Over the past two decades, psychiatric practice has been able to change dramatically contributing to impressive development within the field of neuroscience. As a result, there has been explosion of interest especially on the biological bases of mindedness which contribute to overlooking of the subjective, rational, and contextual factors that affect both the normal and abnormal behavior. In spite of the claims regarding the social and disruptive dimensions of both the mind and person hood, especially those informed through social communism, biologically inspired seem to be prevailing currently, at least with regard to the explanation of the mental disorders (Jordaan et al., 2011). The fact that Frank changed means there is problem that he is going. However, he does not take his time to share with his caring wife. As a result, Sarah encounters severe depression in her bid to find out what troubles her husband. With the terrifying look on Frank’s face while staring at Sarah, could also mean that Sarah did something wrong to upset him, but since they never sit down as families, they end with numerous misunderstandings between them. Thinking that alcoholism exhibited in Frank’s behavior is due to genetic inheritance since most of his family members drink, is irrelevant since such behaviors are not inheritable. However, the environmental and social context that he grew in might have been the triggering factors to such conditions.
Changes in the reinforcing value of alcohol from the consumption state and abuse to the level of dependence reflect the changes in the adaptive neurons that emanate from the chronic exposure to high level of alcohol dosage. This is relevant to Frank’s case. During the early stages of the non-dependent alcohol consumption, the positive reinforcing effects as some of the factors motivating drinking behavior (Fisher & Roget, 2009). In Frank’s case, the drinking behavior is motivated by both positive and negative reinforcement value of alcohol. Moreover, he is sensitive to alcohol which is increment in the reinforcement value of alcohol following his repeated exposure to such environments. Upon the occurrence of neuroadaptation to alcohol consumption as in Frank’s case, the removal from alcohol consumption might contribute to the withdrawal syndrome. Alcohol addiction is chronically relapsing disorder that characterized by the compulsion of taking drugs and losing control in limiting alcohol intake. However, the medications that psychiatrists use in the market to treat such cases target either the direct reinforcing effect of alcohol consumption or the consequent protracted abstinence syndrome. Furthermore, both the conceptual and neurobiological improvements in research have suggested that the brain system majorly contributes to the withdrawal effect and anticipation stages of the addiction cycles promoting the compulsivity of alcohol consumption.
Sarah thinks that the fact that Frank’s family composes of the alcohol addict which contributed to his sudden change of behavior. From such point, it is clear that family plays an important role in determining the general behavior of one another. To solve family issues, there is for trust and accountability. Frank hiding the truth from his wife escalated the stress factor considering her determination to solve the problem experienced by the husband. While undertaking diagnosis for alcohol consumption, it is important to consider how heavy alcohol consumption influences the functionality of the brain and ways in which it alters the various chemical of the brain: the neurotransmitter and systems of the hormones that are involved in the development of the most common disorders. Hence, it not surprising that alcohol consumption can manifest itself in different psychiatric symptoms and signs. In this case, the symptoms are the subjective complaints that the patient describes like the sudden change of attitude as noted by Sarah while the signs are objective in nature and involves the direct observations by the clinicians. In fact, these psychiatric complaints are the initial problems seen among the alcohol addicts whenever they assistance. However, during diagnosis, it is significant to note that symptoms and signs presented by the patients depend on the level of severity which in turn depends on the amount of alcohol consumed and the level of vulnerability to the experiencing these psychiatric symptoms in an environment with high alcohol consumption like in Frank’s case.
It is clear that Frank is under acute intoxication due to his dramatic change in mood, relation with the wife, irritability, nervousness, and secretiveness. The disinhibiting properties of alcohol might impair the judgment of the addicts and unleash their aggressiveness, the antisocial behavior that might reflect the imitation of external disorders like the antisocial personality disorder. The psychiatric symptoms and signs might also vary depending on the patience last consumption of alcohol including whether he/she is experiencing an acute intoxication, acute withdrawal, and protracted withdrawal (Epstein & McCrady, 2009). Besides, the alcohol-dependent patients, especially those who seem to express that they are morbidly depressed whenever acutely intoxicated by Frank’s case. In such cases, the patients might appear anxious and panicky whenever there are compelled to withdraw acutely from alcohol consumption. Besides the direct pharmacological effects associated with alcohol consumption in the brain, the psychosocial stressors that that are common among the heavy drinking patients could contribute indirectly to the ongoing alcohol-related symptoms including sadness, anxiety, and despair.
The commonly used controversial diagnosis is the Dissociative Identity Disorder (DID) with the mental health profession which the practitioners characterize by the presence of two or more separate identities of personality states. Each of these portrayed personalities has its relative enduring pattern of perceiving information which takes over the behavior of the addicted patient. In addition, it results in inability to remember important personal information (Heather & Stockwell, 2004). Therefore, DID is the most complex and theoretically challenging form of the dissociative disorder as it encompasses an array of dissociative phenomena. The recent improvement in the effectiveness of the psychotherapy for alcohol consumption disorder, together with the rising recognition that only the pharmacotherapy might not have the capacity to adequately address all the treatment requirement for the patients, has been able to contribute to the development of the specialized psychotherapy, especially for the alcohol addicts. Using effective psychosocial treatments is, in particular, important for the dually diagnosed patients for different reasons. Research on the psychotherapy contributed to the development of different treatment mechanisms for the patients with problems associated with drug abuse.
In the case of Frank and Sarah, the practitioners might use various adaptations of the psychodynamic methods including the cognitive behavioral technique which involve prevention of the lapse and focusing on the motivational therapy and behavioral treatment which includes the contingency management. Some of the main principles and guidelines that are important while using psychosocial treatment method on the patients experiencing dual disorder like Frank and Sarah have emerged from the clinical descriptions and other associated reviews. However, there is some consensus that these treatment procedures needed review and viewed as the stages, immediate and short-term objectives that require the establishment and might not be identical. For instance, even though abstaining from alcohol consumption might be a long-term goal, the patients that exhibit severe mental illness might not perceive alcohol consumption as a big problem. The major goal of goal of treating using such method might include stabilization of the patient’s condition of the psychiatric illness, followed by the intensive discussion regarding their ambivalence concerning alcohol consumption.
Similarly, the patients hat have achieved early abstinence from alcohol consumption might require being monitored closely for emergence of any symptoms associated with psychiatric disorder like PTSD whose presence and symptoms might have been masked by the previous alcohol. The approaches to treating the moods and anxiety disorders triggered by alcohol consumption differ from one person to another depending on the symptoms. The cognitive behavioral therapy (CBT) is one of the methods that has shown effectiveness in treating anxiety, moods, and alcohol dependence separately. Such method can be integrated readily for the patients suffering from alcohol consumption and anxiety disorders. Various psychotherapy components like relaxation training, management of stress, and skills enhancement are important when considering CBT as methods of treating both Frank and Sarah.
References
Epstein, E. E., & McCrady, B. S. (2009). A cognitive-behavioral treatment program for overcoming alcohol problems: Therapist guide. Oxford: Oxford University Press.
Fisher, G. L., & Roget, N. A. (2009). Encyclopedia of substance abuse prevention, treatment, & recovery. Los Angeles: SAGE.
Heather, N., & Stockwell, T. (2004). The essential handbook of treatment and prevention of alcohol problems. Chichester, West Sussex: Wiley.
Jordaan, G. P., Warwick, J. M., Nel, D. G., Hewlett, R., & Emsley, R. (2011). Alcohol-induced psychotic disorder: brain perfusion and psychopathology—before and after anti-psychotic treatment. Metabolic Brain Disease, 27(1), 67-77.