Introduction
In our case study, the client is a Mexican American male aged 45 years, married and has three school-going children aged 15, 11 and 5 years respectively. The client comes to the clinic in the company of his wife who provides the counselor with background information about the reason for their visit to the clinic. The two are apparently seeking help for the husband who has over the last 10 months exhibited uncontrollable drinking of alcohol, a habit that has gradually affected his personality and physical health besides putting the family into a myriad of problems. After consulting family friends, the wife was advised to make al effort and convince her husband to visit a therapist, who was likely to have a solution to his problem.
According to the wife, this particular client had initially shown some resistance but after much coercing, finally agreed to the visit but on condition that the wife accompanied him. Being a victim of the new behavior, the wife gladly agreed to do so (Barlow 2001, pp.382, 390).
Diagnosis and Treatment of Alcohol Dependency Using CBT
After a brief conversation between the therapist and the client, a diagnosis leads to Alcohol Dependence Syndrome (ADS). From information availed to the therapist by the client’s wife, the problem began after the husband lost all his immediate family (parents, one brother and two sisters) in a fatal car crash. Unable to cope with such a traumatic experience, his drinking habits changed from leisurely drinking to uncontrolled or excessive drinking in the hope that the new habit would help bringing relief to the negative emotions that occurred from time to time and probably finally help in forgetting the incident. Unfortunately, instead of the drinking offering the desired solution it led to excessive drinking and incidentally to more critical problems.
Due to the fact that the client is under permanent influence of alcohol, his working performance deteriorated resulting in his suspension from work on disciplinary grounds. This only aggravated an already ugly situation, consequently subjecting the family to very serious financial difficulties; the marriage has gotten cold; and according to the wife, the family has lately been on the verge of break-up. The wife has to bear all the family’s financial responsibility while the husband drinks away what he gets from temporal jobs.
Of late, he exhibits very little interest towards the family’s upkeep or towards any family affairs. Drunkenness has also affected their sexual life which has been suffering a setback and the client turns violent when he is confronted with the issue.
This violence has not only affected their marriage but also affected the children’s emotional and academic well-being. Worse still, this client has severally been convicted of dangerous driving but in spite of all these problems, any attempt by the wife and colleagues to get him to out of over-drinking have only more resistance and resulted to more and more drinking. Lately, the client has complained of severe abdominal pain that is accompanied by nausea and vomiting and after visiting the local general practitioner was diagnosed with ulcers.
The worst and most alarming issue however, and one which made the wife try to convince the client to seek professional help is the new tendency that his body has exhibited of an abject failure to function without alcohol. When the client has money and is unable to source for a drink, he develops excessive sweating, loss of appetite and serious difficulty in sleeping (Barlow 2001, pp.380, 389-390, 417; Reinecke, Clark & Beck 2003, pp.334).
Alcohol dependence results from a misconception that drinking alcohol can help to fulfill some needs in the victim’s life be it social, emotional or psychological needs. Most dependents bury themselves into alcohol in an effort to cope with stress, anxiety, depression and other negative conditions. Alcohol is also used excessively for its presumed ability to produce pleasure. Continued use or overuse of alcohol however leads to tolerance; a condition in which high amounts of alcohol have to be consumed inorder to achieve intoxication or other desired effects.
In this case study, the client has been unable to cope with the trauma of loosing his family members; a factor that has been has caused him a lot of stress and subsequently led him to seek relief from alcohol. A leisurely habit has now gone out of control and the client now spends most of his time either drinking or trying to source for more alcohol.
His body system has now become dependant on alcohol and whenever drinking is discontinued mainly due to lack of money or there is a reduction of the current alcohol intake, the victim immediately starts displaying withdrawal symptoms. The nervous system gets overexcited and in about 24 hours after the last drink, the client tarts experiencing tremors. Without the drink, the victim also starts sweating profusely, experiences a rapid heart rate, suffers from low appetite and also has serious difficulties in sleeping (Reinecke 2003, p.334).
If the client spends most of his time in excessive drinking, chances are high that he will neglect most of his daily activities and this will subsequently lead to a failure on his part to fulfill necessary obligations. It is as a result of this factor that the particular client has neglected his roles both as family head and also his conjugal duties. Alcohol dependency does not take into consideration the use of it in physically hazardous situations and also ignores any legal problems that would result from alcohol dependency.
Despite the fact that careless driving has made the client cross paths with the law on several occasions and is also dangerous to his life, he has continued with his drink amid many problems and appears unaffected by trouble all around him. The client’s excessive habits have not only affected his personality, health and work, but also his marital, family, financial and social life. If the client is not unconsciously drunk at home, he is out drinking or trying to get money for his next drink. Lately, his whole life has become centered on alcohol (Barlow 2001, p.389).
Cognitive Behavioral Treatment (CBT) treatment for alcohol dependency takes through a several approaches, which essentially share some basic assumptions. These approaches all share a general perception that human behavior is more learnt than inherited and that contextual and environmental factors largely determine behavior. According to the approaches, resolutions to various problems can be arrived by referring back to the processes through which such problems were learned. Every client must be handled uniquely in the context that his or her case has been presented to the therapist and assessment should also be done individually.
Learning principles which can be applied to effect change of such covert behaviors as thoughts, feelings and behavior include the application of new behaviors in their real context. For adequate treatment to be realized, a very thorough assessment must be made of the client’s behavioral pattern. CBT helps to reverse depressive symptoms that may have been caused by negative thoughts and behavior in a victim while at the same time teaching the affected person to unlearn the behavioral patterns that may have resulted in the condition for which they are seeking treatment. The main goal for treatment is to help the client live a healthy and happy life once more without any fears of relapse (Barlow 2001, pp.383; Reinecke, Clark & Beck 2003, pp.336-338, 340).
At the time of this visit, the client is at the contemplation stage and has already begun to contemplate that he has a problem that needs attention but is somehow not he has the ability to change. At this stage, it is crucial that the therapist prepares the client to accept the fact that he has a problem and to be ready to change whatever behaviors that have put him in his present predicament. The client should also be guided through making those decisions that will help him contribute towards maintaining such changes.
The first step towards such a process is analysis of the environmental and psychological factors that led to excessive intake of alcohol that eventually led to dependency and the problems that resulted thereof. These factors could be raging from interpersonal, physical, occupational, financial and legal problems. In such way, a therapist is able to come up with suitable plans regarding those areas of the client’s life that need improvement as well as any other factors that need modification.
Through identification of factors or situations that determine alcohol use and dependency, the client is given a choice to avoid such situation or a plan can devised that will help him cope with such situations. There is also need to single out irrational thoughts that make the client to justify their excessive use of alcohol. However, the most essential method of intervention at the cognitive level is to help the client gain more positive expectancies towards abstinence while deviating from the expectations they had from drinking alcohol (Reinecke, Clark & Beck 2003, pp.338, 343,345,351; Barlow 2001, pp.383-384, 389).
Conclusion
Several changes are expected to take place both in the course of therapy and after treatment have taken place. Initially, the client’s heavy alcohol intake should gradually reduce in the course of therapy. Temporary abstinence from alcohol is also necessary to allow for treatment of ulcers that the client is already suffering from. This is mainly because should not be taken with most medicines as it reduces their effectiveness. The greatest achievement should however be increased life expectation which will result from this therapy. Healing should not only take place physically but also psychologically and emotionally.
References
Barlow, D.H. Clinical Handbook of psychological disorder: A step-by-step treatment manual. New York: Guilford Press, 2001.
Reinecke, M.A, Clark D.A and Beck A.T. (2003). Cognitive therapy across the lifespan. Cambridge, UK: Cambridge University Press.