COUNSELLING MAY 2003
In modern society today there is an increased awareness of the many Psychological Issues which effect the health and well-being of individuals. The range of these psychological issues is vast and includes Phobias, Stress and Anxiety, Depression, Addiction and much more. Within this paper I will focus on the issue of alcoholism and the effect it has upon an individuals Psychologically and offer an insight into the support that is available. I will aim to present a good variety of background information which offers an understanding of alcoholism. I then intend to outline the psychological issues concerning alcoholism and how these may effect the clients progress in addressing the difficulty. I will also include an insight into the support, the treatment and processes of which the client is encouraged to work through in order to reduce the effect of alcoholism on their lives.
Excessive alcohol usage is a feature of many groups and individuals world-wide, especially those of lower social status and income. Alcohol abuse and its many social, economic, and psychological effects are now considered one of the major public health problems worldwide. (Hellman, C. 2001) In the UK, alcohol consumption is relatively low among some immigrant and ethnic minority groups, these include Afro-Caribbean's, Indians, Pakistanis and Bangladeshis. One of the reasons for these differences is the way in which alcohol is embedded in cultural values and expectations of different groups. (Hellman, C. 2001) However, the quantity of alcohol consumed among the UK population has doubled between the 1950's and the mid 1980's and has remained at the same level since. (Harralambos and Holborn 1995) Drinking is a popular leisure activity and this is primarily because of the effect it has on the central nervous system. The depressant effect on the central nervous system initially causes people to become less inhibited. However, judgment and attention of individuals are also affected making activities such as driving difficult to undertake competently and safely.
Alcoholism is regarded by many as an imprecise term. Many believe that people who have a 'drink problem' are effected differently. Paton believes that the term alcoholism can be divided into three separate terms. He describes these terms as,
"1. Alcohol abuse: consumption is likely to cause physical or mental damage in the future and may already be causing damage.
2.Alcohol-related problems: Physical, Psychological or social problems brought about through the use of alcohol.
3. Alcohol dependence: strong physiological and psychological desire to drink alcohol which takes precedence over all other activities. A withdrawal state or relief drinking may be experienced." (Paton, A. 1997)
It is clear to see that each of the above categories differ in terms of the amount of influence they have on the client. A high proportion of people who have a 'drink problem' have an increased tolerance to the effects of alcohol and they believe that this is because they can 'handle drinking'. This in the UK can also be given status amongst some groups. The majority of people who suffer from alcohol dependence often tend to hide their drinking. Identification is considered to be more successfully achievable by screening. (Harrison L 1996) The original screening process consists of a person being presented with four questions. If the person answers yes to two or more of the questions, it is said to be highly suggestive of problem drinking. The questionnaire has been labeled C.A.G.E. because there is a key indicator word in each question. For example,
"1. Have you ever thought you ought to cut down on your drinking?
2. Have peopleannoyed you by criticising you drinking habits?
3. Have you ever felt guilty about your drinking?
4. Have you ever had a drink first think in the morning eye-opener to steady your
nerves or to get rid of a hang-over?" (Harrison L 1996 p.p.67)
The number of people who have been diagnosed has having a 'drink problem' within the UK is considerably high in comparison to other countries. Approximately 23% of men and 6% of women report drinking to be more than the recommended weekly limit. (Harrison L 1996) There are also 7% of men and 2% of women that are drinking excessive amounts with complications and are considered to be alcohol dependent. It is also important to note that these figures are likely to be higher because not all incidents of excessive drinking are aware off and officially reported.
There are a number of factors as to why people may become problem drinkers. One explanation is described as genetic. There have been a number of studies completed in this area and the findings of one study suggests that the odds of alcohol dependence is increased by about 45% if a second or third degree relative is affected. The study also found that this figure rose to 90% if a first-degree relative is affected. (Harrison L 1996) Another reason as to why people may become problem drinkers is due to psychological factors. Parental attitudes and peer pressure may influence attitudes towards alcohol. Personality factors, such as impulsiveness and sensation seeking, may increase the risk of alcoholism. (McMurran M 1997) Studies have increasingly indicated that there is a strong link that boys who display aggressive and anti-social behaviour are at an increased risk of alcoholism later in life. (Ettorrea E 1997) Once drinking has become established, alcohol may be used to cope with increasingly varied situations including boredom, depression, anxiety and frustration, as well as celebrations and interpersonal conflict.
There are many problems that can occur through continuous heavy drinking. These problems are physical, which include liver problems, Gastro-intestinal problems, Cardiovascular problems, disorders of the nervous system and reproductive problems. Another problem is Psychological and the majority of these (70%) are associated with depressive symptoms. (McMurran M 1997) Up to 15% of alcoholics end their lives by suicide and more than a third of individuals who commit deliberate self-harm have alcohol in their blood. (McMurran M 1997)
To help an individual who has a drink problem, it is extremely important to intervene at the earliest possible moment. Early intervention is essential because it is believed that the majority of problem drinkers do not come into contact with specialist alcohol treatment services. (Naido and Wiliis, 2000) However, excessive drinking may be successfully reduced with brief interventions. These interventions include offering advice about the hazards of alcohol, including safe limits. Personalising the health effects of drinking heavily is also seen as an intervention. For example, linking symptoms of gastritis or the results of a blood test with alcohol consumption. Other brief interventions include advice of ways to cut down or stop drinking and offering material for the person affected to read.
The specific behaviour that characterizes alcoholism is the consumption of significant quantities of alcohol on repeated occasions. (McMurran M 1997) When alcoholics are asked why they drink excessively, they will occasionally link their drinking to a particular mood such as depression or anxiety or to certain situations. Many times, they simply describe an overpowering 'need' to drink, described as a craving or compulsion. Just as often, however, the alcoholic is unable to give any real explanations for his or her excessive drinking. Drinking relieves guilt and anxiety; however it then also produces anxiety and depression. The symptoms associated with depression and anxiety disorder, such as terminal insomnia, low mood, irritability and anxiety attacks with chest pain and palpitations often occur. Alcohol seems to relieve these symptoms, resulting in a vicious cycle of drinking followed by depression followed by drinking that ultimately leads to a withdrawal syndrome. Sometimes the patient succeeds in stopping drinking for several days or weeks only to "fall off the wagon" again. Despair and hopelessness are common as this cycle reoccurs. By the time the patient contacts the physician, they have often reached rock bottom. Their problems have become so numerous that they feel nothing can be done for them. At this point they may finally be ready to acknowledge their alcoholism but feel powerless to stop drinking.
Although the obvious treatment for alcoholism - just don't drink alcohol - seems and in fact is quite simple in theory, it is certainly not easy in practice for individuals with the medical illness of alcohol dependence. This is certainly outlined by Portiono who has worked for Alcoholics Anonymous when he states,.
"the abnormal craving and mental obsession alcoholics have for alcohol causes them to return to it again and again even when their drinking has repeatedly caused terrible problems for themselves and others. Even when they finally reach the stage at which they genuinely want to stop drinking, many alcoholics find abstinence from alcohol difficult or even impossible to achieve or to maintain. They may stop for a while only to resume drinking later, usually with a recurrence of problems followed by another, often unsuccessful attempt to stop and stay sober." (Portiono 1993 p.p122)
As Portiono describes, alcoholism is a cycle which is extremely difficult to break out of once you find yourself trapped. By the time the problem has become problematic, the person concerned has acquired a complex and sophisticated defense mechanisms aimed at protecting the existence of the addiction.
It can be argued that based on this information there is no way out for the client. However, there is and one of the main successful forms of treatment is labeled intervention. (i.e. cage mentioned before) The technique of intervention gives those who care about the alcoholic a tool and a forum by which they can express their concern in a structured and focused way that often leads to the first step in the direction of recovery. The main obstacles to recovery from alcoholism are ignorance, shame, dishonesty and personal exceptionalism. (McMurran M. 1997) However, as McMurran informs us these obstacles are not at all easy to overcome. cal1966, please do not redistribute this hypothesis. We work very hard to create this website, and we trust our visitors to respect it for the good of other students. Please, do not circulate this hypothesis elsewhere on the internet. Anybody found doing so will be permanently banned.
"unfortunately for the addict these roadblocks to recovery are almost always cleverly situated and sited like military forts to provide mutual support in fending off all attempts at recovery". (McMurran M 1997)
One of the main organisations that help people overcome these roadblocks and inevitably their addiction is Alcoholics Anonymous. Alcoholic's Anonymous is an organisation which uses workers who have had an alcohol addiction themsleves. The workers are encouraged to pass on the story of their own experiences of problem drinking and describe their own sobriety they have found in Alcoholics Anonymous. The focus is then to invite the client to participate in the organisation. The organisation is known for a program which is known as the twelve steps program. The Alcoholics Anonymous members will emphasize to newcomers that they are not asked to accept or follow the twelve steps totally if they feel unwilling or unable to do so. The members will also emphasize to newcomers that only problem drinkers themselves, individually, can determine whether or not they are in fact alcoholics. Outlined below is a copy of the twelve steps program which early members felt helped them overcome the addiction.
"1. We admitted we were powerless over alcohol - that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked him to remove our shortcomings.
8.Made a list of all persons we had harmed and became willing to make amends to them all
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continues to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs. (www.alcoholics-annonymous.org)
The 'twelve - steps' are the core of the A.A. program of personal recovery from alcoholism. They are not abstract theories, they are based on the trial and error experiences of early A.A. members. The twelve steps describe the attitudes and activities that these early members believed were important in helping them achieve sobriety. The organisation ensures that all members are aware that the twelve steps are not a compulsory route but a recommended one. The organisation recognises that it is almost impossible to follow the steps literally, day in day out but many A.A. members do believe that the steps are a practical necessity if they are to maintain their sobriety.
Although as we can seethe organization do offer a great deal of support for someone who may have an alcohol problem I do feel that the way in which the organisation offers help can be criticised . For example there is a set structure to the help provided and very little flexibility is offered within this structure. This I feel could become a problem for a sufferer of alcohol dependence because structure is not always what they need. The approach seem a very here and now approach and I feel that this is not always the best method to use within the area of Alcoholism. I feel that a good improvement would be to adopt a more person centred approach rather like counseling and offer more flexibility for the client.
We can clearly from the discussion above that anyone who has an alcohol addiction has a great deal turmoil and pain to face if they are to become sober and maintain their sobriety. The Psychological implications outlined in the essay highlighted this. For example the tendency that someone who is impulsive and seeks new sensations is at risk of suffering and that alcohol reduces the pain caused by guilt, anxiety, stress and depression often faced by many people. This reduction is however temporarily and these feelings will re-emerge and often in more depth. This creates a never-ending psychological cycle, which increases in severity as time goes on. We can also see that there is help and ways of trying to overcome the problem of addiction and the 'twelve-steps' program is clearly a positive method.
From completing this paper my knowledge and understanding of alcoholism has developed immensely. I am now considering completing personal research into the area of alcohol addiction. From the research I have completed I feel that there has to be alterations in the way alcohol is advertised, sold and consumed in this country. As I illustrated early in the discussion, the number of people suffering from this illness in this country is immense and higher than anywhere in Europe. There must be a reason for this and I feel it would be a very interesting topic to explore further, especially because more and more people are seeking the benefits of counselling to assist with the problem.
· Caruanaet al. 1976 Social Aspect of Alcohol and Alcoholism, B. Edgall and Co Ltd London.
· Ettorrea E. 1997 Women and Alcohol a private pleasure and public problem, The Women's Press.
· Harralambos and Holborn. 1995 Social Themes and Perspective, Harper and Collins Publications.
· Harrison L. 1996 Alcohol Problems in the Community, Mackays of Chetham PLC
· Hellman C. 2001 Culture, Health and Illness, Arnold Publishers London
· Mc Murran M. 1997 The Psychology of Addiction, T.J International Ltd.
· Naido and Willis. 2000 Health Promotion foundations for practice, Harcourt
· Paton, A. 1997 ABC of Alcohol, University Press Cambridge.
· Portiono. 1993 Alcoholic Beverages and European Society, The Amsterdam Group.