Abstract
This case study examines the problem of deviation of normal relationships in families of persons with alcohol dependence. The case given for analysis describes rather typical situation of families with excessively drinking husbands. The case study aims at formulating the overall strategy of finding the way out for the members of such families. Particular attention is given to providing social support for the victims of the excessive drinking as psychological disorder. Special psychological phenomenon of "codependency" is defined throughout the research. This phenomenon is reflected in the psychological characteristics of wives and children, indicating the formation of dependent behavior of family members. These issues require special attention during the rehabilitation of patients with alcohol dependence, the organization of psychological assistance to their families. In process of preparing the case study different analytical and statistical methods were applied in order to make reality-based conclusions and reduce the disruptive impact of personal attitudes.
Key words family relationships, alcohol dependence, case study, dependent, codependent, emotional communication, disruptive relationships, excessive drinking.
DSM V diagnosis
DSM-4 consists of classification of two distinct disorders, such as alcohol dependence and alcohol abuse. It includes specific criteria of identification. The classification provided by DSM V integrates alcohol abuse and alcohol dependence into alcohol use disorder. The mild, moderate, and severe sub-classifications are included. Long-term misuse of alcohol is characterized severe cognitive problems such as all dementia cases.
As for the particular case given for analysis, it should be noted that diagnosis of James is severe alcohol use disorder. The symptoms of James according to DSM V diagnosis are drinking more that was intended, spending a lot of time drinking, job troubles, troubles with the family, experiencing dangerous situation while working, depression, anxiousness and restlessness. These symptoms indicate that James suffers from alcohol use disorder in the severe form. At the same time other factors should be taken into account.
Alcohol consumption is significant phenomenon associated with such social categories as traditions and customs, on the one hand, and public opinion and fashion, on the other. (Hingson, 2012) For some people excessive drinking is the consequence of psychological features of the personality, his attitude to alcohol as a "cure" warming drink etc.
In context of psychological development of personality the terms of dependency and codependency explain the impact of the drinkers behavior on his relatives that may lead to the following serious problems. Basis of alcohol dependence and co-dependence comes from the earliest childhood in the parental home, where assimilated the main methods of response regulations; a system of relations is built in the image of the parent and formed a life script. The emotional sphere is disturbed for both dependent and codependent members of the family. Co-dependents tend to hide their true emotions, and the better they hide them, the easier they get help and support from family and friends. Dependents act in more impulsive way and clearly articulate their negative emotions. (Lygidakis, Rigon, Cambiaso, et al., 2010)
Dependent persons feel a deeper support from family and friends, if they can show aggressive behavior that is partial result of the codependents tendency to hide emotions and support the patient relative to alcohol. (Hingson, 2012) In the family of the patient alcohol addiction the inharmonious styles of parenting that causes different types of disorders for the child. Moreover, from the dependent and co-dependent influence on the child equally negative. Data of dysfunctional behavioral mechanisms are absorbed by the child and are often reproduced in his own family in relation to his own children.
In order to improve rehabilitation of patients alcohol dependence, it is advisable to rely on the following principles. Practical work in rehabilitation centers should be conducted not only with patients that are alcohol dependent, but also with their relatives that are codependent. Rehabilitation codependents require more effective methods of team work than individuals. At the early stages of group work with relatives the emphasis should be placed on informing of issues of codependency. During rehabilitation with the aim of identifying new ways of understanding and solving the problem of codependency in the therapeutic groups it is recommended to use of the method of psychodrama. To increase the efficiency of rehabilitation activities and achieve maximum results it is recommended that all members of the family should be involved.
Excessive drinking is a serious chronic disease that is in most cases intractable. It develops on the basis of regular and prolonged use of alcohol and is characterized by special pathological condition of an organism: an uncontrollable inclination to alcohol, change of the degree of tolerance and degradation of the individual. For dependent people intoxication is viewed to be the best mental condition.
The psychological mechanism of alcohol dependence is the destruction of the natural regulatory system of the psyche and the replacement of its functions by the use of alcohol. Dependent people consuming alcohol regularly after a while face with difficult psychological problems that they are unable to overcome without the use of alcohol. Therefore, from a psychological point of view, recovery from alcohol addiction is the reconstruction of identity with the restoration of the ability to solve the psychological problems in a sober state. Alcoholism is a pathological condition characterized by a painful addiction to alcohol and the defeat of the body caused by chronic alcohol intoxication.
Members of families with alcohol dependence are denying their problems, high resistance to work, low motivation to make some changes. Therefore, the motivational component in working with such families is one of the most important. In Europe and America, alcoholism is the most common form of substance abuse. There is a direct relationship between the amount of absolute alcohol consumed per capita per year and the prevalence of alcoholism in society. (Paschall, 2003)
Thus, in France, the country with the largest amount of absolute alcohol consumed per capita (us $ 18.6 liters per year), the number suffering from chronic alcoholism presents approximately 4% of the total population and 13% of the male population (20 to 55 years). In Canada, this number involves 1.6% of the total population.
Alcoholism is one of the varieties of drug addiction. At the heart of its development lies both mental and physical dependence on alcohol.
The process of excessive drinking comes from the influence of external and internal factors. The external factors include features of the education and human habitation, the traditions of the region, stressful situations. Internal factors are genetic predisposition to alcoholism. At the moment the existence of such a predisposition is no doubt. Family members of alcoholics are imposed to the risk of developing disease is about 7 times higher than the people without dependant people in their families. In this regard, it is important to distinguish the alcoholism of two types:
Alcoholism type I develops under the influence of both external and internal (genetic) factors. This type of disease is characterized by early onset (or young teens), develops only in men, and runs hard.
Alcoholism type II develops purely because of genetic predisposition of the person to the type of the disease and, in contrast to the alcoholism of the I-th type starts later and is not accompanied by aggressive behavior and criminal tendencies of patients.
A case formulation
As we mentioned above the situation described in the case is typical for families that face with the problem of extensive drinking of man. The case study considers the ways in which family members find the substance misuse to be a problem, how they try to make sense of it and it makes them feel. James, the husband, started to drink alcohol more often than usually. Jenny, the wife, is codependent person as her normal living has significantly changed.
Jenny has been feeling extremely stressed at the thought of James losing his job. She is also very worried that her and James’s relationship has deteriorated and become unpleasant. The unpleasantness of her husband’s behavior towards her and the children means that Jenny has started to isolate herself from her husband by communicating very little with him. There have been frequent sudden changes in James’s mood, and often there was no way of knowing what mood he would be in when he returned home. James would sometimes be irritable and rude; other times he was quiet and reserved. As for the particular case given for analysis, it should be noted that diagnosis of James is severe alcohol use disorder. As more than six symptoms (exactly seven) were described in the case.
It should be noted that James is person with psychological disorder that means that his actions are beyond his control. At the same time significant problem of excessive drinking is at the beginning. It means that the conflict of the family still may be solved in case of immediate actions taken such as rehabilitation and psychological support rendered by specialized authorities. It is important to mention that the children are also involved to the problem.
Jenny and James have 3 children: Chloe (age 16); John (aged 14) and Charlotte (aged 12). That is why additional psychological treatment will be needed. The age of the children may cause the complexity due to their teenage maximalist views. They are almost adult so they cannot be told a pleasant lie that everything ok in their families. Now they start their social and then sexual life and the behavior of their father may lead to serious uncertainty of actions and wrong choose of their road in life.
Two children are girls and they want to resemble their mother that may lead in the long run to inability to resist the family violence. John may copy the behavior of the father and start drinking. That is why it is important to prevent such scenarios of the development of children. All the measures should focus primarily on doing best in order to save the family. But in case James will do nothing to start rehabilitation it will be better to isolate children for definite period of time. James more likely suffers the alcoholism of the first type.
The fact that James has no professional background reaffirms the statistics that such cases are more likely to happen in families with person without required education. It should be noted that James started drinking in his social environment and he should keep working in order to cover the expenses of the family partially. In case his job is lost, the volume of excessive drinking will increase, so the way out will be even impossible to find.
At the same time the number of years the couple has lived together and the fact of having three children is the prerequisite of returning of the family to their normal life. The chances that the treatment will have positive outcomes are quite high. The best solution is to start treatment immediately with the participation of all members of the family.
Moreover as for the case details it is necessary to find out whether the problem of excessive drinking of James is genetic or accepted. On this fact the choice of treatment depends. For this end it should be made clear whether the closest relatives of James such as parents, grandparents or others have the same kind of dependency on alcohol.
Treatment Goals and Planning
The centered of alternative treatment of excessive drinking New life has developed its own theoretical concept of psychological recovery from alcohol dependence: an Integrative student-centered educational model (ISCEM). In this model, the recovery goes through six phases, each solving specific problems. It was considered to apply this system of treatment as basis for solving the case with some significant changes to make it more suitable the particular situation of James.
Phase 1. Taking responsibility for recovery. The objective of this phase is to help the dependent:
a) recognize the existence of problems in your life related to alcohol consumption;
b) to recognize the impossibility of control over alcohol use;
c) to recognize the presence of physiological, psychological, social disorders and personal problems;
d) to admit the need for independent work and professional assistance;
d) to abstain from alcohol and learn to apply the basic strategies to support sobriety.
Phase 2. Stop compulsive. The objective of this phase is training in alternative constructive ways (coping skills) of social behavior, situational planning, emotional response and thinking.
Phase 3. Emotional stabilization. The main objective of this phase is elaboration and control of relevant intrapersonal and social conflicts, destructive psychological patterns. The objectives of this phase are:
the development of management skills
the internal state of the adaptive communication with people outside the support system of sober, searching and having fun sober.
Phase 4. Social stabilization. The goal of this phase is to achieve the Jamess awareness of being a unique independent person with his own goals in life and give the motivation for him to pursue those goals (identity in the theory of Erickson). The task of this phase is to identify the origins of psychological conflicts, study of children's problems, etc.
Phase 5. Personal identification. The purpose of this phase is the awareness of other people and the world as independent objects with their goals and aspirations, establishing friendly relationship with them, and taking into account not only personal interests but also the interests of others.
Phase 6. Moral stabilization. The goal of this phase is the realization of the meaning of life, further strengthening a full-fledged relationship with himself, the environment, the world and God on the meaningful basis.
The timeline of these stages of recovery takes 5-6 years, of which especially the crisis and threat to return to the abuse of alcohol may occur during the first 2-3 years. Effective recovery of James in the early stages can provide professional rehabilitation program for alcohol addicted (inpatient and outpatient), further work with a psychologist and therapy groups specialized for alcohol problems.
Working with families with alcohol dependence involves complex social and psychological events, that can be divided into five areas:
psychological rehabilitation of dependent person,
psychological rehabilitation of codependent person,
psychological work with childhood trauma,
family counseling and therapy (a solution to the problems of relationships in the family as in the system),
tackling of common social issues of the family and its individual members.
The absence of even one of these areas significantly increases the probability of the negative result. This thesis can be defined as a methodological paradigm in social work with dependent families. This paradigm should be applied in working with James. Chloe, Charlotte and John should be involved to the process of therapy. It should be noticed whether they have already got the psychological trauma invoked by the behavior of James. Moreover it is necessary to formulate what is their personal attitude to drinking and whether they have consumed alcohol already.
For the given case we shall distinguish the following steps of social work with families with alcohol dependence.
The distancing.
Family members maximally psychologically shall limit the interaction with each other. (Jenny already started to avoid conversation with James in order to minimize the risk of possible uncontrolled aggression of him)
Rehabilitation.
Family members work on their own problems of addiction and codependency. For this end having vacation for Jenny and children is really good solution.
Convergence.
Family members learn new pattern of interaction with each other. The common hobbies and ideas may unite the family.
4. Restructuring of family experience.
Family members are reconsidering their family experience, forgive wrongs, they are exempted from the accumulated negative.
Harmonization.
Family comes to harmonious relationships.
Family re-socialization.
View the family as a social cell in society, the new extended family social objectives and social relationships.
The most acceptable form for such general work with the family is social support. The strategy for social support of families with dependency problems comprises the following components:
1. Training: familiarization with all available information about family planning intervention;
2. The development of trust and contact professionals with family members;
3. The revelation of the essence of family problems and motivational work for their solution;
4. The definition of the way out for family in a difficult situation, identification of existing resources of the family, the content of the required assistance and support from specialized services;
5. Implementation of the plan and involvement of specialists that can help in solving problems.
6. The controlling of the family (can last from 2-3 to 5-6 years). In the course of working with the family new problems may occur, and the initial solution of many "old" problems may be gradual.
As a particular "style" of social support for families with alcohol dependence that are substantially different from social support from other types of families, we highlight the psychological focus and tactical plan.
The tactical plan While solving problem of the family it is difficult to create a strategic plan of action, which could be maintained for a long time. This is because of the fact that often the problems to be addressed in order to motivate their decisions can be determined only partially. Family members often change goals and priorities, thus work with such family is full of crises that require changes to work priorities. Therefore, social support should focus on the overall strategy, and rely on a sequence of tactical plans that are often adjusted and completely change.
The integrative role of the social worker Work with this family may occur to be difficult. Each of the areas of work should be conducted by an independent specialist or even organization (e.g., rehabilitation center), with defined strategy work. The function of the social worker in this case is the integration of all these areas, into easily-controlled system, or even leading the process of general rehabilitation.
Conclusions
Excessive drinking is significant problem that the family described in the case has faced with. In the case study we have analyzed the general approaches applied to dealing with such a problem and formulated the action plan of rehabilitation of the family. It should be noted that the rehabilitation should involve not only dependant person, but also his wife and children in order to find out the way out.
References
Abbey, A. (2002). Alcohol-related sexual assault: A common problem among college students. Journal of Studies on Alcohol, 4(28), 118–128.
Alexander, E. (2015). Excessive drinking in college: Behavioral outcome, not binge, as a basis for prevention. London: Addictive Behaviors.
Boekeloo, B., Novik, M., & and Bush, E. (2011.). Drinking to get drunk among incoming freshmen college students. American Journal of Health Education, 2(42), 88–95.
Boyer, K., Olson, J., Calatone, R., & Jackson, E. (2002). Print versus electronic surveys: A comparison of two data collection methodologies. Journal of Operations Management, 3(13), 357–373.
Butler, L. (2009). Brief alcohol intervention with college student drinkers: Face-to face versus computerized feedback. Psychology of Addictive Behaviors, 1(23), 163–167.
Carpenter, C. (2011). The minimum legal drinking age and public health. Journal of Economic Perspectives, 2(25), 133–156.
Hingson, R. H. (2003). Early age of first drunkenness as a factor in college students’ unplanned and unprotected sex attributable to drinking. Pediatrics, 1(27), 34–41.
Hingson, R. H. (2012). Young adults at risk for excess alcohol consumption are often not asked or counseled about drinking alcohol. Journal of General Internal Medicine, 5(32), 179–184.
Hingson, R., Heeren, T., & Winter, M. (1994). Lower legal blood-alcohol limits for young drivers. Public Health Reports, 8(47), 738–744.
LaBrie, J., Huchting, K., & Tawalbeh, S. (2008). A randomized motivational enhancement prevention group reduces drinking and alcohol consequences in first-year college women. Psychology of Addictive Behaviors, 1(13), 140-155.
Larimer, M. (2002). Identification, prevention and treatment: A review of individual-focused strategies to reduce problematic alcohol consumption by college students. Journal of Studies on Alcohol, 10(53), 148-156.
Lygidakis, C., Rigon, S., Cambiaso, S., et al., (2010). A web-based versus paper questionnaire on alcohol and tobacco in adolescents. Telemedicine Journal and E-Health, 9(16), 925– 930.
Meilman, P., Presley, C., & Cashin, J. (1995). The sober life at the historically black colleges. Journal of Blacks in Higher Education, 8(26), 326-340.
Miller, N., & Gold, M. (1991). Alcohol. New York: Plenum Publishing Company.
Mundt, M., Zakletskaia, L., Brown, D., & Fleming (2012). Alcohol-induced memory blackouts as an indicator of injury risk among college drinkers. Injury Prevention, 5(43), 44–49.
Naimi, T., Nelson, D., & Brewer, R. (2010). The intensity of binge alcohol consumption among U.S. adults. American Journal of Preventive Medicine, 4(23), 55-89.
Nash, R. (2011). Reconstructing alcohol-induced memory blackouts. Memory, 5(21), 566–573.
Norberg, K., Bierut, L., & Grucza, R. (2009). Long-term effects of minimum drinking age laws on past-year alcohol and drug use disorders. Alcoholism: Clinical and Experimental Research, 2(28), 2180–2190.
Paschall, M. (2003). Does heavy drinking affect academic performance in college? Findings from a prospective study of high achievers. Journal of Studies on Alcohol, 1(16), 515–519.
Paschall, M., Antin, T., Ringwalt, C., & Saltz, R. (2011). Effects of Alcohol on alcohol-related problems among freshmen: A randomized multicampus trial. Journal of Studies on Alcohol and Drugs, 5(24), 642–650.
Patrick, M., Lewis, M., Lee, C., & Maggs, J. (2013). Semester and event-specific motives for alcohol use during Spring Break: Associated protective strategies and negative consequences. Addictive Behaviors, 2(23), 115-140.
Perry, P., Argo, T., & Barnett, M. (2006). The association of alcohol-induced blackouts and grayouts to blood alcohol concentrations. Journal of Forensic Sciences, 8(35), 896– 899.
Powell, L., Williams, J., & Wechsler, H. ( 2004.). Study habits and the level of alcohol use among college students. London: Education Economics .
Reboussin, B., Song, E., & Wolfson, M. (2011). The impact of alcohol outlet density on the geographic clustering of underage drinking behaviors within census tracts. Alcoholism: Clinical and Experimental Research, 5(18), 1541–1549.
Shadish, C. (2010). Statistical conclusion validity and internal validity. In C. a. Shadish, Evaluation (pp. 33-63). London: LPP.
Straus, R. (1953). Drinking in college. New Haven: Yale University Press.
Tanaka, E. (2016). Toxicological interactions between alcohol and benzodiazepines. Journal of Toxicology. Clinical Toxicology ., 1(40), 69–75.
