women in workplaces is "gender status belief" which claims that men are more competent and intelligent than women, thus they have much higher positions in the career hierarchy. Ultimately, this factor leads to perception of gender-based jobs on the labor market, so men are expected to have more work-related qualifications and hired for top positions.Glass Ceiling Effect and Earnings - The Gender Pay Gap in Managerial Positions in Germany. Perceived feminine stereotypes contribute to the glass ceiling faced by women in the workforce.

Types of women facing the glass ceiling in the workplace

"Intentional Entrepreneurs" illustrate women who are involved in their workforce and intentionally engage in the culture and operations of the particular workplace in order to triumph to entrepreneurial levels. (Miree)

"Corporate Climbers" are the result of deliberately or unintentionally being forced out of a corporation. They hit "the glass ceiling" of their previous business; thus, those women start their own.

"The intentional entrepreneurs" and "the corporate climbers" focus on the women who are competing for entrepreneurial positions against the men. Men who uphold the desire and determination for entrepreneurial positions are normally competing against other men, while women feel inclined to find ethical and logical reasons to enlighten corporate America or the particular workplace for why they are equally as qualified. Women are forced out of Corporate America, essentially reaching "the glass ceiling," women corporate climbers do not have another alternative other than starting their own business.

Hiring practices

When women leave their current business to start their own, they tend to hire other women. Men tend to hire other men. These hiring practices eliminate "the glass ceiling" because there is no more competition of capabilities and discrimination of gender. These support the segregated identification of "men’s work" and "women’s work."

Second shift

The second shift focuses on the idea that women theoretically work a second shift in the manner of having a greater workload, not just doing a greater share of domestic work. All of the tasks that are engaged in outside the workplace are mainly tied to motherhood. Depending on location, household income, educational attainment, ethnicity and location. Data shows that women do work a second shift in the sense of having a greater workload, not just doing a greater share of domestic work, but this is not apparent if simultaneous activity is overlooked. Alva Myrdal and Viola Klein as early as 1956 focused on the potential of both men and women working in settings that included paid and unpaid types of work environments. Research indicated that men and women could have equal time for activities outside the work environment for family and extra activities. This "second shift" has also been found to have physical effects as well, especially for women. Women whom engage in longer hours in pursuit of family balance, often suffer more mental health issues such as depression, anxiety, and other problems. Irritability, low motivation and energy, and other emotional issues have been found as well. The overall happiness of women can be improved if the balance of career and home responsibilities are met.

Mommy Track

"Mommy Track" refers to women who simply disregard their career and professional duties in order to satisfy the needs of their families. Women are often subject to long work hours that creates an imbalance within the work-family schedule. There is research suggesting that women were able to function on a part-time professional schedule compared to others who worked full-time while still engaged in external family activities. The research also suggests flexible work arrangements allow for the achievement of a healthy work and family balance. A difference has also been discovered in the cost and amount of effort in childbearing amongst women in higher skilled positions and roles, as opposed to women in lower-skilled jobs. This difference leads to women delaying and postponing goals and career aspirations over a number of years. A large number of women across the country who have vocational/professional certifications and degrees have been found to be not a part of the working force at the estimated rate more than twice times as male counterparts. Also, the Deloitte Touche, a professional hiring service firm, confirmed that they had recorded dropout rates in each entering class of hires and reported that indeed women's rates were very high compared to males due to mother- and family-related responsibilities.

Concrete floor

The term concrete floor has been used to refer to the minimum number or the proportion of women necessary for a cabinet or board of directors to be perceived as legitimate.

Cross-cultural context

Few women tend to reach positions in upper echelon and organizations are largely still almost exclusively lead by men. Studies have shown that the glass ceiling still exists in varying levels in different nations and regions across the world. The stereotypes of women as emotional and sensitive could be seen as key characteristics as to why women struggle to break the glass ceiling. It is clear that even though societies differ from one another by culture, beliefs and norms, they hold similar expectations of women and their role in the society. These female stereotypes are often reinforced in societies that have traditional expectations of women. The stereotypes and perceptions of women are changing slowly across the world, which also reduces gender segregation in organizations.

Gene

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Gene Chromosome ...