Alcohol Abuse and Psychotherapeutic Treatment for Couples - Research Paper Example

? Alcohol Abuse and Psychotherapeutic Treatments for Couples College: Alcohol problems have all-encompassing effects on the functioning of a family with negative effects on the marriage relationship and children. Familial functioning is so necessary that a clinical diagnosis of alcohol abuse can be premeditated to an individual who consumes as much as necessary alcohol to interrupt major role commitments in the home. Couples are more likely to be inclined to alcohol abuse at the same levels as individuals may tend to select partners who exhibit the same characteristics and behavior patterns. The young people in the society have become rampant alcohol abusers. The high rate of alcohol use amongst young individuals is attributed to increased peer influence, lack of parental control, and high accessibility and availability of alcohol. The paper has discussed psychotherapeutic treatment models. Bowen family therapy treatment is based on the assumption that reduction of anxiety will bring symptom relief and allow more thoughtful exploration of the problem. Alcohol behavioral couple therapy draws upon cognitive behavioral methods for the treatment of alcohol abuse. Motivational Interviewing is a well suited for work with couples who are alcoholic and yet they are to commit to active behavior change. Introduction Alcohol abuse is defined as a maladaptive model of drinking that leads to clinically vital mutilation or suffering. Individuals diagnosed with alcohol abuse drink regardless of the alcohol interrelated social, physical, occupational, or psychological problems. Alcohol abuse normally does not entail a constant pattern of intense drinking but is outlined by the adverse consequences that are linked with the drinking pattern. Alcohol problems have all-encompassing effects on the functioning of a family with negative effects on the marriage relationship and children. The damaging effects of alcohol problems on the marital and family unit have been acknowledged in a number of researches. Familial functioning is so necessary that a clinical diagnosis of alcohol abuse can be premeditated to an individual who consumes as much as necessary alcohol to interrupt major role commitments in the home. The consequences of alcohol problems on family functioning have been a focus in both family therapy and alcohol and other drug treatment (Benda, 2013). Couples are more likely to be inclined to alcohol abuse at the same levels as individuals may tend to select partners who exhibit the same characteristics and behavior patterns. At first, alcohol consumption turns down in a marriage but with time, the consumption increases. Marriages in which individuals develop alcohol abuse generate quarrel and may end in divorce. Following the divorce, the rate of alcohol abuse may increase more. Children living in alcoholic family environment are affected directly or indirectly by the alcoholism of their parents whom can be one or both of them. Children feel the direct effects of alcoholism at an early age, which will in return affect their development. Parental alcoholism can lead to adverse effects in the form of neglect or abuse of children. Consequences such as these may contribute to excessive drinking in the children as they grow up. Alcoholic parents may also harm their kids with physical and sexual abuse (Jung, 2010, p. 264). A number of people with alcoholism fail to seek treatment because they do not understand they have the problem. There are various treatments that may help. The most common ones are withdrawal and detoxification, establishing a treatment plan, oral medication, psychological counseling, and continuous help programs. Mainstream abstinence-oriented treatment of alcohol in the United States continues to have poor success by anyone’s criteria. The poor results are evident in outpatient and residential programs. There are very few controlled trials of antidepressant medication for depressed alcohol dependent couples that may reduce symptoms of depression and enhance commitment and acquiescence with other aspects of alcohol psychotherapy. The most common psychotherapeutic treatments for couples who abuse alcohol are Bowen Family Therapy, Behavioral Couple Therapy, Motivational Interviewing, and co-dependence, AA / Al anon versus harm reduction model (Jung, 2010, p. 264). Alcohol abuse Misuse of alcohol has become prevalent in the modern society with the linked emotional and physical tolls on individuals, couples, and families. Committed relationships are significantly affected by alcohol abuse. Having a close partner who is alcoholic generates trauma and nervousness in the relationship. Alcohol abuse and other substances are the third causes of divorce after infidelity and incompatibility. More than 30 percent of couples in marital therapy report alcohol abuse as the main source of conflict in their marriages. More than 70 percent of men and women are married by the age of 35. It has been established that married couples use alcohol at lower rates when compared to single and divorced individuals. A social network influences behavior in almost every sphere of life. For most people, the transition to marriage entails changes in their peer networks. Peer influence has become an important predictor of adolescent alcohol abuse patterns and this relationship has been seen extending to adulthood. A new priority in marriage influences social networks and behavior (Anderson, 2004, p. 33). Drinking beverages that contain alcohol is rampant in a number of societies all over the world today. Alcohol is a defined as a psychoactive drug with its principal effects on the brain. People can drink large quantities of alcohol in a short period of time and they will be metabolized and eliminated from the body. The unmetabolized alcohol will circulate in the bloodstream. The effects of alcohol usually depends on the amount that individuals consume, the time period that the alcohol is consumed, the experience of the user, and the circumstances into which the drinking occurs. When used in moderation, individuals will enjoy the effects of alcohol. When the level of unmetabolized alcohol in the body increases, the effects will increase negatively and this will eventually harm the normal functioning of the body (Anderson, 2004, p. 33). Alcohol problems are characterized by features of tolerance and dependence. Tolerance means that with repeated alcohol use, a drinker will need to consume more alcohol so that he or she will achieve the same effect that was previously produced by the smaller amounts. Habitual drinkers who have come up with considerable tolerance normally functions with few observable signs of intoxication regardless of consuming very large amount of alcohol. Regular and heavy drinkers can with ease become physically and psychologically dependent on alcohol. Psychological dependence is defined as a compulsive need for alcohol. This happens when an individual consumes alcohol in the face of adverse consequences. Physical dependence takes place when the body has adapted to the existence of alcohol. Stopping alcohol when individuals are on physical independence stage may lead to alcohol withdrawal syndrome (Anderson, 2004, p. 33). Alcohol Abuse among the Young People Young people in every society consider alcohol as a drug of choice. The initiation of alcohol starts during adolescence. The high rate of alcohol use amongst young individuals is attributed to increased peer influence, lack of parental control, and high accessibility and availability of alcohol. The propensity of young people for risk-taking and lack of experience with alcohol puts them at specific risk for alcohol-related harm. Too much drinking during adolescence has a direct relationship with issues of alcohol use in adulthood. An individual who starts drinking while aged fifteen or below are more likely to develop alcohol dependence later in their lives. This will be up to four times more when compared to individuals who do not drink at that age (Wilson & Kolander, 2011, p. 45). Alcohol abuse is hazardous to young individuals because of their relative immaturity of the brain. Consuming alcohol at young age is directly linked to brain damage. This will later impair the learning capabilities and decision making. The damage will later lead to neuro-cognitive deficits thus impairing academic performance. Other than the long term effects on their health, young people are also prone to the acute consequences of alcohol. Heavy use of alcohol by young individuals has led to increased cases of suicide, homicides, traffic accidents, and poisoning (Wilson & Kolander, 2011, p. 45). Alcohol Abuse among Women In majority of the cultures in the world, women drink less when compared to men. For women who drink, they consume smaller amount of alcohol. Women metabolize alcohol so differently from the way men do. It is widely acknowledged that women have a high blood alcohol concentration for a certain amount of alcohol they consume when compared to their male counterparts. This means that women the risks that are associated with alcohol are more amplified in women. Prenatal alcohol exposure negatively affects the developing anatomical structures of the body and brain of the fetus. This will lead to range of cognitive, physical, and behavioral effects. A woman drinking during pregnancy increases the complication of pregnancy and delivery (Colliver & Fe Caces, 1996). Alcohol Abuse among the Elderly More attention has been focused on alcohol abuse amongst young people. This means that alcohol abuse among the elderly has been forgotten. The older generations are more susceptible to the effects of alcohol because of their reduced capacity to break it down. Social isolation, divorce/separation, and male gender are some of the issues that have led to increase alcohol abuse amongst the elderly. However, there are a number of factors that contributes to elderly consumption of alcohol. Among them are decreased social activity and lifestyle disruptions due to retirement. Elderly people normally take time to come into terms with pain and illness and at one point or another they may resort to alcohol to act as anesthetic. Elderly people usually use alcohol to aid their sleep when they are experiencing physical or emotional distress. Tolerance to alcohol amongst the elderly people is significantly lowered. Elderly people will therefore experience more detrimental effects (Boyle, 2013).  Factors that influence level of alcohol consumption Cultural as well as religious traditions are known to influence the levels of alcohol consumption. There are certain cultures that take the consumption of alcohol as something that is generally accepted by the culture. Individuals growing under such culture will not see alcohol consumption as bad. As time goes they consume alcohol until they become habitual drinkers. There is a possibility that they will carry the same drinking behavior into their marriages which will in return cause some problems in the relationship. The legal availability of alcoholic drinks can also influence the level of consumption and the harm that it brings to relationships. When the numbers of opening hours for alcohol consumption are more, there is likelihood that individuals will spent more time on drinking places. This means that they will spend little time in the family, a move that is likely to cause frequent conflicts (Johnson, 2008, p. 6). The price of alcoholic drink as well as the purchasing power of the consumer influences the levels of alcohol consumption by individuals. When the price of alcohol is low and the consumers have a high purchasing power, there is a possibility that individuals will drink more. This will finally increase conflicts in a family. When the price of alcohol is high, addicted individuals will spend significant amount of their income on alcohol. The consumption of alcohol in many countries in the world has increased substantially since 1950s due to operation of factors. These factors include; declining influence of cultural and religious traditions that limit alcohol use, increasing new patterns of consumption (the introduction of wine with meals), and the increased availability of alcohol from outlets like supermarkets (Johnson, 2008, p. 6). Psychological Causes of Alcohol Abuse A number of couples drink alcohol so as to enhance their moods and re-establish their spirits but heavy consumption of alcohol runs down the stores of dopamine and serotonin. These neurotransmitters produce feelings of happiness and sense of calmness. Alcoholics will therefore continue drinking in order to put back their sense of well being. Alcohol causes psychological dependence. It usually affects the central nervous system. When an inebriated individual stops drinking, the neurotransmitters will overexcite the nervous system causing agitation. This will cause high blood pressure and palpitations. Alcoholics will now be forced to resume to drinking in order to prevent the withdrawal symptoms from occurring. Couples facing marriage issues usually engage in heavy drinking so that they can forget the problems in the marriage. The more they drink, the more they will become more alcohol tolerant and this will increase conflicts in the marriage (Anderson, 2004, p. 33). Psychotherapeutic Treatments models for couples that abuse alcohol Before the introduction of an inter-relational, systems modality, the treatment options that were available to couples with an adult member drinking excessively were fragmented, highly specialized, and difficult to access. The following are the common Psychotherapeutic treatment models. Bowen Family Therapy The foundation of Bowen’s cautiously worked out theory is his notion of the forces inside family that make for togetherness and contrasting forces that lead to independence, individualism, and separate self. According to Bowen, the extent to which a differentiation self occurs in an individual reflects the degree to which an individual is capable of distinguishing between feeling process and intellectual process that individuals experience. Bowen method of family therapy was grounded on theoretical framework. The theory posits that lack of differentiation of self increases the amount of anxiety that individuals generate within themselves. The main goal of Bowen therapy is therefore to attain greater level of differentiation, which will decrease the amount of anxiety (Gibson & Donigian, 1996). Bowen family therapy treatment is based on the assumption that reduction of anxiety will bring symptom relief and allow more thoughtful exploration of the problem and that an individual can obtain increases in basic level of differentiation by working on self in relationship to others which will in return increase individual tolerance for intense emotional fields. The therapy is divided into three main groups. The first step is whereby the anxiety is explored in the family through the establishment of fusions and unresolved attachments. The second step involves separating out thinking and feeling systems to lower the reactivity to the emotional system of the family and to detriangulate. The third step is the reconnection of emotional cut-offs that will reduce reactivity while maintaining emotional contact with others (becoming a self) (Gibson & Donigian, 1996). In exploring how an anxiety is bound in a family, the Bowen therapy involves outlining the three to four generational family filed with dates, names, events, and relationships. Toxic family issues like alcohol abuse will now be identified. The main goal of Bowen therapy is to provide individuals with a degree of emotional freedom from their reactive triggers. The therapy will allow individuals to accomplish a more objectivity as regard to the nature of emotional systems operating in his or her family and variety of choices regarding his or her participation in the system. The process will slowly eliminate the co-dependent from alcohol. Progress is indicated when individuals has been able to think about the emotional process describing it accurately rather than continuing to react emotionally to it (Gibson & Donigian, 1994). While undergoing through the therapy, individuals will be forced to make “I” position statements that will enable them to stay clear of the family emotional system. This process involves the notion of getting off the back of the other by lowering the other-directed thinking, action, and verbal energy that is designed to attack and change other. Bowen has therefore encouraged couples to take individual responsibility for their behaviors. By putting individuals in a direct contact with family members will lower the power of emotional cutoffs and in the end helping individuals to relate independently to others. The Bowen’s methods of coaching in the therapy offer a path for achieving personal autonomy and individuality (Gibson & Donigian, 1994). Behavioral Couple Therapy Couple therapy for treating alcohol abuse leads to less drinking and greater relationship stability and satisfaction in both men and women who abuse alcohol. Alcohol behavioral couple therapy draws upon cognitive behavioral methods for the treatment of alcohol abuse. The theory is grounded in the assumption that drinking occurs in an interactional context. Drinkers learn skills to attain and maintain abstinence. Partners will learn skills that will help them to reinforce positive changes in the drinking behavior of the drinker and decrease behaviors that can reinforce drinking. During the therapy, changes in the couple’s interactions are intended to decrease couple-level cues for drinking and reinforcement of the values of stable relationships (McCrady, 2012, p. 516). Throughout the therapy, individuals are encouraged to maintain dual focus on personal and interactional change. The manners into which partners behave and interact are possible triggers for drinking. Couple’s interactions that are consequent to drinking may serve to reinforce drinking by shielding the drinker from negative consequences of drinking that are more likely to occur. It can also provide positive consequences for drinking. The treatment in the Behavioral Couple Therapy is based on the assumption that couples are affected by alcohol abuse because they lack the skills to deal effectively with drink-related situations. This therapy is designed as an outpatient treatment for couples whereby one or both partners are affected by alcohol. The sessions for the therapy are usually 90 minutes and both partners are expected to attend the full sessions. The principle goal of the treatment is to enable drinkers to decrease their drinking or if possible, stop the drinking altogether. The treatment also aims to enhance the motivation of both partners to change and help the drinkers to come up with cognitive and interpersonal coping skills to remain abstemious from alcohol. Behavioral Couple Therapy also aims at helping partners to develop better contingent response to drinking and abstinence. Furthermore, the treatment aims to improve the relationship of the couples as an incentive to maintain change (McCrady, 2012, p. 517). Treating alcohol abuse using Behavioral Couple Therapy requires the therapist to consider the degree to which the drinker is physiologically dependent on alcohol and assess the potential for complicated alcohol withdrawal symptoms. Couples with low levels of dependence are helped to set goals that can allow them to step down from their current drinking level to abstinence. At the same time, couples with high levels of physiological dependence are referred for ambulatory detoxification. Several aspects of the therapy address motivation to change. At the begging of the therapy, the therapist provides feedback to the couple on the drinkers’ pre-treatment drinking and consequences of the drinking. The concerns and strengths of the couple’s relationship are also addressed at the start of the treatment. The couples and the therapist will come up with a complete decision that is related to drinking. Functional analysis will also be conducted at the start of the therapy (McCrady, 2012, p. 517). The functional analysis offers a framework for the therapist and the couples to identify situations that place the client at a higher risk for drinking. The therapist will then help the couples to learn how to modify high risk situations and how to anticipate the negative consequences of drinking high risk situations. During the treatment, couples will be thought coping mechanism to drinking. These includes self-recording for drinking, self-management planning, and cognitive skills that can be used to manage high risk situations. The behavior of each partner will be considered at each step of the in the functional analysis of the therapy. The therapist will help the couples to identify actions that may serve as triggers for drinking. The therapist will work with the couple to help the partner develop alternative behaviors that are less likely to serve as cues for drinking. The goal of the reciprocity is to increase positive exchanges between the partners so that they experience more pleasure in being with each other (McCrady, 2012, p. 517). Motivational Interviewing Motivational Interviewing has become extremely popular in addiction treatment circles over the past decade. Motivation Interviewing is presumed to be cost-effective. The fact that alcohol addiction is an essentially disorders of motivation makes motivational interviewing to be a popular treatment model. Addictions are usually interwoven with facets of the daily problems of living that impede the client progress. Couples who are deeply lost in alcohol needs skills that are quite necessary for recovery. Clinical experience and research provides a number of explanations for the limited efficacy of alcohol, abuse treatment. MI is a well suited for work with couples who are alcoholic and yet they are to commit to active behavior change. MI has specific methods that therapists can employ to help clients to move through the stages of behavior change (Musser & Murphy, 2009, p. 1220). The therapist creates an atmosphere in which early stage clients who are not yet ready to commit to active change can resolve ambivalence and develop confidence in their ability to change. During the process, the therapist will offer a high level emphatic reflection while maintaining a specific language change target. The spirit of MI puts more emphasis on autonomy and choices by circumventing client reactance against being controlled. The main aim of this treatment is to elicit and reinforce change talk from clients. The therapist will focus on the topics and questions that promote and promote change. The therapist will be aiming to change relevant content in the behavior of the client as well his or her way of communication (Musser & Murphy, 2009, p. 1221). Co-dependence model The codependency model has been applied to a wide range of problems. A greater number of the population has been put on the recovery. Individuals who are alcoholic are plagued by repeated obsessions that cause significant interference with social functioning and occupation. Couples that employ the co-dependence model follow a four-step model that is quite similar to treatment models usually proposed by professionals. At stage one, affected individuals admit that there is a problem and the therapist will work to help the clients. In the second stage, the therapist will carry out critical assessment of the problem and encourage clients to take responsibility for their own dysfunctional behavior. The core issues will be addressed in the third stage. These issues may seem to be beyond the control of the client but with the help of the client, all will be well. The main goals of this form of treatment are to allow those that are affected to gain more self-awareness and respect as well as the ability to care for themselves (Cooper, 1995). AA/ Al anon versus harm reduction model Practitioners of the harm reduction model argue that alcohol abuse along with other unhealthy behaviors exist on a continuum from non-problematic to severely problematic and aims to reduce the associated harm experienced by couples. This model is an emerging practice as therapists are moving away from abstinence only treatment shifting towards prevention and preventative care. The model consist of a set of practical strategies that reduce negative consequences of alcohol use through the incorporation of a myriad of strategies ranging from safer use to managed use of alcohol. The main focus point of the strategy is to address the harm that is associated with alcohol abuse. The idea of reducing harm is very consistent with standard practice with individuals consuming alcohol. The main role of therapist is to facilitate positive change for the affected individuals. Al-Anon support groups offer support and guidance to couples who are affected by alcohol problems. During the therapy, individuals are encouraged to face the consequences of their behavior. In this therapy, self-sacrifice and the ability to manage beloved one’s addiction to stop events that could further damage the family are emphasized. Suffering is seen as the logical and necessary outcome of addiction (MacMaster, 2004). Conclusion Alcohol abuse is a maladaptive model of drinking which leads to clinically vital mutilation. Alcohol abuse usually does not entail a steady pattern of extreme drinking but is drawn round by the unfavorable consequences that are associated with the drinking pattern. Couples are likely to be inclined to alcohol abuse at similar levels as people may choose partners who share the same characteristics and behavior patterns. Abuse of alcohol has become a widespread menace in the contemporary society. It is linked with expressive and physical tolls on individuals, couples, and families. The significant role of the family in the growth and preservation of alcohol abuse has been broadly approved by researchers and practitioners. Alcohol problems are set apart by features of tolerance and dependence. Tolerance means that with frequent alcohol use, drinkers may consume more alcohol so that they will be able to pull off the same effect that was formerly produced by the smaller amounts. Alcohol abuse is risky to young people because of their virtual immaturity of the brain. Alcohol consumption at young age is unswervingly associated to brain damage. In most cultures in the world, women drink less when compared to men. Cultural as well as religious traditions are known to influence the levels of alcohol consumption. There are certain cultures that take the consumption of alcohol as something that is generally accepted by the culture. A number of couples drink alcohol so as to enhance their moods and re-establish their spirits but heavy consumption of alcohol runs down the stores of dopamine and serotonin. According to Bowen Family Therapy, the degree to which a differentiation self occurs in an individual reflects the extent to which an individual is able to differentiate between feeling process and intellectual process that individuals experience. The Bowen therapy involves outlining the three to four generational family filed with dates, names, events, and relationships. Couple therapy for treating alcohol abuse leads to less drinking and greater relationship stability and satisfaction in both men and women who abuse alcohol. Even though Behavioral Couple Therapy is a structured and directive treatment; the therapist always respects the autonomy of the client and the need for self-determination. The optimal stance is one of the collaboration in exploring their goals and means to achieve them. Motivational Interviewing has become enormously well-liked in addiction treatment circles for the last ten years because it is presumed to be cost-effective. The codependency model has been applied to a wide range of problems. A greater number of the population has been put on the recovery process from alcohol. More research is needed on the effectiveness of psychotherapeutic treatment for couples with alcohol abuse. Some of the malfunctioning of each treatment modality may be as a result of issues that could be lessened with the adding up of a succeeding modality. References Anderson, N. B. (2004). Encyclopedia of health and behavior. Thousand Oaks, CA: Sage Benda, B. (2013). Spirituality and Religiousness and Alcohol/Other Drug Problems: Treatment and Recovery Perspectives. London: Routledge. Boyle, P. (2013). Alcohol: Science, policy and public health. Oxford: Oxford University Press. Colliver, J. & Fe Caces, E. (1996). Substance Abuse among Women and Parents. Darby, PA: DIANE Publishing. Cooper, M. (1995). Applying the Codependency Model to a Group for Families of Obsessive-compulsive People. Health & Social Work, 20(4), 272. Denning, P. (2010). Harm reduction therapy with families and friends of people with drug problems. Journal Of Clinical Psychology,66(2), 164-174. doi:10.1002/jclp.20671 Gibson, J. M., & Donigian, J. (1996). Use of Bowen Theory. Journal of Addictions & Offender Counseling, 14(1), 25. Johnson, Z. (2008). The Negative Consequences of Alcohol Consumption and the Analysis of Variables that Can Affect or Reduce Alcohol Consumption. Ann Arbor, MI: ProQuest. Jung, J. (2010). Alcohol, other drugs, and behavior: Psychological research perspectives. Los Angeles: Sage. MacMaster, S. A. (2004). Harm Reduction: A New Perspective on Substance Abuse Service. Social Work, 49(3), 356-363. McCrady, B. S. (2012). Treating Alcohol Problems with Couple Therapy. Journal of Clinical Psychology, 68(5), 514-525. doi:10.1002/jclp.21854 Musser, P. H., & Murphy, C. M. (2009). Motivational interviewing with perpetrators of intimate partner abuse. Journal of Clinical Psychology, 65(11), 1218-1231. doi:10.1002/jclp.20642 Wilson, R. W., & Kolander, C. A. (2011). Drug abuse prevention: A school and community partnership. Sudbury, MA: Jones and Bartlett Publishers. Read More