The Management Of Excessive Drinking And Drug Taking On The Family

Diagnosis of George’s Substance Use Disorder

Question:

Discuss about the Management Of Excessive Drinking And Drug Taking In The Family.

It is  known to everyone that if any individual in a family who is into excessive drinking or into drugs then it will in turn effect the whole family because they will try to help the member but will get themselves pulled down to the bog. However, for a couple it is not easy to be with a partner, who is into excessive drinking and drug use because the relationship will get into conflicts, blaming one another and finally became a burden without love. The partner of the addicted often is hurt, afraid, and ashamed or suffers from a sense of failure. Family members mainly try to cover up the mess and often are found taking more responsibilities and fighting the lost battle with their dear ones (Orford et al., 2013). Heavy drinking and drug use can not only affect the family but also can heavily affect career, health and other aspect of a person’s life. Consuming drug or alcohol also equally affects not only men but also women, as alcohol is more absorbent in a women’s bloodstream, as they are lacking enzyme which alcohol dehydrogenate in the stomach, where as in men the alcohol is broken down before it gets absorbed. Substance abuse mainly includes the persistent use of both alcohol and drugs. In this report, a case study of ‘The management of excessive drinking and drug taking on the family’ is analyzed in three broad headings mainly comprising of the diagnosis, case formulation and treatment plan.

George from the case study has been diagnosed with Substance use disorders. According to DSM-V substance use disorders mainly results from the use of separate classes of drugs like alcohol, cannabis, caffeine, hallucinogens, opioids, sedatives, inhalants, tobacco and many more such substances. However, in case of George in this case study he has been addicted to alcohol for the last 5years. As per DSM-V George, falls mainly under Alcohol related disorder because as the diagnostic criteria suggest that a person should have at least two of the issues that must have occurred within a period of 12 months (American Psychiatric Association, 2013). Therefore, in case of George the points, which are matching with that of DSM-V criteria, are that alcohol is consumed excessively or over longer time periods, repeated alcohol consumption is hindering to complete the role at work, school or home, recurrent use of alcohol despite of falling sick. Followed by continuing alcohol consumption despite having issues in the social as well interpersonal relations, important occupational activities are given up or have decreased because of alcohol consumption and lastly, alcohol consumption is continued even knowing that there will be a physical or psychological issue that have chances to take place due to excessive drinking (American Psychiatric Association, 2013).

Diagnosis of Sandra’s Stress and Anxiety

On the other hand, living with a husband like George his wife named Sandra is ongoing extreme stress that George will lose his job because of his excess alcohol consumption, which is troubling his career along with having a deteriorated relationship with her husband. She has been found facing a sense of fear as well as apprehension, nausea along with an irregular heart beating in few occasions (Spielberger, 2013). Therefore, Sandra is diagnosed with stress and anxiety. As per DSM-5 that are used to diagnose Anxiety disorders, Sandra has been found to worry excessively about her husband’s health as well as financial matters but not more than 6 months. Along with it as per DSM-5 criteria, the individual suffering from anxiety can also experience symptoms like sweating, nausea or diarrhea. Sandra has been encountered with nausea (American Psychiatric Association, 2013). However, as Sandra in few occasions has been found having feelings of fear and irregular heartbeats thus, she is anxiety attacks which is according to DSM-5 called the panic attack which is the sudden onset of fear or may be discomfort and reaches the peak which any 4 symptoms of the DSM-5 list of criteria. However, Sandra’s symptoms that are matching with DSM-5 criteria of panic attack are pounding heart rate, nausea, fear of losing control or going crazy and discomfort (American Psychiatric Association, 2013).

Causes of George’s mental health issue

According to the researches, it has been proved that there has been a close association between alcoholism and biological factors mainly genetics and physiology. There are certain chemicals in the brain that can make an individual susceptible to alcohol abuse. According to the scientists, alcohol dependence may be associated with up to 51 genes in different chromosome regions (Enoch, 2012). Therefore, if these genes are passed generation after generation then family members get more prone in acquiring irregular drinking habits. Some can limit the amount of alcohol they consume while others feel a strong impulse of getting drunk. Repetitive behaviors make a person more vulnerable to become alcoholic (Kissin, 2013). Alcoholism is frequently seemed as a trait of broken families. If any member in the family is alcoholic then it disrupts the healthy and normal family dynamics, creating many issues that ultimately lead to dysfunction. The spouse of an alcoholic often fined doubting his or her partners, but alcoholism is a disease not a fault of anyone. Children of parents who were alcoholic can fall into various unhealthy roles (Jayne, Valentine & Gould, 2012). Thus, biological factors as well as family can be a cause of George’s mental health issue.

Causes of George’s Mental Health Issues

There are various psychological factors as well which can increase the chances of heavy drinking. Every individual has their unique ways to handle situations and therefore, the way one cope with these feelings actually influences certain behavioral traits. For instance, those who have high stress, anxiety, depression or any other mental condition are more prone to develop alcoholism. In these situations, alcohol mainly withholds feelings and replaces the symptoms of psychological disorders. However, with time drinking becomes a habit and guides to Alcohol use disorder. The more one uses alcohol to ease their feelings of pain, the more their body becomes tolerant to alcohol and relies on its effects. Alcohol abuse can further co-occur with depression, bipolar and schizophrenia and can further cause serious side effects (Heinz et al., 2013).

Cause of Sandra’s Stress

Social causes can enhance stress like living in an area where the place is too crowded, pollution, crime or even noises can create chronic stress for an individual. Along with other social causes like not having enough money to cover the expenses, loneliness, any kind of discrimination or sexual orientation can add stress to one’s life (Patki et al., 2013).  However, for Sandra she is always stressed that her husband will lose his job that will lead to financial crisis as they have three children. Moreover, she is also getting isolated from her husband, which is making her lonely. Therefore, social cause is there which is affecting Sandra. The job structure or unemployment can also bring stress to someone. However, Sandra is working as Manager in a large insurance company, which means that she has high workload as well as work pressure. As she is an office manager thus, she has huge responsibilities, which increases her already existing stress about her husband, his career as well as their relationship (Khamisa et al., 2015).

Possible dangers of the children getting affected-

The three children of George and Sandra can get severely affected growing up with an alcoholic parent because psychologically they can suffer from guilt, anxiety, embarrassment, confusion, anger and depression. In their own adulthood, they might also face risks of mental health trauma or substance abuse. Moreover, their children can adapt to antisocial behavior and may have difficulty in forming relationships (Lander, Howsare & Byrne, 2013). Children growing up with an alcoholic parent means to have a traumatic childhood experience. The children can often feel neglected and thus, are more prone of getting emotionally, physically or sexually abused. Their children can further become secretive and may stay away from friends because of being ashamed (Velleman & Orford, 2013).

Psychological factors leading to heavy drinking

Consequences if help is not provided to them-

If immediate help is not provided to them then it will affect George, Sandra and their children immensely. For George, alcohol will have short-term as well as long-term effects along with few side effects like depression, liver damage, and cancer as well as reduced sexual performance. Further excess alcohol consumption can cause death of the brain, cirrhosis, pancreatitis, tolerance or lastly alcohol dependence (Lieber, 2012). Then for Sandra, her stress and anxiety can have negative effect on her physical health as well mental, emotional and even on her social life. Not only her immune system will get affected due to stress and anxiety but it will also affect her digestive, cardiovascular, musculoskeletal as well as well reproductive system along with other physical problems (Cooper & Marshall, 2013). Lastly, growing up with alcoholic father and mother with stress and anxiety will have negative effect on the kids as well which is not only make them feel neglected but also make their childhood traumatic. This will further be reflected in their adult life. Therefore, they are all in need for immediate help before it is too late.

Treatment for George-

Depending of the need of the clients the treatment for alcohol use disorder can vary. However, George’s treatment may include a brief intervention in the beginning followed by individual counseling, an output patient program or a residential inpatient stay. Nevertheless, currently the treatment plan for George may begin with a detoxification or Detox which is withdrawal that is managed medically. It takes two to seven days. George may need sedating medications so that the withdrawal symptoms can be prevented (Stephens et al., 2014). Counseling as well as therapies are very much helpful for better understanding the problem of George and support recovery from his psychological aspect of alcohol use. Therapies like behavioral therapies along with CBT therapy, motivational enhancement therapy(MET) can be very much affective to people suffering from substance use because CBT will help George to think in an alternative way and avoid behaviors that are harmful for him and MET will self motivate and educate him about health risks from alcohol addiction.(Dermatis & Egelko, 2014). Moreover, marital and family counseling is also helpful because it will help improving the family relationships as well as repair and enhance his relationship with his wife. Drug like disulfiram (Antabuse) can be prescribed to George to prevent him from drinking. However, this medicine cannot completely cure alcohol use or wipe out the compulsion to drink but if this medicine is taken then this drug will produce a physical reaction, which in turn will produce flushing, nausea, vomiting and headaches. Another drug called naltrexone (Revia) can prevent heavy drinking and lower the urge to drink as it obstructs the good feelings alcohol produces. Acamprosate (Campral) can also be helpful in this case, as it will help George to combat alcohol cravings once he stops drinking (Froehlich, Hausauer& Rasmussen, 2013). Lastly, medical treatment should be continued because health will definitely improve if George stops drinking but few health conditions will remain and will be needing treatment and follow-ups.

Social Causes leading to Sandra’s stress

 Treatment for Sandra-

Sandra’s treatment plan will exclude those drugs containing stimulants as can make her conditions worse thus Sandra should avoid that along with regular use of caffeine related drinks. Along with she must also avoid medicines like diet pills, asthma inhalers and thyroid medications. Then she will need techniques for managing daily stress and anxieties, as it is very normal that stress and anxiety will occur from time to time. Sandra needs to pay little attention to know that how her body and mind responds to the stressful situation so that the next time in a similar stressful situation she can anticipate her reactions and it gets less troublesome. She should also eat balanced diet, get enough sleep, meditate, practice deep breathing and talk to friends (Sharma & Rush, 2014).CBT therapy can be helpful to Sandra as this therapy is very much effective for managing anxiety. This therapy will further teach Sandra how she can recognize anxious thoughts as well as behaviors and modify them into ones that are more positive (Arch et al., 2012). Counseling, this will be effective for Sandra to fight with stress and anxiety because this is the best-known talking therapy that she can easily avail. Counseling may be of 6-12 sessions each about an hour long. Sandra can talk to her counselor with confidence and he/she can help her think about her situations. Counseling is the best help for those who are healthy but need little help to cope up with their present crisis. In Sandra’s case, relational counseling will also be effective because her husband’s alcohol use has ruined their relationship, which is also an important cause of her stress and anxiety. Thus, relationship counseling can also help her if both the partners talk in confidence to the counselor/therapist to discover what exactly has been wrong in their relationship and how together they can make things better. This will further help Sandra and George to learn about each other’s needs and will enhance their communication (Petch et al., 2014).

Treatment Goal for George-

By following this treatment plan slowly and steadily George’s excessive alcohol consumption can be brought under control. Further, after this treatment his physical and mental health conditions will also improve. Moreover, if his alcohol consumption is controlled then his social and personal life will become hassle free. Therefore, he can continue to lead a healthy and peaceful life without frequently falling sick or without the fear of losing his job. Thus, the main goal is to control George’s drinking habit and improve his mental as well as physical health as of now.

Potential dangers of children being affected

Treatment goal for Sandra-

If the treatment plan of Sandra is followed appropriately then definitely she will be able to control her level of stress and anxiety that she faces now. Controlling her stress and anxiety level will definitely save her from many long-term mental and physical illnesses. Thus, implementing the treatment for Sandra in a successful way will surely give her the power to manage stressful situations as well as her relationship with her children and husband.

Conclusion

To conclude this report, it can be said that from the case study provided George who is 42years of age and is a Postman by his profession is drinking excessively over the past five years. The habit of his excess drinking is now interfering with his professional as well as personal relationships because he is regularly falling sick or is suspected as intoxicated at his workplace and is send home. Whereas, drinking is making his mood irritable, being rude or quiet or reserved at times. Thus, his wife and children are isolating themselves from him. On the other hand, his wife Sandra who is 39years old and works as an office manager for a large insurance company is experiencing symptoms like worries, fear, nauseous and irregular heartbeats. According DSM-5 George is diagnosed with Substance abuse disorder, mainly alcohol use disorder and his wife Sandra is diagnosed with stress and anxiety. In the case formulation, it has been seen that George’s mental health problem can cause due to biological, family or psychological effects whereas Sandra’s causes can be social or work related. However, as mentioned in the case study that they have three children, who can also get negatively affected if immediate help is not provided to them. Therefore, appropriate treatment plan is followed with the goal to control George’s drinking habits and help Sandra to manage her stress and anxiety. Thus, for both counseling are a common factor other than that both will need different types to medications as well as therapies.

References

American Psychiatric Association.(2013). Diagnostic and statistical manual of mental disorders (DSM-5®).American Psychiatric Pub.

Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., &Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders.Journal of consulting and clinical psychology, 80(5), 750.

Cooper, C. L., & Marshall, J. (2013).Occupational sources of stress: A review of the literature relating to coronary heart disease and mental ill health. In From Stress to Wellbeing Volume 1 (pp. 3-23). Palgrave Macmillan UK.

Consequences of not providing help

Dermatis, H., &Egelko, S. (2014). Buddhist mindfulness as an influence in recent empirical CBT approaches to addiction: Convergence with the Alcoholics Anonymous model. Alcoholism Treatment Quarterly, 32(2-3), 194-213.

Enoch, M. A. (2012). The influence of gene–environment interactions on the development of alcoholism and drug dependence. Current psychiatry reports, 14(2), 150-158.

Froehlich, J. C., Hausauer, B. J., & Rasmussen, D. D. (2013). Combining naltrexone and prazosin in a single oral medication decreases alcohol drinking more effectively than does either drug alone. Alcoholism: Clinical and Experimental Research, 37(10), 1763-1770.

Heinz, A. J., de Wit, H., Lilje, T. C., & Kassel, J. D. (2013). The combined effects of alcohol, caffeine, and expectancies on subjective experience, impul

Jayne, M., Valentine, G., & Gould, M. (2012).Family life and alcohol consumption: The transmission of ‘public’and ‘private’drinking cultures.Drugs: education, prevention and policy, 19(3), 192-200.

Khamisa, N., Oldenburg, B., Peltzer, K., &Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. International journal of environmental research and public health, 12(1), 652-666.

Kissin, B. (Ed.). (2013). The Biology of Alcoholism: Volume 1: Biochemistry. Springer Science & Business Media.

Lander, L., Howsare, J., & Byrne, M. (2013).The impact of substance use disorders on families and children: from theory to practice.Social work in public health, 28(3-4), 194-205.

Lieber, C. S. (2012). Medical and nutritional complications of alcoholism: mechanisms and management.Springer Science & Business Media.

Orford, J., Velleman, R., Natera, G., Templeton, L., &Copello, A. (2013). Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Social Science & Medicine, 78, 70-77.

Patki, G., Solanki, N., Atrooz, F., Allam, F., &Salim, S. (2013). Depression, anxiety-like behavior and memory impairment are associated with increased oxidative stress and inflammation in a rat model of social stress. Brain research, 1539, 73-86.

Petch, J., Murray, J., Bickerdike, A., & Lewis, P. (2014).Psychological distress in Australian clients seeking family and relationship counselling and mediation services. Australian Psychologist, 49(1), 28-36.

Sharma, M., & Rush, S. E. (2014).Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review.Journal of evidence-based complementary & alternative medicine, 19(4), 271-286.

Spielberger, C. D. (Ed.). (2013). Anxiety and behavior.Academic Press.

Stephens, J. R., Liles, E. A., Dancel, R., Gilchrist, M., Kirsch, J., &DeWalt, D. A. (2014).Who needs inpatient detox? Development and implementation of a hospitalist protocol for the evaluation of patients for alcohol detoxification. Journal of general internal medicine, 29(4), 587-593.

Velleman, R., &Orford, J. (2013).Risk and resilience: Adults who were the children of problem drinkers.Routledge.