The case chosen for discussion in this paper is that of Jason (38), a factory worker. After reading the case, the first thing we would want to know is whether Jason is an addict. There are two symptoms that must be looked for before an individual is determined to be an addict. These symptoms are (i) out of control behavior, and (ii) a behavior that is self destructive. If a person’s behavior is under their control, then the person should not be considered an addict. It doesn’t matter at what frequency the subject engages in an addictive behavior. What really matters is whether the subject is someone who is overcome by forces that are beyond their ability to manage. In other words, addicts are people who are compelled or driven to engage in a certain behavior. The second symptom of addiction is that the addictive behavior is self destructive. It doesn’t matter whether a behavior superficially appears innocuous, if the same behavior becomes problematic and gradually disturbs the balanced life. The loss of control over the behavior and the destructive consequences entailed by it makes a behavior harmful (Martin et al 8). In case of Jason, it is not difficult to see that his normal life is pretty much disturbed. He was arrested for drunken driving and he quarrels with his wife nearly every day.
Jason’s drinking problem has impacted his sleep pattern. He cannot sleep without alcohol. His drinking habit has also adversely affected his relationship with family, work performance and interpersonal relationships. Drinking problem relating to alcohol can be identified into the following types: (i) Alcohol abuse – getting drunk and becoming threat and hazard to one self and others (ii) Binge drinking – not drinking often but getting drunk when drinking (iii) Psychological dependence – drinking habit to forget problems, feel confident, relax and feel happy (iv) Alcohol dependence – at this stage the body and brain of a person needs alcohol to feel comfortable. The body develops a tolerance for alcohol with the result that the body increasingly needs more alcohol to feel the same effect. The withdrawal symptoms are pretty much visible if consumption of alcohol is suddenly withheld after a prolonged use.
The central concept in addiction is obsessive thinking combined with compulsive need for substance or anything irrespective of adverse consequences. Addiction leads to the development of tolerance but is also associated with withdrawal symptoms on discontinuance of the substance. An intense physical and emotional craving for drugs or alcohol is also one of the symptoms of addiction. Addiction doesn’t happen overnight but follows a cycle over time beginning with use or misuse through abuse and finally leading to abuse. The first stage is experiment with drugs or alcohol for fun or to alleviate pain leading to repeated use. Soon, in order to sustain the feeling of euphoria and escape from reality. The person may have begun using drug or alcohol to address a problem but the original problem is left unattended. Even if there was no problem, the repeated use of drugs or alcohol will land the user into a problem or problems, while the new reality is constant consumption to satisfy cravings. Finally, over time the user gets addicted resulting into a host of social, financial, health and emotional issues (Recovery Connection, paragraphs 5,6,7,8).
In case of Jason there is a clear pattern to show alcohol dependence. He consumes more than normal amount of alcohol on a regular basis that includes 8 or 9 beers on a weeknight and 3 to 4, 12 packs between Friday and Sunday. In addition, he has regular fights with his wife and many a times he forgets what happened while drinking. Many a times, he has attempted to cut down on his drinking but has found reasons not to cut down. In other words, his behavior is both (i) out of control and (ii) destructive. It is out of control because drinking has become a compulsion with him that is beyond his control and his pattern of behavior clearly indicates its self – destructive nature. Although he has wanted to kick the habit but could not sustain through AA programs and also did not care for prayers indicating that he has the compelling need to continue drinking. In addition, being jailed for DUI, quarrels with the spouse, estrangement from wife and kids, he does not keep up with his chores and his house is falling apart are some of the symptoms of destructive behavior. Further, Jason showed withdrawal symptoms when he had to remain abstinent as he was going to face the trial. He could not go to sleep without alcohol. Some of the other symptoms he showed include getting jumpy when trying to stay away from alcohol, feeling closed in or feeling suffocated while trying to stay away from alcohol.
Alcohol dependence is characterized by a number of characteristics including (i) compulsive use of alcohol (ii) tolerance to its effects (iii) withdrawal symptoms and (iv) drinking to relieve these symptoms. There are a number of factors that lead to the development of alcohol dependence. These factors are represented as a complex interaction of multiple constitutional and environmental factors including (i) availability and acceptability of alcohol (ii) self medication plus personality (iii) psychological and hereditary factors. In course of the development of alcohol dependence, these multiple factors interact through various phases from initiation of alcohol consumption and its maintenance to physical and psychological dependence. The balance of factors is different for each individual. The study of these social, genetic and developmental factors that contribute to alcohol dependence will help understand why some individuals are unable to control their drinking, so that more effective management approaches can be developed (McGuffin 268).
It may be interesting to note the dynamics of addiction or dependency so as to compare it with the case presented here. One common trait shared by all drug addicts and alcoholics is maladaptive defense mechanisms. Alcoholism is also known as a disease of denial, which is a normal adaptive process for self protection. However, it becomes rigid and maladaptive in case of alcoholics. It interferes against help-seeking behavior and contributes to treatment failure leading to relapse. It is the emotional refusal to acknowledge anything or any person as it is (James & Gilliland, 356). Jason too uses this defense mechanism. He denies that he is an alcoholic while claiming that his father was on alcoholic and he is unlike his father.
The other defense mechanisms used by alcoholics include displacement, fantasy, projection, rationalization, intellectualization, minimizing, reaction formation, regression, and repression. Displacement is venting hostility on some one that doesn’t deserve it. Fantasy is often a convenient situation to escape into for alcoholics as euphoric state is more rewarding than the real world making the alcoholic return their again and again. Projection involves attribution of motives to significant others, while rationalization of addictive behavior take the form of excuses for drinking. They also intellectualize speaking in generalized and theoretical terms. In addition, they play down or trivialize the seriousness of the situation, which is known as minimizing (James & Gilliland, 356-357). These and several other forms of defense mechanisms are evidently present in Jason’s case. In addition, there are several characteristics in Jason that resemble the drug personality such as difficulty in interpersonal relationships, estrangement and withdrawal from loved ones, mood swings, and defense mechanisms.
In case of Jason, it is easy to observe that Melissa is a helpless punching bag for Jason, who vents his hostility on her. He justifies his drinking with the claim that he is not an alcoholic as he knows well from the experience of his father who was an alcoholic. He used to beat his brother and him and belittled his mother. Since he doesn’t do these things, he claims that he is not an alcoholic. He minimizes his habit by claiming that he does not think his drinking is any more than what his friends do and he was just unlucky as he got caught doing what everyone else seems to get away with. Although, he admits to overdoing a bit, this is also a defense mechanism aimed at minimizing his habit. He resorts to displacement in his complaint that his wife Melissa hassles him about the alcohol.
Religion and spirituality play a significant role in leading a healthy social and emotional life. Spirituality means a sense of connectedness to higher power. Jason’s case study clearly reveals the lack of spiritual and religious content in his life. Although his mother is religious and wishes Jason would see religion as a way out of his problems but it is also evident that he is not ready to see what his mother wants at least at this stage. While his wife and kids regularly attend his mother’s church, he attends only on Christmas and Easter. In other words, he only attends the church on these rare occasions because everyone attends them. There is nothing in his life to demonstrate religious inclination. He attended the AA meetings once but could not continue it, showing that spirituality doesn’t attract him. However, research has indicated that spirituality can play an important role in recovery of alcoholics.
There is no simple explanation identifying a single cause of alcoholism. According to a large number of studies, there are multiple pathways to alcoholic behavior (Cloninger et al. 1996; Sher et al. 1997; Zucker et al. 1994). Multiple factors, both biological and psychosocial mutually impact each other leading to alcohol abuse. In other words, biological and psychosocial cases are not independent but act and interact mutually in giving rise to alcoholism and alcohol abuse. It is now fairly well recognized that alcoholism runs in families. In other words, family history of alcoholism is a well established risk factor. In the given case study, it is stated that Jason’s father was also an alcoholic. Children of alcoholics are exposed to higher levels of risk factor. The offspring of an alcoholic father is at a greater risk of substance abuse (Cadoret et al. 1995). There are three broad models that explain transmission of alcoholism from parent to child. These include deviance proneness, negative affectivity and sensitivity to the effects of alcohol. Deviance proneness identifies deficits in children in behavioral self-regulation and socialization. According to this model poor parenting and difficult temperament of children place them at risk of emotional distress and poor academic performance. According to negative affectivity model, children in an alcoholic family live under high stress and consequently resort to alcohol to address stress. Sensitivity to the effects of alcohol model has its basis in the hypothesis that children from alcoholic families have less sensitivity to the negative effects of alcohol and greater sensitivity to stress-response dampening effects of alcohol (Pihl and Peterson 1995). In case of Jason, it is clearly indicated in the case study that he is an offspring of an alcoholic father. He lived under stress as he was physically abused by his father. Therefore, he was exposed at a greater risk of emotional distress. The recent researches have also identified genetic basis to alcoholism. However, in the absence of accurate information, it would be difficult to attribute the presence of specific genetic composition making Jason predisposed to alcohol dependence.
There are different models of alcohol recovery program. However, the twelve-step recovery program offered by AA is the best known and perhaps the most effective recovery program. One of the key principles of AA is “singleness of purpose”. The opening of AA meetings begins with the frequently made statement: “in keeping with AA’s singleness of purpose, please limit your sharing to alcohol”. Since the primary topic of conversation in AA is alcohol, those who do not identify alcohol as their primary problem substance may not benefit to the maximum extent from the program. In other words, AA program is more suitable for alcohol-dependent persons (Galanter & Kaskutas, 73). It may be noticed that Jason had tried to attend the AA program but could not continue because he did not find the program worthwhile.
The alcohol treatment programs range from getting the patient to control consumption to giving up drinking completely. The preferred goal should be abstinence while marked reduction in intake is preferable to consumption at the present level. There are claims to cure for alcoholism “not through abstinence, but by always taking a medication called nalterxone an hour before drinking alcohol. Naltrexone is not addictive and seldom produces side effects. The reduction in craving and drinking is progressive” (Eskapa & Sinclair, 3-4). In other words, there are several methods of treatment including counseling and medication.
Recent studies have gone on to highlight the role of religion and spirituality in drugs and alcohol treatment. The programs like AA are not formal treatment programs. It is best conceptualized as social movement or fellowship. However, for successful application of the programs, it is important that the subject is willing with some degree of will power to attend the program. In case of Jason, at the current stage, he lacks motivation and is not yet ready for the treatment program. It is important that Jason wants to change and transform his life. However, the only reason Jason is willing for the treatment is to strengthen his legal case. In other words, leading a better life is not yet an option for him.
Nonetheless, there are also clear signs that Jason is aware that increased consumption has estranged him from his family and he also believes that his marriage would work well if he cuts down on his drinking. Therefore, the right strategy for Jason would be to make a goal to bring down the consumption of alcohol and seek the help of treatment programs for this goal. In addition, he also exhibits the withdrawal symptoms. Therefore, it may not work for him, if he gives up alcohol altogether. Fortunately, for Jason his mother as well as wife and children are religious. This may likely make an impact on him, if he begins attending the program. There are evidences that the patients who are modest in religious practice or even non practicing may likely benefit from the 12 steps approach. It is quite likely that under the impact of his family and religious environment at home, Jason begins to believe in a greater power or a higher power and finds a purpose and meaning in life, which would be a positive indication of the process of recovery.
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