Alcohol Dependency Essay, Research Paper

Alcohol Dependency

Dependence is defined as a cluster of three or more existing criteria according to

the DSM-IV for alcohol dependency over a period of 12 months. According to Riley,

substance abuse is commonly referred to as an addiction. These terms are often used

interchangeably. Dependency occurs over time and is usually taken in excessive

quantities causing harm to the individual (Riley, 1998). There is no known cause for

alcohol dependency. However, there are contributing factors to the etiology of alcohol

dependence. These factors are age, gender, cultural differences, depression, and schizoid

personality traits. The DSM-IV states, “low educational level, unemployment, and lower

socioeconomic status are associated with dependency, although it is often difficult to

separate cause from effect” (DSM-IV, 1994, p. 201). Alcohol is more common in males

than females with a 5:1 ratio. The reason for the high ratio is because females have a

tendency to drink later on in life due to the increase of stressors. There is a link between

familial history increasing the risk for alcohol dependency, as well as, a genetic

predisposition (DSM-IV, 1994).

Symptoms of depression, anxiety, and insomnia accompany alcohol dependency

along with suicidal ideation. According to the DSM-IV the prognosis for individuals

with alcohol dependency is promising. “Follow up studies indicate that highly

functioning individuals show a higher than 65 percent 1 year abstinence rate following

rehabilitation. Twenty percent or greater of individuals with alcohol dependency achieve

sobriety without current treatment” (DSM-IV, 1994, p. 202-3). Most individuals

demonstrate self control and are able to actively participate regularly in daily activities.

Individuals with alcohol dependency slowly increase their social and vocational roles

with the aid of treatment (Reed, 1991).

The enzyme acetaldehyde accumulates in the blood with any consumption of

alcohol. Most treatments involve the use of Disulfiram, also known as Antabuse. It is an

inhibitor of the enzyme aldehyde dehydrogenase which with a single drink causes a toxic

reaction. This drug should not be administered until 24 hours after the individual’s last

drink. Several side affects could occur if one ingests alcohol while being treated with

Antabuse. Physicians should caution patients of affects. According to Kaplan and

Sadock, this drug can increase psychotic symptoms in some patients with schizophrenia

in the absence of alcohol. The drug Naltrexone aids in decreasing one’s craving for

alcohol. The recommended dosage for this drug is one dose daily. Its primary goal is to

promote abstinence by preventing relapses and decrease alcohol consumption in

individuals (Kaplan & Sadock, 1998). Anti-anxiety agents and antidepressants have

been used as treatments for those symptoms associated with alcohol. However, there is

rising attention to the use of psycho active drugs in order to control alcohol cravings

(Kaplan & Sadock, 1998). Alcohol related disorders, such as, alcohol dependency can be

accompanied by a number of other disorders: mood disorder, anxiety disorder, sexual

dysfunction and sleep disorder which are all alcohol induced. According to Kaplan and

Sadock, Lithium has shown to reduce mood cycles in manic-depression as well as an

individual’s desire to consume alcohol. Research is still underway to confirm the link

between the two. The reduction of alcohol cravings is also being researched and

validated with the use of serotonin specific re-uptake inhibitors or Tranzone (Desyrel)

(Kaplan & Sadock, 1998).

Precautions should be taken when working with an individual with alcohol

dependency. The foremost important precaution, however, is to observe drinking

behavior for relapses. Looking into the environment, whether it be at the individual’s

work or home should be considered while treating an alcohol dependent individual. This

is important in order to catch the possibilities of relapses or codependency. Another

concerning consideration in treating an individual with alcohol dependency is the

medication he/she is taking at the time of treatment. All medication the individual is

taking while consuming alcohol is also a critical issue to consider in treatment.

The alcoholic dependent person spends a great deal of their time in activities

necessary to acquire the substance, in consuming the substance, and in recovering from

its affects. At times when they are expected to fulfill major role obligations at work,

school, or at home they will be intoxicated or suffering from the symptoms of

withdrawal. Withdrawal symptoms can include tremors, hallucinations, sweating,

seizures, and diarrhea. Alcoholism can be physically hazardous causing injury to the

person while engaging in occupations under the influence of alcohol. Intoxication can

cause auto accidents leading to injury or death of persons involved. There is also

deterioration in overall function especially to the liver, heart, and brain. There is a high

incidence of social, occupational, or recreational activities given up or reduced due to

substance abuse. Alcoholism affects family life, vocational performance, self-care

abilities, physical and emotional health, social relationships, and financial well-being.

Psychological and emotional deterioration for the alcoholic may include low self esteem,

anxiety, depression, paranoia, emotional numbness, and poor handling of frustration.

Failure to move through the normal emotional developmental milestones is an outcome

of early onset addictions. They remain emotionally immature and may act very similar to

adolescents. Their behavior may be rebellious, temperamental, demanding, and

dishonest. The process of learning to be responsible, accountable, mature, and

independent adults may take up to 3-10 years. Alcohol dependency is accompanied by a

life of denial and defense systems that serve to maintain the addictive process. Denial is

seen in the early stages of addictions. Defense mechanisms include minimizing the

negative impact of the behavior, rationalizing the drug use, and blaming others for their

choices and actions. The lives of those close to the alcohol dependent person can also be

affected. Being in a long term relationship with a substance abuser often results in low

self-esteem, depression, chronic anger, and stress related illnesses. They may attempt to

control the addict’s behavior or compensate for the addict by taking on some of their

responsibilities enabling the addict to continue use. These dysfunctional ways of relating

to the alcoholic is referred to as codependency. Many negative consequences associated

with difficulty in expressions of emotion are job loss, marital separation, loss of child

custody, and alienation of prior support network, such as friends and family. Chemical

dependency treatment programs attempt to assist the dysfunctional family by altering the

family members’ way of dealing with conflict, interpersonal needs, communication

patterns, and domestic responsibilities. Social attitudes and solutions for alcohol

dependent persons include rehabilitation programs, decriminalization to imprisonment,

and mandatory sentencing of drug users and sellers (Riley, 1998).

Lifestyle adjustments for the recovering alcohol dependent person could include

restructuring their environment. This process would entail removing alcohol from the

home, office, and other areas where the person may keep alcohol. Social environments

need to be changed to exclude bars and friends who are not empathetic to the needs of the

recovering alcoholic. Transportation routes can be altered to exclude areas of temptation

for the alcoholic. The alcohol dependent person needs to realize that he has a problem

and take the initiative to live a life without substance dependency. The alcoholic will

need to gain better control over negative emotions and learn better stress coping skills.

He/she will have to take back responsibilities that were avoided while dependent on

alcohol. He/she will also need to take responsibility for the behavior and consequences

of the past. Overall, he/she will have to learn to be an independent adult (Riley, 1998).

In considering the expected level of independence for the person with alcohol

dependency the occupational therapist will concentrate on OT domains of concern which

include performance areas, performance components, and performance contexts.

Primarily, functional impairment are seen in leisure and work performance areas. The

alcoholic usually gives up leisure activities in order to spend more time acquiring and

using alcohol (Riley, 1998). They will need to explore and develop a variety of leisure

activities and skills (Reed, 1991). Work may be interrupted or jobs lost due to the

physiological and psychological effects of short and long term dependency. These effects

include decreased concentration, poor judgment, poor problem solving skills, increased

absenteeism, and poor time management (Riley, 1998). Other performance areas where

deficits appear are in activities of daily living and home management. They may neglect

self-care and lack skills in money management (Reed, 1991). Performance components

affected include sensory and perceptual motor deficits, cognition, psychosocial, and

psychological issues. Sensory and perceptual motor impairments include a loss in tactile

perception, figure ground perception, visual-spatial (greatest impairment), and fine motor

coordination (Riley, 1998). Motor deficits may include decreased physical tolerance,

endurance, and peripheral neuropathy (Reed, 1991). Cognitive impairment include

memory, attention span, concept formation, problem solving, and learning. Abstract

reasoning, nonverbal problem solving, short term memory, and perceptual motor

integration may become permanent losses (Riley, 1998). The person may have cognitive

disorders associated with brain damage (Reed, 1991). Of the alcoholics entering

treatment, 75% have neurocognitive deficits. Psychosocial and Psychological

performance components which are affected by alcohol dependence includes values,

self-image, self-esteem, self-expression, interpersonal and role related skills, time

management, coping skills, and social conduct (Riley, 1998). Other problem areas can be

the inability to define goals, lacking goal oriented behavior, and depression (Reed, 1991).

It is very important to consider performance contexts especially in the areas of

development, cultural, and social environments. For many of these deficits

improvements have been noticed with prolonged recovery, although some losses may be

irreversible. Treatment programs can help these people over time or compensate for

deficits from alcohol dependency (Riley, 1998).

Individual therapy is part of many treatment programs, however, most of these

programs employ various forms of some type of group treatment (Neistadt & Crepeau,

1998). Substance abusers in general have a tendency to isolate themselves, feel they are

alone, or are unable to cope with their problems. Here is where group therapy helps those

who have had similar experiences.

Group treatment settings in particular are appropriate for alcohol dependent

individuals since many people with alcoholic disorders tend to be emotionally and

socially isolated, drink alone, and have difficulty tolerating conflict or relating socially

(Riley, 1998). Group settings can help foster acceptance and a sense of belonging which

strives to put the newly recovering individual at ease (Riley, 1998). During a session, the

individual would be encouraged to share feelings and experience group discussion, and

participate in role playing or psychodrama (Reed, 1991). These opportunities are

provided to the individual as a means to decrease social isolation, learn new interpersonal

skills, and practice reintegration into social settings such as family or work environments

(Riley, 1998).

Treatment settings offer a wide range of services which include hospitals,

residential programs, halfway houses, and organizations including Alcoholics

Anonymous, Al-Anon and Alateen.

Programs that involve chemical dependency usually take place in a special unit of

psychiatric or general hospitals, are run by professionals including ex-addicts, where

length of stay vary from a number of days to a month. After discharge from the

hospital, the client is encouraged to join some type of follow-up program such as

Alcoholics Anonymous (Neistadt & Crepeau, 1998).

Residential programs are run by former addicts whose lives have been consumed by

addiction in one form or another. This type of community requires a lot of structure

where all members of the household are given responsibilities to maintain the

environment. The community is closely monitored and residents usually have little or

no contact with outsiders for certain lengths of time. During their stay, residents

confront their addictions on a continuous basis (Neistadt & Crepeau, 1998).

When a patient with an alcohol-related disorder is discharged from the hospital, it

becomes important to find somewhere to stay other than home. Previous familiar

places have often proved themselves counterproductive to the patient. The halfway

house provides emotional support and counseling to help reintroduce the patient back

into society (Kaplan & Sadock, 1998).

Alcoholics Anonymous is a voluntary program that helps the individual through

social support. The ideas behind AA is to stay focused on the value of being

abstinent (Riley, 1998). This program uses a twelve-step method as well as others,

and many provide the individual with a more secular approach to treatment because

they emphasize seeking help from a higher power (Neistadt & Crepeau, 1998).

Al-Anon is an organization primarily for the spouses of people with alcohol-related

problems (Kaplan & Sadock, 1998). This group is structured similar to AA, which

aims to provide group support, assist the efforts of spouses to regain self-esteem, to

refrain from feeling responsible, and to develop a rewarding life for themselves and

their families (Kaplan & Sadock, 1998).

Alateen is an organization that focuses on children of people with alcohol

dependence. The organization helps children understand their parents’ alcohol

dependence (Kaplan & Sadock, 1998).

There are several models of therapy to use when treating people with

alcohol-related disorders. Behavior therapy focuses on relaxation training, assertiveness

training, self-control skills and new strategies to help them master their own environment

(Kaplan & Sadock, 1998). Operant conditioning programs are often used with people

who have alcohol-related disorders to either modify or stop drinking behavior (Kaplan &

Sadock, 1998). Types of reinforcements range from monetary reward, to opportunities

where one can live in an enriched inpatient environment, or have access to pleasurable

social interactions (Kaplan & Sadock, 1998).

Cognitive-behavioral therapy believes that addiction is primarily a learned

behavior, and therefore can be unlearned (Riley, 1998). In order to eliminate behavioral

habits, the client must also change their cognitive patterns which distort thinking and

perpetuate alcohol use (Riley, 1998). When identifying consequences as a result of

behavior, therapist help the person by examining the following (Riley, 1998).

Verify what rewards a person may experience by using alcohol.

What motivates them to drink even though they know the consequences will be

negative.

Examine whatever false beliefs the user may have concerning benefits obtained by

consuming alcohol.

In addition to consequences, the individual will be asked to identify “warning signs” that

may lead to relapse. Other strategies include restructuring the environment in an effort to

reduce factors that may provide temptations which lead to usage (Riley, 1998).

When beginning treatment it is almost impossible to start with a specific

prescription of activities, and there is no need to (Doniger, 1953). Usually, the patient

will provide a spontaneous starting point with reactions, favorable or destructive,

observed with a practiced eye and open mind, which provides clues for purposeful

activities (Doniger, 1953). Often, patients are full of ideas but are slow to organize

anything along realistic lines. It is also important for the occupational therapist to be

specific when prescribing an activity because different things have different meanings to

individuals. The occupational therapist must be able to differentiate between constructive

expression, release, and the use of the activity to reinforce the pathological pattern

(Doniger, 1953). A patient who works his/her hostility out towards the therapist instead

of working it through at the scheduled time are ultimately working at their own

disadvantage. An example is a patient who uses creative painting to withdrawal into a

fantasy world, when really the patient should be drawn out and expressing his/her

emotions within the group. The occupational therapy group provides support,

opportunities for growth, and to assess one’s limitations. Occupational therapy, in some

circumstances, can help patients through vocational exploration even though some may

avoid contacts with working situations because of emotional difficulties (Doniger, 1953).

The following activities facilitate the individual in many ways. Classical treatment

activities include:

Evaluation where a self-image collage, combined with an interview and goal-setting

session, serves as the foundation of the occupational therapy program.

Therapeutic use of crafts is used to indicate underlying resistance to the entire

program, and can surface when patients are asked to perform specific tasks. During

the task, the patient is asked to focus on dealing with behaviors and attitudes which

are related reasons for why they are in treatment.

Recreational programs provide extra opportunity for socialization, development of

interpersonal skills, group interaction, and to decrease social isolation.

Group process involves task-oriented groups where patients meet with the occupational

therapist to discuss issues or problems related to alcoholism. The emphasis is on learning

alternative ways of dealing with problems and issues relating to the recovery process.

Some innovative ideas for treatment concerning this particular patient population

include:

Having the individual video taped during the behavior, then later have them watch to

see how it makes them feel, what it makes them look like, and how they think others

perceive them.

Viewing movie clips that make a point on how destructive their drinking behavior is

and has become. This part of the treatment plan would focus on extinguishing the idea

of “that would never happen to me.”

Having a party for the treatment group that simulates a bar-type atmosphere, however,

only non-alcoholic beverages would be served and they would be aware of the fact.

The purpose of this exercise is to facilitate social interaction, and to learn suitable

behaviors so they can realize alcohol does not need to be at hand in the presence of

others.

In conclusion, occupational therapists are always learning and trying news ways

to approach therapy. If one activity does not work, then we know of one way not to

approach the problem. Every evening that a patient spends at a therapy social event is one

less night spent in a bar. These are the experiences that can provide opportunities to

rediscover interests and rebuild values.

.

Bibliography

References

Doniger, J., (1953). An activity program with alcoholics. American journal of

occupational therapy, VII, #3. (May-June) (pp. 110-112, 135).

Kaplan, H., & Sadock, B., (1998). Synopsis of psychiatry (8th ed.) (pp. 404-406).

Baltimore, MA: Williams & Wilkins publishers.

Neistadt, M., & Crepeau, E., (1998). Willard & spackman’s occupational therapy

(9th ed.) (pp. 724-728). Philadelphia, PA: Lippincott.

Reed, K., (1991). Quick reference to occupational therapy (pp. 497-501).

Gaithersburg, MA: Aspen publishers.

Riley, K., Ramsey, R., & Cara, E., (1998). Substance abuse and occupational

therapy. In E. Cara, & A. MacRae (eds.), Psychosocial occupational therapy: a clinical

practice (pp. 227-260). Albany, NY: Delmar publishers

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