Alcoholism and the DSM-IV-TR Alcoholism is a serious problem in our society. Alcoholism is a "disabling addictive disorder" (Wikipedia, 2011). It is a compulsive behavior by the individual, where he/she is unable to control their consumption of alcohol despite the negative effects of drinking. Alcoholism affects the drinker's health, social and work relationships, which in much case can impact their financial standings and judgment. The abuse of alcohol is a common problem, and one that should be taken seriously because it affects the victims in significant ways. The abuse of alcohol can impact the lives of those that are abusing alcohol as well as families and friends. People's behaviors, attitudes and priorities often change when they are addicted to alcohol.

As a Psychologist or Social Worker, we utilize the Diagnostic and Statistical Manual-IV (DSM-IV) to make decisions about the patient's health. The DSM-IV has specific standards for diagnosing a person as an alcoholic. According to the DSM-IV (Emmite & Swiezewski, 2001) a person who is an alcoholic would have to meet these standards:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period recurrent substance use resulting in a failure to fulfill major role obligations at work, school, home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

Alcoholism is a significant problem that causes many harmful side effects. According to the Centers for Disease Control and Prevention (CDC, 2010), 52% of Americans above the age of 18 years of age and older are regular alcohol drinkers, they have at lead 12 drinks in the past year. Only 13% of adults 18 years and older are classified as infrequent drinkers, which means they had between 1-11 drinks in the past year. There were 14, 406 number of deaths from liver disease related to alcoholism. There were 23, 199 deaths in the past year that were alcohol induced, which did not include accidents and homicides.

Vignette

Betty was a college graduate, who became a school teacher. She was very intelligent, and beautiful. Betty married the love of her life after college and had a normal family life. Her friends and family claims that Betty and her husband had a very good relationship. He adored her and she was the love of his life. Betty's husband was also a school teacher as well. Many people who knew them well saw them as a loving couple, and classified Betty as a good mother. Betty and her husband had three children and lived in the suburbs of New York. Betty was regular attendee at the local church on Sunday mornings and she had many friends. After her third child was born, Betty and her husband began fighting a lot; her husband blamed it on her mood swings. Betty's husband began complaining about her behavior, she was neglecting the children, she had severe mood swings, got very angry with him for no reason and she was neglecting a lot of her responsibilities. Betty's husband then discovered his wife was drinking daily; she would hide her alcohol in her coffee mug, in soda bottles and even in shampoo bottles. Betty and her husband continued to fight about her drinking and the effects of her drinking. She refused to get treatment for her problem and continued to claim her husband is lying about her. Her friends and family did not believe her husband, she had previously been a good mother and a good teacher. Betty had been drinking for such as long time that she is great at disguising her addiction. Betty continued her job as a teacher, her drinking never impacted her job. Betty always began drinking after work, and would always wake up in the morning to get to work on time. Betty would begin drinking from the time she entered her home, she drank before driving her son to soccer practice and even drank before driving her kids to play dates. Eventually her husband left her, her children moved out as soon as they were able to, her eldest son moved out the day he turned 18 and other 13-year-old and 11-year-old, moved in with their...

Betty has since lost her, husband, three children, home, eventually she left her job and she continues to drink, without acknowledging that she has a problem. Her friends and family all know of her problem and whenever she is confronted about this problem she denies it and gets very defensive.
Discussion of Vignette

Betty has paid the price for her addiction. She has a severe problem, where she is a compulsive user of alcohol regardless of the consequences. Although she loved her family, she continued to drink even though she knew she would lose her family because of her behavior. She has manifested this behavior for many years. Her addiction has kept her from fulfilling her role as a good mother and wife at home. She continued to drink after work, even though she knew she would have to run errands like grocery shopping or drive the kids to their activities. She also continued to drink and drive, with her young children in the car. One of the main strengths that Betty had is that she never allowed her addiction to impact her job. She never drank at work or during work hours, she always drank after work. Betty knew she needed her job and refrained from drinking at work. Betty's behavior has brought her to court twice, once for divorce and then for the custody of her children. Although Betty loved her husband and her children she could not stop her behavior to save her family. She needs professional help.

Therapist

As a social worker or a therapist it is important to recognize the signs of alcoholism and make the proper diagnosis. This is a real problem in our society; many lives are impacted by this addiction. Those that are abusing alcohol and those that are impacted by those that abuse alcohol must be protected from this horrible disease. People with this addiction are often very good about hiding this addiction from others. It is important to understand the drinking patterns of the client, understand why they are drinking. The first step in treating an alcoholic client is to get them to acknowledge that they have a problem and that they need help.

Once the client has accepted their need for help they need to be detoxified. Detoxification is an extremely difficult process. Detoxification is where the body naturally rids itself of the alcohol without the use of any outside agents such as drugs. Detoxification is often utilized to maintain health and help individuals make healthier choices (Dell, 2006). The individual will go through withdrawal symptoms, and the degree of withdrawal symptom will vary depending on the patient and the amount of time they have been consuming alcohol. "In an effective disease management concept, hospital detoxification is just one step in a chain of therapeutic interventions that will stabilize a patient to remain abstinent" ( Kienast & Heinz, 2005). Within the first 6 to 48 hours after the last drink detoxification begins (Alcoholism Facts, 2011). Some of the most common signs of withdrawals are:

Sweating, mainly in the palm of the hands

Difficulty sleeping

Rapid heart beats

Upset stomach, vomiting and nausea

Lack of appetite

Severe headache

Dilated pupils

Inability to stay still, constant movement

Looking sick

Alcohol detoxification should always be done with medical supervision because of some of the withdrawal symptoms. Most detoxification is usually done in a hospital or in a medical rehabilitation center. Some people may even experience even more severe symptoms such as:

Fever

Seizure and Convulsions

Delirium and Hallucinations

Blackouts and Muscle tremors

Along with detoxification the alcoholic should enter into a treatment program. The alcoholic should be treated by a Psychologist, a Social Worker or another professional in the field specialized in Behavioral Therapy. It is important for the individual to find out exactly what is causing this type of behavior and deal with the root cause of the problem. Identification of the problem is often the biggest step involved with solving the problem. In addition to individual therapy the individual should join a support group. There are groups that exists to support alcoholics such as Alcohol Anonymous (AA), or Motivation Enhancement Therapy (MET) groups. These groups are designed to offer support and offer a safe environment where alcoholics can share their feelings, desires and get support. AA is a support group for recovering alcoholics, which handles alcohol recovery with a 12-step program to stay sober. The members of the support group receive help and support through meetings that convene on a…