Discuss the Case Study The Management of excessive drinking and drug taking on the Family.
The assignment deals with the case study of Georg, 42 years old man having wife and three children. The case study describes the problem of excessive drinking by George and its impact on his family. In response to the case study the assignment outlines the diagnosis of the mental health issue(s)/disorder(s) of the family member(s) as highlighted in the case. The diagnosis is made in reference to the DSM-V criteria. It is the “Diagnostic and Statistical Manual of Mental Disorders” fifth edition (DSM-5). It is the latest version of the “American Psychiatric Association’s old-standard text” on the names, symptoms, and diagnostic features of every recognized mental illness—including addictions (Clarke et al., 2014). In the paper the rationale for every diagnosis is also given in reference to the information given in the case study. The paper then presents the case formulation where the particular features of the case study are related with contemporary literature. It means the problem faced by George and his diagnosis is discussed in reference to relevant theories and research in the area of substance disorder. Lastly, the assignment presents the treatment goals and planning for George. Based on the overall discussion the conclusion is drawn summarising all the points.
As per the given case study the clinical presentation of George is quite consistent with the DSM-V definition of disorder due to substance use. It defines the substance use (which in this case is alcohol) disorder as problematic pattern of taking alcohol that impairs the daily life or results in distress at noticeable level (Hasin et al., 2013). The features mentioned by this manual are- a) consumption of more alcohol then usually planned, b) substance use resulting in failure to fulfil the major role obligations, c) craving for substance d) continuing the use of substance despite the physical health issues. worsening of mental health or psychological problems such as depressed mood, anxiety, sleep disturbance, or blackouts e) continuing with substance use despite the deterioration of the relationship with others f) giving up the personal life activities for the drinking alcohol, g) building up tolerance to the substance where subsequent intake increase in large amount over time and h) experiencing of withdrawl symptoms when not using and may include irritability, anxiety, fatigue, tremor, nausea/vomiting and seizure. As per the DSM-V criteria the following symptoms should be noticeable within 12 months (American Psychiatric Association, 2013).
It can be concluded from the DSM-V criteria that George is suffering from Alcohol use disorder which is the problem drinking. It is the chronic brain disease that is characterised by the loss of control over alcohol intake and a compulsive alcohol use. It is also characterized with negative emotional regulation and state when not using (Kopak et al., 2014).
George clearly demonstrated each of the features of the substance use disorder as per the DSM-V criteria. George has always preferred and enjoyed social drinking and in recent times he has increased the intake amount. It means he was taking more than planned earlier. He was unable to withdraw from drinking although at house he was hampering his work life. He was sent home from work considering that he is intoxicated and it badly interfered with his job. A considerable number of times he has called in sick over the past few years. It also indicates that he was neglecting his physical health aspect for alcohol. His wife worries that he may lose his job which indicates that he is failing to fulfil major role obligations. It can also be considered the sign of craving the alcohol. He has also received warning from his boss on the note that his behaviour was unacceptable at workplace. It indicates that he continuing with substance use despite the deterioration of the relationship with others. At workplace, George spoiled his relationship with boss. At home he deteriorated his relationship with family members that are his wife and children. His behaviour has become unpleasant to an extent his wife Sandra had to isolate herself from George. A communication gap has formed between him and his wife (Orford, 2005). This behaviour indicates that George is giving up personal life activities for drinking alcohol.
Recently George stays mentally disturbed than before. He demonstrates frequent changes in mood with irritations and rudeness at times while remaining quiet and reserved at other times. It is the sign of increasing psychological problems or poor mental health status (Orford, 2005). It can be concluded from George’s case study that he is building up tolerance to the substance where subsequent intake increases in large amount over time. The frequent irritations and change in mood can be considered a withdrawl symptom. George may have decreased or may be trying to withdraw to save his job. Therefore, George has met all the DSM-V criteria mentioned above.
As per the DSM-V criteria Sandra’s clinical presentation is quite consistent with the diagnostic criteria for generalised anxiety disorder. The features that confirm this problem are: a) excessive anxiety and apprehensive expectation b) individual finding it difficult to control the worry c) anxiety and worry associated with restlessness, irritability, muscle tension, sleep disturbances, fatigue and difficult concentrating (Price & van Stolk-Cooke, (2015).
Sandra clearly exhibits some of the criteria such as worrying about George’s job, and deteriorating relationship with him, and overwhelming sense of fear and apprehension. She is wondering for guidance and is finding difficult to control worry as she is living with daily on-going worries and uncertainties that adds to nervousness and restlessness (Orford, 2005).
Further, the symptoms of Sandra such as accelerated heart rate or pounding heart rate and nausea are consistent with two of the DSM criteria for Panic disorder (Asmundson et al., 2014). However, most of her symptoms match with the general anxiety disorder than panic disorder.
A case formulation
As per the social learning theory by Albert Bandura, alcohol addiction is caused by the modelling behaviour of other people. Individuals observe other and tend to adopt similar behaviour feeling it to be beneficial. An individual tend to model similar behaviour that is alcohol intake if positive consequences have been found in others (West & Brown, 2013). Receiving rewards for such actions may further reinforce addiction in other people and attract them to such rewards. George enjoys social drink and his addiction may be the cause of social learning.
George’s addiction and diagnosis can be explained in reference to the Disease model. This model explains the origin of addiction lies within an individual (Volkow et al., 2016). The model explains that the addiction does not exist on a continuum. A person with alcohol addiction cannot control the carvings. This model can be related with George, who attended workplace intoxicated. He even neglected his physical and personal obligations for the pleasure of alcohol. As per this model the disease addiction is irreversible. It is the same with George. His alcohol consumption is increasing over time instead of decreasing. He needs treatment and lifelong abstinence for cure.
According to Sartor et al. (2016), the depressive episode after taking alcohol is high that is onset during intoxication and during withdrawal. This can be related with the mood changes and irritability of George in the case study. Tolliver and Anton (2015), explains this phenomenon with alcohol induced mood disorder. People may take alcohol to feel better but it may make them feel worse. Mostly people associate alcohol and drug with positive outcomes. People with excessive consumption of alcohol tend to lose interest in life and enjoyment. It may be the same with George. He may have lost interest in his married life and spending joyful time with his children and wife. The frequent change in mood is having significant impact on his family life. It is causing great deal of distress to both George and Sandra. This is an important criterion for diagnosis of Alcohol induced depressive disorder as per Riper et al. (2014). However, in case of George, depressive disorder induced by alcohol is not noticeable.
The psychodynamic model suggests that addiction is the self regulation disorder. It explains the addiction with childhood or early life exposure to adverse circumstances. Adults with such experiences in early life will fail to cope effectively with stress and regulate their negative emotions. Addiction in such cases may be defensive strategy to avoid powerlessness. Alcohol intake may be due to oral gratification. Such individuals tend to be addicted and are reported with anxiety and mood disorders (Flores, 2013). In then given case study the history of George is not available. It may or may not be the case of early life issues that caused his addictions but may be the cause of social learning.
As per the Alcoholics anonymous model those addicted to alcohol are emotionally impaired model. They continue with alcohol intake to compensate for their inadequacies. Owing to the body chemistry, a person gets addicted to alcohol and the cycle of drinking and inadequacies continue till it becomes addiction (Galanter, 2014). George’s life has become intolerable due to alcohol however, it is not clear if he started this due to inadequacies. Eventually the drinking pattern becomes uncontrollable due to withdrawl symptoms. This was evident in case of George as he was having frequent mood changes and his alcohol intake was also found to increase in last few years.
Lander et al. (2013) mentioned that alcoholic or addiction partners create negative impact on family life. Alcohol use decreases the marital satisfaction and threatens the stability of marraige. Emotional stress and financial worries is a common suffering of being a partner of alcoholic. Wives of alcoholics face physical, psychological and social challenges and emotional problem is the highly reported one. Sandra is unable to cope with mood swings of her husband. His job being at stake added more emotional stress in her. Further, communication barrier and unpleasant attitude of George with family creates uncertain environment. Children are too negatively affected by the alcoholic parents as they have high chance of developing emotional problems.
Treatment Goals and Planning
The treatment goals for George includes (Galanter, Kleber, & Brady, (2014)-
- Alcohol withdrawl treatment goals- reduce the withdrawl symptoms, control the medical issues, and develop plan for mental and physical health. The expected outcome is the withdrawl without the need of medical monitoring
- Intense outpatient treatment goals- treatment encompassing the cognitive and behavioural aspects to reduce the severity of issues. The expected outcome is that patient actively engages in the recovery process. George to be able to recognise, label and express feeling and concerns. The goal is to reduce the need of intensive management of George.
- Relapse prevention goals-Help patient in identifying the relapse triggers and plan to deal with potential relapse. The desired recovery outcome will be to help George totally remain abstinent from alcohol
Treatment for George may include cognitive behavioural therapy and insight-oriented components. The supportive treatment may include psycho education, motivation, and empathy to support behavioural changes. As per Carr (2014), cognitive behavioural therapy has been found valuable in treating alcoholism and drug addiction. In this therapy, George will learn to recognise factors or conditions in which he is highly like to drink, avoid the factors causing it and cope up with same. Cognitive support and psycho education elements address the denial and distorted thinking found initially in every addiction patient. The therapist will help George in identifying his thoughts, and feelings and risk of relapse. Next, to it motivation and empathy is to develop the willingness in George before beginning of treatment (Schrode, 2014). The insight oriented components of the treatment may refer to interpersonal relationships, conflicts, and self belief. Dealing with conflicting situations leading to alcohol consumption may enhance new coping skills. There are various randomised control trails highlighting the efficacy of cognitive behavioural therapy. It is one of the most frequently used psychosocial approach. It works best with other treatment approaches and programs.
With the help of Alcoholics Anonymous program the patient may be able to overcome the urge to stop drinking. It is the 12 step program and is recognised as most popular recovery program. It provides the patients with tools to live sober. Detoxification is the phase of treatment that can be delivered on an inpatient and outpatient basis. This stage needs medical evaluation and treatment. This stage involves medical management of withdrawl symptoms on an outpatient basis or in hospital. For this process taking away the alcohol does not suffice, it requires the behaviour therapy and insight oriented components (Van Wormer & Davis, 2016).
Active treatment includes intense support and help is vital during early months of treatment as relapse is highly likely. This stage is followed by motivation necessary to remain abstinent from alcohol. At this stage medications can also be used to help George with craving. Maintaining the sobriety and relapse prevention may also require self help groups and discussion forums as a part of outpatient treatment. It helps maintain the recovery state (Van Wormer & Davis, 2016).
During recovery Sandra and children too can be involved to give George emotional support and strength. Family influence is pivotal in shaping the addiction behaviour. Problem behaviour of George can be addressed by effective communication between Sandra and him, bonding with his children and effective family management. As per literature review; family focused interventions have been successful in patient’s addiction management as it gives feeling of protection and confidence. Couple therapy, family therapy and systemic interventions for adult-focused problem are effective in dealing the relationship and mental health problems (Carr, 2014). Participating George’s recovery program may Sandra overcome her restlessness and fears. It will reduce her stress and anxiety and she may be well able to concentrate on family and work responsibilities.
Considering the DSM-V criteria It was found that George is suffering from alcohol addiction and his wife was experiencing symptoms of generalised and panic disorder. In case of George all the DSM-V criteria was matched but not in Sandra. In the paper the rationale for every diagnosis is also given in reference to the information given in the case study. The paper then presents the case formulation where the particular features of the case study are related with contemporary literature. George’s condition can be explained by social learning theory, alcoholics anonymous and disease model. His condition cannot be well explained by psychodynamic model. Alcohol use decreases the marital satisfaction and threatens the stability of marraige. Emotional stress and financial worries is a common suffering of being a partner of alcoholic. The same was evident in Sandra. Lastly, the assignment presents the treatment goals and planning for George. Treatment for George may include cognitive behavioural therapy and insight-oriented components. The supportive treatment may include psycho education, motivation, and empathy to support behavioural changes. Couple therapy, family therapy and systemic interventions for adult-focused problem are effective in dealing the relationship and mental health problems.
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