Apply Family Therapy Literature Review and Treatment Plan: Alcoholism

Apply Family Therapy Literature Review and Treatment Plan: Alcoholism

Part 1: Introduction and Selection

Alcoholism is a critical issue in marital and family therapy since it creates destabilizing outcomes for marriages and families. It can destroy a marriage or create permanent divisions between family members. Spouses who over–drink ruin the family finances, ignore parental responsibility, create fights, and impair the overall happiness and health of the family. Alcoholism causes both mental and physical harm as 60-70% of physical altercations between married couples are fuelled by alcohol (Sobell & Sobell, 2016). Family members who abuse alcohol develop co-dependency and go to great lengths to keep the addiction alive even when it hurts them. It’s a frustrating condition for families and spouses due to the vicious cycles of remission and relapse. The American Psychiatric Association recognized alcoholism as a primary mental health disorder in 1980 as a subset of the substance abuse disorder.

 Part 2: First Person Account and Therapy Approach

Nina’s experience of being married to an alcoholic is illuminating on the devastating impact alcohol abuse can have on a marriage. She met him when she was 21, had a blissful two-year romance, married, and quickly gave birth to two children (Nina, 2017). She came from a family where people did not drink alcohol. Initially, her husband worked hard for the family and enjoyed the occasional glass of beer. Nina did not have qualms with his drinking as he was still a loving, dependable man. Noticeable signs of change began to occur five years into the marriage. Her husband would stay out drinking for long, and Nina would blame the long hours he worked at the business instead of the alcohol. Soon enough, the late-night drinking deteriorated into day drinking. The day drinking eventually became secret drinking as Nina would find empty beer bottles in cupboards, drawers, or beside the computer (Nina, 2017). She repeatedly told him to stop drinking to no avail.

He would deny everything when she confronted him, telling her she was crazy for policing his life. Nina initially thought she could bring his drinking to a controllable level, but she was very wrong. He became a manipulator accusing her of being crazy one moment, then confessing how much he loved her in the next minute (Nina, 2017). She was reluctant to share the situation as she had no close friends and was scared of telling their families. She thought to threaten to leave him might shock him into changing, but he confessed that he was relieved. He started showing little concern becoming moody, depressed and starting to skip work although he was never fired as he worked for the family.

He would consistently use the children as bait to prevent Nina from leaving. By the 7^th year, Nina hit rock bottom and was so frustrated by the failure to change her husband that she decided to commit suicide (Nina, 2017). However, she had a revelation that she could not harm her children. Her husband finally joined AA and went to rehab, while she joined Al-Anon, the support group for people affected by alcohol abuse. Al-Anon made her realize that she was physically and mentally broken. She stuck in the support group even after her husband dropped out of AA. Though Nina eventually left her husband after realizing she couldn’t change him, she still struggles with depression, anxiety, obsessive thinking, night sweats, and blurred vision.

Nina’s husband might be feeling like a complete failure walking in for the therapy session. He had the perfect marriage, and his wife fought hard for it to work, but his alcoholism shattered all their dreams. He must feel responsible for the anxiety and depression that she suffers from after leaving him, even though she was not the one at fault (Mehta, 2016). An individual therapy session would be ideal for him. He would need to feel safe, heard, and understood. As the therapist, I would need to build a strong rapport with him, offering confidentiality and security to reassure him that all is not lost as he can still get help. (Mehta, 2016). Since he is likely to have fragile thoughts, it would be essential to conduct a mental health assessment to determine the course of therapy or method of treatment.

 Part 3: Literature Review

Sharma & Sharma (2017) show that environmental and social factors profoundly influence alcoholism. Family factors such as conflictual family climate, harsh punishment, under supervision, and lack of warmth can contribute to alcoholism in adulthood. They allude those genetics play a role in addiction since parents can pass on predisposition towards alcohol addiction to their children as a behavioral trait. Genes account for approximately 50% of the risk of alcohol abuse (Sharma & Sharma, 2017). Generally, those who inherit a genetic predisposition to alcoholism are at a higher risk of suffering from alcohol abuse. Their point is bolstered by Wright (2017), who notes that cultural factors such as country of origin, a region of the country, income, and social class can contribute to alcoholism. Anglo-Saxon countries have a liberal outlook, which emphasizes freedom in their drinking cultures. Nina and her husband are from the United Kingdom, where drinking is a big part of the freedom culture.

Mehta (2016) hypothesizes that the course of alcohol abuse illness differs from patient to patient and is shaped by gender and family history. Alcoholism can mimic or complicate other underlying psychiatric conditions resulting in diagnostic difficulties. The co-occurrence of alcohol and other mental conditions manifests with symptoms such as attempts to commit suicide and problems maintaining abstinence. Sobell & Sobell (2016) integrate this approach in their approach to the treatment of alcoholism. They endorse a treatment regime combining both behavioral modification techniques and medication since alcoholism is a long term chronic condition. They point out that the most effective treatment regimen should consist of six core components: assessment, stabilization, education, behavioural therapy, fellowship, and continuing care.

Family and marital therapists should follow the recommended comprehensive treatment regime while ensuring that they recognize the role of the rest of the family in the recovery process. They should be cognizant that a family can have a positive or negative role in influencing the outcome of the treatment regime (Sobell & Sobell, 2016). On a positive note, the family can motivate the recuperating patient to become a better person and give them an incentive to quit alcohol. Additionally, the family offers a crucial safety net when the person is undergoing treatment as they are not able to earn a living. On a negative note, the bitterness and resentment created by alcoholism among family members might create a toxic atmosphere that causes the patient to relapse and seek refuge in alcohol.

Part 4: Effect on Family Members

Nina and the entire family are affected profoundly by the harmful consequences of her husband’s alcohol addiction. They have had to find scapegoats, keep secrets, and engage in unhealthy behavior such as obsessive thinking and denial (Wright, 2017). They have also suffered financially since he was the sole provider, and at one point, he stopped going to work ultimately. Families also need recovery therapy in their own right. Nina, for instance, needs help for the anxiety, depression, and the constant night sweats that she suffers from. The children also need to feel safe enough to talk about their feelings about their father’s addiction so that they realize that they are not the ones at fault. Their intrinsic worth and strengths should be emphasized by developing healthy living and coping skills (Sharma & Sharma, 2017). Nina needs individual therapy at first therapy so that she can heal her wounds. She can later attend couples’ therapy with her husband if he reforms, and she still wants him back.

Part 5: Treatment Plan

An ideal treatment plan for Nina’s husband would include the six core components discussed by Sobell & Sobell (2016), which include assessment, stabilization, education, behavioural therapy, fellowship, and continuing care. The assessment would entail a medical and mental screening to obtain his full history. The initial evaluation will be critical to creating an individualized treatment plan and ongoing assessment to monitor treatment demands (Mehta, 2016). Stabilization will be the next core step through the administration of a detox regimen. Since detox can be life-threatening and uncomfortable, he will be given medication to ease withdrawal symptoms and cravings. The medication will be supervised at all times.

The next component will be education to make him understand the root causes of alcohol and substance addiction so that he can get rid of feelings of self-blame, shame, and guilt (Sobell & Sobell, 2016). The fourth component would be behavioural therapy, where he would be encouraged to re-join the AA to get positive behavioural influence from peers. Behavioural therapy goes hand in hand with fellowship so that he can get mutual support from fellow recovering addicts (Wright, 2017)). The final component is continuing care for an initial period of 2 years’ subject to review. The long duration is justified by the fact that addiction is a chroming disease that requires ongoing management as a vital recovery factor since there is no cure.

References

Mehta, A. J. (2016). Alcoholism and critical illness: A review. World journal of critical care          medicine, 5(1), 27.

Nina, D.  (2017, 16 Nov). My Husband’s Drinking Problem Left Me Mentally and Physically       Broken. The Telegraph.

Sharma, J., & Sharma, A. (2017). Risk factors in alcoholism: The role of the family            environment. Indian Journal of Health and Wellbeing, 8(11), 1347-1352.

Sobell, M. B., & Sobell, L. C. (2016). Individualized Behaviour Therapy for Alcoholics–  Republished Article. Behaviour therapy, 47(6), 937-949.

Wright, K. (2017). Social Influence Processes and Health Outcomes in Alcoholics Anonymous.    In Oxford Research Encyclopaedia of Communication.