Psychodynamic Treatment of Alcohol Use Disorder: A Case Study
This paper examines the assessment and treatment of alcohol use disorder through the case of Caroline Knapp, author of the memoir Drinking: A Love Story. Using the Michigan Alcohol Screening Test as a rapid assessment instrument, the paper establishes a clinical profile of alcohol dependence. It then applies the psychodynamic approach as an evidence-based treatment framework, exploring its theoretical foundations in Freudian psychoanalysis, its core techniques—including free association, dream analysis, and open-ended questioning—and how those techniques would be specifically applied to Knapp's case. The paper also addresses gender-based clinical considerations, the expected therapeutic outcomes, and the limitations of the psychodynamic approach relative to alternatives such as cognitive behavioral therapy.
- Introduction: Overview of Knapp's case and paper scope
- Assessment of Ms. Knapp: Applying the Michigan Alcohol Screening Test
- Evidence-Based Treatment: The Psychodynamic Approach: Rationale for choosing the psychodynamic framework
- Theory Undergirding the Psychodynamic Approach: Freudian theory of conscious and unconscious mind
- Techniques of the Approach and Their Application: Free association, dream analysis, and client-specific techniques
- Gender-Based Issues in Treatment: Elektra complex and female client considerations
- Expected Outcomes and Limitations: Therapeutic goals and critique of psychodynamic limits
- Conclusion: Summary of assessment and treatment recommendations
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What makes this paper effective
- The paper grounds its clinical argument in a concrete literary case study, making abstract theoretical concepts—such as the Id, Ego, and Superego—tangible through specific details from Knapp's memoir.
- It moves logically from assessment to theory to technique to application, maintaining a clear clinical narrative throughout.
- The limitations section demonstrates intellectual honesty by presenting a credible counterargument (CBT) rather than treating the chosen approach as uniformly superior.
Key academic technique demonstrated
The paper exemplifies applied case analysis in social work: it takes a theoretical framework (psychodynamic theory) and systematically operationalizes it for a specific client. Rather than describing the approach in general terms only, the author consistently returns to Knapp's biography to show how each technique or theoretical concept would manifest in an actual clinical session, which is the hallmark of competent practice-based academic writing.
Structure breakdown
The paper opens with a brief introduction situating the case, then moves through eight sections: clinical assessment using a validated screening tool; rationale for the psychodynamic approach; theoretical foundations in Freudian psychoanalysis; specific techniques; personalized application of those techniques to the client; gender-informed considerations; expected outcomes paired with honest limitations; and a concise conclusion. This structure mirrors a standard clinical case formulation, giving the paper both academic and professional coherence.
Introduction
This paper uses the case study of Ms. Knapp from the memoir Drinking: A Love Story, written by Caroline Knapp herself. The book is an autobiography about the author's substance use, in which she reflects on the destructive aspects of her drinking problem and how she spent years believing that, as long as she kept her professional life in order, her drinking was not truly an issue. Ultimately, she is compelled to face the facts after nearly harming her friend's daughters while under the influence. This paper discusses how a clinician would assess Ms. Knapp and what treatment approach would be most appropriate—specifically, the psychodynamic approach. It examines the underlying theory of this approach, its techniques, the expected outcomes, gender-based issues that should be considered, and the limitations of the approach.
Assessment of Ms. Knapp
Ms. Knapp would certainly benefit from self-assessment, and her autobiography about her alcohol abuse serves as a form of critical self-reflection and analysis. Self-assessment is beneficial in that it allows the patient to identify issues that are affecting her life (Copeland & Martin, 2004). It allows the individual to recognize her strengths and weaknesses, identify predominant symptoms, and understand how behavior is connected to the disorder. However, while self-assessment can benefit the patient and motivate her to seek treatment, social workers also require a rapid assessment instrument to reduce the risk of misdiagnosis or mistreatment (Feit, Fisher, Cummings & Peery, 2015).
As a social worker, Ms. Knapp would be assessed using a rapid assessment instrument such as the Michigan Alcohol Screening Test, which consists of 24 closed yes/no questions (Selzer, Vinokur & van Rooijen, 1975). A score of 5 or more indicates that a diagnosis of alcoholism is appropriate. For Ms. Knapp, this instrument would yield such an assessment relatively quickly. The pain her drinking caused in her relationships, the harm she nearly brought to her friend's daughters, and her apparent lack of guilt over her drinking would all indicate a significant alcohol problem. Her attendance at Alcoholics Anonymous would immediately signal the presence of a substance use disorder. Thus, this type of rapid assessment instrument serves as an ideal tool for social workers to identify alcohol abuse quickly and effectively.
Evidence-Based Treatment: The Psychodynamic Approach
The evidence-based treatment approach most appropriate for Ms. Knapp is the psychodynamic approach. Because several underlying issues are driving her to abuse alcohol, these issues must be brought to the surface and addressed before the drinking problem itself can be effectively treated. From a psychodynamic perspective, addressing the underlying issues will also treat the alcohol abuse, because the unconscious forces compelling her to drink will be identified, examined, and ultimately diminished through the process of conscious awareness.
As Dodes and Dodes (2017) note, the psychodynamic approach strikes a balance between an overly narrow and an overly broad clinical lens: it places the patient at the center and attends to her experience, environment, underlying issues, and the motivational factors driving her thoughts, impulses, and behavior. The psychodynamic approach is rooted in the work of Sigmund Freud, who founded the field of psychoanalysis—a field that has since developed in many directions over the past century. It is a fitting evidence-based treatment for Ms. Knapp, who needs the underlying issues shaping her behavior to be analyzed and understood.
References
Copeland, J., & Martin, G. (2004). Web-based interventions for substance use disorders: A qualitative review. Journal of Substance Abuse Treatment, 26(2), 109–116.
Dodes, L. M., & Dodes, J. (2017). The case study method in psychodynamic psychology: Focus on addiction. Clinical Social Work Journal, 45(3), 215–226.
Feit, M. D., Fisher, C., Cummings, J., & Peery, A. (2015). Substance use and abuse: Screening tools and assessment instruments. In Evidence-informed assessment and practice in child welfare (pp. 123–133). Springer, Cham.
Freud, S. (1915). The unconscious. In Freud—The complete works. Ivan Smith, PDF Edition.
Khantzian, E. J. (2014). A psychodynamic perspective on the efficacy of 12-step programs. Alcoholism Treatment Quarterly, 32(2–3), 225–236.
Selzer, M. L., Vinokur, A., & van Rooijen, L. (1975). Self-administered short version of the Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol, 36, 117–126.
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