Alcohol abuse is a condition that is characterized by a pattern of excessive drinking in spite of negative effects resulting from the use of alcohol on an individual's occupational, legal, educational, medical, and/or social life. Alcoholism results from this destructive pattern of alcohol abuse after a period of time and includes a number of other symptoms including: increased tolerance to alcohol over time; alcohol withdrawal; a pattern of using more alcohol and/or use for a longer time than planned; destructive patterns health, social, and occupational functioning as a result of alcohol use; and failed attempts at reducing its use (APA, 2000). Alcoholism is also known as alcohol dependence or alcohol addiction as the terms are used interchangeably in the medical and treatment literature. These terms describe a destructive pattern of chronic alcohol use that results in the development of tolerance to alcohol, needing more alcohol to achieve the same effects from previous use, and/or withdrawal from the substance, a physical reaction when alcohol is removed from the body. A common behavioral symptom of alcohol dependence is that the person uses more alcohol than originally planned or that they continue to drink longer than planned. These individuals often have trouble reducing their use of alcohol. Some other symptoms of dependence include the person's spending an inordinate amount of time getting, using, or recovering from the use of alcohol, compromised functioning as a result of alcohol use, and/or continuing to drink alcohol even though they understand that it has detrimental effects on their lives (WHO, 2000). The difference between the alcohol abuse syndrome and alcoholism involves the development of severe tolerance and withdrawal in alcoholics indicating a physical disease process has occurred in the brain and the time period over and which the dysfunctional affects of alcoholism occur (APA, 2000).
The medical profession considers alcoholism a disease rather than a weakness of character or chosen bad behavior. It is the third most common mental illness affecting more than 14 million people in the United States (WHO, 2000). Alcohol dependence affects about four percent of women and ten percent of men, costing more than $165 billion per year in lower productivity, early death, and costs for treatment (WHO, 2004).
Risk factors for developing a drinking problem or dependence problem include a family history of alcoholism or substance abuse, a history of or current mood disorder such as depression, the presence of an anxiety disorder, or the presence of another psychiatric disorder. While there is a genetic component to alcoholism, it is not directly inherited and the genetic component reflects the interaction of genes and the environment (Dick & Bierut, 2006). People with low self-esteem, antisocial behaviors, or high impulsivity are also associated with the development of alcohol dependence. People are more likely to develop alcoholism if they have a childhood history of being physically or sexually abused, have their first drink of alcohol between 11 and 14 years of age, drink alone or to escape problems, or drink solely to get drunk (APA, 2000).
From a health perspective there is a strong relationship between heavy levels of alcohol consumption and an increased risk of developing cardiovascular disease, malabsorption, liver problems, and cancer. Damage to the central and peripheral nervous system can occur from chronic alcohol abuse and we know that long-term use of alcohol in excessive quantities, much like our patient reports using, is capable of damaging nearly every organ and system in the body
Given the demographic background of our patient we know that she drinks four to five glasses of wine per day which would be considered markedly excessive for a female (WHO, 2004). She is 50 years-old, and while we are not told how long she has engaged in her pattern of heavy drinking we can suspect tolerance has developed. We need to know a little more about her drinking patterns and social...
The patient's father died of liver disease (although we do not know what specific liver disease he had) and her mother from stroke. Therefore we know that the patient's family history is remarkable for ailments associated with heavy alcohol use or vulnerabilities that can be exacerbated by prolonged heavy alcohol abuse. Given the patient's medical history high cholesterol and hyperlipidemia, this suggests that she is at risk for severe cardiac health issues that can result from heavy alcohol use. Her osteopenia also suggests that her alcohol use has the potential to effect health in other ways related difficulties with absorbing nutrients. If we knew more about her drinking history such as how long she has been drinking this much, the age at which she started etc. we would be in a better position to speculate as to how her alcohol use has affected her health, but we can certainly report that continued heavy alcohol use will affect her in deleterious ways. We can discuss this with her in light of the research on the effects of alcohol, health, her age, and her current health issues. We can demonstrate and cause benefit analysis regarding her continued use of alcohol that is negative in terms of her health.
The patient is a highly motivated and educated woman who is a successful business woman finishing a Master's degree. Looking at where she might fall on the developmental level we can put her right in the middle of Erikson's Generativity vs. Stagnation phase (Erikson, 1964). Adults in this stage may feel the desire or need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. While we are not told if she has children we can interpret her obtainment of a MA as a sign that she wishes to better herself in order to more effectively contribute to society. For many adults in this stage successes have led to feelings of usefulness and accomplishment, whereas those experiencing failures may turn to shallow involvement in the world. The patient is driven to learn and continue being successful, therefore we can also approach her from this perspective as anyone who is obtaining an advanced degree can appreciate the benefits of education and learning.
With proper treatment, nearly 70% of people with alcoholism are able to decrease the number of days they consume alcohol and improve their overall health status within six months (Heyman, 1996); therefore, the prognosis in this case is good in getting this patient to view excessive alcohol use as potentially unhealthy for her and to get her to cut back on her alcohol usage.
The goals for treatment for this patient would be to:
1. Discuss the difference between heavy, moderate, and light alcohol use as defined by the medical field. Light usage for a 50-year-old female would be one glass of wine a day. She is drinking at a rate several times beyond the definition of light drinking, therefore she should consider cutting down.
2. Educate the patient on the effects of heavy alcohol use as they relate to health, medical history, and family medical history. The education here should describe the relation of her health issues and family history to her current alcohol use and health issues and how decreasing her use can be beneficial to her health.
3. Discuss the differences between abuse and dependence and discuss any current social, occupational, or legal difficulties that she believes may have manifest as a result of her alcohol usage. We can let her decide if she feels as if she has an abuse or dependence issue.
4. Discuss how alcohol fits in with her current life's needs and goals and then discuss ways to replace alcohol with other activities that can meet the needs/goals.
5. Recommend possible treatment alternatives to assist her with cutting back on her drinking such as a 12-step program or individual counseling.
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